WORK , STRESS & MENTAL HEALTH

1. WORK , STRESS& MENTAL HEALTH Dr. Srikala Bharath Professor of Psychiatry NIMHANS Bangalore srikala.bharath@gmail.com

2. Concept of Stress Stress – Eustress Distress Selye - ‘Fight’ or ‘Flight ‘ General Adaptation Syndrome Srikala Bharath, NIMHANS

3. Mind and Body Closely related – HPA Axis - Immunity and Cortisol Symptoms of Anxiety- Stage of Alarm - Stage of Resistance Burnout – Stage of Exhaustion Srikala Bharath, NIMHANS

4. Yerkes – Dodson Law Srikala Bharath, NIMHANS

5. Types of Stress Single Multiple Natural Man-Made Srikala Bharath, NIMHANS

6. Stress – Physiological ANS – Systems Emotional Anxiety, Worry Behavioral Agitation • Coping – Emotional - Cognitive - Behavioral Srikala Bharath, NIMHANS

7. Resources less Stress Coping strategies Environmental factors Perception By the person Resources more No Stress Srikala Bharath, NIMHANS

8. Physiolog Responses Resources Options Psych Beliefs Commitments Secon appraisal Coping Threat challenge Behav Environmental factors Primary Appraisal Irrelevant Ignore No stress Srikala Bharath, NIMHANS

9. Stress & Disease • Hypertension • Diabetes • Hyperlipidemia • Obesity • Ischemic Heart Diseases • Psychosomatic Diseases – Asthma, Psoriasis, Dysmenorrhoea • Headaches • Repeated cold and illnesses indicating lack of immunity • Low back ache Srikala Bharath, NIMHANS

10. Stress & Mental Health • Irritability, Hostility • Anger • Anxiety and Worry • Headaches, Multiple aches and pains • Depression, Chronic Minor Depr. • Suicide/DSH • Substance abuse – Alcohol, Tobacco • Absenteeism • Sexual issues • Hysterical Symptoms • Burnout • Indecisiveness, Errors at work Srikala Bharath, NIMHANS

11. Work & Stress • Job • Home Career interface – one role leaving little time for the other - Behavior appropriate in one not so in other - strain of one spills on to other • Home Srikala Bharath, NIMHANS

12. Work & Stress • Multiplicity of Roles • Role Ambiguity • Role Overload • Cultural/Gender Issues All the above in both Work and Home situation Srikala Bharath, NIMHANS

13. Daily Hassles at Work • Trouble w/ customer/client • Having to work late • Trouble w/ boss • Constant people interruption • Deadline and time pressure • Decision making • Dealing w/ bureaucracy at work • Technical breakdowns • Trouble w/ colleagues • Tasks not stimulated • Too much responsibility • Too many jobs at hand • Traveling to and fro long distance • Too many telephone interruptions • Too many meetings • Cannot say ‘no’ • Do not know where career is going • Job security not clear • Spouse not supportive of working • Having to do difficult things – firing sub ordinates Srikala Bharath, NIMHANS

14. Family Types • Symmetrical – Egalitarian/ Power Struggle • Asymmetrical – One partner more empowered than the other. (self assessment) • Communication Styles – Assertive, Aggressive, Passive Srikala Bharath, NIMHANS

15. The Individual Srikala Bharath, NIMHANS

16. Coping with Stress • Coping – Action vs Emotion • Mindfulness or awareness of the stress and the source of it. • Awareness of the Body Reactions • Awareness of the Emotional Reactions of self when faced with stress Attitude – If not enabling an attempt to alter it. Srikala Bharath, NIMHANS

17. My Thoughts • Thoughts – Automatic / Intentional - Positive / Negative - Past Experience/ Present Information - Self /Others/Things /Issues - Feelings - Learnt process Examples of Automatic Positive Thoughts? Examples of Negative Thoughts Srikala Bharath, NIMHANS

18. Example • You are walking along in the morning to work after a bad night due to poor sleep. You are worried about the feed-back of your work by your senior. • Your colleague crosses you in a car and does not offer you a lift. • What are your thoughts? Srikala Bharath, NIMHANS

19. Automatic Negative Thoughts • Filtering. You magnify the negative aspects of a situation and filter out all of the positive ones • Maximization /Minimization/ Selective Attention • Personalizing. When something bad occurs, you automatically blame yourself. • Catastrophizing. You automatically anticipate the worst. • Polarizing. You see things only as either good or bad, black or white. Srikala Bharath, NIMHANS

20. Substance Use & Mental Health • 35% of Indians use tobacco • 21 to 45% use alcohol ; 10% dependent. ↑ in use in the last decade • 1/3 husbands drink – Domestic Violence • 60% of injuries, 20% of head injury are due to alcohol • The small advantage of ‘one drink’ is not big. Substance Abuse Srikala Bharath, NIMHANS

21. Social Origins of Depression • Depression – Life Events – exit events, negative events • Crowding of Effects • Mediating Factors of Social Support – Primary, Secondary and Tertiary • Elderly and Women – more relevant Srikala Bharath, NIMHANS

22. How do I Deal ? • AWARENESS – knowing, recognizing, identifying, recording • CHALLENGE – revisiting, reviewing, reconsider Socratic questioning, reframing, restating • CONFIRM – discussing, validating, asking feed-back, re-affirm • CONGRATULATE – recognize positive thoughts DOES THAT MEAN I LIVE IN A FOOL’S PARADISE? Srikala Bharath, NIMHANS

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24. Positive Actions Srikala Bharath, NIMHANS

25. Psychological Benefits of Exercise in Clinical & Non Clinical Population • Academic Performance • Assertiveness • Confidence • Emotional Stability • Independent Fung. • Intellectual Fung • Internal Locus of Control • Memory • Mood • Perception • Popularity • Positive Body Image • Social Skills • Self-Satisfaction • Sexual Satisfaction • Well-Being • Work- Efficiency Systematic Review – Taylor et al Public Health Report 1985) Srikala Bharath, NIMHANS

26. Empowering Life Skills • Critical Thinking • Creative Thinking • Problem Solving • Decision Making • Effective Communication • Inter personal Relationships • Self Awareness • Empathy • Coping with Emotions • Cope with Stress Srikala Bharath, NIMHANS

27. Social Connectedness – Protective Factor • Social support is a buffer & mitigates distress • Resilience and Social Relationship Srikala Bharath, NIMHANS

28. Positive FeelingsLaughter Club Srikala Bharath, NIMHANS

29. Problem Solving Techniques • Set Priorities & deal w/ problems accordingly • Effective Time Management • Plan Ahead • Reorganize Work • Use selective attention – focus on specific Problems • Deal w/ problems as soon as they occur • Recognize your limitations • Try to stand aside and think of the situation • Deliberately separate ‘work’ & ‘home’ • Expand interests and activities outside work • Resort to hobbies and pastimes • Adopt slower lifestyle • Having a home that is a refuge • Have a stable relationships • Talk to understanding friends Srikala Bharath, NIMHANS

30. Coping at Work • Update skills periodically • Delegate appropriately • Regular review with specific goals • Criticism – constructive; also the action and not the person • If certain administrative issues are beyond one’s power to recognize it and accept that there may be some stress due to it. Srikala Bharath, NIMHANS

31. Coping Strategies • Have Reality based Priorities according to the Life Cycle Stage • Have reality based expectations of spouse and children • Improve communication skills with others (role play) • Improve social network • Be of relevance to others – making a difference Srikala Bharath, NIMHANS

32. GOAL • The main factor is to deal with “Stress’ and not to wish for ‘living in a Stress Free world’. • A sense of control changes the outlook and that is the goal. Srikala Bharath, NIMHANS

33. Circle of Positivity Positive Mood CONTROL OF SITUATION so STRESS Srikala Bharath, NIMHANS

34. Prediction of Dementia over 20 years Srikala Bharath, NIMHANS

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36. THANK YOU ??????Questions FEED BACK TIME Srikala Bharath, NIMHANS