Stress management in students

DR.T.V.RAO MD 1

Dr.T.V.Rao MD

STRESS MANAGEMENT IN

STUDENTS

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THE CHALLENGES IN COLLEGE• The best years of your life? Expectations..• Even positive change is stressful• Greater academic demands• Unstructured time• Decreased adult availability• Being on your own in a new environment• Changing relations with family

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CHALLENGES OF COLLEGE: CHOICES

• Alcohol and other drugs• Sex-identity, values, practices• Food• Sleep• Balancing Academic and Extracurricular• Roommates

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LIFE MANAGEMENT SKILLS:

• GENERAL: Life management skills, for the purposes of this section, include stress management, time management, information management, financial management, personal health management, and crisis management. Personal planning and adeptness at managing each of these issues will increase the serenity and reduce the stressors within a busy, productive life.

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• Personal planning and adeptness at managing each of issues will increase the serenity and reduce the stressors within a busy, productive life.

PERSONAL PLANNING

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EVERY BODY IS UNDER STRESS• Every human on the earth will experience stress, even

medical students and physicians--it is a common denominator in life. Some stress is good stress (eustress) that is helpful and assists the drive toward achievement and success. Negative stress (distress) affects life in an adverse manner and is a common cause of ill health in our society. Individuals who ignore stress signals or who cope in a negative fashion will experience escalating symptoms of stress. The symptoms may appear as burnout, exhaustion, emotional illnesses such as depression and anxiety, and physical illnesses such as ulcers, heart attacks, hypertension, and abuse of alcohol and other drugs with all the social and professional consequences.

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WHAT IS STRESS?Stress is your mind and body’s response or

reaction to a real or imagined threat, event or change.

The threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes or external (loss, tragedy, change).

ADOLESCENTS AND STRESS ?

• Teens are under more stress

• Since adolescence is a period of significant changes

• physical,

• emotional,

• social, and

• academic changes

many than at any other time of life.

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• It's important to remember that stress is a natural part of life. Experiencing stress can be good, but it can also have negative effects on one's well being. What makes stress a positive or negative factor lies with how effectively the person experiencing the stress is able to manage it.

STRESS IS GOOD AND BAD TOO….

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• Medical education has deleterious consequences. Trainees (students, interns, and residents) suffer high levels of stress, which lead to alcohol and drug abuse, interpersonal relationship difficulties depression and anxiety, and even suicide. Medical students have mean anxiety scores one standard deviation above those of non-patients, and their depression levels increase significantly

IMPACT OF MEDICAL EDUCATION AND STRESS

SIGNS AND SYMPTOMS OF STRESS

Physical • Poor appetite or overeating • Feeing tired and fatigued • Various aches and pains ---headache body ache muscle pain • Nausea & abdominal Pain• Sleep problems• Falling sick very often e.g. fever cough cold diarrhea

( because of lowering of immunity due to stress)

• Feeling low • Nervousness and Anxiety• Excessive Anger or

Depression • Being easily upset• Poor self confidence • Low self esteem• Lack of Concentration• Poor performance in

studies

MENTAL STRESS

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EXERCISE REDUCES STRESS• As a way of draining off stress energy, nothing beats aerobic

exercise. To understand why, we need to review what stress is. People often think of stress as pressure at work, a demanding boss, a sick child or rush-hour traffic. All these may be triggers but stress is actually the body's reaction to factors such as these. Stress is the fight-or-flight response in the body, mediated by adrenaline and other stress hormones, and comprised of such physiologic changes as increased heart rate and blood pressure, faster breathing, muscle tension, dilated pupils, dry mouth and increased blood sugar. In other words, stress is the state of increased arousal necessary for an organism to defend itself at a time of danger .

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Eustress or positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished.

EUSTRESS

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Distress or negative stress occurs when your level of stress is either too high or too low and your body and/or mind begin to respond negatively to the stressors.

DISTRESS

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As you begin to experience a stressful event or perceive something to be stressful psychological changes occur in your body. This experience or perception disrupts your body’s normal balance and immediately your body begins to respond to the stressor(s) as effectively as possible.

ALARM STAGE

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THE “PARADOX OF MEDICINE”:BALANCING BETWEEN THE FACT THAT PEOPLE ARE

MOSTLY THE SAME & YET UNIQUELY DIFFERENT.

The “Bell Curve”

Individuals are all “Genetic Snowflakes”

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• Most people who need care don’t seek it or receive it

• Stigma, cultural pressure, mistrust, lack of information keep people out of care

• So do lack of resources; treatment and medication are expensive

• Care is disjointed

• Some schools don’t see emotional well-being and growth as in their “mission”

OBSTACLES

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• Relationship problems

• Depression• Anxiety• Eating Disorders • Substance Abuse• Sleep Problems

COMMON PROBLEMS

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• Situational

• Developmental

• Generalized anxiety disorder

• Performance

• Panic disorder, OCD, phobias

ANXIETY

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• 35% of adult population experience insomnia

• 11% of college students get a “good night’s sleep”

• Loss of cognitive functioning, driving

• Increased risk of depression

• < 7 hours yields sleep deprivation

SLEEP PROBLEMS

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LEARN STRESS MANAGEMENTEMOTION FOCUSED STRATEGIES

• L• E• A• R• N• S

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LEARN STRESS MANAGEMENT

• Laugh• E• A• R• N• S

STRESS MANAGEMENT TIPS

• Making little changes in your life can really add up to a big feeling of relief.

• Learn to recognize when you are feeling stressed and simple ways you can relax.

• Take a break. Have a cold drink, get some fresh air, or close your eyes for a minute to refocus.

• Stay positive to help friends and family cope with stress.• Let others know you're feeling overwhelmed and tell them how

they can help.• Allow yourself to simply say "no" to friends and family when you

know you cannot meet their demands without becoming overwhelmed.

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• Can you change your stressors by avoiding or eliminating them?

• Can you reduce their intensity (manage them over time instead of immediately)

• Can you shorten your exposure to stress (take a break, leave)

• Can you devote the

time necessary to make

a change

RECOGNIZE WHAT YOU CAN CHANGE

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CULTURES, HUMOR & MEDICINE

• Greeks – home of the comediane• Native Americans… Clown Doctors• Voltaire: • “The Art of Medicine consists of amusing

the patient while nature cures the disease.”

• Medicine today?

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• An attitude toward life.• Taking your work

seriously… but yourself lightly.

• Humor is healthy.• Humor connects us to

others!• It makes us MORE

effective!

WHAT IS HUMOR?

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HUMOR A GREAT TONIC TO STRESS – ENJOY IT

• Humor is a wonderful stress reducer, an antidote to upsets. Laughter relieves tension. In fact, we often laugh hardest when we have been feeling most tense.

• Humor is an individual thing - what is funny to one individual may be hurtful to another. It is wonderful when patients can poke fun at themselves. We can also do this with patients, but we have to be careful and respectful in what we say. If you think of something funny that may help the patient, say it if you feel it will ease their tension and not be offensive. I will often throw in a quip or joke when I think it is appropriate. When it is done sensitively, laughter is a great gift to people you care about.

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• Gather Data• Provide Rapid Access to

Care• Offer Education and

Outreach• Involve Students• Coordinate Care• Be aware of community

resources• Understand your limits

WHAT SHOULD COLLEGES DO?

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• Documentation

• How busy is counseling? Identify patterns and peak times of use.

• Where else do students get care?

• How many students take time off for medical reasons? Who comes back?

• How many students are hospitalized?

GATHER DATA

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EDUCATION AND OUTREACH• Be known. Get out in the community.• Train residence staff to recognize warning signs of

common problems.• Serve as liaisons/consultants to residence staff, deans,

coaches. • Supervise student groups: peer counselors, wellness

reps, advocacy groups• Offer for-credit course to freshmen on stress and time

management

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WELLNESS ACTIVITIES• Start a Wellness Center on campus• Focus on prevention: Eat, Sleep, Exercise• Engage Students in community- study breaks, hikes,

massage• Teach yoga, sleep hygiene, relaxation response as part of

leading balanced life.• Have annual “wellness” or “caring events” or “maximize

academic potential, minimize stress”• Student Wellness Reps.

• Practice time management

• Learn relaxation exercises. • Rehearse and practice situations.• Learn practical coping skills.

• Decrease negative self talk. • Learn to feel good with a workable result – Don’t be a

perfectionist.

• Build a network of friends.

Stress Management Plan

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• Ultimately, the only people who can get through to students with any consistency are the students themselves…” Peer Counseling/ Education Programs

• Student Health Advisory Group• Wellness representatives in the

dorms• Mental Health Advocacy Group• Involve in screenings and

education

INVOLVE YOUR STUDENTS

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• Legal issues

• Confidentiality

• What about parents?

• How much care for whom? How are sickest students cared for?

• When should students take a medical leave of absence? Re-entry?

UNDERSTAND YOUR LIMITS

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• Orient them and make them partners

• Don’t say “I can’t talk to you.”

• Process of communication is key: don’t shut them out

• Invite them to get permission

• Discuss general concerns, suggestions without breaching confidentiality

WHAT ABOUT PARENTS?

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• Balancing needs of individual and community

• Balancing care and education

• How are sickest students cared for?

• When should students take a medical leave of absence?

• Re-entry

HOW MUCH CARE FOR WHOM?

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• Emotional and physical well-being are crucial for academic success

• The entire student body benefits from a strong counseling program

• The institution benefits by increased retention and graduation, which enhance reputation

RETURN ON INVESTMENT

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• Get plenty of exercise and sleep. Improved focus and concentration help increase efficiency, so you can complete tasks in less time.

EXERCISE AND RELAXATION ARE FOUNDATION FOR EFFICIENCY

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• Even during their medical colleges careers, many students take on extracurricular activities and projects that are not covered at medical colleges.

• Extracurricular activates reduces the stress level

EXTRACURRICULAR ACTIVITIES REDUCES THE STRESS

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Develop mutually supportive friendships/relationships.

Pursue realistic goals which are meaningful to you, rather than goals other have for you that you do not share.

Expect some frustrations, failures and sorrows.

Always be kind and gentle with yourself – be a friend to yourself.

MAINTAIN YOUR EMOTIONAL RESERVES

STRESS MANAGEMENT TIPS

• Be prepared for unexpected problems such as traffic, a lost pet or a family emergency.

• Prioritize. Take control of your "to do" list by deciding what's really most important on your list.

• Write down feelings of sadness, frustration or anger to get a clearer perspective of your emotions.

• Enjoy life's simple pleasures like colorful flowers, dancing, music, and social outings, etc.

• Share your talents to better the lives of others as well as your sense of well-being.

STRESS is very commonUse stress in a positive way• Limit NOT eliminate

stress.• Use it to improve

your performance.

Learn Coping Skills

BEST TO WAY TO OVERCOME STRESS

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THE TAKEAWAY• Academic performance is enhanced by physical

and emotional health• We can learn to recognize problems much earlier• Depression, Anxiety and Stress are treatable• Education, Psychotherapy and Medication are all

effective • Self Care--eat, sleep, exercise--is a cornerstone of

health (for all of us!)

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• Being in control of your life and having realistic expectations about your day-to-day challenges are the keys to stress management, which is perhaps the most important ingredient to living a happy, healthy and rewarding life.

• Marilu Henner

BE REALISTIC AND NOT BE OVERAMBITIOUS

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• The programme created by Dr.T.V.Rao MD for Students in the Developing World

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