COPING WITH STRESS TO BENEFIT YOUR MENTAL AND PHYSICAL HEALTH AND QUALITY OF LIFE YOU CAN MAKE IT HAPPEN Bruce S. Rabin, M.D., Ph.D. Professor of Pathology, Psychiatry, Psychology University of Pittsburgh Medical Director, UPMC Healthy Lifestyle Program THE REALITY DEATH IS INEVITABLE A LIFE OF ILL HEALTH IS NOT THE LONGER YOU REMAIN HEALTHY AS YOU AGE, THE SHORTER WILL BE YOUR DEMISE Dependent Activities of Daily Living (ADLs) for Each Month Cohort, by Trajectory Group 7 activities of daily living (ADLs): walking across a small room, bathing, grooming, dressing, eating, transferring from bed to chair, and using the toilet Lunney, J. R. et al. JAMA 2003;289:2387-2392. THE REALITY There is an increased risk of mental and physical health problems in individuals who cannot COPE with the stress in their life SOMETHING CAN BE DONE TO REDUCE THE RISK OF DISEASE AS ONE GOES THROUGH THE AGING PROCESS CARING SPECIAL PEOPLE GROUPS TIME REPETITION What is stress? Stress results when something that happens or something that you observe EXCEEDS the ability of your mind to effectively COPE with the event When your mind cannot COPE with the stress: Stress reactive areas of your brain become activated The concentration of stress hormones in blood increases The increased amount of stress hormone is the reason that stress has an effect on the quality of your mental and physical health IT IS THE HORMONES THAT ALTER HEALTH COPING with stress is the use of behaviors and techniques to reduce the response of the brain to stress resulting in less of an elevation of the stress hormones when you experience stress THIS IS WHAT YOU WANT TO ACHIEVE What do the stress hormones do to mental health? Depression-Stress causes you to feel depressed because the stress hormones change the way your brain cells function in the area of the brain associated with depression Memory-Stress hormones damage brain cells responsible for memory Focusing-Stress hormones interfere with your ability to think clearly and to focus (this may be why you sometimes say something to someone when you are stressed that you are sorry you said) What do the stress hormones do to physical health? Blood pressure - Stress hormones cause blood pressure to increase by making blood vessels smaller. The rise in blood pressure may cause a stroke. Heart disease - Stress hormones cause blood vessels in the heart to increase how quickly they accumulate cholesterol deposits and become narrowed Heart attacks - Stress hormones cause blood platelets to stick together and form clumps that may plug up blood vessels and cause a heart attack Infections - Stress hormones decrease the ability off the body to resist infectious disease Autoimmune disease - Stress hormones cause diseases such as psoriasis, multiple sclerosis, rheumatoid arthritis, ulcerative colitis and Crohn’s disease to become more active Asthma and Irritable Bowel Disease - Stress hormones cause these diseases to flare up Wound healing - Stress hormones decrease the ability of the body to heal wounds Diabetes - Stress hormones cause blood sugar to rise and increase the likelihood of difficulty managing diabetes Weight Management – Stress hormones contribute to central obesity (fat around the belly) which contributes to developing diabetes. Stress hormones also interfere with making healthy decisions about what to eat as they interfere with the ability to think clearly STRESS CANNOT BE AVOIDED IF YOU CANNOT COPE WITH STRESS IT IS DIFFICULT TO ENGAGE IN BEHAVIORS THAT PROMOTE A HIGH QUALITY OF MENTAL AND PHYSICAL HEALTH IF STRESS CANNOT BE AVOIDED IS THERE SOMETHING THAT CAN BE DONE TO MINIMIZE THE NEGATIVE EFFECTOF STRESS ON HEALTH? YES, THERE IS We call it the development of “buffering skills” that minimize the activation of the stress reactive areas of the brain. COPING BEHAVIORS BLOCK ACTIVATION STRESS Areas of brain responsive to stress Increased stress hormones in blood are reduced by coping behaviors People who incorporate buffering skills into their lives will REDUCE the stressor induced alteration of their health Religion/Spirituality Expectations Laughter Acquaintances Xercise BUFFERS Religion (and/or Spirituality): Having a belief system in religion or having a spiritual nature that allows you to relax and calm yourself when faced with stress Expectations (Optimism): Being optimistic that things will go well for you and those problems that occur will not alter your basic belief that you are a good person Laughter (Sense of Humor): Having a sense of humor so that you can find amusement in events and can even laugh at yourself (remember the old saying that “laughter is the best medicine”) Acquaintances (Social Support): Having a social support system that you enjoy and can depend upon Xercise (Physical Fitness): Being physically fit as appropriate for your age, rather than being sedentary Acute stress – lasts for a few minutes (although you may continue to stew over it for hours) Chronic stress – lasts for hours, days, weeks, years TECHNIQUES TO COPE WITH ACUTE STRESS DEEP BREATHING FOR CALMING YOURSELF WHEN EXPERIENCING AN ACUTE STRESSOR DO NOT TAKE MORE THAN 3-5 DEEP BREATHS AS YOU MAY GET DIZZY IF AFTER 3 YOU ARE DIZZY DON’T TAKE ANY MORE IF YOU ARE NOT DIZZY AFTER 5 – STOP YOU CAN WAIT 15 MINUTES AND THEN DO IT AGAIN HUMOR FOR CALMING YOURSELF WHEN EXPERIENCING AN ACUTE STRESSOR CHANTING FOR CALMING YOURSELF WHEN EXPERIENCING AN ACUTE STRESSOR TECHNIQUES TO COPE WITH CHRONIC STRESS WRITING ABOUT WHAT BOTHERS YOU TO BRING CALMNESS AND RELAXATION Take a sheet of paper and something to write with. Find a quiet place where you will not be disturbed for 15 minutes. Pick any issue of concern to you to write about The only rule is that you write continuously for 15 minutes. If you run out of things to say, just repeat what you have already written. Don’t worry about grammar, spelling, or sentence structure. While writing DO NOT READ what you have already written Do not be concerned if you start crying while writing, it is common for this to happen. Your writing is completely confidential. When you finish writing, tear up what you have written and toss it out so that NO ONE WILL EVER SEE WHAT YOU WROTE TECHNIQUES TO COPE WITH CHRONIC STRESS GUIDED IMAGERY TO HELP YOUR MIND COOL DOWN Guided imagery is a script that someone reads and you listen to that directs you to create beautiful and comfortable thoughts and pictures in your mind where temperature, smell, sounds, beauty, people, sights, are comfortable and relaxing. Somewhat similar to a wonderful vacation taken without going anywhere. The importance of your behavior before walking through the door into your home _______________________ AB U S E Think about your influence as a ROLE MODEL for the next generation: Children usually have a limited ability to understand the long-term consequences of their behavior. If adults demonstrate that healthy behaviors contribute to good health and the joy of life, it is more likely that children will use these behaviors. The behaviors you teach and demonstrate to children when they are young are likely to be the behaviors they use when they are adults Let’s be realistic - stress will not go away To maintain health we must change the way our brain and that of children respond to stress so that there will be less depression and more joy of life Don’t just use stress coping techniques when you are experiencing stress Use them throughout the day when you are happy. This will train your mind to associate the techniques you use with feeling good. Then when you use the relaxation techniques when you are experiencing stress they will work more quickly and effectively because your mind will associate them with your being relaxed. As an example of the effectiveness of the program here is data of pre vs post-program changes in several psychosocial measures from a program just completed for 10 local non- profit organizations: Analyzing by paired T-tests and repeated measures ANOVA, all results were significantly different pre vs post Cynicism pre vs Cynicism post: p<0.000 Hostility pre vs Hostility post: p=0.001 Aggression pre vs Aggression post: p<0.000 Depression pre vs depression post: p<0.000 Optimism pre vs optimism post: p<0.000 Perceived stress pre vs perceived stress post: p<0.000 Life engagement pre vs life engagement post: p<0.000 Changing a behavior (habit) is not easy Behavioral change takes time, patience, support, and recognition that life is lived over years-not weeks Eventually, your new behavior will replace the old behavior What helps when you are trying to change a behavior? Positive social interaction Tricks to help you think clearly The motivation of knowing that you will be a meaningful role model for those who love you Be physically active Be highly optimistic you will do it and it’s OK if it takes awhile Don’t try to do it all at once The earlier in life a habit is learned-the harder it is to change Therefore, it is important to learn healthy lifestyle habits at the earliest stages of life and use the healthy behaviors throughout life. Adults need to make sure children understand what behaviors are bad for their long term health. SUSTAIN Believe in the importance of your goal of being healthy and a meaningful role model for those who love you and who you love Religion/spirituality Mind Expectations (optimism) Laughter Stress Acquaintance (social interaction) Techniques Xercise Body To create a new journey from unhealthy to healthy Happy and healthy Stressed Out Ill and blue Your journey choice Techniques For rapid relaxation and calm: Abdominal breathing to increase clear thinking Humor to increase clear thinking Chanting to increase clear thinking For coping with chronic stress: Happy and healthy Guided imagery Expressive writing Tai chi or Yoga Meditation Physical activity Body awareness Progressive relaxation It is not our purpose to make the stress in your life go away Indeed, we cannot do that However what we can and will do by your participation in our Journey is to lessen the impact of stress on your mental and physical health We will do this by increasing your ability to COPE with stress Will I learn to do this quickly? Probably not. You must practice and repeat the techniques being taught to you If you have taken piano lessons, you know that without practice your mind could not get your fingers to where you wanted them to be Your mind gets better with practice The more you practice relaxing your mind, the easier and more effective it will become Learning to relax will not make you a less effective person or negatively affect your work performance. In fact, learning to relax will make you more efficient in your everyday life, calmer, and will enable you to interact with others better. If implemented on a wide scale: Health care providers lose $ Health care insurers make $ RESULTS WILL TAKE A LONG TIME TO BE ACHIEVED SO WHAT!!!!!!!!!!!!