Stress

Dr Aidah Abu Elsoud Alkaissi

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Stress Paradigm for understanding the relationships among the

determinants of health, the leading health indicators and health outcomes

Stress cause or exacerbate many of the leading health problems such as obesity, alcohol and drug abuse ans sexually transmitted diseases

Caring for and supporting individuals, families and communities to help them find more effective ways to respond to stress is important for promoting health

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Stress Stress management is an effective intervention for health

promotion, disease prevention and symptom management

Stress management strategies such as relaxation and imagery, self monitoring, goal setting, cognitive restructuring and problem solving have been the staple of community problems, including alcohol anonymous, smoke enders and weight watchers, which help people improve quality of life by modifying health-risking behaviors

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Stress United state is good at expensive, heroic care,

it is poor at low-cost preventive care, particularly stress management

Individuals within high risk groups such as immigrants, refugees and families with few financial resources

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The goal of stress management Improve quality of life by increasing healthy,

effective coping, thereby reducing the unhealthy consequences of distress

This process produces a dynamic interaction of mind , body, and spirit, which effect not only physical haelth and well being, but also cognitive and emotional states and behavior

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Sources of stress A stressor is any experience that disrupts homeostasis

thereby requiring change or adaptation

Indviduals encounter a variety of physical, psychological, social, spiritual and environmental stressors

Stressors range from physical illness, truama or blood loss, to activities of daily living (caring for children, meeting work deadlines and cleaning or repairing the house), to event such as taking a critical examination, experiencing the death of relatives, losing possessions in a fire, losing a job, getting a divorse, or getting married

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Sources of stress Stressors can be categorized as those over which

people have no control (extrinsic factors), such as the weather, a traffic jam, death of spouse; stressors that individuals can modify by changing their environment, social interactions or behaviors and stressors created or exacerbated (intrinsic factors( by poor time management, procrastination مماطلة (putting off or delaying or defering an action to a later tim), poor communication, catastrophic negative thinking (expecting the worst) , or strugling with self defeating (to frustrate ) behaviors

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Sources of stress

Stress is a part of living, it is a complex relationship between a person and the environment in which the person appraises a situation as taxing or exceeding the individual´s resources and endangering the individual´s well being

Appraisal or perception is an important concept because it helps explain why two people react in different ways to the same situation

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Sources of stress Stress is the negative physical, psyckological, social or

spiritual effect of life´s pressures and events The term for the negative effect of stress is distress Canadian physiologist Dr. Hans Selye (1982) demonstrates

that, to a certain extent, stress can be challenging and useful, which he identifies or eustress (a pleasant or curative stress)

Selye observes when stress becomes chronic or excessive, the body is unable to adapt and maintain homeostasis and coined the term distress

Other reserchers have shown sress is oth useful and harmful

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Sources of stress

As stress or challenge increases, efficiency and performance also increase but not endlessly

As a certain point, performance and efficiency start to decrease significantly if stress continues to build

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Physiolgical effect of stress

An individaul´s response to stress provides a model to examine changes across the biopschosocial-spiritual domains

In response to a perceived threat (stressors) , the body prepares to meet the challenge

The perception of threat (stress) stimulates a physiological pattern of neural and endocrine activation and behavioral changes mediated by the central nervous system

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Physiolgical effect of stress In most cases this response is an adaptive,

short term, acute response to a stressor First termed te fight or flight response and later

called the stress response The individual´s reaction to stress prepares the

body for emergency reaction and fosters survival in circumstances of immediate, time-limited threat

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Physiolgical effect of stress This physiological arousal proceeds along three main

pthways 1. The musculolskeletal system (MSS) 2. The autonomic nervous system (ANS) 3. The psychoneuroendocrine system (PNE) The MSS respond by increasing tension and tone At the same time, the ANS, via the sympathetic

branch, orchestrates a generalized arousal that includes increases in heart rate, blood pressure and respiratory rate

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Physiolgical effect of stress Additionally a heightened awareness of the

environment is triggered, blood shifts from the visceral organs to the large muscle groups, lipid metabolism is altered and platelet aggregability is increased

Concurrtly, the PNE stimultes the hypothalmic-pituitary-adrenal axis and the secretion of glucocorticoid (primarily cortisol) and other neuroendocrine substances into the systemic circulation, increasing glucose levels, influencing sodium retention and in the acute phase, increasing the antiinflammatory response

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Physiolgical effect of stress

Eventually, however there is a decrease in immune function

Additionally, other hormones regulated by the PNE system, such as reproductive and growth hormones, endorphins and enkephalins can be affected by chronic stress

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Physiolgical effect of stress In most cases the stressrespone is a beneficial

adaptive pattern but it can prove maladaptive when a stressor continues indefinitely

Maladaptive stress is an enduring and sometimes self sustaining cscde of response that degenerate physical, psychosocial and spiritual well being

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Studies show that maladaptive stress can cause or exacerbate disease or symptoms of diseases such as angina, cardiac arrhythmias, pain, tension, headaches, insomnia and gastrointestinal complaints

This influence is well documented in comprehensive experimental and clinical literature

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Physiolgical effect of stress Not surprisingly stress has been found to

influence the development of coronary heart disease in women, to cause slow wound healing in women caregivers of relatives of dementia

Increase the susceptibility of catching the common cold

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Psychological effects of stress The negative mood states including anxiety,

depression, hostility, and anger

50% of all patients with severe depression show hypersecretion of cortisol

Cortisol concentration is raised in urine, plasma and cerebrospinal fluid of patients with depression

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Depression is associated with increased risk of morbidity and mortality from cardiovascular disease

Increased isk for hypertension related to factors such as cigarette smoking, sedentary lifestyle, family history also document relationship between anxiety and hypertension

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Social-Behavior Effects of Stress In response to stress, individuals often revert

(practice) to or increase their reliance (the state of relying on something) on less healthy behaviors such as overeacting, excessive use of alcohol, smoking, sedentary life style, drug use and increase in violent behavior

Recognition that behaviors are inconsistent with the healthy behaviors needed to cope with stress is easy

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The inability to control health risking behaviors as a result of increased stress is called the stress disinhibition effect

Health risking behaviors such as a sedentary lifestyle, obesity, overeating high fat-foods, smoking, drug use, and social isolation have been clearly linked to morbidity and mortality

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Social-Behavior Effects of Stress Exercise, healthy diet, smoking cessation,

healthy weight maintenance and social interaction have been identified as leading indicators of health

Stress management strategies that help break the cycle of stress-disinhibition in response to stress are important to mediate the unhealthy pattern

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Spiritual effects of stress The study of spirituality and health is of significant

interest

In response to stress, people often feel disconnected from life´s meaning and purpose which effects spiritual health and well being

Studies are confirming that prayer can affect healing

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Religious practices are examples of ways in which some people choose to express their spitituality

Koenig et al (1998) report that Christians who attended religios services at least once per week and those who read the bible or pray regularly have consistently lower diastolic pressure readings compaed with people who do not engage in spiritual activities

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Health Benefits of Managing Stress The importance of controlling stress to promote

health and quality of life for people with a variety of health problem is highlited in a continoully growing body of evidence

Cancer, HIV, and other immune system disease have been shown to respond to interventions to reduce the stress response

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Health Benefits of Managing Stress

Arthritis, , chronic pain, chronic disease, diabetes, coronary heart diseases, hypertension, cardiac arrhythmias, insomnia, premenstrual syndrome, infertility and the nausea and vomiting associated with chemotherapy have been shown to respond to stress management interventions

In addition, interventions that help counter the negative effects of stress have been shown to be cost-effective

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Health Benefits of Managing Stress

Kobas et al (1982) descibed individuals with stress-hardy characteristics who, when exercising and accessing social support were shown to be less vulnerable to stress-related symptoms and diseases

The characteristics of stress hardiness are control, challenge, and commitment

For stress hardy individuals stress is viewed as a challenge rather than a threat, the feel in control of situation in their lives and they are commited to rather than alienated from work, home and family

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Health Benefits of Managing Stress

The researchers theorize that a pessimistic explanatory style or attitude weakness the immune system through a sustained increase in sympathetic aruosal in addition to negatively affecting behavior

For example, pessimist exhibit more health- risking behaviors such as smoking, alcohol misuse, and sedentary lifestyles

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Health Benefits of Managing Stress

Evidence is presented that perceptions or the way the individuals view situations can lead to stress and in turn adversely affect biological activity, emotions, behavior and the connection with life meaning and purpose which in turn increase stress and foster a negative stress cycle

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Interviewing techniques to help individuald describe their evaluations of stressful events

Primary appraisal of coping includes descriptions of perceived actual and potential positive and negative outcomes

Negative outcomes refer to harm, whereas positive outcomes refer to the challenges that an individual perceives can be acheived as a result of the stressors

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Examples of negative outcomes are physical injury, disease, loss of a cherished relationship, position or possession and death

Positive outcomes include graduation, promotion and development of important relationships

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Interviewing techniques to help individuald describe their evaluations of stressful events

Secondary appraisal: which includes the individual´s identification of available choices to cope with the actual or potential harm, threat, or challenge

The choices may be internal or external resources and responses

For example, a social resourcs in coping with the needs of a toddler might be learning strategies in a parent-effectiveness training course

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Interviewing techniques to help individuald describe their evaluations of stressful events

A coping response to the challenges of parenting a toddler might be restructing the toddler´s and parent´s schedules to allow for more frequent cycles of activities and rest

By using measurement instruments with established validity and reliability, nurses can increase their accuracy of assessing and individual´s stress and coping

Using these tools can help nurses distinguish between diagnosis that have many signs and symptoms in common

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Interviewing techniques to help individuald describe their evaluations of stressful events

A wide variety of tests and questionnaires are available for nurses to assess orientation, attention, cognitive skills and patterns, traits and states of emotions and overall quality of life

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Stress Management intervention Nurses are sensitive to the needs of

individuals in highrisk groups, such as immigrants, refugees, and families with few financial resources

The language, belief system and cultural distinctions of individuals guide the choice or alteration of stress management strategies

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Developing self-Awareness Helps people learn about the relationship of mind-body-spirit,

increase a sense of control and counter self defeating perceptions

The purpose is to help people make sense of life events and circumstances that may be be wildering or discomforting

Many experiences in life lead to feelings of emptiness and disharmony because the person is unable to connect the experience with thoughts , feelings, actions, and physiological responses

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Developing self-Awareness Self-awareness helps individuals recognize stress that

they create through negative, exaggerated, unrealistic thinking

These recognition affords an opportunity to change these negative thought patterns, thereby decreasing stress and increasing control

Using strategies that increase self-awareness can empower individuals to make new connections and to reframe and reinterpret their experiences in light of their own inner strength and wisdom

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Techniques for developing self-awarenessmonitoring stress warning signs

The negative stress cycle can be difficult to interrupt Recognizing the warning signs of stress is a necessary

first step Often individuals have long ignored the stress warning

signs (physical, emotional, or behavioral cues or reactions to a stressror) that their mind and body gives them

The man suffering from chronic intermittent backaches who ignores the daily muscle tension caused by poor posture, which precedes the backaches

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Techniques for developing self-awarenessmonitoring stress warning signs

Example, if he had attended to his early stress warning signs (poor posture, and muscle tension) then he might have avoided the backache that kept him from exercising and socializing

Becoming aware of these stress warning signs is the first step

Attending to these cues is the next step After this connection is made, developing skills to

reduce negative mood states, unhealthy behaviors and physical symptoms becomes much easier

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Techniques for developing self-awarenessmonitoring stress warning signs

To continue with the previous example, when the man notices muscle tension and then stops, take a few deep breaths, correct his posture, and gently stretches the area rather than waiting for the backache to become incapacitating before acting

It is eaier to prevent a backache from becoming disabling

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Learning and practicing a relaxation technique

Relaxation technique counter the stress response by reducing sympathetic arousal

The immediate physiological effects of relaxation are decreases in heart rate, blood pressure, respiratory rate and muscle tension

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The long term physiological effect is a decrease in central nervous system arousal with a concomitant decrease in MSS, ANS and PNE arousal

Psychological changes such as improved mood and behavioral changes including reduced health-risking behavior can occur

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Learning and practicing a relaxation technique

This relaxed state of mind can also help individuals develop a spititual perspective that can engender a shift in value and beliefs that are important to personal growth and development

The relaxation technique ca have components such as:

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The repetition of a word, sound, phrase, prayer, image or physical activity

The passive dusregard of every day thoughts when they occur

Audiotapes are recommended to help guide his process of focusing, especially in the intial learning phase

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The repetition of a word, sound, phrase, prayer, image or physical activity

The passive disregard of every day thoughts when they occur

Audiotapes are recommended to help guide his process of focusing, especially in the intial learning phase

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Learning and practicing a relaxation technique

One effective way is to have the person make a fist and notice what happens to the breathing pattern

Most people have a tendency to hold their breath while tensing a body pat

Now ask the person to take a few deep diaphragmatic breaths while making a fist

Most people will notice that the tension is much harder to maintain while taking a deep breath

This awareness helps to recognize the relationship between breath and tension

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Using mini-Relaxation

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