holiday stress: survival tips and strategies mary g. brownsberger, psy.d., abpp, cbist november 2013...

Holiday Stress: Survival Tips and Strategies

Mary G. Brownsberger, Psy.D., ABPP, CBIST

November 2013

© 2013 Bancroft | All rights reserved

Happy HolidaysOur Ideal Images

Common Stress Triggers • “Ideal” vs. “Reality”

– Extra tasks, activities– Grief, guilt– Change in routine– Financial concerns– Strained relationships

• For brain injury survivors:physical , cognitive, emotional challenges reduce capacity to manage stress

• And what about family members and caregivers for brain injury survivors?

STRESS!!Acute Stress

• Fight, flight, freeze!– Increased blood

pressure– Increased pulse– Increased

breathing rate– Increased

inflammation– Decreased gastro-

intestinal function

Chronic Stress

• High Blood Pressure

• Heart arrythmias• Sleep disorders• Chronic headache,

backache• Anxiety, depression• Immune

dysfunction• Self-destructive

behaviors– Overwork, Substance

use

SuicideHoliday Suicides: Fact or Myth?• The idea that suicides occur more frequently during the

holiday season is a long perpetuated myth. The Annenberg Public Policy Center has been tracking media reports on suicide since 2000. A recent analysis found that 50% of articles written during the 2009–2010 holiday season perpetuated the myth.1

• CDC’s National Center for Health Statistics reports that the suicide rate is, in fact, the lowest in December.2 The rate peaks in the spring and the fall. This pattern has not changed in recent years. The holiday suicide myth supports misinformation about suicide that might ultimately hamper prevention efforts.

• Suicide remains a major public health problem, one that occurs throughout the year. It is the 10th leading cause of death for all Americans. Each year, more than 36,000 people take their own lives.2 In addition, more than 374,000 are treated in emergency departments for self-inflicted injuries.

An Evidence-based Framework for

Understanding Stress Reaction and Stress

Response

ICF Framework


Using the ICF to Understand Holiday

Stress• What are environmental factors that impact stress levels?

• What are personal factors?• What health condition factors?• How have our roles changed

post-injury?• What are our “go to” stress

management strategies?

Environmental Factors• Weather• Different location than routine

– Accessibility– Travel stressors

• Who is around us that is different from routine

Personal Factors• Anxiety• Depression• Personality (introverted,

extraverted)• Adaptability to change

Health Factors• Physical functioning

– Mobility– Chronic pain– Fatigue

• Cognitive functioning– Attention– Memory– Fatigue

• Emotional/Behavioral functioning– Labile emotions– Impulsivity

Role Changes• What were roles/responsibilities

pre-injury?– Are there “productive” post-injury

roles?– What’s possible? How to carve out

typical tasks (e.g., if I can’t set the whole table, can I carry a fork?)

• Hallet et al, 1994: – Most role changes post-TBI were

losses (71%)– Over 64% participants reported 3 –

4 role losses

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

Victor Frankl, Man’s Search for Meaning


Stress Reaction

Stress Response


Generally Unhealthy(Stress Reaction)• Alcohol • Other substances

(prescribed or illicit)• Rumination

– “coulda, shoulda, woulda”

• Worry• Extra push to meet

others’ expectations • Pushing others away• Junk food

Generally Healthy(Stress Response)• Physical exercise

– Walking, jogging– Yoga– Martial arts

• Talking to a trusted person

• Extra rest time• Healthy food• Spiritual traditions• Meditation/

mindfulness• Practice generosity,

compassion

Tips from the Mayo Clinic• Acknowledge

your feelings.• Reach out.• Be realistic.• Set aside

differences. • Stick to a

budget.

• Plan ahead.• Learn to say

no.• Don't abandon

healthy habits.• Take a

breather.• Seek

professional help if you need it.

Tips from Lee Woodruff – for those of us who care for others• Don’t hang back – make contact• Help people feel ‘normal’ – allow people to be helpers as

well as “helpees”• Recognize power of human touch – as people feel

comfortable• Establish healthy information exchange – be aware of non-

verbal signals – too much? Too little?• Avoid overmothering• Be sensitive to what people need to hear – validate

emotions, peoples’ capacity to handle tough situations – without overdoing it

• Think practically about what people really need• Choose words and actions wisely• Understand where faith belongs – respect different values,

cultures• Be there for the long haul

What is Mindfulness?• The non-

judgmental cultivation of attention and awareness– Actual

experience vs. interpretation or elaboration© 2013 Bancroft | All rights reserved

Why Mindfulness for Holiday Stress?

• Some things are difficult to change– Environmental factors– Personal factors– Health factors

• What we CAN change– How we respond


Mindfulness-Based Stress Reduction

• We ALL experience stress

• MBSR helps us self-regulate our response to stress vs. involuntary reactions


Recent Research (APA, 2012)Cognitive/physical benefits• Reduced rumination • Improved working

memory• Improved sustained

attention, ability to focus

• Increased cognitive flexibility

• Increased information processing speed

• Increased immune functioning

Psychological benefits• Increased emotion

regulation (decreased depression, anxiety, emotional reactivity)

• Increased relationship satisfaction

• Enhanced self-awareness

• Increased empathy, compassion


Mindfulness Changes Brain Structure (Gray Matter)• Levels of perceived stress and related

structural changes in amygdala (Holzel et al, 2010)

• Thicker gray matter in areas related to pain sensitivity resulting in reduced pain sensitivity (Grant et al, 2010)

• Increased cortical gyrification (creases and folds) in areas related to attention, emotion regulation (Luders et al, 2012)

Mindfulness changes Brain Function (White Matter)• Changes in gamma bands (EEG)

related to “mind wandering,” self-reference, attention (Berkovich-Ohana, et al, 2012)

• Increases in markers of attentional control (Moore, et al, 2012)

• Increased connectivity of attentional networks – shifting and sustaining attention (Hasenkamp et al, 2012)

• Changes in self-regulation networks (Tang et al, 2012)

Two functional brain scans of the author’s brain: a baseline scan and one done while meditating.These show metabolic activity—red is most active, black is inactive. The one done while meditatingshows a different pattern of metabolic activity. “This shows that meditation doesn’t just affect ourmind—it changes the way that the brain works,” Michael Baime says.

How to apply to holiday stress• Time management• “No” is a complete sentence• Rolling with change – without

judging• Imperfect is ok

Important concepts• There is more RIGHT with you

than wrong• Simply notice what IS

– (vs. analyzing, having opinions)

• We are all works in progress– Ongoing, life-long learning


Important concepts• Be kind to yourself• Integrate practice with life• The “ideal” will NEVER

happen– So show up – even if not perfect

or prefer not to


Getting started • Comfortable

posture – sitting or lying down

• Close eyes • Attention to belly• Focus on breath

– in and out• If mind wanders,

invite back to watch breath


Resources• I’ll Carry the Fork, Kara Swanson, 1999• Where is the Mango Princess, Cathy

Crimmins, 2000• In an Instant, Lee and Bob Woodruff, 2007• Perfectly Imperfect, Lee Woodruff, 2009• Wherever You Go, There You Are, Jon Kabat-

Zinn, 1994• Mindfulness for Beginners CD set, Kabat-Zinn• Center for Mindfulness:

http://www.umassmed.edu/content.aspx?id=41252

• Penn Program for Mindfulness: http://www.pennmedicine.org/stress/

• Jefferson Mindfulness Institute: http://www.jeffersonhospital.org/cim/article5030.html


References• Baime, M. (2011). This is your brain on mindfulness.

Shambhala Sun, July 2011.• Berkovich-Ohana, A., Glicksohn, J., Goldstein, A. (2012).

Mindfulness-induced changes in gamma band activity – Implications for the default mode network, self-reference and attention. Clinical Neurophysiology, 123 (2012), 700-710.

• CDC: http://www.cdc.gov/ViolencePrevention/suicide/holiday.html

• Davis, D. M., Hayes, J. A. (2012) What are the benefits of mindfulness. APA (online, www.apa.org).

• Grant, J. A., et al. (2010). Cortical thickness and pain sensitivity in Zen meditators. Emotion, 10 (1), 43-53.

• Hasenkamp, W., Barsalou, L. (2012). Effects of meditation experience on functional connectivity of distributed brain networks. Frontiers in Human Neuroscience, 6 (38), 1-14.

• Holzel, B. K., et al (2012). Stress reduction correlates with structural changes in the amygdala. SCAN, 2010 (5), 11-17.

• Kabat-Zinn, J. (1990/2005). Full Catastrophe Living. Bantam Dell, NY, NY.© 2013 Bancroft | All rights reserved

http://www.cdc.gov/ViolencePrevention/suicide/holiday.html

http://www.cdc.gov/ViolencePrevention/suicide/holiday.html

http://www.apa.org/

References (con’t)• Luders, E., et al. (2012). The unique brain anatomy of

meditation practitioners: alterations in cortical gyrification. Frontiers in Human Neuroscience, 6 (34), 1-9.

• Moore, a., Gruber, T., Derose, J., Malinowski, P. (2012). Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control. Frontiers in Human Neuroscience, 6 (18), 1-15.

• Tang, Y., Lu, Q., Fan, M., Yang, Y., Posner, M. I. (2012). Mechanisms of white matter changes induced by meditation. PNAS, 109 (26), 10570-10574.


Be Well.

holiday stress: survival tips and strategies mary g. brownsberger, psy.d., abpp, cbist november 2013...

Documents