2 What is Stress?By Definition, stress is any uncomfortable “emotional experience accompanied by predictable biochemical, physiological, and behavioral changes”In other words, it is not the demand or the event that causes us stress, but rather our reaction or emotional response that determines how we are going to handle what we consider a perceived threat.unavoidable and in small doses it is beneficialmotivates us to achieve our goals.Baum, A (1990). “Stress, Intrusive Imagery, and Chronic Distress, “ Health Psychology, Vol.6.pp
3 What is stress? (cont) fight or flight response In moderation, it produces a boostprovides us with energy and drive to get through situations.
4 Types of stress Acute stress often situationalCause is known(examples include: looming deadlines, test taking, running late for an appointment, getting into an argument with a loved one)Resolution occurs when perceived stress is goneNo long term effects** You have heard the saying “Everything in moderation” It is this level of stress that helps us work efficiently, motivates us to complete tasks, prepares us for new experiences, so what this means is a little bit of stress keeps us on track and allows us to perform at an optimal level.
5 Allostasis A regulatory process a stress mechanism that protects and promotes short term adaptation to a perceived physical or behavioral demand.maintains equilibrium during the exposure period and allows for return to normal functioning once the demand is gone.The ability of the body to have time to recover from stress is crucial to maintaining one’s overall health.McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease,” Ann NY Acad Sci., February: pp
7 Ongoing Acute Stress Ongoing acute stress No resolution Situation that is causing you to feel the stress does not end.examples: the pile of paperwork that sits on your desk, always being in a hurry but not ever managing to get anywhere on time, inability to say “no” to people and then getting upset that you didn’t say “no”No resolutioncan have an effect on you physically and emotionally.causes a shift in equilibrium.
8 Chronic Stress Chronic Stress causes wear and tear on your body ongoing acute stressmuch larger scale and over a much longer period of time.becomes part of your everyday life.examples: poverty, an unhappy marriage, and chronic illness“fight or flight “ response meant to be utilized in emergency situations never fully shuts off causing your body to stay in stress mode longer than it should.causes wear and tear on your bodyPotential for long term physical and emotional health problems.
9 Allostatic Load“This wear and tear on the body and brain promotes ill health, involving not only the consequences of the stressful experiences themselves, but also the alterations in lifestyle that result from a state of chronic stress”Equilibrium cannot be maintainedThe body’s inability to shut off its physiological responses and ineffective coping mechanisms can invoke illness and chronic diseases.McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links tosocioeconomic status, health, and disease,” Ann NY Acad Sci., February: pp
10 See-Saw Effect The lower image is an image of Allostasis- maintaining little stressover the life course.The upper image is oneof allostatic load- if youput too much chronicstress, the see saw willinevitably break.McEwen, B. and Lasley, E. The endOf stress: As we know it. WashingtonDC: John Henry Press
11 Causes of perceived stress This can be broken down into 3 categories:HomeWorkEverything else
12 Sources of stress at home Death of a loved oneDivorce, separation, relationship problemsChronic illness or major life altering injuryMoney problems due to loss of job, high debt, home foreclosure, just not having enough money to meet your everyday needs or wantsMarriagePregnancy or birth of a new babyYour childrenDavis, M. (2000) The Relaxation and Stress Reduction Workbook, New Harbinger, Inc.
13 Sources of stress at work Losing your job, a demotion or change in work dutiesA new jobYour relationship with your coworkers or bossThe workplace environmentThe amount of pressure you are underNumber of hours you work (too many, not enough, work schedule)Feeling unappreciated or not valuedBeing passed over for a promotion or pay raiseDavis, M (2000) The Relaxation and Stress Reduction Workbook. New Harbinger, Inc.
14 Sources of stress everywhere else PovertyEnvironment (where you work, play, live)RacismGenderEmotional Health (how you feel about yourself, relationships, your purpose)Fears about SafetyEducationLack of a support systemNegative feelings about oneselfDrug and Alcohol abuseDavis, M (2000) The Relaxation and Stress Reduction Workbook. New Harbinger, Inc.
15 Socioeconomic Status and Stress “There is evidence to support that disparities in income, education, occupation, health care accessibility, housing, and many other variables account for appreciable variance in cause and disease specific morbidity and mortality rates as well as the prevalence of risk factors for chronic medical conditions, psychopathologies of mood and substance abuse.McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links tosocioeconomic status, health, and disease,” Ann NY Acad Sci., February: pp
16 Environment and Racism Chronic stressors of neighborhood environment and racial discrimination have shown to be associated with preterm birth especially among the African American population which may contribute to the disparity in preterm births and infant mortality rates.The feelings of physical isolation, living in unsafe and violent neighborhoods, lack of social support, and racism contribute to the stress that is felt among these women.“Racism is seen as a significant health risk because of the psychosocial or affective responses it produces (stress, anxiety, anger, depression, etc), this leads to a physiological response that is associated with chronic illness.”Giurgescu, C., Banks, A., Dancy, B., Norr, K ( July/August2013). “African American Women’s Views of Factors Impacting Preterm Birth,” MCN, Volume 38. Number 4. ppJackson, F., Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality,” Joint Center for Political and Economic Studies Health Policy Institute.
17 Delaware StatsBlack infants experienced significantly higher mortality rates than white infants for the time period ofFor this time period, black IMRs were anywhere from 2.2 to 2.8 times that of white IMRs.Significant disparities existed between black non-Hispanics and each of the two other groups, white non-Hispanics and Hispanics.Black non-Hispanics had the highest IMRs of 14.1 in was more than double the white non-Hispanic rate of 5.4 and nearly twice the Hispanic rate of 7.4 infant deaths per 1,000 live births.Delaware Vital Statistics Report 2010
18 Gender Stressjust being a woman invokes a level of stress due to role of expectations placed upon a womanSandwich GenerationBalancing multiple rolesthe decision makers and organizersJackson, F. “Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality,” Joint Center for Political and Economic Studies Health Policy Institute.
19 Socioeconomic Status and Stress (Individual Level) low socioeconomic status can invoke feelings of:insecurity, low self worth, low self esteem, social exclusion and an overall feeling of just not being good enough.has a direct impact on emotional and physiological reactivity and recovery from life stressors thus impacting the risk of ill health.McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links tosocioeconomic status, health, and disease,” Ann NY Acad Sci., February: pp
20 Snowball Effect How does it happen? A person who develops, matures, and ages in a low socioeconomic position is more vulnerable to impairments in the function of the regulatory process that is meant to maintain equilibrium which puts them at greater risk for disease and maladaptive coping behaviors.Take that a step farther, now their children are being raised in a low socioeconomic environment in which they are being exposed to toxic substances, excessive noise, unfavorable housing conditions, the possibility of unhealthy family dynamics, as well as other forms of early life stress which very likely will alter their abilities to lead a healthy life.McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links tosocioeconomic status, health, and disease,” Ann NY Acad Sci., February: pp
22 What does it feel like?the initial feeling is the “fight or flight response”:Your heart beats fasterYour breathing increasesYou feel an adrenaline rushYour muscles tighten upYour pupils dilateBlood moves from the center of your body to your limbs
23 Physical Symptoms Chest pain or tightness Weight gain or weight loss Muscle tension, aches and painsSkin breakoutsExcessive sweatingIncrease in blood pressureLoss of interest in sexHair lossHeadachesStomach upset/nauseaShortness of breathSleep issues- too much or too littleGritting or grinding teethHivesTrembling of lips and handsKarren KJ, et al. Mind-Body Health: The Effects of Attitudes, Emotions and Relationships. 4th ed. San Francisco, Calif.: Pearson Education; 2010:28.Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014.Charlesworth EA, et al. Stress Management: A Comprehensive Guide to Wellness. New York, N.Y.: Ballantine Books; 2004:24.Stress: Coping with everyday problems. National Mental Health Association. Accessed April 5, 2013.
24 Emotional Symptoms Mood swings Anxiety Depression Frustration NervousnessFeelings of guilt, shame, helplessness, loss of controlPoor self esteem and lack of confidenceFeelings of failure***Long term effects have been linked to eating disorders, depression and anxiety disorders, panic attacks and suicide***Karren KJ, et al. Mind-Body Health: The Effects of Attitudes, Emotions and Relationships. 4th ed. San Francisco, Calif.: Pearson Education; 2010:28.Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014.Charlesworth EA, et al. Stress Management: A Comprehensive Guide to Wellness. New York, N.Y.: Ballantine Books; 2004:24.Stress: Coping with everyday problems. National Mental Health Association. Accessed April 5, 2013.
25 Behavioral Symptoms Irritability or anger outbursts Maladaptive behaviors such as drinking too much, smoking, poor eating habitsInability to concentrateMemory lapses, forgetfulness or short term memory lossRelationship problemsPoor work performancePoor time managementOverreacting to minor irritantsKarren KJ, et al. Mind-Body Health: The Effects of Attitudes, Emotions and Relationships. 4th ed. San Francisco, Calif.: Pearson Education; 2010:28.Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014.Charlesworth EA, et al. Stress Management: A Comprehensive Guide to Wellness. New York, N.Y.: Ballantine Books; 2004:24.Stress: Coping with everyday problems. National Mental Health Association. Accessed April 5, 2013.
26 Signs of Stress Overload Frequent anxiety or panic attacksAn overwhelming sense of impending doomConstant feelings of sadness, hopelessness, not feeling like you are ever good enoughFeeling of being constantly pressured and hurriedDevelopment of health problems: Hypertension, Diabetes, Depression, Obesity, Eating disorders, Substance Abuse, Irritable Bowel, Memory Loss, Autoimmune Disease, Insomnia, Thyroid Problems, increased risk of poor birth outcome, and Infertility (result of allostatic load)“Weathering effect”- prolonged stress is thought to create this effect which prematurely ages the body thus leading to the development of chronic diseases and may contribute to results of poor birth outcomes. The body is prematurely aging as a result of chronic, longitudinal stress.Jackson,F. “Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality,” Joint Center for Political and Economic Studies Health Policy Institute.
27 The Effects of Stress Hair: high levels of stress may lead to Excessive hair loss or some form of baldnessStress triggers mental and emotional problems such as insomnia, headaches,Personality changes, irritability, anxiety, and depression.Mouth ulcers and excessive dryness may be symptoms of stressMuscles: stress has been associated with pain inThe neck and shoulders, tension, twitches, andNervous tics.Cardiovascular disease and hypertension are linked to accumulatedStress.High levels of emotional stress have can adversely affect asthmaticsDigestive tract: stress has been associatedWith stomachaches, irritable bowel and weight gain/lossStress can affect the reproductive system causing menstrual disordersAnd recurrent vaginal infections, infertility and has been linked to prematurityIn men, it has been linked to impotence and premature ejaculation.Some individuals react to stress withSkin outbreaks such as eczema and psoriasis
29 How stressed out are you? Take the test How many of the following statements or feelings apply to you?Little things make me angry.I don’t laugh as much as I used to.I feel sad and anxious most of the time.I am eating or drinking too much.I am engaging in risky behaviors.I can’t seem to remember things as well.I am having recurring headaches, stomachaches, tension in jaw, shoulders, back or chest.I recently got married, divorced, or separated.I was recently injured or have been sick.I am having major financial problems.I work more than 10 hours a day.I was recently fired, laid off from my job.I hate my job or some of the people I work with.I have not had a vacation in 3 years.I sleep less than 6 hours a night.I hardly have anytime for myself.I am always in a hurry and cannot manage to get anywhere on time.I don’t have an emotional support network.A close friend or relative is sick or recently died.Brott, Armin. Your Head: An Owner’s Manual. Understanding and Overcoming Depression, Anxiety, and Stress.
30 How did you answer and what does this mean? Chances are, at least 5-6 of the above statements are true for you. This should not come as a surprise. Stress is so widespread that The American Institute for Stress estimates that % of all visits to PCPs are for stress related issues.According to The American Psychological Association, American Institute of Stress, NY, the top causes of stress are:Job pressureMoneyHealthRelationshipsPoor nutritionMedia overloadSleep deprivation
31 StatisticsAccording to American Psychological Association, American Institute of Stress, NY,77% of people in the U.S. regularly experience physical symptoms caused by stress73% of people in the U.S experience psychological symptoms caused by stress33% of people in the U.S. feel that they are living with extreme stress.48% of people in the U.S. feel their stress has increased over the past 5 years48% of people in the U.S. said that stress has had a negative impact on their personal and professional life.$300 billion dollars is being spent annually by employers on stress related health care and missed work.51% of people in U.S. reported fatigue as the number 1 physical symptom50% of people in U.S. reported irritability and anger as the number 1 psychological symptom
32 So…what do we do about it??? Good and Bad NewsThe good news is that we are not alone, the bad news is, is that it is costing us billions of dollars and making us sick!!So…what do we do about it???
33 How do you handle stress? Positive vs. Negative
34 Maladaptive Coping Strategies Alcohol abuseSmokingDrug AbuseOver eatingEscapismSpending spreesBlaming othersPhysical or verbal abuseOverworkingDenialMagnificationDrinking too much caffeineNegative self talk
35 Bang Head Here Dealing with Stress Stress Reduction Kit Directions: Place Kit on FIRM surfaceFollow directions in circle of kitRepeat step 2 as necessary, or until unconsciousIf unconscious, cease stress reduction activity immediately!!!OR………………….Bang Head Here
36 Dealing with Stress: The 4 A’s AvoidAlterAdaptAcceptMiller LH, et al. The Stress Solution: An Action Plan to Manage the Stress in Your Life. New York, N.Y.: Pocket Books; 1993:86.Patel C. The Complete Guide to Stress Management. New York, N.Y.: Plenum Press; 1991:233.Wheeler CM. 10 Simple Solutions to Stress. Oakland, Calif.: New Harbinger Publications, Inc., 2007:39.Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014:109.How can I manage stress? American Heart Association. Accessed May 23, 2013.Miller LH, et al. The Stress Solution: An Action Plan to Manage the Stress in Your Life. New York, N.Y.: Pocket Books; 1993:86.Patel C. The Complete Guide to Stress Management. New York, N.Y.: Plenum Press; 1991:233.Wheeler CM. 10 Simple Solutions to Stress. Oakland, Calif.: New Harbinger Publications, Inc., 2007:39.Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014:109.How can I manage stress? American Heart Association. Accessed May 23, 2013.
37 Avoid 1. Avoid unnecessary stress Not all stress can be avoided, nor is it healthy to avoid situations that need to be addressed but you may be surprised at the number of undo stressors you place on yourselfLearn to say “NO”- know your limits and stick with it both in your personal and professional life, refuse to accept any added responsibilities that you do not have time for. Taking on more than you can handle is a recipe for unnecessary stress!Avoid people who cause you stress, or at least limit your time with them. Set limits. Understand that you cannot control someone else’s behavior but you do have control of your own.Take control of your environment.Scale down your To-Do list- distinguish between your “shoulds” and the “musts”
38 Alter2. Alter the situation: if you can’t avoid it, figure out a way to change how you respond to the situationExpress your feelings instead of bottling them up. People are not mind readers, you cannot expect people to look at your face or observe your body language and know how you are feelingCommunicate your feelings openly and respectfully otherwise feelings of resentment will fester and the situation will likely remain the sameCompromise, if you are asking another person to make changes, then you should be willing to bend yourselfBe more assertive- don’t take a backseat in your own life. Look out for your own well being and deal with problems that arise head on.Manage your time- don’t overextend yourself. Don’t make promises you cannot keep, you will only feel badly about yourself.
39 Adapt3. Adapt to the stressor: if you can’t change the stressor, change how you react to it.Reframe the problem: try to see the positive in every situation (ex: stuck in traffic jam, take a moment to listen to your favorite music)Look at the big picture: “Don’t sweat the small stuff” Ask yourself will this really matter in a few days, a month, a year, if the answer is no, then it is time to put your focus and energy somewhere else.Adjust your standards: stop comparing yourself to others, stop setting yourself up for failure by demanding perfection. Set reasonable goals for yourself. You are not a Super Hero, so don’t try to act like one.(Sojourner Syndrome and Superwoman Complex)Focus on the positive: learn to be grateful and appreciative of what you do have in your life instead of focusing on what you don’t have. Be sure to take note of all of your own positive qualities and gifts that you have to share.
40 Accept 4. Accept the things that you cannot change “it is what it is”, there are just some things and situations we cannot control, instead of stressing about these things, learn to focus on the things that you do have control over.Look for the upside: when faced with challenging circumstances, take a moment to look at how this is a chance for you to grow as a person. If you make a mistake, don’t see it as a failure but as a way to learn from it and move forward, look at it as if there are no mistakes just life lessons to learn along the journeyShare your feelings: opening up about how you feel if nothing else makes you feel better even if you cannot change itLearn to forgive- accept that we live in an imperfect world and that people make mistakes, let it go. Freeing yourself from all of that negative energy and resentment leaves room for more positive experiences. It frees you up from time and energy spent on things you cannot change.Eliminate the words: “always, never, should, and must”. These are self defeating words that will only set you up for failure.
41 Achieving Inner Health through Stress Reduction Techniques Learn To:Appreciate Yourself- value who you are and what you doProblem: Questioning your ability?Solution: Do a self inventory of your skills, strengthsAsk for Help, seek out resources that are availableProblem: Feeling Pessimistic?Solution: Keep a gratitude journal, do a self inventory, rent a funny,uplifting movie, surround yourself with positive peopleProblem: Worn out, Burned out?Solution: Take care of you!! Eat Healthy, sleep, exercise, engage inactivities that make you happy
42 Achieving Inner Health through Stress Reduction Techniques Learn To:Find Balance and PurposeProblem: Frequently Late?Solution: Prioritize, map out your day: segment by segmentGet to the bottom of why you are really late!!Problem: Angry and Irritated?Solution: Pause, Breathe, Reflect, Regroup, and ChooseDon’t magnify or leap to conclusionsProblem: Overextended?Solution: Decide what is important to youDelegate
43 Achieving Inner Health through Stress Reduction Techniques Learn To:Connect with OthersProblem: Feeling Lonely?Solution: Volunteer, Strike up a conversation, connect on social media,phone a friend, avoid judging others, identify with your own racial, ethnic, or cultural background, learn about other cultures surround yourself with people who respect and value youProblem: Upset by conflict/Poor CommunicationSolution: Try Being more assertive, let your needs be known in a respectful way.Avoid words like “you always” or “you never” instead try sayingI feel _____ when you____.”
44 Other Solutions to Stress Create a worry box- great for childrenMeditation- clears your mind of all the clutter, helps to find an inner calmness and inner peace (www.how-to-meditate.org)Deep Breathing: Less than a minuteCount down slowly from 10-0: takes 2 minutesSelf Massage: 5 minutes or lessFind your happy place: 10 minutes or lessYogaEngage your sensesDrive in the slow lanePrayBefore work, sit in the car for a minute and plan out your day, leaving behind any negativity that happened before coming to workAfter work, sit in car and reflect on your day, let go of the negativity that happened during your work dayTake a break from technology, unplugAsk for help, Dial 2-1-1(adapted from Healthy Lifestyles: Improving and Maintaining the Quality of your Life.
45 Tips for Health Care Providers When dealing with a difficult or stressed patient, remember to:Observe- voice, words, attitudeConnect- Ask open ended questionsBe an active listenerValidate their feelings: (examples: “What I hear you saying is..”)Show Respect: make eye contactSlow downAddress their basic human needsFocus on feelingsBe safe, know when to de-escalate and know when to terminate
46 Benefits of Effectively Managing Your Own Level of Stress Improved physical and emotional healthImproved memory and cognitive functioningIncrease in energy during the day and more restful sleep at nightIncrease in emotional connectedness, feeling of contentment and satisfaction with lifeDecrease in impatience, irritability, depression and sadness.Increase in positive attitude and in joy of everyday activities, finding humor in situationsThe acknowledgement that managing stress is a lifestyle, not just a single event.(adapted from Healthy Lifestyles: Improving and Maintaining the Quality of your Life.
47 The Role of Public Policy in Stress Reduction Investments in Women’s Healthpush for better access, affordability, and quality of health care across the lifespan (loss of Medicaid coverage at 60 days postpartum even if poor pregnancy outcome)a multidisciplinary approach in treatment, so that there is follow through and follow up services, a continuity of care is needed.push to educate women before their reproductive years( preconception education) (Healthy women beget healthy children)Lu, M and Halfon, N (2003). “Racial and Ethnic Disparities in Birth Outcomes: A Life –Course Perspective,” Maternal and Child Health Journal, Vol. 7, No. 1, March. pp
48 The Role of Public Policy in Stress Reduction Investments in Community HealthCreate a comprehensive health care system that takes preventative steps to illness and injury, that maintains the well being of those who are already sickOffer full services (medical ,dental ,vision, screening and diagnostic services and disease management) all within the communities where people live (Prevention institute)push for what influences our health outside of this, which is where we live, work, play, socialize, and learn(location, location, location)Creating affordable and decent housingSafe neighborhoods that allow for parks and recreationProvide clean air and waterProvide access to healthier foods (farmers markets that accept food stamps), there is a problem when there are more liquor stores and fast food restaurants than there are grocery stores.Make bus routes more accessible and saferLu, M and Halfon, N (2003). “Racial and Ethnic Disparities in Birth Outcomes: A Life –Course Perspective,” Maternal and Child Health Journal, Vol. 7, No. 1, March. pp
49 The Role of Public Policy in Stress Reduction Investments in improving social conditions:Create programs that address drug and alcohol issues without prejudice or punitive chargesDecrease domestic violenceEngage fathers and encourage them to be active, positive role models in their children’s lives by including them in preconception education, the pregnancy and the parenting. Giving them value and place in the future of their children.Create better working conditions for women by decreasing work load, creating flexibility in work schedules, offering daycare options so that women can work. Create neighborhoods that foster a sense of connectedness that create opportunities that foster positive community relationships ( it takes a village)McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease,” Ann NY Acad Sci., February: ppLu, M and Halfon, N (2003). “Racial and Ethnic Disparities in Birth Outcomes: A Life –Course Perspective,” Maternal and Child Health Journal, Vol. 7, No. 1, March. pp
51 Conclusion Your Heart is Free…. Have the courage to follow it!! “Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma-which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your inner voice. And most important have the courage to follow your heart and intuition. They somehow know what you truly want to become. Everything else is secondary.”by Steve JobsThank You!!!