the term "stress" was popularised in 1950's by Hans Selye, an
Austrian-born Canadian physician. Prior to this the usual phrase used was
"under strain".
in engineering terms, strain is a measure of the extent to which a body is
deformed when it is subjected to stress, while stress is the force exerted
on a body that tends to cause it to deform.
in response to Selye, psychologists developed tables of what were asserted
to be highly stressful events, such as death of a spouse, being sacked from
a job, moving house, getting a divorce, etc.
everyone experiences stress, but of itself it does not cause emotional
distress:
athletes inflict force upon themselves in order to change their form -
they voluntarily subject themselves to stress with enthusiasm &
commitment, in the expectation of improving performances - they call it
training.
an environmental stress may generate emotional distress or it could be
used as the challenge that strengthens us.
nevertheless, like athletes who over-train, excessive stress for our
level of coping will tend to result in exhaustion, conflict, frustration,
anxiety & depression.
if your daily work offers you unique opportunities for rewards by directly
dealing with people. You can make a difference to people's
lives.
teach others.
Middle-term coping strategies:
variety is the spice of life:
consider doing something new, or work somewhere else
plan to change/evolve gracefully:
out of the flexibility we can make for ourselves comes the
opportunity to evolve through various roles & indeed lifestyles.
get out of a rut if it has become a canyon
maintain control of the big picture of your life & maintain a
balance
take time out
absence can make the heart grow fonder, so take leave allocations
& even take leave without pay
see the potential ahead
reward yourself
have another interest
distraction from your troubles at work can provide your life with
another perspective & can regenerate the composure, confidence
& enthusiasm needed to deal with the workplace more effectively
appreciate how fortunate you are
when you think life is tough, reflect on hardships of others less
fortunate than yourselves.
Long-term coping strategies:
re-train the way we think & live:
train to respond not with distress, but with a positive
disposition, in which we can maintain a calm & stable outlook
identify & cultivate positive thinking (that which
leads to happiness)
identify & eliminate negative thinking (that which
prevents happiness)
replacing our negative conditioning, those bad habit responses
of irritability, anger & frustration, with positive
conditioning for tolerance & patience is a process of
learning. Fortunately, our brains are adaptable & have
'plasticity'.
train to shift your perspective:
if we focus intensely on the problem when it occurs, it may
appear uncontrollable, but if we compare the event to a greater
event or look at the problem from a distance, then it appears
smaller & less over-whelming & we can then see that
something can be gained from experience - 'out of every crisis
comes opportunity'
be aware of the basics of our value system:
difficulty is integral to life
one can find meaning in difficulties - they are challenges
& opportunities
tolerance & patience are powerful tools
compassion is the key to peace of mind - compassion is caring
without attachment
we can only grow by confronting and solving life's problems,
avoiding problem solving gets you no where.
remember that learning is more effective with motivation,
enthusiasm & a sense of urgency & bringing about enduring
change takes sustained effort & is a gradual process
extreme emotionally stressful events may lead to delayed post-traumatic
stress syndrome in susceptible people
this can be an intractable, difficult to treat condition where memories of
a highly emotional event in the past keep flooding back, often triggered by
similar emotional states, resulting in recurrent fear states and chronic
psycho-somatic illness.
fear memories:
the memories stored during extreme emotional states have different
properties to our "normal" memories including:
requirement for elevated sympathothomimetic hormones for the
memories to be initially stored
it appears beta blockers that cross the blood brain barrier
such as propranolol, when given at the time of the emotional
event and for the next week, will block the memories being
stored
the memory tends to be extremely detailed, including the smells
present, vivid imagery & sounds, etc
like normal memories, requires new protein synthesis for the delayed
consolidation of the memory - up until it is consolidated, the memory is
quite fragile:
the protein synthesis blocking agent, anisomycin, when given to
experimental rats after the initial "fear" event resulted
in the rats not displaying fear to the same stressor 24hrs later -
either the fear memory was lost or the retrieval mechanism for it is
blocked in which case, the memory may be retrieved at a later date
by similar emotional states.
in fact, when the same associative stimulus to the stressor was
given to the rats, their amygdala became active but the rat did not
respond to it suggesting the memory is indeed still there and ready
to generate a fear response, but that the infralimbic portion of the
brain was signalling that a fear response was not needed.
who will encounter long term psychiatric problems after trauma?
in general, the initial response is not predictive & immediate
problems such as nightmares, difficulty sleeping, obsessive thoughts
about the trauma, feeling emotionally numb, memory problems, anxiety,
fear, increased state of arousal such as always being on edge and
irritable tend to be universal.
most people start to resolve these issues after the first month, those
that still have symptoms at 4 months will probably have symptoms at 4
yrs, and if left untreated, some symptoms may persist for decades.
there is some suggestion that those with smaller than normal
hippocampus may be susceptible
it is difficult to predict susceptible people in the first 2 weeks
risk factors:
stressors:
military service or civilian exposure to combat (high risk)
involvement in rescue missions, exposure to natural disasters
emigration from areas of social & political unrest
childhood abuse
serious accidents
criminal assaults such as being held at gunpoint, hostage
situations, torture, terrorism
rape or attempted rape
witnessing a shooting or devastating traumatic event
sudden unexpected loss of a loved one
inner-city residence
females, youth, pre-existing anxiety/depression
behavioural problems before age 15yrs
FH psychiatric illness
prevention:
debriefing - does this help or will it serve to consolidate the
fearful memories?
delayed counselling and social supports
psycho-education
normalise the reaction to the event
relieve irrational guilt
facilitate emotional recalling & retelling of the event
provide training in anxiety management techniques
propranolol at the time of trauma:
current research by LeDoux and Nader is underway to see if this
will prevent the fearful memories being retained - but will may
prevent any "good" memories from the event being retained,
and will also mean that the majority who would not be susceptible
are not allowed to learn and grow from the experience, after all it
is our memories - good or bad that define who we are.
changing the content of memories or altering their emotional
tonalities, however desirable to alleviate guilty or painful
consciousness, could subtly reshape who we are,
will this reduce our ability to empathise with others who may have
an embarrassing or traumatic experience
will it mean that individuals can avoid the painful, awkward
memories and lose their usual checking mechanism on their behaviour
and perpetuate anti-social behaviours?
will becoming numb to life's sharpest arrows make us numb to
life's greatest joys?
it seems the main obstacle to this prevention, assuming it works,
is to determine the minority who will be at risk of post-traumatic
stress syndrome.
treatment:
psychotherapies including cognitive therapy, exposure therapy
