MENTAL HEALTH MOMENT
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
June 15, 2001
"All of life is the management of risk, not its elimination."
- Walter Wriston, executive
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School Psychology Quarterly, published by APA Division 16
(School Psychology), has issued a call for papers for the "Research
Design and Methodology" section. Manuscripts should feature methods
and designs that offer a starting point for advanced research in school
psychology. The journal seeks to augment the methodological
sophistication of school psychology research and find diverse
approaches to answering questions in the field. Deadline: Ongoing.
Contact: Terry Gutkin, PhD, 117 Bancroft Hall, Department of
Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE
68588-0345; (402) 472-1154; Email: tgutkin@unl.edu
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State Behavioral Health Headlines. This online database is
designed for policy-makers, consumers and health-care providers and
offers current information on trends in the public sector ob behavioral
health-care services for each state. Web Site: http://www.samhsa.gov/mc/mc.html
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SMALL TALK: GETTING CHILDREN BRACES
First graders in braces? It's happening. Children should be screened
for braces by age seven. At that age, they may receive braces or
appliances such as nighttime headgear that can often reverse or
prevent overbites and other abnormalities. If a child does need
braces, they won't be anything like the ones today's adults wore in
their childhoods - they're more effective, consisting of new wires
made of nickel titanium that are activated by body heat and exert
gentle pressure on teeth, helping move them with less pain and fewer
visits to the orthodontist. They're also more fun to wear, coming in
different colors. Many retainers come in glow-in-the dark colors or
personalized with a picture of a favorite singer, cartoon or animal.
"Small Talk," a weekly column of safety and health information for
parents and other caregivers for children, is a community service of
the Penn State Children's Hospital at The Milton S. Hershey Medical
Center. Please direct any comments or questions to Patricia Millner,
director of nursing, mailto:pmillner@psu.edu.
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SUMMER COURSE on DISASTER SERVICES AND CRISIS INTERVENTION IN DISASTERS
A one credit course offered through the Counselor Education Department
at the University of Wyoming for upper level and graduate credit. The
course will be offered on July 27-28, 2001. See the online flier for
more details at: https://www.angelfire.com/biz3/news/flier.html
Also, the information about the course and registration can be
accessed at: http://www.uwyo.edu/summer
The course is listed under Counselor Education.
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The ACISA 2001 “Trauma Across Cultures” Conference Program is now
available on http://www.acisa.org.au/conference2001
The Conference will be held at the Carlton Crest Hotel in Brisbane 2 -
5 August. Post-Conference workshops will be at Warilda Conference
Centre, Brisbane, on 6 August. For further information please contact:
Sally Brown Conference Connections
PO Box 108 Kenmore QLD 4069
Telephone (61 7) 3201 2808
Facsimile (61 7) 3201 2809
E-mail sally.brown@uq.net.au
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The Red Cross Disaster Mental Health Services-I (DMHS-I) course will
be offered in Casper, WY on Friday-Saturday, September 14-15, 2001.
If you want to take this course as a Disaster Mental Health
Professional, please send an email for further details on how to
register to: larlion@usa.net The enrollment is limited to 20
participants. APA has approved this course for 12 CEUs. Other
mental health professions have also approved it for continuing
education.
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STRESS MANAGEMENT ON THE JOB
Over the past ten or so years, stress and its management have become voguish.
The problem with such fashionable concepts and related buzz words is paradoxical.
The repeated emphasis draws attention to and reflects concern while simultaneously
diminishing its importance by overuseage.
"Stress" as a word has assumed lexical significance. It depicts concept,
experience and response. However, the tendency is to view it exclusively in
terms of its negative effects, thereby negating the positive aspects that
Selye (1977) termed "the spice of life". The reality is that stress is both
ubiquitous and manageable. It is first necessary to understand stress as a
concept; then recognize it as a process; and finally, to learn and then apply
specific strategies and methods to prevent, reduce, or alleviate its effects,
whichever is applicable.
All three of these steps are essentially cognitive ones. Understanding and
recognition require an ability to objectively examine the stimulus and then
subjectively become consciously aware of its impact. The final step naturally
follows in the form of a tailormade prescription for stress management which
takes into account personal style and reaction.
THE STRESS RESPONSE: WHAT IT IS AND WHAT IT IS NOT
Since stress is a word which is frequently overused and misunderstood, a
working or operational definition is in order before proceedin further. Hans
Selye, whose name has become synonymous with stress-related research, defined
it in both simple and abstract terms. Simply stated, stress can be viewed as
the rate of wear and tear on the body and as a nonspecific response of the
body to any demand placed upon it (Selye, 1974, 1976).
The basic paradigm for physiological effects of stress on the body is the
following:
1. An event occurs or is anticipated. It could be anything. Since the
experience of stress is a highly subjective one, the range of triggering
events is as varied as the individuals involved.
2. Negative evaluations are formed about one's ability to cope with the
event. The perceived threat may be real or imagined. Self-esteem is threatened,
with concomitant pressure felt to alleviate the threat.
3. Negative self-talk produces emotions that can be painful, such as anxiety,
frustration, aggression, fear, and anger.
4. The brain receives the signal that sets off a series of physiological
changes to summon the body's resources to meet the danger. This is termed
the general adaptation syndrome (GAS). As outlined by Selye, this is the
body's response to handling stressors by seeking out and calling into action
the most appropriate channel of defense.
5. Adrenalin and other hormones are released, resulting in increased heart
rate and blood pressure. Stored sugar enters the blood stream, with increased
blood flow to the limbs. Muscles tense in readiness for action.
The above is an outline of the adaptation response. What has been called an
adrenalin jolt is an extremely effective and protective mechanism for handling
actual danger. However, it goes awry when it is activated in response to daily
stressors.
It is important to note that not all physiological responses are this extreme
and do not inevitably lead to pathology. However, the potential for pathogenesis
does exist and is more likely in response to chronic stress. The terms "acute",
"intermediate", and "chronic" characterize the time course of a stress response.
Acute stress reactions are marked in minutes, hours or days. Signs and symptoms
are related to the activated nervous and endocrine systems, although other organs
may be involved. Intermediate stress may extend over days and weeks. Signs and
symptoms may become varied and include those related to organ systems, and there
is sufficient definition of response to be designated a syndrome. Chronic stress
extends into months and years, causing marked strain on the body systems sufficient
to indicate frank pathology (Jacobson & McGrath, 1983).
What Stress Is Not
According to Selye, stress is not merely nervous tension. While emotional stimuli
rank high in activating stress responses, it should be noted conversely that
lower animal forms and even plants without nervous systems reflect the effects of
stress (Selye, 1974).
Stress is not always a nonspecific result of or cause of damage. This is apparent
when we look at the wide array of activities which serve as stressors without
necessarily causing or resulting from damage. One needs merely to be present at
any celebratory event marking a rite of passage to take note that the increased
stress and tension levels and the adaptive capacities which are invoked in response.
Finally, stress is not something to be avoided. Whereas this statement might seem
to be self-evident, it is an important one to reflect on. Since a total absence
of stress is equivalent to death, it follows that goal setting regarding stress
levels should aim at reduction and titration rather than elimination. Determination
of what constitutes acceptable and manageable, yet productive, stress levels is
important and can be arrived at by individual exploration, reflection, and decision.
In the basic stress language, the fight or flight mechanisms coupled with adaptive
and defensive reactions can be applied to all areas of response. Since neither
fighting nor fleeing provide practical solutions for most stressful situations,
it is necessary to sort out which events require another approach - one of
adaptation rather than defense. It can be argued that any gradation or alternate
response on the flight-fight continuum represents a form of adaptation which
effectively becomes the sine qua non in a complex social structure. It is obvious
that an employee who is reprimanded by a manager has learned alternatives to
either walking off in a huff or engaging in a battle royal on the spot. What will
most likely occur is the employee will exercise some control against the wish to
engage in battle or free from it.
While self-control is not to be exchewed - quite the contrary, it is necessary
and desirable - it should be recognized that the symptoms of chronic stress are
frequently associated with a stimulus (stressor), a response (defense), and
control (internal response). It is not a lessening of self-control, but rather
a reduction in the kind and number of issues that are perceived as stressors.
Selye (1974) described an alternative mechanism which he called "syntoxic". This
implies a passive tolerance toward stimuli - a tolerance which permits a kind of
peaceful coexistence with specific stressors.
Mind Body Response
The literature on stress management is vast. The workshop format (Wolfe, 1984)
for learning how to deal with stress is geared toward elaboration of cognition
with a focus on increased awareness of participants in what experiencing stress
means, encouraging exploration of conditions under which stress is experienced
and providing focus for existing coping mechanisms. Workshops, by virtue of
group membership, offer advantages inherent in the process of sharing experiences.
Participants are able to learn from one another to develop increased repertoires
of coping skills.
Special interest groups in which the management of stress is placed within the
context of the stressors specific to the group is well documented. For example,
Nelson & Quick (1985) described a group designed specifically for professional
women. A senior citizen group using a stress management model has been described
as an effective format for working with a well elderly population (Siegel & Liefer,
1983).
The helping professions are readily recognized as being susceptible to the
negative effects of stress. Groups designed to help nurses deal with stress
are documented. For example, Donovan (1981) reported in her research the
positive effects of a stress management group designed for use with cancer
nurses. Randolph, Price & Collins (1986) described research on the benefits
for nurses from a 2-day stress and burn-out prevention workshop format. The
study concluded that a significant reduction of stress-related symptoms resulted
for those who participated as compared to a control group who did not.
In these studies the ingredients for inclusion in stress management groups
and workshops were essentially the same. Only the style and emphasis were
varied. The maintenance of good health through good nutrition, exercise,
adequate rest, goal setting and time management are all integrally related
to feeling well and staying well. Relaxation and visualization techniques
are excellent and effective strategies for coping with stress. Additional
and important dimensions in the approach to stress management, relaxation,
visualization, and imagery fall in the domain of what Epstein (1980) referred
to as the "so-called minor hemisphere", or right-brain, function. As techniques,
they are integrally related to hypnosis but, as has been pointed out by
Zahourek ((1978), they can be used with less formal knowledge than specified
by hypnosis proper, which implies "formal induction of an altered state with
specific suggestions accompanying the induction" (p. 225). The use of relaxation
and imagery falls under the rubric of hypnotic techniques and can be used
within a variety of contexts so long as the methods are appropriately adapted
to the frame. In other words, the goals are clear and the visualization
techniques are tailored to those goals.
Relaxation and its benefits have been described in full by Luthe (1970) and
by Benson (1976), who has called it the "relaxation response". Benson stated
that relaxation activates an innate mechanism available to all. It can serve
as an antidote to the flight-fight response activated by the sympathetic
nervous system, It is a method for using "one innate mechanism to counteract
the effects of another" (p.178).
The use of guided imagery and visualization has been documented in the
literature as an effective means for learning, experiencing, and increasing
affective response for self-exploration and as a means to expand imagination
(Koshab, 1974).
Simonton et al. (1978), oncology specialists, demonstrated a relationship
between the ways in which individuals cope with stress and the incidence of
illness. In response to these findings, Simonton et al. developed a treatment
program that included learning a positive attitude toward life (cognition) in
combination with relaxation and visualization techniques (imagination).
LeShan (1974) went a step further in prescribing meditation on a regular
basis as an enabling mechanism for the individual to summon inner resources
to counter stress. Meditation when practiced regularly produces a physiological
state of deep relaxation coupled with increased alertness. Tension indicators
are reduced and the metabolic rate and heartbeat slow down. This physiological
state appears to be the opposite of the state brought about by stress.
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REFERENCES
Benson, H. (1976). Relaxation response. New York: Avon.
Donovan, M.I. (1981, April). Study of the impact of relaxation with guided
imagery on stress among cancer nurses. Cancer Nursing, pp. 121-126.
Epstein, G. (1980). Waking dream therapy. New York: Human Sciences Press.
Jacobson, S.F., & McGrath, H.M. (Eds.) (1983). Nurses under stress New York:
John Wiley.
Koshab, F.F. (1974, Sept.), Imagery techniques in psychiatry. Archives of General
Psychiatry, 283-290.
LeShan, L. (1974). How to meditate. Boston: Little Brown Co.
Luthe, E. (1970). Autogenic therapy research and theory. New York: Grune
and Stratton.
Nelson, D. L. & Quick, J. (1985). Stress of professional women. Academy of Management
Review, 10 (2), 206-218.
Randolph, G. L., Price, J.L. & Collins, J. K. (1986). The effects of burnout prevention
training on burnout symptoms in nurses. Journal of Continuing Education in Nursing,
17 (2), March/April.
Selye, H. (1956). The stress of life. New York: McGraw-Hill, 1976.
Selye, H. (1974). Stress without distress. New York: Signet.
Selye, H. (1977). A code for coping with stress. Association of Operating Room Nurses,
Inc. Journal, 25 (1), 35-42.
Siegel, E. & Liefer, A. (1983). A staying well group. In M. Rosenbaum (Ed.), Relaxation
and imagery: Therapeutic strategies for nurses. San Diego: Grune and Stratton.
Simonton, O. C., Matthews-Simonton, S. & Creighton, J. (1978). Getting well again.
New York: St. Martin's Press.
Wolfe, R. (1984, July). Coping with stress: A workshop framework. British Journal of
Guidance and Counseling, 12 (2), 141-153.
Zahourek, R.P. (1978). Overview - The context of clinical hypnosis in nursing practice.
In R.P. Zahourek (Ed.). Clinical Hypnosis and Therapeutic Suggestion in Nursing.
Orlando, FL: Gurne & Stratton.
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For further information on this topic and to search for and purchase books online,
gfo to the url below and begin your search by trying the following descriptors in
the search engine: Stress management, work and stress, stress and physiology, stress
responses, stress and cognition, stress and illness, stress and cancer, stress and
relaxation, stress and imagery, stress and meditation, stress and visualization, etc.
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
