KAPLAN UNIVERSITYHW410 Stress: Critical Issues in Management and Prevention

Stress Management and

Prevention

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Program Resource Guide

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KA P L A N U N I V E R SI T Y

Stress Management and Prevention Program Resource Guide

By

Jennifer Booth

Kaplan University

HW410: Stress: Critical Issues in Management and Prevention

July 15, 2016

Table of Contents

U N I T 1 T H E N A T U R E O F S T R E S S

Information to Remember............................................................4Self-Assessment Exercises...........................................................4Journal Writing.............................................................................7

U N I T 2 T H E P H Y S I O L O G Y O F S T R E S S

Information to Remember............................................................8Self-Assessment Exercises...........................................................8Journal Writing...........................................................................11

U N I T 3 P S Y C H O L O G Y O F S T R E S S

Information to Remember..........................................................14Self-Assessment Exercises.........................................................14Journal Writing...........................................................................17

U N I T 4 P E R S O N A L I T Y T R A I T S A N D T H E H U M A N S P I R I T U A L I T Y

Information to Remember..........................................................19Self-Assessment Exercises.........................................................19Journal Writing...........................................................................21

U N I T 5 D E A L I N G W I T H S T R E S S : C O P I N G S T R A T E G I E S

Information to Remember..........................................................26Journal Writing...........................................................................26

U N I T 6 R E L A X A T I O N T E C H I Q U E S 1 : B R E A T H I N G , M E D I T A T I O N , A N D M E N T A L I M A G E R Y

Information to Remember..........................................................29Self-Assessment Exercises.........................................................29Journal Writing...........................................................................32

U N I T 7 N U T R I T I O N A N D S T R E S S

Information to Remember..........................................................35Self-Assessment Exercises.........................................................35

U N I T 8 P H Y S I C A L E X E R C I S E A N D A C T I V I T Y

Information to Remember..........................................................38Self-Assessment Exercises.........................................................38Journal Writing...........................................................................42

U N I T 9 A P P L Y I N G S T R E S S : C R I T I C A L I S S U E S F O R M A N A G E M E N T A N D P R E V E N T I O N T O Y O U R P R O F E S S I O N A L L I F E

Information to Remember..........................................................45

A D D I T I O N A L I N F O R M A T I O N 4 6

R E F E R E N C E S 4 7

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Unit 1: The Nature of StressInformation to Remember:

Key Learning Point: There are 3 types of stress; good stress (eustress), bad stress (distress) and neutral stress (neustress). Eustress is motivating the person toward good, Neustress is a situation that is found to be unimportant, distress is a situation where the person feels threatened or fearful and what we commonly think of when we think of stress (Seaward, 2015).

Key Learning Point: Optimal health consists of a balance between mental wellbeing, emotional wellbeing, spiritual wellbeing, and physical wellbeing. When one area is not well, all areas can suffer (Seaward, 2015).

Key Learning Point: Chronic stress has been linked to negative health effects. Examples include, heart disease, insomnia, and cancer (Seaward, 2015).

Self-Assessment Exercise:1. The circle is a universal symbol of wholeness as recognized by many worldwide organizations. It is also referred to as a mandala — circle-shaped objects symbolizing unity. Construct your own mandala emphasizing the components of mental, spiritual, and physical and emotional wellbeing in order of importance to you. Yours might be evenly spaced or more heavily weighted to one or another wellbeing. One example can be found on page 28 within Seward's digital book; or page 22 of the print version. To make your own mandala in Microsoft word, click on “insert” in the tool bar, click on chart, choose “pie”, fill in the excel part of the chart; click save and insert into your paper.2. Describe each of the four areas of the model and discuss why each area is important to balancing your wellness and stress levels.3. What is one environment in which you live or work that fosters a balance of your wellness paradigm? Why?

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2. My mandala above shows the four components of wellbeing in equal sections because I

believe they are all of equal importance and together create wholesome and balanced wellness.

Mental wellbeing, spiritual wellbeing, emotional wellbeing and physical wellbeing can be separate

components of the whole but are also connected and may also have some overlapping areas. Wellness

paradigm is defined in the Seaward text as, “The integration, balance and harmony of mental,

physical, emotional, and spiritual wellbeing through taking responsibility for one’s own health; posits

that the whole is greater than the sum of the parts (Seaward, 2015).”

While the four components are connected, each component of wellbeing has its own

characteristics and importance. Mental wellbeing involves the intellectual process of gathering,

remembering and communicating information. This aspect of the wellness mandala is important

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because of the need to make smart decisions and communicate accurate information for work and

private life. Physical wellbeing describes the functions of the physical body systems, such as digestive

system, cardiovascular system, nervous system and muscular system. The body requires balance to

work properly and this is another important aspect of wellness in order for the individual to function

and survive. Emotional wellbeing involves the ability to control human emotions, this aspect is

important in order to avoid depression, excess fear or excess anger. Being able to balance these

emotions not only affect personal health but also the health of the relationships with those around you.

Finally, spiritual wellbeing involves meaningful purpose in life, personal value systems, and strong

relationships. This area of wellness is important as a guideline of how to live one’s life; relationships,

personal values, and meaningful purpose of life are part of understanding oneself in order to live out a

life that where one can be happy with themselves. These four areas of total wellbeing are equally

important and maintaining balance of all areas of wellbeing is important to overall health.

3. One environment that fosters a balance of my wellness paradigm in my home is through

walks with my mom. This environment is a place where we can build our relationship, discuss

personal values, express and support each other emotionally, learn through communication with one

another, as well as support the physical needs of the body for activity. This environment helps me to

balance the four aspects of wellbeing to lead to optimum health. Walking with my mom is not only

for physical exercise but helps to balance my emotions after a full day of work and stress. I also enjoy

conversations with my mom where we can discuss what is important in our lives. It is important to

find environments that promote balance of physical, spiritual, mental and emotional wellbeing in

order to establish and maintain an overall standing of good health.

(Seaward, 2015).

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Journal Writing:Unit One Journal Writing

Complete the Journal Assignment entitled: “How Stressed

Are You?” Directions are found on pages 11 and 12 of the

Mindfulness workbook. List the situation on the left. Use a rating

scale of 1 through 10 for the start, midway, and end. You will use this

Journal Assignment as a way of mapping your stress throughout

the course. Keep it handy and refer back to it often. Provide at

least 10 stressors; utilize all three types: eustress [good stress],

neustress [neutral stress] and distress [bad stress]!

Situation Start Midway

End

When I am overbooked with patients at work -Distress 7When I forget something I needed at the store -Distress 5Paying student loan bills - Distress 6Worrying about my grandmother in another state -Neustress

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When I have to give a presentation -Neustress 5Waiting in traffic - Distress 6Planning and preparing healthy meals for the week -Eustress

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Completing assigned readings and assignments -Eustress 7Meeting daily step goals using my Fitbit -Eustress 4Searching for my first house to purchase -Eustress 4

(Stahl & Goldstein, 2010).

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Unit 2: The Physiology of Stress

Information to Remember:Key Learning Point: Mindfulness allows the person to be present in the moment. Mindfulness can be helpful in dealing with stress, pain and illness. Walpola Rahula, author of What the Buddha Taught, was quoted in the Stahl and Goldstein’s text, “[Mindfulness] is simply observing, watching, examining. You are not a judge but a scientist (Stahl & Goldstein, 2010).”

Key Learning Point: Perceived stress affects 3 systems of the body, immune system, endocrine system and nervous system. The nervous system is split into the central nervous system, which is made up of the brain and spinal cord, and peripheral nervous system, which is the nerves connecting to the extremities off of the spinal cord. The endocrine system is made up of glands that secrete hormones to other parts of the body to regulate homeostasis. The immune system is responsible for fighting disease in the body and can be compromised by prolonged stress (Seaward, 2015).

Key Learning Point: Allergies, colds, rheumatoid arthritis, lupus, cancer, ulcers and colitis are immune system diseases associated with stress. Irritable bowel syndrome, coronary heart disease, bronchial asthma, TMJ dysfunction, tension headaches, and migraine headaches are nervous system related diseases associated with stress (Seaward, 2015).

Self-Assessment Exercise:1. Describe neuroscience and neuroplasticity. Explain the importance to the brain.2. Identify and describe five diseases that occur when the nervous system is affected by stress.3. Identify and describe one disease that occurs when the immune system is affected by stress.

Neuroscience involves the connection of the brain with the functions of the body. An

article by Christian Nordqvist from Medical News Today defines neuroscience as, “is the study

of how the nervous system develops, its structure, and what it does (Nordqvist, 2014). The

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brain is important because it communicates with other body systems to adjust functions of the

body as it sees needed. This process also involves the body’s reaction to stress, either

sympathetic nervous system response of increased heart rate and blood pressure or

parasympathetic nervous system response of lowering heart rate and blood pressure (Stahl &

Goldstein, 2010). Neuroscientist have connected thoughts and emotions with the physical

process of the body and linking prolonged stress to other health issues (Stahl & Goldstein,

2010). It is also important for the brain tissue to be able to adapt to different cognitive

challenges and stimuli and this describes neuroplasticity (Seaward, 2015). Stress can

negatively affect the body and the brain causing nervous system and immune system diseases.

Irritable bowel syndrome (IBS), coronary heart disease, bronchial asthma, tension

headaches, and temporomandibular joint dysfunction (TMJD) are examples or 5 diseased that

occur when the nervous system is affected by stress. IBS is related to excessive stimulation to

the gastrointestinal tract and is characterized by abdominal pain, cramps, diarrhea, nausea,

constipation and excessive flatulence (Seaward, 2015). This disease is commonly related to

anxiety and depression and studies have shown relaxation skills as an effective treatment

(Seaward, 2015). Coronary heart disease is a leading cause of death and is related to stress

with elevated blood pressure and the release of cortisol. Stress can cause elevated blood

pressure because the body is preparing to respond to the stress and supplying muscles with

oxygenated blood in order to react. The body also releases hormones related to the stress

including cortisol which can cause heart damaging cholesterol deposits (Seaward, 2015).

Bronchial asthma is another example of disease that occurs when the nervous system is

affected by stress. Studies have shown a link between asthmatic attacks and anxiety, and

relaxation techniques have also been shown to be effective in reducing asthmatic attacks

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(Seaward, 2015). Tension headaches can be caused by the nervous systems signals for muscle

contraction due to stress. Meditation, mental imagery and biofeedback have been shown to be

successful treatment to reduce stress and tension headaches (Seaward, 2015). The final

example of disease that occur when the nervous system is affected by stress is TMJD. TMJD

can be related to tension headaches and migraines because it is often associated with the

inability to express feelings of anger (Seaward, 2015). Like the other diseases discussed,

relaxation techniques can be effective treatment for TMJD because relaxation techniques help

the body, including the nervous system manage and cope with stress.

The immune system is also affected by stress and one disease that occurs when the

immune system is affected by stress is cancer. Cancer is a complex disease that has been a

growing issue in today’s medical sciences, causing many deaths each year to a wide variety of

individuals. The job of the immune system is to identify foreign and dangerous substances in

the body and protect the body from these dangers but stress can compromise the immune

system. Cancer can be caused by a stress comprised immune system where the body is not

able to effectively fight off the harmful cancerous cells. Early detection and prevention are key

factors in decreasing cancer risks and one important step in preventing cancer is decreasing

and managing stress (Seaward, 2015). Stress can be detrimental to health and knowing how to

manage and decrease stress can promote healthy lives and decrease disease.

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Journal Writing:Complete the Journal Assignment entitled, Explore: How is stress or anxiety affecting

your life? Directions are found on pages 33 through 35 of the Mindfulness workbook. Upon

completion of this Assignment, you will take the first step toward greater well-being and

become aware of how stress is impacting your life. This should be a minimum of two full pages.

How is stress or anxiety about people affecting your life?

Stress and anxiety about people can affect my life both positive and negatively. I notice that if

there is a large crowd of people or I have to give I presentation, I can become more stressed and more

anxious. This has even made me want to avoid some situations. For example, it can be stressful for

me to go to a large event where I do not know many people and at sometimes it is easier for me to

want to avoid those types of situations. I believe that this can negatively affect my life because I am

letting anxiety of what I don’t know stop me from new experiences and meeting new people. I have

noticed that I am more comfortable talking with strangers and that is an area that would have caused a

lot of anxiety and stress in that past. I also think that stress and anxiety about people affect my life in a

positive way by strengthening my relationships with my loved ones because I feel comfortable with

them and spend a lot of time with them because I do not feel stressed or anxious.

How is stress or anxiety about work affecting your life?

Stress and anxiety about work has greatly changed for me over the 4 years that I have been

working with the same company as a physical therapist assistant. When I first began this job I would

feel very anxious going to work not knowing what types of patients I would be working with or what

types of treatments I would need to be able to provide. I think this made me study harder and continue

to learn so that I would feel more comfortable and prepared going to work. Now I am less stressed

over specific treatments because I have more experience and know if I need help I can go to a co-

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worker with any questions. But I still become anxious and stressed over time-management at work,

especially if I am booked with a short amount of time for a patient who needs longer time for hands

on treatment. I have noticed this affect my life to where I feel exhausted leaving work.

How is stress or anxiety about the world affecting your life?

Stress and anxiety about the world affects my life by making me hesitant to travel out of the

country. Between the spread of disease and terrorism I now have greater anxiety about travel and

although I would like to see more of the world there is a level of stress and anxiety that contributes to

the very little traveling I have done. I also worry about my grandmother because she is in another

state and if something were to happen I would want to be there for her. Although I have not done any

traveling out of the U.S., I try to often plan time to visit my grandmother and that helps to decrease

my stress and anxiety over her being in another state.

How is stress or anxiety about food and eating habits affecting your life?

I am trying to make healthier decisions when it comes to food and eating habits but it seems

that the stress of meal planning and prepping can lead me to the unhealthy fast-food or pre-cooked

meal options. I notice that when I am making healthy choices about food I can stick with it for a little

while but when I slip and eat unhealthy foods then I become derailed and have a hard time getting

back into the routine of healthy eating.

How is stress or anxiety about sleep and sleeplessness affecting your life?

I feel lucky that I very seldom undergo sleeplessness, I have always valued by time for sleep

and still feel it is important to get around 8 hours of sleep. I feel that I have little stress and anxiety at

this time about sleep and sleeplessness, but I do notice if I do not have enough sleep then I may

become more anxious or stressed over situations that would not affect me as much if I had enough

sleep.

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How is stress or anxiety about exercise or lack of physical activity affecting your life?

I am currently having a difficult time reaching my daily physical activity recommendations. I

wear a Fitbit that tracks my steps for the day and I have a daily goal of 10,000 steps but I have not

consistently reached that goal. On the days that I do reach or exceed that goal, I feel proud and on that

days that I don’t I usually am not very stressed or anxious that I have not reached the goal. I notice

that I become more stressed and anxious over how my clothes fit instead of physical activity and

when my clothes do not fit well I am more motivated to be physically active.

Summary

I notice that stress and anxiety in some areas affect my life more than others, as well as some

having a positive affect and some having negative affect. While I may still have anxiety/stress with

large crowds or giving presentations I do notice that this has improved compared to what it was in the

past. I am also able to depend on my close friends and family for support in stressful situations. Also,

when I am worried about my grandmother who lives in another state, it positively affects my life

because I make it a priority to go and visit her. These and other examples show how I have made

improvements in coping with stress and anxiety but there are still areas that I can improve through

this class.

(Stahl & Goldstein, 2010).

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Unit 3: Psychology of Stress

Information to Remember:Key Learning Point: Self-love and self-acceptance are noted as having importance in theories for human

behavior and dealing with stress. Maslow’s theory describes self-actualized people as being able to cope with stress and having similar personality traits. A few of these traits include, independence, creativity, acceptance, a sense of humor, and a strong sense of ethical values (Seaward, 2015).

Key Learning Point: Mindful breathing is a practice that can be done anywhere and serves to remind the person to be present in the moment. Also bringing attention to how one is breathing, from the belly rather than just the chest is a beneficial relaxation and meditation technique (Stahl & Goldstein, 2010).

Key Learning Point: New technology can make communication more stressful and increase miscommunications. Computers and cell phones lead to less face to face communication and without face to face communication, body language and tone is missing which can cause miscommunication (Seaward, 2015).

Self-Assessment Exercise:1. What can be learned from the Tibetan culture about the mind and stress?2. What do the views espoused by theorists have in common? Explain your perspective.3. Describe one or more ways to cope with manage and/or resolve fear.4. Describe a minimum of five ways in which you can improve your communication style.

The philosophy of Buddhism has been a part of the Tibetan culture for many years. In today’s

world it is discussed that Buddha, the enlightened one, attempted to understand the nature of human

existence and human suffering many years before modern theories of the mind and stress were

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developed. Much can be learned about the mind and stress from the Tibetan culture, including the

need to separate from attachments, achieve a higher self and true happiness. The Tibetan culture

teaches that stress is due to desires with strong attachments (Seaward, 2015). The teaching depicts

that true happiness is found within instead of through attachments of physical things. The Tibetan

culture also teaches that when mental stability and balance is obtained one can find happiness and

connect with the true self (Seaward, 2015). Another important teaching from the Tibetan culture is

that laziness procrastination, fear and desires are faults of the ego and need to be controlled, one way

to do this is through meditation (Seaward, 2015). I agree with the philosophy of the Tibetan culture

that desires with attachments cause stress and finding inner peace and connection to a higher self

through meditation and self-reflection leads to greater happiness and fulfillment of one’s full

potential.

Along with Tibetan philosophy many other theories have been discussed to try to give an

explanation to the mind and stress. A common area for theories includes an area of balance and high

level understanding, self-actualization or self-awareness. Many theories explain why stress is a part of

life and that there is an imbalance, for example between ego and identity as Freud outlined (Seaward,

2015). I think these theories all have a similarity to Tibetan philosophy of stress being caused by

desire for attachment instead of the desire to do good and be happy. Self-actualization or self-

awareness relate to a complete understanding of one’s self without judgement or jealousy interference

from the ego. Maslow also support the theory of self-actualization as a sense of inner peace and self-

understanding (Seaward, 2015).

The Seaward text defines emotional well-being as the ability to feel and express emotions,

while being in control of them, not controlled by them (Seaward, 2015). Fear is one of those emotions

that should be controlled, and not be in control of the individual or group. Fear is a complex emotion

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and could also be embarrassment, prejudice, anxiety, despair, worry, arrogance, doubt, intimidation or

paranoia (Seaward, 2015). Fear is a necessary emotion is some cases but uncontrolled fear can have

negative effects on the body and immune system. When it comes to resolving or coping with fears it

is a common understanding that fear much be confronted at some level (Seaward, 2015). One way to

cope with or resolve fear is through behavioral therapy. Behavioral therapy is explained as, “where

the individual engages in coping and relaxation techniques to desensitize himself or herself to the

stressor (Seaward, 2015).” Confronting a fear can be a difficult task but in the end the control of fear

will help to establish optimal well-being.

Along with controlling emotions, communication and healthy relationships are important to

establish optimal well-being. Five ways that I can improve my communication style include;

awareness of my nonverbal communication, giving my full attention when listening, avoid becoming

defensive when confronted, avoid information overload and finally, addressing and resolving issues as

they come up (Seaward, 2015). Reflecting on areas that are in need of improvement for my

communication style I first think of my nonverbal messages. At times I am not aware of the nonverbal

messages I am sending until someone mentions to me what I am saying through my nonverbal

communication. This is an area that I need to have a better control over so that I do not send the

wrong nonverbal messages without realizing it. I also need to improve on being an active listening

and allowing the other person a chance to communicate before I begin thinking about what I will

respond or what I want to get across. This also related to the area I need to improve of not becoming

defensive and shutting down in a confrontation. The last two areas of communication that I can

improve are related in my situation because I have found that when I do not address a problem as it

comes up, then decide to discuss it later with many other issues it is too much information and the

other person involved becomes overwhelmed by amount of information. It is better to address one

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issue at a time in order to allow all persons involved to share their thoughts and feelings without being

overcome by the amount of information given when multiple issued are addressed at one time after

the time of the initial problem. These improvements to my communication styles will promote healthy

relationships and overall optimal well-being for myself and others I communicate with.

Journal Writing:Complete the Journal Assignment entitled: Five-Minute Mindful Breathing and

Bringing the Eight Attitudes of Mindfulness into Your Life. Directions are found on pages 45

and 46 of the Mindfulness workbook. Upon completion of this Assignment, you will begin to

understand the importance of making them a part of your daily life. See what changes occur in

relationships with yourself and others around you. This should be a minimum of one full page.

Take some time to write about whatever you came up for you mentally, emotionally, and physically

when doing this practice for the first time.

When completing this practice of five-minute mindful breathing I was able to focus on the rise

and fall of my chest and shoulders with each breath. With this focus on my breathing I felt as if my

mind was cleared for a short time and I was relaxed and then new thoughts would appear in my mind,

such as, “how much time do I have before I need to get ready for work? What will I make for

breakfast?” and I let these thoughts come and go as I refocused my attention to my breath and felt

relaxed again. When I was focused on my breathing I also noticed some tension in my shoulders and

this was a clue for me to relax my shoulders as I breath and this relaxed the tension I had been feeling

in my shoulders. Since the first time practicing the five-minute mindful breathing I have tried to

incorporate it into my daily life. I have noticed it is very helpful when I am in the car and in traffic,

instead of getting frustrated with the traffic I am able to focus on my breathing relax tensed muscled

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and just breath. I have also found this to be helpful with my personal relationships and myself. I am

able to relax through the focus on breathing and instead of acting out of anger or cowering in fear I

can clear my mind with the five-minute practice of focusing on my breath and acknowledge that I

have done myself a favor by taking the time to meditate.

I also have tried to incorporate the eight attitudes of mindfulness into my life and for me this

practice is more difficult. I know that one area I can improve is self-compassion, I need to tell myself

that I am doing my best effort instead of keying in on mistakes or what I could have done better.

When I do practice self-compassion I feel a sense of pride and accomplishment even if it is a small

task of doing the dishes, I have accomplished something and feel good about it. I have also found the

practice of being in the present moment to be beneficial to my professional and personal relationships,

especially taking the time to carefully listen to others instead of being distracted with what I have to

do next.

Making the changes of being more aware in the present moment and relaxing has shown to be

helpful. It is a goal of mine to continue with these practices and also share this information with

others. I especially like the five-minute mindful breathing and think that it is a practice that everyone I

know could benefit from. Taking the time to bring myself away from the stress of daily life and relax

while being aware of my thoughts and feelings allows me to better understand myself and manage the

stress I experience.

(Stahl & Goldstein, 2010).

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Unit 4: Personality Traits and the Human Spirituality

Information to Remember:Key Learning Point: High self-esteem is associated with a stress resistance personality, meaning someone

with a high self-esteem is better able to handle stress and avoid negative effects of stress. Low self-esteem is linked to chronic stress and negative health effects. A preventative measure to negative health effects related to stress is building self-esteem (Seaward, 2015).

Key Learning Point: Spirituality has many definitions and involves a connection to something greater than one’s self. Spiritual well-being is important for overall health and stress management. Three areas that promote spiritual well-being include, a meaningful purpose in life, strong personal values and meaningful relationships (Seaward, 2015).

Key Learning Point: Body scan is a practice that is beneficial when dealing with stress. This practice brings awareness inward to the body allowing the individual to understand feelings and emotions in different parts of the body (Stahl & Goldstein, 2010).

Self-Assessment Exercise:1. Describe self-esteem and explain what role it plays in promoting and resolving stress.2. Explain how relationships, values, and meaningful purpose in life are affected by stress.3. Explain your perspective on the differences between values, attitudes, and beliefs.4. Take one lifestyle activity [e.g., exercise, smoking] through Prochaska’s Stages of Change Model.

Self-esteem is related to one’s personal confidence in themselves and how they view their

worth. Self-esteem is described as including self-value, self-love and self-acceptance (Seaward,

2015). When an individual has a negative view of themselves or sees little value in themselves they

may have low self-esteem. Self-esteem is important regarding stress and studies have shown benefits

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of high self-esteem in regard to resolving stress and low self-esteem related to promoting stress.

Different personality types have been described that relate to these differences in self-esteem levels. A

hardy personality is described as a stress-resistant personality and these individuals are known to also

have a higher self-esteem, while a codependent personality is more prone to stress and related to low

self-esteem (Seaward, 2015.) These correlations with self-esteem and stress were also discussed in an

article about a study conducted on college students. The article describes the finding of the study as,

“Students who feel negatively about themselves may not have the confidence to approach demands

and, consequently, prefer avoidance as a coping strategy. On the other hand, people with high self-

esteem are more likely to feel capable of handling stressful events and feel less threatened by them

and utilize adaptive coping strategies (Eisebarth,2012).” There are many factors to consider when

measuring one’s self-esteem as it relates to stress but studies are showing and promoting raising of

self-esteem as a preventative measure to the negative effects of stress prone personalities.

Like self-esteem, relationships, values and meaningful purpose in life are also affected by and

affect stress. These three components, relationships, values and meaningful purpose in life, are

important aspects of one’s spiritual well-being which has an effect on overall well-being. When an

individual does not experience nurturing relationships, strong value systems and a meaningful

purpose in life they are lacking in spiritual health and this then affects the big picture of overall health

and wellness. Kubler-Ross described the importance of balance and harmony of four different areas of

well-being, mental, physical, emotional and spiritual. Where a balance and harmony of these four

areas of well-being leads to optimal health (Seaward, 2013). If one’s spiritual well-being is ignored

optimal health cannot be achieved and stress is increased.

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In my perspective attitudes, values and beliefs are all different and play a different role in

personal well-being. Strong value systems refer to what the individual views to be of importance and

have strong ties to the individual. Examples of values include, love, freedom and family. Attitude is

the opinion that the individual makes about values. Seaward’s Managing Stress text describes,

“negative attitudes are associated with perceived stress (Seaward, 2015).” Beliefs are what the

individual thinks to be true. An example of a personal belief related to attitudes and values is my

belief that every individual has a right to life. This belief relates to my value of freedom and my

attitude toward life as being positive and life is precious.

Prochaska’s Stages of Change Model describes 6 stages for behavior modification, while

working on modifying the behavior the individual may relapse to previous stages. These stages

include precontemplation stage, contemplative stage, determination stage, action stage, maintenance

stage, and relapse stage (Seaward, 2015). When relating these stages to the behavior modification of

stopping smoking the first stage, precontemplation stage would involve a denial of the need to stop

smoking. The second stage, contemplative stage would involve the individual recognizing the need to

make a change and begin thinking of stopping smoking. Next, the action stage is when the individual

takes steps toward stopping smoking, an example would be going to hypnotherapy. The next stage is

the maintenance stage when the individual makes the change of no longer smoking part of their

regular routine. Finally, the relapse stage is where the individual returns to smoking until they return

to the behavior change of quitting smoking.

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Journal Writing:Complete the Journal Assignment entitled: Explore: Identifying Emotions in the Body.

Directions are found on pages 74 through 77 of the Mindfulness workbook. Upon completion of this

Assignment, practice taking a moment to mindfully tune in to your body and discover any physical

sensations associated with strong emotions. This should be a minimum of three full pages.

FEAR: apprehension, anxiety, distress, edginess, jumpiness, nervousness, panic, tenseness,

uneasiness, worry, fright, feeling overwhelmed.

In this group of words associated with fear, anxiety, jumpiness, nervousness, worry and

feeling overwhelmed are the emotions that seem more familiar to me. When I think of these emotions

I think of my palms sweating, my heart rate increasing and my chest and shoulders tightening. I have

also noticed that when I am worried or feeling anxious I fidget, one disgusting habit that I have

stopped is biting my fingernails when I am nervous or anxious. While I have stopped that habit I do

still either tap my foot, shake my leg or crack my knuckles. When I read these emotions I feel myself

becoming tense through my chest and shoulders. The images that come to mind when I read these

words are of traumatic experiences. I was very worried and anxious when my sister had to have

emergency surgery last year and I was sitting in the waiting room with my dad and my brother-in-law.

While we were waiting I remember in my fear and nervousness I just wanted to sit quietly but the way

my dad dealt with his nervousness was to talk. My dad is usually pretty quiet so knowing that he was

nervous because he could not stop talking made me feel uneasy but none of us would talk about our

fears in that moment. Thankfully my sister had a successful surgery and recovery but I remember

feeling drained from worrying and thinking of what could have happened.

CONFUSION: bewildered, uncertain, puzzled, mystified, perplexed, chaotic, foggy, or unaware.

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Uncertain, puzzled, foggy and unaware are the words from this group that are more familiar to

me. When I think of these emotions I visualize a cloud over my head that is blocking my brain from

understanding the information. I feel these emotions as tension in my head, face and neck. I have been

told that when I am confused I make facial expressions that I am not always aware of so I am trying to

keep this in mind and monitor my facial expressions. I was out to breakfast last week and the group at

the table behind me was having a conversation that I could overhear and as I was thinking, “that does

not make any sense, what do they mean?” my 12-year-old family member that I was with said to me

“why are your eyebrows scrunched up?” I had not noticed that my facial expression had changed as I

was listening to the other conversation but it did and was brought to my attention.

ANGER: aggravation, agitation, annoyance, destructiveness, disgust, envy, frustration, irritation,

grouchiness, grumpiness, rage.

Annoyance, frustration, irritation, grouchiness, and grumpiness are the emotions associated

with anger that I am more familiar with. I notice these emotions in my body as the temperature of my

face increases, tension in my shoulders, chest and arms as I ball my hands into fists. My breathing is

another area that I think of with these emotions because I may hold my breath when feeling angry or

frustrated. I also notice clenching my teeth my I experience these emotions associated with anger.

When I think of grouchiness, grumpiness, frustration and irritation I think of having very little

patience and visualize a cartoon bomb with a very short fuse that could go off quickly. I also notice

when I do not get an adequate amount of sleep I am grouchier, grumpy and irritable. In this situation I

try to remind myself to breath, relax my jaw and shoulders to decrease tension. When I am feeling

frustrated I may wake up and have to remind myself to unclench my teeth.

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SADNESS: alienation, anguish, despair, disappointment, gloom, grief, hopelessness, insecurity,

loneliness, misery, unhappiness, rejection.

Disappointment, grief, insecurity, loneliness and unhappiness are emotions associated with

sadness that I am familiar with. These emotions manifest in my chest and instead of feeling tense I

feel my shoulders and chest drop as if my muscles are atrophied. I visualize someone with their head

hanging low without anyone around them. I also think of the physical act of crying when I read these

emotions. Similar to feeling drained due to emotions of fear, emotions of sadness and crying leave me

feeling drained and tired. I recently had a close friend lose her father and his death was sudden and

my heart felt as if it was breaking thinking of the friend and her family and these emotions of sadness

left me with little energy or motivation to complete daily tasks.

SHAME: guilt, embarrassment, humiliation, invalidation, regret, remorse, mortification.

Guilt, embarrassment, and humiliation are emotions associated with shame that I am most

familiar with. When I read these emotions I visualize my face becoming red in embarrassment. This

physical response of my face becoming red to shame emotions is something that I have found very

interesting because at times it seems to be out of my control. Similar to physical response to fear, with

these emotions associated with shame I also notice increased sweating, especially sweating of my

palms. At times I notice that I can overthink a situation of something that I said or did and feel

embarrassed by it and wish I could take that embarrassing situation back but I have to remind myself

that it is not a big deal and move on.

LOVE: affection, arousal, attraction, caring, compassion, desire, fondness, infatuation, kindness,

liking, longing, warmth, sympathy, sentimentality.

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Affection, attraction, caring, compassion, kindness and warmth are emotions associated with

love that I am familiar with. When I read these terms I visualize my family and the action of giving a

hug or holding a hand. When I think of these emotions I think of them manifesting around my heart

but instead of being heavy or my chest feeling tight it is a full feeling. I think of physical contact and

in my family we hug a lot. I also think of kindness, caring, and compassion with working with my

patients in physical therapy. I have seen where a caring handshake or hug can bring a sense of

healing.

JOY: amusement, bliss, contentment, eagerness, elation, enjoyment, enthusiasm, excitement,

exhilaration, hope, optimism, pleasure, satisfaction.

Eagerness, enjoyment, excitement, hope, optimism, and pleasure are emotions associated with

joy that I am familiar with. When I read these terms I visualize smiling faces, clapping and

celebration. I feel these emotions throughout my entire body, it feels as if a warming sensation is sent

from my head to the tips of my fingers and toes. Another physical response to these emotions is an

increase of heart rate but it is different from the increased heart rate associated with fear or anger,

with feeling of joy my chest does not feel tense. I noticed these feelings last week when my brother

graduated from high school. He is the youngest in my family and 7 years younger than I am so

thinking of him reaching this milestone in his life was very exciting and joyful.

Summary

When looking closely at these different emotions and how I physically respond to these

emotions there are some differences and some similarities. I think it is important for me to be more

aware of the physical responses that correlate to different emotions and how to manage these

26

emotions. When I am able to understand my emotions and control them I believe I will be better able

to manage stress in my life.

(Stahl & Goldstein, 2010).

Unit 5: Dealing with Stress: Coping Strategies Information to Remember:

Key Learning Point: Stimuli to the brain is either perceived as negative, positive or neutral. Research shows that negative/toxic thought can suppress the immune system. Pessimism, blaming and self-victimizing are examples of toxic thoughts (Seaward, 2015).

Key Learning Point: Borysenko explains reframing as a way of changing negative thoughts. In reframing a stressful situation is looked at in a positive light. When a positive light does not seem possible acceptance is suggested, going with what you cannot control (Seaward, 2015).

Key Learning Point: Awareness, reappraisal of a situation, adoption of a new frame of mind, and evaluation of the new frame of mind are the four steps recommended when reconstructing negative thoughts. Cognitive restructuring also includes meditation, taking responsibility, positive affirmation, seeing the positive in stressful situations (Seaward, 2015).

Journal Writing:Choose from either formal practice: Walking Meditation or Mindful Self-Inquiry for Stress and

Anxiety. Directions are found on either pages 58 through 60 or 119 through 121 of the Mindfulness

workbook. Upon completion of either practice, take a moment to reflect on whatever came up for you

mentally, emotionally, and physically. This should be a minimum of two full pages.

Unit

5

27

Take some time to write about whatever came up for you mentally, emotionally and physically when

doing this practice for the first time.

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For my unit five journal I decided to write about my reflection for the Mindful Self-Inquiry for

Stress and Anxiety. I very much enjoy using the audio CD that is provided with the textbook because

it leads me through the meditation without having to read through the text. Although, the first thing

that I noticed when I began the Mindful Self-Inquiry for Stress and Anxiety was the amount of time

that was set for this track, which is around 30 minutes. I remember thinking initially, “will I be able to

sit for this long without getting distracted? How will I keep my mind in the present instead of all the

other things I need to do today?” But I found the audio guidance to be very helpful and when my

mind did start to drift off the audio gave a gentle reminder to either focus on breathing, focus on a

body part or acknowledge the thought and “let it be (Stahl & Goldstein, 2010).”

The cueing was important to me mentally because it did not make me feel like I was failing

the task by thinking of others things but must be normal, which is why the reminders come up often.

At times it was difficult for me to be mentally present in the moment of the meditation and but at

other times I was able to acknowledge the thoughts as they came and then move on. I would say that

at the beginning of the meditation I was mentally overthinking and over analyzing the process. But

through the breathing exercise and body scan I was able to clear my mind and be in the present

moment and relax mentally.

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By the end of the practice I also felt that I was able to relax emotionally and physically even

though I did not begin right away relaxed. Emotionally, I felt overwhelmed before beginning the

practice but by the end of the practice those emotions were replaced with peace and relaxation. I enjoy

that the practice begins with taking time to congratulate yourself for participating in the practice. This

congratulation to myself made me emotionally invested in the practice because I felt that it would be

of benefit to me even though I wasn’t sure yet exactly what I would get out of it. The emotional

benefit of relaxation and calmness is a success and can benefit individuals coping with stress and

anxiety.

As I worked with the audio through the breathing exercise as part of this practice I physically

felt my chest and stomach rise and fall with the inhale and exhale of my breath. I also felt comfortable

in a seated position throughout the practice which I was unsure about. During the body scan as the

audio directed me to focus my attention on different parts of my body I was able to notice tension,

acknowledge it and relax those areas. The areas that I noticed the most tension was my back and my

shoulders and through the practice I noticed that the tension was reduced by the end. I enjoyed that

there was a pause between changing from one body part to the other and that allowed me time to

physically acknowledge that specific body part and how it felt at that specific moment.

Overall I feel that this practice is very beneficial in reducing stress and anxiety by making you

personally aware of your thoughts and feelings without negative judgement, just simply

acknowledging. I would recommend this practice to others to help manage stress and anxiety. I would

also suggest to them the use of the guided audio CD, so that they can do the practice in a private

setting where they feel comfortable. I remember participating in yoga classes where the instructor

guided the class in a type of body scan similar to what was part of this practice, but I personally feel

that I was more comfortable in a private setting versus a group/class setting for better relaxation and

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mindfulness. I may feel more comfortable in a class or group setting after more practice but for now I

will practice in a private setting which is most comfortable for me. I think that each individual should

find where they are most comfortable and that will provide the best setting for them. I very much

enjoyed this practice of Mindful Self-Inquiry for Stress and Anxiety, as well as the practice of Walking

Meditation.

(Stahl & Goldstein, 2010).

Unit 6: Relaxation Techniques 1: Breathing, Meditation, and Mental Imagery Information to Remember:

Key Learning Point: The American Heart Association recommends meditation. It has been found that meditation reduces stress and therefore reduces risks of heart disease (Seaward, 2015).

Key Learning Point: Regular meditation has positive physiological results. Including, decreased resting heart rate, decreased resting blood pressure, and decreased ventilation (Seaward, 2015).

Key Learning Point: Mental imagery has been used for many years as a way to calm and heal the body, mind and soul. There are three types of mental imagery; tranquil natural scenes, body imagery, and behavioral change (Seaward, 2015).

Self-Assessment Exercise:1. Why is diaphragmatic breathing thought to be an effective relaxation technique?2. What three steps are important to engage in this technique?

Unit

6

31

3. What effects does meditation have on the mind and the body?4. List three ways that imagery and visualization can be useful for relaxation. Explain why.

Diaphragmatic breathing is defined by Seaward as, “the most basic relaxation technique;

breathing from the lower stomach or diaphragm rather than the thoracic area (Seaward, 2015).” This

technique draws the attention and mindfulness to the act of breathing. This technique can be done

anywhere because breathing is a normal action that is necessary to survival and which is normally

done automatically and without much thought. Bringing attention to the breath and expanding

breathing to the diaphragm instead of just the thoracic area allows for a deeper breath and relaxation.

According to Seaward, diaphragmatic breathing is thought to be an effective relaxation technique

because, “when the emphasis of breathing is centered in the lower abdomen rather than the thoracic

cavity, a less sympathetic neural activity is generated, causing a greater relaxation effect (Seaward,

2015).” The technique is known as a simple technique and is often used in combination with other

relaxation techniques.

Using this technique of diaphragmatic breathing is known as a relatively simple task and

includes three important steps. The first step for initiating diaphragmatic breathing is finding a

comfortable position. Seaward describes sitting or lying down with eyes closed and a hand over your

stomach to feel the movement as you learn this relaxation technique (Seaward, 2015). When one is

familiar and comfortable with this technique it can be done anywhere. The next step for

diaphragmatic breathing is focused concentration with an effort to minimize external interruptions.

This concentration can include a focus on filling the upper, middle and lower lobes of the lungs with

air and expelling the air from the lungs (Seaward, 2015). The third step in diaphragmatic breathing is

visualization. Seaward describes two common visualization exercises. The first image is breathing

32

clouds, visualizing the air being inhaled as clean, fresh, healing air and the air being exhaled as dirty,

darky smoke leaving the body (Seaward, 2015). The second image is alternate nostril breathing and

requires more practice than the first image. This practice involves focusing your attention on

breathing and visualizing inhaling through only the right nostril and exhaling through only the left

nostril (Seaward, 2015).

Many studies have been conducted and continued research will be conducted to explore the

effects of meditation on the mind and body. Seaward lists the known physiological changes from

regular meditation practice. These physiological changes are, “decreased oxygen consumption,

decreased blood lactate levels, increased skin resistance, decreased heart rate, decreased blood

pressure, decreased muscle tension and increased alpha waves (Seaward, 2015).” Psychological

effects of meditation include, improved mental health, decreased anxiety and “greater sense of general

well-being or inner peace (Seaward, 2015).” These effects of meditation have been shown through

studies to be beneficial to overall health (mind, body and spirit).

Seaward lists three ways imagery and visualization can be useful for relaxation. The first way

is tranquil natural scenes, this is explained as “individuals mentally place themselves in the peaceful

and relaxing scenes (Seaward, 2015).” Examples of this include ocean beach, mountain view or

garden scenery. Seaward also explains why this is effective relaxation technique, “Once introduced to

this technique, participants who repeatedly engage in the practice of visualization find that, like

actually being at a vacation site, the re-creation of these settings provides an equal if not more

profound sense of relaxation (Seaward, 2015).” The next way visualization and imagery can be useful

for relaxation is behavioral changes, examples include; quitting smoking or weight loss. Systematic

desensitization is a type of mental imagery where the individual uses imagination to “build up a

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tolerance to a stressor through progressive exposure (Seaward, 2015).” Seaward also describes in the

text that visualization can improve the behavioral change of boosting or maintaining high self-esteem

which is important to overcome stressful situations. The third way imagery and visualization can be

useful for relaxation is internal body images. Seaward describes this as “direct changes in

physiological functions by using imagination to see a particular body region in a healthy state

(Seaward, 2015).” This promotes relaxation by focusing positive attention instead of stress to the

body. These are ways that imagery and visualization can be useful for relaxation.

Journal Writing:Complete the Journal Assignment entitled: Explore: Is Your Body-Mind Happy? Directions are found

on pages 151 through 153 of the Mindfulness workbook. Upon completion of this Assignment,

practice identifying unkind messages you send to yourself and turn it around with positive

affirmations. This should be a minimum of two full pages.

34

Mindful of how you interact with yourself?

It is often said that we are our own worst critic and I can relate to that myself. I am working on

improving the way I think about myself and the messages that I send to myself. When I reflect on the

ways I think throughout the day I notice unkind messages to myself. I may think to myself, “I am fat.”

“I can’t do anything right.” “I am not smart enough.” These are things that I would not say to other

people and would not want someone to say to me, but I send these messages to myself, sometimes

without understanding how it affects me. When reflecting on these unkind messages, I have found

that I physically feel tense and tired when I communicate unkind messages to myself. Emotionally, it

is a feeling of defeat and wanting to give up because I am telling myself that I am not worth it or

cannot do it. I also found that these messages do increase stress and anxiety which is caused by my

negative thinking and negative communication with myself. These are things that I can change and

improve in order to decrease stress and anxiety.

Seeds of suffering?

Aspects of my life could change if I stopped sending unkind messages to myself. One area that

would improve would be self-confidence and self-esteem. When I am able to replace unkind

messages with positive messages, I feel encouraged, empowered and more successful which decreases

overall stress and anxiety. Decreasing or eliminating self-inflicted stress and anxiety would also

improve my overall health.

Day-to-day life feelings of resentment?

35

Feelings of resentment or holding a grudge against someone can make communication more

difficult and more stressful because one is anticipating a problem before it even occurs based on

previous experiences. This can change the way one communicates, maybe defensively or hostilely

which can lead to more challenges and misunderstandings. Facing an individual without judgment or

with an open heart can improve communication because one would be more understanding and open

to listen to the other individual. It is also important to keep in mind that the personal may have acted

unkindly due to other private or personal problems that are unknown to you. Treating an unkind

individual with unkindness usually does not provide a solution but treating an unkind person with

compassion and respect can open new doors for communication and success. I would want someone

to show compassion and forgive me if I was having a bad day and acted unkindly.

Reflection on writing?

We are in control of the messages that we send to ourselves and instead of over criticizing we

will have less stress, be more successful, have better health if we replace negative messages with

positive messages. For example, instead of saying to myself, “I am not smart enough to multi-task.” I

can tell myself, “I am dedicated to completing one job with quality before I move on to the next job.”

Also, instead of telling myself, “I can’t complete a task.” I can acknowledge that I am trying my best

and that is what is most important. Instead of saying to myself “I am fat.” I can send a positive

message to myself, “I am working to improve my health and that is more important than what number

is on the scale.” These positive thoughts to replace unkind messages encourage me and motivate me

to succeed where unkind messages exhaust me and increase stress and anxiety. It is important to keep

in mind that we have flaws but can work to improve them and when we do our best we are successful.

It is also important to remember that others have flaws and if they are unkind they may be suffering

from other problems that you do not know about. Approaching an unkind person with an open mind

36

and compassion may be the response that they need to help cope with other problems in their life.

Encouraging yourself and encouraging others can decrease stress and promote health and success.

(Stahl & Goldstein, 2010).

Unit 7: Nutrition and Stress Information to Remember:

Key Learning Point: Changing eating habits shows benefit to managing stress. Eliminating caffeine, refined sugar, fats, and sodium reduce the risk of stress related health problems (Seaward, 2015).

Key Learning Point: A malnourished diet causes stress to the body. It is important to consume the needed vitamins and minerals and supplements can be helpful to adequately supply the body. Research the supplements to be sure processing does not get rid of what you need and overconsumption of supplements is harmful to the body (Seaward, 2015).

Key Learning Point: Spiritual nutrition involves a balance of all foods, including a balance of acids and bases. Spiritual nutrition also promotes eating a variety of fruits, vegetables, and grain that support health of the 7 primary chakras (Seaward, 2015).

Self-Assessment Exercise:For the assignment this unit I decided to describe my experience with “Mindful Lying Yoga”

from the Stahl and Goldstein text, A Mindfulness-Based Stress Reduction Workbook. The text gives an

enlightening description of yoga and the development of yoga from meditators watching animals

stretch and mimicking these stretches which increased the flexibility and strength of the meditators. I

have can relate to the difficulty and aches and pains they experienced after prolonged sitting, as well

at the benefits of stretches. The text also describes benefits of yoga, stating, “in Sanskrit, yoga means

Unit

7

37

‘to yoke,’ in this case bringing together the body and mind. And not only is yoga an excellent way to

bring mindfulness to the body in movement, it’s also a rejuvenating practice that offers many other

health benefits, such as keeping aging bones, joints, muscles, nerves, and organs healthy, supple and

flexible (Stahl & Goldstein, 2010).”

I was most interested in this practice because many of the stretches I do or instruct patients in

physical therapy to perform but I do not often focus of mindfulness while I perform these same or

similar stretches. I also like that the text specifically acknowledges the need for caution as

“everyone’s body is different.” This allowed me to limit my critic and judgement of myself as I

performed the practice. I began with reviewing the images in the text then following along while

listening to the 45-minute audio. At first it was difficult for me to focus on my breathing and become

mindful as I am in the habit of just going through the stretch without being mindful but the audio was

helpful in reminding me to be mindful of my breathing and what I was feeling at the time.

The first postures of the supine pose and supine full body stretch are not painful but also are

not the most comfortable positions for my low back as I noticed a gap between my back and the floor.

But the next of supine twist relieved low back discomfort and allowed for me to relax more

completely without the distraction of discomfort. During the supine twist I also noticed a comfortable

stretch in my neck with looking to the opposite side of my knees. The leg stretch and single knee to

chest stretches were also very comfortable and relaxing where I was able to be mindful of the stretch

and of my breath. I enjoyed the length of time for each stretch in the 45-minute session as I felt I was

able to calm my emotions and be present in the stretch. Tension in my low back released as I worked

through the different yoga poses and with the release of muscles tension I also felt as if an emotional

tension had released. During the pelvic rock and tilt I noticed I needed to remind myself to breath

fully instead of taking shallow breaths or even holding my breath. Next the bridge stretch was a little

38

more work as I felt my heart rate increase a little as I exerted more energy to lift my hips and low

back off of the ground but I did not feel fatigued with this pose, I felt energized and encouraged to

continue with the practice. I was able to acknowledge the benefit of the exercise instead of judging

my strength. During the leg side stretch I noticed different muscles working and stretching, as I felt

the outer hip working to lift my leg and the inner thighs stretch. Of all the poses I felt most relaxed

and mindful during the prone leg stretch, modified cobra, full cobra and child’s pose stretches. I was

able best feel I had cleared my mind of other distractions and focused on my breathing and feeling of

muscle and mental relaxation as I held each stretch. Cow pose and cat pose on all 4’s required more

thought to engage breathing with the motion, and similar to that was the bird dog pose which required

focus to balance. The final poses of corpse pose and pose of openness allowed for self-reflection and

being present.

At the end of the practice I felt relaxed and rejuvenated at the same time. I also felt that this

practice was a benefit to the rest of my day and I was better able to handle stressful situations. I will

continue with this practice of mindfulness with yoga poses and stretches. I will also incorporate

mindfulness when instructing patients for stretches so that they benefit from not only the physical but

also the emotional and mental benefits.

(Stahl & Goldstein, 2010).

39

Unit 8: Physical Exercise and Activity

Information to Remember:Key Learning Point: Yoga works on the union of the mind, body, and spirit with meditation. Hatha yoga

is the most common type of yoga in the US and promotes physical balance. Hatha yoga has been found to improve flexibility, decrease back pain, improve muscle tone and promote inner calmness (Seaward, 2015).

Key Learning Point: T’ai Chi is also called moving meditation, and is thought to help balance the flow of energy. The goal of the exercise and movements are to move with the flow of energy instead of against it. The has been shown as an effective relaxation technique (Seaward, 2015).

Key Learning Point: Physical exercise shows benefits for managing stress but frequency, intensity, duration and mode of exercise must be appropriate to the needs of the individual. Physical benefits of regular exercise can begin to be seen after 6 to 8 weeks. Exercise also shows mental benefits of increase self-esteem and decreased depression (Seaward, 2015).

Self-Assessment Exercises:Proposal for Health and Wellness Management

July 2016

This proposal is prepared for health and wellness management. The scope of the project outlined includes vendors of national evidence-based products and services. To meet these needs, this proposal offers consulting services to provide the following expertise: (a) rationale; (b) mind-body programs or practices; (c) capital outlay; and (d) benefits.

RATIONALEThe purpose of this program is to provide the hospital staff with resources for stress

management and stress reduction. This will allow for the staff to manage stress, reduce risk of burnout

and improve health. The purpose of this program is to also be a preventive measure against illness and

chronic disease for the hospital staff.

Unit

8

40

MINDBODY PROGRAMS/PRACTICESAudio guided meditation and mindfulness

Exercise classes (staff will be able to vote for what classes they would like to participate in:

Zumba, Yoga, Pilates, Tai Chi) along with access to exercise at the hospital gym

Walking groups

CAPITAL OUTLAYFor meditation and mindfulness, a room or area in the hospital is needed where the staff can sit

or lay comfortably. A CD player, CDs and pillows are also needed for the audio guided meditation

and mindfulness area of the hospital. Only maintenance will be required for the gym equipment since

it is already established in the hospital, and employees will be able to designate time in their work

week to use gym equipment or participate in exercise class or walking groups.

BENEFITSThe staff will benefit from opportunities to participate in exercise programs, meditation and

mindfulness practices in order to manage stress and avoid burnout. The text from Seaward describes

the benefits of physical exercise as including decreased depression and anxiety as well as, “decreased

resting heart rate, decreased resting blood pressure, decrease muscle tension, better quality sleep,

increased resistance to colds and illness, decreased cholesterol and triglyceride levels, decreased body

fat, improved body composition, increased efficiency of heart, decreased done demineralization,

decreased rate of aging, and increased tolerance of heat and cold through acclimatization (Seaward,

2015).” Providing the staff with tools to manage their stress and avoid burnout will provide many

benefits to the hospital. These benefits include, more productive staff, less sick days, longer employee

tenure, and less health insurance cost. These benefits will help the hospital to save money as well as

financially support this wellness program.

TIMELINE

41

The startup time for this program will be 3 months, first beginning with surveys of what the

staff would like to see in the program and then making changes to allow for space for the program and

hiring instructors and staff to maintain the program. The length of the program will be ongoing, with

continuous adjustments and changes made as needed.

PERSONNELExercise instructors will be needed for the group exercise classes.

Participation from management will also be needed for revisions to the program as well as tracking

requirements of staff for meeting incentives.

TOTAL BUDGETThe program will be supported financially by the hospital with an initial cost of $300 to set up

a meditation/mindfulness area in the hospital as well as survey the staff for what they would like to

see as part of the program. Following the setup of the program, a monthly cost of $800 to pay for

exercise class instructors.

PITCHMy health and wellness management program proposal is designed for the staff of Calvert

Memorial Hospital. It is well-known that the job of a healthcare worker involves high stress and at

times even burnout, that is why this program of is needed. The staff will benefit from opportunities to

participate in exercise programs, meditation and mindfulness practices in order to manage stress and

avoid burnout. Providing the staff with tools to manage their stress and avoid burnout will provide

many benefits to the hospital. These benefits include, more productive staff, less sick days, longer

employee tenure, and less health insurance cost. The staff will also be motivated to participate in the

program because management staff will actively participate and provide incentives to those who

utilize the gym or exercise class 2 days a week and/or meditation area 2 days a week.

42

The exercise programs will include free access to the hospital gym, walking groups, and free

group exercise classes (Zumba, yoga, Pilates, and tai chi). There will be no cost for walking groups or

the gym because the is already established at the hospital. The cost for the exercise programs will

include payment to an instructor to come to the hospital and teach classes 6 days a week, estimated

cost for group fitness classes $200 a week. These classes will depend upon voting from staff and will

require a signing up a day in advance.

Meditation and mindfulness practices will be established by providing a peaceful area with

mindfulness and meditation audio. For this a CD player and CDs will be needed, estimating a cost of

$250 (including setting up a “meditation area/room” and CD player and CDs.

The startup time for this program will be 3 months, first beginning with surveys of what the

staff would like to see in the program and then making changes to allow for space for the program and

hiring instructors and staff to maintain the program. The length of the program will be ongoing, with

continuous adjustments and changes made as needed.

CLASSMATE FEEDBACK“Hi Jennifer,

I really like your proposal, it is very well thought out.  I like the idea of surveying the employees, after all it is a program

for them so they should be offered things they are interested in.  The cost of the programs, $200 and $250, would the

hospital be picking up the cost or would employees be asked to pay a small fee to participate? I am figuring that because

so much of the everyday work is done in shifts, that this would have to be done on their own time or would there be

informational programs scheduled maybe during different lunch times? Will incentives be offered? Things like

pedometers, water bottles, etc. One thought I had since so many employees are almost constantly on their feet is

something called NEAT, non-exercise activity thermogenesis.  It is the energy we use for everything but sleeping. Having

a program that introduces that concept to nurses and technicians who are always on the move might get them motivated by

showing to them that they do get exercise throughout the day. 

43

Best of luck on your paper, you are off to a great start with your proposal.

Paula”

SUMMARY The health and wellness program for the hospital will be beneficial to all parties. The staff will

be motivated to participate in order to receive incentives and decrease stress. The hospital will receive

a return on their investment in the program through quality of work, decrease healthcare costs, less

sick employees and longer tenure of employees leading to less time needed to train new employees.

I found it beneficial to work with a partner for advice on the proposal for this assignment. I

was able to review her proposal for a health and wellness program which gave suggestions similar to

a program she was a part of and found successful before. This was helpful because it provided real

would experience that she was able to share.

(Seaward, 2015).

Journal Writing:Complete the Journal Assignment entitled: Explore: Creating Connection. Directions are found on

pages 161 through 163 of the Mindfulness workbook. Upon completion of this Assignment, practice

developing these qualities in building stronger and healthier relationships.

This should be a minimum of one full page.

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Healthy and meaningful relationships are important for overall optimal health and well-being.

Taking the time to learn about qualities of interpersonal mindfulness will benefit not only your

relationships but also your overall health. Openness, empathy, compassion, loving-kindness,

sympathetic joy and equanimity are 6 qualities that the text, A mindful-based stress reduction

workbook, identifies as essential to for interpersonal mindfulness and improving relationships (Stahl

& Goldstein, 2010). For the “Creating Connection” practice I imagined the relationship with my mom

as I reread the descriptions for each quality.

OPENNESS: Reading about the quality of openness and relating it to a relationship with my mom

bought to mind times that I had become defensive in communication and built barriers. As I read

about openness I was able to visualize what I could have done differently, including trying to see her

perspective as equal importance to my perspective. I like the suggested imagery of visualizing your

initial judgement as just a small piece of the pie chart.

EMPATHY: When reading about the quality of empathy it brought to mind feeling of empathy for

my mom that I recall last Christmas. Her parents both passed away over 20 years ago and last

Christmas was the first time I put myself in her shoes as to how she must feel during this time of year

without them. I first thought how I would feel without her and my dad and asked her if Christmas

time was hard for her because I knew it would be hard for me without my parents. She seemed

surprised that I asked her about this but I am glad that I did because I was able to hear about how she

was feeling, which is something she may not have shared without being asked about it.

COMPASSION: As I read through the description for compassion I also thought about the situation

above with my mom and being able to empathize with how she was feeling I was also able to show

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compassion with listening and giving her a hug to comfort her. I enjoy the description from the text of

thinking how you’d comfort your child.

LOVING-KINDNESS: It is easy to relate loving-kindness to the relationship with my mom because I

truly wish her safety and good health. As the text describes this can be more challenging with

“difficult” relationships but imagining the difficult person and your child and extending well-wishes

to them.

SYMPATHETIC JOY: When reading about sympathetic joy, I want my mother to be able to access

joy and I am happy for her successes. I have found myself to become jealous at times but instead will

think of what challenges the person has overcome and be joyful with them.

EQUANIMITY: This quality is important in being able to bring all 5 other qualities together through

balance of relationships. My mom has always said the famous, “treat others as you would like to be

treated.” I think this is appropriate for this quality because it acknowledges that you would want to be

treated with equal importance and it is beneficial to relationship to treat others with that same equal

importance.

Summary

These 6 qualities of interpersonal mindfulness will benefit relationships and communication

by imagining how you would want to be treated or how you would want a loved one to be treated. In

my own words I have quickly summarized each quality: Openness is important in avoiding judgment.

Empathy involves feeling yourself how the other person would feel. Compassion involves empathy

along with comforting. Loving-kindness is wishing the best for another individual. Sympathetic joy is

acknowledging the challenges that another has been through and feeling joyful with them for

accomplishments and success. And equanimity is important in bringing a balance for all qualities and

showing equal importance to each relationship.

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(Stahl & Goldstein, 2010).

Unit 9: Applying Stress: Critical Issues for Management and Prevention to your Professional LifeInformation to Remember:

Key Learning Point: Creativity and self-esteem are important for effective stress management. Take time to work on these areas. Notice your positive attributes and let your creative side flourish (Seaward, 2015).

Key Learning Point: Taking the time to get to know what stressors are present in your life will help you to cope and manage with the stress. Apply coping and relaxation techniques to the specific stressors that you have noticed affect you (Seaward, 2015).

Key Learning Point: It is important to schedule time in your day for meditation/relaxation techniques. In that time for relaxation/meditation avoid distractions and have a comfortable position (Seaward, 2015).

Unit

9

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Additional Information The book, Learned Optimism by Martin E. Seligman provides a secondary source of

evaluating your depression with the test called CES-D (Center for Epidemiological Studies-Depression) developed by Lenore Radloff. This test is found of page 59 of this text. This text also valuable information from a primary source as Seligman describes first hand experiences on the benefits of optimism (Seligman, 2006).

The World Health Organization provide a primary source discussing stress in the work place. The website discusses causes of stress in the workplace, dangers of stress in the workplace, and what can be done to decrease stress in the workplace (Stress, 2006).

The University of Minnesota website provides a primary source for relaxation techniques and stress reduction. These involve breathing techniques, decreasing muscle tension, and visualization (University, 2002).

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References

Eisebarth, C. (2012). Does self-esteem moderate the relations among perceived stress, coping, and

depression? College Student Journal, 46(1), 149.

Nordqvist, C. (2014). What is neuroscience? Retrieved from Medical news today:

http://www.medicalnewstoday.com/articles/248680.php

Seaward, B. (2013). Health of the human spirit: Spiritual dimensions for personal health (2nd ed.).

Burlington, MA: Jones & Bartlett Learning.

Seaward, B. (2015). Managing stress: Principles and strategies for health and well-being (8th ed.).

Boston, MA: Jones and Bartlett Publishers.

Seligman, M. (2006). Learned optimism: How to change your life and mind. New York, NY: Random

House, Inc.

Stahl, B. & Goldstein, E. (2010). A mindfulness-based stress reduction workbook. Oakland, CA: New

Harbinger Publications, Inc.

Stress at the workplace. (2006). Retrieved from World Health Organization:

http://www.who.int/occupational_health/topics/stressatwp/en/

University counseling and consulting services. (2002). Retrieved from University of Minnesota:

http://www.uccs.umn.edu/oldsite/lasc/handouts/relaxstrat.html

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