1. Lecture 2 Identifying your stressors and how you handle stress
Dr. Paul Wong D.Psyc.(Clinical)
Centre for Suicide Research and Prevention (CSRP)

2. This Lecture’s Overview
Recap of Lecture 1
In-class activity - Myths and Facts of Suicide
Video – The aftermath of suicide
What is Stress?
Sources of Stress
Bio-psycho-social Aspects of Stress
How Stress Affects Health
Coping with it

3. Objectives
Students will learn the difference between good and bad stress.
Students will learn to identify signs of stress in themselves and others.
Students will learn the difference between positive and negative ways of coping with stress.
Students will identify and choose specific methods that can reduce stress.

4. Myths and Facts of Suicide In-class activity

5. Suicide usually happens without warning.
Myth or Fact
Suicide usually happens without warning.

6. Myth
Research has demonstrated that in over 80% of completed suicide, a warning sign or signs were given.
(Coleman & O’Halloran, 1998)
Many studies have revealed that the suicidal person gives many clues and warning regarding suicidal intentions. This is not to say that all suicidal people always give warnings.
(Center for Mental Health in Schools at UCLA, 2003)

7. There are no special/certain types of people who commit suicide.
Myth or Fact?
There are no special/certain types of people who commit suicide.

8. Fact
Suicidal behavior cuts across all socioeconomic boundaries. People of all ages, races, faiths, and cultures die by suicide, as do individuals from all walks of life, all income levels. Most who die suffer from serious mental illness; many of whom have not been diagnosed; some have no diagnosable mental illness. We have to pay serious attention to all suicidal talk and behavior.

9. Suicide is preventable
Myth or Fact?
Suicide is preventable

10. Fact
It is simply not true that “once suicidal, always suicidal.” Most people who are considering suicide will be suicidal for a relatively short period of time. Given proper assistance and support, there is a strong possibility that there will not be another suicidal crisis.

11. Many people think about suicide at some
Myth or Fact?
Many people think about suicide at some
point in their lives.

12. (Prevalence Study of Suicidality in Hong Kong)
Fact
50% to 70% of people have thought of suicide at some point in their lives as shown in studies that investigated lifetime suicidal ideation.
(Ramsay et al., 1999)
In Hong Kong, 29.6% of those aged in the population have ever thought about suicide in their lives, and 6.7% have suicidal ideation in the past year.
(Prevalence Study of Suicidality in Hong Kong)

13. People who talk about suicide don’t really
Myth or Fact?
People who talk about suicide don’t really
commit suicide.

14. Myth
Of every 10 persons who kill themselves, 8 have given definite verbal warning signs of their suicidal intentions.
(Center for Mental Health in Schools at UCLA, 2003)
50.7% of those who committed suicide had either implicitly or explicitly expressed their suicidal plan prior to their death.
(Psychological Autopsy Study of Suicide in Hong Kong)

15. Suicidal people fully intend to die.
Myth or Fact?
Suicidal people fully intend to die.

16. (Center for Mental Health in Schools at UCLA, 2003)
Myth
Most suicidal people are ambivalent about dying. On one hand, they wanted to commit suicide to end their pain, yet on the other hand, they wanted someone to be there to help them and listen to them.
(Center for Mental Health in Schools at UCLA, 2003)

17. Once a person is suicidal, the person is suicidal forever.
Myth or Fact?
Once a person is suicidal, the person is suicidal forever.

18. Myth
Individuals who wish to kill themselves are suicidal only for a limited period of time. In other words, it is almost always a temporary state.

19. People who threatens or attempts suicide are merely seeking attention.
Myth or Fact?
People who threatens or attempts suicide are merely seeking attention.

20. Myth
28.2% of all suicide cases in 2003 had an attempt history. 30.5% of the deceased aged below 25 had attempted suicide before.
(Surveillance and Monitoring, 2003)
Compared to the people who are alive, those who died by suicide were 24.8 times more likely to have attempted suicide before.
(Psychological Autopsy Study of Suicide in Hong Kong)

21. Myth or Fact?
Talking about suicide or asking someone if they feel suicidal will encourage suicide attempts.

22. (Coleman & O’Halloran, 1998)
Myth
There is no evidence that asking an individual about suicidal ideation will increase the change that the individual will commit suicide. Most people thinking about suicide want very much to talk about how they are feeling and are relieved when someone else recognizes their pain. To avoid the subject of suicide is deadly.
(Coleman & O’Halloran, 1998)

23. The Aftermath of Suicide – People bereaved by suicide

24. Video on People bereaved by Suicide in Hong Kong

25. What is Stress?

26. What is Stress?
It is a stimulus – things that “stress” us, e.g., “This broadening course’s course co-ordinator stresses me!”
It is a response – how we react to a stimulus, e.g., “I feel a lot of stress when I an being asked to answer questions in lectures of this course”
It is a process – in which the person is an active agent who can influence the impact of a stressor through behavioural, cognitive, and emotional strategies. E.g., “though this broadening course makes me stress, I can deal with it by following the suggested ways from this class”.

27. So WHAT stress you?
In-class activity no.2 – Hassles in Your life (Sarafino & Ewing, 1999).

28. The definition of stress -
Stress as the condition in which person-environment transactions lead to a perceived discrepancy between the physical or psychological demands of a situation and the resources of the individual’s biological, psychological, or social system (Lazarus & Folkman, 1984).

29. In English
Stress is the reaction people have excessive pressures or other types of demand placed upon them. It arises when they worry that they can’t cope.

30. When do we see something as stressful?
Determined by two components:
Whether a demand threatens our physical or psychological well-being (primary appraisal); and
The resources available for meeting the demand (secondary appraisal).
*** in emergency situations, i.e., disaster, our cognitive functioning is impaired during shock, it is unlikely that appraisal processes play an important role in the stress experienced while in that state***

31. Sources of Stress
External
Internal

32. External Stressors
Physical Environment (Noise, Bright Lights, Heat, Confined Spaces)
Social Interaction (Rudeness, Bossiness, Aggressiveness by others, Bullying)
Organizational (Rules, Regulations, Deadlines)
Major Life Events (Birth, Death, Lost job, Promotion, Marital status change)

33. Internal Stressors
Negative self - talk (Pessimistic thinking, Self criticism, Over analyzing)
Thinking errors (Unrealistic expectations, Taking things personally, All or nothing thinking, Exaggeration, Rigid thinking)
Personality traits (Perfectionists, Workaholics)

34. Types of Stress Negative stress (dy-stress)
Positive stress (eu-stress)

35. Note:
Most of the stress we experience is self-generated. How we perceive life - whether an event makes us feel threatened or stimulated, encouraged or discouraged, happy or sad - depends to a large extent on how we perceive ourselves.

36. Note:
Self-generated stress is something of a paradox, because so many people think of external causes when they are upset.
Recognizing that we create most of our own upsets is an important first step towards coping with them.

37. How stress affects our Bio-Psycho-Social Aspects?

38. How stress affects our Bio-Psycho-Social Aspects?
Biological
During emergencies – fight-or-flight response
Pupils dilated, far vision
Dry mouth
Sweaty palms
Increased heart rate
Maximum blood supply to muscles
Digestion inhibited
When stress prolongs
GAS (General Adaptation Syndrome)

39. What is GAS? Three stages:
Alarm Reaction – similar to the fight-or-flight response
Stage of Resistance - If the source persists, the body prepares for long-term protection, secreting hormones to increase blood sugar levels. This phase is common and not necessarily harmful, but must include periods of relaxation and rest to counterbalance the stress response. Fatigue, concentration lapses, irritability and lethargy result as the stress turns negative.
Stage of Exhaustion - In chronic stress situations, sufferers enter the exhaustion phase: emotional, physical and mental resources suffer heavily, the body experiences ‘ adrenal exhaustion’ leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse.

40. The Psychosocial Aspects of stress
Mental
Behavioural
Emotional

41. Mental Symptoms Lack of concentration Memory lapses
Difficulty in making decisions
Confusion
Disorientation
Panic attacks

42. Behavioural Symptoms Appetite changes - too much or too little
Eating disorders - anorexia, bulimia
Increased intake of alcohol & other drugs
Increased smoking
Restlessness
Fidgeting
Nail biting

43. Emotional Symptoms Bouts of depression Impatience Fits of rage
Tearfulness
Deterioration of personal hygiene and appearance

44. Stress Related Illnesses
Stress is not the same as ill-health, but has been related to such illnesses as:
Cardiovascular disease
Immune system disease
Asthma
Diabetes
Recurrent headache
Cancer

45. Why some people are more prone to stress, and some are not?
Social Support?
A sense of personal control?
A Hardy personality?
Hardiness include control, commitment, and challenge.

46. Coping with STRESS

47. Coping is the process by which people try to manage the perceived discrepancy between the demands and resources they appraise in a stressful situation.
In English – people come up with ways to either reduce “demands” or increase “resources” or both.

48. Two major functions of coping
Emotion-focused coping
Problem-focused coping
In-class activity no.3 – “Your Focuses in Coping” - Billings and Moos, 1981.

49. Two major functions of coping
Emotion-focused coping – is aimed at controlling the emotional response to the stressful situation
Problem-focused coping – is aimed at reducing the demands of the stressful situation or expanding the resources to deal with it.
Please see examples of ways of coping from handout

50. Stress Management Techniques
Change your thinking
Change your behaviour
Change your lifestyle

51. Change your Thinking Re-framing Positive thinking
Re-framing is a technique to change the way you look at things in order to feel better about them. There are many ways to interpret the same situation so pick the one you like. Re-framing does not change the external reality, but helps you view things in a different light and less stressfully.
Positive thinking
Stress leaves us vulnerable to negative suggestion so focus on positives;
Focus on your strengths
Learn from the stress you are under
Look for opportunities
Seek out the positive - make a change.

52. Change your Behaviour Be assertive Get organized Ventilation
Have a sense of Humour

53. Be assertive
Being assertive involves standing up for your personal rights and expressing your thoughts, feelings and beliefs directly, honestly and spontaneously in ways that don’t infringe the rights of others.
Assertiveness helps to manage stressful situations, and will, in time, help to reduce their frequency. Lack of assertiveness often shows low self - esteem and low self - confidence. The key to assertiveness is verbal and non - verbal communication. Extending our range of communication skills will improve our assertiveness.

54. Equality and Basic Rights of being Assertive
1) The right to express my feelings
2) The right to express opinions / beliefs
3) The right to say ‘Yes/No’ for yourself
4) Right to change your mind
5) Right to say ‘I don’t understand’
6) Right to be yourself, not acting for the benefit of others
7) The right to decline responsibility for other people’s problems
8) The right to make reasonable requests of others
9) The right to set my own priorities
10) The right to be listened to, and taken seriously

55. Get Organized
Poor organization is one of the most common causes of stress. Structured approaches offer security against ‘out of the blue’ problems. Prioritizing objectives, duties and activities makes them manageable and achievable. Don’t overload your mind. Organization will help avoid personal and professional chaos.

56. Time Management Make a list What MUST be done What SHOULD be done
What would you LIKE to do
Cut out time wasting
Learn to drop unimportant activities
Say no or delegate
Plan your day
Set achievable goals
Don’t waste time making excuses for not doing something

57. Ventilation ‘A problem shared is a problem halved’
Develop a support network through friends or colleagues to talk with. It’s not always events that are stressful but how we perceive them.
Writing a diary or notes may help release feelings but do not re-read what has been written.

58. Change Your Lifestyle Diet Smoking & Alcohol Exercise Sleep Leisure
Relaxation

59. Benefits of Exercise
Uses up excess energy released by the ‘Fight or Flight’ reaction.
Improves blood circulation
Lowers blood pressure
Clears the mind of worrying thoughts
Improves self image
Makes you feel better about yourself
Increases social contact

60. Alternatives (less evidence, though)
Conventional Medicine
Counselling & psychotherapy
Relaxation
Meditation
Massage
Yoga
Acupuncture
Aromatherapy
Floatation
Herbalism
Biofeedback
Homeopathy
Hypnotherapy
Osteopathy
Pet Therapy
Reflexology

61. Please do send me things you find interesting that you want to share with your classmates and friends!
#1Title of the website(Please also copy a link)
Where did you find it?
Recommended by others; Search online; Come across; Others
Why do you recommend this material?
If the website was found through searching online, please share with us:
What search query/key word did you use?
What search engine did you use?