Stress Management:

How to recognize and

alleviate common

workforce stressors.

James Rizer, D.C.

Stress

Stress can be anything such as:

Mental and Emotional

Work, family or social

Physical

Gravity, trauma or exercise

Physiological (functions and activities of

living organisms and their parts )

Diet or diseases

Stress in the Work Environment

Price tag for U.S. industry estimated at over $300 billion

annually as a result of:

Accidents

Absenteeism

Employee turnover

Diminished productivity

Direct medical, legal, and insurance costs

Workers' compensation awards as well as tort and FELA

judgments

Stress in the Work Environment

Assessment of Work Stress. Do you experience any of these challenges?

Cannot finish work in time available

Too many interruptions

Infrequent work breaks

Work schedule is inflexible

Too much overtime

Shifts are too long

Too many days without time off from work

Too much paperwork

Colleagues or co-workers not available

Too many job duties to manage

Work is incongruent with training and experience

Source: Adapted from Muldary TW. Burnout and Health Professionals: Manifestations and Management. California: Capistrano Press, 1983.

Psychosomatic Syndromes

Psychosomatic syndromes have often been dismissed

as "all in your head."

At the physiological level, stress is viewed in terms of

disruptions of bodily functions.

Fight or Flight• Brain perceives a stress stimulus

• Pituitary gland responds by increasing the release of a hormone called adrenocorticotropic hormone (ACTH)

• ACTH is like an alarm system going off deep inside your brain

• Adrenal glands (situated atop your kidneys) releases a flood of stress hormones into your bloodstream

• Including cortisol and adrenaline

• A whole series of physiological changes in your body occur

• Increasing your heart rate and blood pressure

• Shutting down your digestive system

• Altering your immune system

• Increased blood sugar

• Cortisol sustains energy, but it also curbs the surge of adrenaline

(Image credit: Kathryn Born)

How can stress cause so many

diseases?

1. Sympathetic Nervous System activity

• Dilates pupils, heart rate increases and the hearts force of contraction intensifies, bronchioles of the lungs dilates

2. Endocrine System activity

• Chronic/Long term release of Adrenaline Hyper-excitable, irritability, and more

• Chronic/Long term release of Cortisol Impaired concentration, weight gain, fatigue and more

Affects of Prolonged/Chronic Stress

Respiratory System Triggering hyperventilation syndrome, chronic bronchitis, or asthma

Cardiovascular System High blood pressure, migraine headaches, or irregular heartbeats

Gastrointestinal System Aggravation of peptic ulceration, irritable bowel syndrome

Genitourinary System Menstrual disorders or frequent infections

Musculoskeletal system Backache, neck pain or tension headache

Source: Jamison J. Health Promotion for Chiropractic Practice. Maryland: Aspen Pub, 1991;167-172.

Affects of Prolonged/Chronic Stress

Weakened immune system

Exacerbates present health conditions

Psychological disorders

Suspected shortened life span

Biological vs. Chronological Age

Telomeres

Possible Signs of Stress

Anxiety

Back pain

Constipation / Diarrhea

Depression

Fatigue

Headaches

High blood pressure

Irritable

Loss of sex drive

Poor attitude

Relationship problems

Shortness of breath

Sleep disturbances

Stiff neck or jaw

Upset stomach

Weight gain or loss

Dr. Hans Selye

―Father of Stress Research"

Negative stress - ―distress‖ When we are Mentally, Emotionally, Physically and/or

Physiologically traumatized • Short-term: such as a trauma

• Long-term: chronic or repetitively insulted

Positive stress - ―eustress‖ Rollercoaster ride, scary movie, being a new parent

Stress such as deadlines, competition, confrontation -even our frustration and sorrow - adds depth, enrichment, character and quality to our lives

Preparedness for stress leads to better outcomes

Virginia Satir

―Life is not what it's supposed to be. Its what it is.

The way you cope with it is what makes the

difference.‖

Virginia Satir (1916-1988)

―The Pioneer of Family Therapy‖

Her books Peoplemaking and Conjoint Family are

two of the central texts of humanistic psychology

On the Job Stress Management

Plan ahead

Prepare for stressful events

Prioritize Daily tasks

Weekly tasks

Break all the larger tasks up into bits you can handle

Be realistic about how long each task will take

As you complete each task, check it off your list

Delegate

Work as a team when possible

Take time to set the project down for 15 or 20 minutes and regroup your thoughts

Listen to your gut

On the Job Stress Management

For the Employer and/or Management

Ways to decrease stress by work management Define roles and responsibilities

Allow workers to utilize their skills

Involve workers to make decisions that affect their jobs

Reduce uncertainty about future job prospects

Short term and long term evaluations Subjective reports from employees

Objective reports such as attendance and health conditions

On the Job Stress Management

Keeping a positive attitude

Try to look at change as a positive

challenge, not as a threat

Don't worry about things you can't control

Have a back–up plan

Limit water cooler and coffee break gossip

of doomful predictions that may never

come to fruition

Complementary and Alternative

Medicine

What is CAM?

Used with, and in place of, conventional medicine Combines medical and Complementary and Alternative

Medicine therapies for which there is some high quality evidence of safety and effectiveness

Hippocratic Oath Start with least invasive

Example: Start with sleep habits, diet, exercise, then dietary supplements then other CAM therapies then medications and surgeries.

Classification of CAM

1. Mind – Body InterventionsPrayer, Meditation, Relaxation Therapy, Hypnotherapy, Biofeedback, T’ai Chi

Biologically-Based Treatments Diet Based Therapies, Megavitamin Therapy, Natural Products (Herbs)

Manipulative and Body-Based MethodsChiropractic, Massage, Osteopathic Medicine

1. Alternative Medical SystemsAcupuncture / Traditional Asian Medicine, Homeopathy, Naturopathic Medicine

Dietary Choices

Malnutrition leads to the bodies inability to

combat stress

Eat for energy

―Eat clean‖

―Live foods‖

Foods high in ―good fats‖

Fruits and Vegetables

―Live foods‖

2 cups a day of fruits

daily

Snack on dried fruits

Add berries to cereal or

oatmeal

Add frozen fruit to plain

yogurt Don’t get fooled by juices—check the

label to make sure they’re 100% fruit.

2.5 cups a day of

vegetables daily

Try fresh or frozen

Choose different

colors for different

nutrients.

Considered Good Fat Anti-Infammatory Diet: Omega-3 / Fish Oil

The polyunsaturated fats are from:

Omega-3 (EPA, DHA, Linolenic)• Mostly seafood

• Better fat to fight inflammation.

Omega-6 (Arachidonic Acid, Linoleic)

• Vegetable oils

• Found in chips, crackers, french fries, fast food

Omega-3 consumption should be balanced with omega-6 fatty acids

Omega-6 to Omega-3 ratio (between 1:1 and 4:1)

No more than four grams omega-6 for every one gram of omega-3

EAT MORE FISH AND/OR TAKE FISH OIL SUPPLEMENTS

Monosaturated and polysaturated are healthier than Transfats and Saturated Fats

Avoid Simple Carbohydrates

Simple carbohydrates Low in fiber and are rapidly

broken down by the body, so they can be consumed in large amounts WITHOUT feeling full.

Can trigger overeating, as well as blood-glucose slumps, which can lead to…

Fatigue Headaches

Craving sweets

Depression

Irritability

And a host of other symptoms

Examples of BAD choices

Sugar

Candy

Pizza

Chips

Cookies

White bread

Caffeine and Soft Drinks

Soft Drinks - AVOID

Adds senseless calories to your daily intake.

Blood maintains equal levels of both calcium and phosphorus.

High in phosphorus and causes the body to leech calcium from the bones. (Anti-Aging and Osteoporosis, Dynamic Chiropractic, Nancy Molina, DC)

Caffeine - AVOID

Increases loss of calcium and magnesium

Is a diuretic, causing you to loose important electrolytes.

Dietary Supplements Magnesium

Energy metabolism (carbohydrates, fats, proteins)

30% is in muscle, when under stress Magnesium is released to fight stress

Whole grains, nuts, seeds (esp. pumpkin), vegetables, potatoes

Vitamin D D3 Cholecalciferol (Most beneficial/Bioavailable)

Replenishes adrenal glands of the body, immune system, bone development

Best from the sun, yet supplementation is beneficial

5-HTP with B6 Responsible for producing serotonin (the bodies feel-good neurotransmitter)

Dark leafy green vegetables and beans

B-Complex Release of serotonin and dopamine in the brain

Relieves anxiety

Whole grains, nuts, dried fruits and eggs

St. John’s WartHypericum perforatum

There is scientific evidence that St. John's Wort may be useful for short-term treatment of:

Mild to Moderate Depression

Used to prepare teas, tablets, and capsules containing concentrated extracts. Liquid extracts and topical preparations are also used.

St. John's Wort interacts with many medications in ways that can interferewith their intended effects. Examples of medications include: Antidepressants

Birth control pills

Cyclosporine, which prevents the body from rejecting transplanted organs

Digoxin, a heart medication

Indinavir and possibly other drugs used to control HIV infection

Irinotecan and possibly other drugs used to treat cancer

Seizure-control drugs, such as dilantin and phenobarbital

Warfarin and related anticoagulants.

Tips for Dealing with Stress

Sleep Cooler temperatures help

many people doze easier.

Try lowering yours to 68

degrees and adjust from

there

The process of digestion

can actually make it

harder to get to bed

No fewer than four hours

before sleeping)

Exercise Releases endorphins and enkephalins

Occurring naturally in the brain

Binds to pain receptors and blocks pain sensation

Creates longer telomeres Slows down the aging process

Numerous studies have shown that people who begin exercise programs demonstrate a marked improvement in their ability to: Concentrate

Sleep better

Suffer from fewer illnesses

Suffer from less pain

Report a much higher quality of life than those who do not exercise

Exercise

2 ½ hours each week

Moderate aerobic activity, Example: walking fast or

biking

Minimum of 10 minutes at a time

Do strengthening activities Example: sit–ups or lifting

weights

At least 2 days a week

Consider exercising outside. Boot camps

Active Rest

Relaxing in a way the rejuvenates you Sports and exercise

Socializing with friends

Hobbies of your choice• Reading

• Painting

• Listening to music

• Playing a musical instrument or singing

Sitting, reading, or even watching television for 20 minutes a day, caring nothing of the world or your responsibilities does not make you lazy or irresponsible

Limit round the clock news coverage of the negative state of the economy Limit negativity

Relaxation Techniques

Types and Goals Achieve a hypometabolic state of

reduced sympathetic nervous system arousal

• Example: Breathing techniques

Reduction of muscular tension

• Example: Progressive muscle relaxation in which muscles are alternatively tensed and relaxed

Steps to Elicit the

Relaxation Response

1. Sit quietly in a comfortable position.

2. Close your eyes.

3. Deeply relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.

4. Breathe through your nose. Become aware of your breathing. As you breathe out, say the word, "one―, silently to yourself. For example, breathe in ... out, "one",- in .. out, "one", etc. Breathe easily and naturally.

5. Continue for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed and later with your eyes opened. Do not stand up for a few minutes.

Do not worry about whether you are successful in achieving a deep level of relaxation. Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them by not dwelling upon them and return to repeating "one."

With practice, the response should come with little effort. Practice the technique once or twice daily, but not within two hours after any meal, since the digestive processes seem to interfere with the elicitation of the Relaxation Response.

Progressive Muscle Relaxation

NCCAM

The goal of progressive muscle relaxation is to reduce the tension in your muscles.

Quiet place where you’ll be free from interruption.

Tense each muscle group for at least five seconds and then relax for at least 30 seconds.

Repeat before moving to the next muscle group.

Relaxed breathing

Also called diaphragmatic breathing

Place a hand on your stomach, just above your navel.

1. Inhale: With your mouth closed and your shoulders relaxed, inhale as slowly and deeply as you can to the count of six.

• As you do that, push your stomach out. Allow the air to fill your diaphragm.

2. Hold: Keep the air in your lungs as you slowly count to four.

3. Exhale: Release the air through your mouth as you slowly count to six.

4. Repeat: Complete the inhale-hold-exhale cycle three to five times.

Transcendental Meditation NCCAM

As many as six million people have been trained in the TM technique, including The Beatles and other well-known public figures.

A mantra sound is utilized as a thought in the meditation process, and as a vehicle that allows the individual's attention to travel naturally to a less active, quieter style of mental functioning. The technique is practiced morning and evening for 15–20 minutes each time.

The total number of mantras used is 16, and that they are assigned using a simple formula based on gender and age

Transcendental Meditation

Helps Young Adults Cope With Stress

Researchers from Maharishi University of Management and American University studied approximately 200 students from American University and other schools in the Washington, D.C., area.

Significant improvement in: Total psychological distress

Anxiety

Depression

Anger/hostility

Coping ability

Blood pressure (Changes in psychological distress and coping paralleled changes in.)

Yoga

Meditative

Postural

Breathing Techniques

No serious adverse effects

Risk vs. Benefit Balance: Positive

The Status of Yoga Research

Research suggests that yoga may: Improve mood and sense of well-being

Counteract stress

Reduce heart rate and blood pressure

Increase lung capacity

Improve muscle relaxation and body composition

Help with conditions such as anxiety, depression, and insomnia

Improve overall physical fitness, strength, and flexibility

Positively affect levels of certain brain or blood chemicals

More well-designed studies are needed before definitive conclusions can be drawn about yoga's use for specific health conditions.

Massage

Scientific evidence on massage therapy is limited.

According to one analysis, however, research supports the general conclusion that massage therapy is effective.

A single session of massage therapy can reduce "state anxiety" (a reaction to a particular situation) Blood pressure

Heart rate

Multiple sessions can reduce "trait anxiety" (general anxiety-proneness) Depression

Pain

In addition massage may benefit certain conditions Chronic low-back pain.

Chronic neck pain

Advanced cancer patients may have some relieve of pain and improvement in their moods

Somatic Numbing

Disconnect between the mind and the

body

Example: Massage therapist palpates their

patients and finds muscles that are tight

and painful, which the patient did not know

was present until then

Chiropractic Care―Move well and feeling well‖

Alleviating pain

Correcting alignment

problems

Functional Joints

Joints that move as they should

Increased range of motion

Increased exercise

Increased daily activities

Increased bone and muscle

building

Nervous system functioning at

a greater capacity Chiropractic promotes homeostasis,

which is the bodies inherent was of doing

things the right way.

Chiropractic

A 2010 review of scientific evidence on manual therapies concluded that spinal manipulation / mobilization may be benefit:

Migraine headaches

Cervicogenic (neck-related) headaches

Neck pain

Upper- and lower-extremity joint conditions

Back pain

Whiplash-associated disorders

Strong

Balanced

Posture

Vs.

Weak,

Unbalanced

Posture

Weak Posture

Causes pain and effects overall health

―Posture affects & moderates every physiologic function from breathing to hormone production.‖

―Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture.‖

There is a ―striking influence of postural mechanics on function and symptomatology‖.

Postural & Respiratory Modulation of Autonomic Function Pain & Health. Lennon J., Shealy C., et.al., American Journal of Pain

Management, 1994; 4:36-39 Strong Posture

Diagram

Upper Cross Syndrome

Anterior head carriage

Headaches

Neck, upper back and

shoulder pain

Thoracic Outlet

Syndrome

Attitude of Optimism

Zig Ziglar

If you learn from defeat, you haven't really lost.

Expect the best. Prepare for the worst. Capitalize on what comes.

Failure is a detour, not a dead-end street.

Virginia Satir

―We need 4 hugs a day for survival.

We need 8 hugs a day for maintenance.

We need 12 hugs a day for growth.‖

Mayo Clinic Proceedings

Discovered that there were 41% of websites that had incorrect, misleading, and harmful claims?

How can you determine if CAM claims are true?

FDA, FTC and NCCAM

www.pubmed.gov

Internet Reliable Sources

U.S. Food and Drug Administration (FDA)

The FDA oversees the safety of many products, such as foods (including dietary supplements), medicines, medical devices, and cosmetics. Web site: www.fda.gov

National Center for Complimentary and Alternative Medicine website:

The National Center for Complimentary and Alternative Medicine is a very resourceful organization that has a very helpful website to find evidence based medicine. A lot of healthcare is based upon a persons beliefs, individual experiences and sales tactics. The National Center for Complimentary and Alternative Medicine does research to determine the validity of many claims made in areas of healthcare. I like this website a lot. http://nccam.nih.gov/

Office of Dietary Supplements (ODS), NIH

ODS seeks to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, supporting research, sharing research results, and educating the public. Its resources include publications and the International Bibliographic Information on Dietary Supplements (IBIDS) database. Web site: ods.od.nih.gov

American Pain Society http://www.ampainsoc.org/

Center for Food Safety and Applied Nutrition (CFSAN)

CFSAN oversees the safety and labeling of supplements, foods, and cosmetics. Publications include "Tips for the Savvy Supplement User: Making Informed Decisions and Evaluating Information." Web site: cfsan.fda.gov

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