STRESS MANAGEMENT
Background
Josh was a successful 34 year old Account Manager for a
well known advertising company. Married to Julie they had
one child, Ben, who was eighteen months old. Josh was close
to his family of origin and, in particular, his twin brother.
He described his parents as loving and said the only problem
he experienced was being diagnosed as Dyslexic when he was
16 . In many ways his diagnosis was a relief as it made
sense of the academic struggle he experienced. Josh made
it to University leaving with a good degree and was soon
fast-tracking through the employment market. He was currently
being considered for yet another promotion and money was
not a problem.
Presenting Problems
Using the comprehensive BASIC ID Multimodal Assessment Model
we were able to identify a number of problems that were
troubling Ben.
Sensory
Tension Tension headaches. Tension in shoulders. Palpitation.
Sleep problems
Modality |
Problem |
| Behaviour
|
Takes
on too much work but does not complete Increasing avoidance
of giving presentations. |
| Affect
|
Anxious
when giving presentations. Anger when personal deadlines
are not met regardless of the reason. |
| Imagery
|
Images
of performing badly |
| Cognition
|
“I have to do well otherwise it means I am a failure”
“I am not as good as other people because I have
a disability and am therefore faulty goods and am likely
to fail" |
| Interpersonal
|
Finds
it hard to say ‘No’ Does not ask for support |
| Drugs/biology
|
Poor
nutrition – does not eat Breakfast Drinks 10 cups
of coffee, Very little water consumption, Uses a considerable
amount of headache pills to control tension and headaches
No exercise |
In addition to the above by using the “Locus of Control”
and “Type A” questionnaires we are able to ascertain
that Josh tended to put pressure on himself by being an
over achiever who took responsibility for everything. Discussion
took place regarding the psychological effects of being
Dyslexic and it soon became clear that Josh had always felt
a failure because of his early academic difficulties. He
was fearful of failure and this affected his ability to
say ‘no’ to people and to be more realistic
about what he could achieve. He tended to discount his abilities
and achievements always focusing on what he “should”
be doing. A good working relationship was established.
As Josh was being seen for a Stress Management programme
it was important to explain to him what Stress was, how
it affected people and what the long-term implications could
be. This included providing Josh with a biological model
of stress as well as a way of identifying the stressors
that were affecting his life.
The Programme
We agreed to meet for six one-hour sessions on a weekly
basis. The first session considered changes to Josh’s
lifestyle. Josh agreed to:
- Have a piece of wholemeal toast and a banana for breakfast
and to eat this sitting down at the table before leaving
for work.
- Cut down on his caffeine intake slowly over the following
two weeks. The pros and cons of a total detoxification
programme were discussed. However, given that it was likely
that Josh would experience withdrawal symptoms he opted
for a gradual reduction programme. This involved replacing
half of his normal coffee consumption with fruit teas
and water during the first week and then halving that
again during the second week. Josh also agreed to increase
his water consumption to 8 glasses a day.
- Visit his doctor to get his headaches checked out.
Although it was likely that they were being caused by
tension it was still wise to ensure that no organic reason
was present.
- Undertake a few neck and shoulder stretching exercises
during the day.
- Park the car a mile away from the office to increase
his daily exercise as well as walking up the stairs at
work (2 flights) rather than taking the lift.
At the next session Josh reported that these changes had
been more easily incorporated into his life than he had
thought. In fact he had enjoyed walking so much that he
now parked his car about a mile and a half away from the
office as he found the walk gave him time to wind down as
well as being good for him. He now had a bowl of fruit on
his desk and, as there was a kitchen at work, had started
to take in healthy meals that could be cooked quickly at
the office. His water intake was not up to eight glasses
day, more like 4/5, but still a great improvement and the
doctor had given him a clean bill of health.
During sessions two to four the more difficult areas of
tackling Josh’s thinking style and behaviour were
dealt with. Josh held a core belief about being a failure
and this was the driver behind much of his unhealthy behaviour
and his anxiety and anger. By using techniques from the
cognitive-behavioural school of therapy time was spent identifying,
disputing and challenging his thinking style. A variety
of anxiety and anger management techniques were introduced
and Josh was encouraged to experiment with his behaviour
at work and at home. For example, by going home on time
two nights a week.
During session four, Josh was introduced to an exposure
programme and was encouraged to stop avoiding giving presentations.
Further cognitive work was done on his fears as well as
practical interventions in the form of breathing exercises
and appropriate coping imagery. Josh had the opportunity
to take on a project that would mean undertaking a considerable
number of presentations over a short period of time. After
discussion Josh thought that this would provide him with
an opportunity to conquer his avoidance, particularly as
he now had a range of strategies to call upon to help him.
He also reported that his sleep problems had stopped, as
had his palpitations. He continued to maintain his healthy
lifestyle.
During session five, Josh was introduced to some assertiveness
techniques that included asking for support and saying ‘no’.
He reported that the imagery and relaxation work had really
helped and that he found himself actually looking forward
to a giving a presentation. As there was only one session
left Josh was asked to prepare for the next meeting by considering
how he would have evaluated himself prior to undertaking
the stress management programme. He was to consider where
he felt himself to be now and what aspects of his life he
felt he still needed help with.
During session six we went back to his original list of
problems and considered, using a rating scale of 0 (no problem)
to 8 (major problem) the differences in his ratings at the
beginning and end of the programme. Josh rated major improvements
in all the areas mentioned and also told me that his wife
had commented on how much more relaxed he seemed. Josh felt
he was now able to be more realistic about what could be
achieved and in what time scale and had joined a local gym
where he went straight from work two nights a week. He said
that he still found himself worrying about whether he was
good enough, but that when he noticed himself doing this
he told himself that “if he could talk himself into
being anxious he could talk himself out”. In particular,
Josh said he had enjoyed using the biodots as a way of monitoring
his physiological state throughout the day. He now felt
he had more energy and cleared the same amount of work in
less time.
We agreed that it would be helpful if Josh had a follow-up
appointment for three months time. We also agreed that if
Josh needed to see me before then he could contact me.
About the Author
Gladeana McMahon
BACP Fellow, Senior Registered Practitioner, Accredited
Counsellor and Supervisor. BABCP Accredited Cognitive-Behavioural
Psychotherapist. UKCP CBT and UKRC Individual Counsellor
Registered.
As well as being a Psychotherapist, Gladeana is a Life/Business
Coach and Commercial Trainer as well as Lecturer on Diploma
and Masters programmes in Counselling at the University
of East London. She has written, contributed to or edited
more than 16 books on counselling and personal development.
Her most recent, "Coping With Life’s Traumas"
was published in the Autumn of 2000. Gladeana is Associate
Editor of Counselling, the Journal of the British Association
for Counselling and Psychotherapy and is also BACP’s
Deputy Head of Media Relations. Gladeana is the Managing
Editor of Stress News, the quarterly Journal of the International
Stress Management Association (UK). Email: stress@isma.org.uk.
Website: www.isma.org.uk
To contact Gladeana McMahon
Email: gladeana@dircon.co.uk
Website: www.gladeana.co.uk
