Running head: HEALTH PROMOTION: STRESS MANAGEMENT

Health Promotion: Stress Management

Cheryl Veres
Ferris State University

HEALTH PROMOTION: STRESS MANAGEMENT

Abstract
The premise of this paper is to discuss stress and health promotion in stress management. Stress
is a normal part of life and can have both good and bad implications. As there are many
conditions and diseases that have been linked to the effects of ill-managed stress, it is
increasingly important to educate and adopt appropriate stress management skills in order to
obtain optimal wellness, balance, and harmony. Within the contents there is a description of
what takes place in the body when stress transpires. From there, the focus is on the concepts of
stress and how coping mechanisms can be incorporated into health promotion to facilitate the
reduction of frequency and extent of the morbidities that result from stress. Included topics are
prevalence of stress in the United States, the different types of stress that occur throughout the
lifespan, discussion on the manner in which individuals perceive and appraise stress, the factors
that can influence the responses to stressors, and the strategies that are beneficial in stress
reduction. Optimal functioning and wellness are the goal.

HEALTH PROMOTION: STRESS MANAGEMENT

Health Promotion: Stress Management

Stress affects everyone at some point and to various degrees. It is an unavoidable human
experience and happens in every society, particularly in societies that has accelerating or rapid
change (Pender, Murdaugh, & Parsons, 2011). Stress can arouse our thinking process and keep
us observant in our environment. Human beings actually need stress to stay motivated and avoid
apathy; however, it is a matter of how the stress is perceived and how we handle it that makes the
difference. There are many different types of stressors, or the things that cause stress, and they
come in many forms. Positive life events can induce an increase in our level of stress as well as
negative life events, but negative situations usually are the types that cause more distress because
the consequences are more severe and there is minimal benefit. Eustress is a certain level of
stress that is experienced positively, and distress is another level that can compromise our wellbeing (Corbin, Welk, Corbin, & Welk, 2006).
The human body responds to stress with a physiological response as described in Hans
Seyles General Adaptation Syndrome (GAS). These physiological responses involve the
endocrine system and autonomic nervous system (ANS). Physical demands or injury cause the
pituitary gland to initiate GAS as well as the hypothalamus to secrete endorphins that can
provide a sense of well-being. By this token, GAS protects against stress by triggering our
neuroendocrine system and by imparting endorphins that can help to decrease the awareness of
pain (Potter & Perry, 2007). According to Pender, Murdaugh, and Parsons (2011), the body will
attempt to maintain homeostasis, or balance of the internal body systems, for basic survival.
Allostasis denotes the process of attaining stability by changing, and during stressful occasions
the adaption process is continuous in the pursuit of balance and harmony. During this time
catecholamines (adrenalin), glucocorticoids (cortisol), and other hormones are released. There

HEALTH PROMOTION: STRESS MANAGEMENT

are also other physiologic occurrences in response to stress like pupillary dilation, peripheral
vasoconstriction, clammy and cold skin, as well as, an increased respiratory and heart rate,
increased perspiration, blood pressure, muscle tension, gastric motility, and blood glucose level.
When the stressful period resolves or has been controlled the body will return to its normal state,
but if this is not achieved overtime, a continued elevated level of the stress response will result in
allostatic overload (Pender et al., 2011). Common everyday stressors can be managed with
healthy stress management behaviors, but untreated chronic stress can cause anxiety, insomnia,
muscle and back pain, high blood pressure and a weakened immune system (American
Psychological Association, 2012). Allostatic overload represents the collective effects of
sustained negative psychosocial and environmental stressors, and has been implicated in the risk
for many diseases that include cardiovascular disease, diabetes, obesity, and cancer (Pender et
al., 2011).
An individuals ability to cope with challenges over the duration of a lifetimes is
influential in their status of allostasis and allostatic overload, and therefore in the risk for
resultant morbidities (Pender et al., 2011). Many of these manifestations can be avoided if steps
are taken to manage stress as there is a direct correlation between wellness and stress
management.
Prevalence in the United States
The American Psychological Associations Stress and Region reports that two-thirds of
Americans think they are doing OK with their stress management, with some regions faring
better than others. For instance, 46 % of Midwest adults are more likely to say that stress has
increased over the past year and they are also more likely to name various physical and nonphysical ways that stress manifests itself (American Psychological Association, 2012). The

HEALTH PROMOTION: STRESS MANAGEMENT

Midwest also reports more than any other region with 49% reporting irritability, 47%
nervousness, 46% lacks having interest, energy, or motivation, 44% feels sad or depressed, 43%
have fatigue, and feel overwhelmed, and 41% feel as though they could cry. Some health
conditions show the highest occurrence in this region as well with 30% reporting high
cholesterol, 14% diabetes, 20% arthritis, 19% depression, and 14% with anxiety disorders. What
is even more of a concern is that this is also the region were more people say that their family
does not try to be active; 16% which is a 5% increase from the prior year (American
Psychological Association, 2012). The 2011 Stress in America reports Overall, people seem to
recognize that stress can have an impact on health and well-being, but they do not necessarily
take action to prevent stress or manage it well (American Psychological Association, 2012).
Stress Throughout the Lifespan
There are maturational factors that vary the kinds of stressors that are prevalent during
different life stages. Potter and Perry (2007) give insight to some of the elements of life that can
present as stress. Infants, for example, are developing attachment, separation anxiety, and
stranger awareness. Toddlers have a strong need for autonomy, and this can become a major
source of stress. Pre-school children are refining the mastery of their bodies and are eager to
begin school and make new friendships. The school-age child is developing their sense of
industry and the influence and importance of peers increases. There is stress that is related to
self- esteem as well as with adolescents. Adolescents are also striving for independence and as
they search for their identity within peer groups, there is a separation from family and they
undergo resultant stress. Adult stress typically revolves around major life events. Young adults
have developmental tasks that can potentially be sources of stress like identifying a preferred
occupation and college. In middle-adulthood the expected changes sometimes involve changes

HEALTH PROMOTION: STRESS MANAGEMENT

such as children moving away, divorce, or death of a spouse or parent. The older adult faces
death of friends or a spouse, and sometimes even children. There are many changes in social
roles. They can be lonely, and their health status may force them to alter their living
arrangements (Potter & Perry, 2007).
Perception and Appraisal of Stress
The reaction to psychological stress is explained in Potter and Perrys Basic Nursing:
Essentials for Practice Stress and Coping (2007). Evaluation of an event for the personal
meaning is the primary appraisal and happens automatically. If within the primary appraisal an
individual identifies the event as a threat, harmful, a challenge, or loss stress will be felt. At this
point when stress has been recognized, a secondary appraisal follows in pursuance of conceiving
possible coping strategies (Potter & Perry, 2007).
Factors that Influence Responses
Many factors can influence how individuals respond to stress and how they utilize coping
mechanisms. Some of the factors that influence stress response negatively are: the intensity or
how great the perceived magnitude of the stressor is, the scope or the how much of the persons
total well-being is affected, the duration or how long the person endures the stressor, and the
nature or number of other stressors that are being experienced simultaneously. There are other
factors that can enhance coping and decrease the stress experience like predictability or being
able to anticipate the next occurrence. This is because even if it cannot be controlled it can
reduce the experience of stress. The level of perceived personal control over the experience can
matter even if control is not exercised. It can reduce anxiety. Individuals who have greater selfconfidence in their ability to manage stress can also have an impact as well as having the concern
and support of others. It is important to remember that people will have a different cognitive

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appraisal of the same type of event as in the greater the personal meaning of an event, the
greater the stress associated with it (Potter & Perry, 2007, p. 598).
Stress Reduction Strategies
According to Concepts of Fitness and Wellness: A Comprehensive Lifestyle Approach
(2006), there are four different categories of strategies for stress management. Emotion-focused
strategies include relaxing, exercising, seeking passive and social support, and prayer. Appraisalfocused strategies, like cognitive restructuring, involve changing automatic negative thoughts
that lead to unnecessary distress. Another appraisal-focused strategy is seeking knowledge or
practicing skills by finding ways to increase confidence that one has the ability to cope. Problemfocused strategies are strategies that attempt to minimize or resolve the stressful situation. This
includes systemic problem solving by creating a plan of action and following through, being
assertive by standing up for your rights and values while maintaining respect for others, and
seeking active social support that incorporates getting advice or help from others. The fourth is
the avoidant coping category. These are strategies that are used to distract the individual from
the real problem by ignoring and refusing to think about the situation or pretending it does not
exist. Escaping by searching for ways to feel better or stop thinking about the issue can include
eating, nicotine, alcohol, or other drug use. The avoidant coping strategies are normally
ineffective and cause more damage and stress in the end (Corbin et al., 2006).
Health Promotion in Nursing Practice (2011) also discusses the three positive coping
strategies. When emotion-focused strategies are used there are many complementary therapies
that can be used to manage stress. Complementary therapies are used by more than two-thirds
of the world population, and Americans have dramatically increased their use of such therapies
in recent years (Pender, Murdaugh, & Parsons, 2011, p. 206). These therapies are used in

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conjunction with traditional medicine and can include mindfulness-based stress reduction
(MBSR), progressive relaxation through tension-relaxation, and relaxation through imagery,
yoga, acupuncture, self-hypnosis, and positive thinking.
When using appraisal focused strategies the focus is on increasing the resistance to stress.
This can be achieved through physical or psychologic conditioning of the self. In the promotion
of exercise, psychological changes are the by-product of cardiorespiratory fitness even though
psychologic responses and fitness usually are not associated. However, gains in exerciserelated self-efficacy and mastery generalize to other situations, resulting in improvements in selfconcept and coping ability (Pender, Murdaugh, & Parsons, 2011, p. 204). Enhancing selfesteem and self-efficacy, increasing assertiveness, setting realistic goals, and building coping
resources are also part of appraisal focused strategies.
Lastly, problem-focused strategies take steps to minimize the frequency of stressinducing situations, change the environment is possible, avoid excessive change if not necessary,
set aside time to specifically focus on changes and for strategy development, and utilizing time
management (Pender, Murdaugh, & Parsons, 2011).
The main sentiment here is reflected in a statement from the Journal of Advanced
Nursing (2011), Stress resiliency and psychological empowerment are human traits, combining
to strengthen the capacity of an individual to respond to stressors. More than 50 years of
scientific evidence supports the power or resilience in relation to positive outcomes (Pine et
al., 2012, p. 1483).
Conclusion
Stress management strategies are crucial in abating much morbidity. Health promotion in
stress management is critical and educational and support programs should be expanded.

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References
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Potter, P A., & Perry, A. G. (2007). Stress and coping. In Basic nursing: Essentials for practice
(6th ed.). St. Louis, MO: Mosby, Inc.