STRESS

DR. O.H EZEH

 STRESS

Introduction
• stress is a worldwide public health problem that affects
more than 77 percent of people globally(APA, WHO).
• About 43 percent of adults suffer adverse health effects
from stress .
• Between 75 and 90 percent of all physician office visits are
for stress-related ailments and complaints.
• The Occupational Safety and Health Administration has
declared stress as hazard of the work place.
• Chronic stress is present and persistent in all areas of life
including: at work, home, and in personal relationships.
 Definitions
•Any physical or psychological event that is perceived as a potential
threat to physical or emotional well-being.

Distress
• Negative or debilitating reactions to events resulting when the stress
response exceeds the individual’s controllable limits.
• Perceived as threat.
• Negative events e.g. Loss of a loved one, death in the family etc.

Eustress
• Positive reaction to a stressor.
• Stress is defined/interpreted as a challenge rather than a threat.
• Positive events e.g. getting married, receiving a promotion, birth of a
wanted baby etc.
Stressor
- Any situation, condition, event or circumstance that causes stress.

- Stress depends partly on perception.

- Something that is stressful to one person may not be so to another.

Examples of common external stressors

- Major life changes.
- Work/occupation.
- Relationship difficulties.
- Financial problem.
- Children and family.
- Etc.
Acculturative Stress
.Stress caused by the many changes and
adaptations required when a person moves to a
foreign culture.
Burn-out
.Job-related conditions of physical, mental,
emotional exhaustion(usually in helping
professions e.g medicine, nursing, clergy men
etc)
Emotional exhaustion
.”used up” and apathetic toward work-
.cynicism-
Detached from the job.
Feeling of reduced personal accomplishment
Traumatic Stress
-extreme events that cause psychological injury
or intense emotional pain.

Post-traumatic Stress Disorder/PTSD

(Not all wounds are visible)
-a psychological disorder characterized by episodes of ;
-severe anxiety
-flash backs
as well as uncontrollable thoughts about the event
-resulting from disturbing past events

.
Behaviour Risk Factors
.Behaviours that increase the chances of
disease, injury, or premature death. More than
70% of leading causes of death are directly
related to behavioural risk factors.
External sources of stress
-Family.
-Work.
-Economic.
-School.
-Major life events.
-Unforeseen events.
-Environment.
-Etc.
SOURCES OF CLINICAL STRESS
A) For Patients
.Uncertainty.
.Pain.
.Fear.
.Cost of health care.
.Lack of knowledge.
.Risk of harm.
SOURCES OF CLINICAL STRESS
B)For Health Worker.
.Poor patient outcome.
.Risk of making an error.
.Unfamiliar situations.
.Excessive work load.
.Inadequate resource.
.lack of state of the art equipments.
.Poor remuneration and conditions of service.
.Risks of contracting disease/occupational hazards.
.Etc.
CAUSES OF STRESS
Internal causes of stress.
(i.e self-generated):
- Inability to accept uncertainty.
- Pessimism.
- Negative self-talk/mental-talk.
-Negative thought patterns.
-Worry.
-Fear.
-Attitudes
-Expectations
-Unrealistic.
-Etc
 Stress patterns

• Are unique
• Vary from person to person
• Even in the same person, vary with time.
• Can be:
– Predictable e.g developmental stress – as when an individual enters different
periods of time,
– Unpredictable .e.g accident, death in family, drastic social change, life events
e.t.c
– Accumulated stress
– Stresses do not usually come singly or operate independently of one another.
_Stress of the moment
• The way individuals cope with stress overtime shapes the course of their
lives.
• Reactions to stress are one way in which needed competencies are
developed.
 Determinants of stress patterns

• Age
• Sex/gender
• Occupation
• Economic status
• Personality make up
• Competencies
• Family situation
• E.t.c
Stress is the balance between stressor- demand and coping
skills.
If the coping skills/resources are greater than stressor-
demand stress will not result.
 Stress reaction.

1 Contribution of Hans Selye – The Father of stress

research.

General Adaptation Syndrome (G.A.S)

• A series of bodily reactions to prolonged stress.
• Occurs in 3 stages.

1. The Alarm Stage

• During which bodily resources are mobilized.
2. Resistance Stage.
- During which bodily adjustments to stress stabilize
to cope with a stressor.

3. Exhaustion.
- At which time the body’s resources are exhausted
and serious health consequences or even death
may occur.
- Selye noticed that the first symptoms of any disease or trauma (e.g.
poisoning, infection, injury or stress) are almost identical. His
studies showed that the body responds to any stress/stressor in the
same way, be it:
- Infection.
- Exam failure.
- Embarrassment.
- A new job.
- Trouble at school.
- Etc.

- He described specific features of the body’s response to stress.

- Called this the General Adaptation Syndrome (G.A.S).
2 Contribution of Cannon
• He called the entire stress reaction ‘fight or
flight’ response because it prepares the
animal/individual for the behavours of either
attacking or fleeing the source of threat. The
fight or flight response is essentially identical
to Selye’s concept of the alarm reaction- the
1st stage of the GAS.
Contribution of Stress to Health problems
Development of Illness
• According to research findings, germs are not the
only cause of illness. Other factors are also
important in order for a person to become ill.
Among the factors related to the development of
illness are:

1. Stress
- Chronic negative stress increases chances of
becoming ill.
2. Coping Style.
- Can decrease or increase the risk of illness
- problem-focused) coping can lead to a decrease in
illness, whereas (emotion-focused) coping can lead to an
increase in illness.

3. Social Support and social network/web of social

relationships
- Having an increased number of social ties lowers the risk
of developing colds/illness.

In summary, stress can increase susceptibility to illness,

while coping style and social support can decrease the
susceptibility to illness.
How does stress cause and contribute to disease.
• According to Cohen, there are 2 likely pathways:

1. Behavioural
People under stress:
• Sleep poorly.
• Are less likely to exercise.
• Adopt poor eating habits.
• Smoke more.
• Abuse alcohol or other abusable substances more.
• Do not comply with medical treatment.
2. Endocrine System.
-Stress triggers a response by the body’s endocrine system which
releases hormones that influence multiple other biological
systems including the immune system. Psychoneuroimmunology
is the study of the links among behaviour, stress, disease and the
immune system.

- Effects of stress on regulation of immune and inflammatory

processes have the potential to influence:
Depression.
Infections (can prolong infection).
Autoimmune and coronary artery disease and at least some
cancers.
Stress Management – The application of behavioural strategies to reduce stress and improve coping
skills. Coping ; responding to stress in a way that reduces the threats and its effects ; includes
what a person does, feels, or thinks in order to master , tolerate or decrease the negative effects of
a stressful situation . Coping strategies fall into 3 broad classes:

1. Emotion-focused.
2. Problem-focused coping.

3.Appraisal coping

EMOTION-FOCUSED COPING

Addressing the feelings or emotions associated with the stressor. Some may use drugs /substance to
dull the negative emotions , e g by releasing , distracting or managing their mental states .Some
types of emotion-focused coping include:
-Emotional discharge/venting
-Efforts to maintain hope
-Self-blame,
-Blaming others,
-Avoiding or denial of issues,
-Wishful thinking,
-Resigned acceptance etc,
Have been linked to: Depression, anxiety, etc.
2) problem-focused (engaged coping) techniques/strategies.
-deal with the cause of the problem or the stressor directly.
-try to change or eliminate the source of the stress by researching the problem.
-learning the skills to solve it.

•Talking to others.
•Seeking information.
•Seeking support
•Learning to provide own medical care
•Setting goals for successful management

•Confronting the situation.

•Etc. Have been found to protect against: Anxiety, depression, etc.

3) Appraisal-focused strategies(to examine one’s perception of the situation).

-attempt to modify thought processes associated with stress. People alter the way they think about a
problem by approaching it differently or altering their goals and values
.Logical analysis
.Cognitive redefinition
.Avoidance
.Denial etc
Adaptive
-constructive
-helpful
-reduces stress levels
-Aids survivability
-Suitable

Maladaptive
-destructive
.-unhelpful
.-worsens preexisting problems
.-harmful
Coping – Is a process. It involves appraisal, then trying to apply a strategy, followed by
an evaluation of the benefit this brings.
• Stress management can improve the chances
of survival following life threatening diseases
e.g. cancer, heart disease, HIV/AIDS.
Combination of treatments helps people to resist diseases.

Stress Inoculation.
- Use of positive coping statements to control fear and anxiety.

Negative Self-Statements.
- Self critical thoughts that increase anxiety and lower
performance.

Coping Statements.
- Reassuring self-enhancing statements that are used to stop
self-critical thinking.

- Studies show that the immune system is weakened in

students during major exam times.
 Immunity is also lowered by:
• Divorce.
• Bereavement/grief.
• Troubled marriage.
• Job loss.
• Depression.
• Similar stresses.
• Etc.
Could reducing stress prevent illness or promote health?
YES.

Various psychological and behavioural strategies can actually; -boost immune system functioning.
By doing so, they help promote and restore health. E.g. stress management reduced severity of cold and flu in university students.
-increase positive emotions
-increase energy, performance and productivity
-lessen depression
-elevate mood, producing calmer mood.
-better sleep
-reduces stress-related health problems.
-induce relaxation.
-improves quality of life.
-prevent both physical and psychological morbidities and mortalities!
# Stressful circumstances are rendered considerably less stressful when a person successfully copes well with them.
Coping is one of the medications in stress and stress-related illnesses.
Certain medications may also help in reducing stress caused by specific disorders

Long term exposure to stress can lead to serious health problems.

- Chronic stress disrupts nearly every system in the body.
 It can:
• Raise blood pressure.
• Increase rates/chances of heart attack and stroke.
• Contribute to infertility.
• Speed up aging process.
• Delay healing process in wounds.
• Can even rewire the brain leaving the individual
more vulnerable to anxiety and depression.
Psychosomatic Illnesses/Psychophysiological Disorders.

‘Psychic’ = Mind
‘Soma’ = Body.
Mind – Body connection.

Nearly every illness/all illnesses are somehow related to stress

and psychological states/ factors but some are more related to
these factors.

Many health problems are caused or

exacerbated/aggravated/worsened/heightened by stress and
psychological factors or psychological/mental states.
Both physical and mental health problems are affected e.g.
• Pain of any kind.
• Heart disease.
• Digestive problems.
• Sleep problems.
• Obesity/eating problems.
• Autoimmune diseases.
• Skin conditions e.g. eczema.
• Hypertension.
• Headaches. Etc
• Treatment; assessing also patient’s stress load/stress factors, and
psychological councelling with medical treatment.
QUESTION;
How would stress management programs help reduce physical morbidity
and mortality?
Measurement of stress
• Stress is measured in Life Change Units(LCU) using Social Readjustment Rating
Scale(SRRS) developed by Holmes and Rahe
Overall Cumulative Stress Load
depends on;
1) the severity of each stress
2)the severity of each stressor

3)the length of time the stress has occurred

Personality, Stress and Health.

• Type A Personality/Type A Behavioural Pattern.

• Also called Cardiac personality.
• An elevated risk of heart disease.
Characterized by:
– Time urgency/workaholism.
– Anger/aggression.
– Hostility.
– Copes badly during stress
Type B Personality/Behavioural Pattern
• All personality types other than type A.
• A low cardiac risk personality.
• Copes better/well during stress.
Hardy Personality.
• A personality style associated with superior stress
resistance.
• Characterized by 3 key beliefs/attitudes.
– Challenge.
– Control.
– Commitment.
• The commitment attitude leads people to be involved in
ongoing events, rather than feeling isolated.
• The control attitude leads people to struggle and to
influence outcome rather than lapse into passivity and
powerlessness.
• The challenge attitude leads people to view stress changes
whether positive or negative as a challenge rather than
threat
Disease-Prone Personality.
• Characterized by negative emotional reactions to stress,
ineffective coping strategies and unhealthy behavioural patterns
•Among correlates are higher incidence of illness and a shorter
lifespan.

Self-Healing Personality.
•Characterized by effective coping with illness.
•Self-healing individuals are:
–Energetic.
–Responsive to others.
–Positive about life.
–Q;What are the public health implications of stress?
DEEP BREATHING
Learning to breath deeply;
-calms nerves and clears the head.
- comes handy whenever the individual feels upset or
stretched to the limit.
-inhale deeply, filling your lungs with much air.
-imagine there is an imaginary sack in your stomach that must
be filled to the capacity as you inhale.
-hold for a count of 8.
-repeat the cycle 5 times.
-this process can be applied anywhere and as many as 4-5
times daily.
Thank you