Stress Management

Stress is a normal part of life. How you cope with that stress likely has a strong impact on your physical and emotional health. Coping with stress has two aspects: stress awareness and stress management

For an overview of this topic watch the Don’t Stress the Stress webinar recording or read the Quick Guide to Stress Management.

Stress Awareness:

Each individual has their own personal sources of stress (called stressors), as well as physical reactions to acute stress, and physical, psychological, and behavioral reactions to chronic stress (called stress responses). Many people are often unaware of the scope and/or intensity of their stressors or their stress responses. Completing the following stress awareness worksheets is the first step in learning to cope with stress.

1. Sources of Stress

2. Signs of Acute Stress

3. Signs of Chronic Stress

4. Three Day Stress Diary

Once these worksheets are completed, the following stress management tools can be utilized.

Stress Management

Stress management techniques include problem solving, changing attitudes or cognitive appraisal, and relaxation techniques. While presented in this sequential order, any of the techniques can be used independently and in any order.

1. Problem Solving

Problem solving is the first step in managing stress, after you have identified your stressors and stress responses. The goal of problem solving is to eliminate major stressors or, at the very least, to make them less stressful.

A. Relax: Pick a time and place that is comfortable and without distraction. Focus only on the process of problem solving. This helps to clear the mind of extraneous thoughts and to lower emotional levels down to a point that is better for working through the problem.

B. Identify the Real Problem: This many not always be clear. For example, many people may say they hate their jobs. The real problem could be related to their bosses, co-workers, work environment, type of job they actually do, or even the commute necessary to get to work. It is also important to separate out feelings (e.g., anger, anxiety), which are stress responses, from the source of the stress (i.e., the stressor). Pinpoint the exact problem.

C. Brainstorm Possible Solutions: List every possible solution no matter how serious, silly, or realistic it may be. It can be tension reducing just to imagine some of these ideas.

D. Select One Solution and Implement It: Look at your list of possible solutions and pick the solution that has the best chance of solving the problem and being workable. Try it out. Don’t sabotage yourself before even trying something by saying it won’t work. Nothing ventured, nothing gained!

E. Evaluate Result of Solution: Did it work? Did it have the result you expected?

F. If it worked – celebrate! If it hasn’t worked, go back to step D and E and keep on trying! 

At some point, it will become clear that: 1) the problem is solved, or 2) the problem is at least less stressful, or 3) the problem can’t be problem solved away.

2. Changing Attitude or Cognitive Appraisal

If a stressor cannot be eliminated or at least improved through problem solving, the next stress management technique to try is altering how you think about the stressor. Changing your attitude towards a stressor involves asking yourself if it really is all that important. For instance, how important is it really if the house in not perfectly clean or if someone else got the office with a window? Of course, some stressors really are important and can be a threat (e.g., cancer) but many of the daily hassles that we get upset about are not all that crucial. Ask yourself: “Is this really important in the grand scheme of things, life altering, or will it really matter in 20 years?”

To understand how individuals can perceive or assess the same thing quite differently is demonstrated by this cartoon.

3. Relaxation

Finally, it is helpful to know how to alter your physiological responses to stressors when they do occur. A variety of relaxation techniques can be helpful. Progressive Muscle Relaxation (PMR) with Guided Imagery (GI). PMR was first described in the medical literature in the 1930s. Since then it has been proven effective at managing of a whole range of emotional and physical problems, including pain. As we become stressed, our muscles begin to tense (even though we may be unaware of this) in readiness for action. PMR consists of becoming progressively aware of the level of tension in each of the major muscle groups in your body by contracting those muscles and then releasing the tension. By focusing on relaxing the body, it is possible to achieve a simultaneous state of mental relaxation. As we redirect our attention from stressful thoughts and images, we become immersed in the activity of “letting go” of tension.

Guided Imagery is a technique that individuals can use to achieve a positive mental imaginary state. Initially, individuals can learn the GI technique with the help of a trained health care professional.  PMR and GI should be thought of as a skills, and like any other skill, it requires practice. Once these skills has been mastered it will require only a few seconds to initiate and can be used effectively to decrease physical responses and master stress. Patience and practice are the keys to learning relaxation. To learn these techniques listen to the recorded exercise below a few times.  The goal is to eventually learn these techniques and to be able to initiate and perform them on your own.

Progressive Muscle Relaxation (PMR) and Guided Imagery (GI) Exercise

NOTE: The exercise below involves physically tensing and relaxing your muscles. If you are experiencing any physical limitations, you can skip tensing any muscle groups as necessary, and still benefit from this exercise. 

If, after using these resources, you are still struggling with stress management, you should talk to your health care team to access additional support.

There are different types of health care professionals that can help manage the various psychological and psychosocial issues that can arise after a cancer diagnosis. However, different types of health care professionals provide different services. Therefore, it is important to be clear in communicating your needs in searching for and selecting a mental health professional. You should also check to see which types of health care professionals are covered by your insurance.  You can typically call the number on the back of your insurance card for more information about providers and your plan’s network. For more information about health insurance basics watch our short video: Triage Cancer Presents: Health Insurance Basics

Psychiatrists are trained medical doctors (MDs) and there are some psychiatrists who work extensively with cancer patients. They are licensed to prescribe medications. They may spend much of their time with patients on managing medications for such issues as pain, anxiety, and depression as well as providing psychotherapy. They may be the best choice for managing multiple physical and psychological conditions.

Psychologists have PhDs and focus extensively on psychotherapy and treating emotional and mental suffering in patients with behavioral interventions. They may not prescribe medication, but often work in conjunction with a psychiatrist to assist their patients who may need such therapy.

Advanced Practice Registered Nurses (APRNs) earn master’s or doctoral degrees. They apply the nursing process to assess, diagnose, and treat individuals and families with psychiatric disorders or the potential for such disorders using their full scope of therapeutic skills, including the prescription of medication and administration of psychotherapy.

Psychiatric Mental Health Nurses (PMHNs) practice as Clinical Nurse Specialists (CNS) or Nurse Practitioners (NP). The doctoral degree for the advanced clinical practice of psychiatric nursing is the Doctor of Nursing Practice (DNP). All PMH-APRNs should be able to provide consultation and services to patients and families with multiple and complex mental and physical health concerns.

Licensed Clinical Social Workers (LCSWs) receive a significant degree of training in mental health counseling after earning a Master of Social Work (MSW) degree. LCSWs follow a traditional psychological approach towards counseling, which primarily concentrates on providing individual treatment. They often place emphasis on psychosocial diagnosis, assessment and treatment, client advocacy, consultation, evaluation, and therapeutic intervention.

Master of Family Therapy (MFTs) are mental health professionals who have undergone training in psychotherapy and family systems. Therapeutic treatment goes beyond an individual client and focuses on the mechanics of relationships as they pertain to a marriage, family unit, and/or other group. In other words, they provide marriage counseling, group therapy, and family interventions.

To find a mental health care professional in your area, you can start by asking your existing health care team for references or contact the American Psychosocial Oncology Society (APOS). APOS’s Helpline is a national referral program to help people with cancer and their caregivers find emotional support in their own communities.