UNIT 5 STRESS MANAGEMENT

Structure
5.0 Objectives
5.1 Introduction
5.2 ' What is Stress?
5.2.1 Definition of Stress and Stressor
5.2.2 Origin of Stress
5.2.3 Types of Stressors
5.2.4 Stress Cycle
5.2.5 How Do Our Body Cope wlth Stress
5.2.6 Effect of Stress on Performance
5.3 Stress Management
5.3.1 Self Help Methods
5.3.2 Learnt Methods (Behavioural Methods)
5.4 Role of Nurse Administrator in Stress Management
5.5 Let Us Sum Up
5.6 Answers to Check Your Progress

5.0 OBJECTIVES
After going through this unit, you will be able to:
define and explain stress;
identify sources of stress;
explain stress cycle;
understand body response to stress;
list various self-help methods of stress management; and
describe role of a nurse administrator in stress management.

5.1 INTRODUCTION
The twentieth century has been called the age of anxiety and stress. There is alarming
increase m health problems related to tension and anxiety. Some 75 per cent of
diseases are said to be stress related. For e.g., hypertension, heart disease, gastric
ulcers, migraine, ulcerative colitis etc. Stress related mental diseases are seen regularly.
People are spending lots of money to get tranquilizers prescription to relieve tension.
Lots of relaxation centers have come up to give respite to the stressed. Younger
generation is experiencing more stress as they are constantly in competition with
others, but others are also not spared as the stress factor changes, but stress persists.
Today job related stress is commonest of all, as it involves high expectations, result
oriented jobs, constant monitoring, rewards and punishment linked with performance.

Nursing is a profession demanding rigorous physical and mental input. Job related
stress are very common among nurses, as they have to work and stand for long hours,
have odd working hours round the clock, have to be always alert and careful as they
are dealing with human life. Ever increasing work pressure, shortage of staff, interaction
with patients, public and other professionals further expose them to extreme stress.
Low job satisfaction, stagnation, with little scope for growth leads to boredom and
monotony. All these factors collectively lead to stress and may ultimately precipitate
physical or mental illness and cause social problems.

This unit will help you understand and identify stressors and their effect on om-
physical, mental and social health. You will also be able to list ways to manage stress.
, %
This unit also suggests some very easy self-help methods to reduce stress. These Stress Management
methods can be tried and used by any body to help oneself.

5.2.1 Definition of Stress and Stressor

I
Stress is an internal state which can be caused by physical demands on the body (e.g.,
illness, extreme temperature, exercise etc) or by environmental and social situations,
which are evaluated as potentially harmful, uncontrollable or exceeding our resources
for coping.

Stress is any kind of pressure that affects a person in his daily life: This effect may be
healthy or unhealthy depending on his reactions to the stress factors. ,
b

The physical, environmental and social causes of stress are called stressors. Once
encountered by stressor, it may lead to number of physical and bodily responses. On
the other hand it can precipitate psychological responses like anxiety, hopelessness,
depression, fatigue, irritability etc.

Any change in the environment demands some coping but when this change or the
demand exceeds certain point it becomes 'distress' for an individual.

5.2.2 Origin of Stress

1) The origin of stress can be any stressor (presence or absence of a factor), e.g.,
high temperature can be a source of stress (presence of a factor) and absence of
comfortable sitting arrangement in office (absence of a factor) can also be a factor.
2) Life events: certain life events in our life can have a stressful impact on us. Loss
of dear ones, financial loss, strained relations, etc., are few examples of the same.
Our reaction to them and our handling of these situations decide how stressful we
become.
3) Personality: The response to stress depends upon various dimensions in the
individual's personality like emotional make up, aggression, adjustment ability,
practiLal approach, expectations from life, past experiences, beliefs, vulnerabilities,
resources, values, emotional stability and so on. Type 'A' personality characterized
by hostility, haste, and aggression is more prone to stress.

5.2.3 Types of Stressors

There are all kind of factors that can cause stress. They range from physical illness to
financial problems, to change of work, to strain relations, to loss of dear one, to social
situations. All these stressors can be listed under following headings:
1) Emotional stressors
2) Family stressors
3) Social stressors
4) Change stressors
5) Chemical stressors
6) Work stressors
7) Decision stressors
8) Commuting stressors
9) Phobia stressors
10) Physical stressors
11) Disease stressors
12) Pain stressors
13) Environmental stressors
Sup srvision, Guidance and Emotional Stressors
Counst'iling
Emotional stressor includes the fear and anxieties with which we struggle: what will
happen in future?, What if I loose my job?, What about my child's future?, What If I
fall ill?. Excessive aggression, hostility, sadness, hopelessness, irritability and mood
fluctuations are few examples of emotional stressors.

Family Stressor
Changing relationship in family structure can be a source of stress. Strained
relationship with blood related, children, parents and ofiers can be stressful. Having a
newborn, an adolescent, aging parent or grand parents may lead to stress for some.

Social Stressors
Interaction with others in society can involve social stress for some. Dealing with
neighbors, friends, relatives can cause stress to few. Any drastic change in the
position of an individual in society can lead to social stress.

Change Stress
For some, any change in their well-defined schedule can be a stress. For others,
leading a monotonous life with no change-can involve stress. Usually change demands
readjustment. Many of us are not very comfortable making readjustment and can
experience stress.

Chemical Stressor
These may include alcohol, drugg caffeine and nicotine. We may ingest excessively large
quantity of alcohol or smoke, which can cause physiological changes leading to stress.

Work Stressor
Work stressor includes work place, occupation, work pressureljob responsibility leading
to work related stress. Jobs which have greater job responsibilities, dead lines to
complete jobs, excessive supervision, output linked rewarded, odd working hours are
more likely to lead to work stress.

Decision Stressors
Taking decisions can also become a stressful act for some. Rational decisions depend
on our ability to predict the consequences of our actions. Decision about vocation is
one of the most difficult decisions. This can become stressor for parents and their
children. Decision stress on the job is also increasing. Many job carry too much
responsibility with only little authority. As a result of this, individuals experience role
ambiguity and conflicting job demands.

Commuting Stressor
Many people spend lots of their energy, time and money in commuting long distances
to work. They may drive rash to reach on time and drive in rush hours and ultimately
suffer physical exhaustion. For them commuting, itself, becomes more tiring than job
and may suffer with commuting stress.

Phobia stressor
Irrational and excessive fear of any thing is called phobia. Many people have
exaggerated fears of certain animals, places, objects or situations and this can be a
great source of stress for them.

Physical Stressor
Physical stressors are demands that change the state of our bodies. Physical stressor
can be the strain we feel when we physically over extend ourselves, fail to get enough
sleep, lack of diet or suffer an injury. Pregnancy is another example of physical stress.

Disease Stressor
Both long term and short-term disease can cause disease related stress. Chronic
diseases like headaches, arthritis, asthma, allergies, ulcers, hypertension, diabetes, and
dermatitis etc cause disease stress making an individual irritable and vulnerable to
pmntinnal niithiir~tc
 Stress Management
Pain Stressor
Aches and pains of new and old injuries, accidents or diseases are pain stressors.
Chronic pains result in decrease of both physical and social activities leading to
sola at ion and inactivity.

Environmental Stressor
Physical conditions of environment can sometimes be very stressful. A noisy
environment, dim light, suffocated room, old and dirty furniture, uncomfortabl~sitting
etc are all environmental stressors.

5.2.4 Stress Cycle

Long term exposure to stressors lead to permanent behaviour, physical and cognitive
changes. These changes hinder adaptation to the environment and create distress.
These changes themselves become a source of stress and tend to perpetuate a cycle
of distress (Fig. 5.1). on the other hand, people who develop ways to cope with
stressors are able to respond adaptively. They are able to handle stress and protect
themselves of ill effects of stress. This is called wellness cycle (Fig. 5.2).

Distress
I 1

- - - --+ Change stressors

Chemical stressors
Disease stressors
Emotional stressors
Phobic stressors
Physical stressors
Where
stress Commuting stressors Environmental stressors Social stressors
comes Decision stressors Family stressors Work stressors
I
from: Pain stressors
I

Stress Overloading
I
Behavioural
(e.g., overeating
Immediate and
effects: excessive
alcohol
consumption)
L A
Physiological (e.g.,
heightened muscle
tension, elevated
blood pressure, and
rapid heart beat)

Medical
disorders (e.g.,
headaches,
.
r Emotional
(e.g.,
heightened
anxiety,
depression
and anger)

Emotional disorders
(e.g., chronic anxiety
and depression,
(e.g., increased
distractibility,
decreased
concentration)

Cognitive
disorders
(e.g., memory
hypertension, phobias, personality problems,
alcoholism) and heart changes, and obsessive
disease) mental illness) thoughts, and
sleep disorders)

I Over- Decreased Productivity

I all Decreased Enjoyment
/ 1 costs: Decreased Intimacy

t
Fig. 5.1: Distress Cycle

1 5.2.5 How Do Our Body Cope with Stress

D~fferentpeople respond differently to stress. They respond by either, fighting or
I
runlung away c.xlled fight or flight response. The autonomic nervous system in our
i l.,,1.. I..." ...- 2 -- -
--11.3 ., .. 3 n . . -
Supervision. Guidance and
<'ounselling

Wellness
.
I
I
Where Change stressors Disease stressors Phobic stressors
stress Chemical stressors Emotional stressors Physical stressors
comes Commuting stresson Environmental stressors Social stressors
from: Decision stressors Family stressors Work stressors
Pain stressors
I I

Health-promoting
Lifestyle Responses

Adaptive Adaptive Adaptive, cognitive,

Techniques Behavioural Physical and emotional
and skills: Responses Responses responses (e.g.,
(e.g., assertiveness, (e.g., nutrition, stress innoculation.
time management) exercise, relaxation) cognitive restr~~cturing)

health and health and

resistance to resistance to
and self-confidence disease future stressors

Over- all lncreased Productivity

benefits: Increased Enjoyment
lncreased Intimacy

Fig. 5.2: Wellness Cycle

means before and pathetic means to arouse the feelings. Thus sympathetic means
before the feelings are aroused. Increased heart rate and breathing are the body's
sympathet~cnervous system responses to stress. These responses are automatiwand
are aroused even before the feeling of fear or of any kind are experienced by an
individual.

Para sympathetic nervous system IS also part of autonomic newous system but
Influence the body in almost the exactly opposite manner. Parasyrnpathetlc nervous
system modifies the sympathetic nervous system responses like decreasing heart rate,
slowlng the breathing, retarding perspiration etc. Parasympathetic nervous system
conserves and replenishes the energy. Sympathetic nervous system is like emergency
system and Para-sympathetic system is like maintenance system.

People with higher sympathetic responses may find difficult to sustain stress for long.
Whereas individuals with stronger Para-sympathetic system are better equipped to
manage stress and may prefer "stay and play" than to "fight or flight".

Dr. Hans Selye (1956, 1976) is referred to as father of stress research He termed the
body response to stressor as 'general adaptation syndrome'.

The 'general adaptation syndrome' has three stages:

I) The A l m Reaction. '
9
2) The Stage of Resistance
3) The Stage of Exhaustion
a,
 Stress Management
The Alarm Reaction
During the alarm reaction the stressor activates the body to prepare for fight or flight.
Both electrical and hormonal signals are involved in mobilizing the energy needed for
an emergency. Heart rate, breathing and perspiration increase. Pupils are dilated.
Adrenalin and cortisol are released in blood stream. Stored energy floods to
bloodstream. According to Selye if the stress is strong enough, it may result to death
during alarm reaction.

The Stage of Resistance

On prolonged exposure to stressor, body responds by resisting the effects of
continuous stressor. This is called the stage of resistance. The body responds by
release of certain hormones, which help in coping the stressor.

Perception of stressor activates hypothalamus to release Corticotrophin Releasing

Factors (CRF), which in returns activates gland to release Adreno Corticotrophin
Hormone (ACTH).

ACTH stimulates cortex to release cortisol into the blood stream. Cortisol and other
similar hormones allow the body to deal adaptively with stressor for long period during
the stage of resistance.

Stage I I Stage 2

I \
Alarm ~eactibn Fight Exhaustion illness
or Flight Response Burn out syndrome

I Fig. 5.3: Selye's General Adaptation Syndrome

Nerve cells Pitutory gland to

of hypothalamus to CRF activate release ACTH
a""ate e)
stressor . release mrticotropin
releasing factor > (adreno cortico tropin
hormone)
CRF

-
ACTH
stimulates

Cortisol and other V

similar hormones have
many actions which
allow the body to deal
< Adrenal cortex to
secrete cortisol
adaptively with stressor
 b

Supervision, Guidance and Excessive exposure to stressor leads to continuous high level of these defensive
Counselling
hormones. High levels of these hormones in blood can be harmful. and can precipitate
diseases likk diabetes, hypertension and lowered resistance to i?fections.
1
In nutshell in the stage of resistance the body apparently puts a brave front but
internally it becomes weak and prone to illness due to excessive and prolonged
exposure to stress.

The Stage of Exhaustion

This is the final stage of general adaptation syndrome, where the continuous exposure
to stressor has nearly depleted the organism's adaptive energy. In this stage the
body's capacity to respond to both continuous and new stressor gets seriously
affected. The signs of initial alarm reaction reappear but they d~ not abate. Resistance
is decreased and illness or death may follow.

Stressor induced hormonal effects precipitate illnesses like gastric ulcers, diabetes, skin
disorders, asthma, hypertension, and increased susceptibility to cancer an$ other
infections.

Psychosomatic disorders are also likely to set in during this stage.

5.2.6 Effect of Stress on Performance

Stress takes it toll on all spheres of life. It affects the perforhance. According to
Yerkes and Dodson, when the level of stress is low, the performance is also poor, but
as the stress level rises so does the performance. This statement is true till the stress
reaches an optimum level to give maximum performance but once the stress crosses the
optimum~levels,the performance fall significantly.

5.3 STRESS MANAGEMENT

-

The life today is becoming more and more stressful. We will not be able to control
many external factors responsible for stress. For, e.g., we cannot control traffic, or job
related stress, or family discords, or the rat race of s o c i b . These all are few examples
of external stressors and are not in our control. But yes, there are ways to control our
reactions to these stressors. A mild or delayed reaction to these stressors can help us
cope better. By using- various means we can deal with them effectively. By altering our
responses to these stressors we can control their ill effect on us.

There are rnany simple ways to combat stress. These can be practiced by all of us on
daily basis to strengthen our defense against. stress. But if the situation becomes
 Stress Management

Fig. 5.5: Yerkes and Dodson Law

We can club these methods of stress management in two broad categories

1) Self Help methods
.2) ' Learnt Methods

5.3.1 Self Help Methods

This category covers ways of managing stress by observing its cause and effect
relationship with our response and thereby controlling, eliminating or reducing the
intensity of stressor. Another way to handle ill-effect of stress is to regulate our
response to the stressor by either delaying the response or reducing the intensity of
response. For, e.g., if drinlung too much coffee makes your jittery or irritable, it is better
td reduce the intake of coffee (chemical stressor) by substituting wlth caffeine free
$inks. By reducing the intake of coffee you have controlled/reduced the stressor. Lets
take another example. If standing continuously in your work place tires you and makes
you irritable. You can take short breaks from continuous standing by sitting and doing
some written work or by taking some energy drink in between or by doing some
physical and breathing exercises to improve your stamina.

Many environmental stressors can be managed by making minor environment changes.

For, e.g., if you get exhausted by driving through traffic jam and experience 'commuting
stress'. It is better to start little early to avoid heavy traffic hours, or to go for car
pool, or to use charted bus and listen to some relaxing music or enjoy recreational
reading, It is essential to identify these stressors and be creative in handling them.

Many of our stress related reactions are due to minor, chronic and unattended health
problems. It is observed that stress response gets triggered in the presence of health
problems. Therefore it is important to value and enhance well being, by attending to
health problems and getting proper treatment for them. Taking care of health would
reduce the number of stressors.

Another way of managing stress is to change your life style and adapting new ways
of viewing the world A lot depends on how we view the world. If you think the world
is bad; it is bad. If you feel that people are selfish, they are; and if you think there is
always a good reason for every thing, there is. It is very essential to be optimistic and
be objective in viewing the situation. It helps to plan an effective management of the
situation without causing damage to physical and mental health. This method is a self-
help method, where we learn to view a situation from different viewpoints. Initially, we
, have to put in effort to practice it but gradually it becomes a part of our thinking
process and an inevitable component of stress management. Lots of stressors can be
elim~natedand nullified by objectively evaluating their nuisance value and by simply
lgno;ing or over looking them. In the process of evaluation, we may find them not
,. ...,&I. , +L,..,I.+ ,.-I -,.: ,+A-,-+
:,,,.. ,+ :
I.
,-
S u p e r v i s i o ~ l .G u i d a n c e a n d Usually we all 'react to a situation and not act', i.e., we some times react blindly to the
C'ounselling situation. Instead, we should act rationally and identify the stressor and look for
alternative modes of handling these stressors. A balanced diet, sufficient sleep, some
physical exercises, yoga, little entertainment and good insight can help adapt to many
stressors.

Role of yoga, physical exercise and meditation in the management of stress has already
been established. These methods relax both body and mind and equip the individual
with effective coping mechanisms. They increase both physical and mental stamina of
an individual. During meditation both breathing and heart rates slow down. Muscle
tension gets reduced, oxygen consumption goes down and blood levels of lactate and
cortisol hormone decrease indicating relaxation of both body and mind. Regular exercise
and meditation are two good ways of achieving relaxation and stress reduction.

All these adaptive behaviour responses can be clubbed under following headings:
1) Adaptive Behaviour Responses (managing stress at behaviour lev~l).
2) Adaptive physical Responses (managing stress at physical level).
3) Adaptive Cognitive Emotional Responses (managing stress at thought and
emotional level).

The 10 commandments of stress Management:

1) Preparation for Life Transition: Anticipate the stress that is likely to come in the
near future and prepare to handle it.
2) Social Support: It must be with friends and relatives as they form a special part
of emotional well being.
3) Communication: The ability to express and share feelings, thoughts and emotions
clearly, openly and honestly is one of the most important aspects of managing
personal and professional life.
4) Acceptance and Confrontation: It must be accepted that you are having stress
and it must be managed.
5) Belief System: This is a process of reading ones own mind and clarifying
conflictual issues and help you set realistic goals for your self.
6) Adapting the Right Attitude: Relationships with others depend a lot on our
personality structure and our attitude towards others and life situations. Adapting
a right attitude towards self, others and life events significantly decreases the
stress.
7) Avoid Drugs: Taking alcohol, caffeine or sedatives is h?rmful and worsens the
situation in long run and therefore must be totally avoided.
8) Life Style: To be a good stress manager one must be fit and healthy. Balanced
diet, sufficient sleep. exercise on regular basis, use of relaxation technique and
entertainment provides strength and stamina needed to meet daily challenges of
life.
9) Problem Solving Attitude: Identifying a problem and fighting it in a scientific
manner helps resolve stress. Simply ignoring stress leads to a greater stress
situation.
10) Professional Help: When one is not able to handle the stress and finds one self
under constant pressure, it is time to take professional opinion. A mental health '
professional can view your situation from different perspectives and help you .
cope situation.

5.3.2 Learnt Methods (Behavioural Methods)

There are many other methods of stress management that can be learnt with the help
of professionals e.g.
1) Relaxation training
2) Bio feeaback
3) Systematic desensitization
1, IT-.
1) Relaxation Training Stress Management

In relaxation training the therapist teaches different ways of inducing relaxation. The
therapist may use progressive muscle relaxation from head to face, to neck, to shoulder,
to hands, to back, to lower limbs and to toes. They may use cue controlled relaxation,
where the client repeats a cue word such as 'relax' while taking deep breath and
recalling their sensations during the progressive relaxation training. Clients are
encouraged to practice these methods using audiotapes or using self-instructional
technique. These methods have been found to be effective in dealing with stress
related headache, migraine, insornnias, anxiety etc.

Sometimes relaxation instructions are supplemented by guided imagery where the

therapist directs the client to focus on pleasant, relaxing scenes may be sitting or lying
on the beach or sitting in a park etc. These activities have tranquilizing effects on the
client and help relax him.

2) Bio Feed Back Method

This is a technique in which, people learn to modify internal body responses, such as,
heart rate and body temperature. In this method involuntary physiological responses
can be brought under voluntary control through instrumental conditioning.

A feed back device connected to the body of the client gives information in the form
of a light signal about the existing heart rate and body temperature. Clients go through
training session to observe these signals, pay close attention to subtle bodily cues and
regulate their heart rate. They learn to control it even in the absence of electronic
signal.

Miller (1969) showed that involuntary physiological responses could actually be

brought under voluntary control through what seems to be instrumental conditioning.
This discovery of regulating heart rate and body temperature is used as therapy in the
treatment of conditions llke cardiac arrhythmias or irregular heartbeat.

Bio feed back training has also been effective in relieving Raynand's syndrome, a
disorder in which blood vessels constrict 'and cause the hand and feet to grow cold.
Some forms of headaches have also been found to be relieved with bio feed back
training.

Bio feed back method can be used to manage stress as it teaches people skills in
generalized relaxation. Relaxation towards overall sympathetic nervous system activity,
this in turn, withdraws physiological processes from over activity.

3 ) Systematic Desensitization
Exposure to certain objects or situations may trigger phobia reactions and cause
distress to an individual. Systematic desensitization helps individuals control and
change their reactions to them and hence relieve stress.

Systematic desensitization is a procedure, in which relaxation and pleasant feelings are

learned as conditioned responses to stimuli that once acted as fear producers. A
systematic exposure to stimulus (fear causing) trains individual to remain calm and
relaxed in the face stimuli. A systematic pairing of the feared stimulus with a relaxed
bodily state helps the individual over come his fear and anxiety.

Take an example of an individual who is excessively afraid of dogs. Systematic

desensitization would start from. may be showing the pictures of a dog, to looking at
chained dog, to seeing others play with dog'and finally to touching the dog himself.
This requires numbers of sessions and the progress will depend on individual's ability
to tolerate the situation and control his reaction.

A skilled therapist, who estimates ;he fear and identifies the various presentations of
stimulus as weak to strong stimulus, and finally puts them into series from weak
stimulus to strong stimulus, usually does this. procedure.
Supervision, Guidance and 4) Hypnosis
Counselling
Hypnosis is also one of the methods used for treating and managing stress. Hypnosis
puts the client int0.a trance like situation where the client is very suggestible.
Relaxation instructions used for deep muscle relaxation may include suggestions of
drowsiness or deep sleep. This state is called hypnosis. The heightened suggestibility
is used to get clients to comply with direct suggestions for behaviour change. '
Hypnotic treatment is used to stop health threaiening habits like smoking or over
eating.

Some therapists use hypnosis to uncover subconscious psychological causes of a problem.

5.4 ROLE OF NURSE ADMINISTRATOR IN STRESS

MANAGEMENT - - - -

Timely identification of building stress among staff members is the responsibility of the
nurse administrator.

There are various factors responsible for occupational stress:

How do you cope with stress at work?

Rate your response according to your experience over the last 2 months on a scale of
0 to 5, where 0 denotes never, and 5 denotes almost always.
 Stress Management
Constant exposure to stress can ultimately lead to 'bum out syndrome'.

The signs of burn out syndrome are:

1) Feeling that work cannot be done properly.
2) Total loss of interest in work.
3) Unable to motivate the 'self' for work.
4) Feeling sick at the thought of work.
5) Avoiding worWresponsibilities.
9 Avoiding colleagues.
7) Mood fluctuation, anxiety, depression.
g) Loss of zeal and desire.
9) Somatic complaints like aches and pains.
10) Relationship problems.

A vigilant administrator (be it ward sister, ANS or DNS or Nursing superintendent) will
be able to identify these signs of stress and manage them promptly.

Her management of stress may include prompt and extensive listening of problem,
careful observation of the staff, identification of problem, source of stress, exploring
different methods of correcting the source of stress and helping the staff to develop
healthy coping mechanisms.

Considering the demands of nursing as a profession, arrangement for some relaxation

and entertainment can be made to help reduce the occupational stress.

Keeping the work environment stress free, harmonious, light and lively can also help to
reduce the mounting pressure on staff. Improving wotking conditions and posting
sufficient staff especially in places like emergency, I.C.U, Nursery, O.T., etc., can reduce
stress among staff members.

In service training to enhance the professional skills, humane skills and coping skills
will strengthen the staffs' ability to meet the situation stress free.

Issue like promotion, personal growth, job security, workload and management problems
need to addressed and fairly handled to relieve the staff of unnecessary stress.

5.5 LET US SUM UP

Stress is an unwanted child of the present era. Every body has to face it and learn to
manage it. There are various factors responsible for stress. Some of the sources are not
in our control and only way to manage is to learn to cope with it.
Various adaptive responses can be learnt to cope with stress. These responses will
I
help avert the disaster of any mental as physical illness which otherwise is sure to
I occur.
I
Careful assessment of stress situation would help identify the source of stress. Among
the various management techniques are self help methods like exercise, yoga,
meditation. music. massaee. entertainment. which can helo relieve stress.
Superv'lsion, Guidance and When the stress starts affecting your personal or professional life and when none of
Courtselling
the above mentioned methods seem to work, one should not hesitate taking
professional help of a psychologist or psychiatrist.

5.6 ANSWERS TO CHECK YOUR PROGRESS

i
Check Your Progress 1 1
1) Refer sub-section 5.2.3.
2) Refer sub-section.5.2.3.

Check Your Progress 2

Refer sub-section 5.3.1.