Stress

Question 1

What are the effects of stress?

Answer 1

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

Question 2

What are the physiological effects of stress on patients?

Answer 2

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

After discharge:
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

Question 3

What are the three perspectives to understand stress?

Answer 3

Stimulus: Focus on the cause (stressor)
Response: Focus on the effect (physiological)
Process: Focus on the person-environment interaction (transaction)

Question 4

Define stress

Answer 4

Stress is a non-specific physiological response to a
threat to one’s physical or emotional well-being

Question 5

What are the three stages of physiologcal response to stress?

Answer 5

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

Question 6

Name four clinical conditions associated with physiological effects of stress

Answer 6

Ulcers

IBS

Amenorrhea

Migrane

Acne

Eczema

Question 7

What are the three dimensions used to describe stress?

Answer 7

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

Question 8

Describe the transactional model of stress

Answer 8

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

Question 9

Name the two coping mechanisms for stress

Answer 9

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.

Question 10

Name four stress management techniques

Answer 10

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.