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 related Medical costs $1 billion $150 billion lost productivity Immune: colds infections, HA GI disorders: irritable bowel, colitis Sleep disturbances, fatigue, hormone Depression, anxiety, emotional disorders Cardiovascular: BP, heart attacks, palpitations, stroke Major contributing factor to family discord and violence Major contributing factor to 6 leading causes of death in USA CAD, cancer, respiratory diseases, accidental injuries, diabetes suicide

"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 Diseases Depression Diabetes Heart Disease High Blood Pressure Poor Immune System Respiratory Disease Ulcers

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 Effectiveness of Performance 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 LowHigh 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 Response Our 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 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 defense against 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… o I am relaxed o Calm down o I am competent o One thing at a time o I can do this o My best is good enough o I am enough o I am calm and relaxed o It’s okay to make mistakes Repeat Until You Feel Calmer Take a deep breath in and as you exhale think of a calming word or phrase such as… o I am relaxed o Calm down o I am competent o One thing at a time o I can do this o My best is good enough o I am enough o I am calm and relaxed o It’s okay to make mistakes Repeat Until You Feel Calmer Minutes to Relaxation

Heart Math: emWave program Heart 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 Performance Good 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 PATIENTS o Work with patients with diseased hearts - heart transplant waiting list o End-stage Congestive Heart Failure o 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 STUDY o 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 HRV o 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 wellness 3 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

Mindfulness 15 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 way 2.If you really cared you would… 3.I am not as smart and attractive as she is 4.He makes me so mad 5.I can’t understand it 6.I’m getting nervous 7.I’ll disappoint them and let them down 8.I’m not good enough 9. I’ve never been any good at this 10.I’ll never do this right 11.Everything depends on this 12.If I don’t reach that goal, it will be terrible 13.If others disagree with me, I must be wrong 14.He ought to know what I’m feeling 15.It must be my fault 16.I will never get it done in time 17.If I don’t get good grades, my future is ruined 18.I’m not BYU material 19.I’m so stupid 20.I should be more like… 21.S/he would never go out with me 22.I hate it when… Tension Reducing Statements 1.It is not worth getting upset over 2.My best is good enough 3.I can handle it 4.It’s okay to make mistakes 5.I am enough 6.It is okay to be me and to feel the way I do 7.I’ll compare myself with myself and not others 8.Worry won’t help solve the problem 9.I can do what I can do and that is all 10.I am a fallible human being 11.I’ll survive 12.I’ll do what I can under the circumstances 13.Five years from now, who will care 14.The Lord will support me in my trials 15.No one can be loved by everyone 16.Being different doesn’t make me less than others 17.What is the worst thing that can happen 18.One thing at a time 19.It is not requisite that I run faster than I have strength 20.I can figure this out 21. I am a smart woman/man and can do this

Change Your Brain Telomeres: 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 Recording caps.byu.edu/biofeedback Click on Stress Management Click 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 skills Learn Skills to tolerate and manage EMOTIONS- anxiety/depression/addictions Deal with your SLEEP issues EAT well EXERCISE regularly

Coping with Stress

Paced Breathing Programs & Apps Breath-Sync Music Tracks and CD’s  Diaphragmatic breathing training video  Sample music tracks to choose Optimal rate of breathing  CD’s available for purchase EZ-Air Breath Pacer  Free for 30 days ($20 to keep it)  CD’s available for purchase Free Smart Phone Apps  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 – – 1551 WSC – (801) – Counseling and Psychological Services (CAPS) Stress Management and Biofeedback Services Website: caps.byu.edu/biofeedback Google “byu biofeedback”