Stress Management

1. www.jagrutirehab.org Stress Management DR. AMAR SHINDE MBBS, DPM(FIPS) CONSULTANT PSYCHIATRIST • NOBLE HOSPITAL • JAGRUTI REHAB CENTER

2. www.jagrutirehab.org ‘JAGRUTI’ REHABILITATION CENTER Jagruti Rehab is a 120 bedded center for Psychiatric Patients of • Schizophrenia • Bipolar Mood Disorders i.e. Mania & Depression • Obsessive Compulsive Disorders etc. De-Addiction • Alcohol, Smoking, Tobacco Chewing etc. • Cannabis like Ganja Charas. • Brown Sugar, Opioids, Corex, Medicines etc. Alzheimer's Dementia

3. www.jagrutirehab.org What is Stress/ Tension? • Stress: The human reaction to the events in our environment

4. www.jagrutirehab.org Stress • “….stress is the nonspecific response of the body to any demand, whether it is caused by, or results in pleasant or unpleasant conditions.” Hans Selye, MD

5. www.jagrutirehab.org Sources of Stress The Good Get married Have children Buy a new home Go on vacation New Job Promotion The Bad Break a leg Spouse loses job Lose wallet In-laws coming The Ugly Nasty car accident Bankruptcy Divorce Loved one dying

6. www.jagrutirehab.org Various Stressors Environmental Career Pressures Injury Emotional Illness Physical

7. www.jagrutirehab.org FOUR TYPES OF STRESS • 1. General Stress: • Everyone has this kind of stress • It resolves itself within a day or two • No intervention is necessarily required

8. www.jagrutirehab.org FOUR TYPES OF STRESS • Cumulative Stress: • Stress builds up in your body • It becomes more difficult to alleviate your symptoms • more serious physical symptoms • more mental anguish

9. www.jagrutirehab.org FOUR TYPES OF STRESS 3. Acute Traumatic Stress: • Critical Incident Stress • Produces considerable psychological distress • A normal reaction to abnormal events

10. www.jagrutirehab.org FOUR TYPES OF STRESS 4. Post Traumatic Stress: • Severe stress produced by severe psychological trauma • Created by unresolved Critical Incident Stress • Produces lasting changes

11. www.jagrutirehab.org General Adaptation Syndrome • Stage I - Alarm Reaction • The “fight or flight” response which causes you to be ready for physical activity • However, it decreases the effectiveness of the immune system which makes you more susceptible to illness

12. www.jagrutirehab.org “Fight or flight” response

13. www.jagrutirehab.org General Adaptation Syndrome • Stage II – Stage of adaptation • If stress continues, the body adapts to the stressors it is being exposed to • If the stressor is starvation, the person experiences a reduced desire for physical activity to conserve energy, and the absorption of nutrients from any food intake is maximized

14. www.jagrutirehab.org General Adaptation Syndrome • Stage III – Stage of Exhaustion • Stress persists for a long time • The body’s resistance may be reduced or collapse quickly • People who experience long-term stress may have heart attacks, severe infections, or chronic pain or illness

15. www.jagrutirehab.org Autonomic Nervous SystemResponsible for stress reaction Sympathetic • Increased HR, BP, RR • Muscles tense • Brain becomes more alert • Liver increases blood glucose level • Digestion inhibited Parasympathetic • Normalizes HR, BP, RR • Muscles relax • Energy storage • Promotes growth • Mediates calm • Pupils constrict

16. www.jagrutirehab.org How Can the Stress Response Make Us Sick? • Chronically elevated BP • atherosclerosis • myocardial ischemia • Constantly using stored energy • tire more easily • Blocked insulin secretion • higher risk of diabetes

17. www.jagrutirehab.org Why Stress Management? Researchers indicate 2/3 of medical visits are for stress related illnesses • Stress response contributes to: • coronary artery disease • cancer • respiratory disorders • unintentional injuries • cirrhosis • suicide

18. www.jagrutirehab.org Any Emotion can produce Stress • Anger • Fear • Depression • Worry • Love etc.

19. www.jagrutirehab.org Short Term Physical Stress Symptoms • Dry mouth • Cold hands and feet • Increased sweating • Rapid breathing • Faster heart rate • Tense muscles • Feelings of nausea • Diarrhea • A desire to urinate

20. www.jagrutirehab.org Long Term Physical Stress Symptoms • Sleep disturbances • Change in Appetite • Sexual disorders • Aches and pains • Frequent colds • Feelings of intense and long-term tiredness • Prone to illness

21. www.jagrutirehab.org Emotional Signs of Stress • Fearfulness • Feeling low • Grief • Anger • Worry • Uncertainty • Hopelessness • Helplessness • Feeling lost • Anxiety • Panic • Inappropriate Emotions

22. www.jagrutirehab.org BEHAVIOR STRESS SYMPTOMS • These symptoms will have a negative effect on your performance • By reducing your effectiveness • Making you accident prone • Causing you to be forgetful • Causing you to be very negative • You may neglect your appearance • You may make poor judgments • Causing you to make more mistakes • Increasing your absenteeism

23. www.jagrutirehab.org PERFORMANCE STRESS SYMPTOMS • You may not make good decisions • Your fine motor skills are affected • You may no longer enjoy your work • Your attention span may be affected • You may have more negative thoughts • Your self confidence will suffer • You may have difficulty concentrating

24. www.jagrutirehab.org Anger:- Physical Symptoms • Increased HR, BP • Increased Muscle Tension & Sweating • Restlessness • Emotional Symptoms • Shattered Beliefs in a Just World • Ready to Fight • Defensive

25. www.jagrutirehab.org Depression • Mild • Moderate • Severe • Last two always requires professional help.

26. www.jagrutirehab.org Physiology of Circadian Rhythms Stages of Sleep REM Sleep Shift Work

27. www.jagrutirehab.org Negative Self-Talk • The Worrier Voice - “What if…..?” • Make a plan then get it out of your head. • The Critic Voice - “How stupid…..” • Recognize what is really true.

28. www.jagrutirehab.org Negative Self-Talk • The Victim Voice- “I’ll never be able to…..” • There is always something to do to work toward a goal. • The Perfectionist - “I should……” • Assess your unrealistic expectations of yourself.

29. www.jagrutirehab.org MANAGING STRESS • Our goal is not to eliminate • stress but to learn how to • manage and use it • to help us.

30. www.jagrutirehab.org Steps to Building a Positive Attitude Step 1: change Focus, Look for the Positive. Make a Habit of Doing it Now. Develop an attitude of gratitude. Get into a continuous education program. Build positive self-esteem. Stay away from negative influences. Learn to like the things that need to be done. Start your day with a positive. Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Step 8:

31. www.jagrutirehab.org HEALTHY LIVINGTO CONQUER STRESS • Examine your diet • Lower your salt intake • Lower your intake of refined sugars and carbohydrates • Lower your caffeine intake • Add to your diet • Vegetables • Fruits • Complex Carbohydrates • Vitamins • Water

32. www.jagrutirehab.org Stress-Friendly Diet • Eat fresh foods • Eat regular meals • Eat slowly • Resist the temptation to overeat • Eat a variety of foods • The acid/alkaline balance • Fluids • Fiber

33. www.jagrutirehab.org HEALTHY LIVING • Rest: • Get a minimum of six hours of continuous rest

34. www.jagrutirehab.org HEALTHY LIVING • Exercise: • At least twenty minutes, five times a week • break a sweat, to release endorphins

35. www.jagrutirehab.org HEALTHY LIVING • Talk things out with someone you trust - a family member or a good friend

36. www.jagrutirehab.org HEALTHY LIVING • Make an increased effort to organize your life • Ask for help • Delegate things when you need to

37. www.jagrutirehab.org HEALTHY LIVING • Learn to manage your anger • Anger affects your health • Anger causes you to over react to many situations

38. www.jagrutirehab.org HEALTY LIVING • We get angry often because someone did not do what we thought they should • Rethink the situation and learn to be more flexible

39. www.jagrutirehab.org Anger Management • Anger Intensifying • Yelling • Pouting • Hitting • Other Violence • Competitive Games • Accusations • Arguing • Cooling Off Habits • Abdominal Breathing • Count to Ten • Non-Competitive Exercise • Distraction • Humor • Empathy for Other Person

40. www.jagrutirehab.org • Causes Deep Abdominal Breathing • Increases Circulation • Releases Endorphins & Enkyins • Relieves Tension • Puts Life into Perspective

41. www.jagrutirehab.org HEALTHY LIVING • Fill your life with fun things to do!!!! • Keep your sense of humor!!!! • We call it : PLAY THERAPY

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43. www.jagrutirehab.org HEALTHY LIVING • Take charge of your life. • Act appropriately -don’t simply react to stressful situations • Find balance in all that you do.

44. www.jagrutirehab.org HEALTHY LIVINGToo many people look for an easy answer to stress management by misusing • Alcohol • Drugs • Marijuana • Medicines & Pills

45. www.jagrutirehab.org Increase Quality of Sleep Do • Exercise (early in day) • Avoid Caffeine • Avoid Alcohol • Don’t Self Medicate for Sleep (some sedatives interfere with deep sleep) • Relaxation Techniques Before Sleep • Warm Bath • Avoid Rich Foods Before Sleep

46. www.jagrutirehab.org Coping Skills to Manage Stress Scheduling • Daily • Weekly • Months, years etc Goal Setting • Short Term • Long Term • Ultimate Problem Solving • Algorithms • Stepwise

47. www.jagrutirehab.org HEALTHY LIVING • We all need a lengthy list of things that will help us relax…..

48. www.jagrutirehab.org HEALTHY LIVING • Relaxing needs to be part of your daily routine.

49. www.jagrutirehab.org HEALTHY LIVING • RELAAAAAAX

50. www.jagrutirehab.org Relaxation Techniques • Abdominal Breathing • Active Progressive Muscle Relaxation • Visualization • Meditation • Music • Stretching • Exercise