Physiological and Psychological Response to Stress

will everyone experience stress?

YES

what are stressors?

an event, situation, or condition that results in psychological or physical stress; can be internal or external

examples of internal stressor

overthinking, anxiety, worry

examples of external stressor

major life changes, job loss, loss of loved one

what is a stress response?

• A physiological response to stressors.

• acute is for survival

• repeated or excessive stress- negative impact

what can stressful situation or stressor do to the body?

make your heart rate and breathing increase, and muscles tense up

does stress affect all systems of the body?

YES

stress can be a biological and physiological response

can be perceived- thought about stressor or experienced

effects of stress

• Maladaptive- A type of stress that includes characteristics both biological and behavioral that are detrimental and interfere with optimal functioning and coping with life. poor coping

• Resilience- The ability to successfully adapt to difficult or challenging life experiences that are mentally and emotionally challenging, requiring flexibility in behaviors to adapt to external and internal demands. good coping

• chronic stress- Prolonged internal and external exposure to stressful events, situations, or experiences (stressors).

physiological effects of the body

• The heart beats more rapidly, pumping more blood. Blood flow to muscles increases, while blood flow to organs decreases. Blood pressure rises.

• The endocrine system releases cortisol, adrenaline, and noradrenaline, which constricts blood vessels. Less growth hormone is released, and fewer sex hormones are produced.

• More oxygen is consumed, and more carbon dioxide is expelled. Breathing is faster and shallower.

• The skin begins to sweat.

• The pancreas releases glucagon. It produces less insulin, and blood glucose levels rise.

general adaptation syndrome GAS

• the explanation was based on physical responses and how the body wants to adapt or reduce stress; body has limits and can eventually run out of energy when stressed

what are the stages of GAS

alarm, resistance, and exhaustion

alarm (acute) stage

• Increased sympathetic nervous system (SNS) activity

• Prepares for fight-or-flight response

• Not sustainable for extended periods of time

• if the threat does not subside the body will go into the resistance stage

• ex- finley jumped out of the way of the vehicle

signs of increased SNS/ countershock

• Elevated HR and BP 

• Increased blood flow to the heart and peripheral muscles 

• Increased RR, resulting in extra oxygen being sent to the brain 

• Heightened cognitive processes 

• Heightened senses (awareness) 

• Increased blood glucose, muscle endurance, and stamina 

• Decreased nonessential bodily functions (digestion)

resistance stage

• Described as adaptative stage; is when the body attempts to adapt to the stressor

• At this stage, if the stressor diminishes, the individual can return to homeostasis 

• will move to exhaustion if stressor not diminished

• Finley left the ditch to check on the other driver

exhaustion stage

• their body has depleted its resources and can no longer adapt to the stressor. Internally, the body’s tissues and organs are depleted, and the result can lead to illness, disease, or death

• Finley does not remember going to the hospital

fight

anger, aggression, stomping, kicking, punching, stomach in knots, nausea, vomiting

flight

anxiety and feeling trapped, tension, wide eyes, restlessness (legs, feet), fidgeting

freeze

dread, heart pounding and numbness, pallor, holding breath

fawn

self-directed anger, lack of boundaries, feeling no identity, trying to please aggressors, ignoring own desires

faint

changes in vision, feeling lightheaded, blacking out, falling

positive stressors

eustress

adaptation and learning

examples of eustress

• Birth of child

• Marriage

• Buying a home

• Retirement

• Starting a new job 

• Holiday season

• Vacation

• Promotion at work

• Graduation from school

negative stressors

distress

depletion of energy and exhaustion

examples of distress

• Death of a loved one

• Financial burdens

• Divorce

• Legal problems

• High demands at work or school

• Abuse or neglect

• Conflict in relationships

• Hospitalization (self/others)

• Injury or illness (self/other)

acute stress

• Sudden exposure to stressor or adverse experience

• aligns with alarm stage of GAS

• short period of time

acute stress response

increased reaction time, increased energy, hyperawareness, elevated heart rate

impact of acute stress

can have a longer effect on the individual

chronic stress

• prolonged exposure to stressors from adverse experiences or trauma

• the body becomes overwhelmed resulting from the accumulation of the effects of the stressors over time

• Some of the psychological and physiological effects of chronic stress include depression, anxiety, and recurring infections.

chronic stress response

• Persistent feelings of being overwhelmed and accumulation stress

• Overexposure to cortisol

chronic stress causes increased risk for

• Eating disorders, mood disorders, and substance use disorders

• Hypertension, heart disease, obesity, metabolic syndrome, arthritis, type 2 diabetes

toxic stress

• Prolonged or chronic stress response system

• Body learns experiences of stress, fear, or trauma are normal

• could be resulted from chronic exposure to neglect, interpersonal violence, community violence, or bullying.

• experience of sustained stressors

toxic stress response

• Biological and neurological changes to brain and body

• any age during early development

toxic stress and adverse childhood experiences ACEs involvement

• Children are excessively vulnerable to toxic stress

• Changes in brain and organ development

long term or lifelong complications of toxic stress

• Stress-related disorders

• Cognitive impairment and complications in learning

• Physical health issues

• Mental illness

health impact of stress

physical symptoms of stress

psychological and behavioral manifestations of stress

risk factors of stress response

hoplessness, poverty, ACEs, genetics, substance abuse

protective factors of stress response

perception of control, spiritual practices, parental bonding, healthy lifestyles

individual factors of stress response

• Perception

• Attitude

• Temperament- how an individual reacts to the world around them.

• Personality Traits- Sustained characteristics of an individual that are drawn from a pattern of behaviors, attitudes, feelings, and habits.

• Genetics and neurodevelopment

• lifestyle

health behaviors and well-being

• Health behaviors become protective factors when they include adequate sleep, healthy exercise, healthy eating, and adequate hydration. 

• well-being are considered protective lifestyle factors, such as mindfulness, gratitude, meditation, and deep breathing

hardiness

Set of beliefs and attitudes that perceived stress or stressful circumstances are opportunities for growth and development. Particularly focused on managing occupational stress.

mediators of stress

• Environment factors

• Setting

• Cultural factors

• Support systems: family and community

• Spirituality and religion

Social and Societal Risk Factors for Stress

• Poverty

• Previous trauma, including war, violence, or disasters

• Adverse childhood experiences

• Compounding societal stressors

  • Unemployment, Financial insecurity, Housing insecurity, Political or social unrest, Discrimination or racism

coping

The use of strategies, both cognitive and behavioral, to recognize and manage during the stress response and reduce the negative effects of stress.

coping style

• Two general styles or categories of strategies people have in responding to stress

• negative or maladaptive resulting in an unhealthy response or adaptive resulting in a healthy response.

• problem or emotion focused or avoidant

problem-focused coping style

• requires adjusting or managing the problem that has caused the stress. It is action-focused.

• Example: A client who creates a list or a plan on how to tackle the issue and reduce stress. 

emotion-focused coping style

• vary and are action-focused. These coping styles reduce the negative emotions associated with stress.

• Example: A client who seeks out support and resources that nurture their emotional health.

avoidant coping style

• described as cognitive and behavioral efforts directed toward diminishing, ignoring, or denying stressful situations in an effort to avoid dealing with the stressor.

• Avoidant coping is a passive way of coping that focuses on ignoring the stressor.

• Example: A client who avoids the stressor by drinking or sleeping. 

defensive mechanisms

• A conscious or unconscious reaction an individual uses to protect themselves from stress or anxiety, sometimes referred to as escape mechanism

• adaptive (mature)

• maladaptive (immature)

The Holmes-Rahe Social Readjustment Scale

• commonly known as the Holms-Rahe Life Stress Inventory, is a life change measurement scale.

• The scale measures positive and negative life events and assigns a value to certain stressors. The purpose of the scale is to assess an individual’s vulnerability to stress-related disorders.

altruism

• Transforming feelings and emotions by helping someone who is experiencing something similar

• Ex. Adaptive- A client, whose child died after being hit by a drunk driver, chooses to work with a local group to support others who have also lost their children to drunk drivers.

denial

• Dismissing the situation as not being true or based in reality

• Ex. Adaptive-The client decides to get up and watch a movie to get their mind off the situation and eventually falls asleep.

• Ex. Maladaptive-A client is told that they are diagnosed with a terminal illness, believes that the health care provider mixed up their clients, and does not believe the diagnosis is correct.

displacement

• Redirecting unacceptable feelings or thoughts about the stressor to a less threatening target

• Ex. Maladaptive- A client is angry with their boss for a poor review directs their anger toward their spouse, a perceived less threatening target

projection

• A person's painful thoughts or emotions about themselves, something they have done, or the way they are feeling are projected to other people, places, or situations

• Ex. Maladaptive- A child who consistently lies to their parent assumes that the parent lies consistently as well.

rationalization

• Using reasoning and logic to avoid or explain the stressor or their actions and avoid their own emotions.

• Ex. Adaptative- A client feels humiliated during a presentation and states, “The audience is silent because they are interested in what I have to say.”

• Ex. Maladaptive- After surviving an episode of abuse, the victim states, “This would not have happened if I just paid more attention to their (perpetrator) needs.”

regression

• A return to a previous developmental stage of behavioral, cognitive, or emotional functioning

• Ex. Adaptative- A client comes home from work after a stressful day and decides to watch their favorite childhood television show.

• Ex. Maladaptive- One person in an argument begins to yell and throw objects at the other person.

repression

• A person that avoids thinking or talking about stressor, who can admit certain feelings about the stressor but cannot think about what led up to the feeling or cause of the stressor

• Ex. Adaptative- A client is providing the eulogy at their cousin’s funeral. After feelings of intense sadness, the client unconsciously decides to tell a funny story about when they were children.

• Ex. Maladaptive- A client cannot remember being abused as a child but has a problem developing relationships.

supression

• A conscious (voluntary or purposeful) effort where the individual chooses to inhibit or control unwanted thoughts or feelings caused by the stressor

• Ex. Adaptative- A client who is angry at their parent but refuses to let it spoil a family holiday celebration.

• Ex. Maladaptive- A client who is unable to work due to a recent surgery states that they will worry about paying their bills once they are fully recovered.

Adjusting Expectations

this can avoid disappointment and reduce stress. It may best be done by considering a variety of different outcomes of a situation

Biofeedback

• this incorporates the use of biosensors and monitoring physiological responses to activities or stressor to inform the client of internal responses to stress.

• The clinician introduces the instrument and assists the client in interpreting their response with the goal of the client becoming aware of their internal response and learning skills to self-regulate toward a healthier response

Deep Breathing

• refers to taking deliberate, slow, and deep breaths.

• When taking deep breaths, our bodies can better exchange carbon dioxide for oxygen, which results in a slower heart rate, lower blood pressure, and consequently, a feeling of relaxation.

• Refocuses stress as the client is more aware of their breathing, resulting in relief from negative emotions

Develop Positive self-talk and reduce self-blame

• these are based internalizing the stressors.

• The nurse should encourage their client to learn to talk to themselves with kindness rather than doubt or blame. Linked to physical and mental health benefits

Guided Imagery

• involves using deep breathing, moving into a calm and relaxed state, and imagining a scene or place that represents calmness and relaxation, such a as a beach, a park, or an outdoor space.

• During this time, the client considers what their senses may be experiencing and how they are feeling.

• Very often, this is done with someone verbally guiding the client or the use of an audio recording.

 

Mindful Meditation

• is paying attention to what is happening at the moment and focusing on thoughts, physical sensations of the body, and what is being experienced.

• The client is then taught to accept the feelings and sensations without judgement, and rather than responding, is encouraged to recognize them and let the feeling go.

Cognitive reframing

is a technique used to change the way a person thinks about something.