Lesson 1 Lecture: Stress and Mindfulness

I. Introduction and completion of the Perceived Stress Scale

II. Problems of Stress
a. Life
The Problem of Stress Life today presents: A schedule that is too busy, pressure
to perform, too much media, lack of face to face relationships, increasing anxiety
and depression, a brain that is in a constant state of fight or flight

The result: Decreased efficiency, problems with attention, impulsive behaviors,

increased depression and anxiety, sleep difficulties, social struggles

b. Acute stress
Acute stress is the most common form of stress. It comes from demands and
pressures of the recent past and anticipated demands and pressures of the near
future.
Because it is short term, acute stress doesn't have enough time to do the
extensive damage associated with long-term stress. The most common
symptoms are:
 Emotional distress — some combination of anger or irritability, anxiety
and depression.
 Muscular problems including tension headache, back pain, jaw pain and
other muscle pain
 Stomach, gut and bowel problems such as heartburn, acid stomach,
diarrhea, constipation and irritable bowel syndrome.
 Can lead to elevation in blood pressure, rapid heartbeat, sweaty palms,
heart palpitations, dizziness, migraine headaches, cold hands or feet,
shortness of breath and chest pain.

c. Chronic Stress
Long term stress.
Chronic stressors are not as intense as acute stressors, but their duration is
unbearably long
It is this type of stress that is associated with disease because the body is
perpetually aroused for danger.

III. Impact of stress

a. Chronic
Impact of Chronic Stress:
Diseases associated with stress: heart disease, insomnia, anxiety, depression,
digestive problems, headaches, weight gain, memory and concentration
impairments

The bad: anxiety disorders most common mental illness in US: 40 million adults –
Result in 22 billion dollars in repeated use of health care services
Depression affects 14.8 million (6.7%) – 26 billion in direct costs, 83 billion total
 The immune system has been discovered to be greatly affected by prolonged
bouts of stress.

The good: mindfulness programs have moderate evidence for improvement of

symptoms

b. Impact on Healthcare:
Medical Error – 400,000 annual deaths
Burnout – 46% of physicians in 2015
Disengagement – Gallup, 2014: 51% of workforce

IV. Hardwired thoughts:

Avoiding danger, learned helplessness, learn faster from pain than pleasure, faster
recall of negative memories.
Negative emotions disconnect us from higher brain function
a. Automatic Negative thoughts:
1. “Always/never” thinking: thinking in words like always, never, no one,
everyone, every time, everything
2. Focusing on the negative: seeing only the bad in a situation
3. Fortune-telling: predicting the worst possible outcome to a situation
4. Mind reading: believing that you know what others are thinking, even though
they haven’t told you
5. Thinking with your feelings: believing negative feelings without ever
questioning them 6. Guilt beating: thinking in words like should, must, ought, or
have to
7. Labeling: attaching a negative label to yourself or to someone else
8. Personalizing: investing innocuous events with personal meaning
9. Blaming: blaming someone else for your own problems
b. Self-Talk
 Negative – automatic, contributes to stress, impacts quality of life
 Positive – conscious effort, removes self-limiting scripts or thoughts, finds
opportunities in every obstacle, focuses on triumphs, requires practice

V. Behavior Change
a. Change is hard
b. Brain training – we can train our brains for optimal interactions and well-being
c. How?

BREAK
VI. What is Mindfulness?

Definition: Mindfulness is the basic human ability to be fully present, aware of

where we are and what we’re doing, and not overly reactive or overwhelmed by
what’s going on around us.

 The purposeful direction of focused attention to the internal and external

experiences of our lives

 Acceptance of the present moment, without resistance, “as if you had

purposefully chosen it”

 The ability to identify and disengage from automatic and negative thoughts,
habits and behaviors

 The capacity for lowering ones’ reactivity to challenging experiences

a. Discussion:
1. A time when you had a strong unpleasant emotion – How did you react?
2. A time when another person expressed a negative emotion to you – How did you
react?
3. What happens when you are aware of not liking what you are doing, who you are
with, where you are, etc.

VII. Mindfulness practices

a. Can include a wide variety of different exercises and activities. Focuses on
increasing calm awareness of our own thoughts, emotions and experiences in
the moment. Such as:
 Mindful breathing
 Meditation
 Visualization and mental imagery
 Body Scan
 Mindful movement
 Journaling
 Yoga
 Music therapy
 Art therapy
 Massage therapy
 T’ai Chi
 Progressive muscular relaxation
 Exercise
 Hobbies

VIII. Mindful Breathing exercise

Video – 3 minutes
https://www.youtube.com/watch?v=SEfs5TJZ6Nk
 IX. End of lesson 1

References:

Seaward, Brian. (2018). Managing stress: Principles and strategies for health and well-
being. Burlington, MA: Jones & Bartlett Learning.
Goyal M. Meditation programs for psychological stress and well-being: A systematic review and
meta-analysis. JAMA Intern Med 2014;174(3):357-368.
Koinis, A., Giannou, V., Drantaki, V., Angelaina, S., Stratou, E., & Saridi, M. (2015). The Impact
of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping
Strategies: The Case of a Local General Hospital. Health psychology research, 3(1),
1984. https://doi.org/10.4081/hpr.2015.1984
Mayo Clinic. (2019). Stress Management. Chronic stress puts your health at risk. Retrieved
from: https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-
depth/stress/art-20046037.
Perceived Stress Scale. (n.d.) Mind Garden. Retrieved from:
http://www.mindgarden.com/documents/PerceivedStressScale.pdf.
Lesson 2 Lecture: Mindful Meditation

I. Review/Questions about stress

II. Mindful breathing
a. Basics of deep breathing (diaphragmatic breathing): for this concept it’s important
to learn how to breathe using the diaphragm muscle instead of the upper chest.

 Sit comfortably, with your knees bent and your shoulders, head and neck
relaxed.
 Place one hand on your upper chest and the other just below your rib cage.
This will allow you to feel your diaphragm move as you breathe.
 Breathe in slowly through your nose so that your stomach moves out against
your hand. The hand on your chest should remain as still as possible.
 Tighten your stomach muscles, letting them fall inward as you exhale through
pursed lips. The hand on your upper chest must remain as still as possible.

b. Guided Mindful Breathing Meditation (handout provided for future use)

Video – 5 minutes
https://www.youtube.com/watch?v=dEzbdLn2bJc

III. Meditation
a. What is meditation?
Meditation is a mindfulness practice that produces a deep state of relaxation and
a tranquil mind. During meditation, you focus your attention and eliminate the
stream thoughts that may be crowding your mind and causing stress.
b. Types of Meditation
There are many types of meditation and relaxation techniques that have
meditation components. All of them share the same goal of achieving inner
peace.
 Visualization/Guided imagery meditation - this type of meditation is where you
form mental images of places or situations you find relaxing. You try to use as
many senses as possible, such as smells, sights, sounds and textures.
 Mantra meditation – for this type of meditation, you silently repeat a calming
word, thought or phrase to prevent distracting thoughts.
 Mindfulness meditation - this type of meditation is based on being mindful, or
having an increased awareness and acceptance of living in the present
moment. In this type of meditation, you broaden your conscious awareness.
You focus on what you experience during meditation, such as the flow of your
breath. You can observe your thoughts and emotions, but let them pass
without judgment.
 Transcendental meditation. Transcendental meditation is a simple, natural
technique. In this type of meditation, you silently repeat a personally assigned
mantra, such as a word, sound or phrase, in a specific way. This form of
meditation allows your body to settle into a state of profound rest and
 relaxation and your mind to achieve a state of inner peace, without needing to
use concentration or effort.
 Qi gong - Qi gong is part of traditional Chinese medicine. This practice
generally combines meditation, relaxation, physical movement and breathing
exercises to restore and maintain balance.
 Tai chi is a form of gentle Chinese martial arts. In tai chi, you perform a self-
paced series of postures or movements in a slow manner while practicing
deep breathing.
 Yoga. You perform a series of postures and controlled breathing exercises to
promote a more flexible body and a calm mind. As you move through poses
that require balance and concentration, you're encouraged to focus less on
your busy day and more on the moment.

c. Benefits
 Meditation manages and reduces stress and anxiety
 Meditation helps to strengthen your immune function
 Meditation builds compassion
 Mediation levels-up your consciousness (awareness, living in the present
moment)

IV. Mindful Eating Meditation

a. Although the workplace can be a great source of stress and anxiety, more often
than not, people do not engage in mindfulness practices at work. During our
busy days, it is difficult to take time out to practice meditation, even though it is
extremely beneficial to help us regain our focus and attention, give us more
energy, increased our working memory, and decreased our depression, anxiety
 and stress levels. Meditation can have a misconception that it takes a longer
period of time to complete, and you need to be in a tranquil environment. On the
contrary, meditation can take as little as five minutes, and can be practiced
anywhere. For individuals who are new to meditation and feel they don’t really
have the time, especially at work, mindful eating meditation can be a good start.
We all eat during the day. By incorporating mindful meditation into our meals can
be a stepping stone into opening up our eyes and minds to the benefits of
meditation.
b. Mindful eating meditation can be practiced by anyone, anywhere they choose.
Mindful eating meditation promotes the meditation concept of living in the present
moment to produce and enjoy a tranquil state of mind.
c. Mindful eating video – 5 minutes (handout provided for future use)
https://www.youtube.com/watch?v=yeuDxlJgtj4

V. Thoughts? Questions?

BREAK
VI. The Wheel of Awareness (handout)
a. The key ingredient of mindfulness is awareness. Dr. Daniel Siegel created the
Wheel of Awareness practice as a way to practice becoming aware of all that we
can be aware of, at once. The Wheel offers a visual metaphor for the way the
mind works. The center of the wheel, the hub, is the area from which we become
aware. From the hub, we can choose to focus our attention on (i.e., become
aware of) experiences both within and outside ourselves. Awareness of internal
experiences is represented by areas of the wheel that house our thoughts,
images, feelings, and bodily sensations. Awareness of external experiences is
represented by an area of the wheel that houses our sense of connection to
others. The aim of the tool is to help us increase mindful awareness of ourselves
and also the outside world.
b. Presenter led “The Wheel of Awareness” Meditation – 30 minutes
c. Reflection and questions

VII. End of lesson

References:

Chopra (n.d.). Why Meditate? http://www.chopra.com/ccl/why-meditate

Mayo Clinic (n.d.). Meditation: A simple fast way to reduce stress. Retrieved from
http://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858
Seaward, Brian. (2018). Managing stress: Principles and strategies for health and well-
being. Burlington, MA: Jones & Bartlett Learning
Positive Psychology (2019) The Wheel of Awareness. Retrieved from:
https://positivepsychology.com/
Stahl, B., & Goldstein, E. (2019). A mindfulness-based stress reduction workbook. Oakland, CA:
New Harbinger Publications, Inc.

Lesson 3 Lecture: Yoga

I. Yoga overview
a. What is yoga?
 Combination of physical poses (asanas), mediations (dyana) and
breathing techniques (pranayama) that focuses on the relationship
between the body and breathing.
 Purpose is to create unity between the mind, body and breathing
b. Benefits
 Keeps body fit, centers the mind, improved energy, reducing stress,
reduces tension in muscles, lengthen muscles, increased flexibility,
decrease heart rate and lower blood pressure
 Survey =
o 86% said it helped reduced stress
o 67% said they feel better emotionally
o 63% said it motivated them to exercise more regularly
o 59% said they had improved sleep
o 85% said they had improved overall health and made them feel
better
c. Risks:
 Usually safe for of physical activity for healthy people
 Older people should use caution
 Common injuries are generally sprains and strains
 Avoid extreme poses if new to yoga
 Hot yoga risks related to overheating and dehydration
 Pregnant women, older adults, and people with health conditions should
consult their health provider about their individual needs. May need to
modify or avoid some yoga poses and practices
d. Types of Yoga:
 Kundalini Yoga – “life force toga” Sequences designed to
stimulate or unlock this energy to reduce stress and negative
thinking
 Vinyasa Yoga – “flow yoga” Common, style where yoga poses are
synchronized with the breath in a continuous rhythmic flow
 Hatha Yoga – Often used as “catch-all” term for the physical side
of yoga. Hatha yoga must consist of a mix of asana (poses),
pranayama (breathing exercises) and meditation
 Ashtanga Yoga – Consists of a series of 6 specific poses taught in
order. Physical, flow-style yoga with spiritual components
  Yin Yoga – Slower style where poses are held for a minute and
eventually up to 5 minutes or more
 Iyengar Yoga – Uses props such as chairs, walls, benches,
blocks, etc. More static form of yoga, emphasizes alignment and
longer holds of positions
 Bikram Yoga – “hot yoga” Set series of poses performed in same
order with strict rules. 90-minute sessions, 26 postures, 2
breathing exercises, room at 105 degrees Fahrenheit, 40%
humidity
 Power Yoga – Generally more active and done at a quicker pace
than other styles of yoga. Strengthens, increases flexibility, and
keeps brain engaged.
 Sivananda Yoga – Form of Hatha yoga. Classes generally
relaxing and spiritual. Starts with corpse pose, moves into
breathing exercises, sun salutations, then 12 basic asanas.
 Restorative Yoga – Uses props to support the body. Goal is to
completely relax into poses which are held at least 5 minutes.
Focus on down-regulating the nervous system which benefits
those who need to de-stress.
 Prenatal Yoga – Focuses on easing pains associated with
pregnancy. Offers stress relief, exercise, self-care, and breathing
exercises which can come in handy during labor.
 Aerial Yoga – Relatively new, known as anti-gravity yoga.
Traditional poses with the use of a strong, silky hammock prop
which hangs from the ceiling.
 Acro Yoga – Takes familiar poses and adds a partner. One
partner is the “base” and the other the “flyer.” Builds connections
with others

BREAK
II. Yoga Practice
Video – 30 minutes
https://www.youtube.com/watch?v=HumTWtseGno

III. Additional Resources (handout)

 Local resources

IV. Conclusion
a. Thoughts/Questions?

References:

Yoga Medicine (2018). Types of yoga: A guide to the different styles. Retrieved from:
https://yogamedicine.com/guide-types-yoga-styles/
Medical News Today (2018). How does yoga work? Retrieved from:
https://www.medicalnewstoday.com/articles/286745
Yoga Journal (n.d.). Yoga Poses. Retrieved from: https://www.yogajournal.com/poses
Yoga Daily Tips (2019) How to master the 12 best hatha yoga poses for beginners. Retrieved
from: https://yogadailytips.com/hatha-yoga-poses-for-beginners/