STRESS

“You are responsible for all of your experiences of life.”

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STRESS MANAGEMENT

MANAGING STRESS IN YOUR LIFE: A PERSONAL APPROACH

J.P. PECORELLI, PH.D.Behavioral Health Services of Sharon Regional Health System724-983-5454

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STRESS MANAGEMENT

IS A PART OF EVERYDAY LIFE IS NECESSARY

TIME, MONEY, AND RELATIONSHIPS

ENSURE THAT STRESS WILL ALWAYS BE WITH US

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STRESS MANAGEMENT

STRESS

DOES NOT HAVE TO BE NEGATIVE OR OVERWHELMING

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STRESS MANAGEMENT

DEFINITION:

THE NON-SPECIFIC RESPONSE OF THE BODY TO ANY DEMAND

Hans Selye, MD

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STRESS MANAGEMENT

OUR RESPONSE TO STRESS:

IS THE AUTOMATIC STATE THAT RESULTS WHEN THE BODY ATTEMPTS TO MAKE CHANGES IN ORDER TO ADAPT TO ANY DEMAND

General Adaptation Syndrome or the Stages of Stress Response

STRESS

Fight or FlightSTRESS

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STRESS MANAGEMENT

STRESSWHAT YOU NOTICE: HEART RATE SPEEDS UP BP RISES BREATHING SPEEDS UP BLOOD TO MUSCLES SWEATING BLOOD SUGAR INCREASES

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STRESS MANAGEMENT

STRESS

DRIVEN BY HORMONES

HORMONES ACT LIKE A CONDUCTOR

HORMONES INNERVATE BODY SYSTEMS/ORGANS

Modern Stress

“The essence of modern stress is change!” Dr. Dan Johnston

Stress can be Chronic or Acute

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STRESS MANAGEMENT

DR. HANS SELYE WROTE:

“…STRESS IS ESSENTIALLY REFLECTED BY THE RATE OF ALL THE WEAR AND TEAR CAUSED BY LIFE.”

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STRESS MANAGEMENT

WHAT DOES THAT MEAN TO US?

IT DOES NOT MATTER IF THE STRESSOR IS PLEASANT OR UNPLEASANT, OR THE RESULTS ARE GOOD OR BAD

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STRESS MANAGEMENT

NOT ALL STRESS IS NEGATIVEEUSTRESS: POSITIVE STRESSRESULTS FROM EXHILARATING

EXPERIENCES:WINNING THE LOTTERYUNEXPECTED PROMOTION AWARD

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STRESS MANAGEMENT

DISTRESSSTRESS OF:LOSING, FAILING, OVERWORKING

AND NOT COPINGCAN BE HARMFUL AND IT IS NORMAL

FROM TIME TO TIME

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STRESS MANAGEMENT

CAUSES OF STRESS FALL INTO TWO CATEGORIES:

EXTERNAL INTERNAL

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STRESS MANAGEMENTEXTERNAL STRESSORMAY BE MAJOR LIFE EVENTS:(REFER TO HOLMES-RAHE SCALE)

MOVING DEATH OF SPOUSE, FAMILY

MEMBER OR FRIEND DIVORCE

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STRESS MANAGEMENT

MAY BE CAUSED BY EVERYDAY PRESSURES SUCH AS:

FINANCIAL DEADLINES ARGUMENTS FAMILY CONCERNS LACK OF SLEEP

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STRESS MANAGEMENT

INTERNAL STRESSORS“INSIDE OURSELVES”

THIS TYPE OF STRESSOR MAY PLAY A GREATER ROLE IN THE STRESS OF DAILY LIFE

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STRESS MANAGEMENT

EXAMPLES ARE:“VALUES AND BELIEFS”

FAITHGOALSSELF-IMAGE EXPECTATIONS OF SELVES &

OTHERS

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STRESS MANAGEMENT

MANY PEOPLE HAVE SYMPTOMS OF DISTRESS EVERYDAY.

WE ACCEPT IT AS PART OF A NORMAL DAY.

TO REDUCE THE WEAR AND TEAR ON OURSELVES, WE MUST INCREASE AWARENESS

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STRESS MANAGEMENT

COMMON SYMPTOMS OF STRESS

PHYSICAL MENTAL EMOTIONAL BEHAVIORAL COGNITIVE

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STRESS MANAGEMENT

PHYSICAL SYMPTOMS INCLUDE:

MUSCLE TENSION NAUSEA, VOMITING HEADACHES JAW, NECK & BACK PAIN DIARRHEA SLEEP DISTURBANCES DRY MOUTH, SWEATY PALMS UPPER RESPIRATORY INFECTIONS COLD HANDS BREATHING CHANGES (E.G., SHALLOW, SIGHING)

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STRESS MANAGEMENT

EMOTIONAL/MENTAL SYMPTOMS:

ANXIETY, WORRY, GUILT, NERVOUSNESS ANGER, FRUSTRATION MOODINESS DEPRESSION APPETITE VARIES RACING THOUGHTS NIGHTMARES DIMINISHED CONCENTRATION IMPAIRED MEMORY OR FORGETFULNESS

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STRESS MANAGEMENT

INDECISIVENESS CLOSE TO TEARS OR CRYING LONELINESS FEAR OF GETTING CLOSE SUICIDAL THINKING TROUBLE LEARNING NEW INFO CONFUSED/DISORGANIZED

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STRESS MANAGEMENT

BEHAVIORAL SYMPTOMS TARDINESS SERIOUS APPEARANCE NERVOUS BEHAVIOR/HABITS RUSHING/PACING ON EDGE INCREASED FRUSTRATION/IRRITABLE MORE ACCIDENTS OVERREACTING

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STRESS MANAGEMENT

REDUCED PRODUCTIVITY SOCIAL WITHDRAWAL DEFENSIVE SLEEP PROBLEMS/TIREDNESS INCREASED USE OF OTC DRUGS INCREASED TOBACCO INCREASED ALCOHOL INCREASED RECREATIONAL DRUGS

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STRESS MANAGEMENT

LONG TERM EFFECTS ARE HARMFUL.

MOST OF US BOUNCE BACK. UNDER LONG-TERM STRESS HOWEVER:

OUR PERSONALITIES CHANGE MAY BECOME DEPRESSED FEEL HELPLESS/HOPELESS BECOME EXPLOSIVE/IMPULSIVE

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STRESS MANAGEMENT

HAVE EXAGGERATED FEARS DEVELOP ANXIETY/PANIC DEVELOP PHYSICAL PROBLEMS

INCLUDING CV DISEASE, HBP, ULCERS OR HEADACHES

DAILY HASSLES AND UPLIFTS

Faulty Perceptions and Daily hassles:

Control and Daily uplifts:

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STRESS MANAGEMENT

WHAT HAPPENS WHEN WE ARE STRESSED:

HYPOTHALAMUS STIMULATES PITUITARY

PITUITARY RELEASES ACTH INTO BLOOD

ACTH STIMULATES ADRENAL GLANDS TO SECRETE FURTHER CHEMICALS THAT AFFECT OTHER ORGAN SYSTEMS

Response to Stress

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STRESS MANAGEMENT

QUESTIONS?

Optimal stress: stress is intense enough to motivate and physically prepare us to perform well but not enough to cause harm.

Distress: negative stress

Eustress: positive stress

STRESS TERMS

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STRESS MANAGEMENT

NOW THAT YOU ARE FAMILIAR WITH SOME OF THE SYMPTOMS OF

STRESS, HOW DO YOU MANAGE IT?

SIMPLE, RIGHT?

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STRESS MANAGEMENT

DEEP BREATHING PROGRESSIVE MUSCLE

RELAXATION BIOFEEDBACK MEDITATION BEGIN AN EXERCISE PROGRAM REAPPRAISE YOUR LIFE AND

PRIORITIES

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STRESS MANAGEMENT

COPING SKILLS FOR STRESS MANAGEMENT:

DEEP BREATHING EXERCISE RELAXATION GUIDED IMAGERY

STRATEGIES FOR STRESS MANAGEMENT

STRATEGY 1: EXERCISE

STRATEGY 2: RELAXATION TECHNIQUES

STRATEGY 3: LIFESTYLE CHANGES

STRATEGY 4: REFRAMING

STRATEGY 5: LAUGHTER AND HUMOR

STRATEGY 6: CREATE A MEMORY BANK

STRATEGY 7: FORGIVENESS

THE STRESS RESISTANT HARDY PERSON

Type C personalities; • Control – internal control of self.• Commitment – to meaningful

involvement in life.• Challenge – is an opportunity rather

than a threat.• Choices – lifestyle choices that enhance

health. You always have a choice on how you react to life.

• Connectedness – network of social support, helping and being helped by others.

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STRESS MANAGEMENT

LEARN TO SAY “NO”: THERE ARE SOME DEMANDS THAT WE HAVE NO CONTROL OVER. SEPARATE THOSE FROM ACTIVITIES OVER WHICH WE HAVE SOME CONTROL, AND LEARN TO SAY “NO” TO DEMANDS.

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STRESS MANAGEMENT

POSITIVE SELF TALK: LEARN THAT YOU CAN MANAGE A STRESSFUL SITUATION BY WHAT YOU SAY TO YOURSELF, “I CAN HANDLE THIS ONE STEP AT A TIME”.

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STRESS MANAGEMENT

TAKE CHARGE: TAKE RESPONSIBILITY FOR MAKING YOUR LIFE WHAT YOU WANT.

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STRESS MANAGEMENT

GET ORGANIZED: USE CALENDERS OR “TO DO LISTS”

KNOW YOUR LIMITS: BE REALISTIC

CHANGE ATTITUDE: LEARN TO SEE STRESSFUL

SITUATIONS AS CHALLENGESTALK IT OVER:

TALK THE SITUATION OVER WITH A FRIEND

Attitude“The longer I live the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more important than appearance, giftedness, or skill. It will make or break a company…a church…a home. The remarkable thing is we have a choice everyday regarding the attitude we will embrace for that day. We cannot change our past…we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing that we can do is to play on the one string we have and that is our attitude…I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you…we are in charge of our attitudes.”

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STRESS MANAGEMENT

LOVE, PRAY, FORGIVE

REALIZE THAT MOST STRESS COMES FROM WITHIN, NOT WITHOUT.

TAKE TIME TO SMELL THE FLOWERS AND TASTE THE STRAWBERRIES.

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STRESS MANAGEMENT

QUESTIONS?

THANK YOU VERY MUCH FOR YOUR ATTENTIVENESS

STRESS TERMS

1. Stressor: factor causing stress.2. Acute stress: body’s response to

imminent danger.3. Chronic stress: caused by prolonged

physical or emotional stress, more than can be coped with.

Response to Stress

HARMFUL EFFECTS OF STRESS Psychosomatic disease: physical ailment that is

mentally induced. Psychoneuroimmunology: study of mind body

connection The following can be developed by stress:

• Hypertension• Stroke• Cardiovascular disease• Ulcers• Migraine headaches• Tension headaches• Addictions

• Cancer• Allergies• Asthma• Hay fever• Rheumatoid arthritis• Backache• Depression

© 2008 McGraw-Hill Higher Education. All rights reserved.

PERSONALITY TYPE

Type A Stressed, hurried,

angry, hostile, organized, on time.

Body produces an extra amount of stress hormones.

Take the positive qualities and reduce anger and hostility.

Type B Procrastinate, weight

gain, creative, laid back, no worries.

Take the good and reduce putting off responsibilities.

© 2008 McGraw-Hill Higher Education. All rights reserved.

Fight or FlightSTRESS

FORGIVENESS

“I shall allow no man to belittle my soul by making me hate him” Booker T. Washington

FORGIVENESS

What it is:

Moral: Goodwill: Paradoxical: Beyond duty:

Forgiveness is an internal process done primarily for you. It frees you from the control of the “offender”

Forgiveness need not require reconciliation

FORGIVENESS

What is not:

Forgetting/Denial:

Condoning: Excusing:

Condemning:

Seeking justice or compensation:

Forgiveness is the moment to moment experience of peace and understanding that occurs when an injured party’s suffering is reduced by the process of transforming a grievance they have held against an offending party” Luskin

FORGIVENESS

Distinctions:

Forgiveness: One person’s moral response to another’s injustice

Reconciliation: Two parties coming together in mutual respect

Interpersonal forgiveness: goal is reconciliation

Intrapersonal forgiveness: only within the individual, does not require interaction between two parties, goal is not reconciliation, even though it may happen

FORGIVENESS

Bearing a grudge and refusing to forgive = response brought by major stress episode = can cause chronic stress

Chronic anger, hurt, guilt, hostility can have a debilitating effect on us. Create avalanche of stress hormones.

FORGIVENESS

Forgiveness can:

BP HR immune system responseAlter insulin response anxiety and depression self-esteemBetter anger managementBuild stronger relationships Chronic pain Peace of mindRestore positive thoughts, feelings, and behaviors.

FORGIVENESS

FORGIVENESS

Understand Forgiveness and Decide to Forgive

Acknowledge Painful Emotions

Uncover Your Resistance

Change Your Perception

Mind Body Strategies

Pyramid Model Everett Worthington Jr.

Recall the Hurt

Empathize

Altruistic gift of forgiveness

Commit to forgive

Holding on to forgiveness

FORGIVENESS

Depression

WHAT IS DEPRESSION? Depression is an illness that affects

your thoughts, feelings, behavior and overall health.

You feel sad or down for long periods of time

It can even have physical affects on your body

WHAT IT IS LIKE TO BE DEPRESSED

“A depressed person can feel hopeless, helpless and worst of all alone” (Ayer, 1997)

People suffering from depression always feel they’ve done something wrong when things go bad

Many times people with depression become irritable and upset at small things

WHO GETS DEPRESSED Mental health professionals used to

believe that depression was an adult’s disorder.

In fact depression can affect anyone from infants to teens to adults.

SYMPTOMS OF DEPRESSION Hopelessness Increased irritability, anger, or hostility Low self esteem Withdrawal Loss of appetite or constant hunger Alcohol or drug abuse

Self injury Discussion or thoughts of suicide Feelings of guilt Inability to concentrate Difficulty with relationships

CAUSES OF DEPRESSION There is not one single cause of depression,

it is usually a combination of things. Stress is however the leading cause of

depression. Other things such as genetics, traumatic

events, low self esteem, stress and physical illness can contribute to depression.

DEPRESSION TREATMENTS The most common treatments for depression

are antidepressant prescriptions and therapy. The most known prescription antidepressants

are Paxil, Zoloft, and Prozac. There are however many different kinds of antidepressants.

The other most common type of treatment for depression is therapy. Different types of therapy include: psychotherapy, cognitive, interpersonal, family and behavioral therapy.

DEPRESSION STATISTICS 10-25 percent of women and 5-12 percent of men

will likely become depressed in their life One of eight women will develop depression but only

one in three women will seek care 15 percent of those with severe depression will

commit suicide

70 percent of antidepressant prescriptions are given with misdiagnosis

Major depression occurs most often in the mid to late 20’s

Depression occurs most frequently in women 25-44 years of age.

(Statistics, 2003)

CULTURAL STATISTICS Hispanic women have a 24 percent rate

of depression, the highest among all women

Caucasian women have a 22 percent rate of depression

African American women have a 16 percent depression rate with half of that being severe

DEPRESSION PREVENTION Try to find ways to avoid stressful

situations Don’t be too hard on yourself. Nobody is

perfect Try not to procrastinate Don’t worry about all the little things Communication is the key. Talk to

people about your problems Stay healthy with diet and exercise Get out and have fun every once in a

while When you get stressed out try things

like meditation, it can be very helpful

(statistics, 2003)

DEPRESSIONCenters for Disease Control reports: Antidepressants most-

described drugs in the United States

48% jump in prescriptions from 1995-2002

118 million prescriptions in 2005

25% of adults will have a major depressive episode

http://www.webmd.com/depression/depression-tv/default.htm

http://www.webmd.com/depression/slideshow-depression-myths

DEPRESSION

Types of Depression

Major depressive disorder Chronic Depression or Dysthymic

disorder Atypical Depression Psychotic Depression Seasonal Affective Disorder (SAD) Bipolar Disorder (Manic Depressive) Post-partum depression

1. persistently sad, anxious, or empty moods

2. loss of pleasure in usual activities (anhedonia)

3. feelings of helplessness, guilt, or worthlessness

4. crying, hopelessness, or persistent pessimism

5. fatigue or decreased energy

6. loss of memory, concentration, or decision-making capability

7. restlessness, irritability

DEPRESSION

8. sleep disturbances

9. change in appetite or weight

10. physical symptoms that defy diagnosis and do not respond to treatment (especially pain and gastrointestinal complaints)

11. thoughts of suicide or death, or suicide attempts

12. poor self-image or self-esteem (as illustrated, for example, by verbal self-reproach)

DEPRESSION

Common Causes of Depression

•Biology. •Genetics. •Gender. •Age. •Health conditions. •Trauma and grief. •Changes and stressful events. •Medications and substances. 

DEPRESSION

DEPRESSION

Triggers• Grief from deaths, divorce, separation • Interpersonal deficits leading to social

isolation or feelings of being deprived.• Major life changes• Alcohol or drug abuse• Physical, sexual, or emotional abuse• Medications• Family history• Major illnessesDepression may have no triggering event

DEPRESSION

Symptoms

1. Persistent sad, anxious, or “empty” mood

2. Sleep problems3. Changes in appetite4. Lack of interest or pleasure in usual

activities..5. Feelings of guilt, worthlessness,

insecurity6. Difficulty concentrating7. Lack of energy-fatigue8. Thoughts of suicide

DEPRESSION

Treatment

Prescription medications (anti-depressants)

Talk therapy (CBT, IPT, Psychodynamic Therapy

Electroconvulsive therapy’ Lifestyle changes

http://www.webmd.com/depression/depression-diet-stress-exercise-slideshow

DEPRESSION

Prescription Medications

1. Selective serotonin reuptake inhibitors (SSRIs) Prozac, Zoloft, Celexa, Paxil, Lexapro, Luvox2. Serotonin norepinephrine reuptake inhibitors –

Effexor, Cymbalta, Pristiq3. Tricyclic antidepressants – Elavil, 4. Monoamine oxidase (MAO)inhibitors

2. Common side effects Nausea Headaches Sexual dysfunction Sleep disturbances

SSRI

SSRI Mechanism of Action

DEPRESSION

1. Depression is a real illness, with real causes

2. Depression is not something you brought on yourself, and it does not reveal a personal weakness or an inability to cope.

3. There is a high rate of success for treatment of depressionhttp://www.webmd.com/depression/slideshow-depression-overvie

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