Concordia University Health Services

STRESS MANAGEMENT
A Practical Guide

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Stress is part of life in a fast-paced society. However, contrary to popular belief, stress is not always bad. We need some stress to stimulate us. A certain level of stress is beneficial. This type of stress is called eustress. It helps us to set and achieve goals as well as perform at a higher level. For example, the demands of an upcoming competition, work project or exam can create stress, which stimulates a person to work harder to win the competition, finish the project on time or do well on the exam. However, there are times when stress is overwhelming. This type of stresscalled distress paralyses rather than stimulates. It contributes to decreased health and well-being. In fact, stress is a factor in 11 of the top 15 causes of death in Canada and is a significant reason for physician visits. Therefore, an important part of healthy living is to learn to bring stress to beneficial levels. In order to help you learn more about managing stress, we have assembled this guide on stress management. Read on to find out more about how stress is produced and some practical ways to bring stress back to a functional level, where it can work for you, rather than against you.

2 Types of Stress
EUSTRESS: Stress that helps a person perform at a higher level and achieve their goals. DISTRESS: Stress that is overwhelming and hinders performance and overall well-being.

What is stress?
Although stress has been defined in many ways, the definition we use in this guide is: Stress is the bodys physical response to a perceived threat. In other words:

STRESS IS A RESPONSE TO DANGER

For stress to occur, there must be a perception of some level of danger or threat. If there is no danger...there is no stress. The perception of danger is usually a result of evaluating the demands of a situation, identifying the resources you have to address it and realizing that you do not have enough resources to adequately meet the demands. This is the main feature of stress. We expand on this important point later in the guide.

How does the Body Respond to Stress?

Since stress is the bodys response to a perceived demand or threat, what then is that response? It is called the fight or flight response and has been with us for millions of years. The stress response helped our early ancestors escape from danger. As such, it gave those who had it an evolutionary advantage. The stress response was so advantageous for survival that most animal species today respond to stress in a similar way. The fight or flight response helps us escape from danger. For most of human history, danger came in the form of surprise encounters with predators. When faced with this danger a person had two options for survival: attack the predator (fight) or run away as fast as possible (flight). Although these are two different ways of addressing the situation, they both require the same physical response, which is to prepare the body for some intense physical activity. This response is hardwired into us. So what happens in a persons body to prepare them to face danger? A body preparing to fight or flee needs to get the most power out of muscles. This means it needs to release and use energy, absorb oxygen and circulate oxygen-rich blood to organs that need it such as heart, muscles, and the brain. This is accomplished mainly through the release of hormones; namely adrenaline and cortisol. Together, these hormones have several important physiological effects including: Increasing heart rate Increasing breathing rate (respiration) Increasing muscle tension Increasing blood pressure Increasing the secretion of insulin Increasing blood flow to the brain, lungs, heart and muscles The increased blood flow to essential body systems such as the lungs and heart is accompanied by a decreased blood flow to less critical systems, which include the digestive tract, kidneys and skin. Other effects of stress hormones are: a decrease in libido, an increase in the ability of blood to clot, a decrease in growth and tissue repair, and an increase in immune function. Although the immune system initially becomes stronger in times of stress, this response lasts for a brief period. Studies show that during chronic (i.e. long-term or ongoing) stress, immune function actually decreases, which leaves the body more vulnerable to infection. Fortunately for our ancestors, once the predator was dead or safely out of range, they were able to sit down on a rock somewhere and relax. With the threat gone, the body would stop secreting

Stress and Health

Stress has been linked to many diseases, conditions and even societal problems. They include: 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 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

adrenaline and cortisol and the persons body would return to its normal state of equilibrium. The days of being chased by a predator are long gone, but the fight or flight response is still wired into us. Todays threats and demands last much longer than what our ancestors were accustomed to. Going to school, getting a job, dealing with conflicts, managing finances, daily hassles and raising a family are only a few examples of long-lasting, stress-provoking situations. The body responds to these demands the same way it did when our ancestors were faced with a predator. Keeping the body in a stimulated state of fight or flight for long periods of time contributes to health problems, but even a short period of stress can be detrimental to health.

A 5-step Guide to Managing Stress

Stress management is an extremely important skill to develop, both for better health and for a better life experience. The following step-by-step guide can help you structure your approach to stress management.

Some Signs of Stress

Physical Signs Increased heart rate Chest pains Dry mouth Headaches Muscle aches, stiffness or Indigestion pain (especially in the Constipation neck, shoulders and Stomach cramps lower back) Sweating High blood pressure Nausea Frequent colds or flu Trembling Worsening of an existing Fatigue illness (asthma, skin Weight gain or loss rashes etc.) Behavioural Signs Increased smoking, Changes in eating habits drinking, drug use (increase or decrease) Yelling Changes in sleeping habits Swearing (increase or decrease) Aggression Nervousness (nail biting, fidgeting, pacing etc.) Mental Signs Difficulty concentrating Decreased memory Difficulty making decisions Mind going blank or mind racing Anxiety Anger Irritability Impatience Confusion Loss of sense of humour Decreased libido Inattentiveness Bad dreams

Step 1: Identify if you are stressed

If you are going to work on stress, then it is important to start at the very beginning and identify if you are actually experiencing stress. Sometimes this is easy to do. At other times it can be challenging. The first things you should look for are your particular signs of stress. Although there are hundreds of signs of stress, each person does not experience all of them. In reality, people tend to have their own specific reactions to stresssomething like a stress fingerprint (or stressprint). For one person, the signs might be difficulty sleeping, back pain and aggressive behaviour. For another, they might be sleeping too much, forgetting things and sexual problems. Generally speaking, a persons reaction to stress remains relatively stable over situations and over time. In order to identify if you are stressed it is important to get to know your own stressprint. Take some time to think about how you respond to stress and write down the signs you experience in the box below. If you have difficulty recognizing your signs of stress you might want to ask for the opinion of a close friend or family member. They often can provide great insight into how you react to stress. It is important to note that some signs of stress are also signs of a physical illness or health problem, and some of themsuch as chest painscan be My Signs of Stress are: serious. In search of a physical __________________ explanation, many people see a physician for stress-related symptoms. It is a good __________________ idea to see a health care professional for __________________ serious symptoms, or for ongoing ones __________________ that seriously affect your quality of life. If you do visit a health care professional __________________ and suspect that your symptoms may be __________________ stress-related then you should clearly let your physician know that you think stress may be a factor.

Emotional signs Short temper Frustration Worry Fear

Step 2: Identify the stressor

Now that you know you are stressed, the next step is to look for the cause. An event or situation that causes stress is called a stressor. Some people can easily pinpoint the cause of their stress, while for others it can be difficult. The following are some tips for identifying the situation or event that is causing your stress. Write down your stressor in the box on the next page. Stress is usually related to change, so a good place to start is to look for changes in your life. You can narrow down the stress-related changes by looking back at when the symptoms started. If you started having problems sleeping two weeks ago, then look at the changes in your life that took place two weeks ago (or around then). Those who know you well might be able to shed some light on what is causing your stress. Ask them for their opinion if you cant seem to pinpoint the stressor(s) yourself. Review the list below of general categories of sources of stress and see if this stimulates any ideas. Clearly this is not a complete list of stressors. Rather, it is a general overview of them: Physical environment: Bright lights, noise, heat, cold, weather, traffic... Social/relational: Rudeness or aggressiveness in others, conflicts with others, not spending enough time with important people, lack of social support, loneliness... Financial: Taxes, bills, unplanned expenses, making ends meet...

Organizational: Rules, regulations, school or work deadlines, getting a passing grade, school or work culture... Life events: Death of a family member, loss of a job, illness, starting university, work promotion, birth of a child, marriage, winning the lottery... Lifestyle choices: Not enough sleep; increased caffeine, alcohol, or drug consumption; poor time management; unhealthy nutrition... Physiological: Poor health, physical illness, pregnancy, injury...

The Cause of My Stress is:

Below, write the situation/event that is causing you to experience stress:

________________________ ________________________ ________________________

Step 3: Identify the reason for the stressor

Now that you know the stressor, you need to identify why it is causing you stress. This is a very important question as it will help you select the best strategy to manage your stress. Remember, the stress response is only triggered when you perceive a danger. In this step you need to determine why you see the situation you identified in Step 2 as a danger. In general, a person evaluates a situation to be dangerous if they perceive that they lack resources to effectively handle the demands of the situation. Therefore, a person needs to look at two aspects of the situation: their perceived demands and their perceived resources. If the perceived demands are greater than the perceived resources, then the person sees that they wont be able to handle the situation. They see it as a threat or a danger. However, if the person perceives their resources to be greater than the demands, they know that they will be able to handle the situation and they will not experience stress. It is important to emphasize that the person needs to examine the perceptions they hold of the demands and of the resources. Sometimes our perceptions are consistent with reality (i.e. the facts) and sometimes they arent. Often, stress happens because the perception we have of the demands is greater than they really are, or because the perception we have of our resources is less than they actually are, or a combination of both. A few examples might help to clarify this: Susan is experiencing stress because she has just received her Visa bill with a balance owing of $936. She is shocked that she owes so much, but upon looking over the items she realizes that she purchased all of the charges. She cant believe that she lost track of her spending. Her stress is from not having enough money to pay her Visa bill. In other words her resources ($415) are not sufficient to meet the demands ($936). This is a situation where her perception of demands and resources is in line with reality. The facts are that the Visa bill is for $936 and her bank account has $415. Anyone else looking at her Visa bill and bank account would come to the same conclusion: she doesnt have enough money in the bank to pay her Visa bill. Mike was an A student in high school who has entered university for the first time. After the first few days of classes he feels stressed. He looks at all the assignments, readings and exams he has to do and thinks that he wont be able to get As in all his courses. Sure he did well in high school, but he doesnt think he is smart enough to get the same grades in university. He doesnt think that he has enough resources (intelligence, study skills etc.) to meet the demands (get As in all his courses). This is a case where his perception may not be consistent with reality. Someone who knows Mike might say that he has underestimated his intelligence and study skills and that he is smart enough to get As in all his courses. They might also think that he has overestimated the demands of university studies. Additionally, by setting a goal of getting As in all his courses he has increased the demands, and this contributes to his stress.

Demands
In this step, the question to ask yourself is Why is this situation a danger or threat for me? Here you need to honestly look at what you think the demands of the situation are and to also look at what resources you think you have to address it. Demands (what you need) and resources (what you have) can be for just about anything. The box to the right provides some examples of what this exercise might look like. Think about the situation that is causing you stress and write below what you think are the demands and your resources. This information will be used in the next step where you select and implement stress management strategies.
I need 6 hours to finish this project I need $1,800 to pay my tuition I need for all my classmates to like me I need to have full control over the work I do

Resources
I have 2.5 hours to finish this project I have $1,000 to put towards my tuition I have a few classmates who dont like me I have an employer who gives me little control over the way I do my work

I need to have low body fat I have too much fat

Demands
In this situation/event I need:

Resources
To handle this situation/event I have:

I need my neighbours to treat me respectfully I need to be smart enough to do well in university I need to have good health I need to have a girlfriend I need to have clear roads for my drive home

I have a neighbour who is disrespectful I have a level of intelligence that is not sufficient to do well at university I have several health problems I have no-one in my life I have roads full of traffic

____________________ ____________________ ____________________ ____________________ ____________________

____________________ ____________________ ____________________ ____________________ ____________________

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Step 4: Select an appropriate stress management strategy and apply it

Now that you know you are stressed, what is causing the stress and the reason why it causes stress, your next step is to select a stress management strategy and to apply it. There are literally hundreds of ways to manage stress. The strategy you use will depend on your particular situation. However, all stress management strategies can be placed into 2 general categories: 1. Strategies that address the symptoms of stress 2. Strategies that address the stressor

Stress Management Strategies that Address the Symptoms of Stress

Stress management strategies that address the symptoms of stress are typically relaxation strategies. Remember that the "fight or flight" response stimulates the body by increasing heart rate, blood pressure, respiration and more. It is this continued state of stimulation that contributes to health problems. Relaxation strategies help to reverse the stimulation caused by the stress response. Therefore, they can reduce the risk of stress-related health problems. It is important to note that relaxation strategies can be useful for managing stress in the short term, but because they don't get to the heart of what is causing stress (i.e. they don't remove the danger), they are not useful at managing stress in the long term. Ultimately, your goal is to manage stress in the long term. We provide long-term strategies in the next section titled Stress Management Strategies that Address the Stressor. What follows are various relaxation strategies that have been proven effective for short-term stress management: A Note about Further Resources
In the following sections we provide a variety of stress management strategies. Unfortunately, there is not enough space in this guide to address each of these in depth. As such, we summarize the main points in each strategy and usually provide a further resource. Many of these resources are websites. In the case of long web addresses we provide the address to the site and you can search for the topic of interest using the websites search box. If you are looking for specific text on a page, you can hold down the Ctrl key and the letter F key at the same time and a Find box will appear. Type the word you are looking in that box and the text will be highlighted. The links we provide were accurate at the time of printing. Unfortunately, websites do come and go so it is possible that the link wont work. In this case, type the key words into your favourite search engine and start exploring. It is important to assess the reliability of information you find on the Internet, as some sites provide accurate and well researched information while others dont. To learn more about evaluating health information on the Internet try the Evaluating Internet Health Information on-line tutorial on the National Library of Medicines website (www.nlm.nih.gov).

Breathing exercises
Breathing exercises have been scientifically shown to induce relaxation. There are several ways to perform breathing exercises. Outlined in the box on this page is a method called the relaxing breath that originated in the tradition of yoga. You can listen to and download a guided version of the relaxing breath at www.box.net/public/y9u60xold3. Two additional effective breathing techniques for relaxation can be found online at drweil.com (type three breathing exercises into the search box).

Progressive Muscle Relaxation

Not surprisingly, the goal of progressive muscle relaxation (PMR) is to progressively relax your muscles. As with breathing exercises, techniques vary but the essence of the exercise remains the same: to progressively tense and then relax muscle groups. As you learn to distinguish between tense muscles and relaxed ones you can become more efficient at inducing a state of relaxation in the group of muscle that you are focusing on. You can find information on how to perform PMR on the Internet at sites such as mentalhelp.net (search for "progressive muscle relaxation") and you can search for, view and download audio and video PMR exercises using your favorite search engine.

The Relaxing Breath

1. Sit or lie comfortably with your back straight and place your tongue in what is called the yogic position: touch the tip of your tongue to the back of your upper front teeth and slide it up until it rests on the ridge of tissue between your teeth and palate. Keep your tongue there for the duration of the exercise. 2. Put one hand on your chest and the other on your belly button. 3. Exhale completely through the mouth, making an audible whoosh sound. 4. Close your mouth lightly. Inhale through your nose quietly, counting to 4. Make sure that the hand on your belly button is the one that moves out. This will ensure that you are breathing from the abdomen. 5. Hold your breath for the count of 7. 6. Exhale through your mouth to the count of 8. If you have difficulty exhaling with your tongue in place, try pursing your lips. Again, make sure that the hand on the belly button is the one moving. 7. Repeat steps 3 through 5 three more times, for a total of 4 cycles. Breathe normally and observe how your body feels.

Massage
The experience of stress can result in tense muscles. Since massage is an effective technique to relax tense muscles, it can be a great short-term approach to managing stress. You can have someone massage you or you can use self-massage techniques. Plenty of resources can be found on the Internet. Use massage techniques or self massage as your search term. You can also find information in books and videos, some of which are available in your local library or bookstore.

Exercise
During exercise, the body releases a hormone called adrenalinethe same stimulating hormone that is released in the fight or flight response. During exercise adrenaline serves a purpose as it is needed to get the body moving and keep it moving. It gets "used up" and the body returns to normal when the exercise is over. However, in times of stress the hormone is secreted but there is generally no physical action (e.g. running, jumping etc.) so the body stays in this stimulated state. Research reveals that a relaxed state usually occurs after physical activity. A few types of exercise including Yoga and T'ai Chi have additional benefits as they promote body awareness and breath control. If you are feeling stressed, take some time to go out for a brisk walk or a run, play a sport with some friends, go to the gym, go skating or try any kind of physical activity that you enjoy. The benefits of physical activityespecially regular physical activityextend well beyond stress management.

Visualization
The mind and body are intricately connected. Our thoughts can lead to changes in the body. For example, you may have been in a movie theater watching a film when a scary scene appears and you suddenly scream or tense up: your body reacts as if you were in danger, even though you are sitting in a comfortable seat and not at all in danger. You can intentionally use this mind body connection to achieve a state of relaxation. Visualization is a technique whereby you use the power of your imagination to induce feelings of relaxation. You close your eyes and imagine things that make you feel good or that are relaxing or soothing to you, such as spending time with loved ones, sitting on the beach, watching a waterfall or looking out at a lake surrounded by mountains. Don't just visualize this scenefeel it as if you were there. Beware of letting negative thoughts creep in: these will add to the experience of stress rather than promote relaxation. Another way to use visualization for stress relief is to visualize tension fading away. You can get in a comfortable position, close your eyes and imagine the tension in your body as a tight rope. Then, visualize that rope loosening up as the tension leaves your body. Yet another way is to imagine a situation that may cause you stresssuch as giving a presentation to a group of peopleand visualize yourself performing well at it. Guided imagery is a form of visualization. Here you listen to a recording of someone guiding you through the visualization and relaxation process. You can listen to a variety of guided imagery scripts on Youtube or other video sites and you can download your favorite to an MP3 player, where you can have access to it anytime you want.

Meditation
The word meditation derives from the Latin meditatum, which means "to ponder". It involves focusing attention and awareness so that you gain greater control over your thoughts. It is believed to have originated in Eastern religious tradition and has been adapted for a western audience. There are different methods of practicing meditation. Typically, it begins by assuming a comfortable posturesuch as sitting on a cushion or in a chairwhere you wont be disturbed. Then you gently close your eyes and begin to relax your muscles. The next step is to clear your mind. You want to put all your thoughts to the side. Dont think of the past or the future: just focus on the present moment. A popular way to do this is to focus on the breath. The goal is to reach a point where your thoughts disappear and you are left with an uncluttered mind. Learning effective meditation techniques requires time and effort, but the benefits extend beyond stress management. Many resources are available on the Internet, in books or through coursesincluding on-line classesto help guide you through the practice of meditation. Mindful meditation is an adaptation of traditional meditation. The goal of mindful meditation is to be in the present moment. Your focus is on the here and now. You are aware of all the information that your senses pick up, but you apply a non-judgmental and accepting attitude. You become an impartial observer of what is going on around you. Jon Kabat-Zinn has adapted mindfulness into a program called Mindfulness-Based Stress Reduction (MBSR). You can find out more about MBSR through the book A Mindfulness-based Stress Reduction Workbook by Bob Stahl or by viewing some of the many videos on the Internet about it (search for Mindfulness & Stahl, or Mindfulness & Kabat-Zinn, or MBSR).

Hot bath, sauna, hot tub

The physical changes that happen in the body as a result of stress include the constriction of blood vessels, which can lead to an increase in blood pressure. The warmth of a hot bath, a sauna or a hot tub opens up blood vessels, so that there is greater circulation of blood to the muscles, which can help you relax. Besides the physiological effects of the warmth, simply taking time to have a hot bath or sit in a sauna or hot tub can be relaxing.

Safer Sex Practices

Music appreciation
Most of us listen to music regularly, but we rarely take the time to truly appreciate the many facets of music such as the lyrics, the beat, or even the contribution of each individual instrument. Through music appreciation a person takes time to sit with the music and appreciate it as a whole as well as its parts. Obviously, just taking the time to listen to music can be relaxing, but research shows that going beyond simple listening can help you relax. Some types of musicsuch as classical, ambient or easy listeningare more conducive to arriving at a relaxed state than other types such as heavy metal or hard rock. Enjoy solo activities (e.g. masturbation). Use a barrier consistently and properly (e.g. condom or dental dam). Negotiate sexual activity with your partner(s). Participate in activities where body fluids are not shared. Avoid contact with another person's sores. Limit the number of sexual partners. Get tested for sexually transmitted infections (STIs). Share relevant information with each other about sexual history and STI status. Avoid sex under the influence of an amount of alcohol and/or drugs that would interfere with decision making or sticking with decisions you have made about sexual activity.

Sex
Sex can be a great way to relax. Sexual activity can release tension and can take a persons mind off their problems for a while. After an orgasm, an intense wave of calm and relaxation can overcome a person. The fight or flight response has the effect of decreasing libido (i.e. sexual interest) so it can be difficult to be ready for sex when you are stressed. Sex as a relaxation strategy does not mean anonymous or unsafe sex; this type of sex can contribute to more stress because of an increased risk for sexually transmitted infections, concerns for safety or an unwanted pregnancy. See the box on the right for safer sex practices, which reduce the risk of getting or spreading a sexually transmitted infection.

Hobby
Anyone who spends time doing a hobby knows that it can take a their mind off stress-producing thoughts and can also be relaxing. A hobby that is too demanding, time-consuming, or expensive, however, will probably add to stress. So will hobbies that are very stimulating, such as playing shoot-em-up video games or gambling, so it is best to avoid these if you are stressed. Hobbies that are reported to produce satisfaction and contentment are those that are creative, productive or build expertise in a skill. Some ideas include crafts, gardening, noncompetitive sports, playing an instrument, writing, singing, and dancing.

Spending time with loved ones, including pets

The time we spend with people (or animals) we love promotes feelings of calmness and relaxation.

Stress Management Strategies that Address the Stressor

Remember that stress is the body's physical response to a perceived demand or threat: Stress is a response to danger. In general, we see a situation as dangerous when we evaluate that we don't have enough resources to deal with the demands we think the situation has placed on us. In other words, when our perceived resources are less than the perceived demands, we evaluate it as a danger. As we pointed out in Step 3, a danger can be real (e.g. I dont have enough money to pay the bills) or it can be imagined (e.g. My life is over is I dont get all As in my courses). There are two categories of stress management strategies that correspond to these two categories of danger: 1. The problem solving approach (for real dangers) 2. The cognitive approach (for imagined dangers) The goal of both of these approaches is to reduce the demands, build the resourcesor a combination of bothso that the situation is no longer seen as dangerous. In the problem solving approach you do something to remove the danger, whereas in the cognitive approach you change the way you think so you no longer perceive the situation as dangerous. Because these strategies aim to remove the danger, they are long-term strategies. Once the danger is gone, so is the stress. These strategies are more effective than the relaxation strategies, but it can take some time to learn these skills and master them. As you are learning these skills, implement the relaxation strategies to manage your stress.

The Problem-solving Approach to Stress Management

The problem solving approach is effective in situations where the stressor is real. The goal of this strategy is to do something to remove the stressor, which should also remove the stress. Action is required to either reduce the demands or increase your resources. The actions you take in the problem solving approach will likely require that you build and apply skills. There are many skills that can be used during this stress management approach. The one(s) you use will depend on the stressor. Below are some skills you can build and use in your efforts to manage stress:

The Problem Solving Process

Define the problem Be clear and specific Analyze the problem What factors are related to the problem? Who is involved? When did it begin? Why is it happening? Brainstorm possible solutions Write down as many solutions as you can without discarding any right away Evaluate each solution and select the best option What are the pros and cons of the solution? Do you have sufficient resources to implement this solution? Is this solution realistic? What will be the impact? Will it resolve the problem? Will it create new problems? What are they? Implement the best solution This is where you develop a plan of action: - Who will do what? When? etc. Evaluate Has the problem been resolved?

Problem Solving
Using good problem solving skills can be very effective in managing stress. Look at the demands you have listed in the exercise in Step 3 and identify if you can problem solve to reduce them. Perhaps you can withdraw from some of these tasks or get them deferred to a later date. Also, look at the resources that are available to you from Step 3 and problem solve to see if you can find more resources. Perhaps you can find more time, more money or people to help you out. To the right, we have summarized the general steps of the problem solving process. Problem solving may seem instinctive and natural and you may feel so confident in your problem solving skills that you think you dont need to develop them more. The truth is that people are not born with good problem solving skills. They are learned, developed and refined over time. Problem solving skills can always be improved. For best results, approach problem solving formally by going through each step in the process and writing everything down. For more information on problem solving consult mindtools.com, managementhelp.org, mayoclinic.com. Keep in mind that most problem solving resources on the Internet are geared towards business and management, but you can adapt the process to your needs.

Decision Making
In the problem solving process you usually need to decide between several options, so problem solving and decision making are intimately connected. We regularly make decisions about our personal life, our work life, our school life, our social life and other areas. These decisions can affect the demands or resources related to a situation. For example, in your efforts to finish your degree early you may decide to take an extra course in each semester, but this will clearly add to your academic demands. If you base your decision solely on one criteria (I want to finish my degree early) without considering the impact it will have on other parts of your life, you may be setting yourself up for several stressful semesters. Making good decisions is not as straight forward as one might think. Good decisions are best achieved using a systematic and disciplined approach. Use the guidelines outlined in the box on the next page to improve the quality of your decisions, which can reduce stress rather than increase it. You will notice many similarities between the problem solving and the decision making processes. The main difference is that in the decision making process you begin with an objective: there is something you wish to achieve, which is the decision you will take. Your decision will be a successful one if it achieves your objective. For more information on decision making consult mindtools.com.

The Decision Making Process

Define your objective(s) What is it you want to achieve? Be clear. An objective usually begins with "I want to.." Gather relevant information Don't assume that you have all the information you need to make a good decision. Seek out as much information as possible. Consult a variety of sources. Check the assumptions you have related to the decision. Incorrect assumptions can result in poor decisions. Brainstorm possible ideas Be creative. Think outside the box. Don't edit at this point, just write down what comes to your mind. Evaluate each potential decision Will it achieve the objective(s)? What are the potential risks? What will be the impact? What resources will you need to put this decision in place? Do you have sufficient resources? Is this decision feasible? Realistic? Select the most desirable decision: the one that best satisfies the objective(s) with the fewest drawbacks Review to identify any problems or oversights. Identify any other actions that will be necessary to implement in order to prevent undesirable consequences. Communicate the decision and put it in place Evaluate Have you achieved your objective(s)?

Critical Thinking
Your thinking controls every part of your life. But are you in control of your thinking? Are you a good critical thinker? Unfortunately, critical thinking is not valued in Western society and, as a result, many people lack well-developed critical thinking skills. Fortunately, critical thinking skills can be improved and even mastered. As with anything worth having, building good critical thinking skills requires effort and energy, but the payoff is tremendous. Good critical thinking skills can positively affect all areas of you life, including reducing or eliminating stress. By taking a critical approach to a stress-provoking situation you will likely discover opportunities to reduce the demands of that situation or identify additional resources that you can use to deal with it. Furthermore, effective problem solving and making good decisions require a critical examination of the many factors involved. Critical thinking skills can be developed using a variety of approaches. We recommend the method developed by Paul and Elder. They define critical thinking as "that mode of thinkingabout any subject, content, or problemin which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them." The structures of thought are the components of thinking. They are present every time we think, whether we are thinking critically or not. The intellectual standards are the tools to evaluate the structures of thought. The intellectual standards can be applied to all the structures of thought. We take a brief look at these on the next page. You can learn much more about this essential skill by consulting the website criticalthinking.org (start with the Where to begin section) as well as the book Critical Thinking: Tools for taking charge of your professional and personal life, by Richard Paul and Linda Elder, which is available in the Concordia libraries.

Time Management
A source of stress for many people is having too many things to do and not having enough time in which to do them. You can't increase the amount of time there is in a day. Therefore, in stress management terms, you can't increase your resource: you only have 24 hours. Therefore, time management strategies seek to make effective use of the time that you do have. To be effective you must modify the demands on your time. The approach to effective time management can be divided into 2 stages: 1. Identify values and set goals 2. Develop mechanisms of effective time management One way to remember these two stages is: First, do the right things: then, do those things right. This approach highlights the fact that being efficient with your time is not necessarily a great time management strategy. If you are efficient with your time you may find that you have more time to do more things. However, if you havent identified your values, you will just keep piling more and more things onto an already busy schedule without asking yourself if doing these things is the way you want to spend your time.

A Few Words About Procrastination

Some people are procrastinators: they regularly put off things until the last minute. Procrastination can lead to stress from time pressures. If you are a procrastinator, taking steps to overcome this can be an excellent stress management strategy. There are many websites that can be helpful (such as mindtools.com) as well as books such as The Complete Idiots Guide to Overcoming Procrastination. You can also speak with a counselor at Counseling and Development or take one of their workshops on time management and procrastination (http://cdev.concordia.ca/workshops/).

Stage 1: Identify values and set goals A value is something that is important to you. It is something that has worth and gives your life meaning. Values include such things as health, good friendships, career, travel, and being good to the environment. Too often, people spend time doing things that aren't important, which takes time away from meaningful activities. Prioritizing your activities based on your values increases your sense of purpose and contributes to better mental and physical healthand it can help reduce stress. You may already be able to articulate your values. If you are not sure what they are, take some time to discover them. There are several tools that can help you with this process. One simple way is to review a list of values and to rank them. You can easily find a list of values on the Internet by typing personal values checklist into your favourite search engine. Another way is to ask yourself some questions such as those in the box on page 9.

Structures of Thought
These are the components of thought that present every time we think...whether it is critically or not. Purpose: Why am I thinking about this? What am I trying to achieve? Take time to state your purpose clearly. Check periodically to be sure you are still on target. Question: What question(s) am I asking? Take time to clearly and precisely state the question at issue. Break the question into sub questions. Identify if the question has one right answer, is a matter of opinion, or requires reasoning from more than one point of view. Information Data, facts, observations, experiences Restrict your claims to those supported by the data you have. Search for information that opposes your position as well as information that supports it. Make sure you have gathered sufficient information. Inferences Interpretations, conclusions, solutions Infer only what the evidence implies. Check inferences for their consistency with each other. Concept Theories, definitions, axioms, laws, principles, models Identify key concepts and explain them clearly. Consider alternative concepts or alternative definitions of concepts. Make sure you are using concepts with care and precision. Assumptions What am I taking for granted? What assumptions am I making? Clearly identify your assumptions and determine whether they are justifiable. Implications Consequences of thinking this way Trace the implications and consequences that follow from your reasoning. Search for negative as well as positive implications. Consider all possible consequences. Point of view Frame of reference, perspective Identify your point of view. Seek other points of view and identify their strengths as well as weaknesses. Strive to be fair-minded in evaluating all points of view.

Intellectual Standards
These are the tools to assess the structures of thought. They can be applied to all of the structures. Clarity Understandable, the meaning can be grasped Is my purpose clear? Am I clear about my assumptions? Is my question clear? Accuracy Free from errors or distortions, true Can I accurately state my purpose? Am I accurate about my inferences? Is the information I am using accurate? Precision Exact to the necessary level of detail Is my purpose precise? Have I precisely stated my assumptions? Can I precisely state my point of view? Relevant Relates to the matter at hand Is my question a relevant one? Am I using concepts that are relevant to my question? Is the information I am using relevant to my question? Depth Contains complexities and multiple interrelationships Do the assumptions I am using have enough depth? Is there depth in the inferences I am making? Does the information I am using have enough depth? Breadth Considers multiple viewpoints Do the assumptions I am using have enough breadth? Does the information I am using have enough breadth? Do the implications I have identified have enough breadth? Logic The parts make sense together, no contradictions Is my question logical? Is this information logical? Are my inferences logical? Significance Focuses on the important, not trivial Are the concepts I am using significant? Is the question I am asking significant? Are the inferences I am making significant? Fairness Justifiable, not self-serving or one-sided Have I fairly included all the information? Am I fair in my conclusions? Is the question a fair one?

Source: criticalthinking.org

Once you clear about your values, look at where you spend your time and identify if you are spending time doing things that you value. Work towards reducingor even removingthe things you do that are not consistent with your values and replace them with meaningful, rewarding and satisfying activities. An additional benefit of clarifying your values is that if you are asked to do something (or feel that you should do something) that is not in line with your values, you can confidently decide to not spend your time there. Stage 2: Develop mechanisms of effective time management Once you are doing the things that are consistent with your values, you can examine how you are doing them and, if necessary, modify your approach so that you are more efficient with your time. The mechanisms are also useful when doing things that you are obliged to do such as work tasks. Some ways to make the most effective use of your time include: Be realistic How much time will an activity take? Too often, people underestimate how much time an activity will take. To ensure that you have enough time, add extra time to what you think something will take. For example, if you think it will take you 30 minutes to get to the airport, plan your time so that you have 50 minutes to get there. Plan out daily activities The most popular way to plan out activities is to use an agenda. In order to be effective, you need to actually stick to the plan. Be sure to incorporate flexibility. For example, leave time between appointments in case one goes longer than expected. Also, build efficiency into your plan. For example, if you have four errands to run in four different places, do them in an order that minimizes the travel distance between each. Use a "to do" list A to do list gives you a quick glance at what needs to be done. Prioritize each item on your list and work to get the most pressing items completed first. You can find templates for to do lists on the Internet. Type in to do list template in Google and choose among the many options. Look for a to do list with a column for priority. One is available at mindtools.com.

Some Questions to Ask to Identify Your Values

What am I truly passionate about? What brings me alive? When have I been truly satisfied? What was I doing? If money were no object, what would I do? What things do I do where I find myself losing track of time? What is missing from my life? What would make it more satisfying? How do I define success? (Think beyond money) What do I absolutely have to have in my life to feel whole or fulfilled? What would I like to say about myself at the end of my life? What would I like others to say about me at the end of my life?

Delegate You dont need to do everything yourself. If possible, delegate tasks to others. Be sure to delegate appropriately, which means to the person who should be doing it, is willing to do it, or is able to do it well. Take advantage of "wasted" time An example of using wasted time is to catch up on reading while waiting at the doctors office or while riding the bus or the metro. Manage interruptions Most people work best when they focus on one task at a time. Interruptions can break momentum. Some ways to manage interruptions are reading your e-mail only a few times a day, closing your office or room door when you are working, and not answering the phone when you are working. Build organization skills If you are well organized you can save a lot of time. Some examples include creating an efficient system for filing and retrieving paper and digital documents, as well as laying out your clothesor making your lunchthe night before to save you time in the morning.

Communication
One of the most common sources of stress is from interactions we have with other people. Examples of stressors related to these interactions include conflicts with other people, feeling that you are not being heard, working in a group that is not functioning well and needing help but not knowing how to ask for it. In stressful situations that involve others, using effective communication skills can decrease your demands (e.g. you are able to politely, but firmly, tell someone who is asking for your time that you are unable to help, which results in less to do) or it can increase your resources (e.g. you can effectively ask for someones help to do a task, which means it can get done faster). There are three general communication styles: aggressive, passive and assertive. See the next page for a brief summary of them. The most effective of these is the assertive style. The goal of assertive communication is to honestly communicate your thoughts and needs in a respectful manner. The following are some strategies you can use to communicate assertively: Use "I" statements Using I statements is one of the most effective assertive communication strategies. Here you speak about things from your perspective. You are not blaming or accusing another person, you are simply stating things the way you see them. Some examples of I statements

are: The way I see it, I am frugal with the finances while you are more liberal. I feel anxious that we are going to be late for dinner with friends. What I want is for us to work together to get the house cleaned up. Using I statement can be effective in expressing your needs, especially when you wish for another person to change their behaviour. Here you can use the format When (you)..., I feel.... What I need is...... For example, When you constantly interrupt me, I feel like you have no interest in what I have to say. What I need is for you to listen to what I am saying without interrupting. You may not always get what you want, but the outcome will likely be better than that from using aggressive or passive communication.

Passive
Self-denying. Sacrificing. Avoids conflict. Apologetic. To please. To be nice. To avoid conflict. Don't get what you want. Relationships deteriorate. I'm not OK. You're OK.

Aggressive
Insensitive. Blaming. Intimidating. Creates conflict. To dominate. To get own way.

Assertive
Open. Honest. Direct. Respectful. Objective. Responsible for own feelings. To communicate. To give and get respect. To have control over oneself. May get what you want. Builds relationships.

Characteristics

Goal

Results

Often get what you want at the expense of others. Relationships deteriorate. I'm OK. You're not OK.

What you think when you behave this way

I'm OK. You're OK.

Be clear and direct One way to be clear is to use the KISS principle: Keep it Short and Simple. Avoid using 50 words when 10 words will do. Speak only about what is important and avoid going off topic. Take a few seconds to think about what you are going to say and how you are going to say it before you actually speak. Avoid giving a mixed message. Use assertive non-verbal communication We communicate with words as well as through non-verbal elements such as body language. When nonverbal elements are inconsistent with our words, people tend to believe the non-verbal message more. For example, if you tell someone Thats a great idea yet you roll your eyes, the other will probably think that you didnt really mean what you said. In assertive communication your verbal and non-verbal messages are consistent. Practice/rehearse Changing to an assertive communication style and being good at it requires effort. Think through what you will say and even practice it out loud before you actually have a discussion with someone. This way, when the time comes you will likely be prepared to approach it in an assertive way.

Assertive Non-verbal Communication

Maintain eye contact Smile, where appropriate Keep a relaxed, comfortable posture Speak in a clear, steady voice Use appropriate gestures

Learning How to Say "NO"

For some people, stress arises from a difficulty in saying no to the requests of others. As a result, extra tasks, projects or responsibilities pile up. Eventually stress can result as there isnt enough time in the day to do it all. Saying no can be difficult, but learning to do it in an assertive way makes it easier and more effective than being aggressive or passive. without adding anything more. You can start with As I just said..... If they continue tell them "I don't think you are hearing me, I am saying." and then end the discussion. When caught off guard: If someone surprises you with a request and you dont know what to say try "I have to think about it" or "I'll get back to you".

Some points to consider when saying no:

You have the right to say no: Your time is just as precious as anyone elses. You are not obliged to take on everything you are asked to do. Saying no is not selfish. It means that you are aware of your limits and that you want to honour the commitments you have already made. Focus on what is important: Before deciding to say yes to a request, think about how it fits with what is important to you. If it is important to you and you have the time to take it on, go ahead and say yes. Be brief: It is acceptable to provide a reason for denying a request. However, dont go on-and-on about it. Provide a brief explanationif you choose to do soand move on. Use the broken record technique: Some people dont take no for an answer. When someone is persistent, repeat your wishes

Some ways to say no:

In case you are in need of a way to say no, try the following: Just "no" : Thanks, but I'm going to pass. Gracious "no": I really appreciate you asking me, but my time is already committed. Someone else's decision "no": I promised my partner/mother/kids I wouldn't take on a new project without discussing it with him/her/them first. I'm already booked "no": I appreciate your thinking of me, but I'm afraid I'm already booked that day. Family reason "no": Thank you for the invitation. That's the day I spend time with my boyfriend/mother/sister and I've decided not to miss that special time together. Alternative "no": I just don't have the time to help you, but let's think of someone else/another way, etc..

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Conflict resolution and negotiation

Conflict is normal andwhen resolved appropriatelycan contribute to strengthening the bond between those involved. However, conflict can be a source of stress. By building your conflict resolution skills you will be better able to resolve conflicts that arise, which can eliminate stress. Conflicts involve differences between two or more people in things such as values, opinions, perceptions, ideas, procedures and more. Resolving differences is best achieved using the conflict resolution process. The best time to start resolving conflict is as soon as it happensso dont wait to start working on it. As part of the conflict resolution process you will likely need to negotiate aspects of the solution. The book Getting to Yes : Negotiating agreement without giving in by Fisher, Ury and Pattonwhich is available in the Concordia University Librariesprovides a framework for effective negotiation that can be used in every type of conflict. The authors stress four main points: Separate the people from the problem Focus on interests, not positions Invent options for mutual gain Insist on using objective criteria Negotiation resources can also be found on the Internet at sites such as mindtools.com.

Conflict Resolution Process

Acknowledge that there is a conflict and express your interest in resolving it. Gather information from all parties involved related to the differences. - E.g. interests, needs, feelings, preferred outcomes etc. Agree on the problem. -What exactly are the differences? Identify objective criteria for a solution. - How will you know when the conflict has been resolved? Brainstorm solutions. Dont discard any ideas right away. Evaluate each solution in light of the objective criteria and with the goal of best satisfying the needs of each party. - This is a win-win solution. Select the solution that best satisfies the objective criteria. Implement the solution. Monitor the results and make adjustments if necessary.

Budgeting

For many people, their financial state is the cause of their stress. Although some people face financial difficulties because of unexpected eventssuch as the loss of a jobmost people who struggle with finances are in that position because they spend more than they make. If this is true for you, then budgeting skills will likely help. With good budgeting skills you will likely reduce the amount of money that you spend (i.e. reduce the demands for your money) and increase your resources (i.e. keep more money for yourself ). There are many sources of information that can help you get your finances in order. In fact, there are too many for us to recommend one or two in particular. We suggest that you go to a bookstore, flip though books in the personal finance section and select one that suits your needs. You can buy the book oreven bettersee if it is available in your local library. The Financial Aid and Awards department at Concordia (http://faao.concordia.ca) has budgeting resources for students that you may find useful. Click on the Managing Your Money tab.

Other skills
We have listed some of the most important stress management skills. However, there are many more that can be helpful. Identifying the source of your stress will help you determine which skill you will need to build. A few examples of other skills are: Parenting skills Academic/professional skills (e.g. writing skills, presentation skills, leadership skills etc.) Specific work related skills (e.g. computer program, using sophisticated equipment etc.)

The Cognitive Approach to Stress Management

The previous section presented stress management skills that can remove a danger by reducing the demands, increasing your resources, or a combination of the two. These strategies are to be used when you can actually do something about the stressor. However, the danger that we see in a stressful situation is often not a real one; rather it is imagined. Imagined dangers are generated by our perception of a situation. They are often a result of self-created demands, not being able to recognize resources, minimizing the resources you have, or a combination of these. A self-created demand is often one in which you determine what you must have. Examples of self-imposed demands include: I must be perfect in everything I do. I must win the competition. I must look a certain way. I must be popular. I must be happy. I must be better than others. An imagined danger can also be a result of not seeing the resources you have or minimizing them. Examples or this include: Im not rich enough. Im not popular enough. Im not attractive enough. I dont have the respect of everyone. I dont have enough friends. I dont have enough talent. In stressful situations where the danger is imagined, the most effective stress management approach is to change the way you think about the situation: you need to change your perceptions of demands and resources. The strategies in the cognitive approach to stress management will help you identify stress-producing thoughtsalso called maladaptive thoughts, cognitive distortions or stinkin thinkinand replace them with thoughts that dont produce stress.

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Stress-producing Thinking
You may be familiar with the quote There is no such thing as reality, only perception. This is the central idea behind stress-provoking thinking. Each of us views the world through a filter. What one person perceives in a situation may be quite different than what another person would perceive. As a result, one situation may not be stressful for one person, while for another person the exact same situation can produce a tremendous amount of stress. Fortunately, stress-producing (i.e. maladaptive) thoughts can be changed. These maladaptive thoughts can be divided into three general categories: Negative automatic thoughts (NATs) Assumptions/rules and regulations Core beliefs

Reality is what we take to be true. What we take to be true is what we believe. What we believe is based upon our perceptions. What we perceive depends upon what we look for. What we look for depends upon what we think. What we think depends upon what we perceive. What we perceive determines what we believe. What we believe determines what we take to be true. What we take to be true is our reality. Gary Zukov

Negative automatic thoughts Negative automatic thoughts are those thoughts that pop into a persons mind without prompting. Because they are automatic, they come to mind immediately and they are not processed. Of the three categories of maladaptive thoughts, NATs are the most easily identified and the easiest to change. NATs tend to be specific to the situation: the NATs you have in one situation may not be the same as those you have in another situation. Some people are very self-aware and can easily identify their NATs. However, for many this is a difficult thing to do. If you are one of those who have difficulty, here are some ways that you can identify your NATs: Let your emotions guide you: When you experience negative emotions ask yourself "What is going through my mind right now?" Use imagery: Sometimes NATs are revealed through mental images. For example, a person who finds public speaking very stressful may have an image of themself turing red and having difficulty speaking when in front of a group. They may also see the members of that audience laughing. From these images they may discover that the NAT is I am no good at public speaking and people will think I am an idiot and laugh at me! The worst case scenario. Asking yourself "What is the worst that could happen?" can reveal NATs. For example, your partner tells you that his work is sending him to another city for three days to attend a training session. This causes you stress but you dont know why. Asking the worst case scenario question, you may discover that you think He will have an affair when he is away, or He might die in a plane crash. Rules and assumptions Rules are statements about how you believe the world should work or how you and others should behave. An example of a rule is People must always be courteous to each other. Assumptions are statements about what will happen in a certain situation. They are usually stated in the form of If..., then... An example is If I dont get an A in this course, then I will not get into graduate school. One way to identify rules is to search for thoughts that contain the words must or should (e.g. I must never make a mistake). Assumptions can be identified through if-then statements such as If someone asks me for help and I say no, then they will hate me! Core beliefs Core beliefs are beliefs about yourself, others, the world or the future. They are the deepest, the most difficult to identify, and the most difficult to change of the three categories of maladaptive thoughts. A core belief can be believed quite strongly and it may even "feel" like it is true even though it may be mostlyif not entirelyuntrue. It is usually rooted in childhood events, which may or may not have been true at the time it came to be believed. Maladaptive core beliefs continue to be maintained through regularly acknowledging any information that supports the belief while ignoring or discounting data to the contrary. Unlike NATs, which tend to relate to specific events, core beliefs are absolute and consistent: They are always with us.

Examples of Core Beliefs

I am weak I am a failure I am disrespected I am unlovable I am unattractive I am bound to be rejected The world is a dangerous place People are only interested in themselves Other people cannot be trusted

How to Modify Stress-Producing Thinking

Changing the way you think is never easy. However, there are several proven techniques that can be used to modify stress-producing negative automatic thoughts; rules and assumptions; and core beliefs. The most popular technique is called cognitive restructuring. It has been effectively used to treat a variety of problems including depression, anxiety, back pain and more. Another approach is called Rational Emotive Behaviour Therapy. Cognitive restructuring: The goal of cognitive restructuring is to replace irrational thoughts with more balanced ones. Although a person can perform cognitive restructuring in their head, it is more effective as a written exercise. Several similar formats for this technique have been developed. One of these is summarized on the next page along with two simple examples. You can learn much more about this method by consulting the highly recommended books Mind Over Mood: Change the way you feel by changing the way you think by Greenberger and Padesky or Feeling Good: The new mood therapy by David Burns.

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1. What is the situation that is causing you stress? Where were you? Who was there? What happened? When? 2. What are the thoughts you have about the situation? These can be negative automatic thoughts, rules, assumptions, or core beliefs. If you have difficulty identifying your thoughts, use the strategies outlined previously. You may identify one thought or several. 3. How do you feel when you think this way? Sad? Stressed? Anxious? Helpless? Out of control? 4. Evidence that supports the thought. In order to identify more balanced thoughts you need to look at the evidence for and against the thought. When we think negatively we tend to focus on things that support the negative thought. We treat the thought as if it were the truth. In order to do this exercise fairly, it can be helpful to treat your thought as an hypothesis that you are testing, rather than a given fact. This way you can distance yourself from the emotions of this situation. Also, it is important to focus on the factual evidence and to avoid interpretations of the evidence. 5. Evidence that doesnt support the thought. Often, when we have irrational thoughts it is because we havent examined the evidence that opposes the thought. In this step you need to take an honest look at the evidence that contradicts your stressful thoughts and supports other possible conclusions. Below we have provided some questions that can help you with this part of the exercise as well as Step 6. 6. Alternative/balanced thought. Look at the thought you have written down in Step 2 and examine it in light of the evidence from Steps 3 and 4. If the evidence does not support your negative thought, write an alternative thought here. If the evidence only partially supports your negative thought, rewrite the thought to incorporate the evidence supporting as well as the evidence contradicting your negative thought. 7. Outcome. How will you feel if you truly adopt the new alternative/balanced thought?

Scenario 1
1. Situation
Some friends are going out to dinner this weekend and I wasnt invited. My friends dont like me. They

Scenario 2
I made a suggestion at the weekly staff meeting and most people thought it wasnt a good idea. People think I am stupid. I am terrible at my work. I have no good ideas. Anxious. Disrespected. Stupid. Stressed. The people who didnt like my idea pointed out that we dont have enough resources to implement it. A few people did think it was a good idea. I often get complimented on my ability to think outside the box. Mine was not the only idea that the group didnt like. People tell me they like the way I work. I usually do a good job. People at work think that I am capable and often have good ideas. I do my work well, but this wasnt one of my best ideas.

2. Thoughts think I am boring. I will end up

having no friends.

3. Feelings

Sad. Disliked. Alone. Stressed.

4. Evidence that I do get moody every now and supports the then. thought
My friends have told me several times that they think I am fun and that I make them laugh. Other friends have not been invited to other activities. I do get invited to most things.

5. Evidence that doesnt support the thought

6. My friends like me but that Alternative/ doesnt mean they have to invite me to everything. balanced thought

7. Outcome

I feel happier. I no longer feel stressed about this.

I feel calmer. I no longer feel stressed about this.

Rational emotive behaviour therapy: Another approach to changing maladaptive thoughts is called Rational Emotive Behaviour Therapy (REBT). The approach is similar to cognitive restructuring. You can learn more about REBT by consulting the website rebt.org.

Questions to Help Identify Evidence that Doesnt Support the Thought or Alternative Thoughts
What experiences do I have that show that this thought is not true 100% of the time? If a person close to me knew I was thinking this, what would they say to me? What evidence would that person point out to me to show that my thought is not 100% true? What would I say to a friend who said to themself what I am saying to myself? When I am not feeling like this, would I think differently about this situation? In the past when I have felt this way, what have I said to myself to feel better? Have I been in similar situations in the past? How did I cope then? What did I learn from that situation that I could use now? Is this situation any different than what I experienced in the past? Are there any small things that contradict the thought I am discounting? Five years from now, how will I look at this situation? Will I focus on different aspects of it? Do I have any strengths, skills or other positive aspects that I am ignoring? Am I blaming myself for something over which I do not have complete control? Am I focusing on the evidence, or are my thoughts guided by the way I feel? Am I assuming that this is the only way of looking at things? Am I making any thinking errors? (see next page for common thinking errors) Am I judging myself more harshly than I would judge others?

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Common Cognitive Distortions

For some people, stress is often the result of making the same thinking error over and over again. It can be helpful for these people to identify the thinking error they keep making and work to change it in order to streamline their stress management strategies. For example, a person whose stress is a result of always focusing on the negative aspects of a situation can learn to become a more positive thinker, which should have a positive impact on stress. We have listed some common cognitive distortions at the bottom of this page. Review them to determine if they may be a factor in your stress. If so, take steps to change this way of thinking.

Stress and the Social Determinants of Health

This booklet provides information on what you, as an individual, can do to manage your stress. However, many factors beyond the individualsuch as family, organizations, community, society and culturecontribute to stress by creating the conditions that make us stressed in the first place. For example, many students experience stress because of insufficient income; juggling school, work, and family responsibilities; and academic pressures. In the workplace, many employees attribute job stress to unrealistic workloads and uncompensated overtime. Still for others, stress is a result of living in sub-standard housing and unsafe neighbourhoods. It is important for individuals to learn the skills that are presented in this booklet to be better able to manage their stress. However, an approach that would have a greater effect on reducing stress for the population is to modify the conditions that cause stress in the first place. Some of these are called the Social Determinants of Health. It is not easy to change a school or workplace culture, the education system, or housing and safety in entire neighbourhoods. Nonetheless, each of us can make a difference by learning more about the social determinants of health (search What Makes Canadians Healthy or Unhealthy on the Public Health Agency of Canada website), by casting our vote for politicians who work to change stress-producing conditions, and by supporting initiatives that remove the barriers to healthy living.

Step 5: Evaluate
Now that you have done your best to manage stress, it is time to evaluate and see if your stress has been eliminated. To do this go back to step one and identify if you are still stressed: Are you still experiencing the symptoms of stress? If the answer is no then you can pat yourself on the back for doing such a good job. But be prepared because this certainly wont be the last time that you will experience stress. If the answer to the question Am I still stressed? is yes, you should review the stress management steps. Perhaps you didnt accurately identify the stressor or why it was a stressor. Perhaps you selected an ineffective stress management strategy. Perhaps your stress is not a result of the situation, rather it is a result of your perceptions of the situation. If you are trying to manage your stress but dont have much success, you might consider meeting with a counselor or other mental health professional. There are several services at Concordia that have professionals who can help, including Health Services and Counseling and Development.

Cognitive Distortion
Mindreading Fortune telling

What it is
You assume you know what a person is thinking without verifying with them. You predict that future events will turn out badly. You make thingsespecially your faults and failuresseem greater than they are. You "blow things out of proportion" or "make a mountain out of a mole hill". You make thingsespecially your strengths and successesseem small and unimportant. You reject the positive things in your life. You think that they don't count. You see the negative aspects of a situation and focus exclusively on them. You view a situation only in two categories instead of on a continuum. You think in terms of extremes (always, every, never etc.) You conclude that one negative event is part of a pattern that occurs over and over again. You demand a lot of yourself and others. You think you (and others) "should" or "must" do certain things or act a certain way. You conclude that what has happened was your fault, even when the evidence suggests otherwise. You feel a certain way and reason that there must be something about the situation that makes you feel this way. "She thinks I'm stupid." "He thinks I'm unattractive."

Example

"There's no way I'll get that job I want" or "I'm not going to do well on the next midterm." You make a mistake at work and think that everyone will notice and think poorly of you.

Magnifying

Minimizing Discounting the positives

Someone compliments you on something you have done and you say "He's just being nice." You receive an award of recognition and say "They give one of these to everybody." There was a little bit of rain when you were on holidays. When asked how your trip was, you tell people that "The weather was bad and it ruined the trip!" An "A" student gets a "B" on an exam and thinks "I'm a total failure".

Focusing on the negatives

All-or-nothing (black-andwhite) thinking Overgeneralizing Demanding (should-ing, "must-urbatory" thinking) Personalizing

You have difficulty learning a new computer program and say "I'm no good at working with computers". "I must never make mistakes".

Your partner didn't pay the electric bill and you think "It was my fault. I didn't remind him/her to pay it." "I feel overwhelmed and hopeless. Therefore, my problems must be impossible to solve."

Emotional reasoning

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Healthy Living and Stress

Adopting health-enhancing behaviours can help you be less vulnerable to stress or make you better able to manage it when it arises. After all, health is arguably your greatest resource, and the more resources you have the better able you are to manage stress. Beyond having a positive impact on stress, these behaviours are also associated with many other benefits such as reduced risk of physical and mental illness and an enhanced sense of well-being.

Further Resources for Healthy Living

You can find more information about healthy living by consulting past issues of the Health Notes newsletter. You can find Health Notes online under the Health Information and Promotion tab of the Concordia University Health Services website (http://www-health. concordia.ca/). Nutrition: September 2009, September 2010 Physical Activity: October 2009 Sleep: December 2009 Tobacco: You can find a link to the selfguided smoking cessation program called Your Guide to Quitting Smoking for Good with the December 2009 issue of Health Notes online. Other reliable resources include: Health Canada (www.hc-sc.gc.ca); WebMD (www.webmd.com); The Mayo clinic (www.mayoclinic.com); The Harvard School of Public Health Nutrition Source (www.hsph.harvard.edu/nutritionsource) The National Library of Medicine (www.nlm.gov)

Eat a Healthy Diet

A healthy diet focuses on plant-based foods such as fruit, vegetables, grains, beans, nuts and seeds. The Canada Food Guide (www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php) offers guidelines for healthy eating that you can adapt to your personal preferences. Some general guidelines for healthy eating include: eat a diet that is rich in plant foods (e.g. fruit, vegetables, grains, cereals, nuts, and seeds); eat a diet that is low in overall fat, low in saturated fat, low in sodium and low in sugar; avoid trans fats, which are found mostly in commercially prepared baked goods (e.g. cookies, crackers, pies) and hydrogenated fats (e.g. shortening, some margarines); eat regularly throughout the day by including a breakfast, a mid-morning snack, lunch, a mid-afternoon snack, dinner and an evening snack; eat a variety of foods; eat real food, not junk such as fast food, junk food and highly processed foods.

Engage in Regular Physical Activity

Regular physical activity is associated with many health benefits including a significant reduction in the risk of heart disease, high blood pressure, diabetes, cancer, stroke, depression and other illnesses as well as better sleep, better sex, and a healthy weight. The recommendation to achieve these benefits is to engage in 150 minutes of moderate to vigorous physical activity each week. This translates to 30 minutes, 5 days a week. Moderate activities are those that increase your breathing so that you can still talk but cant sing during the activity. They include leisure bicycling, low-impact aerobics, dancing, shoveling snow, and recreational badminton. Vigorous activities are those where your breathing is such that it is challenging to talk during the activity. These include jogging, high-impact aerobics, most competitive sports and swimming steady-paced laps. Other forms of physical activity include flexibility activities (e.g. stretching, yoga) and strength training activities such as weight lifting.

Dont Use Tobacco

There is not one good thing about using tobacco. If you use tobacco, the best thing you can do for your healthby faris to quit. The only reason the vast majority of people continue to use tobacco is that they are addicted to nicotine. Nicotine stimulates the pleasure center of the brain. When the brain of a smoker is deprived of nicotine he or she experiences negative emotions, which feels like stress. Tobacco does not relieve stressin fact it causes it. Although it can be difficult to quit, millions upon millions of people have done so, most of them without the help of a professional or quit smoking aids such as nicotine gum or the patch. If you would like free professional help to quit smoking contact Concordia University Health Services.

Get Sufficient, Quality Sleep

Lack of quality sleep negatively affects some of your resources. It reduces your level of energy; decreases your ability to think clearly and problem solve; negatively affects your mood (e.g. increased irritability); weakens your immune system (so you get sick more often) and more. The best way to promote sufficient, quality sleep is to establish a routine by going to bed at the same time every night and getting up at the same time every morning.

Establish and Maintain Healthy Relationships

The people in your life are extremely important resources for stress management. They can provide help (e.g. feed your cat when you are away) as well as emotional support. Although Facebook and other social networking sites are a convenient way to communicate with people, they are not the basis of a mutually-beneficial, health-enhancing relationship. Qualities of good relationships include a balance of taking and giving, being able to share, expressing vulnerability, trusting the other, showing respect and more. The flip side of nurturing healthy relationships is eliminating those relationships that are toxic, abusive or otherwise unhealthy. It can be difficult to end a relationship with a friend or a partner; however, it can also be quite detrimental to hold on to these relationships.

Build Skills
The problem solving approach to stress management requires building and using skills to remove the danger. Dont wait until you are stressed to learn these skills. In fact, the best time to build these essential stress management skills is when you are not experiencing stress. Take any opportunity you can to learn more about the skills we have outlined and to practice and refine them.

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