Managing Stress: Health Psychology

Managing stress
Health Psychology
Drugs
1. Benzodiazepine; antianxiety drugs such as
Librium and Valium. Reduces the activity of
the neurotransmitter serotonin. Inhibitory
effect on the brain reducing muscle relaxation
and a calming effect.
2. Beta-blockers such as Inderal. Reduces
activity in the sympathetic nervous system,
effective against raised heart rate and blood
pressure.

Problems
1. Long-term use of benzodiazepines can lead
to physical and psychological dependency,
therefore should only be used for short
periods.
2. All drugs have side-effects. Benzodiazepines
can cause drowsiness and adversely affect
memory (Green 2000).
3. Drugs treat the symptoms of stress not the
causes. Most stresses are psychological,
therefore physical measures do not address
the real cause of the problem.

Defense Mechanisms
Freud
Defense mechanisms protect us from being
consciously aware of a thought or feeling
which we cannot tolerate. The defense only
allows the unconscious thought or feeling to
be expressed indirectly in a disguised form.
Let's say you are angry with a professor
because he is very critical of you. Here's how
the various defenses might hide and/or
transform that anger:
Defence Mechanisms
Denial: You completely reject the thought or
feeling.

"I'm not angry with him!"
Suppression: You are vaguely aware of the
thought or feeling, but try to hide it.

"I'm going to try to be nice to him."

Defence Mechanisms
Reaction Formation: You turn the feeling
into its opposite.

"I think he's really great!"
Projection: You think someone else has your
thought or feeling.

"That professor hates me."
"That student hates the prof."
Defence Mechanisms
Displacement: You redirect your feelings to
another target..

"I hate that secretary."
Rationalization: You come up with various
explanations to justify the situation (while
denying your feelings).

"He's so critical because he's trying to help us
do our best."
Defence Mechanisms
Intellectualization: A type of rationalization,
only more intellectualized.

"This situation reminds me of how Nietzsche
said that anger is ontological despair."
Undoing: You try to reverse or undo your
feeling by DOING something that indicates
the opposite feeling. It may be an "apology"
for the feeling you find unacceptable within
yourself.

"I think I'll give that professor an apple."
Defence Mechanisms
Isolation of affect: You "think" the feeling but
don't really feel it.

"I guess I'm angry with him, sort of."
Regression: You revert to an old, usually
immature behavior to ventilate your feeling.

"Let's shoot spitballs at people!"
Defence Mechanisms
Sublimation: You redirect the feeling
into a socially productive activity.

"I'm going to write a poem about anger."
Defence Mechanisms
Your Group's Role play: In your small
group, develop a role play that you can
peform in front of the class. In it demonstrate
several defense mechanisms. Try to give
everyone in the group a part to play. Good
role plays usually spend a minute or so to
develop the scene, the characters, and the
situation at hand. At that point start to
introduce the defenses into the scene. The
whole role play should last about 3-5 minutes.
After you finish the scene, the class will try to
guess which defense mechanisms you were
demonstrating.
Coping Strategies
Problem-focused strategies
Confrontive coping - standing one's
ground or expressing one's anger
Planful problem solving - having a plan
of action or doubling effort

Emotion-focused strategies

I. Distancing - making light of the situation,
pretending nothing has happened, trying
to forget about things
II. Self-controlling - keeping feelings to
oneself, not letting others know how bad
things are
III. Seeking social support - talked to
somebody to find out more about the
situation, asked a friend for advice

Emotion-focused strategies

IV. Accepting responsibility - self-criticism,
saying to oneself that things will be better
next time
V. Escape-avoidance - wishing the situation
would go away, hoping for a miracle, trying
to make oneself better by eating and
drinking a lot.
VI. Positive reappraisal - changing or
growing up a better person, discovering
what is important in life.

Problem-focused Vs
emotion-focused
The method that works best, depends
on the individual, but generally active
strategies work better than avoidance
strategies.

Conflicting evidence
Cairns and Wilson (1984) found the
opposite in Northern Ireland. If stress is
prolonged then it may be better to deny
that there is much violence (in the case
of Northern Ireland). People who denied
the level of violence were less stressed
than those that had a realistic appraisal
of the situation.

Conflicting evidence
Wilson and Cairns (1992) found most
people were using `distancing' as a
coping strategy. This was not true of
Enniskillen, that had had a bomb aimed
at civilians. here the coping strategy
became one of positive reappraisal.
Problem-focused Vs
emotion-focused
Suls and Fletcher (1985) pooled the results of
a large number of studies in a meta--analysis
to clarify the effects of avoidance and
attention strategies. Their analysis led to two
conclusions.
1. Avoidance strategy can benefit coping mainly
in the short run
2. As time goes by, attention strategies become
more effective than avoidance in the coping
process

Problem-focused Vs
emotion-focused
A 1-year study compared people who differed
in their reported use of avoidance coping
approaches. Of the subjects who experienced
a high degree of stress during the intervening
year, those who had reported a greater
tendency to use avoidance methods had, at
the end of the study, more psychosomatic
symptoms-for example, headaches and acid
stomach (Holahan and Moos, 1986).

Developing methods of coping
Young children are very poor at coping with
stress. Middle-aged people tend to use more
problem-focused forms of coping, whereas
elderly people tend to use emotion-focused
forms of coping. For example a middle-aged
person might say "I stood my ground and
fought for what I wanted", whereas an elderly
individual might say "I went on as if nothing
happened".
Developing methods of coping
The difference in coping strategies
between middle-aged people and
elderly people could be due to the
different sorts of problems that they
face. Middle-aged people experience
stress from work and raising a family
whereas elderly people may experience
stress from home maintenance, for
example.
Resources
I. Material - Enough money
II. Physical - health etc.
III. Intra-personal - self esteem etc.
IV. Educational - knowledge about stress
V. Cultural - placing the stress in a wider
context
Social support

1. Esteem -intra-personal
2. Informational -Educational
3. Instrumental - Material
4. Social Companionship - being with
others

Social support

Although men tend to have larger
social networks than women, women
seem to use theirs more effectively for
support.

Social support

People who report that they are coping well
with stressful events in their lives are more
likely to be regarded as attractive by others
and less likely to be avoided than those who
indicate that they are having some
difficulties coping.
The implications of these results are
depressing, because they suggest that
those in greatest need for social support
may be least likely to get it (Wortman &
Dunkel-Schetter, 1987).

Social support

Network size is related to social
prestige, income, and education: the
lower the prestige, income, and
education level of individuals, the
smaller their social networks tend to
be.

Social support

Wexler - Morrison et al (1991) 133
women diagnosed as suffering from
breast cancer. Major factor - social
support, leads to longer survival.
Social support works for 2 reasons
I. Encouragement to adopt healthy behaviours
II. Buffering Model - Guard against and reverse the
effects of stress.

Social support
Employers can help improve support
systems on the job (Quick and Quick,
1984). They can do this in many ways,
such as:
1. Organising workers in teams or work groups
2. Providing facilities for recreation and fitness training
during lunchtime or other non-work hours, arranging
social events for workers and their families on
weekends,
3. Providing counselling service to help employees
through troubled times.

Social support
A supportive boss discusses
decisions and problems with
employees, compliments
subordinates and gives them credit
for good work, and stands behind
reasonable decisions they make
(Kobasa,1986).
Social support
Social support can also be ineffective
if the recipient interprets it as a sign
of inadequacy, feels uncomfortable
about being unable to reciprocated,
or believes his or her personal control
is limited by it (Cohen and McKay,
1984).
Social support
Being in a relationship reduces the number
of complaints a person can suffer from. A
study of German Women found that single
women suffered the following complaints
more often: Hiccups, Toothache,
Heartburn, Colds, Flatulence, Nausea,
Stomach-ache, and Headache. Whereas,
women in relationships suffered more
backache and insomnia!
Hardiness (Kobasa and
Maddi 1977)
The concept of 'hardiness' is taken to
mean resistance to illness, or ability to
deal with stress. From studies of highly
stressed executives, Kobasa et al were
able to identify the characteristics of
those who handled stress well from
those who did not.
Maddi 1977)
Those who reported the fewest illnesses
showed three kinds of hardiness.
1. They showed an openness to change, i.e. life
changes are seen as challenges to be overcome
rather than threats or stressors.
2. They had experienced a feeling of involvement or
commitment to their job, and a sense of purpose
in their activities.
3. They experienced a sense of control over their
lives, rather than seeing their life controlled by
outside influences.

Maddi 1977)
Kobasa found that the most important
of these factors was the first,
openness to change. Those who
perceived change (such as the loss of
a job) as a challenge rather than a
devastatingly person event, were
more likely to interpret the event
positively and show fewer signs of
stress.
Maddi 1977)
Kobasa proposed three ways in which
hardness could be improved.
I. Focusing. People can be encouraged to focus on
various body sensations in order to identify times of
stress. This will help the person to consider what
these sorts of stress might be.
II. Reconstructing stressful situations. This technique
has the person think about a recent stressful situation
and make two lists: ways it could have turned out
better and ways it might have turned out worse. Doing
this allows the person to examine alternative courses
of action and realise that the situation could be worse.
Maddi 1977)
III. Compensating through self-improvement.
When people face a stressor they cannot
avoid or change, it may be helpful for them
to take on a new challenge they are likely to
master. Doing so reassures them that they
can still cope.
Hardiness at work
Employers can help by giving workers some
degree of control over aspects of their jobs
(Quick and Quick, 1984). One approach
involves having employees working in groups
to make certain managerial decisions or solve
problems, such as how to improve the quality
of the product they manufacture. Other
approaches include allowing workers to have
some control over their work hours, which
tasks to work on, and the order in which they
do them.

Hardiness and the elderly
Elderly people in nursing homes and
families can be allowed to do things for
themselves and have responsibilities,
such as in cleaning, cooking, and
arranging social activities.

Evaluation of hardiness
I. The relative importance of the three
aspects of 'hardiness (control,
Commitment and challenge) is uncertain,
although it is likely that control is the most
significant of these.
II. Kobasa's studies have tended to involve
middle-class businessmen - results cannot
reliably be generalized to other social and
cultural groups.

Time Management
Oh dear! Oh dear! I shall be too
late!
- The Rabbit
in Lewis Carrolls
Alice in Wonderland
Time is a man-made concept
We have become slaves to,
rather than masters of time?
Time management
Time management skills are
now taught to people to help
them gain a sense of control
over personal responsibilities.
Personality styles
and behavior
the Type A person
the workaholic
the time juggler
Personal
Parents
Children
Career
Personality styles
and behavior
the procrastinator
the perfectionist
life-style trap
Personal
Parents
Children
Career
Prioritization
ABC rank order method
Pareto principle 20%
matters
Important vs. urgent method
Steps to initiate time
management techniques
Steps to initiate time-
management techniques
Execution
assign specific deadlines
break large projects into small tasks
work on one section or task at a time
reward your accomplishments
Additional
time management
ideas
Learn to delegate
responsibilities
Learn to schedule
interruptions
Schedule personal
time each day
Carry and use
an idea book
Additional
time management
ideas
Edit your life
Refine your
networking skills
Refine your
organization
skills
Bring balance
back into your life
Time management
1. Set goals.
2. Make daily "to do" lists
3. Set up a schedule for the day. The
estimated time for each item on the list
should be calculated, but if an urgent
matter arises the list should be adjusted
to include it.
Additional tips for studying

Physical Exercise and Stress
A sound mind in a sound body.
-
Juvenal

Physical exercise
and stress
Physical exercise is a
form of stress; the
enactment of all the
physiological systems that
the fight-or-flight response
triggers for physical
survival.

Physical
Exercise
and Stress
Physical exercise is a very effective
means to reduce stress and a most
natural means to express the
manifestation of the stress
response.
Physical Exercise
Anaerobic
without oxygen
short, intense, and powerful activity
aerobic
with oxygen
moderately intense activity for a
prolonged period of time.
Physiological Effects of
Physical Exercise
decreased resting heart rate
decreased resting blood pressure
decreased muscle tension
better quality sleep
increased resistance to colds and
illness
increased tolerance of heat & cold
Physical Exercise
decreased serum levels of
cholesterol and triglycerides
decreased percent of body fat
increased efficiency of heart
muscle
decreased bone demineralization
decreased rate of aging
greater sense of overall well-being
Physical Exercise, Stress,
and Balance
Physical exercise may be a stress
to the body
but in moderate amounts,it tends to
regulate (balance) the bodys
physiological functions.
Homeostasis is regained
through parasympathetic rebound.
Newest Guidelines
From the US Surgeon General
Accumulate at least
30 minutes of moderate
intensity physical
activity at least 4,
preferably all,
days of the week.
Intensity by Perceived Exertion
6
Very, Very Light 7
8
Very Light 9
10
Fairly Light 11
12
Somewhat Hard 13
14
Hard 15
16
Very Hard 17
18
Very, Very Hard 19
20
Able to talk
comfortably
Able to
say some
syllables
Phases of a Workout
warm-up period
(5-10 minutes)
stimulus
period
(20-30 minutes)
cool-down period
(5-10 minutes)
Phases of a workout
rest warm-up exercise cool-down recovery
5
min..
20
min..
5
min..
h
e
a
r
t

r
a
t
e

160
140
120
100
80
60
training zone
Psychological Effects of
Physical Exercise
improved self-esteem
improved sense of self-reliance,
self-efficacy
improved mental alertness,
perception, and information
processing
Psychological Effects of
Physical Exercise
increased perceptions of
acceptance by others
decreased feelings of
depression and anxiety
decreased overall sense of
stress and tension
Steps to Initiate a
Fitness Training Program
start cautiously, progress
moderately
pick an activity that you really
enjoy
select a time of day to exercise
exercise using the right clothes and
equipment
Steps to Initiate a
Fitness Training Program
for motivation,
workout with
friends
set personal
fitness goals for
yourself
take precautions,
avoid injuries
Physical exercise
Most studies use correlational or
retrospective methods, and show that
people who exercise or are physically fit
often reported less anxiety, depression,
and tension in their lives than do people
who do not exercise or are less fit
(Blumenthalof & McCubbin, 1987).
Unfortunately, causality cannot be
established with such techniques.

Physical exercise
Jennings S. L. (1986) conducted an
experiment with healthy 19 to 27-year-
old individuals who had sedentary
occupations and had not regularly
engaged in vigorous physical activity in
the previous year.
Physical exercise
Over the next four months, the subjects spent
one month at each of four levels of activity:
1. Their sedentary normal activity
2. Below normal activity, which included two weeks
of rest in a hospital setting
3. Above normal activity, which included three
sessions of vigorous exercise weekly
4. Much above normal activity, consisting of their
normal activity plus daily vigorous exercise.
Physical exercise
Each exercise period lasted 40 minutes.
Measurements of heart rate and BP
were taken after each month. The
results demonstrated that regular
exercise lowers heart rate and both
systolic and diastolic blood pressure.
Preparing for stressful events
Parents can help prepare a child for
starting day care by taking the child
there in advance to see the place, meet
the teacher, and play for a while
(Sarafino, 1986).

Janis (1958) studied the need for people to
prepare for stressful life events, such as
surgery. He found those patients with
moderate levels of anxiety before the surgery
showed better adjustments after the
operation compared with those with very high
or very low anxiety. Janis proposed that some
degree of anticipatory worry about a stressful
event is adaptive because it motivates coping
via the process he called the "work of
worrying".
There are three steps in this process:
1. The person first receives information about
the event, which generates anxiety
2. Expectations are developed by rehearsing
the event mentally
3. Coping techniques are mobilised in an
effort to become reassured of a successful
outcome.
Subsequent research has confirmed
that Janis may be correct about high
levels of anxiety impairing the patient's
success in coping with or recovery from
surgery. There is no evidence to
support the view that low levels of
anxiety could impair recovery, in fact the
opposite has been found (Anderson &
Masur, 1983).
Other ways of improving people's
preparedness for stressful events is by
using psychotherapy, in which patient's
express their worries and receive
emotional support. Another method
would be hypnosis, but much would
depend upon the person's ease of
suggestibility.
Another method would be enhancing the
patient's feelings of control.
Patients can be taught behavioural control by
teaching them how to reduce discomfort or
promote rehabilitation through specific
actions, such as by doing exercises to
improve strength or deep breathing exercises
to reduce pain.
Another method enhances cognitive control,
by instructing people on ways to concentrate
on the pleasant or beneficial aspects of the
surgery.
Another method would use informational
control, in which patients received information
about the procedures and/or sensations they
will experience.
Care has to be taken over how much
information one should give when trying
to provide informational control. Los
Angeles City Council placed cards in
the city lifts assuring passengers that
they should stay calm, since "there is
little danger of the car dropping
uncontrollably or running out of air".
The Council had to remove the cards in
the end because many passengers
were becoming anxious after reading
the message; they had not thought
about the dangers until they saw the
cards! (Suzanne Thompson, 1981).
Young children become more anxious if
given too much information about
medical procedures (Miller and green,
1984).
Progressive Muscular
Relaxation
Relaxation is the direct negative
of nervous excitement. It is the
absence of nerve-muscle
impulse.
- Edmund Jacobson,
M.D.
Relaxation
Muscles respond
to thoughts of perceived threats
with tension or contraction
Muscular tension
the most common symptom of stress
can lead to:
stiffness, pain, discomfort, distorted and
disaligned posture and joint stability
Relaxation
Muscles can contract in one of
three ways:
concentrically (shortening)
eccentrically (lengthening)
isometrically (no visible change
in length)
Relaxation
Muscle tension
produced through the stress
response
primarily isometric
Over time, muscles
contracted isometrically
begin to show signs of
shortening
Relaxation
Systematic approach to relieving
muscle tension
Edmund Jacobson
a simple technique used to promote
rest and relaxation
by systematically tensing and
relaxing the bodys musculature,
from feet to the head
Benefits of PMR
Decreased
levels of
muscle
tension
Increased
awareness
of
muscle
tension
Reduced
muscle
tension
&
deepened
sense of
relaxation
Steps of Initiate PMR
Comfortable position
Monitoring your breathing
Inhale when you contract each
muscle group
Exhale when you relax each muscle
group
Focus your concentration on each
muscle group as you work regions
of your body
Typical phase for each muscle
group using PMR
First contraction: 100% @ 5-10 seconds
release and relax (exhale)
compare relaxation to contraction
Second contraction: 50% @ 5-10 seconds
Third contraction: 5-10% @ 5-10 seconds
Relaxation
Research,
specifically biofeedback using
electromyography,
proves that this technique reduces
muscular tension.
Evaluation
It is fairly easy to practice relaxation, even in
unusual situations. These techniques may
also involve cognitive strategies that help
reduce arousal in unpleasantly arousing
circumstances. Although relaxation
techniques can be useful by reducing the
levels of stress response, the action is non-
specific. Effective long-term stress reduction
requires focused intervention on the source of
the stress.

Biofeedback
Biofeedback is a technique in which an
electromechanical device monitors the status
of a persons physiological processes, such
as heart rate, blood pressure or muscle
tension, and immediately reports that
information back to the individual. The person
is able to then gain voluntary control over
these processes through operant
conditioning. The feedback from the device
becomes the reinforcement.

Biofeedback
An experiment was conducted with patients
suffering from chronic muscle-contraction
headaches (Budzynski et al., 1973). Those
who were given biofeedback regarding
muscle tension in the forehead later showed
less tension in those muscles and reported
having fewer headaches than subjects in
control groups. These benefits were found at
a follow-up session after three months.
Biofeedback seems to be as effective as
progressive muscle relaxation methods for
treating headache (Blanchard and Andrasik,
1985).
Limitations of biofeedback
techniques
It is claimed that biofeedback techniques can
have significant positive effects in the
reduction of generalised anxiety disorders.
The use of this technique and the related
efforts to reduce heart rate in sufferers of
anxiety disorders has had only limited
success.
Biofeedback may be no more effective than
muscle relaxation in the absence of
biofeedback. This is a critical issue as
biofeedback can be expensive as a
technique.

Biofeedback
Virginia Attanasio, et al. (1985) gave three
reasons why biofeedback is particularly
suitable for use with children:
1. Children treat biofeedback as a game, and are
therefore interested and motivated in the
procedure.
2. Children are less sceptical about their ability to
succeed in biofeedback training.
3. Children are more likely to practise their training at
home, as they are instructed to do.
Biofeedback
The problems with using biofeedback
with children are:
1. Children have shorter attention spans,
particularly when below the age of 8.
2. Children may perform disruptive
behaviours such as disturbing the
electrodes or by interrupting by talking
about tangential topics.

Modelling
Children watched a short film
showing a five-year-old boy's
reactions to figures of the
cartoon characters Mickey
Mouse and Donald duck (Venn
and Short, 1973). In the film,
when the boy's mother showed
him the Mickey Mouse figure he
screamed and withdrew; but
when she showed him the
Donald duck figure he remained
calm and displayed no distress.
Modelling
While the subjects watched the film
physiological measures of stress were taken,
confirming that the children were more
aroused while watching the episode with
Mickey Mouse (fearful) than while watching
the one with Donald duck. After the film they
tended to avoid a Mickey Mouse figure (the
stressful one) in favour of Donald duck. The
effect only lasted for one or two days.
Modelling
Modelling is useful in reversing this
learning and in helping people to cope
with stressors. The procedure is rather
like desensitisation: the person relaxes
while watching a model calmly perform
a series of activities arranged as a
stimulus hierarchy. The stimulus can be
presented using films or video tapes, or
by using real life models and events.
Modelling
Barbara Melamed et al., 1983, found
that by showing children video tapes
she was able to reduce the stress of
being in hospital and improve their
recovery from surgery. However,
children under the age of 8 who had
had previous surgery experienced
increased anxiety!

Post-traumatic Stress
Disorder

I. Behavioural treatments
II. Cognitive treatments
III. Psychotherapeutic approaches
IV. Group methods
V. Bereavement counselling
VI. Grief therapy

Main treatment
This method is based on the view that
fears are learned by classical
conditioning. Desensitisation is a
classical conditioning procedure that
reverses this learning by pairing the
feared object or situation with either
pleasant or neutral events. The method
uses a stimulus hierarchy.
Main treatment
The patient is given the opportunity to
get used to something that is similar to
their fear, for example in order to
overcome a fear of dentists the patient
might be asked to imagine waiting with
a friend, who is to have treatment, in the
dentists waiting room.
Main treatment
After the patient gets used to this idea
they can be introduced to something a
little more like the real situation. After a
series of 10 to 15 steps the patient
might be able to imagine having their
tooth extracted. As an exercise think of
a phobia and plan a series of steps that
could be used in applying the
systematic desensitisation technique.
systematic desensitisation
In one study with dental-phobic adults
who simply imagined each step in a
hierarchy, the procedure successfully
reduced their fear in six one and a half
hour sessions (Gatchel, 1980).
Sessions with children tend to be
shorter because of their short attention
span.

Cognitive restructuring and
Rational Emotive Therapy
Cognitive restructuring - developed by
Arnold Lazarus (1971). Faulty, irrational
thinking. These irrational thoughts are
replaced by more constructive or
realistic ones.
Rational-emotive therapy (RET) is
based on cognitive restructuring and
was developed by Albert Ellis (1962).

Cognitive restructuring and
Rational Emotive Therapy
Commonly used irrational ways of
thinking include:
awfulizing-for example, "it is awful if I get turned
down when I ask for a date."
Can't-stand-itis-"I can't stand not doing well on a
test"
Musterbating-"people must like me, or I'm
worthless."
ABCDE framework for
rational emotive therapy

RET involves patients reading materials
about irrational believes or doing
desensitisation exercises. RET has
been found to be successful in treating
anxiety and depression (DiGiuseppe &
Miller, 1977).
Activating -experience that creates the
stress. For example being fired from a
job.
ABCDE framework for

Beliefs - and thoughts that are a
response to the stress. A rational
response might be "I must do better
next time". An irrational response might
be " I can't do any thing right, I am
totally worthless and useless. I can't
stand myself and I can't bear facing
people and telling them that I was fired."
ABCDE framework for

Consequences - positive or negative
coping behaviours. For example, the
above irrational belief could lead to a
person not bothering to seek another
job.
ABCDE framework for

Disputing - the patients learns to
differentiate between irrational and
rational thoughts, and then learns to
dispute the irrational thoughts, such as
"I am a loser".
Effect - of the therapy. For example,
seeking and successfully securing a
new job.
ABCDE framework for

We are not sure whether there are any
long term effects of RET.
Stress - inoculation
(Meichenbaum)

Preparing people for stress. Just like an
injection to prevent a disease.
Michenbaum and Cameron (1983)
(Meichenbaum)

Conceptualisation - identify and express
feelings and fears.
Educated about stress. The client is
encouraged to relive stressful situations,
analysing what was stressful about
them and how they attempted to deal
with them.
(Meichenbaum)

Skill acquisition and rehearsal
For example, how to relax,
desensitisation, emotional discharge,
turning to others and cognitive
redefinition. specific skills might be
taught, such as, parenting techniques,
communication skills, time management
or study skills.

(Meichenbaum)

Application and follow through.
The trainer guides the patient through
progressively more threatening
situations so that the patient can apply
their newly acquired skills. The
techniques become reinforced and this
makes the practises self sustaining.
(Meichenbaum)

Zeigler et al (1982) found cross-country
runners found stress inoculation useful
in reducing stress and in improving
running performance.
Evaluation of
Meichenbaum's stress-
inoculation training

Meichenbaum's model focuses on both
the nature of the stress problem
(enabling clients to more realistically
appraise their life) and the ways of
coping with stress giving clients more
understanding of the strengths and
limitations of specific techniques).
Evaluation of

The combination of cognitive strategies
and behavioural techniques makes
stress-inoculation a potentially effective
way of managing stress. Despite this
potential, few controlled studies have
confirmed its predictions.
Evaluation of

Stress inoculation has been effective in
a variety of stressful situations, ranging
from anxiety about mathematics in
college students, managing
hypertension in all age groups and
stress management in general. It has
been successfully combined with other
treatment methods to alleviate stress.
Evaluation of

For example, Kiselica et al. (1994) used
a combination of stress inoculation,
progressive muscle relaxation, cognitive
restructuring and assertiveness training
to significantly reduce trait anxiety and
stress related symptoms among
adolescents.
Evaluation of

These results however, did not
extended to their improving academic
performance, suggesting that other
factors may also be involved here.
Interventions cannot necessarily rule
out the possibility of placebo or
expectancy effects.
Meditation
When the pupil is ready, the
teacher will come.
- Ancient Chinese Proverb
Meditation
In simple terms, meditation is a
mind-cleansing or emptying
process
At a deeper level, meditation is
focused concentration and
increased awareness of ones
being
Meditation
When the mind is emptied of
conscious thought
unconscious thoughts can
enter the conscious realm
to bring enlightenment to our
lives
Types of meditation
Exclusive or restrictive meditation
I nclusive or opening-up meditation
concentration
concentration
awareness
awareness
inner
peace
inner
peace
Vehicles for Exclusive
Meditation
mental repetition (mantra)
visual concentration (tratek)
repeated sounds (nadem)
physical repetition (breathing,
rhythmic exercise)
tactile repetition (beads, shell,
stone etc.)
Examples of exclusive
meditation
Transcendental Meditation
(TM)
The Relaxation Response
Inclusive Meditation
Observance with emotional
detachment
Examples include:
Zen Meditation
Mindfulness Mediation
divine
enlightenment
Zen
Meditation
Split-Brain Theory
left-brain hemisphere
left-brain functions
right-brain hemisphere
right-brain functions
meditation can lead to
an altered state of consciousness
associated with right-brain functions
Altered States of Consciousness
Characteristics
time distortion
ineffability
present centredness
perception distortion
enhanced receptivity
self-transcendence
Meditation
decreased oxygen
consumption
decreased blood
lactate levels
increased skin
resistance
decreased heart
rate
decreased blood
pressure
decreased muscle
tension
increased alpha
waves
Meditation
Transcendental meditation is a method
in the practice of yoga that was
promoted by Maharishi Mahesh Yogi.
The method is a way of improving
physical and mental health and
reducing stress (Benson, 1984).
Meditation
People using this procedure are
instructed to practise it twice a day,
sitting upright but comfortably relaxed
with eyes closed, and mentally
repeating a word or sound (such as
"om"), called a mantra. The mantra is to
prevent thoughts from occurring.
Meditation
Reviews of studies into the
effectiveness of transcendental
meditation have found that the levels of
rest produced are not that profound.
There are no consistent differences in
blood pressure, heart rate, or respiration
rate between the meditating and resting
control subjects (Holmes, 1984).

Meditation
However Buddhist monks in South-East
Asia can dramatically alter their bodies
metabolism and their brains electrical
activity through meditation (Benson et
al., 1990).
Meditation
Evaluation
Meditation has the advantage of portability and may
give individuals more confidence to deal with
stressful situations (Green 2000).
As with relaxation techniques, the action of
meditation techniques is none specific rather than
focused on effective intervention at source.
Hypnosis
Hypnosis is considered to be an altered
state of consciousness that is induced
by special techniques of suggestion and
leads to varying degrees of
responsiveness to directions for
changes in perception, memory, and
behaviour (Orne, 1989).
Hypnosis
Only 15 to 30% of the population is
easily and deeply hypnotisable (Evans,
1987). Children between the ages of
seven and 14 are the most suggestible
(Hilgard, 1967). People can learn to
hypnotise themselves, this is called
self-hypnosis.
Hypnosis
There are two problems with doing
therapy and research with hypnosis:
most people are not highly suggestible
the success of the treatment depends heavily on how
suggestible the subjects are.
Hypnosis
However, studies have found that
hypnosis can be helpful in stress
management, but it is not necessarily a
more effective method than other
relaxation techniques (Tapp, 1985).
Using stress management to
reduce coronary risk
Modifying type A behaviour
Ethel Ruskin et al. (1978) began a
research and therapy programme in the
1970s to modify type A behaviour. The
patients studied were type A male
subjects who were healthy and
employed in professional or managerial
positions.
The subjects were assessed for type A
behaviour with the structured interview
method and given a physical
examination. The healthy type a men
were randomly assigned to two therapy
groups:
progressive muscle relaxation
brief psychotherapy, in which a therapist discussed
with the men how their childhood experiences may
have led to their competitive, hard driving behaviour.
A third group was formed from type A
individuals who showed signs of chronic
heart disease; these men received the
progressive muscle relaxation therapy.
Each group had weekly therapy
sessions over 14 weeks, during which
time the subjects were asked to
maintain their usual habits.
Psychological and physiological
measures taken before, immediately
after and six months after the treatment
phase began. All three groups improved
with respect to their feelings of time
pressure, blood cholesterol levels, and
BP. Six-months later, the two relaxation
groups maintained their improvements
better than the psychotherapy group
did.
The programme was revised by using a
multimodal approach (Roskies, 1983).
The revised programme included
progressive muscle relaxation and most
aspects of RET and stress inoculation
training. The multimodal approach was
used to control the individuals physical
tension through relaxation, emotional
outbursts through RET, and
interpersonal friction through stress
inoculation training in problem-solving
and communication skills.
This revised programme was tested in a
study with men who were employed in
managerial jobs, had passed a physical
examination, and exhibited the type A
pattern in the structured interview
(Roskies et al., 1986). They were
randomly assigned to either the revised
multimodal programme or to one of two
physical exercise groups (aerobic
training or weight training). All subjects
attended two or three sessions a week
for ten weeks. The men were tested at
the end of the training period using the
structured interview, and their blood
pressure and heart rate reactivity were
assessed in response to stressors, such
as doing mental arithmetic. None of the
three treatments reduced the men's
physiological reactivity, but the
multimodal programme was more
successful than either of the exercise
programmes in reducing the three
components of type a behaviour.

Psychological and physiological
measures taken before, immediately
after and six months after the treatment
phase began. All three groups improved
with respect to their feelings of time
pressure, blood cholesterol levels, and
BP. Six-months later, the two relaxation
groups maintained their improvements
better than the psychotherapy group
did.
training.
The multimodal approach was used to
control the individuals physical tension
through relaxation, emotional outbursts
through RET, and interpersonal friction
through stress inoculation training in
problem-solving and communication
skills.
training or weight training).
All subjects attended two or three
sessions a week for ten weeks. The
men were tested at the end of the
training period using the structured
interview, and their blood pressure and
heart rate reactivity were assessed in
response to stressors, such as doing
mental arithmetic.
None of the three treatments reduced
the men's physiological reactivity, but
the multimodal programme was more

training.
The multimodal approach was used to
control the individuals physical tension
through relaxation, emotional outbursts
through RET, and interpersonal friction
through stress inoculation training in
problem-solving and communication
skills.
training or weight training).
All subjects attended two or three
sessions a week for ten weeks. The
men were tested at the end of the
training period using the structured
interview, and their blood pressure and
heart rate reactivity were assessed in
response to stressors, such as doing
mental arithmetic.
None of the three treatments reduced
the men's physiological reactivity, but
the multimodal programme was more

Raymond Novaco (1975)
Raymond Novaco (1975) has
demonstrated the usefulness of stress
inoculation training and relaxation in
helping people to control the anger. He
trained patients who were both self
identified and clinically assessed as
having serious problems controlling
anger.
The subjects learnt about the role of
arousal and cognitive processes in
feelings of anger. Then they learned
muscle relaxation along with
statements, for example:
Preparing for a provocation
This could be a rough situation; I have the
know-how to deal with it. I can work out a
plan to handle this. Easy does it.
Remember, stick to the issues and don't
take it personally. There won't be any need
for an argument. I know what to do.
Impact and confrontation
As long as I keep my cool, then I am in
control of the situation. You don't need to
prove yourself. Don't make more out of this
than you have to. There is no point in
getting mad. Think of what I have to do,
look for the positives and don't jump to
conclusions.
Coping with arousal
Muscles are getting tight. Relax and slow
things down. Time to take a deep breath.
Let's take the issue point by point. My
anger is a signal of what I need to do. Time
for problem-solving. He probably wants me
to get angry, but I'm going to deal with it
constructively.
Subsequent reflection
Conflict unresolved
Forget about the aggravation. Thinking
about it only makes you upset. Try to shake it
off. Don't let it interfere with your job.
Remember relaxation. It is a lot better than
anger is. Don't take it personally. It's probably
not so serious.
Subsequent reflection
Conflict resolved
I handled that one pretty well. That's doing
a good job. I could have got more upset than it
was worth. My pride can get me into trouble,
but I'm doing better at this all the time. I actually
got through that without getting angry.
The subjects practiced the techniques
while imagining and role playing realistic
anger situations arranged in a hierarchy
from least to most provoking. The
subjects were able to control their anger
as measured by self reports and their
blood pressure when provoked in the
laboratory.

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