Stress and Its Management – Sample Response
The Activity
Visit a Stress Management Workshop website, making notes on stress and its
management. Read and make notes on two stress management intervention studies.
Imagine you are an occupational psychologist. Write a report relating to a supplied case
study, detailing an appropriate stress management programme.
This activity involves reading material across several website pages and making notes on this material. It also
involves making notes on published studies investigating the effects of stress and lifestyle management on
cardiac function and coronary disease progression, during which you will no doubt encounter unfamiliar terms
which will need further investigation (for example, LVEF). The actual report is where you get to apply what you
have read and this is where your preparation will be put to the test. Remember that the questions are intended
to serve as a structural guide for your report.
Case Study Report
Overview of Harry B’s Case
You may wish to begin your report with an overview of your case study (using bullet points) or to
provide the case study in its entirety. Should you decide to give an oral presentation to your class, it
is suggested that bullet points are best used.
Symptoms of Harry’s Stress
As you will no doubt have noted, Harry was suffering symptoms of stress before he and his wife
parted company. You may wish to link the ongoing stress prior to their separation with the separation
itself, which in turn exacerbated Harry’s problems. You may choose to tackle Harry’s symptoms prior
to the separation separately from those evident after the separation. You should ideally differentiate
the cognitive, behavioural, emotional and physical symptoms of stress.
Whilst physical symptoms such as headaches and palpitations are relatively obvious manifestations
of stress, other symptoms such as loss of libido and decreased concentration span are perhaps less
obvious. Some of Harry’s symptoms are identified below by category. You may find it useful to
embellish on these symptoms, giving examples of when they occurred.
Harry’s Symptoms
Sense of loneliness and
isolation
Depression or general
unhappiness
Cognitive Symptoms
Memory problems
Indecisiveness
Problems concentrating
Trouble thinking clearly
Poor judgment
Anxiety
Constant worrying
Loss of objectivity
Emotional Symptoms
Moodiness
Agitation
Restlessness
Short temper
Irritability, impatience
Inability to relax
Feeling tense and “on
edge”
Feeling overwhelmed
Weight gain and/or loss
Loss of sex drive
Frequent colds
Fatigue/tiredness
Physical Symptoms
Headaches
Muscle tension
Diarrhoea and/or
constipation
Insomnia
Rapid heartbeat
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Behavioural Symptoms
Eating more or less
Sleeping too much
Isolating yourself from
others
Procrastination
Using alcohol and
cigarettes to relax or cope
Overreacting to
unexpected problems
Picking arguments with
others
Factors Contributing to Harry Stress & Anxiety
Whilst there are most likely additional factors contributing to Harry’s stress (we are not party to
information relating to whether his marriage was happy prior to problems at work), the obvious
precipitating factors of which we are informed early in this case study are occupational in nature.
Harry’s problems appear to have been triggered around the time of the resignation of his
colleague, some 12 months before the case study was written. The fact that his colleague was
not replaced, the consequent work overload Harry experienced and the prevailing work climate
(workplace change, threat of redundancy) all appeared to contribute to Harry’s feelings of being
overwhelmed and his perceived inability to cope. General feelings of fatigue, decrease in
concentration span and an inability to meet deadlines are all cognitive and behavioural
consequences of the above stress provoking factors. Lack of support from his supervisor
almost certainly further contributed to his problems, his workload apparently unrelenting when
Harry’s supervisor should have recognised he was struggling at work and perhaps have
afforded him a period of respite. Harry stopped playing football at this time, creating a further
potential problem as exercise can be used as a coping mechanism - an escape valve - anger
and anxiety being channelled into physical exertion. Additional benefits of exercise include
improved blood flow to the brain, relaxation of muscle groups and aiding sleep.
Chronic stress can eventually lead to physical problems and impairment of physiological
systems so it is not surprising that nine months ago Harry started to experience headaches,
likely immune system impairment (as inferred from his constant cold) and his heart palpations.
Despite being signed off from work for six weeks, the nature of Harry’s problems were not
addressed during this period – which could have been viewed as a window of opportunity - and
so it is only to be expected that on his return to work, the factors which led to his stress initially
remained, continuing to cause problems. These work-related problems would almost certainly
have contributed to the arguments at home, the problems with his wife in turn helping to fuel his
reactions to others and inability to cope at work.
It is clear that once Harry and his wife separated and Harry moved back into his parents’ home,
things became worse for him. Harry began to use alcohol and cigarettes as (maladaptive) ways
of coping with his stress. Around this time, he also appears to have started isolating himself
from others, drinking alcohol alone. We do not know from the available case details whether
this continued on his return home at the end of the evening. His diet also changed and we are
informed that Harry exists pretty much on coffee during the day, relying on fast food in the
evening. Despite stating that pizza is “the healthy option”, the saturated fats present in many
pizzas of course make it far from being a healthy choice, particularly when alternated with the
high content of saturated fats in doner kebabs. Together with regular exercise, healthy diet and
regular meals are important for coping with stress and the lack of both exercise and healthy diet
in his life has a significant effect on the arsenal of available weapons he has to combat stress.
His apparent animosity towards his wife (the term “bitterness” suggests a degree of acrimony),
his continuing high workload and his growing sense of loneliness, isolation and unhappiness all
appear to be final straws. It is likely that poor diet, lack of exercise and an increasing reliance
on alcohol will further diminish Harry’s ability to deal with such feelings, likely exacerbated by
feelings of fatigue. Is it surprising that he decides enough is enough?
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Possible Treatments and Interventions
The factors which have led Harry’s inability to cope, maladaptive behaviours and physical problems
have been identified. Consequently, there are a number of cognitions, attitudes and behaviours,
which would need to be targeted as part of a comprehensive stress management programme. You
should realise that effective stress management programmes should be tailored to the individual.
Hence, not all of the strategies and techniques for reducing stress that you covered in the Stress
Management Workshop are appropriate for Harry B.
The following strategies may be effective in helping Harry B manage his stress. In your report, you
might further describe how each of these is applicable to details in Harry’s case study. For example:
Harry should establish a support system.
It is clear that Harry’s immediate support system has broken down. He no longer has the support of
his wife and it is unclear as to the support offered by his parents. He appears to have little support at
work from his immediate supervisor. As he has distanced and isolated himself socially (drinking
alone) there seems to be little support forthcoming from his work peers. A support system is vital for
venting feelings and talking through problems, with friend or more formal counsellor. This is
something that needs to be addressed early on in Harry’s programme.
Other strategies:
Harry should change his attitude and be realistic about his work and situation.
Thinking about why he is stressed and why he can’t manage work; reappraising self-expectations.
Expand on this.
Harry needs greater organisation in his life and must take charge.
Reorganising, prioritising and taking control of work and social life. This may include learning to
communicate more effectively and learning to say “No” at work (though this, of course, is a delicate
matter and dependent upon the situation).
Expand on this.
In addition, there are other important elements of Harry’s behaviour in need of urgent attention, which
are targeted by all effective stress management programmes.
Harry needs to take better care of himself.
This is a general point relating to several aspects of Harry’s lifestyle:
Harry needs to take regular exercise.
Extremely important. Interventions studies such as The Lifestyle Heart Trial (Ornish et al, 1990) have
found exercise coupled with dietary change and stress management to reverse the degree of
atherosclerosis. However, the protective effects of exercise are not limited to heart patients and
healthy individuals will also benefit - a moderate level of exercise is an important way of dealing with
stress, as well as being extremely beneficial to immunity, cardiovascular integrity and general health.
Expand on this.
Harry might start playing football again, or take up a hobby.
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Not only is football a form of exercise, it will also likely serve as a mechanism for coping with the
problems of the day. Taking up an additional hobby will aid Harry in learning to relax and taking time
out from his problems.
Harry needs to eat healthy, regular meals.
Again, an extremely important lifestyle issue. Harry has stopped eating regular meals and this will
have a detrimental effect on his mental functions. Vitamins, fatty acids and minerals are all
fundamental requirements of a healthy, working brain and nutritional deficiencies will have adverse
effects on brain function and his ability to deal with stress and pressure (please refer to Changing
Diets, Changing Minds for more on this). Unhealthy diets may also have adverse effects on various
physiological systems; in the long-term they can accelerate the process of atherosclerosis and impair
immunity. In heart patients undergoing comprehensive lifestyle changes, low-fat vegetarian diet
coupled with moderate exercise and stress management training was associated with regression of
coronary atherosclerosis (Ornish et al, 1990).
Expand on this.
Harry might benefit from learning relaxation exercises.
Many intervention studies have found psychosocial interventions such stress management beneficial
to patients and healthy individuals alike. Blumenthal’s work has shown stress management training
to have a significant impact on long-term clinical outcomes such as mortality in cardiac patients.
Stress management is also associated with decreases in blood pressure, heart rate, and cholesterol
levels in healthy individuals and is incorporated into many occupational stress management
programmes. Thus, Harry may benefit from learning and practicing a deep breathing technique or a
progressive muscle relaxation exercise.
Expand on this.
You may have tailored your stress management programme to a few key strategies or techniques.
Alternatively, you may have adopted a more general approach and included strategies such as time
management and relaxation techniques such as visualisation. Based on existing published studies
(try searching PubMed), is your package likely to work for Harry B? What problems are associated
with stress management programmes?
© Villiers Park Educational Trust 2010
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