STRESS MANAGEMENT TRAINING: 

It is important to highlight five skills that form the core of almost all stress management programs:

• self-observation
• cognitive restructuring
• relaxation training
• time management
• problem solving 

SELF-OBSERVATION:

• One of the most effective easy to help individuals become more aware of how they respond to problem situations is to have them keep a daily record of their behavior.
• A daily diary format is often used to keep a record of how they responded to challenging or stressful events that occurred each day.
• Entries are made in 3 columns: Antecedents, Behavior and Consequence.
• In the Antecedent column, patients record a specific environmental event that they perceived as stressful. To assess appraisal about the stressors, patients are asked to rate how stressful they found this event on a 0 to 100 scale.
• In the Behavior column, patients are instructed to record their cognitive and behavioral reactions to the stressful event. It encompasses not only the overt behavioral responses, but also more covert cognitive, affective and physiological responses.
• In the Consequence column, patients record the outcomes resulting from their behavior in this situation.

COGNITIVE RESTRUCTURING:

• A hallmark of CBT is its insistence that cognition plays a central role in the stress and coping process.
• In CBT, cognitive appraisals about stressful events are considered to be the key factor in determining stress-related responding.
• The major thrust of CBT is helping patients become aware of and change their maladaptive thoughts, beliefs and expectations.
• There are several steps:
  1. the cognitive restructuring begins by educating patients about the cognitive model – that the underlying cognition is a major determinant of emotional responding.
  2. the second step is monitoring and analyzing the dysfunctional thoughts.
  3. the third step is to challenge and change cognitive distortions
  4. finally, participants develop a rational response that represents a more accurate and helpful cognitive response to the situation.
• Patients are given home practices assignments in which they are asked to expose themselves to stressful events, monitor their negative thoughts and respond with a more rational thought pattern. 

RELAXATION TRAINING:

• Relaxation skills can be very helpful in managing stress. When individuals learn to relax, their overall muscle tension is reduced, as is their overall level of autonomic arousal.
• Individuals who are able to relax are also more likely to be able to think more rationally and restructure negative cognitions when faced with stressful events.
• Relaxation skills may be helpful in reducing maladaptive behavior patterns.
• One of the most important tasks in relaxation training is helping patients learn how to generalize their skills in relaxation from home practice sessions to stressful and demanding daily life events.
• In Differential Relaxation, the trainee is instructed to engage in a daily task and only use the muscles that are necessary for carrying out the task.
• Mini-practice: this consists of a brief relaxation procedure in which the trainee takes a deep breath, and then, while slowly exhaling, focuses on sensations of relaxation flowing downward from the muscles of the face to those of neck, shoulders, trunk and legs. 

TIME MANAGEMENT:

• A stressful event can place inordinate demands on time. When exposure to such an event is prolonged or is combined with exposure other stressors, the demands on time and energy are multiplied.
• Individuals often report feeling that they have lost control of their daily schedule and that, as a result, they have little or no time in which to attend their own needs.
• Time management methods are designed to help individuals restore a sense of balance to their lives.
  1. The first step in training in time-management skills is designed to enhance awareness of current patterns of time use. Individuals are asked to keep a record of how they spend their time each day, noting the amount of time spent in important categories.
     • Alternatively they may be asked to list the important areas I their lives and then asked to provide two time estimates: the 1.amount of time they currently spend engaging these activities 2. the amount of time they would like to spend engaging these activities. With awareness of this difference comes increased motivation to make changes.
  2. The second step in time management is designed to help individuals set their priorities. In setting priorities, an important distinction can be drawn between urgency and importance.
     • It is helpful to envision a table that has the dimension of urgency along one axis and the dimension of importance along other axis. Patients are then encouraged to enter examples of activities from their own lives into each quadrant of the table and reflect on the patterns they observe.
  3. Once the participants have developed a better sense of their priorities, they are ready to move on to the third step in time management, goal setting.
     • The individual is asked to identify a goal to be accomplished in the next week.
     • Patients are asked to critically analyze the goal to ensure that it is reasonable, specific and personally meaningful.
     • Individuals are asked to reconfirm a time frame in which they will meet the goal.
     • Finally, the individual’s efforts in reaching the goal are reviewed.
     • Successful completion of a goal that has long been neglected can be very rewarding. Even if the goal was not achieved, important information about goal setting can be gleaned by reviewing performance. 

PROBLEM SOLVING:

• Problem solving is a skill that is introduced in the later stages of stress-management training. As trainees try to apply, they may find that some problem situations are particularly challenging and difficult to manage using only one or two stress-management techniques.
• Problem solving involves several basic steps:
  1. The first step is Problem Identification: in this step one tries to identify the key problematic aspects of a stressful event, such as problematic behaviors, thoughts, feelings and physiological responses.
  2. The second step is Generating Alternatives: Brainstorming is used to generate a wide range of alternative problem solutions. The rules of brainstorming include:
     • The individual should offer as many solutions as he or she can even if the solutions do not immediately seem reasonable.
     • No criticism is allowed.
     • There should be an attempt to mix and match solutions in creative ways.
  3. The third step involves Evaluating alternatives and selecting the best solution. The result is full review of the pros and cons of each solution. Typically, one solution stands out as the best and most practical.
  4. The final step is Implementing the solution.
• There is growing recognition that the development of problem-solving skills is crucial to the prevention of relapse and maintenance of the effects of CBT.
• Participants who learn how to approach a problem situation and formulate and implement effective coping options benefit in several important ways:
  1. they are often able to anticipate problems and make plans to avoid them.
  2. they cope with setbacks more effectively and are able to get their coping efforts back on track after a setback, so as to prevent a major relapse.
  3. they are prepared for termination of therapy, because they have learned to engage in a form of self-therapy in which they can pin-point and solve their own problems.