Stress Management 101 - NJ State Library Webinar March 16, 2021 Rajiv K. Vyas, M.D. Capital Health Behavioral Health Specialists
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Stress Management 101 NJ State Library Webinar March 16, 2021 Rajiv K. Vyas, M.D. Capital Health Behavioral Health Specialists
Learning Objectives • Define stress and its physical effects on the body and mind • Learn ways to decrease physical and mental stress • Learn about the benefits of meditation and mindfulness • Participate in a meditation exercise
Capital Health Behavioral Health Specialists
Christi Weston, MD PhD
Arvind Bhasker, DO
Irene Gabrial, MD
Rajiv Vyas, MD
Elaine Kwok, MD
Stacy Grissett, BSN, MSN, FNP-C
Victoria Pena-Cardinali, LCSW
Kristina McGuire, PsyD
Chelsea Hoagland, LCSW
Samantha Gatewood-Rivera, LCSW
Kristin Cardona-Coccia, LCSW
Tatyana Gray, LCSW
Joanne McHugh, RN
Lauren Yelito, RN
Niharika Patel, CMA
Mikalynn Miller, MA
Heather Serdikoff
Capital Health Behavioral Health Specialists
1445 Whitehorse-Mercerville Rd
Suite 111
Hamilton, NJ 08619
1 Third Street
Bordentown, NJ 08505
3 Penns Trail
Newtown, PA 18940
Phone: 609-689-5725
Capital Health Behavioral Health Specialists
Serving Adults, Adolescents, and Children
Psychopharmacology (Medication)
Transcranial magnetic stimulation (TMS)
Individual Psychotherapy
Supportive psychotherapy
Psychodynamic
CBT
EMDR
Mindfulness based
Group Therapy
CBT for depression
CBT for grief
Mindfulness for stress reduction
Holiday Stress
Take 5 deep breaths…
Disclaimer: Any recommendations in this presentation are not a substitute for medical advice from a health care practitioner that knows your specific health issues.
Stress and the Stress Response
• Stress is a bodily or mental tension
resulting from factors that tend to
alter an existent equilibrium.
(Merriam-Webster)
• Response to stress is mediated by
complex interactions between the
nervous, endocrine, and immune
systems
Smith, S. M., & Vale, W. W. (2006). The role of the hypothalamic-
pituitary-adrenal axis in responses to stress. Dialogues in clinical
neuroscience, 8(4), 383–3 neuroendocrine 95.
Stress
• Response to a challenge or a threat
• Can be positive or negative
• Perception plays a key role in interpreting stressful situations
• An optimal level can act as a motivational force
• Response to stress is a result of complex interactions between the nervous,
endocrine, and immune systemsConsequences of Stress
On your body On your mind On your behavior
Overeating or
Headache Anxiety
undereating
Muscle tension or pain Restlessness Angry outbursts
Lack of motivation or
Chest pain Drug or alcohol misuse
focus
Fatigue Feeling overwhelmed Tobacco use
Change in sex drive Irritability or anger Social withdrawal
GI distress Depression Exercising less often
Sleep problems
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-symptoms/art-
20050987(Some) Stress Related Conditions • Anxiety and Depression • Heart disease • Asthma • Obesity • Diabetes • Headaches • Gastrointestinal problems • Sleep problems • Memory and concentration problems https://www.webmd.com/balance/stress-management/features/10-fixable-stress-related-health-problems#1 https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037
Acute Stress v. Chronic Stress • Being pulled over by a cop for speeding • Health problems • Argument with spouse • Caregiver burden • Project deadline • Toxic home environment • Acute Injury • Stressful job • Loss of loved one • Unhealthy relationship • Moving • Long-term unemployment Our body is evolutionarily suited to handle acute stress better than chronic stress
(Some) Strategies to Reduce Stress: Physical • Exercise • Adequate sleep • Healthy diet (anti-inflammatory) • Being outdoors in nature • Relaxation exercises • Yoga • Tai chi
Stress and Your Heart • Affects the heart in direct and indirect ways • Stress leads to inflammation which is linked to high blood pressure and lower “good” HDL cholesterol • Stress increases risk for heart disease, cardiac arrest, stroke • High hostility (interpreting world and others in a cynical and neg manner) is a predictor of coronary heart disease • Chronic stress can lead to poor sleep, poor food choices, smoking, alcohol use, reduced exercise which put your heart at risk as well https://www.apa.org/monitor/jan03/hostility
The Importance of Exercise
• Bolsters immune response
• Blunts cortisol (”flight or fight”) hormone production
• Releases serotonin, endorphins “runner’s high”
• Decreases tension
• Improves sleep
• Feel productive, more confident
https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/physical-activity-reduces-stExercise and Depression • Studies indicate that exercise has an antidepressant effect. • Those engaging in exercise showed a decrease in their depression on validated rating scales. • May be related to release of endorphins and serotonin. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495 https://www.psychologytoday.com/us/blog/brain-bootcamp/201009/can-exercise-cure-depression https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/
Yoga and Health • A number of studies have demonstrated that yoga is as effective (and in some cases more effective) as exercise in improving both physical and mental health. • The benefits of yoga may be related to its activation of the parasympathetic nervous system (“rest and digest”) and dampening of the sympathetic nervous system (“flight or fight”). THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 16, Number 1, 2010, pp. 3–12
Chronic Inflammation • Acute inflammation is helpful to get rid of infection but chronic inflammation causes cellular and tissue damage • Chronic inflammation, however, is a cause of many chronic diseases such as heart disease, diabetes, cancer, Alzheimer’s, and “itis” diseases like arthritis and colitis • Lack of sleep, lack of exercise, stress and aging can fuel chronic inflammation but diet is a major contributor. Consumer Reports On Health, “Eat to beat inflammation,” March 2021
Diet and Chronic Inflammation
Increase inflammation Decrease inflammation
-red and processed meat -leafy green and colorful
-highly processed foods vegetables
-saturated and trans fats -whole fruits
-refined carbohydrates -whole grains
-fried foods -fatty fish (salmon, herring, mackerel)
-sugary foods/drinks -nuts
-extra-virgin olive oil
-coffee and tea
Harvard Health Letter, “Why junk food
diets may raise heart disease risk,” March
2021Strategies to Reduce Stress: Mental Positive thinking results in better health outcomes • “Attitude of gratitude” • “Make a mind that never minds” • “Live and let live” • “Forgive and forget” Recognize thinking errors (cognitive distortions)
CBT Simplified
• Your thinking effects how you feel (e.g. sad, angry,
nervous) and ultimately your behavior
• If you change your thoughts you can change how
you feel
• Events may evoke negative self-talk (“automatic
thoughts”) which leads to negative feelings which
leads to negative thoughts…a vicious cycle which
may lead to depression and chronic anxiety
https://ellensocdblog.files.wordpress.com/2014/02/20140225
-184617.jpgCatch it, Check it, Change it • Event: Best friend does not call you on your birthday • Emotion: sad, upset • Automatic thoughts: She doesn’t like me; I can’t count on her • Rational response: She might have been having a very busy day and just forgot to call. • Automatic thoughts are often a result of cognitive distortions (e.g. overgeneralization and mind reading) • When you feel a negative emotion—catch it and check your (automatic) thoughts, and change them to more realistic thoughts http://downloads.bbc.co.uk/headroom/cbt/catch_it.pdf
Cognitive Distortions
• All or none thinking: black and white; e.g., "I did not get an ‘A’
on the exam, I’m a total failure as a student.”
• Mental filter: dark glasses; e.g., “I was nervous during the
interview…they are not going to hire me.”
• Overgeneralization: one (negative) event predicts all events;
e.g., “They did not hire me—”I am terrible at job interviews.”
Cognitive Distortions (Burns, 1989)Cognitive Distortions • Disqualifying the positive: seeing negative in something positive; e.g., “I got the job but I just got lucky this time.” • Magnification (catastrophizing) or minimization: making a mountain out of a mole hill; e.g., “I burnt the casserole dish, everyone must think I am a terrible cook.” • Emotional reasoning: feelings equal reality; e.g., “I feel hurt so I am sure he was trying to hurt my feelings.” Cognitive Distortions (Burns, 1989)
Herbal and Nutritional Supplements for Anxiety • Supplements may interact with OTC and prescribed medications • Are not regulated by the FDA and can make claims about benefits without evidence • Ashwagandha root extract for anxiety and sleep • Cannabidiol (CBD) for anxiety https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979308/ http://www.thepermanentejournal.org/issues/2019/winter/6960-cannabis.html
Herbal and Nutritional Supplements for Depression • Omega-3 fatty acids—insufficient evidence • Folate or folic acid—some evidence that it may boost response to antidepressants • SAMe (S-adenosyl-L-methionine)—may speed or boost antidepressant response • St. John’s Wort—may be effective in mild depression but cause similar side effects to antidepressant and interacts with other medications. • L-tryptophan and 5-hydroxytryptophan (5-HTP)—may be effective but concern about safety and side effects https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004692.pub4/full?highlightAbstract=supplements%7Cherbal%7Cfour%7Csupplement%7Cfor%7Cdep ress%7Cdepression https://www.health.harvard.edu/newsletter_article/herbal_and_dietary_supplements_for_depression https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003198/full?highlightAbstract=for%7Cdepress%7Cdepression%7Cfour%7Ctryptophan
Marijuana • Marijuana can cause addiction • Marijuana can cause a withdrawal syndrome • Marijuana used early on, frequently, and in larger quantities can be harmful—anxiety, depression, psychosis, cognitive decline • Marijuana plant has two main cannabinoids—THC and Cannabidiol (CBD)
Medical Marijuana • Physicians can certify (but cannot Rx) a patient for medical marijuana to be obtained at designated dispensaries • Medically approved uses: glaucoma, nausea/vomiting, appetite stimulant, analgesia • Most medical marijuana is used for other “debilitating medical conditions” such as anxiety, chronic pain, PTSD, migraines, inflammatory bowel disease
Cannabidiol (CBD)—is it safe?
We do not know… We know…
• if it causes toxicity in humans • it can cause agitation and
as seen in animal studies irritability
• its effects on the fetus or • it can cause GI distress
breast fed infant • it can interact with alcohol
• what are safe levels of use and benzos to increase
and for how long sedation
• its effect on children and • it can cause liver injury
brain development
https://www.fda.gov/consumers/consumer-updates/what-
you-need-know-and-what-were-working-find-out-about-
products-containing-cannabis-or-cannabisSocial Support
Research has documented many physiological and mental health
benefits of social support, including decreased depression and anxiety
• Emotional Social Support- affirmations of one’s worth, concern about
one’s feelings
• Informational Social Support -information/advice that can help
someone who is experiencing a stressor or challenge they don’t know
how to handle
• Tangible Social Support -sharing resources, either material or
financial, time
• Belonging Social Support-providing social leisure and belonging
• True connection versus social media
https://www.verywellmind.com/stress-and-social-support-research-3144460The Relaxation Response • Hebert Benson, M.D. a Harvard professor and cardiologist coined the phrase the “relaxation response” in the 1970’s. • Stress can activate our sympathetic nervous system which allows us to respond to danger (“fight or flight”) situations. It increases our heart rate, rate of breathing, muscle tension, heightened state of arousal, etc. • The relaxation response activates our parasympathetic system, the “rest and digest” part of our nervous system. It slows our heart rate, breathing, and bring about a return to balance or equilibrium. https://www.psychologytoday.com/us/blog/heart-and-soul-healing/201303/dr-herbert-benson-s-relaxation-response
(Some) Relaxation Techniques
• Meditation
• Deep breathing
• Guided visualization
• Progressive muscle relaxation
• Prayer
• YogaMeditation • Meditation is one way to evoke the relaxation response. • Short term benefits are easily experienced even with one session but more enduring benefits come with regular practice. • Try sitting for 10-20 minutes once in the morning and evening if possible.
Brain Changes with Meditation The brain changes responsible for the benefits of meditation are far from clear, however, a study of subjects having participated in Mindfulness Based Stress Reduction classes was associated with increases in gray matter volume in the hippocampus, posterior cingulate cortex, temporo-parietal junction, and the cerebellum--brain regions involved in learning and memory, emotional regulation, and placing things into perspective. Mindfulness practice leads to increases in regional brain gray matter density lBritta K.HölzelabJamesCarmodycMarkVangelaChristinaCongletonaSita M.YerramsettiaTimGardabSara W.Lazara Psychiatry Res. 2011 Jan 30; 191(1): 36–43.
Benefits of Meditation
Studies suggest improvements in:
• Depression
• Anxiety
• Chronic pain
• Substance use disorders
• Eating disorders
• Feeling of well being
• Fibromyalgia
• Hypertension
• InsomniaMindfulness Meditation • The most common type practiced in the West • Focusing away from outward thoughts and feelings to an inward attention and awareness • Process of letting go instead of holding on • Awareness in the present moment • Acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment
Attitudes for Mindfulness • Living in the present, the here and now • Beginner’s mind—open to new experience • Non-striving—not trying to achieve or have a special experience • Non-judging—accepting your experience whatever it is • Non-hurrying (patience)—not trying to get to the next project, the next step Jon Kabat-Zinn
Mindful Listening
• Listening to the other person in a nonjudgmental way
• Listening with compassion to their suffering
• Listening in the present—non responding attitude, not
trying to make your point
Thich Nhat HanhBringing Mindfulness in Relationships Mantras for healing in relationships… • Darling I am here • Darling I know you are there • Darling I know you suffer that is why I am here for you • Darling I suffer, I am trying my best to practice, please help me Thich Nhat Hanh
Meditation Exercise
What was your experience of the meditation?
What will you change to reduce stress?
Now make a commitment
Recommended Reading • Burns, David D. The Feeling Good Handbook. New York: Plume, 1990,1999. • Hanh, Thich Nhat. The Miracle of Mindfulness. Boston: Beacon Press, 1987. • Kabat-Zinn, Jon. Full Catastrophe Living. New York: Bantam Books, 1990,2013. • Kabat-Zinn, Jon. Wherever You Go There You Are. New York: Hyperion, 1994.
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