STRESS MANAGEMENT

Waris Qidwai Professor and Chairman

Department of Family MedicineThe Aga Khan University

Karachi - Pakistan

Rabindranath Tagore

Man's abiding happiness is not in getting anythingbut in giving himself up to what is greater than himself,to ideas which are larger than his individual life,the idea of his country, of humanity, of God

History

Walter Bradford Cannon Hans Selye

•Walter Cannon and Hans Selye used animal studies to establish the earliest scientific basis for the study of stress.

•They measured the physiological responses of animals to external pressures, such as heat and cold, prolonged restraint, and surgical procedures, then extrapolated from these studies to human beings.

History

Stress is the spice of life

Hans Selye (1907-1982)

DEFINITION OF STRESS

• An external demand made upon the adaptive capacities of the mind and body.

• If these capacities handle the demand and enjoy the stimulation involved, then stress is welcome and helpful. • If the capacities cannot handle the demand, then stress is unwelcome and unhelpful.

DEFINITION OF STRESS

• Stress results when “pressure exceeds one's perceived ability to cope”

• This concept about stress forms the basis for it being “Controllable”

DEFINITION OF STRESS

• Stress does not necessarily follow the presence of a potential stressor

• It is ultimately a person's thought processes that determine the response to potentially stressful external

STRESS AS A STIMULUS

Too many positive or negative changes (such as marriage and divorce) occurring in a very short period, can tax the adaptive capacity of the individual and lead to increased susceptibility to mental and physical illness

STRESS AS A RESPONSE

• Stress results in a certain pattern of physiological changes such as gastrointestinal, glandular and cardiovascular disorders.

• Moreover, it affects the entire body, not just a single part.

• There are large differences in response within and between individuals.

Quotation

Adopting the right attitude can convert a negative STRESS into a positive one

Hans Selye

THREE STAGES OF ADAPTASION IN STRESS

1. Alarm reaction: When a person is exposed to an unadapted stimulus there is an initial shock (in which resistance is lowered) followed by a rebound reaction (counter shock phase) during which the organism’s defence mechanisms become active.

2. Stage of resistance: During this stage the person’s full adaptation may lead to successful return to equilibrium.

3. Stage of exhaustion: In case of failure of adaptability the organism becomes exhausted.

HUMAN FUNCTION CURVE

Intended Performance

Exhaustion

III Health

P

Fatigue

Actual Performance

BreakdownHealthy Tension

PERFORMANCE

AROUSALP = The point at which minimum arousal may bring on a breakdown

STRESSORS

• Environmental

• Work related

• Interpersonal

• Life events

Quotation

The human body has been designed to resist an infinite number of changes and attacks brought about by its environment. The secret of good health lies in successful adjustment to changing Stresses on the body

Harry J. Johnson 

PHYSICAL SYMPTOMS AND SIGNS

• Back Pain• Constipation• Diarrhoea• Dizziness• Dry Mouth• Excess Perspiration• Excessive Hunger• Exhaustion• Headaches

• Heart Burn• Insomnia• Muscle Spasms• Nausea• No Appetite• Pounding Heart• Shortness of Breath• Skin Rashes• Upset Stomach

PSYCHOLOGICAL SYMPTOMSAND SIGNS

• Anger• Anxiety• Apathy• Boredom• Depression• Fatigue• Fear of Death• Frustration

• Guilt• Hopelessness• Hostility• Impatience• Inability to

Concentrate• Irritability• Rejection• Restlessness

BEHAVIOURAL SYMPTOMSAND SIGNS

• Biting Lips• Foot Tapping• Grinding Teeth• Impulsive Actions• Moving in Tense,

Jerky ways• Nervous Tics

• Overreacting• Stuttering• Swearing• Touching Hair, Ears,

or Nose• Trembling Hands

STRESS AND HEALTH

Accidents:

• Accidents at home, on the roads, and at work are more likely to occur when individuals are under stress.• People are more easily distracted when abnormally anxious.

INFECTIONS AND IMMUNESYSTEM

• Stress impairs the workings of the immune system, which may lead to greater susceptibility from

infections.

• Stress is significantly associated with subsequent infections, in

particular those of the respiratory tract.

HIGH BLOOD PRESSURE & STROKES

It was demonstrated that the incidence of raised blood pressure and strokes was three to four times greater in the Air Traffic Controllers than in comparable workers in other occupations

HEART DISEASE

• In the 1960s Friedman and Rosenman, found that heart disease patients

under study behaved similarly-- they were aggressive, striving for achievement.

• These individuals were described as type A personalities, as opposed to more relaxed type B personalities.

CANCERS

Those who respond to stress by smoking or drinking more heavily will increase their risk of developing cancers of the esophagus, larynx, and lung.

It is also possible that some cancers might be produced as a result of an immune response within the body.

WHAT IS BURNOUT ?

Three stages of burnout are recognised:1. Job stress -- working excessive hours,

foregoing holidays, a tendency towards hurried and skipped meals and giving little time to the family.

2. Mental or emotional exhaustion -- tiredness, lethargy, hypochondria, irritability, anxiety, depression, insomnia or possibly uncontrolled alcohol consumption.

3. Inability to feel sympathy for others. This is accompanied by a deterioration in communication skills and tardiness.

A model of occupational psychosocial stress

Intrinsic Stress

Work Overload

Role in the Organisation

Organisational structure & climate

& Security

Home/work interface

Demographic factors

SelfStress coping ability

Job dissatisfaction

Excessive drinking

Excessive smoking

Drug use

Anxiety

Depression

Coronary heart disease

Marital disharmony

Source of stress The Individual Outcomes

PROFESSION Sources of Stress

Intrinsic Stress:

We experience stress almost everyday as an

intrinsic part of our profession and this is

unavoidable.

• Dealing with unsatisfied clients

• Problem clients

• Uncertainty

• Interpersonal : Issues with colleagues and peers

WORK OVERLOAD AND TIME PRESSURE

• Both qualitative (too difficult) and quantitative (too much to do).

• Not having personal free time and carrying a heavy workload

• Time factors are a major source of dissatisfaction

Role in the Organization

• Clarity in the role/job description

• Career progression

• Responsibility Vs Authority

• Vision and Mission

• Ownership

ORGANIZATIONAL STRUCTURE AND CLIMATE

Source of stress for the employee arises from the organizational structure and climate:

>Participation in the decision making process

>Effective communication

>Restrictions in behavior

EMPLOYEES AND THEIR FAMILIES

• Although stress is predominantly work-related, sufferers get caught in a vicious circle of neglecting the family life.

• Excessive involvement of husbands and wives in demanding occupational roles, can have an adverse effect on the family

EMPLOYEE and SPOUSE

• Professional spouse are more likely to suffer from Psychiatric problems and suicides

• When there is a marital problem, denial may take the form of :

(a) withdrawal into longer hours at the office, or

(b) passive and condescending tolerance of her angry outbursts

WOMEN PROFESSIONALS

• Despite working full-time, women are often expected to meet domestic commitments.

• Married women are either divorcing, limiting their family size, or coping with both worlds at the expense of their physical and psychological health.

• The ratio of divorces for female doctors compared with male doctors is 3 to 2.

• More female doctors are single than male doctors. The percentage for female doctors is 31% and for male doctors 8% (UK study)

PERSONALITY

• High achievers are described as competitors and achievement oriented.

• This trait may increase in intensity as one climbs the career ladder.

• Takes pride in over-production and often has a pathologically overdeveloped ability to postpone pleasure.

PERSONALITY

• Feelings of doubt, guilt feelings, and an exaggerated sense of responsibility.

• Excessive conscientiousness is a character trait that is socially valuable but personally expensive

Measuring stress

Holmes and Rahe stress scale

• In 1967, psychiatrists Thomas Holmes and Richard Rahe developed the

scale, based on data of 5000 patients• A list of 41 stressful life events that

can contribute to illness was developed and scaled

Measuring stress

Holmes and Rahe stress scale

• Rahe carried out a study in 1970 testing the reliability of the stress scale as a predictor of illness.

• The scale was given to 2,500 US sailors and they were asked to rate scores of 'life events' over the previous six months. Over the next six months, detailed records were kept of the sailors' health.

• There was a positive correlation between stress scale scores and illness.

Measuring stress

Holmes and Rahe stress scale

Life event   Life change units  

Death of a spouse 100

Divorce 73

Marital separation 65

Imprisonment 63

Death of a close family member 63

Measuring stress

Holmes and Rahe stress scale

Life event   Life change units  

Change in number of family reunions 15

Change in eating habits 15

Vacation 13

Christmas 12

Minor violation of law 11

Measuring stress

Holmes and Rahe stress scale

Score of 300+: At risk of illness

Score of 150-299: Risk of illness is moderate (reduced by 30% from the

above risk)

Score 150 or less: Only have a slight risk of illness

A STRESS DIARY

• It is important to be able to identify precisely those individual or series of related events that may be causing stress or tension.

• One way of doing this is to maintain a stress diary for a few weeks, noting all activities and using a simple code to indicate the strain involved

• An awareness of this should help the to develop an action plan to minimize or eliminate the stressors

TIME MANAGEMENT

• Identify key areas where you need to spend most of your time.

• Work out an acceptable balance of work and relaxation.

• Try to have sometime from each day that is for you.

• Plan your time, prioritize your tasks and try to build some flexibility.

• Set yourself realistic achievable goals

SIMPLE STRESS MANAGEMENT ADVICE

To avoid stress:1. Accept it is normal to be an imperfect person in

an imperfect world

2. Problems are analysed logically and plans made to resolve them

3. Work out those situations and people which cause you stress and why?

4. Change those things that actually can be changed

5. Identify and respect your own good points

6. Improve your shortcomings as much as possible and then accept them as part of you

SIMPLE STRESS MANAGEMENT ADVICE Cont’d

7. Don’t compare yourself with others

8. Set realistic goals -- tackle big problems one step at a time, expect to make mistakes, apologise and then learn from them

9. One may delegate tasks but one cannot delegate responsibility

10. Look at ways to delegate jobs that are urgent but not important.

11. Avoid interruptions, if possible.

12. Assertiveness training is particularly helpful for people who have difficulty in saying ‘no’

PHYSICAL ACTIVITY

Physical activity is a way of responding to stress. and allows the discharge of the energy the body is anticipating.

Physical activity can be taken in many ways, including activities such as walking, jogging, dancing, or sport.

MEDITATION/SIMPLE RELAXATION

Frequent and regular meditation, even if only for a few minutes a day, does four things that are helpful in a stress-reducing programme:

1. It trains the attention.

2. It increases control over thought processes.

3. It increases the ability to handle emotions.

4. It aids physical relaxation.

OTHER FORMS OF RELAXATION

Other forms of relaxation are similar to meditation in that they lead to the same results through somewhat different means.

Because muscles can be more easily trained to respond to conscious control the technique of progressive muscular relaxation can often be used.

Hypnosis is a very effective medium for relaxation and is widely practiced by the medical profession all over the world.

SERVICE AT CORPORATE FIELD SITES

1. ENI, Pakistan2. OMV, Pakistan3. HUBCO4. British Petroleum, Pakistan5. BHP6. Tethyan Copper Company7. UCH Power Plant8. ROUCH Power Plant9. KAPCO Power Plant

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FIRST OCCUPATIONAL HEALTH CONFERENCEAPRIL 21, 2011

Tenderness and kindness are not signs of weakness and despair but are manifestations of strength and resolution

Khalil Gibran

THANK YOU VERY MUCH