The earliest research into the stress response (Figure 10-2) began as a result of observations that stressors brought about physical disorders or made existing conditions worse. Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation. Walter Cannon (1871–1945) methodically investigated the sympathetic nervous system as a pathway of the response to stress, known more commonly as fight (aggression) or flight (withdrawal). The well-known fight-or-flight response is the body’s way of preparing for a situation an individual perceives as a threat to survival. This response results in increased blood pressure, heart rate, and cardiac output.

While groundbreaking, Cannon’s theory has been criticized for being simplistic, since not all animals or people respond by fighting or fleeing. In the face of danger, some animals become still (think of a deer) to avoid being noticed or to observe the environment in a state of heightened awareness. Also, Cannon’s theory was developed primarily based on responses of animals and men. New research indicates that women may have unique physiological responses to stress. Physically, women have a lower hypothalamic-pituitary-adrenal axis and lower autonomic responses to stress at all ages, especially during pregnancy, and researchers hypothesize that estrogen exposure may regulate stress responses (Kajantie & Phillips, 2006). Men and women also have different neural responses to stress. While men experience altered prefrontal blood flow and increased salivary cortisol in response to stress, women experience increased limbic (emotional) activity and less significantly altered salivary cortisol (Wang et al., 2007).

Hans Selye (1907–1982) was another pioneer in stress research who introduced the concept of stress into both the scientific and popular literature. He expanded Cannon’s theory of stress in 1956 in his formulation of the general adaptation syndrome (GAS). The GAS occurs in three stages:

The alarm stage is extremely intense, and no organism can sustain this level of reactivity and excitement for long. If the organism survives, the resistance stage follows.

One of the most important concepts of this theory is that regardless of the threat, the body responds the same physiologically. It is a matter of individual perception. The threat may be real or only perceived. It does not matter if the threat is physical, psychological, or social; the physiological response is the same.

Additionally, the body cannot differentiate between the energy generated by positive and negative stimuli. Lazarus and colleagues (1980) described these reactions as distress and eustress:

Selye’s GAS remains a popular theory, but it has been expanded and reinterpreted since the 1950s. Some researchers question the notion of “nonspecific responses” and believe that different types of stressors bring about different patterns of responses, and that it is the degree of stress that is important (Koolhaas et al., 2011). Stress seems to be characterized by a reduced recovery. The magnitude of the stress response is determined by unpredictability or uncontrollability of the neuroendocrine reaction.

Furthermore, the GAS is most accurate in the description of how males respond when threatened. Females do not typically respond to stress by fighting or fleeing but rather by tending and befriending, a survival strategy that emphasizes the protection of the young and a reliance on the social network for support., Women are more vulnerable to stress-related disorders. This may be due to females being more sensitive to even low levels of corticotropin-releasing factor (CRF), a peptide hormone released from the hypothalamus in response to stress. Additionally, females seem to be less able to adapt to high levels of CRF as compared to men (Bangasser et al., 2010).

Increased understanding of the exhaustion stage of the GAS has revealed that illness results from not only the depletion of reserves but also the stress mediators themselves. For example, people experiencing chronic distress have wounds that heal more slowly. Table 10-1 describes some reactions to acute and prolonged (chronic) stress.

Many dissimilar situations (e.g., emotional arousal, fatigue, fear, loss, humiliation, loss of blood, extreme happiness, unexpected success) are capable of producing stress and triggering the stress response (Selye, 1993). No individual factor can be singled out as the cause of the stress response; however, stressors can be divided into two categories: physical and psychological. Physical stressors include environmental conditions (e.g., trauma and excessive cold or heat) as well as physical conditions (e.g., infection, hemorrhage, hunger, and pain). Psychological stressors include such things as divorce, loss of a job, unmanageable debt, the death of a loved one, retirement, and fear of a terrorist attack as well as changes we might consider positive, such as marriage, the arrival of a new baby, or unexpected success.

Spirituality and religious beliefs

Many spiritual and religious beliefs help persons cope with stress, and these deserve closer scientific investigation. Studies have demonstrated that spiritual practices can enhance the immune system and sense of well-being (Koenig et al., 2012). Some scholars propose that spiritual well-being helps people deal with health issues, primarily because spiritual beliefs help people cope with issues of living. Thus, people with spiritual beliefs have established coping mechanisms they employ in normal life and can use when faced with illness. People who include spiritual solutions to physical or mental distress often gain a sense of comfort and support that can aid in healing and lowering stress. Even prayer, in and of itself, can elicit the relaxation response (discussed later in this chapter) that is known to reduce stress physically and emotionally and to reduce stress on the immune system.

Figure 10-3 operationally defines the process of stress and the positive or negative results of attempts to relieve stress, and Box 10-1 identifies several stress busters that can be incorporated into our lives with little effort.

BOX 10-1      EFFECTIVE STRESS BUSTERS

Sleep

• Chronically stressed people are often fatigued, so going to sleep 30 to 60 minutes early each night for a few weeks is suggested.

• If fatigue persists, try going to bed another 30 minutes earlier.

• Sleeping later in the morning is not helpful and can disrupt body rhythms.

Exercise (aerobic)

• Exercise can dissipate chronic and acute stress.

• It may decrease levels of anxiety, depression, and sensitivity to stress.

• It can decrease muscle tension and increase endorphin levels.

• A recommended level of exercise is at least 30 minutes, three or more times a week.

• It is best to exercise at least 3 hours before bedtime.

Reduction or cessation of caffeine intake

• Lowering or stopping caffeine intake can lead to more energy, fewer muscle aches, and greater relaxation.

• Slowly wean off coffee, tea, colas, and chocolate drinks.

Music (classical or soft melodies of choice)

• Listening to music increases the sense of relaxation.

• Increased healing effects may result.

• Therapeutically, music can decrease agitation and confusion in older adults.

• Quality of life in hospice settings is enhanced.

Pets

• Pets can bring joy and reduce stress.

• They can be an important social support.

• Pets can alleviate medical problems aggravated by stress.

Massage

• Massage can slow the heart rate and relax the body.

• Alertness may actually increase.

In 1967, Holmes and Rahe published the Social Readjustment Rating Scale. This life-change scale measures the level of positive or negative stressful life events over a 1-year period. The level, or life-change unit, of each event is assigned a score based on the degree of severity and/or disruption. This questionnaire has been rescaled twice, first in 1978 and again in 1997 when it was adapted as the Recent Life Changes Questionnaire.

Since the scale was developed in 1967, life seems to have become more demanding and stressful. For example, travel is perceived as much more stressful now compared to 30 years ago. In 2007, online interviews were conducted to collect data from 1306 participants and then compared to data collected in the original study by Holmes and Rahe (First30Days, 2008). Although some life-change events were viewed as more stressful in 1967 (such as divorce and death of spouse), most events were viewed as more stressful in 2007 (Table 10-2).

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