Stress and Coping Mechanisms

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Stress and Coping Mechanisms
Class 1, Atatürk University Medical Faculty
Assist. Prof. Dr. Memet ISIK memetisik_at_yahoo.com h
ttp//aile.atauni.edu.tr/profildoc.-dr.-memet-isi
k
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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.

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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

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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.

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Common Stress Associated Diseases

• Diminished Immunity
• Headache
• Fatigue
• Weight gain
• Dyslipidemia
• Hypertension
• Heart Disease
• Psoriasis/Eczema
• Digestive problems

• Anxiety
• Depression
• Alcoholism
• Substance abuse
• Insomnia
• Irritable bowel syndrome
• Fibromyalgia
• Decreased sex drive

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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)

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The Stress Target Zone
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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

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Causes of Stress

• External causes
• Family, work, economics, school, major life
  changes, unforeseen events, etc.
• Internal causes
• Worry, uncertainty, fear, attitudes, unrealistic
  expectations, etc.

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Causes of Stress

• Environmental
• Heat, noise, crowding
• Physiological
• Drugs, caffeine, tobacco
• Emotional (psycho-social)
• Pressures, life

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Characteristics of Stressful Events

• Negative
• Harder to accept than
• positive
• Uncontrollable
• Take control of what you
• can
• Ambiguous
• Accompanies poorly defined
• expectations

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Contemporary Views of the Nature of Stress
The Process of Stress
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Appraisal of Stressors
High Stress
See stressor as a threat
Stressor
Stress
Appraisal

See stressor as a challenge
Low Stress
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Sources of Clinical Stress

• For patients

• For doctors

• Poor patient outcomes
• Risk of making an error
• Unfamiliar situations
• Excessive workload
• Inadequate resources

• Uncertainty
• Fear
• Pain
• Cost
• Lack of knowledge
• Risk for harm
• Unknown resources

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Stages of the Stress ResponseGeneral Adaptation
Syndrome of Hans Selye (1907-1982)

• Alarmwhen one feels threatened
• Activation of the fight or flight reaction
• Resistancemobilization of resources to solve the
  problem
• Continued stress causes adaptation
• Exhaustion
• Adaptation fails and level of function decreases

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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

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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

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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

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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

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Genetics Development

• Genetics

• 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

• Genes control the stress response
• Individuals have different responses to stress
• There is a genetic component to
• fearful behavior
• anxiety disorders
• Neurobiological response

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Responses to Stress

• Physiological
• Increased HR
• Tense muscles
• Cognitive
• Worry, lack of concentration
• forgetfulness
• Emotional
• Anger, sense of dread
• Behavioral
• Less patient, hurrying

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Coping Resilience

• Coping

• Resilience

• Ability to control emotions
• Ability to perceive reality
• Ability to think rationally
• Ability to problem solve
• Culturally defined

• The ability to bounce back
• The positive capacity to cope with stress
• Provides resistance to negative events
• Hardiness,
• Resourcefulness

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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

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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

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Promote Adaptive Coping

• Training
• Prepares for stressful events
• Nutrition
• Eat healthy, avoid skipping meals
• Exercise
• Include regular exercise
• Sleep
• Get adequate sleepavoid fatigue

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Avoid Maladaptive Coping

• Blurring of boundaries
• Avoidance/withdrawal
• Negative attitude
• Anger outbursts
• Alcohol/Drugs
• Hopelessness
• Negative self-talk
• Resentment (kindarlik)
• Violence

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Promote Resilience Factors

• Positive Role Models
• Optimism
• Humor
• Moral Compass
• Altruism (baskalarini düsünme)
• Religion Spirituality
• Social Support

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Positive Role Models

• Transmit
• Attitudes
• Values
• Skills
• Patterns of thoughts and behaviors

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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

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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

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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

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Altruism

• Unselfish regarding the welfare of others
• Believe in a meaningful cause
• Mutual cooperation
• Activates of the brains reward center

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Religion and Spirituality

• Associated with psychological and physical well
  being
• Guards against despair
• Provides social support
• Provides positive role models
• Provides a positive mission

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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

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Signature Strengths

• Recognize skills and talents
• Inventory strengths
• Use your strengths and talents
• Decide what works
• Actively cope
• Apply concepts to enable active coping.

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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

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Review Practical Tips

• Set realistic expectations
• Exercise regularly
• Eat healthy
• Get adequate sleep
• Maintain a work-leisure balance
• Positive Reframing optimism
• Enhance social support

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Internet Resources

• Building resilience http//www.slideshare.net/3do
  gMcNeill/building-resilience
• Diet, exercise, stress and the immune system
  http//my.clevelandclinic.org/disorders/chronic_fa
  tigue_syndrome/hic_diet_exercise_stress_and_the_im
  mune_system.aspx
• Exercise Rev up your routine to reduce stress
  http//www.mayoclinic.com/health/exercise-and-stre
  ss/SR00036
• Positive thinking Reduce stress, enjoy life
  more http//www.mayoclinic.com/health/positive-th
  inking/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-ma
  nagement/SR00031
• Stress reduction techniques A must for a healthy
  lifestyle http//www.managestresstips.com/categor
  y/stress-reduction/