Stress Management

Allan Sanders, MN, ARNP

asanders@wsu.edu
Objectives

o Explore the biological, psychological, and

social aspects of the human stress
response.

o Describe the difference between adaptive

and maladaptive coping strategies.

o Understand coping strategies that

increase resilience to promote productive
living and healthy aging.
 Common Stress Associated Diseases
o Diminished Immunity o Anxiety
o Headache o Depression
o Fatigue o Alcoholism
o Weight gain o Substance abuse
o Dyslipidemia o Insomnia
o Hypertension o Irritable bowel
o Heart Disease syndrome
o Psoriasis/Eczema o Fibromyalgia
o Digestive problems o Decreased sex drive
 Overview of Terminology
o Stress: A state of disharmony or a threat to
homeostasis
– Physiological changes increase alertness, focus, and
energy
– Perceived demands may exceed the perceived
resources
o Coping: The ability to maintain control, think
rationally, and problem solve
o Resilience: Resistant quality that permits a
person to recovery quickly and thrive in spite of
adversity
 Stress
o Eustress
– Manageable Stress can lead to growth and enhanced
competence
o Distress
– Uncontrollable, prolonged, or overwhelming stress is
destructive.
o Acute Stress
– Immediate response to a threat or challenge
o Chronic Stress
– Ongoing exposure to stress, may seem unrelenting
 Causes of Stress

o External causes

– Family, work, economics, work, school,

major life changes, unforeseen events, etc.

o Internal causes

– Worry, uncertainty, fear, attitudes,

unrealistic expectations, etc.
 Sources of Clinical Stress

For patients For nurses

o Uncertainty o Poor patient
o Fear outcomes
o Pain o Risk of making an
o Cost error
o Lack of knowledge o Unfamiliar situations
o Risk for harm o Excessive workload
o Unknown resources o Inadequate
resources
 Stages of the Stress Response
General Adaptation Syndrome of Hans Selye (1907-1982)

o Alarm—when one feels threatened

– Activation of the fight or flight reaction
o Resistance—mobilization of resources to solve
the problem
– Continued stress causes adaptation
o Exhaustion
– Adaptation fails and level of function
decreases
 ALARM: Activation of Hypothalamic
Pituitary Adrenal Axis

Catecholamines Cortical Steroids

o Increases cardiac output o Elevates glucose

o Dilates airways o Increases amino acids
o Dilates pupils o Increases NA resorption
o Mobilizes glucose o Increases extracellular
o Causes vasomotor fluid volume
changes o Inhibits histamine and
o Decreases digestion bradykinin
o Enhances coagulation o Suppresses the immune
response
 Resistance

o Adaptation occurs
– Activation of the hypothalamic pituitary
adrenal axis continues
o The stressor may be resolved
– The body returns to homeostasis
o May progress to exhaustion
– Stress continues as resources are depleted
 Exhaustion

o Occurs when the demands of the stress

exceeds the persons ability to adapt.
o Functioning declines
o May result in health problems
– Physical symptoms
– Mental symptoms
 Signs & Symptoms of Stress
o Cognitive
– Decreased concentration, comprehension, & memory
o Behavioral
– Irritability, withdrawal, violence
o Emotional
– Fear, anxiety, depression, fatigue
o Physiological
– Increased BP, HR, Respirations, etc
– Somatic symptoms
– Decreased immune response
 Genetics & Development
Genetics
o Genes control the stress
response
– Individuals have different
responses to stress
o There is a genetic
component to:
– fearful behavior
– anxiety disorders
– Neurobiological response
Development
o Life experiences can
affect a person's stress
response
o Social support
– Strong support is protective
o Early life stress
– Increases stress reactivity
as an adult
 Coping & Resilience
Coping
o Ability to control
emotions
o Ability to perceive
reality
o Ability to think rationally
o Ability to problem solve
o Culturally defined
Resilience
o The ability to bounce
back
o The positive capacity to
cope with stress
o Provides resistance to
negative events
– Hardiness,
– Resourcefulness
 Coping

Adaptive Coping
– Contribute to resolution of the stress response

Maladaptive Coping
– Strategies that cause further problems

Active Coping
– Actively seeking resolution to the stress
 Promote Adaptive Coping
o Realistic expectations
– Set realistic goals
o Planning
– Anticipate problems, have a backup plan
o Reframing
– Change the way you look at things
o Relaxation
– Learn relaxation techniques, take time-out for
leisure
o Discuss the problem
– Utilize existing social supports to problem solve
 Promote Adaptive Coping

o Training
– Prepares for stressful events
o Nutrition
– Eat healthy, avoid skipping meals
o Exercise
– Include regular exercise
o Sleep
– Get adequate sleep—avoid fatigue
Avoid Maladaptive Coping

o Blurring of boundaries
o Avoidance/withdrawal
o Negative attitude
o Anger outbursts
o Alcohol/Drugs
o Hopelessness
o Negative self-talk
o Resentment
o Violence
Promote Resilience Factors

o Positive Role Models

o Optimism
o Humor
o Moral Compass
o Altruism
o Religion & Spirituality
o Social Support
 Positive Role Models

Transmit:

o Attitudes

o Values

o Skills

o Patterns of thoughts and behaviors

 Optimism

o Positive Beliefs
– Associated with well being
– Cognitive reframing
– Positive thinking
– Refute the negative thinking
– Believe in a meaningful cause

o It is important to acknowledge relevant

negative factors
 Humor

o Highly effective
o Mature coping mechanism
“Another of the souls’ weapons for the fight
for self-preservation, it is well known that
humor, more then anything else in the human
makeup, can provide an aloofness and the
ability to rise above any situation, even for a
few seconds.”
Viktor Frankl
 Moral Compass

o Conduct a moral inventory

– “Look not for any greater harm then this, destroying
the trustworthy, self-respecting, well-behaved man
within you.” Epicetus

o Maintain your integrity

– “Between stimulus and response there is a space. In
that space is our power to choose our response. In
our response lies our growth and our freedom.”
Viktor Frankl
 Altruism

o Unselfish regarding the welfare of others

o Believe in a meaningful cause
o Mutual cooperation
– Activates of the brain’s reward center
 Religion & Spirituality

o Associated with psychological and

physical well being
o Guards against despair
o Provides social support
o Provides positive role models
o Provides a positive mission
 Social Support

o Social support has a profound effect on

life expectancy
o Patients have better outcomes with
strong social support
o Isolation and poor social support are
associated with a poor stress response
o Few hardy individuals “go it alone”
 Signature Strengths

o Recognize skills and talents

– Inventory strengths

o Use your strengths and talents

– Decide what works

o Actively cope
– Apply concepts to enable active coping.
 Review
o Stress is part of everyday life
– It can promote growth and competency
– If unrelenting or overwhelming it can cause
adverse effects
o Adaptive coping enhances resilience
o Maladaptive coping causes additional problems
o Enhanced coping increases resilience while
diminishing the adverse affects of stress, thus
promoting health
 Review: Practical Tips

o Set realistic expectations

o Exercise regularly
o Eat healthy
o Get adequate sleep
o Maintain a work-leisure balance
o Positive Reframing & optimism
o Enhance social support
 Internet Resources
o Building resilience:
http://www.slideshare.net/3dogMcNeill/building-resilience
o Diet, exercise, stress and the immune system:
http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome
/hic_diet_exercise_stress_and_the_immune_system.aspx
o Exercise: Rev up your routine to reduce stress:
http://www.mayoclinic.com/health/exercise-and-stress/SR00036
o Positive thinking: Reduce stress, enjoy life more:
http://www.mayoclinic.com/health/positive-thinking/SR00009
o Stress management for patient and physician:
http://www.mentalhealth.com/mag1/p51-str.html
o Stress management: Understand your sources of stress:
http://www.mayoclinic.com/health/stress-management/SR00031
o Stress reduction techniques: A must for a healthy lifestyle:
http://www.managestresstips.com/category/stress-reduction/
 Learning Exercise

1. List your current sources of stress.

2. Conduct an inventory of coping strategies that
you use or have used in the past.
– Include maladaptive strategies
3. List your signature strengths and factors that
may enhance your resilience.
4. While considering the above, develop a
personalized stress management plan to
enhance your coping and resilience.
 References
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Images retrieved from Microsoft: http://office.microsoft.com/en-us/images/?CTT=97
 Contact Information

Allan Sanders, MN, ARNP

asanders@wsu.edu