Stress Management

Hans Selye first introduced the concept of stress in 1926. In his early work, Selye defined stress as a bodily response to overuse or damage. Modern definitions view stress as a response to internal or external factors that are perceived as threatening. Refinements in this field have led to the use of two terms: stressor, the stimulus that causes stress, and stress, the reaction or response of the individual to the stressor.

Stressors tend to fall into two categories: biological and psychosocial. Biological (or biogenic) stressors have properties that elicit a physiological response. They cause chemical or electrical stimulation in the body that causes the body to react with arousal. Biogenic stressors bypass cognitive processes and include substances like caffeine, nicotine, and stimulant drugs.

Psychosocial stressors are real or imaginary events that, because of a person’s interpretations, cause the body to respond with the stress response. Richard Lazarus first described the importance of cognition in the stress process with the term cognitive appraisal. Cognitive appraisal is the idea that the interpretation individuals assign to an event determines whether it is stressful or not. If the cognitive appraisal is that the stimulus is a threat, the stress response will be activated. Psychosocial stressors may be psychological (worries or fears) or social (relationships, racism, or sexism).

Once a stimulus is appraised as a stressor, a complex set of processes occurs in the body. It was labeled the general adaptation syndrome (GAS) by Selye and consists of a series of three stages. George Everly, Jr. described the GAS as “the missing link” that explains how stress causes physical dysfunction. When facing a stressor, the body prepares itself for action. Evolutionarily useful, the alarm phase is commonly known as flight-or-fight. In this phase, the sympathetic nervous system is aroused. Stress symptoms like rapid heartbeat, perspiration, increased blood pressure, dilation of pupils, and difficulties swallowing are signs that the body is responding to a stressor.

If the threat or stressor continues, the individual enters the resistance phase. During this phase, the body works to reestablish homeostasis and repair any physical damage that occurred during the alarm stage. If the stressor continues and homeostasis cannot be achieved, the body will eventually enter the exhaustion phase in which physical breakdown occurs. During this phase, the individual is vulnerable to opportunistic disease and damage to target organs in the cardiovascular, gastrointestinal, and immune systems. The alarm and resistance phases are repeated many times over the life span. In fact, some individuals experience this type of activation and return to homeostasis on an almost daily basis. The damage that occurs with the exhaustion phase is significant and may not be able to be repaired.

Coping and Stress Management

Coping is an individual’s response to the stressor. The ability to cope can greatly mitigate the impact of a stressor. Coping is defined as any attempt to manage a stressor and can be adaptive or maladaptive. Relaxation, imagery, and meditation are examples of adaptive coping while abusing drugs and alcohol are maladaptive means of coping. When coping is successful, the individual returns to homeostasis and no physiological damage occurs. When coping is unsuccessful, the stressor continues to cause arousal in the individual and eventually causes physical harm.

Managing Stress

Everly developed a multidimensional model of managing stress that targeted each part of the stress response (see Figure 1). Intervention can occur at the level of the stressor, during the appraisal process, at the point at which neurological systems are triggered, or at the physiological level. At each of these points, several interventions can occur that enable individuals to manage their response to stress and return to homeostasis.

Stress Management Figure 1

Figure 1. Stress intervention points

Source: Adapted from Everly, G., S., Jr. (1989). A clinical guide to the treatment of the human stress response. The Plenum series on stress and coping. New York: Plenum Press.

Managing Stress through Environmental Engineering

Stress may first be reduced at the level of the stressor. D. A. Girando and Everly labeled intervention at this level environmental engineering. Environmental engineering involves changing the external and internal environment so that exposure to the stressor does not occur. Forms of environmental engineering range from ergonomic aids (a more functional keyboard) to simple changes in the environment (closing one’s door while working) to more drastic measures (changing careers to develop a less stressful lifestyle). In some cases, knowledge about the stressors in an environment helps people make changes so that the environment is less stressful. For example, knowing that a NASCAR race will be loud causes many spectators to bring earplugs, changing the level of the stressor (the noise) that they experience.

Self-modification of behavior is another way to change the environment and reduce interaction with stressors. Behavior modification involves recognizing and defining a target behavior, assessing its frequency, developing a plan to modify the behavior, reinforcing the change, and evaluating the plan for effectiveness. Through this process, individuals can change behaviors that cause them stress.

Planning and time management are interventions that change the environment. Planning involves thinking about the future, and it can be narrow (planning the day) or broad (planning a career). Time management may help in coping with current or future stressors as the individual works to develop goals, priorities, and schedules. Both methods involve identifying and preparing for stressors.

Psychotherapy functions as an intervention at several places in the model. In environmental engineering, psychotherapy may involve communication skills, assertiveness training, or anger management. Understanding nonverbal communication and being able to reflect, paraphrase, and summarize can change an individual’s interpersonal environment drastically. In assertiveness training, individuals learn to speak their thoughts in order to communicate their inner perceptions more clearly. Anger management courses generally consist of helping individuals recognize their problems with anger and developing more effective ways to express negative feelings. Environment changing therapy may be as simple (or complex) as individuals working with a therapist who enables them to remove themselves from stressors. In some cases, leaving a stressful job or abusive marriage is the only way to reduce exposure to a stressor. In these cases, intense individual or group therapy may be the most useful intervention for changing the environment and managing exposure to stressors.

Managing Stress through Changing Cognitive Appraisals and Emotional Interpretations

Another point of intervention occurs when an individual makes a cognitive appraisal or emotional interpretation of an event. Several cognitive styles have been found to be helpful in managing stress. Individuals with an optimistic outlook on life have been found to have greater longevity, remain in their jobs longer, and have superior immune system functioning when compared to individuals with more pessimistic outlooks. Martin Seligman defined optimistic style as a hopeful view of the world that enhances well-being and fights depression. For many individuals, a more optimistic style may be learned and/or practiced through psychotherapy and coaching.

Although psychologists have long ignored religious life and spirituality, a spiritual life may aid in managing stress by providing a filter through which appraisals are made. Organized religion may provide forgiveness, fellowship, social support, and hope for the future. Regardless of the spiritual tradition, security may be obtained through attachment to a higher power. Like an optimistic outlook, spirituality has been shown to provide a positive foundation from which stressors can be appraised.

Salvatore R. Maddi’s transformational coping helps individuals reinterpret stressors as opportunities, which can be appraised positively. In this type of coping, an individual works to develop a different perspective and views stressors as opportunities for growth. As individuals change their perspective, they feel more in control, thereby changing their appraisal to a less stress-provoking stance. Transformational coping can occur individually or with the help of a therapist.

Modifying internal conversation can be an important form of changing a cognitive appraisal of events. As delineated by Albert Ellis, overgeneralizations, catastrophising, black and white thinking, and blaming are modes of unproductive thought that can cause almost any situation to become a stressor. In working with self-statements that cause stress, individuals must first become aware of their negative self-statements and begin to challenge these statements when they occur. Writing negative thoughts and developing positive challenges to them can help manage stress at the level of cognitive appraisal. For example, instead of thinking, “I’m so stupid! I’ll never figure this out!” a student might think, “Math isn’t my thing, but with some extra tutoring, I can grasp this concept.” The goal is to replace negative self-appraisal with more effective and rational thinking. In this way, the cognitive appraisal and the ensuing emotions are changed at the point at which they occur and the stress process is halted.

Another form of stress management that helps individuals change their appraisals is Francine Shapiro’s eye movement desensitization and reprocessing (EMDR). EMDR is a behavioral treatment developed to help individuals overcome traumatic events. Traumatic events often have cognitive appraisals and strong affect that accompany them, leading to extreme amounts of stress. EMDR works through changing cognitive self-statements, awareness of emotional and physical states, and bilateral brain stimulation to revise an individual’s cognitive appraisals of an event and calm the affective reaction.

Systematic desensitization can also change cognitive and affective appraisal. Traditionally practiced by behavior therapists, systematic desensitization helps individuals decrease anxiety from stressors by developing a hierarchy of anxiety-provoking events and practicing alternating relaxation with anxiety. In essence, the client relaxes while imagining increasingly anxiety-provoking material. Alternating relaxation with the stressor provides an opportunity to practice managing negative emotions and controlling anxiety. As an individual relaxes while thinking about the stressor, his or her appraisal of the stressor is changed.

Managing Stress by Calming Neurological Triggering

The third intervention point occurs when a stressor has triggered the sympathetic nervous system. If the individual perceives a threat, this system will become activated in defense of the body and psyche resulting in the classic physiological distress symptoms. Helpful interventions at this level are those that directly affect arousal and enhance the relaxation response by making changes at a neurological level. Over time, use of the relaxation response protects the individual from the disease and psychological dysfunction incurred in Selye’s exhaustion phase. Relaxation, meditation, mindfulness, breathing exercises, and pharmacology are interventions that act at the point of neurological arousal and are effective in calming the sympathetic nervous system.

Probably the best known of all stress management techniques is progressive muscle relaxation (PMR). First described by Edmund Jacobson in 1938, PMR combats stress by producing physiological responses that are incompatible with stress. In PMR, individuals are taught to relax the major muscles of the body by alternately tensing and relaxing muscle groups. This process produces a state of physiological calm. Because the body cannot be activated and relaxed at the same time, PMR is particularly effective at reducing the neurological arousal that occurs when faced with a stressor. Another approach is to focus on breathing while progressively relaxing each muscle group without tensing. After sequentially relaxing each muscle group, the individual experiences less tension and can achieve a state of deep relaxation. PMR is a skill that can be learned with practice. Many individuals find that they can monitor their tension levels and reduce them at will. This has the effect of intervening in the stress response process by decreasing neurological activation.

While relaxation works to inhibit stress by quieting the body, meditation works by quieting the mind. Meditation is the practice of narrowing one’s attentional focus to breathing or a single thought (a mantra) with the goal of lowering mental activity. There are many types of meditation, but the best known is transcendental meditation (TM). In TM, the meditator focuses on the mantra for 15 or 20 minutes. Other types of meditation are centering prayer and meditative walking. Meditation has been shown to slow metabolism; decrease breathing rate, heart rate, and blood pressure; increase immune activity; and improve reaction time and memory.

In a related way, mindfulness mediation helps individuals manage stress by focusing on thoughts and narrowing attention to notice each thought that enters their consciousness. Mindfulness can be defined as nonjudgmentally paying close attention to present experience. Jon Kabat-Zinn developed mindfulness based stress reduction (MBSR) for use with chronically ill patients. Essentially, MSBR teaches mindfulness meditation techniques to be used every day. The goal of the program is to help individuals manage the stress and pain of disease by becoming aware of their automatic/habitual thoughts without judging them, allowing for the possibility that these feelings can pass and reality can be reframed.

Deep breathing is another form of stress management that works to decrease neurological triggering.

Sometimes called brief relaxation, breathing relaxation consists of taking several deep slow breaths. Deep breathing may help individuals make an immediate association with relaxation while providing relief at a physiological level. It has been found to help manage pain and may also be helpful in preparing for stressors like making a speech.

A final form of neurological intervention can be found in psychopharmacology. There are a number of psychoactive drugs on the market (benzodiazepines, antidepressants, and sedatives) that can be very effective for calming neurological reactions and emotional distress that accompany exposure to extreme stressors. At the same time, many of these drugs are addictive and can lead to greater problems and distress when used long term. Each of these medications should be taken under the supervision of a psychiatrist or medical practitioner. Pharmaceutical intervention for stress management should be used for short periods of time and only for extreme distress.

Managing Stress to Protect Organs and Systems

A fourth point of intervention is the use of stress management techniques to protect organs and systems that would be damaged by exposure to long-term stress. Research shows that chronic stress has negative effects on a variety of bodily systems and organs. Biofeedback, exercise, and proper nutrition are interventions that protect against the chronic effects of stress.

Biofeedback enables individuals to manage their responses to stressors by learning to control their autonomic nervous system. Specifically, biofeedback involves electrical monitoring of muscle contractions (electromyograph EMG), brain waves (electroencephalograph, EEC), sweating (galvanic skin response, or GSR), or heat monitoring of skin to increase awareness of the functioning of one’s autonomic nervous system. Electric or thermal monitors provide information regarding nervous system arousal. As individuals experience autonomic nervous system arousal (muscle tension, increased heart or brain waves, sweating), a system of tones or lights alerts them to the increase in arousal. They practice relaxing and are given “feedback” through the tones or lights that they are becoming more relaxed. Biofeedback, especially when combined with cognitive methods described previously, can be effective for learning how to relax deeply. The goal of biofeedback is control of physiological functioning. At the same time, this method provides empowerment for clients who experience the ability to control their autonomic nervous system and manage their stress reactions. Biofeedback has been used to manage chronic headaches, musculoskeletal pain, fibromyalgia, premenstrual syndrome, and menopausal symptoms. The limitations of biofeedback are that it requires specialized equipment and a skilled instructor.

Conventional wisdom suggests that exercise is a positive intervention for managing the emotional and physiological effects of stress and helping the body heal, recover, and prepare for stressors. Several hypotheses exist to explain the effectiveness of exercise. These include familiarity with physiological arousal due to exercise causes appraisals of arousal to be less threatening, increases in self-efficacy, diversion of attention from stressors, and biochemical and/or physiological changes that occur because of exercise. Although the mechanisms are not completely clear, research strongly suggests that individuals who exercise have an increased sense of well-being and reduction in tension. Studies have also shown the positive effects of exercise on systems like the cardiovascular system, which are most likely to be harmed by chronic stress. Thus, exercise can have the threefold benefit of strengthening underlying systems while reducing physiological arousal and changing the individual’s appraisal of a stressor.

Nutrition plays an increasing role in managing a number of medical conditions and its impact in the area of stress management is important. Donald Morse and Robert Pollack have argued that nutrition can be a physiological stressor if an unhealthy diet is eaten. They also have argued that a poor diet and lack of nutrition can lead to a vicious cycle in which psychological stressors lead to unhealthy eating, which, in turn, becomes a physiological stressor that affects psychological and physiological health. Morse and Pollack have suggested that a healthy diet can aid in stress management by protecting physiological systems, repairing damage done by chronic stress, and causing less psychological reactions to stressors.


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