Stress Management/Introduction to the stress management process

Contributors
David McQuillan 2008

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.

= 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

Medical screening for stress management
Medical clearance should be sought when clients have any of the following conditions


 * Asthma
 * Diabetes
 * Hypertension
 * Epilepsy
 * Psychiatric illness

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.

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.

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.

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

= Treatment = The treatment process includes four elements


 * Develop stress management programme
 * Train & Treat
 * Monitor progress
 * Discharge / Ongoing 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

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

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