1. Stress Management Liz Pounds-Cornish Clinical Psychologist Department of Clinical Psychology National Spinal Injuries Centre

2. The impact of SCI It is a major trauma It is a major trauma Normal emotional responses in an abnormal situation Normal emotional responses in an abnormal situation There is no set pattern of responses; they are personal There is no set pattern of responses; they are personal Disability can highlight our own negative assumptions Disability can highlight our own negative assumptions

3. NATURAL - A demand placed on our physical or psychological energy NATURAL - A demand placed on our physical or psychological energy NORMAL - An integral part of our everyday lives NORMAL - An integral part of our everyday lives NEUTRAL - May lead to either positive or negative effects NEUTRAL - May lead to either positive or negative effects Stress

4. What happens when we don’t manage stress: The stress reaction PHYSICAL - Tiredness, Tension, Headache, Sleep disturbance, Irregular heart rate. PHYSICAL - Tiredness, Tension, Headache, Sleep disturbance, Irregular heart rate. PSYCHOLOGICAL - Negative thinking, Impaired memory, Confusion, Thought absences. PSYCHOLOGICAL - Negative thinking, Impaired memory, Confusion, Thought absences. EMOTIONAL - Sadness, Fear, Depression, Agitation. EMOTIONAL - Sadness, Fear, Depression, Agitation.

5. Can impair problem solving, reduce confidence, increase sense of being overwhelmed. Can impair problem solving, reduce confidence, increase sense of being overwhelmed. Socially it can lead to increased sensitivity, impaired communication skills, reduced desire for social contact and cause us to lose sight of what is really happening Socially it can lead to increased sensitivity, impaired communication skills, reduced desire for social contact and cause us to lose sight of what is really happening The effects of the stress reaction

6. Coping is what you actually do and think. Coping is what you actually do and think. Helps you to manage or alter the problems causing distress. Helps you to manage or alter the problems causing distress. Helps deal with the emotional response. Helps deal with the emotional response. Coping

7. Existing coping skills ineffective Stress reaction Further stress reaction Learn New Skills Stress Coping skills mobilised = COPE =

8. Stress is not only influenced by external events, but also by our reaction, what we do or don’t do, and our thoughts about the situation Stress is not only influenced by external events, but also by our reaction, what we do or don’t do, and our thoughts about the situation Stress is a psychological, emotional and physical response to events

9. Identifying sources of stress The Hospital Environment separation, hospital procedures/communication, feelings or being overwhelmed “what can I do?” separation, hospital procedures/communication, feelings or being overwhelmed “what can I do?” Experience of Symptoms dealing with pain, dealing with problems within the hospital, maintaining a relationship, loss of privacy. dealing with pain, dealing with problems within the hospital, maintaining a relationship, loss of privacy. Negative Predictions About The Future - What actually are the losses? - What skills do I have to deal with them? - How can I prepare? - How can I maintain my quality of life? - Has everything changed?

10. Do something Get good quality of information: books, leaflets, staff, Spinal Injuries Association (SIA), peers and their relatives. Get good quality of information: books, leaflets, staff, Spinal Injuries Association (SIA), peers and their relatives. Prioritise problems and decide on what is needed to cope with each Prioritise problems and decide on what is needed to cope with each Think realistically Think realistically

11. Look after yourself Coping with SCI demands dealing with stress over a period of time Coping with SCI demands dealing with stress over a period of time Think about the amount of time you spend here; take breaks Think about the amount of time you spend here; take breaks Take time to make sure that you are looking after yourself otherwise you won’t be able to effectively support your relative/friend Take time to make sure that you are looking after yourself otherwise you won’t be able to effectively support your relative/friend Try to maintain normal life: do things that are not related to the SCI Try to maintain normal life: do things that are not related to the SCI

12. Good self-care Part of maintaining a normal life is incorporating pleasure and relaxation Part of maintaining a normal life is incorporating pleasure and relaxation Make time for enjoyable activities Make time for enjoyable activities take a hot bath take a hot bath relaxation training/meditation relaxation training/meditation Get some exercise Get some exercise Pay attention to sleep and eating well Pay attention to sleep and eating well

13. Acknowledge your feelings Don’t feel you have to suppress your feelings Don’t feel you have to suppress your feelings Accept your feelings Accept your feelings Express your feelings (with someone or alone) Express your feelings (with someone or alone) Get Support Accept help when offered Accept help when offered Talk to people who make you feel good Talk to people who make you feel good Obtain confidential support if required Obtain confidential support if required

14. Use active coping strategies Set realistic goals (not everything that is important can be done) Set realistic goals (not everything that is important can be done) Act on decisions Act on decisions Be assertive Be assertive Say ‘No’ Say ‘No’ Accommodate and accept Accommodate and accept

15. Unhelpful ways of coping Research shows doing nothing is not a helpful solution Thoughts: ‘ I can’t do anything, so what’s the point?’ Thoughts: ‘ I can’t do anything, so what’s the point?’ Avoiding problems is only a short term solution, and can create more problems in the long term Avoiding problems is only a short term solution, and can create more problems in the long term Eating or drinking heavily Eating or drinking heavily

16. Managing Stress Identify sources of stress Identify sources of stress Manage it: recognise the impact, cope with physical and emotional consequences e.g. relaxation Manage it: recognise the impact, cope with physical and emotional consequences e.g. relaxation Coping skills – identify what you can and cannot change and do something! Coping skills – identify what you can and cannot change and do something!

17. And finally…. Research shows: that most people with SCI are very resilient and do learn to cope that most people with SCI are very resilient and do learn to cope many people with SCI rate their quality of life as good many people with SCI rate their quality of life as good