The document discusses stress management for allied health professionals. It provides an overview of stress physiology, explaining the sympathetic nervous system, parasympathetic nervous system, and their roles in the fight or flight response. It also discusses modern stressors, cognitive behavioral approaches, and techniques for managing stress through exercise, nutrition, mind-body practices like yoga, and heart rate variability biofeedback training.

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”
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3. What is Stress?
• Stimulus • Response
– Work – Physiological
– Time • Autonomic
• Central
– People
• Endocrine
– Conflicting demands
• Respiratory
– Psychological
• Anxiety
• Depression
– Behavioral
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4. Interactional Models of Stress
• Perception/appraisal
• Physiological Mediators
• Phenomenological experiences
• Responses
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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
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6. New Trends Cognitive Therapy
Raymond puts and end to his critical inner dialog.
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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
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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.
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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
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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}
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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
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33. Stress Management Approaches I
Physiological
• Exercise
• Nutrition
• Mind/Body Techniques
– Yoga
– Tai Chi
– Mindfulness Meditation
– Breathing
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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
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Time (sec)

35. Peak= 79
Respiration
Heart Rate
Valley= 63
Pacer set at 7.0 bpm
Valley
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36. StressEraser.com

37. HeartMath.Com

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40. 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
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