2. What we will talk about in this session…
How to recognize when and why I’m stressed
Why do people who use tobacco crave it when they are stressed
Using a variety of stress management techniques to reduce the urge to use tobacco
Relaxation Response – three techniques

3. Discussion Thoughts on Former Tobacco Users Night
How are you doing with your personal plan
What good things have you noticed?
How have you rewarded yourself?
Triggers – how do you cope?

4. Understanding Stress What is stress?
What is a stressor?
What happens during the stress response?
“ Fight or Flight”
Page 65 of participant manual
Ask the group participants what their definition is for stress and stressors. Then build on their definitions as below.
What is stress? The mind and body's response to challenges and threats. Threats may be real, imagined or anticipated.
• Stress is a change that we have to adapt to.
• Stress comes from both good and bad things that happen to us.
• When we are not sure how to handle these events or situations or how they will work out, we worry and feel stressed.
• Some stress gets us going and gives us things to do (i.e. a list of things to do).
• Other stress makes us feel like we are overloaded and unable to cope (i.e. lots of bills to pay).
• It is how we respond to stress that can negatively affect our lives.
• The things that cause one person stress may not cause another person stress. Your reaction to stress
affects your health, both mentally and physically.
What is a stressor?
A stressor is a situation or event which presents you with the real or imagined challenge or threat.
What happens during the stress response?
All the physical changes as your body gets ready for you to “fight for your life or run for you life”.
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5. The bodies reaction during a stress response
Increased heart rate and blood pressure
Increased or rapid breathing
Increased sweating
A sudden rush of strength “ adrenaline rush”
Slowed digestion
Dilated pupils
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6. Stress and tobacco use
Why do people who use tobacco crave it when they are stressed?
Why does using tobacco seem to relieve stress?
How does using tobacco cause the body stress?
Pg 66
Each time an individual starts to go into withdrawal they experience symptoms that make them uncomfortable – they have a cigarette, or a dip of smokeless tobacco, and with the hit of nicotine they quickly feel better as withdrawal disappears. Over time this cycle of going into and out of withdrawal reinforces the perception that using tobacco helps them deal with stress.
What happens during a smoke break? The person takes a break from work and usually goes outside. They are doing some relaxed deep breathing (even though they are inhaling cigarette smoke), often visiting with someone else, and distracting themselves from the stressor.
What if they do these things without tobacco?
From a physical point of view using tobacco actually causes increased stress – nicotine increases heart rate, and blood pressure, making the heart work harder. When the heart works harder it requires more oxygen; however, if they are smoking the carbon monoxide they are inhaling reduces their ability to absorb oxygen placing their body under extra stress. 47

7. Personal Stress Awareness
Pay attention to:
Your usual reactions to stress
What are your usual stressors
Stop and decide how you are going to manage
Pg 68 47

8. Ideas to replace tobacco to cope with stress
Physical Activity and Eating Healthy
Get organized
Spend time outside in nature each day
Make time for things you like to do
Practice Relaxation Exercises each day
Other ideas?
Use this as an opportunity to get participants to share ideas on how they can, or have, replaced tobacco in coping with stress
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9. 4 major ways to manage stress
Alter stress – remove the source by changing something
Avoid stress
Change the way your perceive the stressor or yourself
Accept the stress by building your resilience
Pg 69 through 70
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10. Alter stress Time management Planning Organizing Direct communication
Modify demands
Be more assertive
Time Management, Planning, and Organizing – don’t sweat the small stuff, and manage more efficiently
Direct communication and Modify demands – clarify expectations and what you are able to be accountable for – i.e. if you need this done what are our priorities and what can wait?
Be more assertive – links to the last two, you can be positive/respectful but still clearly identify what you can and cannot do.

11. Avoid Stress Walk away from conflict Let go of “baggage” Say “no”
Delegate other tasks
Withdraw from situation
Know Your Own Limits

12. Change Your Perceptions
Change unrealistic expectations or beliefs
Build Your Self Esteem
Use Humour, and keep a positive attitude
Reframe how you perceive the stressor

13. Accept Stress and Build Resilience
Adequate sleep and Healthy Diet
Physical Exercise – minimum 150 minutes per week
Practice Relaxation Techniques
Take medication as prescribed
Take time for Mental Health
Social interaction
Find Ways to Nurture Yourself
An optional video which can be used if time permits is Dr. Mike Evans video 50

14. Relaxation Practice Set aside time each day to practice
Don’t practice when you are sleepy
Choose a technique which appeals to you
The best one is the one which fits with you
Starts page of participant manual

15. Relaxation Response Sense of Calm Relaxed Muscles
Lower Blood Pressure and Heart Rate
Clear thinking
Slower breathing
Comfortable Digestion
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16. 3 Techniques Deep Breathing Progressive Muscle Relaxation
Visualization
Others?
Use this opportunity to provide an overview of each of the three techniques: deep breathing, progressive muscle relaxation, and visualization.
Ask participants which one they would like to try as a group – and then practice one technique
If time permits ask if participants have used another technique they personally like i.e. mindfulness, meditation, yoga, etc
Deep Breathing:
With its focus on full, cleansing breaths, deep breathing is a simple, yet powerful, relaxation technique. It’s easy to learn, can be practiced almost anywhere, and provides a quick way to get your stress levels in check. Deep breathing is the cornerstone of many other relaxation practices and can be combined with other relaxing elements.
1. Sit in a comfortable chair, arms at sides, feet uncrossed.
2. Note any tension or tightness in your muscles.
3. Relax your neck and shoulder muscles
4. Put one hand on your chest and your other hand on your stomach.
5. Take a slow, deep breath through your nose. As your lungs fill the hand on your stomach should move outwards, the hand on your chest will move very little.
6. Hold the air in for at least two seconds.
7. Purse your lips together like you are going to whistle or blow on a hot drink to cool it.
8. Slowly push the air out through your lips while contracting your abdominal muscles. The hand on your stomach should move in as you are breathing out, but your other hand should move very little.
9. Continue to breathe in through your nose and out through your mouth. Try to breath in deeply enough so that your lower abdomen rises and falls.
*If you have hard time breathing from your abdomen while sitting up, try lying on the floor. Put a small book on your stomach, and try to breathe so that the book rises as you inhale and falls as you exhale.
*If you have a chronic lung disease like COPD, or Emphysema, try and make breathing out last twice as long as breathing in.
Progressive Muscle Relaxation: tense and relax
Progressive muscle relaxation is another effective and widely used strategy for stress relief. It involves a two-step process in which you tense and relax different muscle groups in the body.
With regular practice, progressive muscle relaxation helps your learn what tension—as well as complete relaxation—feels like in different parts of your body. This awareness helps you spot and counter the first signs of the muscle tension that accompanies stress. And as your body relaxes, so will your mind. You can combine deep breathing with progressive muscle relaxation for an additional level of relief from stress.
Loosen your clothing, take off your shoes, and get comfortable.
1. Take a few minutes to relax, breathing in and out in slow, deep breaths.
2. Most people start at their feet and work their way up to their face.
3. When you’re relaxed and ready to start, shift your attention to your right foot. Take a moment to focus on the way it feels.
4. Slowly tense the muscles in your right foot, squeezing as tightly as you can. Hold for a count of 10.
5. Relax your right foot. Focus on the tension flowing away and the way your foot feels as it becomes limp and loose.
6. Stay in this relaxed state for a moment, breathing deeply and slowly.
7. When you’re ready, shift your attention to your left foot. Follow the same sequence of muscle tension and release.
Move slowly up through your body — legs, abdomen, back, arms, neck and shoulders, and finally face — contracting and relaxing the muscle groups as you go.
Visualization:
Visualization, used as a relaxation technique involves imagining a scene in which you feel at peace, free to let go of all tension and anxiety. Choose whatever setting is most calming to you, whether a tropical beach, a favorite childhood spot, or a quiet wooded glen. You can do this visualization exercise on your own, with a therapist’s help, or using an audio recording.
Close your eyes and let your worries drift away. Imagine your restful place. Picture it as vividly as you can—everything you can see, hear, smell, and feel. Guided imagery works best if you incorporate as many sensory details as possible. For example, if you are thinking about a dock on a quiet lake:
• See the sun setting over the water
• Hear the birds singing
• Smell the pine trees
• Feel the cool water on your bare feet
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17. Homework Know and recognize when you are stressed.
Identify you stressors
Plan how you will manage your stress without tobacco
Practice a Relaxation Technique at least 5 days
Review and Update your tobacco change plan