Stress Management

Dr Pavan Kumar kadiyala, MD (Psy)

Professor
 Defining Stress
▪ used for many centuries
– - “hardship, adversity, force, pressure”

▪ physical force that strains a material object

▪ As a biological phenomenon – similar conceptually to simple laws of physics.

– applies to living organisms just as it does to nonliving objects – with increased complexity
– Evolution: cellular stress response (CSR)  neuroendocrine stress response (NESR) in
animals psychological and emotional stress response (PESR) in humans
▪ Kültz, D. (2020). Defining biological stress and stress responses based on principles of physics. Journal of Experimental Zoology Part A:
Ecological and Integrative Physiology.
Hooke’s law:
▪ force (F) α change in length of object (ΔL) - [F = ΔL·k]
▪ Stress = F/A
▪ Strain = ΔL/L
 Homeostasis
▪ Life exists through the maintenance of
▪ a complex dynamic equilibrium, homeostasis

▪ constantly challenged by internal or external

adverse forces, stressors,
– can be emotional or physical
– push/pull cellular and
organismal physiological set‐
points out of homeostasis H
RELATIONSHIP BETWEEN STRESS AND STRAIN
▪ Hooke’s law: force (F) α change in length of object (ΔL) - [F = ΔL·k]

▪ For biological systems (cells and organisms) –

– ΔL is equated to Δ H (difference from homeostatic set‐point)

(the extent of dysregulation of the system in its entirety)

(“abnormal” strain)
▪ Increase in complexity of living systems – many (physiological and
morphological variables)
– any given variable ( i ) has its own homeostatic set‐point – affected by stress - (ΔHi).
Material Object vs Biological System

CSR -Cellular homeostasis response

CSR - Cellular stress response
Stress
What exactly is stress?
▪ Hans Seyle (Father of stress) coined the term “stress”
▪ The word “stress” comes from the Latin stringere “to draw tight”
▪ He misnamed as “stress”, it should have been “strain” as he was Austrian endocrinologist
– Too late. The term struck
▪ Dictionary def:
– A condition where an environmental demand exceeds the natural regulatory capacity of an organism

▪ In simpler terms
– Is what you experience when you believe you cant cope effectively with a threatening situation
– The difference between
▪ the demands of the situation and
▪ your perception of how well you can cope with that situation is
▪ what determines how much stress you feel

▪ Stress: a state of threatened or perceived by the individual as threatened homeostasis

▪ re-established by a complex repertoire of
– behavioral and physiologic adaptive responses of the organism
Stress causes stress?
▪ The word stress refer to the thing or circumstance out there that stresses us
– Stress = the bus that never comes, the deadline, the traffic jam, the sudden noise and so on.

▪ Same word to describe the physical and emotional discomfort we feel about the situation
– Stress = anxious, headachy, irritated and so on.

▪ Thus, feeling stress about stress.

▪ To avoid confusion,
– stressor or stress trigger – refer to potentially stressful situation or event
– Stress for emotional and physical responses
Understanding the signs of stress
▪ Can take different forms:
– Bodily changes
– Emotional changes
– Behavioral changes
Bodily changes
▪ HR speeds up and BP rises (more blood pumped to your muscles and lungs)
▪ Breathe more rapidly and nostrils flare, causing an increased supply of air
▪ Digestion slows
▪ Blood is directed away from your skin and internal organs and shunted to brain and skeletal muscles
– The muscles get tense. You feel stronger and ready for action.

▪ Blood clots more quickly, ready to repair any damage to arteries

▪ Pupils dilate for seeing better
▪ Liver converts glycogen into glucose, which teams up with free FAs to supply with fuel and some
quick energy
▪ All these bodily changes readies for a life-threatening emergency.
– Clearly, stress has adaptive survival potential.
– Stress, way back when, was nature’s way of keeping alive
Feelings and behavior change
▪ Emotional symptoms:
– Feel anxious, upset, angry, sad, guilty, frustrated, hopeless, afraid, or overwhelmed

▪ Behavioral reactions help “fight” or “flee”

▪ Fight or flight may not be an appropriate response to a non-life-threatening situation such as
misplacing your keys or failing your driving test
▪ The right amount of anxiety can motivate adaptive behavior, such as doing best or working
toward important goals
– However, too much of emotional trigger can cause to over-react or under-react
– Annoyance become anger, concern can turn into anxiety
– Excessive emotion can result in inappropriate responses. You may act too angrily, quarrel and later regret what you
said or did
– If you’re feeling anxious or fearful, you may go in the other direction. You may withdraw, avoid, and give up too
quickly.
A broken heart?
▪ A study by Mayo clinic in 2010
– Extreme or sudden stress that may accompany a relationship breakup or death of a loved one 
– “Broken Heart Syndrome” (BHS) or
– Stress cardiomyopathy (severe heart muscle weakness)
– Octopus trap cardiomyopathy (Lt ventricle balloons out in a peculiar shape) in Japan
– Usually in women
How this whole stress thing got started
▪ Believe it or not, you have stress in your life for a good reason
▪ A cave person with same routine every day suddenly spotted a tiger – fight-or-flight response
(life-preserving stress reaction)
▪ In modern jungle
– Life-preserving stress reaction is hard-wired in this system
– But replaced by social and psychological stress triggers, which aren’t worthy of a full fight-
flight stress response
– Your body doesn’t know this, and it reacts the way it did when ancestors were facing real
danger
– Being struck in traffic, confronting a disgruntled client, facing an angry spouse, or trying to
meet some unrealistic deadline is what stresses you.
– These far-less-threatening stressors trigger that same intense stress response. It’s overkill.
Your body is not just reacting; its overeacting. And that’s definitely not good
Classifying stressors
▪ Major stresses
– Death, divorce, financial ruin, serious illness
Classifying stressors
▪ Major stresses
– Death, divorce, financial ruin, serious illness

▪ Moderate stresses
– Losing your wallet, denting the car, or catching a cold
Classifying stressors
▪ Major stresses
– Death, divorce, financial ruin, serious illness

▪ Moderate stresses
– Losing your wallet, denting the car, or catching a cold

▪ Smaller stresses – mini/micro stresses – known as hassles

– Noisy traffic, crowds, long waits, crashing of computers, rude customers….
– You can deal with one, may be two or even three at once, but when number begin to rise, so does your stress level
– When you reach a high enough level of stress, you overreact to next hassle that comes along
Daily hassles (the little things add up)
▪ People usually deal fairly well with the major stress – deaths, illnesses, financial setbacks
– trigger hidden resources/unrecognized inner strength – manage to cope

• What magnifies stress is that the stressors in life are cumulative

• Multiple stressors create a synergy that makes the resulting stress much greater than the sum of its parts.

▪ Little annoyances, petty frustrations, and minor irritations – ultimately lead to a continuing
sense of stress
What makes stress such a problem
▪ Because stress can be continuous and ongoing
▪ A stressor here and there, now and then – one can handle
– If stressed out only once in a while, stress isn’t really a concern
– The body and mind react, but soon recover and return to a more relaxed state

▪ But too often we experience a near-continuous stream of stressors

– No enough recovery time
Signs and symptoms of chronic stress
▪ Benign to dramatic
▪ From simply feeling tired at the end of the day to having a heart attack (with intense & prolonged
periods of stress)
▪ Benign, commonly experienced physical symptoms/signs of stress
– Tiredness, fatigue, lethargy
– Heart palpitations; racing pulse; rapid, shallow breathing
– Muscle tension and aches
– Shakiness, tremors, tics, twitches
– Heartburn, indigestion, diarrhea, constipation
– Nervousness
– Dry mouth and throat
– Excessive sweating, clammy hands, cold hands and/or feet
– Rashes, hives, itching
– Nail-biting, fidgeting, hair-twirling, hair-pulling
– Frequent urination
– Lowered libido
– Overeating, loss of appetite
– Sleep difficulties
– Increased use of alcohol and/or drugs and medications
▪ Psychological signs of stress
– Irritability, impatience, anger, hostility
– Worry, anxiety, panic
– Moodiness, sadness, feeling upset
– Intrusive and/or racing thoughts
– Memory lapses, difficulty in concentrating, indecision
– Frequent absences from work, lowered productivity
– Feeling overwhelmed
– Loss of sense of humor
How Stress can make you sick
▪ Research estimate – 75-90% of all visits to primary-care physicians are stress related
▪ Every bodily system or body part is affected by stress
▪ Stress can exacerbate the symptoms of a wide variety of disorders and illnesses
▪ Linked to 5 leading causes of death:
– Heart disease
– Cancer
– Lung disease
– Accidents
– suicide
How stress can be a pain in the neck (and other places)
▪ Muscles are a prime target for stress
– When you’re under stress, your muscles contract and become tense

▪ Chronically tense muscles result in

– Muscle spams
– Cramping
– Facial or jaw pain
– Bruxism (grinding your teeth)
– Tremors and shakiness

▪ Many forms of headache, chest pain and back pain result from stress-induces muscle tension
Taking stress to heart
▪ Play a role in diseases such as CAD, sudden cardiac death and strokes
– b/c stress can increase your BP, constrict your blood vessels, raise your cholesterol level, trigger arrhythmias and
speed up the rate at which your blood clots

▪ Psychological stress  physiological inflammatory response in blood vessels

▪ Chronic stress  chronic inflammation
▪ Many research studies  stress, inflammation and heart disease are all linked
– Higher amounts of psychosocial stress and depression  elevated C-reactive protein and IL-6 levels =
both markers of inflammation

▪ Stress is now considered a major risk factor in heart disease, like smoking, being overweight and
not exercising
Hitting below the belt
▪ GIT can be a ready target for much of the stress
– Secretion of acid in your stomach
– Speed up or slow down the peristalsis (the rhythmic contraction of the muscles in intestines)

▪ Constipation, diarrhea, gas, bloating and weight loss all can be stress related
▪ Stress can contribute to GERD, IBS, colitis and Chohn’s disease
▪ People under stress usually experience changes in their weight
▪ 2 different ways
▪ Stress diet:
– Eating less; but isn’t best way to lose weight

▪ Feeding your emotions

– Overeating; unconscious intent to feel better/distraction from emotional distress
– But this “good feeling” lasts for about 12 seconds before you need another fix  putting notch on your belt

▪ When stressed  Cortisol  fat accumulation around your abdomen  enlarges individual fat
cells  “diseased fat”
Compromising immune system
▪ Chronic stress  immune system less effective in resisting bacteria and viruses
▪ Lower your resistance to colds
– The higher a person’s stress score, the more likely he was to come down with a cold when exposed to a cold virus
– A person catches cold
▪ If experiences chronic stress lasting a month or more
▪ Doubles the risk, if stress for more than a month but less than 6 months
▪ Quadruples the risk, if stress lasting >2 years

▪ Precipitate the ulcers

▪ Cholesterol goes up
– Studies on accountants before and after the month of April
– Rose significantly before the April deadline and fell after the deadline
Stressing Out Your Family
▪ Being stressed is little like having a cold. Others can catch it.
▪ When stressed, moods change, behavior changes, trigger negative interactions
▪ You’re not the same you – feels more angry, more upset and more worried
▪ People under stress can withdraw emotionally and communicate less.
– Friends and family may not understand what’s going on and in turn become stressed
– The cycle can escalate, leading to even more distress

▪ Children who see their parents stressing out (worrying, yelling, arguing) tend to become stressed
themselves
– Feel sad, worried and frustrated
– And it’s not just their emotions that are affected
– Trouble falling asleep at night, headaches, upset stomach, impair developmental growth
Management
Understanding Stress is as simple as ABC
▪ ABC model by psychologist Albert Ellis
▪ A B C
– A = Activating event or triggering situation. It’s the “stressor”
– B = Beliefs, thoughts or perceptions about A
– C = emotional, physical and behavioral Consequence or “stress” that results from holding these beliefs

▪ A potentially stressful situation  your perceptions  your stress (or lack of stress)
Real time examples to understand ABC model
▪ Scenario of common source of stress in life: the fear of being late
– You’re in a taxi headed for the airport, where you’ll board a plane to interview for a job
– Traffic is heavy and you didn’t expect that
– Your palms are sweaty and your breathing is rapid and shallow. You’re feeling anxious. You are stressed out
– A B C
– Late for the plane  “I’m never going to make it, and I won’t get this job!”  Anxiety and panic with sweaty palms and
rapid, shallow breathing
Managing stress: A three-pronged approach
▪ 1. Managing your stressors
▪ The events that trigger your stress can range from the trivial to the dramatic
▪ They can be very minor
– A hassle such as broken shoelace, a crowded subway, or the world’s slowest check-out line

▪ Can be more important

– Losing your wallet, hearing sharp words from your boss, or getting a bad haircut a week before your wedding

▪ Can be even more dramatic

– A divorce, a serious illness, the loss of a job, the loss of a loved one

▪ The number of potential stressors is endless

▪ Changing your “A” means altering, minimizing or eliminating your potential stressors

▪ Problem-solving and time-management skills

2. Changing your thoughts
▪ Even if you can’t significantly change the situations and events that are triggering your stress,
you can change the way you perceive them
2. Changing your thoughts
▪ Even if you can’t significantly change the situations and events that are triggering your stress,
you can change the way you perceive them
▪ Your beliefs, thoughts, perceptions, and interpretations – critical in determining how much stress
you feel
▪ Whenever you perceive a situation or event as overwhelming or beyond your control, or
whenever you think you can’t cope, you experience stress.
2. Changing your thoughts
▪ Even if you can’t significantly change the situations and events that are triggering your stress,
you can change the way you perceive them
▪ Your beliefs, thoughts, perceptions, and interpretations – critical in determining how much stress
you feel
▪ Whenever you perceive a situation or event as overwhelming or beyond your control, or
whenever you think you can’t cope, you experience stress.
▪ Stress is self-induced, can learn to see things differently.
▪ So, if you’re waiting in a long line, perhaps you’re thinking. “I just can’t stand this! I hate waiting!
Why can’t they figure out a better way of doing this? I hate lines! I hate lines! I hate lines!”
▪ Chances are, you’re creating more than a little stress for yourself.
2. Changing your thoughts

▪ On the other hand, if you’re thinking “Perfect! Now I have time to watch the fascinating video in
on “How to make stress your friend” by McGonigal in youtube “TED Talks”, you are feeling much
less stress.
▪ Your thinking plays a larger role than you may believe in creating your stress
Stress can be good?
▪ Stress is not always bad
▪ In fact “Stress is the spice of life” (Hans Selye)
▪ Good kind of stress eustress, as opposed to distress
▪ A positive force in life
– Right amount of stress can motivate you, focus you and get to perform at your peak
– The nervousness experiencing about presentation you’re making tomorrow can actually improve your performance

▪ Thrive on stress
– I’m at my best when I’m under pressure – a tight deadline, a major crisis.
– That’s when I feel most alive, most vital
– They like to be challenged, to have their abilities stretched and tested. For them this is a good kind of stress that can
be satisfying and rewarding.
– Many people who claim to thrive on stress are workaholics
– They get stressed when they have nothing to do. Lying on a beach, sitting in the park – stressful for them
▪ Change and the pressures of modern life don’t necessarily create the bad kind of stress
▪ Rather,
– how you view the potential stresses in your life and
– how you cope with them make all the difference
3. Managing your stress responses
▪ Even if you cant eliminate potential stressor and can’t change the way you view that situation,
you can still manage your stress by mastering other skills
▪ You can change the way you respond to stress.
▪ You can learn how to relax your body and quiet your mind
Getting started: Gathering
your tools
How stressed are you? Findings ways to measure your stress level
▪ 1st step in mastering your stress is
– Knowing how stressed you are

▪ But measuring stress is trickier business than you may think.

– Stress is both a stimulus and a response
– Some easy ways to identify and quantify just how stressed you are
Using stress gauge
▪ You may say to yourself,
– “I’m feeling a little five-ish.”
– This morning when you were struck in major traffic, you
probably would’ve described your stress level as a seven.
Measuring your stress in other ways
▪ Sometimes you experience stress but aren’t aware of it.
▪ That’s when a questionnaire, a more objective measure of your stress level, may be appropriate
▪ Do these scales from time to time, your scores can tell you how well you’re doing as you master
the various stress-management techniques and strategies.
The stress-symptom scale
▪ Rate the frequency with which you’re experienced each of the following items during last 2 wks
(0 = never; 1 = sometimes; 2 = often; 3 = very often)
▪ The higher your score, the more stress you’re having
The stressor identification scale
▪ Helps you not only assess the amount of stress you’re experiencing now but also identify where
the stress is coming from.
(N = No stress; S = some stress; M = moderate stress; G = great stress)
Monitoring your stress with a stress journal
▪ Stress journal or stress log
▪ This tool shows you
– What’s triggering your stress right now
– Measures your ongoing stress level

▪ It acts as a cue or prompt, reminding you should take some action and use one or more of the
stress-management tools you’ve mastered.
▪ A small notebook, or a smart phone if u are techy
Knowing how to record your stress
▪ Step 1:
– Write down what’s stressing you
– An event, a situation, an encounter or a problem
– Be sure to also note the approx. time in the “Time column”
Knowing how to record your stress

▪ Step 2:
– Rate the relative importance of the stressor
– Major – death of loved one, financial loss, life-threatening illness…
– Moderate- breaking leg, losing wallet, car break down on highway…
(big deals, not catastrophies)
– Everyday hassles – being late for a movie, caught in rain with no umbrella,
encountering a rude clerk….
Knowing how to record your stress

▪ Step 3:
– Write down what your stress looked like and rate your distress level
– Worried, anxious, upset, fearful, angry…..
Evidence-based stress
management techniques
▪ Jacobson Progressive Muscle Relaxation (PMR)
– alternately tensing and relaxing the muscles in a sequential pattern

▪ Αutogenic Training (AT)

– individual learns a set of directions/exercises that command the body to relax and control breathing, blood pressure,
heartbeat, and body temperature.

▪ Relaxation Response (RR) by Herbert Benson

– a counterbalancing mechanism to the stress response: just as stimulating an area of the hypothalamus can cause the
stress response, so activating other areas of the brain results in its reduction.
– He defined this opposite state the "relaxation response.
– α) repetition of a word, sound, prayer, thought, phrase or muscular movement, through which concentration is
achieved
– β) passive return to the repetition when other thoughts intrude.
▪ Βiofeedback
– Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and
skin temperature.
– These instruments rapidly and accurately 'feed back' information to the user.
– The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior —
supports desired physiological changes.
– Over time, these changes can endure without continued use of an instrument

▪ Guided Imagery (GI)

– utilizes the subject‘s personalized images to promote health through several standardized, yet adaptable, techniques,
including relaxation/stress reduction.
▪ Diaphragmatic Breathing
– Diaphragmatic breathing, or abdominal or belly or deep breathing is marked by expansion of the abdomen rather than
the chest when breathing.

▪ Transcendental Meditation
– Maharishi Mahesh Yogi, a scholar of the ancient Vedic tradition of India
– practiced for 20 minutes twice daily while sitting with eyes closed and repeating a mantra

▪ Cognitive Behavioral Therapy

– people are directly responsible for generating dysfunctional emotions and their resultant behaviours
– Cognitive restructuring is the process of learning to refute cognitive distortions, aiming to replace one's irrational,
counter-factual beliefs with more accurate and beneficial ones.
▪ Mindfulness-Based Stress Reduction (MBSR)
– employing mindfulness meditation in order to alleviate mental and physical suffering
– technique assumes that greater awareness of the here-and-now will provided clearer and more accurate perception,
reduce negative affect and improve energy and coping

▪ Emotional Freedom Technique (EFT)

– rapidly reduce the emotional impact of memories and incidents that trigger emotional distress.
Summarizing
To conclude
▪ Your thinking plays a larger role than you may believe in creating your stress
Thank you
Why?
▪ A lot of change in a short span of time
– If any thing characterizes our lives these days, it’s an excess of change

▪ Insecurity

Uncertainty
Fear
▪ We have less control over our lives,
– we live with more uncertainty, and
– we often feel threatened and, at times, overwhelmed
Sources: At work
▪ A recent study by APA
– 2/3rd (62%) cite work as one of their main sources of stress
– 2 in 5 employed adults (41%) feel stressed out during the workday
– Fewer than 6 in 10 (58%) reported that they had the resources to manage stress effectively
– 1 in 4 workers has taken a “mental health” day off from work to relieve stress

▪ Concerns about
– job security, killer hours, long commutes, unrealistic deadlines, bosses from hell,
– office politics, toxic coworkers, and testy clients
At home
▪ After you leave work, you realize that the rest of your life is not exactly stress-free.
▪ In two-parent families, it’s now common for both parents to work
– 40yrs ago, women workers are 1/3rd, now nearly ½ and
– Relatives often living great distances away (of course can be stress reducing)

▪ A women’s work is never done (mothering add to stress)

▪ Piling on new stresses with technology
– In spite of all the new innovations and contraptions that could make our lives easier, same amount of
time is needed to do what has to be done at home.
– A study by APA
▪ 44% said their stress levels had increased over the past 5 years.
Stressed Out?
▪ Are U feeling more tired lately than you used to?
▪ Are U worrying more?
▪ Are U enjoying life less?
▪ Then you aren’t alone; count yourself among the ranks of the overstressed
▪ Your stress may come from your
– job or lack thereof
– money worries
– personal life
– simply not enough time to do everything you have to do or want to do

▪ How often you heard the plea “I need 2 more hours in the day!”
Not tonight, dear. I have a (stress) headache.
▪ Stress can reduce and even eliminate the pleasure of physical intimacy
▪ Irony is that sex can be a way of relieving stress.
▪ Stress may account for 30% of all infertility problems