Stress Counseling

Stress is an unpleasant state of emotional arousal that people experience in situations that they perceive as dangerous or threatening. It is accompanied by physiological, behavioral, and cognitive changes. Although stress signals danger and thus has a protective function, the experience of chronic stress is a causative factor in physical illness as well as poor life adjustment and psychiatric disturbance.

Individuals differ in their propensity to experience stress and in their ability to cope effectively. Effective coping ultimately involves effective problem solving although emotion-focused strategies are useful in the short term and in uncontrollable situations. When stress and poor coping are experienced chronically, the resultant physiological changes may contribute to the onset of disease. Sustained stress and poor coping may also produce psychopathological reactions that have been termed anxiety disorders. The workplace is a source of stress for many individuals. Intervention programs have been developed to help anticipate and prevent occupational stress, to deal with ongoing workplace stressors, and to address the aftermath of workplace stress.

Stress and Physiological Changes

Walter Cannon, one of the first people to study the stress response, coined the term flight-or-fight to describe the body’s activation as it prepares to confront or retreat from a stressor. Both responses require an alert, rapidly aroused individual, poised for action. Although the flight-or-fight system may have been adaptive in the ancient past when people dealt mostly with physical stressors, it is less effective in contemporary society where people often face threats to self-esteem that are not amenable to direct action. Continual activation of the flight-or-fight system via arousal of the sympathetic nervous system and secretion of stress hormones is thought to account for many health problems, such as chronic pain disorders and cardiovascular disease.

Another stress pioneer, Hans Selye, observed that medical patients with different illnesses often shared symptoms such as muscle weakness and weight loss. He theorized that these responses might all be part of a generalized pattern of physiological response to stress that occurred irrespective of the nature of the stressor. His three-stage model of the stress response (the general adaptation syndrome) consisted of an initial stage of generalized arousal (alarm stage), followed by the body’s attempt to adapt to and resist the stressor (resistance stage). If the stressor persists over a long period of time, the resources of the chronically overtaxed body are exhausted and the resulting physiological damage leaves the body vulnerable to disease and even death (stage of exhaustion). Recent research indicates that many of the damaging effects of chronic stress are due to cortisol, a hormone that is secreted by the adrenal gland via activation of the hypothalamic-pituitary-adrenal axis during stress arousal.

Stress and Behavioral Changes

No single behavior has emerged as a reliable indicant of stress. Stress is often reflected in changes in outward behavior such as tremors, heavy breathing, nail biting, teeth clenching and grinding, speech disturbances, and avoidance behaviors. However, these behaviors may reflect boredom or other emotional states. Psychologist Paul Ekman has noted that one way people commonly express strong emotions is through facial expressions. He concluded that when a person confronts a stressor and experiences extreme fear the facial features that become most distinctive are the eyebrows (raised and drawn together), eyes (open, lower lids tensed), and the lips (stretched back).

Stress and Cognitive Changes

Richard Lazarus and Susan Folkman have developed the most influential model of the cognitive changes that occur during the stress process. Lazarus and Folkman emphasize that the stress process begins with a conscious appraisal of threat in the environment. This initial assessment or primary appraisal of an event may involve anticipated threats, ongoing stressors, or past occurrences that are producing negative self-evaluations. Secondary appraisal involves assessment of the resources individuals have at their disposal to deal with threatening circumstances. These appraisals can change rapidly and affect a person’s decision regarding how to cope with the situation.

The cognitive appraisal model provides a useful description of the processes involved in responding to the kinds of stressors most people confront daily. However, some stress reactions do not involve sustained conscious activity. When confronted with life-threatening stimuli (e.g., an attacking snake), “crude” sensory information is rapidly passed by the thalamus (a sensory way station in the brain) to the amygdala, a structure in the brain that prompts people to take immediate defensive action to insure their survival (e.g., fighting, fleeing, freezing) and “ask questions later.”

Stressors

Stressors—those circumstances that induce stress responses—are classified into three general categories: catastrophic events, major life changes, and daily hassles. A catastrophe is a sudden disaster or other life-threatening event that strains individuals’ coping capabilities to their limits. Exposure to such traumatic events may have enduring negative consequences, as indicated by the incidence of posttraumatic stress disorder in the wake of war trauma, sexual assault, and natural disasters.

Major life changes include serious illness, breakup of a marital relationship, job loss, imprisonment, or death of a close family member. Even events that are planned and generally considered to be desirable (e.g., marriage, voluntary retirement, or the birth of a child) require readjustments that can be stressful. Death of a spouse and divorce were rated as the most disruptive major events, according to a survey conducted in 1967. Although the relative ranking of stressors has changed somewhat, as seen in surveys conducted in 1978 and 1994, death of a spouse and divorce, along with death of a close family member, have continued to be rated as the most stressful life events.

Daily hassles, sometimes termed chronic background stressors, refer to seemingly minor annoyances associated with everyday living. Examples include troublesome neighbors, inconsiderate smokers, having to care for a pet, commuting to work daily in heavy traffic, and living and working in a noisy environment. These events may pose only minor inconveniences taken alone, but they can cause significant levels of stress when experienced repetitively. Cumulative exposure to daily hassles is associated with illness to a greater degree than exposure to major life events.

Stress and Personality

There is considerable evidence that some individuals are stress prone (i.e., more likely to respond with high levels of stress to any given situation). People who score higher on measures of trait anxiety, such as the trait anxiety scale of the State-Trait Anxiety Inventory, have been found to consistently experience higher levels of stress (or state anxiety) when exposed to situations involving threat to self-esteem or threat of failure than persons who score lower on those measures. However, fears of specific situations that are not social or evaluative in nature—especially those that have a strong physical threat component—are not related to trait anxiety. Individuals who have a strong fear of snakes or spiders or of going to the dentist are not necessarily generally fearful people, and they usually function well in social situations. Specific fears or phobias usually stem from aversive experiences people have had with that particular situation. Proneness to fear-specific situations is best measured by specific-fear inventories such as the Dental Anxiety Scale.

Although some people find the prospect of encountering circumstances involving some element of physical threat to be particularly stressful, other individuals (labeled “sensation seekers”) actively seek out risky and dangerous situations. Sensation seekers are not the opposite of chronically anxious individuals, and sensation seeking is unrelated to general trait anxiety. Despite the fact that sensation-seeking activities are often life threatening, sensation-seeking behavior is influenced by a genetic predisposition. Furthermore, this seemingly fearless, heroic behavior is encouraged by others and is likely perpetuated via the more frequent sexual activity that is characteristic of those who score high on this trait.

Coping With Stress

Coping is the process of managing the demands imposed on a person during stressful encounters. When using problem-focused coping behaviors, people attempt to diminish their stress level by actively dealing with the situation that is inducing the stress. People’s problem-focused strategies include confrontation, making a plan of action, and getting advice from someone who can help them do something concrete about the problem they are facing. Emotion-focused coping strategies involve trying to directly moderate the unpleasant emotions that accompany stress without necessarily attending to the stressor that is inducing those emotions. Common emotion-focused strategies include denial, escape-avoidance, turning to religion, acceptance, and positive reappraisal. Sometimes people seek support from others for strictly emotional reasons (to get sympathy or as a way to express their feelings) without seeking anything concrete from the encounter.

Accurate reality testing is considered the hallmark of mental health, and effective problem-focused coping is a prime contributor to a sense of self-worth or self-efficacy. Nevertheless, emotion-focused coping is useful as a short-term strategy and as a way of managing seemingly uncontrollable situations. In marital counseling, for example, teaching emotion-focused strategies such as acceptance and detaching from problems using humor is important to set the stage for the introduction of more active problem-solving approaches.

The stress appraisal and coping process is dynamic and transactional. People are continually reappraising situations, and for those perceived as threatening they are constantly considering different potential coping strategies. Complex events such as interpersonal relationships include multiple stressors, and people are often dealing with multiple events simultaneously. How a person deals with each encounter is influenced by other ongoing events, by his or her knowledge of past successes and unsatisfactory outcomes, and by the coping strategies he or she used in those instances.

Traits Associated With Effective Coping

It is important to distinguish between coping and coping outcomes. The latter refer to the effectiveness of coping strategies. Several related personality traits (relatively stable behavioral dispositions) have been associated with the ability to cope more effectively. These traits include (a) hardiness, which is characterized by the view that life experiences are controllable and that change is a positive rather than an aversive event; (b) an internal locus of control orientation, which is characterized by the belief in personal control over events and one’s ability to directly influence important outcomes through one’s behavior, and (c) optimism, which is characterized by the general expectancy that good things will happen. In contrast to pessimists, who believe that negative events will persist, optimists view bad experiences as temporary setbacks. Optimism has been found to be associated with the effective use of problem-focused coping and the ability to adapt successfully to stressful events such as coronary-artery bypass surgery. Optimists deal better with negative information that challenges their positive beliefs and make better use of the information to solve problems than pessimists.

Stress and Psychopathology

There is no clear dividing line between normal stress reactions and those that are maladaptive and indicative of psychopathology. Nevertheless, some cardinal features of maladaptive stress reactions are known. Maladaptive stress reactions appear to be overdetermined and out of proportion to the actual degree of danger confronting the individual. They are sustained over an extended period of time, resulting in continued stress arousal, preoccupation with thoughts of failure, and a sense of loss of control that is often independent of ongoing life events. The individual’s behavior is characterized by “anxious apprehension,” in which attention turns inward and problem solving becomes increasingly ineffective.

Psychopathological reactions characterized by anxiety and poor ability to cope with stress have been termed anxiety disorders. Anxiety disorders include:

  • generalized anxiety disorder (chronic anxiety with worries about family, money, work, and illness)
  • simple phobia (persistent fear of specific objects such as animals and heights)
  • social phobia (fear of being in situations where there is the prospect of being watched and evaluated)
  • panic disorder (recurrent, unexpected panic attacks)
  • obsessive-compulsive disorder (persistent thoughts that are viewed as uncontrollable accompanied by repetitive behaviors designed to ward off those anxiety-inducing thoughts)
  • posttraumatic stress disorder (exposure to a traumatic stressor outside of the usual range of human experience followed by recurrent reexperiencing of the event, avoidance of thoughts associated with it, and arousal symptoms such as sleeping disturbances and anger outbursts)

Most of these disorders are treated effectively with behavioral stress management techniques, sometimes in combination with antianxiety medication.

Stress and the Workplace

Occupational stress is a serious and increasing problem in the United States. For most people their work is not only a source of income but also an important source of self-esteem and status. Frustrating and unsatisfying job conditions produce personal distress and have also been associated with inefficient job performance, increased employee theft, accidents, absenteeism, and substance abuse. Another increasingly common reaction to job stress is violent behavior directed against those whom the worker deems responsible for his or her problems.

The recent rise in occupational stress has been attributed in part to the increased numbers of people employed in service industry work. These occupations are said to produce burnout and are associated with an unusually high incidence of violence. Other factors are corporate restructuring and the uncertainty produced by it, and social and technological changes that have rendered previously desirable skills unmarketable. General causes of occupational stress include physically unpleasant working conditions, an inability to form satisfying interpersonal relationships on the job, sexual harassment, role ambiguity, and role conflict.

Among the most important variables contributing to job stressfulness are the extent to which a job is perceived as demanding and the flexibility the worker has to make decisions and do what is necessary to get the job done. The most stressful job is one that makes high demands but gives the worker little decision latitude. Jobs with those characteristics often produce debilitating stress symptoms.

There is some evidence that women are more likely than men to experience stressors related to sexual harassment and pay inequity. Age appears to bear a curvilinear relationship to job stress, with people in their 20s and 30s reporting lower levels of occupational contentment than younger or older workers. Individuals characterized by extreme competitiveness, time urgency, difficulty in controlling their impatience, and difficulty expressing their hostility in acceptable ways (i.e., the type A personality) are physiologically overresponsive to stress, more prone to develop cardiovascular disease, and a greater source of stress for others in the work setting.

Worksite stress-management interventions include preventive interventions, programs designed to deal with ongoing stressors, and programs addressing the aftermath of workplace stress. Examples of preventive interventions programs are those designed to ease the transition into the work environment by helping workers prepare for and anticipate job stressors, and selection and placement procedures to avoid mismatching individuals and jobs. Interventions for ongoing stress include in-house fitness or wellness programs that include relaxation and exercise classes and health promotion activities such as dietary control and cardiovascular fitness. In some work settings (e.g., police, fire, emergency medical services), the incidence of traumatic events is sufficiently high that critical-incident stress debriefing teams are available to help workers deal with the aftermath of work stress. These teams provide a setting for trauma victims to interact, exchange information, and provide mutual support.

References:

  1. Auerbach, S. M., & Gramling, S. E. (1998). Stress management: Psychological foundations. Upper Saddle River, NJ: Prentice Hall.
  2. Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.
  3. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
  4. McEwen, B. S., & Lasley, E. N. (2002). The end of stress as we know it. Washington, DC: Joseph Henry Press.
  5. Sapolsky, R. M. (1998). Why zebras don’t get ulcers: An updated guide to stress, stress-related diseases, and coping. New York: Freeman.

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