Observation of mental health week at Jagjivan Ram Hospital Western Rly Mumbai Central Following activities were carried out 1 – Public awareness lecture.

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 -