Stress code. Prevention of professional stress. O. I. Suhoveeva (No. 4, 2013)

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Lifestyle is a daily reality that continues from morning to evening throughout life. The components of a relaxing and active lifestyle include a working day, eating habits, sports, sleep and rest, relationships, and reaction to emerging stress factors. All this affects the quality of the subjects’ lifestyle - depending on them, it can be either active or passive, unhealthy. Treatment consists of correcting the reaction to stressful situations that happen to modern people almost every day.

Relaxation helps relieve nervous tension

In order to calmly perceive stressors, and not avoid them, you need to change your main principles in life. You will need to ensure that concentration and relaxation begin to occupy a significant place in your life. Every person has the ability to autoregulate, that is, they can consciously change processes in the body by mastering special techniques for relieving tension.

Mental reactions during the COVID-19 pandemic

A health threat situation with a high degree of uncertainty inevitably causes emotional stress in people. A pandemic, that is, the spread of a new disease on a global scale, poses a threat to the health of any person. In a pandemic, feelings such as anxiety, fear, restlessness, sleep disturbance are quite justified, especially if we are talking about a case of a chronic disease, for example, cancer or mental [2; 4; 5; 24].

There are risk factors for the emergence and development of stress symptoms (anxiety, fear, depression, anger) during isolation:

• restrictions on basic necessities (food, clothing, medicine);
• restriction of reliable information about the pandemic situation;
• duration of isolation;
• restriction of movement;
• difficulties in organizing leisure time and its structuring;
• aggravation of interpersonal conflicts with constant interaction with members of the immediate environment;
• history of chronic mental and somatic diseases;
• financial difficulties [4; 5; 13; 16; 19; 21; 23].

Normal reactions of people during the COVID-19 pandemic may include:

• feeling of fear about the possibility of contracting COVID-19;
• fear of death, fear of cancer recurrence;
• fear, anxiety, worry, anger in connection with the current situation, which is of an uncertain nature;
• feeling of anxiety, irritability due to unknown periods of quarantine/self-isolation;
• feelings of anxiety and fear due to difficulties in detecting symptoms of the new coronavirus infection COVID-19;
• fear of loss of livelihood, inability to work under conditions of quarantine/self-isolation, dismissal from work;
• feelings of fear, anxiety and irritability due to limited opportunities to receive planned treatment, postponement of therapeutic and diagnostic measures;
• feelings of anxiety and fear due to fears of not receiving timely medical care in an emergency or life-threatening conditions;
• feelings of anxiety, fear due to a possible deterioration in mental state, the inability to independently cope with traumatic circumstances, strong emotional stress;
• feelings of helplessness to protect loved ones and fear of losing them;
• feeling of anxiety due to the loss of the usual way of life, limited social contacts, limited leisure activities;
• feelings of helplessness, boredom, loneliness and apathy due to restrictions on movement and self-isolation [4; 6; 7; 9; 10; 12; 15; 16; 20].

Emotional stress in itself is an adaptive function that encourages us to adapt to changing conditions of existence. It is normal to feel sad, upset, worried, confused, afraid or angry during a crisis. Difficulties in coping with stress can arise in an emergency situation or in a situation combined with a threat. In such cases, you can use emotional stress regulation techniques.

Method 6: Freezing Stress

Surprisingly, going into a cold room (or outside in winter) can be a way out of stress. Our body, getting into the cold, begins to actively produce joy hormones. Maybe that’s why the expression “to clear your head” is so popular? Remember how many emotions a skiing trip (or even on foot) in the frost causes, when the sun is shining brightly and the snow is solid under your feet?

The main thing is not to forget that we freeze stress, not our own body. It is unlikely that hypothermia will give you pleasure.

Tips for managing stress during the COVID-19 pandemic for cancer patients

1. Minimize watching, reading or listening to news about COVID-19 that makes you feel anxious or restless; Use information only from reliable sources and mainly to understand what preventive measures you can take to protect yourself and loved ones. Focus on positive and encouraging stories of people who have recovered from COVID-19 and are willing to share their experiences [28]. A constant stream of news about the pandemic can increase feelings of fear, anxiety, uncertainty, and create a feeling of misinformation. It is advisable to determine for yourself the measure of daily information load and stick to it. It is necessary to avoid unverified information and not pass it on to others.

To distinguish facts from rumors, seek information from reliable sources:

• World Health Organization website – https://www.who.int/ru;
• official information about coronavirus in the Russian Federation – https://www.stopcoronavirus.rf
• Rospotrebnadzor – https://rospotrebnadzor.ru;
• Ministry of Health of the Russian Federation – https://www.rosminzdrav.ru/

1. Reduce boredom by organizing leisure activities during quarantine/self-isolation. Focus on your own hobbies to distract your attention and enjoy them [16].

Activities during the day can be substitutive (performing a protective and regulatory function of the psyche). It is aimed at eliminating or minimizing feelings of anxiety. Usually these are the things that were previously put off, for which there was not enough time in the normal pace of life. It makes sense to do not only “short” things, but also those that require continuation over time (medium-term, long-term), which will need to be returned to after the end of the period of restrictions. This allows you to build a perspective of your own life - medium-term, long-term, minimize the delayed impact of this difficult period on the psyche and your life, and avoid catastrophizing your experiences. Also, activity can be of a conscious, goal-oriented nature - “supra-situational activity” (a person’s ability to rise above the level of the situation, set goals that exceed the initial task). Through supra-situational activity, a person overcomes external and internal limitations of activity, stimulates his creativity in different spheres of life.

1. In a situation of physical isolation, do not isolate yourself psychologically. Keep in constant touch with friends and family. During communication, try not to devote much time to discussing rumors/unreliable information about the current situation. Form your point of view on the current situation, avoid communicating with people prone to panic and anxiety [28].

1. Avoid using alcohol and substances as a way to cope with stress reactions [28].
2. Create a plan for what to do if you need help related to your physical or mental health [28].
3. Try to maintain your personal daily routine or create a new one if circumstances change [28].

In a situation of uncertainty, changes in the usual rhythm of life and external restrictions, it is important to structure time and space, find areas in which you can regulate circumstances, manage your life and influence the situation around you. Even the simple structuring of everyday life creates a sense of regularity and stability for the psyche, balancing the social situation of uncertainty. It makes sense to create a daily routine, organize space (for example, allocate a work area), alternate activities, including periods of physical activity and mental activity, observe a work and rest schedule, allocate time for communication and solitude. Awareness of boundaries, rhythm, action planning and summing up make it easier for a person to record and comprehend what the day was filled with, the benefits of what was done, the effectiveness of efforts, and the meaning of the time lived.

1. In a situation of stress, do not resort to alternative medicine methods. If possible, contact your doctor to find out reliable information about the planned treatment and diagnostic procedures, possible complications of physical well-being and ways to relieve them [26].

Remember, the conditions that have arisen are temporary, your task is to live through this situation without frightening yourself with various negative outcomes. Negative modeling of events significantly increases anxiety and reduces the body’s adaptive forces. It is important to focus on what you know for sure: diagnostic and treatment procedures will be implemented taking into account the COVID-19 outbreak.

1. In a situation of stress, try to provide yourself with an adequate release of emotional stress: adequate physical activity, doing normal household activities; transformation of emotional stress into creative activity; dialogue with loved ones and friends; methods of regulating emotional state [26].

Self-regulation algorithm

A. The most difficult thing for an adult to experience is the uncertainty of a threat.
Example: “I have a plan. This plan is disrupted due to external circumstances. These circumstances are not materialized. I don't see the threat. I only hear about her. Resistance to external restrictions is growing. Anxiety is growing. What to do?"

Write down/think through/discuss with a significant person the answers to the following questions:

1. How much does anxiety affect my daily life?
2. What am I most afraid of in this situation?
3. Can I protect myself from what scares me?
4. Is there anything I can do to accomplish my original plan?

B. Uncertainty anxiety is reduced in a situation of directed manifestation of activity.

Example: “I believe I can carry out my original plan now.” Write/think through/discuss the following with a significant person:

1. Tasks to be completed
2. The priority of these tasks (what is more important right now?)
3. Do I need help from other people?

B. Emotional stress is reduced due to emotional “reaction”

Example: “I feel like a hostage to circumstances. I'm helpless. I'm scared".

Express your feelings at a safe time in a safe place (choose the method that suits you):

1. Relieving emotional tension through active action (physical activity, social and everyday activities).
2. Psychophysiological release of emotional tension (expression of feelings).
3. Sublimation of emotional stress into activity (creativity, solving minor problems).

D. It is easier to make a decision when emotional stress is reduced.

Example: “I have released emotional tension and am ready to make a decision/create a new course of action.”

Write down/think through/discuss the following with your significant other:

1. My decision for today
2. Plan for the next four weeks
3. 3. Tools to help me during the implementation of my decision

1. In a situation of accumulation of emotional stress, try to perform relaxation exercises (breathing exercises, meditation) [25].

Neuromuscular relaxation according to Jacobson

It is advisable to practice neuromuscular relaxation before meals - during the digestion process, blood flow to the stomach area increases. This makes the relaxation process difficult, since the relaxation response is characterized by blood flow to the extremities.

1. Find a relatively quiet place where you won't be disturbed. It is better to turn off your phone or lower the call volume.
2. Make sure your clothes are loose and the room is warm enough. It is advisable to take off your shoes. Attention! Do not strain deformed or damaged muscle groups.

Body position during exercise

1. To begin the exercises, lie down on the floor.
2. Lying on your back, find a comfortable position for your arms and legs. Hands can be placed on the chest, stomach or extended along the body, the position of the legs is arbitrary.
3. You can put a small pillow under your neck, and you can also put a pillow under your knees. As you gain experience with neuromuscular relaxation, you will be able to relax while sitting or even standing (for example, this applies to relaxing the neck muscles). However, it is better to study while lying down.

Instructions

Attention! Don't skip any body part (only if injured) or any exercise. Also make sure that you spend more time on relaxation than stress.

Hand relaxation (5–10 minutes)

1. Make a fist with the fingers of your right hand. Squeeze them tighter and tighter, exploring the feeling of tension as you squeeze. Feel the tension in your hand, as well as the tension in your arm and forearm. Now relax. Allow the fingers of your right hand to relax. Notice the difference in sensations. Clench your hand tightly into a fist again. Leave her like this. Feel the tension again. Now release the tension, relax, allow your fingers to straighten. Again, notice the difference. Now do the same with your left hand.
2. Clench both fists tightly and tightly, feel the tension in your hands. Explore this sensation and relax. Straighten your fingers and feel relaxed. Continue to relax your hands.
3. Bend your elbows and tighten your biceps. Tighten them harder and focus on the feeling of tension. Now straighten your arms. Relax them and feel the difference again. Allow the relaxation process to continue. Now contract your biceps again. Maintain tension and study it carefully. Straighten your arms and relax. Every time you tense and relax, pay attention to the sensations.
4. Straighten your arms so that you feel the tension in your triceps. Relax. Allow your hands to find a comfortable position. Allow the relaxation process to flow freely. A feeling of pleasant heaviness should spread through your hands as they relax. Straighten your arms again so that you feel the tension in your triceps. Feel this tension and relax.

1. Focus only on relaxing your hands, without tension. Allow your hands to take a comfortable position and relax - more and more. Continue to relax your hands. Break 30–60 seconds.

Lying on your back, slow deep breathing: take a deep breath through your nose (the belly inflates) – exhale deeply through the mouth (the belly retracts).

Relaxation of the face, neck, shoulders and upper back (20–25 minutes)

1. Wrinkle your forehead. Relax and smooth your forehead.
2. Imagine your forehead and scalp smoothing out as you relax. Frown and wrinkle your eyebrows, feel the tension. Continue tense your eyebrows and forehead. Smooth your forehead again. Close your eyes. Notice the feeling of relaxation.
3. Clench your jaw and grit your teeth. Examine the tension in your jaws. Relax your jaws, open your lips slightly. Feel relaxed. Press your tongue firmly against the roof of your mouth. Locate the location of the tension. Allow your tongue to return to its natural, comfortable position. Close your lips as tightly as you can. Relax your lips. Notice the contrast between the sensations of tension and relaxation. Feel how your face, forehead, scalp, eyes, jaws, lips, tongue relax. Relax more and more.
4. Move on to the neck muscles. Tilt your head back as far as possible to feel the tension in your neck. Turn your head to the right, feel the change in tension. Turn your head to the left. Straighten and tilt your head forward. The chin presses on the chest. Allow your head to return to its original position and feel relaxed.
5. Shrug your shoulders. Keep your shoulders tense. Drop your shoulders and relax. Feel your neck and shoulders relax. Shrug your shoulders again and move them in a circular motion. Move your shoulders up and down and back and forth. Feel the tension in your shoulders and upper back. Relax your shoulders. Allow the relaxation to penetrate deep into your shoulders and into your back muscles. Relax your neck, jaw and other parts of your face. The feeling of relaxation penetrates deeper and deeper.

Break 30–60 seconds

Lying on your back, slow deep breathing: take a deep breath through your nose (the belly inflates) – exhale deeply through the mouth (the belly retracts).

Relaxation of the chest, abdomen and lower back (15–20 minutes)

1. Relax your whole body. Feel the pleasant heaviness that accompanies relaxation. Inhale and exhale - easily and freely. Notice how the relaxation deepens with your breathing. As you exhale, focus on the feeling of relaxation.
2. Inhale and fill your lungs with air. As you inhale, hold the air. Concentrate on tension. Exhale, allow the walls of your chest to fall and automatically push the air out of your lungs. Continue to relax, breathe freely and softly. After relaxing all other parts of your body as much as possible, draw air into your lungs again. Hold your breath as you inhale. Exhale, feel relief, breathe calmly. Continue to relax your chest, allow this feeling to move to your back, shoulders, neck and arms.
3. Pay attention to your abdominal muscles. Tighten your abdominal muscles and let your stomach become firm. Focus on tension. Relax, release tension and feel the contrast of sensations. Tighten your abdominal muscles again. Hold this tension, study it. Relax. Feel that pleasant feeling that occurs when you relax your stomach. Pull your stomach in. Feel the tension. Now relax again and let your stomach return to its natural position. Continue to breathe easily and freely, feel the pleasant effect of the massage in the chest and abdomen. Draw your stomach in again and feel the tension. Relax your stomach completely. Allow tension to dissipate as relaxation spreads. Feel your stomach relax more and more. Release all tight muscles throughout your body.

1. Pay attention to your lower back. Arch your back, bend well and feel the tension along your spine. Return to a comfortable position and relax your lower back. Simply arch your back and feel the tension as you arch. The rest of the body should be as relaxed as possible. Localize the tension in your lower back. Relax again, more and more. Relax your lower and upper back, allowing the relaxation to move to your stomach, chest, shoulders, arms and face. Relax these parts more and more, deeper and deeper.

Break 30–60 seconds

Lying on your back, slow deep breathing: take a deep breath through your nose (the belly inflates) – exhale deeply through the mouth (the belly retracts).

Relaxing the thighs and calves (10–15 minutes)

1. Tighten your gluteal and thigh muscles. Tighten your thighs by bending your legs as far as possible. Stretch your legs, relax and feel the difference. Bend your knees again and tighten your thighs. Hold this tension. Stretch your legs again, relax your thigh muscles. Let the relaxation process happen naturally.
2. Stretch your feet away from your head so that your shins are tense. Explore this feeling of tension. Relax your feet and calves. Now stretch your toes towards your head and again feel the tension in the muscles of your lower leg. Return your feet to their original position. Relax again, stay relaxed for a while. Allow yourself to relax even more. Relax your feet, legs, knees, hips and buttocks. Feel the heaviness in your lower body as you relax.
3. Allow the relaxation to move to your stomach, waist and lower back. Let it penetrate deeper and deeper. Relax your jaw and neck, as well as all the muscles in your face. Allow your body to relax for a while. Allow yourself to relax.

Completion 30–60 seconds

Inhale deeply and feel how heavy your body is. Exhale slowly. If you are truly relaxed, you will not be able to move a single muscle. Think about the effort it would take to lift your right arm. As you think about this, notice if tension appears in your shoulders and arms. Now you understand that it is better not to raise your hand, but to continue to relax.

1. If you have elderly relatives in your family, familiarize them with the situation and tell them how to reduce the risk of infection. Try to speak in simple language, without using unnecessary terminology, so that older people can understand you. Repeat this information as necessary. Make sure that your elderly relatives have a supply of necessary medications [26].
2. Try to maintain an emotionally favorable climate with family members who live with you, reduce the level of conflict, avoid mutual accusations, cope with irritability and intolerance [11].

Prolonged stay in a constant shared space can lead to aggravation of interpersonal tension, quarrels, and conflicts. To maintain mental balance, emotional stability and favorable relationships with loved ones, it is advisable to create pauses during the day for solitude, pursuing your own affairs and interests.

It is also important to take into account the preferences of other family members and find a balance between all residents.

1. If you cannot cope with stress on your own, seek help from psychological and psychiatric specialists. This will allow you to avoid the long-term consequences of stress and “pathologization” of emerging reactions [1; 3].

Other ways to relieve stress

Tonic or relaxing baths will help relieve general stress in the body. You need to lie quietly in the bath, putting a towel under your head and relaxing your muscles. The heart area and neck should be under water. After this procedure, lie down or sit for about an hour.

In stressful situations, people often blame themselves or someone else, this is human psychology, but this should not be done. Remember, any situation can be fixed. Ask your loved ones to help you. Try to understand the reasons for what happened and reconsider your attitude towards what happened so that this does not happen again in the future.

The psychology of the experience is such that if you do not get rid of it, then stressful tension and further aggravation of stress are guaranteed for you. So try to be less distracted by various failures and spend more time on yourself, your family, relatives and friends. Learn to relax, spend more time in the fresh air, and no amount of stress can ruin your health and your life.

Tips for parents to help children cope with stress during the COVID-19 outbreak

1. Encourage children to talk to you and be understanding and empathetic when interacting with them. Children may react differently to the situation that has arisen: violate discipline and show aggression, withdraw emotionally and experience a sense of resentment towards their parents due to forced restrictions; feel anxious, angry, or emotionally agitated; suffer from bedwetting; experience frequent mood changes, etc. [27]

1. Children usually feel relieved when they can express their feelings in an understanding and supportive environment. Every child has their own way of expressing emotions. Sometimes engaging in creative activities such as playing and drawing can make this process easier. Help children find open ways to express feelings [27].
2. Try to create a friendly environment for the child. Children need more love from adults and their attention in difficult times [27].

Remember that children often react to adults' emotions, so adults need to monitor their reactions and statements regarding the pandemic situation. It is important that adults are able to cope with their emotions and remain stable in their mood [27].

If possible, maintain the usual rhythm of life or help create a new way of life in new conditions. It is important to maintain the child’s usual activities – educational activities, games and leisure activities. Structuring a child's life helps him adapt to a change in his usual rhythm. Try to create conditions to ensure that the child is physically active [27].

1. Explain to children what is happening and how to reduce the risk of infection in a simple, accessible and age-appropriate manner. For example: games with rhymes to develop hand washing skills; invented stories about the virus to clarify the mechanism of infection and the need for self-protection measures; playful forms of house cleaning and surface disinfection; draw a virus, microbes for coloring; Explain to children how personal protective equipment works so that they are not afraid of it [27].
2. Avoid speculation on rumors or unverified information in the presence of children [27]. If you are unable to help your child cope with stress on your own, seek help from psychological and psychiatric specialists. This will avoid long-term consequences of stress and pathologization of emerging reactions [15].

Method 5: smile and breathe

Overcoming stress is actually about pretty simple things. But for some reason they are the ones that are more difficult for us to accomplish. It’s easier to buy medicine, do yoga, perform rituals and tie red strings on your wrists than just smile at the new day and breathe deeply.

10 deep breaths will save you from irritability. Imagine yourself as a kind of apparatus in which universal evil has accumulated. Inhale - we take good from the world and retain it within ourselves. Exhale - let out your steam. Inhale and exhale. We understand that smiling through force is a willful effort on oneself. But a few smiles or reasons to laugh will help brighten up your mood significantly.

Watch a comedy, scroll through funny photos on Instagram, read good stories. Build your inner world!

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Important Resources:

1. Ministry of Health of the Russian Federation – https://www.rosminzdrav.ru
2. Rospotrebnadzor – https://rospotrebnadzor.ru
3. https://www.stopcoronavirus.rf
4. World Health Organization – https://www.who.int/ru

Authors of recommendations

Belyaev Alexey Mikhailovich Doctor of Medical Sciences, Professor, Director of the Federal State Budgetary Institution “National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia, Head of the Department of Oncology, North-Western State Medical University named after. I.I. Mechnikov of the Ministry of Health of Russia, chief freelance oncologist of the Northwestern Federal District

Bortnikova Elena Gennadievna Candidate of Psychological Sciences, Associate Professor of the Department of Clinical Psychology and Psychological Assistance of the Federal State Budgetary Educational Institution of Higher Education Russian State Pedagogical University named after. A.I. Herzen, medical psychologist of the rehabilitation department of the Federal State Budgetary Institution “National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia

Vagaytseva Margarita Valerievna Candidate of Psychological Sciences, Researcher of the Scientific Department of Innovative Methods of Therapeutic Oncology and Rehabilitation of the Federal State Budgetary Institution National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia, medical psychologist of St. Petersburg State Clinical Institution "Hospice No. 1", director of the Association of Oncopsychologists of the North-West Region

Karavaeva Tatyana Arturovna Doctor of Medical Sciences, Head, Chief Researcher of the Department of Treatment of Borderline Mental Disorders and Psychotherapy of the Federal State Budgetary Institution National Medical Research Center of Psychiatry and Neurology named after. V.M. Bekhterev" of the Ministry of Health of Russia, leading researcher of the scientific department of innovative methods of therapeutic oncology and rehabilitation of the Federal State Budgetary Institution "National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia, Professor of the Department of Medical Psychology and Psychophysiology of the Federal State Budgetary Educational Institution of Higher Education of St. Petersburg State University, Vice-President of the "Russian Psychotherapeutic Association"

Komarov Yuriy Igorevich Candidate of Medical Sciences, head of the department for organizational and methodological work with regions - methodologist, researcher at the scientific department of innovative methods of therapeutic oncology and rehabilitation of the Federal State Budgetary Institution "National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia

Kondratyeva Kristina Orkhanovna Assistant, Department of Clinical Psychology and Psychological Assistance, Federal State Budgetary Educational Institution of Higher Education, Russian State Pedagogical University named after. A.I. Herzen, Researcher of the Scientific Department of Innovative Methods of Therapeutic Oncology and Rehabilitation of the Federal State Budgetary Institution "National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia, medical psychologist of the rehabilitation department of the Federal State Budgetary Institution "National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia

Semiglazova Tatyana Yurievna Doctor of Medical Sciences, Associate Professor, Head of the Scientific Department of Innovative Methods of Therapeutic Oncology and Rehabilitation - Leading Researcher of the Federal State Budgetary Institution "National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia, head of the rehabilitation department - oncologist of the Federal State Budgetary Institution "National Medical Research Center of Oncology named after. N.N. Petrov" of the Ministry of Health of Russia, Professor of the Department of Oncology of the North-Western State Medical University named after. I.I. Mechnikov of the Ministry of Health of Russia