Stress Management

1. Stress Management Before After NJ AIHA Local Section Meeting October 19, 2006

2. Definitions Webster’s Dictionary • Stress • Human Definition • Engineering Definition

3. Human DefinitionWhat theDictionary Says Stress: A mentally or emotionally disruptive or disquieting influence

4. Engineering DefinitionWhat theDictionary Says Stress: An applied force or system of forces that tends to strain or deform a body

5. The History of Stress To be, or not to be: that is the question. Whether ‘tis nobler in the mind to sufferThe slings and arrows of outrageous fortune,Or to take arms against a sea of troubles,And by opposing end them?

6. Recognized that stress is a normal part of life. (ca. 1926) He developed a theory of the influence of stress on people’s ability to cope with the physical pressures of injury and disease Dr. Hans SelyeEndocrynologist: Johns Hopkins University

7. More of Hans Selye’s Views • Stress is the response of the body to any demand placed upon it whether that demand produces pleasure or pain.

8. Richard Lazarus, Ph.D.Professor of Psychology: UC Berkeley • Stress is a state of anxiety produced when events and responsibilities exceed one’s ability to cope with their forces.

9. Stress in Modern Times • Dr. Selye’s researchindicates that up to70 - 80 percent ofdiseases and illnessesare either caused orexacerbated by stress. • And only recently hasthe word become common to describe the emotional impact of life forces.

10. Factors Drawing Attention to Stress • Rapid change has become the norm of modern society • The number of (perceived) stressors is increasing; • Leisure time is (perceived) to be decreasing

11. Furthering the Definition Stress is also a culturally defined concept. The Result: different interpretations exist.

12. Some Examples • Eastern philosophies • stress is an absenceof inner peace. • Western culture • stress is a loss of control.

13. Holistic Medicine View • Stress is the inability to cope with a real (or imagined) threat to one’s • physical • mental • emotional, and • spiritual well-being • This results in a series of physiological changes known as the stress response.

14. The Stress Response:A Basic Decision:Fight or Flight? Concept conceived by Walter Cannon (WWI era) A survival instinct. Meant for physical stressors. I’ll be Back! Never mind, “I’ll be Back!” I’m here now, I’m in your face, and what are you going to do about it!!!???

15. The Stress Response Also occurs for emotional or spiritual stressors. Occurs if the threat is real or imaginary. Occurs in proportion to the perceived level of danger. Danger – Warning

16. Response Stages • The brain (also continuously) monitors the information. • Like any continuum, there is a range of values, against which the sensory information is measured. • When values become seriously elevated, a threatening condition is perceived and physical responses are initiated. • These physical responses are chemically-based and continue until well after the sensory levels have returned to normal values. • Body chemistry and physical conditions then slowly return to pre-threat levels. i.e., the chemical half-life effect. Stimuli are received (continuously) by the brain through all of its sensory channels simultaneously.

17. Vision Photopic Scotopic Hearing Smell Taste Kinesthesis (proprioception) Muscle Tension Tendon Tension Joint Position Joint Acceleration Vestibular (Balance) Feeling Pressure Contact Deep Pressure Prick Pain Quick Pain Deep Pain Temperature Heat Cold Sensory Channels

18. Stress Response Effects

19. Stress Types Eustress Neustress Distress

20. Eustress: Positive Stress • Motivates • Excites • Energizes

21. Distress: Negative Stress • Oppresses • Severely Elevates Emotions • Can Degrade Performance

22. Neustress • Toxicology Basic Concept • The dose determines whether a chemical is toxic or not. • A similar concept can be applied to stress. The level determines if there will be positive, negative, or neutral effects on health and the human ability to cope with life forces. • Neustress is defined as the optimal stress level for normal human functioning.

23. Maximum Performance Good Low performance illness Eustress Distress poor performance poor performance Poor High low bored moderate optimal high overwhelmed The Eustress - Distress Curve

24. Basic Types of Stressors Physical Psychological Social

25. General Adaptation Syndrome Stage 1 Alarm & React Stage 2 Resist & Endure Stage 3 Exhaustion & Burnout

26. General Adaptation Syndrome • Stage 1 (Alarm) • Escalating Emotions • Confusion • Anxiety • Worry • Fear • Shock Anger Fear

27. General Adaptation Syndrome • Stage 2 (Resist and Endure) • Focus on To-Do List • Git-R Done Attitude • Psychological Profiles • Aggression • Fixation

28. General Adaptation Syndrome • Stage 3 (Exhaustion) • Physiological • Headaches • Tremors • Illnesses • Psychological Profiles • Depression • Repression • Withdrawal • Interpersonal • Damaged Relationships Burnout • Unable to continue

29. The Physiology of Stress Recall: Dr. Hans Selye recognized that there is a direct relationship between chronic stress and excessive wear and tear throughout the body.

30. Brain Architecture

31. The Triune Brain • R-Complex • LimbicSystem • Neomammalian (neocortex)

32. The Reptilian Complex • Lowest level comprised of the: • brain stem • reticular formation

33. The Reticular FormationReticular Activating System (RAS) • A link connecting the brain to the spinal cord. • Stress physiologists believe it is a communication link joining the mind and body • Function: • The RAS controls the sleepwake cycle and the level ofattention when awake. Itsends its signals to the cortexto arouse it from sleep.

34. Brain Stem • Comprised of Several Discreet Parts • mesencephalon (midbain) • pons • medulla oblongata • Responsible forinvoluntary functions • heart beat • respiration • vasomotor activity

35. Limbic System • Emotion Control Center • thalamus • hypothalamus • pituitary gland • a k a. the masterendocrine gland • These three glandswork together tomaintain a level ofhomeostasis

36. Neomammalian LevelGray Matter Cerebellum(motor function) • Highest level of the brain • Processes sensory information • along the continuum from levels representing normal conditions to threatening • where cognition takes place. • Can override a lower level • Can influence emotional responses ?

37. Physiological Systems Involved in the Stress Response: • Nervous system {Electrical} • Endocrine system {Chemical} • Immune system {Chemical}

38. Sympathetic Nervous System • Responsible for responses associated with fight-or-flight response • This physical arousal is stimulated through release of hormones • Epinephrine(adrenaline) • Norepinephrine(noradrenaline) • Corticol

39. Epinephrine • Epinephrine is a catecholamine. It acts on receptor sites of the sympathetic nervous system. Its most prominent actions are on the heart, vascular, and other smooth muscle groups. When introduced, it produces a rapid rise in blood pressure by: • Direct stimulation of cardiac muscle and strengthening its contraction, • Increasing the heart rate, and • Constricting the arterioles in the skin, mucosa and visceral areas of the circulation.

40. Endocrine system • Glands involved with the stress response: • Pituitary: releases trophic hormones that stimulate other endocrine glands. Receives releasing hormones from the hypothalamus • Thyroid: releases thyroxine and triiodothionine that regulate metabolic rate • Adrenals: release corticol and adrenaline

41. Effects Associated with Stress Response • Three Stages • Immediate effects • Intermediate effects • Prolonged effects

42. Immediate Effects2 - 3 seconds • Sympathetic nervous response • Epinephrine & nor-epinephrine released

43. Adrenal Cortex and Blood Flow Inferior Vena Cava

44. Intermediate Effects20 - 30 seconds • Adrenal response • Epinephrine & nor-epinephrine continue to be released

45. Prolonged Effectsminutes, hours, days, weeks • Continued elevated levels of stress hormones and continued vasodilation: • thought processes • emotional processes • motor functions and physical performance • sleep-wake cycle • hunger, thirst, and digestive system • immune system

46. Stress Management(to be continued) NJ AIHA Local Section Meeting November 16, 2006