Read Chapter 3 in Health: The Basics - Managing Stress.

3
Managing Stress
COPING WITH LIFE’S CHALLENGES
Why am I physically affected by stressful situations?
Why do I always catch a cold during finals week?
How can I cope with daily
pressures and annoyances?
How can I prioritize everything
I try to do in a day?
OBJECTIVES
■ Define stress, and examine the potential impact of stress on health,
relationships, and success in college.
■ Explain the phases of the general adaptation syndrome and the
physiological changes that occur.
■ Examine the health risks that may occur with chronic stress.
■ Discuss sources of stress, and examine the special stressors that
affect college students.
■ Explore techniques for coping with or reducing exposure to stress
and using positive stressors to enrich your life.
ISBN: 0-558-34154-3
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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It is a common occurrence in today’s world to hear ourunderstanding of how the body responds to threats or
people say, “I’m so stressed out,” or to describe
challenges. A stressor is any condition or event that we
their job or life as too stressful. Writings and con-
perceive challenges or threatens us, and a stress response is
versations about the impact of stress on our lives
the series of physiological changes and adaptations that result
are everywhere. You may even have been led to
from that stressor. Stressors may be physical, social, emo-
believe that all stress is bad for you. In reality,
tional, intellectual, economic, or spiritual. They may be tangi-
stress can be our best friend or our worst enemy.
ble or intangible, positive or negative. Key to the whole stress
Stress can motivate, protect, energize, and excite us. Imagine
response is our personal perception and interpretation of daily
scoring the winning goal in the championship soccer game,
events and situations. These perceptions are filtered by our
falling in love, meeting a famous person you have always
past experiences, biological factors (e.g., race, age, and gen-
idolized, scoring an A on a tough exam, or reacting quickly to
der), characteristics of the event or situation (Can I control it?
avoid a car accident. Our ability to respond and adapt to these
Is it predictable? Does it occur often?), and by our present set
challenges is positive and healthful. Under some conditions,
of coping resources. Coping is the act of managing events or
however, stress can overpower us and fatigue our body
conditions to lessen the impact of a stressor. Remember that
systems to the point of breakdown and disease.
stress is literally in the eyes of the beholder. Each person’s
The negative aspect of stress is a major concern in the
unique combination of heredity, life experiences, personality,
United States, and it appears to be getting worse: according
and ability to cope influences how the person perceives an
to a national survey conducted annually by the Higher Educa-
event and what meaning he or she attaches to it.
tion Research Institute, almost a third of college freshman
Stress can be associated with most daily activities. Generally,
report feeling “frequently overwhelmed by all they have to
positive stress—stress that presents the opportunity for personal
do,” up from a low of 16 percent when the question was first
growth and satisfaction—is termed eustress. Getting married,
asked in 1985.1 If we want stress to be much more a friend
successfully kayaking Class II rapids, beginning a career, and
than an enemy, there are things we can do. We can begin by
developing new friends may all give rise to eustress. Distress,
learning to anticipate and recognize our personal stressors
or negative stress, is caused by events that result in debilitative
and to develop skills to reduce or better manage those we
stress and strain, such as financial problems, the death of a
cannot avoid or control.
loved one, academic difficulties, and the breakup of a relation-
ship. Prolonged distress can have negative effects on health.
You cannot get rid of distress entirely: like eustress, it is a
part of life. However, you can train yourself to recognize the
What Is Stress?
events that cause distress and to anticipate your reactions to
Stress may be defined as “the experience of a perceived
them. You can learn coping skills and strategies that will help
threat (real or imagined) to one’s well-being, resulting from
you manage stress more effectively.
a series of physiological responses and adaptations.”2 This
definition has evolved over time as research has advanced
The Body’s Response
to Stress
stress The experience of a perceived threat (real or
imagined) to one’s well-being, resulting from a series of
physiological responses and adaptations.
The Fight-or-Flight Response
stressor A physical, social, or psychological event or
Whenever we’re surprised by a sudden stressor,
condition that we perceive challenges or threatens us and
such as someone swerving into our lane of traf-
that produces a stress response.
fic, our emotional reactions trigger the adrenal
glands (two almond-sized glands sitting atop the kidneys) to
stress response The series of physiological changes and
secrete adrenaline and other hormones into the bloodstream.
adaptations that result from a stressor.
As a result, the heart speeds up, breathing rate increases,
coping The act of managing events or conditions to lessen
blood pressure elevates, and blood flow to the muscles
the physical or psychological effects of excess stress.
increases with a rapid release of blood sugars into the blood-
eustress Stress that presents opportunities for personal
stream. This sudden burst of energy and strength is believed
growth; positive stress.
to provide the extra edge that has helped generations of
distress Stress that can have a detrimental effect on health;
humans survive during adversity. Known as the fight-or-
negative stress.
flight response, this physiological reaction is one of our most
basic, innate survival instincts.3 When activated, our bodies
fight-or-flight response Physiological arousal response
go on the alert either to fight danger or to escape from it.
ISBN: 0-558-34154-3
in which the body prepares to combat or escape a real or
The series of behavioral, neurological, and immunological
perceived threat.
changes are designed to help us; however, if overtaxed, the
response can be damaging to our bodies.
62 PART ONE Finding the Right Balance
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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A stressor is
Adaptation resources
Adaptation energy
More blood
perceived. Slight drop
are mobilized to
stores are depleted.
goes to brain
in homeostasis occurs
combat stressor.
Replenish them, and
Pupils dilate to
as the mind and body
Endocrine system
the body will return to
increase visual
Hearing ability
temporarily lose balance.
comes into play.
homeostatic state.
perception
increases
Salivation
decreases
More blood goes
to muscles
S
Perspiration
S
E
increases
R
T

S
Respiration rate
O

T
Heart rate and
increases
E
C
blood pressure
N
All systems reacting
increase
A
T
to everyday stressors
I
S
S
in a balanced and
E
RESISTANCE TO STRESS
R
healthful manner.
Digestive system
slows as blood supply
Urine production
is diverted to more
decreases
Stage 1
Stage 2
Stage 3
critical areas
Alarm
Resistance
Exhaustion
T I M E
T I M E
Blood receives more
FIGURE 3.1 The General Adaptation Syndrome
energy-producing
substances
The General Adaptation
Body cells release
Syndrome
energy faster
What has just been described in very general terms is a com-
Blood clotting
ability increases
plex physiological response to stress in which our bodies
move from homeostasis, a level of functioning in which the
body’s systems operate smoothly and maintain equilibrium,
to one of crisis as the body attempts to return to homeostasis
Muscles tense
after responding to a stressor. This adjustment is referred to
as an adaptive response. First characterized by Hans Selye
in 1936, this internal fight to restore homeostasis is known as
the general adaptation syndrome (GAS) (Figure 3.1).
The GAS has three distinct phases: alarm, resistance, and
exhaustion.4
Alarm Phase When the body is exposed to a real or
perceived stressor, the fight-or-flight response kicks into gear.
FIGURE 3.2 The General Adaptation Syndrome: Alarm Phase
Stress hormones flow, and the body prepares to do battle.
The subconscious perceptions and appraisal of the stressor
stimulate the areas in the brain responsible for emotions.
This emotional stimulation triggers the physical reactions we
associate with stress (Figure 3.2). The entire process takes
only a few seconds.
homeostasis A balanced physical state in which all the
Suppose that you are walking to your residence hall after
body’s systems function smoothly.
a night class on a dimly lit campus. As you pass a particularly
adaptive response Form of adjustment in which the body
dark area, you hear someone cough behind you, and you
attempts to restore homeostasis.
sense that this person is fairly close. You walk faster, only to
hear the quickened footsteps of the other person. Your senses
general adaptation syndrome (GAS) The pattern
become increasingly alert, your breathing quickens, your
followed in the physiological response to stress, consisting
heart races, and you begin to perspire. The stranger is getting
of the alarm, resistance, and exhaustion phases.
closer and closer. In desperation you stop, clutching your
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CHAPTER 3
Managing Stress
63
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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book bag in your hands, determined to use force if necessary
The responses of the sympathetic
to protect yourself. You turn around quickly and let out a
Why am I
nervous system to stress involve a series
blood-curdling yell. To your surprise, the only person you see
physically
of biochemical exchanges between differ-
affected by
is your classmate Cindy, who has been trying to stay close to
ent parts of the body. The hypothalamus,
stressful
you out of her own anxiety about walking alone in the dark.
a structure in the brain, functions as the
situations?
She screams and jumps back, only to trip and fall. You look at
control center of the sympathetic nervous
her in startled embarrassment. You have just experienced the
system and determines the overall reaction
alarm phase of GAS.
to stressors. When the hypothalamus perceives that extra
When the mind perceives a real or imaginary stressor, the
energy is needed to fight a stressor, it stimulates the adrenal
cerebral cortex, the region of the brain that interprets the
glands, located near the top of the kidneys, to release the hor-
nature of an event, is called to attention. If the cerebral cortex
mone epinephrine, also called adrenaline. Epinephrine causes
perceives a threat, it triggers an autonomic nervous system
more blood to be pumped with each beat of the heart, dilates
(ANS) response that prepares the body for action. The ANS
the bronchioles (air sacs in the lungs) to increase oxygen
is the portion of the central nervous system regulating body
intake, increases the breathing rate, stimulates the liver to
functions that we do not normally consciously control, such
release more glucose (which fuels muscular exertion), and
as heart function, breathing, and glandular function. When we
dilates the pupils to improve visual sensitivity. The body is
are stressed, the activity rate of all these bodily functions
then poised to act immediately.
increases dramatically to give us the physical strength to pro-
As epinephrine secretion increases, blood is diverted away
tect ourselves or to make the physiological changes needed to
from the digestive system, possibly causing nausea and
respond and mobilize internal forces.
cramping if the distress occurs shortly after a meal and drying
The ANS has two branches: sympathetic and parasympa-
of nasal and salivary tissues, which produces dry mouth. The
thetic. The sympathetic nervous system energizes the body
alarm phase also provides for longer-term reaction to stress.
for fight or flight by signaling the release of several stress
At the same time, the hypothalamus uses chemical messages
hormones that speed the heart rate, increase the breathing rate,
to trigger the pituitary gland within the brain to release a
and trigger many other stress responses. The parasympathetic
powerful hormone, adrenocorticotropic hormone (ACTH).
nervous system functions to slow all the systems stimulated
ACTH signals the adrenal glands to release cortisol, a
by the stress response—in effect, it counteracts the actions
hormone that makes stored nutrients more readily available
of the sympathetic branch. In a healthy person, these two
to meet energy demands. Finally, other parts of the brain and
branches work together in a balance that controls the negative
body release endorphins, the body’s naturally occurring
effects of stress. However, long-term stress can strain this
opiates, which relieve pain that a stressor may cause.
balance, and chronic physical problems can occur as stress
reactions become the dominant forces in a person’s body.
Resistance Phase The resistance phase of the GAS is
similar to the alarm phase in that the same organs and sys-
tems are mobilized, but at a less intense level. The body tries
to return to homeostasis, but because some perceived stressor
autonomic nervous system (ANS) The portion of the
still exists, the body does not achieve complete rest. Instead,
central nervous system regulating body functions that a
the body stays activated or aroused at a level that causes a
person does not normally consciously control.
higher metabolic rate in some organ tissues. These organs and
sympathetic nervous system Branch of the autonomic
systems of resistance are working “overtime” and after pro-
nervous system responsible for stress arousal.
longed stress will become depleted to the point where they
cannot function effectively.
parasympathetic nervous system Branch of the
autonomic nervous system responsible for slowing systems
Exhaustion Phase Stress promotes adaptation, but a
stimulated by the stress response.
prolonged response leads to allostatic load, or exhaustive
hypothalamus A structure in the brain that controls the
wear and tear on the body.5 In the exhaustion phase of the
sympathetic nervous system and directs the stress response.
GAS, the physical and emotional energy used to fight a stres-
epinephrine Also called adrenaline, a hormone that
sor has been depleted. The toll the stress takes on the body
stimulates body systems in response to stress.
depends on the type of stress or how long it lasts. Short-term
stress probably would not deplete all energy reserves in an
cortisol Hormone released by the adrenal glands that
otherwise healthy person, but chronic stress can create
makes stored nutrients more readily available to meet energy
continuous states of alarm and resistance, resulting in total
demands.
depletion of energy and susceptibility to illness.
allostatic load Wear and tear on the body caused by
As the body adjusts to chronic unresolved stress, the
prolonged or excessive stress responses.
adrenal glands continue to release cortisol, which remains
ISBN: 0-558-34154-3
immunocompetence The ability of the immune system
in the bloodstream for longer periods of time due to slower
to respond to assaults.
metabolic responsiveness. Over time, without relief, corti-
sol can reduce immunocompetence, or the ability of the
64 PART ONE Finding the Right Balance
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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immune system to respond to various assaults. Blood pres-
sure can remain dangerously elevated, you may catch colds
more easily, or your body’s ability to control blood glucose
levels can be affected.
Stress and Your Health
Although much has been written about the negative effects
of stress, researchers have only recently begun to untangle
the complex web of physical and emotional interactions
that can break down the body over time. Stress is often
described as a “disease of prolonged arousal” that leads
to other negative health effects. Nearly all body systems
become potential targets, and the long-term effects may
be devastating. Look at the stress symptom checklist in
Table 3.1. Do you have any of these physical symptoms
of stress?
Studies indicate that 40 percent of deaths and 70 percent
of disease in the United States are related, in whole or in
part, to stress.6 The list of ailments related to chronic stress
Studies indicate that people who have little control or decision-
includes heart disease, diabetes, cancer, headaches, ulcers,
making powers in their employment are at an increased risk for
low back pain, depression, and the common cold. Chronic
stress-related cardiovascular disease.
stress has also been linked to abdominal fat (see the Health
Headlines box on page 67). Alarming increases in rates of
suicide, homicide, and domestic violence across the United
caregiving, bereavement, and natural disasters.11 Whatever
States are additional symptoms of a nation under stress.
the mechanism, the evidence is clear that stress is a significant
contributor to CVD morbidity and mortality. (For more infor-
Stress and Cardiovascular
mation about CVD, see Chapter 12.)
Disease Risks
Stress and Impaired Immunity
Perhaps the most studied and documented health conse-
As discussed in Chapter 2, a growing area of scientific
quence of unresolved stress is cardiovascular disease (CVD).
investigation known as psychoneuroimmunology (PNI)
Research on this topic has demonstrated the impact of
analyzes the intricate relationship
chronic stress on heart rate, blood pressure, heart attack, and
Why do
between the mind’s response to stress
stroke.7 The largest epidemiological study to date, the
I always
and the immune system’s ability to
INTERHEART Study with almost 30,000 participants in
catch a cold
function effectively. A review of re-
52 countries, identified stress as one of the key modifiable
during finals
search linking stress to adverse health
risk factors for heart attack.8 Similarly, the National Health
week?
consequences suggests that too much
Interview Study, conducted annually by the Centers for
stress over a long period can negatively
Disease Control and Prevention (CDC) National Center for
regulate various aspects of the cellular immune response.12
Health Statistics, has reported that stress accounts for approx-
In particular, stress disrupts bidirectional communication
imately 30 percent of the attributable risk of myocardial
networks between the nervous, endocrine, and immune
infarction (heart attack).9
systems. When these networks fail, messenger systems that
Historically, the increased risk of CVD from chronic stress
regulate hormones, blood cell formation, and a host of other
has been linked to increased plaque buildup due to elevated
health-regulating systems begin to falter or send faulty
cholesterol, hardening of the arteries, alterations in heart
information. Whereas the acute stress response is essentially
rhythm, increased and fluctuating blood pressure, and difficul-
protective, prolonged fight-or-flight depresses the immune
ties in cardiovascular responsiveness due to all of the above.
system, particularly through the actions of cortisol. During
Although these continue to be considered major risks, recent
prolonged stress, elevated levels of adrenal hormones
research also points to metabolic abnormalities, insulin resis-
tance, and inflammation in blood vessels (perhaps due to
lingering viral effects) as major contributors to heart disease.10
In the past 15 to 20 years, research has grown exponentially,
psychoneuroimmunology (PNI) Science of the
and direct links have been identified between the incidence
interaction between the mind and the immune system.
and progression of CVD and stressors such as job strain,
ISBN: 0-558-34154-3
CHAPTER 3
Managing Stress
65
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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TABLE 3.1
What Stress Symptoms Do You Have?
Circle the number that indicates the frequency of occurrence of each symptom.
At least once in
At least once in
At least once in
Never
the last 6 months
the last month
the last week
1. Tension headache
1
2
3
4
2. Migraine (vascular) headache
1
2
3
4
3. Stomachache
1
2
3
4
4. Cold hands
1
2
3
4
5. Acid stomach
1
2
3
4
6. Shallow, rapid breathing
1
2
3
4
7. Diarrhea
1
2
3
4
8. Muscle cramps
1
2
3
4
9. Burping
1
2
3
4
10. Gassiness
1
2
3
4
11. Increased urge to urinate
1
2
3
4
12. Sweaty hands/feet
1
2
3
4
13. Fatigue/exhausted feelings
1
2
3
4
14. Oily skin
1
2
3
4
15. Dry mouth
1
2
3
4
16. Hand tremor
1
2
3
4
17. Backache
1
2
3
4
18. Neck stiffness
1
2
3
4
19. Gum chewing
1
2
3
4
20. Constipation
1
2
3
4
21. Tightness in chest or heart
1
2
3
4
22. Dizziness
1
2
3
4
23. Nausea/vomiting
1
2
3
4
24. Butterflies in stomach
1
2
3
4
25. Skin blemishes
1
2
3
4
26. Heart pounding
1
2
3
4
27. Blushing
1
2
3
4
28. Palpitations
1
2
3
4
29. Indigestion
1
2
3
4
30. Hyperventilation
1
2
3
4
31. Skin rashes
1
2
3
4
32. Jaw pain
1
2
3
4
33. Grinding teeth
1
2
3
4
Evaluating Your Score
38
low physiological symptoms
38–50
moderate physiological symptoms
51–75
high physiological symptoms
76–99
excessive physiological symptoms
Source: R. Blonna, Coping with Stress in a Changing World, 4th ed. (New York: McGraw-Hill, 2007), 145.
destroy or reduce the ability of certain white blood cells,
cancer, arthritis, HIV/AIDS, asthma, and many other ailments
known as killer T cells, to aid the immune response. When
have been studied through PNI.13 Although each of these
killer T cells are suppressed and other regulating systems
diseases has distinct clinical consequences, the change
ISBN: 0-558-34154-3
aren’t working correctly, illness may occur.
in the immune system from balanced and flexible to un-
Loss of immune regulation can result in various disease
balanced and inflexible suggests increased vulnerability
states. The links between stress and physiological features of
to stress-related immune impairment.
66 PART ONE Finding the Right Balance
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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HEALTH headlines
REDUCE STRESS TO REDUCE FAT?
Can chronic stress reshape your factor for several diseases, including hyper- stay-slim solution: engage in regular physi-
body? Research suggests that
tension, coronary heart disease, stroke, and
cal activity. Physical activity will reduce your
stress is linked to belly fat and,
diabetes.
stress hormones and minimize some of
possibly, that you can keep the
Accumulating evidence from clinical to
the appetite-triggering and fat-storage
inches off your midsection by learning to
cellular to molecular studies tend to sup-
effects of cortisol.
manage stress.
port the aforementioned hypothesis. For
Sources: T. Parker-Pope, “Belly Fat May Be the
The exact mechanisms still need clarifi-
example, in animal studies, stress-induced
Body’s Way of Coping with Stress,” Wall Street
cation, but the hypothesis is that greater
cortisol secretion has been shown to
Journal, July 19, 2005; M. F. Dallman et al.,
vulnerability to stress increases exposure
increase central (abdominal) fat. In human
“Minireview: Glucocorticoids—Food Intake,
to stress-induced cortisol, a powerful hor-
studies, women with central fat distribution
Abdominal Obesity, and Wealthy Nations in
mone that contributes to increased hunger
have displayed heightened cortisol secre-
2004,” Endocrinology, 145, no. 6 (2004):
2633–38; E. S. Epel et al., “Stress and Body
(which acts as a stimulus to replace fuel
tion in response to an acute laboratory
Shape: Stress-Induced Cortisol Secretion Is
used during the fight-or-flight response)
stressor and an increase in food consump-
Consistently Greater among Women with
and to the deposit of fat in a particularly
tion following the stressful event. Only
Central Fat,” Psychosomatic Medicine 62
annoying spot—the waist. When cortisol
longitudinal and genetic studies will deter-
(2000): 623–32; E. Epel et al., “Stress May Add
hits any cell, it activates fat-storing
mine conclusively whether stress and cen-
Bite to Appetite in Women: A Laboratory Study
of Stress-Induced Cortisol and Eating Behavior,”
enzymes that cause the cell to enlarge.
tral fat are causally related, but correlational
Psychoneuroendocrinology 26 (2001): 37–49;
Fat cells in the belly have the largest num-
data suggest that greater life stress and
J. Marniemi et al., “Visceral Fat and Psychosocial
ber of receptors for cortisol, so the hor-
stress reactivity are linked to central fat.
Stress in Identical Twins Discordant for Obesity,”
mone is particularly attracted to this area.
If we want to win the battle of the
Journal of Internal Medicine 251 (2002):
The extra calories and the added abdomi-
bulge, we must focus on both stress
35–43; M. Duclos et al., “Fat Distribution in
Obese Women is Associated with Subtle
nal fat are both unsightly and dangerous.
management and weight-loss strategies.
Alteration of the Hypothalamic-Pituitary-Adrenal
Experts have identified excess weight
By learning to relax, we can de-stress and
Axis Activity and Sensitivity to Glucocorticoids,”
around the middle (central fat) as a risk
prevent excess cortisol secretion. A simple
Clinical Endocrinology 55 (2001), 447–54.
How long do you have to be stressed to suffer from
environmental stimuli, may be involved. Even so, studies
impaired immunity? A look at the research yields evidence
supporting this relationship outnumber those that don’t, and
of impaired immunity following acute stressors, such as
there is convincing evidence that susceptibility to disease
arguments, public speaking, and academic examinations.
is influenced by stress-induced alterations in immune
More prolonged stressors, such as the loss of a spouse,
functioning.18
exposure to natural disaster, caregiving, living with a handi-
cap, and unemployment, also have been shown to impair the
Stress and Diabetes
natural immune response among various populations.14
Other studies have linked stress with infectious diseases:
Recent data from large epidemiological studies have provided
■
strong evidence of a link between psychological or physical
More than 20 years of research examining psychosocial
stress and diabetes, a disease in which the pancreas fails to
factors in susceptibility to upper-respiratory-tract infections
produce enough insulin or to use insulin effectively.19 The
have revealed that higher stress levels are associated with
activation of the sympathetic nervous system by the stress
higher rates of viral infection and clinical cold symptoms.15
■
response can result in a combination of increased glucose
Psychological stress and loneliness correlate to poorer
(blood sugars) and inadequate production and release of
immune responses following influenza vaccinations in
insulin, a hormone that controls blood sugar levels.20 An
college students.16
■
occasional stress reaction might not harm you, but high stress
Exposure to academic stressors and self-reported stress are
in your job; unresolved problems with family, school, or
associated with increased upper-respiratory-tract infection
finances; and other sources of chronic stress can contribute
among students.17
Although strong indicators support the hypothesis of a
relationship between high stress and increased risk for dis-
diabetes Disease in which the pancreas fails to produce
ease, we are only beginning to understand this link. Some
enough insulin or to use insulin effectively.
research indicates that other factors, such as genetics and
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CHAPTER 3
Managing Stress
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Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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nations. Studies have shown that the rates of mental disor-
ders, particularly depression and anxiety, are associated with
various environmental stressors, including divorce, marital
conflict, economic hardship, and stressful life events.22 In
particular, mental disorders are more prevalent among young
people aged 15 to 24 than among other age groups. Based on
this finding, researchers suggest that as individuals move
from adolescence to adulthood, they face stressors of all
kinds, from school to employment to relationships, that may
challenge their mental health.23
Evidence suggests a strong relationship between stress and
the potential for negative mental health reactions. Consider
the following:24
■ Stressful life events and inadequate sources of social
support have been identified as predictors of psychiatric
morbidity, including anxiety, insomnia, and depression.
■ The high incidence of suicide among college students is
assumed to indicate high personal and societal stress in the
lives of young people.
■ 85 percent of college counseling centers report an increase
in the number of students they see with severe psychologi-
cal problems—problems largely related to stress and adjust-
ment difficulties.
Post-Traumatic Stress Disorder In severe cases,
War veterans and other survivors of traumatic events, such as rape,
an individual’s response to stress may develop into post-
car crashes, and natural disasters, may experience symptoms of post-
traumatic stress disorder (PTSD). PTSD generally devel-
traumatic stress disorder for months or even years thereafter.
ops within the first hours or days after a traumatic event, but
in some cases symptoms do not begin until months or years
later. Typically, persons suffering from PTSD have been
to the onset or progression of diabetes. Over time, high blood
soldiers returning from war, particularly those who saw
sugar levels may begin to damage body organs such as the
friends killed or wounded or who experienced terrible pain
kidneys and blood vessels in the extremities and eyes.
themselves. Many of these soldiers continued to suffer from
Controlling stress levels is critical for successful short- and
these experiences for decades afterward. Other traumatic
long-term diabetes management.21 People under lots of stress
events that can cause PTSD include rape or other severe
often don’t get enough sleep, don’t eat well, and may drink or
physical attacks, near-death experiences in accidents,
take other drugs to help them get through a stressful time. All
witnessing a murder or death, being caught in a natural
of these behaviors can alter blood sugar levels further, on top
disaster, or terrorist attacks.
of the increased blood sugars the body creates to fuel the
The development of PTSD is based on the hyperrespon-
fight-or-flight response. Exercise and relaxation techniques are
sive action of the fight-or-flight response. Symptoms include
particularly important. Even a short 15-minute walk can cause
the following:
glucose levels to drop dramatically, as well as yielding other
stress-reducing effects. Losing weight is also important. Being
■ Dissociation, or perceived detachment of the mind from the
at a healthy weight contributes to overall glucose control and
emotional state or even the body. The person may have a
prevents the stress that people feel when they are overweight.
sense of the world as a dreamlike or unreal place and have
For more information on diabetes, see Chapter 12.
little memory of the events—a form of dissociative amnesia.
■ Acute anxiety or nervousness, in which the person is hyper-
aroused, may cry easily or experience mood swings, and
Stress and the Mind
experience flashbacks, nightmares, and recurrent thoughts
Stress may be one of the single greatest contributors to
or visual images. Some people may sense vague uneasiness
mental disability and emotional dysfunction in industrialized
or feel as though the event were happening again and
again. Others may experience intense physiological reac-
tions, such as shaking or nausea, when something reminds
post-traumatic stress disorder (PTSD) An acute
them of the event. In some cases, they may have difficulty
ISBN: 0-558-34154-3
stress disorder caused by experiencing an extremely trau-
returning to areas that remind them of the trauma.
matic event, such as rape or combat.
68 PART ONE Finding the Right Balance
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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TABLE 3.2
The Student Stress Scale
The Student Stress Scale represents an adaptation of Holmes and
19. First quarter/semester in school
_____
36
Rahe’s Social Readjustment Rating Scale (SRRS). The SRRS has been
20. Change in living conditions
_____
31
modified for college-aged adults and provides a rough indication of
21. Serious argument with an instructor
_____
30
stress levels and health consequences for instructional purposes.
In the Student Stress Scale, each event is given a score that repre-
22. Lower grades than expected
_____
29
sents the amount of readjustment a person has to make as a result
23. Change in sleeping habits
_____
29
of the life change. To determine your stress score, check each event
24. Change in social activities
_____
29
that you have experienced in the last 12 months, and then add up the
25. Change in eating habits
_____
28
number of points corresponding to each event.
26. Chronic car trouble
_____
26
1. Death of a close family member
_____
100
27. Change in number of family gatherings
_____
26
2. Death of a close friend
_____
73
28. Too many missed classes
_____
25
3. Divorce between parents
_____
65
29. Change of college
_____
24
4. Jail term
_____
63
30. Dropping of more than one class
_____
23
5. Major personal injury or illness
_____
63
31. Minor traffic violations
_____
20
6. Marriage
_____
58
Total: _____
7. Firing from a job
_____
50
Scoring
8. Failure of an important course
_____
47
If your score is 300 or higher, you may be at high risk for developing
9. Change in health of a family member
_____
45
a stress-related illness. If your score is between 150 and 300, you
have approximately a 50:50 chance of experiencing a serious health
10. Pregnancy
_____
45
problem within the next 2 years. If your score is below 150, you have
11. Sex problems
_____
44
a 1 in 3 chance of experiencing a serious health change in the next
12. Serious argument with close friend
_____
40
few years.
13. Change in financial status
_____
39
The following can help you to reduce your risk:
14. Change of major
_____
39
■ Watch for early warning signs, such as irritable bowels.
15. Trouble with parents
_____
39
■ Avoid negative thinking.
16. New girlfriend or boyfriend
_____
37
■ Exercise regularly and eat nutritiously.
17. Increase in workload at school
_____
37
■ Practice some form of relaxation regularly.
18. Outstanding personal achievement
_____
36
■ Ask for help when necessary.
Source: Reproduced from R. Blonna, “The Social and Spiritual Basis of Stress,” in Coping with Stress in a Changing World, 4th ed. (New York:
McGraw-Hill, 2007), 116. Original source: T. Holmes and R. H. Rahe, “The Social Readjustment Rating Scale,” Journal of Psychosomatic
Research 11 (1967): 213. Copyright © 1967 Elsevier, Inc. Used with permission.
>try it NOW!
we and others have of ourselves, and the social conditions
we live in force us to readjust constantly. Key psychosocial
Write it down! Journal writing is a great method to cleanse
stressors include change, hassles, pressure, inconsistent
the mind, release emotions, and draft strategies for resolu-
goals and behaviors, conflict, overload, and other factors.
tion. The next time an event or situation activates your
Change Any time change occurs in your normal routine,
stress response, identify the emotions that accompany it,
whether good or bad, you will experience stress. The more
and then list several options to bring closure to the event.
changes you experience and the more adjustments you must
make, the greater the stress effects may be. Four decades ago,
Sources of Stress
Drs. Thomas Holmes and Richard Rahe developed the Social
Readjustment Rating Scale (SRRS) to identify whether major
life events preceded illness onset.25 They determined that
Both eustress and distress have many sources. They include
certain events (both positive and negative) were predictive of
psychosocial factors, environmental stressors, and self-
increased risk for illness. Since this time, the SRRS has served
imposed stress.
as the model for scales that measure stress levels of certain
groups, including students, and research has documented that
Psychosocial Sources of Stress
life events are related to a wide variety of physical and psycho-
logical problems. Table 3.2 shows the Student Stress Scale,
Psychosocial stress refers to the factors in our daily lives that
one example of a scale based on the SRRS.
cause stress (see the Assess Yourself box on page 70).
Interactions with others, the subtle and unsubtle expectations
(Text continues on page 72.)
ISBN: 0-558-34154-3
CHAPTER 3
Managing Stress
69
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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ASSESS yourself
HOW DO YOU RESPOND TO STRESS?
Fill out this assessment online at
www.aw-bc.com/myhealthlab or
www.aw-bc.com/donatelle.
Each of us reacts differently to life’s little challenges. Faced
heart rate, nausea, sweating, and other hot-reactor indicators
with a long line at the bookstore, most of us will get anxious
may occur. Completing the following assessment will help
for a few seconds before we start grumbling or shrug and
you think about how you respond to daily stressors.
move on. For others—the one in five of us whom researchers
Although this survey is just an indicator of what your stress
call hot reactors—such incidents are part of a daily health
levels might be, it will help you focus on areas that you may
assault. These individuals may get outwardly angry or appear
need to work on.
calm and collected. It is what is going on under the surface
Respond to each of the following statements with a rating
that affects health. Surges in blood pressure, increases in
of how likely you are to react to a given stressful event.
Some of
Usually or
Never
Rarely
the Time
Always
SCENARIO 1
You’ve been waiting 20 minutes for a table in a crowded restaurant, and the
hostess seats a group that arrived after you.
1. You feel your anger rise as your face gets hot and your heart beats faster.
1
2
3
4
2. You yell, “Hey! I was here first,” in an irritated voice to the hostess.
1
2
3
4
3. You angrily confront the people who are being seated in front of you
and tell them you were there first.
1
2
3
4
4. You say, “Excuse me,” in a polite voice and inform the other group
and/or the hostess that you were there first.
1
2
3
4
5. You note it, but don’t react. It’s no big deal, and the hostess obviously
didn’t notice the order of arrival.
1
2
3
4
SCENARIO 2
You get to a movie theater early so that you and a friend can get great
seats. You strategically pick a seat that will give you a good view.
Although the theater is nearly empty, a large, tall man plops himself in
the seat directly in front of you. Try as you might, you cannot see the
screen.
1. You say in a very loud voice, “There’s a whole theater, and he
has to sit right in front of us!”
1
2
3
4
2. You yell directly at the man, saying, “Can’t you sit somewhere else?
I can’t see!”
1
2
3
4
3. You tap the man on the shoulder and say, “Excuse me, I wonder
if you could slide down a seat. I can’t see.”
1
2
3
4
4. You calmly nudge your friend and decide to move.
1
2
3
4
5. You aren’t bothered by the person in front of you. This is just part
of going to the movies, and it is no big deal.
1
2
3
4
OTHER SCENARIOS
How would you respond to the following?
1. Your sister calls out of the blue and starts to tell you how much you mean to her.
Uncomfortable, you change the subject without expressing what you feel.
1
2
3
4
2. You come home to find the kitchen looking like a disaster area and your
spouse/roommate lounging in front of the TV. You tense up and can’t seem to
ISBN: 0-558-34154-3
shake your anger, but you decide not to bring it up.
1
2
3
4
3. Faced with a public speaking event, you get keyed up and lose sleep for a
day or more, worrying about how you’ll do.
1
2
3
4
70 PART ONE Finding the Right Balance
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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