stress can influence our body and mind

1. Dr NELSON.K.J
Chief Consultant (psychiatry)
MHC,Peroorkada
Trivandrum
Kerala.India
noslen

2. noslen

3.  A Cup of Tea
 Nan-in, a Japanese master during the Meiji era (1868-
1912), received a university professor who came to
inquire about Zen.
 Nan-in served tea. He poured his visitor’s cup full, and
then kept on pouring.
 The professor watched the overflow until he no longer
could restrain himself. “It is overfull. No more will go
in!”
 “Like this cup,” Nan-in said, “you are full of your own
opinions and speculations. How can I show you Zen
unless you first empty your cup?”
noslen

4. What is stress
 A circumstance that disturb/likely disturb
-Functioning-physiological/psychological
 Body’s physical response to a percieved demand/threat
 1920 Walter cannon---Flight/Fight
 Man-freez
 William Beaumont(American surgeon)-
patient(Alexis.st.Martin)
 Hans Selye-General adaptation syndrome-(alarm
reactions,resistence,exhaustion)
noslen

5. Types of stress
 Distress
 Eustress
 Stress: is the non-specific response of the body to
any demand ,whether it is caused by, or results in
the pleasant or unpleasant conditions. (Hans
selye)
noslen

6.  Stress has become integral part of everyday life.
 Starting from 2 year of life .
 We can’t eliminate stress but yes ,we can reduce
stress in our life.
 Gross route of problems is individual failing to
comprehend their own selves.
noslen

7. Possible causes of stress:
 Family problems, relationship problems,
 job problems- r u satisfied?-working women
 Financial difficulties, poor health, death of love one(s)
 False expectation
 Pressure up for grade A
 Overload of assignment
noslen

8. noslen

9. Stress - Response
 Biological
 Response Threshold
 Exposure
 Personality
 Coping Styles
 Previous Experience
noslen

10. HOW DOES THE BODY RESPOND
TO STRESS
 Increased heart rate
 Increased breathing rate (respiration)
 Increased muscle tension
 Increased blood pressure
 Increased secretion of insulin to liberate energy
 Increased blood flow to the brain, lungs, heart and
muscles
noslen

11. Physical Symptoms
 Headaches
 Indigestion
 Sleep problems
 Back pain and muscle tension
 Restlessness
noslen

12. Behavioral Symptoms
 Excess smoking
 Excessive use of alcohol
 Compulsive eating
 Aggressiveness
 Inability to get things done
 Predominantly in men
noslen

13. Emotional Symptoms
 Crying
 Nervousness
 Edginess
 Overwhelming sense of pressure
 Loneliness
 Easily upset
 Predominantly in woman
noslen

14. Cognitive symptoms
 Trouble thinking clearly
 Forgetfulness
 Lack of creativity(for an ordinary person interacting to
his situations beautifully is a creativity)
 Trouble making decisions and problem solving (leads
to postponing)
 Loss of sense of humor
noslen

15. Effects of stress
 “Functioning is an expression of neurophysiological
activity”
 Stress -Activate Neurotransmittors
 Catacholamines
 Serotonin
 CRF
 Glutamate
 GABA
noslen

16. Stress response
Endocrine
 CRF from hypothalamus
 ACTH from ant pituitary
 Glucocorticoid (a steroid)from adrenal gland
 Inhibit growth,reproduction &immunity
noslen

17. Effects of stress
 Inhibition of immune functioning
 Some times activation
noslen

18. Somatic compliance
Expression of stress as illness is different in different
people
 Stomach reactors
 Skin reactors
 Cardiovascular reactors
 Respiratory reactors
Conscious versus unconscious-defense
noslen

19. Stress versus GIT
 Resting tone(esophageal spincter)
 contraction amplitude(distal esophagus)
 Myoelectrical &motor activity(large intestine)
 activate autonomic NS
 Antral motor activity(stomach)
 Migrating motor function(small intestine)
noslen

20. Stress versus CVS
 Cardiac arrhythmias can be triggered by
Acute emotion(intense anger,fear,sadness)
- further coronary events in MI
- white coat hypertension
- sudden cardiac-death
- Vasovagal syncope
noslen

21. Stress related GIT disorders
 Globus (lump in throat)
 Rumination (repetitive regurgitation)
 Nutcracker esophagus(distal esophageal contraction)
 Functional heart burn(without anatomical abn/esitis)
 Aerophagia(repetitive air swallowing & belching)
 IBS
 Functional biliary pain(rt upper quadrant pain)
 Functional anorectal pain(chronic/intermittent pain)
 Dyschezia(difficulty with evacuation)
noslen

22. Stress &Peptic ulcer
 Stress Increased acid production
 Studies on prisoners of war
 Stress
 Reduce immunity
 H.pylori inf
 ulcerative colitis(large intestine-bloody diarrhea)
 Crohns dis(small int &colon-diarrhea,abdpain,wt loss)
noslen

23. Stress versus RS
 Asthma
 Hyperventillation syndrome
 Copd(chronic obstructive pulmonary disease
noslen

24. Stress versus endocrine system
 Hypo/hyperthyroidism
 Diabetes
 Cushing syndrome(excessive ACTH)
 Hyper prolactinemia(breast milk production)
noslen

25. Stress versus sexual dysfunction
 Dysparunia
 anorgasmia
 Erectile dysfunction
 Premature ejaculation
noslen

26. Tension headache
 Stress Contraction of muscles(neck&head)
 Constrict blood vessels ischemia
noslen

27. Stress management
 General
 psychological
noslen

28. General
 Exercise
 Sleep –sleep hygiene
 Diet
 Sex
 Recreation
 Prayer
 Yoga/meditation
noslen

29. Diet and stress
 All carbs prompt the brain to make more serotonin
 Orange- vitamin C. Studies suggest this vitamin can
curb levels of stress hormon.
 Green leafy vegetables-One cup of spinach goes a long
way toward replenishing magnesium stores.
 Fatty fish- Omega-3 fatty acids, found in fish such as
salmon and tuna, can prevent surges in stress
 Milk contain tryptophan
noslen

30. sleep
 Comfortable bed room – quiet, dark, use only for sleep
 Something relaxing – before sleep
 Light dinner – a glass of fruit juice, milk, a quick light
bath before bed
 Go to bed when u r sleepy-Don’t wait for more then 1
hour in bed for sleep
noslen

31. Sleep hygiene
 Maintain regular bed time and wake time
 Avoid coffee, tea, cola, alcohol, smoking
 Bed is only for sleeping.
 Avoid day time sleep
 A glass of milk at night
noslen

32. exercise
 Aerobic exercise 45 mts
 Atleast 3 times/wk
 Improve CV status
 Reduce stress
 Improve self esteem
 Pleasant mood
 NT-serotonin,adrenalin,endorphines
noslen

33. prayer
 Spiritual health
 Soul is the seat of life
 Communion with God
 shared prayer,silent prayer,intercessory prayer
 Decrease depression,addictive beh,BP
 Increase life span in cancer pts
 Healing by introspectio-,removing guilt and
rage/hatred
noslen

34. sex
 Tranquilizing sex-how many times,
foreplay,duration,method
 Avoid antisocial/immoral sex/sexual beh
 As an expression of love between partners
 Avoid conflicting sexual relationship-sexual practices
noslen

35. A 5 STEP GUIDE TO MANAGING STRESS
 Step 1: Identify if you are stressed
 Step 2: Identify the stressor(s)
 Step 3: Identify the reason for the stressor(s)
 Step 4: CHANGE – Behavior, Emotions,
 Step 5: Practice
noslen

36. General tips
 Making little changes in your life can really add
up to a big feeling of relief.
 Learn to recognize when you are feeling stressed
and simple ways you can relax.
 Take a break. Have a cold drink, get some fresh
air, or close your eyes for a minute to refocus.
 Stay positive to help friends and family cope with
stress.
 Let others know you're feeling overwhelmed and
tell them how they can help.

noslen

37. Be assertive
 Allow yourself to simply say "no" to friends and family
when you know you cannot meet their demands without
becoming overwhelmed.
Interpersonal relation
 passive
 Aggressive
 Assertive
 Emotional intelligence-sensitivity,appropriate,stability
noslen

38.  Be prepared for unexpected problems –the
queue
 Prioritize. Take control of your "to do" list by
deciding what's really most important on your list.
 Write down feelings of sadness, frustration or
anger to get a clearer perspective of your emotions.
 Enjoy life's simple pleasures like colorful
flowers, dancing, music, and social outings, etc.
 Share your talents to better the lives of others as
well as your sense of well-being.
noslen

39. need professional help ?
 Deteriorating family/occupational performance
 Inability to sleep or excessive sleep
 Losing or gaining weight
 Feeling low or tired all the time
 Mood swings : crying, getting angry
 Not wanting to talk to anybody
noslen

40. psychotherapy
Cognitive behavioral therapy
 Self observation
 Cognitive restructuring
 Relaxation exercises
 Time management
 Problem solving-best soln to the problem situation
noslen

41. Time management
 To enhance awareness of current patterns of time use
 Diary/record of how I spend my time each day
 Time spend in important categories
-work,family,leisure activities,exercise,day time sleep
-important areas in my life-list it out
-two time estimates-time currently spend in these area versus
the amount of time I would like to spend
-awareness of the difference is a motivation to make changes
Prioritize-the list to follow in a wk-don’t postpone due to
anxiety
noslen

42. Relaxation Techniques
 Progressive muscular relaxation
 Breathing exercises
 Autogenic training
 Yoga, Meditation
 Biofeedback
noslen

43. RT means
 A relaxation technique is any method, process,
procedure, or activity that helps a person to relax;
 to attain a state of increased calmness; or otherwise
reduced levels of anxiety, stress or tension.
noslen

44. Contraindication for RT
 Bronchial asthma
 Psychotic patients
 Agitated depression
 Those prone for dissociation
noslen

45. Chacteristic of relaxation
 Relaxation training is the simplest behavioural therapy
 Immobility of the body
 Low muscle tone
 Control over the focus of attention
 Cultivation of A special form of mind
noslen

46. What is happening in RT
 The physiological changes are opposite to those
induced by sympathetic stimulation in STRESS
 During relaxation there will be decrease in muscular
tension, heart rate, BP and skin conductance
noslen

47. AUTOGENIC TRAINING
 Relaxation technique developed by the German
psychiatrist Johannes Schultz (1932)
 Method of self suggestion
 15min 3 times a day
 During each session, the person will repeat a set of
visualisations that induce a state of relaxation
noslen

48.  Sit in the meditative posture and scan the body
 Imagine & repeat 3 times the following
 "my left arm is light and cool"
 "my arms and legs are light and cool“
 "my heartbeat is calm and regular“
 "my solar plexus is cool“
 "my forehead is cool"
noslen

49. Biofeedback
 Involves recording and display of changes in physiological
parameter such as skin conductivity& temperature,muscle
tone ,BP,HR,brain wave activity
& convey the information to the patient.
 This raises the patient's awareness and conscious control of
involuntary physiological activities
 EMG,EEG,GSR(galvanic skin response)gauge,thermistor
noslen

50. Tension visible as
 EMG-increased muscle tone
 EEG-beta waves during tension, Alpha waves during
relaxation
 GSR gauge-increased skin conductivity during tension
 Thermistor-skin temperature drops due to vasospasm
noslen

51. Diaphragmatic/Abd breathing
 To breathe with the diaphragm, one must draw air
into the lungs in a way which will expand the
stomach and not the chest.
 Long, slow intakes of air allowing the body to
absorb all of the inhaled oxygen.
 Therapeutic aspect of this breathing is the
exhalation which is at least two times the length of
the inhalation.
noslen

52.  Sit or lie comfortably, with loose garments.
 Put one hand on chest and one on stomach.
 Slowly inhale through your nose.
 As you inhale, feel your stomach expand with your
hand. If your chest expands, focus on breathing
with your diaphragm.
 Slowly exhale through nose or pursed lips.
 Rest and repeat
noslen

53. Jacobsons progressive m r
 Early 1920
 Muscular tension accompanies anxiety, one can reduce
anxiety by learning how to relax the muscular tension
 alternately tensing and relaxing the muscles (16)
 a prescribed sequence
 Hands>Arms>Shoulders>Neck>Head
 Patient attends to the feeling of tension & relaxation that
occur
noslen

54.  The effect of the tension-relaxation sequence is to
cause deeper relaxation than would be achieved by
simply attempting to relax.
 Patient learns to produce relaxed states by merely
focusing on a muscle group & letting go of detected
tension
noslen

55.  COMFORTABLE,LEAN BACK,BOTH FEET FLAT
 DEEP BREATHE IN>HOLD>OUT SLOW
 SCALE AREAS OF TENSION
 SCALE LEGS,ARMS,SHOULDERS
 POWER TO RECOGNISE TENSION & RELAX
THEM
noslen

56.  Push your feet into the floor>tense the foot
muscle>hold for some time>release at once>relax (rpt)
 Drag ur feet>tense the calf muscle>hold>release>relax
(rpt)
 Push ur back& shoulders into the chair>tense back
m>hold>relax (r)
 If u notice any areas of tension still remaining, just
breathe in & imagine sending breathe to the part most
needed
noslen

57. VISUALIZATION
 Virtual reality
 is an experience that, significantly resembles the
experience of perceiving some object, event, or
scene, but that occurs when is not actually present
to the senses
 Can be done by the patient
 Pleasant, calming images can be used to elicit
relaxation
noslen

58. Happiness
 Something to do for oneself
 Something to do for others
 Something to Love
 Something to hope for
noslen

59. Generating Happiness ….
“No perfect practice, practice makes perfect”
 Look upon others as yourself
 Renounce War
 Give up aggression
 Cultivate friendship
 “Be ship on the water”.
noslen

60. The spectrum
 “The mind can go either direction under stress—
toward positive or toward negative: on or off. Think of
it as a spectrum whose extremes are unconsciousness
at the negative end and hyperconsciousness at the
positive end. The way the mind will lean under stress
is strongly influenced by training.”
― Frank Herbert, Dune
noslen

61. Negative thoughts-Neg,emotion
Painful medical procedure - I wont be able to tolerate the pain
– Fear
Argument with a Friend - She will never speak to me again
– Discouraged
Co-worker injured while on duty - its my fault, I would have warned him
– guilt
Late for a dead line - Its hopeless I am always confusing him –
depression
Spouse criticise you - He just doesn’t get it, he never under
stand what I say
– anger
noslen

62. Challenging neg-thoughts
It there an alternative explanation ?-pain-cancer
What is the evidence that this thought is true ?
What will be the effect of continuing to think this way ?
What is the best out come, worst outcome, realistic
outcome ?
What is the likely-hood that this will happen ?
noslen

63. Negative thoughts and rational
response
 I have no control over this situation –
 Rational- Its true that I can’t change what
happened, but I can control how I respond
noslen

64.  Once upon the time there was an old farmer who had worked his
crops for many years. One day his horse ran away. Upon hearing
the news, his neighbors came to visit. “Such bad luck,” they said
sympathetically.
 “Maybe,” the farmer replied.
 The next morning the horse returned, bringing with it three
other wild horses. “How wonderful,” the neighbors exclaimed.
 “Maybe,” replied the old man.
 The following day, his son tried to ride one of the untamed
horses, was thrown, and broke his leg. The neighbors again came
to offer their sympathy on his misfortune.
 “Maybe,” answered the farmer.
 The day after, military officials came to the village to draft young
men into the army. Seeing that the son’s leg was broken, they
passed him by. The neighbors congratulated the farmer on how
well things had turned out.
 “Maybe,” said the farmer.
noslen

65. Reframing our thought
Its not fair that I am being treated this way
Life is not always fair sometimes things go my way, other
times they don’t.
 I can’t return to my old job, I am worthless –
Though I may not be able to do the same work, there are
no: of other options which I can do.
noslen

66. I am a burden to my family
My family had to give me more support now,ButIdo
a lot of things for them
as well.
No one really cares about me
There are people in my life that I can turn for
support.
noslen

67. Put it down
 Put it down- If u hold a glass of water for just 2 hrs at a
stretch-allowing even minor stressors to bother u
continuously make u fed up with ur own life.
 Over thinking-frog and centipede-a frog was
thinking…”which leg I m putting first when I jump”…the
over thinking made the jump a difficult task.Then he went
to a centipede to get the answer.when centipede start to
think…he also got confused,his movn also got restricted
 Cohabitants with anxious stressed people can make u more
anxious
noslen

68.  Two monks were returning to the monastery in the
evening. It had rained and there were puddles of water on
the road sides. At one place a beautiful young woman was
standing unable to walk accross because of a puddle of
water. The elder of the two monks went up to a her lifted
her and left her on the other side of the road, and
continued his way to the monastery.
 In the evening the younger monk came to the elder monk
and said, “Sir, as monks, we cannot touch a woman ?”
 The elder monk answered “yes, brother”.
 Then the younger monk asks again, “but then Sir, how is
that you lifted that woman on the roadside ?”
 The elder monk smiled at him and told him ” I left her on
the other side of the road, but you are still carrying her.”
noslen

69. Meditation
 Taking mind into a deeper state of relaxation or awareness.
 Turning attention to a single point of reference
 Focus on the breathing & relaxation with each expiration
 All religious groups, across continents& cultures
 “Lotus Posture”
noslen

70. Mindfulness
noslen

71. Mindfulness in Daily Life
 Stop and become aware of your breath once in a while
during the day, even for just 1 or 2 minutes
 Try eating a meal mindfully
 If you wake up early in the morning, go outside, look
around, feel the air, the cold, the warmth…
 Watch your reactions in situations that annoy you or
make you angry.
noslen

72. Stress relieving therapies
 Laughing therapy
 Music therapy-Samaveda,king saul in bible
 Dance therapy
 Massage-Rolfing- circulation-blood and lymph
 Colour therapy-red-blue
 Prayer
 Reiki –light touch-flow of energy
 Drug therapy
noslen

73. Laugh therapy
 Air kiss laughter greeting: kiss the air 3 or 4 times a few
inches away one from another and laugh as you do so.
 Army salute laughter: raise your right hand sharply and
slightly to the right of your right eye. Keep your fingers and
thumb joined and extended as you make this motion.
Laugh as you salute.
 Asian greeting laughter: hands by the side, laugh as you
bend forward and greet others.
 Confetti greeting laughter: laugh and make joyful
movements as you throw around lots of imaginary confetti.
 Constant contact laughter handshake: laugh as you shake
hand with people as if to greet them, but only let go the
hand of a person when you are shaking the hand of
someone else (both your hands will be busy).
noslen

74. Raga in music therapy
 Raga Malhar pacifies anger, excessive mental
excitements and mental instability.
 Raga Saurat and raga Jaijaivanti have also been found
effective in curing mental disorders and calming the
mind.
 Raga Hindola helps sharpening the memory and
focussing mental concentration
noslen

75. Be a Light unto Yourself
noslen

76. Questions & comments
noslen
?
?

77.  Thanks to
 Dr.Krishnan,associate prof,medical college,TVM
 Dr.Anupama,psychiatrist,MHC,Kozhikode
 Dr.Abdul Bary,retd supdt,MHC,TVM
 Ref:-
-Synopsis of psychiatry
-Wikipedia
-Zen stories
noslen