STRESS: SHORT TERM
SHORT TERM "ACUTE STRESS"
 Uneasiness and concern
 Sadness
 Loss of Appetite
 Suppression of the immune system
 Increased metabolism and use of body fats
 Hypertension
 Infertility
 Impotence, anovulation
 Increased energy and learning
 Increased cardiovascular tone
 Increased risk of blood clots and stroke
 Increased cardiopulmonary tone
STRESS: LONG TERM
LONG TERM/PROLONGED "CHRONIC STRESS"
 Anxiety and panic attacks
 Depression
 Anorexia or overeating
 Lowered resistance to infections, leading to increase in opportunistic viral and bacterial
infections
 Insulin-resistant diabetes
 Amenorrhea or loss of sex drive
 Increased fatigue and irritability
 Increased risk for cardiac events (e.g., heart attack, angina, and sudden heart related
death)
 Increased respiratory problems
STRESS: THEORISTS
Walter Cannon's "Fight or Flight" stress model
 Fight or Flight (aka) Acute Stress Response
 The Body's way of preparing for a situation an individual perceives as a threat to
survival.
Hans Selye's "General Adaptation Syndrome" (GAS)
 Expanded upon Cannon's Fight or Flight into GAS Stages.
1. ALARM STAGE
 The initial, brief, and adaptive response (fight or flight) to the stressor.
2. SYMPATHETIC STAGE
 Hypothalamus signals the autonomic nerves to the adrenal glands. The adrenals pump
catecholamine
epinephrine (aka adrenaline) into the blood stream, thereby activating the sympathetic
nervous system.
 3. HYPOTHALAMIC-PITUITARY-ADRENAL (HPA) AXIS
The "gas pedal' of the system that keeps the sympathetic nervous system on high alert.
STRESS: STRESS RELIEF
EFFECTIVE STRESS BUSTERS
 SLEEP- 7-9 hours is recommended.
 EXERCISE- 20 minutes a day or 150 minutes a week of moderate intensity aerobic
activity, such as walking.
 REDUCTION OR CESSATION OF CAFFIENE INTAKE- No more than 4 cups of coffee or
colas. Slowly wean off.
 MUSIC- Promotes relaxation and quality of life.
 PETS- Can bring joy, reduce stress, and provide social support.
 MASSAGE- slows heart rate, relaxes the body and improves alertness
 BIOFEEDBACK, DEEP BREATHING, GUIDED IMAGERY, PROGRESSIVE RELAXATION,
MEDITATION, COGNITIVE REFRAMING, JOURNALING, HUMOR.
ANXIETY
 Anxiety is a universal human experience and is among the most basic
of emotions,

Anxiety is the feeling of apprehension, uneasiness, uncertainty, or
dread resulting from a real or perceived threat.

Normal Anxiety is a healthy reaction necessary for survival. It
provides the energy needed to carry out the tasks involved in living
and striving toward goals. It motivates people to make and survive
change.
ANXIETY: MILD ANXIETY
 MILD- occurs in the normal experience of everyday living and allows an individual to
perceive reality in sharp focus.

PERCEPTUAL FIELD- Heightened perceptual field; Focus is flexible and is aware of the
anxiety.

ABILITY TO PROBLEM SOLVE- Able to work effectively toward a goal and examine
alternatives.
-
Mild and moderate levels of anxiety can alert the person that something is wrong
and can stimulate appropriate action.
PHYSICAL OR OTHER CHARACTERISTICS
 Slight discomfort
 Attention-seeking behavior
 Restlessness
 Easily startled
 Irritability or impatience
 Mild tension-relieving behavior (foot or finger tapping, lip chewing, fidgeting
ANXIETY: MODERATE ANXIETY
 MODERATE- as the anxiety increases, the perceptual field narrows, and some details are
excluded from observation.

PERCEPTUAL FIELD- Narrowed perceptual field
- Grasps less of what is going on
- Focuses on the source of the anxiety
- Less able to pay attention

ABILITY TO PROBLEM SOLVE- Able to solve problems but not at optimal ability.
PHYSICAL OR OTHER CHARACTERISTICS
 Voice tremors
 Change in voice pitch
 Poor concentration
 Shakiness
 Somatic complaints (urinary frequency, headache, backache, insomnia)
 Increased respiration, pulse, and muscle tension
 More tension-relieving behavior (pacing, banging of hands on table)
ANXIETY: SEVERE ANXIETY
 SEVERE- the perceptual field of a person experiencing severe anxiety is greatly reduced.

PERCEPTUALFIELD- Greatly reduced and distorted perceptual field/ Focuses on details or
one specific detail. Attention is scattered

ABILITY TO PROBLEM SOLVE- Problem solving feels impossible
- Unable to see connections between events or details
- Severe and panic levels of anxiety prevent problem solving
- Unproductive relief behaviors
PHYSICAL OR OTHER CHARACTERISTICS
 Feelings of dread
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Confusion
Purposeless activity
Sense of impending doom
More intense somatic complaints (chest discomfort, dizziness, nausea, sleeplessness)
Diaphoresis (sweating)
Withdrawal
Loud and rapid speech
Threats and demands
ANXIETY: PANIC
 PANIC- is the most extreme level of anxiety and results in markedly dysregulated
behavior.
 PERCEPTUÁL FIELD- Unable to attend to the environment. Focus is lost, may feel unreal
(depersonalization) or that the world is unreal (derealization).
 ABILITY TO PROBLEM SOLVE
- Completely unable to process what is happening
- Disorganized or irrational reasoning
- Severe and panic levels of anxiety prevent problem solving
- Unproductive relief behaviors perpetuate a vicious cycle
PHYSICAL OR OTHER CHARACTERISTICS
 Experience of terror
 Immobility or severe hyperactivity or flight
 Unintelligible communication or inability to speak
 Somatic complaints increase (numbness or tingling, shortness of breath, dizziness, chest
pain, nausea, trembling, chills, overheating, palpitations)
 Severe withdrawal
 Hallucinations or delusions
 Likely out of touch with reality
ANXIETY: DEFENSE MECHANISMS
 Defense Mechanisms- automatic coping styles that protect people from anxiety and
maintain self-image by blocking feelings, conflicts, and memories.
 Adaptive Defense Mechanisms help people lower anxiety to achieve goals in acceptable
ways.
 Maladaptive Defense Mechanisms occur when one or several are used in excess,
particularly in the overuse of immature defenses.
BENZO'S
 Drugs: Alprazolam (Xanax), Chlordiazepoxide, Clorazepate, Diazepam (Valium),
Lorazepam (Ativan), Oxazepam, Clonazepam (Klonopin).
 Most commonly used because of the quick onset of action.
 Should be used for short periods due to risk for dependance.
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Side effects: *potential risk for dependance, sedation, ataxia, decreased cognitive
function, anxiety, agitation, talkativeness, loss of impulse control
Not recommended: patients with substance use disorder. Elderlv patients due to risk for
delirium, falls, fractures.
NON-BENZO'S
 SSRl's
 SNRIS
 Beta-Blockers
 Antihistamines
 Anticonvulsants
 Antipsychotics
 Buspirone (Buspar)