Alexandria University

Faculty of Nursing
Psychiatric Nursing &
Mental Health Department
Fundamentals of Psychology

Stress and Stress Management

Outline:
- Introduction.

- Definitions.

- Types of stress.

- Individual perception of the stressor or event.

- Major sources of stress.

- Factors influencing the impact of stress.

- Responding to stress.

- Stress management.

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 Stress and Stress Management

Introduction:
Stress is a part of normal life. It comes in all forms and affects people of all ages and
all walks of life. Although stress is not all bad, it needs to be effectively managed in order
to prevent occurrence of physical and mental disturbances associated with homeostatic
instability of our bodies.

Definitions:
Stress: refers to "experiencing events that are perceived as endangering one’s physical or
psychological well-being".
Stress also is defined as: "the condition that results when the individual perceives a
discrepancy between the demands of a situation and the resources of the person’s
biological, psychological, or social systems".

Stressors: They are events or circumstances that are perceived as threatening or harmful.
Stressors can range from the traumatic events (fires, crashes, combat, rape, attempted
murder) to the merely irritating and annoying (delays, rude people, losing the car keys).
Stressors can be even imaginary, such as when a parent imagines the worst happening to a
teenage child who is not yet home from an evening out.

Types of Stress:
Actually, there are two types of stress; those that cause distress (negative stress),
which occurs when people experience unpleasant stressors, and those that cause eustress
(positive stress), which results from positive events that still make demands on a person to
adapt to the change. marriage, a job promotion, and having a baby may all be positive
events for most people, but they all require a great deal of change in people’s habits,
duties, and even life style thereby creating stress.

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Individual Perception of the Stressor or Event:
The experience or feeling stressed depends on what events one notices and how one
chooses to evaluate or interpret them. Events that are stressful for one person may be
routine for another.
a) Primary appraisal: It is the first step in appraising stressor, which involves an
assessment of the severity of the stressor and classifying it as a threat (something that
could be harmful in the future), a challenge, or harm or loss that has already occurred.
For example, a student who has not read the text or taken good notes will certainly
appraise an upcoming exam as threatening, but if that student has studied, read and feels
prepared , the upcoming exam is much more likely to be appraised as an opportunity to do
well.
Perceiving stress as a challenge instead of a threat makes coping with the stress
more successful, whereas perceiving it as an embarrassment or imagining failure or
rejection is more likely to lead to increased stress reactions, and negative emotions.
b) Secondary appraisal: It is an assessment of resources that the person poses to deal with
the situation. Resources might include social support, money, time, energy, ability. If
resources are perceived as adequate, the degree of stress will be less than if resources are
missing or lacking.

As an example, a person position at a company has just been lost. That is fairly a big
stressor in most situations, but the degree of stress experienced and the coping abilities of
that person will depend on both primary and secondary appraisal.
➜ In most cases primary appraisal might: "I have lost my job. I need a job, so this is
very bad" (this is a threat).
➜ The secondary appraisal might: "I don’t have much money in savings. I don’t have
anyone I can borrow money from or live with while I’m looking for more work".
This person is going to experience more stress and have more health problems as a
consequence.

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Major Sources of Stress:
A variety of events can be stressful for one person or another.
1. Traumatic events:
They are situations of extreme danger that are outside the range of usual human
experience. These include:
Natural disasters, such as earthquakes and floods.
Disasters caused by human activity, such as wars.
Catastrophic accidents, such as car or plane crashes.
Physical assaults, such as rape or attempted murder.

2. Life changes:
Life changes are any noticeable alterations (changes) in one’s living circumstances
that require readjustment.
 The importance of life changes was first demonstrated by "Thomas Holmes" who
believed that any life event that require people to change, adapt, or adjust their
lifestyles would result in stress.
 Why would positive events, such as moving to a nicer home, produce stress?
According to Holmes, it is because they produce change. In their view, changes in
personal relationships, changes at work, and so forth can be stressful even when the
changes are welcomed.
 Based on this analysis, "Holmes and Rahe" developed the Social Readjustment
Rating Scale (SRRS) to measure life changes as a form of stress. The scale assigns
numerical values to 43 major life events. These values are supposed to reflect the
magnitude of the readjustment required by each change.
 Studies have shown that people with higher scores on the SRRS tend to be more
vulnerable to many kinds of physical illness and psychological symptoms as well.

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 Table 1. Selected items from Social Readjustment rating scale:
Life Event Mean Value
1. Death of a spouse 100
2. Divorce 73
3. Personal injury or illness 53
4. Marriage 50
5. Retirement 45
6. Pregnancy 40
7. Gain of a new family member 39
8. Begin or end school 26
9. change in sleeping habits 16
10. Vacation 13

3. Frustration:
Frustration occurs when people are blocked or prevented from achieving a desired
goal or fulfilling a perceived need, i.e., you experience frustration when you want
something and you can’t have it.
Obviously, some frustrations are minor and others are more serious. The seriousness
of a frustration is affected by how important the goal or need actually is.
 Some Frustrations can be sources of significant stress. Failures and losses are two
common kinds of frustration that are often highly stressful.
 Some people make failure almost inevitably by setting unrealistically high goals for
themselves.
 Losses can be especially frustrating because people are deprived of something that
they are accustomed to having.

4. Conflict:
It is occurring when a person has to choose between different and incompatible or
opposing goals.
Some studies found that higher levels of conflict were associated with higher levels of
anxiety, depression, and physical symptoms.

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 There are several forms of conflict:
a. Approach-approach conflict:
In this type the individual wants two or more desirable but incompatible goals. This
type of conflict is observed in ambitious person who want to achieve multiple
successes at the same time, e.g., when one has to choose between two interesting jobs
or two desirable studies.
 Among the three kinds of conflict, the approach-approach type tends to be the least
stressful.
b. Avoidance -avoidance conflict:
In an avoidance-avoidance conflict a choice must be made between two unpleasant
goals, e.g., suppose you have painful backaches. Should you submit to surgery that
you dread, or should you continue to live with the back pain?
Because neither of alternatives is pleasant, many people avoid making a choice by
delaying decisions.
 Avoidance-avoidance conflicts are most unpleasant and highly stressful.
c. Approach -avoidance conflict:
This conflict only involves one goal or event. That goal or event may have both
positive and negative aspects that make the goal appealing and unappealing at the
same time. For example, in order to marry the girl he loves, it may be necessary to
accept living with an intolerable mother-in-law.
Sometimes positive and negative features are present in the same goal, e.g. a friend
with equally good and bad characters.
 Approach-avoidance conflicts are common and can be quite stressful, causing many
people to vacillate or be unable to decide.

5. Pressure:
Pressure involves expectations or demands that one behave in a certain way.
 You are under pressure to perform when you’re expected to perform tasks and
responsibilities quickly, efficiently, and successfully.
 Pressures to conform to others’ expectations are also common in our lives, e.g.
teenagers are expected to adhere to their parents’ values and rules.
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Factors Influencing the Impact of Stress:
A variety of elements influence how an individual perceives and responds to a stressful
event. These factors strongly influence whether the response is adaptive or maladaptive.
These factors include:
1. Nature of stressor: Severity, number, duration and controllability of stressors. The
more uncontrollable, an event seems, the more likely it is to be perceived as stressful.
2. Meaning of the stressor.
3. Developmental maturity: A person developmental maturity influences the impact of
the stressor. For example, death of a parent is highly traumatic for any child, but
particularly so during the years four to six, and during early adolescence.
4. Previous life experiences with similar stressor.
5. Social support: A social support system is a network of friends, family members,
neighbors, coworkers and others who can offer help to a person in need. That help
can take the form of advice, physical or monetary support, information, emotional
support, love and affection or companionship. Researches have shown that, having a
good social support system is of critical importance in a person’s ability to cope with
the stressors. Social support can make a stressor seem less threatening because people
with such support know that there is help available.
6. Autonomic reactivity: Individuals who have a high reactive autonomic nervous
system (ANS) are more affected by stress than others.
7. Spirituality: There are many religious and spiritual beliefs that are helpful for many
people in coping with stress. Studies have demonstrated that spiritual practices can
enhance the immune system and sense of wellbeing. People who include spiritual
solutions to physical or mental distress often gain a sense of comfort and support that
could aid in healing and lowering stress.
8. Personality type:
 Type "A" personality: Researchers have found a link between type "A"
personality and high blood pressure and coronary heart disease. Type "A"
personality includes three elements: highly competitive; impatience and time
urgency; and anger and hostility.

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  Type "B" personality: Individuals with type "B" personality are relatively relaxed,
patient, and easygoing. They are less harried, less competitive, and less easily
angered than type "A" personality.
 Type "C" personality: The type "C" personality has difficulty expressing emotions
and tends to suppress emotions particularly negative ones such as anger. According
to Temoshok (1987), type "C" personalities are cancer-prone.
 Hardy personality: It was found that individuals who have strong feelings of
confidence in their ability to control circumstances, a willingness to see the life
events as challenges, a strong commitment to the demands of daily living, and have
fewer illnesses than those who lack these qualities.
 Optimistic personality: There is a correlation between optimism and relatively
good health. They have more tendencies to emphasize the positive in their appraisal
of stressful events.

Responding to Stress:
a. Emotional Responses:
Stress tends to elicit unpleasant emotions rather than pleasurable ones. As stress
increased, mood tended to become more negative (annoyance, anger, anxiety, fear,
grief).

b. Physiological Responses:
The General Adaptation Syndrome (GAS):
Psychologist "Hans Selye" the founder of the research concerning stress and its effect
on the human body, studied the sequence of physiological reactions that the body goes
through when adapting to stressor. This sequence is called the General Adaptation
Syndrome (GAS) and consists of three stages:
 Alarm reaction: When the body first recognizes the existence of a threat, the
sympathetic nervous system is activated and the adrenal glands release hormones
that increase heart rate, blood pressure and the supply of blood sugar and fat
resulting in a burst of energy. Reactions such as fever, nausea, and headache are
common.

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 Resistance: As the stress continues, the body is continuing to release the stress
hormones that help the body fight off or resist the stressor. The early symptoms of
alarm decrease and the person may usually feel better. This stage will continue until
the stressor ends or the organism has used up all of its resources.
 Exhaustion: This stage occurs when there is prolonged exposure to the stressor
occur. If the stress can’t be overcome, the body’s resources may be depleted, and
physiological arousal will decrease and the organism may collapse from exhaustion.
Exhaustion can lead to the formation of stress related diseases (i.e., high blood
pressure or a weakened immune system) or the death of organism.
➜ Alarm and resistance are stages that people experience many times throughout
life, allowing people to adapt to life’s demands.

c. Behavioral Responses:
Common patterns of behavioral responses:
 Aggression:
People often respond to stressful events by striking out at others with aggressive
behavior. Aggression is any behavior that is intended to hurt someone, either
physically or verbally.
 Engagement in unhealthy behaviors:
Some people under stress have greater tendency to engage in unhealthy behavior
such as eating, spending money, smoking, and use of alcohol or drugs. A new
manifestation of this coping strategy is a syndrome called internet addiction.
People may try to compensate by pursuing substitute forms of satisfaction.

d. Psychological Responses: (Effects of stress on psychological functioning):

Stress makes life challenging and interesting. Moreover, stress can have beneficial
effects. Stress can force people to develop new skills, and acquire new personal
strengths.
When stress is severe or when many stressful demands pile up, one’s psychological
functioning may be affected.

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 1. Burnout:
Burnout is one of the more serious effects of workplace stress. It can be defined
as a negative change in thoughts, emotions and behavior as a result of prolonged
stress.
 The physical changes: include chronic fatigue, weakness, and low energy.
 The mental changes: are manifested in highly negative attitudes toward
oneself, one’s work and life in general.
 The emotional changes: include feelings hopeless, and helpless.

2. Post-traumatic Stress Disorder (PTSD):

The post-traumatic stress disorder involves enduring psychological
disturbances due to the experience of a major traumatic event.

3. Psychological problems and disorders:

Studies indicate that stress might contribute to poor academic and
occupational performance due to forgetfulness, disturbed social relationships,
insomnia, nightmares, sexual difficulties, and alcohol and drug abuse.
Stress might contribute to psychiatric disorders, including psychosomatic
disorders, anxiety disorders, eating disorders, depression, and schizophrenia.

Stress Management:
Reappraisal of stressful events:
People can short-circuit their emotional reactions to stress by altering their appraisals
of stressful events.

Think positively:
Make an effort to stop negative thoughts.

Clarify your values and develop a sense of life meaning:

Clarify your values and deciding what you really want out of your life, can help you
feel better about yourself and have that sense of satisfaction that help you deal with the
stresses of life. A sense of spirituality can help with this.
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 Releasing pent-up emotions:
The individual can sometimes reduce his physiological arousal by expressing his
emotions (writing or talking about life’s difficulties can be valuable in dealing with
stress).

Social support:
Social support can help to provide protection against stress.

Adopt a healthy life style:

It is a good idea to consume a nutritionally balanced diet, get adequate sleep, and
engage in a regular exercise. It is also a good idea to learn how to control overeating
and the use of tobacco, alcohol and other drugs. Failure to do them may increase your
vulnerability to stress- related diseases.

Manage your time:

One of the greatest sources of stress is poor time management. Give priority of the
most important ones and do those first. If a particularly unpleasant task faces you, start
with it.

Keep your sense of humor:

Studies indicated that finding a humorous aspect in the stressful situation redefines
situation in a less threatening way. Studies also indicated that laughter can serve to
discharge pent-up emotions. These dual functions of humor may make joking about
life’s difficulties a particularly useful coping strategy.

Making time for recreation:

Making time for recreation is very essential for healthy living. A recent study indicated
that daily pleasant event had a positive effect on the immune system.

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 Keeping an informal diary of daily events and activities:
This is an extremely useful simple method in identifying what makes a person stressed.
When noting which activities put a strain on energy and time, those that trigger anger
or anxiety, or those that precipitate negative physical experiences (headache, backache,
fatigue), can be an actual first step in stress reduction.

Practice specific relaxation techniques:

Relaxation Techniques:
They include meditation, guided imagery, and breathing exercises. Techniques that
require special training include progressive muscle relaxation and biofeedback.
a) Meditation: It is a method for training the mind to develop greater calm.
Meditation has four components: quiet surrounding, a passive attitude, a
comfortable position, and a word or mental image on which to focus. A
person sits comfortable with closed eyes, relaxes the major muscles groups,
and repeats the selected word silently with each exhalation. Alternatively, the
person may focus on a pleasant scene while breathing slowly.

b) Guided imagery: In guided imagery, a person creates a mental image,

concentrates on the image and becomes less responsive to stimuli (including
pain). For example, the nurse might start and directs the patient as follows:
"You are floating in your swimming pool. The water is cool and comfortable.
Birds are signing in the trees…..etc".

c) Biofeedback: It is a method of gaining mental control of the autonomic

nervous system and thus regulating body responses such as blood pressure,
heart rate and headache. A measurement device (e.g., skin temperature
sensor) is used, and the patient tries to control the readings through relaxation
and conscious thought.

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