Concepts of Stress

Definition of terms:

Stress

A disruptive condition that occurs in response to adverse influences from the internal or external environments

A condition in which the person responds to changes in the normal balanced state

Stressors

A stimulus or situation that causes stress.

Classification of StressorsGeneral Classification

1. Internal Stressor Originate within the person

2. External Stressor Originate outside the individual

3. Developmental Stressor Occurs at a predictable time throughout life

4. Situational Stressor Unpredictable may occur any time during life Can Be Positive or Negative

According to Location1. Physical e.g. (Cold,Heat, chemical agents)2. Physiologic e.g. (pain and Fatigue)3. Psychosocial e.g. (Failing exams and losing a job)

According to involved persons1. Day to day stressors2. Major complex occurrences involving large groups3. Less frequent stressors involving few groups

According to Duration1. Acute time limited stressor2. Stressor sequence3. Chronic intermittent stressor4. Chronic Enduring Stressor

Stress as Stimulus

Stress is defined as a stimulus, life event, or a set of circumstances that arouses physiologic and psychologic reactions that may increase the individuals vulnerability to illness

Adolph Meyer

Relating life response to illness

Holmes and Rahe

Life change units A numerical scale ranking stressful life events and the amount of distress they

cause( 43 life changes)

Stress as a Response

Hans Selye defined stress as the nonspecific response of the body to any demand made upon it

Schafer defined stress as the arousal of mind and body in response to demands made upon them

Generalized Adaptation Syndrome (GAS or Stress syndrome) Describes stress as wear and tear on the body occurring regardless of whether the

stressor is positive or negativeLocalized Adaptation Syndrome (LAS)

Inflammatory and repair processes that occur in the at the local site of tissue injury

Phases of GAS/LASA. Alarm reaction

2 phases 1. Shock Phase

SNS and Endocrine system react to stress(fight or flight response)2. Countershock Phase

Reversal of changes brought by Shock phaseB. Stage of Resistance

1. Adaptive responses that attempt to limit the damage of stressC. Stage of exhaustion

1. Physiologic and psychological resources are depleted and immune system becomes depressed

Stress as a Transaction

Transactional Stress theory Encompasses a set of cognitive, affective and adaptive(coping) responses that

arise out of person-environment transaction Mediating process(cognitive-motivational-relational) - Lazarus

a. Cognitive appraisali. Primary appraisal

Event is evaluated to what is at stake1. Stressful

Harm or loss has occurred Harm or loss is anticipated(Threatening) Opportunity or gain is anticipated(Challenging)

2. Nonstressful (irrelevant/benign/positive)ii. Secondary appraisal

Event is evaluated to what is might and can be doneiii. Reappraisal

Change of opinion based on new information

Manifestations of Stress

Physiologic Dilatation of Pupils Sweat production Heart rate & Cardiac output inc Skin is Pale Na and H2o retention Respiratory rate and depth inc Urinary output inc Dry mouth Peristalsis Dec Mental alertness Inc Muscle tension Inc Blood sugar inc

Psychological Depression

Extreme feeling of sadness, despair, dejection, lack of worth, or emptinessEmotional Symptoms

Tiredness Sadness Emptiness Numbness

Behavioral Signs Irritability Inability to concentrate Difficulty in making decisions Loss of sexual desire Crying Sleep disturbance Social Withdrawal

Physical Signs Loss of appetite Weight loss Constipation Headache Dizziness

Anxiety State of mental uneasiness, apprehension, dread, or foreboding or a feeling

helplessness related to impending or anticipated threat to self or significant relationships

Can be experienced at conscious, subconscious, or unconscious Levels of Anxiety

Level Verbalization Changes

Motor activity changes

Perception Alteration and Attention Changes

Respiratory and Circulatory Changes

Other Changes

Mild Increase Questioning

Mild RestlessnessSleeplessness

Inc arousal and alertnessUses learning to adapt

None None

Moderate

Voice tremors and Pitch Changes

Tremors, Facial twitches, shakiness

Narrowed , inattentive and selective attention focusSlightly impaired learning

Slight inc Mild gastric symptoms

Severe Communication difficult to

Motor activity inc, Inability to

Easily distracted

Tachycardia, Hyperventilati

Headache, dizziness,

understand relax, Fearful Facial Expression

No FocusLearning severely impaired

on nausea

Panic Communication not understandable

Motor activity inc, Agitation, Unpredictable responses, Trembling, Poor motor coordination

Distorted exaggerated PerceptionUnable to learn

Dyspnea, Palpitations, choking, Chest Pain

Feeling of impending doom, paresthesia, sweating

Fear Emotion or feeling of apprehension aroused by impending or seeming danger pain or

a perceived threat

Anger Emotional state consisting of a subjective feeling of animosity or strong displeasure Can be Verbal or Non verbal

Hostility – overt antagonism harmful or destructive behavior Violence – exertion of physical force to injure or abuse Aggression – unprovoked attack, or a hostile, injurious or destructive action or

outlookCognitive

Problem Solving Thinking through threatening situations, using specific steps to arrive at a

solution Structuring

Arrangement or manipulation of a situation so that threatening events do not occur

Self-control(Discipline) Assuming a manner and facial expression that conveys sense of being in control

or in charge Suppression

Consciously and willfully putting a thought or feeling out of mind Fantasy or Daydreaming

Unfulfilled wishes and desires are imagined as fulfilled.

PREDISPOSING FACTORS FOR STRESS GENETIC FACTORS INABILITY TO ADAPT INADEQUATE RELAXATION RESPONSE

RESPONSE ACTIVITY VARIATIONS AGE PERSONALITY ISOLATION Environment

Eustress and Distress Eustress

The pleasurable stress that accompanies positive events. For example, a person may receive a $10,000 bonus and experience stress in deciding how to spend the money.

Distress The unpleasant stress that accompanies negative events.

Type a/type b (Friedman and Rosenman, 1974) Type a

Competitive, achievements orientation. Self-critical. No joy in accomplishments. Time urgency. Impatient. Always on the go. Do several things at once. Anger/hostility- easily aroused to anger, which may be overt or covert.

Type b Low levels of competitiveness Time urgency - patient Hostility - not easily aroused to anger Easy going Philosophical

Coping Dealing with problems and situations, or contending with them successfully Cognitive and behavioral effort to manage specific external /internal demands that are

appraised as taxing or exceeding the resources of a person(Folkman and Lazarus)Coping strategy/mechanism

1. Emotion Focused Coping Lessens emotional distress

2. Problem Focused Coping Direct change to the environment