Stress, Coping, and Health
ANXIETY
Dr. Davendra Sharma
The Relationship
Between Stress and Disease
• Contagious diseases
vs. chronic diseases
– Biopsychosocial model
– Health psychology
• Health promotion and
maintenance
– Discovery of
causation, prevention,
and treatment
Stress: An Everyday Event
• Major stressors vs. routine hassles
– Cumulative nature of stress
– Cognitive appraisals
Major Types of Stress
• Frustration: blocked goal
• Conflict: incompatible
motivations
– Approach-approach
– Approach-avoidance
– Avoidance-avoidance
• Change: having to adapt
– Social Readjustment
Rating Scale
– Life Change Units
• Pressure
– Perform/conform
Overview of the Stress Process
Responding to Stress Emotionally
• Emotional
Responses
– Annoyance, anger,
rage
– Apprehension, anxiety,
fear
– Dejection, sadness,
grief
– Positive emotions
• Emotional response
and performance
– The inverted-U-
Responding to Stress
Physiologically
• Physiological Responses
– Fight-or-flight response
– Selye’s General Adaptation Syndrome
• Alarm
• Resistance
• Exhaustion
Responding to Stress Behaviorally
• Behavioral Responses
– Frustration-aggression
hypothesis
– catharsis
– defense mechanisms
• Coping
– Reappraisal
– Confronting problems
– Using humor
– Expressing emotions
– Managing hostility
Effects of Stress:
Behavioral and Psychological
• Impaired task
performance
• Burnout
• Psychological
problems and
disorders
• Positive effects
Effects of Stress: Physical
• Psychosomatic diseases
• Heart disease
– Type A behavior - 3
elements
• strong competitiveness
• impatience and time
urgency
• anger and hostility
– Emotional reactions and
depression
• Stress and immune
functioning
– Reduced immune activity
Factors Moderating the Impact of
Stress
• Social support
– Increased immune functioning
• Optimism
– More adaptive coping
– Pessimistic explanatory style
• Conscientiousness
– Fostering better health habits
• Autonomic reactivity
– Cardiovascular reactivity to stress
Firefighter Specific Stressors
• Reliance on teamwork
• Low job control
• Sleep disturbances/Shift work
• Boredom
• Coworker conflict
• Management-Labor conflict
• Second jobs
• Marital/Family spillover
Firefighter Stress Reactions
• Apprehension/Dread
• Intrusive thoughts
• No hope
• Sleep difficulties
• Gastrointestinal symptoms
• Throat and mouth symptoms
At-Risk Firefighters
• Research reveals 2 distinct profiles for at-risk
firefighters
– Profile 1 (somaticizers) Reported greater frequency
and intensity of physical symptoms
• Head/neck/facial tension
• Gastrointestinal distress
• Cardiopulmonary complaints
– Profile 2 (psychological stress) Reported higher levels
of
• Apprehension/dread
• Anger
• Generalized anxiety
• Agitated depression
Implications for treatment
• Identify high-risk firefighters
– No penalty or stigmatization
• Potential interventions
– Psychoeducation
• Work redesign
• Coping skills training
• Relaxation training
• Conflict-resolution training
• Leadership training
• Sleep hygiene education
Coping Skills
• Problem-focused coping • Emotion-focused coping
– Taking direct action – Focusing on and venting
– Planning emotions
– Suppression of competing – Behavioral disengagement
activities – Mental disengagement
– Restraint coping – Positive reappraisal
– Seeking social support – Denial
– Acceptance
– Turning to religion
Stress and Adaptation
Anxiety
Dr. Davendra Sharma
MBBS(Ind.)MIHE (UK) DM (UWI)
Professor of Behavior Sciences
Clinical consequences
• Acute stress disorders
• Chronic stress associated with depression,
cardiovascular disease, respiratory problems,
poor wound healing, autoimmune disorders
Anxiety
• Can motivate one to act or can produce
paralyzing fear
• Symptoms of anxiety exist in healthy
individuals
• Diagnosed as anxiety disorder if anxiety is
excessive or out of proportion to the
situation
Degrees of Anxiety
Mild Aware, alerted, sees, hears and grasps more than before;
Learning is enhanced
Moderate Sees, hears, and grasps less than previously; Able to
sustain attention on a particular focus; Aware of anxiety
Severe Tendency toward dissociation; May be unaware of anxiety;
Requires intervention
Panic Massive dissociation; Learning is impossible; Perplexity;
Terror; Requires intervention
Factors Affecting Coping Patterns
Lifestyle considerations
• Diet- body better equipped to handle stress with
the right nutrients and balance
• Activity and Exercise- can be used as defense
mechanism, physiological benefits
• Sleep- need at least 6-9 hours, can cope with
stress better
• Safety and Security- security is based on
perception, safety can affect coping ability
Factors Affecting Coping Patterns
Previous Experience
• The way each stressor is handled and the
outcome of the event will influence subsequent
stressful situations
• Success in managing stress can build
confidence and lead to further success
Factors Affecting Coping Patterns
Involuntary Relocation
• Moving, hospitalization, discharge, nursing
home
Social Interaction
• Abuse, divorce, death
• Dysfunctional home situations can lead to a
lifetime of ineffective coping skills
Sensory Deficits
• Under stress it is difficult for a person with loss
of vision or hearing to effectively cope
Altered Coping Patterns
Addictive Behaviors
• Substance abuse, smoking, oversleeping,
over/under eating, over exercising, excessive
daydreaming, fantasizing
Physical Illness
• Chronic stress can lead to illness
• Impairs immune function
Altered Coping Patterns
Anxiety and Depression
• Extreme response to chronic stress can lead to
depression and suicide
• Poor coping mechanisms and inadequate
support can lead to suicide
Violent Behavior
• Poor impulse control and poor coping
mechanisms can lead to acting out violently and
abusing others
Assessment
1. Subjective data: How do you handle
stressful situations? What support systems
do you rely on? What present situations are
causing you stress?
2. Objective data: Mental Status Examination
Physical Assessment
Do not assume that the only cause of some
physical findings is stress
• Cardiovascular System
– Directly effected by epinephrine and norepinephrine
– Increased heart rate, “pounding chest”
– Increased blood pressure (systolic and/or diastolic)
– Irregular heartbeat and rhythm changes
– Angina
– Headaches
Physical Assessment
• Respiratory System
– Norepinephrine increases breathing rate and
bronchodilates
– ^RR
– hyperventilation
– “air hunger”
– dizziness
– tingling of hands and feet
Physical Assessment
• Gastrointestinal System
– Loss of appetite
– Nausea/vomiting
– Increased peristalsis
• hyperactive bowel sounds
• Increased # of bowel movements
• ^ hydrochloric acid → ulcers or gastritis
Physical Assessment
• Musculoskeletal System
– Increased tension in larger muscles
– Shakiness/tremors in smaller muscles
– Prolonged tension can lead to muscle spasms in
back, shoulders and neck
• Integumentary System
– Diaphoresis (sweating) and cool to touch
– Arrector pili muscle contraction
– Interventions: coping enhancement,
counseling, family support, support group
– Outcomes: acceptance of health status, social
interaction skills, self-esteem
