He would also like to thank his colleague and friend Russ Hibler, Ph.D., ABPP, for discussing the biofeedback chapter. Lating, Ph.D., is a professor of psychology and director of clinical training for the Doctor of Psychology Program at Loyola University in Maryland.
First Study the Science, Then Practice the Art
Stress, Behavior, and Health
More than 30 years ago, the US Surgeon General's Office stated that when stress reaches excessive levels, the psychological changes can be so dramatic that they have serious implications for both mental and physical health (Public Health Service of the US, 1979. Contained in the Surgeon General's Report, Healthy People (US Public Health Service, 1979), it was the most significant indication ever that stress and its potentially pathological effects are considered serious public health factors.
De fi ning Stress
Using the term stress to denote a response left Selye without a term to describe the stimulus that causes the stress response. Selye chose the term stressor to denote any stimulus that causes a stress response.
Ten Key Concepts in the Study of Stress
When used in such a way, it is easy to see the adaptive utility of the stress response. We shall limit ourselves to a discussion of the clinical treatment of the psychophysiological stress-response process itself.
Plan of the Book
A structural modeling analysis of the mediating role of cognitive-affective arousal in the relationship between workplace stressors and illness among accountants. The role of stress arousal in the dynamics of the stressor-to-illness process among accountants.
Neurological Foundations
The Anatomy and Physiology of the Human Stress Response
Thus, the outside of the neuron has a positive charge and the inside a negative charge. The reticular formation and brainstem represent the lowest level of the trigeminal brain.
A Systems Model of the Human Stress Response
Cannon wrote extensively about one aspect of the role of the ANS in the stress response: the neuroendocrine process. Since the early 1930s, there has been speculation about the role of the posterior pituitary gland in the stress response.
Coping
This phenomenological model is used as a common reference in the following chapters to facilitate understanding of the topics of measurement and treatment of the human response to stress.
Summary
Due to the extreme mobilization of the stress response axis, the target organ is activated. Further studies on the physiology and pathophysiology of central nervous system tuning.
Selye’s “General Adaptation Syndrome”
While the literature on psychosomatic phenomenology as a global concept is voluminous, relatively few models exist that deal more directly with the relationship between extraordinary arousal of the stress axes and the eventual manifestations of stress-related illnesses. Considering that Selye's were important formulations from the perspective of an endocrinologist more interested in pathogenic mechanisms than target organ pathology per se, later writers in the emerging field of psychosomatic medicine would elaborate extensively on the relationship between stress generation and stress management. related. disease.
Lachman’s Model
Sternbach’s Model
Kraus and Raab’s “Hypokinetic Disease” Model
The action of the striated muscle directly and indirectly influences blood circulation, metabolism and endocrine balance. The idea that lack of physical activity is a risk factor for disease and dysfunction is supported by the World Health Organization (Chavat et al), who conclude that suppression of somatomotor activity in response to stress arousal is likely to lead to increased cardiovascular burden.
Schwartz’s “Disregulation” Model
Last but not least, the striated muscle serves as an outlet for our emotions and nervous reactions. Therefore, Kraus and Raab coined the term "hypokinetic disease" ( hypo = under; . kinetic = movement/exercise) to refer to a wide variety of diseases that result from the lack of healthy expression/use of the physiological mechanisms of the stress. reaction.
Con fl ict Theory of Psychosomatic Disease
Thus, the negative feedback loops described by Schwartz dominate the normal physiological environment and are necessary for efficient, adaptive function. Still, Schwartz claims that it is a dysregulation in stage 4 homeostatic mechanisms that can lead to a wide variety of stress-related diseases through target organ overstimulation.
Everly and Benson’s “Disorders of Arousal” Model
Too intense and/or too frequent or chronic activation of the stress response axis → overstimulation and pathology of the target organ. It is suggested that excessive frequent, chronic or intense activation of target organs based on limbic hypersensitivity could eventually exhaust the target organ and cause stress-related illness.
Gastrointestinal Disorders
Ulcerative colitis is inflammation and ulceration of the lining of the large intestine. Mitchell and Drossman (1987) list irritable bowel syndrome (IBS) as the most common functional disorder.
Cardiovascular Disorders
Again, when the heart beats, it sends the electrical impulse from the sinoatrial node through the left atrium to the atrioventricular node, which ultimately results in the contraction of the left ventricle. The arterial system, including the left heart, is a high-pressure system powered by the contraction of the left ventricle.
Stress-related asthma appears to be associated with activation of the parasympathetic nervous system (Moran, 1995). The clinician should be wary of this specific manifestation of the stress response to protect the individual from unnecessary suffering and expense in the search for the cause.
Musculoskeletal Disorders
This is again part of the fight-or-flight response, where the body is ready for action by increasing O 2 and decreasing CO 2 ; however, no action occurs. There have even been some studies indicating a possible role for stress in the development or influencing the course of the inflammatory joint disease, rheumatoid arthritis (Amkraut & Solomon, 1974; Heisel, 1972; Selye, 1956.
Skin Disorders
Immune System
Some of the progeny of these B cells differentiate to form plasma cells known as antibodies that circulate in the lymph and blood and selectively combine with the triggering antigen (Abbas & Lichtman, 2011; Guyton & Hall, 2006. One of the fi. De first instance of this type of investigation took place after nuclear weapons.
Psychological Manifestations of the Stress Response
Therefore, the purpose of this chapter is to discuss the measurement of the human response to stress. Let's take this opportunity to take a closer look at measuring the human response to stress.
Stressor Scales
The recognized consistency in life events research, combined with low effect sizes, leads to the belief that life event scales such as the SRRS do tap into some area of importance in the phenomenology of stress; however, there appear to be other indirect variables that need to be better understood. From the perspective of the current model, the life event scales tap into the stressor domain and thus cannot be said to assess the stress response itself or the causal mechanisms that underpin stressful arousal.
Cognitive–Affective Correlate Scales
The scale is not only an indicator of traumatic events, but it also serves as an assessment of the events. Nevertheless, scales such as the SRRS can be of value, particularly in stress research when the researcher wishes to obtain valid and reliable assessments of the "background noise," that is, intervening or other confounding variables in psychosocial stressor research (see Everly & Sobelman, 1987.
Neurological Triggering Mechanisms
Measuring the Physiology of the Stress Response
It can be argued that the frontal muscles of the forehead are a useful site for assessing stress arousal. Assessment of the neuroendocrine axis of the stress response involves measurement of medullary adrenal catecholamines: epinephrine (adrenaline) and norepinephrine (noradrenaline).
Assessment of Target-Organ Effects
Another important advantage of the MCMI-II over the MMPI and 16-PF is that it consists of only 175 items. Respondents rate each of the items on an 11-point scale indicating the frequency of symptoms from 0 (never) to 10 (always).
The Assessment of Coping
The Symptoms Checklist 90 (SCL-90-R) (Derogatis, 1994) is a self-report measure that assesses symptoms of psychopathology on nine different dimensions and three global indices. The Post Traumatic Stress Symptoms (SPTSS) Screen (Carlson, 2001) is a 17-item self-report inventory that assesses the symptoms of PTSD listed in the DSM-IV.
Law of Initial Values
The most important question about measuring stress response is "How do you choose the most appropriate measurement criterion?" The answer to this question is by no means clear cut. There are several measurement options for assessing the physiological stress reaction itself (if deemed appropriate). one).
Historical Foundations
The initial search for the type A pattern was, in fact, a search for a consistent pattern of behavior predisposing to premature coronary artery disease. The use of different measurement technologies may have inadvertently added to the confusion about the nature of the Type A model (Everly & Sobelman).
The Principle of Personologic Primacy
Personologic Psychotherapy and Stress-Related Disorders
Millon’s Personality Theory and Stress
The negative reinforcement is revealed as a pattern in which submissiveness "earns" the affection and support of others, whereby through a negative reinforcement pattern one avoids the penultimate stressor - rejection, abandonment and interpersonal isolation. Indeed, we have tried to make the reader aware of the belief that personality traits play an important role in the nature and treatment of the human stress response.
Resilience De fi ned
By this we mean that stress management was originally intended as a means of managing the stress it has become. We may be standing at a point in the evolution of the stress management construct where we may see the latest iteration, ie. its "final limit". From our 57-year perspective of watching this field emerge and evolve, we believe that the final frontier in the science and practice of stress management is human resilience.
The Johns Hopkins Model of Resiliency
Seven Characteristics of Highly Resilient People
In the military, the mantra is "unit cohesion, unit cohesion, unit cohesion." In the social and business world, sometimes it's really about who you know, who you know, who you know, and how strong the bond of affinity is. Active optimism is "acting" in a way to increase the likelihood that things will indeed turn out well in the future.
Self-Ef fi cacy
Thus, self-efficacy is the belief in one's own ability to organize and implement the measures necessary to achieve necessary and desired goals. Personal and group resilience seem to be largely based on this notion of self-efficacy.
Hardiness
Finally, physiological and affective states influence self-efficacy, as comfortable physiological sensations and positive affect are likely to increase one's confidence in a given situation. This perception of control, or influence, Bandura points out, is an essential aspect of life itself; "People guide their lives by their beliefs about personal efficacy" (p. 3).
Resilient Leadership and the Culture of Resilience
Positive Psychology
Albert Bandura points out that "self-efficacy is an essential aspect of life itself; Bandura described four sources that influence the perception of self-efficacy and are particularly relevant in terms of building stress resilience. a) Self-efficacy by doing things successfully.
The Treatment of the Human Stress Response
Having provided the reader with what we feel is a comprehensive overview of the phenomenology of the human stress response, this chapter begins our focus on therapeutic intervention. It should now be clear that the patient's cognitive interpretation of the environment leads to the formation of a psychosocial stressor from an otherwise neutral stimulus.
Cognitive Primacy
Rather, we hope that this chapter will sensitize the reader to the critical role that cognition plays in the development and perpetuation of human stress, and to the important role of cognitive-based therapies in the treatment of stress-related problems. He acknowledges that a definitive empirical separation of appraisal and emotion is difficult due to obvious methodological limitations; however, he argues that there is more empirical support for cognitive primacy than for any other theory.
Cognitive-Based Psychotherapy
Ellis then applies his RET model, which consists of adding a "D" to the A-B-C paradigm, which represents a conscious effort to "challenge" the irrational cognitive belief that caused the emotional distress. The goal of this strategy is to help the patient "decatastrophize" the environmental transaction and develop coping strategies and problem-solving skills.
A Neurophysiological Rationale for the Use of the Relaxation Response: Neurological
Research on the relaxation response as a therapeutic mechanism and its clinical application has been hampered, however, by a lack of conceptual clarity regarding its therapeutic and/or underpinnings. To formulate such a view of the relaxation response as a therapeutic mechanism, it first becomes necessary to reformulate the common view on psychiatric and somatic stress-related disorders.
Disorders of Arousal
Psychiatric Disorders of Arousal
Finally, the work of Nauta (Nauta, 1979; Nauta & Domesick, 1982) repaired and further clarified our understanding of the vital role that the limbic system plays in emotional arousal, the integration of internal and external stimulation, and the processing of processes "psychosomatic" hypothalamic mediated. It is important to note at this point that the limbic system receives efferent impulses from, as well as sends afferent impulses to, brainstem structures—more specifically, the reticular activating system and the locus coeruleus.
Somatic Disorders of Arousal
The Neurological Foundations of Limbic Hypersensitivity and the Disorders of Arousal
Weil notes that he agrees with Gellhorn that it is possible to change the activation thresholds of the ANS (especially the hypothalamic nuclei) as well as the limbic centers. After discharge, it can be understood as the residual depolarization of neurons in the absence of direct exogenous stimulation.
Models of Neuronal Plasticity
Specifically, such changes included a 33% increase in synaptic contacts, as well as a reduction in the length and width variation of dendritic spines (Deadwyler, Gribkoff, Cotman & Lynch, 1976; Lee, Schottler, Oliver & Lynch, 1980. Joy's excellent review of the nature and effects of kindling (1985) summarizes the potential changes in biological substrates that may be involved in the ignition phenomenon.
