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Stress TheoryHistorical Perspective andStress Adaptation Theory

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What stress is and what it isn’t

•Stress is one’s reaction to any change that requires a restructuring of one’s orientation to any given situation.

•It is not always a detrimental reaction.

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Stressor

•Any stimulus that causes tension.

•May contribute to certain illnesses.

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Sister Callista Roy(1976)

•Distinguished between adaptive and maladaptive responses:

•Adaptive—responses that preserve one’s physical and/or mental integrity

•Maladaptive—responses that interrupt the individual’s physical and/or mental integrity.

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Methods of Conceptualizing Stress•As a biological response (Selye)

•As an environmental event

•As a transaction (Lazarus and Folkman)

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Hans Selye (1976)

•Described the “General Adaptation Syndrome.”

•The physical reaction to stress prompting the “fight or flight” syndrome.

•The reaction occurs in 3 defined stages.

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1. Alarm Reaction Phase

•“Fight or flight” responses are stimulated.•Sympathetic nerves release acetylcholine•Adrenal medulla releases epinephrine and

norepinephrine.•Trigger immediate increase in heart rate

and breathing, blood vessels constrict and muscles tighten.

•Initiates spontaneous behaviors associated with combat or escape.

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2. Stage of Resistance

•The triggered physiological responses of Stage 1 are used to defend the individual in an attempt to adjust to the stressor (adaptation).

•If adaptation is successful, this is the end of the biological response and Stage 3 does not occur.

•Eventually the physiological responses decline.

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3. Stage of Exhaustion

•Occurs if adaptation is not successful.•The person/body fatigues under the

internal stress of the physiological responses of the sympathetic nervous system.

•Reserves are depleted.•Stage is associated with disease and even

death.

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Stress as an Environmental Event•The Recent Life Changes Questionnaire

(RLCQ).•Attempts to quantify an individual’s

current life stress.

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Stress: The Interaction Between the Individual and the Environment

PrecipitatingEvent

Predisposing Factors:• Genetics• Past

Experiences• Existing

Conditions

Individual’s Perception of the Event:• Irrelevant• Benign• Stress due

to Harm or Loss

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Stress Management

Adaptation

Awareness

Relaxation

Meditation

Communication

Problem Solving

Pets

Music

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Roots of Modern Mental Health Care

Benjamin Rush•“Father of American Psychiatry”•Signator of the Declaration of

Independence•Founded a movement for more humane

treatment of the mentally ill•Believed in the need for restraint to help

the patient “regain his senses.”

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Roots of Modern Mental Health Care

Dorthea Dix•Advocated for more human treatment of

the mentally ill (1840s)•Instrumental in founding the first public

mental health hospitals

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Roots of Modern Mental Health Care

Linda Richards•First American trained professional nurse•“First American Psychiatric Nurse”•Helped establish the first school of

psychiatric nursing

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Multiple Definitions of Mental Health

•Successful adaptation to stressors…•from internal and external

environments…•with thoughts feelings and behaviors that

are…•age appropriate and •congruent with local and cultural norms

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Cultural Relativity

•Culture and society determine normal and abnormal behavior.

•The more removed a culture is from the mainstream culture of a society, the more likely any aberrant behavior will be met negatively.

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Maslow’s Hierarchy of Needs

•A “humanistic” psychologist•Theory focuses on potentials of the

individual•Humans are constantly striving for higher

levels of capabilities•Always seeking higher levels of

consciousness, creativity and wisdom•The obstacles of society prevent reaching

the next higher level

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Maslow’s Hierarchy of Needs

Self-Actualization

Esteem & Self-Esteem

Love & Belonging

Safety & Security

Physiologic

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Primary Response Patterns to Stress

Stress

Anxiety Grief

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Anxiety

•“A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.”

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Levels of Anxiety (Peplau, 1963)

Mild Anxiety•Everyday occurrence•Can be beneficial, motivating•Increased awareness and alertness

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Levels of Anxiety

Moderate Anxiety•Perceptual field reduces•Reduced alertness, awareness•Increased restlessness, muscular tension

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Levels of Anxiety

Severe Anxiety•Perceptual field greatly diminished•Very limited attention span•Unable to concentrate•Feelings of dread

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Levels of Anxiety

Panic•Unable to focus at all•Unable to comprehend•Impending doom•Bizarre behavior

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Behavioral Responses to Anxiety

Responses to Mild Anxiety

•Mild anxiety is…uncomfortable!•The coping mechanism is selected to

satisfy the need for comfort .

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Behavioral Responses to AnxietyResponses to Mild to Moderate Anxiety

•One’s ego is challenged to defend itself as anxiety increases.

•Ego defense mechanism are protective.•May be adaptive or maladaptive.

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Behavioral Responses to Anxiety

Responses to Moderate to Severe Anxiety

•Individual is likely to manifest symptoms of disease of any physiological system

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Behavioral Responses to Anxiety

Responses to Severe Anxiety•Ego defense mechanisms are carried to

extreme.•The person knows his behavior is harmful

to his well-being.•He does not know there is a psychological

origin to the behavior.•He feels helpless to change.

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Behavioral Responses to Anxiety

Response to Panic Anxiety

•Person may lose contact with reality•There is a mental retreat to a less

threatening world.

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Grief

Grief is a Response to a Loss.

•The loss may be obvious.•The loss may be apparent to only the

individual.•The loss may be one that the individual

merely fears in the future (anticipatory).

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Elizabeth Kubler-Ross’ Theory

Acceptance

Depression

Bargaining

Anger

Denial

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Maladaptive Grief Responses

Prolonged• Lasts for many

years

Delayed• Fixed in denial

stage

Distorted• Fixed in anger

stage