PATIENT EDUCATION MODULE 9
Stress Management

 Stress is a normal part of life.  Changes that trigger the stress response may be external, or internal. Internal triggers can include physical illness or "psychological stress".  Examples of each would be:

                   External:     - world events

                                        - noise

                                        - time pressure

                  Internal       - illness

                      - ageing

           

            "Psychological Stress" or how we interpret the events or circumstances of the

external/internal triggers.  For example, losing a job because the company is "down-sizing" may be stressful in a different way than losing a job because we believe we have been falsely accused of incompetence.

 

REGARDLESS OF THE SOURCE OF "STRESS", THERE ARE CERTAIN PHYSICAL

REACTIONS THAT CAN OCCUR WHICH MAY HAVE HARMFUL EFFECTS.

ACUTE STRESS SUCH AS ALMOST BEING IN A CAR ACCIDENT CAN BE FELT AS SUDDEN POUNDING IN THE HEAD (DUE TO INCREASED BLOOD PRESSURE), A SPEEDING UP (OR SLOWING DOWN) OF THE HEART, OR A WARM FLUSHED SENSATION OVER THE FACE AND TRUNK.  THIS IS DUE TO THE SUDDEN RELEASE OF "ADRENALINE" AND IS GENERALLY KNOWN AS THE "FIGHT OR FLIGHT" RESPONSE.  THIS IS NORMAL - IT IS THE CHRONIC STRESS WHICH NEEDS TO BE MANAGED.

When the human body experiences stress, a series of chemical changes occur.  The pituitary gland releases a hormone that in turn triggers the adrenal glands to release epinephrine and various other hormones.  This process produces a physical reaction of the body that includes increased heart rate, increased blood pressure, increase respiration, muscle tension, and increased perspiration.  This process of adaptation is a normal reaction that is usually considered healthy.  Prolonged and unwanted stress, however, can have undesirable effects on mental and physical health, the body's adaptive and resistance mechanisms may become exhausted, and hormonal changes may weaken the body's defences against disease.  Reactions can vary among individuals.

I:  Potential Effects of Stress on Health

Cardiovascular:

- Coronary artery disease

- Heart attack

- Hypertension

- Stroke

Immunologic:

-      Reduced resistance to infection

-      Tumour promotion

Gastrointestinal:

- Ulcers

- Irritable bowel syndrome

Psychiatric:

- Neuroses

- Post-trauma stress syndrome

Genito-Urinary:

-      Failure to menstruate

-      Impotence

II:  Signs of Stress/Distress

Physical:

·            Pain can include chest pain - but don't automatically assume this is the cause

·            Tight stomach

·            Prolonged muscle tension

·            Shortness of breath

Psychological:

·            Decreased concentration

·            Decreased ability to make decisions

·            Worry, anxiety, depression

·            Decreased confidence

·            Absent-mindedness

·            Mixed emotions like sadness and anger

·            Irritability or frequent anger

·            Irrational fear or outright panic

Behavioural:

·            Inability to sit still

·            Nervous tics or mannerisms like nail-biting, toe tapping

·            Reckless driving

·            Increased use of alcohol or drugs

·            Increased or decreased eating or sleeping

·            SMOKING

The factors that trigger the stress response are called stressors.  The stressor is the cause.

Stress is the effect.

III:  Common Stressors

-      Death of a spouse

-      Divorce

-      Marital separation

-      Worry about children

-      Personal injury or illness

-      Marriage

-      Fired at work

-      Retirement

-      Birth of a baby

-      Traffic jams

-      Exams

-      Unclear job expectations

-      Conflict with family

-      Difficulty saying no

-      Lack of confidence

-      Low self esteem

-      Job responsibilities overload

-      Waiting in line

 

Usually we cannot do much to alter the stressful conditions in which we live.  We can, however,

improve the ways in which we react to stressful stimuli.

Make a list of the things you find most stressful in your life:

 

Would you like us to help you manage any of these?  Speak to your nurse.

 

IV:  Managing Stress

There are different ways of managing stress, and since everyone is different, no single technique will be right for every individual.  You must find the  technique that suits you best.  Two general categories of stress  management can be considered:   physical and  psychological

Managing Stress Physically

Exercise is the most beneficial and least destructive way to work off frustration, and has the extra bonuses of toning and strengthening your body.  Stressors that we deal with more are often psychological, but our bodies still respond physiologically.  With physical exercise the body can process the physiological changes, and clear the harmful build-up of chemicals.

A balanced diet contributes to a healthy body, enabling one to be better prepared for stressors.

Regular sleep rejuvenates the body and mind.  Allow for more sleep time during extra stressful periods.  If the sleep pattern is affected, a ritual such as half-hour wind-down period before going to bed may be helpful.  Herbal teas or warm milk can have a sleep-inducing effect.  They have fewer side effects than sleeping pills

Managing Stress Physically cont’d

Breathing slowly and deeply tends to release the tension build-up.  Often we react to a stressful

event with rapid shallow breathing  which itself serves to makes us feel more stressed.

Breathing exercises, meditation techniques and regular participation in sports are found to counteract life's pressures.  It has been shown that these relaxation techniques can modify the response to epinephrine and other adrenal hormones directly responsible for stress-induced changes.

Relaxation Exercises:

1) Progressive muscle relaxation:

Allow yourself 15-20 minutes to practice this procedure once or twice a day.  Try to find a quiet room where you will not be disturbed and that is comfortable for you.  You may either sit or lie down.  If sitting, try to have a comfortable armchair where your head and arms can be supported.  Once you have become comfortable, close your eyes and think about a pleasant, quiet place where you have been or one that is easy for you to imagine (like being on the beach and listening to the waves).  As you are going through the relaxation procedure and you find yourself thinking about problems at work or things you have to do, gently ease them away by returning to thinking about your more relaxing thought.

2)    Relaxation Breathing..

I . Sit comfortably in a chair.  Loosen any constrictive clothing such as belts.

2.         Assess your breathing. place one hand on your chest and one hand on your abdomen.  Breathe in through your nose and out through your nose or mouth.  Your upper chest is probably the only part rising.  To relax, you must breathe deeply.  Now breathe deep through to your belly.  Let your belly rise.  Allow yourself to relax.  Breathe in and out slowly.

3 .    Inhale deeply, filling belly first then lower lungs, then filling the chest and pushing ribs out.  Reach out, allowing yourself to become more relaxed.

4.     Inhale through your nose to a slow count of 4; hold your breath to a slow count of 4; breathe out to a count of 4.

5.     Allow yourself to relax.

6,   With time, increase to a count of 6 or 7. Hold the same count; exhale to the same count.

3) Breathing Technique to feel more alert:

Inhale to a count of 6; hold for a count of one; exhale for a count of 3.

4) Breathing technique to help sleep:

Inhale to a count of 3; hold for a count of one; exhale to a count of 6.

5) Tension and relaxation exercises:

Tense each muscle group for about 5-10 seconds before releasing it.  Then concentrate the relaxation you feel for 30 seconds to I minute before proceeding to the next muscle group so that you may become aware of the difference in feeling.  Breathe normally.

1.     Hands: clench each fist separately and feel the tension, then do both together.

2.     Lower arms: make a fist and bend each arm up at the elbow, first with the right arm,

then repeat with the left arm,

3.     Upper arms: reach out the right arm in front of you as if you are reaching for

something, then relax it.  Repeat with the left arm.

4.    Facial muscles: tightly close your eyes and "scrunch up" your face.

5.    Eyebrows: lift with your eyes still closed.

6.    Clench your teeth.

7.    Purse your lips.

8.    Neck: bend your head back then forward so your chin touches the chest.

9.    Shoulder: shrug one and then the other and then both.

10.  Chest: fill lungs with air, hold and breathe out.

11.   Back: arch your back.

12.   Abdomen: tense stomach muscles by bearing down.

13.   Buttocks and thighs: flex by pressing heels of feet into the floor.

14.   Lower leg:. point toes toward your head then away from your head.

15.   Feet: crinkle toes and hold.

Managing Stress Psychologically

Communicate effectively: Learning to express your feelings and opinions directly, honestly, and respectfully is one key factor in reducing stress.  Active listening reduces misunderstandings.  If you are uncertain about a message, take time to check out what you believe the other person is saying.  Trying to read people's minds instead of clarifying the issue usually results in a misunderstanding.

Accept people as unique individuals.  When we respect our own value, we become more aware of the value of others.  Before flying off the handle, remember that anger is frequently an indication that you expect someone to be more like you.  Check out the source of your frustration or anger and be clear about where changes, if any, need to be made.  You may find that working with others is easier and less stressful than competing with others in everyday activities.

Perfection is for gods and angels: be realistic.  Some people expect too much from themselves and forget to give themselves credit for a job well done.  Be clear about your own standards, and check that you are not being controlled by someone else's standards.  Being superior in everything is simply not possible.

Plan quiet time: Develop a daily habit of spending some time alone to relax.  The place that you

choose to be alone can be real or created in your imagination.

Managing Stress Psychologically  cont’d

It's OK to give in occasionally.  No one is always right.

Learn the fine art of saying "NO": This will give you more time.

Handle one thing at a time.  Divide your workload into smaller tasks and enjoy a feeling of

accomplishment when each is completed.

Appreciate small beauties.  Take time to appreciate the beauties in the environment.  The part of

blue between the clouds, the seasonal colours, the artwork on office walls.

Talk about problems and concerns.  Don't bottle up your feelings.