Overcoming Stress

Contents
How You React To Stress Stress Awareness Training Challenging Anxious And Negative Thoughts Controlled Breathing And Relaxation Techniques Meditation Creative Visualization Self-hypnosis Autogenics Eye Movement Technique (EMT) Rational Emotive Imagery Imago Graded Exposure	In Vivo Graded Exposure Mood Anger Management Managing Your Time Problem-Solving Assertiveness Training Competitiveness and Perfectionism Nutrition Exercise Sleep Management Conclusion

How You React To Stress
- Stress is unavoidable and part of everyday life. Some stress is essential to normal functioning. Stress ranges from physical danger, to falling in love or achieving success.
- Major life changes or the accumulation of minor everyday worries can lead to stress.
- You need to know how to respond to these experiences to lessen the impact stress has on your life.
- Stress can be environmental (e.g. weather, pollution, traffic), social (e.g. bereavement, disagreements, financial problems), physiological (e.g. illness, aging, insufficient exercise and sleep or poor nutrition), or from your thoughts – your brain can turn on the ‘fight or flight’ response (biochemical changes prepare your body to deal with danger).
- Stressed people tend to view events as difficult or dangerous and consider that they do not possess the resources to cope.
- Stress-related disease may result from chronic or persistent stress – if the stress response remains turned on.
- Stress affects almost every system in your body from being more susceptible to colds and flu, headaches and ulcers to exacerbating cancer, AIDS, arthritis, asthma and diabetes, to causing amenorrhea (cessation of menstruation), impotency in men and loss of libido, depression and ageing.
- Consider the change that has occurred to you recently and how you can best adjust to these changes.
- What does each change mean to you and how do you feel about each experience?
- Plan ahead for any life changes you may anticipate and do not rush making decisions.
- Implementing effective coping strategies to deal with your stress will take time so be patient with yourself.
- Stress management is about finding the right types and amounts of stress for you to maximize your performance.
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Stress Awareness Training
- You need to monitor your stress and become familiar with what sets it off and the feelings, thinking and actions associated with the anxiety. You can do this by keeping a diary. When you feel anxious note the date and time. What was the event? Rate your distress 1-10 (1 is no distress and 10 is extreme panic). What caused your anxiety? What was your response to cope with the problem? Re-rate your distress.
- After two weeks of monitoring your stress levels you should become aware of what triggers your distress, your bodily feelings and thoughts when distressed, how your distress levels vary with different situations, what you tend to do when distressed and what is the best way for you to cope with your distress.
- Make two lists – one of short-term only coping strategies and the other of long-term coping strategies. You can refer to these when you feel stressed. Try to incorporate more of the long-term strategies into your set of coping techniques and attempt to gradually abandon your short-term methods.
- Avoid turning to stimulants such as alcohol, caffeine and nicotine as coping methods. These have unpleasant effects in the long-term.
- Study your diary to determine what drives your cycles of distress. Is it bodily, psychological, behavioural or social?
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Challenging Anxious And Negative Thoughts
Dealing With Psychological Aspects: Challenging Anxious Thoughts

Thinking affects your feelings and how you feel affects your thinking. By altering your thoughts you will feel better.
You need to recognize the different types of thoughts which include ideas, expectations and attitudes.
Worrying thoughts become a difficulty when you cannot get rid off them easily.
A cycle of mounting anxiety can result if you do not identify and challenge your worrying thoughts.
Ask yourself if your worry is irrational and unrealistic. If so then find a rational statement to replace it.
There are three steps to challenging worrying thoughts: Identify your worrying thoughts – Try to catch the thoughts that go through your mind. Monitor your thoughts when you are anxious each day. Note the date and time and your anxious thought. Rate it 1-10 (1 is no distress and 10 is most distress) and write down thinking biases.
You need to recognize bias in your thinking so that you can rectify your thoughts. Patterns of biased thinking include:
1. being personally affected by things;
2. taking the blame when you are not at fault;
3. mind reading – thinking you know someone’s thoughts when you do not;
4. discounting the positive;
5. jumping to negative conclusions – interpreting things without evidence;
6. emotional reasoning – an over-reliance on feeling to guide judgments;
7. catastrophizing – predicting the very worst;
8. over-generalizing – you notice something true and make generalizations about it;
9. predicting the future;
10. labeling – calling yourself names;
11. wishful thinking.
Consider how you can challenge your worrying thought by finding alternative ways of thinking. Think about the reasons both for the worrying thought and against maintaining it. What is the worst case scenario and how could you cope? Try to form a more rational and constructive view of the circumstances. Re-rate your distress.

Feelings and Thoughts

We interpret things that happen to us by many thoughts about what the event conveys to us.
These thoughts can be automatic and just enter your mind immediately with little or no effort.
You may spiral down into more intensely anxious feelings because one automatic thought can lead to another.
Our inner feelings, fantasies, what we notice about our body and past actions can contribute to negative thoughts as well as particular situations.
We can clarify our thoughts by asking ourselves questions.
Try not to dwell on these negative thoughts or you may spiral down into more deep intense anxiety.
Train yourself to identify the themes you tend to dwell on and become more aware of your automatic thoughts.
Make a habit of writing down your thoughts – this will enable you to become aware of your thinking.
Basic negative beliefs could be guiding your life and causing negative automatic thoughts. Until you gain knowledge of your automatic thoughts, you may be unaware of these basic beliefs.
Think about your thoughts and write them down in a notebook. Use three columns to separate triggering events, beliefs and key thoughts, and feelings.
Start by writing down anything that comes into your mind then learn to grasp your thoughts as your mood changes.
Clarify your thoughts by asking questions about how you see yourself as a person, how you think others see you and about implications, including for the future.
When you become familiar with grasping and writing down your thoughts, work on a fourth column – Challenging Your Thoughts. Continuing reading will help you do this.
Beware of negative thoughts such as "This is a waste of time – it won’t work for me." Say to your self "Even if this does not help, what will I lose from trying?"

Challenging Negative Feelings and Thoughts

To fight negative feelings and thoughts you need to be rational (logical, work like a detective) and compassionate (warm and friendly).
Often we do not see that there is evidence for and against a negative belief.
Produce alternatives by considering a problem from a number of different viewpoints.
Try to recognize the key advantages and disadvantages of a situation. You can attempt to challenge a block that may be noted.
You can do experiments to obtain more evidence for and against your thoughts and beliefs; test things out and practice new skills. Design your experiment step by step to give yourself a chance of success.
Write down and look carefully at your negative thoughts about a specific set of circumstances.
Consider how you think when you are not anxious and what you might say to a friend in your position. Challenge and question the validity of your negative thoughts using a rational and compassionate approach.
In order to start to challenge your negative thoughts examine the evidence for and against your idea or belief and try producing alternatives to your negative thoughts and beliefs.
Focus on a particular problem and think about the pros and cons and the advantages and disadvantages of altering your circumstances.

Types of Negative Thinking

The manner in which you think about things can cause your emotional problem to increase rather than decrease.
You should try to concentrate on and gain knowledge of your negative thoughts.
The types of negative thoughts that arise in emotional problems include:
1. catastrophizing (predicting the very worst);
2. jumping to negative conclusions (interpreting things without evidence);
3. emotional reasoning (an over-reliance on feelings to guide judgments);
4. ‘I must’(these thoughts involve feelings of being compelled to do something);
5. disregarding and disbelieving the positives;
6. disregarding and disbelieving others;
7. increasing the strength of the negatives by dwelling on them;
8. all-or-nothing thinking (black-and-white thinking);
9. overgeneralizing (you notice something that is true and make generalizations about it)
It is possible to successfully challenge all these thoughts.
From the different types of negative thinking given above try to recognize the ones relevant to you.
As you record your thoughts try to become aware of the type of thinking you are employing. You need to get as much practice as possible at recognizing and challenging your thoughts.
Look closely at your negative thought monitoring record. Which type of negative thinking is each thought an example of?
Note the sort of thought you are using and how to challenge it by being rational and compassionate.
Notice if these types of negative thoughts are entering your mind. Identify and question the validity of the thoughts as they do.
How might you assist a friend to challenge one of these types of thoughts e.g. jumping to conclusions? You need to be kind to yourself and take a middle view rather than extremes.
Concentrate on your abilities rather than what you are incapable of doing.
Ask "In what way am I taking care of myself?" "Are my thoughts assisting me in this?" Gradually increase your perceptions and understanding.

Further Challenging Negative Thoughts

To help you focus on controlling negative thoughts use flash cards with the thoughts and alternatives. On one side of the card write down one of your negative thoughts and on the other write down some key challenges to this.
If you can identify your feelings but not your thoughts, give your feelings a voice – what would they say?
Sit in a mediator chair opposite two chairs placed together which are your internal bully and your inner helper or rational and compassionate self. Ask yourself what each would say respectively and write down your thoughts.
Try to change your internal images so that they become more comforting and healing.
Explore some of your fundamental values and attitudes. Think about those that are no longer useful and try to change them by considering what values and attitudes you would convey to someone else. These will probably be your authentic values and attitudes.
"Life scripts" or typical roles give us all an identity. If you identify a life script that you would like to change, consider what you have to do to achieve this and how you would act differently if you had different values. Deal with the problem in steps.

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Controlled Breathing And Relaxation Techniques
1. Dealing With Bodily Experiences: Controlling Your Breathing
  - Hyperventilation – faster breathing occurs in response to exertion and stress. In the long-term this can be uncomfortable and cause unpleasant physical symptoms which trigger more anxiety and more hyperventilation. Another cycle of stress is set up and can result in a panic attack.
  - You can rectify hyperventilation by learning to control your breathing.
  - First practice lying down and later sitting or standing. Place one hand on your stomach and the other on your chest. Breathe in slowly through your nose until your lungs are full then exhale slowly through your nose. Breathing in and out counts as one breath – aim to take 8-12 breaths a minute.
  - In order to be effective you need to practice this exercise repeatedly.
2. Dealing With Bodily Experiences: Relaxation
  - You need to develop relaxation into a skill you can use when you feel muscular tension due to stress.
  - Try to develop a routine and practice your relaxation exercises. Start by lying down and later you can try sitting or standing. Control your breathing.
  - Record your experiences noting the date and time. Rate your distress before the relaxation exercise, 1-10 (1 is tense and 10 is very relaxed). Which exercise did you use? Rate your distress afterwards. Make notes of the sort of day it was, your preoccupations etc.
  - Below are three exercises – only move to the next one when you are fully relaxed after a routine.
    1. Progressive Muscular Relaxation (PMR)
      - Breathe slowly and regularly as you focus on different parts of the body: feet – tense your feet then relax and repeat; legs – straighten your legs then relax and repeat; abdomen – tense your abdomen then relax and repeat; back – arc your back then relax and repeat; shoulders/neck – bring your shoulders up and in and press your head back. Relax and repeat; arms – stretch out your arms and hands. Relax and repeat; face – tense your face and bite hard then relax and repeat; whole body – tense your whole body then relax and repeat.
      - After the routine if you still feel tense then repeat it then when you are relaxed think of something calming to relax your mind. Get up slowly and gently.
      - You should practice PMR twice a day until you feel relaxed after the exercise.
    2. Shortened PMR
      - You can miss out the tensing and go straight to relaxing the different muscles. When you have achieved this you can progress to using the routine at other times and places.
    3. Simple Relaxation Routine
      - Identify a word, object or scene you find calming. Sit comfortably and close your eyes. Be aware of your breathing as you inhale through your nose. As you exhale, think about your calming mental image. Continue this until you feel relaxed. You should practice this exercise frequently.
  - When you have learned to relax using the three exercises you can start to use the skills throughout the day. Use something to remind you regularly to relax. Apply your relaxation skills whenever you need to use them in response to physical tension.
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Meditation
- Meditation is achieved in attempting to focus your attention on one thing at a time.
- You need to meditate regularly to become adept at meditation.
- Preparing to meditate:
  1. Choose a sitting position you find comfortable e.g. sitting in a chair, cross-legged on the floor or on your knees with your feet under your bottom.
  2. Sit, with your back relaxed but straight and let it arch.
  3. Breathe through your nose with your mouth closed and place your tongue on the roof of your mouth.
  4. Notice the sensations of contact with the chair or cushion and of where your body touches itself.
  5. Notice your breathing. Take several deep breaths and feel your abdomen expand and contract with your breathing.
  6. It is important you maintain a passive, unconcerned attitude about what you are doing during meditation.
  7. You may wish to start by meditating for only five minutes at a time. Do not force yourself to sit longer than you want to – twenty to thirty minutes once or twice a day is sufficient relaxation.
- Three basic meditations will be outlined. Choose your favourite and practice it regularly, at least once a day.
  1. Mantra Meditation
    1. Select as your mantra a word or syllable e.g. ‘one’ or ‘OM’ – it may be a nonsense syllable you find pleasing.
    2. Prepare to meditate. Sit comfortably and take several deep breaths.
    3. Chant your mantra silently noticing any sensations in your body with the repetition of your mantra.
    4. You may wish to chant your mantra aloud. Notice any sensations in your body that are different from when you chant your mantra silently. Do you find chanting your mantra silently or aloud more relaxing?
    5. Be aware of your chanting and do not let it become mechanical.
  2. Sitting Meditation
    1. Sit comfortably
    2. Focus on the rise and fall of your breath. Concentrate on the sensations of breathing – inhaling and exhaling and your breath filling your lungs.
    3. When you are distracted from your breathing, gently focus on it again.
    4. Acknowledge any distracting thoughts by naming the thoughts e.g. worry, planning.
    5. You need to practice regularly so that you can focus on your breathing more effortlessly and dismiss your thoughts more easily.
  3. Breath-Counting Meditation
    1. Sit comfortably and take several deep breaths. Close your eyes or fix them on a spot in front of you. Your eyes may be focused or unfocused.
    2. Take deep breaths and focus on:
      - Inhaling
      - The point at which you stop inhaling and start exhaling
      - Exhaling
      - The pause between the exhale and inhale
      - The point at which you start to inhale
      - The inhale.
      - Continue with this noticing any sensations in your body as you inhale and exhale.
    3. As you exhale say ‘one’ and continue counting aloud to the fourth exhale when you say ‘four’. Then begin this count again.
    4. If thoughts intrude, gently return to counting your breathing. Do not worry if you lose count – simply start again.
    5. If you are distracted by any sensation in your body, focus on it until it recedes then return to counting your breathing.
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Creative Visualization
- Stress can be reduced significantly by using your imagination.
- You are what you think you are e.g. if your thoughts are sad you feel unhappy.
- Positive thinking and healing images are popularly used to treat physical symptoms e.g. daily repeating the phrase ‘Every day in every way I am getting better and better.’
- Visualization can effectively treat stress-related illnesses such as headaches, chronic pain, muscles spasms and anxiety. Relief may be immediate or take several weeks of practice.
- Preparing to visualize:
  1. Lie in a quiet place with your eyes gently closed and your clothes loosened.
  2. Become aware of any tension in your muscles and relax them as much as possible.
  3. Form images of scenes including all your senses: sight, hearing, smell, touch and taste.
  4. Affirm your relaxation using positive, present tense statements e.g. ‘I am relaxing’ or ‘Tension is flowing out of my body’ – not ‘I am not relaxed’
  5. Visualize three times a day. At first you will find visualization easiest when lying in bed but eventually you will be able to visualize in other situations.
- Learn to use your visualizations e.g. daydreams or memories to train your body to relax. Three types of visualization will be outlined.
  1. Receptive Visualization
    Relax and empty your mind. Imagine a relaxing scene e.g. being on the beach. As you visualize the scene ask a question and wait for a response e.g. ‘Why am I so tense?’ ‘Because you have not prepared sufficiently for the presentation at work tomorrow.’
  2. Programmed Visualization
    Create an image with sight, sound, smell, touch and taste, for a goal or healing you wish to attain. Daily visualize achieving the goal or healing until it is a reality.
  3. Guided Visualization
    Imagine a scene in detail but leave out important elements. Then wait for your subconscious to fill in the missing details.
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Self-hypnosis
- Hypnosis is similar to sleep and very relaxing but you never totally lose consciousness during hypnosis. Hypnosis can be done with the eyes open or closed.
- During hypnosis your body will respond as if you are actually doing the activities you are imagining. Daydreaming or long-distance driving are hypnotic states.
- Symptoms hypnosis can effectively treat include insomnia, minor anxiety, headaches, chronic pain and muscular tension.
- Practice the basic induction once a day for a week, then add your specific hypnotic suggestions and practice until you no longer need it.
  1. You need first to understand the power of suggestion:
    1. With your eyes closed imagine carrying on your right a suitcase that gets heavier and heavier. After two minutes open your eyes and see if your posture has changed.
    2. With your eyes closed imagine the wind is pushing you back. Notice if your body is swaying back in response to your imagination.
    3. Stretch out your arms horizontally in front of you. Close your eyes and imagine heavier and heavier weights pulling your right arm down and then imagine a helium filled balloon tied to your left arm pulling it up into the air. Open your eyes and notice where your arms are relative to each other.
    If you do not notice any movement with these exercises, hypnosis may not be for you.
  2. You need to write and tape record a self-induction script – you could use the following:
    - Sit comfortably with your eyes gently focused on a point in front of you. Take deep relaxing breaths. As your eyes become tired continue to keep them open and take deep breaths. When your eyes have become very heavy, close them as you say your key word or phrase (this is the opposite of your problem e.g. for anxiety ‘Relax now’. With practice this key word or phrase will be sufficient to quickly induce hypnosis).
    - Now relax the muscles in your body – feel your legs get heavier and heavier as the tension flows out of them. Feel your arms get heavier and heavier as they are pulled down by gravity and become deeply relaxed. Your face – forehead, cheeks then jaw begin to relax. Feel the tension go from your face as it becomes loose and relaxed and your lips begin to part.
    - Next feel your neck and shoulders become more and more deeply relaxed.
    - Take deep breaths and as you exhale each time feel your chest, stomach and back become calm and relaxed.
    - Feel yourself become more and more drowsy, peaceful and calm, drifting deeper and deeper and deeper into total relaxation.
    - Now its time to go to your special place where you feel peaceful and safe. You reach your special place down a stairway or path, and with each step you count backward from ten to zero. With each step you feel more and more deeply relaxed. Ten …nine…eight…seven…six…five…four…three…two…one…..zero. (You may want to repeat this countdown a few times to deepen hypnosis).
    - See, feel, hear and smell your special place. You can feel calm and safe drifting deeper and deeper and deeper and feeling drowsy and peaceful in your special place – you drift down, down and down into total relaxation. (Spend some time feeling relaxed in your special place).
    - Now you know that you can...
    - (Leave a blank space on the tape here for the positive suggestion for change you wish to use e.g. ‘I will be calm, in control and confident’). Allow yourself time to repeat the suggestion at least three times).
    - Now, when you feel ready it is time to come back up to feeling alert and refreshed. Count up: one…two …three…four…feel yourself becoming more and more alert …five...six...seven…more wide awake…eight…nine...start to open your eyes… and ten…you are totally wide awake, alert and refreshed. Wide awake, alert and refreshed.
- Do not practice hypnotic induction in any situation where you need to be alert for your safety e.g. in a car. After hypnosis, make sure you are completely wide awake before reentering such situations.
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Autogenics
- Autogenics is a hypnotic technique. It is a self-generated state of relaxation used in a hypnotic way for self-improvement.
- It is possible to create a state very much like a hypnotic trance just by thinking of heaviness and warmth in your extremities. Essentially all you have to do is relax, undisturbed, in a comfortable position and focus passively on verbal formulas that suggest warmth and heaviness in your limbs.
- Verbal suggestions can be used to relax the body, calm the mind and resolve specific problems.
- The verbal formulas to normalize the body aim to reverse the ‘fight or flight’ state that occurs when you experience physical or emotional stress.
- There are six themes:
  1. Relaxation of the voluntary muscles;
  2. Relaxation of the blood vessels to allow greater blood flow;
  3. Normalizing cardiac activity;
  4. Regulating the respiratory system;
  5. Relaxing and warming the abdominal region – the solar plexus;
  6. Reducing blood flow to the head.
- AT can effectively treat various disorders, including muscle tension, hyperventilation, bronchial asthma, constipation, diarrhea, ulcers, high blood pressure, headaches, general anxiety, irritability and fatigue.
- AT is not recommended for children under five years old or people with severe mental or emotional problems. Before commencing AT you need to have a physical exam and discuss with your medical doctor the effects AT will be likely to have on you. You may need to be under medical supervision while in AT, if you are diabetic, hypoglycemic or have a heart condition. If you have high or low blood pressure you need to check with your medical doctor that AT is regularizing it. If you are anxious or feel any side effects after AT, you should continue AT only under the supervision of a professional AT instructor.
- You will need to practice your autogenic formulas at least twice a day for twenty minutes. If this is too long, you can try shorter more frequent sessions each day.
- After one month of regular exercise you should be able to relax quickly using all six themes.
- Facilitating relaxation for AT:
  - Ensure you are wearing loose clothing.
  - Choose a quiet, comfortably warm room where you will not be disturbed.
  - Turn the lights down low.
  - Sit comfortably with your head, back and extremities supported by the armchair or lie with your head supported, your arms by your side but not touching your body and your legs about eight inches apart, with your toes pointing slightly outward.
  - Check that your position is tension free then close your eyes or focus softly on a point in front of you.
  - Breathe slowly and deeply and relax then begin repeating your autogenic formulas.
- Make an audiotape of the verbal formulas and listen to it twice a day or memorize the formulas. You need to repeat each formula four times, saying it slowly then pause briefly. On the audiotape leave half a minute between each formula for silent repetition, as you passively concentrate on the part of the body it refers to. If you are focusing on memorizing one set at a time you can repeat the set for twenty minutes in a session or for mini sessions.
- You may experience transitory unpleasant or pleasant experiences. They will pass as you continue to practice – just note them and return to your AT formulas.
- To finish an AT session say to yourself ‘I will be refreshed and alert when I open my eyes.’ Make sure you are wide awake when you resume regular activities.
- Autogenic Verbal Formulas for Normalizing the Body:
  Start with your dominant arm.
- When you have mastered the six basic autogenic themes you can use modifications for specific problems e.g. ‘My [tense or painful area] is warm and relaxed. Never use the suggestion ‘My forehead feels warm’ because this increases the blood flow to the head and could result in pain. For headaches and blushing intersperse the formula ‘My forehead is cool.’ To stop smoking you could repeat ‘Smoking is a disgusting habit, and I can do without it.’ The formulas should be brief, and realistic to the rational mind.
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Eye Movement Technique (EMT)
- When you move your eyes rapidly back and forth while vividly imagining a stressful event, negative thoughts can be interrupted and you will gain relief from associated distress.
- EMT can help you control anxiety that is caused by recent or past events.
  1. Focus on a stressful thought.
  2. Rate your level of distress (0-10) while focusing on the stressful thought (0 is complete relaxation and 10 is extreme distress). For EMT to be most effective you need a stress level rating of 5 or 6 (a moderate level of stress). If your initial rating is higher than 6, try reducing your stress level to 5 or 6 by using relaxation techniques. If your initial rating is less than 5, try focusing on the stressful event until you reach a stress level of 5 or 6.
  3. Once you have reached a stress level of 5 or 6 keep your head still and move your eyes back and forth twenty to twenty-five times between two corners of a room, between your hands placed on each knee or between two sides of a table. You should be able to stop focusing on the stressful event. If you are in a public place you can do EMT moving your eyes from side to side when your eyes are closed – it will look as if you are in deep thought or resting.
  4. As soon as you have finished rapid eye movement re-rate your distress. EMT significantly diminishes or blocks your ability to focus a thought or image. You should find you get a rating of 4 or less and additional sessions will reduce your level of distress further.
  5. Repeat steps 1-4 whenever the stressful thought recurs. EMT becomes more effective with repeated exposure. At first you may need to do EMT every ten minutes but soon you will get relief for longer. Eventually you should be able to use EMT to gain relief in the moment you have a distressful thought.
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Rational Emotive Imagery
- This technique will help you develop strategies to alter stressful emotions.
  1. Imagine vividly a situation that causes stress and unpleasant emotions. See, hear, smell the details of the event
  2. Let yourself experience your uncomfortable emotions
  3. Push yourself to change these dysfunctional emotions (e.g. anxiety, depression, rage or guilt) to functional emotions (e.g. concern, disappointment, annoyance or regret)
  4. Having altered your stressful emotions to more functional feelings, you can examine how you altered your original feelings – what were you thinking about yourself, others, or the situation to cause this change in your feelings.
  5. You have changed your dysfunctional emotions to more appropriate feelings by altering your beliefs from maladaptive to adaptive thinking. Once you have identified the belief you can substitute it anytime you want to lead you away from stress.
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Imago Graded Exposure
- 1. Make a hierarchy of stressful events and start with the easiest event. Make a list of coping thoughts which reduce your anxiety for that event.
  2. Relax – if necessary use Controlled Breathing and Relaxation Techniques.
  3. Imagine you are in the stressful situation – see, hear, taste, touch and smell the situation. Think about your anxiety provoking thoughts and feel your tension mounting.
  4. Once you are anxious, start relaxing and using coping thoughts while imagining the anxiety-provoking scene for about one minute.
  5. Rate your anxiety 0-10 (0 is no anxiety and 10 is extremely anxious). If your anxiety is 1 or 0 proceed to step 6 then move to the next situation in your hierarchy. If your anxiety is 2 or more, relax (step 6) and then repeat steps 3 and 4.
  6. Relax deeply before moving on to the next scene.
  7. Continue imagining and coping with the scenes until you can cope with the most difficult scene in your hierarchy.
  8. Practice daily – your first session may be 15-20 minutes but later you may want to extend this to 30 minutes.
- You can also use this technique to cope with anger-provoking situations – make an anger hierarchy and list coping thoughts to reduce your anger; imagine the anger-provoking scene and use coping thoughts; rate your anger and proceed as instructed above.
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In Vivo Graded Exposure
- To overcome your fear you need to face it at your own pace. Identify and write down an accurate description of your fear. Deal with one fear at a time.
- Graded exposure will show you that your fears are not really alarming and build your confidence. You are trying to learn to master your anxiety rather than avoiding it. There are three stages:
  1. Setting targets – Your descriptions of fears such as objects and situations that cause avoidance and anxiety needs to be arranged in order of difficulty with the easiest first. These are your targets.
  2. Grading tasks – Choose a target and plan a series of steps which become progressively difficult so that you can build on your successes. Each step should be altered in one aspect at a time to increase the difficulty and allow you to build your confidence. E.g. If your target is to shop at the supermarket, alone – you could start by shopping for one item at the local shop with the correct money then with a credit card then buy several items with a credit card. Next you could try graded steps at a local store followed by a mini-market and finally at a supermarket.
  3. Practicing – Repeat each step until your anxiety is no longer there, then proceed to the next task and reward yourself for your achievements.
- Keep a diary to remind you of your progress. Note the date and task and give a rating for your anxiety 1-10 (1 is no distress and 10 is most distress). Write down any other related details.
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Mood
- Your mood affects almost every area of your life. Irregularities in your mood lead to feeling irritable with no obvious trigger. When this is the case almost anything can set off your anger.
- The main factors influencing your mood and how you can attain a stable good mood are considered below.
- Your body wants to eat and sleep regularly so you need to form a good circadian rhythm or daily routine. Make a list of your rising time, mealtimes and bedtime and try to keep to within 30 minutes of these times either way. Record the actual times you eat and sleep in a diary.
- Exercise is good for you and it need not be strenuous – do not undertake strenuous exercise without consulting your doctor. Wear comfortable and even stylish shoes and think of exercise as important. Exercising will increase your energy. Try exercising earlier in the day if you are usually too tired in the evening. You should get as much exercise as you want. Keep a diary of how much exercise you are getting. This can be part of your routine (e.g. walking between places) or planned timetabled exercise (e.g. going for a swim).
- Eat a balanced diet and make sure you chew your food well to digest it properly. Drink plenty of water. You should eat mostly fruits and vegetables, least of high fat foods such as cake and chocolate and a moderate amount of foods such as bread, rice and potatoes and high protein foods such as meat and fish with less of the latter category than the former.
- Cut down on your stimulant intake to about three cups of coffee a day. Reduce your alcohol intake to 21 units a week for a man and 14 for a woman. Go easy on nicotine and other ‘recreational’ drugs. Try to get down to your recommended alcohol intake. If you need help to do this your doctor may be able to suggest someone or you could contact Alcoholic Anonymous (contact number available from local phone book) – you do not need to be drinking excessively to enlist their help.
- Get into the routine of getting a good night’s sleep. Rise and eat regularly and reduce your stimulants and alcohol intake. Get sufficient physical and mental exercise in the day and be less active before you go to bed so that you do so more relaxed. Make sure you are adequately full and have a regular bedtime. Try to go to bed happy and comfortable without any disturbances such as external noise.
- If your bad mood is due to illness then try to get well. When this is not possible endeavour to blame your illness rather than other people. For those whose bad mood is caused by depression see ‘Overcoming Depression’ in the Forward Counselling Advice Service.
- Reduce the effects of stress on your life by: Examining the pressures you are under and removing one or two of these stresses; Learning to deal with the stresses more effectively – identify your stresses and ask others how they cope with those stresses then make a plan of action and implement it; Viewing your stresses in a different way and acting on this new view.
- Nurture and consolidate your intimate, work and outside of work and intimacy relationships (e.g. friends and neighbours). Beware of distributing disturbances in one area to the other two areas.
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Anger Management
- You need to learn to deal with your anger effectively rather than suppressing it or being enraged.
  1. Keep Notes About Your Anger
    - When and why you are angry; your thoughts and behaviour when angry; rate how strong your anger is using the scale 0-10, (0 is irritated, 10 is enraged).
    - Make honest, daily anger notes for a fortnight or more, dating each entry – this will enable you to see what things need to be improved.
    - Answer the following questions in your notebook:
      1. How frequently do I get angry?
      2. Do others know when I am angry?
      3. Does my anger help me to cope?
      4. Is my anger preventing recovery?
      5. What do I achieve from being angry?
      6. Can I obtain these things in other ways?
      7. Do I express anger in ways others expressed anger in my childhood or differently?
      8. Do I feel relief from getting angry?
      9. Are there alternatives to getting angry yet achieving the same sense of relief?
      10. Could I consider forgiveness as opposed to revenge or a compromise between the two?
  2. Dealing With Bodily Sensations:
    - Consider the physical sensations that tell you that you are becoming angry e.g. do you become tense and sweat?
    - Control your physical sensations due to anger, by using the Controlled Breathing and Relaxation techniques:
    - As well as the above techniques you could try healthy physical exertion e.g. taking a vigorous walk.
  3. Specific Anger Management Techniques:
    - The ‘Time-out’ technique:
      - Discuss with your partner and others concerned beforehand that as part of learning to control your anger, you will take a ‘Time-out’ next time you are angry.
      - This means that you will leave to be alone for no more or less than an hour, when you feel your anger rising.
      - During this time you should not drink or drive. Use any technique that will help you to calm down and not over react when you return e.g. controlled breathing or physical exertion.
      - Explain to those concerned that you are not rejecting them nor should they worry about you when you need to be alone to calm down.
      - Request their support in your efforts at anger management.
    - The ‘Thermometer’ technique:
      - Visualize a large thermometer with red mercury to represent your temper. Allow yourself to see the graduation marks.
      - When you are calm there is just enough mercury for effective interaction with others. As you become agitated the temperature will rise – you will be aware of bodily sensations such as quickened breathing and flaring nostrils.
      - All thermometers have marks at the top for a ‘danger zone’ and you need to bring the mercury down before you get into this zone where you will lose control over your thinking so will be unable to act appropriately.
      - Use controlled breathing or the ‘time-out’ technique or any other means to get the mercury to fall to a safe level where you are in control of your anger.
      - When you reach room temperature level you can deal with the situation in a rational manner.
      - You will need to use this technique regularly for effective results.
    - The ‘Assertive Communication’ technique:
      - Clarify what you want to discuss that is upsetting you.
      - Communicate your feelings using ‘I’ statements e.g. ‘I am frustrated…’
      - Specify the action you want to happen.
      - State any stipulations or consequences.
      - Thank the other person for listening.
      - Try rehearsing the ‘Assertive Communication’ technique before an encounter.
- If you are doing yourself physical damage e.g. cutting or self-mutilating, you are not coping and should seek the help of a professional.
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Managing Your Time
- Good time management requires being aware of:
  1. Your needs and strengths – list these opposite each other.
  2. Your standard procedure – find out how you use your time at present by keeping a record of how you spend your time. From the record you will be able to work out the best way of working. Try to get a balance of work tasks and include breaks.
  3. Your priorities – identify and rank in order of priority the different areas of your life. Consider the time you allocate to each and what is realistic and necessary. Perhaps others are making demands of you that you need to be more assertive about?
  4. Setting reasonable goals – keep in mind the important areas of your life when pursuing goals. Clearly define your goals so you know when you have achieved them. Some goals will need to be broken down into more manageable steps.
- Once you know the above you can draw up a new more efficient schedule. Use an organizer and list long-term (within six months), medium-term (within a month) and short-term (within a week) goals. Set aside time each day to organize. Try to do a ‘To do’ list of prioritized tasks every day. Plan flexibly and review every month.
- Delegating – giving over responsibility with authority, to others for appropriate tasks, is part of good time management.
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Problem-Solving
- Problems of any sort can cause distress – the problem-solving approach can be useful in these cases. You learn to focus your thinking and find solutions to your problem instead of panicking. There are six steps in problem-solving:
  1. Define the Problem – Be specific and try to break the problem into more manageable tasks. Do one task at a time. Choose your task and specify your goal.
  2. List Solutions – Try to write down as many ideas, to solve your problem, as you can.
  3. Evaluate the Pros and Cons of Each Solution – Consider your solutions and reject the unsuitable ones. List the remaining solutions in order of usefulness.
  4. Selecting a Solution and Planning Action - Choose your first solution and decide how you will put it into action. Rehearse your task and make sure you have a back-up plan in case your task does not go as planned.
  5. Do it - Attempt your solution.
  6. Review the Result of the Solution – If your solution is successful try to understand why it was so. If your solution is unsuccessful try to comprehend why it did not work. Praise yourself for having tried and choose your next solution from your list.
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Assertiveness Training
- The aim of assertive behaviour is to stand up for your legitimate rights and face others without putting yourself or them down.
- Assertiveness training teaches you to increase the number and variety of situations in which you are assertive.
- There are three types of interpersonal behaviour:
  1. Aggressive – you may be forceful in expressing your opinions, feelings and wants.
  2. Passive – your opinions, feelings and wants may be withheld completely or partly.
  3. Opinions, feelings and wants are stated with respect for the rights of others.
- Make sure you are aware of your fundamental rights which include:
  - asking for what you want;
  - saying ‘No’ without guilt;
  - not being perfect;
  - being ignorant about something;
  - being responsible for your actions;
  - having your own perspective and emotions;
  - being indecisive;
  - choosing whether or not to deal with others’ difficulties;
  - expecting privacy, independence and success.
- There are five steps to being assertive:
  1. What do you want? ;
  2. What is fair? ;
  3. Be clear in asking for it;
  4. Contemplate and be ready for the risks;
  5. Stay calm
- Practice your arguments in advance and repeat yourself to get the message across. Be prepared to negotiate.
- Think about situations in which you are not assertive and how you could change this and be assertive.
- Write out a detailed description of problem scenes – note when and where the problem occurs; who is involved; what your difficulties are; how you handle it; your fear of what will happen if you are assertive; your goal.
- To deal with a problem situation:
  1. Consider your rights and wants.
  2. Unless spontaneous action is required, arrange a mutually convenient time to discuss your problem with the other person.
  3. Define the problem as specifically as possible.
  4. Describe your feelings using ‘I’ messages, to give the other person an understanding of how important the issue is to you.
  5. Make your request in one or two simple but firm sentences.
  6. Give positive reinforcement to get what you want e.g. we’ll be able to spend more time together. If this will be ineffective try negative reinforcement, describing the alternative way you will look after yourself if your wishes are not met.
- You need to arrive at a workable compromise. Agree to review this after a specified length of time and if you are not both satisfied you can renegotiate.
- Avoid being manipulated – techniques include:
  1. ‘Broken Record’ where you choose a concise assertive statement to say over and over to get your message across.
  2. Delay responding to a challenging statement until you are more prepared.
  3. Inviting criticism may reveal what is troubling the other person.
  4. When someone puts you down, acknowledge something you can agree with in their criticism and ignore the rest.
  5. You can change the focus, from discussing the topic to analyzing the interaction between the two of you.
- In instances where you lack time you could use the short form assertiveness technique. Consider:
  1. Your thoughts – state the facts as: ‘I think…’
  2. Your feelings - express as ‘I’ statements: ‘I feel…’
  3. Your wants – specify behaviour change as: ‘I want…’
- You need to develop assertive body language. Practice the following basic rules in front of a mirror so that you learn how to apply them to problem situations:
  1. Maintain eye contact and an erect body posture
  2. Speak clearly and firmly.
  3. Emphasize what you are saying with gestures and facial expressions.
- Learn to listen assertively:
  1. Make sure you are both ready to listen.
  2. Listen giving the other person your full attention and ask them to clarify if necessary.
  3. Let the other person know you have heard what s/he has expressed to you.
- Practice being more assertive in problem situations and consider how it makes you feel.
- Role-playing is a good way to improve your assertiveness in a safe environment before trying it out in real life situations.
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Competitiveness and Perfectionism
- Most of our problems arise from failing, so learning how to fail without attacking yourself is useful in gaining more control over your mood. Without realizing it, because of the pressure to succeed, we can become competitive and perfectionist people who are daunted by the thought of failure.
- Perfectionism leads to frequent disappointments which results in feeling low.
- Perfectionism can lead to competitiveness when we want to be seen as superior and wish to avoid inferiority.
- To find out in which areas of your life your competitiveness lies ask yourself which areas of your life you would not settle for being average and which concern you regarding what others possess, are achieving or doing.
- A problem with perfectionism is that you evaluate yourself on the products of your activities and disregard your efforts.
- Competitiveness and perfectionism can be directed at our self or at others or we may feel it is expected of us.
- Another problem with competitiveness and perfectionism is that your internal bully often directs frustration and anger toward yourself.
- You may become self-centered from perfectionism and competitiveness if you let your inner bully take control.
- You may experience frustrative anger, anxiety or guilt at not succeeding, because of your negative thinking styles.
- As a result self-attacking or attacking others may increase, leading to you feeling more low.
- You need to consider how you cope with yourself and others when you cannot meet your ideal standards.
- In order to identify your competitiveness and perfectionism think about an occasion when you did not succeed at something. What were your ideals regarding the matter? What were you hoping to achieve and why would that have been good? Were you afraid of inferiority or were you seeking superiority? Were you attempting to attain your own ideals or those dictated by others? Was your objective to gain the favour of others? Are you success orientated or do you try to avoid failure?
- Praise yourself for even your little successes.
- Examine your actions when you fail. Do you attack yourself or others? What do you say in these circumstances? Do you accept failure, if so why? Write these down to make things clearer for yourself. Next explore if you use types of negative thinking e.g. all-or-nothing thinking.
- Learn how to fail so that you need not fear achieving success. Use your rational and compassionate mind to ask yourself firstly how you would advise a friend, then what you wish them to say to you. Can you find alternatives to challenge your negative thoughts and feelings?
- Try to break things up into a manageable size and proceed in steps concentrating on your achievements rather than what you have been unable to do.
- Set realistic standards, become tolerant of others’ mistakes and learn to identify what is ‘good enough’ and accept it.
- Is your life pleasurable or do you not enjoy things? Can you complete one task today? Consider how you might obtain help from others?
- Learn to accept yourself thus gaining confidence and enjoy your success.
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Nutrition
- A healthy body responds better to life stresses and good nutrition is fundamental to good health.
- Monitor your food intake for a week then analyze the record to see what changes need to be made. Gradually introduce a few changes at a time.
- Positive Eating:
  1. Reduce your fat intake – it is an accepted theory that saturated fats contribute to heart disease and stroke by raising the body’s cholesterol level.
  2. Limit sugar intake – cravings for sugar can be better satisfied with fruit
  3. Avoid too much salt – Recommended sodium intake is 3000 milligrams daily and 2000 milligrams for people with high blood pressure and on a low-sodium diet.
  4. You need in your diet macronutrients (proteins, carbohydrates, and fats) and micronutrients (vitamins and minerals) – the former in larger quantities and the latter in smaller amounts. You should eat mostly fruits and vegetables, least of high fat foods such as cake and chocolate and a moderate amount of foods such as bread, rice and potatoes and high protein foods such as meat and fish with less of the latter category than the former.
  5. Find a healthy weight according to your height and remember that weight fluctuates by 2-3 pounds in either direction.
  6. Restrict your caffeine intake – coffee, tea, chocolate, colas and some medications are high in this stimulant. Caffeine can interfere with sleep and makes some people irritable as well as contributing to gastrointestinal distress.
  7. Limit your alcohol consumption – alcohol is high in calories and low in nutrients.
  8. Supplement your diet with a multivitamin daily – this is not a substitute for not eating well.
  9. You need to eat three meals and two snacks a day. Eat frequently and calmly learning to savour your food.
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Exercise
- Exercise effectively reduces stress by returning the body to its normal equilibrium, from the ‘fight and fight’ state of arousal.
- There are three types of exercise:
  1. Aerobic exercises – these are vigorous and involve the use of the large muscles in the body, such as the legs and arms. Your cardiovascular system is strengthened and your stamina is increased. Examples are jogging, brisk walking and swimming.
  2. Stretching exercises - these are slow and relaxing and can increase muscle strength, flexibility and joint mobility. Examples are yoga and tai chi.
  3. Toning exercises – these concentrate on firming or tightening specific muscles. Examples are squats for thigh muscles and push-ups for arm and chest muscles.
- You need to exercise regularly and adequately.
- Exercise can relieve chronic muscle tension, depression and anxiety. Metabolism will be improved relieving indigestion and chronic constipation. Posture will be improved providing relief for lower back pain caused by stress. Exercise will also fight stress - related chronic fatigue and insomnia.
- Check with your doctor before starting an exercise program. Start slowly and build up gradually. Select exercise you enjoy.
- Make a plan to exercise three times a week for two months and be committed to this schedule to incorporate exercise as a regular part of your life.
- To support you in your endeavours keep a diary noting time, opportunity to exercise, the pros and cons for exercising, response, and solution if you did not take the opportunity to exercise in that instance.
- You will need to determine the best times for you to exercise and your diary may help your decisions.
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Sleep Management
- The length of sleep necessary varies from person to person.
- Worrying will prevent you from sleeping.
- You need less sleep as you get older.
- Sleep is affected by mood, stress, food, alcohol, exercise and medicines.
- In the long-term, sleeping tablets are not helpful and can be addictive.
- You can manage your sleep problems by changing your behaviour rather than resorting to medication.
- Keep a sleep diary for several nights to ascertain if you have a problem. Note the date and anything that might affect your ability to sleep e.g. your activity before retiring. If you have waking episodes, note your activity to restore sleep. Was it helpful? Next day note the number of hours of sleep you managed to get and rate how alert you feel 1-10 (1 is dull and sleepy and 10 is very alert). Rate your performance that day 1-10 (1 is poor performance and 10 is performed well). If you do have a problem the following suggestions might be helpful:
- Analyze your sleep diary to see if poor sleep is due to stress and is likely to get better as this eases; are there behaviours which result in poor sleep that you could change?; identify helpful and unhelpful ways of coping and avoid the latter.
- Introduce pleasant smells into your sleeping environment to help you relax e.g. potpourri or lavender oil.
- Try to relax an hour or two before you go to bed. Keep your daily stress low and seek counselling or the support of friends if you feel the need. Exercise during the day. Avoid caffeine, nicotine and alcohol and try a warm milk drink before bed. Make sure you are not hungry before retiring as this will keep you awake.
- Ensure you have a quiet bedroom and a comfortable bed and have emptied your bladder before trying to sleep. Use your bed only for sleeping and set an alarm so you wake regularly each day. Avoid naps during the day.
- If you sleepwalk you are advised to discuss this with your doctor as it can be dangerous.
- To cope with disturbing dreams you could try:
  1. Constructing a positive ending to your disturbing dream and mentally practicing this alternative ending several times before sleeping;
  2. Practicing beforehand what you might say if the dream occurs;
  3. Keep water and a towel by your bedside to wash your face with if you wake up sweating – this will help you re-orientate;
  4. Keep a notepad and pencil within reach so you can record your dreams but beware of reading too much into their interpretation.
- Relaxed Breathing Method:
  You could try the following method of relaxed breathing to ease tension and promote sleep:
  1. Ensure you have some time to yourself and push your worries to one side;
  2. Sit or lie comfortably and close your eyes with your arms by your side;
  3. Concentrate on breathing naturally;
  4. Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed;
  5. Count back from 10 then open your eyes and feel how relaxed you are now. Slowly get up and resume normal activities.
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Conclusion
- You may encounter difficulty in giving up old habits for new ones.
- Before you allow yourself to be distracted from practicing your new habits, weigh the pros and cons and make a responsible decision for when and where you will next do the exercise.
- Confront your excuses.
- Proceed in small steps, gradually implementing changes and building on each little success.
- It could take some time for your new habits to become second nature but at that point you will have made the final step forward in overcoming your stress.
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Overcoming Stress

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