CHAPTER 10 UNDERSTANDING AND MANAGING RESPONSES TO STRESS

Terms in this set (38)

A technique for gaining conscious control over unconscious body functions, such as blood pressure and heartbeat. Feedback obtained by sensitive instruments can provide information on body function, and individuals can learn to monitor and control responses.

COGNITIVE REFRAMING

A process of changing an individual's perceptions of stress by reassessing a situation and replacing irrational beliefs.

COPING STYLES

Discrete personal attributes that people have and can develop to help manage stress.

DISTRESS

A negative, draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue

EUSTRESS

A positive type of stress that reflects a person's confidence in the ability to successfully master given demands or tasks.

FLIGHT-OR-FLIGHT RESPONSE

Fight-aggression
flight-withdrawal
The body's physiological response to fear or rage that triggers the sympathetic branch of the autonomic nervous system as well as the endocrine system. This response is useful in emergencies; however, a sustained response can result in pathophysiological changes such as high blood pressure, ulcers, and cardiac problems.

GENERAL ADAPTATION SYNDROME (GAS)

The body's organized response to stress, as elucidated by Hans Stelye. It progresses through 3 stages:
1. the stage of alarm
2. the stage of resistance
3. the stage of exhaustion.

GUIDED IMAGERY

A process whereby a person is led to envision images that are both calming and health enhancing.

HUMOR

Intensity of stressful thoughts of situations can be dissipated by viewing the absurd or comical aspects.

JOURNALING

Keeping a diary; may be informal or part of a treatment plan of daily events, activities, and feelings.

MEDITATION

A discipline for training the mind to develop greater calm and then using that calm to bring penetrative insight into one's experience.

MINDFULNESS

A centuries-old form of meditation the emphasizes awareness of ourselves and our mental activity from moment to moment.

PHYSICAL STRESSORS

Environmental and physical conditions that elicit the stress response.

PROGRESSIVE MUSCLE RELAXATION (PMR)

A method of decreasing anxiety in which the individual tenses groups of muscles as tightly as possible for 8 seconds and then suddenly releases them.

PSYCHOLOGICAL STRESSORS

Stressors of the psyche, including divorce, loss of a job, unmanageable debt, death of a loved one, retirement, and fear of a terrorist attack, as well as changes one might consider positive, such as marriage, arrival of a new baby, or unexpected success.

PSYCHONEUROIMMUNOLOGY

The study of the links among stress, the immune system, and disease.

RELAXATION RESPONSE

A set of physiological changes that result in decreased activity of the sympathetic part of the autonomic nervous system and a shift to the parasympathetic mode, which induces a state of relaxation. It is the opposite of the fight-or-flight response and has a stabilizing effect on the nervous system.

STRESSORS

Psychological or physical stimuli that are incompatible with current functioning and require adaptation

Physiological consequences of short-term stress

--Uneasiness and concern
--Sadness
--Loss of appetite
--Suppression of the immune system
--Increased metabolism and use of body fats
--Hypertension
--Infertility
--Impotence, anovulation (failure to produce or release eggs)
--Increased energy mobilization and use.
--Decreased memory and learning
--Increased cardiovascular tone
--Increased risk of blood clots and stroke
--Increased cardiopulmonary tone

Psychological consequences of long-term stress

--Anxiety and panic attacks
--Depression or melancholia
--Anorexia or overeating
--Lowered resistance to infections, leading to increase in opportunistic viral and bacterial infections
--Insulin-resistant diabetes
--Amenorrhea or loss of sex drive
--Increased fatigue and irritability
--Increased risk for cardiac events (heart attack, angina, and sudden heart-related death)
--Increased respiratory problems.

THE STRESS RESPONSE
SHORT-TERM EFFECTS:
HYPOTHALAMUS-PITUITARY-ADRENAL CORTEX (HYPAC)
Cortisol, corticoids, etc

DECREASED FLUID LOSS
INCREASED GLUCOSE BY GLUCONEOGENESIS
DECREASED INFLAMMATION
DECREASED BRAIN NOREPINEPHRINE

THE STRESS RESPONSE
SHORT-TERM EFFECTS: SYMPATHETIC
ADRENAL MEDULLA (SAM)
Epinephrine, norepinephrine, etc

INCREASED HEART RATE
INCREASED RESPIRATION
INCREASED PLASMA FFAs AND SUGAR
INCREASED TRIGLYCERIDES
INCREASED PLATELET AGGREGATION
DECREASED KIDNEY CLEARANCE
INCREASED BLOOD TO SKELETAL MUSCLES
INCREASED MUSCULAR TENSION

THE STRESS RESPONSE
SHORT-TERM EFFECTS:
HYPOTHALAMUS-PITUITARY-ADRENAL CORTEX (HYPAC)
Cortisol, corticoids, etc
---leads to--
LONG-TERM EFFECTS

--IMMUNE SYSTEM COMPROMISE
--ATHEROSCLEROSIS
--DEPRESSION
--HIGH BLOOD PRESSURE
--INSULIN INSENSITIVITY
--OBESITY
--HIGH BLOOD LIPIDS
--PROTEIN BREAKDOWN
----blood
----bones (osteoporosis)
----muscle (heart, too)
----immunoglobulin

THE STRESS RESPONSE
SHORT-TERM EFFECTS: SYMPATHETIC
ADRENAL MEDULLA (SAM)
Epinephrine, norepinephrine, etc
---leads to---
LONG-TERM EFFECTS

--HIGH RESTING HEART RATE
--HEART DISEASE
--PLATELET AGGREGATION
--REACTIVE HIGH BP
--HIGH CHOLESTEROL
--HIGH TRIGLYCERIDES
--RENAL/HEPATIC PROBLEMS
--GLUCOSE INTOLERANCE
--CHRONIC MUSCLE TENSION
--HYPERVENTILATION (CHRONIC)
--DIGESTIVE PROBLEMS
--CHRONIC ANXIETY/ANGER

ALL LONG-TERM EFFECTS LEAD TO

--ESSENTIAL HYPERTENSION
--HEART DISEASE/ATTACK
--STROKE
--ATHEROSCLEROSIS
--DIABETES
--CANCER
--ULCERS
--CHRONIC GI PROBLEMS
--ALLERGIES-ECZEMA
--AUTO IMMUNE DISEASES
--ARTHRITIS
--HEADACHES
--REDUCED IMMUNITY
--KIDNEY AND LIVER DISEASE

COMPARE AND CONTRAST CANNON'S fight-or-flight
SELYE'S general adapation syndrome
PSYCHONEUROIMMUNOLOGICAL models of stress
Cannon's fight-or-flight
1871-1945

Theories based on the sympathetic nervous system as a pathway of the response to stress, known more commonly as fight (aggression) or flight (withdrawal). The well known fight-or-flight response is the body's way of preparing for a situation and individual perceives as a threat to survival. This response results
in increased blood pressure, heart rate, and cardiac output.

COMPARE AND CONTRAST CANNON'S fight-or-flight
SELYE'S general adapation syndrome
PSYCHONEUROIMMUNOLOGICAL models of stress
Hans selye--general adapation syndrome
1907-1982

THE GENERAL ADAPTATION SYNDROME OCCURS IN 3 STAGES:
1. THE ALARM OR (ACUTE STRESS) STAGE
This is the initial, brief, and adaptive response to the stressor. during this phase there are 3 principle responses.
A. Sympathetic--increased heart rate, respirations and BP.
B. Corticosteroids released digestion is decreased.
C. Endorphins are released to reduce sensitivity to pain and injury.
This stage is extremely intense, and no organism can sustain this level of reactivity and excitement for long.
2. THE RESISTANCE STAGE
Also called the adaption stage--it is during this time sustained and optimal resistance to the stressor occurs. Usually, stressors are successfully overcome; however, when they are not, the organism may experience the final exhaustion stage.
3. THE EXHAUSTION STAGE
This occurs when attempts to resist the stressor prove futile. At this point, resources are depleted, and the stress may become chornic, producing a wide array of psychological and physiological responses and even death.
ONE OF THE MOST IMPORTANT CONCEPTS OF THIS THEORY IS THAT REGARDLESS OF THE THREAT, THE BODY RESPONDS THE SAME PHYSIOLOGICALLY.

COMPARE AND CONTRAST CANNON'S fight-or-flight
SELYE'S general adapation syndrome
PSYCHONEUROIMMUNOLOGICAL models of stress
Psychoneuroimmunology

Focuses on the interaction between psychological process and nervous and immune functions.
Stress through the hypothalamic-pituitary-adrenal and sympathetic-adrenal medullary axes, can induce changes in the immune system.

NEUROTRANSMITTER STRESS RESPONSE

SEROTONIN is a brain catecholamine that plays an important role in mood, sleep, sexuality, appetite, and metabolism. It is one of the main neurotransmitters implicated in depression, and many medications used to treat depression do so by increasing the availability of serotonin.
During times of stress, serotonin synthesis becomes more active. This stress-activated turnover of serotonin is at least partially mediated by corticosteroids, and researchers believe this activation may dysregulate (impair) SEROTONIN RECEPTOR SITES AND THE BRAIN'S ABILITY TO USE SEROTONIN.

EXPLAIN HOW COGNITIVE TECHNIQUES CAN HELP INCREASE A PERSON'S TOLERANCE FOR STRESSFUL EVENTS.

The goal of cognitive reframing, also known as cognitive restructuring is to change the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs ("I can't pass this course") with more positive self-statements (If I choose to study for this course, I will increase my chances of success). A positive correlation has been found between cognitive reframing and improved affect and higher self-esteem. We can learn from most situations by asking ourselves the following:
What positive things cam out of this situation or experience
What did I learn in this situation
What would I do in a different say.
Often, cognitive reframing is used along with progressive muscle relaxation, mindfulness, and guided imagery to reduce

Physical exercise and stress

Physical exercise can lead to protection from the harmful effects of stress on both physical and mental states.

You are caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm?

DRY MOUTH

If it is determined that a patient will benefit from guided imagery, what teaching should you provide?

ENVISION AN IMAGE OF A PLACE THAT IS PEACEFUL

Neal, age 30, will be undergoing biofeedback. Which statement by Neal indicates a need for further teaching?

"I will feel a small shock of electricity if I tell a lie."

Neal, age 30, will be undergoing biofeedback. Which statement by Neal indicates no need for further teaching?

"This will measure my muscle activity, heart rate, and blood pressure."
"It will recognize how my body responds to stress."
"The instruments will know if my skin temperature changes."

Your 39-year-old patient, Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is-:

Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you.

Which of the following are believed to help individuals mediate, or lessen the effects of stress. Select all that apply:

--Spirituality and/or religious beliefs
--Social support
--Culture

A MINDFULNESS TECHNIQUE

Creating space to come down from the worried mind and back into the present moment has been shown to be enormously helpful. When one is in the present, they ave a firmer grasp of all the options and resources that often make one feel better.
STOP
S-Stop what you are doing, put things down for a minute.
T-Take a breath, concentrate on the breathing.
O-Observe your thoughts, feelings, and emotions
P-Proceed with something this is important to you in the moment.

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