Understanding and Managing Stress

Ajoy Fernandes sdb

Having arrived a month earlier than the start of the academic year in the Philippines in 2001, I sought admission to a brief Pastoral Counseling program at a hospital. I read a chart in the director’s office, and told her that I manifested the symptoms displayed on it. She looked at me with deep compassion and said: “Then you must be highly stressed.” Come to think of it, I was entering a doctoral program in Psychology, and I did not know that I manifested symptoms of stress, burnout and depression! I gradually realized that in order to deal with stress, I needed to understand what it is, its symptoms, how it is generated and addressed. This article attempts to do just that in a brief and summary fashion. However, those interested in learning more about the intricacies of this topic would need to get in touch with more detailed literature.

Origin and Terminology
The term stress was first employed in a biological context by the endocrinologist Hans Selye in the 1930’s. According to him, stress is an inappropriate response to a real or imagined physical or emotional threat or stressor. Stress involves the interplay between the one’s mental state, nervous and immune systems. Thus acute stress affects an organism in the short term; chronic stress over the longer term.

Stages of Stress
Selye identified three stages of stress: alarm, resistance and exhaustion.
· At first, the body responds with alarm to a stressor. Adrenaline is released to bring about a fight-or-flight response together with some activation of the HPA axis, producing cortisol. This may result in sweating, raised heart rate, hyperventilation, tensing of muscles etc.
· If the stressor persists, the second stage of resistance begins. The body attempts to cope or endure the stress by releasing hormones from several glands adapting to the demands of the environment. In doing so, its resources are gradually depleted.
· When all of the body’s resources are eventually depleted, the body is unable to maintain normal function. This is the third stage of exhaustion. If stage three is extended, long term damage may result, as the capacity of glands, especially the adrenal gland, and the immune system is exhausted and functioning is impaired. This can result in illnesses such as ulcers, trouble with the digestive system, and cardiovascular problems, along with other mental consequences such as anxiety and depression.
· Burnout is a psychological term for the experience of long-term exhaustion and diminished interest. It seems in some ways to be the psychological correlate of Selye’s third stage of biological exhaustion. In the 1970’s Maslach and Jackson proposed that “burnout” involves three dimensions: exhaustion, cynicism and inefficacy. According to them, the antithesis of burnout is “engagement” which is characterized by energy, involvement and efficacy. Some researchers and practitioners have argued for an “exhaustion only” model that sees that symptom as the hallmark of burnout.

Common Stressors (sources of stress)
Negative stressors depress functioning especially when acute, or extended over a period of time. Some common stressors can be categorized as follows:
· Physical/ Environmental: sensory inputs such as pain, loud sounds, bright light; natural calamities etc.
· Psychosocial: conflict with persons; breaches or loss of relationship such as and deaths, expulsions, rejection, divorce; pressure to compete; failure etc.
· Life experiences such as insufficient sleep due to exams, project deadlines; lack of control over environmental circumstances such as food, housing, health, freedom, or mobility; conflicts of choice; daily irritations and hassles, etc.
· Adverse experiences during development such as prenatal exposure to maternal stress, childhood physical, emotional or sexual abuse etc.
· Life Transitions – (focus on Mid-life transition): sensing the passing of youth amidst societies that espouse a “culture of youth” (Elliott Jaques); confusion of life goals due to mid-life re-integration of previously unattended potentials and data of consciousness (Jungian-inspired); review of personal stagnation and lost opportunities to contribute to life vis-à-vis struggles to find meaning and purpose in life (Erik Erikson); ongoing/ past unresolved issues or losses coming to the fore.

Individual Differences in Response to Situations
Persons respond differently to their circumstances. What is stressful for one individual may be energizing for another. For instance, one person may be excited by the prospect of getting into an argument; another person could be totally paralyzed at the mere suggestion of doing so. Some may simultaneously handle several tasks with ease. Others may find handling even a single task stressful. Thus, personality or personal choices and preferences have a role to play in determining what one finds energizing or stressful. Personality-related stress has been extensively researched, but is beyond the scope of this article.

Indicators of Stress/ Burnout
Persons often continue to endure/ cope with stressors that persist in their lives unaware of the toll it takes on them. Thus, it is important to be aware of the indicators or symptoms of stress (which often overlap with symptoms of anxiety and depression). These symptoms may occur independently or in conjunction with other symptoms:
· Cognitive: - poor judgment, a general negative outlook on life
· Emotional - excessive worrying, moodiness, irritability, agitation, inability to relax, feeling lonely, isolated or depressed
· Physiological: aches and pains, diarrhea or constipation, nausea, dizziness, chest pain, rapid heartbeat
· Behavioral – insufficient or excessive eating/ sleeping patterns; social withdrawal, procrastination or neglect of responsibilities; increased alcohol, nicotine or drug consumption; and nervous habits such as pacing about or nail-biting.
Many theories list negative outcomes related to burnout such as:
o Job function: reduced performance, output, etc.
o Health related outcomes: increases in stress hormones, coronary heart disease, circulatory issues
o Mental health issues: anxiety, depression, rumination, cognitive impairment, anger, psychosomatic illness etc.
Psychologists Herbert Freudenberger and Gail North have theorized that the burnout process can be divided into 12 phases, which are not necessarily followed sequentially. However, this might be more characteristic of Type A persons or those with a Conscientious or Compulsive personality style.
· A compulsion to prove oneself; Working harder; Neglecting one's own needs; Displacement of conflicts (the person does not realize the root cause of the distress); Revision of values (friends or hobbies are completely dismissed); Denial of emerging problems (cynicism and aggression become apparent); Withdrawal (reducing social contacts to a minimum, becoming walled off; alcohol or other substance abuse may occur); Behavioral changes become obvious to others; Inner emptiness; Depression; and Burnout syndrome.

Measuring Stress/ Burnout
Personality is thought to play a role in one’s ability to deal with stressors. Thus, tests like the Trier Social Stress Test attempted to isolate the effects of personalities on ability to handle stress in a laboratory environment. Other psychologists, however, proposed measuring stress indirectly, through self-tests. Stress tests help determine the number of stressors in a person’s life. Burnout tests assess the degree to which the person is close to the state of burnout. Combining the results of stress and burnout tests helps researchers gauge the likelihood of a person experiencing mental exhaustion.

MANAGING STRESS
Stress management is the amelioration of stress and especially chronic stress, often for the purpose of improving everyday functioning. Stress management strategies are consonant with the models from which they are derived, as indicated below. Other strategies cut across, or are independent of theoretical models, and are mentioned in the last part of this section.

Transactional Model
Richard Lazarus and Susan Folkman suggested in 1984 that stress can be thought of as resulting from an “imbalance between demands and resources” or as occurring when “pressure exceeds one's perceived ability to cope”. Thus, in this model, interventions include identifying stressors, enabling persons to perceive them as challenges rather than threats, and providing persons with strategies to help them cope with stressors or increasing their ability to do so.

Health Realization/Innate Health Model
The health realization model focuses on the nature of thought. In this model, stress is thought to result from appraising oneself and one's circumstances through a mental filter of insecurity and negativity. On the other hand, a feeling of well-being results from approaching the world with a "quiet mind," "inner wisdom," and "common sense". This model proposes that helping stressed individuals understand the nature of thought—especially providing them with the ability to recognize when they are in the grip of insecure thinking, disengage from it, and access natural positive feelings—will reduce their stress.

Organizational Model
Tracy in her study aboard cruise ships describes organizational burnout as "a general wearing out or alienation from the pressures of work". "Understanding burnout to be personal and private is problematic when it functions to disregard the ways burnout is largely an organizational issue caused by long hours, little down time, and continual peer, customer, and superior surveillance".

In sync with this model, Maslach and Leiter postulated that burnout occurs when there is a disconnect between the organization and the individual with regard to what they called the six areas of work life: Workload, Control, Reward, Community, Fairness, and Values. Resolving these discrepancies requires integrated action on the part of both the individual and the organization. A better connection on workload means assuring adequate resources to meet demands as well as work/life balances that encourage employees to revitalize their energy. A better connection on values means clear organizational values to which employees can feel committed. A better connection on community means supportive leadership and relationships with colleagues rather than discord.

Common Techniques of Stress Management
Stress derives from many areas of life, and stress relief comes in many forms. While some people like using one favorite tool for stress relief, many experts feel that the most efficient approach to stress relief is one that attacks stress from several different directions, utilizing an overall 'plan of attack' for stress relief. Techniques of stress management vary according to the theoretical paradigm adhered to, but may include some of the following:
· Understanding the source of stress and its manifestations; developing skills for coping; and putting them to use in daily life.
· Developing positive coping strategies like solution-focused coping; getting a positive perspective on one’s circumstances; accessing formal and informal social support networks; engaging in prayer and meditation, etc.
· Managing time effectively helps regulate stress by achieving greater control over one’s circumstances. Time management encompasses a wide range of activities towards accomplishing specific goals such as planning, allocating, setting goals, delegation, analysis of time spent, monitoring, organizing, scheduling, and prioritizing.
· Saying “No” to demands that exceed one’s ability to handle even within a well-managed time schedule helps prevent burnout.
· Engaging in de-stressing activities on a regular basis, such as:
o Fun activities or hobbies.
o Ingesting natural relaxants like herbal teas and aromas.
o Engaging in regular physical exercise boosts the immune system; helps prevent heart disease and depression, and maintain positive self-esteem.
o Deep abdominal breathing promotes a sense of relaxation and well-being. It is marked by expansion of the abdomen rather than the chest when breathing; and is considered a healthier and fuller way to ingest oxygen.
o Progressive Muscle Relaxation - tensing and releasing various muscle groups - helps release tension stored in the muscles. Post-tensing feelings of warmth and lightness in the muscles, gives way to a state of mental relaxation.
o Spending time in nature, or even looking at scenes of nature with "effortless attention", such as clouds moving across the sky, leaves rustling in a breeze, etc., helps promote inner quiet and attention.

CONCLUSION
Getting a perspective on one’s sources of stress; developing awareness of one’s physiological and mental reactions to stressors; identifying symptoms of acute/ chronic stress; adopting effective models/ strategies to de-stress; often go a long way in effectively managing stress. When unable to manage this process on one’s own especially when coping with chronic stress and burnout, accessing professional services may be a viable option.