Stress Management

Allan Sanders, MN, ARNP

asanders@wsu.edu

Objectives

o Explore the biological, psychological, and

social aspects of the human stress response.
o Describe the difference between adaptive
and maladaptive coping strategies.
o Understand coping strategies that increase
resilience to promote productive living and
healthy aging.

Common Stress Associated Diseases

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Diminished Immunity
Headache
Fatigue
Weight gain
Dyslipidemia
Hypertension
Heart Disease
Psoriasis/Eczema
Digestive problems

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Anxiety
Depression
Alcoholism
Substance abuse
Insomnia
Irritable bowel
syndrome
o Fibromyalgia
o Decreased sex drive

Overview of Terminology
o Stress: A state of disharmony or a threat to
homeostasis
Physiological changes increase alertness, focus, and
energy
Perceived demands may exceed the perceived
resources

o Coping: The ability to maintain control, think

rationally, and problem solve
o Resilience: Resistant quality that permits a
person to recovery quickly and thrive in spite of
adversity

Stress
o Eustress
Manageable Stress can lead to growth and enhanced
competence

o Distress
Uncontrollable, prolonged, or overwhelming stress is
destructive.

o Acute Stress
Immediate response to a threat or challenge

o Chronic Stress
Ongoing exposure to stress, may seem unrelenting

Causes of Stress
o External causes
Family, work, economics, work, school, major
life changes, unforeseen events, etc.

o Internal causes
Worry, uncertainty, fear, attitudes, unrealistic
expectations, etc.

Sources of Clinical Stress

For patients
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Uncertainty
Fear
Pain
Cost
Lack of knowledge
Risk for harm
Unknown resources

For nurses
o Poor patient
outcomes
o Risk of making an
error
o Unfamiliar situations
o Excessive workload
o Inadequate
resources

Stages of the Stress Response

General Adaptation Syndrome of Hans Selye (1907-1982)

o Alarmwhen one feels threatened

Activation of the fight or flight reaction
o Resistancemobilization of resources to solve
the problem
Continued stress causes adaptation
o Exhaustion
Adaptation fails and level of function
decreases

ALARM: Activation of Hypothalamic

Pituitary Adrenal Axis
Catecholamines

Cortical Steroids

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Increases cardiac output

Dilates airways
Dilates pupils
Mobilizes glucose
Causes vasomotor
changes
o Decreases digestion
o Enhances coagulation

Elevates glucose
Increases amino acids
Increases NA resorption
Increases extracellular
fluid volume
o Inhibits histamine and
bradykinin
o Suppresses the immune
response

Resistance
o Adaptation occurs
Activation of the hypothalamic pituitary
adrenal axis continues
o The stressor may be resolved
The body returns to homeostasis
o May progress to exhaustion
Stress continues as resources are depleted

Exhaustion
o Occurs when the demands of the stress
exceeds the persons ability to adapt.
o Functioning declines
o May result in health problems
Physical symptoms
Mental symptoms

Signs & Symptoms of Stress

o Cognitive
Decreased concentration, comprehension, & memory

o Behavioral
Irritability, withdrawal, violence

o Emotional
Fear, anxiety, depression, fatigue

o Physiological
Increased BP, HR, Respirations, etc
Somatic symptoms
Decreased immune response

Genetics & Development

Genetics

o Genes control the stress

response
Individuals have different
responses to stress

o There is a genetic
component to:
fearful behavior
anxiety disorders
Neurobiological response

Development

o Life experiences can

affect a person's stress
response
o Social support
Strong support is protective

o Early life stress

Increases stress reactivity
as an adult

Coping & Resilience

Coping
o Ability to control
emotions
o Ability to perceive reality
o Ability to think rationally
o Ability to problem solve
o Culturally defined

Resilience
o The ability to bounce
back
o The positive capacity to
cope with stress
o Provides resistance to
negative events
Hardiness,
Resourcefulness

Coping
Adaptive Coping
Contribute to resolution of the stress response

Maladaptive Coping
Strategies that cause further problems

Active Coping
Actively seeking resolution to the stress

Promote Adaptive Coping

o Realistic expectations
Set realistic goals

o Planning
Anticipate problems, have a backup plan

o Reframing
Change the way you look at things

o Relaxation
Learn relaxation techniques, take time-out for
leisure

o Discuss the problem

Utilize existing social supports to problem solve

Promote Adaptive Coping

o Training
Prepares for stressful events
o Nutrition
Eat healthy, avoid skipping meals
o Exercise
Include regular exercise
o Sleep
Get adequate sleepavoid fatigue

Avoid Maladaptive Coping

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Blurring of boundaries
Avoidance/withdrawal
Negative attitude
Anger outbursts
Alcohol/Drugs
Hopelessness
Negative self-talk
Resentment
Violence

Promote Resilience Factors

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Positive Role Models

Optimism
Humor
Moral Compass
Altruism
Religion & Spirituality
Social Support

Positive Role Models

Transmit:
o Attitudes
o Values
o Skills
o Patterns of thoughts and behaviors

Optimism
o Positive Beliefs

Associated with well being

Cognitive reframing
Positive thinking
Refute the negative thinking
Believe in a meaningful cause

o It is important to acknowledge relevant

negative factors

Humor
o Highly effective
o Mature coping mechanism
Another of the souls weapons for the fight
for self-preservation, it is well known that
humor, more then anything else in the human
makeup, can provide an aloofness and the
ability to rise above any situation, even for a
few seconds.
Viktor Frankl

Moral Compass
o Conduct a moral inventory
Look not for any greater harm then this, destroying
the trustworthy, self-respecting, well-behaved man
within you.
Epicetus

o Maintain your integrity

Between stimulus and response there is a space. In
that space is our power to choose our response. In
our response lies our growth and our freedom.
Viktor Frankl

Altruism
o Unselfish regarding the welfare of others
o Believe in a meaningful cause
o Mutual cooperation
Activates of the brains reward center

Religion & Spirituality

o Associated with psychological and
physical well being
o Guards against despair
o Provides social support
o Provides positive role models
o Provides a positive mission

Social Support
o Social support has a profound effect on
life expectancy
o Patients have better outcomes with
strong social support
o Isolation and poor social support are
associated with a poor stress response
o Few hardy individuals go it alone

Signature Strengths
o Recognize skills and talents
Inventory strengths

o Use your strengths and talents

Decide what works

o Actively cope
Apply concepts to enable active coping.

Review
o Stress is part of everyday life
It can promote growth and competency
If unrelenting or overwhelming it can cause
adverse effects
o Adaptive coping enhances resilience
o Maladaptive coping causes additional problems
o Enhanced coping increases resilience while
diminishing the adverse affects of stress, thus
promoting health

Review: Practical Tips

o Set realistic expectations
o Exercise regularly
o Eat healthy
o Get adequate sleep
o Maintain a work-leisure balance
o Positive Reframing & optimism
o Enhance social support

Internet Resources
o Building resilience: http://www.slideshare.net/3dogMcNeill/buildingresilience
o Diet, exercise, stress and the immune system:
http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome/hic_di
et_exercise_stress_and_the_immune_system.aspx
o Exercise: Rev up your routine to reduce stress:
http://www.mayoclinic.com/health/exercise-and-stress/SR00036
o Positive thinking: Reduce stress, enjoy life more:
http://www.mayoclinic.com/health/positive-thinking/SR00009
o Stress management for patient and physician:
http://www.mentalhealth.com/mag1/p51-str.html
o Stress management: Understand your sources of stress:
http://www.mayoclinic.com/health/stress-management/SR00031
o Stress reduction techniques: A must for a healthy lifestyle:
http://www.managestresstips.com/category/stress-reduction/

Learning Exercise
1. List your current sources of stress.
2. Conduct an inventory of coping strategies that
you use or have used in the past.

Include maladaptive strategies

3. List your signature strengths and factors that

may enhance your resilience.
4. While considering the above, develop a
personalized stress management plan to
enhance your coping and resilience.

References
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Bhui, K., King, M., Dein, S., & OConor, (2008). Ethnicity and religious coping with mental
distress. Journal of Mental Health. 12(2).
Copstead, L. C. & Banasik, J. L. (2010). Pathophysiology: Biological and behavioral
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Fielding, R (Undated) Retrieved September 25, 2007
from:http://www.pitt.edu/~super1/lecture/beh0091/img007.GIF&imgrefurl
Hildon, Z., Smith, F., Netuveli, G. & Blane, D. (2008). Understanding adversity and resilience
at older ages. Sociology of Health & Illness. 30(5).
Posen, D. B. (1995). Stress management for patient and physician. Retrieved September 21,
2007 from: Http://Serendip.brynmawr.edu/bb/neuro/neuro00/web3/edmundson.html
Pranulis, M. S. (1975). Coping with acute myocardial infarction. Psychological Aspects of
Myocardial infraction. Mosby: St. Louis
Southwick, S. M. (2007). Cleveland Clinics posttraumatic stress disorder symposium.
California: Audio-digest
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College Health. 56(4).
Images retrieved from Microsoft: http://office.microsoft.com/en-us/images/?CTT=97

Contact Information

Allan Sanders, MN, ARNP

asanders@wsu.edu