Download Stress - Morehouse School of Medicine

Morehouse School of Medicine
Health and Wellness Initiative
Kisha B. Holden, Ph.D.
[email protected]
November 20, 2009
Life is a Balancing Act
Mental Health
The successful performance of mental
function, resulting in productive
activities, fulfilling relationships with
other people, and the ability to adapt to
change and to cope with adversity; from
early childhood until late life; mental
health is a springboard of thinking and
communication skills, learning,
emotional growth, resilience,
and self esteem.
Mental Illness
 Clinically significant emotional, behavioral
or psychological syndrome or pattern
 Mental disorders are health conditions that
are characterized by alterations in thinking,
mood, or behavior (or some combination
thereof) and associated with distress and/or
impaired functioning
 Considered as the product of a complex
interaction among biological, psychological,
social, and cultural factors
Understanding Stress
Physical, Mental, and/or Emotional Strain
A feeling of tension, suspense, anxiety, pressure or
excitement
2 Types of Stress:
Distress “The Negative View”
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Describes damaging or unpleasant stress, provoking states of
fear, worry, and agitation. The core of the psychological
experience is unconstructive, painful, pessimistic, and
something to be avoided.
Eustress “The Positive View”
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Describes pleasurable, satisfying feelings and often leads to
heightened awareness, increased alertness, and superior
cognitive and behavioral performance.
Bio-psychosocial Stressors
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Health Concerns
Individual/Personal Issues (e.g., cognitions, identity, selfperception, body image)
Interpersonal and Intimate Relationships (i.e., commitment,
intimacy, trust, communication, infidelity issues)
Family Relationships and Daily Demands
Unresolved Pain and Trauma (i.e., sexual, emotional, and
physical abuse)
Negative Life Events (death of a loved one, victim of crime etc.)
Confronting historical negative stereotypes and images
Sociopolitical Stressors including Racism and Sexism
Job/Employment Issues
Economic and Financial concerns
Community (e.g., environmental conditions)
Handling Multiple Expectations of Others
Internalization of Emotions
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CHRONIC STRESS
ANGER
FRUSTRATION
PAIN
DISILLUSIONED
MISUNDERSTOOD
RESENTMENT
UNSUPPORTED
FEAR OF FAILURE
ANXIOUSNESS
UNFAIRNESS
UNRESOLVED TRAUMA
 LACK OF ACCEPTANCE
 NEGATIVE PERCEPTIONS BY
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OTHERS & STEREOTYPES
GUILT
POWERLESSNESS
LACK OF CONTROL OF
EXTERNAL FACTORS
MASKING OF TRUE SELF
RACISM
NEVER GET A BREAK OR
SECOND CHANCE
What is Workplace Burn-out?
 Burnout is a state of emotional, mental, and physical
exhaustion caused by excessive and prolonged stress.
 It occurs when you feel overwhelmed and unable to meet
constant demands. As the stress continues, you begin to
lose the interest or motivation that led you to take on a
certain role in the first place.
 Burnout reduces your productivity and saps your energy,
leaving you feeling increasingly helpless, hopeless,
cynical, and resentful. Eventually, you may feel like you
have nothing more to give.
Stress vs. Burnout
Stress
•Characterized by overengagement
•Emotions are overreactive
•Produces urgency and
hyperactivity
•Loss of energy
•Can lead to detachment and
mental disorders
•Primary damage is physical,
mental and emotional
•May kill you prematurely
Burnout
•Characterized by disengagement
•Emotions are blunted
•Produces helplessness and
hopelessness
•Loss of motivation, ideals, and
hope
•Can lead to detachment and
mental disorders
•Primary damage is physical,
mental, and emotional
•May make life seem not worth
living
Work-related Contributors
to Burnout
 Feeling like you have little or no control over
your workload.
 Lack of recognition or rewards for good work.
 Unclear or overly demanding job expectations.
 Doing work that’s monotonous or
unchallenging.
 Working in a chaotic or high-pressure
environment.
Lifestyle Related Contributors to
Burnout
 Working too much, without enough time for relaxing
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and socializing
Being expected to be too many things to too many
people
Taking on too many responsibilities, without enough
help from others
Not getting enough sleep
Lack of close and supportive relationships
Use of drugs and alcohol as primary ways to cope with
life’s difficulties
Personality Related Contributors to
Burnout
 Perfectionist tendencies (nothing is ever
good enough or right)
 Pessimistic view of yourself and the world
 The need to always be in control of
situations
 Reluctance to delegate responsibilities to
others
 High-achieving/Type A personality
You May Be on the Road to
Burnout if….
 Every day is a bad day.
 Caring about your work or home life seems like a total
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waste of energy.
You’re exhausted all the time.
The majority of your day is spent on tasks you find either
mind-numbingly dull or overwhelming.
You feel like nothing you do makes a difference or is
appreciated.
The negative effects of burnout spills over into every area
of life – including your home and social life.
Burnout can also cause long-term changes to your body
that make you vulnerable to illnesses like colds and flu.
Mental Disorders: What the
Numbers Say
 1 in 2 Americans have a diagnosable mental disorder each
year.
 80-90% of mental disorders are treatable using medication
and other therapies.
 80-90% of people who die by suicide are suffering from a
diagnosable mental illness.
 It is estimated that 1/2 of those with a lifetime substance use
disorder have a lifetime mental disorder and vice versa
Making Sense of It All
Mood Disorders
 Major depressive disorder
 Dysthymic disorder
 Bipolar disorders
 Cyclothymic disorder
Anxiety Disorders
 Panic Disorder
 Generalized anxiety disorder
 Agoraphobia
 Post-traumatic Stress Disorder
 Obsessive Compulsive Disorder
 Social Phobia
 Acute Stress Disorder
Substance Related Disorders
 Use, Abuse, Dependency
 Alcohol, Drugs, Caffeine, Nicotine, Food
Depression
 19-21 million Individuals in the U.S. are
affected by depression, and it is a leading
cause of disability
 Women are twice as likely to men to suffer
from depression, and one women in every four
is likely to suffer from a serious depressive
episode at some time in her life.
 Lifetime Prevalence: 10-25% for women and 512% for men
Major Depression
 Is recurrent (like an old boyfriend)
 50% with one episode will have another
 70% with two episodes will have another
 90% with three episodes will have
another
 20-25% will be chronic
 30% who go to primary care doctor have
a major depressive disorder
Signs & Symptoms of Depression
 Persistent sad, anxious, or “empty” mood.
 Feelings of hopelessness, pessimism.
 Feelings of guilt, worthlessness, helplessness.
 Loss of interest or pleasure in hobbies and
activities.
 Decreased energy, fatigue, being “slowed
down.”
 Difficulty sleeping, early-morning awakening, or
oversleeping.
 Appetite and/or weight changes.
 Thoughts of death or suicide; suicide attempts.
 Restlessness, irritability.
 Persistent physical symptoms
Stigma
 Stigma is a barrier and discourages individuals and their families
from getting the help they need due to the fear of being
discriminated against.
 It is the use of negative labels to identify a person living with
mental illness.
 An estimated 50 million Americans experience a mental disorder in
any given year and only one-fourth of them actually receive mental
health and other services.
Judge Greg Mathis
 Judge Mathis was
diagnosed with Attention
Deficit Hyperactivity
Disorder (ADHD)
 Advocate for reducing
stigma around mental
illness
 Member, Board of
Trustees, Morehouse
School of Medicine
Cultural and Social Influences
on Mental Health for Ethnic Minorities
 Social & economic environment of inequality
 Greater exposure to racism, discrimination, violence,
& poverty
 Mistrust of “the system”
 Clinical environments that do not respect, or are
incompatible with the cultures of the people they
serve
African Americans and
Mental Health
 Legacy of slavery, racism, and discrimination
influences social & economic standing
 Rates of mental illness similar to those of whites
 Overrepresented in vulnerable populations because
of homelessness, incarceration, and children in
foster care
 Less access to services than do whites
 Less likely to receive treatment in a mental health
facility
 Fewer African American mental health specialists
 For certain disorders (e.g., schizophrenia and mood
disorders) errors in diagnosis are made more often
American Indians and Alaskan Natives and
Mental Health
 European’s conquest of Indian lands reduced
the population to 5% of its original size
 The most impoverished of all minority groups
and 20% do not have health insurance compared
to 14% of whites
 Traditional healing practices and spirituality are
prominent
 Suicide rate is 50% higher than the national rate
 Mental health service limited by rural and
isolated location of many communities
 Research is limited
Asian Americans and Pacific Islanders and
Mental Health
 Highly diverse consisting of at least 43 separate
ethnic groups
 Risk factors for mental illness related to preimmigration trauma from harsh social conditions
 Prevalence rates similar to whites
 Barriers to services related to limited English
proficiency and lack of providers with appropriate
language skills
 Lower rates of utilization of services than whites
due to stigma and shame
Hispanic Americans
and Mental Health
 Largest and fastest growing minority group in
the US, yet their per capita income is among
the lowest and the least likely group to have
health insurance
 Overall rates of mental illness similar to those
of whites
 Limited access to ethnically or linguistically
similar mental health providers
 More likely to seek help from primary care
provider than mental health specialist
 Less likely to receive evidence based care in
clinical settings
Strategies for Coping
Types of Psychotherapy
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Cognitive-Behavioral
Psychodynamic
Interpersonal
Self-Control
Individual, Family, and Group
Light therapy
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Stress Management
Relaxation Techniques
Self-Monitoring and Assertiveness Strategies
Prayer and Spiritual Fellowship
Meditation
Social Support
Exercise
Types of Training
Medical/Psychiatric Interventions
 Inpatient, Outpatient, Partial Hospitalization
 Medication/Pharmacotherapy including SSRI’s, SNRI’s, Tricyclics, MAOI’s,
Mood stabilizers
Principles of Positive
Co-worker Relationships
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Respect People's Differences
Think Positive
Acknowledge Your Co-workers Achievements
Listen Attentively
Appreciate Others
Pitch In and Help Out
Live Up to Your End of the Job
Respect People's Time & Priorities
Be Willing to Admit your Mistakes and Apologize
Gracefully
 Understand that life on the job will not be perfect
Improving Interpersonal
Communication at Work
 Respect for difference in written, verbal, and nonverbal
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communication exchanges
Initiate Dialogue
Listen Actively
Don’t Interrupt
Stay on the Subject
Tolerance for ambiguity
Flexibility
Suspension of assumptions and judgments
Willingness to see other person’s point of view
Validate other person(s) thoughts, beliefs, and feelings
Time and practice
Building Trust At Work
 Listen in ways that show you respect others and that you value their
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ideas, even when you don’t agree
When you are excited about something, tell why it’s important to
you
Keep your promises and commitments
Share feelings as well as hard facts
Don’t jump to conclusions without checking the facts
Demonstrate that you are working for others’ interests, as well as
your own
Be consistent about the messages that you send so people know
where you stand
View all the alternatives before making a decision
Be open to new ideas but don’t dismiss what has worked before
Be accountable for your work-if you realize you are missing the
mark, avoid making excuses
Moving Towards Empowerment
INDIVIDUAL
WORKPLACE
SOCIETY
“Mental health is fundamental to a
person's overall health,
indispensable to personal well
being and instrumental to leading
a balanced and productive life.”
David Satcher, MD, PhD