UNDERSTANDING AND MANAGING STRESS UNDER PRESSURE Nancy L. Heath, PhD OVERVIEW: MANAGING YOUR OWN STRESS Background Understanding Stress Strategies for Stress Concluding Comments 1
INTRODUCTION BACKGROUND ACADEMIC STRESS IN HONG KONG The view that academic results determines the future puts great pressure on students to achieve and the competitive system makes success challenging. Lee, M. T. Y., Wong, B. P., Chow, B. W.-Y., & McBride-Chang, C., 2006 2
BACKGROUND YOU ARE NOT ALONE 1 in 3 students in Hong Kong suffer from stress, anxiety or depression Stress among adolescents in Hong Kong is on the rise. 1 in 3 youth report moderate to severe stress HONG KONG VS. NORTH AMERICA https://www.scmp.com/news/hong-kong/health-environment/article/2149403/one-three-young-hongkongers-suffers-stress-anxiety BACKGROUND STUDENT STORIES 3
BACKGROUND WHY SO MUCH STRESS? CAUSES OF STRESS IN A COMPLEX WORLD Performance More competitive Genetic/ Temperament Peer Family More connected More stressed World Events More aware BACKGROUND CAUSES OF STRESS FOR STUDENTS: HONG KONG 60% Parental Expectations 38% Socializing with Friends 13% Extracurricular Activities 18% Academic Performance High Self- Expectations 50% 26% Family Relationships 12% Other 4
BACKGROUND CONTRIBUTORS OF STRESS CULTURE INSTITUTIONS COMMUNITY Stress is within the individual, a within person experience. FAMILY Bronfenbrenner, U. (1994) UNDERSTANDING STRESS: WHAT IS STRESS? 5
UNDERSTANDING STRESS STRESS IS AN INTERNAL EXPERIENCE WE HAVE WHEN WE PERCEIVE THE DEMANDS OF THE SITUATION ARE MORE THAN WE CAN COPE WITH. UNDERSTANDING STRESS WHAT IS STRESS? I m going to fail this test! STRESS 6
UNDERSTANDING STRESS HOW STRESSED ARE YOU? In the last month have you: 1. Been upset because of something that happened unexpectedly? 2. Felt that you were unable to control the important things in your life? 3. Felt nervous and stressed? 4. Questioned your ability to handle your personal problems? 5. Felt that things were just not working out for you? Cohen, S., Kamarck, T., & Mermelstein, R. (1994) UNDERSTANDING STRESS RESPONDING EFFECTIVELY TO STRESS Responding effectively to stress involves the use of multiple strategies to regulate emotions at different time points of a stressful situation EVENT BEFORE DURING AFTER 7
UNDERSTANDING STRESS EMOTION REGULATION Emotion regulation is a term used to describe the process by which we manage the experience and expression of our emotions and has three parts: REACTIVITY INTENSITY RECOVERY UNDERSTANDING STRESS EMOTION REACTIVITY SCALE Reactivity: I tend to get emotional very easily Not at all like me...completely like me 0 1 2 3 4 Intensity: When I experience emotions, I feel them very strongly/intensely Not at all like me...completely like me 0 1 2 3 4 Recovery: When I am angry/upset, it takes me much longer than most people to calm down Not at all like me...completely like me 0 1 2 3 4 8
Performance UNDERSTANDING STRESS IS STRESS ALWAYS BAD? Stress is often thought of as bad, but it can actually be protective and good! The human brain is hard-wired to respond to danger. The fight or flight response is what has helped humans protect themselves from danger throughout evolution. Whether the threat is real or perceived, our stress response is activated, which has physiological effects. UNDERSTANDING STRESS GOOD VS. BAD STRESS Exhaustion Relaxed Anxiety/panic/anger Inactive Breakdown Too little stress Optimal Stress Stress Overload Burnout Stress Level 9
UNDERSTANDING STRESS SIGNS OF STRESS EMOTIONAL Nervousness Oversensitivity Irritability Anger PSYCHOLOGICAL Rumination Hopeless/ Poor Problem-solving Catastrophizing Difficulty concentrating PHYSICAL Headaches Muscle tension Fatigue Stomach aches BEHAVIOURAL Drug/alcohol use Excessive internet use Self-injury Change in eating habits Difficulty sleeping UNDERSTANDING STRESS STRESS PROFILE Psychological/Emotional Physical Behavioral Difficulty concentrating Racing thoughts Persistent worry Forgetfulness Difficulty falling asleep due to racing thoughts Low self-esteem Difficulty making decisions Blowing things out of proportion Confusion Unable to let go of unsettling thoughts or feelings Headache Stomach pain and/or digestive problems Feeling tired Muscle tension Jaw clenching or teeth grinding Difficulty falling asleep due to tenseness Skin conditions (ex. rash or hives) Neck or back pain Change in appetite (increased or decreased) Rapid heart beat or tightness in chest Nail biting Constant pacing Persistent foot tapping or constant fidgeting Angry outbursts Frequent crying spells Avoiding situation that cause stress Overeating or not eating enough Fast or abrupt speech Getting into fights Poor choices to manage stress (ex. Not eating properly, substance use, self-injury) SCORE SCORE SCORE 10
UNDERSTANDING STRESS WHEN IS IT TOO MUCH? Stress comes and goes for no apparent reason. Feel unable to cope. Can t seem to relax; feel tense most of the time. Feel a general loss of control. Stress becomes problematic when it interferes with day-to-day functioning UNDERSTANDING STRESS STRESS OVERLOAD ANXIETY AND DEPRESSION Struggling with chronic stress can lead to anxiety/depression Stress Anxiety/ Depression Anxiety/depression reduces one s ability to cope 11
UNDERSTANDING STRESS STRESS AND UNHEALTHY COPING Excessive gaming/internet use Substance abuse Overeating or food restriction Non-suicidal self-injury 12
EMOTION REGULATORY STRESS MANAGEMENT STOP, THOUGHT CHALLENGE PROGRESSIVE MUSCLE RELAXATION BREATHING MINDFULNESS DISTRESS TOLERANCE SELF-CARE STOP, THOUGHT CHALLENGE For self-critical rumination or repetitive negative thoughts. Visualize a stop sign I am so stupid! Which indicates to stop and take a deep breath And challenge the critical thought as if you were your own best friend. 13
MUSCLE RELAXATION Muscle Relaxation Physically turns off the stress response. No cognitive requirements. Can be done anywhere. Involves tensing and then relaxing each muscle group in the body. As you tense-relax you focus on and notice the FEELING of the muscles. MUSCLE RELAXATION Muscle Relaxation Physically turns off the stress response. No cognitive requirements. Can be done anywhere. Involves tensing and then relaxing each muscle group in the body. As you tense-relax you focus on and notice the FEELING of the muscles. 14
BREATHING 1: ESSENTIAL STRESS MANAGEMENT Belly breathing Diaphragmatic or Belly breathing is the most effective type of breathing to manage stress, the goal should be to be doing this most of the time. BREATHING 1: ESSENTIAL STRESS MANAGEMENT Belly breathing Diaphragmatic or Belly breathing is the most effective type of breathing to manage stress, the goal should be to be doing this most of the time. 15
BREATHING 2: ESSENTIAL STRESS MANAGEMENT To calm down: Calming breath Place your right hand over your heart, your left hand on your lower abdomen below the navel. As you inhale/exhale try to make your belly hand go up and down while keeping your heart hand mostly still. Inhale through the nose for 4 slow counts, hold for 2, exhale through the mouth for 6 slow counts. BREATHING 2: ESSENTIAL STRESS MANAGEMENT 16
MINDFULNESS: WHAT IS IT? Acceptance of presentmoment experience Awareness of the present moment Paying attention on purpose Kabat-Zinn, 1995 MINDFULNESS: EFFECTIVENESS Mindfulness has been used in a number of high stress demanding professions to enhance performance and ability to function under stress 17
MINDFULNESS IN HONG KONG MINDFULNESS IN HONG KONG 18
MINDFULNESS IN HONG KONG MINDFULNESS: Informal Mindfulness Mindful Moments (e.g., grounding, coming to your senses etc.) There are many mindfulness strategies to choose from. Mindful Practices (e.g., body scan, mindful movement, sitting meditation etc.) Achieving Mindfulness 19
MINDFUL MOMENTS: COMING TO YOUR SENSES Brief moments where we become aware of our senses without judgments or labeling (30s-2min) EXAMPLE: momentary awareness of physical sensations, of sounds, etc. Should be interspersed throughout the day, ideally once per hour Just listen MINDFUL MOMENTS: COMING TO YOUR SENSES Just listen 20
MINDFULNESS: BODY SCAN SPOTLIGHT Focusing attention to body parts in progression and without judgment Helps us to become aware of and more connected to our body and be able to let go of tension in our body Grounds us in the moment MINDFULNESS: BODY SCAN SPOTLIGHT Focusing attention to body parts in progression and without judgment Helps us to become aware of and more connected to our body and be able to let go of tension in our body Grounds us in the moment Some common challenges Restlessness Distracting Thoughts Physical Discomfort Intense Emotions or Extreme Discomfort 21
MINDFULNESS: MEDITATION SPOTLIGHT SPOTLIGHT attention on different aspects of your moment-to-moment experience Observing breath, sensations, emotions, and thoughts in turn without judgment Enhances awareness and concentration, helps us understand thoughts as just thoughts Helps us be less influenced by our inner critic MINDFULNESS: MINDFUL MOVEMENT Focusing attention on your body and movement with acceptance Develops a sense of body awareness and grounding in the present moment 22
MINDFULNESS: MINDFUL MOVEMENT MINDFULNESS: YOGA NIDRA Bringing awareness to different parts of the body in sequence to relax the body Helps achieve deep relaxation prior to sleep 23
DISTRESS TOLERANCE When all else fails, distress tolerance are strategies for managing when you feel like what you are feeling inside is INTOLERABLE, you can NOT stand it. DISTRESS TOLERANCE Distraction TIP Ride the Wave 24
DISTRESS TOLERANCE: DISTRACTION Distraction might seem easy, but sometimes, when we re upset, worried, angry, or sad, it can be hard to think about anything else. Sometimes we re told distraction can be a negative thing, but it can get us through bad moments. Try an activity or spend time with someone! Focus on someone else! Music or creative outlet! DISTRESS TOLERANCE: TIP T I P T is for temperature. We can adjust the temperature of our body. Cold water on our face. I is for Intense Exercise. Increase your heart rate. P stands for paced breathing, calming breath. 25
DISTRESS TOLERANCE: RIDE THE WAVE Riding the wave means being the observer and watching our emotions in all their intensity. COMFORTABLE WITH DISCOMFORT! SELF-CARE TRAINING FOR STRESS Often we may make unhealthy choices at the most stressful of times to manage our stress. Self-care means doing the opposite during high stress taking care of ourselves by making healthier choices. Structure that improves lifestyle: Sleep, Regular healthy eating, Aerobic exercise 3X week Idea of going into training for periods of high stress! 26
THE BIG PICTURE: SURVIVING FAILURE Growth Mindset Grit Dr. Carol Dweck of Stanford University s growth mindset: When students understand failure as learning, it makes them stronger and they achieve better. Dr. Angela Duckworth of University of Pennsylvania research on grit recognizes that achievement isn t reserved for those with highest intelligence, but for those who redefine their failure and continue to strive for success and persevere. Duckworth, 2007; Dweck, 1988 THE BIG PICTURE: SURVIVING FAILURE Growth Mindset Grit Failure helps me learn I haven t got it YET Excellence does not mean perfection it means persistence in achieving your goal Duckworth, 2007; Dweck, 1988 27
SURVIVING FAILURE Path to success? Sometimes, when we compare ourselves to others, we think that going directly to success is the only way or the best way. In fact many people s path to success is more complex. FAIL FAIL FAIL FAIL SURVIVING FAILURE FAIL Actual path for many! Sometimes, when we compare ourselves to others, we think that going directly to success is the only way or the best way. In fact many people s path to success is more complex. FAIL FAIL FAIL FAIL FAIL FAIL 28
IN SUMMARY STRATEGY RECOMMENDATION: WHEN AND WHERE TO USE IT The following section will briefly present where and when you can use strategies. HOME SCHOOL ELSEWHERE RECOMMENDATIONS: AT SCHOOL When you re preparing for an exam Right before a difficult exam or assignment After an exam or difficult assignment Self-care training (e.g., get enough sleep, eat healthy and exercise) Having a regular mindfulness practice (e.g., practice 10-15 minutes per day) Yoga nidra TIP Muscle Relaxation (you can do this invisibly in your seat!) Calming Breath Mindful Movement Growth Mindset Grit Stop, thought challenge Mindful movement 29
RECOMMENDATIONS: ELSEWHERE When you re feeling selfcritical When you re feeling anxious When you re feeling distressed Growth Mindset Grit Stop, thought challenge Belly breathing Body scan Muscle relaxation Calming breath Momentary mindfulness Muscle Relaxation TIP Calming breath Ride the Wave Distraction GRID OF STOP, THOUGHT CHALLENGE PROGRESSIVE MUSCLE RELAXATION BELLY BREATHING CALMING BREATH MINDFULNESS COMING TO YOUR SENSES BODY SCAN MEDITATION SPOTLIGHT MINDFUL MOVEMENT YOGA NIDRA DISTRACTION TIP RIDE THE WAVE SELF-CARE GROWTH MINDSET GRIT 30
S STUDENT STORIES S DOWNLOADABLE S Perceived stress scale (PSS) Emotion Regulation Scale: reactivity, intensity and recovery Stress Profile Recommendations Grid of strategies 31
S DOWNLOADABLE S Perceived stress scale (PSS) Emotion Regulation Scale: reactivity, intensity and recovery Stress Profile Recommendations Grid of strategies S DOWNLOADABLE S Perceived stress scale (PSS) Emotion Regulation Scale: reactivity, intensity and recovery Stress Profile Recommendations Grid of strategies 32
S DOWNLOADABLE S Perceived stress scale (PSS) Emotion Regulation Scale: reactivity, intensity and recovery Stress Profile Recommendations Grid of strategies S DOWNLOADABLE S Perceived stress scale (PSS) Emotion Regulation Scale: reactivity, intensity and recovery Stress Profile STOP, THOUGHT CHALLENGE MINDFULNESS MINDFUL MOVEMENT PROGRESSIVE MUSCLE RELAXATION COMING TO YOUR SENSES BELLY BREATHING BODY SCAN CALMING BREATH SITTING MEDITATION YOGA NIDRA DISTRACTION TIP Recommendations Grid of strategies RIDE THE WAVE SELF-CARE GROWTH MINDSET GRIT 33
S DOWNLOADABLE S TedTalk: Angela Duckworth TedTalk: Carol Dweck Growth mindset vs. Fixed mindset S DOWNLOADABLE S TedTalk: Angela Duckworth TedTalk: Carol Dweck Growth mindset vs. Fixed mindset 34
S DOWNLOADABLE S TedTalk: Angela Duckworth TedTalk: Carol Dweck Growth mindset vs. Fixed mindset CONCLUDING COMMENTS CONCLUSION Understanding of your stress you are stronger! CULTURE INSTITUTIONS COMMUNITY FAMILY Strategies for stress you are more resilient! Perspective you can see other paths to success! 35
THANK YOU! Dr. Nancy Heath nancy.heath@mcgill.ca QUESTIONS 36