MANAGING STRESS

Stress is part of life. Some people have to face more than others, some periods of ones life may be more stressful than others, and some cope better than others. Stress can be beneficial if it spurs one on to further challenge. Too little stress or stimulation can be just as debilitating as too much. The goal of stress management is to establish an optimal level, not too high and not too low - to learn how to thrive as well as survive. Stress has been defined as the arousal of the mind and body in response to demands made on them. We have all heard the explanation of the stress or alarm reaction as a human survival mechanism that our forefathers utilized when they were being chased by saber tooth tigers. When stressed, the body single mindedly prepares for battle. The adrenal gland speeds up the secretion of adrenaline and epinephrine and the body closes down the unnecessary functions of digestion, tissue repair, and immune system work. If the threat is temporary, whether to outrun a tiger or mugger, it is helpful. However most stress experienced today is social or psychological rather than physical; and chronic rather than acute. The accelerated heart rate, the extra glucose shuttled to the blood stream, the raised blood pressure, the release of supplementary protein and fat help prepare for an emergency but damage the body if left turned on. The release of fat provides energy but promotes atherosclerosis through build up of plaque in the arteries. The extra protein likewise provides a burst of energy but can deplete the body of the protein needed for construction of the white blood cells and other antibodies, thereby weakening the immune system and leaving the individual more vulnerable to disease. The effect of stress on lowering the immune system has been quite clearly demonstrated in animal experiments along with suggestive research on humans. Laboratory mice that were exposed to stressful experiences had fewer T-cells (part of the immune system) and those born to mothers with a known mammary-tumor virus developed the tumor in 90% of the cases if subjected to a stressful environment (crowding, isolation) compared to 7% of the mice in a stress-free environment. Human volunteers injected with cold viruses who had more stress in the prior year were more likely to develop a cold. Cancer patients who were in group counseling had a better survival rate. Heart disease (35%) is the leading cause of death in the United States, followed by cancer (24%), stroke (7%), pulmonary diseases (4%), and accidents (4%). Stress plays a role in arthritis, the most common chronic health problem in the country and costs over $50 million in lost wages each year. Pneumonia and influenza, the killers at the beginning of the century, garnered only 3% of the deaths in 1992. Medical science has had less success the on the life style-related disease of today. Stress is thought to affect our health as follows: By imposing long-term wear and tear on the body and mind, thereby reducing resistance to disease such as with colitis, cancer, migraines, or high blood pressure. By directly precipitating an illness such as a heart attack, tension headache, or depression By aggravating an existing illness such as arthritis, psoriasis, angina, diabetes, or hypertension. By precipitating unhealthy or even illness-generating coping habits such as smoking, alcohol abuse, overeating, or sleep deprivation.

If we add other lifestyles issues of diet, exercise, sleep, and environmental toxins the effect on ones health increases. Stress researcher Walt Schafer (1996) describes the role of our lifestyle on our health as follows:

Evidence from epidemiological and behavioral medicine clearly shows that wellness is largely a function of our daily habits: sleep, diet, exercise, relationships, how we handle anger, our chronic and acute tension levels, work satisfaction, and the presence or absence of energizing visions of ourselves and our world.

A 1994 national Gallop Poll found adults rated their job as the causing the most stress (71%), followed by money problems (63%), and family (44%). A sampling of research on the cost of unmanaged stress finds the following:

Stress-related problems cost a company an average of $2,773 per employee per year. An estimated 50% to 80% of illness episodes are stress-related. Industry loses $50 billion a year due to absenteeism and medical expenses caused by headaches. Half of all hospital admissions could be prevented by changes in lifestyle (overeating, lack of exercise, alcohol and smoking).

The goal is to control and channel stress rather than to allow it to exceed ones resources. Regardless of ones personal history or strengths, we all have three choices in dealing with stress. We can change, leave, or endure the stressful situation. Change: Can you change the situation that is causing stress? If marital problems are causing you stress, can you and your spouse go to counseling to resolve the problems and eliminate the stress? Can you improve your health through adoption of an exercise program and healthier eating habits?

Leave: If you cannot change the stressful situation, should you leave it? It is important to thoroughly explore the consequences of this action to assure you do not end up with more stress than which you started. Should you leave a bad marriage that shows no indication of improving, should you leave a job that you dislike, or should you move to the country to get away from urban crime?

Endure: There may be stressful situations that you can neither change nor leave. Dealing with a family members terminal illness, staying in a job with high tension deadlines or dealing with financial problems are examples of situations that may have to be endured. Adopting a healthy life style of exercise, good nutritional and sleep habits, and relaxation techniques can condition ones body and mind to constructively deal with these stressors.

Different situations call for different responses as the above examples indicate, but developing, or revising a stress management plan, should always start with a thorough assessment. Identifying the source of your stress will help determine what actions to take. Work: In what way is stress related to your work? What affect do deadlines have on you, what is the nature of the working conditions, and what affect does lack of promotional opportunity or an insecure job

future have on you? Can you change the situation? Can you take training courses to enhance your promotional opportunities? Are deadlines just part of your job and do you need to learn to endure and better cope with them? Meditation or relaxation techniques may help you get through the day and an exercise program help you leave the worries at the office. Relationships: To what extent is your stress caused by your personal relationships? Can you obtain family counseling to improve the communication with your adolescent daughter? Is the stress the result of the lack of an intimate relationship? Do you want a relationship but does fear keep you from taking steps to find one? Are you in a marriage that has lost its meaning? Do you see a pattern in your relationships, either in the type of person chosen or the end result? Can you go to counseling or contact your workplace employee assistance program (EAP) to get help in finding answers to these questions? Psychological: To what extent does the stress originate from within you? Do you feel inadequate no matter what you accomplish? Do you feel unattractive and undesirable even though others do not share this impression? Are you afraid to take actions to realize your potential? We reach adulthood with a host of past experiences, some we remember and some we do not. Even experiences we do not remember can affect the way we feel about ourselves. If a child was treated as inferior to his intellectually gifted older brother, this can continue to affect him in adulthood. This individual might be confused about why he never feels smart enough and/or why he obsessively must compete for first place with all males. To deal with stress that is the result of ones thoughts, counseling can help you connect them to the original cause, and over time, disengage from that way of thinking. Environmental: Now moving back to the external, what effect does your environment have on your stress level? What role does your daily commute play in your stress, what about the noise level, the climate, and crime? Again, can you change it (save money and move to a better neighborhood), should you leave it, or must you find a way to endure it? As there is always going to be stress that simply must be endured, techniques of doing this needs to be part of everyones stress management plan. It is a way of conditioning the body and mind for the trip of life. Choose activities from each of the following categories: Relaxation Techniques: Practice meditation or a visualization exercise for at least 20 minutes a day. Progressive muscle relaxation techniques, yoga, stretching, and deep breathing exercises can also be utilized. Most bookstores have a section on personal health which includes stress management books and relaxation tapes. Exercise: Physical exercise needs to be part of everyones stress management plan. Exercise not only takes your mind away from your worries but can cause the release of hormones (endorphins) in the brain that promotes relaxation. Ongoing rhythmic exercises such as walking, jogging, biking, rowing, aerobic dancing, and swimming are particularly helpful as they exercise the heart and lungs as well as the psyche. Most important in a choice of exercise is to do something you most enjoy. It is crucial to structure exercise into your week just as you do work. Waiting until you feel like exercising is likely to result in a sparse exercise program. Exercise three to five times a week. You may want to find an exercise partner so you can socialize while you exercise. Nutrition: Most of us know what is healthy and what in not. Changing ones eating habits is another story. We often hold on to our childhood foods as comforts from earlier days. Potato chips, hamburgers, and banana cream pie may remind us of carefree summer days but provides little benefit for our cholesterol level. Eating healthy does not mean depriving oneself of all ones favorite foods, just limit them and see if you can find healthier favorite foods. Decrease fried and high fat content foods,

limit sweets, and add fruits and vegetables. Foods high in vitamin B such as leafy green vegetables are particularly good for stress. Remember to watch you intake of caffeine, tobacco, and alcohol. A healthier diet not only can decrease fatigue and irritability, typically associated with stress symptoms, but can prevent certain stress from arising. A person who has a healthier lifestyle is less likely to develop health problems, which become another stressor one must deal with. In our weight conscious society one generally feels better about oneself, and is responded to more favorably, if he/she is not overweight. Sleep: A large number of Americans function in a sleep-deprived state. Although there are individual differences, most adults function better on eight hours of sleep. Albert Einstein reportedly needed 11 hours (Schafer). Time Management/Prioritize: You cannot do everything at once, and depending on your lifestyle, may never be able to do all you would like to do (or feel you must do). Firstly, sit down and evaluate your life. Are you really spending it on the important things or are they getting lost in lifes race? Are you feeling stressed because you never seem to have time and energy to spend with those you love or your favorite activity? Divide your life into long and short term goals. What steps need to be taken to meet the long term goals? Start at the beginning of each day by listing what you need to accomplish (personal and work). Put them in order of importance. Complete the first task before you go to the second, and the second before you go to the third. If urgent enough, the bottom or least pressing, will eventually move up to the top. You can only put off your laundry for so long. Plan tasks that take more creativity or brainpower when you are at your best. Do not try to compose an important letter when you are half asleep. Some people are sharper early in the morning and others do not fully come awake until afternoon. Recreational Outlets: There are a number of things we cannot control in our lives, but having fun is not one of them. Everyone needs to find, and take time, to pursue leisure time activities. Playing cards, dinner with friends, basketball, or going to the movies may not make lifes problems go away, but they do provide a nice respite. Most people know stress is a killer, but still do not follow through with the above recommendations. It does take time that is difficult to find in a busy schedule. It also entails making a deliberate choice to adopt constructive coping mechanisms rather that relying on those that we may have learned growing up. Virginia Satir, the family therapist, succinctly summarized the basis of stress management as follow: Life is not the way its suppose to be. Its the way it is. The way you cope with it is what makes the difference.

METROPOLITAN EAP .49 West 12th Street, Suite 1D.NY, NY 10011 212-352-3274

STRESS MANAGEMENT
LIFES PRESSURE COOKER

Destructive Outlets Irritability/Anger Outbursts Withdrawal/ Depression Addiction/Abuse

SOCIAL STRESSORS Family/Marital/Children Work/Deadlines Multiple Roles Financial ENVIRONMENTAL STRESSORS Weather Transportation Noise Pollution Overcrowding PHYSIOLOGICAL STRESSORS Illness Chronic Pain Life Cycle Changes
(adolescence, menopause, aging)

Constructive Outlets Talk Exercise

Good Nutrition

Adequate Slee Relaxation Techniques

Alcohol Drugs Cigarettes Food Gambling Shopping

Progressive Relaxation Visualizatio

Yoga/Medit

Health Problems
Insomnia Headaches Respiratory

Problems Back Pain Hypertensi on Heart Attacks Colitis Ulcers

YOUR THOUGHTS Low Self-esteem Self-fulfilling Prophesy Passivity/Aggressiveness

Recreational Outlets Socializin Hobbies

Plan/Prioritize Life Goals Daily Tasks Bio-feedback Acupuncture

METROPOLITAN EAP .49 West 12th Street, Suite 1D.NY, NY 10011

STRESS SIGNALS
PHYSICAL

Increased heart rate Sweating Dizzy or light headed Shortness of breath Tense & unable to relax Insomnia Diarrhea or indigestion Fatigued Impotence or decreased interest in sex Lack of appetite or overeating High blood pressure Racing thoughts Fidgety & agitated Headaches Backaches

PSYCHOLOGICAL

Anxious or fearful Irritable & short tempered Difficulty concentrating or making decisions Withdrawal from family & friends Feeling overwhelmed Dread of the future Immobilized & allowing things to slide Feeling like a failure Feeling helpless & unable to cope Cry for no reason Sad Suicidal thoughts

STRESS AND JOB BURNOUT

Job Burnout: A debilitating psychological condition brought about by unrelieved

stress which in the extreme can result in total dysfunction and breakdown. Operating on overload results in frequently feeling: fatigued irritable without sufficient energy to accomplish what you need to listless and angry unable to enjoy family and time off

JOB BURNOUT STAGES

****** ****** Honeymoon Stage High energy and job satisfaction Like job and going to work. Feel good about what you are doing ***** ***** Fuel Shortage Disappointment / enthusiasm wanes Inefficiency and lack of productivity at work Fatigue and sleep disturbances Escape activities (overeating, drinking, overspending) **** **** Chronic Symptoms Chronic exhaustion, anger, depression Sense that something is happening Lack of productivity, energy, enjoyment *** *** Crisis Symptoms become critical Obsesses with frustrations Pessimistic (sour on job, self, people) Feel like a trapped animal Develop escape mentally want out of job, family, consider suicide Increased absenteeism and inefficiency at work Lowered resistance to illness ** ** Hitting the Wall Total dysfunction, breakdown, possible suicide

WINNING OVER STRESS

Stress is all around us! Worry about your children, money, health, job, and relationships are only some of the likely concerns. It is not possible, nor even desirable, to eliminate all stress. Stress can act as a warning sign that something is wrong in one's life, much as a fever can point to an underlying infection. Stress symptoms can motivate one to face and resolve a problem in one's family, job, or self before it escalates out of control. Something usually must hurt before a person is motivated to make a change. The first step in any stress management plan is to determine the source. Is your stress coming from external or internal forces? Is it coming from a job with high pressure deadlines and responsibility, a company undergoing downsizing, or the loss of a loved one? Or is it coming from an unclear self image, a lack of confidence, or unrealistic self expectations? Does your stress originate from a childhood belief system? Are you plagued with old fears and doubts? Do you feel inwardly like a vulnerable child despite your chronological age? Do feelings of not being lovable permeate your adult and work relationships? Do you respond to your boss like you did to your "hard to please" mother? The first step is to acknowledge to yourself what your true feelings are. Ask yourself, what is it about these people or situations that make you anxious? Start to separate past conflicts from present ones. It can be more stressful to try to repress or deny what you are truly feeling and experiencing. If your company has an employee assistance program you might want to talk to an objective person. Adults have more control over their lives, and options to choose from, than they did as children. At the very least, take an inventory of your unrealistic beliefs. How many of the following do you answer in the affirmative?
1) It is a sign of weakness to ask for help. 2) It is important to please everyone. 3) You must be unfailingly competent and almost perfect in all you undertake. 4) You are helpless and have no control over what you experience or feel. 5) People are fragile and should never be hurt. 7) When people disapprove of you, it invariably means you are wrong or bad. 8) Anger is automatically bad and destructive.

How do you prevent stress from effecting you physically (headaches, hypertension, backaches) or mentally (depression, anxiety)? One can either change, leave, or endure a stressful situation. The first question is, can the stressful situation be changed? Can you change the way you react to rejection, can you change the communication pattern with your spouse, can you change the antagonistic relationship with your supervisor, or can some of your responsibilities be delegated to others? Can you change your spending patterns to lessen the financial pressures? If the situation cannot be changed, should you consider leaving it? Should you leave your marriage, move to a new job, or find a new neighborhood in which to live? There are a number of situations in life that one cannot change and one chooses not to leave. One's job may be stressful because of the nature of the

work, because of the economic climate, or because of the changing nature of your industry. How do you remain in your job without having your productivity impaired from burnout symptoms which would only increase your stress level? The following plan is for those situations which you can neither change nor leave. Sleep: A sleep-deprived body is not capable of effectively dealing with stress. Most people need around eight hours a night. Exercise: Rhythmic, repetitive exercise such as brisk walking, jogging, swimming, dancing, and cycling for 30 minutes three to five times per week. This type of exercise permits the mind to wander freely and facilitates pleasurable meditative-like states away from worries and life responsibilities. Exercise has beneficial physical consequences in addition to its role as a stress reducer. Prioritize: Plan your day, week, and year so the things most important get done first. Be aware of your own cycle and when you are most "creative" and allow that time for the more difficult or demanding tasks. Do not waste time on bottom drawer activities when top and middle ones have not been accomplished. It is important to be flexible and allow for priorities to change from what was formerly a low priority to what has now moved to top priority. A self evaluation of life priorities should be done at least yearly to make sure you are doing with your life what you really want. Do not wait until the end to regret that you spent your time doing the wrong thing.

your mind away from worries and the responsibilities of life (knitting, gardening, painting, music, reading, movies, socializing). You may not be able to control certain things at your job and in other areas of your life but you can control and plan leisure time activities. Guided Imagery/Meditation: Sit comfortably in a quiet area, close your eyes and focus your mind on the word "one," gently saying it in your mind over and over. After a while allow your mind to wander, with the word "one" more of a background thought. Recall the word "one" when you find your mind focusing on your daily worries. Meditate for 20 minutes in the morning and 20 minutes in the evening, preferably before eating. You may also focus on a pleasant image such as lying on a warm beach or walking through a beautiful forest. Let your mind stay on that image for a while and imagine yourself there. Audio tapes can be purchased with a variety of relaxation and guided imagery messages. Maintain Good Health and Nutrition: Eat a balanced and healthy diet. Limit the amount of sugar, caffeine and alcohol in your diet. If you still smoke, can you consider stopping? Personal Stress Management Plan: List the areas (work, family, relationships, inner self) from which most of your stress originates. Taking each category, what can you do to change it? For those things you cannot change or leave make a weekly plan by choosing an activity from each of the above categories. Make a commitment to adhere to your plan for three months. Chances are you will feel a lot better, and be healthier too!

Leisure Time/Recreational Activities: Schedule time for activities that take METROPOLITAN EAP - 49 West 12th Street, Suite 1D, New York, NY 10011 212-352-3274

Priorities
Determine Life Goals: Set aside time every six months to re-evaluate your goals and the steps you are taking to achieve them. What is important to you (work and personal) and are you pursuing it? Make a Plan of Action: What specific tasks do you need to do to reach your goals? If the goal is to obtain a college degree you may start with one class per semester. If it is to raise a healthy child, you may set aside time each day to talk to or read to your child. Use Time for Important Things: Make a list of things you would like/need to do by year, month, week, and day. Now prioritize by those you must do (A), those that are second in importance (B), and finally the least important (C). Do not do any Bs and Cs until you complete your As. Realize You Cant Do It All: You will have to make choices and some things you will not be able to accomplish; so do what is most important first (having a conversation with your husband may be more important than washing the dishes, in the long run). Learn to say no to requests that do not fit with your priorities. Delegate and share household responsibilities with other family members. Work Smart: Make lists and tackle life in an organized manner. Group together tasks that can be accomplished together, rather than continually retracing your steps. Organize your work so you do not waste time repeating yourself or looking for lost items. Break difficult tasks into manageable components. Complete one task before going on to the next. Dont Forget Your Health: If you do not have your health, what do you have? Schedule in time for good nutrition, rest, exercise, and stress management activities.

1. Remember that stress is inevitable! If we live, we experience stress. Stress is not necessarily a bad thing. It can be growth producing and provide new challenges. What can be bad is when we let stress control us, rather than learning how to control it. 2. Acknowledge to yourself what your true feelings are. Remember it can be more stressful to try to repress or deny what you are truly feeling and experiencing. 3. Learn to identify you own particular stress signals. Begin to familiarize yourself with your own internal and external cues. What people or situations tend to cause you the most stress? Ask yourself, what is it about these people or situations that make you anxious? 4. Often individuals react to present situations based on unresolved conflicts and relationships from the past. For example, if you were raised to think that you should be able to handle everything by yourself, that it is a sign of weakness to ask for help or to express feelings, then chances are that this will carry over into your work and social life. If you had a critical parent, you might be more affected by a critical boss. Ask yourself, to whom or what am I really reacting? Start to separate past conflicts from present ones. Adults have more control over their lives, and options to choose from, than they did as children. 5. Once you have identified the sources of your stress you can learn to deal with it more effectively. You can alter it, accept it, bypass it, or eliminate it. 6. Take a self inventory. Are your values realistic or are you trying to meet unrealistic and impossible demands? Examples of unrealistic thinking is as follows:

You should be able to do everything. It is a sign of weakness to ask for help. It is important to please everyone. You must be unfailingly competent and almost perfect in all you undertake. You are helpless and have not control over what you experience or feel. People are fragile and should never be hurt. When people disapprove of you, it invariable means you are wrong or bad. Your worth as a person depends on how much you achieve or produce. Anger is automatically bad and destructive. It is bad or wrong to be selfish.

7. Determine priorities. Do what is important. Ask yourself, Am I doing what I really want to do now? If not, ask yourself why. 8. Break large goals into their parts and make a plan of action, one step at a time, geared to the long-term goal. 9. Plan your tasks. Dont take on more than you can handle. Refusing tasks is less stressing than having a number of unfinished ones hanging over your head. Unfinished tasks are very stressful. 10. Reward yourself. Do an easy task if you need a stroke for achievement. Allow yourself a small reward for a job well done. Being internally motivated is less stressful than depending on someone else for positive strokes. 11. Stay loose. The game isnt always played according to the plan. Plan in detail but always be prepared to chuck it and go with whatever feels right at the time. 12. Maintain good healthgood nutrition and an exercise plan. 13. Schedule time for leisure time/recreational pursuits. Remember stress-related problems such as hypertension can be more time consuming and costly than preventive care. 14. Have a support base. Find someone with whom you can mutually share thoughts and feelings. Dont be surprised if this turns out to be someone other than your spouse. Holding problems in only makes it more difficult to deal with them. In some cases, it may be preferable to talk to someone outside your family and friendship circle, and in this case, a professional counselor may be helpful. 15. Lastly, regardless of your religious beliefs, remember the tenets of the Serenity Prayer: Grant me the serenity to accept the things I cannot change; The courage to change the things I can; And the wisdom to know the difference.

METROPOLITAN EAP .49 West 12th Street, Suite 1D.NY, NY 10011 212-352-3274(EAP4)

STRESS MANAGEMENT PLAN

LIST IN ORDER OF MOST TO LEAST STRESSFUL
WORK: Most of my stress is related to my work. Specify the nature of the stress such as too much work, lack of advancement opportunities, too much pressure, interpersonal conflict, etc.

SOCIAL/RELATIONSHIPS: Most of my stress is related to my relationships or social

life. Specify with whom you have problems, what type of problems, or if there is a lack in your relationship and social life.

YOURSELF: Most of my stress is related to my feelings about MYSELF. Specify poor

self-image, lack of confidence, insecure, etc.

Faulty Stress Valves: List the destructive ways you deal with stress.

Focusing on the MOST stressful area identified above, please respond to the following questions. 1. Can I eliminate the thing that is causing the stress or change the situation? Specify what you could do.

2. If the stressor cannot be changed or eliminated, should I leave it (change jobs, get a divorce, not attend holiday dinners, etc.)?

3. If it cannot be changed and I cannot leave it, how can I better endure it? What can I do differently so I will not get so stressed about the situation (i.e. focus energy on outside interests to make up for dissatisfactory job or marriage, practice relaxation techniques, start an exercise program, etc.)?

My individualized stress management plan will be as follows: Exercise: Priorities/Organizing: Nutrition: Sleep: Recreation/Leisure: Relaxation Techniques: Family/Personal:

List the most likely reasons you will give for NOT following your stress management plan.

What are the likely consequences if you do not adopt and follow this plan?

Individualized Stress Management Plan

My individualized stress management plan will be as follows: I. Exercise (what, when, how long)?

II. Priorities/Delegating:

III. Nutrition (what changes)?

IV. Sleep (optimum number of hours)? V. Relaxation Techniques (what & when)?

VI. Recreation/Leisure (what, with whom, when)?

VII. Family/Personal Problems (what changes need to be made)?

VIII. List the most likely reasons you will give for NOT following your stress management plan.

IX. What are the likely consequences if you do not adopt and follow this plan?

X. List the destructive ways you deal with stress

METROPOLITAN EAP.49 WEST 12TH STREET, SUITE 1D, NY, NY 10011 212-352-3274

BEACH TRIP
Guided Imagery

Get relaxed, loosen any tight articles (take off your glasses, loosen your belt), and place both feet on the floor. Now close your eyes, and take 3 deep breaths Breathe in ., breathe out , Breathe in , breathe out, Breathe in , breathe out. Using your imagination, I want you to imagine we are going on a trip. In your minds eye your are going to see yourself walking on a boardwalk. It is a beautiful day and the sun is shining. The sky is blue. Some white clouds just slowly drift by. You are walking along the boardwalk, feeling the warm sun and cool breeze. And looking out onto the sand, looking out onto the water, you are watching the waves gently lapping on the shore. It is just a lovely day, and you are walking along at your own pace. . The sand looks so inviting and you decide you want to go down into the sand. You see a staircase going down into the sand, and as you approach the staircase, you start going down the steps 10, 9, 8, down, 7, 6, down, down, 5, 4, down, 3, 2, and 1. You walk onto the sand and see another staircase and go down even further and down you go: 10, 9, 8, 7, down, down, 6, 5, 4, down, 3, 2, 1. Now you are on the sand and you start walking toward the shore, you feel the sand kicking up around your ankles as youre walking ... You get closer and closer to the shore and you just stand there. Let the waves just gently roll up around your ankles , you can feel the cool wetness around your feet, as the waves come in and out, and in and out You are just standing there enjoying this beautiful day .The water is really clear and you can smell the salty sea breeze. The sky is so blue and as you look up in the sky you see the clouds slowly rolling by You decide to take a walk slowly along the shore. You are just looking around . very peaceful and quiet .feeling the sun. You see a spot on the beach that looks really comfortable and you decide to go and lie down on the sand for a while. You lie down, make yourself comfortable, and sink right into the sand . You can feel the sun, the sun is shining on you it is so warm..The warmth of the sun relaxes you even more. You can hear the waves, the gentle waves, lapping on the shore.Some sea gulls are passing by, just watch them pass byyou can hear them. You can feel the sun on your arms, relaxing your arms. The sun is shining on your legs, relaxing your legsthe warmth is on your face, just relaxing the muscles in your face, any tightness in your jaw, let it relax, any tightness in your forehead, smooth it out.any tightness in your scalp, let it go.Feel the sun.the warm sun on youand the cool breeze, just lying there. Now you can do whatever you want, you are feeling so relaxed and energized You might feel like getting up and walking along the shore or just lying there and soaking up the sun and the sound of the sea, as it rolls in and out.Maybe you feel like swimming or playing in the water..You are looking around and there are some flowers on the beach.beautifully colored flowers.notice the colors. Smell the sweetness.

Soon it will be time to go back, but you can return anytime that you want to this place. This is your special place. But for now it is time to go. You get up and start walking again on the sand towards the staircase, still feeling the sun and the coolness of the air. As you approach the staircase, you start walking up 1, 2, 3, up, 4, 5, 6, up, up, 7, 8, 9, and 10. You are on the top of the first staircase in the sand. You walk a bit further and now you are approaching the second staircase. You are going to go up 1, 2, 3, 4, up, 5, 6, up, up, 7, 8, 9, and10. You are now on the top of the staircase and walk back to the boardwalk. Soon it will be time to be transported back to your office, where you will very slowly, on the count of 5, open your eyes, feeling relaxed and refreshed. 1, 2, 3, you are becoming more alert and awake, 4, and 5. You can now open your eyes, feeling totally alert and refreshed.

BOAT TRIP
Guided Imagery Loosen up, take off shoes and glasses if they are uncomfortable. Good posture is usually better than slouching so please put both feet firmly on the floor, and move around in your chair until you find a comfortable position. Im going to take good care of you for the next 10 minutes as we go on a little relaxation trip. Close your eyes, and make three big shrugs of your shoulders, raising up as to touch your ears. Ok 1, 2, 3. Now take 3 deep breaths. Now we are ready to go. I want you to imagine were going to go on a trip. In your minds eye, I want you to picture that behind this wall theres a door, a door you didnt notice when you came in, walk up in front, put your hand on the door and slowly open it. Down below you see a staircase, an earthen staircase, dimly lit but well enough so you can see, and it is safe. There is a nice cool breeze, and you can put your hand on the rail to hold on to. Take 3 deep breaths 1, 2, 3. Now imagine stepping down on the first step, 1, and 2, and go on down to the third, and fourth, and fifth. As you step down onto 6, you can start to see some type of underground river bank, 7, go ahead onto 8. The river is close to the stairs and coming closer. Step down to the 9th, and the last step, 10. Theres a very calm underground river and there on the side of the bank is a small wooden boat. Inside is a whole bunch of soft cushions lining the boat propped up in the back. They are begging for you to come over and sit down inside. And you do. You walk over to the edge, and in your minds eye you step inside the boat and comfortably lower yourself onto the cushions, and lean back. Imagine yourself moving your back muscles and finding just that right place, and as you do that, the boat slowly lifts off the bank and starts to gently move into the flow of the water, and you are safe. Theres a very soft gentle breeze and you can feel it on your face. Its nice and cool and you start to rock, very gently, as the boat follows the flow of the river. You can hear the water lapping along the sides of the boat, and youre very relaxed as you lean against the pillows and trust that the river is carrying you some place very calm, very delightful, and where youll feel completely at ease. Up ahead, you can see a little arch of sunlight, and it appears the river will be flowing into a clearing. And you continue to move down the river in the boat, the sounds of the water and air are against your face. It starts to become a little warmer as you get closer to the arch of sunlight, and you get closer and closer, and see some tree leaves hanging down over the water. Youre closer and closer, and you move into the sunlight. It is just beautiful, and on either side of you are huge meadows with all kinds of

flowers, all sorts of shapes and colors. And smells, breathe in the sweetness. Flowers are springing up everywhere, and occasionally a tree branch hands down and youre going under these green boughs and the water continues to lap at the side of the boat. And in your minds eye you imagine your eyes are adjusting to the sunlight and you can look around on either side, very comfortably. And theres grass and trees, and as you keep flowing down the river you can feel more and more tension easing out of your body. And up ahead on the right is a very mossy bank with a tree, a very beautiful tree, about 10 feet up from the shore. And you are coming closer and closer to where the tree is. Just as you become even with it, your boat bumps upon the shore, and sways and comes to a gentle stop. And in your minds eye, you carefully and safely lift yourself up off the cushions and step out onto the grassy shore. And you move up into the grassy area where the tree is, and you come right up to the tree, and it is just such a healthy, strong, and vibrant tree. It is so comfortable looking you decide to sit down under it. You look down and find a place on the grass in which you can comfortably sit, lower yourself down, and lean back against the trunk of the tree. As you sit under the tree you take 3 deep breaths, and 1, youre breathing slow, 2, and 3. As you exhale that 3rd breath, you drop your head back against the trunk and you look up through the branches and overhead is the bluest sky you could possibly imagine, just a wonderful, wonderful color blue. Theres the green of the leaves and the blue of the sky. Some fluffy white clouds slowly float by. You sit against the trunk of the tree and let any tension that might still be in your body run right out. Let it be absorbed by the tree trunk, let it be absorbed by the earth, just lean back and relax. As you look up through the branches, way high up, you can barely make out a bird, and the bird is circling, and he circles again, and he seems to be playing with the wind, it picks him up, and hes suspended in the air for a moment, and then hell glide down again. Now as you watch the bird, you feel yourself relaxing just a little bit more. And as youre sitting here looking up at the sky, through the trees, at the bird, again take 3 nice breaths. Fill your body with fresh air, lots of oxygen, good fresh air. Take another breath, and the 3rd. And now keeping your eyes closed, I want you to scan your body for any tension, and let it run right out, like heavy sand flowing out of a bag. Let the tension out and relaxation flow in to take its place. Gently say to yourself, I am calm and safe. Remember, this is your special place where you can return here anytime you like. But for now it is time to start back. Now very slowly, on the count of 5 youre going to imagine yourself lifting up from this beautiful meadow, from this tree and returning to your office. One, youre standing up, 2 your legs are moving, 3 you are walking towards me, 4 youre almost here, and 5 you are back in the room with me. Take one more deep breath and go ahead and open your eyes, feeling relaxed and refreshed.

PROGRESSIVE RELAXATION
Close your eyes and will alternately tense and relax muscle groups, starting with toes and going to the top of the head. Starting with toes and feet hold your legs straight out in front of you and curl your toes upward toward your face and tense your toes and feet as hard as can (easier to do without shoes), hold (5 seconds) and relax (15 seconds). Now, again straighten legs and tense your feet, calves and lower legs as hard as can and hold relax. Upper legs & thighs: Tense by pushing your upper legs together as tight as your can and hold. Imagine your muscles are made of elastic bands being pulled tighter & tighter. Now relax and imagine that your muscles are bags of sand from which the sand is running out. Buttocks: Squeeze buttocks together and hold now relax. Now tighten your stomach muscles by taking a deep breath and holding it while you pull your stomach in and up, as if you were preparing to receive a punch. Now let go and take a deep breath. Feel your stomach muscles relaxing as you breathe in and out. With each breath, a warm, comfortable feeling radiates out from the center of your body. Feel this warmth traveling through your chest, your back, and your stomach. Now your shoulders and neck: Shrug you shoulders up as high as you can, as close as you can to touching your ears and relax. Now one more big shrug and relax. Let your head drop back and stretch it as far as you can hold and relax. Hands: Now, tense the muscles in your hands by making tight fists and hold. Feel how much effort goes into keeping your fists tight. Hold for just a moment longer. Now, let your fists fall open and let your fingers dangle free. Make another fist and while you hold this, tighten your arms and hold and relax and again let your fingers fall free. Feel how relaxed the muscles in your arms and hands feel. Your arms feel heavy and floppy. They are limp and relaxed. Face: Tense your forehead by making the biggest frown possible, squint your eyes tightly shut, tighten your jaw. Now hold as you wrinkle your whole face and head in a huge frown and relax. your jaw drop slack, let your eyelids gently smooth out, let your forehead slide back into a relaxed comfortable position. Now move your jaw in a side to side motion, letting go of any residual tension. your tongue lie passively in your mouth. Whole Body: Now tense your whole body - hold and relax. One more time. Your body is feeling heavier and heavier and you have no desire to move. You are drifting deeper and deeper into a state of total relaxation. Let wave after wave of gentle relaxation sweep over your body. Let your body melt and become limp and soft. Your breathing is deep and slow. Take 3 deep breaths, filling your lungs with good fresh air. And one more. On the count of 5, you will open your eyes feeling refreshed and relaxed. One, .5. You may open your eyes. and Let and Let

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