stressmanagement

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  • 1. Stress Management for Allied Health Professionals Richard Gevirtz, Ph.D. CSPP@Alliant International University-San Diego 9/11/2007 1
  • 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. What is Stress? • Stimulus • Response – Work – Physiological – Time • Autonomic • Central – People • Endocrine – Conflicting demands • Respiratory – Psychological • Anxiety • Depression – Behavioral 9/11/2007 3
  • 4. Interactional Models of Stress • Perception/appraisal • Physiological Mediators • Phenomenological experiences • Responses 9/11/2007 4
  • 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. New Trends Cognitive Therapy Raymond puts and end to his critical inner dialog. 9/11/2007 6
  • 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
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  • 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. 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. 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. 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
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  • 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. Anxiety attack while driving home
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  • 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. Low blood flow High blood flow This is your brain This is your brain on normal breathing. on hyperventilation.
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  • 32. Stress Management • Using our knowledge of stress physiology 9/11/2007 32
  • 33. Stress Management Approaches I Physiological • Exercise • Nutrition • Mind/Body Techniques – Yoga – Tai Chi – Mindfulness Meditation – Breathing 9/11/2007 33
  • 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. Peak= 79 Respiration Heart Rate Valley= 63 Pacer set at 7.0 bpm Valley 9/11/2007 35
  • 36. StressEraser.com
  • 37. HeartMath.Com
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  • 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