Stress and Coping (Class 23)

Stress

An actual or alleged hazard to the balance of homeostasis.

Stressor

Physical, psychological, or social stimuli that can produce stress and endanger homeostasis

Appraisal

How a person interprets the impact of the stressor

General Adaptation Syndrome (GAS)

Describes how the body responds physiologically to stressors. The purpose is to regain a sense of balance.

Stages of GAS

1. Alarm Stage
2. Resistance Stage
3. Exhaustion Stage

Alarm Stage

* “Fight or Flight”
* Symptoms:
* Pupils dilate
* Blood volume increases
* Heart rate increases
* Blood glucose levels increase
* Blood flow to muscles increases
* Oxygen intake increases
* Mental alertness increases

Resistance Stage

* Body stabilizes and responds
* Hormone levels, heart rate, blood pressure, and cardiac output should return to normal
* The body tries to repair any damage that occurred

Exhaustion Stage

* Continuous stress the body to no longer be able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation
* The physiological response has intensified, but the person’s ability to adapt to the stressor diminishes
* Leads to allostatic load

Stress Neutral

Coping is effective

Stress Challenge/Manageable

Coping effective, but new coping skills may be needed.

Stress Not Manageable

Coping ineffective; exceeds capacity to manage. Requires outside assistance.

Allostatic Load

* Even in the face of chronic demands, an ongoing state of chronic activation of GAS can occur.
* This chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs and is called allostatic load.
* Can cause long-term physiological problems such as chronic hypertension, depression, sleep deprivation, etc.

Primary Appraisal

Evaluating an event in terms of personal meaning. When a person identifies an event or circumstance as harm, loss, threat, or challenge.

Secondary Appraisal

The process by which a person considers possible available coping strategies or resources, occurs at the same time.

Coping

The person’s cognitive and behavioral efforts to manage a stressor. Important to physical and psychological health because stress is associated with a range of psychological and health outcomes.

Ego-Defense Mechanisms

* Regulate emotional distress and thus give a person protection from anxiety and stress
* Help a person cope with stress indirectly and offer psychological protection from a stressful event
* Everyone uses them unconsciously to protect against feelings of worthlessness and anxiety

Compensation

Making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset.

Compensation Example

A person in financial bankruptcy purchases a new Tesla in hopes of convincing others they are doing well financially.

Conversion

Unconsciously repressing an anxiety-producing emotional conflict and transferring it into nonorganic symptoms.

Conversion Example

A woman walks into the ER for stomach pain, after a recent motorcycle crash she has stopped eating and lost 30 pounds since the incident.

Denial

Avoiding emotional conflict by refusing to consciously acknowledge anything that causes intolerable emotional pain.

Denial Example

After receiving a terminal diagnosis, a cancer patient insists that the test results are incorrect and they will beat their cancer and life will return to normal soon.

Displacement

Transferring emotions, ideas or wishes from a stressful situation to a less anxiety-producing substitute.

Displacement Example

A child has a lot going on him his homelife, so he bullies another child in school.

Identification

Patterning behavior after that of another person and assuming that person’s qualities, characteristics, and actions (dressing life a friend.)

Identification Example

After experiencing rehab for Substance Abuse Disorder, a woman decides to study psychology so she can help others the way she was helped.

Dissociation

Experience in which people feel disconnected from their sensory experience, sense of self, or personal history. Experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings.

Dissociation Example

After losing a loved one, a woman states that she hasn’t been herself, her mind wanders and she doesn’t feel like she’s completely there.

Regression

Coping with a stressor through actions of behaviors associated with an earlier developmental period.

Regression Example

A toilet trained 5-year-old begins wetting themselves after experiencing a traumatic event.

True

True or False: The difference between coping and Ego-Defense mechanisms is that coping mechanisms are conscious while defense mechanisms are unconscious.

Importance of Understanding a Patients Stress Level

* Stress can impact the physical and mental well-being of patients, as well as entire families and communities.
* When stress overwhelms existing coping mechanisms, patients lose emotional balance, and a crisis results.
* If symptoms of stress persist beyond the duration of the stressor, a person experiences a trauma.

Acute Stress

* Most common type of stress
* Occurs for a short period of time
* Occurs in reaction to a real or perceived demand, threat, or pressure.
* Resolution leads to elimination of the stress response.

Episodic Acute Stress

* Self-inflicted or in regular chaos.
* Common in type A personalities.
* Unrealistic assignments beyond reasonable expectation.
* These individuals are always in a hurry and irritable.
* Constant worry is another for of episodic stress.

Chronic Stress

* This type of stress represents a perpetual or sustained demand, threat, or pressure that is harmful to health because it wears on the individual continuously.
* Can stem from a long-term stressor. Ex. occupational stress, relationship stress, financial stress, etc.
* Associated with a loss of hope

Secondary Traumatic Stress

* Trauma a person experiences from witnessing other people’s suffering.
* Component of compassion fatigue and common in healthcare workers.
* Results in nightmares and anxiety.
* People with this condition begin to avoid interactions and have difficulties in sleeping and relating to friends and family.

Consequences of Chronic Stress on the Body

Results in continuous activation of the nervous system nd eventually produces negative outcomes across multiple body systems leading to several chronic health conditions.

Effects on Central Nervous System

* Headaches
* Nervousness
* Memory problems
* Insomnia
* Confusion
* Anxiety disorders
* Depression
* Problems with decision making

Effects on Cardiovascular System

* Stroke
* Myocardial infarction
* Hypertension
* CVD
* Atherosclerosis
* Cardiac arrhythmias

Effects on Immune System

* Decreased WBCs
* Cancer
* Immunosuppression
* Chronic Illnesses
* Asthma

Effects on Musculoskeletal System

* Pain/discomfort
* Nervous tics
* Migraines/tension headaches

Effects on Gastrointestinal System

* Gastritis
* Ulcerative colitis
* Irritable colon
* Diarrhea
* Obesity
* Eating disorders

Effects on Integumentary System

* Hair loss
* Acne
* Eczema
* Psoriasis
* Ulcers in the mouth (cold sores)

Effects on Male Reproductive System

* Reduced sex drive
* Reduced testosterone
* Reduced sperm
* Erectile dysfunction
* Impotence

Effects on Female Reproductive System

* Menstrual disorders
* Menopause symptoms (Irritability, hot flashes)
* Mood swings

Crisis

Implies that a person is facing a turning point in life. This means that previous ways of coping are ineffective and the person must change.

Maturational/Developmental Crisis

Occurs as a client moves through the stages of life. Ex. Marriage or childbirth.

Situational Crisis

Result of the unexpected trauma such as losses, illness, or displacement. Ex. Job loss, motor vehicle crash, death.

Adventitious Crisis

Rare, unexpected happenings that are not part of everyday life. Ex. A major natural or man-made disaster or a crime of violence.

Stress Management Strategies

* Time management
* Guided imagery
* Mindfulness-based stress reduction
* Journal writing
* Regular exercise

Maladaptive Coping Response

* Include responses that ignore the underlying cause of the stress and may lead to other problems.
* Ex. Alcohol abuse, drug abuse, smoking, excessive eating, denial, withdrawal, or avoidance.

Neuman’s System Model

Uses a systems approach to explain how stress affects patients. A stressor at one place in a system affects other parts of the system.

Roy’s Adaptation Model

Describes how an individual can effectively respond to stressors in the environment. A person has the ability to modify external stimuli to allow adaptation to occur.

Pender’s Health Promotion Model

Focuses on promoting health, managing stress, and increasing level of well-being. People can assess their own abilities/assets and want to live in ways that enable them to be as healthy as possible.