Lesson 3: Less Stress, More Care

The American Psychological Association (2017) has these statements about

stress: “Stress is often described as a feeling of being overwhelmed, worried, or run-
down. Stress can affect people of all ages, genders, and circumstances and any
uncomfortable emotional experience accompanied by predictable biochemical,
physiological, and behavioral changes.” Some stress can be beneficial at times,
producing a boost that provides the drive and energy to help people get through
situations like exams or work deadlines. However, an extreme amount of stress can
have health consequences and adversely affect the immune, cardiovascular,
neuroendocrine and central nervous system.

Since stress is inevitable to life, we have to learn how to handle and cope up with
it. More so, we have to be familiar with other approach to a healthy lifestyle, which is
self-care.

What to expect

At the end of this lesson, you should be able to:

1. explain the effect of stress to one’s health;

2. examine cultural dimension of stress and coping; and

3. design a self-care plan.

Stress and Human Response

The American Institute of Stress (AIS) has distinguished different types of stress
and the human response to it.

Hans Selye defined stress as the body’s nonspecific response to any demand,
whether it is caused by or results in pleasant or unpleasant stimuli. It is essential to
differentiate, between the unpleasant or harmful variety of stress termed distress, which
often connotes disease, and eustress, which often connotes euphoria. Eustress is
stress in daily life that has positive connotations, such as marriage, promotion, baby,
winning money, new friends, and graduation. On the other hand, distress is stress in
daily life that has negative connotations such as divorce, punishment, injury, negative
feelings, financial problems, and work difficulties (AIS 2017).

During both eustress and distress, the body undergoes virtually the same
nonspecific responses to the various positive or negative stimuli acting upon it.
However, eustress causes much less damage than distress. This demonstrates
conclusively that it is how an individual accepts stress that determines ultimately
whether the person can adapt successfully to change (AIS 2017).

Selye hypothesized a general adaptation or stress syndrome. This general stress

syndrome affects the whole body. Stress always manifests itself by a syndrome, a sum
of changes, and not by simply one change (AIS 2017).

The general stress syndrome has three components:

1. The alarm stage – represents a mobilization of the body’s defensive forces. The
body is preparing for the “fight or flight” syndrome. This involves a number of
hormones and chemicals excreted at high levels, as well as an increase in heart
rate, blood pressure, perspiration, and respiration rate, among others.

2. The stage of resistance – the body becomes adaptive to the challenge and
even begins to resist it. The length of this stage of resistance is dependent upon
the body’s innate and stored adaptation energy reserves and upon the intensity
of the stressor. Just as any machine wears out even if it has been properly
maintained, the same thing happens with living organisms – sooner or later they
become the victim of this constant wear and tear process. The acquired
adaptation is list if the individual is subject to still greater exposure to the
stressor. The organism then enters into the third and final stage.
 3. The exhaustion stage – the body dies because it has used up its resources of
adaptation energy. Thankfully, few people ever experience this last stage.

Stress diseases are maladies caused principally by errors in the body’s general
adaptation process. They will not occur when all the body’s regulatory processes are
properly checked and balanced. They will not develop when adaptation is facilitated by
improved perception and interpretation. The biggest problems with derailing the general
stress syndrome and cause disease are an absolute excess, deficiency, or
disequilibrium in the amount of adaptive hormones. For example, corticoids,
Adrenocorticotropic Hormone (ACTH), and growth hormones are produced during
stress. Unfortunately, if stress is induced chronically, our defense response lowers its
resistance since fewer antibodies are produced and an inflammatory response
dwindles(AIS 2017).

In the article “Understanding Stress Response” of the Health Harvard Journal

(2017), it further discussed chronic stress and human body response:

“Chronic stress is unpleasant, even when it is transient. A stressful situation –

whether something environmental, such as a looming work deadline, or psychological,
such as persistent worry about losing a job – can trigger a cascade of stress hormones
that produce well-orchestrated physiological changes. A stressful incident can make the
heart pound and breathing quicken. Muscles tense and beads of swear appear.”
 This combination of reactions to stress is also known as the “fight-or flight”
response because it evolved as a survival mechanism, enabling people and other
mammals to react quickly to life-threatening situations. The carefully orchestrated yet
near-instantaneous sequence of hormonal changes and physiological responses helps
someone to fight the threat off or flee to safety. Unfortunately, the body can also
overreact to stressor that are not life-threatening, such as traffic jams, work pressure,
and family difficulties. Over time, repeated activation of the stress response takes a toll
on the body. Research suggests that chronic stress contributes to high blood pressure,
promotes the formation of artery-clogging deposits, and causes brain changes that may
contribute to anxiety, depression, and addiction. More preliminary research suggests
that chronic stress may also contribute to obesity, both through direct mechanisms
(causing people to eat more or indirectly (decreasing sleep and exercise) (Health
Harvard 2017).

The stress response begins in the brain. When someone confronts an oncoming
car or other danger, the eyes or ears (or both) send the information to the amygdala, an
area of the brain that contributes to emotional processing. The amygdale interprets the
images and sounds. When it perceives danger, it instantly sends a distress signal to the
hypothalamus (Health Harvard 2017).

When someone experiences a stressful event, the amygdala, an area of the

brain that contributes to emotional processing, sends a distress signal to the
hypothalamus. This area of the brain functions like a command center, communicating
with the rest of the body through the nervous system so that the person has the energy
to fight or flee. (Health Harvard 2017).

The hypothalamus is a bit like a command center. This area of the brain
communicates with the rest of the body through the automatic nervous system, which
controls involuntary body functions like breathing, blood pressure, heartbeat, and the
dilation or constriction of key blood vessels and small airways in the lungs called
bronchioles. The automatic nervous system has two components, the sympathetic
nervous system and the parasympathetic nervous system. The sympathetic nervous
system functions like a gas pedal in a car. It triggers the fight-or-flight responses,
providing the body with a burst of energy so that it can respond to perceived dangers.
The parasympathetic nervous system acts like a brake. It promotes the “rest and digest”
response that calms the body down after the danger has passed (Health Harvard 2017).

After the amygdala sends a distress signal, the hypothalamus activates the
sympathetic nervous system by sending signals through the automatic nerves to the
adrenal glands. These glands respond by pumping the hormone epinephrine (also
known as adrenaline) into the bloodstream. As epinephrine circulates through the body,
it brings on a number of physiological changes. The heart beats faster than normal,
pushing blood to the muscles, heart, and other vital organs. Pulse rate and blood
pressure go up. The person undergoing these changes also starts to breathe more
rapidly. Small airways in the lungs open wide. This way, the lungs can take in as much
oxygen as possible with each breath. Extra oxygen is sent to the brain, increasing
alertness. Sight, hearing, and other senses become sharper. Meanwhile, epinephrine
triggers the release of blood sugar (glucose) and fats from temporary storage sites in
the body. These nutrients flood into the bloodstream, supplying energy to all parts of the
body (Health Harvard 2017).

All of these changes happen so quickly that people are not aware of them. In
fact, the wiring is so efficient that the amygdale and hypothalamus start this cascade
even before the brain’s visual centers have had a chance to fully process what is
happening. That is why people are able to jump out of the path of an incoming car even
before they think about what they are doing. As the initial surge of epinephrine
subsides, the hypothalamus activates the second component of stress response system
known as hypothalamic pituitary adrenal (HPA) axis. This network consists of
hypothalamus, pituitary gland, and the adrenal glands. The HPA axis relies on a series
of hormonal signals to keep the sympathetic nervous system – the “gas pedal” –
pressed down. If the brain continues to perceive something as dangerous, the
hypothalamus release corticotrophin – releasing hormone (CRH), which travels to the
pituitary gland, triggering the release of ACTH. This hormone travels to the adrenal
glands, prompting them to release cortisol. The body thus stays revved up and on high
alert. When the threat passes, cortisol levels fall. The parasympathetic nervous system
– the “brake” – then dampens the stress response (Health Harvard 2017).

Persistent epinephrine surges can damage blood vessels and arteries,

increasing blood pressure and rising risk of heart attacks or strokes. Elevated cortisol
levels create physiological changes that help to replenish the body’s energy stores that
are depleted during the stress response. But they inadvertently contribute to the buildup
of fat tissue and to weight gain. For example, cortisol increases appetite, so that people
will want to eat more to obtain extra energy. It also increases storage of unused
nutrients as fat. Chronic low-level stress keeps the HPA axis activated, much like a
motor that is idling too high for too long. After a while, this has an effect on the body that
contributes to the health problems associated with chronic stress (Health Harvard
2017).

Techniques to Counter Chronic Stress

Several techniques to counter chronic stress were presented in the same article
(Health Harvard 2017):

1. Relaxation response. Dr. Herbert Benson, director emeritus of the Benson –

Henry Institute for Mind Body Medicine at Massachusetts General Hospital, has devoted
much of his career to learning how people can counter the stress response by using a
combination of approaches that elicit the relaxation response. These include deep
abdominal breathing, focus on a soothing word (such as peace or calm), and
visualization of tranquil scenes, repetitive prayer, yoga, and tai chi.

Most of the research using objective measures to evaluate how effective the
relaxation response is at countering chronic stress have been conducted in people with
hypertension and other forms of heart disease. Those results suggest the technique
may be worth trying, although for most people it is not a cure at all. For example,
researchers at the Massachusetts General Hospital conducted a double-blind,
randomized controlled trial of 122 patients with hypertension, ages 55 and older, in
which half were assigned to relaxation response training and the other half to a control
group that received information about blood pressure control. After eight weeks, 34 of
the people who practiced the relaxation response – a little more than half – had
achieved a systolic blood pressure reduction of more than 5 mm Hg. and were therefore
eligible for the next phase of the study, in which they could reduce levels of blood
pressure medication they were taking. During that second phase, 50% were able to
eliminate at least one blood pressure medication – significantly more than in the control
group, where only 19% eliminated their medication.

2. Physical activity. People can use exercise to stifle the building of stress in
several ways. Exercise, such as taking a brisk walk shortly after feeling stressed, not
only deepens breathing but also helps relieve muscle tension. Movement therapies
such as yoga, tai chi, and qi gong combined with fluid movements, with deep breathing,
and mental focus, all of which can induce calm.

3. Social support. Confidants, friends, acquaintances, co-workers, relatives,

spouses, and companions all provide a life – enhancing social net, and may increase
longevity. It is not clear why, but the buffering theory holds that people who enjoy close
relationships with family and friends receive emotional support that indirectly helps to
sustain them at times of chronic stress and crisis.

The Cultural Dimension of Stress and Coping

Ben Kuo (2010) reviews studies on cultural dimensions of stress and coping. His
study, “Culture’s Consequences on Coping: Theories, Evidences, and
Dimensionalities,” published in the Journal of Cross – Cultural Psychology had the
following findings:

Stress and coping research constitutes one of the most intensively studied areas
with health, social, and psychological research because of its broad implications for
understanding human well-being and adaptation. Early thesis on stress and coping, the
interwoven relationship of culture and stress responses was implicated, conceptually.
The thesis postulated that a person’s internalized cultural values, beliefs, and norms
affect the appraisal process of stressors and factors delimit the coping options available
to an individuals regardless of culture, ethnicity, and race, but members of different
cultures might consider and respond to stressors differently with respect to coping
goals, strategies, and outcomes.

Kuo’s study identified and revealed compelling evidence for cultural variations
and specifications on coping based on theoretical and empirical findings generated over
the last two decades’ cultural coping research. Based on the broad problem-versus-
emotion-focused coping nomenclature, repeated studies have pointed to the prevalence
of “emotion-focused,” “indirect,” “passive,” or “covert,” “internally target,” or “secondary
control,” coping individuals of Asian backgrounds, as well as, to a lesser extent, among
individuals of African and Latino backgrounds. Specifically, the avoidance, withdrawal
and forbearance coping methods are common among African-Americans and African-
Canadians. Additionally, spiritual and religious coping and coping through family support
are common among individuals of Latino / Latina backgrounds (Kuo 2010).

Furthermore, emotion-focused coping has been shown to be beneficial (e.g.,

reducing distress) for Asian-Americans and Asian-Canadians in dealing with various
stressors, including family conflicts and racial discrimination. Problem-focused coping
has also been found to be effective for Asian-Americans and Asian-Canadians in
responding to male gender conflicts, racial discrimination, and cross-cultural
adjustment. For non-Asians, emotion-focused coping was shown to be negative in
increasing stress for African-American adult caregivers but problem-focused coping was
shown to be negative in exacerbating stress for Hispanic-American college students in
facing family conflicts. As evident, the existing knowledge on the adaptive quality of
different coping strategies is currently incomplete and inconclusive and necessitates
further research (Kuo 2010).

The current review also highlighted the salience of “collective coping”

approaches among culturally diverse individuals, including Asians, African-Americans,
and Latino-Americans, based on more recent research. This distinctive domain of
coping represents the collective and interdependent characteristics of many ethnic
minorities which is a critical aspect of coping, overlooked by both the extant coping and
the cultural coping literature until recently. As has already been demonstrated in a
number of recent published studies, to fully represent and account for the coping
system of ethnic minority individuals, an integrated approach incorporation conventional
and culture-based collective coping measure is imperative (Kuo 2010).

Finally, this review also points to coping’s link to: (a) broad societal climate, such
as collectivism-individualism and independent-interdependent cultural norms, (b)
individuals’ acculturation and ethnic identity; (c) primary / internally versus secondary /
externally controlled orientations; (d) accessibility and attitudes toward seeking social
and family support; and (e) degrees of religious / spiritual beliefs and identifications.
Together, these findings further underscore the significance of person-cultural
environment interaction in the coping process and provide corroborating evidence in
support of the contextual and transactional theories of coping (Kuo 2010).

However, the said synthesis need to be interpreted with caution in view of

several limitations. First, it should be noted that the way in which types of coping were
defined, categorized, and measured varied quite significantly from study to study and
would likely have skewed the findings and the conclusions drawn and reduced the
comparability across studies.

Second, the relationship between coping methods and coping outcomes is not
straightforward but is moderated by a constellation of contextual and personal factors as
suggested by the theoretical models reviewed earlier. Empirical data, in fact, have
evidenced the effects of a person’s perceived “intensity” and “controllability” of the
stressor and cultural orientations (e.g., acculturation, self-construals) on coping. Lastly,
it should be recognized that an individual’s actual coping system often compromises a
complex and diverse range of coping behaviors. For instance, Chinese-Canadian
adolescents were found to engage in collectivistically based coping, in conjunction with
individualistically based coping when dealing with interpersonal conflict, adjustment
stress, and gender role-related stress. Those qualitatively and functionally opposite
coping strategies should not automatically be construed as mutually exclusive within
culturally diverse individuals (Kuo 2010).

Self-care Therapy

A positive way to counter stress is self-care therapy. Nancy Apperson (2008) of

Northern Illinois University has provided steps for self-care:

1. Stop, breathe, and tell yourself: “This is hard and I will get through this one
step at a time.” During an unexpected event or crisis, we are faced with dealing with a
new reality and it takes time to incorporate what happened into our everyday lives.
Identify the steps you need to take first, write them down, and focus on each step one at
a time. If you look at everything you have to do, you will become overwhelmed.
Remember you can only do one thing at a time and focus exclusively on that one thing.

2. Acknowledgement to yourself what you are feeling. All feelings are normal so
accept whatever you are feeling. Once you recognize, name, and accept your feelings,
you feel less out of control. You can then find a comfortable place to express your
feelings. During periods of extreme stress and grief, it is very hard to hold back your
feelings, particularly your tears and anger. This is normal so describe this as grieving or
sadness or anger. You are not falling apart. You are grieving or falling angry or sad. It is
important during this time of intense feelings to own your feelings and NOT hurt yourself
or lash out at someone else.

3. Find someone who listens and is accepting. You do not need advice. You
need to be heard. Sharing our story is how we begin to accept whatever happened and
integrate it into our new reality. It may be that you just need to let go of your expectation
of how things should be and taking about your feelings and beliefs is the beginning of
that process.

4. Maintain your normal routine as much as possible. Making everyday decision

– decidingto get dressed, doing the dishes, or going to work – gives you a sense of
control and feels comforting as it is a familiar activity. Be realistic with what you can do
and remember everything right now will take you longer to do. Avoid making major
decision based on the stress you feel right now.

5. Allow plenty of time for a task. You will not be as productive as you normally
are. Accept how much you are able to do right now and recognize it will not be this way
forever. During periods of extreme stress, prolonged stress, or after a crisis, your ability
to concentrate and focus on tasks is diminished and it will take time for your
concentration to return so give yourself extra time and be gentle and accepting of
yourself and what you can do.

6. Take good care of yourself. Remember to:

a. Get enough rest and sleep. Sleep at least six hours and more than nine
hours. If you are having difficulty sleeping, listen to peaceful or slow music
and/or do progress relaxation before you go to sleep. Sleep helps our body
heals and strengthens our immune system.

b. Eat regularly and make healthy choices. Skipping meals, particularly

breakfast, contributes to fatigue, mood swings, and poor concentration.
Healthy food choices (not high in simple sugars) maintain blood sugar level,
energy, and concentration of the body.

c. Know your limits and when you need to let go. Some problems are beyond
our control. If something cannot be changed, work at accepting it for what it
is. Resist the urge to fix unfixable or try to control the uncontrollable.
Sometimes a mantra helps: “it is what it is, I just need to accept it”. For things
within your control, remember that change takes time. If you are holding on
and need to let go, journal about it.

d. Identify or create a nurturing place in your home. A rocking chair, a nice view,
and a soothing music are important components to a nurturing place. Twenty
minutes of spending in a rocking chair reduces both your physical pain and
 anxiety. It is like giving yourself a hug. Music and nature sounds nurture our
being and lifts our spirits.

e. Practice relaxation or meditation. Go to your nurturing place and listen to

guided relaxation tapes. Time spent in meditation or prayer allows your mind
and body to slow down and let go of the stress. Take a mental vacation in the
midst of stress by relaxing your body, shutting you eyes, and visualizing
yourself in your favorite vacation spot or quite haven.

f. Escape for a while through meditation, reading a book, watching a movie, or

taking a short trip.

Self-compassion Therapy

Self-compassion is another way to counter stress. Kristin Neff (2012) has

discussed self-compassion in her article, “The Science of Self-Compassion.”
“Self-compassion entails being warm and understanding toward ourselves when
we suffer, fail, or fell inadequate, rather than flagellating ourselves with self-criticism. It
recognizes that being imperfect and experiencing life difficulties is inevitable, so we
soothe and nurture ourselves when confronting our pain rather than getting angry when
life falls short our ideals. We clearly acknowledge our problems and shortcomings
without judgment, so we can do what is necessary to help ourselves. We cannot always
get what we want. We cannot always be who we want to be. When this reality is denied
or resisted, suffering arises in the form of stress, frustration, and self-criticism. When
this reality accepted with benevolence, however, we generate positive emotions of
kindness and care that help us cope. Self-compassion recognizes that life challenges
and personal failures are part of being human, an experience we all share. In this way, it
helps us to feel less desolate and isolated when we are pain.
Self-compassion Phrases

Neff provided self-compassion phrase when feeling stress or emotional pain,

perhaps when you are caught in a traffic jam, arguing with a loved one, or feeling
inadequate in some way. It is helpful to have set of phrases memorized to help you
remember to be more compassionate to yourself in the moment. You can take a deep
breath, put your hand over your heart, or gently hug yourself (if you feel comfortable
doing so), and repeat the following phrases:

● This is a moment of suffering.

● Suffering is a part of life.

● May I be kind to myself.

● May I give myself the compassion I need.

These phrases capture the essence of the three components of self-compassion.

The first phrase helps to mindfully open to the sting of emotional pain. (You can also
just simply say “This is really hard right now” or “This hurts”). The second phrase
reminds us that suffering unites all living begins and reduces the tendency to feel
ashamed and isolated when things go wrong in our lives. The third phrase begins the
process of responding with self-kindness rather than self-criticism. The final phrase
reinforces the idea that you both need and deserve compassion in difficult moments. Be
experimental with the phrases. Other phrases that may feel more authentic in a given
situation are: “May I accept myself as I am,” “May I forgive myself,” or “May I learn to
accept what I cannot change”(Neff 2012).

Self-compassion and Emotional Well-being

One of the most consistent findings in the research literature is that greater self-
compassion is linked to less anxiety and depression. Of course, a key feature of self-
compassion is the lack of self-criticism, and self-criticism is known to be an important
predictor of anxiety and depression. However, self-compassion still offers protection
against anxiety and depression when controlling for self-criticism and negative effect.
Thus, self-compassion is not merely a matter of looking on the bright side of things or
avoiding negative feelings. Self-compassionate people recognize when they are
suffering, but are kind toward themselves in these moments, acknowledging their
connectedness with the rest of humanity. Self-compassion is associated with greater
wisdom and emotional intelligence, suggesting that self-compassion represents a wise
way of dealing with difficult emotions. For instance, self compassionate people engage
in rumination and think suppression less often than those low in self-compassion. They
also report greater emotional coping skills, including more clarity about their feelings
and greater ability to repair negative emotional states. Self-compassion appears to
bolster positive states being as well. By wrapping one’s pain in the warm embrace of
self-compassion, positive feelings are generated that help balance the negative ones
(Neff 2012).

Self-compassion, Motivation, and Health

Research supports the idea that self-compassion enhances motivation rather

than self-indulgence. For instance, while self-compassion is negatively related to
perfectionism, it has no association with the level of performance standards adapted for
the self. Self-compassionate people aim just as high, but also recognize and accept that
they cannot always reach their goals. Self-compassion is also linked to greater personal
initiative – the desire to reach one’s full potential. Self-compassionate people have been
found to have less motivational anxiety and engage fewer self-handicapping behaviors
such as procrastination than those who lack self-compassion. In addition, self-
compassion was positively associated with mastery goals (the intrinsic motivation to
learn and grow) and negatively associated with performance goals (the desire to
enhance one’s self-image) found on the study of Deck in 1986. This relationship was
mediated by lesser fear of failure and perceived self-efficacy of self-compassionate
individuals. Thus, self-compassionate people are motivated to achieve, but for intrinsic
reason, not because they want to garner social approval (Neff 2012).

Self-compassion versus Self-esteem

Research indicates that self-compassion is moderately associated with trait

levels of self-esteem as one would expect, given that both represent positive attitudes
toward the self. However, self-compassion still predicts greater happiness and optimism
as well as less depression and anxiety when controlling for self-esteem. Moreover, the
two constructs differ in terms of their impact on well-being. Also, self-esteem had a
robust association with narcissism while self-compassion had no association with
narcissism. In contrast to those with high self-esteem, self-compassionate people are
less focused on evaluating themselves, feeling superior to others, worrying about
whether or not others are evaluating them, defending their viewpoints, or angrily
reacting against those who disagree with them. Self-esteem is thought to be an
evaluation superiority/inferiority that helps to establish social rank stability and is related
to alerting, energizing impulses and dopamine activation. While self-esteem positions
the self in competition with others and amplifies feelings of distinctness and separation,
self-compassion enhances feelings of safety and interconnectedness (Neff 2012).

Self-compassionate Letter

An example of self-compassion exercise is the self-compassionate letter. This

exercise has been used in therapeutic programs. Below are the steps in doing the self-
compassionate letter exercise as provided by Neff (2012):

1. Candidly describe a problem that tends to make you feel bad about yourself,
such as a physical flaw, a relationship problem, or failure at work or school.
Note what emotions come up – shame, anger, sadness, fear – as you write.
2. Next, think of an imaginary friend who is unconditionally accepting and
compassionate; someone who knows all your strengths and weaknesses,
understands your life history, your current circumstances, and understands
the limits of human nature.
3. Finally, write a letter to yourself from that perspective. What would your friend
say about your perceived problem? What words would he or she use to
convey deep compassion? How would your friend remind you that you are
only human? If your friend were to make any suggestions, how would they
reflect unconditional understanding?
4. When you are done writing, put the letter down for a while and come back to it
later. Then read the letter again, letting the words sink in, allowing yourself to
be soothed and comforted.
Less Stress, Care More

We should be in control of the stress that confronts us every day. Otherwise,

when we are overwhelmed by stress, it can be detrimental to our health. Self-care and
self-compassion are two ways to positively confront stress. We should love and care for
our self more and more each day.