1. “Stress is an unavoidable consequence of life.”
Managing Stress
“Stress is an unavoidable consequence of life.”
Hans Selye, M.D., Ph.D. (1951)

2. Experience Stress!
What would you need to do or think about at this moment that would increase you feeling of stress or anxiety?
What do you notice about your experience of stress?

3. What is Stress
I. Stressor- an event or adjustive demand placed on an individual or group.
II. Stress- effects created within an organism by the application of a stressor.
OTHER DEFINITIONS
Crisis- a stressful situation that approaches or exceeds the adaptive capacities of an individual or group.
Coping Strategies- efforts to deal with stress.

4. Two Different Kinds of Stress
Distress- negative stress, associated with pain, anxiety, or sorrow.
Examples include: work demands, death of friend or family member, car troubles, and financial issues.
Eustress- positive stress
Examples include: job promotion, purchasing a new home, marriage or birth of a baby, and the holidays.
Both tax a persons limited resources; generally, distress has the potential to do more damage

5. Predisposing Factors of Stress
Nature of the Stressor
significance, immediacy, cumulative effect, duration (marital separation)
Persons Perception of the Stressor
Important to have realistic expectations
Individuals Stress Tolerance
Ability to withstand stress without becoming seriously impaired.
Lack of External Resources and Social Supports
Alone vs. surrounded by others.

6. Responding to Stress
Stress threatens a person’s well being and produces automatic, persistent attempts to relieve the tension.
Stress Forces Us to Do Something (think, act, feel, etc)
That something can actually increase stress
Three Interactional Response Levels
Biological (immune system etc.)
Psychological and Interpersonal (coping & social)
Sociocultural (group resources)
Two Challenges in Confronting Stress
Task-oriented response- behavior is directed towards resolving the stressful situation.
Defense-oriented response- protecting self from hurt & disorganization.

7. Responding to Stress Two Challenges in Confronting Stress
Meet the requirements of the stressor
Protect the self from psychological damage
Two General Responses to Stress
Task-oriented response- behavior is directed towards resolving the stressful situation.
Defense-oriented response- protecting self from hurt & disorganization.

8. The Effects of Severe Stress: Biological
General Adaptation Model (Selye, 1956)
The biological reaction to sustained exposure follows three phases:
Alarm Reaction (activation of autonomic system)
Stage of Resistance (maximal use of bio-defenses)
Exhaustion (biological resources are depleted)
Homeostasis is harder to achieve.
Sympathetic Nervous System
Immune System is suppressed by stress

9. The Effects of Severe Stress: General Adaptation Syndrome

10. Nervous System

11. Central Nervous System (Brain)
Bear in the Woods (Fight/Flight)
Hypothalamic-Pituitary-Adrenal system releases:
cortisol (primary stress hormone)
Heart rate, lungs, circulation, metabolism, immune system, and skin.
catecholamines (neurotransmitters-adrenaline)
Amygdala- emotional response
Hippocampus- stores emotionally loaded experience in long term memory.
Suppress short term memory (concentration, inhibition, and rational thought).

12. Sympathetic Nervous System
Stress causes activation of SNS (sympth.)
Release of adrenaline
Body’s need for oxygen increases.
Heart rate and blood pressure go up.
Blood vessels in your skin constrict.
Muscles become tense.
Blood sugar level increases.
Blood has an increased tendency to clot.
Cortisol is released (triggers appetite incr.)

13. Biological Symptoms of Chronic Stress
Headaches
Sleep disturbance
Gastrointestinal problems
Ulcers
High blood pressure
Weakened immune response
Muscle pain

14. Symptoms of Stress Physical Emotional Cognitive
Muscle tension, illness, high blood pressure, indigestion, ulcers, difficulty sleeping, fatigue, headaches, backaches.
Emotional
Irritability, depression, anger, fear or anxiety, feeling overwhelmed, mood swings.
Cognitive
Forgetfulness, unwanted or repetitive thoughts, difficulty concentrating. Headaches

15. Psychological Effects of Stress
Impairment of intellectual functioning
Difficulty making decisions
Poor concentration
Decrease in creativity
Diathesis-Stress Model
Constant stress brings about changes in the balance of hormones in the body.
Depressive Disorders
Anxiety Disorders (panic attacks)
Formation of unhealthy defense patterns

16. Psychological Effects of Stress
Personality (psychological) decompensation-
lowering adaptive psychosocial functioning in the face of sustained or severe stress.
Course of Decompensation
Alarm and Mobilization
Increased tension, heightened sensitivity, greater alertness, efforts of self-control.
Resistance
Task oriented response. Ego-Defenses used. Some mild reality distortions
Exhaustion
Inappropriate defense mechanisms used. Break with reality.

17. Adjustment Disorder: Reactions to Common Life Stressors
Stress from unemployment
Stress from bereavement
Stress from divorce or separation

18. Adjustment Disorder
The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
These symptoms or behaviors are clinically significant as evidenced by either of the following:
marked distress that is in excess of what would be expected from exposure to the stressor
significant impairment in social or occupational (academic) functioning

19. Adjustment Disorder
The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
The symptoms do not represent Bereavement.
Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Specify if:
Acute: if the disturbance lasts less than 6 months
Chronic: if the disturbance lasts for 6 months or longer

20. Acute Stress Disorder
The person has been exposed to a traumatic event in which both of the following were present:
person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
the person's response involved intense fear, helplessness, or horror
Either while experiencing or after experiencing the distressing event, the individual has 3 dissociative symp.:
a subjective sense of numbing, detachment, or absence of emotional responsiveness
a reduction in awareness of his or her surroundings (e.g., "being in a daze")
derealization
depersonalization
dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

21. The traumatic event is persistently re-experienced: recurrent images, thoughts, dreams, illusions, flashbacks, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.
Marked symptoms of anxiety or increased arousal.
Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, activities, places, people).
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance.
The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.
The disturbance is not due to the direct physiological effects of a substance or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

22. Post-Traumatic Stress Disorder
The person has been exposed to a traumatic event in which both of the following were present:
the person experienced, witnessed, or was confronted with an event (s) that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
the response involved intense fear or helplessness.
The traumatic event is persistently reexperienced in one (or more) of the following ways:
recurrent and intrusive distressing recollections of the event, including images, thoughts, perceptions, or dreams of the event.
acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

23. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
efforts to avoid thoughts, feelings, or conversations associated with the trauma
efforts to avoid activities, places, or people that arouse recollections of the trauma
inability to recall an important aspect of the trauma
markedly diminished interest or participation in significant activities
feeling of detachment or estrangement from others

24. restricted range of affect (e.g., unable to have loving feelings)
sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
difficulty falling or staying asleep
irritability or outbursts of anger
difficulty concentrating
hypervigilance
exaggerated startle response
Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

25. Causal Factors in PTSD Personality Nature of the Traumatic Stressor
Accounts for most of the stress response
Everyone has a breaking point.
Conditioned Fear Response
Need for Prompt Psychotherapy

26. The Trauma of Rape Most common cause of PTSD in females
Stranger Rape vs Acquaintance Rape
Factors of Influence:
Age
Developmental Stage
Life Circumstance
Family and Friends

27. Coping with Rape Anticipatory phase Impact phase
Victim perceives danger
“This isn’t really happening to me.”
Impact phase
Recognition that she will be raped
Fear for life greater than sexual act
Fear is paralyzing
Post-traumatic recoil phase
Immediately after rape
Guilt of their actions and dependency
Reconstitution phase
Person starts to makes plans for leaving crisis center
Self protective activities, nightmares, phobias

28. The Trauma of Military Combat
Temperament
Limited evidence to suggest that temperament makes a difference in resistance to combat stress
Psychosocial Factors
Unpredictable, loss of freedom, killing, et.
Sociocultural Factors
Acceptability of war goals
Quality of leadership
Group identification with their combat unit

29. Treatment of Stress Disorders
Stress Prevention
Stress Inoculation Training
Stress Management Skill Development
Crisis intervention therapy
Talk it out in a supportive environment
Medications
Direct therapeutic exposure
Real or imagined

30. Stress Prevention and Management
Expect Stress
Identify Personal Stressors
Time Management
Learn Relaxation Techniques
Good Health Practices
(Diet and Regular Exercise Routine)
Change Cognitions
Clarify Values
Reframe negative stressors
Maintain a Social Support Network

31. Identify Stressors What is stressful to me? How does stress affect me?
Different responses by individual.
How does stress affect me?
Symptoms listed earlier.
When am I most vulnerable to stress?
Time of day (4:59), week (Sunday), month (bills, menstrual cycle etc.), year (winter blues)
When is stress good for me?
Moderate amounts of stress actually improve performance (curvilinear)
Too much impairs. Too little decrease motivation.

32. Time Management Prioritize (clarify values) Make To-Do-Lists.
Use a Schedule.
Schedule Time for Breaks, Socializing, and Fun.

33. Relaxation Techniques
Diaphragmatic Breathing (takes practice)
Are you a “belly-breather” or “chest breather”?
Influences parasympathetic “quieting response”.
Increases oxygenation of blood.
Distracts from stressful stimulus.
Increases sense of control over body and stress reactions.

34. Good Health Practices Eat Healthy Foods
Cut Back on Caffeine, Nicotine, and Other Stimulants.
Have an Exercise Plan.

35. Cognitive Techniques Realize What You Can and Cannot Do.
Recognize Irrational or Negative-Automatic-Thoughts.
Reframe Negative Thoughts and Focus on Positive Aspects.

36. Social Support
Stay connected with family
Connect with peers