CHAPTER 1

STRESS

Stress is the "mental and physical response of our bodies to thechanges and challenges" in life (Donatelle, 2010, p. 57). Stresscan be chronic or acute. Stress is also categorized into goodstress, also known as eustress, and bad stress, or distress (Donatelle,2010). Stress can motivate people and help them meet goals. Itcan also overload people, causing physical, mental or behavioralproblems, keeping them from accomplishing tasks. Each personreacts differently to stress. When individuals optimize stress, theyare able to function in a balanced way. When individuals reachthe point where stress no longer helps them meet goals, negativeeffects to their health may occur, including depression, anxiety,heart attack, stroke, hypertension, disturbance of immune systemfunctioning, skin problems, gastrointestinal upset, and insomnia(American Institute of Stress, n.d.a). Costs associated with stressin the workplace include absenteeism, productivity loss, turnover,and healthcare. Approximately $300 billion annually is lost due tostress in the American workplace (Walach et al., 2007).

Sociocultural Influences

The concept of stress has evolved from scientists and social scientistsweighing in on what stress is and what effects it has. Stress has beenstudied as an influence to a person's health since the 17th century(Cooper & Dewe, 2004). Robert Hooke, known as the Father ofModern Science in England during the 17th century, suggestedstress in humans was similar to the concept of load in engineering.Hooke suggested the law of elasticity was similar to stress on thehuman body. In the law of elasticity, if a machine experiences aload, the machine will either be strong enough to sustain the loador succumb to the load and collapse or break down (Cooper &Dewe, 2004). Human body functioning was being likened to amachine's with the nervous system acting as the energy for thebody; therefore, human bodies would also be susceptible to theeffects of forces being placed upon them and break down or giveway to wear and tear (Doublet, 2000).

Since 2006, the American Psychological Association (APA) hasconducted an annual nationwide study on stress and its effectson Americans. The studies have uncovered the leading causes ofstress, the stress-management behaviors being practiced, and theimpact stress has. According to the 2007 study, one third of thosestudied reported that they experienced extreme stress. Nearly halfof those studied reported that stress had a negative impact on theirpersonal and professional lives while 77% reported having hadphysical symptoms from stress and 73% reported psychologicalsymptoms from stress. The physical symptoms indicated in thestudy included: fatigue (51%), headache (44%), upset stomach(34%), muscle tension (30%), change in appetite (23%), teethgrinding (17%), change in sex drive (15%), and feeling dizzy (13%).The indicated psychological symptoms of their stress (APA, 2007)included: experiencing irritability or anger (50%), feeling nervous(45%), lack of energy (45%), and feeling as though one could cry(35%). Symptoms of stress reported by the 2010 survey includedall of the physical symptoms from the 2007 survey as well asinsomnia, sadness or depression, tightness in the chest, stomachupset, and change in appetite (APA, 2010). The study also foundthat individuals who reported higher levels of stress were morelikely to be overweight or obese.

In 2010 (APA, 2010), nearly 40% of the study participantsreported their stress had increased during the last five years.Money, work, and the economy were the most common sourcesof stress in the 2010 report. This study found that, in addition toserious economic struggles, Americans were overstressed due totrying to live a balanced lifestyle of healthy behaviors, work, andrelationships.

Stages of Stress

Hans Selye, "The Father of Stress," was an internationally renownedphysician who further investigated the concept of stress on the humanbody and how it related to physical illness (American Institute ofStress, n.d.b). In 1936, Selye illustrated the concept of stress witha model called the General Adaptation Syndrome (GAS). Whenindividuals encounter a stressor, a physiological response sets intomotion enabling them to deal with the stressor as they see fit. GASdescribes this response using three phases: Alarm, Resistance, andExhaustion (Selye, 1974, pp. 28-29). The Alarm Phase is describedas the "fight or flight" response setting into action. This responseis a series of chemical reactions causing the heart, blood pressure,and breathing rates to increase, allowing for a supply of energy tobe available to muscles in order to fight or flee a danger (Donatelle,2010). For example, when facing a mental stressor during the AlarmPhase, the stress-response system initiates the release of hormonesthat direct energy to the brain, so one can mentally address thestressful event; when facing a physical stressor, the stress-responsesystem starts the release of hormones that supply muscles with thenecessary oxygen and nutrients to fight that stressor (Donatelle,2010).

In the Resistance Phase of GAS, the organs needed to fight orflee the stressor are still being utilized but to a lesser degree. Duringthis phase, the body is attempting to return to a state of balanceunless the threat of a stressor still exists. If the body cannot returnto a state of balance, stress hormones continue to flow, leaving thebody in a state of overarousal, eventually leading to the ExhaustionPhase (Donatelle, 2010). The Exhaustion Phase leads to wear andtear on the body because no relief from the stress response hasoccurred to allow the body to recover (McEwen, 2003). Individualswho experience chronic stress without allowing their body to returnto a balanced state are at risk of developing stress-related healthconditions.

Health Implications of Chronic Stress

Chronic, unpredictable or uncontrollable stress is more detrimentalto a person's health than acute stress due to the continuous state ofarousal of the body's stress response system (MedicineNet, 2011).Cardiovascular disease (CVD) is a serious health condition thatcan be brought on by or worsened by chronic stress (Donatelle,2010). During GAS, the heart rate and blood pressure increase, andchronic high blood pressure causes hardening of the arteries, oratherosclerosis. It leads to damaged blood vessels and an increasedrisk for heart attack and stroke (Cohen, Janicki-Deverts, & Miller,2007). All people, young and old, who experience chronic stress,are at risk for these effects.

In addition to risk for CVD, immune system functioning issuppressed during chronic stress. In the Exhaustion Phase, thebody's immune response is compromised leaving the person moreat risk of contracting illness or disease. The body's white bloodcell count is lowered leaving the body less able to fight infection(Dugdale, 2009). A study examining data compiled over the last30 years on stress management and immune system functioningillustrated how the body's immune system is negatively affected byacute or chronic stressors (Segerstrom & Miller, 2004).

Many other health issues can be attributed to chronic stress.Individuals may discover that pre-existing gastrointestinal issuesor asthmatic conditions are worsened by it (Donatelle, 2010).Depression and anxiety can also result from it. Both are associatedwith stressful life situations like divorce, marital conflict, economicdifficulties, and environmental factors (Katerndahl & Parchman,2002). Stress can also play a role in causing headaches such asmigraines and tension headaches (Insel & Roth, 2011).

Stress-Management Techniques

In order to prevent or reduce the negative effects on the body fromstress, individuals can learn to better manage it. Stress-managementtechniques have been shown to reduce these effects (Insel &Roth, 2011). Studies show that other positive results from stress-managementtechniques include increased empathy and greater useof positive coping skills (Shapiro, Shapiro, & Schwarts, 2000). Inaddition, the techniques have been shown to improve blood sugarlevels in type-2 diabetics and assist with the emotional and physicalside effects of chemotherapy among cancer patients (Bennet &Carroll, 1990; Surwit et al., 2002).

Stress-management techniques apply different practices to calmthe mind and body during stressful situations. A key to stressmanagement is choosing healthy forms of it and avoiding dealingwith stress in ways that increase risk factors for chronic diseases.When dealing with stress, individuals should avoid unhealthybehaviors, such as emotional eating or overeating, verbally orphysically lashing out at others, and using tobacco, drugs, or alcohol.Instead, they should try out new stress-management techniquesto determine which best fits their personal situation because atechnique, such as meditation, may be successful for some but notfor others (American Institute of Stress, n.d.a). Stress managementcan range in style from simple breathing techniques to listening tomusic or watching a funny movie or show (Donatelle, 2010).

Stress-management techniques recommended by medicalprofessionals include daily exercise; a diet of fruit, vegetables,and whole grains; moderate alcohol use; no tobacco use; socialsupport; yoga; meditation; and medications for chronic medicalconditions (Cohen et al., 2007). Studies have shown that exerciseincreases white blood cell count, which assists immune systems infunctioning well (Segerstrom & Miller, 2004). In addition, exerciseburns off the by-products of the stress response system, so they willnot lead to increased risk factors for disease or illness (Donatelle,2010). Practicing daily stress management via exercise decreasesrisk factors associated with poor weight management, like diabetes,CVD, or stroke; allows one to sleep better at night; and combatsdepression (Insel & Roth, 2011). Recent studies have shown thatboth stress management and exercise improve risk factors for CVDby increasing blood flow to the heart and decreasing blood pressure(Blumenthal et al., 2005).

Social support via friends, teachers, clergy, or family can alsoassist one through stressful life situations, minimizing the negativeconsequences of chronic stress (Bovier, Chamot, & Perneger, 2004).Relaxation techniques like yoga, Qigong, tai chi, deep breathing,meditation, progressive muscular relaxation, and massage therapyare also forms of stress management. Relaxation techniques work byslowing breathing and calming the body and mind. Other popularforms of stress management include journaling, participating in ahobby, drawing, playing an instrument, listening to music, humor,visualization, quiet time, and stretching.

For a personal point of view on coping with stress, we interviewedJessica, a 29-year-old woman. For Jessica, stress is an everydayoccurrence and comes in every incarnation, but her financial issuesseem to be at the root of most of her stress. Stress causes Jessica tolose sleep, which is the biggest challenge she has associated with itbecause losing sleep creates more stress for her.

If the cause of stress is controllable, Jessica will try to change it;if the cause is inevitable, she learns to deal with it. That is how shesuccessfully copes. But if she is not successful, Jessica can physicallyfeel it in her neck and shoulders. The pain does not exist when sheis calm and at ease. Music and exercise help place her in that stateand deal with stress. Jessica also finds solace in a funny or relaxingtelevision show. She realizes that none of those activities make thestressors disappear, but those momentary distractions may allowher to have a different perspective on them and possibly realizethat there was nothing to be stressed about. Jessica notes that, if itis really bad, she can count on comfort food as a stress reliever.

For her personal perspective on stress management, weinterviewed Lisa, a 25-year-old woman. As a student, Lisa is tenseabout writing papers, giving presentations, and studying. Recently,she had been very stressed during final exams. She was not able tosleep very much during that time and suffered from headaches, highblood pressure, and stomach problems. Lisa thought it was a livinghell and she could not relax.

When Lisa is stressed, she angers easily and is mean to otherseven though she may care a lot about them. She also feels frustrated,pessimistic, and self-centered during times of high stress. Thoughshe knows she is not the only one that feels this way, she feelslonely and will break down and cry. Lisa believes she has succeededin coping with stress when she has received a good grade underpressure. She also feels good when she is able to finish projectswithout becoming sick. If she misses a regular workout in herexercise routine, she knows something is wrong. She also knowsthings have gone awry if she gets into an accident, hurts herself, orloses control. Unnecessary shopping is another indication of her notcoping with stress effectively.

Lisa recommends healthy eating, sleeping at least seven hoursper day, and exercising as effective behaviors to help cope withstress. Regular exercise also benefits her sleep schedule, which shetries to maintain. Eating healthy foods like salad and fruits makeher feel more controlled and good. High fat and high sugar foods,which she wants when she is under stress, make her feel awful. Lisacombats the potential for unhealthy eating by preparing her lunchthe night before, having a low-calorie snack bar handy, eating morefruits than sweets while studying or writing a paper, and choosingsugar-free candy and gum if she wants to eat when not hungry.Because Lisa gets upset when she is stressed, she tries to think aboutthings that she has, things for which she is grateful, and that helpsalleviate her stress level as well.

Conclusion

The release of stress hormones, such as cortisol, with no return tohomeostasis can increase susceptibility to health problems such asCVD, immune system vulnerability, sleep disturbances, anxiety ordepression, gastrointestinal conditions, headaches, and worsenedasthma symptoms (Insel & Roth, 2011). Learning and utilizingstress-management techniques will benefit an individual's health.These techniques work to decrease stress symptoms by increasingblood flow to organs, relieving tension and chronic pain, improvingconcentration, reducing anger and frustration, and by lowering theheart rate, breathing rate, and blood pressure. Stress managementallows people to live a healthier lifestyle both physically andemotionally.

Recommendations

Stress is a fact of life. Stress-management techniques allow peopleto handle it in a more positive way while decreasing risk factorsfor chronic disease or illness. A healthy balance of stress and stressmanagement in life needs to be created in order to function well andavoid chronic stress-induced health conditions. Individuals shoulddetermine what is causing stress in their lives and manage thesestressors by living a healthy lifestyle that includes regular exerciseand sleep, a healthful diet, and relaxation techniques. Other steps tobetter manage stress include avoiding alcohol and tobacco, fosteringhealthy and supportive relationships, setting and keeping priorities,and maintaining a positive outlook (U.S. Department of Health andHuman Services, 2009).

Evaluating the stressors in a person's life and dealing with themin constructive ways is an important strategy in decreasing healthrisk factors and managing stress. The following plan may assistindividuals with that strategy:

1. Identify the stressor.

What is causing the distress? Time management issues,relationship problems, job stress, lack of physical exercise, or lackof quiet time are often at the base of stressful situations. Assessthe stressors in your life and determine which unhealthy ways ofcoping need to be addressed.

2. Evaluate the stressor.

Is there too much emphasis on an event or situation? Is thestressor going to affect your future? Will the situation or stressorbe important in one year, five years, or longer? Does the stressorneed to be addressed immediately or can it wait?

3. Create a plan of action.

What can you do to manage the stressor(s)? You can attemptstress-management techniques to balance the effects of the stressresponse system. Is the stressor something that can be avoided?Can the stressor be dealt with straight on? Should the stressor beembraced?

4. Carry out the plan.

No matter what the stress-management plan is, be sure to carryit out to satisfaction. Begin the exercise program or meditationpractice and stay with it. If you get off course, then you should getback to practicing the stress-management technique(s).

The following recommendations for an individual coping withstress are from the CDC (2009):

• Stay in touch with family. Stay around people who arecaring and positive.

• Stay active. Go for a walk or run.

• Get involved. Get involved in activities to support yourcommunity.

• Avoid drugs and alcohol. Drugs and alcohol may seemto help with the stress temporarily; in the long run theycreate additional problems that compound the stress youare already feeling.

• Find support. Ask for help from a parent, friend, counselor,doctor, or pastor. Talk with them about the stress you feeland problems you face.

• Take care of yourself. Get plenty of rest and exercise andeat properly.

• Take a time-out. If you feel stressed, give yourself a break.

Allow some down time, even if it is only a 30-second timeout.

Selected Resources

The American Institute of Stress
124 Park Avenue
Yonkers, NY 10703
914-963-1200
Stress125@optline.net
www.stress.org/

American Psychological Association
750 First Street, NE
Washington, DC 20002
800-374-2721
www.apa.org/

Mayo Clinic
www.mayoclinic.com/health/stress-management/MY00435

National Institutes of Health
200 Independence Avenue
Washington, DC 20201
877-696-6775
www.nlm.nih.gov/medlineplus/stress.html

Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Rockville, MD 20857
877-SAMHSA-7