STRESS MANAGEMENT

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STRESS MANAGEMENT

• Waris Qidwai
• Professor and Chairman
• Department of Family Medicine
• The Aga Khan University
• Karachi - Pakistan

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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
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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.

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History
Hans Selye (1907-1982)
Stress is the spice of life
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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.

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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

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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

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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

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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.

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Quotation

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

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THREE STAGES OF ADAPTASION IN STRESS

• 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
  organisms defence mechanisms become active.
• Stage of resistance During this stage the
  persons full adaptation may lead to
• successful return to equilibrium.
• 3. Stage of exhaustion In case of failure of
  adaptability the organism becomes exhausted.

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HUMAN FUNCTION CURVE
Intended Performance
PERFORMANCE
Exhaustion
III Health
Fatigue
Actual Performance
P
Healthy Tension
Breakdown
AROUSAL
P The point at which minimum arousal may bring
on a breakdown
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STRESSORS

• Environmental
• Work related
• Interpersonal
• Life events

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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 

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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

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PSYCHOLOGICAL SYMPTOMSAND SIGNS

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

• Guilt
• Hopelessness
• Hostility
• Impatience
• Inability to Concentrate
• Irritability
• Rejection
• Restlessness

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BEHAVIOURAL SYMPTOMSAND SIGNS

• Overreacting
• Stuttering
• Swearing
• Touching Hair, Ears, or Nose
• Trembling Hands

• Biting Lips
• Foot Tapping
• Grinding Teeth
• Impulsive Actions
• Moving in Tense, Jerky ways
• Nervous Tics

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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.

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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.

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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

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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.

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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.

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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.

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A model of occupational psychosocial stress
Source of stress
The Individual
Outcomes
Intrinsic Stress
Job dissatisfaction Excessive drinking Excessive
smoking Drug use Anxiety Depression Coronary
heart disease Marital disharmony
Work Overload
Demographic factors
Role in the Organisation
Stress coping ability
Self
Organisational structure climate Security
Home/work interface
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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

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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

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Role in the Organization

• Clarity in the role/job description
• Career progression
• Responsibility Vs Authority
• Vision and Mission
• Ownership

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ORGANIZATIONAL STRUCTURE AND CLIMATE

• Source of stress for the employee arises from
  the organizational structure and climate
• gtParticipation in the decision making process
• gtEffective communication
• gtRestrictions in behavior

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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

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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

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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)

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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.

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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

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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

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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.

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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

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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

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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

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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

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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

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SIMPLE STRESS MANAGEMENT ADVICE

• To avoid stress
• Accept it is normal to be an imperfect person in
  an imperfect world
• Problems are analysed logically and plans made to
  resolve them
• Work out those situations and people which cause
  you stress and why?
• Change those things that actually can be changed
• Identify and respect your own good points
• Improve your shortcomings as much as possible and
  then accept them as part of you

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SIMPLE STRESS MANAGEMENT ADVICE Contd

• 7. Dont 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

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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.

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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.

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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.

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Service At Corporate Field Sites
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• ENI, Pakistan
• OMV, Pakistan
• HUBCO
• British Petroleum, Pakistan
• BHP
• Tethyan Copper Company
• UCH Power Plant
• ROUCH Power Plant
• KAPCO Power Plant

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First Occupational Health Conference April 21,
2011
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Tenderness and kindness are not signs of
weakness and despair but are manifestations of
strength and resolution
Gibran
Khalil
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THANK YOU VERY MUCH