Fundamentals of Stress and Anxiety ~ Transformasi Kaunseling Kesihatan

Fundamentals of Stress and Anxiety

This article was published on Friday, March 9th, 2012

Although never quite adequately defined, vague generalisations such as “stress and tension are normal reactions to events that threaten us” are used to describe it. Such threats can come from accidents, financial troubles and problems on the job or with family and through our emotional and physical reactions to the given situations, we become what is termed ‘stressed’. Not that long ago, the terms of worry, anxiety, fear, impatience, and anger gave way to what has been formally termed ‘stress’ and its offshoots, stressful, stress-related, and stressed-out. Further complicating matters is the fact that different people react to the same “stress” in unpredictable ways.

Stress is not a diagnosis but a process happening over time. The level and extent of stress a person may feel depends a great deal on their attitude to a particular situation. An event which may be extremely stressful for one person can be a minor event in another person’s life. Stress is not always a bad thing because some people thrive on it and even need it to get things done. However, when the term ‘stress’ is used in a clinical sense, it generally refers to a situation that causes discomfort and distress for a person and that is the area we will look at in this article.
Regardless of who you are or what you do, chances are you spend a lot of time entrenched in the busyness of life, worrying about getting everything done, and feeling out of control. We feel obligations and pressures which are both physical and mental and the attached stress, which can be quite debilitating, is not always obvious to us. Most people don’t handle their stress well. They focus on the unpleasant and unexpected things that happen daily. This should just be called ‘life’; however, we need to learn to handle the stressors that life sends our way.
There is a major difference between stressors – those things that happen every day that have the potential for driving us crazy, or making us angry, frustrated, and hurt, and stress – the way we choose to respond to these stressors. You make a choice about how situations will affect the rest of your day.
We cannot help but allow our daily routines to take over our lives. Working, studying, running the errands, groceries, kids, deadlines, projects, budgeting – the list can go on and on. And the things that are supposed to make our lives essentially easier are the same things that often cause us the most stress. For example, think about your computer, your car, and all the gadgets in your household that just happen to breakdown right when they are most needed.
Backaches, headaches, strokes, migraines, sleeplessness, anger and hostility etc. are showing us that we are more stressed than ever before. Even our hobbies and interests are stressful and demanding activities.
Different types of Stress
One of the reasons why people have a hard time ending stress is that they are not addressing the core issues within their lives. Following are six categories of stress.
1. Work/Study-Related Stress
The workplace and the school are very stressful environments. Deadlines are a major cause of Work/Study Related Stress. Other factors that might contribute to this type of stress are conflict with your boss/co-workers and/or teachers, changes that happen abruptly, where you cannot cope with them, threats to job security, or a fear of having a failing mark.
2. Relationship/Family Related Stress
Family related stress includes divorce/separation issues, extra-marital affairs, child-rearing, teenage break ups and unwanted pregnancies among others. This area is a major stressor for most people and oftentimes, stress coming from this area can have a major impact in other areas.
3. Environment Related Stress
Environment related stress is where the normal daily routine of a person is bombarded by disturbances and changes that the person cannot cope with. Disturbances include noise from the surroundings (i.e. jackhammer in a nearby construction site, traffic noise, etc.), and weather disturbances among others. Changes in the environment such as moving to a new state, having a new job or having a completely different lifestyle are stressors too.
Critical incident stress (CIS) is the emotional stress that individuals experience after being exposed to a specific incident that is perceived as traumatic. It is very common and normal for people to experience a range of reactions to critical incidents which may be cognitive, physical, behavioural or emotional in nature (Carlier, Voerman & Gersons, 2000). Different people have different reactions. Some people have limited reactions that last only a few days while others may take weeks or months to feel comfortable again. Others can even have a delayed onset reaction too. There are also some reactions that suggest a person is having difficulty coping with the incident.
4. Psychological Stress
Psychological stress can include fear of an individual which can either be real or be a phobia which is not grounded in reality. Sleeplessness, anxieties and worries are sometimes caused by unrealistic fears which have no basis. The subconscious of a person and/or his/her belief systems, cultural background and social activity can all contribute to a socio-psychological stress complex.
5. Financial Stress
Feelings of helplessness in financial terms are one of the most common causes of stress, and because the economic well-being of an individual is connected to other areas of his/her life, a financial problem can also have spill over effects in areas such as relationship and health.
6. Health Related Stress
The health of a person is the wellspring of his life. Health related stress ranges from sleeplessness to drug abuse. Illnesses are also sources of stress. Some of the most common illnesses can be the most major stressors – such as influenza, asthma or psoriasis.
These categories are not isolated from each other. Mostly, one stressor can lead to other forms of stress. The categories can mix and match to create more stress and pressures can creep in from an area of one’s life to another. Above all this, the degree of stress can be mild to extreme. A suffering from stress in one area could not possibly isolate this area from infecting and inflicting damage to other areas of life.
The Fight or Flight Response
The fight or flight response is a primitive inbuilt response to stress or threat. Also referred to as hyperarousal or an acute stress response, it occurs in both animals and humans, enabling us to deal with threatening situations by preparing us for action. This is very useful if attacked because our bodies will be highly alert and strong, allowing us to either stay and fight the enemy or flee as fast as we can.
When the fight or flight response occurs, the sympathetic nervous system goes into action, releasing the hormone adrenalin into the bloodstream. This causes the heart to beat faster to deliver oxygen to the muscles, which become tense and ready for action. Breathing becomes more rapid and shallow, increasing oxygen supply to the blood.
The digestive system slows down to divert energy to the muscles and in more extreme hyperaroused states the body may even discharge the content of bladder and bowls to further prepare the organism for intense fighting or fleeing. Sweating also increases to keep the muscles cool for when they begin to work hard. In this way, the organism enters a state of increased alertness, vigilance and a preparedness for some form of physical action involving either fighting the threat or fleeing from the threat.
The fight or flight response evolved in prehistoric times when survival relied on both aggressive, combative behaviour and flight from a predator. In modern times, this response has remained with us and has been recognised as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms (Andrews, Crino, Hunt, Lampe, & Page, 1996).
The Fight or Flight Response:

The brain becomes aware of danger.
Hormones are released and the involuntary nervous system sends signals to various parts of the body to produce the following changes:

The mind becomes alert
Blood clotting ability increases, preparing for possible injury
Heart rate speeds up and blood pressure rises
Sweating increases to help cool the body
Blood is diverted to the muscles, which tense ready for action
Digestion slows down
Saliva production decreases, causing a dry mouth
Breathing rate speeds up, nostrils and air passages open wider to allow more air in quickly
Liver releases sugar to provide quick energy
Sphincter muscles contract to close the openings of the bowel and bladder
Immune responses decrease to allow for a massive response to immediate threat.

The General Adaptation Syndrome
General adaptation syndrome describes the body’s short-term and long-term reaction to stress. Originally described by Hans De Solye in the 1920s, the general adaptation syndrome describes a three stage reaction to stress covering our initial reaction to the stressor, our resistance and adaptation to coping with the stressor and our eventual exhaustion after dealing with the stress whereby in normal circumstances we will recover from that exhaustion and live to deal with stressors another day.
Alarm reaction phase
During the alarm reaction phase, a stressor disturbs homeostasis. Homeostasis is a point of balance or internal biological equilibrium. The brain subconsciously perceives the stressor and prepares the body either to fight or to run away (the “fight or flight” response).
When the mind perceives a stressor, the cerebral cortex, is called to attention. If the cerebral cortex consciously or unconsciously perceives a threat, it triggers an autonomic nervous system response that prepares the body for action. The autonomic nervous system is the portion of the central nervous system that regulates bodily functions that we do not normally consciously control. When we are stressed, the rate of all these bodily functions increases dramatically to give us the physical strength to protect ourselves against an attack, or to mobilize internal forces.
In addition to this, the hypothalamus, a section of the brain, functions as the control centre and determines the overall reaction to stressors. When the hypothalamus perceives that extra energy is needed to fight a stressor, it stimulates the adrenal glands to release the hormone epinephrine, also called adrenaline. Epinephrine causes more blood to be pumped with each beat of the heart, dilates the air sacs in the lungs to increase oxygen intake, increases the breathing rate, stimulates the liver to release more glucose, and dilates the pupils to improve visual sensitivity. The body is then poised to act immediately.
Other physical responses to stress during this stage include “butterflies” in the stomach, an elevation in blood pressure, dry mouth and tensing of muscles. In some instances if too intense or if for too long the individual may find it difficult to concentrate on preparing well to deal with the stress properly. The alarm reaction directs resources away from the digestive and immune systems to more immediate muscular and emotional needs. In normal circumstances the alarm reaction phase will not last for very long, in some instances it may only be for a few seconds, in other instances longer. The alarm reaction phase is only meant to be a preliminary phase of activating the body and mind into dealing effectively with the presenting stressor or threat.
Resistance (adaptation) phase
As we move from the initial alarm reaction phase, as a preparatory response to the presenting stressor, we then move onto the resistance or adaptation phase. It is in this phase where the body is now actively dealing with the stressor. If this adaptation phase continues for a prolonged period of time without periods of relaxation and rest to counterbalance the stress response and allow time for the body to replenish and repair from the exertion required to execute the appropriate stress response, sufferers become prone to fatigue, concentration lapses, irritability and lethargy as the effort to sustain arousal slides into negative stress.
At the most fundamental level of response the organism is going to be either fighting or fleeing in some way, in an attempt to resist the negatively perceived consequences of the threatening stressor. This resistance may be required for either, a few moments, days, months and sometimes even years. The form of resistance employed will have varying degrees of success depending on how well it is employed and how relevant it is in dealing with the stressor situation. Regardless of the length of time, once the threatening stressor has been dealt with effectively the organism is able to return to its pre-activated state and recover from the ordeal. It is in the process of recovery that adaptation occurs.
Every organism has restricted resources to adapt to stressors. Therefore, whenever someone has to adapt to a stressor they will lose “adaptation energy” meaning that they will have less resources to adapt next time they are confronted with a stressor unless they adapt successfully.
Successful adaptation from resistance is when the body and mind adapts to a point of being more capable in its capacity to resist if ever confronted by the stressor again. In this sense, successful adaptation means the organism has increased its biopsychosocial level of fitness whereby it can take on the same threat more effectively next time or successfully take on a bigger threat next time.
It is through this process of adaptation that we learn how to cope better and deal with things more effectively. At a physiological level successful adaptation actually means getting physically fitter. Psychosocially it means having greater levels of resilience, working better coping strategies and having more appropriate emotions and thought processes around the challenging situation.
Problems occur at the resistance/adaptation phase if the combined biological, psychological and social responses employed do not deal with the threat effectively or if the threat is chronic whereby it eventually wears down the capacity of the organism to resist the threat or deal with it properly. This problem leads us to the exhaustion phase of the general adaptation syndrome.
Exhaustion phase
A person can only fight or flee for so long before they begin to wear down in their capacity to resist and deal with it. If the stressor environment is chronic and excessive without any real opportunity to recover or adapt successfully, the organism will begin to show signs of adaptation failure. Systems begin to break down and we become more susceptible to a range of biopsychosocial symptoms. If we persist in functioning at this level, death can occur.
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