 |
This Web site is a component of the SAMHSA Health Information Network. |
|
Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Illness Management and Recovery Workbook
Chapter 8
Practitioner Guidelines for Handout #7:
Coping with Stress
Introduction
Stress can contribute to symptoms and relapses for people with a psychiatric
disorder. Coping with stress effectively can reduce symptoms and prevent relapses.
This module helps people to recognize different types of stress and to identify
the signs that they are under stress. It also provides a variety of strategies
that people can use to cope with stress. Practicing coping strategies both in
the sessions and as part of homework can decrease symptoms and distress, and
increase people’s ability to manage their illness more effectively.
Goals
- Convey a sense of confidence that people can reduce stress
and improve their ability to cope with stress effectively.
- Help people identify the life events and daily hassles
that can cause them to feel under stress.
- Help people identify and practice strategies for preventing
some sources of stress.
- Help people identify and practice coping strategies for
reducing the effects of stress.
- Encourage people to involve family members and other supportive
people in their plans for coping with stress.
Number and pacing of sessions
“Coping with Stress” can usually be covered in two to four sessions.
Within each session, most people find that covering one or two topics and completing
a questionnaire is a comfortable amount.
Structure of sessions
- Informal socializing and identification of any major problems.
- Review the previous session.
- Discuss the homework from the previous session. Praise
all efforts and problem-solve obstacles.
- Follow-up on goals.
- Set the agenda for the current session.
- Teach new material (or review material from the previous
session if necessary).
- Summarize progress made in the current session.
- Agree on homework to be completed before the next session.
Strategies to be used in each session
Motivational strategies
Most people are motivated to reduce and/or cope with stress, both to improve
their everyday life experience and to help reduce symptoms and relapses. It
may also be helpful to point out that stress is a common problem for most people,
with countless magazine articles, books, and television programs focusing on
how to cope more effectively with stress. Because most people experience stress
in their lives, being able to cope with stress effectively can be described
as a good skill for anyone to have, regardless of whether or not he or she has
experienced psychiatric symptoms.
The following suggestions may be helpful:
- For each major topic covered in the handout, practitioners
can help people discuss their own experiences. Most of the sections have checklists
(“Life Events Checklist,” “Daily Hassles Checklist,”
“Signs of Stress Checklist,” “Strategies for Preventing
Stress Checklist,” “Strategies for Coping with Stress Checklist,”
“Individual Plan for Coping with Stress”) which can be completed
by people based on their own experiences
- Practitioners should keep in mind the goals identified
by people in earlier sessions. For many people, reducing stress may facilitate
the ability to pursue personal goals. For example, someone may have the goal
of part-time work, but is worried about the stress of deadlines, etc. The
practitioner could discuss how having the ability to cope effectively with
stress could increase the person’s ability to perform well on
a job.
Educational strategies
Educational strategies for this module focus on increasing people’s
knowledge about recognizing sources of stress, recognizing signs of stress,
preventing stress and coping with stress in their own lives.
The following educational strategies were discussed in detail in Guidelines
for Educational
Handout #1:
- Review the contents of the handout by summarizing or taking
turns
reading paragraphs.
- Pause at the end of each topic to check for understanding
and to learn more about the person’s point-of-view.
- Allow plenty of time for questions and interaction.
- Pause to allow the person to complete the checklists and
questionnaires.
- Break down the content into manageable “pieces.”
- Find a pace that is comfortable to the person.
Cognitive-behavioral strategies
Cognitive-behavioral strategies focus on helping people learn new and more
effective strategies for recognizing and responding to stress.
During the sessions, practitioners can help people role-play how they might
use information from the handout.
The following examples may be helpful:
- Practitioners can help people recall an example of a recent
relapse and then evaluate what stressors preceded the relapse.
- Practitioners can ask people to discuss any forthcoming
major change and help them anticipate how they might minimize the stress involved.
For example, if someone were planning to move, would it be helpful to start
making lists of the various tasks involved in moving? Would it be helpful
to do the packing in short sessions over the course of a week or two? Would
it be helpful to involve friends in taking boxes to the new location?
- After people complete the “Daily Hassles Checklist,”
practitioners can ask them to think of ways to decrease some of their daily
hassles. For example, if someone feels rushed when leaving for work in the
morning, how could she plan the morning to be more comfortable? Could she
prepare more the night before? Go to bed and get up earlier?
- After people complete the “Strategies for Preventing
Stress Checklist” there are many opportunities to help them practice
the strategies they choose. For example, if someone would like to try the
strategy of scheduling meaningful activities, the practitioner could help
him pick out specific activities and plan when he could do them. If someone
chooses to attend art classes to pursue an interest, the practitioner could
help her investigate where and when classes are offered. If the person was
apprehensive about talking to the art teacher or to fellow students, the practitioner
could help her role-play how she might respond to questions and keep the
conversation going.
- After people complete the “Strategies for Coping
with Stress Checklist,” the practitioner can help them practice the
coping strategies they choose. The following
are examples:
- If someone wanted to try the strategy of talking to someone
else about feeling stressed out, the practitioner could help him choose whom
he would talk to and role-play how he might approach the person.
- If someone wanted to practice maintaining her sense of humor,
the practitioner could help her decide if she wanted to watch a particular
television show or video or if she liked to read funny books or comics. If
she wanted to spend time with someone who has a good sense of humor, the practitioner
could help her role-play how she might approach the person.
- If someone wanted to practice writing in a journal, the
practitioner could help him decide what kind of notebook he would like, where
he would keep it, etc. Part of a session could be reserved to write an entry
in the journal.
- If someone wanted to use relaxation techniques to cope with
stress, the practitioner could help her practice one or more of the techniques
described in the Appendix (relaxed breathing, muscle relaxation, and imagining
a peaceful scene.)
Homework
Homework for this module focuses on helping people put into action what they
have learned about preventing and coping with stress. During the sessions, people
identify prevention and coping strategies to use in their own lives. The homework
assignments follow up on this by making specific plans to practice the strategies
on their own.
Practitioners should follow up on homework assignments in the next session
by asking how it went. They should reinforce completed homework or the effort
people have made to complete homework. If people are not able to complete the
homework, practitioners can explore the obstacles they encountered and help
them come up with a solution for following through on the homework.
The following examples of homework may be helpful:
- Reviewing some of the checklists with family members or
other supportive people. What have they noticed regarding sources and signs
of stress for the person?
- Reviewing what helped and what did not help during stressful
situations in the past. Family members and other supportive people can also
be asked for their observations about this.
- Keeping track of daily hassles for a week, using the checklist
provided.
- Asking family members, friends and other supportive people
to play a role in a prevention or coping strategy. For example, a person might
like someone to join her on a daily walk as part of a plan for reducing stress.
- Keeping track of signs of stress for a week, using the checklist
provided.
- Practicing a strategy for preventing stress, such as scheduling
time for relaxation, and keeping track of how it affects the person’s
stress level.
- Practicing a coping strategy, such as listening to music,
and keeping track of how it affects the person’s stress level.
- Locating resources needed for a prevention or coping strategy.
For example, if someone wanted to eat a healthier diet as part of coping with
stress, he could make a shopping list and buy specific groceries as part of
homework.
Tips for common problems
- People may have difficulty identifying signs that they
are under stress.
When someone can’t identify signs of stress, it may be helpful for the
person to talk to family members or other supportive people about what signs
they noticed in the past when the person was under stress. For example, family
members might have noticed that the person had a decrease in appetite, slept
more, or was more irritable over small things that happened.
- People may find it difficult to select a coping strategy
that they want to try to deal with stress.
When people are depressed or experience the negative symptoms of schizophrenia,
they may find it especially hard to imagine that a coping strategy could be
helpful. In such situations, the practitioner should encourage the person
to keep an open mind, and to give the coping strategy a try “just to
see what happens,” while conveying an understanding of their concerns.
Practitioners can also suggest that the person ask someone to join him or
her in using a coping strategy. For example, as part of a coping strategy,
a person could ask friends to play cards once a week or go for a bike ride
or watch a video together.
Review Questions
At the end of this module, the practitioner can use either open-ended questions
or multiple-choice questions to assess how well the person understands the main
points.
Open-ended questions
- What is an example of a life event that was stressful for
you?
- What is an example of a daily hassle in your life?
- What are some signs that you are experiencing stress?
How do you know when you’re under stress?
- What is something you can do to prevent stress in your
life?
- What can you do to cope with stress?
Multiple choice and true/false questions
- A life event can be stressful even when it is a positive event,
like getting married. True or False
- Which of the following is an example of a daily hassle?
A tornado
Unreliable transportation
Receiving a compliment
- Which of the following is a sign of being under stress?
Happiness
Headaches
Feeling rested
- One effective strategy for preventing stress is:
Schedule time for relaxation on a regular basis
Keep your feelings to yourself
Drink alcohol or smoke marijuana
- One effective strategy for coping with stress is:
Staying in bed all day
Ignoring stress entirely
Using a relaxation technique
Back to top
TOC | PREVIOUS
| NEXT
|
|
