Opinion | Stress Management : I choose to be happy and productive

Stress is unavoidable in modern life, but it doesn’t have to get you down. Work, money and family all create daily stress, while bigger issues like the global pandemic and politics contribute to our underlying stress levels. But approach it the right way, and it won’t rule your life — it can even be good for you.

Stress is caused by being HERE but wanted to be THERE (ECKHART TOLLE)

When I look back on all these worries, I remember the story of the old man who said on his deathbed that he had had a lot of trouble in his life, most of which had never happened.” – Winston Churchill.

HEALTH

From the World Health Organization’s (WHO) definition of health as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity”, it is clear that mental health is an essential part of a person’s health.

MENTAL HEALTH

The former Director-General of the WHO, Dr Margaret Chan alluded to the fact that “good mental health enables people to realize their potential, cope with the normal stresses of life, work productively, and contribute to their communities”.

PREVALENCE OF MENTAL DISORDERS ACROSS GLOBE

The Global Burden of Disease Study (2019) estimated that

280 million people suffered from depression, include 23 million children and adolescents

301 million more suffered from anxiety disorders, include 58million children and adolescents

40 million from bipolar disorder,

24 million from schizophrenia,

while 140 million people were affected by alcohol and drug disorders.

WHAT IS STRESS?

In a general sense, stress refers to a collection of physiological, emotional, behavioral, and cognitive reactions that occur in response to environmental demands.

At times, environmental demands are easily handled, such as when you have to press a button on a key to unlock your car. However, at other times, the demands of the environment can seem daunting or unmanageable, such as when you have to take three exams on the same day, and result in feelings of physical tension, negative thought patterns, and unpleasant emotional experiences.

Lazarus and Folkman in their book (Stress, appraisal and coping in1984) suggested that stress results when the demands of the environment are greater than the individual’s perceived coping resources. As we interact with the world around us, we must make constant appraisals of environmental threats, challenges, and demands and attempt to cope with any issues that arise.

WHAT CAUSES STRESS TO YOU?

Classes

Childcare

Mental health

Studying

Finances

Law violation

Relationship with partner

Appearance

Spiritual/Religious issues

Relationship with family

Physical Health

Major/Career decisions

Relationship with friends

Not “fitting in”

Attitudes/thoughts

Trauma

Getting married

Buying a house

Change in residence

Change to a new school

Change in amount of recreation

Change in amount of social activities

Change in eating habits

Death of friend/family member

STRESSER

A “stressor” is any event or stimulus that causes stress. However, what serves as a stressor for one person may not be the same for another. For example, being asked to attend a social event may create stress for someone who perceives that they lack the necessary social skills to fit in, whereas another person who feels comfortable in social situations may not experience any stress. Stressors can take many forms, ranging from the daily hassles of life to significant life changes

Daily hassles are the regularly occurring events or situations that we experience in everyday life, such as misplacing items, concerns about weight, or having to wait your turn. Any one of these events is unlikely to have a major impact on our overall quality of life. In contrast, life changes, such as death of a family member, getting married, or a negative health diagnosis are more significant.

Notice that not all stressors are negative. Getting married, having children, and starting a new job are often positive experiences, though they can create a significant amount of stress because they require us to alter our lives and adjust to new circumstances.

Why Do We “Stress Out”?

For two major reasons:

We perceive a situation as dangerous, difficult, or painful.

We don’t believe we have the resources to cope.

BODY RESPONSES TO STRESS

When threatened by environmental dangers, changes, or demands, humans experience a variety of physiological and psychological changes. Once a threat has been recognized and appraised as dangerous, the individual evaluates available coping resources. If the demands of the situation are deemed to be greater than the available coping resources, an “alarm” or ”Fight-or-Flight Response” is generated. During the fight-or-flight response, the body prepares for action, generally consisting of either confrontation or avoidance of the threat.

The sympathetic nervous system is activated, and hormones, including adrenaline and noradrenaline, are released into the blood stream. Heart and respiration rates accelerate and blood pressure increases, enabling the body to quickly circulate oxygen-rich blood to the brain and large muscles of the body. Blood is redirected away from the extremities to the core, and digestive processes are slowed. Muscles tend to become tense, eyes dilate, and hearing becomes more acute. Sweat glands activate to cool the body, and the skin often becomes paler or flushed.

Medical environment

A study was done on the stress levels in general practitioners and hospital consultants in 1999. Over 500 medical employees participated in this study done by R.P Caplan. These results showed that 47% of the workers scored high on their questionnaire for high levels of stress. 27% of the general practitioners even scored to be very depressed. These numbers came to a surprise to Dr. Caplan and it showed how alarming the large number of medical workers become stressed out because of their jobs. Managers stress levels were not as high as the actual practitioners themselves. An eye opening statistic showed that nearly 54% of workers suffered from anxiety while being in the hospital. Although this was a small sample size for hospitals around the world, Caplan feels this trend is probably fairly accurate across the majority of hospitals.[36]

In addition, there is a study that the objective of this study was to investigate the relationship between work performance and self-reported symptoms of depression, stress, and anxiety among nurses working in tuberculosis (TB)/HIV and COVID-19 units on Timor Island, Indonesia. The study used a comparative, cross-sectional design and collected data between October 2020 and January 2021. The study group comprised 236 nurses working in TB/HIV isolation rooms and 423 nurses in COVID-19 isolation rooms. The Depression, Anxiety, and Stress scale (DASS-42) and a work performance questionnaire were used to collect data, which were analyzed using independent t-testing and Pearson correlation coefficient. The results showed that the mean DASS-42 scores of nurses in TB/HIV isolation units were low, indicating minimal effects, while those in COVID-19 isolation units demonstrated moderate levels of depression, stress, and anxiety. Additionally, the work performance results indicated that the nurses in the TB/HIV isolation rooms had sufficient work performance, while those in the COVID-19 isolation rooms had weaker work performance. There was a significant difference in work performance between nurses in the two units. The study concluded that there was a correlation between nurses’ depression, stress, and anxiety levels and their work performance in TB/HIV and COVID-19 isolation units.[3

BENEFITS OF STRESS

Although we generally think of stress as something to avoid, stress is a natural, adaptive response that serves a protective function. At moderate levels, stress helps alert us to potential threats in the environment and enables us to focus our attention on resolving the threat. Stress also provides us with the energy needed to confront or retreat from the threat via the “fight-flight” response. Although some stress is beneficial, prolonged or intense stress can be associated with a variety of negative physical and psychological outcomes. For example, emotional disturbances, including irritability, depression, and anxiety disorders, whereas moderate amounts of stress helps to focus our attention,

COSTS OF STRESS

Excessive stress leads to diminished attention, concentration, decision-making, and short-term memory. High stress can also lead to a variety of emotional disturbances, including irritability, depression, and anxiety disorders. Indeed, many researchers consider stress a core component of the cause of emotional disorders. Chronic high stress is associated with serious physical health concerns, including cardiovascular disease, hypertension, immunosuppression and more frequent illnesses, sexual dysfunction, gastrointestinal disorders, and recurrent headaches.

High levels of stress are also associated with a variety of behaviors and lifestyle choices that can have negative health outcomes. Research indicates that individuals experiencing high stress are more likely to engage in excessive alcohol consumption and increased use of drugs and tobacco products. Ironically, alcohol increases cortisol levels, which can prolong the feeling of tension generated by stress responses. Stress can change the way the body processes alcohol, resulting in a reduction in the pleasant effects of alcohol and increased craving for more alcohol. In addition, chronic alcohol consumption and tobacco use are leading causes of a variety of chronic health problems, including lung and liver cancer, cirrhosis of the liver, emphysema, coronary heart disease, and stroke.

It is important to recognize that exceptionally low levels of stress can have negative consequences as well. For example, when arousal levels are too low, people generally experience boredom, poorer cognitive and physical performance, procrastination, and lack of attention to detail. The Yerkes-Dodson Law, developed by psychologists in the early 1900’s, holds that organisms’ physiological and mental functioning tends to be optimal when experiencing mild to moderate levels of arousal. Although the level of stress and arousal required for optimal functioning varies depending on the type of task, research over the past century has generally been supportive of this notion, which has shaped how stress and anxiety are conceptualized and treated.

STRESS MANAGEMENT

Find a support system.

Find someone to talk to about your feelings and experiences.

Be realistic.

Set practical goals for dealing with situations and solving problems.

Develop realistic expectations of yourself and others.

Get organized and take charge.

Being unorganized or engaging in poor planning often leads to frustration or crisis situations, which most always leads to feeling stressed.

Plan your time, make a schedule, establish your priorities.

Take breaks, give yourself “me time.”

Learn that taking time to yourself for rejuvenation and relaxation is just as important as giving time to other activities.

At minimum, take short breaks during your busy day.

Learn to say “no.”

Learn to pick and choose which things you will say “yes” to and which things you will not.

Protect yourself by not allowing yourself to take on every request or opportunity that comes your way.

Slow down. Know your limits and cut down on the number of things you try to do each day, particularly if you do not have enough time for them or for yourself.

Be realistic about what you can accomplish effectively each day.

Monitor your pace. Rushing through things can lead to mistakes or poor performance. Take the time you need to do a good job.

Poorly done tasks can lead to added stress.

PHYSICAL ACTIVITY AND EXERCISE

Considerable evidence has accumulated indicating that regular physical exercise is associated with numerous physical and psychological health benefits. For example, regular engagement in moderate exercise, such as a brisk walk, strengthens the immune system and decreases rates of illness. Exercise also strengthens body muscles, including the heart, preserves muscle mass, and helps with weight management. Individuals who exercise regularly are also at a reduced risk for some chronic diseases, such as diabetes and hypertension.

HEALTHY EATING

When experiencing high levels of stress, research suggests that many people change their eating patterns. One of the most common dietary changes associated with stress involves the increased consumption of caffeine in an effort to improve early morning or late night productivity. Ironically, although caffeine is associated with short term increases in alertness, caffeine can also exacerbate the stress response. For example, caffeine stimulates the body to release various stress hormones, including cortisol and glucocorticoids, as well as catecholamines, which include epinephrine (adrenaline), norepinephrine, and dopamine. The release of these chemicals is associated with heightened levels of stress for hours after ingestion. In addition, caffeine consumption can lead to other conditions that can affect the body’s ability to respond to stress, including insomnia, hypertension, increased risk of heart disease, gastrointestinal problems, and immune system suppression, making you more prone to infections.

ADEQUATE SLEEP

Research suggests that the relationship between stress and sleep is bidirectional in that high levels of stress tend to be associated with impaired sleep, and lack of sleep tends to exacerbate the experience of stress. Numerous studies have indicated that excessive stress tends to lead to diminished ability to fall and stay asleep, increased rate of nightmares, and poorer sleep quality. In addition, various emotional disorders associated with stress and anxiety, such as posttraumatic stress disorder and generalized anxiety disorder, are often associated with significant sleep disruption.

On the other hand, lack of sufficient sleep often leads to suboptimal physiological and psychological functioning. For example, sleep deprived individuals report higher levels of stress, anxiety and anger in response to even low-level psychological demands. Further, some evidence suggests that sleep deprivation affects cortisol (a stress hormone) levels, and neuroimaging studies indicate that sleep deprivation is associated with impaired neurological functions, including increased amygdala (part of the brain associated with emotional responses) reactivity and pre-frontal control regions of the brain. In addition, considerable evidence indicates that poor sleep is associated with poorer immune functioning. Epidemiological research suggests that most individuals require 7 to 8 hours of sleep nightly to obtain the maximum physiological and psychological benefits from sleep.

RELAXATION, MINDFULNESS, AND MEDITATION

Relaxation, or easing of physical or mental stress, is often thought to be the antidote to stress. Relaxation and anxiety are thought to be opposing emotions, in that one cannot be relaxed and anxious at the same time. Indeed, the achievement of a state of relaxation during a period of stress is often a challenging task. However, a variety of techniques have been devised with the intention of helping one to reach a state of relaxation, several of which have demonstrated reliable efficacy in psychological research: Diaphragmatic breathing, progressive muscle relaxation, guided imagery, and meditation exercises..

RELAXATION, MINDFULNESS, AND MEDITATION

Diaphragmatic breathing, or deep abdominal breathing, is a technique designed to slow one’s breathing and regulate oxygen intake. Diaphragmatic breathing involves taking slow, deep breaths with the intention of expanding and contracting the diaphragm, which is a muscle separating the chest and abdominal cavities. Typically, diaphragmatic breathing exercises involve sitting in a comfortable chair or lying down and taking slow, deep breaths with the intention of breathing so that the air expands the abdomen more than the chest.

RELAXATION, MINDFULNESS, AND MEDITATION

Research suggests that practicing diaphragmatic breathing can significantly reduce perceived stress. In one study, a sample of medical school students participated in a deep breathing program for 5 minutes per day prior to class over a 10-month period. After six weeks, students engaging in the deep breathing exercises reported significantly less test anxiety, self-doubt, nervousness and increased concentration during exams.

LAUGHTER, SELF-EXPRESSION, AND SOCIAL SUPPORT

It has long been said that, “laughter is the best medicine.” Indeed, we now know that laughter produces many positive physiological and psychological changes in the body. Research indicates that laughter increases oxygen intake and stimulates various muscles and organs, including the heart and lungs

Laughter also reduces blood pressure and blood sugar levels, increases blood flow, and improves energy levels. In addition, laughter causes the release of endorphins, which can increase pain tolerance and induce feelings of euphoria. Humor provides a psychological distance from the current state and enables us to replace our negative appraisals with more positive ones. In fact, some research suggests that laughter may be as effective as mild aerobic exercise or relaxation training at improving mood

COGNITIVE RESTRUCTURING

Often, we presume that the events that we experience have a direct effect on our emotions. For example, finding out that you made a poor grade on an exam or that your partner wants to break up with you CAUSES you to feel sad. However, it is not the event itself that leads to the emotion. Rather, it is the meaning that you give to the event or your interpretation of the situation that determines the event’s emotional impact. If you interpret the poor grade to mean that you are not very intelligent or that you will never succeed in school no matter how hard you try, you will likely experience a depressed mood. In contrast, if you interpret the grade as a fluke or the wake-up call you have needed to enhance your motivation for school, your mood will likely be much less negative.

DR. JAVEED IQBAL DAR (MD) Associate professor GHMC Kathua (J&K) drjavid9.jd@gmail.com.