Stress-Related Problems

Originally, the term “stress” was used in the field of engineering to describe the weight or force necessary to cause something to bend or break. Then, in the mid-twentieth century, researchers began using the term in a similar way to describe forces or events that cause comparable responses in living beings, including humans. These days, “stress” is often defined as a state of general arousal or heightened experience that causes mental strain, emotional anxiety, fear, physical tension, exhaustion, and illness, as well as behaviors related to these symptoms.

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SYMPTOMS

Four different types of stressors, or a combination of them, are responsible for most stress-related problems: social stressors, environmental stressors, physical stressors, and cognitive stressors. Social stressors are emotionally arousing events that occur in situations such as relationships, friendships, and the workplace. Environmental stressors are arousing sensory stimuli, such as noise, traffic, smells, and pollution. Physical stressors put excessive demands on the body and include things like illness, poor nutrition, and insufficient exercise. Cognitive stressors put excessive demands on a person’s thinking abilities, as a result of thoughts such as “Everything is overwhelming and I can’t handle it.”

Despite the unpleasant and sometimes dangerous effects of stress, it’s important to recognize that the stress response is a normal reaction that happens to everyone. It’s not something that only happens to people who are weak willed. In fact, stress can be caused by generally happy events just as easily as it can be caused by sad or frightening events. One study found that generally positive events such as marriage, retirement, pregnancy, promotions, personal achievement, and vacations were often equally as stressful as generally negative events, such as getting divorced, changing jobs, and experiencing the death of a loved one. Therefore, it’s easy to understand why so many people feel stressed-out in modern society. In addition to these big events, there are also the many daily hassles each person has to deal with, like traffic, waiting in line, dealing with rude people, and paying bills. Some researchers think that it might be the cumulative effect of all these stressful situations, big and small, that eventually takes its toll on our minds and bodies.

So, what makes an event like a wedding or an illness more stressful for one person than it is for another? The answer generally depends on the person’s perception of his or her ability to cope with the event. Those who think they can successfully handle a potentially stressful event will most likely deal with that situation with less stressful consequences, whereas those who think they can’t cope will experience the situation as more stressful—even if they really do have the skills to handle it.

Everyone experiences some kind of stress during life. Sometimes the stressor will disappear on its own, like a brief earthquake, and other times it may be long-term, like going to work every day. Most of the time, stressors have only limited and minimal effects, especially if the person has good coping skills. However, the long-term effects of chronic stress can be potentially damaging. Examples of chronic stress include living with a long-term illness like cancer or depression, dealing with problematic relationships, living in poverty, being unemployed, and living in a place that is effected by war.

Other Problems Related to Stress

Perhaps most famously, chronic stress has been linked to an increased risk for heart attacks in people with type A personalities. People with this type of personality are very competitive and ambitious. They often try to do many tasks at once to save time, but they are also perfectionists who want everything done perfectly. Partly as a result, they are impatient and frequently get angry with others. To put it simply, they lead very stressful lives. By comparison, type B personalities are more relaxed and patient. Not surprisingly, when these two groups are compared, people with type A personalities appear to have double the risk for heart attacks as their type B counterparts.

Chronic stress also inhibits the immune system and the body’s ability to repair damaged cells. This makes people more prone to illnesses, such as the common cold and flu, and it can also interfere with the treatment of preexisting illnesses, like cancer and HIV. In one study, a link was found between a person’s communication style and the rate at which the person’s body was able to heal itself. The researchers found that people who had more stressful interactions with their partners also showed slower healing of damaged skin tissue.

In addition, chronic stress can shut down the reproductive systems of both sexes, leading to impotence and problems with ovulation; it can turn off the production of insulin, which may be a factor in the development of diabetes; and it can aggravate preexisting conditions such as chronic pain and arthritis. Research has even shown that people with higher levels of chronic stress in their lives exhibit increased rates of aging in their cells.

CAUSES

Ironically, despite all the problems that stress can cause, it’s actually a very normal and healthy reaction in the human body. The stress response is the same set of reactions that a person would have if he or she were threatened by a lion or some other dangerous circumstance. During these situations, the body’s sympathetic nervous system is triggered, causing the reaction known as the fight-or-flight response, in which the body automatically prepares itself to run away from the danger or to stay and fight. For example, the muscles tense in preparation for action, breathing becomes shallow and rapid, and heart rate and perspiration increase. Similarly, many people who experience chronic stress will experience the same symptoms. In a very real way, the human brain doesn’t know the difference between a stressor that has ended, like a brief argument, and a stressor that a person continues to worry about, like thinking about that same argument over and over again.

Here’s a list of symptoms often experienced during the stress response:

Tense muscles and clenched jaw
Dry mouth
Nervous stomach
Shallow, rapid breathing
Pounding heartbeat
Feelings of irritability, anxiety, anger, or fear
Cold, clammy hands and feet
Headache
Excessive sweating
Frequent urge to urinate

In 1956, stress researcher Hans Selye discovered that the stress response can generally be divided into three separate phases, which, together, he called the general adaptation syndrome. In the first phase, called the alarm reaction, the person’s body responds as if he or she were being chased by a lion: The fight-or-flight response is triggered by the sympathetic nervous system, and the person’s breathing, heart rate, and blood sugar levels all increase to prepare the body for immediate action. Adrenaline, produced by the adrenal glands, is also released to give the body an extra amount of quick energy.

If the stressor continues, the body moves into the second phase of the stress response, called the resistance phase. This can happen if a stressor is chronic, such as when a person lives in poverty or in a country experiencing war. However, it can also happen if a person continues to worry about a stressor, work in a very demanding job, or behave in ways that invite stress, as those with type A personalities often do. During the resistance phase, the person’s breathing and heart rate return to normal, but the stress hormone cortisol is released to maintain the increased levels of blood sugar. However, cortisol achieves this by turning off the production of insulin. During this stage, cortisol also shuts down reproductive functions as well as the immune system.

From the standpoint of survival, this makes perfect sense. During the second phase, the person continues to live in stress or think about stressful thoughts. As a result, the brain continues to prepare the body for basic survival. During this time, neither reproduction nor battling germs is necessary if the bigger threat is getting eaten by a lion (or something similar that the person has created for himself or herself).

The final phase of the general adaptation syndrome is the exhaustion phase. At this point, the body’s resources have been depleted and it can no longer maintain the heightened state of arousal. This is often when people feel like they can no longer go on, because their bodies are literally exhausted.

Although this is the general pattern of stress, each person is different and will respond in different ways. Some people have specific biological weaknesses that can be affected by stress. For example, a person with an already weak heart might develop more complicated heart problems as the result of stress. Some people may breathe more heavily, others will experience a more rapid heart rate, and yet others might worry more. On the other hand, some people appear to be less vulnerable to stress. Sometimes referred to as stress-hardy individuals, these people view stressors as positive opportunities for personal growth, and therefore they’re less negatively affected by it.

Some researchers also think that people’s level of optimism determines their reaction to stressful events. When something stressful happens to pessimists, they think the situation will last forever, they blame themselves for causing the situation in the first place, and they give up on other parts of life (“If I can’t handle this situation, I probably can’t handle other situations as well”). In comparison, in similar situations optimists think the situation is only temporary, they don’t take responsibility for it, and they don’t allow the stress to spread to other parts of their lives (“Just because this is stressful, it doesn’t mean that everything else has to be”).

TREATMENT

The best treatment for stress depends on the cause of the stress and how the person reacts to stress. Remember, there are generally four categories of stressors: social, environmental, physical, and cognitive. Plus, some people respond to stress by holding it in their bodies, while others might respond to it with their actions, such as by lashing out at others. Taking these factors into consideration will help determine the best course of treatment. In general, cognitive behavioral therapy is a very effective type of psychological treatment for many different problems and can help a person address all of these areas.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of treatment that combines elements of both cognitive therapy and behavior therapy. Cognitive therapy examines the way people’s thoughts about themselves, others, and the world affect their mental health. Behavior therapy investigates the way people’s actions influence their own lives and their interactions with others. By combining the two, CBT examines the way people can change their thoughts and behaviors in order to improve their lives.

The CBT treatment for stress focuses on addressing the causes and the results of stressors. In general, this treatment can be divided into six steps:

Conduct an assessment and provide education
Practice relaxation techniques
Practice visualization techniques
Practice cognitive techniques
Develop specific coping skills
Prevent relapse and move past resistance

6 Steps for Cognitive Behavioral Therapy

Step 1: Conduct an Assessment and Provide Education

The first step in the CBT treatment of stress is to conduct an assessment. This will help determine both the cause of the stress and the ways in which the person is responding to it. For many people, it can be helpful to fill out a questionnaire like the Schedule of Recent Experience, which identifies both positive and negative events in the person’s life that can induce stress. Similarly, others might find it helpful to fill out a stress inventory or to use a chart to identify the most effective stress-reduction techniques for their particular problems.

Once people have been diagnosed with a problem related to stress, it’s important that they understand the basic nature and causes of stress (as highlighted above). It’s also important that they understand CBT is an active form of treatment that requires them to do work outside of the therapy session.

Step 2: Practice Relaxation Techniques

For most people, relaxation exercises are the core of their stress treatment. This is because stress, particularly chronic stress, takes a very heavy toll on a person’s mind, body, and relationships. Relaxation exercises can help reverse some of these effects, but more importantly, they can also prepare a person to confront the causes of stress in a much healthier way. For example, suppose a woman’s relationship with her husband has been problematic. For the last few years, she has avoided dealing with the conflicts, and as a result she has developed many physical symptoms of stress, such as tight muscles and high blood pressure. Practicing relaxation techniques in a consistent way can help ease these problems. In addition, they can also help if she chooses to address the relationship issues with her husband. Relaxation techniques can prepare a person for confronting stressors and help the person deal with problems in a more effective way.

Typically, relaxation exercises begin with building body awareness to help people scan their bodies for signs of stress and muscles tension.

Next, it’s very important to learn proper breathing techniques. Many people who are under stress breathe in a very constricted way. Some of them breathe very rapidly. Either of these types of breathing can make a person more vulnerable to stress. Learning proper breathing technique, using long, slow breaths, can help a person relax quickly and easily.

Progressive muscle relaxation is also a very important exercise. Many people experience stress as muscle tension. Progressive muscle relaxation helps people relax the entire body. Then, once this basic technique is established, people can learn to relax even more quickly by using cue-controlled relaxation and other rapid relaxation techniques.

Meditation is also helpful for many people. Learning how to stay focused in the present moment is a healthy alternative to being overwhelmed by stress-provoking thoughts. Meditation, or mindfulness, can take many forms, none of which have to be spiritual. People can learn to be mindful of their breathing, to meditate while walking or eating, or to use visualization to meditate.

Effective relaxation also includes developing good nutritional habits and engaging in healthy physical exercise. Therefore, people coping with stress should make time in their lives to address these issues, too.

Step 3: Practice Visualization Techniques

Visualization techniques use the power of the imagination to help people relax and create mental space for evaluating stressful situations. Techniques such as special-place visualization can help people relax by imagining a safe place in their mind, where they can completely relax.

Self-hypnosis is a very effective tool for relaxing and giving oneself powerful suggestions for dealing with stressful situations, such as “I will be calm, confident, and in control.” Self-hypnosis can also be used for coping with anxiety, fear, muscle tension, and pain.

Autogenics is a form of self-hypnosis that can help people quickly relax by giving themselves suggestions that promote feelings of heaviness and warmth throughout the body.

Once a person has learned both relaxation and visualization techniques, it’s often helpful to combine the two in order to create an even more relaxing experience.

Step 4: Practice Cognitive Techniques

Remember, stress is often the result of stressful thoughts or the person’s belief that he or she can’t cope with a stressor. Therefore, one of the most effective skills for dealing with stress is learning how to challenge stress-inducing thoughts. This is sometimes called refuting irrational beliefs.

Irrational beliefs can take many forms. Often, people aren’t even aware that they have them until they stop to listen to the self-talk inside their head. Examples of irrational beliefs include “I’m not capable of handling my problems alone,” “I should always do everything perfectly,” and “I’m responsible for everyone else’s happiness.” Thoughts like these can certainly make a stressful situation even worse. And for many people, thoughts like these are constantly being replayed in their mind like an endless tape loop, making them even more vulnerable to the effects of stress.

Coping with these thoughts in an effective way takes practice. It also takes time to identify the irrational beliefs and refute them with actual evidence. For example, for the person who holds the belief “I’m not capable of handling my problems alone,” appropriate questions would be “What’s the evidence that contradicts that statement? Have I ever handled significant problems on my own? What were the results?”

Other techniques can also be helpful, like using thought stopping to end nagging worries, and an eye movement technique in which moving the eyes from side to side in a specific way can break up troublesome thoughts and take the emotional sting out of them.

Worry control skills are designed to help a person cope more effectively with the stress of chronic fears and worries. For example, problem-solving skills can help a person brainstorm new solutions to old problems and then test the effectiveness of using those solutions.

A risk assessment can help people recognize the irrational beliefs they have about a stressful situation and then identify several

possible coping strategies for dealing with the situation. The result is usually that a person’s fear and anxiety diminish after thinking about several alternative outcomes that hadn’t been considered.

Worry exposure actually requires that a person set aside time to worry on purpose. The goal of this exercise is to schedule twenty-five minutes a day to worry about something in full, vivid detail. Doing so helps many people recognize that their anxiety about the worrisome topic actually diminishes over time, especially after they start imagining alternative, more positive outcomes.

And, finally, worry behavior prevention is designed to help people reduce behaviors that actually create more stress in their lives. For example, a man who worries about work might get to work an hour early and stay an extra hour to make sure everything is done perfectly, despite the fact that his boss doesn’t require him to do this, and despite the fact that the behavior is putting a strain on his relationship with his wife. Worry behavior prevention can help the person identify what actions lead to more stress and find ways to make needed changes.

Step 5: Develop Specific Coping Skills

For many people, the stress reduction skills mentioned above will be very effective at treating the ill effects of stress. But many other people will also need to address the specific causes of the stress by developing certain coping skills.

To deal with stressful situations that cause anxiety, it’s very helpful to create a hierarchy of those situations, arranged by how difficult it is to perform them, and then to develop a plan to engage in those situations starting with the least feared situation. Relaxation skills are useful in this process, as are coping statements that provide motivation. For example, when confronting a stressful situation, people might use coping statements such as “This will be uncomfortable, but I’ll do the best I can” or “I’ve done this before; I can handle this.” It’s often helpful to begin with visualization—imagining being in the stressful scenario and coping successfully. Then, once the various coping skills have been practiced and used successfully in imagined contexts, the person can progress to real-life stressful situations.

A similar process can also be used for people who are coping with stressful situations that make them angry.

Learning how to set goals is another valuable skill for people struggling with stress-related problems. Often, people dealing with multiple stressors can lose sight of what they’re doing or lose focus about what the original goal was. Setting clear, well-defined goals can help get the person back on track. This is accomplished by exploring a person’s values, which are like compass points that steer a person’s life in a particular direction. After identifying their values, people can create goals that move them toward those values.

Learning how to budget one’s time can be a great help for people who feel stressed-out because they’ve taken on too many tasks. Creating a time log and evaluating which tasks can realistically be accomplished often helps people organize their time more effectively.

Assertive skills training can help people learn to communicate more effectively, get their needs met in an appropriate way, stop being passive or aggressive, and set appropriate boundaries. Assertiveness isn’t a trait with which people are born; it’s a skill that must be learned. And learning how to communicate in an effective way can often make the difference between suffering in a stressful situation and getting one’s needs met in a healthy way.

And, finally, skills for managing job stress can help people cope with stressors that arise in the workplace. There are eight steps to managing stress in the workplace: identify the symptoms of the stress, identify the sources of stress, identify how the person generally responds to those stressors, set goals to respond more effectively, develop motivation, change the way the person thinks about the stressor, learn how to negotiate, and learn how to pace activities.

Step 6: Prevent Relapse and Move Past Resistance

Coping with stress is very difficult, and practice is required if the skills in this section are to be effective. Despite people’s best efforts, sometimes they can still feel stuck in a stressful situation or find themselves falling back into a stressful situation. If this happens, the person shouldn’t give up hope. There are effective motivational and problem-solving techniques that can be used to help the person move beyond feelings of resistance, hopelessness, and failure.

Disclaimer

This website is for informational purposes only and does not provide an official diagnosis. Anyone struggling with a physical or mental health problem should seek the services of a medical or psychological professional as soon as possible. Furthermore, if you’re having thoughts about suicide or hurting someone else, please see our crisis resources list, contact your local emergency services, or go to a local hospital immediately.

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Stress-Related Problems

Step 1: Conduct an Assessment and Provide Education

Step 2: Practice Relaxation Techniques

Step 3: Practice Visualization Techniques

Step 4: Practice Cognitive Techniques

Step 5: Develop Specific Coping Skills

Step 6: Prevent Relapse and Move Past Resistance

Disclaimer

RECOMMENDED READING

The Relaxation and Stress Reduction Workbook, Seventh Edition

A Mindfulness-Based Stress Reduction Workbook, Second Edition

The Stress Reduction Workbook for Teens, Second Edition

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