# Motivation and emotion/Book/2011/Stress and emotional health

* Multimedia presentation (5 min)

## Introduction

This chapter addressed two focus questions:
* What is the effect of stress on emotional health and well-being?
* How can the negative effects of stress be avoided and minimised?
Stress is best described as being the lowest common denominator in an organism’s reaction to any kind of strain (Cooper, 2005). Stress varies on a case by case basis, but it may be found on some level in all living organisms. If stress is present in every case, is it harmful? This depends on the context of the stress. Stress can be good and bad, and fortunately for humans, can not be biologically switched off (Lovallo, 1997). Stress is a necessity for life and is a primary biological incentive for all. In order to live a happy and productive life, attention needs to be directed towards questions such as; How great is it? or Should I react like this in this situation? Emotional wellbeing is dependent on ones control over stress, as stress can be seen as a challenge instead of a threat. When one lacks this sense of control, stress can be bad news, causing health issues and community concerns (Levi & Levi, 2000). When humans are exposed to “stressors” such as excessive demands, over stimulation, financial hardship, under stimulation and broken relationships, most people experience negative emotional reactions that effect our emotional wellbeing such as; anxiety, depression, uneasiness, apathy, alienation, and hypochondriasis (Cooper, 2005). These negative emotional reactions affecting emotional wellbeing can also contribute to behavioural reactions. Stress affected people might start smoking or overeating, find comfort in alcohol, and take unnecessary risks at work (Cooper, 2005). Stress not only affects ones psychological health but also initiates a physiological reaction in your body, which can cause serious health issues. For example, imagine you are at basketball practice and your coach has stopped training and unfairly criticises you in front of the team by yelling at you. Your typical reactions would include increased blood pressure, increased or irregular heart rate, muscular tension, dryness of throat and mouth, and over production of acid gastric juice. Of course, not everyone’s reactions are the same to these sorts of situations, so one might ask, Who is most at risk? The answer is simple, people higher at risk are those who are highly competitive, over achieving type personalities, impatient, and those who try to fit in more and complete more in less tme and who also do not make time for relaxation and periods of rest (Karasek & Theorell, 1990).

## Stress and emotional well-being

Can stress really affect my Emotional Wellbeing? Most people might think that stress can only affect them physiologically; however, this is not the case. Self-esteem is used to refer to a sense of positive regard. In other words self-esteem is a level of how positive or negative you feel about yourself. If your self-esteem is high your emotional wellbeing and mental state aligns itself accordingly and vice versa. When someone displays low level of self-esteem they are more likely to have negative thoughts about their abilities with education, self appearance and self confidence (Rice, 1992). Stress, believe it or not, impacts ones self esteem, and emotional wellbeing by allowing thoughts of failure and anxiety to take control of their thoughts in threatening or stressful situations. According to Rice, people who have high levels of self esteem are less likely to respond or perceive an event as emotional or stressful. Low self-esteem contributes to a lack of coping abilities when one is confronted with stressors. When self-esteem is low, the ability to deal with stressful situations diminishes, as individuals believe they cannot do anything ‘right’ to escape the situation or avoid it in the future (Rice, 1992). Low self-esteem shares a close relationship with such mental illnesses and disorders as depression and anxiety (Durand & Barlow, 2010). It is when self-esteem arrives at such a low point that a person must seek professional help or advice.

## The stress response theory

Theories of stress began with the ‘Stress Response Theory’, introduced by a medical student Hans Seyle. Seyle proposed that three elements (adrenal cortex hypertrophy, thymicolymphatic atrophy, and gastrointestinal ulcers) were the basis for his stress response pattern (Rice, 2000). It was these three elements that Seyle thought to be interpendent as they seemed to accompany most illnesses and were provoked no matter the stimulus or illness (Rice, 2000). Seyle came at his theory from a backwards approach and chose to conceptualise stress as what it was not. Seyle wrote that stress is not:
* Simply nervous tension: It can occur in organisms without nervous systems or in anesthetised or unconscious patients
* An emergency discharge of hormones from the adrenal medulla: Although catecholamines are a part of the stress reaction, they are not the only hormones activated, and they play no role in generalised inflammatory diseases or local stress reactions
* Everything that causes a secretion of the adrenal cortex (i.e. corticoids): Adrenocorticotrophic hormone (ACTH) can stimulate the release of corticoids without producing a stress response.
* Always the nonspecific result of damage: Normal activities, such as tennis or a passionate kiss, can produce a stress response without conspicuous damage.
* The same as a deviation from homeostasis, the body’s steady state: Reactions to loud noises, blinking of the eye, or contracting a muscle may cause deviations from the resting state without evidence of a generalised stress reaction.
* Anything that causes an alarm reaction: It is the stressor that is the stimulus not the stress itself.
* Identical with the alarm reaction: These reactions are characterised by certain end-organ changes caused by stress and, hence, cannot be stress.
* Nonspecific reaction: The pattern of the stress response is specific, although its cause and effects may vary.
* Necessarily bad: The stress of success, challenge, and creativity is positive, whereas that of failure, anxiety and infection can be negative.
* To be avoided: Stress cannot be avoided. It is ubiquitous; it is an essential ingredient of life. Selye viewed stress as the common denominator of all adaptive reactions in the body and complete freedom from stress as death.

## General Adaptation Syndrome (GAS)

Hans Selye was also the pioneer for the General Adaption Syndrome (GAS). GAS is a general physiological response when an organism experiences threat (Cooper, 2005). Selye divided GAS into three stages; Alarm Stage, Resistance Stage, and Exhaustion stage. The Alarm Stage involves activation of certain cells in the hypothalamus to a state of emergency and the autonomic nervous system is stimulated during this shock phase (Rice, 2000). This shock phase can last from a few minutes to 24 hours depending on the severity of the situation. The Resistance Stage is a dramatic reduction in the alarm reaction as the body readies itself to transcend the stressor (Rice, 2000). The Resistance Stage is viewed as a survival attempt from the body in order to defend itself from the stressor (Rice, 2000). The Exhaustion Stage is the final stage in the GAS theory. Human resources become depleted and the initial insult or injury is too overwhelming for the body to repair. Since the introduction to GAS, research has outgrown Selye's initial theory and focus has been directed towards:
* Stimulus factors
* Response factors
* An interactive process
Lazarus and Folkman, also added to this theory by stating that individuals can engage in a process or primary appraisal when confronted with a new or changed situation and in a secondary appraisal when assessing their coping abilities required to meet the challenge or possible harm of the potential event (Rice, 2000).

## Physiological impacts stress has on health and emotion well-being

Stress has multiple physiological reactions and affects the bodies brain function, immune system, digestive system, respiratory system, and the cardiovascular system. Early literature and biomedical research has directed more attention to the physical origins of the heart, however, the recent rise of psychological research has broadened their views and shifted their attention towards psychosocial and lifestyle factors that contribute to cardiovascular problems (Rice, 1992). One of the major focuses for this shift in attention to research is stress. As mentioned previously, stressful and emotionally heavy situations can cause problems in the rate and intensity of the cardiovascular system and respiratory system. From research conducted, stress does have severe impacts on the cardiovascular system. Stress can cause hypertension, cardiomyopathy, and atherosclerosis (Rice, 1992). Other physiological reactions one may experience when exposed to stressful situations include: muscular tension or pain; gastrointestinal symptoms; indigestion; heartburn; vomiting; constipation; depressive reactions;, insomnia; weakness; faintness; headaches; and sexual dysfunctions. Females may also experience a disturbance with their menstrual cycle.

### Cortisol

Cortisol, also known as the “Stress Hormone”, plays an integral part in motivation and emotion (Reeve, 2009). The hypothalamic-pituitary-adrenocortical system reacts within ones brain, and releases the hormone cortisol from the adrenal glad when one is exposed to a stressor. Cortisol is most likely to be activated when a person is placed in a situation to be socially judged or evaluated (Dickerson & Kemeny, 2004). Cortisols' activation with stressful events should not be ignored as high levels of cortisol is associated with poor intellectual functioning, negative affect, and poor health. (Brown & Suppes, 1998).
According to Lovello, higher and more prolonged levels of cortisol in the bloodstream are found with those suffereing from Chronic Stress. Sufferers of chronic stress may have negative effects from said levels of cortisol, such as:
* Impaired cognitive performance
* Suppressed thyroid function
* Blood sugar imbalances
* Decreased bone density
* Decrease in muscle tissue
* Higher blood pressure
* Lowered immunity and inflammatory responses in the body, slowed wound healing, and other health issues
* Increased abdominal fat, which is associated with a greater amount of health problems than fat deposited in other areas of the body, which can lead to heart attacks, strokes, and the development of metabolic syndrome.

## Psychological impacts stress has on health and emotional well-being

According to Cooper, stress and mental illness is a controversial area of study, as it depends on your perception of how mental ill health arises. Stress is particularly involved in the beginning steps of symptoms for mental disorders (Rice, 2000). The DSM-IV-TR states that Major Depressive Disorder episodes usually follow a stressful situation. From this information, studies have proven that stress plays a pivotal role in the episodes associated with depression, Post Traumatic Stress Disorder (PTSD), and Anxiety.

### Depression

Most humans can say they have experienced some type of depressive mood or feeling. At one stage in our lives something or someone has affected our thoughts and feelings, so that we feel down or negative towards ourselves. But most of us have had the ability to pull ourselves out of this dark state with either help from a friend or another social or environmental influence creating happiness in our lives again. For the other "not so lucky" people, this turn to happiness may not be so easy to accomplish. According to the DSM-IV-TR, there are several types of depressive disorders affecting ones psychological well-being. The most prevalent and easily recognised depressive disorder is the Major Depressive Disorder (Durand & Barlow, 2010). Major Depressive Disorder episodes are often caused by severe psychosocial stressors. A devoted attention towards depression is due to the frightening rise of depression and as a consequence suicide (Durand & Barlow, 2010). The average age of onset of Major Depressive Disorder is 22 years, however, it has become more prevalent in young adolescents in the past ten years and has been proven by researchers that onset of depression before 21 years of age can be linked to three characteristics; 1 – It lasts longer (greater chronicity), 2 – poor response to treatment, and 3 – likelihood of the disorder running in the family (hereditary) (Cooper, 2005). The lengths of depressive episodes vary depending on each individual case. Some may last up to 2 weeks, with others lasting several years or for their entire life (Durand & Barlow, 2010). Although some people may suffer from depression their entire life, due to hereditary reasons, many can recover from this state with the help of ongoing psychological treatment (CBT, and ECT), and medicinal products such as; monoamine oxidase inhibitors, Trycyclics, and selective serotonergic reuptake inhibitors (Durand & Barlow, 2010).

### PTSD

* CASE STUDY
* George is a 35 year old man, he is married and has 3 children. George has recently returned from a posting in Afgahnistan with the Australian Army. Upon return he has been experiencing flash back memories and nightmares of the traumatic events he witnessed and experienced while on post. At first George thought that these would slowly stop occurring and eventually vanish, however, after returning to the city, any loud noises (eg. raod works, banging noises etc) that George heard, acted as a trigger and took him back to the war zone. George blacks out and becomes extremely distressed and anxious, and can stay in this state for as little as a few minutes and in some cases for up to 2 hours. George's wife experienced one of his episodes and became very scared as he spoke and acted like he was in the war zone, using military-style language and skills. George and his wife sought professional help and booked into the Army's psychologist, and talked about both their experiences. At the end of the session George was diagnosed with PTSD and has been recommended to continue treatment to help him and his family through his psychosocial disorder.
True to its name PTSD is caused by one or more stressor/s that sufferers must have been exposed to, witnessed, or been confronted with during a traumatic event (Cooper, 2005). Sufferers of PTSD are confronted with feelings of helplessness, fear, or horror when experiencing their traumatic event. Afterward, memories or nightmares of this traumatic event are relived and the event is seen by the sufferer as a flashback (Durand & Barlow, 2010). Sufferers of PTSD avoid anything that reminds them of the trauma, whether it is particular noises, smells, people or places. It is most common for sufferers of PTSD to repress their memories to avoid reliving or gaining information about their traumatic event. Memory repression in PTSD victims usually occurs automatically and unconsciously. PTSD can be subdivided into acute and chronic and cannot be diagnosed until a month after the traumatic event (Albano, Miller, Zarate, & Barlow, 1997). Acute PTSD can be diagnosed a month after the traumatic event and is associated with mild avoidance behaviours. When PTSD continues over 3 months and longer it is considered to be chronic. Chronic PTSD is also associated with more dominant avoidance behaviours. It is clearly known to researchers that PTSD is triggered by a traumatic event; however, depending on whether or not someone develops PTSD is due to biological, psychological and social factors (Durand & Barlow, 2010). So if people try to avoid memories and familiarities of this disorder, how do we treat PTSD? Well according to Durand and Barlow, the psychological approach is to have victims of PTSD face their original trauma to develop effective coping strategies. Creating these strategies will help dissolve the effects of PTSD and overcome the disorder. When undergoing treatment the repressed memories of the victims may flood back (this is called a flashback) causing the patient to relive the event. This can be quite frightening for both the patient and the therapist; however, it is an important part of successful therapy (Durant and Barlow, 2010).

### Anxiety

Anxiety is a negative mood state characterised by physical symptoms such as tension and apprehension about future events (Durand & Barlow, 2010). Like stress, anxiety is necessary for human performance, as long as it is controlled and does not overwhelm emotional state. Anxiety is hard to study in humans, as it can be brought on by many contributing factors and can be expressed by facial expressions, biological factors, and behavioural changes (Durand & Barlow, 2010). Anxiety is a very complex issue and is becoming more difficult to determine as research continues.

## Self help and avoidance

Are you being affected by Stress or Emotional Stress?
Avoiding stress is not always easy. As humans cannot get rid of stress they must find ways around it, by taking control. Firstly one needs to recoginise and see what stress is to them, and how it affects them individually. There are many ways of knowing if you're displaying signs of emotional stress. It’s a matter of focussing your attention that is more important. According to Lovallo, signs of stress can be in the form of;
* Apathy – lack of energy
* Difficulty making decisions
* Feeling on edge
* A change in eating habits
* Sleeping more than usual, or disturbed sleeping patterns
* Displaying more states of emotion
* Use of alcohol or drugs to relieve or forget stress
If you are displaying any of these signs of stress you should talk to your local GP or Health practitioner as early as possible.
Tips to help you de-stress?
There are many ways to avoid stress and control an oncoming stressful disaster. It all depends on the individual and the situation one is in. It is extremely important that sufferers seek social support as it is a necessity to helping anyone through stressful situations (Rice, 1992). Just as biological equilibrium is important for the bodies existence, it is also as important to uphold equilibrium in your day-to-day life. Everyone should display good levels of ‘work-life-balance’, by ensuring they make time away from work to experience and participate in enjoyable activities and hobbies (Lovallo, 1997). Below are five quick and easy ways to regain clarity and your calm when confronted with stress; (Rice, 1992).
* Take a walk – Exercise can be a great stress reliever, as it helps you blow off steam and releases endorphins into the body. Going for a walk removes you from the situation but also provides you with a clearer frame of mind.
* Take a Breath – This is useful when you cannot leave the situation. Using breathing exercises, you can get more oxygen into the body and relieve tension.
* Take a Mental Break – When you have the chance to steal away a few minutes of peace, do so! Visualising and imagining a peaceful mind set not only relaxes you mentally but it relaxes you physically too.
* Reframe Your Situation – You may over intensify your situation at first glance. By looking at the situation differently you may be able to put it into a less stressful perspective.
* Muscle Relaxation – Progressive Muscle Relaxation (PMR) is a great tool to use to help you de-stress. PMR involves tensing all of your muscle groups and then letting them go. Any stress that was in your body decreases within seconds.

## Summary

Stress is a biological factor that has positive and negative effects on humans. As explored throughout this chapter it can affect ones health and emotional wellbeing in many ways. In this chapter we have discussed the complex ways in which stress effects the bodies make up, with particular devotion towards psychological and emotional wellbeing and brief attention directed towards the physiological effects. Stress is a major contributor, to triggering such mental illnesses as; depression, anxiety, and PTSD. These illnesses need immediate medical attention and must be successfully managed and treated before any attention is directed towards stress, and how to manage it. Although physiological effects were touched on lightly in this chapter they are not to be ignored. Stress still has pivotal impacts on ones respiratory and cardiovascular system, and if the symptoms are present then you should seek professional help.