CH:43 Stress and Adaptation

Basic Concepts of Stress and Adaptation:

1. stress

2. stressors

3. adaptation

4. homeostasis

Stress:

• a condition in which the human system responds to changes in its normal balanced state

  • results from a change in environment that is perceived as a challenge, threat, or danger

  • major sources of stress in modern society arise from interpersonal relationships and performance demands

  • affects all aspects of the human dimension both positively and negatively; highly individualized

Stresors:

• anything that is perceived as challenging, threatening, or demanding that triggers stress reaction

  • can be internal (illness, hormonal changes, fear) or external (loud noise, cold temperature)

  • can be physiologic (trauma, infection, nutritional imbalance) or psychosocial (life events, environment in which we live, relationships)

Adapation:

• changes that take place in response to a stressor

  • an ongoing process to maintain internal and external balance

Homeostasis:

the process by which physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment

Examples of Physical Illnesses Associated With Stress:

autoimmune disorders:

• graves’ disease (hyperthyroidism)

• myasthenia gravis

• psoriasis

• rheumatoid arthitis

• systemic lupus erythematosus (SLE)

• ulcerative colitis

cardiovascular and hematologic disorders:

• coronary artery disease

• hypertension

• sickle cell disease

gastrointestinal disorders:

• constipation

• diarrhea

• esophageal reflux

respiratory disorders:

• asthma

Local Adaptation Syndrome (LAS):

• defined as a localized response of the body to stress

• involves only one specific body part (such as a tissue or organ) instead of the whole body

• can be traumatic or pathologic

• usually a short-term adaptive response

Two most common LAS responses:

• reflex pain response

• inflammatory response

Reflex Pain Resposne:

rapid and automatic; protects the body from injury

Inflammatory Resposne:

a local response to injury or infection; localizes and prevents the spread of infection and promotes healing

General Adaptation Syndrome (GAS):

a model that describes the body’s general response to stress

• can be a response to either physical or emotional stressors

Three Stages of GAS:

• alarm reaction

• stage of resistance

• stage of exhaustion

Alarm reaction:

• initiated when a person perceives a specific stressor and various defense mechanisms are activated

• the sympathetic nervous system initiates the fight-or-flight response OR shock phase

  • increase energy levels, O2 intake, cardiac output, blood pressure, and mental alertness

Stage or resistance:

• the body attempts to adapt to the stressor; vital signs, hormone levels, and energy production returns to normal

  • if the stress can be managed or confined to a small area (LAS), the body regains homeostasis

  • if the stressor is prolonged or severe enough to overwhelm the body’s attempts or gaining homeostasis exhaustion occurs

Stage of exhaustion:

results when the adaptive mechanisms can no longer provide defense; resources deplete → body either rests and recovers or death occurs

What is psychological homeostasis?

maintaining emotional and mental well-being and keeping a sense of emotional balance

What basic psychological needs do humans have?

• love sense

• sense of belonging

• a feeling of safety and security

• to have self-esteem

What happens when a person’s psychological needs are threatened or not met?

the person uses coping or defense mechanisms to try to restore emotional balance

What types of changes can affect psychological homeostatis?

• physical changes

• psychological changes

• social changes

• changes in the internal or external environment

What happens when a person has resources and positive coping mechanisms?

adaptations takes place, and psychological homeostasis is achieved

What can happen when a person does not have adequate resources or positive coping mechanisms?

stress results, making it harder to maintain emotional balance

What factors affect a person’s ability to maintain psychological homeostatis?

• age and developmental level

• past experiences

• support systems

• coping mechanisms

• nature and intensity of stressors

• timing, number, and duration of stressors

Anxiety:

• vague, uneasy feeling of discomfort or dread; oftentimes the source is unknown or nonspecific

• can also present as a feeling of apprehension caused by anticipating a perceived danger

• the most common human response to stress

• is generally experienced at some point by everyone, but can have negative impacts on a person’s body, self-perception, and relationships

• differs from fear in that fear is a feeling of dread in response to a known threat

• can be helpful if mild, but beyond that is negative and has unpleasant effects

Four levels of anxiety:

• mild

• moderate

• severe

• panic

Mild Anxiety:

present in day-to-day life; increases vision & hearing, motivates learning & growth, facilitates problem solving; manifested by restlessness, increases questioning, difficultly sleeping

Moderate Anxiety:

narrows a person’s perceptual fields to focus on immediate concerns; unable to focus on communication and details; manifested by tremors, increases muscle tension, slight increases in respirations and pulse

Severe Anxiety:

creates a narrow focus on specific details, causing all behavior to be geared towards gaining relief; characterized by extreme fear of a danger that is not real, emotional distress that interferes with life, and avoidance of situations causing anxiety; causes impaired learning ability, distractibility, difficulty communicating, increases motor activity, headache, nausea, dizziness, tachycardia, hyperventilation no longer considered a signal for danger, but instead is maladaptive and debilitating → signals presence of anxiety disorder

Panic:

causes loss of control with feelings of dread and terror; disorganized state that causes increases physical activity, distorted reality, and loss of rational through; can lead to exhaustion and death

Coping Mechanisms:

• behaviors used to decrease stress and anxiety

• they are usually learned and based upon a person’s family, past experiences, and sociocultural influences and expectations

• can have positive or negative effects on a person’s health

Defense Mechansims:

unconscious reactions to stressors

• compensation

• denial

• displacement

• dissociation

• introjection

• projection

• rationalization

• reaction formation

• regression, repression, sublimation, undoing

Effects of Stress:

• physiologic and psychological stress affects every dimension of a person

• can impact how and to what extent a person meets their basic human needs

• the health illness continuum is affected by stress → health and homeostatic balance are at one end, while exhaustion and death are at the other extreme

• long term stress poses a serious threat to physical and emotional health

  • the duration, intensity, or number of stresses involved decreases a person’s ability to adapt

• family stress may occur when a person’s illness begins to impact the entire family

Factors that contribute to family stress:

• changes in structure and roles

• anger

• guilt

• loss of control over normal routines

• financial concerns

Caregiver burden:

may occur when caring for a family member at home for long periods of time causes prolonged stress

• can cause chronic fatigue, sleep problems, hypertension, heart disease, and negative mental health effects

Factors Affecting Stress and Adaptation:

stress and adaptation are affected by sources of stress (stressors) and personal factors

Sources of Stress:

there are infinite sources of stress, but can be categorized in two ways

• developmental stress

• situational stress

Developmental Stress:

occurs as a person progresses through the normal stages of growth and development from birth to old age; ex: school age child socializing, middle age adult coping with aging (remember Erickson)

Situational Stress:

differs from developmental stress in that it is unpredictable; can be positive or negative; includes stressors such as illness, injury, marriage, divorce, loss of loved ones, new job, role changes