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

Accordin to !ocation . "#$sical e.g. !Cold"#eat" chemical agents$

%. "#$siolo ic e.g. !pain and &atigue$ '. "s$c#osocial e.g. !&ailing exams and losing a (ob$

Accordin to involved persons 1. Da$ to da$ stressors 2. %a&or complex occurrences involvin lar e roups 3. !ess fre'uent stressors involvin fe( roups

Accordin to Duration 1. Acute time limited stressor 2. Stressor se'uence 3. C#ronic intermittent stressor 4. C#ronic Endurin Stressor

Stress as Stimulus
)tress 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 Adolp# %e$er *elating life response to illness )olmes and *a#e +ife change units A numerical scale ran,ing stressful life events and the amount of distress they cause! -' life changes$

Stress as a *esponse

)ans Sel$e defined stress as the nonspecific response of the body to any demand made upon it

 Sc#afer defined stress as the arousal of mind and body in response to demands made upon them

Generali+ed Adaptation S$ndrome ,GAS or Stress s$ndrome .escribes stress as wear and tear on the body occurring regardless of whether the stressor is positive or negative !ocali+ed Adaptation S$ndrome ,!AS /nflammatory and repair processes that occur in the at the local site of tissue in(ury

"#ases of GAS.!AS A. Alarm reaction % phases . )hoc, Phase )N) and 0ndocrine system react to stress!fight or flight response$ %. Countershoc, Phase *eversal of changes brought by )hoc, phase /. Sta e of *esistance . Adaptive responses that attempt to limit the damage of stress C. Sta e of ex#austion . Physiologic and psychological resources are depleted and immune system becomes depressed

Stress as a 0ransaction

0ransactional Stress t#eor$ 0ncompasses a set of cognitive" affective and adaptive!coping$ responses that arise out of person1environment transaction %ediatin process,co nitive1motivational1relational- 1 !a+arus a. Co nitive appraisal i. "rimar$ appraisal 0vent is evaluated to what is at sta,e 1. Stressful #arm or loss has occurred #arm or loss is anticipated!2hreatening$ Opportunity or gain is anticipated!Challenging$ 2. 2onstressful ,irrelevant.3eni n.positiveii. Secondar$ appraisal 0vent is evaluated to what is might and can be done iii. *eappraisal Change of opinion based on new information

%anifestations of Stress

"#$siolo ic .ilatation of Pupils )weat production #eart rate 3 Cardiac output inc ),in is Pale Na and #%o retention *espiratory rate and depth inc

Urinary output inc .ry mouth "eristalsis Dec 4ental alertness /nc 4uscle tension /nc Blood sugar inc

"s$c#olo ical .epression 0xtreme feeling of sadness" despair" de(ection" lac, of worth" or emptiness

Emotional S$mptoms 2iredness )adness 0mptiness Numbness

/e#avioral Si ns /rritability /nability to concentrate .ifficulty in ma,ing decisions +oss of sexual desire Crying )leep disturbance )ocial 5ithdrawal

"#$sical Si ns

+oss of appetite 5eight loss Constipation #eadache .i66iness

Anxiet$ State of mental uneasiness4 appre#ension4 dread4 or fore3odin or a feelin #elplessness related to impendin or anticipated t#reat to self or si nificant relations#ips Can 3e experienced at conscious4 su3conscious4 or unconscious !evels of Anxiet$ !evel 5er3ali+ation C#an es %otor activit$ c#an es "erception Alteration and Attention C#an es /nc arousal and alertness Uses learning to adapt Narrowed " inattentive and selective attention focus )lightly impaired learning )evere Communication difficult to understand 4otor activity inc" /nability to relax" &earful &acial 0asily distracted No &ocus 2achycardia" #yperventilatio n #eadache" di66iness" nausea )light inc 4ild gastric symptoms *espirator$ and Circulator$ C#an es None 6t#er C#an es

4ild

/ncrease 7uestioning

4ild *estlessness )leeplessness

None

4oderate

8oice tremors and Pitch Changes

2remors" &acial twitches" sha,iness

0xpression

+earning severely impaired .istorted exaggerated Perception Unable to learn .yspnea" Palpitations" cho,ing" Chest Pain &eeling of impending doom" paresthesia" sweating

Panic

Communication not understandable

4otor activity inc" Agitation" Unpredictable responses" 2rembling" Poor motor coordination

7ear 0motion or feeling of apprehension aroused by impending or seeming danger pain or a perceived threat

An er 0motional state consisting of a sub(ective feeling of animosity or strong displeasure Can be 8erbal or Non verbal Co nitive Problem )olving 2hin,ing through threatening situations" using specific steps to arrive at a solution )ostilit$ 9 overt antagonism harmful or destructive behavior 5iolence 9 exertion of physical force to in(ure or abuse A ression 9 unprovo,ed attac," or a hostile" in(urious or destructive action or outloo,

)tructuring Arrangement or manipulation of a situation so that threatening events do not occur

)elf1control!.iscipline$

Assuming a manner and facial expression that conveys sense of being in control or in charge

)uppression Consciously and willfully putting a thought or feeling out of mind

&antasy or .aydreaming Unfulfilled wishes and desires are imagined as fulfilled.

"*EDIS"6SI2G 7AC06*S 76* S0*ESS :0N02/C &AC2O*) /NAB/+/2; 2O A.AP2 /NA.07UA20 *0+A<A2/ON *0)PON)0 *0)PON)0 AC2/8/2; 8A*/A2/ON) A:0 P0*)ONA+/2; /)O+A2/ON 0nvironment

Eustress and Distress 0ustress 2he pleasurable stress that accompanies positive events. &or example" a person may receive a = >">>> bonus and experience stress in deciding how to spend the money.

.istress 2he unpleasant stress that accompanies negative events.

0$pe a.t$pe 3 ,7riedman and *osenman4 1894 2ype a Competitive" achievements orientation. )elf1critical. No (oy in accomplishments.

 2ype b

2ime urgency. /mpatient. Always on the go. .o several things at once. Anger?hostility1 easily aroused to anger" which may be overt or covert.

+ow levels of competitiveness 2ime urgency 1 patient #ostility 1 not easily aroused to anger 0asy going Philosophical

Copin .ealing 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!&ol,man and +a6arus$

Copin strate $.mec#anism . 0motion &ocused Coping +essens emotional distress %. Problem &ocused Coping .irect change to the environment

Defense %ec#anisms

Compensation

Covering wea,nesses by emphasi6ing a more desirable trait

.enial .isplacement /dentification /ntellectuali6ation /ntro(ection *egression

Attempt to screen unacceptable realities by refusing to ac,nowledge them 2ransferring emotional reactions to another ob(ect or person .ec anxiety by imitating someone Use of rational explanation /dentifying with others norms *esorting to an earlier more comfortable level of functioning