How can stress be managed? - Chapter 13

What theories about stress are there?

Stress management training is the general term for interventions developed to teach participants how to handle stress. These interventions are based on cognitive-behavioral theories of stress, which consider stress as the result of an outcome of various environmental and cognitive processes. Stress is seen as a negative emotional and physiological state that is the result of cognitive responses to events that happen to us. That is why stress is seen more as a process than an outcome.

Beck and Ellis assumed that our cognitive responses to events determine our mood, not the events themselves, and that feelings of stress or other negative emotions are the result of wrong or irrational thinking. This means that the emotions are the result of misinterpretations of events or cognitions.

Beck has identified different categories of thinking that lead to negative emotions, namely:

• Catastrophic thinking: if an event is considered negative and possibly dangerous.
• Over-generalization: when a negative conclusion is drawn as a result of just one incident.
• Arbitrary inference: draw a conclusion without sufficient evidence.
• Selective abstraction: focus on a detail outside the context.

What does stress management training entail?

The stress response model suggests a series of factors that can be changed by reducing the stress of an individual. Examples of this are:

• Environmental events that trigger the stress response.
• Inappropriate behavioral, physiological, or cognitive responses that occur in response to the event.

Most stress management programs focus on changing people's responses to events that happen around them. Triggers can be identified and modified using problem-solving strategies. In addition, wrong thoughts can be identified and changed by a number of cognitive techniques, such as cognitive restructuring. Hereby automatic negative or catastrophic thoughts are brought up to bring them more in line with reality.

Changing triggers

The triggers that lead to stress are different for each person. A good approach to combat stress is therefore to investigate which triggers lead to stress in a person and how these triggers can be reduced. One of the most commonly used approaches to identify and change triggers is that of Egan. Stress triggers are identified and changed through three phases:

1. Problem exploration and clarification: what are the triggers that lead to the stress?
2. Goal setting: which triggers does the person want to change?
3. Facilitating action: how do they set about changing these stress triggers?

When setting goals, it is important that someone sets specific goals. "I want to relax more" is a vague goal and usually nothing comes of it. But if someone decides to relax 20 minutes halfway through and after work with a sudoku puzzle, that is a clear plan. This is something someone will not easily forget because there are clear times for relaxing.

Training in relaxation

Relaxation exercises help to reduce the feeling of stress in specific situations, but they also make someone feel calmer in general. Meditation not only has the effect of making someone feel relaxed, but also has the effect that people are more likely to come up with good, realistic solutions and that they have a greater sense of control.

Relaxing is best learned under optimal conditions, so that you are not distracted by anything. It is important to practice often, sometimes several times a day. If someone has mastered the exercise well, they can be applied in stressful situations.

The most common way to relax is to tighten the muscles one by one in a specific order and then relax again. In addition to the relaxation training sessions, it is often effective if someone tracks during the day when they are tense or relaxed. In this way, someone can find out when they can best apply the relaxation exercises.

Cognitive interventions

In 1985, Meichenbaum developed a strategy called self-instruction. The intention is that stress-inducing thoughts are identified and replaced by more positive ones. You can talk to yourself in two ways. Namely, by observing your behavior and then saying that you need to take it easy. A second way is to tell yourself that you have been in this situation before and that you could handle it then. Such techniques break the flow of negative and stress-inducing thoughts in any case. Sometimes, if someone is really good at this, they can actually reduce stress.

A more complex form of cognitive intervention works as follows: the individual must start to see the doom thoughts as possibilities rather than facts. This requires intervention in both superficial cognitions and cognitive schemata. This is usually done in therapy sessions through a method called the Socratic method or guided discovery. In this, the client often identifies a number of stress-provoking thoughts that have recently occured, and then challenges their accuracy under the guidance of their therapist. 

Behavioral interventions

The purpose of these interventions is to teach someone behavior so that they can respond to stress as optimally and effectively as possible. For some behaviors, it is very easy and a matter of remembering to do it rather than learning new ones. Here you can think of no longer wanting to feel rushed in traffic and therefore driving more calmly and not cutting in front of other cares. It is more difficult when someone reacts aggressively quickly in certain social situations. Here it can be a solution to play role games.

Inoculation against stress

The Stress inoculation training is a way of reducing stress that focuses on thinking and becoming calm before someone enters a certain situation.

You can think of the following points:

• Check whether the (planned) behavior is relevant in the situation.
• Maintain relaxation.
• Engage in self-talk in a relevant way.

What is meant by third wave therapies?

The stress management interventions mentioned above are known as the second wave therapies. The conditioning theories of Pavlov and Skinners are known as the first wave therapies. These were not concerned with adjusting cognitions. The second wave therapies saw cognitions as the development and treatment of emotional problems. The third wave therapies are becoming increasingly known and are known for a combination of cognitive and behavioral adjustments. The purpose of this therapy is, among other things, to withstand the feared situation and to find that the situation is much less scary than expected.

Mindfulness-based interventions

According to a Buddhist tradition, mindfulness is needed to achieve enlightenment. Someone focuses his thoughts on the here and now. This teaches that thoughts are just thoughts that can be true and false. Mindfulness is not easy and fast to learn, usually a training of a few weeks or months precedes. Bishop et al. (2004) indicates that there are two components within mindfulness:

• Self-regulation of attention: an individual is completely focused on the here and now. Thoughts, feelings and emotions pass by and they cannot be judged.
• An orientation toward one's experience in the present moment is characterized by curiosity, openness and acceptance: because an individual does not fully elaborate and assess his thoughts, much attention is paid to the present. He views and experiences his experiences in an unfiltered way.

Acceptance and commitment therapy

To achieve greater psychological flexibility, is used commitment, acceptance, mindfulness and behavioral change. Classical and operant conditioning are at the basis of thoughts, emotions and behavior. Operant conditioning is a process in which the outcomes of behavior determine the behavior of an individual. Results are achieved through contextual variables or direct behavioral change. The therapy also wants to increase individual flexibility when confronted with situations. This can be achieved by focusing on the following five core processes: acceptance, cognitive defusion, contact with the present moment, values ​​and committed action.

• Acceptance: an individual must allow himself to become aware of his thoughts, feelings and physical sensations. These must be experienced and not assessed.
• Cognitive defusion: feelings, thoughts and physical sensations are what they are and are not harmful to the individual. The individual must accept that they must not be changed or must be verifiable.
• Contact with the present moment: open and not favored contact with the present. This can be achieved through mindfulness.
• Values: an individual must have the motivation to change.
• Committed action: plans must be made to achieve the intended changes.

ACT is a complex therapy with different behavioral methods as well as the use of stories, metaphors and mental exercises to bring about change.

How can stress be prevented?

The simplest way to prevent stress for many people is to teach stress management techniques. This can be at school, at work or at courses that people can approach themselves. Research also shows that people who do relaxation exercises and other stress-reducing exercises experience less stress than people who don't. A problem is that only a small part of a population participates in such courses by itself.

More and more employers are teaching their employees how to cope with stress by allowing them to participate in stress management workshops. In Great Britain, it is often already included in workplace safety regulations. Research has shown that half a million people get sick every year due to stress and 20 percent of the population indicated that they found work too stressful. Taken together, stress, anxiety and depression in the UK account for the loss of 13.5 million working days a year. Jobs are becoming increasingly stressful. Most work-related stress interventions focus on better handling the demands of a job.

Physical training programs can have a positive effect because it improves overall fitness and fitness, giving someone more energy to do their job. However, real stress management ensures that someone generally feels less stress.

The disadvantage of work-related stress intervention is that not every employee or employer wants to participate in such programs. If employees have the choice to do this, it is usually people with relatively little stress who participate. Employees with a lot of stress are often anxious and think that a course will have little influence.

Reducing stress is not just a matter of investigating where the stress comes from and then doing something about it. Some sources of stress are common and occur in many professions, others are specific to a particular job. Some things are also simply not changeable. In a hospital people will always die and you will regularly be very busy. So some jobs require real stress.

If you want to do something about the stress on the work floor, you can do that best in three steps:

• Identify the causes of stress in the work environment.
• Identify the solutions of the people most affected by this.
• Initiate a process to tackle the issues raised in point two.

Sometimes the causes of stress are things like the bus that does not run at times that shifts begin. Then people have to go to work very early and then sit there and do nothing, or they always arrive just in time or just too late. A simple solution can be that the shift is shifted by 15 minutes.

Other relatively simple solutions are giving people more control over the layout of work and improving communication between management and subordinates.

How can stress in hospital settings be minimised?

Whether it is a major or minor surgery or local or complete anesthesia, undergoing surgery is always exciting. The fear of the operation affects the amount of painkillers that someone wants and the time it takes for someone to recover. For these reasons, researchers have tried to find out what could cause patients to feel less stressed.

Because people cannot put themselves under anesthesia and cannot operate on themselves, the sense of control must arise in this case because someone is sufficiently informed and can, for example, indicate when he is ready for the operation. You can provide procedural information to a patient, which means that you tell what exactly will happen before, during, and after the operation. When you provide sensory information it means that you inform the patient about what he or she will feel after the operation. For example, he will have headaches for a few more weeks.

The best way to inform a patient varies greatly from patient to patient. People with a problem-oriented way of dealing with difficult situations want to know what they can expect. They therefore benefit the most from information provision. Other people, on the other hand, prefer not to know anything because they will only make it worse in their heads. People who use stress-avoiding coping strategies benefit most from learning distracting techniques.

A colonoscopy is a small surgical procedure in which a small piece of the stomach wall is removed. This piece can then be tested for the presence of abnormal cells.

With a bone marrow biopsy, a sample is made from a bone.

When children need surgery, it is sometimes useful to first show them what will happen with a book or with a doll.