Appraisals and Stress

images[2] Richard Lazarus conducted research on stress and emotions for four decades. He found a link between appraisals and stress. An appraisal is an evaluation of the significance of what is going on between the person and the environment in terms of that person’s well being. Appraisals establish the meaning of an encounter for us. At its simplest level, it is a quick assessment of what is going on and then what we can do about it. If we confront a snake, the first appraisal may be that it will harm us (e.g. it kills) and quickly, on the heels of that appraisal, we evaluate what we can do about it (e.g. move quickly away). These appraisals are instantaneous and automatic.

In understanding the role of emotions in regulation of stress the distinction between a primary and a secondary appraisal is most helpful. A primary appraisal is an evaluation of whether something (e.g. a snake) is of relevance to our well-being. What is our stake in the event (e.g. not being bitten)? A Secondary appraisal is an evaluation of our options for coping and expectations about what will happen.

Another key concept in understanding our capacity for self-regulation is coping. It is defined as activity to manage demands that tax or exceed our resources. When demands exceed our resources we experience stress. There are two important types of coping:

· Action-focused – which involves making changes in the environment (e.g. killing a snake

· Emotion-focused – which involves changing the way we interpret or we experience the event (e.g. “Oh, it’s not poisonous.”)

It is useful to view stress as having four stages:

Stage 1- Environmental demand

Stage 2- Perception or appraisal of the demand

Stage 3- Physical and psychological response to stress

Stage 4- Behavioral consequence or performance

An event in the environment makes a demand on the person. That demand is not automatically a source of stress unless the person views the event as a threat or that an adequate response may stretch the capacity of the person. In Stage 3 the body may show signs of increased tension and arousal (e.g. increased heart rate, perspiration, rapid breathing) and a flood of thoughts. Finally the person acts in a way that may either reduce the level of tension or increase it further, and the cycle renews at Stage 1. If the behavior succeeds in meeting the demand, the person will approach similar demands in the future with greater confidence. Learning is very important in determining our response to stress.

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Conflicts at Work

6ca927zw4caknem8tcau9uqzecaue3baacaji4bi5caf2tttvcaadp4tocaopqjrlcanza3ngca47k0h9cabn9x3zcalszn22ca9kuss3caw59564ca1j1nzfcagq7j2ocatewibucapi7bzkcanh40n51Conflict may be described as a situation in which one person feels that another person has harmed or is about to harm something you care about. Such conflicts may involve incompatibility of goals, differences in interpretation of facts, and disagreements over expectations.

These conflicts can occur at a full range of intensities and levels from more subtle forms of disagreement to violent acts.

The traditional view of conflict, that all conflict in relation to group behavior was bad, prevailed into the 1930s and 1940s. The prevailing solution was to identify the causes of the conflict and correct them to improve group and organizational performance.

More recently conflict is seen as a natural occurrence. Some conflict is inevitable. Proponents say conflict cannot be eliminated and that conflict may even be beneficial in certain circumstances.

Conflict may be either constructive or destructive. Conflict is of three types. They are:

  • Task conflict – divergent views as to the task itself
  • Relationship conflict –disagreements between people or groups
  • Process conflict – differing views on how the work gets done

By its nature low to moderate task conflict can be productive because it encourages the discussion of ideas that can facilitate groups working better together. For process conflict to be productive it must be kept at a low level. It can become counterproductive when turf battles break out, or when it increases the time needed to complete tasks or results in employees working at cross purposes.

Relationship conflicts are almost always dysfunctional because friction and hostilities between people increase the likelihood of personality clashes while decreasing the understanding needed for completion of organizational tasks.

The research literature suggests that within organizations structural factors and individual value differences are greater sources of conflict than communication problems. For example when people work together but pursue different goals conflicts arise. While managers may incorrectly attribute the problem to communication issues further communication efforts only worsen the situation.

The definition of a conflict is important because it delineates a possible set of solutions. Emotions are also important because positive feelings increase the tendency to see possible relationships among elements of a problem and encourage taking a broader view of the situation. Negative emotions tend to result in over simplification of the issues, reduce trust and encourage negative interpretations the behavior of others.

Conflict management techniques include:

  • Problem solving – face to face meetings to identify and resolve conflicts
  • Superordinating goals – a shared goal is created that cannot be achieved unless both parties cooperate
  • Expanding resources – when a conflict is caused by a scarcity of a resource, such as opportunities for advancement, or the potential to make more money, etc., opening up additional opportunities may provide a solution
  • Avoidance – pulling out of a conflict or containing a conflict
  • Smoothing – emphasizing common interests and minimizing differences
  • Compromise – each party is willing to give up something of value
  • Authoritative command – management uses its authority to settle the conflict
  • Altering human variables – using behavioral change techniques to alter behaviors and attitudes that result in conflict
  • Altering structural variables – change the formal organizational structure and interaction patterns for conflicting parties, i.e., transfer employees, redesign jobs, coordinate positions, etc.

Learning to manage conflict can significantly improve resilience to stress at work..

Stress and Health

5catdz8jzcaw3aackcazenv9mcabottr6caopqlifcao4qirqca4bwmqccaa8nn1hcaho32l4ca80lhhkca2voyzaca584yijcar59fr1cai16fetca8yolnfcax3z7clca7l4gj9ca9nw0sdcar6padvThere is growing evidence that stress is a major factor in maintaining health and well-being. Health means more than the absence of illness. In China and in ancient Greece health was thought of as being in balance with nature. The vital task was seen as maintaining equilibrium in the face of extensive demands. The World Health Organization (WHO) definition of health is a state of complete physical, mental and social well being.

It seems increasingly clear that the naive notion that a germ automatically leads to illness is no longer acceptable, although much of the lay public subscribes to the theory. Today we know that the idea of a single external cause, such as a germ, is oversimplified. The presence of the germ does not always cause the illness. The vulnerability of the person or the host animal is a major factor and that vulnerability is influenced by such factors as immunity and stress levels. So the cause of illness is not quite as simple as we once thought.

Stress vs. Distress

Another important distinction that came out of the seminal work of Hans Selye is between stress and distress. Both involve demands on the person to adapt to a challenging event. However, when we appraise the situation as being something we can handle it can be an exhilarating experience. When a person appraises the event as beyond their ability or as exceeding resources the situation is experienced as distress. Another way to look at it is that stress is positive and distress is negative. It is a valuable distinction since many people believe all stress is bad for you. It is not.

The diathesis-stress theory

The diathesis-stress theory of the origin of certain illnesses holds that we are born with certain biological predispositions but that whether or not an illness manifests itself is dependent on the level of stress one experiences and the resources one can use to overcome the stress. For example, although a person may have inherited a genetic deficiency in metabolizing alcohol, whether that person becomes an alcoholic or not also depends on the types and levels of stress they experience. Another person may have inherited a problem with glucose metabolism; however, it is factors such as the level of stress, or a sedentary life style or a combination of the two that result in development of type 2 diabetes. We may be born with certain vulnerabilities; it is stress that tips us into active illness.

Impact of stress on illnesses

Certain ailments have been recognized for some time as being influenced by stress. The most common example is intestinal distress such as indigestion and colitis. Other disorders like migraine, tension headaches, high blood pressure, arthritis and certain skin disorders may also be influenced by stress. In some instances, stress emotions seem to make an ailment worse, while in others stress may be a factor in bringing on illness. Research increasingly supports the hypothesis that stress may have at least some impact on many diseases.

There are several reasons for believing that stress contributes to the development of cardiovascular disease. First, stress emotions increase the level of low-density blood cholesterol and this leads to clogging of the arteries of the heart. Second, stress emotions result in maladaptive coping behaviors such as smoking, drinking and overeating, which can damage the heart and surrounding vessels. Finally, stress emotions result in the release of powerful hormones which result in increases in heart rate and blood pressure. One of these stress emotions is anger, and anger expressed in the form of hostility is known to increase the risk of cardiovascular disease.

Several hypotheses are being explored in the role of emotions in cancer. Again stress emotions may play an indirect role leading the person to smoke or drink excessively. More direct influence is attributed to a tendency to suppress or deny emotions. There is some evidence that those who suppress emotions are more susceptible to cancer. Again the mediating factor is hormonal activity.

At the 2002 meeting of the American Psychological Association a group-based stress management study was presented that indicated that group stress management training could lower blood glucose levels in Type 2 diabetes. Patients that received instruction regarding the health consequences of stress and instruction in the use of cognitive and behavioral skills such as deep breathing and recognition of major life stresses as well as instruction in progressive muscle relaxation lowered their glucose levels more than patients that did not have stress management training. Thirty-two percent of the patients receiving stress management lowered their A1C glucose levels by one percent or more as compared to 12% of the patients who did not receive this training. This modest change is larger than the half percent change that has been associated with significant reduction in microvasclar complications that can accompany out of control diabetes. While this change might move someone with tightly controlled diabetes to near normal levels; even those diabetics with poorer control would benefit from the reduction in glucose levels with fewer diabetic complications.

In summary, if you are a type 2 diabetic, learning to manage stress should have special health consequences for you. Although this was a group program, if none is available in your area, individual stress reduction strategies should be beneficial, especially if you have a friend or family member trying to learn stress management with you.

Stress and the immune system

The immune system has been called our liquid nervous system. With our growing knowledge of the human body has come an increasing conviction that stress may be a factor in susceptibility to colds, flu, mononucleosis and other infectious illnesses. It appears that some of the hormones secreted in the presence of stress emotions impair or weaken the immune process by reducing the number of disease-fighting components such as lymphocytes (white cells) thus leaving us more vulnerable to infection. This may be one of the reasons why so many people die within a year or so of their spouse’s death. Recently there has been research into why some HIV positive patients develop full blown AIDS while others do not. One interesting finding is that patients with a more effective style of coping with stress seem to have stronger resistance as a result. It is now reasonable to hypothesize that stress emotions increase secretion of certain hormones. These hormones weaken the immune system and that weakness results in an increased likelihood of infectious illness.

Recent research indicates that brief time-limited stress that may be viewed as a challenge (e.g. passing an exam, good performance in sports, solving a difficult puzzle under pressure) may actually enhance the body’s immune response. However, chronic stress seems to reduce the effectiveness of the immune system and thus make the person more susceptible to diseases.

Selecting Your Exercise program

2CAF75TXWCAQWM13YCA2I3TB1CA6GS6UOCATEYVS3CAIP46L5CADU0RW8CAL2M1YKCAKH9VO6CAPKSUNNCA8UU70SCAURGJ0SCAY1FN6ZCALD9K42CAWKFN2MCAA1JZJKCAMLWKSXCAE1DIBJCA5CRGQQ The real task is to find a form of exercise that you will find enjoyable. Joy not just in having gone through the workout but pleasure in actually doing the activity. When you find such an activity you will have won a major part of the battle in being able to sustain a program.

What are your personal goals when it comes to exercise? Do you strive primarily to attain health benefits? Are you interested in adding more everyday activities/lifestyle choices to meet a minimal level of exercise? Does gym membership interest you? If so, are you more interested in individual or group fitness options? If group activity is important to you have you investigated what types of classes are available? Is there a sport or sports that interest you that you would like to explore? Has your doctor recommended that you exercise, do resistance training for bone health, encouraged you to seek increased flexibility to reduce the risk of injury and accidents?

Or, do you already exercise but feel you have reached a plateau from which you would like to advance or are you considering moving from being a casual runner to preparing for and beginning to compete in road races of various lengths? There are master level competitions in many activities—so don’t let the passage of time prevent you from pursuing the idea of competition if that appeals to you. Or maybe you have exercised on your own for awhile and are now interested in joining a group or feel confident enough to join a gym? It is not true that you have to be in shape to go to a gym—there are plenty of couch potatoes trying to change their ways mixed in with those who already have experienced the advantages that come from regular exercise.

You also need to consider whether you are a morning or night person—if you are a night person you will learn to hate any activity that requires you to be at the gym at 5:45 am several days a week. A morning person will also not much care for vigorous activity in the evening during the time that person normally begins to wind down from the day. Are you self-motivated or do you need the pressure of schedule to keep you on track. Do you crave routine or do you relish change? Do you need to design your own program or would you be more satisfied by having someone else do this for you?

All of these factors can influence your choice of the correct program for you. It also helps to keep an open mind and try different things in the search to discover what types of activity bring you joy. You may find, for example, that running gives you a wonderful endorphin rush but yoga gives you a sense a calm and the flexibility to keep running. There is no reason why you cannot do both.

Stop Smoking

ocayaddeucaod94excawbukdacayvy779caemcgzuca3l62m8cai6nu5oca0calmhca84gs7lcaazu3tccal53ogjcagygv4bcazn8ml9ca37b4eccam19e1kcalq0ajvcajseop1casgqeoacahsi0dsNicotine activates the pleasure center of the brain. Within 10 seconds of inhaling a puff on a cigarette nicotine levels peak in the brain. The average smoker takes about 10 puffs on every cigarette smoked. Since the pleasurable effects of nicotine are short-lived the smoker soon craves another cigarette. If one cigarette supplies ten surges of nicotine to the brain, smoking 1½ packs of cigarettes a day provides a smoker 300 nicotine hits. Since cigars and pipe smokers usually do not inhale, their nicotine must be absorbed through the mucosal membranes in the mouth. The mucosal membranes are also the entrance way for nicotine delivered from smokeless tobacco. These other forms of tobacco use may not delivery their nicotine fix as efficiently as a cigarette, but it is delivered.

Some smokers say that smoking relaxes them while others say that it gives them a boost. According to the National Institute of Drug Abuse, nicotine does both—acting as both a stimulant and a sedative. A hit of nicotine stimulates the adrenal glands which cause a release of adrenaline. This release of adrenaline stimulates the body and causes a release of glucose, as well as an increase in respiration, blood pressure and heart rate. Meanwhile insulin output is suppressed which leaves smokers with slightly elevated levels of glucose in their bloodstream. Nicotine also causes the release of dopamine in the part of the brain that controls pleasure and motivation. A similar effect is caused by cocaine and heroin and is believed to be behind the pleasurable sensations reported by many smokers. Nicotine is also able to cause a sedative (calming) effect depending on a smoker’s nervous system arousal and how much nicotine is taken. These effects occur with the use of all tobacco products; cigarette smoking merely provides the most rapid dosing.

Frequent use of tobacco products results in addiction to nicotine. Repeated exposure to nicotine results in the development of tolerance for the drug. As tolerance is build it takes a higher dose of the drug to produce the same level of stimulation. Nicotine is metabolized rapidly which means it disappears from the body in a few hours. Thus morning doses of nicotine have a greater physiological effect on the body than those occurring later in the day because of a period of abstinence during the night.

The addictive properties of nicotine contribute significantly to the difficulty tobacco users have in giving up the habit. The withdrawal symptoms from discontinuing nicotine use can be challenging and often drive people back to tobacco use.

Psychological factors also influence the difficulty experienced by a user trying to break an addiction to tobacco. The pleasurable consequences of smoking are considerable and they affect not only the body but also the mind. While we rarely think of tobacco use as an addiction of the same caliber as a craving for cocaine or heroin, tobacco’s legal status does not prevent it from being highly addictive. Nicotine is a drug. The initial high from obtaining a hit of the substance relieves the immediate craving for the drug, which may be followed by the user feeling calm and relaxed. Unfortunately this satisfaction is very short-lived and a new craving quick to develop. A person attempting to quit smoking will miss the boost a cigarette gives them and/or the calming effect they perceive. Tobacco has become a dependable friend.

Psychologically, when you quit using tobacco you may go through a period of mourning for your longtime friend. Dr. Kübler-Ross analyzed the stages that human beings go through when in grief. The stages are: denial, bargaining, anger, sadness (depression), guilt and acceptance. It is definitely not an indictment of you if you miss smoking as a kind of friend and companion. It has been a big part of your life for a long time. Be kind to yourself if you have these feelings; they are part of being human. Work through the stages and they will set you free to go on as a non-smoker. Think positively. You can do this.

Obesity Epidemic

gcadshvjncaxaxcdbcaixc4kkcabfrd5wcaapjbgtcavvpddccad7t9mpcapy4999cayl3l3fcavevdrocav56sm8cae3cmh3ca0fhwjacaew128bca242os2cav195t9cau8jzvzca07mjifcaswut16Obesity is epidemic in the United States. The number of overweight and obese Americans has grown at a disturbing rate, especially over the past few years. Today more Americans are overweight than are normal weight. Over sixty percent of the population is now considered to be overweight, with over 30 percent of the population considered to be obese. This is tragic for America. A very large (and growing) percentage of our citizens are at increased risk for developing serious chronic diseases, and face the prospect of early death. Meanwhile the entire society struggles under the burden of the resulting increase in health care costs.

While genetics plays a role in the predisposition to obesity, the actual development of obesity is strongly influenced by environmental factors, most notably a sedentary lifestyle. Exercise is essential in weight management. For example, if an extra 100 calories a day is consumed above that needed by the body, in one year that will result in a ten pound weight gain. This is particularly tragic since a 20 minute walk is sufficient to burn those extra calories for many people! There are a number of web sites that allow a visitor free access to calculations on how many calories an individual would burn doing various activities based on weight is one such site. Pick a favorite food, snack, whatever and see the energy cost of that item for you. It is quite illuminating!

Portion size is a large part of the problem. As our lives have become increasingly busy, more and more Americans have turned to restaurant food, sit down or take out, for many of their meals. In an effort to attract customers many establishments began to offer larger portions of high-calorie food at inexpensive prices. Ever fond of a bargain, Americans have been quick to take advantage of these supersized portions. Since people tend to eat more if given more in a portion, calorie consumption has significantly increased. In time the larger portions have come to be considered normal and expected. Thus the amount of food we eat has increased during the same time period that more and more people have become sedentary. Weight gain has been the result.

Risks of obesity include: coronary artery disease (CAD), heart attack, heart failure, angina, abnormal heartbeat, high blood pressure, elevated cholesterol and triglycerides levels, lowered beneficial HDL cholesterol levels, stroke, type 2 diabetes, and certain cancers such as prostate, gallbladder, colorectal, breast, endometrial and kidney. In addition, obesity increases the risk of developing gallstones (in women), liver problems such as an enlarged liver, cirrhosis, or a fatty liver, gastroesophageal reflux disease (GERD), sleep apnea, asthma, shallow breathing (Pickwickian syndrome) which can lead to heart disease, and arthritis. Obesity also increases the risk of reproductive problems such as irregular periods, an increased risk of birth defects, especially neural tube defects, and an increased risk of death of the mother and baby.

The risk of developing type 2 diabetes increases as a person gets heavier. This is very unfortunate as diabetes is a major risk factor for the development of heart disease. While obese individuals are more at risk for arthritis than normal weight individuals, each additional few pounds of weight gain increases the risk for developing this potentially debilitating condition. Finally, recent research suggests that being obese can increase the risk of lowered mental ability, especially in memory and learning, in men over time.

The location of body fat is also important in assessing risk. If the fat accumulates disproportionably around the abdomen, it is an independent predictor of increased risk and morbidity. Thus individuals whose fat accumulates around the abdomen are at greater risk than individuals whose fat accumulates around the hips and thighs. A man with a waist measurement of more than 40 inches or a woman with a waist measurement greater than 35 inches is considered at increased risk for type 2 diabetes, high blood pressure, high cholesterol, and coronary artery disease than normal weight individuals or those whose fat accumulates around the hips.

Diabetes is a Killer

dca1i1dm3cakiatfocajg4668caeop54mca8dpilfcapmgmwjca9beh89ca5j15n6calppwxncauvjp03cazp1bm7cay8fb0zcabaq09ycavkp65oca9usbc0caf7y7evcatgsp0mcaig37dhcauhvwa5Diabetes mellitus is a heterogeneous group of disorders characterized by high blood glucose levels (hyperglycemia). The World Health Organization has defined four major types: Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes and Diabetes secondary to other conditions. Type I is associated with low (or absent) levels of insulin, develops in childhood and requires daily insulin injections for survival. Type II usually develops in persons over 40 years of age and can be managed with lifestyle changes and oral medication.

Diabetes mellitus is a chronic, incurable disorder of carbohydrate metabolism. It involves an imbalance of the supply and demand for insulin. Food ingested is eventually converted to glucose (sugar) when it is carried in the blood to nourish all cells of the body. In diabetes mellitus insufficient insulin is available to meet this need because of:

(1) Failure of the islets of Langerhans to produce enough insulin

(2) The destruction of the insulin before it can be used, or

(3) Inability of body tissues to use the insulin

When cells are unable to use glucose large amounts accumulate in the blood and the condition called hyperglycemia results. Due to the concentration of glucose the kidneys excrete large amounts of water and the patient wants to drink large amounts of water. In addition, a loss of energy derived from food which is eaten results in compensation by increasing food intake. The body metabolizes its own store of fat and protein and a substance called ketones is produced. A toxic level of ketones can cause a condition called ketosis which can cause a coma.

Type I or insulin-dependent diabetes is the most severe form of this disease. Insulin is the essential therapy and it must be injected into the subcutaneous, fatty layer of tissues. The goal of insulin therapy is to maintain the blood sugar levels as close to the normal range as possible. To avoid frequent injections some patients use an insulin pup which provides a slow, continuous subcutaneous infusion of insulin throughout the day.

In Type II or non-insulin dependent diabetes the body produces insulin but not enough to meet the body’s total needs. Insulin is not required and treatment includes dietary management, exercise, and medication that helps the body make better use of the available insulin.

Diabetic diets are individualized based on such factors as age, weight and daily activity level. Adherence to the diet is essential. Exercise is also essential but must be coordinated with the use of insulin in Type I diabetics.

Diabetic coma occurs when there is too much circulating glucose in the blood. The onset may be gradual. Few symptoms may be evident until levels become severely elevated. Individuals may become confused, drowsy, have difficulty breathing, nausea, vomiting and flushing of the skin. Diabetic coma is a medical emergency that can result in death without treatment.

Insulin shock is the opposite of diabetic coma, occurring when there is too much insulin in the blood. It may result from injecting too much insulin or from an unusual amount of exercise that burns up glucose normally available. Individuals may feel weak, hungry and nervous. They patient may perspire although the skin is cold to the touch. Confusion and personality changes may occur. If not treated the patient may become unconscious and brain damage and eventually death may occur.

Complications from diabetes can affect a number of body systems and result in major disability. Vascular changes can contribute to myocardial infarction or cerebrovascular accident. Circulation problems can result in peripheral vascular insufficiency so that even minor injuries are prone to become so severely infected that amputation becomes necessary. Deprivation of blood supply to the kidney can result in kidney failures. There can also be changes in the nervous system and changes in the peripheral nerves that result in loss of sensation and pain sensations.

In Type 2 diabetes lifestyle changes can be of great value and the psychologist’s knowledge of motivation and adherence can be of great help. The key to self-regulation in diabetes is testing blood sugar each day and for optimal effect more than once a day. Self-testing is rare in Long Term Care but it remains important that the patient be engaged and keeps track of levels even if the nurse does the testing.

One service that the Primary Care Psychologist should provide is Motivational Interviewing to promote (e.g. especially for Type I). Behavioral strategies aimed at enhancing motivation and self-regulation have been shown of great value. Also, hypoglycemia can be very frightening and many patients remain hyperglycemic as an avoidance strategy. The psychologist’s knowledge of fear and the management of fear can be of value.

Stress coping and affective regulation are important in management of diabetes. Depression has been shown to lead to failure of adherence to the medical regimen. Improved ability to manage stress has been shown to enhance the management of the disease. A well designed personalized program for better management of stress can result in:

  • Improved psychological well-being
  • Improved blood glucose control and thus reduced risk of complication
  • Reduced insulin regulation
  • Fewer emergency episodes.