STRESS MANAGEMENT

1. STRESSMANAGEMENT Waris Qidwai Professor and Chairman Department of Family Medicine The Aga Khan University Karachi - Pakistan

2. Rabindranath Tagore Man's abiding happiness is not in getting anythingbut in giving himself up to what is greater than himself,to ideas which are larger than his individual life,the idea of his country, of humanity, of God

3. History Walter Bradford Cannon Hans Selye • Walter Cannon and Hans Selye used animal studies to establish the earliest scientific basis for the study of stress. • They measured the physiological responses of animals to external pressures, such as heat and cold, prolonged restraint, and surgical procedures, then extrapolated from these studies to human beings.

4. History Hans Selye (1907-1982) Stress is the spice of life

5. DEFINITIONOFSTRESS • An external demand made upon the adaptive capacities of the mind and body. • If these capacities handle the demand and enjoy the stimulation involved, then stress is welcome and helpful. • If the capacities cannot handle the demand, then stress is unwelcome and unhelpful.

6. DEFINITIONOFSTRESS • Stress results when “pressure exceeds one's perceived ability to cope” • This concept about stress forms the basis for it being “Controllable”

7. DEFINITIONOFSTRESS • Stress does not necessarily follow the presence of a potential stressor • It is ultimately a person's thought processes that determine the response to potentially stressful external

8. STRESS AS A STIMULUS Too many positive or negative changes (such as marriage and divorce) occurring in a very short period, can tax the adaptive capacity of the individual and lead to increased susceptibility to mental and physical illness

9. STRESS AS A RESPONSE • Stress results in a certain pattern of physiological changes such as gastrointestinal, glandular and cardiovascular disorders. • Moreover, it affects the entire body, not just a single part. • There are large differences in response within and between individuals.

11. Quotation Adopting the right attitude can convert a negative STRESS into a positive one Hans Selye

12. THREE STAGES OF ADAPTASION IN STRESS • Alarm reaction: When a person is exposed to an unadapted stimulus there is an initial shock (in which resistance is lowered) followed by a rebound reaction (counter shock phase) during which the organism’s defence mechanisms become active. • Stage of resistance: During this stage the person’s full adaptation may lead to successful return to equilibrium. 3. Stage of exhaustion: In case of failure of adaptability the organism becomes exhausted.

13. HUMAN FUNCTION CURVE Intended Performance PERFORMANCE Exhaustion III Health Fatigue Actual Performance P Healthy Tension Breakdown AROUSAL P = The point at which minimum arousal may bring on a breakdown

14. STRESSORS • Environmental • Work related • Interpersonal • Life events

16. Quotation The human body has been designed to resist an infinite number of changes and attacks brought about by its environment. The secret of good health lies in successful adjustment to changing Stresses on the body Harry J. Johnson 

17. Back Pain Constipation Diarrhoea Dizziness Dry Mouth Excess Perspiration Excessive Hunger Exhaustion Headaches Heart Burn Insomnia Muscle Spasms Nausea No Appetite Pounding Heart Shortness of Breath Skin Rashes Upset Stomach PHYSICAL SYMPTOMS AND SIGNS

18. Anger Anxiety Apathy Boredom Depression Fatigue Fear of Death Frustration Guilt Hopelessness Hostility Impatience Inability to Concentrate Irritability Rejection Restlessness PSYCHOLOGICAL SYMPTOMSAND SIGNS

19. Biting Lips Foot Tapping Grinding Teeth Impulsive Actions Moving in Tense, Jerky ways Nervous Tics Overreacting Stuttering Swearing Touching Hair, Ears, or Nose Trembling Hands BEHAVIOURAL SYMPTOMSAND SIGNS

21. STRESS AND HEALTH Accidents: • Accidents at home, on the roads, and at work are more likely to occur when individuals are under stress. • People are more easily distracted when abnormally anxious.

22. INFECTIONS AND IMMUNESYSTEM • Stress impairs the workings of the immune system, which may lead to greater susceptibility from infections. • Stress is significantly associated with subsequent infections, in particular those of the respiratory tract.

23. HIGH BLOOD PRESSURE & STROKES It was demonstrated that the incidence of raised blood pressure and strokes was three to four times greater in the Air Traffic Controllers than in comparable workers in other occupations

24. HEART DISEASE • In the 1960s Friedman and Rosenman, found that heart disease patients under study behaved similarly-- they were aggressive, striving for achievement. • These individuals were described as type A personalities, as opposed to more relaxed type B personalities.

27. CANCERS Those who respond to stress by smoking or drinking more heavily will increase their risk of developing cancers of the esophagus, larynx, and lung. It is also possible that some cancers might be produced as a result of an immune response within the body.

28. WHAT IS BURNOUT ? Three stages of burnout are recognised: 1. Job stress-- working excessive hours, foregoing holidays, a tendency towards hurried and skipped meals and giving little time to the family. 2. Mental or emotional exhaustion -- tiredness, lethargy, hypochondria, irritability, anxiety, depression, insomnia or possibly uncontrolled alcohol consumption. 3. Inability to feel sympathy for others. This is accompanied by a deterioration in communication skills and tardiness.

31. A model of occupational psychosocial stress Source of stress The Individual Outcomes Intrinsic Stress Job dissatisfaction Excessive drinking Excessive smoking Drug use Anxiety Depression Coronary heart disease Marital disharmony Work Overload Demographic factors Role in the Organisation Stress coping ability Self Organisational structure & climate & Security Home/work interface

32. PROFESSION Sources of Stress Intrinsic Stress: We experience stress almost everyday as an intrinsic part of our profession and this is unavoidable. • Dealing with unsatisfied clients • Problem clients • Uncertainty • Interpersonal : Issues with colleagues and peers

33. WORK OVERLOAD AND TIME PRESSURE • Both qualitative (too difficult) and quantitative (too much to do). • Not having personal free time and carrying a heavy workload • Time factors are a major source of dissatisfaction

34. Role in the Organization • Clarity in the role/job description • Career progression • Responsibility Vs Authority • Vision and Mission • Ownership

37. ORGANIZATIONAL STRUCTURE AND CLIMATE Source of stress for the employee arises from the organizational structure and climate: >Participation in the decision making process >Effective communication >Restrictions in behavior

38. EMPLOYEES AND THEIR FAMILIES • Although stress is predominantly work-related, sufferers get caught in a vicious circle of neglecting the family life. • Excessive involvement of husbands and wives in demanding occupational roles, can have an adverse effect on the family

40. EMPLOYEE and SPOUSE • Professional spouse are more likely to suffer from Psychiatric problems and suicides • When there is a marital problem, denial may take the form of : (a) withdrawal into longer hours at the office, or (b) passive and condescending tolerance of her angry outbursts

41. WOMEN PROFESSIONALS • Despite working full-time, women are often expected to meet domestic commitments. • Married women are either divorcing, limiting their family size, or coping with both worlds at the expense of their physical and psychological health. • The ratio of divorces for female doctors compared with male doctors is 3 to 2. • More female doctors are single than male doctors. The percentage for female doctors is 31% and for male doctors 8% (UK study)

42. PERSONALITY • High achievers are described as competitors and achievement oriented. • This trait may increase in intensity as one climbs the career ladder. • Takes pride in over-production and often has a pathologically overdeveloped ability to postpone pleasure.

43. PERSONALITY • Feelings of doubt, guilt feelings, and an exaggerated sense of responsibility. • Excessive conscientiousness is a character trait that is socially valuable but personally expensive

45. Measuring stress Holmes and Rahe stress scale • In 1967, psychiatrists Thomas Holmes and Richard Rahe developed the scale, based on data of 5000 patients • A list of 41 stressful life events that can contribute to illness was developed and scaled

46. Measuring stress Holmes and Rahe stress scale • Rahe carried out a study in 1970 testing the reliability of the stress scale as a predictor of illness. • The scale was given to 2,500 US sailors and they were asked to rate scores of 'life events' over the previous six months. Over the next six months, detailed records were kept of the sailors' health. • There was a positive correlation between stress scale scores and illness.

47. Measuring stress Holmes and Rahe stress scale Life eventLife change units Death of a spouse 100 Divorce 73 Marital separation 65 Imprisonment 63 Death of a close family member 63

48. Measuring stress Holmes and Rahe stress scale Life eventLife change units Change in number of family reunions 15 Change in eating habits 15 Vacation 13 Christmas 12 Minor violation of law 11

49. Measuring stress Holmes and Rahe stress scale 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 or less: Only have a slight risk of illness

50. A STRESS DIARY • It is important to be able to identify precisely those individual or series of related events that may be causing stress or tension. • One way of doing this is to maintain a stress diary for a few weeks, noting all activities and using a simple code to indicate the strain involved • An awareness of this should help the to develop an action plan to minimize or eliminate the stressors