Stress and Coping

eustress

positive stress that is associated with challenges and accomplisments

defense mechanisms

predominantly unconscious, protective coping methods that people may apply in response to a perceived threat includes: compensation, denial, displacement, intellectualization, projection, rationalization, regression, repression, reaction formation, and sublimation

Defense Mechanisms

predominantly unconscious, protective coping methods that people may apply in response to a perceived threat. Use of defense mechanisms on a short-term basis initially may prevent harm to the person in distress.

Coping process

Involves -Primary appraisal: assessment of the stressor -Secondary appraisal: assessment of the available resources to deal with the stressor - engagement though the adoption of one or more coping strategies -Reappraisal: evaluation of coping strategies and their results

Problem-focused coping

Involves the cognitive process of evaluating the situation and then taking an action to manage or change the situation or circumstance associated with the stressor. The focus is usually geared toward eliminating or reducing the underlying cause of the stressor.

Coping

Involves the continual conscious and unconscious activities of an individual designed to maintain balance in response to internal or external situations perceived as difficult.

Primary Appraisal

Judging how much of a threat is involved, and how important the outcome is

Behavioral response

Running away

coping***

based on individual perception, relationship to the environment, and evaluation of the environment as well as availability of resources

coping (Ray and colleagues)

being action oriented toward a goal of changing a situation; in other words, the conscious or unconscious behaviors of an individual to avoid harm and restore balance

Adaptive coping

constructive mechanisms of coping, occur when an individual treats the stressor as a warning and elects to resolve the problem

Hormone released by the hypothalamus during a stress reaction

corticotropin releasing factor

Maladaptive coping

destructive mechanisms of coping, occur when an individual addresses the feeling associated with the stressor without resolving the problem

Negative stress

distress

coping

dynamic cognitive and behavioral efforts to manage demands (internal or external) that are appraised as exceeding immediately available resources

Scope

effective (or adaptive) coping responses to ineffective (or maladaptive) coping responses that result from constructive or destructive coping mechanisms

scope of coping

from ineffective/maladaptive responses to effective/adaptive responses

stress neutral

perceived as an event that is easy to manage and easy to mobilize resources

stress neutral

perceived as an event that is easy to manage and easy to mobilize resoureces

threat-not manageable

perceived as requiring extraordinary resources, support, mobilization of resources that do not currently exist, or the exhaustion of existing resources and abilities.

challenge-manageable

perceived as requiring new ordinary resources that are currently available or can easily be accessed

challenge-mnageable

perceived as requiring new ordinary resources that are currently available or can easily be accessed

Scope of Coping

Ineffective/Maladaptive responses (destructive) -------> Effective/Adaptive Coping (Constructive)

Normal Physiological Process: Stress

- Central Nervous System - Limbic System - Symathetic Nervous system Sympathetic nervous system activation: - Norepinephrine & epinephrine (increased heart rate, BP, cardiac output, blood perfusion skeletal muscles, bronchial dilation, pupil dilation, increased blood glucose) Anterior Pituitary---->ACTH----->Adrenal Cortex - Aldosterone (increased sodium and water retention) - Cortisol (increased, protein synthesis, blood glucose, blood pressure, cardiac output, antiinflammatory response, immunosuppression) Posterior Pituitary ------> ADH ( increased water retention) - Endocrine System

Normal Physiological Process - Coping

- Cognitive Assessment - Engagement

Interrelated Concepts: Stress

- Functional ability - Family Dynamics - Coping - Anxiety - Cognition - Sexuality - Immunity - Sleep - Mood & Affect - Perfusion

Identify the three types of stress.

- Physiological stress is the body's potentially harmful reaction to a stimulus (Selye). - Psychological stress comprises the emotional and cognitive factors involved in the appraisal of threat (Lazarus). When an individual interprets an event as a threat, the physiological stress response is activated. - A third form of stress, sociocultural stress, occurs when social systems are challenged by factors such as racism, economic hardship, or political upheaval.

coping (Lazarus and Folkman)

-an ever changing process involving both cognitive means and behavioral actions, in order to manage internal or external situations that are perceived as difficult and/or beyond the individual's current resources (person and the environment) -

Signs and symptoms of anxiety/stress

Increased heart rate, blood flow to muscles, oxygen intake, rr, blood sugar for energy, dilation of pupils for vision, mental alertness

Hormone released by anterior pituitary

ACTH

Hormone released by posterior pituitary

ADH

Intervention

Activities to block a stressor from resulting in negative consequences

Hormones of adrenal cortex

Aldosterone and cortisol

Never assume patient is having an

Anxiety attack

Increase glucose, pupils dialate

Biological response

Effects of cortisol

Increase in: Protein synthesis, nlood glucose, BP, cardiac output. Anti-inflammatory response and immunosuppression

Self-Efficancy

Confidence in the ability to manage a demand

Secondary Appraisal

Determining whether resources needed to meet the demand are available

Coping

Engaging in a behavior or thought to respond to a demand

Hormones released by sympathetic NS activation

Epinephrine and norepinephrine

No Stress

Experience is perceived as easily manageable, and equilibirum is not disrupted.

Challenging

Experience is perceived as manageable but requires mobilization of resources; is not harmful, and equilibrium is maintained

Threatening

Experience is perceived as taxing; exceeds existing resources; causes disruption to equilibrium; can impact health.

Alarm reaction (General adaptation syndrome)

Hypothalamic-pituitary-adrenal and autonomic nervous systems are activated, successively triggering responses in the sympathetic nervous system and the endocrine and immune system.

Cognitive response

Inability to think clearly

When true tissue damage is caused by the effects of anxiety, the result can be classified as a

Psychophysiological response

Stress

Refers to an individual experience in response to a deman (internal or external) which occurs on a physical, psychological and/or behavioral level.

Engagement - coping

Refers to how the problem is addressed - or the individual's engagement with the problem. In other words, the primary and secondary appraisal drive the action an individual takes in attempts to cope with the stressor. After an individual takes action, a reappraisal process is done whereby the individual evaluates which coping mechanisms were effective and which ones were not, leading to the process of adaptation, or the incorporation of all coping processes to reach a new equilibrium or a return to the previous or normal state.

Reappraisal

Response was effective or not effective

How is stress defined?

Stress is defined by Kasl as a demand from the internal or external environment that exceeds the person's immediately available resources or ability to respond. Selye defines stress as "a non-specific response of the body to any demand made upon it."

Resistance (General adaptation syndrome)

The body attempts to adapt to the stressor, and some the initial responses are attenuated as the parasympathetic nervous system reverses the sympathetic stimulation and stabilization occurs. The body begins to repair damage and restore resources.

destructive mechanisms of coing

occur when an individual addresses the feeling associated with the stressor without resolving the problem

Cognitive Assessment - Coping

This assessment represents the process of sorting out information to derive meaning and is the underlying factor in how an individual how respond. - Two phases; primary appraisal and secondary appraisal. Primary Appraisal: initial evaluation to understand the situation, individual evaluates the potential for harm to self or to a loved one's well-being, self-esteem, or personal values and may determine how mushc personal control can be exercised over the situation. Secondary Appraisal: Individual evaluates the resources available to overcome, eliminate, or reduce the stressor and determine to what extent the problem is controllable. - Multiple variables influence persieved stress, context of the stressful event, current coping style, past life experiences, etc.

Exhaustion (General adaptation syndrome)

When the stress is not relieved or the resources are inadequate to meet persistent demands.

constructive mechanisms of coping

occur when an individual treats the stressor as a warning and elects to resolve the problem

psychosis

a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

Anxiety

a response to stress that causes apprehension or uncertainty. It differs from fear, which has an identifiable source of impending danger.

Fight-or-flight response, which are physiological response? Select all that apply.

a. bradycardia b. pupil constriction c. increased BP d. palpitations e. decreases gastric motility. f. bradypnea Answer: c, d, e

coping (Keil)

abstract thoughts based on past experiences to reduce stress

what differentiates coping form a physiological reflex?

adaptation- the conscious thought to modify

Anger

an emotion that involves antagonism toward another person or situation. It is evoked by a feeling of being wronged in some way. Anger actually prepares the affected person to "attack," physically or otherwise.

Coping

an ever-changing process involving both cognitive means and behavioral actions, in order to manage internal or external situations that are perceived as difficult and.or beyond the individuals current resources

Ineffective coping

inability to assess the stressor and/or respond appropriately

Effects of aldosterone

increase NA and water retention

stress

internal or external event or demand of life experienced by the individual that is perceived and appraised for scope and meaning on a continuum to determine whether resources and abilities for management are available, exceeded, or exhausted

coping process

involves an assessment of the stressor, an assessment of the available resources to deal with the stressor, and then engagement though the adoption of one or more coping strategies.

allostasis

means by which homeostasis is reestablished

Burnout

mental or physical exhaustion due to constant stress or activity

Scope of Stress

no stress --> challenging --> threatening

scope of stress

stress neutral to challenge manageable to threat not managed

Coping

the dynamic cognitive and behavioral efforts to manage demands (internal or external) that are appraised as exceeding immediately available resources (Lazarus and Folkman, 1984)

Allostasis

the means by which homeostasis is reestablished, and the purpose of allostasis is to assist the body in maintaining stability

Stress

the result of a demand that exceeds resources available to meet the demand

allostasis

unhealthy stress, when severe, sustained, and/or when the individual exhausts coping resources