Stress And Its
Management
DEFINITION OF STRESS
A disruptive condition that occurs in
response to adverse influences from the
internal or external environments
OR
A condition in which the person
responds to changes in the normal
balanced state, the response can be
physical, mental or emotional
DEFINITION OF STRESSOR
A stimulus or situation that causes stress.
Or
A biological, psychological, social or
chemical factor that causes physical or
emotional tension and may be a factor in
the etiology of certain illnesses.
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
CLASSIFICATION OF STRESSORS
contd…..
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)
CLASSIFICATION OF STRESSORS
contd…..
According to Duration:
Acute time limited
stressor
Chronic intermittent
stressor
Chronic Enduring
Stressor
STRESS AS A BIOLOGICAL
RESPONSE
(RESPONSE BASED MODEL)
Stress may also be considered as a response.
Selye (1976) defined stress as “the nonspecific
response of the body to any kind of demand made
upon it.”
Selye stress response is characterizes by a chain or
pattern of physiological events called general
adaptation syndrome (Gas) or stress syndrome.
The GAS is physiological response of the whole body
to stress, which involves the autonomic nervous
system and the endocrine system.
STRESS AS A BIOLOGICAL RESPONSE
(contd..)
General adaptation syndrome(GAS)
consist of three stages:
ALARM REACTION STAGE
RESISTANCE STAGE
EXHAUSTION STAGE
Three stages of GAS…….
ALARM REACTION STAGE
The initial reaction of the body.
Alerts the body defense.
Hormones level rises to increases blood volume &
thereby prepare the person to act.
Other hormone are released to increase bld gluc.
level to make energy available for adaptation.
Increased level of epinephrine & nor epinephrine
result in an increased heart rate, increased blood
flow to muscles, increased oxygen intake &
greater mental alertness.
ALARM REACTION STAGE (contd..)
The extensive hormonal activity prepares
the person for the fight or flight response.
Increased mental activity
Dilated pupils
Bronchiolar dilatation
Increased respiratory rate
Increased heart rate
Increased glucose
Increased cardiac output
Increased blood pressure
Increased blood flow to skeletal muscles
RESISTANCE STAGE
The body stabilizes & hormone level, heart rate,
B.P & cardiac output returns to normal.
The person is attempting to adapt to the
stressor.
If the stress can be resolved, the body repairs
damage that may have occurred.
If the stressor remains present (as in continued
blood loss debilitating disease or long term severe
mental illness) & adaptation fails, the person
enter the third phase of exhaustion.
EXHAUSATION STAGE
Occurs when the body can no longer resist stress
& when the energy necessary to maintain
adaptation is depleted.
Physiological response is intensified but the
person’s energy level is compromised &
adaptation to the stressor diminishes.
The body is unable to defend itself against the
impact of stressor.
Physiological regulation diminishes & if stress
continues, death may result.
LOCAL ADAPTATION SYNDROME
CHARACTERSTICS:
the response is localized, it does not involve
entire body
the response is adaptive (to maintain
homeostasis)
the response is short term
the response is restorative
Inadequate or excessive
Egocentric, tiring
MODES OF ADAPTATION
Physiologic/ Biologic Adaptive Mode
Psychological Adaptive Mode
Sociocultural Adaptive Mode
Technologic Adaptive Mode
ACUTE LOCAL ADAPTATION
The body reacts to a local
stressor (e.g. postural distortions,
repetitive physical activities,
trauma, leg-length difference,
reflex activity) with an increase in
local muscular tone.
LOCAL ADAPTATION SYNDROME -
ACUTE PHASE
ADAPTION/RESISTANCE PHASE
When local muscular tone is increased for any length of time, the
affected tissues suffer from :-
Local ischemia due to increased muscular tone & demand
Restricted elimination leading to retention of metabolic wastes
This leads over time to fatigue then irritation & may cause
inflammation. The pain & discomfort that are likely to arise can
lead to further increases in tone & pain via the Pain-Spasm cycle.
Palpation at this time would show tissues to be warmer than other
tissues. The tissues could be oedematous, and would usually be very
sensitive.
CHRONIC LOCAL ADAPTATION
If the adaption phase lasts longer than a few
weeks, the sustained stresses stimulate the
production of collagen.
The body uses this collagen to lay down
bands of fibrous tissue in support of the
hypertonic muscle.
This point could be considered the
transition from an acute condition to a
chronic condition
LOCAL ADAPTATION SYNDROME - CHRONIC
PHASE
LOCAL ADAPTATION SYNDROME - CHRONIC
PHASE (contd..)
Ischaemia & retention of metabolites continue to
increase & myofascial trigger points begin to
develop. At this point taut bands are palpable in
the local muscle tissues &satellite trigger points
begin to develop
The effects of increased muscular tone also begin to
be felt at the muscles tendonous insertions. This
increased tone may lead to
LAS of the tendon OR
LAS of the tendo-periostial junction OR
Early stage joint dysfunction
LOCAL ADAPTATION SYNDROME - CHRONIC
PHASE (contd..)
When the body’s adaptive capacities are
exhausted (which may take many years), the
exhaustion or collapse stage sets in. This may
be characterized by arthritic joint changes
or chronic muscular/soft-tissue dysfunction.
The progression of tissue changes in an
individual body through these three stages
depends on age, exercise, and nutritional
status among other things.
REFLEX PAIN RESPONSE
This response is a localized response of the
CNS to pain
An adaptive response and protects tissues
from further damage Response involves a
sensory, motor response.
Example:- reflex removal of hand from a
hot surface
INFLAMMATORY RESPONSE
FIRST PHASE SECOND PHASE THIRD PHASE
Injury site Wound
Regeneration
Narrowing of
blood vessels Exudates Damaged tissues
histamine
Cut or surgically Scar formation
incised
WBCs
Healing
Combat infect
MUSCULAR ADAPTATION
Factors contributing to an increase in muscular
tone:
Stress response, Emotional distress
Postural distortion, Trauma
Repetitive physical activities (sports, occupation,
hobbies, etc.)
Structural factors (e.g. leg-length difference)
Visceral & other reflex activity
The first two items cause a body-wide increase in
muscular tone as part of the alarm stage GAS
STRESS AS AN ENVIRONMENTAL
EVENT
(STIMULUS BASED MODEL)
Stress is defined as a stimulus, a life event or
set of circumstances that arouse
physiological & psychological reaction/
change that may increases the individual’s
vulnerability to illness.
The emphasis is on change from existing
steady state of individual’s life pattern.
STRESS AS AN ENVIRONMENTAL EVENT
(contd..)
Holmes & Rahe (1967) assigned 43 life
changes or events. This scale (Social
Readjustment Rating Scale)has stressful life
events such as divorce, pregnancy &
retirement.
Women react to life stress events at higher
levels of response
Unmarried people & younger subjects gave
higher scores
STRESS AS AN ENVIRONMENTAL EVENT
(contd..)
High score on the Recent life Changes
Questionnaire places individual at greater
susceptibility to physical & psychological
illness.
Positive coping mechanisms & strong
social & familial support can reduce the
intensity of stressful life change &
promote a more adaptive response.
STRESS AS A TRANSACTION BETWEEN INDIVIDUAL
& ENVIRONMENT
Emphasizes relationship between
individual & environment
Personal characteristics & nature of
environmental event are considered
No longer is causation viewed solely as an
external entity, occurrence of illness
depends on the receiving organism’s
susceptibility.
STRESS AS A TRANSACTION BETWEEN
INDIVIDUAL & ENVIRONMENT (contd..)
PRECIPITATING EVENTS:
is a stimulus arising from the internal or
external environment & is perceived by the
individual in a specific manner
Determination that particular person/
environment relationship is stressful
depends on the individual’s cognitive
appraisal of situation
STRESS AS A TRANSACTION BETWEEN INDIVIDUAL
& ENVIRONMENT (contd..)
PRECIPITATING EVENTS (contd..)
Cognitive appraisal is individual’s evaluation
of the personal significance of the event or
occurrence.
Event “precipitates” a response on the part
of individual & response is influenced by
individual’s perception of the event.
STRESS AS A TRANSACTION BETWEEN
INDIVIDUAL & ENVIRONMENT (contd..)
INDIVIDUAL’S PERCEPTION OF THE EVENT:
PRIMARY APPRAISAL
SECONDARY APPRAISAL
STRESS AS A TRANSACTION BETWEEN
INDIVIDUAL & ENVIRONMENT (contd..)
PRIMARY APPRAISAL:
By Lazarus & Folkman (1984)
3 types:
Irrelevant (when outcome holds no significance for
the individual)
Benign- positive (produces pleasure for the
individual)
Stressful (include harm/loss, threat & challenge;
leads to secondary appraisal)
STRESS AS A TRANSACTION BETWEEN
INDIVIDUAL & ENVIRONMENT (contd..)
SECONDARY APPRAISAL:
Assessment of skills, resources &
knowledge that person possesses to deal
with the situation
Interaction between primary & secondary
appraisal determines the quality of
individual’s adaptation response to stress.
STRESS AS A TRANSACTION BETWEEN
INDIVIDUAL & ENVIRONMENT (contd..)
PREDISPOSING FACTORS:
Are the elements which influence an
individual’s perception & response to
stressful event.
Strongly influence whether the response is
adaptive or maladaptive.
STRESS AS A TRANSACTION BETWEEN
INDIVIDUAL & ENVIRONMENT (contd..)
PREDISPOSING FACTORS (contd..) - 3 types:
Genetic (family history of physical& psychological
conditions & temperaments)
Past experiences (to stressor, learned coping
responses, degree of adaptation to previous stressors)
Existing conditions (adequacy of individual’s
physical, psychological & social resources for dealing
with adaptive demands; health status, age, maturity,
financial & educational resources)
TRANSACTIONAL MODEL
OF STRESS
Encompasses a set of cognitive, affective
and adaptive(coping) responses that arise
out of person-environment transaction
TRANSACTIONAL MODEL
OF STRESS
PREDISPOSING PRECIPITATING EVENT
FACTORS
COGNITIVE APPRAISAL
PRIMARY
STRESS APPRAISALS
HARM/LOSS THREAT CHALLENGE
SECONDARY
TRANSACTIONAL MODEL
OF STRESS (contd..)
• AVAILABILITY OF COPING STRATIGIES
• PERCEIVED EFFECTIVENESS OF COPING STRATIGIES
• PERCEIVED ABILITY TO USE COPING STRATIGIES
EFFECTIVELY
QUALITY OF RESPONSE
ADAPTIVE MALADAPTIVE
ADAPTATION
Adaptation is said to occur when an
individual’s physical or behavioral
response to any change in his/her internal
or external environment results in
preservation of individual integrity or
timely return to equilibrium.
MALADAPTATION
Maladaptation occurs when an
individual’s physical or behavioral
response to any change in his/her internal
or external environment results in
disruption of individual integrity or in
persistent disequilibrium.
STRESS MANAGEMENT
STRESS MANAGEMENT (contd..)
simple realization that you’re in control of
your life is the foundation of stress
management.
Involves use of coping strategies in
response to stressful situations
STRESS MANAGEMENT (contd..)
Managing stress is all about taking charge of:
your thoughts, your emotions
your schedule, your environment
the way you deal with problems.
The ultimate goal is a balanced life, with time
for work, relationships, relaxation, and fun –
plus the resilience to hold up under pressure and
meet challenges head on.
1. IDENTIFY THE SOURCES OF
STRESS
look closely at your habits, attitude & excuses:
Do you explain away stress as temporary even
though you can’t remember the last time you
took a breather?
Do you define stress as an integral part of your
work or home life?
Do you blame your stress on other people or
outside events, or view it as entirely normal &
unexceptional
2. START A STRESS JOURNAL
helps identify the regular stressors in your
life & the way you deal with them.
Write down:
What caused your stress (make a guess if
you’re unsure).
How you felt, both physically & emotionally
How you acted in response.
What you did to make yourself feel better.
3. LOOK AT HOW YOU CURRENTLY COPE
WITH STRESS
Are your coping strategies;
healthy or unhealthy
helpful or unproductive?
many people cope with stress in ways that
compound the problem
Unhealthy ways of coping with
stress
Smoking, Drinking too much
Overeating or under eating
Zoning out for hours in front of the TV or computer
Withdrawing from friends, family & activities
Using pills or drugs to relax
Sleeping too much, Procrastinating
Filling up every minute of the day to avoid facing
problems
Taking out your stress on others (lashing out, angry
outbursts, physical violence)
4. LEARNING HEALTHIER WAYS TO
MANAGE STRESS
Dealing with Stressful Situations: The
Four A’s
Change the situation:
Avoid the stressor.
Alter the stressor.
Change your reaction:
Adapt to the stressor.
Accept the stressor.
a. Avoid unnecessary stress
Learn how to say “no”
Avoid people who stress you out
Take control of your environment
Avoid hot-button topics
Pare down your to-do list
Adjusting Your Attitude
b. Alter the situation
If you can’t avoid a stressful situation, try
to alter it
Express your feelings instead of bottling
them up
Be willing to compromise
Be more assertive
Manage your time better
c. Adapt to the stressor
If you can’t change the stressor, change
yourself
Reframe problems
Look at the big picture
Adjust your standards
Focus on the positive
d. Accept the things you can’t
change
Some sources of stress are unavoidable
Don’t try to control the uncontrollable
Look for the upside
Share your feelings
Learn to forgive
e. Make time for fun &
relaxation
Healthy ways to relax and recharge-
Sweat out tension with a good workout;
Go for a walk;
Spend time in nature; Call a good friend;
Take a long bath; Light scented candles;
Play with a pet; Work in your garden;
Get a massage; Curl up with a good
book;
Listen to music; Watch a comedy
f. Adopt a healthy lifestyle
You can increase your resistance to stress
by strengthening your physical health
Exercise regularly
Eat a healthy diet
Reduce caffeine and sugar
Avoid alcohol, cigarettes, and drugs
Get enough sleep
