华盛顿大学压力管理

Stress ManagementAllan Sanders, MN, ARNP,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.,Common Stress Associated Diseases,Diminished ImmunityHeadacheFatigueWeight gainDyslipidemiaHypertensionHeart DiseasePsoriasis/EczemaDigestive problems,AnxietyDepressionAlcoholismSubstance abuseInsomniaIrritable bowel syndromeFibromyalgiaDecreased sex drive,Overview of Terminology,Stress: A state of disharmony or a threat to homeostasisPhysiological changes increase alertness, focus, and energyPerceived demands may exceed the perceived resourcesCoping: The ability to maintain control, think rationally, and problem solve Resilience: Resistant quality that permits a person to recovery quickly and thrive in spite of adversity,Stress,EustressManageable Stress can lead to growth and enhanced competenceDistressUncontrollable, prolonged, or overwhelming stress is destructive.Acute StressImmediate response to a threat or challengeChronic StressOngoing exposure to stress, may seem unrelenting,Causes of Stress,External causesFamily, work, economics, work, school, major life changes, unforeseen events, etc.Internal causesWorry, uncertainty, fear, attitudes, unrealistic expectations, etc.,Sources of Clinical Stress,For patients,UncertaintyFearPainCost Lack of knowledgeRisk for harmUnknown resources,For nurses,Poor patient outcomesRisk of making an errorUnfamiliar situationsExcessive workloadInadequate resources,Stages of the Stress ResponseGeneral Adaptation Syndrome of Hans Selye (1907-1982),Alarmwhen one feels threatenedActivation of the fight or flight reactionResistancemobilization of resources to solve the problemContinued stress causes adaptationExhaustionAdaptation fails and level of function decreases,ALARM: Activation of Hypothalamic Pituitary Adrenal Axis,Catecholamines,Increases cardiac outputDilates airwaysDilates pupilsMobilizes glucoseCauses vasomotor changesDecreases digestionEnhances coagulation,Cortical Steroids,Elevates glucoseIncreases amino acidsIncreases NA resorptionIncreases extracellular fluid volumeInhibits histamine and bradykininSuppresses the immune response,Resistance,Adaptation occursActivation of the hypothalamic pituitary adrenal axis continuesThe stressor may be resolvedThe body returns to homeostasisMay progress to exhaustionStress continues as resources are depleted,Exhaustion,Occurs when the demands of the stress exceeds the persons ability to adapt. Functioning declinesMay result in health problemsPhysical symptomsMental symptoms,Signs & Symptoms of Stress,CognitiveDecreased concentration, comprehension, & memory BehavioralIrritability, withdrawal, violence EmotionalFear, anxiety, depression, fatiguePhysiologicalIncreased BP, HR, Respirations, etcSomatic symptomsDecreased immune response,Genetics & Development,Genetics,Genes control the stress responseIndividuals have different responses to stressThere is a genetic component to:fearful behavioranxiety disordersNeurobiological response,Development,Life experiences can affect a persons stress responseSocial supportStrong support is protectiveEarly life stressIncreases stress reactivity as an adult,Coping & Resilience,Coping,Ability to control emotionsAbility to perceive reality Ability to think rationallyAbility to problem solveCulturally defined,Resilience,The ability to bounce backThe positive capacity to cope with stressProvides resistance to negative eventsHardiness, Resourcefulness,Coping,Adaptive CopingContribute to resolution of the stress responseMaladaptive CopingStrategies that cause further problemsActive CopingActively seeking resolution to the stress,Promote Adaptive Coping,Realistic expectationsSet realistic goalsPlanningAnticipate problems, have a backup planReframingChange the way you look at thingsRelaxationLearn relaxation techniques, take time-out for leisureDiscuss the problemUtilize existing social supports to problem solve,Promote Adaptive Coping,TrainingPrepares for stressful eventsNutritionEat healthy, avoid skipping mealsExerciseInclude regular exerciseSleepGet adequate sleepavoid fatigue,Avoid Maladaptive Coping,Blurring of boundariesAvoidance/withdrawalNegative attitudeAnger outburstsAlcohol/DrugsHopelessnessNegative self-talkResentmentViolence,Promote Resilience Factors,Positive Role ModelsOptimismHumorMoral CompassAltruismReligion & SpiritualitySocial Support,Positive Role Models,Transmit:AttitudesValuesSkillsPatterns of thoughts and behaviors,Optimism,Positive BeliefsAssociated with well beingCognitive reframingPositive thinkingRefute the negative thinkingBelieve in a meaningful causeIt is important to acknowledge relevant negative factors,Humor,Highly effectiveMature coping mechanism“Another of the souls weapons for the fight for self-preservation, it is well known that humor, more then 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,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,Altruism,Unselfish regarding the welfare of othersBelieve in a meaningful causeMutual cooperationActivates of the brains reward center,Religion & Spirituality,Associated with psychological and physical well beingGuards against despairProvides social supportProvides positive role modelsProvides a positive mission,Social Support,Social support has a profound effect on life expectancyPatients have better outcomes with strong social supportIsolation and poor social support are associated with a poor stress responseFew hardy individuals “go it alone”,Signature Strengths,Recognize skills and talentsInventory strengthsUse your strengths and talentsDecide what worksActively copeApply concepts to enable active coping.,Review,Stress is part of everyday lifeIt can promote growth and competencyIf unrelenting or overwhelming it can cause adverse effectsAdaptive coping enhances resilienceMaladaptive coping causes additional problemsEnhanced coping increases resilience while diminishing the adverse affects of stress, thus promoting health,Review: Practical Tips,Set realistic expectations Exercise regularlyEat healthy Get adequate sleepMaintain a work-leisure balancePositive Reframing & optimism Enhance social support,Internet Resources,Building resilience: /3dogMcNeill/building-resilienceDiet, exercise, stress and the immune system: /disorders/chronic_fatigue_syndrome/hic_diet_exercise_stress_and_the_immune_system.aspxExercise: Rev up your routine to reduce stress: /health/exercise-and-stress/SR00036Positive thinking: Reduce stress, enjoy life more: /health/positive-thinking/SR00009Stress management for patient and physician: /mag1/p51-str.html Stress management: Understand your sources of stress: /health/stress-management/SR00031Stress reduction techniques: A must for a healthy lifestyle: /category/stress-reduction/,Learning Exercise,List your current sources of stress.Conduct an inventory of coping strategies that you use or have used in the past.Include maladaptive strategiesList your signature strengths and factors that may enhance your resilience.While considering the above, develop a personalized stress management plan to enhance your coping and resilience.,References,Ahern, N., Ark, P., Byers, J. (2001). Resilience and coping strategies in adolescents. Paediatric Nursing. 28(10).Beckmann-Murray, R., Proctor-Zentner, J., & Yakimo, R. (2009). Health promotion strategies through the life span. New Jersey: Prentice HallBhui, K., King, M., Dein, S., & OConor, (2008). Ethnicity and religious coping with mental distress. Journal of Mental Health. 12(2).Copstead, L. C. & Banasik, J. L. (2010). Pathophysiology: Biological and behavioral perspectives (2nd ED.) USA: W. B. Saunders CompanyFielding, R (Undated) Retrieved September 25, 2007 from:http:/www.pi