Women's Wellness & Spa Weekend
at Bedford Springs Resort
in Bedford, Pennsylvania
Julie Register attended this event in January 2008

Note: Click on any photo to see a larger image and go to the photo gallery.

Inspiration Station: The Art of Understanding and Managing Stress, Beating the Blues and Calming Anxiety.

Saturday, January 26, 2008

Dr. Bruce Rabin, professor of pathology, psychiatry and psychology at the University of Pittsburgh School of Medicine, medical director of the University of Pittsburgh Medical Center Healthy Lifestyle Program, recognized authority in the effects of stress on the human immune system and author of Stress, Immune Function, and Health: The Connection presented Inspiration Station: The Art of Understanding and Managing Stress, Beating the Blues and Calming Anxiety. Dr. Rabin asked us not to take notes and instructed us to just listen. He provided a handout that contained all the material from his talk as well as a CD for relaxation. He told us to share the information with everyone we could, so here it is:

CD: Mental Journey for Stress Coping and Relaxation

• Mental Journey (10:57)
• Breathing (6:16)
• Guided Imagery (15:02)
• Meditation (13:21)
• Guided Imagery (11:24)
• Music Only (10:44)
• Music Only (6:16)

COPING WITH STRESS FOR HEALTH AND WELLNESS
THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER HEAL THY LIFESTYLE PROGRAM

Bruce S. Rabin, M.D., Ph.D.
E-mail: hlp@upmc.edu
Web site: http://healthylifestyle.upmc.com

The following provides information and techniques to help you increase your ability to cope with stress. We cannot make the stress in your life go away but we can change the way your brain responds to stress. By being better able to cope with stress you will have less of an elevation of stress hormones. It is the elevation of the stress hormones that alters your mental and physical health.

I'M STRESSED OUT!
YEAH, WELL I'M MORE STRESSED THAN YOU ARE!!

How many times do we hear people speaking like this, almost as if being under a lot of stress is a badge of honor. However, stress should be classified along with being overweight, being sedentary rather than physically fit, having high blood pressure, and being a smoker, for its
DANGER TO HEALTH. It would be wonderful to be able to say that you have stress in your life but that you use the behaviors and techniques we will teach you as the badge of honor so that you will be a healthy lifestyle role model for other adults and children.

Questions and Answers:
Q: What is stress?
A:

• Stress results when something that happens to you or something that you observe exceeds the capability of your mind to deal with the event effectively.
  
• When you believe that you cannot cope with the demands or perceived consequences of the event stress-reactive areas of your brain become activated and the concentration of stress hormones in blood increases
  
• The mental and physical health effects of stress are due to the elevation of stress hormones that occurs when the stress reactive areas of the brain are activated
  
• Coping with stress means that you use behaviors and techniques to keep the stress reactive areas of the brain calm
  

Q: What are the effects of stress on the mind?

• You have difficulty thinking clearly and focusing
  
• You become depressed and have the "'blues"
  
• Your ability to remember things may decrease at a younger age than would occur if you could cope with stress
  

Q: What are the effects of stress on the body?

• your heart beats more rapidly
  
• blood pressure increases
• there is an accelerated accumulation of cholesterol into the blood vessels of the heart with narrowing of the blood vessels
  
• blood platelets clump together and may plug up a blood vessel in the heart
  
• the ability of the body to resist infectious disease decreases
  
• the ability of the body to heal wounds decreases
  
• autoimmune diseases such as psoriasis, multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease may become more active.
  
• your skin becomes sweaty
  
• diabetes is more difficult to manage
  
• weight is more difficult to manage because you tend to eat foods that are not healthy
  

Q: Is stress always bad?
A: Some aspects of the stress response are not always bad. If you were stressed because you saw a tiger running toward you, the changes in your body would help you flee to safety. Indeed, the response of the body to stress may be to increase the chance of escaping from danger.

Q: If stress is capable of impairing our health why not just avoid it? For example, if someone is worried about being overweight they don't have to eat foods that are high in saturated fats.
A: Sometimes we can avoid stress. If we know that someone is angry with us, we can avoid seeing them until they calm down. However, much of life's stress is unavoidable. Divorce, losing one's job, an angry employer, children that get into trouble, caring for a relative with a serious disease, preparing for an exam at school, are all examples of stress that cannot be avoided.

Q: Is there more stress today than in past years?
A: It doesn't matter whether there is more or less stress. What is important is whether your brain perceives events as stress.

Q: If stress cannot be avoided is there a way that I can change the way my brain perceives stress to minimize the negative effect of stress on health?
A: Yes, there is. We call it the development of "coping skills" that minimize the activation of the stress reactive areas of the brain. People who incorporate the coping skills into their lives will have less stressor induced alteration of their health than individuals who do not. The principal buffers are:

• Having a social support system that you enjoy and can depend upon. Friends are important; being lonely may increase the risk of disease development.
  
• Being optimistic that things will go well for you and those problems that occur will not alter your basic belief that you are a good and well-liked person. Always feeling that you are responsible when things go wrong can increase your chance of becoming depressed and developing heart disease and diabetes.
  
• Having a sense of humor so that you can find amusement in events and can even laugh at yourself (remember the old saying that "laughter is the best medicine").
  
• Being physically fit as appropriate for your age, rather than being sedentary. This does not mean you have to go to a gym and work out. What you need to do is to increase the amount of walking you do.
• Enjoy participating in religious activities or having a spiritual nature that allows you to relax and calm yourself when faced with stress
  

A way many people have found helpful to remember the behaviors that are important is to think of the word RELAX:
Reflection: Enjoying participation in spiritual or religious activities, or simply taking time to reflect on the things that add meaning, purpose, and joy to your life helps to reduce the negative influence of stress on health
Expectations: Being high in optimism, seeing the glass as half full rather than half empty helps to reduce the negative influence of stress on health
Laughter: Having a sense of humor and being able to laugh at some of the things you do helps to reduce the negative influence of stress on health
Acquaintances: Being socially active and spending time with people you enjoy being with helps to reduce the negative influence of stress on health
Xercise: Being physically active (walking as often as you can) and not just sitting around watching television or playing games on a computer helps to reduce the negative
influence of stress on health

Q: Why is it important to be concerned about coping with stress?
A: If we do not utilize the behaviors that can help to reduce the influence of stress on health, we increase our likelihood of developing illness. We may then turn to the health care establishment to take care of us. However, if we are to be more responsible for the quality of our own health by eating a healthy diet, managing our weight, exercising, and not smoking, we need to also be aware of how we cope with stress. Indeed, the more we do to keep ourselves healthy, the more likely it will be that we will go through the aging process being less dependent on care provided by others, we will maintain our joy of life and enjoy our families and friends and not be a burden to them, and be able to contribute to the joy of others.

We also know that our demise is shorter the longer we stay healthy as we go thru the aging process. Living a long healthy life without chronic illness, pain, and suffering, and then dying suddenly or after a brief illness is the blessing.

Q: Let's be realistic. There is nothing that I can do about the stress in my life. It is not going to go away. What can I do?
A: We can not change the stress in your life. What we can do is provide you with behaviors that will change tile way that your brain responds to stress. The important things that we are concerned about are the hormones that increase in concentration in your blood when you are under stress. The behaviors that we will train you to do will help to minimize the hormonal elevation induced by stress. Some of the benefits that result by increasing your ability to cope with stress:

Q: I am concerned with my ability to cope with stress. What can I do about it?
A: There are behaviors that you can use to decrease the impact of stress on your health. The behaviors are discussed below.

Techniques to calm your mind and improve the quality of your mental and physical health when experiencing an ACUTE STRESS (one that is unanticipated, has sudden onset, and short duration):

• Deep breathing
  
• Thinking of funny things
  
• Chanting
  

Techniques to help you cope with CHRONIC STRESS that will improve the quality of your mental and physical health (the stress of daily life events):

• Writing
  
• Guided Imagery
  
• Meditation
  

However, before going on there is a question we would like you to answer:

In general, would you say that your health is?
EXCELLENT
VERY GOOD
GOOD
FAIR
POOR

If you answered the question FAIR or POOR, it is more likely that you will have medical problems in the coming years than if you answered EXCELLENT, VERY GOOD, or GOOD.

If you answered FAIR or POOR, we believe that your practicing the skills that will help you cope with stress, will increase your optimism and change you into someone who believes that the quality of their health is excellent, very good, or good.

DEEP BREATHING FOR CALMING YOURSELF WHEN EXPERIENCING AN ACUTE STRESSOR

The following focuses on a technique that you will be able to use to calm your mind, reduce the concentration of stress hormones in your blood, and contribute to an enhancement of your health.

You use this technique when something happens that you find disturbing and you feel an increased amount of anxiety and stress. These techniques will help to rapidly calm you, help you to think more clearly, and to focus on what you are doing. It is even helpful for children who are having difficulty keeping calm.

Q: What is abdominal or diaphragmatic breathing?
A: This is a way that you can rapidly increase the amount of oxygen in your blood to a much greater extent than occurs when you take a breath by expanding the wall of your chest. When you take an abdominal breath and increase the amount of oxygen in your blood, your brain will detect the increased oxygen and will respond by decreasing the concentration of stress hormones in the blood.

The diaphragm separates the abdominal and chest cavities. Pushing the wall of your abdomen out causes the diaphragm to drop further than when you merely expand your chest wall to take in air. This increases the space that the lungs can expand into and increases the amount of air and oxygen that is inhaled. As we age, however, most of us take more shallow breaths and get less oxygen into our blood than we are capable of.

Q: What is the difference between abdominal/diaphragmatic breathing and chest breathing?
A: Breathing from the chest delivers approximately a teacup of air to the lungs (about 500 ml), breathing from the abdomen can deliver as much as 8 times the amount of air to the lungs. This makes a huge difference in the amount of oxygen in the blood.

How we breathe also has an impact on our nervous system. Less oxygen stimulates the production of shorter, more "restless" beta waves in the brain. More oxygen stimulates the longer, slower alpha waves associated with relaxation and calm mind states. For this reason, breathing from the abdomen is helpful in eliciting relaxation and protecting the body from the harmful effects of stress.

Q: Abdominal breathing is difficult. How do I learn to breathe this way?
A: You're right. It is hard to change the way you breathe. Practice! You've had a lifetime of breathing incorrectly; it will take a while to learn to breathe correctly. Breathing is generally easier to practice initially when lying down, so practice at home lying down or sitting up.

Use the following to learn how to increase the volume of air flowing into the lungs. The essential point is that by pushing the abdominal wall out, the diaphragm will drop, increasing the space that the lungs can expand into. This maximizes the flow of air into the lungs and of oxygen into the blood.

Techniques for learning abdominal/diaphragmatic breathing (on our web site - healthyIifestyle.upmc.com -under stress coping and relaxation techniques, there is a video that will demonstrate the deep breathing technique):

1. Put your right hand on your abdomen, right at the navel, and put your left hand on your chest, right in the center. You may find it helpful to close your eyes.
   
2. Take a deeper inhalation than usual and focus on the rising of the abdomen as the lungs fill with air and the diaphragm flattens down, causing the belly to rise. You should feel your stomach rising about an inch as you breathe in, and falling about an inch as you breathe out.
   
3. Most of the movement should be in the lower hand; the other hand on the chest moves only slightly.
   
4. The trick to shifting from chest to abdominal breathing is to make one or two full exhalations (pushes air out from bottom of lung, creating a vacuum that will pull in an abdominal breath on your next inhalation), pause, then inhale slowly.
   
5. Nostril breathing is generally recommended but if you are more comfortable breathing through your mouth, do so.
   
6. You should not take more than five deep breaths. If you feel a little dizzy, take fewer deep breaths.
   

It is important to emphasize that one needs to practice this technique to increase its effectiveness. Remember, it is impossible to take deep breaths if you are holding your stomach in.

Important:

• Use this technique of breathing when you experience something that is upsetting to you. Do your regular breathing at other times.
  
• If you experience an acute stressor that lasts for several hours, only use abdominal breathing intermittently, not all the time. Take 3-5 deep breaths to calm yourself and then breathe regularly. When you again feel anxious, take 3-5 deep breaths.
  

HUMOR FOR CALMING YOURSELF WHEN EXPERIENCING AN ACUTE STRESSOR

Another way to rapidly calm yourself when experiencing an acute stressor is to find something to laugh about. Of course when you are being stressed it is difficult to think of something funny, so it is a good idea to have something ready. To do this find some calm time and think of some things that make you laugh. It may be an episode of a TV show, a movie, or things you have experienced. Select 3-5 memories that make you laugh and store them away in your mind. You can call the place in your mind where you keep your funny memories your "funny relaxer". Then when something is upsetting you and causing stress and you don't feel like doing deep breathing, go to your "funny relaxer" and lighten up as you chuckle to yourself.

CHANTING FOR CALMING YOURSELF WHEN EXPERIENCING AN ACUTE STRESSOR

Another technique that we have found to be effective to help reduce the response to an acute stress is to say a brief relaxing chant to yourself. The chant can be a religious phrase or just a few words, such as "I am a good person", or, "All will be well", or "I will be well".

After deciding on the words you will use you set them to a simple tune, one that you find pleasant or one that has a religious feeling to it, such as the tune of a Gregorian chant.

First chant your phrase quietly. Do this several times. Then do it without making any sound. While you are doing this feel calm, relaxed, and comfortable. Practice this for several days, quietly saying your chant to yourself while being in a relaxed state. We want your mind to associate the chant with a relaxed feeling.

Now, when you experience an acute stress say the chant silently to yourself. Notice how this relaxes and calms you and allows you to focus.

At different times of experience with stress you may decide to take a few deep breaths, go to your "funny relaxer", or do your chant. All may be effective for you, or just one or two of them. Decide what works best for you. Use what is effective to calm you.

WRITING ABOUT WHAT BOTHERS YOU TO BRING CALMNESS AND RELAXATION

Interestingly, writing can contribute to the prevention of illness and help you move ahead by reducing the anxiety associated with things that are of concern to you. The technique that we are going to ask you to use is different than keeping a daily diary, often called "Journaling". You can use the following to write about things that have bothered you for years or something that occurred yesterday and is bothering you. It looks simple to do, and it is. However, the effects are usually dramatic.

Take a sheet of paper and something to write with. Find a quiet place where you will not be disturbed for 15 minutes-

• Pick any issue of concern to you to write about
  
• The only rule is that you write continuously for 15 minutes. If you run out of things to say, just repeat what you have already written. Don't worry about grammar , spelling, or sentence structure.
  
• While writing DO NOT READ what you have already written
  
• Do not be concerned if you start crying while writing, it is common for this to happen-
  
• Your writing is completely confidential. When you finish writing, tear up what you have written and toss it out so that no one will ever see what you wrote.
  
• If you find it helpful you can write 3-4 times a week.
  

AN ADDITIONAL WRITING EXERCISE YOU MAY WANT TO TRY:

Each day, or whenever you wish, write about something you are grateful for. It may be as few or many words as you want. Then whenever you are feeling "blue", think about some of the things that you are grateful for.

GUIDED IMAGERY TO HELP YOUR MIND COOL DOWN

Q: What is guided imagery?
A: Guided imagery is a script that someone reads and you listen to that directs you to create beautiful and comfortable thoughts and pictures in your mind where temperature, smell, sounds, beauty, people, sights, are comfortable and relaxing. Somewhat similar to a wonderful vacation taken without going anywhere (and achieving some of the same relaxing benefits without having to return home and wait for a long time for your luggage at the airport baggage claim). Guided imagery is used for relaxation and healing.

Q: How does guided imagery help calm the mind?
A: The thoughts that are disturbing to you are set aside and your brain can calm itself. Guided imagery helps to create a sense of peace and tranquility.

Q: Are there other advantages to guided imagery?
A: Guided imagery has also proved effective in patients as an aid to healing. Studies have indicated that encouraging patients to listen to imagery during anesthesia induction and/or medical or surgical procedures has decreased anxiety and stress levels significantly. It has been demonstrated to reduce the need for analgesic medication of hospitalized patients, thus reducing side effects and decreasing the recovery time frame.

Q: How can I do guided imagery?
A: There are many tapes and CD's available. On our web site - healthylifestyle.upmc.com - under stress coping and relaxation techniques, there are guided imagery's for you to listen to.

Here is the CD Dr. Rabin gave out in class: Mental Journey for Stress Coping and Relaxation

• Mental Journey (10:57)
• Breathing (6:16)
• Guided Imagery (15:02)
• Meditation (13:21)
• Guided Imagery (11:24)
• Music Only (10:44)
• Music Only (6:16)

MEDITATION -A TECHNIQUE THAT MAY BE EFFECTIVE FOR HELPING YOU TO RELAX

We now want to add another technique to your repertoire of what you can do to increase your ability of coping with stress. The material that we are providing to you may not work for you. Everyone is different. Not everyone likes modem art, or a New York strip steak, or Sushi, or starch in their shirts, or tan khaki pants. All we can do is hope that enough participants find the information that we are providing life changing so that as a result you will not only achieve a better quality of mental and physical health but you will also help others to achieve the same.

Before teaching you how to meditate we need to clarify some things. There are books and courses taught by experts who study meditation and how to teach the technique to others. Multiple sessions of training have the advantage of giving you practice and providing you with different approaches to meditation with the expectation that you will find one that works for you. We are going to give you an adequate amount of information and technique so that you can meditate. It may be all that you need now that you have apparently made a commitment to work to achieve a better quality of mental and physical health.

Q: What is meditation?
A: Meditation is a technique to take your attention and focus it on something that has no emotional value to you. This will contribute to lowering the concentration of the stress hormones in your blood. Meditation will train your mind to become less responsive to stress and will result in physiologic changes that counteract the harmful effects of stress throughout the day.

Q: What is the goal of the meditation?
A: It is to find a way for you to NOT pay attention to thoughts that you find disturbing (such thoughts will activate the stress pathways in your brain). Therefore, you will want to train your mind to briefly clear disturbing thoughts from your mind.

Interestingly, when we want to increase muscle strength we use our muscles. In fact, most of what we do to achieve better health involves using our bodies to achieve better heart, lung, and muscle strength. However, to achieve a healthier relationship between our mind and our body, we want to relax our mind. Interestingly, to do so requires that we use our mind. It is possible that activation of some areas of the brain leads to a decreased activity of the areas of the brain that respond to stress.

Q: Is there a trick to get me to stop thinking about things that disturb me?
A: When you are trying to relax your mind and an intrusive thought enters, focusing your attention on a word, phrase, sound, or repetitive movement (such as achieved with Tai chi) helps you to temporarily let go of the invading thought. It is important that for a few minutes you focus on the neutral event rather than the thoughts that are bothersome to you. Knowing that there is nothing that you are going to do about a thought that is disturbing you will help in letting the thought go.

Q: Will I learn to do this quickly?
A: Probably not. You must practice and repeat the techniques being taught to you. If you have taken piano lessons, you know that without practice your mind could not get your fingers to where you wanted them to be. Your mind gets better with practice. The more you practice relaxing your mind, the easier and more effective it will become.

Q: Is there a reason that I should be concerned about doing this?
A: No, learning to relax will not make you a less effective person or negatively affect your work perfomance. In fact, learning to relax will make you more efficient in your everyday life, increase your feeling of being calm, and will enable you to interact with others better.

Q: Can learning how to meditate help me in my everyday life?
A: Yes, you will notice that you are comfortable when you are aware of the following, whereas you may not have been comfortable before practicing meditation:

• Slowing down, not trying to do multiple things at once
  
• Bringing your full awareness to what you are doing at any given time. Your mind will wander less.
  

Q: It sounds to me as if praying can be considered a form of meditation
A: It can and is.

Meditation technique:

• Find a quiet place where you can sit and be comfortable (it is important that you are comfortable so that you are not disturbed by thoughts of being uncomfortable)
  
• Make sure your clothes are comfortable and that your belt or shoes or underwear are not uncomfortable
  
• Find a place that is quiet so that you are not disturbed by noise or trying to listen to something that you may suddenly find interesting
  
• Select a word that you will use as a focus of your attention. The word should not have any meaning to you. Some examples are PEACE, QUIET, RELAX, SMOOTH, REST
  
• You will also pay attention to your breathing. You will focus your attention on your breath as you inhale (through your mouth or nose, which ever is more comfortable) and exhale (again, through your mouth or nose )
  
• Remember, that meditation is a trick (I'm sure meditation teachers will not be happy with me) that for a few minutes helps you focus on a neutral event rather than thoughts that are bothersome to you. Knowing that there is nothing that you are going to do about the thought that is disturbing you for the brief time that you are trying to relax, will help in letting the thought go.
  
• The importance of the word and paying attention to your breathing is to get your attention away from the thoughts that are disturbing to you
  
• Allowing your brain (not the whole brain but primarily the stress reactive areas of the brain) to relax for a few minutes will help you achieve more calmness and lower levels of stress hormones with health benefits
  
• Have a clock placed so that you can see it
  
• Sit, be comfortable, you can close your eyes or leave them open, whatever you prefer
  
• Periodically look at the clock so that you do this for about 15 minutes (if you meditate with your eyes closed you will have to open them to look at the clock)
  
• Begin by sitting quietly, being aware of when you slowly inhale and slowly exhale, and think your word to yourself while you exhale
  
• If while you are doing this a thought comes into your mind, consciously direct your attention back to your breathing and your word
  
• Do this for 15 minutes daily while you are learning and then at least 3 times a week when you are comfortable and you find the technique is easy for you to do
  

Q: Can I get a book or take a class on meditation?
A: Of course, if what you have just done is helpful and you would like to explore whether meditation can be made more comfortable for you to do, please, buy a book, video, or attend a class.

Remember: Some people like to play the piano and others the violin. Some like to play football and others squash. People differ in the behaviors that are comfortable and enjoyable for them. You will find that we offer a variety of behaviors for you to use to help you cope with stress. This provides you with the opportunity to pick those that are comfortable and enjoyable for you. You do not need to use them all, rather you need to find what works for you so that it is something that you will use.

You must practice and repeat the techniques being taught to you. Your mind gets better with practice. The more you practice relaxing your mind, the easier and more effective it will become. It may take as long as 8 weeks before you begin to feel comfortable with meditation and realize that the technique is helping you to feel calm. Don't give up by being disappointed if you do not feel that the technique is working for you.

Something else that I would like you to do:

• PLEASE GET OUT AND GO FOR A WALK!
  
• DO IT EVERY DAY!
  
• DO IT WHENEVER YOU CAN!
  

IT IS UP TO YOU. YOU CAN USE THE ABOVE BEHAVIORS TO HELP KEEP YOURSELF MENTALLY AND PHYSICALLY HEALTHY. YOU WILL BENEFIT ALONG WITH YOUR FAMILY, FRIENDS, AND COWORKERS. IN ADDITION, REMEMBER THAT KEEPING PHYSICALLY ACTIVE, EATING A NUTRITIOUS DIET, NOT BEING OVERWEIGHT, AND NOT SMOKING, ARE IMPORTANT PARTS OF KEEPING YOURSELF HEALTHY. ALSO, THE FOLLOWING BEHAVIORS ARE REPEATED FROM ABOVE AS THEY WILL CONTRIBUTE TO YOUR BEING HEALTHY:

• Have a social support system that you enjoy and can depend upon
  
• Be optimistic that things will go well for you and those problems that occur will not alter your basic belief that you are a good and well-liked person
  
• Have a sense of humor so that you can find amusement in events and can even laugh at yourself (remember the old saying that "laughter is the best medicine")
  
• Be physically fit as appropriate for your age, rather than being sedentary
  
• Be religious or spiritual
  

Let's do this question again.
In general, would you say that your health is?

EXCELLENT VERY GOOD GOOD FAIR POOR

Remember, if you answered the question FAIR or POOR, it is more likely that you will have medical problems in the coming years than if you answered EXCELLENT, VERY GOOD, or GOOD.

- END -