STRESS

Why study stress?

Epidemiological data
70%-80% of all visits to the doctor are for stress-related and stress-induced illness

Stress can cause or exacerbate (make worse) any illness.

Stress
-broad class of experiences in which tension occurs when demanding situations tax the resources,
coping and the level of adaptation of the individual
-state of anxiety produced when events and responsibilities exceed ones coping abilities
-the nonspecific response of the body to any demand placed upon the it to adapt, whether that demand
produces pleasure or pain
-the experience of perceived (real or imagined) threat to mental, physical, emotional and spiritual well-
being resulting in a series of physiological responses and adaptations

Stress: Good or Bad?

Good when it provides positive motivation.
3 Types of Stress:
1. Eustress-arise in many situations that a person finds inspiration and motivation
E.g. Joining a contest may be stressful but a person is very well motivated to win
2. Neustress-describes no consequential effect
3. Distress-considered as bad and simply abbreviated stress
-body is unable to adapt or balance (homeostasis)
Acute stress-short time, intense but disappear quickly
Chronic stress-prolong, may not be intense but lingers for a long time(hours, days)

Stress is viewed in 3 different ways:

Stress as a stimulus-a life event or set of circumstances
-disturbing and disruptive events within the environment
Stress as a Response-an outcome of a certain stimuli
-particular pattern of response to as to a stressor
Stress as a Transaction-a set of cognitive, affective and adaptive response that arise out of person-
environment transactions (broader, dynamic relationship)

Stress as a Stimulus (not flexible)

Some assumptions:
Life changes are normal and require the same type and duration of adjustment
People are passive recipients of stress and perception of events are irrelevant
All people have a common threshold of stimulus and illness results at any point after the threshold

Stress as a response
According to Phipps, et al, 1999; stress is a general term describing patterns of physiological and
psychological response to a variety of emotional and physical stimuli

Stress as a Transaction

STRESSOR
Stressor and stress

The pressure from the outside.

Stress is your response to your stressor.

Definition of Stressor
-any factor that produces stress and disturbs the bodys equilibrium or homeostasis thereby requiring
change or adaptation
-situations, circumstances, or any stimulus perceived to be a threat or that which causes or promotes
stress

2 Classification of Stressor:
1. Internal and external stressor
Internal
a. Lifestyle choices (caffeine, lack of sleep, overloaded schedule)
 b. Negative self talk (pessimistic thinking, self-criticism, over analyzing)
c. Mind trap-unrealistic expectations, taking things personally, all or nothing thinking, exaggeration,
rigid thinking)
d. Personality traits-perfectionist, workaholics, Type A
Type A
Hurry sickness
Quest for numbers (expected tasks/ goals should be reach)
Insecurity of status
Aggression and hostility
External
a. Physical environment(noises, bright lights, heat, confined spaces)
b. Social interaction(rudeness, bossiness, aggressiveness by others, bullying
c. Organizational (rules, regulations, red-tape e.g enrollment, deadline, deadlines)
d. Major Life events (birth, death, lost of job, promotion, marriage)
e. Daily hassles(commuting, traffic, lost keys, flat tire)

2. Intrinsic and Extrinsic factor

Intrinsic (can be control)
-can be created and exacerbated by poor time management, procrastination, poor
communication, catastrophic negative thinking to struggling with self-defeating behavior
Extrinsic
-stressors which people have no control of (e.g weather, traffic jam, death of spouse)
Adaptation-
Attempt to maintain optimal functioning
Maintain psychological equilibrium (behaviors)
Includes:
1. reflexes
2. autoimmune body mechanism for protection
3. coping mechanism
4. ideally lead to adjustment and mastery of a situation
Coping-process or skills that individual use to deal with events, circumstances or situations that are out of the
ordinary
- the cognitive and behavioral effort to manage specific external and internal demands that are
appraised as taxing the resources of person

Coping is the art of finding balance between acceptance and action of letting go and taking control.

Theories
WALTER CANNON
-Walter Cannons Theory noted to modes of immediate action (flight and attack or fight)
-1914 Harvard physiologists
-First coined the term Fight or Flight response (describes the dynamics involved in the bodys
physiological arousal to survive a threat)
Fight response-required physiologic preparations that would recruit power and strength for a short
duration
Flight response-induced by fear
-designed to fuel the body to endure prolonged movement such as running away from the
lions and bears
-includes not only fleeing but also hiding or withdrawing

4 STAGES OF FIGHT OR FLIGHT RESPONSE

a. Stage 1-Stimuli from senses: where the brain will interpret as a threat
b. Stage 2-Deciphers the stimuli: deciphers stimulus: threat or non-threat
c. Stage 3-Brain activates the nervous and endocrine system: body stays keyed-up till the threat is
over (heightened level of awareness)
d. Stage 4-returns to homeostasis

Manifestations
increased mental activity -bronchial dilatation to allow increase in oxygen
increased respiratory rate -dilated pupil
increased heart rate -increased flow to skeletal muscles
increased cardiac output -increased glucose
increased arterial BP
increased fatty acids
 HANS SELYE (put stress in a biological context)
-endocrinologist
-studied the effects of stress on the human body

Selye: Stress-induced changes

-enlargement of adrenal cortex
-constant release of stress hormone (corticosteroids)
-atrophy of lymphatic glands (thymus gland, spleen and lymph nodes)
-significant decrease in the WBC count
-bleeding ulcerations of the stomach and colon
-death of the organisms

Collective name for these changes:

General Adaptation Syndrome (GAS)
-process-body accommodate stress by adapting
-describes the bodys general response to stress
-neuroendocrine response

Selyes General Adaptation Syndrome

Phase 1: Alarm reaction (mobilize resources)
-describes Cannons fight-or flight response
-minute to hours
-protective resources mobilized
-body systems activated(nervous and endocrine system)
-hormone levels rise to fully prepare the body to react
(autonomic nervous system)

Phase 2: Resistance (cope with stressor)

First phase shock phase
-increase in energy level, oxygen intake, cardiac output, BP and mental alertness
Second phase: countershock reversal of body changes
-body reverts homeostasis by resisting the alarm
(still perceives the stress)
-vital signs, hormone levels, energy return to normal
-occurs when full syndrome is in place and stressor is being controlled
-body still activated but lesser intensity
-If damage too great3rd stage

Phase 3:Exhaustion
The body is unable to defend itself against the impact of the stressor
Physiological regulation diminishes
If stress continues, death may occur.

More of Selyes Work

Triad of Symptoms
Adrenal enlargement
Thymus atrophy
Gastric ulcers
L-HPA axis (HPA axis)
limbic-hypothalamic-pituitary-adrenal axis
plays a pivotal role in the stress response
mechanism for a set of interactions among glands, hormones and parts of the mid-brain that mediate a
general adaptation syndrome

Hypothalamus

Releasing factor (corticotrophin releasing factor)-a peptide hypothalamic hormone

releasing stimulating the release of ACTH from the anterior pituitary

Anterior Pituitary
 ACTH (Adrencorticotrophic hormone/adrenocorticotrophin/corticotrophin)
(Through blood)

Adrenal Cortex

Cortisol (glucocorticoids)

Review of Hormone Effects

A. ADH (Antidieuretic Hormone)
-other term is Vasopressin
-a hormone released by the pituitary gland that increases the reabsorption of water
-Primary purpose: Prevents diuresis (increase excretion in urine)
or regulates fluid loss by:
increase water retention
decrease urine output
decrease perspiration
-alters blood volume
-regulates blood pressure

B. ACTH (Adrenocorticotropic hormone)

-stimulates the adrenal cortex to release corticosteroids
glucocorticoids(any group of corticosteroids including cortisone-a naturally occurring
corticosteroid-, that are essential for the utilization of carbohydrate, fat, and protein) or
cortisol
mineralocorticoids (any of a group of corticosteroids, such as aldosterone that are necessary
for the regulation of salt and water balance) or aldosterone

C. Cortisol (major glucocorticoid synthesized and released by the human adrenal cortex)
-Increase gluconeogenesis (the production of glucose especially in the liver form amino acids, fats, and
other substances that are not carbohydrates) -increase in serum glucose level
-protein catabolism-degradation
decrease body weight
promotes muscle wasting
-also involved in Lipolysis (breakdown of fats into fatty acids and glycerol)
-suppression of the immune system
Appears to degrade WBC
-excess amount of cholesterol in blood artery plaque building hypertension & CHD (Coronary Heart
Disease)
-decrease insulin production
-promotes gastric acid secretion

D. Aldosterone-steroid hormone that is synthesized and released by the adrenal cortex and acts on the kidney
to regulate salt (potassium and sodium) and water balance
mineralocorticoid
secretion to maintain plasma volume and electrolytes (Na and K) balance
promotes Na retention
Enhances K elimination
Osmotic retention of water
Increase BP by increase blood volume

E. Other hormones released

Sex hormones
happy beta-endorphins
Growth hormones
In adrenal Medulla
Catecholamine(epinephrine and norepinephrine)

SYMPATHETIC NERVOUS SYSTEM (nerve cells involved in stress response: the part of the autonomic nervous
system that is active during stress or danger and is involved in regulating pulse and blood pressure, dilating
pupils, and changing muscle tone
and the Adrenal Medulla
The sympathetic Nervous System (SNS) division of the ANS confers an adaptive during the stressful situation.
The SNS is responsible for the Fight or-flight response

The hypothalamus
Has a direct neural pathway (sympathetic neural endings) that links it to the adrenal medulla
Initiates the activation of SNS

Through HYPOTHALAMUS
sympathetic
neural
endings

stimulation of SNS

ADRENAL MEDULLA

Release of catecholamines releases epinephrine

(acts as neurotranstmitter) and norepinephrine to the bloodstream

Norepinephrine -hormone and neurotransmitter: a hormone, secreted by the adrenal gland and similar to epinephrine,
that is the principal neurotransmitter of sympathetic nerve endings supplying the major organs and skin.
It increases blood pressure and rate and depth of breathing, raises the level of blood sugar, and decreases the activity of the
intestines.
Epinephrine-synthetic adrenaline: a synthetic form of adrenaline. Use: to relax the airways and constrict blood vessels.

EFFECTS OF CATECHOLAMINE RELEASE

Increase epinephrine increase heart rate
-increase oxygen intake
-increase blood sugar
-increase mental acuity
Increase norepinephrine
-increase blood flow to skeletal muscles
-increase arterial blood pressure
EFFECTS OF SNS AND PNS

Organ or gland Sympathetic actions Parasympathetic

(arousing) actions
(calm)
Pupils Dilate constrict
Salivary glands Reduce secretions secrete
Lungs Expand constrict
Heart Rate increase rate slows
Digestion Interrupted resumed
Adrenal gland secretes --------
Bladder ---------- Empty fluids
Arteries Constrict relax

PARASYMPATHETIC BRANCH: (2ND)

-responds after the emergency
-the system is attempting to achieve homeostasis
 -the parasympathetic corresponds to the adaptive or resistance stage

RESISTANCE STAGE:
(1)Stabilization, (2) hormonal levels return to normal, (3)parasympathetic nervous system activity,
(4)adaptation to stress

EXHAUSTION STAGE:
Body: cant resist stress
Energy: depleted and compromised
Physiologic response: intensifies
Adaptation to the stressor: diminished
Body: unable to defend itself

LAS (Local Adaptation Syndrome)

The body produces local responses to stress
Includes:
Blood clotting
Wound healing
Accommodation of the eye to light
Response to pressure
Characteristics
1. localized response
2. adaptive response
3. short term (does not persist)
4. response is restorative
Examples of LAS
Inflammatory Process
-stimulated by trauma or infection
Pain response
-purpose of pain-protection from further tissue damage
Ex. Removal of hand

Other Theories on Stress

JOHN MASONS THEORY OF SPECIFICITY OF THE STRESS RESPONSE (the psychological response
matters)
-Both a specific physiologic response and a non psychological response exists
-Stress response is dependent on the psychological factors.

Components of this theory include

-Cortisol hormonal response to stress increase in the following conditions
Individuals first experience a new stimulus
Individuals learn to avoid noxious stimuli; and
When individuals receive punishment
-Individuals can modify the control response by coping effectively with a stressor

LAZARUS THEORY
-Richard Lazarus Theories of the Stress Response
-Transaction-based models
-The degree of resistance to infection depends on how well a person copes with stress and general life
expectancies
-The brain, thru ones perception of the stressor appears to be the mediating influence on how the body
respond to stress

Hypothesized:
Accumulation of acute stressors or daily life hassles-just as likely to adversely affect ones
health as death of a spouse

Lazarus et al: Cognitive Model of Stress

Primary appraisal Second Appraisal Yes, I can

cope.
Minimum
STRESSOR Is this event beneficial, harmful, threatening, Can I cope with the stress?
 or challenging
Sorry , I cant
Emotions are generated by the appraisal. What are the alternatives?
cope. I experience
a lot of stress
E.g. Examdifficult---not passing
Alternatives study hard, read more

HAROLD WOLFFS THEORY

-Theory of Stress, Organ Maladaptation and Disease
-Disease: results from adaptive attempts to restore homeostasis that were appropriate in kind but
incorrect in magnitude.
-Stressors are created by the need to be successful at work and with other people.
-Some individuals consistently respond to frustrating situations through a response by a particular
body system or organ
-Pathological changes will eventually lead to tissue damage

III. MANIFESTATIONS OF STRESS

1. Physiologic
The physiological arousal proceeds along 3 main pathways
Musculoskeletal
Autonomic Nervous system
Psychoneuroendocrine system

Musculoskeletal-due to the increased activity of the Reticular Activating System (RAS)

Muscle tension-leads to siff neck, back pain, etc
Chest tightness or pain
Slumped posture

Autonomic Nervous System-via the sympathetic branchorchestrates (organize) a general arousal includes:
-Increase HR -heightened awareness of the environment is triggered
-Increase BP -blood shifts from visceral organ to large muscle groups
-Increase RR -Increase sweating of the hands
-Dilated pupils -Increase coagulability of blood
-Dry mouth

Psychoneuroendocrine System
Stimulates the HPA axis and secretions of glucocorticoids(primarily cortisol)
Manifestations:
-increase glucose levels
-Na retention (release of ADH-leads to increase BP)
-increases inflammatory responses
-eventually decreases the immune system

Other manifestations of the stress response: (due to neuroendocrine-immune interactions)

Pounding headache
Stiff neck
Increased incidence of infection
Alterations in sleep patterns
Other Fight or flight symptoms

Endocrine response
Suppression of growth-prolonged activation leads to suppression of growth hormone
Other hormones involved: ADH and sex hormones

Does stress cause infertility?

-Decrease of reproductive hormones (inhibition of sex hormones) by various components of the HPA axis
-sepsis and severe trauma can induce anovulation and amenorrhea in woman and decrease spermatogenesis
and decrease levels of testosterone in men (Porth)

2. Psychological or Emotional Symptoms of stress

-Fearful -lack of self-confidence
-helpless -fatigued
-sense of pending doom -irritable
 -insecure
-nervousness and anxiety
-boredom(no meaning to things)
-edginess(ready to explode)
-feeling powerless to change things(locus of control)
-loneliness
-overwhelming sense of pressure
-unhappiness for no reason
-easily upset

3. Spiritual Symptoms
-hopelessness -looking for magic
-feeling abandoned by God -loss of direction
-Blaming God for the suffering -cynicism (pessimistic)
-Doubting -apathy (no feelings)
-unforgiving -need to prove self
-martyrdom

IV. FACTORS INFLUENCING THE MANIFESTATIONS OF STRESS

1. Perception of stressors
-perception of control over the situation and the stressor may be potent factors in regulating the multi-
hormonal stress response
2. Number of stressors
-as the number of stressor increase, a persons ability to adapt is lessened
3. Effects of Prolonged stress (mental is affected)
4. Past experience
5. Age
Extreme ages-are more prone to stress
Infant-immature body systems
Elderly-decline in functioning reserves

V. STRATEGIES IN THE MANAGEMENT OF STRESS

A. To reduce stressful situation
1. Habituation
Establish routines
Change avoidance
Time blocking(specific period to address specific goals, increases feeling of control and feeling or
urgency)
Environmental modifications(avoid situations or people that cause stress)
2. Time management
Establish order of priorities
Learn to say No to potential disruptions
Schedule appointment
Set short-term goals (e.g daily) and long term goals(yearly)
B. To decrease physiological response to stress
1. Healthy eating
2. Physical activity
3. Adequate sleep and rest
4. Relaxation techniques
-Guided imagery
-visualization
-progressive muscle relaxation
-biofeedback
-Tai chi
-Qi Gong
5. Meditation
Focus Point-use to force out stressful thoughts
a. Mantra-syllable or sound
. Koan riddle
. Nadam-drum or thunder
. Other-environmental sounds, scenic vista, peaceful music, feel of warm sun on skin
. Mandala-geometric shape, a symbol representing the self and inner harmony

C. To improve behavioral and emotional response to stress

 Support system
Crisis Intervention
Enhancing self-esteem-monitor stress syndromes
Other specific stress management approaches
-developing self-awareness
-sleep hygiene
-Cognitive restructuring
Steps:
1. Awareness
2. Reappraisal
3. Adoption and substitution
4. Evaluation
-affirmations
-assertive communications
-I feel (emotion) when you (behavior) because (explanation).
-empathy
-healthy pleasures
-Spiritual practices
-setting realistic goals
-humor-releases endorphins (pain relieving properties)

JESUS NEVER FAILS