CN INS IES Ged en cg) oa abel Sie eA @ SC (Ona se 700,000 COPIES SOLD The Relaxation & Stress Reduction WORKBOOK FIFTH EDITION SIMPLE, CONCISE, STEP-BY-STEP DIRECTIONS FOR MASTERY OF: Breathing * Progressive Relaxation * Meditation * Self-Hypnosis * Visualization Refuting Irrational Ideas * Thought Stopping * Worry Control © Coping Skills me Exercise © Nutrition * Time Management ® Assertiveness e Job Stress Management * Quick Relaxers = Martha Davis, Ph.D. * Elizabeth Robbins Eshelman, MSW * Matthew M‘Kay, Ph.The Relaxation & Stress Reduction WORKBOOK FIFTH EDITION: Martha Davis, Ph.D. Elizabeth Robbins Eshelman, MSW Matthew M¢Kay, Ph.D. New Harbinger Publications, Inc.All of the authors of this workbook wish to dedicate this book to our families Without their continuous support, this book would not be possible. Thank you, Bill and Amanda, Don, Judy, Rebekah and Jordan,Preface to the Fifth Edition The year 2000 marks the twentieth anniversary of the first edition of The Stress Manage- ment and Relaxation Workbook. The authors of this book look back over the years, asking what inspired us to write it to begin with and what spurs us to rewrite it today. In the late seventies and early eighties stress management was not a household word as it is today. But more and more frequently stress was at the root of why people were seeking psychotherapy and medical consultation. There were virtually no classes or groups to teach people how to handle stress. There were no books that provided under one cover sufficient tools for people to manage their own stress. While a few intrepid individuals spent a good deal of time and money on books, workshops, and psychother- apy to piece together their own stress management plan, many people continued to live lives compromised by chronic stress. Observing this problem, the authors of The Stress Management and Relaxation Workbook began offering stress management and relaxation workshops. Through trial and error, they compiled their own workbook of techniques that were easy to teach and were most effective in alleviating symptoms of stress. They decided to publish this workbook for the lay public to fill a vacuum in the popular psy- chology literature. Stress is defined as any change to which you must adapt. In the past twenty years the rate of change in our society has continued to accelerate, so it is not surprise that the rate of stress related illnesses has also continued to climb at an alarming rate. Fortunately, there has been an increased interest in stress management and relaxation on the part of researchers, the mass media, and the lay public. The authors of this workbook, in review- ing the literature on stress management and relaxation, have found that most of the con- cepts and techniques presented in our first workbook have stood the test of time and research. Some of the techniques have undergone refinement, while others have multiple variations that give the reader more choices. ‘As the authors of this workbook continue to work in the field of stress management, we are excited to be able to offer in the fifth edition a number of new techniques for chal- lenging problems. For example, we have added a chapter on “worry control” to help peo- ple manage their mental stress. Due to popular demand, we have included in the Copingxii The Relaxation & Stress Reduction Workbook Skills chapter a section on how to handle anger-provoking situations. In the Thought Stopping chapter we have added “eye movement therapy” as a means to not only stop distressing thoughts but also to neutralize them. Throughout the book, content, examples, and bibliography have been updated. One of the major stressors today is information overload. With this thought in mind, the authors have made a number of changes in the fifth edition to simplify your accessing the information you need to address your specific stress management questions. We have added an expanded table of contents and a subject index. We have deleted portions of some chapters that we considered nonessential and shortened others to save you time. We have made the text more readable by breaking it up into more clearly defined learning chunks. We thank our readers for your continued support and your feedback, which you have generously given us over the years regarding what you find most effective about the book, the situations in which you use it, and what you want to see added or changed in the next edition. As in writing our first edition, today we are motivated to keep improv- ing this workbook on the basis of this feedback.How to Get the Most Out of This Workbook This workbook is designed to teach you the most popular stress management and relaxa- tion techniques and exercises used today. Consider it your guide to increasing your awareness of your personal reaction to stress and building your sense of control and mas- tery over the stressors in your life. We hope that this process will give you more pleasure and less frustration in your life. Read chapters 1 and 2 first. They are the foundation upon which all of the other chapters are built. After you have read the first two chapters, you will know enough about stress and your personal reactions to stress to decide which chapters it will be most helpful for you to read next Chapters 3 through 12 teach techniques for relaxation. Chapters 13 through 15 help you with your stressful thoughts. Chapter 16 assists you managing your time more effec- tively so that you can free up time to relax and do more of what is most important to you. From chapter 17 you can learn to communicate more assertively and chapter 18 gives you many options to deal with environmental and interpersonal stress on the job. Chapters 19 and 20 teach the basics of nutrition and exercise and their relationship to stress manage- ment. Chapter 21 gives you some hints to increase motivation, deal with problems that come up along the way, and stick to your plan. ‘A basic premise of this workbook is that the benefits of relaxation and stress reduc- tion techniques can only be fully realized after they have been practiced regularly over a period of time. Intellectual understanding of most techniques is of little value, unless ac- companied by first hand experience. Whether you plan to use these techniques for your- self or in a professional setting to help others who are experiencing stress, your personal experience is key. The purpose of regular practice is twofold. First, it will ensure that you will be able to consciously carry out the exercise instructions anytime you need to, without having to refer to written materials. Second, regular practice will help you develop the habits at an unconscious level.xvi The Relaxation & Stress Reduction Workbook The length of time required each day to practice the relaxation techniques in this workbook varies. To start, we suggest that you spend ten to fifteen minutes twice a day doing the exercises of your choice. Make a contract with yourself. Consider the time you spend practicing the exercises you find to be most helpful a reward or a break. You can decide to expand the time you give yourself to relax as you discover which exercises work best for you. Choose a quiet place where you will not be interrupted to learn the techniques. Since this is new activity for you, it is wise to explain to the people around you what you are doing. Politely ask them to help you by leaving you alone without distractions. You'll find that family members, fellow office workers, and friends tend to be very supportive of these exercises once they understand what you are doing and why. If you find it difficult to stick to a daily schedule or discover that barriers such as motivation or time get in your way, we have a couple of suggestions. * Consider doing the exercises with another person. That way you can share your experiences and give and receive encouragement. * If time is always the excuse, make an appointment with yourself just like you would make an appointment for a haircut or with a friend for lunch. If you have to cancel, immediately set up the next appointment or date. If you still have trouble accomplishing what you set out to do, turn to chapter 21 for addi- tional suggestions. If you are over thirty or if your reaction to stress involves physical symptoms such as frequent headaches, stomach problems, or high blood pressure, make an appointment with your doctor for a physical examination before you begin these exercises. Tell your doctor or health-care provider that you intend to practice relaxation and stress manage- ‘ment techniques and ask him or her to determine whether your physical symptoms are caused entirely by stress, or if there are physiological causes as well. Your doctor can be a supportive partner in your efforts to live a more healthy life. Once you start your pro- gram, consult a physician if you experience any prolonged negative physical effects.The authors wish to acknowledge the following contributors to the fifth edition. Their expertise, experience, and collaboration have made this a more valuable edition. Andrea Epel, M.P.H., R.D. is a Behavioral Health Program Coordinator at Kaiser Perma- nente’s Oakland Medical Center in northern California. She has developed, evaluated, and taught programs in stress and pain management and mind-body approaches to health for over ten years. She has degrees from Stanford University and the University of California at Berkeley. Ms. Epel contributed to the Meditation chapter. Caryl B. Fairfull, R.D. is a Registered Dietitian and member of the American Dietetic Association. She has provided individual and group nutrition counseling, developed nutrition care guidelines, and managed the Department of Nutrition Services for Kaiser Permanente’s Santa Clara Medical Center in northern California. Ms. Fairfull wrote the Nutrition chapter. Cheryl Pierson-Carey, P.T., M.S. Is currently a Care Management Consultant with the Care Management Institute in the program offices at Kaiser Permanente in Oakland, Cali- fornia. Her clinical specialization is in neurologic physical therapy. She holds degrees from Indiana University, Purdue University, and Samuel Merritt College. Ms. Pierson- Carey wrote the Exercise chapter.Contents Preface to the Fifth Edition Acknowledgments How to Get the Most Out of This Workbook How You React to Stress Sources of Stress The Fight or Flight Response Chronic Stress and Disease Schedule of Recent Experience ‘Symptoms Checklist Tactics for Coping with Stress Symptom Effectiveness Body Awareness Internal Versus External Awareness Body Scanning Letting Go of Your Body Stress Awareness Diary Record of General Tension xi xiii 156 ‘The Relaxation & Stress Reduction Workbook Breathing 2 * Breathing for Awareness Diaphragmatic or Abdominal Breathing Deep Breathing Complete Natural Breathing * Breathing for Release Tension Breath Counting The Relaxing Sigh Letting Go of Tension * Breathing for Symptom Control or Release Abdominal Breathing and Imagination Alternative Breathing Controlled Breathing Progressive Relaxation 3 * Basic Procedure * Shorthand Procedure Meditation 35 + Establishing Your Posture * Centering Yourself + Attitude + Three Basic Meditations Mantra Meditation Sitting Meditation Breath-Counting Meditation + Releasing Muscular Tension The Inner Exploration Moving Band Meditation + Mindfulness and Present-Moment Awareness Eating Meditation Walking Meditation Seeing Meditation * Mindfulness of Pain or Discomfort + Letting Go of Thoughts Visualization 51 + Types of Visualization + Rules for Effective Visualization Eye Relaxation (Palming) Metaphorical Images Creating Your Special Place Finding Your Inner Guide Listening to Music Humor Creativity7 10 "4 12 Contents — vil Applied Relaxation Training 61 Progressive Relaxation Release Only Relaxation Cue-Controlled Relaxation Rapid Relaxation Applied Relaxation Self-Hypnosis 69 + The Power of Suggestion Postural Sway Postural Suggestion Personalized Self-Induction Basic Self-Induction Script Abbreviated Inductions Hypnotic Suggestions Self-Hypnotic Induction for A Specific Problem Example: Insomnia Autogenics 83 How to Facilitate Your Response When Doing Autogenic Training How to Practice the Six Basic Autogenic Themes to Normalize Your Body Autogenic Formulas for Calming the Mind Autogenic Modification Exercises Brief Combination Techniques 1 Stretch and Relax Autogenic Breathing Stop and Breathe Changing Channels Using a Coping Mantra 1 Am Grateful Deep Affirmation The Tension Cutter Breath Counting Taking Control Accepting Yourself Recording Your Own Relaxation Tape 99 Your Voice and Background Sound Mantras and Affirmations Constructing Your Relaxation Script Using Your Tape Buying Tapes Refuting Irrational Ideas 107 + Rational Emotive TherapyThe Relaxation & Stress Reduction Workbook Assessment of Your Beliefs Irrational Ideas Rules to Promote Rational Thinking Refuting Irrational ideas Rational Emotive Imagery Developing Alternative Emotional Responses Insight 13. Thought Stopping Thought Stopping Instructions Eye Movement Technique 14 Worry Control Distinguishing Healthy versus Unhealthy Worry Worry into Problem Solving Four Steps to Managing Your Worry Relaxation Risk Assessment Scheduling Worry Time and Worry Exposure Worry-Behavior 15 Coping Skills Training 16 17 + Mistaken Traditional Assumptions Versus Your Legitimate Rights Coping Skills for Anxiety Learn to Relax Efficiently Make a Stressful-Events Hierarchy Create Stress-Coping Thoughts for Anxiety Imago Coping Skills In Vivo Coping Skills Coping Skills for Anger Learn to Relax Efficiently Make a Stressful-Events Hierarchy Create Stress-Coping Thoughts Image Coping Skills Invivo Coping Skills Goal Setting and Time Management Clarifying Your Values Setting Goals Developing an Action Plan Evaluating How You Spend Your Time Combating Procrastination Organizing Your Time Assertiveness Training Three Basic Interpersonal styles The Assertiveness Questionnaire 127 135 151 175 197Contents ix Describing Your Problem Scenes Your Script for Change Short Form Assertiveness Technique Assertive Body Language Learning How to Listen Assertive Listening and Expressing Go Together Arriving At a Workable Compromise Avoiding Manipulation 18 Job Stress Management 221 © What Causes Job Burnout? Identify Your Symptoms of Job Stress Identify the Sources of Your Job Stress * Identify How You Respond to Your Specific Job Stressors * Set Goals To Respond More Effectively to Your Job Stressors *© Motivate Yourself * Change Your Thinking * When In Conflict, Negotiate * Pace and Balance Yourself 19 Nutrition 237 * Ten Steps to Positive Eating + Self-Assessment * Taking Charge of Your Nutritional Well-Being, 20 Exercise 259 * Aerobic Exercise * Stretching and Toning Exercises * Developing Your Own Exercise Program Diary of Opportunities to Exercise Choosing the Best Type of Exercise for You Establishing Goals Sample Exercise Program Heart Rate in Beats Per Ten Seconds and Per Minute Estimated Heart Rates for Selected Ages Table Exercise Diary 21 When It Doesn’t Come Easy—Getting Unstuck 283 * Questioning Your Goals and How You Spend Your Time Taking Responsibility for Your Decisions Confronting Roadblocks in the Road to Stress Management and Relaxation When Symptoms Persist Index 287How You React to Stress Stress is an everyday fact of life. You can’t avoid it. Stress is any change that you must adapt to, ranging from the negative extreme of actual physical danger to the exhilaration of falling in love or achieving some long-desired success. In between, day-to-day living confronts even the most well-managed life with a continuous stream of potentially stress- ful experiences. Not all stress is bad. In fact, stress is not only desirable but also essential to life. Whether the stress you experience is the result of major life changes or the cumula- tive effect of minor everyday hassles, it is how you respond to these experiences that determines the impact stress will have on your life. Sources of Stress You experience stress from four basic sources: 1. Your environment bombards you with demands to adjust. You must endure weather, pollens, noise, traffic, and pollution. 2. You also must cope with social stressors such as deadlines, financial problems, job interviews, presentations, disagreements, demands for your time and attention, and loss of loved ones. 3. A third source of stress is physiological. The rapid growth of adolescence, meno- pause in women, illness, aging, injuries, lack of exercise, poor nutrition, and inadequate sleep all tax the body. Your physiological reaction to environmental and social threats and changes can also result in stressful symptoms such as mus- cle tension, headaches, stomach upset, and anxiety. 4. The fourth source of stress is your thoughts. Your brain interprets complex changes in your environment and body and determines when to turn on the “emergency response.” How you interpret and label your present experience and what you predict for the future can serve either to relax or to stress you. Interpreting a sour look from your boss to mean that you are doing an inadequate job is likely to be very anxiety provoking. Interpreting