Stress Management

What is stress?

Stress is composed of internal pressure that is generated by the world outside that causes us to feel 'under threat'. When we feel there is a danger to us we feel under pressure and undergo rapid physiological changes in the amygdala or 'old brain'. We are wired to either fight the danger, or else to flee from it. Then we mobilise ourselves to return to our original physical and mental balance as soon as the perceived danger has passed. Dr Hans Selye has identified three stages which are caused by stress:-

1. A stage of alarm when one feels at risk or threatened. 2. A stage of resistance - mobilising all personal resources to try to solve the problem. 3. A stage of exhaustion - when the threat is of greater intensity and duration than was expected. The person can not cope, and either physical and/or mental health deteriorates.

Symptoms of 'burn out' can include the following - (click Stress Questionnaire).

Causes of stress

In the workplace often it is the long hours, pressure of deadlines, and an inordinately heavy workload that contributes negatively to perceived feeling of stress.

The workplace statistics show that the average person works five times as much as they did thirty years ago. Fifty nine percent of the population has difficulty falling/or staying asleep. We work on average 46 hours a week, the highest figures in Europe. In this age of anxiety there is job uncertainty with only one in three workers in permanent contracts.

Professional managerial stress is identified in the workplace as follows:-

• poor job performance feedback
• lack of authority to make decisions
• relationship problems with superiors
• command and control management style
• noise/lighting
• poor communication skill
• workstation problems
• job uncertainty/insecurity
• lack of praise, validation or recognition from superiors
• a negative psychological contract with staff or poor change management
• no training or support to staff
• no say on how work is done
• poor delegation of tasks
• company mergers / takeovers

Stress is likely to become the most dangerous risk to business this century with 180 million working days lost annually at a cost of over £4 billion to industry. One in five workers report feeling stressed at work a total of five million people in the United Kingdom. Personal and Social Causes of Stress - related problems can include: relationship problems including divorce, physical illness, alcoholism. gambling, anger problems, panic attacks or anxiety/depression.

CBT/Stress Management

On the first session a series of CBT diagnostic tests are administered to assess both the internal and external stressors which are contributing to the presence of excessive stress reactions. Personality tests are administered. For example (click to Type A Questionnaire) to determine Type A/B personality variables in the areas of:-

• achievement striving
• time urgency
• perfectionism
• multi-tasking
• low self-esteem
• hostility
• excessive job involvement
• lack of relaxation/recuperation

These above variables contribute to continuous high arousal, and feeling under pressure.

When a differential diagnosis is made client and therapist draw up a problem list of five or six problems they would like to change as a result of the treatment. This acts as the contract for the aims and objective for the Stress Management Programme.

The work of Dr Choudhury in this year's Reith lectures in Neuroscience states that in the future clients who are predominately left brain, analytical and goal oriented will be taught to use both hemispheres of the brain.

In the bi-cameral mind, switching between the right and left hemispheres produces more innovative, intuitive and creative ways of problem-solving.

Daniel Pink in his recent book The Whole New Mind (click) explores the direction that right brain problem solvers have over their left brain analytical counterparts, especially in the area of information technology, at the click of the Internet's information super highway.

Stress Management Questionnaire
(Pdf)

There are three stages to effective stress management - they include the following stages.

Stage 1

Reducing the symptoms associated with stress (anxiety, depression, losing control, insomnia, vulnerability etc.) using a holistic programme for relaxation training and recuperation. Clients often use a voice activated dictaphone to tape sessions to use at home to augment what is gained in therapy.

Coping techniques include breathing techniques, visualisation, progressive muscle relaxation, stress innoculation training, distraction techniques, mindfulness and problem-solving skills. From the first session onward the goal of the treatment is to teach clients to metamotivationally switch freely between the left and right brain hemispheres of the brain to learn to modulate the degree of response to any stress trigger.

Clients learn how to 'work smart not hard' and minimise the amount of energy expended on any one task. Clients begin early on to recognise the benefits of learning to recuperate before moving on to the next task. It has been statistically proven that the quality of work improves proportionately when clients recuperate fully. It is this more effective use of energy that is noticeable.

By learning to become more aware of physical tension levels there is an increased resistance to stress. As more advance coping skills are learned the perception of threat diminishes. Both in the preparation for possible stressful situations, and a coping repertoire for meeting unexpected stressors the client has a full coping repertoire at their disposal.

Alternative therapeutic use of aromatherapy massage - a fully trained nutritionalist, and a physical exercise programme to trigger the natural morphine response of endorphins and a stress medical designed by Dr Geoffrey Barker to assess overall levels of stress i.e. (cortisol, moradenalin etc.).
Treating the whole person has greatly increased recovery rates with a 100% success rate with clients.

Stage 2

Using standard CBT in the areas identified as causing negative thoughts, beliefs and images, clients learn to identify the themes which generate faulty thinking ("I'm not good enough", "I'm going to fail", "I'm stupid" etc.) and learn to test there thoughts as hypotheses rather than take them as facts.

Because cognitive-behavioural therapy is an information processing model, when clients restructure their thinking by rewriting thoughts in an alternative, and more balanced way, both mood and behaviour change.

By reality testing thoughts the interpretation of the event, and its meaning changes, with significant reduction in the way the stress is experienced.
Cognitive Behavioural/Therapy has been statistically proven to change brain chemistry without anti-depressant medication.

All of us experience things in life which frustrate, disappoint, and sometimes can defeat us. Learning how to manage internal self talk using CBT helps us to more effectively speak to others and feel more in control in the specific life events we encounter. Our negative automatic thought patterns interfere with our ability to judge situations realistically (i.e. "I am stupid" vs what "I did was stupid")

Stage 3

In the last stage of CBT treatment clients work on the deeper core beliefs/schemas that have been developed during their early life (up to 16 yrs of age). These deeply held beliefs function like absolutes or biases and form a template for how we see ourselves, other people, and the world around us. For example: "I'm never good enough", "I'm a failure", "I'm not lovable", "People cant be trusted" acts as a filter for how they live in the world, who they are attracted to, and what situations they avoid after a comprehensive schema questionnaire. Clients learn to modify these deeply held beliefs which mitigate against relapse.