StressStress

““…….stress is the nonspecific response of the .stress is the nonspecific response of the body to any demand, whether it is caused body to any demand, whether it is caused by, or results in pleasant or unpleasant by, or results in pleasant or unpleasant

conditions.”conditions.”

Hans Selye, MDHans Selye, MD

StressStress“…“…a a sociopsychophysiologicalsociopsychophysiological phenomenon. It is phenomenon. It is

a composite of intellectual, behavioral, a composite of intellectual, behavioral, metabolic, immune, and other physiological metabolic, immune, and other physiological

responses to a stressor (or stressors) of responses to a stressor (or stressors) of endogenous or exogenous origins. The stressors endogenous or exogenous origins. The stressors may involve thoughts and feelings or may be a may involve thoughts and feelings or may be a

perceived threat or some other condition such as perceived threat or some other condition such as cold. The response generally serves a protective, cold. The response generally serves a protective,

adaptive function.adaptive function.

Lindsay, Carrieri-Kohlman, PageLindsay, Carrieri-Kohlman, Page

StressStress

““……a reaction in your mind and body to an event a reaction in your mind and body to an event in the outside world that alarms or arouses you.”in the outside world that alarms or arouses you.”

EMS Stress: An Emergency EMS Stress: An Emergency Responder’s Handbook for Living WellResponder’s Handbook for Living Well

Sources of StressSources of StressThe GoodThe GoodGet married

Have children

Buy a new home

Go on vacation

New Job

Promotion

The BadThe BadBreak a leg

Spouse loses job

Kidlet in trouble

Lose wallet

In-laws coming

The UglyThe UglyNasty car accident

Bankruptcy

Divorce

Loved one dying

Types of StressorsTypes of Stressors

EmotionalEnvironm

ental

Injury

PhysicalIllness

Career Pressures

Mind Body IntegrationMind Body Integration

Mind

Body

MindBody

Mind

Body

Mind BodyBody

Mind

Chocolate

Mind

Why Stress Management?Why Stress Management?

Stress Related Disorders & Chemical Stress Related Disorders & Chemical DependencyDependency

• Cost U.S. Employers Billions $$$$$Cost U.S. Employers Billions $$$$$– lost productivitylost productivity– increased health care expensesincreased health care expenses– increased absenteeismincreased absenteeism– increased accidentsincreased accidents

98.6

pH 7.4

Oxygen 99%

98.6

pH 7.4

Oxygen 99%

The Stress Response is the The Stress Response is the Body’s Body’s 911911 System System

Autonomic Nervous SystemAutonomic Nervous System• SympatheticSympathetic

– Increased HR, BP, RRIncreased HR, BP, RR– Muscles tenseMuscles tense– Brain becomes more Brain becomes more

alertalert– Liver increases blood Liver increases blood

glucose levelglucose level– Digestion inhibitedDigestion inhibited– Pupils dilate Pupils dilate

• ParasympatheticParasympathetic– Normalizes HR, BP, RRNormalizes HR, BP, RR– Muscles relaxMuscles relax– Energy storageEnergy storage– Promotes growthPromotes growth– Mediates calmMediates calm– Pupils constrictPupils constrict

CUMULATIVE STRESSCUMULATIVE STRESS

““Any idiot can face a crisis…….Any idiot can face a crisis…….

Its the day to day living that wears you out.”Its the day to day living that wears you out.” Anton CherkhovAnton Cherkhov

How Can the Stress Response How Can the Stress Response Make Us Sick?Make Us Sick?

• Chronically elevated BPChronically elevated BP– atherosclerosisatherosclerosis– myocardial ischemiamyocardial ischemia

• Constantly using stored energyConstantly using stored energy– tire more easilytire more easily

• Blocked insulin secretionBlocked insulin secretion– higher risk of diabeteshigher risk of diabetes

Why Stress Management?Why Stress Management?Researchers indicate 2/3 of medical visits are for Researchers indicate 2/3 of medical visits are for

stress related illnessesstress related illnesses• Stress response contributes to:Stress response contributes to:

– coronary artery diseasecoronary artery disease– cancercancer– respiratory disordersrespiratory disorders– unintentional injuriesunintentional injuries– cirrhosiscirrhosis– suicidesuicide

Physiologic Signs of StressPhysiologic Signs of Stress

• Immediate ChangesImmediate Changes– Increased cardiac outputIncreased cardiac output– Increased circulationIncreased circulation– Increased BP, RRIncreased BP, RR– Increased sweatingIncreased sweating– PiloerectionPiloerection– Pupil dilatationPupil dilatation– Decreased salivationDecreased salivation

– Decreased gastric motilityDecreased gastric motility– HyperalertnessHyperalertness– Increased blood sugarIncreased blood sugar– Use of blood glucose Use of blood glucose – Decreased stored energyDecreased stored energy– Increased fatty acidsIncreased fatty acids– Increased metabolismIncreased metabolism

Physiologic Sign of StressPhysiologic Sign of Stress

• Long Term EffectsLong Term Effects– Increased breakdown of Increased breakdown of

proteinprotein– Increased blood glucoseIncreased blood glucose– Increased vascular Increased vascular

constrictionconstriction– Decreased inflammatory Decreased inflammatory

responseresponse

– Decreased immune Decreased immune responseresponse

– Increased fluid volumeIncreased fluid volume– Increased sodium & fluid Increased sodium & fluid

retention in kidneysretention in kidneys

Emotional Signs of StressEmotional Signs of Stress• DenialDenial• FearFear• DepressionDepression• GriefGrief• AngerAnger• WorryWorry• UncertaintyUncertainty

• HopelessnessHopelessness• HelplessnessHelplessness• Feeling lost Feeling lost • Wishing to hideWishing to hide• AnxietyAnxiety• PanicPanic• Inappropriate EmotionsInappropriate Emotions

Cognitive Signs & SymptomsCognitive Signs & Symptoms• Difficulty Making DecisionsDifficulty Making Decisions• ConfusionConfusion• Difficulty Naming Familiar ItemsDifficulty Naming Familiar Items• Poor ConcentrationPoor Concentration• Blaming OthersBlaming Others• Memory ProblemsMemory Problems• Replaying Events Over & OverReplaying Events Over & Over

Behavioral Signs of StressBehavioral Signs of Stress• WithdrawalWithdrawal• SuspiciousnessSuspiciousness• Excessive Humor or SilenceExcessive Humor or Silence• Increased Smoking, Alcohol or FoodIncreased Smoking, Alcohol or Food• Change in Activity LevelChange in Activity Level• Angry OutburstsAngry Outbursts• Crying SpellsCrying Spells

Negative Self-TalkNegative Self-Talk• The Worrier VoiceThe Worrier Voice - “What if…..?” - “What if…..?”

– Make a plan then get it out of your head.Make a plan then get it out of your head.

• The Critic VoiceThe Critic Voice - “How stupid…..” - “How stupid…..”– Recognize what is really true.Recognize what is really true.

• The Victim VoiceThe Victim Voice - “I’ll never be able to…..” - “I’ll never be able to…..”– There is always something to do to work toward a There is always something to do to work toward a

goal.goal.

• The PerfectionistThe Perfectionist - “I should……” - “I should……”– Assess your unrealistic expectations of yourselfAssess your unrealistic expectations of yourself..

Feeling “on edge”Feeling “on edge”

Vague sense of future doomVague sense of future doom

Fear losing controlFear losing control

Racing thoughtsRacing thoughts

Detached from selfDetached from self

Decreased ability to learnDecreased ability to learn

Physical Symptoms of AnxietyPhysical Symptoms of Anxiety

• Increased Muscle TensionIncreased Muscle Tension• DizzinessDizziness• Rapid HeartbeatRapid Heartbeat• Shortness of BreathShortness of Breath• Queasy StomachQueasy Stomach• Dry MouthDry Mouth• Increased PerspirationIncreased Perspiration• Problems with SleepProblems with Sleep

Coping Skills to Manage Coping Skills to Manage AnxietyAnxiety

• Relaxation TechniquesRelaxation Techniques• ExerciseExercise• Examine Self TalkExamine Self Talk• Develop Action PlanDevelop Action Plan• Avoid Stimulants Avoid Stimulants

– caffeine, nicotine, sugarcaffeine, nicotine, sugar

• CounselingCounseling• Drug TherapyDrug Therapy

AngerAngerPhysical SymptomsPhysical Symptoms

• Increased HR, BPIncreased HR, BP• Increased Muscle Tension & Increased Muscle Tension &

SweatingSweating• RestlessnessRestlessness• Emotional SymptomsEmotional Symptoms• Shattered Beliefs in a Just WorldShattered Beliefs in a Just World• WrongedWronged• Ready to FightReady to Fight• DefensiveDefensive

““When angry, count four, when very When angry, count four, when very angry, swear.”angry, swear.”

-Mark Twain-Mark Twain

Anger ManagementAnger Management• Anger IntensifyingAnger Intensifying

– YellingYelling– SulkingSulking– PoutingPouting– HittingHitting– Other ViolenceOther Violence– Competitive GamesCompetitive Games– AccusationsAccusations– ArguingArguing

• Cooling Off HabitsCooling Off Habits– Abdominal BreathingAbdominal Breathing– Count to TenCount to Ten– Non-Competitive Non-Competitive

ExerciseExercise– DistractionDistraction– HumorHumor– Empathy for Other Empathy for Other

PersonPerson

Workaholic BehaviorsWorkaholic Behaviors

A person whose desire to work long and A person whose desire to work long and hard is intrinsic, and whose work hard is intrinsic, and whose work habits always exceed the job habits always exceed the job description and expectation of others.description and expectation of others.

Personality Traits of a Personality Traits of a WorkacholicWorkacholic

• Detail orientedDetail oriented• PerfectionisticPerfectionistic• High personal High personal

standardsstandards• Action orientedAction oriented

• Easily boredEasily bored• Highly dedicatedHighly dedicated• Task orientedTask oriented

Workaholic BehaviorsWorkaholic Behaviors• ImpairedImpaired

– No pleasure in No pleasure in leisureleisure

– Distressed when not Distressed when not workingworking

– Isolated lifestyleIsolated lifestyle– Family in distressFamily in distress

• ContentedContented– Family accepts work Family accepts work

habitshabits– Autonomy & variety in Autonomy & variety in

workplaceworkplace– Good match between Good match between

personality & job skillspersonality & job skills– Good healthGood health

Suggested BehaviorsSuggested Behaviors• Don’t ruminate over problemsDon’t ruminate over problems• Respond to signs of fatigueRespond to signs of fatigue• Don’t self medicate Don’t self medicate

• ie. alcohol/drug abuseie. alcohol/drug abuse

• Take scheduled time offTake scheduled time off• Stabilize domestic situationsStabilize domestic situations• Develop/maintain friendshipsDevelop/maintain friendships• Engage in regular exerciseEngage in regular exercise• Foster sense of humorFoster sense of humor

DepressionDepression

• MildMild• ModerateModerate• Severe Severe

– Always requires professional help.Always requires professional help.

Garbage In = Garbage OutGarbage In = Garbage Out

Told you so...Told you so...

Heart DiseaseHeart Disease HypertensionHypertension

Arthritis Arthritis HeadacheHeadache

StrokeStroke Irritable Irritable BowelBowel

CancerCancer DiabetesDiabetes

CumulativeCumulativeStressStress Ugly Ugly

Health Health HabitsHabits

Healthy HabitsHealthy Habits• NutritionNutrition• Attention to SymptomsAttention to Symptoms• ExerciseExercise• SleepSleep• RecreationRecreation• StretchingStretching• Social SupportSocial Support• HumorHumor

Balance is the Key

Physiology of Circadian RhythmsPhysiology of Circadian Rhythms

Stages of SleepStages of Sleep

REM SleepREM Sleep

Shift WorkShift Work

Increase Quality of SleepIncrease Quality of Sleep• DoDo

– Exercise (early in day)Exercise (early in day)– Avoid CaffeineAvoid Caffeine– Avoid AlcoholAvoid Alcohol– Don’t Self Medicate for SleepDon’t Self Medicate for Sleep

(some sedatives interfere with deep sleep)(some sedatives interfere with deep sleep)

– Relaxation Techniques Before SleepRelaxation Techniques Before Sleep– Warm BathWarm Bath– Avoid Rich Foods Before SleepAvoid Rich Foods Before Sleep

““A person without a sense of humor A person without a sense of humor is like a wagon without springs --- is like a wagon without springs --- jolted by every pebble in the road.”jolted by every pebble in the road.”

-Henry Ward Beecher, American clergyman-Henry Ward Beecher, American clergyman

• Causes Deep Abdominal Causes Deep Abdominal BreathingBreathing

• Increases CirculationIncreases Circulation• Releases Endorphins & Releases Endorphins &

EnkyinsEnkyins• Relieves TensionRelieves Tension• Puts Life into PerspectivePuts Life into Perspective

““Laughter and tears are both responses Laughter and tears are both responses to frustration and exhaustion . . .I to frustration and exhaustion . . .I myself prefer to laugh, since there is myself prefer to laugh, since there is less cleaning up to do afterward.”less cleaning up to do afterward.”

-Kurt Vonnegut-Kurt Vonnegut

BANGHEADHERE

ANTI- STRESS THERAPYANTI- STRESS THERAPY

REPEAT UNTIL STRESS IS GONE OR YOU ARE UNCONSCIOUS

Relaxation TechniquesRelaxation Techniques Abdominal BreathingAbdominal Breathing Active Progressive Muscle RelaxationActive Progressive Muscle Relaxation VisualizationVisualization Self-HypnosisSelf-Hypnosis MeditationMeditation MusicMusic StretchingStretching ExerciseExercise