J-SAT



|CASEWORKER'S CBT COACHING GUIDE |[pic] |

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| |Stress Management Skills | |

|STEP 1 |Assess: Once you have determined your client’s need for assistance, follow these steps. |

|STEP 2 |Educate: In your own words, define stress management and its sources: |

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|Definition |Stress is the mental and emotional strain on you caused by either external or internal sources; your body also feels |

| |the effects of stress. Stress manage-ment is about (1) taking preventive steps to keep stress levels down, and (2) |

| |reducing high stress levels when they happen. |

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| |Some of the external and internal sources of stress are commonly called stressors. |

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| |External Sources |Internal Sources |

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| |( Family members and conflicts. |( Negative attitudes. |

| |( Job/boss/work environment. |( Negative feelings. |

| |( Peers and peer pressure. |( Unhelpful thoughts. |

| |( Daily hassles. |( Unrealistic expectations. |

| |( Money, housing, poor diet/sleep, |( Worrying in excess. |

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|Summarize |(1) You've probably noted your own personal ways of reacting to stress: they can be a headache; shallow breathing; |

| |changes in your appetite/sleep; upset stomach; nervousness and irritability; general fatigue; and, of course, some |

| |people attempt to use drugs/alcohol to cope, |

| | |

| |(2) Stress management is about maintaining a balance between things going on in your life. When stress isn't managed,|

| |we view it as an irritation. This fact applies to everyone; it's a permanent part of our modern world. All of us must|

| |focus on managing stress at acceptable levels in our lives. |

|STEP 3 |Model: Explain that you're going to show the client a deep breathing method that will help them relax. The method is |

| |quick and easy to do almost anywhere. Model these steps, now, in front of your client: |

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| |(1) Stand erect with the feet shoulder-width apart. Hands down at your sides. |

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| |(2) Inhale through the nostrils, as if slowly filling a balloon inside your belly. |

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| |(3) Continue inhaling until you feel the air expanding into your chest. |

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| |(4) Hold the air in for a couple of seconds, and raise your shoulders straight up just a little. |

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| |(5) Now we go in reverse: letting your shoulders fall and let the air seep slowly out from the chest and then the |

| |belly. |

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| |(6) Repeat steps 1-5 only 3 times (beginners); or 8-10 times (once a routine is established). |

|STEP 4 |PRACTICE: Ask your client to stand and practice the deep breathing exercise. Suggest that your client fix his/her |

| |eyes at a spot head-level on a wall. See the coaching steps below. |

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|Deep |(1) Stand erect with the feet shoulder-width apart. Hands down at your sides. |

|Breathing | |

|Steps: |(2) Inhale through the nostrils, as if slowly filling a balloon inside your belly. |

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| |(3) Continue inhaling until you feel the air expanding your chest. |

| |(4) Hold the air in for a couple of seconds, and raise your shoulders straight up just a little. |

| |(5) Now we go in reverse: letting your shoulders fall and let the air seep slowly out from the chest and then the |

| |belly. |

| | |

| |(6) Repeat steps 1-5 only 3 times (beginners); or 8-10 times (once a routine is established). |

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| |1. Explain that you will read the steps out loud. |

|Coaching Practice: |2. Read steps 1 & 2 (above), wait two seconds, read steps 3 and 4, wait a couple more seconds, and read step 5. |

| |3. Repeat the first five steps once more with your client. |

| |4. Ask for client's feedback; how do their muscles feel? Emphasize that they should hold the air in long enough to |

| |get the benefit, but not so long that it begins to feel uncomfortable. |

| |5. Give the client (a) a copy of page 3 and (b) the Cooling Off from Stress Handout (pp. 5-6) and briefly explain |

| |what page 3 means. |

| |6. Assign at-home tasks: asking for help and the deep breathing (pp.3-4) |

|MANAGING MY STRESS |

|Steps to Keep My Stress Levels Down | |Reducing High Stress Levels When They Occur |

| | | |

|( Abstain from alcohol/drugs to cope | |A. Deep breathing exercises: |

| |(1) Stand erect with the feet shoulder-width apart. Hands down at your |

| |sides. |

| | |

| |(2) Inhale through the nostrils, as if slowly filling a balloon in your |

| |belly. |

| | |

| |(3) Continue inhaling until you feel the air expanding your chest. |

| | |

| |(4) Hold the air in for a couple of seconds, and raise your shoulders |

| |straight up. |

| | |

| |(5) In reverse, exhale: letting your shoulders fall and the air to |

| |slowly seep out from the chest and then the belly. |

| | |

| |(6) Repeat steps 1-5 only 3 times (beginners); or 8-10 times (once |

| |familiarized). |

|( Ask for support (see info below) | | |

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|( Assert your rights, needs, and wants. | | |

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|( Avoid situations of higher personal stress | | |

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|( Eat a healthy, balanced diet | | |

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|( Exercise to burn off tension | | |

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|( Express your feelings appropriately | | |

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|( Keep a journal of stresses I handled well | | |

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|( Organize my time and plan my tasks | | |

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|( Not dwell on unhelpful thoughts | | |

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|( Plan some humor or fun into daily my schedule | |B. Learn yoga or take up jogging, etc.; but you are not always able to |

| | |do these on the spot. |

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|( Take needed rest breaks and get enough sleep | |C Do an activity from your Cooling Off from Stress List. |

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|( Think more positively about myself and look for the positive in my| |D. Get training in progressive muscle relaxation. |

|situation & day | | |

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|Asking for Support: |

|Support can be as simple as reaching out and contacting good friends and relatives. That alone can help keep stress levels down. Support can (1) |

|keep us from going in circles; (2) it can boost our morale when we're a little down; (3) it can save us big, big chunks of time with difficult |

|tasks. |

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|Is asking for help your last resort? You're not alone. Many people wait until they hit a dead end. If asked why, they say, "I didn't want to |

|bother anybody." |

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|Here's the funny part: most people like to help out and feel good about doing it! [Yes, some people won't want to be bothered, but that's reality.|

|It's no excuse not to ask and keep asking for help.] |

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|Especially when the demands are too much, or a situation is too big to handle: we need to ask for help. Asking for help isn't a sign of weakness; |

|it's a sign of maturity. It's what adults do. |

| |

|When asking for help, the only obligation you have is to give thanks in person, by phone, or by mail. My list of 2 things I need help with: |

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|1. Who I'll ask for help: |

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|2. |

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HOME ASSIGNMENTS WORKSHEET

Client____________________________ Date Assigned____________ Return Date____________

( Asking for Help assignment was completed ( Deep breathing assignment was completed

1. Client is to demonstrate his/her ability to use the deep breathing steps at your next contact meeting. Give the client feedback/praise for their performance.

2. Have the client describe the Who, What, and Why of two asking-for-help situations they were able to perform. [Ask open ended questions and apply reflective listening to draw out their response.]

Caseworker's Comments at Follow-up on Home Assignments:

Handout: Cooling Off from Stress

This is a list of simple pleasures for cooling off under personal stress. Which ones would you do?

|Take a drive to see something new | |Visit an old friend |

|Relax and read the newspaper | |Cook a favorite meal |

|Help your child with homework | |Lie on the grass |

|Plant something to watch it grow | |Go out for a special meal |

|Go for a walk | |Rent a funny movie |

|Take a nap | |Play tennis |

|Build something from wood | |Try a new recipe |

|Feed the birds or ducks | |Go to a yard sale or garage sale |

|Hang a hummingbird feeder | |Have your own yard sale |

|Enjoy a special dessert | |Go skateboarding or rollerblading |

|Go for a run | |Go roller-skating or ice-skating |

|Get up early to watch the sun rise | |Have coffee with a friend |

|Walk a dog | |Visit a museum |

|Play Frisbee | |Walk along the water |

|Sew something | |Visit someone who is homebound |

|Have a relaxed breakfast | |Walk or ride along a bicycle path |

|Spend an hour in a favorite store | |Buy a small gift for a friend or child |

|Have a makeup demonstration | |Find a place for a moment of solitude |

|Visit a shopping mall | |Make a pizza |

|Add one new item to your wardrobe | |Visit the library |

|Pamper your feet in a basin of warm water | |Play a card or board game |

|Massage your feet with a cooling lotion | |Buy thick fluffy new bath towels |

|Write a letter to someone who helped you | |Put fresh sheets on the bed |

|Work on a quilt | |Hunt for bargains at a thrift store |

|Pray | |Trade back rubs for 20 minutes |

|Compliment someone | |Take a relaxing hot bath |

|Baby-sit for someone who needs relief | |Indulge in your favorite childhood treat |

|Send a care package to a student | |Enjoy one perfect flower in a vase |

|Call someone special in your family | |Add an item to your collection |

|Write to an old friend | |Hum or sing |

|Go to a movie, perhaps with a child | |Write in a diary or journal |

|Make a big bowl of popcorn | |Ride a motorcycle |

|Have or give an oil massage | |Play golf or miniature golf |

|Listen to your favorite music | |Clean out your purse |

|Read a book you've heard about | |Read old letters you have kept |

|Bake a batch of cookies | |Read or write poetry |

|Make some food for a friend | |Start a memory box |

|Rearrange the furniture | |Read your favorite children's book |

|Call a friend who makes you laugh | |Enjoy the quiet of an early morning |

|Bake biscuits or tortillas | |Have lunch with a friend |

|Daydream a little | |Roll down a hill |

| | |Polish your nails a new color |

|Enter a contest | |Grow (or shave off) a beard or mustache |

|Research your family history | |Try a new hairstyle |

|Volunteer to be a coach | |Take a creek walk - stream is your path |

|Paint a room | |Pick fresh fruit or berries |

|Wash and wax your car | |Make homemade ice cream |

|Lie under a tree and watch the sky | |Read a favorite magazine |

|Do some gardening | |Go to a demonstration in a store |

|Take a class | |Join a gym and work out |

|Play a musical instrument (or learn to) | |Go to a sporting event with someone |

|Visit a wildlife refuge | |Spend an hour alone with your child |

|Visit (or volunteer at) the zoo | |Be creative-tryout a new kind of art |

|Go horseback riding | |Make a family scrapbook |

|Look at maps for places to visit | |Build a swing in a tree |

|Cover a bulletin board with family pictures | |Refinish old furniture |

|Meditate | |Call someone you'd like to talk to |

|Go camping | |Wash your windows |

|Search the Web | |Have a picnic in the park |

|Have dinner at a romantic restaurant | |Find a good spot and watch the night sky |

|Give and receive a foot massage | |Go fly a kite |

|Visit an aquarium | |Go dancing |

|Ski or play in the snow | |Sing in a chorus |

|Work on a car or truck | |Go downtown |

|Plan a holiday or trip | |Go to an open house |

|Smile | |Draw a cartoon |

|Find shapes in the clouds | |Roast hotdogs and marshmallows |

|Go to a talk or concert | |Cut, chop, or carve wood |

|Put your feet up | |Go for a swim |

|Skip stones across water | |Listen to a favorite radio station or program |

|Go to the mountains | |Frame a picture |

|Ride a train | | |

Handout Source:

"Pleasurable Activities" list available in the Combined Behavioral Intervention Manual, COMBINE Monograph Series Volume 1; a publication of the U.S. Dept. of Health and Human Services, National Institutes of Health

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