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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 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: 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/
