Concepts of Stress

Definition of terms:

Stress

 A disruptive condition that occurs in response to adverse influences from the internal or
external environments

 A condition in which the person responds to changes in the normal balanced state

Stressors

 A stimulus or situation that causes stress.

Classification of Stressors

General Classification

1. Internal Stressor

 Originate within the person

2. External Stressor

 Originate outside the individual

3. Developmental Stressor

 Occurs at a predictable time throughout life

4. Situational Stressor

 Unpredictable may occur any time during life

 Can Be Positive or Negative

According to Location

1. Physical e.g. (Cold,Heat, chemical agents)

2. Physiologic e.g. (pain and Fatigue)

3. Psychosocial e.g. (Failing exams and losing a job)

 According to involved persons

1. Day to day stressors

2. Major complex occurrences involving large groups

3. Less frequent stressors involving few groups

According to Duration

1. Acute time limited stressor

2. Stressor sequence

3. Chronic intermittent stressor

4. Chronic Enduring Stressor

Stress as Stimulus

 Stress is defined as a stimulus, life event, or a set of circumstances that arouses

physiologic and psychologic reactions that may increase the individuals vulnerability to
illness

Adolph Meyer

 Relating life response to illness

Holmes and Rahe

 Life change units

 A numerical scale ranking stressful life events and the amount of distress they
cause( 43 life changes)

Stress as a Response

 Hans Selye defined stress as the nonspecific response of the body to any demand
made upon it
  Schafer defined stress as the arousal of mind and body in response to demands made
upon them

Generalized Adaptation Syndrome (GAS or Stress syndrome)

 Describes stress as wear and tear on the body occurring regardless of whether the
stressor is positive or negative

Localized Adaptation Syndrome (LAS)

 Inflammatory and repair processes that occur in the at the local site of tissue injury

Phases of GAS/LAS

A. Alarm reaction

2 phases

1. Shock Phase

 SNS and Endocrine system react to stress(fight or flight response)

2. Countershock Phase

 Reversal of changes brought by Shock phase

B. Stage of Resistance

1. Adaptive responses that attempt to limit the damage of stress

C. Stage of exhaustion

1. Physiologic and psychological resources are depleted and immune

system becomes depressed

Stress as a Transaction
 Transactional Stress theory

 Encompasses a set of cognitive, affective and adaptive(coping) responses that

arise out of person-environment transaction

Mediating process(cognitive-motivational-relational) - Lazarus

a. Cognitive appraisal

i. Primary appraisal

 Event is evaluated to what is at stake

1. Stressful

 Harm or loss has occurred

 Harm or loss is anticipated(Threatening)

 Opportunity or gain is anticipated(Challenging)

2. Nonstressful (irrelevant/benign/positive)

ii. Secondary appraisal

 Event is evaluated to what is might and can be done

iii. Reappraisal

 Change of opinion based on new information

Manifestations of Stress

Physiologic

 Dilatation of Pupils

 Sweat production

 Heart rate & Cardiac output inc

 Skin is Pale

 Na and H2o retention

 Respiratory rate and depth inc

  Urinary output inc

 Dry mouth

 Peristalsis Dec

 Mental alertness Inc

 Muscle tension Inc

 Blood sugar inc

Psychological

 Depression

 Extreme feeling of sadness, despair, dejection, lack of worth, or emptiness

Emotional Symptoms

• Tiredness

• Sadness

• Emptiness

• Numbness

Behavioral Signs

• Irritability

• Inability to concentrate

• Difficulty in making decisions

• Loss of sexual desire

• Crying

• Sleep disturbance

• Social Withdrawal

Physical Signs
 • Loss of appetite

• Weight loss

• Constipation

• Headache

• Dizziness

Anxiety

 State of mental uneasiness, apprehension, dread, or foreboding or a feeling

helplessness related to impending or anticipated threat to self or
significant relationships

 Can be experienced at conscious, subconscious, or unconscious

Levels of Anxiety

Level Verbalization Motor activity Perception Respiratory Other

Changes changes Alteration and Changes
and Circulatory
Attention Changes
Changes

Mild Increase Mild Inc arousal None None

Questioning Restlessness and alertness

Sleeplessness Uses learning

to adapt

Moderate Voice tremors Tremors, Narrowed , Slight inc Mild gastric

and Pitch Facial inattentive symptoms
Changes twitches, and selective
shakiness attention
focus

Slightly
impaired
learning

Severe Communication Motor activity Easily Tachycardia, Headache,

difficult to inc, Inability to distracted Hyperventilatio dizziness,
understand relax, Fearful n nausea
Facial No Focus
 Expression Learning
severely
impaired

Panic Communication Motor activity Distorted Dyspnea, Feeling of

not inc, Agitation, exaggerated Palpitations, impending
understandable Unpredictable Perception choking, Chest doom,
responses, Pain paresthesia,
Trembling, Unable to sweating
Poor motor learn
coordination

Fear

 Emotion or feeling of apprehension aroused by impending or seeming danger pain or

a perceived threat

Anger

 Emotional state consisting of a subjective feeling of animosity or strong displeasure

 Can be Verbal or Non verbal

 Hostility – overt antagonism harmful or destructive behavior

 Violence – exertion of physical force to injure or abuse

 Aggression – unprovoked attack, or a hostile, injurious or destructive action or

outlook

Cognitive

 Problem Solving

 Thinking through threatening situations, using specific steps to arrive at a

solution

 Structuring

 Arrangement or manipulation of a situation so that threatening events do not

occur

 Self-control(Discipline)
  Assuming a manner and facial expression that conveys sense of being in control
or in charge

 Suppression

 Consciously and willfully putting a thought or feeling out of mind

 Fantasy or Daydreaming

 Unfulfilled wishes and desires are imagined as fulfilled.

PREDISPOSING FACTORS FOR STRESS

 GENETIC FACTORS

 INABILITY TO ADAPT

 INADEQUATE RELAXATION RESPONSE

 RESPONSE ACTIVITY VARIATIONS

 AGE

 PERSONALITY

 ISOLATION

 Environment

Eustress and Distress

 Eustress

 The pleasurable stress that accompanies positive events. For example, a person
may receive a $10,000 bonus and experience stress in deciding how to spend
the money.

 Distress

 The unpleasant stress that accompanies negative events.

Type a/type b (Friedman and Rosenman, 1974)

 Type a

 Competitive, achievements orientation. Self-critical. No joy in accomplishments.

  Time urgency. Impatient. Always on the go.

 Do several things at once.

 Anger/hostility- easily aroused to anger, which may be overt or covert.

 Type b

 Low levels of competitiveness

 Time urgency - patient

 Hostility - not easily aroused to anger

 Easy going

 Philosophical

Coping

 Dealing with problems and situations, or contending with them successfully

 Cognitive and behavioral effort to manage specific external /internal demands that are
appraised as taxing or exceeding the resources of a person(Folkman and Lazarus)

Coping strategy/mechanism

1. Emotion Focused Coping

 Lessens emotional distress

2. Problem Focused Coping

 Direct change to the environment