HSS 1101 - Determinants of Health
[Link]
Chapter 3
Stress – The
Constant
Challenge
Slides prepared by:
Dave Kato
MacEwan University
Answer each question with a number:
never = 0; almost never = 1; sometimes = 2; fairly often = 3; very often = 4. Stress
In the past week, how often have ALMOST FAIRLY VERY OFTEN
you… NEVER NEVER SOMETIMES OFTEN • How it is perceived is dependent on the individual
Been upset because of something • Stressor: A situation or event that triggers physical
1. 0 1 2 3 4
that happened unexpectedly? and emotional reactions
Felt that you were unable to • Stress response: The physical and emotional
2. control the important things in 0 1 2 3 4
your life?
changes associated with stress or a stressor.
3. Felt nervous and “stressed”? 0 1 2 3 4
*Felt confident about your ability
4. to handle your personal 0 1 2 3 4
problems?
*Felt that things were going your Table 3.1 Perceived Stress Scale
5. 0 1 2 3 4
way? To calculate your score, add your answers to
6.
Found that you could not cope
with all the things you had to do?
0 1 2 3 4 questions 1, 2, 3, 6, 9, and 10, and subtract your
answers to questions 4, 5, 7, and 8 (the questions
*Been able to control irritations in
7.
your life?
0 1 2 3 4 with the asterisks). The result is your total score.
8.
*Felt that you were on top of
0 1 2 3 4
If your total score is above 14, you should take time
things?
to develop effective stress management techniques.
Been angered because things
9. happened that were outside your 0 1 2 3 4 This chapter describes many coping strategies that
control? can aid you in dealing with college stressors. Your
Felt difficulties were piling up so school’s counselling center also can provide valuable
10. high that you could not overcome 0 1 2 3 4
them? support.
Source: Adapted from Cohen, S., Kamarck, T., & Mermelstein,
R. (1983). A global measure of perceived stress. Journal of
Health and Social Behavior, 24, 386–396. 3
Actions of the Nervous System
• Autonomic system (“Automatic system”) – not under voluntary control
• Sympathetic
• Activated in times of arousal: emergency, fear or anger, respond to a crisis
• Uses the neurotransmitter norepinephrine
• Parasympathetic
• Relaxation
• The opposite action of the sympathetic system
Actions of the Endocrine System
• Releases hormones into the bloodstream
• Influences metabolism and other body processes
• Prepares the body to respond to the stressor
Two Systems Together
• People respond differently to various stressors (fight, flight, or freeze reactions)
• Common response is flight
• Freezing may occur because of previous trauma
• Aggression may display fewer freezing reactions
• Heightened reflexes to deal with the stressor
• Stressors can be: Positive, Negative, Physical, Psychological
• Release of chemical messengers: cortisol and epinephrine (adrenaline)
• Triggers:
• Heart and respiration rates accelerate
• Hearing and vision become more acute
• Liver releases extra glucose into the bloodstream
• Perspiration increases to cool skin
• Brain releases endorphins
Figure 3.1 Physiological Changes During
Stress
Return to Homeostasis
•Parasympathetic system takes
over and halts the stress
response
•Restoration of homeostasis
•Calms your body and resumes
normal functioning
•Extra glucose is reabsorbed
6
Figure 3.2 Stress Level, Performance and Well-Being
Cognitive Responses
• Appraisal of a potential stressor
influences how you respond to it
• Two factors:
• Successful prediction of the outcome
• Perception of control
• Related to emotions:
• What does this mean for me?
• Who, what, where when?
• Can I do anything about it?
• Will it improve or worsen?
Source: Babson College. 2018. Stress. [Link]
promotion/Pages/stress/aspx.
Psychological Responses
• Common responses include anxiety, depression, fear.
• Controlled by the somatic nervous system (entirely under our control)
• Effective behavioural responses include:
• Laughing, Exercising, Meditating, Time management skills
• Ineffective behavioural responses include:
• Overeating, Expressing hostility, Using tobacco, alcohol or other drugs
Personality and Stress
• Personality is the sum of cognitive, behavioural, and emotional tendencies
• Most widely used model is called the Big Five Model (Five Factor Model)
• Consciousness, Agreeableness, Neuroticism, Openness to experience, Extraversion
• Trait anxiety
• People with higher trait anxiety are more vulnerable to stress than those that score low on
this trait
• Resilience
• Resilience helps people handle stress more positively
• Academic resilience helps students succeed
• Research suggests that you can change some of your basic elements of your
personality
Cultural Background
• Clashing of cultures can be a major source of stress
• Centres around disrespectful treatment
• Learn to accept and appreciated the cultural backgrounds of other people
Experience
• Past experiences can influence the reaction to a particular stressor
• E.g., A person may have had a bad experience in a public speaking activity and may be more
distressed about an upcoming public speaking activity
The Stress Experience as a Whole
• Although the behavioural symptoms of excess negative stress are distinct, they are
intimately interrelated.
• Effective behavioural responses can lessen stress while ineffective responses may make it worse
• Development of appropriate coping skills
• May need professional help in this area
• Most people can learn to handle stressors on their own. Strategies may include:
• Building greater social support systems
• Contributing to your family and community in productive manners
• Building life skills such as decision making
• Set high but realistic expectations for yourself
• Avoid the urge to control every situation
• Know your limits
• Trust others
General Adaptation Syndrome (GAS)
• Modeled by Hans Selye (believed to be universal response to stressors)
• Three stages of the GAS
1. Alarm
2. Adaptation
3. Exhaustion
• Pleasant stress is referred to as eustress
• Unhappy or unpleasant stress called distress
Figure 3.3 The General Adaptation Syndrome
During the alarm phase, a lower resistance to injury is evident. With continued stress, resistance to
injury is enhanced. With prolonged exposure to repeated stressors, exhaustion sets in, with a
return of low resistance levels seen during acute stress
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Allostatic Load
• Long term distress causes exposure to stress hormones such as cortisol
leading to some health problems
• Heart disease // Obesity // Hypertension
• Long term wear and tear of the stress response is called the allostatic load
• Allostatic load may be due to:
• Frequent stressors
• Poor adaptation to common stressors
• Imbalances in the stress response systems in the body
• Genetics
• Life experiences
• Behavioural responses to stressors
Psychoneuroimmunology
• Study of the interactions between the nervous system and the endocrine system
• Immune system is remarkably flexible and adaptable
• Chronic stress may have substantial consequences in persons predisposed to or
experiencing disease
• Complex network of interactions between the two systems
• Cortisol decreases the number of immune cells
• Epinephrine promotes the release of immune cells but decreases their efficiency
• Neuropeptides translate successful emotions into biochemical events
Psychoneuroimmunology
• Different types of stress affects immunity in different ways
• Acute stress may cause white blood cells to move into the skin
• Personal trauma may not cause significant immune changes
• Chronic stress (unemployment) may accelerate the rate of inflammatory diseases
• Heart disease // Type 2 diabetes // Multiple sclerosis
• Mood, personality and immune function are intertwined
• Those who are generally pessimistic may neglect the basics of health care
• Those who are depressed may reduce physical activity and social interaction
• Optimism, successful coping and positive problem-solving may positively impact
immunity
Cardiovascular Disease
• Heart rate increases and blood vessels constrict causing an increase in blood
pressure (hypertension)
• Chronic hypertension can lead to atherosclerosis
• Cause of heart attacks and strokes
• People who tend to react to stressors with anger and hostility are more likely
to have cardiac events
• Stress increases inflammation throughout the body
• Stress increases the level of cholesterol plaque in the blood vessels
• Increased levels of homocysteine and C-reactive protein (CRP)
• Elevated levels of CRP are linked to insulin resistance
Altered Functioning of the Immune System
• PNI research helps explain the effects of stress on the immune system
• Health problems have been linked to stress related changes in the immune system
• A person is more susceptible to common infections:
• Colds
• Flu
• Asthma
• Flare up of chronic disease
• Susceptibility to some cancers
Other Health Problems
• Other health problems that are mediated by stress include:
• Digestive problems
• Cancer
• Asthma
• Tension headaches
• Insomnia and fatigue
• Injuries – on the job injuries caused by repetitive strain
• Menstrual irregularities, erectile dysfunction, and pregnancy complications
• Loss of interest in enjoyable activity
• May make underlying conditions worse
Major Life Changes
• Any major life change is stressful and requires a certain level of adjustment
• Graduation
• Marriage
• Birth of a child
• Clusters of negative life changes may be linked to health problems
• Personality and coping skills are important
• A strong support network and stress-resistant personality is beneficial
Daily Hassles
• Minor problems can have a greater impact since they happen more often
• Persons perceiving hassles negatively are more likely to experience a moderate
stress response
• Daily hassles may lead to a decrease in overall general wellness
Post Secondary Stressors
• University or college is a major source of stress:
• Academic stress
• Interpersonal stress
• Time pressures
• Financial concerns
• Worries about the future
Job-Related Stressors
• Job stress is a world-wide epidemic (WHO)
• Unemployment and job instability are key stressors
• High levels of stress demonstrated if employees are left out of important decisions
• Severe or chronic stressors can lead to burnout
• Associated in persons who feel their contributions are not valued
• People in helping professions are most affected
• Millions of workdays are lost due to illness
• Stress related sleep disturbances, headaches, and damaged relationships
• Chronic diseases are harder to identify since they take longer to develop
• For people with high levels of stress, their health care costs are 50% higher
Social Networks & Stressors
• Social support can be a buffer again stress
• Change in interpersonal relationships
• Social stressors include discrimination and prejudice
• Members of a visible minority ethnic group face pressures to assimilate or focus socializing
to people who share the same background
• If English is not your first language, potential burden of conducting daily activities in a
language with which you are not comfortable.
Virtual Social Networks & Stressors
• Increased electronic interactivity may impinge on personal space, facilitate cyber-bullying
• The effect of being “on” all the time comes at a price
Environmental Stressors
• Most are inconveniences that are easy to avoid // Others, such as war or
violence, may be a significant source of unavoidable stress
• Examples of environmental stressors include:
• Pandemics, Natural disasters, Acts of violence, Industrial accidents, Intrusive noise or smells
Internal Stressors
• Some stressors are within ourselves
• Pressure to reach goals, evaluate progress and performance
• Unrealistic expectations
• Illnesses and exhaustion
Managing Stress
Figure 3.4 Changing Levels of Stress Hormones in the Bloodstream
• You can control and minimize the
impact of stress by:
• Shore up your support system
• Improve communication skills
• Be nurturing and kind to others
• Develop healthy exercise, eating and
sleeping habits
• Identify and moderate stressors in your life
• Learn mindfulness skills
Stress hormones, such as cortisol, fluctuate throughout the day and night and reach a high level during the last stages of sleep.
Source: Palma B. D., Tiba, P. A., Machado, R. B., Tufik, S., & Suchecki, D. (2008). Immune outcomes of sleep disorders: The h ypothalamic-pituitary adrenal axis as a modulatory factor.
Revista Brasileiro de Psiquiatria, 29 Suppl(1), S33–S38, Figure 3.1 .
Cultivating Spiritual Wellness
• Linked to longer life expectancy, reduced risk of disease and faster recovery
• Associated with more effective coping skills
• Developing spiritual wellness:
• Look inward
• Spend quiet time
• Spend time in nature
• Notice art, architecture and music
• Engage in favourite activity
• Reach out to others
• Engage in personal spiritual practice
• Practice small acts of personal kindness
Time Management
•Can be critical in dealing with • Keep track of the tasks put off
everyday stressors • Consider doing the least favorite task first
• Consolidate tasks when possible
• Identify quick transitional tasks
•Time management Skills • Delegate responsibility
• Set priorities • Say no when necessary
• Schedule tasks • Give yourself a break
• Set realistic goals • Avoid personal time sinks
• Budget your time • Stop thinking or talking about it, just do it!
• Break up long term engagements
• Visualize the achievement of your goals
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Cognitive Techniques
• Some stressors arise in our own minds
• Techniques can help change unhealthy thought patterns:
• Think and Act Constructively
• Take control
• Problem solve
• Modify Your Expectations
• Stay Positive
• Cultivate Your Sense of Humour
• Focus on What’s Important
Confiding in Yourself Through Writing
• Keep a diary (helpful for shy or introverted people)
• Write about the emotional responses to stressful events
• Set aside a special time each day to write
Relaxation Techniques & Progressive Relaxation
• Characterized by a feeling of warmth and quiet mental alertness
• Simply tense and relax your muscles – group by group
• Eases up on stress response
• Start with one group, inhale, tense, exhale and relax
Meditation
• Meditation is used by many cultures all over the world
• Tells the mind to be quiet for a while
• Temporarily tune out the world
• Mindfulness meditation
Visualization
• Daydream without guilt
• Helps you relax, change your habits or perform well
• Go to your “happy place”
• Can be used to rehearse for an upcoming event and enhance performance
Deep Breathing
• Breathing pattern is tied to the stress level: Breathing techniques can be
used for on the spot tension relief
• Change from a chest breather to a stomach breather
• Stomach (diaphragmatic) breathing is slower and more relaxing
Yoga
• Hatha yoga emphasizes physical balance and breath control
• Integrates components of flexibility, muscle control, and relaxation
Tai Chi
• Brings the body into balance and harmony
• Practitioners remain calm and centred – gentle, slow, fluid, and elegant
movements
Listening to Music
• Can influence pulse, blood pressure and electrical activity of muscle
• Newborns are calmed by listening to music
• Reduces the levels of stress hormones
• Set aside time to listen to music – makes you feel more relaxed
Biofeedback
• Reduce the stress response by being more aware of the physiological arousal
• Involves electrical monitoring of some measure of physiological stress
• Idea is to learn what relaxation feels like and how to introduce it
• These techniques are designed to facilitate resilience
• Experience fewer negative impacts from stressors
Counterproductive Coping Strategies
• Tobacco Use
• Use of Alcohol and Other Drugs
• Other Psychoactive Drugs (caffeine, marijuana, opioids)
• Unhealthy Eating Habits
Identifying Stressors
• Before you can manage stressors, you
need to know what they are
• Keep a journal for a couple of weeks
• Note your actions, feelings, time,
circumstances and outcome of the
response
• Take note of any evolving patterns
• Keeping a journal allows for analysis of
behaviour
Tracking stressful events and reactions can help you understand how
you normally cope with stress.
Designing Your Plan
• Choose strategies that work for you
• Find a friend to work with
• Draw up a formal contract with yourself
• Evaluate your plan regularly
Getting Help
• Self-help guides can be found online or in the library
• Consult the student health office
• Find support groups
• Short term psychotherapy has been shown to help
• Choose one you are comfortable with
