Developing Cognitive Coping Skills - Week 4 Lecture Material PDF

EL Developing cognitive coping skills PT N  What is coping? Coping refers to the thoughts and actions we use to deal EL with a threatening situation. A stressful situation may be considered a threat for you but not necessarily for your neighbor. You and...

EL Developing cognitive coping skills PT N  What is coping? Coping refers to the thoughts and actions we use to deal EL with a threatening situation. A stressful situation may be considered a threat for you but not necessarily for your neighbor. You and your neighbor may become stressed by the same situation, but for PT different reasons (e.g. the situation is new for you, but unpredictable for your neighbor). After all, since we all become stressed for various reasons we will need to choose different coping strategies. N As you will see, there are many strategies and some are better than others.  What Are Coping Skills (Strategies)? We all develop defense mechanisms to avoid or lessen EL psychological pain. Coping skills are ways in which we learn to deal with various stressors. Each person copes with stress differently. Over time, we all construct PT coping strategies that are “right” for us as thinking and feeling individuals. “Right” is in quotes because many people often do not realize that how they deal with life stressors is not only unhelpful, but also destructive, N negative, and painful for not only themselves but those around them  Coping strategies can be both constructive/adaptive or destructive/ maladaptive. Maladaptive coping skills are ways of dealing with EL stress that usually make things worse. These types of coping strategies can hurt your social relationships, make preexisting problems worse, and even result in new symptoms of a stress- related injury. Many of us have known someone who has overreacted to something which resulted in them losing touch with PT a friend or loved one. Maladaptive coping strategies put pressure on your relationships with friends, family, comrades, and coworkers. They can damage your body or create more emotional pain in the long term, even when they seem helpful in the short term. In extreme cases, maladaptive coping skills can ruin lives. N Through the information in this booklet, and psychological activism, we can lessen the impact of negativity in our lives, including that which we inflict on ourselves through learned maladaptive coping skills.  Building resilience to stress Prevention: EL – Decreasing source of stress in occupational / family environment – Increasing the coping skills PT Targeted Intervention: Helping the individual change the source of N stress Teaching ways to adapt to situation without it leading to stress and discomfort  Coping Styles There are many coping styles that people use, and some may prove more effective EL than others, depending on the nature of the stressful situation and the person who is employing them. Ineffective coping mechanisms, also referred to as maladaptive coping, may also be applied to stressful events or internal conflict, often unconsciously. Maladaptive coping mechanisms are counterproductive. Among researchers, coping styles are commonly assigned broad categoriesthat draw distinctions between methods. For example, instrumental coping (referred to PT as problem-solving) focuses on ways to tackle the issue in order to reduce stress around a given situation, while emotion-focused coping gathers tools to nurture one's emotional health during the stressful period. Additionally, coping is identified as being either active or avoidant. Active coping strategies involve an awareness of the stressor, followed by attempts to reduce the negative outcome. By contrast, avoidant coping is characterized by ignoring the issue, often resulting N in activities that aid in the denial of the problem (e.g., drinking, sleeping, isolating).  Specific Coping Strategies Now that we've examined common styles of coping, let us take a EL look at specific coping strategies: Humor. Pointing out the amusing aspects of the problem at hand, or "positive reframing," is thought to help deal with small failures. Seeking support. Asking for help, or finding emotional support from PT family members or friends, can be an effective way of maintaining emotional health during a stressful period. Problem-solving. As described above, problem solving is an instrumental coping mechanism that aims to locate the source of the problem and determine solutions. This coping mechanism is N often helpful in work situations. Relaxation. Engaging in relaxing activities, or practicing calming techniques, can help to manage stress and improve overall coping.  Physical recreation. Regular exercise, such as running, or team sports, is a good way to handle the stress of given situation. This may involve yoga, EL meditating, progressive muscle relaxation, among other techniques of relaxation. Adjusting expectations. Anticipating various outcomes to scenarios in life may assist in preparing for the stress associated with any given change or event. PT Denial. Avoidance of the issue altogether may lead to denying that a problem even exists. Denial is usually maintained by distractions, such as excessive alcohol consumption, overworking, or sleeping more than usual. Self-blame. Internalizing the issue, and blaming oneself (beyond just taking responsibility for one's actions), leads to low-self esteem and sometimes depression. N Venting. An externalizing coping technique, venting is the outward expression of emotions, usually in the company of friends or family. In moderation it can be healthy; however, ruminating on the negative can lead to strained relationships over time. N PT EL  Two different coping strategies Problem-focused strategy This strategy relies on using active ways to directly tackle the EL situation that caused the stress: you must concentrate on the problem. Here are some examples: Analyze the situation e.g. Pay attention, avoid taking on more responsibility than you can manage. Work harder PT e.g. Stay up all night to study for an exam Apply what you have already learned to your daily life. e.g. You lose your job for the second time - you now know the steps N to apply for a new job Talk to a person that has a direct impact on the situation e.g. Talk directly to your boss to ask for an extension to the project that is due in one week.  Emotion-focused strategy Emotion-focused coping strategies are used to handle feelings of distress, rather than the actual problem situation. You focus on your emotions: EL Brood e.g. you accept new tasks instead of saying “no”, but you keep complaining and saying it is unfair. Imagine/Magic thinking e.g. You dream about a better financial situation. Avoid/Deny PT e.g. You avoid everything that is related to this situation or you take drugs and/or alcohol to escape from this situation. Blame e.g. You blame yourself or others for the situation. N Social support e.g. You talk to your best friend about your concerns.  Studies have recorded considerable consistency in coping strategies employed to confront EL stressful situations, independently of situational factors and in connection with permanent personality and temperamental traits, such as neuroticism, extraversion, sense of humour, persistence, fatalism, conscientiousness, and openness to experience. Positive affect has been associated with positive reappraisal (reframing) of stressful situations, goal-directed problem-focused coping, using spiritual or religious beliefs to seek comfort, and infusion of PT meaning into the ordinary events of daily life in order to gain a psychological time-out from distress Life skills Education - critical thinking, analyzing and problem-solving, building of self- N confidence, confronting various negative pressures imposed by the environment, improving self-assessment, developing communication and social adjustment skills, and gaining control over stressors and one's own affective and behavioral response.  Coping with a Stressor Th e most widely accepted notion of coping and stress appraisal was formulated many years ago by Richard Lazarus. 1 Lazarus perceived stress to be the result of EL a determination that a demand exceeds resources available to meet that demand. Consequently, the demand is evaluated as a threat. In that case, some form of coping is needed. Coping is engaging in a behavior or thought to respond to a demand. For example, you might have a diffi cult fi nal exam and perceive that as stressful because it is not one of your better subjects. In response to this demand, taskoriented PT you try to fi nd a successful way to cope. Th at may mean fi nding a better way to learn the material and earn a good grade on the exam. Lazarus called that coping. Or it might mean managing your feelings and/or accepting that this is a subject in which you are not particularly talented. Lazarus called that N emotion-focused coping.  In a long-term perspective, are these strategies harmful? Imagine that you are having a bad day at work and that you EL do not feel like seeing your boss. You can avoid him for many hours or even a day, but if you avoid him everyday this strategy will become unsuccessful and may even cause extra stress. This is why it is important to develop different PT strategies in order to adapt to different situations. Efficient coping strategies Coping strategies are different depending on the situation and the person; here are some good coping strategies. N  To engage in either coping mechanism requires an appraisal of the demand. EL Lazarus described three primary categories of appraisal: primary appraisal, secondary appraisal, and reappraisal. Primary appraisal involves judging how much of a threat is involved, and how important is the PT outcome. Once that primary appraisal occurs, you must determine whether you have the resources needed to meet the demand. Lazarus called that secondary appraisal. Once attempts are made to respond to the N threat or to meet the demand, a reappraisal occurs to determine whether any further coping is needed. N PT EL  Lazarus’s model then considers stress occurring when we perceive a threat. That determination is made by primary EL appraisal. Then a determination is made— secondary appraisal —regarding whether we have the resources available to effectively respond to that threat. Once we do respond, we evaluate whether the response was effective, PT and if not, choose a different response ( reappraisal ). One important form of appraisal is determining how confident you are in managing the demand/threat. If you are confident, you will engage in behavior or thought to manage the demand/threat since you believe what you do N will be effective. If you are not confident, why even attempt to do anything? You don’t think it will work.  In his classic article, Bandura called this s elf-efficacy. There are EL two forms of self-efficacy: outcome efficacy and personal efficacy. You might believe that people can engage in a number of strategies to give up cigarette smoking. That is outcome efficacy. However, you PT might also believe that although many people can do this, you will never be successful at giving up cigarette smoking. That is personal efficacy. To believe it is worth the effort to attempt to manage a demand/ N threat, you must believe not only that there is a strategy that can be effective but that you can successfully employ that strategy.  Researchers have found that humor has significant healthful effects. For example, when 52 healthy men viewed a humorous video for EL one hour, they produced increased levels of natural killer cells, immunoglobulin, T-cells, and other changes that lasted 12 hours. a In a similar study,b 27 healthy volunteers watched a cheerful, comical video for 30 minutes. It was found that their levels of free radical-scavenging capacity signifi cantly increased, indicating better PT health. Recognizing these healthful effects, those in stressful jobs are particularly advised to use humor as a eustressor. For example, this advice has been recommended to nurses c and, in particular, to nurses who work in the operating room. When nurses used humor, their bodies reacted in ways that indicated they were healthier. N So, make a point of smiling, finding the humor in situations, and clowning it up. You will be happier and healthier if you embrace eustress. Greenberg, 2012  Be positive! Look at each obstacle you encounter as a learning experience EL e.g. you may not have done well on your mid-term exam, but that has motivated you to study harder and ace your final exam. Make the choice not to over-react to stressors and deal with them one at a time e.g. take a few deep breaths and carry on. PT Take an objective view of your stressor e.g. is preparing dinner for 12 people really that horrible? Communicate! Don’t ruminate or bottle up your emotions, as this will lead to an explosion later on. N Accept yourself (and others). No one is perfect and there is always room for mistakes.  Make connections with people Social support is key! EL Deal effectively with mistakes i.e. Learn from your mistakes and apply them to future decision making. Deal effectively with successes also! This will build on your competence. Develop self-discipline and control PT e.g. train yourself to study harder in preparation for your final exam, or train yourself to work out four times a week to lose those pounds you gained since last Thanksgiving dinner! Maintenance! Practice, practice, practice for a long life of resilient living! N Now that you know how to recognize your stress and you know the different coping strategies, you just need to find the coping strategies that work best for you and apply them to your daily life.  EL STRESS MANAGEMENT PT N RAJLAKSHMI GUHA IIT KHARAGPUR  EL STRATEGIES FOR RELIEVING STRESS PT N  OUTLINE OTHER RELAXATION TECHNIQUES EL PT N  DIFFERENT RELAXATION TECHNIQUES Biofeedback mechanism EL Diaphragmatic breathing Yoga and stretching Tai Chi PT Mindfulness N  BIOFEEDBACK The use of electronic instruments to monitor and physiological changes mostly regulated by EL the Autonomic Nervous System PT Biofeedback – awareness of how to change physiological activity for improving health and performance N - instruments measure physiological activity EL such as brainwaves, heart function, breathing, muscle activity, and skin temperature - These instruments rapidly and accurately PT 'feed back' information to the user N  DIFFERENT INSTRUMENTS USED IN BIOFEEDBACK Electromyograph (EMG) EL Feedback Thermometer (Thermistar) Galvanic Skin Response Recorder (GSR) PT Electroencephalograph (EEG) Electrocardiograph (ECG) N  EL DIAPHRAGMATIC BREATHING PT N  EL YOGA AND STRETCHING PT N  Different types of yogas include: EL Prana yoga Brahma yoga Raja yoga PT Kriya yoga Hatha yoga (involves stretching) N Research in Yoga… Asthma – breathe more comfortable, Quality of life improved EL (Manocha et al, 2002) Helps in reducing stress and Anxiety (Smith et al, 2007) PT Yoga involves deep slow breathing and activation parasympathetic nervous system Pranayama – regulating breathing N Decrease in respiration rate, oxygen consumption, CO2 elimination  EL MINDFULNESS PT N  MINDFULNESS Mindfulness  focusing attention at the EL present moment Paying attention to each moment  living in the “here-and-now” PT Mindlessness  going through life ignoring N the present moment Focusing on the goal instead of experience  Major tenets of Mindfulness To recognize the emotion present EL Acknowledge the emotion Accept the feelings and sensations that the body is undergoing PT Recognizing that this is a passing mental state N Mindfulness Based Stress Reduction (Zinn and Santorelli, 1979)  Tai chi Self paced gentle physical exercise and EL stretching Originally formed for self defense – Chinese tradition PT Involves a series of movements performed in a slow, focused manner N It is accompanied by deep breathing  Other Techniques Music and relaxation EL Owning a pet Pursuing a hobby PT N  EL Thank you PT N  EL STRESS MANAGEMENT PT N RAJLAKSHMI GUHA IIT KHARAGPUR  EL STRATEGIES FOR RELIEVING STRESS PT N  EL MODULE 2 PT N  OUTLINE EL AUTOGENIC RELAXATION TRAINING USE OF IMAGERY IN RELAXATION PT PROGRESSIVE MUSCULAR RELAXATION N  Autogenic Training EL Imagery Progressive Muscle Relaxation PT N  AUTOGENIC TRAINING Relaxation Technique  stress-induced EL psychosomatic disorders AUTOGENIC TRAINING - 1932 - Johannes Heinrich PT Schultz (German Psychiatrist) and Wolfgang Luthe (General Practitioner and Chest Physician) N  Benefits of Autogenetic Training Autogenic means “self-generating” EL - you do the procedure to yourself - self-healing nature of autogenics PT Special indication for AT - Internal locus of control - autogenics more N effective than external locus of control (Lehrer,1996)  EL Meditation and Autogenic Training PT How do they relax us? N  PHYSIOLOGICAL BENEFITS OF AT Decrease - Heart rate, respiratory rate, muscle tension, and serum-cholesterol level EL Increase - Alpha brain waves and blood flow to the arms and legs PT Help to alleviate various disease - Improve the immune function in people with cancer - Improve the quality of life of people with multiple sclerosis N - Decreased headaches - AT used to help people with drug abuse  PHYSIOLOGICAL BENEFITS OF AT Other findings EL – alleviate menstrual discomfort – Breathing in dyspnea – sleep in insomnia PT – relieve pain N  PSYCHOLOGICAL BENEFITS OF AT Helps Reduce EL – Anxiety, – Depression – tiredness, and PT Increase resistance to stress Improved performance of athletes N  PREREQUISITES OF AUTOGENIC TRAINING High involvement and motivation EL Self-direction and self-control Ability to maintain a particular body posture PT Minimizing influence of external stimuli Focusing on the process Attending to bodily sensations N  HOW TO DO AUTOGENIC TRAINING Body Position EL - There are three basic positions Reclining position Seated position – 2 types PT N  SIX STAGES OF AUTOGENIC TRAINING 1. Focus on sensations of heaviness throughout the arms and legs EL 2. Focus on sensations of warmth throughout the arms and legs PT 3. Focus on sensations of warmth and heaviness in the area of the heart 4. Focus on slow, calm breathing N 5. Focus on sensations of warmth in the abdomen 6. Focus on sensations of coolness in the forehead Greenberg, 2012  EL IMAGERY PT N  IMAGERY To imagine a scene, place or event that you EL remember as safe, peaceful, restful, beautiful and happy Bring all your senses into the image with PT -Sounds of running water and birds - Smell of cut grass N - Taste of favourite ice cream - Warmth of the sun  Physiological benefits Decrease headaches EL - When children and adolescents with chronic headaches were taught imagery, 88 percent reported a decrease in the frequency of their PT headaches and 26 percent said they were headache-free. N  Psychological benefits Improve sleep EL Decrease posttraumatic stress disorder (PTSD) severity Help to alleviate moderate depression PT Decrease to urge behavioral addiction like gambling N Decrease performance anxiety  EL Progressive Muscle Relaxation PT N  Progressive Muscle Relaxation To induce nerve-muscle relaxation Developed by Edmund Jacobson EL Based on the premise that the body responds to anxiety-provoking thoughts and events with muscle tension This physiological tension, PT in turn, increases the subjective experience of anxiety. Synonyms N - neuromuscular relaxation (because the nerves control muscular contraction) or Jacobsonian relaxation (named after its developer)  Physiological Benefits of PMR learned relaxation of skeletal muscles can be generalized to smooth muscles, causing EL relaxation of the gastrointestinal and cardiovascular systems Effective in treating PT - headaches - backaches N - side effects of cancer - insomnia, pain, and high blood pressure  Psychological Benefits of PMR Treating depression, anxiety, PTSD and EL Insomnia Other research findings of PR - Reduced psychological distress in heart failure PT - improved academic performance among N college students -  EL HOW TO DO PMR PT N  EL STRESS MANAGEMENT PT N RAJLAKSHMI GUHA IIT KHARAGPUR  EL STRATEGIES FOR RELIEVING STRESS PT N  OUTLINE HEALTH AND EXERCISE EL ROLE OF EXERCISE IN STRESS RELEASE – AEROBIC AND ANAEROBIC EXERCISE AN EXERCISE PROGRAM FOR STRESS MANAGEMENT PT N  THE OLD SAYINGS…. Exercise acts as a stress buster – a way of EL ventilating the stress response Exercise improves overall health and well being PT Any form of exercise acts as a stress reliever - yoga, breathing techniques (Pranayam), N physical exercise, playing outdoor games, dance, martial arts, brisk walks  THE CONTRADICTION…. EL Exercise – a form of physical stress PT Then how can one form of physical stress be used to reduce stress? N What really happens? Exercise uses the stress products—increased heart EL and respiratory rates, blood fats, muscle tension—so they are not able to affect health negatively PT Exercise redirects your attention from stressors to the exercise N Exercise involves focused purposeful behavioral decisions Greenberg, 2012  Brief history of therapeutic exercise 5th century BC – Herodicus (Greek Physician) prescribed gymnastics for various diseases EL 16th Century Europe – Joseph Duchesne used swimming as a therapeutic tool for strengthening heart and lungs 1829 – Journal of Health – publications advocating regular exercise, PT walking considered the best exercise for remaining healthy Since 1980s – research interests in exercise and mental health increased – Supplementary Food products industry boomed N – Aerobics became a part of other sports activities In India – Asanas have been used to prepare body for meditation Hatha yoga  Brief history of therapeutic exercise Hans Selye contended that regular exercise EL would better prepare someone to resist other stressors, and that stressful situations would not be as perilous to a physically fit individual PT compared to someone who has led a sedentary lifestyle N (Miller and Allen,1995)  Exercise and brain Exercise has robust effects in reducing the damaging EL effects of chronic stress Exercise reduces harmful effects of acute exposure to stress at different levels of function – PT – Behavioural – Emotional – Immunological N – Neuronal  Mechanisms in action Effectiveness of exercise for stress reduction is EL based on 3 mechanisms: - Mechanisms active during exercise - Mechanisms active immediately after exercise PT - Long term mechanisms N BODY MECHANISMS DURING STRESS AND EXERCISE Cortisol Breaks down EL adipose tissue for energy Free Fatty Acid Regular exercise PT FFA utilised for (FFA) released into the bloodstream FFA converted to Triglycerides and LDL Sedentary lifestyle No exercise energy by muscles N (bad cholesterol) Leading to Heart FFA levels decline Disease  EFFECT ON CARDIOVASCULAR AND CARDIORESPIRATORY SYSTEMS During stress: Increase in cardiac output, BP, resistance to peripheral blood flow, EL breathing rate During Exercise: PT Increase in cardiac activity, but rhythmic use of striated muscles help blood to return to the heart (venous return) Helps redistribute blood from less active body parts like digestive organs and kidneys, to active muscles N Improves efficiency of breathing muscles allowing greater lung capacity An active individual uses lesser number of breaths to move the same amount of air, which improves diffusion of O2 into the lungs SHORT TERM THERAPEUTIC EFFECTS OF EXERCISE Initiation of a state of relaxation following the physical activity EL Afferent proprioceptive stimulation as Feedback from striated muscles go to Limbic system, hypothalamus and cerebral cortex PT Reduction in striated muscle tension reduces energy N consumption of the body  decreases anxiety level and increases feelings of tranquility Exercise helps release endorphins – induces euphoria  LONG TERM EFFECTS OF EXERCISE EL Long-term mechanisms of health promotion in exercise appear when exercise is aerobic and practiced for a minimum of at least 1 month PT Improves Physical Health and Psychological N health  EFFECT OF EXERCISE ON PSYCHOLOGICAL FUNCTIONING Feeling fit  feeling good  high self esteem EL Others’ approval and appreciation – increases self esteem More agile, alert PT More healthy More involved in work – less brooding/grumbling Feeling of being in control N Increased self discipline  EFFECT OF EXERCISE ON PHYSIOLOGICAL FUNCTIONING Improves cardiorespiratory efficiency EL Improves glucose utilization Reduces body fat Reduces muscle tension PT Decreases ANS reactivity Reduces anxiety Improves self-concept N Improves sense of self-efficacy, physical self- concept, and self control  EL Exercise increases individuals ability to tolerate high levels of stress and PT Decreases likelihood of developing stress related pathology N Everly and Lating, 2002  EXERCISE GUIDELINES Important to decide how much exercise is EL enough to promote health and better cope with stress exercise prescription  FITT (Foss & Keteyian, 1998) PT Frequency Intensity N Time (duration) Type  EXERCISE GUIDELINES Pate et al, 1995 - Journal of the American Medical Association suggested the following physical exercise EL criteria for enhanced cardiopulmonary fitness: Duration: 20–60 minutes of moderate- to high-intensity endurance exercise PT Intensity: 60–90% of maximum heart rate Frequency: three or more times per week N EXERCISE TRAINING HEART RATES BY AGE FOR NORMALS (BEATS PER MINUTE) AGE MAXIMUM PERCENT 70% 60% 50% EL 21-30 195 159 147 135 31-40 185 152 141 130 41-50 51-60 61-70 PT175 165 155 145 138 1311 135 129 123 125 120 115 N Foss and Keteyian, 1998  EL AEROBIC VS ANAEROBIC EXERCISES PT N  ANAEROBIC EXERCISE Anaerobic exercise: EL short in duration and high in intensity better at building strength and muscle mass keep muscles fit and strong – helps in old age promote strength, speed, and power PT Anaerobic activities include strength training, weightlifting, tennis, hill climbing N  AEROBIC EXERCISE Aerobic exercise exercise with air or oxygen EL it is rhythmically in nature low intensity exercise for long duration lasting for at least 15–20 min or longer PT maintaining 60–80% of heart rate reserve The American College of Sports Medicine defines aerobic exercise as “any activity that uses large muscle groups, can be maintained N continuously, and is rhythmic in nature” Aerobic activities - walking, cycling, jogging, swimming, aerobic classes, and long hikes  EFFECTS OF AEROBIC EXERCISE Control of body fat EL Increased resistance to fatigue and extra energy Toned muscles and increased lean body mass Decreased tension and aid in sleeping PT Increased general stamina improves mood and reduces depression and anxiety N  FOR STRESS MANAGEMENT Exercise should be aerobic EL Movements should be rhythmic rather than uncoordinated movements that may cause muscle strain PT Exercise should be for self improvement, long term improvement in bodily coordination, motor skills, ventilation N Without competition – comparison with others  SUMMARY HEALTH AND EXERCISE EL ROLE OF EXERCISE IN STRESS RELEASE – AEROBIC AND ANAEROBIC EXERCISE AN EXERCISE PROGRAM FOR STRESS MANAGEMENT PT N  EL Thank you PT N  EL STRESS MANAGEMENT PT N RAJLAKSHMI GUHA IIT KHARAGPUR  EL STRATEGIES FOR RELIEVING STRESS PT N  OUTLINE DO IT YOURSELF STRATEGIES FOR STRESS EL MANAGEMENT PT N  SELF HELP EL A positive attitude to help yourself to bring about a change Tell yourself: PT “I am not helpless – the situation is making me feel so. I just need to bring about a few changes to make the situation better” N Identify stressors – chart it down Identify vulnerable zones of your body – aches and pains in EL different organs, disturbances in appetite, digestion, sleep Identify disturbing Negative Automatic Thoughts triggered during stress PT Chart down strategies that you have used so far to deal with them – adaptive or maladaptive? N Explore Strategies to avoid / minimize / modify / modulate stressors Employ strategies to reduce excessive arousal and dysfunction EL Reminding yourself the relationship between thought mood and behaviour PT Thoughts: Awareness of Negative Automatic Thoughts, employing strategies to stop them Behaviour – exploring opportunities / facing situations rather N than avoidance, engaging in face to face social interactions, employing problem solving strategies Strategies to ventilate, or express, the stress response EL Practicing relaxation techniques Regular exercise Practicing assertiveness PT Time management techniques N  A FEW WORDS ABOUT TIME MANAGEMENT Time awareness and time scheduling Prepare Activity chart - How do you spend your day EL Get a planner – using to jot every work to be done, keep it with you, efficient managers always use a planner watch handy PT evaluate yourself – whether you UNDERESTIMATE or OVERESTIMATE time N Task – plan 2 activities today – write down expected time, after task write down time taken , whether you completed it or left it incomplete, did you avoid the task? Why? Is it anxiety provoking? Is there a fear you won’t be able to complete it?  TIME MANAGEMENT To do list: EL Break a problem / topic into small parts put it priority wise fix a time of day to write down next day’s agenda - preferably before going to bed PT Stick to your commitments Evaluate - at the end of the day evaluate how much was done – what went right/ what went wrong N Reward yourself  EL Thank you PT N