Lecture 2 Identifying your stressors and

how you handle stress

Dr. Paul Wong D.Psyc.(Clinical)

E-mail: paulw@hku.hk

Centre for Suicide Research and Prevention (CSRP)

This Lecture’s Overview

1. Recap of Lecture 1

2. In-class activity - Myths and Facts of Suicide

3. Video – The aftermath of suicide

4. What is Stress?

5. Sources of Stress

6. Bio-psycho-social Aspects of Stress

7. How Stress Affects Health

8. Coping with it

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.

Myths and Facts of Suicide

In-class activity

Myth or Fact

Suicide usually happens without warning.

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)

Myth or Fact?

There are no special/certain types of people who commit suicide.

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.

Myth or Fact?

Suicide is preventable

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.

Myth or Fact?

Many people think about suicide at some

point in their lives.

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 15-59 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)

Myth or Fact?

People who talk about suicide don’t really

commit suicide.

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)

Myth or Fact?

Suicidal people fully intend to die.

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)

Myth or Fact?

Once a person is suicidal, the person is suicidal forever.

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.

Myth or Fact?

People who threatens or attempts suicide are merely seeking attention.

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)

Myth or Fact?

Talking about suicide or asking someone if they feel suicidal will encourage suicide attempts.

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)

The Aftermath of Suicide –

People bereaved by suicide

Video on People bereaved by Suicide in Hong Kong

What is Stress?

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”.

So WHAT stress you?

In-class activity no.2 – Hassles in Your life (Sarafino & Ewing, 1999).

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).

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.

When do we see something as stressful?

Determined by two components:

1. Whether a demand threatens our physical or psychological well-being (primary appraisal); and

2. 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***

Sources of Stress

External

Internal

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)

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)

Types of Stress Negative stress (dy-stress)

Positive stress (eu-stress)

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.

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.

How stress affects our Bio-Psycho-Social Aspects?

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)

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.

The Psychosocial Aspects of stress

Mental

Behavioural

Emotional

Mental Symptoms

Lack of concentration

Memory lapses

Difficulty in making decisions

Confusion

Disorientation

Panic attacks

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

Emotional Symptoms

Bouts of depression

Impatience

Fits of rage

Tearfulness

Deterioration of personal hygiene and appearance

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

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.

Coping with STRESSSTRESS

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.

Two major functions of coping

Emotion-focused coping

Problem-focused coping

In-class activity no.3 – “Your Focuses in Coping” - Billings and Moos, 1981.

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

Stress Management Techniques

Change your thinking

Change your behaviour

Change your lifestyle

Change your Thinking Re-framing

• 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.

Change your Behaviour Be assertive

Get organized

Ventilation

Have a sense of Humour

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.

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

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.

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

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.

Change Your Lifestyle

Diet

Smoking & Alcohol

Exercise

Sleep

Leisure

Relaxation

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

Alternatives (less evidence, though)

Conventional Medicine

Counselling & psychotherapy

Relaxation

Meditation

Massage

Yoga

Acupuncture

Aromatherapy

Floatation

Herbalism

Biofeedback

Homeopathy

Hypnotherapy

Osteopathy

Pet Therapy

Reflexology

Please do send me things you find interesting that you want to share with your classmates and friends!

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