limiting the amount of salt and water the kidney is
allowed to excrete. Cortisol increases the production
of glucose and assists in the breakdown of fat and
proteins to provide the additional energy needed to
protect the body from the perceived threat. When
cortisol levels are increased, DHEA
(dehydroepiandrosterone) levels are reduced. The
hormones released during the stress response have
many effects on the body (
Exhibit 6-1
).
EXHIBIT
61
EFFECTS OF STRESS
P
HYSIOLOGIC
Increased heart rate, grinding of teeth, rise in blood pressure,
insomnia, dryness of mouth and throat, anorexia, sweating, fatigue,
tightness of chest, slumped posture, headache, pain, tightness in
neck and back, nausea, vomiting, urinary frequency, indigestion,
missed menstrual cycle, diarrhea, trembling, twitching, and
accident proneness
E
MOTIONAL
Irritability, tendency to cry easily, depression, nightmares, angry
outbursts, suspiciousness, emotional instability, jealousy, poor
concentration, decreased social involvement, disinterest in
activities, bickering, withdrawal, complaining, criticizing,
restlessness, tendency to be easily startled, anxiety, increased
smoking, increased use of sarcasm, reduced interest in sex, and
use of drugs or alcohol
I
NTELLECTUAL
Forgetfulness, errors in arithmetic and grammar, poor judgment,
preoccupation, poor concentration, inattention to detail, reduced
creativity, blocking, less fantasizing, reduced productivity
W
ORK
H
ABITS
Increased lateness, absenteeism, low morale, depersonalization,
209
avoidance of contact with coworkers, excess breaks, resistance to
change, impatience, negative attitude, reluctance to assist others,
carelessness, verbal or physical abuse, poor quality and quantity of
work, threats to resign, resignation
Sources of Stress
The sources of stress in daily life are different for
each individual. One person may find a 20-mile
drive home through a mountain pass after work
tedious and frustrating, whereas another may view it
as a source of pleasure and relaxation. Sources of
stress can be associated with the physical
environment, job, interpersonal relationships, past
experiences, work, finances, and psychological
makeup. Identifying what stresses them and how
they react to that stress is the first step for people to
take in developing effective personal stressmanagement strategies. A variety of tools can help
people to identify the stresses in their lives, one of
which is offered in
Exhibit 6-2
.
EXHIBIT
62
HOLISTIC SELF-ASSESSMENT OF STRESS
L
IST
MAJOR
FORMS
OF
STRESSES
IN
YOUR
LIFE
I
DENTIFY
THE
SOURCE
OF
EACH
FORM
OF
STRESS
L
IST
ACTIONS
THAT
CAN
BE
TAKEN
TO
ADDRESS
EACH
SOURCE
OF
STRESS
Sources of stress can be:
Mental (e.g., feeling bored, overloaded)
a
b
a
210
Physical (e.g., disease, injury)
Emotional (e.g., anger, grief, fear)
Relational (e.g., altered feelings between self and significant
others, violation of trust)
Spiritual (e.g., values conflict, feeling God is not listening)
Vocational (e.g., job dissatisfaction, undesirable schedule,
insecurity, poor work conditions)
Examples of actions that can be taken to reduce stress
Obtaining medical attention
Asking for help with a project
Being realistic in what can be achieved
Following a reasonable schedule
Seeking counseling
Developing a hobby
Exercising
Meditating
Praying
Overscheduling has been shown to be a source of
considerable stress for a growing number of people.
More than one-third of Americans claim they have
hectic schedules and don’t have sufficient time in
the day to fulfill all their demands (
Dickinson,
2016
). Busyness and the “time poverty” that results
can lead to irritability, trouble focusing, sleep
problems, and mental and physical fatigue. To
combat this problem it is recommended that people
should reduce their commitments, structure their
lives around what matters (which may mean
b
211
sacrificing some income to have time to do what is
viewed as important), and be intentional about
carving out time to do what they desire.
REFLECTION
Take a few minutes to complete the self-assessment in
Exhibit
6-2
.
What are the three major stresses in your life that you
have identified?
Stress and Disease
As mentioned, the recognition of the link between
the mind and the body is not new; however, the
specific mechanism to explain the link between
stress and disease is still unclear despite years of
scientific research. It is widely believed that the
impact of stress—especially chronic stress—on the
human body greatly increases the risk of developing
a variety of diseases such as asthma, arthritis,
cancer, hypertension, heart disease, migraine
headaches, strokes, and ulcers. Statistics from a
variety of sources state that 50% to 90% of healthrelated problems are linked to or aggravated by
stress (
Seward, 2013
). Nearly every consumeroriented publication from hospitals, public health
departments, health maintenance organizations,
and physicians’ offices recommends or offers some
type of stress-management program.
212
Most people probably are able to recognize the
major physical symptoms of stress in their lives.
They also need to be aware of other important
behavioral, emotional, or mental symptoms that may
be stress related, such as compulsive eating,
drinking or smoking, restlessness, irritability or
aggressiveness, boredom, inability to focus on the
task at hand, trouble thinking clearly, memory loss,
or inability to make decisions.
Exhibit 6-3
lists
common physical symptoms often related to stress.
It is helpful for people to engage in a selfassessment as a means to gain insight into the
impact of stress in their lives. This is not only
important to maintaining a state of wellness, but
also as part of living with chronic conditions.
EXHIBIT
63
PHYSICAL SIGNS OF STRESS
This list can be used for a self-assessment for the impact of stress
on one’s life. Consider how frequently a sign/symptom occurred
and if it is related to any specific event.
•
Tense muscles
•
Upset stomach
•
Headache
•
Change in bowel habits
•
Dizziness
•
Palpitations
•
Chest pain
•
Fatigue
213
•
Insomnia
•
Frequent colds, infections
Stress-Reduction Measures
After people recognize the symptoms of stress in
their lives, they can minimize the impact of stress on
their physical, mental, emotional, and spiritual wellbeing by using one or a combination of measures
designed for stress reduction. The ultimate goal of
stress reduction or stress management is the
relaxation response, or a state of profound rest and
peace. The term
relaxation response
was first used
by Dr. Herbert Benson in his book of the same
name. He and others have described elements
common in most stress-reduction measures
(
Benson, 2000
, pp. 110–111;
Benson & Proctor,
2011
, pp. 111–112):
•
A quiet environment
•
Focus on a word, short prayer, or a phrase that is repeated over
and over again
•
The adoption of a passive attitude (which is perhaps the most
important of the elements). A
passive attitude
is one in which a
person is open to a free flow of thoughts without analysis or
judgment
•
A comfortable position, sitting calmly with eyes closed
•
Slow, deep breathing
•
Progressive relaxation of all muscles.
214
K
EY
P
OINT
Numerous studies of the results of stress reduction have
demonstrated positive findings to include the reduction of blood
pressure in individuals with hypertension, improved sleeping
patterns in individuals suffering from insomnia, decreased nausea
and vomiting in chemotherapy patients, and reduction in the
multiple symptoms of women diagnosed with premenstrual
syndrome or who are experiencing menopausal symptoms (
Cash
et al., 2015
;
Kwekkeboom & Gretarsdottir, 2006
;
la Cour &
Petersen, 2015
).
T
IP FOR
P
RACTICTIONERS
Individual preferences and circumstances influence the selection of
stress-reduction measures. Some stress-management techniques
are simple, whereas others require some initial instruction.
Regardless of the choice of method or combination of methods, all
require practice and need to be used on a regular basis to be
effective. Instructing, assisting, and coaching people in the use of
stress-reduction techniques can increase their success in
addressing this problem.
Exercise
In the early days of human existence, most threats
were physical and demanded an immediate, intense
physical response to ensure survival. The response
was literally fight or flight. All of the stress hormones
215
released were quickly consumed, and their physical
effects were diminished in that burst of activity. In
today’s environment, the majority of the sources of
stress are much less physical and more complex.
They usually result from cumulative factors, such as
multiple, often simultaneous demands at home and
at work.
Physical, emotional, and mental well-being depends
on finding a way to dissipate the negative effects of
those stressors. Aerobic exercise burns off existing
catecholamines and stress hormones by directing
them toward their
intended metabolic functions,
rather than allowing them to linger in the body to
undermine the integrity of vital organs. A consistent
exercise program has also been demonstrated to
help decrease the level of reaction to future
stressors. The key to using exercise for stress
reduction is to develop an individualized program
that is tailored to one’s physical abilities, time
constraints, and finances. Additionally, to reduce
stress, it is beneficial to select an activity that is
relaxing and enjoyable rather than competitive.
Progressive Muscular Relaxation
When you are stressed, anxious, angry, or
frightened, your body automatically responds by
increasing muscle tension. You may have
experienced the effects of that response resulting in
216
muscular aches and pains in various parts of your
body after an unpleasant encounter or a hectic day.
Progressive muscular relaxation (PMR) was
developed in the 1930s by Dr. Edmund Jacobson, a
physician–researcher at the University of Chicago,
as a method to reverse this tension and elicit the
relaxation response. Moving sequentially from one
major muscle group or area of the body to another,
for example, from head to toes or vice versa,
muscles will be consciously tensed and then
relaxed. This conscious muscular activity interrupts
the stress response by interfering with the
transmission of stress-related tension via the
sympathetic nervous system to the muscle fibers.
Among the benefits of PMR are decreases in the
body’s oxygen use, metabolic rate, respiratory rate,
and blood pressure. These effects can have
benefits for people diagnosed with hypertension and
chronic obstructive lung disease. Additionally, PMR
has been shown to be a useful pain management
tool in some patients with cancer and chronic pain
(
Chang, Fillingim, Hurley, & Schmidt, 2015
;
Kwekkeboom & Gretarsdottir, 2006
;
Zhou et al.,
2015
).
PMR is relatively easy to learn. The method cited
Exhibit 6-4
is only one of the variations on the
original technique designed by Dr. Jacobson.