REPORT ON STRESS MANAGEMENT

Introduction
There are a number of ways in which stress management can be approached,
but the stress management process should always include assessment and
treatment. This learning module describes an assessment protocol which has
been designed for massage therapists. Some elements of the learning module
will be expanded later in the course.

Now let's try to get a better understanding of what stress is and how to
manage it. Stress is anything that puts demands upon our bodies and minds
to cope, adjust, change, or accommodate to the demand. Although stress can
come from an ongoing, routine, and chosen activity like long work hours or
a hurried work pace, it is often associated with an intense reaction to an
event in our lives which can be either pleasant or unpleasant. We often seek
out positive, stressful events such as roller coaster rides or white water
rafting or competitive sporting events. By the way, watching competitive
sporting events can even be stressful. On the other hand, any time we
perceive a threat to us either physically or psychologically, we respond in the
same way. This distress response has been labeled the "fight or flight
response". This response occurs when we perceive that the challenge facing
us is dangerous, difficult, painful, or unfair, and we are concerned that we
may not be able to cope with it successfully(Davis, Eshelman, and McKay,
2000).

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REPORT ON STRESS MANAGEMENT

Assessment
This assessment protocol includes the following stages

 Medical screening
 Identify client goals
 Stress assessment
 Identify need for referral if any
 Identify level of training required
 Identify client's level of commitment to change
 Palpation

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REPORT ON STRESS MANAGEMENT

Medical screening for stress management

Medical clearance should be sought when clients have any of the following
conditions

 Asthma
 Diabetes
 Hypertension
 Epilepsy
 Psychiatric illness

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REPORT ON STRESS MANAGEMENT

Assessment
Through assessment you can determine two important questions

 Does my client need my help with stress management?

 Does my client want my help with stress management?

I'm sure that the need to identify your client's goals for treatment, and to
base what you do on these goals has been drummed into you by now. If your
cilent's goals are aligned with stress management, then it may be worthwhile
suggesting this to your client.

If you do this be sure to discuss your reasons for believing it would benefit
the client, and what it would mean if they did not use stress management
techniques.

One both you and your client have agreed to embark on a stress management
programme, you will need to run through an assessment process with them.
One important thing to do at the start of the process is to get a measure of
their current level of stress.

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REPORT ON STRESS MANAGEMENT

Establishing the baseline

When your aim is treatment of a condition which is affecting your client, it's
important that you are able to measure the severity of their condition. If you
can do this, you can compare their current level of stress (in this case)
against their original level of stress to see if the approach that you have
chosen is having a postive effect.

Measuring their current level is stress is also called establishing a baseline

assessment measure.

It's best if baseline assessment measures can be objective (e.g. joint range of
movement) rather than subjective ("rate pain on a scale of 1-10"). You don't
really want the measure to change depending on the mood of your client on
the day of assessment. It's fairly difficult to develop an objective measure of
stress for use in clinical practice. Stress-related research often uses blood
sampling of hormones such as cortisol which are related to the stress
response as an objective assessment measure, however this is not an
approach that you can commonly take in your practice. Another way to
attempt to measure someone's stress levels is to take a multi-factor approach.

Otago Polytechnic has developed a stress assessment instrument which is

specialised to the use of massage therapists. The boxes for the statements for
the form are currently blank. They will be developed in the course of this
programme.

The assessment is modelled on one developed by the Cleveland health

clinic.

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REPORT ON STRESS MANAGEMENT

Identifying stressors
Once you've gone through the medical screening process and have taken an
objective measure of your client's stress, the next stage in the assessment
process is to identify the major stressors in your client's life. The stress
monitor form will give you some information about how stress is affecting
your client which will give you some pointers about the kinds of stressors
which could be involved, but you will need to also question your client
about the kinds of factors which could be involved.

When developing your stress management plan, you should try to encourage
your client to reduce their exposure to factors which increase their stress and
increase exposure to any factors which reduce their stress.

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REPORT ON STRESS MANAGEMENT

Other considerations when assessing for stress

There are several other important conisderations in a stress assessment
process.

 Identify need for referral if any

 Identify level of training required
 Identify client's level of commitment to change
 Palpation

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REPORT ON STRESS MANAGEMENT

Treatment
The treatment process includes four elements

 Develop stress management programme

 Train & Treat
 Monitor progress
 Discharge / Ongoing management

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REPORT ON STRESS MANAGEMENT

Develop stress management programme

The stress management programme should include

 Programme goals
 Lifestyle modification (activities to increase/decrease)
 Massage (frequency and focus)
 Stress management exercises
 Expected length of the programme

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REPORT ON STRESS MANAGEMENT

Train & Treat

Once the stress management programme has been developed, the client must
be trained in any stress management exercises that are involved, and
massage should be applied in accordance with this priorities identified in the
programme.

According to Lichstein (1988), a therapist that uses relaxation techniques

must go through the following steps before applying any relaxation
technique with their clients.

 Study the method

 Experience the method
 Practice the method on friends, relatives, etc. to build up a skillful
presentation

Monitor progress
The client's progress in the stress management programme should be
regularly monitored both through the use of the stress assessment
instrument, and through questioning the client about their adherence to the
stress management programme.

Changes may be made to the programme based on assessment information

that is gathered over

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REPORT ON STRESS MANAGEMENT

Discharge / Ongoing management

At the date which has been identified as the end of the stress management
programme, the client should be reassessed. At this stage, it will be
identified that the client needs either

 Extension of the stress management programme (if the client needs

more time to achieve their stress management goals)
 Discharge (if the client has met the goals identified in the programme,
or is well on their way to meeting these goals)
 Ongoing management

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