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how stress interrupts the capacity for self care

First, identify the sources of stress on two levels. One level is "outside-in" (functional stress management), referring to social supports, living situation and work environment.

"Inside-out" (personal stress management) refers to an individual's specific ability to cope with unexpected emotions or situations. For example, it can be helpful to include questions identifying specific individual triggers that impede a patient's ability to carry out exercises.

chronic disabilities can continuously cycle through chronic pain or acute relapses, but even when a person is not in acute distress, he or she still faces the stress of managing the daily challenges of any medical condition.

brain-storming with patients about the level of energy, both practical and emotional, required to implement the strategy by categorizing the activity as requiring low, moderate or high levels of energy.

I instructed her to categorize these strategies by level of exertion, providing her with a range of options to use on low-energy days versus high-energy days.

Breaking up the day into units can help alleviate anxiety and stress.

Maribel, 42, shares how she implements this concept: "Having MS and three children has been overwhelming. My kids are only starting to understand what is happening to me. When the kids would arrive home from school, I would just be overwhelmed. Now I break the evening up into units. The kids arrive at 2:30. I am

Finally, it is critical that practitioners commit to developing their own stress management capacities. It is important for OTs to experiment with as many strategies as possible, so they have first-hand knowledge of the gains, limits and time demands of each technique. Stress management is an interdependent learning process; patients can be put at ease when we can be good role models of successful stress management.