STRESS MANAGEMENT IMPORTANT

WEEK1

LECTURE 1(WHAT IS STRESS)

 WHAT IS STRESS?

Stress can be defined as a response of the body to any

demand placed on it. It could be an external demand, or
it could be an internal demand.

 WHY DO INDIVIDUALS RESPOND DIFFERENTLY

DURING STRESS

Because of the way they perceive the stress is a stressful

situation.

 PIONEERS IN STRESS RESEARCH

Adjustment problems creates disharmony between the

environment and the individual. Now, this creates stress
within the individual that 5brings about other
psychosomatic problems other bodily issues that may
cause of several illnesses and several psychological
illnesses like depression light psychosomatic disorders
psycho-physiological disorders etc.,

The maximum amount of stress research started during

the world wars.
Walter Cannon was a physiologist in Harvard Medical
School, and he first described body's response to stress.

Body prepares itself --> when confronted by a threat -->

to either stand
ground and fight or run away.

Walter Cannon termed this response as the FIGHT OR

FLIGHT RESPONSE

Hans Selye was an endocrinologist, and he found while

working with rats he found that the rats response he
introduced some stress on the rat, and he saw that
several changes in the body happened due to that
introduction of the stressors (a stressors is something
that is that has a potential to create stress).

Selye identified that regardless of the source of stress,

the body responded in the same manner to a stressful
situation and this he summarized as stress reactivity. In
stress reactivity, he said it was a three-phase process
which he termed as GENERAL ADAPTATION SYNDROME.

3 PHASES OF GENERAL ADAPTATION SYNDROME

Alarm reaction, where the body shows changes at the

first exposure of the stressor, so the body is identifying
that there is a stressful stimulus, so that is the stage of
alarm reaction.
Stage of resistance, where the body is trying to fight the
stressors so and is trying to get adapted to the stressful
situation if it can adapt well and good if not the body
shows signs characteristic of the resistance, where their
resistance rises higher than the normal and definitely.

Stage of exhaustion, where long-continued stressful

situation makes the body get
when depleting the energy of the body and leads to
exhaustion.
Now, the alarm reactions may reappear, but this time
the body is not able to fight it.

Hans Selye defined stress as “the nonspecific response

of the body to any demand made upon it.”

That means good things (e.g., a job promotion) to which

we must adapt (termed eustress) and bad things (e.g.,
the death of a loved one) to
which we must adapt (termed distress); both are
experienced the same physiologically.

Holmes and and Rahe (1967) – emphasized the role

of Life Events in stress . They showed that the more
significant the
changes in one’ s life, the greater the Chance of the
onset of illness

Lazarus, Delongis and others found that daily hassles are

even more detrimental to health than major life
changes
ATW Simeons (1961), another very interesting
individual, related evolution to psychosomatic disease. I
have spoken of psychosomatic disease. The
psychosomatic disease is bodily change, a bodily illness
that is created due to stress within the individual.
The human brain (Especially Diencepphalon) has failed
to develop at the pace needed to respond to symbolic
stressors of the twentieth century
Symbolic stressors are stressors that are not a threat to
our survival.

See if there is a threat to the self-esteem from a fear of

embarrassment during public
speaking, the fight-or-flight response would not be a
healthy response.

Harold Wolff (1953) – found that a large number of

death before release had resulted
among inmates of Japanese concentration camps as
compared to German camps due to the increased
amount of emotional stress
LECTURE 2 (SOURCES OF STRESS)

STRESSOR
A stressors is a stimulus with the potential of triggering a
fight-or-flight response, that is, the stressors is a
stimulus that could be internal or external so it could be
when somebody tells me something abusing that could
be a stressors.

Stressors can be:

• biological and environmental (toxins, heat, cold) -
external factors
• psychological (threat to self esteem, depression), -
internal factor
• sociological (financial loss, unemployment, social
isolation),
• philosophical (loss of purpose or goal in life) - internal
factor

STRESS REACTIVITY
Stress reactivity is the fight-or-flight response, or it is the
response to
the stressor. So, we have a stimulus which is inducing a
response of the fight-or-flight and what happens.

 increased muscle tension

• increased heart rate, stroke, volume, and output
• elevated blood pressure
• increased neural excitability
• less saliva in the mouth causing dryness of mouth
• increased perspiration

STRAIN

The strain is the outcome of stress reactivity, that is, it

to a long
term stressor.
We have spoken stress reactivity as the response to a
stressor, and strain is the resultant.

Physical – tension headaches and backaches resulting

from excessive
muscle tension
Psychological –ex - fear of being in crowd resulting from
contemplating
the experience
Behavioural – alcohol abuse and getting into fights
Ex: daily hassles increasing stress reactivity leading to
strain

stressor is a stimulus,
stress reactivity is the response to that stimulus
strain is the outcome of the stress reactivity to that
stimulus.

Simeons (1961), and he said that our brain has not

developed at this
space, for adjust and accommodate to the century
She is given this model, and she talks of external
stressors and internal values and needs that add up to
the stressful stimuli, so that is it adds up to how we
perceive the stressful stimuli. Now, if my internal values
tell me that this is a stressful situation, and this is of the
prior importance of the very important issue, then I will
consider it much more stressful as compared to a
person who does not think that this is very important.
Now, these combine to make the act of stress, also
induce stress. Now here we see the responses to more
important things one is the coping resources and
external support. Now even if an individual perceives a
stimulus as stressful, it need not be induced stress if he
can resourcefully use his coping strategies and his
external support. But if these two things are absent, the
coping resources and the external support, or these do
not add up to help him deal with the situation; then it
will bring about an imbalance of stress. Now, we have
the psychological response that can be divided into the
emotional experience of the stress as well as the mental
response. So,it could be something like Oh god I cannot
deal with it, or the emotional experience of fear and
these bring about the physiological reactions, so here
we are talking of the autonomic responses like increased
heart rate, muscle
tension etc. and the behavioural risk reactions, like
isolating self or getting angry, agitated etc.. And all these
responses lead to the stress reaction, that's outcome.
Now how I have responded at this time will also get
feedback to my response next time to the same stimulus
or a similar stimulus. For example, if I was feeling
anxious during my interview and I did not attend the
interview, the next time, that is, I thought that my
coping resources, my knowledge and whatever support I
have gathered from my friends and professors are not
enough to deal with this stimuli. And I get so scared, and
the response is Oh God this is impossible to deal with it,
and because of the autonomic nervous system (ANS)
responses, I run away altogether.
This feedback, moving away from the situation is taking
increasing the perceptual value of the stressor will act as
a feedback to the next time I go for an interview.
So, it could be that in the next interview session, I will
not face the interview at all because I will remember
that the previous time it was awful. Thus it is very
important to recognize eustress and distress so what is
the way we have to break this model, so somewhere we
have to stop deal with the stressors and stop ourselves
from perceiving this stress stimulus as really an
aggravating situation.

Hans Selye suggested that we need to recognize our

eustress that is when our body and mind is in a balance
When we are feeling a similar situation when we are
feeling energetic, adaptable, approachable and relax,
this is eustress. But when we cross that
boundary, that is, when you feel exhausted, anxious,
fretful, aggressive and defensive, that is a time when we
are distressed, so that is the negative effect of stress.

STRESS IS NOT BAD

So, if we see this model you see that performance is on

the y-axis and the stress level is on the x-axis.if there is
too little stress, the performance is low and if there is
too high stress, then also the performance is low, so
how do we know where our optimum stress lies? Hans
Selye already spoke about it, but this is where we need
to maintain our stress level, so if we have a stress level
between 0 and 0 dashes, then our performance is at its
optimum.

The stress we have seen that can it can also be good for
the performance, and that is known as eustress. The
eustress is that part of the stress that helps us to do
well, when the stressor becomes more as compared to
and the performance falls, then is known as distress.

LECTURE 3 (TYPES OF STRESS)

Wheaton (1994) said that the stressors can be primarily
of two types, one is an event stressor, and the other is a
chronic stressor.

An event stressor is an acute stress, generally due to

some
particular event that is suddenly happening in one’s life.

A few acute stressors…

• Failed an exam
• Interview / presentation / submissions around the
corner
• Recent relationship break up
• Lost a job recently
• Accident
• Deadline to meet soon
• Car broke down / maid didn’t come
• Sudden illness or death of a close one

Chronic stressor spreads over a long period that is why

the term is as its named as chronic, so it has been
continuing for a long time and what happens is, that as
you can see that after a certain level of time, it is almost
set at plateau, so the level of stresses almost at a
plateau, so it is there is not a sudden peak like in the
event stressor.

War
• Financial crisis
• Long term relationship problems
• Traumatic experiences
• Unwanted career/ job
• Chronic illnesses
• Dysfunctional families

But in the chronic stressor, the stressor is continuously

effecting even though it starts at very low levels. If you
see that the acute stressor rapidly short up, and the
intensity of the stressor was very high within the short
period, while in chronic stress the chronic stressor
actually the stress may increase gradually, but the major
criteria is that it is there or a long period and that by
itself causes a lot of physiological changes and lot of
change physiological changes that bring about several
psychosomatic disorders and also other problems in
occupation and elsewhere.
POINTS TO REMEMBER ABOUT ACUTE STRESSOR

 Acute stress several times can be pretty exciting too.

So, though the adventures sports and the thrills of
acute stress can be extremely accelerating, it is
fun for short periods of time, and if it continues for long,
it can be tiring and draining.

 Effects of acute stress are physiological changes,

emotional changes,
cardiovascular changes, and digestive changes.

 Acute stress can be very well managed through

several lifestyle changes.

 Most of the times acute stress is recognized by

individuals.

POINTS TO REMEMBER ABOUT CHRONIC STRESSOR

 Chronic stress spreading across a large period of

time.

 In the case of an individual who goes through

intermittent stress, he may not realize that the
stressor what the stress it is, he might say that. it is
because of this situation, it is because of that
situation, but he may not identify it will increase
personality factors or him himself being a factor.
LEARNED HELPLESSNESS

Seligman introduced this principle, and he spoke about

individuals who feel helpless once they have this sense
of lack of control of the situation. So now several times
traumatic childhood experiences, an individual
internalizes the symptoms and feel, I cannot control the
situation, I shall be a victim of circumstances, no matter
when and what the situation it is, while being a victim of
circumstances throughout my life. So, several times such
a sense of helplessness is imbibed into the personality
pattern, and that aggravates a stressful situation.

Many times we see the individual in chronic stress also

exhibiting the same symptoms or similar symptoms as in
acute stress. Some of the physical signs mean dry
mouth, difficulty in breathing, pounding heart, stomach
aches and chronic headache and also the psychological
signs of irritability, problems in concentrating,
tensioning something, it was a narrowed perception of I
was talking of loss of control, and frequency of fatigue
but this what is the difference between acute stress and
chronic stress.

EFFECT OF STRESS ON PERFORMANCE

• Effect of stress on Appetite and digestion – “LOST MY

APPETITE” –
Digestion is a Para sympathetic activity
During stress, Sympathetic Nervous system - activated
making
individual vigilant and aroused, but suppresses appetite

• Effect on sexual activity – sexual arousal and

reproduction are
inhibited by the physiological concomitants of stress
– Precludes testosterone release in males
– Reduces concentration of estrogen in females

• Effects of stress on cognition – chronic stress affects

beliefs
and views of the world

sympathetic nervous system  release of various

digestive enzymes
affected nutrients not absorbed  nutritional deficits 
growth
Affected.

In adults:
stress hormones disrupt
• the processes by which the body reconstructs itself
through the use of
calcium  Stress is responsible for the disintegration of
bone
LECTURE 4 (PERSONALITY FACTORS AND STRESS)

What is personality?

Personality refers to individual differences in

characteristic patterns of thinking, feeling and behaving
.These are developed through interaction with our
environment over time - values, attitudes, personal
memories, social relationships, habits, and skills.

PERSONALITY AND STRESS

Individual differences
• cognitive reaction to a situation - appraisal of the
nature, importance and implications of the event, and
by your ability to effectively manage or cope with the
event
• emotional responses to a situation - determined by
appraisal of situation and coping abilities
Ex: “I can handle this,” – planning ways to handle the
situation
“This is terrible. I’m going crazy” - quitting, getting
more anxious

Genetic makeup

influences health and behavior

• All human beings face stress when dealing when faced
with making a difficult or frustrating decision
• Some individuals may have a heightened level of
arousal in the central nervous system, causing them to
react more excitedly to events and adapt more slowly.

Factors of Personality related to stress

Locus of control
Self esteem
Personality Type
Hardiness

LOCUS OF CONTROL

Locus of control refers to the degree of control which

individuals think they have over what happens to them
Internal locus of control
- Persons who see themselves as having control over
their environment
less likely to be disrupted by stress
External locus of control:
They do not believe they have control over their lives
what happens to them determined by others or by
outside events
Stressors have much influence on their lives
Learned Helplessness (Seligman ,1975)

 Studies show that people will learn better and use

their past experience to greater advantage if they
 believe that their success or failure is determined by
their skill rather than by luck.
• There is also evidence that people will experience less
stress in aversive situations if they believe they have
some personal control over the outcomes of the
situation.

SELF ESTEEM

- individual’s self-perception of his/her abilities, skills,

and overall qualities that guides and/or motivates
specific cognitive processes and behaviors
Self-esteem has also been reported to predict stress in
individuals with chronic disease
Lazarus - a potential stressor (e.g. external event) causes
people to undergo two
cognitive appraisal processes
• primary appraisal - focuses on the nature (positive,
negative, or neutral) and
respective level of threat an event presents
• secondary appraisal - determines one’s available
coping abilities and resources
are sufficient to overcome the stressor
Lazarus and Folkman (1984)

Individuals with low self-esteem may lack the coping

resources necessary to regulate environmental
stressors.
Schneiderman et al., 2005
low self-esteem - with negative life outcomes, including
substance abuse, delinquency, unhappiness, depression,
and worsened recovery after illnesses
Leary and McDonald, 2003

• High self esteem - happiness and longevity

Baumeister et al., 2003

In studies of aging, a positive self-concept and internal

locus of control predict successful aging, predicting
independence, cognitive stability, and general health
Baltes and Baltes 1990

PERSONALITY TYPES

History: Two California cardiologists, Meyer Friedman

and Ray Rosenman, observed differences in patterns of
behavior of their cardiac patients, ifferences they
related to types of cardiac
problems Beginning in the 1980s, health care
professionals sought to identify these individuals in
order to intervene and prevent the development of
coronary problems

TYPE A

A sense of time urgency and hostility

1. Time urgency - This is the feeling that there is not
enough time to do all the things that we believe should
be done or that we wish to do.
It leads to the following symptoms:
 Rapid movements: The afflicted person usually walks,
talks or eats fast.
 Impatience: There is a feeling that the rate at which
most events take place is too slow. Frequently there
is an attempt to hurry the speech of others by
saying very quickly over and over again, ''Uh huh, uh
huh," or "Yes, yes, yes,"
or interrupting before people finish their sentences
 Anguish at waiting in line or waiting to be seated in a
restaurant.
 Avoids repetitive tasks - making out bank deposit
slips, writing checks, and washing
and cleaning dishes

 Tension: finds it difficult to sit and do nothing. Feels

guilty when relaxing
He often has a characteristic facial tautness expressing
tension and anxiety
• Restlessness: knee jiggling, rapid tapping of the
fingers, head nodding,
rapid eyebrow lifting while speaking, sucking in air while
speaking, tongue
to-front-teeth clicking during conversation, or tuneless
humming
• Preoccupation: Inattentive to others. Unable to detect
mental and physical
fatigue while engaged in a task. Fails to observe
seemingly unimportant
unrelated things.
2. Hostility –
a predisposition to evaluate people or events negatively,
often in a suspicious, distrustful, cynical, and paranoid
fashion . There is a generalized aggression or excessive
competitive drive
Hostile expressions:
• Sarcastic during conversations: Accentuating various
key words in talking,
even when there is no real need for such emphasis
• Always plays a game to win
• Clenching the fists, pounding the table, or forceful use
of the hands and fingers
• Preoccupation and irritation with the trivial errors of
others.
• excessively critical of oneself and others -
Characteristic facial expression
of aggression, hostility, and struggle, habitual clenching
of the jaw or grinding of the teeth
• Tendency to swear or use obscene language

CHARACTERISTICS OF TYPE A PERSONALITY

Competitiveness - Belittles achievements of others in

efforts to feel superior.
Perceives other group members as adversaries

Resentment - Harbors feelings of ill will toward others

Deterministic worldview - Believes self to be a pawn of

the environment, rather than active determiner of fate.
Short-term perspective - Deals with problems from the
view of immediate consequences.

Impatience - Belief that success has been due to the

ability to get things done faster than others, and fear of
ceasing to do thingsfaster and faster.

Perfectionism - Believes, "I can do it best so I will do it."

Unable to delegate authority.

Punctuality - Always on time

Tendency to be critical - Ruminates over a past mistake

TYPE B

Type B people very often land up with several

exhaustions. Several chronic illnesses like high blood
pressure and heart disease and they are generally very
snappy and irritable. Type B personality trait is just the
opposite of type A. The there are several advantages of
Type B personality as in it is not related to stressful
behaviour but there is also what you see is
procrastination.

TYPES C

The Type C personality has difficulty expressing emotion

and tends to suppress or inhibit emotions, particularly
negative ones such as anger. Such individuals also
display ‘pathological niceness’, conflict avoidance, high
social desirability, over-compliance and over-patience •
While there’s no clear-cut evidence that these
personality characteristics can actually cause cancer,
they influence the progression of cancer and, hence, the
survival time of cancer patients
Weinman, 1995

TYPE D

Type D personality - the joint tendency to experience

negative emotions and to inhibit these emotions while
avoiding social contacts with others
• experience increased negative emotions across time
and situations and tend not to share these emotions
with others, because of fear of rejection or disapproval
• Gloomy, anxious, and socially inept worrier
• Have fewer personal ties with other people and tend
to feel less
comfortable with strangers
J Denollet, 2000

Type D personality Traits

• has a high risk of cardiac disorders
• Has a high risk of emotional disorders like depression

HARDINESS

Hardiness – Protective factor

In 1981 Illinois Bell Telephone (IBT) downsized from
26,000 to half
Dr. Salvatore R Maddi and his team studied - 400 +
supervisors, managers and executives at IBT (before and
after downsizing till 1987)

2/3 employees suffered significant performance,

leadership and health declines
heart attacks, strokes, obesity, depression, substance
abuse
and poor performance reviews

1/3 thrived - under same conditions

maintained health, happiness and performance and
felt renewed
enthusiasm

What made the two groups so different?

Dr. Maddi found that those who thrived maintained
three key beliefs
that helped them turn adversity into an advantage.
COMMITMENT, CONTROL AND CHALLENGE ATTITUDES

Hardiness comprises the three Cs:

COMMITMENT – involve oneself in whatever one is

doing to approach life with a sense of curiosity and
meaningfulness
The Commitment attitude led them to strive to be
involved in ongoing events, rather than feeling isolated
CONTROL – related to Rotter’s (1966) locus of control
individual differences in people’s beliefs regarding what
controls events in their everyday lives
The Control attitude led them to struggle and try to
influence outcomes, rather than lapse into passivity
and powerlessness

CHALLENGE –
a tendency to believe that change is normal in Life to
anticipate change as an incentive to personal growth
and development rather than a threat to security
The Challenge attitude led them to view stress
changes, whether positive or negative, as opportunities
for new learning

COMMITMENT AND CONTROL associated with good

health
• CHALLENGE is not always necessary
• FEELING HELPLESS (NOT IN CONTROL) and being
UNCOMMITTED
FIND THEMSELVES IN STRESSFUL CONDITIONS
• OPTIMISTIC OUTLOOK TO LIFE - HEALTHIER
Hardiness moderates the stress–illness relationship by
reducing
cognitive appraisals of threat, and reducing the use of
regressive
coping
Funk, 1992

CULTURAL/ETHNIC BACKGROUND
• competitiveness and striving for achievement are
common goals in
capitalist societies, but probably not in more
traditional, communal ones
Penny, 1996
• the physical and mental health of African-Americans
is worse than that
of whites, especially in terms of the spread of AIDS and
hypertension.
While this is partly due to the direct negative effects of
poverty, such as
poor diet, low levels of education and poor medical
care, there are many
psychological and social stressors involved as well
Although these are extremely difficult to measure,
especially across cultures:
… there is little dispute that blacks in North America and
Europe face
a unique kind of stress – racial discrimination
Cooper et al., 1999

STRESS ITSELF AS A CAUSE OF STRESS

Once emotional responses begin to build up, people will
start responding in terms of their perception of these
emotional changes as well as to the context. So
emotional problems cause stress too, particularly
feelings of inferiority, conscience and emotional conflict.
Ex: person who feels inferior under pressure, since
every contact, every event in his life is a cue for the
activation of this sense of inferiority.
Highly moral person - imposes unattainable demands on
self failing to meet them causes stress.
LECTURE 5 (STRESS AND COLLEGE STUDENT)

Case vignettes:
Case 1: AC- “I have low grades”
Case 2: BD – “I can’t understand the language”
Case 3: EG – “I can’t balance my academics and family”

DEVELOPMENTAL TASKS DURING COLLEGE YEARS

• Achieving emotional independence from family

• Choosing and preparing for a career
• Preparing for emotional commitment and family life
• Developing an ethical system
Managing these transitional changes requires college
students to develop
new roles and modify old ones, and that can result in a
great deal of stress
Chickering, A. and Havighurst, R. , 1998

Chronic stress in college life

Younger student / fresher:

• Leaving home - Life style changes - Adjustment to new
place, food, climate, people
• Grades and performance
• Communication skills
• getting involved in College activities
• balancing academics and other social involvements
Senior student:
• Career decisions
• relationship issues
• family responsibilities
• meaning in life

Stress signals

• Here are a few common indicators:

• Difficulty concentrating
• Increased worrying
• Trouble completing assignments on time
• Not going to class
• Short temper or increased agitation
• Tension
• Headaches
• Tight muscles
• Changes in eating habits (e.g., “stress eating”)
• Changes in sleeping habits

Effects of stress

• Sleep disturbance
• Avoidance behaviour  Absentism
• Poor academic performance
• Internet / computer addiction
• Social isolation
• Alcoholism and substance abuse
• Tension headache
• Obesity
• Irritable bowel syndrome
• Clinical depression
• Anxiety Disorders
• Suicide

Resilience

Resilience means bouncing back from stress. We come

across individuals who will deal with stress effectively
and come back no matter what the situation is, while
there are others who in a stressful situation given. We
have started about the personality variables, but it is
also very important to work on resilience.

WEEK 2
LECTURE 6 (STRESS AND NERVOUS SYSTEM)

Hans Selye(1956) develops the idea that a direct

relationship exists between chronic stress and excessive
wear and tear throughout the body. When he spoke
about facing resistance and the period stage of
exhaustion, he was talking about the excessive wear and
tear that the body goes through during stress.

Stress and its physiology

• As a survival response The brain reacts to stress in a
sequence of biological and chemical reactions
Stress caused by
biological agents – viruses
environment – temperature
psychological agents – threat to self esteem, loss of
loved one resulting in loneliness, social isolation etc

Brain and Stress

These stressors are perceived by the body and
interpreted by the brain The brain then instructs the
rest of the body as to how to
 respond to the stressor
 adjust to it
 Freeze response

Lazarus's Cognitive Appraisal Theory

Where it is not the stressor by itself that is actually the
cause of stress within an individual. It is the perception
of the stressor, how the individual or in this case how
the brain sees the stressor and then how does it
respond instruct the body to respond to it.

Importance of knowing physiology of stress:

• Helps improve health and well being through stress
management techniques
• Understanding how the techniques work It is
important to know what happens to our body during a
stressful situation…

What happens to our body during a stressful situation?

Eg: giving a presentation in front of experts

Physiological changes: heart pounding, muscles
tensed up, sweating, dryness of mouth

Psychological changes: fear and nervousness

Physiological Systems Involved in the Stress Response

• The nervous system

• The endocrine system
• The immune system
Optimally, interaction of these systems maintains
homeostasis and wellness. But when there is a problem
with any of these systems then it causes an eruption of
over stressful responses, and it may also affect the
different systems of the body like one may develop
some endocrine problems like this regulation of the
thyroid hormone or it one may develop several
immunological problems due to stress.

BRAIN STRUCTURE

The brain consists of primarily the three parts the

forebrain, the midbrain and the hindbrain. So, the
forebrain is the higher part of the brain or which is
involved in the higher-order functioning, and it consists
of the cerebrum, the cerebral cortex and also the
diencephalon that is the thalamus and the
hypothalamus. The midbrain is a
very important part which is related to the sensory
impulses, and the hindbrain
consists of the cerebellum the pons, medulla oblongata
and the spinal cord.

The human brain

The human brain is divided into three levels:
• The Vegetative level
the vegetative level is primarily related to the
autonomic arousal, so that is breathing, heart rate, so
these are more of the physiological responses,
• The Limbic system
limbic system is related to the emotional thought
processing
• The neocortical level
the cortical level is for the higher-order functions, that is
what we were
talking about the forebrain structures primarily the
cerebral cortex.

THE VEGETATIVE LEVEL

The vegetative level, the lowest level of the brain the

vegetative level consists of the two structures the
reticular formation and the brain stem. Now both these
structures as we have seen are related to the regulation
of the responses, so like heart rate, breathing, sleep
etc.,

THE RETICULAR ACTIVATING SYSTEM & STRESS

PHYSIOLOGY

Reticular Activating System takes its impulses from the

optic fibres, the auditory fibres like various cranial
nerves and this actually screens the stimulus and with
the help of the relay centre or the thalamus sends the
impulses to the various parts of the brain.

Reticular Activating System (RAS): A network of nerves

that connects the mind and the body
It is the part of the brain where the world outside, and
thoughts and feelings from inside meet
• When functioning normally, it provides the neural
connections that are needed for the processing and
learning of information and the ability to pay attention
to the correct task

If the RAS doesn’t excite the neurons of the cortex as

much as it ought to, then an under aroused cortex
results in such effects as difficulty in learning, poor
memory, and little self-control

• If RAS is too excited and arouses the cortex too much,

stressful responses such as being easily startled, Hyper-
vigilance, restlessness, and hyperactivity occur

The brain stem

• The brain stem: (pons, medulla oblongata, and
mesencephalon)
• Involuntary functions of the human body

Medulla Oblongata: regulates heartbeat, respiration,

and other such basic physiological processes
Pons:
regulates the sleep cycle
Mesencephalon:
It is associated with vision, hearing, motor control,
sleep/wake, arousal (alertness), and temperature
regulation
This part of the brain is responsible for various
physiological processes necessary to stay alive

THE LIMBIC SYSTEM – EMOTIONAL RESPONSE

• The limbic system is the emotional control center and

comprised of the:
Thalamus: the major areas the thalamus is not a
structure of the limbic system, but it is related to
relaying the responses of the limbic system to other
areas of the brain.

Hypothalamus : just under the thalamus, there is a very

small structure which is one of the major regulators of
homeostasis in the body. It is also a regulator for
releasing several human hormones within the body

Amygdala: The amygdala which is an almond-shaped

structure on either side of the
thalamus and then the lower end of the hippocampus,
deals with emotions, and we see that the if there is a
lesion in the amygdala, there is a very strange team
response that is seen within the individual. So, the
amygdala is related to emotions like stress, anger and
also aggression

Hippocampus: The hippocampus another structures, a

very important structure of the limbic system is as
situated at the curved back of the amygdala, and it is
like two horns, and this is related to the long-term
memory or the storage of memories. So, if there is a
damage in the hippocampus, then it affects new
memories being formed.

Pituitary gland : The pituitary gland is known as a master

gland, and it releases stress hormones.
We must remember that the thalamus, the
hypothalamus and the pituitary gland work in unison to
maintain a level of homeostasis within the body.

THE NEO CORTICOL LEVEL

Involved in higher order functions like sensory

perception, generation of motor commands, conscious
thought, language
• Sensory information is processed as threatening or
non threatening after cognition
– Lazarus theory of Cognitive Appraisal
• The neo cortex can also control more primitive areas
of the
brain
When the diencephalon recognizes fear, the neo cortex
can use
judgment to recognize the stimulus as nonthreatening
and
override the fear

So, the information that is received by the lower level

structures, and which is mediated through the reticular
activating system, passes through the limbic system and
then when it goes to the even if it is perceived as a
fearful stimulus when it comes to the forebrain, in this
case, the neocortex, then the decision is made whether
this is so threatening to offer the fight of light response.
In fact, what response will it be whether it will be a fight
response or flight response or many times freeze
response, as in pretending to be dead which is actually
done by several animals and even by raped victim during
the traumatic event. This selection of the response is
done in this cortical neocortical level. The most
interesting part is that this higher level of the brain can
actually override a lower level and can influence
emotional responses. As I mentioned that even if the
diencephalon that's the thalamus and thehypothalamus
recognizes fear, the neocortex can use its judgment to
recognize the stimulus as
non-threatening and override the fear.

THE ROLE OF THE DIENCEPHALON

Diencephalon is made up of the thalamus and

hypothalamus
• Thalamus: relays sensory impulses from other parts of
the nervous system to the cerebral cortex
• Hypothalamus: lies under the thalamus important in
stress reactivity
Activates the Autonomic Nervous System

THE AUTOMATIC NERVOUS SYSTEM

The autonomic nervous system regulates the visceral

activities and the vital organs that is circulation,
digestion, respiration and temperature regulation. The
autonomic nervous system consists of two parts the
sympathetic activation system and the parasympathetic
nervous system.
Sympathetic Nervous System
• fight-or-flight response
• This physical arousal is stimulated through the release
of hormones
– epinephrine (adrenaline)
– norepinephrine (noradrenaline)

Parasympathetic Nervous System

• Maintains homeostasis - acetylcholine
• energy conservation and relaxation

WHAT HAPPENS WHEN WE ENCOUNTER A

STRESSOR?

• In the presence of a stressor, the different sense

organs and bodily parts (eyes, nose, muscles, etc.)
acknowledges the stressor and passes a message to the
brain
• These messages pass through the Reticular Activating
System to the limbic system and the thalamus
• The emotion evolves in the limbic system and the
thalamus send it to the appropriate centres

During stress -
• The hypothalamus activates the endocrine system
and the autonomic nervous system
LECTURE 7 (HYPOTHALAMIC-PITUITARY ADRENAL (HPA)
AXIS )

The Endocrine System

• Consists of a series of hormonal glands located

throughout the body which regulate metabolic functions
that require endurance rather than speed
• The endocrine system is a network of four
components:
– glands, hormones, circulation, and target organs

The glands most closely involved with the stress

response are the:
– pituitary
– thyroid
– adrenal

Initiation of the stress response in the brain

The sense organs sends information to amygdala which
interprets images and
sounds and sends a distress signal to the hypothalamus
The hypothalamus communicates with the rest of the
body so that the person
can immediately respond to the stressor
Harvard Health Publications, 2016

HYPOTHALAMUS

The Hypothalamus is a small structure situated below

the Thalamus and above the Brain Stem
(Hypo – under; In humans it is the size of an almond)
• It links the nervous system to the Endocrine system via
the Pituitary gland
• It controls the release of hormones from the Pituitary
Gland – a hormone secreting gland just below the
Hypothalamus
• The hypothalamus is like a command centre
• It communicates with the rest of the body through the
AUTONOMIC NERVOUS SYSTEM  SYMPATHETIC
NERVOUS SYSTEM

THE PITUITARY GLAND

The Pituitary gland (master gland) is a pea sized

structure located below the
Hypothalamus During stress it releases
Adrenocorticotrophic Hormone (ACTH) which
stimulates the adrenal stress hormone,

ADRENAL GLAND

• The adrenal gland is located at the top of each kidney;

therefore each person has two Adrenal glands. It is
divided into 2 parts:
• The Adrenal cortex: mineralocorticoids,
glucocorticoids, gonadocorticoids
• Adrenal Medulla: epinephrine, norepinephrine

TRIGGERING THE HPA AXIS

• The Hypothalamic Pituitary Adrenal Axis or HPA axis

– best known for its role in body’s natural reaction to
stress HPA axis includes a group of hormone secreting
glands from the NERVOUS and ENDOCRINE SYSTEM

• This network consists of the Hypothalamus, the

Pituitary
gland and the Adrenal glands

Brian M Sweis, 2012

When one experiences a stressful event:

• the hypothalamus releases a hormone called the

Corticotrophin Hormone(CRH)
• CRH signals the Pituitary Gland to secrete the Adreno
Cortico Tropic Hormone (ACTH) into the blood stream
• ACTH travels down to the Adrenal glands where it
prompts the release of Glucocorticoids from the
Adrenal Cortex
• One of these Glucocorticoids is Cortisol which plays
an important role in stress response
• With increased cortisol level  Epinephrine and
Norepinephrine (hormones) secreted from Adrenal
Medulla

As epinephrine circulates through the body, it brings

on a number of physiological
changes:
– The heart beats faster than normal
– pushing blood to the muscles, heart, and other vital
organs
– Pulse rate and blood pressure go up
– The person undergoing these changes also starts to
breathe more rapidly
– Small airways in the lungs open wide - the lungs can
take in as much
oxygen as possible with each breath. Extra oxygen is
sent to the brain,
increasing alertness
– Thus, Sight, hearing, and other senses become
sharper

The release of cortisol causes a number of changes that

help the body to deal with stress
Eg: Helps body mobilise energy like glucose so that body
has enough energy to cope with prolonged stress
• In general, when the threat passes, cortisol levels fall
The parasympathetic nervous system — the "brake" —
then dampens the stress response

Negative Feedback Mechanism

cortisol level in blood - high receptors in Hypothalamus
shutting down of the stress response
Efficiency of the Sympathetic activation

• All of these changes happen so quickly that people

aren't aware of them
• Efficient - amygdala and hypothalamus activated
before the brain's visual centres process what is
happening

OVERSTRESSED?
• Many people are unable to find a way to put the
brakes on stress
• Chronic low-level stress keeps the HPA axis activated
LECTURE 8 (EFFECT OF STRESS OF IMMUNE SYSTEM)

Physiological Systems Involved in the Stress Response

• The nervous system

• The endocrine system
• The immune system
How does the immune system function during a
stressful situation ?

What do we mean by the immune system?

• The immune system is the body’s form of defense

• The immune system is a collection of billions of cells
that travel through the bloodstream. They move in and
out of tissues and organs, defending the body against
foreign bodies (antigens), such as bacteria, viruses and
other micro organisms
• The immune system is comprised of organs,
tissues,cells and cell products that all work together to
fight harmful substances like the pathogens that cause
infection and disease
• The white blood cells (leukocytes), which are the main
fighter cells of the immune system are made up of three
classes: lymphocytes, monocytes, and granulocytes
The cells

• The main types of immune cells are white blood cells.

There are two types of
white blood cells – lymphocytes and phagocytes

There are two types of lymphocytes:

• B cells- produce antibodies which are released into the
fluid surrounding the body’s cells to destroy the
invading viruses and bacteria
• T cells - if the invader gets inside a cell, the T cells lock
on to the infected cell, multiply and destroy it

Think about your last bad day. How did you feel?

Were you a little more tired then usual? Did you feel
unusually fatigued? The chances are you probably did
Why does this happen?

• No one really knows for sure why the immune system

acts weak when one thinks it should function strongly
• The evolutionary perspective: the immune system is
suppressed during periods of stress to serve as a
protective function in the evolution of our species
– The belief is that it helps prevent people from
developing autoimmune diseases

Carson, Butcher, & Mineka, 2002

How does stress effect immune system?

• When we’re stressed, the immune system’s ability to

fight off antigens is reduced. That is why we are more
susceptible to infections
• The stress hormone corticosteroid can suppress the
effectiveness of the immune system (e.g. lowers the
number of lymphocytes)
• Stress can also have an indirect effect on the immune
system as a person may use unhealthy behavioral
coping strategies to reduce their stress, such as drinking
and smoking
• Stress is linked to: headaches; infectious illness (e.g.
‘flu); cardiovascular disease; diabetes, asthma and
gastriculcers.

HISTORY OF RESEARCH IN STRESS AND IMMUNE

SYSTEM

• In the early 1980s, psychologist Janice Kiecolt-Glaser,

and immunologist Ronald Glaser, of the Ohio State
University College of Medicine, were intrigued by animal
studies that linked stress and infection. From 1982
through 1992, they studied medical students

• Among other things, they found that the students'

immunity went down every year under the simple stress
of the threeday exam period
• Test takers had fewer natural killer cells, which fight
tumors and viral infections

• They almost stopped producing immunity-boosting

gamma interferon and infection-fighting T-cells
responded only weakly to test-tube stimulation

• Think about yourself during a stressful

situation

• Hospital visits at IIT Kharagpur

• Suzanne Segerstrom and Gregory Miller(2004) – found

that: For stress of any significant duration - from a few
days to a few months or years, as happens in real life -
all aspects of immunity went downhill

• Thus long-term or chronic stress, through too much

wear and tear, can ravage the immune system  Hans
Selye (1956) and the G-A-S

Endocrine system and immune system

• Brain sends defense signals to Endocrine system

releases hormones for emergency situations depresses
immunity
STRESS AND ALLOSTATIC LOAD

• The primary hormonal mediators of the stress

response, glucocorticoids and catecholamines, have
both protective and damaging effects on the body

In the short run: they are essential for adaptation,

maintenance of homeostasis, and survival (Allostasis)

over longer time intervals: they exact a cost (Allostatic

load) that can accelerate disease processes

Allostasis and Allostatic load centre around the brain as

interpreter and responder to environmental challenges
and as a target of those challenges

While homeostatic changes (such as ANS response to

acute threat) may be adaptive, maintaining an allostatic
state in the long term causes physiological wear and
tear,
leading to pathology

LeMoal, 2007

The allostatic load model aims to explain why biological

changes designed to protect the organism can also be
harmful

Sterling and Eyer, 1988

Allostasis and homeostasis

• Adrenal glands promote Allostasis
(protectivemechanism) together with other
catecholamines by helping to move immune cells
(‘trafficking’) to organs and tissues where they’re
needed to fight infection. But chronic over-activity of
these same mediators can produce immunosuppressive
effects

McEwan and Seeman, 1999

Allostatic load takes the form of chemical imbalances as

well as perturbations in the diurnal rhythm in:
• anxiety disorders
• depressive illness
• hostile and aggressive states
• substance abuse
• post-traumatic stress disorder (PTSD)

In chronic stress… the protein status

• Chronic stress lower amounts of a protein that

is critical to signaling other immune cells

Effect of stress on immune system

• Stress has a direct, negative effect on the immune

system:
1. It creates chronic inflammatory conditions
2. It lowers the immunity healthy individuals
TRIGGERING THE HPA AXIS

When one experiences a stressful event:

• the hypothalamus releases a hormone called the
Corticotrophin Hormone (CRH)

• CRH signals the Pituitary Gland to secrete the

AdrenoCortico Tropic Hormone (ACTH) into the blood
stream

• ACTH travels down to the Adrenal glands where it

prompts the release of Glucocorticoids from the Adrenal
Cortex

• One of these Glucocorticoids is Cortisol which plays an

important role in stress response

• With increased cortisol level  Epinephrine and

Norepinephrine (hormones) secreted from Adrenal
Medulla

Cortisol and immune system:

• Cortisol levels go too low or too high - lead to regular

infections, chronic inflammation, autoimmune diseases
or allergies Maintaining a balanced level of cortisol is an
important part of staying healthy
• One of cortisol’s many functions is to reduce
inflammation – When your body encounters a pathogen
(bacteria virus or microorganism that can
cause disease), the immune system responds by quickly
attacking it

This causes inflammation (it means the immune system

is working) In those with healthy immune and endocrine
systems, cortisol works to moderate the inflammation
caused by an immune system response, but it does not
completely eliminate it

• Cortisol levels can become imbalanced during the

different stages of adrenal fatigue
Cortisol levels largely depend on which stage of the
condition you have reached

In the early stages of Adrenal Fatigue, cortisol levels are

likely to be elevated, along with epinephrine and
norepinephrine.
In the later stages of Adrenal Fatigue, cortisol levels will
be much, much lower Neither result is beneficial for
your immune system

Elevated cortisol

• Adrenal Fatigue  HPA axis produces stress hormones

• Cortisol level is high - suppresses the immune system

and reduces inflammation
Why does the body do this?

• A suppressed immune system leaves us vulnerable to

disease
• Individuals in chronic long term stress tend to suffer
disproportionately from cold and flu viruses, as well as
bacterial infections

Looking at Cushing’s syndrome

• This condition is sometimes known as hypercortisolism

and is recognized through excessively high levels of
cortisol “Cushing’s syndrome, with its elevated cortisol
levels, certainly suppresses the immune system. Patients
with Cushing’s syndrome are at risk for many unique
and unusual infectious diseases”

Cushing’s Support and Research Foundation

Lowered cortisol

(One of cortisol’s many functions is to reduce

inflammation – When body encounters a pathogen
(bacteria virus or microorganism that can cause
disease), the immune system responds by quickly
attacking it)
• When Cortisol falls too far below the optimal level
then you are completely removing the safety valve that
prevents your immune system from over-reacting to
threats
• During the later stages of Adrenal Fatigue the adrenal
glands become tired, depleted and unable to produce
the hormones that your body needs

• Cortisol levels begin to fall rapidly and the Adrenal

Fatigue sufferer quickly switches from having too much
cortisol to having very little indeed

• This means that the regulating anti-inflammatory

effect of cortisol is absent. Without sufficient cortisol,
there is nothing to prevent severe, chronic
inflammation. In effect, the immune system is running
out of control.

• Low cortisol leads to increased production of pro

inflammatory cytokines, which lead to an over-
activation of the immune system and inflammation

• The result is increased susceptibility to developing

inflammatory diseases, including autoimmune diseases,
mood disorders, malignancy, chronic fatigue syndrome,
chronic pain syndromes, obesity, gluc ose dys-regulation
and fibromyalgia (widespread muscle pain and
tenderness)

An interesting study…

Pressman and Cohen, 2005 in a study of first year

college students found that social isolation and feelings
of loneliness each independently weakened first-
year students' immunity

• The students got flu shots at the Carnegie Melon

University health center, described their social
networks, and kept track of their day-to-day feelings
using a handheld computer (a new technique called
"momentary ecological awareness"). They also provided
saliva samples for measuring levels of the stress
hormone cortisol

Findings: Small networks and loneliness each

independently weakened immunity to a core vaccine
component. Immune response was most weakened by
the combination of loneliness and small social networks,
an obvious health stress facing shy new students who
have yet to build their friendship circles

These findings extend what we know about how stress

management and interpersonal relationships can
benefit day-today health, doing everything from helping
us combat the common cold to speeding healing after
surgery The research is in synch with anecdotal reports
of how people get sick in stressful times, but
understanding exactly how psychology affects biology
helps scientists to recommend the best ways we can
build up immunity

How to deal with the immune system

• Finally, the newest findings on social stress underscore
the value of good friends; even just a few close friends
can help someone feel connected and stay strong

• Social ties may indirectly strengthen immunity

because friends - at least health-minded friends -- can
encourage good health behaviors such as eating,
sleeping and exercising well

• Good friends also help to buffer the stress of negative

events

• Because the effects of stress are cumulative, even

ordinary, day-to-day activities can eventually lead to
more serious health issues. So it’s important to be
aware of the simple daily stress in our lives

Some of the mind-body therapies that help

reverse that are:
• Relaxation exercises:
• Positive thinking:
• Behaviour Modification techniques:
• Social support:

To remember….

• The immune system is not an isolated entity from the

psychosocial state of an individual
• A person experiences many stressors throughout a day
and lifetime.
• These stressors are affecting the ability of the immune
system to function at the highest possible level. Many
important studies have shown that there is a
correlation between these stressors and a person's
health
• A person's psychological state is also a prominent
factor in health
LECTURE 9 (HEALTH RISK ASSOCIATED WITH CHRONIC
STRESS)

Stress is commonly assumed to play a role in the

etiology, exacerbation, and maintenance of several
health Problems.

Chronic stress may cause disease, either because of

Changes in your body or Overeating, smoking and other
bad habits people use to cope with stress
(APA,2013)

Stress and the Musculoskeletal System

Muscle tension, muscle atrophy stress-related

musculoskeletal conditions

• response to the injury suffer from chronic pain

Relaxation techniques have been shown to effectively
reduce muscle tension, decrease the incidence of
certain
stress-related disorders, such as headache, and increase
a sense of well-being
• When the body is stressed, muscles tense up
• Chronic stress muscles guarded
• Triggering stress-related disorders
HEADACHES

• Migraine Headaches
– result of a constriction and dilation of the carotid
arteries of one side of the head
The carotid arteries are major blood vessels in the Neck
that supply blood to the brain, neck, and face
– predominant thought on the cause of migraine focuses
on emotional stress and tension
– People often have migraines during times of increased
emotional or physical stress

Relaxation techniques have been found successful in the

prevention and treatment of migraine

• Tension Headaches
- Dull pain, tightness, or pressure around your forehead
or the back of your head and neck
- Caused by muscle tension accompanying stress
Relaxation techniques have been found successful in
Tension Headaches

Cardiovascular System

The heart and blood vessels that provide nourishment

and oxygen to the organs of the body
• Their activity coordinated in the body's response to
stress
• Acute stress — short-term stress - an increase in heart
rate and stronger contractions of the heart muscle, with
the stress hormones — adrenaline, noradrenaline and
cortisol — acting as messengers for these effects
• Fight or Flight Response - The blood vessels that direct
blood to the large muscles and the heart dilate, thereby
increasing the amount of blood pumped to these parts
of the body elevating blood pressure
• Chronic stress, contribute to long-term problems for
heart and blood vessels
• The consistent and ongoing increase in heart rate, and
the elevated levels of stress hormones and of blood
pressure increases risk for hypertension, heart attack
or stroke

Stress and Hypertension

• Approximately 90 percent of hypertension is termed

essential hypertension and has no known cause
• Stress does not directly cause hypertension, but can
have an effect on its development
• Emotional stress is generally regarded as a major
factor in the etiology of hypertension
• Stress management has also been employed to control
high blood pressure

High Blood pressure

• A diagnosis of hypertension may be made when one or
both readings are high
- Systolic (the pressure as the heart pumps blood around
the body) is over 140 mmHg
- diastolic (pressure as the heart relaxes and refills with
blood) is over 90 mmHg

STRESS and CORONARY

HEART DISEASE

• Increased serum cholesterol

• Accelerated heart rate
• Increased blood pressure
• Increased blood volume
• Smoking ,Overeating, lack of exercise
• High production of plasma homocysteine (amino acid-
building block of protein)
(Anger and Hostility increases homocysteine level)

Sudden emotional stress can be trigger for serious

cardiac problems, including heart attacks Stressed-out,
type A personality has a higher risk of high blood
pressure and heart problems
Main Characteristics of Type A Behavior

A sense of time urgency and hostility

 Time urgency - This is the feeling that there is not
enough time to do all the things that we believe
should be done or that we wish to do
 Competitiveness - Belittles achievements of others in
efforts to feel superior.
 Perceives other group members as adversaries
 Resentment - Harbors feelings of ill will toward
others
 Deterministic worldview - Believes self to be a pawn
of the environment, rather than active determiner of
fate
 Short-term perspective - Deals with problems from
the view of immediate consequences
 Impatience - Belief that success has been due to the
ability to get things done faster than others, and fear
of ceasing to do things faster and faster
 Perfectionism - Believes, "I can do it best so I will do
it." Unable to delegate authority
 Punctuality - Always on time
 Tendency to be critical - Ruminates over a past
mistake

STROKE
• Stroke is a lack of oxygen in the brain resulting from a
blockage or rupture of one of the arteries that supply it
• Depending on the exact location of the brain tissue
dying from this lack of oxygen and the amount of time
oxygen was denied, paralysis, speech impairment,
motor-function impairment, or death may result
• Chronic stress is one of the risk factors for stroke

Gastrointestinal System
Esophagus

• When stressed eating more or different foods

increased use of alcohol or tobacco, can result in
heartburn or acid reflux
• Stress or exhaustion can also increase the severity of
heartburn pain

Stomach

• When stressed  brain becomes more alert to

sensations in your stomach Your stomach can react with
"butterflies" or even nausea or pain
• Vomitting  if the stress is severe
• if the stress becomes chronic  developing ulcers or
severe stomach pain even without ulcers
Bowel

• Stress can affect digestion, and what nutrients

intestines absorb
• It can also affect how fast food moves through your
body leading to diarrhea or constipation
GASTROINTESTINAL PROBLEMS

Ulcers

• Stress leads to the production of excessive amounts of

hydrochloric acid in the stomach Lindemann reported 33
out of 41 ulcer patients
“developed their disease in close relationship to the loss
of an important person”
 Stress is also a common factor in Irritable bowel
syndrome

IRRITABLE BOWEL SYNDROME

IBS is a common disorder that affects the large intestine

(colon)

The signs and symptoms of irritable bowel syndrome

can vary widely from person to person and often
resemble those of other diseases.

Among the most common are:

• Abdominal pain or cramping
• A bloated feeling
• Gas
• Diarrhea or constipation — sometimes alternating
bouts of
constipation and diarrhea
• Mucus in the stool
For most people, IBS is a chronic condition, although
there will likely be times when the signs and symptoms
are worse and times when they improve or even
disappear completely

Most people with IBS find that their signs and symptoms
are worse or more frequent during periods of increased
stress, such as final examinations or the first weeks on a
new job But while stress may aggravate symptoms, it
doesn't cause them

Respiratory System

• Stress can make breathing harder

• For people with asthma or a lung disease such as
emphysema, getting the oxygen you need to breathe
easier can be difficult
• Studies show that an acute stress — such as the death
of a loved one — can actually trigger asthma attacks, in
which the airway between the nose and the lungs
constricts
• In addition, stress can cause the rapid breathing — or
hyperventilation — that can bring on a panic attack in
someone prone to panic attacks

Working with a psychologist to develop relaxation and

breathing strategies can help

Endocrine System
When the body is stressed, the hypothalamus signals
the autonomic nervous system and the pituitary gland
and the process is started to produce epinephrine and
cortisol, sometimes called the "stress hormones."

Liver
• When cortisol and epinephrine are released, the liver
produces more glucose, a blood sugar that would give
you the energy for "fight or flight" in an emergency. For
most the body is able to reabsorb the blood sugar if the
energy is not used. People vulnerable to Type 2 diabetes
— the extra blood sugar can lead to diabetes

In Type I diabetes very less secretion or no secretion of

insulin, and the patient must have daily insulin
injections.

In the Type II  increased resistance to insulin places an

increased demand on the insulin-secretory capacity of
the system in individuals who cannot release sufficient
insulin to meet these demands

DIABETES
Stress can worsen diabetes in two ways:
• Increases the likelihood of maladaptive behaviors,
such as unhealthy eating and excessive drinking
• Stress seems to raise the glucose levels of people with
type 2 diabetes directly
Who's vulnerable? Obese and genetic disposition
inclined to diabetes
 Studies show that if you learn how to manage stress,
you can control your blood sugar level

OBESITY

• Excess fat in the belly seems to pose greater health

risks than fat on the legs or hips -- and unfortunately,
that's just where people with high stress seem to store it
• Higher levels of the hormone cortisol increase the
amount of fat that's deposited in the abdomen

CANCER

Chronic stress increases rates of cancer development

and growth

Long-term exposure of stress hormones causes:

• DNA damage and impaired immune function
• increase inflammation through the production of
inflammatory proteins (cytokines) –> impair immune
function and promote cancer growth
– Reduce the ability of abnormal cells to undergo
apoptosis (cell death) and DNA repair
• Promote tumor cell growth

STRESS AS RESPONSE TO ILLNESS

• In addition to the effects that stress may have in the

etiology or development of various physical illnesses,
the illnesses themselves, and their associated
treatments, also constitute stressors the individual must
confront

STRESSORS INDIRECTLY INFLUENCING HEALTH

OUTCOME

• Stressors can also have an indirect effect on health

outcome. That is, exposure to a major life event or
events may be associated with the occurrence of some
type of accident that affects health status

• Cooper and Leuchtag (1982) - stress of a family move

on children's burn accidents
– A period at 2 to 5 months after the move, was
identified as critical, when the child is particularly
vulnerable to burn accidents
– These findings were concordant with subjective
reports of stress:

• 66% of the movers, in contrast to 34% of the non-

movers,
• indicated that they felt the family had been under
greater stress than usual over the year before the burn
accidents

Is it possible to encounter stress and remain healthy?

• Kobasa et al. (1979) based their investigation on the
anecdotal observation that certain individuals,
regardless of exposure to stress, somehow manage not
to succumb to stress
disorders
• Kobasa et al. (1979) studied two groups of managers
from a large public utility in a major metropolitan area.
Two groups of subjects were identified as either high in
stress but low in illness or high in stress and high in
illness.

The results…

• high stress/high illness more alienated from self

• High stress/low illness less nihilistic than high
stress/high illness subjects
indicating a belief that one can control events in one's
environment
• High stress/low illness more interested in novel
experience, more oriented toward achievement
displayed greater endurance
• High stress/low illness subjects  perceived less threat
in personal, financial, and
interpersonal areas than high stress/high illness subjects

LECTURE 10 (Stress and Major Psychiatric Disorders )

Stress and Psychiatric Disorders

• Stress Associated with negative events

• Positive events and experiences may be stressful as
well
• Meaninglessness in life or lack of goal

• Stress is anything that challenges a person, requiring

some kind of adaptation
• Serious stressful events include losing a loved one,
getting fired from a job, being a victim of crime, or
having conflicts with close people
• Stress in the environment can worsen biological
vulnerability, worsen symptoms and cause relapses

DIFFERENCES BETWEEN STRESS AND ANXIETY

Everyone expresses stress and anxiety at one time or

another
The difference between them is that Stress is response
to a threat Anxiety is a reaction to the stress

Anxiety Disorders

Generalized Anxiety Disorders

- If the anxiety is manifested as uncontrollable and

excessive anxiety and worry about events or activities
(e.g., finances or school performance)
- Typically the worry is combined with somatic
symptoms or other anxiety symptoms such as
restlessness, fatigue, irritability ,muscle tension, and
concentration and sleep difficulties
Generalized Anxiety Disorder, what we see is free-
floating anxiety. So, it is not focused on a particular
thing. The individual talks about anxiety about
everything almost in the world.

Panic Attack

-Feelings of terror that strike suddenly and repeatedly

with no warning.
Symptoms:
- "Racing" heart, Feeling weak, faint, or dizzy chest pain
- Tingling or numbness in the hands and fingers
- Sense of terror, or impending doom or death
- Feeling sweaty or having chills
- Breathing difficulties
- Feeling a loss of contro

Obsessive-Compulsive Disorder

- Obsessions are persistent thoughts, impulses, or

images
- Compulsions are repetitive behaviors such as hand
washing and checking or mental activities such as
praying or silently repeating words.
- The essential features of OCD are recurrent,
uncontrollable that are performed with the ostensible
purpose of reducing anxiety

Acute Stress-Reaction

• A mental condition that can occur following exposure

to extreme stress or trauma
• Symptoms must last for at least 2 days up to 4 weeks.
- Intrusive symptoms
- Avoidance
- Hyperarousal

POST-TRAUMATIC STRESS DISORDER

• The symptoms last for a period of at least a month

following the traumatic event
• Acute - symptom duration of 3 months or less) or
Chronic (symptom duration of more than 3 months).
• The onset of PTSD can be delayed for months and
even years.
• Intrusive reexperiencing , Avoidance, Hyperarousal

Time line Comparing ASD and PTSD

Depression and Stress

Depression is caused by stress or if depression itself is a

form of a stressor?

• The stress exposure can cause the glucocorticoid

hormone to be overly active which causes a depletion of
norephinehprine levels in locus coeruleus neurons. This
has an effect of slowing the attentiveness within the
individual. They become emotionless and inactive
(Salzano, 2003).

• Perceived stress
• Sense of lack of control

If an individual experiences great anxiety because of

constant thought about a stressor, their fight or flight
mechanism could be in perpetual heightened response.
Just thinking about the stressor could set off the
elevated response. These stresses amount to a constant
initiating of the response multiple times a day if the
thoughts preoccupy the individual

Adjustment Disorder

• Development of emotional or behavioural symptoms

in response to one or more identifiable psychosocial
stressors.
• Chief complaint may be a nervous breakdown, inability
to manage problems of life, or anxiety
or depression associated with a specific stressor
• Patient’s history reveals normal functioning before the
onset of the stressor

Stress and Psychosis

• Stressful events can influence the onset and course of

major psychotic disorders
• A 1977 vulnerability – stress model by Zubin and
Spring
- relationship exists among the level of inherited
vulnerability, stress that exceeds a certain threshold,
and the onset or relapse of psychotic illness

Schizophrenia and Stress

• Kudoh, Sakai, Ishiria, & Matsuki, (2001) : found that

Schizophrenic patients have
longer healing times after major surgeries

• Conclusions: schizophrenic patients had a reduced

ability for cytokine to fight inflammations. The reason
for the findings could be explained by a schizophrenic's
hypothalamus-pituitary-adrenal dysfunction

Increasing Resiliency against Stress

• Developing effective coping skills for managing stress

and persistent symptoms
• Getting involved in meaningful activities that structure
one's time and reduce the stress of having nothing to do
• Building socially supportive relationships that help one
manage the mental health disorder and maintain
sobriety
`
WEEK 3

LECTURE 11 (UNDERSTANDING YOUR STRESS LEVEL)

EARLY EXPERIENCE AND ITS ROLE IN STRESS

A - loves playing the guitar – has a ear for music

B – born in a musical family, had a tune for music,

Same situation can be stressful for one – harmless /

selfenhancing, for another
Difference – in perception and interpretation
A – pleasant experience – positive memories, self
appreciation
B – every performance is a test of personal worth
It might be argued that the stress drives B to excellent
levels of performance, but it is far more certain that
the repeated stress will take its toll on B both
physically and mentally

Like A, each of us experiences uniquely stressful

situations-
• events in our lives that we customarily react to with
alarm, resistance, and-if the reaction continues long
enough exhaustion
Since these stress-inducing situations are personally
determined, however, the only way to detect them-
and thereby begin to gain some sense of control over
them-is by mapping out the role they play in our lives

STRESS MAPPING
• sensitize yourself to potential stressors in the
environment
(B might ask himself, for instance, when it is that he
feels stressed and discover that it is usually before a
guitar performance)
• keep a stress journal or notebook, a day-by- day
account of when and where the signs of stress appear
Helps in developing self control as it reveals the patterns
of stress, those unique configurations of stressor and
response that operate in your life
• Personal stress analysis - a method by which you
systematically evaluate and
interpret the information in the journal This analysis,
when well grounded in your examination of potential
stressors and in your careful observation of your own
behavior, can then serve as the basis for the subsequent
development of a comprehensive program of stress
management
Knowing your personal stressors and how you react to
them provides a tremendous opportunity for you to
alter your behavior, coping more
efficiently or perhaps avoiding stressful situations
altogether
Shaffer, 1982

EXTERNAL AND INTERNAL DIMENSIONS OF STRESS

Stimulus  cognitive processing  stressor 
General Adaptation Syndrome springs into Operation

EXTERNAL DIMENSIONS OF STRESS

INTERNAL DIMENSIONS OF STRESS

BEGINNING YOUR STRESS SELF-ANALYSIS

To discover patterns of stress operating in your life
Awareness of these signs of physical and mental
response to stress. Identifying the triggers analyzing the
relationship between the stress reaction and the
stressful situation that evoked it
to set realistic and effective stress control goals
Shaffer, 1982

BODILY SYMPTOMS
• Flushing
• Sweating
• Dry mouth
• Shallow breathing
• Chest oppression and pain
• Heart palpitation
• Pounding pulse
• lncreased blood pressure

FEELING STATES
• Agitation
• Shakiness
• Easy tiring
• Worry
• Panicky feeling
• Depression (feeling blue)
• Irritability

COGNITIVE STATES
• Dread
• Inattention
• Distractibility
• Forgetfulness
• Nightmares
• Fear of death
Shaffer, 1982

MOTOR SYMPTOMS (MUSCLES INVOLVED)

• Muscular tightness
• Tremors
• Tics (spasms)
• Increased startle reaction
• Incoordination
• Sighing
• Freezing, feeling immobilized

FORMATS FOR STRESS JOURNAL

Stress journal effective if maintained for a longer period

of time (weeks)
- Observations and insights may be immediate, may be
prolonged
INTERPRETING THE STRESS REACTION
Self discovery – using free association
Eg: associate the body parts and sensations related to
your stress pattern
LECTURE 12 (ROLE OF PERSONALITY PATTERN,
SELF ESTEEM, LOCUS OF CONTROL)

STRESSOR SCALES

• SOCIAL READJUSTMENT RATING SCALE – Holmes and

Rahe (1967) based
upon the theory that “life change” is causally associated
with subsequent illness
• The SRRS contains 43 items consisting of commonly
experienced “life
events.” Each life event is weighted with a life change
unit score
(LCU). Respondents are simply asked to check each of
the items they
have experienced within the last 12 months

LIFE EXPERIENCES SURVEY (LES) – Sarason et al (1978)-

lists a series of life
events and also inquires into the desirability of each of
the events

• THE HASSLES SCALE – (Kanner et al, 1981)–

investigated the daily hassles
versus major life events issue as it pertains to the
prediction of subsequent illness. It lists a series of minor
daily hassles, that is, sources of frustration that
commonly recur to many individuals. It has 117 items

MILLON’S BEHAVIOR HEALTH INVENTORY

- Millon, Green, & Meagher, (1982)
The MBHI is a 150-item self-report inventory that has
been normed on medical patients. “Its intent is to aid in
the psychological understanding of these patients and
facilitate the steps required to formulate a
comprehensive treatment plan”

STRESS SCALES TO MEASURE PSYCHOLOGICAL EFFECT

OF STRESS
RESPONSE

PERSONALITY SCALES

• MMPI (Minnesota Multiphasic Personality Inventory)–

10 basic clinical scales - sample a wide range of
maladjusted personality traits (a personality trait is a
rather chronic and consistent pattern of thinking and
behavior) – disadvantage – over 560 items

• 16PF – 187 items - assesses a wide range of

personality traits. It measures
16 “functionally independent and psychologically
meaningful dimensions
isolated and replicated in more than 30 years of factor-
analytic research on
normal and clinical groups”

• MCMI III – (Millon, 1997) 175-item self-report, true–

false questionnaire

MCMI-II SCALES:
• Schizoid
• Avoidant
• Antisocial
• Narcissism
• Passive–aggressive

• STANFORD ACUTE STRESS REACTION

QUESTIONNAIRE (SASRQ) - The SASRQ
• (Cardena & Spiegel, 1993; Shalev, Peri, Canetti, &
Schreiber, 1996)
• 30 self-report items that assess acute stress disorder.
The scale takes 5–10 minutes to complete and appears
to be useful in predicting PTSD(Post-Traumatic Stress
Disorder )

STATE–TRAIT ANXIETY INVENTORY (STAI)- The STAI

(Spielberger, Gorsuch, & Luchene, 1970)
• The first 20 items measure state anxiety (a
psychological state is an acute, usually situationally
dependent condition of psychological functioning).
• The second 20 items measure trait anxiety. This is the
same basic phenomenon as that measured by the TAS
• The STAI can be administered in full form (40 items) or
be used to measure only state or trait anxiety

PERSONALITY AS A FACTOR FOR INDUCING STRESS

TYPE A PERSONALITY – Jenkins Activity Survey

• Online version for college students
www.psych.uncc.edu/pagoolka/TypeA-B-intro.html
Locus of Control (Julian B Rotter,1954)

• The degree to which people believe that they have

control over the outcome of events in their lives, as
opposed to external forces beyond their control
• People's "loci", plural of "locus", (Latin - location) –
either internal, those people who believe they can
control their life, or external, meaning they believe their
decisions and life are controlled by environmental
factors which they cannot influence, or that chance or
fate controls their lives

• Individuals with a strong internal locus of control

believe events in their life derive primarily from their
own actions
Ex: • Internal locus of control - results seen as personal
achievement or personal failure
• external locus of control – External factors like good
teacher easy exam or bad teaching, other external
problems cause of result

FORCED CHOICE SCALE (ROTTER, 1966) - measure locus

of control is the 23-item (plus six filler items)
• Online: http://www.psych.uncc.edu/pagoolka/LC.html
• findings suggest that higher levels of external locus of
control combined with lower levels self-efficacy are
related to higher illness-related psychological distress
• Roddenberry et al, (2010) - individuals who have a
high external locus of control tend to have higher levels
of psychological and physical problems
• These people are also more vulnerable to external
influences and as a result they
become more responsive to stress

SELF ESTEEM
Self-esteem answers the question, “How do I feel about
who I am?” We learn self-esteem in our family of origin;
we do not inherit it.

Global self-esteem - “who we are” generally constant

• Situational self-esteem - “what we do” - fluctuates
• Low self-esteem is a negative evaluation of oneself
• Personalizing the incident - experiencing physical,
emotional, and cognitive
arousal
• responding by acting in a self-defeating or self-
destructive manner
• actions become automatic and impulse-driven
• feel upset or emotionally blocked
• Narrowed thinking
• losing sense of self
• become self-absorbed

The vicious cycle of self esteem

HOW TO RAISE YOUR SELF ESTEEM

• Practice self-care
• Identify triggers to low self-esteem.
• Reduce personalizing
• Stop and take notice
• Acknowledge your responses
• Choose response
• Accept your responses
Lecture 13: (Role of Thoughts Beliefs
and Emotions – I)

Stress is a natural response to a nerve-racking situation.

Often
it is a feeling of anger, frustration or distress. It is a
normal part
of life and, in small amounts, can motivate you to be
more
productive. Frequent stress, however, can have negative
effects on physical and psychological health

• Anxiety disorders involve chronic, debilitating and

seemingly
unprompted feelings of apprehension, nervousness or
fear
Both stress and anxiety disorders have many symptoms
in
common but stress tends to be managed through
lifestyle
changes, whereas anxiety disorders require both
lifestyle changes
and medical therapies

MODEL OF ANXIETY

Generic Model: (Padesky , 1990)

Biology
Thoughts
Mood
 Behavior

WHAT HAPPENS IN ANXIETY

• Perception of danger and threat

• Underestimation of personal ability to cope
• Development of Negative Automatic Thoughts
• Triggering a belief system that there is danger / threat
in the environment - “I am vulnerable to the threat”
• Triggering more anxiety responses  that are
misinterpreted increasing anxiety
Ex: anxiety may be interpreted as a sign of serious
physical or mental disorder (Heart Attack)

COGNITIVE MODEL OF ANXIETY

Wells, 1997

So, just to understand the cognitive model of anxiety in

brief what happens is there is a learning experience. So,
through our early experiences over time in the previous
session we were talking about A and B two guitarists
who had a different upbringing and how that affected
their behaviour patterns in college while playing the
guitar or during a guitar performance. So, early
Experiences actually helped us build our thoughts and
our belief systems so what is dangerous what is what
other should send must how we should behave and
what is right and what is wrong, so these principles or
these core beliefs or these schemas are created. So, the
danger schemas are formed that way over time, over
the school, over a family, values and our experiences
and also by knowing others experiences over time so it
could be something like
you know once my friend I saw him that he could not
speak in class, and everybody laughed and abused him.
So, then I have not experienced that, but it is a learned
phenomenon for me so I have built this belief system
that if you are not perfect, then people will laugh at you,
so something like that. And then, there is a critical
incident, a critical incident is something is an event that
happens, say suppose the individual has to speak in
public. So, that is an incident, and so the schema is
activated we know that the first schema was formed
that you have to be perfect, if you are not, then people
will laugh at you, so then these bring out the automatic
thoughts. The moment the schema is activated the
moment I start believing that some assumptions, that if I
do not perform well. Then some people are going to
laugh at me. So, it is more like an if and then situation
and so there are some rules set, and these trigger the
automatic thoughts in the critical situation, and this
leads to anxiety behaviours. So, they will be behavioural
responses, some cognitive thoughts, and other anxiety
features. We will study this a little in detail,Wells gave
this model in 1997.

SCHEMAS AND ASSUMPTIONS

Schema: key elements of our frame of reference
- a set of rules determining how we judge ourselves,
situations, others how we interact with other people
• Assumptions (if / then statements) - Rules formed by
experience, revised by newer experiences – becoming
silent assumptions
– link events and self-appraisals (e.g. 'if I show signs of
anxiety then people will think I'm inferior; if I have bad
thoughts means I am a bad person; unexplained physical
symptoms are usually a sign of serious illness; if I can't
control anxiety I am a complete failure')

NEGATIVE AUTOMATIC THOUGHTS, WORRIES

• Negative automatic thoughts (NATs) are appraisals or

interpretations of events, and can be tied to particular
behavioural and affective responses. Immediate
thoughts
Ex: walking down the road, smile at a friend, he looks
away - what would be the immediate thought that
would come to your mind?

NATS AND WORRY

• Worry is a chain of negatively affect laden thoughts
aimed at problem solving (Borkovec
et al. 1983)

• Worry is a verbally based thought process while

negative automatic thoughts can occur in a verbal and
an imaginal form

THE ROLE OF BEHAVIOUR

• When a threat is perceived - the cognitive system

facilitates caution by eliciting a series of self-doubts,
negative evaluations, and negative predictions

• The somatic manifestation range of feelings such as

unsteadiness, faintness, and weakness

• Beck et al. (1985) assume that this is part of a primal

survival mechanism that exists to terminate risk-taking
behaviour and orient behaviour towards self-protection

• In social performance situations these responses can

increase the danger - i.e. they interfere with social
performance

BEHAVIOUR INCREASING ANXIETY

Ex: A social phobic is fearful of babbling and talking
incoherently in a social situation may focus more
attention on the self and monitor his/her spoken words
closely
In addition to this cognitive self- monitoring strategy
there may be attempts to pronounce words in a clear
and controlled way, and rehearse mentally the material
to be spoken before speaking in order to check that it
sounds acceptable . Safety behaviours (Salkovskis, 1991)
play a significant role in
the maintenance of anxiety

SAFETY BEHAVIOURS

• Controlling one's breathing may lead to

hyperventilation
• Controlling certain thoughts may contribute to
paradoxical effects of increased preoccupation with
thoughts
• Perception that - non-occurrence of feared outcomes
resultant of safety behaviour rather than correctly
attributed to the fact that catastrophe will not occur
• Particular safety behaviours, such as increased
vigilance for threat, reassurance seeking, etc., enhance
exposure to danger-related information that
strengthens negative beliefs
COGNITIVE BIASES

• Once danger schema is activated  biases the

information processing
• These biases are distortions that affect interpretations
of events in a way that is consistent with the content of
dysfunctional schemas
Biases in processing include:
– selective attention for threat-related material,
– interpretation of events
– Beck and associates, and Burns (1989) labeled
interpretive biases as 'thinking errors' or 'cognitive
distortions‘

Cognitive distortions (biases)……….

• Catastrophizing
• Mind reading
• Over generalization
• Selective abstraction
• Personalization
• Arbitrary Inference
• Maximization -
Minimization

EXAMPLE OF DISTORTIONS…
A socially phobic person involved in a conversation with
a work
colleague…The colleague suddenly cuts short the
conversation and leaves the
situation

Interpretation:
'I must be so boring' / 'he thinks I'm an idiot, he doesn't
like me‘ (arbitrary inference'
and 'mind reading)
In the next encounter: the social phobic is pre-occupied
with negative thoughts about
'appearing boring and idiotic' he/she selectively attends
to his/her own anxious performance- selective attention
fails to notice positive signals from the work colleague -
minimisation or discounts these as evidence that he is
'just trying to be nice‘ - minimisation biases of attention
and inference serve to maintain belief in negative
appraisals, as negative information is abstracted, and
positive information is not processed, or is discounted.
LECTURE 14: (ROLE OF THOUGHTS BELIEFS
AND EMOTIONS – II)

Understanding & Managing Stress

Recognise and admit that you are feeling stressed

SELF CONTROL

Constructive Self-Talk

 Identify negative self-talk

 Write it down
 Develop alternative positive self-talk statements

Cognitive Restructuring

A–B–C–D-E
 A – An active situation /
experience
– unable to do a task on time
 B – beliefs relating to the situation
– I’m GFN
 C – behavioural, emotional, physiological changes
– sad, stressed
 D – identifying irrational beliefs
– I’ll have to take care of using my time
properly instead of I’m GFN
 E – trying out newly learnt coping
strategies

Problem Solving

 Acknowledge and clarify the problem

 Analyse the problem + identify needs of
 those affected
 Brainstorm for all possible solutions
 Evaluate each option
 Select best option and implement plan
 Evaluate the outcome

Some tips....

 Take short breaks

  Set priorities
  Talk about your stressors with someone and put
 it in perspective
  Participate socially

To improve planning
 Lists of tasks to be done posted on
refrigerator
• Choosing one day for appointments and
errands
• Master list for home chores done weekly,
monthly .....
• Identify individual strengths while
exploring resources
• Ask partner for input
• Re-evaluate effectiveness
LECTURE 15 (Life Situation Intrapersonal: (Assertiveness,
Time Management))

WHAT IS ASSERTIVENESS?

Assertiveness is asking for what one wants are acting to

???get one wants
what one wants in a way that respects the rights and
feelings of other people. So, what is very important is
respecting without losing respect or without being
abusive towards somebody else you are also being very
firm, so you are firmly expressing what you want or you
acting in a way that you desire to without hurting
others.

WHAT DOES IT MEAN TO BE

NON ASSERTIVE?

PASSIVE

 Individuals not committed to their own rights

 More likely to allow others to infringe on their rights
 -than to STAND UP and SPEAK OUT

AGGRESSIVE

 Defend their own rights and work to achieve own

goals
 Likely to disregard rights of others
 Blame others for problems instead of offering
solutions
BEHAVIOUR STYLE OF PASSIVE
INDIVIDUALS

• Hoping to get what you want without actually having

to say it
• Giving in to the will of others
• Leaving it to others to guess or letting them decide for
you
• Taking no action to assert your own rights
• Putting others first at your expense
• Giving in to what others want
• Remaining silent when something bothers you

BEHAVIOR STYLE OF AGGRESSIVE INDIVIDUALS

 threatens or punishes the other person

  Standing up for your own rights with no thought for
the other person
 Putting yourself first at the expense of others
  Overpowering others
  Reaching your own goals, but at the sake of others
  Dominating behaviors
E.g.: Shouting, Demanding, Not listening to others;
Saying others are wrong; Leaning forward; Looking
down on others; Wagging or pointing

BEHAVIOR STYLE OF ASSERTIVE INDIVIDUALS

 Telling someone exactly what you want in a way that
does not seem rude or threatening to them
 Standing up for your own rights without putting down
the rights of others
 Respecting yourself as well as the other person
 Listening and talking
 Expressing positive and negative feelings
 Being confident, but not pushy

WHY PRACTICE ASSERTIVENESS?

 let others boss us around

• react to the things that other people expect of us
• Unable to express feelings, thoughts
• Not using ability to think ‘out of the box’
• Become dependent on others for decision making
• Low on confidence

PRACTICING ASSERTIVENESS

Assertive Listening
- To let the other know that you want to understand his
or her point of view
- To understand accurately what another person is
saying
- To let the other person know that he or she has been
understood
For Example:
I'd like to hear your views on...
Could you tell me about them?
Would you tell me more about how you see the
situation?
I think we are approaching this from two different
perspectives...
What does the situation look like from your perspective?
I 'd like to hear your thoughts on…

BODY LANGUAGE AND

ASSERTIVENESS

• Maintaining direct eye contact

• Maintaining erect posture
• Speaking clearly and audibly
 Not Whining!!!!
• Using facial expressions and gestures to add
emphasis to words

ASSERTIVE COMMUNICATION CAN

Improve interpersonal relationships

• Reduce conflicts/anxiety
• Enhance self esteem
• Retrain self respect
• Minimize stress
• Treats others respectfully
• Reduce feelings of
helplessness/depression
• Gives a sense of control

FOUR STYLE OF COMMUNICATION POSTURE

 PASSIVE – “I don’t count”
• AGGRESSIVE - “I count, but you don’t count”
• PASSIVE-AGGRESSIVE – “I count. You don’t count, but
I’m not going to tell you about it”
• ASSERTIVE – “I count and you do too”

5- Steps to Assertive Communication

1) When approaching someone about behavior you’d

like to see changed, stick to factual descriptions of what
they’ve done that’s upset you, rather than labels or
judgments
• Situation: Your friend, who habitually arrives late for
your plans, has shown up twenty minutes late for a
lunch date
• Inappropriate: "You’re so rude! You’re always late."
• Assertive Communication: "We were supposed to
meet at 11:30, but now it’s 11:50."

2) The same should be done if describing the effects of

their behavior. Don’t exaggerate, label or judge; just
describe:
Inappropriate: “Now lunch is ruined.”
Assertive Communication: “Now I have less time to
spend lunching because I still need to be back to work
by 1pm”

3) Use “I Messages”
Simply put, if you start a sentence off with “You”, it
comes off as more of a judgment or attack, and puts
people on the defensive.
If you start with “I”, the focus is more on how you are
feeling and how you are affected by their behavior.
Also, it shows more ownership of your reactions, and
less blame
‘You Message’: “You need to stop that!”
‘I Message’: “I’d like it if you’d stop that”

4) Here’s a great formula that puts it all together:

“When you [their behavior], I feel [your feelings].”
When used with factual statements, rather than
judgments or labels, this formula provides a direct,
non-attacking, more responsible way of letting people
know how their behavior affects you
For example: “When you yell, I feel attacked.”

5) A more advanced variation of this formula includes

the results of their behavior (again, put into factual
terms), and looks like this:
“When you [their behavior], then [results of their
behavior], and I feel [how you feel].”
example: “When you arrive late, I have to wait, and I
feel frustrated.”
WEEK 4

LECTURE 16 (Developing Cognitive Copying Skills )

WHAT IS COPING?

Coping refers to the thoughts and actions we use to deal

with a threatening situation.
• A stressful situation may be considered a threat for
you but not necessarily for your neighbor. You and your
neighbor may become stressed by the same situation,
but for different reasons (e.g. the situation is new for
you, but
unpredictable for your neighbor).
• After all, since we all become stressed for various
reasons we will need to choose different coping
strategies.
• As you will see, there are many strategies and some
are better than others.

STRESS APPRAISAL & COPING

Lazarus described three primary categories of appraisal:
primary appraisal, secondary appraisal, and reappraisal.
Primary appraisal involves judging how much of a threat
is involved, and how important is the outcome. Once
that primary appraisal occurs, you must determine
whether you have the resources needed to meet the
demand. Lazarus called that secondary appraisal. Once
attempts are made to respond to the
threat or to meet the demand, a reappraisal occurs to
determine whether any further coping is needed.
Coping strategies

can be both constructive/adaptive or destructive/

maladaptive. Maladaptive coping skills are ways of
dealing with stress that usually make things worse.
These types of coping strategies can hurt your social
relationships, make preexisting problems worse, and
even result in new symptoms of a stress-
related injury. Many of us have known someone who
has overreacted to something which resulted in them
losing touch with a friend or loved one. Maladaptive
coping strategies put pressure on your relationships
with friends, family, comrades, and
coworkers. They can damage your body or create more
emotional pain in the long term, even when they seem
helpful in the short term. In extreme cases, maladaptive
coping skills can ruin lives. Through the information in
this booklet, and psychological activism, we can lessen
the impact of negativity in our lives, including that which
we inflict on ourselves through learned maladaptive
coping skills.

TASK ORIENTED COPING STRATEGIES

Lazarus named it as task-oriented coping. So, again this

is a positive coping strategy where Lazarus says when is
a coping strategy required when the demands exceed
available resources. So, then there is a stress, and the
demand is evaluated as a
threat. So, then we get stressed and once we get
stressed and the demands are more we need to deal
with it with effective coping skills.

BANDURA’S THOERY OF SELF EFFICACY

Self efficacy --- outcome efficacy & personal efficacy

Important to believe that there is a strategy and I can

employ that strategy effectively to deal with the
situation.

PROBLEM FOCUSED STRATEGIES

problemfocused strategy, it is basically using active ways

to address the stressor directlyin our problem-focused
coping strategy what is done primarily is focusing on the
problem or concentrating on the problem then
analyzing the situation.
So, explore, analyzing what the problems that are
leading to the stressor are, and how so after that
exploring the situation when I am talking of exploring
we are actually identifying what are the different ways
of coping.

EVALUATE FOCUSED STRATEGY

emotion-focused coping strategies emphasize on the
distress rather than the actual problem situation.

Focusing on emotions : magical thinking , broading ,

blaming , avoidance

POSITIVE COPING STRATEGIES

Be positive!
Look at each obstacle you encounter as a learning
experience e.g. you may not have done well on your
mid-term exam, but that has motivated you to study
harder and ace your final exam.
• Make the choice not to over-react to stressors and
deal with them one at a time
e.g. take a few deep breaths and carry on.
• Take an objective view of your stressor
e.g. is preparing dinner for 12 people really that
horrible?
• Communicate! Don’t ruminate or bottle up your
emotions, as this will lead to an
explosion later on.
• Accept yourself (and others). No one is perfect and
there is always room for mistakes.
LECTURE 17 (Autogenic Training, Imagery and
Progressive Relaxation )

AUTOGENIC TRAINING

• Relaxation Technique  stress-induced psychosomatic

disorders
• AUTOGENIC TRAINING - 1932 - Johannes Heinrich
Schultz (German Psychiatrist) and Wolfgang Luthe
(General Practitioner and Chest Physician)

Benefits of Autogenetic Training

• Autogenic means “self-generating”
- you do the procedure to yourself
- self-healing nature of autogenics
• Special indication for AT
- Internal locus of control - autogenics more effective
than external locus of control
(Lehrer,1996)

PHYSIOLOGICAL BENEFITS OF AT

• Decrease - Heart rate, respiratory rate, muscle tension,

and serum-cholesterol level
• Increase - Alpha brain waves and blood flow to the
arms and legs
• Help to alleviate various disease
- Improve the immune function in people with cancer
- Improve the quality of life of people with multiple
sclerosis
- Decreased headaches
- AT used to help people with drug abuse

Other findings
– alleviate menstrual discomfort
– Breathing in dyspnea
– sleep in insomnia
– relieve pain

PREREQUISITES OF AUTOGENIC TRAINING

• High involvement and motivation

• Self-direction and self-control
• Ability to maintain a particular body posture
• Minimizing influence of external stimuli
Focusing on the process
• Attending to bodily sensations

HOW TO DO AUTOGENIC TRAINING

• Body Position
- There are three basic positions
Reclining position
Seated position – 2 types

SIX STAGES OF AUTOGENIC TRAINING

1. Focus on sensations of heaviness throughout the

arms and legs
2. Focus on sensations of warmth throughout the arms
and legs
3. Focus on sensations of warmth and heaviness in the
area of the heart
4. Focus on slow, calm breathing
5. Focus on sensations of warmth in the abdomen
6. Focus on sensations of coolness in the forehead
Greenberg, 2012

IMAGERY

• To imagine a scene, place or event that you remember

as safe, peaceful, restful, beautiful and happy
• Bring all your senses into the image with
-Sounds of running water and birds
- Smell of cut grass
- Taste of favourite ice cream
- Warmth of the sun

Physiological benefits

• Decrease headaches
- When children and adolescents with chronic
headaches were taught imagery, 88 percent reported a
decrease in the frequency of their headaches and 26
percent said they were headache-free.
 Improve sleep
• Decrease posttraumatic stress disorder (PTSD) severity
• Help to alleviate moderate depression
• Decrease to urge behavioral addiction like gambling
• Decrease performance anxiety

Progressive Muscle Relaxation

• To induce nerve-muscle relaxation
• Developed by Edmund Jacobson
• Based on the premise that the body responds to
anxiety-provoking thoughts and events with muscle
tension This physiological tension, in turn, increases the
subjective experience of anxiety.
• Synonyms
- neuromuscular relaxation (because the nerves control
muscular contraction) or Jacobsonian relaxation (named
after its developer)
Physiological Benefits of PMR

• learned relaxation of skeletal muscles can be

generalized to smooth muscles, causing
relaxation of the gastrointestinal and cardiovascular
systems
• Effective in treating
- headaches
- backaches
- side effects of cancer
- insomnia, pain, and high blood pressure
 Treating depression, anxiety, PTSD and Insomnia
• Other research findings of PR
- Reduced psychological distress in heart failure
- improved academic performance among college
students
LECTURE 18 (OTHER RELAXATION TECHNIQUES)

BIOFEEDBACK MACHANISM

 The use of electronic instruments to monitor and

physiological changes mostly regulated by the
Autonomic Nervous System
• Biofeedback – awareness of how to change
physiological activity for improving health and
performance

instruments measure physiological activity such as

brainwaves, heart function, breathing, muscle activity,
and skin temperature - These instruments rapidly and
accurately 'feed back' information to the user.

DIFFERENT INSTRUMENTS USED IN BIOFEEDBACK

• Electromyograph (EMG) - EMG measures the muscular
activity and what it does is it records the electrical
activity produced by the skeletal muscles.

• Feedback Thermometer (Thermistar) - feedback

thermometer measures in the Fahrenheit and Celsius
but it is a little different as in what it does is, it measures
the skin temperature through arteriole diameter, that is
how the skin temperature is reflected.

• Galvanic Skin Response Recorder (GSR) - measures

changes in the electrical conductance of the skin, which
varies with moisture levels caused by sweat gland
activity. This sweat response is influenced by the
autonomic nervous system and is often associated with
emotional or psychological arousal.

• Electroencephalograph (EEG) - is a device used to

record the electrical activity of the brain. It measures
brainwaves by detecting electrical signals produced by
neurons when they communicate. These signals are
captured via electrodes placed on the scalp, providing
insights into brain function.

• Electrocardiograph (ECG) - is a medical device used to

measure and record the electrical activity of the heart
over a period of time. The resulting record is called an
electrocardiogram, which helps diagnose various heart
conditions by identifying irregularities in the heart’s
rhythm, rate, and electrical conduction patterns.
DIAPHRAGMATIC BREATHING

Diaphragmatic breathing is different from thoracic

breathing in the sense that this is more of abdominal
breathing and it is like expanding the belly rather than
the chest.
So, what is done is the individual breaths in from the
bell, from the stomach.

YOGA AND STRECHING

Different types of yoga includes : Prana yoga, Brahma

yoga, Kriya yoga, Raja yoga, and Hatha yoga. Hatha yoga
involves stretching exercises and it has been seen.

Research in Yoga…
• Asthma – breathe more comfortable, Quality of life
improved
(Manocha et al, 2002)
• Helps in reducing stress and Anxiety
(Smith et al, 2007)

Yoga involves deep slow breathing and activation

parasympathetic nervous system
• Pranayama – regulating breathing
• Decrease in respiration rate, oxygen consumption,
CO2 elimination

MINDFULNESS

• Mindfulness  focusing attention at the present

moment
• Paying attention to each moment  living in the “here-
and-now”
• Mindlessness  going through life ignoring the present
moment
• Focusing on the goal instead of experience

Major tenets of Mindfulness

• To recognize the emotion present
• Acknowledge the emotion
• Accept the feelings and sensations that the body is
undergoing
• Recognizing that this is a passing mental state
Mindfulness Based Stress
Reduction (Zinn and
Santorelli, 1979)

Tai chi

• Self paced gentle physical exercise and stretching

• Originally formed for self defense – Chinese tradition
• Involves a series of movements performed in a slow,
focused manner
• It is accompanied by deep breathing.
LECTURE 19 (EXERCISE AND HEALTH)

THE CONTRADICTION….

• Exercise – a form of physical stress

• Then how can one form of physical stress be
used to reduce stress?

What really happens?

• Exercise uses the stress products—increased heart and

respiratory rates, blood fats, muscle tension—so they
are not able to affect health negatively
• Exercise redirects your attention from stressors to the
exercise
• Exercise involves focused purposeful behavioral
decisions
Greenberg, 2012

Brief history of therapeutic exercise

• 5th century BC – Herodicus (Greek Physician)

prescribed gymnastics for various diseases
• 16th Century Europe – Joseph Duchesne used
swimming as a therapeutic tool for strengthening heart
and lungs
• 1829 – Journal of Health – publications advocating
regular exercise, walking considered the best exercise
for remaining healthy
• Since 1980s – research interests in exercise and
mental health increased

– Supplementary Food products industry boomed

– Aerobics became a part of other sports activities

In India – Asanas have been used to prepare body for

meditation Hatha yoga

 Hans Selye contended that regular exercise would

better prepare someone to resist other stressors, and
that stressful situations would not be as perilous to a
physically fit individual compared to someone who
has led a sedentary lifestyle

(
Miller and Allen,1995)
Exercise and brain

• Exercise has robust effects in reducing the damaging

effects of chronic stress
• Exercise reduces harmful effects of acute exposure to
stress at different levels of function –
– Behavioural
– Emotional
– Immunological
– Neuronal

Mechanisms in action

• Effectiveness of exercise for stress reduction is based

on 3 mechanisms:
- Mechanisms active during exercise
- Mechanisms active immediately after exercise
- Long term mechanisms
EFFECT ON CARDIOVASCULAR AND
CARDIORESPIRATORY SYSTEMS

During stress:
• Increase in cardiac output, BP, resistance to peripheral
blood flow, breathing rate
During Exercise:
• Increase in cardiac activity, but rhythmic use of
striated muscles help blood to return to the heart
(venous return)
• Helps redistribute blood from less active body parts
like digestive organs and kidneys, to active muscles
• Improves efficiency of breathing muscles allowing
greater lung capacity
• An active individual uses lesser number of breaths to
move the same amount of air, which improves diffusion
of O2 into the lungs

SHORT TERM THERAPEUTIC EFFECTS OF EXERCISE

• Initiation of a state of relaxation following the physical

activity
• Afferent proprioceptive stimulation as Feedback from
striated muscles go to Limbic system, hypothalamus and
cerebral cortex

Reduction in striated muscle tension reduces energy

consumption of the body  decreases anxiety level and
increases feelings of tranquility
Exercise helps release endorphins – induces euphoria

LONG TERM EFFECTS OF EXERCISE

• Long-term mechanisms of health promotion in

exercise appear when exercise is aerobic and
practiced for a minimum of at least 1 month
• Improves Physical Health and Psychological health

EFFECT OF EXERCISE ON PSYCHOLOGICAL FUNCTIONING

• Feeling fit  feeling good  high self esteem

• Others’ approval and appreciation – increases self
esteem
• More agile, alert
• More healthy
• More involved in work – less brooding/grumbling
• Feeling of being in control
• Increased self discipline

Exercise increases individuals ability to tolerate high

levels of stress and Decreases likelihood of developing
stress related pathology
E
verly and Lating, 2002

EXERCISE GUIDELINES

• Important to decide how much exercise is enough to

promote health and better cope
with stress exercise prescription . FITT
(
Foss & Keteyian, 1998)
Frequency
Intensity
Time (duration)
Type

Pate et al, 1995 - Journal of the American Medical

Association suggested the following physical exercise
• criteria for enhanced cardiopulmonary fitness:
• Duration: 20–60 minutes of moderate- to high-
intensity endurance exercise
• Intensity: 60–90% of maximum heart rate
• Frequency: three or more times per week
ANAEROBIC EXERCISE

Anaerobic exercise:
• short in duration and high in intensity
• better at building strength and muscle mass keep
muscles fit and strong – helps in old age
• promote strength, speed, and power
Anaerobic activities include strength training,
weightlifting, tennis, hill climbing

AEROBIC EXERCISE

Aerobic exercise exercise with air or oxygen it is

rhythmically in nature low intensity exercise for long
duration lasting for at least 15–20 min or longer
maintaining 60–80% of heart rate reserve

The American College of Sports Medicine defines

aerobic exercise as “any activity that uses large muscle
groups, can be maintained continuously, and is rhythmic
in nature”
Aerobic activities - walking, cycling, jogging, swimming,
aerobic classes, and long hikes

EFFECTS OF AEROBIC EXERCISE

• Control of body fat

• Increased resistance to fatigue and extra energy
• Toned muscles and increased lean body mass
• Decreased tension and aid in sleeping
• Increased general stamina
• improves mood and reduces depression and anxiety

FOR STRESS MANAGEMENT

• Exercise should be aerobic
• Movements should be rhythmic rather than
uncoordinated movements that may cause muscle strain
• Exercise should be for self improvement, long term
improvement in bodily coordination, motor skills,
ventilation
• Without competition – comparison with others

LECTURE 20 (DIY STRATEGIES STRESS MANAGEMENT)

SELF HELP
A positive attitude to help yourself to bring about a
change
Tell yourself: “I am not helpless – the situation is making
me feel so. I just
need to bring about a few changes to make the situation
better”

Identify stressors – chart it down

• Identify vulnerable zones of your body – aches and

pains in different organs, disturbances in appetite,
digestion, sleep
• Identify disturbing Negative Automatic Thoughts
triggered during stress
• Chart down strategies that you have used so far to
deal with them – adaptive or maladaptive?
Explore Strategies to avoid / minimize / modify /
modulate
stressors

Employ strategies to reduce excessive arousal and

dysfunction

Reminding yourself the relationship between thought

mood and behaviour

Thoughts: Awareness of Negative Automatic Thoughts,

employing strategies to stop them
Behaviour – exploring opportunities / facing situations
rather than avoidance, engaging in face to face social
interactions, employing problem solving strategies
Strategies to ventilate, or express, the stress response

• Practicing relaxation techniques

• Regular exercise
• Practicing assertiveness
• Time management techniques

A FEW WORDS ABOUT TIME MANAGEMENT

 Time awareness and time scheduling

 Prepare Activity chart - How do you spend your day
 Get a planner – using to jot every work to be done,
keep it with you, efficient managers always use a
planner
 watch handy
 evaluate yourself – whether you UNDERESTIMATE or
OVERESTIMATE time

Task – plan 2 activities today – write down expected

time, after
task write down time taken , whether you completed it
or left
it incomplete, did you avoid the task? Why? Is it anxiety
provoking? Is there a fear you won’t be able to complete
it?
TIME MANAGEMENT

To do list:
• Break a problem / topic into small parts
• put it priority wise
• fix a time of day to write down next day’s agenda -
preferably before going to bed
• Stick to your commitments
• Evaluate - at the end of the day evaluate how much
was done – what went right/ what went wrong
• Reward yourself