Managing Stress

1. Managing Stress “Stress is an unavoidable consequence of life.” Hans Selye, M.D., Ph.D. (1951)

2. Experience Stress! • What would you need to do or think about at this moment that would increase you feeling of stress or anxiety? • What do you notice about your experience of stress?

3. What is Stress • I. Stressor- an event or adjustive demand placed on an individual or group. • II. Stress- effects created within an organism by the application of a stressor. • OTHER DEFINITIONS • Crisis- a stressful situation that approaches or exceeds the adaptive capacities of an individual or group. • Coping Strategies- efforts to deal with stress.

4. Two Different Kinds of Stress • Distress- negative stress, associated with pain, anxiety, or sorrow. • Examples include: work demands, death of friend or family member, car troubles, and financial issues. • Eustress- positive stress • Examples include: job promotion, purchasing a new home, marriage or birth of a baby, and the holidays. • Both tax a persons limited resources; generally, distress has the potential to do more damage

5. Predisposing Factors of Stress • Nature of the Stressor • significance, immediacy, cumulative effect, duration (marital separation) • Persons Perception of the Stressor • Important to have realistic expectations • Individuals Stress Tolerance • Ability to withstand stress without becoming seriously impaired. • Lack of External Resources and Social Supports • Alone vs. surrounded by others.

6. Responding to Stress • Stress threatens a person’s well being and produces automatic, persistent attempts to relieve the tension. • Stress Forces Us to Do Something (think, act, feel, etc) • That something can actually increase stress • Three Interactional Response Levels • Biological (immune system etc.) • Psychological and Interpersonal (coping & social) • Sociocultural (group resources) • Two Challenges in Confronting Stress • Task-oriented response- behavior is directed towards resolving the stressful situation. • Defense-oriented response- protecting self from hurt & disorganization.

7. Responding to Stress • Two Challenges in Confronting Stress • Meet the requirements of the stressor • Protect the self from psychological damage • Two General Responses to Stress • Task-oriented response- behavior is directed towards resolving the stressful situation. • Defense-oriented response- protecting self from hurt & disorganization.

8. The Effects of Severe Stress: Biological • General Adaptation Model (Selye, 1956) • The biological reaction to sustained exposure follows three phases: • Alarm Reaction (activation of autonomic system) • Stage of Resistance (maximal use of bio-defenses) • Exhaustion (biological resources are depleted) • Homeostasis is harder to achieve. • Sympathetic Nervous System • Immune System is suppressed by stress

9. The Effects of Severe Stress:General Adaptation Syndrome

10. Nervous System

11. Central Nervous System (Brain) Bear in the Woods (Fight/Flight) • Hypothalamic-Pituitary-Adrenal system releases: • cortisol (primary stress hormone) • Heart rate, lungs, circulation, metabolism, immune system, and skin. • catecholamines (neurotransmitters-adrenaline) • Amygdala- emotional response • Hippocampus- stores emotionally loaded experience in long term memory. • Suppress short term memory (concentration, inhibition, and rational thought).

12. Sympathetic Nervous System • Stress causes activation of SNS (sympth.) • Release of adrenaline • Body’s need for oxygen increases. • Heart rate and blood pressure go up. • Blood vessels in your skin constrict. • Muscles become tense. • Blood sugar level increases. • Blood has an increased tendency to clot. • Cortisol is released (triggers appetite incr.)

13. Biological Symptoms of Chronic Stress • Headaches • Sleep disturbance • Gastrointestinal problems • Ulcers • High blood pressure • Weakened immune response • Muscle pain

14. Symptoms of Stress • Physical • Muscle tension, illness, high blood pressure, indigestion, ulcers, difficulty sleeping, fatigue, headaches, backaches. • Emotional • Irritability, depression, anger, fear or anxiety, feeling overwhelmed, mood swings. • Cognitive • Forgetfulness, unwanted or repetitive thoughts, difficulty concentrating. Headaches

15. Psychological Effects of Stress • Impairment of intellectual functioning • Difficulty making decisions • Poor concentration • Decrease in creativity • Diathesis-Stress Model • Constant stress brings about changes in the balance of hormones in the body. • Depressive Disorders • Anxiety Disorders (panic attacks) • Formation of unhealthy defense patterns

16. Psychological Effects of Stress • Personality (psychological) decompensation- • lowering adaptive psychosocial functioning in the face of sustained or severe stress. • Course of Decompensation • Alarm and Mobilization • Increased tension, heightened sensitivity, greater alertness, efforts of self-control. • Resistance • Task oriented response. Ego-Defenses used. Some mild reality distortions • Exhaustion • Inappropriate defense mechanisms used. Break with reality.

17. Adjustment Disorder: Reactions to Common Life Stressors • Stress from unemployment • Stress from bereavement • Stress from divorce or separation

18. Adjustment Disorder • The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). • These symptoms or behaviors are clinically significant as evidenced by either of the following: • marked distress that is in excess of what would be expected from exposure to the stressor • significant impairment in social or occupational (academic) functioning

19. Adjustment Disorder The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder. The symptoms do not represent Bereavement. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months. Specify if: Acute:if the disturbance lasts less than 6 months Chronic:if the disturbance lasts for 6 months or longer

20. Acute Stress Disorder • The person has been exposed to a traumatic event in which both of the following were present: • person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others • the person's response involved intense fear, helplessness, or horror • Either while experiencing or after experiencing the distressing event, the individual has 3 dissociative symp.: • a subjective sense of numbing, detachment, or absence of emotional responsiveness • a reduction in awareness of his or her surroundings (e.g., "being in a daze") • derealization • depersonalization • dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

21. The traumatic event is persistently re-experienced: recurrent images, thoughts, dreams, illusions, flashbacks, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event. Marked symptoms of anxiety or increased arousal. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, activities, places, people). The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. The disturbance is not due to the direct physiological effects of a substance or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

22. Post-Traumatic Stress Disorder • The person has been exposed to a traumatic event in which both of the following were present: • the person experienced, witnessed, or was confronted with an event (s) that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. • the response involved intense fear or helplessness. • The traumatic event is persistently reexperienced in one (or more) of the following ways: • recurrent and intrusive distressing recollections of the event, including images, thoughts, perceptions, or dreams of the event. • acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

23. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event • Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: • efforts to avoid thoughts, feelings, or conversations associated with the trauma • efforts to avoid activities, places, or people that arouse recollections of the trauma • inability to recall an important aspect of the trauma • markedly diminished interest or participation in significant activities • feeling of detachment or estrangement from others

24. restricted range of affect (e.g., unable to have loving feelings) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: difficulty falling or staying asleep irritability or outbursts of anger difficulty concentrating hypervigilance exaggerated startle response Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

25. Causal Factors in PTSD • Personality • Nature of the Traumatic Stressor • Accounts for most of the stress response • Everyone has a breaking point. • Conditioned Fear Response • Need for Prompt Psychotherapy

26. The Trauma of Rape • Most common cause of PTSD in females • Stranger Rape vs Acquaintance Rape • Factors of Influence: • Age • Developmental Stage • Life Circumstance • Family and Friends

27. Coping with Rape • Coping with rape • Anticipatory phase • Victim perceives danger • “This isn’t really happening to me.” • Impact phase • Recognition that she will be raped • Fear for life greater than sexual act • Fear is paralyzing • Post-traumatic recoil phase • Immediately after rape • Guilt of their actions and dependency • Reconstitution phase • Person starts to makes plans for leaving crisis center • Self protective activities, nightmares, phobias

28. The Trauma of Military Combat • Temperament • Limited evidence to suggest that temperament makes a difference in resistance to combat stress • Psychosocial Factors • Unpredictable, loss of freedom, killing, et. • Sociocultural Factors • Acceptability of war goals • Quality of leadership • Group identification with their combat unit

29. Treatment of Stress Disorders • Stress Prevention • Stress Inoculation Training • Stress Management Skill Development • Crisis intervention therapy • Talk it out in a supportive environment • Medications • Direct therapeutic exposure • Real or imagined

30. Stress Prevention and Management • Expect Stress • Identify Personal Stressors • Time Management • Learn Relaxation Techniques • Good Health Practices • (Diet and Regular Exercise Routine) • Change Cognitions • Clarify Values • Reframe negative stressors • Maintain a Social Support Network

31. Identify Stressors • What is stressful to me? • Different responses by individual. • How does stress affect me? • Symptoms listed earlier. • When am I most vulnerable to stress? • Time of day (4:59), week (Sunday), month (bills, menstrual cycle etc.), year (winter blues) • When is stress good for me? • Moderate amounts of stress actually improve performance (curvilinear) • Too much impairs. Too little decrease motivation.

32. Time Management • Prioritize (clarify values) • Make To-Do-Lists. • Use a Schedule. • Schedule Time for Breaks, Socializing, and Fun.

33. Relaxation Techniques • Diaphragmatic Breathing (takes practice) • Are you a “belly-breather” or “chest breather”? • Influences parasympathetic “quieting response”. • Increases oxygenation of blood. • Distracts from stressful stimulus. • Increases sense of control over body and stress reactions.

34. Good Health Practices • Eat Healthy Foods • Cut Back on Caffeine, Nicotine, and Other Stimulants. • Have an Exercise Plan.

35. Cognitive Techniques • Realize What You Can and Cannot Do. • Recognize Irrational or Negative-Automatic-Thoughts. • Reframe Negative Thoughts and Focus on Positive Aspects.

36. Social Support • Stay connected with family • Connect with peers