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Preventing burnout the physiology of stress

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					Preventing burnout: the physiology of stress

In this second article on stress, Steve Mynard looks more closely at what actually
happens to our bodies when we are in stressful situations and suggests some ways of
taking control of those situations.

Early research in the 1930s on the stress response as a straightforward physiological
(bodily) response to a stimulus has evolved into the modern transactional view which
states:

‘Stress is a lack of fit between the perceived demands of the environment and the
perceived ability to cope with those demands.’
(Cardwell, Clark and Meldrum, 2003)

This definition brings in a cognitive element; our ability to cope with stress is influenced
by how we think about it. This helps us refine a definition of the stress reaction: ’state of
psychological tension and physiological arousal caused by something (a stressor) in the
environment.’

In this article we will look in detail at the physiological side of stress, how the body
reacts to stressors, as a prelude to taking control of stressful situations through
psychological approaches to stress management – in particular time management.

Stress as a bodily response
The body essentially has to deal with two different types of stressors
–       acute
–       chronic
and we will look in more detail at each.

The response to acute stress
Some stressors are instant (acute) and then they are over; you see a child stumbling on the
stairs and suddenly you are there catching them. Someone pulls out in front of you on a
roundabout and you slam on the brakes or swerve to avoid a collision. Your reaction is
instant – you don’t have time to think about it.

In this situation the autonomic nervous system (ANS) has been triggered. It is called
autonomic because it governs itself and controls essential mechanisms such as heart beat
and breathing rate.

The ANS is a pathway of nerves running from the lower parts of the brain to the organs
of the body such as heart, digestive system and various glands. The ANS concerns itself
with the normal functioning of the body and maintaining balance.

In the context of the stress reaction the ANS triggers the adrenal medulla. This is the
central part of the adrenal gland; you have two of these glands situated on top of your
kidneys. This stimulation releases the hormones adrenaline and noradrenaline. These are
the stress reaction hormones.

The heart rate and blood pressure increase, fats and carbohydrates are mobilised and
converted into sugars and fatty acids (you need energy) and the digestive system slows
down. All these events are controlled by one aspect of the ANS known as the sympathetic
branch. This branch prepares the body for action. In evolutionary terms this reaction
would allow us to run fast when a sabretooth tiger appeared on the horizon.

The body is wonderfully adapted to balancing itself and so there is another side to the
ANS known as the parasympathetic branch. This returns heart rate and blood pressure to
normal and speeds up digestion. It calms and relaxes the body after a burst of activity.
This aspect of the stress reaction allows us to act quickly and then get back to normal. It
serves us well.

The response to chronic stress
Chronic in this context means ’persisting for a long time’. Some stressors simply will not
go away. You have a deficit budget, you are dealing with a disciplinary matter or you
have a parent who will insist on sharing all her views with the local press.

The body’s response to chronic stressors is triggered at the same time as the ANS but the
impact lasts longer.

This response triggers the pituitary gland. This powerful gland releases many hormones
that control/regulate bodily functions. In this case, the hormone released is
adrenocorticotrophic hormone – let’s call it ACTH.

ACTH makes its way through the bloodstream to the adrenal glands. This time it is the
adrenal cortex (the outside) of the adrenal glands that is stimulated. This causes hormones
called corticosteroids to be released. These have a metabolic effect on the body; they
maintain energy levels through regulating the supply of blood sugar.

This is an important coping response as the long-term effects of corticosteroids are to
help the body deal with stress more effectively – muscle development is enhanced and
there is more food in the blood stream to cope with energy demand.

While the body’s approach to chronic stress may sound beneficial it can cause serious
problems if there really is no let up in stimulation by the stressor. This is where we will
now turn our attention as this is where the stress reaction has implications for causing
burnout.

Selye’s general adaptation syndrome
We owe a great deal of our knowledge in this field to the pioneering work of Hans Selye
in the 1930s. Through experimental work on rats Selye found that prolonged exposure to
a stressor, particularly in situations of low control, leads to harmful physiological
changes.
Based on this work Selye proposed the General Adaptation Syndrome (GAS). This has
three stages (see below).

The three stages of General Adaptation Syndrome (GAS)
Stage 1: Alarm reaction
The body recognises a stressor and responds accordingly. Adrenaline is produced. The
‘fight or flight’ reaction is stimulated. There may be some production of corticosteroids.
Stage 2: Resistance
Continuing stress makes it necessary for the body to find some way of coping. The body
adapts to the stress but at the same time resources are being used up. We appear to be
coping but physiologically we are actually deteriorating. The body is tough – it can deal
with this for some time.
Stage 3: Exhaustion
Eventually we reach burnout. The body can no longer maintain its normal functioning.
Blood pressure may be high. The adrenal glands have been overworking and can no
longer produce adequate levels of hormones. Stress related illnesses follow; ulcers,
depression, heart problems, mental illness.

This is the basic model as proposed by Selye. Since then, further work on hormones
suggests that it is not depletion that is the problem but over-production of cortisol, one of
the corticosteroids. A long-term effect of the body’s response to chronic stress is that
there are higher levels of cortisol in the bloodstream. This leads to higher levels of blood
sugar and fatty acids and this can cause arteriosclerosis – the narrowing of the coronary
arteries owing to an accumulation of fatty substances. This leads to increased blood
pressure and heart problems.

In the context of a headteacher having to deal with a persistent problem over many weeks
or months and maybe feeling powerless to control the situation there will be a payback.
Something’s got to give – and it will be your physical or mental well-being.

Stress-related illness
There are several ways in which chronic stress can cause illness.
We have already mentioned the impact of increased sugars and fats on blood vessels.
This is a direct mechanical effect of stress. Another would be increased blood pressure
leading to wearing away of the blood vessel lining. Increased energy mobilisation has
other effects including potential brain haemorrhage or stroke.

Prolonged stress can cause suppression of the immune system. In a healthy individual,
white blood cells (lymphocytes and phagocytes) seek out and destroy invading particles
(bacteria and viruses, for example). One particular type of white blood cell is directly
affected by increased levels of stress hormones. These are lymphocytes known as T cells,
because they are produced in the thymus gland. High levels of corticosteroids can shrink
the thymus gland and prevent the growth of T cells.
This can happen to a degree with short-term stressors but the major impact is with long-
term stressors. Unresolved stress will suppress the immune system and lead to more
frequent illness and infections. As a headteacher you see examples of this among your
staff regularly – sometimes people just can’t shake off illness.

Disruption to hormone levels caused by prolonged stress can also affect sexual and
reproductive functions, bone growth and repair and sensitivity to pain.

Stress also makes us more likely to adopt an unhealthy approach to life. We change our
lifestyle in response to stress. We may rush or skip meals, we may make unhealthy
choices about our food. We may drink more alcohol or smoke. We may not get enough
sleep. All of these can have effects on our bodies and these are the indirect effects of
stress.

A heart attack is still a heart attack whether it is caused by increased levels of cortisol
leading to arteriosclerosis or eating five doughnuts instead of a balanced lunch!

Coping strategies
The impact of stress on our bodies should not be underestimated. Teaching is regularly in
the top five most stressful occupations – you know this.

At the beginning of this article it was stated that the modern transactional view of stress
linked our perceived stress with our perceived ability to cope. Therein lies the key. When
Selye was being unkind to rats he was looking at purely physiological responses. His
work was important in that it helped us to understand the physiology of stress. Rats don’t
have our ability to control the environment and make decisions; they lack our cognitive
dimension. This is where the solution lies.

We have higher brain functions that can allow us to process our experiences, adapt our
lifestyle, make decisions and choices and find our own way of increasing our perceived
ability to cope with perceived stressors.
–        There are physical approaches such as eating a healthy diet, taking more exercise
or choosing to quit smoking or only drinking a moderate amount of alcohol.
–        There are more psychological approaches such as being aware of how our body
reacts to stress and managing situations differently to alter our stress response. We can
also draw on the benefits of supportive groups of friends, family or colleagues.

This sounds great – let’s do it today. But the big factor is time. You don’t have time to go
to the gym or meet socially with friends. You don’t have time to be less stressed!
The rest of this article is concerned with time management as the underlying bedrock of
stress management.

Time management
Time management is really a misnomer. We can’t manage time. There is a set amount of
it. We all have 168 hours each week and it is up to us what we do with those hours.
Really we are talking about self management.
Conventional time management strategies and advice are concerned with tips and ideas
on how to do more in less time. Making lists, scheduling down to the last minute and so
on. This has the potential to make you even more stressed as you try to cram more and
more results into the same 168 hours.

The internationally acclaimed author Stephen Covey puts the emphasis on deciding what
your priorities are first. In his best-selling book, The Seven Habits of Highly Effective
People, Covey draws on some of the best approaches gathered from hundreds of
successful people over hundreds of years. These aren’t new ideas, most of them aren’t
even Covey’s ideas; his skill lies in gathering them, organising them and presenting them
to us in a clear way that promotes action and encourages us to take responsibility.
The first of the seven habits is, ’Be proactive’. We each have to take responsibility for
our own life and what we choose to do with it. The second habit is concerned with
identifying your values and principles, establishing your roles and goals – knowing what
you believe in and where you want to go. Covey calls this habit, ’Begin with the end in
mind’. It is the third habit that has the greatest implication for how we manage ourselves
(our time). This habit is called, ’Put first things first’.

Time management matrix
              Urgent                 Not Urgent
      Quadrant One                   Quadrant Two
      Activities:                          Activities:
      – crises                                     – preparation
      – pressing problems                  – prevention
      – deadline-driven projects           – values clarification
      meetings, preparations               – planning
      – relationship building
      – true re-creation
      – empowerment

Quadrant Three                      Quadrant Four
      Activities:                         Activities:
      – interruptions, some phone         – trivia
      calls, some mail, some reports      – busywork
      some meetings                       – some telephone calls
      – many proximate, pressing          – time wasters
      matters                             – ‘escape’ activities
      – many popular activities           – excessive TV


Put first things first
Covey states that we should ’organise and execute around priorities’. To help us identify
what is and is not a priority he uses a Time Management Matrix (overleaf).
We spend time in one of four ways:
–       important/urgent activities
–      important/not urgent activities
–      not important/urgent activities
–      not important/not urgent activities

If something is important it fits in with your values and your high priority goals. If
something is not important – don’t do it!

Quadrant 1 is urgent and important. It has to be done now. This is the realm of crises and
problems. People who work in this area are crisis managers and are deadline-driven.
People who spend too much time in this area are stressed and ultimately they become
burned out.

Quadrant 3 is not important but we think or are told it is urgent so we do it. This is where
we focus on the priorities and expectations of others and not our own. This leads to a
short-term focus, trying to please everyone and ending up pleasing no one. Often there
are meetings, paperwork and telephone calls that just aren’t important – don’t deal with
them.
Quadrant 4 is a place where quadrant 1 people can escape to. It is also a place where
some people spend a lot of their time. It is work or other activities that are not important
or urgent. This is where time-wasting activities and diversions lie. It is also where an
unhealthy lifestyle tends to be nurtured. People who spend time here aren’t proactive and
they end up being dependent on other people to do their work.

Look at what you do. If it is not important, if it does not meet your values or priorities,
then don’t do it.

This leaves quadrant 2 and this is where people who manage themselves effectively
spend 80 per cent of their time. Activities in this quadrant are not urgent but they are
important. This is the realm of long-term planning, developing a vision, putting in place
procedures that allow matters to be dealt with effectively on a day-to-day basis. This is
where relationship building happens and preventative work. Being one step ahead, seeing
what needs doing and doing it before it becomes urgent.

People who focus on quadrant 2 still spend time in quadrant 1 – there is always going to
be some emergency to deal with, no matter how well planned things are. The difference
is that they spend most of their time focused on what is important but not urgent.
Take another look at the diagram of the ’Time management matrix’. Draw yourself a
blank outline of the structure of the diagram and over the next week jot down notes in the
different quadrants of the activities that you do that you feel belong in each of the
quadrants. At the end of the week take a look at what you have found and ditch some of
the unimportant stuff.

In conclusion
Everyone is stressed – not just teachers. Stress is a major killer in the modern world. We
can’t have an injection to inoculate ourselves against it, but we can learn to manage
ourselves so that stress does not have a life-threatening impact on us. Your perceived
ability to cope with perceived stressors will depend on what action you take to ensure you
understand the complexities of the problem of stress and have a range of strategies to deal
with it in your own life.

Steve Mynard is a former headteacher and the director of Metaphor Learning, offering
training courses for primary schools

References/resources
Cardwell, Clark and Meldrum (2003) Collins Psychology for AS-Level (3rd ed). London:
Harper Collins.

Covey S. R. (1989) The Seven Habits of Highly Effective People. London: Simon &
Schuster.

Franklin Covey Limited, based in Banbury, Oxfordshire, runs excellent courses,
including ‘Focus: achieving your highest priorities’, and ’The seven habits of highly
effective people’. These are partly based on the material in the Stephen Covey’s books
and are an excellent starting point if you wish to tackle these issues at their root. They
have also worked specifically with schools at both teacher and student level. Find out
more at www.franklincoveyeurope.com or call 01295 274100.

				
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