STRESS IS A PERSON’S PHYSICAL AND EMOTIONAL RESPONSE TO CHANGE.

1. STRESS IS A PERSON’S PHYSICAL AND EMOTIONAL RESPONSE TO CHANGE.

2. CLASSIFICATION OF STRESS • POSITIVE STRESS • NEGATIVE STRESS • ACUTE STRESS • CHRONIC STRESS

3. WHAT CAUSES STRESS ? • LIFE EVENTS SUCH AS DIVORCE OR SEPARATION, DEATH OF A LOVED ONE, THE BIRTH OF A CHILD, MOVING, A MAJOR FINANCIAL SETBACK, EMPLOYMENT CHANGES OR BECOMING THE VICTIM OF A CRIME OR NATURAL DISASTER • DAILY EVENTS SUCH AS TRAFFIC CONGESTION, LONG COMMUTES, WORKING OVERTIME, DEADLINES, PERSONAL CONFLICTS, CAR TROUBLE, JOB STRESS, AND JUGGLING HOUSEHOLD CHORES AND CHILDCARE • ENVIRONMENTAL STRESSORS SUCH AS POLLUTION, WEATHER EXTREMES OR EXCESSIVE NOISE • PHYSICAL STRESSORS SUCH AS PHYSICAL INJURY, CHRONIC PAIN, TIRING PHYSICAL ACTIVITY (SUCH AS TRAVELING), AND UNSATISFIED PHYSICAL NEEDS SUCH AS HUNGER, THIRST OR LACK OF SLEEP Continued….

4. 1. DEATH OF A SPOUSE 2. DIVORCE 3. MARITAL SEPARATION 4. IMPRISONMENT 5. DEATH OF A CLOSE RELATIVE 6. PERSONAL INJURY OR ILLNESS 7. MARRIAGE 8. FIRED FROM A JOB 9. MARITAL RECONCILIATION 10. RETIREMENT 11. ILLNESS OF A RELATIVE 12. PREGNANCY 13. SEXUAL PROBLEMS 14. BIRTH OR ADOPTION 15. BUSINESS READJUSTMENT Continued…

5. 16. Change in financial status 17. Death of a close friend 18. Change to different work 19. Increased arguments with spouse 20. Mortgage or loan for major purchase 21. Foreclosure on mortgage or loan 22. Change in job responsibilities 23. Child leaving home 24. Problems with in-laws 25. Outstanding personal achievement 26. Spouse begins or stops work 27. Begin or end school 28. Change in living conditions 29. Changing personal habits 30. Problems with your boss Continued…

6. 31. CHANGE IN WORK 32. HOURS/CONDITIONS 33. CHANGE IN RESIDENCE OR SCHOOL RECREATION 34. CHURCH OR SOCIAL ACTIVITIES 35. MORTGAGE OR LOAN 36. CHANGE IN SLEEPING HABITS 37. CHANGE IN FAMILY GATHERINGS 38. CHANGE IN EATING HABITS 39. VACATION 40. ANY FESTIVALS 41. MINOR LAW VIOLATION

7. PREDISPOSING FACTORS FOR STRESS • GENETIC FACTORS • INABILITY TO ADAPT • INADEQUATE RELAXATION RESPONSE • RESPONSE ACTIVITY VARIATIONS • AGE • PERSONALITY • ISOLATION • Environment

8. SYMPTOMS OF STRESS • Behavioral symptoms • Physical symptoms

9. BEHAVIORAL SYMPTOMS • TOO MUCH SLEEP (HYPERSOMNIA) OR TOO LITTLE SLEEP (INSOMNIA) • NIGHTMARES • NERVOUS HABITS LIKE NAIL-BITING OR FOOT-TAPPING • DECREASED SEX DRIVE • TEETH GRINDING • IRRITABILITY OR IMPATIENCE • CRYING OVER MINOR INCIDENTS • DREADING GOING TO WORK OR OTHER ACTIVITIES

10. PHYSICAL SYMPTOMS • MIGRAINE OR TENSION HEADACHES • DIGESTIVE PROBLEMS LIKE HEARTBURN OR DIARRHEA • SHALLOW BREATHING OR SIGHING • COLD OR SWEATY PALMS • JAW PAIN, NECK PAIN,SHOULDER PAIN

11. EARLY WARNING SIGNS OF STRESS 1.    Excessive fatigue 2.    Gastric disturbance 3.    Withdraw from social life 4.    Menstrual problems 5.    Speech difficulties 6.    More impatient 7.    Headaches 8.    Infertility 9.    Ulcers 10. Nail biting 11. Grinding teeth 12. Low blood sugar 13. High blood sugar

12. EARLY WARNING SIGNS OF STRESS-2 14.Need more sleep 15. Tired but can't sleep 16. Sudden weight loss      17. Sudden weight gain      18. Low blood pressure      19. High blood pressure      20 .Lack of coordination      21. Repeated influenza      22. Repeated colds      23. Muscle aches      24. Hair loss 25. Chest pain

13. EARLY WARNING SIGNS OF STRESS-3 1.  Forgetfulness 2.     Nervous talking 3.     Lower back pain 4.     Loss of appetite 5.     Increased appetite 6.     High cholesterol 7. High triglycerides

14. Increased heart rate Pounding heart Elevated blood pressure Sweaty palms Tightness of the chest, neck, jaw, and back muscles Headache Diarrhea Constipation Urinary hesitancy Trembling Being easily startled Chronic pain and Dysponea Twitching Stuttering and other speech difficulties Nausea Vomiting Sleep disturbances Fatigue Shallow breathing Dryness of the mouth or throat Susceptibility to minor illness Cold hands Itching Physical signs and symptoms of stress

15. Irritability Angry outbursts Hostility Depression Jealously Restlessness Withdrawal Decreased perception of positive Experience opportunities Narrowed focus Obsessive rumination Reduced self-esteem emotional response reflexes Weakened positive emotional response reflexes Anxiousness Diminished initiative Feelings of unreality or over-alertness Reduction of personal involvement with others Lack of interest Tendency to cry Being critical of others Self-deprecation Nightmares Impatience Reduced self-esteem Insomnia Changes in eating habits Emotional signs and symptoms of stress

16. Forgetfulness Preoccupation Blocking Blurred vision Errors in judging distance Diminished or exaggerated fantasy life Reduced creativity Lack of concentration Diminished productivity Lack of attention to detail Orientation to the past Decreased psychomotor reactivity and coordination Attention deficit Disorganization of thought Negative self-esteem Diminished sense of meaning in life Lack of control/need for too much control Negative self-statements and negative evaluation of experience Cognitive/Perceptual Signs and Symptoms of Stress

17. Increased smoking Aggressive behaviors (such as driving - road rage, etc.) Increased alcohol or drug use Carelessness Under-eating Over-eating Nervous laughter Compulsive behavior Impatience Withdrawal Listlessness Hostility Accident-proneness Behavioral Signs and Symptoms of Stress

18. Stress Arousal Stage Persistent irritability and anxiety Bruxism and/or Insomnia Occasional forgetfulness and/or inability to concentrate Stress Resistance Stage Absenteeism or tardiness for work Tired and fatigued for no reason Procrastination and indecision Social withdrawal with cynicism Resentful, indifferent, defiant Increased use of coffee, alcohol, tobacco, etc. Signs of Stress in The Workplace

19. Jobs and stress • The TUC identifies four main causes: • Environmental (noise, overcrowding, open plan offices, for child care facilities, for instance): • Contractual (low pay, shift work, excessive overtime, job insecurity); • Job designed (boring work, too much/little work, lack of job control): • Relationships (poor relations with colleagues, lack of communication, impersonal treatment). • Loss of self-esteem and a lack of control are two very common themes.

20. Demands of the task  • Excessive workloads are associated with increased rates of accidents and health problems (Mackay & Cox, 1978). The workload for mothers is particularly heavy because not only do they work outside of the home but also do most of the chores at home (Frankenhaeuser, 1991). Repetitive jobs that under utilise the workers abilities can produce stress. The evaluation of an employee's job or performance is also particularly stressful for both the supervisor and the employee (Quick and Quick, 1984).

21. Responsibility for people's lives People working in the health professions need to take many life and death decisions instantly and experience appalling things, this leads to feelings of emotional exhaustion (Maslach & Jackson, 1982). The same applies to the police and fire fighters.

22. Stress can result from other aspects of jobs: • The physical environment of the job. Extreme levels of noise, temperature, humidity, or illumination cause stress (Mackay & Cox, 1978). • Perceived insufficient control. People experience stress when they have little influence over work procedures or the pace of the work (Cottington &House, 1987).

23. Stress can result from other aspects of jobs: 3 Poor interpersonal relationships. Stress increases when an employee's boss or colleague is socially abrasive, being insensitive to the needs of others or condescending and overly critical of the work other individuals do (Quick and Quick, 1984). 4 Perceived inadequate recognition or advancement. Workers feel stress when they do not get the recognition or promotions they believe they deserve (Cottington et al, 1986).

24. Stress can result from other aspects of jobs: 5 Job loss. The sense of job insecurity is stressful, particularly if the employee has little prospect of finding another job (Cottington et al, 1986). Unemployment is associated with stress, such as in people's loss of self-esteem and heightened blood pressure (Olafsson & Svensson, 1986).

25. Retirement • Retirement can be stressful because retired people have lost opportunities for social interaction and an important part of their identity. They may miss the power and influence they once hand, the structure and routines of a job, and the feeling of being useful and competent (Bohm & Rodin, 1985). In addition retired people often live on low incomes, which again produces stress.

26. Life transitions • Life transitions tend to be stressful (Moos and Schaefer, 1986). Changing from one phase to another in life is called a transition; examples include: • Starting school • Moving home • Reaching puberty • Starting college, especially away from home • Starting a career • Getting married

27. Langer and Rodin (1976) • A study carried out by Langer and Rodin (1976) attempted to discover the effects of giving people a greater sense of personal control. They compared two different wards in a nursing home for elderly people in Connecticut, USA. The residents in the two wards were of similar age, health and socioeconomic status, and they had been resident in the home for the same period of time on average (residents who were too uncommunicative or bedridden to take part were excluded from the study).

28. Langer and Rodin (1976) • Both groups of residents were given a talk, but the issue of personal responsibility was strongly stressed with one of them and not the other. Furthermore, residents in this first group were offered a plant each for their rooms and were asked where they wanted it placed. Additionally, they were allowed to choose which night to go and watch a film. Residents in the other group were simply given the plant and told which night to go and see the film.

29. Langer and Rodin (1976) • Even this fairly minimal manipulation of personal control seemed to have a dramatic effect. Residents who were given a greater sense of personal control were happier, more active, more alert and, when the researchers returned after eighteen months, were in better health and fewer had died. This study implies that having a greater sense of personal control actually helps to reduce stress.

30. Commentary • • There are methodological and ethical criticisms that can be made of Langer and Rodin’s study. The sam­ple was very limited (elderly Americans living in a particular care home). On the other hand, Langer and Rodin took care to avoid demand characteristics by not informing the residents, nurses or research assis­tants (who collected the data) of the purpose of the study. Controlled experiments on the damaging effects of stress in human beings can be very unethical.

31. Commentary • In this case, Langer and Rodin would argue that they did not harm anyone’s health, but actually improved it for those residents who were given a greater sense of control. On the other hand, when the experiment was over, we do not know whether the situation reverted to what it had been before, and it may be that being given a sense of control for three weeks, then having it removed again, did more harm than good in the long term.

32. Commentary • There are clear implications of this study for the way people are treated in residential homes. There is also a lesson to be learnt when developing therapy to help people suffering from extreme stress. If it is true that a low sense of personal control (that is, having a very external locus of control) can lead to stress, then in cases where this applies it may be beneficial for ther­apy to focus on shifting people’s locus of control from external to internal.

33. Sources within the person • Approach/approach conflict • This is the conflict produced when the choice is between two good strategies. For example needing to follow a diet and wanting to eat a fattening cake. These conflicts are easily resolved but the more important the decision seems to be, the more difficult it is for the person to solve the conflict.

34. Sources within the person • Avoidance/Avoidance conflict • This is the conflict produced when the choice is between two bad strategies. For example, the choice between two equally harrowing treatments for an illness. Patients often delay making a choice and might easily change their minds repeatedly. Patients might even change their doctor in the hope that they will be given an easier choice. They might even get somebody else to make the decision for them. This conflict is difficult to resolve and very stressful.

35. Sources within the person • Approach/Avoidance conflict • This is when a single goal has good points and bad points. For example giving up smoking might mean a gain in weight.

36. Sources in the family • Interpersonal conflict can arise from financial problems, from inconsiderate behaviour, and from opposing goals. Overcrowded conditions increases conflict over privacy and the use of family resources, such as the Bathroom. Major sources of stress in the family are the addition of a new family member, illness, infirmity, and death in the family.

37. An addition to the family • Obviously the mother will experience much stress during pregnancy and after the birth. But the father may also worry over money, or his wife's and baby's health, or fear that his relationship with his wife may deteriorate. • Parents may experience stress from their relationship with the baby. Each baby comes into the world with certain personality dispositions, which are called temperaments (Buss & Plomin, 1975). There are easy babies and difficult ones. Babies react differently to feeding, cuddling, bathing, and dressing.

38. An addition to the family • Difficult babies tend to cry a great deal. They resist new foods, routines, and people, and their patterns of Sleep, hunger, and bowel movements are hard to predict. About 10% of babies are classified as difficult displaying most of these traits fairly consistently, many others show some of these traits occasionally. Longitudinal studies have shown that children's temperaments are stable across time. Many traits continue for many years, although many difficult children show changes toward the development of easy traits (Carey & McDevitt, 1978).

39. An addition to the family • The arrival of a new baby can also be stressful to other children in the family (Honig, 1987). Much stress can be experienced in children aged two or three years old who do not want to share their parents with the new brother or sister. These children often show increased clinging to the mother and their sleeping and toileting problems also increase. Older children experience stress from the changes in the pattern of family interaction, such as when the parents introduce new rules.

40. Family illness, disability, and death • A working mother with a sick child will experience much stress. When children have a serious chronic illness, their families have to cope with stress over a long period. The amount of time needed to care for the child conflicts with other activities. The family also needs to make difficult decisions. They need to learn about the illness and how to care for their child. There is much expense and other children begin to feel left out.

41. Family illness, disability, and death • Adult sickness can also produce much stress in the family. If a principal breadwinner is ill there will be a strain on the family's financial resources. The family's time and personal freedom are curtailed producing changes in interpersonal relationships. • If an elderly person who is ill or disabled must live with and be careful by relatives, the stress for those in the household can be severe, especially if the person requires constant care and shows mental deterioration (Robinson & Thurner, 1986).

42. Family illness, disability, and death • If a parent dies children under about five years of age seem to grieve for the lost parent less strongly and for a shorter time than older children and adolescents do (Garmezy, 1983). Children's concept of death changes between four and eight years of age (Lonetto, 1980). Young children think death is reversible: the person will come back eventually.

43. Family illness, disability, and death • An adult whose child or spouse dies suffers a tremendous loss. Bereaved mothers reported that they had lost important hopes and expectations for the future (Edelstein, 1984). A mother who loses her only child loses her identity and role as a mother too. The loss of a spouse is especially stressful in early adult (Ball, 1976-77).

44. Child abuse • The stress caused by long-lasting psychological effects of sexual abuse in childhood has been found to increase the likelihood of certain diseases in old age. Women who were assaulted in their teens appeared to run greater risk of developing arthritis and breast cancer in later life, while Male victims are more likely to develop diseases of the thyroid than men who were not abused as children. 1,300 elderly middle-class participants were studied 12% of the women and 5% of the men reported unwanted sexual contact for childhood.

45. Child abuse • Breast cancer and arthritis were relatively common amongst participants who had suffered sexual abuse; the more sustained the abuse the higher the risk of developing the diseases. However those abused were less likely to suffer from hypertension, but this was probably due to survivor bias, in other words, people with hypertension tend to die younger, so do not feature in studies of elderly people. Stein and Barrett-Connor (2000).

46. Environmental stress • Crowded conditions can be stressful for three reasons: • Lack of control over interpersonal interaction, as when other people can overhear your conversation. • The restricted ability to move about freely or reduced access to resources, such as seats. • Intrusion into personal space (Sarafino, 1987).

47. Environmental stress • People exposed to hazardous substances in their environment worry for years about what will happen to them (Baum, 1988).  • People who lived near the three mile Island power plant in Pennsylvania, where a nuclear accident had happened suffered more stress more than a year after the accident than other residents near a similar facility (Fleming et al., 1982). 

48. Stressors and stress response • Stressors - produce stressSource of stressors can be Family (as when trying to cope with a newborn baby or when looking after a sick relative), Work or the Environment. • Stress response - response to stresssor

49. Stressors and stress response • Stressors - external - e.g. heat, crowding, noise, difficulties with a loved one or contact with a hated one. • internal - e.g. pain, thoughts, feelings. • But not straightforward - heat can be relaxing and crowds can be exciting.Individual differences.

50. Other factors • Other factors • Event • negative - Divorce (-ve), Marriage (+ve) • Controllable or predictable • ambiguous - not sure what is happening. e.g. stuck on underground train without being informed.