# Presentation: 087713

## What is Stress?

- Richard Harvey, Ph.D.
- VA National Center for Health Promotion and Disease Prevention
- (NCP)

**Notes:**
Today we will go over some information about stress.  Stress is a commonly used term these days, and today’s presentation is meant to give you a broader view of it than is commonly available.  We won’t talk about stress reduction here in any detail, but just about the phenomenon itself.

## What is Stress?  (cont.)

- Concept of homeostasis   (Walter B. Cannon, 1935)
- The “stress response” is the nonspecific response of the body to any demand put upon it.  (Selye, _The Stress of Life_, 1956)

**Notes:**
The concept of stress is based at least partly on the idea of homeostasis- that organisms strive to maintain a constant physiological state.  Dr. Hans Selye, who was the father of modern stress research, described the stress response as the body’s nonspecific (generalized) response to any demand put upon it.  Hence, stress responses occur when there is a force applied that disturbs the body’s equilibrium.  In general, the responses are meant to restore equilibrium.

## A bodily or mental tension resulting from factors that tend to alter an existing equilibrium.  (Websters, 1988)
Physical challenges to the integrity of an organism provoke responses to counteract those threats. (Claude Bernard, 1865)

**A bodily or mental tension resulting from factors that tend to alter an existing equilibrium.**  (Websters, 1988)
- Physical challenges to the integrity of an organism provoke responses to counteract those threats. (Claude Bernard, 1865)

**Notes:**
Here is what Webster's Dictionary has to say about stress.  Again, it refers to a force that disturbs equilibrium.  And way back in 1865 Claude Bernard talked about stress responses, although in slightly different terms.

## What is Stress?  (cont.)

- General Adaptation Syndrome  (Selye, 1956)
**Systemic Alarm Reaction**
**Adjustment Phase**
**Exhaustion Phase**

**Notes:**
Back in the 1950’s Selye coined the term “General Adaptation syndrome” to describe the physiological response pattern to the ongoing presence of stressors in an animal’s (or person’s) environment.  In its most basic form, the “Systemic Alarm Reaction” is where the organism prepares for “fight or flight” in response to a newly introduced stressor (e.g., an emergency, an eminent danger).  It’s sort of “all systems go!”  There is a cascade of physiological events that lead to a rush of adrenalin and other substances and the body rapidly becomes fully activated to deal with the situation.  However, if the stressor continues without significant abatement, the body starts to adjust by attenuating the alarm reaction to some degree, although remaining partly activated.  This is termed the “Adjustment Phase” and is sort of where the organism “Gets used to it”, although it may not like the situation or feel good.  In situations where the stressor continues for an extended period (or not so long under extreme conditions) the body simply exhausts its ability to adjust, and enters the “Exhaustion Phase”.  In this phase tissue/organ damage begins to occur, and may lead to death.  This phenomenon Selye referred to as “Diseases of Adaptation”.

## What is Stress?  (cont.)

- “Diseases of Adaptation”  (Selye, 1956)
- Consistent triad of tissue damage in animals exposed to prolonged stress:
**decrease in size of thymus gland and lymph nodes**
**Gastric ulceration**
**Enlargement and discoloration of the adrenal glands**

**Notes:**
In his research Selye put animals (rabbits, cats, rats, etc) under conditions of continuous stress by doing some pretty mean things to them, and noted what happened.  Many of the animals simply died under those conditions, and others suffered various degrees of illness. All animals were autopsied.  He found a consistent triad of damage in all animals.  The thymus gland and lymph nodes were all shrunken indicating dysfunction of the immune system.  There were gastric ulcers present in all animals as well, many of them open bleeding ulcers.  And finally all animals had discoloration and enlargement of the adrenal glands, indicating adrenal dysfunction.  Any and/or all of these could eventually lead to death.  

## What is Stress? (cont.)

**Relationship between stress & health has long been recognized.**
**Hippocrates noted that one’s confidence in their physician often largely governed their recovery.**
**William Harvey noted the relationship between “affliction of the mind” and its effect on the heart.**

**Notes:**
So there is a clear relationship between stress and health, which was recorded as far back as Hippocrates, who noted that a mental state (confidence in one’s physician) was related to recovery from illness.  And scientist William Harvey (who discovered the circulation of blood) in the 1600’s noted a similar relationship between mental states and their effects on the heart.

## Where does stress come from?

**Major events such as death of a loved one, divorce, major loss, job change, etc.**
**Time & money demands, minor hassles, etc.**
**Changes coming too fast**

**Notes:**
We know that we are surrounded by stressors in modern American life.  Here are some of the events and situations known to lead to stress reactions for people.  (Go over each of these, giving examples when possible)

## Where does stress come from?

**Information coming too fast- information overload**
**Environmental stressors (weather, pollutants, noise, etc.)**
**Wherever there is a demand to adjust or change**

**Notes:**
Here are others.  There is an overload of information, and I’m sure we have all experienced that.  Unpleasant stimuli in our environment will stress us.  And whenever we have to change for some reason it becomes stressful because it is easier and takes less effort to just stay the same.

## Where does stress come from? (cont.)

**Any situation where there is a lack of control**
**Disease, injury**
**Poor diet, drinking, smoking, etc.**
**Maladaptive thinking patterns**

**Notes:**
Here are others.  People who have no control over their jobs, their relationships, their living or financial situations, and so on, experience stress.  It is like being trapped.  Any disease or injury stresses the body’s reserves.  So do chemical stressors such as too much junk food, smoking, too much alcohol, and so on.  And the last one refers to our tendency to engage in negative thinking, worry, angry or fearful thoughts, and so on, which lead to stress.  (for example, “Oh my God, oh my God, what am I going to do? I don’t know what to do.  I can’t take this, this is killing me!!!”)

## What Does Stress do to Us?

**It is related to:**
**Accidents**
**Allergies**
**Asthma**
**Arthritis**
**Back pain**
**Cancer**
**Depression**

**Notes:**
Are we different from those helpless animals that Selye subjected to extremely stressful conditions?  Yes, because we have many more ways to escape the stressful situations or attenuate the stress we feel through some means we have control over.  But not enough, because stress is nonetheless clearly related to a number of human maladies from A to Z, and here are some of them.

## What Does Stress do to Us? (cont.)

**Diabetes**
**Fatigue**
**Gastric Ulcers**
**Headaches**
**Heart disease**
**Hypertension**
**Insomnia**
**Irritable bowel syndrome**

**Notes:**
Here are more...

## What Does Stress do to Us? (cont.)

**Pregnancy & childbirth problems**
**Sexual dysfunction**
**Skin problems**
**Emotional states**
**Impaired memory**
**Headaches, backaches**
**Etc.,Etc., Etc.**

**Notes:**
And yet more.

## Goals of Stress Reduction Treatment

**Reduce cognitive reactivity.**
**Reduce physiological arousal.**
**Strengthen coping skills.**
**Remove or escape from stressors.**

**Notes:**
Stress can be reduced through treatment.  Although at times a way can be arranged to escape from stressors or to remove them from one’s presence, many times that can’t be made to happen.  What has to happen then is to change the person’s reaction to a stressor.  Interventions can be aimed at reducing both the mental and physiological reactivity, and strengthening skills for coping with the stressful situations as well.  

## Stress Reduction Methods

**Pharmaceutical intervention**
**Cognitive reprogramming**
**Behaviorally mediated physiological alterations**
**Teach coping skills**
**Alteration of environment**

**Notes:**
The cheapest and most efficient way of treating stress is to prescribe tranquilizing medications.  Of course, one doesn’t learn anything by gaining relief through taking pills, so the moment the pills are withdrawn the stress problems are likely to recur.  Nonetheless, medications may be helpful in temporary situations.  Changing habitual stress-producing/mediating thought patterns can be accomplished by teaching patients to identify maladaptive thoughts and replace them with more realistic and adaptive thoughts.  Physiological arousal may be reduced through various forms of relaxation training exercises, meditation, or hypnosis, as well as through physical exercise or practices such as yoga.  Coping skills such as assertiveness and other communication skills, social skills, problem solving skills, time management skills, and pleasuring skills can also be taught, all of which help people reduce stress.  As mentioned previously, the environment or situation can sometimes be altered.  Examples might include getting some respite care for an Alzheimer's patient caregiver, providing financial counseling, arranging for temporary employment to make extra money or for temporary housing, leaving an overly stressful job or relationship, simply imparting critical information, and so on.

## Stress Doesn’t Have to Make your Life so Hard....

**You **_**CAN**_** Control Stress!**

**Notes:**
We have covered basic information about what stress is, where it comes from, what it does to people, and just a bit concerning what to do about it.  Perhaps the most important message through all this is that you can reduce stress in your life.  The exact methods you can apply to yourself are in another presentation, but I want you to leave knowing that there is hope!  Questions?