1

Managing Stress and Developing Resilience

Introduction Common Triggers

Statistics Aims of Resilience Training

Anatomy of Stress Physical Reaction (fight of flight)

Identifying Signs and Symptoms

Personal signs scale (self-scoring exercise)

Positive Coping Strategies

Sleep Causes of sleep disturbances Skills for getting a good night sleep

Utilising Down time Diary keeping exercise

Skills for leaving work at work

Alcohol Consumption Relaxation Techniques

Deep Relaxation Resources

2

INTRODUCTION

Aims of Stress Management

ü Find relief from tension, anxiety & fatigue

ü Develop resilience to deal with everyday problems

ü Be emotionally stronger

ü Stay healthy and avoid disease

ü Improve concentration

ü Be more positive

ü Be more tolerant

ü Get more out of life

ü Stay motivated to enhance performance

3

WHAT IS STRESS?

Stress is different things to different people. To the bungie jumper it is the excitement or fear of pushing outside comfort zones to jump off a tall building or bridge on a piece of elastic rope. To the driver who is late for a meeting it can be the hassles of heavy traffic or changed traffic conditions. To the data entry person it can be the monotony of repeating the same task over and over again. However it is not the action of jumping off a building or the changed traffic conditions or repeating the same task over and over again that causes stress. How we think about events and react to them determines how stressful they are. We can say that the degree of stress we end up with depends a great deal on the meaning that we attach to our experiences. Negative stress results from failure to adequately cope with stressors. Stressors could be changed traffic conditions, unrealistic deadlines, debts, difficult relationships, pain, a telephone that continually rings, equipment that keeps breaking down or a thousand other things that impact upon us in the normal course of life.

Due to the ever changing and unpredictable world we live in it is impossible to avoid stressors. The only totally stress-free state is death. Although we are often unable to control many of the stressors in our environment, we are able to develop and utilise skills so we cope better and stress does not reach harmful levels. Our ability to cope with stressors often determines the amount of stress that we will experience. The Anatomy of Stress

The Fight or Flight Response:

The fight or flight response refers to the physical reaction that is automatically triggered when the stress response is activated. It is activated through our thoughts and feelings and will respond to any stimulus that ‘pushes our buttons’. It is our reaction to perceived demands or pressures placed upon us, and can be both positive and negative.

The fight or flight response was appropriate for our hunter-gatherer ancestors. The chemicals released by this reaction enabled them to trigger ‘fight or flight’ responses to the perils and pleasures of hunting. However the stressors of the high-tech lifestyle we live in today are a far cry from the stressors of our ancestors.

4

How does the body react to stress? Once a threat is perceived, the body automatically reacts by diverting blood to the major muscle groups, in the legs and arms, to assist the ‘fight or flight’ response. The following signs and symptoms follow:

- Elevated heart rate - Panicky breathing - Muscles feel tense - Sight becomes acute (Attentional narrowing) - Nausea and stomach cramps - Feelings of lightness and speed - Surge of energy - Cold hands and feet - Concentration improves (in the short term) - We need to go to the toilet - We feel excited

The Brain:

- The Cerebral Cortex, the main site of so-called ‘higher’ cognitive functions, is involved in attention and thought, voluntary movement, decision making, planning, problem solving and language.

- The Limbic system is a group of brain structures and is an important element of the body’s response to stress

The Nervous System:

- Sympathetic nervous system (SNS) is responsible for stimulating activities associated with ‘fight or flight’, the ‘accelerator’ of the nervous system

- Parasympathetic nervous system (PSNS) is responsible for ‘rest and digest’ activities, the ‘decelerator’ of the nervous system

The Vagus Nerve:

- The largest nerve in the body - Activation of the Vagus Nerve can stimulate the PSNS and lessen the

effects of the ‘fight or flight’ response

5

HOW DO WE RECOGNISE STRESS IN OURSELVES? Physical Signs Directions: Please respond to each of the following statements. Mark a number in each column that best describes how frequently you have experienced the following symptoms in the last 30 days. Frequently = 3 or more times per week. Occasionally = weekly. Rarely = less than once per week. Score all items. F R E Q U E N T L Y

O C C A S I O N A L L Y

R A R E L Y

N O T F O R 3 0 D A Y S

3 2 1 0 Suffer from frequent headaches or migraines 3 2 1 0 Often feel fatigued or worn out 3 2 1 0 Have difficulty falling asleep.

If awakened find it difficult to fall asleep again. 3 2 1 0 You pant or your breathing is panicky 3 2 1 0 Lump in throat, difficulty swallowing 3 2 1 0 Experience digestive upsets 3 2 1 0 Recurrent and persistent stomach ulcers 3 2 1 0 Fail to get adequate exercise 3 2 1 0 Grind your teeth 3 2 1 0 Excess gas or heartburn 3 2 1 0 Constipation 3 2 1 0 Experience episodes of diarrhoea 3 2 1 0 Frequently catch colds or flu 3 2 1 0 Drink more than 4 cups of tea of coffee per day 3 2 1 0 High blood pressure 3 2 1 0 Suffer from chest pains 3 2 1 0 Experience tension in back of neck or head 3 2 1 0 Suffer from dizziness, light headedness or faintness 3 2 1 0 Often take sleeping pills or tranquillisers 3 2 1 0 Hot & cold spells or excessive perspiration 3 2 1 0 Get sick during first week of holidays

6

Behavioural & Performance Signs of Stress Directions: Please respond to each of the following statements. Mark a number in each column that best describes how frequently you have experienced the following symptoms in the last 30 days. Frequently = 3 or more times per week. Occasionally = weekly. Rarely = less than once per week. Score all items. F R E Q U E N T L Y

O C C A S I O N A L L Y

R A R E L Y

N O T F O R 3 0 D A Y S

3 2 1 0 Difficulty getting to sleep or staying asleep. 3 2 1 0 Often feel fatigued or worn out, sleep not restorative 3 2 1 0 Mental disorganisation, difficulty concentrating, forgetting

things 3 2 1 0 Multi-tasking inefficiently; too many things on the go 3 2 1 0 Missing deadlines, meetings, appointments 3 2 1 0 Work piles up; quality breaks down 3 2 1 0 Avoidance of certain situations or people 3 2 1 0 Calls not returned 3 2 1 0 Absences; increased sick days 3 2 1 0 Increased intake of alcohol, drugs or food 3 2 1 0 Lash out at others 3 2 1 0 Experience low libido 3 2 1 0 Make negative statements about self and others 3 2 1 0 Not engaging in hobbies 3 2 1 0 Don’t introduce new innovations into your work 3 2 1 0 Don’t express your feelings through creative outlets 3 2 1 0 Hardening of stances on touchy issues.

7

Relationship & Emotional Signs of Stress Directions: Please respond to each of the following statements. Mark a number in each column that best describes how frequently you have experienced the following symptoms in the last 30 days. Frequently = 3 or more times per week. Occasionally = weekly. Rarely = less than once per week. Score all items. F R E Q U E N T L Y

O C C A S I O N A L L Y

R A R E L Y

N O T F O R 3 0 D A Y S

3 2 1 0 Frightening dreams 3 2 1 0 Cynical, hostile or rigid attitudes to work or other

circumstances 3 2 1 0 Reduced tolerance; inability to see both sides of an issue 3 2 1 0 Marked mood swings 3 2 1 0 Often feeling anxious 3 2 1 0 Unhappy with life: finding fault: irrational blaming 3 2 1 0 Experience little joy 3 2 1 0 Feel angry 3 2 1 0 Criticise yourself, your abilities and your achievements 3 2 1 0 Withdraw from friends and lover 3 2 1 0 Low libido 3 2 1 0 Avoid social situations and commitments 3 2 1 0 Talk only about problems 3 2 1 0 Feel that life is pointless A score above 25 on the Physical Scale indicates a stress management plan needs to be implemented. It is recommended that exercise be a part of this program. A physical check from your GP is recommended. A score above 20 on the Behavioural & Performance Scale indicates a stress management plan needs to be implemented. Breathing & relaxation techniques are recommended as well as exercise. It may also be useful to see a psychologist. A score above 15 on the Relationship & Emotional Scale indicates a stress management plan needs to be implemented. It may be useful to see a psychologist.

8

Identifying Personal triggers A trigger is a particular event that causes you to have a stressful thought thus activating your stress response. Read through this list and mark any events that you find ‘stressful’. Then choose your 3 most common stress triggers. Please feel free to add to the list. Office gossip Missing out on a promotion

Constant telephone interruptions Saying ‘yes’ when you mean ‘no’

Colleagues who leave the phone to ring Not getting a chance to have a break

Drawn out meetings where no solutions seem in sight

Having to give up social engagements due to workload

Meetings scheduled outside normal office hours.

Having to miss work due to illness

Meetings with no agenda Disagreeing with a colleague

Rude clients Restructure of your department

Inconsistent policy & procedures Making a presentation

International travel Making a mistake

Files going missing Feeling criticised

Changes in your schedule Heavy traffic

Too many tasks to complete, feeling snowed under

Crowded public transport

Reduction in time with family due to travel & working hours

Someone using your desk & computer while you are away

Deadlines Financial difficulties

Being late for an appointment Arguing with partner

Someone else being late Difficulty with children

Colleagues being unavailable

Colleagues not responding to emails

Answering emails

Others not doing what they say they will do

Stupid questions

Computer / system problems

9

Stress Buster Tips

1) Exercise – Regular exercise increases both serotonin and dopamine, and affects other important systems as well. Generally speaking, the more the better (unless you spend all day at the gym). The role of exercise for both physical and mental health has been well established. Consider realistic ways of incorporating regular exercise into your life. Set yourself manageable goals. To help with motivation, find an exercise buddy with whom to workout.

2) Relaxation / Meditation – The body’s natural relaxation response is a

powerful antidote to stress. Relaxation techniques such as deep breathing, visualization, progressive muscle relaxation, meditation, and yoga can help you activate this relaxation response. When practiced regularly, these activities lead to a reduction in your everyday stress levels and a boost in your feelings of joy and serenity. True relaxation calms the mind and allows you to switch off from your concerns and worries of daily life.

3) Sleep – Various hormonal changes are needed for healthy

development and cellular growth happens when you sleep. Quality sleep is important for the production of many chemicals and memory consolidation.

4) Laughter – There is research to suggest that laughter can cause

physiological changes in your body. There is a reduction in cortisol, a chemical that indicates stress in the body, and an increase in mood elevating endorphins. Laughter is also thought to improve circulation, stimulate the nervous system, heighten the immune system, and make the heart stronger.

5) Sex – Recent studies have found that sexual intercourse can result in

lower baseline blood pressures, less of a blood pressure rise during stressful events, or both. These findings suggest that having sex can lead to less of a stress response during challenging situations, which is a good thing.

6) Sunshine – There is evidence to suggest that morning sunlight

increases the level of melatonin in your bloodstream at night, which induces sleep, and also increases the level of serotonin (“Sunshine on my shoulders makes me happy....”).

10

Sleep

People who suffer from the most common sleep disorder, insomnia, have difficulty falling or staying asleep. Sleepiness caused by insomnia reduces concentration and slows reaction time during waking hours, leading to reduced productivity and accidents. One in three adults experience some degree of insomnia or sleep problems at one time in their life, especially during periods of stress. Poor sleep is characterised by:

• Being unable to fall asleep within 30 minutes of trying • Being awake and unable to sleep for more than 30 minutes

during the night, including waking up very early and not being able to go back to sleep

• Restless sleep with many brief awakenings • Sleep for a nightly total of less than six and a half hours.

Common causes of sleep disturbances

§ Stress § Poor sleep habits § Using your bed for other activities § Sleeping drugs. § Eating or drinking § Heart Burn § Temperature § Pain or disease § Depression

Avoid poor sleep habits by developing a nightly routine

• Try to implement a regular nighttime routine before going to

sleep. This should condition your body into recognising the cues for winding down and preparing for sleep.

• Try to go to bed and get up at the same time each day • Limit activities (sleep and sex) in bedroom and don’t allow any

screens (television, tablets, computers, phones) • Avoid having naps during the day if you have a sleep problem.

List writing

- Before going to bed write a list of all the issues you are likely to

worry about once in bed. This will create brain space so you are able to wind down and forget your problems.

- If you are someone who comes up with great ideas in bed, keep a pad and paper beside the bed.

11

Sleeping medication

- One of the most common causes of insomnia is the use of sleeping medication. These drugs treat a symptom but do nothing to alleviate the underlying problem.

- Keep sleeping drugs to a minimum - Avoid using sleep drugs on a regular basis - If you think you may be using too many sleep drugs talk with your

doctor. Eating and drinking What you eat and drink during the day and especially at night can effect the time it takes to fall asleep and the quality of sleep.

• Rich and spicy foods are not recommended within 3 hours of going to bed.

• Limit coffee and tea to 3 cups per day and do not drink coffee within 3 hours of going to bed.

• Keep alcohol consumption to within the recommended safer limits

• Do not smoke cigarettes • Try to exercise during the day but not within 3 hours of going to

bed. Pain or disease If pain or disease is causing insomnia discuss it with your doctor. Depression If you are feeling depressed and unable to sleep see a doctor or a psychologist.

12

Balancing your lifestyle Some ways of utilising down time and leaving work at work

• Before leaving the office write a list of unfinished business

• Make a plan for the following day with realistic goals and realistic time frames allocated to each task

• Recognise what you did achieve throughout the day

• Debrief before leaving the office

• Do not take work home with you: Work stays at work

• Make a plan of evening activities

• Shower and/or change your clothes

• Set limits about discussing work issues

• Re-train your mind • Have regular breaks during the day so stress levels do not reach

dangerous levels • If you think of an idea outside work hours, phone your office

answering machine and leave a reminder message for yourself. It is essential to provide yourself with frequent rewards for your achievements and efforts. Plan at least one reward each week. If you work from home:

• Have a specific space in the house dedicated to work, with a door that can be closed

• Get dressed for work each day • Keep strict hours and have scheduled breaks • Do not allow work to spill out into the living area of your home • Have a separate phone line for the office

Recommended safe levels of alcohol consumption: (Australian Department of Health and Ageing) Men: 2 Standard drinks per day with 2 alcohol free days per week. Women: 2 standard drinks per day with 2 alcohol free days per week.

13

WHERE TO GO IF THE GOING GETS TOUGH Your Human Resource Department (if you have one) is always a good place to get advice if you are experiencing difficulties in your work place. All Sydney based hospitals have various free counselling services that you can attend for up to 6 sessions. These counselling services offer grief counselling, alcohol and other drug services, quit smoking counselling and critical incident debriefing. The Alcohol & Drug Information Service is a 24-hour advice, information & referral telephone line. Sydney (02) 9361 2111 Country (1800) 422 599. Community Health Centres in every capital city offer up to 6 sessions free counselling for a range of issues. Darlinghurst Community Health Centre: (02) 9361 1111 Anxiety Disorders Unit, Darlinghurst Sydney. (02) 9361 2100 Clinic for Anxiety & Traumatic Stress, Bankstown. (02) 9722 8992 Sleep Disorders Unit, Royal Prince Alfred Hospital (02) 9231 2251 The Australian Psychological Society will refer you to a Registered Psychologist in your area. www.psychology.org,.au (03) 990 66504. Health Initiatives: Health Initiatives has a number of registered psychologists available for counselling. Venues are based around the CBD. Contact Annie Ross on 0414 457 638. Reid Wilson Consulting: Marina Reid Wilson is a highly experienced and Registered Psychologist, Coach and Mindfulness Trainer. Contact Marina at marina@reidwilson.com.au or 0429 020 171. Suggested Reading The Less Stress Book, David Winseborouh & Kay Allen, 1998, A Choice Book, 57 Carrington Road Marrickville NSW. You And Stress, Bob Montgomery,1995, Penguin Books Australia, Ringwood Australia. Instant Calm, Paul Wilson, 1995, Penguin Books Australia, Ringwood Australia. The Calm Technique, Paul Wilson, 1985, Greenhouse Publications, 385 Bridge Road Richmond Victoria Australia. After the Ball is Over, Dr Richard Gates & Robin Hammond, 1999,University of New England Press, Beardy St Armidale. The Promise of Sleep, William C. Dement & Christopher Vaughan, 1999, Macmillan, Kent, Great Britain.