Therapeutic Information Giving as a Treatment for Stress
It is important that Clients understand how a build up of stress can cause problems, and that they are given as much information about their condition as possible. This is known as 'therapeutic information giving' and forms an important part of any treatment for stress and related conditions.
If Clients can understand stress in terms of the three interrelated systems of physiology (the physical changes they experience), cognition (their anxious thoughts) and their behaviour, this may be the first step in breaking the stress spiral.
We have seen how the physical symptoms of stress are caused by the activation of the Fight or Flight Syndrome: The heartbeat increases to pump blood carrying oxygen and nutrients to cells and clearing away waste. This causes the blood pressure to rise. Breathing becomes rapid and shallow. The liver releases stored sugar into the blood to meet increased need. The pupils dilate to let in more light. The other senses are more receptive. Muscles tense ready for movement. Blood flow to digestive organs and the hands and feet is constricted, but is increased to the brain and major muscles. The increased metabolism generates more heat, so sweating occurs.
Thus people may become pale, suffer palpitations, dizziness, breathlessness, tingling, cold hands and feet, nausea, diarrhoea, blurred vision, chest pains and muscular tension. Breathlessness and overbreathing may in turn result in an altered blood chemistry which gives rise to numbness, tingling and cramps (Christie and Mettlett,). Clark believes that panic attacks result form catastrophic interpretations of these physical symptoms of stress, and that this can contribute to the development of a phobic response, particularly agoraphobia. It is common for sufferers to believe that they are seriously ill, physically or mentally. Weekes refers to this fear as 'second fear', being additional to the 'first fear' of the symptoms themselves.
In order to allay Clients' 'second fear' of illness and insanity, it is useful to describe the Fight or Flight Syndrome in relation to their individual symptoms of stress. A detailed explanation enables people not only to gain awareness of their condition, but also to develop a confidence that they will be able to cope effectively with the symptoms. Such findings are shared by many psychological treatments and are not special to Stress Management (Childs-Clark, Whitfield, Cadbury and Sandu). Powell) found that Clients rating individual components of Stress Management Training rated Information Giving as significantly higher than some other parts of the treatment.
The Causes and Symptoms of Stress
Stress has been defined as the condition that results when person/environment transactions lead the individual to perceive a discrepancy between the demands of a situation and the resources of their biological, psychological and social systems (Lazurus and Folkman).
Stress is however, an unavoidable aspect of life. When stress is handled effectively, helping us to achieve our goals, it is described as 'eustress'. When stress gets out of control leading to illness and poor performance, it is described as 'distress'. Stress is experienced differently by different people. What might be an anxiety provoking experience for one individual, may be exciting for another. It is the individual's perception of the situation which is important.
The transactions that lead to stressful conditions generally involve a cognitive appraisal process, this takes two forms, primary and secondary appraisal. The primary appraisal process focuses on whether or not the demand on the individual poses a threat to their well-being, this produces three judgements, either the demand is good, irrelevant or stressful. Stressful appraisal will go on require further assessment regarding the amount of harm or loss, the threat of future harm and the challenge it presents to the individual. When the individual appraises a large discrepancy between demand and resources, stress is experienced. As to whether the demands are appraised as stressful is dependant on two types of factors, those relating to the individual and those relating to the situation or environment.
The person-centred factors are those including motivational, intellectual and personality characteristics. Situational factors are those relating to strong demands which are undesirable, imminent, uncontrollable and involve major life transitions, or occur at an unexpected age in the individuals life span.
There are many events which may precipitate feelings of stress. Stuart and Sundeen identify two distinct theoretical categories, those which threaten an individual's physical integrity and those which threaten self-esteem. Threats to personal integrity include impending physical disability and deficits in the ability to attend to the activities of daily living. Threats to self-esteem suggest harm to an individual's identity, their social functioning and self-esteem. There is however, an overlap between the mind and body and threats to physical integrity also threaten self-esteem.
Stress has short term effects and long-term effects. The immediate short term alarm reaction which we refer to as the Fight or Flight Syndrome was first recognised by Cannon in 1929. This is our automatic response to danger. For individuals who have learnt the wrong messages or have inadequate coping mechanisms, the Fight or Flight Syndrome switches on at the wrong times. If there is a constant release of low-level adrenaline, the muscles will be kept in a state of readiness; this can build up over time to damage the heart muscles and weaken the immune system. When the stress response is triggered too often and too intensely we accumulate the effects of the released chemicals in our bodies. Eventually this will lead to illness as the weakest part of the body breaks down under the strain.
Stress can also have a profound effect on psychosocial processes within the individual. Cognitive functioning can become impaired. There are several emotions associated with stress, they are anger, depression, anxiety and fear. These feelings tend to remain even after the stressful event is over, continuing to impair the individuals immune response and contributing to risk of stress related illness.
Hans Selye describes a three stage model of stress which he called the general adaptation syndrome. The first stage is the Fight or Flight syndrome, the second stage is one of resistance, where the body tries to return to a state of equilibrium and the third stage is that of exhaustion and collapse. Selye describes adaptive responses to stress as including the recognition of external stressors, awareness of resources, choosing appropriate strategies, problem solving and ventilating repressed feelings. Maladaptive strategies are described as failure to recognise and understand the stressors, negative, catastrophic thinking which may create a vicious circle of response such as panic attacks, avoidance, aggression, isolation, drug and alcohol consumption and withdrawal from social support.
Holmes and Rahe have suggested that the impact of some life events can increase the risk of stress related illness. They drew up the stress inventory which we have presented in Session one of this Training. Their aim was to measure the impact of some life events. Holmes and Rahe examined 5,000 case histories in order to identify those life events which most often precede the onset of illness or the exacerbation of an existing illness. They ranked the life events and asked 394 people to attend a stress value to each. Studies suggest a relationship between life change scores and the onset of tuberculosis, heart disease, skin disease and a general deterioration in health and performance. Research has also found a strong link between life changes and mental illness. Patients hospitalised for depression are six times more likely to have suffered a recent bereavement. Paykel and Prusoff found that the incidence of significant life events during the preceding six month period was four times greater in suicidal patients than in non-suicidal patients.
The personality of an individual also affects their reaction to stress. Friedman and Rosenman found that individuals can be classified into two types. Type A individuals being characterised by highly competitive behaviour, inability to relax or switch off after work, impatience, restlessness and a tendency to do everything in a hurry. Type B individuals are more relaxed, calmer and have a less anxious approach to life. Clinical experience shows that low levels of assertiveness, difficulties in expressing personal feelings, unrealistically high expectations of self and others, often accompanied by a strong perfectionist streak, can lead to high levels of stress.
Stress can be viewed as a dynamic process which has a negative effect on an individual's lifestyle and can seriously impair their ability to function at an optimal level.