CHAPTER
10
Implementing a Stress Reduction Plan
STRESS MANAGEMENT PRINCIPLE
Work on a plan; then the plan will work on you.
IMPORTANCE OF IMPLEMENTING A PLAN
Any intention—however noble it may be, any plan—however well conceived it may be, any desire—however
chaste it may be, unless implemented cannot produce the necessary results. We need to implement our inten-tions,
plans, and desires in order to obtain the necessary results. The purpose of this workbook is to provide prac-tical
suggestions toward preventing, reducing, and managing the harmful and negative consequences of stress in our daily
lives, thus enabling us to effectively manage changes that are an inevitable part of life. These practical suggestions,
if not implemented in our lives, are meaningless. We need to make conscious efforts at integrating these suggestions
into our daily activities. These efforts will foster positive health and promote our wellbeing.
The starting point in the process of implementation is to take stock of the resources that are available to us. In
implementing a stress reduction plan, a prerequisite is to have self-motivation. Unless and until we are motivated to
bring about change in our lives, nobody can force us to make that change. We need to be committed. We need to
have faith in ourselves and the techniques that we are going to implement. We also need to be aware of what needs
to be changed (Romas & Zenga, 2001).
Another prerequisite for success is the degree of changeability in what we intend to change in our behavior. This
changeability varies from individual to individual and is person-specific. For example, applying relaxation
techniques may be more changeable for some of us but difficult for others who have a more rigid lifestyle, or applying
anxiety-coping techniques may be more changeable for some of us while others may find it more diffi-cult, and so
on. From a practical point of view, we need to prioritize and put our efforts into those behavior patterns that are
changeable and important (Green & Kreuter, 2005). We need to identify for ourselves, on our own, which behaviors
are less changeable and which behaviors are more changeable, and which behaviors are more important and which
behaviors are less important. The behaviors that are more important and more changeable need to be our first priority.
Then, we need to alter behaviors that are more important but less changeable. After accomplishing these two sets of
behaviors, we can tackle behaviors that are less important and more changeable. Behaviors that are less important
and less changeable need to be ignored. This aspect is presented later in the chapter.
After having this requisite motivation and conditioning, we need to identify friends, coworkers, family members,
associates, and others who can help us in our efforts to implement our stress reduction plan. We need to take them
into confidence and share our plan. We need to solicit their support in helping us adhere to the plan. They will
provide us with the necessary mental, emotional, and social support that will help keep us from deviating from our
decisions. We also need to procure any special accessories or equipment required for imple-menting the desired set
of behaviors. For example, for a cross-country skiing program, we need to have ski gear, appropriate clothing,
conditioning, and a location.
Practical Stress Management. DOI: http://dx.doi.org/10.1016/B978-0-12-811295-3.00010-3 189 © 2017 Elsevier Inc. All rights reserved.
190 10. IMPLEMENTING A STRESS REDUCTION PLAN
We also need to make definitive time allocations for implementing our plan. This requirement will entail
scheduling the activities for desired behaviors (as suggested in several worksheets throughout this workbook) into
our daily plan, however busy we may be. We need to allocate regular blocks of time for implementing tech-niques
for prevention, reduction, and management of stress.
Finally, we need to make this stress reduction plan fit into our overall scheme of life. To do so, we need to have
clarity about where we want to be, or in other words—what our goal is. We also need to clearly know how we will
achieve this goal, i.e., which objectives will lead us to that goal.
Such planning has been shown to improve our coping skills with everyday stressors as well as chronic stres-sors.
Kleinke (2002) uses the basic framework of goal setting for coping with a myriad of situations such as fail-ure,
loneliness, loss, aging, pain, illness, and injury. Hopefully, you will find these planning techniques very helpful.
STAGES OF CHANGE
In making a plan for changing stress-related behaviors, we need to understand that, when making this change, we
progress through several stages. Since the 1980s, James Prochaska and his colleagues have developed a model
popularly known as the “transtheoretical model” or the “stages of change model” to explain these stages systematically
(Prochaska, Redding, & Evers, 2015) (see Fig. 10.1). According to this model, with regard to any behavior,
a person begins in precontemplation, or is not aware that he or she needs to make the change and has no inten-tion
to change over the next 6 months. The second stage is contemplation, in which the person starts thinking about
making a change regarding the behavior and wants to make the change within the next 6 months. The third stage is
preparation, in which the person intends to take action within the next 30 days and has begun taking some behavioral
steps in that direction. The fourth step is action, in which the person has initiated the changed behavior but has not
done so continuously for 6 months. The final stage is maintenance, in which the person has been performing the
desired behavior for more than 6 months continuously. After you have read this workbook, we are sure that you
would have progressed to at least the contemplation or preparation stages and would be ready to enter into the action
and maintenance stages concerning one or more specific areas of stress management.
The stages of change model has been applied to a variety of health behaviors in a number of settings (Sharma,
2017). This model has been useful in helping people change behaviors. The model also elaborates on the role of selfefficacy
and decisional balance in initiation of behavior change. Self-efficacy is the behavior-specific confidence
that a person has in his or her abilities to perform a given behavior at any moment. It can be built by performing the
behavior in small steps. In this workbook, you have learned the small steps for stress management-related behaviors.
You must apply these steps to gain mastery of the behavior slowly over
Maintenance
Keeps up the desired behavior!
Action
Changed behavior is initiated.
Preparation
Intends to take action.
Contemplation
Begins to think about changing.
Precontemplation
Not aware that a change needs to be made.
FIGURE 10.1 James Prochaska’s stages of change model.
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DETERMINING GOALS, OBJECTIVES, AND TARGETS 191
time. In developing self-efficacy, it is also essential to overcome temptations or urges to engage in a specific habit
under difficult situations. Reducing stress, controlling cravings, and having positive social situations can achieve
self-efficacy. The decisional balance is about having an understanding that the pros, or benefits, of changing
outweigh the cons, or costs, of changing. Only when we are convinced that the pros of behavior change are more
worthwhile than the cons will we initiate the behavior change. We should try to make a list of all the benefits of the
change that we propose to make. With this understanding we are ready to develop our specific goals and objectives.
DETERMINING GOALS, OBJECTIVES, AND TARGETS
Goal Setting
Goals are the total of projections of our long-term plans. Goals are an indication of what we want to accom-plish
in our lives. Goals signify a mission, an ambition, a purpose, and overall aim in life. These goals are oftentimes
broad in nature. We need to identify goals for ourselves in different spheres of life, namely per-sonal, professional,
social, financial, and spiritual. An example of a personal goal could be achieving personal happiness and peace of
mind; an example of a professional goal could be achieving a certain position within an organization; an example of
a social goal could be marital contentment; an example of a financial goal could be establishing a solid savings plan;
and an example of a spiritual goal could be achieving world peace. Attaining goals within these spheres is important
from the perspective of deriving balance, harmony, and satisfaction in life. If any of these components are missing,
then life will not be holistic, and thus, complete happiness will elude us. A person without goals is also likely to have
greater stress in life because of undi-rected, aimless efforts.
Goal analysis or goal setting is a procedure useful in helping us describe the meaning of what we want to achieve
in terms of attitude and understanding (Mager, 1972). The concept of setting goals implies that it is not necessarily
important to achieve things in the “right way” but to do the “right things.” An understanding of what these “right
things” are for us is central to goal setting. The sense of direction in our activities is essentially an internally driven
behavior. A number of theories have been presented to explain this behavior. One of the most popular theories in
psychology, Maslow’s hierarchy of needs theory on motivation (Maslow, 1954, 1962), identifies the following five
levels of needs:
1. Physiological (food, clothing, shelter, sex, and so on);
2. Security and safety (protection from physical and emotional harm);
3. Love, affection, belonging, and social acceptance;
4. Self-esteem (internal factors such as self-respect, autonomy, and achievement; and external factors such as
status, recognition, attention, and so on);
5. Self-actualization (to achieve one’s maximum potential).
According to Maslow, a person progresses from lower-level needs, such as physiological and security and safety,
to higher-level needs, such as self-esteem and self-actualization, during the course of one’s lifetime. Maslow
hypothesized that the ultimate goal in life for all human beings was to reach self-actualization. According to this
theory, it is important to accomplish a lower level of need before proceeding to the next level.
However, later research led to a modification of this theory. Alderfer (1969) revised this concept and presented
an ERG theory. ERG is an acronym of the words existence, relatedness, and growth. These are the three groups of
core needs. Existence is concerned with basic material requirements (same as Maslow’s physiological and safety
needs); relatedness is similar to Maslow’s love need and the external component of Maslow’s self-esteem classification;
and growth is similar to the internal self-esteem component and self-actualization of Maslow’s theory.
However, the key features that differentiate this ERG theory from Maslow’s theory are: (1) more than one level of
need may be operative at the same time, and (2) if gratification of a higher-level need is blocked, then the desire to
satisfy a lower-level need is increased. The ERG theory has greater scientific validation (Robbins & Judge, 2017).
This basic understanding of motivation is important in enabling us to set our goals. We need to be conscious about
the “level of need” operating within our mind at any time. We also need to understand that the ultimate goal in life
is to achieve our maximum potential or self-actualization.
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92 10. IMPLEMENTING A STRESS REDUCTION PLAN
Establishing Objectives
Objectives can be defined as concerted, directed, and focused step-by-step efforts to achieve goals. Objectives are
more precise than goals and represent smaller steps. Some of the attributes in establishing objectives are as follows:
• Precise (clear and not vague statements directed toward goal accomplishment);
• Made to include a determined timeframe (e.g., 1 month, 1 year);
• Realistic (accomplishable within available timeframe and resources);
• Sequenced (logical flow of steps leading to reaching the goal);
• Written (to enhance clarity and provide a documented record for future reference);
• Proactive (described by action verbs and self-driven);
• Measurable (changes can be monitored in concrete terms);
• Behaviorally oriented (imply specific behavior changes that need to be accomplished).
Example of an Objective
I will be able to identify one irrational belief responsible for causing my work-related anxiety, within the next
week, and achieve proficiency in practicing progressive muscle relaxation (PMR), as evinced by a feeling of
relaxation by my body, after 10 minutes of daily practice, performed after coming home from work.
This objective may appear to be slightly verbose, but we have attempted to explain most of the attributes within
this example. While formulating objectives for ourselves, only we can be the best judge of the criteria that need
inclusion and the criteria that can be excluded.
Deciding Targets
To achieve practical accomplishment of goals and objectives, we need to perform a number of day-to-day
activities. Identifying these daily activities in advance is important in planning. This process is known as deciding
targets. Targets are things you do every day to advance you toward your goal. An example of a target would be “I
will, at 6:00 p.m., after returning from work, perform progressive muscle relaxation.”
Now, with the help of Worksheet 10.1, you can set goals and establish objectives. Worksheet 10.2 has been
designed to prioritize your objectives. Worksheet 10.3 will help you decide upon daily targets in order to prioritize
objectives. Record your daily targets for different objectives either on photocopies of Worksheet 10.3 or a separate
blank sheet of paper.
Thoughts for Reflection 10.1 will help you ponder some ideas to keep in mind before setting goals and establishing
objectives. Box 10.1 presents some Eastern thoughts on obtaining results.
THOUGHTS FOR REFLECTION 10.1 POINTS TO PONDER
Goal setting and establishing objectives . . .
. . . are not wishful thinking or daydreaming.
. . . are positive and proactive.
. . . are an individual activity that no one else can do for us.
. . . are not something to make us regret the past or worry about for the future.
. . . are a powerful tool for success in life.
. . . are an act of discipline.
. . . are effective for reducing stress, managing change, and promoting health.
PRACTICAL STRESS MANAGEMENT
FINDING THE BEST TECHNIQUES THAT SUIT YOUR GOALS 193
BOX 10.1
EASTERN VIEWS ON OBTAINING RESULTS
Most of our stress is due to expecting specific results from
our actions. We are not sure what results we will get, and this
uncertainty is often a source of fear, anxi-ety, and other forms
of stress. According to Eastern phi-losophy, results are bound to
follow any action. This is the basic law of nature: the law of
cause and effect. The uncertain nature of results is also
mandatory. According to this theory, results depend on the
following three aspects:
• Effort. No result can occur without an effort on our
part. Effort is the first and foremost step toward
obtaining results.
• Direction. If our effort lacks an appropriate direction,
then we will not be able to obtain the necessary results.
Therefore, having a direction, or focus, is important to
achieving success in our effort.
• Unknown factor. Even after applying an effort in an
appropriate direction, success sometimes does not
come. Such failures are due to the unknown factor
that is operating in the universal system of law.
Religious-minded people refer to this as God; scientists
attribute it to probability and chance. Without being
unduly concerned about the semantics, the basic fact
remains that we need to acknowledge and accept this
inherent phenomenon. We then need to strengthen our
mind and not be upset if the results do not go our way.
The only aspects over which we have control are effort and
direction. Having applied our effort and having done so in the
right direction, we need to think no fur-ther. We need to develop
an attitude of bearing what-ever the results may be. If they are
good, we need to be thankful to the unknown; if they are not to
our expecta-tion, we need to think about what went wrong, how
we can rectify anything, if at all, and accept the result with
fortitude and grace. If the result has been negative, we also need
to think about changing our effort and direc-tion—i.e., the
behavior—if it is faulty.
SOCIAL SUPPORT
Each of us has a set of social relationships. Some of these social relationships are merely people who we know
casually. These relationships are called social networks. All members of the social network may or may not be
helpful to us. However, some members are helpful to us and provide positive aid or assistance, especially during
moments of crises. These members are known as social support (Holt-Lunstad & Uchino, 2015). Social support is a
key factor that protects the individual from negative consequences of stress (Holt-Lunstad & Uchino, 2015). Social
support is always perceived by the sender to be positive and is intended to help in modifying the thoughts and actions
of the receiver. House (1981) has identified four kinds of social support: (1) emotional, which includes expressions
of love, empathy, caring, and trust; (2) instrumental, which includes tangible aid or service; (3) informational, which
includes advice, suggestions, and information; and (4) appraisal, which includes feedback for self-evaluation. These
days a lot of college students and others are finding social support through interaction on social networking sites
such as Facebook. In later years of college life, Facebook is particularly important in providing social support and
well being to students (Kalpidou, Costin, & Morris, 2011). Worksheet 10.4 is designed for you to reflect on your
sources of social support, and Worksheet 10.5 is about how to enhance the effectiveness of your social support. Take
some time to reflect and complete these two worksheets before proceeding further.
FINDING THE BEST TECHNIQUES THAT SUIT YOUR GOALS
All of us are different entities in ourselves. Our personalities, biological constitution, behaviors, values, attitudes,
and beliefs are unique. Likewise, our goals are also bound to be unique and personal. There may be a similarity of
pattern in our attributes and goals with other individuals, but ultimately this set of attributes that each of us has is
unique and specific in itself. Therefore, as we have seen, it is important to identify stress man-agement and reduction
techniques that suit this uniqueness in our individuality and goals.
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194 10. IMPLEMENTING A STRESS REDUCTION PLAN
Worksheet 10.6 is designed to provide you with an opportunity to identify and practice stress management and
reduction techniques that suit your goals and “fit” your own unique individuality. These techniques, if prac-ticed
with regularity and commitment, are bound to produce beneficial results in achieving your goals.
Thoughts for Reflection 10.2 will help you reinforce a sense of commitment in order to keep up with the plan you
decide upon.
THOUGHTS FOR REFLECTION 10.2 PROMISE TO MYSELF
Let me make a promise to myself, for my own good, that . . .
. . . I will make an effort to practice what I have learned.
. . . I will be disciplined and proactive in my approach.
. . . I will remain optimistic and positive about life.
. . . I will have faith in myself, my goals, and the techniques I have learned.
. . . I will be enthusiastic and implement my plans with zeal.
. . . I will wear a cheerful countenance at all times and greet everyone around me with a smile.
. . . I will bless everyone around me, even if they may appear to be my enemies.
. . . I will devote my time to self-improvement—so much so that I will have no time to find mistakes in others.
. . . I will have no unrealistic expectations from people and situations around me.
. . . I will try to understand more often than I try to be understood.
. . . I will not allow worry over the future to overpower me and past events to disturb my peace.
. . . I will be relaxed, happy, and content in my disposition with the present.
TOWARD A STRESS-FREE LIFE
This workbook has provided you with techniques for preventing, reducing, and managing stress in your life. It is
never too late to implement and practice these techniques regularly to obtain beneficial results. These results can be
maximized if you incorporate these techniques within your daily life at a young age. Therefore, you should enter
into an agreement with yourself to attain regularity by implementing the stress reduction plan in your life. If you
attain this regularity for a continuous period of at least 1 year, it will become fully etched within your lifestyle. To
achieve this continuity, you may reward yourself periodically with some tangible, self-decided rewards or incentives.
Worksheet 10.7 is designed to help you with this objective. Worksheet 10.8 introduces you to writing a self-diary
for stress management.
Another helpful way to ensure this regularity is through social networking or building social support. Social
networking also contributes to managing your stress directly. You need to identify a close group of people who are
available for listening empathetically to your views and concerns, who can help clarify questions, and who are willing
to challenge you to grow if and when needed. Associating with such people helps prevent, reduce, and manage stress
in your life. Finally, we emphasize that by regularly practicing selected techniques identified through this workbook
you can effectively manage your stress.
CHAPTER REVIEW
Summary Points
• Implementation of a plan is central for success.
• Self-motivation and degree of changeability are prerequisites for implementing a plan.
• The behaviors that are more important and more changeable deserve your first priority in implementation.
• You need to take stock of all your resources before you implement a plan. This process includes soliciting help
from people close to you and obtaining necessary material resources.
PRACTICAL STRESS MANAGEMENT
WEBSITES TO EXPLORE 195
• Goals are an indication of what you want to accomplish. They cover five different spheres of life: personal,
professional, social, financial, and spiritual.
• Goal analysis or goal setting helps you describe the meaning of what you want to achieve in terms of attitude
and understanding.
• Maslow’s hierarchy of needs theory for motivation identifies five levels of needs: physiological, security, love,
self-esteem, and self-actualization.
• Alderfer’s ERG theory describes the core needs as existence, relatedness, and growth.
• Objectives can be defined as concerted, directed, and focused step-by-step efforts for achieving goals.
• Some attributes in establishing objectives include precision, a determined timeframe, and being realistic,
sequenced, proactive, measurable, and behaviorally oriented.
• Deciding targets includes planning for the various day-to-day activities required in accomplishing goals and
objectives.
• According to Eastern philosophy, success in any enterprise depends upon effort, direction, and an unknown
factor.
• Regular practice of techniques described in this workbook will help you prevent, reduce, and manage your
stress.
IMPORTANT TERMS DEFINED
Goal: A total of all projections or long-term plans. Goals signify an overall aim in life.
Objectives: A concerted, directed, and focused step-by-step effort to achieve a goal. Objectives are precise,
include a timeframe, are realistic, are sequenced, use action verbs, and are measurable.
Social support: The positive aid, either tangible or intangible, that is exchanged through social relationships and
interpersonal transactions.
Targets: Anything that a person does in everyday life to advance toward his or her goals.
WEBSITES TO EXPLORE
Goal Setting
www.about-goal-setting.com/
This website, from a private organization, is about goal setting.
• Visit this website and complete a 20-minute tutorial.
Social Anxiety Support Group
www.socialanxietysupport.com/
This website provides structured interactive forums and special programs to help those who suffer from social
anxiety disorder (social phobia).
• Visit this website and peruse the cartoons or chat in one of the forums. Summarize your reactions.
Ten Steps to Getting What You Want in Life
www.gems4friends.com/goals/
This is the website of a private organization.
• Go through the 10 steps. Did this reflection make sense in your life?
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WEBSITES TO EXPLORE 201
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FEEDBACK ON WORKSHEETS 10.1 10.7
This worksheet has provided you with insight to determine
techniques that best suit your individuality in terms of
effectiveness, ease of applicability, and practical util-ity. You
should also have discovered why some of the techniques are not
successful for you. If these reasons are under your control, you
can try to modify them. However, if these reasons are not under
your control,
you need to discover and practice other techniques that work.
The key for success lies in consistency and deter-mination in
practicing these techniques. These techni-ques are more helpful
in preventing and reducing stress than in managing stress.
Therefore, the younger you start and incorporate these
techniques, the greater the benefit will be.
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208 10. IMPLEMENTING A STRESS REDUCTION PLAN
FEEDBACK ON WORKSHEET 10.8
Make it a daily habit to reflect on your day in terms of the
stressors encountered and how you overcame those. Finish your
day by practicing any one technique
of relaxation or meditation before you sleep. Keep prac-ticing
this ritual for a stress-free life.
References and Further Reading
Addington, J. E. (1977). All about goals and how to achieve them. Marina del Rey, CA: DeVorss.
Alderfer, C. (1969). An empirical test of a new theory of human needs. Organizational Behavioral and Human Performance, , 142 175.
Cassel, J. (1976). The contribution of the social environment to host resistance. American Journal of Epidemiology, 104, 107 123.
Green, L. G., & Kreuter, M. W. (2005). Health promotion planning: An educational and environmental approach (4th ed.). Boston, MA:
McGraw-Hill.
PRACTICAL STRESS MANAGEMENT
REFERENCES AND FURTHER READING 209
Holt-Lunstad, J., & Uchino, B. N. (2015). Social support and health. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior.
Theory, research and practice (5th ed., pp. 183 204). San Francisco, CA: Jossey Bass.
House, J. S. (1981). Work, stress, and social support. Reading, MA: Addison-Wesley.
Kalpidou, M., Costin, D., & Morris, J. (2011). The relationship between Facebook and the well being of undergraduate college students.
Cyberpsychology, Behavior and Social Networking, 14(4), 183 189.
Kleinke, C. L. (2002). Coping with life challenges (2nd ed.). Prospect Heights, IL: Wave- land Press.
Liebler, J. G., & McConnell, C. R. (2016). Management principles for health professionals (7th ed.). Sudbury, MA: Jones & Bartlett.
Mager, R. F. (1972). Goal analysis. Belmont, CA: Fearon Publishers/Lear Siegler.
Maslow, A. (1954). Motivation and personality. New York, NY: Harper & Row.
Maslow, A. (1962). Toward a psychology of being. Monterey, CA: Brooks/Cole.
Prochaska, J. O., Redding, C. A., & Evers, K. E. (2015). The transtheoretical model and stages of change. In K. Glanz, B. K. Rimer, & K.
Viswanath (Eds.), Health behavior. Theory, research and practice (5th ed., pp. 125 148). San Francisco, CA: Jossey Bass.
Robbins, S. P., & Judge, T. A. (2017). Organizational behavior (17th ed.). Boston, MA: Pearson.
Romas, J. A., & Zenga, D. W. (2001). It’s about change. . . it’s about you!. Dubuque, IA: Kendall Hunt.
Sharma, M. (2017). Theoretical foundations of health education and health promotion (3rd ed.). Sudbury, MA: Jones and Bartlett.