Lecture 2 Identifying your stressors and how you handle stress

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Lecture 2 Identifying your stressors and how you
handle stress

• Dr. Paul Wong D.Psyc.(Clinical)
• E-mail paulw_at_hku.hk
• Centre for Suicide Research and Prevention (CSRP)

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This Lectures Overview

1. Recap of Lecture 1
2. In-class activity - Myths and Facts of Suicide
3. Video The aftermath of suicide
4. What is Stress?
5. Sources of Stress
6. Bio-psycho-social Aspects of Stress
7. How Stress Affects Health
8. Coping with it

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Objectives

• Students will learn the difference between good
  and bad stress.
• Students will learn to identify signs of stress
  in themselves and others.
• Students will learn the difference between
  positive and negative ways of coping with stress.
• Students will identify and choose specific
  methods that can reduce stress.

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Myths and Facts of SuicideIn-class activity
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Myth or Fact

• Suicide usually happens without warning.

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Myth

• Research has demonstrated that in over 80 of
  completed suicide, a warning sign or signs were
  given.
• (Coleman OHalloran, 1998)
• Many studies have revealed that the suicidal
  person gives many clues and warning regarding
  suicidal intentions. This is not to say that all
  suicidal people always give warnings.
• (Center for Mental Health in Schools at UCLA,
  2003)

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Myth or Fact?

• There are no special/certain types of people who
  commit suicide.

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Fact

• Suicidal behavior cuts across all socioeconomic
  boundaries. People of all ages, races, faiths,
  and cultures die by suicide, as do individuals
  from all walks of life, all income levels. Most
  who die suffer from serious mental illness many
  of whom have not been diagnosed some have no
  diagnosable mental illness. We have to pay
  serious attention to all suicidal talk and
  behavior.

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Myth or Fact?

• Suicide is preventable

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Fact

• It is simply not true that once suicidal, always
  suicidal. Most people who are considering
  suicide will be suicidal for a relatively short
  period of time. Given proper assistance and
  support, there is a strong possibility that there
  will not be another suicidal crisis.

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Myth or Fact?

• Many people think about suicide at some
• point in their lives.

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Fact

• 50 to 70 of people have thought of suicide at
  some point in their lives as shown in studies
  that investigated lifetime suicidal ideation.
• (Ramsay et al., 1999)
• In Hong Kong, 29.6 of those aged 15-59 in the
  population have ever thought about suicide in
  their lives, and 6.7 have suicidal ideation in
  the past year.
• (Prevalence Study of Suicidality in Hong Kong)

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Myth or Fact?

• People who talk about suicide dont really
• commit suicide.

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Myth

• Of every 10 persons who kill themselves, 8 have
  given definite verbal warning signs of their
  suicidal intentions.
• (Center for Mental Health in Schools at UCLA,
  2003)
• 50.7 of those who committed suicide had either
  implicitly or explicitly expressed their suicidal
  plan prior to their death.
• (Psychological Autopsy Study of Suicide in Hong
  Kong)

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Myth or Fact?

• Suicidal people fully intend to die.

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Myth

• Most suicidal people are ambivalent about dying.
  On one hand, they wanted to commit suicide to end
  their pain, yet on the other hand, they wanted
  someone to be there to help them and listen to
  them.
• (Center for Mental Health in Schools at UCLA,
  2003)

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Myth or Fact?

• Once a person is suicidal, the person is suicidal
  forever.

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Myth

• Individuals who wish to kill themselves are
  suicidal only for a limited period of time. In
  other words, it is almost always a temporary
  state.

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Myth or Fact?

• People who threatens or attempts suicide are
  merely seeking attention.

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Myth

• 28.2 of all suicide cases in 2003 had an attempt
  history. 30.5 of the deceased aged below 25 had
  attempted suicide before.
• (Surveillance and Monitoring, 2003)
• Compared to the people who are alive, those who
  died by suicide were 24.8 times more likely to
  have attempted suicide before.
• (Psychological Autopsy Study of Suicide in Hong
  Kong)

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Myth or Fact?

• Talking about suicide or asking someone if they
  feel suicidal will encourage suicide attempts.

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Myth

• There is no evidence that asking an individual
  about suicidal ideation will increase the change
  that the individual will commit suicide. Most
  people thinking about suicide want very much to
  talk about how they are feeling and are relieved
  when someone else recognizes their pain. To
  avoid the subject of suicide is deadly.
• (Coleman OHalloran, 1998)

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The Aftermath of Suicide People bereaved by
suicide
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Video on People bereaved by Suicide in Hong Kong
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What is Stress?
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What is Stress?

• It is a stimulus things that stress us, e.g.,
  This broadening courses course co-ordinator
  stresses me!
• It is a response how we react to a stimulus,
  e.g., I feel a lot of stress when I an being
  asked to answer questions in lectures of this
  course
• It is a process in which the person is an
  active agent who can influence the impact of a
  stressor through behavioural, cognitive, and
  emotional strategies. E.g., though this
  broadening course makes me stress, I can deal
  with it by following the suggested ways from this
  class.

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So WHAT stress you?

• In-class activity no.2 Hassles in Your life
  (Sarafino Ewing, 1999).

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The definition of stress -

• Stress as the condition in which
  person-environment transactions lead to a
  perceived discrepancy between the physical or
  psychological demands of a situation and the
  resources of the individuals biological,
  psychological, or social system (Lazarus
  Folkman, 1984).

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In English

• Stress is the reaction people have excessive
  pressures or other types of demand placed upon
  them. It arises when they worry that they cant
  cope.

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When do we see something as stressful?

• Determined by two components
• Whether a demand threatens our physical or
  psychological well-being (primary appraisal) and
  
• The resources available for meeting the demand
  (secondary appraisal).
• in emergency situations, i.e., disaster, our
  cognitive functioning is impaired during shock,
  it is unlikely that appraisal processes play an
  important role in the stress experienced while in
  that state

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Sources of Stress

• External
• Internal

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External Stressors

• Physical Environment (Noise, Bright Lights, Heat,
  Confined Spaces)
• Social Interaction (Rudeness, Bossiness,
  Aggressiveness by others, Bullying)
• Organizational (Rules, Regulations, Deadlines)
• Major Life Events (Birth, Death, Lost job,
  Promotion, Marital status change)

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Internal Stressors

• Negative self - talk (Pessimistic thinking, Self
  criticism, Over analyzing)
• Thinking errors (Unrealistic expectations, Taking
  things personally, All or nothing thinking,
  Exaggeration, Rigid thinking)
• Personality traits (Perfectionists, Workaholics)

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Types of Stress

• Negative stress (dy-stress)
• Positive stress (eu-stress)

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Note

• Most of the stress we experience is
  self-generated. How we perceive life - whether an
  event makes us feel threatened or stimulated,
  encouraged or discouraged, happy or sad - depends
  to a large extent on how we perceive ourselves.

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Note

• Self-generated stress is something of a paradox,
  because so many people think of external causes
  when they are upset.
• Recognizing that we create most of our own upsets
  is an important first step towards coping with
  them.

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How stress affects our Bio-Psycho-Social Aspects?
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How stress affects our Bio-Psycho-Social Aspects?

• Biological
• During emergencies fight-or-flight response
• Pupils dilated, far vision
• Dry mouth
• Sweaty palms
• Increased heart rate
• Maximum blood supply to muscles
• Digestion inhibited
• When stress prolongs
• GAS (General Adaptation Syndrome)

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What is GAS?

• Three stages
• Alarm Reaction similar to the fight-or-flight
  response
• Stage of Resistance - If the source persists, the
  body prepares for long-term protection, secreting
  hormones to increase blood sugar levels. This
  phase is common and not necessarily harmful, but
  must include periods of relaxation and rest to
  counterbalance the stress response. Fatigue,
  concentration lapses, irritability and lethargy
  result as the stress turns negative.
• Stage of Exhaustion - In chronic stress
  situations, sufferers enter the exhaustion phase
  emotional, physical and mental resources suffer
  heavily, the body experiences adrenal
  exhaustion leading to decreased stress
  tolerance, progressive mental and physical
  exhaustion, illness and collapse.

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The Psychosocial Aspects of stress

• Mental
• Behavioural
• Emotional

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Mental Symptoms

• Lack of concentration
• Memory lapses
• Difficulty in making decisions
• Confusion
• Disorientation
• Panic attacks

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Behavioural Symptoms

• Appetite changes - too much or too little
• Eating disorders - anorexia, bulimia
• Increased intake of alcohol other drugs
• Increased smoking
• Restlessness
• Fidgeting
• Nail biting

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Emotional Symptoms

• Bouts of depression
• Impatience
• Fits of rage
• Tearfulness
• Deterioration of personal hygiene and appearance

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Stress Related Illnesses

• Stress is not the same as ill-health, but has
  been related to such illnesses as
• Cardiovascular disease
• Immune system disease
• Asthma
• Diabetes
• Recurrent headache
• Cancer

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Why some people are more prone to stress, and
some are not?

• Social Support?
• A sense of personal control?
• A Hardy personality?
• Hardiness include control, commitment, and
  challenge.

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Coping with STRESS
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• Coping is the process by which people try to
  manage the perceived discrepancy between the
  demands and resources they appraise in a
  stressful situation.
• In English people come up with ways to either
  reduce demands or increase resources or both.

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Two major functions of coping

• Emotion-focused coping
• Problem-focused coping
• In-class activity no.3 Your Focuses in Coping
  - Billings and Moos, 1981.

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Two major functions of coping

• Emotion-focused coping is aimed at controlling
  the emotional response to the stressful situation
• Problem-focused coping is aimed at reducing the
  demands of the stressful situation or expanding
  the resources to deal with it.
• Please see examples of ways of coping from handout

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Stress Management Techniques

• Change your thinking
• Change your behaviour
• Change your lifestyle

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Change your Thinking

• Re-framing
• Re-framing is a technique to change the way you
  look at things in order to feel better about
  them. There are many ways to interpret the same
  situation so pick the one you like. Re-framing
  does not change the external reality, but helps
  you view things in a different light and less
  stressfully.
• Positive thinking
• Stress leaves us vulnerable to negative
  suggestion so focus on positives
• Focus on your strengths
• Learn from the stress you are under
• Look for opportunities
• Seek out the positive - make a change.

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Change your Behaviour

• Be assertive
• Get organized
• Ventilation
• Have a sense of Humour

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Be assertive

• Being assertive involves standing up for your
  personal rights and expressing your thoughts,
  feelings and beliefs directly, honestly and
  spontaneously in ways that dont infringe the
  rights of others.
• Assertiveness helps to manage stressful
  situations, and will, in time, help to reduce
  their frequency. Lack of assertiveness often
  shows low self - esteem and low self -
  confidence. The key to assertiveness is verbal
  and non - verbal communication. Extending our
  range of communication skills will improve our
  assertiveness.

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Equality and Basic Rights of being Assertive

• 1) The right to express my feelings
• 2) The right to express opinions / beliefs
• 3) The right to say Yes/No for yourself
• 4) Right to change your mind
• 5) Right to say I dont understand
• 6) Right to be yourself, not acting for the
  benefit of others
• 7) The right to decline responsibility for other
  peoples problems
• 8) The right to make reasonable requests of
  others
• 9) The right to set my own priorities
• 10) The right to be listened to, and taken
  seriously

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Get Organized

• Poor organization is one of the most common
  causes of stress. Structured approaches offer
  security against out of the blue problems.
  Prioritizing objectives, duties and activities
  makes them manageable and achievable. Dont
  overload your mind. Organization will help avoid
  personal and professional chaos.

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Time Management

• Make a list
• What MUST be done
• What SHOULD be done
• What would you LIKE to do
• Cut out time wasting
• Learn to drop unimportant activities
• Say no or delegate
• Plan your day
• Set achievable goals
• Dont waste time making excuses for not doing
  something

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Ventilation

• A problem shared is a problem halved
• Develop a support network through friends or
  colleagues to talk with. Its not always events
  that are stressful but how we perceive them.
• Writing a diary or notes may help release
  feelings but do not re-read what has been
  written.

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Change Your Lifestyle

• Diet
• Smoking Alcohol
• Exercise
• Sleep
• Leisure
• Relaxation

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Benefits of Exercise

• Uses up excess energy released by the Fight or
  Flight reaction.
• Improves blood circulation
• Lowers blood pressure
• Clears the mind of worrying thoughts
• Improves self image
• Makes you feel better about yourself
• Increases social contact

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Alternatives (less evidence, though)

• Conventional Medicine
• Counselling psychotherapy
• Relaxation
• Meditation
• Massage
• Yoga
• Acupuncture

• Aromatherapy
• Floatation
• Herbalism
• Biofeedback
• Homeopathy
• Hypnotherapy
• Osteopathy
• Pet Therapy
• Reflexology