Stress

Stress (Theory by Hans Selye)
  • Non specific response of the body to nay demand made upon it
  • Any situation in which a non specific demand requires an individual to respond or take action

1. Characteristics of Stress

  1. Stress is not nervous energy. Emotional reactions are common stressors
  2. Stress is not always the result of damage to the body
  3. Stress does not always result in feelings of distress (harmful or unpleasant stress)
  4. Stress is a necessary part of life and is essential for normal growth and development
  5. Stress involves the entire body acting as a whole and is an integrated manner
  6. Stress response is natural, productive and adaptive

2. Stressors

  • Factor or agent producing stress, maybe: physiological, psychological, social, environmental, developmental, spiritual or cultural and represent an unmet needs
  1. Classification of Stressors
    • Internal Stressors – originate from within the body. E.g. fever, pregnancy, menopause, emotion such as guilt
    • External Stressors – originate outside a person. E.g. change in family or social role, peer pressure, marked change in environmental temperature
  2. Factors influencing response to stressors
    • Physiological functioning
    • Personality
    • Behavioral characteristics
    • Nature of the stressor: integrity, scope, duration, number, and nature of other stressors
  • Homeostasis – Process of maintaining uniformity, stability and constancy with in the living organisms. (From Greek word homotos – like, and stasis – position)
  • Adaptation – Body’s adjustment to different circumstances and conditions. Process by the physiological or psychological dimensions change in response to stress; attempt to maintain optimal functioning
Adaptation to Stress-Physiological Response (Hans Selye)

1. Local Adaptation Syndrome (LAS) – Response of a body tissue, organ or part to the stress of trauma, illness or other physiological change

  1. Characteristics
    • The response is localized, it does not involve entire body systems
    • The response is adaptive, meaning that a stressor is necessary to stimulate it
    • The response is short term. It does not persist indefinitely
    • The response is restorative, meaning that the LAS assists in restoring homeostasis to the body region or part
  2. Two Localized Responses
    • Reflex Pain Response – is a localized response of the central Nervous system to pain. It is an adaptive response and protects tissue from further damage. The response involves a sensory receptor, a sensory nerve from the spinal cord, and an effector muscle. An example would be the unconscious, reflex removal of the hand from a hot surface.
    • Inflammatory Response – is stimulated by trauma or infection. This response localizes the inflammation, thus revenging its spread and promotes healing. The inflammatory response may produce localized pain, swelling, heat, redness and changes in functioning.
  3. Three Phases of Inflammatory Response
    • First Phase – Narrowing of blood vessels occurs at the injury to control bleeding. Then histamine is released at the injury, increasing the number of white blood cells to combat infection.
    • Second Phase – It is characterized by release of exudates from the wound
    • Third Phase – The last phase is repair of tissue by regeneration or scar formation. Regeneration replaces damaged cells with identical or similar cells.

2. General Adaptation Syndrome (GAS) or Stress Syndrome – characterized by a chain or pattern of physiologic events.

  1. 3 Stages
    • Alarm Reaction – initial reaction of the body which alerts the body’s defenses. SELYE divided this stage into 2 parts:
      • The SHOCK PHASE
      • The COUNTERSHOCK PHASE
    • Stage of Resistance – occurs when the body’s adaptation takes place; the body attempts to adjust with the stressor and to limit the stressor to the smallest area of the body that can deal with it.
    • Stage of Exhaustion – the adaptation that the body made during the second stage cannot be maintained; the ways used to cope with the stressors have been exhausted
  2. Stressors
    • Stimulate the sympathetic nervous system, which in turn stimulates the hypothalamus.
    • The HYPOTHALAMUS releases corticotrophin releasing hormone (CRH). During times of stress, the ADRENAL MEDULLA secretes EPINEPHRINE & NOREPINEPHRINE in response to sympathetic stimulation. Significant body responses to epinephrine include the following:
      • Increased myocardial contractility, which increases cardiac output & blood flow to active muscles
      • Bronchial dilation, which allows increased oxygen intake
      • Increased blood clotting
      • Increased cellular metabolism
      • Increased fat mobilization to make energy available & to synthesize other compounds needed by the body.

Stress

Physiologic Indicators of Stress
  1. Pupils dilate to increase visual perception when serious threats to the body arise.
  2. Sweat production (diaphoresis) increases to control elevated body heat due to increased metabolism.
  3. The heart rate & cardiac output increase to transport nutrients and by-products of metabolism more efficiently.
  4. Skin is pallid because of constriction of peripheral vessels, an effect of norepinephrine.
  5. Sodium & water retention increase due to release of mineralocorticoids, which results in increased blood volume.
  6. The rate & depth of respirations increase because of dilation of the bronchioles, promoting hyperventilation.
  7. Urinary output may increase or decreases.
  8. The mouth may be dry.
  9. Peristalsis of the intestines decreases, resulting in possible constipation and flatus.
  10. For serious threats, mental alertness improves.
  11. Muscle tension increases to prepare for rapid motor activity or defense.
  12. Blood sugar increases because of release of glucocorticoids & gluconeogenesis.
Psychologic Indicators
  • Psychologic manifestations of stress include anxiety, fear, anger, depression & unconscious ego defense mechanisms.
    1. Anxiety – a common reaction to stress. It is a state of mental uneasiness, apprehension, dread, or foreboding or a feeling of helplessness related to an impending or anticipated unidentified threat to self or significant relationships. It can be experienced, subcutaneous or unconscious level.
    2. Fear – an emotion or feeling of apprehension aroused by impending or seeming danger, or other perceived threat. The object of fear may or may not be based in reality.
    3. Anger – an emotional state consisting of a subjective feeling of animosity or strong displeasure. People may feel guilty when they feel anger because they have been taught that to feel angry is wrong.
    4. Depression – common reaction to events that seem overwhelming or negative. It is an extreme feeling of sadness, despair, dejection, lack of worth or emptiness.
  • Emotional symptoms can include: Feelings of tiredness, sadness, emptiness, or numbness
  • Behavioral signs include: Irritability, inability to concentrate, difficulty making decisions, loss of sexual desire, crying, sleep disturbance and social withdrawal.
  • Physical signs include: Loss of appetite, weight loss, constipation, headache and dizziness
Cognitive Indicators
  • Are thinking responses that include problem-solving, structuring, self-control or self-discipline, suppression and fantasy
    1. Problem solving – involves thinking through the threatening situation, using a specific steps to arrive at a solution
    2. Structuring – arrangement or manipulation of a situation so that threatening events do not occur.
    3. Self-Control (discipline) – assuming a manner of facial expression that convey a sense of being in control or in change.
    4. Suppression – consciously and willfully putting a thought or feeling out of mind
    5. Fantasy – (daydreaming) – likened to make believe. Unfulfilled wishes & desires are imagined as fulfilled, or a threatening experience is reworked or replayed so that it ends differently from reality.
Coping Strategies (Coping Mechanisms)
  • Coping – dealing with problems & situations or contending with them successfully.
  • Coping Strategy – innate or acquired way of responding to a changing environment or specific problem or situation.
  • According to Folkman and Lazarus, coping is “the cognitive & behavioral effort to manage specific external and/ or internal demands that are appraised as taxing or exceeding the resources of the person”.
Coping Strategies: 2 Types
  1. Problem-focused coping – efforts to improve a situation by making changes or taking some action
  2. Emotion-focused coping – does not improve the situation, but the person often feels better.
Coping strategies are also viewed as:
  1. Long-term coping strategies – can be constructive & realistic
  2. Short-term coping strategies – can reduce stress to a tolerable limit temporarily but are in the end of ineffective ways to deal with reality.
Coping can be adaptive or maladaptive:
  1. Adaptive Coping – helps the person to deal effectively with stressful events & minimizes distress associated with them.
  2. Maladaptive Coping – can result in unnecessary distress for the person & others associated with the person or stressful event.
  • Effective coping results in adaptation; ineffective coping results in maladaptation. The effectiveness of an individual’s coping is influenced by a number of factors:
    • The number, duration & intensity of the stressors
    • Past experiences of the individual
    • Support systems available to the individual
    • Personal qualities of the person
  • If the duration of the stressors is extended beyond the coping powers of the individual, that person becomes exhausted and may develop increased susceptibility to health problems.
  • Reaction to long term stress is seen in family members who undertake the care of a person in the home for a long period. This stress is called caregiver burden & produces responses such as chronic fatigue, sleeping difficulties & high BP.
  • Prolonged stress can also result in mental illness.
Relaxation Techniques
  • Used to quiet the mind, release tension & counteract the fight or flight responses of General Adaptation Syndrome (GAS).
  1. Breathing Exercises
  2. Massage
  3. Progressive Relaxation
  4. Imagery
  5. Biofeedback
  6. Yoga
  7. Meditation
  8. Therapeutic Touch
  9. Music Therapy
  10. Humor & Laughter
Psychological Response
  • Exposure to a stressor results in psychological and physiological and physiological adaptive responses. As people are exposed a stressors, their ability to meet their basic needs is threatened. This threat whether actual or perceived, produces frustration, anxiety and tension. Psychological adaptive behaviors assist the person’s ability to cope with stressors. These behaviors are directed at stress management and are acquired through learning and experience as a person identifies acceptable and successful behaviors.
  • Psychological adaptive behaviors are also related to as COPING MECHANISMS. It involves:
  1. Task – Oriented Behaviors – Involve using cognitive abilities to reduce stress, solve problems, resolve conflicts and gratify needs. It enables a person to cope realistically with the demands of a stressor.
    • Three General Types:
      • Attack Behavior – Is acting to remove or overcome a stressor or to satisfy a need
      • Withdrawal Behavior – Is removing the self physically or emotionally from the stressor
      • Compromise Behavior – Is changing the usual method of operating, substituting goals or omitting the satisfaction of needs to meet other needs or to avoid stress.
  2. Defense Mechanisms – Unconscious behaviors that offer psychological protection from a stressful event. They are used by everyone and help protect against feelings of worthlessness and anxiety. Frequently activated by short-term stressors and usually do not result in psychiatric disorders.