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1. STRESS MANAGEMENTA Practical Guide Owen Moran, MSc, RNHealth Promotion SpecialistConcordia University Health Servicesmorano@alcor.concordia.ca

2. First, a word from your sponsor… • Concordia Health Services • Doctors, nurses, psychiatrists, a psychotherapist, health promotion specialists • With or without appointment • General medical care • Mental health • Health Promotion • Health Notes newsletter • Individual counseling • smoking cessation • healthy eating • physical activity • stress management • healthy weight • sleep … • Condoms (4 for $1) and other items for sale • 2 locations: • Downtown: GM 200 (1550 de Maisonneuve W) • Loyola: AD 103 (7141 Sherbrooke West) health.concordia.ca

3. Outline • What is stress? • What causes stress? • Signs and symptoms of stress • 5-step guide to stress management • Healthy living and stress

4. What is STRESS? STRESS is the body’s physical response to a perceived demand or threat RESPONSE TO DANGER

5. Video on the “Fight or Flight” response see: http://www.youtube.com/watch?v=trPuXkbTpok http://www.youtube.com/watch?v=7S_BB7R8NMU&feature=related

6. The Body’s Response to Stress(“ Fight or Flight Response”) •  Increased • blood to heart, muscles, brain and lungs • heart rate • respiration • muscle tension • blood pressure • metabolism •  Decreased • blood to digestive tract, kidneys and skin • growth • tissue repair • immune response

7. Eustress Functional stress Helps us perform better and achieve our goals Distress Overwhelming stress Detrimental to health Types of Stress

8. Stress and Performance

9. Stress Management:Why Bother? Ongoing and acute stress have been linked with a variety of negative health consequences

10. Stress and Health • Immune system problems • Child and partner abuse • Suicide • Homicide • Alcohol and drug use and abuse • Tobacco use • Violence and aggressive behaviour • Accidents • Sleep problems • Sexual problems • Heart disease • High blood pressure • Stomach problems • Respiratory problems • Type II diabetes • Back problems • Headaches and migraines • Obesity • Rheumatoid arthritis • Cancer • Skin problems • Mental health problems

11. Increased heart rate Dry mouth Muscle aches, stiffness or pain High blood pressure Chest pains Frequent colds, the flu or other infectious diseases Weight gain or loss Worsening of an existing illness Signs of Stress Physical Signs • Headaches/migraines • Indigestion • Constipation • Stomach cramps • Sweating • Nausea • Trembling • Fatigue

12. Difficulty concentrating/focusing Decreased memory Difficulty making decisions Mind going blank or mind racing Signs of Stress Mental Signs • Confusion • Loss of sense of humour • Decreased libido • Bad dreams

13. Anxiety Anger Irritability Impatience Signs of Stress Emotional Signs • Short temper • Frustration • Worry • Fear

14. Increased smoking, drinking, drug use Yelling Swearing Aggression Changes in eating habits increase or decrease Signs of Stress Behavioural Signs • Changes in sleeping habits • increase or decrease • Nervousness • nail biting, fidgeting, pacing etc.

15. Sources of Stress • Something that causes the stress response is called a stressor • Can be real or “imagined” • Must be perceived as a danger

16. How We Evaluate Danger • Perceived demands are greater than perceived resources in a situation/event • These demands and resources can be for: • Time • Money • Energy • Appearance • Intelligence • Knowledge • Support • Control… Perceived Resources Perceived Demands

17. If perceived demands are greater than perceived resources, the stress response is elicited STRESS $950 Perceived Demands Perceived Resources My credit card bill is $950.00 $420 I have $420.00 in the bank

18. If perceived resources are greater than perceived demands, the stress response is not elicited NO STRESS Perceived Demands Perceived Resources 2:00 6:00 It will take me 2 hours to complete this project This project is due in 6 hours

19. Some Stressors Physical environment: • Bright lights, noise, heat, cold, traffic… Social/relational: • Rudeness or aggressiveness in others • Conflicts • Not spending enough time with important people • Lack of social support • Loneliness...

20. Some Stressors Financial • Taxes, bills, debt, unplanned expenses… Organizational • Rules, regulations, deadlines, work or school culture... Physiological • Poor health, physical illness, pregnancy, injury…

21. Some Stressors Life events • Death of a family member • Unemployment • Illness • Work promotion • Birth of a child • Marriage • Winning the lottery...

22. Some Stressors Lifestyle choices • Sleep • Time management • Nutrition…

23. 5-Step Guide to Stress Management STEP 1 Identify if you are stressed

24. Identify If You Are Stressed • Look for signs and symptoms of stress • Get to know your response to stress • Seek medical attention for serious signs of stress • e.g. chest pains • Friends and family can help

25. STEP 2 Identify the stressor(s) 5-Step Guide to Stress Management

26. Identify the Stressor • What is causing the stress? • Finances? • Work? • Relationships? • School? • Look for life changes when signs of stress began • Friends and family can help

27. STEP 3 Identify why it is a stressor 5-Step Guide to Stress Management

28. Why Is This a Stressor Explore the demands of the situation and the resources you have to address it Explore the situation as well as your perceptions about Can be helpful to think in terms of “I don’t have enough….to deal with….” What is dangerous about this situation?

29. STEP 4 Identify an appropriate stress management strategy and apply it 5-Step Guide to Stress Management

30. Two General Categories of Stress Management Strategies Those that address the symptoms of stress Those that address the cause of stress

31. Short-term Can be effective at reducing stress in the moment Don’t get to the heart of the problem They don’t remove the danger These strategies “buffer” the body’s physical response to stress (i.e. the symptoms of stress) Reverse the stimulation from the “fight or flight”response Generally, these are relaxation strategies Strategies that Address the Symptoms of Stress

32. Short-term Strategies • Breathing exercises • E.g. relaxing breath • Progressive muscle relaxation • Massage • Visualization / imagery • Meditation • Traditional meditation • Mindful meditation • Non-judgemental awareness, acceptance • Mindfulness-based stress reduction (MBSR)

33. Short-term Strategies • Hot bath, sauna, hot tub • Exercise • Humour • Music appreciation • Sex • Hobby • Spending time with loved ones

34. Long-term They remove the danger Two approaches Problem-solving approach Do something about the stressor so that it is no longer a danger Cognitive approach Change the way you think about the stressor so that it is no longer perceived as a danger Strategies That Address the Cause of Stress

35. Develop and apply skills that can Reduce demands and/or Build resources Strategies that Address the StressorProblem-solving approach

36. Skills You Can Use to Reduce Demands or Build Resources Problem solving

37. THE PROBLEM SOLVING PROCESS • Define the problem • Analyze the problem • Brainstorm possible solutions • Evaluate each solution • Select and implement the best solution • Evaluate

38. Problem solving Decision making Skills You Can Use to Reduce Demands or Build Resources

39. Problem solving Decision making Critical thinking Skills You Can Use to Reduce Demands or Build Resources

40. One way to build critical thinking skills is through the framework of Paul and Elder (criticalthinking.org)

41. One way to build critical thinking skills is through the framework of Paul and Elder (criticalthinking.org) Definition: That mode of thinking—about any subject, content, or problem—in which the thinker improves the quality of his or her thinking by skillfullytaking charge of the structuresinherent in thinking and imposing intellectual standards upon them.

42. CRITICAL THINKING Apply intellectual standards to the elements of thought. Cultivate intellectual traits. Elements of Thought Intellectual Standards Intellectual Traits Purpose Question Information Inferences Concepts Assumptions Implications Point of view Clarity Accuracy Precision Relevance Depth Breadth Logic Significance Fairness Intellectual humility (vs. intellectual arrogance) Intellectual courage (vs. intellectual cowardice) Intellectual empathy (vs. intellectual close-mindedness) Intellectual autonomy (vs. intellectual conformity) Intellectual integrity (vs. intellectual hypocrisy) Intellectual perseverance (vs. intellectual laziness) Confidence in reason (vs. distrust of reason and evidence) Fair-mindedness (vs. intellectual unfairness) Source: Paul and Elder, criticalthinking.org

43. Problem solving Decision making Critical thinking Time management Skills You Can Use to Reduce Demands or Build Resources

44. You can’t increase the amount of time there is in a day can’t change resource Time management strategies seek to make effective use of the time you have must modify demands on your time TIME MANAGEMENT

45. Two steps to effective time management Identify values and set goals Develop effective mechanisms TIME MANAGEMENT DO THE RIGHT THINGS DO THOSE THINGS RIGHT

46. A value is something that is important to you Some values include: financial security interesting career high standards loving relationships good friends health treating people fairly fighting injustice family being good at your job travel being good to the environment Identify Values and Set GoalsDoing the Right Things TIME MANAGEMENT

47. Spend your time in meaningful activities Set goals about where you will spend your time based on your values Set priorities based on your values This increases your sense of purpose Contributes to better mental health There are several resources on the Internet (e.g. mindtools.com) as well as books that can help TIME MANAGEMENT Identify Values and Set GoalsDoing the Right Things

48. Some strategies to be effective with your time: TIME MANAGEMENT • Be realistic • Plan out daily activities • Use a “to-do” list • Delegate • Take advantage of “wasted time” • Manage interruptions • Build organizational skills

49. Problem solving Decision making Critical thinking Time management Communication assertiveness Skills You Can Use to Reduce Demands or Build Resources

50. A comparison of passive, aggressive and assertive communication