Staying Sane?

Summary Post

2008-09-03T17:42:00.000-07:00

It's hard to decide how this project went upon reflection. On one hand, it was frustrating, annoying, time-consuming, and hard to follow through. On the other hand, I can say that I know a little bit more about stress relief and alternative methods of relieving stress.

In terms of my activities for the last session of the project, I used a stress intervention eleven times out of 49 days. I used yoga three times, mostly at the end of my session. I went on a cross-country driving trip and really enjoyed the yoga as both a nighttime destress activity and as a way to stretch out tired muscles. In this manner, it was a great intervention. I also used exercise 3 times during the last session. I think it was a rarely used intervention because July and August in North Carolina is very hot and humid. Also, the end of the summer semester was very busy with classes and finals that I could not find time to exercise. Mantram use was the most popular: five times. I think this was due to the ease of use and the stress of my cross-country trip. It's hard to deal with stress while locked in a car for hours upon hours--mantram use was the only intervention at my disposal and was used during that time period.

I'm not sure if I naturally gravitate towards one type of stress intervention or the other. In part, I feel like project is artificial from the start. The baseline was not normal for me. Nursing school is not a normal lifestyle, unless you're a nursing student. Then again, every person has a baseline that is not "normal" due to their unique lifestyles. When I compare my life and my stressors (namely nursing school induced) to the lives of patients with chronic diseases, I realize that everyone is different and has to build up the coping skills needed for their situations. For someone with cancer, exercise might not be a good coping skill, but mantrams might be perfect. The best thing about stress interventions is that they are as varied as the person's imagination and creativity will allow--which is something that I'm just beginning to appreciate.

Looking back over the past seven months, I am surprised to be here, in my last semester of nursing school and without having gone through a full-blown nervous breakdown. Maybe that's due to me, on my own. Maybe that's due to the fact that nursing school isn't that bad actually. Maybe its because, without me realizing it, this project has helped me. It has helped me realize when I'm stressed and how to deal with it. I pay attention to subtle cues more and am more ready to try something to help with my stress rather than ignore it, allowing stress to escalate to unmanageable levels. All in all, this project has been helpful. I'm not sure if it was a success in terms of specific outcomes, but for me it was successful for my personal goals and skills.

On my own.

2008-07-25T11:54:00.000-07:00

This last installment of my PPP was to let me choose which stress intervention I wanted to use on a day by day basis. Surprisingly I keep going back to the mantra and yoga. While I love exercise, I think that recently I've been too busy with school and traveling to keep up any sort of exercise schedule. It's also North Carolina in the summer, which is too hot for me to exercise outside.

The plus of yoga for stress relief is that it calms me down as well as provides me a way to stretch out my limbs. Stress can causes muscle knots and tension, as does poor sleep. Yoga is a great way to stretch out all the muscles. I find this especially useful for the legs muscles, because sometimes when those are tight the back muscles become tight as well. And who doesn't have back problems? I've found that stretching the legs really does help with the sore back. (In fact writing about this makes me realize that my back hurts and that I need to do a little yoga after this post is written).

Mantram is my big surprise. My last post I think I expound on mantrams and how much I don't like them because they're not active and only require your mind. I've since changed my mind. Mantrams are great because they are the ultimate in portable interventions. They don't require lots of floor space and no observers (like yoga) nor do they require a change of clothing and nice weather (like exercise). All you need is just to close your eyes (that's optional, if say you're using your mantram while driving) and focus on your mantram and consciously relaxing for 30 seconds at a minimum. I've been using the "in joy I am calm" mantram. I like it because I can alter the mantram to my situation at hand. If I'm walking, I say "In joy I walk." If I'm driving, I say "in joy I drive." It's great--very personalized and short enough for me to remember during frazzled moments.

Final Phase

2008-07-11T17:31:00.000-07:00

The last section of my project is a personal choice between exercise, yoga, or mantram interventions for stress relief. I feel less pressure at the start of this to use an intervention consistently, but I hope I can still remember to use these interventions until the end of the project. So far, I've used both my mantram and exercise as stress reduction. I have yet to decide how to evaluate this section of the project. I suppose I'll use an ANOVA for this data, but given how often I've been using my stress interventions I'm worried I might not have enough data points. However, as this is just the start I will do what I can and keep on using my stress interventions. It will be interesting to see which ones I use more often and which ones are not used.

More on mantrams

2008-06-16T17:17:00.000-07:00

The more I use my mantram, the more I see how versatile a tool it can be. They are always available and are very time friendly. My only problems are that sometimes I feel mantrams are not enough--they are good for quick calming down and in-the-moment relaxation but they fail to provide a lasting calm. I feel that exercise is much better at providing a long-lasting relaxed state and in this reguard is superior to both yoga and mantrams. However, I do have an appreciation for mantrams.

In other news, taking weekly tests about my stress levels is becoming very very hard to remember. I stopped using the Daily Stress Inventory a long time ago but it's hard to use the other inventories even. I feel that they are useful, but it is difficult to self-monitor and motivate to take tests as opposed to the relative ease of remembering to record my stress levels before and after an intervention.

Mistakes

2008-06-02T19:20:00.000-07:00

Midway through my project, I have encountered the first main stumbling block: my own mistakes in scheduling my interventions. I initially set up my project to be an experiment. My independent variable is intervention type with the dependent variable my stress scores as measured by various tests. While this might not have been the best idea, it was an idea that came naturally (having come from a natural science background) and made this project a little more interesting to me. However, I did not set up my project as well as I would have liked.

When I reviewed my plan of action yesterday, I realized that I missed the date for switching from my yoga intervention to my mantram intervention by about 3 weeks (this is probably due to finals and break proving to be excellent distractions). This was very upsetting and made me feel like I failed at this project. Also, it was sad for me because I was really getting into the yoga and didn't want to switch to something else. But I had to follow my plan... After some rescheduling and revision to my proposal, I am newly back on track with my project.

That said, I started my mantram intervention. This is based on an article I read (and included in my portfolio) that looked at nurses who repeated mantrams (mini-prayers/words) during stressful situations to calm down. I wanted to include something very mental in the stress-reduction techniques, as opposed to the physical activities like exercise and yoga. This intervention differs from the others in that I will not be using my intervention on a regular basis (unlike exercise and yoga) but rather when I feel the need or are stressed and can use mantram repetition for immediate calming-down.

My tentative mantrams are included below. I would probably use part of one as opposed to the entire phrase. I did not have an occasion to use one today, so maybe tomorrow?

In beauty we are united, / through beauty we pray, / with beauty we conquer. (Nicholas Roerich)

…I am the aim of wisdom. / I am gained by wisdom. / In the heart am I set firm. (Bhagaved Gita 13: 34)

For it is in giving that we receive… (Part of the Prayer of Saint Francis of Assisi)

In joy I walk. In joy I cool down…In joy my head becomes serene. (Part of a prayer by Torkom Saraydarian)

Grant me, O Lord, the mastery of self! (Agni Yoga Society, Leaves of Morya’s Garden, Vol. I, para. 35)

From the book:

Prayers, Mantrams, and Invocations. Selections from Torkom Saraydarian and other sources. TSG Publishing Foundataion, Inc. Cave Creek, USA. 2001.

I think my favorite is the "in joy I walk" mantram because it includes phrases that specify cooling down from stress and being serene--just the words one needs when stressed out!

Doing the yoga

2008-06-01T06:53:00.000-07:00

The paucity of updates about stress relief by practicing yoga has been due to the added stress of having laptop problems. Now that the laptop is functioning again, I can write about my thoughts on yoga.

I think my biggest problem with yoga is that I am doing yoga to relieve stress on command rather than just doing it when I feel like relaxing. I got to the point where I was ready for bed and remembered that I had to do yoga to help my mental health status. So I would rush through some sun salutes and stretches then brush teeth and go to bed. At the point when I failed to keep my balance during a pyramid pose, I had to stop and think for a bit. I was realizing my problem with this yoga stress relief intervention. This was something that I actually had to work at to incorporate into my daily life, as opposed to exercise for stress relief. I am used to running on a semi-daily basis as is, which I continue to do to stay in shape even though I’ve switched interventions. But yoga is something that is new to my life and incorporating it has been a struggle. This is the goal of this project. I’m finally getting at the meat of this project and struggling with what I’m supposed to have been struggling with since the start of this project.

I am also finding it frustrating to feel like I’m being forced to do something for an extrinsic reason rather than an intrinsic reason. This mostly happens when I remember to do yoga before bed and rush through it. It’s also frustrating when my form is bad and I lose balance while doing yoga. I realize it’s because yoga is meant to be slow and focused on form and breath and when I rush through it so I can check off that I did yoga for the day I’m not actually succeeding at my intervention.

In retrospect I wish I had designed my project so that I would consistently use exercise as a means of stress relief because that would have fit better within my existing lifestyle. But that is not the point of this project. This project was meant to challenge me and force me to adopt a lifestyle change. Doing yoga has definitely been a change. It’s not the first thing my mind leaps to when I think of ways to calm down. But it makes sense that I’m trying new things in my life, which is the entire point of this project.

Starting up Yoga

2008-04-07T14:54:00.000-07:00

I've recently done the switch between two different stress management interventions: running to yoga. In all honesty, it has been difficult for me to move from one activity to the other. Running has been very good for me: it's a great way to literally run out stress and tension, with the result that I'm too tired at night to lay awake in bed and worry about things. It's also getting me into very good shape. Hence why the difficulty in switching over to yoga. I like running so much and am starting to get good at it (improved muscle memory) and I know it works. After a good run I feel so much better. Usually my stress level goes down after a run and my mind feels clearer. The time spent on a run allows my mind to calm down and relax and BE here in the present instead of thinking about the future (something we spend too much time doing). Granted, sometimes I do spend my run thinking about what I'm going to make for dinner or what homework I want to get done tonight, but when the entire run is spend enjoying the run, the pounding of feet on pavement, the breathing of cool dusty air, and feeling sweat dry in the breeze and knowing that my mind is fully linked up with my body and my present actions--it's a great thing to do for life itself and also for stress relief.
Yoga on the other hand is not as physically intensive as running. I'm doing some basic poses on my own, a few sun salutes, stretching. Enough that by the time I work through my entire routine, my mind is usually calmed down and my body does feel the stretch and movement, which is necessary so I know I have some of the physical activity. I think that to have the mind fully relaxed and engaged, I need to have some form of mind-body interaction that fully engaged both spheres of Chelsea. My mind needs to be concentrating on something that my body is doing. I guess that's why yoga does work for stress relief--you need your mind to concentrate on enough for the body to let go of the daily stresses and wind down.
I'm also trying to think about how other people may be able to incorporate these stress management techniques into their lives. Yoga works if you can concentrate and have the courage to go with it even if you lack the flexibility. Running works if you don't care that you may be walking or going slow--you have to remember to not get competitive with the other people you may see outside with you and mentally encourage those around you to do their best, just like you are trying to do.
So for now, I'm working on this yoga thing, trying to connect my mind more to the yoga and let go of the stresses. I'm still running, but that's just for me, not the project. I was running before the project started so why stop now? Adding yoga to the mix is challenging but it is becoming a nice way to end my day.

East Campus

2008-03-03T07:35:00.000-08:00

With one week left in "month one: exercise" I found the East Campus loop for running. So nice. And only 4 blocks from my house (I just moved last weekend, so woot!) I will say this: life events keep happening and preventing me from implementing my lifestyle change. And I'm lucky that my lifestyle change is just for a project. It's something that I can skip if I have to because I need to pack or move or study more. For my patients (past, present, future) I'm sure that they cannot skip out on their lifestyle change. For them, it's more serious. It's something that they need to do to maintain their health and wellbeing. For the diabetic, not maintaining that lifestyle change of reducing sugar and having daily exercise can have serious consequences. For the heart failure patient with hypertension, eating the biggie size french fries can really push them over the edge in terms of their heart failure and symptoms. For me, not running just means I feel guilty and edgy because I haven't worked off my stress and tension. Big deal. I'll survive it. But it's good to know and recognize that my changes are good but not necessary for my health while the changes for my patients are necessary for their health. Hopefully throughout this project, I'll learn new ways of motivating myself and thus will have ways to motivate my patients.

Rough Week

2008-02-22T17:23:00.000-08:00

So this has been a really rough week and I have made pretty much no progress on this project, which makes me upset and frustrated. This is especially bad because my project is to reduce or manage my stress level, so by not doing my interventions presumably my stress level is increasing? The reason I haven't been up on this project is because I've been having really weird bad headaches for a week (and still having them) so I physically couldn't exercise this week. My head might have exploded.

Oddly enough, it's been very hard for me to find the time to destress because I'm too busy being stressed about everything right now. My headaches are taking the cake right now, mostly because nursing school is making me a HUGE hypochondriac but also I'm moving this weekend so that's a big stress. And then just classes... So while I haven't been following up on my project this week, my lack of participation has just reaffirmed that I really really do need to work on my stress management and that this is the right project topic for me at this time in my life.

To do list: move, fix headaches, and actively work on de-stressing!

Starting the PPP

2008-02-11T16:47:00.000-08:00

My first stress intervention is daily exercise--I'm interested to see if this helps my stress level. I've been exercising a few times a week throughout January and February, but this time I am charting my stress level along with the exercise.

Officially started the project last night, with 45 minutes of elliptical while studying pharmacology. Not sure if that's a good way to reduce my stress, but it works. Today I did 35 minutes of elliptical while also studying pharm. I took my various self-administered tests (PSS, WSI, DSI, and the good old 1-10 scale how would I rate my stress level). I will not be publishing daily scores on the blog, but rather bimonthly score updates and preliminary statistical analysis. I think that's it for now.

Proposal

2008-02-02T09:31:00.000-08:00

Personal Prevention Project
Chelsea Glessner
Draft #2 (2-2-08)

I. Project Vision

Name: Staying Sane?

Project Identity: This project is designed to test various coping mechanisms with regard to daily stresses and use statistical analysis to determine the validity of distinct interventions upon my personal stress levels as measured by self-report (See I. A. a. for specific tests used).

Goal: To improve mental health and increase ability to use positive coping mechanisms

Healthy People 2010 Focus Area: Mental Health and Mental Disorders (#18)

Outcomes:
1. Show consistently lower stress measures upon completion
2. Reduce recurrence of stressful states
3. Show ability to lead a 10-30 minute teaching workshop on positive coping strategies and their benefits using first-hand knowledge

Secondary Outcomes:
1. Increase knowledge of mental health problems and diseases
2. Increase knowledge of positive coping mechanisms
3. Increase awareness of services for mental health

Level of Prevention: Secondary

Project Timeline: February 1 – August 24

Project Documented: blog found at http://stayingsaneppp.blogspot.com/ with weekly journaling, milestones, intervention plans, and assessment report as completed

Milestone Check: The specific interventions for stress management will change monthly. Upon this change, the Perceived Stress Scale (Cohen, 1983) will be completed to get data on the monthly stress level prior to starting an intervention and finishing another. Another check will be to obtain cathecolamine and cortisol tests (urine and saliva, respectively) from the Duke Student Health Center to get a physiologic picture of stress in between stress interventions. The milestone check will include assessment of compliance to interventions and a self-analysis of possible barriers to compliance as well as written suggestions to improve compliance. This will all be completed on the blog.

A. Assessment Parameters
a. Self-evaluation tests
b. Self-identified weekly stressors
c. Physiological Response to stress and interventions
i. Heart rate self-measured before and after every intervention
ii. Blood pressure weekly as measured by a student nurse
iii. Catecholamines (urine test) and cortisol (saliva) monthly
d. Statistical analysis on stress-measurement scores and any evidence of statistical correlation between self-assessment scores and intervention plans

B. Empirics
a. Bormann, J. E., Becker, S., Gershiwin, M., Kelly, A., Pada, L., Smith, T. L., et al. (2006). Relationship of Frequent Mantram Repetition to Emotional and Spiritual Well-Being in Healthcare Workers. The Journal of Continuing Education in Nursing , 218-224.
b. Brantley, P. J., Bodenlos, J. S., Cowles, M., Whitehead, D., Ancona, M., & Jones, G. N. (2007). Development and Validation of the Weekly Stress Inventory-Short Form. Journal of Psychopathological Behavioral Assessment , 55-60.
c. Brantley, P. J., Waggoner, C. D., Jones, G. N., & Rappaport, N. B. (1987). A Daily Stress Inventory: Development, Reliability, and Validity. Journal of Behavioral Medicine , 61-74.
d. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A Global Measure of Perceived Stress. Journal of Health and Social Behavior , 385-396.
e. Granarth, J., Ingvarsson, S., von Thiele, U., & Lundberg, U. (2006). Stress Management: A Randomized Study of Cognitive Behavioral Therapy and Yoga. Cognitive Behavior Therapy , 3-10.
f. Harris, A. H., Cronkite, R., & Moos, R. (2006). Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients. Journal of Affective Disorders , 79-85.
g. Roth, D. L., & Holmes, D. S. (1987). Influence of Aerobic Exercise Training and Relaxation Training on Physical and Psychological Health Following Stressful Life Events. Psychosomatic Medicine , 355-365.

C. Action Strategies
a. Participate in self-monitored predetermined interventions
b. Self-evaluate stress before and after every intervention action
c. Keep personal and professional journal
d. Attend therapy sessions at CAPS
e. Consult with Dr. Martin for self-assessment scales
f. Consult with CAPS therapist for self-therapies and interventions
g. Consult with Duke Integrative Medicine for self-therapies and interventions

D. Baseline Assessment
a. Self-evaluation tests
i. Perceived Stress Scale (Cohen, 1983)
ii. Heart rate and blood pressure measurements
iii. Catecholamine and cortisol measurements
b. Initial assessment visit with CAPS at Duke University
E. Implementation Plan
a. Use of different intervention strategies for predetermined amount of time
b. Self-evaluation during each intervention
i. Prior to and after intervention (monthly): Perceived Stress Scale (Cohen, 1983)
ii. Weekly Stress Inventory-Short Form (Brantley, 2007)
iii. Daily Stress Inventory (Brantley, 1987)
c. Intervention Schedule:

February: Daily Exercise
March: Meditation
April: Volunteer Work
May: Mantram Repetition
June: Yoga
July: Progressive Relaxation
August: Subject Choice

F. Evaluation
a. Descriptive Statistics of assessment scores
b. Statistical examination of correlation between interventions and assessment scores
c. Subjective opinion of intervention effectiveness
d. Peer Evaluation of Portfolio

Preparing for this...

2008-02-02T09:27:00.000-08:00

So this is my first posting. This blog is designed to record my lifestyle changes that I will be making from February to August as part of a Community Health Class I am taking at Duke University School of Nursing. Somewhere on this blog is the second draft of my Personal Prevention Project Proposal if I can figure out how to add documents...