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Stress Management Group Way Back Inn Anita Pindiur

Stress Management Group

Anita Pindiur

07-17-2013


• Six (6) week didactic and in-vivo exercise

• 2 hour group

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

• 1 hour of didactic education

Stress Management Group

Way Back Inn Anita Pindiur

• 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 Way to Cope with Stress

• Group Rules:

– Be relaxed and Happy

– Have fun

– Embrace new ideas

– Try something new

– Push yourself, but be respectful of your body

• Group Suggestions

– Keep the group fun and casual

– Defer topics of trauma or severe mental health 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.

• Week One – Good Stress Vs. Bad Stress

• Take the stress assessment

• 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

• 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.[citation needed]

• 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.[citation needed]-Wikipedia

• 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 4 time.

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

• Positive/Good/Eustress Stress

• Motivation

• Pushing factor

• Need or desire to succeed

• Passion

• Joy

• Love

• Life with no stress • Boring and dull

• Unhappy

• Rudderless

• Stress is only bad

• In large does

• And chronic

• Examples of Good Stress

– Wedding

– Child

– Performance (fun activity)

– Roller coaster

• What do you feel with good Stress

– Pulse quickens

– Feel exited

– Hormones change

– No or little threat or fear

• 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

• Best example is • Gambling and Substance Use

– Gambling as a good stressor

• Gambling start out as a fun activity

• To socialize

• To win

• Adrenaline rush – good stress

• Playing for fun, not money

• Gambling as a bad stressor

• Playing to win or recoup loses

• Highs and lows when playing

• Becomes a need not an activity

• No more socializing

• No more fun

• Good Stress when gambling

– Used to reduce “stress”

– Used to enjoy time with others

– Used to enhance life

– Used in balance in life

• Bad Stress when gambling

• Causing “Stress”

• Owing money

• Lies and secrete keeping

• Not taking care of self due to gambling

• No balance in life

• Symptoms of Chronic or Bad Stress

– Headache

– Insomnia

– Decreased productivity

– High blood pressure, heart disease, obesity and diabetes

• Body mood behavior

• Headache anxiety overeating or underrating

• Muscle tension or pain restlessness angry outburst

• Chest pain lack of motivation Drug, alcohol or Gambling abuse

• Fatigue Lack of focus Tabaco abuse

• Change in sex drive Irritability Social withdrawal

• Stomach upset Anger

• Sleep problems Sadness/ Depression

• Resources • Mayo Clinic

– Stress Assessment

– (online version)

• Week Two

• Anger Management

• Anger Scale inventory

• 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

• Anger result from frustration

– Needs, desires, and goals are not met

• Lose patience, act impulsive, aggressively or violently

• 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

• 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

• 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

• Verbal violence can lead to

– Intimidation or threatening behavior

– Consequences: – Alienation

– Others fear

– Resent

– And lack trust

• Short term benefits of aggression; • You feel better

• Tension released

• Others listen do what you want

• You can manipulate others

• Expression of anger is learned

– It becomes familiar and routine

• Become aware of Anger • What triggers me?

• What negative consequences follow?

• Controlling Aggression

• Immediate • Timeout, deep breathing, thought stopping

• Preventive » Exercise, and change irrational believes

• Thing, 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.

• 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.

• 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 this is not as bad – This too shall pass

• Cues to Anger

• Physical (hear rate increase)

• Behavioral (clench fist, pace, slam a door, raise voice)

• Emotional (feel abandoned, insecure, jealous, rejected)

• Cognitive (self talk is critical and hostile)

• What can I do?:

• Talk to a friend

• Time out

• Use conflict resolution

• Exercise (walk, go to gym)

• Attend a 12 step meeting

• Explore feelings beneath the anger

• Ways to limit anger=aggression

• Good time management

• Avoid People, places and things that make you angry

• Leave when you feel triggered by anger

• Physical Behavior when Angry

• Go for walk

• Deep breathing

• Talk to someone

• Write in a journal

• Do something you like

• Avoid something you don’t like

• 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

• Words to avoid

• Should

• Must

• Always

• I have no power over things I cannot control,

• I have to accept that I cannot change

• Thought Stopping

• Simple: tell self to “stop thinking these thoughts”

• Place in a box for review/analysis later

• Cancel, Cancel, Cancel

• Conflict Resolution Model • Assertiveness

• Assertiveness

• Thoughts, feelings and believes are important and valid

• 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

• Anger Scale Inventory

• 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!


• Week Four

• Unplug, De-clutter and Organize

• Unplug

• We are overwhelmed with an inpute of technology and information.

• We can live with out the information

• We need to make a conscious effort to give ourself time away from technology.

• 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.

• Prolong sitting can cause many posture problems, and can contribute to other illness (hypertension, heart disease, and diabetes) according to Equinox Fitness Training Institute.

• Move around

• Every hour take a break from the screen and walk around the office, get some fresh air, do some chair yoga, meditate.

• 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

• Set rules for screen time:

• Each hour 10 minute break from the computer

• After a certain time, 8pm, no more computer/phone

• Phone is not answered during dinner

• Only real emergencies are handled after hours, not each email

• Take time to do something else;

• Read, paint, knit, etc.

• Have no screen days

• A whole day of no computer, TV, or phone

• (or at least part of the day)

• 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)

• 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.

• DE clutter a little at a time • 15min 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

• Create sections and see what like or duplicate items you have

• Segregate items into

• 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 items)

• Give away – read books, clothing that does not fit

• don’t fell 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)

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 * Resist the urge to buy in bulk or on sale (only what you need, and what you have space for)

General Rule

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

prioritize what is important (weeding dress keep

each card recycle)

Do not add or rent additional storage space

Set rules that work for you

One year box

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

Maybe pile

Vacation

What can I not live with out

Unregister- magazines, yellow pages, etc.

• Organize

• Organization

• change the way you think

• Change the way you act

• Keep up the change

• DE clutter

• Organize

• Keep

• Motivation

• I want to change, I want to be organized

• Management

• Keep doing it (shoes, keys, briefcase go in the same place, every day)

• 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

• 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.

• 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

• 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

• Don’t apologize for being organized

• Don’t make excuses for it

• Allow others to help

• Week Five

• Mental Health, Medication, Meditation

• 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

Anxiety

persistent worry

Symptoms

feeling

apprehensive

powerless

impending danger, panic or doom

Sweeting,

Increase heart rate

Hyperventilation

Trembling

Feeling week or tired

• 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.

• 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- following Flow Philosophy

• The Butterflies • Starbright 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.

• 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

• 10 mindful Minutes – Goldie Hawn

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

• Week Six

• Positive vs. Negative Way to Cope with Stress

• Positive

• Live a well balanced life

• Take time for self

• Relax

• Go outside

• Eat well and healthy

• Exercise

• Work, home, life, fun moderation

• Have fun

• 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)

• Give yourself permission to be happy and laugh

• Fake it till you make it

• Smiling/Laugher lowers the temperature in the brain and decreases sadness, depression. Activates dopamine

• Laugh at self

• Increase time around happy people, situations, and exposure

• 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

• 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.

• 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

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