Stress Management Allan Sanders, MN, ARNP asanders@wsu.edu

1. Stress Management Allan Sanders, MN, ARNP asanders@wsu.edu

2. Objectives • Explore the biological, psychological, and social aspects of the human stress response. • Describe the difference between adaptive and maladaptive coping strategies. • Understand coping strategies that increase resilience to promote productive living and healthy aging.

3. Common Stress Associated Diseases • Diminished Immunity • Headache • Fatigue • Weight gain • Dyslipidemia • Hypertension • Heart Disease • Psoriasis/Eczema • Digestive problems • Anxiety • Depression • Alcoholism • Substance abuse • Insomnia • Irritable bowel syndrome • Fibromyalgia • Decreased sex drive

4. Overview of Terminology • Stress: A state of disharmony or a threat to homeostasis • Physiological changes increase alertness, focus, and energy • Perceived demands may exceed the perceived resources • Coping:The ability to maintain control, think rationally, and problem solve • Resilience: Resistant quality that permits a person to recovery quickly and thrive in spite of adversity

5. Stress • Eustress • Manageable Stress can lead to growth and enhanced competence • Distress • Uncontrollable, prolonged, or overwhelming stress is destructive. • Acute Stress • Immediate response to a threat or challenge • Chronic Stress • Ongoing exposure to stress, may seem unrelenting

6. Causes of Stress • External causes • Family, work, economics, work, school, major life changes, unforeseen events, etc. • Internal causes • Worry, uncertainty, fear, attitudes, unrealistic expectations, etc.

7. Sources of Clinical Stress For patients For nurses Poor patient outcomes Risk of making an error Unfamiliar situations Excessive workload Inadequate resources • Uncertainty • Fear • Pain • Cost • Lack of knowledge • Risk for harm • Unknown resources

8. Stages of the Stress ResponseGeneral 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

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

10. 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

11. 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

12. Signs & Symptoms of Stress • Cognitive • Decreased concentration, comprehension, & memory • Behavioral • Irritability, withdrawal, violence • Emotional • Fear, anxiety, depression, fatigue • Physiological • Increased BP, HR, Respirations, etc • Somatic symptoms • Decreased immune response

13. Genetics & Development Genetics Development Life experiences can affect a person's stress response Social support Strong support is protective Early life stress Increases stress reactivity as an adult • Genes control the stress response • Individuals have different responses to stress • There is a genetic component to: • fearful behavior • anxiety disorders • Neurobiological response

14. Coping & Resilience Coping Resilience The ability to bounce back The positive capacity to cope with stress Provides resistance to negative events Hardiness, Resourcefulness • Ability to control emotions • Ability to perceive reality • Ability to think rationally • Ability to problem solve • Culturally defined

15. Coping Adaptive Coping • Contribute to resolution of the stress response Maladaptive Coping • Strategies that cause further problems Active Coping • Actively seeking resolution to the stress

16. Promote Adaptive Coping • Realistic expectations • Set realistic goals • Planning • Anticipate problems, have a backup plan • Reframing • Change the way you look at things • Relaxation • Learn relaxation techniques, take time-out for leisure • Discuss the problem • Utilize existing social supports to problem solve

17. Promote Adaptive Coping • Training • Prepares for stressful events • Nutrition • Eat healthy, avoid skipping meals • Exercise • Include regular exercise • Sleep • Get adequate sleep—avoid fatigue

18. Avoid Maladaptive Coping • Blurring of boundaries • Avoidance/withdrawal • Negative attitude • Anger outbursts • Alcohol/Drugs • Hopelessness • Negative self-talk • Resentment • Violence

19. Promote Resilience Factors • Positive Role Models • Optimism • Humor • Moral Compass • Altruism • Religion & Spirituality • Social Support

20. Positive Role Models Transmit: • Attitudes • Values • Skills • Patterns of thoughts and behaviors

21. Optimism • Positive Beliefs • Associated with well being • Cognitive reframing • Positive thinking • Refute the negative thinking • Believe in a meaningful cause • It is important to acknowledge relevant negative factors

22. Humor • Highly effective • Mature coping mechanism “Another of the souls’ weapons for the fight for self-preservation, it is well known that humor, more then anything else in the human makeup, can provide an aloofness and the ability to rise above any situation, even for a few seconds.” Viktor Frankl

23. Moral Compass • Conduct a moral inventory • “Look not for any greater harm then this, destroying the trustworthy, self-respecting, well-behaved man within you.”Epicetus • Maintain your integrity • “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” Viktor Frankl

24. Altruism • Unselfish regarding the welfare of others • Believe in a meaningful cause • Mutual cooperation • Activates of the brain’s reward center

25. Religion & Spirituality • Associated with psychological and physical well being • Guards against despair • Provides social support • Provides positive role models • Provides a positive mission

26. 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”

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

28. Review • Stress is part of everyday life • It can promote growth and competency • If unrelenting or overwhelming it can cause adverse effects • Adaptive coping enhances resilience • Maladaptive coping causes additional problems • Enhanced coping increases resilience while diminishing the adverse affects of stress, thus promoting health

29. Review: Practical Tips • Set realistic expectations • Exercise regularly • Eat healthy • Get adequate sleep • Maintain a work-leisure balance • Positive Reframing & optimism • Enhance social support

30. Internet Resources • Building resilience: http://www.slideshare.net/3dogMcNeill/building-resilience • Diet, exercise, stress and the immune system: http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome/hic_diet_exercise_stress_and_the_immune_system.aspx • Exercise: Rev up your routine to reduce stress: http://www.mayoclinic.com/health/exercise-and-stress/SR00036 • Positive thinking: Reduce stress, enjoy life more: http://www.mayoclinic.com/health/positive-thinking/SR00009 • Stress management for patient and physician: http://www.mentalhealth.com/mag1/p51-str.html • Stress management: Understand your sources of stress: http://www.mayoclinic.com/health/stress-management/SR00031 • Stress reduction techniques: A must for a healthy lifestyle: http://www.managestresstips.com/category/stress-reduction/

31. Learning Exercise • List your current sources of stress. • Conduct an inventory of coping strategies that you use or have used in the past. • Include maladaptive strategies • List your signature strengths and factors that may enhance your resilience. • While considering the above, develop a personalized stress management plan to enhance your coping and resilience.

32. References Ahern, N., Ark, P., Byers, J. (2001). Resilience and coping strategies in adolescents. Paediatric Nursing. 28(10). Beckmann-Murray, R., Proctor-Zentner, J., & Yakimo, R. (2009). Health promotion strategies through the life span. New Jersey: Prentice Hall Bhui, K., King, M., Dein, S., & O’Conor, (2008). Ethnicity and religious coping with mental distress. Journal of Mental Health. 12(2). Copstead, L. C. & Banasik, J. L. (2010). Pathophysiology: Biological and behavioral perspectives (2nd ED.) USA: W. B. Saunders Company Fielding, R (Undated) Retrieved September 25, 2007 from:http://www.pitt.edu/~super1/lecture/beh0091/img007.GIF&imgrefurl Hildon, Z., Smith, F., Netuveli, G. & Blane, D. (2008). Understanding adversity and resilience at older ages. Sociology of Health & Illness. 30(5). Posen, D. B. (1995). Stress management for patient and physician. Retrieved September 21, 2007 from: Http://Serendip.brynmawr.edu/bb/neuro/neuro00/web3/edmundson.html Pranulis, M. S. (1975). Coping with acute myocardial infarction. Psychological Aspects of Myocardial infraction. Mosby: St. Louis Southwick, S. M. (2007). Cleveland Clinic’s posttraumatic stress disorder symposium. California: Audio-digest Steinhardt, M. & Dolbier, C. (2008). Evaluation of a resilience intervention to enhance coping strategies and proctitive factors and decrease symptomatology. Journal of American College Health. 56(4). Images retrieved from Microsoft: http://office.microsoft.com/en-us/images/?CTT=97

33. ContactInformation Allan Sanders, MN, ARNP asanders@wsu.edu