FROM DISTRESS TO DE-STRESS: EFFECTIVE TECHNIQUES FOR NURSES

LUCILA O. ESPINOSA, RN, MAN

MENTAL HEALTH

“IS THE ABILITY TO: Meet and handle problems Make choices and decisions Find satisfaction in accepting tasks to carry

on without undue dependence on others Contribute one’s share in life Enjoy Be able to love and be loved”

CRITERIA OF POSITIVE MENTAL HEALTH

Knowing thyself Growth, development and self-

actualization Autonomous behavior Integrative capacity Perceptive ability Mastery of environment

STRESS

A part of being alive Broad class of experiences in w/c a demanding

situation taxes a person’s resources or coping capabilities causing a negative effect

A Person-Environment interaction An adaptive response A part of human existence A stimulus or demand that generates disruption in

homeostasis or produces a reaction

TYPES OF STRESSORS

PREDISPOSING STRESSORS a. Biological – genetics, nutritional status,

general health

TYPES OF STRESSORS

PREDISPOSING STRESSORS b. Psychological – IQ, present and past

experiences, self - concept,

personality

TYPES OF STRESSORS

PREDISPOSING STRESSORS c. Socio-cultural age – age, gender,

education, social

position, cultural background

TYPES OF STRESSORS

PRECIPITATING STRESSORS – immediate causes influenced by:

a. Nature – biological, psychological & socio- cultural

b. Origin – internal or external environmentc. Timing – when the stressors occurred,

the duration and frequency of the stressord. Number – very difficult to deal with when they

occur close together

SOURCES OF PRECIPITATING STRESSORS

1. Stressful life eventsa. Social activity – family, work, education,

interpersonal health,

financial, legal or community causes b. Individual’s social field – those events are

entrances and exitsc. Social desirability – favorable or desirable are

promotion, engagement, marriage? Undesirable are financial problems,

being fired etc.

2. Life Strains and Hasslesa. Marital strainsb. Parental strainsc. Strains associated with household economicsd. Overload and dissatisfaction associated with the work role

APPRAISAL OF A STRESSOR

1. Cognitive – a person’s understanding of the situation. Hardiness or resistance to stress is indispensable. Psychologically hardy individual are less likely than non hardy people to fail as a result of stressful life events. The rationale is that hardy individuals are high in:

A. commitment – ability to involve one’s self in whatever one is doing

B. CHALLENGE

– BELIEF THAT CHANGE RATHER THAN STABILITY IS TO BE EXPECTED IN LIFE SO EVENTS ARE SEEN AS STIMULATING RATHER THAN THREATENING.

C. CONTROL – TENDENCY TO FEEL AND BELIEVE THAT THEY INFLUENCE EVENTS, RATHER THAN FEELING HELPLESS IN THE FACE OF LIFE PROBLEMS

B. CHALLENGE – BELIEF THAT CHANGE RATHER THAN STABILITY IS TO BE EXPECTED IN LIFE SO EVENTS ARE SEEN AS STIMULATING RATHER THAN THREATENING.

C. CONTROL – TENDENCY TO FEEL AND BELIEVE THAT THEY INFLUENCE EVENTS, RATHER THAN FEELING HELPLESS IN THE FACE OF LIFE PROBLEMS

2. Affective – arousal of a feeling state like anxiety and fear

3. Behavioral – fight or flight responsesFight – aggression responsesFlight – withdrawal responses

4. Social – three aspects are:

a. Search for meaning – seeks information about their

problem b. Social attribution – identifies the unique factors

that contribute the situation.

Self- blame may block an

active coping response c. Social comparison – compares skills and

capabilities with those of others

with similar problem

IMMEDIATE RESPONSE TO STRESS (FIGHT OF FLIGHT)

Dull sense of pain Improved memory Pupillary dilation Better oxygenation High sugar level BP and RR increase Epinephrine surge Halted digestion

DELAYED RESPONSE TO STRESS Activation of the hippocampus to

process stress Diminished immune response Fat conversion Cortisol release (high blood sugar

immunosupression, anti-inflammation)

CHRONIC RESPONSE TO STRESS

Cortisol becomes toxic to brain cells Fatigue, anger and depression Weakening of immunity Peptic ulcer diseases Elevated BP and HR Damage elasticity of blood vessels

COPING RESPONSES WILL BE DETERMINED BY:

1. Personal abilities

2. Social support

3. Material assets

4. Positive beliefs

COPING MECHANISMS

1. Problem-focused – tasks and direct efforts to cope with the threat itself. Includes negotiation, confrontation, seeking advice

2. Cognitive-focused – attempts to control the meaning of the problem thus neutralized it. Example are positive comparison, selective, ignorance, substitution of rewards.

3. Emotion-focused – moderating emotional distress. Use of ego defense mechanism.

COPING MECHANISMS MAY ALSO BE:1. Constructive – anxiety

is treated as a warning signal and accepts it as challenge

2. Destructive – ward off anxiety without resolving the conflict, using evasion instead of resolution

STRESSED OUT?

Do minor problems and small disappointments throw you in a distress?

Do you find it difficult to get along with people, and are people having trouble getting along with you?

Do the small pleasures of life fail to satisfy you? Are you unable to stop thinking of your anxieties? Do you fear people or situations that never used to

bother you? Are you suspicious of people, mistrustful of your

friends? Do you feel inadequate, suffer the tortures of self-

doubt?

HOW OFTEN HAVE YOU BEEN UPSET BECAUSE OF SOMETHING THAT HAPPENED UNEXPECTEDLY?

0 – never 3 - fairly often

1 – almost never 4 – very often

2 – sometimes

HOW OFTEN HAVE YOU FELT THAT YOU WERE UNABLE TO CONTROL THE IMPORTANT THINGS IN YOUR LIFE?

0 – never 3 - fairly often

1 – almost never 4 – very often

2 – sometimes

HOW OFTEN HAVE YOU FELT NERVOUS AND STRESSED?

0 – never 3 - fairly often

1 – almost never 4 – very often

2 – sometimes

HOW OFTEN HAVE YOU FELT CONFIDENT ABOUT YOUR ABILITY TO HANDLE YOUR PERSONAL PROBLEMS?

4 – never 1 - fairly often

3 – almost never 0 – very often

2 – sometimes

HOW OFTEN HAVE YOU FELT THAT THINGS WERE GOING YOUR WAY?

4 – never 1 - fairly often

3 – almost never 0 – very often

2 – sometimes

HOW OFTEN HAVE YOU BEEN ABLE TO CONTROL IRRITATIONS IN YOUR LIFE?

4 – never 1 - fairly often

3 – almost never 0 – very often

2 – sometimes

HOW OFTEN HAVE YOU FOUND THAT YOU COULD NOT COPE WITH ALL THE THINGS THAT YOU HAD TO DO?

0 – never 3 - fairly often

1 – almost never 4 – very often

2 – sometimes

HOW OFTEN HAVE YOU FELT THAT YOU WERE ON TOP OF THINGS?

4 – never 1 - fairly often

3 – almost never 0 – very often

2 – sometimes

HOW OFTEN HAVE YOU BEEN ANGRY BECAUSE OF THINGS THAT WERE OUTSIDE YOUR CONTROL?

0 – never 3 - fairly often

1 – almost never 4 – very often

2 – sometimes

HOW OFTEN HAVE YOU FELT DIFFICULTIES WERE PILING UP SO HIGH THAT YOU COULD NOT OVERCOME THEM?

0 – never 3 - fairly often

1 – almost never 4 – very often

2 – sometimes

AVERAGESAGE GENDER

18 - 29 14.2 Men 12.4

30 - 44 13 Women 13.7

45 - 54 12.6

55 - 64 11.9

65 & Over 12

Widowed 12.6

Married or Living with

12.4

Single or never used

14.4

Divorced 14.7

Separated 16.6

THE TOLL STRESS TAKES ON THE BODY Immune response – people who care for

spouses with dementia didn’t respond to a flu vaccine as well as a control group.

Coronary disease – men who said they were highly stressed were more likely to have heart attacks and strokes

Viral infection – the chances of catching a cold increase the longer people experience work or interpersonal stress

STRESS AND GENDER

Though a man’s blood pressure rises more sharply in response to stress, women react to a wider range of stressors and say they feel stress more often, perhaps because they take a holistic view of everyday life.

COPING WITH COMMON STRESS

MANAGING STRESS

1. Manipulate the environment2. Monitor stress level3. Cope with stress

a. Identify stress levelb. Analyze stress statusc. Diversional coping like:

1. Physical diversion2. Mental diversion

d. Meditatione. Laughter

4. Manage stress from a holistic levela. through exerciseb. through dietc. alter lifestyle pattern

5. Through controlled breathing

6. Through relaxation

. .

. .

. .

SOME SUGGESTIONS TO HANDLE STRESS Try physical activity – exercise Share your stress – talk to friends, strong

support system Know your limits – practice acceptance Take care of yourself – watch your habits Find time for FUN Avoid being alone Check on your task – get organized

SOME SUGGESTIONS TO HANDLE STRESS

Try cooperation instead of confrontation – disarm yourself

It is OK to CRY Create a quite scene Avoid self medications Learn to relax – reduce time urgency

BREAST FRIENDS

Being told you have a cancer is like being meted out a death sentence. The Great reaper hovering at your door. An uphill battle with no victory in sight. But Marisette Galang and her newfound friends who call themselves Bosom Buddies are out to prove they can beat the Big C with two Cs, in capital letters: COURAGE and COMRADESHIP.

BREAST FRIENDSMarisette muses: “Genetically you can’t

control cancer. But there’s a book that says you do not have the luxury of a negative thought. Maybe we should learn to cope with emotional stress. Before, I suppressed it and internalized it. Another lesson I learned through all this is we should start eating healthy. I have refrained from eating red meat. And I’m into the quigong practice (a self-healing system that combines conscious regulation of the body, breath and mind to enhance the flow of vital energy (qi) through the body, improve immune function, increase blood circulation and calm the mind.

MEDITATION – PEARSON’S TECHNIQUE

1. Quiet environment2. Comfortable position3. Passive stance / attitude4. Mental devise

DEEP BREATHING GUIDELINES

1. Sit, stand, or lie with your spine straight2. Scan for body tension3. Place one hand on your chest4. Inhale slowly and deeply so that your

abdomen pushes up your hand5. Visualize your lungs slowly filling with air.

Your chest should move only slightly as you inhale, but you should be aware of the movement of your abdomen.

DEEP BREATHING GUIDELINES

6. Exhale through your mouth, making a soft, whooshing sound by blowing gently. Keep your face, mouth, and jaw released.

7. Be aware of what it feels like and what you sound like when you breathe properly.

8. Continue to take long, slow, deep breaths for at least 10 minutes at a time, once or twice a day.

9. Increase the frequency if you wish once you have mastered the technique.

10. Scan your body for tension again, comparing the tension to what it was like before you begin the deep breathing exercise

MODIFIED AUTOGENIC RELAXATION

Assume a relaxing position. Slowly take in a very deep breath. Exhale

very slowly Repeat each of the following phases to

yourself four times. Say the first part of the phrase as you breathe in for 2 to 3 seconds. Hold your breathe in for 2 – 3 seconds. Hold your breathe out for 2 – 3 seconds.

Breathe in Breathe out

I am relaxed

My arms and legs are heavy and warm

My heartbeat is calm and regular

My breathing is free and easy

My abdomen is loose and warm

My forehead is cool

My mind is quiet and still

LIFE PROBLEMS AND RELATED HYPNOTIC SUGGESTIONS

Life Problems Hypnotic Suggestions

1. Fear of coming into the dark house at night

1. I can come in tonight feeling relaxed and glad to be home

2. Anxiety that prevents working or studying to meet deadlines

2. I can work steadily and calmly. My concentration is improving as I become more relaxed

3. Insomnia 3. I will gradually become more and more drowsy . In just a few minutes I will be able to fall asleep and sleep peacefully all night.

4. Chronic fatigue 4. I can waken feeling refreshed and rested

5. Obsessive and fearful thoughts about death

5. I am full of life now, I will enjoy today

LIFE PROBLEMS AND RELATED HYPNOTIC SUGGESTIONS

Life Problems Hypnotic Suggestions

6. Minor chronic headache or backache

6. As I become more relaxed, my headache (backache) lessens. In just a few minutes, it will go away. Soon my head will be cool and relaxed. Gradually I will feel the muscles in my back loosen. In an hour, they will be completely relaxed. Whenever these symptoms come back, I will simply turn my ring a quarter of a turn to the right and the pain will relax away.

7. Feelings of inferiority 7. The next time I see _______, I can feel secure in myself. I can feel relaxed and at ease because I am perfectly all right.

LIFE PROBLEMS AND RELATED HYPNOTIC SUGGESTIONS

Life Problems Hypnotic Suggestions

8. Anxiety about an upcoming evaluation or test

8. Whenever I feel nervous, I can say to myself…(Insert your special keyword or phrase here)… and relax.

9. Chronic anger (or chronic guilt) 9. I can turn off anger (guilt) because I am the who turns it on. I will relax my body and breathe deeply

10.Worry about interpersonal rejection

10. Whenever I lace my fingers together, I will fell confidence flowing me.

11.Chronic tension in a particular part of the body

11. I will think about my _______ every hour and let it relax.

WINDMILL EXERCISE

1. Stand relaxed – feet one foot apart2. Bend knees slightly and remain loose at hip level3. Inhaling evenly – Make a six backward circles by

swinging the left arm backward and then the right arm as the left reaches the top of its swing, similar to the crawl in swimming

4. Holding your breath, make sixteen backward circles, eight with each arm

5. Now exhale evenly, making six forward circles, three with each arm

6. Repeat the exercise three times and relax

EFFECT – A RETURN TO ACID-BASE BALANCE

STRESS AWARENESS DIARYDate February 14 Day of the Week SaturdayTime Stressful Event Physical and

Emotional Reactions

6:30 a.m. Alarm didn’t go off; rushing to report to duty

7:30 a.m. Late to duty, scolded by C.I

9:45 a.m. Slight headache; took paracetamol

10:15 a.m. Headache pounding; paracetamol not helping

11:00 a.m. Client’s wife makes several unreasonable demands

Anger

2:30 p.m. Classmate uncooperative during endorsement

Anger

3:00 p.m. Headache back

3:30 p.m. Hard time getting a ride going home

Indigestion

7:00 p.m. Argument with sister

7:05 p.m. Mother defends sister

7:30 p.m. Indigestion attacks

Negative Feelings to Release

Manifested by Physical Symptoms

May be replaced by Positive State

Thru the ff. C.E. Exercise

Depression Tightness of chestShortness of breathCurling forward of shoulders

Happiness Deep breathingElbow flexRaisearms at sidesDeep breathing

Nervousness and Other tensions

Fast BreathingShaking of some parts like hands, legsTwisting of FeetTightening of some parts

Relaxation Deep breathingGrounding neck and shoulder rollShake legs, arms, wrist, feetDeep breathing

Negative Feelings to Release

Manifested by Physical Symptoms

May be replaced by Positive State

Thru the ff. C.E. Exercise

Verbal Frustration

Fast breathingTightness of lipsLocking of jawsGritting of teeth

Release Deep breathingVoice ProjectionKarate ChopOpen-close mouthBite towelDeep breathing

Anger Fast BreathingTightening of hands and feetClenched fistsDesire to hit with hands and kick with feetClenched jaws

Peace Deep breathingKarate chopHitting pillow or mattressTwisting towelsThrowing soft objectsGroundingDeep breathing

Negative Feelings to Release

Manifested by Physical Symptoms

May be replaced by Positive State

Thru the ff. C.E. Exercise

Lack of Confidence

Shortness of breathTightening of the face, muscle and shoulders

Confidence Deep breathingGroundingRaise arms and sidesShoulder rollElbow flexDeep breathing

Sluggishness Lazy feelingLimp bodyDesire to rest, sleep

Energy Deep breathingArm stretch above headElbow flexBack rollKick, jump, shakeDeep breathing

Negative Feelings to Release

Manifested by Physical Symptoms

May be replaced by Positive State

Thru the ff. C.E. Exercise

General Fatigue

Tired body esp. eyes, neck, shoulder, back, legs

Relaxation Deep breathingNeck rollTense dropShoulder rollBody massageDeep breathing

Fear Short uneven breathsTightening of shoulders

Courage Deep breathingGroundingVibrate all partsDeep breathing

Characteristics of Total Relaxation

1.Rhythmic Breathing

2.Reduced Body Tension

3.Altered State of Consciousness

3.1 Beta Level

3.2 Alpha Level

THE PHILOSOPHY OF FAITH Faith in the ability of ourselves and

others to improve and grow Faith in the desire and capacity of

human beings to work out problems Faith in spiritual and moral values, in

the essential decency of mankind which will carry us through stresses that might otherwise shatter us.