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Centre for Suicide Research and Prevention

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									                   Lecture 2
Identifying your stressors and how
         you handle stress

                           Dr. Paul Wong D.Psyc.(Clinical)
                              E-mail: paulw@hku.hk
   Centre for Suicide Research and Prevention (CSRP)
This Lecture’s Overview
1. Recap of Lecture 1
2. In-class activity - Myths and Facts of Suicide
3. Video – The aftermath of suicide
4. What is Stress?
5. Sources of Stress
6. Bio-psycho-social Aspects of Stress
7. How Stress Affects Health
8. Coping with it
Objectives
   Students will learn the difference between good and bad stress.
   Students will learn to identify signs of stress in themselves and
    others.
   Students will learn the difference between positive and negative
    ways of coping with stress.
   Students will identify and choose specific methods that can
    reduce stress.
Myths and Facts of Suicide
     In-class activity
             Myth or Fact


Suicide usually happens without warning.
                                Myth
Research has demonstrated that in over 80% of completed suicide, a
                 warning sign or signs were given.

                     (Coleman & O’Halloran, 1998)


  Many studies have revealed that the suicidal person gives many
    clues and warning regarding suicidal intentions. This is not to
          say that all suicidal people always give warnings.

           (Center for Mental Health in Schools at UCLA, 2003)
                      Myth or Fact?


There are no special/certain types of people who commit suicide.
                                Fact
Suicidal behavior cuts across all socioeconomic boundaries. People
       of all ages, races, faiths, and cultures die by suicide, as do
    individuals from all walks of life, all income levels. Most who die
    suffer from serious mental illness; many of whom have not been
    diagnosed; some have no diagnosable mental illness. We have
         to pay serious attention to all suicidal talk and behavior.
 Myth or Fact?


Suicide is preventable
                                 Fact

It is simply not true that “once suicidal, always suicidal.” Most people
      who are considering suicide will be suicidal for a relatively short
       period of time. Given proper assistance and support, there is a
        strong possibility that there will not be another suicidal crisis.
            Myth or Fact?


Many people think about suicide at some
          point in their lives.
                               Fact
50% to 70% of people have thought of suicide at some point in their
      lives as shown in studies that investigated lifetime suicidal
                               ideation.

                       (Ramsay et al., 1999)



 In Hong Kong, 29.6% of those aged 15-59 in the population have
    ever thought about suicide in their lives, and 6.7% have suicidal
                       ideation in the past year.

          (Prevalence Study of Suicidality in Hong Kong)
             Myth or Fact?


People who talk about suicide don’t really
             commit suicide.
                                 Myth

Of every 10 persons who kill themselves, 8 have given definite verbal
                warning signs of their suicidal intentions.


        (Center for Mental Health in Schools at UCLA, 2003)


    50.7% of those who committed suicide had either implicitly or
        explicitly expressed their suicidal plan prior to their death.


       (Psychological Autopsy Study of Suicide in Hong Kong)
         Myth or Fact?


Suicidal people fully intend to die.
                              Myth

Most suicidal people are ambivalent about dying. On one hand, they
  wanted to commit suicide to end their pain, yet on the other hand,
  they wanted someone to be there to help them and listen to them.


        (Center for Mental Health in Schools at UCLA, 2003)
                     Myth or Fact?


Once a person is suicidal, the person is suicidal forever.
                                Myth

Individuals who wish to kill themselves are suicidal only for a limited
     period of time. In other words, it is almost always a temporary
                                  state.
                  Myth or Fact?


People who threatens or attempts suicide are merely
                  seeking attention.
                              Myth

28.2% of all suicide cases in 2003 had an attempt history. 30.5% of
     the deceased aged below 25 had attempted suicide before.
               (Surveillance and Monitoring, 2003)


Compared to the people who are alive, those who died by suicide
   were 24.8 times more likely to have attempted suicide before.
     (Psychological Autopsy Study of Suicide in Hong Kong)
                  Myth or Fact?


Talking about suicide or asking someone if they feel
       suicidal will encourage suicide attempts.
                               Myth
There is no evidence that asking an individual about suicidal ideation
     will increase the change that the individual will commit suicide.
    Most people thinking about suicide want very much to talk about
       how they are feeling and are relieved when someone else
    recognizes their pain. To avoid the subject of suicide is deadly.

                     (Coleman & O’Halloran, 1998)
 The Aftermath of
    Suicide –
People bereaved by
     suicide
Video on People bereaved by Suicide in Hong Kong
What is Stress?
What is Stress?

   It is a stimulus – things that “stress” us, e.g., “This broadening
    course’s course co-ordinator stresses me!”
   It is a response – how we react to a stimulus, e.g., “I feel a lot of
    stress when I an being asked to answer questions in lectures of
    this course”
   It is a process – in which the person is an active agent who can
    influence the impact of a stressor through behavioural, cognitive,
    and emotional strategies. E.g., “though this broadening course
    makes me stress, I can deal with it by following the suggested
    ways from this class”.
So WHAT stress you?




   In-class activity no.2 – Hassles in Your life
             (Sarafino & Ewing, 1999).
The definition of stress -


   Stress as the condition in which person-
   environment transactions lead to a
   perceived discrepancy between the
   physical or psychological demands of a
   situation and the resources of the
   individual’s biological, psychological, or
   social system (Lazarus & Folkman, 1984).
In English


   Stress is the reaction people have excessive
   pressures or other types of demand placed
   upon them. It arises when they worry that they
   can’t cope.
When do we see something as stressful?


 Determined by two components:
   1. Whether a demand threatens our physical or psychological
      well-being (primary appraisal); and
   2. The resources available for meeting the demand (secondary
      appraisal).


   *** in emergency situations, i.e., disaster, our cognitive
        functioning is impaired during shock, it is unlikely that
        appraisal processes play an important role in the stress
        experienced while in that state***
Sources of Stress



        External



        Internal
External Stressors

   Physical Environment (Noise, Bright Lights, Heat, Confined
    Spaces)


   Social Interaction (Rudeness, Bossiness, Aggressiveness
    by others, Bullying)


   Organizational (Rules, Regulations, Deadlines)


   Major Life Events (Birth, Death, Lost job, Promotion, Marital
    status change)
Internal Stressors

   Negative self - talk (Pessimistic thinking, Self criticism, Over
    analyzing)


   Thinking errors (Unrealistic expectations, Taking things
    personally, All or nothing thinking, Exaggeration, Rigid
    thinking)


   Personality traits (Perfectionists, Workaholics)
Types of Stress
   Negative stress (dy-stress)
   Positive stress (eu-stress)
Note:

  Most of the stress we experience is self-
  generated. How we perceive life - whether an
  event makes us feel threatened or stimulated,
  encouraged or discouraged, happy or sad -
  depends to a large extent on how we perceive
  ourselves.
Note:

 Self-generated stress is something of a paradox,
  because so many people think of external causes
  when they are upset.


 Recognizing that we create most of our own
  upsets is an important first step towards coping
  with them.
   How stress affects our
Bio-Psycho-Social Aspects?
How stress affects our Bio-Psycho-Social Aspects?
   Biological
    •   During emergencies – fight-or-flight response
        • Pupils dilated, far vision
        • Dry mouth
        • Sweaty palms
        • Increased heart rate
        • Maximum blood supply to muscles
        • Digestion inhibited


    •   When stress prolongs
        • GAS (General Adaptation Syndrome)
    What is GAS?
    Three stages:
     •   Alarm Reaction – similar to the fight-or-flight response
     •   Stage of Resistance - If the source persists, the body prepares for
         long-term protection, secreting hormones to increase blood sugar
         levels. This phase is common and not necessarily harmful, but must
         include periods of relaxation and rest to counterbalance the stress
         response. Fatigue, concentration lapses, irritability and lethargy result
         as the stress turns negative.
     •   Stage of Exhaustion - In chronic stress situations, sufferers enter the
         exhaustion phase: emotional, physical and mental resources suffer
         heavily, the body experiences ‘ adrenal exhaustion’ leading to
         decreased stress tolerance, progressive mental and physical
         exhaustion, illness and collapse.
The Psychosocial Aspects of stress


 Mental
 Behavioural
 Emotional
Mental Symptoms

   Lack of concentration
   Memory lapses
   Difficulty in making decisions
   Confusion
   Disorientation
   Panic attacks
Behavioural Symptoms

   Appetite changes - too much or too little
   Eating disorders - anorexia, bulimia
   Increased intake of alcohol & other drugs
   Increased smoking
   Restlessness
   Fidgeting
   Nail biting
Emotional Symptoms

   Bouts of depression
   Impatience
   Fits of rage
   Tearfulness
   Deterioration of personal hygiene and appearance
Stress Related Illnesses

   Stress is not the same as ill-health, but has been related to
    such illnesses as:
    •   Cardiovascular disease
    •   Immune system disease
    •   Asthma
    •   Diabetes
    •   Recurrent headache
    •   Cancer
Why some people are more prone to stress, and
some are not?
 Social Support?
 A sense of personal control?
 A Hardy personality?
   •   Hardiness include control, commitment, and challenge.
Coping with STRESS
   Coping is the process by which people try to manage the
    perceived discrepancy between the demands and resources they
    appraise in a stressful situation.


   In English – people come up with ways to either reduce
    “demands” or increase “resources” or both.
Two major functions of coping


 Emotion-focused coping
 Problem-focused coping

In-class activity no.3 – “Your Focuses in Coping” - Billings
                        and Moos, 1981.
Two major functions of coping


 Emotion-focused coping – is aimed at controlling
  the emotional response to the stressful situation

 Problem-focused coping – is aimed at reducing the
  demands of the stressful situation or expanding the
  resources to deal with it.

 Please see examples of ways of coping from handout
Stress Management Techniques

   Change your thinking
   Change your behaviour
   Change your lifestyle
Change your Thinking
   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.


   Positive thinking
    •   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.
Change your Behaviour
   Be assertive
   Get organized
   Ventilation
   Have a sense of Humour
Be 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.
   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.
Equality and Basic Rights of being Assertive

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
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
Get Organized

   Poor organization is one of the most common causes of
    stress. Structured approaches offer security against ‘out of
    the blue’ problems. Prioritizing objectives, duties and
    activities makes them manageable and achievable. Don’t
    overload your mind. Organization will help avoid personal
    and professional chaos.
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 or delegate
   Plan your day
   Set achievable goals
   Don’t waste time making excuses for not doing something
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.
Change Your Lifestyle

   Diet
   Smoking & Alcohol
   Exercise
   Sleep
   Leisure
   Relaxation
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
Alternatives (less evidence, though)
   Conventional Medicine             Aromatherapy
   Counselling & psychotherapy       Floatation
   Relaxation                        Herbalism
   Meditation                        Biofeedback
   Massage                           Homeopathy
   Yoga                              Hypnotherapy
   Acupuncture                       Osteopathy
                                      Pet Therapy
                                      Reflexology
Please do send me things you find interesting that
you want to share with your classmates and
friends!
   http://csrp.hku.hk/WEB/eng/pageHandler.asp?id=826

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