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Contemporary Psychiatric-Mental
Health Nursing
Third Edition
CHAPTER
8
Stress, Anxiety,
and Coping
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
Figure 8-1 A family is shocked at the devastation caused by the powerful March 11, 2011 earthquake in their
hometown in Fukushima Prefecture, Japan. The stressed and anxious family has an additional worry—the state of
emergency at the nearby Fukushima nuclear power plant damaged by the earthquake and its strong aftershocks.
Photo courtesy of Photoshot Holdings.
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
Figure 8-2 Factors involved in stress. Several important factors are involved in understanding stress. They
include personality factors (such as how we handle anger), cognitive factors (such as whether we perceive an
event as a challenge or threat), physical factors (such as how the body responds to stress), environmental
factors (such as fog, fire, or snow), cultural factors (such as our learned beliefs about religion, health, and
family), and coping strategies (such as what we do to manage stress).
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
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Figure 8-3 Selye’s general adaptation syndrome. The diagram at the top shows some of the physical reactions
to stress in each stage. The diagram at the bottom shows the relationships of the stages to the individual’s ability
to resist a stressor. In the alarm stage, resistance drops at first as the sympathetic nervous system quickly
activates. But resistance then rapidly increases as the body mobilizes its defense systems. In the resistance
stage, the body is working at a much increased level of resistance, using resources until the stress ends or the
resources run out. In the exhaustion stage, the body is no longer able to resist because resources have been
depleted. At this point, disease and even death are possible. The third stage of exhaustion may be reversible if
the total body is not affected and if the person can eventually eliminate the source of stress. Adapted from
Ciccarelli, S. K., & White, J. N. (2009). Psychology (2nd ed.) Upper Saddle River, NJ: Prentice Hall, p. 445.
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
Box 8-1
General Causes of Anxiety
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
Figure 8-4 The effect of anxiety on the perceptual field. Notice that the perceptual field is increased in mild
anxiety, becomes increasingly constricted as anxiety increases, and is completely disrupted at the panic level.
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
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8/22/2016
Figure 8-5 Involuntary control of bodily functions. The autonomic nervous system has two divisions, the
sympathetic and the parasympathetic, which exercise automatic control over the body’s organs, generally in
opposing ways. The parasympathetic generally has inhibitory or relaxing effects, while the sympathetic has
stimulatory effects. Axons of the parasympathetic division emerge not only from the spinal cord, but from the
brain as well. Krogh, D. (2000). Biology: A guide to the natural world. Upper Saddle River, NJ: Prentice Hall, p.
515.
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
Table 8-1
Common Defense Mechanisms
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
Table 8-1 (continued)
Common Defense Mechanisms
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
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Table 8-2
Examples of Physical Conditions Having Psychological Components
Contemporary Psychiatric-Mental Health Nursing, Third Edition
Carol Ren Kneisl • Eileen Trigoboff
4