STRESS

BY- Soumya Ranjan ParidaMSC NURSING 1 yr

INTRODUCTION:

In psychology stress is a feeling of strain andpressure. Small amounts of stress may bedesired, beneficial, and even healthy. Positivestress helps improve athletic performance.

It also plays a factor in motivation, adaptation,and reaction to the environment. Excessiveamounts of stress, however, may lead to bodilyharm.

Stress can increase the risk of strokes, heartattacks, ulcers, dwarfism, and mental illnessessuch as depression.

TERMINOLOGY

1. StressIn a medical or biological context stress is aphysical, mental, or emotional factor that causesbodily or mental tension. Stresses can beexternal (from the environment, psychological,or social situations) or internal (illness, or from amedical procedure). Stress can initiate the "fightor flight" response, a complex reaction ofneurologic and endocrinologic systems.

Categories of stress Distress- can threaten health(continual

worries Eustress – good stress (passionate kiss)

financial

Developmental –Associated with life stages (e.g–college ,graduation)

Situational –Random, unpredictable (e.g.Hurricane or accidents)

Physiological – affect body structure /function (diseases or mobility problems

Psychological –arise from life events (e.g workpleasure ,family arguments )

Where does stress come from ?

Stress can come from Inside -–

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–

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INTERNAL STRESSOR:-

Body image

Not happy with the way you look

self-conscious feel everyone is staring atyou

Stress can come from OutsideEXTERNAL STRESSOR:-

i.e. surroundings, environment–

–

–

–

–

Family ……..

School ….

Friends /Peers …

Society ….

Others ……

Stresses physical

– Prolonged school

hours

Over-packed class

rooms

Transport

Pollution air, noise

Overcrowding road

Poor ventilation

–

–

–

–

–

–

Stresses psychological

–

–

–

–

Bullies,

Changing schools,

Conflicts with teacher,

Forced

competitiveness,

Falling grades,

Have to present in

class

Learning disorders,

–

–

–

–

Physiological Stress response

Adrenal medulla :-

- Releases norepinephrine and epinephrine

Eye :-

- pupil dilate

-secretion is increased from lacrimal glands

Respiratory system :-

-Bronchioles dilate.

-Respiration rate is increased

Cardiovascular system :-

-Increased force of cardiac contraction

-Increased cardiac output

-Increased heart rate

-Increased blood pressure

Gastrointestinal system :-

-Decreased gastric and intestinal motility

-Sphincters contract

-Decreased secretions

Liver :-

-Increased glycogenolysis

-Decreased glycogen synthesis

Urinary system :-

-Increased ureter motility

-Bladder muscle contracts

-Bladder sphincter relaxes

Skin :-

-Increased secretions

STRESS RESPONSE

Stress mastery

Stress Mastery Stress Mastery is theutilization of coping strategies in theresponse to stressful situations.

Adaptive coping strategies protect theindividual from harm and restore physical andpsychological homeostasis.

Coping strategies are considered maladaptivewhen the conflict being experienced goesunresolved or intensifies

EFFECTS OF CHRONIC

STRESS Increase Gluconeogenisis

Decrease Immune

Decrease inflammatory response

Retention of sodium and water

Decrease in libido, frigidity and impotence

Increase in blood pressure

Psychological adaptation ofstress

Anxiety and grief have been described as two major, primarypsychological response patterns to stress.

A variety of thoughts, feelings, and behaviors are associated with eachof these response patterns.

Adaptation is determined by the extent to which the thoughts,feelings, and behaviors interfere with an individualǯs functioning.

Psychological adaptation ofstressMind and body interaction

2. Anxiety

3. Coping mechanisms

1. Mind body interaction:-

humans react to threats of danger as if they were physiologic threats ofa person perceives the threat on an emotional level& the body preparesitself to either resist the danger or to run away from it. Each personreacts in

Backache

Constipation

Diarrhea

Dilated pupils

Dry mouth

Headache nausea

Sleep disturbances

Psychological adaptation ofstress

Anxiety:

-A diffuse apprehension that is vague in nature and isassociated with feelings of uncertainty and helplessness.

-Extremely common in our society.

-Mild anxiety is adaptive and can provide motivation forsurvival.

Peplau’s four levels of anxiet

Mild – seldom a problem

Moderate – perceptual field diminishes

Severe – perceptual field is so diminished thatconcentration centers on one detail only or on manyextraneous details

CONT...

Anxiety at the moderate to severe level thatremains unresolved over an extended periodof time can contribute to a number ofphysiological disorders – for example,migraine headaches, IBS, and cardiacarrhythmias.

• Extended periods of repressed severeanxiety can result in psychoneurotic patternsof behaving – for example, anxiety disordersand somatoform disorders.

CONT...

Extended periods of functioning at the paniclevel of anxiety may result in psychoticbehavior; for example, schizophrenic,schizoaffective, and delusional disorders.

At the mild to moderate level ,the ego callson defence mechanism for protection .

CONT...

3. Coping mechanism:- DENIAL DISPLACEMENT INTROJECTION PROJECTION RATIONALIZATION REACTION FORMATION REPRESSION SUBLIMATION UNDOING COMPENSATION

Intervention to reduce anxiety

a). Exercise:- Regular exercises help to maintainphysical & emotional health.b). Rest and sleep:- Rest and sleep helps the body to

maintain homeostasis & restore energy levels.c). Nutrition:- It plays an important role inmaintaining the bodyǯs homeostatic mechanisms & in increasing resistance to stress. Obesity &malnutrition are major stressors & greatly increasethe risk of illnessd). Encouraging the use of support system:- Supportsystem provides emotional support that helps aperson identify & verbalize feelings associatedwith stress.

Stress adaptation model

Three main models of stress :

1. Stimulus based model

2. Response based model

3. Transaction based model

1. Stimulus based model:-

Acc. To this model ,stress is defined as astimulus,a life event ,or a set of circumstances thatarouses physiologic and psychologicalreactions that may increase the individuals vulnerability to illness.

Stress adaptation modelcont..2. Response model :-• Hans Selye (1907- 1982) was a

Hungarian endocrinologist, first to give a scientific

explanation for biological stress.

• Hans Selye explained his stress model based on

physiology and psychobiology as General

Adaptation Syndrome (GAS).

His model states that an event that threatens an organism’s well-being (a stressor) leads to a three-stage bodily response:

Stage 1: Alarm

Stage 2: Resistance

Stage 3: Exhaustion

He explained about hypothalamic-pituitary-adrenal axis (HPA axis) system which prepares the body to cope with stress.

Selye also explained about a local adaptation syndrome which refers to the inflammatory response and repair processes occur at the local site of tissue injury as in small, topical injuries, such as contact dermatitis which may lead to GAS if the local injury is severe enough.

Stages

Stage 1: Alarm

Upon encountering a stressor, body reacts with “fight-or-

flight” response and sympathetic nervous system is

activated.

Hormones such as cortisol and adrenalin released into the

bloodstream to meet the threat or danger.

The body’s resources now mobilized.

Stage 2: Resistance

Parasympathetic nervous system returns many

physiological functions to normal levels while body

focuses resources against the stressor.

Blood glucose levels remain high, cortisol and adrenalin

continue to circulate at elevated levels, but outward

appearance of organism seems normal.

Increase HR, BP, breathing

Body remains on red alert.

Stage 3: Exhaustion

If stressor continues beyond body’s capacity, organism

exhausts resources and becomes susceptible to disease

and death.

Stress adaptation modelcont..

3.Transaction based model :-

•Transaction (interaction) occursbetween a person & theenvironment

•Stress results from an imbalance

between (a) demands & (b) resources

•Thus we become stressed when

demands (pressure) exceeds our

resources (our ability to cope &

mediate stress)

•Thus the interpretation of the

stressful event was more important

than the event itself

LAZARUS MODELOF STRESS & COPING

•Considers whether the person has apersonal stake in encounter (are theirgoals thwarted)

•Evaluates the significance of theencounter – which either

1. Has no significance for

person

2. Is a benign-positive encounter(desirable)

3. Harmful/ threatening/

challenging

Primary appraisal –concerns relevance to our

well-being

•Stressful situations are appraised asinvolving

1. Harm/ loss - that has occurred (sofar)

2. Threats – i.e. potential

future harm

3. Challenges – i.e. how can we learn/gain confidence from this experience

PRIMARY APPRAISAL

•Individual will then engage in secondary appraisalto work out how we can best deal with situation &change undesirable conditions•Evaluate internal/ external coping options as wellas more specifically resources to create a morepositive environment.

1. Internal options – e.g. will power, inner strength2. External options – peers, professional health• Thus it may become a reappraisal of stressor and

our coping resources

SECONDARY APPRAISAL

•Used when we feel we have control of thesituation, thus can manage the source of theproblem•Thus our possible strategies could include:

1. Defining the problem2. Generating, evaluating alternative solutions3. Learning new skills to manage stressor4. Reappraising – by reducing our ego

involvement

PROBLEM BASED COPING

•Used when we feel we have little control of thesituation, thus we cant manage the source of the problem•Involves gaining strategies for regulating emotionaldistress – e.g.

1. Avoiding – ͚I’m not going school.2. Distancing yourself from the emotion, I am not

stressed, it does not matter to me.3. Acceptance – ͚I failed the exam but I still have 4 other

subjects.4. Seeking emotional support from your partner5. Selective attention

6. Alcohol

EMOTIONAL BASED COPING

Is STRESS good or bad forus ?

All stresses can be GOODSo all efforts should be to convert all

stresses into EUSTRESS –This can be

achieved by stress management techniques

STRESS MANAGEMENT

MANAGE AT ALL THE THREE LEVEL– PSYCHOLOGICAL LEVEL: MEDITATION,

REASSESSING OUR THOUGHTS &FEELINGS– PHYSICAL LEVEL: EXERCISES,

YOGA,PHYSICAL ACTIVITIES– BEHAVIOURAL LEVEL: RESPONDING WITH

EQUANIMITY .

IF the distress crosses the threshold levelmedical problems like Depression, Anxietydisorders, Hypertension etc. sets in. seekmedical help from a qualified medicalpractitioner

SUGGESTED COPINGSTRATEGIES

• Take life the way it comes

• Stop blaming others

• Develop your own inherent potential

• Live in the present & Work for the future

• Maintain harmonious relation with others

• Learn to be happy & cheerful

SUGGESTED COPINGSTRATEGIES

MEICHENBAUM’SAPPROACH TO STRESS

MANAGEMENT

1. Teaching individuals that negative self-evaluation increase stress

2. Monitoring one’s own self-defeatingstrategies – teaching new cognitivestrategies

3. Teaching new skills like relaxation

4. Providing real life homework assignmentthat become increasingly difficult to carryout

CONCLUSION

• Stress is manageable -It needs efforts

• Engage truthful thinking

• Modulate your behavioral pattern

• Lead a well balanced life of satisfaction.

• Assert control on self in terms of thinking &action

ADAPTABILITY IS THE “MOTHER KEY” TOCONVERT DISTRESS TO EUSTRESS

STRESS MANAGEMENT

TIPS

• Making little changes in your life can really add upto a big feeling of relief.

• Learn to recognize when you are feeling stressedand simple ways you can relax.

• Take a break. Have a cold drink, get some fresh air,or close your eyes for a minute to refocus.

• Stay positive to help friends and family cope withstress.

• Let others know you're feeling overwhelmed andtell them how they can help.

• Allow yourself to simply say "no" to friends andfamily when you know you cannot meet theirdemands without becoming overwhelmed.

STRESS

MANAGEMENT TIPS• Be prepared for unexpected problems such

as traffic, a lost pet or a family emergency.

• Prioritize. Take control of your "to do" list bydeciding what's really most important on yourlist.

• Write down feelings of sadness, frustrationor anger to get a clearer perspective of youremotions.

• Enjoy life's simple pleasures like colorfulflowers, dancing, music, and social outings,etc.

Exercise regularly.

Have healthy eating habits never skip breakfast

Reduce sedentary activities like TV Videogames etc.

Eat healthy nutritious food. Avoid Junk food .

Avoid excess caffeine intake eg tea coffeechocolates and cola drinksDo NOT TAKE QUICK FIX REMEDIES likealcohol tobacco and drugs

‘as they have long term and very harmfuleffects on your body and mind ‘’.

STRESS

MANAGEMENT PLAN

THANKYOU