Stress Management, Self Efficacy,

Health Promotion and Wellness,

Starting with Ourselves
Marcia Hamilton, OTD, MSHS, OT/L, BCP
AOTA Board Certified in Pediatrics
Background
• Occupational therapists are challenged with helping persons and
populations adapt to and cope with trauma, disability and life
challenges.
• Evidence supports the foundational understanding of the profound
effect of both acute and chronic distress on the mind and body (Abreu
et al, 2013, Fine, 1991; Bandura, 1925; Pragashnie & Mikhabele,
2015, 2015; Rakel, 2008; Selye, 1975).
• Promote knowledge of interventions designed to promote mitigation of
stress and promote well-being.
 Objectives:
1. Identify acute and chronic stressors associated with life one’s own life, over the lifespan and engage in
acknowledgement of challenges. Identify present life stage and acknowledge understanding of temporality.
2. Explore the Trans-Theoretical Model of Coaching and design self-regulation interventions promoting self-
efficacy and lifestyle change.
3. Collect physiological measures, (HR/O2) to explore the use of self-determined strategies, such as mindful
thinking, mirthful laughter and mediation, supporting self-efficacy and management of stress.
4. Experience an environment of social support within the cohort, increasing connections and hope while
collectively strengthening the network of support.
5. Construct the process of person-centered health promotion and wellness plan starting with ourselves.
6. Generalize methodologies and intervention strategies to promote stress management, self-efficacy and
overall health and well being of ourselves, and others.
Well-Being & Wellness
Well-Being: “General term encompassing the total universe of human life
domains, including physical, mental and social aspects” (WHO, 2006,
p.211). Well-being is considered to be an outcome of health promotion
and occupational therapy.

Wellness: “Perception of and responsibility for psychological and

physical well-being as these contribute to overall satisfaction with one’s
life situation”, (Boyt- Schell et al., 2014, p.1243).
Understanding Stress:
Eustress: can promote positive change, adaptation and accommodation
(Nathaniel, Schultz, & Draughn, 2015).
Distress: “actual or perceived threat to the body’s ability to maintain
homeostasis” (Abreu et al, 2013, p.19).
Both long-standing and current evidence-based literature regarding the
effect of distress on both the body and mind supports the foundational
understanding of the profound deleterious effect caused by both acute
and chronic stress (Abreu et al., 2013; Fine, 1991; Govender,
Pragashnie & Mikhabele, 2015; Lazarus & Folkman, 1984; Rakel, 2008;
Selye, 1975).
Stress Response

• Neuroendocrine response
• Limbic response
• Acute Stress
• Nervous system
• Musculoskeletal system
• Respiratory system
• Cardiovascular system
• Endocrine system
• Gastrointestinal system
Chronic Stress:
• Gastrointestinal
• Respiratory
• Skin
• Musculoskeletal
• Metabolic
• Neurologic
• Cardiovascular
• Pain reported as well as suffering
• Cognitive
(McEwen, 2001; Rakel, 2018)
Coping and Intervention in the
Stress-Distress Cycle:
Encounter-Perceive-Interpret Stressor
Stress management approach begins with self-regulation:
• Take a breath, employing increased O2 level & decreased CO2 level
• Increasing acuity of a perception through cognitive mediation
• Use of cognition to make a plan…in the present…what should be
done?
(Loy, 2014)
Self-regulation
• Current brain research in the field of neurophysiology, neuroanatomy,
neuropsychology and psychoneuroimmunology support our platform of
understanding the impact of dysregulation of the sympathetic nervous
system and the link between the Hypothalamic Pituitary Adrenal
System (HPA) and the rest of the body, (Little, 2004).
• The impact of neurotransmitters on cognitive function and recall has
been established and supports use of self-regulation to decrease
anxiety and promote working memory and overall executive function
(Rakel, 2018)
To try the Quick Coherence Technique access Heart Math Institute:
https://www.heartmath.org/resources/heartmath-tools/quick-coherence-
technique-for-adults/
 Psychobiological Effects of Physical Exercise
• Biological effects:
• Strengthens cardiovascular system,
via increasing O2 intake, fuels
metabolism
• Metabolic activities
• Altering hormonal and
immunological function
• Improving blood lipid profiles
• Neurologic functions
• Musculoskeletal
(Childress, 2014)
• Psychological benefits
• Helps to alleviate aversive states
• Physically fit are less challenged
from a cardiovascular standpoint
during periods stress
• Role in decreasing depression
• Role in increasing cognitive
performance
(Daley, 2008)
Physical Activity Guidelines
• For disease prevention: 30-60 minutes per day, include weight bearing,
stretching and range of motion, by bending and stretching in ADL and IADL
tasks.
• For basic health: Play or large muscle repetitive activity 20+minutes,
3x/day, 2-4 limitation specific stretches after exercise, 1 rep. 30-40
seconds, lift to challenge level
• Incorporate 4 main forms of exercise: cardiovascular, strengthening,
stretching, balance & agility
• Apply FITT Principle: Frequency, Intensity, Type, Time (American College of
Sports Medicine, 2011)
(Hewitt, 2018)
Psychological Options for Managing Stress:
Mirthful Laughter and Music
• Mandel, Hanser, Secic and Davis (2007) conducted research in
cardiac rehabilitation unit.
• This research demonstrated a direct correlation with reduction in systolic blood
pressure following the use of musical experiences, counseling, and Music
Assisted Relaxation and Imagery.
• The research provided evidence to suggest that changes resulting from the self
-regulation of physiology could be helpful in reducing anxiety and improving
general health and social functioning for up to four months following the
patient’s initial learning of the intervention.
Wellness Recovery Action Plan (WRAP)
Used in Psychiatric Rehabilitation, the WRAP is a technique used to
support self-management and coherence, reduce depression and anxiety
and improved participants' self-perceived recovery over time. Results
confirmed the importance of WRAP as part of a group of evidence-
based, recovery-oriented interventions.
(Psychiatric Services 63:541–547, 2012; doi: 10.1176/appi.ps.201100125)
WRAP is Underpinned by Five Key Principles
• Hope: people who experience mental health difficulties get well, stay well and go
on to meet their life dreams and goals.
• Personal responsibility: it's up to you, with the assistance of others, to take action
and do what needs to be done to keep yourself well.
• Education: learning all you can about what you are experiencing so you can make
good decisions about all aspects of your life.
• Self advocacy: effectively reaching out to others so that you can get what it is that
you need, want and deserve to support your wellness and recovery.
• Support: while working toward your wellness is up to you, receiving support from
others, and giving support to others, will help you feel better and enhance the
quality of your life.
Occupational Therapy and Health Promotion
• Occupational therapy practitioners believe that “health is strongly
influenced by [individuals] having choice and control in everyday
occupations” (CAOT, 2002, p.31), and as such, occupation is a
determinant of health.
• “Occupations are purposeful and meaningful daily activities that fill a
person’s time” (AOTA, 2008).
• Occupational therapy has a valuable contribution to make to
occupational performance as it affects the health and well-being of
people. It can positively influence health, welfare, education and
vocation at an international level. (World Federation of Occupational
Therapy)
Using the Standards of Presence- Coaching Approach

• Respect, honor, connection, possibility and an expansion of what is good in people

• Shared responsibility, being allies, common intention, mutual respect and trust
• “Sacred Space”-being present, with a clear non-judging mind and open heart
• Focus on what is working
• Acknowledging, holding the individual or ourselves as complete
http://www.coachfederation.org/icfcredentials/core-competencies
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