Stress

1. Stress Dr Aidah Abu Elsoud Alkaissi

2. Stress • Paradigm for understanding the relationships among the determinants of health, the leading health indicators and health outcomes • Stress cause or exacerbate many of the leading health problems such as obesity, alcohol and drug abuse ans sexually transmitted diseases • Caring for and supporting individuals, families and communities to help them find more effective ways to respond to stress is important for promoting health

3. Stress • Stress management is an effective intervention for health promotion, disease prevention and symptom management • Stress management strategies such as relaxation and imagery, self monitoring, goal setting, cognitive restructuring and problem solving have been the staple of community problems, including alcohol anonymous, smoke enders and weight watchers, which help people improve quality of life by modifying health-risking behaviors

4. Stress • United state is good at expensive, heroic care, it is poor at low-cost preventive care, particularly stress management • Individuals within high risk groups such as immigrants, refugees and families with few financial resources

5. The goal of stress management • Improve quality of life by increasing healthy, effective coping, thereby reducing the unhealthy consequences of distress • This process produces a dynamic interaction of mind , body, and spirit, which effect not only physical haelth and well being, but also cognitive and emotional states and behavior

6. Sources of stress • A stressor is any experience that disrupts homeostasis thereby requiring change or adaptation • Indviduals encounter a variety of physical, psychological, social, spiritual and environmental stressors • Stressors range from physical illness, truama or blood loss, to activities of daily living (caring for children, meeting work deadlines and cleaning or repairing the house), to event such as taking a critical examination, experiencing the death of relatives, losing possessions in a fire, losing a job, getting a divorse, or getting married

7. Sources of stress • Stressors can be categorized as those over which people have no control (extrinsic factors), such as the weather, a traffic jam, death of spouse; stressors that individuals can modify by changing their environment, social interactions or behaviors and stressors created or exacerbated (intrinsic factors( by poor time management, procrastination مماطلة (putting off or delaying or defering an action to a later tim), poor communication, catastrophic negative thinking (expecting the worst) , or strugling with self defeating (to frustrate ) behaviors

8. Sources of stress • Stress is a part of living, it is a complex relationship between a person and the environment in which the person appraises a situation as taxing or exceeding the individual´s resources and endangering the individual´s well being • Appraisal or perception is an important concept because it helps explain why two people react in different ways to the same situation

9. Sources of stress • Stress is the negative physical, psyckological, social or spiritual effect of life´s pressures and events • The term for the negative effect of stress is distress • Canadian physiologist Dr. Hans Selye (1982) demonstrates that, to a certain extent, stress can be challenging and useful, which he identifies or eustress (a pleasant or curative stress) • Selye observes when stress becomes chronic or excessive, the body is unable to adapt and maintain homeostasis and coined the term distress • Other reserchers have shown sress is oth useful and harmful

10. Sources of stress • As stress or challenge increases, efficiency and performance also increase but not endlessly • As a certain point, performance and efficiency start to decrease significantly if stress continues to build

11. Physiolgical effect of stress • An individaul´s response to stress provides a model to examine changes across the biopschosocial-spiritual domains • In response to a perceived threat (stressors) , the body prepares to meet the challenge • The perception of threat (stress) stimulates a physiological pattern of neural and endocrine activation and behavioral changes mediated by the central nervous system

12. Physiolgical effect of stress • In most cases this response is an adaptive, short term, acute response to a stressor • First termed te fight or flight response and later called the stress response • The individual´s reaction to stress prepares the body for emergency reaction and fosters survival in circumstances of immediate, time-limited threat

13. Physiolgical effect of stress • This physiological arousal proceeds along three main pthways • 1. The musculolskeletal system (MSS) • 2. The autonomic nervous system (ANS) • 3. The psychoneuroendocrine system (PNE) • The MSS respond by increasing tension and tone • At the same time, the ANS, via the sympathetic branch, orchestrates a generalized arousal that includes increases in heart rate, blood pressure and respiratory rate

14. Physiolgical effect of stress • Additionally a heightened awareness of the environment is triggered, blood shifts from the visceral organs to the large muscle groups, lipid metabolism is altered and platelet aggregability is increased • Concurrtly, the PNE stimultes the hypothalmic-pituitary-adrenal axis and the secretion of glucocorticoid (primarily cortisol) and other neuroendocrine substances into the systemic circulation, increasing glucose levels, influencing sodium retention and in the acute phase, increasing the antiinflammatory response

15. Physiolgical effect of stress • Eventually, however there is a decrease in immune function • Additionally, other hormones regulated by the PNE system, such as reproductive and growth hormones, endorphins and enkephalins can be affected by chronic stress

16. Physiolgical effect of stress • In most cases the stressrespone is a beneficial adaptive pattern but it can prove maladaptive when a stressor continues indefinitely • Maladaptive stress is an enduring and sometimes self sustaining cscde of response that degenerate physical, psychosocial and spiritual well being

17. Studies show that maladaptive stress can cause or exacerbate disease or symptoms of diseases such as angina, cardiac arrhythmias, pain, tension, headaches, insomnia and gastrointestinal complaints This influence is well documented in comprehensive experimental and clinical literature

18. Physiolgical effect of stress • Not surprisingly stress has been found to influence the development of coronary heart disease in women, to cause slow wound healing in women caregivers of relatives of dementia • Increase the susceptibility of catching the common cold

19. Psychological effects of stress • The negative mood states including anxiety, depression, hostility, and anger • 50% of all patients with severe depression show hypersecretion of cortisol • Cortisol concentration is raised in urine, plasma and cerebrospinal fluid of patients with depression

20. Depression is associated with increased risk of morbidity and mortality from cardiovascular disease Increased isk for hypertension related to factors such as cigarette smoking, sedentary lifestyle, family history also document relationship between anxiety and hypertension

21. Social-Behavior Effects of Stress • In response to stress, individuals often revert (practice) to or increase their reliance (the state of relying on something) on less healthy behaviors such as overeacting, excessive use of alcohol, smoking, sedentary life style, drug use and increase in violent behavior • Recognition that behaviors are inconsistent with the healthy behaviors needed to cope with stress is easy

22. The inability to control health risking behaviors as a result of increased stress is called the stress disinhibition effect Health risking behaviors such as a sedentary lifestyle, obesity, overeating high fat-foods, smoking, drug use, and social isolation have been clearly linked to morbidity and mortality

23. Social-Behavior Effects of Stress • Exercise, healthy diet, smoking cessation, healthy weight maintenance and social interaction have been identified as leading indicators of health • Stress management strategies that help break the cycle of stress-disinhibition in response to stress are important to mediate the unhealthy pattern

24. Spiritual effects of stress • The study of spirituality and health is of significant interest • In response to stress, people often feel disconnected from life´s meaning and purpose which effects spiritual health and well being • Studies are confirming that prayer can affect healing

25. Religious practices are examples of ways in which some people choose to express their spitituality Koenig et al (1998) report that Christians who attended religios services at least once per week and those who read the bible or pray regularly have consistently lower diastolic pressure readings compaed with people who do not engage in spiritual activities

26. Health Benefits of Managing Stress • The importance of controlling stress to promote health and quality of life for people with a variety of health problem is highlited in a continoully growing body of evidence • Cancer, HIV, and other immune system disease have been shown to respond to interventions to reduce the stress response

27. Health Benefits of Managing Stress • Arthritis, , chronic pain, chronic disease, diabetes, coronary heart diseases, hypertension, cardiac arrhythmias, insomnia, premenstrual syndrome, infertility and the nausea and vomiting associated with chemotherapy have been shown to respond to stress management interventions • In addition, interventions that help counter the negative effects of stress have been shown to be cost-effective

28. Health Benefits of Managing Stress • Kobas et al (1982) descibed individuals with stress-hardy characteristics who, when exercising and accessing social support were shown to be less vulnerable to stress-related symptoms and diseases • The characteristics of stress hardiness are control, challenge, and commitment • For stress hardy individuals stress is viewed as a challenge rather than a threat, the feel in control of situation in their lives and they are commited to rather than alienated from work, home and family

29. Health Benefits of Managing Stress • The researchers theorize that a pessimistic explanatory style or attitude weakness the immune system through a sustained increase in sympathetic aruosal in addition to negatively affecting behavior • For example, pessimist exhibit more health- risking behaviors such as smoking, alcohol misuse, and sedentary lifestyles

30. Health Benefits of Managing Stress • Evidence is presented that perceptions or the way the individuals view situations can lead to stress and in turn adversely affect biological activity, emotions, behavior and the connection with life meaning and purpose which in turn increase stress and foster a negative stress cycle

31. Interviewing techniques to help individuald describe their evaluations of stressful events • Primary appraisal of coping includes descriptions of perceived actual and potential positive and negative outcomes • Negative outcomes refer to harm, whereas positive outcomes refer to the challenges that an individual perceives can be acheived as a result of the stressors

32. Examples of negative outcomes are physical injury, disease, loss of a cherished relationship, position or possession and death Positive outcomes include graduation, promotion and development of important relationships

33. Interviewing techniques to help individuald describe their evaluations of stressful events • Secondary appraisal: which includes the individual´s identification of available choices to cope with the actual or potential harm, threat, or challenge • The choices may be internal or external resources and responses • For example, a social resourcs in coping with the needs of a toddler might be learning strategies in a parent-effectiveness training course

34. Interviewing techniques to help individuald describe their evaluations of stressful events • A coping response to the challenges of parenting a toddler might be restructing the toddler´s and parent´s schedules to allow for more frequent cycles of activities and rest • By using measurement instruments with established validity and reliability, nurses can increase their accuracy of assessing and individual´s stress and coping • Using these tools can help nurses distinguish between diagnosis that have many signs and symptoms in common

35. Interviewing techniques to help individuald describe their evaluations of stressful events • A wide variety of tests and questionnaires are available for nurses to assess orientation, attention, cognitive skills and patterns, traits and states of emotions and overall quality of life

36. Stress Management intervention • Nurses are sensitive to the needs of individuals in highrisk groups, such as immigrants, refugees, and families with few financial resources • The language, belief system and cultural distinctions of individuals guide the choice or alteration of stress management strategies

37. Developing self-Awareness • Helps people learn about the relationship of mind-body-spirit, increase a sense of control and counter self defeating perceptions • The purpose is to help people make sense of life events and circumstances that may be be wildering or discomforting • Many experiences in life lead to feelings of emptiness and disharmony because the person is unable to connect the experience with thoughts , feelings, actions, and physiological responses

38. Developing self-Awareness • Self-awareness helps individuals recognize stress that they create through negative, exaggerated, unrealistic thinking • These recognition affords an opportunity to change these negative thought patterns, thereby decreasing stress and increasing control • Using strategies that increase self-awareness can empower individuals to make new connections and to reframe and reinterpret their experiences in light of their own inner strength and wisdom

39. Techniques for developing self-awarenessmonitoring stress warning signs • The negative stress cycle can be difficult to interrupt • Recognizing the warning signs of stress is a necessary first step • Often individuals have long ignored the stress warning signs (physical, emotional, or behavioral cues or reactions to a stressror) that their mind and body gives them • The man suffering from chronic intermittent backaches who ignores the daily muscle tension caused by poor posture, which precedes the backaches

40. Techniques for developing self-awarenessmonitoring stress warning signs • Example, if he had attended to his early stress warning signs (poor posture, and muscle tension) then he might have avoided the backache that kept him from exercising and socializing • Becoming aware of these stress warning signs is the first step • Attending to these cues is the next step • After this connection is made, developing skills to reduce negative mood states, unhealthy behaviors and physical symptoms becomes much easier

41. Techniques for developing self-awarenessmonitoring stress warning signs • To continue with the previous example, when the man notices muscle tension and then stops, take a few deep breaths, correct his posture, and gently stretches the area rather than waiting for the backache to become incapacitating before acting • It is eaier to prevent a backache from becoming disabling

42. Learning and practicing a relaxation technique • Relaxation technique counter the stress response by reducing sympathetic arousal • The immediate physiological effects of relaxation are decreases in heart rate, blood pressure, respiratory rate and muscle tension

43. The long term physiological effect is a decrease in central nervous system arousal with a concomitant decrease in MSS, ANS and PNE arousal Psychological changes such as improved mood and behavioral changes including reduced health-risking behavior can occur

44. Learning and practicing a relaxation technique • This relaxed state of mind can also help individuals develop a spititual perspective that can engender a shift in value and beliefs that are important to personal growth and development • The relaxation technique ca have components such as:

45. The repetition of a word, sound, phrase, prayer, image or physical activity The passive dusregard of every day thoughts when they occur Audiotapes are recommended to help guide his process of focusing, especially in the intial learning phase

46. The repetition of a word, sound, phrase, prayer, image or physical activity The passive disregard of every day thoughts when they occur Audiotapes are recommended to help guide his process of focusing, especially in the intial learning phase

47. Learning and practicing a relaxation technique • One effective way is to have the person make a fist and notice what happens to the breathing pattern • Most people have a tendency to hold their breath while tensing a body pat • Now ask the person to take a few deep diaphragmatic breaths while making a fist • Most people will notice that the tension is much harder to maintain while taking a deep breath • This awareness helps to recognize the relationship between breath and tension

48. Using mini-Relaxation