Psychological stress

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Psychological stress

In psychology, stress is a feeling of emotional strain and pressure. Some stress may be beneficial, motivating people to perform better. Such stress is often termed "eustress," or good stress. It is not defined by the level or type of stress, but rather how the individual perceives the stressor. A positive response depends on the person's feelings of control, desirability, location, and timing of the stressor. Somewhat severe stress may also be experienced as eustress when the individual has a positive response to the situation.

Distress is the opposite of eustress. 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. It is an aversive state in which a person is unable to adapt to stressors and shows maladaptive behaviors, such as inappropriate social interaction (aggression, passivity, or withdrawal). Excessive amounts of distress can increase the risk of illness as well as aggravate any pre-existing condition.

The nature of life is such that stress is inevitable. Stressors themselves are neither good nor bad; it is the perception and response to them by the individual that determines the outcome of the stressful situation. To fulfill our potential as human beings it is necessary to learn to cope with stress, to respond with enthusiasm when the stressor is perceived as positive, and to learn how to react appropriately to more challenging stressors without allowing them to become toxic and lead to illness.

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,[1] 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."[2] 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," while negative responses are called "distress," from the Latin root dis-.[3] Eustress results when a person perceives a stressor as positive; distress when the stressor is perceived as negative.[4]

Selye proposed four variations of stress.[5] 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.[6]

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.[7] Challenge is an opportunity-related emotion that allows people to achieve unmet goals.[8]

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.[7]

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.[4] Common subjective methodologies were incorporated in a holistic stress model created in 2007 to acknowledge the importance of eustress, particularly in the workplace.[9] 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.[4]

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.[4]

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.[10] 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."[11]

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.[6]

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.[5]

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.[4] 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.[12]

It has been suggested that the Yerkes–Dodson model demonstrates the optimum balance of stress with a bell curve.[13] 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.[14][15]

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,[16] 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.[17] 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.[18] 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.[18]

Changes in the home

Divorce, death, and remarriage are all disruptive events in a household.[19] 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.[19]

Daily hassles/microstressors

This category includes daily annoyances and minor hassles.[18] 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:[18]

  • 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."[20] 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.[21]

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.[22]

A modified version also exists for non-adults.[18]

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. Stress can make individuals more prone to both physical and psychological problems, such as heart disease and anxiety. Stressors are more likely to affect an individual's health when they are "chronic, highly disruptive, or perceived as uncontrollable."[18] 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.[23]

Studies of the stress–illness link suggest that both acute and chronic stress can cause illness.[24] 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.[25] However, there is much variability in the link between stress and illness.[26]

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.[27] Chronic 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). 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.[28]

Even though psychological stress is often connected with illness or disease, most healthy individuals can still remain disease-free after confronting chronic stressful events. This suggests that there are individual differences in vulnerability to the potential pathogenic effects of stress. Such differences 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.[29]

Social impact

Charity relieving stress of an overloaded mother.

Social support is defined as psychological and material resources provided by a social network that are aimed at helping an individual cope with stress. Several types of social support can be categorized as follows: instrumental support – which refers to material aid (such as financial support or assistance in transportation to a physician's appointment), informational support (for example, knowledge, education or advice in problem-solving), and emotional support (such as empathy, reassurance, etc.).[30]

Studies consistently show that social support can protect against physical and mental consequences of stress.[31] 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.[32]

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

Minimizing anxiety and stress in a preventative manner can be effective. If one works towards coping with stress daily, the feeling of stress and the ways in which one deals with it as the external event arises becomes less of a burden. Suggested strategies to reduce the impact of stress include:[33]

  1. Regular exercise – set up a fitness program, 3–4 times a week
  2. Support systems – to listen, offer advice, and support each other
  3. Time management – develop an organizational system
  4. Guided imagery and visualization – create a relaxing state of mind
  5. Progressive muscle relaxation – loosen tense muscle groups
  6. Assertiveness training – work on effective communication
  7. Journal writing – express true emotion, self-reflection
  8. Stress management in the workplace – organize a new system, switch tasks to reduce own stress.

Depending on the situation, all of these coping mechanisms may be adaptive, or maladaptive. Exercise is found to be effective in reducing 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.[34]

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.[35] 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.[36]

Coping mechanisms

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. 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.[37]

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. In many cases, though, the relief is temporary and if the underlying cause of stress is not addressed negative consequences will re-emerge.

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
Laughter heals

Therapeutic humor can be defined 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.”[38]

Experiencing a different mind set allows a person to feel more in control of their response, and how they would go about dealing with the event that caused stress. Humor allows the individual to step outside of a situation in order to gain greater perspective, and also to highlight any comic aspect to be found in their stressful circumstances. Laughing during a tough situation allows them to feel absent from their worries, and this allows them to think differently.[38] Lefcourt suggests that this perspective-taking humor is effective due to its ability to distance oneself from the situation of great stress.[37]

Sublimation

Sublimation allows an "indirect resolution of conflict with neither adverse consequences nor consequences marked by loss of pleasure."[39] 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.[40]

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, and so forth, that come from being conscious of the perceived threat. While they allow the individual to function in a more normal manner for a time, eventually the stressor(s) must be dealt with directly.

  • 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. These actions are not positive or constructive and do not allow the individual to function normally nor do they address the underlying issues.

  • 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.

Notes

  1. Stevan E. Hobfoll, (ed.), Stress, Social Support, And Women (Taylor & Francis, 1986, ISBN 978-0891164043).
  2. Hans Selye, The Evolution of the Stress Concept American Scientist 61(6) (November-December 1973): 692-699.
  3. Hans Selye, Implications of stress concept New York State Journal of Medicine 75(12) (October 1975): 2139–2145. Retrieved September 21, 2022.
  4. 4.0 4.1 4.2 4.3 4.4 Mark Le Fevre, Gregory S. Kolt, and Jonathan Matheny, Eustress, distress and their interpretation in primary and secondary occupational stress management interventions: which way first? Journal of Managerial Psychology 21(6) (January 2006): 547–565. Retrieved September 21, 2022.
  5. 5.0 5.1 Hans Selye, Stress without Distress (Lippincott Williams & Wilkins, 1974, ISBN 978-0397010264).
  6. 6.0 6.1 Hans Selye, "The Stress Concept: Past, Present and Future" in Cary L. Cooper (ed.). Stress Research Issues for the Eighties (John Wiley & Sons, 1983, ISBN 978-0471102465).
  7. 7.0 7.1 C. R. Snyder, Handbook of Social and Clinical Psychology: The Health Perspective (Allyn & Bacon, 1990, ISBN 978-0080361284).
  8. Michele M. Tugade, Michelle N. Shiota, and Leslie D. Kirby (eds.), The Handbook of Positive Emotions (The Guilford Press, 2014, ISBN 978-1462513970).
  9. Virginia H. Rice (ed.), Handbook of Stress, Coping, and Health: Implications for Nursing Research, Theory, and Practice (SAGE Publications, 2011, ISBN 978-1412999298).
  10. Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience (New York: Harper and Row, 1990, ISBN 0060920432).
  11. Matthew Blake Hargrove, Debra L. Nelson, and Cary L. Cooper, Generating eustress by challenging employees: Helping people savor their work Organizational Dynamics 42(1) (2013): 61–69. Retrieved September 21, 2022.
  12. Peter Suedfeld, Reactions to Societal Trauma: Distress and/or Eustress Political Psychology 18(4) (December 1997): 849-861.
  13. James Campbell Quick, 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).
  14. Colette Bouchez, 10 Signs of an Ailing Mind WebMD, January 1, 2006. Retrieved September 23, 2022.
  15. Warning Signs and Risk Factors for Emotional Distress SAMHSA, May 16, 2022. Retrieved September 23, 2022.
  16. Fiona Jones and Jim Bright, Stress: Myth, Theory, and Research (Pearson, 2001, ISBN 978-0130411891).
  17. Dirk Hellhammer, Irmela Florin, and Herbert Weiner (eds.), Neurobiological Approaches to Human Disease (Hans Huber Pub, 1987, ISBN 978-0920887271).
  18. 18.0 18.1 18.2 18.3 18.4 18.5 Ellen E. Pastorino and Susann M Doyle-Portillo, What is Psychology?: Foundations, Applications, and Integration (Cengage Learning, 2021, ISBN 0357373960).
  19. 19.0 19.1 Ruth F. Craven, Constance J. Hirnle, and Christine M. Henshaw, Fundamentals of Nursing: Human Health and Function (Wolters Kluwer Law & Business, 2016, ISBN 978-1496345509).
  20. Joan M. Campbell, Ambient Stressors Environment and Behavior 15(3) (1983): 355–380. Retrieved September 24, 2022.
  21. Marcia Lynn Whicker, Toxic leaders: When Organizations Go Bad (Praeger, 1996, ISBN 978-0899309989).
  22. Thomas Holmes and Richard Rahe, The Social Readjustment Rating Scale Journal of Psychosomatic Research 11(2) (1967): 213–218. Retrieved September 24, 2022.
  23. Robert M. Sapolsky, Why Zebras Don't Get Ulcers (Holt Paperbacks, 2004, ISBN 978-0805073690).
  24. Neil Schneiderman, Gail Ironson, and Scott D. Siegel, Stress and health: psychological, behavioral, and biological determinants Annual Review of Clinical Psychology 1 (2005): 607–628. Retrieved September 25, 2022.
  25. T.B. Herbert and S. Cohen, Stress and immunity in humans: a meta-analytic review Psychosomatic Medicine 55(4) (1993): 364–379. Retrieved September 25, 2022.
  26. Jane Ogden, Health Psychology (McGraw-Hill Education, 2019, ISBN 978-1526847126).
  27. Wolff Schlotz, Ilona S. Yim, Peggy M. Zoccola, Lars Jansen, and Peter Schulz, The perceived stress reactivity scale: Measurement invariance, stability, and validity in three countries Psychol Assess. 23(1) (2011):80-94. Retrieved September 25, 2022.
  28. Martin Pinquart and Silvia Sörensen, Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis Psychology and Aging 18(2) (2003): 250–267. Retrieved September 25, 2022.
  29. Gregory Miller, Edith Chen, and Steve W. Cole, Health psychology: developing biologically plausible models linking the social world and physical health Annual Review of Psychology 60 (2009): 501–524. Retrieved September 25, 2022.
  30. Sheldon Cohen, Social relationships and health The American Psychologist 59(8) (November 2004): 676–684. Retrieved September 25, 2022.
  31. Bert N. Uchino, Understanding the Links Between Social Support and Physical Health: A Life-Span Perspective With Emphasis on the Separability of Perceived and Received Support Perspectives on Psychological Science 4(3) (May 2009): 236–255. Retrieved September 25, 2022.
  32. Sheldon Cohen and Thomas A. Wills, Stress, social support, and the buffering hypothesis Psychological Bulletin 98(2) (September 1985): 310–357. Retrieved September 25, 2022.
  33. Patricia A. Potter, Anne Griffin Perry, Patricia Stockert, Amy Hall, Barbara J. Astle, and Wendy Duggleby (eds.), Canadian Fundamentals of Nursing (Mosby, 2018, ISBN 978-1771721134).
  34. Exercise for Stress and Anxiety Anxiety and Depression Association of America. Retrieved September 25, 2022.
  35. Donald Robertson, Build your Resilience: CBT, Mindfulness and Stress Management to Survive and Thrive in Any Situation (Teach Yourself, 2019, ISBN 978-1473679528).
  36. Jerrold Greenberg, Comprehensive Stress Management (McGraw-Hill Education, 2020, ISBN 978-1260575750).
  37. 37.0 37.1 C.R. Snyder (ed.), Coping With Stress: Effective People and Processes (Oxford University Press, 2001, ISBN 978-0195130447).
  38. 38.0 38.1 Julia Balzer Riley, Communication in Nursing (Elsevier, 2019, ISBN 978-0323625487).
  39. G.E. Vaillant, Adaptive mental mechanisms. Their role in a positive psychology The American Psychologist 55(1) (January 2000): 89–98. Retrieved September 25, 2022.
  40. Susan Folkman and Judith Tedlie Moskowitz, Stress, Positive Emotion, and Coping Current Directions in Psychological Science 9(4) (2000): 115–118. Retrieved September 25, 2022.

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
  • Greenberg, Jerrold. Comprehensive Stress Management. McGraw-Hill Education, 2020. ISBN 978-1260575750
  • 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
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External links

All links retrieved December 2, 2022.

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