Surviving the Distress: Stress Management Strategies · PDF fileSurviving the Distress: Stress Management Strategies ... • Crohn's disease ... Nutritional Interventions

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Surviving the Distress:Stress Management

Strategies

Debra Rose Wilson

PhD MSN RN IBCLC AHN-BC CHT

Tennessee State University

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Presenter Disclosure Information

In compliance with the accrediting board policies, the American Diabetes Association requires the

following disclosure to the participants:

Dr. Debra Rose Wilson:

Disclosed no conflict of interest

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1. Examine the concepts of stress and health

2. Describe strategies to integrate stress management strategies for self, patients and colleagues.

Objectives

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• 1983

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Stress: What is it?

• Stress

• Stressors

• Internal and external

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Theories of StressCannon• Fight or flight response. • Stimulus from outside the body triggers the

physiological changes• Taylor et al. (2000) suggested women have a tend

and befriend response

Hans Selye • Endocrinologist (1930’s) General Adaptation

theory of stress & eustress1. Alarm reaction to stress; 2. Resistance; 3. Exhaustion

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More Theories of stress

Holmes and Rahe• (1967) identifies stressful life events that may predict future illness.

Lazarus • Cognitive appraisal of the stressor; primary & secondary

Chronic, acute, & distant stressors• Acute stressors are time limited & involve confronting a challenge• Chronic stressors require active, sustained coping mechanisms• Duration of stress directly influences the immune system • Distant stressors are earlier traumatic experiences & continue to

influence immune functioning

StressOrigins

• Frustrations

• Life changes

• Conflict

• Control

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Types of stressAcute stressors• Time limited

• Brief

• Involve confronting a short term challenge

Chronic stressors• Pervasive

• Require active and sustained coping mechanisms

Distant stressors• PTSD

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Stress Pathways

Immune Function

Pupil Dilation

Gastric Secretion

Dilation of Skeletal Vessels

Dilation of Bronchi

BP Digestion

Vasoconstriction of Smooth Muscle

Norepinephrine

Blood Sugar

Glycogenesis

Liver

Cardiac Output

Heart Contractions

Fatty Acids

Fat Breakdown

Insulin Glucagon

Pancreas

Epinephrine

Sympathetic Nervous System

Blood Sugar

Liver

Amino Acids in Blood

Catabolism of Protein

Cardiac Output

BP

White Blood Cells Antibodies Histamine

Immune Function

Adrenal Cortex Secretes Cortisol

Anterior Pituitary Secretes ACTH

Hypothalamus Releases CRF

Perceived as Threat

STRESSOR

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Connections between stress & health

• Normally precisely balanced.• Psychological stress → imbalance of immunity• ↓ salivary IgA & ↓ lymphocytes during exam periods• ↓ immune functioning during bereavement• NK cell count ↑ with relaxation training• Cortisol levels influence WBC levels and immune

maintenance• Pert’s theory of the molecules of emotion • Target organs of autoimmune disease are influenced –

asthma, diabetes, fibromyalgia, IBS, CVD, TMJ, infections, allergies, RA, ulcers & colitis, cancer

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Autoimmune disease

• More than 50 million Americans have at least 1 AI • Approximately 80 AI diseases identified • One of the top 10 causes of death in women under 65• Second highest cause of chronic illness• Top cause of morbidity in women in the US• On the rise globally • Public health crisis compared to CVD & cancer• Poorly understood category of disease• Lack of coordinated care and research funding • A significant portion of healthcare cost

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NIH, 2011

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Examples of AI disease• Rheumatoid arthritis (RA) and Juvenile RA

(JRA)• Lupus [Systemic Lupus Erythematosus]) • Guillain-Barre syndrome • Type 1 Diabetes Mellitus • Hashimoto's, Graves' disease • Celiac disease• Crohn's disease• Ulcerative colitis• Multiple sclerosis• Addison's disease • Primary biliary cirrhosis

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Stress and Autoimmune Disease

• Stress alone does not cause autoimmune diseases

• Removing stress does not cure the disease.• But relaxation can help the body heal and

respond more effectively to the advanced medications

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Where do you feel stress?

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Stress Assessment

• Holmes and Rahe (handout)

• The Dolphin Stress test

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Stressor

PrimaryAppraisal

SecondaryAppraisal

Assessment of resources, options,experiences, control

Perception filtered through personal beliefs, goals, and experiences Perceived as threat.

No threat, irrelevant.

Coping

Biology-focused CopingIncrease awareness of biological response, use relaxation tools,

reduce stress response.

Emotion-focused CopingChange perceptions, alter responses

and defenses, reappraise.

Problem-focused CopingChange the stressor directly.

An Appraisal Model. (adapted from Lovallo, 2005 & Lazarus, 1998).

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Stress management

Three approaches to stress management:

1. Change the stressor?

2. Change the way you feel about the stressor?

3. Change the way your body responds to the stressor?

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Stress Management

• Action-oriented skills: change the problem.

• Emotionally-oriented skills: change how you feel about the problem.

• Acceptance-oriented skills: change how your body responds to the problem.

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Stress Management

• Behavioral and Cognitive

• New coping strategies

• Relaxation

• Assertiveness

• Time management

• Nutrition

• Self Care

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Healing Environment

• Safe

• No disturbances

• Atmosphere

• Comfortable

• Quiet

Wilson,2001

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Body Awareness• Everyone

responds differently.

• Get to know your own personal stress response.

• Do a body inventory.

• Get to know yourself better. M. C. Escher

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Body Awareness

• It’s the beginning of understanding.

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Breathe anytime and all the time

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Breathing

• Breathing is life.

• Be aware of your breathing.

• Allow breathing to happen.

• Breath deeper and slower.

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Progressive Relaxation

• Blood Pressure

• Heart Rate

• Immunity

• Muscle Tension

• Lactic Acid

• Sensitivity to Pain

• Difficulty Sleeping

Benefits

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Progressive Relaxation

• Effective relaxation method

• Variety of applications

• 2 weeks to master

• Jacobson method

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Guided Imagery

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Principles of Guided Imagery

1. The mind can influence the body.

2. In an altered state we are more capable of of healing and personal growth.

3. We feel better and do better when we have a sense of control.

4. The subconscious thinks we are really there.

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Research has shown guidedimagery can:

• Reduce stress and anxiety• Decrease pain• Decrease blood pressure• Decrease blood glucose levels • Decrease allergy and respiratory symptoms• Decrease the severity of headaches• Enhance bone and wound healing• Enhance sleep• Enhance self confidence• Assist in grieving• Enhance skin grafts

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Self Hypnosis

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Mindfulness

• The purpose of meditation is to realize where and who you are.

• Buddhist origins

• Learn to live in harmony

• Moments are richer

• We are in touch

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Mindfulness Meditation

• Simple concept

• Not easy

• Paying attention

• Present Moment

• Intentionally

• Nonjudgmental

• Awareness

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Nutritional Interventions

• Proper diet

• Whole foods

• Supplements

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Vitamin B Complex

• B1 - Thiamine

• B2 - Riboflavin

• B6 - Pyridoxine

• B9 – Folic acid

• B12 - Cobalamin

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Caffeine

• Consumption

• Stress response

• Mechanism of action

• Potentiation

• Usefulness

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Alcohol

• Coping mechanism

• HPA axis interference

• Resistance to infection

• Vitamins

• Cortisol

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Tryptophan

• Amino acid

• Serotonin

• Mechanism of action

• Depression

• Appetite

• Supplements

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Fat

• Lipid responses

• Dietary increase

• Prostaglandin precursors

• Sources

• Omega 3s

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Anti oxidents

• Interaction, balance

• Numerous processes

• Deficiency

• Sources

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• Anti-oxidant sources

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Mindful Eating

• Mindfulness

• Mindful eating

• Usefulness

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Sleep

• Length of sleep

• Quality of sleep

• Sleep apnea

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Choose

• To include stress management in your self care and patient teaching

• To slow down, breathe, be peaceful

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Three approaches to stress management:

1. Change the stressor?

2. Change the way you feel about the stressor?

3. Change the way your body responds to the stressor?