Module exercises & Handouts

STRESS
MANAGEMENT
MODULE

Exercises & Handouts

Generic Skills Integration Project (GENSIP)

Student Counselling Service & Staff Development

University of Dublin

Trinity College

Compiled by Tamara O’Connor
January 2003

EXERCISES

Performance Quiz

Stress Test
How Do I Respond to Stress?
Sorting - Stress & Coping
Creating Positive Affirmations
I Am Grateful
Deep Breath or Quick Release of Tension
Short Relaxation
Body Scanning
Breathing and Visualization
Stress Prescription
A Balanced Life Style

HANDOUTS OR EXAMPLES

Stress Diary

Signs, Symptoms and Reactions of Stress
Coping Strategies
Time Management Tools
Performance Quiz

2 H 7 Q 9 R Z 8 A 15

X 3 B 10 P 1 5 G 12 N

The above is a key. If the presenter calls out “2”, you put the letter “X” in the box, if he or she calls out “H” you put the number 3 in the box. The quiz is timed.

1.          

2.          

3.          

4.          

STRESS TEST

Answer yes or no to the following questions:

1. 
   Do you worry about the future?
   

2. 
   Do you sometimes have trouble falling asleep?
   

3. 
   Do you often reach for a cigarette, a drink, or a tranquilliser in order to reduce tension?
   

4. 
   Do you become irritated over basically insignificant matters?
   

5. 
   Do you have less energy than you seem to need or would like to have?
   

6. 
   Do you have too many things to do and not enough time to do them?
   

7. 
   Do you have headaches or stomach problems?
   

8. 
   Do you feel pressure to accomplish or get things done?
   

9. 
   Are you very concerned about being either well liked or successful?
   

10. 
    Do you perform well enough in life to satisfy yourself?
    

11. 
    Do you get satisfaction from the small joys or simple pleasures of life?
    

12. 
    Are you able to really relax and have fun?
    

Scoring: Give yourself one point for each question 1 – 9 with a yes response and one point for each question 10 – 12 with a no response.

If your score is four or more, then you may be under significant stress. You may want to find out more about managing stress.

From The University of Texas Learning Center. Making the grade 101. Austin: The University of Texas. www.utexas.edu/student/utlc/makinggrade/ Accessed 13 November 2001.

How Do I Respond to Stress?
Take a minute to think about past experiences of performing under stress. Think about times when you did well and also times when you felt you could have performed better. When you have thought of a few examples from your life of performing under stress, answer the following questions in order to become more aware of your own optimal level of stress.

1. 
   A time when I performed well under stressful circumstances was . . .
   

2. 
   On a scale of 1 to 10, at the time my stress level was _____.
   

3. 
   I prepared for this task by . . .
   

4. 
   I did the following things to manage the stress I felt . . .
   

5. 
   A time when I would have liked to perform better under stress was . . .
   

6. 
   On a scale of 1 to 10, at the time my stress level was _____.
   

7. 
   I prepared for this task by . . .
   

8. 
   I did the following things to manage the stress I felt . . .
   

9. 
   Right now, my stress level on a scale of 1 to 10 is _____.
   

10. 
    In order to get to a more optimal level of stress I need to . . .
    

(get organised, get some exercise, practice relaxation or ??)

Sorting Exercise – Stress and Coping
Instructions: Here are 24 cards (presenter will have to print and cut) which have a stressful situation, a symptom of or reaction to stress, and a way of helping a person to cope with the stress printed on them. You have to sort these cards into three bundles, according to the categories mentioned above.

Stressful Situations

Being arrested by the Gardai Moving living premises

Losing one’s best friend Being in a car crash

Losing your part-time job Having to go for an operation

Having a fight with a friend Getting a poor mark on essay/exam

Symptoms or Reactions

Not being able to concentrate Dry mouth

Avoiding people Muscle tension

Sweating hands Forgetting things

Not being able to sleep Being very moody

Ways of Coping

Think of positive things Talk to a friend

Eat good food Share your problem with others

Tell yourself that you can make it Do relaxation exercises

Take part in sports Go out with a friend

Deep Breath or Quick Release of Tension

Whenever you feel anxious, panicky or uptight …………

1. 
   Let your breath go (don’t breathe in first).
   

2. 
   Take in a slow, gentle breath, breathing in through your nose.
   

3. 
   Hold it for a second or two (count to four).
   

4. 
   Let it go, slowly with a leisurely sigh of relief out your mouth.
   

5. 
   Make sure your teeth are not clenched together.
   

6. Repeat 4 times.

This exercise forces your shoulders down and it relaxes the abdomen – both areas where tension gathers. It also gives you a short break to think some positive thoughts and get back in control.

Short Relaxation

This exercise is very useful when you don’t have much time available or are somewhere you cannot lie down (e.g. library, waiting for an interview, etc.).

Make sure you are sitting comfortably. It works better if you close your eyes.
Sit upright and rest your hands on your thighs. Let your feet rest on the floor.
Gently breathe out. Slowly breathe in, and gently breathe out again. Do this slowly several times, starting to let the tension ease. Continue gentle breathing.
Now focus on your body parts. First your feet – tense all the muscles in your feet, curling your toes. Now let your toes, feet and ankles relax. Feel the tension draining away into the floor.
Next your legs – tense all the muscles in your legs, pressing your legs against the chair. Then relax, letting your legs loose, allowing the tension to drain down your legs, through your feet and into the floor.
Now your back and your spine. Tense your shoulders and back muscles. Press into the chair. Relax, letting the tension drain slowly down your spine, down your legs, into your feet and into the floor.
Remember to continue gently breathing. You are slowly getting more and more relaxed. Let your stomach muscles relax as you breathe.
Focus on your hands and arms. Tense all the muscles, curling your hands and fingers in your lap. Now slowly let the tension drain down your arms, through your hands into your thighs, down your legs, down your feet and into the floor.
Finally the neck and head. Tighten your facial muscles; locate the tension in your neck. Relax now and allow the tension to drain down your back, down your legs, into your feet and into the floor.
Check to see if your muscles are relaxed. Your breathing is still gentle and even. Enjoy the feeling of relaxation for a few moments.
When ready, gently shake your body and open your eyes.





Body Scanning

To help identify areas of tension:

Close your eyes.
Starting with your toes and moving up your body, ask yourself, “Where am I tense?” Whenever you discover a tense area, exaggerate it slightly so you can become aware of it.
Be aware of the muscles in your body that are tense. Then, for example, say to yourself, “I am tensing my neck muscles . . . I am creating tension in my body.”
Note that all muscular tension is self-produced. At this point, be aware of any life situation that may be causing the tension in your body and what you could do to change it.

From Davis, M., Eshelman, E.R. & McKay, M. (1995). The relaxation and

stress reduction workbook, 4^th edition. Oakland: New Harbinger Publications, Inc.

Creating Affirmations

An affirmation is simply a statement of what you want. They are most effective if they are personal, positive and in the present tense. Also they need to be practiced, so try saying them several times a day, out loud if possible.

Here are a couple of examples:
I am healthy.

I work well with many different kinds of people.

I have friends who love me.

I try hard.

I am a loving son, daughter, etc.

Now you write 3 positive affirmations for yourself. Remember – personal, positive and present tense!

1. 
   ________________________________________________________________________________________________________________
   

2. 
   ________________________________________________________________________________________________________________
   

3. 
   ________________________________________________________________________________________________________________
   

I Am Grateful

This exercise is particularly helpful as the day is wearing on and your sense of stress and frustration is rising. It is also an excellent sequence for relaxing and putting yourself in a pleasant frame of mind before you drift off to sleep.

1. 
   Use a short form of progressive relaxation:
   

1. 
   Curl fists, tighten biceps.
   
2. 
   Wrinkle forehead, face like a walnut.
   
3. 
   Arch back, take a deep breath.
   
4. 
   Pull feet back; curl toes while tightening calves, thighs, and buttocks.
   

2. 
   Reflect back over your day so far and select three things for which you feel grateful. These do not have to be major events. For example, you may be grateful for the warm shower you took this morning, a colleague helping you, your child giving you a hug and telling you he loves you, a lovely sunrise, and so on. Take a moment to relive and enjoy these experiences.
   

3. 
   Continue to think back over your day. Recall three things you did that
   

you feel good about. Remember, these don’t have to be major feats. For example, you may feel good about saying no to something you really didn’t want to do, taking time for yourself to exercise or relax, doing something you had put off, or being supportive to someone you like. Take a moment to re-experience those positive moments.

Adapted from Davis, M., Eshelman, E.R. & McKay, M. (1995). The relaxation

and stress reduction workbook, 4^th edition. Oakland: New Harbinger Publications, Inc.

Breathing and Visualization Exercise
This exercise will help you manage the stress and anxiety associated with taking exams. It is a good idea to practice the exercise every day. That way, your body will begin to relax just out of habit when you begin the exercise (this is called the relaxation response). When you are in a stressful situation, such as an exam you can use this exercise to get relief and allow yourself to use the stress to your advantage.
Get comfortable, close your eyes, and begin to notice your breathing. Try to notice each breath and nothing else. As you inhale, say to yourself “one” and as you exhale, say to yourself “two”. Keep doing this for several minutes.
When you feel relaxed, turn your attention from your breathing to a situation you find stressful (such as picturing yourself sitting in the room just before an exam). Picture yourself arriving at the exam venue. Imagine yourself finding the seat number. See yourself sitting comfortably. See yourself getting the exam and reading each question calmly and with confidence. Picture yourself selecting the questions you’ll do. See yourself writing answers to the questions in a relaxed and efficient manner. Know that your answers don’t have to be perfect, and accept that no one is perfect. See yourself finishing the exam and turning it in, knowing that you have been successful. Sit for a minute with that feeling of accomplishment and relief. Remind yourself that you have experienced success in the past, and that you will experience success again.
Spend a few seconds enjoying the feeling of success, and then focus on your breathing again. When you feel ready, open your eyes and return to whatever you were doing.

To make this exercise even more effective, try incorporating more of your senses the picture. For example, hearing the noise of people writing, smelling the fragrances, the feel of the pen in your hand, etc. This will make the image more real.

Adapted from Davis, M., Eshelman, E.R. & McKay, M. (1995). The relaxation and

stress reduction workbook, 4^th edition. Oakland: New Harbinger Publications, Inc.

Stress Prescription
Identify stressful situations or demands. These can be academic, personal, family or job related.

Why do you think it is stressful? What are your thoughts, feelings, and behaviours?

What can you do about changing these situations/demands?

Are you able to think about them/appraise them differently?

What resources do you have to cope with the demand/stressor?
Do you need other ways of coping? What might you try?
Behavioural Strategies:

Cognitive Strategies:

A Balanced Life Style

1. 
   Calculate the number of hours you spend on college/studying (lectures, labs, independent work).
   

2. 
   Calculate the number of hours you spend socialising (including coffee breaks).
   

3. 
   Calculate the number of hours you spend exercising.
   

4. 
   Calculate the number of hours you spend doing paid work.
   

Now go back and calculate the same items, this time using the number of hours you would ideally like to spend on each item.

If you think there is an imbalance between what is ideal for a balanced life style and what you actually do, consider the following questions.

• 
  What needs to change in your lifestyle?
  

• 
  What might be the difficulties in changing?
  

• 
  What help might you need to make changes?
  

Keeping a Stress Diary

One good way to learn about your optimal level of stress is to keep a stress diary. It can be a very effective way of learning about what causes you stress, and what level of stress you prefer.

In this diary, you monitor your stress levels and how you feel throughout the day. In particular, you should make note of stressful events and what led to you to perceive them as stressful.

Signs, Symptoms and Reactions to Stress

Physical (physiological and behavioural)

• 
  Racing heart
  
• 
  Cold, sweaty hands
  
• 
  Headaches
  
• 
  Shallow or erratic breathing
  
• 
  Nausea or upset tummy
  
• 
  Constipation
  
• 
  Shoulder or back pains
  
• 
  Rushing around
  
• 
  Working longer hours
  
• 
  Losing touch with friends
  
• 
  Fatigue
  
• 
  Sleep disturbances
  
• 
  Weight changes
  

Cognitive (or Thoughts)

• 
  Forgetting things
  
• 
  Finding it hard to concentrate
  
• 
  Worrying about things
  
• 
  Difficulty processing information
  
• 
  Negative self-statements
  

Emotional (or Feelings)

• 
  Increased irritability or anger
  
• 
  Anxiety or feelings of panic
  
• 
  Fear
  
• 
  Tearfulness
  
• 
  Increased interpersonal conflicts
  

Everyone has developed his or her own response to stress. The key is to learn to monitor your own signs and become aware of when they are indicating the stress level is unmanageable.

COPING WITH STRESS
Coping resources can broadly be divided into cognitive coping strategies and physical coping strategies. Some of these coping strategies will suit some people, others will not. The key is to have a range of resources that can be applied, depending upon the situation and the individual. Furthermore, it is important to have strategies one is comfortable using.

Cognitive coping strategies
These refer to ways of dealing with stress using our minds. Cognitive coping strategies are a good way to combat stress-producing thoughts. As Shakespeare’s Hamlet said, “. . . for there is nothing either good or bad but thinking makes it so. . .” Examples of these strategies are:

• 
  Reframing – focus on the good not the bad; think in terms of ‘wants’ instead of ‘shoulds’. It’s best if our thinking is related to our goals. For example, “I want to read and understand this chapter in Chemistry so I do well in my lab practical” instead of “I have to read this difficult chapter in Chemistry”.
  

• 
  Challenging negative thinking – stopping the negative thoughts we may have about a situation or ourselves. Examples of negative thoughts include expecting failure, putting yourself down, feelings of inadequacy - a thought such as “Everyone else seems to understand this except me.”
  

In order to gain control of negative thoughts or worries, you must first become aware of them. Next, yell “Stop!” to yourself when they occur. Try replacing with positive affirmations or at least challenge or question any irrationality of the thoughts.

• 
  Positive self-talk – using positive language and statements to ourselves. These are sometimes referred to as positive affirmations; they are useful for building confidence and challenging negative thoughts. For example, “I can do this or understand this” or “I’ll try my best”. These work best when they are realistic and tailored to your needs and goals.
  

• 
  Count to ten – this allows you time to gain control and perhaps rethink the situation or come up with a better coping strategy.
  

• 
  Cost-benefit analysis – Is it helping me to get things done when I think this way?
  

• 
  Keeping perspective – when under stress it is easy to lose perspective; things can seem insurmountable. Some questions to ask yourself: Is this really a problem? Is this a problem anyone else has had? Can I prioritise the problems? Does it really matter? “Look on the bright side of life!” - Cultivate optimism.
  

• 
  Reducing uncertainty – seek any information or clarification you may require to reduce the uncertainty. It helps to ask in a positive way. Situations that are difficult to classify, are obscure or have multiple meanings can create stress.
  

• 
  Using imagery/visualisation –imagining yourself in a pleasant or a successful situation to help reduce stress. One way to use imagery is as a relaxation tool; try to remember the pleasure of an experience you’ve had or a place you’ve been. The more senses you involve in the image the more realistic, therefore the more powerful. This strategy is often combined with deep breathing or relaxation exercises.
  

Visualisation can also be used as a rehearsal strategy for an anticipated stressful event. For example, if you have a presentation to give, practice it in the mind a few times, picturing the audience’s reaction and even visualising yourself overcoming any potential pitfalls.

• 
  Smell the roses – “Experiencing life as fully as possible requires conscious effort, since we become habituated to things which are repeated. Varying our experiences (such as taking different routes to school or work) can help in this process” (Greenberg, 1987, p. 129).
  

Behavioural coping strategies
These refer to ways of dealing with stress by doing something or taking action to reduce the stress experienced. Examples of these strategies are:

• 
  Physical exercise – aerobic exercise is the most beneficial for reducing stress. It releases neurochemicals in the brain that aid concentration. For some people, even a short walk is sufficient to relieve stress.
  

• 
  Relaxation – from simple relaxation such as dropping the head forward and rolling it gently from side to side or simply stretching, to more complex progressive relaxation exercises. Progressive relaxation involves tensing and releasing isolated muscle groups until muscles are relaxed. There are also tapes and books available on this topic.
  

• 
  Breathing – from simple deep breaths to more complex breathing exercises related to relaxation and meditation.
  

• 
  Smile and Laugh - gives us energy and helps to lighten the load; relaxes muscles in the face.
  

• 
  Time management – specific strategies such as clarifying priorities, setting goals, evaluating how time is spent, developing an action plan, overcoming procrastination and organising time. These help us to cope with the numerous demands placed upon us, often a source of stress.
  

• 
  Social Support/Friends – encourage the development and nurturing of relationships.
  

• 
  Seek Help – to help us cope with unmanageable stress. Supports for students in College include the Student Health Centre, Student Counselling Service, College Tutors, and Chaplains.
  

Date: ___________

TO DO LIST

Priority Item (be specific) Reward (if necessary)
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Study / Social Timetable
Day-time

Time	Mon	Tue	Wed	Thurs	Fri	Sat	Sun
7.00
8.00
9.00
10.00
11.00
12.00
1.00
2.00
3.00
4.00
5.00

Evening

Time	Mon	Tue	Wed	Thurs	Fri	Sat	Sun
6.00
7.00
8.00
9.00
10.00
11.00

Notes

Total Study Hours	Total Social Hours	Total Physical Recreation Hours