Stress Management

The Development of Health Promotion Program Guides for the Workplace

By Pamel, Rose Ward B.N.

A Projec',ubmin fd to tbe F.culty or Eduutioninpani.1'u)fJllmen' of 'he rtouirtmeotsfor

'he dam of Master of[d uca l ion

F.culty of Eduation MemorialUni"eni ty of NewfoundJand

, ...

SL John's,NF

ACKNOWLEOOEMENTS

I would liketo thankmyfaculty supervisor.Dr.HarryEIlion. forhis sapportandguidanceintheplanninganddevelopmcmofthisprojectHisprompt and supportivefeedback.hispatience,as wellas lxisaccessibilityhavebeengreatly appreciated

Iwouldalsoliketo Ihankmy family for theirsupport.especiallymy husbandand myparents,withoutwhoseencouragementandsupportIcouldnot have completed this program

Finally,Iwouldlike10dedicate thiswork to thememory of myuncle.Or.

AustinJHarte,whoIhroughhis fiiendship andgreata«:omplishment5..,inspired me10strivetoanainmygoalofhighereducation

This projectprovidesapractical approachtothedevelopment ofprogram guideswhichserveasthe mainresources for selectedhealtheducationsessions withina workplace wellness program.Fiveguideshavebeendevelopedwhich strivetomeet a numberof needsidentified withinthis relativelynewfieldof education.Thegoal ofthis projectistoprovidematerialwhich is comprehensive anduserfriendlyfortheeducator/facilitator,whileensuringaproduct whichmeets thehighexpectationsof organizationsinterms of efficiencyandeffectiveness in affectingemployeehealthbehaviors

The guidesprovidethe facilitatorwith materialandresourcesneededto deliverqualityeducationsessions.Activitiesare includedto promoteactive involvement on the part of thelearner,in keepingwith atransactionalapproachto learning. These guidesmaybeused withinanynumberof settingswithin the workplace,andprovide a foundationfor the developmentof guideswhichcover other healthrelatedtopics

Table of Contents

I) Introduction .

2)TheNeed forProgram Guides...

. 1

...2

3) TheoreticalFramework .4

4)APracticalApproachtoProgramGuide Developmen t.... . ....7

5)ProjectDescription 11

6) Conclusion.; ...15

7)References.... . 16

The conceptofhealth maintenanceandthe promotionof healthyactive lifestyleshas becomea pervasivethemewhich permeatesalmost everyfacetof the worldin which we live.People areconstantlystrivingtolivelonger and improvethe overall qualityoflife.This themewhichoften dominatesour home lifehasalso carried overinto the workplace.Organizationsare beginning:to recognizethevalueof ahealthy workforce, considering the cost ofhealthcare relatedleaves.downtime,and importanceofoverall workermorale.Theseorganizations are also beginning10playa role in theinstitutionof healthpromotionwithintheirsystems.

Saphire(1995)defined health promotionas"theanof helpingpeoplechange their lifestyletoward a stateof optimalhealth"(p.570).Oneof the mostvital aspects of this promotionis education.For thepurposeof thisproject.I chose10focus on this aspect ofheallh promotion.Theneed for healtheducation in the workplacehas givenrise10the conceptof workplacewellnessprograms.Theseprogramsprovide onsite health educationon a broad numberof10piaranging fromback care to menopause.Organizationsaremost ofteninterestedineducational activitiespresented on apart-time basis.however.someorganizations have gone so far as tohire a full time healtheducator.Theimplementationof such programs most oftenfallsunder the responsibilityof nurseeducatorswithinthehealtbcare sector.

Asanurseeducatorandcoordinator ofa workplacewellness program.I am responsible for the developmentand delivery of healtheducation and promotioninthe worksetting,including the determinationofcoursecement andcurriculum, as well as thecoordination ofother nurses whomustpresent various topics. While workingin suchaposition, 1feel I havegained some insightintothe healthneeds of myclients andthepopulationasa whole Thisinsight,along withtheknowledgegainedthrough severalgraduateeducationcourses,hasallowedme todevelopa projectwhichcanbe appliedin a practicalmannerwithinmy field. Thisprojectdirectlyaddressesa number ofneedswithinthe fieldof worlc:place wellnesseducation.

The Need for ProgramGuides

Traditionally,health educationandhealth promotionhas beenconsidered the responsibilityof public healthandthe goalof anumber ofheallh related special interest organizationsstriving 10increase awarenesson particularissues.Until recently,employerswithinthebusinessandgovernmentsectors,have not accepted partof thisresponsibilityand thushealtheducationwithinthe workplacehasbeen verylimited.Asorganizationsbegintorecognizethe benefits of healtheducation withintheworkplace, there hasbeenan increaseddemandfor healtheducation services

One must recognizethatwithin businessand governmentsectors, accountabilityisextremelyimponantifthe programis tobesuccessfulAswith any businessventure, organizationsin this instanceexpectto gettheir"money'sworth".

They expect an educationalproduct which is:

I}effective-inthatitshouldresultin an overallincreaseinemployeehealth, decreased healthrelatedtimeoff work,and positiveemployeefeedback. 2)~is-in thatit should provide allvitalinformationin a shan timeperiod 3) interesting-in thatit shouldengagethe learnerin the educationalprocess to increaseoveralleffectiveness.

Sincetheconceptofworkplacewellnessprogramsisrelatively new.and consideringthat most educationsessionswithinthe workplaceare limited to1-2 hour

"hmch-n-leam'sessions, it is notsurprisingthatthe availabilityof programteaching guides which promote efficiencyand effectivenessis limited.Through evaluationof the presentteaching resourcesinthe chosen subjectareas,I have recognizeda distinct need for programguides which are more comprehensiveandeducator/facilitator friendly.Manyof the availableguidesare poorlyorganized,poorly referenced.and are lackingin direction, resourcesandactivitieswhichpromote activeinvolvementon the pan of the learner.Infact,a numberof the "packages"viewed weremerelya compilationofinfonnation onthegiventopic.In keepingwith these considerations, the specificneedswhich were identifiedin developingtbis project are listedas

follows

I)improvedorganization:conducivetothe provisionof educationwhichis meaningfulandefficient.Thefacilitator shouldfeelcomfortablein conducting the education sessionwithlimitedpreparation.The guidesshould provide distinct sectionsoutliningobjectives,course content.mediaapplications and learner involvement

2)greaterselectioncf'resources:whicharemorereliable andcurrent.ensuring the inclusionofrecentresearch

3)greater utilizationof media:includingoverheads. video and printed material.

4)increased facilitationoflearnsinvolvement:emphasizinga shiftfrom a strictlyIransmissionalapproach 10amore transactionalapproach.allowingfor learnerinputand evaluation

TheoreticalFramework

Workplace wellness programs are basedontheconcept thaianindividual's healthrelatedbehaviorpatternsmay influencehis orheroverall level ofheaJth.

Proponents of such programssuggestthatifhea!thbehaviors canbepositively changedormodified,thenone'shealth shouldimprove and the incidenceofiUness shouldbereduced.Heaney&Goetzel(1997)stated that there remains"little doubt

thatbehaviorsplayanimportantroleinthe etiology of disease"(p.30S).This statementis supportedbySalazar(1995)whosuggestedthaimanydiseasesorhealth problemsare behaviorally based.Healthbehaviors,according 10Salazar,arerootedin a person's attitudes and beliefs with regards to their health.These "attitudesand beliefsare oftenmodifiableandhencetheyprovideaconvenienttargetfor health promotion"(p.3I S)

Saphire(1995)presented workplacehealth promotionasoneeffective intervention.Healthpromotionwithintheworkplacesetting. accordingtoSaphire.,is

".process thatsupponspositivebfest)iebeha-.iorsthroughcorporatepolicies.

individuallydirectedefforts10lowerriskof diseaseandinjuryandcrealionofan environment thatsupportshealthenhancing activitiesandbehaviors"(p570).Itis seen"as an educationallyorientedprocess ofplanned changewhichfocusesonthose behaviorsorproblemsthatdirectlyor indirectl.yaffectpeoples'health"(Ross&.Mica , 1980,p,7)Itsintentis"tomcrivareindividualstopenonalizehealthandlifestyte informadoninsuchafashionIJwtheywillmake positivedecWonsaboutpc:nonaI health"(Anspaugh,Hunter,.tMosley,1995,p.203)

AccordingtoSalazar(1995),progmndn·e1opersandfacilitatorsare challenged tobesensitive10the complexityof humanbehavior and difficultiesin changingbehavior.Programsmustbedesignedtomeetthe educationalneeds of employees through considerationoftheiredueationallevd,healthattitudes,

motivation. and socialsupport(Pugh, (992;Strychar,Shannon.Sowa&Wang.

1992)

Thenumberof organizationsand corporationsofferingworkplacewellness programshasincreased dramaticallyin recentyears. Wilson,Holman,&Hammock (1996) stated that81%of aUU.S.worksitesoffer some type ofhealthpromotion program. The motivationfbrthis rapidgrowth, above andbeyondthe ethical and moral obligationsof employersas presentedbyStokers,Pelletier&Fielding(1996),is cost effectiveness.Healtheducationandpromotionactivities atthe workplacehave resulted ina reductionofinsurance costandemployeeabsenteeism (Fries eral,1994 Anspaughetai,1995:Popp,1989),Inareview of 48 studies of comprehensive healthpromotion programsintheworkplace.Pelletier(1993) found thathealth educationandpromotionalactivitiesfacilitated reduced healthcare costs,improved overallemployee healthandmorale, andimproved employeehealthknowledge Heany&Goetzel(1997).ina reviewof47studiesof healthoutcomesofmulti- component workplace wellnessprograms, foundthe reduction of absenteeismto be the most consistentresultfollowing implementation.Goetzel,Kahr,&Aldana(1996), inan evaluationofthe effectiveness oftheJohnson&Johnson"Live for Life"

program found thatpanicipantsreportedsignificantly fewerabsenteeism hours than non-panicipantsandthe number of employeesconsidered tobeathighrisk was

reduced

Cogwdl-Anderson&Anderson(1991)found thatworIcplacewe llness educationproducedsignificantresultsinassistingemployeestomakecertain positive healthrelatedbehaviorchanges.Follow-up.. as notseentoproducesignificantly betterresults.Erfurt,Foote.&Herrich(1991),in contrast toAndcnon&Anderson.

found that although education significantly affectedemployeehealth behavior.

educational follow-upandcounseling provided resultswhichwere morestatistically impressivethan thosewithout follow-upand counseling

A Practical Approach to Program Guide Denlopment Theliterature clearly shows that healtheducationinthe worlr.place.,produces positive resultsforbothemployeeandemployer.Theresponsibilityforthesuccessful implementationof such aprogramlieslargely withthe health educator.Health educationprogramsmustprovidetheproper informationin themosIeffectiveand efficient format.This informationmustbestructuredto producehealthbehaviorand attitude changesin employees.whichbecomeevidentto employers.,whetheritbe through decreased absenteeism,improved morale orpositiveemployee feedback.. Indeveloping programguideswhichare tobeutilizedwithinaworksetting. it was impo rtan tto ensurethat theyprovidedthefacilitator/educatorandthelearnerwith

current information, in themost effectiveandefficient format.To accomplishthis, currentliterature oneachtopicwas researchedand reviewed.and relevant information was incorporated intothelearningmaterial.Medicaltermsandjargon werelimitedinnumberand clearlyexplained whenusedwithintheprogramguides Concepts and health issues were presentedinrelatively simple. uncomplicated terms toaccountforvariationsin lea.nereducational/learningbackgrounds. Thoseissues whichwere lesspertinentbut relevantwere presentedinsectionsclearly markedas optional.Inthis instance the facilitatorisexpectedto use his or her discretionto determinewhetherthesesectionsshouldbeused, dependingon timeorthe panicular learning group

Theguidesdevelopedwithin thisprojectwere structuredinsucha wayas to addressthepreviouslystated needswithregardstoavailableteachingpackages.For example. the need forgood organizationwas centralto the developmentofthis project.The programguideswere designedto enhancethe easeof presentationonthe panof the nurse/facilitatorwho mustconductthe learningsessionwith limited preparation.Aclear table of contents was provided.followedby a descriptionof guidestructureand directionswith regards to howit shouldbeused.Through efficient organizationtheseguidesare more user friendlyand requirelinle timein termsof facilitatorpreparation.Objectiveshavebeenclearlystated so the facilitatoris

awareofttJegoals ef thesession.Sessioncontentisdesignedto answer anumberof distinctquestions whichawfyto theseobjectivesto facilitateeaseofprescm:ation Iconsareusedtoprovide thefacilitator withadequate instructionwith regardsto placementofoverheads.specialnotes,andsuggested acthitiesOverteads, activues, referencesandresourcesare placedinappendicesfolJowingsessioncontentandarc clearlymarkedforthe facilitalor'sconvenience.

Aspreviously stated,manyof the availableguides orleachingpackagesas theyare referredto,arelackingincurrent referencesanddirectionwith regards10 resources (whereto access pamphlets,videos,and usefulinfom ationonthegiven topics)Thisprojecthasaddressedthisneed byclearly referencingallsourcesof informalionused withinthegiven guidesand presentinglheminacco«iancewith APAguidelines.Theguidesalsoprovide namesandaddressesof organizationslTom

\lrhicheducationalmaterialsmaybeordered, as wellas suggestedvideoswhichmay beprovidedon Joan.A lisaof imemetsiresisprovjdedwhichaHoM the facilitator andIorIeamerto access uJHo-daIeinformationonthegivaJ topic.Finally,a backgroundessayonlhegiventopicisprovidedforthelearner.This serves to clarifY orreinforce sessioncontent

Theneedfor uultaencn of moreeffective mediaisquiteevident when reviewingavailablepackages on thegiven topics.Ofthe availablepackages reviewed,

10 most provided too few or toomanyoverheadswhich didn't coo rdinat e properl y with

thecontentprovided. Many werevisuallyunappealing,utilizinglarge amounts of black on white textandveryfew graphics.Thisprojectattempted to improve the visual appealandtheeffectivenessofoverheadsbypresentingthem withlarge colorfulfonts and clipart.Thefacilitator is providedwitha clear outlinewhich presents the numberedoverheadsincorrect order.Whilepresenting thesession

content. the facilitatoris clearly advisedofthe needfor anew overheadbyicons placednexttotheoverhead number

The facilitatoris also provided withthenames of suggestedvideoswhichmay be used alo ng withtheprogram guideiftime allows.These namesare also

accompaniedbynamesand addresses oforganizations which lendthesevideos freeof charge

Finally,thisprojectaddressesthe need foractive involvement onthepanof thelearner.Withlittle timetoprepare activities whichwillengage thelearner,nurse educatorsmayopt for a transm issional approach,whichmaynotbe themost effective ineliciting positivehealthchangesinthe learner.The guideswhichhavebeen developed within thisprojecthaveincludedsuggested activities,thegoal ofwhich is 10ensureashiftfromastrictlytransmissionalapproachtothatofatransactional approach,so the learnerfeels likean activeparticipantinthelearning process

11 Activitiesarc:clearlymarkedusing icons and arcexplained to the facilitator. Any required handoutsare foundinappendix. B afthe guides.

The importance ofJeamer involvementand the need for a transactional approach tolearningis emphasizedwithinthe sectionon purpose and use of the program. Facilitatorsare stronglyencouragedto usethe activitiesand involvethe learneras muchas possible.The use oflearner evaluationformsalso allowsthe [earnerto provide input and feedbackwith regards to the learning sessions.

ProjectDescription

The projectconsists of a seriesof5lunch-n-learnprograms guideswhich are beingutilizedwithina workplacewellnessprogram.Theseguides have been designed as independentunits whichserve asthekeyresources for learning sessionson the giventopics.These topicsinclude

I) SImsM,nnemrnl"

~Stress Management:The Key to SuccessfulLiving!

This guidefocuses on"

-tbetypesof stress (positive and negative.acuteand chronic):this elementincorporatesastress scaleinwhichthe learnercan measurehis orher overall stresslevel.

-the effects of stress onone' s overalllevel ofhealth:this elementinvolves a discussionof thepsychologicalandphysicalramifications of stress.

-strategiesto reduce stress athomeandintheworkplace:this element familiarizes the learnerwithstress reductiontechniquessuchas progressive relaxation,imagery,time management,and meditation

Z)~

~HeanHealth:A Matter of Necessity!

Thisguidefocuseson:

·a briefdiscussion of the anatomyandphysiologyof theheart.

-discussionsof suchconceptsas hem attack,angina., hypertensionand contributingfactorsThis elementincorporatesdiscussionsand activities regarding risk factors,prevention.signs and symptoms,emergencyresponse andtreatment,aswellas commonmythsregarding hean disease

3) SmokiDICHutNn:

~SmokingCessation:AWonhwhile Venture!

This guidefocuses on

·a discussionofwhy peoplesmokeconsidering the conceptsof addiction.

12

IJ

habitand socialization.Thelearner is encouraged to participateinactivitiesto determine his or her mainreasons for smokingandthesituationswhichtrigger smoking

-adiscussionof tobaccofacts and immediateand long term effects including effects of second hand smokeand smokingin pregnancy

-adiscussionof the stages ofchange involvedin the decisionto quitand remainsmoke-free

-strategies to help quit smoking andremain smoke free.The learneris provided with informationon how tocope with withdrawaland nicotine craving

4) Osteoporosis

Ii!!t;.Osteoporosis:The SilentThiefl This guide focusesQO"

-a discussionof osteoporosis withregards tothecontributing factors,who is affected.howit ismanifested.

-involvementofthe [earner in a checklist to determine risk factors.

-2discussion of measures used to diagnose, prevent, and treat osteoporosis -20discussion of measures to reduceandcopewithpainrelated to

14 osteo porosis

5) Ergonomic::s

Tille:Ergonomic s:A Sensible Ap proach to WorkplaceSafely!

This !l!Jide focuseson

-thedefinition of ergonomics:asystem in whichthe workorjobstation is designed to properlyticthe worker,instead of the worker having tofit the workstation.

·a discussion ofhow thework environment can contributeto healthproblems such as ell's(cumulativetraumainjuries)and backinjuries.Thisincludesa discussionon signsandsymptoms andtreatment ofthese injuries

·adiscussionoftheprinciples of ergonomicsand howtheycanbeused to reduce worksite injuries

-intormationon properwork site setups withregards to ergonomically designedfurniture,proper positioning,andbodyawareness.Thiselementalso incorporates activeinvolvement of the [earnersin terms of assessingthe efficiencyof theirown work sitesandsuggestingergonomicalternatives.

-a discussionof the barriersto ergonomicswithinthe workplace

l5

With the recent trendtoward the healthyactive lifestyles,the field ofheailh educationhas seena markedincreaseintheinterest in workplacewellnessprograms. Many employersarerecognizingthatthe promotionand maintenanceof a healthy activeworkforcefacilitatesan increase inpositive employeehealth attitudesand behaviors.allowingfora healthier,moreprod uctiveworkforce,while also reducing healt h related spendinginthe form ofsick [eave and health insurance.

The rapid growthin thisareaofhealth educationhas providedaninteresting andchallengingfocusforthedevelopmentofthis project. Consideringthe challenges withintheworkplacewithregards 10health education,the guides provideinfonna tio n whichensures facilitation oflearningwhichisrelevant and effective.Throughthe presentationof wellresearchedand organizedmaterial.thegoals

or

16

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17

Cogwell-Anderson.R..&Anderson, E.(1991).Worksitehealthpromotion:

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Stress Management

A Key to Successful Living!

A lunch-n-learn program guide.

By: Pamela R. Ward

Table of Conte nts

I)Purposeof this module .

2) Structureand useofthis module...

...1

. 1

3)Leamerobjectives... . .3

4)Sessioncontent What is Stress?..

. .4

... ... ...4

Is Stress Always a Bad Thing? 6

How DoesStressAffectUs? 7

DoWeAllExperienceStressin theSame Way? 10

HowCan WeManage Stress? 12

5)Overheads .

6)SuggestedActivities .

. ....AppendixA

. AppendixB

7)Referencesand resources Appendix C

8)Learner evaluation form Appendix D

PU[jloseof this module

This modulebas been developedinresponse to a need for well organized,interestingand efficientlearningmaterialon the topic of stress management.Itis intendedto provide nurses facilitatinglunchand learn sessions, withaccurate,up-to-dateinformation and supporting resources,whichcan be effectively presentedwithlimitedtimepreparation.

Structure and use of this module:

The nurse/facilitatoris providedwithlearnerobjectives,alongwithall infonnationand resources (includinghandoutsand overheads)required to aid the learnerin achievingthese objectives. Other resourcesare referencedand maybe usedto support or enhance the material provided.Also,suggestedlearner activities are provided,which support the material and encourage participationon the part of the learner.The facilitator is notifiedby icons when to display overheads, when to carryout activities,and when to takespecial note of certain information:

. , ~displayoverhead

1M ..

~ •take specialnote

...

The contentpresented inthis moduleisdivided intodistinctsectionswhich serve to answerS mainquestions:I)Whatisstress'?2)Isstress alwaysabad thing? 3)Howdoes stress affect us?4)Dowe all experiencestress inthesameway?and 5)Howcanwemanagestress?Apresentation of objectivesassociatedwith these questionsencouragesthe learner to contemplatethetopic beforerelevant informat ionisprovided.

Thismoduleisintendedtobeutilizedinatypical1-2 hour lunchandlearn session.As noted onthetitlepageitisto beusedasaguidetoaninteractive learning session.Itisnotintendedtobe presentedinlectureformal. The learner should be encouragedto sharehisorherviewswith regardstothegiven topicwhile becominginvolvedinthesuggestedactivities.The facilitatorisencouragedtouse the moduleto initiateandpromotediscussionand interaction.

Consideringthismodulecovers sessionsrangingfrom 1·2boursin durarioe, some materialisconsideredoptionalThis materialis clearlymarked.Itisthe responsibility of the facilitatortodeterminewhetheroptional materialshouldbe included.withconsiderationto timeandthe particularlearning group.Inaone hour sessionfor example, mucb ofthe optional material maybeomitted.

Learner Objectives

Followingthis learningsessionon the topic ofstress management,the learnerwill:

1) be able to define stress and differentiatebetween positiveand negative stress.

2) have gained a greater understandingof howstress affects us, both physicallyand mentally.

3)recognizethat everyone experiencesstressin a differentway.

4) haveassessed his or her own levelof stress utilizingthe Holmes&Rahe SocialReadjustmentRating Scale.

5) be familiarwithtechniquesusedtoreduceor manage one'sstress level.

~Objectives maybe presentedtothe learner as handouts oroverhead.Anoverheadisprovided.

OVERHEAD# I ., "t

Cover"StressManaeemenl(thisoverheadisintended to be usedwhileintroducingoneselfandthetopicathand.Itshouldbe placed ontheprojectorbeforeyou beginthis session).

OVERHEAD

2 .,

'-

LeamerobjectiveS(theobjectivesshouldbepresentedtothe learnerbeforethecontentis presented).

OVERHEAD #3 .. "t

WhatisStress?

Theconceptofstressis a complex andvariedone.Itseemsmostpeople havea differentviewof whatstressactuallyis.Stress canbe viewedina numberof differentways.

AccordingtoRice (1992) stress maybe viewed in three ways:

I) as an internalstateof mental arousalor tension.

2)asan extemal orenvironmental stimuluswhichcauses the person to be tense or aroused.

3)as the body'sphysicalreaction to the demands placed uponit.

OVERHEAD#4

..

When consideringthe concept ofstress it is importanttoaccept a definition forstress.Forthe purposesof this presentationweshall definestressas:

"The physicalandmentalresponse of thebodytodemandsmade uponit".

OVERHEAD#S

..

Ifwe accept thisdefinitionfor stress,then astressorinthis case couldbedefinedas

"achallengeorthreattothe mindorbodywhichelicits sucb a response" .

IsStress Always a BadThing?

Stressisnotalwaysbod.Humansrequiresomedegreeofstress tofunction.

Toolittlestressprovides uswithnochallengeorincentivetobe alert,productive people.We become bored and unmotivated.Toomucb stresshowever.canresultin ourinabilitytoadaptor cope thusnegativelyimpactingour mentaland physical health.

~ote:Theclassshouldbeprompted togiveexamples ofpcsmveand neganve srress

OVERHEA D#6 ..,

-.

....Thissection re:obj ective#I isoption al.w

Selye(1974) described positive and negativestressas EustressandDistress.

According10Selye:

1)Eustnssdescribes experiences whichalthough stressful,arebothpositive andpleasurable,resultinginanincreaseinproductiveness.Itisseenas something which increasesour mentalacuityandmotivatesus10acceptchallenges.Thistype

ofstressisoftenshorttermoracuteinnature.

ExamplesofEustress:

·aweddingday -graduation -birthofachild

2)Distressdescribesexperienceswhichare negativeinnature andare damagingto one' s overall level of health;both physicallyandmentally.Thisstress is oftenchronicandongoing,leading ultimatelytoanxiety,panic,andinability to cope or adapt.

ExamplesofDistTn.s:

-ongoingfinancialhardship -personalorfamilyillness -jo bdissatisfaction -maritalorrelationshipdifficulties

How Does Stress AlIcet Us?

Ashwnans, we prideourselveson beingadaptableto changeandresilientin thefaceof crisis.Whenstressis chronicor longlermhowever,weoftenfind

ourselves unable10bandIethedemandsof such stress.Whenwelosethe abilityto cope oradapt wefindourselvesincrisis.Thismanifestsitself both physicallyand mentally.

OVERHEAD^I)~: #7

..

Accordingto Cooper(1979),"continuedexposure10astressful situationor thatwhichthreatens security.selfimage.prideorgeneralwellbeing of the individualcan leadto stale of anxiety" (p.8).Anxietyintumresultsina fear response.Thisinitiatesanumberofresponsesfromournervoussystems.

These include:

Ibreathingrate anddepth Ibloodpressure

Iheartrate

Iblood flow tomajormuscles

Ibloodflowtointernalorgansnotneeded for "flight".(stomach intestines, kidneysj.w 'Ibefacilitatorshouldexplain the concept of fightorflight.^"'U

secretion of adrenaline

Sote'These responsesuse up a great deal of energyAprolonged stress responseoften resultsinexhaustionwhichultimatelyweakensthe immune system,leavingthe person moresusceptibletoillness and disease

OVERHEAD2)Mentally and Emotionally:#8

..

Althougha certain levelof stressperiodicallycanbepositiveinthat it stimulates alertness,clear thinking,and increased productivity,too much stresscan resultindifficultythinkingand confusion.When experiencing prolonged stress, people becomepreoccupiedwiththe problemwhetheritberealor perceived.This preoccupationresultsin:

•irritability - insecurity

• fear

• anger -frustration

•depression

10

Chronicallystressedpeopleoftenbecome:

-lesssocial -more hostile

OVERHEAD#9

.. "t

Do All People Experience Stress in the Same Way?

Althoughstress is aphenomenonwhich affects every humanat onepoint or another,somepeoplemaybemore susceptible tothenegative effects of stressthan others.The way we dealwithstressdepends ona numberof contributingfactors suchas:

I)InteDsityloddura tionofstr ess:

Stress becomesmoredifficultto copewithwhenintense and long lasting.

2)Socialsupport:

Peoplerespond positively to interaction,conversation, feedback, informationandadvice.

\I

3) Prior 'J:oerieocc with stressful situations:

Ifthe person has had a positiveoutcomewhencopingwithstressin the past,be orshe ismore likely tocope better when facedwithstress again.

However, lithe personbashad a negative outcome whencoping withstress inthe past,heorshemay findit more difficulttocope with future stress.

4)KnowledgeDreDpingstrategies:

Peoplewho possesscertaincopingskills mayutilizethemeffectively to reduce their levelsofstress or preventa certain degree of stressaltogether.

OVERHEAD#10

.. "t

5) ~:In1974twodoctors.MeyerFriedmanand Ray Rosenman described Type A personalityor behavior pattern.They suggestedthattypeA personalities are moreproneto coronaryarterydisease.Theseindividuals are seenas highlystressed,drivenpeople.Thiswas one of the firststudies to link stressto illnessordisease.Type: Apersonalities, accordingto Friedmanand Rosenman, are often impatient,highly competitive and aggressive.They sufferfrom"burrysickness",

12

Incontrast.typeBpersonalitiestend tobe morepassive,patient,relaxed individuals.They can pace themselvesaccordingto workloadand don'tfeela generalsenseofneedingtohurry.

SUggfiCedActi\'ity: Distributethehandout provided entitled..Criteriato determineType A behaviorpattern".Theteamer shouldbe allowed5·10minutes to completethisquesnonnaire.Thisshouldbe followedby a discussionof Type A behavior. Alt hough the [earner isnot requiredto divulgehis or her results.they are welcomedto volunteerinformation. Forexample:did thesebehaviorpatternsseem familiar?Were you aware this was typeA behavior'!

OVERHEAD# 11 ~ What is Stress Management?

'*

Stress managementis asystemthatprovidestools to help copewithstress.

Through utilization of suchtoolsone can learnto regulateODe'slevelsof physiologicaland emotionalstress.

13

OVERHEAD#12

J,

What are the goals gIstress management?

I) To identify and assessstrnsoninone's life.

-People mayoften be unaware of manystressors in theirlives.Iftheyare awareoCtbestress, they are often unawareof the degree to whichit impacts their lives.

2)10empower peopletocopewithstrm or remove strnson from their lim.

-Thismaybedonethrough relaxation andother stress reducing techniques such as progressiverelaxation.imagery and positivethinking,meditation, and timemanagement.

3)To apnly tbm techniques and skills inODesdailylivestoCQDewith

~

Suggc5led activity:Present thelearnerwiththehandoutentitled Holmes and RaheSocialReadjustment Rating Scale.The learner shouldbeallowed 10 minutestocompletethisscale.The learner shouldbepresented with scoringfor thescaleandgivena coupleof minutes to tabulatetheresults Theseresultsdo nothave tobeshared withthe class.This shouldbe followedbyadiscussion of thesressorswhichimpact us all. The learner should begivenopportunity10commenton the thingstheyfoundtobe stressfulaccording10 thisscale

14

OVERHEAD#13

..

Thereare a vast nwnberof stress reduction techniquesinexistence.The followingis a list of some popularexamples:

1)Progressive relautioo:This techniqueinvolvesthe progressive contractionand relaxationof majormusclegroups,one at a rime,leading toa completelyrelaxedstate.

Sotr :Many think it' s paradoxical or contradictoryto tense musclesfor the purposeof relaxation.However. according10Beech eral(1982), - researchdemonstrates that whena groupof musclesis tensedfora few secondsandthen instantlyrelaxed.a greater decreaseof tensionmaybe achievedthan byattempting to relax themusc lesbyletting go; the momentumasit were, allowsthetensionin themusclesto drop far below theadaptat ion level" (p 47)

SUllftledaeci"ity~Provide the [earnerwiththehandoutentitled"

ProgressMuscleRelaxation Exercise".The learnershouldbegiventime

[0readthishandout.Thelightsshould thenbeloweredand the learner instructedto sitina comfonable position with hisor her eyes closed.The facilitator shouldthen take 10-15 minutes toguide the learnerthrough this exercise.If'timeislimited the learner can simplyreadthe informationand practice the technique atalatertime

IS

2)~:This techniqueisdefinedas asystem of mental focusing wh ichis said to producealphaWQ\'es(afourth state of consciousnessor wakefulbypometabolic stale becauseenergy expendituregoesdown).

(Benson.,1975).Itis derived from ancient Hindu societyin which meditationwas considered..thehighroadto spiritualenlightenment' (Rice.L992,p.334).Someresearchersargue thatmeditationmerelyresults ina generalstaleofrelaxation as opposed to an alteredstateof consciousness.Most agreehoweverthat it isconduciveto stress reductionandimproved health.

o-This inform a tionre:meditati on is optional.' P

The concentrationandmental focusingproducedby meditationresultsfrom a numberof factors:

- therepetitionofmantra-this canbeany word. symbol,or sound -rhythmic brealhing.

-thoeghtblockingtechniques-notallowing obtrusive thoughtstobreak concentration.

-allowinga generalstateof relaxationto occur withoutthinkingabout relaxation.

16

Fouringredientsare necessaryformeditationto beeffective:

1)aquietenvironment

2)anobjectonwhichto focusmentally 3)a passive attitude

4)a comfortableposition(avoid positionswhichareconduciveto sleep).

~.Meditationis oftenadifficultundertaking.Thelearnershouldbe made awarethatitwould be impossibleto leachin asho rtclassperiod Classesinyoga andmeditation however are oftenavailablewithinthe community.Theseare normallytaught bypeopleknowledgeableinthis area whopro..idethelime needed10learn this technique

3)lmum::This technique isbased00athoughtproeesswhichutilizesthe imaginationandallofthesensestoevoke stress relieving and relaxation producing images.Like meditation,imageryissaid topromoterelaxationand maintainaphysicalandemotionalbalance inthebody.Unlike meditation however,imageryisaneasier techniqueforbeginnerswantingtolearna tension reducingmethod.

17 Whenwe produce a thoughtor visualize an imagein ourmindsit stimulates the nervoussystemsto respond.For example:

I) Apowerfullyfearfulmental image resultsina fear responseinour bodies(asdiscussed earlier),leadingto:

~theartrate -lbloodpressure

~Ibreathing rate

.Isweating

-tblood flowto majormuscles

2)A powerfullyrelaxing mentalimage results in:

-Iheart rate

•Ibloodpressure -Ibreathingrate -Irelaxationof major muscles

18 To produce images whichare relaxing and stress reducing,the individual

should focus on: (Zahourek, 1988)

a favoriteplace- can be fantasy.vacation, nature. homeetc.

positive experience-real or imagined,may draw upon previous relaxingexperiences.

allsenses-forexample.one may visualizea deserted beach.In doing soaUof the senses shouldcome into play.One shouldtry to smell thesaltairand taste thesaltwater,listen to the sound of the waves crashingagainst the shore, feel the sand WIder your feet and see thepalmtrees swayingin the wind.

Imagerymaybeusedinthe workplace to enhance one'sego and increasejob performance and motivation.The individual might use positive thinkingto picture himselfor herselfin a positive situation,achievinghis or her goals, gainingrecognition and appreciationfor his or her efforts.Self-talk maybe usedas a formof assertivenesstrainingusingsuch phrases as "I am smart","1 amcompetent", or"Icanandwillachievemy goals".

19 Suggested aUi"jty:distribute the handou tentitled"Imagery Exercise".This exerciseisasimpleexampleofimageryand providesthelearner witha scale to measuretheirabilitytoimaginethe givenscenario.Theclass mayeither take5-10minutesto review thescenariothemselves orthe facilitatormay instructtheclass to closetheir eyes andlisten to thescenarioas read bythe fac ilitator.The learnershouldbepromptedtoprovide feedbackon hisorher responsetothescenario

4) Time Management: This technique bas been definedas..the efficient use of our resources,includingtime.insuch a way that we areeffectivein achievingimportantpersonal goals"( Ferner,1980,p. 12).

Inorder to manage time effectivelyitis importanttorecognizeone's weaknesseswithregards to time. Youmust askyourself: - Do youavoid work?

~Areyou interruptedoften?

• Doyou consideryourself a perfectionist?

• Do you procrastinate(put off until tomorrowwhat you can do today)?

• Are youindecisive?

• Are yousuffering fromwork overload?

[fyou answeryes to manyor all of thesequestions,thanaccordingto Rice (1992),youareinneed of someeffectivetimemanagement skills.

20

OVERHEAD#14

..

How CanWe ManageTime Effectively?

I)~:

( Rice,1992)

• Set goals andreevaluatethem on a regular basis(a to-dolist).-goals shouldberealistic andachievable.

~Set targetdates.

2)Followthe Pareto Principle: "thevitalfew and thetrivialmany".

-Devotethe majorityof your time tothe mostimportantandvaluable tasks.(One can be very efficient,butifyour doingthe wrong thing. task time is wasted.)

3)Don'tprocrastinate:

-Breaktasks downintosmallerparts so it appearsmoreattainable.In thisway,getting started is easier.

21 4} Concentrate onthe eSsentials:

-Conquerthe essentialtasksfirst.Worryabout non-essentialslater.

5)Learntodelegate:

- Delegatingtasksto others can free up timefor other tasks.

6) Ma.rktime and progreSS

•Create check listsand project calenders.

- Cross tasksoff when donesoyou can view whathasbeen accomplished.

7)~:

- Don' , overloadon work.This can be counterproductive,resultingin stress and workburnout.

&It:Time managementshouldbe viewedas a tool tobeused when needed.It is not to beconsideredadaily chore or thisinitselfmay producea stressresponse.

Remember!

Itis importanttorecognizethat peoplearenot slavesto stress. Wecan do somethingtoreduceor moderatethelevel of stressinour lives.Thekey tomanaging one'sown levelof stress istobecomeawareof the stressorsinone'slifeand accept responsibility for controllingor eliminatingthese stressors.

AppendixA

• .,

OVERHEADS

Oyrrhpd Oudio!!

Overhead#1 Ovcrbea.d#2 Overhead#3

[b - ^{~ .} .. ^~ ...._._. . _ -

t ^{=-- =====- - ._-- :::::.. -._--}

Overheads4 Overltead#5 Overhead# 6

Overhead#7 Overhead#8 Overhead# 9

Ovcrhead#10 Overhead# 11 Overhead#12

~ :::::.::.... ==- = ^c.&... _., - ~ '"''''''''''''

~ :=.

_ .. ::: _ ---- =.. -

Overhead#13 Ovcrhead# 14

Objectives

!l following this session the learner will:

define and dlnerentlate between +\le and -ve stress.

be aware of how stress anects us.

recognize that everyone experiences stress dlnerently.

nave assessed his or her own stress teve],

be familiar with stress management techniques.

3 WAl'S TO VII~W STRI:SS

rl As an internal stimulus.

~ As an external stimulus.

&'i As the body's response to external

demands.

= ^{(i ,... --} _\IJ

= _{eo '=} ^(II _{=" rD} ,...

rD=,= -t

== ^{=" (I)} rD

,=(II~

= rD (II = _. (I)

=.... ^~

_. ,... =

,... _{:: =" =} -

• rD

=

='eo &=

-e rD ,...= _{= ,...}

Co!. rD

= =

=

Co (II

Stressor

"a challenge or threat to the mind or body which elicits a

stress response".

Types of Stress (Selye, 1974)

~ fustress- experiences which, although stressful, are pleasureable and positive.

iii Distress- experiences which are

negative in nature - damaging to overall

health.

Physical meets of 5tress~ ~1 P i

1. "

," , J

!l -t- breathing rate & ~ -t- blood flow to

depth major muscles

~ -t- blood pressure

~ -t- heart rate

~B ~ blood flow to organs not needed for flight

ii1 -t- secretion of

adrenaline

~ ^,

^"

" ,. L =:;-"

it ~frustratlon II ~ Irritability

Mental and [motional [ffects of Stress

~ ~ Insecurity ~, ~ depression

s ~ fear r. ~ hostility

~ ~ anger , ; -I- socialization

now We Cope With Stress Depends On:

li Intensity and duration of stress ni social support

~ previous experience

l§ available coping strategies

~ personality

Type 4 Personality

~ more prone to heart disease

~ highly stressed I competitive lJ impatient

~ aggressive :" .

Stress ~anagement

" a system that provides tools to

help cope with stress".

fioals of Stress ~anagement

iI To Identify and assess stressors.

I To empower people to cope stress.

IE To apply these techniques.

Stress Reduction Techniques

II Progressive Relaxation Al Imagery

~~ ~edltatlon

:.;; Time ~anagement

fffective Time prJanagement

~ Set priorities

~ follow Pareto principle

~ Don't

procrastinate

~ Concentrate on the essentials

1~ Learn to delegate

11; Mark time and

progress

1t Take a break

SUGGESTED ACTIVITIES

Appendix B

(Holmes&R.he,1987)

STRESS MANAGEMENT

The Social Readjustment RatingScale

.~~

nvmember

Stress Value 100

7355 63 63 53 50

47To To

..-

4039

39

Number of limesyou exper ien cedthe event inayear

Your total life change sco res

39

3a37 3a 3s31 30"

2929 292a 2a26 2524 2320"

20"

20"

19 iB iB 17 16

15 15

13

12 11

Evaluation of Life Changes

Highscoreshave beencorrelated withvulnerabilily 10 ilinesssooacc;:lclenls If yoorscoreIs above300il aces nol alwaysmeanyouwill oetsickor hav 8An800Mnl veopierespc no onereonstome samesrressorstora venety of reasons

People witha high score who are",Iready in dlstrll';$l'Ifealgreaterrisk Mode rate Score

Hlgh SCOIlI

150 300

300

Evaluation of life Changes

400.~,.... 300 '300 " .,

~

laMo . d~~~j;-~;";J

8

en 100

o

1 2

Moderate High

cJI4

Criteria Used to Identifv Tvpe A Behavior Patte rn

Rice11991)(3dap(ed(romFnedm1n&;Roscnm3ll{197-1l.-1 I Doyouoveremphasize some Ulordin speechand hurry

thelast words in yoursentence?

_.Do}'OUalways move. eatand walk rapidly?

Areyougenerallyimpatientandgetirritated when things do notmove fastenoughtoryou"

.. Doyoufrequentlytryto domorethanonethingat a time?

S DoyougenerallytrytomovetheIOpicofconversation toyourowninterests?

o Doyou feel some senseof guill when you arerelaxing'

7 DoyOU frequentlyfail 10 lakenoteof newthings inyour environment?

8 Are youmoreconcernedwithgetting(han beco ming?

9 Doyouconstantly try10 schedulemore activities inless rime')

10.Doyoufindyourself competing with other peoplewhoare alsotime-driven?

11.Doyouengageinexpressi...egestures,clenchingafist orpoundingthetabletoemphasizeapoint,whileengaged inconversation"

Yes_ No- V"

-

-

V"_ No

-

Yes- ^No

-

V"

-

V"

-

-

V"

-

-

V"

-

-

V"- ^No_

V"

-

-

V"_ No

-

12Doyou believethatyour fast pacetsessennarto yoursuccess?Yes_ No_

13Doyou score successinlife intermsofnumbers:numbersof

sales, cars, and50on? Yes_ No_

Sc;:ori ne'Ifyouansweredmostof the"y es"then you wouldbedescribedasalypeA personality.Ifyouansweredyes to overhalf of themyoumightstillberegarded astype A,but notanextremetypeA.

Imagery Exercise

Sitina relaxedpositionand closeyoureyes.Imagineyouareina kitchen,~P5your kitchen Hear anysoundsyoumightbeerinthisplace.sec thecolon. smellthesmeUs...and)'OUslowty walkover totherefrigera tor Feeldle doorhandleand«sresistance asyou pullanit...fedthe coldairthatwaftsOUIasyou.openthedoor.theligh tcomes oninthefridge

Go10thaI placeinthe fridgewhereyoumightkeephuiL.reachinandlakeout a bigyello w lemon.Feelthe weight ofthelemoninyour hand.its texture..,the coolnessof'its skin.Now close thedoorandwalk.overtowhereyou mightcut up fruil.Putthelemonon acutting serface,;pic:kup a knife __.feel itsweightandbalanceinyourhand.Nowcutthe lemoninhalf- see the beads ofjuice on the knife' smell the fain!smelloflemon.Now cutone halfinto quarters...pickupa quan erofthelemonand bringitup toyournose-smellthesharp scent- now bringitto your mouth andlake a bigbiteofthatlemon. ,okay,comeback intothe room Refl« ting on Ihe just completedimageryexercise circlethe numberthatbest relates toyour exper ience:

I.Could~OIIimdl lhekmon~

2 Could~OIIrcdthe:kmon.

doorhandle.ete'"

~,Coulch Ollhc:u sounds'l

7.CouId)ou 5(:nsc~our body lTIO'oin&~

;'liotAt All

l •

VeryClearly

'0

10

10

Progressive Muscle Relaxation Exercise (Rice,1992)

Thisexercisefollowsasequence of alternatingtensionandrelaxationin16 majormuscle groups.The sequence isnot necessarilyimportant. lt is up tothe individualto followtheirpreferred sequenceinorderto promotemaximal relaxation.

Find a comfortableposition.Youshouldtenseortightenup the givenmuscle, holditfor 10-15secon dsthenrelaxthemuscle for15~20seconds.Itis sugges ted thatgreaterrelaxati onoccursifamuscleistensedprior torelaxation.

1) preferredarm 1)alternate ann 3)preferredhand 4) alternatehand 5)shoulde rmuscles

a) preferredhandside b)alternateside

6)neckmuscles- headtochest and sidetoside 7) forehead,eyes,scalp

8)jawsandmouth (tongue-may use extra step) 9)breathing- chestandtrunk-deep breath and exhale 10)stomach

II )lowerback (2) buttoc ks (3 )preferred thigh 14) alternate thigh 15)preferred foot andcalf 16) alternatefoot and calf Goals:-2sessionsperday

- Jrepetitionsfor each musclegroup

·1()..I5 seconds for tension -15-20 seconds for relaxation

Appendix C

REFERENCES

AND

RESOURCES