ceramah kesihatan tarikh: 6 Julai 2019

1. PENGURUSAN
STRESS &
KESIHATAN
MENTAL
Dr. Zahiruddin Othman
Jabatan Psikiatri, USM

2.  Stress mengerahkan tenaga
untuk melawan atau
melarikan diri dari stressor

3. Sympathetic nervous system is
activated during “fight or flight”
response

5.  Stressor adalah sebahagian
kehidupan normal (Selye)
 Eustress
 Stress yang merangsang dan
memberi motivasi
 Distress
 Stress yang menyebabkan
kekeliruan, kurang tumpuan
dan kebimbangan

7. Stressors
• Bencana
•“Life changes”
•“Hassles”
Intervening Factors
•“Perceived control”
•“Coping behavior”
• Personality
Stress Reactions
• Fisiologikal
• Emosional
• Tingkahlaku

8.  Melibatkan ramai orang
walaupun jarang berlaku
 Semulajadi / alam
 Banjir, taufan, kemarau,
gunung berapi
 Angkara manusia
 Peperangan, kebakaran,
kebocoran gas

9. War is a man made disaster – water and sanitation,
electricity, food stores, and food supply routes are destroyed

10.  Perubahan besar dalam
kehidupan seseorang yang
membawa perubahan besar
dalam rutin seharian
 Contohnya; mula bekerja,
bekeluarga, bertukar kerja,
berpindah, mendapat
penyakit yang serius dsb.
Becoming a parent
Getting married

11.  Gangguan kecil yang
dihadapi dalam kehidupan
seharian
 Contohnya; masalah
kesesakan lalulintas,
perbezaan gaya hidup
dengan rakan sebilik, kerja-
kerja tertunda dsb

12. Daily hassles are not necessarily encountered everyday
but represent disruptions of or annoyances to one's daily
routine

13.  Setiap perubahan, baik atau buruk, memerlukan adaptasi
 Terdapat perbezaan individu dalam persepsi sesuatu peristiwa
 Konsep "life change unit" (LCU)
 besar (e.g. Kematian isteri = 100 LCU)
 kecil (e.g. Peperiksaan akhir = 20 LCU)

14.  Jumlahkan
LCU yang
terkumpul
dalam 12 bulan
 Tahap “life
change stress”
 Rendah: <
150
 Sederhana:
150 – 300
 Tinggi: >
300:

15.  “Perceived control” membawa kpd
 Hayat lebih panjang
 Kajian atas pemain besbol (Seligman)
 Kerjaya lebih berjaya
 Kajian atas jurujual insurans (Seligman)
 Berkait dengan
 Optimism (melihat kehadapan)
 Attribution (melihat kebelakang)

18. Avoidance learning experiment (Seligman)

19.  Emotion-based coping
 Fokus kepada emosi yang terhasil akibat stress
 Problem-based coping
 Fokus kepada punca stress
 Effektif: stress diatasi
 Tidak effektif: stress berterusan
 Pengambilan dadah/alkohol, pasif aggresif

20.  Pessimistik
 Tiada tindakan untuk atasi stress
 Jika stressor berterusan  keadaan stress berlanjutan 
system exhaustion and fatigue  penyakit

22.  Hurry sickness
 Sentiasa mengejar masa, melakukan terlalu banyak
perkara dalam masa yang terlalu singkat
 Quest for numbers
 Sentiasa mahu jadi yang terbaik, terbanyak dsb
 Insecurity of status
 Sentiasa mahukan ukuran objektif untuk harga diri,
mengejar kejayaan untuk dikagumi orang lain
 Aggression & hostility
 Sentiasa bersaing dengan orang lain, mudah hilang
kesabaran, pemarah

23. Type A personality individual is preoccupied with
ratings, being better than others, earning more
money, etc.

24.  Agresif
 Mendesak, memandang rendah orang yang tidak bersetuju dsb
 Pasif
 Tidak boleh menyatakan kemahuan sebenar, selalu tunduk pada
kemahuan orang lain
 Asertif (tegas)
 Menyatakan isihati tanpa menyakiti orang lain

25.  Untuk menjadi asertif (Albert & Emmons)
 OK berkata tidak ... Tiada rasa bersalah
 OK untuk ubah fikiran
 OK untuk ambil masa berfikir sebelum
melakukan sesuatu
 OK untuk minta dihormati
 OK untuk melakukan kurang dari yang
terdaya
 OK untuk menyatakan perasaan
 OK untuk rasa gembira atas diri sendiri ...
Bila-bila ... Dimana-mana

26. Being assertive means saying what you
feel but not being aggressive

28.  Permintaan > keupayaan
/ sumber
 Timbul dari pelbagai
punca:
 Kesuntukan masa
 Terlalu banyak
tanggungjawab
 Kurang sokongan
 Jangkaan yang terlalu
tinggi

29. Adakan rutin
(kelaziman)
 Pastikan kehidupan teratur
 Kerja / belajar
 Makan
 Tidur
 Berehat
 Teknik relaksasi
Tangguhkan
perubahan
 Jika sudah terlalu banyak
perubahan (e.g. LCU > 300)
 e.g. jangan berpindah
sekarang
 e.g. jangan ubah gaya
kehidupan sekarang

30.  Luahkan perasaan
 Learn to delegate
 Pengurusan masa
yang berkesan
 Asertif
 Periksa objektif diri
sendiri. Adakah
matlamat terlalu
tinggi?

31. Deadlines are common source of
occupational overload

32.  Gariskan matlamat dan pelan tindakan
 Jangka panjang - 1 to 10 years
 Sederhana (plus plan) - 3 to 6 months
 Pendek - Setiap minggu
 Memberi keutamaan (prioritize)
 Penting (important)– tak penting
 Segere (urgent) – tak segera
 Minta bantuan
 Don't be a PERFECTIONIST on a little task
 Pecahkan 1 tugasan besar kepada tugasan-tugasan
kecil

33. DO
FIRST
DO
NEXT
DO
LATER
DON’T
DO
High/Low
High/Low

35.  Air is taken in more
efficiently
 Blood is better
oxygenated
 Nerves are calmed
 The body is more
rested

36.  Lie on your back on a flat surface or in bed, with
your knees bent and your head supported. You can
use a pillow under your knees to support your legs.
Place one hand on your upper chest and the other
just below your rib cage. This will allow you to feel
your diaphragm move as you breathe.

37.  Breathe in slowly through your nose so that your
stomach moves out against your hand.
 The hand on your chest should remain as still
as possible.

38.  Tighten your stomach muscles, letting them fall
inward as you exhale.
 The hand on your upper chest must remain as
still as possible.

39. 1. Sit comfortably left hand on
abdomen, right hand against it
2. Imagine a hollow pouch under your
hand ... breathe in so as to fill the
pouch - right to the top (initially 3
sec. inspiration, later 5 sec.) ...
"look" at the air going in
3. Hold your breath and imagine
being calm
4. Slowly exhale until the pouch is
empty

40.  Berlatihlah 10-15 kali sehari.
 Lazimkan waktu pagi, tengahari, malam
dan waktu anda rasa stress.
 Langkah 1 dan 2 hanya untuk peringkat
latihan
 Latihan yang konsisten dapat
mengurangkan stress

41.  Duduk atau berbaring dengan mata tertutup
 Pernafasan diaphragmatic
 Tumpukan kepada pernafasan
 Bilang kadar nadi semasa hembus nafas biasa
 Biasanya 5-10
 Berlatih untuk tarik nafas, tahan nafas dan
hembus nafas dengan bilangan nadi yang
sama

43.  Perlukan lebih masa, tumpuan dan komitmen
 Bila sudah menguasai teknik ini, maka anda boleh memilih
turutan yang paling bermanfaat dan memenuhi keperluan
semasa
 Prinsip
 Associative learning
 Reciprocal inhibition

44.  Meningkatkan tumpuan
 Persekitaran
 Bunyi bising, gangguan rakan, telefon, TV dsb
 Badan anda
 Posisi yang relaks, pakaian yang selesa

45.  Dorsiflexion pergelangan kaki
 Bend up the feet ... pull hard ... harder! And
let go
 Plantar flexion pergelangan kaki
 Push the feet down as far as you can ... push
harder! And slacken the muscles completely

46.  Selaraskan dengan pernafasan
 Tumpukan perhatian pada perbezaan rasa otot yang relaks
dan otot yang regang (tense)
 Jangan fikirkan perkara yang merisaukan

47.  Extension of knee and hip.
 Straighten the knees as much as possible ...
 Now press the leg down into the mat ...
 Hard ... harder! Now relax ...

48.  Extensor muscles of the spine
 Push the chest forward until you have
hollowed the back strongly ... lift a little more!
And let go ...
 Abdominal muscles
 Pull the abdominal muscle until they are
quite flat ... pull a little bit more! And rest ...

49.  Finger and wrist extension
 Straighten the fingers and pull back the
wrists ... Pull hard
 Repeat 5 times

50.  Fingers and wrist flexion
 Clench your fists and curl your wrists inward

51.  Adduction of shoulder joints
 Straighten the arm against your sides ... press tightly

52.  Shoulder shrug
 Shrug your
shoulder high ...
higher ... touch
your ears

53.  Rotation.
 Shut the eyes ... now
roll the head slowly
forward, then slowly
back ... roll the head
to the right, then
slowly to the left ...
it’s heavy ... and it’s
rolling easily – front
to back, side to side
...
 Now stop, with the
face turned forward,
and rest ...

54.  Senaman muka
 Clench the teeth
together.
 Now draw up the
facial muscles very
tightly ... tighter!
And relax ...

56.  Meditasi =
Mengelakkan stress
 Aktiviti fizikal =
Membuang stress
yang terkumpul

57.  Senaman melibatkan ego
 Competitive golf, tennis etc
 Bermatlamat menewaskan
pesaing
 Kriegel, 1984: Pertandingan
menghasilkan lebih stress
dari yang dihilangkan
 DeGues et al, 1993:
senaman dengan “hateful
thoughts”  tingkatkan
nadi dan tekanan darah

58. Self
awareness
Social
awareness
Self
management
Social skills
• Working within a
diverse environment
• Working in group
• Understanding our
attitude and
personality
• Communicating
effectively
• Etiquette
• Networking
• Communicating
verbally and non-
verbally
• Dealing with conflict
• Understanding our
attitude and
personality
• Working within union
• Decision making in
group
• Negotiation skills
• Communicating
effectively, verbally and
in writing
• Understanding non-
verbal communication
• Ability to handle change
• Motivating myself
• Being an effective leader
• Making good ethical
choice
• Continuous learning
• Time management
• Self esteem
• Understanding
personal motivation
• Stress management
• Goal setting
SELF / SOCIAL
REGULATION/RECOGNITION

60. There should
always be a
timeframe
attached to a
specific goal.
Most
individuals
will have
longer-term
and shorter-
term goals.
TIME-
ORIENTED
The goal that
is set must be
something you
are willing
and able to
work toward
The goal
cannot be
someone else’s
goal.
REALISTIC
Is the goal
reasonable
enough to be
accomplished?
Make sure the
goal is not out
of reach or
below
standard
performance
ATTAINABLE
From and to
Can you track
the progress
and measure
the outcome
MEASURABLE
Who, What,
Where, When,
Why, Which
Define the
goal as much
as possible,
with no
ambiguous
language
SPECIFIC

61. HYPERAROUSAL
HYPOAROUSAL
NORMAL
Anxiety
Sensitivity
Relaxation
Tranquil State
Opiates
Tranquilizers
Marijuana
Alcohol
Nicotine
Caffeine
Amphetamine
Psychedelics
Meditation
Autogenics
Yoga
Muscle relaxation
Biofeedback
Dadah dan aktiviti yang mengubah tahap kesedaran

62.  Social readjustment
 Emotional intelligence
 Time management
 Understanding motivation
 Goal setting, etc.
 Counselling & therapy
 Behavioural
 Cognitive
 Medication
•Catastrophe
•Life changes
•Hassles
Stressors
•Appraisal
•Perceived control
•Personality
•Coping behavior
•Social support
Intervening factors
•Biological e.g. psychosomatic illness
•Psychological e.g. mental illness
•Social e.g. conduct and drug problem
Stress reactions