FROM DISTRESS TO DE-STRESS:

EFFECTIVE TECHNIQUES FOR NURSES

LUCILA O. ESPINOSA, RN, MAN
MENTAL HEALTH
IS THE ABILITY TO:
Meet and handle problems
Make choices and decisions
Find satisfaction in accepting tasks to carry on
without undue dependence on others
Contribute ones share in life
Enjoy
Be able to love and be loved
CRITERIA OF POSITIVE MENTAL HEALTH
Knowing thyself
Growth, development and self-actualization
Autonomous behavior
Integrative capacity
Perceptive ability
Mastery of environment
STRESS
A part of being alive
Broad class of experiences in w/c a demanding situation
taxes a persons resources or coping capabilities causing a
negative effect
A Person-Environment interaction
An adaptive response
A part of human existence
A stimulus or demand that generates disruption in
homeostasis or produces a reaction
TYPES OF STRESSORS
PREDISPOSING STRESSORS
a. Biological genetics, nutritional status,
general health

TYPES OF STRESSORS
PREDISPOSING STRESSORS
b. Psychological IQ, present and past
experiences, self - concept,
personality


TYPES OF STRESSORS
PREDISPOSING STRESSORS
c. Socio-cultural age age, gender, education,
social position,
cultural background

TYPES OF STRESSORS
PRECIPITATING STRESSORS immediate
causes influenced by:

a. Nature biological, psychological & socio-
cultural
b. Origin internal or external environment
c. Timing when the stressors occurred,
the duration and frequency of
the stressor
d. Number very difficult to deal with when they
occur close together

SOURCES OF PRECIPITATING STRESSORS


1. Stressful life events
a. Social activity family, work, education,
interpersonal health,
financial, legal or community causes
b. Individuals social field those events are
entrances and exits
c. Social desirability favorable or desirable are
promotion, engagement, marriage?
Undesirable are financial problems, being
fired etc.
2. Life Strains and Hassles
a. Marital strains
b. Parental strains
c. Strains associated with household
economics
d. Overload and dissatisfaction associated
with the work role

APPRAISAL OF A STRESSOR
1. Cognitive a persons understanding of the
situation. Hardiness or resistance to stress is
indispensable. Psychologically hardy
individual are less likely than non hardy
people to fail as a result of stressful life
events. The rationale is that hardy individuals
are high in:
A. commitment ability to involve ones self
in whatever one is doing




























B. CHALLENGE

BELIEF THAT CHANGE
RATHER THAN STABILITY IS TO
BE EXPECTED IN LIFE SO
EVENTS ARE SEEN AS
STIMULATING RATHER THAN
THREATENING.

C. CONTROL TENDENCY TO
FEEL AND BELIEVE THAT THEY
INFLUENCE EVENTS, RATHER
THAN FEELING HELPLESS IN
THE FACE OF LIFE PROBLEMS




















B. CHALLENGE BELIEF THAT
CHANGE RATHER THAN
STABILITY IS TO BE EXPECTED
IN LIFE SO EVENTS ARE SEEN
AS STIMULATING RATHER THAN
THREATENING.

C. CONTROL TENDENCY TO
FEEL AND BELIEVE THAT THEY
INFLUENCE EVENTS, RATHER
THAN FEELING HELPLESS IN
THE FACE OF LIFE PROBLEMS
2. Affective arousal of a feeling state like
anxiety and fear

3. Behavioral fight or flight responses
Fight aggression responses
Flight withdrawal responses


4. Social three aspects are:


a. Search for meaning seeks information about their
problem
b. Social attribution identifies the unique factors that
contribute the situation. Self-
blame may block an active
coping response
c. Social comparison compares skills and capabilities
with those of others with similar
problem
IMMEDIATE RESPONSE TO STRESS
(FIGHT OF FLIGHT)
Dull sense of pain
Improved memory
Pupillary dilation
Better oxygenation
High sugar level
BP and RR increase
Epinephrine surge
Halted digestion
DELAYED RESPONSE TO STRESS
Activation of the hippocampus to process
stress
Diminished immune response
Fat conversion
Cortisol release (high blood sugar
immunosupression, anti-inflammation)
CHRONIC RESPONSE TO STRESS
Cortisol becomes toxic to brain cells
Fatigue, anger and depression
Weakening of immunity
Peptic ulcer diseases
Elevated BP and HR
Damage elasticity of blood vessels

COPING RESPONSES WILL BE
DETERMINED BY:
1. Personal abilities

2. Social support

3. Material assets

4. Positive beliefs
COPING MECHANISMS
1. Problem-focused tasks and direct efforts
to cope with the threat itself. Includes
negotiation, confrontation, seeking advice
2. Cognitive-focused attempts to control the
meaning of the problem thus neutralized it.
Example are positive comparison, selective,
ignorance, substitution of rewards.
3. Emotion-focused moderating emotional
distress. Use of ego defense mechanism.
COPING MECHANISMS MAY ALSO BE:
1. Constructive anxiety
is treated as a warning
signal and accepts it
as challenge

2. Destructive ward off
anxiety without
resolving the conflict,
using evasion instead
of resolution
Do minor problems and small disappointments throw you in
a distress?
Do you find it difficult to get along with people, and are
people having trouble getting along with you?
Do the small pleasures of life fail to satisfy you?
Are you unable to stop thinking of your anxieties?
Do you fear people or situations that never used to bother
you?
Are you suspicious of people, mistrustful of your friends?
Do you feel inadequate, suffer the tortures of self-doubt?


HOW OFTEN HAVE YOU BEEN UPSET
BECAUSE OF SOMETHING THAT HAPPENED
UNEXPECTEDLY?
0 never 3 - fairly often
1 almost never 4 very often
2 sometimes
HOW OFTEN HAVE YOU FELT THAT YOU
WERE UNABLE TO CONTROL THE
IMPORTANT THINGS IN YOUR LIFE?
0 never 3 - fairly often
1 almost never 4 very often
2 sometimes
HOW OFTEN HAVE YOU FELT NERVOUS AND
STRESSED?
0 never 3 - fairly often
1 almost never 4 very often
2 sometimes
HOW OFTEN HAVE YOU FELT CONFIDENT
ABOUT YOUR ABILITY TO HANDLE YOUR
PERSONAL PROBLEMS?
4 never 1 - fairly often
3 almost never 0 very
often
2 sometimes
HOW OFTEN HAVE YOU FELT THAT THINGS
WERE GOING YOUR WAY?
4 never 1 - fairly often
3 almost never 0 very
often
2 sometimes
HOW OFTEN HAVE YOU BEEN ABLE TO
CONTROL IRRITATIONS IN YOUR LIFE?
4 never 1 - fairly often
3 almost never 0 very
often
2 sometimes
HOW OFTEN HAVE YOU FOUND THAT YOU
COULD NOT COPE WITH ALL THE THINGS
THAT YOU HAD TO DO?
0 never 3 - fairly often
1 almost never 4 very often
2 sometimes
HOW OFTEN HAVE YOU FELT THAT YOU
WERE ON TOP OF THINGS?
4 never 1 - fairly often
3 almost never 0 very
often
2 sometimes
HOW OFTEN HAVE YOU BEEN ANGRY
BECAUSE OF THINGS THAT WERE OUTSIDE
YOUR CONTROL?
0 never 3 - fairly often
1 almost never 4 very often
2 sometimes
HOW OFTEN HAVE YOU FELT DIFFICULTIES
WERE PILING UP SO HIGH THAT YOU
COULD NOT OVERCOME THEM?
0 never 3 - fairly often
1 almost never 4 very often
2 sometimes
AVERAGES
AGE GENDER
18 - 29 14.2 Men 12.4
30 - 44 13 Women 13.7
45 - 54 12.6
55 - 64 11.9
65 & Over 12
Widowed 12.6
Married or Living
with
12.4
Single or never
used
14.4
Divorced 14.7
Separated 16.6
THE TOLL STRESS TAKES ON THE BODY
Immune response people who care for
spouses with dementia didnt respond to a flu
vaccine as well as a control group.
Coronary disease men who said they were
highly stressed were more likely to have
heart attacks and strokes
Viral infection the chances of catching a
cold increase the longer people experience
work or interpersonal stress
STRESS AND GENDER
Though a mans blood pressure rises more
sharply in response to stress, women react
to a wider range of stressors and say they
feel stress more often, perhaps because they
take a holistic view of everyday life.
MANAGING STRESS
1. Manipulate the environment
2. Monitor stress level
3. Cope with stress
a. Identify stress level
b. Analyze stress status
c. Diversional coping like:
1. Physical diversion
2. Mental diversion
d. Meditation
e. Laughter

4. Manage stress from a holistic level
a. through exercise
b. through diet
c. alter lifestyle pattern

5. Through controlled breathing

6. Through relaxation
. .
. .
. .

SOME SUGGESTIONS TO HANDLE STRESS
Try physical activity exercise
Share your stress talk to friends, strong
support
system
Know your limits practice acceptance
Take care of yourself watch your habits
Find time for FUN
Avoid being alone
Check on your task get organized

SOME SUGGESTIONS TO HANDLE STRESS
Try cooperation instead of confrontation
disarm yourself
It is OK to CRY
Create a quite scene
Avoid self medications
Learn to relax reduce time urgency
BREAST FRIENDS
Being told you have a cancer is like being
meted out a death sentence. The Great
reaper hovering at your door. An uphill battle
with no victory in sight. But Marisette Galang
and her newfound friends who call
themselves Bosom Buddies are out to prove
they can beat the Big C with two Cs, in
capital letters: COURAGE and
COMRADESHIP.
BREAST FRIENDS
Marisette muses: Genetically you cant control
cancer. But theres a book that says you do not
have the luxury of a negative thought. Maybe we
should learn to cope with emotional stress.
Before, I suppressed it and internalized it.
Another lesson I learned through all this is we
should start eating healthy. I have refrained from
eating red meat. And Im into the quigong
practice (a self-healing system that combines
conscious regulation of the body, breath and
mind to enhance the flow of vital energy (qi)
through the body, improve immune function,
increase blood circulation and calm the mind.
MEDITATION PEARSONS TECHNIQUE
1. Quiet environment
2. Comfortable position
3. Passive stance / attitude
4. Mental devise

DEEP BREATHING GUIDELINES
1. Sit, stand, or lie with your spine straight
2. Scan for body tension
3. Place one hand on your chest
4. Inhale slowly and deeply so that your
abdomen pushes up your hand
5. Visualize your lungs slowly filling with air.
Your chest should move only slightly as you
inhale, but you should be aware of the
movement of your abdomen.
DEEP BREATHING GUIDELINES
6. Exhale through your mouth, making a soft, whooshing
sound by blowing gently. Keep your face, mouth, and jaw
released.
7. Be aware of what it feels like and what you sound like when
you breathe properly.
8. Continue to take long, slow, deep breaths for at least 10
minutes at a time, once or twice a day.
9. Increase the frequency if you wish once you have mastered
the technique.
10. Scan your body for tension again, comparing the tension to
what it was like before you begin the deep breathing
exercise

MODIFIED AUTOGENIC RELAXATION
Assume a relaxing position.
Slowly take in a very deep breath. Exhale
very slowly
Repeat each of the following phases to
yourself four times. Say the first part of the
phrase as you breathe in for 2 to 3 seconds.
Hold your breathe in for 2 3 seconds. Hold
your breathe out for 2 3 seconds.

Breathe in Breathe out
I am relaxed
My arms and legs are heavy and warm
My heartbeat is calm and regular
My breathing is free and easy
My abdomen is loose and warm
My forehead is cool
My mind is quiet and still
LIFE PROBLEMS AND RELATED HYPNOTIC SUGGESTIONS
Life Problems Hypnotic Suggestions
1. Fear of coming into the dark house
at night
1. I can come in tonight feeling relaxed
and glad to be home
2. Anxiety that prevents working or
studying to meet deadlines
2. I can work steadily and calmly. My
concentration is improving as I
become more relaxed
3. Insomnia 3. I will gradually become more and
more drowsy . In just a few minutes I
will be able to fall asleep and sleep
peacefully all night.
4. Chronic fatigue 4. I can waken feeling refreshed and
rested
5. Obsessive and fearful thoughts
about death
5. I am full of life now, I will enjoy today
LIFE PROBLEMS AND RELATED HYPNOTIC SUGGESTIONS
Life Problems Hypnotic Suggestions
6. Minor chronic headache or backache 6. As I become more relaxed, my
headache (backache) lessens. In just
a few minutes, it will go away. Soon
my head will be cool and relaxed.
Gradually I will feel the muscles in
my back loosen. In an hour, they will
be completely relaxed. Whenever
these symptoms come back, I will
simply turn my ring a quarter of a turn
to the right and the pain will relax
away.
7. Feelings of inferiority 7. The next time I see _______, I can
feel secure in myself. I can feel
relaxed and at ease because I am
perfectly all right.
LIFE PROBLEMS AND RELATED HYPNOTIC SUGGESTIONS
Life Problems Hypnotic Suggestions
8. Anxiety about an upcoming
evaluation or test
8. Whenever I feel nervous, I can say to
myself(Insert your special keyword
or phrase here) and relax.
9. Chronic anger (or chronic guilt) 9. I can turn off anger (guilt) because I
am the who turns it on. I will relax my
body and breathe deeply
10. Worry about interpersonal rejection 10. Whenever I lace my fingers
together, I will fell confidence flowing
me.
11. Chronic tension in a particular part of
the body
11. I will think about my _______ every
hour and let it relax.
WINDMILL EXERCISE
1. Stand relaxed feet one foot apart
2. Bend knees slightly and remain loose at hip level
3. Inhaling evenly Make a six backward circles by swinging
the left arm backward and then the right arm as the left
reaches the top of its swing, similar to the crawl in swimming
4. Holding your breath, make sixteen backward circles, eight
with each arm
5. Now exhale evenly, making six forward circles, three with
each arm
6. Repeat the exercise three times and relax

EFFECT A RETURN TO ACID-BASE BALANCE
STRESS AWARENESS DIARY
Date February 14 Day of the Week Saturday


Time Stressful Event Physical and Emotional
Reactions
6:30 a.m. Alarm didnt go off; rushing to report
to duty
7:30 a.m. Late to duty, scolded by C.I
9:45 a.m. Slight headache; took
paracetamol
10:15 a.m. Headache pounding;
paracetamol not helping
11:00 a.m. Clients wife makes several
unreasonable demands
Anger
2:30 p.m. Classmate uncooperative during
endorsement
Anger
3:00 p.m. Headache back
3:30 p.m. Hard time getting a ride going home Indigestion
7:00 p.m. Argument with sister
7:05 p.m. Mother defends sister
7:30 p.m. Indigestion attacks
Negative
Feelings to
Release
Manifested by
Physical
Symptoms
May be
replaced by
Positive State
Thru the ff. C.E.
Exercise
Depression Tightness of chest
Shortness of
breath
Curling forward of
shoulders
Happiness Deep breathing
Elbow flex
Raise
arms at sides
Deep breathing
Nervousness
and Other
tensions
Fast Breathing
Shaking of some
parts like hands,
legs
Twisting of Feet
Tightening of some
parts
Relaxation Deep breathing
Grounding neck
and shoulder roll
Shake legs,
arms, wrist, feet
Deep breathing
Negative
Feelings to
Release
Manifested by
Physical
Symptoms
May be
replaced by
Positive
State
Thru the ff. C.E.
Exercise
Verbal
Frustration
Fast breathing
Tightness of lips
Locking of jaws
Gritting of teeth
Release Deep breathing
Voice Projection
Karate Chop
Open-close mouth
Bite towel
Deep breathing
Anger Fast Breathing
Tightening of
hands and feet
Clenched fists
Desire to hit with
hands and kick
with feet
Clenched jaws

Peace Deep breathing
Karate chop
Hitting pillow or
mattress
Twisting towels
Throwing soft
objects
Grounding
Deep breathing


Negative
Feelings to
Release
Manifested by
Physical
Symptoms
May be
replaced by
Positive State
Thru the ff. C.E.
Exercise
Lack of
Confidence
Shortness of
breath
Tightening of the
face, muscle and
shoulders

Confidence Deep breathing
Grounding
Raise arms and
sides
Shoulder roll
Elbow flex
Deep breathing
Sluggishness Lazy feeling
Limp body
Desire to rest,
sleep
Energy Deep breathing
Arm stretch
above head
Elbow flex
Back roll
Kick, jump,
shake
Deep breathing
Negative
Feelings to
Release
Manifested by
Physical
Symptoms
May be
replaced by
Positive State
Thru the ff. C.E.
Exercise
General Fatigue Tired body esp.
eyes, neck,
shoulder, back,
legs
Relaxation Deep breathing
Neck roll
Tense drop
Shoulder roll
Body massage
Deep breathing
Fear Short uneven
breaths
Tightening of
shoulders
Courage Deep breathing
Grounding
Vibrate all parts
Deep breathing
1. Rhythmic Breathing
2. Reduced Body Tension
3. Altered State of Consciousness
3.1 Beta Level
3.2 Alpha Level
THE PHILOSOPHY OF FAITH
Faith in the ability of ourselves and others to
improve and grow
Faith in the desire and capacity of human
beings to work out problems
Faith in spiritual and moral values, in the
essential decency of mankind which will
carry us through stresses that might
otherwise shatter us.