Jill Schoeneman-Parker, Psy.D.

Licensed Clinical Psychologist

Stress Management

What each of us experiences as stressful may or may not be viewed similarly by others. This does not invalidate your perception of an event as stressful. Who you are and your prior experiences greatly influences how you perceive and cope with a given situation.


What is stress? When you hear the word “stress”, what do you think of? Probably not something that good. What if you could see stress as neither a good nor a bad thing. Could you try thinking of it as energy and motivation as well as pressure of (possibly) an obstacle. In some situations, stress can be a positive and productive experience. However, when too many demands from the world or ourselves are present and not enough skills to cope with such stressors exist, this is when we feel overwhelmed and out of control. It is at this point people typically recognize they are feeling stressed. Imagine being able to intervene before the meltdown-- yours or your child's!


Coping can be defined as an effort to master, tolerate, or reduce environmental demands and conflicts which tax a person’s resources. Coping involves an array of behaviors through which individuals can prevent, alleviate and respond to stress-inducing experiences or circumstances. This often includes a process of analysis and evaluation to decide how to protect oneself against the adverse effects of any stressor and its associated outcomes.


Stress and Coping is not a linear process, but much more like a see-saw


What can I do about stress?

Prevention is something done to eliminate a stressor or stop it from becoming a source of distress.


Relief is something done to help dissipate or overcome stress that already exists.·


Think about your family of origin, culture, and religion. You may have developed a certain style of coping—and you may not know it. Do you use humor? Complaints? Ignoring it? Think about and identify your best prevention or relief strategies. They may work great-- or not as well as they once have.


Effective coping involves developing ways of thinking and behaving that either neutralizes the stress-provoking potential of stressor or helps the individual develop resistance or immunity to negative stress outcomes and consequences. The approach we take to overcoming stressors needs to evolve and adapt as we mature and experience new phases in our lives.


Stress management techniques:

Cognitive techniques (to learn with a therapist-- often inclue but are not limited to approaches like positive thinking, slow breathing, progressive muscle relation exercises, visualization exercises, compartmentalizing, distracting)

journaling

art

writing

meditation

biofeedback

exercise

yoga

social support systems

self nurturing

spirituality and prayer


These are some suggestions for coping with stress. Try them. If you find that one isn’t working for you, try another. However, if you’re finding that after several approaches you are still feeling stressed, this may be time to speak with a licensed professional therapist for additional

help. One additonal approach I use with my clients is developing and recording individualized relaxation exercises. These can then be downloaded onto an MP3 player and used to practice these exercises at home- or whenever the feelings of stress and anxiety return.

OCD

The first step in treating Obsessive-Compulsive Disorder (OCD) is educating the patient and family about OCD and its treatment as a medical illness. During the last 20 years, two effective treatments for OCD have been developed: cognitive-behavioral psychotherapy (CBT) and medication with a serotonin reuptake inhibitor (SRI).

  • Many family members feel frustrated and confused by the symptoms of OCD. They don't know how to help their loved one. If you are a family member or friend of someone with OCD, your first and most important task is to learn as much as you can about the disorder, its causes, and its treatment. At the same time, you must be sure the person with OCD has access to information about the disorder. When a person with OCD denies that there is a problem or refuses to go for treatment, this can be very difficult for family members. Continue to offer educational materials to the person. In some cases. it may help to hold a family meeting to discuss the problem, in a similar manner to what is often done when someone with alcohol problems is in denial.
  • Family problems don't cause OCD, but the way families react to the symptoms can affect the disorder, just as the symptoms can cause a great deal of disruption and many problems for the family.
  • Negative comments or criticism from family members often make OCD worse, while a calm, supportive family can help improve the outcome of treatment. Telling someone with OCD to simply stop their compulsive behaviors usually doesn't help and can make the person feel worse, since he or she is not able to comply. Instead, praise any successful at tempts to resist OCD, while focusing your attention on positive elements in the person's life. You must avoid expecting too much or too little. Don't push too hard. Remember that nobody hates OCD more than the person who has the disorder.
  • When children or adolescents have OCD, it is important for parents to work with schools and teachers to be sure that they understand the disorder. Just as with any child with an illness, patients still need to set consistent limits and let the child or adolescent know what is expected of him or her.

Stages Of Treatment


The first step in treating OCD is educating the patient and family about OCD and its treatment as a medical illness. During the last 20 years, two effective treatments for OCD have been developed: cognitive-behavioral psychotherapy (CBT) and medication with a serotonin reuptake inhibitor (SRI).

  • Acute treatment phase: Treatment is aimed at ending the current episode of OCD.
  • Maintenance treatment: Treatment is aimed at preventing future episodes of OCD.

Components Of Treatment

  • Education: This is crucial in helping patients and families learn how best to manage OCD and prevent its complications.
  • Psychotherapy: Cognitive-behavioral psychotherapy (CBT) is the key element of treatment for most patients with OCD.
  • Medication: Medication with a serotonin reuptake inhibitor is helpful for many patients.

Cognitive behavioral psychotherapy (CBT) is the psychotherapeutic treatment of choice for children, adolescents, and adults with OCD. In CBT, there is a logically consistent and compelling relationship between the disorder, the treatment, and the desired outcome. CBT helps the patient internalize a strategy for resisting OCD that will be of lifelong benefit. This is the "C" of "CBT"-- the cognitions and thoughts.


The BT in CBT stands for behavior therapy. Behavior therapy helps people learn to change their thoughts and feelings by first changing their behavior. Behavior therapy for OCD involves exposure and response prevention (E/RP).

  • Exposure is based on the fact that anxiety usually goes down after long enough contact with something feared. Thus people with obsessions about germs are told to stay in contact with "germy" objects (e.g., handling money) until their anxiety is extinguished. The person's anxiety tends to decrease after repeated exposure until he no longer fears the contact.
  • For exposure to be of the most help, it needs to be combined with response or ritual prevention (RP). In RP, the person's rituals or avoidance behaviors are blocked. For example, those with excessive worries about germs must not only stay in contact with "germy things," but must also refrain from ritualized washing.
  • Understanding the cycle from anxiety to worry to obsessive thoughts to compulsions or rituals is a critical component to the treatments. Stopping the cycle is focus in therapy.

Exposure is generally more helpful in decreasing anxiety and obsessions, while response prevention is more helpful in de creasing compulsive behaviors. Despite years of struggling with OCD symptoms, many people have surprisingly little difficulty tolerating E/RP once they get started. Cognitive therapy is a critical compnent to successful treatment. This part helps reduce the catastrophic thinking and exaggerated sense of responsibility indicivudals which othose with OCD often struggle.


ADHD

ADD/ADHD (Attention Deficit Disorder with or without Hyperactivity)is a neurological disorder involving a cluster of behaviors including problems with concentration, attention, impulsivity, and often an excessively high level of motor activity that emerges early in a child’s life and persists over time.


Diagnostic considerations:

  • Symptoms lasting 6 months or longer and severe enough to be considered problematic and inconsistent with typical development?
  • Did the symptoms need to appear before age 7?
  • Is there impaired functioning in at least 2 areas (school , sports, activities after school, occupational setting)?
  • Before a diagnosis can be give, we also need to rule out other potential problems which can look like ADHD such as Learning Disabilties, processing issues, visual/ hearing problems, Behavioral/ social issues, OCD, PTSD, depression, and anxiety.

ADHD Inattentive type (must have 6 symptoms)

  • Often fails to give close attention to details or makes careless error/ mistakes in schoolwork
  • Often has difficulty sustaining attention in tasks or play activities.
  • Often does not seem to listen when spoke to directly.
  • Often does not follow through on instructions and fails to finish schoolwork or chores. (rule out any auditory issue!) Check our processing speed and processing issues.
  • Often has difficulty organizing tasks and activities
  • Often avoids tasks which require sustained mental effort
  • Often looses things necessary for tasks (pencils, assignments, books…)
  • Often is distracted by external stimuli
  • Often forgetful in daily activities

ADHD with Hyperactivity/ impulsivity (must have 6):

  • Runs about or climbs excessively when it is inappropriate
  • Often is “on the go” and acts as if he is “driven by a motor” (rule out metabolic issues – like thyroid problems, need medical exam)
  • Often has difficulty playing and engaging in leisure activities quietly
  • Often fidgets with hand or feet (rule out anxiety)
  • Often gets of seat in classroom
  • Often talks excessively
  • Often blurts out answers/ things before questions have been competed
  • Often has difficulty waiting his turn
  • Often interrupts/ intrudes on others
  • (rule out social behavior issues like Aspergers)

What to do: Interventions and Strategies


Interacting with your child:

  • Train / coach child to build self awareness skills
  • Help try to avoid dysfunctional behaviors
  • Build up self esteem
  • Address the emotional component (being different, on medication, teasing)
  • Acknowledge the “unfairness” of ADHD and empathize
  • Help your child distinguish between the condition and his behaviors (no blame of the condition, forgive the past behaviors, help him learn to be responsible for actions and behaviors now, get help to prevent future mistakes)
  • Help child recognize “trouble” situations and actions and how to avoid them
  • Help your child develop a signal with teacher when need to go to a quiet spot, permission to listen to calming music
  • Use of manipulatives
  • Reinforce awareness skills
  • Positive feedback prioritize battles with incentives for improved behavior
  • Need high structure and routines
  • Daily rituals
  • Repetition is key
  • One behavior at a time
  • Be clear and concise
  • Give advance notice of changes
  • Include fun incentives
  • Allow the child to contribute creative embellishments
  • Don’t personalize the child’s forgetfulness and rule breaking
  • Have an “oops card” to give to your child for when he messes up—easier to tolerate this feedback.
  • ADHD kids cannot stay home alone

Set specific goals

Provide clear rewards

Keep using reinforcements


In the environment at school or at home/ bedroom:

  • Gentle colors are less over-stimulating.
  • Decrease clutter- reduce distracting hanging objects.
  • Smell is the only sense with direct access to our limbic system (our neuro-emotional center) smells impact endorphins and feelings of well-being.

           Vanilla- helps with anxiety

            Lemon is good in winter to combat blahs

           Rosemary and eucalyptus are good for alertness and focus and attention

           Peppermint and cinnamon enhance learning and mental alertness

           Lavender is relaxing even mildly sedating.

  • Incorporate music and sound with a purpose:
  • White noise and river/stream sounds low in the background help offset the extraneous stimuli in background. Low music during independent work time. Drumming or more intense music can be good for breaks (higher energy)
  • Music impacts heart rate, stress levels, and hormone

At school

  • ask to have your child seated near the teacher
  • use small groups
  • keep assignments into sections/ segments
  • use behavior charts to track progress
  • ask to have the teacher reinforce positive efforts
  • emphasis on organization skills
  • put in writing to the school social worker your requests.