Stress Management

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Stress Management

• C. Jeffrey Terrell, Ph.D., M.Div.
• Psychological Studies Institute

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Stress

• Many people are familiar with a cognitive model
  of counseling which suggests that events
  themselves dont affect us--our thinking about
  those events does.
• Hans Selye was an early thinker in the field, who
  argued that stress may be considered good
  stress, or bad stress, depending upon its
  effects on the person experiencing it. If stress
  in and of itself is not bad for you, then arent
  we talking about managing our response to stress,
  instead of the stress itself?

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Stress

• With this in mind, what kinds of feelings
  (physical and emotional do you get when you get
  stressed out?
• Apprehension.
• Uneasiness.
• Butterflies in the stomach.
• Autonomic reactivity.
• Withdrawal and isolation.

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Myths about Stress Management

• Stress is always bad.
• How many people like to be stressed?
• If you stopped people on the streets and asked
  what they think about stress, what kind of
  response would you expect?
• On the one hand, we hear that over 50 of routine
  medical visits are due to stress-related
  conditionsbut what does this mean?
• Temptation is to believe that if we just did away
  with stress, our problems would also vanish.
• Problem is, stress has an adaptive function, too.
  Sometimes we need stress responses in order to
  perform.
• Endocrine response prepares body for action.
• Cognitive focus improves.
• In addition, good things can be stressors, too.

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Myths about Stress Management

• Catastrophic stress is the worst kind.
• When we think of stressors, we often think about
  the really bad things that happen, and theres no
  question that we dont want to experience these
  things.
• But the fact is that we are also affected by the
  routine, everyday hassles that all of us do
  experience.
• And sometimes the effects of those hassles can
  build up and have similar effects as even the
  most serious catastrophic crises and stressors.
• Lazarus has done significant work in this area,
  and has demonstrated the injurious effects of
  these hassles. Top ten hassles
• Physical appearance
• Crime
• Money and taxes
• Home maintenance
• Losing or misplacing things
• 5) Too many things to do
• 4) Cooking and cleaning
• 3) Rising prices
• 2) Health
• 1) Concern about weight

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Myths about Stress Management

• Stress causes illness.
• There is a clear link between stress and illness.
  No question about that fact.
• There have been some elegant studies. One from
  the NEJM in 1991, examined development of cold
  symptoms from individuals stratified according to
  stress level, who were then administered a cold
  virus through a nasal spray! Sure enough,
  individuals with higher stress levels tended to
  get colds more than those with lower stress.
• What is in question, however, is what kind of
  stress, to what kinds of people, in what kinds of
  settings, under what kinds of conditions, is most
  harmful?
• The problem is, no one has been able to find a
  link that works all the time. There are obviously
  moderators, like personality variables (optimism,
  negative affect, perceptions of stress), previous
  experience, SES, and a host of other factors.

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Some typical stressors

• Pressure situations.
• Why is it that pressure seems to bother some
  people so much more than others?
• Personal meaning.
• Individual differences in tolerance.
• Capacity and intelligence.
• Ability to work quickly.
• ??

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Some typical stressors

• Frustrating situations.
• Some obstacle that stands in your way.
• Examples
• Physical tree in road coming home.
• Social being rejected from a club.
• Individual limitations old joke about the man
  who asked his surgeon if he would be able to play
  the piano after the operation. Our personal
  limitations can present obstacles.
• What are some of the ways that people respond to
  frustrating situations?
• Even here there are differences and effects that
  are generated by personality and persistence.

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Some typical stressors

• Boredom.
• The issue of balance is probably the most
  significant one we face in almost every arena of
  life.
• Do you get crazy after a couple of days of
  sitting around?
• You see assembly line workers in factories get
  stressed, even though they may be sewing on the
  same button day after day after day. Boredom can
  be a tremendous stressor.
• Again, personality issues may predominate here as
  well.
• If forced to choose, would you choose to have
  absolutely nothing to do, or would you choose to
  be overloaded with work?

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Some typical stressors

• Trauma.
• Any kind of shocking physical or emotional
  phenomenon.
• May be a death or other tragedy.
• Doesnt even necessarily have to involve someone
  you know.

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Some typical stressors

• Conflict.
• External
• Interpersonal conflict.
• Examplechild hears parents argue every night.
• Internal
• Conflicts about decisions, or other problems.
• Exampleclient loves child very much, but must
  confront irresponsible lifestyle.
• Some people deal with conflict better than do
  others. In fact, there are conflict-habituated
  families.
• Conflict, like any other stressor, increases
  stress.

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Some typical stressors

• Change.
• This is another one of those concerns that come
  up even with positive changes.
• What is it about change that makes it so
  stressful?
• There are those who will hold on to terribly
  dysfunctional patterns of behavior just so that
  they can avoid dealing with the pain of change.
  If something is known, then in a sense it feels
  safer, even if it isnt really.

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Some typical responses to stress.

• Psychological stress responses become more
  pronounced as the intensity and duration of the
  stressors increase.
• Emotional stress responses.
• Generalized anxiety disorder.
• Panic disorder.
• Depression.

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Some typical responses to stress.

• Psychological defenses- the purpose of these
  defenses is to protect people from anxiety
  producing situations. Can cushion the emotional
  impact of stress, but really doesnt do much to
  eliminate it. May function much like substance
  use feels better for a while, but problems are
  still thereand may have gotten worse.

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Some typical responses to stress.

• Psychological defenses
• Repression.- unconsciously excluding
  painful/threatening thoughts from awareness.
• Projection- attributing to others ones own
  unacceptable impulses.
• Rationalization- creation of good reasons for
  failure or loss, thus justifying specific
  behaviors.
• Reaction formation- defending against
  unacceptable impulses by actively expressing the
  opposite behavior or belief
• Displacement- coping with anxiety by getting rid
  of impulses through focusing on a safer target.
• Identification- enhancing self-worth and
  protecting self from failure by linking self
  with another.

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Some typical responses to stress.

• Behavioral stress responses are represented by
  changes in how people look, act, or talk.
• When stress is greater than person is prepared to
  cope with, you will notice disruption in physical
  coordination, behavioral skills (e.g., normal
  social skills), cognitive ability, emotional
  equilibrium, or other overt, noticeable
  demonstration.
• These responses are more acute. Chronic stress
  produces a different set of behaviors.
• Tends to look more depressed than anxious.
• Anhedonia (loss of joy in life).
• Apathy.

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Type A Behavior Pattern (TABP)

• Some people are more predisposed to stress than
  others.

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Type A Behavior Pattern (TABP)

• Quote from Rosenman
• type A individuals are more aggressive,
  competitive, alert, impatient, time-conscious,
  impatient and fast-paced, hostile, orderly,
  well-organized, self-confident, self-controlled,
  deeply involved with vocation and less able to
  relax away from work, not easily distracted from
  task performance and preferring to work alone
  when challenged, and striving to control their
  environment.

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Type A Behavior Pattern (TABP)

• What is most helpful about this conceptualization
  is that it recognizes the interaction of the
  individuals behavior pattern and/or personality
  style and the environment in which he finds
  himself. Involves a number of things
• Behavioral dispositions
• Aggressiveness.
• Competitiveness.
• Impatience.
• Specific behaviors
• Muscle tension.
• Alertness.
• Loud, pressured speech.
• Accelerated activities.
• Emotional responsiveness
• Irritation.
• Covert hostility.
• Above-average potential for anger.

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Type A Behavior Pattern (TABP)

• Characteristics of Type A Persons
• Hurry sickness.
• Time urgency is perhaps the most significant
  trait.
• Attempt to accomplish too much in too little
  time.
• So many internal deadlines that they are under
  almost constant time pressure.
• Always looking for ways to save time.
• This often results in stereotypical thinking that
  can subvert creative energy and impair judgment.

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Type A Behavior Pattern (TABP)

• Characteristics of Type A Persons
• Quest for the numbers.
• Preoccupation with numbers.
• Numbers become measures of self-worth.
• Can include money, but this is usually just a
  focus on accumulating (i.e., money is another
  index of success).

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Type A Behavior Pattern (TABP)

• Characteristics of Type A Persons
• Insecurity of status.
• Despite their seeming self-confidence, Type A
  people tend to be extremely insecure.
• This is why they need objective measures of their
  self-worth.
• Pursue achievements in order to gain respect and
  admiration.
• Prefer the respect of a superior to the affection
  of a peer.

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Type A Behavior Pattern (TABP)

• Characteristics of Type A Persons
• Aggression and hostility.
• Aggressiveness is the way to get ahead (if I
  can prevent the other guy from doing it, then I
  might have a better chance).
• Because of this style of relating, they develop a
  kind of free-floating hostility.
• Competitiveness becomes a lifestyle.
• See everything as a challenge constantly engaged
  in some kind of struggle.

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Type A Behavior Pattern (TABP)

• Characteristics of Type A Persons
• Dissatisfaction in many areas of life.
• Always on, people with TABP can never relax and
  enjoy what theyve accomplished.
• There is always something else to do. Ends up
  producing a paradoxical dissatisfaction with the
  rat race, yet they dont know how to get off
  the wheel.
• End up being rather dissatisfied with everything.

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Stress and Illness

• Stress is linked to several serious illnesses
• Hypertension (High Blood Pressure)
• Headaches
• Irritable Bowel Syndrome.
• Rheumatological disorders (Fibromyalgia,
  arthritis, etc).
• Peptic ulcer disease.

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Stress and Illness

• Remember that all of these disease processes are
  psychophysiological, not psychogenic. These
  diseases are not all in your head, nor will
  psychological treatment methods always work with
  them. There are psychological considerations
  which can exacerbate the symptom complex, and
  psychological treatments are often helpful in
  reducing frequency and intensity of symptoms.

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Basic Irrational Beliefs

• Albert Ellis proposes that a major source of
  stress in life is holding irrational beliefs,
  including

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Basic Irrational Beliefs

• It is an absolute necessity for an adult to have
  love and approval from peers, family and friends.
  
• You must be unfailingly competent and almost
  perfect in all you undertake
• Certain people are evil, wicked, and villainous,
  and should be punished.
• It is horrible when people and things are not the
  way you would like them to be
• External events cause most human misery-people
  simply react as events trigger their emotions
• You should feel fear or anxiety about anything
  that is unknown, uncertain, or potentially
  dangerous

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Basic Irrational Beliefs

• It is easier to avoid than to face life's
  difficulties and responsibilities
• The past has a lot to do with determining the
  present.
• You are helpless and have no control over what
  you experience or feel
• People are fragile and should never be hurt
• Good relationships are based on mutual sacrifice
  and a focus on giving
• If you don't go to great lengths to please
  others, they will abandon or reject you

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Basic Irrational Beliefs

• When people disapprove of you, it invariably
  means you are wrong or bad.
• Happiness, pleasure, and fulfillment can only
  occur in the presence of others, and being alone
  is horrible
• There is a perfect love, and a perfect
  relationship.
• You shouldn't have to feel pain you are entitled
  to a good life.
• Your worth as a person depends on how much you
  achieve and produce
• Anger is automatically bad and destructive

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Guidelines to Promote Rational Thinking

• It doesnt do anything to me.
• Situation doesnt make me nervous, or angry, or
  afraid.
• I create my own emotions.
• Everything is exactly the way it should be.
• Conditions for people or things to be otherwise
  dont exist (or else they would).
• To say should is to believe in magic.
• All humans are fallible creatures.
• Plans should allow for failure.
• Increase self-blame when we expect otherwise.

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Guidelines to Promote Rational Thinking

• It takes two to have conflict.
• 30 percent rule any party to a controversy is
  contributing at least 30 of fuel to keep it
  going.
• When we find yourself in conflict, recognize your
  part.
• The original cause is lost in antiquity.
• Waste of time to affix blame.
• Best strategy is to make decisions relative to
  your behavior now.
• We feel the way we think.
• Events dont cause emotions.
• Interpretations cause emotional reactions.

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How to Overcome Irrational Thinking.

• Write down the facts of the event as they
  occurred at the time you were upset. Be certain
  to include only the objective facts, not
  conjecture, subjective impressions, or value
  judgments.
• Write down your self-talk about the event. State
  an your subjective value judgments, assumptions,
  beliefs, predictions, and worries. Note which
  self-statements have been previously described as
  irrational ideas.
• Focus on your emotional response. Make a clear
  one or two word label such as angry, depressed,
  felt worthless, afraid, and so on.

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How to Overcome Irrational Thinking.

• Dispute and change the irrational self-talk
  identified at step B
• Select the irrational idea that you wish to
  dispute.
• Is there any rational support for this idea?.
• What evidence exists for the falseness of this
  idea?
• Does any evidence exist for the truth of this
  idea?
• What is the worst thing that could happen to me
  if what I want to happen doesn't, or what I don't
  want to happen does?
• What good things might occur if what you want to
  happen doesn't what you don't want to happen
  does?

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How to Overcome Irrational Thinking.

• Substitute alternative self-talk, now that you
  have clearly examined the irrational idea and
  compared it with rational thinking.
• There's nothing special about me. I can accept
  painful situations when they emerge.
• Facing the problem is more adaptive than
  resenting it or running away from it.
• I feel what I think. If I don't think negative
  thoughts, I won't feel stressful emotions. At
  worst I will experience inconvenience, regret,
  and annoyance-not anxiety, depression, and rage.