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STRESS MANAGEMENT GROUP

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ANITA PINDIUR

Stress Management Group

Anita Pindiur

07-17-2013


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Six (6) week didactic and in-vivo exercise

2 hour group

1hour of yoga, Pilates, Eurothmy, Tai Chi, etc..

1 hour of didactic education


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Curriculum

Week One Good Stress Vs. Bad Stress

Week Two Anger Management

Week Three Food, Diet and Stress

Week Four Unplug, De-clutter and Organize

Week Five Mental Health, Medication, Meditation

Week Six Positive vs. Negative Coping with Stress


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Group Rules

Be Relaxed and Happy

Have fun

Embrace new ideas

Try something new

Push yourself, but be respectful of your body

Others as applicable to organization

(WBI; no alcohol/drugs/gambling, no weapons, no

threats of or violent behavior)


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Group Suggestions

Keep the group fun and casual

Defer topics of trauma, severe mental health,

problem gambling or substance abuse to appropriate

group

If possible and budget allows bring in props

(i.e. food, stress toys, cd’s with relaxing

music, etc.)

If a person needs to leave group, have a pre-discussed

safe place, plan of action, and time to return.


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Take the stress assessment


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Stress is a person's response to a stressor such as

an environmental condition or a stimulus. Stress

is a body's way to react to a challenge. According

to the stressful event, the body's way to respond

to stress is by sympathetic nervous system

activation which results in the fight-or-flight

response. Stress typically describes a negative

condition or a positive condition that can have an

impact on a person's mental and physical well-

being - Wikipedia


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The term stress had none of its contemporary connotations before the 1920s. It is a form of the Middle English destresse, derived via Old French from the Latin stringere, "to draw tight."[1] The word had long been in use in physics to refer to the internal distribution of a force exerted on a material body, resulting in strain. In the 1920s and 1930s biological and psychological circles occasionally used the term to refer to a mental strain or to a harmful environmental agent that could cause illness. Walter Cannon used it in 1926 to refer to external factors that disrupted what he called homeostasis.[2] But "[...] Stress as an explanation of lived experience is absent from both lay and expert life narratives before the 1930s".[3]

Homeostasis is a concept central to the idea of stress. In biology, most biochemical processes strive to maintain equilibrium, a steady state that exists more as an ideal and less as an achievable condition. Environmental factors, internal or external stimuli, continually disrupt homeostasis; an organism’s present condition is a state in constant flux moving about a homeostatic point that is that organism’s optimal condition for living. Factors causing an organism’s condition to diverge too far from homeostasis can be experienced as stress. A life-threatening situation such as a physical insult or prolonged starvation can greatly disrupt homeostasis. On the other hand, an organism’s effortful attempt at restoring conditions back to or near homeostasis, often consuming energy and natural resources, can also be interpreted as stress. In such instances, an organism’s fight-or-flight response recruits the body's energy stores and focuses attention to overcome the challenge at hand.

The ambiguity in defining this phenomenon was first recognized by Hans Selye (1907-1982) in 1926. In 1951 a commentator loosely summarized Selye's view of stress as something that "…in addition to being itself, was also the cause of itself, and the result of itself."[4][5] First to use the term in a biological context, Selye continued to define stress as "the non-specific response of the body to any demand placed upon it". As of 2011 neuroscientists such as Bruce McEwen and Jaap Koolhaas believe that stress, based on years of empirical research, "should be restricted to conditions where an environmental demand exceeds the natural regulatory capacity of an organism".[6] Despite the numerous definitions[which?] given to stress, homeostasis appears to lie at its core.

• Wikipedia


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Stats and Data

75% of people experience stress 2x per month

50% of those, have “high” levels of stress 2x per month

In the last two decades the report of work stress has gone

up X 4.

25% of drug prescription in the U.S.A are for treatment of

stress


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Week One

Good Stress Vs. Bad Stress


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Positive/Eustress/Good Stress

Motivation

Pushing factor

Need or desire to succeed

Passion

Joy

Love


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Life with no stress

Boring and Dull

Unhappy

Rudderless


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Stress is only bad

In large dosage

And chronic


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Examples of Good Stress

Wedding

Child (birth, and parenting)

Performance (fun activity, recital)

Roller coaster


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What do you feel with good Stress

Pulse quickens

Feel exited

Hormones change

No or little threat or fear


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Good Stress can turn to Bad Stress

Motivation to compulsion

Fun activity to chore

Overwhelming, no more fun, to much, now its

creating pressure not joy


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Gambling as a Good Stressor

Gambling start out as a fun activity

To socialize

To win =joy=good story

Adrenaline rush – good stress

Playing for fun, not money


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Gambling as a Bad Stressor

Playing to win to recoup loses

Highs and Lows when playing

Becomes a need not an activity

No more socializing

No more fun


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Good Stress when Gambling

Used to reduce “stress”

Used to enjoy time with others

Used to enhance life

Used in balance


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Bad Stress when Gambling

Causing “Stress”

Owing money

Lies and secrete keeping

Not taking care of self due to gambling

No balance in life


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Symptoms of Chronic or Bad Stress Headache

Insomnia

Decreased productivity

Low grade fever

Memory/Judgment/Concentration problems

Lowered Immune System

High blood pressure, heart disease,

obesity and diabetes


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Body Mood Behavior

Headache Anxiety Overeating or Under Eating

Muscle tension or pain Restlessness Angry outburst

Chest pain Lack of motivation Drug, Alcohol, Gambling abuse

Fatigue Lack of focus Tobacco abuse

Change in sex drive Irritability Social withdrawal

Stomach upset Anger

Sleep problems Sadness/ Depression


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Resources

Mayo Clinic

Stress Assessment

(online version)

http://www.mayoclinic.com/health/stress-

assessment/SR00029


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Week Two

Anger Management


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Anger Scale inventory

(take test)


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Anger is a feeling or emotion that ranges from

mild irritation to intense fury and rage.

Anger is a natural response Threatened, wronged, harm us

When child or loved one is in harms way or threatened


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Anger result from frustration

Needs, desires, and goals are not met

lose patience, act impulsive, aggressively or

violently


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Anger and Aggression are often confused

Aggression: behavior Intention to cause harm

Verbal abuse or threats or violent act

Anger is an emotion A feeling

We can be angry and not aggressive


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Feeling anger intensely or frequently will place

strain or stress on the body.

Anger = Stress= Flight or Fight

Increase in

Blood pressure

Heart rate

Problems:

Hypertension, heart disease and decreased immune system


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Extreme Anger that leads to aggression may

result in violence

This may result in negative consequences:

Arrest or jail

Injured

Feelings of guilt, shame or regret

Anger=Aggression=Stress


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Verbal violence can lead to

Intimidation or threatening behavior

Consequences:

Alienation

Others fear

Resent

And lack trust


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Short term benefits of Aggression

You feel better

Tension released

Others listen & do what you want

You can manipulate others


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Controlling Aggression

Immediate Timeout, deep breathing, thought stopping

Preventive

Exercise, and change irrational believes


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Think people, situations can make you angry

but they can not make you aggressive

Anger = choice

How do it deal with it

Aggression = loos of control over self and the

situation.


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Anger leads to stress

Our body know that when we get angry we respond a

certain way. We keep that anger with us for a long

time.


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Take away the power of anger by

Retelling the story- venting

(it looses power after a while)

Find humor in it

Laugh right away

Find the silver lining

Remember a past event, and how you handled it

This too shall pass


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Cues to Anger

Physical (heart rate increase)

Behavioral (clenched fist, pace, slam a door, raise

voice)

Emotional (feel abandoned, insecure, jealous,

rejected)

Cognitive (self talk is critical and hostile)


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What can I do? Use conflict resolution

Talk to a friend

Go for walk

Time out

Exercise (walk, go to gym)

Attend a 12 step meeting

Deep breathing

Write in a journal

Do something you like

Avoid something you don’t like

Explore feelings beneath the anger (seek therapy)


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Ways to limit Anger=Aggression

Good time management

Avoid People, places and things that make you

angry

Leave when you feel triggered by anger


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Cognitive Restructuring

A-B-C-D Model and Thought Stopping

Developed by Albert Ellis

“A” –Activating Event

“B” -Beliefs

“C” – Emotional Consequences (what I feel)

“D” - Dispute


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Words to avoid

Should

Must

Always

I have no power over things I cannot

control,

I have to accept that I cannot change (others or situations, you can change self)


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Thought Stopping

Simple: tell self to “stop thinking these thoughts”

Place in a box for review/analysis later

Cancel, Cancel, Cancel

(Silva Method, Jose Silva 1960)


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Conflict Resolution Model

1. identify the problem

2. identify feelings associate with the problem

3. identify specific impact

4. decide resolve conflict or let it go

5. address and resolve the conflict


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Do Anger

Symptom checklist


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ANITA PINDIUR BY: ROCHE DIETITIAN

Week Three

Food, Diet and Stress

SUBSTANCE ABUSE & NUTRITION

The Way Back Inn

Roche Dietitians LLC 2012

DIET AND SUBSTANCE ABUSE

Substance abuse can harm the body in two ways

The substance directly affects the body

Substance abuse can cause negative lifestyle changes

such as irregular eating and poor diet

Recovery from substance abuse can affect your

bodies metabolism, organ function and mental

well being


IMPACT OF DRUGS ON NUTRITION

Opiates (codeine, oxycontin, heroin and

morphine) can affect the GI system. Symptoms

include: diarrhea, nausea and vomiting

Stimulants (crack, cocaine, and

methamphetamine) can reduce appetite and lead

to weight loss and poor nutrition

Marijuana can increase appetite leading to

overweight/obesity.

Alcohol is one of the major causes of nutritional

deficiency in the US


RECOVERY AND NUTRITION

Most recovering addicts have developed

nutritional deficiencies of key proteins, fats,

vitamins and minerals.

Common food patterns include:

No breakfast

High consumption of sugar and refined

carbohydrates

High consumption of processed foods

Low consumption of protein

Low consumption of fresh fruits and vegetables

High milk consumption


RECOVERY AND NUTRITION

Nutritional deficiencies may also…

Increase cravings of poor dietary choices

Contribute to major withdrawal like symptoms such

as fatigue, depression, irritability, mental

derangement

Possibly block recovery and lead to a relapse


Lets take a closer look at the

following key nutrients:

Carbohydrates

Protein

Fat

Vitamins and Minerals


CARBOHYDRATES

Simple vs. Complex carbohydrates

Many recovering drug and alcohol addicts, like many Americans, consume too many simple carbohydrates and too few complex carbohydrates

Simple carbohydrate: soda, alcohol, pastries

Complex carbohydrates: whole grains, nuts and seeds

• Simple vs.

• Complex Carbs


CARBOHYDRATES AND ADDICTION

Carbohydrates and sugar are highly addictive

Consuming a diet high in simple carbohydrates

may lead to severe malnourishment or

digestive/nutrient absorption problems


WHAT TO DO?

Replace simple carbohydrates with complex carbohydrates

Avoid: cereals (except oatmeal), breads, pies, cakes, spaghetti, soft drinks, caffeine and other ‘junk’ foods with little nutrients

Add: whole grains, nuts and seeds, vegetables

Increase protein in the diet!

Check labels for foods high in sugar


PROTEIN

Protein is needed for growth tissue repair, and a

healthy immune system

The brain and body depend on protein

Protein can be found in:

Meat

Poultry

Eggs

Cheese

Milk

Nuts and Beans


PROTEIN AND ADDICTION

Chemical substances such as alcohol can impair

the digestion of proteins

A deficiency of protein can lead to common

recovery problems such as depression, poor

recall, aggressive behavior, mental confusion,

anxiety and paranoia

When in recovery you need to eat even more protein

than normal!


WHAT TO DO?

Increase protein in the diet by eating at least 3

high protein meals per day

Consume high quality proteins that are low in fat

High quality proteins include: beans, fish, tuna,

chicken, and low fat dairy

Supplement when medically necessary and under

medical supervision


FATS

Fats are important in normal growth and

development as well as energy

Fats are needed to absorb certain vitamins and

maintain healthy cells in the body

Saturated fats vs. Unsaturated fats

It has been found that many recovering addicts

are deficient in Omega 3 and Omega 6 fatty acids


WHAT TO DO?

Decrease the saturated fats

Incorporate Omega 3 and Omega 6 fatty acids on

the diet

Salmon

Tuna

Nuts

Seeds

Consider an Omega 3 fish oil supplement


VITAMINS AND MINERALS

Vitamin and minerals are needed each day for

the body to function properly

Alcohol and drug users are often deficient in

key minerals such as calcium, magnesium, zinc and

iron

AND

Vitamin C and B Vitamins


CALCIUM AND MAGNESIUM

A calcium deficiency is due to a poor diet and

inadequate intake of calcium

Substances such as sugar, caffeine, alcohol and other

drugs can also cause the body to eliminate calcium

Magnesium deficiency is also common among those

that consume high amounts of sugar, caffeine, alcohol

and other drugs

LOW calcium and magnesium levels contribute to

irritability, pain, and muscular/nervous system

disorders that recovering addicts may face during

withdrawal


ZINC

A poor diet and over consumption of sugar,

caffeine, alcohol and drugs can cause the stores of

zinc in the liver to be pulled out

Zinc may have benefits in recovery by adding to a

healthy immune system

Zinc deficiencies may produce symptoms such as

cold extremities, poor circulation, loss of taste

and smell, poor wound healing, lethargy and poor

appetite


IRON

An iron deficiency can cause a disease called

anemia

A recovering addict may be deficient in iron due

to damage caused to the liver where iron is

absorbed

Iron deficiencies may have symptoms such as

fatigue, depression, poor memory and headaches


VITAMIN C

Vitamin C plays an integral role in brain function

The body requires more Vitamin C in times of

stress

Vitamin C can help with withdrawal symptoms

and help rebuild the liver, and immune system


B VITAMINS

B vitamins play a role in metabolism and are required

to break down carbohydrates that fuel the body

There are eight B vitamins Biotin

Folate

Niacin

Pantothenic acid

Riboflavin (B2)

Thiamin (B1)

Pryridoxine (B6)

Folic acid (or cobalamins, B12)

Vitamin B deficiencies have been found to cause

symptoms such as paranoia, hyperactivity, confusion

and depression

Vitamin B deficiencies have also been shown to cause

cravings for addictive substances


FOODS TO CONSUME TO AVOID

VITAMIN/MINERAL DEFICIENCY

Zinc Oysters, gingerroot, round steak, lamb, pecans, peas, shrimp, parsley, and potatoes

Calcium Dairy products, almonds, sunflower seeds, parsley, meat, fish, eggs, whole grains, beans, and vegetables

Magnesium Leafy green vegetables, kelp, peas, molasses, nuts like almonds and cashews, brown rice, whole grains, and seafood

Iron Liver, oysters, leafy greens, red meat, kelp, brewer’s yeast, eggs, and beans

Vitamin C Fresh fruits and vegetables like green peppers, citrus fruits, tomatoes, potatoes, cauliflower, Brussels sprouts, broccoli, and cabbage

B-complex Found in most whole, unprocessed foods such as potatoes, lentils, chili peppers, beans, brewer’s yeast and molasses


WHAT SHOULD I EAT?

To ensure you are eating a diet that includes all

nutrients, eat the following types of foods daily…

Whole Foods

Whole Grains

Fiber

Protein

Fats

Fruits and Vegetables


WHAT FOODS TO AVOID!

Sugar

Processed Foods

White Flour

Caffeine


MEAL PATTERN

Eat 3 main meals per day + 2-3 light snacks

Never go more than 6 hours without eating

(except overnight)

No skipping meals (especially breakfast!)


REMEMBER…

A nutrient packed and healthy diet will give your body the fuel you need during recovery

Following a healthy diet and eating at regular intervals will help alleviate some of the withdrawal symptoms you may be experiencing

A poor diet may make you feel worse and delay your recovery

Listen to your body and make a plan that works for you!



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Week Four

Unplug, De-clutter and Organize


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Un-Plug

We are overwhelmed with an inpute of technology

and information.

We can live with out the information/news

We need to make a conscious effort to give ourself

time away from technology.


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We spend to much time sitting, not moving, and

looking at screens.

A study presented a the British Psychological

Society’s annual Occupational Conference (2012)

found that 70 percent of employees studied did

not meet the recommended guidelines for

physical activity, spending approximately 5 hours

and 41 minutes per day at their desk.


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Prolong sitting can cause many posture

problems, and can contribute to other illness

Hypertension, Heart Disease, and Diabetes

according to Equinox Fitness Training

Institute.


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Move around

Every hour take a break from the screen and

walk around the office, get some fresh air, do

some chair yoga, meditate.


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With screen time there is no People

time

Dinner are by the TV not the table

Checking emails or text during dinner

No real relationship with the person next to you


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Set rules for screen time

Each hour 10 minute break from the computer

Chores, responsibilities, before screen time

(clean up, practice instruments/sports, go to meeting or class)

After a certain time, 8pm, no more

computer/phone/TV

Phone/emails/text is not answered during dinner or other

human activities (teaching/re-teaching etiquette at dinner, movie’s, social engagements)

Only real emergencies are handled after hours


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Nature Deficit Disorder By Richard Louv

2005 Last Child in the Woods

Less time outdoors

Result wide range of behavioral problems

(lack of interest and respect for nature, shorter life span, attention disorders and depression, anxiety, lower grades, obesity)

Louv cause Parental fears

Restricted access to natural areas

Lure of the screen (44 hours a week on average)


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De-Clutter

Clutter

Can become a mental health problem –Hording

Makes you feel anxious and depressed

Often results when there is unhealthy attachment

and unresolved emotional issues.


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De-clutter a little at a time

15min to 1 hour per day

Have a plan

Create a chart

Cross off when done (you will feel that something was accomplished)

Don’t do to much all at once To overwhelming and to stressful

Do one room, section, or cabinet at a time

Finish the project that you start, don’t just move it from place to place

Don’t buy anything to help in the process (containers, boxes, specialty items)

Create sections


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Segregate

Keep- I need, I like, I want

Donate- I will not use or like it, can go to charity

Trash/Recycle – no use for it (old magazines,

broken)

Give away – read books, clothing that does not

fit, duplicates, borrowed items don’t feel bad about either section, that increases stress

Have a mantra while organizing (life will be simpler, I will be able to

find things, I will be less stressed when items are not falling on me out

of the closet)


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Don’t buy or bring stuff into the house

gifts – *Donate

*Return if gift receipt (baby, kids exchange small things for one large that you need)

*Store (in box, with label)

* If you don’t love it, get rid of it (don’t stress over others feelings, that is their issue)

Don’t Buy on impulse Keep a list (on phone, that way always by you)

Things I want

1.

2.

3.

*Ask when you buy what the return policy is. Then bring it back if its not perfect.

*Use the one in two out rule (or similar)

* Resist the urge to buy in bulk or on sale

(only what you need, and what you have space for)


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General Rule

I can only have and keep as much as I have space

prioritize what is important (wedding dress keep

Birthday card recycle)

Do not add or rent additional storage space

Set rules that work for you

One year box – if not used by date

Clothing (not used in a year, or does not fit)

Maybe pile

Vacation principal (I only need what I would take on vacation)

What can I not live with out

Unregister- magazines, yellow pages, etc.


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Organize

Change the way you think

Change the way you act

Keep up the change

De-clutter

Organize

Keep


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Motivation

I want to change, I want to be organized

Management

Keep doing it (shoes, keys, briefcase go in the same

place, everyday)

Monitoring

Small clean up, de-cluttering, organizing daily

Waiting for water to boil, clean up counter

Before going to bed, pick up and put things in place


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Time Management

To be organized, you need to have good time management

Only schedule, do as much as is possible

Do not under or over estimate

(include getting ready time, driving time)

Do a trial run

(morning; practice on Sunday )

Make a list, prioritize, eliminate

(seven invitations for one weekend, can only do three events)

Give yourself options

(I can’t go to all events, send a card, go next time)

Use a calendar

Create a daily plan, write down if necessary, review before

bed and in the morning.


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Urgent/Important Chart

First thing First Covey, Merrill and Merrill, 2003

I II

Urgent and important Important not urgent (most

important)

III IV

Urgent but not important Unimportant and not urgent


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Learn to embrace and enjoy the organization

Disorganization = Chaos= Bad Stress

Replace the time you spend in Chaos with

something

Fun, soothing or relaxing

Take a class, paint, meditate, yoga, go outside, read a book

Don’t apologize for being organized

Don’t make excuses for it

Allow, encourage, enforce others to help


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Week Five

Mental Health, Medication, Meditation


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Mental Health

Mental Health is just as important as physical health

We see mental health as separate

And it gets separate treatment in the health care field

Things are changing; Parity law,

Obama Care

A healthy life style = Good Mental Health


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Anxiety

Symptoms

Persistent worry

feeling:

apprehensive

powerless

impending danger, panic or doom

Sweeting,

Increase heart rate

Hyperventilation

Trembling

Feeling week or tired


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Medication

Consult a physician and or a psychiatrist

See if medications are right for you

Know all your options

Choose from various options

Explore alternatives

Know risks and side effects

See how the medication works for you and with your body.

Don’t try the first day of a new job, on a Monday or the day of a big presentation.


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Meditation

Find time every day

Find a technique that works for you

(cd, book, self talk<mantra>, silent, journaling)

Do it together as a couple or family

Attach to another activity or instead of if the excuse is I don’t have time

-Before bed

-instead of TV in the evening (specially the news)

-while doing outdoor activities; gardening, cooking, walking Flow: The Psychology of Optimal Experience

by Mihaly Csikszentmihalyi

http://www.amazon.com/Flow-Psychology-Experience-Mihaly-Csikszentmihalyi/dp/0061339202/ref=sr_1_1?s=books&ie=UTF8&qid=1373561301&sr=1-1







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The Butterflies Starbright

By: Maureen Garth

The air is fresh with a light breeze touching your cheek, and

the sun is beaming down on you. The green grass is like a

soft carpet under your feet, and the huge trees with their

spreading branches are protecting the smaller plants.


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Exercise for Mindfulness

Pulse Game

Count the beats of your pulse for 1 min

Jump up and down, run around, scream, shake for 1

min

Check pulse again for 1 min

Take three long deep breaths

Check pulse again

Book:

10 Mindful Minutes By: Goldie Hawn


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Deep Relaxation

Yoga Nidra Patty Townsent

CD


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Are you a Carrot, and Egg, or a Coffee Bean?


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Week Six

Positive vs. Negative Way to Cope with Stress


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Questioner


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Positive

Live a well balanced life

Take time for self

Relax

Go outside

Eat well and healthy

Exercise

Work, home, life, fun all in moderation

Have fun


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Use positive psychology and the benefits of humor

Laughter

-releases endorphins – fights pain

-Lowers cortisol levels and protects

the immune system

-Activates T-Cells

Laughter can decrease stress, lower blood pressure and decrease muscle tension

(Neuro Endocrine and Stress Hormone Changes During Mirthful Laughter-American Journal of Medical Sciences, 1990, 298: 390-396)


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Give yourself permission to be happy and laugh

Fake it till you make it

Laugh at self

Smiling/Laugher lowers the temperature in the

brain and decreases sadness, anxiety and

depression.

Activates Dopamine

Increase time around happy people, situations,

and exposure


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Negative

Problem/pathological Gambling

Alcohol

Psychoactive drugs

Over use/abuse of medications

Abuse: verbal or physical

Single focus Work

Isolation from others, from fun, from life


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When you feel stressed, anxious or overwhelmed at first gambling, alcohol or drugs take the edge off.

You might loos yourself in the activity, you might really enjoy the activity.

It feels and looks like a social activity, but soon leads to isolation and loneliness

The loos of time and money need to be covered up; leads to lies; leads to stress; leads to anxiety; can become suicidal or abusive.


WAY BACK INN

ANITA PINDIUR

All I Really Need to Know I learned in Kindergarten By: Robert Fulghum

Share everything

Play fair

Don’t hit people

Put things back where you found them

Clean up your own mess

Don’t take things that aren’t yours

Say you’re sorry when you hurt somebody

Wash your hands before you eat

Flush

Warm cookies and cold milk are good for you

Live a balanced life – learn some and think some and draw and pain and sing and dance and play and work every day some.

Take a nap every afternoon

When you go out in the world, watch out for traffic, hold hands and stick together.

Be aware of wonder. Remember the little seed in the Styrofoam cup; the roots go down and the plant goes up and nobody really knows how or why, but we are all like that

Goldfish and hamsters and white mice and even the little seed they all die. So do we.

And then remember the Dick and Jane books and the first word you learned the biggest word of all LOOK

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