“This comprehensive workbook deserves to be in the library of every active therapist, but it shouldn’t be left on the shelf! Once again, the authors have empowered the reader with straight- forward instructions on every major approach to stress management known. From worry to chronic headaches to information overload, here is your one-stop guide to recovery.” — R. Reid Wilson, Ph.D., author of Don’t Panic: Taking Control of Anxiety Attacks “This text remains, after twenty years, the clearest, best-organized, and most readable book on stress management. It has achieved the status of the ‘classic’ self-help reference in the field.” — Edmund J. Bourne, Ph.D., author of The Anxiety and Phobia Workbook, Coping with Anxiety, and Beyond Anxiety and Phobia “An exemplary book on stress. It is lucidly written, rationally ordered, and comprehensive, and each section is densely packed with instructions and exercises which make the workbook easy to practice.” — Somatics Magazine: Journal of the Mind/Body Arts and Sciences The Relaxation & Stress Reduction WORKBOOK SIXTH EDITION Martha Davis, Ph.D. Elizabeth Robbins Eshelman, MSW Matthew McKay, Ph.D. New Harbinger Publications, Inc. Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought. The material in chapter 13 that is based upon the work of Michelle G. Craske and David H. Barlow’s Master Your Anxiety and Worry, 2nd ed. (2006) pages 99–109 is used by permission of Oxford University Press. Distributed in Canada by Raincoast Books Copyright © 2008 by Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com All Rights Reserved Acquired by Tesilya Hanauer; Cover design by Amy Shoup; Edited by Kayla Sussell Library of Congress Cataloging-in-Publication Data Davis, Martha, 1947- The relaxation and stress reduction workbook / Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay. -- 6th ed. p. cm. Includes bibliographical references and index. ISBN-13: 978-1-57224-549-5 (pbk. : alk. paper) ISBN-10: 1-57224-549-2 (pbk. : alk. paper) 1. Stress management. 2. Relaxation. I. Eshelman, Elizabeth Robbins. II. McKay, Matthew. III. Title. RA785.D374 2008 616.9’8--dc22 2008003637 PDF ISBN: 978-1-57224-680-5 We would like to dedicate this book to our families. Thank you, Bill and Amanda, Don, Judy, Rebekah and Jordan. Contents Preface to the Sixth Edition . ix Acknowledgments . xi How to Get the Most Out of This Workbook . .xiii 1 How You React to Stress . 1 * Sources of Stress * Fight-or-Flight Response * Chronic Stress and Disease * Schedule of Recent Experience * Prevention * Symptoms Checklist * Tactics for Coping with Stress * Tactics for Coping with Stress Inventory * Knowing Your Goal * Symptom-Relief Effectiveness * Symptom-Relief Effectiveness Chart * Further Reading 2 Body Awareness . 19 * Background * Body Inventory * Stress-Awareness Diary * Record of General Tension * Further Reading 3 Breathing . .27 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Preparing to Do Breathing Exercises * Breathing Basics * Special Considerations * Breathing for Tension Release and Increased Awareness * Breathing for Symptom Control or Release * Final Thoughts * Further Reading * Recordings 4 Progressive Relaxation . 41 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading * Recording 5 Meditation . 47 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Exercises * Special Considerations * Further Reading * Recordings The Relaxation & Stress Reduction Workbook 6 Visualization . 65 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Basic Tension and Relaxation Exercises * Special Considerations * Further Reading * Recordings 7 Applied Relaxation Training . 75 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading * Recording 8 Self-Hypnosis . .83 * Background * Symptom-Relief Effectiveness * Contraindications * Time to Master * Instructions * Special Considerations * Further Reading 9 Autogenics . 99 * Background * Symptom-Relief Effectiveness * Contraindications * Time to Master * Instructions * Special Considerations * Further Reading * Recording 10 Brief Combination Techniques . 109 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Further Reading * Recordings 11 Focusing . 117 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Suggestions for Focusing on Special Problems * Special Considerations * A Real-Life Example of the Power of Focusing * Final Thoughts * Further Reading * Websites 12 Refuting Irrational Ideas . 135 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Refuting Irrational Ideas * Special Considerations * Further Reading 13 Facing Worry and Anxiety. 157 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Instructions for Imagery Exposure * Special Considerations * Turn Worry into Problem Solving * Problem-Solving Worksheet * Final Thoughts * Further Reading 14 Coping Skills Training for Fears . 187 * Background * The Five Steps of Coping Skills Training for Fears * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading vi 15 Anger Inoculation . 205 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading 16 Goal Setting and Time Management . 223 * Background * Limits of Multitasking * Symptom-Relief Effectiveness * Time to Master * Instructions * Clarifying Your Values * Setting Goals * Developing an Action Plan * Evaluating How You Spend Your Time * Combating Procrastination * Organizing Your Time * Further Reading * Recordings 17 Assertiveness Training . 249 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Further Reading 18 Work-Stress Management . 279 * Background * What Causes Work Burnout? * Symptom-Relief Effectiveness * Time to Master * Five Steps Toward Managing Your Work Stress * Final Thoughts * Further Reading * Website 19 Nutrition and Stress . 297 * Background * Symptom-Relief Effectiveness * Time to Master * Twelve Steps to Positive Eating * Self-Assessment * Taking Charge of Your Nutritional Well-Being * Set Your Personal Positive Eating Goals Now * Final Thoughts * Further Reading * Other Resource * Websites 20 Exercise . 329 * Background * How Does Exercise Reduce Stress? * What Is the Evidence? * Types of Exercise * Symptom-Relief Effectiveness * Time to Master * Developing Your Own Exercise Program * Choosing the Best Type of Exercise for Yourself * Establishing Goals * Sample Exercise Program * Special Considerations * Further Reading * Television Programs, Videos, and DVDs * Websites * Community Resources * Training Resources for Long-Distance Activities 21 When It Doesn’t Come Easy—Getting Unstuck . 355 * Taking Responsibility for Your Decisions * Confront Your Excuses * Confronting Roadblocks to Stress Management and Relaxation * When Symptoms Persist * Persistence Pays Index . 361 vii Preface to the Sixth Edition Today, we are inundated with all kinds of information, including a lot of information about stress and stress management. What is unique about this book is that it immediately zeros in on what is relevant to you; that is, the specific stressors in your life and how you react to them. Once you’ve identified the sources of your stress, your most disturbing symptoms, and how you typi- cally cope with them, you are directed to the techniques that will help you in your particular situation. In short, you don’t have to waste your time reading material that isn’t relevant to your specific needs; instead you can focus on simple step-by-step instructions that will teach you how to feel better now. This workbook is based on more than twenty-five years of clinical experience working with clients who came to us with symptoms of tension and stress like insomnia, worry, high blood pressure, headaches, indigestion, depression, and road rage. When they seek help, many of these people report they are experiencing some kind of a transition, such as a loss, a promotion, or a move. This isn’t surprising, since stress can be defined as any change to which you must adapt. Most clients describe feeling worn down by everyday hassles such as dealing with inconsiderate or rude people, commuting long distances, caretaking children and elderly relatives, and man- aging tons of paperwork. One client referred to this “wearing down” process as a “death by a thousand cuts.” Indeed, unmanaged stress can have an accumulative effect that may lead to major psychological and physical illnesses. Clients also tell us about some of their less successful stress- management strategies: working harder and faster; numbing their pain and soothing themselves with drugs, alcohol, and food; worrying about their problems; procrastinating; and taking their frustrations out on others. To date, more than 700,000 people have purchased this book to learn how to relax their bodies, calm their minds, turn around their self-defeating