7

Stress and Stress Management

with the Elderly

BENJAMIN L. HANDEN

INTRODUCTION

The relationship of stress to psychological functioning and health has been exam-
ined for some time by both basic and applied researchers. Stress has been associ-
ated with the onset and/or course of a number of physical and psychological
conditions. Consequently, stress reduction procedures have been increasingly uti-
lized with children and adults in both primary and adjunctive treatment. Such
procedures have been used successfully to treat a range of anxiety disorders such as
phobias, obsessive-compulsive behavior, and generalized anxiety. They have also
been used in the treatment of other psychological disorders in which anxiety plays
an important role, such as somatic complaints, paranoid ideation, depression, and
in the treatment of psychophysiological dysfunctions such as high blood pressure,
lower-back pain, headache pain, and the aversive side effects of cancer treatment.
Despite relatively high rates of both psychological disorders and psychophysio-
logical conditions, the elderly have been systematically neglected in the stress
management literature. These individuals face a number of potentially stressful
situations that are unique to this age group and place them at risk for developing
stress-related disorders. This chapter will focus upon the use of stress management
procedures with the elderly. First, there will be abrief examination of conceptual
issues in stress research. This will be followed by a discussion of reported problems
in generalizing stress management procedures to the elderly population. Finally,
there will be a review of the literature on stress reduction procedures involving
elderly individuals and recommendations for future research needs.

BENJAMIN 1. HANDEN • Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-3417.

169
P. A. Wisocki (ed.), Handbook of Clinical Behavior Therapy with the Elderly Client
© Springer Science+Business Media New York 1991
170 BENJAMIN L. HANDEN

CONCEPTUAL ISSUES IN STRESS RESEARCH

Despite wide acceptance of the negative impact of stress upon both psycho-
logical and physical health, research has been hindered by disparity in conceptual
and methodological areas. Moss (1973) reviewed models of stress and placed them
into three categories: (1) stress as a psychological response to physical, chemical,
and organic agents (based upon Selye's General Adaptation Syndrome), (2) stress as
a physiological response to sodal and psychological stimuli (viewing stress as an
interaction between the external environment and the organism), and (3) stress as a
behavioral response to sodal psychological stimuli (viewing stress from a cognitive
perspective). These differing perspectives on stress have resulted in a range of
research endeavors and subsequent treatment approaches that can be used individ-
ually or in combination. Spedfic treatment approaches will be addressed in more
detail in a later section.
Were it possible to develop a conceptualization of stress that encompassed the
variety of perspectives identified above, research in this area would nonetheless
remain problematic. A primary difficulty is the observation that laboratory
stressors may not be consistently perceived as stressful by all subjects or even by
the same subject over time (AveriIl, 1979). Consequently, the designation of a
stimulus as stressful as weIl as an individual's response to that stimulus may be
extremely idiosyncratic. Yet despite such observations, a wide consensus seems to
exist among researchers as to the types of stimuli that may be perceived as stressful
(Antonovsky, 1980), hence, the weIl-accepted use of stress rating scales (e.g.,
Holmes & Rahe, 1967), which consist of lists of potentially stressfullife events and
assurne a certain universality in individual responses to these stimuli. It is impor-
tant to note that such scales provide information about the relationship between
exposure to a presurned stressful event and subsequent developrnent of maladap-
tive responses among a large group of subjects. Despite statistically significant
assodations, these findings do not allow for the prediction of individual responses
to such stimuli and cannot necessarily be used for clinical purposes.
The treatment focus for stress-related disorders is often based upon a clini-
dan's conceptualization of both stressful stimuli and subsequent responses. Indi-
vidual responses to stress have typically been divided into three categories: physio-
logical responses, behavioral responses, and the reporting of subjective states. As
will be seen, the treatment of elderly individuals often requires that the clinidan
address the entire range of possible stress responses.

GENERALIZING STRESS MANAGEMENT TECHNIQUES

TO THE ELDERLY

There are indications that standard behavior therapy procedures rnay need to
be modified for use with an elderly population. For example, there is some research
evidence that older individuals require longer periods of time to acquire new skills
than younger subjects (cf. review by Botwinick, 1970). Such findings may have
implications for the methods used to instruct elderly clients in seH-management