Emotions, Anxiety, and the Stress Response

Stress is a normal human response to an internal or external threat to homeostasis, or the body’s stable equilibrium, and can be prompted by stressors.

These stressors such as illness, high workload, or economic hardship, can induce the stress response, also known as allostasis, in an attempt to reestablish homeostasis.

In the short term, the body can adapt to the physiological changes to stress; however, when stress becomes chronic, it can have a negative impact on mental and physical health.

Now, not all stress is harmful, in fact, it is essential for daily life. There are two types of stress; eustress and distress.

is positive stress, which is necessary for normal development and motivation and can occur with beneficial life changes like buying a home or getting a new job; whereas distress is negative stress that occurs when a person is unable to adapt or cope effectively to the stressor.

Okay, the body’s response to a stressful event can be explained by the General Adaptation Syndrome, or GAS, which has three stages.

First, the alarm stage occurs as the sympathetic nervous system is activated, triggering the fight-or-flight reaction, which involves the release of hormones and neurotransmitters to support the body’s reaction to stress.

The posterior pituitary releases antidiuretic hormone, or ADH, and the adrenal cortex releases aldosterone, both of which increase circulating blood volume.

The adrenal cortex also releases cortisol, which increases the body’s supply of glucose, while the adrenal medulla releases epinephrine and norepinephrine, which increases the heart rate, blood pressure, and blood flow to the skeletal muscles.

Next, the resistance stage is when the body attempts to stabilize and return to homeostasis. If the stress has been dealt with effectively, vital signs return to normal, and the body begins to repair tissue damage.

However, if the stress continues, the sympathetic activation will continue, and the person moves to the exhaustion stage.

This stage is characterized by excessive wear and tear on the body, a suppressed immune system, and depletion of the body’s resources, referred to as allostatic load.

When allostatic load is not resolved, it can lead to health problems like depression, diabetes, and autoimmune disorders.

Coping is a process by which a person uses cognitive and behavioral strategies to manage stress; and their response to stress will depend on their own appraisal of the stressful event and their perceived ability to respond to the stressor.

Now, the use of coping strategies may not always involve healthy behaviors and they may not always be effective in resolving stress.

For example, defense mechanisms are unconscious coping strategies that can be detrimental or beneficial. For example, a detrimental defense mechanism includes denial, where a person completely ignores distressing aspects of reality.

On the other hand, a beneficial defense mechanism is sublimination, which occurs when unacceptable emotions are channeled into acceptable actions, like exercise.

Other coping strategies include problem-focused coping and emotion-focused coping. In problem-focused coping, the person attempts to alter a stressor; for example, a patient with a new diagnosis of heart failure may gather information to learn about their condition, and to learn skills like how to take their blood pressure or manage their medications.

Conversely, emotion-focused coping involves reducing emotional distress caused by a stressor, like when a patient with lung cancer sees a therapist to discuss their perceived stressors.

Okay, so, as the nurse, you’ll collect information about your patient’s stress levels and coping strategies. You’ll first need to build trust and rapport so your patients will feel comfortable in providing the needed information.

You can also use open-ended questions such as, “What are sources of stress in your life?” and “What coping strategies have worked for you in the past?” to give your patient an opportunity to share their thoughts in their own words.

It’s also crucial to ask about the presence of a support system and include them in the plan of care, as appropriate. You're also responsible for reinforcing education provided to patients about stress reduction techniques they can use to promote effective coping.

Keep in mind that each patient will require individualized interventions; for example, some patients could benefit from anger management and support groups, whereas other patients prefer complementary therapies such as meditation and biofeedback.

Since patients can be at risk for physical and emotional problems due to stress, you should collaborate with the registered nurse and prioritize interventions to address their needs accordingly.

For example, sometimes stress can be so severe that patients are unable to fulfil the roles of daily living or may report the desire to harm themselves or others.

In this situation, you should initiate crisis intervention, which may include working with other members of the health care team, including emergency services, a counselor, or social worker, as prescribed.

Alright, as a quick recap… Stress is a normal human response to an internal or external threat to homeostasis. In the short term, the body can adapt to the physiological changes to stress; however, when stress becomes chronic, it can have a negative impact on mental and physical health.

As the nurse, you’re responsible for collecting information about your patient’s stress and coping strategies, reinforcing education, and collaborating with the registered nurse to prioritize