Transcript Stress Management - The Hillingdon Hospitals NHS

Cardiac Rehabilitation Programme
Stress Management
Andrea Papitsch-Clark
Clinical Health Psychologist
Stress in everyday life
What does it feel like to be stressed?
What does it feel like not to be
stressed?
What causes YOU stress?
 Emergencies (e.g. fall, emergency stop, being
startled by something etc.)
 Life events (e.g. bereavement, illness,
marriage, holiday, change job)
 Daily hassles (e.g. stuck traffic jam,
arguments, queue in supermarket etc.)
What is stress?
What is stressful differs from one
person to the next, and also how we
experience stress may differ from
person to person.
Definition of stress: “stress is a
condition or feeling, experienced when
a person perceives that demands
exceed the personal and social
resources the individual is able to
mobilize” (according to Richard S
Lazarus)
Symptoms of stress
Physical
Muscle tension, aches
Tension headaches
Breathlessness
Change in appetite
Tiredness, sleeplessness
Increased blood pressure
Behavioural
Smoking
Drinking more alcohol
Poor concentration
Putting things off
Inability to finish things
Avoiding people
Thoughts
Intrusive, unwanted thoughts
Worrying obsessively
Inability to make a decision
Self-criticism
Being critical of others
Lapses in memory
Feelings
Irritability
Anger or resentment
Loss of temper
Anxiety
Feeling tearful
Loss of sense of humour
Feeling guilty
Physiological effects of stress
Adrenaline is released when our brains perceive we are
under threat or in danger. Evolutionary fight or flight
response.
Body's reaction:
The effect:
•Pupils dilate
•Blurred vision
•Heart rate increases to
send o2 to muscles
•Palpitations, heart pounding
•Blood pressure rises
•Breathing faster
•Light-headed
•Dry mouth, short of breath
•Digestion slows down
•Indigestion, butterflies,
nausea
•Muscles tense, ready
for action
•Tremor, jelly legs
Useful in real emergency…but not in everyday hassles
Stress thermometer
Panic
Fear
Worried
Bad tempered
Some adrenaline =
Excited
Good
Alert
Wide awake
Calm
Sleepy
Very relaxed
Tense
Too much adrenaline
= Bad
Most people have
raised adrenaline
levels after a
cardiac event normal to feel
worried.
Any other worries
or events can be
enough to put
adrenaline levels
even higher
Does stress cause heart disease?
 It is recognised that stress contributes
to CHD, but we can’t say for certain whether
stress directly causes CHD.
….BUT Long-term stress can make us feel miserable,
drained and unwell.
It can affect our attitude or ‘state of mind’ and
make us rely on ‘short-term fixes’ like smoking,
drinking, not exercising, unhealthy eating,
all of which DO contribute to heart disease…
Does stress cause heart disease?
….ALSO stress can affect the heart by releasing
certain hormones that increase blood pressure
and can encourage clotting of the arteries.
Stress can also make us feel less motivated to
spend time on healthy behaviours such as
relaxation or exercise.
Unhelpful thoughts/interpretations
 Being under stress can lead to unhelpful thoughts
such as:
“There’s nothing that will help me”
“I’m not getting better, I’m getting worse”
“It’s dangerous for people with heart problems to
argue”
“I should be able to cope”
This can lead to a vicious cycle, with unhelpful thoughts
raising adrenaline and producing unpleasant physical
effects, which leads to more worrying thoughts, in turn
leading to more stress and so on…
VICIOUS CIRCLE OF STRESS/ANXIETY
Trigger stimulus
•Internal
•external
Thoughts:
“There’s not much you can
do about heart problems”
“There’s something wrong
with my heart”
Feelings:
Behaviour:
Stop what doing,
reduce overall
activity, lose fitness
etc.
Raised anxiety, fear,
frustration
Physical effects:
e.g. increase adrenaline
(increase HR, faster
breathing, tension etc.)
Coping with stress
1. Learning to spot when stress levels
are building up
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Feeling stressed and
tense can become a habit
Panic
Be aware of daily hassles
and strains increasing
stress levels
What was I thinking
about, or doing or what
had happened just before
I started to feel like
this?
Are there other ways of
looking at the situation?
Scared
Worried
Bad
tempered
Excited
Alert
Wide awake
Calm
Relaxed
Tense
Challenging unhelpful thoughts
Remember that unhelpful thoughts can raise
adrenaline levels, and in turn increase stress.
BUT: can try to challenge unhelpful thoughts
 Ask yourself:
Is this thought really true/true all the
time?
Am I considering all the evidence?
Am I ignoring any strengths or positives?
Am I jumping to conclusions?
2. Challenge unhelpful thoughts
 Having considered these questions, can you come
up with a different, more balanced, more positive
thought?
“My heart is not worn out”
“Most people make a full recovery after a heart“ attack”
“There are many things I can do to prevent CHD”
“It was a blockage in an artery – not the heart that
caused the problem”
“Relaxation is not just being lazy it’s important for
health and well-being”
BREAK THE VICIOUS CYCLE
Thoughts:
“There are many things I
can do to fight CHD”
Behaviour:
Feelings:
Healthy lifestyle
changes, active,
see friends, set
goals
Positive, calm,
optimistic, motivated
Physical effects:
More relaxed
3. Problem-solving
For example….
 Are you managing your time effectively?
 Can you cut back on some things if you’ve taken
on too much?
 Are your goals/expectations realistic?
 Can you speak to somebody about it?
 Can you prioritise the most important things that
need to be done?
 Can you say NO to some things?
Adopting ‘Low stress’ ways of living
and working
Making time for enjoyable activities
Switching off from thoughts/worries
Slowing down, taking your time
Taking a break
Being relaxed; practising relaxation
Thinking about what you have achieved,
not worrying about what you haven’t
Talking about how you’re feeling
Leading a healthy lifestyle
4. Relaxation
 Important for everyone to have times when they relax
during the day – stick to them – it doesn’t mean you’re
being lazy.
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Lowers adrenaline
Reduces stress
Lowers blood pressure
Increases feelings of being in control
Reduces pain
Improves sleep
Reduces tension
Helps us feel better able to cope with problems
Helps reduce fears and anxieties
Improves well-being
Rest and relaxation are as important as work. Relaxation
is more than just watching TV!
Things you can do…
 1. Learn to recognise when you are stressed before it
becomes a long-term problem. Be aware of daily hassles
keeping adrenaline levels high.
 2. Be aware of unhelpful thoughts and how they can
increase adrenaline. Try and replace with more balanced
alternative ways of thinking.
 3. Make time for yourself for relaxation and enjoyable
activities and stick to them. Practice breathing
exercises everyday
 4. Change ways of doing things to lower stress levels and
anxiety
 5. If things are too much to cope with, remember there
is help and support available. Talk to the CR team.
THANK YOU!
Any questions?