Overview: SMART Lessons (8 sessions)

Lesson 1: Overview, Setting Goals, Resiliency and Relaxation Response

Lesson 2: The Relaxation Response

Lesson 3: Stress Awareness

Lesson 4: Mending Mind and Body

Lesson 5: Creating an Helpful & Balanced Perspective

Lesson 6: Building Positivity

Lesson 7. Healing State of Mind

Lesson 8. Humor, Empathy, and Staying Resilient

Miscellaneous

Mindfulness app list

<Lesson 1: Overview, Setting Goals, Resiliency and Relaxation Response>

Title: Overview, Setting Goals, Resiliency and Relaxation Response, SMART Lesson 1 of 8

Summary: Lets focus on resiliency, learning the relaxation response and setting goals.

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

Stress can cause problems with our health and emotions. The Stress Management and Resiliency Training program (SMART) is an eight-part program that teaches you how to lower the negative effects of stress and increase your resiliency. When we talk about resiliency in this program it means having the skills to make it through stressful times. This program focuses on the connections between mind and body, which teaches strategies to build mind-body practice (like meditation, breathing techniques, and gentle yoga), thought changing skills that help you to lower your stress reactions, and skills that help you to get good sleep, proper nutrition, and physical activity. The SMART program is effective in lowering stress and building healthy lifestyles.

The SMART program was developed at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. For more information about SMART classes online or in person, see https://bensonhenryinstitute.org/smart-program/

SMART will use three key components to decrease stress and build your growth and relaxation

1. You will learn how to turn on a relaxation response in your body. The relaxation response is a reaction that your body uses to lower stress. It is triggered by safely lowering your breath rate and heart rate, which will normalize your brain activity and other processes in your body. We will show you different ways to learn the relaxation response. Practicing in different ways will boost your relaxation response and its effect.

2. You will learn to notice your stress cues. Understanding the situations and beliefs that make your stress worse is an important way to control how you respond to stress. We will teach you about the stress response and what you can control.

3. You will learn healthy and balanced strategies to manage stress. We will teach you how to shift your thinking towards more positive outlooks. We use the practice of positive psychology to help you to see things in a balanced way. We also support building social connections with people you care for, and finally, we will invite you to practice healthy lifestyle behaviors.

What is causing stress?

The goal here is to start to examine your personal stressors and identify what resources you can use to cope with stress. What are the situations that create stress for you?

What is the body’s response to stress?

Anytime we sense a threat, either physical, emotional, real or imagined, our brain has a stress response, which sets off many changes in our body. Over time, the brain programs responses to memory of stress we have experienced before. When you sense real or imagined danger, your body will quickly ascertain if it should fight, freeze, or flee to protect you. During this, your body will automatically save resources by shutting down digestion and sending blood flow to your muscle groups so you can fight, stay quiet, or get out of the situation. As a result, you may notice quick breathing, tight chest, fast heart rate, sweaty palms, dry mouth, shakiness, hot/cold clammy feelings, stomachache, and nausea. These changes are your body’s natural method to cope with stress. The symptoms of stress will not harm you and will not damage your body in the short term. However, when we have stress again and again, your brain will have a hard time sorting out harmful from non-harmful situations, and so the stress system stays on and can start to create problems in your body.

Relaxation responses can be learned

One relaxation response practice involves intentionally slowing the breath (belly breathing) and other involves noticing the breath (simple breath awareness). The third is using muscle awareness.

The relaxation response is a skill that you can use to change the flight-fight-freeze stress response. When you try this strategy (explained below) your rest-and-digest nervous system turns on. The relaxation response can lower muscle tension, slow your breathing, and lower your heart rate, as well as reset your blood pressure. At the cell level in your body, practicing the relaxation response keeps your cells from building up toxic chemicals and sets off new cell growth in your brain, which helps your brain work well.

Practice 1. Instructions for Belly Breathing

Belly breathing, or diaphragmatic breathing, stretches the muscles in your body which signal relaxation to your brain and body. It engages the “rest and digest” system in your body and calms the “fight, freeze, or flight” system. Benefits of belly breathing include releasing tension, increasing emotional control, increasing your ability to concentrate, brings oxygen to your cells, promotes better sleep. Click on this link for audio guidance:

Click here to hear instructions on this approach: Add audiog[JKG1]

Practice 2. Instructions for Simple Breath Awareness

A simple way to learn how to do this is to sit in a chair, or if you are more comfortable, lie down on your back.

Click here to hear instructions on this approach[JKG2] :

Practice 3. Instructions for Body Awareness

Squeeze your fist and hold it as tight as you can. Let go of your fist and take a deep breath. Now while making a fist take slow relaxed breaths. By taking deep breaths that stretch muscle fibers, you may keep those muscles from tightening, and stop the trigger of the stress response.

Energy Battery exercise

This exercise is the first step to paying attention to things that cause stress and build resiliency. Reflect on your life and list what people, events, experiences, or activities affect how you see the world and your health. See if those things add to (charge) or drain your energy.

Appreciations

When we notice and pay attention to pleasant moments – sights, sounds, smells, emotions, physical sensations, and time with others – we build resiliency by experiencing and noticing what we appreciate each day that charges our energy battery. There is always something good happening in our day if we spend time noticing. Sometimes “just breathing today” is an appreciation. Begin by reflecting on something that you appreciate. You can use the weekly practice note to write down simple appreciations. Write down your appreciation down in as much as detail as possible. Use your senses to relive each appreciation until you feel the positive emotions.

<Lesson 2: The Relaxation Response>

Title: The Relaxation Response, SMART Lesson 2 of 8

Summary: Ways to bring the relaxation response into your daily routine

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Practice 1. Body Scan

The body scan is a way to practice placing our attention where we want it, helping us to feel grounded and present in the body. We recommend that you practice this daily using these instructions[JKG3] .

Restorative (Good) Sleep

It is important to get restorative or good quality sleep. But sometimes it may seem like we are getting less sleep time or quality that we need to move well throughout the day. Though the National Sleep Foundation recommends a minimum of seven hours of sleep per night for adults, pregnancy and postpartum changes in your body along with caring for an infant can make it difficult to get enough sleep. To improve the amount you sleep and your sleep quality, refer to sleep these tips:

You will find the sleep education in these links:

· https://www.sleepfoundation.org/

· https://sleepeducation.org/resources/

Stress Warning Signals

An important part of your health is to learn how stress shows up for you and how to identify signs or signals that you are feeling stress. This process will help you to lower your stress.

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Practice 2. The MINI Relaxation Response

A simple way to lower stress during the day is to use mini relaxation response exercises. These are most effective when used with daily relaxation response practice. Our body will deepen its ability to quickly turn on the rest and digest state and you will feel less stressed.

You will find the video link below:

· Vimeo URL: Mini Relaxation Response Instructions[JKG4]

<Lesson 3: Stress Awareness>

Title: Stress Awareness. SMART Lesson 3 of 8

Summary: Ways to lower stress responses and how to use mindfulness

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

We will explore different ways to lower our response to stress, and we introduce the concept of mindfulness.

Mindfulness means that you are paying attention to the present moment without judgment.

Mindfulness is one way to change how we respond to stress in our lives. Mindfulness is being aware or paying attention to the present moment without judgment – not judging others, ourselves, or our thoughts and feelings.

Mindfulness stops us from drifting into memories or thoughts that make us anxious, stressed, or depressed. Mindfulness involves drawing our attention to the present by bringing an open, non-judgmental, and curious attitude toward whatever is happening in the moment right now.

Practice 1. Mindfulness

Here is a relaxation exercise that can build your mindfulness practice: Body scan meditation[JKG5]

You can also use mindfulness during day-to-day activities. The goal here is to use your attention focused on the present moment without adding other exercises/tasks/burden. Have you thought about the mindful practice of brushing your teeth? Try this if you feel safe and comfortable. Tap into your five senses. When brushing your teeth, what do you see? The brush moving back and forth? Yourself in the mirror? What touch do you feel? The bristles on your teeth? Foamy toothpaste? What do you hear? Scrubbing? What do you smell and taste? Mint? Bubblegum? How are you feeling? Refreshed?

You can continue to build your awareness of stress-linked thoughts, behaviors, and physical experiences as we introduce social support.

Practice 2. Social Support

Sometimes it can be helpful to talk with your partner (or main person who is helping you care for your baby) to build your bond and connection with one another. If this is challenging, try to support yourself with stress reduction. Take a moment to pause and reflect on who is part of your social support network. If your network feels small, what are ways that you can build it? Perhaps joining a new parents group. Check out www.npn.org, or local meetup groups.

There are many benefits for building your social support. We learn from other people, and we can see that we are managing similar challenges. Having other people to exchange ideas and experiences is a fundamental human need.

Practice 3. New and Good

Writing down and thinking about what we appreciate can improve your positivity. Think about appreciations that focus on ‘new and good’ experiences. Share these “new and good” moments with someone and see how it feels.

<Lesson 4: Mending Mind and Body >

Title: Mending Mind and Body, SMART Lesson 4 of 8

Summary: We introduce gentle yoga and how to change your thoughts to lower your stress.

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

Stress affects the mind and body. We start this lesson with a new body-based relaxation response strategy called gentle yoga. Then we will talk about automatic negative thoughts and thought distortions or “thinking traps.” We will teach you ways to change these thoughts to lower stress.

Awareness of Movement

Moving around can deepen your relaxation response and mindful focus. Reflect on your physical activity, particularly as you wish to turn on the relaxation response. If you are rushing to ‘get things done’ you are likely to turn on your stress responses. If you are aware that you can move gently and with awareness, you will be able to lower some of your tension.

Practice 1. Gentle Yoga

Yoga is a set of physical movements that build strength, balance, and flexibility. Because it uses breath and mindfulness exercise along with movement, you may find that you enjoy the release and focus that yoga offers. There are numerous places to find yoga practice in your community, we also recommend finding it online.

You will find the video link and materials below:

· Vimeo URL: Yoga practice[JKG6]

Practice 2. Mental Stress Produce Thinking Traps

We all have automatic thoughts about our experience. They occur quickly and we tend to believe our thoughts are true. However, not all thoughts are true or useful. When you have a ‘negative automatic thought’ it is unhelpful, unbalanced, and unfair to you. Stress turns on these ‘thinking traps,’ which lead to negative automatic thoughts.

Practice 3. Changing Thoughts

There are ways you can respond to automatic negative thoughts to shift your thinking to be more neutral and realistic. Look at our ‘challenging automatic negative thoughts’ lesson in our library. For more information on cognitive behavior therapy, refer to https://beckinstitute.org/

Here are links that explain cognitive traps and how to change them:

· Cognitive traps: https://www.youtube.com/watch?v=rfrvrNekzLE

Challenging cognitive traps: https://www.therapistaid.com/therapy-guide/cognitive-restructuring

<Lesson 5: Creating an Helpful & Balanced Perspective>

Title: Creating a helpful and balanced perspective SMART Lesson 5 of 8

Summary: Creating adaptive viewpoints using positive perspectives, gentle movement, and coping logs.

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

Adaption means flexibility of both mind and body. To build this, we introduce guided imagery of a joyful setting. You can use your imagination to lower stress and make you aware of how you are thinking and feeling. Guided imagery can take you to a place where you can think helpful thoughts. Also, we encourage you to test your thoughts when you start to feel stressed.

Practice 1. Positive Outlook: What is new and good?

To build helpful thinking, take time each day to reflect and think about the good, bad, and neutral things that happened you today. Look at what positive meaning can come from these experiences and what flexible qualities thinking positively can bring.

Practice 2. Using gentle movement to increase flexibility

There are recommendations for exercise during pregnancy and postpartum. If your doctor approves, we invite you to aim for at least 15 minutes per day of walking. Ultimately, the goal is to get to you the recommended 150 minutes (for example, 30 minutes a day, five days a week) of moderate-intensity aerobic physical activity per week, such as brisk walking, during and after pregnancy. It is best to spread this activity throughout the week.

You will find links and materials below:

· https://www.cdc.gov/physicalactivity/basics/pregnancy/index.htm

https://www.acog.org/womens-health/faqs/exercise-after-pregnancy

Practice 3. Coping Log

Now that we have explored your responses to stress and the negative thoughts that signal stress in lesson 4, let’s look at helpful responses to build positive emotions. Acceptance and problem solving are two methods that help to build a helpful (or alternative) view.

P

Changing what you can, accepting what you cannot

Title: Promoting Positivity, SMART Lesson 6 of 8

Summary: Building loving kindness and compassion to lower stress

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

We begin with a meditation that highlights positive, helpful qualities such as kindness and love. Next, we build your healthy and balanced viewpoint by seeing how we can show that hope. We also look at our fear that can lead to negative thinking. Finally, we invite you to stay active and practice relaxation response exercises.

Practice 1. Contemplation

In this practice, we find the sources of inspiration and appreciation, two key healing states of mind.

Guidance for contemplation meditation[JKG7]

Practice 2. Loving kindness meditation

In this practice, we find the source of loving kindness towards one’s self and others. Our instructions are adapted from Cardiac work by S. Levine, A Gradual Awakening[JKG8] .

Comparing optimism with pessimism

Optimistic thinking is a hopeful human response where we have confidence in ourselves and think positively about the future. Pessimistic or negative thinking is a protective response when we think there is a threat, when we feel disappointed, or when we feel afraid. Negative thinking can lead to unhelpful emotions and decisions. Optimism and pessimism are two ends of the range of the way we think and can change how we see things. Like if you’ve heard the saying “seeing the world through rose colored glasses” which means seeing something more positively, or on the other end “like a cloud hanging overhead” which means seeing things more gray and negatively. When we have stress, we tend to think negatively to defend ourselves. A good way to stop and interrupt negativity is to pause, breathe, reflect, and choose what about the situation you can be positive about. Below are characteristics of optimistic and pessimistic viewpoints.

<Lesson 7. Healing State of Mind>

Title: Healing States of Mind, SMART Lesson 7 of 8

Summary: Empathy and self-compassion to lower stress.

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

We invite you to use empathy (understanding) and compassion (gentle kindness) to lower stress.

Practice 1. Compassion Meditation

Compassion is a feeling response where we notice if someone is suffering and we feel motivated or driven to help them feel better. Compassion is about care and concern for another person and wanting to relieve their pain. Compassion helps the person as well as yourself because it distracts us from our own problems. This compassion meditation helps to build our compassion for others by imagining someone suffering, noticing our thoughts and feelings when we see them suffering, and sending our well wishes to the person through our imagination. The goal of this meditation is to help us to understand other people’s emotions, learn to sit with the experience of suffering, and to boost our wish to help others, which will also help ourselves.

Guidance for compassion meditation[JKG9]

Practice 2. Empathy

Empathy means to be aware of and to understand the feelings, thoughts, and experiences of another person. Practicing empathy will help us to feel more connected with others (social support) and to lower our stress. Compared to empathy, compassion is sharing the emotions of others and wanting to help others be happy. Empathy simply is being aware and not judging or changing the experience of others. Empathy requires understanding. Self-empathy is a first step and builds the foundation for our ability to have empathy for others. Think about how you talk to yourself during a stressful situation. Is your self-talk empathic or does it cause suffering? Like talking down to yourself with a negative attitude. To test yourself, ask yourself: How am I feeling in this moment? What am I struggling with? Check to see if you are using a positive, supportive tone. Are you speaking to yourself as if you were speaking to someone you cared for like a friend?

<Lesson 8. Humor, Empathy, and Staying Resilient>

Title: Humor, Empathy, and Staying Resilient, SMART Lesson 8 of 8

Summary: Using humor, empathy to build a resilient perspective.

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

Overview

We invite you to learn to use humor and imagination to add to your helpful, healthy coping skills. We will also review your energy battery to see if you have more charges than drains.

Practice 1. Personal battery exercise

Fill in your energy battery. When you add more charges, how is your stress?

Humor, Laughter, Coping

We invite you to focus on humor in daily life. Humor can help to lighten our mood, release tension, and increase positive feelings. Humor also helps us make social connections and can help us feel less lonely. Laughter is a physical movement that relaxes muscles, lowers pain, and can boost our immune system. Humor and laughing are an important part of coping with stress. Humor can protect us from an uncomfortable truth, make fun of awkward situations, create surprise, and to sit with hard times and uncomfortable emotions. How can you find humor in your life? We may turn to humor to help us get through risky situations, or in times when situations go from bad to worse. You can practice telling jokes and puns, watch funny clips online, or watch comedy to feel more playful. Podcasts are also a good option, or you could watch a funny movie, and laughing with a friend is a great option that can lower stress.

Review of Strategies

Across the SMART lessons, you have learned and tried three types of methods to lower your stress.

I

For more information about SMART classes online or in person, see https://bensonhenryinstitute.org/smart-program/.

Title: List of mindfulness apps and resources of meditation

Summary: List of mindfulness apps and resources of meditation

Source: Park, E.R., Baim, P., Kaga, L. (2021). Stress management and resiliency training: A relaxation response resiliency program. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.

List of mindfulness apps and resources for stress reduction

You may want to learn and practice meditation to lower your stress. These are available on your smart phone or digital device. We do not recommend one over another, see what is best for you.

Calm

Meditation Studio

Insight Timer

Simply Being

Mental Workout

Grateful

Headspace

Map of Love

YouTube: Relaxation Response video exercise: Meditate with Peg Balm

YouTube: Yoga Nidra with Jennifer Reis

Internet: https://cih.ucsd.edu/mindfulness/guided-audio-video

[JKG1]Module 1, Audio 1.

1. Start by placing one hand on your chest and one hand on your stomach.

2. Breathe in through your nose and out through your mouth at your own pace, or if helpful, count to four in your head.

3. As you breath in, slowly say “one Missipippi two Missipippi three Missipippi four Mississippi.” As you inhale, bring the air all the way down to your belly, imagining your belly blowing up like a balloon.

4. As you breath out, slowly say “one Missipippi two Missipippi three Missipippi four Missipippi.” As you exhale, breathe out through your mouth gently enough to flicker a candle but not blow it out, and imagine your belly button being pulled by a string back to your spine.

5. Continue this breath into your belly so that your chest does not move much at all. Your breath is always with you - you can do this anywhere, anytime.

[JKG2]Module 1, Audio 2

Script on SMART protocol, page 34.

If we don’t want to create our own, and it seems okay, we can use this one: at UCSD [https://soundcloud.com/ucsdmindfulness/sets/body-scan]

[JKG3]Module 2, audio 1, SMART page 40

[JKG4]Module 2, audio 2.

text from pg 49-50 SMART protocol

[JKG5]Module 3, Audio 1 (this is the same as Module 1, audio 1)

Either use our own (Module 1, audio 1) or use this link:

[https://soundcloud.com/ucsdmindfulness/sets/body-scan]

[JKG6]Module 4, Audio 1.

SMART protocol, pg 80-81

[JKG7]Module 6, audio 1