Stress management

The following was part of a little research project I did as part of my homework in psychology, and because I thought it was interesting, I wanted to post it.

Psychological and physiological methods of stress management

Stress is a universal phenomenon, experienced by most people at some point during their lives. It can be brief and passing, or more chronic. People who experience chronic stress often suffer from specific medical complaints. This means that stress can be quantified, defined and measured.

The proper definition of stress is that of the transactional model of stress which is:

The perceived lack of fit between the demands of the situation and the person’s ability to cope

Stress is harmful for numerous reasons. When somebody undergoes a stress response it is because they perceive something as a threat to their safety. This was an evolutionary advantage when we hunted or were hunted as it allowed one of two actions to take place more effectively – that is, we were able to fight or run away. This is called the fight or flight stress response.  However, nowadays, one cannot simply fight or run away from whatever we perceive to be a threat because it could be something as simple as job insecurity or ambiguity, or other such stressors.

The end result is that the stress response which would once have been a short lived and temporary solution now does not work, but because you continue to be stressed, you continue to undergo the physiological changes which are attributed to flight or fight. These carry serious complications if they continue for too long, like an increased risk of coronary heart disease (CHD), and a lowered immune defence (Kiecolt-Glaser 1984)

Psychological methods of stress management

The psychological methods for dealing with stress include but are not limited to Meichenbaum’s stress inoculation training and Kobasa’s hardiness training.

Cognitive-behavioural therapy

This technique was devised to help individuals prepare for instances in the future where they may experience stress, and promotes resilience in patients. There are three main phases within this therapy. They are:

·         Conceptualisation

·         Skills training and practice

·         Real life application

Conceptualisation: This is where the patient is encouraged to remember and thoroughly recreate any previous events where they may have experienced stress. They are then asked to analyse it – what was their reaction? Was it successful? Why? This helps patients reach a more realistic understanding of the demands of the situation. That is, their perceived demands are reduced, and this reduces the stress of the situation.

Skills training and practice: this where, having identified the stressful aspects of the situation, the patient is expected to develop strategies to combat them. For instance, if they find job interviews stressful, they could practice job interviews and learn techniques to make themselves come across as a more viable candidate.

Real life application: this is where the training is put into effect without the therapist. Meetings are still arranged with the therapist to follow up, but the idea is that from here on, they should be able to go their own way.

Evaluation of the stress inoculation technique

Pros:

·         It works

·         It targets both sources of stress and symptoms

Cons:

·         It is expensive

·         It takes a long time

·         It is a difficult process

Kobasa’s hardiness training

Kobasa believed that hardiness was a measure of how well people could cope with stress and was a reason for the differences in peoples responses to stress and their potential physiological or psychological changes when they experienced prolonged stress.

Hardiness training is based around three key concepts of:

·         Focusing

·         Reliving stressful encounters

·         Self improvement

Focusing: this is where a patient is asked to pay attention to their body signals – sweating, raised heart beat, anxiety etc – so that they can identify stressful situations and can therefore deduce the source of the stress

Reliving stressful encounters: this is when they are encouraged to remember what the stressful event was and what they did about it; They are asked to imagine how it could have gone worse, to make them realise that their coping resources are not as bad as they could have been, and how they could have gone better, to improve their current coping strategies.

Self improvement: this is where the patient is encouraged to make reasonable and achievable goals. There will be problems within life which someone cannot cope with. By aiming for achievable goals the patient confirms to themselves that they do have control over their lives and lack of control can be a key cause of stress.

Evaluation of Kobasa’s hardiness training

Pros:

·           It appears to have a positive effect

Cons:

·         Takes time

·         Is expensive

·         The concept of “hardiness” is in dispute

·         Kobasa’s studies cannot be generalised – they only happened on white, middle class businessmen

·         Not many studies as to how effective it is

Physiological methods of treating stress

There are two methods of treating the physiological, both involving drugs. Because of the nature of the stress response which is a physiological one (meaning your body emits chemicals and changes how it works) the physiological response can be altered by introducing synthesised drugs into the equation. These can reverse the effect of the naturally produced hormones or block them, and act as inhibitors.

Benzodiazepines (BZ’s)

These are anti anxiety agents. They include, but are not limited to, drugs like Valium or Librium. They act directly on the brain and have a calming influence, reducing brain activity. They work by increasing the effect of an inhibitor, gamma amino butyric acid or GABA for short. GABA influences the brain on a neuronal level by making it calmer, or less excitable. BZ’s enhance gaba’s effectiveness, by acting as a pump for the chloride ions into the neurotransmitters. This means that other neuronal impulses are less effective. BZ’s work on about 40% of the brains neurones and can cause the body to relax. Impulses to or from the pituitary gland, for example, to release ACTH, could be inhibited. ACTH is one of the main hormones involved in the physiological stress response, and by inhibiting it you can calm the user down for a period of time.

Beta Blockers (BBs)

Beta blockers are another stress relieving drug. They do not work in the brain on a neuronal level like BZ’s, but in and around the body. They inhibit the hormones adrenaline and noradrenaline in the blood stream by competing for the same receptor sites. Adrenaline and noradrenaline are activated in the body’s physiological stress response. They stimulate beta-adrenergic receptors around the body, particularly in the heart, brain and blood vessels. When a body undergoes the stress response to a perceived threat they release the hormones adrenaline and noradrenaline. This causes the activation of the sympathetic ganglia (a process known as sympathetic arousal), part of the autonomic nervous system, which reduces blood flow to the stomach and other digestive organs, and increases blood pressure and heart rate, and allows the release of energy in the form of fats and sugars from the muscles where it is stored as glycogen. By taking BB’s they reduce the effect of adrenaline and noradrenaline and as a result the body does not experience sympathetic arousal. By competing for the same receptor sites the BBs stop adrenaline from increasing heart rate and blood pressure. This reduces the strain on the heart. BBs can also be taken by musicians and snooker players where “nerves” might make them jittery and reduce performance.

Evaluation of a drug based approach to treating stress

Pros

·         Instant effects

·         Clear and noticeable effects

·         Easily available

Cons

·         Dependency/addiction to the instant fix

·         Tolerance – the drugs have less effect the longer they are used. Higher doses are needed

·         Symptoms – drugs target the symptoms of the problem, not the source

·         Side effects – most anti anxiety drugs have side effects. BBs can be dangerous for individuals with serious asthma, and can contribute to type 2 diabetes

Alternative stress management techniques

These include physiological approaches which are not drugs and psychological ones which are alternatives to the ones stated above.

Progressive muscle relaxation technique (PMR)

Relaxing is often thought to be a natural process but it is in fact an art. A patient undergoing PMR would be encouraged to find a comfortable position and consciously contract and relax every muscle in their body, starting low down at the feet and working their way up. Eventually the patient is used to the sensations enough that they can recreate the feelings themselves and use it on an everyday basis. This allows the activation of the parasympathetic ganglia, a nervous pathway which enables digestion to take place, lowers blood pressure and heart rate. This is an alternative psychological stress management technique.

Evaluation of muscle relaxation technique

Pros

·         It can be very effective in reducing stress

Cons

·         It requires practise

·         It often is not practical (traffic jams can be stressful, using this technique would be difficult and inconvenient)

·         It’s time consuming

·         It targets the symptoms and not the problems

Biofeedback

This is a physiological technique used to treat stress. It involves someone being hooked up to a device which measures and reports blood pressure and heart rate, from information gathered from electrodes placed on the body. They are then encouraged to experiment themselves, and see which techniques they can use to lower either their blood pressure or their heart rate or both. Once they have proven to be able to consistently use a specific technique or combination of techniques they are then encouraged to try and utilise these in everyday life.

Evaluation of biofeedback

Pros

·         It can be very effective for particular individuals, especially children

Cons

·         It is expensive – it takes time to practise and the equipment needed is sophisticated

·         Some scientists have stated that it is no more effective than the other techniques like PMR without biofeedback, and that the addition of the machines do not help

In conclusion, the best approach would be to utilise one of the psychological methods of stress management which targets the source of the stress. Physiological methods can and should be used in certain circumstances (the build up to important life events causing severe stress) but should be a temporary measure, and dependant on the patient also attending and using the other methods.

Resources used

Psychology for AS (AQA) fourth edition published 2008 ISBN 978-0-00-725503-0

http://www.bcnc.org.uk/howtheywork.htm