Part 2: Managing Stress

The Stress Tool Box

Remember, not all tools we discuss will not necessarily resonate with you, and that is ok. Pick and choose what is meaningful and applicable. Then give it a try for a couple of weeks and see how you feel.

The Stress Tool Box: Dealing with things in real-time.

Deal with things as they arise, don’t let it sit and fester. This might mean scheduling time every day to reflect – How have things gone? How have I felt? Did I take today in my stride, or did I feel out of control? Then ask yourself, could I have done things differently and perhaps felt better? When we deal with things as they come up, we can react and adapt in different way. This allows us to not repeat the same mistake every day. It also stops life and our stress levels from getting out of control.

Tip #1 Try scheduling 15mins each night to sit and reflect on the good and bad, and what you could do differently tomorrow.

The Stress Tool Box: Schedule worry time.

Scheduling worry time can be an invaluable practice. Worrying is when we think excessively about potential issues in the future that may or may not arise. We worry for a good reason; it helps us to feel in control and safe. But more often than not, the things we worry about we cannot control and overanalysing only feeds anxiety and stress. Scheduling worry time allows us to delegate time every day to do all our “worrying”; creating clear boundaries and uninterrupted focus. The overall aim, to reduce how much time we spend worrying.

Tip #2: How to schedule worry time:

Create a 15-30min of uninterrupted time each day to worry, no more.
Pick the same time every day.
Pick somewhere that is not “comfortable” or “pleasant” for you, particularly your bedroom.
Set a timer and don’t go over.
Throughout the day write down worries as they come up.
Once you write your worry down, do something else to distract you from get caught in the “worry-loop”
Use your scheduled worry time to run through your list and organise them into what you can control or change and what you can’t.
If the answer is you can, create a plan for tackling it.
If the answer is no, work on letting it go.Self-compassion and mindfulness can be effective practices for working on letting go of what it beyond our control.

The Stress Tool Box: Dealing with Stressors.

It is normal to become overwhelmed by stressful situations, but this feeling, if left uncontrolled can be like placing petrol on a fire that is already burning.

Dealing with stressor involves finding helpful ways to:

Understand why you feel stressed or overwhelmed by the situation
Determine what you have influence over and can create a plan for and organise this into 3D’s “Do It, Dump It, Delegate It”
Let go of what you can’t control, through self-compassion and mindfulness practices or speaking with your health care team

Tip #3: One technique that can be beneficial for calming our fight, flight response is “STOP”

Stop what you are doing

Take a few deep breaths to bring you back to the present moment

Observe what is going on in your body, mind and with your emotions

Proceed with something that is helpful and will support you in this moment – talking with a friend, a cup of tea, a walk in the sun.

The Stress Tool Box: Dealing with emotions.

Emotions are a way of drawing our attention to a need that has not been met. When it comes to stress, our “emotional brain” is incredibly active: shooting of emotions left-right-and-centre such as anxiety, worry, sadness, pain, distress, just to name a few. All of these emotions have the aim of protection and safety. The challenge with stress and emotions, they feed into one another, often making us feel more helpless and out of control.

Strategies for dealing with emotions include:

Self-awareness. Being aware of what is happening in our body and how we are feeling.

Mindfulness. Being present in the uncomfortable emotion, without judging ourself for how we are feeling.

Relabelling emotions. Try challenging how you feel about your emotions, moving from negative or positive, to helpful or unhelpful.

Find an outlet. Finding ways to diffuse or “take the punch out” of emotions can be very beneficial e.g., journaling, expressive writing, communication, challenging thoughts and so on.

Reduce vulnerability to emotions. Take care of yourself with exercise, relaxation, sleep, a good quality diet, reducing caffeine and alcohol.

Act in opposite. Shift the emotion, by forcing yourself to behave in opposite to what you feel e.g., going for a walk when you feel like hiding, watching a funny movie when you feel like crying.

Self-compassion. Be present in the emotion, choose empathy and kindness to yourself for how you are feeling.

Acceptance. Move away from “beating” yourself up for how you are feeling, towards awareness, acknowledgement and allowing.

Tip #4: Try the PLEASE Technique

PL – Physical Illness: Treat illness and injury in a timely manner

E – Eating: Eat a well-balanced diet, restricting caffeine, alcohol, sugar, transfats and processed foods.

A – Avoid Mood Altering Drug: Only take prescription medications as prescribed, avoid recreational drugs and alcohol.

S – Sleep: Aim for good quality and quantity when it comes to sleep, and avoid too much or too little.

E – Exercise: Create a regular exercise routine, which includes something to get your heart pumping and something to relax and unwind. The best exercise is the ones you love.

The Stress Tool Box: Dealing with Distress and Crisis.

There are some times when we can find ourselves in high levels of distress or crisis. In these times, using temporary strategies to break the “fight, flight, freeze” response can be vital for reducing suffering in these moments. This can be similar to taking a “vacation” from the moment and transporting ourselves to a quieter, safer space temporarily. We may use memories, imagery, distraction or meaningful practices e.g., prayer, meditations, poetry, lyrics, quotes, mantras or scrapbooks.

Tip #5: Try the ACCEPTS Technique

Activities – engage in doing something e.g., hobbies, exercise, spending time with supportive people

Contributing – do something for some else

Comparisons – think about a time when things were worse: the skills you learnt that could help you through this experience; and the impermanence of the distress we feel

Emotions – try forcing a shift in emotions, by doing something in opposition to how you feel

Pushing Away – try distracting yourself to put the problem on a shelf temporarily

Thoughts – try challenging the thoughts you are experiencing, by writing them down and finding the evidence that doesn’t support them.

Sensations – try grounding yourself by engaging in a mindfulness routine of using the 5 senses to hear, taste, touch, hear and smell.

The Stress Tool Box: Mindfulness.

Often people think mindfulness is the art of emptying your mind and meditating. But this is far from the truth. Mindfulness is the act of redirecting your mind, over and over again, to the present moment. This redirection can be found in concentrating on the breath, the sensations in the body, the sounds which surround us, a mantra we repeat in our head or simply counting each time we take a breath in or out. Mindfulness allows us to train our “rational thinker” – making it stronger and more reactive. Mindfulness allows us to notice, without judgement how many thoughts race through our mind. This noticing, helps us to recognise the ever-changing landscape of our mind, thoughts and emotions. Allowing us to see its impermanence.

Tip #6: 5 Senses Exercise. The goal is to calm your mind by using your five senses to focus on the present moment instead of your racing thoughts.

Notice 5 things that you can see. Look around you and become aware of your surroundings. Try to pick out something new or different.
Notice 4 things you can feel. Bring attention to what you’re currently feeling, such as your clothing or the surface in front or beneath you.
Notice 3 things that you can hear. Listen and notice the sounds in the background. Is it a clock, the traffic, your own breath?
Notice 2 things you can smell. Bring attention to scents that surround the air around you, they may be pleasant or unpleasant.
Notice 1 thing you can taste. Take a sip of a cup of tea or coffee, really taste the flavours as you swirl it around your mouth.

The Stress Tool Box: Soften – Soothe – Allow for Difficult Emotions.

This technique involves, 3 steps:

Labelling the emotion you are experiencing
Being mindful of the experience of the emotion you are having
Softening-soothing-allowing the emotion you are experiencing

Tip #7: Soften-Soothe-Allow Technique: To practise this technique

Find a comfortable position, close eyes, take 3 slow breaths
Place your hand over your heart
Bring to mind a mild to moderate situation you are experiencing right not
Clearly visualise the problem – who, what, where, when, how
Label the strongest emotion you are experiencing
Repeat the emotion to yourself in the voice of a friend
Bring awareness to your body, where are you feeling this emotion
Expand your awareness to your whole body
Where does the emotion feel strongest?How does the body feel – tight, pain, ache?
Now focus on softening this location e.g., warm water, a soft massage, relaxation.
Now focus on soothing yourself e.g., your hand over your heart, warmth and kindness washing over you, words of comfort like that of a friend
Finally, allow the discomfort to be there.Making room for it and releasing the need to make it go away.
Repeat to yourself several times “softening, soothing, allowing” whilst continuing to breath.
Now, let go of the practice and expand your awareness to your body and the room around you, whilst opening your eyes.

The Stress Tool Box: Coping Strategies.

Coping strategies are how we solve all the problems that arise in our day-to-day lives. They allow us to feel we have the capacity to manage the problem and tolerate the stress they cause us. Coping strategies often arise out of life-experience, role models, support networks, maturity, self-belief, personality traits and learned behaviours. Our ability to cope can be likened to a bank account – too many withdrawals and we can find our resources depleted. But just like a bank account, we can make deposits to increase our resources, these include self-care, time-management, delegation, slowing our “yes”, overcoming perfectionism and guilt, and setting healthy boundaries, to name a few.

Tip #8: Self-talk

An important coping strategy to practice and master is our self-talk.

Our internal dialogue tends to arrive with a negative bias in times of stress. Give this “chatter” too much airtime and it can impact our self-confidence, self-belief, and self-esteem. The “chatter” is not the issue, it is how much we buy into it.

2 strategies that can be practiced, building a healthy internal dialogue include:

Mindfulness – shifting the perspective and not letting thoughts and feelings define us.
Reframing self-talk:

Positive coping self-statements – aimed at encouraging and reinforcing self-belief e.g., “I am learning and practicing ways to help myself”

Releasing statements – aimed at acknowledging and articulating the emotions and then being forgiving, compassionate and accepting of the hardship you are facing e.g., “I accept that sometimes my thoughts take control of me, and I am learning to challenge them”

Interrogative statements – aimed at fostering a curiosity to emotions and experiences, tweaking the way you speak to yourself e.g., “I wonder why I am feeling this way?” or “Is there something I could try differently that might change how I am feeling?”

The Stress Tool Box: Manage Triggers.

Stress triggers are the things that happen in our life that may cause us to feel stressed. They may include:

Big changes in our life such as the addition or subtraction of a spouse, child, family member, friendship group or job; changing where or how we live
How we interact or relate to the people in our life, both significant and other
How we plan and prioritise our day
How we view stress and challenges

Managing stress triggers may mean learning to:

Communicate differently with people
Setting boundaries and slowing our “yes”
Reprioritising where we spend our time and who we spend our time with
Removing things from our life that we can that cause us stress
Reducing the number of commitments, we have in a single day
Lessening our daily load
Planning our day and removing the things that aren’t important or urgent

Tip #9: Urgent versus Important

Learning how to prioritise everything you have planned in your day can reduce the feeling of stress and overwhelm that comes with “too much to do, too little time to do it”

This matrix designed by Steven Covey, can be incredibly useful to breaking up our to-do:

The Stress Tool Box: Build Stress Resilience.

A study released in 2010, showed how overcoming adversity helps build our ability to deal with future stress. It appears that when we deal with adversity, we are forced to increase our skill set by necessity. These learned skills can then become resources we rely on in the future.

Stress Resilience can be built by:

Finding skills that give us a sense of pride and achievement e.g., hobbies, sports, employment, creativity etc.
Finding support that allows us to feel acknowledged, heard and accepted.
Creating a practice for enhancing the positives such as gratitude or self-compassion
Learning to be curious and open to challenges and change
Learning to relabel “stress” as a challenge, a growth opportunity, a chance to adjust and adapt our path
Learn to find a sense of control in the chaos e.g., look to your life and the things you have personal responsibility over like pets, children, plants, hobbies, or passions

Tip #10: Find your strengths and use them

Strengths are the skills we possess that make up who we are and what makes us tick. Research in 2000 looked at 24 signature strengths that make up human personality and noticed how we all possess these to varying degrees, but how these display in us, is what makes us unique. Interestingly, these strengths can be cultivated to become stronger and more dominant.

These 24-signature strengths are arranged into 6 virtues:

Wisdom
Courage
Humanity
Justice
Temperance
Transcendence

When we find and use our strengths, we can often feel greater senses of purpose, meaning and contentment in our day to day lives. They can also help us align our lives with how we want to live, due to a greater understanding of ourselves. Learn more about this here

The Stress Tool Box: Overcome Guilt & Perfectionism.

When our “fight, flight and freeze” response alarms, we feel a sense of urgency and pressure to act. It is normal to pressure ourselves to act – work harder, work faster, don’t slack off, don’t take breaks. It is also normal to start to berate ourselves for not “fixing” or “preventing” the problem. We can find ourselves moving between guilt “what I have done has led me to this mess” and shame “I am the mess”.

Shame or the belief that we are bad or to blame, is crippling. It forces us into hiding and often forces us to a grinding halt. Guilt or the belief that what we have done is bad, can also feed into the stress cycle, but can at least focuses on behaviour and that is something we can work with … if the blame lies here. The challenge with guilt, is that sometimes it is triggered by thought traps such as perfectionism or “should’s” … I should exercise more, I should have a cleaner house, I should earn more money, I should be a better parent, I should be happy all the time … “Should’s” are often one of the leading causes of stress, because they are often unrealistic demands we place on ourselves. When we “should” we also often berate ourselves for not being enough, or what we think we ought to be. “Should’s” are often so far from our present reality, that trying to tackle them is overwhelming.

Tip #11: Overcoming guilt and perfectionism

These 10 practices are adapted from “The Stress-Proof Brain” – Melanie Greenberg PHD:

Challenge your guilt – each time you feel you are not “being” or “doing” enough, find the evidence that supports how much you are doing or being e.g., what you do for your kids, family, or partner.
Find solutions for the problem – if you are feeling guilty, change tacts and look to what you can do about it.Are you taking too much on? Are other’s expecting too much from you? Is there a way to manage your time differently or reprioritise how you are spending your time?
Be grateful of you – find 3 things each day that you are grateful for about yourself.Take time to note, any things you did that day to move you forward with your goals. Guilt, Shame and Perfectionism all like to seek the negative bias, finding rituals to override these can be incredibly helpful in shifting this.
Are you being a friend to yourself – sometimes combating guilt can be as simple as asking, what I say or expect this from someone else? Try making yourself the observer to your thoughts and ask “is this reasonable or fair?”
Don’t let perfection be the enemy of good – if you tend to be a perfectionist, then setting limits to the time you will dedicate to a task can be invaluable. Set a timer and when it goes up, get up and walk away. This timeframe will help you to be more efficient in how you use your time.
Make a list and check it once – don’t let proof reading and checking become the never-ending cycle, that stops you getting things done and moving forward. Limit how many times the perfectionist allows you to second guess yourself.
Pause the worst-case scenarios – the act of perfectionism is based on control and fear of the worst-case scenario and not being prepared.The antidote to this fear, is gradual exposure to deliberate mistakes to challenge this belief. Before you make the mistake, write down what you think will happen, and then compare this with what happens.
Just do it – practice makes progress, perfection is an illusion.We can find ourselves procrastinating when we want everything to be perfect. The risk is that nothing gets done and stress skyrockets. The remedy – break it down, break it up – and do anything right now, to get a small win under your belt.
Use the perspective of someone who loves you – think of someone who loves you and view your work through their eyes. How would they talk to you? How would they review your efforts?
Challenge “all-or-nothing” – perfectionist’s often see the world through an “all-or-nothing” lens – if it is not good, it is bad. Take note of the lens you are looking through, and then challenge this.

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Learn more about The 12 Pillars of Wellbeing for Managing Chronic Pain; Reimagined for 2021

Learn More

If you are wanting to learn more about stress reduction, relaxation and chronic pain, this section includes:

Stress Management Resources
Mindfulness Resources
Relaxation Resources
Free Worksheets

Stress Management Resources

Article: NPC: 12 Quick Tips for Managing Stress (link)
NPC YouTube Channel: Manage Stress (link)
Article: IPC: Stress and Chronic Pain (link)
Factsheet: CCI: Stress and Anxiety (link)
Factsheet: CCI: Coping with Stress (link)
Factsheet: TA: Self-Care Tips (link)
Factsheet: TA: Stress Management Tips (link)
Factsheet: TA: Fight or Flight Response (link)
Factsheet: TA: Time Management Tips (link)
Factsheet: TA: Positive Steps to Wellbeing (link)
Factsheet: TA: Symptoms of Stress (link)

Mindfulness Resources

NPC Youtube Channel: Practising Mindfulness and Meditation (link here)
Free Online: Mindfulness Based Stress Reduction Course (link)
Website: Jon Kabat-Zinn: Mindfulness Based Stress Reduction (link)
Journal Article: Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses (link)
Article: APA: Mindfulness-based Stress Reduction (link)
Article: NPC: Relaxation, Mindfulness and Meditation (link)
Article: TA: The Benefits of Mindfulness (link)
Factsheet: ACI: Mindfulness (link)
Factsheet: TA: Mindfulness Skills (link)
Book or Movie: My Year of Living Mindfully. Shannon Harvey (link)
Movie: The Connection. Shannon Harvey (link)

Relaxation Resources

Article: NPC: Relaxation, Mindfulness and Meditation (link)
Factsheet: ACI: Progressive Muscle Relaxation (link)
Factsheet: CCI: Progressive Muscle Relaxation (link)
Factsheet: ACI: Focused/Slow Breathing (link)
Factsheet: CCI: Breathing retraining (link)
Factsheet: ACI: Imagery (link)
Factsheet: ACI: Relaxation (link)
Article: NIH: Relaxation Techniques for Health (link)
Article: Inner Health Studio: Relaxation Techniques (link)
Article: Chronic Pain Australia: Relax (link)
Factsheet: TA: Relaxation Techniques (link)

Free Worksheets

Worksheet: TA: Mindfulness Exercises (link)
Worksheet: TA: Stress Exploration (link)
Worksheet: TA: Self-Care Tips (link)
Worksheet: TA: Family Mindfulness Schedule (link)
Worksheet: TA: Mindful Meditation (link)
Worksheet: TA: Progressive Muscle Relaxation Script (link)
Worksheet: TA: Stress Management (link)
Worksheet: TA: Problem Solving (link)
Worksheet: TA: Emotion Thermometers (link)
Worksheet: CCI: Fun Activities Catalogue (link)
Worksheet: CCI: Behavioural Activation Worksheet (Fun and Achievements) (link)
Worksheet: CCI: Healthy Me (link)
Worksheet: TA: Worry Exploration (link)
Worksheet: TA: Gratitude Exercises (link)
Worksheet: CCI: Daily Record of Your Breathing Rate (link)
Worksheet: CCI: Monitoring Your Relaxation Level (link)
Worksheet: TA: Recognising Stress (link)

Others

Book: The Stress-Proof Brain. Master your emotional response to stress using mindfulness and neuroplasticity. By Melanie Greenberg, PHD
Book: Rushing Woman’s Syndrome. The impact of a never ending to-do list on your health. By Dr Libby Weaver
Book: Neuroscience of Pain, Stress, and Emotion. By Magne Flaten Mustafa al’Absi (link here)
Website: Institue for Chronic Pain: Chronic Pain and Stress (link here)
Website: Help Guide: Stress Management (link here)
Website: Positive Psychology: 62 Stress Management Techniques, Strategies and Activities (link here)
Website: Zety: Burnout: Prevention, Treatment, and Advice for Employees & Employers (link here)
Website: Psychology Today: The Connections Between Emotional Stress, Trauma and Physical Pain (link here)
Journal Article: Chronic Pain and Chronic Stress: Two Sides of the Same Coin? (link here)
Journal Article: Pain in Times of Stress (link here)
Journal Article: Anxiety and stress can predict pain perception following a cognitive stress (link here)
Journal Article: The stress model of chronic pain: evidence from basal cortisol and hippocampal structure and function in humans (link here)
Website: Harvard Health: The Pain-Anxiety-Depression connection (link here)
Website: The Stress & Chronic Pain Cycle (and how to break it!) (link here)
Website: The American Institute of Stress (link here)
Website: Cureable: Chronic Pain a cycle of stress and pain (link here)