Transcript 18 - Stress and Health

Class 1, Atatürk University Medical Faculty
Assist. Prof. Dr. Memet IŞIK
[email protected]
http://aile.atauni.edu.tr/profil=doc.-dr.-memet-isik
Objectives
 Explore the biological, psychological, and social
aspects of the human stress response.
 Describe the difference between adaptive and
maladaptive coping strategies.
 Understand coping strategies that increase
resilience to promote productive living and
healthy aging.
Overview of Terminology
 Stress: A state of disharmony or a threat to
homeostasis
 Physiological changes increase alertness, focus,
and energy
 Perceived demands may exceed the perceived
resources
 Coping: The ability to maintain control, think
rationally, and solve problem
 Resilience: Resistant quality that permits a person
to recover quickly and thrive in spite of adversity
Stress Facts
 The
American Academy of Family
Physicians estimates that 60% of the
problems brought to physicians in the U.S.
are stress related. Many are the result of
stress; others are made worse or last longer
because of it.
Common Stress Associated Diseases
 Diminished Immunity
 Anxiety
 Headache
 Depression
 Fatigue
 Alcoholism
 Weight gain
 Substance abuse
 Dyslipidemia
 Insomnia
 Hypertension
 Irritable bowel
 Heart Disease
syndrome
 Fibromyalgia
 Decreased sex drive
 Psoriasis/Eczema
 Digestive problems
How Stress Promotes Illness
 Direct effect
 Raises blood pressure
 Impairs immune system
 Indirect effect
 Less positive behaviors
(exercise, healthy diet, lack of sleep)
 More negative behaviors
(drinking, smoking, unhealthy diet)
The Stress Target Zone
RUST
OUT
BURN
OUT
(Boredom)
(Distress)
EUSTRESS
(The optimal amount of stress)
Stress
 Eustress
 Manageable Stress can lead to growth and enhanced
competence
Creativity, problem solving, change,
satisfaction
 Distress
 Uncontrollable, prolonged, or overwhelming stress is
destructive
Fatigue, frustration, dissatisfaction
 Acute Stress
 Immediate response to a threat or challenge
 Chronic Stress
 Ongoing exposure to stress, may seem unrelenting
Over-stimulation, ineffective problem solving, exhaustion,
illness, low self-esteem
Causes of Stress
 External causes
 Family, work, economics, school, major
life changes, unforeseen events, etc.
 Internal causes
 Worry, uncertainty, fear, attitudes,
unrealistic expectations, etc.
Causes of Stress
 Environmental
 Heat, noise, crowding
 Physiological
 Drugs, caffeine, tobacco
 Emotional
(psycho-social)
 Pressures, life
Characteristics of Stressful Events
 Negative
 Harder to accept than
 positive
 Uncontrollable
 Take control of what you
 can
 Ambiguous
 Accompanies poorly defined
 expectations
Contemporary Views of the Nature of Stress
The Process of Stress
Appraisal
Stressor
Coping
Stress
Outcome
Appraisal of Stressors
High Stress
See stressor
as a threat
Stressor
Appraisal
Stress
See stressor
as a challenge
Low Stress
Sources of Clinical Stress
For patients
For doctors
 Uncertainty
 Poor patient outcomes
 Fear
 Risk of making an error
 Pain
 Unfamiliar situations
 Cost
 Excessive workload
 Lack of knowledge
 Inadequate resources
 Risk for harm
 Unknown resources
Stages of the Stress Response
General Adaptation Syndrome of Hans Selye (1907-1982)
 Alarm—when one feels threatened
 Activation of the fight or flight reaction
 Resistance—mobilization of resources to solve
the problem
 Continued stress causes adaptation
 Exhaustion
 Adaptation fails and level of function
decreases
ALARM: Activation of Hypothalamic
Pituitary Adrenal Axis
Catecholamines
Cortical Steroids
Increases cardiac output
Dilates airways
Dilates pupils
Mobilizes glucose
Causes vasomotor
changes
 Decreases digestion
 Enhances coagulation
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Elevates glucose
Increases amino acids
Increases NA resorption
Increases extracellular fluid
volume
 Inhibits histamine and
bradykinin
 Suppresses the immune
response
Resistance
 Adaptation occurs
 Activation of the hypothalamic pituitary
adrenal axis continues
 The stressor may be resolved
 The body returns to homeostasis
 May progress to exhaustion
 Stress continues as resources are depleted
Exhaustion
 Occurs when the demands of the stress
exceeds the person's ability to adapt.
 Functioning declines
 May result in health problems
 Physical symptoms
 Mental symptoms
Signs and Symptoms of Stress
 Cognitive
 Decreased concentration, comprehension, and
memory
 Behavioral
 Irritability, withdrawal, violence
 Emotional
 Fear, anxiety, depression, fatigue
 Physiological
 Increased BP, HR, Respirations, etc
 Somatic symptoms
 Decreased immune response
Genetics & Development
Genetics
 Genes control the stress
response
 Individuals have different
responses to stress
 There is a genetic
component to:
 fearful behavior
 anxiety disorders
 Neurobiological response
Development
 Life experiences can affect a
person's stress response
 Social support
 Strong support is protective
 Early life stress
 Increases stress reactivity as
an adult
Responses to Stress
 Physiological
 Increased HR
 Tense muscles
 Cognitive
 Worry, lack of concentration
 forgetfulness
 Emotional
 Anger, sense of dread
 Behavioral
 Less patient, hurrying
Coping & Resilience
Coping
 Ability to control
emotions
 Ability to perceive
reality
 Ability to think
rationally
 Ability to problem
solve
 Culturally defined
Resilience
 The ability to bounce
back
 The positive capacity
to cope with stress
 Provides resistance to
negative events
 Hardiness,
 Resourcefulness
Coping
Adaptive Coping
 Contribute to resolution of the stress response
Maladaptive Coping
 Strategies that cause further problems
Active Coping
 Actively seeking resolution to the stress
Promote Adaptive Coping
 Realistic expectations
 Set realistic goals
 Planning
 Anticipate problems, have a backup plan
 Reframing
 Change the way you look at things
 Relaxation
 Learn relaxation techniques, take time-out for
leisure
 Discuss the problem
 Utilize existing social supports to problem solve
Promote Adaptive Coping
 Training
 Prepares for stressful events
 Nutrition
 Eat healthy, avoid skipping meals
 Exercise
 Include regular exercise
 Sleep
 Get adequate sleep—avoid fatigue
Avoid Maladaptive Coping
 Blurring of boundaries
 Avoidance/withdrawal
 Negative attitude
 Anger outbursts
 Alcohol/Drugs
 Hopelessness
 Negative self-talk
 Resentment (kindarlık)
 Violence
Promote Resilience Factors
 Positive Role Models
 Optimism
 Humor
 Moral Compass
 Altruism (başkalarını
düşünme)
 Religion & Spirituality
 Social Support
Positive Role Models
Transmit:
Attitudes
Values
Skills
Patterns of thoughts and
Optimism
 Positive Beliefs
 Associated with well being
 Cognitive reframing
 Positive thinking
 Refute the negative thinking
 Believe in a meaningful cause
 It is important to acknowledge relevant
negative factors
Humor
 Highly effective
 Mature coping mechanism
“Another of the souls’ weapons for the fight for
self-preservation, it is well known that humor,
more than anything else in the human makeup,
can provide an aloofness and the ability to rise
above any situation, even for a few seconds.”
Viktor Frankl
Moral Compass
 Conduct a moral inventory
 “Look not for any greater harm then this, destroying
the trustworthy, self-respecting, well-behaved man
within you.”
Epicetus
 Maintain your integrity
 “Between stimulus and response there is a space. In
that space is our power to choose our response. In
our response lies our growth and our freedom.”
Viktor Frankl
Altruism
 Unselfish regarding the welfare of others
 Believe in a meaningful cause
 Mutual cooperation
 Activates of the brain’s reward center
Religion and Spirituality
 Associated with psychological and physical well
being
 Guards against despair
 Provides social support
 Provides positive role models
 Provides a positive mission
Social Support
 Social support has a profound effect on life
expectancy
 Patients have better outcomes with strong
social support
 Isolation and poor social support are
associated with a poor stress response
 Few hardy individuals “go it alone”
Signature Strengths
 Recognize skills and talents
 Inventory strengths
 Use your strengths and talents
 Decide what works
 Actively cope
 Apply concepts to enable active coping.
Review
 Stress is part of everyday life
 It can promote growth and competency
 If unrelenting or overwhelming it can cause
adverse effects
 Adaptive coping enhances resilience
 Maladaptive coping causes additional problems
 Enhanced coping increases resilience while
diminishing the adverse effects of stress, thus
promoting health
Review: Practical Tips
 Set realistic expectations
 Exercise regularly
 Eat healthy
 Get adequate sleep
 Maintain a work-leisure balance
 Positive Reframing & optimism
 Enhance social support
Internet Resources
 Building resilience:
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http://www.slideshare.net/3dogMcNeill/building-resilience
Diet, exercise, stress and the immune system:
http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome
/hic_diet_exercise_stress_and_the_immune_system.aspx
Exercise: Rev up your routine to reduce stress:
http://www.mayoclinic.com/health/exercise-and-stress/SR00036
Positive thinking: Reduce stress, enjoy life more:
http://www.mayoclinic.com/health/positive-thinking/SR00009
Stress management for patient and physician:
http://www.mentalhealth.com/mag1/p51-str.html
Stress management: Understand your sources of stress:
http://www.mayoclinic.com/health/stress-management/SR00031
Stress reduction techniques: A must for a healthy lifestyle:
http://www.managestresstips.com/category/stress-reduction/