John R. Cook, Ph.D.
Registered Psychologist

What is Stress?

Stress is any response we have to any kind of psychosocial or physical demand placed on us. These demands are called stressors. Hans Selye, the famous Canadian pioneer in stress research believed there were positive and negative forms of stress which he called eustress and distress, respectively. Our individual responses to stress vary depending on our physical makeup, personalities and past learning experiences. Some of us are more resilient than others.

Stress vs. anxiety

Although anxiety is often part of how we experience stress, it isn't quite the same as stress. The nervous arousal of anxiety stems from worry about how well a person will cope with some future threat or danger. Consequently, anxiety sufferers tend to be concerned about their level of preparedness, and tune into how well they are doing on the inside. In contrast, stress sufferers tend to be more nervous about the immediate challenges in their outside world - getting that job promotion or making it through traffic on the way home.

Anxiety and stress are similar insofar as we need both in moderation to be able to function effectively in our daily lives. Without it, our lives become dull and blasé, and we risk mediocre performance. On the other hand, if there is too much stress, our performance begins to break down.

How much is too much?

For the most part, stress serves to activate us so we're better able to respond to the challenge. How do you know when you have crossed the line with stress in your life? In general, you know you have a problem when you aren't performing up to your usual standards at work, in school or in social relationships.

You either "numb out" and become emotionally unresponsive or overreact and "bite people's heads off" for the smallest things. Even the simplest tasks start to feel overwhelming, and you notice yourself feeling strung out, tense and on edge much of the time. You just want to crawl away in a hole somewhere.

Types of stress

Stress comes in four basic forms - acute stress, episodic acute stress, chronic stress, and traumatic stress. It is important to distinguish among them because the type of stress has a bearing on your prognosis for recovery and the type of treatment that is likely to be successful.

The most common form is acute stress. Acute stress occurs mostly in reaction to easily identifiable events in the recent past or near future. It is short-term, and for this reason, it doesn't do the kind of damage associated with longer-term stress. People with acute stress have some temporary emotional disturbance, muscle tension, gut problems and transient symptoms of nervous arousal. The condition is highly treatable and manageable.

Recurrent episodic acute stress occurs for people who follow patterns of chaos and disorder in their lives. They do not readily address the personality (e.g., Type A personality) and lifestyle problems in maintaining this pattern. They become symptomatic with relatively little provocation, and therefore tend to experience these symptoms on a more or less continuous basis. Professional help is often required.

Chronic stress can be deadly because of its depletion of physical and mental resources leading to systemic illness. Examples of situations that produce chronic stress reactions include poverty, unhappy marriages or careers, and civil strife/war. Most chronic stress situations require help from a team of professionals, and the prognosis is guarded.

Traumatic stress is beyond the scope of this workshop, and results from single or multiple incidents of stress that are much more severe and overpowering than in any of the other forms of stress. In fact, these incidents generally involve experiencing or witnessing the threat of death or serious injury under conditions of intense fear, helplessness or horror.

Stress hurts

Whatever its form, stress is a serious problem in our society. It is widespread, and the cost are staggering. Seventy-five to ninety percent of visits to family physicians are due to stress-related disorders. The annual cost of stress to United States industry in terms of absenteeism, lost productivity, accidents and medical insurance claims is well in excess of 300 billion. Some of the medical consequences are such stress-related illnesses as hypertension, heart attacks, strokes, cancer, diabetes, asthma, and arthritis.

The First Two S's of Stress Management

The approach to successfully managing stress that I would like to offer this evening is made up of four Ss: susceptibility, signs, sources and strategies. Let's start by looking at health behaviours and coping resources that affect your susceptibility to stress.

Susceptibility to stress

The following items have been modified from the Stress Audit of Miller and Smith (1993). As I read each of five items, decide whether it is true of you ALMOST ALWAYS, NEVER, or somewhere in between. Then circle the appropriate number on your sheet.

Scoring:

8 - mild susceptibility
8 to 10 - moderate susceptibility
11 to 13 - high susceptibility
14 and above - serious susceptibility

For convenience sake, we can categorize our stress symptoms according to how they bother us - physically, emotionally or cognitively. How many of the following five physical symptoms are bothering you?

How many of these five emotional symptoms have caused you stress?

Finally, how many of the following cognitive symptoms apply?

The Third S of Stress:

Source Internal sources of stress
Several different models have been proposed to explain why some of us are more vulnerable to stress-related illness than others. One is the model of the coronary prone personality type or Type A personality developed by Friedman and Rosenmann in the 1960s. According to Friedman and Rosenmann, the Type A personality was a collection of behaviours or action potentials that made heart attacks more likely. Some of these behaviours were:

External sources of stress

Other models have been proposed to account for external sources of stress. Adolph Meyer, a turn-of-the-century psychiatry professor at Johns Hopkins medical school kept a "life chart" of his patients in which he recorded illnesses of all kinds. He noticed that illnesses tended to follow times of significant change in his patients' lives. Holmes and Rae went on to refine this idea in 1967 by developing the Social Readjustment Rating Scale to measure the amount of change we go through in our lifetime relative to getting married. Holmes and Rahe believed happy as well as negative events could be impactful, and that the effects of life change were cumulative.

Scoring

The major sources of stress in our lives are job, family, personal, social, environment and financial. Once we recognize how we are experiencing stress, these are the areas we need to investigate to find out what is causing our stress, and what we can do about it. Take the example of job stress, below.

Job burnout

Seventy-five percent of Americans describe their jobs as stressful, 34 percent consider quitting because of stress, and 90 percent experience high stress at least once a week. Sources of job stress can include uncertainty about job permanence, lack of control over demands and time tables, ambiguity in your job description, being mismatched in skills or interests, and exposure to on-the-job traumatic events, to mention a few.

Perhaps the most insidious and tragic kind of job stress is burnout, described by Miller and Smith (1993) as "a state of physical, emotional, and mental exhaustion caused by unrealistically high aspirations and illusory or impossible goals." Burnout happens in four stages, and when it happens to us we rarely recognize it until it's too late. During the honeymoon phase we think our job is wonderful and experience boundless energy and enthusiasm.

The awakening stage of burnout is heralded by a realization that our initial expectations were unrealistic. That is, we begin to recognize the limitations of our job, and even as we work harder to overcome these limitations we find ourselves becoming discouraged and begin to question our competence.

Brownout is the stage before full-scale burnout. This is the phase during which we become increasingly tired and irritable. Our eating and sleeping patterns are significantly altered and we start to become cynical and detached, and begin to project blame for our difficulties onto others, particularly our bosses. Our work deteriorates as we become physically ill, emotionally unstable and abuse substances.

In full-scale burnout we become physically and mentally exhausted, often breaking down completely in physical and emotional illness. Suicide, strokes or heart attack are not unusual in this final stage. The only way back to full health from here is through time off work, appropriate medical care, and professional counselling.

The Fourth S of Stress:

Strategies The 3 A's of stress management
Once you have identified your sources of stress, choose among the options for dealing with these sources. There are three basic strategies for stress management:

altering situations to make them less stressful,

avoiding stressful situations, or

accepting them.

Try to be flexible in your implementation - freely switching among these strategies as situations change and/or you experience fluctuations in your resources for coping.

Managing your outside world

In general, altering strategies involve working with controllable factors in our outside world. Some of these strategies include:

Alternatively, you may wish to avoid external sources of stress by setting stress-resistant boundaries. These boundaries allow you to achieve physical separation and/or psychological distance from stressful people, places and things.

Managing your inside world

Finally, accepting strategies involve letting go of what isn't in our control, and managing our internal world through relaxation techniques.

Recommended Reading
     Chaitow, L. (1995). Stress. Proven stress-coping strategies for better health. Harper Collins Publishers: London.

     Davis, M., Eshelman, E. R. and McKay, M. (1995). The relaxation and stress reduction workshop (4th ed.). New Harbinger Publications, Inc.: Oakland, CA.

     Edstrom, Krs (1993). Conquering stress. The skills you need to succeed in the business world. Barnon's Educational Series, Inc.: New York.

     Gordon, J. S. (1990). Stress management. Chelsea House Publishers: New York.

     Miller, L. H. and Smith, A. D. (1993). The stress solution. Simon & Schuster, Inc.: New York.