Stress | The 5 Stages of Stress with Distress

Stress, as it progressively escalates from being just a minor irritant of life to becoming full blown distress with major emotional or physical crisis, goes through 5 stages. Practically everyone passes through all 5 stages as the stressors in their lives continue to intensify, and their ability to cope with them diminishes. Although each stage is distinct in its characteristics, people can experience the symptoms of one stage while they have moved into another stage. For example, while a person might be in Stage 5 (Burnout) they may still be experiencing some of the symptoms of Stage 1 (trouble sleeping) along with, lets say, hostility (Stage 2) and migraine headaches (stage 4). Quite often they will cycle through the 5 stages over and over and over again. However, it is interesting to note, that there are some people who tend to get stuck spinning their wheels in a specific stage and consequently do not move through all 5 stages. What are the 5 Stages? Let's take a closer look. Stage 1: Chronic Mental or Physical Fatigue

you sleep poorly and wake up tense, or you sleep soundly but don't wake up refreshed. you need a caffeine hit in the morning to get you going. you need several more caffeine hits during the day to keep you going. you probably suffer an energy low in the middle to late afternoon. when you come home from work you need to "kick-back" because you feel as though you are going to collapse. you may feel the need for a drink to help you unwind. over time the feeling that you are so tired that you are about to collapse comes earlier and earlier and then one morning you wake up so tired that you are barely able to drag yourself out of bed. Stage 2: Interpersonal Problems / Withdrawal from Others

you develop problems in relating to friends, family, business associates, and even strangers. an increased withdrawal from friends, family, and other close relationships. increasingly suspicious of others. increasingly hostile towards others. your boiling point becomes significantly lower. you begin developing an "attitude" towards others. you become angry or upset for little or no reason. you spend less time on maintaining or developing relationships and consequently get less satisfaction from them. you begin to increasingly withdraw into yourself. mole hills become mountains as small problems become seemingly insurmountable. Stage 3: Emotional Turbulence

unable to focus. unable to prioritize. it becomes more difficult to make decisions. you begin to be filled with self doubt. interpersonal problems are magnified. diminishing ability to maintain emotional balance.

becoming increasingly hyper or depressed or you're cycling between both extremes. you're "blowing-up" with no apparent cause or reason. your reaction to other people's comments about you are completely out of proportion to the actual comments. experiencing crying fits. you fly into rages. your relationships become unsatisfying. your life controls you as you have lost control of your life. Stage 4: Chronic Physical Discomfort In this stage your body is unequivocally telling you that you are now in the Resistance Phase of the General Adaptation Syndrome.

chronic muscle tension especially in the neck, shoulders, lower back, and across the forehead. you may clench your jaw a lot. you may grind your teeth a lot. you may find that you're biting articles of clothing which you are wearing, such as; your tie, tip of shirt collar, or parts of your sweater. chronic headaches and/or migraine headaches when you let go a little after a long hard week. Brief explanation of Part 3 of the General Adaptation Syndrome - the Resistance Stage Stage 5: Stress-related Illness Now you are in the chronic version of the Exhaustion Phase or Burnout Phase. Your body manifests itself in specific illnesses, many which are due to the long-term suppression of your immune system. Here's a partial list: Stress Related Diseases People who cycle through the 5 stages of distress are playing a dangerous game because eventually the body forgets what it is like to operate at normal, healthy stress levels because it has become recalibrated to ever-higher stress levels. Accustomed to a new and higher stress set point it wastes enormous amounts of energy trying to maintain homeostasis, or its normal balanced state. The result is that the body's engine is continually revving at a high RPM level and never has the opportunity to rest, recover and to restore itself. Your body is constantly seeking to return to a steady, healthy state because it is a naturally health-seeking mechanism. It will always function in harmonic accordance with the laws of nature as long as you don't force it to operate in a state of distress. Remember that ultimately it will be you who will determine whether your life will be lived with distress or whether Stress will become the Spice of your Life!

Stress Stages
Alarm stage:
Short term physiological mobilization. Adrenaline and cortisol increase, blood flows away from brain to muscles, dendrites shrink back in the brain as a way of moderating the flow of information, slowing or shutting

down of nonessential body functions (e.g. gastrointestinal and sexual systems) takes place.

Resistance stage:
Adaptive efforts by the body to cope with or resolve stressor. Return to normal.

Exhaustion stage:
Initial stage - If stress persists - reserves of energy are used. Body
continues in Alarm stage mode. Fatigue results. Self-medication and self-comforting coping skills are utilized. There is increased anxiety. Decreased ability to concentrate and stay on task. Greater susceptibility to minor illnesses.

Advance stage - Energy reserves are depleted. Body systems begin to

malfunction and there is a much greater susceptibility to serious illnesses. Increased use of self-medication and maladaptive selfcomforting methods. Normal process in which the stomach lining constantly replenishes itself to counteract digestive fluids is put on hold. Eating for comfort during this time can cause damage to the stomach. Typical appetite and eating patterns are disturbed. Increased irritability, poor judgment and personality changes. Physical and emotional problems.

The body's response to stress is generally healthy and adaptive. It functions to help an individual respond and get through unusual circumstances. This system becomes maladaptive when: The threat is psychological instead of physical The threat (the possibility of the circumstance occurring) is prolonged When distress (the actual circumstance) is prolonged

Key Figures & Theories

Hans Selye Hans Selye was an endocrinologist, a type of specialist who treats disorders connected with glands and hormones in the body. Selye coined the word "stress" to refer to inappropriate physical reactions to any demand. He further divided this term into 2 types of stress, eustress and distress. Eustress is good stress, i.e. stress that motivates and improves function. Distress is overwhelming stress that results in anxiety, depression, and the other symptoms mentioned above. Selye also developed the general adaptation syndrome. This consists of three stages. In the alarm stage, the individual has a "flight or fight" response and his or her ability to cope with the stressor increases. This ability continues to increase in the resistance stage until the individual starts to tire, wear down and become exhausted (exhaustion stage.)

Read more: http://alleydog.com/topics/stress.php#.UVBZSBz-GD4#ixzz2OYnfUVBo Richard Lazarus Richard Lazarus argued that stress is unique to each individual and is dependant on appraisal (perception of stress). Lazarus believed that an individual appraises a situation and if it is stressful, the person starts using coping skills. He described two types of coping styles. The first one, problem solving, consists of managing the problem. The second, emotion-focused coping, is used to manage the negative emotions resulting from the stress. Walter Cannon Walter B. Cannon was an American Physiologist who coined the phrase "fight or flight" and the word homeostasis. "Fight or flight" refers to the response that animals and people have to a threatening situation. During "fight or flight" people are able to exert a great deal of energy in a short period of time due to increased blood flow, oxygen, and glucose stores. This response can cause damage to the body, however, it is a survival mechanism that can save the person's life. This explains why prolonged stress causes such a wide variety of physical symptoms. Cox and MacKay Cox and MacKay devised a model of stress that reflected the eustress of Hans Selye. Their model differed from the general adaptation model in that it illustrated the level of stress affects on performance. Cox and MacKay stated that too little stress resulted in boredom and low performance. Too high stress results in exhaustion and low performance. Optimum performance is a balance where stress is neither to high or too low.

Original pciture: http://wikieducator.org/Introduction_to_Stress_Theory Bruce McEwin Bruce McEwin described stress effects on the body by a term he called allostatic load. An allostatic load is a reflection of how stress hormones such as cortisol are affecting the immune system. When the body experiences stress, it secretes a hormone called cortisol. Cortisol raises the body's blood sugar in preparation for "fight or flight." Chronically high cortisol levels alter the immune system so that the body cannot fight disease effectively. This chronically high level of cortisol and lowered immune function in response to stress is defined as a high allostatic load. High levels of cortisol can also damage cells in the brain that regulate the cortisol levels resulting in a lowered resistance to stress. Meyer Friedman and Ray Rosenman Friedman and Rosenman identified a high risk personality for stress induced illnesses called the Type A personality. A Type A personality is a set of behavioral features favoring achievement, competition, time urgency, impatience and hostility. Researchers have found that Type A characteristics are correlated with a higher risk of heart disease in these individuals.

Read more: http://alleydog.com/topics/stress.php#.UVBZSBz-GD4#ixzz2OYnmPc00

The Phases of Stress

What is stress?
Life stressors involve changes in your environment that your central nervous system must adapt to during the course of daily living. Stressors include either positive or negative life events (e.g., death, divorce, new job, new house, new baby) that require you to adapt to these changes in your life. Stress results when pressures, challenges, or demands in life exceed your coping abilities. Stress can manifest itself in physical, emotional, or behavioral symptoms.

Phases of the stress experience

There are three basic phases of the stress experience. Understanding these phases can help you to identify and cope with the stress in your life.

Phase I
Stressors trigger your body's response to stress. This physiological response is also known as the "fight or flight" response in your nervous system. Symptoms include:

Increase in heart rate and blood pressure Decreased blood flow to the extremities Slowed digestion The stress response is meant temporarily to improve your chances of surviving a physical threat to your safety (i.e., outrunning a predator), but becomes dangerous to your health if activated for prolonged periods of time. Troublesome events that can activate the stress experience include death, divorce, illness, conflict, job loss, and retirement. Other negative stressors are worries, memories, or images that are produced internally by our minds. Positive life events also trigger the stress response in our bodies. These include marriage, birth of a child, purchase of a new home, or starting a new job.

Phase II
Interpretation of stressors affects our ability to cope with stress. Our beliefs, attitudes, and values determine how we interpret and react to potentially stressful situations. If we tend to see those situations as threats, pressures, demands, or catastrophes, we compromise our ability to cope. The resulting feeling of helplessness sets us up for a variety of unpleasant responses to stress.

Phase III
Reaction to stress might create or worsen physical, emotional, or behavioral symptoms if the fight or flight response is activated chronically over time.

Physical high blood pressure, heart disease, ulcers, strokes, rashes, migraine, tension headaches, infertility, irritable bowel Emotional anxiety, depression, anger, forgetfulness, panic attacks Behavioral overeating, poor appetite, drug abuse, excessive smoking, irritability, social withdrawal, insomnia

What to do about stress

Phase I
There are several things that you can do to decrease the impact of stressors in your life. Problem-solving prevents the recurrence of a stressful experience. Managing your time better reduces stress by creating a balance between difficult and pleasurable experiences.

Phase II
It is important to become aware of your thoughts and attitudes when you feel stressed. Once you are aware of the stressful slant you are placing on the situation, you are able to develop ways to re-evaluate those situations in ways that make them less threatening and more manageable.

Phase III
Relaxation techniques, exercise, leisure, and nutritional awareness all play a part in improving your physical, behavioral, and emotional response to stress. By increasing your physical resistance to stress and learning how to relax yourself, you can reduce your vulnerability to stressful events. Developing a network of social supports and adopting good self-care habits serve as buffers against the inevitable stresses of daily living.

Stages of Stress
When you are under stress, you experience and pass through three specific stages. These stages are Alarm, Resistance, and Exhaustion. However, you may or may not pass through all stages of stress, depending on the events that triggered the occurence.

First Stage: ALARM

When you face any danger, your nervous system immediately sends an emergency signal to your brain. All the different body parts and their functions coordinate to either fight or flee away from the danger. You get more energy and your limbs work faster. This is clearly visible in your facial expressions as fear or tension. Normally, this stage of stress can be due to an actual event such as an accident. It is then primary stress. Otherwise, you could cause your stress like when you are appearing for an important examination. This is secondary stress. The general indications of this stage are your fast breathing with sweating and accelerated heart beat which leads to higher blood pressure and indigestion.

Second Stage: RESISTANCE

When you do not get any relief from the first stage of stress, you slowly start feeling a reduction in your energy levels. However, still you want to keep fighting the danger. Hence, you feel exasperated and are impatient with trivial matters. You miss your sleep schedules and find your resistance breaking Your body reacts by releasing the stored sugars and fats into your system. This leads to defined changes in your physical and mental behavioral patterns. The normal indications of this level are exhaustion, weariness, anxiousness, and being forgetful. You start smoking and drinking more to come out of your stress. Being weak, you are an easy target for colds and flu.

Third Stage: EXHAUSTION

When stress continues beyond the second stage and you do not adhere to remedial measures, the final stress stage of exhaustion settles in. You are now totally tired and drained out of all energy. You do not even have the desire or the drive to do your work or live your life. This stage symbolizes a breakdown of your system and your basic physical existence itself. This leads to loss of mental equilibrium and extreme complications such as heart diseases, blood pressure, and ulcers.

Self-discovery Through Journaling

Some thoughts on journaling
The fact that one journals indicates that he or she believes what is written is worth preserving - that it has a value that will continue past the present time. Journaling is a self-affirmation - an indicator that a person values self in a much deeper way than spending money, collecting things or even pampering one's self. To share these deep thoughts and emotions with another is a high honor and should only be done with those who understand the preciousness of being invited into another's private world.

" The unexamined life is not worth living. " Plato quoting Socrates, The Republic

"A well-written life is almost as rare as a well-spent one. " Thomas Carlyle

"In the creative state a man is taken out of himself. He lets down, as it were, a bucket into his subconscious, and draws up something which is normally beyond his reach. He mixes this thing with his normal experiences, and out of the mixture he makes a work of art. " E. M. Forster

Twenty-one reasons to journal

Why keep a journal? 1. A place in which to express your creative side 2. Release pent-up emotions 3. Work on personal growth 4. Clarify your own unique views of the world 5. Set goals and chart your successes 6. Resolve questions and problems from the past 7. Chronicle your life 8. Help in weighing and making decisions 9. Have a private place to which to retreat 10.Sketch in words or pictures the interesting things that are seen during the
day

11. A place to keep your scattered thoughts and ideas 12.Write out your prayers to God 13.Somewhere to write down and wrestle with the questions of life 14.A laboratory where ideas can be developed and tested 15.A place in which to struggle with the disappointments and tragedies of life 16.A legacy to family 17.Somewhere to record the history and stories of your family 18.Accountability to self by writing down weight lost, miles walked, etc. 19.Helpful lists (prayer, gratitude, sensory, to do or fun) 20.
A place to archive jokes and humorous anecdotes

21.Keeps your mind active and could help prevent Alzheimer's and dementia

Theories of Stress

What is stress?
Stress has been viewed in three ways: 1. Stimulus 2. Response 3. Process. Stimulus refers to stress, which can be categorised as emanating from three sources: 1. Catastrophic events, such as Tornadoes and earthquakes 2. Major life events 3. Chronic circumstances, such as living in crowded or noisy conditions. Response refers to how somebody responds to a particular stress, for example sitting an examination. There are two components: 1. Physiological, heightened bodily arousal-your heart pounds, mouth goes dry your stomach feels tight and you perspire. 2. Psychological, involving behaviour, thought patterns, and emotions. Feeling nervous. Process views stress as a series of interactions and adjustments between the person and the environment. These interactions and adjustments are called transactions. Stress is not seen as a stimulus or a response, but rather as a process. The person suffering stress is seen as an active agent who can influence the impact of a stressor through behavioural, cognitive and emotional strategies. A good definition of stress would be that stress is the condition that results when the person/environment transactions lead the individual to perceive a discrepancy-whether real or not-between the demands of a situation and the resources of the persons biological, psychological, or social systems. Success and failure in previous transactions would determine the amount of stress perceived.

Cognitive appraisal (Richard Lazarus)

Lazarus and Folkman (1984) propose a model that emphases the transactional nature of stress. Stress is a two way process; the environment produces stressors and the individual finds ways to deal with these.

Cognitive appraisal is a mental process by which people assessed two factors: 1. Whether a demand threatens their well being 2. Whether a person considers that they have the resources to meet the demand of the stressor There are two types of appraisal: 1. Primary 2. Secondary.

Primary and secondary appraisal

Primary appraisal
During the primary appraisal stage a person will be seeking answers as to the meaning of the situation with regard to their well being. One of three types of appraisals could be made: 1. It is irrelevant 2. It is good (benign-positive) 3. It is stressful. Imagine there was a snow blizzard. You might consider that the blizzard would not affect you, as you do not have to go to work the following day. You might consider the blizzard a blessing because this means that your college exam would be postponed or you can go skiing! The situation could be stressful because you have few supplies and you need to get to the shops and driving would be hazardous. Further appraisal is made with regard to 3 implications: 1. Harm-loss 2. Threat 3. Challenge.

Harm-loss refers to the amount of damage that has already occurred. There may have been an injury. The seriousness of this injury could be exaggerated producing a lot of stress. Threat is the expectation of future harm, for example the fear of losing one's job and income. Much stress depends on appraisals that involve harm-loss and threat. Challenge is a way of viewing the stress in a positive way. The stress of a higherlevel job could be seen as an opportunity to expand skills, demonstrate ability, and make more money. The stress transaction can be vicarious. Empathising with others who are in stress. An example of vicarious stress is a study, which involved showing college-student subjects a film, called "Sub-incision" (Speisman et al, 1964). The film showed a right of passage for young adolescent boys in a primitive society in which the underside of the penis is cut deeply from the tip to the scrotum using a sharp stone. The subjects were divided into four groups. One group saw the film with no sound. Another group heard a soundtrack with a "trauma" narrative emphasising the pain, danger, and primitiveness of the operation. A third group heard a "denial" narration that denied the pain and potential harm to the boys, describing them as willing participants in a joyful occasion who "look forward to the happy conclusion of the ceremony." The fourth group heard a " scientific" narration that encouraged viewers to watch in a detached manner-for example, the narrator commented, "as you can see, the operation is formal and the surgical technique, while crude, is very carefully followed." Physiological and self-report measures of stress were taken. The physiological measure was of the heart rate during the viewing of the film. The self-report measures were questionnaires that evaluated feelings of stress immediately after the film was shown. Those who heard the trauma narration reacted with more stress than the control group (no sound); those who heard the denial and scientific narrations reacted with less stress than the control group.

Secondary appraisal
Secondary appraisals occur at the same time as primary appraisals. A secondary appraisal can actually cause a primary appraisal. Secondary appraisals include feelings of not being able to deal with the problem such as:

I can't do it-I know I'll fail I will try, but my chances are slim I can do it if I get 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.

Stress can occur without appraisal such as when your car is involved in an accident and you haven't had time to think about what has happened. Accidents can often cause a person to be in shock. It is difficult for people to make appraisals whilst in shock as their cognitive functioning is impaired.

What factors lead to stressful appraisals?

Events are stressful depending on two types of factors: 1. Those that relate to the person 2. Those that relate to the situation (Cohen and Lazarus, 1983). Personal factors include intellectual, motivational, and personality characteristics. People who have high self-esteem are likely to believe they have the resources to meet demands. Stressful events are seen as challenges rather than as threats (Cohen and Lazarus, 1983). The application of this theory to understanding stress in streetwalkers With regard to motivation: the more important the threatened goal is, the more stress the person is likely to perceive (Patterson and Neufeld, 1987). Many people have irrational beliefs. If somebody strongly desires to have a safe, comfortable, and satisfying life which they believed is achieved by everything being absolutely easy, convenient and gratifying then the slightest inconvenience would be seen as harmful or threatening. Events that involve very strong demands and are imminent tend to be seen as stressful (Kelly and Lazarus, 1983). Life transitions tend to be stressful (Moos and Schaefer, 1986). Changing from one phase to another in life is called a transition; examples include:

Starting school Moving home Reaching puberty Starting college, especially away from home Starting a career Getting married

Becoming a parent Losing a spouse through divorce or death Retiring.

Becoming a parent can be stressful before and after the birth (Miller and Sollie, 1986). Before birth there is the physiological burden of pregnancy on the mothers body and concern about the babies and mothers health. After birth, stress can result from the parents feeling tied down, having a less orderly and predictable lifestyle, and having their sleep interrupted often, among other things. The timing of a life transition can affect the stress it produces. If a life events occur as at a time when it is not expected then this is stressful. One reason could be that having an event too early or too late could mean that one is deprived of the support of peers. An example of this would be having a baby at the age of 38 or later. Achieving life events late in life could be seen as failing. Some people who graduated late or were promoted late in life feel as though they have failed. Ambiguity can cause stress. Two types of ambiguity are: 1. Role ambiguity 2. Harm ambiguity. Role ambiguity can occur in the workplace, for instance when there are no clear guidelines, standards for performance and no clear consequences. Role ambiguity is stressful because people are uncertain about what actions and decisions to make. Harm ambiguity occurs when people are not sure what to do to avoid harm. Stress will depend upon the person's personality, beliefs and general experience (Lazarus and Folkman, 1984). A person who is seriously ill and has no clear information might draw hope from this ambiguity, believing that they will get well. Another person in the same situation may believe that people are deliberately giving ambiguous information because the prognosis is poor. The desirability of the situation is also another important factor. An event like losing your home is undesirable and therefore stressful. Buying and selling a house could be because one is moving to a more desirable house but still there will be many demands that tax or exceed the individuals resources. Many of life's events, whether desirable or undesirable, can produce stress (for example getting a parking ticket or preparing to throw party). Generally, undesirable events are more likely to be appraised as stressful (McFarlane et al., 1980)

Controllability is another factor that will affect the perception of stress. People tend to appraise uncontrollable events as being more stressful than controllable events (Miller, 1979). There are two types of control: 1. Behavioural 2. Cognitive. Behavioural control means performing some action. For example, being unable to take a tablet for a headache will make experiencing a headache less stressful. In the case of cognitive control, we can affect the impact of the events by using some mental strategy, such as distraction or by developing a plan to overcome the problem.

Biological aspects of stress

Walter Cannon (1929) describes the fight or flight response of the body after perceiving danger or stress. This response mobilises the organism to respond quickly to danger but the state of higher arousal can be harmful to health if it is prolonged.

General adaptation syndrome

Selye (1956) observed in laboratory animals and in human patients the body's reaction to stress. He found that the fight or flight response was only the first in a series of reactions, which he called the general adaptation syndrome (GAS). The GAS consists of three stages: 1. Alarm reaction 2. Stage of resistance 3. Stage of exhaustion. The alarm reaction is like the fight or flight response to an emergency. The body is mobilised. At the beginning of the arousal blood pressure drops below normal for a moment, but then quickly rises to above normal. This arousal is produced by the release of hormones by the endocrine system: the pituitary glands secrete ACTH, which causes a heightened release of adrenaline, noradrenaline, and cortisol by the adrenal glands into the bloodstream. The body cannot stay in this state for long without serious consequences. Some organisms in a continuous state of alarm have died within hours or days

Stage of resistance. If the reaction continues and is not strong enough to cause death the physiological reaction enters the stage of resistance. The body tries to adapt to the stressor. Physiological arousal declines but remains higher than normal and the body replenishes the hormones released by the adrenal glands. The organism may show few outward signs of stress. However, the body may not be able to resist new stresses. The body becomes increasingly vulnerable to health problems. These health problems include ulcers, high blood pressure, asthma, and illnesses that result from impaired immune function. Stage of exhaustion. Severe long-term or repeated stress will cause the organism to enter the third stage, the stage of exhaustion. The immune system and the body's energy reserves are weakened until resistance is very limited. If the stress continues, disease and physiological damage become increasingly likely and death may result.

Evaluation of GAS
A problem for GAS is that some stressors elicit a stronger emotional response than others do. The theory does not take account of psychosocial processes. A sudden increase in temperature, for example, would produce more emotion than a gradual increase. Another problem for GAS is that cognitive appraisal is not taken account of. A study by Katherine Tennes and Maria Kreye (1985) found that intelligent schoolchildren experienced more stress on the day of an exam than unintelligent schoolchildren. Cortisol levels were measured in urine samples taken on regular school days and on days when tests were given. Intelligence test scores were obtained from school records. The results suggest that brighter children are more concerned about academic achievement. To summarise, the GAS incorrectly assumes that all stressors produce the same physiological reactions and fails to take account of psychosocial factors in stress. Even so the GAS is basically a valid model of stress.

Psychosocial aspects of stress

Cognition and stress
A high level of stress impairs people's memory and attention during cognitive activities such as when taking examinations (Cohen et al 1986).

Noise can be a stressor, for example when people live next to a busy railway or motorway. People cope by tuning out the noise. Cohen (1980) has proposed that children who tried to tune out chronic noise may develop generalised cognitive deficits because they have difficulty knowing which sounds to attend to and which to tune out (see my web-page on classroom design). One study tested primary school children who lived in a block of flats that was built on bridges spanning a busy highway. The children in the noisy flats had more difficulty discriminating between pairs of words (for example, house and mouse) (Cohen et al., 1973). People living near the three mile island nuclear power plant in Pennsylvania who had difficulty in coping with the stress that was produced by the fear that the nuclear emissions would affect their health, found it difficult to keep their minds from thinking about the accident. Thoughts can perpetuate stress and make it chronic.

Emotions and stress

Cognitive appraisal processes can influence both the stress and the emotional experience (Maslach, 1979; Schachter and Singer, 1962) for example, one person coming across a poisonous snake might be frightened whereas another person, who studied poisonous snakes, would be excited. Fear is a common emotional reaction that can be classified into two categories: 1. Phobias 2. Anxiety. Phobias are intense and irrational fears that are associated with specific events and situations. An example of this would be claustrophobia, a fear of being enclosed in small rooms. Anxiety is a vague feeling of uneasiness or apprehension. A gloomy anticipation of impending doom caused by a relatively uncertain or unspecific threat. People may not be aware of the situations that seem to arouse anxiety or to know how the "doom" will manifested itself. Patients awaiting surgery or the outcome of diagnostic tests generally experience high levels of anxiety. Anxiety may result from appraisals of low self-worth and the anticipation of a loss of self-esteem. The things children fear tend to become less concrete and more abstract and social as they get older (Sarafino, 1986). A study of children's fears of dental treatment found

that the most frightened children were those who had not experienced invasive procedures, such as having a tooth extracted during the prior few years (Murray et al., 1989). Children who see themselves as less able than their peers are likely to appraise their own resources as insufficient to meet the demands of stressors. Stress can lead to feelings of depression. Depression is quite normal, but severe and prolonged depression is a serious disorder. Symptoms of clinical depression are:

A generally unhappy mood Feelings of helplessness about the future They appear listless and passive Disrupted eating and sleeping habits Low self-esteem (Rosenhan & Seligman, 1984).

A long-term disabling health problem, such as being paralysed, often leads to depressive disorders. There is controversy over whether the type of disorder seen in adults ever develops before adolescence (Quay & La Greca, 1986). Assessing depression in children is difficult because they are unable to express their feelings very well. Another emotional reaction to stress is anger. This often occurs when the person perceives the situation as harmful or frustrating. Anger can produce aggressive behaviour.

Social behaviour and stress

In some stressful situations, such as train crashes, earthquakes, etc. people may work together to help each other survive. This could be because they have a common goal that requires co-operative efforts (Sherif & Sherif, 1953). When stress is accompanied by anger, negative social behaviours tend to increase. Stress-produced anger increases aggressive behaviour, and these negative effects continue after the stressful event is over. Child abuse is often related to parental stress (Kempe, 1976). Prior to a parent battering their child the parent usually has experienced a stressful crisis, such as the loss of a job. At high levels of stress the parent is at risk of losing control. If a child is running around making a lot of noise in the house the parent could become very angry and lose control. Stress affects helping behaviour. An experiment was conducted in a shopping centre (Cohen & Spacapan, 1978). The subjects either had a difficult shopping task or uneasy one and the shopping centre was either crowded or uncrowded. The difficult

shopping task as well as the crowded shopping centre therefore produced stress. After completing the shopping task, each subject walked through a deserted hallway to meet with the researcher. In the hallway the subjects encountered a woman who pretended to have dropped a contact lens. Subjects who had experienced a lot of stress did not help as much as those that had completed an easy shopping task in uncrowded conditions.

Psychosocial modifiers of stress

Social support
Social support refers to the perceived comfort, caring, esteem, or help the person receives from other people or groups (Cobb, 1976). Types of social support There are five basic types of social support: 1. Emotional support. The expression of empathy, caring and concern toward the person. 2. Esteem support. This occurs through people's expression of positive regard for the person, encouragement or agreements with the individual's ideas or feelings, and positive comparison of the person with others such as people who are less able or worse off. This kind of support serves to build the individuals feeling of self-worth, competence and of being valued. Esteem support is especially important during the appraisal of stress, when the individual is assessing whether the demands exceed their personal resources. 3. Tangible or instrumental support involves direct assistance. 4. Informational support includes giving advice, suggestions or feedback. 5. Network support provides a feeling of membership in a group of people who share interests. The type of support depends upon the stressful circumstances, for instance, emotional and informational support is particularly important for people who are seriously ill. Students who received more frequent esteem support tended to report less depression following stressful experiences.

Who gets social support?

People are unlikely to receive support if they are unsociable, don't help others, and don't let others know that they need help. Some people are not assertive enough to ask for help. Providers of support may not themselves have the resources needed, or may be under stress and in need of help themselves. One way of measuring social support is to use the "social support Questionnaire" (Sarason et al. 1983). It consists of 27 items, such as, "who helps you feel that you truly have something positive to contribute to others?" For each item, the respondents list the people they can rely on and then indicate the overall degree of satisfaction with the support available.

Test how much emotional support you get.

Think of the ten people to whom you feel closest. For each of the following questions rate each person on a 5-point scale, where 1 = "not at all" and 5 = "extremely." 1. 2. 3. 4. How reliable is this person; is this person there when you need him or her? How much does this person boost your spirits when you feel low? How much does this person make you feel he or she cares about you? How much do you feel you can confide in this person?

Add together all of these scores. Atypical score lies between 120 & 150. This would suggest that you have a reasonably good level of emotional support (source: Sarafino, 1994, based on material in Schaefer, et al, 1981).

A sense of personal control

People who have a strong sense of personal control report experiencing less strain from stressors.

Types of control
1. Behavioural control involves the ability to take concrete action to reduce the impact of a stressor. An example of this would be special breathing techniques that reduce the pain of Labour 2. Cognitive control is the ability to use thought processes or strategies to defy the impact of a stressor. Such strategies would be thinking about the event differently or focusing on a pleasant or neutral thought or sensation.

3. Decisional control is the opportunity to choose between alternative procedures or courses of action. This would occur when the patient is allowed to make a decision between alternative treatments. 4. Informational control involves the opportunity to get knowledge about the stressful event. 5. Retrospective control involves reflecting upon what caused the stressful event. An example of this would be blaming somebody. The most effective type of control is cognitive control (Cohen et al., 1986).

Lundberg (1976) Using urine samples Commuters on crowded trains more stressed than in empty trains, but those that had been on the train since the start, showed less stress, even though they had been exposed to the crowded condition longer. Being able to choose seat, control the situation, reduced the stress.

People who believe they have control over their successes and failures are described as possessing an internal locus of control. Other people believe that their lives are controlled by forces outside themselves, for example, by luck; they have an external locus of control (Rotter, 1966). The I-E scale measures locus of control. This scale presents a series of paired items, such as: "the average citizen can have an influence in government decisions," and, "this world is run by a few people in power, and there is not much the little guy can do about it." The respondent selects the one with which he or she most agrees. Most people fall within the mid-range. Self-efficacy is the belief that we can succeed at something we want to do (Bandura, 1977). People estimate their chances of success and failure on the basis of their prior experiences. A decision to attempt an activity depends on:

A belief that their behaviour would produce a favourable outcome A belief that they are able to perform the behaviour properly.

People with a strong sense of self-efficacy shown less psychological and physiological strain in response to stressors (Bandura et al, 1982).

Experiencing stress over a long period of time can produce a feeling of helplessness. As a result of this people may stop striving for goals. This condition is calledlearned helplessness (Seligman, 1975). Hiroto and Seligman (1975) demonstrated learned helplessness in an experiment. Students were assigned to one of three training groups. They all experienced an unpleasant loud noise. In one group, the controllable-noise condition, the subjects were told the noise would come on from time to time and " there is something you can do to stop it." Subjects were able to press a button to stop the noise, which they did. The uncontrollable-noise group had the same instructions and apparatus, except the button was ineffectual in stopping the noise. In a comparison group, the subjects were simply told "from time to time a loud tone will come on for a while. Please sit and listen to it." After this all of the subjects were tested for helplessness: they were told that the noise would come on and off and that "there is something you can do to stop it." The subjects were presented with a different apparatus that had a sliding knob that, when manipulated correctly, would stop the noise. Students in the uncontrollablenoise group performed much more poorly than those in the other two groups.

Type a/type b (Friedman and Rosenman, 1974)

Type a
1. 2. 3.

Competitive, achievements orientation. Self-critical. No joy in

accomplishments.

Time urgency. Impatient. Always on the go. Do several things at once. Anger/hostility easily aroused to anger, which may be overt or covert.

Type b Low levels of competitiveness, time urgency and hostility. Easy going -philosophical.

Type a/type b personalities are measured by a structured interview but can be measured by a questionnaire (for example

the Jenkins activity survey, a 52 item Questionnaire - Jenkins et al, 1979).

In the structured interview the interviewer encourages type a behaviour, for example "most people who work have to get up fairly early in the morning. In your particular case, uh, what time, uh, do you, uh, ordinarily, uh-uh-uh, get up?" A type a person would interrupt the hesitations. The interviewer interrupting the respondent with "what do you mean by that?" produces annoyance. The interview is videotaped and a trained rater can rate the speech, facial expressions, posture, and fidgeting. The structured interview is more accurate than the Questionnaire because it measures all three symptoms.

Type a people can cause themselves more stress. They seek demanding employment and are always in a hurry. People in a hurry have more accidents.

An experiment by Glass et al (1980) had participants playing a computer game against a confederate. The game was rigged so that it could not be won. A prize was offered. A structured interview determined whether participants were type a or type b. Half of each type were harassed by the confederate the other half played with that the confederate in silence. Several physiological measures were taken. Both type a and type b participants showed increases in stress. In the harassment condition type a showed more stress than type b.

Factors that play a part in producing type a behaviour are: 1. Intrapersonal. Behaviour is produced as a result of controlling personal stress. 2. Interpersonal. They are more competitive and when insulted are more likely to be aggressive. 3. Institutional. The is limited opportunity for promotion and therefore more competition. A demanding boss or teacher. 4. Cultural. The work ethic. The importance of having expensive status symbols.
Personal qualities affecting appraisal of stress.

Suzanne Kobasa (1979) People who can handle stress possess 'hardiness'. There are three components I. II. III. Control - can you control events? (See Locus of control) Commitment - Sense of purpose, involvement. Challenge - problems seen as an opportunity for personal growth.

Kobasa (1979) - High stress executives 2 groups - high illness Vs low illness. Using questionnaire, the low illness group had more hardiness. Problems I. II. III. People vary with their personality. Unlikely to be one type of person all of the time. Only looked at white professional American men - may not be true of other groups. Hardiness and social support correlate so what is attributed to hardiness could really be the effect of social support (Blaney & Ganellen, 1990).

Other factors Resilience (Garmezy, 1983) Some people may have terrible things happened to them in their lives and remain relatively un-scarred. They tend to have the following characteristics:

good social skills friendly at ease with peers and adults high esteem personal control could have compensating skills to become absorbed in

Moos and Moos (1981) looked at a number of social climates, including psychiatric wards, college dorms, prisons, work groups, families.
relationship dimensions involvement peer cohesion supervisor support the extent to which employees are concerned about and committed to their jobs the extent to which employees are friendly and supportive to one another the extent to which management is supportive of employees and encourages employees to be supportive of one another personal growth autonomy task orientation work pressure the extent to which employees are encouraged to be self-sufficient and make their own decisions the degree of emphasis on good planning, efficiency and getting the job done the degree to which the pressure of work and time dominate the job milieu systems maintenance and systems change clarity the extent to which employees know what to expect in their daily routine and

how explicitly rules and policies are communicated control innovation physical comfort the extent to which management uses rules and pressures to keep employees under control the degree of emphasis on the variety, change and new approaches the extent to which the physical surroundings contribute to a pleasant work environment

Positive environments - reduce recovery time from illness. Responsibility, work pressure and change increase the likelihood of illness or subjective distress

TRANSACTIONAL MODEL OF STRESS AND COPING

coping with stressful events History and Orientation Stressors are demands made by the internal or external environment that upset balance, thus affecting physical and psychological well-being and requiring action to restore balance (Lazarus & Cohen, 1977). Beginning in the 1960s and 1970s, stress was considered to be a transactional phenomenon dependant on the meaning of the stimulus to the perceiver (Lazarus, 1966; Antonovsky, 1979). Core Assumptions and Statements The Transactional Model of Stress and Coping is a framework for evaluating the processes of coping with stressful events. Stressful experiences are construed as person-environment transactions. These transactions depend on the impact of the external stressor. This is mediated by firstly the persons appraisal of the stressor and secondly on the social and cultural resources at his or her disposal (Lazarus & Cohen, 1977; Antonovsky & Kats, 1967; Cohen 1984). When faced with a stressor, a person evaluates the potential threat (primary appraisal). Primary appraisal is a persons judgment about the significance of an event as stressful, positive, controllable, challenging or irrelevant. Facing a stressor, the second appraisal follows, which is an assessment of peoples coping resources and options (Cohen, 1984). Secondary appraisals address what one can do about the situation. Actual coping efforts aimed at regulation of the problem give rise to outcomes of the coping process. In the table below the key constructs of the Transaction Model of Stress and Coping are summarized. Concept Definition Primary Appraisal Evaluation of the significance of a stressor or threatening event. Secondary Appraisal Evaluation of the controllability of the stressor and a persons coping resources. Coping efforts Actual strategies used to mediate primary and secondary appraisals. Problem management Strategies directed at changing a stressful situation. Emotional regulation Strategies aimed at changing the way one thinks or feels about a stressful situation. Meaning-based coping Coping processes that induce positive emotion, which in turn sustains the coping process by allowing reenactment of problem- or emotion focused coping. Outcomes of coping Emotional well-being, functional status, health behaviors. Dispositional coping styles Generalized ways of behaving that can affect a persons emotional or functional reaction to a stressor; relatively stable across time and situations. Optimism Tendency to have generalized positive expectancies for outcomes. Information Seeking Attentional styles that are vigilant (monitoring) versus those that involve avoidance (blunting) Table from Glanz et al, 2002, p. 214. Conceptual Model See Glanz et al, 2002, p. 215. Favorite Methods Surveys, experiments and quasi-experiments are used. Glanz et al (2002) use therapeutically techniques as well. Techniques such as biofeedback, relaxation and visual imagery are used. Biofeedback aims to develop awareness and control of responses to stressors. Furthermore, biofeedback reduces stress and tension in response to everyday situations. Relaxation techniques use a constant mental stimulus, passive attitude and a quiet environment. Techniques that are used are relaxation training, hypnosis and yoga. Visual imagery is a technique used for improving the mood of a person and improving coping skills. This can be done for example with visualizing host defenses destroying tumor cells. Scope and Application The Transactional Model of Stress and Coping is useful for health education, health promotion and disease prevention (see the example below for explanation). Stress does not affect all people equally, but stress can lead to illness and negative experiences. Coping with stress is therefore an important factor, it affects whether and how people search for medical care and social support and how they believe the advice of the professionals. Example

For understanding determinants of lifestyle of a cancer patient a variety of treatments are needed. This treatment should contain primary appraisals, secondary appraisals and specific coping strategies. Primary appraisals in this example are perceptions of risk of recurrence. Secondary appraisals can be self-efficacy in adopting health behavior recommendations. Specific coping strategies such as problem-focused coping, emotion-focused coping and meaning-based coping can be used (Glanz et al, 2002). These assessments could provide useful information about appraisals that facilitate or hinder lifestyle practices. Such information would be useful for interventions such as motivational messages and coping skills training techniques.

Stress Management What is stress? Every person has experienced stress in some form or other and many writers have defined stress in different ways. Some definitions have gained recognition while others are still been passionately debated, avidly argued and aggressively defended. Stress, if not ...Stress Management What is stress? Every person has experienced stress in some form or other and many writers have defined stress in different ways. Some definitions have gained recognition while others are still been passionately debated, avidly argued and aggressively defended. Stress, if not managed effectively, can cause serious health problems, even death. Self-medication in such situations is never advisable. Only qualified health professionals should treat stress-related illnesses. What happens to the body in stressful conditions? Walter Cannon (1932) conducted researches on stress and came up with his theory of fight-or-flight response. He found out that when an organism comes in a situation that it cannot comprehend, at that time either the organism fights or runs away. This is so because the organism in the perception of threat, releases such hormones that enable it to survive either by fighting or by fleeing. In humans, these hormones enable the heart to pump faster, thereby delivering more blood to the body and more oxygen to the body parts. The heart rate and blood pressure increases as it flows much faster delivering sugar and oxygen to important muscles. The sweat glands produce more sweat in an effort to cool down these muscles thereby increasing their efficiency. The blood is diverted from the skin to the core of the body in an effort to minimize blood loss if wounded. The hormones enable the mind to concentrate only on the object of threat so that the individual can exclusively deal with it. All these biochemical actions and reactions take place in direct proportion to the perceived threat, some shock, something unexpected, or something that frustrates. If the threat is small, the response is small, and likewise, if the threat is large the response is large. These biochemical hormones enable the individual to survive stressful conditions. The darker side of this critical mobilization of the body is that the body becomes more highly-strung, more excitable, more jumpy, more irritable, and more anxious. This state reduces the ability to interact successfully making it difficult to execute precise and controlled skills. In addition, when the mind focuses exclusively on the subject of threat, then it fails to draw from the other sources present and thus no fine judgment is possible. Hans Selye (1956), one of the founding fathers of stress research, stated, that stress may be good or bad depending on how the person takes it. Exhilarating, successful, and creative work done under stress is beneficial, whereas stress caused by infection, humiliation, or failure is detrimental. He was of the opinion that certain biochemical effects take place irrespective of stress being helpful or harmful. Modern research is of the view that stress has mainly negative effects, and starts a chain reaction of biochemical actions, which has harmful long-term effects. In a positive environment, such biochemical actions and reactions is not witnessed; hence, it conclusively proves that stress is s omething bad for human health. Richard S. Lazarus, stated the most widely accepted definition of stress, as a condition or feeling that is experienced by a person when the demands put on the person exceed the social and personal resources that the person is able to garner. Management of Stress Stress can be and should be managed to enable survival. Modern working life creates tremendous personal and occupational pressures, which need immediate management and successful resolution. Stress management techniques are many and all of them try to control this fight-flight response. Stress has to be managed with a rational, calm, controlled and socially sensitive approach. To avoid burnout and debilitated health in the end, stress may be managed by the following techniques: * Action-oriented approach - In this kind of approach, the problem creating the stress is identified and confronted directly. Appropriate changes are made to alter the situation or the environment and thereby reduce or eliminate stress by resolution of the problem creating the stress. * Emotion-oriented approach - In this kind of approach, the individual does not have the power to change the environment or the situation. The individual modifies personal emotions to interpret the situation differently and thereby attempts to reduce to eliminate stress. * Acceptance-oriented approach - In this kind of approach, the individual has no direct or indirect control over the factors causing the stress, along with no emotional control to alter the interpretation of the situation. Total acceptance of the stress is undergone and the focus is only on to somehow let the time pass and survive the stress. This shows results in short term or long term health damages. * Adaptation-oriented approach - In this kind of approach, the individual adapts to the situation, and instead of trying to fight it, tries to go along with the flow, thereby becoming one of the factors causing stress. This is done with a view that if the individual also becomes one of the factors causing stress then stress shall be diverted to some other individual and thereby the individual shall be free from stress. This approach is widely practiced in office politics, where the officers transfer their stress to their subordinates who again pass it on to their juniors. The negative side of this approach is that if the last individual who finally receives the stress is unable to face it or fails in the resolution of the stress, then additional stress is created, which goes on increasing, and if uncontrolled, may result in a severe mental derangement of the individual, leading even to suicide or death.

Conclusion There are many other approaches identified by researchers, and any approach that suits the individual should be applied. However, if stress is unbearable and seems to be beyond control, then a qualified health professional should be immediately consulted. Even minor changes in diet or exercise should be informed to the health professional, so that with adequate professional help, stress can be controlled and if possible, eliminated. Alternative therapies like meditation, yoga, deep breathing, etc., are also very popular in the management of stress.

http://books.google.co.in/books?id=N_ayEsUSVVIC&pg=PA4&lpg=PA4&dq=The+transactional+and+inte ractional+model&source=bl&ots=nOLVOrF6Aq&sig=uEhI0424k7q_846LpzJZ1sGUx8E&hl=en&sa=X&ei=Z 2lQUd_vFsHXrQeUkoCYCQ&ved=0CIQBEOgBMAk#v=onepage&q=The%20transactional%20and%20inter actional%20model&f=false (for The transactional and interactional model)

Interaction (Transactional) Theories and Research

Stress is a main contributor to many modern ailments. So, the million dollar question is, how can we cope? How can we protect ourselves, and lighten the load? What do we need to know about stress so that we can manage it successfully? Although some theoretical perspectives have focused on stress as a stimulus and others have focused on stress as a response, most modern conceptualizations of stress can be considered interactive or transactional in nature. Transactional theories incorporate the importance of both stressors and stress responses in explaining the linkage between stress and illness or disease. Additionally, transactional theories of stress suggest that stress responses can serve as new stressors that elicit more intense stress responses. For example, if an individual responds to interpersonal conflict (a stressor) by drinking alcohol and smoking cigarettes (an acute behavioral stress response), these behavioral responses may become new stressors that warrant additional stress responses. Thus transactional theories of stress incorporate components of stress stimuli and responses that operate upon one another in a cyclic fashion. In addition, interaction or transactional theories emphasize the relation between the individual and the environment, something rarely discussed by purely stimulus or response theorists. Transactional theorists recognize that a great deal of variability exists regarding the magnitude of acute stress responses to seemingly comparable stimuli. As such, they have looked to individual difference factors to help explain these common observations. Lazurus and Folkman (1984) proposed a transactional theory of stress that has received considerable attention over the years. According to their perspective, it was not the initial stressor per se that was critical in linking stress to disease, but the individuals response to the stressor that determined whether a cyclic stress reaction developed. Focusing upon the acute cognitive stress response system, Lazurus suggested that three types of cognitive appraisal occurred in determining the magnitude of the stress reaction: primary appraisal, secondary appraisal, and reappraisal. Primary appraisal focused upon the degree to which a person detected a stressor as being harmful (leading to potential injury or illness), threatening (causing anxiety, fear, or damage to self-esteem), or challenging (leading to potential gain or growth). According to Lazurus, individuals determined whether a stimulus was irrelevant, benign-positive, or stressful; only stimuli appraised as stressful elicited ongoing stress responses. Imagine, for example, brushing ones leg against something furry while hiking. It might be appraised as irrelevant if it was moss, benign-positive if it was a baby rabbit, or stressful if it was a rabid skunk! Primary appraisal was conceptualized as being accompanied by secondary appraisal, which focused upon a persons determination of his or her resources to cope with the stressor perceived during primary appraisal. Most individuals clearly possess the re sources to cope with brushing up against moss or a furry baby rabbit; however, many would question what to do when encountering a rabid skunk. Finally, the process of reappraisal involved any change in the primary appraisal as a result of the assessment of coping resources that occurred during secondary appraisal. Not all transactional perspectives rely on cognitive appraisal. Jay Weiss, for example, conducted seminal laboratory examinations of the stimulus characteristics of predictability and control on stress responses in rats (1970; 1971a; 1971b).

Weiss devised a set of sophisticated experiments demonstrating that rats that were provided with both control and predictability over a stressful stimulus exhibited reliably smaller stress responses and lesser tissue damage than yoked control animals without control or predictability (Weiss, 1970; 1971; 1971b). Therefore, controllability and predictability represented contextual components of the laboratory experiment that were shown to determine the magnitude of the stress response evoked by the stressor. Weisss influential work on the importance of control and predictability of the stimulus affecting an organisms stress respo nse provided the empirical foundation for a transactional theory of stress commonly referred to as the Defense-Defeat Model of Stress (Henry and Stephens, 1977). According to these authors, there are two distinct stress responses: the defense reaction and the defeat reaction (see Figure 3.2). As this perspective employed attention to both stimulus and response characteristics, it represented another good example of an interactive or transactional perspective on stress. As depicted in Figure 3.2, the controllability of the stimulus was clearly related to the type of cortical response that occurred. In a situation that provoked a threat to an organism, the fight-flight response was triggered, resulting in the defense reactioncharacterized by fleeing or displaying aggression. In contrast, if the situation resulted in a loss of control by the organism, the defeat reactionoccurred, characterized by limited activity and subordination. These two systems clearly were differentiated behaviorally as well as physiologically. Not only were they associated with distinct observable behavioral differences, they also involved different brain mechanisms, different neurotransmitter systems, and different peripheral manifestations of the response in the peripheral nervous system.