# Motivation and emotion/Book/2022/Psychological distress

* Multimedia presentation (3 min)

## Overview

Have you ever been worried for weeks about an important upcoming event? Feeling like no matter what you do nothing will help you relax? This is a glimpse at what psychological distress can feel like. It's awful, which is why this chapter aims to explore ways the everyday individual can deal with their own stress in order to mitigate the likelihood of it evolving into psychological distress.
Psychological distress can be defined as a state of emotional suffering characterised by symptoms of anxiety and depression (Drapeau et al., 2012). Although there are many potential causes of psychological distress, the main sentiment is that it may arise from consistent or intense stress, which may lead to chronic stress, anxious or depressive disorders. In this chapter physiological and neurological theories on the cause of psychological distress are discussed. Lastly, some methods of management for everyday life are considered. These include sleep, physical activity, socialising, meditation, diet, time management and spending time in nature. Overall, this chapter focuses on behavioural interventions to deal with psychological distress.
* Focus questions:
* What is psychological distress?
* What theories explain the causes of psychological distress?
* What can be done by everyday individuals to prevent and manage psychological distress?

## What is psychological distress?

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### Psychological distress

Psychological distress can arise from life experiences which are traumatic to different degrees to the individual. A wide range of events can contribute to developing psychological distress, such as employment, financial difficulties, health issues, racism, interpersonal issues and predispositions to becoming distressed (Bhui et al., n.d.). Consistent exposure to daily stressors has been found to be a significant predictor of subsequent psychological problems (Monroe, 1983). Psychological symptoms that may arise from consistent or intense psychological distress have been linked with both anxiety and depressive disorders (Viertiö et al., 2021). In this context it is important to distinguish between stress and distress.
Stress responses are a normal part of everyday life and as such are not always negative, for example eustress (positive stress) is defined by enhancement in functioning. Meanwhile, stress turns to distress when it is severe, prolonged or a combination of the two. It is in this context that stress becomes an issue as it can lead to the onset of mental disorders if not treated. It is important to distinguish that although there may be similarities in symptomology, mental distress and mental disorders are separate. Mental disorders are strictly psychiatrically defined through relevant symptoms, while psychological distress is more concerned with the presence of adverse symptoms.

#### Theories of emotion and how they relate to the cause of stress and psychological distress

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##### Physiological theories of emotion and stress

Physiological theories of emotion are good indicators of why we experience stress. Both the James-Lange theory of emotion and the Cannon-Bard thalamic theory of emotion highlight that stress is a response to aversive environmental stimuli. These theories differ in their interpretation of emotional perception however, as the James-Lange theory puts forward that we interpret our physical symptoms to determine emotions, while the Cannon-Bard theory suggests we experience both physiological and psychological symptoms simultaneously, as dictated by instructions from the hypothalamic structures in our brain (see figure 2).
Alternatively, Lazarus and Folkman (1984) proposed a transactional model of stress appraisal. This model suggests that stress derives from the individual's appraisal of their ability to cope with stressing stimuli, based on their physical and mental resources. This transactional model of stress appraisal also indicates that distress may arise from an inability to adapt to stimuli or an exhaustion of the individual's resources to deal with stress.

##### Neurological theories emotion and distress

Neurology based approaches to emotion support the thalamic theory to an extent in dealing with stress, as evidence shows that the amygdala and the hypothalamus are responsible for stress responses in the brain (Zhang et al., 2018; Smith & Vale, 2006). This is where the amygdala sends a message to the hypothalamus, which in turn signals the pituitary glands to pump epinephrine into the bloodstream as a stress response. This stress response turns into distress when we take on an allostatic load, which is often characterised by maladaptive processes or responses that are unable to resolve stressing stimuli. This concept, first introduced by McEwan and Stellar in 1993, is the effect on the body from chronic stress, which is typically formulated in the sympathetic nervous system and the HPA[explain?] axis. Risk factors that have been positively correlated with allostatic loads include low socioeconomic status, discrimination, low educational attainment, poor health habits and adverse environmental influences (Guidi et al., 2021). There is a synergy between the Cannon-Bard theory and neurological theories of emotion and distress in explaining the causation of psychological distress in that both put heavy emphasis on the HPA axis and its constituents.

## Presentation of psychological distress

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### Effects of distress on the body

Psychological distress entails both adverse physiological and psychological symptoms. Some of these physiological symptoms may include changes in dieting, deregulation of sleep patterns, social withdrawal, drug abuse, immune system suppression and difficulties adjusting. It is also important to note that some of these symptoms can amplify this distress, especially poor diet, sleep issues and drug abuse[factual?]. In more severe cases HPA axis overstimulation can cause persistent epinephrine surges, which may lead to blood vessel and arterial damage. This damage can lead to increases in individual risk for heart attacks and strokes (Kershaw et al., 2017; Salleh, 2008). Psychologically, symptoms include mood swings, anger management issues, diminished libido and decreases in motivation[factual?]. All of these are good reasons to avoid entering a state of psychological distress or chronic stress.

### Anxious symptomology

Distress can lead to anxiety, a different state of worrying. It is distinguished from stress in that anxiety does not need a particular stimulus to trigger the response; it is the state of worrying without anything in particular to worry about. Distress can lead to anxiety through an imbalance in the brain chemicals cortisol and corticotropin (McEwen, 2017; Salleh, 2008). Symptoms of anxiety include restlessness, irritability, difficulty controlling worries, panic attacks or discomfort in social settings. Feelings of anxiety may come and go, but they get particularly problematic when they are constant; which may indicate the presence of an anxious disorder. With the latter distinction in mind, treatments may range from mindfulness oriented approaches to psychiatric approaches.

### Depressive symptomology

Stress seems to have a circular relationship with depression. Stress can increase depression and depression can increase stress[factual?]. Of the many types of stress, interpersonal and work related stress are most correlated with depressive outcomes (Shin et al., 2017). This relationship can become reciprocal, for example, the loneliness associated with depressive behaviours (through isolation and other socially avoidant behaviours) has been positively correlated with stress outcomes in individuals (Cole et al., 2015). This means that both conditions have the potential to make each other worse, thus both may need to be addressed in order to approach either or both conditions. The symptoms of depression vary and at times contradict one and other (Kanter et al., 2008). Depressive disorders can lead to a decline in psychosocial functioning, negative affectivity and at worst suicide. Depression should be seen and treated as a serious condition. Chronic stress should be avoided to prevent it feeding into the reciprocal relationship it has with depressive disorders.

## Psychological Distress Management

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### Sleep

Studies have associated less sleep with higher prevalence of psychological distress (Glozier et al., 2010) Additionally, polysomnographic evidence has linked depression with sleep disturbances, particularly during slow wave sleep and a prolonged initial REM period of sleep (Rieman et al., 2001). For individuals suffering from prolonged bouts of stress, better sleep may help alleviate negative mental health outcomes (which include stress, anxiety and depressive symptoms) given that the individuals have poor or irregular sleep patterns (Scott et al., 2021). A strict sleep schedule, regular exercise, no electronics (avoiding blue light) and avoiding excessive consumption of food or consumption of stimulants or alcohol before bed is recommended to not interrupt sleep. Overall, sleep reduces stress as it lowers cortisol levels, and has been alleged to help with dealing with anxious symptoms through refreshing prefrontal emotional mechanisms[factual?]. Considering bad sleep is a risk factor for developing depressive symptoms, good sleep should be prioritised to benefit mental health.

### Physical activity

Physical activity is tied to the release of endorphins, [grammar?] chemicals in the brain that make people feel good. In 2014, an Australian study highlighted that frequent engagement in at least moderate physical activity reduced psychological distress in participants (Perales et al., 2014). An increase in endorphins helps individuals relax, reducing both stress and anxiety levels (Anderson & Shivakumar, 2013). The Black Dog Institute also recommends exercise as a treatment for mood disorders such as depression, noting that endorphins can provide an antidepressant effect. Overall, exercise can improve positive affect and reduce negative mental health outcomes (Sharma et al., 2006). With this in mind, it is recommended that adults engage in 30 minutes of exercise a day from three to five days per week to reap the most benefits for their mental health[factual?].

### Socialising

Socialising has been linked to dopamine release, which helps alleviate symptoms of distress and anxiety (Krach et al., 2010). This focus on outward energy has a distracting effect, leaving less time to spend focusing energy inwards on the self, reducing the individual’s window for worrying about the self. The Mayo clinic notes that in-person socialisation is the best for producing mental health benefits, however online socialisation is better than not socialising at all[factual?]. Furthermore, in order for socialising to have the best benefits on your mental health, it is recommended to have at least 6 hours of socialising on a regular basis[factual?][How often?].
* Video
* A TED talk about how exercise can benefit your mental health, watch from 8 to 10 minutes in
* Click here: access video

### Meditation

Meditation, particularly mindfulness meditation (see figure 3) has been put forward as a great everyday method to reduce distress. Apa.org notes that mindfulness mediation[spelling?] has two main parts, one focusing on attention and another centering around acceptance. The attention side of meditation is about bringing yourself back into the present and aims to take individuals out of their worries if they are concerned about something they cannot immediately fix. Alternatively, the acceptance side centres around acknowledgement, where you register the feelings then try to part from them afterwards.
Meta-analysis on mindfulness based approaches to stress reduction indicate it has a strong effect on reducing overall stress outcomes (Eberth & Sedlmeier, 2012), a medium to small effect on alleviating depressive disorders and finally another medium effect on those suffering from anxious disorders. Institutions such as Harvard provide instructions on how to practice mindfulness meditation.

### Diet

A balanced diet is great for managing stress, with research suggesting that omega-3 fats and veggies can help control cortisol levels (see Harvard's page on stress and health). Poor diet is also associated with an increased risk for both anxiety and depression (Dutheil et al., 2016). With this in mind, either cook your own food or consider meal prepping in order to create a diet with optimum nutrition for your health needs.
Additionally, some drugs affect the brain in the same way that stress does, which leads to a predisposition to experience more stress in users. Furthermore drug use should be kept to a minimum, with studies finding positive correlations between drug abuse and chronic stress (Sinha, 2008). Anxiety and depressive disorders can also push individuals towards drug abuse, the negative affects of which should also be avoided[factual?]. Ultimately, diets should be as balanced as possible, with an increase in vegetables and omega-3s and a decrease in processed foods to best support your health, as well as limiting drug consumption as to not deal with negative side effects.

### Time management skills

Working on time management skills can also be a method to manage stress. Proper time management allows for both work and time to rest, which reduces the likelihood of burnout. A study on the matter found that perceived control over time was the best indicator of mental health outcomes and performance outcomes in students (Macan et al., 1990). Ways to promote time management skills could be through the incorporation of a daily planner, prioritising tasks in order of importance, establishing a routine and avoiding multitasking. Successful time management may not actually decrease demands on the individual, however studies uniformly link it to reduced stress outcomes and increased perceptions of control over time in individuals (Hafner et al., 2015). With this in mind working on time management skills may be an avenue to reduce chronic stress and anxiety in individuals.

### Indulgence in nature

Exposure to nature can reduce psychological distress. The biophilia hypothesis proposes that connecting with nature may bolster positive emotions in individuals. Attention restoration theory puts forward that nature can also reduce negative emotions in individuals. Time spent with nature has a positive effect on individual mental health.[factual?]

## Case study

John has been feeling down lately. He’s finding that it’s hard to get to sleep at night and stress keeps piling up. After coming to terms with the fact that something is wrong, he decides to investigate, changing his behaviour to help him sleep better at night. After doing a quick google search he decides to stop drinking coke before bed, turns off his phone an hour beforehand and sets a consistent sleep schedule. It takes a few days for these changes to take effect, but he notices his sleep becoming more restful and starts to feel much less stressed and anxious in his daily life.
Quiz
1
The chemical causing John's distress is most likely:
Cortisol
Epinephrine
Dopamine
2
What factor may be contributing to John's sleep issues:
Investigating his sleep behaviours
Caffeine before bed
Having a generic name
3
What else could John do to help himself sleep, that hasn't been mentioned in the case study:
Drink until he blacks out
Exercise during the day
Exercise before bed
Watch movies until he falls asleep on the couch :

## Conclusion

This chapter defined psychological distress, noting that symptoms may be indicative of chronic stress, or relating to anxious and depressive disorders. The synergy between the Cannon-Bard hypothesis and neurological theories of emotion were noted; as both put forward hypothalamic structures as the cause of stress responses in the body. The effects of stress on the body were discussed, including physical effects such as changes in behaviour and increased risk of illness, as well as psychological issues that may arise under chronic stress such as anxiety and depression. Finally, methods of management for individuals were discussed along with their effectiveness. These solutions mainly revolved around adjusting behaviour, however meditation focused on adjusting thought patterns through mindfulness. The important message of this chapter is that stress is not always bad, however it is important to manage stress in a healthy way to avoid health complications that may arise when it turns to psychological distress.