Stress Management for Allied
       Health Professionals

              Richard Gevirtz, Ph.D.
            CSPP@Alliant In...
Theme of the presentation
• Understanding the underlying physiology of
  stress is useful in managing it.
• “If our brain ...
What is Stress?
• Stimulus                     • Response
     –   Work                    – Physiological
     –   Time  ...
Interactional Models of Stress
•   Perception/appraisal
•   Physiological Mediators
•   Phenomenological experiences
•   R...
Nature of Modern Stressors
• Few require massive mobilization
  (fight/flight)
• Most involve interpersonal challenges,
  ...
New Trends Cognitive Therapy




            Raymond puts and end to his critical inner dialog.
9/11/2007                 ...
Physiology of Stress
• Four most important systems:
     – Sympathetic Nervous System/Adrenal Medullary
       system
    ...
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Parasympathetic (PSNS) Activity
• Parasympathetic activity:
     – Decreases heart rate, polarizes cells.
     – Acts thro...
Phylogenetic Hierarchy in
        Cardiovascular Response to Stress
                       Chromaffin   DMNX   SNS   Adren...
Stage   ANS Component Behavioral
                      Component

III     Myelinated vagus          Social communication,
...
9/11/2007   21
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Vagal Withdrawal: An alternative
                             to Sympathetic Activation


•   .: Neurosci Biobehav Rev. 19...
9/11/2007   25
Worrying about being late for an appointment. See FFT B



                                                        33 Br/m...
Anxiety attack while driving home
9/11/2007   28
“As a consequence of hyperventilation,
the decrease in PCO2 will reduce the
caliber of the arteries and thereby
impede the...
Low blood flow       High blood flow




 This is your brain             This is your brain
on normal breathing.          ...
9/11/2007   31
Stress Management
• Using our knowledge of stress physiology




9/11/2007                                    32
Stress Management Approaches I
         Physiological
• Exercise
• Nutrition
• Mind/Body Techniques
     –   Yoga
     –  ...
EFFECTS OF HRV BIOFEEDBACK ON
         HEART RATE

                                                      Biofeedback      ...
Peak= 79
Respiration

Heart Rate
                                  Valley= 63
  Pacer set at 7.0 bpm
                     ...
StressEraser.com
HeartMath.Com
9/11/2007   38
Stress Management Techniques II:
           Cognitive
 • Reframing/ humor
 • Decatastrophizing
 • Reducing the duration of...
stressmanagement
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stressmanagement

  1. 1. Stress Management for Allied Health Professionals Richard Gevirtz, Ph.D. CSPP@Alliant International University-San Diego 9/11/2007 1
  2. 2. Theme of the presentation • Understanding the underlying physiology of stress is useful in managing it. • “If our brain was simple enough for us to understand, we would be too dumb to understand it” 9/11/2007 2
  3. 3. What is Stress? • Stimulus • Response – Work – Physiological – Time • Autonomic • Central – People • Endocrine – Conflicting demands • Respiratory – Psychological • Anxiety • Depression – Behavioral 9/11/2007 3
  4. 4. Interactional Models of Stress • Perception/appraisal • Physiological Mediators • Phenomenological experiences • Responses 9/11/2007 4
  5. 5. Nature of Modern Stressors • Few require massive mobilization (fight/flight) • Most involve interpersonal challenges, social hierarchies, rejection/acceptance • Often characterized by internal rumination and worry states; anticipatory anxiety • Strong involvement of negative or critical self-judgement 9/11/2007 5
  6. 6. New Trends Cognitive Therapy Raymond puts and end to his critical inner dialog. 9/11/2007 6
  7. 7. Physiology of Stress • Four most important systems: – Sympathetic Nervous System/Adrenal Medullary system • Fight/Flight/Fright – Parasympathetic Nervous System • Rest/Digest – Hypothalamic Pituitary System • Cortisol – Respiratory System • Hyperventilation 9/11/2007 7
  8. 8. 9/11/2007 8
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  18. 18. Parasympathetic (PSNS) Activity • Parasympathetic activity: – Decreases heart rate, polarizes cells. – Acts through acetylcholine, high turnover in cells means beat-to-beat regulation. – Acts to stabilize the cardiac membrane and re- establish homeostasis. – Usually exceeds SNS activity. 9/11/2007 18
  19. 19. Phylogenetic Hierarchy in Cardiovascular Response to Stress Chromaffin DMNX SNS Adrenal Med NA DMNX=dorsal DMNX=dorsal motor nucleus motor nucleus Cyclostomes ⇑ SNS=sympathetic SNS=sympathetic Cartilaginous fish ⇑ ⇑ nervous system nervous system NA= nucleus NA= nucleus Advanced fish ⇑ ⇓ ⇑ ambiguous ambiguous Amphibians ⇑ ⇓ ⇑ Reptiles ⇑ ⇓ ⇑ ⇑ Mammals * ⇑ ⇓ ⇑ ⇑ ⇓ *Allows rapid *Allows rapid regulation of regulation of metabolic metabolic output:useful in output:useful in 9/11/2007 social regulation 19 social regulation
  20. 20. Stage ANS Component Behavioral Component III Myelinated vagus Social communication, (ventral vagal complex) self-soothing and calming, inhibit symp- adrenal-influences II Sympathetic- Mobilization, adrenal-system fight/flight, active (sympathetic nervous avoidance system) I Unmyelinated Immobilization, death vagus feigning, passive (dorsal vagal complex) avoidance, shutdown.
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  24. 24. Vagal Withdrawal: An alternative to Sympathetic Activation • .: Neurosci Biobehav Rev. 1995 Summer;19(2):225-33. – Cardiac vagal tone: a physiological index of stress. Porges SW. Institute for Child Study, University of Maryland, College Park 20742, USA. Cardiac vagal tone is proposed as a novel index of stress and stress vulnerability in mammals. A model is described that emphasizes the role of the parasympathetic nervous system and particularly the vagus nerve in defining stress. The model details the importance of a branch of the vagus originating in the nucleus ambiguus. In mammals the nucleus ambiguus not only coordinates sucking, swallowing, and breathing, but it also regulates heart rate and vocalizations in response to stressors. In mammals it is possible, by quantifying the amplitude of respiratory sinus arrhythmia, to assess the tonic and phasic regulation of the vagal pathways originating in the nucleus ambiguus. Measurement of this component of vagal tone is proposed as a method to assess, on an individual basis, both stress and the 9/11/2007vulnerability to stress. 24
  25. 25. 9/11/2007 25
  26. 26. Worrying about being late for an appointment. See FFT B 33 Br/min 13 Br/Min 9/11/2007 Driving. See FFT A 26
  27. 27. Anxiety attack while driving home
  28. 28. 9/11/2007 28
  29. 29. “As a consequence of hyperventilation, the decrease in PCO2 will reduce the caliber of the arteries and thereby impede the flow of blood to body tissue (ischemia), and the increase in blood pH will reduce the amount of oxygen that hemoglobin can release to the body tissue (hypoxia). Therefore, the heart must pump more frequently and with greater vigor in order to compensate for the decrease in pCO2 and increase in pH.” { Ley, 1987, p.309} 9/11/2007 29
  30. 30. Low blood flow High blood flow This is your brain This is your brain on normal breathing. on hyperventilation.
  31. 31. 9/11/2007 31
  32. 32. Stress Management • Using our knowledge of stress physiology 9/11/2007 32
  33. 33. Stress Management Approaches I Physiological • Exercise • Nutrition • Mind/Body Techniques – Yoga – Tai Chi – Mindfulness Meditation – Breathing 9/11/2007 33
  34. 34. EFFECTS OF HRV BIOFEEDBACK ON HEART RATE Biofeedback Rest 85 80 H eart R ate (beat/min) 75 70 65 60 55 50 45 40 1 12 23 34 45 56 67 78 89 100 111 122 133 144 155 166 177 188 9/11/2007 34 Time (sec)
  35. 35. Peak= 79 Respiration Heart Rate Valley= 63 Pacer set at 7.0 bpm Valley 9/11/2007 35
  36. 36. StressEraser.com
  37. 37. HeartMath.Com
  38. 38. 9/11/2007 38
  39. 39. Stress Management Techniques II: Cognitive • Reframing/ humor • Decatastrophizing • Reducing the duration of “stress attacks” – Acceptance of flawed self – Acceptance of early engrams – Reduction of duration – Experiential avoidance can’t work • Cognitive workbooks (Ex. Mind over Mood) • Get Out of your Mind and into your Life- Hayes 9/11/2007 40

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