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STM8282 - SECTION 7: PRACTICAL APPROACHES TO STRESS MANAGMENT

 


In looking for practical approaches to stress management, we will focus on a key stress management issue: the need to balance response time with recovery time. What we will use for this regard is a combination of practical stress tips, and an overall strategy in the form of an analogy that is both familiar and sensible, and translates well to a deep understanding of stress management: the Bank Account Approach to Stress Management. We will look at this shortly.

It is likely that both the practical stress tips and the Bank Account Approach to Stress Management will appear very simplistic to the experienced clinician. There are, however, reasons for using this approach. How many of our trainees follow all of our practical stress tips in their day to day life? Probably very few. However well we know, sometimes we do not do.

Given that our clients are often less sophisticated in their level of understanding, the information will be presented in simple terms and concepts that can be readily grasped by even somewhat lower functioning clients.

Practical Stress Tip #1: Strive to keep a balance in your life between the things that stress you out and the things that relieve the stress and allow you time to rest and recover.


THE "BANK ACCOUNT" APPROACH TO STRESS MANAGEMENT

The bank account approach to stress management is based upon a simple principle: the overall ongoing stress you will experience is going to be determined by the balance between the stresses you have in your life and the de-stressing activities that allow you to recover and restore yourself.

This balance takes place in a complex interaction of things that operates in a manner similar to an "economy". The "economy" is not necessarily like a world or country's economy, but more like the economy of your own personal finances.

Like in your own finances, there are "payments" coming in and "payments" going out. Similarly, there may be periods of time when you have more payments coming in than are going out, as well as times when there are more payments going out than are coming in.

How well your own personal "stress economy" is doing at any point in time will be determined by this relationship of things coming in and things going out. Like with your bank account, you will have a balance - that is, a sum of "payments" coming in and going out.

Please refer to the items below:

WITHDRAWALS:

-EXTERNAL STRESSES THAT INCREASE ERGOTROPIC RESPONSES
-INTERNAL STRESSES THAT INCREASE ERGOTROPIC RESPONSES

DEPOSITS

-EXTERNAL STRESS RELEASES THAT INCREASE TROPHOTROPIC RESPONSES & RECOVERY
-INTERNAL STRESS RELEASES THAT INCREASE TROPHOTROPIC RESPONSES & RECOVERY


         DEPOSITS MINUS WITHDRAWALS = STRESS BALANCE

 

WITHDRAWALS

EXTERNAL STRESSORS

WORK STRESS
HOME STRESS
FINANCIAL STRESS
OTHER LIFE STRESSORS

INTERNAL STRESSORS

LOW SELF-ESTEEM
HOPELESSNESS
FREE FLOATING ANXIETY

DEPOSITS

EXTERNAL DE-STRESSORS

SLEEP & RELAXATION
EXERCISE
PLAY
GETTING AWAY FROM THE STRESSORS



INTERNAL DE-STRESSORS

CONFIDENCE
OPTIMISM
CAPACITY TO RELAX AND ENJOY


This approach is useful because it provides a better visual picture of the information that we described in our overall understandings of stress management. It causes people to think about life style changes to create a better balance between their ergotropic and trophotropic responses – but in a manner that is familiar to other parts of their lives.

People are often trapped in stressful life styles because they do not examine their own expectations about their energy outputs, and are conditioned to ignore internal, physical messages about the effects of this imbalance between response and recovery time.

The bank account analogy is quite effective in helping people to take stock of the real life consequences of their choices in using their energies. Whereas exhaustion and physical breakdown are amorphous and abstract concepts that are not easily quantified, running out of money and going into bankruptcy is something that is much more easily visualized.

This opens the door to a much more extensive investigation of how to create a workable balance in a person's life, and leads to the possibility of creating a good stress management program.

Stress tip #2: Reduce stress by keeping to a minimum the number of stressors that you have at any point in time.



Stress tip #3: Improve your stress by increasing the number of activities that allow you to relax and enjoy yourself. Don't deprive yourself of rest, relaxation and play.

The analogy is one that can be utilized to create a very detailed understanding of the principles behind stress management. The secret to good stress management is to keep your "balance" at the best place possible, just as it is in your finances.

You can improve your balance by keeping your "bills" low. This means you must have as few "bills" as possible, and avoid "bills" that are expensive. This reflects our principles of keeping the numbers of stresses down, and the intensity of the stresses low.

You can also improve your balance by having a greater number of "deposits". This is to say, the more things you do to create trophotropic responses - and move yourself into the response phase - the more "money" will be in your stress management bank account. Play time, especially involving laughter and fun, produces trophotropic responses. Relaxed exercise, and prayer or meditation, are also capable of producing trophotropic effects.



Stress tip #4: Improve your stress management by making sure you get enough sleep, which is the most successful activity of all in producing trophotropic effects.

The most productive of all trophotropic activities, of course, is sleep. Sleep is a complex restorative and regulatory mechanism essential to well being. Within the economy analogy we are using, sleep is the equivalent of your regular paycheck. It is the most dependable and most important of all trophotropic "deposits".

In fact, increasing the amount of sleep a person is getting is the first suggestion that should be made when helping a person manage stress.



Stress tip #5: Improve your stress by focusing on both decreasing your stressors and increasing your de-stressors.



Stress tip #6: Improve your stress management by approaching it in terms of doing many little things to decrease the stress and increase the rest and relaxation, not major things that are hard and disruptive to everyday life.

As in a real economy, it is much more effective in terms of stress management if a person both engages in activities that increase "deposits" and engages in activities that decrease "withdrawals".

There is another point at which the bank account analogy becomes useful in terms of creating change. Many people view stress management in terms of needing to make profound life changes that they are not prepared to make. Stress can be managed in a partial or continuous way, and the economic approach can translate this well.

It is not always possible to create significant increases in one's salary, or pay off all one's bills immediately. However, it is usually possible to create small increases in one's "deposits", and small decreases in one's "bills", and, over time, these improve one's overall balance.

Stress management operates in the same fashion. Relatively small improvements in the overall balancing of one's personal stress economy can create positive shifts that succeed in decreasing the negative effects of stress.



Stress tip #7: View stress as occurring in a vibrant, complex economy in which there is a virtually unlimited number of points of impact to improve the overall balance.


Stress tip #8: Improve your stress management by managing your stress economy well day to day, so you free up energy to handle things better and prepare your resources for the future. This is like interest in your economy.

From this analogy, one begins to see stress as something that can be handled in small increments in many different areas. Even minor increases in "deposits" or decreases in "withdrawals" can create some improvement in the overall balance.

This is not just useful as a paradigm for beginning the process of managing stress. This also creates an increased sense of control and mastery. It works to create a more comprehensive sense of how many resources are available to handle stress.

The usefulness of this analogy does not end there. For clients with the capacity to understand more complicated concepts, there are other ways to create understanding from this approach.

As in a financial economy, there are issues related to "interest". If a person handles his/her stress "economy" well, there will be more energy available to handle things. His/her focus and attention will be better. Work will get done more quickly and efficiently, leaving more time to play. He/she will likely be less grumpy, and better able to take care of important relationships.



Stress tip #9: Improve your stress management by avoiding periods of inefficiency, in which it takes more energy to perform tasks, leaving less time for rest and recovery. This is like interest against your economy.


Stress tip #10: Improve your stress management by not letting the stress mount too high when it can be avoided. For instance, don't take on any new stresses in periods when the stress is already high.

In short, there are advantages that come to a person who takes good care of his/her stress management. It is almost like having money in your bank account, for which you receive interest, giving you additional money to use in your personal economy.

Conversely, people under a lot of stress will usually work less efficiently. This means more time to perform tasks that may be stressful, leaving less time to play and take care of oneself. Relationships may be negatively affected by too much stress, causing - more stress. Plus, people may not sleep as well, because they are stressed out and worried. This is like interest that is paid on overdue bills, or credit cards. When you get behind in terms of stress management, it can become harder and harder to create a balance that works.

The final end point of this process of getting behind is the same in stress management as it is in finances: a point of increasing instability that results in a breakdown, a kind of emotional bankruptcy. In such instances, less and less flexibility is available to get the overall economy back on track.



Stress tip #11: If you start to get behind with stress, don't give up. Keep working at it. The less behind you get, the easier it is to pull yourself back up, and the sooner you will get back to a better place in terms of managing the stress.

Because life is complicated, it is not always possible to control events enough to avoid periods of high stress. In such times, people will often go into stress "debt". They will simply try to hold things together until the situation improves.

There are two important considerations here. The first is that you still want to practice good stress management decision making, even when you are in a period of overwhelming stress. It is much better to be only somewhat in "debt", than it is to be deeply in debt.



Stress tip #12: When things are bad, don't necessarily work harder to fix things. It may actually be more effective to play more to re-establish a better stress balance. This may free up energy to work better at reducing the stress.

Many people, in periods of extreme stress, attempt to reassert control by working non-stop to try to correct the problems. In so doing, they may completely ignore time to play and take care of themselves. Ultimately, this may be detrimental to bringing events under control, as the stress management imbalance spirals out of control.

It is sometimes far better to devote some measure of time to play and other forms of self-caretaking, in order to avoid the dangers of stress "bankruptcy".



Stress tip #13: When times are good, invest some time and energy into building your stress management resources and creating a better balance in preparation for more difficult times.


Stress tip #14: Don't procrastinate taking care of stresses that can be handled now. Like with bills, you may end up having to take care of them when your resources are at a depleted point.

The second point has to do with a larger issue with regard to stress management. The better prepared one is prior to a period of high stress, the more effectively one can weather the expenditures of energy required to handle challenges.

This means that stress management is better approached by making sure that the balance is in good shape day to day. If one is well rested and fully restored at all times, when the inevitable periods of high stress set in, one is in a good position to respond to the challenge.

It is therefore a wise idea to maintain a clear sense of how well one's balance is doing. If there are "bills" hanging over one's head - long-standing problems that are persistent sources of stress - it is advisable to take care of them in periods of relative calm. In this way, they won't be around to cause problems when the stress level is much higher.

This also ties into the "investment" approach to stress management. In periods where things are smooth, it is often useful to build one's resources. Resources include relationships, energies, skills, abilities, and other things which help manage stress.

People frequently approach stress management with a poor understanding of how many resources they have available to help manage stress. This is a key issue for several reasons.

First, people do not know where to focus their energies when it comes to building resources that will allow them to manage stress better. Second, people do not know where to turn for support and energy when they are in periods of increased stress.


Stress tip #15: Know what skills and resources are in need of work and improvement, so when you are ready to invest time and energy into improving them, you know where to start.



Stress tip #16: Don't focus on why you can't handle things. Work to have a better idea of all the resources you do have. This will allow you to handle challenges with more confidence and less stress.

Also, people who are not aware of the number of resources that are available tend to undervalue their own ability to handle stress. As we noted in an earlier section, we don't just look at external circumstances to determine how stressful an event is. We also evaluate our supply of available resources to handle the stress.

The clearer we are about how many resources we have, and how useful the resources will be, the less likely we will be to become overly stressed out about the challenge before us.


Stress tip #17: Count and keep track of all of your resources, including all the people and things that can be supportive and helpful to you. It is helpful and de-stressing to find out that your list is longer than you think.

As we become more aware of our pool of available resources, it helps us to see that the stress will be manageable. This means that during the response phase of the five stage stress response, the level of response will be less pronounced. This saves wear and tear on the body's energies.

On the pages that follow, you will find examples of the many different kinds of resources available to manage stress. Some resources are internal ones - housed in people themselves. Some are external - existing in the support systems around people.



Stress tip #18: Take care of your body by eating healthy foods, seeking good medical care, exercising to keep your body in shape, and not exceeding your capabilities. Your body is a great machine that will last a lifetime if you take care of it.

 

Stress tip #19: Take care of your emotional well-being by fixing anything that has been damaged emotionally, and creating sources of positive emotional energy in your life.


Stress Management Resources

INTERNAL

PHYSICALLY BASED

-Wellness
-Physical stamina
-Resistance to disease
-Mental clarity
-Tension self-monitoring & control

EMOTIONALLY BASED

-Self-confidence and optimism
-Sense of control
-Emotional vitality
-Ability to feel love
-Motivation for achievement


Stress tip #20: Find values that build a sense of purpose in your life and provide meaning to the tasks in which you engage. This will mean that the tasks restore and strengthen you, not drain and damage you.


COGNITIVELY BASED

-Flexibility and creativity
-Sense of mastery
-Cognitive restructuring
-Information seeking
-Avoidance or withdrawal
-Denial and suppression
-Structuring

VALUE BASED

-A sense of hope and fairness in life
-Spiritual groundedness
-Worthwhile, purposeful vision
-Commitment
-Goal and challenge orientation
-Resourcefulness

SKILL BASED

-Responsibility for self
-Communication skills
-Assertiveness skills
-Resourcefulness
-Other social and people skills
-Time management skills
-Organizational skills


Stress tip #21: Build relationships that support you, not drain you. Invite the people in your life to give you sources of love, nurturance and affection. Whenever possible, only invite positive relationships into your life, and work purposefully to avoid the negative.


Stress tip #22: Whenever possible, choose to work in positive environments, live in positive environments, contribute to the community in positive environments, and play in positive environments.


Stress Management Resources

EXTERNAL

FAMILY BASED

-Intimate bonds
-Sources of affection and love
-Sources of emotional support
-Sources of material support
-Sense of belonging
-Sources of reality testing and
grounding
-Sources of structure and limit setting

FRIENDSHIP BASED

-Intimate bonds
-Sources of affection and love
-Sources of emotional support
-Sources of material support
-Sense of belonging
-Sources of reality testing and grounding
-Sources of structure and limit setting

WORK BASED

-Sources of emotional support
-Sense of belonging
-Sense of direction and purpose
-Support for skill building
-Sources of reality testing and grounding
-Sources of structure and limit setting

COMMUNITY BASED

-Sources of material support
-Sense of belonging

AFFILIATIONS BASED

-Network affiliations
-Cultural identity


Some of the resources are shaped by forces outside our control. We do not get to choose our genetic equipment. Some of us are born with less resilient immune systems, less flexibility in our thinking, less sociable tendencies.

Likewise we do not get to choose the families into which we are born. Some families help their member to develop powerful resources to handle life's challenges. Other, less supportive families, may hinder the development of useful resources. Some families may even create such problems with their members' perceptual abilities that there is almost no awareness that resources exist.



Stress tip #23: Improve your stress management by correcting any perceptual disturbances that cause you to over-estimate the challenges or threats you face, or under-estimate the resources to handle the challenges or threats.


Stress tip #24: When you expend time and energy on building better skills to handle stress, work on the kinds of skills that will give you the best return for your efforts.

When perceptual disturbances exist at very deep emotional, or even instinctive, levels, it can make it very difficult for the person to utilize an awareness of his/her resources to keep the level of perceived stress under control.

In this way, the issues of stress management are at the heart of many therapeutic issues. One of the key features of successful psychotherapy, as well as of stress management, is a process of building and championing a person's resources, helping the client to have a clearer picture of the resources they have available to manage their real and imagined threats and challenges.

It is particularly important - in terms of stress management - to build and champion the particular sets of resources that represent a client's skills sets. While most skills will improve a person's resources for handling stress, there are several areas of skills that are especially important.

These skill areas are shown on the pages that follow. They will be skills that are familiar to most mental health clinicians. The final two skill sets will also lead to further discussion related to important concepts in stress management.



Stress tip #25: Spend some time learning how to organize. If you are organized, it takes less time to do the things you have to do, leaving more time to do the things you want to do.


Stress tip #26: Spend some time learning how to communicate better, so you can have more control over how well your relationships work out.


KEY STRESS REDUCING SKILLS

ORGANIZATIONAL SKILLS:

- Provides deep seated and positive sense of competence for handling challenging tasks
-Reduces time spent handling tasks, thus time spent in response mode
-Time management is a specific kind of organizational skill

COMMUNICATION SKILLS:

- Reduces stress in your interactions with other people
- Improves ability to develop and maintain sources of support and nurturance
-Different sets of skills needed for a variety of situations: negotiation, conflict management, asking for what you want, assertiveness, relationship building



Stress tip #27: Spend some time getting better at being assertive. If you learn how to be more assertive, you can stop people from making you do things you don't want to do that stress you out, and prevent people from taking away your play time.


Stress tip #28: Spend some time improving your thinking skills, so you can see things more clearly, and not become your own worst enemy through unnecessary negativity and pessimism.

ASSERTIVENESS SKILLS:

- Involves psychological components, as well as communication skill components: confidence, self-respect, anxiety management
-Assertiveness skills include setting good boundaries with other people, asking for what you want, standing up for yourself in conflict, not allowing others to take advantage of you
-Confidence in your assertiveness capacities decreases your anxiety in a wide variety of interpersonal situations

THINKING SKILLS:

- Positive thinking to improve your sense of your own resources for handling challenges
- Thought stopping to redirect negative thinking
- Self-affirmations to decrease self-esteem challenges
- Focused self-talk to aid perceptual/evaluatory skills


Stress tip #29: Take charge of your ergotropic and trophotropic responses by improving cognitive perceptual and evaluatory skills, and increasing your capacity to control relaxation.



PERCEPTUAL/EVALUATORY SKILLS:

- Involve a capacity to clearly see the level of stress response that will be required to handle a challenge, opportunity or threat
-The primary point of entry into improving these skills sets will be cognitive and conscious in nature, however, cognitive/behavioral techniques, and experiential therapy approaches, such as body work, systematic desensitization and bio-feedback, can target perceptual/evaluatory problems at deeper levels of the brain
-Are essential for decreasing ergotropic over-response

RELAXATION SKILLS:

- Deep breathing, visualization, meditation or prayer
- Systematic desensitization, bio-feedback, body work all work to develop stronger trophotropic responses
- Repeated use of relaxation skills develops ability to turn on your body's trophotropic responses at will
-The more practiced you become, the more quickly you can turn on the relaxation response

The development of better perceptual/evaluatory skills is one important key to being able to slow down ergotropic responses.The development of relaxation skills is concerned with increasing the brain's capacities to set in motion trophotropic responses. Particularly if there are stresses than can't be avoided, the ability to create relaxation - and periods of recovery - is essential to keeping better balance.

There are many models of psychotherapy that utilize skill building as an important component of change. However, as most clinicians have experienced, resistance is a frequent result of attempts to encourage our clients to engage in skill building in new areas. The resistance can come from the degree of work that is required to build a new skill (called process resistance) or from the anticipation of how the acquisition of a new skill will lead to a changed self (called outcome resistance).

When skill building is presented in the context of a client’s identified problems, it can be perceived by the client as more threatening in terms of outcome resistance. It requires the client to visualize the skill sets as being directly connected to the change sought, meaning that the skills become associated with the distress of the primary symptoms and whatever those symptoms mean to the client in terms of self-image and self-esteem.

However, if that same skill set is introduced to the client as a simple tool for reducing stress and facilitating better stress management, it changes the quality of the skill building work. This may allow the clinician to introduce some of these important interpersonal effectiveness skills to clients in a more normalized manner.

These last two skill areas are concerned with internal approaches to working with the six principles of stress management. This is the subject of our next section. First, however, we will do stress exercise number four.


Stress exercise #4

Do an informal assessment of your stress management "bank account". How well do you manage to keep enough de-stressing activities in your schedule to keep up with the number of stresses you have? Be sure to include use of all of your resources for handling stress.


Review Questions for Section VII

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

What is the essential concept behind the bank account approach to stress management and how can this be helpful for clients visualizing their stress management?

In the hierarchy of things that help to manage stress, where does adequate sleep fit in?

What are the key stress reducing skills that were mentioned in this section?

 

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