1. Stress Management in Students
Dr.T.V.Rao MD
Dr.T.V.Rao MD

2. The Challenges in College
The best years of your life? Expectations..
Even positive change is stressful
Greater academic demands
Unstructured time
Decreased adult availability
Being on your own in a new environment
Changing relations with family
Dr.T.V.Rao MD

3. Challenges of College: Choices
Alcohol and other drugs
Sex-identity, values, practices
Food
Sleep
Balancing Academic and Extracurricular
Roommates
Dr.T.V.Rao MD

4. LIFE MANAGEMENT SKILLS:
GENERAL: Life management skills, for the purposes of this section, include stress management, time management, information management, financial management, personal health management, and crisis management. Personal planning and adeptness at managing each of these issues will increase the serenity and reduce the stressors within a busy, productive life.
Dr.T.V.Rao MD

5. Dr.T.V.Rao MD

6. Personal planning
Personal planning and adeptness at managing each of issues will increase the serenity and reduce the stressors within a busy, productive life.
Dr.T.V.Rao MD

7. Every body is under stress
Every human on the earth will experience stress, even medical students and physicians--it is a common denominator in life. Some stress is good stress (eustress) that is helpful and assists the drive toward achievement and success. Negative stress (distress) affects life in an adverse manner and is a common cause of ill health in our society. Individuals who ignore stress signals or who cope in a negative fashion will experience escalating symptoms of stress. The symptoms may appear as burnout, exhaustion, emotional illnesses such as depression and anxiety, and physical illnesses such as ulcers, heart attacks, hypertension, and abuse of alcohol and other drugs with all the social and professional consequences.
Dr.T.V.Rao MD

8. WHAT IS STRESS?
Stress is your mind and body’s response or reaction to a real or imagined threat, event or change.
The threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes or external (loss, tragedy, change).
Dr.T.V.Rao MD

9. Adolescents and stress ?
Teens are under more stress
Since adolescence is a period of significant changes
physical,
emotional,
social, and
academic changes
many than at any other time of life.

10. Stress is good and Bad too….
It's important to remember that stress is a natural part of life. Experiencing stress can be good, but it can also have negative effects on one's well being. What makes stress a positive or negative factor lies with how effectively the person experiencing the stress is able to manage it.
Dr.T.V.Rao MD

11. Impact of medical education and stress
Medical education has deleterious consequences. Trainees (students, interns, and residents) suffer high levels of stress, which lead to alcohol and drug abuse, interpersonal relationship difficulties depression and anxiety, and even suicide. Medical students have mean anxiety scores one standard deviation above those of non-patients, and their depression levels increase significantly
Dr.T.V.Rao MD

12. Signs and Symptoms of Stress
Physical
Poor appetite or overeating
Feeing tired and fatigued
Various aches and pains ---headache body ache muscle pain
Nausea & abdominal Pain
Sleep problems
Falling sick very often e.g. fever cough cold diarrhea
( because of lowering of immunity due to stress) As
If a boy has gone for a outing with her GF and they met an accident, and girl has broken her leg, now the boy has to inform her parents, his own parents, deal with the police, deal with the local public etc… just imagine the amount of nervousness – specially if his/her parents are like me – who have very fixed ideas about children and talk very little, similarly how impatient a girl or a boy is before his first dating. And if on the first date the girl asks for a dinner in a five star hotel, that too in a taxi to Dr Bansal’s son who hardly has 100 bucks in his pocket – think about his self image – it will certainly go down (does it mean I should keep 1000 in his pocket so that he can entertain many GFs not only one !)
This decreased low self image coupled with nervousness and impatient behavior will lead to frustrations and this can be manifested either by depression when after returning he will not talk to any one – will sit very quite – looking in sky – or to the vacant wall – as if he is trying to count brush marks on the wall. Or he will start reacting violently – throwing objects and taking even the trivial remarks as very serious assaults on his personality.

13. Mental stress Feeling low Nervousness and Anxiety
Excessive Anger or Depression
Being easily upset
Poor self confidence
Low self esteem
Lack of Concentration
Poor performance in studies

14. Exercise reduces stress
As a way of draining off stress energy, nothing beats aerobic exercise. To understand why, we need to review what stress is. People often think of stress as pressure at work, a demanding boss, a sick child or rush-hour traffic. All these may be triggers but stress is actually the body's reaction to factors such as these. Stress is the fight-or-flight response in the body, mediated by adrenaline and other stress hormones, and comprised of such physiologic changes as increased heart rate and blood pressure, faster breathing, muscle tension, dilated pupils, dry mouth and increased blood sugar. In other words, stress is the state of increased arousal necessary for an organism to defend itself at a time of danger.
Dr.T.V.Rao MD

15. EUSTRESS
Eustress or positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished.
Dr.T.V.Rao MD

16. DISTRESS
Distress or negative stress occurs when your level of stress is either too high or too low and your body and/or mind begin to respond negatively to the stressors.
Dr.T.V.Rao MD

17. ALARM STAGE
As you begin to experience a stressful event or perceive something to be stressful psychological changes occur in your body. This experience or perception disrupts your body’s normal balance and immediately your body begins to respond to the stressor(s) as effectively as possible.
Dr.T.V.Rao MD

18. The “Paradox of Medicine”: Balancing between the fact that people are mostly the same & yet uniquely different.
The “Bell Curve”
Individuals are all “Genetic Snowflakes”
Dr.T.V.Rao MD

19. Obstacles Most people who need care don’t seek it or receive it
Stigma, cultural pressure, mistrust, lack of information keep people out of care
So do lack of resources; treatment and medication are expensive
Care is disjointed
Some schools don’t see emotional well-being and growth as in their “mission”
Dr.T.V.Rao MD

20. Common problems Relationship problems Depression Anxiety
Eating Disorders
Substance Abuse
Sleep Problems
Dr.T.V.Rao MD

21. Anxiety Situational Developmental Generalized anxiety disorder
Performance
Panic disorder, OCD, phobias
Dr.T.V.Rao MD

22. Sleep Problems 35% of adult population experience insomnia
11% of college students get a “good night’s sleep”
Loss of cognitive functioning, driving
Increased risk of depression
< 7 hours yields sleep deprivation
Dr.T.V.Rao MD

23. LEARN Stress Management Emotion Focused Strategies
Dr.T.V.Rao MD

24. LEARN Stress Management
Laugh E A R N S
Dr.T.V.Rao MD

25. Stress Management Tips
Making little changes in your life can really add up to a big feeling of relief.
Learn to recognize when you are feeling stressed and simple ways you can relax.
Take a break. Have a cold drink, get some fresh air, or close your eyes for a minute to refocus.
Stay positive to help friends and family cope with stress.
Let others know you're feeling overwhelmed and tell them how they can help.
Allow yourself to simply say "no" to friends and family when you know you cannot meet their demands without becoming overwhelmed.   

26. Recognize what you can change
Can you change your stressors by avoiding or eliminating them?
Can you reduce their intensity (manage them over time instead of immediately)
Can you shorten your exposure to stress (take a break, leave)
Can you devote the
time necessary to make
a change
Dr.T.V.Rao MD

27. Cultures, Humor & Medicine
Greeks – home of the comediane
Native Americans… Clown Doctors
Voltaire:
“The Art of Medicine consists of amusing the patient while nature cures the disease.”
Medicine today?
Dr.T.V.Rao MD

28. What is humor? An attitude toward life.
Taking your work seriously… but yourself lightly.
Humor is healthy.
Humor connects us to others!
It makes us MORE effective!
Dr.T.V.Rao MD

29. Humor a great tonic to stress – enjoy it
Humor is a wonderful stress reducer, an antidote to upsets. Laughter relieves tension. In fact, we often laugh hardest when we have been feeling most tense.
Humor is an individual thing - what is funny to one individual may be hurtful to another. It is wonderful when patients can poke fun at themselves. We can also do this with patients, but we have to be careful and respectful in what we say. If you think of something funny that may help the patient, say it if you feel it will ease their tension and not be offensive. I will often throw in a quip or joke when I think it is appropriate. When it is done sensitively, laughter is a great gift to people you care about.
Dr.T.V.Rao MD

30. What should colleges do?
Gather Data
Provide Rapid Access to Care
Offer Education and Outreach
Involve Students
Coordinate Care
Be aware of community resources
Understand your limits
Dr.T.V.Rao MD

31. Gather Data Documentation
How busy is counseling? Identify patterns and peak times of use.
Where else do students get care?
How many students take time off for medical reasons? Who comes back?
How many students are hospitalized?
Dr.T.V.Rao MD

32. Education and Outreach
Be known. Get out in the community.
Train residence staff to recognize warning signs of common problems.
Serve as liaisons/consultants to residence staff, deans, coaches.
Supervise student groups: peer counselors, wellness reps, advocacy groups
Offer for-credit course to freshmen on stress and time management
Dr.T.V.Rao MD

33. Wellness Activities Start a Wellness Center on campus
Focus on prevention: Eat, Sleep, Exercise
Engage Students in community- study breaks, hikes, massage
Teach yoga, sleep hygiene, relaxation response as part of leading balanced life.
Have annual “wellness” or “caring events” or “maximize academic potential, minimize stress”
Student Wellness Reps.
Dr.T.V.Rao MD

34. Stress Management Plan
Practice time management
Learn relaxation exercises.
Rehearse and practice situations.
Learn practical coping skills.
Decrease negative self talk. 
Learn to feel good with a workable result – Don’t be a perfectionist.
Build a network of friends.

35. Involve Your Students
Ultimately, the only people who can get through to students with any consistency are the students themselves…” Peer Counseling/ Education Programs
Student Health Advisory Group
Wellness representatives in the dorms
Mental Health Advocacy Group
Involve in screenings and education
Dr.T.V.Rao MD

36. Understand Your Limits
Legal issues
Confidentiality
What about parents?
How much care for whom? How are sickest students cared for?
When should students take a medical leave of absence? Re-entry?
Dr.T.V.Rao MD

37. What about Parents? Orient them and make them partners
Don’t say “I can’t talk to you.”
Process of communication is key: don’t shut them out
Invite them to get permission
Discuss general concerns, suggestions without breaching confidentiality
Dr.T.V.Rao MD

38. How Much Care for Whom? Balancing needs of individual and community
Balancing care and education
How are sickest students cared for?
When should students take a medical leave of absence?
Re-entry
Dr.T.V.Rao MD

39. Return on Investment
Emotional and physical well-being are crucial for academic success
The entire student body benefits from a strong counseling program
The institution benefits by increased retention and graduation, which enhance reputation
Dr.T.V.Rao MD

40. exercise and Relaxation are Foundation for Efficiency
Get plenty of exercise and sleep. Improved focus and concentration help increase efficiency, so you can complete tasks in less time.
Dr.T.V.Rao MD

41. Extracurricular activities reduces the stress
Even during their medical colleges careers, many students take on extracurricular activities and projects that are not covered at medical colleges.
Extracurricular activates reduces the stress level
Dr.T.V.Rao MD

42. Maintain your emotional reserves
Develop mutually supportive friendships/relationships.
Pursue realistic goals which are meaningful to you, rather than goals other have for you that you do not share.
Expect some frustrations, failures and sorrows.
Always be kind and gentle with yourself – be a friend to yourself.
Dr.T.V.Rao MD

43. Stress Management Tips
Be prepared for unexpected problems such as traffic, a lost pet or a family emergency.
Prioritize. Take control of your "to do" list by deciding what's really most important on your list.
Write down feelings of sadness, frustration or anger to get a clearer perspective of your emotions.
Enjoy life's simple pleasures like colorful flowers, dancing, music, and social outings, etc.
Share your talents to better the lives of others as well as your sense of well-being.

44. Best to way to overcome stress
STRESS is very common
Use stress in a positive way
Limit NOT eliminate stress.
Use it to improve your performance.
Learn Coping Skills

45. The Takeaway
Academic performance is enhanced by physical and emotional health
We can learn to recognize problems much earlier
Depression, Anxiety and Stress are treatable
Education, Psychotherapy and Medication are all effective
Self Care--eat, sleep, exercise--is a cornerstone of health (for all of us!)
Dr.T.V.Rao MD

46. Be realistic and not be overambitious
Being in control of your life and having realistic expectations about your day-to-day challenges are the keys to stress management, which is perhaps the most important ingredient to living a happy, healthy and rewarding life.
Marilu Henner
Dr.T.V.Rao MD

47. The programme created by Dr. T. V
The programme created by Dr.T.V.Rao MD for Students in the Developing World
Dr.T.V.Rao MD