Stress Management

Presented by:

Mangal Kardile

Clinical Psychology

Advocacy - Mental Health Law & Human Rights

What is stress

• Defining Stress – Positive & Negative aspects

• Stress factors (social/personal)

• Reaction to Stress

• Stress phases

• Stress – Psychological & Physical problems

• Coping with stress

• Managing stress – various guidelines

(self regulated or training)

Defining Stress – Positive & Negative aspects

• Stress in the biological sense cannot be eliminated

- Positivity- Without it, the process of life would cease, for the absence of stress means death

- Negativity- What needs to be avoided is unnecessary and noxious stress

• The relevant questions are: How great is it? Is it appropriate to the needs of the situation?

Defining Stress – Positive & Negative aspects

• Stress in control - stress becomes the spice of life, a challenge instead of a threat

• When we lack this crucial sense of control, stress can spell crisis — bad news for us, our health, and our community

• Our decision latitude, our influence over various aspects of our own lives, is a strong determinant of whether stress becomes a spice of life or a kiss of death

Stress factors

• Social factors (Community/TV/Networking)

• Environmental (Earthquake/Flood/Terrorist attack/Trauma)

• Small group factors (Family/work environment)

• Relational factors-Interpersonal

• Internal factors- Health/Finance/Family

- Age factor-

• Childhood, Adolescence, Adult, Elder Adult

Stress factors- Personality

• Ego – comparison/Prejudice/over-expectations

- Superiority/Inferiority/competency

Challenges/Goal achievement

• Defense/Offence/Denial

• Unemployment/Business loss/Addiction

• Disaster/Abuse (Physical/Emotional loss)

• Loss of beloved person

• Emergency/Suicide/Murder

Type of personalityA + B = balanced personality

How stress develops

• When we are exposed to stressors — such as a lack of control over our lives combined with excessive demands, unsatisfied needs, unfulfilled expectations, overstimulation, under-stimulation, or role conflicts

• most of us experience emotional reactions -such as anxiety, depression, uneasiness, apathy, alienation, and hypochondriasis.

Reactions to Stress

• Stress also causes behavioral reactions

• Some of us start smoking or overeating

• We seek comfort in alcohol or take unnecessary risks at work or in traffic

• Aggressive, violent, or other types of antisocial behavior

• Many commit suicide — or try to

- Many of these reactions lead to disease and premature death

Reactions to Stress

• We also react physiologically• Example - the employee who has been unjustly

criticized by his or her supervisor - employee’s typical reactions - increased blood

pressure, increased or irregular heart rate, muscular tension with subsequent pain in the neck, head, and shoulders, dryness of throat and mouth, and overproduction of acid gastric juice

- When long-lasting, intensive, or frequently recurring, some of these reactions can lead to -hypertension, myocardial infarction, or stroke

Stress curve (Dr. Selye)

Stress- Phase 1

Stress hormones elevated (fight or flight)

Blood flow increasesHeart rate speeds up

Digestion slowsMuscle tense

The Alarm Phase

Stress- Phase 2

Physiological responses continue

Body attempts to resist or cope

Body vulnerable to other stressors

Annoyed by minor frustrations

Eventually adopt & return to normal

The Resistance phase

Stress- Phase 3

Persistent stress depletes energy

Increases vulnerability to physical problemsBody becomes unhealthy as long-range responses

Tense muscles – headache, neck pain Increased blood pressure - chronic hypertensionDigestive process shut down – digestive disorders

The Exhaustion phase

Psycho-physiology - Stress

Stress – Psycho-neuro-immunology

• White blood cells-recognize Foreign & harmful bodies (antigen)

• T cells – helper cells regulate immune response• B cells - destroy the invading viruses and bacteria

• When we’re stressed, the immune system’s ability to fight off antigens is reduced

• The stress hormone corticosteroid can suppress the effectiveness of the immune system (e.g. lowers the number of lymphocytes)

• That is why we are more susceptible to infections

Coping with Stress

- Much depends not only on what we are exposed to but also on how we cope with the situation

• We can change our environment/share concerns

• we can flee from our problems/examine consequences

• we can ask for help/alter situations

• we can accept things as they are/redefine situations

• by changing our appraisal of our environment (denial)

• Our ability to use humor to defuse situation

- Whatever our choice, it influences our stress reactions

Stress - positive aspects

• Positivity- Coping

- mean either altering the situation or (without doing this) altering one’s perception of, or adaptation to the situation

Negative or positive -

- Both approaches affect health and well-being

- Psychological health = Physical health

Stress Management

Stress Management

- There are three basic paths to consider:

• 1. Eliminate or modify the stress-producing situation or remove the individual from it; find “the right shoe for the right foot,”

• 2. Adjust the shoe — that is, change the social situation — to fit the individual’s foot

• 3. Strengthen the person’s resilience to stress, for example, through physical exercise, meditation and relaxation techniques, and social support

Managing stress- Approaches

• Stress management has traditionally focused on individual approaches, usually by counseling individuals or small groups on ways to adapt to, or cope with, various stressors and their consequences

• Holistic approach - people’s symptoms and illnesses, their causes and consequences, are appraised in medical, psychological and social perspective

Releasing stress

• Stressed posture and position - Stretching (e.g. yoga)

• Stressed muscles - Progressive muscle relaxation

• Stressed breathing - Breathing exercises

• Stressed body – Biofeedback/Inoculation

• Stressed emotion - Imagery/positive self-talk

• Stressed attention - Meditation/mindfulness

R – states (Relaxation)

• 1. Accepting• 2. At Ease/Peaceful (Mentally Relaxed)• 3. Aware/Focused/Clear• 4. Disengaged (feeling distant, indifferent, far away)• 5. Joyful• 6. Mystery (experiencing the “deep mystery” of things)• 7. Optimistic• 8. Physically Relaxed• 9. Quiet (mind still, without thought)• 10. Reverent/Prayerful• 11. Sleepy• 12. Timeless/Boundless/Infinite/At One

Psychological Relaxation

• R-Beliefs (relaxation beliefs)-

personal philosophies and spiritual perspectives

• R-Attitudes-

Positive – promote relaxation practice

Negative- interfere with practice

- fears about disengagement, relaxation-induced anxiety, the possibility of losing control, having an unqualified trainer, and religious or hypnotic control

Psychological Relaxation

- R-Motivations reflect the desire to experience more (or less) of an R-State

• IRCs (idiosyncratic reality claims) are irrational/paranormal/supernatural beliefs

that may enhance certain R-States. The list includes religious influence;

magic (astrology, crystals, new age beliefs, etc.); communication with the dead;

Miraculous powers of meditation, prayer, and belief; and space aliens

- N-states (negative states) are aversive distracting thoughts, feelings, or sensations

Physical relaxation- Dr. Jacobson’s research

• To relax the mind and the body, one must relax all of the skeletal musculature

• Each stressful situation (“stressor”) everyday –generates consistent, excessive covert tightening of the skeletal musculature

• overdrives the central nervous system and increases activity of the autonomic, cardiovascular, endocrine, and other systems

• Prolonged, heightened skeletal muscle tension may result in a variety of pathological conditions

Neurophysiology of Relaxation

• Tension is the contraction of skeletal muscle fibers that generates the tension sensation

• Relaxation is the elongation (lengthening) of those fibers, which then eliminates the tension sensation

• Progressive muscle relaxation- muscular relaxation reduces proprioceptive input to the hypothalamus, with a resulting lessening of hypothalamic–cortical and autonomic discharges

• lessening emotional reactivity during muscular relaxation reduces proprioceptive impulses to the hypothalamus, which then decreases excitability of the sympathetic nervous system.

Differential Relaxation

• optimal contraction of only those muscles required to accomplish a given purpose

• Those and only those muscles should contract, and

• All other (irrelevant) muscles of the body should be relaxed

e.g. people can often catch themselves wasting energy

Neuro- muscle relaxation

• Muscular events are present during cognitionE.g. During visual imagery, the eyes are uniquely

active• Imagining lighting a cigarette produces a distinct

covert response in the active arm• Heightened speech muscle activity in both

children and adults during silent reading;• Increased speech muscle activity covertly occurs

while individuals are engaged in cursive handwriting

Developing Emotional Control

• Individuals who are excessively anxious often continually rehearse their grief, worries,

and difficulties with life

- Using PR- If they can acquire control of the skeletal muscle tensions that key this internal speech, they can consequently control their emotions and other negative mental processes

(A trained person can stop, momentarily relax, and assess a situation)

Hypnosis-viable applicability

- sees a series of simple verbal suggestions that result in relatively spectacular alterations of behavior, thought, emotion, and perception

• For example, the hypnotized burnt patient lies quietly and reports no pain, seemingly relaxing while his or her dressings are changed (a highly painful procedure)

• irritable bowel syndrome• anticipatory, consequent side effects of chemotherapy• for addictive disorders- After 50 years of modern research, the lack of evidence for

any unique psycho-physiological marker resulted into clinically abandoning the concept of a hypnotic trance

Biofeedback

• teaching voluntary control of various physiological functions by providing instantaneous “feedback” for variations in physiological activity

• Feedback usually is given in the form of visual and/ or auditory signals derived from physiological recording devices

• Most other biofeedback methods are designed to control tonic levels of various physiological functions (e.g., muscle tension, finger temperature, heart rate, blood pressure, etc.).

• Significant effects of these methods have been found for reducing blood pressure,

- although the magnitude and consistency have not been sufficient for the method to gain widespread acceptance

Biofeedback Training for stress disorder

Stress Inoculation

• Cognitive – Behavioural approach with added psychological resilience against the effects of stress

• managed program of successful exposure to stressful situations

1) The Conceptualization Phase – Learn to conceptualize and re-conceptualize stress

2) Skills Acquisition & Rehearsal Phase - inc. problem solving, cog. restructuring & guided self dialogue

3) Application & follow through Phase - staff are encouraged to write ‘coping contracts’ and undertake homework for their own wellbeing

Respiration- stress relaxation

• Respiration is a rhythmic contraction and expansion of the body, as a result of which air flows in and out of the lungs

• Respiratory efficiency increases when people breathe at about six breaths per minute (CPM)

• better tolerance for exercise and altitude, with some advantage to people who have engaged in long-term practice of yoga

• a method for treatment of stuttering based on the breathing techniques

• breathing therapy for cardiac rehabilitation

- Hyperventilation???? – smokers should always have trained person.

Whole body breathing

• breathing is a sensory motor activity that serves to provide important feedback to the conscious individual about his or her state

• the sense of freedom of movement or restriction in space,

• the sense of tension or relaxation within oneself, the sense of safety or danger within the environment

• all have much to do with the quality of internal feedback

Breathing - Stress

• breathing movement largely depend on posture, on mental state (focused or passive), on emotional or expressive state and on physical tension state (energy and ventilation requirement, nervous tension)

- Thus abdominal breathing, diaphragmaticbreathing, and slow deep breathing are common practices

• This strategy is quite effective in remaining or becoming quiet and calm and in reducing stress

Breathing therapy

Tension-related problems without specific cause

• Feelings of tension

• Hyperventilation complaints

• Burnout

• Headache

• Chronic fatigue

• Sleeping problems

• Concentration problems

Breathing therapy

Psychological problems

• Anxiety and phobia

• Panic disorder

• Depression

Functional problems of musculoskeletal nature and breathing

• Lower back, shoulder, and neck complaints

• Shortness of breath

• Chronic pain (e.g. repetitive strain injury whiplash)

• Functional voice disorders – e.g. stuttering

Breathing therapy

Tension problems with a specific, somatic cause

• Lung disease (e.g. asthma)

• Heart disease

• Neurological disease (e.g. Hemiplegia, Parkinson disease)

* Tape instructions????—do not just follow tape instructions- training required at beginning

Visual Imagery

- Guided Imagery is a convenient and simple relaxation technique

• Get into a comfortable position as for meditation or self-hypnosis • opt for a cross-legged position, or recline in a comfortable chair• Use diaphragmic deep breathing and close your eyes, focusing on

breathing in peace and breathing out stress• Imagine yourself in a wishful situation (relaxing)• Try to involve all of your senses. What does it look like? How does it

feel? Make your vision so real you can even taste it!(e.g. sea shore)• Stay here for as long as you like. Enjoy your ‘surroundings’, and let

yourself be far from what stresses you• When you’re ready to come back to reality, count back, • when you get to ‘one’, you’ll feel serene and alert, and enjoy the

rest of your day

Exercise therapy

• Exercise therapy (also known as walk/talk therapy) is the practice of combining a program of exercise with traditional psychotherapy

• Therapeutically, brisk activity (such as walking side by side with the client) is helpful in breaking down barriers and subtly helping clients engage in difficult topics of conversation

• The walking helps to stimulate both the client and the therapist to be alert and creative in the problem-solving process

Mindfulness meditation

• also referred to as “insight meditation” or “Vipassana practice,” contribute to therapeutic growth and personal development

• Although all meditation techniques cultivate the ability to focus and manage attention,

• mindfulness meditation primarily cultivates an ability to bring a nonjudgmental sustained awareness to the object of attention (e.g. breath)

• Not on a word or mantra, as occurs in concentrative meditation• traditional mindfulness meditation practices, mostly based in

Buddhism• Western cultures trained in Asian countries - Tibetan meditation

practices on emotional and physical self-regulation (Dalai-Lama) • Thai Theravadan tradition, Burmese traditions

Mindfulness meditation

• involves the cultivation of moment-to-moment, nonjudgmental awareness of one’s present experience,

• whether narrowly or more broadly focused• The goal of these practices is to cultivate a stable and nonreactive

awareness of one’s internal (e.g., cognitive–affective–sensory) and external (social–environmental) experiences

• stable attention and nonjudgmental awareness that mediates the much wider range of effects, including physical relaxation, emotional balance, behavioral regulation,

• changes in self-judgment, self-awareness, and relationship to others

• Improvements in each of these areas of functioning may then decrease the experience of stress

Other resources

• Music therapy

• Yoga therapy

• Eye Movement Desensitization

• Pharmacological treatment

• Stress continues to remain………on the hit list…….

Stress- single component

• The amount of physical, psychological, social destruction

Stress world statistics (WHO)

An estimate made in a World Health Organization- indicates that such “diseases of lifestyle” are the cause

of 70 to 80% of premature deaths in industrialized countries

- This insight was expressed in three summarizing sentences about these “modern killers”:

• We are killing ourselves by our own careless habits• We are killing ourselves by carelessly polluting the

environment• We are killing ourselves by permitting harmful social

conditions to persist

“In the end, it's not the years in your life that count. It's the life in your years.”

- Abraham Lincoln

Thank you