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1. Stress and its management
Dr.Shashikant.S.K
Snow Mountain Yoga Center

2. Views of Stress
Eastern philosophies have viewed
stress as an absence of inner peace.
Western culture has more recently
viewed stress as a loss of control.

3. Chinese medicine men Hippocrates Rene Descartes
Galen Robert Koch
Hans Selye Rudolph Virchow

4.  Hans Selye, the father of scientific foundation for
mind-body medicine, who in the 1950's introduced
it as "the non-specific response of the body to any
demand for change".
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5. Stress
 The mental and physical response of our bodies to the
changes and challenges in our live
 Stressor – any physical, social, or psychological event
or condition that causes the body to adjust to that
situation
 Adjustment may cause strain or wear and tear on our bodies
and minds

6. S=P>R
 Stress occurs when the pressure is
greater than the resource

8. Three types of stress
Eustress
Neustress
Distress

9.  Distress
 Eustress
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10. Eustress

11. Distress

12. The Yerkes-Dodson Curve
Maximum Performance
Good Low
performance
illness
Eustress Distress
Poor poor performance poor performance High
low moderatre high
underaroused- optimally overaroused-
bored aroused overwhelmed

13. 8 Types of Stress Factors
 Conscious Factors: thought, judgement, decision making
 Unconscious Factors: past influences, memories
 Personality Factors: character and temperament
 Psychological Factors: emotional condition
 Physiologic Factors: biological influences/condition
 Environmental Factors: noise, comfort, ergonomics
 Experiential Factors: situational influences
 Sociocultural Factors: family, finances, life-changes

14. 8 Interactive Stress Variables
 Intensity: magnitude (low vs high)
 quality: insignificant vs significant
 Duration/frequency: short vs long; high/low
 Focus of Stressor: vulnerability (high vs low)
 Extent of Stress: scope of influence (isolated vs extensive)
 Mental/Physical Status: hardiness (high vs low)
 Resistance: active vs inactive
 Perception: reductive vs magnifying

16. Pathways in Body’s Response to
Stressors
 Two main pathways are involved in the body’s
response to stressors:
 neuroendocrine-immune pathway
 sympathetic nervous system pathway
©2006 by the McGraw-Hill Companies, Inc. All
McGraw-Hill rights reserved. 4-16

17. Two Biological
Pathways in Stress
©2006 by the McGraw-Hill Companies, Inc. All
McGraw-Hill rights reserved. 4-17

18. Sympathetic and parasympathetic divisions
Sympathetic division
 Its brings about the emergency reaction, and
triggers off the production of adrenaline to keep
it going.
 It is involved in „active“ emotions like fear, anger,
or excitement.
Parasympathetic division
 It operates later to correct the balance and to
restore body functions to normal operation. It is
involved in the „quiet“ emotions, like depression
or sadness, when we are not really active at all.

19. chapter 13
The autonomic nervous
system

20. HPA Axis and Role in Stress

21. THE HPA AXIS
Stimulus LIMBIC SYSTEM
+ve
HYPOTHALAMUS
(Paraventricular Nucleus)
CRH -ve
PITUITARY GLAND
(Anterior Pituitary)
ACTH
ADRENAL GLAND
Glucocorticoid
(Adrenal Cortex)

22. Hypothalamopituitary adrenal (HPA) axis
Immune
Stress system:
Circadian altered
rhythm Hypothalamus
Muscle:
CRH Net loss of amino
Posterior Acids (glucose)
Anterior Pituitary Gland
Pituitary Gland Liver:
(-) Deamination of
proteins into amino
ACTH acids,
gluconeogenesis
Glucocorticoids,
Adrenals Catecholamines, etc.. (glucose)
Fat Cells:
Free fatty
acid
Kidney mobilization
Heart rate:
Increased

23. The Story of the Cave Man and
the Saber-toothed Tiger
10/4/2012

24. Picture this scene a million years ago. You
come out of of your cave. The sun is up and
the birds are chirping. Your heart rate is
normal.
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25. All of a sudden you hear a twig snap. Off to
your right you see a large saber-toothed tiger.
You have two options. What are they?
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26. Fight
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27. Or flight
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29. To fight that tiger or run away fast, the
body prepares by releasing stress
hormones
 Cortisol increases blood sugar and speeds
metabolism
 Epinephrine supplies extra glucose
 Norepinephrine speeds up your heart rate and
raises your blood pressure
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30. There is no longer a tiger to kill or
run away from!
10/4/2012

31. The Body’s Response to Stress
 General adaptation syndrome (GAS) – an adaptive
response where our bodies move from homeostasis to
crisis:
 Alarm phase
 “Fight or flight” response
 Resistance phase
 Exhaustion phase

32. General Adaptation Syndrome
Stage 1
Alarm Reaction
Stage 2
Resistance
Stage 3
Exhaustion

33. Alarm Phase
 The cerebral cortex – region of brain responsible for higher mental
functions – interprets nature of event (stressor).
 The sympathetic nervous system is triggered.
 Hypothalamus – interprets the body’s needs for more energy –
triggers the pituitary gland to release ACTH (adrenocorticotropic
hormone)
 ACTH acts on the adrenal gland to release stress hormones –
cortisol, epinephrine and norepinephrine
 These stress hormones trigger the muscles and liver to release
glycogen (glucagon) into glucose (energy)
 Heart rate, blood pressure and respiration increases
 The body’s resources have to be prioritized! Activities of the body
that are important – but not urgent are put on “hold”, such as
digestion.

35. Resistance Phase
 The body is actively trying to reverse the actions that
transpired during the alarm phase. During the
resistance phase the body is under the control of the
parasympathetic nervous system.
 The body’s vital functions such as heart rate, blood
pressure, respiration, digestion, spleen function, vision,
bladder function, glucose level, saliva and mucous,
endorphins and hearing return to normal functioning.
Remember – the body is trying to reach Homeostasis as
a defense mechanism. The body wants to survive!

36. Exhaustion Phase
 Long term exposure to a stressor or stressors can result
in overload. When the body is over-taxed and there
are no recovery periods illness can result.
 This is a depleted state that has been the result of an
ineffective balance of the alarm and resistance phase.

37. The General Adaptation Syndrome

38. The General
Adaptation
Syndrome:
Alarm
Phase
Figure 3.2

39. 3 components of Stress
 Frustration
 Conflict
 Pressure

40. Aetiology of Physical Stress Disorders (3)
 Personality
Friedman & Rosenham
Strive to Achieve/Competitive
Type A Time Urgency/Impatience
Hostility/Aggression
‘Chilled’/Relaxed
Type B Less time concerned
Less aggressive
NB: Type A behaviour linked to CHD &
hypertension

41. 10/4/2012

42. Stress affects the whole person in all
human dimensions :
Physical
Emotional
Intellectual
Social
Spiritual

44. How do your feelings impact your health?
Depressed Normal Bliss
Unhappy Euphoric
Distressed

45. Stress: Short-term (Immediate)
consequences
Physical Signs/Symptoms
 sleep disturbances  irregular heartbeat, palpitations
 back, shoulder or neck pain  asthma or shortness of breath
 tension or migraine headaches  chest pain
 upset or acid stomach, cramps,  sweaty palms or hands
heartburn, gas, irritable bowel  cold hands or feet
syndrome  skin problems (hives, eczema,
 constipation, diarrhea psoriasis, tics, itching)
 weight gain or loss, eating disorders  periodontal disease, jaw pain
 hair loss  reproductive problems
 muscle tension  immune system suppression: more
 fatigue colds, flu, infections
 high blood pressure  growth inhibition

46. Stress
Emotional
 lack of concentration
Signs/Symptoms
 trouble thinking clearly
 nervousness, anxiety
 feeling out of control
 depression, moodiness
 substance abuse
 “butterflies”
 phobias
 irritability, frustration
 overreactions
 memory problems

47. Long-term Consequences
Chronic Diseases
 Cardiovascular Disease
 Stroke
 Cancer
 Diabetes
 Accidents
 Flu/pneumonia

64. Stress Control
ABC Strategy

65. ABC STRATEGY
A = AWARENESS
What causes you stress?
How do you react?

66. ABC STRATEGY
B = BALANCE
There is a fine line between positive / negative stress
How much can you cope with before it becomes negative
?

67. ABC STRATEGY
C = CONTROL
What can you do to help yourself combat the negative
effects of stress ?

68. Stress Management Techniques
 Change your thinking
 Change your behaviour
 Change your lifestyle

70. Change your Thinking
 Re-framing
 Positive thinking

71. Re-framing
Re-framing is a technique to change the way you look
at things in order to feel better about them. There are
many ways to interpret the same situation so pick the
one you like. Re-framing does not change the external
reality, but helps you view things in a different light
and less stressfully.

72. Positive Thinking
Forget powerlessness, dejection, despair, failure
Stress leaves us vulnerable to negative suggestion so
focus on positives;
 Focus on your strengths
 Learn from the stress you are under
 Look for opportunities
 Seek out the positive - make a change.

73. Change your Behaviour
 Be assertive
 Get organised
 Ventilation
 Humour
 Diversion and distraction

74. Be Assertive
Assertiveness helps to manage stressful situations, and
will , in time, help to reduce their frequency. Lack of
assertiveness often shows low self - esteem and low
self - confidence. The key to assertiveness is verbal and
non - verbal communication. Extending our range of
communication skills will improve our assertiveness.

75. Equality and Basic Rights
1) The right to express my feelings
2) The right to express opinions / beliefs
3) The right to say ‘Yes/No’ for yourself
4) Right to change your mind
5) Right to say ‘I don’t understand’
6) Right to be yourself, not acting for the benefit of
others

76. 7) The right to decline responsibility for other people’s
problems
8) The right to make reasonable requests of others
9) The right to set my own priorities
10) The right to be listened to, and taken seriously

77. Being Assertive
Being assertive involves standing up for your personal
rights and expressing your thoughts, feelings and
beliefs directly, honestly and spontaneously in ways
that don’t infringe the rights of others.

78. Assertive People
 Respect themselves and others
 Take responsibility for actions and choices
 Ask openly for what they want
 Disappointed if ‘want’ denied
 Self - confidence remains intact
 Not reliant on the approval of others

79. Assertive Skills
 Establish good eye contact / don’t stare
 Stand or sit comfortably - don’t fidget
 Talk in a firm, steady voice
 Use body language
 ‘I think’ / ‘I feel’
 ‘What do you think?’ ‘How do you feel ?’
 Concise and to the point

80. Benefits
 Higher self-esteem
 Less self-conscious
 Less anxious
 Manage stress more successfully
 Appreciate yourself and others more easily
 Feeling of self-control

81. Get Organised
Poor organisation is one of the most common causes of
stress. Structured approaches offer security against
‘out of the blue’ problems. Prioritising objectives,
duties and activities makes them manageable and
achievable. Don’t overload your mind. Organisation
will help avoid personal and professional chaos.

82. Time Management
 Make a list
What MUST be done
What SHOULD be done
What would you LIKE to do
 Cut out time wasting
 Learn to drop unimportant activities
 Say no

83.  Plan your day
 Set achievable goals
 Don’t waste time making excuses for not doing
something

84. Ventilation
‘A problem shared is a problem halved’
Develop a support network through friends or
colleagues to talk with. It’s not always events that are
stressful but how we perceive them.
Writing a diary or notes may help release feelings but
do not re-read what has been written.

85. Humour
 Good stress - reducer
 Applies at home and work
 Relieves muscular tension
 Improves breathing
 Pumps endorphins into the bloodstream - the body’s
natural painkillers

86. Diversion and Distraction
 Take time out
 Get away from things that bother you
 Doesn’t solve the problem
 Reduce stress level
 Calm down
 Think logically

87. Change Your Lifestyle
 Diet
 Smoking & Alcohol
 Exercise
 Sleep
 Leisure
 Relaxation

88. Benefits of Exercise
 Uses up excess energy released by the ‘Fight or Flight’
reaction.
 Improves blood circulation
 Lowers blood pressure
 Clears the mind of worrying thoughts
 Improves self image
 Makes you feel better about yourself
 Increases social contact

89. Sleep
 Good stress reducer
 Difficult to cope when tired
 Wake refreshed after night’s sleep
 Plenty of daytime energy

90. Leisure
 Interest
 Gives you a ‘break’ from stresses
 Provides outlet for relief
 Provides social contact

91. Benefits of Relaxation
 Lowers blood pressure
 Combats fatigue
 Promotes sleep
 Reduces pain
 Eases muscle tension

92.  Decreases mental worries
 Increases concentration
 Increases productivity
 Increases clear thinking

93. Alternatives
 Conventional Medicine  Floatation
 Counselling &  Herbalism
psychotherapy  Biofeedback
 Relaxation  Homeopathy
 Meditation  Hypnotherapy
 Massage  Osteopathy
 Yoga  Pet Therapy
 Acupuncture  Reflexology
 Aromatherapy

94. Is a pill dissolving in your stomach more
effective than a healing thought
dissolving in your mind?

99. Some common specific phobias
Acrophobia Heights
Algophobia Pain
Astraphobia Thunderstorms & lightning
Claustrophobia Enclosed places
Hydrophobia Water
Monophobia Being alone
Mysophobia Contamination or germs
Nyctophobia Darkness
Ochlophobia Crowds
Pathophobia Disease
Pyrophobia Fire
Zoophobia Animals, or some particular animal