Stress management dr.yks

“Stress and its Management”

Dr. Yogesh K SinghalPG Resident Ist Year

PSM DepartmentRNT Medical College,

Udaipur

OVERVIEW of PRESENTATION1. DEFINITION2. TYPE OF STRESS3. STRESSORS4. SUICIDE : Stress is a big cause5. GENERAL ADAPTATION SYNDROME6. STRESS MEASURMENT 7. EFFECT ON HEALTH8. STRESS MANAGEMENT9. STRESS MANAGEMENT TECHNIQUES

“My limbs quail, my mouth goes dry, my body shakes and my hair stands on end”

(from Bhagwat Gita Chapter I verse29)

This is a situation of a person going through the extremely stressful situation.

• It was the condition of Arjuna when he was standing in front of Kaurav army, thinking about the different possibilities, like killing his own relations.

After listening Geeta versus from Krishna, Arjuna became free from that extreme stress. In modern world we can term it, counseling by close friend.

While Kaurav army did not have the same feeling of stress . This is a proof that apart from external factors, your response to the situation determines the degree of stress.

Stress? • Stress is the body’s

automatic response to any physical or mental demand placed on it.

• Stress is the human reaction to events in our environment

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Stress?•Stress can be any force that impairs the stability and balance of bodily functions.

• Stress is wear and tear on the body• Adrenaline produced in our body as a response to stress.• Fight or Flight response is elicited.

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Stress

Normal People

Psychiatric Patients

• The reason for stress is our own attachment to a particular outcome, and our inability to adjust to any other outcome.

STRESS!!!• If stress disrupts body balance and function, then

is all stress bad? “Not necessarily”

• A mild degree of stress and tension can sometimes be beneficial.

• Moderate levels of stress may actually improve performance and efficiency

• It is termed as Eustress• Eustress occurs when activities slightly pushed, but

not overwhelmed. • When goal is out of reach, but not too far

EU-STRESS = good stress• it is the positive cognitive response

to stress that is healthy, or gives positive feelings

• slightly more than what one can handle.• Examples -Winning the lottery, Gambling,

Getting engaged, Meeting or engaging in a challenge, Watching a scary movie, Going to First Date

However, it depends upon the personality

DISTRESS !!!• It is an aversive state in which

a person is unable to adapt completely to stressors and shows maladaptive behaviours.

• Distress: Stress from bad sourcesExamples : – Difficult work environment– Overwhelming sights and sounds– Fear– Threat of personal injury– aggression

FOUR TYPES OF STRESS 1. General Stress:

– Everyone has this kind of stress

– It resolves itself within a day or two

– No intervention is necessarily required

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FOUR TYPES OF STRESS2. Cumulative Stress:

– Stress builds up in the body– It becomes more difficult to

alleviate your symptoms– One can have more serious

physical or mental symptoms.

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FOUR TYPES OF STRESS3. Acute Traumatic Stress:

– Critical Incident Stress

– Produces considerable psychological distress

– A normal reaction to abnormal events

– Ex : RTAContinue…….

FOUR TYPES OF STRESS

4. Post Traumatic Stress:– Severe stress produced by

severe psychological trauma

– Created after any Critical Incident Stress

– Produces lasting changes– Need visit of Psychic clinic

StressorsStressor is any physical,

chemical, or emotional factor that causes bodily or mental unrest.

Trouble saying no Incompatibility with roommate’s habits,

schedule, lifestyle Tension with family, friends or romantic partner Death of a close friend or family member Parents divorce, separation or conflicts. Harassment at workplace

Stress

Justified Stressor

No Justified Stressor

Stress management

Psychiatrist Opinion

If there is not a source, may be mental status of subject is subnormal.Stress without any justified cause is warning signal of mental illness.

• Over one lakh suicides in India every year• WHO- Suicide rate highest in India in SEAR.

(21.1 per 1 lakh people)• 2,58,075 suicidal deaths in 2012• Rajasthan – less than 5 per lakh• Highest suicide rate in Pondicherry (36.8)• Lowest in Bihar (0.8), Nagaland and Manipur• 34% cases in age group of 15-29 & 30-44• 80% victims were literate• Suicide rate in male is twice that of female

Suicide : Stress is a big cause

Who is most susceptible to stress?

• People without strong social support networks• People who are physically unwell (Chronic ill) • Age related stages- Students, working parents,

Senior citizens, • People of Type A personality• Type A personality• Persons who are ambitious, impatient, status conscious, rigidly

organized, take on more than can handle, anxious, proactive, workaholics

• Type B personality• Persons who are funny, creative, enjoy exploring ideas,

General Adaptation SyndromeGeneral Adaptation Syndrome is Body Response to Stress

• Stage I - Alarm ReactionThe “fight or flight” response which causes you to be ready for

physical activity

• Stage II – Stage of adaptationIf stress continues, the body adapts to the stressors

• Stage III – Stage of Exhaustion

Stress persists for a long time

The body’s resistance may be reduced or collapse quickly

• Physical– Headache – Back Pain– Fatigue– Aches and Pains– Sinus Tachycardia– sleep disturbances– lack or increase in

appetite• Mental

– Difficulty Concentrating– Increased Errors– Poor Decision Making– Anxiety– Depression– Anger– lack of interest in

routine work

Effects on health due to excess stress

• Use of Tobacco leads to Hypercholesterolemia, Cardiac problems

• Use of Alcohol leads to Acute Pancreatitis, Gastritis, CLD.

• Using pills or drugs cause Drug Dependence leads to side effects and withdrawal symptoms

Direct effects In-Direct effects

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Physical Stress SymptomsShort Term– Dry mouth– Cool skin– Cold hands and feet– Increased sweating– Rapid pulse & heart rate– Diarrhea– A desire to urinate

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Long Term– Insomnia– Change in Appetite– Sexual disorders– Feelings of intense

tiredness– Prone to illness

• Stress may worsen the intensity of symptoms and progression of diseases in many people.

Clinical manifestation due excess stress

Stress Measurement• Holmes and Rahe stress scale is a list of 43 stressful life events

that can contribute to illness– Score of 300+: At risk of illness.– Score of 150-299: Risk of illness is moderate (reduced by 30% from the

above risk).– Score <150: Only have a slight risk of illness

• Depression Anxiety Stress Scales is made up of 42 self-report items to be completed over five to ten minutes, each reflecting a negative emotional symptom.

• Changes in body vitals can be used to measure stress. • Cortisol is released during a stress response and measuring

cortisol from hair will give a 60-90 day baseline stress level. This method of measuring stress is currently the most popular method in the clinic.

Identify the sources of stress in your life

• It may seem that there’s nothing you can do about stress. The bills won’t stop coming, there will never be more hours in the day, and your career and family responsibilities will always be demanding.

• But the simple realization that you’re in control of your life is the foundation of stress management.

• Stress management starts with identifying the sources of stress in your life.

• To identify your true sources of stress, look closely at your habits, attitude, and excuses

Healthy ways to relax and recharge

Relax• Our brain fires electrical waves at 14 or more cycles

a second. • These are beta waves and are great for getting tasks

done, but not for learning new things.• Taking a few minutes to relax deeply slows your

brain waves down.• These slower waves are alpha waves.• They occur at between 7 and 14 cycles a second• Studies show alpha waves improve learning.

Healthy ways to relax and recharge

• Blame others- blaming the God and luck is most used method of stress management

• Express your emotions loudly- shout, weep, laugh,

• a good workout.• have a warm cup of

coffee or tea• Watch a comedy.

• Have healthy sexual life• Spend time in nature• talk to close friend• write in your diary • Play with a pet• Work in your garden• Get a massage.• Curl up with a good book • Listen to music

Dealing with Stressful Situations : The 6A’s

• Avoid the stressor• Alter the stressor

• Adapt to the stressor• Accept the stressor

Change the situation

Change your reaction

•Arrange time for fun and relaxation•Adopt a healthy lifestyle Change your life

Stress management strategy #1: Avoid unnecessary stress

“Handle every stressful situation like a dog, if you can’t eat or play with it. Just pee

on it and walk away”

• Learn how to say “no” – Know your limits and stick to them, taking on more than you can handle is a recipe for stress.

• Take control of your environment – If the evening news makes you anxious, turn the TV off.

• Avoid hot-button topics – If you get upset over religion or politics, cross them off your conversation list.

• Avoid people who stress you out – If someone consistently causes stress in your life and you can limit the amount of time you spend with that person or end the relationship entirely.

Stress management strategy #1: Avoid unnecessary stress

Stress management strategy #2: Alter the situation

• If you can’t avoid a stressful situation, try to alter it.• Express your feelings : If something or someone is

bothering you, communicate your concerns in an open and respectful way.

• Be willing to compromise. When you ask someone to change their behaviour, be willing to do the same.

• Be more assertive. Deal with problems head on. If you’ve got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk.

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• Manage your time better. Poor time management can cause a lot of stress. – Get organized– Get structured– Set short term goals– Set long term goals– Use a planner – daily schedule and “To Do” list

Stress management strategy #2: Alter the situation

Stress management strategy #3: Adapt to the stressor

• Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam think, is it really worth getting upset over?

• Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. If the answer is no, focus your time and energy elsewhere. Continue…….

If you can’t change the World, change yourself.

Stress management strategy #3: Adapt to the stressor

• Adjust your standards. Perfectionism is a major source of avoidable stress. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”

• Eliminate words such as "always," "never," "should," and "must.“

• Focus on the positive. When stress is getting you down, think about the things you appreciate in your life, including your own positive qualities and gifts.

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One negative thought leads to another……….. then another……….. then another …..

Pretty soon you have ruined your entire life

Stress management strategy #4: Accept the things you can’t change

• Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are.

• Don’t try to control the uncontrollable.

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Stress management strategy #4: Accept the things you can’t change

• Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes.

• Free yourself from negative energy by forgiving and moving on.

• Rethink the situation and learn to be more flexible

• Learn to manage your anger • Anger affects your health and you

over-react to many situationsContinue…….

Stress management strategy #5: Arrange time for fun and relaxation

• Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs.

“Nurturing yourself is a necessity, not a luxury”

BECAUSE

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• Fill your life with fun things to do!!!!

• Keep your sense of humor!!!!

• It is called: PLAY THERAPY

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• We all need a lengthy list of things that will help us relax…..

• I love horse back riding.

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• Relaxing needs to be part of your daily routine.

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• Temple, Church, etc• Help others• Spend quiet time every day• Be thankful• Think positively• Put your faith to work!

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Spirituality


• RELAAAAAAX

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• RELAAAAAAX

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• RELAAAAAAX

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• RELAAAAAAX


Stress management strategy #6: Adopt a healthy lifestyle

• You can increase your resistance to stress by strengthening your physical health.

• Get enough sleep • Exercise regularly• Eat a healthy diet • Reduce caffeine and sugar. • Avoid alcohol, cigarettes, and drugs.

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• Rest:– Get a minimum of six

hours of continuous rest

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• Exercise:– At least twenty minutes,

five times a week – break a sweat, to release

endorphins

• Too many people look for an easy answer to stress management by misusing

• It may temporarily reduce stress, but they cause more damage in the long run

• Alcohol• Drugs• Smoking• Medicines & Pills


Stress-management techniques

• Yoga• Autogenic training• Biofeedback• Imagery• Meditation techniques• Qigong• Tai chi• Start a Stress Journal• Organizational skills

Stress-management techniques

Yoga• One goal of yoga is to

restore balance and harmony to the body and emotions through numerous postural and breathing exercises.

• Among the benefits of yoga are increased flexibility and capability for relaxation.

Autogenic training• This technique is based upon passive concentration

and awareness of body sensations. Through repetition of so-called autogenic "formulas" one focuses upon different sensations, such as warmth or heaviness, in different regions of the body.

• Popular in Europe (where it is even covered by some insurance plans).

• No particular physical skills or exercises are involved.• Since this technique is slightly more complex than

some relaxation methods, a course is generally the best way to learn the method.

Biofeedback• Biofeedback is measurement of body vitals during

stress and after achieve relaxation by use of the monitoring equipment.

• For example, instruments can be used to measure heart rate, blood pressure, brain activity, muscle tension.

• By receiving this feedback, one can learn to identify the processes that achieve the desired result, such as reduction in heart rate and blood pressure.

• Because the technique involves the use of measuring devices, it can only be performed by a professional.

Imagery

• Create a mental image of a pleasant and relaxing place in your mind. Involve all your senses in the imagery: see the place, hear the sounds, smell the aromas, feel the temperature and the movement of the wind. Enjoy the location in your mind.

Meditation techniques

• Transcendental meditation involves generation of the so-called relaxation response through the repetition of a word of phrase while quietly seated, 10-20 minutes per day

• The meditation is deep centring and focusing upon the core of one's being; there is a quieting of the mind, emotions, and body. •Some people like to focus on sounds. The classic example is the 'Ohm‘.

Qigong• The martial art qigong is an ancient Chinese health-care

system that combines physical training (such as isometric, isotonic, and aerobic conditioning).

• Some forms are practiced while standing, sitting, or lying down; others involve structured movements or massage.

• Over 70 million Chinese practice some form of qigong daily. • Learning qigong involves time, commitment, patience, and

determination, and learning from a master or group is advisable.

• Since this technique involves physical exertion, check with the doctor before beginning, particularly if you have a chronic medical condition or are over 40 years old.

Tai chi

• Like qigong, tai chi is a Chinese martial art. It has been termed a kind of "meditation in motion" and is characterized by soft, flowing movements that stress precision and force. Also known as tai chi chuan, this method is thousands of years old.

• training from a master is necessary to learn the art of tai chi. Again, since motion and force are required, check with the doctor before beginning training.

Start a Stress Journal

• A stress journal can help to identify the regular stressors in the life and the way to deal with them. Each time you feel stressed, keep track of it in the journal. As you keep a daily log, you will begin to see patterns and common themes. Write down:

• What caused your stress (make a guess if you’re unsure)

• How you felt, both physically and emotionally• How you acted in response• What you did to make yourself feel better

• If your physical surroundings (office, desk, kitchen, closet, car) are well organized, you won't be faced with the stress of misplaced objects and clutter.

• Make it a habit to periodically clean out and sort through the messes of paperwork and clutter that accumulate over time.

Organizational skills

How can I get help with stress management?

• Consider counselling. • Stress-management counselling is offered by

various types of mental-health professionals. Stress counselling and group-discussion therapy have proven benefits in reduction of stress symptoms and improvement in overall health and attitude.

THANKS…….

Health & Medicine

Stress management dr.yks