Lecture 2 Identifying your stressors and how you handle stress

1. Lecture 2 Identifying your stressors and how you handle stress Dr. Paul Wong D.Psyc.(Clinical) E-mail: paulw@hku.hk Centre for Suicide Research and Prevention (CSRP)

2. This Lecture’s Overview • Recap of Lecture 1 • In-class activity - Myths and Facts of Suicide • Video – The aftermath of suicide • What is Stress? • Sources of Stress • Bio-psycho-social Aspects of Stress • How Stress Affects Health • Coping with it

3. Objectives • Students will learn the difference between good and bad stress. • Students will learn to identify signs of stress in themselves and others. • Students will learn the difference between positive and negative ways of coping with stress. • Students will identify and choose specific methods that can reduce stress.

4. Myths and Facts of SuicideIn-class activity

5. Myth or Fact Suicide usually happens without warning.

6. Myth Research has demonstrated that in over 80% of completed suicide, a warning sign or signs were given. (Coleman & O’Halloran, 1998) Many studies have revealed that the suicidal person gives many clues and warning regarding suicidal intentions. This is not to say that all suicidal people always give warnings. (Center for Mental Health in Schools at UCLA, 2003)

7. Myth or Fact? There are no special/certain types of people who commit suicide.

8. Fact Suicidal behavior cuts across all socioeconomic boundaries. People of all ages, races, faiths, and cultures die by suicide, as do individuals from all walks of life, all income levels. Most who die suffer from serious mental illness; many of whom have not been diagnosed; some have no diagnosable mental illness. We have to pay serious attention to all suicidal talk and behavior.

9. Myth or Fact? Suicide is preventable

10. Fact It is simply not true that “once suicidal, always suicidal.” Most people who are considering suicide will be suicidal for a relatively short period of time. Given proper assistance and support, there is a strong possibility that there will not be another suicidal crisis.

11. Myth or Fact? Many people think about suicide at some point in their lives.

12. Fact 50% to 70% of people have thought of suicide at some point in their lives as shown in studies that investigated lifetime suicidal ideation. (Ramsay et al., 1999) In Hong Kong, 29.6% of those aged 15-59 in the population have ever thought about suicide in their lives, and 6.7% have suicidal ideation in the past year. (Prevalence Study of Suicidality in Hong Kong)

13. Myth or Fact? People who talk about suicide don’t really commit suicide.

14. Myth Of every 10 persons who kill themselves, 8 have given definite verbal warning signs of their suicidal intentions. (Center for Mental Health in Schools at UCLA, 2003) 50.7% of those who committed suicide had either implicitly or explicitly expressed their suicidal plan prior to their death. (Psychological Autopsy Study of Suicide in Hong Kong)

15. Myth or Fact? Suicidal people fully intend to die.

16. Myth Most suicidal people are ambivalent about dying. On one hand, they wanted to commit suicide to end their pain, yet on the other hand, they wanted someone to be there to help them and listen to them. (Center for Mental Health in Schools at UCLA, 2003)

17. Myth or Fact? Once a person is suicidal, the person is suicidal forever.

18. Myth Individuals who wish to kill themselves are suicidal only for a limited period of time. In other words, it is almost always a temporary state.

19. Myth or Fact? People who threatens or attempts suicide are merely seeking attention.

20. Myth 28.2% of all suicide cases in 2003 had an attempt history. 30.5% of the deceased aged below 25 had attempted suicide before. (Surveillance and Monitoring, 2003) Compared to the people who are alive, those who died by suicide were 24.8 times more likely to have attempted suicide before. (Psychological Autopsy Study of Suicide in Hong Kong)

21. Myth or Fact? Talking about suicide or asking someone if they feel suicidal will encourage suicide attempts.

22. Myth There is no evidence that asking an individual about suicidal ideation will increase the change that the individual will commit suicide. Most people thinking about suicide want very much to talk about how they are feeling and are relieved when someone else recognizes their pain. To avoid the subject of suicide is deadly. (Coleman & O’Halloran, 1998)

23. The Aftermath of Suicide – People bereaved by suicide

24. Video on People bereaved by Suicide in Hong Kong

25. What is Stress?

26. What is Stress? • It is a stimulus – things that “stress” us, e.g., “This broadening course’s course co-ordinator stresses me!” • It is a response – how we react to a stimulus, e.g., “I feel a lot of stress when I an being asked to answer questions in lectures of this course” • It is a process – in which the person is an active agent who can influence the impact of a stressor through behavioural, cognitive, and emotional strategies. E.g., “though this broadening course makes me stress, I can deal with it by following the suggested ways from this class”.

27. So WHAT stress you? In-class activity no.2 – Hassles in Your life (Sarafino & Ewing, 1999).

28. The definition of stress - Stress as the condition in which person-environment transactions lead to a perceived discrepancy between the physical or psychological demands of a situation and the resources of the individual’s biological, psychological, or social system (Lazarus & Folkman, 1984).

29. In English Stress is the reaction people have excessive pressures or other types of demand placed upon them. It arises when they worry that they can’t cope.

30. When do we see something as stressful? • Determined by two components: • Whether a demand threatens our physical or psychological well-being (primary appraisal); and • The resources available for meeting the demand (secondary appraisal). *** in emergency situations, i.e., disaster, our cognitive functioning is impaired during shock, it is unlikely that appraisal processes play an important role in the stress experienced while in that state***

31. Sources of Stress External Internal

32. External Stressors • Physical Environment (Noise, Bright Lights, Heat, Confined Spaces) • Social Interaction (Rudeness, Bossiness, Aggressiveness by others, Bullying) • Organizational (Rules, Regulations, Deadlines) • Major Life Events (Birth, Death, Lost job, Promotion, Marital status change)

33. Internal Stressors • Negative self - talk (Pessimistic thinking, Self criticism, Over analyzing) • Thinking errors (Unrealistic expectations, Taking things personally, All or nothing thinking, Exaggeration, Rigid thinking) • Personality traits (Perfectionists, Workaholics)

34. Types of Stress • Negative stress (dy-stress) • Positive stress (eu-stress)

35. Note: Most of the stress we experience is self-generated. How we perceive life - whether an event makes us feel threatened or stimulated, encouraged or discouraged, happy or sad - depends to a large extent on how we perceive ourselves.

36. Note: • Self-generated stress is something of a paradox, because so many people think of external causes when they are upset. • Recognizing that we create most of our own upsets is an important first step towards coping with them.

37. How stress affects our Bio-Psycho-Social Aspects?

38. How stress affects our Bio-Psycho-Social Aspects? • Biological • During emergencies – fight-or-flight response • Pupils dilated, far vision • Dry mouth • Sweaty palms • Increased heart rate • Maximum blood supply to muscles • Digestion inhibited • When stress prolongs • GAS (General Adaptation Syndrome)

39. What is GAS? • Three stages: • Alarm Reaction – similar to the fight-or-flight response • Stage of Resistance - If the source persists, the body prepares for long-term protection, secreting hormones to increase blood sugar levels. This phase is common and not necessarily harmful, but must include periods of relaxation and rest to counterbalance the stress response. Fatigue, concentration lapses, irritability and lethargy result as the stress turns negative. • Stage of Exhaustion - In chronic stress situations, sufferers enter the exhaustion phase: emotional, physical and mental resources suffer heavily, the body experiences ‘ adrenal exhaustion’ leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse.

40. The Psychosocial Aspects of stress • Mental • Behavioural • Emotional

41. Mental Symptoms • Lack of concentration • Memory lapses • Difficulty in making decisions • Confusion • Disorientation • Panic attacks

42. Behavioural Symptoms • Appetite changes - too much or too little • Eating disorders - anorexia, bulimia • Increased intake of alcohol & other drugs • Increased smoking • Restlessness • Fidgeting • Nail biting

43. Emotional Symptoms • Bouts of depression • Impatience • Fits of rage • Tearfulness • Deterioration of personal hygiene and appearance

44. Stress Related Illnesses • Stress is not the same as ill-health, but has been related to such illnesses as: • Cardiovascular disease • Immune system disease • Asthma • Diabetes • Recurrent headache • Cancer

45. Why some people are more prone to stress, and some are not? • Social Support? • A sense of personal control? • A Hardy personality? • Hardiness include control, commitment, and challenge.

46. Coping with STRESS

47. Coping is the process by which people try to manage the perceived discrepancy between the demands and resources they appraise in a stressful situation. • In English – people come up with ways to either reduce “demands” or increase “resources” or both.

48. Two major functions of coping • Emotion-focused coping • Problem-focused coping In-class activity no.3 – “Your Focuses in Coping” - Billings and Moos, 1981.

49. Two major functions of coping • Emotion-focused coping – is aimed at controlling the emotional response to the stressful situation • Problem-focused coping – is aimed at reducing the demands of the stressful situation or expanding the resources to deal with it. • Please see examples of ways of coping from handout

50. Stress Management Techniques • Change your thinking • Change your behaviour • Change your lifestyle