The Stress Vulnerability Model – Learning What Improves Symptoms and Reduces Relapses – Getting Social Support


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This third blog in the series details how to get social support to reduce symptoms of mental illness and reduce relapses.

In this blog series there are several sub-blogs that are listed for your reference below:

Having people to talk to and do things with is important to everyone. Social support from friends and family members helps people enjoy their lives more and cope better with life challenges. For example, many activities are more fun when you do them with others. Also, just being able to hang out with someone who understands you helps you feel supported and can relieve some of the pressure you are under.

People in your support system can help you achieve your goals, both by encouraging you and by helping you with concrete steps. They can also help you solve problems that come up and even help you monitor how things are going with mental health symptoms. For example, sometimes friends and family may notice before you do that your energy is lower than usual or that you are staying in your room more. THey can help you fiogure out what might help you feel better.

Check this out: The following table contains some strategies for increasing social support.

Increasing Social Support Checklist

Strategy for Increasing Social Support

I already use this strategy

I would like to try this strategy or develop it further

Practice saying “hello” on a daily basis to people in your home environment.

Gradually build up the number of people you talk with.

Look for small opportunities to practice pleasant interactions.

If you have contact with family members, make plans to connect with them regularly (once a week or more).

Consider reconnecting with old friends or family members with whom you have lost contact.

Get involved in a club, activity, or class that naturally brings you in contact with other people.

Look for opportunities to make new friends.


? Looking at how you filled out the Increasing Social Supports Checklist what is one thing that you could do to increase your social support in the coming weeks?


The Stress Vulnerability Model – Learning What Improves Symptoms and Reduces Relapses.


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What Improves Symptoms and Reduces Relapses?

(Continued from The Stress Vulnerability Model Page 1 – Introduction).

Because both biological vulnerability and stress worsen psychiatric symptoms and cause relapses, reducing your vulnerability and increasing your ability to manage stress can improve the course of your illness. Here are some helpful strategies for reducing vulnerability and improving stress management.

  1. Take medications as prescribed.

  2. Avoid alcohol and other drug use.

  3. Reduce and manage stress.

  4. Get social support.

  5. Use coping strategies.

You can also reduce symptoms and prevent relapses by setting and pursuing recovery goals, learning about your disorder, and developing a relapse prevention plan. These strategies together can be described as recovery management skills. The following diagram illustrates how the stress-vulnerability model can be used in the treatment of mental illness. Each part of the model will be explained in more detail in this blog.

Principles of Mental Illness Management Based On The Stress-Vulnerability Model

Principles Of Mental Illness Management Based On The Stress-Vulnerability Model

Principles Of Mental Illness Management Based On The Stress-Vulnerability Model

Taking Medication

Medications help reduce biological vulnerability to symptoms by correcting chemical imbalances in the brain. There are several different medicines to treat different symptoms. It is your decision whether to take medication. Medications are not perfect: they don’t cure mental illness, and they have side effects. Medications also help some people more than others. However, medications are one of the most powerful tools we have for reducing or eliminating symptoms and preventing relapses and re-hospitalizations.

Avoiding Alcohol and Drugs

Another way to reduce biological vulnerabilities is to avoid alcohol and other drugs. Alcohol and other drug use affect neurotransmitters in the brain, which can lead to worse symptoms and relapses. Alcohol and other drug use can also lead to legal, financial, and health problems, resulting in stress that can trigger symptoms. In addition using alcohol and other drugs can interfere with the benefits of medication.

Taking medications as prescribed and avoiding drug and alcohol use can reduce biological vulnerability.


? Have medications helped you to reduce symptoms?

? Has avoiding (or decreasing) drug and alcohol use helped you to reduce symptoms?

Reducing Stress

Each person experiences stress in his or her own way. In addition, what is stressful to one person may not be stressful to another. For example, some people feel stressed by going to a large family gathering, whereas others enjoy it.

There are two may ways to reduce the negative effects of stress. One way is to reduce some common sources of stress. The other way is to have strategies for dealing with stress so that has less harmful effects.

Reducing sources of stress

Here are some general guidelines for reducing common sources of stress:

  1. Identify situations that caused stress for you in the past, and think of ways to handle the situations so they won’t be as stressful.

  2. Set reasonable expectations for yourself – try not to do to much or too little.

  3. Find activities that are meaningful to you – whether working or volunteering or pursuing hobbies.

  4. Maintain good health habits by eating well, getting enough sleep, and exercising regularly.

  5. Seek out supportive relationships in which you feel comfortable telling people what you are feeling and thinking.

  6. Avoid situations where people argue with you or criticize you.

  7. Give yourself credit for your talents and strengths; don’t be hard on yourself.

Reducing stress can help reduce symptoms.

Reducing stress can help reduce symptoms.


? What is one thing you could do in the next week to reduce a source of stress in your life?

Coping with Stress

Stress is a natural part of life, and everyone experiences it. Stress is also part of taking on new challenges and living a meaningful life. When stress occurs, however, it is helpful to have some strategies for dealing with it, so it will have a less harmful effect on you.

Consider using some of the following strategies for dealing with stress:

  1. Talk to someone about your feelings.

  2. Use relaxation techniques, such as deep breathing, meditation, picturing a pleasant scene, or progressive muscle relaxation.

  3. Use “positive self talk” by saying things to yourself such as “This is a challenge, but I can handle it”

  4. Keep your sense of humor and try to look at the lighter side. Seek out a funny movie or a book or cartoons.

  5. Attend a religious service or another form of spiritual inspiration.

  6. Take a walk or do some other kind of physical exercise.

  7. Write your thoughts and feelings down in a journal.

  8. Draw or create other kinds of artwork.

  9. Think of the situation as a problem to solve, and then work on solving the problem.

  10. Engage in a hobby such as cooking, gardening, reading, or listening to music.

Try to keep an open mind, and experiment with new ays of coping with stress. The more strategies the better you can cope.



? What is one strategy you could use in the next week to cope with stress?

The next blog in this series will describe how to use social supports to cope with stress.

Introduction to S.M.A.R.T Goal Setting and How to Define S.M.A.R.T Goals


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This article details what S.M.A.R.T. goals are and how to define them to lead a more productive life.

SMART is a mnemonic acronym, giving criteria to guide in the setting of objectives, for example in project management, employee-performance management and personal development. The letters S and M usually mean specific and measurable. The other letters have meant different things to different authors, as described below. Additional letters have been added by some authors.

SMART criteria are commonly attributed to Peter Drucker’s management by objectives concept. The first-known use of the term occurs in the November 1981 issue of Management Review by George T. Doran. The principal advantage of SMART objectives is that they are easier to understand, to do, and then be reassured that they have been done.

Other definitions

Each letter in SMART refers to a different criterion for judging objectives. Different sources use the letters to refer to different things. Typically accepted criteria are as follows.

Letter Most common Alternative
S SPECIFIC Significant, stretching, simple, sustainable
Motivational, manageable, meaningful
Appropriate, agreed, assignable, attainable,actionable, action-oriented, adjustable, ambitious, aligned with corporate goals, aspirational, acceptable, aggressive
Result-based, results-oriented, resourced, resonant, realistic, reasonable
Time-oriented, time-framed, timed, time-based, timeboxed, time-specific, timetabled, time limited, time/cost limited, trackable, tangible, timely, time-sensitive, timeframe

Choosing certain combinations of these labels can cause duplication, such as selecting ‘attainable’ and ‘realistic’, or can cause significant overlapping as in combining ‘appropriate’ and ‘relevant’ for example. The term ‘agreed’ is often used in management situations where buy-in from stakeholders is desirable (e.g. appraisal situations). The first column of terms provides an adequate starting structure.

Developing SMART goals


The criterion stresses the need for a specific goal rather than a more general one. This means the goal is clear and unambiguous; without vagaries and platitudes. To make goals specific, they must tell a team exactly what’s expected, why it’s important, who’s involved, where it’s going to happen and which attributes are important.

A specific goal will usually answer the five ‘W’ questions:

  • What: What do I want to accomplish?
  • Why: Specific reasons, purpose or benefits of accomplishing the goal.
  • Who: Who is involved?
  • Where: Identify a location.
  • Which: Identify requirements and constraints.


The second criterion stresses the need for concrete criteria for measuring progress toward the attainment of the goal. The thought behind this is that if a goal is not measurable it is not possible to know whether a team is making progress toward successful completion. Measuring progress is supposed to help a team stay on track, reach its target dates and experience the exhilaration of achievement that spurs it on to continued effort required to reach the ultimate goal.

A measurable goal will usually answer questions such as:

  • How much?
  • How many?
  • How will I know when it is accomplished?
  • Indicators should be quantifiable


The third criterion stresses the importance of goals that are realistic and also attainable. Whilst an attainable goal may stretch a team in order to achieve it, the goal is not extreme. That is, the goals are neither out of reach nor below standard performance, since these may be considered meaningless. When you identify goals that are most important to you, you begin to figure out ways you can make them come true. You develop the attitudes, abilities, skills and financial capacity to reach them. The theory states that an attainable goal may cause goal-setters to identify previously overlooked opportunities to bring themselves closer to the achievement of their goals.

An achievable goal will usually answer the question How?

  • How can the goal be accomplished?
  • How realistic is the goal based on other constraints?


The fourth criterion stresses the importance of choosing goals that matter. A bank manager’s goal to “Make 50 peanut butter and jelly sandwiches by 2pm” may be specific, measurable, attainable and time-bound but lacks relevance. Many times you will need support to accomplish a goal: resources, a champion voice, someone to knock down obstacles. Goals that are relevant to your boss, your team, your organization will receive that needed support.

Relevant goals (when met) drive the team, department and organization forward. A goal that supports or is in alignment with other goals would be considered a relevant goal.

A relevant goal can answer yes to these questions:

  • Does this seem worthwhile?
  • Is this the right time?
  • Does this match our other efforts/needs?
  • Are you the right person?
  • Is it applicable in the current socio- economic environment?


The fifth criterion stresses the importance of grounding goals within a time-frame, giving them a target date. A commitment to a deadline helps a team focus their efforts on completion of the goal on or before the due date. This part of the SMART goal criteria is intended to prevent goals from being overtaken by the day-to-day crises that invariably arise in an organization. A time-bound goal is intended to establish a sense of urgency.

A time-bound goal will usually answer the question

  • When?
  • What can I do six months from now?
  • What can I do six weeks from now?
  • What can I do today?



This worksheet is a S.M.A.R.T. Goal setting worksheet designed to help you identify a new goal using SMART techniques as described in this article.

STEP 1: Write down your goal in as few words as possible.

MY GOAL IS TO: ____________________________________________________


Answer the who/what/where/how/when. “How Will You Reach This Goal? List at least 3 action steps you’ll take (be specific).”

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

STEP 3: Make sure your goal is MEASURABLE

Add details, measurements, and tracking details.

I will measure/track my goal by using the following numbers or methods:


I will know I’ve reached my goal when


STEP 4: Make your goal ATTAINABLE

What additional resources do you need for success?

Items I Need To Achieve This Goal: _______________________________________

How Will I Find The Time: ______________________________________________

Things I Need To Learn More About: ______________________________________

People I Can Talk To For Support: ________________________________________

STEP 5: Make your goal RELEVANT

List why you want to reach this goal:




STEP 6: Make Your goal TIMELY

Put a deadline on your goal and set some benchmarks:

I will reach my goal by (DATE): ___ / ____ / ____

My halfway measurement will be _____________ on (DATE) ___ / ____ / ____

Additional dates and milestones I’ll aim for:


To download this worksheet please select a file format from one of the icons shown below:

Microsoft Word  
Open Office Doc
PDF Format


The Stress Vulnerability Model


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“For me it’s been vital to be aware of when i am under stress. because of my illness, I’m extra sensitive to stress. it has also been vital for me to take the lead role in my treatment, since i believe that i know best what is going on inside my head”

– david klime, artist, writer, floral designer, person in recovery from bipolar disorder.

This article describes the stress-vulnerability model for understanding the nature of psychiatric disorders, including factors that can influence their development and course. According to this model, psychiatric illnesses have a biological basis. This biological basis, or vulnerability, can be made worse by stress and substance use but can be improved by taking medication and leading a healthy lifestyle. The stress-vulnerability model can help you understand what influences your disorder and how you can minimize the effects of the disorder on your life.

There are four main topics in this article:

1. Understanding The Cause of Mental Illnesses.

2. Learning What Improves Symptoms and Reduces Relapses.

3. Understanding Treatment Options.

4. Reducing Relapses.

In general, we recommend one IMR session per topic. However, based on your preferences and comfort level you may want to spend either more or fewer sessions covering these four topics. Several topics in this handout include a section called “Check It Out.” These sections include things for you think about or try out in IMR sessions, so when the opportunity arises you will be better prepared to put into action what you have learned.

At the end of each topic, you will find a Home Practice Sheet. Part is about applying something you learned in the IMR session and has a list of options (including the opportunity to create your own option). Part B is about taking a step toward the personal recovery goal you indentified in handout 1 (Recovery Strategies) and recorded on your IMR Goal-Tracking Sheet. At the end of each IMR session we encourage you to design your own hom epractice assignment by selecting an activity for part A and part B.

What Causes Mental Illness?

Mental illnesses are not anyone’s fault. This means that a person with a psychiatric disorder did not cause the disorder and neither did his or her family members or anyone else. Scientists do not yet understand exactly why some people develop a mental illness and others do not. They also cannot predict who will have several episodes of symptoms and who will have one or only a few episodes. One theory that has received strong support is called the “Stress-Vulnerability Model”. According to this theory, both stress and biological vulnerability contribute to symptoms, as shown in the following diagram:

The Stress Vulnerability Model Of Mental Illness


The term “biological vulnerability” refers to an increased chance of developing a physical or mental healthy disorder. People are born with or acquire this sensitivity very early in life. For example, some people have a biological vulnerability to develop asthma, and other people have a biological vulnerability to develop high blood pressure or diabetes. Similarly, it is thought that people can have biological vulnerabilities to develop schizophrenia, bipolar disorder, or depression.

In diabetes, the part of the body that is affected is the pancreas, which keeps the level of insulin in balance. In mental illness, the part of the body that is affected is the brain, which is made up of billions of nerve cells called neurons. These nerve cells contain different chemicals known as neurotransmitters. Scientists believe that mental illnesses are caused by imbalances in these neurotransmitters in the brain.

As with other disorders, such as diabetes, hypertension, and heart diseases, genetic factors play a role in the vulnerability to mental illness. The chances of a person developing depression, bipolar disorder, or schizophrenia are higher if a close relative also has the disorder. Many scientific studies, including some of those carried out based on the international human genome project, are examining the genetic factors related to mental illness.

Genetic factors, however, do not explain everything about the development of mental illness. For example, many people with mental illness have no family history of psychiatric symptoms. It is widely believe that non genetic factors may also contribute to the development of mental illness. For example, early biological factors, such as obstetric complications (the baby not having enough oxygen during the delivery, for example) may be important.

There is little scientific evidence that alcohol or drug use causes people to become biologically vulnerable to mental illness. However, when someone already has a biological vulnerability, alcohol and drug use may trigger symptoms or make them worse.


? Do you know if anyone in your family has had (or might have had) a mental illness?

? Have you had experiences with alcohol or drugs that have made your symptoms more severe or triggered relapses?

What is the Effect of Stress on Mental Illnesses?

Scientists believe that stress also plays an important part in psychiatric symptoms. Stress can trigger the onset of symptoms or make them worse. Stress may play a particularly strong role in increasing the biological vulnerability to depression. For example, if someone has lost a loved one, been the victim of a sexual or phsyical assault, witnessed a tragic event, or experienced other extraordinary stressors, he or she may be more likely to become depressed.

People experience stress in very different ways. In fact, what is stressful to one person may not be stressful all all to someone else. The following list, hwoever, includes examples of situations that most people experience as stressful:

  • too much to do, such as being expected to complete several tasks.

  • too little to do such as sitting around all day wioth no meaningful activities.

  • tense relationships, in which people are often arguing or expressing angry feelings or criticizing each other.

  • major life changes, such as losing a loved one, moving away from home, starting a new job, getting married, or having a child.

  • financial or legal problems.

  • being sick or fatigued.

  • abusing drugs or alcohol.

  • being the victim of a crime.

  • poverty or poor living conditions.

There is no such thing as a stress-free life, so you can’t avoid all stress. In fact, to pursue important goals in your life, you need to be willing to take on new challenges, which can be stressful. But it is helpful to be aware of times when you’re under stress and to learn strategies for coping with it effectively. stress-2


? Have there been times when you were under stress and experienced more symptoms?

Between sessions, most people find it helpful to put some of the knowledge or skills they learned in the session into practice. It’s also important to keep making progress toward your recoveryt goals. You can use the following Home Practice Sheet to develop your own home pratice assignment and record how it goes.

Click here to download the Home Practice Sheet For “Understanding The Causes of Mental Illnesses.”

Graphic_2015-01-25 3_30_55 PM

Download the Home Practice Worksheet – “Understanding The Causes of Mental Illness.

In the next blog within this series, you will learn what improves symptoms and reduces relapses.

Anger Management: 12 Strategies for Controlling Aggression


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Dealing with anger.

“Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.” – Mark Twain, American author.

All of experience anger from time to time. It is a normal, commonly experienced emotion. However, anger can be incredibly destructive if we do not know how to control it. Frequent or misplaced anger can to hurt our reputations, destroy our relationships, limit our opportunities, and even damage our health.

In this article, we’ll look at what anger is, and what its consequences can be. We’ll also look at 12 strategies we can use to control anger and aggression.


understanding anger

According to pyschologist, T.W. Smith, anger is “an unpleasant emotion ranging in intensity from irritation or annoyance to fury or rage.”

Every day, we can experience things that could make us angry. Common causes include feelings of

  • Frustration.
  • Hurt.
  • Harrassment.
  • Injustice, regardless of whether real or perceived.

Other causes include:

  • Requests or criticisms that we believe are unfair.
  • Threats to people, things, or ideas that we hold clear.

People experience anger in different ways and for different reasons. Something that makes you furious may only mildly irritate someone else. This subjectivity can make anger difficult to understand and manage. It also highlights that your response to anger is up to you.


The Dangers of Anger

An appropriate level of anger energizes us to take proper actions, solve problems, and handle situations constructively. However, uncontrolled anger leads to many negative consequences, especially in the workplace. For instance, it can damage relationships with our bosses and colleagues; and it can lead people to lose trust and respect for us, especially when we react instantly and angrily to something that we’ve misperceived as a threat.

Anger also clouds our ability to make good decisions and find creative solutions to problems.. This can negatively affect our work performance.

Frequent anger poses health risks too. One study found that people who get angry regularly are more likely to suffer from coronary heart disease, eating disorders, and obesity. Research has also found a correlation between anger and premature death. Further studies have found that there is a link betwen anger and conditions such as anxiety and depression.


Managing Anger

We manage anger when we learn to defuse it before it becomes destructive. Below, we’ve outlined 12 strategies that you can use to control anger when you experience it. These reflect an abridged version of 17 strategies that Drs Redford Williams and Virginia Williams described in their best-selling book, “Anger Kills”.

  1. Acknowledge That You Have a Problem

If you find it difficult to manage your anger, the first thing you need to do is to be honest with yourself and acknowledge that you have a problem.

You can then make a plan to deal with it.


2. Keep a hostility log

Do you know what causes your anger? Chances are, you don’t understand why you react angrily to some people or events.

When you know what makes you angry, you can develop strategies to channel it effectively.


 3. Use Your Support Network

Let the important people in your life know abou tthe changes that you’re trying to make. They can motivate and support you if you lapse into old behaviours.

These should be give-and-take relationships. Put some time aside every day to invest in these relationships, especially with close friends and family. You need to be there for them, just as they’re willing to be there for you.

You can alleviate stress when you spend time with people you care about. This also helps you control your anger.


4. Interrupt the Anger Cycle

When you start to feel angry, try the following techniques:

  • Yell “Stop!” loudly in your thoughts This can interrupt the anger cycle.
  • Use physical relaxation techniques like deep breathing or centering.
  • Count to 20 before you respond.
  • Manage your negative thoughts with imagery and positive thinking.
  • Close your office door or find a quiet space, and meditate for five minutes.
  • Distract yourself from your anger – visit your favorite website, play a song that you like, daydream about a hobby that you enjoy, or take a walk.

Another approach is to consider the facts of the situation, so that you can talk yourself out of being angry.

To use this strategy, look at what you can observe abou the person or situation, not what you’re inferring about someone’s motivations or intentions. Does this situation deserve your attention? And is your anger justified here?

When you look only at the facts, you’ll likely determine that it’s unproductive to respond with anger.


5. Use Empathy

If another person is the source of your anger, use empathy to see the situation from his or her perspective.

Be objective here. Everyone makes mistakes, and it is through mistakes that people learn how to improve.


6. See the Humour in Your Anger

Learn to laugh at yourself and do not take everything seriously. The next time you feel tempted to lash out, try to see the humour in your expressions of anger.

One way to do this is to “catastrophize” the situation. This is when you exaggerate a petty situation that you feel angry about, and then laugh at your self-importance.

For example, image that you’re angry because a sick team member missed a day of work. As a result, a report you were depneding on is now late.

To catastrophize the situation, you think “Wow, she must have been waiting months for the opportunity to mess up my schedule like this. She and everyone on the team probably planned this, and they’re probably sending her updates about how angry I’m getting.”

Obviously, this grossly exaggerates the situation. WHen you imagine a ridiculous and overblown version of the story, you’ll likely find yourself smiling by the end of it.


7. Relax

Angry people let little things bother them. If you learn to calm down, you’ll realize that there is no real need to get upset, and you’ll have fewer angry episodes.

Regular exercise can help you relax in tense situations. When possible, go for a walk, or stretch and breathe deeply whenever you start to feel upset.

You will also feel more relaxed when you get enough sleep and eat a healthy diet.

Dehydration can often to lead to irritability too, so keep hydrated throughout the day by drinking plenty of water.


8. Build Trust

Angry people can be cynical. They can believe that others do things on purpose to annoy or frustrate them, even before anything happens. However, people often focus less on you then you might think!

Build trust with friends and colleagues. That way, you’ll be less likely to get angry with them when something goes wrong. You’ll also be less likely to attribute the problem to malicious intent on their part.

To build trust, be honest with people. Explain your actions or decisions when you need to , and always keep your word. If you do this consistently, people will learn that they can trust you. They’ll also follow your lead, and you’ll learn that you can trust them in return.


9. Listen Effectively

Miscommunication contributes to frustration situtions. The better you listen to what someone says, the easier it is to find a resolution that doesn’t involve an angry repsonse.

So, improve your active listening skills. When others are speaking focus on what they’re saying, and don’t get distracted by formulating your response before they’ve finished. When they’re done speaking show that you listened by reflecting back what they have just said.


10. Be Assertive

Remember, the word is “assertive,” not “agressive.” WHen you’re aggressive, you focus on winning. You care little for others’ feelings, rights, and needs. When you’re asertive, you focus on balance. You’re honest about what you want, and you respect the needs of others.

If you’re angry, it is often difficult to express yourself clearly. Learn to assert yourself and let other people know your expectations, boundaries, and issues. When you do, you’ll find that you develop self-confidence, gain respect, and improve your relationships.

11. Live Each Day as if it’s Your Last

Life is short. If you spend all of your time getting angry, you’re going to miss the many joys and suprises that life offers.

Think about how many times your anger has destroyed a relationship caused you to miss a happy day with friends and family. That’s time you’ll never get back.

12. Forgive and Forget

To ensure that you make long-term changes, you need to forgive people who have angered you. It is not easy to forget past resentments, but the only way to move on is to let go of these feelings (depending on what or who is at the root of your anger, you may have to seek a professional’s help to achieve this).

So, start today. Make amends with one person that you;’ve hurt through your anger. It might be difficult, but you’ll feel better afterwards. Plus, you’ll be one step closer to healing the relationship.

TIP: These strategies are only a general guide. If anger continues to be a problem, you might need to seek the help of a suitably qualified health professional, especially if your anger hurts others, or if it causes you physical pain or emotional distress.