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Stress Management

Mindfulness & Neurobiological 

Tools for Healing - A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T
Definition of Stress
  • Stress is defined as a individual's response to his environment. Stress is measured in terms of arousal or stimulation. As such, stress must be present for a person to function.
  • Everyone has their own normal (homeostatic) level of arousal at which they function best. If something unusual in the environment occurs, this level of arousal is affected.

Stress as a process involves environmental event (a stressor)

  • its appraisal by the individual
  • various responses of the organism

Reevaluations resulting from responses and changes in the stressors.

  • Depends on the quality of an external stimulus
  • Depends on the response to such stimulus
  • Depends on the results from interaction between stimulus and response

Diathesis and Stress Interaction

  • Diathesis: is the predisposition (genetics) of the human body to disease or disorder
  • Stress: is the term which refers to the factors in the environment: which offer challenge, distress, problems to solve, which are unique to each individual and as a result are the environmental condition which elicit disease or disorder in the individual or are the conditions in the human which are ripe for the disease or disorder.

What are sources of stress?

There are four categories of sources of stress:

1. Change of any kind can induce stress because of:
  • fear of the new, the unknown
  • feelings of personal insecurity
  • feelings of vulnerability
  • fear of rejection
  • need for approval
  • lack of tolerance for ambiguity
  • fear of conflict
  • fear of taking a risk
  • fear of developing trust
  • fear of inability to cope with changed circumstances

2. Individual personality characteristics that can induce stress include:
  • low self-esteem
  • feelings of over-responsibility
  • fear of loss of control
  • fear of failure, error, mistakes
  • fear of being judged
  • lack of belief in “being good enough”
  • chronic striving to be perfect
  • chronic guilt
  • unresolved grief over a loss or a series of losses
  • chronic anger, hostility, or depression

3. Interpersonal issues that can induce stress include:
  • a lack of adequate support within the relationship
  • a lack of healthy communication within the relationship
  • a sense of competitiveness between the parties involved
  • threats of rejection or disapproval between people
  • an inability to be appropriately assertive
  • struggle for power and control in the relationship
  • poor intimacy or sexuality within the relationship
  • chronic conflict and disagreement with no healthy resolution
  • over-dependency of one party on another
  • a troubled person who refuses to recognize the need for help

4. System (family, job, school, club, organization) issues that can induce stress include:
  • lack of leadership
  • lack of sense of direction
  • uncooperative atmosphere
  • competitive atmosphere
  • autocratic leadership
  • unclear expectations
  • a chronic sense of impending doom
  • a lack of teamwork
  • confused communications
  • developmental disability or chronic ill health of one or more members.
Social Readjustment Rating Scale (SRRS) - The Holmes and Rahe Stress Scale

The Social Readjustment Rating Scale (SRRS), more commonly known as the Holmes and Rahe Stress Scale, was created to helps us measure the stress load we carry, and think about what we should do about it.

In 1967, psychiatrists Thomas Holmes and Richard Rahe decided to study whether or not stress contributes to illness. They surveyed more than 5,000 medical patients and asked them to say whether they had experienced any of a series of 43 life events in the previous two years.

Each event, called a Life Change Unit (LCU), had a different "weight" for stress. The more events the patient added up, the higher the score. The higher the score, and the larger the weight of each event, the more likely the patient was to become ill.

To learn the level of stress (distress) in your life, mark down the value at the right of each of the following events if it has occurred within the past 24 months and add the values of all the items you identified with:
Event (Value)
  1. Death of spouse (100)
  2. Divorce (73)
  3. Marital separation (65)
  4. Jail term (63)
  5. Death of close family member (63)
  6. Personal injury or illness (53)
  7. Marriage (50)
  8. Fired from job (47)
  9. Marital reconciliation (45)
  10. Retirement (45)
  11. Change in family member's health (44)
  12. Pregnancy (40)
  13. Sexual difficulties (39)
  14. Addition to family (39)
  15. Business readjustment (39)
  16. Change in financial status (38)
  17. Death of close friend (37)
  18. Career change (36)
  19. Change in number of marital arguments (35)
  20. Mortgage or loan over $10,000 (31)
  21. Foreclosure of mortgage or loan (30)
  22. Change in work responsibilities (29)
  23. Son or daughter leaving home (29)
  24. Trouble with in-laws (29)
  25. Outstanding personal achievement (28)
  26. Spouse begins or ceases working (26)
  27. Starting or finishing school (26)
  28. Change in living conditions (25)
  29. Revision of personal habits (24)
  30. Trouble with boss (23)
  31. Change in work hours, conditions (20)
  32. Change in residence (20)
  33. Change in schools (20)
  34. Change in recreational habits (19)
  35. Change in church activities (19)
  36. Change in social activities (18)
  37. Mortgage or loan under $10,000 (17)
  38. Change in sleeping habits (16)
  39. Change in number of family gatherings (15)
  40. Change in eating habits (15)
  41. Vacation (13)
  42. Christmas season (12)
  43. Minor violation of the law (11)

Interpretation of your score:

Below 150      You have only a low to moderate chance of becoming ill in the near future.

150-299          You have a moderate to high chance of becoming ill in the near future.          

300 or above  You have a high or very high risk of becoming ill in the near future.

How to analyze your score:

If your total score is more than 150, find ways to reduce stress in your daily life so that your stress level doesn't increase. The higher the score, the harder one needs to work at staying physically well.

For more information on this scale go to:

Suggested uses for SSRS scale:

  • Become familiar with the different events and the amounts of stress they promote.
  • Put the list of events where your family can easily refer to it several times a day.
  • Practice recognizing the stress level when one of these events happens.
  • Think about the meaning of the event for you and identify your feelings.
  • Think about the different ways you can adjust to the event.
  • Take your time in arriving at decisions.
  • Anticipate life changes and plan for them well in advance whenever possible.
  • Pace yourself. It can be done even if you are in a hurry.
  • Look at the accomplishment of a task as a part of ongoing daily living; avoid looking at such an achievement as a stopping point. Congratulate yourself and push ahead.
  • Recognize that your internal mechanism of coping with stress is directly tied to how your health and well-being will be influenced by it.

Is all stress bad?

Not all stress is distress:

  • a certain amount of stress or pressure is necessary and shows a positive adaptation being made by a person. This is called eustress.
  • Bad or negative stress is called distress: the negative physiological and emotional response when stress is intense and unresolved.

 There are three degrees of stress:
  1. Low: This is distress leading to boredom, fatigue, frustration, or dissatisfaction.
  2. Optimum: This is eustress leading to creativity, problem solving, progress, change, learning, and energetic satisfaction.
  3. High: This is distress leading to exhaustion, illness, lack of concentration, excessive mood swings, low self-esteem, and irrational problem solving.


There are three phases of arousal:
  1. Phase 1 Alarm phase: When an unusual (or stressful) event occurs, the output of energy drops for a short period as the event is registered in the person's mind.
  2. Phase 2 Adaptation phase: Next, the output of energy increases above the normal level; arousal is heightened as the person seeks to deal with the situation. Adaptation responses available to humans include physically running away, fighting, freezing (self-immobilization), suppression emotion, or learning.
  3. Phase 3 Exhaustion phase: Finally the person's available energy is expended and his capacity to function effectively is reduced.

Physiological Effects of Stress

Sympathetic Nervous System (system responsible for mobilizing body resources in urgent situations) stimulate the adrenal medulla of the adrenal glands

The adrenal stimulation results in production of catecholamines, Epinephrine and Norepinephrine, affecting the body’s heart rate, respiration, blood flow and muscle strength.

Stress causes the pituitary gland (structure connected to hypothalamus in forebrain) to release the andreno-corticotropic hormone (ACTH).

ACTH stimulates the adrenal cortex of the adrenal gland to secrete glucocorticoids. The most important of the glucocorticoids is cortisol which mobilizes the body’s resources by increasing energy and decreasing inflammation especially in injuries.

The signs of this physical response include


  • heart rate
  • blood pressure, respiration
  • perspiration
  • pupil dilation
  • muscle tension


What are the results of chronic stress?

In the state of chronic stress

  • heart rate
  • blood pressure
  • respiration are chronically elevated

Common stress-related illnesses include:

  • Coronary artery disease
  • Peptic ulcer
  • Mental illness

Negative Impact of Prolonged Stress Response

There is a negative impact on the body’s organs, mental functioning and Immune system

There is an impact on the immune system which impedes the immune system from destroying viruses, bacteria, tumors, and irregular cells

Stress impacts immunosuppression and  it is an important influence on health and illness of the individual

Hormone Stress Cascade during Severely Stressful or Traumatic Events

1. Hypothalamus is activated by messages from nervous system or blood stream during a “stressful event” and it releases CRH which initiates the fight-flight response.

2. Corticotrophin-releasing hormone (CRH) is a polypeptide hormone secreted by the hypothalamus into the pituitary portal system where it triggers the release of adrenocorticotropic hormone (ACTH) from the pituitary gland. During stress it surrounds the pituitary gland which then releases ACTH.

3. Adrenocorticotropic Hormone (ACTH) stimulates the adrenal glands to release Cortisol and Adrenalin

4. Cortisol and Adrenalin increase heart rate and metabolic rate

ACTH - Adrenocorticotropic Hormone

ACTH stimulates the adrenal cortex of adrenal gland to secrete glucocorticoids.
Most important of glucocorticoids is cortisol which mobilizes body’s resources by increasing energy and decreasing inflammation especially in injuries.
ACTH triggers “survival hormones” during the stressful event especially Cortisol until the threat is removed.
With long-term stress or constantly repeating triggers such as with re-experiencing the hormone release does not shut down

Bilateral response of brain to stress and trauma

Major stress and trauma are right side of brain activity – rich in images of the stressor and trauma
The left side of the brain which involves talking shuts down in severe stress and trauma. The bracus area of the brain on the left side of the brain becomes unresponsive under severe stress and trauma and individuals are heard to say: “I don’t have words to tell you what I have experienced.”
There is a need to help both sides of the brain to recover from the stress and trauma so there is a need for bilateral processing similar to used in EMDR
It is important to realize that humans use their body to help their brain think through things and to process the stress and trauma


The Hippocampus is involved in learning and memory
Damage to the hippocampus causes memory problems and interferes in new learning and even current memory.
Victims of PTSD have been found to have smaller hippocampuses-the more memory problems they had the smaller was their hippocampus
Adults who have been severely physically and/or sexually abused have similar memory problems with reduced hippocampus
Smaller hippocampus does result in dissociative symptoms-greatest decrease in volume of the hippocampus correlates to most pronounced symptoms of dissociation
Depression is also associated with reduced hippocampus size

Stress Management Videos

Video 1: Mindfulness Meditation - Quick 15 Min Stress Relief Version at:

This is a Jon-Kabat Zinn style Mindfulness Meditation. As you listen you learn to value the transient nature of life and realize that you can tolerate anything for the moment. It's great for those who may have tried silent meditation and found it difficult. Traditionally, mindfulness meditation is done with your eyes closed.  However, the video offers you the ability to refocus your thoughts should you feel the need to open your eyes.

Video 2: Guided Meditation for Reducing Anxiety and Stress--Clear the Clutter to Calm Down at:

This is a guided meditation to take you on a journey of relaxation.  You will clear the clutter of your mind to calm you.   It will reduce your stress level,  as well as improve your overall health and well being when practiced regularly. 

Video 3: Mindfulness Meditation to help Relieve Anxiety and Stress at:

This is a mindfulness meditation with Josh Wise. This meditation will help you connect with your breath. Relax. Let go of stress. Release anxiety. Allow yourself to relax. Simply breathe and watch your breath. Notice what it feels like. No need to change anything or do anything. Simply accept this moment just as it is. Enjoy.

Video 4: 15 Minute Meditation for Stress Relief and Building Confidence at:

This guided meditation and relaxation is a great way to start the day. It can also be used before an event you are nervous about or after a stressful event to help calm down. Share with anyone you feel will find value in this meditation. Do not use this as a replacement for seeking medical advice if necessary. Do not listen while driving.

Video 5: Stress Relief ~ Daytime Meditation To Let Go Of Stress | Mindful Breathing Meditation at:

Breathe the stress, tension, and anxiety away. Find yourself...your mind, body, and spirit return to a state of balance, peace, and wellness.This deep breathing meditation for stress reduction guides you through simple breathing techniques to reduce chronic stress, tension, and anxiety. After listening to this session, find yourself...your mind, body, and spirit return to a state of balance, peace, and wellness.

YouTube Videos & Articles on How Stress Affects the Body

1. How Stress Affects your Body by Sharon Horesh Bergquist at

2. What does Stress do to Your Body? by Seeker at:

Articles related to this video:

3. 10 Signs Your Body is Begging for Help at:

4. How Stress Affects You Body and Mind at:

5. Stress and Your Brain by Jaime Tartar at TEDxNSU at:


6. Stress Management Strategies: Ways to Unwind at:

Apps for Stress Management

Guided Mind (cost: free)

Relax and get guided through meditations on a variety of topics dealing with the stresses and challenges of day-to-day life. At:


Mindfulness - Everyday guided meditations (cost: free)

Science-backed audios for everyone from entrepreneurs to stay at home moms. Use Mindfulness to quiet the chatter in your brain and to achieve clarity. Come back anytime you need an extra dose of serenity. At;


The Mindfulness App – meditate (cost: free)

Start your journey to a more relaxed and healthier state of mind with The Mindfulness App. Whether you are just starting out or experienced in meditation, The Mindfulness App will help you to become more present in your daily life. At:


Take a Break! - Meditations for Stress Relief (cost: free)

Take a break now and let your stress melt away! You can enjoy the deep relaxation, stress relief and benefits of meditation now with this app by Meditation Oasis™. Featuring two popular meditations from the the Meditation Oasis podcast, the app gives you the option to listen with or without music or nature sounds. You can also listen to the relaxing music and nature sounds alone. At:


Calm (cost: free)

Calm Body sessions are 10 minute guided video lessons on mindful movement and gentle stretching. Lessons include "Morning Wakeup", "Afternoon Reset", "Back Care" and "Evening Wind Down". Addition programs on the app include: Calm Masterclass, Breathe Bubble, Scenes selector, Calm Body, and your Profile. At:


Headspace: Meditation Breathe, sleep, relax & focus (cost: free)

Headspace is the simple way to reframe stress. Sleep trouble? Meditation creates the ideal conditions for a good night’s rest. Relax with guided meditations and mindfulness techniques that bring calm, wellness and balance to your life in just a few minutes a day. At:

How to Proceed to Assist Clients Cope

with Unhealthy Stress in Their Lives

If clients come to you saying they want help with dealing with the stress in their lives here are four steps to take:

First: It is important that you ask for a release of information so that you can read their medical records and understand better what are the sources of stress and if such stress is based on some existing medical condition if and if there is a medical condition what has been attempted previously to help them to relieve their stress due to their medical condition.

Second: If the clients have been to other professionals to address their stress-related issues then you need releases of information so that you can get reports on their treatment and progress of these clients in working with them.

Third: Before developing a plan for your clients you must be sure to do a complete Initial Clinical Assessment ( which includes exploration of ACE Factors ( and history of any other major medical, social or interpersonal traumatic events which might account for the severity and duration of their stress.

You might also want to use the Social Readjustment Rating Scale (SRRS) - The Holmes and Rahe Stress Scale. More information on this scale is available at:

Fourth: It is important once the initial assessment is completed that you then utilize Motivational Interviewing Strategies ( to determine if the clients are actually ready to do the work necessary to deal with their stress as a reality of life, to work seriously at following through with the steps being outlined for them to pursue to lessen the impact of stress in their lives.

Fifth:Introduce your clients to an already existing program in your setting in which you would hope they would  be willing to become a part of. In your setting set up a modified SEA's 12-Step Program which is modified to meet the needs of your client populations which is conducted on a weekly basis with no time limits. This program's manual and supportive document is available at:Self-Esteem Seekers Anonymous-The SEA's Program Manual at:

Coping with Stress 

How can people cope with stress in healthy positive ways?

People can cope with stress while in a variety of positive ways, such as these. Write down which positive coping strategies you can and are willing to use in your stress reduction efforts.


Exercise: aerobic exercise, walking, swimming, dancing
Stress‑reduction Activities:  stretching, progressive muscle relaxation, breathing, self‑hypnosis, yoga
Mental Relaxation Techniques: Mindfulness, meditation, centering, clearing mind, imagination, visual imagery
Spirituality: prayer, worship, letting go and letting God, valuing, commitment, one day at a time
Recreational Diversions: music, hobbies, movies, theater, reading, cards, sewing
Interpersonal Relationship Enhancement: affirmation, networking, assertiveness, setting limits, creating supportive structures, expressions of love, affection, and concern
Problem Solving: time management, brainstorming, priority setting, rational thinking, thought stopping, re‑labeling, organizing, and planning
Family Life Skills: esteem building, conflict resolution, togetherness, support, positive reinforcement
Intellectual Practices: learning new concepts, learning new behavior patterns and attitudes, developing new insights, making subjective data objective, creating new generalizations and rules based on a reasonable analysis of data
Sense of Humor: putting things into perspective, lightening up, reducing the intensity, having fun, joking, clowning around, being a little kid again

What are some negative ways in which people cope with stress?

People cope with stress in a variety of negative ways, such as these. Write down which of the following behaviors you have used prior to recovery.


Impulsive Behavior: acting before thinking about consequences, binging, continually getting into trouble
Compulsive Behavior: addictive‑like behavior that gets out of control and results in overindulging, alcoholism, workaholism, drug abuse, excessive eating, smoking, shopping, sex, gambling
Obsessive Behavior: meticulous‑like behavior that you find the need to repeat over and over again, picky picky, neat freak, overly organized, rigid thinking, inflexible
Vindictive Behavior: seeking revenge for real or imagined hurts or offenses, conniving, stubborn
Blaming Behavior: laying the blame for problems on others, fault finding, overly critical
Worrying: anxious, tense, keeping problem in constant focus, not being able to let go of it, mulling over the problem in your mind
Anger: having temper tantrums, ventilating hostility, using sarcasm, cynicism, screaming
Withdrawn Behavior: denial of problem, passivity in face of stress, pulling away, isolation
Depressed Behavior: weepy or tearful, blue, despairing, guilty, downcast, lethargic
Physical Illness: real or psychosomatic illnesses, headaches, back pain, muscle tension, gastrointestinal problems, hypertension, diabetes. There are many illnesses related to stress, some terminal.

What are the benefits of coping with stress in a healthy way while in recovery?

When you cope with stress while in recovery in a healthy, positive way, you can experience:

A sense of accomplishment.
Enhancement of self‑esteem.
Improved interpersonal relationships.
Improved physical health.
A clear mind.
Less anxiety.
A feeling of being in control of your life.
A sense of being centered, focused, and "on target'' in life.
Peace and harmony, a sense of good will for and from others.
A reduction of the emotional cues that lead to impulsive or compulsive habits.
A sense of mastery over your life's obstacles.
More Videos to Deal with Stress

Video 1: Simple tips to help you DE-STRESS. (Stress management techniques & Personality Development) at

This video speaker encourages 5 tips for De-stressing:

Exercise - Be Active Exercise in almost any form can act as a stress reliever. It won't make your stress disappear but being active can definitely boost your feel-good endorphin and take you away from your daily worries. So be it 40 minutes of brisk walking, yoga, aerobics or some laps in the pool you will find that you have forgotten the day's irritation and concentrating on your body. The results are - energy, optimism, calm mind and fit body.

Connect with people A problem shared is a problem halved. A good support network of colleagues, friends and family can ease your work troubles and help you see in a different way. If you don't connect with people, you won't have support to turn to when you need help. The activities we do with friends help us relax and we often have a good laugh with them., which is an excellent stress reliever And may be your friends or colleagues can also help you out with some solutions to your problems.

Avoid unhealthy habits Don't rely on alcohol, smoking and caffeine as your ways of coping. This will not help you to relieve any stress in fact it will create new problems. It might provide temporary relief but it won't make the problems disappear. Drink plenty of water and eat healthy small nutritious means. Hunger and dehydration provoke anxiety and stress. So, stay fit and healthy.

BE positive Look for positives in life and things for which you are grateful. Write down three things at the end of everyday which went well and for which you are grateful. People don't always appreciate what they have. They always tend to crib and complain about everything. Make a conscious effort to train yourself to be more positive about life. Change your perspective and you will be able to see your situation from a more positive point of view.

Plan something Rewarding at the end of your stressful day Rewards like taking a hot water bath or half an hour of reading a good book or even watching your favorite T.V show helps. So basically, I am talking about some me time. Put aside work, housekeeping and family concerns for brief period before bed time. Don't spend this time planning for the next day or doing house chores. Remember you need time to recharge and energize yourself. You will be much prepared to face the next day. So, take control of the situation you are in and say goodbye to stress with these techniques above

Video 2: How to make stress your friend  with Kelly McGonigal – A TED Talk at:

Stress. It makes your heart pound, your breathing quicken, and your forehead sweat. But while stress has been made into a public health enemy, new research suggests that stress may only be bad for you if you believe that to be the case. Psychologist Kelly McGonigal urges us to see stress as a positive and introduces us to an unsung mechanism for stress reduction: reaching out to others.
3 Exercises To Manage Stress

1.  Full Breathing Exercise
Step 1:  Lie prone on the floor. Loosen your belt and restrictive clothing.


Step 2:  Relax and exhale as completely as possible. Begin to inhale slowly making your belly rise. Now move your rib cage. Now your chest. Hold it for a second. Now, exhale completely, all the air out of your lungs. Try it again. This is complete breathing. Breathe normally for a while, and in the next minute take at least one more complete breath. Pause one minute.


Step 3:  You are still lying prone. As you lie there you will begin stretching muscles to achieve unblocked circulation. Bring your arms above your head and stretch them away from you fully. Now stretch your legs and feet downward, away from you, take a deep breath, let go and relax. Pause ten seconds. Feel the effects of the stretch on your body and on your breathing. Pause 15 seconds. Now sit up very slowly.


Step 4:  Stand up for this part of the exercise. There are three very basic stretching postures to increase flexibility.
  • backward bend
  • forward bend
  • side-to-side bend

 As you do your backward bend pay attention to stretching your abdomen and back muscles. Important:Go only as far as you can. Don't push yourself. Bend slowly. As you do your forward bend, pay attention to the stretch of your back muscles and backs of legs; blood in head and arms. As you do your side stretch, pay attention to stretching in your chest, sides and neck.


Step 5:  Assume a comfortable sitting posture, one you can hold for 15 to 20 minutes. This could be in a chair. Get comfortable and close your eyes when you are ready. Please note everything you are aware of C outside sounds, your bodily awareness, thoughts; note this awareness and do not change it. Then, notice shifting from outside sounds to thoughts of bodily awareness.


After approximately five minutes of this, notice that breathing is occurring; again, not to change it but only to notice it. One can enhance this noticing by attaching the words breathing out to the breath as it leaves the nostrils and breathing in as the breath reenters. As awareness shifts from breathing to thoughts of external sounds, allow that to happen and the return to breathing out-breathing in (following the breath).


Continue this for five to seven minutes. At this point, try to incorporate some visual imagery in the form of a golden light with the in-breath. See yourself breathing in this golden light and watching it fill the inside of your body. This could be in a particle, vapor, smoke, or mist-like form, whatever is comfortable for you. Visualize this light in your head, shoulders, chest and breath out any tensions in the form of a black color. Continue until you visually experience your whole body as being filled with this golden light. Experience that feeling.


Stay with this experience for another minute or two. Then, become aware of your breath again, with your body sitting on the floor or chair (feeling grounded). When ready, open your eyes.


Step 6:  Try this breathing exercise for 15 to 20 minutes daily until you are able to achieve full breathing and stress reduction in a progressively shorter period of time.

2. Thought Stopping Exercise
Systematically address your fears which cause stress and anxiety for you, you may need to use “thought stopping" as a technique to cease your obsessing or dwelling on the fear, feared objects, or events. If it is needed, follow these directions:

Directions for Thought Stopping
Step 1: Use the relaxation training and breathing exercises above to get yourself relaxed. It is important to be relaxed to stop a recurring thought.

Step 2: With a recorder, record the word stop on alternating 1, 2, and 3 minute intervals for a 30-minute recording. Call yourself into a relaxed state before using the ``Stop'' tape. Then, think of your fear, feared object, or event. Every time you hear stop; stop the thought. Return to the thought again and only stop the thought when you hear stop. Do this for 30 minutes every night for two weeks or until you are able to stop the thought every time you hear stop.

Step 3: After you are trained to stop thoughts by using the Stop recording, you are ready to stop your thoughts by yelling stop out loud. For 30 minutes think of your fear, feared object, or event and yell stop to stop the thought. Once you stop the thought go back to thinking about the thoughts for awhile, then yell stop again. Do this over and over again for 30 minutes each night for two weeks or until you are able to stop the thought every time you yell stop.

Step 4: After you have trained yourself to stop thoughts by yelling stop, you are ready to train your thoughts to stop by whispering stop. For 30 minutes repeat the process of dwelling on your fears, feared object, or event, but this time whisper stop to stop your thoughts. Do this for 30 minutes nightly for two weeks or until you are able to stop the thought every time you whisper stop.

Step 5: After you have trained yourself to stop thoughts by whispering stop, you are ready to train your thoughts to stop by thinking the word stop. For 30 minutes repeat the process of dwelling on your fears, feared object, or event, but this time think stop to stop your thoughts. Do this for 30 minutes nightly for two weeks or until you are able to consistently stop the thoughts by thinking the word stop.

Step 6: Use thinking the word stop to stop thoughts of your fear, feared object, or event from then on. It is a technique that will halt your dwelling on the fearful thought in the future.

3. Personal Progressive Relaxation Exercise

What is the Relaxation Response?

The signs of this physical response include:


heart rate

blood pressure


pupil dilation

muscle tension

Stress-management strategy is to evoke the relaxation physical response on a regular, daily basis.


The physical response to relaxation is as follows:

Progressive relaxation consists of:

1. Learning to relax:
You may have grown to accept a certain high level of stress and anxiety as normal. You may be unfamiliar with what it feels like to be relaxed, calm, and unstressed. With progressive relaxation you learn what it feels like to be relaxed, you learn to increase relaxation to a new level. By doing this you not only improve your physical well being by reducing hypertension, headaches, and other physical complaints, but you improve your mental state by reducing stress, anxiety, irritability, and depression.


2. The physical setting:
Progressive relaxation should take place in a quiet, attractive room. You should be completely supported. There should be no need for exertion to maintain body support. You should wear comfortable, loose-fitting clothing during the sessions.


3. The process:
Lie on the floor or a bed and follow the directions of the relaxation technique (contained latter in this chapter) as you tense and relax various muscle groups. After the initial tensing of the muscles, release the tension instantly and completely. This is very important in order to get the pendulum effect. The muscles relax beyond the point of their normal relaxed state. You should then feel the important difference between tension and relaxation. You should concentrate on the feeling of relaxation, learn what it is to relax and how to increase it. Continually repeat to yourself, “Know what it feels like to be relaxed, deepen the relaxation, know what it is to be relaxed.”
Do's and don'ts of relaxation:
Do:  Make sure you have comfortable, loose clothing and proper back support
Don't: Put yourself in an awkward position or in a position that will make it easy to fall asleep


Do: Allow your mind to quiet down. If tense thoughts enter while you are relaxing, let them pass out of your head.
Don't: Think your way into tension. If you can't clear your mind, take a long, deep breath and let it out slowly.


Do: Stay alert and conscious while you are relaxing. Pay close attention and note any changes in your body (feelings that stand out for you).
Don't: Allow yourself to become groggy and sleepy. If you start falling asleep, open your eyes and sit up. When you are ready, return to relaxation posture.


Do: Go at your own pace and let go of your muscles as your body decides to give up tension.
Don't: Expect yourself to relax all at one. Like any other physical exercise, you must practice letting go step by step.


Do: Give your body messages of appreciation for relaxing as you notice these feelings going through your body.
Don't: Get down on yourself for not relaxing. Your body should be trusted to go at its own pace.


Do: Stay aware of your breathing. Observe how much air you're taking in full breaths at regular rhythms.

Don't: Smoke before, during or after relaxation as it tightens lung tissue and blood vessels. Let your body breathe.

Relaxation Training Technique

Directions: Record these directions for yourself by reading them slowly. Use the tape daily to practice the relaxation response:

Settle back as comfortably as you can and close your eyes. Let your self relax to the best of your ability. Now, as you relax like that, clench your right fist. Just clench your fist tighter and tighter and study the tension as you do so. Keep it clenched and feel the tension in your right fist, hand, and forearm. Now relax. Let the fingers of your right hand become loose, and observe the contrast in your feelings. Now, let yourself go and try to become more relaxed all over. Once more, clench your right fist really tight - hold it, and notice the tension again. Now let go, relax; your fingers straighten out and you notice the difference once more. Repeat that with your left fist. Clench your left fist while the rest of your body relaxes; clench that fist tighter and feel the tension. Now relax. Again, enjoy the contrast. Repeat that once more. Clench the left fist, tight and tense. Now do the opposite of tension: relax and feel the difference. Continue relaxing like that for a while. Clench both fists tighter and tighter, both fists tense, forearms tense. Study the sensations. Relax; straighten out your fingers and feel the relaxation. Continue relaxing your hands and forearms more and more.

Now bend your elbows and tense your biceps, tense them harder and study the tension feelings. All right. Straighten out your arms, let them relax and feel that difference again. Let the relaxation develop. Once more, tense your biceps; hold the tension and observe it carefully. Straighten the arms and relax; relax to the best of your ability. Each time, pay close attention to your feelings when you tense up and when you relax. Now straighten your arms. Straighten them so that you feel the most tension in the triceps muscles along the backs of your arms; stretch your arms and feel that tension. Now relax. Get your arms back into a comfortable position. Let the relaxation proceed on its own. The arms should feel comfortably heavy as you allow them to relax. Straighten the arms once more so that you feel the tension in the triceps muscles; straighten them. Feel that tension  - relax. Now concentrate on pure relaxation in the arms without any tension. Get your arms comfortable and let them relax further and further. Continue relaxing your arms even further. Even when your arms seem fully relaxed, try to go that extra bit further; try to achieve deeper and deeper levels of relaxation.

Let all your muscles go loose and heavy. Just settle back quietly and comfortably. Wrinkle up your forehead now; wrinkle it tighter. Now, stop wrinkling your forehead; relax and smooth it out. Picture the entire forehead and scalp becoming smoother as the relaxation increased. Now, frown and crease your brows and study the tension. Let go of the tension again. Smooth out the forehead once more. Now, close your eyes tighter and tighter. Feel the tension. Relax your eyes. Keep your eyes closed, gently and comfortably, and notice the relaxation. Now clench your jaws, bite your teeth together; study the tension throughout the jaws. Relax your jaws now. Let your lips part slightly. Appreciate the relaxation. Now press your tongue hard against the roof of your mouth. Look for the tension. All right. Let your tongue return to a comfortable and relaxed position. Now purse your lips. Press your lips together tighter and tighter. Relax the lips. Note the contrast between tension and relaxation. Feel the relaxation all over your face, all over your forehead and scalp, eyes, jaws, lips, tongue and throat. The relaxation progresses further and further.


Now attend to your neck muscles. Press your head back as far as it can go and feel the tension in the neck now roll it to the left. Straighten your head and bring it forward. Press your chin against your chest. Let your head return to a comfortable position and study the relaxation. Let the relaxation develop. Shrug your shoulders. Hold the tension. Drop your shoulders and feel the relaxation. Neck and shoulders relaxed. Shrug your shoulders again and move them around. Bring your shoulders up and forward and back. Feel the tension in your shoulders and in your upper back. Drop your shoulders once more and relax. Let the relaxation spread deep into the shoulders, right into your back muscles; relax your neck and throat, and your jaws and other facial areas as the pure relaxation takes over and grows deeper, deeper, ever deeper.

Relax your entire body to the best of your ability. Feel that comfortable heaviness that accompanies relaxation. Breathe easily and freely in and out. Notice how the relaxation increase as you exhale. As you breathe out, just feel that relaxation. Now breathe right in and fill your lungs inhale deeply and hold your breathe. Study the tension. Now exhale, let the walls of your chest grow loose and push the air out automatically. Continue relaxing and breathe freely, gently. Feel the relaxation and enjoy it. With the rest of your body as relaxed as possible, fill your lungs again. Breathe in deeply and hold it again. That's fine, breathe out and appreciate the relief. Just breathe normally. Continue relaxing your chest and let the relaxation spread to your back, shoulders, neck and arms. Merely let go. Enjoy the relaxation.

Now let's pay attention to your abdominal muscles; your stomach area. Tighten your stomach muscles, make your abdomen hard. Notice the tension. And relax. Let the muscles loosen and notice the contrast. Once more, press and tighten your stomach muscles, make your abdomen hard. Notice the tension. And relax. Let the muscles loosen and notice the contrast. Once more, press and tighten your stomach muscles. Hold the tension and study it, relax. Notice the general well being that comes with relaxing your stomach. Now draw your stomach in, pull the muscles in and feel the tension this way. Relax again, let your stomach out. Continue breathing normally and easily. Feel the gentle massaging action all over your chest and stomach. Now pull your stomach in again and hold the tension. Push out and tense like that; hold the tension. Once more, pull in and feel the tension.

Now relax your stomach fully. Let the tension dissolve as the relaxation grows deeper. Each time your breathe out, notice the rhythmic relaxation both in your lungs and in your stomach. Try and let go of all contractions anywhere in your body. Now direct your attention to your lower back. Arch your back, making your lower back quite hollow, and feel the tension along your spine. Settle down comfortably again, relaxing the lower back. Just arch your back and feel the tension as you do so. Try to keep the ready of your body as relaxed as possible. Try to localize the tension throughout your lower back area. Relax once more, relaxing further and further. Relax your lower back, relax your upper back. Spread the relaxation to your stomach, chest, shoulders, arms and facial area, these parts relaxing further, further, further, ever deeper.

Let go of all tensions and relax. Now flex your buttocks and thighs. Flex your thighs by pressing down your heels as hard as you can. Relax and note the difference. Straighten your knees and flex your thigh muscles again. Hold the tension. Relax your hips and thighs. Allow the relaxation to proceed on its own. Press your feet and toes downward, away from your face, so that your calf muscles become tense. Study the tension. Relax your feet and calves. This time, bend your feet toward your face so that you feel tension along your shins. Bring your toes right up. Relax again. Keep relaxing for a while.

Now let yourself relax further all over. Relax your feet, ankles, calves and shins, knees, thighs, buttocks and hips. Feel the heaviness of your lower body as you relax still further. Now spread the relaxation to your stomach, waist, lower back. Let go more and more. Feel that relaxation all over. Let it proceed to your upper back, chest, shoulders and arms, right to the tips of your fingers. Keep relaxing more and more deeply. Make sure that no tension has crept into your throat; relax your neck and your jaws and all your facial muscles. Keep relaxing your whole body like that for a while. Let yourself relax all over.

Now you can become twice as relaxed as you are merely by taking in a deep breath and exhaling slowly. With your eyes closed you become less aware of objects and movements around you, thus preventing any surface tensions from developing. Breathe in deeply and feel yourself becoming heavier. Take in a long, deep breath and let it out very slowly. Feel how heavy and relaxed you have become.

In a state of perfect relaxation you should feel unwilling to move a single muscle in your body. Think about the effort that would be required to raise your right arm. As you think about raising your right arm, see if you can notice any tensions that might have crept into your shoulder and arm. You decide not to lift the arm but to continue relaxing. Observe the relief and the disappearance of tension.

Just carry on relaxing like that. When you wish to get up, count backward from four to one. You should then feel fine, refreshed, wide awake and calm.