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KAPLAN UNIVERSITY
HW410 Stress: Critical Issues in Management and Prevention
Stress Management and Prevention
Program Resource Guide
K A P L A N U N I V E R S I T Y
Stress Management and Prevention Program Resource
Guide
By
Lola Lurch
Kaplan University
HW410: Stress: Critical Issues in Management and Prevention
October 1, 2013
Table of Contents
U N I T 1 T H E N A T U R E O F S T R E S S
Information to Remember
What is Stress? ....................................................................................... 5
The General Adaptation Syndrome (GAS)..........................................5-6
Types of Stressors………………………………………………………6
Resources: Exercises:
Exercise 1.6 The Wellness Paradigm Revisited………………….……..6
Tools: Journal Writing:
Exercise1.5. Personal Stress Inventory: Top Ten Stressors………....…6
U N I T 2 T H E B O D Y A S B A T T L E F I E L D
Information to Remember
How the Immune System Works………………………………………7
Nervous System—Related Disorder. ………………………...………..7
The Stress-Disease Connection .………………..…………….………..7
Resources: Exercises:
Exercise3.2 Immediate, Intermediate, and Prolonged Stress Effects7-8
Tools: Journal Writing:
Exercise: 4.1 Physical Symptoms Questionnaire……………………....8
U N I T 3 F E A S T O R F A M I N I N E
Information to Remember
The Anatomy of Anger……....................................................................9
The Anatomy of Fear..............................................................................9
Building Blocks of Psychological Stressors….........................................9
Resources: Exercises:
Exercise: 6.1 Anger Recognition Checklists………………..…………...9
Tools: Journal Writing
Exercise: 5.1 The Psychology of Your Stress…………………………10
U N I T 4 O N E P L A N E T U N D E R S T R E S S
Information to Remember
Personality Traits and Stress………..…………………………….….....11
Self-esteem and Stres...............................................................................11
Human Spirituality……………………………………………….….….11
Resources: Exercises:
Exercise: 8.5 Your Personal Value System...........................................11
Tools: Journal Writing
Exercise: 7.1 Under the Gun: Stress and Personality………………..12
U N I T 5 U N D E R S T R E S S : W H A T N O W ?
Information to Remember
Effective Coping Strategies…………………………………………...13
Cognitive Restructuring: Reframing………………………………......13
Time Management for Stress Reduction………………………………13
Resources: Exercises
Exercise: 9.3 Positive Affirmation Statements………………………..13
Tools: Journal Writing
Exercise: 9.1 Reframing: Seeing a Bigger, Clearer Perspective……….14
U N I T 6 A G E L E S S W I S D O M O F M E D I T A T I O N
Information to Remember
What is Meditation? ..............................................................................15
Diaphragmatic Breathing.......................................................................15
Mental Imagery and Visualization………………………………….…15
Resources: Exercises
Exercise: 19.3 Bridging the Hemispheres of Thought……………....15
Tools: Journal Writing
Exercise: 21.1 I Have a Vision: The Art of Visualization…………..16
U N I T 7 S I G H T , S O U N D , A N D B O D Y W O R K
Information to Remember
The Ageless Wisdom of Imagery and Visualization………………….17
Music as a Relaxation Technique……………………………………..17
Diet for a Stressed Planet……………………….…………………….17
Resources: Exercises
Exercise IV. The Art of Calm: Relaxation through the Five Senses…17
Tools: Journal Writing
Exercise 28.3 The Rainbow Diet……………………………………..18
U N I T 8 T H E W E L L N E S S M A N D A L A
Information to Remember
Physical Exercise: Stress Response and Parasympathetic
Rebound Response………………………………………...…………19
Music as a Relaxation Technique……………………………………..19
Steps to Initiate a Fitness Training Program………………………….19
Resources: Exercises
Exercise 28.6 Self-Assessment: Nutritional Eating Habits…………20
Tools: Journal Writing
Exercise 28.1 Physical Exercise…………………………………….20
U N I T 9 A P P L Y I N G S T R E S S : C R I T I C A L M A N A G E M E N T
A N D P R E V E N T I O N T O Y O U R P R O F E S S I O N A L L I F E
Information to Remember
Additional Coping Techniques…………….………………………….21
T’ai Chi Relaxation Technique.…….……………………………….....21
Creating Your Own Stress Management Program…….………………21
Resources: Exercises
Exercise 28.1 Physical Exercise……………………….………………22
Tools: Journal Writing
Exercise IV. B Relaxation Survival Kit……………………….………22
U N I T 1 0 A P P L Y I N G S T R E S S : C R I T I C A L M A N A G E M E N T
A N D P R E V E N T I O N T O Y O U R P R O F E S S I O N A L L I F E
Information to Remember
Historical Perspective of PMR………………………….…………….23
Physiological Benefits of PMR……………………………………….23
Steps to Initiate Progressive Muscular Relaxation……………………23
Resources: Exercises
Progressive Relaxation Audio Companion- CD………………………23
Tools: Journal Writing
Exercise 28.1 Physical Exercise………………………………………24
A D D I T I O N A L I N F O R M A T I O N
Yoga Therapy………………………………………………………………..25
Anxiety……………………………………………………………………...25
Herbs and Natural Supplements…………………………………………….25
Helpguide for Stress Management………………………………………….25
5
Unit 1: The Nature of Stress
Information to Remember:
What is Stress?
There are many definitions for stress:
Tension
Wear and tear on the body (physical stress)
The inability to cope with problems (mental stress)
Loss of emotional control (emotional stress)
Absence of inner peace (spiritual stress)
“Stress is a perceived treat (real or imaged) to your mind, body, spirit, or emotions” (Seaward,
2006).
There are two kinds of stress: Acute (intense and short lived); and Chronic (not so intense, but last
for a prolonged period of time).
The General Adaptation Syndrome (GAS)
There are three general adaption stages:
Alarm Stage: This is the first signal for a call to action. There is a perceived threat and the stress
hormones (cortisol, adrenaline, and noradrenaline) are released for instant energy. If there is
anger (fight) or fear (flight); whichever, choice is made, the body is prepared (Seaward, 2012).
Resistance Stage: This is the second stage that is intended to stabilize the body functions and
return to a normal balance (homeostasis). If the perceived stressful event does not subside, the
body adapts to the condition; and it tries to provide a defense, even if the body has returned to a
balanced state (Seaward, 2012).
Exhaustion Stage: At stage three, the stress has become chronic (lasting for a sustained period of
time) and the adaptation energy is depleted. This is the most dangerous stage, because it puts the
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body at risk for serious damage to the nerve cells, tissues, organs, lowers the immune system, can
lead to anxiety and depression (Seaward, 2012)
Types of Stressors
Bioecological Influences are those external stressors from the environment (e.g. sunlight, air
pollution, and gravitational pull) (Seaward, 2012).
Psychointrapersonal Influences make up the largest percentage of stressors (e.g. thoughts, beliefs, values,
Attitudes and perceptions) (Seaward, 2012).
Social Influences include territorial boundaries, political issues, and socioeconomic status, financial
insecurity
and violation of human rights (Seaward, 2012).
Resources: Exercises:
Exercise 1.6 The Wellness Paradigm Revisited
It is important to understand the components of wellness. Health is not just the absence of
disease. “Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity” (WHO, 2003). Disease is a symptom that an out of
balance condition exists. There is an integrated connectivity between mind body, and spirit
which must be in balance for a healthy state of well-being (Seaward, 2011).
Tools: Journal Writing:
Exercise 1.5.Personal Stress Inventory: Top Ten Stressors
You cannot solve a problem until you identify it; and stress is no exception. Once you identify
your stressors, categorize them as mental, emotional, spiritual, or physical. It is important to
know the duration of a stress episode, and whether it causes anger, fear, or both. Taking an
inventory of your top ten stressors provides a snapshot of your challenges. (Appendix A)
7
Unit 2: The Body as Battlefield
Information to Remember:
How the Immune System Works
The immune system remembers what every cell in the body looks like; and it is designed to defend the
body from the invasion of foreign organisms (e.g. viruses, bacteria, fungi, and parasites). When an invader
attacks the body, the immune system will not only recognize this foreign organism, it will remember
it for future invasions. Introducing a small amount of a bacteria into the body (a vaccination) will allow
the immune system to record the identity of this organism and be prepare for an actual invasion (Seaward,
2007).
Nervous System—Related Disorders
The nervous system is in charge of controls and communication for the body. The nervous
system can be divided into two parts: the central nervous system (CNS), which consists of the
brain and spinal cord, and the peripheral nervous system (PNS), comprising all neural pathways
to the extremities(Seaward, 2007, p.37). Nervous system related disorders include tension,
migraine headache, temporomandibular joint dysfunction, bronchial asthma, irritable bowel
syndrome, and coronary heart disease.
The Stress-Disease Connection
The presence of disease in the body is directly associated with either the immune system or the
nervous system. Glucocorticoids are a family of biochemical agents that includes cortisol and
cortisone, produced and released from the adrenal gland (How Stuff Works, 2008).
Resources: Exercises:
Exercise 3.2 Immediate, Intermediate, and Prolonged Stress Effects
This exercise is included because it identifies the effects through which the symptoms of physical
stress can manifest. Understanding the durations of these symptoms can help determine the
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possible risk factors associated with each stage (Seaward, 2011).
Tools: Journal Writing:
Exercise: 4.1 Physical Symptoms Questionnaire
Patterns or relationships between stress levels and physical health can be observed when
completing a physical symptoms questionnaire. The frequency, severity, and duration can
determine the best form of treatment; which could range from simple relaxation techniques
to prescribed medication (Seaward, 2011). (Appendix B)
9
Unit 3: Feast or Famine
Information to Remember:
The Anatomy of Anger
All anger is a result of unmet expectations; and unresolved anger is closely connected to chronic
health conditions. Anger is manifested in many ways, Road rage, sports rage, air rage, phone
rage, and gas pump rage, workplace and domestic violence. Feelings of anger are a
result of frustration, guilt, fear, hostility, jealousy, prejudice, impatience, and envy (Seaward,
2012).
The Anatomy of Fear
The six basic human fears are the fear of failure, the unknown, death, isolation, rejection, and the
loss of self-dominance. The five symptoms of fear include anxiety, worry, doubt, paranoia, and
embarrassment. The strategies for overcoming fear are the four fearless living rules: fine-tune
expectations, stop making excuses, stop complaining, and don’t beat yourself up (Seaward,
2012).
Building Blocks of Psychological Stressors
“The building blocks of psychological stressors are: outlets for frustration, social support,
Predictability, control, and a perception of things getting worse” (Sapolsky, 2004). An outlet
for frustration can mean different things to different people (getting involved in a hobby or
going for a bike ride). Everyone needs a confidant, an ear to bend, and shoulder to lean on. At
least the perception of predictability is comforting during a stressful moment. A feeling of being
in control gives the ego a boost; and perception of things worsening causes one to brace
themselves mentally for the worse scenario.
Resources: Exercises:
Exercise: 6.1 Anger Recognition Checklists
It is important to be able to recognize the signs of anger or frustration that may creep up during
your daily routine. Raising your awareness of habits and emotion associated with feelings of
anger can alert you to take action when an episode occurs (Seaward, 2011). (Appendix C)
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Tools: Journal Writing:
Exercise: 5.1 The Psychology of Your Stress
During episodes of stress, it is important to be aware of your perceptions, attitudes, and
behaviors. Do you become defensive (I didn’t do it), use projection (she did it), use repression
(I don’t remember doing it), use displacement (he made me do it), use rationalization (everyone
does it), use humor (I can laugh about it now), or other (everything happens for a reason).
This exercise is a helpful tool to analyze the psychology of your stress profile (Seaward, 2011).
11
Unit 4: One Planet Under Stress
Information to Remember:
Personality Traits and Stress
Personality traits could affect the way we handle stress. “Could your personality kill you—or
might it make you live longer? Could it give you heart disease, or protect you from illness
(USNews Health, 2010? Are you type A (impulsive) or type B (relaxed)?
Self-esteem and Stress
Self-esteem is the perception of your own abilities, worth, and values. If you feel that you are
competent, capable, worthy of respect, and have a defined set of values, your self-esteem will be
high. Feelings of inadequacy, incompetence, and worthlessness lead to low self-esteem. Factors
that help shape our self-esteem begin in early childhood relationships with parents, siblings, and
teachers (Mayo Clinic, 2013).
Human Spirituality
Spirituality and religion are not synonymous. “When people hear the word spirituality, many
think of religion. Although spirituality and religion share common ground, they are not the same
thing. Spirituality is inclusive where religions are exclusive” (Seaward, 2012). Human spirituality
can be described as a personal journey in search of enlightenment and connectedness to others,
the environment and the universe.
Resources: Exercises:
Exercise: 8.5 Your Personal Value System
It is important to analyze your personal value system; it is the core pillar of the human spirit
that is constantly undergoing renovation. Your values and beliefs influence the way you
handle stress (Seaward, 2011). (Appendix D)
Unit
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Tools: Journal Writing:
Exercise: 7.1 Under the Gun: Stress and Personality
While we may not be able to change our personality completely, we can change personality
traits that tend to promote stress in our lives (Seaward, 2012). The Hardy personality traits
(commitment, control, and challenge) may help overcome the genetic predisposition to illness;
and maintain a positive attitude under stressful conditions. Commitment involves an
investment of one’s values and life purpose to the growth of one’s human potential and is a
direct reflection of one’s willpower; Self-control, or empowerment, helps one overcome
factors and elements in one’s environment so that one does not feel victimized; and see
challenge as an opportunity for growth, instead of a threat to existence(Seaward, 2011).
13
Unit 5: Under Stress: What Now?
Information to Remember:
Effective Coping Strategies
It is important to have the skill sets to turn a negative situation into a positive experience.
Effective coping during a stressful event begins with one’s attitude; change your attitude, change
the outcome. For a coping technique to be effective it must: help increase awareness of the
situation, augment the information processing of stress, help modify any related stress-prone
behaviors, and work toward a peaceful resolution of the stressor (Seaward, 2012).
Cognitive Restructuring: Reframing
It takes skill and focused thought to rephrase a negative statement into a positive one. Cognitive
restructuring can produce a win/win resolution by reframing a statement. “Reframing is a term
used to describe a positive mind frame of a stressful event. It is not denial; but ego detachment
from the unmet emotional expectation” (Seaward, 2012).
Time Management for Stress Reduction
Developing good time management skills can greatly reduce some of the daily stressors.
“Effective time management can be broken down into three skills: prioritization, scheduling, and
execution. Good time management requires you to balance your life between work and leisure.
Remember that balance is essential for optimal well-being” (Seaward, 2012). An evaluation of
time management skills: (Appendix E)
Resources: Exercises
Exercise: 9.3 Positive Affirmation Statements
Positive affirmations can be used as a mantra in conjunction with relaxation techniques and
visualization. They reinforce positive behaviors and boost self-esteem. These thoughts or
expressions lift the spirits and raise the individual’s level of confidence (Seaward, 2011).
Unit
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Tools: Journal Writing:
Exercise: 9.1 Reframing: Seeing a Bigger, Clearer Perspective
Although the initial thought may be one of anger and fear, taking the time to rethink and
And rephrase your thoughts or words can change the outcome. It is important to practice positive
reframing to the threatening perception to a nonthreatening perception (Seaward, 2011).
15
Unit 6: Ageless Wisdom of Meditation
Information to Remember:
What is Meditation?
Meditation is a self-directed modality that can employ different methods to calm the mind and
make the mind-body connection. Meditation produces a deep state of relaxation and tranquility.
You focus your attention on the elimination of mental clutter that crowds the mind and causes
Stress. This process results in enhanced physical and emotional well-being (May Clinic, 2013).
Diaphragmatic Breathing
Diaphragmatic breathing is thought to be an effective relaxation technique because it shifts the
breathing process from thoracic (chest breathing) to deep breathing using the diaphragm (lower
abdomen). Deep breathing is controlled and slower than thoracic (shallow) breathing. When the
emphasis of breathing is centered in the lower abdomen rather than the thoracic cavity, a less
sympathetic neural activity is generated, causing a greater relaxation effect (Seaward, 2012).
Mental Imagery and Visualization
Mental imagery and visualization are sometimes used interchangeably; however, they are not
synonymous. Mental imagery involves unconscious thoughts that become conscious; and these
thoughts can trigger the stress response or induce relaxation. Visualization is a conscious thought
process (an exercise) directed toward self-improvement (Seaward, 2012). (Appendix F)
Resources: Exercises:
Exercise: 19.3 Bridging the Hemispheres of Thought
It is beneficial to understand how you process your information. Are you left-brain thinker or
right-brain thinker? Left-brain thinking skills are associated with judgment, analysis,
mathematical and verbal acuity, linear thought progression, and time consciousness; right-
brain functioning is associated with global thinking, holistic thinking, imagination, humor,
emotionality, spatial orientation, receptivity, and intuition (Seaward, 2011).
Unit
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Tools: Journal Writing:
Exercise: 21.1 I Have a Vision: The Art of Visualization
Perfect the art of visualization, and you can take a mental trip, induce a state of relaxation, or
promote the natural healing process. Visualization can also be used to heal the body by using
your imagination to create a vision of restored health of a specific organ or region of your
body. In fact, visualization is one of the leading techniques in mind-body medicine (2011).
17
Unit 7: Sight, Sound and Body Work
Information to Remember:
The Ageless Wisdom of Imagery and Visualization
For thousands of years ancient civilizations have practiced mind over matter; from Traditional
Chinese Medicine (TCM), Ayurveda (means knowledge of life), to modern western concepts
(e.g. hypnosis and the power of positive thinking) man has utilized this mental energy to manifest
physical phenomena. According to Seaward, “the mind is a powerful ally in managing and
preventing stress. The use of conscious intention as a key part of creative visualization can
empower the human mind by directing “…images on the screen of the mind’s eye…”
(Seaward, 2007).
Music as a Relaxation Technique
Music can produce many different effects on the human condition; and relaxation is one the
positive effects that music can produce. The distinctive qualities of music (e.g. tone, pitch,
timbre and harmony) have an effect upon the nervous system. “Music appears to affect human
physiology directly, through the cerebral cortex and autonomic nervous system; depending on
interpretation (like or dislike), either the sympathetic or parasympathetic nervous system may be
activated (Seward, 2012).
Diet for a Stressed Planet: Americans are overfed and under nourished; the consumption of
fatty, sugary, salty, and highly processed foods have led to obesity and many other chronic
diseases in people of all age groups. Diet and stress are interrelated; stress leads to poor diet and
poor diet leads to stress. Seaward explains the vicious cycle with the domino effect: stress
depletes the body of needed nutrients; poor eating habits promoted by lifestyle, triggers the
stress response that leads to toxic overload (Seaward, 2012). (Appendix G)
Unit
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Resources: Exercises:
Exercise IV. A The Art of Calm: Relaxation through the Five Senses
List ideas for relaxation for each of the five senses. A sixth category, the divine sense, was
added for any ideas that might be a combination of these or perhaps something beyond the five
senses (e.g., watching a child being born). Describing each experience allows a person to
Associate the experience with one or more of the five senses in a unique and creative way.
List ten for the sense of sight and ten for the sense of smell (Seaward, 2011).
Tools: Journal Writing:
Exercise 28.3 The Rainbow Diet
In the science of subtle energies, each of the body’s primary chakras is associated with a
specific color; therefore the color of a food has more significance than a nice
presentation, each color holds a specific vibration in the spectrum of light. When this is
combined with the nutrient value of food, it can help to enhance the health of the physical
body. It is thought that eating fruits and vegetables associated with the color of various
chakras provides healthy energy to that specific region (Seaward, 2011). (Appendix H)
19
Unit 8: The Wellness Mandala
Information to Remember:
Physical Exercise: Stress Response and Parasympathetic Rebound Response
Although exercise causes the stress response, while one is in motion, when the physical activity
ceases, the body returns to homeostasis. The stress response increases the heart rate, blood
blood pressure, rate of breathing, metabolic activity, muscle contraction, and perspiration.
The parasympathetic rebound response decreases the resting heart rate, blood pressure, rate of
breathing, and causes a quicker return to homeostasis (Seaward, 2012).
Types of Physical Activity
There are two types of physical exercise: Anaerobic work done in the absence of oxygen; activity
that is powerful and quick but does not last more than a few minutes (e.g., weightlifting); and
Aerobic, rhythmic physical work using a steady supply of oxygen delivered to working muscles
for a continuous period of not less than 20 minutes (e.g., jogging). There are six components of
fitness: cardiovascular endurance, muscular strength and endurance, flexibility, agility, power,
and balance
(Seaward, 2012)
Steps to Initiate a Fitness Training Program
The prerequisite to initiating a fitness training program includes a physical evaluation, a fitness
assessment and an exercise prescription which includes frequency, intensity, type, and time.
(FITT). The seven steps of a fitness training program are:” (1) Start cautiously and progress
moderately with your program, (2) pick an activity you really enjoy, (3) select a time of day to
to exercise, (4) exercise using the right clothing and equipment, (5) initiate a support group, (6)
set personal fitness goals, and (7) take precautions to prevent injuries (Seaward, 2012).
Unit
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Resources: Exercises:
Exercise 28.6 Self-Assessment: Nutritional Eating Habits
Get a clear picture of your eating habits and how they affect your stress levels by keeping score.
List the foods that you ingest that contain caffeine (e.g., coffee, tea, and sodas, chocolate) and the
estimated amounts you consume per day. Describe any other eating habits that you associate with a
stressed lifestyle (Seaward, 2011).
Tools: Journal Writing:
Exercise 28.1 Physical Exercise
Completing this exercise will give you an opportunity to identify your exercise habits; write a
personal exercise prescription, and prepare a weekly exercise schedule. List your favorite
physical activities, your priorities, and the things that motivate you to stay active (Seaward,
2011). (Appendix I)
21
Unit 9: Applying Stress: Critical Management to
your Professional Life
Information to Remember:
Additional Coping Techniques
Additional coping techniques include: information seeking (searching for details concerning a
Situation that is perceived as a threat); taking up a hobby (a pleasurable interest outside the daily
work routine); forgiveness (coping with unresolved anger, where ones feels violated or
mistreated); social orchestration (eliminating environmental stressors or changing one’s
environment); and exercising the power of prayer, showing gratitude, forgiveness, or
intercessory prayer (Seaward, 2012).
T’ai Chi Relaxation Technique
While Western (conventional) health is viewed as the absence of disease, produced by bacteria
and viruses; the Chinese concept of health is based on an unrestricted flow of subtle energy
throughout the body. This subtle energy (Chi) flows through a network of meridians. When these
energy gates are congested, the body is susceptible to physiological dysfunction (Seaward, 2012).
T’ai chi is a meditation of self-defense that produces balance and harmony. It’s is symbolized by
the circular mandala Yin and Yang (equal opposite forces.) (Seaward, 2012).
Creating Your Own Stress Management Program
Creating a stress management program is a personal initiative; there is not set formula or one size
fit all solution. The only secret to a successful stress management program is one’s inner
resources; that personal enter connection and enlightenment. There are some suggestion from
which one can structure their personalized program: (1) make a habit of spending some quality
time each day to get to know yourself, (2) make a habit of reading your emotional barometer,
(3) practice the art of unconditional love, (4) nurture your creativity skills, (5) balance all
components of your well-being and take time to nurture them, and (6) be like a child (Seaward,
2012).
Unit
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Resources: Exercises:
Exercise 24.1 The Yin and Yang of Life
Here is an opportunity to try the balancing act. T’ai Chi is based on the Taoist concept of seeking
balance and going with the flow. The yin/yang symbol represents two opposite aspects coming
together not in opposition but in union, creating the totality of the whole. The yin/yang symbol
represents the balance of life (Seaward, 2011).
Tools: Journal Writing:
Exercise IV. B Relaxation Survival Kit
Create a relaxation survival kit with select comfort items to treat a stress attack. Keep it well
stocked with things that nurture or sustain your personal sense of homeostasis—in this case,
homeostasis that comes from pleasing one or all of the five senses. Just like a first-aid kit, be
sure to replace any items that have been used—such as chocolate (taste)—so you are always
prepared.
(Seaward, 2011).
23
Unit 10: Applying Stress: Critical Management
to your Personal Life
Information to Remember:
Historical Perspective of PMR
Dr. Edmund Jacobson observed the connection between muscle tension and disease in his
in his patients in the early part of the twentieth century. He concluded that if muscle tension
was reduced or eliminated, these somatic diseases may decrease or completely disappear.
He created a simple relaxation technique called progressive muscular relaxation (PMR).
(Seaward, 2012).
Physiological Benefits of PMR
The practice of progressive muscular relaxation reduces muscular tension and raises the
awareness of its existence. This technique has proven effective in managing anger, tension
headaches and dealing with the smoking cessation (Seaward, 2012).
Steps to Initiate Progressive Muscular Relaxation
This relaxation technique can be performed lying down or sitting. It is advised that beginners
lie on a carpeted floor, wearing comfortable clothing. The objective is to contract
a muscle group hold the tension for 5-10 seconds and then completely relax the entire body.
Breathe in on the contraction and exhale on the release. Concentrate on the muscle tension in
your body (Seaward, 2012).
Resources: Exercises:
Progressive Relaxation Audio Companion- CD
This exercise is a guided visualization of progressive muscular relaxation, set to peaceful classical
music (Jones and Bartlett, 2013).
Unit
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Tools: Journal Writing:
Exercise 25.1 Progressive Muscular Relaxation
This is an important exercise because muscle tension is the number one symptom of stress.
Muscle tension can affect the muscles of your jaw (known as temporomandibular joint
dysfunction, or TMJD), the muscles of your shoulders, and perhaps most commonly the
muscles of your lower back. Typically, it is the muscles on the back of the body that are most
affected by neural tension and stress (Seaward, 2011).
25
Additional Information
Anxiety: Everyone experiences some degree of anxiety on a daily basis. It can actually be an
alert to danger or protection from being overly confident. However, a persistent state of
anxiety that interferes with routine daily functions (e.g. work, school, sleep) may indicate a
serious disorder. “Generalized anxiety disorder (GAD) is characterized by consistent
worrying about major or minor concerns” (Mayo Clinic, 2011), secondary source.
Mosby’s Handbook of Herbs and Natural Supplements, by Linda Skidmore-Roth, is a
secondary source of herbs and natural supplements listed in an A-Z format. This book has
been reviewed by nurses and herbalist alike. It is an excellent resource and reference book
(Skidmore-Roth, 2010).
Yoga Therapy: The modern Yoga techniques that focus on meditation and relaxation have
been effectively incorporated in our Western medical practices. The mind, body, and spirit
concept is reversed in Yogic philosophy because the objective is to disconnect from the
physical world (people and things) and connect with the inter self and ultimately the highest
Deity (McCall, 2012) secondary source.
Helpguide.org is a valuable resource for reducing, preventing and managing stress. This
website offer tools and step by step strategies for effective stress management (Helpguide,
2013).
26
References
Essence of Stress Relief (n. d.). Hans Selye’s general adaptation syndrome. Retrieved
from http://www.essenceofstressrelief.com/general-adaptation-syndrome.html
Google Images (2013). Neuro-behavioral.ning.com. Retrieved from http://www.google.com/imghp
Helpguide.org (2013). Stress management: How to identify, prevent and cope with stress. Retrieved
from http://www.helpguide.org/mental/stress_management_relief_coping.htm
How Stuff Works (2008). Immune system. Retrieved from
http://health.howstuffworks.com/immune-system1.htm
Mayo Clinic (2011). Adult health: Self-esteem check: Too low, too high or just right?
Retrieved from http://www.mayoclinic.com/health/self-esteem/MH00128
Mayo Clinic (2011). Generalized anxiety disorder. Retrieved form
http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS0050
Mayo Clinic (2013). Meditation: A simple, fast way to reduce stress. Retrieved from
http://www.mayoclinic.com/health/meditation/HQ01070
McCall, T., M.D. (2012). Yoga therapy and the mind-body connection, part 1. Retrieved from
from http://www.yogajournal.com/for_teachers/2621
Sapolsky, R. M. (2004). Why Zebras don't Get Ulcers (3rd ed.). New York, NY: St. Martin's Press.
Seaward, B.L. (2006). Essentials of managing stress: Definition of stress. Jones and Bartlett
Publishers
Seaward, B.L. (2007). The ageless wisdom of imagery and visualization: Essentials of managing stress:
Jones and Bartlett Publishers
Seaward, B.L. (2007). How the immune system works: Essentials of managing stress. Boston, MA:
Jones and Bartlett Publishers.
27
Seaward, B. L. (2011). Exercise 1.5.Personal stress inventory: top ten stressors: The art of peace
and relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460357
Seaward, B. L. (2011). Exercise 1.6 The wellness paradigm revisited: The art of peace and
relaxation workbook.
Retrieved from http://online.vitalsource.com/#/books/9781284048476/pages/78460362
Seaward, B. L. (2011). Exercise 3.2 Immediate, intermediate and prolonged stress effects: The
art of peace and relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460401
Seaward, B. L. (2011). Exercise 4.1 Physical symptoms questionnaire: The art of peace and
relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460410
Seaward, B. L. (2011). Exercise 5.1 The psychology of your stress: The art of peace and
relaxation workbook.
Retrieved from http://online.vitalsource.com/#/books/9781284048476/pages/78460430
Seaward, B. L. (2011). Exercise 6.1 Anger recognition checklist: The art of peace and relaxation
workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460444
Seaward, B. L. (2011). Exercise 7.1 Under the gun: stress and personality: The art of peace and
relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460461
Seaward, B. L. (2011). Exercise 8.5 Your personal value system: The art of peace and relaxation
workbook. Retrieved from
28
http://online.vitalsource.com/#/books/9781284048476/pages/78460488
Seaward, B. L. (2011). Exercise 9.1 Reframing: seeing a bigger, clearer perspective: The art of
peace and relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460505
Seaward, B. L. (2011). Exercise 9.3 Positive affirmation statements: The art of peace and
relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460506
Seaward, B. L. (2011). Exercise 19.3 Bridging the hemispheres of thought: The art of peace and
relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460598
Seaward, B. L. (2011). Exercise 21.1 I have a vision: the art of visualization: The art of peace and
relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460603
Seaward, B. L. (2011). Exercise 24.1 The yin and yang of life: The art of peace and relaxation
workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460612
Seaward, B. L. (2011). Exercise 25.1 Progressive muscle relaxation: The art of peace and relaxation
workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460615
Seaward, B. L. (2011). Exercise IV The art of calm: relaxation through the five senses: The art of
peace and relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/content/element/16682
29
Seaward, B. L. (2011). Exercise IV B Relaxation survival kit: The art of peace and relaxation
workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460637
Seaward, B. L. (2011). Exercise 28.1Physical exercise: The art of peace and relaxation workbook.
Retrieved from http://online.vitalsource.com/#/books/9781284048476/pages/78460621
Seaward, B. L. (2011). Exercise 28.6 Self-assessment: Nutritional eating habits: The art of peace
and relaxation workbook. Retrieved from
http://online.vitalsource.com/#/books/9781284048476/pages/78460626
Seaward, B. L. (2011). Exercise 28.7 The rainbow diet: The art of peace and relaxation workbook.
Retrieved from http://online.vitalsource.com/#/books/9781284048476/pages/78460627
Seaward, B. L. (2012). Additional coping skills: Managing stress: strategies for health
and well-being. Retrieved from
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health and well-being.
Retrieved from http://online.vitalsource.com/#/books/9781449665159/pages/37005153
Seaward, B. L. (2012). Creating your own stress management program: Managing stress: strategies
for health and well-being.
http://online.vitalsource.com/#/books/9781449665159/pages/37005620
Seaward, B. L. (2012). Diaphragmatic breathing: Managing stress: strategies for health and
well-being. Retrieved from
http://online.vitalsource.com/#/books/9781449665159/pages/37005350
Seaward, B. L. (2012). Diet for a stressed planet: Managing stress: strategies for health and
30
well-being. Retrieved
from http://online.vitalsource.com/#/books/9781449665159/pages/37005567
Seaward, B. L. (2012). Effective coping strategies: Managing stress: strategies for health and
well-being. Retrieved
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Seaward, B. L. (2012). Human spirituality: Managing stress: strategies for health and well-
being. Retrieved
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Seaward, B. L. (2012). Mental imagery and visualization: Managing stress: strategies for health
and well-being.
Retrieved from http://online.vitalsource.com/#/books/9781449665159/pages/37005426
Seaward, B. L. (2012). Music as a relaxation technique: Managing stress: strategies for health
and well-being.
Retrieved from http://online.vitalsource.com/#/books/9781449665159/pages/37005449
Seaward, B. L. (2012). Physical exercise and activity: Managing stress: strategies for health and
well-being. Retrieved from
http://online.vitalsource.com/#/books/9781449665159/pages/37005592
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strategies for health and well-being. Retrieved from
http://online.vitalsource.com/#/books/9781449665159/pages/37005517
Seaward, B. L. (2012). Progressive muscular relaxation: Managing stress: strategies for health and
well-being. Retrieved from
31
http://online.vitalsource.com/#/books/9781449665159/pages/37005516
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for health and well-being. Retrieved from
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Seaward, B. L. (2012). Steps to initiate a progressive muscle relaxation program: Managing stress:
strategies for health and well-being. Retrieved from
http://online.vitalsource.com/#/books/9781449665159/pages/37005518
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being. Retrieved from
http://online.vitalsource.com/#/books/9781449665159/pages/37005027
Seaward, B. L. (2012). The anatomy of fear: Managing stress: strategies for health and well-
being. Retrieved
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and well-being.
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32
well-being. Retrieved from
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Retrieved from http://online.vitalsource.com/#/books/9781449665159/pages/37004881
Seaward, B. L. (2013). Audio files: Managing stress: strategies for health and well-being.
Retrieved from http://health.jbpub.com/managingstress/6e/audio.cfm
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Appendices
Appendix A
EXERCISE 1.5.Personal Stress Inventory:
Top Ten Stressors
It is time to take a personal inventory of your current stressors—those issues, concerns,
situations, or challenges that trigger the fight-or-flight response in your body. The first step to
resolving any problem is learning to identify exactly what the problem is. Take a moment to list
the top ten issues that you are facing at the present moment. Then place check marks in the
columns to signify whether this stressor directly affects one or more aspects of your health
(mind, body, spirit, emotions). Take note of how many of your stressors affect more than one
aspect. Then, next to each stressor, chronicle how long it has been a problem. Finally, check
whether this stressor is one that elicits some level of anger, fear, or both.
Stressor Mental Emotional Spiritual Physical Duration Anger
Fear
1. Overanalyzing everything
2. Fear of failure
3. Expectations of others are
too high
4. Fear of taking test/quiz
5. Expectations of self are too
high
6. Constantly thinking of
agenda (projects)
7. Struggling to adjust to a
daytime schedule
8. Rude drivers
9. Deceitful people
10. Physical fitness exercise
34
Appendix B
EXERCISE 4.1 Physical Symptoms Questionnaire Please look over this list of stress-related symptoms and circle how often they have
occurred in the past week, how severe they seemed to you, and how long they lasted.
Then reflect on the past week’s workload and see whether you notice any connection
between your stress levels and possible stress-related symptoms.
How Often? How Severe? How Long? (Number of days (1 = mild; (1 = 1 hour; in the past week) 5 = severe) 5 = all day)
1. Tension headache 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
2. Migraine headache 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
3. Muscle tension (neck and/or shoulders) 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
4. Muscle tension (lower back) 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
5. Joint pain 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
6. Cold 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
7. Flu 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
8. Stomachache 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
9. Stomach/abdominal bloating/distention/gas 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
10. Diarrhea 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
11. Constipation 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
12. Ulcer flare-up 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
13. Asthma attack 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
14. Allergies 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
15. Canker/cold sores 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
16. Dizzy spells 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
17. Heart palpitations (racing heart) 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
18. Temporomandibular joint dysfunction (TMJD) 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
19. Insomnia 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
20. Nightmares 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
21. Fatigue 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
22. Hemorrhoids 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
23. Pimples/acne 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
24. Cramps 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
25. Frequent accidents 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
26. Other 0 1 2 3 4 5 6 7 1 2 3 4 5 1 2 3 4 5
(Please specify: _______________________)
Score: Look over this entire list. Do you observe any patterns or relationships between
your stress levels and your physical health? A value over 30 points most likely indicates a stress-
related health problem. If it seems to you that these symptoms are related to undue stress, they
35
probably are. Although medical treatment is advocated when necessary, the regular use of
relaxation techniques may lessen the intensity, frequency, and duration of these episodes.
Comments:
36
Appendix C
EXERCISE 6.1 Anger Recognition Checklists He who angers you, conquers you.
Elizabeth Kenny
The following is a quick exercise to help you understand how anger can surface in the course of a
normal working day and how you may mismanage it. Please place a check mark in front of any
of the following that apply to you when you get angry or feel frustrated or upset. After
completing this section, please refer to the bottom right hand corner to estimate, on average,
the number of episodes of anger you experience per day.
When I feel angry, my anger tends to surface in the following ways:
_____ anxiety _____ threatening others
_____ depression _____ buying things
_____ overeating _____ frequent lateness
_____ starting to diet _____ I never feel angry
_____ trouble sleeping _____ clenched jaw muscles, TMJD
_____ excessive sleeping _____ boredom
_____ careless driving _____ nausea, vomiting
_____ chronic fatigue _____ skin problems
_____ abuse of alcohol/drugs _____ easy irritation
_____ exploding in rage _____ sexual difficulty
_____ cold withdrawal _____ sexual apathy
_____ tension headaches _____ busy work (clean, straighten)
_____ migraine headaches _____ sulking, whining
_____ use of sarcasm _____ hitting, throwing things
_____ hostile joking _____ complaining, whining
_____ being accident prone _____ cutting/mutilating myself
_____ guilt and self-blame _____ insomnia
_____ smoking or drinking _____ promiscuity
_____ high blood pressure _____ helping others
_____ frequent nightmares _____ other? Speak in a low tone
_____ tendency to harp or nag _____ other? Become quiet
_____ intellectualization _____ swearing or name calling
_____ crying _____ upset stomach (e.g., gas, cramps,
IBS)
_____ muscle tension (neck, lower back)
* My average number of anger episodes per day is ___.
37
Appendix D
EXERCISE 8.5 Your Personal Value System
We all have a personal value system—a core pillar of the human spirit that is constantly
undergoing renovation. What does your value system currently look like? Perhaps this diagram
can give you some insights and, in turn, help resolve some issues that might be causing stress.
The circle in the center represents your core values: abstract or intangible constructs of
importance that can be symbolized by a host of material possessions. It is believed that we hold
about four to six core values that constitute our personal belief system, which, like a compass,
guide the spirit on our human journey. Give this concept some thought and then write in this
circle what you consider to be your current core values (e.g., love, happiness, health).
The many circles that surround the main circle represent your supporting values: those values
that lend support to your core values (these typically number from five to twelve). Take a
moment to reflect on what these might be and then assign one value per small circle. Inside
each small circle, include what typically symbolizes that value for you (e.g., wealth can be
symbolized by money, a car, or a house). Finally, consider whether any stress you feel in your
life is the result of a conflict between
your supporting and core values.
Spirituality
Health
Love
Wealth
38
Appendix E
EXERCISE 15.1 The Time-Crunch Questionnaire
The following is a survey based on the traits of the codependent personality. Please answer the
following questions with the most appropriate number.
1 = rarely 2 = sometimes 3 = often
1. I tend to procrastinate with projects and responsibilities. 1 2 3
2. My bedtime varies depending on the workload I have each day. 1 2 3
3. I am the kind of person who leaves things till the last minute. 1 2 3
4. I forget to make To Do lists to keep me organized. 1 2 3
5. I spend more than two hours watching television each night. 1 2 3
6. I tend to have several projects going on at the same time. 1 2 3
7. I tend to put work ahead of family and friends. 1 2 3
8. My life is full of endless interruptions and distractions. 1 2 3
9. I tend to spend a lot of time on the phone. 1 2 3
10. Multi-tasking is my middle name. I am a great multi-tasker. 1 2 3
11. My biggest problem with time management is prioritization. 1 2 3
12. I am a perfectionist when it comes to getting things done. 1 2 3
13. I never seem to have enough time for my personal life. 1 2 3
14. I tend to set unrealistic goals to accomplish tasks. 1 2 3
15. I reward myself before getting things done on time. 1 2 3
16. I just never have enough hours in the day to get things done. 1 2 3
17. I can spend untold hours distracted while surfing the Internet. 1 2 3
18. I tend not to trust others to get things done when I can do them
better myself. 1 2 3
19. If I am completely honest, I tend to be a workaholic. 1 2 3
20. I have been known to skip meals in order to complete projects. 1 2 3
21. I will clean my room, garage, or kitchen before I really get to
work on projects. 1 2 3
22. I will often help friends with their work before doing my own. 1 2 3
23. It’s hard to get motivated to get things done. 1 2 3
Total Score
Questionnaire Key
0–25 points = excellent time management skills (keep doing what you are doing!)
39
50–26 points = fair time management skills (time to pull in the reins a bit)
75–51 points = poor time management skills (time to reevaluate your life skills)
40
Appendix F
Guided Imagery:
Find a comfortable and quite place to sit or you may lie down.
Make sure your clothing is loose, remove your shoes and any restrictions Take a few slow and deep breaths
When you feel relaxed, close your eyes, and see yourself lying on a beautiful beach.
Picture a clear blue sky above, soft white sand between your toes, hear the sound of the waves, and smell the salt water.
Notice the taste of a refreshing tropical drink as you bring it to your
mouth. Stay in this scene for as long as you like.
Notice how relaxed and calm you feel. Enjoy the feeling of relaxation as it spreads throughout your entire body.
Notice how far away you feel from anxiety and stress. When you are ready, slowly count backward from 10.
Open your eyes, feeling relaxed but alert.
41
Appendix G
EXERCISE 28.2
Self-Assessment: Nutritional Eating Habits
1. Do you regularly consume caffeine? Yes No
2. List the foods that you ingest that contain caffeine
(e.g., coffee, tea, sodas, chocolate) and the estimated
amounts you consume per day.
Type of Food with
Caffeine
a.
b.
c.
d.
e.
f.
Amount
per Day
3. Do you take vitamin supplements? If yes, what kinds?
Multiple Vitamins; Vitamin D; Potassium Yes No
4. Do you frequently use table salt? Yes No
5. Do you eat one or more meals that are prepared
outside the home daily? Yes No
6. Do you consume junk food (from vending machines or
convenience stores) regularly? Yes No
7. Do you eat cereals that contain sugar? Yes No
8. Do you drink a lot of soft drinks? Yes No
9. Do you find that when you are stressed you tend to eat
more? Yes No
10. Do you find that when you are angry you tend to eat
more? Yes No
11. Do you eat a wide variety of fruits and vegetables? Yes No
12. Do you eat foods (e.g., fish and nuts) with the
essentials oils (omega-3 and omega-6)? Yes No
13. Do you tend to eat quickly (e.g., to wolf down your
food)? Yes No
14. Do you tend to drink alcohol as a means to relax? Yes No
15. List your top five comfort foods: 1.
2.
3.
4.
5.
16. Describe any other eating habits that you associate
with a stressed lifestyle:
42
Appendix H
EXERCISE 28.3 The Rainbow Diet
Food color is more important than just having a nice presentation on your dinner plate. Each
color holds a specific vibration in the spectrum of light. When this is combined with the nutrient
value of food, it can help to enhance the health of the physical body.
In the science of subtle energies, each of the body’s primary chakras is associated with a specific
color (see accompanying chart). It is thought that eating fruits and vegetables associated with
the color of various chakras provides healthy energy to that specific region. For example, women
with urinary tract infections (root chakra) are encouraged to drink cranberry juice (red). Diabetic
people with macular problems are encouraged to eat blueberries and take the herb bilberry
(blue). Moreover, recent research suggests that the active ingredients in fruits and vegetables
that give them their color, called bioflavonoids, help prevent cancer. Regardless of Eastern
philosophies or Western science, the bottom line is to eat a good variety of fruits and vegetables.
The following table identifies the seven chakras, their respective body regions, and the color
associated with each chakra or region. List five fruits, veggies, or herbs for each color.
Chakra Body Region Color Food Choices
7: Crown Pineal Violet/White Ginger, Bermuda onions,
Garlic, Plums, and Turnips
6: Brow Pituitary Indigo
Blueberries, Blackberries,
Raisins, Elderberries, and
Figs
5: Throat Thymus Aqua blue
Purple Cabbage, Purple
Potatoes, Blue Grapes, Blue
Plums, and Eggplant
4: Heart Heart Green
Brussels Sprouts, Spinach,
Broccoli, Kiwi, and
Asparagus
3: Solar plexus Adrenals Yellow
Pineapple, Lemon,
grapefruit, Yellow Squash,
and Sweet Corn
2: Navel Spleen Orange
Carrots, Sweet Potatoes,
Mangoes, Oranges, and
Pumpkin
1: Root Gonads Red
Raspberries, Pomegranates,
Tomatoes, Beets, and
Cherries
43
Appendix I
EXERCISE 28.1 Physical Exercise Sketch out a quick weekly program of exercise, including days to work out,
time of day, and activity. Allow intermittent days for recovery.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
top related