Observation of mental health week at Jagjivan Ram Hospital Western Rly Mumbai Central Following activities were carried out 1 – Public awareness lecture.
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Observation of mental health week at Jagjivan Ram Hospital Western
Rly Mumbai Central Following activities were carried out— 1 – Public awareness lecture by Dr Charles Pinto,
Dr Malay Dave and Dr J P Rawat on the importance of psychological issues in chronic medical illnesses 7 and 8th October 2010
2 – poster exhibition on the theme of mental health week 2010 8th to 10th October 2010
3- stress management programmed for the medical personnel on 9th October 2010
Mental Health Day Theme (WFMH)
MENTAL HEALTH AND CHRONIC PHYSICAL ILLNESSES
THE NEED FOR CONTINUED AND INTEGRATED CARE
10 Strategies to manage the Psychological Impact of Chronic
Illness Nutrition Exercise Spiritual Health care Communication Education Pace yourself Humour Relationships STRESS Management
STRESS MANAGEMENTSTRESS MANAGEMENT
BY:BY:
DR.J.P. RAWATDR.J.P. RAWAT
PSYCHIATRISTPSYCHIATRIST
Sr DMO JRH BCTSr DMO JRH BCT
What is stress?What is stress? Who is affected Who is affected ––living , age ?living , age ? Why they are affected? Why they are affected? –– Role of Good Role of Good
parenting, parenting, Temperament > Personality and Temperament > Personality and
develops good Coping mechanismdevelops good Coping mechanism Is it preventable?Is it preventable? Whether it is manageable?Whether it is manageable?
WHAT IS STRESS ?WHAT IS STRESS ?
Stress is the “wear and tear” our minds and Stress is the “wear and tear” our minds and bodies experience as we attempt to cope bodies experience as we attempt to cope with our continually changing environmentwith our continually changing environment
I HATE YOU
WHAT IS STRESS ?WHAT IS STRESS ?
Stress is the reaction people have to Stress is the reaction people have to excessive pressures or other types of excessive pressures or other types of demand placed upon them. It arises when demand placed upon them. It arises when they worry that they can’t cope.they worry that they can’t cope.
HELP ME!
Stress Stress is notis not in in our environmentour environment……
……it isit is what we what we perceive in our perceive in our mind and body.mind and body.
DEFINITIONDEFINITION
S = P > RS = P > RStress occurs when the pressure is greater than the resourceStress occurs when the pressure is greater than the resource
Internal state which can be caused by:Internal state which can be caused by:1.1. Physical demand on the body:Physical demand on the body: ExerciseExercise DiseaseDisease2.2. Environmental factors:Environmental factors: Extremes of temperatures:Extremes of temperatures: Natural calamitiesNatural calamities3.3. Social situationsSocial situations
When these are evaluated as potentially harmful, When these are evaluated as potentially harmful, uncontrollable uncontrollable
or exceeding our resources for coping.or exceeding our resources for coping.
STRESSORS STRESSORS STRESS STRESS DISTRESSDISTRESS
Varies from person to person.Varies from person to person. Some stressors are common to all:Some stressors are common to all:1.1. Infection.Infection.
2.2. Injuries.Injuries.
3.3. Dangerous events.Dangerous events.
4.4. Actual threat to self-esteem.Actual threat to self-esteem.
Stages Duration Optimum out come Unfavorable ratio
1. Basic Trust Vs Basic mistrust
Up to 1 yr.ADMO 25years
Hope Depression, 295
2. Autonomy Vs shame & doubt
1-3 yrs.ADMO
Self control OCD, delinquent behavior
3. Initiative Vs Guilt
3-5 yrs.ADMO DMO
Sense of purpose GAD, phobia
4. Industry Vs Inferiority
6-11 yrs.DMO, SrDMO ,
Sense of competence & pleasure in work
Inferiority
5. Identity Vs role confusion
11-20 yrs.JAG
Sense of consistency 295, conduct disorder
6. Intimacy Vs isolation
21-40 yrs.SAG
Loving relationship Schizoid
7. Generativity Vs stagnation
40-65 yrs.CMD
Productivity & creativity, CARE
Depression
8. Ego Identity Vs despair
65 yrs.DGRHS
Uses Wisdom Psychosomatic illness, hypo chondriasis
1. Physiological needs2. Safety needs3. Belonging & love needs4. Esteem needs5. Self actualization
FOR ATTENDING THE TOP POSTS - NEEDS IN THE HIERARACHY ARE :
1. Authoritative and caring parents a) Firm about rules & expected high level of maturity & achievements. b) Nurtuant and responsive to their children Result: Energetic, friendly, curious & self –reliant 2. Permissive parents: Little self reliance, poor self control Result: Impulsive and aggressive 3. Highly controlling authoritarian: HITLER Result: Apprehensive, withdrawn, unhappy, distrustful
PARENTING:
AROUSAL & AROUSAL & PERFORMANCEPERFORMANCE
Arousal energizes performanceArousal energizes performance..
Optimal levelOptimal level
STRESS RATING STRESS RATING SCALE`SCALE`Life eventLife event
1.1. Death of life partnerDeath of life partner
2.2. Major injury/illness Major injury/illness
3.3. MarriageMarriage
4.4. Being fired at workBeing fired at work
5.5. Argument with spouseArgument with spouse
6.6. Major change in work Major change in work responsbility-prm/dem/trfresponsbility-prm/dem/trf
7.7. Trouble with bossTrouble with boss
8.8. Major change in living Major change in living conditionsconditions
9.9. Debt for small purposesDebt for small purposes
10.10. Major change in sleeping Major change in sleeping habitshabits
AdolescentAdolescent
6969
5050
5050
5050
4141
3838
2626
3535
2828
1818
AdultAdult
100100
5252
5050
4747
3535
2929
2323
2525
1717
1616
ElderlyElderly
7373
6565
5050
6262
4545
4040
3939
4848
5252
3636
Life eventLife event
11.11. Major change in health of fly. Major change in health of fly. membmemb
12.12. PregnancyPregnancy
13.13. Gaining a new family memberGaining a new family member
14.14. Death of close friendDeath of close friend
15.15. Son/daughter leaving homeSon/daughter leaving home
16.16. Major change in eating habitMajor change in eating habit
17.17. VacationsVacations
18.18. Minor violation of lawMinor violation of law
19.19. Outstanding personal achievementOutstanding personal achievement
AdolescentAdolescent
4444
4545
4343
4646
3434
1818
1919
1212
3131
AdultAdult
4444
4040
3939
3737
2929
1515
1313
1111
2828
ElderlyElderly
5959
4747
3636
5252
4343
4545
3030
4747
3434
STRESS RATING SCALE`̀
GRADES OF STRESSGRADES OF STRESS
By adding the life change units, a life crisis score By adding the life change units, a life crisis score can be obtained for that year can be obtained for that year
MILD: 150-199 life change unitsMILD: 150-199 life change units MODERATE: 200-299 “MODERATE: 200-299 “ MAJOR: >300 “ MAJOR: >300 “
The Stress ResponseThe Stress ResponseThe Stress ResponseThe Stress Response
1930’s1930’sDr. Hans SelyeDr. Hans Selye Dr. Walter CannonDr. Walter Cannon
‘ ‘ Flight or Fight Response’Flight or Fight Response’
How body reacts with stress psycho How body reacts with stress psycho physiologicallyphysiologically
Alarm responseAlarm response
AdaptationAdaptation
ExhaustionExhaustion
ALARM RESPONSEALARM RESPONSE
This is the “ Fight or Flight” response that This is the “ Fight or Flight” response that prepares the body for immediate action.prepares the body for immediate action.
ADAPTATION PHASEADAPTATION PHASE
If the source persists, the body prepares for long-If the source persists, the body prepares for long-term protection, secreting hormones to increase term protection, secreting hormones to increase blood sugar levels. blood sugar levels.
This phase is common and not necessarily harmful, This phase is common and not necessarily harmful, but must include periods of relaxation and rest to but must include periods of relaxation and rest to counterbalance the stress response. counterbalance the stress response.
Fatigue, concentration lapses, irritability and Fatigue, concentration lapses, irritability and lethargy result as the stress turns negative.lethargy result as the stress turns negative.
EXHAUSTIONEXHAUSTION
In chronic stress situations, sufferers enter In chronic stress situations, sufferers enter the exhaustion phase: - emotional, physical the exhaustion phase: - emotional, physical and mental resources suffer heavily, and mental resources suffer heavily,
the body experiences ‘ adrenal exhaustion’ the body experiences ‘ adrenal exhaustion’ leading to decreased stress tolerance, leading to decreased stress tolerance, progressive mental and physical exhaustion, progressive mental and physical exhaustion, illness and collapse.illness and collapse.
TYPES OF STRESSORSTYPES OF STRESSORS
ExternalExternal
InternalInternal
EXTERNAL STRESSORSEXTERNAL STRESSORS
Physical EnvironmentPhysical Environment Social InteractionSocial Interaction OrganisationalOrganisational Major Life EventsMajor Life Events Daily HasslesDaily Hassles
PHYSICAL ENVIRONMENTPHYSICAL ENVIRONMENT
NoiseNoise Bright LightsBright Lights HeatHeat Confined SpacesConfined Spaces
SOCIAL INTERACTIONSOCIAL INTERACTION
RudenessRudeness BossinessBossiness Aggressiveness by othersAggressiveness by others BullyingBullying
ORGANISATIONALORGANISATIONAL
RulesRules RegulationsRegulations ““Red - Tape”Red - Tape” DeadlinesDeadlines
MAJOR LIFE EVENTSMAJOR LIFE EVENTS
BirthBirth DeathDeath Lost jobLost job PromotionPromotion Marital status changeMarital status change
DAILY HASSLESDAILY HASSLES
CommutingCommuting Misplaced keysMisplaced keys Mechanical breakdownsMechanical breakdowns
INTERNAL STRESSORSINTERNAL STRESSORS
Lifestyle choicesLifestyle choices Negative self - talkNegative self - talk Mind trapsMind traps Personality traitsPersonality traits
LIFESTYLE CHOICESLIFESTYLE CHOICES
CaffeineCaffeine Lack of sleepLack of sleep Overloaded scheduleOverloaded schedule
NEGATIVE SELF - TALKNEGATIVE SELF - TALK
Pessimistic thinkingPessimistic thinking Self criticismSelf criticism Over analysingOver analysing
MIND TRAPSMIND TRAPS
Unrealistic expectationsUnrealistic expectations Taking things personallyTaking things personally All or nothing thinkingAll or nothing thinking ExaggerationExaggeration Rigid thinkingRigid thinking
PERSONALITY TRAITSPERSONALITY TRAITS
PerfectionistsPerfectionists WorkaholicsWorkaholics
TYPES OF STRESSTYPES OF STRESS
Negative stressNegative stress
Positive stressPositive stress
NEGATIVE STRESSNEGATIVE STRESS
It is a contributory factor in minor It is a contributory factor in minor conditions, such as headaches, digestive conditions, such as headaches, digestive problems, skin complaints, insomnia and problems, skin complaints, insomnia and ulcers.ulcers.
Excessive, prolonged and unrelieved stress Excessive, prolonged and unrelieved stress can have a harmful effect on mental, can have a harmful effect on mental, physical and spiritual health.physical and spiritual health.
POSITIVE STRESSPOSITIVE STRESS
Stress can also have a positive effect, Stress can also have a positive effect, spurring motivation and awareness, spurring motivation and awareness, providing the stimulation to cope with providing the stimulation to cope with challenging situations.challenging situations.
Stress also provides the sense of urgency Stress also provides the sense of urgency and alertness needed for survival when and alertness needed for survival when confronting threatening situations.confronting threatening situations.
THE INDIVIDUALTHE INDIVIDUAL
Everyone is different, with unique Everyone is different, with unique perceptions of, and reactions to events. perceptions of, and reactions to events.
There is no single level of stress that is There is no single level of stress that is optimal for all people. optimal for all people.
Some are more sensitive owing to Some are more sensitive owing to experiences in childhood, the influence of experiences in childhood, the influence of teachers, parents and religion etc.teachers, parents and religion etc.
Self PerceptionSelf Perception
Most of the stress we experience is self-Most of the stress we experience is self-generated. generated.
How we perceive life - whether an event How we perceive life - whether an event makes us feel threatened or stimulated, makes us feel threatened or stimulated, encouraged or discouraged, happy or sad - encouraged or discouraged, happy or sad - depends to a large extent on how we depends to a large extent on how we perceive ourselves.perceive ourselves.
IntrospectionIntrospection
Self-generated stress is something of a Self-generated stress is something of a paradox, because so many people think of paradox, because so many people think of external causes when they are upset. external causes when they are upset.
Recognising that we create most of our own Recognising that we create most of our own upsets is an important first step towards upsets is an important first step towards coping with them.coping with them.
SYMPTOMS OF STRESSSYMPTOMS OF STRESS
Physical symptomsPhysical symptoms Mental symptomsMental symptoms Behavioural symptomsBehavioural symptoms Emotional symptomsEmotional symptoms
PHYSICAL SYMPTOMSPHYSICAL SYMPTOMS
Sleep pattern changesSleep pattern changes FatigueFatigue Digestion changesDigestion changes Loss of sexual driveLoss of sexual drive HeadachesHeadaches Aches and painsAches and pains InfectionsInfections IndigestionIndigestion
DizzinessDizziness FaintingFainting Sweating & tremblingSweating & trembling Tingling hands & feetTingling hands & feet BreathlessnessBreathlessness PalpitationsPalpitations Missed heartbeatsMissed heartbeats
MENTAL SYMPTOMSMENTAL SYMPTOMS
Lack of concentrationLack of concentration Memory lapsesMemory lapses Difficulty in making decisionsDifficulty in making decisions ConfusionConfusion DisorientationDisorientation Panic attacksPanic attacks
BEHAVIOURAL SYMPTOMSBEHAVIOURAL SYMPTOMS
Appetite changes - too much or too littleAppetite changes - too much or too little Eating disorders - anorexia, bulimiaEating disorders - anorexia, bulimia Increased intake of alcohol & other drugsIncreased intake of alcohol & other drugs Increased smokingIncreased smoking RestlessnessRestlessness FidgetingFidgeting Nail bitingNail biting HypochondriaHypochondria
EMOTIONAL SYMPTOMSEMOTIONAL SYMPTOMS
Bouts of depressionBouts of depression ImpatienceImpatience Fits of rageFits of rage TearfulnessTearfulness Deterioration of personal hygiene and Deterioration of personal hygiene and
appearanceappearance
STRESS RELATED ILLNESSESSTRESS RELATED ILLNESSES
Stress is not the same as ill-health, but has Stress is not the same as ill-health, but has been related to such illnesses as;been related to such illnesses as;
Cardiovascular diseaseCardiovascular disease Immune system diseaseImmune system disease AsthmaAsthma DiabetesDiabetes
STRESS RELATED ILLNESSESSTRESS RELATED ILLNESSES
Digestive disordersDigestive disorders UlcersUlcers Skin complaints - psoriasisSkin complaints - psoriasis Headaches and migrainesHeadaches and migraines Pre-menstrual syndromePre-menstrual syndrome DepressionDepression
DISTRESS CYCLEDISTRESS CYCLEStressorsStressors::
Immediate Immediate
effect effect ::
Long term effectLong term effect::
Overall costOverall cost::
ChemicalChemical EmotionalEmotional SocialSocial
CommunityCommunity FamilyFamily WorkWork
DecisionDecision PlanPlan PhobicPhobic
Stress overloadingStress overloading
BehavioralBehavioral PhysiologicalPhysiological EmotionalEmotional CognitiveCognitive
OvereatingOvereating
alcohol intakealcohol intake
SmokingSmoking
muscle muscle tension, HR, tension, HR, BPBP
Anger, Anger, anxiety, anxiety, DepressionDepression
Concern Concern tractiontraction
Obesity, Obesity, alcoholismalcoholism
HT, IHD, HT, IHD, DM, migraineDM, migraine
anxiety dep anxiety dep phobia, phobia, personalitypersonality
Sleep, Sleep, memory, memory, obsessive. obsessive.
DecreasedDecreased productivityproductivity EnjoymentEnjoyment & & intimacyintimacy
STRESS CONTROLSTRESS CONTROL
A B C STRATEGYA B C STRATEGY
ABC STRATEGYABC STRATEGY
A = AWARENESSA = AWARENESS
What causes you stress?What causes you stress?
How do you react?How do you react?
ABC STRATEGYABC STRATEGY
B = BALANCEB = BALANCE
There is a fine line between positive / There is a fine line between positive / negative stressnegative stress
How much can you cope with before it How much can you cope with before it becomes negative ?becomes negative ?
ABC STRATEGYABC STRATEGY
C = CONTROLC = CONTROL
What can you do to help yourself combat What can you do to help yourself combat the negative effects of stress ?the negative effects of stress ?
Stress Management TechniquesStress Management Techniques
Change your thinkingChange your thinking
Change your behaviourChange your behaviour
Change your lifestyleChange your lifestyle
Change your ThinkingChange your Thinking
Re-framingRe-framing
Positive thinkingPositive thinking
Re-framingRe-framing
Re-framing is a technique to change the Re-framing is a technique to change the way you look at things in order to feel way you look at things in order to feel better about them. better about them.
There are many ways to interpret the There are many ways to interpret the same situation so pick the one you like.same situation so pick the one you like.
Re-framing does not change the external Re-framing does not change the external reality, but helps you view things in a reality, but helps you view things in a different light and less stressfully.different light and less stressfully.
Positive ThinkingPositive Thinking
Forget powerlessness, dejection, despair, Forget powerlessness, dejection, despair, failure failure
Stress leaves us vulnerable to negative Stress leaves us vulnerable to negative suggestion so focus on positives;suggestion so focus on positives;
Focus on your strengthsFocus on your strengths Learn from the stress you are underLearn from the stress you are under Look for opportunitiesLook for opportunities Seek out the positive - make a change.Seek out the positive - make a change.
Change your BehaviourChange your Behaviour
Be assertiveBe assertive Get organisedGet organised VentilationVentilation HumourHumour DiversionDiversion
Being AssertiveBeing Assertive
Being assertive involves standing up for Being assertive involves standing up for
your personal rights and your personal rights and expressing your thoughts, feelings and expressing your thoughts, feelings and
beliefs beliefs directly, honestly and spontaneously in directly, honestly and spontaneously in
ways that don’t infringe the rights of ways that don’t infringe the rights of others.others.
Get OrganisedGet Organised
Poor organisation is one of the most common Poor organisation is one of the most common causes of stress. causes of stress.
Structured approaches offer security against Structured approaches offer security against ‘out of the blue’ problems. ‘out of the blue’ problems.
Prioritising objectives, duties and activities Prioritising objectives, duties and activities makes them manageable and achievable. makes them manageable and achievable.
Don’t overload your mind. Don’t overload your mind.
Organisation will help avoid personal and Organisation will help avoid personal and professional chaos. professional chaos.
Time ManagementTime Management
Make a listMake a list
What MUST be doneWhat MUST be done
What SHOULD be doneWhat SHOULD be done
What would you LIKE to doWhat would you LIKE to do Cut out time wastingCut out time wasting
Learn to drop unimportant activitiesLearn to drop unimportant activities Say no or delegateSay no or delegate
Time ManagementTime Management
Plan your dayPlan your day Set achievable goalsSet achievable goals
Don’t waste time making excuses for not Don’t waste time making excuses for not doing somethingdoing something
VentilationVentilation
‘‘A problem shared is a problem halved’A problem shared is a problem halved’ Develop a support network through Develop a support network through
friends or colleagues to talk with. It’s not friends or colleagues to talk with. It’s not always events that are stressful but how always events that are stressful but how we perceive them.we perceive them.
Writing a diary or notes may help release Writing a diary or notes may help release
feelings but do not re-read what has been feelings but do not re-read what has been written.written.
HumourHumour
Good stress - reducerGood stress - reducer Applies at home and workApplies at home and work Relieves muscular tensionRelieves muscular tension Improves breathingImproves breathing Pumps endorphins into the bloodstream - Pumps endorphins into the bloodstream -
the body’s natural painkillersthe body’s natural painkillers
DiversionDiversion
Take time outTake time out Get away from things that bother youGet away from things that bother you Calm down Calm down Think logicallyThink logically
Change Your LifestyleChange Your Lifestyle
DietDiet Smoking & AlcoholSmoking & Alcohol ExerciseExercise SleepSleep LeisureLeisure RelaxationRelaxation
DietDiet
Healthy eating habitsHealthy eating habits Avoid Caffeine (Stimulant)Avoid Caffeine (Stimulant)
Avoid Sugar and SaltAvoid Sugar and Salt Avoid Fast FoodsAvoid Fast Foods
Regular MealsRegular Meals
Smoking and AlcoholSmoking and Alcohol
Avoid or Moderate your consumptionAvoid or Moderate your consumption No to DRUGSNo to DRUGS
Benefits of ExerciseBenefits of Exercise
Uses up excess energy released by the Uses up excess energy released by the ‘Fight or Flight’ reaction.‘Fight or Flight’ reaction.
Improves blood circulationImproves blood circulation Lowers blood pressureLowers blood pressure Clears the mind of worrying thoughtsClears the mind of worrying thoughts Improves self imageImproves self image Makes you feel better about yourselfMakes you feel better about yourself Increases social contactIncreases social contact
SleepSleep
Good stress reducerGood stress reducer Difficult to cope when tiredDifficult to cope when tired
Wake refreshed after night’s sleepWake refreshed after night’s sleep Plenty of daytime energyPlenty of daytime energy
LeisureLeisure
InterestInterest Gives you a ‘break’ from stressesGives you a ‘break’ from stresses
Provides outlet for reliefProvides outlet for relief Provides social contactProvides social contact
Benefits of RelaxationBenefits of Relaxation
Lowers blood pressureLowers blood pressure Combats fatigueCombats fatigue Promotes sleepPromotes sleep Reduces painReduces pain
Eases muscle tensionEases muscle tension
RelaxationRelaxation
Decreases mental worriesDecreases mental worries Increases concentrationIncreases concentration Increases productivityIncreases productivity
Increases clear thinkingIncreases clear thinking
SpiritualitySpirituality
Yoga beneficialYoga beneficial Meditation UsefulMeditation Useful Prayers and Reading Holy Books helps in Prayers and Reading Holy Books helps in
changing mindset and attitudechanging mindset and attitude Inner Healing and self Awareness Inner Healing and self Awareness
decreases stressdecreases stress Faith , beliefs not Rituals are vitalFaith , beliefs not Rituals are vital
WELLNESS CYCLEWELLNESS CYCLE
StressStress
Health promoting lifestyle responsesHealth promoting lifestyle responses
Techniques & skills: Techniques & skills: Adaptive Adaptive AdaptiveAdaptive Adaptive Adaptive
Behavioral Physical Cognitive & emotionalBehavioral Physical Cognitive & emotional
Responses Responses ResponsesResponses Responses Responses
assertiveness, nutrition stress inoculation,assertiveness, nutrition stress inoculation,
time mgmt. Exercise cognitive restructuretime mgmt. Exercise cognitive restructure
relaxationrelaxation
Long term effects: Long term effects: self esteem improved improved mental health self esteem improved improved mental health self self respectrespect self respect self respect physicalphysical Resistance to futureResistance to future
self confidence health & stresses self confidence health & stresses resistance toresistance to diseasediseaseOverall benefits: productivity, enjoyment & intimacy Overall benefits: productivity, enjoyment & intimacy
CONCLUSIONCONCLUSION
Prevention is better than cure.Prevention is better than cure. For preventing the mental illness there is no For preventing the mental illness there is no
vaccine like polio,DPT Etc.vaccine like polio,DPT Etc. Identify the stressors & develop good Identify the stressors & develop good
coping mechanism so that stress can be coping mechanism so that stress can be managed before it kills you.managed before it kills you.
Perception – Analysis – ActionPerception – Analysis – Action
THOUGHT FOR THE DAYTHOUGHT FOR THE DAY
Never blame anyone in your life Never blame anyone in your life because -because -
good people give happinessgood people give happiness bad people give experiencebad people give experience worst people give you a lesson worst people give you a lesson and best people give you memories. and best people give you memories.
Dr Charles Pinto Dr Malay Dave Dr Ravi Kamath Staff of JRH
FOR MAKING THIS MENTAL HEALTH WEEK SUCESSFUL
SPECIAL THANKS TO -SPECIAL THANKS TO -
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