Stress Management and Biofeedback for the Holidays Maureen Rice, PhD November 21, 2013 caps.byu.edu/biofeedback.

Stress Management

and Biofeedback

for the Holidays

Maureen Rice, PhD November 21, 2013

caps.byu.edu/biofeedback

HANDOUTS (see website)

• Mind/Body Connection

• Breathing• Resonant Breathing

• Basic Relaxation Skills

• Refresher Strategy• Stress Card• Thoughts & Perceptions

• Managing Stress• Deal with Anxiety• Insomnia Busters• Headache Treatment

SCRIPTURES….Relating to Stress• For it must needs be, that there is an opposition in all things…2 Nephi 2:11• Be patient in afflictions, for thou shalt have many, but endure them well…D&C 24:8• Search diligently, pray always, and be believing, and all things shall work together for your good, if ye walk uprightly…D&C 90:24• Do not run faster or labor more than you have strength and means provided…D&C 10:4• In the world ye shall have tribulation: but be of good cheer; I have overcome the world…John 16: 33

PHYSICAL AND PSYCHOLOGICAL STRESS

Constant Stress can result in a chronic state of stress in the

MIND and BODY

Negative thoughts cause unnecessary stress on the mind and

body resulting in a decrease in performance

CHANGING YOUR THOUGHTS

AND Actions

STRESS 80% stress in lives

2/3 MD stress relatedMedical costs $1 billion

$150 billion lost productivityImmune: colds infections, HA

GI disorders: irritable bowel, colitisSleep disturbances, fatigue, hormone

Depression, anxiety, emotional disordersCardiovascular: BP, heart attacks, palpitations, stroke

Major contributing factor to family discord and violenceMajor contributing factor to 6 leading causes of death

in USACAD, cancer, respiratory diseases,

accidental injuries, diabetessuicide

"When under stress, immune system cells are unable to respond to hormonal control, and consequently, produce levels of inflammation that promote disease. Because inflammation plays a role in many diseases such as cardiovascular, asthma and auto-immune disorders, this model suggests why stress impacts them as well.“

Sheldon Cohen, PhD, Carnegie Melon University

Stress and Disease Process

Blood Pressure Reactivity to Psychological Stress Predicts Heart Disease

• Carroll et al., 2012, Psychophysiology – increased blood pressure reactions to acute

mental stress predicted 16-year cardiovascular disease mortality

• Carroll et al., 2011, Psychosomatic Medicine – systolic blood pressure reactivity to stress

predicted future resting blood pressure and risk of being hypertensive 12 years later

• Carroll et al., 2003, Psychosomatic Medicine – blood pressure reactions to stress predicted blood

pressure levels 5 years later

Short Term Consequences of Stress

PSYCHOLOGICAL Anxiety/Nervousness Anger/Irritability Concentration Depression Memory Performance

PHYSICAL Fatigue Frequent Illness Gastrointestinal problems Headaches Insomnia Tense Muscles

Long Term Consequences of Stress

Auto-Immune DiseasesDepressionDiabetesHeart DiseaseHigh Blood PressurePoor Immune SystemRespiratory DiseaseUlcers

Burnout Effects of Stress

• Impaired Task Performance

• Psychological and Physical

PERFECTIONISM AND STRESS

“Perfectionism is not a quest for the best. It is a pursuit of the worst in ourselves, the part that tells us that nothing we do will ever be

good enough — that we should try again.”- Julia Cameron

Perfectionism

• Unreasonable goals

• Self worth based on achievements

• Can’t feel satisfied

• Based on comparisons with others

• Feels unloved and unvalidated unless performing well; cannot share mistakes without excessive shame

• Excessive fear of failure; chronic

• External standards for success

• Goals exceed present performance by a great degree

• Cannot find pleasure in progress toward the goal. Focus is only on the outcome

• Emphasis is on keeping life under control

Dr. Marleen Williams (BYU Counseling and Psychological Services) 

Wholeness

• Obtainable, realistic goals

• Self worth is inherent

• Can self-reward and feel satisfied

• Recognizes individual uniqueness

• Accepts self as valuable while acknowledging human weakness; does not require approval of others

• Can accept failure as a part of learning process; able to keep trying

• Goals derived from inner awareness

• Goals reflect growth to next stage of progressive development

• Enjoys the “journey” as well as the outcome

• Emphasis is on keeping life in balance

Fight, Flight, Freeze

Real Danger• Threats to life: harm

or possible death

Perceived Threats• Worries, fears, regrets, self-criticisms, negative expectations, deadlines

Physical danger triggers the stress response to make us Faster and Stronger

for Survival

Fight or Flight or Freeze

Sympathetic (flight/fight/freeze)Parasympathetic (relaxed, balanced)

Muscles: Tense Up, Poised for Action

Mind: Instinctive, Higher Thinking Shuts Down

Stress Hormones Released: Adrenalin Cortisol, Immune Repair Shuts Down

Stomach: Digestion Shuts Down, “Butterflies”

Heart Rate/BP: Speeds Up Blood Flows to Large Muscles

Breathing: Shallow and Quick

Sweat Glands: Active

Strong Emotions: Fear, Anger, Panic

Stress and Performance

Level of Stress

Effe

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s of

P

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Normal Fight/Flight Responses to Psychological Stress Overload:

Decrease in Performance

Poor Concentration & Memory

Feeling Overwhelmed (Freeze)

Avoidance of Tasks (Flight)

Giving Up (all or nothing)

Emotions: Bottled up, Erupt, Roller-Coaster (Fight or Flight)

Anxiety, Nervousness

Peak Performance

Low High

High

Yerkes-Dodson Principle Robert M. Yerkes, M.D. and John D. Dodson, M.D, 1908.  

You might try this method

Biofeedback

bi·o·feed·back  n.

The technique of furnishing information regarding an

autonomic bodily function, such as heart rate,

muscle tension, hand

temperature, or sweat gland

activity in an attempt to gain

some voluntary control

over the stress

response.

Activating our Relaxation ResponseOur inner gas pedal is automatic. We go from 0 to 60 in an instant in response to any stressor

Our mind does not differentiate danger from stress

Our inner brake is not automatic.

It takes awareness and practice to• Catch ourselves “speeding”• Develop skills to relax “at will”• Maintain appropriate cruising

speed• Make braking more automatic

3 Ways to Deal with Stress• Change the stressful situation• Change our perception of the stressful situation• Change our capacity to deal with the stressful situation

– Improve skills• Preparation and organization• Work and study efficiency• Assertiveness

– Increase body efficiency• Food• Sleep• Exercise• Relaxation: Fight tension with relaxation

Abdominal Diaphragmatic Breathing www.breath-sync.com

COACH:• Place one hand over upper chest, other over stomach

Make sure stomach moves more

• Think slow, gentle, smooth, and deep. Breathe in through your nose and Exhale through your mouth as if blowing out a candle to slow it down

• Let shoulder and chest muscles relax

• Pause before each in-breath and out-breath

• Think of your stomach as a balloon filling up with air and slowly releasing the air

• Release tension in body each time you exhale 

Breathing as a Brake

• Diaphragmatic breathing is our best defenseagainst Stress

• Slower, deeper, smoother and gentler breathing is immediately calming

• Diaphragmatic breathing brings our Stress Response System, our Gas Pedal and Brake, into balance.

• Autonomic Balance = Less Sympathetic Activation = Increased Heart Rate Variability = Calmness and Mental Clarity = Peak Performance

• Peak performance comes from the balance of the energy of the stress response and the calmness of the relaxation response

Take a deep breath in and as

you exhale think of a calming

word or phrase such as…oI am relaxedoCalm downoI am competentoOne thing at a timeoI can do thisoMy best is good

enough oI am enoughoI am calm and

relaxedoIt’s okay to make

mistakes

Repeat Until You Feel Calmer

Minutes to Relaxation

Heart Math: emWave programHeart Rate Variability (HRV) Breathing/Biofeedback

• HRV is the beat to beat change in Heart Rate (HR)– HR speeds up as inhale and slows down as exhale

Calmness & Peak PerformanceGood heart Health

• HRV is decreased by shallow, fast breathing, anxiety, stress, negative thoughts

and emotions

• EASY-AIR PLUS

Strategies to Improve Heart-Brain Health Christine Moravec, PhD

Cardiac Physiologist Cleveland, Ohio Heart Clinic - Department of Cardiovascular Medicine Molecular Cardiology Center for Integrative Medicine

Michael McKee, PhD Psychiatry and Psychology, Cardiovascular Medicine PATIENTSo Work with patients with diseased hearts - heart transplant waiting

listo End-stage Congestive Heart Failureo Breathing 18+ BPM (normal 12 BPM), SOB, enlarged heart, no

energy, weak stiff heart muscle, cardio-pulmonary edema fluid accumulation, poor contractility for pumping action – only hope is transplant

STUDYo Study with 27 pre-teen–elderly patients, 11 outpatients, 16

inpatients (congenital and diseased hearts)o All taught to breath 6-8 BPM, 20 minutes for 3 months, to

increase HRVo Retrieved failed hearts after transplant to study muscle striations

– focus on 16 different individual muscles for contractility, relaxation and response to chemical stimulation

Research

RESULTS (unpublished)o Improvement and some degree of reversal on cellular, muscular and molecular level as seen on muscles on inside surface of left ventricle (muscle contractility and relaxation)

o Nearly half of 27 patients able to regulate HRV to improved wellness3 were removed from the heart transplant list

o Biofeedback training better than failing heart and heart on LVAD heart pump (left ventricular assist device)

o Improved cardiovascular flexibility

o Improved clinical status, quality of life and disease reversal

o Promising direction in causing some degree of disease reversal

o Continued studies with CAD (Coronary Artery Disease), Diabetes, MS measuring blood markers and HRV

Mindfulness15 Second Refresher

• Become present moment to moment• Slow down – awareness of

thoughts/actions• Non-judgmental• Non-reactive• Decrease own internal harsh dialogue• Calmness • Mental Clarity• Peak Performance

Changing Thoughts and Perceptions

Tension Producing Statements

1. I should not feel this way2. If you really cared you would…3. I am not as smart and attractive as she is4. He makes me so mad5. I can’t understand it6. I’m getting nervous7. I’ll disappoint them and let them down8. I’m not good enough9. I’ve never been any good at this10. I’ll never do this right11. Everything depends on this12. If I don’t reach that goal, it will be terrible13. If others disagree with me, I must be wrong14. He ought to know what I’m feeling15. It must be my fault16. I will never get it done in time17. If I don’t get good grades, my future is ruined18. I’m not BYU material19. I’m so stupid20. I should be more like…21. S/he would never go out with me22. I hate it when…

Tension Reducing Statements

1. It is not worth getting upset over2. My best is good enough3. I can handle it4. It’s okay to make mistakes5. I am enough6. It is okay to be me and to feel the way I do7. I’ll compare myself with myself and not others8. Worry won’t help solve the problem9. I can do what I can do and that is all10. I am a fallible human being11. I’ll survive12. I’ll do what I can under the circumstances13. Five years from now, who will care14. The Lord will support me in my trials15. No one can be loved by everyone16. Being different doesn’t make me less than others17. What is the worst thing that can happen18. One thing at a time19. It is not requisite that I run faster than I have

strength20. I can figure this out21. I am a smart woman/man and can do this

Change Your BrainTelomeres: Clock of Cell Health

• Mindfulness and relaxation strategies change the physiobiology of your brain

• Telomeres are protective caps at the ends of our chromosomes (like plastic caps on shoe laces)

• Telomere shortening plays an important role in human disease and mortality, affecting our cardiovascular disease (strokes, heart attacks), diabetes, cancer, osteoporosis, arthritis, cognitive functioning, dementia

• Long telomeres are related to healthy aging and overall longevity, improved health

• Healthy eating, exercise, reduced stress levels

Stress Management and Biofeedback Services

Relaxation Recordingcaps.byu.edu/biofeedbackClick on Stress ManagementClick on Relaxation Recordings 

Stress Busters for Resilience• BREATHE diaphragmatically, consciously, calmly• Mini RELAXATION of your mind and body - NOTICE

TENSION in the moment and release it• DEEPLY RELAX once a day (before bed is helpful)• Do something you find soothing

– Use Refresher strategies – 15 Second Refresher– Try Mindfulness practice or relaxation recordings– Take breaks for rest and fun

Develop realistic EXPECTATIONS - Seek EXCELLENCE instead of Perfection

Prioritize – improve TIME MANAGEMENT skillsLearn Skills to tolerate and manage

EMOTIONS-anxiety/depression/addictionsDeal with your SLEEP issuesEAT wellEXERCISE regularly

Coping with Stress

Paced Breathing Programs & Apps

• Breath-Sync Music Tracks and CD’swww.breath-sync.com

Diaphragmatic breathing training video Sample music tracks to choose Optimal rate of

breathing CD’s available for purchase

• EZ-Air Breath Pacerwww.bfe.org/ez.htm

Free for 30 days ($20 to keep it) CD’s available for purchase

• Free Smart Phone Apps

www.mybrainsolutions.com My Calm Beat Breathe 2 Relax t2health.org

Biofeedback Apps

• Inner Balance: $99– emWave HRV program for tablets and smart phones– Heartmathstore.com

• Stress Doctor: $4.99– HRV app for I-phone (not yet on Android)– measures heart rate and shows graph of

heart rate variability

• My Calm Beat: $79.99– Calculates personal breathing rate for optimum balance– MyBrainSolutions.com

• Sleep Time: $1.99– Evaluates sleep cycles and quality of sleep– Azumio.com

Thank you!Don’t forget to smile!!!

Contact Information

Maureen Rice–[email protected] – 1551 WSC– (801) 422-3035– Counseling and Psychological Services

(CAPS)

Stress Management and Biofeedback Services Website: caps.byu.edu/biofeedbackGoogle “byu biofeedback”