Stress Theory Historical Perspective and Stress Adaptation Theory 1

What stress is and what it isnt Stress is ones reaction to any change that requires a restructuring of ones orientation to any given situation. It is not always a detrimental reaction. 2

Stressor Any stimulus that causes tension. May contribute to certain illnesses. 3

Sister Callista Roy(1976) Distinguished between adaptive and maladaptive responses: Adaptiveresponses that preserve ones physical and/or mental integrity Maladaptiveresponses that interrupt the individuals physical and/or mental integrity. 4

Methods of Conceptualizing Stress As a biological response (Selye) As an environmental event As a transaction (Lazarus and Folkman) 5

Hans Selye (1976) Described the General Adaptation Syndrome. The physical reaction to stress prompting the fight or flight syndrome. The reaction occurs in 3 defined stages. 6

1. Alarm Reaction Phase Fight or flight responses are stimulated. Sympathetic nerves release acetylcholine Adrenal medulla releases epinephrine and norepinephrine. Trigger immediate increase in heart rate and breathing, blood vessels constrict and muscles tighten. Initiates spontaneous behaviors associated with combat or escape. 7

2. Stage of Resistance The triggered physiological responses of Stage 1 are used to defend the individual in an attempt to adjust to the stressor (adaptation). If adaptation is successful, this is the end of the biological response and Stage 3 does not occur. Eventually the physiological responses decline. 8

3. Stage of Exhaustion Occurs if adaptation is not successful. The person/body fatigues under the internal stress of the physiological responses of the sympathetic nervous system. Reserves are depleted. Stage is associated with disease and even death. 9

Stress as an Environmental Event The Recent Life Changes Questionnaire (RLCQ). Attempts to quantify an individuals current life stress. 10

Stress: The Interaction Between the Individual and the Environment Precipitating Event Predisposing Factors: Genetics Past Experiences Existing Conditions Individuals Perception of the Event: Irrelevant Benign Stress due to Harm or Loss 11

Stress Management Adaptation AwarenessRelaxationMeditationCommunicationProblem SolvingPetsMusic 12

Roots of Modern Mental Health Care Benjamin Rush Father of American Psychiatry Signator of the Declaration of Independence Founded a movement for more humane treatment of the mentally ill Believed in the need for restraint to help the patient regain his senses. 13

Roots of Modern Mental Health Care Dorthea Dix Advocated for more human treatment of the mentally ill (1840s) Instrumental in founding the first public mental health hospitals 14

Roots of Modern Mental Health Care Linda Richards First American trained professional nurse First American Psychiatric Nurse Helped establish the first school of psychiatric nursing 15

Multiple Definitions of Mental Health Successful adaptation to stressors… from internal and external environments… with thoughts feelings and behaviors that are… age appropriate and congruent with local and cultural norms 16

Cultural Relativity Culture and society determine normal and abnormal behavior. The more removed a culture is from the mainstream culture of a society, the more likely any aberrant behavior will be met negatively. 17

Maslows Hierarchy of Needs A humanistic psychologist Theory focuses on potentials of the individual Humans are constantly striving for higher levels of capabilities Always seeking higher levels of consciousness, creativity and wisdom The obstacles of society prevent reaching the next higher level 18

Maslows Hierarchy of Needs Self-ActualizationEsteem & Self-EsteemLove & BelongingSafety & SecurityPhysiologic 19

Primary Response Patterns to Stress StressAnxietyGrief 20

Anxiety A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. 21

Levels of Anxiety (Peplau, 1963) Mild Anxiety Everyday occurrence Can be beneficial, motivating Increased awareness and alertness 22

Levels of Anxiety Moderate Anxiety Perceptual field reduces Reduced alertness, awareness Increased restlessness, muscular tension 23

Levels of Anxiety Severe Anxiety Perceptual field greatly diminished Very limited attention span Unable to concentrate Feelings of dread 24

Levels of Anxiety Panic Unable to focus at all Unable to comprehend Impending doom Bizarre behavior 25

Behavioral Responses to Anxiety Responses to Mild Anxiety Mild anxiety is…uncomfortable! The coping mechanism is selected to satisfy the need for comfort. 26

Behavioral Responses to Anxiety Responses to Mild to Moderate Anxiety Ones ego is challenged to defend itself as anxiety increases. Ego defense mechanism are protective. May be adaptive or maladaptive. 27

Behavioral Responses to Anxiety Responses to Moderate to Severe Anxiety Individual is likely to manifest symptoms of disease of any physiological system 28

Behavioral Responses to Anxiety Responses to Severe Anxiety Ego defense mechanisms are carried to extreme. The person knows his behavior is harmful to his well-being. He does not know there is a psychological origin to the behavior. He feels helpless to change. 29

Behavioral Responses to Anxiety Response to Panic Anxiety Person may lose contact with reality There is a mental retreat to a less threatening world. 30

Grief Grief is a Response to a Loss. The loss may be obvious. The loss may be apparent to only the individual. The loss may be one that the individual merely fears in the future (anticipatory). 31

Elizabeth Kubler-Ross Theory AcceptanceDepressionBargainingAngerDenial 32

Maladaptive Grief Responses Prolonged Lasts for many years Delayed Fixed in denial stage Distorted Fixed in anger stage 33