Stress, Anxiety and Coping Chapter 8

1. Stress, Anxiety and CopingChapter 8 West Coast University NURS 204

2. Stress • A broad class of experiences in which a demanding situation taxes a person’s resources, or coping capabilities, causing a negative effect

3. 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).

4. Conflict Sources • Unconscious needs • Everyday and family life • Social Issues • Ethical Issues

5. Types of Conflict • Approach-Avoidance • Avoidance-Avoidance • Vacillation

6. Biopsychosocial Theories • Fight or Flight • Maladaptive • Physiologic stress

7. Life Change Theory of Stress • Life change units (LCU) • Holmes and Rahe Scale • Assumptions/cautions when applying the theory to mental health

8. Assumptions/ Cautions • Same response to stress • Common threshold for stress effect • Same event = same stress • Same amount of adaptation required • Stress = change • Some life events irrelevant to some people

9. Stress as a Transaction • Primary appraisal • Secondary appraisal • Coping • Reappraisal

10. Psychoneuroimmunology Framework • Self-healing personalities • Hardiness and health • Disease-prone personalities

12. Anxiety • Neurobiological basis • Measurable • Assessment • Emotional/behavioral • Physiological • Cognitive

13. Anxiety - continued • Levels of Anxiety • Mild • Moderate • Severe • Panic

14. Coping • Task-oriented • Problem solving • Defense-oriented • Protective

15. Coping Strategies • Seeking comfort • Relying on self-discipline • Intense expression of feeling • Avoidance and withdrawal • Talking it out • Privately thinking it through • Working it off

16. Coping Strategies - continued • Engaging in self-healing and mind/body practices • Spirituality and prayer • Symbolic substitutes • Somatizing

17. Coping Resources • Sense of Coherence -Comprehensible -Manageable -Meaningful • Generalized Resistance Resources (GRR)

18. Coping Resources - continue • Generalized Resistance Resources (GRR) • Physical and biochemical • Artifactual and material • Cognitive • Emotional • Valuative and attitudinal • Interpersonal-relational • macrosociocultural

19. Defensive Mechanisms • Repression-Unconsciously keeping unacceptable feelings out of awareness • A man jealous of a good friend’s success but is unaware of his feelings • Suppression-Consciously keeping unacceptable feelings and thought out of awareness • A student taking an examination is upset about an argument with her boyfriend but puts it out of her mind so she can finish the exam • Interventions – support, protect, and help client develop objectivity

20. Defense Mechanisms • Dissociation-Handling emotional conflicts, or internal or external stressors, by a temporary alteration of consciousness or identity. • A woman has amnesia for the events surrounding a fatal auto accident in which she was the speeding driver • Intervention – help client recall and resolve past conflicts • Projection-Attributing one’s own unacceptable feelings and thoughts to others • A man who is quite critical of others thinks that people are joking about his appearance • Intervention – respect, separate feelings from facts

21. Defense Mechanisms • Identification - Unconscious assumption of similarity between between oneself and another • After hospitalization for minor surgery, a woman decides to be a nurse • Introjection - Acceptance of another’s value and opinions as one’s own • A woman who prefers a simple lifestyle assumes the materialistic, prestige-oriented values of her husband • Identification/introjection – clarify roles, assist with client self-care plan and self-awareness

22. Defensive Mechanisms • Denial – Blocking out painful or anxiety-inducing events or feelings • A manager tells an employee he may be laid off. On the way home, the employee shops for a new car. Discern protective function, then either support denial or focus on reality • Fantasy – Symbolic satisfaction of wishes through nonrational thought • A student struggling through graduate school thinks about a prestigious, high-paying job. Focus on realistic plans and expectations

23. Defense Mechanisms • Rationalization – Falsification of experience through the construction of logical or socially approved explanations of behavior. • A man cheats on his income tax return and tells himself Focus on strengths and past success • Reaction formation – Unacceptable feelings disguised by repression of the real feeling and by reinforcement of the opposite feeling. • A woman who dislikes her mother-in-law is always very nice to her. respect and support, provide security Respect and support, provide security

24. Defense Mechanisms • Displacement – Discharging pent-up feelings on people less dangerous that those who initially aroused the emotion • A student who has received a low grade on a term paper blows up at his girlfriend when she asks about his grade. Focus on reason for anger • Intellectualization – Separating an emotion from an idea or thought because the emotional reaction is too painful to be acknowledge. • A man learns that he has cancer. He studies the physiology and treatment of cancer without experiencing any emotion. Explore emotional reactions

25. The multicausational concept of the illness process. The phrase “Meaning and Symbol” refers to the fact that clients interpret all experiences in a highly individual manner according to their specific meaning and the broader meaning in the client’s culture.

26. Conditions with Psychological Components • Cardiovascular • Gastrointestinal • Hormonal • Immune • Integumentary • Neuromuscular and Skeletal • Respiratory

27. The Challenge • As nurses work with individuals to increase their awareness of stress and improve health-promoting behaviors, they will find that these tasks are not always easy, nor do they always result in change.