Stress

Professor: Mohamed Elwasify

Professor of Psychiatry - Mansoura
University
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Semester 8 Psychiatry Division

Stress
 Definition

It refers to the cognitive appraisal of

external events (transaction), in relation
to one's coping resources and its
physiological response in the individual
(arousal).
 Components of stress

Stressor Stress responses Stress

mediators
-Natural Physiological -Direct
disasters (arousal)
-Life changes Psychological -Indirect
-Chronic (transaction) -Increase or
conditions ………… decrease
 Components of stress
The External Components: The environmental events that precede
the recognition of stress (Stressors). It involves; a) Environmental
circumstances as natural disasters; b) Changing life events as losing a
job and c) Chronic conditions as crowding and poverty.

The Internal Components: It is the emotional and physical

response of the body to stressors (Strain). Objectively
measured by hormonal assay and polygraphic monitoring. It
passes through three stages (stress curve):
Alarm: Fight and flight, by release of sympathetic and pituitary
catecholamines.
Resistance: Persistence of high levels of hormones to adapt.
Exhaustion: Energy reserve is exhausted and breakdown
occurs. Parasympathetic division dominates with low arousal
resulting in depression and even death.
 Components of stress
• Exhaustion: Energy reserve is exhausted and breakdown occurs.
Parasympathetic division dominates with low arousal resulting in
depression and even death.
Alarm Resistance Exhausion
AlarmAAAAA Alarm Alarm
 Components of stress

• The Interaction between the Two

Components: The interaction between these
external and internal factors that determine
triggering of the proper response, i.e.
Transaction, passes through two steps: primary
and secondary cognitive appraisal.
The top Ten stresses

The loss of a loved one .

Major illness or injury.

Divorce or separation.

Serious financial difficulties.

Loss of job.

Getting married.

Moving to a new place.

A serious disagreement with a close friend.

Birth of a child.

Retirement:
The top ten stressful jobs

1. Inner city high school teachers

2. Police officers
3. Miners
4. Air traffic controllers
5. Medical interns
6. Stock brokers
7. Journalists
8. Customer service
9. Waitresses
10. Secretaries
Cognition: The entire range of mental
processesfrom input stimuli to output
response
Coping: Effort required to manage
stress
Vulnerability: In conditions exceeding
one's ability
Distress: Negative emotion: boredom
and dissatisfaction
 Cognitive appraisal (CA)

It is a two part mental process during which

ndecisions are made about stressful stimuli.
1-Primary CA
Deals with determination of stress as either:
a-Eustress with effort facilitation
b- Stressful: threatening with higher arousal
 Cognitive appraisal (CA) continued

2-Secondary CA
Deals with determination of one's coping either:
a- Sufficient: Siccessful coping
b-Insufficient:Vulnerable to illness
 Stress Mediators

Factors capable of increasing or decreasing the

effect of stress directly through arousal
(physiological) or indirect through transaction
(psychological, cognitive).
Some stress mediators (studies):
 Stress Mediators continued

1- Type A and B behaviour pattern

2- Social support
3- Personal control
- Locus: Rotters 1975: External and internal
4- Self efficacy (Bandura) 1982
5- Learned helplessness (Seligman; 1975)
 Stress Mediators continued
4- Hardiness (Kobosa; 1982): Commitment,
control and challenge.
5- Exercise activity (Roth; 1990).
6- Humour: ( Dixon; 1980).
7- Spritual support (Maton; 1989).
 Type A and B behavior pattern

Type A Type B

a) Competitive. a) Non competitive.

b) Goal striving without joy. b) Enjoys the process as much as the goal.
c) Time urgency, impatient. c) Patient.
d) Angry urgency hostile. d) Little anger and hostility.
e) Higher reactivity with rapid response to threat.
f) Take more activities thus increasing number
of stresses.
 Personal control
Having a sense of control makes it easier to deal stress and it encourages people to help
themselves (and vice is right).

• Three concepts are essential to identify in this issue:

• Locus of control (Rotter, 1975). Where person refers responsibility
for his successes and failures. It may be internals (they take the
responsibility for what happens to them) and externals (believe that
outside forces or chance circumstances, or fate, luck and other people
control their lives). Research suggests that internals are less
susceptible to medical and psychological problems.
• Self-efficacy (Bandura, 1982). A person’s belief in his own ability to
succeed at a task to cope. Beliefs that “I can do it” makes person
more able to cope with psychological or physical stress.
• Learned helplessness (Seligman, 1975) A sense that there is
nothing you can be done to make a difference develops when people
repeatedly fail in situations they are unable to control.
 Hardiness (Hardy personality)

It is a personality characteristic proposed by Suzanne

Kobasa (1982) as a mediator of stress. It combines 3
characteristics:
• Commitment: This develops when one approaches life with
a sense of meaning and active involvement in work
• Control: This is a feeling of being able to influence events.
• Challenge: This is a view of change as an opportunity for
growth rather than thereat.

• Those people are less likely to perceive stress as harmful

and they are better equipped to cope with it if they do.
 Signs & symptoms of stress
• Physical signs of stress:
1. Tiredness, fatigue, lethargy.
2. Heart palpitations, racing pulse, rapid shallow breathing.
3. Muscle tension and aches.
4. Shakiness, tremors, tics, & twitches.
5. Heart burn, indigestion, diarrhea, constipation, nervousness.
6. Dry mouth & throat. 7. Excessive sweating, clammy hands, cold hands &
feet.
8. Nail biting, hair twirling, or hair puling.
9. Frequent urination.
10. Overeating or loss of appetite.
11. Sleeping difficulties.
12. Increased use of alcohol and/or drugs and medications.
 Signs & symptoms of stress
• Psychological signs of stress:
• Irritability, impatience, anger, hostility.
• Worry, anxiety, panic.
• Moodiness, sadness, feeling upset.
• Intrusive thoughts or racing thoughts.
• Memory lapses, difficulties in concentrating in decision.
• Loss of sense of humor.
•
• Prolonged and/or intense stress can have more serious effects.
• heart diseases (ischemia, hypertension, angina)
• Peptic ulcer
• Stress may play role in exacerbating a variety of immune system
disorders such as: HIV, herpes, cancer metastasis, viral infection,
and autoimmune diseases as rheumatoid arthritis.
•
Thank You
 Managing stress continued

2- Transaction management
To affect the cognitive appraiasal when facing
stress. It seeks control by cerebral cortex, either:
1- Problem focused coping: With changeable
problems
2- Emotion focused: Unchangeable situations:
a- By distracting one's self
b- Changing CA: Cognitive re-definition
 Managing stress
The goal is not to eliminate stress but to learn
how to live compatibly with it.
Appling the biopsychosocial model:
1- Arousal management:
To affect physiological responses bytargeting the
autonomic NS to re-establish homeostasis: By
medication- Relaxation traing-Exercise
 References
1-Keil, R.M.K. (2004) Coping and stress: a conceptual analysis
Journal of Advanced Nursing, 45(6), 659–665
2-Ulrich-Lai, Y. M.; Herman, J. P. (2009)."Neural regulation of
endocrine and autonomic stress responses".Nature Reviews
Neuroscience 10 (6): 397–409