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A CBT Approach to Stress Management

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Understanding stress and looking at how changing your way of thinking can help you cope with it.

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Page 1: A CBT Approach to Stress Management

12/04/23 1

Page 2: A CBT Approach to Stress Management

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Managing WorkplaceManaging Workplace Stress

“Stress is insidious: it creeps up on us on padded feet, and suddenly thrusts a knife in our vulnerable spot. Knowing what stress is, is one way of avoiding it; being able to recognise it in ourselves is probably

more difficult than recognising it in someone else.”

- Institute of Counselling

Knowing what stress is and its effects

Being able to recognise it in ourselves

Being able to recognise it in others

Knowing what we can do to help ourselves and others

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Work in threes or fours and

• Agree a simple definition of stress

• What sort of things tend to stress you?

• Describe how you would look, feel and sound like when under stress

• How do you detect these things in other people?

• Is it possible for you to cause stress in others?

• Can others cause you stress?

• What do you feel is the short term/longer term affect of stress?

• What is the impact on South Ayrshire Council?

What do you think stress is?What do you think stress is?

Page 4: A CBT Approach to Stress Management

12/04/23 4StimulationStimulation

Peak Performance

Stress (Rust-Out)

Chronic low energy level

Defensive behaviour

Emotional distancing from

people

Stress (Burn-Out)

Chronic low energy level

Defensive behaviour

Emotional distancing from

people

EfficiencyEfficiency

What is Stress?What is Stress?

“When the pressure of life, in what ever form it comes, exceeds your ability to cope, then you are in the whole arena of stress”

Professor Cary Cooper

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Perception and Expectation v Reality?Perception and Expectation v Reality?

“In fact events do not in themselves produce stress reactions which can be cognitive, behavioural or emotional. So stress is a perception of threat, or an expectation of future discomfort”

-Dr Ros Taylor

“Stress is a state not an illness”- Health & Safety Executive

Stressors occur in two major ways:Stressors occur in two major ways:

• The EnvironmentThe Environment – décor, lightning, noise levels, relations with colleagues, demands of balancing family and career

• The Way We ThinkThe Way We Think – cut and thrust of meetings, looking after a toddler, speaking in public, confidence in our abilities or performance

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Sources of StressSources of Stress

EnvironmentalEnvironmental - time pressures, noises, work demands, finance

PhysiologicalPhysiological – ageing, illness, life-style, diet, poor sleep, trauma

EmotionalEmotional – ambitions, relationships, desires, skills, drives

MentalMental – perception, thoughts, wisdom, imagination, reason, talent

BehaviouralBehavioural – affectionate, hostile, possessive, decisive, independent

TranspersonalTranspersonal – personality, values, attitudes, ideals, beliefs

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Common Symptoms of StressCommon Symptoms of Stress

EmotionalTense

Irritable

Outbursts

Unsettled

Feeling low

Tearful

Resentful of demands

Anxiety

Depression

PhysicalMuscle tension

Can’t relax

Headaches

Fatigue

Minor illnesses

Indigestion

Weight loss/gain

Skin conditions e.g. eczema

Long Term – Raised blood pressure

Gastric ulcer

BehaviouralDeadline urgency

Increased pace

Over-committed

Self neglect

Inefficiency

Withdrawal

Sleep disturbance

nightmares

CognitiveConcentration fragmented

Easily distracted

Inflexible

Threat laden thought

Perception of hopelessness

Feeling of injustice

RelationshipsLess able to cope with people needs

Problems at home

Impatient

Intolerant

Inclined to row

Wanting to be left alone

Over controlling towards others

Need to “lean” on others

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Common Symptoms of StressCommon Symptoms of Stress

Work PerformancePerformance declining

Silly mistakes

Poor planning

Motivation

Commitment

Indecision

Memory lapse

Longer hours

Fewer holidays taken

Regression

Crying

Arguments

Undue:

-sensitivity

-irritability

-moodiness

Over-reaction to problems

Personality clashes

Sulking

Withdrawal

Late for work

Leaving early

Extended lunches

Absenteeism

Resigned attitude

Reduced social contact

Elusiveness or evasiveness

Aggressive BehaviourMalicious gossip

Criticism of others

Vandalism

Shouting

Bullying or harassment

Poor employee relations

Temper outbursts

Other BehavioursOut of character behaviour

Difficulty in relaxing

Increased alcohol consumption

Increased smoking

Lack of interest in appearance or hygiene

Reckless driving

Physical SignsNervous stumbling speech

Sweating

Tiredness or lethargy

Stomach upsets

Tension headaches

Hand tremor

Rapid weight gain/loss

Constantly feeling cold

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FightFight or Flight Response?

The Baby Dinosaur

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Fight or Flight Response?

The Mommy Dinosaur

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The Impact of StressThe Impact of Stress

Our body prepares us for Fight or Flight:

• Our vision becomes clearer

• Hearing becomes more acute

• Muscles tense

• Blood flow to the brain increases

• Heart and respiratory rates increase

• Thought processes speed up

• Blood is redirected from the extremities to trunk and head

• Hands and feet become sweaty

The body needs relief from this or chronic stress may occur

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The Impact of Stress

The stressor causes the body to prepare to cope :

• The liver releases extra sugar to fuel the muscles

• Hormones are released that stimulate the conversion of fats/ and proteins to sugar

• The bodies metabolism increases in preparation for increased activity

• Certain unessential activities such as digestion are slowed up

• Endorphins, the body’s painkillers are secreted

• The surface blood vessels constrict to reduce bleeding in case of injury

• The spleen releases more red blood cells to help carry oxygen, and the bone marrow produces more white cells to help fight infection

• Saliva and mucus dry up, so increasing the size of the air passages to the lungs and giving rise to the early signs of stress, a dry mouth

When we are unable to either “fight or flight” the remnants of the hormonal surge shows as palpitations, shakiness, nausea

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Why do we need to tackle Stress?Why do we need to tackle Stress?

"Health activities should not be driven by a concern over legislation, but by the understanding that improved well-

being can generate significant benefits to morale and performance”.

Elizabeth Gyngell, Programme Director , Workplace Health Connect.

In Scotland at least 337 teachers of all grades - from probationers to head-teachers - are off work due to stress, depression and anxiety, with teaching unions and support groups claiming local authorities are not doing enough to protect staff from stress. Sunday Herald

In Scotland at least 337 teachers of all grades - from probationers to head-teachers - are off work due to stress, depression and anxiety, with teaching unions and support groups claiming local authorities are not doing enough to protect staff from stress. Sunday Herald

Stress costs UK industry an estimated £9.6billion per year.

In 2004–05 a total of 12.8 million working days were lost to stress, depression and anxiety.

In the ground breaking case of Walker versus Northumberland County Council (1994), John Usher, a solicitor working for Thompsons, representing UNISON member social worker John Walker, estimated that the cost to the employer of "management failure" was over £400,000. This included: damages of £ 175,000; £150,000 for the 2-week trial; Sick pay; and Ill-health pension

Staff costs take up around 60% (approx £150 million)of the SAC budget. It is estimated that we lose ? days each year through stress related illness at a cost of £m. This does not take into account the effect on efficiency where people suffering from stress continue to report for work.

Each case of stress leads to an average 29 days working days lost

There is also the fact that we spend half our waking hours

Monday to Friday at work- shouldn’t this be as positive an experience as possible?

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Your Legal ObligationsYour Legal Obligations

Health and Safety at Work Act1974

“Your employer has a 'duty of care' to ensure, as far as possible, your health, safety and welfare while you're at work. They should start with a risk assessment to spot possible health and safety hazards.”

“You have responsibilities for your own well-being and that of your colleagues.”

Under the Management of Health and Safety at Work Regulations 1999:

 Regulation 3 of the Management of Health and Safety at Work Regulations

1999 requires employers to assess risks to health and safety from the

hazards of work. This includes the risk of employees developing

stress-related illness because of their work.

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Your Legal ObligationsYour Legal Obligations

Disability Discrimination Act 1995

Changes to the Disability Discrimination Act 1995 (DDA) in December 2005 mean that mental illness no longer has to be a clinically well-recognised condition to be covered. So ‘anxiety’, ‘stress’ and ’depression’ may be sufficient to qualify a person as disabled and therefore covered by the DDA, as long as there is a substantial and long-term effect (for at least a year) on their ability to carry out normal day-to-day duties.

European Legislation

At an EU level, current legislation under the European Framework Directive 89/391 on the introduction of measures to encourage improvements in the health and safety of workers at work covers work-related stress and its causes, in addition to other risks to health and safety. Future developments will include focus on the EC Social Partners voluntary agreement issued in 2004 between employer and employee organisations which concerns work-related stress. The UK Social Partners launched supporting guidance on 13 July 2005.

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• Driven by ambition

• Self-demanding

• Sense of time urgency

• Aggressive

• Competitive

• Impatient

• Free-floating (but well rationalized) hostility

• Less rushed

• More genuinely easygoing

• Able to separate work from play

• Not rushed or impatient

• Even-handed

• Non-hostile Type B's are only around 1/7 as likely as Type A's are to have a heart attack or to develop heart disease.

Type AType A and Type B Behaviours

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Can Type AType A become a Type B?

Work

Play

“Whether by exercise, relaxation, dietary choices and eating behaviours, or other means, it is possible for a person to participate in preventive maintenance even while having a hefty dose of Type A characteristics.”

Meyer Friedman and Ray Rosenman, cardiologists credited with identification of

Type A behaviour and the associated risks

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Work in threes/fours and

• What do you do at the moment to cope with stress which could be described as an ineffective solution e.g. some people smoke more with the result being short term gain/long term sacrifice

• What do you do at the moment to cope with stress which could be described as an effective solution e.g. some people play sport/some people take time to themselves by walking/relaxing to music with the result of short term and long term gain.

• Can you describe the differences your coping strategies make to your approach to work/dealing with people (home and work)/anything else positive

• How could you have a positive influence on others i.e. How could you change something you do to have a positive impact on other people?

• What is the overall impact on your 24 hour day – home/work/sleep, from adopting your positive strategies

Combating Stress – What can we do?Combating Stress – What can we do?

Exercise 2 – This would be part 2 of the course “Knowing what we can do to help ourselves and others”

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Ineffective Personal Coping StrategiesIneffective Personal Coping Strategies

• Increased Drinking

• Increased Smoking

• Working Longer Hours

• Skipping Lunch

• Withdrawal

• Rushing About

• Sleeping More

• Denial

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Effective Personal Coping StrategiesEffective Personal Coping Strategies

PHYSIOLOGICAL

Controlled Breathing

Relaxation

Diet and Exercise

Sleep Management

Environmental Change

COGNITIVE/EMOTIONAL

Challenging Anxious Thinking

Controlling Emotions

Positive Thinking

Self Awareness

BEHAVIOURAL

Time Management

Acting Relaxed

Assertiveness

Working as a team

Changing your behaviour

“Change the way you think – Change the way you act”

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Managing Workplace StressManaging Workplace Stress

“Stress is insidious: it creeps up on us on padded feet, and suddenly thrusts a knife in our vulnerable spot. Knowing what stress is, is one way of avoiding it; being able to recognise it in ourselves is probably

more difficult than recognising it in someone else.”

- Institute of Counselling

Knowing what stress is and its effects

Being able to recognise it in ourselves

Being able to recognise it in others

Knowing what we can do to help ourselves and others

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We can look at things differentlyWe can look at things differently

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Could it be as easy as ABC?Could it be as easy as ABC?

• The ABC process is a method to identify and dispute our irrational beliefs, thoughts and feelings.

• By doing so we can come up with new, rational beliefs, thoughts and feelings.

• This helps us resist urges and regain control.

The phenomenal power of the human mind   I cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg

The phaonmneal pweor of the hmuan mnid! Aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it deosn't mttaer inwaht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be in the rghit pclae. The rset

can be a taotl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig

huh? Yaeh, and I awlyas thought slpeling was ipmorantt.

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Basic PrinciplesBasic Principles

• There are 3 aspects of human functioning:– Thoughts

– Feelings

– Behaviours

• People or events don’t make us feel good or bad.• It is our perceptions of them that result in our feeling good

or bad.• These perceptions influence our feelings and behaviour.

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The Basic ABCThe Basic ABC

• A = Activating Event– What do you think happened?

– What would a camera see?

• B = Beliefs about Activating Event– What did you tell yourself?

• C = Consequences– How did you act?

– How did you feel?

I failed that exam by miles

I must be absolutely useless

I am packing in the course

I feel stupid and a total failure

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Four Categories of Irrational BeliefsFour Categories of Irrational Beliefs

• Dogmatic demands– Musts, absolutes, should

• Awfulizing– It’s awful, terrible, horrible

• Low Frustration Tolerance (LFT)– I can’t stand it, I need it

• Self/Other Rating– I’m or he/she is bad, worthless

I must be absolutely useless

I failed that exam by miles

I am packing in the course

I feel stupid and a total failure

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Disputing Irrational BeliefsDisputing Irrational Beliefs

• After identifying A, B and C, we move on to D.• D = Disputing Irrational Beliefs (iB’s)

– Where is holding this belief getting me? Is it helpful or self-defeating?

– Where is the evidence to support my belief? Is it consistent with reality?

– Is my belief logical? Does it follow from my preferences?

– Is it really awful (as bad as it could be)?

– Can I really not stand it?

I must be absolutely useless I failed that exam by miles

I am packing in the course

I feel stupid and a total failure

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Irrational vs. Rational BeliefsIrrational vs. Rational Beliefs

• Irrational beliefs are the result of irrational thoughts.• Irrational beliefs lead to unhealthy feelings and behaviors.• Rational beliefs are reasonable, objective, flexible and

constructive.• Rational beliefs lead to survival, happiness and healthy

feelings and behaviours.

I actually failed that exam by 5%

I must be absolutely useless

I failed that exam by miles

I’m disappointed. I didn’t study as much as I should have and yet I only failed by 5% I should pass the re-sit

with a bit more effort

I feel stupid and a total failure

I am angry with myself for not putting the time in

I am packing in the courseI

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Irrational vs. Rational DiagramIrrational vs. Rational Diagram

RationalBelief

rB

IrrationalBelief

iB

HealthyConsequence

C

UnhealthyConsequence

C

ActivatingEvent

A

Rational Beliefs lead to healthy feelings & behaviours

Irrational Beliefs lead to unhealthy feelings & behaviours

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New Effective BeliefsNew Effective Beliefs

• After Disputing (D), we move on to E.• E = New Effect (New Rational Beliefs)

– New healthy negative emotions• Disappointment• Concern• Annoyance• Sadness• Regret• Frustration

– New constructive behaviours – I should pass the re-sit with a bit of effort

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Summary: ABC Flow ChartSummary: ABC Flow Chart

EffectiveChange

(E)

ActivatingEvent

(A)

RationalBelief

(rB)

HealthyConsequence

(C)

Disputation

(D)

IrrationalBelief

(iB)

UnhealthyConsequence

(C)

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The Extended ABCThe Extended ABC

The Basic ABC can be extended (with it’s D and E) to include F and G.

• F = New Feelings– After disputing irrational beliefs and making them rational, how

do you feel?

– Annoyed not angry, concerned not anxious, sad not depressed?

• G = Goals– How does the E (New Effect) help you reach your goals?

– In the short-term? In the long-term?

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Looking at the HSE Management Standards Looking at the HSE Management Standards for Work Related Stressfor Work Related Stress

DEMANDS – Includes issues like workload, work patterns and work environment

CONTROL – How much say a person has in the way they do their work

SUPPORT – Includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues

RELATIONSHIPS – Includes promoting positive working to avoid conflict and dealing with unacceptable behaviour

ROLE – Whether people understand their role within the organisation and whether the organisation ensures that the person does not have conflicting tasks

CHANGE – How organisational change (large or small) is managed and communicated in the organisation

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HSE - Management CompetenciesHSE - Management Competencies

Managing workload and resources

Dealing with Work Problems

Process Planning & Organisation

Empowerment

Participative Approach

Development

Accessible/Visible

Health & Safety

Feedback

Individual Consideration

Managing Conflict

Expressing & Managing Own Emotions

Acting with integrity

Friendly Style

Communication

Taking Responsibility

Knowledge of the Job

Empathy

Seeking Advice

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Lets begin to clear the fog

TREAT THE CAUSE NOT THE

SYMPTOMS

As a Manager you can ….

By …

Positive Performance Management

Staff wants from managers to reduce workplace stress

Monitoring and managing workloads (77%) Listening to and consulting their team (68%) Keeping staff informed about what was happening (63%) Showing consideration for individuals and their personal lives (61%) Consider

Coaching your team Encouraging work – life balance through effective time management Discouraging a “long hours culture” Making assertiveness not aggression or submissiveness the accepted behaviour

• Train the Trainer

• Microsoft Office Applications

• Managing Absence

• Minute Taking

• Negotiation Skills

• PDR Reviewer

• Report Writing

• Scottish Vocational Qualifications

• Study Skills

• Telephone Techniques

• Time Management

• Assertiveness

• Coaching Skills

• Customer Service

• Developing Teams

• ECDL

• Effective Discipline

• Facilitation Skills

• Interview/ing Skills

• Making meetings effective

Support Available through Employee Development• Management Development Programmes for staff at all levels

• Customised programmes or programmes for you or your staff

• Available Short Courses include ;(Central Development Budget)

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REACTIVEPROACTIVE

Where do you spend most of your time?Where do you spend most of your time?

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“We who lived in concentration camps can remember the men who walked throughout the huts comforting others,

giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that

everything can be taken away from a man but one thing : the last of the human freedoms – to choose ones’ attitude in

any given set of circumstances, to choose ones own way”

Viktor Frankl – Man’s Search for Meaning

Attitude is Everything Who chooses yours?Attitude is Everything Who chooses yours?

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Do youDo you really want to achieve want to achieve Work-Life Balance?Work-Life Balance?

“Work-life balance is about people having a measure of control over when, where and how they work. It is achieved when an individual's right to a fulfilled life inside and outside paid work is accepted and respected as the norm, to the mutual benefit of the individual, business and society.”

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“We first make our habits then our habits make us” Stephen Covey

Knowledge (what to, why to)

Desire (want to)

Skill (how to)

Habits

Changing HabitsChanging Habits