Katrina Fisher Senior Occupational Therapist Cardiac Rehabilitation Team Luton & Dunstable Hospital NHS Foundatio

1. BACR Conference 8th - 9th October 2009Benefits of a “One Day Stress Management Workshop” A Menu Based Option for Cardiac Rehabilitation Patients Katrina Fisher Senior Occupational Therapist Cardiac Rehabilitation Team Luton & Dunstable Hospital NHS Foundation Trust Bedfordshire

2. Toolkit

3. Patient’s Perspective

4. One Day Stress Management Workshop for Cardiac Rehabilitation Patients

5. Morning Workshop • Welcome and introduction to the day • A-Z of coping strategies – on arrival • Ice breaker – list patient’s expectations of the day • Definitions of stress and anxiety • Causes of stress in relation to Human Performance Curve • The Autonomic fight / flight response • Comfort break……… • Signs and symptoms of stress • Complete another HADS • Show “Don’t lose Heart video” • Feedback HADS scores • Break for lunch………

6. A-Z Coping Stategies AROMATHERAPY JOKES SWIMMING BOWLING KITE FLYING TALKING CROSSWORDS LAUGHTER UNDERSTANDING DISTRACTION MUSIC VISITING EXERCISE NOTHING WALKING FISHING ORGANISING XYLOPHONE GOLF POSITIVE YOGA HUMOURQUIZZES ZOO IRONING RELAXATION

7. Morning Workshop • Welcome and introduction to the day • A-Z of coping strategies – on arrival • Ice breaker – list patient’s expectations of the day • Definitions of stress and anxiety • Causes of stress in relation to Human Performance Curve • The Autonomic fight / flight response • Comfort break……… • Signs and symptoms of stress • Complete another HADS • Show “Don’t lose Heart video” • Feedback HADS scores • Break for lunch………

8. Afternoon workshop • Welcome back and introduction to coping strategies • A-Z coping strategies • Cycle of change (Ref Prochaska and Diclemente 1982) • Teach 4-5 coping strategies • Inform patients of other support available: 1:1 session, referral to clinical psychologist, counselling arranged via GP • Make sure expectations have been met • Evaluation forms completed • Close session.........

9. Choice of coping strategies • Changing unhelpful thoughts into helpful thoughts • Anger management techniques • Energy conservation and pacing techniques using MET values • Goal setting using SMART principle • Assertiveness training • Problem solving techniques • Sleep hygiene techniques • Time management principles • Stability zones

10. Diaphragm Breathing and Relaxation Techniques • Diaphragm breathing techniques • Relaxation techniques: • Progressive • Autogenic • Visualisation

11. Afternoon workshop • Welcome back and introduction to coping strategies • A-Z coping strategies • Cycle of change (Ref Prochaska and Diclemente 1982) • Teach 4-5 coping strategies • Inform patients of other support available: 1:1 session, referral to clinical psychologist, counselling arranged via GP • Make sure expectations have been met • Evaluation forms completed • Close session.........

12. Key Findings From the One Day Workshop Evaluation • 64% attended – 29% UTA and 7% DNA (2009) • 94% patients reported “delivery of the workshop was just right” • 93% reported “the length of the session was just right” • 90% “felt their knowledge of stress management had improved” • 12% patients referred for a clinical psychology assessment

13. Key Findings From the Two Month Follow up Evaluation of the Workshop • 93% reported that “they still use the ways of coping identified on the day” • 88% reported that “these ways of coping help them to manage their stress more effectively” • 80% HADS scores have reduced 20% significantly to within normal range

14. Future Plans • Running a follow up day for patients • Offering a similar stress management workshop for partners and other family members • Providing a professionally printed manual to support the content covered in the workshop. Patients would be able to continue to use this as a reference tool to maintain effective stress management techniques • Continue to develop the emergency in-patient Clinical Psychology referral service

15. Any Questions?