Stress Management Stress Management: Nptel

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STRESS MANAGEMENT
STRESS MANAGEMENT 
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RAJLAKSHMI GUHA
IIT KHARAGPUR 
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SCIENTIFIC FOUNDATIONS 
OF STRESS
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MODULE 1
MODULE 1
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OUTLINE

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• UNDERSTAND WHAT STRESS IS
• WHY TWO INDIVIDUALS RESPOND DIFFERENTLY DURING
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A STRESSFUL SITUATION?
• EXPLORE THE HISTORY AND GENESIS OF STRESS
RESEARCH
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What is stress?
What is stress?

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Stress can be defined as a response of the body 
to any demand placed on it
to any demand placed on it

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Stress can be influenced by both 
external and internal factors
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WHY DO INDIVIDUALS BEHAVE DIFFERENTLY DURING STRESS?

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• It follows that what is stressful to one person may be a refreshing 
challenge to another, depending upon his  perception of the situation as 
p p y p
well as his perception of his ability to cope with that situation
(Later explained in personality factors and stress) 

response


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The individual's judgment that a stressful situation exists, initiates a stress 

Without this appraisal there is no stress in the person's psychological 
schema 
schema
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• Even though a situation is perceived as a demand or threat it may still not 
mobilize a stress response if the individual thinks that he is able to cope 
with it adequately, either on his own or with the help of external 
resources or support from other people in his life
resources or support from other people in his life
PIONEERS in stress research
PIONEERS in stress research
• There are earlier antecedents to the concept of stress. 
For centuries physicians and patients have made the 

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association between adverse life events and illness

• The links between emotion and sudden cardiac death 
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have been repeatedly noted in sources as diverse as 
the Bible anthropological texts and clinical experience
the Bible, anthropological texts, and clinical experience

• Many contemporary cultures regard illness as the 
y p y g
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outcome of being out of balance with the environment
and its demands, a manifestation of inadequate coping 
with diverse stressors
with diverse stressors
PIONEERS….
Walter Cannon (1932) ‐ a Physiologist with Harvard Medical School ‐ first 
described body’s response to stress
described body’s response to stress

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• Ex: walking down a lonely by lane dimly lit, while you are half way down to 
p y y g y g g
the point of no return you see a burly figure carrying a club standing on 
your way. What do you feel? 


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 increased heart beat, shortness of breath, increased  perspiration, 
muscles tense and a whole array of changes occur in the body
muscles tense, and a whole array of changes occur in the body 

body prepares itself when confronted by a threat to either stand 
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ground and fight or run away
g y
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Walter Cannon termed this response as the FIGHT OR FLIGHT RESPONSE
PIONEERS….

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Hans Selye
S l (1956) summarized stress reactivity 
( 9 6) i d i i
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as a three phase process termed the 
General Adaptation Syndrome 
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PIONEERS

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GENERAL ADAPTATION SYNDROME

ALARM REACTION – The body shows changes at the first 

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exposure of the stressor

STAGE OF RESISTANCE – Resistance ensues if continued 
exposure to the stressor is compatible with adaptation.
exposure to the stressor is compatible with adaptation. 
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The bodily signs characteristic of the alarm reaction have 
disappeared and resistance rises above normal 
PIONEERS
GENERAL ADAPTATION SYNDROME
GENERAL ADAPTATION SYNDROME

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• SSTAGE OF EXHAUSTION: Long continued 
G O S O i d
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exposure to the same stressor depletes the 
adaptation energy and leads to exhaustion. 
d i dl d h
The alarm reaction reappears, but the 
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resistance phase being absent, individual 
i h b i b i di id l
succumbs to the stressor
Ex: fever – immune system’s attempt to fight infectious agents 
like virus and bacteria 
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PT
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Greenberg, J. 2012
PIONEERS
• Hans
Hans Selye
Selye defined stress as 
defined stress as “the
the nonspecific 
nonspecific

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response of the body to any demand made 
upon it ” 
upon it.
• That means good things (e.g., a job promotion) 
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to which we must adapt (termed eustress ) and
to which we must adapt (termed eustress ) and 
bad things (e.g., the death of a loved one) to 
which we must adapt (termed distress ); both
which we must adapt (termed distress ); both 
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are experienced the same physiologically
PIONEERS
Holmes and Rahe
Holmes and Rahe (1967) 
(1967) – emphasized the role 
emphasized the role

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of Life Events in stress

They showed that the more significant the 
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changes in one’ss life, the greater the chance of 
changes in one life, the greater the chance of
the onset of illness
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Lazarus, Delongis and others found that daily 
hassles are even more detrimental to health
hassles are even more detrimental to health 
than major life changes
In one of my papers on Attempted Suicide, my 
In one of my papers on Attempted Suicide my

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colleagues and me found that life events were 
an important factor pushing an individual to
an important factor pushing an individual to 
attempt suicide
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PIONEERS
A T W Simeons
S eo s ((1961) –
96 ) related evolution to 
e ated e o ut o to

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psychosomatic disease
p y p
The human brain (especially Diencephalon) has 
failed to develop at the pace needed to respond to 
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symbolic stressors of the twentieth century
Ex: when our self‐esteem is threatened, the brain 
prepares the body with the fight‐or‐flight response. 
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If th th t t
If the threat to self‐esteem stems from fear of 
lf t t f f f
embarrassment during public speaking, neither 
fighting nor running away is an appropriate reaction
fighting nor running away is an appropriate reaction
Several researchers have added to the work of 
Several researchers have added to the work of

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Cannon, Selye, Simeons, and others to shed 
more light on the relationship of stress to body
more light on the relationship of stress to body 
processes
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With this understanding has come a better
With this understanding has come a better 
appreciation of which illnesses and diseases are 
associated with stress and how to prevent these
associated with stress and how to prevent these 
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conditions from developing
PIONEERS

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Harold Wolff (1953) – found that a large 
number of death before release had resulted
number of death before release had resulted 
among inmates of Japanese concentration 
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camps as compared to German camps due to
camps as compared to German camps due to 
the increased amount of emotional stress
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PT
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Greenberg, J. 2012
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to summarize….. 

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In the next module we shall discuss about the 
sources of stress and how stress can also be 
helpful to the individual 
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Thank you
Thank you 
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STRESS MANAGEMENT

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RAJLAKSHMI GUHA
IIT KHARAGPUR
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SCIENTIFIC
FOUNDATIONS OF

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STRESS
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MODULE 2

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OUTLINE
• sources of stress

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• how stress can also be helpful to the individual

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Preview…
In the previous module we discussed about individuals responding

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differently to stress

We spoke about the internal and external factors inducing stress

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Many of you may have wondered what these factors are – to
understand these, we must take a relook at stress
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A re-look at stress….
The role of stressor, stress reactivity and strain

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STRESSOR - A stressor is a stimulus with the potential of triggering the fight-or-flight
response The stressors for which are body was evolutionarily trained were threats to safety –

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This response was required for primitive man for survival - imagine a caveman who sees a lion
outside his cave -
modern man - may be jumping off the road on the verge of being hit by a car – physiological
responses are same as the cave man
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Symbolic stressors are stressors that are a threat to the psychological being and not a threat to survival like loss of
self esteem, fear of ridicule - imagine when you have an interview to attend – running away or fighting the
interviewer would be an inappropriate response
The role of stressor, stress reactivity and strain
Stressors can be:

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• biological and environmental (toxins, heat, cold)
• psychological (threat to self esteem, depression),
• sociological (financial loss, unemployment, social isolation),

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• philosophical (loss of purpose or goal in life)
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• One of the most severe stressors is guilt – associated with behaving in
a way contrary to one’s moral framework, ex – lying, cheating
SOURCES OF STRESS
External factors: sociological factors and some environmental factors

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Internal factors: psychological and philosophical factors

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A primary source of stress is the presence of Major Life Events and daily
hassles in an individual’s life
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Reference to Strain – long term stressor
The role of stressor, stress reactivity and strain
Stress Reactivity: The fight-or-flight response

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• increased muscle tension
• increased heart rate, stroke, volume, and output
• elevated blood pressure
• increased neural excitability

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• less saliva in the mouth causing dryness of mouth
• increased perspiration
• change in respiratory rate
• increased serum glucose

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increased release of hydrochloric acid in the stomach
• changes in brain waves
• Increased urination
The role of stressor, stress reactivity and strain
Strain - outcome of stress reactivity

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Physical – tension headaches and backaches resulting from excessive
muscle tension

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Psychological –ex - fear of being in crowd resulting from contemplating
the experience
Behavioural – alcohol abuse and getting into fights
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Ex: daily hassles increasing stress reactivity leading to strain
• Our bodies have evolved to respond to stressors with an immediate action

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by altering their physiology for greater speed and strength. When we
encounter symbolic stressors, our bodies are altered in the same manner,
although we do not use the changed physiology by responding with some
action

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• We build up stress products, which include elevated blood pressure and
increased muscular contractions, serum cholesterol, and secretions of
hydrochloric acid in the stomach
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• The results are illness and disease
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• People who have learned stress management skills often respond to a
greater degree to a stressor but return to their resting rate sooner
than those not trained in stress management

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Analogy to joggers - heart rate may increase tremendously when they
exercise but returns to normal sooner than that one who doesn’t
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exercise
Exercise – to help identify muscle tension
As you begin to read this, FREEZE. Don’t move a bit! Now pay attention to your body sensations and
position

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Can you drop your shoulders? If so, your muscles were unnecessarily raising them

Are your forearm muscles able to relax more? If so, you were unnecessarily tensing them.

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Is your body seated in a position in which you appear ready to do something active? If so, your
muscles are probably unnecessarily contracted.

Can your forehead relax more? If so, you were tensing those muscles for no useful purpose. Check
your stomach, buttocks, thigh, and calf muscles. Are they, too, contracted more than is needed?
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Take a moment for yourself now. Concentrate on just letting as many of your muscles relax as
possible. Notice how that feels.

Adapted from Greenberg, J. 2012


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PT
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:Patel C, 1991
Not all Stress is bad….

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Recognising your Eustress and Distress

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Summarising it…..

Sources of stress with emphasis on stressor, stress reactivity and strain

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Human model of stress
Maintaining a balance by identifying eustress and distress
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Human performance curve and how stress can be useful
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Thank you

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STRESS MANAGEMENT
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RAJLAKSHMI GUHA
IIT KHARAGPUR
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SCIENTIFIC FOUNDATIONS
OF STRESS
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MODULE 3
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OUTLINE

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• TYPES OF STRESS
• EFFECT OF STRESS ON MIND AND BODY
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Review…
A few important points to remember about Stress –

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• We all experience stress at times
• feeling overloaded, wound up tight, tense, worried


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sometimes motivates to finish a task /perform well
Harmful if over-stressed
- interferes with ability to get on with normal living
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PT
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Wheaton, 1994
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Acute Stress
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Symptoms….
Acute stress symptoms – easily recognized by

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people in stress

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A few acute stressors…
• Failed an exam

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• Interview / presentation / submissions around the corner
• Recent relationship break up
• Lost a job recently



Accident
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Deadline to meet soon
Car broke down / maid didn’t come
Sudden illness or death of a close one
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The exciting part about Acute stress
Thrilling events cause acute stress

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Adventure sports
Someone jumping on you – startled response –
link to F-or F response
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The disadvantages..
Thrills are exhilarating and fun for short periods

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of time
Tiring and draining if continued for long

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Effects of Acute stress
• Physiological changes

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• Emotional changes
• Cardio vascular changes
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Digestive changes
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Acute stress can affect anyone
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It is manageable and can be treated
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Chronic stress
Grinding stress that wears people away day after day year after year

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• War
• Financial crisis
• Long term relationship problems
• Traumatic experiences



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Unwanted career/ job
Chronic illnesses
Dysfunctional families
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- unrelenting demands and pressures for interminable periods of time –
LEARNED HELPLESSNESS

- From traumatic childhood experiences – internalized as a part of daily life


Common signs of chronic stress

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Physical signs:

Psychological signs:

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Effect of stress on performance
• Effect of stress on Appetite and digestion – “LOST MY
APPETITE” –

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Digestion is a Para sympathetic activity
During stress, Sympathetic Nervous system - activated making
individual vigilant and aroused, but suppresses appetite

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• Effect on sexual activity – sexual arousal and reproduction are
inhibited by the physiological concomitants of stress
– Precludes testosterone release in males
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– Reduces concentration of estrogen in females

• Effects of stress on cognition – chronic stress affects beliefs


and views of the world
Effect on growth

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• sympathetic nervous system  release of various digestive enzymes
affected nutrients not absorbed  nutritional deficits  growth
affected

In adults:
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stress hormones disrupt
• the processes by which the body reconstructs itself through the use of
calcium  Stress is responsible for the disintegration of bone
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SUMMARY
• TYPES OF STRESS

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• EFFECT OF STRESS ON BEHAVIOUR
COGNITION
SEXUAL ACTIVITY
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DIGESTION AND GROWTH
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THANK YOU
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STRESS MANAGEMENT
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RAJLAKSHMI GUHA
IIT KHARAGPUR
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SCIENTIFIC FOUNDATIONS
OF STRESS
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MODULE 4
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OUTLINE

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– ROLE OF PERSONALITY FACTORS IN STRESS
– ROLE OF CULTURAL AND ETHNIC BACKGROUND
– RESILIENCE AND BOUNCING BACK FROM STRESS

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What is personality?
Personality refers to individual differences in
characteristic patterns of thinking, feeling and

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behaving
These are developed through interaction with
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our environment over time - values, attitudes,
personal memories, social relationships, habits,
and skills
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How does it affect stress?
PERSONALITY AND STRESS
Individual differences

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• cognitive reaction to a situation - appraisal of the nature,
importance and implications of the event, and by your ability
to effectively manage or cope with the event

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• emotional responses to a situation - determined by appraisal
of situation and coping abilities

Ex: “I can handle this,” – planning ways to handle the


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situation
“This is terrible. I’m going crazy” - quitting, getting
more anxious
Factors of Personality related to stress

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Locus of control
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Self esteem
Personality Type
Hardiness
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Genetic makeup

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influences health and behavior

• All human beings face stress when dealing when faced with making a
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difficult or frustrating decision
• Some individuals may have a heightened level of arousal in the central
nervous system, causing them to react more excitedly to events and adapt
more slowly
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Locus of control
Locus of control refers to the degree of control which individuals think they have over what
happens to them

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Internal locus of control - Persons who see themselves as having control
over their environment
less likely to be disrupted by stress

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External locus of control: They do not believe they have control over their
lives what happens to them determined by others
or by outside events
Stressors have much influence on their lives
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Learned Helplessness (Seligman ,1975)
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This loss of control over the environment is
exemplified by the many accounts of healthy
natives who, having had 'bones' pointed at them
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by a witch doctor, have died within hours
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Common among Kurdaitcha – Australian Aborigines
Personality and locus of control

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• Studies show that people will learn better and use their past
experience to greater advantage if they believe that their
success or failure is determined by their skill rather than by
luck
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• There is also evidence that people will experience less stress
in aversive situations if they believe they have some personal
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control over the outcomes of the situation
Self esteem - individual’s self-perception of his/her abilities, skills, and overall
qualities that guides and/or motivates specific cognitive processes and behaviors

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Self-esteem has also been reported to predict stress in individuals with chronic
disease

Lazarus - a potential stressor (e.g. external event) causes people to undergo two
cognitive appraisal processes

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primary appraisal - focuses on the nature (positive, negative, or neutral) and
respective level of threat an event presents

• secondary appraisal - determines one’s available coping abilities and resources


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are sufficient to overcome the stressor
Lazarus and Folkman (1984)

Individuals with low self-esteem may lack the coping resources necessary to regulate
environmental stressors
Schneiderman et al., 2005
• low self-esteem - with negative life outcomes, including
substance abuse, delinquency, unhappiness, depression, and

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worsened recovery after illnesses
Leary and McDonald, 2003

• High self esteem - happiness and longevity


PT Baumeister et al., 2003

In studies of aging, a positive self-concept and internal locus of


control predict successful aging, predicting independence, cognitive
stability, and general health
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Baltes and Baltes 1990
PERSONALITY TYPES AND STRESS

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History: Two California cardiologists, Meyer Friedman and Ray
Rosenman, observed differences in patterns of behavior of their
cardiac patients, differences they related to types of cardiac
problems
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Beginning in the 1980s, health care professionals sought to
identify these individuals in order to intervene and prevent the
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development of coronary problems
Main Characteristics of Type A Behavior

A sense of time urgency and hostility

1. Time urgency - This is the feeling that there is not enough time to do all
the things that we believe should be done or that we wish to do.

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It leads to the following symptoms:
– Rapid movements: The afflicted person usually walks, talks or eats fast.

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– Impatience: There is a feeling that the rate at which most events take place is
too slow. Frequently there is an attempt to hurry the speech of others by
saying very quickly over and over again, ''Uh huh, uh huh," or "Yes, yes, yes,"
or interrupting before people finish their sentences
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– Anguish at waiting in line or waiting to be seated in a restaurant. Avoids
repetitive tasks - making out bank deposit slips, writing checks, and washing
and cleaning dishes
Main Characteristics of Type A Behavior
• Tension: finds it difficult to sit and do nothing. Feels guilty when relaxing
He often has a characteristic facial tautness expressing tension and anxiety

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• Restlessness: knee jiggling, rapid tapping of the fingers, head nodding,
rapid eyebrow lifting while speaking, sucking in air while speaking, tongue-
to-front-teeth clicking during conversation, or tuneless humming

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• Preoccupation: Inattentive to others. Unable to detect mental and physical
fatigue while engaged in a task. Fails to observe seemingly unimportant
unrelated things
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2. Hostility – a predisposition to evaluate people or events negatively,
often in a suspicious, distrustful, cynical, and paranoid
fashion
There is a generalized aggression or excessive competitive drive
Hostile expressions:

• Sarcastic during conversations: Accentuating various key words in talking,


even when there is no real need for such emphasis

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• Always plays a game to win
• Clenching the fists, pounding the table, or forceful use of the hands and
fingers
• Preoccupation and irritation with the trivial errors of others
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• excessively critical of oneself and others - Characteristic facial expression
of aggression, hostility, and struggle, habitual clenching of the jaw or
grinding of the teeth
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• Tendency to swear or use obscene language
CHARACTERISTICS OF TYPE A PERSONALITY

Competitiveness - Belittles achievements of others in efforts to feel superior.


Perceives other group members as adversaries

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Resentment - Harbors feelings of ill will toward others
Deterministic worldview - Believes self to be a pawn of the environment,
rather than active determiner of fate.
Short-term perspective - Deals with problems from the view of immediate
consequences. PT
Impatience - Belief that success has been due to the ability to get things done
faster than others, and fear of ceasing to do things faster and faster.
Perfectionism - Believes, "I can do it best so I will do it." Unable to delegate
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authority.
Punctuality - Always on time
Tendency to be critical - Ruminates over a past mistake
Type C

• The Type C personality has difficulty expressing emotion


and tends to suppress or inhibit emotions, particularly

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negative ones such as anger. Such individuals also display
‘pathological niceness’, conflict avoidance, high social
desirability, over-compliance and over-patience
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• While there’s no clear-cut evidence that these
personality characteristics can actually cause cancer, they
influence the progression of cancer and, hence, the
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survival time of cancer patients
Weinman, 1995
Type D personality Traits
Type D personality - the joint tendency to experience negative emotions
and to inhibit these emotions while avoiding social contacts with others

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• experience increased negative emotions across time and situations and
tend not to share these emotions with others, because of fear of rejection
or disapproval
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• Gloomy, anxious, and socially inept worrier

• Have fewer personal ties with other people and tend to feel less
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comfortable with strangers

J Denollet, 2000
Type D personality Traits

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• has a high risk of cardiac disorders

• Has a high risk of emotional disorders like depression

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Hardiness – Protective factor

In 1981 Illinois Bell Telephone (IBT) downsized from 26,000 to


half

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Dr. Salvatore R Maddi and his team studied - 400 + supervisors, managers and
executives at IBT (before and after downsizing till 1987)

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2/3 employees suffered significant performance, leadership and health declines
heart attacks, strokes, obesity, depression, substance abuse
and poor performance reviews
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1/3 thrived - under same conditions
maintained health, happiness and performance and felt renewed
enthusiasm
What made the two groups so different?

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Dr. Maddi found that those who thrived maintained
three key beliefs

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that helped them turn adversity into an advantage

COMMITMENT, CONTROL AND CHALLENGE ATTITUDES


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Hardiness – Protective factor
Hardiness comprises the three Cs:

COMMITMENT – involve oneself in whatever one is doing

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to approach life with a sense of curiosity and meaningfulness
The Commitment attitude led them to strive to be involved in ongoing events, rather
than feeling isolated

CONTROL – related to Rotter’s (1966) locus of control


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individual differences in people’s beliefs regarding what controls
events in their everyday lives
The Control attitude led them to struggle and try to influence outcomes, rather than
lapse into passivity and powerlessness
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CHALLENGE – a tendency to believe that change is normal in Life
to anticipate change as an incentive to personal growth and
development rather than a threat to security
The Challenge attitude led them to view stress changes, whether positive or negative, as
opportunities for new learning
• COMMITMENT AND CONTROL associated with good health
• CHALLENGE is not always necessary

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• FEELING HELPLESS (NOT IN CONTROL) and being UNCOMMITTED
FIND THEMSELVES IN STRESSFUL CONDITIONS
• OPTIMISTIC OUTLOOK TO LIFE - HEALTHIER

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Hardiness moderates the stress–illness relationship by reducing
cognitive appraisals of threat, and reducing the use of regressive
coping
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Funk, 1992
Cultural/ethnic background
• competitiveness and striving for achievement are common goals in
capitalist societies, but probably not in more traditional, communal ones
Penny, 1996

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• the physical and mental health of African-Americans is worse than that
of whites, especially in terms of the spread of AIDS and hypertension.
While this is partly due to the direct negative effects of poverty, such as
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poor diet, low levels of education and poor medical care, there are many
psychological and social stressors involved as well

Although these are extremely difficult to measure, especially across cultures:


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… there is little dispute that blacks in North America and Europe face
a unique kind of stress – racial discrimination
Cooper et al., 1999
Stress itself as a cause of stress
Once emotional responses begin to build up, people will start
responding in terms of their perception of these emotional

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changes as well as to the context
So emotional problems cause stress too, particularly feelings of
inferiority, conscience and emotional conflict
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Ex: person who feels inferior under pressure, since every
contact, every event in his life is a cue for the activation of this
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sense of inferiority
Highly moral person - imposes unattainable demands on self 
failing to meet them causes stress
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STRESS MANAGEMENT
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RAJLAKSHMI GUHA
IIT KHARAGPUR
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SCIENTIFIC FOUNDATIONS
OF STRESS
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MODULE 5
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OUTLINE

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• STRESS IN COLLEGE LIFE

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Case vignettes:

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Case 1: AC- “I have low grades”

PT
Case 2: BD – “I can’t understand the language”

Case 3: EG – “I can’t balance my academics and


N
family”
Developmental tasks during college years

• Achieving emotional independence from family

EL
• Choosing and preparing for a career
• Preparing for emotional commitment and family life
• Developing an ethical system

PT
Managing these transitional changes requires college students to develop
new roles and modify old ones, and that can result in a great deal of stress
N
Chickering, A. and Havighurst, R. , 1998
Chronic stress in college life

Younger student / fresher:

EL
• Leaving home - Life style changes - Adjustment to new place,
food, climate, people
• Grades and performance
PT
• Communication skills
• getting involved in College activities
• balancing academics and other social involvements
N
Senior student:

EL
• Career decisions
• relationship issues
family responsibilities


PT
meaning in life
N
Stress signals
• Here are a few common indicators:
• Difficulty concentrating

EL
• Increased worrying
• Trouble completing assignments on time
• Not going to class



Tension
Headaches
PT
Short temper or increased agitation

• Tight muscles
N
• Changes in eating habits (e.g., “stress eating”)
• Changes in sleeping habits
Effects of stress
• Sleep disturbance
• Avoidance behaviour  Absentism

EL
• Poor academic performance
• Internet / computer addiction
• Social isolation
• Alcoholism and substance abuse


• Obesity
PT
Tension headache

• Irritable bowel syndrome


N
• Clinical depression
• Anxiety Disorders
• Suicide
Resilience studies on college settings

EL
PT
N
Resilience studies…

EL
PT
N
EL
Resilience studies in College settings In India
PT
N
EL
THANK YOU
PT
N

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