Stress

Question 1

Up to ___% of primary care visits are problems related to stress and lifestyle

Answer 1

70%

Question 2

Hans Selye (zel ye) … what is this dude associated with?

Answer 2

• stress & physiology

General Adaptation Syndrome – body’s response to stress

Question 3

3 stages of general adaptation syndrome

Answer 3

Alarm Stage:
Stage of Resistance:
Stage of Exhaustion:

Question 4

alarm stage

Answer 4

Initial response; fight or flight, but can decrease immune system’s ability to fight illness

Question 5

stage of resistance

Answer 5

If the stressors continue, body adapts

Question 6

stage of exhaustion

Answer 6

Long term stress diminishes immune system’s ability to resist illness and disease

Question 7

when did measuring stress start?

Answer 7

1930s

Question 8

what is the holmes and rahe stress scale?

Answer 8

In 1967, scale of 43 life events, along with a method of quantifying life changes according to the amount of readjustment they require for the average person.

This scale allowed greater quantitative precision in life change and illness studies
previously, stressful life changes had been measured in terms of illness outcome, rather than in terms of the inherent magnitude of the stressor

Question 9

what is the “perceived stress scale”

Answer 9

The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one’s life are appraised as stressful

Question 10

who made the perceived stress scale?

Answer 10

Cohen

Question 11

What is the optical model of stress?

Answer 11

Adapted from an optical model first proposed by Rahe and Arthur (1978), it depicts stressors as light rays filtered through successive lenses representing the individual’s perception (threat appraisal), coping, physiologic processes, and arousal reduction activities, and then projected onto illness outcome screens

Question 12

optical model of stress: what fall into the “perception” category (8)

Answer 12

Openness to change
Preference for control
Perceived control/locus of control/self-efficacy
Expectations
Spiritual beliefs
Perceived coping resources
Need for stimulation
Psychological hardiness : commitment, challenge, and control

Question 13

mediating/moderating variable: coping : what are the two styles?

Answer 13

Emotion-focused coping – reducing the impact of a stressor by ignoring or escaping it rather than dealing with it directly
Problem-focused coping – confronting a stressor directly

Question 14

optical model of stress : what fall into the “coping” category? (7)

Answer 14

Social support/self-disclosure
Stimulus screening/exposure management
Denial
Hostility
Approach/avoidance
Time management
Spiritual practices

Question 15

optical model of stress: physiological response to stressors: cortically mediated through ____ and ____

Answer 15

perceptions and methods of coping

Question 16

two types of physiological response to stressors

Answer 16

autonomic hyperreacivity and immunosuppression

Question 17

what is autnomic hyperreactivity?

Answer 17

Defense reaction (Alarm or Resistance Stage)

• Increased sympathetic arousal, BP, heart rate
• Vulnerable organ systems are affected in those with preexisting disease

Question 18

what is immunosuppression (from stress)?

Answer 18

Defeat reaction (Exhaustion Stage)

• When exposed to long-term stressful situations
• Down-regulation of the immune system; increases vulnerability to disease

Question 19

opitcal model of stress: arousal reduction : definition and two parts

Answer 19

Mitigate physiologic activation and disruption of homeostatic processes during periods of stress
- health enhancing and health degrading

Question 20

arousal reduction: health enhancing

Answer 20

exercise, massage, meditation, etc.

Question 21

arousal reduction: health degrading

Answer 21

substances (alcohol/drugs), smoking, bad eating habits

Question 22

opitcal model of stress: illness outcomes: 3 parts

Answer 22

Biomedical disease
Cardiovascular, immunologic, neurologic, gastrointestinal, musculoskeletal, pulmonary, reproductive/GU, dermatologic

Emotional and cognitive disorders
Depression, anxiety, somatization

Behavioral disorders
Violence, performance impairment, absenteeism, health care use

Question 23

clinical Dx of stress is ____

Answer 23

multifactorial

Question 24

during the medical interview, what should you inquire about in regards to stress? (4 parts)

Answer 24

1. Current life stressors (Clusterings of stressors and onset of illness, disease)
2. Beliefs, expectations, perceptions (Of stress, coping, control)
3. Coping strategies (Choice of different strategies when barriers emerge)
4. Strategies for arousal reduction (enhancing and degrading)

Question 25

“dos and donts” of medical interviewing for stress

Answer 25

Don’t infer that it is “all in their heads”
Don’t blame them
Don’t minimize their stressors or perceptions

Do use motivational interviewing techniques
Do ask lots of questions
Do let them determine their plan, with your help
Typically need lifestyle changes
Do refer for psychotherapy if needed

Question 26

Andrew Wiel - breathing

Answer 26

The 4-7-8 (or Relaxing Breath) Exercise


Question 27

two breathing techniques

Answer 27

breath counting and the andrew wiel 4-7-8 exercise