 So, today we are going to begin with the next module. This is basically a module where we would be putting two, three different topics together. Usually if you go for the curriculum of most of the inverse you would realize that these topics are discussed separately. Here we would be first talking about stress, then we would be talking about post-traumatic stress, then we will go to resilience, then we will go to coping. So, these are the four broad topics that we would be covering as part of this module. All of them can be discussed as a separate module all together, but the reason why we are putting all of them together is that we are again trying to draw a continuum and try to understand that there are certain life circumstances which leads to certain ends. And from adjustment view point is it that there is a possibility of one understanding the continuum. That is how the situation leads somebody to explore the possibility that is there still a possibility of coming back, three we are trying to we will also try to make a distinction know that is it that up to this level it is still manageable and beyond this it proceeds towards a situation where more of clinical interventions are needed. So, that is the reason we are putting all of them together. Therefore, what we would do is that we will start with stress, we will initially talk about the gamut of symptoms, the way it is manifested in human responses. Then we will also look at know some then we will also look at the biochemical regulation of stress, we look at two important syndromes what is called as the general adaptation syndrome popularly called as gas and then the burnout syndrome what is popularly called as boss. But once we cover this part of the stress we will also look at the situation where the stress reactions manifested by individuals could become extremely intense in nature and that is where we would know talk about something that is usually not talked about with respect to stress rather it is talked about when people talk about disorders. So, we are not interested in understanding a human behavior with respect to disorders rather we are more interested understanding human behavior with respect to the point of origin the starting point to the gradual increment in the intensity of the symptoms and because we would also be looking at the other end of the spectrum therefore, we would be looking at some of the symptoms which are actually part of a stress symptoms but because of the gravity of the symptoms they are considered as disorders. So, the end of the discussion on stress would be on acute stress disorder where stress is no more something that can be managed on one's own rather you need a proper clinical intervention. After we complete this part of a stress then we would move to post traumatic stress you remember some time back we had talked about the fact that there is still a debate in psychology that whether post traumatic stress should be classified as a disorder or it should not be classified as a disorder. If you look at the initial proposition when PTSD was included in the clinical categorization of disorders there it was clearly stated that this is a disorder even we would look at the diagnostic criteria which is actually not taken from the diagnostic and statistical manual. So, it is exactly how worldwide this disorder is supposed to be identified we would look at that but then we would also look at the emerging view point which says which gives an argument that PTSD should not be considered as a disorder. We would not go into this debate at length but I will I just want you to know that this is an ongoing debate right now. Once we complete PTSD we would move to the positive dimension of post traumatic stress means there is a possibility that say if 100 people they experience a traumatic event in life it is not that all of them becomes susceptible to post traumatic stress rather in fact we will also see some of the epidemiological data which suggests that only a small percentage becomes you know susceptible to PTSD. A larger chunk rather evolves as a much better human being so that is the positive reflection of a traumatic experience this is referred to as post traumatic growth. So, after we complete our discussion on PTSD then we will move to PTG post traumatic growth. There also we would look at you know two different models third model is just that sorry type of a thing so we will just superficially touch the third model but two models we would really you know look into them at length. Once we complete PTSD then we would move to the inability capacity of the individuals to bounce back in an adversity what is called as resilience. So, we will devote some time to resilience and then of course the ability of a human being to finally fight back and come forth what is referred to as coping. So, that would be the whole spectrum of discussion as part of this module. Usually stress is looked upon with respect to demanding life situations which an individual considers difficult enough to handle. So, basically it is your subjective interpretation that the situation that you are encountering is you know so difficult that you have extreme problem in terms of handling it. Another interpretation that we provide to a stressful situation is that it exerts certain demand on our physical resources or psychological resources as well as on our emotional resources. So, a time comes when you feel you are physically incapable of you know still continuing with this process when you realize that you are psychologically fatigued you do not have the strength to come forward with an appropriate response and even emotionally you feel that you are drained. So, you do not show the level of emotional involvement that one is expecting from you in that type of a situation and it is the nature and the intensity of the situation that decides whether this situation would be understood by you would be accepted by you as a normal situation or would it be interpreted as a stressor. So, stressor would be a situation that induces a stress reaction in you. Now, what is very interesting is that a stressful situations can have positive outcomes it can also have negative outcomes usually what we usually talk about in most of our discussions is the negative outcome of stress we usually do not focus on the positive corollaries of the stressful situations. One syllabus ecologist who worked extensively on stress and little later we will come to one of the popular models given by him. He said that you can look at a stressful situations, stressful conditions and you can bifurcate them into two heads you have use stress and distress. So, stressful conditions that finally, it is positive outcomes though the stressful situations he said that these are your stress. But if conditions put you high demand on you and it you know challenges your ability to cope with it and finally, it leads you to a direction where the outcome is negative then this situation this condition becomes distressful. Now, according to Hansel the difference between you stress and distress depends on the real or imagined experiences as well expectations of the individual. Means whether you would consider a particular situation to be stressful or not that would primarily depend on your real experience. It could also depend on your fabricated you know imagination. So, you do not have the real experience you do not have the real rational ground for making that situation considering that situation to be a stressful, but you fantasize certain things and based on your imagination you consider this situation to be extremely stressful. And the third factor that would also play role is what actually you expect from yourself in that very situation and how capable you feel that you would be able to meet that expectation or your feeling that you will fall short of the expectation in that very situation. That will finally, make you decide whether to consider this situation to be a you stress or distress. So, this is what Hansel says many situations you can realize now for example, you have to prepare for your mid semester examination right now you all have gone through it. Now, there is a stress that is built up within you you realize that this is the date and you also realize that you are not so well prepared for certain set of subjects and certain courses and therefore, you put extra effort. You compromise with your leisure time, you compromise with your sleep time, you compromise with the time which you otherwise invest in the wing talking to friends all those things you compromise with. And there is an extra emphasis on the level of preparation that you expect that you should certainly have to face the mid semester examination. That type of a condition where you are looking at certain imaginary experience. You do not have the real experience of this mid semester examination, but you have experience of certain examinations. So, you know what examinations mean you also know finally, what is expected out of your participation in the examination process and you have certain expectation from you. This finally, makes you decide that whether I should cut from certain engagements and dedicate more and more towards studies or there is no need for it. And therefore, you realize that if you are still you know compromising with your investment of time and energy in other activities and investing it into studies and you feel great I am now well prepared for the examination. The situation although you experience that stress, but that stress did not lead to any negative outcome. You experienced it you had you know redesigned your time and energy and based on you know this withdrawal from certain engagements and reinvestment in studies made you very nicely handle the situation cope with the situation. You got good grades and this stress has finally, led to some positive outcome. Situation like you are say you are supposed to put an exhibit integrity and you invest your entire time and energy for making that thing come into place. The stress that you undergo is tremendous, but it does not lead to a negative outcome it leads to a positive outcome. So, there could be many such situations in life where you realize that the final product of the stressful situation was positive it was not negative and this is what Hans Leib considered that these are you stress in life you derive positive outcome out of it. Problem comes when you have you know conditions where you have your own experience to say that it is really demanding and you are not competent to handle it or you consider that you know I cannot meet the expectation or you imagine certain things and that makes you know finally, come forward with few or lot many negative you know outcomes out of the imaginary know ideas that you are trying to evolve and then such situations becomes extremely stressful. It could start from small things in life and go up to much, much, much bigger things in life. I will start with the smaller events where you could have difference between individuals and then we would know go to the extreme of it. Couple of years back to three years back some of us decided to go to the city for dinner and one of the members in our group said that you know he suggested a restaurant and when we asked that when did you come here and he gave a very interesting explanation and he said that you know I had come to Kanpur central to board a train. My train was declared five hours late so I thought what to do there is there was no point waiting on the railway station for five hours so I went to watch a movie and half way I thought what is the point in watching such a bad movie so I went to this restaurant which was nearby I had my food then I came to the station boarded the train and went to wherever I was supposed to go I thought fantastic I did reflect on my own self and I thought that if I was told that your train is five hours late I would have still sat on the platform. At max you know go to the waiting room and then engage yourself mentally into some activity but I could have never ever dared to know go to a theatre which is nearby watch a movie half way go to a restaurant have some food again come back to the station for me it was impossible but I do admire people who think like this know and who really executed and then suddenly another thing came to my mind it is a couple of years back two of us me and one of my colleague both the first were coming back after trip abroad and we were in one of the hotels which was very very close to the New Delhi railway station we had our train in the night Shramshakti so we were very relaxed we had our dinner and then we decided it because we have sufficient time so we will even take a nap and then just twenty twenty five minutes before the departure time we will go to the station and I think around seven o'clock this train was around midnight no eleven fifty in the night so around seven o'clock this colleague of mine tells me that I think you should call the reception and settle the bills okay I told him that no I would settle it when we check out okay so maybe in between we might need something who knows so we will settle the bill at the time of checking out he said okay again after ten minutes again after ten minutes okay he will remind me that no you should settle the bill and we had sufficient time no from the hotel if say consider that everything was there was a complete traffic jam and if we would have started moving on our foot then also in ten minutes time you would have reached the station we were so close to it okay and still two hours in advance this colleague of mine tells me that no no no we should go to the station now okay finally I had to surrender one hour before time went to the station and then in that train I asked him that no just look back no right from seven o'clock in the evening when you started telling me that I should be settling the bill to boarding the train and he said that yes I am like that if I have to board a train in the night right from the morning I know I get ready and then I'll see clock thousand times I'll no do this I'll do that this is the amount of no discomfort that you generate you do not know that this time how pleasant or unpleasant the journey is going to be perhaps you had some uncomfortable journeys in the past or you had both type of experiences comfortable as well as uncomfortable journey but then you imagine this can happen that can happen even that can happen okay and you keep on keep on you creating a pile in and around you so high okay that finally you realize that the pressure that you are putting on your own self okay becomes too much the reason I am giving these examples are okay same situation boarding a train okay but then somebody who's a real experience somebody who's imagined experience okay and expectation no you find completely people in two different directions and I would consider my own no thought at that time of course not going towards the extremes but it was still no more likes a standing still on the station now human beings vary in those terms like this no where each situation there would be different interpretation somebody who might consider the situation to be very very stressful the other person might not consider it to be that I don't remember the name of the movie but once I had watched it tell me the name of an actor not so well known but for acting he is known but not a big name like the stars some Pandey or something the fat man little shorter in height little plump no no no not sort of Shukla not sort of Shukla I am not getting his name some Pandey most probably okay and Neha Dhupia okay Delhi Chalo yeah Chalo Delhi I don't know is it Delhi Chalo or Chalo Delhi what is the name of the movie but one of these names okay there is this have you watched this movie no there is no a beautiful plot I liked it I don't know whether you would like it or not basically it shows that this women is trying to he she has to board a flight she has to go to Delhi and there is this man also who has to board the same flight and to go to Delhi okay and they had tough time managing the traffic in Bombay and finally they managed to board the plane and because of certain reasons instead of landing in Delhi the flight lands in Jaipur okay it happens several times no so the flight lands there and the reason why I am taking this example is that there are certain situations in that movie where the lead actress will repeatedly say oh oh God that's terrible okay unbearable and the actor says he repeatedly throughout the movie he keeps on repeatedly saying okay and the moment he says no it's once twice it was okay this lady gets irritated no but what else do you want no because every time you say it's and it goes to all types of extreme no they board a local train they have a pick pocketing they don't have money they have they get in a small time hotel then there is a curfew in the city all types of things happen but the best part was the end of the movie where this lady along with her husband who was in the armed forces he comes to Jaipur to not Jaipur somewhere between Jaipur and Delhi in the road and then this officer comes and takes her wife back to Delhi this man also accompanies no and then he gets down at one of the locations in Delhi and this husband wife paired they move and then the wife says that she was supposed to travel abroad and she says that I'm not traveling abroad so we'll celebrate the birthday here and the husband reminds him that won't you like to invite this man with whom you had shared this fantastic journey and then she comes back searches the house of this man to realize that her wife was sorry his wife was completely paralyzed lying on the bed was not able to even speak and then this lady says that what you are experiencing in life compared to this all that we experienced throughout this journey it is really too small so now I can make sense of when you said to me constipated and now I can make out okay that you have seen so much you know of things in real life that rest all of the events are too you know small compared to this life experience okay there are beautiful things no the reason I am talking about that movie with respect to stress is multiple reasons no there is also a sequence in that movie where this husband goes and says something to the wife that you know somebody has come a guest has come say hello to her and all those things and then he goes and brings the water and something for her and then this guest asks her that what's what has happened to your wife and she say and he says that my wife my wife car she's completely paralyzed and she can't even speak and then that lady asked but you were talking to your wife and he says yes she can't talk no but I can't talk no so I continue talking to her the reason I am giving such examples are that you have extreme situations of course it's a cinematographic representation of the event I don't know but I'm sure there would be many many people know in this world who would have similar type of life experience no but it sends a message to you that even when you have an extremely stressful situation in your life where you are handling a patient who is very close to a terminally ill situation you are still know very happily managing the whole sequence of life no and the rest of the events of your life you enjoy like anything so that is what you stress and distress primarily means so basically it is your real life experiences your imagined experience as well as what you expect of yourself in that very situation that finally makes you decide whether you would make that condition that situation you would consider it stressful for yourself or not if you look at the symptoms of stress what we are doing is that we are classifying into them into three categories know the physical symptoms the symptoms which are reflected in terms of behavioral manifestation and then the psychological reactions that we see in terms of physical symptoms of stress one can experience tension in the muscles and that's the reason why you would realize that people who are under tremendous stress okay they are reportedly repeatedly they report of you know certain aches okay and their aches are very interestingly they are localized in certain parts of the body so usually you will find people saying that you know this region no they have aches in the back and chronic aches okay then the lower foot muscle okay so there are selected muscles of the body usually where people report that they are facing muscle tension but even otherwise also know in a stressful state one can have know multiple muscles which can you know become tense including something like say clenching of the stomach muscles okay we do not have voluntary control over the movement of our stomach muscles okay but in the stressful state even the muscles of the stomach also the clench okay and that's the reason you have sometimes know butterfly sensation in the stomach there might be change in the eating habit okay but change also can be again you know both ways either you start eating very little compared to what you used to eat or you start eating more and more compared to what you used to eat okay so there could be an under or an overeating type of phenomena and that's the reason why you would realize that after overcoming the state of especially depression many people become plump because you keep on keep on consuming food without realizing okay that you didn't need it okay so you are doing something meanwhile you are still you know continuously eating something and you over eat and finally at the end of that state you realize that gradually you have accumulated more and more of weight there could be bowel upset so earlier say if morning the moment you leave your bed you used to go to the toilet it could be delayed okay or you could go multiple times to the toilet so complete bowel upset can be there there could be repeated episodes of headaches and even if you read headaches the type of headaches okay there is something called you know tension headache okay that basically it has to do with the contraction reduction of the muscles here okay which leads finally to the headache okay there could be back aches complete sense of restlessness okay and you realize that at the end of the day you are exhausted you are fatigued okay you are drained out of your physical energy but in the state of stress gradually what happens that most of the time you leave the bed early in the morning and again you feel that you are you know completely completely completely running out of your energy so irrespective of the time of the day you realize that you do not have energy at all then we come to the behavioral manifestation one might have a difficulty concentrating on something so you are watching movie and you realize that you heard the dialogues but then you do not remember what the actor or the actress on the screen right now said so you constantly keep on keep on shifting between channels okay but trying to read books and you keep on keep on looking at the font but you are not able to recollect what you are actually reading okay so complete you know problem in terms of concentrating on any event decrease duration of the sleep okay that could be there so instead of say if you used to sleep for six hours seven hours now it has reduced to five hours or there could be repeated no waking sessions during the sleep that is the sleep disturbances no so you sleep for some time and say half an hour one hour and suddenly you wake up again you remained awakened for say half an hour you feel drowsy and again you sleep again after two three hours you wake up so repeated you know disturbance in the sleep that could also be there one can also report difficulty in terms of recollecting things from memory okay say I remember something had happened right now I am not able to recollect it so that is you know the difficulty in terms of recollecting something from your memory okay there could also be an increase in the clumsiness level clumsiness level would mean that earlier if I used to say for example I have to go to the bag and put all these stuffs there earlier if I used to do it with precision okay now when I do it I still I am able to do it but then maybe that sometime the laptop hits the bag harder or my finger no gets stuck in the zip okay or I scratch my skin I rub it against some surface means that accident proneness in my day to day behavior increases earlier if I had to take a seat somewhere here I would very easily manage to go but now when I move sometime I hit another chair okay sometime when I walk I suddenly you know happen to mismanage my steps on the staircase okay so that is the increase in the clumsiness level okay there could also be in certain cases no people in whom you would find that their intake of cigarette alcohol okay drugs that can also increase most important thing that you realize that this person who is under stress would start withdrawing from the activities where he or she used to earlier get engaged himself or herself in okay so say earlier if every evening this boy or this girl would go for games now even if you invite him or her that okay okay we are going for to the sports ground join me okay and this person gives you one or the other excuse but doesn't join you okay so you start withdrawing from your regular engagements in the worldly activities okay and most importantly if you invite the person twice or thrice are a chalo chalo chalo here okay the person becomes irritated no so you cannot manage even when small small changes in your life circumstances and you easily become irritated okay those are the behavioral manifestations then we come to the psychological reactions suddenly the overall you know manifestation of anger increases okay so you tend to be very easily angry okay there could be a possibility of increase in the level of anxiety fear confusion as well as body okay but very interestingly when you know these people turn angry in the state of stress when you turn angry you realize that you suddenly burst into tears while shouting at other person so say I am angry I shout at you but while I am shouting suddenly you know I have no change in my voice I have tears in my eyes okay so great degree of tearfulness comes okay frequent emotional outbursts no so it's not only anger but other types of emotions also know frequently one sees outbursts one can also have diminutive thoughts and overall decrease in self-confidence you understand what is diminutive thought say if I ask you that just look back at your past experiences of this life and overall what would you say how life has been for you you would find two sets of people people who would usually know selectively choose negatively oriented situations and say that it has been really tough but okay I have managed but I don't know there many things happened that should not have happened one set the other set who would say it's a mixed bag of experience but overall good and when you ask that say if you scratch some details so what were the odds in the mixed bag and then you say you know I remember I had a very good friend and later on for certain reasons we developed some misunderstanding now when I look back I think I should have clarified the doubts okay these are two distinct set of people somebody who looks back interprets the situation okay what he or she is doing is adopting a reflective thought you reflect upon your life experience okay so reflection would be that you take a very balanced view point of the life we consider that you know life will cannot be only and only positively oriented for somebody okay it will always have no mixture but then when you look at it okay you reflect upon it you do not feel that life had really asked you to pay a heavy price for whatever you have attained okay and overall you show certain degree of acceptability certain degree of no confidence that finally see I have been able to attain this level okay these are the indicators of your reflective thoughts the example that I took that even something if I scratch and say that so share some of the negative experiences when you said that life was mixed bag of experience for you and you say that I had a good friend know my school days we were very good friends no during our coaching period for JEE we developed some misunderstanding and now we do not even talk to each other okay since last three years I haven't talked to him okay you reflect back and you say that I still regret missing a good friend like him this is reflection but what happens instead of reflective thoughts in the stage of stress you have a diminutive thoughts and diminutive is the earlier example that I was giving no that you selectively choose the negative experiences of life and you say that you know I didn't had a good sleep that last night in the morning I didn't feel waking up when I went to the bathroom know the pressure of water was little slow and when I came to T201 even the person who was supposed to do the recording was also late okay because of him the whole thing was delayed since morning life has not been exactly the way I have interpreted it right now but what I have done I have selectively selectively chosen only only negative things and then I have put them all together many people in their life they what they do usually they will select you know the negativities of their life experiences they will stack them together and to say how painful life has been for him or her and during the stage of stress this is usually what happens no you do not take a balanced view of the life rather you selectively choose only the diminutive thoughts thoughts which will further make you stressed okay thoughts that will further make you depressed so I have not only stressed out of the fact that I have to give my mid semester examination but my good friend Saurav also is not prepared well for the exam okay I think there is some Saurav here no but this is a hypothetical example at have to okay then I say oh I think we know there is also not prepared and Ajit has also not prepared so I collectively take know the burden of all of them to make myself more and more stressed to say that it is not only the instructor will tell me that you have underscored it is not that my parents will tell me that you have underscored but they will tell me that all your friends have underscored okay and therefore all of you are doing something other than academics okay these are no diminutive thoughts so in the stage of stress you would realize that instead of reflective thoughts one recollects more and more of diminutive thoughts any question good then we come to the biochemical regulation but I think you know we have only five minutes left so we won't move to biochemical regulation the reason being that again next day I will have to continue with it for long so therefore we will know return back to the symptoms of stress rather than going to biochemical regulation next day when we meet we will go ahead with the biochemical regulation but there is an interesting no phenomena in a stress that many of our what you call behavioral engagements they can easily help us manage many of these symptoms okay life would give some stressful experience to everybody that is truth of this life but out of whatever life gives to you the stressful conditions many of them can still be managed okay they can still be managed either with the capabilities that one oneself has or with the help of the group resources okay but stressful events can certainly be managed but if one realizes okay that one has developed one of them or a group of them usually it will be a group no so you will have some of physical some of psychological some of behavioral that group and if you're near and dear ones tell you that why are you you know so irritated now what is no you very easily get irritated earlier used to be a you used to be a very pleasant friend of mine okay usually are usual tendencies to snub the friend and say come on come on always I was like this okay there is a beauty that if somebody tells you something somebody gives you a feedback about your behavior okay do respond back there is no harm in responding back but just wait for some time take time okay and then come forward with the response but that no latency period that you are providing to yourself will at least know help you gauge whether your reaction which was given by a real really true friend because he or she has told you what change he or she has seen in you okay there should be certain degree of acceptance okay and if you show this type of a latency period this latency period will allow you to accept things at least to certain degree you might not accept it completely because you are under tremendous stress but at least you will be able to digest a bit of it okay that will also allow you to manage your anger once we complete our discussion on this module then the next module we would be referring to anger there and one interesting technique even in anger management is what is called as one two three technique one two three technique is basically I feel angry I feel shouting at you but then before I shout I start counting one two three one two three three two one one two three three two one okay so you count it couple of times no and because you are in the state of anger so clinch your fist and then you say one two three three two one one two three three two one and you would realize that gradually part of the anger subsides okay this type of no exercise where you provide a latency period to yourself before responding to somebody okay helps you both ways no it helps you in your stressful state it also helps you manage your anger okay the great thing when we come to anger they will realize that the great thing also is that you do not become a person who is considered impulsive by others okay but do know do not delay the response also too much otherwise people would consider no that you are a tube light who takes a longer time to process the information and then to respond accordingly okay so we will end up here