1. Stress and its management Dr.Shashikant.S.K Snow Mountain Yoga Center

2. Views of StressEastern philosophies have viewed stress as an absence of inner peace.Western culture has more recently viewed stress as a loss of control. 3. Chinese medicine menHippocrates Rene Descartes GalenRobert Koch Hans Selye Rudolph Virchow 4. Hans Selye, the father of scientific foundation for mind-body medicine, who in the 1950s introduced it as "the non-specific response of the body to any demand for change".10/4/2012 5. Stress The mental and physical response of our bodies to thechanges and challenges in our live Stressor any physical, social, or psychological eventor condition that causes the body to adjust to thatsituation Adjustment may cause strain or wear and tear on our bodiesand minds 6. S=P>R Stress occurs when the pressure isgreater than the resource 7. Three types of stressEustressNeustressDistress 8. Distress Eustress10/4/2012 9. Eustress 10. Distress 11. The Yerkes-Dodson CurveMaximum PerformanceGoodLow performanceillness Eustress DistressPoor poor performancepoor performance High lowmoderatre high underaroused-optimally overaroused- boredaroused overwhelmed 12. 8 Types of Stress Factors Conscious Factors: thought, judgement, decision making Unconscious Factors: past influences, memories Personality Factors: character and temperament Psychological Factors: emotional condition Physiologic Factors: biological influences/condition Environmental Factors: noise, comfort, ergonomics Experiential Factors: situational influences Sociocultural Factors: family, finances, life-changes 13. 8 Interactive Stress Variables Intensity: magnitude (low vs high) quality: insignificant vs significant Duration/frequency: short vs long; high/low Focus of Stressor: vulnerability (high vs low) Extent of Stress: scope of influence (isolated vs extensive) Mental/Physical Status: hardiness (high vs low) Resistance: active vs inactive Perception: reductive vs magnifying 14. Pathways in Bodys Response toStressors Two main pathways are involved in the bodysresponse to stressors: neuroendocrine-immune pathway sympathetic nervous system pathway2006 by the McGraw-Hill Companies, Inc. AllMcGraw-Hill rights reserved. 4-16 15. Two BiologicalPathways in Stress2006 by the McGraw-Hill Companies, Inc. AllMcGraw-Hill rights reserved. 4-17 16. Sympathetic and parasympathetic divisionsSympathetic division Its brings about the emergency reaction, andtriggers off the production of adrenaline to keepit going. It is involved in active emotions like fear, anger,or excitement.Parasympathetic division It operates later to correct the balance and torestore body functions to normal operation. It isinvolved in the quiet emotions, like depressionor sadness, when we are not really active at all. 17. chapter 13The autonomic nervoussystem 18. HPA Axis and Role in Stress 19. THE HPA AXIS StimulusLIMBIC SYSTEM +veHYPOTHALAMUS (Paraventricular Nucleus)CRH-ve PITUITARY GLAND (Anterior Pituitary)ACTH ADRENAL GLANDGlucocorticoid (Adrenal Cortex) 20. Hypothalamopituitary adrenal (HPA) axisImmuneStresssystem:Circadianalteredrhythm HypothalamusMuscle:CRHNet loss of aminoPosterior Acids (glucose)Anterior Pituitary Gland Pituitary GlandLiver: (-) Deamination of proteins into amino ACTH acids,gluconeogenesisGlucocorticoids,Adrenals Catecholamines, etc..(glucose)Fat Cells:Free fatty acid Kidneymobilization Heart rate: Increased 21. The Story of the Cave Man andthe Saber-toothed Tiger10/4/2012 22. Picture this scene a million years ago. Youcome out of of your cave. The sun is up andthe birds are chirping. Your heart rate isnormal.10/4/2012 www.yogamaarg.com 23. All of a sudden you hear a twig snap. Off to your right you see a large saber-toothed tiger. You have two options. What are they?10/4/2012 www.yogamaarg.com 24. Fight10/4/2012 www.yogamaarg.com 25. Or flight10/4/2012 www.yogamaarg.com 26. To fight that tiger or run away fast, thebody prepares by releasing stresshormones Cortisol increases blood sugar and speeds metabolism Epinephrine supplies extra glucose Norepinephrine speeds up your heart rate and raises your blood pressure10/4/2012www.yogamaarg.com 27. There is no longer a tiger to kill orrun away from!10/4/2012 28. The Bodys Response to Stress General adaptation syndrome (GAS) an adaptive response where our bodies move from homeostasis to crisis: Alarm phase Fight or flight response Resistance phase Exhaustion phase 29. General Adaptation SyndromeStage 1 Alarm Reaction Stage 2ResistanceStage 3Exhaustion 30. Alarm Phase The cerebral cortex region of brain responsible for higher mentalfunctions interprets nature of event (stressor). The sympathetic nervous system is triggered. Hypothalamus interprets the bodys needs for more energy triggers the pituitary gland to release ACTH (adrenocorticotropichormone) ACTH acts on the adrenal gland to release stress hormones cortisol, epinephrine and norepinephrine These stress hormones trigger the muscles and liver to releaseglycogen (glucagon) into glucose (energy) Heart rate, blood pressure and respiration increases The bodys resources have to be prioritized! Activities of the bodythat are important but not urgent are put on hold, such asdigestion. 31. Resistance Phase The body is actively trying to reverse the actions thattranspired during the alarm phase. During theresistance phase the body is under the control of theparasympathetic nervous system. The bodys vital functions such as heart rate, bloodpressure, respiration, digestion, spleen function, vision,bladder function, glucose level, saliva and mucous,endorphins and hearing return to normal functioning.Remember the body is trying to reach Homeostasis asa defense mechanism. The body wants to survive! 32. Exhaustion Phase Long term exposure to a stressor or stressors can resultin overload. When the body is over-taxed and thereare no recovery periods illness can result. This is a depleted state that has been the result of anineffective balance of the alarm and resistance phase. 33. The General Adaptation Syndrome 34. The GeneralAdaptationSyndrome:AlarmPhaseFigure 3.2 35. 3 components of Stress Frustration Conflict Pressure 36. Aetiology of Physical Stress Disorders (3) PersonalityFriedman & RosenhamStrive to Achieve/CompetitiveType ATime Urgency/ImpatienceHostility/AggressionChilled/RelaxedType BLess time concernedLess aggressiveNB: Type A behaviour linked to CHD & hypertension 37. 10/4/2012 38. Stress affects the whole person in allhuman dimensions : Physical Emotional Intellectual Social Spiritual 39. How do your feelings impact your health?DepressedNormal BlissUnhappy EuphoricDistressed 40. Stress: Short-term (Immediate)consequencesPhysical Signs/Symptomssleep disturbances irregular heartbeat, palpitationsback, shoulder or neck pain asthma or shortness of breathtension or migraine headaches chest painupset or acid stomach, cramps, sweaty palms or hands heartburn, gas, irritable bowel cold hands or feet syndrome skin problems (hives, eczema,constipation, diarrheapsoriasis, tics, itching)weight gain or loss, eating disorders periodontal disease, jaw painhair loss reproductive problemsmuscle tension immune system suppression: morefatigue colds, flu, infectionshigh blood pressure growth inhibition 41. StressEmotional lack of concentrationSigns/Symptoms trouble thinking clearly nervousness, anxiety feeling out of control depression, moodiness substance abuse butterflies phobias irritability, frustration overreactions memory problems 42. Long-term ConsequencesChronic Diseases Cardiovascular Disease Stroke Cancer Diabetes Accidents Flu/pneumonia 43. Stress ControlABC Strategy 44. ABC STRATEGY A = AWARENESS What causes you stress?How do you react? 45. ABC STRATEGYB = BALANCE There is a fine line between positive / negative stressHow much can you cope with before it becomes negative? 46. ABC STRATEGY C = CONTROL What can you do to help yourself combat the negative effects of stress ? 47. Stress Management Techniques Change your thinking Change your behaviour Change your lifestyle 48. Change your Thinking Re-framing Positive thinking 49. Re-framing Re-framing is a technique to change the way you look at things in order to feel better about them. There are many ways to interpret the same situation so pick the one you like. Re-framing does not change the external reality, but helps you view things in a different light and less stressfully. 50. Positive ThinkingForget powerlessness, dejection, despair, failureStress leaves us vulnerable to negative suggestion sofocus on positives; Focus on your strengths Learn from the stress you are under Look for opportunities Seek out the positive - make a change. 51. Change your Behaviour Be assertive Get organised Ventilation Humour Diversion and distraction 52. Be Assertive Assertiveness helps to manage stressful situations, and will , in time, help to reduce their frequency. Lack of assertiveness often shows low self - esteem and low self - confidence. The key to assertiveness is verbal and non - verbal communication. Extending our range of communication skills will improve our assertiveness. 53. Equality and Basic Rights1) The right to express my feelings2) The right to express opinions / beliefs3) The right to say Yes/No for yourself4) Right to change your mind5) Right to say I dont understand6) Right to be yourself, not acting for the benefit of others 54. 7) The right to decline responsibility for other peoplesproblems8) The right to make reasonable requests of others9) The right to set my own priorities10) The right to be listened to, and taken seriously 55. Being Assertive Being assertive involves standing up for your personal rights and expressing your thoughts, feelings and beliefs directly, honestly and spontaneously in ways that dont infringe the rights of others. 56. Assertive People Respect themselves and others Take responsibility for actions and choices Ask openly for what they want Disappointed if want denied Self - confidence remains intact Not reliant on the approval of others 57. Assertive Skills Establish good eye contact / dont stare Stand or sit comfortably - dont fidget Talk in a firm, steady voice Use body language I think / I feel What do you think? How do you feel ? Concise and to the point 58. Benefits Higher self-esteem Less self-conscious Less anxious Manage stress more successfully Appreciate yourself and others more easily Feeling of self-control 59. Get Organised Poor organisation is one of the most common causes of stress. Structured approaches offer security against out of the blue problems. Prioritising objectives, duties and activities makes them manageable and achievable. Dont overload your mind. Organisation will help avoid personal and professional chaos. 60. Time Management Make a list What MUST be done What SHOULD be doneWhat would you LIKE to do Cut out time wasting Learn to drop unimportant activities Say no 61. Plan your day Set achievable goals Dont waste time making excuses for not doing something 62. Ventilation A problem shared is a problem halved Develop a support network through friends or colleagues to talk with. Its not always events that are stressful but how we perceive them. Writing a diary or notes may help release feelings but do not re-read what has been written. 63. Humour Good stress - reducer Applies at home and work Relieves muscular tension Improves breathing Pumps endorphins into the bloodstream - the bodys natural painkillers 64. Diversion and Distraction Take time out Get away from things that bother you Doesnt solve the problem Reduce stress level Calm down Think logically 65. Change Your Lifestyle Diet Smoking & Alcohol Exercise Sleep Leisure Relaxation 66. Benefits of Exercise Uses up excess energy released by the Fight or Flightreaction. Improves blood circulation Lowers blood pressure Clears the mind of worrying thoughts Improves self image Makes you feel better about yourself Increases social contact 67. Sleep Good stress reducer Difficult to cope when tired Wake refreshed after nights sleep Plenty of daytime energy 68. Leisure Interest Gives you a break from stresses Provides outlet for relief Provides social contact 69. Benefits of Relaxation Lowers blood pressure Combats fatigue Promotes sleep Reduces pain Eases muscle tension 70. Decreases mental worries Increases concentration Increases productivity Increases clear thinking 71. Alternatives Conventional Medicine Floatation Counselling & Herbalismpsychotherapy Biofeedback Relaxation Homeopathy Meditation Hypnotherapy Massage Osteopathy Yoga Pet Therapy Acupuncture Reflexology Aromatherapy 72. Is a pill dissolving in your stomach moreeffective than a healing thoughtdissolving in your mind? 73. Some common specific phobiasAcrophobia HeightsAlgophobia PainAstraphobiaThunderstorms & lightningClaustrophobia Enclosed placesHydrophobiaWaterMonophobia Being aloneMysophobia Contamination or germsNyctophobiaDarknessOchlophobiaCrowdsPathophobiaDiseasePyrophobia FireZoophobiaAnimals, or some particular animal