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Managing Stress
“Stress is an unavoidable
consequence of life.”
Hans Selye, M.D., Ph.D. (1951)
Experience Stress!
 What would you need to do or think about at
this moment that would increase you feeling
of stress or anxiety?
 What do you notice about your experience of
stress?
What is Stress
 I. Stressor- an event or adjustive demand placed on
an individual or group.
 II. Stress- effects created within an organism by the
application of a stressor.
 OTHER DEFINITIONS
 Crisis- a stressful situation that approaches or
exceeds the adaptive capacities of an individual or
group.
 Coping Strategies- efforts to deal with stress.
Two Different Kinds of Stress
 Distress- negative stress, associated with
pain, anxiety, or sorrow.
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Examples include: work demands, death of
friend or family member, car troubles, and
financial issues.
 Eustress- positive stress
 Examples include: job promotion, purchasing a
new home, marriage or birth of a baby, and the
holidays.
 Both tax a persons limited resources;
generally, distress has the potential to do more
damage
Predisposing Factors of Stress
 Nature of the Stressor
 significance, immediacy, cumulative effect,
duration (marital separation)
 Persons Perception of the Stressor
 Important to have realistic expectations
 Individuals Stress Tolerance
 Ability to withstand stress without becoming
seriously impaired.
 Lack of External Resources and Social
Supports
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Alone vs. surrounded by others.
Responding to Stress
 Stress threatens a person’s well being and produces
automatic, persistent attempts to relieve the tension.
 Stress Forces Us to Do Something (think, act, feel, etc)
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That something can actually increase stress
 Three Interactional Response Levels
Biological (immune system etc.)
 Psychological and Interpersonal (coping & social)
 Sociocultural (group resources)
 Two Challenges in Confronting Stress
 Task-oriented response- behavior is directed towards
resolving the stressful situation.
 Defense-oriented response- protecting self from hurt &
disorganization.
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Responding to Stress
 Two Challenges in Confronting Stress
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Meet the requirements of the stressor
Protect the self from psychological damage
 Two General Responses to Stress
Task-oriented response- behavior is
directed towards resolving the stressful
situation.
 Defense-oriented response- protecting self
from hurt & disorganization.
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The Effects of Severe Stress:
Biological
 General Adaptation Model (Selye, 1956)
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The biological reaction to sustained exposure
follows three phases:
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Alarm Reaction (activation of autonomic system)
Stage of Resistance (maximal use of bio-defenses)
Exhaustion (biological resources are depleted)
 Homeostasis is harder to achieve.
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Sympathetic Nervous System
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Immune System is suppressed by stress
The Effects of Severe Stress:
General Adaptation Syndrome
Nervous System
Central Nervous System (Brain)
Bear in the Woods (Fight/Flight)
 Hypothalamic-Pituitary-Adrenal system releases:
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cortisol (primary stress hormone)
 Heart rate, lungs, circulation, metabolism,
immune system, and skin.
catecholamines (neurotransmitters-adrenaline)
 Amygdala- emotional response
 Hippocampus- stores emotionally loaded
experience in long term memory.
 Suppress short term memory (concentration,
inhibition, and rational thought).
Sympathetic Nervous System
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Stress causes activation of SNS (sympth.)
Release of adrenaline
Body’s need for oxygen increases.
Heart rate and blood pressure go up.
Blood vessels in your skin constrict.
Muscles become tense.
Blood sugar level increases.
Blood has an increased tendency to clot.
Cortisol is released (triggers appetite incr.)
Biological Symptoms of
Chronic Stress
 Headaches
 Sleep disturbance
 Gastrointestinal problems
 Ulcers
 High blood pressure
 Weakened immune response
 Muscle pain
Symptoms of Stress
 Physical
 Muscle tension, illness, high blood pressure,
indigestion, ulcers, difficulty sleeping, fatigue,
headaches, backaches.
 Emotional
 Irritability, depression, anger, fear or anxiety,
feeling overwhelmed, mood swings.
 Cognitive
 Forgetfulness, unwanted or repetitive
thoughts, difficulty concentrating. Headaches
Psychological Effects of Stress
 Impairment of intellectual functioning
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Difficulty making decisions
Poor concentration
Decrease in creativity
 Diathesis-Stress Model
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Constant stress brings about changes in the
balance of hormones in the body.
Depressive Disorders
Anxiety Disorders (panic attacks)
Formation of unhealthy defense patterns
Psychological Effects of Stress
 Personality (psychological) decompensation
lowering adaptive psychosocial functioning in the face
of sustained or severe stress.
 Course of Decompensation
 Alarm and Mobilization
 Increased tension, heightened sensitivity,
greater alertness, efforts of self-control.
 Resistance
 Task oriented response. Ego-Defenses used.
Some mild reality distortions
 Exhaustion
 Inappropriate defense mechanisms used. Break
with reality.
Adjustment Disorder: Reactions to
Common Life Stressors
 Stress from unemployment
 Stress from bereavement
 Stress from divorce or separation
Adjustment Disorder
 The development of emotional or behavioral symptoms
in response to an identifiable stressor(s) occurring
within 3 months of the onset of the stressor(s).
 These symptoms or behaviors are clinically significant
as evidenced by either of the following:
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marked distress that is in excess of what would
be expected from exposure to the stressor
significant impairment in social or occupational
(academic) functioning
Adjustment Disorder
 The stress-related disturbance does not meet the
criteria for another specific Axis I disorder and is
not merely an exacerbation of a preexisting Axis I
or Axis II disorder.
 The symptoms do not represent Bereavement.
 Once the stressor (or its consequences) has
terminated, the symptoms do not persist for more
than an additional 6 months.
 Specify if:
 Acute: if the disturbance lasts less than 6 months
 Chronic: if the disturbance lasts for 6 months or longer
Acute Stress Disorder
 The person has been exposed to a traumatic event in
which both of the following were present:
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person experienced, witnessed, or was confronted with an event
that involved actual or threatened death or serious injury, or a
threat to the physical integrity of self or others
the person's response involved intense fear, helplessness, or
horror
 Either while experiencing or after experiencing the
distressing event, the individual has 3 dissociative symp.:
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a subjective sense of numbing, detachment, or absence of
emotional responsiveness
a reduction in awareness of his or her surroundings (e.g., "being in
a daze")
derealization
depersonalization
dissociative amnesia (i.e., inability to recall an important aspect of
the trauma)
 The traumatic event is persistently re-experienced: recurrent
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images, thoughts, dreams, illusions, flashbacks, or a sense of
reliving the experience; or distress on exposure to reminders
of the traumatic event.
Marked symptoms of anxiety or increased arousal.
Marked avoidance of stimuli that arouse recollections of the
trauma (e.g., thoughts, feelings, activities, places, people).
The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning or impairs the individual's ability to pursue some
necessary task, such as obtaining necessary assistance.
The disturbance lasts for a minimum of 2 days and a
maximum of 4 weeks and occurs within 4 weeks of the
traumatic event.
The disturbance is not due to the direct physiological effects
of a substance or a general medical condition, is not better
accounted for by Brief Psychotic Disorder, and is not merely
an exacerbation of a preexisting Axis I or Axis II disorder.
Post-Traumatic Stress Disorder
 The person has been exposed to a traumatic event in which both of
the following were present:
 the person experienced, witnessed, or was confronted with an
event (s) that involved actual or threatened death or serious injury,
or a threat to the physical integrity of self or others.
 the response involved intense fear or helplessness.
 The traumatic event is persistently reexperienced in one (or more) of
the following ways:
 recurrent and intrusive distressing recollections of the event,
including images, thoughts, perceptions, or dreams of the event.
 acting or feeling as if the traumatic event were recurring (includes
a sense of reliving the experience, illusions, hallucinations, and
dissociative flashback episodes) intense psychological distress at
exposure to internal or external cues that symbolize or resemble
an aspect of the traumatic event
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physiological reactivity on exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic
event
 Persistent avoidance of stimuli associated with the trauma
and numbing of general responsiveness (not present before
the trauma), as indicated by three (or more) of the following:
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efforts to avoid thoughts, feelings, or conversations associated
with the trauma
efforts to avoid activities, places, or people that arouse
recollections of the trauma
inability to recall an important aspect of the trauma
markedly diminished interest or participation in significant
activities
feeling of detachment or estrangement from others
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restricted range of affect (e.g., unable to have loving
feelings)
sense of a foreshortened future (e.g., does not expect to
have a career, marriage, children, or a normal life span)
 Persistent symptoms of increased arousal (not present
before the trauma), as indicated by two (or more) of the
following:
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difficulty falling or staying asleep
irritability or outbursts of anger
difficulty concentrating
hypervigilance
exaggerated startle response
 Duration of the disturbance (symptoms in Criteria B, C,
and D) is more than 1 month.
 The disturbance causes clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.
Causal Factors in PTSD
 Personality
 Nature of the Traumatic Stressor
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Accounts for most of the stress response
Everyone has a breaking point.
 Conditioned Fear Response
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Need for Prompt Psychotherapy
The Trauma of Rape
 Most common cause of PTSD in females
 Stranger Rape vs Acquaintance Rape
 Factors of Influence:
 Age
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Developmental Stage
 Life
Circumstance
 Family and Friends
Coping with Rape
 Coping with rape
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Anticipatory phase
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Impact phase
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Recognition that she will be raped
Fear for life greater than sexual act
Fear is paralyzing
Post-traumatic recoil phase
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Victim perceives danger
“This isn’t really happening to me.”
Immediately after rape
Guilt of their actions and dependency
Reconstitution phase
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Person starts to makes plans for leaving crisis center
Self protective activities, nightmares, phobias
The Trauma of Military Combat
 Temperament
 Limited evidence to suggest that temperament
makes a difference in resistance to combat stress
 Psychosocial Factors
 Unpredictable, loss of freedom, killing, et.
 Sociocultural Factors
 Acceptability of war goals
 Quality of leadership
 Group identification with their combat unit
Treatment of Stress Disorders
 Stress Prevention
 Stress Inoculation Training
 Stress Management Skill Development
 Crisis intervention therapy
 Talk it out in a supportive environment
 Medications
 Direct therapeutic exposure
 Real or imagined
Stress Prevention and Management
 Expect Stress
 Identify Personal Stressors
 Time Management
 Learn Relaxation Techniques
 Good Health Practices
 (Diet and Regular Exercise Routine)
 Change Cognitions
 Clarify Values
 Reframe negative stressors
 Maintain a Social Support Network
Identify Stressors
 What is stressful to me?
 Different responses by individual.
 How does stress affect me?
 Symptoms listed earlier.
 When am I most vulnerable to stress?
 Time of day (4:59), week (Sunday), month (bills, menstrual
cycle etc.), year (winter blues)
 When is stress good for me?
 Moderate amounts of stress actually improve performance
(curvilinear)
 Too much impairs. Too little decrease motivation.
Time Management
 Prioritize (clarify values)
 Make To-Do-Lists.
 Use a Schedule.
 Schedule Time for Breaks, Socializing, and
Fun.
Relaxation Techniques
 Diaphragmatic Breathing (takes practice)
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Are you a “belly-breather” or “chest breather”?
Influences parasympathetic “quieting
response”.
Increases oxygenation of blood.
Distracts from stressful stimulus.
Increases sense of control over body and
stress reactions.
Good Health Practices
 Eat Healthy Foods
 Cut Back on Caffeine, Nicotine, and Other
Stimulants.
 Have an Exercise Plan.
Cognitive Techniques
 Realize What You Can and Cannot Do.
 Recognize Irrational or Negative-Automatic-
Thoughts.
 Reframe Negative Thoughts and Focus on
Positive Aspects.
Social Support
 Stay connected with family
 Connect with peers