OBJECTIVES

To perform well under pressure, relax when under unavoidable stress

and eliminate background irritations that contribute to stress levels.
To improve the performance of employees under high pressure work
conditions.

WHAT IS STRESS?
Stress is the reaction people have to excessive pressures or other
types of demand placed upon them. It arises when they worry that
they cant cope.
Stress is the bodys automatic response to any physical or mental
demand placed on it.
Stress is the wear and tear our minds and bodies experience as we
attempt to cope with our continually changing environment

STRESS MANAGEMENT
Stress management refers to the wide spectrum of techniques and
psychotherapies aimed at controlling a person's levels of stress, especially
chronic stress, usually for the purpose of improving everyday functioning.

TYPES OF
STRESSORS

Internal

Lifestyl
e
c oices
h

Negativ
e self talk

Mind
traps

Caffein
e
Overloade
d schedule

Noise

Lack
of
sleep

Rigid
Exaggeratio Mechanical
breakdown
thinking
n
s

External

Personalit
y traits
Pessimist
ic
thinking
Selfcriticis
m
Over
analyzin
g

Taking
things
personally

Physical
Environme
nt
Perfectioni
Noise
st
Heat
Workaholi
Light
cs
s

Unrealistic
expectation
s

Social
Interactio
n

Organisatio
nal

Rudenes
s
Aggressiven
ess
Bullying

Commuting

Major
Life
Events

Daily
Hassle
s

Rules

Birth

Regulatio
ns

Death

Deadline
s

Lost
job

Misplaced
keys

TYPES OF
STRESS

Negative

Positive

SYMPTOMS OF
STRESS

Mental

Behavioral

Fatigue
and
headache
s

Confusion
and

Appetite
changes - too
much or too
little

Aches
and pains

Lack of

Physical

Disorientatio
n
concentratio
n

Breathles
sness

Difficulty
in making
decisions

Tingling
hands & Worry
feet

Panic
attacks

Increased
smoking
and drugs
usage
Restlessnes
s and nail
biting

STRESS FEELINGS
Eating
disorders anorexia,
bulimia

Emotional

Bouts of
depression

Impatience
and
Fits of rage
Deterioration
of personal
hygiene and
appearance

Tearfulness

 Tense
Tired
Frightened
Elated
Depressed
Anxious
Anger

SOURCES OF STRESS
Death of a loved one

Change in financial status

Divorce / separation

Change of job / work

Imprisonment

Mortgage or loan

Injury/illness (self / family)

Foreclosure of mortgage/loan

Marriage/ engagement

Change in responsibilities

Loss of job

Moving house

Retirement

Holidays

Pregnancy

Christmas

Sexual Problems

Minor violations of the law

HOW DO WE REACT TO STRESS

Lets look at some of the effects of this negative or bad stress. One of the
negative effects of stress is that our bodies respond to it by releasing a hormone
called cortisol. Research now indicates that sustained release of this stress hormone
cortisol can actually damage our brains (Drs. Sadek and Nemeroff).
Brainstorm
What ideas do you have about how the bad stress hormone of cortisol works in
our brains? How does it affect us?
Allow a brief discussion among participants on their understanding of cortisol and
how it affects our brains and behavior.
Some of us have heard of the fight or flight response, which was documented
by early research (Walter Cannon, 1932). It basically says we all have an innate
biological response (for animals as well as humans) to severe stress, whereby the
nervous system is aroused and the body releases the hormone cortisol. This stress

hormone helps us run faster or fight harder in life threatening situations. We

experience increased heart rate and respiratory rate, perspiration, increased muscle
tension and energy. This response is helpful for survival in threatening and
traumatic events like being chased by a lion, fleeing violence in a war or escaping a
burning car.
However, today the problem with our fight or flight response is that:
o It can be triggered (at work, at home) even if the situation if not life
threatening
o It has negative consequences on our health (makes us uneasy by
impairing the immune system, causing stress-related illnesses)
o It interferes with our ability to perform and make good decisions
o Makes us ineffective at our work and leaves us accident prone
o It reduces our ability to interact positively with others and enjoy life
The reality is that we only need to activate this fight or flight response in rare
circumstances for survival. However, our bodies can go into this type of response
with other kinds of (non-life threatening) stress, which is a problem for us and our
health.
An essential concept in stress management is that: We all need to look at ways to
keep our fight or flight response under control to avoid negative health
consequences and to prevent feelings of burnout in our personal and professional
lives.

COST OF STRESS
80% of all modern diseases have their origins in stress.

STRESS MANAGEMENT STRATEGIES

#1: Avoid unnecessary stress
Not all stress can be avoided, and its not healthy to avoid a situation that
needs to be addressed. You may be surprised, however, by the number of
stressors in your life that you can eliminate.
Learn how to say no Know your limits and stick to them. Whether in
your personal or professional life, refuse to accept added responsibilities
when youre close to reaching them. Taking on more than you can handle is a
surefire recipe for stress.
Avoid people who stress you out If someone consistently causes stress
in your life and you cant turn the relationship around, limit the amount of
time you spend with that person or end the relationship entirely.

Take control of your environment If the evening news makes you

anxious, turn the TV off. If traffics got you tense, take a longer but lesstraveled route. If going to the market is an unpleasant chore, do your grocery
shopping online.
Avoid hot-button topics If you get upset over religion or politics, cross
them off your conversation list. If you repeatedly argue about the same
subject with the same people, stop bringing it up or excuse yourself when its
the topic of discussion.
Pare down your to-do list Analyze your schedule, responsibilities, and
daily tasks. If youve got too much on your plate, distinguish between the
should and the musts. Drop tasks that arent truly necessary to the
bottom of the list or eliminate them entirely.

#2: Alter the situation

If you cant avoid a stressful situation, try to alter it. Figure out what you can
do to change things so the problem doesnt present itself in the future.
Often, this involves changing the way you communicate and operate in your
daily life.
Express your feelings instead of bottling them up. If something or
someone is bothering you, communicate your concerns in an open and
respectful way. If you dont voice your feelings, resentment will build and the
situation will likely remain the same.
Be willing to compromise. When you ask someone to change their
behavior, be willing to do the same. If you both are willing to bend at least a
little, youll have a good chance of finding a happy middle ground.
Be more assertive. Dont take a backseat in your own life. Deal with
problems head on, doing your best to anticipate and prevent them. If youve
got an exam to study for and your chatty roommate just got home, say up
front that you only have five minutes to talk.
Manage your time better. Poor time management can cause a lot of
stress. When youre stretched too thin and running behind, its hard to stay
calm and focused. But if you plan ahead and make sure you dont
overextend yourself, you can alter the amount of stress youre under.

#3: Adapt to the stressor

If you cant change the stressor, change yourself. You can adapt to stressful
situations and regain your sense of control by changing your expectations
and attitude.
Reframe problems. Try to view stressful situations from a more positive
perspective. Rather than fuming about a traffic jam, look at it as an
opportunity to pause and regroup, listen to your favorite radio station, or
enjoy some alone time.
Look at the big picture. Take perspective of the stressful situation. Ask
yourself how important it will be in the long run. Will it matter in a month? A

year? Is it really worth getting upset over? If the answer is no, focus your
time and energy elsewhere.
Adjust your standards. Perfectionism is a major source of avoidable stress.
Stop setting yourself up for failure by demanding perfection. Set reasonable
standards for yourself and others, and learn to be okay with good enough.
Focus on the positive. When stress is getting you down, take a moment to
reflect on all the things you appreciate in your life, including your own
positive qualities and gifts. This simple strategy can help you keep things in
perspective.

#4: Accept the things you cant change

Some sources of stress are unavoidable. You cant prevent or change
stressors such as the death of a loved one, a serious illness, or a national
recession. In such cases, the best way to cope with stress is to accept things
as they are. Acceptance may be difficult, but in the long run, its easier than
railing against a situation you cant change.
Dont try to control the uncontrollable. Many things in life are beyond
our control particularly the behavior of other people. Rather than stressing
out over them, focus on the things you can control such as the way you
choose to react to problems.
Look for the upside. As the saying goes, What doesnt kill us makes us
stronger. When facing major challenges, try to look at them as opportunities
for personal growth. If your own poor choices contributed to a stressful
situation, reflect on them and learn from your mistakes.
Share your feelings. Talk to a trusted friend or make an appointment
with a therapist. Expressing what youre going through can be very cathartic,
even if theres nothing you can do to alter the stressful situation.
Learn to forgive. Accept the fact that we live in an imperfect world and
that people make mistakes. Let go of anger and resentments. Free yourself
from negative energy by forgiving and moving on.

#5: Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce

stress in your life by nurturing yourself. If you regularly make time for fun
and relaxation, youll be in a better place to handle lifes stressors when they
inevitably come.
Set aside relaxation time. Include rest and relaxation in your daily
schedule. Dont allow other obligations to encroach. This is your time to take
a break from all responsibilities and recharge your batteries.
Connect with others. Spend time with positive people who enhance your
life. A strong support system will buffer you from the negative effects of
stress.

Do something you enjoy every day. Make time for leisure activities that
bring you joy, whether it be stargazing, playing the piano, or working on your
bike.
Keep your sense of humor. This includes the ability to laugh at yourself.
The act of laughing helps your body fight stress in a number of ways.

Healthy ways to
relax and recharge:
Go for a walk.
Spend time in
nature.
Call a good
friend.
Have a good
workout.
Write in your
journal.

Savor a cup of

coffee or tea.
Play with a pet.
Work in your
garden.
Curl up with a
good book.

Light scented

candles.
Take a long bath.
Listen to music.
Watch a comedy.
Get a massage.

#6: Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical

health.
Exercise regularly. Physical activity plays a key role in reducing and
preventing the effects of stress. Make time for at least 30 minutes of
exercise, three times per week. Nothing beats aerobic exercise for releasing
pent-up stress and tension.
Eat a healthy diet. Well-nourished bodies are better prepared to cope with
stress, so be mindful of what you eat. Start your day right with breakfast,
and keep your energy up and your mind clear with balanced, nutritious
meals throughout the day.
Reduce caffeine and sugar. The temporary "highs" caffeine and sugar
provide often end in with a crash in mood and energy. By reducing the
amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, youll
feel more relaxed and youll sleep better.
Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or
drugs may provide an easy escape from stress, but the relief is only
temporary. Dont avoid or mask the issue at hand; deal with problems head
on and with a clear mind.

Get enough sleep. Adequate sleep fuels your mind, as well as your body.
Feeling tired will increase your stress because it may cause you to think
irrationally.

STRESS MANAGEMENT TECHNIQUES

1) Organize Yourself.
Take better control of the way you're spending your time and energy so
you can handle stress more effectively.
2) Control Your Environment by controlling who and what is
surrounding you.
In this way, you can either get rid of stress or get support for yourself.
3) Love yourself by giving yourself positive feedback.
Remember, you are a unique individual who is doing the best you can.
4) Reward yourself by planning leisure activities into your life.
It really helps to have something to look forward to.
5) Exercise Your Body since your health and productivity depend
upon your body's ability to bring oxygen and food to its cells.
Therefore, exercise your heart and lungs regularly, a minimum of three
days per week for 15-30 minutes. This includes such activities as
walking, jogging, cycling, swimming, aerobics, etc.
6) Relax yourself by taking your mind off your stress and
concentrating on breathing and positive thoughts.
Dreaming counts, along with meditation, progressive relaxation,
exercise, listening to relaxing music, communicating with friends and
loved ones, etc.
7) Rest yourself as regularly as possible.
Sleep 7-8 hours a night. Take study breaks. There is only so much your
mind can absorb at one time. It needs time to process and integrate
information. A general rule of thumb: take a ten minute break every
hour. Rest your eyes as well as your mind.
8) Be Aware of Yourself.
Be aware of distress signals such as insomnia, headaches, anxiety,
upset stomach, lack of concentration, colds/flu, excessive tiredness,
etc. Remember, these can be signs of potentially more serious
disorders (i.e., ulcers, hypertension, and heart disease).
9) Feed Yourself / Do Not Poison Your Body.
Eat a balanced diet. Avoid high calorie foods that are high in fats and
sugar. Don't depend on drugs and/or alcohol. Caffeine will keep you
awake, but it also makes it harder for some to concentrate. Remember,
a twenty minute walk has been proven to be a better tranquilizer than
some prescription drugs.
10)
Enjoy Yourself.
It has been shown that happier people tend to live longer, have less
physical problems, and are more productive. Look for the humor in life

when things don't make sense. Remember, you are very special and
deserve only the best treatment from yourself.

SIMULATION ACTIVITIES
Burst Your Stressful Feelings with the Message in a Bottle Balloon
Activity

Rationale: Sometimes it just feels good to burst a balloon that was filled
with negative feelings and release the stress within.
In this stress reduction exercise, the client will write down negative thoughts
and feelings on a small strip of paper.
Once these thoughts are placed on the inside of a balloon you get the client
to try to burst the balloon with their hands or feet.
Materials:
-Balloons (Larger ones work best)
Strips of paper for writing down negative thoughts and feelings
- A sharpie marker to write the title of the feeling on the balloon or draw a
face on it.
Stress Reduction Directions:
1. Ask the client to disclose what is causing them stress. Have the client
write down these negative thoughts and feelings on a small piece of
paper.
2. Wad the thought up and insert it into a flat balloon.
3. Blow up the balloon half way (Do not blow up all the way as this will
cause the balloon to pop easily.
4. Encourage the client to give the balloon a title or name. The client can
also draw a face on the balloon that relates to the feeling.

5. The final step is to get the client to try to step on or hit the balloon.
This will take a while because the balloon is half way blown up. Give
the client plenty of space to try to pop the balloon.
6. After the balloon finally pops discuss with the client some other
activities to use for stress reduction.

Deep Breathing Exercise (Belly Breathing)

Audience: Activity is appropriate and can be adapted for all levels
Purpose: Students practice deep breathing techniques as part of
stress reduction
Materials: No materials needed
Content: Teacher/facilitator introduces and demonstrates the concept
of deep breathing as a stress reduction strategy that can be used in
the present moment as well as an excellent skill to master to more
effectively cope with future stressors. Teacher/facilitator has all
students stand with comfortable space between each other or seated
in a chair. Provide students with the following directions:
1. Stand straight up with feet shoulder-width apart
2. Arms and hands are relaxed downward
3. Body is relaxed
4. Eyes closed
5. Focus on lower abdomen (belly) and imagine a small balloon in that
space
6. Breath in slowly and deeply through nostrils, imagining the balloon
inflating (getting bigger/larger/growing) slowly, hold a few seconds
7. Slowly exhale through the mouth, imagining the balloon gently
deflating (getting smaller, shrinking); blow out of the mouth as if
blowing out a candle
8. Tip: Place a hand over the lower abdomen to feel it go up and down,
and make sure youre not breathing with the chest
9. Repeat at least 10 times Ask students how different their bodies feel
after the exercise. (Are they more relaxed/calm? Do they feel lighter?
Great? Tired?) Extension: Practice several times with the class until
they

achieve

comfortable

competence

with

deep

breathing.

Encourage students to practice on their own as well (e.g. while they

are waiting in line for something, sitting on the bus to school, at
bedtime, etc.). Have students teach the deep breathing technique to a
friend or family member. Once students develop this habit, they will
automatically go into deep breathing mode and relaxation.

Animal Charades (Physical Activity)

Target: Activity is appropriate for elementary students.
Purpose: Students participate in a fun physical activity to reduce
stress and tension. Materials: Several folded pieces of paper with
different names of animals on each A hat or container to hold the
folded pieces of paper
Optional: A CD or tape player (it can be fun to play music during this
activity) Content: Students pick a paper from the hat and figure out
how to present their animal charade. Since charades is a non-verbal
activity, playing music in the background can add to the fun of acting
out the animals. Instructions:
1. Depending on class size, break class into groups of 2, 3 or 4
students.
2. Write several different names of animals on paper; one name per
folded up piece of paper (students may help with this as part of the
activity).
3. Put names in the hat.
4. Each group picks a name and figures out how to present their
charade to the class. 5. Each group takes a turn presenting their
charade, while the audience guesses the animals presented.
6. Depending on time, number of groups and number of folded papers,
teacher determines how many rounds of charades each group
presents.

7. OPTIONAL: At the end of the activity, distribute paper, pencils, and

crayons/markers for students to draw and color their favorite animal.

Silent Ball (Physical Activity)

Audience: Activity can be adapted for all levels
Purpose: All utilize a fun, safe, quiet physical education activity to
relieve tension/stress
Materials: Use one or more Nerf ball(s), gator skin ball(s), or
lightweight ball(s). If you do not have one in your classroom, please
see your physical education instructor or appropriate staff person at
your school site.
Content: Trainer introduces the idea that physical activity is an
excellent stress management tool and explains the rules of silent ball:
Trainer is the only referee regarding bad passes and missed catches
Talking or making sounds is an out
Missed catch or bad pass is an out
A good throw is within arms length of the intended catcher and
does not include fast balls (model good throws for students)
Students that are out must remain quiet at their desks and not
interfere with the game in any way Instructions:
1. No one can talk or make a sound; that is the object of the game
2. Students may stand by their desks or position students in any
arrangement to facilitate tossing the ball to each other around the
classroom
3. Make a good throw to a classmate; explain that students cannot
throw back to the person who threw to them
4. If student misses the ball or makes a bad pass, student is out and
must sit at his/her desk until the next round
5. Play until all students are seated; last two are the champs!

Case study

Managing stress Joe's story

How stress develops and how it can be prevented if
people work together
This case study gives the individual persons perspective. It reminds us that
health, work and wellbeing is ultimately about people. It shows what can go
wrong if developing health conditions are not managed properly. It also
shows the difference we can make to the lives of individuals and their
families, to the success of business and to our society as a whole.
The story focuses on Joe, whose workload and stress levels are building up at
work and at home. The first video shows how such situations can quickly
become untenable and how, without the right support, Joes problems
rapidly multiply, until he reaches breaking point.
In the second video, we see possible solutions for Joes situation and how
Joes problems could have been prevented. The video shows how
government, health professionals, employers and individuals can work
together to find new ways of helping people to be healthy and productive at
work.

How Joes stress and workload increased at home

and work
Joe (on phone): Hi. Joe Wallace here. Yeah, Yeah. Thats fine.
Warehouseman: Joe! Joe!
Joe: Whats the matter?
Warehouseman: The machines down again.
Joe: That load needs to be done by three so youre going to have to do it by
hand.

Warehouseman: It isnt going to get done by 3.

Joe: Alright, let me clear my emails and Ill come and give you a hand
myself. OK?
Warehouseman: Its got to be done by 3.
Joe: Just get started on it.
Joe (on phone): SorryLet me just erm Yeah, I can do that, yeah.
Phone rings.
Second phone also starts to ring.
Joe: Hi Joe Wallace here. Yeah.
Baby crying.
Joes wife: Id thought youd be back ages ago.
Joe: Ive just been so busy.
Joes wife: Shes been playing all day. I dont know whats wrong with her.
Oh. Theres some rice in the cupboard.
A clock ticks.
Joes wife: Have you been awake for ages?
Joe: Yeah.
Phones ringing.
Joe: I cant cope with it. I need to be thinking about a dozen different things
at once. I just cant get anything done.
Doctor: Perhaps if you had a word with your manager.
Joe: Its me. I should be able to do the job.
Doctor: May be you need a break. Ive written you a note.
Joes wife: Joe! Just speak to them. They want you back. They understand.
Joe (remembering in echo): Let me check my emails.
Joes wife: Joe. If you dont go back you might lose your job.
Joe (remembering in echo): Hi. Joe Wallace.
Joes wife: Joe.
Collage of confused sounds.
Heartbeat.

How people can work together to deal with stress

Professor Dame Carol Black: The Health, Work and Wellbeing Strategy is
about realizing a vision everybody working together to find new ways of
helping people to be healthy and productive at work. Its a dynamic and
exciting new approach that brings government, employers, employees and
healthcare professionals together. This will generate major new benefits for
individuals, companies and the country as a whole.
Rob Miguel: Stress related problems are the most common reason why
people are off work. We can tackle this problem by working together.
Joes boss: I thought it was important to speak to you about it because you
seemed to get the brunt when things are difficult when things are difficult.
Joe: I definitely feel stressed when we miss deadlines.
Dr Steve Feast: Generally speaking reducing stress isnt just about
reducing workload. Its about all the other contributory factors which tend to
have an accumulator effect. Managers need to understand that.
Dr Chris Pugh: Its not just about looking after the individual, its about
managing the risks in the workplace and providing the necessary advice and
support mechanisms.
Joes boss: Youre a valued member of the team. If things arent working for
you then come and see me.
Joe: Thank you, yeah.
Rob Miguel: Were working with employers, our own safety representatives
and the relevant authorities to create a healthier and safer workplace. In
fact, in the long term, were trying to change attitudes to managing sickness
and absence.
Dr Su Wang: We launched our initiative over two years ago. It wasnt easy.
Since its been up and running, people have turned to work, remained in
work, in full duties.
Joe: I am actually. I am feeling a lot better, which is great.
Joes adviser: Good. Did you manage to get stuff sorted out at work?
Joe: I did. I had a really good conversation with my line manager. Weve
made a lot of changes and things are working a lot better, yeah
Dr Steve Feast: Work is good for us economically, psychologically, in any
way. So it makes sense for us to try and keep people in work wherever we
can.

Dr Su Wang: The key thing is to create a culture and programme so that

when problems arise they can be identified quickly and the solution tailored
to the individuals needs.
Dr Steve Feast: We all know the effects of being out of work long term.
People suffer, they suffer low self-esteem, they become demoralized and
they and their families suffer financially. Thats why its so important that we
keep it in work.
Dame Carol Black: None of us doubt the negative effects of smoking,
excessive alcohol consumption or obesity on health. But few of us have any
understanding of the value of work to an individuals health. Work is
important, not only for physical and mental health but also for social
integration. People are diminished by the experience of long term sickness
absence, loss of contact with the world of work, means they lose skills and
confidence in returning to work.
Dr Chris Pugh: There is no doubt that there are many situations where sick
leave is not the best option. This is certainly the case with mental health
conditions but also with certain physical problems such as back pain.
Woman patient: My backs feeling much better. Ive been managing fine at
the moment.
Woman doctor: Have you been keeping up with the exercise?
Dr Steve Feast: What were doing now is focusing much more on the
individual and not the problem. Were keeping our horizons wide. But what
we need to do is tailor something thats right and best for that individual
Dr Su Wang: By investing in our staff and their wellbeing we can actually
reduce costs. At Royal Mail we brought in a rehabilitation specialist to help
our staff return to their normal lives. And this is beneficial to not only them
and their families but to the organization.
Dr Chris Pugh: If we really want to break the cycle, we need new ways of
looking at illness. This also applies to chronic health problems, such as heart
disease, where we need to re-evaluate peoples perceptions and fears.
Male patient: My wife was a bit unhappy about me going back to work.
Shes concerned at the potential stress and bringing on another heart attack
Male doctor: Thats understandable but properly managed it is the best
course of action.
Dr Su Wang: The feedback from our people has been tremendous. Helping
them return to work after a long term absence has improved their wellbeing
and morale.
Male patient: Quite looking forward to it.

Professor Dame Carole Black: Of course there are no easy answers as to

how were going to achieve this strategy but we do know that there is more
that we can do to help people stay in work and be confident in returning to
work. That will take the combined efforts and skills of everyone involved. The
Health, Work and Wellbeing Strategy represents a unique opportunity for all
government departments and stakeholders to work together.