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About the Author
Read an Excerpt
Once I moved into primary care as a mental health clinician, I began to work with a very close interdisciplinary team. I found myself working with dietitians, health management nurses, pharmacists, nurse practitioners, diabetes educators, social workers, and physicians. It was great to be able to connect patients with the clinicians who could be of the most help to them, depending on what health concerns they were addressing.
As a mental health clinician, whether I was a mental health therapist or a behavioral health consultant, a large part of my role was to help patients learn healthy coping strategies for managing stress. I initially did this through individual sessions and then later created a stress-management group that I have been facilitating right in doctors' offices. Feedback from patients has been positive, and the doctors I work with are happy to refer people to these classes. At the time of this writing, 90% of patients who completed this program reported a reduction in symptoms of stress.
Not long into my time in primary care, my interdisciplinary colleagues began to approach me with a recurring question: “I have a patient who has a lot of stress but doesn't want to attend for counseling or can't make it to the class program. Do you have any quick stress-management strategies I could teach him or her?”
I would find myself pulling out my tools and giving a quick summary of how to teach a deep-breathing exercise or a quick cognitive-grounding strategy. These were not strategies that required a graduate degree in social work or psychology. As noted in The Clinical Guide to the Treatment of the Human Stress Response, “the traditional psychologist, counselor, physical therapist, social worker or health educator can effectively intervene in the treatment of the stress arousal process itself” (Everly, Jr. and Lating, 2013, p. 12). My colleagues were more than capable of teaching these strategies to people experiencing stress, and the fact that they could add this five- to ten-minute strategy into their session gave the patient even more resources for making healthy changes.
The Purpose of This Book
The purpose of this book is to provide you with a short guide to teaching quick stress-management strategies to your patients or clients. These strategies do not require that you have an extensive biopsychosocial assessment or spend an hour-long session with them.
If you work with patients who have physical or mental health issues, stress can exacerbate them. If you are having a face-to-face session with your patient, you already have a relationship with her or him; patients are more likely to trust what you teach them over what they could read in a book or online. Never underestimate the influence you have on your patients as their clinician. Sometimes the simplest strategy or piece of information you give them can make the biggest change in their lives and health.
Who this book is for
This book is created for any professional or paraprofessional in a medical or community-based setting. If you work with people who struggle with stress and part of your role is to support them and help them manage stress, the strategies in this book will work for you.
I have used these strategies in the following settings:
- women's crisis center- restorative justice program- addiction treatment centers- university counseling services- community health center- primary health care- private-practice therapy
I have provided clinical consultation to a variety of counselors and clinicians in addictions and mental health, teaching them these strategies to use with patients in various settings.
If you are studying in any of the health care or helping professions, the strategies in the book will jump-start your practice. It's the book I wish I had in my third year of university when I began interning.
I have worked with physicians who are part of our shared mental health care model and who have had the opportunity to sit in with a mental health consultant. They have told me that because they were able to witness the teaching of these strategies to one patient, they were then able to teach them to other patients. This book is the next best thing to having a mental health consultant in your office with you.
What You Can Expect from This Book
This book will provide you with 20 different strategies. The purpose of these strategies is to teach patients to recognize the stress response, know what it does to the body, and develop techniques to reduce exposure to stress. Patients can't simply treat the symptoms of stress; they need to learn how to recognize it and reduce it.
According to Everly, Jr. and Lating (2013), three different interventions are helpful in the treatment of psychophysiological stress, including helping the patient develop and implement strategies by which to avoid/minimize/modify exposure to stress, thus reducing the patient's tendency to experience the stress response; helping the patient develop and implement skills that reduce excessive psychological functioning and reactivity; and helping the patient develop and implement techniques for the healthful expression of the stress response. Everly, Jr. and Lating (2013) recognize that stress “represents the epitome of the mind-body interaction” (p.12). The strategies in this book fit within these three forms of intervention and are predominantly based on a mind-body framework.
I recommend reviewing the 20 strategies and trying out a few with your patients. Over time, you will discover which ones you feel the most comfortable teaching and which ones your patients tend to respond to the best. There are five in this book that I use daily with patients; the rest I use on occasion.
Using the scripts
For each strategy, I have included a script on how to teach it. This is not because I think you don't have the education or skills to teach it. I include the scripts because over the past ten years, I have learned the language that tends to help patients understand, retain, and implement the strategies.
You certainly are not expected to pull out the book and read a script in its entirety. Feel free to take what works for you and adapt scripts to your own style so that you are comfortable with the material. Having noted that, please keep in mind that simple language and lay terminology are going to be easier for patients to understand and retain, preferably at the grade-seven reading and comprehension level.
If you have a long-standing relationship with your patient, you may know more details about a particular situation and can personalize the examples in the strategies. In my script, I provide general examples, but if you can give examples that are similar to what your patient is dealing with, you will connect with him or her at a deeper level. For example, when I am working with a mother who has young children and who works full time, the examples I am likely to use involve taking care of children, driving them around, the demands of the household, and the demands of working.
How to Use This Book
This book is designed to give you 20 different stress-management strategies that you can teach your patients in less than ten minutes.
I highly recommend you start with Strategy #1 on page 14. This strategy provides your patients with a basic understanding of the stress response and the relaxation response in terms they can comprehend. Strategy #1 also helps your patients identify their stress warning signs, which will be the trigger to implement any of the other 19 strategies in this book. You will notice that most of the handouts that follow state, “Begin this practice as soon as you notice your stress warning signs.” If I have enough time, I often pair Strategy #1 with one of the deep-breathing strategies (Strategies #8, #9, or #10), as they are fairly quick to teach.
Each patient will respond to different strategies in different ways. The goal is to give a patient multiple strategies so he or she can find one that works best. I encourage you to have your patients practice the strategy in session if possible, as they are much more likely to use the strategy after leaving your office if they have already worked through it once.
The language used in this book
Whether you refer to the people you work with as patients or clients, or even consumers, is your choice. This book can be used in a medical setting that refers to patients as well as in a community-based setting that refers to clients. Over the course of my career, I have referred to the people I work with as both. As I am currently in a medical setting, and the idea for this book came from other health care professionals in a medical setting, I have usually chosen to use the term patient, but please do not feel that this choice limits these strategies to clinicians working in medical settings.
You will find that I use language at a basic reading and comprehension level. Again, this choice is not because I think patients do not have the intelligence to understand a higher level; it is because I have found that when patients are working with professionals, they are often nervous, struggle to focus, and have difficulty remembering what is being discussed. When I use basic language, I find that most people are able to comprehend the concepts.
Some of the strategies refer to an audio file that you can play in session. Most audio files are five minutes or less in length and are designed to give your patient a chance to experience the strategy with you present.
You will see an icon beside the strategies that have accompanying audio files. The audio files are included on the CD packaged with this book.
The handouts referred to in this book are summary versions of each strategy presented and are included in the appendices. Full-size versions (8½" x 11") that can be printed out and given to patients are included on the CD packaged with this book. For your convenience, thumbnail references are shown in the corresponding text.
What This Book Is Not
This book is not an academic treatise on the human stress response.If you feel you want a more comprehensive understanding of the complex systems that play a role in the human stress response, then I suggest you read A Clinical Guide to the Treatment of the Human Stress Response by George S. Everly, Jr. and Jeffrey M. Lating.
This book is also not in itself medical advice or an alternative to medical advice. The strategies in this book are designed to be complementary to any medical treatment that your patients are receiving. They are not meant to replace, or contradict, any treatment your patients are receiving from their health care professionals.
Similarly, this book is not a workbook that you can hand out to patients. It has handouts that you can use with patients, but the handouts will require that you teach patients the information that accompanies each handout. Again, as their health care provider, your patients trust you and are more likely to use the strategies if you have explained them, endorsed them, and demonstrated how to use them.
Finally, this book is emphatically not an alternative to mental health counseling. If your patients are presenting with mental illness, please refer them to a mental health clinician.
Table of Contents1. Stress and your patients
2. Awareness strategies
3. Self-management strategies
4. Relaxation strategies
5. Sensory grounding strategies
6. Cognitive strategies
7. Clinician wellness
Summary: How to use this book
Strategy 1: Human stress response and warning signs
Strategy 2: Daily stress log
Strategy 3: Stress thermometer
Strategy 4: Stress-management plan and resources
Strategy 5: My stress-management goal
Strategy 6: Self-care plan: Lifestyle factors for stress management
Strategy 7: My support map
Strategy 8: Deep breathing: Technique
Strategy 9: Deep breathing: Extended exhale
Strategy 10: Deep breathing: Boxed breathing
Strategy 11: Guided visualization
Strategy 12: Progressive muscle relaxation
Strategy 13: 5–4–3–2–1 sensory grounding exercise
Strategy 14: Pictures on the wall exercise
Strategy 15: Cognitive-awareness grounding strategy
Strategy 16: Journaling and relaxation
Strategy 17: Gratitude lists and journaling
Strategy 18: Surfing your stress
Strategy 19: Awareness of negative thoughts
Strategy 20: Setting boundaries and saying no
Signs and symptoms of compassion fatigue
Ten nourishing activities for clinician wellness