Stress Coping

							Stress & Coping


   Carolyn Y. Johnson
 Stress-change in the normal balanced state
   Stress stimulates the thinking process & helps
    you stay alert to your environment. Stress
    provides stimulation & motivation as well as
    discomfort & retreat. If stress  existing coping
    mechanisms  crisis.
 Stressors-disruptive forces operating within
  any system
 Sources of stress
     Internal (ex: infection)
     External (ex: peer pressure, death in family)
     Developmental stressors
     Situational stressors (unpredictable ex: new
      job, illness, marriage)
 Effect of stress depends on developmental stage
  as well as personality and general resources (3 yr
  old vs 50 yr old)
 Effects of stress are: physical, emotional
  (negative feelings about self), intellectual
  (problem solving abilities), social (relationships), &
  spiritual (challenge beliefs & values)
 Fight or flightsympathetic n.s. response to
  stress (d pulse, resp., b.p., glucose)
 Selye stress response General adaptation
  syndrome (GAS)- 3 stage reaction to stress;
  sympathetic response is balanced by endorphins
  secreted by the hypothalamus; reduces pain &
  produces sense of well-being (internal opiates)
 Note: prolonged stress can  atrophy of
  lymphatic structures
 Local adaptation syndrome (LAS) (ex:
  inflammation)
 Both local and general adapt. syndromes have 3
  stages
   Alarm reaction-shock phase (person may or may not
    be conscious of stressor; epi & norepi are
    releasedd myocardial contractility, bronchial
    dilation, d blood clotting, d cell metabolism, d fat
    mobilization (energy stores); counter shock phase-all
    the above reversed
   Resistance stage-body stabilizes & repairs any damage
   Exhaustion stage-physiologic response intensifies,
    physiologic regulation s, if stress continues death will
    result
 Transactional Based
  Model
 Lazarus - more
  colorful ccount of
  individual stress
  responses;
  transactional stress
  theory-person &
  environment are
  inseperable;
  individual responds to
  percieved external
  stress by adaptive or
  coping responses;
  stress is personal &
  varies widely among
  individuals
 Physiologic response includes immune
  response & prolonged stressdisease due
  to d hormones, poor coping (drugs,
  ETOH, cigarettes, acting out behavior, not
  enough rest, too much caffeine, disturbed
  eating), neglecting warning signs of illness
 Instead of poor coping what can we do?
   Relaxation response elicited by meditation or
    progressive muscle relaxation d b.p., 
    pulse,  resp.
   If people are overwhelmed by anger &
    continually seek revenge then anger becomes
    are burden instead of protective mechanism;
    forgiveness or releasing or excessive anger
    has been shown to decrease stress hormones
   Physiologic manifestations of stress
   CV-tight chest; d pulse, b.p.
   Resp.-dyspnea, tachypnea
   Neuro-headache, fatigue, sleep disturbances,
    restlessness, tremors, profuse sweating, dry
    mouth, cold hands & feet
   GU/GI-urinary frequency, n & v, diarrhea, more
    than 10 lb wt. gain, GI bleed, change in appetite
   Musculoskeletal-backaches, muscles aches,
    slumped posture
   Reproductive-amenorrhea, failure to ovulate,
    impotence, loss of libido
   Immunological-frequent/prolonged cods/flu
 Psychological manifestations of stress
 Cognitive
    forgetful/preoccupied, denial, poor concentration,
     inattention to detail, orientation to past instead of
     present, d creativity, slowed thinking/reactions,
     learning difficulties, apathy, confusion, d attention
     span, calculation difficulties, memory problems
 Emotional
    disruption of logical thinking, blaming others, lack of
     motivation, excessive crying, irritability, lack of interest,
     isolation diminished initiative
 Behavior/lifestyle
    worrying,  involvement with others, withdrawal,
     change in interactions with others, d or d food
     intake, d smoking or ETOH, over vigilance to
     environment, excessive humor or silence, no exercise
 Reaction to psychological
  stress:
 Primary appraisal-
  evaluating event for its
  personal meaning (quick
  & automatic)
 Secondary apprais.-
  following recognition of
  stress, focus is on
  possible coping strategies
 Coping-means by which
  people manage
  psychological stress; we
  obtain information, take
  action to change situation
  & regulate our emotions
  tied to the stress; in some
  cases we change our
  thinking instead of the
  changing the situation or
  we avoid thinking about it
 Psychological Stress-Anxiety
 Mild anxiety-enhances perception, learning &
  productive abilities
 Moderate anxiety-perceptual abilities are
  narrowed; mild GI symptoms (“butterflies”)
 Severe anxiety-consumes most of person’s
  energy & requires intervention; perception is
  further d; unable to focus on whole situation;
  learning severely impaired; easily distracted;
  headaches, dizziness, nausea
 Panic-overpowering-perception can be distorted;
  unable to learn or function; feeling of impending
  doom; communication may not be understandable
 Depression-common
  reaction to events that
  seem overwhelming or
  negative; def: feeling of
  sadness, emptiness,
  numbness; behaviors:
  irritability, difficulty
  concentrating, crying,
  sleep changes, social
  withdrawal; physical
  signs: headache,
  dizziness, loss of appetite,
  constipation
 Short periods normal
  response to some
  stressors ; prolonged is
  cause for concern & may
  require treatment
   Defense Mechanisms:
   Compensation: Iverson
   Denial
   Displacement
   Identification
   Intellectualization-replaces emotion
   Projection
   Rationalization-faulty logic
   Reaction formation-act opposite of feeling
   Regression
   Repression
   Sublimation
   Substitution
 Health Promotion
 Regular exercise
 Support system-family, friends, church,
  organizations (ex:Amer. Cancer Society)
 Assertiveness training
 Stress management in the workplace-burnout!
  (colleague support groups, daily relaxation
  routine, regular exercise program, get involved
  ion constructive change efforts if organizational
  policies cause stress)
 Encourage pt. verbalization of fears, identification
  of own strengths/abilities; arrange situations that
  encourage autonomy; provide atmosphere of
  acceptance; explore with pt. previous methods of
  coping; foster constructive outlets for anger