STRESS & COPING

Introduction

Stress and coping are natural part of life. If children are protected from experiencing stress and developing coping skills, they are likely to be vulnerable to stress in later life and unable to effectively cope with life events (relocation, marriage, death, etc.)

STRESS
Definitions

Stress is the nonspecific response of the body to any demand made upon it. Stress is a general term that links environmental demands and the persons capacity to meet those demands.

Stress is also the appraisal or perception of a stressor.

Appraisal is how people interpret the impact of the stressor on themselves, of what is happening and what they can do about it.

Types of stress
According to Selye two types Distress or damaging stress. Eustress or stress that protects health.

Eustress is motivating energy, such as happiness, hopefulness and purposeful movement.

Cont..

According to Lazarus, several types of stress

Work stress, Family stress, Chronic stress, Acute stress, Daily hassles, Trauma, Crisis.

Work and family stress interact, family being the background for work stress, and work the background for family stress.

Patho-physiological Response

Stress Responses

Physiological Responses Sympathetic Responses Emotional Responses.

Physiological Responses

Changes are automatic & not under control. Intensity depends on the appraised risk of the situation.

The immune system & the sympathetic nervous system are implicated in the stress response.
The locus cells in the brain initiate the stress response by responding to the appraisal with the release of nor epinephrine.

It stimulates the sympathetic nervous system responds by discharging almost as a complete unit, causing excitatory effects in some organs and inhibitory effects in others. This mass discharge activates large portions of the system and is called a sympathetic alarm reaction or the fight or flight response.

Sympathetic Responses

Increased arterial pressure. Increased blood flow to active muscle concurrent with decreased blood flow to organs. Increased

rate of cellular metabolism through out the body. blood glucose concentration. glycolysis in the liver and in muscle. muscle strength. mental activity. rate of blood coagulation

Stimulate adrenal gland. Not all appraisals provoked a severe fight or flight response. Chronically unfavorable person-environment relationships also elicit both sympathetic and immune system responses. Examinations, job strain, marital conflict and daily hassles elevate white blood cell counts.

Negative moods also adversely affect the immune system.

Emotional Response

After cognitive appraisal a person experiences specific emotions, while physiologic changes are occurring. Emotions are organized psychological reactions. Person experiences of emotion depends on the significance of person environment event to his or her personal well being. Intense emotion disturb intellectual functions.

Emotions are developed through a process: Anticipation (hope), Provocation (frustration), Unfolding, and Outcome

Theories of Stress

Hans Selyes theory.

Aldwins immunological responses.

Neuro pharmacologic Theories. Walter Canon s homeostasis mechanism. Harold Wolf and Stewart Wolf theory.

Hans Selyes theory

In the 1930s, 1940s,and 1950s Hans Selye enlarged on cannons fight-or-flight hypothesis to describe the general adaptation syndrome (GAS), a three stage reaction to stress. The GAS describes how the body responds to stressors through the

Alarm reaction, Resistance stage and Exhaustion stage.

The GAS is an immediate physiological response of the body to stress and involves several body systems, especially the autonomic nervous system and the endocrine system. When a physical demand is made on the body, such as an injury, the GAS is initiated by the pituitary gland. The pituitary gland is closely linked to the hypothalamus. That secretes endorphins. Endorphins are hormones that act on the mind like morphine and opiates, producing a sense of well being and reducing pain.

Model

Alarm reaction

During the alarm reaction rising hormone levels result in increased blood glucose levels, epinephrine and nor epinephrine, heart rate, blood flow to muscles, oxygen intake, mental alertness and the pupils of the eyes dilate to produce a greater visual field. These changes prepares an individual for fight or flight and may last from 1 minute to many hours.

If the stressor poses an extreme threat to life or remains for a long time, the person progress to the second stage, Resistance.

Resistance stage

During the resistance stage the body stabilizes and responds in an opposite manner to the alarm reaction. Hormone levels, heart rate, blood pressure and cardiac output return to normal and the body repairs any damage that may have occurred. If the stressor remains and there is no adaptation, the person enters the third stage, Exhaustion.

Exhaustion stage

This occurs when the energy necessary to maintain adaptation is depleted. The physiological response is intensified, but the persons energy level is compromised and adaptation to the stressor diminishes. The body is unable to defend itself against the impact of the event, physiological regulation diminishes and if the stress continues, death may result.

COPING
Definition

It is the process whereby a person manages the demands & emotions that are generated by the appraisal. Any effort directed at stress management. It can be problem, cognitive or emotion focused. It refers to the persons cognitive & behavioral efforts to manage, reduce, master or tolerate the stressor and its effects,

It is persons effort to manage psychological stress.

It is any effort directed toward management of dangerous, threatening or challenging situations.

Types of Coping
A person may cope differently from one time to another.

Problem Focused Coping means dealing with the problem. Emotion Focused Coping is dealing with the emotions that arise from the problem. Cognitive Focused Coping means dealing with the help of existing knowledge.

Concepts of Coping

People learn to cope with and adapt to stressors by using methods that were successful for them in the past. The concept of coping is similar to that of adaptation. Adaptation is a process through which individuals accommodate to changes in the internal or external environment to preserve functioning and pursue goals.

Human struggle to achieve balance or homeostasis is through psychosocial coping. Coping is any effort directed toward management of dangerous, threatening, or challenging situations. Coping is believed to be a major component in the relationship between the experience of stress and health.

Method of Coping

People tend to use coping devices that are familiar to them Coping behaviors can be

adaptive maladaptive.

People also respond to stress by using defense mechanisms.

These are mental processes used, without planning or even full awareness, to protect or defend ones (psychological) self from stress, and to maintain psychological homeostasis.

Adaptive coping fosters problem solving, growth & development, the ability to perceive reality and respond in a way that supports emotional & physical well being.

Listening to music or other relaxing activities Talking with a supportive person. Engaging in leisure activities. Praying, meditating, or engaging in spiritual activity. Interacting with pets. Other creative activities. (i.e. writing, drawing, dancing etc.)

Maladaptive coping results in feelings and behavior that decrease the quality of life and lead to unhealthy outcomes. It can cause difficulty with interpersonal relationships, mastery & growth and it can negatively affect treatment outcome.

Use of drugs and alcohol Violence directed at self, others, animals or property. Withdrawal from family and friends. Overeating, Gambling. Refusal to participate in treatment, noncompliance, demands for attention, or manipulation of staff or family.

Defense Mechanisms

Acting out by actions rather than reflections of feelings. Affiliation by turning to others for help or support. (sharing problems with others) Anticipation by experiencing emotional reactions in advance of, or anticipating consequences of, possible future events & considering realistic, alternative responses or solutions. Denial by refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others.

Challenges to coping skills

Both anxiety-provoking and crisis situations challenge a persons coping skills. Anxiety - Anxiety is a vague, uneasy feeling.

Crisis: - A crisis is an upset in a balanced or stable state for which the usual methods of adaptation and coping are not sufficient.

Nurses role
=> Identify and describe the patients diagnosis. => Describe the role of stress in contributing to psychiatric disorders. => Help to gain a sense of control by recognizing personal pattern of signs and symptoms and coping strategies.

=> Enhance social and living skills to enable full participation in vocational and recreational activities. => Identify and describe community support system. => Describe medications. and discuss psychoactive