STRESS MANAGEMENT
Waris Qidwai
Professor and Chairman
Department of Family Medicine
The Aga Khan University
Karachi - Pakistan
Rabindranath Tagore
Man's abiding happiness is not in getting anything
but 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
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.
History
Hans Selye (1907-1982)
Stress is the spice of life
DEFINITION OF STRESS
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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.
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”
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
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
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.
Quotation
Adopting the right attitude can convert a
negative STRESS into a positive one
Hans Selye
THREE STAGES OF ADAPTASION IN
STRESS
1.
2.
3.
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 organism’s defence mechanisms become
active.
Stage of resistance: During this stage the
person’s full adaptation may lead to
successful return to equilibrium.
Stage of exhaustion: In case of failure of
adaptability the organism becomes exhausted.
HUMAN FUNCTION CURVE
Intended Performance
P
E
R
F
O
R
M
A
N
C
E
Exhaustion
Fatigue
Actual
Performance
Healthy Tension
III Health
P
Breakdown
AROUSAL
P = The point at which minimum arousal may bring on a breakdown
STRESSORS
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Environmental
Work related
Interpersonal
Life events
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
PHYSICAL SYMPTOMS AND
SIGNS
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Back Pain
Constipation
Diarrhoea
Dizziness
Dry Mouth
Excess Perspiration
Excessive Hunger
Exhaustion
Headaches
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Heart Burn
Insomnia
Muscle Spasms
Nausea
No Appetite
Pounding Heart
Shortness of Breath
Skin Rashes
Upset Stomach
PSYCHOLOGICAL SYMPTOMS
AND SIGNS
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Anger
Anxiety
Apathy
Boredom
Depression
Fatigue
Fear of Death
Frustration
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Guilt
Hopelessness
Hostility
Impatience
Inability to
Concentrate
• Irritability
• Rejection
• Restlessness
BEHAVIOURAL SYMPTOMS
AND SIGNS
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Biting Lips
Foot Tapping
Grinding Teeth
Impulsive Actions
Moving in Tense,
Jerky ways
• Nervous Tics
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Overreacting
Stuttering
Swearing
Touching Hair, Ears,
or Nose
• Trembling Hands
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.
INFECTIONS AND IMMUNE
SYSTEM
•
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.
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
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.
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.
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.
A model of occupational
psychosocial stress
Source of stress
The Individual
Outcomes
Intrinsic Stress
Work Overload
Job dissatisfaction
Role in the
Organisation
Home/work
interface
Excessive smoking
Drug use
Self
Organisational
structure & climate
& Security
Excessive drinking
Demographic
factors
Stress
coping
ability
Anxiety
Depression
Coronary heart disease
Marital disharmony
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
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
Role in the Organization
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Clarity in the role/job description
Career progression
Responsibility Vs Authority
Vision and Mission
Ownership
ORGANIZATIONAL STRUCTURE
AND CLIMATE
Source of stress for the employee
arises from the organizational
structure and climate:
>Participation in the decision
making process
>Effective communication
>Restrictions in behavior
EMPLOYEES AND THEIR
FAMILIES
• Although stress is predominantly workrelated, 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
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
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)
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.
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
Measuring stress
Holmes and Rahe stress scale
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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
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.
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
Measuring stress
Holmes and Rahe stress scale
Life event
Life change units
Change in number of family reunions
Change in eating habits
Vacation
Christmas
Minor violation of law
15
15
13
12
11
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
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
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
SIMPLE STRESS MANAGEMENT
ADVICE
To avoid stress:
1. Accept it is normal to be an imperfect person in
an imperfect world
2. Problems are analysed logically and plans made
to resolve them
3. Work out those situations and people which
cause you stress and why?
4. Change those things that actually can be
changed
5. Identify and respect your own good points
6. Improve your shortcomings as much as possible
and then accept them as part of you
SIMPLE STRESS MANAGEMENT
ADVICE Cont’d
Don’t compare yourself with others
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’
7.
8.
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.
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.
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.
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
FIRST OCCUPATIONAL HEALTH CONFERENCE
APRIL 21, 2011
Tenderness and kindness
are not signs of weakness and despair
but are manifestations of strength and resolution
Khalil
Gibran
THANK YOU VERY MUCH