1. BACR Conference 8 th - 9 th October 2009 Benefits of a “One Day Stress Management Workshop” A Menu Based Option for Cardiac Rehabilitation Patients BACR Conference 8 th - 9 th October 2009 Benefits of a “One Day Stress Management Workshop” A Menu Based Option for Cardiac Rehabilitation Patients Katrina Fisher Senior Occupational Therapist Cardiac Rehabilitation Team Luton & Dunstable Hospital NHS Foundation Trust Bedfordshire

2. Toolkit

3. Patient’s Perspective

4. One Day Stress Management Workshop for Cardiac Rehabilitation Patients

5. Morning Workshop Welcome and introduction to the day Welcome and introduction to the day A-Z of coping strategies – on arrival A-Z of coping strategies – on arrival Ice breaker – list patient’s expectations of the day Ice breaker – list patient’s expectations of the day Definitions of stress and anxiety Definitions of stress and anxiety Causes of stress in relation to Human Performance Curve Causes of stress in relation to Human Performance Curve The Autonomic fight / flight response The Autonomic fight / flight response Comfort break……… Comfort break……… Signs and symptoms of stress Signs and symptoms of stress Complete another HADS Complete another HADS Show “Don’t lose Heart video” Show “Don’t lose Heart video” Feedback HADS scores Feedback HADS scores Break for lunch……… Break for lunch………

6. A-Z Coping Stategies AROMATHERAPY JOKES SWIMMING BOWLING KITE FLYING TALKING CROSSWORDS LAUGHTER UNDERSTANDING DISTRACTION MUSIC VISITING EXERCISE NOTHING WALKING FISHING ORGANISING XYLOPHONE GOLF POSITIVE YOGA HUMOUR QUIZZES ZOO IRONING RELAXATION

7. Morning Workshop Welcome and introduction to the day Welcome and introduction to the day A-Z of coping strategies – on arrival A-Z of coping strategies – on arrival Ice breaker – list patient’s expectations of the day Ice breaker – list patient’s expectations of the day Definitions of stress and anxiety Definitions of stress and anxiety Causes of stress in relation to Human Performance Curve Causes of stress in relation to Human Performance Curve The Autonomic fight / flight response The Autonomic fight / flight response Comfort break……… Comfort break……… Signs and symptoms of stress Signs and symptoms of stress Complete another HADS Complete another HADS Show “Don’t lose Heart video” Show “Don’t lose Heart video” Feedback HADS scores Feedback HADS scores Break for lunch……… Break for lunch………

8. Afternoon workshop Welcome back and introduction to coping strategies Welcome back and introduction to coping strategies A-Z coping strategies A-Z coping strategies Cycle of change (Ref Prochaska and Diclemente 1982) Cycle of change (Ref Prochaska and Diclemente 1982) Teach 4-5 coping strategies Teach 4-5 coping strategies Inform patients of other support available: 1:1 session, referral to clinical psychologist, counselling arranged via GP Inform patients of other support available: 1:1 session, referral to clinical psychologist, counselling arranged via GP Make sure expectations have been met Make sure expectations have been met Evaluation forms completed Evaluation forms completed Close session......... Close session.........

9. Choice of coping strategies Changing unhelpful thoughts into helpful thoughts Changing unhelpful thoughts into helpful thoughts Anger management techniques Anger management techniques Energy conservation and pacing techniques using MET values Energy conservation and pacing techniques using MET values Goal setting using SMART principle Goal setting using SMART principle Assertiveness training Assertiveness training Problem solving techniques Problem solving techniques Sleep hygiene techniques Sleep hygiene techniques Time management principles Time management principles Stability zones Stability zones

10. Diaphragm Breathing and Relaxation Techniques Diaphragm breathing techniques Diaphragm breathing techniques Relaxation techniques: Relaxation techniques: –Progressive –Autogenic –Visualisation

11. Afternoon workshop Welcome back and introduction to coping strategies Welcome back and introduction to coping strategies A-Z coping strategies A-Z coping strategies Cycle of change (Ref Prochaska and Diclemente 1982) Cycle of change (Ref Prochaska and Diclemente 1982) Teach 4-5 coping strategies Teach 4-5 coping strategies Inform patients of other support available: 1:1 session, referral to clinical psychologist, counselling arranged via GP Inform patients of other support available: 1:1 session, referral to clinical psychologist, counselling arranged via GP Make sure expectations have been met Make sure expectations have been met Evaluation forms completed Evaluation forms completed Close session......... Close session.........

12. Key Findings From the One Day Workshop Evaluation 64% attended – 29% UTA and 7% DNA (2009) 64% attended – 29% UTA and 7% DNA (2009) 94% patients reported “delivery of the workshop was just right” 94% patients reported “delivery of the workshop was just right” 93% reported “the length of the session was just right” 93% reported “the length of the session was just right” 90% “felt their knowledge of stress management had improved” 90% “felt their knowledge of stress management had improved” 12% patients referred for a clinical psychology assessment 12% patients referred for a clinical psychology assessment

13. Key Findings From the Two Month Follow up Evaluation of the Workshop 93% reported that “they still use the ways of coping identified on the day” 93% reported that “they still use the ways of coping identified on the day” 88% reported that “these ways of coping help them to manage their stress more effectively” 88% reported that “these ways of coping help them to manage their stress more effectively” 80% HADS scores have reduced 80% HADS scores have reduced 20% significantly to within normal range 20% significantly to within normal range

14. Future Plans Running a follow up day for patients Running a follow up day for patients Offering a similar stress management workshop for partners and other family members Offering a similar stress management workshop for partners and other family members Providing a professionally printed manual to support the content covered in the workshop. Patients would be able to continue to use this as a reference tool to maintain effective stress management techniques Providing a professionally printed manual to support the content covered in the workshop. Patients would be able to continue to use this as a reference tool to maintain effective stress management techniques Continue to develop the emergency in-patient Clinical Psychology referral service Continue to develop the emergency in-patient Clinical Psychology referral service

15. Any Questions?