DOING SKILLS REQUIRED DURING TIMES OF SI:
SELF MANAGEMENT UNDER TIMES OF SEVERE STRESS
UNIVERSITY OF SOUTH AFRICA – SCHOOL OF BUSINESS LEADERSHIP
PRESENTED BY
CORNEL BROWN
MA Clinical Psychology – PU for CHE
Health Worx Medical Centre, Randridge Mall, Randpark Ridge, Randburg
Cell: 082 471 4746 Tel: (011) 801 – 4300 Fax: 801 – 4327 E-mail:
INDEX
1. INTRODUCTION 3
2. THE PROCESS OF STRESS 4
2.1. An integrated model of stress 4
2.2. The event 4
2.3. The appraisal process 5
2.4. The psycho-emotional and physiological stress response 6
2.5. Adaptation 7
3. SELF-MANAGEMENT DURING THE STRESS RESPONSE 8
3.1. Behavioural coping 8
3.2. Emotional coping 9
3.3. Problem-focused coping 10
4. FACTORS THAT INFLUENCE THE PROCESS OF STRESS 11
4.1. Personality 12
4.4.1. Personality factors 12
4.4.2. The Type-A Personality 12
4.2. Culture 13
4.3. Skills and experience 14
4.4. Positive aspects 14
4.4.1. Character strengths 14
4.4.2. Resilience and psychological well-being 16
4.4.3. Healthy living 19
4.5. Negative aspects 20
4.5.1. Adrenalin addiction 20
4.5.2. Depression 20
4.5.3. Psychological disorders 21
5. PATHOLOGICAL STRESS 22
6. CONCLUSION 24
REFERENCES 25
1. INTRODUCTION
Stress can be seen as a person’s psycho-emotional and physiological response to something in the environment that challenges the person (called a stressor or stressful event) (Sternberg, 2001). The aim of this paper is to discuss positive self-management or coping when exposed to severe stressors. Firstly, the process of stress will be discussed; secondly how stress can be managed during this process; and thirdly how different factors that may influence the process of stress can be managed to decrease the frequency and intensity of the stress response. Lastly, some attention will be paid to signs of pathological stress.
The process of stress will be discussed according to the steps of an integrated model of stress. These steps are the event; the appraisal process; the psycho-emotional and psychological stress response; and adaptation.
The discussion on management during the stress response will focus on behavioural coping, emotional coping and problem-focussed coping.
The factors that influences the process of stress that will be discussed are Personality; Culture; Skills and experience; Positive aspects: character strengths, resilience and psychological well-being, and healthy living; and Negative aspects: adrenalin addiction, depression, and psychological disorders.
The examples of pathological stress that will be discussed are Acute Stress Disorder, Posttraumatic Stress Disorder and Panic Attack.
2. THE PROCESS OF STRESS
2.1. An integrated model of stress (adapted from Sternberg, 2001)
2.2. The event
As said before, stress can be seen as a person’s psycho-emotional and physiological response to something in the environment that challenges the person. Such challenges are called stressors. Examples of stressors are time pressure, work pressure, family pressure, financial pressure, divorce, being disciplined at work and moving house. The severity of stressors are determined by the perceived intensity of the challenge and by the time exposed to the stressor. A less intense stressor can therefore become severe when a person is continuously exposed to the stressor (Sternberg, 2001). When a stressor’s intensity reaches the extent of actual or threatened death or serious injury, or a threat to the physical integrity of self or others, the event is seen as a traumatic event (APA, 1994).
2.3. The appraisal process
Though the stress response is experienced as an immediate and direct reaction to the event, it is apparently more one’s appraisal of the event that causes the stress response (Sternberg, 2001). When a person appraises an event to be a harm, loss or threat, and they appraise their coping resources to be insufficient to deal with this challenge, they experience the stress response. If a person would for example walk around a corner and see a green snake, and perceive this snake to be a green mamba and consequently appraise the situation as physically dangerous, the person would probably have a stress response. If the person perceives the snake to be a rubber snake and appraise the situation as safe, the person would probably not have a stress response and rather respond with something like curiosity. A person who perceives the snake to be a green mamba, but works with snakes on a daily basis, might also appraise the situation as safe and not react with a stress response.
From this example the following becomes clear about the appraisal process:
· The appraisal of the situation is really what determines whether a stress response will be experienced or not.
· The stress response is experienced when:
- The event is appraised as harm, a threat or a loss, and
- The coping resources are appraised to be insufficient to deal with the challenge.
· The process functions quickly, automatically and subconsciously.
· There can be different individual factors that influence the appraisal process (of which some will be discussed under Factors that influence the process of stress). This means that two people could appraise the same situation differently, resulting in one having a stress response to the situation, and the other not.
2.4. The psycho-emotional and physiological stress response
The psycho-emotional stress response is when the event was appraised as a threat and the person is ready for the “fight or flight” response. This means that the person will either aggressively confront the challenge, or flee from the challenge. In the past, when people were in more physical danger, this was an important protective reaction to the perceived threat, built in for survival. If a person for example walked in a field and saw a lion, the person would have to react immediately by running away or if it was too late for that defend him/herself. The person did not have time to sit around calmly and consider different options. Because of this, the stress response leads to a narrowing of cognition to two options: fight or flee. A stressed person will also probably feel strong emotions of fear, anger, irritability or hostility and would seem to others to be aggressive and attacking or emotional and evasive. While acting the person might feel as if things happen automatically and that they are almost not in control of themselves. They might even feel that they are detached or outside of themselves (depersonalisation) or time and space (derealisation). Though this stress reaction might sometimes be positive (people have been reported to do miraculous things like lifting heavy objects off trapped victims), it is often excessive to the situation and the narrowing of options lead to the person being less able to resolve the challenge constructively. This then leads to a continuance of stress.
The physical stress response is when the body is ready to “fight or flee”. This means that the body’s resources are used at the most vital organs and muscles. The heart rate needs to increase, the muscles need to tense, the arteries need to constrict (to not bleed to much when injured), less important functions need to be suspended (like the digestive system and blood flow to the face), and the body’s immune inflammatory response needs to be suspended (to not feel pain and be able to run away or act). All this is done through the autonomic nervous system and the adrenal glands (Sternberg, 2001).
The autonomic nervous system triggers the sympathetic response, which increases the person’s heart rate, respiration and blood pressure, and decreases digestion.
The adrenal medulla (the inner part of the adrenal gland) is an agent of the sympathetic response and is triggered by nerve impulses. When activated it secretes catecholamines: epinephrine (adrenalin) and norepinephrine (noradrenalin). This stimulates the heart, raises the blood pressure, widens the pupils, and sends the blood to the most vital organs and muscles (The Learning Company, 1997).
The adrenal cortex (the outer part of the adrenal gland) is triggered by the endocrine gland, which in turn is activated by the hormone ACTH, which is sent from the pituitary gland. When activated, the adrenal cortex secretes corticosteroids: cortisol and aldosterone. Aldosterone regulates the mineral and water balance of the body, prevents excessive loss of water, and influences the contractibility of muscles. Cortisol generates energy by turning carbohydrates into glucose, sends reserves to the liver, and suppresses inflammation (decreasing the body’s immune inflammatory response) (The Learning Company, 1997).
When the psycho-emotional and physiological stress response is at its height, the person is ready to “fight or flee” and the person is in a state of alarm.
2.5. Adaptation
Physically, the body cannot maintain the state of alarm indefinitely, and goes into a state of resistance where it imposes a counterbalance through the parasympathetic nervous system, declining for example the demands on the heart and lungs (Sternberg, 2001). The intensity of the person’s emotions could also decline and the person might gain more control over thoughts and actions. At this time, the person returns to the appraisal process to determine whether the stressor is resolved.
Ideally, the stressor would have been resolved and the body can slow down completely and start to restore its resources. The person would also be able to regain some psycho-emotional balance and might feel a sense of relieve and other positive emotions. Cognitively, they would regain their ability to see different options and behaviourly they would seem more relaxed and less aggressive and attacking.
If the stressor is not resolved, the person does not return to a state of complete rest, but has another stress response. This can continue so that persistent stress is experienced, alternating the body and mind between states of alarm and resistance. This is a condition of chronic stress (Sternberg, 2001).
This ultimately leads to the body’s resources being depleted completely, moving the body into a state of exhaustion. On the short term the person’s ability to restore damaged or worn-out tissues is diminished and the immune system is weakened, resulting in a diminished resistance against opportunistic infections and latent viruses. On the long term, the repeated secretion of adrenalin and cortisol, the weakened immune system, and the continuous taxing of the heart and arteries and the digestive system (which is to frequently suspended) leads to a gradual increase in the alostatic load. Heightened allostatic load has been associated with a number of health problems, where under diabetes, stomach ulcer, heart attack, and stroke (Ryff & Singer, 1998).
Psycho-emotionally prolonged stress might negatively influence the person’s interpersonal relationships and self-esteem and might even lead to depression or an anxiety disorder.
3. SELF-MANAGEMENT DURING THE STRESS RESPONSE
Self-management involves the implementation of techniques that suspend the continuation of the stress response and promote recovery of resources. Self-management should be done on three levels: a behavioural level, an emotional level and a problem-focused level.
3.1. Behavioural coping
On a behavioural level, the person needs to stop the physical stress response by relaxing the body and thereby assisting the parasympathetic response of the body. There are several relaxation techniques, but they can generally be grouped into two categories: Progressive Muscle Relaxation Techniques (of which one is included in Appendix A) and Imagery Relaxation Techniques. Progressive Muscle Relaxation Techniques work by physically tensing and relaxing the muscles in the body. The contrast created between tensing and relaxing the muscles allows the person to experience the feeling of relaxation. The person then purposefully focuses on the relaxed feeling and allows that feeling to become stronger. Imagery Relaxation Techniques work by imagining either a relaxed environment or visualizing how your breath goes to and loosens the stress that is stuck in your body and how that loosened stress is breathed out again.
An important aspect of both approaches is breathing. When people become stressed, they tend to breathe very fast and/or very shallow. This results in a too low amount of oxygen in their body, which intensifies and prolongs the stress response. Slow deep breathing is thus a good intervention on its own when stress is experienced, but is also used as part of a relaxation technique.
Any other method that is personally relaxing to the person, for example listing to music or going for a quick jog may also be used to assist the body to relax.
If the person is caught in chronic stress, the person needs to realize that they would have to break the cycle by taking time out to allow their body to recover. This implies lifestyle changes and changing ones approach to challenges.
3.2. Emotional coping
Emotional self-management involves dealing with the emotions that accompany the stress response. As long as uncontrollable emotions are experienced, the stress response will continue. Managing emotions does however not mean to simply ventilate ones feeling. This means that if the feeling is anger for example, simply ventilating this by screaming at people or throwing things; or if the feeling is sadness simply sitting and crying all day is not necessarily dealing with the emotion. In fact, some researchers warn that the mere ventilation of feelings is destructive and argues that it increases the stress response (Stanton, Parsa & Austenfeld, 2002). Some even suggest that emotions should be temporarily suppressed during the stressful event and that the person should rather take a problem-focused approach to the problem (Sternberger, 2001). This will however be difficult, as negative emotions limits cognitive options to either fight or flight.
Stanto, Parsa and Austenfield (2002) argue that there is a place for emotional self-management if it is done constructively. The first step in managing emotions would be to identify the emotion. The second step would be to acknowledge the emotion and to attribute the emotion to its specific source. Thereafter expression of emotion to another person or in a journal may occur.
Emotional self-management is especially valuable when the person has little control of the stressful situation, for example when somebody discovers that they have cancer. Studies show that people with cancer who acknowledge and constructively deal with their emotions, experience less stress and a better response to treatment than people who suppress their emotions (Stanto, Parsa & Austenfield, 2002).