Stress Management

Allan Sanders, MN, ARNP

asanders@wsu.edu
Objectives

 Explore the biological, psychological, and

social aspects of the human stress response.

 Describe the difference between adaptive

and maladaptive coping strategies.

 Understand coping strategies that increase

resilience to promote productive living and
healthy aging.
 Common Stress Associated
Diseases
 Diminished Immunity  Anxiety
 Headache  Depression
 Fatigue  Alcoholism
 Weight gain  Substance abuse
 Dyslipidemia  Insomnia
 Hypertension  Irritable bowel syndrome
 Heart Disease  Fibromyalgia
 Psoriasis/Eczema  Decreased sex drive
 Digestive problems
 Overview of Terminology
 Stress: A state of disharmony or a threat to
homeostasis
 Physiological changes increase alertness, focus, and
energy
 Perceived demands may exceed the perceived
resources

 Coping: The ability to maintain control, think

rationally, and problem solve

 Resilience: Resistant quality that permits a person to

recovery quickly and thrive in spite of adversity
 Stress
 Eustress
 Manageable Stress can lead to growth and enhanced
competence

 Distress
 Uncontrollable, prolonged, or overwhelming stress is
destructive.

 Acute Stress
 Immediate response to a threat or challenge
 Chronic Stress
 Ongoing exposure to stress, may seem unrelenting
 Causes of Stress
 External causes

 Family, work, economics, work, school, major life changes,

unforeseen events, etc.

 Internal causes

 Worry, uncertainty, fear, attitudes, unrealistic expectations,

etc.
 Sources of Clinical Stress
For patients For nurses
 Uncertainty  Poor patient outcomes
 Fear  Risk of making an error
 Pain  Unfamiliar situations
 Cost  Excessive workload
 Lack of knowledge  Inadequate resources
 Risk for harm
 Unknown resources
Stages of the Stress Response
General Adaptation Syndrome of Hans Selye (1907-1982)

 Alarm—when one feels threatened

 Activation of the fight or flight reaction
 Resistance—mobilization of resources to solve the
problem
 Continued stress causes adaptation
 Exhaustion
 Adaptation fails and level of function decreases
 Hypothalamic Pituitary Adrenal
Axis

Catecholamines Cortical Steroids

 Increases cardiac output  Elevates glucose
 Dilates airways  Increases amino acids
 Dilates pupils  Increases NA resorption

 Mobilizes glucose  Increases extracellular fluid

volume
 Causes vasomotor changes  Inhibits histamine and
bradykinin
 Decreases digestion
 Suppresses the immune
 Enhances coagulation response
 Resistance
 Adaptation occurs
 Activation of the hypothalamic pituitary adrenal axis
continues

 The stressor may be resolved

 The body returns to homeostasis

 May progress to exhaustion

 Stress continues as resources are depleted
 Exhaustion

 Occurs when the demands of the stress

exceeds the persons ability to adapt.

 Functioning declines

 May result in health problems

 Physical symptoms

 Mental symptoms
 Signs & Symptoms of Stress
 Cognitive
 Decreased concentration, comprehension, & memory
 Behavioral
 Irritability, withdrawal, violence
 Emotional
 Fear, anxiety, depression, fatigue
 Physiological
 Increased BP, HR, Respirations, etc
 Somatic symptoms
 Decreased immune response
 Genetics & Development
Genetics
 Genes control the stress
response
 Individuals have different
responses to stress
 There is a genetic
component to:
 fearful behavior
 anxiety disorders
 Neurobiological response
Development
 Life experiences can affect a
person's stress response
 Social support
 Strong support is protective
 Early life stress
 Increases stress reactivity as an
adult
 Coping & Resilience
Coping Resilience
 Ability to control emotions  The ability to bounce back
 Ability to perceive reality  The positive capacity to cope
 Ability to think rationally with stress

 Ability to problem solve  Provides resistance to

negative events
 Culturally defined  Hardiness,
 Resourcefulness
 Coping
Adaptive Coping

 Contribute to resolution of the stress response

Maladaptive Coping

 Strategies that cause further problems

Active Coping

 Actively seeking resolution to the stress

 Promote Adaptive Coping
 Realistic expectations
 Set realistic goals
 Planning
 Anticipate problems, have a backup plan
 Reframing
 Change the way you look at things
 Relaxation
 Learn relaxation techniques, take time-out for
leisure
 Discuss the problem
 Utilize existing social supports to problem solve
Promote Adaptive Coping
 Training
 Prepares for stressful events
 Nutrition
 Eat healthy, avoid skipping meals
 Exercise
 Include regular exercise
 Sleep
 Get adequate sleep—avoid fatigue
Avoid Maladaptive Coping
 Blurring of boundaries
 Avoidance/withdrawal
 Negative attitude
 Anger outbursts
 Alcohol/Drugs
 Hopelessness
 Negative self-talk
 Resentment
 Violence
Promote Resilience Factors
 Positive Role Models
 Optimism
 Humor
 Moral Compass
 Altruism
 Religion & Spirituality
 Social Support
 Positive Role Models
Transmit:

o Attitudes

o Values

o Skills

o Patterns of thoughts and behaviors

 Optimism
 Positive Beliefs

 Associated with well being

 Cognitive reframing
 Positive thinking
 Refute the negative thinking
 Believe in a meaningful cause

 It is important to acknowledge relevant negative

factors
 Humor
 Highly effective
 Mature coping mechanism

“Another of the souls’ weapons for the fight

for self-preservation, it is well known that
humor, more then anything else in the human
makeup, can provide an aloofness and the
ability to rise above any situation, even for a
few seconds.”
Viktor Frankl
 Moral Compass
 Conduct a moral inventory
 “Look not for any greater harm then this,
destroying the trustworthy, self-respecting, well-
behaved man within you.”
Epicetus

 Maintain your integrity

 “Between stimulus and response there is a space. In
that space is our power to choose our response. In
our response lies our growth and our freedom.”
Viktor Frankl
 Altruism
 Unselfish regarding the welfare of others
 Believe in a meaningful cause
 Mutual cooperation
 Activates of the brain’s reward center
 Religion & Spirituality
 Associated with psychological and physical
well being
 Guards against despair
 Provides social support
 Provides positive role models
 Provides a positive mission
 Social Support
 Social support has a profound effect on life
expectancy

 Patients have better outcomes with strong social

support

 Isolation and poor social support are associated

with a poor stress response

 Few hardy individuals “go it alone”

 Signature Strengths
 Recognize skills and talents
 Inventory strengths

 Use your strengths and talents

 Decide what works

 Actively cope
 Apply concepts to enable active coping.
 Review
 Stress is part of everyday life
 It can promote growth and competency
 If unrelenting or overwhelming it can cause adverse
effects

 Adaptive coping enhances resilience

 Maladaptive coping causes additional problems
 Enhanced coping increases resilience while diminishing
the adverse affects of stress, thus promoting health
 Review: Practical Tips
 Set realistic expectations
 Exercise regularly
 Eat healthy
 Get adequate sleep
 Maintain a work-leisure balance
 Positive Reframing & optimism
 Enhance social support

Internet Resources
Building resilience: http://www.slideshare.net/3dogMcNeill/building-resilience

 Diet, exercise, stress and the immune system:

http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome/hic_diet_exerci
se_stress_and_the_immune_system.aspx

 Exercise: Rev up your routine to reduce stress:

http://www.mayoclinic.com/health/exercise-and-stress/SR00036

 Positive thinking: Reduce stress, enjoy life more:

http://www.mayoclinic.com/health/positive-thinking/SR00009

 Stress management for patient and physician:

http://www.mentalhealth.com/mag1/p51-str.html

 Stress management: Understand your sources of stress:

http://www.mayoclinic.com/health/stress-management/SR00031

 Stress reduction techniques: A must for a healthy lifestyle:

http://www.managestresstips.com/category/stress-reduction/
 Learning Exercise
1. List your current sources of stress.
2. Conduct an inventory of coping strategies that you
use or have used in the past.
 Include maladaptive strategies
3. List your signature strengths and factors that may
enhance your resilience.

4. While considering the above, develop a personalized

stress management plan to enhance your coping and
resilience.
 References
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Contact Information

Allan Sanders, MN, ARNP

asanders@wsu.edu