stress management 20000000000000000.pptx

stress management

1. Dr Alok N Ghanate Professor & Head Department of Psychiatry MRMCK; C onsultant psychiatrist at Ghanate Hospital K alaburagi

2. Outline Stress definition Myths Types of stress S tages of stress Cause of stress Effects of stress Coping skills Stress management techniques

3. NIMHANS, Bangalore Stress Stress is “a non-specific response of the body to any demand or challenge” also called “ general adaptation syndrome ” - Hans Selye An individual’s perception of stress was significantly more important than the event per se. - Lazarus

4. DEFINITION S = P > R Stress occurs when the pressure is greater than the resource

5. Myths

6. Myth # 1: All stress is bad : No , there’s good and bad stress. The goal is to recognize personal signs of bad stress and deal with them Myth # 2: Planning my time just takes more time . Actually, research shows the opposite. Myth # 3: I get more done in more time when I wisely use caffeine, sugar, alcohol or nicotine . Wrong! Research shows that the body always has to ‘come down’ and when it does, you can’t always be very effective then after the boost. Myth # 4: The busier I am, the better I’m using my time. Look out! You may only be doing what’s urgent, and not what’s important

7. Myth # 5: I feel very harried, busy, so I must have a time management problem. Not necessarily. You should verify that you have a time management problem. This requires knowing what you really want to get done and if it is getting done or not. Myth # 6 : I feel OK, so I must not be stressed . In reality, many adults don’t even know when they’re really stressed out until their bodies tell them so. They miss the early warning signs from their body, for example, headaches, still backs, twitches, etc. Myth # 7 : Today’s technology improves time management abilities. Technology has definitely made it more ‘convenient’ to transfer and access information. But, the reality is that it has generated information overload, more than it has helped us manage our time, all too often end up controlling us - rather than us controlling them

8. Types of stress.

9. Types of Stress Eustress Manageable Stress can lead to growth and enhanced competence ( good, motivating) Distress Uncontrollable, prolonged, or overwhelming stress is destructive. (bad, hard to cope with ) Acute Stress Immediate response to a threat or challenge Chronic Stress Ongoing exposure to stress, may seem unrelenting

10. Stages (GAS)

11. Stages of the Stress Response General Adaptation Syndrome of Hans Selye (1907-1982) Alarm —when one feels threatened Activation of the fight or flight reaction Resistance —mobilization of resources to solve the problem Continued stress causes adaptation Exhaustion Adaptation fails and level of function decreases

12. General adaptation syndrome 3 stages:– Alarm Resistance Exhaustion

13. 2 Intermediate Adrenal response 20 to 30 seconds Epinephrine and norepinephrine release from adrenal medulla 1 Immediate Sympathetic nervous response - 2 to 3 seconds Epinephrine & norepinephrine Release from symp nerves 3 Prolonged Metabolic response minutes, hours, days or weeks ACTH, vasopressin and thyroxine effect Three Stages of physiological effects Effects of Stress

14. ALARM : Activation of Hypothalamic Pituitary Adrenal Axis Catecholamines Increases cardiac output Dilates airways Dilates pupils Mobilizes glucose Causes vasomotor changes Decreases digestion Enhances coagulation Cortical Steroids Elevates glucose Increases amino acids Increases NA resorption Increases extracellular fluid volume Inhibits histamine and bradykinin Suppresses the immune response

15. Resistance Adaptation occurs Activation of the hypothalamic pituitary adrenal axis continues The stressor may be resolved The body returns to homeostasis May progress to exhaustion Stress continues as resources are depleted

16. Exhaustion Occurs when the demands of the stress exceeds the persons ability to adapt. Functioning declines May result in health problems Physical symptoms Mental symptoms

17. Causes of stress

18. NIMHANS, Bangalore Life events Problems in relationships Serious illnesses A failed romance A death in the family Failure in exams

19. Causes/Source of stress Environmental Stressors - examples include noise, pollution, traffic and crowding, and the weather. Physiological Stressors - examples include illness, menopause, injuries, hormonal fluctuations, and inadequate sleep or nutrition. Cognitive Stressors/ Your Thoughts - the way you think affects how you respond. Negative self-talk, catastrophizing , and perfectionism all contribute to increased stress. Social Stressors - examples include financial problems, work demands, family demands, social events, job interviews, examinations, and losing a loved one.

20. Effects of Stress on Health

21. The Science of Stress Stress is regulated by the hypothalamus, pituitary gland, and adrenal gland. SS

22. Emotional Anxiety , Fear Nervousness Tiredness Anger, Frustration Irritability , Impatience Unhappiness , Crying , Worry Depression Psychological Decrease in concentration Loss of sense of humor Low self esteem Confusion Forgetfulness Unwanted or repetitive thoughts Lack of motivation

23. Behavioral Mood swings Blaming / defensiveness Nervous habits (nail biting, finger or foot tapping) Change in appetite Aggressive or subdued behavior Increase in alcohol consumption Increase in smoking Loss of libido Physical Fatigue Headaches Backaches Muscle tension (common in neck and shoulders) Heart palpitations High blood pressure Indigestion, Ulcers Difficulty sleeping Low immunity to colds etc.

24. Effects of Stress on Health Stress can worse pre-existing illness (Poor control of BP or diabetes) Requires more medications Relapse of illness (mental illness) In vulnerable population illness can be precipitated eg . Stress can induce diabetes and mental illness.

25. Coping skills to manage stress

26. NIMHANS, Bangalore Coping patterns Problem focused coping Coping patterns Emotion focused coping

27. NIMHANS, Bangalore Coping Patterns Stress Maladaptive adaptive Resolution of stress

28. Problem-focused coping People try to deal with the cause of their problem. It is aimed at changing or eliminating the source of the stress. The three problem-focused coping strategies identified by Folkman and Lazarus are: taking control, information seeking, and evaluating the pros and cons. It may not necessarily adaptive, but backfire , especially in the uncontrollable case that one cannot make the problem away.

29. Emotion-focused coping Emotion-focused coping is a mechanism to alleviate distress by minimizing, reducing, or preventing, the emotional components of a stressor.  well suited for stressors that seem uncontrollable (ex. a terminal illness diagnosis, or the loss of a loved one) seeking social support reappraising the stressor in a positive light. accepting responsibility using avoidance exercising self-control and distancing Typically, people use a mixture of several types of coping strategies, which may change over time.

30. Unhealthy Ways of Coping with Stress Smoking , Consuming too much alcohol Over- eating or under-eating Zoning out for hours in front of the TV or computer or mobile Withdrawing from friends, family, and activities Acting out behavior (including physical aggression) Excessive worrying Using pills or drugs to relax Sleeping too much Procrastinating Filling up every minute of the day to avoid facing problems Quitting jobs, relationships, etc. Denying that a problem exists.

31. NIMHANS, Bangalore Stress Management

32. NIMHANS, Bangalore Stress Management Stress and life style; Physical exercise , proper diet , maintenance of weight in the normal range, adequate sleep and rest , cessation of smoking & alcohol , timely medical attention and instructions on safety and overall a healthy lifestyle helps to reduce stress.

33. NIMHANS, Bangalore Avoid Unnecessary Stress: Learn how to say ‘no’ Avoid people who stress you out Take control of your environment (TV, Mobile) Avoid hot-button topics ( religion or politics) Pare down your to-do list Stress Management

34. NIMHANS, Bangalore Awareness and managing emotions : Recognizing one's feelings as they occur is an important aspect of stress Mgmt. Being aware of one's emotions makes one more confident when making important decisions. The ability to modulate negative affects such as anxiety, anger, and depression is a crucial emotional skill. Stress Management

35. Adapt to the Stressor Reframe problems . Look at the big picture Adjust your standards Focus on the positive Adjusting your attitude

36. NIMHANS, Bangalore Relaxation: Many people find that learning to relax helps them reduce worry and anxiety.  It can also help improve sleep and relieve physical symptoms caused by stress, such as headaches or stomach pains. muscle tension accompanies anxiety, one can reduce anxiety by learning how to relax the muscular tension.   Stress Management

37. Progressive muscular relaxation Tensing and relaxing of muscle groups over the legs, abdomen, chest, arms and face. In a sequential pattern, with eyes closed, the individual places tension in a given muscle group purposefully for approximately 10 seconds and then releases it for 20 seconds before continuing with the next muscle group. The mental component requires that the individual focuses on the distinction between the feelings of the tension and relaxation . With practice, the patient learns how to effectively relax in a short period of time.

38. NIMHANS, Bangalore Cognitive appraisal and modification; Because of our past experiences we have our own dysfunctional thoughts and unrealistic/inappropriate assumptions and expectations like ‘ all or none’ thinking , arbitrary inference , selective abstraction , over-generalization , magnification, minimization and personalization , which will further leads to stress. Stress Management

39. NIMHANS, Bangalore Stress Management Past experience Assumption / belief Event Stress

40. Replace maladaptive thoughts (+thinking) Challenge maladaptive thoughts Alternative thinking Positive thinking ADAPT TO THE STRESSOR : Reframe problems, Look at the big picture, Adjust your standards & Focus on the positive ACCEPT THE THINGS YOU CAN’T CHANGE : Don’t try to control the uncontrollable, Look for the upside, Share your feelings & Learn to forgive Stress Management

41. NIMHANS, Bangalore Try to recognize stressful events in day-to-day situations. Monitor for thoughts and emotions Look for negative thoughts Challenge those with logic/reality Alternative thinking   Stress Management

42. NIMHANS, Bangalore Replace maladaptive thoughts (e.g., I am an incompetent worker who cannot handle the work-load) with adaptive thoughts (e.g., I can handle this workload like anyone else/The workload is too high and should approach my superior). Stress Management

43. NIMHANS, Bangalore Problem solving & decision making; Identify the problem, List as many solutions as possible, Discuss the pros and cons of each possible solution, Select the best or most promising solution, Plan how to carry out your chosen solution, Try it out, Tackle only one problem at a time. Stress Management

44. Change your Behaviour Be assertive Get organized Ventilation Humour Diversion and distraction

45. NIMHANS, Bangalore Assertiveness Assertiveness : Assertive behavior enables a person to act in his or her own best interest, to stand up for herself or himself without undue anxiety, to express honest feelings comfortably and to exercise personal rights without denying the rights of others.

46. Assertive Skills Establish good eye contact / don’t stare Stand or sit comfortably - don’t fidget Talk in a firm, steady voice Use body language ‘I think’ / ‘I feel’ ‘What do you think?’ ‘How do you feel ?’ Concise and to the point

47. Ventilation ‘A problem shared is a problem halved’ Develop a support network through friends or colleagues to talk with. It’s not always events that are stressful but how we perceive them. Writing a diary or notes may help release feelings but do not re-read what has been written.

48. Humor Good stress - reducer Applies at home and work Relieves muscular tension Improves breathing Pumps endorphins into the bloodstream - the body’s natural painkillers

49. NIMHANS, Bangalore Communication skills To be assertive an individual also requires good communication skills. Communication can be viewed as human inter action and social relatedness. Communication can be either verbal or nonverbal.

50. NIMHANS, Bangalore Hobbies Hobbies Sports and games Spend time with family and friends trip, excursion, trekking and so forth

51. NIMHANS, Bangalore Spiritual (and philosophical) domain Spirituality Religious faith Religious ceremony Doing good to the community – Orphanage, old age home, MR home, Community activity and so forth.

52. Social Support Social support has a profound effect on life expectancy Patients have better outcomes with strong social support Isolation and poor social support are associated with a poor stress response Few hardy individuals “go it alone”

53. Signature Strengths Recognize skills and talents Inventory strengths Use your strengths and talents Decide what works Actively cope Apply concepts to enable active coping.

54. NIMHANS, Bangalore Family Enhance the bonding between the family members through mutual respect. Develop family rituals (e.g., Family meals, trip, festivals etc). Give time Keep communication open Give your ears to your spouse Social support system

55. NIMHANS, Bangalore Stress Management Life Style Awareness and managing emotions Effect of stress on body Time out Relaxation techniques Cognitive appraisal and modification Problem solving & decision making Time Management Assertiveness and Communication Enrichment: Hobbies, sports, music, yoga Socio-cultural and Spiritual domain

56. Alternatives Conventional Medicine Counselling & psychotherapy Relaxation Meditation Massage Yoga Acupuncture Aromatherapy Floatation Herbalism Biofeedback Homeopathy Hypnotherapy Osteopathy Pet Therapy Reflexology

57. Contact details Dr Alok Ghanate Email [email protected] ph.no. 08472233022, 9241177535