common phd

STRESS AND ITS MANAGEMENT

I. What Is Stress?

A. Stress is a complex series of psychological and physiological (physical) reactions that occur as a person responds to a threatening or demanding situation.

B. Each person may view and appraise a particular situation differently, so the same situation can have positive, negative, or neutral consequences for different people.

C. Ask students if they like to downhill ski, make parachute jumps from planes, or do other risky activities. How do their classmates feel about these activities? What things are

particularly stressful to them?

D. Stressors 1. Stressors are situations that create stress by placing physical or psychological

demands on an individual.

2. Psychological stressors include managing extreme emotions, handling difficult social situations and dealing with troublesome thoughts and

relationships.

3. Physiological (physical) stressors include engaging in exercise; experiencing illness, pain, or injury; and being exposed to dangerous pollutants or extreme

temperature changes.

4. Distress refers to stressful events that are difficult to control and have negative or unwanted outcomes.

5. Eustress refers to stressful events that have beneficial or desirable outcomes. 6. Regardless of the outcomes, stress has similar physical effects on the body, it

can damage the body and disturb the mind.

II. Stress Responses

A. Ask students how they would feel physically and emotionally, if they were driving down a street and a small child runs into the path of their car unexpectedly.

B. Physical Responses to Stress 1. The adrenal glands of the endocrine system produce and release stress

hormones.

2. Hormones are chemical messengers that convey information from a gland to other cells in the body.

3. Stress hormones include cortisol, epinephrine (adrenaline), and norepinephrine. They prepare the body to respond in threatening situations

(the “fight-or-flight” response).

4. People with higher than normal levels of stress hormones, fat, and glucose in their blood are likely to develop chronic high blood pressure and other

diseases of the heart and blood vessels.

5. Refer students to review acute physical adaptations the body makes in response to stressful situations.

6. The general adaptation syndrome (GAS) describes the body’s three stages of adaptation to stress: alarm, resistance, and exhaustion.

7. Review each stage of the GAS

C. Psychological Responses to Stress 1. Individuals experiencing distress are more likely to report psychological

symptoms such as frustration, anxiety, and anger. They may also be irritable,

eat too much food, or abuse drugs.

2. Burnout is caused by continued elevated levels of stress where the individual feels they are no longer able to physically or psychologically cope with stress.

3. Experiencing low levels of stress can sometimes be beneficial because it can stimulate people into taking actions, making changes, and increasing effort.

III. The Impact of Stress on Health

A. Stressful Life Events 1. People who experience numerous major life events within a short time span

are likely to develop illnesses.

2. Refer students to the Holmes and Rahe Social Readjustment Scale 3. Ask students to complete the assessment in the student workbook, which is

geared to college students.

B. The Mind-Body Relationship 1. Psychoneuroimmunology is the study of relationships between the nervous

and immune systems.

2. The immune system includes the red bone marrow, spleen, lymph nodes, white blood cells, and thymus gland, and defends the body against disease-

causing agents

3. Inflammation is a normal result of the immune system’s response to infection or injury and can assist in the recovery process

4. Stress alters the normal functioning of the brain, which in turn, affects immune system functioning. Stress depresses some aspects of the immune

system, resulting in delayed wound healing and increased susceptibility to

infection.

5. Chronic mild inflammation is thought to be associated with the development of many serious diseases, including heart and other blood vessel diseases,

obesity, diabetes, smoking, rheumatoid arthritis, inflammatory bowel

disorders, certain cancers, and Alzheimer’s disease

6. Autoimmune diseases occur when the immune system malfunctions and the system’s defense mechanisms become aimed at the body’s own healthy cells.

Rheumatoid arthritis, “lupus,” celiac disease, psoriasis, type 1 diabetes, and

multiple sclerosis are autoimmune diseases. Although these chronic health

problems have a genetic component, stress may contribute to their

development.

7. Using stress management techniques may indirectly improve health by decreasing one’s response to stressful events.

C. Personality and Stress

1. An individual’s unique combination of personality traits and background experiences contributes to his or her stress response to any given situation.

2. People who see only the negative aspects of a stressor may view a difficult situation as impossible to overcome and be more vulnerable to stress than

those who make positive appraisals of the situation

3. People who have positive outlooks on life may be stress-resistant. 4. Many less healthy behaviors, such as eating too much or too little, sleeping to

little, and using drugs, is associated with increased stress response.

D. Stress and Chronic Health Problems 1. Irritable Bowel Syndrome

i. Anxiety and stress worsen the signs and symptoms of irritable bowel syndrome (IBS). People with IBS have recurrent bouts of intestinal

cramps, constipation, diarrhea, and mucus in bowel movements.

ii. Irritable bowel syndrome often occurs with fibromyalgia syndrome (FMS), a condition characterized by extreme fatigue, muscle and joint

pain, headaches, and sleep disturbances for which no physical cause

can be found.

iii. Between 10-15% of U.S. adults experience IBS, with twice as many woman affected than men.

2. Peptic Ulcers i. Although stress does not cause ulcers, it seems to make them worse

when they occur.

ii. Ulcers form when the protective lining and the overlying mucous layer of the intestinal tract are unable to resist the normal amounts chemicals

such as hydrochloric acid secreted by the stomach.

iii. Ulcers also can develop in the esophagus when acidic acids in the stomach splash back into the food tube, a condition called acid reflux.

3. Headaches i. Although the mechanisms are unknown, stress contributes to the

development of headaches, particularly tension-type headaches.

ii. Inflammation of certain nerves in the meninges is a major factor in the development of migraine headaches.

iii. Refer students for a list of serious headache symptoms. iv. NSAIDs (e.g. ibuprofen) are a common cause of ulcers.

4. Overweight and Obesity i. About 80% of people alter their eating habits when they feel stressed

out.

ii. Stress increases the level of the stress hormone cortisol in the bloodstream. In response to increased blood cortisol levels, the

pancreas releases the hormone insulin. The combined effect of cortisol

and insulin is an increased desire to consume pleasurable, energy-rich

foods—fatty and/or sweet foods.

5. Heart Disease and Cancer i. Chronic stress increases the risk of cardiovascular disease. ii. Some people’s minds overreact to stressors, and their bodies respond

by releasing excessive amounts of stress hormones into the

bloodstream. This response may lead to inflammatory processes that

cause high blood pressure and other physical changes that damage the

inside walls of certain blood vessels.

iii. Platelets, cell fragments that participate in the blood clotting process, become stickier when a person is distressed.

iv. The stress response can reduce the effectiveness of the immune system, possibly interfering with its ability to detect and destroy cells

that become cancerous.

IV. Coping with Stress

A. Coping strategies are behavioral responses and thought processes that individuals use to deal actively with sources of stress.

B. Problem-Focused Strategies 1. Behaviors that can directly reduce or eliminate the negative effects of

stressors.

2. Planning, confronting, and problem-solving can help people feel more in control of stressful situations.

3. Managing Your Time a. Ask students if they feel that there is not enough time in a day to get

things done. Ask them to consider the value of their daily activities.

Which activities waste their time? Which activities are important and

increase the chances of meeting their goals?

b. High-priority activities are those that must be accomplished if you are to meet your most important goals.

c. After analyzing and ranking the high priority activities, determine the amount of time that is needed to carry them out.

d. To manage time, using a calendar or personal computer to record appointments or when papers are due or exams are given can be

helpful. Many people also make daily lists of “things to do,” especially

on very busy days. Allow some time for unexpected situations; it is not

necessary to lock yourself into a rigid work schedule.

4. Journal Writing a. Coping with daily stressors may be easier if you keep a written record

of personal events, thoughts, and feelings.

C. Emotion-Focused Strategies 1. Coping strategies that involve reducing a person’s negative emotional

response associated with stressful events.

2. Humor can be a useful emotion-focused strategy and improve one’s mood during a stressful event.

3. Emotion-focused strategies do not deal directly with the source of stress and therefore may relieve stress in the short term, but the coping strategies may

cause more stress later.

D. Social-Support Strategies

1. Seeking advice, assistance, or consolation of close friends and relatives; participating in support groups; and obtaining spiritual help from members of

the clergy or religious congregations.

V. Relaxation Techniques

A. Relaxation techniques can be used to reduce stress’ impact on your health. B. Deep Breathing

1. Deep breathing involves taking several deep breaths whenever one feels excited, nervous, or stressed out.

2. By deliberately breathing more slowly and deeply, distressed who have been hyperventilating, can feel more relaxed as their blood chemistry values return

to normal.

3. Results from studies show that deep breathing is a quick and simple method to reduce the impact of stress on your health.

4. Ask students to take a deep breath, hold their breath, and then exhale slowly. C. Progressive Muscular Relaxation

1. Stressed persons often look tense even when they are at rest because of their tightened muscles and clenched fists.

2. Grinding one’s teeth is a common sign of stress that can lead to pain in the temporomandibular joint

3. Ask students to tense the muscles of their right hand, then relax the muscles. Muscle tension can be relieved by a simple process of tensing and relaxing

various muscle groups throughout the body.

4. See MHB3-01 for A Technique for PNF D. Meditation and the Relaxation Response

1. Meditation is an ancient method of mental and physical relaxation where one focuses on a single word, object, or thought.

2. Mindfulness meditation involves a variety of relaxation methods that focus your attention completely and in a nonjudgmental way on what you are doing

or experiencing at the moment.

3. May include deep breathing and yoga positions. E. Imagery

1. Imagery is a mental activity that is often combined with progressive muscular relaxation exercises to enhance physical relaxation.

2. Imagery for relaxation can involve thinking of peaceful, pleasurable scenes. 3. Some people use imagery to prepare for stressful situations. For example, a

person who has to give a speech or interview for a job imagines various

stressful aspects of the situation and practices his or her responses.

F. Self-Talk 1. Negative self-talk statements are self-critical or self-degrading thoughts. 2. Individuals can reduce their stress levels by identifying these self-defeating

thoughts and replacing them with positive self-talk statements.

G. Physical Exercise 1. Engaging in exercise and other forms of physical activity can lessen the

impact of stress on the mind and body.

2. Physical activity can metabolize the extra energy released during the stress response, lessening the impact of stress on the body.

3. During strenuous physical activity, like running, the nervous system releases endorphins that may be responsible for creating the “runner’s high,” the

heightened sense of well-being that long-distance runners often experience.

4. Tai Chi and Yoga a. Tai chi, a form of martial art that originated in China, emphasizes

relaxation of the mind while the body is in motion.

b. Yoga, a philosophy of living that originated in India thousands of years ago, includes specific physical exercises, breathing techniques,

meditation activities, and dietary restrictions to promote a healthier

body and manage stress.

VI. Across the Life Span: Stress

A. US. Adults and teens report having stress levels far higher than what they deem healthy.

B. Common stressors for children include: 1. Separation from parents through divorce or death. 2. Moving to a new neighborhood. 3. Changing schools. 4. Illness of close family members.

C. Distressed children often exhibit regressive behaviors such as clinging to their parents. They may become depressed withdrawn, experience sleep disturbances, and have

problems in school.

D. The adolescent years are stressful because individuals undergo numerous physical and social changes during this time. Distressed youth who do not have effective and healthy

coping mechanisms are likely to suffer from depression, abuse drugs, have serious traffic

accidents, and experience problems with parents and school authorities.

E. Aging individuals often feel bored or useless, especially if they have retired from the responsibilities of a job or raising a family.

F. Stressors among the elderly include coping with loneliness and the deaths of friends or close family members, financial problems, having to raise grandchildren, and caring for

spouses with debilitating mental and physical disabilities.