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Introduction


What is Stress?



Definition

Individuals from all walks of life of every race, color, and creed have all experienced an internal, physiological transformation called stress. Hans Selye, a noted endocrinologist and pioneer in this field, has defined stress as "the nonspecific response of the body to any demand made upon it." Frequently, stress is associated with uneasiness, fatigue, increased heart rate, shortness of breath, and other physical and physio logical changes. These changes are triggered by stressors--factors with the potential to cause stress.

The word stress is derived from the same source as distress. As early as the fourteenth-century, writings in that period mention of a man under "so hard stress that his goodness grew the less," and of another one who "had some sickness or other grievance that maketh him stress." A late nineteenth century issue of the Fortnightly Review (an English publication) speaks of "this age of stress and transition," making one think of how people lived back then (Gherman, 1981).

Stress can be decided into three types: eustress, optimal, and distress (see Fig. 1). Eustress refers to the response of the body to a good or positive input (such as a job promotion); optimal is the response to the appropriate amount of stress, good and bad, that is considered healthy (such as studying rigorously for an exam); distress, the type discussed in this research homepage, alludes to the reaction to a bad or negative input (such as the death of a family mem ber). In all cases, the individual must adapt to these transitions; these three types are experienced the same physiologically (Selye, 1974).



The Two Personality Types

Different people have different predisposition or susceptibility to stress. Al- though everyone is subject to it, some people are more aware of it than others or are better in coping with it. In the study of personality types, cardiologists Friedman and Rosenman have classified two behavior patterns, Type A and Type B, in their research of heart disease as one result of stress.

In their studies, Type A personalities are characterized as having intense drive and ambition, maintaining excessively high expectations toward self and/or others, always hurried, and easily aggravated and angered. They are competitive and risk- takers. Type B, on the other hand, are described as patient, calm, and easy-going. They take the time to appreciate leisure, are not preoccupied with social achieve ment, and are less competitive than Type A's. Friedman and Rosenman have actually identified a number of gradations within each behavior type. While there exist numerous solid Type A or Type B individuals, most people tend to swing back and forth from Type A and Type B as their daily activities vary from day to day, week to week. In general, the mainstream, fast-paced, urban American lifestyle essentially embodies the Type A behavior and even requires it. The American definition of success encourages it (Schafer, 1987).

Type A individuals also tend to smoke cigarettes more and have higher level of serum cholesterol; consequently, the findings indicate that they are prone to health risks and "more frequently suffer coronary heart disease and obstruction of the blood vessels" than Type B's. In addition, some researchers have found out that Type A's who have a heart attack are more likely to have a second heart attack, and a more severe one than Type B's. Clearly one can see the unhealthiness of the Type A behavior pattern. The key, then, is to modify this behavior by unlearning those patterns one has grown accustomed to. By sincerely reassesing one's lifestyle and outlook, one must set goals in adopting a healthier, positive behavior pattern. However, the individual must first understand what the causes of stress are.



The Stress Process


Causes of Stress



Stressors

A stressor is defined as a factor with the potential to cause stress. A stressor is a stimulus with the potential of triggering a stress reaction called the fight-or-flight response. This response occurs when the body prepares for action to deal with the current situation at hand. Whether the stressor provokes stress depends largely on how the individual perceives it. The perception is in turn influenced by the differences bet ween people, like two personality types described above, and by various stressors which will covered below. All of these can affect both physiological and behavioral outcomes.

Stressors come in many forms and dimensions. They could be physical: A speeding car, a growling dog, an earthquake. At times they may be social, such as a demanding boss, an annoying relative, a newly-appointed responsibility, etc. They could be mental such as studying for a gruelling exam. Stressors often have both external and internal factors. A lifestyle change such as getting married or moving require adjustment to a new set of of external conditions: new uses of time, new ways of relating to friends, or different surroundings as you set up your household. The couple or family also have to deal with the internal factor as well: new expectations, a new self-image, a new daily routine. For many people this combination of new and interrelated stressors may create intense stress. There is a need for a certain period of adjustment before they can feel comfortable with their new roles, environment, and responsibilities by learning the dynamics and value of compromise and adaptation. No matter what form these stressors take, whether they be external or internal, they create demands on one's thoughts, feelings, and body.

Stressors also range from micro-stressors to macro-stressors. Micro-stressors are those that you encounter everyday--sights, sounds, smells, tastes and other minor stimuli. These are relatively mild ones, and one need not even be cognizant of them. They require little in the way of physical or mental adaptation. However, repeated exposure to these micro- stressors can be damaging to one's health. The average person takes them for granted, un- aware of negative effects of their cumulative impact. Macro-stressors, at the other extreme, are the severe stressors stemming from intense pressures. Examples of these would be a death in the family, an accident, a layoff from work. For some, it may produce antisocial behavior or disease, especially if one macro-stressor occurs right after another (Gherman, 1981).



The Stress Response

Characteristics
The body is equipped with an instinctive chemical response designed to supply energy in stress situations. The activity of certain glands is triggered by a threat or stressor in the environment. Walter Cannon, a noted physiologist in the early twentieth century, was the first to describe the body's reaction to stress. The fight-or-flight response can be characterized by:

  • increased heart rate
  • uneven breathing
  • muscle tension
  • sweating
  • dilated pupils
  • and other physical and physiological changes

This response occurs when an immediate or perceived threat is sensed, and the body prepares itself to stand ground and fight or flee. In many instances, this response is quite important, for instance, in real, life-threatening situations when the individual has to mobilize himself for decisive action. However, in today's rat race, the fight-or-flight response has become a threat itself--a threat to one's health.

Hans Selye, in his research on the fight-or-flight response, identified a three-phase process of the physical stress known as the general adaptation syndrome or GAS (see Fig. 2). It gives a explanation of how the body handles stress over time and how physical stress sometimes gives way to distress (Selye, 1976). Generally, he summarized the fight- or-flight response as thus:

Phase 1: Alarm reaction. The body shows the changes characteristic of the first exposure to a stressor. At the same time, its resistance is diminished and, if the stressor is sufficiently strong (severe burns, extremes of temperature), death may result.

Phase 2: Stage of resistance. Resistance ensues if continued exposure to the stressor is compatible with adaptation. The bodily signs characteristic of the alarm reaction have virtually disappeared and resistance rises above normal.

Phase 3: Stage of exhaustion. Following long-continued exposure to the same stressor, to which the body had become adjusted, eventually adaptation energy is exhausted. The signs of the alarm reaction reappear, but now they are irreversible, and the individual dies.

The fight-or-flight reaction prepares the body for swift action when such a response is war- ranted. Along with the characteristics enumerated above, the body also produces excess products such as serum cholestrol and hydrochloric acid during the reaction. It is when we build up stress products that we don't use that this stress reaction becomes unhealthy. Duration weighs in more as a factor in affecting health. The longer the stressors are with you, the more harmful they are.

Cognitive Appraisal



A given life situation that is presented to one person could result in a different reaction from another. The reason for this disparity is because the situation will be interpreted differently by various people. This is termed their cognitive appraisal. They can be controlled for the purpose of decreasing or eliminating distress one encounters in his everyday life.

For instance, a life situation that is perceived to be distressing is usually followed by emotional reactions as a result. Strong feelings that the person experiences lead to physiological arousal. As explained above the fight-or-flight response includes increases in serum cholestrol and hydrochloric acid, as well as muscle tension, blood pressure and glucose, while the strength of the immune system, cardiac muscle, and the organs decrease. If the physiological arousal is chronic or prolonged, illness or disease may result (Greenberg, 1990). It also produces negative effects such as poor performance or social relationships (see Fig. 3).

The key, then, is to adjust one's typical perception and reaction concerning something that is usually categorized as distressing or threatening. Such a process is called cognitive reappraisal. This method is easier said than done, however. It is quite difficult to "retrain" oneself after being accustomed to a certain way of perceiving things. Through constant practice and a healthy and positive outlook can one be able to adjust to appraising situations in a less threatening manner.

A very useful way of dealing with stress and stressors is through the use of interventions.

Interventions


Interventions are activities to block a stressor from resulting in negative consequences such as psychological discomfort, anxiety or disease. These activities are part of stress management and are sensible, logical, and possible in reducing stress. Though there are numerous forms, this paper will only discuss two main kinds of interventions: Meditation and progressive relaxation.

Meditation
A form of mental exercise that affects body processes, meditation has certain physical benefits. Its purpose is for the user to gain control over his attention so he can select the object of focus rather than being swayed by the external activities of the environment around him. Though are distinct types of meditation, primarily one of two approaches is used: focusing one's attention or opening up attention. The former requires that in focusing attention, one concentrates on an object that is repetitive or or unchanging. The latter, on the other hand, lets one open his senses to all forms of stimuli, taking all in without any specific use of any of them.

A meditation that uses focusing one's attention is similar to focusing on the object while ignoring the background. On the other hand, medita tion that requires opening up one's attention takes in both the object and the background so they are essentially one. In both cases, research has shown that there were benefits to meditation. Some of these include decreased anxiety, greater self-actualization, and overall a general state of positive mental health. Meditation results in certain specific physiological changes that are beneficial, and these changes are termed the relaxation response (the opposite of the fight-or-flight response).

Progressive Relaxation
Another form of intervention is called progressive muscle relaxation (PMR) or progressive relaxation. This technique is used to induce nerve-muscle relaxation. It was originally designed for hospital patients by Dr. Jacobson to alleviate their tension. Jacobson noticed that those patients who were tense did not recuperate as fast or well as the others. In order to intervene in this muscle tension syndrome, he designed a series of exercises that necessitated them to contract a muscle group, then relax it, while progressing from one group to another. The muscle tension is easily recognized when we first contract it. The purpose of the relaxation phase is to become acquainted with the sensation so it can be voluntarily induced. The idea, then, is to sense more readily when we are muscularly tense and, on those occasions, to be able to relax those muscles (Greenberg, 1990).

Progressive relaxation has been a proven method in helping people relax and does not require any special equipment. Even though it takes several years of practice, one can reap its benefits in several weeks time of short sessions. This technique, once learned and applied to skeletal muscles, can lead to relaxation of gastrointestinal and cardiovascular systems. Also, progressive relaxation has been shown effective against tension and migraine headaches, backache, and ineffective muscular tension. Physiologically, it improved psychological well-being, lessened depression and anxiety, aided treatment of insomnia, alcoholism, and drug abuse.

Self-Maintenance


The Relaxation Response


As a counter to the daily stressors one encounters, one must be able to invoke an opposite response to the flight-or-flight response that is triggered during the stage of resistance. One efficacious method is the one mentioned above--the relaxation response. The relaxation response, as described previously, give physiological benefits; it also is able to cutoff the fight-or-flight response (unless we really need it). However, this response does not come naturally; one has to summon it in regular sessions of serene solitude.

The Technique
Developed by Dr. Benson, it is a summation of old techniques condensed into a simplified, modern way. It has the same end: turning off tension and achie ving physical and mental peace. The Benson method is as follows:

  1. Once or twice a day, sit comfortably in a quiet place and close your eyes.
  2. Deeply relax all your muscles, beginning at your feet and working up to your face. Keep them relaxed.
  3. Breathe naturally through your nose and become aware of your breathing. As you exhale, silently say to yourself the word 'one'(or another word of choice).
  4. Maintain a passive attitude. Don't worry about whether you're achieving a state of deep relaxation. Let relaxation come to you. When distracting thoughts come to your mind, try not to dwell on them. Instead, return to your word. Dr. Benson emphasizes that this passive attitude is perhaps the most important element in bringing on the Relaxation Response.
  5. Continue for 10 to 20 minutes. You may open your eyes to check the time, but don't use an alarm clock. After you finish, sit quietly with your eyes closed for a few moments. Then open your eyes and sit still for a few more minutes before you stand up.

    The many healthful benefits of the Relaxation response continue for as long as you keep practicing the method. Dr. Benson have shown that it counteracts the stress response. It decreases blood pressure, lowers heart and respiration rate, decreases blood flow to the muscles and reduces body metabolism. It also increases alpha brain waves, the waves that are present when you're relaxed. And it decreases blood lactate levels (high levels of lactate are known to produce feelings of anxiety). If one practices the Relaxation Res ponse regularly, it is likely to induce better sleep and more reserve energy. It also has been shown to decrease agitation and make individuals more con tent, satisfied, and peaceful.

    Health Maintenance


    Aside from the Relaxation Response outlined above, which is a form of deep relaxation, there are other practical steps one can take to build resistance to stress. No one can, in reality, avoid troublesome or challenging stressors, and one would not want to. Fulfillment of human potential hinges on being challenged time and again throughout one's life. The important point is to be able to see and meet those challenges with vigor, enthusiasm, and good health. Maintaining effective lifestyle buffers is vital--in advance of difficulty or challenge. These lifestyle buffers build resistance to stress, and by practicing them we become more resilient. Some of these include:
    • Running and other forms of aerobic exercise - Aerobic literally means "activity with air." Other main forms of exercise are anaerobic exercise ("without air") such as all-out sprinting or swimming underwater while holding breath; strengthening exercises, such as weight training and iso metrics; and stretching, such as yoga and pre-running stretches. Still other forms of physical activity are golf, softball, volleyball, or ping-pong. Aerobic exercise is any form of activity in which heart rate is elevated substantially above resting level in response to sustained movement.
    • Nutrition - Research have shown certain foods can create the stress response, add to it, or make the individual more vulnerable to prolonged stress arousal. In general, one must avoid or minimize intake of caffeine which is found in coffee, tea, cocao, colas and chocolate. Food high in cholestrol, saturated fats, and sodium add to risk of high blood pressure. Smoking causes cancer, and also is a source of high stress. Too many calories and physical inactivity is not only directly stressful but also often psycho logically distressful. Overall, one should set a dietary goal that avoids or minimizes these factors which contribute to stress.
    • Social Support - Social support is defined as the interpersonal relationships we have with others that enable us to cope with stressful events. These include family, friends, and those close to us. Sociologists say that social support not only directly influence the chances of whether we remain ill or well and the probability of a shorter or longer life, our connectedness with other people also can influence whether stressors have greater or lesser impact. In short, social support can have a buffering effect as well as a direct effect. The key is having enough relationships which help in buffering against the harmful effects of stressful events.
    • Personal Anchorages - A personal anchorage is anything that is meaningful and relatively stable through time regardless of changes around you. It could be people, objects, beliefs, activities, etc. Personal anchorages hold the individual steady amidst a world of change, even when some aspects of life crumble, shift or reorganize. To reduce stress, it is very helpful to maintain meaningful personal anchorages.

    WWW Links


    For further reference in learning more about stress management, here are several useful links about this field:

    References

    1. Greenberg, J. Coping with Stress. Wm. C. Brown Publishers, 1990
    2. Schafer, W. Stress Management for Wellness. Holt, Rinehart and Winston, 1987
    3. Faelton, S.,Diamond, D. et al. Taking Control of your Life. Rodale Press, 1988
    4. Everly, G., Sobelman, S. Assessment of Human Stress response. AMS press, 1987
    5. Plato, P. In-class lecture notes. 1996
      Email: jjcristobal@hotmail.com
      Copyright © 1997 John J. Cristobal. All Rights Reserved.