iCope Blog

Resilience Factor: Self-Esteem

Although the term “self-esteem” is a very general term, most of us have a pretty good idea of the concept. As you would expect, it is better to have generally positive self-esteem, which can help us in many ways, including our thoughts/opinions about ourselves, our emotions, our behavior, and our social life. As you would expect, all of these areas can be affected in a negative way by low self-esteem. This is important because low self-esteem will cause greater stress, and improved self-esteem will enhance your overall resilience to the negative effects of stress.

COGNITIVE FACTORS IN SELF-ESTEEM

Three psychological or mental habits can erode self-esteem: negative labeling, rejecting positive feedback, and making unfavorable comparisonsIf you regularly give yourself negative labelsuch as “loser,” “unattractive,” or “failure,” this will definitely affect your self-esteem. If you hold on to those labels, new life experiences like doing poorly in a particular class /job assignment or having a relationship end will then strongly reinforce the label or self-image. Holding onto a negative label forces you into an all-or none view of yourself. If you hold onto any negative labels, you need to begin challenging the basis of those specific beliefs as soon as possible. As discussed in a prior blog, you can use rational self-talk to counter various negative labels as an “irrational or unhealthy belief.

The second psychological habit is rejecting positive feedback, which can be a mental habit as well as a behavioral habit. Individuals with low self-esteem psychologically filter out positive comments or feedback because it does not fit with their perception of themselves. Behaviorally these individuals react to positive feedback or compliments by discounting them, saying things like “oh, I was just lucky,” or it wasn’t that big of a deal.” If this is the case for you, you want to start accepting positive messages. It’s much better when complimented to say something like “thank you, I appreciate that,” or “it was nice of you to say that.” Try to practice both mentally and behaviorally accepting positive messages from others to enhance self-esteem.

The third mental habit that is damaging to self-esteem is making unfavorable comparisons between yourself and others. From a rational perspective, it is important to recognize that all of us can find others who are “better” with respect to certain qualities. Think about Labron James, Lyndsey Von, etc. Who could compare themselves favorably to these elite athletes in terms of their skills in their sport? However, comparing yourself to others is not the best measure of your self-esteem. It would be irrational to think that you could compare favorably to everyone else on all or even most of your personal qualities, not just athletic skill. Each of us has to do our own inventory of our strengths and begin to value those areas in which we are satisfied, proud, and genuinely positive. None of us can be perfect, but each of us must learn to recognize our qualities that are positive and strive to correct those that fall short.

BEHAVIORAL FACTORS IN SELF-ESTEEM

The cognitive factors discussed above focus on belief systems and mental habits that can damage self-esteem. Behavioral factors focus on things you are doing or not doing that make you disappointed with yourself. Although none of us is perfect, it does not mean that we cannot improve in certain behavioral ways if this is important to our self-esteem. For example, if you have very few hobbies or extracurricular activities, and this limits your confidence or social contacts, you could identify some behavioral changes that could improve this. You could learn a new skill (e.g., playing chess, bowling, shooting pool, taking a dance, yoga, or acting class, etc.) that might open new social opportunities. If you are not very athletic and if playing a sport would improve your self-esteem, participating in a sport by taking lessons for an individual sport (e.g., tennis, golf, karate) or taking a chance on a team sport in school or at your company (e.g., softball teams, bowling leagues, or biking or ski clubs) could be a positive step. However, you do not even have to participate in a sport to deal with any lack of athletic skills if that is what affects your self-esteem. You could accept the fact that you are not athletic using cognitive coping skills, and focus on doing something that is more meaningful and positive to you. You could become a volunteer at a community organization, learn to play a musical instrument, or join an after-school club or work group even though these have nothing to do with athletic skills. Many community organizations like Habitat for Humanity can provide great opportunities for your involvement. The main behavioral point here is to do positive and meaningful things that enhance your self-esteem. Resilience is often directly related to finding and establishing these meaningful activities throughout our lifetime.

SOCIAL FACTORS IN SELF-ESTEEM

In addition to the cognitive and behavioral factors that can enhance or hinder your self-esteem, social factors also play a key role in your self-esteem. Being accepted by others is likely to enhance both social skills and self-esteem. Although it is irrational to strive to be loved and accepted by everyone, it is imperative to find and nurture some healthy social relationships. Learning the skills for positive well-balanced relationships is a key task to start developing as early in life as possible. It is important to keep in mind that the quality of friendships, not quantity is most important. It would be better to have one or two really close friends and a handful of good relationships than to be elected “prom queen” or “captain of the football team.”

Sometimes shyness or social anxiety will be a barrier to establishing these needed social relationships. If this is the case, you would want to find safe non-threatening activities or good environments to spend your time around others who have similar interests. If you avoid too many social opportunities, you will not be able to make the social connections that can then lead to positive relationships. As mentioned above, getting involved in making some behavioral changes in your lifestyle will involve getting into these social environments and overcoming some of the social anxiety you might feel. Take small steps if necessary to build your confidence to expand healthy social networks.

In summary, our self-esteem is very important to your overall well-being in many ways. For resilience to stress, avoid the mental traps and irrational beliefs that limit your confidence and self-esteem. Take charge of the things about which you are dissatisfied and change your behavior whenever possible with reasonable goals and expectations of what you can change and what “imperfections” you need to accept about yourself. Since your social life will be an important factor in self-esteem, work to improve your own skills and develop the willingness to take the reasonable but necessary risks to expand your social network to a level that is right for you. These cognitive, behavioral, and social skills will be extremely helpful in many arenas throughout your lifetime. Improved self-esteem will definitely improve your overall resilience to whatever stressors you might encounter.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

Using Rational Self-Talk to Defuse Stress

In a prior blog (Thoughts that Cause Stress) I discussed how certain mental habits and specific beliefs can actually increase our stress in very powerful ways. For the past 50 years psychologists have researched the best ways to change these stress-inducing mental habits and beliefs. These methods, which are sometimes called “cognitive restructuring,” require a few steps. The first step is simply becoming more aware of which habits and beliefs are causing you the most stress. You can improve your awareness by periodically reviewing the prior blog’s description of the major habits and beliefs that are likely culprits in increasing your stress.

When you become more sensitive to the fact that your thoughts and beliefs about a stressful event can magnify your reaction, you can begin to diffuse any irrational or negative thinking. These types of thinking patterns which are probably going on throughout your daily activities are likely to be somewhat automatic and unconscious. However, you can become more aware of them by asking yourself some basic questions whenever you notice that your stress level increasing in certain situations. For example, when an event occurs that increases your stress noticeably, ask yourself what you are thinking about the situation. What am I telling myself? Is this stressor triggering any of my irrational beliefs? Are some of my stress producing mental habits such as catastrophizing or focusing on the negative kicking in?

Blank Stress Analysis Charts can help you become even more aware of your stress producing self‑talk, which in turn will allow you to change it.

Make several copies of the charts, and whenever you notice a significant stress reaction, record your thoughts and your reactions in the left column. You then try to challenge the stress‑producing irrational thoughts with more rational self‑talk. As you get in the habit of noticing any of your irrational or negative thinking, you will be able to begin to learn a new language. This language produces less stress because it keeps things in perspective ‑ it keeps us more rational. This new language is represented on the right hand column of the chart. Here, truthful thoughts and statements about the stressful event are likely to be more rational and positive. Many of these statements directly challenge and dispute any irrational thoughts that were identified. This does not mean that tragic, painful, or upsetting situations will feel good. However, what it does mean is that the event will not be made any more stressful than it has to be.

The key goal here is learning a new way of thinking ‑ essentially learning a new language. Our old language that magnifies stress can be so strong that it will take a lot of patience and practice to learn the new one. Just as if you were learning a foreign language you would go through stages where the translation process is awkward and cumbersome. You have to consciously think of the correct way to say something and then translate from one language to the other. This is also true with learning how to talk rationally to yourself. Over time, you will begin to speak fluently with a rational dialog if you continue to practice. However, anyone who has taken a foreign language in school will recall that when it was not used regularly we could barely speak that language. You will need to use the language of rational self‑talk regularly in order to be successful in developing this coping skill.

A QUICK REVIEW

Here are a few general reminders about talking rationally to yourself. When you notice uncomfortable stress, take a few seconds to think as rationally and positively as you can.

  • What is making me so stressed?
  • It is probably not as bad as I think.
  • I’ve handled situations like this before.
  • I can calm myself and feel better later.

If these thoughts are not controlling your stress effectively, try to get more practice using the disputing and challenging skills on the Stress Analysis Charts. Make your statements specific to the exact stressor you are facing. Again, the goal is to keep things in perspective so that your stress is not exaggerated unnecessarily. Remember you are still going to feel some emotional reaction, especially if this is a significant event. This skill can become a powerful psychological tool that can be used anywhere, anytime.

You now have a major technique for mentally or psychologically controlling your stress. Remember these general principles of the cognitive methods covered in this blog:

  • Talk calmly to yourself when a stressor occurs.
  • Try to keep the stressful event in perspective.
  • Reassure yourself of your improved abilities to manage stress.
  • Avoid catastrophizing, maintaining unreasonable expectations, and focusing on the negative.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

Building Resilience Through Mindfulness Exercises

One popular strategy to enhance resilience to stress is “mindfulness training,which focuses on improved self-awareness, better attention skills, and deeper relaxation experiences. Research on mindfulness training methods has found numerous positive effects, including several improvements in health which suggests that this approach could provide a significant boost to overall resilience. Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction, describes this as a way of purposely and non-judgmentally paying attention in a particular way to what you are experiencing in the present moment. He and many other researchers have published extensively over the last 30 years on the benefits of mindfulness training.

In the most general terms possible, mindfulness training teaches us to pay attention to whatever we are experiencing. We all tend to tune out a considerable amount of mental information throughout any given day. In essence we go on “auto-pilot” as we engage in many activities. Many drivers will admit that when they are driving their cars, they can think of times when they would be miles down the road and suddenly be aware that they had not paid attention to what they saw or did over the prior few minutes – sometimes for many miles! Similarly, how common is it that we rushed through eating a meal and did not pay any overt attention to what we tasted or experienced in other ways during the meal? Some would call this “mindless” behavior versus a healthier “mindful” pattern. It has a been a cliché for many years, but the notion of “stopping to smell the roses” captures the essence and importance of what mindfulness encourages.

One way to understand this is to try to focus your attention (mind) on what you are experiencing right now. For example, if you closed your eyes and began to focus on your breathing, you would pay attention to the sensations, movement, and physiological reactions that you experience. Here, you would not want to judge the experience, such as: “Oh wow, my breathing is too fast or too slow.” You would just try to attend to your experience. A moment earlier before you focused on your breathing you were not even aware of each breath you took.

In mindfulness training you learn to become aware of your sensations and feelings, but want to avoid making any judgment about that experience. For example, if you focused on your breathing, you would not want to be thinking something negative like: “There must be something wrong since I cannot get calm or relaxed doing this.” Prior to this brief exercise you would be breathing without any conscious awareness or judgement of it. During the exercise you would become “mindful” of the breathing experience. Again, the purpose of mindfulness is to focus your attention on the experience in the present moment without judging it in any way. A potential, and very beneficial, byproduct of mindfulness is that when we focus attention on a current experience, we cannot be worrying or thinking about past or future problems. Obviously that could be helpful for dealing with certain sources of our stress. This may account for the general sense of “well-being” reported by many of those who go through mindfulness training programs.

Some of the basic exercises in mindfulness training are aimed at teaching a form of meditation to help you learn how to focus your attention. In this process, people can learn to achieve deep levels of relaxation. This part of mindfulness training clearly would help you with two of our iCope skills – self-awareness and physical relaxation. However, mindfulness training is much more than just relaxation training. You could practice mindful eating, walking, taking a shower, sitting at your desk, etc. Athletes, musicians, artists, and stage performers have used mindfulness training to enhance their health, relationships, productivity at work, as well as their performance skills. You can read many success stories of mindfulness training within professional sports teams. A recent web search for “mindfulness training in professional sports” produced over 8 million hits.

Here is a basic exercise that is often taught in most mindfulness classes:

This is quite different from the relaxation exercises in a previous blog where you were asked to focus on something like a word or a visual scene. In mindful breathing you are simply focusing your attention on the act of breathing and noticing what that experience feels like. It is described here, but if you have access to the internet, listen to a sample recording of the instructions that will definitely enhance the experience.

Get into a comfortable position, sitting up straight in your chair, or lie down if you prefer. It is helpful if you close your eyes during this practice, but if you do not feel comfortable doing that, you can keep your eyes open. Begin to focus on your breathing, paying attention to each breath as you inhale and exhale. You can breathe in and out through your nose if that is more comfortable, or inhale through your nose and exhale through your mouth.

As you settle into your mindful breathing, simply pay attention to what you experience. Notice any sensations throughout your body. It also helps to pay attention to how your breathing is being done. Check to see if you are using your belly as you breathe in and out. Using your belly (actually your diaphragm) does seem to help with relaxation. If you put your hands on your belly, you most likely will feel your belly expand as you breathe in and it will compress when you exhale. Sometimes emphasizing this type of breathing feels even more relaxing.

Focus on your breathing for about 4-5 minutes. A normal and expected part of this exercise is that you will find that your mind will wander. Your breathing will serve as an “anchor” to return to when you get distracted. You might start thinking about other things, typically from the past or things you need to do in the future. Noticing aches, pains, and physical sensations, or paying attention to sounds around you is also likely to happen. Again, this is normal and to be expected. You simply want to catch yourself when your mind drifts, and try to re-focus gently back on your breathing. Remember, this is a non-judgmental experience so there is not a good or bad experience. This exercise will give you a little sample of what mindful breathing is like. Try to do this at various times throughout the week to see if it leads to a sense of peacefulness, relaxation, or well-being. Regular practice is recommended for some of the health benefits of mindfulness training. Our website has links to some sites that have lengthier breathing exercises recorded.

Here is another easy exercise which only takes a couple of minutes at home:

Get a pleasant aromatic hand soap such as lavender or any other pleasant smelling one that you prefer. Wash your hands for two minutes in fairly warm but not hot water. Try doing this with your eyes closed, and as in the breathing exercise, focus your attention on whatever sensations that you experience. After 2 minutes, open your eyes dry your hands and see if you feel just a little more relaxed. Aside from getting good mindfulness practice by doing this exercise on some regular basis, is the physiological fact that warmer hands go along with the relaxation response and cooler hands typically indicate a stress response.

After you have had a little experience practicing these exercises, look for times throughout your normal daily routines where you can focus on your breathing and other activities, even if it is only for a minute or two. For example, if you drive to/from work you might practice your breathing exercise when you are stopped at some of the red lights; or focus on your breathing for a minute before any breaks you take away from your desk at work. These little practice exercises will help keep your awareness high to look for other situations in your daily activities where you can become more mindful and spend less time being on “auto-pilot.” If you take a mindfulness class, which is recommended, your teacher/leader will work with you to increase the amount of time that you can devote to the basic breathing exercise and add many other exercises to improve mindfulness.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

Thoughts That Cause Stress

When we encounter most stressors we mentally process them quickly like a computer. Many times this processing seems automatic and unconscious. Unfortunately, many of us have been conditioned to process stressful events in a way that magnifies our stress. What could be neutral becomes worrisome and stressful. What typically would create some distress now creates a much more intense reaction. Significant stress can then create panic. The adage “we can make mountains out of molehills” summarizes how we do in fact increase our own stress.

Some specific beliefs or values that we have learned in our culture from our parents, teachers, peers, and religious authorities, act as magnifiers of stress to some degree in just about all of us. Fortunately, we can change how we look at, perceive, or interpret situations so that we do not overreact to stressful events. Rather than magnify our stress, we can learn to filter out some of its negative impact on us.

We can separate these cognitive/mental factors that magnify stress into two categories: mental habits and specific beliefs.

MENTAL HABITS

Four mental habits are very common in our culture. First, you might catastrophize or make things seem dramatically worse than they really are. If so, you often see situations deteriorating or leading to tragic conclusions. You would tend to exaggerate and blow things out of proportion. A second mental habit is where you tend to see things in absolute terms. Do you think in an all or none fashion? If so, you would see things in black and white and have a hard time seeing the gray in between. This would lead you to “over-generalize” in response to certain events and your language will reflect this. Words like “never,” “always,” “everyone,” “no one,” and “impossible” are frequently heard. A third common mental habit is when we have a strong tendency to focus on the negative and tend to ignore the positive. If this is true for you, you may operate as if you have tunnel vision and your attention is likely to focus on what is “wrong,” “bad,” “terrible,” etc. You can easily spot flaws in people, places, and things. Your negative attitude may set you up to be dissatisfied, and to get angry or depressed easily. A final mental habit is having excessive expectations of yourself and/or others. Thoughts such as “I must” or “you should” frequently will run through your mind and your vocabulary. If these expectations are not realistic, you are likely to be disappointed in yourself and others.

These processes are like any other habits in that they are hard to break unless we are highly motivated to change them. However, even when we want to change these mental habitswe still need a good approach to be successful. These methods will be presented in detail in a future blog.

SPECIFIC BELIEFS

In addition to learning what some of your mental habits are, you want to increase your awareness of whether you are magnifying your stressors by examining your specific beliefs and attitudes. We all are likely to have some strong beliefs that can cause us additional distress The iCope books provide an expanded list of irrational beliefs and the effects these have on your behavior and personality. Below are just a few common beliefs that are likely to magnify our stress. See if you identify with some of these troublesome beliefs:

  • I must have love and approval of everyone who is im­portant to me.
  • I must be thoroughly compe­tent at everything I do.
  • The world should be fair.

These beliefs are described by most psychologists as being essentially irrational. This does not mean that the thoughts are “crazy,” but maintaining them will increase your stress. As such, they are major culprits in causing you more stress than you need to experience at any given time. It should be noted that these just happen to be some of the most common beliefs in our culture that are stress producing. Each irrational belief serves as a magnifier of stress, and it would be to your benefit to modify those beliefs. For some quick examples, more rational thoughts to counter any of the irrational beliefs above are listed below.

  • Instead of: I must have love and approval…

More rational thoughts would beI wish I could be loved and approved by ________, and it really hurts that I am not able to get that, but I can survive this. This is not a life or death situation.

  • Instead ofI must be thoroughly compe­tent at everything I do.

More rational thoughts would be: I try to do the best I can at whatever I do. If I am not perfect, or even fail, that is okay because this is how we learn. I am human and none of us are perfect.

  • Instead of: The world should be fair.

More rational thoughts would be: I wish the world was fair, but I cannot expect that in life. Bad things do happen to good people. No one promised me fairness, but it still can be upsetting when this happens to me. My challenge is to get past the “unfairness” and not let this interfere with other aspects of my life.

As stated above, you can buffer yourself from some stress by modifying any irrational beliefs. Fortunately, this can be done by learning to challenge irrational beliefs and talking to yourself in a way that helps break any mental habits or beliefs that are increasing your stress. “Rational self-talk” methods can be a powerful psychological tool that will be extremely helpful in managing your stress in the future. These cognitive restructuring” steps, which will diffuse much of the unwanted stress you encounter, will be presented in the next blog.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

Easy Steps to Relaxation

One of the core skills in any stress management or resilience program includes some type of relaxation training. The good news is that relaxation skills are very easy to learn with a little practice. The health benefits of just doing some form of relaxation or mindful meditation are very impressive and some of these benefits will be covered in future blogs.

Before we discuss this easy relaxation procedure it sometimes helps to understand one basic part of how our autonomic nervous system controls the fight-or-flight response. We are biologically wired for the protective fight-or-flight reaction in which our bodies go into high gear to defend ourselves or to escape. When activated through adrenaline and other hormonal changes our heart rate increases, blood pressure increases, blood vessels in the hands and feet constrict, breathing rate increases, and the bronchia in our lungs dilate to let in more oxygen. This stress reaction is controlled by the sympathetic nervous system. However, something has to turn the fight-or flight reaction off – otherwise we would all collapse with fatigue! Fortunately, we also have a braking mechanism in the parasympathetic nervous system, which counteracts the fight-or-flight reaction. Here your heart rate and breathing rate slows down, blood pressure decreases, and blood flow increases to the hands and feet. These two systems work together to maintain homeostasis, or balance, in our bodily functions. Other biological changes especially in the digestive system also occur in our body as can be seen on the diagram below.

Relaxation training or mindful meditation is vital to all stress management programs because it helps induce the parasympathetic nervous system sooner rather than later to counteract the stress response. Although your fight-or-flight response will eventually subside (as long as there is no continued threat), you can help speed this process up by physically relaxing.

Research has shown that anyone can relax physically under the right set of circumstances. This typically includes a few steps like getting into a quiet space in a comfortable position, and having something pleasant or even neutral to focus upon. Relaxation skills take some time to master and generalize to everyday situations but as with most skills, you will only get better with practice.

Our modified iCope relaxation procedure, which takes about 20 minutes, is as follows: Find a quiet place where you will not be interrupted for the time needed to try this procedure.

1) Get into a comfortable position lying down on your back. You can use a recliner type chair, or simply lie down in bed.

2) Try to loosen your muscles as best as you can. Briefly pay attention to the tension throughout your body, scanning from your head all the way down to your feet. You can roll your head gently side to side and stretch your arms and hands if that helps relax the muscles.

3) Make a mental note of your stress level by rating it from 1 (very relaxed) to 10 (very stressed).

4) Slowly take a very deep breath through your nose. Breathe in deeply enough to extend your stomach and hold it for a few seconds. Then breathe out slowly through your mouth. You can put your hand on your stomach to feel it rise with each deep breath.  Repeat this for three more deep breaths.

Now close your eyes and try to keep any other thoughts out of your mind. Allow your breathing to get into a natural and comfortable pace, breathing slowly in and out. Continue to breathe deeply in through your nose and out through your mouth.

In order to get more deeply relaxed, you will want something on which you can focus your attention. Try both of the following methods at different practice times.

a) Every time you exhale simply say a word such as “cope” or “calm” to yourself, and imagine tension flowing out of your body. Focus on your word as you breathe naturally. Do this for the remainder of your practice session.

b) The other method to try at a different time is particularly good for those who can “visualize” an image with their eyes closed. Instead of focusing on a word, imagine a very peaceful and calm scene such as a sunset or a peaceful place from your past.

5) Continue breathing naturally and focusing on your word or your scene for 15-20 minutesDo not be concerned if you get distracted. This is totally normal and expected. When that happens, and it will, try to bring yourself back to the procedure and remind yourself that you want to continue focusing on your word or scene.

6) When you finish, sit quietly for a few minutes, and make a mental note of your stress level (rating it again from to 10) and what your muscles feel like when you are more relaxed. Doing your pre- and post- stress ratings will help reinforce your relaxation practice. Over time you will see decreases in stress levels during your practice.

7) Open your eyes, but do not stand up suddenly. Remain calm in your body, but alert in your mind. When you feel alert and ready to get up, do so, but try to remember the calm relaxed feelings and sensations (muscle memory) you have just experienced.

To control stress levels in your day-to-day situations where you want something less than the 15-minute procedure, simply take a minute to take 5-6 slow deep breaths whenever you notice your stress level increasing. Also, try to recall your muscle memory of the relaxed feeling you had in your practice sessions.

If you are having difficulty with the 15-20-minute practice sessions after a few attempts at trying it, use some calming music (or one of the many recordings of nature sounds that are easily available on the internet) on which to focus for 15- 20 minutes. If that is not appealing to you, try some of the guided relaxation exercises or the mindful meditation exercises below:

  • You can find three different relaxation exercises by a sport psychologist ranging from a one-minute procedure up to a 14-minute guided procedure here.
  • And you can find a pleasant 5-minute mindful meditation exercise by searching “Guided Breathing Exercise (Clouds)” at YouTube.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

© 2018 Anthony R. Ciminero.