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Self Care in Distress Prevention

I.  Overview

It is well established that maintaining personal health habits can help prevent and reduce distress.  They can also reduce the impact of distress on health.   There are six healthy habits that can help prevent distress by enhancing resilience as well as help people to cope when distress occurs.  It is also helpful for people to seek help in recognizing, establishing and maintaining healthy habits.  There are many resources available for improving healthy habits.  Unit leaders can encourage healthy habits through educational briefings, policy, personal example, and referral.

.  Leisure Activities

Leisure activities involve doing things you enjoy such as spending time with family and friends.  Knowing when to take a break is an important step in managing the accumulation of stress.  When people are "stressed," they often stop doing enjoyable life activities and socializing.  It is healthy for people to balance their daily responsibilities with leisure activities.

• Maintain activities that you have found enjoyable in the past.  This can help make difficult life situations easier.  These activities may be partially important during life transitions such as moving.
• Develop outside interests and activities.  Total involvement in job or home responsibilities can lead to social isolation and obsession with work.  Relax during time off by doing something different from the pattern you have established during the week.
• Take time out from your work.  Schedule regular vacations and opportunities to get away.  Try to plan these in such a way that they are long enough and frequent enough to allow you to relax and change your routine.  Keep in mind that vacations can sometimes be stressful for families.  Plan your vacations so that you have time to prepare to leave and time to recover from your vacation before returning to work.

2.  Exercise

Physical activity enhances psychological well-being and relieves symptoms of distress, including depression and anxiety.

• Regular exercise helps one to feel in control.  This sense of control over the body may translate to an improved sense of control over other aspects of life, a key defense against stress.
• Exercise promotes well-being and relaxation.  Regular exercisers demonstrate higher levels of self-esteem and confidence and maintain a sense of discipline.
• Exercise can help people give up unhealthy habits that interfere with exercise.  For example, smokers may cut down or quit because smoking hinders aerobic performance.
• Other benefits of exercise include:
  • Increased physical fitness that builds and maintains healthy bones, muscles, and joints.
  • Meeting people and socializing.
  • Improved weight management.
  • Improved health and disease prevention.
  • Improved ability to relax and sleep.
  • Improved psychological well-being, self-esteem, reduced feelings of depression, and anxiety.

Walking is a simple, readily available form of exercise.  Moderate exercise, such as walking, can have a beneficial effect on distress, including depression.  For those whose goal includes improved physical fitness, an ideal exercise program includes aerobic exercise 3 to 4 times a week for 20 to 30 minutes preceded and followed by a 5 to 10 minute warm-up and cool-down period, respectively.  You should consider consulting with your primary care provider before beginning a new exercise program.

Recommendations for a successful exercise program include:

• Gradually increase physical activity.
• Set realistic goals.
• Warm up and cool down.
• Try to exercise with others.
• Develop a schedule for exercise.
• Choose activities that you enjoy and that you can do regularly.
• Plan an appropriate exercise program: 
  • The best type of exercise for stress management is gradual and rhythmic.
  • Examples of vigorous exercise include bicycling, jogging, jumping rope, stair climbing, swimming, and walking briskly.
  • Examples of moderate exercise include basketball, handball, soccer, volleyball, and walking moderately.
  • Examples of light exercise include baseball, bowling, football, light gardening, dancing, softball, and walking leisurely.
• Take advantage of daily opportunities for additional physical activity, such as:
  • Use the stairs instead of the elevator.
  • Take a longer route when walking.
  • Conduct walking meetings.
  • Walk or stair climb during coffee break.
• Don’t get discouraged if you miss an occasional workout.

3.  Spirituality

Spirituality represents our search for meaning and significance in life and our desire to conduct ourselves by the highest principles.  Living a life based on moral values is an example of connecting to a spiritual life.  Spirituality often encompasses spiritual growth in religious education and worship experiences.  Chaplains and community spiritual leaders can be good resources for enhancing or reconnecting to a spiritual life.  Spirituality is associated with better overall physical health including lower blood pressure, less frequent hospitalizations, and longer life.  Spirituality is also associated with lower levels of depression, generally healthier lifestyles, and greater life satisfaction.  The following is a list of ways to enhance spirituality:

• Get in touch with and do things you find uplifting, noble, or creative.
• Let your values guide your decisions.
• Put service before self and volunteer.
• Keep a journal focused on self-expressive, value-oriented, or religious thoughts.
• Read spiritual, inspirational, or religious materials.
• Meditate, in religious or non-religious ways.
• Pray alone or with a group.
• Listen to spiritual or religious music.
• Display religious symbols.
• Talk with religious leaders.
• Get involved in a religious community.
• Discuss religious and spiritual topics with others through scripture study or prayer circles.
• Attend religious services and ceremonies and engage in religious rituals.
• If you have had bad experiences with religion or spirituality in the past, talk to someone you trust, such as a close friend, chaplain, or counselor.

4.  Sleep

Sleep needs vary considerably from person to person.  Signs you may not be getting enough sleep include not feeling rested when waking and feeling sleepy during the day or when driving.  If you sleep considerably past your normal wake-up time or when you do not set an alarm, you may be sleep deprived.  Most people can function reasonably well when they are getting less sleep than they need.  However, inadequate sleep can impair optimal work performance and raise safety concerns.

Common symptoms of missed sleep include irritability, poor concentration, and fatigue.  Insufficient sleep can make it more difficult to cope with life stressors.  In turn, life stressors can disrupt sleep.

The following strategies can help people attain good sleep:

• Avoid drinking alcohol in the evening--alcohol interferes with deep sleep.
• Avoid or reduce caffeine and nicotine, especially late in the day.
  • Caffeine stays in the system for up to 12 to 24 hours.
  • In addition to coffee, caffeine is present in many sodas, teas, medicines, and chocolate.
• Avoid eating large meals just before going to bed.
• Exercise regularly but not right before bed.
• Keep your bedroom quiet, dark, and a comfortable temperature.
• Avoid long or late afternoon naps.
• Stick to a routine--try going to bed and getting up in the morning at the same time each day, including weekends.
• Make your sleep environment comfortable--set the room temperature slightly higher and make the room as dark as possible.
• "Wind down" the hour before bedtime by engaging in relaxing activities such as a warm bath.

Coping with shift work:

1. Night shift.  Night shift workers need 6 to 7 days to reverse the normal daytime operation.  Get 7 to 8 restful hours of sleep in a darkened room and avoid early morning daylight, until about 10 a.m.  Once the night routine is established, the shift worker needs to maintain this, even on days off.  If you only work the night shift occasionally, take a long nap (3 to 4 hours) before starting the shift.  After the shift is over, sleep 3 to 4 hours.  This will give you enough recovery sleep to get you through the day and put you back on your normal daytime schedule.
2. Rotating shift.  A rotating shift schedule can be difficult on your body clock.  You should not try to change your normal sleep cycle because the shift only lasts a few days.  If you work a rotating shift, you should try to maintain this rhythm by sleeping only 4 to 5 hours after the night shift is finished.  After awakening, participate in normal daytime activities and return to bed, get 3 to 4 more hours before your shift begins.  When you rotate to swings or days, sleep as normal at night and at consistent times.

Other helpful activities are:

• Enlisting the aid of family is essential to a successful shift worker.  Help the family understand the importance of getting your sleep at the right times of the day.
• Keep the work area well lighted--it can help reduce fatigue.
• If you regularly exercise during a day shift, fit that routine into your night shift.
• Make your shift meals as nutritious as possible and have larger meals for lunch rather than dinner.

5.  Optimism

Optimism involves thinking in a realistic, flexible, and positive way.  Optimists view setbacks as temporary, isolated challenges that they can overcome or get through.  Maintaining a sense of optimism about one’s abilities to cope with current problems can facilitate good problem-solving and prevent a sense of defeat or hopelessness that can make a situation worse.  Optimism has been found to be associated with higher achievement, less mood disturbance, better immune system functioning, better health habits and longer life.  One reason is that greater optimism has been associated with the ability to rally support from friends and other forms of support.  The good news is that optimism can be learned because we are able to choose the way we think.  Learning to recognize and challenge alarming or negative thoughts so that they are more realistic, accurate, and consistent with personal values and/or based on facts, can be a key step in maintaining or improving health.  Learning to distract from negative thoughts can also improve optimism and functioning.

To improve optimism:

• Balance positive and negative aspects of situations--avoid focusing only on the negative.
• Recognize that there are multiple contributing factors to your difficulties--take responsibility for your decisions but avoid blaming yourself for all setbacks.
• Focus on the big picture and avoid all-or-nothing thinking--"one person in the meeting did not like my idea so everyone hates my idea."
• Think realistically and gather the facts--avoid predicting the worse case scenarios or "jumping to conclusions."
• Be flexible--avoid putting rigid expectations on yourself or others, watch for the words "I should," "They must," or "I have to."

6.  Nutrition

It's a common myth that our bodies use more nutrients when we're under mental stress.  Although pressures at home or work sometimes cause people to neglect eating well, we do not use any more or fewer essential nutrients while under stress. 

Physical stress on our bodies, such as broken bones or when recovering from surgery or sickness, would warrant paying extra attention to our nutrition needs. 

But if you're mentally or emotionally stressed out, a few eating tips may help:

1. Don't binge, or just grab whatever is in sight--take time for eating well.
2. Take time out for a healthful breakfast before your day starts.  It will help you get going for your busy day.
3. Try quick foods and recipes, such as fresh, canned, or frozen vegetables and fruits.  Order in if you have to, but try not to skip meals.
4. If you often rely on "comfort foods," look for low-fat or low calorie versions of these foods and pay attention to serving sizes.
5. Keep portions to one serving and focus on smaller more frequent meals.
6. Enjoy your food by sitting down and eating it slowly.

Eating in response to stress is common for many people.  Many people do not realize that they eat differently when they are under stress.  If you find yourself eating every time things get a little stressful, take a minute to figure out why you're feeling that way.  For example, write down what you are eating, and how hungry you are when you eat.  If you are eating when you are not hungry at all, you may be eating as a result of stress.

7.  Plan

Making changes to improve health often means a change in lifestyle.  Establishing a specific plan for making changes in health habits is essential for success:

• Begin by assessing which habits you are doing well with and which areas need improvement.
• Select one area to focus on at a time.
• Consider areas that you most want to improve or areas that you are most likely to succeed with.  Success in one area can help motivate you toward continued improvement.
• Set a goal you would like to achieve.
• Break this goal down into small easily managed pieces.
• Take gradual steps, working through each small piece, until you reach your goal.
• Reward yourself as you complete each step and give yourself a big reward when you reach your goal.
• Tell others in your life what your goals are and enlist their support.
• Seek out guidance and professional support in reaching your goal, when needed.
• After you reach your goal(s), work to maintain your improvements over the long-term.

III.  Suggested Resources.

1. For additional information on health, see:  http://www.health.gov/
    
2. The American Dietetic Association:  http://www.eatright.com 
3. Crossroad/leisure information:  http://www.afcrossroads.com/activities/index.cfm 
4. Tobacco Cessation:  http://www.surgeongeneral.gov/tobacco/ 
5. National Institutes of Health:  http://www.nih.gov/health/ 
6. National Strength and Conditioning Association:  http://www.nsca-lift.org/default.asp 
7. Food & Nutrition Information Center:  http://www.nal.usda.gov/fnic/
    

IV.  References

1. Cunningham J. B. (2000).  The stress management sourcebook.  Lincolnwood Illinois:  Lowell House. 
2. Koenig H. (1999).  The healing power of faith. New York:  Simon and Shuster. 
3. O'Hara, V. (1995).  Wellness 9 to 5, managing stress at work.  New York:  MJF Books. 
4. Prochaska, J. O., Norcross, J. C., & DiClemente C. C. (1994).  Changing for good.  New York:  Avon Books. 
5. Seligman, M. (1998).  Learned optimism.  New York:  Simon and Shuster.
   
6. The book of vitality, a practical guide to everyday self-care. (1995).  Boston:  Park Nicollet Foundation, Mosby Consumer Health.