1. Stress: Symptom Recognition & Management Techniques Dr Emma Robertson Blackmore Carol Ferro, MSW Suzanne Coglitore, BS University of Rochester, Department of Psychiatry.

2. Breaking Down Anxiety Feelings in my body What I do What I think Dr Jill Ehrenreich.

3. Learning to Recognize Anxiety Identifying feelings and triggers through self- observation and monitoring (write these down) Identifying feelings and triggers through self- observation and monitoring (write these down) What do I do when I worry? What do I do when I worry? Describe the ‘worry words’, feelings and behaviors Describe the ‘worry words’, feelings and behaviors Are there certain times or situations that exacerbate these feelings? i.e. triggers Are there certain times or situations that exacerbate these feelings? i.e. triggers Review common themes: health, loved ones, work and school, finances and daily chores. Review common themes: health, loved ones, work and school, finances and daily chores.

4. Common internal causes of stress Inability to accept uncertainty Inability to accept uncertainty Pessimism Pessimism Negative self-talk Negative self-talk Unrealistic expectations Unrealistic expectations Perfectionism Perfectionism Lack of assertiveness Lack of assertiveness

5. Things that influence stress tolerance level Support network (family, friends, coworkers) Support network (family, friends, coworkers) Sense of control (internal vs external) Sense of control (internal vs external) Attitude and outlook Attitude and outlook Ability to deal with your emotions (recognition and recovery) Ability to deal with your emotions (recognition and recovery) Knowledge and preparation Knowledge and preparation

6. Cognitive Symptoms Cognitive Symptoms Memory problems Memory problems Inability to concentrate Inability to concentrate Poor judgment Poor judgment Seeing only the negative Seeing only the negative Anxious or racing thoughts Anxious or racing thoughts Constant worrying Constant worrying Emotional Symptoms Emotional Symptoms Moodiness Moodiness Irritability or short temper Irritability or short temper Agitation, inability to relax Agitation, inability to relax Feeling overwhelmed Feeling overwhelmed Sense of loneliness and isolation Sense of loneliness and isolation Depression or general unhappiness Depression or general unhappiness

7. Behavioral Symptoms Eating more or less Eating more or less Sleeping too much or too little Sleeping too much or too little Isolating yourself from others Isolating yourself from others Procrastinating or neglecting responsibilities Procrastinating or neglecting responsibilities Using alcohol, cigarettes, or drugs to relax Using alcohol, cigarettes, or drugs to relax Nervous habits (e.g. nail biting, pacing) Nervous habits (e.g. nail biting, pacing) Physical Symptoms Aches and pains Aches and pains Diarrhea or constipation Diarrhea or constipation Nausea, dizziness Nausea, dizziness Chest pain, rapid heartbeat Chest pain, rapid heartbeat Loss of sex drive Loss of sex drive Frequent colds Frequent colds

8. Screening for Symptoms Huge variation in symptom presentation Huge variation in symptom presentation Depression Depression Anxiety Anxiety Worry Worry Physical rating Physical rating Somatization of symptoms Somatization of symptoms Could use a general screening tool for any of the above and use it to start a conversation about causes of symptoms. Could use a general screening tool for any of the above and use it to start a conversation about causes of symptoms.

9. Solutions? Write down stress responses and triggers to monitor your progress Write down stress responses and triggers to monitor your progress Physical relaxation Physical relaxation Mental relaxation Mental relaxation Change Your Thoughts, Change your Behavior Change Your Thoughts, Change your Behavior Time management & Organizational skills Time management & Organizational skills Sharing problems and asking for help. Sharing problems and asking for help.

10. Physical & Mental Relaxation Exercise, exercise, exercise. Exercise, exercise, exercise. Aerobic activity Aerobic activity Stretching / walking (even at work) removing yourself from the situation Stretching / walking (even at work) removing yourself from the situation Deep breathing Deep breathing Yoga / meditation Yoga / meditation Hobbies – gardening, pets, reading, tv. Hobbies – gardening, pets, reading, tv. Setting aside 15 mins a day to do something on your own that you enjoy. Setting aside 15 mins a day to do something on your own that you enjoy.

11. Change your Thoughts Cognitive restructuring (‘probability estimation’) Cognitive restructuring (‘probability estimation’) Objective probability of the event (pie chart) Objective probability of the event (pie chart) Previous worry, avoidance and perfectionism may have prevented one from experiencing another outcome – a positive one Previous worry, avoidance and perfectionism may have prevented one from experiencing another outcome – a positive one Catastrophizing- ‘thinking the worst’ Catastrophizing- ‘thinking the worst’ “So what approach” – what if the worst did happen? “So what approach” – what if the worst did happen? Ignoring positive information Ignoring positive information

12. Thoughts – Part 2 Sense of control (internal vs external) Sense of control (internal vs external) What can you actually change? What can you actually change? That’s where to focus your energy. That’s where to focus your energy. Knowledge and preparation Knowledge and preparation The more you know about a situation the more realistic your expectations and goals The more you know about a situation the more realistic your expectations and goals Avoiding Perfectionism Avoiding Perfectionism Realistic goals, thinking through outcomes, de- catastrophizing – what’s the worst that could happen? Realistic goals, thinking through outcomes, de- catastrophizing – what’s the worst that could happen? Break down the chain of thoughts Break down the chain of thoughts

13. Change your Behavior Practice relaxation techniques Practice relaxation techniques Time Management Skills: delegation, saying ‘no’, sticking to an agenda, avoiding perfectionism. Time Management Skills: delegation, saying ‘no’, sticking to an agenda, avoiding perfectionism. Daily goal setting activities: A, B and C tasks Daily goal setting activities: A, B and C tasks A – must be done today, has consequences A – must be done today, has consequences B – would like it to be done, but not by the end of the day B – would like it to be done, but not by the end of the day C – would like them to be done, but it’s not the end of the world. C – would like them to be done, but it’s not the end of the world.

14. Asking for Help Make yourself a priority. Make yourself a priority. Share problems with your support network. If they are unhelpful ask someone else. Share problems with your support network. If they are unhelpful ask someone else. Problem solve with others, or alone, to identify things that would reduce triggers or stressors or help to modify your response. Problem solve with others, or alone, to identify things that would reduce triggers or stressors or help to modify your response. Other people bring a different perspective – good or bad. Other people bring a different perspective – good or bad. Professional help – counseling, problem solving, financial aid, mental health supports. Professional help – counseling, problem solving, financial aid, mental health supports.

15. Self-care for moms Exercise – stand outside in the fresh air, get someone to go for a walk with you (with or without the baby), dance with the kids, play at the playground. Exercise – stand outside in the fresh air, get someone to go for a walk with you (with or without the baby), dance with the kids, play at the playground. Walk around the nearest shopping mall (with or without the baby). Walk around the nearest shopping mall (with or without the baby). Library – free dvds for exercise, yoga, relaxation. Library – free dvds for exercise, yoga, relaxation. Y classes – financial help and childcare available. Y classes – financial help and childcare available. Cable has FitTV with a variety of classes on it. Cable has FitTV with a variety of classes on it.

16. Calming activities If feeling overwhelmed: Take a shower or bath Take a shower or bath Breathe deeply, focus on your breathing rather than on negative thoughts Breathe deeply, focus on your breathing rather than on negative thoughts Telephone a support person Telephone a support person Tell yourself “It will be alright. I am doing the best I can at the moment” Tell yourself “It will be alright. I am doing the best I can at the moment” Remind yourself that you are not alone; others are in the same situation and many more have got through it. Remind yourself that you are not alone; others are in the same situation and many more have got through it.

17. Long -Term Monitor progress and what works Monitor progress and what works Organization through to do lists, time management Organization through to do lists, time management Realistic expectations of events occurring, and what the outcome should be Realistic expectations of events occurring, and what the outcome should be Use all support networks and tools available Use all support networks and tools available Reassess how far you’ve come periodically. Reassess how far you’ve come periodically.