East Village Access
PROS Program
Curriculum
Course Title: Stress Management on the Path to Wellness
Frequency and Duration: [1] per week for [16] weeks, [45] minutes per session
Component and Service: CRS: Wellness Self Management
Course Overview: This course is designed to supplement the standardized Wellness Self
Management Curriculum. This course will expand upon topics which have been touched upon in
the WSM curriculum, and will cover the topics in more depth. It will focus on the concepts of
stress, and triggers, as barriers to all aspects of recovery, including behavioral issues, substance
abuse, physical well-being, and emotional recovery. The focus will be on how good stress
management can break down barriers to reaching identified goals in the different recovery
domains.
Description: Each person has a very individual, personalized path in recovery. This is their own
Path to Wellness. These sixteen modules include various exercises, activities, techniques, and
assignments, designed to identify stressors and triggers, and the skills needed to recognize them
and avoid the consequences of reacting. Modules will use an initial self-assessment by each
participant in the group, as a starting point for the work of that module. The same self-
assessment will be revisited at the end of the sixteen modules to evaluate progress. Homework is
sometimes assigned at the end of a module, and then reviewed at the start of the next module,
and evaluated.
Goals: Often we find that persons who suffer from long-standing mental illness are not able to
identify, access, and use skills that they already have. This may stem from previous experience,
lack of self-confidence, or other issues. The goals of these sixteen modules include increased
ability to identify stressors and triggers, increased ability to handle stress and avoid reacting to
triggers, and increased ability to promote positive behavioral change. The course will explore
how to use these skills in a “wellness” model, always coming from an empowered, strength-
based perspective.
Expected outcomes: Expected outcomes include increased facility in identifying stressful
situations, how the triggers work along with stress, and how to effectively strengthen the ability
to avoid reacting to triggers. Progress will be evidenced by accomplishments such as recounting
situations where stress was identified and handled, and triggers were avoided, and self-reporting
on feelings of stress reduction and improved outlook. The ultimate outcome will be an increased
sense of wellness and ability to progress in all areas of recovery and identified goals.
Modules for Stress Management on the Path to Wellness
I. What Is Stress? What Are the Symptoms that Let Me Know I Am Stressed?
II. What is a Trigger? What Are My Personal Triggers?
III. Coping with Triggers. How do they Affect My Mood and Behavior?
IV. Simple Methods of Stress Reduction
V. More on Stress Reduction
VI. My Stress Management Toolkit
VII. Is Worrying a Trigger? How Can I Worry Less and Feel Better?
VIII. How to Monitor Feelings During Stressful Situations
IX. How to be Assertiveness, Rather than Aggressive, Why.
X. Taking Charge
XI. More Strategies for Coping with Stress
XII. Good Days vs. Bad Days
XIII. Coping with Anxiety
XIV. Expressing Feelings as a Strategy for Managing Stress
XV. How Can I Get Help with Stress – Building a Support Network
XVI. How Far Have I Come?
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Course Title: Stress Management on the Path to Wellness
Module [1]: What is Stress? What Symptoms Let Me Know That I am Stressed?
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will take a look at what stress is, and spend some time
identifying our own personal stressors. This can be a difficult topic, since for many of us, stress
is long standing, and is not only a barrier to reaching our goals in recovery, but can be a direct
cause of mental illness. We will look at barriers to effective stress management, and evaluate
our strengths and weaknesses in this area. We will share past experiences in this area, such as
opportunities to manage stress that we could have handled better. We will also look at situations
where we felt like we effectively managed stress, how that felt, and how successful it was. We
will look at ways to develop more awareness of the relationship between stress and triggers.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had practice in identifying their own stressful situations, anticipating them, linking them to
mood and behavior changes, and some basic coping skills. Participants will learn to recognize
when they are stressed, or starting to feel stressed, from a symptom management approach –
often we do not realize that we are stressed or how stressed we are, until it is too late. This will
form the basis for future modules which address how to cope with the stress once it is
recognized.
III. Engagement:
Activity (1): Brief Self – Assessment:
Participants will first be asked to describe, in their own words “What is stress? How do I know
when I am feeling too much stress? How do my symptoms indicate to me that I am under too
much stress or am “stressing”? Participants will be asked to share some of their experiences in
this area, and if they have any questions or fears about this specific aspect of looking at stress.
They can be asked to do this in informal discussion, based on the following questions:
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What is stress?
Can stress be positive or negative?
What have been some of your experiences with stress?
Do you feel stressed right now?
When was the last time that you remember feeling too stressed?
What did you do?
What do you do when you sense a potential stressful situation?
Do you start to become anxious, frightened, tense, angry?
Do you avoid stressful situations?
Are any of your relationships stressful?
Do you need help in managing stress at your job?
Do you need help in managing stress at school?
Do you need help in managing stress at home?
Activity (2): What is stress?
After participants have had a chance to consider these questions, facilitator will propose the
following ideas for phrases and words that describe stress:
We hear the word “stress” all the time – on TV, in movies, everyone is always talking about it.
What are we talking about when we talk about stress?
Negative Experiences
Positive Experiences
Pressure
Anxiety
Anything that makes us feel overwhelmed
Anything that feels too demanding
Something that makes us worry
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In reality, stress can be negative or positive. It is a REACTION to change of some kind. It is
more about our ability to handle change, whether the change is good or bad. Change is always
happening, and stress is what we feel when we are reacting to it.
Stress is: A set of emotional, physical, and intellectual (thought) reactions to change. In its most
positive form, it can motivate us to make important changes in our lives, to work productively,
and to accomplish great things. In its worst form, it can cause us to feel terrible, relapse into
illness, and act in ways that are not healthy for us.
Activity (3) Good Stress v. Bad Stress
Facilitator will invite participants to complete the following exercise exploring good (positive)
stress vs. bad (negative) stress.
Q: What are some examples of good stress?
A: Getting married, having a baby, getting a new job, moving to a new apartment, going to
school
Q: What are some examples of bad stress?
A: Losing your job, losing a loved one, sick child or parent.
The examples above are all examples of BIG (EXTREME) STRESS. Not all stressors are
that big (life-changing), but sometimes they feel that way. That’s why perspective is
important.
Q: What are some examples of good stress (less extreme)
A: Winning $10 in the lottery, getting a good grade at school, having a surprise birthday party
Q: What are some examples of bad stress (less extreme)
A: Getting stuck in traffic, missing the bus, being late to work, your computer breaking down
Participants are asked to make a list of their stressful situations, both big and small, as follows.
The situation is designated as positive or negative, and then the stress is rated on a scale of one to
ten, with 1 being a very small amount of stress, and 10 being very stressful:
STRESSFUL SITUATIONS RATING: 1-10 POSITIVE OR
NEGATIVE
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After the table is completed, facilitator will invite participants to share their thoughts and
experience with doing this exercise. Facilitator will point out that it is always important to
consider the rating, or how stressful the situation is in comparison to other ones. This can
help us manage our responses.
Characteristics of ―good‖ stress
Motivating
Helps us to focus energy
Short-term
We perceive it as within our ability to cope with
Feels exciting
Improves performance
Characteristics of ―bad‖ stress:
Causes fear
Causes anxiety
Can be long-term
We perceive it as beyond our coping capabilities
Does not feel good at all
Decreases performance
Can lead to chronic long term physical and mental problems
Can cause relapse into unwanted behaviors
Activity (4): How do I know when I am feeling stressed?
Sometimes the following symptoms can be an indication that we are feeling stressed,
usually not in a positive way:
Feeling sad, empty, irritable, weepy
Feeling very anxious all the time
No interest in activities
Weight gain or loss
No Appetite
Overeating
Excessive exercise
Insomnia
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Sleeping too much
Exhaustion
Lack of energy
Guilt
Feeling worthless
Feeling “high” , or better than good
Feeling very irritable
Talking excessively, feeling like you have to keep talking
Easily distracted
Feeling very restless
Racing thoughts
Brain is jumping from one topic to another
Drinking, eating, smoking, gambling, shopping, inappropriate sexual activity
Worrying and Obsessing
Anxiety
Panic attacks
Facilitator will invite participants to answer the following question, using the list above, or any
additions of their own:
When I am feeling stressed, I . . . . . . .
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Activity (5): Homework Assignment:
Facilitator will ask participants to be on the lookout in the coming week for the most stressful
situations that they are experiencing at this time, which could be related to social relationships,
work relationships and/or situations, school relationships or situations, or anything that they are
experiencing. They are asked to rate the stress in level of intensity (1-10).
IV. Summary/Closure: Ask participants how they feel about this subject and what they have
accomplished today. Ask if they feel more confident about being able to identify and rate their
stress levels in different situations. Ask if they have a better understanding of the importance of
this skill in recovery.
.
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Course Title: Stress Management on the Path to Wellness
Module [2]: What is a Trigger? What Are My Personal Triggers?
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will look at triggers, define what they are, and spend some
time identifying our own personal triggers. This can be a difficult topic, since for many of us,
triggers are long standing, and have posed barriers to reaching our goals in recovery. We will
look at triggers as barriers to effective stress management, and evaluate our strengths and
weaknesses in this area. We will start out by establishing what a trigger is, and how the ability to
effectively manage these triggers will help us reach goals we have set for ourselves. We will also
consider how the opposite situation, or how the inability to manage triggers, creates barriers to
recovery, and can often cause relapse into unwanted behaviors. We will share past experiences in
this area, such as opportunities to manage triggers that we could have handled better. We will
also look at situations where we felt like we effectively managed our triggers, how that felt, how
successful it was, and if it was helpful in strengthening our self-confidence in recovery.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have learned to identify their own personal triggers, how to anticipate a trigger, and will learn
how important this is as a pre-requisite to effective stress management. They will learn more
about which are their strongest triggers, and the ones that they need to pay the most attention to,
in order to feel well and pursue their recovery goals.
III. Engagement:
Activity (1): Brief Self – Assessment
Participants will first be asked to describe, in their own words “What is a trigger? How will I
know when a trigger is affecting me?” Participants will be asked to share some of their
experiences in this area, what the results were, and if they have any questions or fears about this
topic based on their past experience. They can be asked to do this in informal discussion, based
on the following questions:
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What is a trigger?
How do I feel when I sense a potential trigger?
Do I start to become anxious, frightened, tense, angry? Any other emotion?
Do I know how to recognize potential trigger situations?
Do I avoid situations where I might encounter a trigger?
In which of my relationships do I think I need the most help in managing trigger situations?
Do I need help in managing trigger situations at my job?
Do I need help in managing trigger situations at school?
Do I need help in managing trigger situations at home?
Activity (2): What is a trigger?
Facilitator will invite participants to compose a list of what a trigger is, in their own words and
experience, opening with the following as a proposed definition:
A trigger is something that stimulates us in some way
A trigger is something that causes us to respond, or to want to respond
A trigger can be an event
A trigger can be a person
A trigger can be a particular place, or a situation within that place
I think a trigger is. . . . . . . . . .
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
When addressing triggers, it is important to keep in mind that a trigger initiates a series of
events, as it relates to wellness and recovery:
A trigger makes me think in a certain kind of way.
Thinking in a certain way, makes me feel a certain way.
Feeling a certain way makes me behave in a certain way.
Behaving in a certain way has consequences, sometimes good, sometimes bad. Trigger→
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Thought → Feeling → Behavior → Action (result, consequence)
Activity (3): Learn how to identify your personal triggers
Learning how to identify your personal triggers will help you be on the lookout for difficult
situations that may lead to relapse into negative moods and behaviors. This gives you a good
HEAD START in maintaining your recovery.
Triggers may be certain people, certain places, and certain situations!
People: Who ―Rubs Me the Wrong Way‖?
Pushes my buttons?
Reminds me of someone who treated me badly in the past?
Always mentions things I would like to forget or not talk about?
Controls or dominates the conversation?
Doesn’t listen when I talk?
Embarrasses me?
Makes me feel stupid?
Places: Where do I feel I am most likely to run into a problem?
At school
My job
My home
On the subway or bus
At a family dinner
On a date
Situations: What are some situations that I like to avoid?
Talking about: Politics, or Religion, or Family, or Money, or My weight . . . .
Getting too tired
Getting too hungry
Getting too angry
Getting too lonely
Getting too anxious, or bored, or frustrated, or happy, or . .....
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Participants will be invited to complete the following exercise:
What are my personal triggers?
1) _______________________________
2) _______________________________
3) _______________________________
4) _______________________________
Facilitator will tell participants that identifying their personal triggers is a process and will take
some time. This is just a beginning. It might help to talk one-on-one with a counselor or case
manager to identify these triggers.
Facilitator will ask for a volunteer to tell the group about their own triggers. Participants will be
invited to respond and give feedback.
Activity (4): Homework Assignment:
Participants will be asked to set a goal for the coming week of recognizing some of their triggers,
and trying to identify or “sense” a trigger before it results in a reaction. Participants will be
asked, to discuss next week whether or not they were able to identify any triggers and avoid
reacting negatively.
IV. Summary/Closure: Ask participants how they feel about this subject and what they have
covered today. Ask if they feel more confident about being able to identify some potential
triggers and avoid reacting to them. Ask if they have a better understanding of the importance of
these skills in recovery.
.
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Course Title: Stress Management on the Path to Wellness
Module [3]: Coping with Triggers: How Do They Affect My Mood and Behavior?
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will take another look at triggers, and how they are related
to changing moods and behavior. We will look at ways to develop more awareness of the
relationship between a trigger, and a change in mood or behavior. We will look at the link
between triggers and moods and behaviors, and how the ability to effectively manage these
triggers will help us reach goals we have set for ourselves. We will also consider how the
opposite situation, or how the inability to manage triggers, creates barriers to recovery, and can
often cause relapse. We will share past experiences in this area, and identify in which areas of
our lives/recovery we need help.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had more practice in identifying their own stressful triggers, anticipating them, linking them
to mood and behavior changes, and some basic coping skills. Participants will have developed
some strategies for coping with triggers if they cannot avoid them.
III. Engagement:
Activity (1): Review of Homework:
Last week participants were asked to set a goal for the coming week of recognizing some of their
triggers, and trying to identify or “sense” a trigger before it resulted in a reaction. Participants are
invited to discuss whether or not they were able to identify any triggers and avoid reacting
negatively, and what this experience was like for them.
Activity (2): Brief Self – Assessment:
Participants will first be asked to describe, in their own words “How do I know when a trigger is
affecting my mood or behavior?” Participants will be asked to share some of their experiences in
this area, what the results were, and if they have any questions or fears about this specific aspect
of looking at triggers. They can be asked to do this in informal discussion, based on the
following questions:
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Do my personal triggers change my mood?
Do my personal triggers cause me to change my behavior?
How do I feel a trigger causes my mood to change? (Example: I was feeling happy and then
something happened (it started to rain), and then I felt sad)
Is it hard to stop the change in mood?
Have I ever been aware of triggers making me change my behavior? (Example: I was on my
way to school and then something happened (I realized I had lost my phone), and I changed
my mind and went home)
Do I know how to cope with the trigger, and not let it change my mood, or my behavior?
Activity (3): Mood Triggers
We all have our own triggers that can cause us to feel happy, depressed, angry, or sad, or any one
of a number of ways. Some of these triggers may be small ones, like it starts to rain when you
don’t have an umbrella, or you just miss the bus. Some of these triggers may be bigger ones, like
not getting any sleep, or being sick, or having an argument with someone, or getting a bill in the
mail that you didn’t expect. And some may be very big, life-changing events, like losing a job or
a loved one.
Facilitator will invite each participant to take their own list of identified personal triggers, and
write down how it affects their mood, either positive or negative, in the following worksheet:
Trigger (Outside Influence) Effect (Positive or Result
Negative)
Example: Missed the Bus Negative Feel Angry at Myself for
Not Leaving the house
earlier
Example: Argument with Negative Feel worthless and sad
friend
Example: Got a good grade Positive Feel happy and good about
on a test at school myself
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Activity (4): Coping with Triggers
Facilitator will reintroduce the series of events discussed in the previous module:
Trigger →Thought→→ Feeling→ Behavior→ Result (consequence)
At every point along the way, there are opportunities to prevent a relapse into inappropriate or
negative, or non-recovery behaviors.
We cannot always avoid our personal triggers. If we cannot stay away from the people,
places, and situations that are our personal triggers, what do we do?
When the negative thought arises from a trigger, STOP
Recognize that your thinking may spiral out of control
Challenge your own thinking to yourself
Ask for help in examining your thoughts and feelings
Ask for help in determining what is real
WAIT before you ACT, or SPEAK
Scenario: Facilitator will describe a scenario in which a trigger stimulates a thought, and what to
do with that thought, before it turns into a change in mood or behavior:
You are trying to get to work and are rushing to catch the bus. You are
looking forward to work and today is an important day. You are
presenting an idea at a staff meeting that you have been thinking about
for a while and want to make a good impression on your co-workers and
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your boss. Before you left the house a friend called and you spent a
couple of extra minutes with her on the phone. If you hadn’t done that,
you’d have a couple of minutes to spare. You get to the stop and the bus
has just pulled away and you know that by the time the next one comes
you will be late to work. Very quickly, you can feel your mood spiraling
downward and your thoughts spinning out of control
Triggers: Missing the bus, being late to work
Thoughts that follow the trigger:
If I had left earlier I would be on time.
Why am I so stupid sometimes?
Why can’t I ever do anything right?
I will look like a fool today when I get to work late for my own presentation.
My co-workers and my boss will see how useless I am.
It’s the bus drivers fault for pulling away from the curb too early.
It’s the fault of the MTA for not putting enough buses on the street.
Feelings that follow the thoughts:
I feel so frustrated; I just don’t know what to do.
I am so angry at myself.
Why do I bother trying?
I always mess everything up.
I am worthless.
I start to feel very manic.
I start to feel depressed.
Behaviors that follow the feelings:
I run after the bus as it pulls away, cursing at the driver.
I stand in the street cursing at the driver.
I decide to have a cigarette, even though I have been trying to quit.
Instead of going to work I go home and have a beer.
I stop at the store and get some ice cream and cake.
I go on a shopping trip for things I don’t need.
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Facilitator will then offer an alternative outcome to the same scenario:
You have missed the bus. . .
Triggers: Missing the bus, being late to work
Thoughts that follow the triggers:
Wish I had left earlier!
This is not a good situation, but let me make the best of this.
I should call work and let them know that I will be a few minutes late and apologize.
I will try harder next time.
Maybe there is another way I can get to work faster.
Let me take the subway instead, even though I usually don’t like taking the subway.
Maybe I could take a cab, just this once to get to work on time.
Feelings that follow the thoughts:
I am angry with myself, but this is not a catastrophe
I am frustrated with myself but think I can find a solution
I mess up sometimes but sometimes I do really well
I’m not perfect and I am trying my best
Behaviors that follow the feelings:
You call the job and let them know that you will be a few minutes late.
You take the subway and get to work on time.
You take a cab, and get to work on time.
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Activity (5): Instead of responding to the trigger. . .
Facilitator will invite the group to create a list of things to do BEFORE the trigger causes a
reaction:
STOP
THINK
WAIT
COUNT TO TEN
ASK FOR HELP
BREATHE, DEEPLY
Activity (6): Homework Assignment:
Facilitator will ask participants to be on the lookout in the coming week for a trigger which
makes them want to engage in any non-recovery behavior: such as wanting to drink, take drugs,
overeat, gamble, curse, act violently or aggressively, argue, not do their tasks at work if they are
employed, slack off on school work, stop exercising, spend all afternoon sleeping, or stay up all
night. They will be asked to report back to the group next week.
IV. Summary/Closure: Ask participants how they feel about this subject and what they have
learned today. Ask if they feel more confident about being able to identify some potential
triggers and avoid reacting to them. Ask if they have a better understanding of the importance of
these skills in recovery.
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Course Title: Stress Management on the Path to Wellness
Module [4]: Simple Methods of Stress Reduction
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will take a look at some simple methods of stress reduction,
that we can learn to use on a daily basis. This module is just an introduction – we will continue
in the next module and throughout this course to identify stress reduction techniques. Stress
reduction is a skill, a way to change our behavior to promote recovery. We will look at ways to
develop more awareness of how to reduce when and how we respond to stress, the impact that a
stressful situation has on us, and for how long we feel that impact. We will look at how the
ability to effectively reduce our stress in simple ways will help us reach goals we have set for
ourselves. We will also consider how the opposite situation, or how the inability to reduce stress,
creates barriers to recovery, and can often cause relapse. We will share past experiences in this
area, and identify in which areas of our lives/recovery we need help.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an introduction to some simple ways to reduce stress that they can practice on a daily
basis. These are basic coping skills that participants may have already have exposure to, and may
already know how to do, but that they have trouble accessing and using on a daily basis.
Learning how to reduce the impact of stress on our lives is only useful if we gain confidence in
our ability to use the skill.
III. Engagement:
Activity (1): Review of Homework:
Last week participants were asked to set a goal for the coming week of recognizing some of their
triggers, and trying to identify or “sense” a trigger before it resulted in a reaction. Participants are
invited to discuss whether or not they were able to identify any triggers and avoid reacting
negatively, and what this experience was like for them.
Activity (2): Brief Self – Assessment:
Participants will first be asked to describe, in their own words “What is stress reduction? How
will I know when to practice stress reduction?” Participants will be asked to share some of their
experiences in this area, what the results were, and if they have any questions or fears about
learning stress reduction techniques. They can be asked to do this in informal discussion, based
on the following questions:
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What do you think of when you think of stress reduction?
Have you ever practiced stress reduction in any way?
Have you ever observed someone you know practice stress reduction?
Have you had any successful experiences with stress reduction?
Have you had unsuccessful experiences with stress reduction?
Do you think stress reduction would be helpful at school?
Do you think stress reduction would be helpful on the job?
Would it be helpful at home?
Would stress reduction help in your recovery goals? In what ways?
Activity (3): What is stress reduction?
Facilitator will propose the following framework for understanding and developing skills in
the area of stress reduction:
Stress reduction, or management, can be thought of in two ways:
1) Prevention: Ways to avoid the impact or influence of the stressful situation
2) Rehabilitative: Ways to reduce the bad effects of stress which has already occurred.
Ideally, we would like to have both of these aspects of stress reduction in our “toolkit” of
recovery skills. Some techniques and strategies can be used for both, as in this first example:
Exercise: Remember to Breathe
When we are stressed, it can be very common to breathe quickly and rapidly, or sometimes to
stop breathing entirely. When this happens we actually cause ourselves to become more anxious
physically. It is very important to REMEMBER TO BREATHE. Deep breathing can be helpful,
but just being CONSCIOUS and AWARE of our breathing can also be very helpful. Sometimes
our breathing will start to quicken even before we realize that we are in a stressful situation.
Calm breathing helps to relax the entire body and the mind.
If possible, the best way to de-stress through breathing is the following:
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Find a quiet place.
Sit quietly in a comfortable position.
Close your eyes.
Feel your muscles relaxing.
Pick a word to repeat to yourself.
Breathe slowly and naturally, repeating the word to yourself.
We might not be able to find a quiet place to do this, but we can do it anywhere. We can even do
it when other people are around, if we just bring our awareness to ourselves and our breath.
Facilitator can take the group through a very brief, guided exercise, if desired, using the steps
outlined above. This should be done for no more than five minutes, as some participants may not
be comfortable sitting in silence for an extended period of time. Facilitator should check in with
group members to see how they are feeling about doing this exercise. When it is complete,
facilitator should check in with the group and ask participants to share their experience in this
breathing exercise, and what it felt like to them. Ask if they feel this is a technique/strategy they
could use in times when they feel stressed.
Activity (4) Getting Exercise
Facilitator can address exercise as both a technique that can be used quickly to avoid responding
to stress, and a strategy for overall stress management.
Technique:
Facilitator will describe the following scenario:
You have just come home. It was your apartment mate’s chore to clean out the
refrigerator. Rather than cleaning it out, she has let it become a mess, overgrown
with old moldy food, etc. You have just gone food shopping and want to put your
groceries away. Before you left this morning she told you that she would do it
today. You open the refrigerator and feel like you want to explode.
How can you use exercise as a technique in this situation?
If possible, you leave the apartment and take a walk outside.
If this is not available, you could walk into the next room, just to get some distance from the
situation
Do some pushups, or some sit ups, or jump rope or jog in place, or anything to distract
yourself.
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Strategy:
Overall, regular exercise is very helpful in reducing stress, managing stress when it comes our
way, improving our physical and mental health, managing weight, and it has many, many other
benefits. There is no down side to exercising – only if you injure yourself by too much or
improper exercise. It is good to plan to exercise thirty minutes at least a few times a week, but
you can also stay active by going up and down stairs, getting off the train or bus a stop early and
walking to your destination, or just moving around whenever possible!
Facilitators will invite participants to complete the following worksheet;
Do you exercise?
If so, what kind of exercise do you do?
Do you like to exercise?
Do you prefer to exercise alone, or with other people?
How often do you exercise?
Do you enjoy sports? If so, what types of sports?
If you exercise regularly, do you find that it helps you manage stress?
Does it help you relax?
Does it make you feel more calm, and better able to manage stress?
Activity (5): Counting to Ten:
When in Doubt, count to 10!
Why do we suggest counting to ten, or twenty, or forty, if we need to?
Because it creates SPACE to breathe, before we REACT.
Facilitator can invite participants to pair off into groups of two, and do a role-play, in a situation
where someone says something that makes the person they are talking to very angry. The person
they are talking to then counts to ten.
Facilitator will ask the group how it feels when they count to ten. Can they feel themselves
relaxing, becoming less angry, or becoming a little bit less tense. Counting to ten helps us think
a bit before we react.
Activity (6): Body Awareness and Muscle Relaxation
21
When we are stressed, we tend to hold our bodies very tense and rigid, clenching our teeth, jaws,
fists, and all of our muscles. This kind of body posture, in turn, creates more stress. When we
become aware of our bodies being tense in this way, we can consciously focus on relaxing our
muscles. As your body relaxes, your mind will follow. Body awareness and muscle relaxation
can be used as both a technique and a strategy.
Technique:
Using the same role play as the previous exercise, facilitator can direct participants, instead of
counting to ten, to become aware of what their bodies feel like as they begin to become angry.
Rather than tensing, participants are guided by facilitator to consciously relax their muscles,
starting with the face, jaw, and hands, and working their way down to legs and feet. Participants
are directed to try to feel the difference as their muscles relax.
Strategy:
As a strategy for stress management, body awareness and muscle relaxation can be used on an
ongoing basis to relax every day. We can do this at the beginning of the day before we get
started, during the day, and at the end of the day. This kind of relaxation has benefits that grow
over time – like putting money in the bank – the more we focus on body awareness and
conscious muscle relaxation every day, the more relaxed and LESS STRESSED we are overall.
Activity (7): Homework Assignment:
Facilitator will ask participants to pick one of the techniques we covered today and practice it
during the coming week in a stressful situation as a technique, or as a strategy, something that
they decide to do every day. They will be asked to report back to the group next week.
IV. Summary/Closure: Ask participants how they feel about this subject and what they have
learned today. Ask if they feel more confident about being able to use stress management
techniques, and incorporating them into their recovery. Ask if they have a better understanding
of the importance of these skills in recovery.
22
Course Title: Stress Management on the Path to Wellness
Module [5]: More on Stress Reduction
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Last week we had an introduction to, and practice with basic methods
of stress reduction. Today we will continue to look at more methods of stress reduction that we
can use, including what are usually called alternative therapies. We will continue to look at how
the ability to effectively reduce our stress in simple ways will help us reach goals we have set for
ourselves.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had more exposure to and practice with ways to reduce stress that they can use on a daily
basis, and as an ongoing component part to their recovery. These are basic coping skills that
participants may have already have exposure to, and may already know how to do, but that they
have trouble accessing and using on a daily basis. By the end of this module, participants will be
able to decide which of the techniques and strategies we have covered work best for them in
terms of addressing their own barriers to recovery.
III. Engagement:
Activity (1): Review of Homework:
Last week participants were asked to pick one of the stress reduction methods we covered in the
module and to practice it in a stressful situation as a technique, or as a strategy to be practiced
every day. Participants are invited to share what method they picked and what their experience
was in using it.
Activity (2): Brief Self – Assessment:
Participants will be asked to reconsider the questions we looked at last week and see if the
method they picked had an impact in any area of their life:
23
Was the stress reduction method you selected helpful to you in your social relationships?
Was the stress reduction method you selected helpful to you on the job?
Was the stress reduction method you selected helpful to you at home?
Was the stress reduction method you selected helpful to you at school?
Was the stress reduction method you selected helpful to you overall in your recovery?
Activity (3): Eating Well
Healthy eating habits are an essential building block to good recovery. It is hard to do anything
right if you are hungry, or run-down, or not eating in a way that promotes a healthy, alert, and
aware lifestyle.
Facilitator can remind participants of the role-play done last week, in which someone says
something that makes the person they are talking to very angry.
Technique:
What if the person who got angry was also very hungry? When we are hungry, or blood sugar is
low, we are less able to effectively cope with anger, or any other emotion. A good technique here
is to check in with yourself and say, “Am I too hungry to deal with this now?” If the answer is
yes, perhaps the best thing to do is to leave the situation and get something healthy to eat.
Strategy:
Good eating habits can be simple, once we get used to them.
Facilitator will invite the group to start a list of basic good eating habits:
Begin the day with a good breakfast
Eat small nutritious meals throughout the day
Eat lots of fruits and vegetables
Eat whole grains
Avoid processed foods
Avoid sugar
Activity (4) Enjoying Music
Drink lots of water
Avoid excessive alcohol consumption 24
Music makes us feel good!
Facilitator can invite participants to describe what kind of music they enjoy listening to, and how
they feel when they listen to it.
When I listen to music I feel . . . . . . . . . .
Relaxed
Energized
Peaceful
Creative
In a good mood
Anything that we do on an ongoing basis that improves our mood, will promote recovery. If
listening to music does that for us, it can de used on a daily basis as an effective way to reduce
stress, improve our overall outlook, and build strength in recovery.
Activity (5): Reaching Out for Help
Recovery is a team effort!
It is always important to remember to reach out for help and support when we need it,
because we can’t recover without help. Reaching out helps us feel less alone and powerless,
and takes us out of isolation, and provides ongoing positive reinforcement in recovery.
Technique:
In the same scenario that we used above, the person who feels angry can reach out for help:
He/she can call someone and say I am feeling angry; can you talk me through this? Sometimes
just the very act of making the phone call and talking to someone else can lessen the anger.
Strategy:
Part of recovery is building a support network
Who is part of your support network? . . .. ..
Friends
Family members
Counselors
Case managers
Spiritual advisors
Activity (6): Alternative Methods of Stress Reduction
25
Facilitator will invite the group to create a list of any alternative methods of stress reduction that
they may have heard of or used, such as:
Acupuncture
Acupressure massage
Meditation
Yoga
Tai Chi
Martial Arts
Some of the methods listed above are also forms of exercise. Facilitator will invite participants to
describe any of their experience with these methods as useful in stress reduction, either as a
technique, or as a strategy that they use overall in their recovery.
Activity (6): Homework Assignment:
Facilitator will invite participants to begin to think about which of the techniques we have
covered would be useful for them in their own path to wellness. Next week we will use this
information for each participant to create their own personal toolkit of stress management
techniques.
IV. Summary/Closure: Ask participants how they feel overall about stress management as a set
of tools for breaking down barriers in recovery. Ask if they feel more confident about being able
to utilize some of these techniques on an ongoing basis. Ask if they have a better understanding
of the importance of these skills in recovery.
26
Course Title: Stress Management on the Path to Wellness
Module [6]: My Stress Management Toolkit
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “For the past two weeks we have been considering and discussing
stress management as a set of tools used to breakdown barriers in recovery. This week we will
create our own personalized stress management toolkit that we can use in recovery. This toolkit
will include methods that we use as techniques, “in the moment”, and as strategies, practiced day
to day to promote and strengthen recovery. We will continue to look at how the ability to
effectively reduce our stress in simple ways will help us address barriers in recovery.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have reviewed the stress management techniques covered in the previous two modules. Then
they will create their own personalized “toolkits” of methods that they may already be using, and
those that they would like to use in their recovery. Participants will be encouraged to connect
their own personal barriers in recovery (for example: anxiety), to the stress management method
that they feel best addresses it (for example: deep breathing and meditation). By the end of this
module, participants should feel comfortable with knowing they have an effective set of tools to
use every day as they move forward in recovery.
III. Engagement:
Activity (1): Review of Homework:
Last week participants were invited to begin to think about which of the methods of stress
management we had covered would be useful for them in their own path to wellness. Facilitator
should ask participants to make a list of what they had decided upon. The next two activities
involve identifying barriers to goals, and tying them to stress reduction techniques.
Activity (2): Identifying Barriers
Participants will be asked to identify barriers in the group that have been identified in their own
IRP’s, as being crucial to overcome in their recovery, and path to wellness. This can be done in
the following worksheet:
What Are My Barriers in Recovery?
27
My biggest barriers in recovery are . . . (anxiety, lack of self-confidence)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
These barriers are the most problematic in my social relationships . . .
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
These barriers are the most difficult at school . .. ..
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________
These barriers pose the most problems at work . . . . .
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Activity (3): Linking Stress Management Method to Barrier
Facilitator will review and list all of the methods covered in the last two modules and ask if
participants have come up with any additional ones in the past two weeks to add to the list:
Exercise
Counting to Ten
Body Awareness
Muscle Relaxation
Music
Eating Well
Asking for Help
Creating Support Network
Yoga
Tai Chi
Acupuncture
Massage
Meditation
28
From the list of barriers that participants have created, ask them to link the barriers to the
methods they have chosen. A barrier may be linked to more than one method. Facilitator
may use the following example to illustrate:
Barrier Stress Reduction Method How Used
Anxiety Deep breathing Daily, and whenever needed,
whenever I feel myself
becoming anxious
Anxiety Exercise Daily, and in the moment if I
can
Lack of self-confidence Yoga Daily Practice
Lack of self-confidence Exercise Daily
Fear Listening to music Whenever I am able to
Anger Counting to Ten In the moment
Anger Asking for Help In the moment and on an
ongoing basis in therapy
Activity (4): Creating your own toolkit:
Participants are invited to create their own toolkits, as something that they can pull out
whenever they need to, to remind themselves of strategies available to them on the path to
wellness:
My Toolkit
When I am stressed, I can >>>>>>>>>>>>>>>>
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Activity (4): Homework Assignment:
Facilitator will invite participants to begin to use their own personal toolkit during the week, and
observe how helpful it is to use these tools and skills in a planned, consistent way.
IV. Summary/Closure: Ask participants how they feel overall about stress management as a set
of tools for breaking down barriers in recovery. Ask if they feel more confident about being able
to utilize some of these techniques on an ongoing basis. Ask if they have a better understanding
of the importance of these skills in recovery.
.
29
Course Title: Stress Management on the Path to Wellness
Module [7]: Is Worrying a Trigger? How Can I Worry Less and Feel Better?
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will consider worrying as both a stressor and a trigger that
poses barriers to recovery. We look at whether or not worrying, or excessive worrying, is a
actually a trigger which causes us to feel more stressed than we need to. We will look at ways to
avoid worrying and the downward spiral of thinking it can cause.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have an understanding of why worrying can trigger stress and negative thinking, and how that
works against recovery. They will have identified how their barriers in recovery are exacerbated
by worry, and worry’s “partner”, anxiety. By the end of this module, participants will have had
more practice in identifying when, and why, they are likely to worry, how to anticipate these
situations, and how to cope with them.
III. Engagement:
Activity (1): Brief Self-Assessment:
Participants will first be asked to describe, in their own words “What is worry? How is it related
to anxiety? Participants will be asked to share some of their experiences with worrying, and if
they have any questions or fears about learning about how to address worrying as an issue in
their recovery.
What do you think of when you think of worrying?
Do you think that you worry too much?
Do you find yourself worrying about the same thing over and over?
What happens to you when you worry?
Does worrying keep you up at night?
Does worrying “hold up” your recovery?
Do you ever feel paralyzed by worry?
If you worried less, would your recovery, or your path to wellness, be smoother?
30
Activity (2) What is worry?
Facilitator will invite participants to create a list of what worry is, with the following
suggestions:
Worry is . . . . . . . . ..
Being preoccupied with the ―what-if’s‖
Thinking about worst case scenarios
Having endless doubts or fear about a decision you may have made
Can be paralyzing and prevent us from accomplishing a task
Makes us feel anxious
A very bad habit
A negative perspective on life
Negative thoughts
Facilitator will invite participants to share their thoughts and experiences with worry.
Q: What are the side effects of worry?
A:
Worry can make you physically sick
Worry can keep you up at night
Worry can take time away from other important things that you need to do
Worry can prevent you from finding positive solutions to issues in your life
Worry leads to negative thinking
Worry leads to undesirable behaviors
Worry lead to non-recovery behaviors
Worry can make you feel VERY STRESSED!
Activity (3): Tips for worrying less as important tools in stress management
Facilitator will ask participants to share a little bit more about their perception of worrying and
the role it plays in causing stress and promoting non-recovery behavior.
The following exercises will be presented as ways to worry less and decrease stress:
Exercise 1: Accept change and uncertainty:
Sometimes the thought of change or uncertainty about a situation or something that is going to
happen, or not happen), causes worry. Worry does not make life predictable or avoid uncertainty.
31
Nor does spending time thinking about the “worst-case scenario.” This only makes us more
anxious.
Facilitator will invite participants to consider the following ideas and to review them when worry
seems to get out of control:
My ―Worry Card‖
It is not possible to be certain about everything in life
Uncertainty does not mean that something bad will happen, it just means that we don’t
know what will happen
Sometimes when we don’t know what will happen, something good happens
If we accept that change will happen, as it is part of life, we can move forward with our
lives and appreciate the moment we are in, rather than worry about what may happen
next.
Participants are invited to add their own thoughts to this list. Participants can create a ―worry
card‖ with these thoughts on it to carry around and read as a reminder, when they find
themselves worrying.
Exercise 2: Make a “worry period”
Rather than trying to make yourself stop worrying, which often makes it worse, why not create a
time every day when you are allowed to worry to your heart’s content?
Steps for creating your ―worry period‖
1) Choose a set time and place for worrying. It should be the same time every day (say six
pm), and for the same amount of time (no more than twenty minutes). During this time,
you can worry about whatever you want. However, the rest of the day is off limits – the
rest of the day is a “worry-free” zone.
2) Postpone worrying – if a worrisome thought comes into your head during the day, no
problem – just write it down and save it for your worry period. By doing this, you can
continue with your day.
3) Go over your worry list during your worry period, including all the things you think you
need to worry about. You may be very surprised. By the time you get to your worry
period, you may have forgotten about some of them, or realized that they are no longer
important. In that case, cut your worry time in half, and ENJOY YOUR DAY!
Exercise 3: Challenge Negative Thinking
A quick way to do this is to take your negative thoughts one by one and examine them carefully,
by asking yourself (or someone else) the following questions:
32
Is this thought true? What is the evidence that it is true?
Is there another way of looking at the situation?
Is there a more positive way of looking at the same situation?
What is the likelihood that what I am afraid of will actually happen?
Am I engaging in “all or nothing thinking” (I’m a total failure).
Am I generalizing (Since I didn’t get this job, I will never get any job).
Am I using a negative mental filter? (Seeing only the negative aspects of the situation, or
exaggerating them)
Am I jumping to conclusions?
Am I catastrophizing (The train conductor said we are being held at the station. Is this train
being delayed forever? I’ll never get home).
Am I personalizing? (If I had been more caring my friend wouldn’t have gotten sick).
Usually, once we examine the negative thoughts in this fashion, they become less powerful, and
we are more able to dismiss as just that: negative thoughts, as opposed to negative reality.
Exercise 4: Taking care of ourselves
The stress management skills that we have explored in some of the other modules are very
helpful in helping us worry less and promote positive behavior.
Facilitator can use this opportunity to review some of the other skills:
Breathing
Body Awareness
Muscle Relaxation
Meditation
Exercise
Good nutrition
Reaching out for help
Limiting caffeine, alcohol, sugar, and nicotine
Resting, getting enough sleep
33
Activity (5): Homework Assignment:
Facilitator will invite participants to become more aware of worrying during the coming week,
when they worry, how much, and about what. This should be done without any judgment or
attempt to stop worrying – the idea is to become more aware of when we do this and how it
poses barriers in recovery. Participants should begin to see how the worry gets in the way of
productive, recovery-oriented behaviors.
IV. Summary/Closure: Ask participants how they feel about what we covered today about
worrying. Ask participants to think about what they would do instead of worrying – in other
words, what productive activities could they be involved in, if they were not worrying. Ask if
they feel more confident about being able to utilize some of the techniques we covered today as
helpful tools to stop worrying,
34
Course Title: Stress Management on the Path to Wellness
Module [8]: How to Monitor Feelings During Stressful Situations
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will consider how to monitor feelings during stressful
situations. Often the inability to be aware of our feelings during stressful situations can get us
into “trouble”. Feelings can escalate without us actually being aware that this is happening, and
suddenly we find that we have fallen into negative thinking and perhaps negative behavior. One
way to avoid this is to monitor our feelings as we are in the situation. If we can do this, we are in
a better position to keep them in “check”, or at least be aware that they are potentially
influencing our actions. We look at whether monitoring feelings can be a helpful tool in breaking
down barriers in recovery, and our path to wellness.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have an understanding of how monitoring feelings can be helpful in handling and managing
stressful situations. They will have identified how their barriers in recovery can be lessened by
learning this skill of monitoring emotions. By the end of this module, participants will have had
practice in learning how to monitor feelings during stressful situations.
III. Engagement:
Activity (1): Review of Homework:
Last week participants were invited to become more aware of worrying, when they worry, how
much, and about what. Participants are invited to share with the group what the results of their
homework were -- what are most of us worrying about? Participants are also invited to share
whether or not the work done last week has produced a greater awareness, and/or understanding
of the role that worry plays in stress and non-recovery behaviors.
35
Activity (2): Brief Self-Assessment:
Participants will first be asked to describe, in their own words “What is monitoring feelings?
How can I do that when I find myself in a stressful situation? Participants will be asked to share
some of their past experiences of feelings during stressful situations. They will be asked to
consider the following questions:
Am I aware of my feelings when I find myself in a stressful situation?
How would it help me if I could become more aware of my feelings in stressful situations?
Would being more aware of my feelings, and being able to monitor them help me cut down
on my reaction to stressful situations?
Do my feelings sometimes seem out of control when I feel myself entering into a stressful
situation?
Is this a barrier to my recovery, and my path to wellness?
Activity (3): Monitoring Feelings in a Stressful Situation
When you monitor your feelings in a stressful situation, you are measuring the level, or intensity
of those feelings. Once we are aware of the level of intensity of the feelings, we are in a better
position to handle them. Stressful situations produce all kinds of feelings, some can be good
(positive), some can be bad (negative). Monitoring our feelings helps us be more aware of how
to handle the stressful situation.
High Level of Intensity = High Potential for Stressful Feelings
Low Level of Intensity = Less Potential for Stressful Feelings
Question: How do we monitor feelings?
Answer:
A. Observe yourself and identify your feelings
B. Pay attention to other participants in the conversation
C. Recognize anger or other “warning” signs
36
Facilitator will suggest to participants that the key question to ask themselves is:
“What am I feeling at this very moment in/ and about this stressful situation?”
If the answer is that you are FEELING SOMETHING, rather that THINKING about the subject
of the conversation that is a sign that there is something going on that is emotional in nature, not
intellectual. If you can identify your feelings before, during, and after the conversation, you can
note changes in the level, or intensity, of the feeling.
How do we measure the intensity of our feelings? The feeling thermometer! How does this
work? If we keep an image of a feeling thermometer in our heads, we can almost see it rise,
when our own feelings go up, or when we sense that the level of someone else’s feelings are
going up. Facilitator can draw the feeling thermometer on a blackboard or flip chart and invite
participants to comment on it.
Role Play and Practice: In this role play participants will be asked to observe cues about
people’s feelings:
NON-VERBAL CUES
Facial expressions: frown, scowl
Body Language: arms on hips or crossed
Gestures: waving arms or fists
Posture: hunched shoulders, no direct eye contact
Physical characteristics: sweating, red face, shaking
Other motions: nail biting, clenching fists, pacing, finger pointing
VERBAL CUES
Tone of voice: soft, hard, neutral
Speech: rapid, slow, slurred, garbles
Language: cursing, repeating the same thing over and over
Speech Pattern: impulsive, chaotic
Content: comments on the subject at hand or personal attacks
Scenario: Facilitator can describe the following stressful situation:
37
You are anticipating going to a family dinner where your sister,
with whom you do not get along, and that you haven’t seen for a
long time, will be present. The last time you spoke ended in a
rather heated agreement. You are already feeling somewhat
anxious about a potential conflict or confrontation with her,
especially in the presence of other family members. You are
thinking that you wish she wouldn’t be there because she
dominates the conversation and is very critical of you. You wonder
why you don’t seem to be able to see her and avoid an argument of
some sort. You arrive at the dinner and your sister remarks in front
of all the family members that you have gained a lot of weight. She
points in out in an uncomplimentary fashion, and you feel
embarrassed. You know that this is a stressful situation, and you
know you are feeling something, but you are not sure what it is.
Facilitator will invite two participants to role play this scenario. After they are done, each will be
asked to share with the group the feelings that they felt, and how intense they were. This is a
negative stressful situation. Facilitator can also use the opposite, or a positive stressful situation
(such as the first day on a new job), to illustrate the same concepts. In a positive stressful
situation the feelings will differ, but intensity may also be high.
Activity (4): Okay, What do we do with the feelings?
Once we learn how to monitor feelings in stressful situations, then we can use the same stress
management skills that we have explored in some of the other modules. While we are in the
stressful situation, we are more likely to use them as techniques, rather than strategies, as we are
concerned about what is happening in the moment.
Facilitator can use this opportunity to review some of these skills:
Deep Breathing
Counting to Ten
TIME OUT
50 Push Ups
Taking a Walk
Taking a Break
Reaching out for help
38
Activity (5): Homework
Participants are asked to set a goal for the coming week of monitoring the intensity of their
feelings when they find themselves in stressful situations as follows, and record their
observations:
When I found myself in stressful situation, I
felt___________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe the
situation_______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe your feelings and the level of
intensity_______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe what you did with those feelings, or which of the techniques you
used__________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
IV. Summary/Closure: Ask participants what they have learned about the skill of monitoring
feelings during stressful situations. Do they feel that they feel more confident about being able to
comfortably monitor their feelings, and use the stress management techniques that we have
learned? How do they feel about moving on to the next session?
39
Course Title: Stress Management on the Path to Wellness
Module [9]: How to Be Assertive Rather Than Aggressive, and Why?
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will consider behaviors and feelings that involve
assertiveness, aggressiveness, and anger. We will consider these three “A’s” in the context of
stress management. Which of these add to stress? Which if them help reduce stress? How do we
tell the difference between assertive behavior and aggressive behavior? How does anger add to
aggressive behavior? How does stress make us want to become more aggressive? These are some
of the questions we will consider today. The skill of recognizing the difference between
assertiveness and aggression is essential to recovery and feeling well, or as well as we can
possibly feel on any given day. The inability to recognize the differences in this area can prevent
us from successfully handling stress in many environments, whether in social, work, or learning
situations.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to explore the differences between being assertive, being aggressive,
and the relationship of both to anger, and stress. The module will have exercises designed to help
participants use the techniques developed in the other modules to reduce stress cause by anger,
and aggression, and practice in being assertive. We will look at the components of these
behaviors, and explore how to turn aggression and anger into appropriate assertive behaviors.
III. Engagement:
Activity (1): Brief Self-Assessment:
Participants will first be asked to describe, in their own words “What is assertive behavior? What
is aggressive behavior? How do I know the difference? Participants will be asked to consider the
following questions and then share with the group:
40
What is aggression?
What is anger?
What is being assertive?
I feel aggressive when . . . . . . . . . .
When I am angry does that make me feel like being aggressive?
What have been my experiences with aggressive behaviors?
Do I know how to be assertive?
What does that feel like?
Is learning how to be assertive part of my recovery and wellness?
What have been my experiences with being assertive?
Does being assertive help me break down barriers in recovery?
Would being more assertive improve my recovery?
Activity (2): What is assertion? What is aggression?
Facilitator will invite participants to make a list of behaviors/feelings which describe both
assertion and aggression. The suggestions listed below are meant to be a starting point for the
conversation.
Assertion Aggression
Clear and direct statement or action Can be indirect, or mis-directed
Open to new or different opinions Closed to new or different opinions
Good communication Authoritarian
Thoughtful, inclusive ―My way or the highway‖
Self-confident Overly critical of others
41
Includes needs of others Self-promoting only
Not harmful to self or others Harmful to self and/or others
Planned Reaction Emotional, ―knee jerk‖ response
Once the list is made, Facilitator will ask participants to describe their own experience of both of
these kinds of behaviors, identifying situations which are likely to make them feel either way, by
answering the following questions:
I feel aggressive when . . . . . . . . . . .. . . … . .
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
When I behave in aggressive ways, I feel . . …………………..
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
My best examples of situations where I have been assertive are . . . . . . . . …
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
42
Aggressive behavior adds to my stress level because. . ….. ……..
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Activity (3): Examples of statements that convey Assertion vs. Aggression
Facilitator will invite participants to compose a list of statements that convey either
assertion or aggression, starting with the following list of suggestions:
Aggressive Statements Assertive Statements
You are such a jerk! I don’t agree with what you said.
I hate you! I don’t like what you just did.
I know you stole my phone. Do you know who stole my phone?
You don’t ever listen . Please listen carefully to me.
The group should say the statements out loud and talk about it feels to say something assertive
rather than aggressive.
Finally, facilitator will invite participants to consider this definition of being assertive:
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Being assertive is a way of saying what you think and
feel without being aggressive, putting others down, or
making yourself and others upset. It is a way of saying
it ―straight‖ which is a good skill for any situation.
When we are assertive we respect ourselves, we respect
others, and we stay cool!
What are some ways to be assertive?
1) What you say:
Use “I” statements
Show that you understand others point of view
State your view clearly
Be prepared to compromise
2) How you say it:
Appear calm
Speak clearly
Speak confidently
Stand straight
Facilitator can ask the group:
Q: How does anger relate to aggression?
A: Anger is a feeling, while aggression is usually a type of behavior which shows that
someone is angry, and may be experiencing extreme stress. Aggression usually leads to
more anger, more stress, and more aggression.
Activity (4): Putting it all together – Why is this important in stress management?
This series of modules has been about LOWERING OR MANAGING OUR STRESS as an
important tool in recovery and wellness.
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If we are acting in ways that are full of anger, or aggression, we are increasing, rather than
decreasing our own stress levels. This is harmful mentally, psychologically, and physically.
If we can learn to be ASSERTIVE rather than AGGRESSIVE, we are promoting recovery and
wellness. This takes practice!
Facilitator will invite the group to pair off into groups of two and role play a scenario in which
there are two options: either reacting and behaving in a way that is aggressive, or one that is
assertive. Any scenario which brings up intense anger will work; the facilitator can ask the group
to suggest the scenario.
Activity (5): Homework
Participants are asked to be aware, in the coming week, of situations in which they feel a desire
to behave aggressively, either verbally, or in some other fashion. They will be asked to observe
themselves and record what actually provoked them into feeling intense anger, or like acting out
aggressively. They will be asked to report back to the group if they were successful in turning an
aggressive response into an assertive one. They will also be asked to report back if this decreased
their stress overall.
IV. Summary/Closure: Ask participants what they have learned about being aggressive vs.
being assertive and why this is important in recovery. Do they feel that they feel more confident
about how to act assertively? Have they seen how it can be used as a skill to improve recovery?
How do they feel about moving on to the next module?
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Course Title: Stress Management on the Path to Wellness
Module [10]: Taking Charge
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will consider the concept of “taking charge” of our recovery
and wellness, as yet another tool for stress management. Taking charge involves a technique of
re-directing our thinking and acting in a positive way, to reduce stress. This is an essential tool in
recovery, as we start to feel more confident about being able to take charge of our lives and feel
more in control. We will introduce the idea of mental fitness, or knowing that we are in control
no matter what is going on around us. This applies to all areas of life – social relationships, and
educational and employment environments.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to explore ways to “take charge” in recovery, as an important tool in
stress management. The module will have exercises designed to help participants develop an
awareness of what taking charge is, what thought processes and behaviors are involved, and how
to create a consistent feeling of confidence in being able to manage life’s challenges.
III. Engagement:
Activity (1): Brief Self-Assessment:
Participants will first be asked to describe, in their own words “What is taking charge?
Participants will be asked to consider the following questions and then share with the group:
How do you take charge?
What does taking charge feel like?
What have been your experiences with taking charge?
Are there areas in your life where you feel like you need to take charge, but don’t?
Do you feel that the inability to take charge is a problem in your recovery?
Are there people in your life who do take charge?
If so, what does it look like when they take charge?
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Activity (2): What is taking charge?
Facilitator will introduce the idea that in taking charge, we acknowledge that often we cannot
control what is happening around us in the world. As a result, we may feel uncomfortable or
notice an increase in symptoms that are unpleasant, or feel unmanageable. In taking charge we
identify two things we can control – our thoughts and our actions.
Q: What happens when we are in a stressful situation?
A: We feel insecure, or frightened, and react by thinking and doing things that are not helpful.
Thinking negatively about a situation is a symptom. Often, these thoughts happen automatically,
because we are so used to thinking in a particular way. The thoughts trigger feelings and
sensations, which then lead to actions.
Facilitator can use the following example to illustrate this process, or chain of events:
You are standing in a long line at the bank. You are in a
hurry to get to work and the line is moving very slowly.
You automatically begin to tap your foot and look
annoyed. You start to think: “That idiot at the desk is
working so slowly. What is his problem? I am going to be
late and my day will be ruined.” As you are thinking this
way, your body starts to feel very tense and you begin to
scowl. You start to feel overheated and like you want to
lash out at someone.
Facilitator will invite the group to name the feelings that come up – such as
Frustration
Irritability
Impatience
Facilitator will ask the group to consider what the consequences are of continuing in this fashion
– such as
A headache
Losing your cool
Yelling at the bank teller when you finally get to the front of the line
Saying something nasty
Just ending up with a bad day
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Facilitator will remind the group that:
EVERYDAY LIFE IS FULL OF FRUSTRATIONS, IRRITATIONS, AND
DISAPPOINTMENTS. THIS IS A FACT OF LIFE.
Facilitator will guide the group through a two step process of “taking charge”
Step One: Thought
We choose an accurate thought:
Instead of “Why is that idiot working so slowly?”,
We choose to think “I cannot control how fast he is working, but I know my turn will come
eventually.”
Instead of “I’ll be late, my day is ruined”,
We choose to think “I probably still have enough time to get to work, or at most I will be a few
minutes late. It is not terrible.”
Step Two: Action
We choose a helpful response to the situation:
Instead of clenching a jaw or fist,
We change our facial expression into a smile
We do some deep breathing
We count to ten
We distract ourselves by starting a conversation with the person next to us
Step Three: Result – We start to feel better. This is taking charge.
Activity (3) Questions to ask ourselves:
Facilitator will help the group compose a list of common daily frustrations or irritations:
Your bus is late
The weather is terrible
The rest room is occupied
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You ran out of toothpaste
Your favorite shirt has a hole in it
You ran out of coffee
Your favorite TV show is cancelled
You get toothpaste on your shirt
The person in front of you can’t find their metrocard
Someone you need to speak with is not available
We can let these frustrations ruin our day. Or, we can ask ourselves the following three
questions:
Is this situation or problem worth ruining my day?
Is this situation worth getting all stressed over?
Is this situation worth feeling very uncomfortable physically and mentally?
IF THE ANSWER IS NO, LET IT GO!
If the answer is no, then the situation you are stressed about is very small, compared to your
recovery, and your sense of wellness. Once we realize that the situation is so small, or trivial,
it becomes easier to manage.
Even if the situation is bigger, or more important than the ones described above, ruining
your day does not help you handle it. Keep it in perspective, and get help. You can allow
yourself to get distressed, or feel sad, or angry, or frustrated, or disappointed, without
having it take you over your day, or make you feel powerless and unable to cope. TAKE
CHARGE, of your thoughts, feelings, and actions.
We can only control what we think and do. Sometimes we can influence other
people or situations, but we can never control them or what they do.
Facilitator can introduce the analogy of the following saying, and ask the group to comment.
―You can bring a horse to water but you can’t make him drink‖.
Activity (5): People and things outside of us can only change our feelings if we let them
Facilitator can use the example of being stuck in a traffic jam, with two possible ways to
approach the situation:
Thought: ―I can’t stand this; I’ll go crazy if I sit here much longer”
Feeling: upset, angry, frustrated
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Alternate thought: “This will give me a chance to listen to some music”
Alternate feeling: relaxed
Activity (6) Working it Up or Down
Facilitator will introduce the idea to the group that we always have the opportunity to
handle a situation in a fashion that de-stresses, rather than dis-stresses!
For example: Someone does something that makes you mad, and you feel yourself starting to get
angry.
Option one: work it UP –
You can rant, and rave, and carry on, and complain. This will escalate uncomfortable and
stressful feelings, and will result in unpleasant symptoms, and possibly non-recovery behavior.
Option two: work it down -
You can change your thoughts, tell your muscles to relax, ask your mouth to curve up in a smile,
walk away from a situation that is escalating, or do a time out, etc. This is a choice.
Activity (7) Calm begets Calm
Facilitator will pose the following question to the group:
How do we work on remaining calm in a distressing situation?
Ask your muscles to open and loosen
Breathe slowly and deeply
Speak slowly and softly
Result:
You maintain your inner peace
Others around you may also feel more peaceful
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Remember: Don’t let feelings determine your actions
o Don’t let what you feel on the inside determine what you do on the outside
o If you feel like hitting someone, don’t do it
o If you feel like throwing something, don’t do it
Facilitator can introduce the idea of ―Avoiding symbolic victories‖
Think of the last time you “told someone what time of day it was”.
How did it feel?
While you were ranting and raving you felt very powerful and alive. That was a temporary
feeling! When the rampage was over you felt guilty, embarrassed, and full of self-blame and
doubt.
Participants are invited to share how they have felt in similar situations.
Facilitator can pose the idea of ―What is a real victory?‖
A real victory is . . . . . . . . . . One where we express our feelings (rather than our temper), act
assertively, rather than aggressively, and respect ourselves and others – which leaves us feeling
better in the long run.
Every act of taking charge (self-control), and not acting out, builds
Self esteem
Self respect
Self confidence
Activity (8): Homework
Participants are asked to be aware, in the coming week, of situations in which negative thoughts
come up, and in which they feel themselves “losing their cool”. They will be asked to observe
their thoughts, and try to use the two step process discussed today to “take charge”. They will
also be asked to report back how this worked, and if this decreased their stress overall.
IV. Summary/Closure: Ask participants what they have learned about taking charge, and why
this is important in recovery. Do they feel more confident about taking charge? How do they feel
about moving on to the next module?
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Course Title: Stress Management on the Path to Wellness
Module [11]: More Strategies for Coping with Stress
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will pursue more strategies for stress management, in
addition to the ones we have already learned in previous modules. The techniques we cover
today will build upon strategies learned earlier, and all the skills we have accumulated in this
course to date. We will focus on some cognitive techniques as ways to change our behaviors in
the face of stress and challenges. We will all share strategies that we are using right now in our
recovery as a way to and increase wellness.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to explore even more ways to manage stress. Participants will have had
an opportunity to assess the strategies they have been using thus far, and how well they have
been working. They will be able to identify areas where they need more work on stress
management, and perhaps some more “advanced” techniques.
III. Engagement:
Activity (1): Positive self-statements
Facilitator will invite the group to consider what a positive self-statement is, and how this can be
used to reduce the impact, or threat, of anxiety and stress producing situations.
What is a positive self-statement?
A positive self-statement is when I say something positive about myself to myself to bolster my
self-esteem.
What are some examples of positive self-statements?
I am going to do well at this.
I’m well prepared.
I can handle this.
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My ability to do this is equal to everyone else here.
I always do my best.
When might I want to use a positive self-statement to reduce my stress?
Before a stressful situation.
During a stressful situation.
When I am hearing negative self-statements in my head (I can’t do this, I am so stupid)
After a stressful situation to reinforce my self-confidence.
Facilitator will invite the group to add to this list, and discuss how and when to use these
statements. Facilitator will ask the group to share their experiences, if any, with the use of
positive self-statements, or how they think this skill can be helpful in recovery and a promoting a
sense of wellness.
Activity (2): Changing Schedules, Routines, and Habits
Sometimes we cling to old habits and routines, even after they become less useful, or even
boring, or destructive, because we are used to them, and we do not like change. But change can
actually reduce stress. Facilitator will invite participants to take another look at their habits,
schedules, and routines, and see how they could be re-organized to reduce stress and promote
wellness.
Example 1: Scheduling
Instead of always scheduling yourself to do as much as possible, schedule yourself to
maximize your enjoyment of life.
Allow time to get to where you are going and try to enjoy the process of getting there,
rather than just getting there as fast as possible. Enjoy the trip, if you can, and try to
“smell the roses along the way.”
Try to figure out what is meaningful for you in your life, and then try to plan a schedule
that adds meaning to your day, rather than just a list of chores to get done.
Plan ahead with flexibility, but plan ahead
Example 2: Changing Routines
Practice saying no, when you need to say no. Saying yes when we want to say no is very
stressful, and we end up doing things we don’t want to do. Then we often become
resentful. Or worse, we do things we shouldn’t do.
Avoid stress producing people and activities. This is similar to avoiding triggers, but a
little more complicated. If it is not possible to move to a new environment, and often it is
not, reduce the amount of time you spend in that environment.
Most importantly, be aware of your own reactions to people, places, and things, maintain
your perspective, and try to maintain neutrality when you can.
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Example 3: Changing Habits
Break out of type “A” habits.
We eat, talk, and move too fast.
Try to consciously slow down.
Don’t be in constant competition.
Don’t ignore or deny tiredness.
Don’t multitask all the time.
Save some time to be alone in every day and then use that time.
Take a different route to work.
Get off the bus early.
Try something you have never done before or haven’t done for a while.
Activity (3) Problem Solving vs. Worrying
Facilitator can refer to the previous module on worrying, and how that can often serve as a
trigger for relapse, or non-recovery behavior. In this activity, we will consider the benefits of
problem solving vs. worrying.
WORRYING IS VERY STRESSFUL AND TIME CONSUMING
Simple steps for problem-solving to use when we need to problem-solve but find ourselves
worrying instead.
Consider what all your options are in the situation.
Consider the pros and cons of each option.
Considering all options, visualize what it would feel like to be in each one.
Consider the possible outcomes of each option.
Weigh your feelings.
Decide what is in your best interest.
Make a decision and CLOSE THE ISSUE.
Facilitator should stress how important the final step is, CLOSEING THE ISSUE. When we re-
open the issue, we are not problem solving, we are worrying.
Scenario:
You have just decided not to go to work today because you are
not feeling well, even though you know you have a lot of work
to do. You have already called in sick. Rather than staying at
home and resting so that you feel better and can go to work
tomorrow, you are sitting on the couch thinking about how it
was really a bad idea to have called in sick. You are thinking
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that your boss will be annoyed, and you really didn’t feel that
sick after all, and that you will never get all your work done,
etc., etc.
Facilitator will ask participants to reflect upon this scenario and ask if they have ever felt like
this in a similar situation, where they agonized about a decision they had made. Ask participants
to describe what it feels like when they are in this kind of situation. Ask participants to describe
how they have felt in a similar situation when they have done this. Facilitator can point out to the
group how stressful and anxiety producing to engage in this kind of activity.
Activity (4): Some Other Useful Strategies:
Facilitator can invite the group to share any experiences they may have had with the strategies
outlined below:
1) Talk out your worries with friends, counselors, spiritual advisors, both in the moment
and on an ongoing basis,
2) Focus on the present, not the past or the future. We cannot change the past (although we
can learn from it), and the future is unknown.
3) Try to learn from mistakes, but don’t be too hard on yourself if you make the same
mistake again.
4) Take a moment and project ahead—give yourself the prospective that now is not
forever. This is not fantasizing; it is giving you some time and space to get into a better
mood.
5) Maintain a steady pace, and then the wearing effects of stress are minimized. Constantly
putting out big spurts of energy can wear you out, and make you very tired.
.
Activity (5): Homework
Participants are asked to pick any of the strategies outlined above and commit to using them
during the coming week.
IV. Summary/Closure: Ask participants if they feel they are starting to increase their “toolkit’
of stress reduction techniques, and the ability to use them more effectively. How do they feel
about moving on to the next module?
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Course Title: Stress Management on the Path to Wellness
Module [12]: Good Days vs. Bad Days
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will consider why some days feel like “good days” and
some days feel like “bad day: Part of this conversation is about how stress can turn a good day
into a bad one, if we let it. This module will contain a series of exercises designed to help us
rethink our day to day life experiences and put them into perspective. Perspective is the context
from which we deal with the challenges we face every day. A “bad day” can feed into relapse if
we let it. A bad day can challenge our recovery and path to wellness. The skill of making every
day a “good day”, or the best day it can be, is an essential skill in recovery. The inability to
experience a good day or to prevent a good day from turning into a bad one can prevent us from
successfully handling stress in many environments, whether in social, work, or learning
situations.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to explore their day to day experiences from a perspective which is
designed to be realistic and recovery based. Part of the perspective is the concept of overall
wellness – that some days are better than others, but that overall, a day in recovery is a good day.
While we may not be reaching our goals as quickly as we would like, we add to our own stress
by feeling like today is a bad day. We will also look at the components of what we think is a
good day vs. a bad day.
III. Engagement:
Activity (1): Brief Self-Assessment:
Participants will first be asked to describe, in their own words “What is a good day? What is a
bad day?” Are stressful days the same as bad days? Participants will be asked to share some of
their past experiences of expressing feelings. They will be asked to consider the following
questions:
My idea of a good day is . . . . . . . .. . . . . .
My idea of a bad day is . . . . . . ………. .
When I have a good day I feel . . ……………
When I have a bad day I feel. . …………….
If I had more good days, my recovery would . . . . ……………… 56
Activity (2): Good Days and Bad Days
Exercise (1): “How is this day going for you?”
Facilitator will invite participants to share with the group how this day is going for them, inviting
them to be as descriptive as possible. Facilitator can refer to some of the other modules to review
descriptive words for feelings.
Exercise (2): “My perfect day looks like . . .....”
Facilitator will invite participants to describe their “perfect” day, and what that would involve.
The next step in the process is to compare today to the “perfect day”.
Exercise (3): What makes a good day?
Participants are asked to complete the following worksheet, with the following as starting
suggestions:
GOOD DAY BAD DAY
Nice Weather Big Snowstorm
Going to see a good movie Getting Nothing Done
Getting together with friends Feeling Lonely
Getting things done Not taking care of yourself
Taking care of yourself Bad day at work
Participants are asked to report back, and there is a group discussion about what makes up a good
day and a bad day.
Exercise (4): How do you feel about yourself on a good day?
Participants are invited to explore how they feel about themselves on a good day or a bad day –
and again, to be as descriptive as possible.
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On a good day, I feel . .. . . . (intelligent, capable, a survivor, hopeful, progressing)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________________
On a bad day, I feel . . ….(stupid, inferior, a failure, hopeless, stagnant)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Activity (4): Making Today a Good Day
Facilitator will point out to the group that the skills used in managing stress are skills that can be
used to make almost every day a good day, or make the bad days not feel so bad. A good day is
not a day in which we have no stress, or challenges. A good day is a day in which we feel we can
manage our stress and face what life sends our way. A good day is a day with BALANCE, some
good, some bad. This idea is a cornerstone of recovery: Via a changed perspective, we can begin
to exert control over our lives.
What are some of the strategies for making today a good day?
Asking for help
Exercise
Meditation
Good nutrition
Getting enough rest
Having a good sense of humor
Expressing your feelings
Deep Breathing and Body awareness
Staying in the moment
Feeling good about ourselves
Remembering that we can’t accomplish everything in one day
Avoiding worry
Avoiding catastrophizing
Celebrating our successes
Emphasizing the positive
Overcoming barriers in recovery
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Activity (4): Homework
Participants are asked to be aware, in the coming week, of how many “good days” they have and
how many “bad days”. They will be asked to see if on a bad day, they could use some of the
work done today to keep their perspective, and maintain an attitude that today is a “good day”!
IV. Summary/Closure: Ask participants what they have learned about good days and bad days.
Do they feel that they feel more confident about being able to comfortably express their feelings?
Have they seen how it can be used as a skill to improve recovery? How do they feel about
moving on to the next session?
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Course Title: Stress Management on the Path to Wellness
Module [13]: Coping with Anxiety
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will look at how to cope specifically with anxiety, as part of
stress management. We are looking at anxiety specifically because so many of us suffer from it,
in addition to other issues. We will focus on some stress reduction techniques which can be used
specifically for anxiety management and reduction. We will all share strategies that we are using
successfully to manage anxiety.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to explore the role that anxiety plays in stress, and see how the stress
reduction techniques that we have covered can be used to manage to anxiety. Participants will
look at anxiety triggers, and learn to identify ways that the body lets us know through symptoms
that we are feeling anxious. Anxiety will be addressed as a significant barrier to goal attainment
in all the domains, and as one that needs to be addressed on an ongoing basis throughout the
stages of recovery.
III. Engagement:
Activity (1): Review of Homework
Last week participants were asked to be aware, of how many “good days” they have and how
many “bad days”. Facilitator will ask anyone from the group who would like to share what their
experience was with the homework, and if they started to notice the differences between days
that are not all good, or not all bad, and the opportunities to turn bad days into good ones, or
good days into better ones!
Activity (2): Brief Self-Assessment
Facilitator will invite the group to share their thoughts about anxiety and how it plays a role in
illness/recovery:
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What is anxiety?
How do I know when I am feeling anxious?
What are the symptoms of anxiety?
How do I feel physically when I am feeling anxious?
How do I know the difference between anxiety and fear?
Do I feel anxious every day?
What are the situations that make me feel the most anxious?
How big of a barrier is anxiety in my recovery?
If I was able to control my anxiety, or lessen it, would this be an important skill in
improving my recovery and path to wellness?
Would I have more energy if I felt less anxious?
Activity (3): What is anxiety?
Facilitator will propose to the group some definitions of anxiety, and will then ask the group to
share their own definitions of anxiety. Facilitator can also point out that if you ask several people
what anxiety is, you will probably get several definitions – depending upon what that person’s
unique experience has been. Everyone experiences anxiety, but not in the same way.
Anxiety is. . ……. . . . ………
A normal human emotion
What happens when I am in a stressful situation
A mental illness
A disorder
Sweaty palms and a racing heart
A sense of dread
A feeling that something terrible is going to happen
Tightness in my chest, feeling like I can’t breathe
Waves of fear coming over me
A feeling that the world is a dangerous place
Subjective – it is what YOU are feeling
A combination of physical sensations, behaviors, emotions, and thoughts
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Facilitator will ask participants to start to think of what their ―anxiety triggers‖ are, in
other words, or in which situations are they most like to experience anxiety:
I start to feel anxious when . . . .
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Activity (4) Anxiety is. ..
Facilitator will describe three different people, all of whom are suffering from anxiety, and invite
the group to comment. In each scenario, the anxiety manifests itself in different ways. Facilitator
can point this out as a way to indicate that anxiety is not always clear-cut. It can feel like pure
physical symptoms, or fear, or anger, or other emotions. It can also manifest as an inability to
concentrate or focus, or being easily distracted.
Jane is a receptionist in the program she attends. Her job is
actually very high pressure – a lot of people come in through
the door every day and she has a lot of different tasks that need
to be accomplished in one day. Sally will tell you that her job is
stress-free and that she likes what she does. She starts to notice
that when she goes into her local grocery store she starts to
sweat, and she feels like she is losing control. Although she
needs to buy food, she has stopped going shopping for the most
part, and eats out in restaurants.
Facilitator can point out how this anxiety is “displaced”, in that it does not appear to come out in
the situation which actually fosters the anxiety. In addition, the anxiety that Sally feels when she
is in the grocery store has caused a rather expensive change in her lifestyle. Facilitator can ask if
anyone can “relate” to this kind of anxiety.
John finds himself worrying about just about everything – his
job, his home life, his dog, how he will figure out how to use his
new computer. In fact, he worries all the time about almost
everything. His worrying (anxiety) feels very out of control.
Facilitator can point out that this is a very all-pervasive, free-floating anxiety. It is not attached to
a particular situation, or person. Bill feels anxious all the time. Facilitator can ask if anyone can
“relate” to this kind of anxiety.
Cathy describes herself as calm and low key, as long as she
doesn’t have to go on an airplane. Being in an airplane makes
her feel like she needs to escape, but she can’t. If she knows
that she will have to go on a plane, she worries about it for
days in advance and obsesses about how she will ever be able
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to get through the experience. She avoids this situation
whenever possible.
Facilitator can point out that that Cathy’s anxiety has become “attached” to one particular
situation that she may need to deal with in her life once in while. It is not clear what she is really
anxious about. Facilitator can ask if anyone can “relate” to this kind of anxiety.
Activity (5): Stress reduction: Coping with Anxiety
Facilitator can help participants make a list of techniques already covered, plus new ones, that
can minimize anxiety.
Muscle Relaxation
Deep Breathing
Challenging inaccurate thoughts (my home is a very dangerous place . . . . .)
Checking in with others about what is real, and what is imagined, or perceived
Positive self-talk
Exercise
Yoga
Meditation
Sports
Martial Arts
Staying Focused
Staying in the Moment
Activity (6): Homework
Participants are asked to pick any of the strategies outlined above and commit to using them
during the coming week, in response to anxiety.
IV. Summary/Closure: Ask participants if they feel they are starting to increase their “toolkit’
of stress reduction techniques, and the ability to use them more effectively. How do they feel
about moving on to the next module?
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Course Title: Stress Management on the Path to Wellness
Module [14]: Expressing Feelings as a Strategy for Managing Stress
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will consider expressing feelings as another skill for
managing stress. Previously in this course we considered how to monitor our feelings, as a way
to manage stress. The ability to express the feelings is a complementary skill in managing stress.
The inability to express feelings can often pose barriers in recovery – it can prevent us from
successfully handling stress in many environments, whether in social, work, or learning
situations. We look at whether expressing feelings can be a helpful tool in breaking down
barriers in recovery.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have an understanding of how expressing feelings can be helpful in handling and managing
stressful situations. They will have identified how their barriers in recovery can be lessened by
learning this skill of expressing feelings. By the end of this module, participants will have had
practice in learning how to express feelings before, during, and after stressful situations.
III. Engagement:
Activity (1): Review of Homework:
Participants are invited to share whether or not the work done last week produced a greater
awareness, and/or understanding of how to cope with anxiety.
Activity (2): Brief Self-Assessment:
Participants will first be asked to describe, in their own words “What is the skills of expressing
feelings? How can I do that when I find myself in a stressful situation? Participants will be asked
to share some of their past experiences of expressing feelings. They will be asked to consider the
following questions:
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How do you feel when you are able to express your feelings?
What do you say, most of the time, when someone asks you how you feel?
What happens when you tell someone how you feel?
What happens when you don’t express your feelings?
When you are able to express your feelings, do you feel less stressed?
How would this skill help you manage stress in your life?
How would expressing feelings support your recovery and your path to wellness?
Activity (3): Expressing Feelings
Facilitator will invite participants to put together a definition of the skill of expressing feelings:
Expressing feelings means that you state out loud the emotion that you are experiencing at a
given point in time.
Expressing feelings means identifying how we feel, in words, rather than by body language or
facial expression.
Expressing feelings is when we describe to others how we feel.
Expressing feelings is a way of getting in touch with ourselves and monitoring our mood.
Expressing feelings can help us identify when we feel stressed, and why.
Facilitator will invite participants to share their thoughts about these definitions of expressing
feeling.
Activity (4): What are the key components of Expressing Feelings?
Facilitator will suggest that the key components of expressing feelings are
1) Assess the situation
2) Name the feelings
3) Decide if and when to share the feelings
4) Verbalize the feelings
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When is it important to express feelings?
When you are feeling stressed
When you think that expressing the feelings may alleviate the stress
When someone does something that has a powerful impact on you
When you notice bodily reactions that may indicate a strong feeling
When the emotion feels like too much to carry around with you
When it feels important to you to express a feeling
Exercise (1): Assessing the Situation
Assessing the situation means figuring out WHAT HAPPENED?
Who was involved?
What was said or done?
When did it happen?
Where did it happen?
Why did it happen?
Exercise (2): Name your feelings
It is not always easy to name a feeling. One of the ways we can make that easier is by creating a
chart with general categories of feelings, so that we have a place to begin: Facilitator can also
refer to the “feeling word chart” in the Boston University compendium module on expressing
feelings, p. 26. for additional suggestions.
Good Bad Mixed
Happy Sad Confused
Peaceful Agitated Unsure
Strong Frightened Doubtful
Creative Stuck Anxious
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Facilitator will invite participants to add to this list, and to create their own list of feelings that
they commonly experience.
Exercise (3) Decide if and when to share the feelings
To decide IF we need to share our feelings, we can consider the following questions:
How important is this situation?
How important is this situation to my overall recovery and my path to wellness?
How intense are my feelings?
What might happen if I express my feelings in this situation (pros and cons)?
Would it be harmful to anyone else if I expressed my feelings in this situation?
What might happen if I do not express my feelings?
Would it help me feel less stressed if I expressed my feelings in this situation?
To decide WHEN to share our feelings, we can consider the following questions:
Do I feel secure in knowing what my feelings are?
Am I comfortable with my ability to name my feelings in this situation?
Do I feel ready to share my feelings?
Is this the right situation to share my feelings?
Is this the right time, in this situation, to share my feelings?
Do I need privacy to share my feelings in this situation?
Are there other people here who might benefit from hearing my feelings?
Are there others here who might object to hearing my feelings?
Exercise (4): Verbalize the feelings
Verbalizing your feelings, once you feel secure in what to say, should be done in the following
fashion:
A STRONG, CONFIDENT, BUT NEUTRAL AND CALM TONE OF VOICE.
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Facilitator can describe the following scenario as preparation for a role play:
Sally and her roommate Jane are having a discussion about why
Jane never cleans the bathroom when she is supposed to. This is a
stressful situation for both of them because Jane hates to clean the
bathroom, and Sally hates to have a dirty bathroom. They have
been roommates for over a year and the situation does not seem to
have improved during that time. Sally is feeling like she is at her
wits end. Sally says to herself – What am I feeling? She feels
agitated and like her heart is racing. She feels like she can’t have
this conversation one more time.
Facilitator will ask for two volunteers to role play this interaction. Participants will be asked if
they can identify the component parts after the role play.
1) Assess the Situation
Sally looks at what actually happened – that she and Jane had the same conversation they’ve had
over and over for the past year. It happened again because they have never solved the problem.
2) Name the Feelings:
Sally names her feelings: She realizes that she is angry but that she is also hurt that Jane won’t
fulfill her responsibilities as a roommate.
3) Decide if and when to share the feelings:
Sally wonders whether or not this is the right time to tell Jane how she feels. She assess whether
or not she needs a time out, or a “count to ten”. She decides that she cannot deal with this anger
any more and needs to let it out. She decides that her continuing relationship with Jane will
benefit from her having shared her feelings.
4) Verbalize the feelings:
Sally thinks about the right words to use, and the she verbalizes her feelings to Jane.
Facilitator can also do a follow up role-play at this point with Sally sharing her feelings with
Jane, and hearing Jane’s response.
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Activity (5): Homework
Participants are invited to pick a stressful situation at home, work, school, or any other
environment. When they are in that situation in the coming week, they should evaluate the
feelings that come up, be aware of them, and if possible, use the steps outlined above to express
the feelings.
IV. Summary/Closure: Ask participants what they have learned about the skill of expressing
feelings. Do they feel more confident about being able to comfortably express their feelings?
Have they seen how expressing feelings can be used as a skill to improve recovery? How do
they feel about moving on to the next session?
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Course Title: Stress Management on the Path to Wellness
Module [15]: How Can I Get Help with Stress: Building a Support Network
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will look at how to how we can manage stress and
challenges in our lives through building a supportive network. We will consider the idea that we
do not recover alone, or on own. We need help, and support, as we continue on the path to
wellness. We will look at areas where we feel we need support in our lives right now – perhaps
in situations which cause stress. We will look at how to reach out for support, when to reach out
for support, and where to reach out for support.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to explore how to build a supportive network as a tool for stress
management. They will have an opportunity to share what kind of supportive networks they may
already have, and how successful they have been in utilizing the network in stressful times.
Participants will look at where they may need to build on the network they already have, and
how to build the confidence to use the network when they need to.
III. Engagement:
Activity (1): Review of Homework
Participants are asked to share any experiences from the past week with expressing feelings, and
the use of the stress reduction techniques we have been focusing on. Which techniques and
strategies have been helpful?
Activity (2): Brief Self-Assessment
Facilitator will invite the group to share their thoughts about building and using a supportive
network.
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What is a support network?
Do I have a support network?
Do I know how to use the network when I am feeling stressed?
Do I know when to use the network?
Do I know how to ask for help?
Do I know how to accept the help when I get it?
When I reach out for help, do I feel less stressed?
How important is the support network to my recovery?
Would building a better support network break down barriers in my recovery?
Activity (3): Breaking Down Isolation as a Method of Stress Reduction
Facilitator will propose to the group that feeling isolated, or alone, is a key barrier to reaching
goals in recovery. Feeling alone, and like we have to do everything for ourselves, can lead to
very high levels of stress and feelings of overwhelm. High levels of stress and feelings of being
overwhelmed can lead to relapse and non-recovery behaviors.
Facilitator might acknowledge with the group that often we feel that we don’t have enough
supportive people in our lives, especially if we live alone. Sometimes we feel lonely, or perhaps
sad, or depressed. It would be ideal to find supports in our lives that we really enjoy! How can
we find those people?
First, we need to talk about friends: Facilitator can invite participants to add to this list.
What is a good friend?
A good friend is . . .
Someone you like
Someone you respect
Someone who likes you
Someone who respects you
Someone who accepts you the way you are
Someone who does not expect you to change
Someone who listens to you
Someone whom you like to listen to
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Someone who listens to the good and the bad
Someone who will not betray your confidence
Someone who lets you express your feelings and emotions
Someone who does not judge you
Someone who does not tease you
Someone who does not criticize you
Someone who lets you help them when they need it
Someone who is available to help you when you need it
Someone who does not take advantage of you
Some people in our life meet some of our needs, and other people meet other needs. No one can
satisfy all of our needs all the time. That is why it is important to have a variety of supportive
people in your life.
Facilitator will invite participants to make a list of the people in their lives that they feel close to.
I feel close to . . . . . . . . .
My roommate
My cousin Carrie
My mother
My sister
My brother . . . . . ……..
Facilitator will invite participants to look at ways to maintain these relationships:
How do we maintain friendships……………..?
We given them consistent attention
We develop a friendship with ourselves
We learn to like ourselves first and a enjoy spending time with ourselves
We learn to be there for others
We listen and share
We communicate openly
We don’t give advice unless someone asks us
We stay in touch but don’t overwhelm the other person
Activity (4): Developing New Friendships/Supportive Relationships
Q: Does it feel difficult to be with people sometimes?
Q: Does it sometimes feel easier to stay home and complain about being alone?
Q: Do relationships feel like “work”?
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Facilitator will invite participants to put together a list of activities that are designed to break
down isolation and build supportive people and networks in their lives. A good way to meet
people that you might like is to do things that you enjoy:
What do I like to do?
Ride a Bicycle (join a bicycle club)
Go to concerts
Cook (join a cooking group)
Make scrapbooks (start a scrapbook group)
Go to the movies (join a movie club)
Learn new things (take a course)
Other ways to meet people:
Attend support groups, with people who are facing similar challenges in their lives
Go to community events
Go to any kind of house of worship
Activity (5): Other Kinds of Support on the Path to Wellness
REMEMBER: LET OTHERS KNOW WHEN YOU ARE IN NEED
Peer support: support from people who understand you – you can find information on the
internet about many kinds of groups, or start your own!
Therapeutic help – counselors, case managers
Spiritual support
Help at work from supervisor, or co-workers
Help at school
Help from government agencies
Help from professional associations.
IV. Summary/Closure: Ask participants how they feel about building a supportive network as
part of their recovery and path to wellness.
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Course Title: Stress Management on the Path to Wellness
Module [16]: How Far Have I Come?
I. Introduction and Explanation of Goals for this Module: This is a basic script that can be
used to open the session: “Today we will review all that we have covered in these past modules
on stress management and see how well our “tool kits” are serving us. We will look at the
various areas of life to see how well the stress management techniques we have learned are
serving us. We will look at where we may need to do more work in the areas of living, learning,
working, and relationship building. We will look again at the importance of a supportive
network in managing stress and feeling well.
II. Learning Objectives and Expected Outcomes: By the end of this module, participants will
have had an opportunity to review progress in the area of stress management. They will have an
opportunity to share how they have been using their toolkits in their lives, and how successful
that has been. They will have an opportunity to share whether or not they have noticed any stress
reduction in their lives, and whether or not they have learned any new stress reduction techniques
that they may want to share with the group.
III. Engagement:
Activity (1): Brief Self – Assessment:
Participants will be reminded of the assessment we did in the first module for this course, in
which we described in our own words: “What is stress? How do I know when I am feeling too
much stress? How do my symptoms indicate to me that I am under too much stress or am
“stressing”? Participants were asked to share some of their experiences in this area. Today,
participants are invited to reconsider the same questions, and see how the answers, have changed
after 16 weeks of working on stress reduction:
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What is stress?
Can stress be positive or negative?
What have been some of your experiences with stress?
Do you feel stressed right now?
When was the last time that you remember feeling too stressed?
What did you do?
What do you do when you sense a potential stressful situation?
Do you start to become anxious, frightened, tense, and angry?
Do you avoid stressful situations?
Are any of your relationships stressful?
Do you need help in managing stress at your job?
Do you need help in managing stress at school?
Do you need help in managing stress at home?
Activity (2): Stress Management Review
Facilitator will review and list all of the methods covered in the last fifteen modules and ask
if participants have come up with any additional ones to add to the list:
Exercise
Counting to Ten
Body Awareness
Muscle Relaxation
Listening to Music
Eating Well
Asking for Help
Creating Support Network
Yoga
Tai Chi
Acupuncture
Massage
Meditation
Positive self statements
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Changing schedules, routines, and habits
Problem solving vs. worrying
Talking out worries with friends, and counselors
Focusing on the present, not the past or the future.
Trying to learn from mistakes
Give yourself the perspective that now is not forever
Maintaining a steady pace
Building Your Support Network
Activity (4): Using your toolkit:
Participants are invited to share how they have used their toolkits in the past fifteen weeks,
and how ―well‖ they feel, as compared to when they started the course:
When I am stressed, I can . . . . . . . . .
………………………………………………………………………………………………………
………………………………………………………………………………………………………
And then I feel . . . . . . .
………………………………………………………………………………………………………
………………………………………………………………………………………………………
I have seen improvement in these areas of my life
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
I no longer feel as anxious when
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………..
I no longer feel as stressed when
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………..
……………………………………………………………………..
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