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STM8282 - SECTION 8: INTERNAL APPROACHES TO STRESS MANAGEMENT

 
Mental health clinicians perform work in internal stress management in almost every therapeutic intervention. The internal work on the ergotropic side is what clinicians do in insight oriented or cognitive-behavioral psychotherapy. The internal work on the trophotropic side is what clinicians and other professionals do under the category of building relaxation skills and techniques.

There are many important things to know about engaging in these internal change efforts for both ergotropic and trophotropic response systems. These change efforts will primarily occur through the pathways of the pre-frontal cortex and hypothalamus. This means the changes will occur down neural pathways whose operations work within the rules outlined earlier in this training.

The pathways holding events stored deepest in the primitive brain structures, events stored with most emotionally charged memories, most often repeated events, most recently occurring events, events most supported by external reality, will be given greater strength as the body evaluates what level of response is needed.

In attempting to reshape a client's internal stress landscape, a clinician will often be faced with correcting perceptions based upon events stored deep in a client's memories, events stored with very emotionally charged material, and events repeated many times.

This will present challenges for the clinician, to say the least. In order to decrease the client's overly active ergotropic responses, the clinician must attempt to reconfigure a client's perceptions about both the degree of threat or challenge any event presents to the client, and the number and strength of the client's resources to handle the challenge or threat.

The therapeutic relationship offers one paradigm for what is required to solve this dilemma. The calm, compassionate, gentle approach of the therapist provides powerful sensory clues - in the external reality of the moment - that safety is possible and present. In study after study on the efficacy of psychotherapy, this is the one variable that always seems to create positive effects, regardless of whatever other techniques, theories and approaches are used in treatment.

From a neuroscientific level, the attuned presence of the clinician, with the capacity to provide assurance and comfort, allows for the release of chemicals that support positive down-regulation of over-active ergotropic responses. One of the chemicals that is believed to be released under these circumstances is oxytocin, the bonding chemical that is released during nursing and intimate sexual relations. This chemical leads to a sense of emotional connection, security, and well-being in the presence of others, and it is extremely powerful in terms of its ability to provide a sense of calm and comfort, the modulating experience that alleviates distress at its most primitive level.

This attunement experience is, of course, supported by verbal messages directed at the misperceptions of the client about the level of threats or challenges, and resources to handle them. The association between the experience of increased security and comfort and the distressing memories reduces the perceived level of threat that is activated with the memory. This can allow the memory to be moved to a more flexible state in the mind’s eye, allowing for it to be connected with new information and become restructured.

In this way, the strength of information in the present works to counterbalance the strength of the deeply held and emotionally charged misperceptions of the past. The corrective information is offered repetitively by the clinician. The messages can be reinforced - repetitively - by reading materials and by the client him/herself. The client's capacity to hold onto this material is aided by the smoothing effects discussed earlier in this training, until the neurochemistry of the brain is changed. If these efforts yield successes - in the real world and in the present - it reinforces the strength of the pathways, and makes connections to emotional areas of the brain.

This combination of elements - of which psychotherapy is composed - can restructure the perceptual and evaluatory systems, and re-set the level of ergotropic responses.

Restructuring can also occur through systematic desensitization, in which the person is exposed to gradually increasing levels of challenge. With successful mastery over each level of challenge, the real level of challenge or threat present in the situation is better understood, as is the ability of the client to draw upon successful resources.



Stress tip #30: Conduct a stress inventory on a regular basis to find practical solutions to your stresses and remind yourself of the control you can have over stress.

A particularly useful practical tool to support both of these approaches is the stress inventory. This is a tool that can be used on an ongoing basis not only to create shifts in perceptions about the level of challenge and the level of available resources, but also to implement, on a practical level, efforts to maintain a successful stress balance.

The stress inventory lines up the stresses faced by a person on one side of a page, and practical solutions to those stresses on the other side of the page. An example of a stress inventory is shown on the next page.


STRESS INVENTORY EXAMPLE



STRESS                                                               SOLUTION

1. Traffic stress.................................Work on relaxed attitude - don't         ..............................................................worry about how long it takes to get   ..............................................................home. Put on radio, enjoy the ride.

2. Work deadlines...........................Create organizational time before       .............................................................undertaking project. Plan how to         .............................................................approach project efficiently. Develop .............................................................prioritized to do list. Plan delegation   .............................................................list. Talk with co-workers about help .............................................................they can contribute.

3. Disagreement w/son..................Sit down to plan discussion,                     .............................................................evaluate his concerns. Set up time   .............................................................to meet with him when you won't be   .............................................................interrupted.


4. Christmas presents....................Establish budget for Christmas.             .............................................................Write list of people to receive             .............................................................presents. Plan gift giving, set plan     .............................................................for getting to stores. 


5. Sleep deprivation........................Plan ahead for early morning work.         ............................................................Avoid temptation to stay up late for     ............................................................two nights before.



A stress inventory allows you to bring all your concerns to the light of conscious evaluation. This removes any hidden misperceptions about how challenging your stresses really are, and can reduce their impact.

A stress inventory allows you to reinforce your awareness of the number of resources you have available to handle your challenges. A stress inventory formalizes your solution seeking approaches, and serves as a good format to organize and focus stress reducing actions.

Stress exercise #5

Take 5 to 10 minutes to develop a beginning stress inventory. See if you finish the stress inventory feeling more confident about your ability to handle the stresses in your life.


The final piece of stress management that we will cover is the area that is traditionally understood as stress management: skills and techniques for increasing trophotropic responses, or relaxation skills.

Hopefully at this point in the training, it is understood that this area is only a component of overall stress management, one strategy among many. This is not to underplay the value of traditional approaches to stress management through relaxation.



Stress tip #31: Think about ways to develop your relaxation skills and techniques. Look for a way that is right for your life style, values, and comfort level.


Stress tip #32: Search for ways to create relaxation and calm. The more you balance your periods of stress with periods of relaxation, the better you will return to the challenges refreshed.

The advantage of this approach to stress management is that it is controllable. Even if the total level of stress from life's challenges can't be decreased, you can increase your body's ability to handle stress by setting in motion regular trophotropic responses.

Fortunately, the trophotropic response system does have the ability to be set in motion independently from the ergotropic system and the five stage stress response. The body can remain aroused from the work of the ergotropic response system, and kept calm through the functioning of the trophotropic response system.

There are cultures, predominately in the Eastern hemisphere, that have incorporated into their cultural traditions deep and early skill building in the development of relaxation skills and trophotropic systems strengthening. Yoga, transcendental meditation, the martial arts, tai chi, and other traditions that have been imported into the West from India, China, Tibet, and other Eastern cultures represent scientifically studied and validated approaches to strengthening the neurological equipment through which trophotropic chemical messages travel. While the development of these specific capabilities occurs more readily if the developmental efforts begin earlier in life, the pathways for enhanced trophotropic control can be strengthened at any point in a person’s life. All that is required is focus and repetition.


Stress tip #33: Get away from your stresses on a regular basis. If you can't get away for days or weeks, get away for minutes or seconds.

There are many ways to set in motion trophotropic responses. Getting away from stressful things will, of course, usually bring you into the resolution and remission stages, setting in motion trophotropic responses. This is recommended on a regular basis. But your body has other methods to set in motion trophotropic responses. There are many ways in which your body is receptive to cues and messages that are soothing, calming and reassuring. When these messages are received by your sensory and perceptual equipment, neuronal pathways are activated that set in motion the trophotropic response systems.


Stress tip #34: Fill your life with pleasant sensations of smell, sight, touch, taste and sound.

At a very deep level, the body reacts with great relaxation to certain olfactory (smell), tactile (touch), auditory (sound) and visual stimuli. The pathways run to very primitive and instinctive parts of the brain and set trophotropic responses in motion.

It is for this reason that instructors of yoga, meditation, and other approaches to strengthening a person’s relaxation capabilities utilize music and aromas to establish a mood conducive to the capabilities they are trying to build. When you receive a massage from a good massage therapist, with pleasant smelling candles and soothing music playing, your body is receiving information inputs on many fronts that promote deep relaxation. There is a deeply restorative effect from this that can be experienced by most people. The physical sensation of having one's body buoyed and supported by warm water is another primitively restorative experience.


Stress tip #35: Increase your positive people connections. Promote and protect your play time. Learn to give and receive big hugs. Invite silly people into your life and laugh with them.

Relaxed, non-competitive play, or laughter work at a more emotional level to create trophotropic responses. A kind hug, a comforting word, a warm smile can all create trophotropic responses. Your body's sleep cycle will bring you through various trophotropic phases automatically.

If you are successful at bringing more things in your life that promote this trophotropic response, you will create more balance on a day to day basis. It is also possible, though, to add a few more activities that can develop the highest level stress management skills of all.



Stress tip #36: Discover your relaxation pathways through meditation, focused breathing, prayer, yoga or other deep relaxation techniques.


Stress tip #37: Build your relaxation techniques through regular practice and repetition.

As noted, meditation, deep prayer, focused breathing, yoga, and other relaxation approaches are all techniques that can push the limits of controlling trophotropic responses. These techniques all seek to find neural pathways, through the pre-frontal cortex/hypothalamus connections, to the chemistry that produces relaxation.

These pathways can be discovered more easily when other areas of the brain are not active, and creating interference. For this reason, these approaches are practiced in quiet and calm surroundings, so there are limited stimuli to which the information receiving areas of the brain need to respond.

Once the correct neural pathways are found, they can be selectively reinforced by repetition. As the pathways are used repetitively, they grow increasing numbers of electrochemical connections, and develop the ability to conduct more and more electricity. With enough growth, the pre-frontal cortex can develop the ability to set in motion a trophotropic response at will. Relaxation control is achieved.

Yoga masters, people who develop these skills with great discipline and years of practice, can consciously lower their blood pressure and heart rate, and achieve a great state of calm, even under extraordinarily stressful conditions.

Most people would not choose to devote that level of time or other resources to developing this skill to that degree. However, like everything else in managing a stress economy, this ability can be successfully used to improve one's balance in smaller increments.

Taking time to meditate, or pray, or practice yoga can be done in ways that suit one's own busy schedule. While the level of control reached may not be full, even small improvements can add their piece to the large puzzle of stress management. You don't need to become a yoga master. Just do whatever you can, and it's still an improvement.


Stress tip #38: Build your overall stress management strategy not from a single thing, but from a wide collection of many things, both big and small, frequent and occasional, stress reducing and relaxation inducing.



Review Questions for Section VIII

At this point in the training, the trainee should be able to answer the following questions:

What is a stress inventory and how can this be helpful for clients in terms of stress management?

What is the importance of repetition in terms of stress management and psychotherapy?

What are some approaches that trigger the trophotropic responses?



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