1. DR. JACKLINE OCHIENG’ PSYCHIATRIST MATHARI NATIONAL TEACHING AND REFERRAL HOSPITAL PHYSICIAN HEALTH PRE-CONFERENCE SYMPOSIUM 44 TH KMA ANNUAL SCIENTIFIC CONFERENCE ACACIA PREMIER HOTEL, KISUMU 19 TH APRIL, 2016

2.  STRESS: a complex series of the body’s reactions, both psychological and physical, in response to demanding or threatening situations  STRESSORS: events/ situations that produce physical and psychological demands on a person  ‘fight or flight’ response – when one is threatened, the body’s nervous system releases a flood of stress hormones, including adrenaline and cortisol, to rouse the body for emergency action

3.  Social engagement: most evolved strategy; eye contact, attentive listening, feeling understood – body functions (B.P, Heartbeat, digestion, immunity) continue to work uninterrupted  Mobilization: fight-or-flight response; body defence or run from danger – normal balance resumed once threat is over

4.  Immobilization: least evolved response; one may be traumatized or even ‘stuck’ in an angry, panic stricken/ dysfunctional state – may lose consciousness, allowing to survive high levels of physical pain.  used only when social engagement and mobilization have failed

5.  Moderate levels of stress may actually improve performance and efficiency – help one to stay focused, energetic and alert.  Too little stress may result in boredom  Too much stress may cause an unproductive anxiety level; causing damage to one’s mind and body

6. COGNITIVE  Memory problems  Poor concentration  Poor judgement  Seeing in the negative  Anxious or racing thoughts  Constant worrying EMOTIONAL  Moodiness  Irritability / short temper  Agitation / not relaxed  Feeling overwhelmed  Loneliness/ isolation  Depression/ general unhappiness

7. PHYSICAL  Aches and pains  Diarrhoea/ constipation  Nausea / dizziness  Chest pain / increased heart rate  Loss of sex drive  Frequent colds and flu BEHAVIORAL  Eating more or less  Sleeping too much or too little  Isolating oneself  Using alcohol, cigarettes, drugs to relax  Nervous habits (nail biting/ pacing)

8. EXTERNAL  Major life changes (marriage/ transfer/promotion)  Work or school  Relationship difficulties  Financial problems  Being too busy  Children and family INTERNAL  Chronic worry  Pessimism  Negative self talk  Perfectionism/ Unrealistic expectations  Rigid thinking – not flexible  All-or-nothing attitude

10.  How well do you handle stress in your life? 1. I have people I confide in when I’m feeling under pressure who make me feel better. 2. I feel more comfortable expressing how I feel when something is bothering me. 3. In general, I feel in control of my life and confident in my ability to handle what comes my way.

11. 4. I find reasons to laugh and feel grateful, even when going through difficulties. 5. No matter how busy I am, I make it a priority to sleep, exercise and eat right. 6. I’m able to calm myself down when I start to feel overwhelmed. Each ‘yes’ answer represents an important stress coping skill Each ‘no’ answer represents an area to work on to become more resilient

12.  Support network –social engagement, strong network of supportive friends and family; being lonely and isolated increases vulnerability to stress  Exercise levels – physical and mental health intrinsically linked –lifts mood, relieves anxiety, anger, frustration and stress; distraction from worries, breaks out negative thoughts

13.  Diet – eat fresh fruit and vegetables, high quality protein and healthy fats rather than processed, convenience foods, refined carbohydrates and sugary snacks  Sense of control –being confident in oneself improves ability to influence events and persevere through challenges  Attitude and outlook – optimistic people are more stress hardy; embrace challenges, strong sense of humor, accept change as part of life

14.  Ability to deal with one’s emotions – helps one bounce back from adversity  Knowledge and preparation – the more one knows about a stressful situation, how long it will last, what to expect, the easier it is to cope. Eg, post-op recovery period

15. Common causes of excessive workplace stress:  More overtime due to staff shortage  Pressure to perform to meet rising expectations but with no increase in job satisfaction  Pressure to work at optimum levels all the time  Fear of being laid off

16.  Recognize warning signs of excessive stress at work –emotional, physical, cognitive, behavioural  Taking care of yourself – regular exercise, diet, relaxation techniques, adequate sleep, talk to an attentive listener, drink alcohol in moderation and avoid nicotine  Breaking bad habits – resist perfectionism, punctuality, avoid negative thinking, don’t try to control the uncontrollable

17.  Prioritizing and organizing –  Time management (balanced schedule, don’t over commit yourself, try to leave earlier in the morning, plan regular breaks)  Task management ( prioritize tasks, break projects into small steps, delegate responsibility, be willing to compromise)

18.  Improving emotional intelligence – realize when you’re stressed; stay connected to your internal emotional experience; recognise and effectively use non verbal cues and body language; develop the capacity to meet challenges with humor; resolve conflicts positively  Learning how managers or employers can reduce job stress – improve communication, consult your employees, cultivate a friendly social climate

19. BURNOUT: a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress  Is a gradual process, occurring over a period of time PHYSICAL SIGNS AND SYMPTOMS  Feeling tired and drained most times  Lowered immunity; often falling sick  Frequent headaches, back pains, muscle aches  Change in appetite  Change in sleep habits

20. EMOTIONAL  Sense of failure and self doubt  Helpless, trapped, defeated  Detachment, alone in the world  Loss of motivation  Increased cynicism, negative outlook  Decreased satisfaction and sense of accomplishment BEHAVIOURAL  Withdrawing from responsibilities  Isolation  Procrastinating  Using food, drugs or alcohol to cope  Taking out frustrations on others  Skipping work, coming late and leaving early

21. WORK RELATED  Feeling you have little or no control over work  Lack of recognition or rewards for good work  Unclear or overly demanding job expectations  Doing monotonous/ unchallenging work  Working in a chaotic or high pressure environment PERSONALITY TRAITS  High achieving Type A personality  Perfectionist tendencies – nothing is good enough  Pessimistic view of oneself and the world  Need to be in control, reluctance to delegate to others

22. LIFESTYLE  Working too much without enough time for relaxing and socializing  Being expected to be too many things to too many people  Taking on too many responsibilities, without enough help from others  Not getting enough sleep  Lack of close, supportive relationships

23. STRESS  Over-engagement  Emotions over- reactive  Produces urgency and hyperactivity  Loss of energy  Leads to anxiety disorders  Primary damage is physical  May kill you prematurely BURNOUT  Disengagement  Emotions blunted  Produces helplessness and hopelessness  Loss of motivation and ideals  Leads to detachment and depression  Primary damage is emotional  May make life seem not worth living

24.  Start the day with a relaxing ritual – at least 15 minutes of meditation, journaling, gentle stretches  Adopt healthy eating, exercising, sleeping habits  Set boundaries – don’t over exert yourself, learn to say ‘no’  Take a daily break from technology  Nourish your creative side -hobby  Learn how to manage stress so as to regain your balance

25.  Slow down – cut back activities and commitments  Get support –family and friends  Re-evaluate your goals and priorities – burnout is a sign that something important in your life is not working  Actively address problems at work – be proactive

26.  Clarify your job description – avoid overworking  Ask for new duties – if you’ve been doing the same duties for a long time  Take time off to recharge and get perspective– take leave, vacation, temporary leave-of absence