Stress, Anxiety and Coping Chapter 8

Stress, Anxiety and CopingChapter 8

West Coast UniversityNURS 204

StressA broad class of experiences in which a demanding situation taxes a person’s resources, or coping capabilities, causing a negative effect

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).

Conflict SourcesUnconscious needs

Everyday and family life

Social Issues

Ethical Issues

Types of ConflictApproach-Avoidance

Avoidance-Avoidance

Vacillation

Biopsychosocial Theories

Fight or FlightMaladaptivePhysiologic stress

Life Change Theory of Stress

Life change units (LCU)

Holmes and Rahe Scale

Assumptions/cautions when applying the theory to mental health

Assumptions/ CautionsSame 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

Stress as a Transaction

Primary appraisal

Secondary appraisal

Coping

Reappraisal

Psychoneuroimmunology Framework

Self-healing personalities

Hardiness and health

Disease-prone personalities

AnxietyNeurobiological basis

Measurable

AssessmentEmotional/behavioralPhysiologicalCognitive

Anxiety - continuedLevels of Anxiety

MildModerateSeverePanic

CopingTask-oriented

Problem solving

Defense-orientedProtective

Coping StrategiesSeeking comfortRelying on self-disciplineIntense expression of feelingAvoidance and withdrawalTalking it outPrivately thinking it throughWorking it off

Coping Strategies - continued

Engaging in self-healing and mind/body practices

Spirituality and prayer

Symbolic substitutes

Somatizing

Coping ResourcesSense of Coherence

-Comprehensible

-Manageable

-Meaningful

Generalized Resistance Resources (GRR)

Coping Resources - continue

Generalized Resistance Resources (GRR)Physical and biochemicalArtifactual and materialCognitiveEmotional Valuative and attitudinalInterpersonal-relationalmacrosociocultural

Defensive MechanismsRepression-Unconsciously keeping unacceptable feelings out of awarenessA man jealous of a good friend’s success but is unaware of his feelings

Suppression-Consciously keeping unacceptable feelings and thought out of awarenessA 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

Defense MechanismsDissociation-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

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

Defensive MechanismsDenial – 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

Defense MechanismsRationalization – 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

Defense MechanismsDisplacement – 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

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.

Conditions with Psychological Components

Cardiovascular

Gastrointestinal

Hormonal

Immune

Integumentary

Neuromuscular and Skeletal

Respiratory

The ChallengeAs 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.