Learn about stress

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Involve your family

People who have never been breathless have difficulty understanding why it is so limiting. Sometimes they forget to help you or they try to do too much. You may feel you are losing your independence. Tell your family and friends the things you need help with and the things that you can manage.
It is understandable that you may have times of frustration, embarrassment, and depression. Complex and conflicting feelings of anger, fear and grief may be felt by you and your family. It is important to talk about these things. Talk with your family, friends, and your doctor, about ways you can get support.
Because it takes so much more of your energy to do your day-to-day activities, you can easily become very focused on yourself. Be aware of this - keep in touch with your friends and pursue your normal interests.

Anxiety attacks

Sometimes anxiety can lead to overbreathing and panic attacks. A physiotherapist can help you learn to control this. Visit the New Zealand Society of Physiotherapists' website www.nzsp.org.nz to locate a physiotherapist in your area.

Learning how to deal with stress

Having COPD (Chronic Obstructive Pulmonary Disease) is often stressful. It is not easy to accept that your breathing limits your daily life. People with COPD differ in what stresses them.

It is possible to work out what triggers stress for you and note how it affects your body, thoughts and behaviour. It may be your environment (e.g. crowds or a smoky room), your physical state (e.g. discomfort from breathlessness or tiredness), or your psychological state (e.g. unrealistic beliefs about yourself, or feeling frightened).

This is the start to changing unhelpful ways of dealing with stress.

Sometimes our response to stress is physical

Our body has only one way of responding to physical and mental stresses. Chemical changes occur as we prepare to confront or avoid the stress ("fight or flight").

These might incude:

heart beats faster
breathing rate increases
muscles become tense/sore
urge to to to the toilet
sweating/shaking
not able to sit still

Sometimes our response is in emotions and thoughts

Thoughts: racing thoughts, difficulty concentrating or making decisions, anticipating or magnifying problems which may not exist, thinking more about ourselves and forgetting others' needs.

Emotions: feeling irritable/angry, feeling anxious or panicky, feeling overwhelmed, helpless or hopeless.

Behaviours: sleep disturbance, decreased ability to say no to "quick but unhelpful fixes" such as alcohol, cigarettes, coffee, more agression towards people and objects, an inability to complete goals.

What can you do about stress? 2 important methods of coping

Two important coping mechanisms relate to actions and acceptance.

1. Actions - acting to make a positive change or resolve a concern

Label three columns with the headings: Action Now, Action This Week, Can't Do Anything. Divide the things you worry about into the three columns, and then write next to each concern, the action that you can take to help resolve it.

e.g. Action Now: Pick up the phone to clarify a worry about medication.

e.g. Action This Week: Going to a concert - plan transport in advance and obtain seating plan to sort out easy access and seating.

e.g. Can't Do Anything: Try to work out if there are any advantages in worrying about these events. If not, try to worry only about things you can action.

Here are some other actions you can take to help reduce stress in your life:

Change your pace or do something different
Try to keep as active as possible. Ask your doctor, physiotherapist or nurse about exercise and COPD
Share the load with a friend or counsellor
When you are feeling overwhelmed by tasks, write a list and halve it. Most people are far too ambitious about the amount of things they can do in ONE DAY
If you feel angry with someone else, distract yourself by going to another room or listening to music. Remember the "fight or flight" reaction only lasts a short time provided you can stop the thoughts which activate it
Try to pursue interests. You may need to swap jobs in the house which demand too much energy (e.g. cooking instead of gardening).

2. Acceptance - learning to accept the limits of your condition

Let go of unrealistic beliefs, such as 'the world should be fair and just'
Learn to accept responsibility for your own feelings. Even when things seem unfair with your health the meaning you attach to this can determine whether you become bitter and resentful or retain control over your feelings and actions
Make sure your goals are FLEXIBLE. You may need to adopt new goals if the old ones cannot be attained. Always have a plan B and emotionally prepare yourself for this option
Talk yourself into being patient. Setbacks and delays happen to many people with COPD - you are no different
For everyone there are times when you do not get what you wanted or deserve. Unpleasant experiences are only permanent setbacks if you allow them to be.
Remember we are not robots or saints, so why do we expect to always perform faultlessly?

Learn to turn off the stress reponse in your body

Relaxation can prevent or lessen the degree of tension you experience when feeling stressed. Start before the tension becomes intense, by scanning your body (do a mental check of each part especially shoulders, neck, face, back and hands) when you feel stressed. Stress may also change your breathing patterns causing shallow breathing from the chest.

Try this.... In this order

Move and stretch all parts of your body
Realign body into correct posture. Check that your shoulders are down
Try the breathing techniques you were taught by your health professional
Shut your eyes if you can and try to visualise a pleasant scene. Water scenes are often very relaxing particularly if they are repetitive such as waves on the beach. Try putting some music in your visualisation and note details in your scene. Your mind will learn to associate that music with relaxation. You can then play it or sing it to yourself to relax when you are away from home.
Stay put for a while, then open your eyes when you are ready. Rescan your body.

Acknowledgement for assistance with this Factsheet to Claire Dawson,
Senior Clinical Psychologist, Canterbury Respiratory Services