What are the effects of stress?
Affective: shock, distress, anxiety, fear, depression, anger, frustration, lowered self-esteem , guilt
Behavioural: smoking, alcohol, help seeking delay, poor adherence, relapse, social withdrawal, illicit drugs, sexual function
Cognitive: poor attention, errors in decision-making, hypervigilance for threats, bias to interpret ambiguous events as threatening, memory loss and learning difficult
Physiological: activation of nervous system, hormone production, metabolic function, immune function, fatigue, disease and illness
What are the physiological effects of stress on patients?
On the ward:
Slower wound healing
More post-surgery complications
Longer in-patient stay
More staff time per day
More analgesia use
Less satisfaction with treatment - associated with poor adherence
Longer recovery, e.g. return to work
More service use, e.g. related symptoms
Less use of rehabilitation services
Increased risk of co-morbidity and early mortality
What are the three perspectives to understand stress?
Stimulus: Focus on the cause (stressor)
Response: Focus on the effect (physiological)
Process: Focus on the person-environment interaction (transaction)
Stress is a non-specific physiological response to a
threat to one’s physical or emotional well-being
What are the three stages of physiologcal response to stress?
Alarm: fight or flight response - nervous, endocrine and immune systems activated for defence against threat
Resistance: conservation response initiated to return homeostasis, but becomes counterproductive if alarm continues
Exhaustion: depletion of physiological resources - collapse of adaptive responses, immune failures and disease outcomes
Name four clinical conditions associated with physiological effects of stress
What are the three dimensions used to describe stress?
Chronicity: discrete sudden traumas to continuous chronic stressors, e.g. car accident and diabetes
Magnitude: life changing events to daily hassles, e.g. getting married / divorced and car parking at WMS
Inclusiveness: individuals to societies
Describe the transactional model of stress
Framework for evaluating how to cope with stressful events. Person-environment transactions.
Causal chain of influence:
- Person faced with a stimulus/stressor
- Primary appraisal: evaluates stressor as a threat, challenge or irrelevent
- Secondary appraisal: evaluates what the person can do - available resourses and options
- A coping response is made (cognitive and behavioural activities initatied to manage demands of the event). This can be problem focused- directed at changing the stressful situation or emotion focused - aimed at changing how a person thinks/feels
Stress is a subjective post-appraisal outcome
Name the two coping mechanisms for stress
Problem-focused coping: attempts to manage or change aspects of the stressor. Most effective when stressor is open/responsive to change.
Emotion-focused coping: Attempts to remove or reduce emotional distress. Most effective when the stressor cannot be changed.
Name four stress management techniques
Visualisation/imagery: Use of senses, imagine a peaceful/relaxed scene, e.g. Beach.
Progressive Muscle Relaxation: Tense and release of muscles.
Passive muscle relaxation: Imagining state of relaxation in muscles without tensing.
Autogenic: “self-hypnosis” – imagining muscles/body/limbs, are heavy warm and relaxed.