Stress Management

C. Jeffrey Terrell, Ph.D., M.Div. Psychological Studies Institute

Stress

Many people are familiar with a cognitive model of counseling which suggests that events themselves dont affect us--our thinking about those events does. Hans Selye was an early thinker in the field, who argued that stress may be considered good stress, or bad stress, depending upon its effects on the person experiencing it. If stress in and of itself is not bad for you, then arent we talking about managing our response to stress, instead of the stress itself?

Stress

With this in mind, what kinds of feelings (physical and emotional do you get when you get stressed out?

Apprehension. Uneasiness. Butterflies in the stomach. Autonomic reactivity. Withdrawal and isolation.

Myths about Stress Management

Stress is always bad.

How many people like to be stressed? If you stopped people on the streets and asked what they think about stress, what kind of response would you expect? On the one hand, we hear that over 50% of routine medical visits are due to stress-related conditionsbut what does this mean? Temptation is to believe that if we just did away with stress, our problems would also vanish. Problem is, stress has an adaptive function, too. Sometimes we need stress responses in order to perform.
Endocrine response prepares body for action. Cognitive focus improves.

In addition, good things can be stressors, too.

Myths about Stress Management

Catastrophic stress is the worst kind.

When we think of stressors, we often think about the really bad things that happen, and theres no question that we dont want to experience these things. But the fact is that we are also affected by the routine, everyday hassles that all of us do experience. And sometimes the effects of those hassles can build up and have similar effects as even the most serious catastrophic crises and stressors. Lazarus has done significant work in this area, and has demonstrated the injurious effects of these hassles. Top ten hassles:

Physical appearance Crime Money and taxes Home maintenance Losing or misplacing things 5) Too many things to do 4) Cooking and cleaning 3) Rising prices 2) Health 1) Concern about weight

Myths about Stress Management

Stress causes illness.

There is a clear link between stress and illness. No question about that fact. There have been some elegant studies. One from the NEJM in 1991, examined development of cold symptoms from individuals stratified according to stress level, who were then administered a cold virus through a nasal spray! Sure enough, individuals with higher stress levels tended to get colds more than those with lower stress. What is in question, however, is what kind of stress, to what kinds of people, in what kinds of settings, under what kinds of conditions, is most harmful? The problem is, no one has been able to find a link that works all the time. There are obviously moderators, like personality variables (optimism, negative affect, perceptions of stress), previous experience, SES, and a host of other factors.

Some typical stressors

Pressure situations.
Why is it that pressure seems to bother some people so much more than others?

Personal meaning. Individual differences in tolerance. Capacity and intelligence. Ability to work quickly. ??

Some typical stressors

Frustrating situations.
Some obstacle that stands in your way. Examples:
Physical: tree in road coming home. Social: being rejected from a club. Individual limitations: old joke about the man who asked his surgeon if he would be able to play the piano after the operation. Our personal limitations can present obstacles.

What are some of the ways that people respond to frustrating situations? Even here there are differences and effects that are generated by personality and persistence.

Some typical stressors

Boredom.

The issue of balance is probably the most significant one we face in almost every arena of life. Do you get crazy after a couple of days of sitting around? You see assembly line workers in factories get stressed, even though they may be sewing on the same button day after day after day. Boredom can be a tremendous stressor. Again, personality issues may predominate here as well. If forced to choose, would you choose to have absolutely nothing to do, or would you choose to be overloaded with work?

Some typical stressors

Trauma.

Any kind of shocking physical or emotional phenomenon. May be a death or other tragedy. Doesnt even necessarily have to involve someone you know.

Some typical stressors

Conflict.
External:
Interpersonal conflict. Examplechild hears parents argue every night.

Internal:
Conflicts about decisions, or other problems. Exampleclient loves child very much, but must confront irresponsible lifestyle.

Some people deal with conflict better than do others. In fact, there are conflict-habituated families. Conflict, like any other stressor, increases stress.

Some typical stressors

Change.

This is another one of those concerns that come up even with positive changes. What is it about change that makes it so stressful? There are those who will hold on to terribly dysfunctional patterns of behavior just so that they can avoid dealing with the pain of change. If something is known, then in a sense it feels safer, even if it isnt really.

Some typical responses to stress.

Psychological stress responses: become more pronounced as the intensity and duration of the stressors increase.

Emotional stress responses.

Generalized anxiety disorder. Panic disorder. Depression.

Some typical responses to stress.

Psychological defenses- the purpose of these defenses is to protect people from anxiety producing situations. Can cushion the emotional impact of stress, but really doesnt do much to eliminate it. May function much like substance use: feels better for a while, but problems are still thereand may have gotten worse.

Some typical responses to stress.

Psychological

defenses:

Repression.- unconsciously excluding painful/threatening thoughts from awareness. Projection- attributing to others ones own unacceptable impulses. Rationalization- creation of good reasons for failure or loss, thus justifying specific behaviors. Reaction formation- defending against unacceptable impulses by actively expressing the opposite behavior or belief Displacement- coping with anxiety by getting rid of impulses through focusing on a safer target. Identification- enhancing self-worth and protecting self from failure by linking self with another.

Some typical responses to stress.

Behavioral stress responses are represented by changes in how people look, act, or talk. When stress is greater than person is prepared to cope with, you will notice disruption in physical coordination, behavioral skills (e.g., normal social skills), cognitive ability, emotional equilibrium, or other overt, noticeable demonstration. These responses are more acute. Chronic stress produces a different set of behaviors.

Tends to look more depressed than anxious. Anhedonia (loss of joy in life). Apathy.

Type A Behavior Pattern (TABP)

Some

people are more predisposed to stress than others.

Type A Behavior Pattern (TABP)

Quote from Rosenman: type A individuals are more aggressive, competitive, alert, impatient, time-conscious, impatient and fast-paced, hostile, orderly, wellorganized, self-confident, self-controlled, deeply involved with vocation and less able to relax away from work, not easily distracted from task performance and preferring to work alone when challenged, and striving to control their environment.

Type A Behavior Pattern (TABP)

What is most helpful about this conceptualization is that it recognizes the interaction of the individuals behavior pattern and/or personality style and the environment in which he finds himself. Involves a number of things:

Behavioral dispositions:
Aggressiveness. Competitiveness. Impatience.

Specific behaviors:
Muscle tension. Alertness. Loud, pressured speech. Accelerated activities.

Emotional responsiveness:
Irritation. Covert hostility. Above-average potential for anger.

Type A Behavior Pattern (TABP)

Characteristics of Type A Persons:

Hurry sickness.
Time urgency is perhaps the most significant trait. Attempt to accomplish too much in too little time. So many internal deadlines that they are under almost constant time pressure. Always looking for ways to save time. This often results in stereotypical thinking that can subvert creative energy and impair judgment.

Type A Behavior Pattern (TABP)

Characteristics of Type A Persons:

Quest for the numbers.
Preoccupation with numbers. Numbers become measures of self-worth. Can include money, but this is usually just a focus on accumulating (i.e., money is another index of success).

Type A Behavior Pattern (TABP)

Characteristics of Type A Persons:

Insecurity of status.
Despite their seeming self-confidence, Type A people tend to be extremely insecure. This is why they need objective measures of their self-worth. Pursue achievements in order to gain respect and admiration. Prefer the respect of a superior to the affection of a peer.

Type A Behavior Pattern (TABP)

Characteristics of Type A Persons:

Aggression and hostility.
Aggressiveness is the way to get ahead (if I can prevent the other guy from doing it, then I might have a better chance). Because of this style of relating, they develop a kind of free-floating hostility. Competitiveness becomes a lifestyle. See everything as a challenge; constantly engaged in some kind of struggle.

Type A Behavior Pattern (TABP)

Characteristics of Type A Persons:

Dissatisfaction in many areas of life.
Always on, people with TABP can never relax and enjoy what theyve accomplished. There is always something else to do. Ends up producing a paradoxical dissatisfaction with the rat race, yet they dont know how to get off the wheel. End up being rather dissatisfied with everything.

Stress and Illness

Stress is linked to several serious illnesses:

Hypertension (High Blood Pressure) Headaches Irritable Bowel Syndrome. Rheumatological disorders (Fibromyalgia, arthritis, etc). Peptic ulcer disease.

Stress and Illness

Remember

that all of these disease processes are psychophysiological, not psychogenic. These diseases are not all in your head, nor will psychological treatment methods always work with them. There are psychological considerations which can exacerbate the symptom complex, and psychological treatments are often helpful in reducing frequency and intensity of symptoms.

Basic Irrational Beliefs

Albert

Ellis proposes that a major source of stress in life is holding irrational beliefs, including:

Basic Irrational Beliefs

It is an absolute necessity for an adult to have love and approval from peers, family and friends. You must be unfailingly competent and almost perfect in all you undertake Certain people are evil, wicked, and villainous, and should be punished. It is horrible when people and things are not the way you would like them to be External events cause most human misery-people simply react as events trigger their emotions You should feel fear or anxiety about anything that is unknown, uncertain, or potentially dangerous

Basic Irrational Beliefs

It

is easier to avoid than to face life's difficulties and responsibilities The past has a lot to do with determining the present. You are helpless and have no control over what you experience or feel People are fragile and should never be hurt Good relationships are based on mutual sacrifice and a focus on giving If you don't go to great lengths to please others, they will abandon or reject you

Basic Irrational Beliefs

When

people disapprove of you, it invariably means you are wrong or bad. Happiness, pleasure, and fulfillment can only occur in the presence of others, and being alone is horrible There is a perfect love, and a perfect relationship. You shouldn't have to feel pain; you are entitled to a good life. Your worth as a person depends on how much you achieve and produce Anger is automatically bad and destructive

Guidelines to Promote Rational Thinking

It doesnt do anything to me.

Situation doesnt make me nervous, or angry, or afraid. I create my own emotions. Conditions for people or things to be otherwise dont exist (or else they would). To say should is to believe in magic. Plans should allow for failure. Increase self-blame when we expect otherwise.

Everything is exactly the way it should be.

All humans are fallible creatures.

Guidelines to Promote Rational Thinking

It takes two to have conflict.

30 percent rule: any party to a controversy is contributing at least 30% of fuel to keep it going. When we find yourself in conflict, recognize your part. Waste of time to affix blame. Best strategy is to make decisions relative to your behavior now. Events dont cause emotions. Interpretations cause emotional reactions.

The original cause is lost in antiquity.

We feel the way we think.

How to Overcome Irrational Thinking.

Write down the facts of the event as they occurred at the time you were upset. Be certain to include only the objective facts, not conjecture, subjective impressions, or value judgments. Write down your self-talk about the event. State an your subjective value judgments, assumptions, beliefs, predictions, and worries. Note which self-statements have been previously described as irrational ideas. Focus on your emotional response. Make a clear one or two word label such as angry, depressed, felt worthless, afraid, and so on.

How to Overcome Irrational Thinking.

Dispute and change the irrational self-talk identified at step B: Select the irrational idea that you wish to dispute. Is there any rational support for this idea?. What evidence exists for the falseness of this idea? Does any evidence exist for the truth of this idea? What is the worst thing that could happen to me if what I want to happen doesn't, or what I don't want to happen does? What good things might occur if what you want to happen doesn't; what you don't want to happen does?

How to Overcome Irrational Thinking.

Substitute alternative self-talk, now that you have clearly examined the irrational idea and compared it with rational thinking.

There's nothing special about me. I can accept painful situations when they emerge. Facing the problem is more adaptive than resenting it or running away from it. I feel what I think. If I don't think negative thoughts, I won't feel stressful emotions. At worst I will experience inconvenience, regret, and annoyancenot anxiety, depression, and rage.