STRESS & ADAPTATION

Stress: is a condition in which the human system responds to changes in its normal balanced state.

Stressor: is any thing that is perceived as challenging, threatening or demanding.

Adaptation: is the change that takes place as a result of the response to a stressor.

Homeostasis: various physiologic mechanisms within the body respond to internal changes to maintain a relative constancy in the internal environment.

SOURCES OF STRESS

Internal e.g. illness, abnormal change, or fear External e.g. noise, cold environment, death, move

PHYSIOLOGIC HOMEOSTASIS

Local Adaptation System (LAS) involves only one specific body part
y y

Reflex pain response Inflammatory response

General Adaptation Syndrome biochemical model of stress (Hans Selye)

y y y

Alarm reaction Resistance Exhaustion

ALARM REACTION
Person perceives stressor, defense mechanisms activated Fight-or-flight response Hormone levels rise, body prepares to react Shock and counter-shock phases (1 min - 24 hrs)

RESISTANCE
Body attempts to adapt to stressor. Vital signs, hormone levels, and energy production return to normal. Body regains homeostasis or adaptive mechanisms fail.

EXHAUSTION
Results when adaptive mechanisms are exhausted Body either rests and mobilizes its defenses to return to normal or dies

PHYSIOLOGICAL RESPONSES TO STRESS

Increases heart rate Increases respiration Increased blood pressure Dilated pupils Muscle tension Headache

EMOTIONAL RESPONSES TO STRESS

Depression Anger Anxiety (most common)

Mild y Moderate y Severe y Panic

y

COPING MECHANISMS
Crying, laughing, sleeping, cursing Physical activity, exercise Smoking, drinking Lack of eye contact, withdrawal Limiting relationships to those with similar values and interests

FACTORS AFFECTING STRESS AND ADAPTATION

Sources of stress Types of stressors experienced Personal factors

CATEGORIES OF STRESS

Developmental stress
Occurs when person progresses through stages of growth and development y E.g.
y

Situational stress
Does not occur in predictable patterns y E.g.
y

TYPES OF STRESSORS

Physiological
y

Chemical agents, physical agents, infectious agents, nutritional imbalances, hypoxia, genetic or immune disorders Includes real and perceived threats

Psychosocial
y

STRESS MANAGEMENT TECHNIQUES

Relaxation Meditation Anticipatory guidance Guided imagery Biofeedback Crisis intervention

CRISIS INTERVENTION

A crisis is a disturbance resulting from a perceived threat that challenges the person's usual coping mechanisms. Crises are a time of increased vulnerability, but they can also stimulate growth. There are two types of crises: maturational and situational. Crisis intervention is a brief, active therapy with the goal of returning the individual to a precrisis level of functioning.

DEFINITION

A crisis is an overwhelming reaction to a threatening situation in which a persons usual problem solving strategies fail to resolve the situation resulting in a state of disequilibrium. Crisis is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the persons current resources and coping mechanisms.(James & Gilliland, 2001)

Causes
Crises

can occur on a personal or societal level. Physical or emotional Death or serious illness Natural disaster Civil unrest Monetary Health Concerns

TYPES OF CRISIS
Developmental (Maturational) CrisisCrisispredicted times of stress in everyones life which occurs in response to a transition from one stage to another in the life cycle.

 Situational

Crisis- occurs in response to a sudden unexpected event in a persons life. The critical life events revolve around experiences of grief and loss. For example loss of a job, divorce, abortion, death of a love one, severe physical or mental illness, etc.

Adventitious Crisis- are not part of everyday life. They are unplanned and accidental resulting in traumatic experiences. Such as Natural disasters.. hurricanes, flood, fire, earthquake, etc National disasters.. war, riots, etc Crime of violence.. Child abuse, rape, assault, bombing in crowded areas, etc

WHAT IS CRISIS INTERVENTION?

Crisis

intervention is a process to assist individuals in finding adaptive solutions to unsettling events.

CRISIS INTERVENTION BALANCING FACTORS

Crisis- good outcome 1. Perception of event realistic 2. Situational support adequate 3. Coping mechanism adequate No crisis Crisis- development 1. Perception of event distorted 2. Situational support inadequate 3. Coping mechanisms inadequate Crisis

SEVERE ANXIETY

PERSONALITY DISORGANIZATION (CRISIS)

TRIAL & ERROR SOLUTIONS

USUAL COPING MECHANISMS INEFFECTIVE

STRESS

ANXIETY

OR

NEW PROBLEM- SOLVING SOLUTIONS AND SUPPORT ANXIETY PRE-CRISIS LEVEL OF FUNCTIONING

CRISIS INTERVENTION
ASSESSMENT
a.

b.

c.

Perception of event: What happened that prompted you to seek help?; How are you feeling now?; etc. Coping mechanisms: Suicidal?; Plans?; What helps you feel better?; etc. Support systems: With whom do you live with?; Who is available to help you?; Who is most helpful?; etc

ASSESSMENT
a. b. c.

Mental status, previous history Identify clients strengths Self-assessment

PERFORMING THE ASSESSMENT

Conducting
y

the interview

History: personal and familial of risk behavior y Any means and plans the client may have about carrying out the risk behavior y Controls: internal and external that are stopping the client from undertaking the risk behavior.
Observations
y

during the interview

Level of anxiety; desperation; despair; sense of hopelessness; contact with reality.

 The

skill and technique most essential at this stage is that of focusing while allowing the client to ventilate and express the overwhelming flood of emotions. Focusing technique can elicit more coherent information for assessment as well as help the client pull themselves together cognitively and emotionally. A focused interview can serve as an instrument of both assessment and intervention.

INTERVENTION
Planning

occurs simultaneously as assessment is made about how much time has elapsed between the occurrence of the stressor event and this initial interview. How much the crisis has interrupted the persons life; The effect of this disruption on others in the family; Level of functioning prior to crisis and what resources can be mobilized.

Goal of intervention

The goal of intervention is to restore the person to pre-crisis level of equilibrium, not of personality changes. Worker attempts to mobilize the clients internal and external resources. Exact nature of the intervention will depend on the clients pre-existing strengths and supports and the workers level of creativity and flexibility

STEPS IN CRISIS INTERVENTION

Determining severity of the crisis: Forming a connection. Showing empathy. Exploring the problem. Active listening Paraphrasing. Expressing emotion. Honoring values. Offering solutions. Development of an action plan. Training and role playing

THE BASIC ELEMENTS OF CRISIS INTERVENTION

A. Safety and Security Physical safety of the victim. A parallel concern should be whether the victim feels safe Provide victims with information to assure them of their safety. If they are not safe, keep them informed about the extent of additional threat A priority for some victims and survivors is the safety of others as well.

All victims and survivors need to know that their reactions, their comments, and their pain will be considered private. If possible, keep media away from victims/survivors or help them in responding to media questions. Give victims permission to express any reactions and respond non-judgmentally. Say, You have a right to be upset over this tragedy, so dont be afraid to tell me what you are thinking.

PSYCHOPATHOLOGICAL CONSEQUENCES
Anxiety Disorders Substance Related Disorders Dissociative Disorders Mood Disorders Disorders of Infancy, Childhood, or Adolescence Sleep Disorders Adjustment Disorders

REMEMBER DOS AND DONTS

Do NOT say things like: I understand. It sounds like . . . Im glad you can share those feelings. Youre lucky that. . . Itll take some time but youll get over it. I can imagine how you feel. Dont worry; its going to be all right. Try to be strong for your children. Calm down and try to relax.

Do say things like: 3 You are safe now (if true). 3 Im glad youre here with me now. 3 Im glad youre talking with me now. 3 I am sorry it happened. 3 It wasnt your fault (if there was no attributable blame to the victim). 3 Your reaction is not an uncommon response to such a terrible thing. 3 I cant imagine how terrible you are feeling. 3 You are not going crazy. 3 Things may never be the same, but they can get better.

THREE APPROACHES
Affective:

y Expression

and management of feelings involving techniques of: y Ventilation. y psychological support. y emotional catharsis..

COGNITIVE:
y

y y y y y

Helping the client understand the connections between the stressor event and their response. Techniques include: clarifying the problem; Identifying and isolating the factors involved; Helping the client gain an intellectual understanding of the crisis Also involves giving information; discussing alternative coping strategies and changing perceptions

 Environmental
y

modification:

Pulling together needed external, environmental resources (either familial or formal helping agencies)

Any

and all three approaches may be used at any time depending where the client is, emotionally and cognitively. The goal is to help the client restore precrisis levels of functioning.

WARNINGS

Danger of misunderstanding the clients nonverbal behavior as well as spoken words due to cultural differences or the clients state of disorganization. Imperative for the worker not to assume that they understand what the client means by his spoken word or non-verbal behavior and vice versa. It is best to clarify and make sure.