Stress

Stress (Psychological stress) • In medical terms: Stress is the disruption of homeostasis through physical or psychological stimuli. • Selye Definition: Body’s physiological response to psychological and physical demands (stressors) Stressors • A Stressor is a stimulus or event that provokes a stress response in an organism. • Stressors can be categorized as:  Acute X  External X  UnpleasantX Chronic Internal Pleasant (Distress) (Eustress)  Physical X Emotional (Psychological; Mental) Common stressors Both negative and positive stressors can lead to stress: • Sensory: pain, bright light • Life events: birth and deaths, marriage, and divorce • Responsibilities: lack of money, unemployment • Work/study: exams, project deadlines • Personal relationships: conflict, deception • Lifestyle: heavy drinking, insufficient sleep • Early life exposure (e.g. child abuse) • Lack of control over environmental circumstances, such as food, housing, health, freedom, or mobility. Psychological Distress Results from three types of experience: 1. Pressure 2. Conflict 3. Frustration Special Stressful Events • Serious Physical Illness • Terminal Illness • Bereavement Components of the Stress Response 1. Emotional (Fear, Anxiety and Depression) accompanied by somatic changes 2.    Psychological to reduce the potential impact of the experience: Impaired recall and numbness Coping strategies Defense Mechanisms Coping Strategies 1. Adaptive: Avoidance Working through problems Coming to terms with situations 2. Maladaptive: Substance abuse Histrionic or aggressive behavior Deliberate self-harm 3. Culturally determined Individual’s Response to Stressors Determined according to: 1. 2. 3. Physiological reactivity Cognitive appraisal Control   Type A behavior Hostility  Antagonism with others STRESS SYMPTOMS        Unusual heart beat (fast, pounding, irregular, etc.) Unusual breathing (fast, shallow) Restless feeling (feels like you have to move) Muscles feel tight or tens Frequent aches and pains Headaches Often get the flu or cold STRESS SYMPTOMS Feels warm or hot when it isn't hot  Sweat more than normal  Dry mouth  Nervous stomach (gas, diarrhea, constipation)  Heartburn, Nausea,  Loss/or increase in appetite  Urinate more than normal  Fatigue  STRESS SYMPTOMS           Obsessive worrying Lack of concentration Memory loss Feeling self-consciousness, Shy, Lonely, Uncomfort, Irritability, seriousness Dissatisfaction, Fear, Anxiety, Anger, Panic Depressed mood, Unhappiness, Crying Insomnia Sexual problems General adaptation syndrome (GAS) A term used by Selye to describe the body's short-term and long-term reactions to stress. GAS involved two major systems of the body: the nervous system the endocrine (or hormonal) system. Three distinctive stages: Alarm reaction Resistance Exhaustion Stage 1: Alarm reaction is the immediate reaction to a stressor. "fight or flight" response, which prepares the body for physical activity. This initial response can also decrease the effectiveness of the immune system, making persons more susceptible to illness during this phase. Stage 2: Resistance (stage of adaptation) During this phase, if the stress continues, the body adapts to the stressors. Changes at many levels take place in order to reduce the effect of the stressor. Example, if the stressor is starvation, the person might experience a reduced desire for physical activity to conserve energy, and the absorption of nutrients from food might be maximized. Stage 3: Exhaustion When stress continued for some time the body's resistance to the stress may gradually be reduced. • The immune system, and the body's ability to resist disease, may be almost totally eliminated. • Patients may develop heart attacks or severe infection due to their reduced immunity. Example, a person with a stressful job may experience long-term stress that might lead to high blood pressure and an eventual heart attack. Neurochemistry and Physiology of GAS Stress activates the sympathetic division of the ANS and release of epinephrine, and cortisol. Sympathetic output produces the fight-or-flight response, causing the body to divert blood flow to large muscles. Less blood flows to the digestive system and other organs, producing dry mouth, motor agitation, sweating, pallor, enlarged pupils and, insomnia. Neurochemistry and Physiology of GAS • Stressors can cause continual sympathetic activation with very little opportunity for the parasympathetic to activate. • parasympathetic activation allows the bowel and other nonmuscle organs receive good blood-flow, the pupils constrict, and the glands all function well and secrete their various compounds. • Absence parasympathetic activation leads to poor digestion and may lead to poor healing and organ function. Neurochemistry and Physiology of GAS The body reacts to stress first by releasing: catecholamine hormones (epinephrine and norepinephrine)  glucocorticoid hormones (cortisol). The hypothalamic-pituitary-adrenal axis (HPA) balances hormone releases from the adrenal medulla, and from the adrenal cortex. Psychoneuroimmunology (PNI) PNI investigates the relations between the psychophysiological and immunophysiological dimensions of Man. PNI also involves endocrinology and is sometimes referred as: psycho endoneuro immunology (PENI). Stress can significantly affect many of the body's immune systems. Stress is thought to affect immune function through emotional and/or behavioral manifestations (such as anxiety, fear, tension, anger and sadness) and physiological changes (heart rate, blood pressure. Sweating). Psychoneuroimmunology (PNI) • Stressful events trigger cognitive and affective responses which, in turn, induce sympathetic nervous system and endocrine changes, and these ultimately impair immune function. • Health consequences include rates of infection, HIV progression, and cancer incidence and progression • These changes are beneficial if they are of limited duration, but when stress is chronic, the system is unable to maintain equilibrium or homeostasis Psychoneuroimmunology (PNI) Stressful events (Acute, Short-term and Long-term) in healthy adults revealed consistent stress-related immune changes:  Increases in numbers of total white blood cells  Decreases in the numbers of helper T cells, suppressor T cells, and cytotoxic T cells, B cells, and Natural killer cells (NK)  Antidepressants seem to exert beneficial effects by decreasing Interferon-beta (IFN-beta) release or augmenting NK activity in depressed patients. Determinants of GAS         overall health and nutritional status, sex, age, ethnic or racial background, level of education, socioeconomic status (SES), genetic make up, others…. Pathological Impact of Stress 1. Psychiatric disorders: 2. Stress disorders: Acute Stress disorder Post traumatic stress disorder Adjustment disorder 3. Physical disorder (Psychosomatic disorders) Stress reduction strategies Generally fall into one of three categories: • avoiding stressors • changing one's reaction to the stressor • relieving stress after the reaction to the stressor Many mainstream as well as complementary or alternative strategies for stress reduction: • exercising • listening to music, • massage Selye Approach to Stress (living wisely in accordance with natural laws) Adopting an attitude of gratitude toward life. Acting toward others from altruistic motives. Retaining a capacity for wonder and delight in the genuinely good and beautiful things in life. Finding a purpose for one's life and expressing one's individuality in fulfilling that purpose. Keeping a healthy sense of modesty about one's goals or achievements.