1. “Stress and its Management”
Dr. Yogesh K Singhal
PG Resident Ist Year
PSM Department
RNT Medical College, Udaipur

2. OVERVIEW of PRESENTATION
1. DEFINITION
2. TYPE OF STRESS
3. STRESSORS
4. SUICIDE : Stress is a big cause
5. GENERAL ADAPTATION SYNDROME
6. STRESS MEASURMENT
7. EFFECT ON HEALTH
8. STRESS MANAGEMENT
9. STRESS MANAGEMENT TECHNIQUES

3. “My limbs quail, my mouth goes dry, my body
shakes and my hair stands on end”
(from Bhagwat Gita Chapter I verse29)
This is a situation of a person going through the
extremely stressful situation.

4. • It was the condition of Arjuna when he was
standing in front of Kaurav army, thinking
about the different possibilities, like killing his
own relations.

5. After listening Geeta versus from Krishna,
Arjuna became free from that extreme stress.
In modern world we can term it, counseling by
close friend.

6. While Kaurav army did not have the same
feeling of stress .
This is a proof that apart from external factors,
your response to the situation determines the
degree of stress.

7. Stress?
• Stress is the body’s
automatic response to
any physical or mental
demand placed on it.
• Stress is the human
reaction to events in
our environment
Continue….

8. Stress?
•Stress can be any force that
impairs the stability and balance
of bodily functions.
• Stress is wear and tear on the
body
• Adrenaline produced in our body
as a response to stress.
• Fight or Flight response is elicited.
Continue….

9. Stress
Normal
People
Psychiatric
Patients
• The reason for stress is our own attachment
to a particular outcome, and our inability to
adjust to any other outcome.

10. STRESS!!!
• If stress disrupts body balance and function, then
is all stress bad?
“Not necessarily”
• A mild degree of stress and tension can sometimes
be beneficial.
• Moderate levels of stress may actually improve
performance and efficiency
• It is termed as Eustress
• Eustress occurs when activities slightly pushed, but
not overwhelmed.
• When goal is out of reach, but not too far

11. EU-STRESS = good stress
• it is the positive cognitive response
to stress that is healthy, or gives positive
feelings
• slightly more than what one can handle.
• Examples -Winning the lottery, Gambling,
Getting engaged, Meeting or engaging in a
challenge, Watching a scary movie, Going
to First Date
However, it depends upon the personality

12. DISTRESS !!!
• It is an aversive state in which
a person is unable to adapt
completely to stressors and
shows maladaptive behaviours.
• Distress: Stress from bad sources
Examples :
– Difficult work environment
– Overwhelming sights and sounds
– Fear
– Threat of personal injury
– aggression

13. FOUR TYPES OF STRESS
1. General Stress:
– Everyone has this kind
of stress
– It resolves itself within
a day or two
– No intervention is
necessarily required
Continue…….

14. FOUR TYPES OF STRESS
2. Cumulative Stress:
– Stress builds up in the body
– It becomes more difficult to
alleviate your symptoms
– One can have more serious
physical or mental symptoms.
Continue…….

15. FOUR TYPES OF STRESS
3. Acute Traumatic Stress:
– Critical Incident Stress
– Produces considerable
psychological distress
– A normal reaction to
abnormal events
– Ex : RTA
Continue…….

16. FOUR TYPES OF STRESS
4. Post Traumatic Stress:
– Severe stress produced by
severe psychological
trauma
– Created after any Critical
Incident Stress
– Produces lasting changes
– Need visit of Psychic clinic

17. Stressors
Stressor is any physical,
chemical, or emotional
factor that causes bodily
or mental unrest.
 Trouble saying no
 Incompatibility with roommate’s habits,
schedule, lifestyle
 Tension with family, friends or romantic partner
 Death of a close friend or family member
 Parents divorce, separation or conflicts.
 Harassment at workplace

18. Stress
Justified
Stressor
No Justified
Stressor
Stress
management
Psychiatrist
Opinion
If there is not a source, may be mental status
of subject is subnormal.
Stress without any justified cause is warning
signal of mental illness.

19. • Over one lakh suicides in India every year
• WHO- Suicide rate highest in India in SEAR.
(21.1 per 1 lakh people)
• 2,58,075 suicidal deaths in 2012
• Rajasthan – less than 5 per lakh
• Highest suicide rate in Pondicherry (36.8)
• Lowest in Bihar (0.8), Nagaland and Manipur
• 34% cases in age group of 15-29 & 30-44
• 80% victims were literate
• Suicide rate in male is twice that of female
Suicide : Stress is a big cause

20. Who is most susceptible to stress?
• People without strong social support networks
• People who are physically unwell (Chronic ill)
• Age related stages- Students, working parents,
Senior citizens,
• People of Type A personality
• Type A personality
• Persons who are ambitious, impatient, status
conscious, rigidly organized, take on more than can
handle, anxious, proactive, workaholics
• Type B personality
• Persons who are funny, creative, enjoy exploring ideas,

21. General Adaptation Syndrome
General Adaptation Syndrome is Body Response to Stress
• Stage I - Alarm Reaction
The “fight or flight” response which causes you to be ready
for physical activity
• Stage II – Stage of adaptation
If stress continues, the body adapts to the stressors
• Stage III – Stage of Exhaustion
Stress persists for a long time
The body’s resistance may be reduced or collapse quickly

22. • Physical
– Headache
– Back Pain
– Fatigue
– Aches and Pains
– Sinus Tachycardia
– sleep disturbances
– lack or increase in appetite
• Mental
– Difficulty Concentrating
– Increased Errors
– Poor Decision Making
– Anxiety
– Depression
– Anger
– lack of interest in routine
work
Effects on health due to excess stress
• Use of Tobacco leads
to
Hypercholesterolemia,
Cardiac problems
• Use of Alcohol leads to
Acute Pancreatitis,
Gastritis, CLD.
• Using pills or drugs
cause Drug Dependence
leads to side effects
and withdrawal
symptoms
Direct effects In-Direct effects
Continue…….

23. Physical Stress Symptoms
Short Term
– Dry mouth
– Cool skin
– Cold hands and feet
– Increased sweating
– Rapid pulse & heart rate
– Diarrhea
– A desire to urinate
Continue…….
Long Term
– Insomnia
– Change in Appetite
– Sexual disorders
– Feelings of intense
tiredness
– Prone to illness
• Stress may worsen the intensity of symptoms
and progression of diseases in many people.

24. Clinical manifestation due excess stress

25. Stress Measurement
• Holmes and Rahe stress scale is a list of 43 stressful life
events that can contribute to illness
– Score of 300+: At risk of illness.
– Score of 150-299: Risk of illness is moderate (reduced by
30% from the above risk).
– Score <150: Only have a slight risk of illness
• Depression Anxiety Stress Scales is made up of 42 self-
report items to be completed over five to ten minutes,
each reflecting a negative emotional symptom.
• Changes in body vitals can be used to measure stress.
• Cortisol is released during a stress response and
measuring cortisol from hair will give a 60-90 day
baseline stress level. This method of measuring stress
is currently the most popular method in the clinic.

27. Identify the sources of stress in your life
• It may seem that there’s nothing you can do
about stress. The bills won’t stop coming, there will
never be more hours in the day, and your career and
family responsibilities will always be demanding.
• But the simple realization that you’re in control
of your life is the foundation of stress
management.
• Stress management starts with identifying the
sources of stress in your life.
• To identify your true sources of stress, look closely at
your habits, attitude, and excuses

28. Healthy ways to relax and recharge

29. Relax
• Our brain fires electrical waves at 14 or more cycles
a second.
• These are beta waves and are great for getting tasks
done, but not for learning new things.
• Taking a few minutes to relax deeply slows your
brain waves down.
• These slower waves are alpha waves.
• They occur at between 7 and 14 cycles a second
• Studies show alpha waves improve learning.

30. Healthy ways to relax and recharge
• Blame others- blaming
the God and luck is
most used method of
stress management
• Express your emotions
loudly- shout, weep,
laugh,
• a good workout.
• have a warm cup of
coffee or tea
• Watch a comedy.
• Have healthy sexual
life
• Spend time in nature
• talk to close friend
• write in your diary
• Play with a pet
• Work in your garden
• Get a massage.
• Curl up with a good
book
• Listen to music

31. Dealing with Stressful Situations :
The 6A’s
• Avoid the stressor
• Alter the stressor
• Adapt to the stressor
• Accept the stressor
Change the situation
Change your reaction
•Arrange time for fun and relaxation
•Adopt a healthy lifestyle Change your life

32. Stress management strategy
#1: Avoid unnecessary stress
“Handle every stressful situation like a
dog, if you can’t eat or play with it. Just
pee on it and walk away”
• Learn how to say “no” – Know your limits
and stick to them, taking on more than
you can handle is a recipe for stress.
• Take control of your environment – If the
evening news makes you anxious, turn
the TV off.

33. • Avoid hot-button topics – If you get upset
over religion or politics, cross them off your
conversation list.
• Avoid people who stress you out – If
someone consistently causes stress in your life
and you can limit the amount of time you
spend with that person or end the relationship
entirely.
Stress management strategy
#1: Avoid unnecessary stress

34. Stress management strategy
#2: Alter the situation
• If you can’t avoid a stressful situation, try to alter it.
• Express your feelings : If something or someone is
bothering you, communicate your concerns in an
open and respectful way.
• Be willing to compromise. When you ask someone
to change their behaviour, be willing to do the
same.
• Be more assertive. Deal with problems head on. If
you’ve got an exam to study for and your chatty
roommate just got home, say up front that you only
have five minutes to talk.
Continue…….

35. • Manage your time better. Poor time
management can cause a lot of stress.
– Get organized
– Get structured
– Set short term goals
– Set long term goals
– Use a planner
–daily schedule and “To Do” list
Stress management strategy
#2: Alter the situation

36. Stress management strategy
#3: Adapt to the stressor
• Reframe problems. Try to view
stressful situations from a more
positive perspective. Rather than
fuming about a traffic jam think, is
it really worth getting upset over?
• Look at the big picture. Take
perspective of the stressful
situation. Ask yourself how
important it will be in the long
run. If the answer is no, focus your
time and energy elsewhere. Continue…….
If you can’t change the World, change yourself.

37. Stress management strategy
#3: Adapt to the stressor
• Adjust your standards. Perfectionism is a major
source of avoidable stress. Set reasonable
standards for yourself and others, and learn to be
okay with “good enough.”
• Eliminate words such as "always," "never,"
"should," and "must.“
• Focus on the positive. When stress is getting you
down, think about the things you appreciate in
your life, including your own positive qualities
and gifts.
Continue…….

38. One negative thought
leads to another………..
then another………..
then another …..
Pretty soon you have ruined your entire life

39. Stress management strategy
#4: Accept the things you can’t change
• Some sources of stress are unavoidable.
You can’t prevent or change stressors such
as the death of a loved one, a serious
illness, or a national recession. In such
cases, the best way to cope with stress is to
accept things as they are.
• Don’t try to control the uncontrollable.
Continue…….

40. Stress management strategy
#4: Accept the things you can’t change
• Learn to forgive. Accept the fact that
we live in an imperfect world and
that people make mistakes.
• Free yourself from negative energy
by forgiving and moving on.
• Rethink the situation and learn to be
more flexible
• Learn to manage your anger
• Anger affects your health and you
over-react to many situations
Continue…….

41. Stress management strategy
#5: Arrange time for fun and relaxation
• Don’t get so caught up in the
hustle and bustle of life that you
forget to take care of your own
needs.
“Nurturing yourself is a necessity, not
a luxury”
BECAUSE
Continue…….

42. • Fill your life with fun
things to do!!!!
• Keep your sense of
humor!!!!
• It is called: PLAY
THERAPY
Continue…….
Stress management strategy
#5: Arrange time for fun and relaxation

43. • We all need a lengthy
list of things that will
help us relax…..
• I love horse back
riding.
Continue…….
Stress management strategy
#5: Arrange time for fun and relaxation

44. • Relaxing needs to be
part of your daily
routine.
Continue…….
Stress management strategy
#5: Arrange time for fun and relaxation

45. • Temple, Church, etc
• Help others
• Spend quiet time every day
• Be thankful
• Think positively
• Put your faith to work!
Continue…….
Spirituality
Stress management strategy
#5: Arrange time for fun and relaxation

46. • RELAAAAAAX
Continue…….
Stress management strategy
#5: Arrange time for fun and relaxation

47. • RELAAAAAAX
Continue…….
Stress management strategy
#5: Arrange time for fun and relaxation

48. • RELAAAAAAX
Continue…….
Stress management strategy
#5: Arrange time for fun and relaxation

49. • RELAAAAAAX
Stress management strategy
#5: Arrange time for fun and relaxation

50. Stress management strategy
#6: Adopt a healthy lifestyle
• You can increase your resistance to stress by
strengthening your physical health.
• Get enough sleep
• Exercise regularly
• Eat a healthy diet
• Reduce caffeine and sugar.
• Avoid alcohol, cigarettes, and drugs.
Continue…….

51. • Rest:
– Get a minimum of six
hours of continuous
rest
Continue…….
Stress management strategy
#6: Adopt a healthy lifestyle
• Exercise:
– At least twenty minutes,
five times a week
– break a sweat, to release
endorphins

52. • Too many people look for an
easy answer to stress
management by misusing
• It may temporarily reduce
stress, but they cause more
damage in the long run
• Alcohol
• Drugs
• Smoking
• Medicines & Pills
Stress management strategy
#6: Adopt a healthy lifestyle

53. Stress-management techniques

54. • Yoga
• Autogenic training
• Biofeedback
• Imagery
• Meditation techniques
• Qigong
• Tai chi
• Start a Stress Journal
• Organizational skills
Stress-management techniques

55. Yoga
• One goal of yoga is to
restore balance and
harmony to the body and
emotions through
numerous postural and
breathing exercises.
• Among the benefits of yoga
are increased flexibility and
capability for relaxation.

56. Autogenic training
• This technique is based upon passive concentration
and awareness of body sensations. Through
repetition of so-called autogenic "formulas" one
focuses upon different sensations, such as warmth or
heaviness, in different regions of the body.
• Popular in Europe (where it is even covered by some
insurance plans).
• No particular physical skills or exercises are involved.
• Since this technique is slightly more complex than
some relaxation methods, a course is generally the
best way to learn the method.

57. Biofeedback
• Biofeedback is measurement of body vitals during
stress and after achieve relaxation by use of the
monitoring equipment.
• For example, instruments can be used to measure
heart rate, blood pressure, brain activity, muscle
tension.
• By receiving this feedback, one can learn to identify
the processes that achieve the desired result, such as
reduction in heart rate and blood pressure.
• Because the technique involves the use of measuring
devices, it can only be performed by a professional.

58. Imagery
• Create a mental image of a pleasant and
relaxing place in your mind. Involve all your
senses in the imagery: see the place, hear
the sounds, smell the aromas, feel the
temperature and the movement of the wind.
Enjoy the location in your mind.

59. Meditation techniques
• Transcendental meditation involves generation of
the so-called relaxation response through the
repetition of a word of phrase while quietly seated,
10-20 minutes per day
• The meditation is deep
centring and focusing
upon the core of one's
being; there is a quieting
of the mind, emotions,
and body.
•Some people like to focus
on sounds. The classic
example is the 'Ohm‘.

60. Qigong
• The martial art qigong is an ancient Chinese health-care
system that combines physical training (such as isometric,
isotonic, and aerobic conditioning).
• Some forms are practiced while standing, sitting, or lying
down; others involve structured movements or massage.
• Over 70 million Chinese practice some form of qigong daily.
• Learning qigong involves time, commitment, patience, and
determination, and learning from a master or group is
advisable.
• Since this technique involves physical exertion, check with
the doctor before beginning, particularly if you have a
chronic medical condition or are over 40 years old.

61. Tai chi
• Like qigong, tai chi is a Chinese martial art. It has
been termed a kind of "meditation in motion"
and is characterized by soft, flowing movements
that stress precision and force. Also known as tai
chi chuan, this method is thousands of years old.
• training from a master is necessary to learn the
art of tai chi. Again, since motion and force are
required, check with the doctor before beginning
training.

62. Start a Stress Journal
• A stress journal can help to identify the regular
stressors in the life and the way to deal with
them. Each time you feel stressed, keep track of it
in the journal. As you keep a daily log, you will
begin to see patterns and common themes. Write
down:
• What caused your stress (make a guess if you’re
unsure)
• How you felt, both physically and emotionally
• How you acted in response
• What you did to make yourself feel better

63. • If your physical surroundings
(office, desk, kitchen, closet,
car) are well organized, you
won't be faced with the
stress of misplaced objects
and clutter.
• Make it a habit to
periodically clean out and
sort through the messes of
paperwork and clutter that
accumulate over time.
Organizational skills

64. How can I get help with stress
management?
• Consider counselling.
• Stress-management counselling is offered by
various types of mental-health professionals.
Stress counselling and group-discussion
therapy have proven benefits in reduction of
stress symptoms and improvement in overall
health and attitude.

65. THANKS…….