Stress and its

management
BY: HIRA JAVAID
LECTURER & CLINICAL PSYCHOLOGIST
DEPARTMENT OF BEHAVIORAL SCIENCES
 Stress

It’s a force acting against some resistance. Stress is defined as “the rate of wear and
tear in the body” and “the state manifested by a specific syndrome which consists of
all the non-specifically induced changes within a biological system.”
According to Richard Lazarus, In General adaptation syndrome (GAS),
glucocorticoids are secreted by the adrenal cortex in response to adaptation demands
placed on the organism by such desperate stressors as heat, cold, starvation, and other
environmental insult. Any such stimulus to the body results in certain physiological
changes in the body which are cumulatively termed as stress (Lazarus; 1984).
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Individuals have a personal view of their stress, based on their perception of the
event, past experiences, strengths, biographical assets and social support.
Other factors which influence the outcome of stress upon an individual include race,
gender. age, marital status, socioeconomic status and early developmental
experiences. For example, black people are more prone to develop hypertension than
Caucasians. Females tend to live longer and recover quicker from illness than males.
They also show less physiological reactivity to stress as compared to males.
Types of Stress

Physiological stress caused by temperature, noise, hunger, disease, smoking, drinking

and similar habits are considered generalized life stressors affecting most people.
Psychosocial stress caused by psychological factors such as low self-es teem, social
factors such as life events, job stability, career satisfaction, economic viability.
marriage, children, relationships etc. Stressors bring about a physiological change in
the body of a person. Some stressors produce impacts in a short span of time; such as
loss of parents or job. Others, such as distressed relationships or care of a disabled
person in the house, influence the person gradually over a period of time. Individual
and situational variables mediate the relationship between life change and illness
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Among the psychological variables that seem to mediate the stress response are:
locus of control the extent to which individuals prefer control of their lives and how
much control they perceive they have over specific events, need for stimulation,
openness to change , stimulus screening, self-actualization, use of denial , social
support.
 Hardiness

Hardiness is a personal characteristic comprising the “3 C’s”, in which an individual

has a sense of:
Commitment to self, work, family, and other important values; • Control over one’s
life; • Change as a challenge rather than a threat. Recently researchers have suggested
a fourth C”: coherence. Coherence is the belief that one’s internal and external
environments are predictable and that things will work out as well as can be expected
 Burn out

Job-related Stress & Burnout Work-related stress can be a source of persistent and
intense stress and strain. Job strain is defined as a combination of high job demands
and low perceived control.
Studies have established that job strain is associated with increased carotid
atherosclerosis among men. Burnout is a syndrome associated with unrelenting
stress. It includes symptoms of emotional exhaustion and a decreased sense of
personal accomplishment.
 Stress Intolerance

Stress intolerance is the inability to be relaxed and composed when faced with
difficulties. Having positive stress tolerance is being able to stay calm without getting
carried away by strong emotions of helplessness and hopelessness.
Factors that influence stress intolerance level include:
Support network. A strong network of supportive friends and family members is an
enormous buffer against stress. When an individual has people he/she can count on,
life’s pressures don’t seem as overwhelming. On the flip side, the lonelier and more
isolated he/she is, the greater his/her risk of succumbing to stress.
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Sense of control. If an individual has confidence in himself/herself and his/her

ability to influence events and persevere through challenges, it’s easier to take stress
in stride. On the other hand, if he/she believes that he/she has little control over life
that he/she is at the mercy of his/her environment and circumstances. Stress is more
likely to knock him/her off course.
Attitude and outlook. The way we look at life and its inevitable challenges makes a
huge difference in our ability to handle stress. If we are generally hopeful and
optimistic, We’ll be less vulnerable. Stress-hardy people tend to embrace challenges,
have a stronger sense of humor, believe in a higher purpose, and accept change as an
inevitable part of life.
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Ability to deal with one’s emotions. If we don’t know how to calm and soothe
ourself when we are feeling sad, angry, or troubled, we are more likely to become
stressed and agitated. Having the ability to
identify and deal appropriately with our emotions can decrease our intolerance to
stress and help us bounce back from adversity.
Knowledge and preparation. The more we know about a stressful situation,
including how long it will last and what to expect, the easier it is to cope. For
example, if a person goes into surgery with a realistic picture of what to expect post-
op, a painful recovery will be less stressful than if he/she was expecting to bounce
back immediately.
 Response to stress

Physical manifestations of stress:

Both sympathetic and parasympathetic nervous systems may go into overdrive when
faced with stress. The sympathetic system comes into play when stress is acute and
manifests in the form of increased heart rate, dilatation of pupils, dry mouth,
piloerection, increased muscle tone, rapid breathing and increased blood pressure.
When this state is sustained for a prolonged period of time, three target organs -
stomach, heart and blood vessels -are affected, but none are spared. There is increased
acid secretion in the stomach, increased gastric emptying, nausea, heartburn, upset
stomach, chest pain, hypertension and muscle aches and pains.
Parasympathetic system is stimulated when stress becomes chronic. Some people are
more vulnerable to respond to stress through parasympathetic system. This causes
increased hunger, delayed gut motility, constipation, increased sweating and disturbed
sleep.
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Emotional Manifestations of Stress:

People who respond with sympathetic reactions tend to show anxiety, fear, anger and
irritability. They try to avoid the stressor by showing the fright and flight response.
Hypervigilance, hyperarousal and increased startle response are seen.
Parasympathetic system responders tend to show guilt. grief, sadness, depression,
feelings of being abandoned and isolated and tend to avoid seeking support from
others.
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Behavioral Manifestations of Stress

Social withdrawal poor sleeping and eating habits, poor exercise, excessive
drinking and smoking, drug abuse, carelessness. problems with authority and rules
and regulations, insubordination, impaired social relations, break up of old
relationships and reckless behaviors are all types of behaviors that indicate a person
is undergoing stress in their life and is unable to manage it,
 Stress management

Managing the stressor:

Managing the environment is the first step towards stress handling. There is
always some aspect of the stressor that can be controlled. That aspect must be
controlled and one thing to be taken at a time. Minimizing the stressors may require
imaginative problem solving and help from the individual’s support group. but it
helps to create a sense of control over the environment
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Managing behavior:
It is important to not get fixated on past failures, the past cannot be changed.
Focusing on what can be done now and in future is a more productive approach.
Adopting the can do attitude, practicing anger management and remembering that
you are the person in charge of your behavior helps. Unless you allow yourself to fall
down, nothing can make you surrender are important mind sets to get one through a
tough situation.
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Time management:
Making a list of things to do each morning and prioritize the work that
needs to be done goes a tong way towards managing time effectively. Rather than
working tong hours with low productivity, it is far more productive to work for 45
minute stretches with short breaks in between. It is also important to take time out to
evaluate and reflect upon the work done and efforts made. Learning to say ‘no’ to
unreasonable demands on your time is an important skill. This is especially true of
our culture where it is considered rude to say no, so instead we say yes, and avoid
being truthful about what we can accomplish. It is also important to give ones own
self “guilt free time off to enjoy. Learning to delegate responsibility also greatly
improves one’s own productivity
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Managing stress:
Accepting the things that ate beyond one’s control can sometimes be the first step
towards relieving stress. It is also important to learn to deal with your stress response and
adopt effective coping methods.
Exercise and Nutrition:
Exercising 3-5 times a week conditions the body to deal with stress by using the
physical stress response. Keeping caffeine intake to minimum, stop ping smoking and eating
less fatty and sugary food and more fiber, vitamin B complex and Vitamin C helps to prime
your body to deal with stress as and when it occur.
Relaxation:
Practicing progressive muscle relaxation (see box), meditation, deep breathing
exercises and engaging in hobbies provides energy and fuel for the body to combat stresses
of all kinds.
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Social Support:
Developing a circle of friends and family where one can talk openly and
honestly can help one better understand stress and learn to manage it more
effectively. It is also important to utilize resources that can help such as doctors or
senior colleagues.
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Communicating With Patients about Stress :

A primary component of stress prevention and treatment involves the way
stress is discussed with patients. A doctor must avoid phrases such as “it’s all in your
head. Equally important is avoiding the message that ‘you are responsible for your
illness’ This induces guilt in patients who become ill and makes them feet that they
have failed at being a “better person Avoiding negative emphasis, for example, ‘Your
hectic pace is going to kill you, in favor of a positive framing of the health benefits of
stress management is more likely to have a positive influence. For example, the
clinician can express optimism about the patient’s ability to influence health as
follows: “Fortunately, there are many avenues available for evaluating and changing
your way of responding to life challenges. I’d like to give you an overview of some
strategies that we can discuss now and in future appointments.”
Take home message