Psychological stress

Psychological stress

In psychology, stress is a feeling of emotional strain and pressure. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excessive amounts of stress, however, can increase the risk of illness as well as aggravate any pre-existing condition.

Definitions

Prior to the introduction of the concept "stress" in the psychological sense, people already identified a range of more nuanced ideas to describe and confront such emotions as worry, grief, concern, obsession, fear, annoyance, anxiety, distress, suffering, and passion.

Hans Selye, who became known as "the father of stress," defined physical or biological stress as a "nonspecific response of the body to any demand made upon it." Stressors are inherently neutral, meaning that the same stressor can induce either a positive or a negative response, depending on the condition of the person and how they perceive the situation. Selye called positives responses to a stressor "eustress," which comes from the Greek root eu- which means "good." Negative responses are called "distress," from the Latin root dis-. Eustress results when a person perceives a stressor as positive.

Selye proposed four variations of stress. On one axis he locates good stress (eustress) and bad stress (distress). On the other is over-stress (hyperstress) and understress (hypostress). Selye advocates balancing these: the ultimate goal would be to balance hyperstress and hypostress perfectly and have as much eustress as possible.

Eustress

Eustress is beneficial stress. It is the positive cognitive response to stress that is healthy, or gives one a feeling of fulfillment or other positive feelings.

Eustress refers to a positive response one has to a stressor, which can depend on one's current feelings of control, desirability, location, and timing of the stressor. It is not defined by the stress or type, but rather how one perceives the stressor (for example, a negative threat versus a positive challenge).

Eustress occurs when the gap between what one has and what one wants is slightly pushed, but not overwhelmed. The goal is not too far out of reach but is still slightly more than one can handle. This fosters challenge and motivation since the goal is in sight. The function of challenge is to motivate a person toward improvement and a goal. Challenge is an opportunity-related emotion that allows people to achieve unmet goals.

Eustress is primarily based on perception; how the person perceives their given situation and how they perceive the given task. Eustress is thus related to self-efficacy, or the person's judgment of how well they can carry out a required task, action, or role. Some contributing factors are a person's beliefs about their options for courses of action and their ability to perform those actions.

Measurement

Much of the research on eustress has focused on its presence in the workplace. In the workplace, stress can often be interpreted as a challenge, which generally denotes positive eustress, or as a hindrance, which refers to distress that interferes with one's ability to accomplish a job or task. Occupational eustress may be measured on subjective levels such as of quality of life or work life, job pressure, psychological coping resources, complaints, overall stress level, and mental health. Common subjective methodologies were incorporated in a holistic stress model created in 2007 to acknowledge the importance of eustress, particularly in the workplace. This model uses hope, positive affect, meaningfulness, and manageability as a measure of eustress, and negative psychological states, negative affect, anxiety, and anger as a measure of distress. Objective measures have also been used and include blood pressure rate, muscle tension, and absenteeism rates.

Efforts have been made to increase eustress in the workplace by promoting positive reactions to an inevitably stressful environment. Techniques such as Stress Management Interventions (SMI) have been employed to increase occupational eustress. SMI's often incorporate exercise, meditation, and relaxation techniques to decrease distress and increase positive perceptions of stress in the workplace. Rather than decrease stress in the workplace, these techniques attempt to increase eustress with positive reactions to stressful stimuli.

Flow

When an individual appraises a situation as stressful, they add the label for distress or eustress to the issue at hand. If a situation induces eustress, the person may feel motivated and can experience flow. Positive psychologist, Mihaly Csikszentmihalyi, created the concept of flow to describe an extremely productive state in which an individual experiences their prime performance. It is described as the moments when one is completely absorbed into an enjoyable activity with no awareness of one's surroundings. Eustress can be described as being focused on a challenge, fully present and exhilarated, which almost exactly mirrors the definition of flow. Flow, therefore, can be understood as the "ultimate eustress experience – the epitome of eustress."

There are several factors that may increase or decrease one's chances of experiencing eustress and, through eustress, experiencing flow. Mindset is a significant factor in determining distress versus eustress. The positive mindset increases the chances of eustress and a positive response to stressors. Optimistic people and those with high self-esteem have eustress experiences. Response to stress is influenced by hereditary predispositions and expectations of society. Thus, a person could be at a certain advantage or disadvantage toward experiencing eustress.

Compared with distress

Yerkes–Dodson curve for a difficult task

Distress is the most commonly referred to type of stress, having negative implications, whereas eustress is usually related to desirable events in a person's life. Selye argued that persistent stress that is not resolved through coping or adaptation should be known as distress, and may lead to anxiety, withdrawal, and depressive behavior. In contrast, if stress enhances one's functioning it may be considered eustress.

Differentiation between the two is dependent on one's perception of the stress, but it is believed that the same stressor may cause both eustress and distress. One context that this may occur in is societal trauma (for example, the black death or World War II) which may cause great distress, but also eustress in the form of hardiness, coping, and fostering a sense of community.

It has been suggested that the Yerkes–Dodson model demonstrates the optimum balance of stress with a bell curve. However, studies have not always confirmed this.

Distress

Distress is the opposite of eustress, the positive stress that motivates people. Distress is an aversive state in which a person is unable to completely adapt to stressors and shows maladaptive behaviors, such as inappropriate social interaction (aggression, passivity, or withdrawal). Psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing, or out of the ordinary.

This may be something which resolves without further medical intervention, though people who endure such symptoms longer term are more likely to be diagnosed with a mental disorder.

Differences from mental disorder

Some psychiatrists may use these two terms "mental distress" and "mental disorder" interchangeably. However, it can be argued that there are fundamental variations between mental distress and mental disorder. "Mental distress" has a wider scope than the related term "mental illness," which refers to a specific set of medically defined conditions. A person in mental distress may exhibit some of the broader symptoms described in mental disorders, without actually being ‘ill’ in a medical sense. People with mental distress may also exhibit temporary symptoms on a daily basis, while patients diagnosed with mental disorder may require treatment by a mental health professional.

Symptoms

Stress often leads to headaches

The symptoms for mental distress include a wide range of physical to mental conditions. Physical symptoms may include sleep disturbance, anorexia (lack of appetite), loss of menstruation for women, headaches, chronic pain, and fatigue. Mental conditions may include difficulty in anger management, compulsive/obsessive behavior, a significant change in social behavior, a diminished sexual desire, and mood swings.

Types of stressors

A stressor is any event, experience, or environmental stimulus that causes stress in an individual. These events or experiences are perceived as threats or challenges to the individual and can be either physical or psychological. Stress can be external and related to the environment, but may also be caused by internal perceptions that cause an individual to experience anxiety or other negative emotions surrounding a situation which they then deem stressful.

The different types of stressors that affect individuals can be classified into four categories: 1) crises/catastrophes, 2) major life events, 3) daily hassles/microstressors, and 4) ambient stressors. The common factor among these stressors is an inconsistency between expected events ("set value") and perceived events ("actual value") that cannot be resolved satisfactorily. Additionally, there are stressors that affect large numbers of people in a common situation.

Crises/catastrophes

This type of stressor is unforeseen and unpredictable and, as such, is completely out of the control of the individual. Examples of crises and catastrophes include devastating natural disasters, such as major floods or earthquakes, wars, pandemics, and so forth. Though rare in occurrence, this type of stressor typically causes a great deal of stress in a person's life.

Combat stress is a widespread acute problem experienced by military personnel as a direct result of the trauma of war. Combat stress reaction is generally short-term and should not be confused with long-term disorders such as post-traumatic stress disorder, although any of these may commence as a combat stress reaction.

Major life events

Common examples of major life events include: marriage, going to college, death of a loved one, birth of a child, divorce, moving to a new home, and so forth. These events, either positive or negative, can create a sense of uncertainty and fear, which will ultimately lead to stress.

The length of time since occurrence and whether or not it is a positive or negative event are factors in whether or not it causes stress and how much stress it causes. Additionally, positive life events are typically not linked to stress, and if so, generally only trivial stress, while negative life events can be linked to stress and the health problems that accompany it.

Changes in the home

Divorce, death, and remarriage are all disruptive events in a household. Although everyone involved is affected by events such as these, it can be most drastically seen in children who have relatively undeveloped coping skills. For this reason a stressful event may cause some changes in their behavior. Falling in with a new crowd and developing some new and sometimes undesirable habits are just some of the changes stress may trigger in their lives.

A particularly interesting response to stress is talking to an imaginary friend. A child may feel angry with a parent or their peers who they feel brought this change on them. They need someone to talk to but it definitely would not be the person with whom they are angry. That is when the imaginary friend comes in. They “talk” to this imaginary friend but in doing so they cut off communication with the real people around them.

Daily hassles/microstressors

This category includes daily annoyances and minor hassles. Examples include: making decisions, meeting deadlines at work or school, traffic jams, encounters with irritating personalities, and so on. Daily hassles are the most frequently occurring type of stressor in most adults. Their high frequency causes this stressor to have the most physiological effect on an individual.

Often, this type of stressor includes conflicts with other people. Daily stressors, however, are different for each individual, as not everyone perceives a certain event as stressful. For example, most people find public speaking to be stressful, nevertheless, a seasoned politician most likely will not. There are three major psychological types of conflicts that can cause stress:

• The approach-approach conflict, which occurs when a person is choosing between two equally attractive options, for example, whether to go to a movie or a concert.
• The avoidance-avoidance conflict, which occurs where a person has to choose between two equally unattractive options, for example, to take out a second loan with unappealing terms to pay off the mortgage or to face foreclosure on one's house.
• The approach-avoidance conflict, which occurs when a person is forced to choose whether or not to partake in something that has both attractive and unattractive traits, such as whether or not to attend an expensive college which would involve taking out substantial loans but also offers a quality education and employment after graduation.

Ambient stressors

As their name implies, these are global (as opposed to individual) low-grade stressors that are a part of the background environment. They are defined as stressors that are "chronic, negatively valued, non-urgent, physically perceptible, and intractable to the efforts of individuals to change them." Typical examples of ambient stressors are pollution, noise, crowding, and traffic. Unlike the other types of stressor, ambient stressors can (but do not necessarily have to) negatively impact stress without conscious awareness.

Organizational stressors

Stress due to bad organizational practices in various types of organizations, including business, political, military, and even religious organizations, has been connected to "toxic Leadership." These leaders may act as busybodies, controllers, enforcers, bullies, or be absentee leaders. Toxic leadership results in widespread organizational problems that can be very stressful to all members of the organization.

Measurement

Life events scales can be used to assess stressful things that people experience in their lives. One such scale is the Holmes and Rahe Stress Scale, also known as the Social Readjustment Rating Scale, or SRRS. Developed by psychiatrists Thomas Holmes and Richard Rahe in 1967, the scale lists 43 stressful events, including items such as death of a spouse, death of a close family member, divorce, pregnancy, imprisonment, and personal injury or illness.

A modified version also exists for non-adults.

There are also many (psycho-)physiological measurement methods that correlate more or less well with psychological stress (mental or emotional) and are thus used as a possible indicator of stress level.

Physical effects

The body responds to stress in many ways. Readjusting chemical levels is just one of them. Stressors are more likely to affect an individual's health when they are "chronic, highly disruptive, or perceived as uncontrollable." There is likely a connection between stress and illness. Stressors can make individuals more prone to both physical and psychological problems, such as heart disease and anxiety. As well as being more likely to become sick, mentally or physically, people under constant distress may experience aggravation of any pre-existing conditions. Excessive amounts of stress can increase the risk of a variety of illnesses including stroke, heart attack, ulcer, and mental illnesses such as depression.

Theories of a proposed stress–illness link suggest that both acute and chronic stress can cause illness, and studies have found such a link. According to these theories, both kinds of stress can lead to changes in behavior and in physiology. Behavioral changes can involve smoking- and eating-habits and physical activity. Physiological changes can be changes in sympathetic activation or hypothalamic pituitary adrenocorticoid activation, and immunological function. However, there is much variability in the link between stress and illness.

Stress can make the individual more susceptible to physical illnesses like the common cold.Template:Qn Stressful events, such as job changes, correlate with insomnia, impaired sleeping, and health complaints. Research indicates the type of stressor (whether it is acute or chronic) and individual characteristics such as age and physical well-being before the onset of the stressor can combine to determine the effect of stress on an individual. An individual's personality characteristics (such as level of neuroticism), genetics, and childhood experiences with major stressors and traumas may also dictate their response to stressors.

Chronic stress and a lack of coping resources available or used by an individual can often lead to the development of psychological issues such as depression and anxiety (see below for further information). This is particularly true regarding chronic stressors. These are stressors that may not be as intense as an acute stressor like a natural disaster or a major accident, but they persist over longer periods of time. These types of stressors tend to have a more negative impact on health because they are sustained and thus require the body's physiological response to occur daily. This depletes the body's energy more quickly and usually occurs over long periods of time, especially when such microstressors cannot be avoided (for example: stress related to living in a dangerous neighborhood). See allostatic load for further discussion of the biological process by which chronic stress may affect the body. For example, studies have found that caregivers, particularly those of dementia patients, have higher levels of depression and slightly worse physical health than non-caregivers.

Studies have also shown that perceived chronic stress and the hostility associated with Type A personalities are often correlated with much higher risks of cardiovascular disease. This occurs because of the compromised immune system as well as the high levels of arousal in the sympathetic nervous system that occur as part of the body's physiological response to stressful events. However, it is possible for individuals to exhibit hardiness – a term referring to the ability to be both chronically stressed and healthy. Chronic stress can correlate with psychological disorders such as delusions. Pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus.

It has long been believed that negative affective states, such as feelings of anxiety and depression, could influence the pathogenesis of physical disease, which in turn, have direct effects on biological process that could result in increased risk of disease in the end. However, studies done by the University of Wisconsin-Madison and other places have shown this to be partly untrue; although perceived stress seems to increase the risk of reported poor health, the additional perception of stress as something harmful increases the risk even further. For example, when humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral responses are most likely to occur. Such changes could lead to disease.^{[citation needed]} Chronic stress results from stressful events that persist over a relatively long period of time, such as caring for a spouse with dementia, or results from brief focal events that continue to be experienced as overwhelming even long after they are over, such as experiencing a sexual assault.

Experiments show that when healthy human individuals are exposed to acute laboratory stressors, they show an adaptive enhancement of some markers of natural immunity but a general suppression of functions of specific immunity. By comparison, when healthy human individuals are exposed to real-life chronic stress, this stress is associated with a biphasic immune response where partial suppression of cellular and humoral function coincides with low-grade, nonspecific inflammation.

Even though psychological stress is often connected with illness or disease, most healthy individuals can still remain disease-free after confronting chronic stressful events. Also, people who do not believe that stress will affect their health do not have an increased risk of illness, disease, or death. This suggests that there are individual differences in vulnerability to the potential pathogenic effects of stress; individual differences in vulnerability arise due to both genetic and psychological factors. In addition, the age at which the stress is experienced can dictate its effect on health. Research suggests chronic stress at a young age can have lifelong impacts on the biological, psychological, and behavioral responses to stress later in life.

Social impact

Charity relieving stress of an overloaded mother.

Researchers have long been interested in how an individual's level and types of social support impact the effect of stress on their health. Studies consistently show that social support can protect against physical and mental consequences of stress. This can occur through a variety of mechanisms. One model, known as the "direct effects" model, holds that social support has a direct, positive impact on health by increasing positive affect, promoting adaptive health behaviors, predictability and stability in life, and safeguarding against social, legal, and economic concerns that could negatively impact health. Another model, the "buffering effect", says that social support exerts greatest influence on health in times of stress, either by helping individuals appraise situations in less threatening manners or coping with the actual stress. Researchers have found evidence to support both these pathways.

Social support is defined more specifically as psychological and material resources provided by a social network that are aimed at helping an individual cope with stress. Researchers generally distinguish among several types of social support: instrumental support – which refers to material aid (e.g., financial support or assistance in transportation to a physician's appointment), informational support (e.g., knowledge, education or advice in problem-solving), and emotional support (e.g., empathy, reassurance, etc.). Social support can reduce the rate of stress during pregnancy. Studies have found that those who had a high change in their life with a low amount of social support has a higher chance of complications. Whereas those with a higher support system would have a chance for less complications.

Management

Stress management refers to a wide spectrum of techniques and psychotherapies aimed at controlling a person's levels of stress, especially chronic stress, usually for the purpose of improving everyday functioning. It involves controlling and reducing the tension that occurs in stressful situations by making emotional and physical changes.

People often find ways of dealing with distress, in both negative and positive ways. Examples of positive ways are listening to music, calming exercises, coloring, sports and similar healthy distractions. Negative ways can include but are not limited to use of drugs including alcohol, and expression of anger, which are likely to lead to complicated social interactions, thus causing increased distress.

Prevention and resilience building

Decreasing stressful behaviors is a part of prevention. Some of the common strategies and techniques are: self-monitoring, tailoring, material reinforcement, social reinforcement, social support, self-contracting, contracting with significant other, shaping, reminders, self-help groups, and professional help.Template:Explain

Although many techniques have traditionally been developed to deal with the consequences of stress, considerable research has also been conducted on the prevention of stress, a subject closely related to psychological resilience-building. A number of self-help approaches to stress-prevention and resilience-building have been developed, drawing mainly on the theory and practice of cognitive-behavioral therapy.

Biofeedback may also play a role in stress management. A randomized study by Sutarto et al. assessed the effect of resonant breathing biofeedback (recognize and control involuntary heart rate variability) among manufacturing operators; depression, anxiety and stress significantly decreased.Template:Primary source inline

Exercising to reduce stress

Studies have shown that exercise reduces stress. Exercise effectively reduces fatigue, improves sleep, enhances overall cognitive function such as alertness and concentration, decreases overall levels of tension, and improves self-esteem. Because many of these are depleted when an individual experiences chronic stress, exercise provides an ideal coping mechanism. Despite popular belief, it is not necessary for exercise to be routine or intense in order to reduce stress; as little as five minutes of aerobic exercise can begin to stimulate anti-anxiety effects. Further, a 10-minute walk may have the same psychological benefits as a 45-minute workout, reinforcing the assertion that exercise in any amount or intensity will reduce stress. Cycling and walking activities have lower stress scores when compared to all other activities.

Coping mechanisms

The Lazarus and Folkman model suggests that external events create a form of pressure to achieve, engage in, or experience a stressful situation. Stress is not the external event itself, but rather an interpretation and response to the potential threat; this is when the coping process begins.

There are various ways individuals deal with perceived threats that may be stressful. However, people have a tendency to respond to threats with a predominant coping style, in which they dismiss feelings, or manipulate the stressful situation.

There are different classifications for coping, or defense mechanisms, however they all are variations on the same general idea: There are good/productive and negative/counterproductive ways to handle stress. Because stress is perceived, the following mechanisms do not necessarily deal with the actual situation that is causing an individual stress. However, they may be considered coping mechanisms if they allow the individual to cope better with the negative feelings/anxiety that they are experiencing due to the perceived stressful situation, as opposed to actually fixing the concrete obstacle causing the stress. The following mechanisms are adapted from the DSM-IV Adaptive Functioning Scale, APA, 1994.

Highly adaptive/active/problem-focused mechanisms

These skills are what one could call as “facing the problem head on,” or at least dealing with the negative emotions experienced by stress in a constructive manner.

Affiliation

Affiliation ("tend and befriend") involves dealing with stress by turning to a social network for support, but an individual does not share with others in order to diffuse or avoid the responsibility.

Humor

Humor allows the individual to steps outside of a situation in order to gain greater perspective, and also to highlight any comic aspect to be found in their stressful circumstances.

Laughter heals

“The Association for Applied and Therapeutic Humour defines therapeutic humour as ‘any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity of or incongruity of life’s situations. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping whether physical, emotional, cognitive, or spiritual”.

When one laughs during a tough situation they feel absent from their worries, and this allows them to think differently. When one experiences a different mind set, they feel more in control of their response, and how they would go about dealing with the event that caused stress.

Lefcourt (2001) suggests that this perspective-taking humor is the most effective due to its ability to distance oneself from the situation of great stress. Studies show that the use of laughter and humor creates a sense of relief of stress that can last up to 45 minutes post-laughter.

Also, most hospitalized children have been seen to use laughter and play to relieve their fear, pain and stress. It has been discovered that there is a great importance in the use of laughter and humor in stress coping. Humans should use humor as a means to transcend their original understanding of an external event, take a different perspective, in which their anxiety may be minimized by.

Sublimation

Sublimation allows an "indirect resolution of conflict with neither adverse consequences nor consequences marked by loss of pleasure." Essentially, this mechanism allows channeling of troubling emotions or impulses into an outlet that is socially acceptable.

Positive reappraisal

Positive reappraisal redirects thoughts (cognitive energy) to good things that are either occurring or have not occurred. This can lead to personal growth, self-reflection, and awareness of the power/benefits of one's efforts. For example, studies on veterans of war or peacekeeping operations indicate that persons who construe a positive meaning from their combat or threat experiences tend to adjust better than those who do not.

Other adaptive coping mechanisms include anticipation, altruism, and self-observation.

Mental inhibition/disavowal mechanisms

These mechanisms cause the individual to have a diminished (or in some cases non-existent) awareness about their anxiety, threatening ideas, fears, etc., that come from being conscious of the perceived threat.

• Displacement – This is when an individual redirects their emotional feelings about one situation to another, less threatening one.
• Repression – Repression occurs when an individual attempts to remove all their thoughts, feelings, and anything related to the upsetting/stressful (perceived) threat out of their awareness in order to be disconnected from the entire situation. When done long enough in a successful way, this is more than just denial.
• Reaction formation – An attempt to remove any “unacceptable thoughts” from one's consciousness by replacing them with the exact opposite.

Other inhibition coping mechanisms include undoing, dissociation, denial, projection, and rationalization. Although some people claim that inhibition coping mechanisms may eventually increase the stress level because the problem is not solved, detaching from the stressor can sometimes help people to temporarily release the stress and become more prepared to deal with problems later on.

Active mechanisms

These methods deal with stress by an individual literally taking action, or withdrawing.

• Acting out – Often viewed as counter-normative, or problematic behavior. Instead of reflecting or problem-solving, an individual takes maladaptive action.
• Passive aggression – When an individual indirectly deals with their anxiety and negative thoughts/feelings stemming from their stress by acting in a hostile or resentful manner towards others. Help-Rejecting Complaining can also be included in this category.

References

ISBN links support NWE through referral fees

• Cooper Cary L. (ed.). Stress Research Issues for the Eighties. John Wiley & Sons, 1983. ISBN 978-0471102465
• Cooper, Cary L., and Philip J. Dewe. Stress: A Brief History. Wiley-Blackwell, 2004. ISBN 978-1405107457
• Craven, Ruth F., Constance J. Hirnle, and Christine M. Henshaw. Fundamentals of Nursing: Human Health and Function. Wolters Kluwer Law & Business, 2016. ISBN 978-1496345509
• Csikszentmihalyi, Mihaly. Flow: The Psychology of Optimal Experience. New York: Harper and Row, 1990. ISBN 0060920432
• Hellhammer, Dirk, Irmela Florin, and Herbert Weiner (eds.). Neurobiological Approaches to Human Disease. Hans Huber Pub, 1987. ISBN 978-0920887271
• Hobfoll, Stevan E. (ed.). Stress, Social Support, And Women. Taylor & Francis, 1986. ISBN 978-0891164043
• Jones, Fiona, and Jim Bright. Stress: Myth, Theory, and Research. Pearson, 2001. ISBN 978-0130411891
• McGonigal, Kelly. The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It. Avery, 2015. ISBN 978-1583335611
• Pastorino, Ellen E., and Susann M Doyle-Portillo. What is Psychology?: Foundations, Applications, and Integration. Cengage Learning, 2021. ISBN 0357373960
• Quick, James Campbell, Thomas A. Wright, Joyce A. Adkins, Debra L. Nelson, and Jonathan D. Quick. Preventive Stress Management in Organizations. American Psychological Association, 2012. ISBN 978-1433811852
• Rice, Virginia H. (ed.). Handbook of Stress, Coping, and Health: Implications for Nursing Research, Theory, and Practice. SAGE Publications, 2011. ISBN 978-1412999298
• Robertson, Ian. The Stress Test: How Pressure Can Make You Stronger and Sharper. Bloomsbury, 2017. ISBN 978-1632867292
• Sapolsky, Robert M. Why Zebras Don't Get Ulcers. Holt Paperbacks, 2004. ISBN 978-0805073690
• Selye, Hans. Stress Without Distress. Lippincott Williams & Wilkins, 1974. ISBN 978-0397010264
• Snyder, C. R. Handbook of Social and Clinical Psychology: The Health Perspective. Allyn & Bacon, 1990. ISBN 978-0080361284
• Tugade, Michele M., Michelle N. Shiota, and Leslie D. Kirby (eds.). The Handbook of Positive Emotions. The Guilford Press, 2014. ISBN 978-1462513970
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External links

All links retrieved

• Manage Stress Health Finder
• Stress relief is within reach American Psychological Association (APA)
• Stress Mental Health America
• Mental Distress Changes
• Eustress: The Good Stress Healthline
• What Is Eustress? Very Well Mind
• What Is Eustress? A Look at the Psychology and Benefits Positive Psychology
• The good stress: How eustress helps you grow American Institute of Stress
• Eustress vs. distress: What is the difference? Medical News Today
• Types of Stressors (Eustress vs. Distress) MentalHealth.net

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