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STRESS MANAGEMENT A Practical Guide Owen Moran, MSc , RN Health Promotion Specialist Concordia University Health Services First, a word from your sponsor…. Concordia Health Services Doctors, nurses, psychiatrists, a psychotherapist, health promotion specialists

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STRESS MANAGEMENTA Practical Guide Owen Moran, MSc, RNHealth Promotion SpecialistConcordia University Health


First, a word from your sponsor…

  • Concordia Health Services
    • Doctors, nurses, psychiatrists, a psychotherapist, health promotion specialists
    • With or without appointment
    • General medical care
    • Mental health
    • Health Promotion
      • Health Notes newsletter
      • Individual counseling
        • smoking cessation
        • healthy eating
        • physical activity
        • stress management
        • healthy weight
        • sleep …
    • Condoms (4 for $1) and other items for sale
    • 2 locations:
      • Downtown: GM 200 (1550 de Maisonneuve W)
      • Loyola: AD 103 (7141 Sherbrooke West)

  • What is stress?
  • What causes stress?
  • Signs and symptoms of stress
  • 5-step guide to stress management
  • Healthy living and stress
what is stress
What is STRESS?

STRESS is the body’s physical response to a perceived demand or threat



Video on the “Fight or Flight” response see:

the body s response to stress fight or flight response
The Body’s Response to Stress(“ Fight or Flight Response”)
  •  Increased
    • blood to heart, muscles, brain and lungs
    • heart rate
    • respiration
    • muscle tension
    • blood pressure
    • metabolism
  •  Decreased
  • blood to digestive tract, kidneys and skin
  • growth
  • tissue repair
  • immune response
types of stress

Functional stress

Helps us perform better and achieve our goals


Overwhelming stress

Detrimental to health

Types of Stress
stress management why bother

Stress Management:Why Bother?

Ongoing and acute stress have been linked with a variety of negative health consequences

stress and health
Stress and Health
  • Immune system problems
  • Child and partner abuse
  • Suicide
  • Homicide
  • Alcohol and drug use and abuse
  • Tobacco use
  • Violence and aggressive behaviour
  • Accidents
  • Sleep problems
  • Sexual problems
  • Heart disease
  • High blood pressure
  • Stomach problems
  • Respiratory problems
  • Type II diabetes
  • Back problems
  • Headaches and migraines
  • Obesity
  • Rheumatoid arthritis
  • Cancer
  • Skin problems
  • Mental health problems
signs of stress
Increased heart rate

Dry mouth

Muscle aches, stiffness or pain

High blood pressure

Chest pains

Frequent colds, the flu or other infectious diseases

Weight gain or loss

Worsening of an existing illness

Signs of Stress

Physical Signs

  • Headaches/migraines
  • Indigestion
  • Constipation
  • Stomach cramps
  • Sweating
  • Nausea
  • Trembling
  • Fatigue
signs of stress1
Difficulty concentrating/focusing

Decreased memory

Difficulty making decisions

Mind going blank or mind racing

Signs of Stress

Mental Signs

  • Confusion
  • Loss of sense of humour
  • Decreased libido
  • Bad dreams
signs of stress2




Signs of Stress

Emotional Signs

  • Short temper
  • Frustration
  • Worry
  • Fear
signs of stress3
Increased smoking, drinking, drug use




Changes in eating habits

increase or decrease

Signs of Stress

Behavioural Signs

  • Changes in sleeping habits
    • increase or decrease
  • Nervousness
    • nail biting, fidgeting, pacing etc.
sources of stress
Sources of Stress
  • Something that causes the stress response is called a stressor
  • Can be real or “imagined”
  • Must be perceived as a danger
how we evaluate danger
How We Evaluate Danger
  • Perceived demands are greater than perceived resources in a situation/event
  • These demands and resources can be for:
    • Time
    • Money
    • Energy
    • Appearance
    • Intelligence
    • Knowledge
    • Support
    • Control…

Perceived Resources

Perceived Demands

If perceived demands are greater than perceived resources, the stress response is elicited



Perceived Demands

Perceived Resources

My credit card bill is $950.00


I have $420.00 in the bank

If perceived resources are greater than perceived demands, the stress response is not elicited


Perceived Demands

Perceived Resources



It will take me 2 hours to complete this project

This project is due in 6 hours

some stressors
Some Stressors

Physical environment:

  • Bright lights, noise, heat, cold, traffic…


  • Rudeness or aggressiveness in others
  • Conflicts
  • Not spending enough time with important people
  • Lack of social support
  • Loneliness...
some stressors1
Some Stressors


  • Taxes, bills, debt, unplanned expenses…


  • Rules, regulations, deadlines, work or school culture...


  • Poor health, physical illness, pregnancy, injury…
some stressors2
Some Stressors

Life events

  • Death of a family member
  • Unemployment
  • Illness
  • Work promotion
  • Birth of a child
  • Marriage
  • Winning the lottery...
some stressors3
Some Stressors

Lifestyle choices

  • Sleep
  • Time management
  • Nutrition…
5 step guide to stress management
5-Step Guide to Stress Management


Identify if you are stressed

identify if you are stressed
Identify If You Are Stressed
  • Look for signs and symptoms of stress
    • Get to know your response to stress
  • Seek medical attention for serious signs of stress
    • e.g. chest pains
  • Friends and family can help

Identify the stressor(s)

5-Step Guide to Stress Management

identify the stressor
Identify the Stressor
  • What is causing the stress?
    • Finances?
    • Work?
    • Relationships?
    • School?
  • Look for life changes when signs of stress began
  • Friends and family can help

Identify why it is a stressor

5-Step Guide to Stress Management

why is this a stressor
Why Is This a Stressor

Explore the demands of the situation and the resources you have to address it

Explore the situation as well as your perceptions about

Can be helpful to think in terms of “I don’t have enough….to deal with….”

What is dangerous about this situation?


Identify an appropriate stress management strategy and apply it

5-Step Guide to Stress Management

two general categories of stress management strategies
Two General Categories of Stress Management Strategies

Those that address the symptoms of stress

Those that address the cause of stress


Can be effective at reducing stress in the moment

Don’t get to the heart of the problem

They don’t remove the danger

These strategies “buffer” the body’s physical response to stress (i.e. the symptoms of stress)

Reverse the stimulation from the “fight or flight”response

Generally, these are relaxation strategies

Strategies that Address the Symptoms of Stress

short term strategies
Short-term Strategies
  • Breathing exercises
    • E.g. relaxing breath
  • Progressive muscle relaxation
  • Massage
  • Visualization / imagery
  • Meditation
      • Traditional meditation
      • Mindful meditation
        • Non-judgemental awareness, acceptance
        • Mindfulness-based stress reduction (MBSR)
short term strategies1
Short-term Strategies
  • Hot bath, sauna, hot tub
  • Exercise
  • Humour
  • Music appreciation
  • Sex
  • Hobby
  • Spending time with loved ones

They remove the danger

Two approaches

Problem-solving approach

Do something about the stressor so that it is no longer a danger

Cognitive approach

Change the way you think about the stressor so that it is no longer perceived as a danger

Strategies That Address the Cause of Stress



  • Define the problem
  • Analyze the problem
  • Brainstorm possible solutions
  • Evaluate each solution
  • Select and implement the best solution
  • Evaluate
Problem solving

Decision making

Skills You Can Use to Reduce Demands or Build Resources

Problem solving

Decision making

Critical thinking

Skills You Can Use to Reduce Demands or Build Resources


One way to build critical thinking skills is through the framework of Paul and Elder (


One way to build critical thinking skills is through the framework of Paul and Elder (


That mode of thinking—about any subject, content, or problem—in which the thinker improves the quality of his or her thinking by skillfullytaking charge of the structuresinherent in thinking and imposing intellectual standards upon them.



Apply intellectual standards to the elements of thought. Cultivate intellectual traits.

Elements of Thought

Intellectual Standards










Point of view










Intellectual humility

(vs. intellectual arrogance)

Intellectual courage

(vs. intellectual cowardice)

Intellectual empathy

(vs. intellectual close-mindedness)

Intellectual autonomy

(vs. intellectual conformity)

Intellectual integrity

(vs. intellectual hypocrisy)

Intellectual perseverance

(vs. intellectual laziness)

Confidence in reason

(vs. distrust of reason and evidence)


(vs. intellectual unfairness)

Source: Paul and Elder,

Problem solving

Decision making

Critical thinking

Time management

Skills You Can Use to Reduce Demands or Build Resources

You can’t increase the amount of time there is in a day

can’t change resource

Time management strategies seek to make effective use of the time you have

must modify demands on your time


two steps to effective time management
Two steps to effective time management

Identify values and set goals

Develop effective mechanisms




identify values and set goals doing the right things
A value is something that is important to you

Some values include:

financial security

interesting career

high standards

loving relationships

good friends


treating people fairly

fighting injustice


being good at your job


being good to the environment

Identify Values and Set GoalsDoing the Right Things


Spend your time in meaningful activities

Set goals about where you will spend your time based on your values

Set priorities based on your values

This increases your sense of purpose

Contributes to better mental health

There are several resources on the Internet (e.g. as well as books that can help


Identify Values and Set GoalsDoing the Right Things

some strategies to be effective with your time
Some strategies to be effective with your time:


  • Be realistic
  • Plan out daily activities
  • Use a “to-do” list
  • Delegate
  • Take advantage of “wasted time”
  • Manage interruptions
  • Build organizational skills
Problem solving

Decision making

Critical thinking

Time management



Skills You Can Use to Reduce Demands or Build Resources

Problem solving

Decision making

Critical thinking

Time management




conflict resolution



Skills You Can Use to Reduce Demands or Build Resources

  • Academic skills
    • writing
    • presentation
    • studying
  • Specific work-related skills
    • computer program
  • other skills…
strategies that address the cause of stress cognitive approach
Strategies that Address the Cause of StressCognitive Approach
  • These seek to identify stress-producing, maladaptive thoughts (cognitive distortions) and replace them with adaptive ones
  • Usually achieved by modifying perceptions so that perceived resources are greater than perceived demands
    • Perception of demands is decreased and/or
    • Perception of resources is increased
3 levels of cognitive distortions
3 Levels of Cognitive Distortions

Negative automatic thoughts (NATS)

  • Thoughts that immediately come to mind in a situation
  • E.g. “I am not going to make friends when I move to Montreal”

Rules and assumptions

  • Rules: How the world should work, how you or others should behave
    • E.g. “Everyone must be courteous to others”
  • Assumptions: If….,then….
    • “If I make a mistake at work then people will think I am stupid and laugh at me”

Core beliefs

  • Beliefs about self, others, the world or the future
  • “I am a failure”, “The world is a dangerous place”, “You can’t trust people”, “I will never meet a partner and get married”
how to modify stress provoking thoughts
How to Modify Stress-provoking Thoughts
  • Several strategies are effective in modifying negative automatic thoughts; rules and assumptions; and core beliefs
  • These strategies are rooted in cognitive therapy
  • Two common approaches are:
    • Cognitive restructuring
    • Socratic questioning


What is the Activating event

What are the Beliefs (thoughts) you have about A

What are the Consequences (emotional response, feelings, behaviours) from this way of thinking

Disputing this belief to find alternative thoughts:

-evidence for thought(s)

-evidence against thought(s)

Effective outcome-how will you feel if you change the way you think



I met with my thesis supervisor and she had many comments about my work.

My supervisor doesn’t like the work I am doing. I will never finish my thesis. I will never have a good career.

I feel stressed. I feel stupid. I feel sad.

I have received many comments in the past on my work and have used the critique to improve it. My supervisor has always been supportive. I have succeeded in all of my academic work in the past…surely this won’t be the first time I fail. The University does not want me to fail and will support me.

I feel hopeful, intelligent, encouraged, not stressed.

What is the evidence that X is true?

What is the evidence against X?

What might be the worst that could happen?

What leads me to think that might happen? If it did happen, what would I do? How would I cope?

Have I been in similar situations in the past? How did I cope then?

How does thinking this way make me feel?

SOCRATIC QUESTIONING: A technique to modify cognitive distortions

Am I thinking in a biased way? (e.g. cognitive distortion)

Am I paying attention only to one aspect? What if I looked at it from a different angle?

What would I say to a friend who kept on saying X to herself?

What might I tell a friend to do in this situation?

What would my friend say to me?

SOCRATIC QUESTIONING: A technique to modify cognitive distortions

Is there an alternative explanation?

Is there any other way of seeing this situation?

What are the advantages and disadvantages of thinking this way?

Is thinking this way helpful or unhelpful?

What would it mean to me to see things differently?

SOCRATIC QUESTIONING: A technique to modify cognitive distortions

Am I making decisions based on my feelings?

Is there something else I could say to myself that might be more helpful?

What do I think I could change to make things better for me?

How would I like things to be different?

What would I like to do instead?

What would have to happen to make that possible?

SOCRATIC QUESTIONING: A technique to modify cognitive distortions

categorizing common cognitive distortions
Categorizing Common Cognitive Distortions
  • It can be helpful to categorize cognitive distortions
    • The cause of stress for some people is the repeated application of a category of cognitive distortions
    • Can streamline stress management strategies
      • E.g. If your stress is often caused by focusing on the negative aspects of a situation, then learning to think more positively will help tremendously with stress management
healthy living and stress
Healthy Living and Stress

Good health helps prevent stress as well as enhance your ability to manage it. Healthy living for stress includes:

  • Eat well
  • Be physically active
  • Get sufficient quality sleep
  • Consume alcohol in moderation, if at all
  • Don’t use tobacco
  • Establish and maintain healthy relationships
  • Cultivate good mental health
  • The stress response stimulates the body to respond to a danger (real or perceived)
  • Negative consequences are associated with ongoing stress
  • 2 main approaches to stress management
    • 1. Strategies that address the signs of stress
      • Relaxation
      • Short-term
    • 2. Strategies that address the cause of stress

A) Do something about the stressor (problem solving approach)

        • Decrease demands and/or increase resources

B) Change the way you think about the stressor (cognitive approach)

        • Change perceptions of demands and/or change perceptions of resources
  • Adopt behaviours that enhance health and make you better prepared to deal with stress when it arises
further resources
Further Resources
  • Relaxing breath online
  • Breathing exercises
  • Mindful meditation
      • Mindfulness for Beginners (Jon Kabat-Zinn)
further resources1
Further Resources
  • Critical thinking
    • Critical Thinking: Tools for taking charge of your professional and personal life (Paul, R & Elder, L.)
  • Time management
    • First Things First (Stephen Covey)
  • Negotiation
    • Getting to Yes (Roger Fisher and William Ury)
  • Assertive communication
    • How to say “NO” in the Health Notes newsletter, March 2005
further resources2
Further Resources
  • Cognitive restructuring
    • Feeling Good: The new mood therapy (David Burns)
    • Mind Over Mood (Greenberger and Padesky)
    •’s online self help book, especially Chapter 5: Changing behavior and thought
further resources3
Further Resources
  • Healthy living
    • Consult the Concordia University Health Notes newsletter online ( for information on:
      • nutrition (September 2009)
      • physical activity (October 2009)
      • sleep (December 2009)
      • smoking cessation (December 2009)
      • healthy relationships (January 2010)
      • building good mental health (February 2010)