Stress

“….stress is the nonspecific response of the

body to any demand, whether it is caused
by, or results in pleasant or unpleasant
conditions.”
Hans Selye, MD
 Stress
“…a sociopsychophysiological phenomenon. It is
a composite of intellectual, behavioral,
metabolic, immune, and other physiological
responses to a stressor (or stressors) of
endogenous or exogenous origins. The stressors
may involve thoughts and feelings or may be a
perceived threat or some other condition such as
cold. The response generally serves a protective,
adaptive function.
Lindsay, Carrieri-Kohlman, Page
 Stress
“…a reaction in your mind and body to an event
in the outside world that alarms or arouses you.”
EMS Stress: An Emergency
Responder’s Handbook for Living Well
The Good
Get married Sources of Stress
Have children
Buy a new home The Bad
Go on vacation Break a leg

New Job Spouse loses job The Ugly

Promotion Kidlet in trouble Nasty car accident
Lose wallet Bankruptcy
In-laws coming Divorce
Loved one dying
 Types of Stressors

Career
Injury
Pressures

Emotional
Environm
ental

Illness
Physical
Mind Body Integration

Mind
Body
Mind Body Mind
Mind
Body Chocolate
Body
Mind Body
Mind
 Why Stress Management?
Stress Related Disorders & Chemical
Dependency
• Cost U.S. Employers Billions $$$$$
– lost productivity
– increased health care expenses
– increased absenteeism
– increased accidents
98.6 98.6
pH 7.4 pH 7.4
Oxygen Oxygen
99% 99%
The Stress Response is the
Body’s 911 System
 Autonomic Nervous System
• Sympathetic • Parasympathetic
– Increased HR, BP, RR
– Muscles tense
– Brain becomes more
alert
– Liver increases blood
glucose level
– Digestion inhibited
– Pupils dilate
– Normalizes HR, BP, RR
– Muscles relax
– Energy storage
– Promotes growth
– Mediates calm
– Pupils constrict
 CUMULATIVE STRESS
“Any idiot can face a crisis…….
Its the day to day living that wears you out.”
Anton Cherkhov
 How Can the Stress Response
Make Us Sick?
• Chronically elevated BP
– atherosclerosis
– myocardial ischemia
• Constantly using stored energy
– tire more easily
• Blocked insulin secretion
– higher risk of diabetes
 Why Stress Management?
Researchers indicate 2/3 of medical visits are for
stress related illnesses
• Stress response contributes to:
– coronary artery disease
– cancer
– respiratory disorders
– unintentional injuries
– cirrhosis
– suicide
 Physiologic Signs of Stress
• Immediate Changes
– Increased cardiac output – Decreased gastric motility
– Increased circulation – Hyperalertness
– Increased BP, RR – Increased blood sugar
– Increased sweating – Use of blood glucose
– Piloerection – Decreased stored energy
– Pupil dilatation – Increased fatty acids
– Decreased salivation – Increased metabolism
 Physiologic Sign of Stress
• Long Term Effects
– Increased breakdown of – Decreased immune
protein response
– Increased blood glucose – Increased fluid volume
– Increased vascular – Increased sodium & fluid
constriction retention in kidneys
– Decreased inflammatory
response
Emotional Signs of Stress
• Denial • Hopelessness
• Fear • Helplessness
• Depression • Feeling lost
• Grief • Wishing to hide
• Anger • Anxiety
• Worry • Panic
• Uncertainty • Inappropriate Emotions
Cognitive Signs & Symptoms
• Difficulty Making Decisions
• Confusion
• Difficulty Naming Familiar Items
• Poor Concentration
• Blaming Others
• Memory Problems
• Replaying Events Over & Over
 Behavioral Signs of Stress
• Withdrawal
• Suspiciousness
• Excessive Humor or Silence
• Increased Smoking, Alcohol or Food
• Change in Activity Level
• Angry Outbursts
• Crying Spells
 Negative Self-Talk
• The Worrier Voice - “What if…..?”
– Make a plan then get it out of your head.
• The Critic Voice - “How stupid…..”
– Recognize what is really true.
• The Victim Voice - “I’ll never be able to…..”
– There is always something to do to work toward a
goal.
• The Perfectionist - “I should……”
– Assess your unrealistic expectations of yourself.
 Feeling “on edge”
Vague sense of future doom
Fear losing control
Racing thoughts
Detached from self
Decreased ability to learn
Physical Symptoms of Anxiety
• Increased Muscle Tension
• Dizziness
• Rapid Heartbeat
• Shortness of Breath
• Queasy Stomach
• Dry Mouth
• Increased Perspiration
• Problems with Sleep
Coping Skills to Manage
Anxiety
• Relaxation Techniques
• Exercise
• Examine Self Talk
• Develop Action Plan
• Avoid Stimulants
– caffeine, nicotine, sugar
• Counseling
• Drug Therapy
 Anger
Physical Symptoms
• Increased HR, BP
• Increased Muscle Tension & Sweating
• Restlessness
• Emotional Symptoms
• Shattered Beliefs in a Just World
• Wronged
• Ready to Fight
• Defensive
“When angry, count four, when very
angry, swear.”
-Mark Twain
 Anger Management
• Anger Intensifying • Cooling Off Habits
– Yelling – Abdominal Breathing
– Sulking – Count to Ten
– Pouting – Non-Competitive
– Hitting Exercise
– Other Violence – Distraction
– Competitive Games – Humor
– Accusations – Empathy for Other
– Arguing Person
 Workaholic Behaviors
A person whose desire to work long and
hard is intrinsic, and whose work
habits always exceed the job
description and expectation of others.
 Personality Traits of a
Workacholic
• Detail oriented
• Perfectionistic
• High personal
standards
• Action oriented

• Easily bored
• Highly dedicated
• Task oriented
 Workaholic Behaviors
• Impaired • Contented
– No pleasure in – Family accepts work
leisure habits
– Distressed when not – Autonomy & variety in
working workplace
– Isolated lifestyle – Good match between
– Family in distress personality & job skills
– Good health
 Suggested Behaviors
• Don’t ruminate over problems
• Respond to signs of fatigue
• Don’t self medicate
• ie. alcohol/drug abuse
• Take scheduled time off
• Stabilize domestic situations
• Develop/maintain friendships
• Engage in regular exercise
• Foster sense of humor
 Depression

• Mild
• Moderate
• Severe
– Always requires professional help.
 Garbage In = Garbage Out
Heart Disease
Cumulative Hypertension
Stress Arthritis Headache
Ugly Health Stroke Irritable
Habits Bowel
Cancer Diabetes

Told you so...

 Healthy Habits
• Nutrition
• Attention to Symptoms
• Exercise
• Sleep
• Recreation
• Stretching
• Social Support Balance is the
Key
• Humor
Physiology of Circadian Rhythms
Stages of Sleep
REM Sleep
Shift Work
Increase Quality of Sleep
• Do
– Exercise (early in day)
– Avoid Caffeine
– Avoid Alcohol
– Don’t Self Medicate for Sleep
(some sedatives interfere with
deep sleep)
– Relaxation Techniques Before Sleep
– Warm Bath
– Avoid Rich Foods Before Sleep
“A person without a sense of humor
is like a wagon without springs ---
jolted by every pebble in the road.”
-Henry Ward Beecher, American clergyman
• Causes Deep Abdominal Breathing
• Increases Circulation
• Releases Endorphins & Enkyins
• Relieves Tension
• Puts Life into Perspective
“Laughter and tears are both responses
to frustration and exhaustion . . .I
myself prefer to laugh, since there is
less cleaning up to do afterward.”
-Kurt Vonnegut
ANTI- STRESS THERAPY

BANG
HEAD
HERE

REPEAT UNTIL STRESS IS GONE OR

YOU ARE UNCONSCIOUS
 Relaxation Techniques
 Abdominal Breathing
 Active Progressive Muscle Relaxation
 Visualization
 Self-Hypnosis
 Meditation
 Music
 Stretching
 Exercise