Management of Stress

E. Fagon FNP/Nurse Educator

Apr 10, 2016

Objectives
Define the term stress.
Describe the physiology of the stress
response mechanism in the body.
Identify some possible causes of stress.
State some signs & symptoms of stress.
Describe some (a) positive & (b) negative
ways in which people manage stress.
Discuss the general management of stress.
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Stress
Def: An emotional reaction to change and
may be positive or negative. The factors
which promote the stress reaction are called
stressors and are events, stimuli or situations
which cause an imbalance in the stressed
individual. Positive stress is called eustress,
while negative stress is called distress.
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DEFINITION: Stress is a physiological and

psychological response to events in ones
life that upset ones balance in some way.
When faced with a threat which threatens
ones equilibrium, the bodys defenses kick
Into high gear in a rapid, automatic process
known as the fight or flight response. Ellen
Jeffe et al (Understanding stress: signs)
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DEFINITION: Stress was defined by Selye in

1946 as the non-specific response of the

body to any demand upon it to adapt, whether
that demand produces pleasure or pain. In
1976, Selye again defined stress as the rate
of wear and tear in the body. The two definitions
illustrate how the same person defined stress at
different times, and hence the confusion in
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the definition of stress. Trauer, in 1986,

defined stress as an unpleasant state of mind
brought on by situations which are found
difficult to handle. Comparing the definitions of
Selye, a Physiologist, and Trauer, a Psychologist,
it becomes evident how people from different
backgrounds view stress. Whereas Selye focused
on the physical changes, Trauer was concerned
more with the behavioural aspects of stress.
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Overview of Stress Response

Mechanism
Todays news include round the clock coverage
of natural and man made disasters. Examples
Include earthquakes, floods, wars & terrorist
attacks just to name a few. Just a few
minutes of watching the news can make ones
stress level soar. If one has a big presentation to
make in a short time without the chance to prepare

adequately, it becomes a stressor.

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Physiology of Stress Response

Mechanism.
Cannon and Selye are noted for their theories
on stress. Cannon in 1939,spoke of the Fight
or Flight Reaction, whereas Selye, in 1946,
proposed the General Adaptation Syndrome.
Cannon recognized the strong involvement
of the catecholamines in mobilizing the
resources for Fight or Flight during a stress
reaction. Selye proposed three stages in the
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General Adaptation Syndrome (GAS), which

comprised (1) alarm stage which represented
the acute phase of stress, and corresponded
to the type of stress described also by
Cannon (2) Resistance phase: During the
resistance phase, the body utilizes the
available resources to nullify or alleviate the
stressors in the environment.
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EXHAUSTION: During this phase, the many

adaptive mechanisms of the body begin to

show signs of failure, this may be the case
in chronic stress, when organs failing in their
effort to adapt cause diseases.
Physiologically, the stress response is
practically uniform regardless of the type of
stressor involved. To the Physiologist, stress
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is recognized as a condition of maladpation

that can generate observable alterations in
body tissues and chemistry. A physiologic
stress response involve a great deal of inter
-play among different areas of the central
nervous system, and culminates in altered
behaviour and augmented secretion of
several neurally mediated hormones.
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When an individual encounters a threat, the

hypothalmus sets off an alarm in the body.
Through a combination of nerve and hormonal
signals, the system prompts the adrenal
glands to release a surge of hormones-the
most abundant being adrenaline and cortisol.
Adrenaline increases the heart rate, elevates
blood pressure, and boost energy supplies.
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Cortisol, the primary stress hormone, increases

sugar in the bloodstream, enhances the
brains use of glucose and increases the
availability of substances that repair tissues.
Cortisol also curbs functions that would be
none essential or detrimental in a Fight-or
Flight situation. It alters immune system
responses and suppresses the digestive
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system, the reproductive system, and

growth processes. The complex alarm
system also communicates with regions of
the brain that controls mood, motivation and
fear.

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CAUSES OF STRESS
The potential causes of stress are numerous
and highly individual. What a person considers
stressful depends on many factors, including
ones personality, general outlook on life,
problem solving abilities, and social support
system. Something that is stressful to one
Person may not faze someone else, or they
May even enjoy it. For example, your
morning
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commute may make you anxious and tense

because you worry that traffic will make you
late. Others, however, may find the trip relaxing
because they allow themselves more than
enough time and enjoy listening to music while
they drive. The pressures and demands that cause
stress are known as stressors. People usually
think of stressors as being negative, such as an
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exhausting work schedule or a rocky relation

-ship. However, anything that forces one to
adjust can be a stressor. This includes
positive things such as getting married, or
receiving a promotion. Regardless whether
or not an event is good or bad, if the adjustment
that it requires strains ones coping skills and
adaptive resources, the end result is stress.
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Specific Causes of Stress

MAJOR LIFE CHANGES: Major life changes

are stressors. Whether it be a divorce, a child

leaving home, a planned pregnancy, a move
to a new town/home, a career change,
graduation from college, or a diagnosis of
cancer or other major health problems are
all stressors. The faster or more dramatic
the change, the greater the strain.
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DAILY HASSLES & DEMANDS: While major life

changes such as death and divorce are

highly stressful, they are also relatively rare.
However, one may battle traffic, argue with
family members and worry about ones
finances on a daily basis. Because these
small upsets occur so regularly, they end up
affecting one the most.
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DAILY CAUSES OF STRESS INCLUDE:

Environmental Stressors-Ones physical
surrounding can set off the stress response
mechanism. Examples of environmental
stressors include an unsafe neighbourhood,
pollution, noise (sirens keeping you up at
nights, a barking dog next door), and
uncomfortable living conditions. For people
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can all send stress levels skyrocketing.

WORK STRESSORS:
In career-driven societies, work can be an
ever present source of stress. Work stress is
caused by things such as job dissatisfaction,
an exhausting workload, insufficient pay,
office politics, and conflicts with ones
employer or co-workers.
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SOCIAL STRESSORS:
Ones social situation can cause stress. For
example, poverty, financial pressures, racial
and sexual discrimination or harassment,
unemployment, isolation, and a lack of social
support all take a toll on the quality of life.

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INTERNAL CAUSES of STRESS

Not all stress is caused by external pressures
and demands. Ones stress can also be self
generated. Internal causes of stress include:
Uncertainty and worries
Pessimistic attitude
Self criticism
Unrealistic expectations or beliefs
Perfectionism
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INTERNAL CAUSES of STRESS

cont,d.
Low self esteem
Excessive or expressed anger
Lack of assertiveness.
RISK FACTORS FOR STRESS:
The presence of a stressor doesnt automatically
result in disabling stress symptoms. The degree
to which any stressful situation or event impacts

ones daily functioning depends partly on the

nature of the stressor itself and partly on
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Vulnerability to Stress
ones own personal and external resources.
STRESS: How vulnerable are you?
Nature of stressor: Stressors that involve
central aspects of ones life (marriage, job)
chronic issues (physical handicap, living
from paycheck to paycheck) are more likely
to cause severe distress.
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 A CRISIS EXPERIENCE: Sudden, intense

crisis situation (being raped, robbed at gunpoint, or attacked by a dog) are
understandably overwhelming. Without
immediate intervention and treatment,
debilitating stress symptoms will become
common.
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 MULTIPLE STRESSORS OR LIFE CHANGES:

Stressors are cumulative, so the more life

changes or the more hassles one has to deal
with at any one time, the more intense the
symptoms of stress .

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 THE PERCEPTION OF THE STRESSOR:

The same stressor can have different effects
on different people. For example, public
speaking stresses out many people, while
others thrive on it. Additionally, if one is able
to see some benefit to the situation as it were
light at the end of the tunnel, or a hard lesson
learned-the stressor is easier to swallow.
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 ONES KNOWLEDGE AND PREPARATION:

The more one knows about a stressful

situation, including how long it will last and
what to expect, the better one is able to face
it. For example, if one goes into surgery with
a realistic picture of what to expect post-op,
a painful recovery will be less traumatic than
if one were expecting to bounce back immediately.
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 ONES STRESS TOLERANCE:

Some people roll with the punches, while
others crumble at the slightest obstacle or
frustration. The more confidence one has in
ones self and ones ability to persevere, the
better able one will be to take things in
strides.
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 ONES SUPPORT NETWORK:

A network strong of supportive friends and
family members is an enormous buffer
against lifes stressors. But the more lonely
or isolated one is, the higher ones risk of
stress.

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SIGNS & SYMPTOMS OF STRESS

To get a handle on stress, one first needs to
recognize it in ones self. Stress affects the
mind, body, and behaviour in many waysall directly tied to the physiological
changes of the Fight-or-Flight response.
The specific signs and symptoms of stress
vary widely from person to person.
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Some people primarily experience physical

symptoms, such and skin outbreaks. In
others, the stress pattern centers around
emotional symptoms such as crying, or
hypersensitivity. For still others, changes in
the way they think or behave predominates.
as low back pain, or stomach problems,
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Specific Symptoms of Stress

COGNITIVE SYMPTOMS:
memory problems
indecisiveness
inability to concentrate
trouble thinking clearly
poor judgment
seeing only negative things
anxious or racing thoughts
constant worrying
loss of objectivity & fearful anticipation
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Physical Symptoms

headaches or backaches
muscle tension and stiffness
diarrhoea or constipation
nausea, dizziness
insomnia
chest pains, rapid heartbeat
weight gain or loss
skin breakouts (hives eczema)
loss of sex drive, and frequent colds
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Emotional Symptoms

moodiness
agitation
restlessness
short temper
irritability, impatience
inability to relax
feeling tense and on edge
feeling overwhelmed
sense of loneliness and isolation
depression or general unhappiness
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Behavioural Symptoms
eating more or less
sleeping too much or too little
isolating ones self from others
procrastination, neglecting responsibilities
using alcohol, cigarettes or drugs to relax
nervous habits (e.g. nail biting, pacing)
teeth grinding or jaw clenching
overdoing activities (e.g. exercising or shopping)
overreacting to unexpected problems
picking fights with others
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Top Ten Stressful Life Events

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Spouses death
Divorce
Marriage Separation
Jail Term
Death of a close relative
Injury or illness
Marriage
Fired from job
Marriage reconciliation
Retirement
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Effects of Severe Stress and

Trauma
Severe stress can result from sudden,
catastrophic events or traumatic experiences
such as a natural disaster, sexual assault,
life threatening accident, or participation in
combat. After the initial shock and emotional
fallout, many trauma victims gradually begin
to recover from its effect. But for some people,
the stress symptoms dont go away, the
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body doesnt regain its equilibrium, and life

doesnt return to normal. This severe and
persisting reaction is known as post traumatic
stress disorder (PTSD). Common symptoms of
PTSD include:
Flashbacks, intrusive thoughts, or nightmares
Avoidance of places and things
Hypervigilance for signs of danger
Chronic irritability band tension, and depression
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Common Coping Responses

POSITIVE COPING RESPONSES:
Listening to music
Playing with a pet
Laughing or crying
Going out with a friend (shopping, movie dining)
Praying or going to church
Exercising or getting outdoors to enjoy nature
Discussing situation with a spouse or close friend
Gardening or making home repairs
Practicing deep breathing, meditation or muscle relaxat.
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Negative Coping Responses

Criticizing yourself (negative self talk)

Driving fast in a car
Chewing ones fingernails
Becoming aggressive or violent
Eating too much or too little or drinking coffee
Smoking or chewing tobacco
Drinking alcohol
yelling at your spouse, children or friends
Taking a recreational drug to calm self
Avoiding social contact
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References
Segal R. ,Smith M. (2014) How to Reduce, Prevent and
Cope with Stress.
http://www.webmd.com/balance/stress-management
Overview accessed 2012.
http://www.holisticonline.com/stress/early-warning-signs
accessed 2012.
http://about.com accessed 2012.
http://www.helpguide.org accessed 2012.
http://en.wkipedia.org/wiki/Homes_Rahes_stress_scale
accessed 2014.

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