Emotional Well Being & Conflict Resolution_VKV.pptx

Presentation

1. “Emotional Well Being and Conflict Resolution/ Stress Management” Dr. Tame Kena MD Associate Professor Department of Psychiatry TRIHMS, Naharlagun

2. Objectives of today’s presentation What is emotion and how does it get disturbed How to identify if one is stressed/ emotionally disturbed Physical and psychological signs and symptoms Complications of stress- effect on our physical/ mental health How to manage stress: Different coping strategies Conflict resolution/ Breaking Bad news Time Management, Diet and sleep hygiene Common Mental Illness & Treatment Local Resources available

3. Emotional Health: What is it? Emotions are a natural response to situations in life Emotions are neither good nor bad; how they get expressed is important Managing emotions is the ability to identify, label and express them appropriately Managing emotions is an important skill that one needs to practice

4. Emotional Stress : What is it? Stress is defined as a condition or feeling experienced when a person perceives that “demands exceed the personal and social resources the individual is able to mobilize” Richard S Lazarus, 1966

5. Stress: Historical perspective The term “stress”, as it is currently used was coined by Hans Selye in 1936, Defined stress as “the non-specific response of the body to any demand for change”.

6. Stress: Current Definition Stress is defined as “a state of homeostasis being challenged- includes system stress and local stress” A specific stressor may potentially bring about specific local stress When the intensity of stress goes beyond a threshold –activation of Hypothalamic-Pituitary-Adrenal (HPA)-Axis result in a systematic stress response Siyu et al Cell Stress 2021

7. Emotional Stress : What is it? Is it a normal feeling? Long-term emotional stress can contribute to or worsen range of health problems including digestive disorders, headaches, sleep disorders, etc Stress may worsen existing illness asthma, diabetes Can lead to depression, anxiety, and other mental illnesses

8. Framework of stress system Three types: Sustress (inadequate stress) Eustress (good stress) Distress (bad stress) Sustress and distress can impair normal physiological functioning and lead to pathological conditions Increase intensity stress---decrease performance Eustress is beneficial by optimization of homeostasis Optimal stress level- essential for building biological shields guarantee normal life processes.

9. Why focus on Emotional Stress ?

10. Feel Drowned in Work!!!

11. Stress at School & Hostel !!! Routine: time bound- everything should be ready Wake up in time, get ready for PT, cleaning, Study, ready for school, play, sleep-light off Make sure everyone is rounded Very less time to relax/ take break: for students and wardens!

12. Burnout can happen Physically stressed- slow in activities Emotionally fatigued- irritable, sleep disturbances Mundane/ routine based: repetitive and can be boring Have to put up with tasks even if you don’t agree Strictness/ disagreement with higher up

13. How does stress effect different systems in our body

14. Causes of stress

15. Reaction to stress Initial Reaction Fight or Flight Body tries to cope and adapt to continued stress/ repair damage caused by stress Once its overcome-physical signs disappear Resistance to stress increase each time we deal with, makes us stronger If no relief from stress Emotional or mental breakdown happens with more physical problems

16. How to know you are stressed Have a hard time making decisions Trouble meeting important deadlines Feel there aren’t enough hours in a day Feelings of fatigue or sleepiness even with enough sleep Have low self esteem Criticize or argumentative Mood swings/ depression Easily forgetful

17. How to know you are stressed Change in appetite Smoking, drinking or using drugs to cope with stress Experience rapid, irregular heartbeats Rapid breathing or hyperventilation Muscle aches, headaches or migraines Raised blood pressure Skin changes

18. So what to do?

19. Aim of Emotional Stress management Goal is not to avoid or eliminate stress It will come in many forms / many times But how to manage/overcome it Need to educate ourselves Ability to eliminate lies in understanding it

20. Emotional Stress Management First of all need to know: Am I stressed out? Acknowledging the presence of stress Identify triggers. work load, customer complains deadlines, conflict with colleagues Effect of stress on me Physical and mental/ emotional Impact of stress on my health Maladaptive way of coping due to stress

21. Emotional Stress Management Making lifestyle changes Adequate Sleep & Diet , Exercise A void maladaptive lifestyle; unhealthy diet and substance of abuse Being aware of emotions & Managing emotions Coping with problem (solving) Learn to deal with emotions if problem cannot be solved Thoughts and emotions – inter related Challenging false assumptions and belief Replace maladaptive with positive thoughts I am bad-leads to feeling low-I am worthless (vicious circle)

22. Emotional Stress Management 4. Communication Encourage communication between team members Make employees comfortable to seek help/ feedback 5. Mindfulness & Relaxation 6. Time Management: 4 Ds 7. Hobbies, Religion and Spirituality

23. Emotional Stress Management 8. One to one: quality time with students Some students need extra guidance One to one mentorship to overcome during that period 9. Socialising in real world Meeting in person, not on social media (mobile use tends to be a Big Issue now) 10. Work Life balance Encourage leave, vacations (if possible) Discourage work from home/ emails (during leave)

24. SWOT Model in Emotional S tress managment SWOT ( Strenth , Weakness, Opportunities, Threats) Strength: Internal resources you have and things that you do very well Can be specific skill or ability that you are born with or that you learn such as singing, playing music, swimming, drawing etc Weakness: Specific skills or abilities which you need to improve upon or are currently lacking

25. SWOT Model in Emotional Stress managment SWOT ( Strenth , Weakness, Opportunities, Threats) Opportunities: Favourable external factors that are available for your support and growth Could be people or situations that help you recognize your strengths, use them and learn new skills Threats: Obstacles that come in your way external factors that have the potential to block your growth or harm you

26. Time Management to decrease emotional stress Why time management? Student like: …Time is precious.. productive use of your time Working smarter, not harder Being busy doesn’t mean you are effective

27. Benefits of time management 1. It helps you achieve your goals faster Proper time management- more effective Avoids multitasking focus on one activity at a time for a specified duration You get more done in less time

28. Benefits of time management 2. Reduces stress You can get with a long list of “to do”- can make you feel everything as “daunting” With proper time management You are in control of your time You are in control of your activities

29. Benefits of time management 3. Prevents procrastination and boosts your confidence Procrastination is a slippery slope leads to stress, frustration Setting aside a specified time for a task Helps you overcome laziness /procrastination

30. Time Management

31. Time Management Help Students to narrow down/ Arrange task or work in order of importance Create a checklist assignments, projects, study groups, etc. Add their deadlines Can make a table and tick off the tasks done If the list seems long grouping similar tasks together Each group can be done at same time

32. Time Management 4. Break down tasks into smaller tasks overwhelmed if a massive project at hand 20-page report 2 pages per day, can finish in ten days 2-page report- less intimidating Vs working 20 page at stretch 5. Have Master Schedule For a week/ month/ year Pencil in essential tasks for the week/ month Template to create timetable for other tasks Serve as overall schedule to have all tasks listed

33. Time Management 6. Rewarding self / students rewards can reinforce this habit Celebrations are fun celebrate the win/on task completion; whether big or small (having a coffee, treating self with a chocolate) Helps in Effective management- needs to be a habit needs to be nurtured

34. Time Management 7. Maintain Consistency in Tasks and Make it a Habit Once you are in a routine mind and body starts adapting to the routine Maintain the rhythm of sleeping, eating, learning, reading, exercising Your focus improves; your motivation goes up May seem simple but very effective to endure stress

35. Time Management

36. Food, Sleep & Stress: Caring our Basic Needs Stress can be cause/ Effect of two basic human needs Proper nutrition/diet Proper Sleep habits

37. Nutrition and Stress During Stress Increased food intake- high fat, sugar or content Drinking too much coffee or soft drinks Lead to sleep disturbances Skipping meals Overeating even when not hungry Eating fast food often Poor nutrition- Poor absorption of vitamins & minerals Lower Immunity hence need for a good balance diet

38. Nutrition and Stress Dietary Changes can affect Serotonin Dopamine Nor-epinephrine Acetylcholine All of them are involved in mood and memory Extreme cases- Anorexia nervosa/ Bulimia nervosa

39. Sleep wake cycle and Stress Systemic Response to Stress Sleep disturbance Sleep deprivation and sleep disorders are associated with maladaptive changes in the HPA axis leading to neuro-endocrine dys-regulation Excess of glucocorticoids -increase glucose and insulin

40. Sleep Hygiene Hypothalamus: Endogenous Circadian Clock 24 hours clock is set at birth- Diurnal variation “Melatonin (sleep hormone) Surge”- at night when there is perceived low light by retina Persistent light prevents “Melatonin Surge” (Light, TV, mobile etc) Adult: Average of 7.5 hours Range 5-9 Hours of sleep Estimated: 1/3 or life spent sleeping

41. Sleep Hygiene Try to wake up and Go to bed at same time, every day Avoid napping during day: max-30-45 minutes Avoid the following 4-6 hours before bedtime Alcohol, Caffeine, Nicotine, Caffeine containing energy drinks, nicotine Heavy meals, spicy or sugary food Exercise regularly but not before bedtime Get regular exposure to outdoor sunlight

42. Sleep Hygiene Use comfortable bedding Comfortable temperature (cool but not cold) Block all distractions- noise & light Mobile phones/ internet Reserve bed for only sleep ( Psychological connection) Warm bath with warm milk/hot drinks Continue same even if you don’t sleep in first few days

43. Sleep Hygiene Do not panic / read a book if not sleepy Don’t take your worries to bed Keep a separate “worry period” in the day/ evening Relaxation- yoga, deep breathing, music CBT (Cognitive Behaviour Therapy)/ counselling Avoid sleepers If needed for short period

44. Common Mental Illness

45. Common mental disorders (CMDs) Depressive Disorders Anxiety Disorders Somatization Disorder/ Psychosomatic disorders Etiology of CMDs Common mental health disorders are multi-factorial in origin. The risk for developing these disorders is inherited genetically. At the molecular level there is derangement in serotonin and norepinephrine levels in the brain.

46. DEPRESSIVE DISORDERS Depressive disorder is characterized by presence of pervasive and persistent low mood, loss of interest and enjoyment in ordinary/routine things and experiences, increased fatiguability for at least 2 weeks Risk factors- Depressive disorder in first degree relatives Stressful life events Chronic or disabling medical illness. Ex- Diabetes, obesity, cardiovascular diseases

47. Clinical features

48. Diagnostic Criteria of DEPRESSIVE DISORDER 50 PRESENCE OF 2 OR MORE NEEDED

49. Cognitive Triad in Depression

50. Aaron Beck, American Psychologist Developer of Cognitive Therapy

51. Cognitive Triad

52. ANXIETY DISORDERS

53. Generalized Anxiety Disorder Generalized Anxiety Disorder (GAD) is characterized by excessive fear, tension, stress, anxiety and worry, about a number of events or activities, occurring on more days than not for a period of at least 6 months. Clinical features An experience of excessive and uncontrollable anxiety/tension/worry with no obvious reason or trivial reason , for many months (>6 months). The characteristics of this anxiety/tension/worry are; Apprehension- patient has worries about misfortunes (about family, health, finances, work etc), feeling ‘on the edge’, difficulty in concentration. Motor tension - being restless, fidgety, trembling, inability to relax, tension headaches. Autonomic overactivity - light-headedness, sweating, tachycardia or tachypnoea, epigastric discomfort, dizziness, dry mouth etc. The above symptoms must be present for at least 6 months to diagnose Generalized Anxiety Disorder.

54. Panic Disorder Panic Disorder is characterized by recurrent, unexpected attacks of extreme anxiety (panic), accompanied by worry about having another attack for at least one month Clinical symptoms Recurrent attacks of intense anxiety (panic), which are not restricted to any particular situation and are therefore unpredictable Anticipatory anxiety- persistent fear of having another attack Panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes and during which time, any of the following symptoms occur

55. Panic Disorder contd... Clinical symptoms Palpitations , sweating, tremors, sensation of shortness of breath, feeling of choking, chest discomfort, nausea, feeling dizzy, tingling or numbness, fear of losing control or going crazy, fear of dying The above symptoms must be present for at least one month and should not be explained by any medical illness

56. SYMPTOMS: Sudden in onset & extreme (one of the reasons for emergency presentation ).

57. Cognitive symptoms Somatic symptoms Fear of dying Chest pain or discomfort Fear of losing control Dizziness or fainting Feeling of detachment from the self Dryness in mouth Hot flashes or chills Nausea or abdominal distress Numbness or tingling sensation Palpitation Shortness of breath/choking Sweating Trembling Shaking Most people with panic disorder, anticipate in worry about another attack and avoid the places of situations where they have previously panicked leading to avoidance behaviour and significantly disturb a person’s daily life. If 4 or more symptoms occur together, then its called Panic attack.

58. TREATMENT : Drugs that are used to treat panic disorders: Antidepressants: SSRIs (Paroxetine, Sertraline, Fluoxetine) or SNRI’s (Venlafaxine). They have fewer side-effects Anti-anxiety drugs, such as benzodiazepines (works faster than antidepressants, but can cause drug dependence) Cognitive behavioural therapy : To manage anticipatory anxiety & agoraphobia. Exposure therapy: gradually exposing individuals to the feared object, situation or memory in a controlled and safe environment. Psychoeducation: to help them confront and gradually overcome their fears of traumatic experiences by learning that the feared stimuli are not as dangerous as perceived. Somatic quietening exercise like Breathing & Relaxation.

59. PREVENTION : Get treatment for panic attacks as soon as possible to help stop them from getting worse or becoming more frequent. Stick with the treatment plan to help prevent relapse or worsening of panic attack symptoms. Get regular physical activity which may play a role in protecting against anxiety.

60. 1. SETTING up the Interview 2. Assessing the student/Family’s PERCEPTION 3. Obtaining the student/Family’s INVITATION 4.Giving KNOWLEDGE and INFORMATION to the student/family 5. Addressing EMOTION S with empathic responses 6. SUMMARIZATION Baile and Buckman  (2000) Breaking Bad News “SPIKES Model"

61. Setting: Privacy, place, confidentiality, no interruptions, Time Having all information about student/ incident All team members on same page Breaking Bad News “SPIKES Model”

62. Assessing student/family’s perception How much they know their understanding of situation/problem Introduction of team members and family members Assessing family-team leader/ dynamics Breaking Bad News “SPIKES Model”

63. Obtaining student’s/Family’s Invitation How much they want to know Completely or partial Make sure ‘Key person in family” is available for interview What they know-Key person is allowed to express Breaking Bad News “SPIKES Model”

64. Knowledge Sharing with stakeholders Share knowledge about the incident/ what was done, what needs to be done/ plan Avoid jargons/ confusing words Explain Clarify if any Breaking Bad News “SPIKES Model”

65. Addressing Emotions Allowing to express emotions (ventilation) Do not stop or curtail emotional expression (allow to cry) Empathic listening Non-verbal communication-appropriate Breaking Bad News “SPIKES Model”

66. Summarising Summarise the discussion Ask any questions Would they like to say something Plan next/ for follow up or next meeting if any Check you own emotions/ debrief team members directly involved Breaking Bad News “SPIKES Model”

67. “the state of keeping or being kept secret or private” “respecting someone's privacy, and abstaining from sharing personal or potentially sensitive information about an individual, especially if that information has been shared in confidence” “ Confidentiality”

68. Other mental Illness Anxiety Spectrum Social Phobia Post-Traumatic Stress Disorder (PTSD) OCD Bipolar Illness: Mania/ Depression Psychotic illness Schizophrenia/ Acute and Transient Psychotic Disorder Delusional Disorder Schizoaffective Disorder Substance Abuse- Cannabis, Heroin, Alcohol etc

69. Local Resources

70. Counselling/ Psychotherapy TeleManas (telephonic consultation-3 tier) Tele Manas Arunachal Pradesh Mental health service Toll free number 14416 or 1-800 891 4416 Email [email protected] Offline: State Mental Hospital, Midpu, Yupia Mind Care Clinic, Naharlagun (Opp TRIHMS) Arunachal Pradesh Psychological Association, Gumto-I, Doimukh

71. OPD and Inpatient Psychiatry Services TRIHMS, Naharlagun State Mental Hospital: Midpu, Yupia Number of Psychiatrist in Arunachal: 7 ICR: 5 (1 pvt) Districts: 2 ( Yinkiong / Pasighat ) Pvt: Niba Hospital, Papunallah, Naharlagun

72. Reducing stress in school… Incentives/ rewards are welcome Boosting the morale of staff Encouraging healthy competition Group activities Going out for outdoor activities periodically/ exposure tours Organising get together Yoga & Exercise/ games

73. Summary

74. Summary: Emotional Stress Management Accept that Stress is bound to happen: at school/ hostel Be aware of signs and symptoms: Try to address rather than avoid or procrastinate Focus on time management Prioritize task according to importance/ Plan ahead 4 D model- Eisenhower Box “Look after your body with proper diet and adequate sleep- It will look after you” Keep a positive approach Reward yourself/ staff- You are special, you body needs you!

75. Summary: Mental Illness Awareness Mental Illness are quite common Increase awareness and acceptance in community now Common Mental Disorders Depression, Generalised Anxiety Disorder, Panic Disorder, social phobia, PTSD Treatment available Medical Psychological (counselling/ therapy) Important to pass on the message to near and dear ones

76. Summary: Mental and Emotional Health The state of mental and emotional well being can keep changing along a continuum When faced with everyday challenges, a person could move along the continuum from state of well being to distress However if one has skills and right support the person can move out of this state and work productively over a long period of time Some people in stress might require timely help and support to move on/ return to normalcy or need professional help One should encourage rather than discourage those seeking help for mental health

77. With best wishes!! Namaste..