STRESS

MR. NELSON R. MENDOZA Psychosocial Specialists Program Manager National Mental Health Program Department of Health

Promoting Healthy Lifestyles

Department of Health
2005

How do you know if you are suffering from stress?

Are you constantly tired? Do you experience flashes of anger over a minor problem? Have you noticed a change in sleeping or eating patterns? Do you suffer from chronic pain, headaches or backaches

How do you know if you are suffering from stress?

Do minor problems and disappointments upset you excessively? Do the small pleasures of life fail to satisfy you? Are you unable to stop thinking of your worries? Do you feel inadequate or suffer from self doubt?

Which of these is stress?

You receive a promotion at work. Your car has a flat tire. You go to a fun party that lasts till 2:00 a.m. Your dog gets sick. Your new bedroom set is being delivered. Your best friend and his wife come to stay at your house for a week. You get a bad case of hay fever. All of the above.

ALL OF THESE ARE STRESS

If you are used to thinking that stress is something that makes you worry, you have the wrong idea of stress. Stress is many different kinds of things: happy things, sad things, allergic things, physical things.

Presentation Outline
Stress
Definition Sources Effects Identification Management Modalities

Stress Management as Health promotion activity

MAN IS:
PHYSICAL Feels MENTAL Think s Reacts Stimuli External SOCIAL SPIRITUAL

Environment

Internal

Facts About Stress

75-90% of visits to physicians are stressrelated Stress related disorders are a major cause of rapidly increasing health care cost Job stress is a major health factor costing an estimated $150B annually

More Facts About Stress

70% of people with drinking problems and 62% of drug users were in full time employment Fatalities at work, related to drug and alcohol use account for 15-30% of all accident cases Problematic drug and alcohol users have 2 to 4 times more accidents than other employees

Still More Facts About Stress

Problematic drug and alcohol users have 2 to 3 times more absences than other employees Problematic drug and alcohol users have 2 to 3 times more level of sickness benefit claims Some industries have 15-40% of their disciplinary cases involving employees with alcohol and drug use

Most Stressful Jobs

National Institute for Occupational Safety & Health, USA, 1994

Licensed Practical Nurse Public Relations Specialist Quality Control Inspector Computer Programmer Bank Teller

10 Leading Causes of Mortality 1968 and 1994

Pneumonia Tuberculosis , all forms Gastroenteritis & colitis Diseases of the vascular system Bronchitis Diseases of the heart Malignant neoplasm's Accidents Beriberi Nephritis and nephrosis

Diseases of the heart Diseases of the vascular system Pneumonia Malignant neoplasm Tuberculosis, all forms Accidents Obstructive pulmonary diseases Diarrheal diseases Other respiratory diseases Diabetes mellitus

Source: Council for Health and Development

10 Leading Causes of Morbidity (2008) 1. 2. 3. 4. 5. 6. 7. 8. 9. Acute Respiratory Infection Acute lower RTI and Pneumonia Bronchitis/ Bronchiolitis Hypertension Acute Watery Diarrhea Influenza TB Respiratory Acute Febrile Illness Diseases of the Heart

10 Leading Causes of Mortality (2005) 1. Diseases of the Heart 2. Diseases of the Vascular System 3. Malignant neoplasm 4. Pneumonia 5. Accidents 6. Tuberculosis, all forms 7. Chronic Lower Respiratory Diseases 8. Diabetes Mellitus 9. Certain conditions originating in the Perinatal Period 10. Nephritis, nephrotic syndrome and Nephrosis

10. Chickenpox

Source: National Epidemiology Center, Department of Health

Changing times- Need social engineering

MEDIATING PATHWAYS TO STRESSRELATED DEATHS

Alcohol abuse Drug abuse Depression Violence
Accidents Cirrhosis of liver Suicide Homicide Stroke Heart attack Cancer

High blood Pressure High Cholesterol Imbalanced or OverEating Cigarette Smoking Weakening of Immune system

Diabetes
Pneumonia and influenza Asthma, Emphysema, Bronchitis

Mission Impossible?

STRESS - Definition
A state of body disequilibrium.

The rate of wear and tear within the body Hans Selye

Definition
Is an everyday fact of life All stress is not bad Is an individual reaction

Definition
A state where ones coping is not enough to maintain balance or equilibrium.
Automatic reaction to danger or demand

which may be physical and psychological, the resulting state may lead to illness or death Duane Hagen

Definition
A major cause of low productivity, high absenteeism, bad judgment, misallocation of resources and poor moral.
Robert Axles

THE DYNAMICS OF STRESS

STRESS

+/S T R E S S O R S Int. / Ext. SENSATIONS FEELINGS EMOTIONS

PERCEPTION

G.A.S.
BODY IN ACUTE TENSION (Temporary Imbalance)

CREATIVE ACTION INEFFECTIVE ACTION

*Eustress *Distress BALANCE (+)

INACTION

PAIN (-) TRAUMA (-) DISEASES OF ADAPTATION

MAIN REFERENCE: Selye, Hans. 1974. Stress Without Distress. Signet Books. New York.

 THREAT

BODY ALARMS GO OFF

When the body has a demand placed on it or perceives a threat, it responds physically with the fight or flight responses

(FIGHT OR FLIGHT RESPONSE)

Danger/threats
Mind quickly assesses
sends messages throughout the body via the central nervous system

Central Nervous System

Increased energy through bloodstream

energy increased throughout the body
Blood pressure increases Sugar pumped to fuel muscles Adrenalin floods nerve endings Blood clotting time reduced

Stress

Bodys resources Mobilized to defend itself

Stress level increase

When a stressful event or situation occurs, the mind quickly assesses its significance and sends messages throughout the body via the central nervous system. Energy is rapidly distributed throughout the body by the bloodstream and the body's resources are mobilized to defend itself against the perceived threat. The level of your stress in a situation depends on the intensity of meaning you attach to the source of the stress.

General Adaptation Syndrome (G.A.S.)

Increase in...

Blood Pressure
Breathing rate

Muscle blood
flow

Energy to handle
perceived threat

Flight or
Fight Response

Heart rate Blood clotting agents White blood count Body metabolism

SOURCE: Productive Stress Management and Winning Lifestyle. ADB Tape..

CRITICAL LINE 100%

E F F I C I E N C Y

JOY OF STRESS

TOO MUCH STRESS

TOO LITTLE STRESS

STRESS

To find where you are on this graph, simply ask one question: Will the added stress of a new responsibility at work or at ho me ( no matter how small) increase my efficiency, or decrease it? To make the best use of your energy, make sure your tasks are essential t o your health, wealth, and happiness, and not a waste of time.

BECOMING ANGRY
Unexpected Reality Unconscious Need/Value

Expectation

Behavior

Object of Satisfaction

Energy for Corrective Action

Unpleasant Experiences Powerlessness Rejection of Reality

(Frustration)

(Anxiety)

ANGER

(Kanapi, Juan Jr. 1986. The Basic Elements of the Experience of Anger. Unpublished thesis. Ateneo de Manila University. Q.C.)

Who is the most vulnerable to distress?

Research shows that all types of people sometime experience distress. No one is immune. Yet these also are evidence that members of certain categories and groups are specially likely to encounter distress. Rates of CHD, CA and suicide are higher for separated-persons than unmarried people. Unhappily married people suffer more stress-related illness than people who are happily re-married. All married groups-men and women, over 30 and under 30 with and without children report higher satisfaction, general good feelings and less stress than unmarried groups single, divorced, or widowed.

 Widows and widowers are more likely than others their age to become ill and die (especially after the death of their spouse) More wives than husbands have felt they were about to have a nervous breakdown, have experience more intense anxiety, and report feelings of inadequacy, depression, and phobia Compared with non-employed housewives, working wives are happier, communicate better than their husbands, report feeling better physically and mentally, and are more satisfied with their marriages and life in general. Compared with husband of non-employed wives, husbands of working wives are less happy, experiencing greater job pressures, poorer health and more dissatisfaction with their jobs and marriages.

 The ages of greatest stress-related ailments are 15-35 and 55-65 The poor are more likely to experience all types of distress than middle-class or wealthy persons. Teenagers with high-achievement pressures from parents are specially likely to be hypertensive. Urban dwellers have more stress related illnesses than rural dwellers. Parents with young children report more feelings or pressure and stress than any other age or maritalstatus group Blue collar workers experiences more boredom, stress related illness and job dissatisfaction than white-collar workers.

 Depression is up to twice as common among women as men. Migrants from rural areas to the city are more likely to experience stress-related illness and death than are non-migrants Families that move a greater deal are specially likely to experience suicide, ulcers, separation and emotional breakdown The unemployed are more likely than the employed to experience suicide ulcers, divorce, and emotional breakdown.

Sources of Stress
1) Personal 2) Family 3) Occupational 4) Environmental

Personal
1) Minor annoyances 2) Adverse life experiences 3) Major life changes 4) Extreme life experiences

Family
1) Spouse/Parents 2) Children/Siblings 3) In-Laws/Other relatives 4) No house help

Occupational
1) Physical Environment 2) Interpersonal Relationship 3) Organizational

Organizational
1) Role Demands 2) Task Demands 3) Benefits 4) Promotion/Demotion/Stagnation

Environmental
1) Peace and Order Situation 2) Socio-economic 3) Political

Life is not a destiny but a journey to be enjoyed.

Synergy Unlimited

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work.
a little bit of stress is good for you.
stress
stress

stress

But if
the challenge has turned into job demands that cannot be met relaxation has turned to exhaustion sense of satisfaction has turned into feelings of stress

Common Costly problem in the workplace:

One-fourth of employees view their jobs as the number one stressor in their lives.
- Northwestern National Life

Three-fourths of employees believe the worker has more on-the-job stress than a generation ago.
- Princeton Survey Research Associates

Problems at work are more strongly associated with health complaints than are any other life stressormore so than even financial problems or family problems.
- St. Paul Fire and Marine Innsuance Co.

Stress in Today's Workplace

The longer he waited, the more David worried. For weeks he had been plagued by aching muscles, loss of appetite, restless sleep, and a complete sense of exhaustion. At first he tried to ignore these problems, but eventually he became so short-tempered and irritable that his wife insisted he get a checkup. Now, sitting in the doctor's office and wondering what the verdict would be, he didn't even notice when Theresa took the seat beside him.
"You got out just in time," he told her. "Since the reorganization, nobody feels safe. It used to be that as long as you did your work, you had a job. That's not for sure anymore. They expect the same production rates even though two guys are now doing the work of three. We're so backed up I'm working twelve-hour shifts six days a week. I swear I hear those machines humming in my sleep. Guys are calling in sick just to get a break. Morale is so bad they're talking about bringing in some consultants to figure out a better way to get the job done."

"Well, I really miss you guys," she said. "I'm afraid I jumped from the frying pan into the fire. In my new job, the computer routes the calls and they never stop. I even have to schedule my bathroom breaks. All I hear the whole day are complaints from unhappy customers. I try to be helpful and sympathetic, but I can't promise anything without getting my boss's approval.
Most of the time I'm caught between what the customer wants and company policy. I'm not sure who I'm supposed to keep happy. The other reps are so uptight and tense they don't even talk to one another. We all go to our own little cubicles and stay there until quitting time. To make matters worse, my mother's health is deteriorating. If only I could use some of my sick time to look after her. No wonder I'm in here with migraine headaches and high blood pressure. A lot of the reps are seeing the employee assistance counselor and taking stress management classes, which seems to help. But sooner or later, someone will have to make some changes in the way the place is run."

Job Conditions That May Lead to Stress

The Design of Tasks.

Heavy workloads, infrequent rest breaks, long work hours and shift work; hectic and routine tasks that have little inherent meaning, do not utilize workers' skills, and provide little sense of control.
Example: David works to the point of exhaustion. Theresa is tied to the computer, allowing little room for flexibility, self-initiative, or rest.

Management Style.
Lack of participation by workers in decision- making, poor communication in the organization, lack of family-friendly policies.
Example:
Theresa needs to get the boss's approval for everything and the company is insensitive to her family needs.

Job Conditions That May Lead to Stress

Interpersonal Relationships.

Poor social environment and lack of support or help from coworkers and supervisors.
Example: Theresa's physical isolation reduces her opportunities to interact with other workers or receive help from them.

Work Roles.

Conflicting or uncertain job expectations, too much responsibility, too many "hats to wear.
Example: Theresa is often caught in a difficult situation trying to satisfy both the customer's needs and the company's expectations.

Job Conditions That May Lead to Stress

Career Concerns.

Job insecurity and lack of opportunity for growth, advancement, or promotion; rapid changes for which workers are unprepared.
Example: Since the reorganization at David's plant, everyone is worried about their future with the company and what will happen next.

Environmental Conditions.

Unpleasant or dangerous physical conditions such as crowding, noise, air pollution, or ergonomic problems.
Example: David is exposed to constant noise at work.

Job Conditions That May Lead to Stress

The Design of Tasks Management Style Career Concerns Environmental Conditions Career Concerns Environmental Conditions

Ten Major Occupational Stressors

Work overload, under load/stagnation Ambiguity or rigidity of task Role conflict Extreme amount of responsibility Negative competition Constant changes Ongoing contact with stress carriers Containment or emotional reactions Poor interaction with management Matters related to corporate work

Five Basic Reactions to Stress

Share grievance without ignoring the situation Work longer and harder to reduce overload Switch to an engrossing recreation to be refreshed Physical withdrawal, quitting or reducing the time and energy spent at work Analyzing the situation, revising strategies and look for ways to change things

Why be stressed:
The interplay of several variables which largely determines what happens to a person or family when stressors or problems are encountered.
These variables include: 1) the hardships associated with the condition or event,

2) how the situation is perceived or defined,

3) the inner resources and coping capacities the person or family has, and 4) the external resources and supports which the family or person can mobilize--formal agencies or professionals and informal networks of kin, friends, and neighbors.

Perception
"Seeing is believing. I wouldn't have seen it if I hadn't believed it."
(Ashleigh Brilliant)

Perceptions Affects: individuals and families involved

1. Communication 2. Problem-solving

3. Decision-making
4. Stress Management

When humans get data (information) from any of their senses, they "perceive" it. That is, they make some sense or meaning of it; they interpret; they define situations and events; they make inferences and draw conclusions.

What is the most important factor in PRODUCTIVITY?

The most important factor is clearly our emotional state during the work situation. When we are feeling motivated, relaxed, determined, energized, calm and confident, high productivity will naturally flow.

Are all forms of Stress BAD?

Certain amount of stress maybe needed to be motivated (e.g. working well under pressure) EUSTRESS enough stress to be motivated, challenged and productive DISTRESS under loaded (boredom) or over loaded

EUSTRESS
Eustress or positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished.

DISTRESS
Distress or negative stress occurs when your level of stress is either too high or too low and your body and/or mind begin to respond negatively to the stressors.

What are the causes of Stress?

ANYTHING different people (social status), different stress
Rich & Powerful getting richer, more powerful Middle Class sustenance, future Poor day to day subsistence

Nobody is spared from, stress

Basic Causes of Stress:

CHANGE inevitable stressor
e.g. Rapid development., technological advances, lifestyles, growth & development.

SNEAKING STRESS little things that add up

E.g. being late, traffic, work load, etc.

 PERSONAL TRAITS stress coming from within (ones personality)

E.g worrier type (negative thinker, perfectionist, unrealistic expectations, low self-esteem) Remember WORRY is a mental abuse, a self-inflicted abuse

PHYSICAL ENVIRONMENT
Noise, uncomfortable chair, smoke-filled surrounding undisciplined people, etc.

COGNITION VS EMOTION

NORMAL

STRESS

NORMAL

The Mechanism of the Physical Stress Response

Stress stimulates the nervous system

The sympathetic and parasympathetic system are activated The Sympathetic Nervous System stimulates catecholamine release of the adrenals .
Flight reactions cause adrenaline secretion

The Mechanism of the Physical Stress Response

Aggression or fight reactions cause Noradrenaline secretion. The adrenal cortex produces cortisol, to enhance the action of the cathecolamines. Increased cortisol may suppress the immune system causing the body to be susceptible to infection/illness

The Mechanism of the Physical Stress Response

The effects of cathecolamines are:
Dilated pupils Constricted blood vessels of the head Skeletal blood vessels are dilated Peristalsis reduced Renal muscles, relaxed, urine secretion decreased Bladder is relaxed, sphincter closed Sex organs and genitalia relaxed, blood vessels constricted Mental ability is reduced

The Mechanism of the Physical Stress Response

Utilization of energy by the body is increased Vit. B Com. , C, E & other energy giving nutrients and minerals are depleted in case of chronic stress Inc of energy requirement may result to gluconeogenesis Energy burned creates by products--lactic acid, uric acid, urea and CO2 Excretion of by products is aided by movement of muscles, circulation of blood & lymph

The Mechanism of the Physical Stress Response

Accumulated by products cause stiffness & soreness of the muscles, affecting the gliding action of muscles
Chronically stressed muscles become fatigued causing loss of elasticity, tone & irritability On the other hand, constantly relaxed muscles may loose their tone, elasticity and irritability accumulating by products that produce frozen joints & knotted muscles.

Physical Intellectual Interpersonal Emotional

(Signs/Symptoms of Stress)

Headaches Sleep disorders (e.g. insomnia, oversleeping, early awake) Lower back pains, Clenching the jaws or grinding teeth Constipation, diarrhea, colitis, indigestion or ulcer Skin rashes Muscle aches (especially neck & shoulders) Hypertension or heart attack Excessive perspiration Appetite change (Physical Symptoms of Stress)

 Inappropriate distrust of others Blaming others Missing appointments or canceling them on short notice Faultfinding and verbal attacking Overly defensive attitude Giving others the silent treatment

(Interpersonal Symptoms)

Intellectual Symptoms
Trouble concentrating Difficulty in making decisions Forgetfulness Confusion Poor memory & recall Excessive daydreaming Preoccupation with a single thought or idea Loss of sense of humor Decreased productivity,lower quality of work Increased number of errors Poor judgment

Anxiety or worry Depression or cries easily Mood swings Irritability Nervousness Lowered self-esteem or feelings of insecurity Increased sensitivity or feeling easily hurt Angry outburst Aggression or hostility Feeling emotionally drained or burned out (Emotional Symptoms)

Unhealthy ways of coping with stress

These coping strategies may temporarily reduce stress, but they cause more damage in the long run: Smoking Drinking too much Overeating or undereating Zoning out for hours in front of the TV or computer Withdrawing from friends, family, and activities Using pills or drugs to relax Sleeping too much Procrastinating Filling up every minute of the day to avoid facing problems Taking out your stress on others (lashing out, angry outbursts, physical violence)

Cognitive Theory of Stress (Lazarus)

Primary Appraisal
Harm or loss Threat Challenge

Secondary Appraisal
Evaluation of Coping Resources
Physical Social Psychological Material

Contingencies

FLAMEOUT
A preventable and treatable condition which occurs when the need for periodic rest. Food, exercise and relaxation is overlooked or ignored. Also known as Rapid Onset Burnout

BURNOUT
A state of mental, emotional and physical exhaustion, characterized by changes attitudes towards work colleagues and clients.

Dont waste your Health to gain WEALTH otherwise at the end you will loose all your wealth to gain back your HEALTH.

Your problems are not your problems. How your problem affect you your attitude is your problem. Fix that and your problems are no problem.

Unhealthy ways of coping with stress

These coping strategies may temporarily reduce stress, but they cause more damage in the long run: Smoking Drinking too much Overeating or undereating Zoning out for hours in front of the TV or computer Withdrawing from friends, family, and activities Using pills or drugs to relax Sleeping too much Procrastinating Filling up every minute of the day to avoid facing problems Taking out your stress on others (lashing out, angry outbursts, physical violence)

Shift Hours Long Hours

Publ i c Sc r ut i ny

Organizational S tre s s

The Police Officers Paradox

To function effectively in our job, you must annihilate, smother, and suppress normal emotions like fear, anger, revulsion, and even compassion. To do other wise is to invite overwhelming doubt or hesitancy when decisive action is required. The penalty for your achieved competence is a mind set that might as well be a foreign language to your social contemporaries. We are..victims of our own success. When these same normal and appropriate emotions..surface in personal relationships, we automatically shut down and wonder why, over time, that the people we care about the most complain that we are aloof, cold, and uncommunicative.
Lt. Al Benner, Ph.D. San Francisco Police

Alcoholism: Myths and Realities

Myth: Once an alcoholic, always an alcoholic Reality: Alcoholism is a disease for which recovery is guaranteed if the alcoholic begins and sticks with a recovery program. If not, whats guaranteed is premature death. Myth: Reality: Alcoholism is caused by a lack of willpower, immorality, weak character, or police stress. No one really knows what drives a person to drink. Studies alternately have implicated physical, genetic, psychological, environmental, and social factors.

Myth: All alcoholics are skid-row drunks. Reality: Many alcoholics hold high-level jobs and function well at work for years before their performance is noticeably affected by drinking. Myth: If an alcoholic can stop drinking, he or she doesnt have a problem. Reality: Abstinence is not a sign that someone is free of alcoholism. Alcoholics Anonymous (AA) calls these abstainers dry drunks because they have no real understanding of their condition, no new ways to cope, and are almost certain to fall off the wagon. Myth: Alcoholics drink every day. Reality: Alcohol abuse patterns vary. Some people get drunk daily, and others only on the weekends. Some stay sober for months and then go on a long binge.
From E. Kirschman, I Love a Cop: What Police Families Need to Know, 1977.

Depression Significant loss actual or threatened Substance abuse Previous suicide attempts or threats Marked change in personality Giving things away Reckless behavior Anniversary reactions Reunion fantasies

Domestic Abuse
Domestic abuse exists along a continuum from verbal abuse to
physical violence.
All controlling behaviors are reasons for concern and for the potential victim to seek help. Domestic abuse is not about anger. All couples get angry and fight. Domestic abuse may be related to PTSD, substance abuse, poor coping or personality. It is the abusers responsibility to control his/her behavior and get help for stress or substance related problems. It is the victims responsibility to look after his/her own safety and the safety of his/her children. Toll free national hot line is 800-799-SAFE.

Conflict resolution and problem solving skills.

Organizational Support For Family Friendly Policies. Mental health benefits (EAP) Peer Support Program CIS intervention resources Police Chaplains Flexible assignments Rotation policies Child care

A family structure with clearly defined roles and responsibil ities.

Social Support system: Family Friends inside/outside police work. Religious communities Social groups Each other

Awareness of jobrelated stress factors and the ability to recognize stress.

Strengthening Your Couple Connection

Spend time alone, without children, regularly every week.

Keep this time sacred and free from interruption. Decide how you want to spend this time. If you disagree, problem solve so that you both win. Use this time to actively listen to each other.