Stress Management
Allan Sanders, MN, ARNP
asanders@wsu.edu
Objectives
o Explore the biological, psychological, and
social aspects of the human stress
response.
o Describe the difference between adaptive
and maladaptive coping strategies.
o Understand coping strategies that
increase resilience to promote productive
living and healthy aging.
Common Stress Associated Diseases
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Diminished Immunity
Headache
Fatigue
Weight gain
Dyslipidemia
Hypertension
Heart Disease
Psoriasis/Eczema
Digestive problems
Anxiety
Depression
Alcoholism
Substance abuse
Insomnia
Irritable bowel
syndrome
o Fibromyalgia
o Decreased sex drive
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Overview of Terminology
o Stress: A state of disharmony or a threat to
homeostasis
– Physiological changes increase alertness, focus, and
energy
– Perceived demands may exceed the perceived
resources
o Coping: The ability to maintain control, think
rationally, and problem solve
o Resilience: Resistant quality that permits a
person to recovery quickly and thrive in spite of
adversity
Stress
o Eustress
– Manageable Stress can lead to growth and enhanced
competence
o Distress
– Uncontrollable, prolonged, or overwhelming stress is
destructive.
o Acute Stress
– Immediate response to a threat or challenge
o Chronic Stress
– Ongoing exposure to stress, may seem unrelenting
Causes of Stress
o External causes
– Family, work, economics, work, school,
major life changes, unforeseen events, etc.
o Internal causes
– Worry, uncertainty, fear, attitudes,
unrealistic expectations, etc.
Sources of Clinical Stress
For patients
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Uncertainty
Fear
Pain
Cost
Lack of knowledge
Risk for harm
Unknown resources
For nurses
o Poor patient
outcomes
o Risk of making an
error
o Unfamiliar situations
o Excessive workload
o Inadequate
resources
Stages of the Stress Response
General Adaptation Syndrome of Hans Selye (1907-1982)
o Alarm—when one feels threatened
– Activation of the fight or flight reaction
o Resistance—mobilization of resources to solve
the problem
– Continued stress causes adaptation
o Exhaustion
– Adaptation fails and level of function
decreases
ALARM: Activation of Hypothalamic
Pituitary Adrenal Axis
Catecholamines
Cortical Steroids
Increases cardiac output
Dilates airways
Dilates pupils
Mobilizes glucose
Causes vasomotor
changes
o Decreases digestion
o Enhances coagulation
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Elevates glucose
Increases amino acids
Increases NA resorption
Increases extracellular
fluid volume
o Inhibits histamine and
bradykinin
o Suppresses the immune
response
Resistance
o Adaptation occurs
– Activation of the hypothalamic pituitary
adrenal axis continues
o The stressor may be resolved
– The body returns to homeostasis
o May progress to exhaustion
– Stress continues as resources are depleted
Exhaustion
o Occurs when the demands of the stress
exceeds the persons ability to adapt.
o Functioning declines
o May result in health problems
– Physical symptoms
– Mental symptoms
Signs & Symptoms of Stress
o Cognitive
– Decreased concentration, comprehension, & memory
o Behavioral
– Irritability, withdrawal, violence
o Emotional
– Fear, anxiety, depression, fatigue
o Physiological
– Increased BP, HR, Respirations, etc
– Somatic symptoms
– Decreased immune response
Genetics & Development
Genetics
o Genes control the stress
response
– Individuals have different
responses to stress
o There is a genetic
component to:
– fearful behavior
– anxiety disorders
– Neurobiological response
Development
o Life experiences can
affect a person's stress
response
o Social support
– Strong support is protective
o Early life stress
– Increases stress reactivity
as an adult
Coping & Resilience
Coping
o Ability to control
emotions
o Ability to perceive
reality
o Ability to think rationally
o Ability to problem solve
o Culturally defined
Resilience
o The ability to bounce
back
o The positive capacity to
cope with stress
o Provides resistance to
negative events
– Hardiness,
– Resourcefulness
Coping
Adaptive Coping
– Contribute to resolution of the stress response
Maladaptive Coping
– Strategies that cause further problems
Active Coping
– Actively seeking resolution to the stress
Promote Adaptive Coping
o Realistic expectations
– Set realistic goals
o Planning
– Anticipate problems, have a backup plan
o Reframing
– Change the way you look at things
o Relaxation
– Learn relaxation techniques, take time-out for
leisure
o Discuss the problem
– Utilize existing social supports to problem solve
Promote Adaptive Coping
o Training
– Prepares for stressful events
o Nutrition
– Eat healthy, avoid skipping meals
o Exercise
– Include regular exercise
o Sleep
– Get adequate sleep—avoid fatigue
Avoid Maladaptive Coping
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Blurring of boundaries
Avoidance/withdrawal
Negative attitude
Anger outbursts
Alcohol/Drugs
Hopelessness
Negative self-talk
Resentment
Violence
Promote Resilience Factors
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Positive Role Models
Optimism
Humor
Moral Compass
Altruism
Religion & Spirituality
Social Support
Positive Role Models
Transmit:
o Attitudes
o Values
o Skills
o Patterns of thoughts and behaviors
Optimism
o Positive Beliefs
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Associated with well being
Cognitive reframing
Positive thinking
Refute the negative thinking
Believe in a meaningful cause
o It is important to acknowledge relevant
negative factors
Humor
o Highly effective
o Mature coping mechanism
“Another of the souls’ weapons for the fight
for self-preservation, it is well known that
humor, more then anything else in the human
makeup, can provide an aloofness and the
ability to rise above any situation, even for a
few seconds.”
Viktor Frankl
Moral Compass
o Conduct a moral inventory
– “Look not for any greater harm then this, destroying
the trustworthy, self-respecting, well-behaved man
within you.”
Epicetus
o Maintain your integrity
– “Between stimulus and response there is a space. In
that space is our power to choose our response. In
our response lies our growth and our freedom.”
Viktor Frankl
Altruism
o Unselfish regarding the welfare of others
o Believe in a meaningful cause
o Mutual cooperation
– Activates of the brain’s reward center
Religion & Spirituality
o Associated with psychological and
physical well being
o Guards against despair
o Provides social support
o Provides positive role models
o Provides a positive mission
Social Support
o Social support has a profound effect on
life expectancy
o Patients have better outcomes with
strong social support
o Isolation and poor social support are
associated with a poor stress response
o Few hardy individuals “go it alone”
Signature Strengths
o Recognize skills and talents
– Inventory strengths
o Use your strengths and talents
– Decide what works
o Actively cope
– Apply concepts to enable active coping.
Review
o Stress is part of everyday life
– It can promote growth and competency
– If unrelenting or overwhelming it can cause
adverse effects
o Adaptive coping enhances resilience
o Maladaptive coping causes additional problems
o Enhanced coping increases resilience while
diminishing the adverse affects of stress, thus
promoting health
Review: Practical Tips
o Set realistic expectations
o Exercise regularly
o Eat healthy
o Get adequate sleep
o Maintain a work-leisure balance
o Positive Reframing & optimism
o Enhance social support
Internet Resources
o Building resilience:
http://www.slideshare.net/3dogMcNeill/building-resilience
o Diet, exercise, stress and the immune system:
http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome
/hic_diet_exercise_stress_and_the_immune_system.aspx
o Exercise: Rev up your routine to reduce stress:
http://www.mayoclinic.com/health/exercise-and-stress/SR00036
o Positive thinking: Reduce stress, enjoy life more:
http://www.mayoclinic.com/health/positive-thinking/SR00009
o Stress management for patient and physician:
http://www.mentalhealth.com/mag1/p51-str.html
o Stress management: Understand your sources of stress:
http://www.mayoclinic.com/health/stress-management/SR00031
o Stress reduction techniques: A must for a healthy lifestyle:
http://www.managestresstips.com/category/stress-reduction/
Learning Exercise
1. List your current sources of stress.
2. Conduct an inventory of coping strategies that
you use or have used in the past.
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Include maladaptive strategies
3. List your signature strengths and factors that
may enhance your resilience.
4. While considering the above, develop a
personalized stress management plan to
enhance your coping and resilience.
References
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Beckmann-Murray, R., Proctor-Zentner, J., & Yakimo, R. (2009). Health promotion strategies
through the life span. New Jersey: Prentice Hall
Bhui, K., King, M., Dein, S., & O’Conor, (2008). Ethnicity and religious coping with mental
distress. Journal of Mental Health. 12(2).
Copstead, L. C. & Banasik, J. L. (2010). Pathophysiology: Biological and behavioral
perspectives (2nd ED.) USA: W. B. Saunders Company
Fielding, R (Undated) Retrieved September 25, 2007
from:http://www.pitt.edu/~super1/lecture/beh0091/img007.GIF&imgrefurl
Hildon, Z., Smith, F., Netuveli, G. & Blane, D. (2008). Understanding adversity and resilience
at older ages. Sociology of Health & Illness. 30(5).
Posen, D. B. (1995). Stress management for patient and physician. Retrieved September 21,
2007 from: Http://Serendip.brynmawr.edu/bb/neuro/neuro00/web3/edmundson.html
Pranulis, M. S. (1975). Coping with acute myocardial infarction. Psychological Aspects of
Myocardial infraction. Mosby: St. Louis
Southwick, S. M. (2007). Cleveland Clinic’s posttraumatic stress disorder symposium.
California: Audio-digest
Steinhardt, M. & Dolbier, C. (2008). Evaluation of a resilience intervention to enhance coping
strategies and proctitive factors and decrease symptomatology. Journal of American
College Health. 56(4).
Images retrieved from Microsoft: http://office.microsoft.com/en-us/images/?CTT=97
Contact Information
Allan Sanders, MN, ARNP
asanders@wsu.edu