Stress Management

1. Dr. Lokendra Sharma
Professor, Pharmacology
SMS Medical College
Jaipur (Rajasthan)
Stress (21st
Century Syndrome)
Management

2. Highlights
• 21st
century syndrome- types, causes, warning
signs, response, strategy to control
• Self directed & motivated stress management
for your skill training and personality
development
• Self harm initiative project of world psychiatry
society
• GMHAT of Chester university (UK)
• Stress management experience with Medical
students

3. What is Stress?
Stress is often termed as 21st
century
syndrome, born out of man’s race towards
modern progress and its ensuing
complexities.

4. What is Stress?

5. 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.

6. Types of Stress
Positive (Eustress)
Negative( Distress)

7. Positive Stress Cycle:
Eustress

8. Difference between
Eustress & Distress

9. Not All Stress is Bad…
Distress is a continuous
experience of feeling
overwhelmed,
oppressed, and behind
in our responsibilities.
Eustress is the other
form of stress that is
positive and
beneficial.

10. Causes of
Stress

11. What Makes Something
Stressful?
-Situations that have strong demands
-Situations that are imminent(Flooding)
-Life transitions (New Place)
-Timing (e.g., deviation from the
“norm”)
-Ambiguity(Future Uncertainty))
-Desirability (Unmatched)
-Controllability

12. Stress Response:
Example
Physical Response?
Behavioral Response?
Mental Response?
Emotional Response?

13. What are the effect
of Stress on our
bodies?
When we are stressed, our:
Blood pressure rises.
Breathing becomes more rapid.
Digestive system slows down.
Heart rate (pulse) rises.
Immune system goes down.
Muscles become tense.
Sleeping can be more of a problem
Photoby®Thinkstock

15. How to control Stress?

16. Change Your Thinking
-Every certificate and achievements
have expiry date

17. Change Your Behavior
-Be assertive
-Get organized
-Ventilation
-Humour
-Diversion and Distraction
 Skill training can be excellent stress
buster

19. Change Your Lifestyle
Try to write your own
story
Smoking & Alcohol
Exercise
Sleep
Leisure
Relaxation

20. Should be time Management for Participation in
games, cultural, literary etc events

21. Enhance Physical
Activities
Like bicycling, walking, running etc.

22. The physical activity produce
endorphins
chemicals in the brain that act as
natural
painkillers—and also improve the
ability to
sleep, which in turn reduces stress.

23. Spend time with Nature
Spending time in nature can help relieve stress
and anxiety, improve your mood, and boost
feelings of happiness and wellbeing.

24. Change your Attitude
-Find other ways to
think about stressful
situations.
-Celebrate your each
achievements.

25. Be Realistic
-Set practical goals for
dealing with situations
and solving problems.
-Develop realistic
expectations of yourself
and others

26. 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.

27. Take good care of yourself, Eat
properly, Get regular rest, Keep a
routine
-Allow yourself to do
something you enjoy each
day.
-Paradoxically, the time we
need to take care of ourselves
the most, when we are
stressed, is the time we do it
the least.

28. Say No to Addiction
-Learn to say no to smoking, alcohol,
drugs, junk food because they create
stress
and rebound stress
-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.

29. Make a Hobby
Get a hobby, do
Something
different for a
balanced lifestyle.
Like trekking,
gardening, listening
music etc

30. Laugh Therapy
Laugh, use humor.
-Do something funny and enjoyable
such as seeing a funny movie,
laughing with friends, reading a
humorous book, or going to a
comedy show.
-Incorporate laughing therapy in
learning and teaching

31. Learn to Relax
-Develop a regular
relaxation routine.
-Try yoga, meditation,
acupressure or some
Simple quiet time.

32. Relaxation Exercises
Relaxation Exercises are different
kinds, some are:
-Deep Breathing
-Visualization: Visualization
is a nice way of giving our
minds and bodies a "mini
vacation.“
-Muscle Relaxation

33. Deep Breathing
-One of the best
ways to lower
stress in the body.
-It sends a
message to your
brain to calm
down and Relax.

34. Meditation for Stress
Management

35. Activities for Stress Reduction
• Make interactive &
interesting teaching
• Involving students in
lectures
• Allowing students
for micro -teaching
at the end of the
lecture.

36. Do the interesting things
as per your Choice

37. Involve yourself in
Spiritualism, Plantation etc

38. Invasive
Acupressure
Therapy
for Stress
Reduction

39. Invasive Acupressure
Therapy for Stress
Reduction
Acupoint 11 :
located on
inner side of
wrist.

40. Invasive Acupressure
Therapy for Stress
Reduction
Acupoint : 15
Located on
middle finger.

41. Invasive Acupressure
Therapy for Stress
Reduction
Acupoint 21 : located in middle of sole of foot.

42. What is self-harm?
-Self-harm is a
behaviour, not a
mental illness
-A way of
managing distress

43. Socially Acceptable Self-Harm
Practices e.g. tattoos, piercing
Rituals, for example, cultural aspects – rites of
passage
Unhealthy behaviours: Smoking, alcohol, diet
Non-socially Acceptable Self-Harm
Self mutilation eg: cutting, biting, hitting
oneself, ingesting objects not designed for
consumption

44. Rituals– Rites of Passage
Examples are:
Male and female circumcision,
Cramping of feet,
Elongating the neck,
Tightening and restricting of waists,
Tattooing,

45. Rituals– Rites of Passage
Cramping of feetElongating the neck

46. Why is self-harm so
common in young
people?
Biological factors:
-Risk taking increases
-Reduction in dopamine
-Future or forward thinking but brain not
fully developed
-Reduce serotonin
-Skin sensitive in nerve endings

47. Assessment of
Stress
Most common and widely used
tool:
The Global Mental Health
Assessment Tool (GMHAT)

48. What is GMHAT?
The Global Mental Health Assessment
Tool
is a computer assisted clinical interview
used in routine clinical practice to detect
and manage mental disorders in most
settings.

51. Assessment of Mental
Health Disorders
By GMHAT
10. Phobia
11. Mania/Hypomania
12. Thought disorder
13. Psychotic symptoms
14. Disorientation
15. Memory impairment
16. Alcohol misuse
17. Drug misuse
18. Personality problems
19. Stressors
1. Worries
2. Anxiety and panic
attacks
3. Concentration
4. Depressed mood
5. Sleep
6. Appetite
7. Eating disorders
8. Hypochondriasis
9. Obsessions and
compulsions

52. Contribution of SMS
Medical College for Stress
Assessment and
Management
The Global Mental Health
Assessment Tool (GMHAT)

53. Research Projects &
GMHAT
1. Mental health assessment by medical students of
Batch 2016 using GMHAT.
2. Mental health assessment by medical undergraduate of
Batch 2017 students using GMHAT.
3.Assessment of Mental health of participants by MBBS
Batch 2018 by using GMHAT.
4. To assess and compare the effect of traditional
teaching with Integrated teaching in MBBS students
with the help of GMHAT this also included in teaching
timetable.
5. Use GMHAT By Postgraduate students in their training
& thesis work on Cancer, HIV, TB, Diabetes and
Osteoarthritis patients.

54. A Milestone in GMHAT
Book /Chapter of Medical
Education Research Work
1. Dr. Lokendra Sharma
2. Dr. ID Gupta

55. Introduction to Mental Health
Disorders Project with SMS
Medical College Jaipur and
University of Chester (UK)
Dr Lokendra Sharma & Dr I D Gupta
Professor Pharmacology, Professor Psychiatry

56. Training in
Medical
Education
(GMHAT)
Dr. Lokendra Sharma : Professor Pharmacology ,
SMS Medical College, Jaipur
Dr. I D Gupta : Professor Psychiatry, SMS
Medical College Jaipur

57. www.gmhat.org
Assess Your Stress Level By
Yourself

61. Rating of Symptoms
0 = No evidence of presence of symptoms.
1 = Symptoms mildly distressing.
2 = Symptoms moderately distressing.
3 = Symptoms severely distressing.
8 = Unsure.
9 = Not relevant.

62. Anxiety

63. Mental Health Assessment Questions

64. Worries
Do you tend to worry a lot? (If yes :-)
• What kinds of things do you worry about?
• What about money or family problems, your
own health or someone else’s health?
Anything else?
• How much do you worry?
• Does this worrying bother you a lot?
• Is it unpleasant (can you stop yourself
worrying)?
• Do the thoughts keep coming back?

65. Anxiety
Do you get frightened or nervous? (If yes :-)
Do you get / have / suffer from: -
• Palpitation.
• Sweating.
• Trembling/shaking.
• Restless feelings (butterflies) in stomach, etc.

66. Concentration
How is your concentration?
• Can you concentrate on talking to
someone, or listening to Radio, or
watching TV or reading news-papers or
books?

67. Mood
-Have you been sad (depressed) recently?
-Have you cried at all or felt like crying?
-Is the depression there most of the time
or just a few hours at a time?

68. Interest
-How is your interest in things?
(Have you lost interest in things?)
-What have you enjoyed doing recently?

69. Sleep
Have you had trouble sleeping recently?
(If yes :-)
-Do you have difficulties in falling asleep?
-Do you wake up early in the morning?

70. Appetite
-What has you appetite been like?
-Do you enjoy your food?
-Have you been eating more or less
than usual?

71. Eating
What are your eating habits?
• Are you UNDULY concerned about eating
fattening foods?
• Do you believe yourself to be fat when others
say you are too thin?
(Ask only if you think that the person is
preoccupied with her/his weight and appears
thin)

72. Phobia
People sometimes have fears they know
don't make sense, like being afraid of
crowds , or going out alone.
-Do you have such fears or do you have
any
other fears? (Agoraphobia)

73. Memory
Have you had any difficulties with your memory?
Alcohol Misuse
-May I ask you about your drinking habits (alcohol)?
-How much do you drink?
(If suspected excessive drinking please ask:-)
-Do you have a strong desire to drink alcohol every day?
-Can you usually stop drinking after having one or two drinks?
-Has the amount you drink increased over a period of time?
-Have you suffered from any withdrawal symptoms such as
shakes, blackouts , DTs, fits, etc.
-Have you given up your hobbies due to drinking?

74. Stressor
-Have you been in any kind of stress/traumatic
experience before your problems started?
for example, anyone close to you died, breakup
of a relationship or any other kind of stress?

75. Conclusion &
Take Home message
• Stress Reduction : Skill development
• Stress Reduction : don’t be like monkey
• Stress Reduction : Have a purpose in life
• Stress Reduction : be happily married/College life
• Stress can cause any disease other than pregnancy

76. Celebration of All Selected

77. Thank You
Live Life,
Love Life