A summary of Wrexham Adult Social Care’s Workforce Development training presentation for Carers

Managing your stressManaging your stress

Aims of this presentation

To become more knowledgeable about the nature of stress, it’s management and prevention

To be able to apply this knowledge to recognises stress in yourself and develop strategies to manage and prevent

A definition of stress

Stress is when pressure exceeds a

person’s perceived ability to cope.

Costs of stress

In individuals, stress has been identified as potentially contributing to a range of illnesses and conditions such as high blood pressure, heart attacks/strokes, stomach ulcers, diabetes, angina, cancer, rheumatoid arthritis, psychological disorders

The 5 stages of stress S.Palmer and W. Dryden 1995

It is now acknowledged that there are 5 stages in the ‘stress response’

1. There is pressure, usually perceived by individual to be from outside

2. Person believes they cannot cope and so feels threatened

3. Psychophysiological changes occur in the body (the actual stress or ‘fight or flight’ response)

4. This stage depends on the consequences of the individual’s response above and how they judge themselves in this

5. Feedback, via the mind to the body – this depends on stage 4 above. Success restores equilibrium, failure increases pressure and prolongs stress

Stage 3 in more detail – the ‘Fight or Flight’ response – referred to as the BASIC ID

• Behavioural eg. avoiding, procrastinating• Affective - emotional feelings eg. anxiety• Sensory - butterflies, dry mouth• Imaginal – pictures in your head of what might

happen)• Cognitive -own perceptions/labelling of yourself• Interpersonal – actions with other people• Biological – physical symptoms eg skin,

bladder, bowels, blood – leads to repressed immune system

Some effects of stress on your body

Blood vessels constrict, except those to the heart, legs and arms, which need the oxygen and sugar transported by the blood in order to run away or fight (eg people go white with fear because the blood has drained from their face)

The muscles in the gut slow down because these are not essential for running away or fighting (eg people feel ‘butterflies’ in their stomach when frightened)

Mental activity in the brain is increased, so people are suddenly much more alert in order to work their way quickly out of danger

Blood suddenly has an increased ability to clot, so if injured (as they fear) they won’t bleed to death as quickly.

Blood also suddenly has increased levels of fats and sugar, to be transported to the muscles in the heart, arms and legs to provide energy for quick action.

Salivary glands are not important for fighting or fleeing, so there is a decreased flow of saliva (eg. people experience going dry-mouthed with fear)

The heart increases it’s rate and force of beat to get the blood round to the legs and arms faster (eg people experience their heart ‘thumping with fear’)

Hormones – the chemical messengers

There is a long list of hormones, each with their own specific effects on the body.

It is only relatively recently that the role of hormones in the stress response has begun to be understood. Some of this understanding has come through the measurement of levels of hormones in the bloodstream, particularly of people in certain situations.

Hormones with important implications for stress include adrenaline, noradrenaline and cortisol

Effects of Hormones

Some effects are:-

Adrenaline:- stimulates heart rate, dilates blood vessels and air passages

Noradrenaline:- increases supply of oxygen to brain improving attention and response, triggers release of sugar into bloodstream

Cortisol:- increases blood sugar levels, shuts down reproductive system, counteracts insulin

Emotions and corresponding levels of hormones appearing in the bloodstream

Anger Noradrenaline big increaseadrenaline small increasecortisol no change

Fear adrenaline big increasecortisol increasenoradrenaline small increase

Depression, cortisol big increase

Loss of adrenaline no change

control noradrenaline no change

Emotions and corresponding levels of hormones appearing in the bloodstream

Serenity, adrenaline decrease

Relaxation noradrenaline decrease

Elation,

Security, noradreanline decrease

Love adrenaline decrease

cortisol decrease

Pressure and Stress

Research shows that there is a physiological difference between pressure and stress

A person experiencing stress has higher levels of various hormones such as adrenaline, noradrenaline and cortisol in their bloodstream than a person who merely feels challenged.

It can be seen from the previous pages what some of the physiological effects of this will be. The stress response is crucial if the body needs to run away or fight, but if it merely has to stay put and take the pressure and this happens repeatedly, the cumulative effects can be negative and harmful.

Physical results of longer-term Stress

We noted earlier for instance, that one result of experiencing the ‘fight or flight’ or stress response is that the blood supply to and working of the muscles in the gut is slowed, because the workings of the gut are not important in these circumstances. If a person regularly and repeatedly feels anxious, angry or afraid, then this interference of the proper working of the gut happens regularly and repeatedly. Stomach ulcers, chronic constipation and Irritable Bowel Syndrome can result. These all in turn affect the proper digestion of food and uptake of nutrients, which will affect many other aspects of the body’s functions.

Fats released into the bloodstream to help muscles fight or flee will course around the system if not used because a person is having to sit and take something. Unused fats will then be deposited on artery walls, eventually risking high blood pressure and strokes.

Reduced immunity.Another result of on-gong stress which is linked to the effects of

hormones in complex ways and which is the subject of on-going research is the effect on the immune system. Lymphocytes or white blood cells in the bloodstream combat disease and measuring their levels is one indication of how healthy a person’s immune system is. Lowered immunity results in more frequent infections, ranging from cold sores (herpes virus) and colds to more serious such as flu, through to ME and cancer. Examples of research are:-

Partner caregivers of patients with dementia revealed decreased responses of blood lymphocytes; reduced cellular immune control over latent herpes viruses – not due to drugs, alcohol, sleep habits or nutrition. (Kiecolt et al 1991)

Spouses of women terminally ill with breast cancer – reduced lymphocyte responses one month after death – return to baseline during 4 to 14 month follow-up period (Schleifer et al, 1983)

Exercise

• Think back to a time you were stressed. How did you feel? What symptoms did you suffer? Did you enjoy the experience?

• Now think back to a time you felt challenged but not overwhelmed. How did you feel? What symptoms did you suffer? Did you enjoy the experience?

Changing thinking to conquer stress

Cary Cooper and Stephen Palmer amongst others propose that we can change how we respond to a pressure by managing how we think about it and thus managing whether it’s in fact merely a pressure, or actually a threat (resulting in the stress response). They advocate

• identifying stress-inducing thinking errors

• using problem –solving thinking skills

Exercise – your thoughts when stressed

Think back to a time you felt stressed

Bring the incident back to mind. What ideas or thoughts were going through your mind at the time?

Did these thoughts help or make things worse?

Stress-inducing Beliefs (SIB), or stress inducing thinking errors

Some beliefs we hold can be self-defeating and task-interfering and can then create or exacerbate stressful situations.

If a person holds on strongly to an SIB, then when an event occurs that does not live up to expectations, this increases the pressure they feel about it and stress may result

Examples of Stress Inducing Beliefs

Things should be going smoothly

I must not get bored

I should get on with my family

Things never work out well for me

If things go wrong, those that are responsible are ‘stupid’, ‘useless’, ‘idiots’

If things go badly I ‘can’t stand it’

Notice how extreme these statements are and how often the words ‘should’ and ‘must’ appear in them.

Helpful challenging questions to counteract a stress-inducing belief (SIB)

Where is the belief written?Is it realistic?Would my friends agree?Does everybody share my attitude? If not, why not?Am I expecting myself or others to be perfect instead of

fallible human beings?Will it seem this bad in 1, 2 or 6 months time?Am I exaggerating the importance of this problem?Am I agonising over how things should be instead of

dealing with them as they are?Am I taking things too personally?If I can’t stand it, will I really fall apart?

Changing your behaviour to conquer stress

• Social support – research shows how important it is for our mental health and strength to have a network of friends and family you can relax with, turn to, talk to, take breaks with. This can be wide or small as long as it feels right for you.

• Assertiveness –be assertive in your behaviour, as opposed to aggressive or passive. Know your rights and develop and practice a range of assertiveness skills

• Time management – you need to practice good management of your time in order to avoid running out and pressure building up. Some of this relates to practicing assertiveness above.

Improving your health to conquer stress – ways of taking this into your own hands to combat the

threats described earlier • Exercise - anything vigorous check with GP

- grade into manageable chunks - try to make it an enjoyable habit

• Nutrition - aim for a healthy, balanced diet - consider lifestyle changes (eg cutting out

snacks)- take obesity seriously

• Relaxation - various techniques including yoga, massage, meditation, imagery