OBJECTIVES:

• Define stress, eustress, and distress.
• Explain the role of stress in maintaining health and optimal performance.
• Identify the major sources of stress in life.
• Define the two major types of behavior patterns.
• Learn to lower your vulnerability to stress.
• Develop time-management skills.
• Define the role of physical exercise in reducing stress.
• Learn to use various stress-management techniques

STRESS - American institute of Stress (http://www.stress.org/)
A. Stress is a part of life.

1. The unpredictable changes in modern living are particularly stressful.
2. Stress is one of the most common health problems we face today.
3. Estimates place the cost of stress and stress-related diseases in excess of $100 billion annually in the U.S.:

a. The cost of treating stress-related diseases produces more stress.
b. Lost productivity and absenteeism on the job cost even more.

1. Most people have learned to accept stress as a normal part of life.
2. Yet, few seem to understand it or know how to cope with it effectively.

1. Dr. Hans Selye, a foremost authority on stress, defined stress as,

a. The nonspecific response of the human organism to a demand placed upon it.
b. “Nonspecific” indicates that the body reacts the same regardless of the nature of the event that leads to the stress.

2. Stress is the body’s emotional and physiological response to any situation that is new, threatening, frightening, or exciting.

1. We do not all react the same way to the same stressor.
2. Our reaction determines whether stress is positive or negative.

a. Many people thrive under stress.
b. Others under similar circumstances are unable to handle it.

3. The problem is not the stress, but the way we react to stress.

E. Selye defined the way in which we react to stress as either:

1. Eustress--the pleasant or beneficial stress.
2. Distress--the unpleasant or harmful stress.
3. In eustress, health and performance continue to improve.
4. In distress, health and performance begin to deteriorate.

1. Everyone needs the level of stress that is conducive to health and adequate performance.
2. However, when stress reaches certain limits, it keeps the person from functioning effectively.
3. Chronic distress raises the risk for many health disorders.
4.  And perhaps even certain types of cancers.
5. Recognizing this turning point and overcoming the problem quickly and efficiently are crucial in maintaining emotional and physiological stability.
Stress Inc. (http://stress.jrn.columbia.edu/site/index.html)

1. Identifies life changes that may impact health.
2. Contains a list of 47 life events.
3. Also provides for other events not listed in the survey.
4. You rate the extent the events you experienced had a positive or negative impact on your life at the time of the event.
5. After scoring each event, a “total life change” score is obtained.
6. The total life change score is a good indicator of total life stress.

1. Type A behavior characteristics:

a. Hard-driving, Overambitious, Aggressive, At times hostile, Overly competitive, Set their own goals, Are self-motivated, Try to accomplish many tasks at the same time, Excessively achievement-oriented, Have a high degree of time urgency

2. Type B behavior characteristics:

a. Calm, Casual, Relaxed, Easy-going, Takes one thing at a time, Do not feel pressured or hurried, Seldom set their own deadlines

1. Type A is associated with too much stress.
2. Type A individuals were counseled to lower their stress level by modifying many of the Type A Behaviors.
3. Many Type A characteristics are learned behaviors that can be modified to help a person become more Type B.
4. However, a debate centered on which Type A behaviors should be changed.

1. Now, only certain characteristics put one at higher risk:

a. Anger
b. Hostility

2. Many behavioral modification counselors work on changing these behaviors.

1. The keys to successful Type C performance seem to be:

a. Commitment
b. Confidence
c. Control

2. Type C people are:

a. Highly committed to what they are doing
b. Have a great deal of confidence in their ability to do their work
c. In addition, they enjoy their work and maintain themselves in top physical condition to be able to meet the mental and physical demands of their work.

E. Type A behavior by itself is no longer viewed as a major risk factor for coronary heart disease.

1. Those especially vulnerable are those who are impatient and readily annoyed when they have to wait for someone or something:

a. An employee
b. A traffic light
c. A restaurant line

2. Counseling is focusing on individuals who:

a. Have anxiety
b. Have depression
c. Have feelings of helplessness
d. Lose control of their lives
e. Give up on their dreams in life

1. Many of the items on this questionnaire are related to:

a. Health
b. Social support
c. Self-worth
d. Nurturance (sense of being needed)

2. The questionnaire will help you identify specific areas of needed improvement.
3. How people deal with these factors can increase or decrease vulnerability to stress.

1. The benefits of physical fitness are emphasized in this book.
2. Social, mental, and emotional well-being is discussed extensively.

1. People can draw upon social support to weather crises.
2. Knowing that someone cares and that support is out there is valuable in times of need.

1. People can improve behaviors that make them more vulnerable to stress.
2. We benefit emotionally from the sense of being needed.

1. People who make the effort to help others end up helping themselves even more.
2. We benefit emotionally from the sense of being needed.

1. People who do not manage their time properly will quickly experience:

a. Chronic stress
b. Fatigue, despair
c. Discouragement
d. Illness

2. In one poll, almost half of the respondents wished they had more time for exercise, recreation, hobbies, and family.
3. Healthy and successfully people are good time managers:

a. Harvard graduates attributed their success to smart work, not hard work.
b. The most successful rated himself as a superior time manager

1. Find the time killers
a. Keep a log for a week
b. Record your activities at half-hour intervals
c. At the end of each day, decide when you wasted time
d. Common time killers are watching television, talking on the phone, and the Internet.
 e. Some activities are necessary, but in excess they’ll lead to stress.
2. Set long-range and short-range goals:
a. This requires some in-depth thinking to put your lie in perspective
1. What do I want out of life?
2. Where do I want to be in 10 years? Next year? Next week? Tomorrow?
3. Identify your immediate goals, and prioritize them for today and this week (Lab 11C).

a. Each day determine what you need to accomplish that day, and that week.
b. Rank your “today” and “this week” tasks in four categories:
1. Top-priority--most important
2. Medium-priority--must be done but can wait
3. Low-priority--to be done after top and medium tasks are done
4. “Trash”--not worth your time
4. Use a daily planner to help you organize and simplify your day:
a. As you plan your day, be realistic
b. Recognize your most productive time for work, study, errands
c. Pick your best hours for top-priority activities
d. Be sure to schedule enough time for exercise and relaxation
5. Take 10 minutes each night to evaluate yourself daily.
a. Cross off the goals you accomplished
b. Carry over to the next day those you did not get done
c. Realize that some goals can be moved down to low-priority.
d. Others can be trashed

1. The following can help you make better use of your time:
a. Delegate
b. Say “no”
c. Protect against boredom
d. Plan ahead for disruptions
e. Get it done
f. Eliminate distractions
g. Set aside “overtimes” for unscheduled projects
h. Plan time for you
I. Reward yourself
Time Management Skills (http://www.mindtools.com/page5.html)
Time Management Web Sites (http://www.selfgrowth.com/timemgt.html)

1. First, the person must recognize that a problem exists:
a. Many people do not want to believe they are under too much stress
b. Many people fail to recognize some of the typical symptoms of distress
c. Noting some of the stress-related symptoms might help

2. Second, try to identify the stress-related symptoms and remove the stressor.
a.  Removing the stress-causing agent is not simple
b. In some situations eliminating the stressor is not know
c. In many instances the stressor cannot be removed
3. When the stressor cannot be identified, keeping a log of when symptoms occur and events preceding the symptoms may help identify the stressor.
4. When the stressor can’t be removed the stress can be managed through relaxation techniques.

1. This prepares a person to take action by stimulating the body’s defense systems.
2. This stimulation originates in the hypothalamus and the pituitary gland
3. The hypothalamus activates the sympathetic nervous system.
4. The pituitary activates the release of catecholamine (hormones) from the adrenal glands.
5. These hormonal changes increase:
a. Heart rate
b. Blood pressure
c. Blood flow to active muscles and the brain
d. Glucose levels
e. Oxygen consumption
f. Strength
6. After the fight or flight response, the body relaxes and stress dissipates.
7. But if the person is unable to take action, the body changes continue
8. This increased tension can be dissipated effectively through some coping techniques.

1. Physical activity is one of the simplest tools to control stress.
2. The value of exercise in reducing stress is related to several factors.
a. Decreases muscular tension
b. Helps to metabolize the increased catecholamine associated with the fight-or-flight mechanism.
c. The early evening hours in a health club are becoming the most popular time and place to exercise for a lot of highly stressed executives.
d. Helps them dissipate the stress accumulated during the day.
e. Although exercise does not solve problems, it ca help a person cope with stress, preventing it from becoming a chronic problem.
3. Physical exercise that is vigorous, continuous, and rhythmic works well.
a. It stimulates the same alpha-wave activity in the brain as does meditation and relaxation
b. Morphine-like substances (endorphins) are thought to be released from the pituitary gland in the brain
c. These substances not only act as painkillers but also seem to induce a soothing and calming effect.
d. Physical exercise gives people a psychological boost because it:
1. Lessens feelings of anxiety, depression, frustration, aggression, anger, and hostility
2. Alleviates insomnia
3. Provides an opportunity to meet social needs
4. Allows the person to share common interests and problems
5. Develops discipline
4. Exercise provides the opportunity to do something enjoyable and constructive that will lead to better health and total well-being.
a. The cardiovascular system is affected seriously by stress
b. Aerobic exercise not only strengthens the cardiovascular system, it also helps a person cope more effectively with the effects of stress
c. Fit individuals can cope more effectively and are less affected by the stresses of daily living

1. Some benefits of relaxation may be realized almost immediately.
2. The full benefits may not be gained until after months of regular practice.
3. If these exercises are not effective, professional help may be called for.

1.  Biofeedback as a treatment modality has been defined as:
a. A process in which a person learns to reliably influence two kinds of physiological responses:
1. Responses which are not ordinarily under voluntary control
2. Responses ordinarily under voluntary control, but for which regulation has broken down due to trauma or disease.
b. In biofeedback the person can “feel” how thought processes influence biological responses:
1. Heart rate
2. Blood pressure
3. Body temperature
4. Muscle tension
2. Some biofeedback instruments are simple but most are complex.
a. Requires expensive complex electronic instruments
b. Also requires adequately trained personnel
c. Teaches people how to influence physiological responses
d. Entails a three-stage, closed-loop feedback system:
1. A biological response to a stressor is detected and amplified
2. The response is processed
3. Results of the response are fed back to the individual immediately
3. Physical exercise and progressive muscle relaxation have been used successfully as an alternative to biofeedback in stress management.

1. Lie on your back in the most comfortable position possible.  Loosen any restrictive clothing.  Close your eyes, rotate your ankles outward, and put your arms at your side.
2. Starting with your feet, involve all major muscle groups in the body.  Don’t forget your face, including your forehead, eyes, nose, mouth, cheeks, and tongue.
3. As you move to each muscle group, contract the muscles as tightly as you can and hold the contraction for 20 or 30 seconds, then relax.
4. Concentrate on the dramatic difference in feeling between a tensed muscle and a relaxed one.  With practice, you’ll be able to achieve relaxation “on demand”

1. Sit in a comfortable position with hands folded over your abdomen, just over your navel.
2. Keeping your eyes open, imagine a balloon lying beneath your hands.
3. Begin to slowly inhale through your nose, concentrating on the warm air entering your nose and slowly filling the balloon.
4. When the balloon is full (this should take 3 to 4 seconds initially), slowly exhale to empty the balloon, feeling your chest and abdomen relaxing.
5. Repeat the entire process two or three times.  Each time concentrate on “breathing away” the tension and inhaling fresh oxygen.
6. When finished, sit quietly for a few minutes before rising.

1. Sit in a straight back chair in a quiet room with mild temperature, free of distractions.
2. Assume the most comfortable position with your feet flat on the floor, your head hanging loosely forward, your eyes closed, and your hands in your lap with your palms turned upward.  Loosen any restrictive clothing.
3. Imagine the parts of your body are tired, heavy, and warm like just after a strenuous workout.  Begin with your legs.  As you inhale and exhale deeply and slowly, repeat “my legs are so tired. My legs are so heavy. My legs are very heavy and warm.”
4. Move to other muscle groups-buttocks, abdomen, chest, arms, shoulders, and so on.  You even might imagine your internal organs, such as your stomach and your heart, relaxed and warm.
5. Concentrate on how cool your forehead feels.  For you to feel refreshed and alert, your forehead must feel cool
6. Once your entire body is relaxed, visualize an image you find relaxing.  It might be waves lapping against a sandy beach, a cloud drifting lazily across the afternoon sky, an eagle soaring silently.  The image should lead you to total relaxation.

1. The objective of mediation is to gain control over one’s attention.
2. It clears the mind and blocks out the stressor(s).
3. This technique can be learned rather quickly.
4. It can be used frequently during times of increased tension and stress.
5. Initially the person who is learning to meditate should:
a. Choose a room that is comfortable, quiet, and free of disturbances.
b. After learning the technique, it can be done almost anywhere.
c. It requires a time block of approximately 15 minutes, twice a day.
6. The process is as follows:
a. Sit in a chair in an upright position with the hands resting either in your lap or on the arms of the chair.
b. Close your eyes and focus on your breathing/
c. Allow your body to relax, assume a passive attitude.
d. Concentrate on your breathing.
1. Allow the body to breathe regularly, at its own rhythm.
2. Repeat in your mind, the word “one” as you inhale.
3. Repeat the word “two” every time you exhale. (This is done to keep distressing thoughts from entering your mind).
4. Continue to breathe in this way for about 15 minutes.
5. This time has been set aside for meditation.

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