by Jennifer Gray-Stanley

Though we all encounter many types of stress in our daily life, we must remember that ultimately, we have control over how it affects us. Through awareness and education, negative stressors can be managed, and positive stressors can be utilized as an impetus for change and added creativity in your life. As managing stress in your life requires proactive and consistent behavioral change, this article addresses how to adopt such changes on a gradual basis.

Defining Stress

A ‘stressor’ consists of anything that causes stress, including physical, emotional, and environmental problems and barriers. These include, but are not limited to factors such as disability, illness, fear, worry, pollution, and noise (Powell & George-Warren, 1994; Seaward, 2006). Hans Seyle, stress researcher, defined stress as ‘the nonspecific response of the body to any demand made on it(1973).’ This refers to how I react to any demand that affects my system from a physical, mental, and/or emotional perspective. Stress can be defined in both positive (good stress) eustress) and negative (bad stress) distress) forms. Eustress or positive stress is the optimal amount of stress which can provide us with the energy to perform a task well, such as public speaking, engaging in competition, or completing a job interview. Exercise and physical activity can also be considered a positive stressor, although overtraining can lead to injury. Additional variations of defining stress include hyperstress, an excess of stress, or hypostress, insufficient stress. Balance should be sought among all types of stress (Manning et al., 1999). Thus, particularly for managing negative stressors, successful stress management helps us to develop an awareness of stress in our lives, and how we respond to and manage these stressors.

Richard Lazarus further developed these definitions by stating that stress is a condition or feeling experienced when a person perceives that ‘demands exceed the personal and social resources that the individual is able to mobilize’ (Lazarus & Folkman, 1984). Certainly, what is stressful one day may not be stressful the next. And each person perceives stress differently than does the next.

Stress Management Assessment

The first step to developing a stress management plan includes a thorough assessment of the stress you are currently experiencing. The following resources include checklists and exercises to help you familiarize yourself with your current stress levels. Choose the exercises that are most applicable to your current circumstances, whether that be work stress or specific symptoms experienced.

A. Quick Stress Management Checklists

1) Quick Stress Assessment:

Check all statements which apply to you:

__ Do you schedule more activities than you can handle into a day’s work?
__ Do you worry chronically?
__ Are you addicted to excitement, stimulation?
__ Do you tend to be overly concerned about what people think?
__ Are you a multi-tasker?
__ Are you an over-achiever or perfectionist?
__ Do you neglect to practice self-nurturing activities?

Affirmative responses to any of the above statements indicate a need for improved awareness and management of your current stress levels.

2) Holmes-Rahe Social Readjustment Rating Scale:

The following scale allows you to estimate your general life stress values. A checklist is listed for both adult and youth stress. Circle the scores of the events that relate to you, and add them up for a total score, or you may complete the survey electronically on the following website:  http://www.mindtools.com/pages/article/newTCS_82.htm

Scoring:
0-149: low stress level
150-199: mild life changes
200-299: moderate stress level
300 +: high stress level

Scoring:
0-149: low stress level
150-199: mild life changes
200-299: moderate stress level
300 +: high stress level

3) Professional Life Stress Scale:
Professional responsibilities on their own can have a dramatic impact on stress levels in general, both in and out of the workplace.

B. Listing Problematic Stressors
Using Table X.1 and Table X.2 as guides, write down key stressors in your life that are of concern to you. Make these lists as detailed as possible, as they can serve as a basis for forming a coherent stress management program. This should fall into multiple areas, including:

• Work
• Personal relationships or family life
• Habits, i.e., eating, exercising

C. Recognizing Signs of Stress

Stress unchecked can have an insidious effect physically, mentally, and spiritually. Consider how you feel from physical, emotional, and behavioral standpoints, and write it down.
Recognition of such symptoms is critical to managing your stress levels. Consider symptoms from physical, emotional, and behavioral sources.

• Physical symptoms: headache, fatigue, high blood pressure, shortness of breath
• Emotional symptoms: anxiety, worrying, depression, mood swings, depression
• Behaviors: increased smoking or alcohol use, overeating

D. The Influence of Personality

Personality must also be factored into the stress equation. The way one interprets and processes stress in one’s life has a tremendous impact on the health outcomes realized. While some persons assume a more serious and competitive approach to life, others are more easygoing.

Type A & B Personality Types
Cardiologists Meyer Friedman and Ray Rosenman created the Western Collaborative Group Study epidemiological project in the 1950s and 1960s, where they developed the typology of type A and B personalities. While type A personality qualities include physical and mental acuity, a quick pace, competitiveness, impatience, and difficulty relaxing and waiting, type B personalities exhibit a more relaxed approach to life and its challenges. Not surprisingly, individuals with type B personalities experience less stress and are less likely to develop heart disease than are those with type A personalities (Manning et al., 1999).

Hardiness/Resilience
Being hardy or resistant to stress typifies a person who can remain healthy and balanced despite an ample work load. Essentially, this person lives in alignment with inner values. Susan Kobasa typified the concept of the hardy personality in 1979, involving the traits of commitment, control, and challenge. Essentially, hardy people live according to their values and commitments to self, family, work, the community, and other goals. They assume responsibility for both personal successes and failures, and believe that they have the power to influence the course of one’s destiny. Moreover, obstacles or problems are viewed as challenges and an opportunity for further growth, rather than threats.

Take a personality hardiness test at the following website: http://www.mhhe.com/catalogs/sem/hhp/student/labs/index.mhtml?file=/catalogs/sem/hhp/labs/stress/04.

Modalities to Decrease Stress

A plethora of modalities exist to help you manage your stress levels, assuming that you incorporate these new behaviors into your lifestyle on a regular basis. They include, but are not limited to relaxation, positive thinking, goal setting and time management, as well as regular exercise and proper nutrition. This section includes some techniques for adoption into daily routines from Powell & George-Warren (1994) and the resources section below. Note that information on physical activity and nutrition will not be covered here. For this information, refer to the National Center on Physical Activity and Disability (NPCAD) website (www.nchpad.org) or call their free hotline at 800-900-8086 for this and other health promotion resources in the references section below.

A. Relaxation:

Getting Started

Relaxation can be practiced in many different forms and environments. To begin, consider a few guidelines:

• Locate a quiet environment where you feel comfortable. Use a blanket if necessary to stay warm.
• Situate yourself in a comfortable position. A seated position is preferred over lying down, so that one does not have the tendency to fall asleep.
• Reserve a regular time each day for practicing relaxation.
• Focus on a word, phrase, sound, or the rhythm of your breath that is repeated regularly throughout the session. It is natural for your mind to wander: simply focus again.
• Use a timer if necessary, so that you can focus on your relaxation practice rather than the time you are allocating to it.
• To learn proper techniques, practice with relaxation tapes from your local library, or take a class in your community, such as meditation, qi-gong, and various forms of yoga.

Positions for Practicing Relaxation Exercises:

Sitting:

• Sit in a comfortable chair where your back is supported, your feet are on the ground, and your knees are bent.
• Your head should feel as if it is a helium balloon, and your spine should lengthen, as if it is floating up freely.

Lying Down:

• Lie flat with your arms comfortably resting at your side.
• Your legs should rest slightly apart.
• A blanket can be used to keep warm.
• Use a small pillow under your neck and/or under your knees, if you experience any strain in this position.

Breathing Guidelines:

• Watch how a baby breathes, with her/his abdomen rising and falling. Place your hand on your belly/abdomen area, and practice breathing from this area, as you watch your hand rise and fall.
• Use your nose to inhale and then exhale through your nose or mouth.
• Breathe initially while lying down, and then practice from a sitting or standing position.
• Consult the following website (http://swamij.com/breath.htm) for tips on proper breathing guidelines and additional exercises.

Quick Exercises

Each of these simple exercises can be practiced throughout the day when you have limited time but desire the benefits of relaxation.

In-Out Breathing

Breathe slowly and steadily. As you inhale, silently say ‘in’ and as you exhale, silently say ‘out’. Repeat for 5 to 10 minutes. Preferred mantras, terms, or images can be substituted for ‘in-out’, if desired.

Self-Massage

Use your fingers, hands, and fists to massage your facial muscles, neck, shoulders, arms, and/or hands. Focus on areas experiencing tension. During massage, practice deep breathing.

Relaxation Response

This exercise can be practiced with the eyes open or closed. Breathe deeply from your abdomen. Hold for two to three seconds. Exhale slowly. While exhaling, let your jaw and shoulders drop. Experience the relaxation response in your arms and hands, as well as throughout your body.

Walking/Wheeling Meditation

Being conscious of your breathing while walking or wheeling can be an ideal exercise to focus your attention on the present, in order to relax your body and clear your mind. Begin walking or wheeling until you establish a comfortable pace. Become aware of the number of steps or pushes you take between breaths. For example: breathe in 1-2-3-4, exhale out 1-2-3-4.

Progressive Relaxation
To learn a complete progressive relaxation series, go to http://www.healthy.net/Health/Article/Relaxation_Techniques_for_Relief_of_Anxiety_Stress/1205, or follow exercises indicated in Manning et al. (1999). To practice a tension-relaxation procedure, try the following: Focus on the muscle group you would like to target, such as your right arm. Inhale and squeeze this muscle group as hard as possible for about 8 seconds. Then, exhale as you release the tension. Experience the sensation as the tightness flows out of your arm, and through your hand and fingertips. Relax for at least 15 seconds, and then repeat the tension-relaxation procedure again for another muscle group.

B. Positive Thinking & Speaking
Similar to a computer, we save our ideas and beliefs within our consciousness, which have an effect on how we conduct and experience our life. Everyone has positive and negative thoughts, yet listening to positive thoughts can help you realize a positive disposition. It just takes practice. It is important to realize that the quality of the input from our consciousness can only be as beneficial as the input. If our mind operates like a ‘Yes’ machine, accepting all that we input into it, we must fill our mind with positive, life-enhancing messages.

The following exercises can be practiced to re-affirm the positive messages that you input in your mind:

Affirmations

Affirmations can be practiced throughout each day to reprogram positive messaging to your consciousness. Use words, prayers, poems, or sentences of your own that convey a positive message for you. Use the following guidelines to develop your own affirmation practice:

• State affirmations in the present tense, as if it has already has happened, and you are witnessing this occurring in your life.
• Use the pronoun ‘I’, or your own name.
• Repeat positive, life enhancing messages within a positive context. Do not, for example, utilize negative terms within the affirmation, ‘My neck is not in pain’.
• Be specific about the messages you want to realize in your life.
• Say affirmations aloud and speak while looking into a mirror to make a stronger connection with the message. Tape record the affirmations to establish a stronger sensory connection with the message. Make use of pre-recorded affirmation tapes/CDs. NOTE: do not listen to such tapes/CDs while driving or using heavy machinery.
• Write down your affirmations and display note cards in places where they are easily visible for you, such as on your computer monitor, vanity, and car dashboard.

Visualization

Visualization is a technique that can be practiced to envision what you would like to materialize in your life, whether it be better health, a clearer career focus, greater internal peace, or other qualities or outcomes.

• Relax. Find a quiet environment free of distractions. Wear comfortable clothing.
• Think about your goal.
• Imagine details: How will you feel? What will you be wearing? Who will accompany you?
• If necessary, record your impressions in a small notebook.
• Return to these images as much as possible throughout the day. Use affirmations to enhance and reaffirm your visualization exercises.
• To become more proficient, attend workshops, listen to visualization audiotapes, and consult books from your local library.

C. Goal Planning and Time Management
Goal planning and time management allows you to prioritize goals for your life, and how you are currently managing your time in order to achieve those goals. Note that determining your goals can be exercised in conjunction with visualization exercises.

Determining Your Goals

• Envision your goal and write it down. Don’t worry about correct spelling and grammar.
• Is there anything you need to achieve these goals in terms of knowledge and skills?
• Is there anything that could prevent you from accomplishing this goal?
• Who can help you in attaining this goal? Friends? Family? Co-workers?
• Detail steps to achieving your goal, with a realistic time frame.
• Visualize yourself in the future as already having achieved this goal.
• Once you have achieved any goal, it is important to acknowledge this by rewarding yourself in a tangible way, i.e., going for a walk with your friend, reading a good book, etc.

Set Time Management Priorities
As most of us perceive that our demands exceed our resources, necessitating our need to set priorities that will guide our actions. Each day on your TO DO list, determine which tasks are A, B, and C priority according to the following definitions. Note that these priorities can fluctuate on a day-to-day basis.

• Priority A: ‘Must Do’: High importance. These tasks have immediate deadlines attached to them and/or are critical for advancement.
• Priority B: ‘Should Do’: Medium importance. These tasks contribute to project development but do not have immediate deadlines.
• Priority C: ‘Could Do’: Less important. Can be rescheduled to do at another time.

It may also be helpful to schedule certain tasks for when you are experiencing the most or least optimal energy level during the day. For example, focus on activities necessitating higher intellectual acuity at your peak times, whereas routine office work can be done later, or delegated to others, if possible.

Time Allocations

• Sketch a large circle onto a blank piece of paper. In a pie chart format, color code slices to what percentage of time you are allocating to various activities throughout the day. Break down categories in ways that seem most useful, i.e., work, housework, leisure, exercise/health promotion, sleep, etc. This can give you a proportional representation to how you are spending your time.
• In a notebook, write down all your activities over the course of the day, including phone calls, e-mails, meetings, family responsibilities, transportation, socializing, etc. Review them and color code the time you are prioritizing your projects instead of others’ emergencies.

Simple Yet Effective Time Managmement Tips

• Determine your core values to determine your immediate and long-term goals, and a TO DO list of daily tasks.
• Use a simple, written TO DO list: Prioritize your essential tasks and work on the sequentially. Make sure it is written down and portable.
• Eliminate time wasters: consolidate errands, eliminate unnecessary meetings, etc.
• Do your most undesirable tasks first while you are full of energy, which should give you energy to do other tasks.
• Say ‘no’ to some tasks, and delegate those you need not do yourself.
• Strive for excellence, but know when perfectionism is unnecessary and impeding your progress.
• Consolidate time for returning telephone calls, e-mails, and handling mail and paperwork: By designating specific times for these tasks, they are less likely to interfere with deadlines and important projects.
• Stick to a schedule: Schedule ample time for sleeping, eating, running errands, and managing household tasks so that you will not feel rushed.
• Plan for emergencies: Get up 10-15 minutes earlier to account for the unexpected. Have extra sets of car and house keys for emergencies.

Stress Management Plan

Considering the stress management assessment that you have completed above, create mini action plans on addressing these stressors in a proactive way. Remember that making lasting behavioral change takes time to adopt on a permanent basis. Thus, propose do-able goals that you can adopt in the time available.

Mini Stress Management Action Plans
Examples of a few mini action plans could include the following:

• Institute an exercise program through going for a 20-30 minute walk or roll in your wheelchair at lunchtime. See the NCHPAD website or call NCHPAD at 800-900-8086 for a myriad of examples of accessible exercises that can be practiced in limited time periods.
• Take regular breaks and move regularly. Practice flexibility exercises at your desk with your arms, neck, and shoulders. A 5-minute break to the water cooler can also assist you with relaxation.
• Make a to-do list, and rotate your tasks on a daily and weekly basis.
• Start a daily practice of gratitude and mindfulness by recording one or two things you are grateful for in a small notebook. This practice can help you orient to a more positive outlook.
• Begin a relaxation program by practicing relaxation exercises in short 5-minute intervals throughout the day, such as in the morning, at lunchtime, late afternoon, and at bedtime. If possible, use a watch with an alarm feature so that you can completely release in the 5 minutes designated for your relaxation. Even closing your eyes and focusing on your breathing for a few minutes while sitting at your desk can help to affect a relaxation response.
• If you have a tendency to snack on food which is high in sugar and fat, prepare healthy snacks, such as cut-up vegetables with hummus, low-fat yogurt, whole-wheat toast with peanut butter, a slice of cheese with whole-wheat crackers, fruit.

A good stress management practice is developed through finding stress management modalities that suit you well and practicing them on a regular basis. Remember that just a limited amount of practice can have immeasurable effects on your well-being.