Stress Management

DEFINITION OF STRESSA disruptive condition that occurs in response to adverse influences from the internal or external environmentsOR A condition in which the person responds to changes in the normal balanced state, the response can be physical, mental or emotional

DEFINITION OF STRESSOR A stimulus or situation that causes stress.OrA biological, psychological, social or chemical factor that causes physical or emotional tension and may be a factor in the etiology of certain illnesses.

CLASSIFICATION OF STRESSORSGeneral Classification1. Internal StressorOriginate within the person2. External StressorOriginate outside the individual3. Developmental Stressor Occurs at a predictable time throughout life

CLASSIFICATION OF STRESSORS contd..4. Situational Stressor Unpredictable may occur any time during lifeCan Be Positive or NegativeAccording to Location:1. Physical e.g. (Cold, Heat, chemical agents)2. Physiologic e.g. (pain and Fatigue)3. Psychosocial e.g. (Failing exams and losing a job)

CLASSIFICATION OF STRESSORS contd..According to Duration:Acute time limited stressorChronic intermittent stressorChronic Enduring Stressor

STRESS AS A BIOLOGICAL RESPONSE

(RESPONSE BASED MODEL)Stress may also be considered as a response.Selye (1976) defined stress as the nonspecific response of the body to any kind of demand made upon it. Selye stress response is characterizes by a chain or pattern of physiological events called general adaptation syndrome (Gas) or stress syndrome.The GAS is physiological response of the whole body to stress, which involves the autonomic nervous system and the endocrine system.

STRESS AS A BIOLOGICAL RESPONSE (contd..)General adaptation syndrome(GAS) consist of three stages:

ALARM REACTION STAGERESISTANCE STAGEEXHAUSTION STAGE

Three stages of GAS.

ALARM REACTION STAGEThe initial reaction of the body.Alerts the body defense.Hormones level rises to increases blood volume & thereby prepare the person to act.Other hormone are released to increase bld gluc. level to make energy available for adaptation.Increased level of epinephrine & nor epinephrine result in an increased heart rate, increased blood flow to muscles, increased oxygen intake & greater mental alertness.

ALARM REACTION STAGE (contd..) The extensive hormonal activity prepares the person for the fight or flight response.Increased mental activityDilated pupilsBronchiolar dilatationIncreased respiratory rateIncreased heart rateIncreased glucoseIncreased cardiac outputIncreased blood pressureIncreased blood flow to skeletal muscles

RESISTANCE STAGEThe body stabilizes & hormone level, heart rate, B.P & cardiac output returns to normal.The person is attempting to adapt to the stressor.If the stress can be resolved, the body repairs damage that may have occurred.If the stressor remains present (as in continued blood loss debilitating disease or long term severe mental illness) & adaptation fails, the person enter the third phase of exhaustion.

EXHAUSATION STAGEOccurs when the body can no longer resist stress & when the energy necessary to maintain adaptation is depleted.Physiological response is intensified but the persons energy level is compromised & adaptation to the stressor diminishes.The body is unable to defend itself against the impact of stressor.Physiological regulation diminishes & if stress continues, death may result.

LOCAL ADAPTATION SYNDROMECHARACTERSTICS:the response is localized, it does not involve entire bodythe response is adaptive (to maintain homeostasis)the response is short termthe response is restorativeInadequate or excessiveEgocentric, tiringMODES OF ADAPTATIONPhysiologic/ Biologic Adaptive Mode

Psychological Adaptive Mode

Sociocultural Adaptive Mode

Technologic Adaptive Mode

ACUTE LOCAL ADAPTATIONThe body reacts to a local stressor (e.g. postural distortions, repetitive physical activities, trauma, leg-length difference, reflex activity) with an increase in local muscular tone.

LOCAL ADAPTATION SYNDROME - ACUTE PHASE

ADAPTION/RESISTANCE PHASEWhen local muscular tone is increased for any length of time, the affected tissues suffer from :-Local ischemia due to increased muscular tone & demand Restricted elimination leading to retention of metabolic wastes This leads over time to fatigue then irritation & may cause inflammation. The pain & discomfort that are likely to arise can lead to further increases in tone & pain via the Pain-Spasm cycle.

Palpation at this time would show tissues to be warmer than other tissues. The tissues could be oedematous, and would usually be very sensitive. CHRONIC LOCAL ADAPTATIONIf the adaption phase lasts longer than a few weeks, the sustained stresses stimulate the production of collagen.The body uses this collagen to lay down bands of fibrous tissue in support of the hypertonic muscle.This point could be considered the transition from an acute condition to a chronic conditionLOCAL ADAPTATION SYNDROME - CHRONIC PHASE

LOCAL ADAPTATION SYNDROME - CHRONIC PHASE (contd..)Ischaemia & retention of metabolites continue to increase & myofascial trigger points begin to develop. At this point taut bands are palpable in the local muscle tissues &satellite trigger points begin to developThe effects of increased muscular tone also begin to be felt at the muscles tendonous insertions. This increased tone may lead toLAS of the tendon OR LAS of the tendo-periostial junction OR Early stage joint dysfunction LOCAL ADAPTATION SYNDROME - CHRONIC PHASE (contd..)When the bodys adaptive capacities are exhausted (which may take many years), the exhaustion or collapse stage sets in. This may be characterized by arthritic joint changes or chronic muscular/soft-tissue dysfunction. The progression of tissue changes in an individual body through these three stages depends on age, exercise, and nutritional status among other things.

REFLEX PAIN RESPONSEThis response is a localized response of the CNS to painAn adaptive response and protects tissues from further damage Response involves a sensory, motor response.Example:- reflex removal of hand from a hot surfaceSECOND PHASE

INFLAMMATORY RESPONSEFIRST PHASE THIRD PHASE Injury siteNarrowing of blood vesselshistamineWBCsCombat infectWound Exudates Cut or surgicallyincisedRegenerationDamaged tissuesScar formation Healing STRESS AS AN ENVIRONMENTAL EVENT (STIMULUS BASED MODEL)Stress is defined as a stimulus, a life event or set of circumstances that arouse physiological & psychological reaction/ change that may increases the individuals vulnerability to illness.The emphasis is on change from existing steady state of individuals life pattern.

STRESS AS AN ENVIRONMENTAL EVENT (contd..)Holmes & Rahe (1967) assigned 43 life changes or events. This scale (Social Readjustment Rating Scale)has stressful life events such as divorce, pregnancy & retirement.Women react to life stress events at higher levels of responseUnmarried people & younger subjects gave higher scores

STRESS AS AN ENVIRONMENTAL EVENT (contd..)High score on the Recent life Changes Questionnaire places individual at greater susceptibility to physical & psychological illness.Positive coping mechanisms & strong social & familial support can reduce the intensity of stressful life change & promote a more adaptive response.STRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENTEmphasizes relationship between individual & environmentPersonal characteristics & nature of environmental event are consideredNo longer is causation viewed solely as an external entity, occurrence of illness depends on the receiving organisms susceptibility.STRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..)PRECIPITATING EVENTS:is a stimulus arising from the internal or external environment & is perceived by the individual in a specific mannerDetermination that particular person/ environment relationship is stressful depends on the individuals cognitive appraisal of situationSTRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..)PRECIPITATING EVENTS (contd..)Cognitive appraisal is individuals evaluation of the personal significance of the event or occurrence.

Event precipitates a response on the part of individual & response is influenced by individuals perception of the event. STRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..)INDIVIDUALS PERCEPTION OF THE EVENT:

PRIMARY APPRAISAL

SECONDARY APPRAISALSTRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..)PRIMARY APPRAISAL:By Lazarus & Folkman (1984)3 types:Irrelevant (when outcome holds no significance for the individual)Benign- positive (produces pleasure for the individual)Stressful (include harm/loss, threat & challenge; leads to secondary appraisal)

STRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..)SECONDARY APPRAISAL:Assessment of skills, resources & knowledge that person possesses to deal with the situation

Interaction between primary & secondary appraisal determines the quality of individuals adaptation response to stress.STRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..)PREDISPOSING FACTORS:Are the elements which influence an individuals perception & response to stressful event.

Strongly influence whether the response is adaptive or maladaptive.

STRESS AS A TRANSACTION BETWEEN INDIVIDUAL & ENVIRONMENT (contd..) PREDISPOSING FACTORS (contd..) - 3 types:Genetic (family history of physical& psychological conditions & temperaments)Past experiences (to stressor, learned coping responses, degree of adaptation to previous stressors)Existing conditions (adequacy of individuals physical, psychological & social resources for dealing with adaptive demands; health status, age, maturity, financial & educational resources)

TRANSACTIONAL MODEL OF STRESSEncompasses a set of cognitive, affective and adaptive(coping) responses that arise out of person-environment transaction

TRANSACTIONAL MODEL OF STRESSPRECIPITATING EVENTCOGNITIVE APPRAISALPRIMARYSTRESS APPRAISALSHARM/LOSSTHREATCHALLENGESECONDARYPREDISPOSING FACTORS

TRANSACTIONAL MODEL OF STRESS (contd..)AVAILABILITY OF COPING STRATIGIESPERCEIVED EFFECTIVENESS OF COPING STRATIGIESPERCEIVED ABILITY TO USE COPING STRATIGIES EFFECTIVELY

QUALITY OF RESPONSEADAPTIVEMALADAPTIVE

ADAPTATIONAdaptation is said to occur when an individuals physical or behavioral response to any change in his/her internal or external environment results in preservation of individual integrity or timely return to equilibrium.MALADAPTATIONMaladaptation occurs when an individuals physical or behavioral response to any change in his/her internal or external environment results in disruption of individual integrity or in persistent disequilibrium.STRESS MANAGEMENT

STRESS MANAGEMENT (contd..)simple realization that youre in control of your life is the foundation of stress management.

Involves use of coping strategies in response to stressful situations

STRESS MANAGEMENT (contd..)Managing stress is all about taking charge of:your thoughts, your emotionsyour schedule, your environmentthe way you deal with problems.The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun plus the resilience to hold up under pressure and meet challenges head on.1. IDENTIFY THE SOURCES OF STRESSlook closely at your habits, attitude & excuses:Do you explain away stress as temporary even though you cant remember the last time you took a breather? Do you define stress as an integral part of your work or home life?Do you blame your stress on other people or outside events, or view it as entirely normal & unexceptional2. START A STRESS JOURNALhelps identify the regular stressors in your life & the way you deal with them.Write down:What caused your stress (make a guess if youre unsure).How you felt, both physically & emotionallyHow you acted in response.What you did to make yourself feel better.

3. LOOK AT HOW YOU CURRENTLY COPE WITH STRESSAre your coping strategies; healthy or unhealthyhelpful or unproductive?

many people cope with stress in ways that compound the problemUnhealthy ways of coping with stressSmoking, Drinking too muchOvereating or under eatingZoning out for hours in front of the TV or computerWithdrawing from friends, family & activitiesUsing pills or drugs to relax Sleeping too much, ProcrastinatingFilling up every minute of the day to avoid facing problemsTaking out your stress on others (lashing out, angry outbursts, physical violence)4. LEARNING HEALTHIER WAYS TO MANAGE STRESSDealing with Stressful Situations: The Four AsChange the situation:Avoid the stressor.Alter the stressor.Change your reaction: Adapt to the stressor.Accept the stressor.a. Avoid unnecessary stressLearn how to say no Avoid people who stress you out Take control of your environment Avoid hot-button topics Pare down your to-do list Adjusting Your Attitude

b. Alter the situationIf you cant avoid a stressful situation, try to alter itExpress your feelings instead of bottling them upBe willing to compromiseBe more assertiveManage your time betterc. Adapt to the stressorIf you cant change the stressor, change yourselfReframe problemsLook at the big pictureAdjust your standardsFocus on the positived. Accept the things you cant changeSome sources of stress are unavoidable

Dont try to control the uncontrollable

Look for the upside

Share your feelings

Learn to forgive

e. Make time for fun &relaxationHealthy ways to relax and recharge-Sweat out tension with a good workout;Go for a walk;Spend time in nature;Call a friend;Take a long bath;Light scented candles;Play with a pet;Work in your garden;Get a massage;Curl up with a good book;Listen to music;Watch a comedy

f. Adopt a healthy lifestyleYou can increase your resistance to stress by strengthening your physical healthExercise regularlyEat a healthy dietReduce caffeine and sugarAvoid alcohol, cigarettes, and drugsGet enough sleep