Stress Management: Techniques for Cancer Survivors · Tips for a stress-free holiday ... Sit in a comfortable position. 2. Place one hand on your chest and the other on your stomach,

Stress Management: Stress Management: Techniques for Cancer Techniques for Cancer

SurvivorsSurvivors

Samantha Burns Artherholt, PhDSamantha Burns Artherholt, PhDFred Hutchinson Cancer Research CenterFred Hutchinson Cancer Research Center

Seattle Cancer Care AllianceSeattle Cancer Care Alliance

What IWhat I’’ll talk aboutll talk about

What is stress?What is stress?

Stress management and copingStress management and coping

Tips for the holidaysTips for the holidays



The physical, mental, or emotional tension The physical, mental, or emotional tension experienced in reaction to an eventexperienced in reaction to an event

Adapted from Dr. Bonnie McGregor, Fred Hutchinson Cancer ResearcAdapted from Dr. Bonnie McGregor, Fred Hutchinson Cancer Research Centerh Center


Typically experienced when we perceive Typically experienced when we perceive demands exceeding our resourcesdemands exceeding our resources

ResourcesDemands



DemandsResources

Typically experienced when we perceive Typically experienced when we perceive demands exceeding our resourcesdemands exceeding our resources

The Fight or Flight ResponseThe Fight or Flight Response

Hormones released and help us run and fightHormones released and help us run and fight Increased heart rate and blood pressureIncreased heart rate and blood pressure

Delivers more oxygen and blood sugar to important Delivers more oxygen and blood sugar to important musclesmuscles

Increased sweating to cool these musclesIncreased sweating to cool these muscles Blood diverted away from the skin to the core of Blood diverted away from the skin to the core of

our bodiesour bodies Reduces blood loss if we are injuredReduces blood loss if we are injured

Attention is focused on the threatAttention is focused on the threat Significantly improves our ability to survive lifeSignificantly improves our ability to survive life--

threatening eventsthreatening events


Stress is a matter of judgmentStress is a matter of judgment Must make two main judgments:Must make two main judgments:

Must feel threatened by the situationMust feel threatened by the situation

Must doubt that their capabilities and resources are Must doubt that their capabilities and resources are sufficient to meet the threat sufficient to meet the threat

Just as with real threats to our survival, Just as with real threats to our survival, perceived threats trigger the full fightperceived threats trigger the full fight--oror--flight flight responseresponse Excitable, anxious, jumpy and irritableExcitable, anxious, jumpy and irritable

Reduced ability to work effectively with other peopleReduced ability to work effectively with other people

AccidentAccident--prone and less able to make good decisionsprone and less able to make good decisions

Is all stress bad?Is all stress bad?


Effects of chronic stressEffects of chronic stress Increased vulnerability to common coldIncreased vulnerability to common cold Slower wound healingSlower wound healing General decrements in immune function General decrements in immune function High blood pressure and high cholesterolHigh blood pressure and high cholesterol Heart disease Heart disease Weight gain (central fat storage)Weight gain (central fat storage) Poor control of blood sugar among diabeticsPoor control of blood sugar among diabetics Poor health behaviors Poor health behaviors (e.g., diet, smoking, no exercise)(e.g., diet, smoking, no exercise)

Shortened telomeres and telomerase activityShortened telomeres and telomerase activity DNA damage and poor repairDNA damage and poor repair

Managing StressManaging Stress


How can we manage stress?How can we manage stress?

ResourcesDemands

Decrease perceived demandsDecrease perceived demands Increase perceived resourcesIncrease perceived resources

The five RThe five R’’s of managing stresss of managing stress

1.1. Recognize the signs of stress Recognize the signs of stress

2.2. Reappraise the situationReappraise the situation

3.3. RespondRespond

4.4. RelaxRelax

5.5. RejuvenateRejuvenate


1. Recognize the symptoms of stress1. Recognize the symptoms of stress

WithdrawalWithdrawalNeck AchesNeck AchesPhysical WeaknessPhysical WeaknessFearsFearsInsomniaInsomniaIrritabilityIrritabilityChronic DiarrheaChronic DiarrheaDrinking/Drug UseDrinking/Drug UseLow Self EsteemLow Self EsteemDepressionDepressionAppetite ChangesAppetite ChangesSleeping DifficultiesSleeping DifficultiesPoor ConcentrationPoor ConcentrationMuscle SpasmsMuscle SpasmsConstipationConstipationUlcersUlcersIndigestionIndigestionBackachesBackachesMuscle TensionMuscle TensionHeadaches Headaches Irritable BowelIrritable BowelResentmentResentmentAngerAngerHostilityHostility


Stressful situation

cognitive

emotional

behavioralphysical

social

Effects of stressEffects of stress


2. Reappraise the situation2. Reappraise the situation Notice your selfNotice your self--talktalk

Overly negative:Overly negative: ““My back hurts. The cancer has spread! There will My back hurts. The cancer has spread! There will

be nothing my doctors can do this time.be nothing my doctors can do this time.””

Overly positive:Overly positive: ““My back hurts. If I ignore it, it will go away.My back hurts. If I ignore it, it will go away.””

Balanced:Balanced: ““My back hurts. I may have pulled a muscle. I My back hurts. I may have pulled a muscle. I

should make an appointment and have my doctor should make an appointment and have my doctor check it out.check it out.””

Other types of negative thoughtsOther types of negative thoughts

All or nothing thinking (black and white All or nothing thinking (black and white thinking)thinking)

OvergeneralizationOvergeneralization

Disqualifying the positiveDisqualifying the positive

Jumping to conclusions (fortune telling) Jumping to conclusions (fortune telling)

Magnification or minimizationMagnification or minimization

““ShouldShould”” statementsstatements


Be aware of your negative Be aware of your negative thoughts, so you can change themthoughts, so you can change them Challenge the overly negative thoughtsChallenge the overly negative thoughts

How accurate is this belief?How accurate is this belief? What would you say to a friend going through this What would you say to a friend going through this

same situation?same situation? What is the evidence for or against this thought?What is the evidence for or against this thought? What is the worst thing that could happen? What is What is the worst thing that could happen? What is

the best?the best? What are some things you can think about or say to What are some things you can think about or say to

yourself to make yourself calmer? yourself to make yourself calmer?

Aim for balanced, rational thinkingAim for balanced, rational thinking


3. Respond to the situation3. Respond to the situation Coping and controlCoping and control

EmotionEmotion--FocusedFocused

ProblemProblem--FocusedFocused

When the storm will When the storm will arrive arrive How much snow How much snow there will bethere will be

Stocking up on Stocking up on suppliessuppliesPreparing your car Preparing your car and your homeand your homeChanging work or Changing work or travel planstravel plans

A winter storm A winter storm warning has warning has been issuedbeen issued

UncontrollableUncontrollableControllableControllableExample:Example:


Coping techniquesCoping techniques

ProblemProblem--focusedfocused Information Information

seekingseeking Goal settingGoal setting Conflict resolutionConflict resolution Asking for helpAsking for help

EmotionEmotion--focusedfocused Reappraisal of the Reappraisal of the

situationsituation Reframing thoughtsReframing thoughts ExerciseExercise Relaxation Relaxation

exercisesexercises Talk with friendsTalk with friends

4. Relax4. Relax

Once you recognize how you show stress, Once you recognize how you show stress, catch it early and learn to relax.catch it early and learn to relax. Diaphragmatic Breathing/CALM exerciseDiaphragmatic Breathing/CALM exercise

Progressive Muscle RelaxationProgressive Muscle Relaxation

ImageryImagery

MeditationMeditation

5. Rejuvenate!5. Rejuvenate!

Exercise Exercise YogaYoga Fresh airFresh air Social supportSocial support HobbiesHobbies Get enough restGet enough rest Eat a balanced diet Eat a balanced diet

and drink plenty of and drink plenty of waterwater

Stress and the holidaysStress and the holidays

Adapted from the Mayo ClinicAdapted from the Mayo Clinic

Recognize holiday triggersRecognize holiday triggers Relationships Relationships

Tensions are often heightened during the holidays Tensions are often heightened during the holidays Family misunderstandings and conflicts can intensify Family misunderstandings and conflicts can intensify Facing the holidays without a loved one Facing the holidays without a loved one

FinancesFinances Increased spending for gifts, travel, food and Increased spending for gifts, travel, food and

entertainmententertainment Physical demandsPhysical demands

Extra shopping and socializingExtra shopping and socializing Exercise and sleep may take a back seat to chores Exercise and sleep may take a back seat to chores

and errandsand errands Exhaustion increases your stressExhaustion increases your stress More susceptible to colds and other illnessesMore susceptible to colds and other illnesses

Adapted from the Mayo ClinicAdapted from the Mayo Clinic

Tips for a stressTips for a stress--free holidayfree holiday

Acknowledge your feelings Acknowledge your feelings Reach out Reach out Be realisticBe realistic Set aside differences Set aside differences Stick to a budgetStick to a budget Plan aheadPlan ahead Learn to say noLearn to say no Don't abandon healthy habits Don't abandon healthy habits Take a breatherTake a breather Seek professional help if you need itSeek professional help if you need it

New evidence that dark chocolate helps New evidence that dark chocolate helps ease emotional stressease emotional stress

J. Proteome Res., Article ASAPDOI: 10.1021/pr900607v

Publication Date (Web): October 7, 2009Copyright © 2009 American Chemical Society

Questions?Questions?

Adapted by Jeff Reiter, PhD

Diaphragmatic Breathing Exercise

1. Sit in a comfortable position. 2. Place one hand on your chest and the other on your stomach, in

order to monitor your diaphragmatic breathing (only your stomach should move.).

3. Inhale deeply and slowly (approximately 4 seconds) through your

nose. 4. Exhale deeply and slowly (again approximately 4 seconds) through

your mouth, allowing the air to fully escape. 5. Continue this deep breathing for 30 to 60 seconds. 6. Practice this at least once a day, but especially at times when

you feel yourself becoming stressed. ** It is normal for this healthy breathing to feel a little awkward at first. With practice, it will become more natural for you.

The CALM Reminder Chest: Breathe slower and deeper Arms: Shoulders and arms sag Legs: Loose and flexible Mouth: Jaw drops

Adapted by Jeff Reiter, PhD

PROGRESSIVE MUSCLE RELAXATION

Both diaphragmatic breathing and the CALM exercise are excellent for breaking up stress when it starts to occur. Sometimes, however, they do not produce the deep level of relaxation that is desired. Other times, they are insufficient for breaking up stress (e.g., when it is very intense). For such occasions, progressive muscle relaxation (PMR) can be quite helpful. It requires more time and a quiet environment, but the results can be very worthwhile!

PMR involves tensing a specific muscle group to about 1/3-2/3 maximum tension for 4-5 seconds, followed by a complete release of tension for 45-60 seconds. The muscle group is then tensed again, followed by release again. After completing both cycles, the next muscle group is indulged. The muscles involved, and the manner of tensing them, are presented below:

1. Both legs: Lift both legs off the ground, straighten your knees and point your toes toward your head.

2. Chest: Take a very deep breath (through the upper chest, not the diaphragm) and hold it.

3. Both arms: Turn your palms up, then make a fist. Bring your fists up to your shoulders while tensing the biceps.

4. Abdomen: Tighten these muscles as if you were about to be hit in the stomach.

5. Shoulders: Lift both shoulders up toward your ears.

6. Back of Neck: Tuck in and lower your chin toward your chest.

7. Forehead: Raise your eyebrows.

8. Eyes: Squint.

Documents

Stress Management: Techniques for Cancer Survivors · Tips for a stress-free holiday ... Sit in a comfortable position. 2. Place one hand on your chest and the other on your stomach,