Managing%20Stress

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Managing Stress

• Stress is an unavoidable consequence of life.
• Hans Selye, M.D., Ph.D. (1951)

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Experience Stress!

• What would you need to do or think about at this
  moment that would increase you feeling of stress
  or anxiety?
• What do you notice about your experience of
  stress?

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What is Stress

• I. Stressor- an event or adjustive demand placed
  on an individual or group.
• II. Stress- effects created within an organism by
  the application of a stressor.
• OTHER DEFINITIONS
• Crisis- a stressful situation that approaches or
  exceeds the adaptive capacities of an individual
  or group.
• Coping Strategies- efforts to deal with stress.

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Two Different Kinds of Stress

• Distress- negative stress, associated with pain,
  anxiety, or sorrow.
• Examples include work demands, death of friend
  or family member, car troubles, and financial
  issues.
• Eustress- positive stress
• Examples include job promotion, purchasing a new
  home, marriage or birth of a baby, and the
  holidays.
• Both tax a persons limited resources generally,
  distress has the potential to do more damage

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Predisposing Factors of Stress

• Nature of the Stressor
• significance, immediacy, cumulative effect,
  duration (marital separation)
• Persons Perception of the Stressor
• Important to have realistic expectations
• Individuals Stress Tolerance
• Ability to withstand stress without becoming
  seriously impaired.
• Lack of External Resources and Social Supports
• Alone vs. surrounded by others.

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Responding to Stress

• Stress threatens a persons well being and
  produces automatic, persistent attempts to
  relieve the tension.
• Stress Forces Us to Do Something (think, act,
  feel, etc)
• That something can actually increase stress
• Three Interactional Response Levels
• Biological (immune system etc.)
• Psychological and Interpersonal (coping social)
• Sociocultural (group resources)
• Two Challenges in Confronting Stress
• Task-oriented response- behavior is directed
  towards resolving the stressful situation.
• Defense-oriented response- protecting self from
  hurt disorganization.

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Responding to Stress

• Two Challenges in Confronting Stress
• Meet the requirements of the stressor
• Protect the self from psychological damage
• Two General Responses to Stress
• Task-oriented response- behavior is directed
  towards resolving the stressful situation.
• Defense-oriented response- protecting self from
  hurt disorganization.

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The Effects of Severe Stress Biological

• General Adaptation Model (Selye, 1956)
• The biological reaction to sustained exposure
  follows three phases
• Alarm Reaction (activation of autonomic system)
• Stage of Resistance (maximal use of bio-defenses)
• Exhaustion (biological resources are depleted)
• Homeostasis is harder to achieve.
• Sympathetic Nervous System
• Immune System is suppressed by stress

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The Effects of Severe StressGeneral Adaptation
Syndrome
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Nervous System
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Central Nervous System (Brain)

• Bear in the Woods (Fight/Flight)
• Hypothalamic-Pituitary-Adrenal system releases
• cortisol (primary stress hormone)
• Heart rate, lungs, circulation, metabolism,
  immune system, and skin.
• catecholamines (neurotransmitters-adrenaline)
• Amygdala- emotional response
• Hippocampus- stores emotionally loaded experience
  in long term memory.
• Suppress short term memory (concentration,
  inhibition, and rational thought).

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Sympathetic Nervous System

• Stress causes activation of SNS (sympth.)
• Release of adrenaline
• Bodys need for oxygen increases.
• Heart rate and blood pressure go up.
• Blood vessels in your skin constrict.
• Muscles become tense.
• Blood sugar level increases.
• Blood has an increased tendency to clot.
• Cortisol is released (triggers appetite incr.)

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Biological Symptoms of Chronic Stress

• Headaches
• Sleep disturbance
• Gastrointestinal problems
• Ulcers
• High blood pressure
• Weakened immune response
• Muscle pain

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Symptoms of Stress

• Physical
• Muscle tension, illness, high blood pressure,
  indigestion, ulcers, difficulty sleeping,
  fatigue, headaches, backaches.
• Emotional
• Irritability, depression, anger, fear or anxiety,
  feeling overwhelmed, mood swings.
• Cognitive
• Forgetfulness, unwanted or repetitive thoughts,
  difficulty concentrating. Headaches

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Psychological Effects of Stress

• Impairment of intellectual functioning
• Difficulty making decisions
• Poor concentration
• Decrease in creativity
• Diathesis-Stress Model
• Constant stress brings about changes in the
  balance of hormones in the body.
• Depressive Disorders
• Anxiety Disorders (panic attacks)
• Formation of unhealthy defense patterns

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Psychological Effects of Stress

• Personality (psychological) decompensation-
• lowering adaptive psychosocial functioning in
  the face of sustained or severe stress.
• Course of Decompensation
• Alarm and Mobilization
• Increased tension, heightened sensitivity,
  greater alertness, efforts of self-control.
• Resistance
• Task oriented response. Ego-Defenses used. Some
  mild reality distortions
• Exhaustion
• Inappropriate defense mechanisms used. Break with
  reality.

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Adjustment Disorder Reactions to Common Life
Stressors

• Stress from unemployment
• Stress from bereavement
• Stress from divorce or separation

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Adjustment Disorder

• The development of emotional or behavioral
  symptoms in response to an identifiable
  stressor(s) occurring within 3 months of the
  onset of the stressor(s).
• These symptoms or behaviors are clinically
  significant as evidenced by either of the
  following
• marked distress that is in excess of what would
  be expected from exposure to the stressor
• significant impairment in social or occupational
  (academic) functioning

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Adjustment Disorder

• The stress-related disturbance does not meet the
  criteria for another specific Axis I disorder and
  is not merely an exacerbation of a preexisting
  Axis I or Axis II disorder.
• The symptoms do not represent Bereavement.
• Once the stressor (or its consequences) has
  terminated, the symptoms do not persist for more
  than an additional 6 months.
• Specify if
• Acute if the disturbance lasts less than 6
  months
• Chronic if the disturbance lasts for 6 months or
  longer

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Acute Stress Disorder

• The person has been exposed to a traumatic event
  in which both of the following were present
• person experienced, witnessed, or was confronted
  with an event that involved actual or threatened
  death or serious injury, or a threat to the
  physical integrity of self or others
• the person's response involved intense fear,
  helplessness, or horror
• Either while experiencing or after experiencing
  the distressing event, the individual has 3
  dissociative symp.
• a subjective sense of numbing, detachment, or
  absence of emotional responsiveness
• a reduction in awareness of his or her
  surroundings (e.g., "being in a daze")
• derealization
• depersonalization
• dissociative amnesia (i.e., inability to recall
  an important aspect of the trauma)

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• The traumatic event is persistently
  re-experienced recurrent images, thoughts,
  dreams, illusions, flashbacks, or a sense of
  reliving the experience or distress on exposure
  to reminders of the traumatic event.
• Marked symptoms of anxiety or increased arousal.
• Marked avoidance of stimuli that arouse
  recollections of the trauma (e.g., thoughts,
  feelings, activities, places, people).
• The disturbance causes clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning or
  impairs the individual's ability to pursue some
  necessary task, such as obtaining necessary
  assistance.
• The disturbance lasts for a minimum of 2 days and
  a maximum of 4 weeks and occurs within 4 weeks of
  the traumatic event.
• The disturbance is not due to the direct
  physiological effects of a substance or a general
  medical condition, is not better accounted for by
  Brief Psychotic Disorder, and is not merely an
  exacerbation of a preexisting Axis I or Axis II
  disorder.

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Post-Traumatic Stress Disorder

• The person has been exposed to a traumatic event
  in which both of the following were present
• the person experienced, witnessed, or was
  confronted with an event (s) that involved actual
  or threatened death or serious injury, or a
  threat to the physical integrity of self or
  others.
• the response involved intense fear or
  helplessness.
• The traumatic event is persistently reexperienced
  in one (or more) of the following ways
• recurrent and intrusive distressing recollections
  of the event, including images, thoughts,
  perceptions, or dreams of the event.
• acting or feeling as if the traumatic event were
  recurring (includes a sense of reliving the
  experience, illusions, hallucinations, and
  dissociative flashback episodes) intense
  psychological distress at exposure to internal or
  external cues that symbolize or resemble an
  aspect of the traumatic event

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• physiological reactivity on exposure to internal
  or external cues that symbolize or resemble an
  aspect of the traumatic event
• Persistent avoidance of stimuli associated with
  the trauma and numbing of general responsiveness
  (not present before the trauma), as indicated by
  three (or more) of the following
• efforts to avoid thoughts, feelings, or
  conversations associated with the trauma
• efforts to avoid activities, places, or people
  that arouse recollections of the trauma
• inability to recall an important aspect of the
  trauma
• markedly diminished interest or participation in
  significant activities
• feeling of detachment or estrangement from others
  

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• restricted range of affect (e.g., unable to have
  loving feelings)
• sense of a foreshortened future (e.g., does not
  expect to have a career, marriage, children, or a
  normal life span)
• Persistent symptoms of increased arousal (not
  present before the trauma), as indicated by two
  (or more) of the following
• difficulty falling or staying asleep
• irritability or outbursts of anger
• difficulty concentrating
• hypervigilance
• exaggerated startle response
• Duration of the disturbance (symptoms in Criteria
  B, C, and D) is more than 1 month.
• The disturbance causes clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning.

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Causal Factors in PTSD

• Personality
• Nature of the Traumatic Stressor
• Accounts for most of the stress response
• Everyone has a breaking point.
• Conditioned Fear Response
• Need for Prompt Psychotherapy

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The Trauma of Rape

• Most common cause of PTSD in females
• Stranger Rape vs Acquaintance Rape
• Factors of Influence
• Age
• Developmental Stage
• Life Circumstance
• Family and Friends

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Coping with Rape

• Coping with rape
• Anticipatory phase
• Victim perceives danger
• This isnt really happening to me.
• Impact phase
• Recognition that she will be raped
• Fear for life greater than sexual act
• Fear is paralyzing
• Post-traumatic recoil phase
• Immediately after rape
• Guilt of their actions and dependency
• Reconstitution phase
• Person starts to makes plans for leaving crisis
  center
• Self protective activities, nightmares, phobias

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The Trauma of Military Combat

• Temperament
• Limited evidence to suggest that temperament
  makes a difference in resistance to combat stress
• Psychosocial Factors
• Unpredictable, loss of freedom, killing, et.
• Sociocultural Factors
• Acceptability of war goals
• Quality of leadership
• Group identification with their combat unit

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Treatment of Stress Disorders

• Stress Prevention
• Stress Inoculation Training
• Stress Management Skill Development
• Crisis intervention therapy
• Talk it out in a supportive environment
• Medications
• Direct therapeutic exposure
• Real or imagined

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Stress Prevention and Management

• Expect Stress
• Identify Personal Stressors
• Time Management
• Learn Relaxation Techniques
• Good Health Practices
• (Diet and Regular Exercise Routine)
• Change Cognitions
• Clarify Values
• Reframe negative stressors
• Maintain a Social Support Network

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Identify Stressors

• What is stressful to me?
• Different responses by individual.
• How does stress affect me?
• Symptoms listed earlier.
• When am I most vulnerable to stress?
• Time of day (459), week (Sunday), month (bills,
  menstrual cycle etc.), year (winter blues)
• When is stress good for me?
• Moderate amounts of stress actually improve
  performance (curvilinear)
• Too much impairs. Too little decrease motivation.

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Time Management

• Prioritize (clarify values)
• Make To-Do-Lists.
• Use a Schedule.
• Schedule Time for Breaks, Socializing, and Fun.

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Relaxation Techniques

• Diaphragmatic Breathing (takes practice)
• Are you a belly-breather or chest breather?
• Influences parasympathetic quieting response.
• Increases oxygenation of blood.
• Distracts from stressful stimulus.
• Increases sense of control over body and stress
  reactions.

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Good Health Practices

• Eat Healthy Foods
• Cut Back on Caffeine, Nicotine, and Other
  Stimulants.
• Have an Exercise Plan.

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Cognitive Techniques

• Realize What You Can and Cannot Do.
• Recognize Irrational or Negative-Automatic-Thought
  s.
• Reframe Negative Thoughts and Focus on Positive
  Aspects.

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Social Support

• Stay connected with family
• Connect with peers