Psychology

Question 1A
Theories of Stress
There are three major theories that are associated with stress and they include Seyles theory (General Adaptation Syndrome-GAS), the Lazarus model theory and McEwens allostasis theory (Lehrer et al, 2007).

1. Seyles Theory.
This theory is based on General Adaptation Syndrome which incorporates the concept of stereotyped and physical responses to stress. This theory focuses on the specific relationship between external demands (stressors) and bodily processes (stress). Endocrinologist Hans Seyle observed in a series of animal studies that if a variety of stimulus events like cold, heat and toxic agents are applied intensively and long enough, they are capable of producing common effects. This means that the common effect that is produced is not specific to any of the stimulus events. According to Seyle, the nonspecific changes caused constitute the stereo typical (specific) response pattern of systemic stress. As a result he defines this stress as a state manifested by a syndrome that consists of all the non-specifically induced changes in a biologic system. Therefore the stereotypical response pattern was referred to as the General Adaptation Syndrome (GAS) and its known to proceed in three stages namely the alarm reaction, resistance stage and the exhaustion stage. The alarm reaction stage consists of the initial shock and the counter shock phase. The shock phase exhibits autonomic excitability, increased adrenaline discharge and gastrointestinal ulcerations while the counter shock phase marks the beginning of defensive processes. The counter shock phase is normally characterized by increased adrenocortical activity. In the stage of resistance, the symptoms of alarm reaction disappear indicating the organisms adaptation to the stressor. Resistance usually gives way to exhaustion when the aversive stimulation persists. In this case the organisms capability to adapt to the stressor becomes exhausted and the symptoms of alarm reaction reappear (Lehrer et al., 2007).

2. Lazarus Theory.
This is a psychological stress theory that is based on appraisal and reappraisal. In this context, appraisal refers to an individuals evaluation of the importance of what is happening for hisher well being and reappraisal refers to the individuals assessment of hisher ability to cope with the stressor. People who are incapable of withstanding maintain a longer arousal of the stressor than those who adapt more quickly. Lazarus regards stress as a relational concept and he does not define stress as a specific kind of external stimulation or a pattern of psychological reaction but a relationship between individuals and the environment. The concept of appraisal is a key factor for understanding the stress relevant transactions. Its based on the idea that emotional processes are dependent on actual expectancies which people exhibit with regard to the outcome of a specific encounter. In addition, these appraisals are further determined by a number of personal and situational factors. Examples of personal factors include motivational dispositions, values and goals while situational parameters include predictability, controllability and the imminence of a potentially stressful event (Lehrer et al., 2007).

3. McEwens Allostasis Theory
McEwen summarizes several scenarios that are related to stress responses. According to him, stress responses are modified by lifestyle factors for example sleep quality and quantity is affected by diet, smoking and alcohol intake. He goes ahead to stipulate that lack of control over stressful situations increases arousal hence people should always be alert about the potential harm that may arise.

McEwens theory shows that responses to stress are protective and are essential to survival although they can also cause harm to an individual. In addition, this theory indicates that habituation occurs with repeated exposure to the stressor but some people continue to react as if its the first time they are encountering the stressor. Mental techniques like relaxation and imagery may be used to decrease arousal although learning is essential to adaptation (Lehrer et al., 2007).

Individual Differences in Responses to Stress
Despite the fact that researchers approach their studies on stress from a stimulus, response and transactional approach, there is still a general recognition that there are individual differences which exist on how people respond to stress. This is true because the types of stress that affect human beings vary with age and the stage of development. The difference in the way people respond to a given situation may depend on an individuals response stereotype. Although physiological stress is known to produce many physiologic reactions, the differences vary in magnitude among different people. This variability is best explained in relation to the hemodynamic adjustments that are induced by stress for example abrupt heart rate changes and blood pressure. To some extent, the variability in stress response can also be due to the varying activity of catecholamine in different people. An example of this is increased levels of epinephrine and norepinephrine in plasma concentration. The difference in response to stress among individuals can also vary because of the variability of physiologic reactions. This happens as a result of differences in behaviorally evoked sympathetic nervous system activation. Physiological stress can also differ among individuals because of the way stress modulates cellular immune functions. This is an effect that is marked by interindividual variability (Lehrer et al., 2007).

Question 1B
Philosophical and Socio-cultural Aspects in Stress Management
Besides, the common or normal method of using clinical methods to manage stress in individuals, its important that some issues related to management of stress can only be comprehended at the level of history, society and culture. Differences in the socio-cultural environment of the current world can impose a kind of unremitting stress in an individual as compared to the less complex stressors in the less complicated societies. Therefore in stress management, a consideration should be made to determine the type of socioeconomic environment that someone is living in to help in development of strategies that will be used to counsel the affected person (Lehrer et al., 2007). This is important because it will aid in encouraging the stressed person to make adjustments to the new socio-cultural matrix. Examples of socio-cultural aspects that should be included in management of stress include interpersonal relationships, sex roles, job environment and management of personal finances. Based on the fact that the activities of stress management professionals are centered within the philosophical and sociocultural matrix, its essential for these aspects to be incorporated in stress management programs (Lehrer et al., 2007).

Question 2A
The Stress Response Triad Nervous, Endocrine and Immune Systems
The stress responses of individuals can be perceived in a multiple psycho physiological system that is associated with the brain, endocrine and immune systems which in general form the collective heart of the stress response. The relationship between these systems may be bidirectional and the cells of the three systems have receptors on their membranes which react differently to information that is transmitted. Plasticity the bodys ability to modify responses to repeated stimuli are important in the feedback system of the body as regards to stress response. This feedback system constantly monitors and organizes the physiological responses and actions that occur from the brain, endocrine system and the immune cells (Lehrer et al., 2007).

 Stress (acute stress) impacts the endocrine system in the following way exposure to emergency situations leads to the production of epinephrine from the adrenal medulla (the core of the adrenal gland) and this effect is a result of the activity of the sympathetic nervous system. The sympathetic nervous system plays its role in threatening situations (fight or flight responses) and leads to increased involuntary processes like increased heart rate, blood pressure, respiration and alertness. All these changes are rapid adaptive responses to short term challenges. On the other hand, the adrenal cortex releases cortisol to increase the metabolic rate hence inhibiting the inflammatory response by release of proinflammatory cytokines. The fibers of the sympathetic nervous system release the transmitter norepinephrine at various organ sites leading to the production of epinephrine (adrenaline) in the blood stream. Research shows that continued exposure to stressors activates this system (sympathetic nervous system) and the activation occurs within seconds and results to the adrenaline push that occurs after encountering an emergency (Lehrer et al., 2007).

The brain (hypothalamic pituitary adrenal axis) is also involved in responding to stress in an individual. Literature has shown that if someone is exposed to a variety of acute psychological stressors, the result is an increase in the levels of the cortisol hormones in blood. This effect is due to activation of the Hypothalamic Pituitary Adrenal (HPA) axis. The HPA axis comprises of the hypothalamus, the pituitary regions of the brain and the adrenal glands. A stressful stimulus leads to an integrated response in the hypothalamus which results in the release of corticotrophin releasing hormone. This hormone stimulates the anterior part of the pituitary gland to release adrenocorticotrophic hormone which in turn stimulates the adrenal cortex to release cortisol.

Stress also has an impact on the immune system and exposure to stressors can diminish various immune functions. It affects the response to immunization especially the secondary immune response (a quick reaction facilitated by memory cells that are responsible of recognizing antigens) than the primary response (slow response activated on first encounter with the antigen). In other words, stress inhibits lymphocyte functions like the ability to proliferate when exposed to foreign substances and slow integrated immune responses. In addition, the immunological effects of stressors are due to the potent suppressive effects of cortisol which inhibits the production of some cytokines and suppresses a variety of immune functions. For example, acute stress can suppress the response to hepatitis B vaccine although such effects commonly occur to older people. Suppression of the immune response is adaptive although if the stressor is resolved, prolonged activation of the sympathetic nervous system, the stress hormones and the immune system become counterproductive (Lehrer et al., 2007).

Question 2 B
DisordersIllnesses Associated with Stress
Stress can cause illnesses and disorders to an individual because it interferes with the bodys immune system and makes someone more susceptible to disease causing pathogens in the environment. Stress, especially the unrelenting type plays havoc to the bodys ability to fight off microscopic invaders. There are several illnesses caused by stress involving both the body and mind but this essay will only explore only three.

Cardiovascular Disease
This is a disease of the heart and its causes include genetic, physical and psychosocial factors. These factors also include excessive reaction to stress, depression, reduction in heart rate and other unhealthy behaviors like smoking. Some behavior patterns like hostility and poor social networks may increase the risk of acquiring acute cardiovascular and long-term coronary artery disease. The chances of contracting cardiovascular disease may be higher in patients who lack motivation (stressed people).

This is because they are unable to take basic responsibility of their personal care due to stress hence they have little or no energy to exercise and plan low-fat meals .In this case, they develop excessive weight and eat foods that expose them to heart disease. Studies have shown that there is a link between cardiovascular disease and stress which acts as an independent risk factor (Lehrer et al., 2007).  This is because increased cardiac morbidity and mortality in depressed patients accounts for the increase in serotonin mediated platelet activation and hyperactive platelet receptor signaling. These are known to raise the risk for thromboembolic events. Stress can also lead to withdrawal behaviors in affected individuals who believe that by doing so, they are reducing the impact of stress. Such people stop carrying out certain activities and in the process they develop diphasic responses in their body systems which cause a decrease in blood pressure and heart rate. Therefore this effect predisposes them to cardiovascular diseases.

Depression
This may result from an abnormal functioning of the HPA axis, high cortisol and disruption of the normal rhythm of the endocrine system. Symptoms like lack of sleep are common in depression patients and they tend to magnify the sensory experiences of the individuals especially pain. In major depressive conditions, cortisol does not increase in response to negative events and this is very common in people with a family history of mood disorders. Therefore for such patients, recovery can only be achieved through increased cortisol responses. Studies have shown that long-term exposure to stress results into depression and mood disorders. Stress causes an imbalance in the neuro transmitters that allow the brain cells to communicate with each other. These neuro transmitters include serotonin and norepinephrine. Deficiency of serotonin causes sleep problems, irritability and anxiety while decreased amount of norepinephrine regulates alertness and arousal. It may also contribute to a depressed mood.

The Metabolic Syndrome
This refers to a group of risk factors that are linked to overweight and obesity and they increase a persons risk of heart disease. These factors include increased blood pressure, elevated insulin levels and abnormal cholesterol levels The development of this disorder is related with repeated activation of the HPA axis and the sympathetic nervous system. Research has shown that repeated stress increases the tendency to develop insulin resistance, central obesity, essential hypertension and dyslipidemia. In stress patients, cortisol secretion is strongly linked to obesity factors like cholesterol and low density lipo-protein, blood pressure and deposition of fat in the abdominal region. Increased cortisol stimulates appetite and decreases serotonin to compensate for the extra energy required in response to physical stress. Metabolic syndrome can be associated with stress because the later contributes to obesity and overweight which are the factors that make up the condition(metabolic syndrome).Stress leads to obesity  through behavioral ways in that eating is driven by the need to be comfortable instead of being motivated by the physiological needs of the body (Lehrer et al., 2007).

Question 3
Families of Relaxation
Relaxation is the state of resting or refreshing the body and mind and there are different ways that are used professionally to achieve the feeling of relaxation. These methods are collectively called the six families of relaxation and they include the following (Smith, 2005).

Yoga Stretching
Yoga is derived from the word yokes that means bring together. Therefore, yoga stretching brings together an individuals body, mind and spirit. It involves a slow, smooth and gentle stretching out of tension in the muscles and joints. This technique is used in people who have assumed a stressed posture and position because when confronted with stress, individuals assume a variety of defensive postures or positions which can cause skeletal muscle tension, joint stress, fatigue and reduced energy. Besides, yoga stretching amalgamates a number techniques employed for stress management and thus offers the collective benefits of fitness programs, stretching exercises and breathing exercises (Smith, 2005). A part from reducing stress, this relaxation approach as well provides other benefits, such as lower blood pressure, reduced cortisol levels, slowed aging process, lower heart rate together with other psychological benefits (spiritual growth and a sense of comfort).

Progressive Muscle Relaxation (PMR)
PMR is a technique employed by an individual(s) to manage stress and achieve a deep relaxation status. It is a relaxation technique that was developed in 1930s by Dr. Edmund Jacobson. PMR is particularly used by individuals or persons whose stress or anxiety is sturdily correlated with muscle tension. It is based on the principle that releasing and tensing of body muscles leads to a deep relaxation status and is able to relieve stress through reducing ulcerative colitis and elevated blood pressure. Other benefits of progressive muscle relaxation to an individual comprise improved concentration, increased self esteem, increased creativity or spontaneity and control over mood (Smith, 2005).

Breathing Exercises
This is applied on people with stressed breathing. Normally when someone is stressed, the person will most probably breathe in a way which is shallow and rapid and will exhibit a greater use of the rib cage and shoulder muscles with limited use of the diaphragm. Use of breathing exercise to such people will be of great help because it will help them to relax. Breathing exercise has been found to be a powerful tool to employ when an individual desires to control his or her mind status. When a person is experiencing a period of change or high stress, breathing deeply has the ability to make him or her feel more relaxed, centered and relieved of stress (Smith, 2005).

Autogenic Training
Autogenic means self-generation or regulation and refers to the way an individual mind can be influenced by his or her body in order to balance self-generative systems which control heart rate, circulation as well as breathing. Autogenic training is primarily mental and includes the use of powerfully suggestive relaxing phrases (Sadigh, 2001). It is applicable in people with stressed body focus and evoking thoughts and images about a specific body part or process can give rise to related neurophysiological changes. Through autogenic training, an individual is able to control stress, as the autonomous nervous system (ANS) becomes so relaxed. The whole idea of autogenic training is founded on the principle of passive concentration that the goal of relaxation can as well be achieved through passive training. This particular family of relaxation is very effective and efficient in reducing psychological conditions, such as tension, stress and anxiety. However, its highly contraindicated to individuals with stern mental disorders (Sadigh, 2001).

Imagery and Relaxing Self-Talk
Imagery mental technique is usually employed in sport psychology to allow athletes relax and focus on the chore at hand. The technique enables an individual to acquire the four major mental qualities that are essential, vital and imperative for triumphant performance (Rees and Meer, 1988). These mental qualities include concentration, confidence, control and commitment. Imagery can help reduce mental anxiety that involves negative thoughts, worry, inadequate concentration and confusion. Relaxing self-talk has the same principle as imagery mental technique, but here an individual reflects upon his or her thinking, whether negative or positive. In addition, self-talk influences mental pictures, emotions, physical states, mental pictures and behavior of an individual and can help relieve stress (Rees and Meer, 1988).

Meditation
This involves sustaining focus on a very simple stimulus whereby in concentrative meditation, the simple stimulus is a single thing like a waterfall or candle whereas mindfulness involves quietly observing the flow of all simple stimuli for example watching clouds float by. This technique is best used in individuals who have stressed attention (Smith, 2005).

Question 4
The Effectiveness of Current Approaches to Workplace Stress Management in the Nursing Profession
This article exploits a study that was carried out to investigate the effectiveness of the current approaches which are used to manage stress in the nursing profession. In executing this study, seven randomized controlled trials and three prospective cohort studies assessing the effectiveness of stress management programmes were identified and reviewed. The reviews were mainly used to contribute in the development of suitable approaches that can be used in stress management among nurses by evaluating the currently used strategies in a systematic manner. This study revealed that stress management techniques can be divided into two environmental management that attempts to alter the work environments so as to reduce the sources of stress and those approaches that aim at supporting the personnel to effectively deal with stressful situations. In the inclusion criteria, nurses were used as the subjects and the study focused on comparing two stress management interventions to determine the most effective one. The expected outcome was a change in the individual levels of stress (Nightingale, 2002).

A review of the results of this study shows that one approach focusing on cognitive techniques was determined to be effective though its evidence was weak but three approaches on exercise, music and relaxation were potentially effective .The approach of social support education is possibly effective although its questionable. On the other hand, the approach of environmental change provided no evidence of effectiveness though the findings of the study supported it. According to the results of this study, there is more evidence which shows that personal support approach is more effective than environmental management in dealing with stress in nursing profession (Nightingale, 2002)
           
In my opinion, this study does not fully exploit the different techniques used in management of stress in the nursing profession. This is because it has not highlighted whether sociocultural aspects were incorporated in the various techniques of stress management. The study should have made use of more additional techniques like mind and body initiative that and demonstrate how the technique can effectively improve the health and, in essence reduce the number of days that the nurse would have to miss out on duty to enhance on the care of the patients and improve relationship among other workers.

According to Nightingale (2002), the causal factors for stress in nursing profession are closely linked to the nature of the working condition in which nurses are exposed to. This includes such variables as uncoordinated shifts that can wear out the physical, mental and emotional preparedness of the nurse. The usefulness of the study could have been greatly elevated by inclusion of how such variables can are interrelated to various degrees of stress among the nurses.  It was also significant to explore the uniqueness of dissatisfaction or satisfaction of nursing duties that could be related and how such factors could be related to stress among the members of the nursing profession. Such factors as the requirement of unconditional emotional attachment to patients and the members of the immediate family could be considered for inclusion. Moreover, the events within the working environment can expose the workers to intense trauma and exhaustion. The interaction with patients and development of emotional attachments is by itself a cause of stress because of the unpredictability of the length of interaction with the patients that can suddenly be interrupted by death, discharge or transfer of the patient.

These unique features affecting nursing profession are paramount in any kind of study in clear demonstration of relationship and interlink between the specific causative factors and the variables relating particularly to nursing profession. In addition, the study used a very small sample size hence the findings may not be purely representative of the entire nursing population. Therefore, the results may not be fully reliable to determine the most effective approach of stress management in the nurses work place. In conclusion, stress can be perceived in several ways depending on the dimension from which someone is addressing it. The response to stress by different people also varies because of the difference in the way individuals react biologically to different stress stimuli. These may actually depend on the measure in which the causative factors of the stress can be controlled or predicted. Moreover, the strong interlink between stress and job satisfaction is an important element that need to be demonstrated and ways of enhancing job satisfaction among the nursing profession established.

Therefore, for effective management of stress to take place, its essential to incorporate various sociocultural and philosophical aspects to help in development of suitable programs that are specific to the profession. Lastly, the fact that stress can cause illnesses and disorders to the body, proper techniques of relaxation should be identified depending on the stressors that are involved so that the end effect, recovery and relaxation are achieved. Effective physical and emotional reduction techniques can be identified and proposed to enhance measures of coping with job requirement alongside other unconventional therapies.