Join us for a lecture about stress and how it can affect your behavior. Clinical psychologist Katherine DiDonato, PhD, will discuss cognitive behavioral techniques and other evidence-based approaches to help reduce stress and manage worry for a better life.

1. Stress & Anxiety
What is it
&
What can be done about it?
Presented by:
Katherine DiDonato, PhD, ACT

2. Physical Results of Ongoing Stress
• Heart disease
 Diabetes
 Asthma
 PMS
 Obesity
 Infertility
 Autoimmune diseases
 Chronic pain
 Migraines
 Ulcers
 Heartburn
 High blood pressure
 Skin problems
 Irritable bowel syndrome

3. Emotional Results of On-Going Stress
• Anxiety
• Depression
• Insomnia
• Isolation
• Conflict
• Substance Abuse
• BURNOUT

4. Today’s Objectives
• What is Stress?
• What is Burnout?
• What is Anxiety?
• Stress/Anxiety Management
 Cognitive Techniques
 Meditation and Relaxation
 Social Connection
 Medication

5. Stress is a normal component of the body’s
response to demands that are placed on it.
It is characterized by the body’s biochemical
changes
It can be health-enhancing or health-depleting
What is Stress?

6. What is Stress?
 When demands are in balance with your coping
abilities and resources you do not feel stressed.
 When demands are greater than your coping abilities
you feel stressed.

7. Appraisal of Threats and Resources
First we evaluate the threat. Is it?...
•Positive / Negative
•Controllable / Uncontrollable
•Challenging / Boring
•Irrelevant / Important
If the answer is “negative, uncontrollable, important” =
STRESS
Then we evaluate our resources. Can I handle this stress?
If the answer is “no” = STRESS

8. The Stress Response is
the Body’s 911 System

9. Fight or Flight Reaction
• Productive if you were in a situation where you need
to protect yourself

10. It is a Matter of Perception
 Since we are very rarely attacked by bears our
perception of threat has changed
 Now, a threat can be:
 Social
 Emotional
 Financial
 Work related

11. Sources of Stress
The Good
Retirement
Get married
Have children
Buy a new home
Go on vacation
New Job, Promotion
The Bad
Break a leg
Spouse becomes
ill
Child gets in
trouble
Lose wallet
In-laws coming
The Ugly
Nasty car accident
Bankruptcy
Divorce
Illness
Loved one dying

12. Who Has Stress?

13. Stress Response = Good in Small Doses
 Gives you a burst of energy when you need it
 Increases your motivation to complete tasks
 Protects you from harm
 Prevents you from walking down a dark alley way at
night

14. Stress and its impact on performance works in a bell
curve
More stress will help you give an optimal
performance
The “optimal” amount of stress is different for
everyone
Stress is Good in Small Doses

15. Stress Can be Health-Depleting
"© copyright Mental Health America"

16. Negative Emotional Reactions
 Feeling angry, irritable or easily frustrated
 Feeling overwhelmed
 Feeling nervous or anxious
 Feeling afraid or worried
 Feeling helpless or hopeless
 Desire to hide or runaway

17. Negative Cognitive Reactions
• Difficulty Making Decisions
• Confusion
• Difficulty Naming Familiar Items
• Poor Concentration
• Blaming Others
• Memory Problems
• Replaying Events Over & Over
• Thinking the Future is bad

18. Behavioral Reactions
• Difficulty functioning at work or home
• Withdrawal
• Isolation
• Suspiciousness
• Working more and being less productive
• Excessive Humor or Silence
• Increased Smoking, Alcohol or Food
• Change in Activity Level
• Angry Outbursts
• Crying Spells
• Sleep

19. What is Burnout?

20. Burnout - A State of Mental Exhaustion
• Powerlessness
 Hopelessness
 Emotional exhaustion
 Detachment
 Isolation
 Irritability
 Frustration
 Being trapped
 Failure
 Despair
 Cynicism
 Apathy

21. Stress Burnout
 Characterized by over-engagement  Characterized by disengagement
 Emotions are over-reactive  Emotions are blunted
 Produces urgency and hyperactivity  Produces helplessness and hopelessness
 Loss of energy  Loss of motivation, ideals, and hope
 Leads to anxiety disorders  Leads to detachment and depression
 Primary damage is physical  Primary damage is emotional
 May kill you prematurely  May make life seem not worth living
Stress vs. Burnout

22. What is Anxiety?

23. Anxiety Includes:
• Fight or Flight Reaction
• Avoidance Behavior
• Worry or Concern
 Concern about the physical reaction or its
meaning
 Concern about the future

25. Anxious Thinking
• Future-Focused Predictions
• Future is Bad
• Reaction is as-if the bad thing is happening or
going to happen
• Avoidance / “Safety” Behaviors

26. Panic Attack = Fight or Flight
• Discrete period of intense fear or discomfort in which four of the
following develop abruptly & reach peak in 10 minute:
• palpitations, pounding heart, racing heart
• sweating
• trembling/shaking
• sensation of shortness of breath or smothering
• feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• feeling dizzy, unsteady, lightheaded, faint
• derealization or depersonalization
• fear of losing control or going crazy
• fear of dying
• paresthesias
• chills/hot flashes
From DSM-IV-TR Copyright 2000 American Psychiatrist Association

27. Stress Management

28. Stress Management
• Cognitive Therapy Techniques - Learning ways to evaluate
situations clearly.
 Is there a true threat or not?
 Is the situation exceeding my coping or am I just thinking it is?
 If it is exceeding my coping what should I do about it?
 Stress Reduction & Management
 Reducing environmental stress
 Changing your physical reactions
 Pay it forward – helping others
 Medication

29. Medication
• Benzodiazepines
 Xanax
 Klonopin
 Ativan
• Antidepressants Zoloft
 Lexapro
 Prozac
 Paxil
• Buspar

30. Cognitive Therapy
• Not simply the events in life that causes
problems
• How we think about those events
• Take our thoughts to be 100% true
• Focus on information that confirms them
• Ignore or bend information that disconfirms

31. Using Cognitive Therapy
• Identify the stressful, anxious thought
• Consider the thought to be a hypothesis –
Not a Fact
• Use Socratic questioning to evaluate
• GOAL = Realistic and Useful thinking
• If needed, experiment to confirm or
disconfirm the thought

32. Information Skewed
Adapted from J.Beck (2005) Cognitive Therapy for Challenging Problems.

33. Thinking Errors
• Fortune Telling
 I know what is going to happen and it will be bad
• All-or-Nothing Thinking (Black and White)
• If I’m not a total Success, I’m a Failure
• Catastrophizing
• I’ll be so upset I will not be able to function
• Discounting the Positive
• I did this project well but I just got lucky
• Emotional Reasoning
• It’s true because I feel it is

34. Thinking Errors
• Magnification/Minimization
• Getting a B proves I’m stupid. I got an A+
because the test was easy
• Mind Reading
• He’s thinking that I don’t know what I’m doing
• Personalization
• He didn’t look at me because he hates me
• Should and Must Statement
• I must always do my best. I should never make a mistake

35. Thought Record
Situation
* Who
* What
* When
* Where
Moods
What did
you feel?
(Rate 0 – 100)
Negative Automatic
Thoughts
What was going thru your
mind (thought/image)?
(Rate 0-100)
Socratic Questions to
Evaluate the Negative
Automatic Thought
Are you using any
Cognitive Distortions?
Alternative Thought to
Counter the Negative
Automatic Thought
Rate Moods &
NATs
Now
 What make me think
the thought is true?
 What makes me think
it is not true or not
competly true?
 What is an alternative
way to look at the
situation?
 What is the worst
thing that could
happen and could I
live thru it?
 What is the best thing
that could happen?
 What is most likely
to happen?
 What will happen is I
keep telling myself
the same NAT over
and over?
 What if I was to
change my thinking?
 What would I tell a
friend who was going
thru the same exact
thing I am going
thru?

36. Situation
* Who
* What
* When
* Where
Moods
What did
you feel?
(Rate 0 – 100)
Negative Automatic
Thoughts
What was going thru your
mind (thought/image)?
(Rate 0-100)
Socratic Question to
Evaluate the Negative
Automatic Thought
Are you using any
Cognitive Distortions?
Alternative Thought to
Counter the Negative
Automatic Thought
Rate Moods &
NATs
Now
Working on a project with
co-worker.
No contact for 2 days even
though she had left them a
message.
Sad
Despondent
Anxious
85
They think the work I
have done on the project is
poor
They don’t want to work
on the project with me
because they think I don’t
know what I’m doing
I’m a Failure
90
 What make me think
the thought is true?
 What makes me think
it is not true or not
completely true?
 What is an alternative
way to look at the
situation?
 What is the worst
thing that could
happen and could I
live thru it?
 What is the best thing
that could happen?
 What is most likely
to happen?
 What will happen is I
keep telling myself
the same NAT over
and over?
 What if I was to
change my thinking?
 What would I tell a
friend who was going
thru the same exact
thing I am going
thru?

37. Testing Your Thoughts
 Ask yourself:
 What makes me think the thought is true?
 What makes me think it is not true or not completely true?
 What is an alternative way to look at the situation?
 What is the worst thing that could happen and could I live through
it?
 What is the best thing that could happen?
 What is most likely to happen?
 What will happen if I keep telling myself the same NAT over and
over?
 What if I was to change my thinking?
 What would I tell a friend who was going through the same exact
thing I am going through?
 Now that you have tested your NAT what is a more realistic way
to think about your situation?

38. Evidence
• Supports
 No contact
 Had some trouble on
the project
 Not feeling sharp
 Hx
• Refutes
 Has a good relationship
 No negative comments
 Presented good ideas
 Willing to meet
 Mind Reading
 Emotional Reasoning

39. Thought Record
Situation
* Who
* What
* When
* Where
Moods
What did
you feel?
(Rate 0 – 100)
Negative Automatic
Thoughts
What was going thru your
mind (thought/image)?
(Rate 0-100)
Socratic Question to
Evaluate the Negative
Automatic Thought
Are you using any
Cognitive Distortions?
Alternative Thought to
Counter the Negative
Automatic Thought
Rate Moods
& NATs
Now
Working on a project with
co-worker.
No contact for 2 days even
though she had left them a
message.
Sad
Despondent
Anxious
85
They think the work I
have done on the project is
poor
They don’t want to work
on the project with me
because they think I don’t
know what I’m doing.
I’m a failure
90
 What make me think
the thought is true?
 What makes me think
it is not true or not
competly true?
 What is an alternative
way to look at the
situation?
 What is the worst
thing that could
happen and could I
live thru it?
 What is the best thing
that could happen?
 What is most likely
to happen?
 What will happen is I
keep telling myself
the same NAT over
and over?
 What if I was to
change my thinking?
 What would I tell a
friend who was going
thru the same exact
thing I am going
thru?
I don’t know why they have
not contacted me and it
does not necessary mean
they are unhappy with me.
If they are unhappy with
me then I can try to work it
out with them and it does
not say anything bad about
me as a person.
75
Mood
45
AT
50

40. Coping Cards
• Written reminders that can be carried
• Excellent for practicing new way of thinking
• Succinct responses to your stressful thoughts
• Best after have uncovered distorted ideas

41. Behavioral Experiments
 Reduce or eliminate
avoidance behavior
 Test stressful thoughts and
assumptions
 Get evidence for alternative
perspectives

42. Stress Reduction & Management
 Environmental Stress
 Physical Reactions
 Pay It Forward

43. Environment
Reduce Stressors
 For example:
 Excessive temperatures
 Excessive noise
 Poor air quality
 Reduce repetitive work tasking and
strenuous movements
 Alcohol

44. Physical Reactions
• Increase
 Exercise
 Regular and Balanced Meals
 Socializing
 Sleep
 Hobbies and Fun

45. Physical Reactions
Relaxation Exercises
Will reduce fight/flight reaction
 Like riding a bike for the first time.
 It is a skill that takes time and practice to do it effectively!
 Don’t expect much after trying it one or two times
 Relaxation exercises can seem deceptively simple at first
 With practice they are very effective

46. Physical Reactions
• Breathing Techniques
• Mindfulness Meditation
• Guided Imagery
• Yoga

47. Pay It Forward
New research suggests oxytocin may
speed recovery from major stressors
The more we give to others, & the more
we get from others, the more oxytocin is
released
Being connected may
protect you from stress
Kelly McGonigal: “How to Make Stress Your Friend”

48. Resources
• Academy of Cognitive Therapy
 www.academyofct.org
• Mind Over Mood
 Dennis Greenberger, PhD & Christine Padesky, PhD
• Worry Cure: 7 Steps to Curing Your Worry
 Robert Leahy, PhD
• Anxiety Free
 Robert Leahy, PhD
• Mindfulness for Beginners
 Jon Kabat-Zinn, PhD (Audio CD)
• Wherever You Go, There You Are: Meditation in Everyday Life
 John Kabat-Zinn, PhD

49. Stress & Anxiety
What is it
&
What can be done about it?
Presented by:
Katherine DiDonato, PhD, ACT