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Patient Stress and Life Management Skills

Introduction

A SMART Approach

An effective Stress Management And Relaxation Training Program (SMART) should be short enough to remember, simple to understand, and easy to follow. The BREAD Formula, used in this program and detailed in Sections 5-9, meets those criteria. The language of this course is “layman’s English.” The vocabulary is purposefully non-technical. This approach should help the medical professional explain stress and how to manage it in terms that their patients readily understand.

Bridging the Gap

As a medical, mental, or physical health professional, you know that clinical studies only discuss the problem and potential destructive nature of stress. They do not offer a detailed, systematic approach to helping patients deal with stress. This course fills that void. It presents a framework which you can custom fit to your patients. Most of them need accurate education, encouragement, and will power. This course is not intended to serve as a medical treatise on stress. Rather, it is written in laymen terms, and designed to help you help your patients develop their own SMART plan.

Format

There are two parts to this course. Part 1 outlines a preliminary approach to teaching stress management to your patients. Part 2 explains how to develop an effective SMART program, along with a personal review and practice of the techniques you will share.

The emphasis is on developing common language explanations to use with patients. The goal is to have a program patients can understand and use to improve the quality of their life.

Goal

Using the techniques presented in this course, you should be able to help your patients:

• understand what stress is and how it affects the mind and body;

• help patients identify their stressors;

• assist patients in developing their own SMART programs;

• help patients gain a greater sense of control.

This course gives general information about stress and how to set up a patient’s personal Stress Management And Relaxation Training (SMART) program. It is not a substitute for further professional care when indicated or beyond the scope of the practitioner. If you find that your patient’s stress level remains high after they have practiced the techniques shared in this course, help him/her find additional medical or mental health assistance.

Part 1: The Dynamics of Stress Management

Overview

Historical Perspective

This part is divided into two sections. Section 1 will review the changes that have led to stress being such a problem in America. It will also discuss some basic solutions for the problem.

Framework for Patient Stress Management

In Section 2, we will develop several approaches to teaching patients stress management techniques. We will discuss mindfulness training, noticing how and why people react as they do. This will help in designing a program for your patient. We will also look at reasons to make healthy choices.

Section 1. Historical Perspective

Changes in Society

Technological advances, changes in family structure, and workplace volatility have caused many changes in today’s society. As the pace of society accelerates, it takes with it many people’s sense of certainty and control. Many of the changes lead to manifestations of stress. Chronic migraines, irritable bowel syndrome, and dependency on substances plague many. Stress has become the buzzword for many of society’s maladjustments to the pressures and challenges of modern living.

For many, the solution to stress has come in a bottle, capsule or pill. This is a dangerous way to live. Although prescription and over-the-counter drugs have their place in maintaining or regaining health, the implication that lifestyle changes are not important, or are impossible, fails to emphasize the danger of having a chronically imbalanced system.

Reestablishing Wellness

With patients, reestablishing overall wellness of the mind and body is the primary goal. Understanding your patient’s stressors is important. This often leads to an approach to correcting the problem.

Help your patients seek immediate relief from symptomatic pain, discomfort, and threatening situations. Then help them discover and correct the underlying cause of stress. This will help bring permanent relief from symptoms.

Communicate with Patients

Talk with your patient to determine the underlying cause of stress symptoms. Listening carefully will put you in a better position to tailor a program to fit a patient’s particular needs. Develop a network of mind/body practitioners who share a common philosophical approach. This will enable you to help patients on a wider, more inclusive scale.

Mind/Body Medicine

The new field of medicine, Psychoneuroimmunology (PNI), seeks to detail the way the mind, body, nervous, and immune systems work together. It does not view the body as separate, unrelated systems. Rather, PNI suggests a commonality and cooperative connection between the various systems of the mind and body.

The writings of Dr. Steven Locke, M.D., of Harvard, (more information further in the course) and Advances, The Journal of Mind/Body Health, provide information that can help you serve your patients from a wider perspective.

Section 2. Framework for Patient Stress Management and Relaxation Training

Goal and Approach

The overall goal is restoration of balance to the mind/body systems. We will develop several approaches to teaching patients stress management techniques. Although no one program is suitable for everyone, allowing for exceptions due to possible organic or psychological conditions, there is usually a program for everyone.

Start By Listening

Listen to your patient. The information you collect will help explain why this person is using your service. Is it for a preventive, curative, or rehabilitative reason?

Ask Questions

Without going beyond the bounds of propriety, ask questions to determine the reasons the patient comes to see you.

Determine if You Can Help

Ask the patient how he or she believes you can help. Are you the professional who can help the patient or should your services play a more supportive role to finding and releasing the underlying causes of stress? For many people, admitting that they may have a problem takes courage. They might be in a fragile emotional, physical, or mental state when they come to see you. Treat them with respect and seriousness.

Make an Assessment

Decide the extent to which stress compounds the problem in question. Dr. Paul Rosch, M.D., President of the American Institute of Stress in Yonkers, New York (www.stress.org) considers 80% of all primary care illnesses stress related. That means that stress is likely to play a role in nearly all the cases you see.

Determine Patient’s Response

Decide whether the patient’s typical response is a sympathetic, activating response or a parasympathetic, withdrawing response, as depicted by Dr. Martin Seligman in his book, Learned Optimism. Does the patient move toward anger, hostility, and aggression or do they display depression, resignation, and hopelessness? This response pattern will help determine the approach you take toward the patient’s stress management program.

Notice Patient’s Level of Somatic Awareness

A stress management program encompasses an awareness of the body and its interrelationships. It is important for a person to understand the results or ramifications of their actions. Without understanding the cause and effect relationship, people can view causes as external and random. This can hinder the individual’s ability to understand that efforts can make a difference in reducing stress levels.

Many ill effects of stress stem from internalizations or a personal interpretation of events. Patients must understand that certain thoughts and actions have a causative effect on the stress they experience.

Ask How Much Sleep Patients Get

Sleep has restorative and recuperative powers. Sleep deprivation has far-reaching negative consequences. When looking for causes of stress in your patients, ask them how much sleep they regularly get. Have them differentiate between the time they spend in bed and the time they spend sleeping.

Understand the Many Causes of Stress

We don’t live in a vacuum. There might be interconnectedness between primarily external events, their subjective, internal responses, and the consequences on mind, body, and health. Few stressful situations have a single isolated cause.

Recognize a Chemistry of Choice

Every thought has a chemical consequence and every emotion has an approximate chemical equivalent. Research suggests that prolonged exposure to adrenalin and cortisol causes immune system impairment and increases vulnerability to disease.

Increase Conscious Awareness

Conditioned responses account for much of our behavior. Conditioned responses are good for habits such as speaking or walking. However, allowing stress reactions to stay below the conscious level, in the form of conditioned habits, causes the person to suffer the consequences of those reactions.

Practice Mindfulness Training

Patients must be trained to develop their present time awareness of the moment. This helps them become aware of their habitual response patterns. Noticing response patterns is a necessary first step to correcting inappropriate behavior. It helps to develop a cause/effect relationship between actions and results.

The foremost practitioner of Mindfulness-Based Stress Reduction (MBSR) is Jon Kabat-Zinn, Ph.D., founder of The Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School (www.umassed.edu/cfm). Their MBSR program is based on restoring a balanced sense of health and well being that requires increased awareness of all aspects of the self, including body and mind, heart and soul. “Mindfulness-based stress reduction is intended to ignite this inner capacity and infuse your life with awareness.”

Remind your patients to watch their internal dialogue. Dr. Martin Seligman of the University of Pennsylvania calls this our “explanatory style.” It is the positive or negative things we say to ourselves making us either tentative or confident. For example, when having trouble completing a project at work, does the patient say, “I’m stupid. I can’t do anything right” or do they say, “I feel tired today. This will be easier to do when I am more rested.”

Correcting destructive habits requires knowing what we do to harm ourselves. With mindfulness, we can devise strategies for replacing inappropriate behavior.

Developing A Consistent Response Pattern (CRP) To Deal With Stressors

The Scientific Method

This method:

• Defines a problem

• Suggests an answer (hypothesis)

• Tests the hypothesis

• Analyzes the results

• Modifies the approach (hypothesis), if necessary

Where there is a true cause/effect relationship between the problem and the answer, the same experiment conducted under the same conditions will produce the same results (replication).

Developing a CRP: A Six-Step Approach

Help your patients become personal scientists. The following six-step approach represents a CRP to use. Using a similar approach with all stressors is effective because it becomes easier with practice. There is no need to invent a new way to respond to every new problem; your patients already have a way.

1. List Stressors

Have your patients list their major stressors. As they control and release the major stressors, many of the smaller ones will disappear.

2. Rank Stressors

Ask them to rank their stressors and then work on the ones that cause the most trouble.

3. Identify Stressors

Determine what type of stressors they are.

4. Isolate the Causes

Isolate the true causes and your patients’ motivation for their actions. They can list contributing factors that can affect their stress management efforts. Encourage them to practice self-honesty in their lives.

5. Use the 10 Parts of an Effective Stress Management Program: The BREAD Formula

1. Breathing with your Diaphragm, having a strong Belief system

2. Relaxation Techniques, Relationships

3. Exercising Aerobically, Education

4. Activity, Attitude of Optimism

5. Diet of Balanced Nutrition, Determination

The goal of the BREAD Formula is to:

Give immediate relief from the symptoms of stress. Help patients understand and control harmful side effects of stress. Eventually gain permanent release from the underlying causes of stress.

6. Seek Help if Needed

If your patient is unable to handle a stressor, given the stage of development or the severity and longevity of the problem, encourage them to seek additional, appropriate professional help.

Obstacles to Effective Stress Management

Your patients may find it difficult to make changes when they set up a SMART program.

Dealing with Change

The difficult part is changing behavior patterns. We follow many unconscious habits that give a sense of continuity and control. When we try to change habits, the subconscious resists.

Develop New Habits

The way to change an inappropriate habit is to replace it with a useful one. Encourage your patients to concentrate on developing new, positive habits. Have them dwell on the rewards of success, like the benefits of losing weight from eating a more nutritious diet.

Fitness video instructor Heidi Tanner says that it takes 21 sessions for exercise to become a habit. It takes time and conscious repetition to make a new activity or behavior pattern a regular part of everyday life.

At first it might be difficult for patients to deal with the stress caused by changing behavior patterns. Most people are accustomed to doing things the “same old way.” When this occurs with one of your patients, encourage him/her to become aware of their habitual response patterns and to try and develop ways to consciously regain control.

Risk/Reward Ratio and Health Statistics

Have your patients look at all behavior changes from a risk/reward viewpoint. Have them ask themselves, “Will the long-term benefits outweigh the short-term discomfort?” Consider these statistics:

• Cardiovascular diseases (CVD) claimed 910,614 lives in 2003. That was 37.3 percent of all deaths.

• Over 152,000 Americans killed by CVD are under age 65.

• Coronary heart disease caused 479,305 deaths in 2003 and is the single leading cause of death in America.

• In 2003 an estimated 1.2 million Americans will have a new or recurrent coronary attack.

Part 2: Dealing With Stress/BREAD Formula

Introduction to Part 2

Purpose

This part of the handbook gives a background of the study of stress and explains why it is a real problem. Then it gives practical, tested information and techniques concerning stress. The techniques can improve the quality and, very likely, lengthen your life and the life of your patients.

Format

Each section will follow the same 5 step approach to determine:

• The Problem: Define the situation

• The Cause: Determine the reasons for the situation

• The Cure: Identify possible solutions

• The Techniques: List actual, practical methods in a how to format

• The Goal: The final desired result

Sections 5-9 will each cover one aspect of the BREAD Formula.

At the end of each section, you’ll find an assignment to help you put into practice the solutions you will learn.

This part of the handbook is written directly to you. By developing your own SMART program, you will be better able to teach the techniques you learn to your patients.

Hear and forget. See and remember. Do and understand.- INDIAN APHORISM

Section 3. Stress

Problem

Stress can be defined as a chronic imbalance of the autonomic nervous system ANS). Hans Selye liked to call it, “the rate of wear and tear on the body.” That is also a fairly accurate definition of the aging process. The Autonomic Nervous System (ANS) has two parts:

a) sympathetic, the stimulator. The chemicals produced by the sympathetic part of the ANS cause the feelings of excitement or anxiety. An example is adrenalin (or epinephrine.)

b) parasympathetic, which functions in the opposite way and produces feelings of relaxation. It causes the “opossum effect” or the “freeze from fright” stress response.

The ANS can be explained to patients by using a simplistic model, easily illustrated by a child’s teetertotter. When one side is up, the other is down and vice versa. Tell them that homeostasis (the goal) occurs when both parts of the ANS are in balance.

Selye’s Model

Dr. Hans Selye’s stress model dealt primarily with the sympathetic part of the ANS. He called helpful stimulation of the ANS, like exercise, “eustress.” The negative stimulation was called “distress.” Selye’s Model described stress as follows:

• State of arousal.

• “Fight or flight” response.

• Recovery phase.

• “Diseases of adaptation,” such as chronic headaches, ulcers, and low back pain occur if the body is not allowed regular intervals of relaxation and recovery

• The Depletion/Exhaustion phase is where the systems are so stressed that they simply quit, and, in some extreme cases, death occurs

Seligman Model

In contrast to Selye, Dr. Martin Seligman’s model deals with parasympathetic dominance. In his learned helplessness research, Seligman showed that, when faced with stressful stimulation, this stress response manifests itself as depression and withdrawal. People who react this way become overly passive and give up. (They “freeze from fright.”)

Homeostasis

According to Webster’s 9th Collegiate Dictionary, homeostasis is a relatively stable state of equilibrium or a tendency toward such a state between the different but interdependent elements or groups of elements of an organism or group. The ideal state is homeostasis, when both elements of the ANS function together to keep our system in balance.

Why Is Stress A Problem ?

• Two-thirds of all office visits to family physicians are due to stress-related symptoms.

• 43 percent of all adults suffer adverse health effects from stress.

• More than 1/3 of Americans say they have had an illness that was primarily caused by stress.

• Stress is linked to the six leading causes of death – heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.

• Stress causes American industry more than $300 billion annually in lost hours due to absenteeism, reduced productivity and workers compensation benefits.

Sources: American Psychological Association. http://www.apahelpcenter.org/articles/article.php?id=103 (2006)

Cause

Generally, the cause of most stress is the mind. The mind stores memories with associated emotions of how we interpret and respond to the challenge of change.

When we perceive situations as positive, happy emotions are stored with the memories. With negative situations we store negative emotions. This leads to unconscious stress responses.

Stress does not cause disease. However, it can affect the immune system which protects us from many serious diseases.

P + A = R Model

The PAR Model states that our perception, plus our attitude toward that perception, equals our response. Our brain and nervous system recognize:

• A stimulus

• Our initial perception of it

• An initial opportunity to respond.

We can consciously or unconsciously condition ourselves to trigger helpful or harmful responses.

Cure

Develop and follow an effective personal stress management program that will give immediate relief from the symptoms and allow us to eventually control most of the causes.

Become conscious of how you react to events. Look at your habits. Some habits are good. However, conditioned habits that cause worry, fear, anger, or anxiety can weaken the immune system. You can take control of much of the stress in your life by being aware of, and then correcting, poor habits.

Techniques

Use the BREAD Formula described in the next five sections as the cornerstone of your stress management program.

These techniques will incorporate the mind and the body. PNI, the emerging field of medicine, investigates the causal links between psychological events and resultant physiologic effects on the mind and immune system.

Goal

The goal of this section is twofold:

• To show the risks in unmanaged stress; and,

• To supply the information and motivation to follow a stress management program.

Assignment

Encourage your patients to take time to identify situations that are most stressful for them and begin to list possible solutions. Suggest that they consider the various techniques that are available to them and choose one to begin practicing.

Suggested Readings & Websites

• The Healer Within, Dr. Steven Locke, M.D., Mentor Books. 1997 (Psychoneuroimmunology, PNI), www.mindbodymedicine.org/s_locke.htm (2006)

• Freedom From Stress, Dr. Phil Nuremberger, Ph.D., Himilayan Institute, 1981.

Section 4. Dynamic Pairs

Problem

As much as we would like it to be a simple world of good or bad, right or wrong, on or off, it isn’t. What we sometimes consider opposites are often descriptions of relative extremes of the same idea.

Cause

Different people experience the same event in different ways. What is uncomfortably warm for an Eskimo might be unbearably cold for an equatorial person.

Preconceptions, opinions, and cultural bias can influence the way we relate to the world.

Cure

Recognize that dynamic pairs exist in a changing, relative relationship with each other. We will look at four dynamic pairs and see the important role each plays in stress and how we control it.

Mind/Body

How we think influences the systems of the body. Thoughts and actions produce immunomodulators that regulate the immune system. They can strengthen or weaken it.

Thoughts of anger or anxiety can discharge harmful chemicals that weaken the immune system. Thoughts of peace and friendship can produce chemicals that strengthen the immune system and help our bodies produce elevated levels of helpful white cells that fight disease.

Breath/Awareness

When we need to focus our attention, we suspend the breath. Imagine that you take a needle in one hand and a piece of thread in the other. Now, try to thread the imaginary needle. Did you hold your breath? Most people do! When we are calm, we breathe slowly and deeply. When we get excited, we breathe with short, shallow breaths. This breath and awareness relationship works in both directions. Breath can be unconscious and follow awareness. Or, breath can be conscious and then awareness will follow breath. The importance of this relationship for managing stress is that we can change our moods by changing our breathing patterns.

Change/Control

When we believe we are in control, we feel balanced and are capable of positive emotions. When we feel out of control, we can experience anxiety, doubt, and fear.

Change is an unalterable constant in life. There will always be change. The key to handling change and to gaining control is to develop what mental health professionals call an “internal locus of control,” namely, a control over the self and the ability to have an internally generated sense of stability as opposed to relying on outer cues for our sense of control.

People who have an “external locus of control” seek to arrange life to their liking. They spend time, energy, and effort in a futile attempt to keep life from changing.

Solitude/Gregariousness

Psychological research maintains that people have two main conflicting needs: solitude and gregariousness. Most of us spend the majority of our time with others. We are often afraid of, or neglect, time alone. Taking time to be alone with our thoughts and feelings gives us insight into who we are and what matters to us.

Techniques

Review the Dynamic Pairs and examine how they impact your life, and your attitude toward each of them.

Become aware of the relationship between:

• thoughts and body responses,

• breath and awareness,

• internal and external locus of control, and

• balancing time alone and time with others.

Goal

The goal of analyzing Dynamic Pairs is help you to:

• Understand that subtle connections exist between different parts of your life.

• Understand that perception is relative to the observer and, as Einstein told us, relative to the point of observation.

• Take enough time alone to become acquainted with personal plans, motivations, and dreams.

Assignment

Take some time alone to think about your overall plans. Begin to list your priorities and goals.

Suggested Reading

Solitude: A Return to the Self, Dr. Anthony Storr, M.D., Ballantine Books. 1988, reprinted 2005.

“All is flux nothing exists but change.”- Heraclitus

Section 5: The BREAD Formula – Breathing & Belief System

Breathing:

Problem

Chest breathing contributes to stress through habituated sympathetic dominance. It is a less efficient way to breathe; people who use this method breathe several more times per minute than diaphragmatic breathers. Most people use chest breathing regularly. How we breathe affects how we think, feel, and our ability to concentrate.

Cause

The most common cause of improper breathing is habit. Another cause is vanity. Having our stomach protrude makes us feel and look fat.

Cure

The cure for improper breathing is awareness and practice. Recognizing your normal breathing pattern allows you to begin to develop correct habits. Breathing occurs naturally and without conscious effort. We can also override the automatic nature of breathing and consciously guide our breath. With enough practice, we can alter chest breathing to become diaphragmatic breathing.

Techniques

Learn and practice these breathing techniques:

Diaphragmatic Breathing (DB)

The diaphragm is a dome-shaped muscle located at the bottom of the chest cavity. It separates the chest and the abdominal regions. When we keep our stomach muscles tight while we breathe, we force the diaphragm up into the chest cavity, restricting lung capacity. People who use diaphragmatic breathing use the entire lung, including the most efficient lower one-third. This allows them to breathe fewer times per minute. Each breath you save per minute amounts to 525,600* fewer breaths annually. If you breathe 5 times less per minute, you will breathe over 2 1/2 million times less in one year than you did before.

When you breathe less, your heart and lungs work less. This lowers pulse rates and, in many cases, blood pressure, and helps you calm down.

• 60 minutes per hour x 24 hours per day x 365 days per year = 525,600*

How to Practice DB

• Sit on the edge of a chair with feet apart and hands on knees.

• Wear loose clothing.

• Inhale, allowing the stomach to expand.

• As you exhale, gently contract the stomach muscles to help expel air.

When to Practice DB

You can change your body responses by consciously changing your breathing patterns.

• As many times as possible during the day, check your breathing.

• During quiet times and breaks, practice DB.

• When you are under pressure and you need to calm down, use DB.

Alternate Nostril Breathing (ANB)

How to Practice ANB

ANB helps to balance the brain wave activity of the two hemispheres of the brain. Gently hold your left nostril closed with your left thumb, and breathe in through your right nostril. Then immediately close your right nostril with your left ring finger and exhale evenly through your left nostril. Then, breathe in through the left, calmly close the left nostril again with your left thumb, and exhale through the right side. This is one complete round of ANB. Do about 4 or 5 rounds of this every morning and night.

Rapid Breathing

Rapid breathing is the opposite of DB. Doing a short “running in place,” walking up a set of stairs, or a few deep knee bends will quickly increase the breathing rate.

Use this method for stimulation when you feel sleepy, mentally dull, lazy, or depressed.

Goal

The goal of this section is to:

• Become conscious of how we breathe

• Train ourselves to breathe abdominally by using the diaphragm instead of the chest and shoulders

• Have corrective techniques to help bring our systems into balance when facing a problem

Assignment

Take your pulse to get your present pulse rate. Practice DB for 5 minutes and then 58 complete rounds of ANB. Then take your pulse again. This exercise will show the direct effect of proper breathing on your heart rate.

Belief System:

Problem

Not having a sense of something greater than ourselves. As C.W. Metcalf says, if we are the center of the Universe, we’re in trouble.

Cause

No affiliation or identification with a church or center of worship. No belief in God or a Universal Power. No sense of a personal relationship with God or a Higher Power.

Cure

Psychological research shows that people who have strong faith recover from disease quicker than those who don’t. Those with faith also have more resilience. This appears to tie in closely with the discussion that will follow on relationships and social support systems. Duke University’s Harold Koenig says people who participate in private religious activities appear to have a survival advantage over those who do not. (J. Gerontol. A Biol. Sci. Med. Sci. 2000 55: M400M405.)

Techniques

As appropriate, discuss personal belief systems with your patients. Encourage those who mention Church or Synagogue to continue their involvement or to reestablish the connection. For others who do not wish to include Spiritual/religious matters in their lives, encourage them to be a part of a group they believe in.

Goal

Encourage patients who have a belief in God or a Higher Power to deepen their relationship with this power. Depth of faith is the key ingredient for the salubrious benefits. A solitary faith without group involvement also works.

Assignment

Think of three or four approaches you can use with your patients to discuss the idea of their personal beliefs and how they might help them live a healthier life.

Section 6. The BREAD Formula – Relaxation Techniques & Relationships

Relaxation Techniques:

Problem

We live at a hectic pace. There are external events that are beyond our control. If not properly dealt with, these sources of stress can lead to mental and physical dysfunction and, possibly, premature death.

Cause

We put in long hours to further career goals. We bypass personal time to spend time with family and friends. We have many chores that fill our day. We’re simply worn out.

Cure

First, we must understand that effective relaxation techniques exist. Next, we must practice several until we find the ones that work for us. Many techniques help develop new lifestyle habits. Short, daily practice sessions are better than longer, infrequent ones.

Techniques

Relief from the Symptoms

Some techniques give relief from the symptoms of stress. If you have a tension headache, slow deep breathing, and gently rolling the shoulders in circular motions, often gives temporary relief. However, to cure the problem, you must identify and correct its underlying cause.

Release of the Cause Stops the Symptom

If the person experiencing stress can determine the root cause and eliminate it, often the symptoms, such as a headache, will cease. Is there a person, place, or object that causes you to have a stress reaction of worry, doubt, fear, anxiety, or hostility? Most people have a situation like this in their life.

A mental shift to quit taking the person, place, or situation personally can be an instant cure. Simply deciding not to allow yourself to have those negative responses can end the problem.

It sounds easy, and sometimes it is. Most often, however, you will have false starts. You think, “This person will not get me upset; this person will not get me upset.” Then the person appears and the habituated response returns.

Try A New Response

• Persevere and be persistent with your actions or reactions.

• Immediately gain control of your breathing deep, slow and even.

• Smile and think a pleasant thought.

• Consciously override the negative response

After your first success, your next challenge will be easier. You can’t overcome a situation if you’ve set yourself in opposition to it. Fighting often perpetuates negative situations. Overcome through substituting new positive responses for your inappropriate actions.

Relief First, then Release

Do you feel anxious, aggravated, or excited? Take long, slow conscious breaths using your diaphragm and within 23 minutes you will begin to calm down. This will give you relief from the symptoms.

Relaxation Techniques:

Meditation

The goal of meditation is to stop the thinking process. When thinking slows, the mind calms down and the body follows. Research shows that proper meditation practice can lower the pulse, blood pressure, breathing rate, and feelings of anxiety. (Herbert Benson, MD, The Relaxation Response) These benefits help us experience the recovery phase of stress management.

5 Keys to Successful Meditation

1. Regularity and consistency. If possible, meditate twice daily for 20 to 30 minutes at the same time, and in the same conducive environment.

2. Expect positive results. Have an open, receptive mind that will allow you to test the claims for yourself. Meditate daily for 6 months, and then judge your experience.

3. Maintain good physical hygiene. Overall health requires that you follow a sensible diet, practice good sleeping habits, and monitor what you read and watch.

4. Proper posture and a conducive meditation environment. Keep your posture straight and upright, and meditate in a quiet, comfortable room.

5. Proper meditation practice. Consider several meditation techniques and decide on whatever feels the most comfortable for you. Stick with your technique long enough to experience results.

Common Meditation Techniques

Five common meditation techniques include the following:

1. Watching the breath

2. Gazing at the internal light

3. Listening to the internal sounds

4. Using a mantra, i.e., mentally repeating a specific word or phrase

5. A combination of two or more of these

A Meditation Practice Session

Here is a simple meditation session to try:

• Go to your meditation spot at your chosen time.

• Sit down, and close your eyes. Relax and take two or three long deep breaths using your stomach instead of your chest and shoulders.

• Allow your breath to slow, and begin to use whatever meditation technique you have chosen. Strive for simplicity. If your mind wanders, just bring it back to your point of focus, and continue.

• After a while, your attention will begin to turn outward, and your meditation practice will be over for that session. Enjoy the silence. Relax for a few moments, and picture your ideal life. Affirm to yourself that the experiences you pictured are possible for you.

• When you have completed your inner viewing, slowly open your eyes. Confidently go about your normal activities, relaxed and refreshed by your meditation experience.

Suggestions for Successful Meditation

These suggestions can help you get the most benefit from your meditation practice.

1. Try to meditate at the same time every day. You will find it much easier to calm the mind and breath. You can enter the peak experience faster, and remain there longer.

2. Wear comfortable, loose fitting clothing that is not binding.

3. Choose a quiet, conducive atmosphere to meditate in.

4. Keep your meditation practices and experiences to yourself. Don’t allow your practice to become disruptive to your home environment.

5. Maintain an erect, comfortable posture.

6. Keep it simple. After experimenting, use the simplest process that works for you.

7. Give whatever technique you choose a 6 month test to allow yourself to become familiar and comfortable with it. Jumping from technique to technique will complicate the process, and slow your progress.

8. Don’t meditate immediately after eating. Try to allow at least an hour between meals and meditating.

9. A few minutes of light, gentle stretching before you begin to meditate will make it easier to sit still and release the stiffness of the body.

10. . After the peak experience for a given meditation session, you will naturally begin to regain body awareness, and thoughts will begin to stir. A calm mind and relaxed body provide the perfect opportunity to work on creative imagination. The left and right hemispheres of the brain are more in balance, and the door to the subconscious is more easily accessible.

11. There is a definite connection between the activity of the mind and the breath. When we are calm, we breathe in a relaxed, rhythmic way. When excited, we breathe rapidly. You can reverse the process. If you begin to breathe slower and deeper than usual using your diaphragm, it will have an immediate calming effect on the mind. If you persist in your gentle control of the breath, calmness will occur.

Meditation is a simple, natural process that gives the practitioner many benefits. Try it at least 5-7 times before judging its effectiveness.

Sleep

Sleep can help many mental and physical ailments. The mind, body, and nervous system get rest, and rejuvenate themselves through restful sleep. Drugs or alcohol can induce sleep, but they cannot induce restful sleep. That is why people taking sleeping pills often feel tired when they wake up.

The 8 Keys To Good Sleep:

Below are 8 keys to good sleep that will help improve your ability to get good, restful sleep.

1. Sleep naturally. Avoid sleeping pills unless absolutely necessary, and then only for a short time and under strict medical supervision.

2. Diet. Eating habits affect the quality of sleep. Cut back on refined sugar intake and caffeine, if possible. Eat lightly at the evening meal at least two hours before retiring. If you feel hungry at bedtime, eat a light snack with a protein/carbohydrate combination.

3. Exercise. Light stretching can be helpful, but avoid hard exercise before going to bed.

4. Read inspirational material. Reading about the significant accomplishments and heroic deeds of others inspires us. Use this time to relax, not to be stimulated.

5. Keep a notebook on your nightstand. After you have read inspirational material, review your day, and make notes for tomorrow. If you wake up during the night with something on your mind, write it down in your notebook. Then you won’t feel the need to try to remember it until morning.

6. Attitude. Studies have shown that we have a tendency to grow into whatever we believe to be true about ourselves. If your feelings about sleep are positive, you can better teach yourself to do it. Use positive affirmations to keep a good attitude.

7. Use relaxation tools. Proper breathing and meditation are useful relaxation tools. Use these tools to help you sleep better.

8. Watch your thoughts at bedtime. Be conscious of your activities at bedtime. Think only about getting ready for a good night’s sleep.

Massage Therapy

Treat yourself to a full body massage done by a professional massage therapist. Therapeutic massage can help work out muscle spasms and tension and enhance somatic awareness. It is possible to feel relaxed, but not actually be relaxed because of habitual muscle tension in the shoulders, forearms, calves, etc. Massage is good as a part of an effective program, but don’t become dependent on it as the centerpiece of your stress management program.

Goal

The goal is to find 3 or 4 relaxation techniques that work for you. When deciding which techniques to use, consider this: if the technique is easy for you to use and gives positive results, keep using it.

Choosing Techniques

Decide whether you prefer to hear, see, or touch (audio, visual, kinesthetic preference).

• Hearing people answer questions by stating, “I hear you; you’re coming through loud and clear.”

• Seeing people say, “I see what you’re saying. I can picture that.”

• Touch people say, “I can’t grasp that. I’ve finally got a handle on it. That’s a heavy question.”

Notice your own responses. With meditation, there is an approach for everyone.

• Hearing types listen to an internal sound or mantra.

• Seeing types do internal gazing.

• Touch types can focus on breath or count their breaths or mantras on fingers or beads.

Coupled with proper breathing, now add relaxation techniques to your overall stress management program that you are developing using the BREAD Formula. The techniques work. Personalize them by practicing and remembering to use them. Give them time to counteract effectively the stressors you have experienced for years. You will feel the results and see the benefits starting to show in your daily life.

Assignment

Practice some relaxation techniques you have learned. Decide which ones you will use.

Suggested Readings & Websites

• The Relaxation Response, Herbert Benson, M.D., Avon Books. 2000. www.mbmi.org (2006)

• A Master Guide to Meditation, Roy Eugene Davis, CSA Press. 1999

• Timeless Healing: The Power and Biology of Belief, Herbert Benson, MD, et al, April 1997

Relationships:

Problem

Isolation and feeling/ being alone.

Cause

The many changes in society and the family structure can contribute to a feeling of or the actual isolation from others, leading to a sense of loneliness. Reasons for isolation include the breakdown of the nuclear family, the ease and need at times to live long distances from family, and security concerns that keep people indoors. All of these can contribute to the breakdown of relationships with family and friends.

Cure

According to the American Institute of Stress, there is evidence that those with strong social support systems live longer. So, encouraging patients to stay connected and expand their circle of friends makes sense.

Techniques

Encourage patients to stay involved and in touch with friends and family regardless of the distance between them. The expense of long distance calling has fallen dramatically. Email has become ubiquitous. Suggest that patients volunteer in the community for a cause they enjoy or believe in. Mentoring is a good way to maintain regular contact with others. Church and civic groups offer opportunities for both fellowship and making meaningful contributions to others.

Goal

To have your patients maintain healthy supportive relationships with family and friends. When people feel needed and appreciated, it affects their attitude in a positive way.

Assignment

Examine your own life. Do friendships matter to you? Do you feel isolated or alone? Would more quality time with others increase your sense of enjoyment of life? These are highly personal questions. Each person should address them to determine the proper mix of being with others and time alone.

Section 7. The BREAD Formula – Exercise & Education

Exercise:

Problem

We live in a sedentary society. As Covert Bailey, author of Fit or Fat puts it, many of us are “under fit and over fat.” America has a very high rate of cardiovascular disease and hypertension.

Cause

Many of us have desk jobs, or spend a great deal of time in cars. Long commutes, late nights, and television have made us a sedentary society. Family, civic, and social duties take up so much time that few people feel they have enough time left to exercise. A 2002 study by the national Center for Health Statistic found that only 30 percent of Americans exercise regularly. That means 70 percent risk serious trouble and premature death.

According to a study released in 2005 by the American Heart Association, men and women with high blood pressure at age 50 can expect to live 5 years less than those with normal blood pressure. Additionally, those with high blood pressure will endure 7 more years of cardiovascular disease compared with their peers with normal blood pressure.

Cure

A big step toward a cure is aerobic exercise. According to Deepak Chopra, people who exercise aerobically statistically reduce their chance of cardiovascular disease by up to 50%.

Aerobic Exercise

Aerobic exercise is exercise “with oxygen.” Properly done, it raises your heart rate into your target zone, a number based on your age, for at least 20 minutes, three or more times a week. (A simple formula for estimating target rate is to deduct your age from 220, then multiply by .7 for your minimum and .85 for your maximum target rate.)

Anaerobic exercise is the opposite of aerobic exercise. This type of exercise, while important, rapidly depletes the glycogen or sugar level in the liver depleting energy reserves. An example of this type of exercise is weight lifting.

Good Aerobic Activities

Techniques

Dr. Kenneth cooper, founder of the Aerobic Institute in Dallas, ranks the top five types of aerobic exercises in order of their aerobic efficiency as follows:

• Cross country skiing

• Swimming

• Running/jogging

• Outdoor cycling

• Walking. For walking to be aerobic, its intensity and duration must be higher than that of a leisurely stroll.

The Mayo Clinic recommends several fun activities that can provide good options for aerobic exercise (www.mayoclinic.com/health/aerobic-exercise). (2006)

• Walking

• Aerobic dance

• Swimming

• Bicycling

• Cross-country skiing

• Running

• Jogging

• Aquatic exercise

• Dancing

• Stair climbing

• Elliptical training

• Rowing

Always consult a physician before you begin a new exercise program or before you increase your present program to determine the appropriateness of your contemplated exercise routine, given your age, medical condition and current level of fitness.

• Commit to making exercise a part of your everyday life. Exercise is a lifetime commitment, not a short term remedial measure. One half hour four or five days a week will produce excellent results for most people. At a minimum, try walking at least four times per week for the next year. You will feel better, be more alert, and probably live longer. You deserve it. Remember, also, that exercise is a natural appetite suppressant.

• Choose your type of exercise and block off a certain time each day. Then, like the Nike shoe commercial, “just do it!”

• Select a club or spa if you plan to use this type of facility. Most clubs and spas have professional staff members qualified to help you design a customized routine, and/or who can act as your personal trainer.

How to Begin to exercise:

• Start your routine slowly and work up to a full workout over four to six weeks or longer if needed.

• Expect some soreness in the beginning; however, your body and mind will respond positively over time to the invigoration of regular exercise.

• Don’t overdo it. Have a written, sensible, moderate routine and schedule. Then stick to it. Make progress, not excuses.

• Choose an exercise you will enjoy. Don’t let exercise become another source of stress through drudgery. This is very important. Choose something to look forward to rather than something to find excuses not to do.

• Do a variety of exercises. Consider taking aerobic classes in the winter and swim in the summer. Jog or walk in the spring and fall.

• Try exercising with a noncompetitive partner. You can add enjoyment to exercise by scheduling regular intervals to exercise with friends or sharing rides to your health club.

S.A.F.E Exercises

A balanced exercise routine includes Strength, Aerobic, and Flexibility Exercises (SAFE).

• Strength (light weight training) exercises maintain muscle tone and bone density.

• Aerobic exercises are for the heart and lungs.

• Flexibility (like stretching or Hatha Yoga) exercises are for the joints, tendons and muscles.

Goal

Health, vitality, and longevity are the goals and benefits of a balanced, consistent exercise program. Sleep better, lose inches and/or weight, more stamina. Isn’t that exactly what we’re after? Start exercising!

Dr. Jorge Rios, M.D., a cardiologist in Washington, D.C., lists more than a dozen benefits for those who exercise aerobically. They include providing you with “a feeling of greater wellbeing by relieving stress and tension.” and “improving heart efficiency.”

Assignment

If you already exercise, review the duration, intensity, and frequency of your present program and adjust it if necessary.

If you don’t exercise, get a physical before you begin. Discuss your current weight and level of physical conditioning with your doctor. Ask for suggestions on what type of program your doctor feels would be good for you.

Don’t overlook beginning exercise programs offered by your local civic groups, hospital, community college, or university. There are many good ones available. There is something right for you.

Suggested Reading & Website

• The New Aerobics, Dr, Kenneth Cooper, M.D., Bantam Books. 1982

• www.cooperinst.org This is the web site for Dr. Kenneth Cooper. 2006

• The Aerobics Program for Total Well Being: Exercise, Diet, Emotional Balance, Kenneth Cooper, Reissue Edition, 1995

• Controlling Cholesterol the Natural Way, Kenneth Cooper, September 1999

Education:

Problem

What we don’t know CAN hurt us. Ignorance is not bliss if it leads to stress, illness, and premature death.

Cause

The media, through its various outlets, contributes to ignorance at times through misinformation, partial information, or premature release of information. Possible cures and new drug applications make catchy headlines. Consumer sources of information often only give part of a story. And individuals accept or rely on questionable sources for medical and health information, and are often willing to try unproven therapies in hopes of relief, cure, or youth.

Cure

Educate yourself about health and wellness. The more you know and put into practice, the better your chances to live a long and vibrant life.

Techniques

Suggest reliable sources of health and medical information to your patients. If possible, have specific flyers, brochures or reprints of articles for specific ailments or situations. Have a sheet of Frequently Asked Questions (FAQ) that you can hand out to patients. Make a “resource list” of competent suppliers, web sites, etc., for your patients.

Goal

To have better informed patients who are capable of reading and understanding information and how it relates to their health and well being. And, to help patients understand and recognize what isn’t good information, and how misinformation can be detrimental to their health.

Assignment

Assemble the handouts, information sheets and resources that you will begin to share with your patients.

Section 8. The BREAD Formula – Activity & Attitude

Activity:

Problem

A sedentary lifestyle has negative health implications. Obesity is pervasive in American society. Those in poor physical condition are more susceptible to heart disease.

Cause

Modern conveniences make it easy to be sedentary: elevators and escalators lift us to our destinations. Cars transport us in comfort and ease. Many appliances remove the physical work portion of the task. We have power lawn mowers, automatic washers, dryers, and dishwashing machines. The remote control removes the need to get up to change channels.

Cure

Make movement an integral part of your lifestyle. Reacquaint yourself with the joy of using your body. You don’t have to be a professional athlete or dancer to enjoy motion. Avoid the easy way.

Techniques

Take the stairs and not the elevator. Park farther away and walk to your destination. Take walks in the morning or evening. Play catch with the kids. Practice bouncing a basketball for coordination. Squat down to pick something up. Walk across the room to change channels at least part of the time. Look for ways to put motion and activity back into your daily routine. Incorporate several short, gentle stretching times during the day.

Goal

Add to your metabolic rate and overall physical conditioning by adding motion and movement back into your life (and your patients’ lives).

Assignment

Make a list of 10 ways you can add movement back into your routine. Then begin to incorporate them into your life.

Attitude:

Problem

• Weariness, frustration, and conditioned attitudes

• The mind, when tired, has difficulty remaining alert, focused, and positive. This can cause errors in judgment or action that results in failure or delayed success. A negative attitude usually limits enjoyment.

Cause

The drudgery of routine, feelings of being trapped in a career or relationship, and a lack of a meaningful challenge can dull the mind.

Routine Tasks

Repetitive tasks can become unconscious actions. When they do, we can feel like a robot. When we quit paying conscious attention to the present moment, we risk loss of control to the subconscious. Some people suffer from Type A Behavior. This includes risk factors which statistically increase the chance that the affected person will contract cardiovascular diseases.

Type A Behavior

Some people suffer from Type A Behavior. This describes risk factors which statistically increase the chance that the affected person will contract heart disease.

Common characteristics of Type A Behavior include:

• Ambition

• Competitiveness

• Time urgency

• Anger

• Hostility

Recent research by Dr. Redford Williams, a Duke University psychiatrist, states that ambition, competitiveness, and hurry do not put you at risk unless you couple these factors with anger and hostility.

Cure

If you are a natural optimist, continue to cultivate this.

Cultivate Optimism

If you are a pessimist, train yourself to become a “flexible optimist” as Dr. Martin Seligman, a University of Pennsylvania psychologist, calls it, in his book, Learned Optimism.

Techniques

In his research on “Optimal Experience or Flow,” Dr. Mihaly Czikszentmihalyi, a psychologist at Claremont Graduate University, calls for an ever-increasing balance between skill and challenge to keep life interesting, and forces us to improve.

PSYCHOLOGY OF OPTIMAL EXPERIENCES (FLOW)

EXPLANATION OF GRAPH:

If a job or assignment is low in difficulty and you have a high skill level you will be bored; if you have a very difficult assignment and you are not qualified, you will be very anxious. When job requirements and personal skill levels match, there will be satisfaction and inner contentment.

Understand Your Motivations

• Become a personal scientist, capable of understanding your true motivations and able to predict accurately the outcome of specific actions.

• Become consistently conscious of the present moment. It is the only certain time you have. The past is history. The future is a wish or a dream. Now is real.

Success Comes In Cans

Set Priorities and Goals

Periodically, take two uninterrupted hours to write, then review and revise your list of personal priorities and goals. Daily and weekly, take time to review your schedule and accomplishments. Everyone who desires success and fulfillment needs an overall strategy. Priorities tell us what our top desires are. Goals show us how we will realize our priorities. And our planning Time tells us when and how long we will work on our goals so that we realize our priorities.

Simplify Your Life

• Consolidate and simplify your life. Drop or combine activities.

• Ask yourself, “What can I do less of? What can I do without? What would happen if I didn’t do this at all?” Often, nothing happens because the behavior was an unnecessary habit or ritual.

Get Organized

Work on personal organization. When everything has a place and everything is in its place, we don’t waste time looking for things. As a result, we don’t become frustrated or angry as easily or as often.

Be Optimistic

Practice optimism by having an underlying confidence that happiness and fulfillment are reasonable goals and that life is a gift worth living. If this is a challenge, read Dr. Seligman’s book Learned Optimism. This book alone could change the world if everyone would read it.

Learn from your Failures

• Allow yourself to fail without condemnation. Learn from the lessons of failure and turn them into positive actions that will help you succeed the next time.

• If you make the same mistake in the same way several times, seek help. You may be missing or denying an important variable in the success equation.

Remember to Laugh

• Keep a sense of humor. Seeing the lighter side of life helps our immune system.

• Read the comics. Listen to comedians. Tell jokes. Think of funny situations you have found yourself in and laugh about them.

Recognize a Chemistry of Choice

Monitor your thoughts. We have a chemistry of choice. Every thought has chemical consequences and every emotion has an approximate chemical equivalent. When we are angry or upset, we produce chemicals that weaken us. What and how we think affects us.

Goal

The goal is to make the mind the primary positive force in maintaining an effective stress management program. Guard against self-sabotaging behavior.

Alignment

Strive toward alignment. This means what you feel, think, say, and how you act all work in harmony toward a common, successful conclusion.

Assignment

• Set aside one or two hours within the next two weeks to write or review and revise your list of priorities and goals. Look at all aspects of your life: spiritual, mental, emotional, physical, financial, social and family. Allow for personal time, family time, professional time, spiritual time.

• Honestly answer the question, “Am I an optimist?” Act to strengthen or change your attitude.

• If you feel headed toward, or are now in a job or relationship burnout, come up with three or four practical ways to improve the situation.

• If you feel overwhelmed, confused, or in need of another opinion, seek professional help regardless of your position.

Dr. Steven Covey suggest that we look at managing our time this way:

TIME MANAGEMENT MATRIX – HABIT 3

EXPLANATION OF COVEY:

Do 1; think about doing 2 when time allows; consider 3; ignore 4.

Suggested Readings & Websites

• Flow: the Psychology of Optimal Experience, Mihaly Csikszentmihalyi, Ph.D, Harper & Row. 1991

• Learned Optimism, Martin E. P. Seligman, Ph.D. Knopf Publishers. 1998. www.authentichappiness.sas.upenn.edu 2006

• The Trusting Heart, Redford Williams, M.D., Times Books. 1991. www.williamslifeskills.com 2006

• You Just Don’t Understand, Deborah Tannen, Ph.D., Ballantine Books. 2001

• How to Get Control of Your Time and Your Life, Alan Lakein, Signet Books. 1989

• The 7 Habits of Highly Effective People, Stephen R. Covey, A Fireside Book, 1989

• Creativity: Flow and the Psychology of Discovery and Invention, Mihalyi Csikszentmihalyi, June 1997

• Beyond Boredom and Anxiety: Experiencing Flow in Work and Play, Mihalyi Csikszentmihalyi, April 2000

• The Optimistic Child, Martin E. P. Seligman, September 1996

• Learned Optimism: How to Change your Life, Martin E. P. Seligman, Reissue Edition, March 1998

• Lifeskills, Redford Williams, May, 1999

• Talking from 9 to 5: Women and Men in the Workplace, Deborah Tannen, Reprint Edition, September 1995

• I Only Say This Because I Love You, Deborah Tannen, May 2001

Section 9. The BREAD Formula – Diet & Determination

Diet:

Problem

• Excess weight

• Lack of energy

• Poor eating habits

• Food addictions

• Inadequate nutrition

Fasting

Fasting or skipping meals to lose weight is like not putting fuel into your car. You can go until your tank runs dry and then the car stops. When we fast or skip meals, we run on reserves. We don’t just burn fat; we burn muscles as well, and the metabolism all but stops.

Weight Loss

Weight loss is a function of the efficiency and the rate of our metabolism, our total caloric intake, and level of activity/exercise output. Regular exercise, combined with moderately reduced caloric intake, is a sensible way to lose fat and keep it off.

Cause

Often, the cause is “the hand gland”; we simply eat too much. We live to eat instead of eating to live.

Improper Nutrition

Ignorance of proper nutrition is another reason people are too thin or too fat, or contract diet related diseases. Certain foods, because of the way, time, or circumstance, under which we eat them, can cause psychological dependency. Others, like caffeine, can cause addiction.

Cure

Learn about proper nutrition. Understand the effects that certain foods have on our system, energy levels, attitude, and self-discipline.

Healthy Diet

A healthy diet for most people who don’t have specific allergies is a diet that is:

• high in complex carbohydrates (starches);

• moderate in protein; and,

• low in fat (less than 25% of total caloric intake). Saturated fats, those which are solid at room temperature, are considered major culprits related to heart disease. “Partially hydrogenated products” are also bad. A balanced, sensible diet is a strong defense against stress and disease. Proper nutrition also encourages high energy levels.

Techniques

Before you alter your present dietary routine, consult your physician. Make certain that what you plan to do makes sense. Many fad diets are worthless and some are harmful. If you are familiar with nutrition, calories, fats, carbohydrates, and protein, examine your present diet for proper balance. Try the following:

• Eat less.

• Chew your food well.

• Drink little or no liquid with meals.

• Avoid snacks.

• Drink water.

Goal

Find a diet that:

• Fits your needs

• Allows you to maintain your ideal body weight

• Gives you energy and vitality

Assignment

For two days, write down every bit of food and beverage you intake. Determine how many calories you averaged each of those days. Break down the calories into proteins, fats, and carbohydrates. Calculate what percentage of total calories came from proteins, fats, and carbohydrates. (There are 4 calories in each gram of protein or carbohydrate and 9 in each gram of fat.)

Check the percentage of your diet against the recommended percentages of:

• carbohydrate: 50%

• protein: 25%

• fat: 25%

Suggested Readings & Websites

• The New Fit or Fat, Covert Bailey, Houghton Mifflin Company. 1991

• Reversing Heart Disease, Dean Ornish, M.D., Random House. 1990

• www.covertbailey.com (Covert Bailey) 2006

• http://www.webmd.com/content/pages/4/3080_453 (Dean Ornish, MD) (2006)

• www.drsears.com (Dr. Barry Sears – The Zone Diet) 2006

• Smart Exercise: Burning Fat, Getting Fit, Covert Bailey, January 2001

• Eat More, Weigh Less, Dean Ornish, MD, Revised Updated Edition, December 2001

• The Glucose Revolution, Helen O’Connor, et al, 2000, Marlow and Company

New Books

• The Complete Fit or Fat Book: The Phenomenal Program that Successfully Guides You from Fatness to Fitness, Covert Bailey & Lea Bishop, 2005

Determination:

Problem

If at first we don’t succeed with our diet, exercise, or educational programs, etc., many of us don’t try again. We then do not realize our priorities. We can feel like failures, and this can lead to a negative, psychological, downward spiral.

Cause

Most change isn’t easy. We want magic bullet cures, but few exist. We lose weight through fewer calories ingested and more expended. We don’t want to hear that. We have difficulty or find it impossible to follow through to make permanent weight loss or improved health a reality. We all have time pressures, family, business, and financial concerns. We know stress is a problem, but the solutions often appear equally daunting.

Cure

Everyone digresses at some point. Forgive yourself if you get off track. Just get back on your plan quickly. Become a hardy person. Resilience in the face of adversity builds the strength to endure.

Techniques

Have a written plan that clearly details what your hopes and dreams are. Commit to the attainment of those hopes and dreams. Recommit every time you digress. Break down your plan

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