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  1. 1. 1 Wali Memon Twitter:walimemon 1
  2. 2. 2 Wali Memon Twitter:walimemon 2
  3. 3. Definition of Stress “It seems wise to use “stress” as a generic term for the whole area of problems that includes the stimuli producing stress reactions, the reactions themselves and the various intervening processes. It defines a large, complex, amorphous, interdisciplinary area of interest and study.” (Lazarus, 1966)3 Wali Memon Twitter:walimemon 3
  4. 4. What Are Your Major Work and Life Stressors? WORK OTHER HEALTH FINANCIAL FAMILY4 Wali Memon Twitter:walimemon 4
  5. 5. Stress ResponseSympathetic Nervous System (SNS) Epinephrine (Ep also known as adrenaline) an norepinephrine (NEp) activate/arouse us during stress Immediate response to stressor (within seconds)Hypothalamic Pituitary-Adrenal Axis (HPA) Releases stored energy (glucose/fatty acids) to deal with emergencies via glucocorticoids (e.g., cortisol) Slower onset following stressor (within minutes)5 Wali Memon Twitter:walimemon 5
  6. 6. Stress Response PatternAlarm “Fight or Flight” activation of the autonomic nervous system (e.g., heart rate, blood pressure, cortisol, etc.)Resistance Immune suppression reaction, release of endorphins and growth hormone Exhaustion phase contributing towardsExhaustion stress related illness and exacerbation of medical conditions6 Wali Memon Twitter:walimemon 6
  7. 7. Stress Response Pattern Stage 1 Stage 2 Stage 3 Alarm Resistance Exhaustion Response to stressful event Normal level of resistance7 Wali Memon Twitter:walimemon 7
  8. 8. Stress Response “Tend-and-Befriend Model” A team of researchers headed by Shelley Taylor, a psychologist at the University of California, Los Angeles, reviewed over 1,000 human and animal stress response studies Men and women also react with a “tend-and-befriend” approach in the face of work and life stress Females respond to stressful situations by protecting themselves and their young through nurturing behaviors--the "tend" part of the model-- and forming alliances with a larger social group, particularly among women--the "befriend" part of the model Males, in contrast, show less of a tendency toward tending and befriending, sticking more to the fight-or-flight response Taylor, Shelley (2002). The Tending Instinct: Women, Men and the Biology of Nurturing. New York: Times Books8 Wali Memon Twitter:walimemon 8
  9. 9. Stress and Health: Important Points Sickness and disease are not the same Stressors do not make you sick Stressors make you more likely to get diseases that make you sick Chronic stress exacerbates pre-existing conditions, rather than, causing disease directly There exists substantial individual variability in response to disease9 Wali Memon Twitter:walimemon 9
  10. 10. The Mind-Body Connection: Chronic StressProblems Associated with Chronic Stress Cardiovascular (e.g., arteriosclerosis) Digestion (e.g., ulcers, decreased nutrient absorption) Bone (e.g., osteoporosis, stunted growth) Glucose (e.g., late onset diabetes) 10 Wali Memon Twitter:walimemon 10
  11. 11. The Mind-Body Connection I Immunocompetence Acute (e.g., final exams, sleep deprivation) and chronic (e.g., bereavement, marital conflict, care giving) stressors are significantly associated with immunosuppression in over 30 years of research Negative appraisal, realistic acceptance, suppression of negative/trauma related thoughts and pessimism appear to directly contribute adversely to immune function11 Wali Memon Twitter:walimemon 11
  12. 12. The Mind-Body Connection II Repressive Coping Definition of Repressive Coping: Repressive coping is a personality trait characterized by low self-reports of anxiety in stressful situations and high scores on defensiveness and social desirability12 Wali Memon Twitter:walimemon 12
  13. 13. The Mind-Body Connection II: Repressive Coping and Health Overall, the evidence suggests a signifcant association between repressive coping and immunosuppression, cardiovascular reactivity and elevated blood pressure Schwartz, G. (1990). The psychobiology of repression and health. In J. Singer (Ed.), Repression and dissociation (pp. 405-434). Chicago: University of Chicago Press. Jorgensen, R., et. al.(1996). Elevated Blood Pressure and Personality: A Meta-Analytic Review. Psychological Bulletin, 120(2), 293-31513 Wali Memon Twitter:walimemon 13
  14. 14. The Mind-Body Connection II: Repressive Coping and Cancer A recent meta-analysis examined the relationship between psychosocial factors and breast cancer Average effect sizes were calculated from 46 studies for 8 major categories The average woman in the breast cancer group generally used a repressive coping style to a greater extent than did 65% of the women in the control group McKenna, Molly C.; Zevon, Michael A.; Corn, Barbara; Rounds, James (1999). Psychosocial factors and the development of breast cancer: A meta- analysis. Health Psychology. Volume 18(5) 520-53114 Wali Memon Twitter:walimemon 14
  15. 15. The Mind-Body Connection II: Repression and Social Support Individuals high in defensiveness reported significantly higher social support compared to others Some limited evidence of a “super repressor” were observed in this study (high defensiveness, low anxiety, high optimism) Nowack, K.M. (2001). Repressive coping and social support: In search of a “super” repressor. Unpublished manuscript.15 Wali Memon Twitter:walimemon 15
  16. 16. How is repressive coping related to emotional intelligence?16 Wali Memon Twitter:walimemon 16
  17. 17. Repressive Coping and Emotional Intelligence Self-manager differences in performance ratings were studied in relation to the ratee’s personality scores for 204 managers Inflated self ratings (relative to those of his/her manager) were significantly associated with higher achievement, high social confidence, high social desirability and low anxiety Goffin & Anderson (2002). Differences in self-and superior rating of performance: Personality provides clues. Paper published at the Society of Industrial and Organizational Psychology. Toronto, Canada17 Wali Memon Twitter:walimemon 17
  18. 18. Repressive Coping and Emotional Intelligence 84 students predicted how their best friends would respond to various inconsiderate behaviors on their part compared to their friends reactions Repressor’s predictions were significantly less negative than their friends and, unlike nonrepressors, showed no association with their friends responses (i.e., low social awareness about their inconsiderate behaviors) McKinney & Newman (2002). Anticipating responses to one’s own misdeeds: Repressive coping and the prediction of other’s reactions to inconsiderate behavior. Journal of Social and Clinical Psychology, 21, 427-43718 Wali Memon Twitter:walimemon 18
  19. 19. Who are the stress resistant and hardy employees?19 Wali Memon Twitter:walimemon 19
  20. 20. Stress Response Types Hot Reactors 3 get sick in the battle of experiencing stress/change Sustainers 3 get sick after the battle of experiencing stress/change The Hardy 3 experience work and life stress/change without20 Wali Memon Twitter:walimemon getting sick 20
  21. 21. Stress Response Type: Hot Reactors Hot Reactors 1 in every 5 people Blood pressure shoots up under pressure High in cynical mistrust, hostility and anger Untreated, hot reactors are subject to heart disease, stroke and sudden cardiovascular death21 Wali Memon Twitter:walimemon 21
  22. 22. Stress Response Type: SustainersSustainers Experience illness or symptoms following stressful events or after the stress is over -- “Let Down Effect” Happens when shifting gears from a state of high activation to one of low activation Is frequently experienced after a stressful project is completed, on or after weekends, holidays, vacations, or after retirement22 Wali Memon Twitter:walimemon 22
  23. 23. Stress Response Type: The Hardy Perceive less work/life stress Practice daily health habits Possess strong social support React less frequently with Type A response to stress Possess a hardy outlook and optimistic explanatory style of work and life events Utilize health enhancing coping23 strategies and behaviors Wali Memon Twitter:walimemon 23
  24. 24. Determinants of Individual Health Genetic 30% Social Circumstances 15% Environment 5% Medical Care 10% Behavior/Lifestyle 40% McGinnis et al., 200124 Wali Memon Twitter:walimemon 24
  25. 25. “Change before you have to.” Jack Welch25 Wali Memon Twitter:walimemon 25
  26. 26. Habits are Hard to ChangeNEW YEARS RESOLUTIONS: 25% abandonnew behaviors after 15 weeks; 60% make thesame resolution the next yearWEIGHT LOSS: 95% of those who loseweight regain it back within 2 yearsSMOKING: Only 13-14% are abstinent 6 to12 months after quittingALCOHOL: 90% of those treated have adrink within 3 months; 50% return to pre-drinking levels within a year 26
  27. 27. Necessary Ingredients for Changing BehaviorNowack, K. and Heller, B. (2001). Making executive coaching work. Trainingmag.comAwareness Emotional Intelligence Motivation 27 Wali Memon Twitter:walimemon 27
  28. 28. Occupational Stress Measures of work and life stress are modestly associated with physical illness, job burnout and psychological distress (average r’s range between .10 to .30) A 2004 survey by Consulting Tools USA revealed that 40% of all employees report they “disagreed” or “strongly disagreed” with the statement “the amount of pressure and stress on my job is reasonable and rarely excessive” Reduction in perceived work and life stress have been found to be associated with immune enhancement (Nowack, 1992) Individual stress-management interventions generally are effective in reducing negative individual health outcomes, but do not consistently affect outcomes such as absenteeism, turnover, accidents, health care costs, productivity or job satisfaction unless additional organizational interventions occur (Nowack, 2000)28 Wali Memon Twitter:walimemon 28
  29. 29. “If I’d known I was gonna live this long, I’d have taken better care of myself” Eubie Blake at 10029 Wali Memon Twitter:walimemon 29
  30. 30. Health Habits: Exercise Physical activity affects many aspects of health including protection against premature mortality, CHD, hypertension, cancer, depression and anxiety Despite established benefits of regular exercise, more than 60% of adults in the US and UK are sedentary or insufficiently active The US American College of Sports Medicine recommends a level of physical activity of 30 minutes on 5 or more days/week or intense activity of 30-60 minutes at least 3 days/week for protective health benefits Lack of exercise has been shown to be an independent risk factor for heart disease (risk of inactivity ranges from 1.5 to 2.4, an increase in risk comparable with that observed for high cholesterol, HBP or cigarette smoking)30 Wali Memon Twitter:walimemon 30
  31. 31. Health Habits: Sleep/Rest Sleep is a 24-hour circadian rhythm REM and NREM sleep Sleep disorders: Insomnia Excessive daytime sleepiness (e.g., sleep apnea, narcolepsy) Circadian rhythm disorders (e.g., delayed phase, shift work, jet lag) There are many causes of sleep deprivation. Some include: 1) Not allowing enough time for sleep; 2) sleep disorders; 3) excessive worry ; 4) depression; repeated awakenings from noise; 5) shift work, working at night and travel across time zones; 6) medications; and 7) medical illness causing pain, difficulty in breathing, etc. Even a small loss of sleep can decrease waking performance and alertness. Research indicates that, for most people, one night with 2 hours less sleep than is usually required is sufficient to affect subsequent waking performance and alertness significantly Popular sleep treatments that might be helpful for sleep problems (e.g., insomnia) include exercise, mental/physical relaxation, light therapy, melatonin, valerian and new generation sleep aids31 Wali Memon Twitter:walimemon 31
  32. 32. Health Habits: Nutrition Approximately 61% of American adults are overweight Healthy eating and nutrition involves the following eight components: 1) high monsaturated fats found in many nuts and olive oils and low saturated fats found in most meat/dairy products; 2) moderate alcohol consumption; 3) high consumption of vegetables; 4) high consumption of cereals, grains and fiber; 5) high consumption of fruits; 6) high consumption of legumes; 7) low consumption of meat; and 8) low consumption of dairy products From a long term health perspective, it appears more important to increase the number of healthy foods regularly consumed than to just reduce the number of less healthy foods regularly consumed32 Wali Memon Twitter:walimemon 32
  33. 33. Health Habits: Preventive Practices The use of aspirin has been shown to have a cardiovascular health benefit Some recent studies suggest that moderate use of alcohol several times a week may have some limited protective effects on the cardiovascular system Lap/shoulder safety belts, when used, reduced the risk of fatal injury to front-seat passenger car occupants by 45 percent and the risk of moderate-to-critical injury by 50 percent33 Wali Memon Twitter:walimemon 33
  34. 34. Health Habits: Alcohol and Health Moderate alcohol consumption is associated with cardiovascular health benefits The lowest mortality occurs in those who consume one or two drinks per day Demonstrated reduction in current and future coronary heart disease (CHD) with moderate consumption of alcohol About 50% of the protective effect of alcohol is mediated through increased levels of HDL cholesterol Higher levels of alcohol consumption have been conclusively linked to more serious illnesses, accidents and adverse health outcomes34 Wali Memon Twitter:walimemon 34
  35. 35. Health Habits: Smoking Smoking in adults has declined in the US from 53% in 1966 to 23% in 2001 Cigarette smoking is a major risk factor for CHD (30% of approximately 170,000 of all coronary deaths are directly attributed to smoking) Smokers risk of heart attack is twice that of non-smokers Lower stress consistently contributes to one’s ability to successfully maintain cessation in both the short and long-term35 Wali Memon Twitter:walimemon 35
  36. 36. Social Support Cross sectional and prospective studies have consistently shown that social support can significantly reduce the severity of stress and psychological experience of it Epidemiological research has established that low social support is associated with both mortality and morbidity Types of social support Emotional Informational Instrumental Sources of social support, perceived availability, utility and overall satisfaction are associated with health and well-being in the face of work and life stressors Positive changes in social support have been found to influence coping behaviors and immune function (Nowack, 1992)36 Wali Memon Twitter:walimemon 36
  37. 37. Social Support: Age Standardized Death Rates per 10,000 Men, Ages 40-69 Nonsmokers Smokers Married 796 1,560 Single 1,074 2,567 Widowed 1,396 2,570 Divorced 1,420 2,67537 Wali Memon Twitter:walimemon 37
  38. 38. Type A Behavior Commonly associated with hard driving, competitive, achievement striving, impatient, hostile, energetic, fast paced and time urgent behaviors The toxic components of Type A Behavior appear to be cynical mistrust and antagonistic hostility Research shows a relationship between38 reduction of Type A Behaviors and CHD Wali Memon Twitter:walimemon 38
  39. 39. Cognitive Hardiness View change as a challenge, rather than a threat Are committed, rather than alienated, with their activities a work and home Possess a more internal, rather than external, locus of control Possess an optimistic explanatory style by appraising bad events as relatively external, unstable and specific Report greater self-esteem, self-efficacy and lower neuroticism (core self-evaluations) associated with increased job satisfaction and job performance Hardy individuals who experience stress report significantly39 lessWali Memon job burnout, and psychological distress illness, Twitter:walimemon 39
  40. 40. Coping Style Coping Styles Positive Appraisal Negative Appraisal Threat Minimization Problem-Focused Coping In two separate longitudinal studies, high scores on the Threat Minimization coping style and exercise significantly predicted lower levels of self-reported physical illness and absenteeism (Nowack, 1994)40 Wali Memon Twitter:walimemon 40
  41. 41. Coping Style: Unwinding Stress Perceived Stress Outcomes Thoughts Behavior Emotions41 Wali Memon Twitter:walimemon 41
  42. 42. Religion/Spirituality: Linkages to Health Religion is a very important part of the lives of approximately 67% of the American public 96% of the American public believe in God 42% attend religious services regularly Interest in spiritual growth is increasing with 82% expressing such interest in 1998 compared to only 58% in 1994 Powell et al., 200342 Wali Memon Twitter:walimemon 42
  43. 43. Religion/Spirituality: Strength of Evidence Linking to Health1. Service attendance protects against death Persuasive2. Religion/spirituality protects against heart disease Some3. Deeply religious people are protected against death No4. Religion/spirituality protects against disability No5. Religion/spirituality slows cancer No6. People who use religion to cope live longer Inadequate7. Religion/spirituality improves recovery from illness No8. Religion/spirituality impedes recovery from illness Some9. Being prayed for improves physical recovery from Some illnessPowell et al., 2003, American Psychologist, 58, 36-52 43 Wali Memon Twitter:walimemon 43
  44. 44. Approaches to Preventive Stress Management Modify the Stressor Change Your Perception or Belief About the Stressor Practice StressChange Your Reaction to Inoculation Behaviors the Stressor44 Wali Memon Twitter:walimemon 44
  45. 45. Coping with Stress: Relaxation Physical Relaxation StretchingMental Relaxation Progressive Meditation Relaxation Breathing Exercises Visualization Yoga Self-Hypnosis Massage45 Wali Memon Twitter:walimemon 45
  46. 46. Coping with Stress: Meditation1. Choose a quiet environment that is not too brightly lit. Allow yourself 5 minutes at first and gradually work up to 20 minutes.2. Sit upright with your spine erect….feet should be flat on the ground with your hands resting in your lap. Close your eyes and keep your body still.3. Start with some deep breathing: inhale and exhale deeply, letting all your breath out. Pause, then inhale letting the breath flow naturally using your abdomen muscles.4. Now allow your breathing to become natural and slow….as you exhale count “one.” Continue counting, each time you exhale. If thoughts enter your mind and your forget to count, simply notice and dismiss the thoughts. Do the same with sounds and bodily sensations—simply notice and dismiss them.5. If you wish to time yourself, use a non-ticking timer…When you are done, rock, gently back and forth before slowly getting up. Practice at least once daily. 46
  47. 47. Coping with Stress: VisualizationCreate Your DaydreamPicture a scene in which you are perfectly relaxed…..Perhaps you are lying at the beach on a warm breezyday….Continue to visualize this scene, noticing thewarmth of the sun on your body, feeling more relaxed,while your breathing becomes slow and rhythmic.You feel the warmth of the sun on your arms, legs, andface….how it totally relaxes and soothes all of yourmuscles…you actually can feel beads of perspirationform and your fingers and hands swell slightly as youcontinue to slow down your breathing and feel relaxedand calm…..Focus on the sounds of the waves crashingat the beach and feel the slight breeze of the wind onyour face as you continue feeling calm, comfortable andvery relaxed…slowly open your eyes….Practice thisvisualization when you experience stress and anxiety. 47
  48. 48. Causes of Work Stress Organizational StressorsTask Demands Physical Demands Role Demands Interpersonal• Quick decisions • Temperature extremes • Role ambiguity Demands• Critical decisions • Poorly designed office • Role conflict • Group pressures• Incomplete informa- • Threats to health • Leadership styles tion for decisions • Conflicting personalities48 Wali Memon Twitter:walimemon 48
  49. 49. Organizational Costs of Health Management A 2001 Kaiser Family Foundation survey found employees with single insurance coverage are now paying 27% more on average than last year The US Health Care Financing Administration forecasts for 2005 suggest a dollar increase of 57% from 2002 to 2005 Relatively progressive companies pay 80 times more in diagnosis and treatment than for employee preventative maintenance health programs Solid evidence suggests that 50% to 70% of all diseases are associated with modifiable health risks and potentially preventable49 Wali Memon Twitter:walimemon 49
  50. 50. Preventive Stress and Health Management A recent review of over 13 studies indicates an average benefit to cost ratio of $3.48 in reduced health care costs and $5.82 in lower absenteeism per dollar invested (Aldana, 2001) Combined health enhancement programs focusing on lifestyle management change have been shown to yield a $3 to $6 return on investment for each dollar invested in 2 to 5 years (Pelletier, 2001)50 Wali Memon Twitter:walimemon 50
  51. 51. Work/Family Balance More and more people in the workforce are putting emphasis on family as an important priority Over 70% of workers do not think there is a healthy balance between work and family Increasingly employees are exploring new careers because of the inability51 to manage work and family stressors Wali Memon Twitter:walimemon 51
  52. 52. Organizational Stressors: Leader Practices 70% of employees’ perception of the organizational climate is associated with the emotional intelligence of the leader (Goleman, 2002) Poorly managed workgroups are an average of 51% less productive and 44% less profitable than well managed groups 80% of turnover is directly related to unsatisfactory relationships with one’s boss52 Wali Memon Twitter:walimemon 52
  53. 53. Consulting Tools 2004 Study: Leadership Matters Results of two company wide employee engagement surveys were analyzed for all corporate staff for a large food service corporation for 2002 and 2004 Employees rated leadership and management practices using a benchmarked 8-item Leadership Effectiveness Index (alpha .91) Employees were asked additional questions about retention (intention to leave in 12 months), job satisfaction and perceptions of stress53 Nowack, K. (2005). Does Leadership Practices affect a Psychologically Healthy Workplace? Wali Memon Twitter:walimemon 53
  54. 54. Leadership Effectiveness and Climate (N=153) Significant Differences (all ps < .01) 3 2.48 2.39 Job Stress 2.07 2 Retention 1.78 Satisfaction 1.51 1.25 1 High Low54 Effectiveness Wali Memon Effectiveness Twitter:walimemon 54
  55. 55. Unscheduled Absence 2005Companies with poormorale have an 12%unscheduled absence rate Illnessof 3.2% compared to 1.5%for companies reporting 35% Family Issues“good” or “very good” 14%morale Personal Needs EntitlementOnly 35% of unscheduled Mentalityabsences are due to actual 18% Stressillness 21%Estimates are thatemployee absenteeismcosts about $660 peremployee CCH Unscheduled Absence Study 2005 55
  56. 56. Organizational Stressors: Team Practices Positive mood of the team leader promotes worker productivity and retention Team members tend to share moods, whether positive or negative, with more positive moods associated with increased performance56 Wali Memon Twitter:walimemon 56
  57. 57. Preventive Organizational Stress and Health Management Organizational Preventive Stress Management Physical/Task Demands Organizational Demands and Stressors Job/task redesign Participative management Physical Demands Flexible work schedules Design of physical settings Task Demands Role/Interpersonal Demands Selection/Promotion systems Role Demands Career/Talent management Mentoring systems Interpersonal Demands Team building Diversity workshops Leadership development57 Wali Memon Twitter:walimemon 57
  58. 58. Selected References Nowack, K. (2000). Occupational stress management: Effective or not? In P. Schnall, K. Belkie, P. Landensbergis, & D. Baker (Eds.). Occupational Medicine: State of the Art Reviews, Hanley and Belfus, Inc., Philadelphia, PA., Vol 15, No. 1, pp. 231-233. Greene, R. and Nowack, K. (1996) Stress, hardiness and absenteeism: Results of a 3-year longitudinal study. Work and Stress, 9, 448-462. Nowack, K. M. (1994). Psychosocial predictors of health, job satisfaction and absenteeism: Results of two prospective studies. Paper presented at the 1994 American Psychological Association National Convention, Los Angeles, CA. Nowack, K. and Pentkowski, A. (1994). Lifestyle habits, substance use, and predictors of job burnout. Work and Stress, 8, 19-35. Schwartz, G.E., Schwartz, J.I., Nowack, K.M., & Eichling, P.S. (1992). Changes in perceived stress and social support over time are related to changes in immune function. University of Arizona and Canyon Ranch. Unpublished manuscript. Nowack, K. M. (1991). Psychosocial predictors of physical health status. Work and Stress, 5, 117-131. Nowack, K. M. (1990). Initial development and validation of a stress and health risk factor instrument. Journal of Health Promotion, 4, 173-180. Nowack, K. M. (1989). Coping style, cognitive hardiness, & health status. Journal of Behavioral Medicine, 12, 145-158.58 Wali Memon Twitter:walimemon 58
  59. 59. 59 Wali Memon Twitter:walimemon 59
  60. 60. Thanks60 Wali Memon Twitter:walimemon Wali Memon 60