/What Is Stress?

What Is Stress?

The condition of stress has two components: physical, involving direct material or bodily challenge, and psychological, involving how individuals perceive circumstances in their lives. These components can be examined in three ways. One approach focuses on the environment: stress is seen as a stimulus, as when we have a demanding job or experience severe pain from arthritis or a death in the family. Physically or psychologically challenging events or circumstances are called stressors.  The second approach treats stress  as a response,  focusing on people’s reactions to stressors. We see an example of this approach when people use the word stress to refer to their state of tension. Our responses can be psychological,  such as your thought patterns and emotions when you ‘‘feel nervous,’’ and physiological, as when your heart pounds, your mouth goes dry, and you perspire. The psychological and physiological response to a stressor is called strain.

The third approach describes stress as a process that includes stressors and strains, but adds an important dimension: the relationship between the person and  environment. This process involves continuous interactions and adjustments—called transactions—with the person and environment each affecting and being affected  by the other. According to this view, stress is not just a stimulus or a response, but rather a process in which the person is an active agent who can influence the impact of a stressor through behavioral, cognitive, and emotional strategies. People differ in the amount of strain they experience from the same stressor. One person  who is stuck in traffic and late for an important appointment keeps looking at his watch, honking his horn, and getting angrier by the minute; another  person in the same circumstances stays calm, turns on the radio, and listens to music.

We will define stress  as the circumstance in which transactions lead a person  to perceive a discrepancy between the physical or psychological  demands of a situation and the  resources  of his  or her  biological,  psychological,  or social resources.

Components of the Definition of Stress

Resources: Stress taxes the person’s biopsychosocial resources for coping with difficult events or circumstances. These resources are limited. as we saw when Vicki had depleted her ability to cope with her problems, became ill, and sought counseling.

Demands: The phrase ‘‘demands of a situation’’ refers to the amount of our resources the stressor appears to require.

Discrepancy: When there is a poor fit, or a mismatch,  between the demands of the situation and the resources of the person,  a discrepancy exists.

Transactions:  In our transactions with the environment, we assess demands, resources, and discrepancies between them. An important point  to  keep  in  mind  is  that  a  demand, resource, or discrepancy may be either real or just believed to  exist.  As an  example,  suppose you had  to  take  an exam  and  wanted  to  do  well, but  worried greatly that you would  not.  If you had  procrastinated and  did  not prepare  for the  test,  the  discrepancy  you see  between the  demands and  your resources might  be  real. But if you had previously done well on similar exams, prepared thoroughly for this one, and scored well on a pretest in a study guide yet still thought you would not do well, the discrepancy you see  would not reflect the  true state  of affairs. Stress often results  from inaccurate  perceptions of discrepancies between  environmental demands and the actual resources.  Stress is in the eye of the beholder.

APPRAISING EVENTS AS STRESSFUL

Transactions in stress generally involve an assessment process that Richard Lazarus and his coworkers call cognitive appraisal. Cognitive appraisal is a mental process by which people assess two factors:
(1) Whether a demand threatens their physical or psychological well-being and
(2) The resources available for meeting the demand. These are called primary and secondary appraisal.

Primary and  Secondary Appraisal

When we encounter a potentially stressful  circumstance. For   example,   feeling symptoms of pain or nausea—we first try to assess the   meaning   of  the situation for our well-being. This assessment process  is called primary appraisal.  This appraisal seeks answers to such questions as, ‘‘What does this mean to me?’’ and ‘‘Will  I be  okay or in trouble?’’ Your primary appraisal regarding  the  pain  or nausea could  yield one  of three judgments:

It is irrelevant—as  you might decide if you had had similar symptoms  of pain and nausea before that lasted  only a short while and were not followed by illness.

It is good (called ‘‘benign-positive’’)—which might be your appraisal if you wanted very much to skip work or have a college exam postponed.

It  is  stressful—as you  might  judge  if  you  feared  the symptoms  were of a serious illness, such as botulism (a life-threatening type of food poisoning).

Circumstances we appraise as stressful  receive further appraisal for three  implications: harm-loss, threat,  and challenge.

Harm-loss refers to the amount of damage that  has already occurred, as when someone is incapacitated and in  pain  following a  serious  injury. Sometimes people who experience a relatively minor stressor think of it as a ‘‘disaster,’’ thereby exaggerating  its  personal impact and increasing their feelings of stress. Threat involves the expectation of future  harm—for  example, when  hospitalized patients contemplate their  medical bills, difficult rehabilitation, and loss of income.  Stress appraisals seem  to  depend heavily on  harm-loss and threat. Challenge is  the  opportunity to achieve growth, mastery, or profit by using more than routine resources to meet a demand. For instance, a worker might view an offer of a higher-level job as demanding, but see it as an opportunity to expand her skills, demon- strate  her ability, and make more money. Many people are happiest when they face challenging  but  satisfying activities.

Secondary  appraisal  refers to  our  assessment of the  resources we have  available  for coping.  Although these  assessments occur continuously in our transactions,   we  are   especially   aware   of  our   secondary appraisals when  we  judge  a  situation as  potentially stressful  and  try to  determine whether  our  resources are  sufficient  to  meet  the  harm,  threat,  or  challenge we face.  Examples  of  secondary  appraisal judgments include:

 

  •  I can’t do it—I know I’ll fail.
  •  I’ll try, but my chances  are slim.
  •  I can do it if Ginny will help.
  •  If this method  fails, I can try a few others.
  •  I can do it if I work hard.
  •  No problem—I can do it.

 

When we judge our resources as sufficient to meet the demands, we may experience  little or no stress; but when we appraise demands as greater  than  our resources, we may feel a great deal of stress.

 

DIMENSIONS OF STRESS

Anyone who has  experienced  a very frightening  event, such as a near accident  or other emergency, knows that there are physiological reactions to stress for instance, almost immediately our heart begins to beat more rapidly and more forcefully, and the skeletal muscles of our arms and legs may tremble. The body is aroused and motivated to defend  itself,  and  the  sympathetic nervous  system and the endocrine system cause this arousal  to happen. After the  emergency  passes, the  arousal  subsides. The physiological portion  of the response to a stressor or strain is  called  reactivity, which researchers measure by comparison against  a  baseline, or  ‘‘resting,’’ level of arousal. Genetic factors influence people’s degree of reactivity to stressors. People  who  are  under  chronic stress  often show heightened reactivity when a stressor occurs, and their arousal  may take more time to return to baseline levels.

The   distinguished  physiologist Walter Cannon  (1929) provided  a basic  description of how the body reacts  to emergencies. He was interested in  the  physiological   reaction   of  people   and  animals to perceived  danger.  This reaction  has  been  called  the fight-or-flight response because it prepares the organism to attack the threat or to flee. In the fight-or-flight response, the perception of danger causes the sympathetic nervous system  to  stimulate many  organs,  such  as  the  heart, directly, and stimulates the adrenal  glands of the endocrine  system,  which secrete  epinephrine, arousing  the body  still  further.  Cannon  proposed that  this  arousal could have positive or negative effects: the fight-or-flight response is adaptive  because it mobilizes the organism to respond quickly to danger,  but this high arousal  can be harmful to health  if it is prolonged.

 

General Adaptation Syndrome

What happens to the  body when high stress  levels are prolonged? Hans Selye, the father of stress, studied this issue  by subjecting laboratory  animals  to  a  variety  of stressors—such as very high  or  low environmental temperatures,  X-rays, insulin  injections,  and  exercise—over  a long period  of time.  He also observed  people  who experienced  stress from being ill. Through this research,  he discovered that the  fight-or-flight  response is only the  first in a series of reactions the body makes when stress  is long-lasting. Selye called this series of physiological reactions the general adaptation syndrome (GAS). The GAS consists of three stages:

  1.    Alarm reaction.  The first stage  of the  GAS is like the fight-or-flight response to an emergency—its  function is  to  mobilize  the  body’s  resources. This fast-acting arousal  results  from the  sympathetic nervous  system, which activates many organs through direct nerve connections, including the adrenal  glands, which when stimulated  release   epinephrine  and   norepinephrine into the bloodstream, producing further activation. Somewhat less quickly, the hypothalamus–pituitary–adrenal axis (HPA) of the stress  response is activated,  and this component of the  stress  response was Selye’s novel and main emphasis. Briefly, the hypothalamus triggers the pituitary  gland to secrete  ACTH, which causes  the adrenal  gland to release  cortisol into the bloodstream, further enhancing  the body’s mobilization.
  2.    Stage  of resistance. If a strong stressor continues, the physiological  reaction  enters  the  stage  of resistance. Here, the  initial  reactions of the  sympathetic nervous system  become  less  pronounced and  important, and HPA activation  predominates. In this  stage,  the  body tries  to  adapt   to  the  stressor.   Physiological  arousal remains  higher than normal, and the body replenishes the hormones the adrenal glands released. Despite this continuous physiological  arousal,  the  organism  may show  few outward  signs  of stress.  But  the  ability  to resist  new stressors may become  impaired.  According to Selye, this impairment may eventually make the individual vulnerable  to the health  problems  he called diseases  of  adaptation.    These  health   problems   include ulcers, high blood pressure, asthma, and illnesses that result from impaired immune  function.
  3.    Stage  of exhaustion.  Prolonged  physiological  arousal produced   by  severe  long-term  or  repeated stress   is costly. It can weaken the immune  system  and deplete the   body’s  energy  reserves   until  resistance  is  very limited.  At this  point,  the  stage  of exhaustion begins. If the stress  continues, disease and damage  to internal organs are likely, and death  may occur.

Four  factors  are  important in  the  overall  amount   of bodily activation  or physiological  stress

  1.    Amount of exposure.   This is  obviously  key:  when  we encounter more frequent,  intense, or prolonged  stressors, we are likely to respond with a greater total amount of physiological activation.
  2.    Magnitude of  reactivity.   In  response  to  any  particular stressor,  such as taking a major academic  exam, some individuals  will show large increases in blood pressure or stress  hormones while others  show  much  smaller changes.
  3.    Rate of recovery.  Once  the  encounter with a stressor is over, physiological  responses return  to normal  quickly for some  people,  but  stay elevated  for a longer  time for others.  Continuing  to  think about  a stressor after it is over, revisiting  it mentally,  or worrying about  it recurring in the future can delay physiological recovery and  add  to  the  accumulated toll  through  prolonged physiological activation.
  1.    Resource restoration. The resources used in physiological strain are  replenished by various  activities, and sleep  may be the most  important of them. Sleep deprivation can be a source of stress,  and contributes to allostatic load directly. What’s more,  poor  sleep  quality  or reduced  amounts of  sleep  predict  the  development of  serious   health problems, such as heart disease.
culture monerkhabor

Three Main Types of Conflict

Approach/approach or double approach: Choice involves two appealing goals that are incompatible. For example, individuals trying to lose weight to improve their health or appearance experience frequent conflicts when delicious, fattening foods are available. Although people generally resolve an approach/approach conflict fairly easily, the more important the decision is to them, the greater the stress it is likely to produce.

Avoidance/avoidance or double avoidance:  Choice between two undesirable situations. For example, patients with serious illnesses may be faced with a choice between two treatments that will control or cure the disease, but have very undesirable side effects. People in  avoidance/avoidance conflicts usually try to postpone or escape from the decision; when this is not possible, people often vacillate between the two alternatives, changing their minds repeatedly, or get someone else to make the decision for them. People generally find avoidance/avoidance conflicts difficult to resolve and very stressful.

Approach/avoidance: A single goal or situation has attractive and unattractive features. This type of conflict can be stressful and difficult to resolve. Consider, for instance, individuals who smoke cigarettes and want to quit. They may be torn between wanting to improve their health and wanting to avoid the weight gain and cravings they believe will occur.

 

COPING WITH STRESS

Coping is the process by which people try to manage the perceived discrepancy between the demands and resources they appraise in a stressful situation. It indicates that coping efforts can be quite varied and do not necessarily lead to a solution of the problem. According to Richard Lazarus and his colleagues, coping can serve two main functions. It can alter the problem causing the stress or it can regulate the emotional response to the problem.

Emotion-focused coping is aimed at controlling the emotional response to the stressful situation. People can regulate their emotional responses through behavioral and cognitive approaches. Examples of  behavioral approaches include using alcohol or drugs, seeking emotional social support   from  friends   or  relatives,   and   engaging   in activities,  such as sports  or watching TV, which distract attention from the problem. Cognitive approaches involve how people  think about  the  stressful  situation. In one cognitive approach, people redefine the situation to put a good face on it, such as by noting  that  things  could be worse, making comparisons with individuals who are less well off, or seeing  something good  growing out  of the problem.

People who want to redefine a stressful situation can generally find a way to do it since there is almost  always some aspect  of one’s life that  can  be  viewed positively.

Other emotion-focused cognitive processes include strategies Freud  called  ‘‘defense  mechanisms,’’  which involve distorting memory or reality in some way. For instance, when  something is too  painful  to face, the  person  may deny  that  it exists.  This defense  mechanism is called denial. In medical  situations, individuals  who are diagnosed with terminal  diseases often use this strategy and refuse to believe they are really ill. This is one way by which people  cope by using avoidance strategies. But strategies that  promote  avoidance  of the  problem  are helpful mainly in the short  run, such as during an early stage of a prolonged  stress  experience.

People  tend  to  use  emotion-focused approaches when  they  believe  they  can  do  little  to  change   the stressful  conditions. An example   of  this  is  when  a  loved  one  dies in   this situation,  people   often  seek  emotional support and distract   themselves  with  funeral   arrangements  and chores  at  home  or  at  work. Other examples   can  be seen  in  situations in  which  individuals   believe  their resources are not and cannot  be adequate to meet  the demands of the stressor. Coping methods that   focus  on  emotions are  important  because  they sometimes interfere  with getting  medical  treatment or involve unhealthful behaviors,  such as using cigarettes, alcohol,  and drugs to reduce  tension. People  often use these substances in their efforts toward emotion-focused coping.

Problem-focused coping  is aimed  at reducing  the demands of a stressful  situation or expanding  the resources to  deal  with it. Everyday life provides  many examples  of problem-focused coping, including quitting a stressful job, negotiating an extension for paying some bills, devising a new schedule for studying (and sticking to  it),  choosing  a  different  career  to  pursue,   seeking medical  or psychological  treatment, and  learning  new skills. People tend  to use  problem-focused approaches when  they  believe  their  resources or  the  demands of the situation are changeable. For example, caregivers  of terminally  ill patients use problem-focused coping more in the months prior to the death than during bereavement.

Can problem-focused and emotion-focused coping be used together?  Yes, and they often are. For instance, a study had patients with painful arthritis keep track of their daily use of problem and emotion-focused coping. Most  often,  they  used  the  two types of coping together;  but when they used  only one type, three-quarters of the time it was problem focused coping.

 

REDUCING STRESS REACTIONS: STRESS MANAGEMENT

The term stress management refers to any program of behavioral and cognitive techniques that is designed to reduce psychological and physical reactions to stress.

Sometimes people use pharmacological approaches under medical supervision to reduce emotions, such as anxiety, that accompany stress.

MEDICATION: Benzodiazepines, which activate a neurotransmitter that decreases neural transmission in the central nervous system. Beta-blockers, are used to reduce anxiety and blood pressure. They block the activity stimulated by epinephrine and norepinephrine in the peripheral nervous system. Beta-blockers cause less drowsiness than benzodiazepines, probably because they act on the peripheral rather than central nervous system. Although many people use drugs

for long-term control of stress and emotions, using drugs for stress should be a temporary measure. For instance, they might be used during an acute crisis, such as in the week or two following the death of a loved one, or while the patient learns new psychological methods for coping.

BEHAVIORAL AND COGNITIVE METHODS

Relaxation

The opposite of arousal is relaxation, so relaxing should be a good way to reduce stress. ‘‘Perhaps so,’’ you say, ‘‘but when stress occurs, relaxing is easier said than done.’’ Actually, relaxing when under stress is not so hard to do when you know how. One way people can learn

to control their feelings of tension is called progressive muscle relaxation (or just progressive relaxation), in which they focus their attention on specific muscle groups while alternately tightening and relaxing these muscles.

MBBS, MBA, MPH, & MD Phase B Resident, Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University. Adjunct Faculty, Department of Public Health, ASA University, Bangladesh. Contact: arafatdmc62@gmail.com