Coping With StressCoping With Stress

Anthony R. Ellis, M.D.Anthony R. Ellis, M.D.

Ingham Regional Medical CenterIngham Regional Medical Center

G.E.M.S. UnitG.E.M.S. Unit

Why Worry About Stress?Why Worry About Stress?

• 2/3 of all physician office visits are for 2/3 of all physician office visits are for stress related illnessesstress related illnesses

• 65% of workers say stress has caused 65% of workers say stress has caused them health problemsthem health problems

• As many as 50% of caregivers for the As many as 50% of caregivers for the elderly develop symptoms due to stresselderly develop symptoms due to stress

• Chronic stress is not good for your brainChronic stress is not good for your brain

Spiritual Suicide?Spiritual Suicide?

• 20% have quit a job due to stress20% have quit a job due to stress

• Monday morning heart attack risk is Monday morning heart attack risk is 33% higher than other days of the week33% higher than other days of the week

• A third of people report insomnia related A third of people report insomnia related to job stressto job stress

• 40% report yelling, verbal abuse or 40% report yelling, verbal abuse or sexual harassment at worksexual harassment at work

What is Stress?What is Stress?

• A state of tension created when one A state of tension created when one responds to the demands and responds to the demands and pressures from external and internal pressures from external and internal sourcessources

• External – Work, child rearing, cultural External – Work, child rearing, cultural stressors, holidays, family issues, stressors, holidays, family issues, marital problems, age-related issuesmarital problems, age-related issues

• Internal – ideals, morals, Internal – ideals, morals, self self expectationsexpectations

More StressorsMore Stressors

• Balancing work with personal and family Balancing work with personal and family responsibilities in a workaholic cultureresponsibilities in a workaholic culture

• Spending time with clients or Spending time with clients or supervisors who have unrealistic supervisors who have unrealistic expectationsexpectations

• Basing your self-worth on success or Basing your self-worth on success or failure at work or on intangibles over failure at work or on intangibles over which you have little controlwhich you have little control

You may have more stress if :You may have more stress if :

• You tend to withdraw from or not ask for You tend to withdraw from or not ask for help?help?

• You have difficulty delegating to others?You have difficulty delegating to others?• You externalize instead of problem solve?You externalize instead of problem solve?• You overload yourself and have a difficult You overload yourself and have a difficult

time saying no to committees, new projects, time saying no to committees, new projects, etc.?etc.?

• You have asymmetrical work relationships in You have asymmetrical work relationships in which you give more than you get?which you give more than you get?

Effects of Excess StressEffects of Excess Stress

• Increased blood Increased blood pressurepressure

• GI complaintsGI complaints• HeadachesHeadaches• FatigueFatigue• IrritabilityIrritability• AnxietyAnxiety• Poor concentrationPoor concentration

• Substance abuseSubstance abuse• OvereatingOvereating• Low moraleLow morale• Poor performancePoor performance• DefensivenessDefensiveness• Job dissatisfactionJob dissatisfaction• Blaming othersBlaming others• InsomniaInsomnia

Mr. or Ms. RushedMr. or Ms. Rushed

• Working too many hours per weekWorking too many hours per week• Always running late, driving too fastAlways running late, driving too fast• Beeper and cell phone always going offBeeper and cell phone always going off• No breakfast, fast food lunch, late for dinner No breakfast, fast food lunch, late for dinner

again, “I’ll be late, I have a meeting”again, “I’ll be late, I have a meeting”• Forgetting important dates, missing family Forgetting important dates, missing family

events, neglecting self careevents, neglecting self care• Headache, insomnia, irritabilityHeadache, insomnia, irritability

Burnout Won’t Happen to Burnout Won’t Happen to Me…Me…• Individuals who work in service jobs are at Individuals who work in service jobs are at

high riskhigh risk due to the very reasons they chose due to the very reasons they chose service as a careerservice as a career

• Attention to detail, high standards, and a Attention to detail, high standards, and a willingness to place others needs before your willingness to place others needs before your own can contribute to burnoutown can contribute to burnout

• Idealistic, hardworking, self-motivated, Idealistic, hardworking, self-motivated, conscientious, committed, achievement-conscientious, committed, achievement-oriented people with a strong sense of oriented people with a strong sense of responsibility are also at higher riskresponsibility are also at higher risk

Burnout Signs and SymptomsBurnout Signs and Symptoms

• Work is Work is no funno fun anymore anymore• Work and home duties feel like a burdenWork and home duties feel like a burden• Excessive Excessive irritabilityirritability, rudeness to staff, clients, , rudeness to staff, clients,

colleagues and family, increasing money focuscolleagues and family, increasing money focus• Poor sleep, poor concentration, low energy, Poor sleep, poor concentration, low energy,

headaches, headaches, detachmentdetachment• Escapist behaviors, substance abuseEscapist behaviors, substance abuse• Poor self-care habits, Poor self-care habits, wanting to quitwanting to quit

Stages of BurnoutStages of Burnout

• The The honeymoonhoneymoon phase is characterized by phase is characterized by boundless energy and enthusiasm, as your boundless energy and enthusiasm, as your new job meets most of your needs and new job meets most of your needs and coworkers and the organization are wonderful.coworkers and the organization are wonderful.

• The The awakeningawakening starts when things aren’t starts when things aren’t working out the way you hoped, rewards and working out the way you hoped, rewards and recognition are scarce, the hours are too long, recognition are scarce, the hours are too long, something is wrong and you work harder but it something is wrong and you work harder but it doesn’t help.doesn’t help.

Stages of BurnoutStages of Burnout

• BrownoutBrownout leads to chronic fatigue, irritability, leads to chronic fatigue, irritability, and escapist behaviors as your productivity and escapist behaviors as your productivity drops, you become cynical, critical of others, drops, you become cynical, critical of others, and detached.and detached.

• Full scale burnoutFull scale burnout can occur as despair sets can occur as despair sets in and you sense the solution is not within in and you sense the solution is not within your control. You become emotionally and your control. You become emotionally and physically exhausted and dream of “just physically exhausted and dream of “just quitting and getting away”.quitting and getting away”.

Consequences of BurnoutConsequences of Burnout

• Emotional exhaustion - feeling drained, not Emotional exhaustion - feeling drained, not having anything to give before the day having anything to give before the day beginsbegins

• Depersonalization - feeling disconnected, Depersonalization - feeling disconnected, resentful and negativeresentful and negative

• Feeling ineffective - as if results achieved Feeling ineffective - as if results achieved are not meaningfulare not meaningful

• Professional and family breakdown - Professional and family breakdown - making errors at work, increased risk of making errors at work, increased risk of divorcedivorce

• Thoughts of quitting, early retirementThoughts of quitting, early retirement

If You Are in DangerIf You Are in Danger

• Re-evaluate your goals and prioritizeRe-evaluate your goals and prioritize• Evaluate the demands placed on youEvaluate the demands placed on you• Reduce excessive commitmentsReduce excessive commitments• Learn stress management skillsLearn stress management skills• Access all supports that are availableAccess all supports that are available• Go back to following a healthy lifestyleGo back to following a healthy lifestyle• Acknowledge the problem and seek helpAcknowledge the problem and seek help

If You Are ToastIf You Are Toast

• First, take some serious time offFirst, take some serious time off

• Seek professional help if depressedSeek professional help if depressed

• Adjust the balance, review your life Adjust the balance, review your life goalsgoals

• As a last resort, look to resources for As a last resort, look to resources for retraining and retooling for a different retraining and retooling for a different jobjob

Protection From BurnoutProtection From Burnout

• Strong sense of self esteem and purposeStrong sense of self esteem and purpose• Good social support systemGood social support system• Use humor as a coping skillUse humor as a coping skill• Take good care of yourselfTake good care of yourself• Know when to say noKnow when to say no• Don’t take yourself or life too seriouslyDon’t take yourself or life too seriously• Develop a broad group of activities and Develop a broad group of activities and

interests outside of workinterests outside of work

Three Major Coping Three Major Coping StrategiesStrategies• Diversional activitiesDiversional activities – television, reading, – television, reading,

hobbies, exercise, music, vacations, napping, hobbies, exercise, music, vacations, napping, soothing bath, shopping (none to excess)soothing bath, shopping (none to excess)

• Relaxation techniquesRelaxation techniques – progressive relaxation, – progressive relaxation, biofeedback, creative visualization, yogabiofeedback, creative visualization, yoga

• Behavior changesBehavior changes – improving communication – improving communication skills, expressing feelings, developing skills, expressing feelings, developing assertiveness skills, managing time and money assertiveness skills, managing time and money more effectively, reducing external pressuresmore effectively, reducing external pressures

Maladaptive CopingMaladaptive Coping

• Substance abuse, using medication not Substance abuse, using medication not prescribed for you, increased smokingprescribed for you, increased smoking

• Reckless behavior, impulsive decisionsReckless behavior, impulsive decisions• Having affairs, crossing boundaries with Having affairs, crossing boundaries with

customers and coworkerscustomers and coworkers• Overeating or eating unhealthy foods Overeating or eating unhealthy foods

frequentlyfrequently• Neglecting important obligations, Neglecting important obligations,

procrastinatingprocrastinating

Adaptive CopingAdaptive Coping

• Ask for help directly and be receptiveAsk for help directly and be receptive• Rid yourself of unimportant obligationsRid yourself of unimportant obligations• Put a self-care routine into place and Put a self-care routine into place and

stick to it (as if you had a chronic stress stick to it (as if you had a chronic stress induced disease that could kill you)induced disease that could kill you)

• Keep your relationships reciprocalKeep your relationships reciprocal• Take time for yourself and set prioritiesTake time for yourself and set priorities• Stay in touch with your goals for your lifeStay in touch with your goals for your life

Top Ten List For Reducing StressTop Ten List For Reducing Stress

1. Balance life and work effectively1. Balance life and work effectively

2. Develop a personal/spiritual frame of 2. Develop a personal/spiritual frame of reference to guide your decisionsreference to guide your decisions

3. Say no when you need to, don’t 3. Say no when you need to, don’t overextend yourselfoverextend yourself

4. Exercise regularly and eat healthy foods4. Exercise regularly and eat healthy foods

5. Prioritize your goals and pace yourself5. Prioritize your goals and pace yourself

Top Ten List For Reducing StressTop Ten List For Reducing Stress

6. Put some fun in your life everyday6. Put some fun in your life everyday

7. Don’t procrastinate7. Don’t procrastinate

8. Develop a healthy support system8. Develop a healthy support system

9. Remember perfection and control are 9. Remember perfection and control are illusory and fleeting, embrace changeillusory and fleeting, embrace change

10. Use a relaxation technique regularly10. Use a relaxation technique regularly