Chapter Objectives

• Describe the difference between a stressor and a stress response
• Describe the fight or flight reaction and the function of this in stress management
• Discuss the long and short term health impacts associated with a stress response
• Describe and/or demonstrate stress management techniques

Stress

These symptoms may also be signs of depression or anxiety, which can be caused by long-term stress.

Women React to Stress Differently Than Men?

One recent survey found that women were more likely to experience physical symptoms of stress than men. However, it cannot be said that this applies to all women. We do know that women often cope with stress in different ways than men. Women “tend and befriend,” taking care of those closest to them, but also drawing support from friends and family. Men are more likely to have the “fight or flight” response. They cope by “escaping” into a relaxing activity or other distraction.

Stress is in the Eye of the Beholder

How to Make Stress Your Friend

The process by which we experience a situation is described by Lazarus’s Theory of Cognitive Appraisal. This theory may be beneficial to our understanding of the differences between individual’s stress levels. The theory’s main points are:

1. When we experience a situation or event we first determine if it is a threat, a challenge, or is neutral.
2. We then assess our inventory of resources to cope with the event. If we do not perceive we are adequate to the task, we must be able to withdraw or we will feel trapped in a situation with aversive consequences coming. That induces distress and all the physiological processes that harm our health. If we perceive that we have the resources to successfully cope with the situation, we feel challenged and optimistic. Note that challenge and optimism are related to enhanced health and sense of well-being.

This second stage of appraisal impacts the first stage in a loop process. If we at first perceive a threat but then realize we can handle it, it reduces the distress and may even create a perception of challenge. If at first we perceive a challenge but then realize that we don’t have what it takes to be successful, we may begin to experience distress as we see the aversive outcome of failure looming ahead. Depending on the meaning of the outcome to us, the distress may be mild or severe. If the situation is always hanging over us and we always feeling inadequate to it and anxious about negative outcomes, we are always under distress. Our health and well-being take a beating in that scenario.

Next, we must select from our repertoire of coping resources. There are two types of coping resources:

• Instrumental
• Palliative (emotion-focused)

Instrumental coping solves the problem and removes the stressor from our experience as in working out a conflict with someone to reduce the distress or by getting a better job to reduce financial pressures.

Palliative coping alters our physiological reactions to stress that will not go away and cannot be escaped. These include relaxation skills, reinterpretation of the meaning or effects of the stressor, acceptance of the situation, or optimism about future improvements in the situation. Palliative skills would include relaxing in the traffic jam even though you have an important appointment that is being missed. You realize you cannot do anything about it, so you may as well relax because anger and tension will not make the cars move any faster, but it will hurt you, so you choose to relax instead.

As we go to our repertoire of coping skills to select one or more, we may become more optimistic of success and reappraise the situation in the first step. It may become less threatening and hence less distressful. We could find that our coping resources will be less adequate than we initially thought and we would become more threatened now. Even a challenge might be converted into a threat as in traveling to a another country for the first time and finding your credit cards are missing and you have no money for anything and no way to get any.

This interactive appraisal and coping process is at the heart of the impact of stress on us. If we interpret a situation as stressful, it has the stress-related effects on us. If we have few coping sources, more situations will be perceived as distressing. If we have many coping resources, more situations will be perceived as challenging or at least neutral.

As I am driving down the road and have a flat tire, I could be annoyed at the trouble it causes or feel threatened by past negative experience associated with changing a tire. If I don’t know how to change a tire and it is dark out, I may feel very threatened as I perceive helplessness and vulnerability to someone’s attacking me. If I assure myself that this is unlikely, and I do know how to change a tire, I may decide that I will get this done in ten minutes and be on the road safely. Or may not have the skills to change a tire  but have a cell phone and a close friend who will quickly lend a hand (social support) which decreases distress.

These factual situations are part of the appraisal and coping process. Perception is also critically important. If I have little confidence in myself to handle a flat tire even though I have been taught how to do it and have the tire, I may feel more threatened. If I have the cell phone but don’t believe I should bother anybody to come here, or don’t believe they would want to help me, the facts do not determine my reaction as much as my perception of the facts determines it.

A second example of the role of coping skills and perception could involve getting started in an online course. If you are a computer whiz and have taken several college courses including online courses before, you were able to start with little problem. Learning to use online resources did not cause much distress. But if you were new to using the Internet, had never taken an online course, and had low self-confidence, you may have been quite distressed. Same situation, different coping resources.

Now add perception. If you perceive college as a supportive environment, and instructors as willing to be flexible when circumstances are beyond all of our control, you may be hassled but not threatened about failing the course because of these factors. But if you see colleges and instructors as money-hungry and deliberately placing obstacles in your path to cause you to fail and drop out, you have may been very distressed when you had difficulties as you would see no support or flexibility to allow you to adapt to the new situation. The reality of the college and instructor’s intent make no difference in your initial perception and resultant choices. It is your perception of reality that determines what you will do.

The appraisal and coping process underlies the statement that “stress is in the eye of the beholder.” Any event or situation may be perceived differently by different individuals due to past experience with it, learned skills, personality traits like Type A and optimism, and the amount of distress being experienced already. Social support may be instrumental in helping cope with problem as in coming to help with the flat tire, or being eager to listen and be supportive with your sharing your experiences. Both reduce the distress levels.

Managing Stress

Everyone must deal with stress. There are steps that can be taken help manage stress in a positive way and keep it from increasing risk of illness. Try these tips to keep stress in check:

Develop a new attitude

• Become a problem solver. Make a list of the things that cause stress. From your list, figure out which problems you can solve now and which are beyond your control for the moment. From your list of problems that you can solve now, start with the little ones. Learn how to calmly look at a problem, think of possible solutions, and take action to solve the problem. Being able to solve small problems will give you confidence to tackle the big ones. And feeling confident that you can solve problems will go a long way to helping you feel less stressed.
• Be flexible. Sometimes, it’s not worth the stress to argue. Give in once in a while or meet people halfway.
• Get organized. Think ahead about how you’re going to spend your time. Write a to-do list. Figure out what’s most important to do and do those things first.
• Set limits. When it comes to things like work and family, figure out what you can really do. There are only so many hours in the day. Set limits for yourself and others. Don’t be afraid to say NO to requests for your time and energy.

Relax

• Take deep breaths. If you’re feeling stressed, taking a few deep breaths makes you breathe slower and helps your muscles relax.
• Stretch. Stretching can also help relax your muscles and make you feel less tense.
  Massage tense muscles. Having someone massage the muscles in the back of your neck and upper back can help you feel less tense.
• Take time for yourself. We all have lots of things that we have to do. But often we don’t take the time to do the things that we really want to do. It could be listening to music, reading a good book, or going to a movie. Think of this as an order from your doctor, so you won’t feel guilty!

Take care of your body

• Get enough sleep. Getting enough sleep helps you recover from the stresses of the day. Also, being well-rested helps you think better so that you are prepared to handle problems as they come up. Most adults need 7 to 9 hours of sleep a night to feel rested.
• Eat right. Try to fuel up with fruits, vegetables, beans, and whole grains. Don’t be fooled by the jolt you get from caffeine or high-sugar snack foods. Your energy will wear off, and you could wind up feeling more tired than you did before.
• Get moving. Getting physical activity can not only help relax your tense muscles but improve your mood. Research shows that physical activity can help relieve symptoms of depression and anxiety.
• Don’t deal with stress in unhealthy ways. This includes drinking too much alcohol, using drugs, smoking, or overeating.

Connect with others

• Share your stress. Talking about your problems with friends or family members can sometimes help you feel better. They might also help you see your problems in a new way and suggest solutions that you hadn’t thought of.
• Get help from a professional if you need it. If you feel that you can no longer cope, talk to your doctor. She or he may suggest counseling to help you learn better ways to deal with stress. Your doctor may also prescribe medicines, such as antidepressants or sleep aids.
• Help others. Volunteering in your community can help you make new friends and feel better about yourself.

Coping with Stress

The effects of stress tend to build up over time. Taking practical steps to maintain your health and outlook can reduce or prevent these effects. The following are some tips that may help you to cope with stress:

• Seek help from a qualified mental health care provider if you are overwhelmed, feel you cannot cope, have suicidal thoughts, or are using drugs or alcohol to cope.
• Get proper health care for existing or new health problems.
• Stay in touch with people who can provide emotional and other support. Ask for help from friends, family, and community or religious organizations to reduce stress due to work burdens or family issues, such as caring for a loved one.
• Recognize signs of your body’s response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Set priorities-decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload.
• Note what you have accomplished at the end of the day, not what you have been unable to do.
• Avoid dwelling on problems. If you can’t do this on your own, seek help from a qualified mental health professional who can guide you.
• Schedule regular times for healthy and relaxing activities.
• Explore stress coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.
• Exercise regularly – just 30 minutes per day of gentle walking can help boost mood and reduce stress.

Exercise and Stress

Exercise builds stronger bodies only if we push ourselves beyond our regular level of strength and endurance. Progressing in your intellectual skills occurs only by going beyond your adaptation level for the complexity and amount of knowledge you must acquire. Stress as “challenge” enhances physical and emotional well-being. Mountain climbers want risk and challenge, but they want the type that they feel they can master and mostly control. They don’t want to be perfectly in control because then the challenge would not be so great. They want to be on the edge between in-control and having to use every degree of skill, concentration, and problem solving to succeed. The same is true of race car drivers, downhill skiers, chess players, musicians, and artists.

These activities have been described by Csikszentmihalyi as inducing the experience of “flow” that totally captures the attention, makes it very easy to continue, and very hard to stop. There are many other activities and professions that produce “flow”, but the essence of the experience is to be on the edge of challenge and failure with the perception that your own efforts will make the difference between good and bad outcomes. In these conditions stress builds healthier bodies and higher well-being. People who experience “flow” frequently report high degrees of satisfaction in life.

Physiological Toughness Model

There is also a psychophysiological framework for explaining how exercise cannot only reduce the immediate effects of stress but also can enhance the recovery from stressors. This framework is called the Physiological Toughness Model and it theorizes that intermittent but regular exposure to stressors, like exercise, can lead to psychological coping, emotional stability, and physiological changes. These physiological changes include increases in endorphins and reductions in stress hormones and lead to improvements in performance during challenging/threatening situations, strengthening of immune system functioning, and improvements in stress tolerance.

Meditation and Health

Many people practice meditation for a number of health-related purposes. A 2007 national government survey found that 9.4% of respondents had used meditation in the past 12 months.

What is meditation?

The term meditation refers to a group of techniques which may be practiced for many reasons, such as to increase calmness and physical relaxation, to improve psychological balance, to cope with illness, or to enhance overall wellness. Most types of meditation have four elements in common:

• A quiet location. Meditation is usually practiced in a quiet place with as few distractions as possible. This can be particularly helpful for beginners.
• A specific, comfortable posture. Depending on the type being practiced, meditation can be done while sitting, lying down, standing, walking, or in other positions.
• A focus of attention. Focusing one’s attention is usually a part of meditation. For example, the meditator may focus on a mantra (a specially chosen word or set of words), an object, or the sensations of the breath.
• Having an open attitude. During meditation this means letting distractions come and go naturally without judging them.

How can meditation affect my health?

It is not fully known what changes occur in the body during meditation; whether they influence health; and, if so, how. Research is under way to find out more about meditation’s effects, how it works, and diseases and conditions for which it may be most helpful.
The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government’s lead agency for scientific research on complementary and alternative medicine (CAM). Some recent NCCAM-supported studies have been investigating meditation for relieving stress in caregivers for elderly patients with dementia and for relieving asthma symptoms.

Is meditation right for me?

Meditation is considered to be safe for healthy people, but if you are thinking about using meditation practices to prevent asthma attacks, to control high blood pressure, to reduce arthritis pain, or for any other medical reason, be smart.

Relaxation Techniques

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being.
Relaxation techniques (also called relaxation response techniques) may be used by some to release tension and to counteract the ill effects of stress. Relaxation techniques are also used to induce sleep, reduce pain, and calm emotions. This fact sheet provides a general overview of relaxation techniques and suggests sources for additional information.

Key Points

• Relaxation techniques are used for a variety of health-related purposes, such as counteracting the effects of stress on the body.
• Most relaxation techniques can be self-taught and self-administered.
• Relaxation techniques are generally safe, but there is limited evidence of usefulness for specific health conditions. Research is under way to find out more about relaxation and health outcomes.
• Do not use relaxation techniques as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
• Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Relaxation Techniques

Relaxation is more than a state of mind; it physically changes the way your body functions. When your body is relaxed breathing slows, blood pressure and oxygen consumption decrease, and some people report an increased sense of well-being. This is called the “relaxation response.” Being able to produce the relaxation response using relaxation techniques may counteract the effects of long-term stress, which may contribute to or worsen a range of health problems including depression, digestive disorders, headaches, high blood pressure, and insomnia.

Relaxation techniques often combine breathing and focused attention on pleasing thoughts and images to calm the mind and the body. Most methods require only brief instruction from a book or experienced practitioner before they can be done without assistance. These techniques may be most effective when practiced regularly and combined with good nutrition, regular exercise, and a strong social support system.

Some relaxation response techniques include:

• Autogenic training: When using this method, you focus on the physical sensation of your own breathing or heartbeat and picture your body as warm, heavy, and/or relaxed.
• Biofeedback: Biofeedback-assisted relaxation uses electronic devices to teach you how to consciously produce the relaxation response. Biofeedback is sometimes used to relieve conditions that are caused or worsened by stress.
• Deep breathing or breathing exercises: To relax using this method, you consciously slow your breathing and focus on taking regular and deep breaths.
• Guided imagery: For this technique, you focus on pleasant images to replace negative or stressful feelings and relax. Guided imagery may be directed by you or a practitioner through storytelling or descriptions designed to suggest mental images (also called visualization).
• Progressive relaxation: (also called Jacobson’s progressive relaxation or progressive muscle relaxation). For this relaxation method, you focus on tightening and relaxing each muscle group. Progressive relaxation is often combined with guided imagery and breathing exercises.
• Self-Hypnosis: In self-hypnosis you produce the relaxation response with a phrase or nonverbal cue (called a “suggestion”). Self-hypnosis may be used to relieve pain (tension headaches, labor, or minor surgery) as well as to treat anxiety and irritable bowel syndrome.

If You Are Thinking About Using Relaxation Techniques for Health

• Do not use relaxation techniques as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
• Ask about the training and experience of the practitioner or instructor you are considering for any complementary alternative medicine practice.
• Look for published research studies on relaxation for the health condition in which you are interested. Remember that some claims for using relaxation therapies may exceed the available scientific evidence.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Resilience

Resilience is the ability to:

• Bounce back
• Take on difficult challenges and still find meaning in life
• Respond positively to difficult situations
• Rise above adversity
• Cope when things look bleak
• Tap into hope
• Transform unfavorable situations into wisdom, insight, and compassion
• Endure

Resilience refers to the ability of an individual, family, organization, or community to cope with adversity and adapt to challenges or change. It is an ongoing process that requires time and effort and engages people in taking a number of steps to enhance their response to adverse circumstances. Resilience implies that after an event, a person or community may not only be able to cope and recover, but also change to reflect different priorities arising from the experience and prepare for the next stressful situation.

Resilience is the most important defense people have against stress.
It is important to build and foster resilience to be ready for future challenges.
Resilience will enable the development of a reservoir of internal resources to draw upon during stressful situations.

Research (Aguirre, 2007; American Psychological Association, 2006; Bonanno, 2004) has shown that resilience is ordinary, not extraordinary, and that people regularly demonstrate being resilient.

Resilience is not a trait that people either have or do not have.
Resilience involves behaviors, thoughts, and actions that can be learned and developed in anyone. Resilience is tremendously influenced by a person’s environment.

Resilience changes over time. It fluctuates depending on how much a person nurtures internal resources or coping strategies. Some people are more resilient in work life, while others exhibit more resilience in their personal relationships. People can build resilience and promote the foundations of resilience in any aspect of life they choose.

Building Resilience

Developing resilience is a personal journey. People do not react the same way to traumatic events. Some ways to build resilience include the following actions:

• Making connections with others
• Looking for opportunities for self-discovery
• Nurturing a positive view of self
• Accepting that change is a part of living
• Taking decisive actions
• Learning from the past

The ability to be flexible is a great skill to obtain and facilitates resilience growth. Getting help when it is needed is crucial to building resilience. An approach to building resilience that works for one person might not work for another. People use varying strategies. Resilience involves maintaining flexibility and balance in life during stressful circumstances and traumatic events. Being resilient does not mean that a person does not experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Stress can be dealt with proactively by building resilience to prepare for stressful circumstances, while learning how to recognize symptoms of stress. Fostering resilience or the ability to bounce back from a stressful situation is a proactive mechanism to managing stress.

Check for Understanding

1. What is the difference between a stressor and a stress response?
2. What is the fight or flight reaction and how is it used by the body?
3. What is the GAS syndrome and what does this mean for long term stress?
4. How does long term and short term stress affect health or wellness?
5. How does perception impact the stress response?
6. What are some stress management techniques that you feel would be useful to you in managing short and long term stress?