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TRANSCRIPT
DOING SKILLS REQUIRED DURING TIMES OF SI:
SELF MANAGEMENT UNDER TIMES OF SEVERE
STRESS
UNIVERSITY OF SOUTH AFRICA – SCHOOL OF
BUSINESS LEADERSHIP
PRESENTED BY
CORNEL BROWNMA Clinical Psychology – PU for CHE
Health Worx Medical Centre, Randridge Mall, Randpark Ridge, RandburgCell: 082 471 4746 Tel: (011) 801 – 4300 Fax: 801 – 4327 E-mail:
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INDEX
1. INTRODUCTION 3
2. THE PROCESS OF STRESS 4
2.1. An integrated model of stress 4
2.2. The event 4
2.3. The appraisal process 5
2.4. The psycho-emotional and physiological stress response 6
2.5. Adaptation 7
3. SELF-MANAGEMENT DURING THE STRESS RESPONSE 8
3.1. Behavioural coping 8
3.2. Emotional coping 9
3.3. Problem-focused coping 10
4. FACTORS THAT INFLUENCE THE PROCESS OF STRESS 11
4.1. Personality 12
4.4.1. Personality factors 12
4.4.2. The Type-A Personality
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4.2. Culture 13
4.3. Skills and experience 14
4.4. Positive aspects 14
4.4.1. Character strengths 14
4.4.2. Resilience and psychological well-being 16
4.4.3. Healthy living 19
4.5. Negative aspects 20
4.5.1. Adrenalin addiction 20
4.5.2. Depression 20
4.5.3. Psychological disorders 21
5. PATHOLOGICAL STRESS 22
6. CONCLUSION 24
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REFERENCES 25
1. INTRODUCTION
Stress can be seen as a person’s psycho-emotional and physiological response to
something in the environment that challenges the person (called a stressor or stressful
event) (Sternberg, 2001). The aim of this paper is to discuss positive self-management or
coping when exposed to severe stressors. Firstly, the process of stress will be discussed;
secondly how stress can be managed during this process; and thirdly how different
factors that may influence the process of stress can be managed to decrease the frequency
and intensity of the stress response. Lastly, some attention will be paid to signs of
pathological stress.
The process of stress will be discussed according to the steps of an integrated model of
stress. These steps are the event; the appraisal process; the psycho-emotional and
psychological stress response; and adaptation.
The discussion on management during the stress response will focus on behavioural
coping, emotional coping and problem-focussed coping.
The factors that influences the process of stress that will be discussed are Personality;
Culture; Skills and experience; Positive aspects: character strengths, resilience and
psychological well-being, and healthy living; and Negative aspects: adrenalin addiction,
depression, and psychological disorders.
The examples of pathological stress that will be discussed are Acute Stress Disorder,
Posttraumatic Stress Disorder and Panic Attack.
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2. THE PROCESS OF STRESS
2.1. An integrated model of stress (adapted from Sternberg, 2001)
2.2. The event
As said before, stress can be seen as a person’s psycho-emotional and physiological
response to something in the environment that challenges the person. Such challenges are
called stressors. Examples of stressors are time pressure, work pressure, family pressure,
financial pressure, divorce, being disciplined at work and moving house. The severity of
stressors are determined by the perceived intensity of the challenge and by the time
Environmental Event
Any event, challenge or situation that could be appraised as a harm/loss or threat
Appraisal process
- Does the challenge constitute a harm/loss or threat?- Do I have sufficient coping resources to deal with the challenge? - If so, the challenge is managed without distress- If not the psycho-emotional and physiological stress response is experienced.
Psycho-emotional and physiological stress response
Psycho-emotionally- Cognitions are limited to “fight or flight” reactions.- Feelings of automatic behaviour, depersonalisation or derealisation may occur. - Aggressiveness, irritability and hostility might be experienced.- Strong emotions like anger, fear or sadness might be experienced.
Physiologically- The body gets ready for “fight or flight”- The autonomic nervous system triggers the sympathetic response, which increases heart rate, respiration and blood pressure and decreases digestion.- Nerve impulses and the endocrine system triggers the adrenal system, which releases adrenalin (arousing the body for action), nor-adrenalin (prolongs sympathetic response) and corticosteroids (increases metabolism, provides energy, decreases immune inflammatory response).- The body is in a state of alarm and the body’s resources are used at a high rate
Adaptation- Physically, the body can not maintain the state of alarm indefinitely, and goes into a state of resistance where it imposes a counterbalance through the parasympathetic nervous system, declining for example the demands on the heart and lungs. - Ideally, the stressor would have been resolved and the body can slow down completely and start to restore its resources.- If the stressor is not resolved, the body does not return to a state of rest, and persistent stress is experienced, alternating the body between sates of alarm and resistance.- This ultimately leads to the body’s resources being depleted completely, moving the body into a state of exhaustion. This leads to a weakened immune system and other health problems.
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exposed to the stressor. A less intense stressor can therefore become severe when a
person is continuously exposed to the stressor (Sternberg, 2001). When a stressor’s
intensity reaches the extent of actual or threatened death or serious injury, or a threat to
the physical integrity of self or others, the event is seen as a traumatic event (APA, 1994).
2.3. The appraisal process
Though the stress response is experienced as an immediate and direct reaction to the
event, it is apparently more one’s appraisal of the event that causes the stress response
(Sternberg, 2001). When a person appraises an event to be a harm, loss or threat, and they
appraise their coping resources to be insufficient to deal with this challenge, they
experience the stress response. If a person would for example walk around a corner and
see a green snake, and perceive this snake to be a green mamba and consequently
appraise the situation as physically dangerous, the person would probably have a stress
response. If the person perceives the snake to be a rubber snake and appraise the situation
as safe, the person would probably not have a stress response and rather respond with
something like curiosity. A person who perceives the snake to be a green mamba, but
works with snakes on a daily basis, might also appraise the situation as safe and not react
with a stress response.
From this example the following becomes clear about the appraisal process:
The appraisal of the situation is really what determines whether a stress response
will be experienced or not.
The stress response is experienced when:
- The event is appraised as harm, a threat or a loss, and
- The coping resources are appraised to be insufficient to deal with the challenge.
The process functions quickly, automatically and subconsciously.
There can be different individual factors that influence the appraisal process (of
which some will be discussed under Factors that influence the process of stress).
This means that two people could appraise the same situation differently, resulting
in one having a stress response to the situation, and the other not.
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2.4. The psycho-emotional and physiological stress response
The psycho-emotional stress response is when the event was appraised as a threat and the
person is ready for the “fight or flight” response. This means that the person will either
aggressively confront the challenge, or flee from the challenge. In the past, when people
were in more physical danger, this was an important protective reaction to the perceived
threat, built in for survival. If a person for example walked in a field and saw a lion, the
person would have to react immediately by running away or if it was too late for that
defend him/herself. The person did not have time to sit around calmly and consider
different options. Because of this, the stress response leads to a narrowing of cognition to
two options: fight or flee. A stressed person will also probably feel strong emotions of
fear, anger, irritability or hostility and would seem to others to be aggressive and
attacking or emotional and evasive. While acting the person might feel as if things
happen automatically and that they are almost not in control of themselves. They might
even feel that they are detached or outside of themselves (depersonalisation) or time and
space (derealisation). Though this stress reaction might sometimes be positive (people
have been reported to do miraculous things like lifting heavy objects off trapped victims),
it is often excessive to the situation and the narrowing of options lead to the person being
less able to resolve the challenge constructively. This then leads to a continuance of
stress.
The physical stress response is when the body is ready to “fight or flee”. This means that
the body’s resources are used at the most vital organs and muscles. The heart rate needs
to increase, the muscles need to tense, the arteries need to constrict (to not bleed to much
when injured), less important functions need to be suspended (like the digestive system
and blood flow to the face), and the body’s immune inflammatory response needs to be
suspended (to not feel pain and be able to run away or act). All this is done through the
autonomic nervous system and the adrenal glands (Sternberg, 2001).
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The autonomic nervous system triggers the sympathetic response, which increases the
person’s heart rate, respiration and blood pressure, and decreases digestion.
The adrenal medulla (the inner part of the adrenal gland) is an agent of the sympathetic
response and is triggered by nerve impulses. When activated it secretes catecholamines:
epinephrine (adrenalin) and norepinephrine (noradrenalin). This stimulates the heart,
raises the blood pressure, widens the pupils, and sends the blood to the most vital organs
and muscles (The Learning Company, 1997).
The adrenal cortex (the outer part of the adrenal gland) is triggered by the endocrine
gland, which in turn is activated by the hormone ACTH, which is sent from the pituitary
gland. When activated, the adrenal cortex secretes corticosteroids: cortisol and
aldosterone. Aldosterone regulates the mineral and water balance of the body, prevents
excessive loss of water, and influences the contractibility of muscles. Cortisol generates
energy by turning carbohydrates into glucose, sends reserves to the liver, and suppresses
inflammation (decreasing the body’s immune inflammatory response) (The Learning
Company, 1997).
When the psycho-emotional and physiological stress response is at its height, the person
is ready to “fight or flee” and the person is in a state of alarm.
2.5. Adaptation
Physically, the body cannot maintain the state of alarm indefinitely, and goes into a state
of resistance where it imposes a counterbalance through the parasympathetic nervous
system, declining for example the demands on the heart and lungs (Sternberg, 2001). The
intensity of the person’s emotions could also decline and the person might gain more
control over thoughts and actions. At this time, the person returns to the appraisal
process to determine whether the stressor is resolved.
Ideally, the stressor would have been resolved and the body can slow down completely
and start to restore its resources. The person would also be able to regain some psycho-
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emotional balance and might feel a sense of relieve and other positive emotions.
Cognitively, they would regain their ability to see different options and behaviourly they
would seem more relaxed and less aggressive and attacking.
If the stressor is not resolved, the person does not return to a state of complete rest, but
has another stress response. This can continue so that persistent stress is experienced,
alternating the body and mind between states of alarm and resistance. This is a condition
of chronic stress (Sternberg, 2001).
This ultimately leads to the body’s resources being depleted completely, moving the body
into a state of exhaustion. On the short term the person’s ability to restore damaged or
worn-out tissues is diminished and the immune system is weakened, resulting in a
diminished resistance against opportunistic infections and latent viruses. On the long
term, the repeated secretion of adrenalin and cortisol, the weakened immune system, and
the continuous taxing of the heart and arteries and the digestive system (which is to
frequently suspended) leads to a gradual increase in the alostatic load. Heightened
allostatic load has been associated with a number of health problems, where under
diabetes, stomach ulcer, heart attack, and stroke (Ryff & Singer, 1998).
Psycho-emotionally prolonged stress might negatively influence the person’s
interpersonal relationships and self-esteem and might even lead to depression or an
anxiety disorder.
3. SELF-MANAGEMENT DURING THE STRESS RESPONSE
Self-management involves the implementation of techniques that suspend the
continuation of the stress response and promote recovery of resources. Self-management
should be done on three levels: a behavioural level, an emotional level and a problem-
focused level.
3.1. Behavioural coping
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On a behavioural level, the person needs to stop the physical stress response by relaxing
the body and thereby assisting the parasympathetic response of the body. There are
several relaxation techniques, but they can generally be grouped into two categories:
Progressive Muscle Relaxation Techniques (of which one is included in Appendix A) and
Imagery Relaxation Techniques. Progressive Muscle Relaxation Techniques work by
physically tensing and relaxing the muscles in the body. The contrast created between
tensing and relaxing the muscles allows the person to experience the feeling of relaxation.
The person then purposefully focuses on the relaxed feeling and allows that feeling to
become stronger. Imagery Relaxation Techniques work by imagining either a relaxed
environment or visualizing how your breath goes to and loosens the stress that is stuck in
your body and how that loosened stress is breathed out again.
An important aspect of both approaches is breathing. When people become stressed, they
tend to breathe very fast and/or very shallow. This results in a too low amount of oxygen
in their body, which intensifies and prolongs the stress response. Slow deep breathing is
thus a good intervention on its own when stress is experienced, but is also used as part of
a relaxation technique.
Any other method that is personally relaxing to the person, for example listing to music
or going for a quick jog may also be used to assist the body to relax.
If the person is caught in chronic stress, the person needs to realize that they would have
to break the cycle by taking time out to allow their body to recover. This implies lifestyle
changes and changing ones approach to challenges.
3.2. Emotional coping
Emotional self-management involves dealing with the emotions that accompany the
stress response. As long as uncontrollable emotions are experienced, the stress response
will continue. Managing emotions does however not mean to simply ventilate ones
feeling. This means that if the feeling is anger for example, simply ventilating this by
screaming at people or throwing things; or if the feeling is sadness simply sitting and
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crying all day is not necessarily dealing with the emotion. In fact, some researchers warn
that the mere ventilation of feelings is destructive and argues that it increases the stress
response (Stanton, Parsa & Austenfeld, 2002). Some even suggest that emotions should
be temporarily suppressed during the stressful event and that the person should rather
take a problem-focused approach to the problem (Sternberger, 2001). This will however
be difficult, as negative emotions limits cognitive options to either fight or flight.
Stanto, Parsa and Austenfield (2002) argue that there is a place for emotional self-
management if it is done constructively. The first step in managing emotions would be to
identify the emotion. The second step would be to acknowledge the emotion and to
attribute the emotion to its specific source. Thereafter expression of emotion to another
person or in a journal may occur.
Emotional self-management is especially valuable when the person has little control of
the stressful situation, for example when somebody discovers that they have cancer.
Studies show that people with cancer who acknowledge and constructively deal with their
emotions, experience less stress and a better response to treatment than people who
suppress their emotions (Stanto, Parsa & Austenfield, 2002).
3.3. Problem-focused coping
Problem-focused management usually works best when somebody has more control over
the challenge. Once the person stopped the physical stress response and constructively
dealt with the associated emotions, their options seem to open up and they are ready to
face the challenge constructively. This is best done with a problem-focused approach.
Again, there are many models of problem-focused coping.
One such a model is that of Egan (1994), who proposes a three-step model of problem-
focused coping. The steps are as follows:
Step I: Identifying and clarifying the problem situation.
The person should at this stage review the facts of the problem, identify the aspects of the
problem which causes the most distress and attempt to reframe those aspects or describe
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it from another perspective, and prioritize which aspects of the problem are the most
important and would be most beneficial if resolved.
Step II: Developing the preferred scenario
During this stage, the person focuses on the preferred outcome of the challenge, which
implies looking at the bigger picture. If the challenge is for example to complete a
specific task before a specified deadline, the person might take a step back and ask what
he/she wants to accomplish by doing the task. If the person wanted to build a reputation
for the outstanding quality of his/her work, he/she might explore the possibility of
finishing the task later, but producing a better product. If the person wanted to prove
his/her own time-efficacy, completing the task with less detail would be more beneficial.
After the preferred outcome has been identified, the question is asked which of those
outcomes can realistically be obtained, and turning those realistic possibilities into viable
goals. Thereafter the person makes the commitment to pursue the chosen goals.
Stage III: Determining how to get there
Now that the person has identified goals, the process of pursuing the goals is started.
Firstly, the person brainstorms strategies for accomplishing the goals, trying to uncover
as many strategies as possible. Secondly, the best strategies are chosen within context of
the person’s environment and resources. Lastly, a plan is formulated whereby the person
identifies a step-by-step procedure for accomplishing each goal of the preferred scenario.
The person is now ready to apply the problem-focused solution to the challenge.
4. FACTORS THAT INFLUENCE THE PROCESS OF STRESS
Different factors may influence the process of stress. Some factors could influence the
process at the appraisal stage and others at the adaptation stage. These factors also
influence the ability of the person to cope with the specified challenge. The factors
therefore become an important point of intervention in self-management under times of
high challenges. If a person could manipulate the factors that influence the process of
stress, it is likely that the person could reduce the frequency and intensity of stress
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experienced. Consequently, a few of the factors that may influence the process of stress
and possible interventions of those factors will be discussed. The factors that will be
discussed here are personality; culture; skills and experience; positive factors: character
strengths, resilience and psychological well-being and healthy living; and negative
factors: adrenalin addiction, depression, and psychological disorders.
4.1. Personality
4.1.1. Personality factors
Personality plays an important part in whether somebody would find a situation stressful
or not. An extrovert could for example find an environment or challenge stressful that
requires him/her to work in isolation and resolve the challenge using only internal
resources, whereas an introvert might find a situation stressful that requires a high level
of interpersonal interaction. Similarly, many personality traits, which are beyond the
scope of this paper to discuss, may influence whether a particular person experiences a
particular situation as stressful or not. The ideal would however be to find an appropriate
fit between a person’s personality and the environment they need to function in and in the
type of challenges presented to them. Personality tests such as the 16 Personality Factor
Inventory (Cattell, Eber & Tatsuoka, 1980) provide an assessment of a wide variety of
personality factors, which could be used as a guide in finding an appropriate fit between
the person and the environment. Furthermore, it could be beneficial to at least realise
when something in the environment is experienced as stressful as a result of a personality
factor. A person can then learn to adapt or compromise with regard to that personality
factor. If the person however is unwilling or unable to adapt in this regard, an attempt
should be made to modify that specific aspect of the challenge or environment.
4.1.2. The Type-A Personality
The next aspect of personality that will be discussed is when a person has a combination
of personality factors and characteristics that cumulate in a specific personality style,
called the Type-A Personality.
A person with a Type-A Personality usually demonstrates:
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a competitive orientation toward achievement,
a sense of urgency about time, and
a strong tendency to feel anger and hostility toward other people.
People with a Type-A Personality experience the stress response more frequently than
other members of the population. Possible reasons for this are that they respond more
forcefully to challenges, that they are more likely to view challenges as threats to their
personal self-control and that they act in ways that would increase their likelihood to
encounter stressful situations. In other words, they create some of their own stress by
seeking out demanding, competitive situations or by creating artificial deadlines for
themselves (Sternberg, 2001). Intervention of Type-A Personality related stress is
difficult, as this would require a change in the person’s approach to life. People with a
Type-A Personality often believe that if they don’t stress about something, nobody will,
and if nobody stresses, nothing will get done. They therefore seek and thrive on stress,
believing that this is the only recipe for successful living. This is however a myth, as the
stress response limits the person’s reaction to “fight or flight”, while a non-stressed
response to a challenge enables the person to have a broad range of options for action
available. The probability is therefore higher that a non-stressed person would find and
apply an appropriate and efficient solution to the challenge. If the person with the Type-A
Personality would however change their approach to life on a cognitive level, they could
also use relaxation techniques to decrease the stress response and make behavioural
changes to their stressful lifestyle.
4.2. Culture
Culture can often determine whether a person would experience a situation as stressful or
not. A person from a culture that places high emphasis on individuality would for
example probably experience more stress when marrying into a hierarchical enmeshed
family than somebody from a culture that places high emphasis on interpersonal
involvement. Stress resulting from a discrepancy between a person’s culture and an
aspect of a challenge could be reduced by improving tolerance for the person’s culture
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and by an approach that differences between cultures does not necessarily mean that the
one is absolutely right and the other absolutely wrong.
4.3. Skills and Experience
The stress response can be experienced when a person is faced with a challenge that they
do not have the necessary skills to do. A person who, for example does not know how to
swim, would probably find canoeing to be a severely stressful rather than a relaxing
experience. The only way to intervene in this stress response is either to develop the
needed skill or to modify the challenge. When a person is however put into such a
situation unexpectedly, the amount of stress experienced would be determined by other
factors, such as the person’s adaptability and confidence in their own ability to learn.
Even when a person has the necessary skills to perform a task, some stress might still be
experienced if the person lacks experience of the specific challenge. A doctor might for
example have all the academic knowledge on how to perform an operation, but
experience severe stress when doing it for the first time. Again, the only way to intervene
would be to gain the needed experience. Less stress could be experienced if the
experience was gained in a safer and supported environment, if the person had confidence
in his/her ability and if the person had a realistic expectation of his/her performance.
4.4. Positive aspects
4.4.1. Character strengths
Character strengths could be another aspect of personality that influences whether a
situation is experienced as stressful or not. Character strengths are personality traits that
can be acquired and promoted and is voluntarily acted upon. Examples of character
strengths are creativity, perspective, persistence, integrity, kindness, fairness, leadership,
prudence, self-control, gratitude, hope and humour (Seligman, 2002). All of these could,
under different conditions, contribute to a person experiencing less or no stress where a
stress response would be expected. A person might for example use humour to defuse an
emotionally volatile situation and thereby avoid the stress response. Another person
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might come up with a creative solution to a challenge, before the challenge reaches the
required intensity to cause a stress response. The theory of character strengths predicts
that a person who is in touch with his character strengths and who consciously applies
those strengths would be less prone to experience his/her environment or challenges as
stressful. Building and broadening character strengths can therefore be seen as a
preventative form of self-management when functioning in a challenging environment.
Though character strengths are positive characteristics, they can also lead to the stress
response being experienced. Three ways in which character strengths can contribute to
experiencing a situation or environment as stressful will be discussed.
First, a situation or task could be experienced as stressful when it requires a character
strength in which the person is less strong. If a person for example has less persistence,
but is faced with long-term tasks and objectives that seem enormous with irregular
opportunities for feedback, that challenge could be experienced as severely stressful.
Character strengths can however be promoted to a certain extend. A possible intervention
could thus be to work on increasing specific strengths if they are frequently required in
the environment one functions in.
A second scenario is when character strengths are frustrated by the environment. A
person could find a challenge or environment severely stressful if the behaviour required
was the opposite from what they feel strongly about. A person who has a high sense of
integrity and honesty would for example find a challenge severely stressful if the
challenge required them to pretend that things are as they are not. Similarly, a person who
places high value on forgiveness, mercy and kindness might find it extremely stressful to
have to fire an employee. The only intervention that can be proposed in this regard is that
a person exercises and develops their ability to judge whether they should apply a
strength in the particular situation or not, remembering that not all strengths are
applicable to all situations (though it is still a positive characteristic). Another technique
to prevent future stress is to prioritise beforehand which strengths or believes can be
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compromised under which circumstances and which strengths, believes or values may not
be compromised, even if that meant failure in the challenge.
Thirdly, a person might find a challenge or environment to be stressful if there are no
opportunities to exercise their strongest character strengths. If a person is for example
very creative and curious, they would experience an environment as severely stressful if
they were given no opportunity to act autonomously or to develop new and productive
ways to conceptualise and do things. A possible intervention in this regard is to identify
one’s most prominent strengths and to find ways to incorporate their use in one’s
environment or in the challenges one faces. An example of this can be seen in the
following story: A man woke up in hospital after an operation and saw a man standing at
the opposite wall meticulously placing and replacing paintings on the wall. When the
man who had the operation asked the person who he was, he learned that this person was
the cleaner whose main job it was to wash the floors and clean out bedpans, but that he
interpreted his job as being responsible for the patient’s well-being to the extent that they
would wake up in a clean environment and that the first thing they would see would be
beautiful, therefore his particular attention to the paintings. The cleaner in this story
therefore took his relatively mundane environment and applied his character strengths of
love for people and his appreciation of beauty to transform his environment and
challenges into a personally fulfilling experience.
All of the above interventions regarding character strengths involve the identification,
enhancement or application of character strengths. More information on assessing and
applying character strengths can be found in Martin Seligman’s book on Authentic
Happiness (Seligman, 2002) (see references) and on his website:
www.authentichappiness.org. A questionnaire for the assessment of character strengths is
also available on the website.
4.4.2. Resilience and Psychological well-being
Resilience refers to “a class of phenomena characterized by patterns of positive
adaptation in the context of significant adversity or risk” (Masten & Reed, 2002).
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Resilient people have also been labelled as “stress resistant”, implying that the resilient
person is less likely to appraise a challenge in such a way that would elicit the stress
response. The overall resilience of a person is therefore an important factor in the process
of stress. A person who is frequently exposed to challenging situations would thus benefit
greatly from developing higher overall resilience.
Seligman (2003) believes that higher psychological well-being serve to buffer against
misfortune and stress during high challenges and that they may be the key to building
resilience. Developing higher overall resilience therefore becomes a matter of improving
general psychological well-being. General psychological well-being refers to the degree
of psychological health of a person and not merely to the absence of disease and
infirmity. The theory is that the more psychologically healthy the person is, the bigger the
buffer and therefore resilience against stress. Many models of psychological well-being
and the enhancement thereof exist, but the core questions are: what makes life worth
living?, and what is the good life? Unfortunately all the models and aspects of
psychological well-being can not be discussed here, but readers are welcome to contact
the author of this paper, should they require more information. Only one model of
psychological well-being will be discussed here, and one other aspect of psychological
well-being will be discussed.
Ryff and Keyes (1995) developed a model of psychological well-being wherein they
identified six aspects of psychological well-being that may be improved to increase
general psychological well-being. The six aspects are as follows:
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AUTONOMY
LowIs concerned about the expectations and evaluations of others;
conforms to social pressures to think and act in certain ways;
relies on judgements of others to make important decisions.
HighIs self-determining and independent; able to resist social
pressures to think and act in certain ways; regulates behaviour
from within; evaluates self by personal standards.
ENVIRONMENTAL MASTERY
LowHas difficulty managing everyday affairs; feels unable to change
or improve surrounding context; is unaware of surrounding
opportunities; lacks sense of control over external world
HighHas a sense of mastery and competence in managing the
environment; controls complex array of external activities; makes
effective use of surrounding opportunities; able to choose or
create contexts suitable to personal needs and values.
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PERSONAL GROWTH
LowHas a sense of personal stagnation; lacks sense of improvement
or expansion over time; feels bored and uninterested with life;
feels unable to develop new attitudes or behaviours
HighHas a feeling of continued development; sees self as growing and
expanding; is open to new experiences; has sense of realising
one’s potential; sees improvement in self and behaviour over
time; is changing in ways that reflect more self knowledge and
effectiveness.
POSITIVE RELATIONS WITH OTHERS
LowHas few close, trusting relationships with others; finds it difficult
to be warm, open, and concerned about others; is isolated and
frustrated in interpersonal relationships; not willing to make
compromise to sustain important ties with others.
HighHas warm, satisfying, trusting relationships with others; is
concerned about the welfare of others; capable of strong
empathy, affection, and intimacy; understands give and take of
human relationships.
SELF-ACCEPTANCE
LowFeels dissatisfied with self; is disappointed with what has
occurred in past life; is troubled about certain personal qualities;
wishes to be different than one is.
HighPossesses a positive attitude toward the self; acknowledges and
accepts multiple aspects of self, including good and bad qualities;
feels positive about past life.
PURPOSE IN LIFE
LowLacks a sense of meaning in life; has few goals or aims; lacks
sense of direction; does not see purpose of past life; has no
outlook or believe that give life meaning.
HighHas goals in life and a sense of directedness; feels there is
meaning to present and past life; holds believes that give life
purpose; has aims and objectives for living.
These six aspects of psychological well-being may be improved by purposefully paying
attention to aspects that the person wants to improve. Purpose in life can often be
improved within religious or spiritual contexts. People who want to improve their sense
of purpose in life can therefore benefit from discussions with their spiritual or religious
leaders. A psychologist can also do well-being psychotherapy. Assessment of these
aspects can be done with the well-being scales developed by Ryff and Keys (1995).
Another aspect of psychological well-being that may influence the frequency and
intensity of the stress response is hope. Hope has been associated with many indices of
constructive coping, especially problem-focused coping. Snyder et al. (1991) argues that
hope is a cognitive set that is based on reciprocally derived sense of successful “agency”
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(goal-directed determination) and “pathways” (planning of ways to meet goals). A person
with hope would therefore expect positive outcomes in new challenges (resulting in less
stress about the challenge) based on their previous experience of themselves as being
goal-directed and determined and being able to find ways in which to reach their goals.
People who function in a challenging environment could therefore aim to improve their
level of hope to reduce their levels of stress. One’s current level of hope can be assessed
with the Hope Scale (Snyder et al., 1991) (Appendix B). Hope can be further developed
by increasing one’s experience of “agency” and “pathways”. This is managed by
following a problem-focused approach to dealing with challenges as described above (see
3.3. problem-focussed coping). Lopez et al. (2000) suggests that hope can be increased
through goal development and developed a questionnaire to assist with goal development.
This questionnaire may be used to improve goal development to increase hope (Appendix
C).
4.4.3. Healthy Living
The last positive aspect that will be discussed is healthy living. A person who lives a
healthy lifestyle is less likely to experience the stress response, and will be physically and
mentally more able to cope with the stress response. There are five aspects of a healthy
lifestyle that a person can pay attention to in order to improve their resistance against
stress. They are as follows:
1) Sleep: Establish a routine of going to bed at the same time every night and
waking up at the same time every morning.
Get at least 8 hours of sleep per night.
Do not use the bed and bedroom for to many other activities like reading
or watching television. An association between going to bed and sleeping
should be established.
2) Eating: Following a healthy diet helps the body produce the energy to face
challenges and to cope better with the stress response.
Again, developing a routine of taking at least three meals a day would be
beneficial.
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3) Exercise: Moderate exercise helps to build the immune system, improve blood flow,
provides energy and helps the body to restore more easily from the stress
response.
4) Exposure
to the sun: Limited exposure to sunlight (about ten minutes a day) promotes the
production of serotonin in the body, which helps to regulate mood, anxiety
and stress.
5) Lifestyle: Paying attention to living a less stress seeking lifestyle, is as said before,
an important part of stress management.
4.5. Negative aspects
4.5.1. Adrenalin addiction
The body secretes adrenalin as part of the stress response to ready the person to fight or
flee (see 2.4. the psycho-emotional and physiological stress response). Adrenalin
however also stimulates the “reward centre” (also known as the pleasure centre) in the
brain. This is the same pathway used by other stimulants such as cocaine. It is therefore
not surprising that a person could become addicted to the high that adrenalin gives. This
leads people to seek out stress, or to create unnecessary stress about minor challenges to
establish a surge of adrenalin. It is therefore a good sign that this process might be at
work if somebody runs from the one “crisis” to the next. Intervention of this process
would almost be the same as with other addictions. The person needs to identify that this
is happening and needs to commit to change the pattern. Then they would have to make
behavioural changes, remembering that they might feel irritated due to withdrawal and be
tempted frequently to restart with the same pattern. The relaxation techniques discussed
above can also be used positively in this regard (Hart, 2001).
4.5.2. Depression
Depression can influence the process of stress in two ways. Firstly, a person who suffers
from depression may use stress to self-medicate their depression. As discussed above,
adrenalin also influences the pleasure centre of the brain, which means that a person
might feel better when they have a surge of adrenalin (Hart, 2001). Nor-adrenalin,
21
adrenalin and serotonin (which is converted from nor-adrenalin) are also important bio-
chemicals in the process of depression. Too low levels of serotonin and nor-adrenalin are
often associated with depression. The person thus attempts to raise their levels of
serotonin by seeking stress.
The second way that depression influences the stress response is at the appraisal phase.
Depression influences the way people think about themselves and the world, leading to
more frequent appraisals of challenges as threatening and therefore stressful. Low self-
worth, for example is one of the symptoms of depression. If someone has low-self worth,
they could become severely stressed because they believe that they or their actions or
their performance is not good enough and that they have failed (even when they did not)
and will be rejected.
Intervention of depression should ideally be done through working with a professional
psychologist or psychiatrist. Treatment usually includes a combination of medicinal
treatment and psychotherapeutic treatment. Some signs of depression that may assist the
reader in recognising depression are given hereunder. These symptoms may be especially
prevalent after a period of high stress or while the person is not concealing or self-
medicating the symptoms with stress.
- Depressed mood - Loss of interest in usual activities
- Lack of pleasure - Suicidal ideation
- Diminished libido - Anticipating the worst
- Worry - Poor concentration
- Irritability - Hypervigilance (overly cautious and aware)
- Crying - Unsatisfying sleep, insomnia or hypersomnia
- Guilt - Fatigue
- Poor memory - Sense of worthlessness
- Hopelessness - Poor appetite or overeating
- Loss of energy - Psychomotor agitation or retardation
- Anxiety - Somatic complaints
(Barlow & Durand, 1995)
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4.5.3. Psychological disorders
Other psychological disorders may also contribute to somebody experiencing high levels
of stress. In personality disorders, for example the Paranoid Personality Disorder,
neuroticism is one of the most prominent symptoms. This means that a person with this
disorder experiences almost constant stress as all people they come into contact with are
perceived as potentially threatening. A person with obsessive-compulsive disorder
experiences constant and obsessive stress with regard to a specific issue, for example
bacteria and germs. Usually the biggest indication of pathology is when a person’s
reactions are grossly inappropriate or excessive to the situation. Psychological disorders
however have to be diagnosed and treated by a medical professional.
5. PATHOLOGICAL STRESS
Stress becomes pathological when the stress is chronic and severe to the extent that it
causes significant functional impairment in an important area of the person’s life (e.g.
work or interpersonal relationships); or when clinically significant distress is
experienced. This usually happens when the person has been exposed to an event that is
so severe that it is classified as a trauma, or when the person had been exposed to
stressors for a prolonged period of time. At this stage self management has also become
insufficient to deal with the stress response. Treatment of pathological stress usually
involves a combination of pharmacological and psychotherapeutic treatment and is done
by medical professionals. The symptoms of three examples of pathological stress will be
listed hereunder to assist the reader in recognizing when stress becomes pathological.
They are panic attack, acute stress disorder and posttraumatic stress disorder.
Panic attack
- A discrete period of intense fear or discomfort
- Symptoms developed abruptly and reached a peak within 10 minutes
- Four or more of the following symptoms were experienced:
* Palpitations, pounding heart, or accelerated heart rate
* Sweating
* Trembling or shaking
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* Sensations of shortness of breath or smothering
* Feeling of choking
* Chest pain or discomfort
* Nausea or abdominal distress
* Feeling dizzy, unsteady, light-headed, or faint
* Derealisation (feelings of unreality) or depersonalisation (being detached from
oneself).
* Fear of losing control or going crazy
* Fear of dying
* Paresthesias (numbness or tingling sensations)
* Chills or hot flushes
(APA, 1994)
Acute stress disorder and posttraumatic stress disorder
- Exposure to a traumatic event in which the person experienced, witnessed, or was
confronted with actual or threatened death or serious injury, or a threat to the
physical integrity of self or others.
- The person’s response involved intense fear, helplessness or horror.
- With Acute stress disorder the person experienced three or more dissociative
symptoms during or after the distressing event. Dissociative symptoms are a
subjective sense of numbing, detachment, or absence of emotional
responsiveness; a reduction in awareness of his or her surroundings (being in a
daze); derealisation; depersonalisation; and dissociative amnesia (an inability to
recall an important aspect of the trauma).
- The traumatic event is persistently re-experienced in at least one of the following
ways: recurrent images, thoughts, dreams, illusions, flashback episodes or a sense
of reliving the experience, or distress on exposure to reminders of the traumatic
event.
- Avoidance of stimuli that arouse recollections of the trauma for example thoughts,
feelings or conversations associated with the trauma; and activities, places or
people associated with the trauma. With Posttraumatic stress disorder other
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symptoms of avoidance that may also be experienced are markedly diminished
interest or participation in significant activities; feelings of detachment or
estrangement from others; restricted range of affect; and a sense of a
foreshortened future.
- Anxiety or increased arousal as evident in difficulty sleeping; irritability; poor
concentration; hypervigilance; exaggerated startle response; and motor
restlessness.
- In Acute stress disorder symptoms last for a minimum of 2 days and a maximum
of 4 weeks. In Posttraumatic stress disorder symptoms last for a minimum of 1
month. Symptoms may appear immediately after or long after the actual traumatic
event.
(APA, 1994)
6. CONCLUSION
The aim of this paper was to discuss self-management under times of severe stress, or
times of high challenges. This was done by first looking at the process of stress according
to the steps of an integrated model of stress. Therein it was seen that stress is a psycho-
emotional and physiological response to an event that is appraised as a harm, threat or
loss. Adaptation as final stage of the stress response was also discussed. Secondly, self-
management during the stress response was discussed from behavioural, emotional and
problem-focused perspective. Therein it was seen that all three of these approaches play
an important role in self-management during times of stress. Thirdly, factors that
influence the process of stress were discussed where it became apparent how many
different factors do influence the process of stress and how these factors can be used to
reduce stress. Lastly, the signs of stress that has become pathological was discussed to
enable the reader to recognise pathological stress.
25
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