Coping with Real, Remembered and Imagined Stress: Focusing Methods

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By Monica Neel, PSYD and Jim Fauerbach, PHD


Editor’s Note: This article is the first in a series of articles based on research funded by the National Institute for Disabilities Research and Rehabilitation (NIDRR).


STRESS!! We all experience it. Feelings of stress may occur in response to approaching deadlines, arguments with loved ones or even traffic jams. For those who have experienced a burn injury, feelings of stress may occur when thinking about circumstances surrounding the injury, when tackling the rehabilitation process, or even when thinking about returning to your normal daily routine. This is the first of a series of articles discussing psychological approaches to managing stress. 

Distress is the complex set of unpleasant psychological, physiological, and behavioral responses we experience in the face of a stressor. Broadly speaking, a stressor is anything that challenges our sense of competence, comfort and well-being. In this article, we describe the human stress response and how it can be brought on by not only current events, but also remembered past events and even imagined future events. This article also provides detailed instruction on two methods of stress management. We suggest that you try recording the italicized words for each activity in a slow, meditative manner and playing the tape for yourself while relaxing. 



Have you ever heard of the “fight or flight” response? This instinctive reaction to a stressor evolved out of evolutionary necessity. When humans roamed the plains with saber-tooth tigers, our only chance for surviving an encounter with such a predator was to challenge the attacker (fight) or run for protection (flight). In modern man, this complex set of reactions still occurs inside each of us whenever we feel threatened:

  • First, awareness of a threat causes the fear-centers in the brain to trigger the stress response.
  • Next, powerful neurochemicals increase the heart rate and blood pressure, make the lungs breath faster, and prepare the muscles for action.
  • At the same time, the body conserves energy by slowing down or stopping other bodily functions such as digestion, excretion, and even the protective functioning of the immune system
  • Finally, all five senses become focused on the source of the threat, while the mind races to analyze the best way to respond to the stressor

During and immediately after your burn injury, this inter-related series of physiological, cognitive, and behavioral changes was probably going on inside you. This is an adaptive response to all real threats occurring in the present moment. 



Humans have an uncanny ability to vividly recall prior experiences and to imagine future situations. This ability, however, may be both a blessing and a curse. On the positive side, memory and imagination enable us to learn from our past experiences and plan for the future. By learning from experience we can prevent bad things from happening again, and make good things more likely to happen. Similarly, imagination allows us to plan for future events ahead of time so we are more prepared. However, the same human stress response that is triggered by a clear and present danger (like noticing an erratically driven car coming towards you) can also be unnecessarily “turned on” by memories of threats from the past, or imagined catastrophes that may occur in the future. 

For example, individuals who have experienced a burn injury may notice that the stress response is triggered when thinking about the circumstances surrounding their injury, when considering what they “should” or “could” have done, or when ruminating over the losses incurred as a result of the burn injury. Similarly, feelings of stress may also accompany thoughts about how to handle future situations like entering certain social situations or engaging in tasks you were doing when you were injured. While all of these thoughts deserve consideration, none warrant a stress response as there is no current threat. When we become “stuck” in this pattern of ruminating about the past or worrying about the future, we pollute the present moment and our ability to live in the “hereand-now.” Try the following “thought monitoring” activities.

Monitoring Future Worries:

Name any thoughts that scare you about:

  1. entering certain social situations
  2. doing things that you were doing when you got hurt
  3. having another intrusive image or nightmare.

Notice how these thoughts take you away from the present moment. 

Monitoring Past Ruminations:

Name any thoughts that sadden you when remembering what happened regarding:

  1. loss of health and function,
  2. loss of control and safety
  3. guilt or shame. 

Notice how these thoughts take you away from the present moment. Be aware of how your thoughts about these things interfere with the present moment. Using a simple “thought stopping” reminder, stop the endless ruminating and worrying. Put these thoughts on hold except for one-hour each day during which you will focus on turning your worries into problems that can be planned for and solved. 

Ancient philosophers and spiritual masters like the Zen Buddhists and yoga gurus have taught for centuries that the ability to live and function in the present moment is the cornerstone of mental health. Much of modern psychological science also subscribes to this point of view. Our health and well-being depend on the ability to be fully aware of our surroundings and our innermost thoughts and feelings. However, it is quite common to create distress in the present moment by distorting memories of an actual event (ruminating over the past), or by exaggerating the probability of a negative outcome in the future (worrying about the future).

Awareness of the present moment is the foundation for many important functions like staying focused on a task, savoring a sensory experience like smelling a pot of brewing coffee, and interacting with those we really care about. After you have used the thought monitoring above to stop your ruminations and worries, doing the following activities may help you be present to the moment and minimize feelings of distress.



Name one thing that you are hearing, one thing that you are seeing, and one object you are touching. Now focus on each, one at a time, allowing the awareness of what you are experiencing to fill your mind. Try savoring each of these sensory experiences in turn. The following passage is an example of present sensory focusing emphasizing the sense of hearing. You may also want to try this with other senses as well (e.g., sight, smell, taste, touch).

Be aware of the symphony of sounds around you at this moment. Start by listening for any rhythmic sounds like those from your heating system, or the traffic in the hall or street. Allow this rhythm to fill your awareness, without anticipating it or recalling it – simply stay with the flow of sounds occurring in the present moment. Now notice any intermittent sounds around you – voices, laughter, birds, etc. Notice how these sounds move around the base rhythm. Sometimes higher, sometimes lower. Savor the texture of each sound around you. Some sounds are rough and almost like sandstone; others are clear and fresh like water flowing in a brook. Next, notice any movement. Some sounds move while others stay in place. Now, notice the pitch of the sounds around you. Allow your awareness to move higher with high tones and to descend with the lower ones. Finally, allow yourself the pleasure of being absorbed in every aspect of the sounds around you – rhythm, texture, pitch… Let this happen. There is no work involved. Simply be present. 



By refocusing on the present moment using sensory focusing, we encourage you accept the past and embrace the uncertainty of the future. It is beneficial, at this point, to describe another method useful in quieting the mind and body. Retraining your breathing is one way of gaining confidence that we are able to soothe, calm, and center ourselves after being upset even in the most stressful times. Begin by sitting or laying down in a position that allows you to breathe freely and where your abdomen does not feel constricted. 

Perhaps you would like to first try this series of slow deep “cleansing breaths” to increase your awareness of your breathing. First, slowly inhale, filling your lungs from the bottom to the top. Pause for a count of three when your lungs are full, then slowly exhale emptying your lungs from the top down. Use your abdominal muscles to gently push out the last remaining air, then pause again for a count of three. Repeat this process of filling and emptying your lungs three times. Next, focus your awareness on the slight sensations of rising and falling as your abdomen expands and contracts with your breathing. Allow this to fill your awareness while reminding yourself that the breath of life anchors you in the present moment. Calm, effortless, rhythmic breathing allows the balance of oxygen and other gasses in your bloodstream to harmonize with your body’s needs. Now allow your awareness to focus on the flow of air at the back of your throat. Feel the cooler, drier air moving in as you inhale and the somewhat warmer, moist air flowing out as you exhale. Notice any constrictions in this flow where tensions outside of your awareness may cause you to hold in, push out, or hold open your airway. Try letting this constriction lessen as you gently focus your awareness on it. Next, allow your awareness to focus on the flow of air at your nostrils and your sinus passages near your nose. Again, notice the effortless flow of cool, dry air in, and the warm, moist air out as your breathing cycle endlessly and effortlessly repeats itself. Finally, allow your awareness to encompass the full rhythm and flow of the breath. Allow your awareness to move in as you inhale and follow the air flowing past the nostrils, the sinuses, and now the back of your throat into your abdomen, and then back out again. Follow now the rhythmic flow of air moving in and out, in and out. Allow your mind to take in fully this awareness and to be absorbed in the rhythm. 



Kabat-Zinn, J. Full-catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing, 1990.

Kabat-Zinn, J. Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion, 1994. 
Kabat-Zinn’s stress management tapes can be ordered from: Stress Reduction Tapes, P.O. Box 547, Lexington, MA 02420, or the website:

Segal, Z.V., Williams, J.M.G., Teasdale, J.D. Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press, 2002. 


MONICA L. NEEL, PsyD is a psychology postdoctoral fellow at Baltimore Regional Burn Center at Johns Hopkins Bayview Medical Center. In addition to providing clinical services to individuals with burn injuries, she is the study coordinator of the burn model system grant funded by the National Institute on Disability and Rehabilitation Research.

JAMES A. FAUERBACH, PhD is the chief psychologist on the burn trauma and cardiology services at the Johns Hopkins Bayview Medical Center. He is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and is Principal Investigator for the National Institute on Disability and Rehabilitation Research model system grant awarded to the Johns Hopkins University (H133A020101, Theresa San Agustin, MD, NIDRR Program Officer). 

This story is an excerpt from The Phoenix Society’s® Burn Support News, Spring Edition 2003, Issue 1. Burn Support News is a tri-annual publication that contains articles on the emotional, psychological, and social aspects of burn recovery.  All Rights Reserved.


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