Stress Management :Dr. Nelson Psychiatrist Mental Health Centre, Thiruvananthapuram,Kerala,India Stress Management


MIND :MIND “Mind or Psyche is the faculty by which one is aware of surroundings and by which one is able to experience emotions, remember, reason and make decision”.


Slide 3:Perception Mood and Affect Behaviour Mind Thought


Slide 4:Brain Alcohol,Drugs Mood and affect Thought Behaviour Environment MIND Perception Mind


MindSigmund Freud :MindSigmund Freud Conscious Mind Preconscious Mind Unconscious Mind


Slide 6:Moral Value Perfection Right or wrong Superego Reality Principle EGO Action ID Reducing tension Immediate by wishfulfilment Gratification Basic Instincts Mind


Brain :Brain Weight 1500 gms. Neurons - Billions Connections - Receptors - Neuro transmitters - Inter Cellular Communications


Characteristics of mentally healthy person :Characteristics of mentally healthy person Mentally healthy person feels right towards others. Mentally healthy person in able to meet the demands of life.


Characteristics of mentally healthy person :Characteristics of mentally healthy person Mentally healthy persons are described as those who have Awareness of self Capacity to work Knowledge of their strengths and weaknesses


Characteristics of mentally healthy person :Characteristics of mentally healthy person - Self – respect and respect for others Satisfying relationship with others Ability to give and receive Behaviour that is generally acceptable to others Benefits from rest and sleep.


Mental Health Team :Mental Health Team Psychiatrist Clinical Psychologist Psychiatric Social Worker Psychiatric Nurse


Stress :Stress Looking AFTER ourselves begins with looking AT ourselves


Stress :Stress Process of adapting to challenge Transaction between the person and the situation Internal With environment


Causes of Stress :Causes of Stress Loss Problems Gains Role Changes Interpersonal problems Work Load Financial Problems


WHAT IS STRESS? :WHAT IS STRESS? The non-specific response of the body to any demand made upon it- Selye (1956) A slippery term An event – stressful event or stressor Consequence of an event – stress response


EUSTRESS :EUSTRESS The stress which results when “good” things happen to us


DISTRESS :DISTRESS The stress which results when “bad” things occur


The Fight or Flight Response :The Fight or Flight Response Instinctive, automatic response (hit out or run away) Period of intense activity ? end when the threat is no longer present ?relaxation response Now The stress response is triggered many times a day Not able to release the tension and allow relaxation response Body chemistry does not return to normal


Severity of Stress :Severity of Stress Magnitude Duration Novelty Predictability


Stress - Response :Stress - Response Biological Response Threshold Exposure Personality Coping Styles Previous Experience


Stress :Stress Stress leads to problems physical, psychological, social health R T A Suicide Drug addictions.


Sources of Stress :Sources of Stress


Main Stresses :Main Stresses The demands of the job- heavy workload Peoples expectations High responsibility Insufficient time to work or relax Interference with family life Alienation from families and social networks


Main Stresses :Main Stresses Difficult professional relationships Sleep deprivation Work at home Dealing with administration Fear of litigation , violence


“God Complex” :“God Complex” Constantly on duty feeling Need to be ‘Always busy’ Exploited by others and institutions Should put limits to the amount and length of the work you do Keep family and social relationships in good order Fair amount of altruism Accept that we cannot do everything in every situation


“I’m Different: It cannot Happen to Me” :“I’m Different: It cannot Happen to Me”


But, I’m O K :But, I’m O K Self assessment / by a colleague Strong emotions in an encounter – reflect Seek help if necessary –friends, colleagues, family or group


Stress- Creative or Destructive?Problem or motivator? :Stress- Creative or Destructive?Problem or motivator?


Stress And Illness :Stress And Illness Link between stress and illness Nervous Endocrine Immune System


FRIEDMAN & ROSENMAN :FRIEDMAN & ROSENMAN The Framingham heart study Linkage between stress and CHD


MAJOR RISK FACTORS FOR CHD :MAJOR RISK FACTORS FOR CHD High cholesterol levels Hypertension, Diabetes Smoking Lack of exercise, Obesity Genetics High Stress American Heart Association


Stress & Illness :Stress & Illness Tobacco Alcohol Drugs Poor diet habit Sedentary


FINDINGS REGARDING STRESS AND CHOLESTEROL :FINDINGS REGARDING STRESS AND CHOLESTEROL Accountants had higher levels of cholesterol during tax season Medical students had higher cholesterol levels before finals Military pilots had higher cholesterol levels at the beginning of training


Challenges in Competitive Society :Challenges in Competitive Society Complicated situations Difficult people Insoluble problems Fear of what will happen


Effects of Stress :Effects of Stress Impaired performance. Burnout, Lethargy Mood disturbance. Concentration difficulties. Sleep and appetite disturbances. Other medical problems.


Burn Out :Burn Out Gradual depletion of emotional, mental and physical energy due to work related stress. Burn Out


Psychiatric Disorders :Psychiatric Disorders Anxiety disorders Panic disorder Depression Adjustment disorders Acute Stress disorder Post-traumatic stress disorder


The Management of Stress :The Management of Stress


Need for counseling and Support :Need for counseling and Support Counseling services Regular team support meetings Just like a football player needs physiotherapist


Main Strategies :Main Strategies Become knowledgeable about stress Come to terms with your feelings Develop effective behavioural skills Strong support network Life-style that strengthen you against stress Spiritual development


Prevention of Stress :Prevention of Stress Staff support and counseling groups Spend some time together, do not work in an isolated way Professionals need counseling services


Coping with Stress : Relaxation Techniques :Coping with Stress : Relaxation Techniques Breathing Exercise Over breathing is common in anxiety Included in most systems of relaxation Learn good breathing habits Slower, using the lower part of lungs, emphasis on breathing out Sitting upright in a chair with legs uncrossed or lying on the floor with legs slightly apart and arms at your side


Abdominal Breathing :Abdominal Breathing Through nose, with mouth shut, attend to your breathing Scan your body for tension release Place one hand on chest, one on abdomen Exhale first and then inhale without forcing your breath Ensure that exhalation is slow, with a slight sigh, pause for a moment


Abdominal Breathing :Abdominal Breathing Focus on the sound and feeling of the breathing Allow the relaxation to become deeper and deeper with each exhalation 5-10 minutes once or twice and whenever you get time.


Exercise :Exercise Gentle exercises Brisk walking Stretching Neck rolls Jumping and running on the spot


Cutting Edge :Cutting Edge


Relaxation Technique :Relaxation Technique


No Reason :No Reason


To Reflect :To Reflect Just being Eat while you eat, work when you work, sleep while you sleep There need not be any reason for living Life can be meaning-free Beyond success or failure Beyond pain and pleasure


This Too Will Pass! :This Too Will Pass!


‘This too will Pass’ :‘This too will Pass’ The story of the king & guru Defeated – exile – opened the message Came back to power- celebration – opened the message This too will pass….


To Reflect… :To Reflect… Nothing is permanent We tend to seek pleasure and avoid pain – two sides of the coin Accept pleasure or pain – do not crave, do not seek


Living in the Present :Living in the Present


To Reflect… :To Reflect… Past exists in memories Future exist only in imagination Present is the only reality


To Reflect… :To Reflect… Living in the present Carrying over yesterday’s garbage


What is the Point? :What is the Point?


To Reflect… :To Reflect… Pointing out other’s mistakes Not seeing ours Blaming the system? “I’ll change if the system changes”


Don’t Say it is “Fortunate/unfortunate” :Don’t Say it is “Fortunate/unfortunate” Old farmer who had worked his crops for many years. - horse ran away. - neighbors came to visit. "Such bad luck," they said sympathetically. Horse returned, bringing with it three other wild horses. "How wonderful," the neighbors exclaimed. “ Son tried to ride one of the untamed horses, was thrown, and broke his leg. Military officials - to draft young men into the army.


To Reflect… :To Reflect… Being dependent Seek help, but be inwardly free… Freedom is not only from external influences, but from your own mind


Essentials of Happiness :Essentials of Happiness Something to do for oneself Something to do for others Something to Love Something to hope for


Slide 112:Look upon others as yourself Renounce War Give up aggression Cultivate friendship Essentials of Happiness


When you meet a new person :When you meet a new person Show interest – Smiling - Wishing Radiate Accessibility Share little information about you Know what topic to talk Part as friends


Sleep Tips :Sleep Tips Maintain regular bed time and wake time Avoid coffee, tea, cola, alcohol, smoking Avoid day time sleep Regular exercise


Sleep Tips :Sleep Tips Comfortable bed room – quiet, dark, use only for sleep Something relaxing – before sleep Light dinner – a glass of fruit juice, milk, a quick light bath before bed Don’t wait for more then 1 hour in bed for sleep


Coping with Anger :Coping with Anger Keep Anger Diary Learn Alternate Behavior Identify warning sings Know your body feelings


Coping with Anger :Coping with Anger Count up to 10. Delay Response Move away from the scene Think some humor Tell the other person that your are getting angry


Cognitive behavior Therapy for anxiety :Cognitive behavior Therapy for anxiety Learning – The therapist explain the problem and teaches the person Monitoring – The person keeps diary to monitor anxiety attacks and inducing situations


Cognitive behavior Therapy for anxiety :Cognitive behavior Therapy for anxiety Breathing – Relaxation techniques – breathing exercise etc., Rethinking – Help to change his interpretation of physical symptoms Exposing – help to encounter situation gradually


Act promptly – if warning sings :Act promptly – if warning sings Decreased Sleep Impatient, irritable Decreased concentration Unable to make decisions


Act promptly – if warning sings :Act promptly – if warning sings Increased drinking / Smoking Not enjoying food / friends / work Unable to relax / Switch off Feeling tense - Head ache, GI upset, sweat, dry mouth


Develop Good Habits :Develop Good Habits Learn to relax – Progressive muscular relaxation - Breathing exercise - Simply sit, listen music,long bath, read Take regular breaks at work - 5 -10 mts. Every 2 – 3 hours Escape from mobile – Once / twice a week be alone, reflect


Develop Good Habits :Develop Good Habits Exercise - Decreases Stress, Keeps fit, Improve Sleep, good for heart Drugs - Tobacco, alcohol, caffeine Distraction – Hobby, Sports, movies music, books - not work related


Consult your doctor :Consult your doctor If any stress , anxiety, depression, drug problem – accept Advice of doctor, friends. Don’t judge yourself If doctor suggest psychiatric consultation – go for it.


Tips for personal development :Tips for personal development “I am right – you are wrong” – negative revolution Five basic principles of positive revolution. Effectiveness Constructive direction Respect Self – improvement Contribution


Stress related negative thought :Stress related negative thought Painful medical procedure - I wont be able to tolerate the pain – Fear Argument with a Friend - She will never speak to me again – Discouraged Co-worker injured while on duty - its my fault, I would have warned him – guilt Late for a dead line - Its hopeless I am always confusing him – depression Spouse criticise you - He just doesn’t get it, he never under stand what I say – anger


Challenging Negative automatic thought :Challenging Negative automatic thought It there an alternative explanation ? What is the evidence that this thaught is true ? What will be the effect of continuing to think this way ? What is the best out come, worst outcome, realistic outcome ? What is the likely-hood that this will happen ?


Negative thoughts and rational response :Negative thoughts and rational response I have no control over this situation – Its true that I can’t change what happened, but I can control how I respond I can’t return to my old job, I am worthless – Though I may not be able to do the same work there are no. of other options which I can do.


Negative thoughts and rational response :Negative thoughts and rational response Its not fair that I am – Life is not always fair being treated this way sometimes things go my way, other times they don’t. I am a burden to my family – My family had to give me more and support now. But I do a lot of things for them as well. No one really cares about me – There are people in my life that I can turn for support.


Coping with Anxiety & Panic :Coping with Anxiety & Panic Remember that although your feelings and symptoms are very frightening, they’re not dangerous or harmful


Coping with Anxiety & Panic :Coping with Anxiety & Panic Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.


Coping with Anxiety & Panic :Coping with Anxiety & Panic When the fear comes, expect and accept it. Wait and give it time to pass without running away from it. The more you are willing to face them, the less intense they will become.


Coping with Anxiety & Panic :Coping with Anxiety & Panic Do not add to your panic by thinking about what might happen. Ask yourself “So what!” instead of “What if?”. Try to stay in the present.


Coping with Anxiety & Panic :Coping with Anxiety & Panic Notice that when you stop adding frightening thoughts to your fear, it begins to fade.


Summary :Summary Identify your major sources of stress Become Knowledgeable about stress Anticipate and plan Develop constructive strategies Recognize early warning signs Come to terms with your feelings Do not suppress, share Be flexible and adaptable


: Do not take work home Balance time and energy between work and home Be assertive, learn to say ‘no’ Learn to delegate Avoid blaming others for situations Establish, maintain a strong support network Learn to ask for and receive help Avoid damaging relationships Spend more time with family and friends Summary


Slide 137:Develop lifestyle Correct weight Exercise regularly Learn to relax – several times a day Limit alcohol/caffeine or do not use at all Do not use tobacco Time management


Summary :Spirituality Do not dwell on unimportant matters Identify what you can change and what you cannot change; accept things that you cannot change Sense of purpose and direction Time for reflection Believe in yourself Summary


Summary :Reduce optional Stress – Reduce Patients – Reduce Work Improve coping techniques Good Time Management Improve Social Network Get more fun out of life Summary


Slide 140:Love - Laugh - Pray Enjoy Family Life Rituals, Picnics, Birthday, Festivals Pray and Play together with family members Take Meals together whenever possible Summary


Be a Light unto Yourself :Be a Light unto Yourself