CHAPTER 1
OVERVIEW OF THE STRESS
1
Chapter 1 Table of Contents
Chapter-1
Overview of the Stress
Page No.
1.1
Introduction to Stress
3
1.2
Meaning of Stress
6
1.3
Fundamentals of Stress
12
1.4
Factors Causing Stress
15
1.5
Types of Stress
17
1.6
Signs & Symptoms of Stress
21
1.7
Characteristics of Stress
27
1.8
Effects of Stress on Human Body
30
1.9
Methods of Measurements of Stress
32
1.10
Management of Stress
34
1.11
How to Avoid / Prevent Stress
43
1.12
Background of the Study
46
1.13
Reasons for the choice of Study
48
1.14
Scope of Study
49
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CHAPTER 1
OVERVIEW OF THE STRESS
1.1
INTRODUCTION TO STRESS
Stress is a complex, dynamic process of interaction between a person and his or her life.
It is the war one reacts physically, mentally and emotionally to the various conditions.
Stress is the debilitating effect caused by constant pressure both at work and home are a
modern phenomenon.
Almost any change in the environment even a pleasant change such as picnic or
vacation demands some stress and little stress is useful in helping us to adapt-or-adjust,
sometimes a person gets used to the change or reorganizes himself for such conditions.
He develops suitable ways to overcome changing conditions, as his/her motivational
property of certain emotions. Such adaptive behavior adds colour and spice to living
and adds pleasure to our lives.
But beyond some point, stress becomes the distress. What acts to produce distress varies
greatly from person to person. We civilized members of western culture, think of
ourselves as rational beings (means balanced and reasonable) who go about satisfying
our motives in an intelligent way. Most of our affairs of everyday life are tinged with
feelings and emotion like joy and sorrow, excitement and disappointment, love and
fear, attraction and repulsion, hope and dismay, all these and many more are feelings,
we often experienced in the course of a day.
When our emotions are too intense and too easily aroused, they can easily get us into
trouble and make us as miserable as if we were sick with fever. As the severity of lifecrisis increases from mild to severe, susceptibility to illness rises progressively.
The physical, environmental and social distress causes internal stress state, can then lead
to various responses. On one hand, it can result in number of physical and bodily
responses. On the other hand, psychological responses such as hopelessness, sadness,
irritability and general feeling of not being well, unhappiness and dissatisfaction.(1)
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1.1.1 PREHISTORIC TIMES
In prehistoric times, the bodily reaction to stress was exactly what was needed. This is
attributed to physiological changes that occurred to the body when danger appeared.
Chemicals, especially, adrenalin were released into the body and blood supply was
transferred from the non-essential to the essential organs, from the skin and digestive
organs to the brain and muscles by beating the heart faster.
This resulted in clearer, swifter thinking and faster stronger muscular responses. The
lungs took in more oxygen, breathing became more rapid and the body anticipated
keeping cool by increasing perspiration. Once the danger has passed successfully, the
bodily functions reverted to normal.
In prehistoric times, these body responses were vital for survival. Then the energy
generated by stress was utilized in physical action.(2)
1.1.2 HISTORY IN RESEARCH OF STRESS
The current usage of the word stress arose out of SELYE’S experiments in 1930. He
started to use the term to refer not just to the agent but to the state of the organism as it
responded and adapted to the environment. His theories of a universal nonspecific stress
response attracted great interest in academic physiology and he undertook extensive
research programs and publication efforts.(3)
A broad psychosocial concept of stress and adaptation offered the promise of helping
everyone achieve health and happiness, by successfully responding to changing global
challenges and the problems of modern civilization.
Selye coined the term “Eustress” for positive stress by contrast to “Distress”. He argued
that all people have a natural urge and need to work for their own benefit, a message
that found favour with industrialists and governments. He also coined the term
“Stressor” to refer to the causative event or stimulus.(4)
From the late 1960,
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Academic psychologists started to adopt Selye’s concept, they sought to quantify “life
stress” by scoring “significant life event” and a large amount of research was
undertaken to examine links between STRESS and diseases of all kinds.
By the late 1970—
Stress has become the medical area of greatest concern to the general population. There
was also renewed laboratory research into the neuro-endocrine, molecular and
immunological bases of stress.
The U.S military became a key centre of stress research, attempting to understand and
reduce combat neurosis and psychiatric causalities.
In 1980….
The psychiatric diagnosis of post traumatic stress disorder (PTSD) was added to the
diagnostic and statistical manual of mental disorders as post traumatic stress disorder.(5)
PTSD was considered a severe emotional reaction to an extreme psychological trauma.
By1990s….
Stress became an integral part of modern scientific understanding in all physiology and
human functioning.
1.1.3 LIFE STYLE TODAY
Today, however, the problems and stresses that we experience have changed radically
and can rarely be resolved with physical action. We are not designed to operate
effectively in this hi-tech world. Hunting for food is now replaced by jostling with our
trolleys in super markets, without struggling forcefully and pushing easily on smooth
surfaces.
Psychological stresses related to mental characteristics or attitude of a person lead to
same bodily state of arousal, but mostly without any accompanying physical activity to
use up the chemicals mainly adrenalin and energy made available when such pressure
and tension is prolonged physical and mental damage will occur. Continuous worrying
and hardship sometimes result in serious disease.
5
Today, it is very common for many students to aim at unrealistic goals, they want to
work in order to achieve the goal. But it is not possible for them. If one has an interest
to become a movie star, you suffer in fulfilling the goal and result in failure. Repeated
failure will make them unhappy and they cannot resist any more stress. Such strain and
hardship in unrealistic goals result sometimes in serious disease. Smoking, drinking, use
of caffeine drugs in modern lifestyle damages the body. It makes a person addict or get
addicted so you will have pressure to smoke and drink and when such pressure is
prolonged, will result in serious disease.
1.2
MEANING OF STRESS
Stress in human beings results from interactions between persons and their environment
that are perceived as straining or exceeding their adaptive capacities and threatening
their wellbeing. The element of perception indicates that the human stress responses
reflect differences in personality as well as differences in physical strength or general
health. People who are dependent on others or who are socially disadvantaged (because
of race, gender, education etc) are at greater risk of developing stress related illness.
Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger
and cynicism.
In good health, increased stress results increased productivity – up to a point, after
which things go rapidly downhill, however, that point differs for each of us, so you need
to be sensitive to the early warning symptoms and signs, that suggests stress overload is
starting to push you over the hump.(6)
Good health is an essential condition in all aspects of life. Many people or students
experience strain as they combine busy lives and demands of work or study, while
trying to save time for friends and family. For such people strain or stress becomes
almost a way of life.
We all experience episodic stress in getting ready for a major examination, completing
an important paper, or getting ready for an interview where it provides the means to use
energy to express talents and pursue happiness.
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One who goes to pieces easily, when confronted with a difficult situation, and strain
extended for prolonged period of time, develops varieties of mental or physical
symptoms and further exhaustion can cause illness.
Risk factor for stress related illness are a mix of personal inter personal and social
variables. These factors include lack of control over one’s physical environment and
lack of social support.
Stress related physical illness like irritable bowel syndrome, chronic headaches, heart
problems. Stress related emotional problems like losing job, disturbed love affair cause
psychological problems.
1.2.1 DEFINITION OF TERMS
STRESS (Occassional Paper Series August 1993 . PMC 2560943)
Stress is a word derived from the latin word Stringere meaning to draw tight and was
used in the seventeenth century to describe hardships or affliction.
Dr. Gillian Butler defined stress in three ways which contributes to current
understanding of the stress and its concept 1.
A stimulus based definition –
A Stimulus based definition suggests that stress results from pressure. The greater the
pressure, the more likely that the recipient person will succumb. When the external
stimulus becomes too great, internal collapse becomes inevitable.
2.
A response based definition –
A response based definition suggests that stress as a response to noxious or aversive
stimuli, explained by Selye in 1956. Who measured stress in terms of physiological
responses such as those represented by sympathetic – adrenal – medullary activity or by
pituitary – adrenal – cortical activity. Hans Selye (1956 to 1976) – (1907 to 1982)
3.
A dynamic process based definition:
Definition of stress with more value in clinical practice now emphasize that stress is a
dynamic process reflecting both internal and external factors: characteristics of a person
and his or her circumstances, as well as the interactions between them. These newer
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views of stress come from greater understanding of the part played by cognitive factors
(thoughts, attitudes, beliefs, images) in psychological well-being. The amount of stress
experienced by individuals is determined by the perceived demands upon them as well
as by their perceived resources. Cognitive factors thus influence both the stimulus and
the response sides of the equation. Lazarus and Folkman's (1984) definition of stress
reflects very clearly this way of thinking. They say that stress is "a particular
relationship between the person and the environment that is appraised by the person as
taxing or exceeding his or her resources and endangering his or her well being". Two
implications of this definition have greatly influenced current thinking about stress and
therefore should be made explicit.
The physical, environmental and social causes of the stress state are termed
STRESSORS. Once induced by stressors the internal stress state leads to various
responses. (1)
WHAT STRESSORS DO TO THE BODY.
Hans Selye (1956 to 1976) termed the body’s response to stressors as “GENERAL
ADAPTATION SYNDROME(1) . (GAS)
GAS consist of three stages –
1.
The alarm reaction
2.
The stage of resistance
3.
The stage of exhaustion
1. ALARM REACTION
The alarm reaction is essentially the emergency response of the body. In this stage,
prompt responses of the body, many of them mediated by the sympathetic nervous
system prepare us to cope up with the stressors.
The activity occurs in the body’s hormonal system and in both the autonomic and
somatic parts of the peripheral nervous system.
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The autonomic nervous system consists of many nerves leading from the brain and
spinal cord out to the smooth muscles of the various organs of the body, to the heart,
certain glands , and to the blood vessels.
The autonomic nervous system has 2 parts. One part – the sympathetic nervous system
is active during aroused state and prepared the body extensive action by increasing the
heart rate , raising the blood pressure, increasing blood sugar levels, raising the level of
certain hormones in many strong emotional states.
The sympathetic nervous system causes the discharge of the hormones epinephrine
(adrenalin) and nor epinephrine (nor adrenalin)
Nerve impulses of the sympathetic system reach the inner part of adrenal gland, located
on top of the kidneys, trigger the secretion of these hormones, which then go into the
blood and circulate around the body.
In the Liver, it helps mobilize glucose (blood sugar) into the blood and this makes
ENERGY available to brain and the muscles.
Epinephrine also causes the heart, to beat harder. In the skeletal muscles, epinephrine
help mobilize sugar resources so that the muscles work more rapidly. The major effect
of norepinephrine is to constrict peripheral blood vessels and so raise blood pressure.
The changes in breathing, muscle tension and posture seen in emotion are brought about
by activity of the somatic nervous system.
In the stage of alarm reaction, prompt responses of the body, prepare us to cope up with
the stressor.
2. STAGE OF RESISTANCE
If the stressor continues to be present, the stage of resistance begins, where in the body
resists the effects of the continuous stressor. However, the resistance to new stressors is
impaired during this stage.
During this stage certain hormonal responses of the body are an important line of
defense in resisting the effects of stressors.
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The hypothalamus, either by means of nerve impulses sent to the pituitary or by
chemicals called releasing factors, controls the secretion of hormones from the pituitary
gland into the blood stream. Hormones are chemical messengers, secreted into blood
stream and carried to various parts of the body, where they have their effect.(1)
Especially important among these hormonal responses is increased activity in the
adrenocorticotropic (ACTH) axis. The rate of ACTH secretion controlled by another
hormone like chemical substance – corticotropin – releasing factor (CRF), made in the
brain cells of Hypothalamus. Stressors are able to activate the nerve cells of the
hypothalamus so that more corticotropin releasing factor is sent to the pituitary gland,
thus increasing the secretion of ACTH into the blood. This is the major link between
stressors and bodily state of stress.
ACTIVATING SHOT OF ADRENALIN
ACTH stimulates cells in the cortex of adrenal glands so that corticoid hormones such
as cortisol are secreted in the blood stream and adrenal gland is activated as the
emergency response.
Cortisol and other hormones have many actions which allow the body to deal adaptively
with stressors for long periods of time during this stage of resistance. But high levels of
these hormones can be harmful. For instance, cortisol promotes the formation of
glucose – a fuel needed for nerve and muscle activity – by breaking down fats and
proteins. In the short run, this is adaptive; the body has more fuel available. In the long
run, though, the increased use of protein to make fuel may be serious because proteins
are needed in the manufacture of new cells. For example, white blood cells which are
crucial for fighting infection, have a short life time and must be continuously replaced.
If the proteins needed to make new white blood cells are in short supply because they
are used to make fuel, fewer white blood cells can be produced and the body will be less
able to fight infection. In the long term, this seriously impairs body’s defenses to
infection. Prolonged elevation of cortisol can also have other harmful effects such as
raising the blood pressure.(1)
3. STAGE OF EXHAUSTION
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In this stage, the body’s capacity to respond to both continuous and new stressors has
been seriously compromised. For instance, due to the actions of cortisol, a person is no
longer to ward off infection and may become sick or because of other stressor induced
hormonal effects, stomach ulcers, diabetes, skin disorders, asthma, high blood pressure,
increased susceptibility to cancer (Bammer and Newberry – 1983) may occur at this
stage (Selye 1976)
Psychological concept of Selye –
In 1975 Selye published a model dividing stress into eustress and distress.
EUSTRESS – Where stress enhances function physical or mental – such as through
strength training (or challenging work) it is considered eustress.
DISTRESS – Persistant stress that is not resolved through coping or adapation, is
distress, may lead to anxiety, withdrawal or depression.
STRESS AND HOMEOSTASIS
Walter Cannon (1926 ) (en.wikipedia.org) used the term Homeostasis. Homeostasis is a
concept central to the idea of stress. In biology, most bio-chemical processes strive to
maintain equilibrium, a steady state that exists more as an ideal and less as an
achievable condition. Environmental factors, internal or external stimuli continually
disrupt Homeostasis.
Factors causing one’s condition to diverge too far from
Homeostasis can be experienced as stress. A life threatening situation such as a physical
insult or prolonged starvation can greatly disrupt Homeostasis.
Biological background of stress
Stress can have profound effects on human biological systems. Biology primarily
explains major concepts of stress using stimulus – response paradigm and how a
psychobiological system operates. The central nervous system works closely with the
body’s endocrine system to regulate stress mechanisms. The sympathetic nervous
system becomes primarily active during a stress response, regulating many of the
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body’s physiological functions in the way to make one more adaptive to its
environment.
Stress is a biological term, which refers to the consequences of the failure of a person to
respond appropriately to emotional or physical threats whether active or imagine.
There are many different definitions of Stress, because stress is made up of many
things. It is a family of related experiences, pathways, responses and outcomes caused
by a range of different events or circumstances. Different people experience different
aspects and identify with different definitions. Hans Selye is the founding father of
Stress research. Selye’s view in 1956 was that “Stress is not necessarily something bad,
it all depends upon how you take it. The stress of exhilarating, creative successful work
is beneficial, while stress of failure humiliation or infection is detrimental. Selye
believed that the biochemical effect of stress would be experienced, irrespective of
whether the situation is positive or negative.
Richard S. Lazarus (1984) defined stress is a condition or feeling experienced when a
person perceives that demands exceed the personal and social resources, the individual
is able to mobilize.
Clifford T Morgan defines Stress as an internal state which can be caused by physical
demands on the body like disease conditions, extremes of temperature heavy exercises
and the like or by environmental and social situation which are potentially harmful,
uncontrollable or exceeding our resources for coping
The physical environmental and social causes of stress state are termed STRESSORS.
Once induced by stressors, the internal stress state can lead to various responses. On one
hand it can result in number of physical, body responses on the other hand
psychological responses such as irritability, sadness, hopelessness, depression and
general feeling of not being able to cope up with the world.(1)
1.3 : FUNDAMENTALS OF STRESS
Fundamental means basic importance or basic rule or basic principle. Before
fundamentals of stress, we will find out basics of mental health.
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Mental health is a state of well being in which the individual realizes his or her own
abilities
•
can work productively and fruitfully.
•
Can cope with normal stresses of life and is able to make contribution to his or
her community.
It is estimated that only about 17% of US are considered to be in a state of optimal
mental health. There is emerging evidence that positive mental health is associated with
improved health outcomes. (www.usa.gov)
Mental Health Indicators – (www.ede.gov/mentalhealth)
In the health care and public health arena, more emphasis and resources have been
devoted to screening, diagnosis and treatment of mental illness than mental health.
Little has been done to protect the mental health of those, free of mental illness.
1.
Emotional wellbeing:- Such as perceived life satisfaction happiness, cheerfulness
and peacefulness.
2.
Psychological Well Being… Such as Self-acceptance, Optimism, Hopefulness,
purpose in life, Spirituality , Self direction, Positive relationships, Control of
one’s environment. Personal growth – including Openness to new experiences.
3.
Social Well Being, such as Social acceptance, Sense of community, Beliefs in the
potential of people And society as a whole. Personal self -worth and usefulness to
society.
MENTAL ILLNESS Mental illness is defined as health condition that are characterized by•
Alteration in thinking, mood changes in behavior
•
Impaired functioning and Distress.
DEPRESSION
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Depression is the most common type of mental illness which is the end result of
continued prolonged chronic stress. ( Ref : World Health Organization strengthening
mental health Geneva WHO fact sheet no. 220)
Stress and Anxiety
Stress is not a diagnosis but a process happening over time. Stress and tension are
normal reactions to events that threaten us. Such threats can come from accidents,
Financial troubles, Problems on the job, Problems in the family and through our
emotional and physical reactions to the given situations, we become 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. Different people react to the same stress in unpredictable ways. The level
and extent of stress a person may feel depends a great deal on their attitude-to a
particular situation. An events 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 (as many people think) because some
people thrive in it to get things done.
However, the term STRESS is used in a clinical sense, it refers to a situation that causes
discomfort and distress for a person. Regardless of who you are Or What you do – you
spend lot of time in the business 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.
DIFFERENCE IN STRESSORS
There is a major difference between stressors – those things which happen every day,
have the potential for driving us crazy, or making us angry, making us hurt, making us
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frustrated and cause stress - the way we choose to respond to these stressors. You make
a choice about how situations will affect the rest of your day.
ACTIVITIES OF DAILY LIVING AND STRESS
We cannot help but allow our daily routines to take our lives. Working, studying, kids,
running the errands, groceries, 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 most stress.
For example, think about your computer, car, and all the gadgets in household that just
happen to breakdown right when they are most needed. Backaches, headaches,
migraines, sleeplessness, anger and hostility show us that we are more stressed than
ever before. Even our hobbies and interests are very stressful and demanding activities.
AIPC March 9.2012, AIPC Article Library. Fundamentals of stress and anxiety.
1.4 – FACTORS CAUSING STRESS
Stress is an internal state and it can be caused by physical demands on the body. There
are several factors that causes stress depending upon your nature of work. Some of the
common causes are as under:
a. Being unhappy in the job.
b. Heavy work load
c. Being a ‘Yes’ Person
d. Money Issues
e. Long working hours
f. Not having enough sleep
g. Working conditions
h. Family responsibilities
i. Not eating well
j. Risk of Termination
k. Harassment at work
In case of students some of these causes are common. In addition to these some student
related causes or factors are:
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ACADEMIC FACTORS
i.
Competition for higher studies.
ii.
Changes in methods of study
iii.
Unpredictability of examinations
iv.
Too many tests / examinations
SOCIAL FACTORS
i.
Inability to speak in public
ii.
High expectations of parents
iii.
Ragging / Trouble from senior students
iv.
Financial Problems
v.
Change in personal habits.
EMOTIONAL FACTORS
i.
No time for personal hobbies
ii.
Getting involved in love affairs
iii.
Not accepted by other students
iv.
Conflicts with colleagues
v.
Fear of failure
vi.
Indifferent behaviour of teachers
vii.
Staying away from home.
STRESS RESPONSES
Stress response is the body’s way of protecting you. It helps you to stay healthy
and alert and energetic.
In emergency situation – STRESS can save your life –
 Giving you extra strength to defend yourself. For example, applying sudden
brakes to your vehicle to avoid an accident.
 Help you to meet challenges.
 Keep you on the toes during presentation at work.
 Sharpens your concentration when you attempt for game winning
 Drives your study for an exam rather than watching TV.
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But beyond a certain point, stress stops being helpful and starts damaging your health,
mood, productivity and quality of life.
Causes of life stresses
 The death of a loved one
 Divorcé
 Loss of job
 Increase in financial obligations
 Responsibility after getting married
 Moving to a new home
 Chronic illness or injury
 Emotional problems – Anger, Grief, Guilt, Low self esteem
 Taking care of an elderly
 Traumatic events - Natural disaster, Theft, rape, Violence against you
Sometimes, the stress comes from inside, rather than outside. You stress yourself by
worrying about things. All such factors can lead to stress
 Fear and Uncertainty
 Attitudes and perceptions
 Unrealistic expectations
 Any major life change
 Major financial set back
 Death in the family
Your stress level will differ based on your personality and how you respond to
situations.
1.5
TYPES OF STRESS
PATTERNS OF BODILY RESPONSES –
Activity happens in the body’s hormonal system and in both the autonomic and somatic
parts of peripheral nervous system during emotional stress states. The bodily changes
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that accompany emotional states are largely due to increased activity in the sympathetic
nervous system, this activity helps the body deal with threatening situations.(1)
One of the reasons, why people have a hard time ending stress is that they are not
addressing the core issues within their lives.
Australian Institute of Professional Councilors (AIPC) describes following Six
categories of STRESS.(7)
a. Work or study related stress
b. Relationship / Family related stress
c. Environment related stress
d. Psychological stress
e. Financial stress
f. Health related stress
a.. Work or 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 workers or teachers, changes that happen abruptly where you cannot cope with
them, threats to job security or fear of having a failing mark. Here the deadline means
the latest time or date by which something should be completed.
Abeles et al in 1980, explained about work choice, work change and life satisfaction.
One reason that early career choices are considered important is that each time we open
one career door, we close others.(1)
When we choose to sharpen one set of skills, we leave other skills undeveloped. Each
choice moves us closer to being locked into, and out of certain career options. On the
other hand, no career choice has to be final.
b. Relationships / family related stress
Family related stress includes –
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 Divorce / separation issues
 Extra martial affairs
 Child rearing
 Teenage break ups
 Unwanted pregnancies
This area is a major Stressor for most people and often times, stress coming from this
area can have a major impact in other areas.
Erikson (1963) - Young adult needs to establish an intimate relationship and enter the
realm of parenthood. Commitment to each other can ultimately help society flourish.
Traditionally, this is accomplished through marriage and expanded with the birth of
children. Partners in such relationships find satisfaction in caring and mutual sharing.
When one or both partners cannot sustain an unselfish relationship of mutual sharing
results in stress (1).
c. 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
•
Weather disturbances –
Changes in the environment such as moving to a new state, having a new job or having
a completely different life style are main stressors.
Critical Incident Stress 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, behavioral or emotional in nature. (Carlier,
Voerman & Gersons, 2000)
Some people have limited reactions that last only a few days while others may take
weeks or months to feel comfortable again. Others can have delayed onset reaction too.
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There are also some reactions that suggest a person is having difficulty coping with the
incident. On the other hand many people develop ways of coping with stressors, so that
they are able to respond adaptively.
d. Psychological stress
Psychological stress includes FEAR of an individual, which can either be real or be a
phobia which is not grounded in reality.
Sleeplessness, anxiety and worries are sometimes caused by unrealistic fears which
have no basis.
Phobias are Irrational Fear. The fear becomes irrational when it generalizes, or spreads
to similar but Harmless Objects – For example Original fear responses to a white
fluffy dog that bit the child- becomes generalized to many white blankets, white beards
– becomes irrational fear of white fluffy things or Phobia. He may be afraid of Santa
Claus or who have white beards – because of generalization of Fear.
e. Financial stress
Feelings of helplessness in financial terms are one of the most common causes of
STRESS and because the economic wellbeing of an individual is connected to other
areas of his / her life, a financial problem can also have spillover effects, in areas such
as relationship and health. Main factors are money making or trading and money saving.
f. Health related stress
The health of a person is the wellspring of his life, because it is a state of being free
from illness and diseases. Good mental and physical condition is an indication of good
health. Health related stress ranges from sleeplessness to drug abuse. Illness is also main
source of stress. Some of the most common illness can be the most major stressors such
as influenza, asthma , psoriasis. Many people do not take medical advice for influenza,
but it is severe infection of respiratory passage with fever, and it spreads by virus
rapidly.
Asthma and psoriasis becomes chronic disease for life time and causes severe stress.
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These six categories of stress are not isolated from each other. Mostly one stressor can
lead to other form of stress. The categories can mix and match to create more stress and
pressures can creep in from an area from infecting and inflicting damage to other areas
of life.
1.6 Signs and Symptoms of Stress
If you feel, stress does not affect you every day, you are lucky but stress gets in our way
nearly every day. It is sure in life that, you will encounter stressful situations on a
regular basis. There are several signs and symptoms that you may notice when you are
experiencing stress.
These signs and symptoms fall into four categories:
a. Feelings
b. Thoughts
c. Behavior
d. Physiology
A. FEELINGS:
Feeling anxious means experiencing worry. Fearful feeling is the hall mark of anxiety.
It is often concealed or reduced by defensive behaviours such as avoidance or ritualistic
actions. Some anxious people develop generalized anxiety disorder with symptoms of
trembling sweating, breathlessness, fainting, headache nervousness and fatigue.
Some people develop intense, persistent irrational fears of places, animals. insects etc.
Some people develop panic attack for an hour or more with choking sensations.
Sometimes anxiety is associated with obsessions with persistent unwanted thoughts,
impulses or ideas and compulsions with irrational behaviour repeatedly carried out in a
fixed repetitive way.(1)
The secretory competent of the immune system exists in the fluids that bathe the
muscular surfaces of the body ie – tears in the eyes, Saliva in the mouth,
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Secretions in the vulva and vagina, Nasal secretions, Gastro intestinal secretions,
Bronchial secretions.
A glycoprotein is found in these secretions called immunoglobulin (IgA), contains
antibodies that are the body’s first line of defence against invading virus or bacteria.
They prevent these virus and bacteria from biding to muscosal tissues.
Stone and Neale’s research showed that when the students experienced relatively high
levels of negative mood, there was less antibody present than on the days with low
levels of negative mood. Similarly antibody level was higher on days with higher levels
of positive mood. These findings interpret the complex interplay among psychological
and physiological processes – and help in etiology of psychophysiological disorders(8)
B. THOUGHTS
- Low self-esteem
- Fear of failure
- Inability to concentrate
- Embarrassing easily
- Worrying about future
- Pre- occupation with thoughts
- Forgetfulness.
Our reactivity and characteristic ways of self regulation is called Temperament.
Everyone shows differences in their emotional and arousal responses to various stimuli,
or their tendency to approach, withdraw or attend to various situations. (Hershey 2000)
Our early temperament to thought to be the basis from which our personality
develops.(9) From early infancy five dimensions of temperament are identified:
•
Fearfulness
•
Irritability
•
Frustration
22
•
Positive affect
•
Activity level
•
Attention and concentration.
C. THINKING
During most of our working hours or even when we are asleep and dreaming, we are
thinking. Everyone is thinking all the time, and even if you stop thinking about what we
are doing now, your thoughts wander off to something else, perhaps to what you are
going to do tomorrow, and you will still be thinking. When we think we mentally or
cognitively process the information.
The Thought Process consists of cognitive rearrangement or manipulation of both
information from environment and the symbols stored in long term memory. A symbol
represents some event or item in the world.
Different varieties of our Thoughts makes two kinds of thinking1.
Autistic Thinking
2.
Directed Thinking.
Some thinking is highly private and may use symbols with personal meanings. This
kind of thinking is called Autistic Thinking. Dreams are an example of Autistic
Thinking.
Other thinking is aimed at Solving Problems, or creating something new this is called
Directed Thinking. Thinking is the form of information processing that goes on during
the period between a stimulus event and the response to it.
Then thinking process move from the world of actual thinking to the world of
Hypothetical. Such skilled thinking allows adolescents to judge the reasonableness. One
makes judgment of right or wrong (1).
Self esteem-
23
Self has two distinct sets of meanings – one set has to do with people’s attitude about
themselves, their picture of the way they look and act, and their perceived traits,
abilities and weakness. This is known as SELF CONCEPT or Self image.
Second set of meanings relate to the executive functions, the process by which the
individual manages thinks, copes and plans.
D. BEHAVIOUR
Behaviour includes anything a person does that can be observed some way. We can see
and measure, what a person does and record what a person says. Internal mental events
can be studies, as they manifest themselves through what people do as their behaviour.
Method of systematic observation tells us how people differ in their behaviour and what
may be the causes of abnormal behaviour.(1)
Human beings react to external or internal events by initiation of series of thoughts,
actions and feelings. Feelings range from happiness to sadness, from irritability to
anger, depending upon the circumstances.
These feelings are appropriate to the situation and can be terminated at will. When a
particular feeling state persist for some time, it is referred to as MOOD. Then their
thinking and behaviour is consequently influenced by their MOOD. Mood disorder
includes two affective states –
1.
State of sadness – depression
2.
State of happiness - euphoria
PRE-OCCUPATION - With thoughts on tasks.
The thinking process is preoccupied either by depressive and negative thoughts or by
emphoric thoughts. Various psychosocial stressors are often reported with the onset of
such behaviour. Thought process reveals excessive talking, irrelevant with flight of
ideas.
Behaviour shows perceptual disturbances their judgement and insight are impaired.
Their sleep is reduced and appetite is increased, sex drive is increased. He talks rapidly,
24
observation reveals marked talkativeness with occasion stuttering. Their memory and
intelligence is not impaired.
His psychomotor activity is increased, he is excited and acts impulsively. He develops
habit of smoking more, and use of drugs and alcohol. With failures, financial loss or
death in the family, he develops sadness. He starts crying and at times the weeping
becomes uncontrollable. He is not able to enjoy the activities that were pleasurable for
him before. Reduced self esteem-he feels that he cannot achieve anything and develop
loss of confidence.(10)
Physiology
Most of the signs and symptoms in stress are clinical manifestations referable to
autonomic nervous system
1
Palpitation
2
Shortness of breath
3
Tremulousness
4
Unsteadiness
5
Dryness of mouth
6
Diminished appetite
7
Headache and heaviness of head
8
Blurring of vision
9
Giddiness
10 Frequency of micturition
11 Excessive sweating
12 Frequent diarrhea
13 Dysthymia or imbalance
14 Severe fatigue – feeling tired
15 Reduced efficiency
Clinical examination shows
1
Tachycardia
2
Elevation of Blood Pressure
3
Increase in rate, depth and frequency
25
4
Exaggerated deep reflexes
Stressors, mainly, difficult family situation, financial difficulties, heavy responsibilities,
prolonged illness and poor support triggers of the stress symptoms(11).
WARNING SIGNS AND SYMPTOMS OF STRESS
It is important to learn or to know how to recognize when your stress levels are out of
control. The signs and symptoms of stress over load, affects the body, mind and
behaviour in many ways and everyone experiences stress differently.
Stress warning signs and symptoms are:
1
Cognitive
2
Emotional
3
Physical
4
Behavioural
COGNITIVE SYMPTOMS are1
Memory problems
2
Inability to concentrate
3
Poor judgement
4
Seeing only the negative
5
Racing thoughts
6
Constant worrying
7
Anxiety
EMOTIONAL SYMPTOMS are
1
Moodiness
2
Irritability or short temper
3
Agitation or inability to relax
4
Feeling overwhelmed
5
Sense of loneliness or isolation
6
Depression
7
General unhappiness
26
PHYSICAL SYMPTOMS of stress are
1
Aches and Pains
2
Diarrhea or constipation
3
Nausea, dizziness
4
Rapid heart beat
5
Chest pain
6
Frequent colds
7
Loss of sex drive
BEHAVIOURAL SYMPTOMS of STRESS are
1
Eating more or less
2
Sleeping too much or too little
3
Isolating oneself from others
4
Neglecting responsibilities
5
Nervous habits like nail biting
6
Using alcohol , drugs, cigarettes to relax one self.
1.7
CHARACTERISTICS OF STRESS
STRESS refers to wide spread generalized responses of the body to various
environmental physical or social situations. Stressors are the situations or events which
cause the stress responses of the body. Among the many situations acting as stressors
are – changes in one’s life, injury, infection, exercises, noises, climate, job and work,
family pressure are important in life. The body’s response to stressors is called the
GENERAL ADAPTATION SYNDROME. Psychosomatic (mind-body) disorders
occurs when perceived stressors increase the susceptibility of the body to disease (1).
Distinctive characteristic of stress is represented in four terms1.
EUSTRESS
Eustress is a positive stress – such as type of stress an athlete experiences rest before the
game, a sort of excitement. An athlete is stirred up. High level of arousal of emotion of
27
joy energizes athlete behaviour and it leads to his best performance and keep the athlete
on his toes. This is a kind of orienting reaction consisting of tensing muscles, change in
positions of the body to maximize the effectiveness in performance.
2
DISTRESS
This is more of a negative stress. Almost any change in the environment demands some
coping and a little stress is useful in helping us adapt but beyond some point “Stress”
becomes “distress”. What acts to produce distress varies greatly from person to person,
but some events seem to be stressors for many of us like annoying or dangerous events
in our environment or changes in routine. This is a type of stress experienced when a
normal routine is constantly adjusted and altered. Human beings are a creature of habit
and love his routines. When such routine is constantly interrupted he becomes distressed
and annoyed, because it forces him to cope in new ways frequently.
3
ACUTE STRESS
This is the distinctive stress that is in your face, so to speak and it moves you to action.
When we are under acute stress, we tend to take inventory, make a decision and take an
action to decrease the stress. The impact of stressors can be reduced if a person has
control over the stressor. (COHEN 1980).
4
CHRONIC STRESS
This is the kind of stress we live with day in and day out, week in and week out. It
wears us out on many levels and we become used to it, so used to it that we don’t feel it
any more.
Stress has a number of immediate effects and if the stressors are maintained, long term
behavioral, physiological, emotional and cognitive (thinking) effects occur. If these
effects hinder adaptation to the environment or create discomfort or distress, they
themselves become stressors and tend to perpetuate a cycle of distress.
On the other hand, many people have developed ways of coping with stressors so that
they are able to respond adaptively. This is the wellness cycle teaching people adaptive
ways of handling stress – promotes the wellness cycle. (1)
28
Special characteristics of stress are
•
Oxidative stress
•
Metabolic stress
•
Dietary stress
•
Environmental stress
OXIDATIVE STRESS
Oxidative stress is a form of metabolic stress. It is a complex scientific process taking
place in our body. Oxidative damage is associated with many diseases and chronic
conditions.
METABOLIC STRESS
-
Hormonal imbalances / deficiencies
-
Allergies and sensitivities
-
Chemical sensitivities
-
Inhalant allergies, Food allergies
-
Infectious agents (Parasites, fungi, bacteria , viruses)
-
Genetic pre-disposition
DIETARY STRESS
-
Nutritional deficiencies
-
Food exercises
-
Chemical/ additives in food
-
Presence of heavy metals in food - mercury in tuna
-
Stress of processing
-
Recreational drug – alcohol
ENVIRONMENTAL STRESS
This is the stress from dealing with things happening around you, such as smoking ,
exposure to toxins and heavy metals and pollution, radiation and electromagnetic waves
that we encounter in day to day life, from satellite dishes to cell phones and cell phone
towers etc.
29
1.8
EFFECT OF STRESS ON HUMAN BODY
Stress is the body’s reaction to any change that requires an adjustment or response. The
body reacts to these changes with physical, mental and emotional responses. Stress is a
normal part of life. Many events that happen to you and around you and many things
that do yourself – put stress on your body. You can experience stress from your
environment, your body and your thoughts. (Web MD Medical References- Article
sources by Joseph Goldberg Reviewed in July 23 2012)
THE HUMAN BODY
The human body is designed to experience stress and react to it. Stress can be positive
keeping us alert and ready to avoid danger. Stress becomes negative, when a person
faces continuous challenges without relief or relaxation between challenges. As a result
the person becomes over worked and stress related tension builds.
Stress that continues without relief can lead to a condition called DISTRESS, a negative
stress reaction. Distress can lead to physical symptoms including:
-
Headaches
-
Stomach upsets
-
Elevated blood pressure
-
Chest pain on physical activity
-
Problems in sleeping
-
Heart rate
-
Breath rate - shortness of breath
-
Sweating, nausea
-
Dizziness, fatigue
Stress can worsen some symptoms leading to diseases – Heart problems, Depression &
Anxiety, Asthma, Pain relating into your shoulder /arm. Stress becomes harmful when
people use alcohol, tobacco or drugs to relieve their stress. Unfortunately, instead of
relieving the stress and returning the body to relaxed state, these substances tend to keep
the body in a stressed state and cause more problems
30
Stress can affect body, thoughts, feelings and behaviour. Stress left unchecked, can
contribute to health problems such as heart disease, obesity, diabetes. Common effects
of stress on your mood, restlessness, irritability, anger, sadness, depression and anxiety.
Common effects of stress on behaviour - over eating, angry outburst, tobacco use,
social withdrawal, drug abuse.
STRESS FACTS
FACT 1 – Your body does not care, if it is a big stress or a little stress – A typical stress
reaction begins with a cascade of 1400 bio chemical events in your body. If these
reactions are left unchecked –
-
You age prematurely
-
Your cognitive function is impaired
-
Your energy is drained
-
You are robbed of your effectiveness.
FACT 2
STRESS can make smart people do stupid thingsStress causes “cortical inhibition” stress inhibits a small part of your brain and you
cannot function at your best. When we are in coherence - a state where we are
cognitively sharp, emotionally calm and we think with enhanced clarity – The brain,
heart and nervous system work in harmony.
FACT 3
People can become numb to their stress. We are physiologically experiencing the stress
yet mentally numb to it because we have become so accustomed to it.
FACT 4
We can control, how we respond to stress and we become more sensitive to stressful
situations and how they are affecting us, before it manifest as a physical, mental or
emotional compliant.
FACT 5
31
The best strategy is to handle stress in the moment you feel it, if you wait for recovery
of stress, your body already activated the stress response and your health suffers.
FACT 6
Emotional stress change your heart rhythm patterns –
Positive emotions create coherent heart rhythms which look like rolling hills. In
contrast, negative emotion create chaotic, erratic patterns on heart rhythm
monitor.
Coherent heart rhythm patterns facilitate higher brain function where as negative inhibit
a person’s ability to think clearly. (Heart math. www. heartmath.com/infographics)
1.9
METHODS OF MEASUREMENT OF STRESS
In order to effectively manage stress, you must become aware of the amount and types
of stressors in your everyday life. One way of developing an awareness is to assess the
frequency and amount of stress in your daily routine, and then trace the stress to its
source (i.e., the stressor). Below are mentioned few easy ways of measuring stress in
your daily life. These methods can be easily used anytime and anywhere.
PSYCHOLOGICAL QUESTIONNAIRE
Psychologists developed questionnaire that cover a wide range of psychological
symptoms associated with stress.
PERCEIVED STRESS SCALE (PSS) - PSS was developed to measure the degree to
which, situations in one’s life are appraised as stressful.
The PSS was published in 1983 and became one of the most widely used psychological
instrument for measuring non-specific perceived stress. It has been used in studies,
assessing the stressfulness of situation, the effectiveness of stress reducing interventions
and the extent to which there are associations between psychological stresses and
physical disorders. In PSS scale, items were designed to tap, how unpredictable,
uncontrollable and over loaded respondents find their lives. The scale also includes a
number of direct queries about current levels of experienced stress.
32
PSS was designed for use in community samples with at least high school education.
The items were easy to understand and responses alternatives are simple to grasp.
Moreover, the questions are of general nature and hence are relatively free of content
specific to any sub population group. The questions in PSS ask about feelings and
thoughts during last months. In each case, respondents are asked how often they felt a
certain way PSS collects and scores student’s feelings and thoughts during the last month. This
gives information about coping power against annoying events, dangerous events, major
environmental changes and transitions. PSS is reprinted with permission of the
American Sociological Association from Cohen.S,(1983). A global measure of
perceived stress(12). The Perceived Stress scale (PSS; Cohen.S, Kamarck. T and
Mermelstein R (1983) is one of the more popular tools for measuring psychological
stress. It is a self – reported questionnaire that was designed to measure “the degree to
which individuals appraise situations in their lives as stressful” (Cohen et al., 1983,
p.385). The PSS items evaluate the degree to which individuals believe their life has
been unpredictable, uncontrollable, and overloaded during the previous month. The
assessed items are general in nature rather than focusing on specific events or
experiences.(13)
There are three versions of the PSS. The original instrument is a 14 – item scale (PSS14) that was developed in English (Cohen et al., 1983), with 7 positive items and 7
negative items rated on a 5-point Likert scale. In 1988, it was shortened by the author to
10 items (PSS-10) using factor analysis based on data from 2,387 U.S. residents. A
four-item PSS (PSS-4) was also introduced as a brief version for situations requiring a
very short scale or telephone interviews (Cohen and Williamson, 1988). According to
Cohen’s Laboratory for the study of stress, Immunity and Disease, (2012), the PSS is
currently translated in to 25 languages other than English (13). The PSS is a ten item self
report that was a Likert scale to assess the participant’s level of perceived stress over the
last month. The PSS is arguably the most widely used instrument for measuring
perceived stress. Research has shown that the scale’s multidimensional analysis of
perceived stress has a high degree of internal consistency and predictive validity(14).
33
1.10 Management of Stress
Being in control of your life and having realistic expectations about your day to day
challenges are the keys to Stress Management which is perhaps the most important
ingredient to living a happy, healthy and rewarding life …… (Marilu Henner)
Stress is one of the psychophysiological disorder causing true physical dysfunctions.
Stress produces numerous symptoms which vary according to the persons, according to
the situations and according to the severity.
Stress can cause
•
Migraine
•
Cardiovascular disorder
•
Essential Hypertension
•
Asthma
•
Metabolic disorders
•
Renal disorders
•
Allergies
•
Diarrhoea
•
Indigestion
•
Vomiting nausea
•
Headaches
•
Sleeping problems – insomnia
•
Giddiness , vertigo , dizziness
•
Breathlessness
Medical Professionals and Mental health professionals
recognize that most drug
interventions treat only the symptoms like increased heart beats, urinating frequency
and genitourinary symptoms. They do not deal with the fact that the person is reacting
emotionally to psychological stress. This fact calls for psychotherapeutic interventions.
34
Therapists of various specialties agree in most general terms that reducing anxiety is the
best way to alleviate the suffering from psychophysiological disorders. The particular
disorder, whether it is coronary heart disease, essential Hypertension or asthma attack,
is considered a consequence of anxiety or to be linked with it in some way.
Psychoanalytically oriented workers employ techniques such as free association and
dream analysis , as they do with other anxiety suffers in their efforts to help the ego of
their patients with the supposed infantile origins of their fears.
Ego analysts consider specific emotional states to underlie the several disorders and try
to strengthen present functioning. Thus, they would encourage someone with essential
hypertension, under a burden of undischarged anger, to assert himself and thereby
siphon it off .
Client-centered therapist similarly regard people with psychophysiological disorders as
needing to reduce anxiety, but they put special blame on the individuals conflict with
society.
Behaviour Therapists employ their usual range of procedures for reducing anxiety like
systemic desensitization, rational emotive therapy and assertion training, depending on
the source of tension. Treatments are devised to lessen HABITS known to contribute to
their illness.(8)
These therapists work on methods to help suffering people, lose weight (described by
Marston and Marston 1980) as carrying around extra pounds, can contribute to coronary
heart disease and to hypertension.
In recent years researchers are exploring the clinical uses of biofeedback as a means of
improving somatic functioning. Biofeedback provides people with prompt and exact
information on heart rate, blood pressure, skin temperature and other autonomic bodily
functions. The particular internal physiological process is detected and amplified by a
sensitive electronic recording device. The person knows instantaneously through an
35
auditory or visual signal, the rate of the process, whether it is too high or too low or just
right.(8)
Numerous studies have shown that most people, if given the task for example of raising
their heart rates or lowering their blood pressure, can do so with the help of
Biofeedback. (Elmore and Tursky 1978)
STRESSORS
Sources of stress are called Stressors. Stressors are all around us, at work, in our
environment and in our personal lives. These stressors cause stress. Stress is a part of
our life. Because the stress arises from so many different factors and conditions, it is
impossible to eliminate it completely. But we can apply techniques to lessen its
potentially harmful effects.(15)
There are 3 kinds of stressors for management of stress:
a) Physical Stressors
b) Social Stressors
c) Psychological Stressors
a)
Physical Stressors are –
Chemicals, Drugs, Poisons, Noise, Vibrations, Radiations, Extreme heat and cold.
b)
Social Stressors – Externally induced stressors, interaction with his environment,
interaction with family members, Traumatic stressors, pleasant events.
c)
Psychological Stressors –
Frustration, Guilt, Worry, Anger, Hate, Disgust, Fear, Anxiety, Jealousy, Sadness.
Robert A.Baron described three stress management techniques as:
1.
Physiological coping techniques:
36
a. Progressive
relaxation:
Progressive
muscle
relaxation:
Common
physiological responses to stress include tense muscles, racing pulse,
pounding heart, dry mouth, queasy stomach, sweating.
b. Regular vigorous exercises: Regular and Regulated physical exercises,
Walking, Jogging, Swimming, Riding bicycle, Playing out door games. Such
exercises are highly useful in combating stress directly, as well as indirectly
through diversion.
2.
Behavioral coping technique:
Time management: Principle of time management is to balance work time
and play time. We are all guilty of behaving in the way that brings stress on
ourselves. We overload our schedules with too many responsibilities, all
adds up to stress. Learning how to make time work for us instead of against
us. Adhering to a well planned schedule helps us to make more efficient use
of our time and eliminate behaviour use of our time and eliminate
behaviours that interfere with our main goals.
3.
Cognitive coping techniques
Cognitive restructuring: The process of replacing negative appraisals of
stressors with more positive ones is called cognitive restructuring.
(Meichenbaum 1977)
To use this technique successfully begin by monitoring what you say to
yourself during periods of stress. Begin to modify these thoughts by thinking
more adaptive thoughts. For example, try to discover something humorous
about the situation or imagine creative ways to reduce or eliminate the
source of stress. Social support is important; family and friends can often
help you to restructure stressors – that is these persons can help you to
perceive stressful events as less threatening and more under control than you
might otherwise do (Bruhn and Phillips 1987).
Davison and Thompson in 1988 described several approaches of Stress
Management and more than one is typically followed in any given instance.
(8)
37
INDIVIDUAL APPROACHES
MEDITATION – Age old practice of mediation.
Meditation is Mental relaxation technique which is of immense value to
relieve stress and re-energize the body.
Meditation is a state where the mind experiences intense joy, peace and
serenity. It is a state of greatest silence or an experience of bliss. There are
practical advantages of meditation :
• We can function more efficiently
• We feel more complete in ourselves
• We are able to realize more of our human potential
• We feel closure to ourselves
• We are better able to relate others
• We become more integrated
• Our personality structure is strengthened
• We achieve more clarity in self-expression
During meditation the heart rate slows down a little, the breathing rate goes
down, the consumption of oxygen decreases, Muscle tension is reduced
blood levels of lactate and Cortisol which are associated with anxiety and
stress decrease, the resistance of skin to the passage of a weak electric
current – Galvanic skin response (GSR) rises (sign of relaxation).(1)
NETWORKING
Social Psychology research has clearly indicated that the people need and
will benefit from social support. Networking entails forming close
associations with trusted empathetic colleague who are good listeners and
confidence builders. These peers are available when needed and provide
support to get the person through stressful situations. Networks show
relationship between social support and stress reduction.
38
ORGANIZATIONAL COPING STRATEGIES FOR STRESS
This is second major type of coping strategies.
Stress can affect any one – workers or a manager, young or old. Any job condition can
create stress depending upon the employees perception. Stress can lead to erratic
behaviour and a lowering of performance and turnover. Therefore, it is very important
that organization makes tangible efforts to prevent or reduce job stress for individual
employees.
Management can design organizational coping strategies by focusing attention on each
specific job stressor. In addition more generalized strategies can include the following:
i.
Emotional climate control –
providing a climate of esteem and regards to employees and by allowing them
to participate in all decision making, involving change in their work
environment.
ii.
Provision of supportive organizational climate.
iii.
Elimination of work overload and underload.
iv.
Reduce conflict and clarify organizational goals
v.
Redefinition of employee rule
vi.
Enriching job designs by improving job task contents
vii.
Planning and developing career paths
viii.
Provision of assistance and counseling to stressed employee
ix.
Participation , Organization , development and training to improve morale and
job satisfaction and interpersonal competence of employees
x.
Effective communication flow in the organization to improve performance and
quality of work life.
xi.
Programmes for prevention of job stress in areas like organizational structure
and climate job design, personal selection , placement and training.
Thus a number of strategies to prevent and alleviate stress can be used successfully at
both individual as well as organizational level.
39
YOGA -
UNITE BODY AND MIND WITH CONSCIOUS BREATH
Yoga is a way of life. Yoga means union. The concept of YOGA is to unite the atma or
individual soul with the Parramatta or the universal soul. Yoga Darshan or Yoga
Philosophy is a valid discipline of Indian Meta Physics or Brahma Vidya,
and
happened thousands of years ago. The basic Hatha Asanas means YOGA postures were
taught to purify and train the body for the practice of meditation.
Asana means easy, comfortable postures. There are special patterns of postures that
stabilize the mind and body through static stretching.
The aims of the Yoga Asana are to establish proper rhythm in the neuromuscular Tonic
impulses tone (Gharote and Ganguly 1988) – Yoga keeps the nervous system classic
and capable of bearing stress. The parasympathetic nervous system is essential to
relaxing, distressing and good health, is activated by yogic movements and breathing
yoga or Pranayam.
Maharishi Patanjali systematized the various Yogic practices and traditions of his times
by encapsulating them in the form of adhorisms in his Yoga Sutra. In this momentous
work, he describes the aim of Yoga as knowledge of the self and outlines the of steps of
achieving it. EIGHT STEPS of achieving knowledge of Self – in Yoga Sutra
1
YAMAS or eternal vows
2
NIYAMAS or Observations
3
Yogasanas or Yoga postures
4
Pranayama or Breath Control exercises
5
Pratyahara or withdrawal of senses from distractions of the outside world.
6
Dharana or concentration on an object , place or subject
7
Dhyana or the continuance of this concentration and meditation
8
Samadhi or ultimate stage of YOGA meditation.
The collation of these eight steps is known as Patanjali’s Ashtanga Yoga .
Meditation is not necessarily a religious practice, but because of its spiritual element, it
forms an integral part of most religions.
40
Human beings are increasingly turning towards various meditative techniques in order
to cope with the increasing stress of modern day life style. (16)
BIOFEEDBACK
Biofeedback is a process that enables an individual to learn, how to change
physiological activity for the purpose of improving health and performance.
Three professional biofeedback organizations
•
Association for Applied Psychophysiology
•
Biofeedback certification International Alliance
•
International society for Neurofeed back and Research – arrived at consensus
definition of biofeedback in 2008.
Precise instruments measure physiological activity such as brain waves, heart function,
breathing, muscle activity and skin temperature. These instruments rapidly and
accurately “feedback” information to the user.
The presentation of this information, often in conjunction with changes in thinking ,
emotions and behaviour – supports desired physiological changes. Over time these
changes
can
endure
without
continued
use
of
an
instrument.
(en.wikipedia.org/wiki/biofeedback)
TYPES OF BIOFEEDBACK
•
ST Skin Temperature Biofeedback – thermal
•
EMG Muscle Tension Biofeedback
•
EEG Brainwave Biofeedback
•
Galvanic skin response
•
Heart rate biofeedback –HRA- Heart rate variability
•
Blood pressure Biofeedback
•
Respiration Feedback
•
Electrodermal activity Feedback (EDA)
Biofeedback is a treatment technique in which the people are trained to improve their
health by using signals from their own bodies.
41
PHYSICAL THERAPIST uses Biofeedback to help stroke victims regain movements in
paralysed muscles.
PSYCHOLOGIST and Physiotherapist uses Biofeedback to help tense and anxious
clients learn to relax.
Rehabilitation Therapist uses Biofeedback to help their patients cope with pain.
Biofeedback machines can detect a person’s internal bodily functions with a greater
sensitivity and precision than a person. (psychotherapy.com/bio.html)
ADVANTAGES OF USING EMG BIOFEEDBACK
Uses and Benefits
Body functions like, heart rate, skin temperature and blood pressure are controlled
involuntarily by nervous system. Our heart beats faster in response to environment , like
when you are nervous excited or exercising.
One technique can help you gain more control over these normally involuntary
functions. It is called BIOFEEDBACK and Biofeedback therapy is used to help or treat
conditions including migraine, headaches, chronic pain, incontinence, high blood
pressure and stress.
CONTRAINDICATIONS FOR EMG BIOFEEDBACK
1
If movement of a joint or isometric contractions are contra indicated.
2
Conditions in which muscle contractions might exacerbate the condition
i. unhealed tendon graft
ii. Avulsed tendons
iii. 3rd degree tears of muscle fibres
3
Unstable fractures
4
Injury to joint structure – ligament, capsule or articulating surfaces.
42
1.11 HOW TO AVOID OR PREVENT STRESS
Try to manage balance between too little and too much pressure by adapting your
behaviour and thinking.
PREVENT PRESSURES TURNING TO STRESS
•
Adopt a healthy life style-
•
Eat healthy diet
•
Exercise regularly
•
Adequate rest
Diet – Nutritional deficiency impairs the health of the body. If the brain is affected so
our thoughts, feelings and behaviour. The vitamin B group is relevant to the brain,
depression and stress susceptibility.
Vitamin B1 deficiency is associated with depression.
Vit B2 deficiency is associated with nervous system disorders.
Vit B3 is essential for protein synthesis and neurotransmitter serotonin.
Vit B6 is essential for neurotransmitter synthesis.
Vit B12 deficiency is associated with peripheral nerve degeneration.
Vit C is essential to protect against STRESS and speeds healing it maintains a
healthy immune system which reduces stress susceptibility.
Vit D is essential for healthy bones and speeds fracture healing.
TOXINS such as alcohol, tobacco smoke, pollutants work against the balance between
minerals, vitamins, mind and body.
Processed food, Battered fish from cheap shop, canned and bottled drinks, squashes
contain Aspartame which is linked with nervous system disorders. (16)
EXERCISE - To avoid or prevent stress
Exercise releases helpful chemicals in our brain and body – such as beta endorphin
which produce powerful feelings of well-being and a physical glow which directly
reduces and prevents stress. Exercise relaxes tense muscles and tight connective tissues
in the body and relieves discomfort or pain.
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Exercise distracts from the cause of stress. Aerobic exercises and cardio- vascular
exercises gets the heart pumping well.
Brisk walking or jogging recharges the body with extra intake of oxygen and release of
muscle tensions. It facilitates blood circulation to all systems of the body. Walking is an
effective and handy stress buster.(16)
REST and SLEEP
Having a good night sleep is vital for a healthy mind and body. We have evolved from
ancestors whose sleep patterns were governed by nature. We are born with genes and
bodies which reflect our successful evolutionary survival over thousands and thousands
of years. Our genes and bodies do not reflect the modern world’s less natural way of
life.
Recent generations have the modern heating, lighting, communications and
entertainment technologies, encouraged people to unnatural walking and working hours.
Resisting and breaking with our genetically programmed sleep and rest patterns create
internal conflicts and STRESSES. Napping during the day is also healthy. It recharges
and energies, relaxes and help to wipe our brain of pressures and unpleasant feelings (16).
It is imperative to create a tranquil and inviting environs in and around the resting place
to slip into a restful sleep. One must make it a point to end the day with a pleasant or
relaxing schedule, listening to choice music, reading a light and leisurely book, doing
some simple, relaxing exercise playing with children or watching a fun filled tele show.
It is significant to keep a watch on what you take at dinner, as most of our mind – body
anomalies spring from indigestion of food at physical level or indigestion of emotions
(irritation, uneasiness) at mental level. A rich and heavy dinner close to bed time can
intervene with your sleeping patterns, make you sluggish in the morning and can disrupt
your normal diet routine.
A change in attitude – such as simple modifications of habits, thoughts, and behaviour
patterns often go a long way in preventing stress or reducing tension and stress.
Practicing to let go or making a conscious choice not become angry or upset over trivial
matters, saves a lot of physical and mental energy. (16)
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LAUGHTER
Adopting a humorous view towards life’s situations can take the edge off everyday
stressors. Not being too serious or in a constant alert mode helps maintain the
equanimity of mind and promote clear thinking.
Being able to laugh stress away is the smartest way to avoid or prevent stress and ward
off its effects.
A sense of humor also allows us to perceive and appreciate the incongruities of life and
provides moments of delight. The emotions we experience directly affect our immune
system. The positive emotions can create neurochemical changes that buffer the
immunosuppressive effects of stress. During stress the adrenal gland releases
corticosteroids which are converted to cortisol in the blood stream. These have an
immune suppressive effect. (16)
What laughter can do against stress and its effects –
1
laughter lowers blood pressure and reduces hypertension
2
It provides good cardiac conditioning especially for those who are unable to
perform physical exercises.
3
Laughter reduces stress hormones. Studies show laughter induces reduction of at
least four of neuroendocrine hormones – epinephrine , cortisol, dopac, and growth
hormone associated with stress response.
4
Laughter cleanses the lungs and body tissues of accumulated stale air, as it empties
more air than it takes in. It is beneficial for patients suffering from respiratory
ailments.
5
Laughter increases muscle flexion, relaxation and fluent blood circulation.
6
Laughter boosts immune function by raising levels of infection fighting tells,
disease fighting proteins called Gama interferon.
7
Laughter boosts immune function by raising levels of disease destroying antibodies
called B cells.
8
Laughter triggers the release of endorphins body’s natural pain killers.
9
Laughter produces a general sense of well being.
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ANGER MANAGEMENT
To avoid or prevent stress – The management of anger (and any other unreasonable
emotional behaviour) and the stress that cause it, can only be improved if the person
wants to change – acceptance, cognizance commitment – so awareness is the first
requirement. Some angry people take pride in their anger and do not want to change,
others fail to appreciate the effect of anger on self and others. Without a commitment to
change there is not alot that a manger or an employer can do to help, anger management
is only possible when the angry person accepts and commits to the need to change. (16)
1.12 BACKGROUND OF THE STUDY
In today’s ultra-competitive environment students face more stress than ever, be it
related to study, examination, peer teachers or parents pressure. Stress is the “wear and
tear” our bodies experience as we adjust to our continually changing environment. On
one hand stress compels us to action. However it can result in feelings of rejection,
anger and depression, leading to health problem such as headaches, stomach upset ,
rashes, insomnia, ulcers, high blood pressure or heart disease and stroke.
A comparative study of stress among students of Medicine, Engineering and Nursing –
by Shashank P Behere, Richa yadav and Prakash B Behere showed stress as an entity, is
universally present among students of all three streams, irrespective of age, sex and
other variables. Students in all three streams showed denial to existence of problems
with maximum among nursing students. Medical and Engineering students had stress
level of such a degree that requires clinical attention, while none of the nursing students
belonged to this category.
Researchers concluded that there is attitude among students of turning a blind eye
toward existing stress which is a serious mental and psychological problem.
•
100 undergraduate students of Mahatma Gandhi Institute of Medical Science
Sewagram Wardha M S
•
100 Undergraduate students of B.D college of Engineering Sewagram Wardha
•
50 B. Sc. Nursing students of Kasturba Nursing College, Kasturba Hospital,
Sevagram, Wardha MS
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Stress may be longer duration of study required to complete professional degree,
coupled with higher expectations from parents in Medical and Engineering students
than Nursing students. It is possible that most nursing students being females have
greater resistance to stress or are faced with fewer expectations than their counter parts.
A study of psychological stress among undergraduate medical students of Government
Medical College, Surat( by Priti Solanki Binita Desai, Abhay Kavishwar S.L Kantharia
October 29 2013).
BACKGROUND
Psychological stress among medical students is common as compared to other
professional courses. The prevalence of perceived stress among medical students affect
not only their academic performances but also to some extent their health.
This study was undertaken to determine the prevalence of self perceived psychological
stress among undergraduate medical students to identify probable factors responsible
for it and to suggest possible interventions.
A cross sectional study using self administered questionnaire was conducted on
undergraduate students, chosen from all the years of MBBS who were enrolled at Govt
Medical College Surat at the time of study period.
Results- In this study 3.12% of the students reported having no stressor experience
55.6% reported mild to moderate stressors experience. Major factors responsible for
stress identified in this study are increased loads towards exam, vast syllabus not getting
expected marks, less time for repeated learning and procrastination.
Conclusion : This study has concluded that
majority of undergraduate students
experience stress. Both academic and emotional factors are responsible for this stress.
Proper guidance and counseling by faculties may help to improve the present
scenario.(17)
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1.13 REASON FOR THE CHOICE OF STUDY
Stress is described as “body’s nonspecific response or reaction to demands made on
it”(18). It is not just a stimulus or a response but a process by which we perceive and cope up
with environmental threats and challenges.(19) It is a significant cause of many
physiological, psychological and mental illnesses.(20) It can lead to academic or
occupational boredom, potential inhibition and professional burnout.(21,22) It affects the
work capacity and performance of individual, and reduces self esteem.(23,24) With change in
education system, students are also subjected to different kinds of stressors.(25) Amount and
severity of stress experienced by students vary according to the settings, curricula,
evaluation methods.(26)
Physiotherapy is a professional field which requires students to attain diverse
proficiencies, including acquisition of theoretical knowledge, clinical competencies and
interpersonal skills.(27) The present curriculum of the Physiotherapy course is vast. As large
syllabus is fitted in a short period, the course is extremely demanding in terms of students’
effort. Competitions for post graduate seats in best clinical units as well as other social and
emotional factors influence students’ mental health. Hence the students undergoing this
course are predisposed to stress.
Professional education can be a stressful experience for some students, and may
have negative impact on emotional well-being and academic performance.(28) It can affect
undergraduate students’ academic achievement, personal and professional development.(29)
Many studies have attempted to examine stressors among diverse student populations
including medical, dental and nursing.(18,20,21,22,25-29) However, studies investigating stress
among Physiotherapy undergraduate students need further exploration.
Need for selection of the topic :
Various studies have been done on medical students regarding their stress. A study of
stress in medical students at Seth G.S.Medical College in 1998 showed that stress in
medical students is common and is process oriented. It is more in second and third year.
Academic factors are greater perceived cause of stress in medical students at Seth G.S
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Medical College. Emotional factors are found to be significantly more in first MBBS.
(30)
A study conducted in Egypt and Saudi Arabia showed that stress, anxiety and
depression are frequent in medical students. The authors of the study suggested that
counseling should be an integral part of the routine clinical facilities caring for students.
(31)
A study conducted among under graduate medical students of NEPAL on the
Psychological morbidity warrants need for interventions like social and psychological
support to improve the quality of life for these medical students.
(25)
A relevant dearth of literature regarding perceived sources of stress, and coping
strategies among Physiotherapy students has being seen. This study is to find out the
stressors in Physiotherapy students and develop systems to reduce stress in future. If
stress can be reduced or controlled, the morbidity could be reduced, thereby, more
functional capacity of students could be restored leading to healthy life.
1.14 SCOPE OF STUDY
According to Compact Oxford Dictionary Indian Edition.(Pg.803) Scope is defined as
the extent of the subject matter that something deals with or to which it is relevant or the
opportunity of possibility for doing something.(32) The most cost effective and therefore
the most commonly used measures are self-report questionnaires, many of which have
been designed to measure stressful states.
Thus, purpose of present study was to find stress, stress inducing agents (stressors)
and stress reducing agents among physiotherapy students. Studying stress, stressors and
ways of reducing or controlling stress on physiotherapy students will enable researcher to
find out suitable ways to reduce stress in physiotherapy students.
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