Emotional Stress

Emotional Stress and its consequences

Photographs of Hans Selye at work in 1951, at his International Institute of Experimental Medicine and Surgery at the University of Montreal

Resistance Arousal high as body tries to defend and adapt. Exhaustion Limited physical resources; resistance to disease collapses; Disease/death Alarm Reaction Fight or flight Three Views of Stress • Focus on the environment: stress as a stimulus (stressors) (The SRRS) • Reaction to stress: stress as a response (distress) (F/F) • Relationship between person and the environment: stress as an interaction (coping) • Fight or Flight Response and its physiological consequences: Increase in Epinephrine & Cortisol, Heart rate & blood pressure, Levels & mobilization of free fatty acids, cholesterol etc • Selye’s General Adaptation Syndrome (1956, 1976, 1985) Perceived Stressor

Cognitive Model of Stress (Lazarus & Folkma) • Potential stressor (external event) • Primary appraisal – is this event positive, neutral or negative; and if negative, how bad? • Secondary appraisal – do I have resources or skills to handle event? If No, then distress. • Primary appraisal – Is there a potential threat? • Outcome – Is it irrelevant, good, or stressful? • If stressful, evaluate further: • Harm-loss – amount of damage already caused. • Threat – expectation for future harm. • Challenge – opportunity to achieve growth, etc

Stress Causes The following are risk factors for uncontrollable stress: • Social and financial problems • Medical illness • Lack of social support • Family history

Affecting the inner emotions Stress usually first affects the inner emotions. Initial symptoms may include the following feelings: • Anxiousness • Nervousness • Distraction • Excessive worry • Internal pressure

Affecting a person's outward appearance These emotional states can then begin to affect a person's outward appearance: • Unusually anxious or nervous • Distracted • Self-absorbed • Irritable

Emotional or physical effects • Excessive fatigue • Depression • Sometimes even think of hurting yourself or others • Headaches • Nausea and vomiting • Diarrhea • Chest pain or pressure • Heart racing • Dizziness or flushing • Tremulousness or restlessness • Hyperventilation or choking sensation • In most cases, these symptoms are very minor and don’t last very long. If they become more severe or increase in frequency and severity, seek medical help.

Relationship Between Stress and Performance

Exams and Tests • Many times, a careful interview can be the best source of information about the cause of patient’s symptoms. It is extremely important to describe any situations that you think might be causing patient’s problems or making them worse. • The doctor then performs a physical exam that is focused on the symptoms you have described. • Lab tests or other diagnostic tests such as an ECG (a heart tracing) may be needed to completely rule out an underlying physical cause for these symptoms. • If these tests and doctor’s exam findings are normal, the doctor may consult other specialists for further evaluation and treatment of patient’s condition.

Secondary appraisal • Situational Factors Affecting Stress Appraisals • Strong demands • Life transition,Timing • Ambiguity – role or harm ambiguity • Desirability, Controllability, Cognitive control – using a mental strategy • Learned Helplessness – Seligman, Peterson, et al. • Sources of Occupational Stress: • Role Overload • Role Ambiguity • Role Conflict • Little Control over Work • Sexual, Gender or Ethnic Harassment • Helping Professions

Intensity of stress • Everyone is familiar with stress. We experience it in varying forms and degrees every day. In small doses, stress can actually be beneficial to us. It is only when the stress becomes too great, affecting our physical or mental functioning, that it becomes a problem. • In small doses, stressors can help give us increased energy and alertness, even helping to keep us focused on the problem at hand. This type of stress is good. People may refer to the experience of this type of stress as feeling "pumped" or "wired."

Individual reaction to stress • As the level of pressure gets too great, stress eventually surpasses our ability to cope with it in a positive way. Often, people describe themselves as being stressed out, burned out, or at wits end. At this point, it is important to find positive and productive ways to deal with the stress and, more importantly, to address the person or situation that is causing the stress. • Everyone reacts to stress differently. Each of us has a different level of pressure and anxiety that we can handle without a bad outcome. Only you can assess your level of tolerance to stressful situations. The best treatment for stress is to prevent getting into situations that are likely to overwhelm your ability to cope. This is not always possible because the stressors may often come from outside sources that are beyond your control.

Biopsychosocial Aspect of Stress How stress affects health • Via behaviour • Increased alcohol • Smoking • Increased caffeine • Poor diet • Inattention leading to carelessness • Psychological Effects: Irritability, Insomnia, Changes in appetite or sleep, Anger, Depression, PTSD, Anxiety, Burnout • Via physiology • Cardiovascular reactivity – e.g., increased blood pressure, • Endocrine reactivity – increased catecholamine and corticosteroids • Digestive system – e.g., ulcers, irritable bowel syndrome • Respiratory system – e.g., asthma • Immune reactivity – increased hormones impairs immune function

When to Seek Medical Care Recommendations for patients: • If, in conjunction with your friends, family, or spiritual advisers, you cannot identify a source or solution for your anxiety and stress. • A physical problem may be causing your symptoms. There may be a hidden cause that requires the assistance of a counselor to help uncover. • You should never be embarrassed about your situation or the fact that you are seeking help. • Remember, the sooner you get help, the sooner you will feel better.

Urgent help required Patient should call 911 or go to the nearest hospital’s emergency department if your stress is resulting in any of these symptoms: • Thoughts about harming yourself • Thoughts about harming others • Chest pain • Fluttering or rapid heartbeats • Headaches unlike usual headaches • Any condition that he feels might cause his serious harm if not treated immediately

MODERATOR and MODIFIER of STRESS: • 1) COPING: Process of managing the discrepancy between the demands of the situation and the available resources. Ongoing process of appraisal and reappraisal (not static) Can alter the stress problem OR regulate the emotional response. • 2) PERSONALITY: Personality factors that influence how one responds to stress. • 3) Social Support

Personality factors that influence how one responds to stress • Coping Style • Negative affectivity • Pessimism – optimism • Hardiness • Negative affectivity is a pervasive negative mood marked by anxiety, depression a,d hostility. High negative affectivity is associated with greater distress, more drinking, more likely to be depressed, poorer health, greater reports of physical symptoms, and they are more likely to commit suicide. • Pessimism-optimism – Seligman’s ASQ – pessimists more likely to attribute negative events in their lives to internal (someone wrong with me), stable (never gong to change), and global (effects all aspects of my life) qualities. • Pessimists generally associated with poorer health and premature mortality. • Optimists on the other hand have better health, engage in more effective coping strategies, and are more likely to engage in slef-management health care practices. Scheirer and Carver’s work with optimism-pessimism.

Personality factors that influence how one responds to stress • Hardiness is another psychosocial modifier of stress. Hardy individuals have a strong sense of • Control, internal locus of control, • Commitment, (tendency to get involved fully), and • Challenge; (willingness to undertake change and to confront new activities that represent opportunities for growth). • They tend to remain healthier when under stress than individuals who are less hardy. • The effects of hardiness, social support, and exercise (or Health-RelatedBehavior) , appear to add to each other in protecting people from illness. • Other personal Factors Affecting Stress Appraisal • Intellectual, Motivational, Beliefs system

Personality factors that influence how one responds to stress • The Type A behavior pattern consists of three characteristics: Competitiveachievement orientation, Time Urgency, and Anger or Hostility. associated with increased risk of heart disease which may have more to do with hostility • Type B Personality Relaxed, patient, easygoing, friendly • – Type C Cooperative, unassertive, inexpressive of negative emotions (suppression), compliance: • Risk for developing cancer ? • Growth of tumours

Social Support • Emotional support – expression of empathy, understanding, caring, etc. Esteem support – positive regard, encouragement, validating self-worth. Tangible or instrumental – lending a helpful hand. Information support – providing information, new insights, advice. Network support – feeling of belonging • Note that not all social support is necessarily beneficial to health. In one study it was found that while participating in pleasurable social activities was associated with a lower risk of premature mortality following an acute myocardial infarction, larger sized social networks was associated with a higher mortality risk (CAMIAT study). • Note that social support can also be a source of stress when supporters don’t provide the kind of support we need (e.g., not empathic, keep offering unrealistic suggestions for what the person can achieve). Generally Social Support Associated with Good Effects. Increase survival rates in women who have breast cancer. Lower blood pressure. Decrease risk of mortality.

Prevention • Set realistic goals and limits for yourself. • Put things into perspective and try not to get upset about insignificant or relatively unimportant matters. • Take stress, time management, or anger management classes. • Find activities that you enjoy and set aside time to participate in them on a regular basis. • Participate in regular physical exercise. • Maintain a positive outlook. • Set goals and break them into easily achievable tasks. • Reward yourself for the good things that you do each day.

Why is there more stress today? • Americans perceive they are under much more stress than a decade or two ago. A 1996 Prevention magazine survey found that almost 75% feel they have "great stress" one day a week with one out of three indicating they feel this way more than twice a week. In the same 1983 survey only 55% said they felt under great stress on a weekly basis. It has been estimated that 75 - 90 percent of all visits to primary care physicians are for stress related problems. • Job Stress is far and away the leading source of stress for adults but stress levels have also escalated in children, teenagers, college students and the elderly for other reasons, including: increased crime, violence and other threats to personal safety; pernicious peer pressures that lead to substance abuse and other unhealthy life style habits; social isolation and loneliness; the erosion of family and religious values and ties; the loss of other strong sources of social support that are powerful stress busters.

To view "WORKING WITH STRESS" online (streaming video) or to download a Flash video version click here.http://www.cdc.gov/niosh/docs/video/

Job Stress • Numerous surveys and studies confirm that occupational pressures and fears are far and away the leading source of stress for American adults and that these have steadily increased over the past few decades. While there are tons of statistics to support these allegations, how significant they are depends on such things as how the information was obtained (self-report vs. answers to carefully worded questions), the size and demographics of the targeted group, how participants were selected and who sponsored the study. • Some self-serving polls claiming that a particular occupation is "the most stressful" are conducted by unions or organizations in a attempt to get higher wages or better benefits for their members. Others may be conducted to promote a product, such as the "Stress In the Nineties" survey by the maker of a deodorant that found housewives were under more stress than the CEO's of major corporations. Such a conclusion might be anticipated from telephone calls to residential phones conducted in the afternoon. It is crucial to keep all these caveats in mind when evaluating job stress statistics.

The NIOSH report on the right is an excellent resource that cites the following: • 40% of workers reported their job was very or extremely stressful; • 25% view their jobs as the number one stressor in their lives; • Three fourths of employees believe that workers have more on-the-job stress than a generation ago; • 29% of workers felt quite a bit or extremely stressed at work; • 26 percent of workers said they were "often or very often burned out or stressed by their work"; • Job stress is more strongly associated with health complaints than financial or family problems.

More recently, the 2000 annual "Attitudes In The American Workplace VI" Gallup Poll sponsored by the Marlin Company found that: • 80% of workers feel stress on the job, nearly half say they need help in learning how to manage stress and 42% say their coworkers need such help; • 14% of respondents had felt like striking a coworker in the past year, but didn't; • 25% have felt like screaming or shouting because of job stress, 10% are concerned about an individual at work they fear could become violent; • 9% are aware of an assault or violent act in their workplace and 18% had experienced some sort of threat or verbal intimidation in the past year.

2000 Integra Survey similarly reported that: • 65% of workers said that workplace stress had caused difficulties and more than 10 percent described these as having major effects; • 10% said they work in an atmosphere where physical violence has occurred because of job stress and in this group, 42% report that yelling and other verbal abuse is common; • 29% had yelled at co-workers because of workplace stress, 14% said they work where machinery or equipment has been damaged because of workplace rage and 2% admitted that they had actually personally struck someone; • 19% or almost one in five respondents had quit a previous position because of job stress and nearly one in four have been driven to tears because of workplace stress;

62% routinely find that they end the day with work-related neck pain, 44% reported stressed-out eyes, 38% complained of hurting hands and 34% reported difficulty in sleeping because they were too stressed-out; • 12% had called in sick because of job stress; • Over half said they often spend 12-hour days on work related duties and an equal number frequently skip lunch because of the stress of job demands.

To read the 2001 "Attitudes in the American Workplace VII" report and take a quick "Workplace Stress" quiz created by the Marlin Company and The American Institute of Stress Click Here From a wood engraving "The Light" by Fritz Eichenberg

Violence has become an increasingly serious problem • According to two studies the United States has the dubious distinction of having the highest violent crime rate of any industrialized nation. An average of 20 workers are murdered each week in the U. S. making homicide the second highest cause of workplace deaths and the leading one for females. 18,000 non-fatal violent crimes such as sexual and other assaults also occur each week while the victim is working, or about a million a year. • The figures are probably higher since many are not reported. Certain dangerous occupations like police officers and cab drivers understandably have higher rates of homicide and non-fatal assaults. Nevertheless, postal workers who work in a safe environment have experienced so many fatalities due to job stress that "going postal" has crept into our language. "Desk rage" and "phone rage" have also become increasingly common terms.

Absenteeism due to job stress has escalated • According to a survey of 800,000 workers in over 300 companies, the number of employees calling in sick because of stress tripled from 1996 to 2000. An estimated 1 million workers are absent every day due to stress. The European Agency for Safety and Health at Work reported that over half of the 550 million working days lost annually in the U.S. from absenteeism are stress related and that one in five of all last minute no-shows are due to job stress. If this occurs in key employees it can have a domino effect that spreads down the line to disrupt scheduled operations. • Unanticipated absenteeism is estimated to cost American companies $602.00/worker/year and the price tag for large employers could approach $3.5 million annually. A 1997 three year study conducted by one large corporation found that 60% of employee absences could be traced to psychological problems that were due to job stress.

Emotional Stress