Indiana University Bloomington

Indiana Prevention Resource Center (IPRC)

Stress and Anxiety

This article is the 4th in a series of six that examine mental health.

Stress and anxiety are mental health conditions that can contribute to personal success or to negative health outcomes. There is not a firm consensus among psychologists on definitions of stress. A traditional definition of stress is that, “Stress arises when individuals perceive that they cannot adequately cope with the demands being made on them or with threats to their well-being. (Lazarus, 1966) Coping refers to the thoughts and actions we use to deal with stress. Anxiety like stress is a normal part of life. Anxiety is defined by the Collins English Dictionary as “distress or uneasiness of mind caused by fear of danger or misfortune.” A certain amount of stress and anxiety can actually be healthy. Work deadlines and school assignments are both examples of situations that cause stress or anxiety. They also cause us to remember to stay focused on our jobs, school work and other life commitments.

source: http://www.thelakewoodscoop.com/news/2010/01/study-youth-now-have-more-mental-health-issues.html

Stress

There are three ways to view stress: The first focuses on the environment, the stimulus or stressor. The second focuses on a personal reaction of strain, anxiety, or suffering. The third focuses on the relationship and interaction between a person and the environment, i.e., coping. When we encounter a potential stressor in our environment, we tend to react with either a fight or flight response, depending in part upon whether we feel we can “cope” with the stressor or not. If not, we react with feelings of strain, anxiety or suffering. The reaction depends furthermore on our past experience, for example, learned helplessness, due to earlier inability to respond (or cope) in a successful manner, resulting in ceasing to try. When we feel unable to adequately respond to the demands being made on us, we experience worry and emotional tension. Stress affects our bodies and our behavior. Stress can lead to behavioral problems like increased use of alcohol, tobacco or other drugs, caffeine and poor nutrition. It can have physiological impacts on the cardiovascular, immune, digestive, respiratory, and/or endocrine system. Especially when past experiences (e.g., a previous event) or other conditions (e.g., health or wealth) contribute to vulnerability, an exposure to stress will cause physiological and psychological wear and tear and/or coping actions and behavior changes. For example, previous experiences of trauma can increase the risk for PTSD from a subsequent traumatic event; and a single parent facing homelessness can suffer increased stress at a job interview.

Our reactions to stress can produce symptoms of illness and ultimately illness or unhealthy behaviors. Coping strategies can focus on controlling the emotional response and/or on the problem to reduce or eliminate it or to transform it into a positive opportunity. For example, after ‘hitting bottom,’ using mandated treatment as an opportunity to turn one’s life around; using loss of a job as an opportunity to explore a career change ; or using grief from loss of a loved one to energize work as an advocate for changes that will reduce the likelihood of others’ suffering a similar loss. Coping focused on controlling emotions can take the form of seeking social support, distancing oneself or detach mentally, avoidance or escape, exerting self-control, acting responsibly, and/or finding positive meaning in the initially negative circumstance. With regard to gender, men tend to focus more on the problem, women more on the emotions, but men and women from the same career or occupation tend to respond similarly rather than according to traditional societal gender role.

The ability to cope successfully with stress depends upon having social and other kinds of support , such as receiving emotional support, informational support, affirmed feelings of being part of a network, respectful encouragement and validation, and personal assistance from a helpful person. Sometimes the stressor can make it difficult for a person to utilize support systems, even becoming so problem-focused that he/she causes supporters to withdraw. The supporter’s reaction sometimes makes a situation worse or the supporter can be negatively impacted by their efforts to help, e.g., caregivers who are overtaxed by the burden of care.

Stress management or coping techniques can help to reduce stress, Cognitive or relaxation therapy can help people deal with stress. Cognitive therapy analyzes stressors to identify illogical thinking or irrational beliefs that result in exaggerating the problem by focusing on negative details rather than the overall situation, which may be much less alarming. Another approach to treating stress involves relaxation exercises to relax muscles and mental exercises, like mental imagery and meditation, to control negative physical (e.g., headaches and body pains) and mental reactions (e.g., fear or depression) and negative behavior (e.g., fight response or social withdrawal) in reaction to stressors. (University of Minnesota, n.d.)

Anxiety

In addition to healthy, normal levels of anxiety, excessive anxiety can become a mental health disorder. Anxiety disorders are grouped into five major types: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD), and social phobia or social anxiety disorder. Generalized anxiety disorder (GAD) is characterized by chronic worry and anxiety, even when there is no cause for concern. Obsessive-compulsive disorder is marked by either repeated undesired thoughts called obsessions or repeated behaviors called compulsions, or both.

A person with panic disorder experiences sudden intense fear along with physiological symptoms like chest pain, shortness of breath or dizziness. Post-traumatic stress disorder can result from witnessing or experiencing a horrific accident or life-threatening event. In PTSD the normal self-defensive “fight or flight” response is altered to produce stress or fear even when not in any danger. Finally, in social anxiety disorder the person feels overcome with anxiety and extremely self-conscious in all ordinary social settings or in specific settings like public speaking or eating in public. (NIMH 2011c)

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can happen at any age as a result of such traumatic events as assault, domestic abuse, imprisonment, rape, terrorism or warfare. An exact cause is not known, though social, psychological, physical and genetic factors play a role. PTSD alters the body’s natural stress responses, including the hormones and neurotransmitters that pass information between nerves. Symptoms include “reliving” disturbing events, avoidance and arousal. A person may detach, feel numb, forget what happened, seem flat in mood, avoid reminders of the traumatic event, and feel hopeless. Arousal problems are another symptom. Arousal refers to your bodily and emotional responses to your surroundings and to things that happen around you. Arousal problems may include problems concentrating, easily startling, exaggerated responses, hyper vigilance, irritability, angry outbursts, and sleep problems. Treatment and a strong social support system can help prevent the development of PTSD after a trauma.

Various types of treatments have been found effective for PTSD. They include 1) a type of counseling called cognitive behavioral therapy (CBT), found to be the most effective type of counseling for PTSD; 2) eye movement desensitizing and reprocessing (EMDR); and 3) medications such as a selective serotonin reuptake inhibitor (SSRI). (VA, 2012) PTSD is often associated with alcohol and other drug abuse, depression, panic attacks and suicide attempts. Desensitization treatment should follow, not precede, treatment for these aforementioned associated problems.

Many veterans of combat in recent wars are returning home with anxiety disorders, particularly PTSD. The Indiana Prevention Resource Center (IPRC) seeks to support active duty and reserve military, veterans, and their families, and also to support their service providers. To this end the IPRC created a searchable database of online resources available both at www.vetresources.org and from the IPRC homepage This searchable database is a rich collection of web sites, online videos, research, publications and data with descriptions and a link to each resource.

About 30 percent of those who spend time in a war zone suffer from PTSD at time of discharge and another 20 to 25 percent will experience partial symptoms. (Nebraska Department of Veterans Affairs, 2007) Estimates of returning veterans from Afghanistan and Iraq with PTSD range from a RAND 2008 study result of 13.8% (Gradus, 2011) to 20 percent (Johnson, 2011). Rates of PTSD and depression have been found to increase markedly among National Guard twelve months post-deployment, while rates remained unchanged among active military. (Carollo, 2010)

For more information on mental health, including statistics (e.g., for mentally unhealthy days, mental disorder deaths, and suicide) for Indiana and her 92 counties, see the IPRC GIS in Prevention County Profiles’ chapter on Mental Health which includes an extensive introduction to the topic of mental health at http://www.drugs.indiana.edu/prev-stat/county-profiles-data.

Select Bibliography

Carollo, Kim. (2010) Combat’s Hidden Toll: 1 in 10 Soldiers Report Mental Health Problems,” ABC News. Retrieved 10-31-2011 from http://abcnews.go.com/Health/MindMoodNews/10-soldiers-foughtiraq-mentally-ill/story?id=10850315

Collins English Dictionary - Complete & Unabridged 10th Edition, 2009.

Gradus, Jaimie L.. (2011) Epidemiology of PTSD. Department of Veterans Affairs. National Center for PTSD. Retrieved 10-31-2011 from http://www.ptsd.va.gov/professional/pages/epidemiological-facts-ptsd.asp

Johnson, Lorie. (2011) PTSD: Conquering Military Suicides with Hope (Jan 9). CBN News. Retrieved 10-31-2011 from http://www.cbn.com/cbnnews/healthscience/2010/October/Ministry-Arms-USMilitary-to-Conquer-PTSD-/

Lazarus, R. S. Psychological Stress and the Coping Process. New York: McGraw-Hill (1966).

National Institute of Mental Health (NIMH) (2011c) Anxiety Disorders. Retrieved 10-30-2011 from http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Nebraska Department of Veterans Affairs. (2007) Post Traumatic Stress Disorder. Retrieved 10-31-2011 from http://www.ptsd.ne.gov/what-is-ptsd.html

University of Minnesota, Department of Psychology (n.d.) Introduction to Health Psychology. Retrieved 10-30-2011 from http://www.psych.umn.edu/courses/spring07/kramerm/psy3617/lectures/lecture_23_health_psychology.pdf

U.S. Department of Veterans Affairs, National Center for PTSD. “Treatment of PTSD” (2012). Accessed 5-26-2012 at http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp.

 

By Barbara Seitz de Martinez, 5/30/2012