Friday, September 01, 2006

Management of Stress

Social Support

There is little doubt that social support does help us to cope with stress, even though at times our social networks can be a source of stress. For example, In 1986 Lisa Berkman looked at previous studies on social support and concluded that soart clearly helps men cope against stress that might be related to mortality, especially death from heart disease. One reason for this is that socially isolted people will be less likely to have friends and acquaintances who encourage them to protect their health or go to the doctor when they are sick. Perhaps the most frequently suggested explanation is that social support lessens or eliminates the harmful effects of stress and therefore protects against disease and death. This buffering hypothesis assumes, of course, some physlological consequences of stress, an assumption well supported by research (Zegans, 1982). Some evidence exists to support this buffering hypothesis. In one study, women who had a close, intimate relationship were largely unaffected by severely stressful events, whereas those with no strong social supports experienced a substantial disturbance when faced (Brown et al, 1975).

Relaxation Training

With progressive muscle relaxation, patients are first given a rationale for the procedure, including an explanation that their present tension is mostly a physical state resulting from tense musles. While reclining in a comfortable chair with no distracting lights or sounds, patients are asked to breathe deeply and then to exhale slowly. After this, the series of deep muscle relaxation exercises begins. Because patients must have some sense of how relaxation feels, they are instructed to tense a particular muscle group (for example, the hand) and to hold the tension for ibout 10 seconds (Jacobson, 1938). Then they are asked to slowly release the tension, concentrating on the relaxing, soothing sensations in their hand as tension gradually drains away. Once the hand is relaxed, patients go through the same tensing and relaxing sequence with other muscle groups, including the arms, shoulders, neck, mouth, tongue, forehead and eyes, toes, calves, thighs, back, stomach, and other muscle groups.

Patients may repeat the breathing exercises until they achieve a deep feeling of relaxation. Frequently, patients are also encouraged to focus on the pleasant feeling of relaxation, which restricts their attention to internal events and away from external sources of anxiety and stress. They can rate their level of relaxation on a scale of 1 to 10 or can signal by raising an index finger when tension begins to increase.

Once patients learn the relaxation technique, they may practice independently at home. If independent practice is too difficult, prerecorded audiotapes are available that allow patients to lisnothing voice of a professional inithout returning to the clinic. The if relaxation training programs varies, 1 and about 10 sessions with :ructor are usually enough to allow patients itly enter into a state of deep relaxation (Blanchard and Andrasik, 1985).


In biofeedback, biological responses are measured by electronic instruments, and the status of those responses is immediately available to the person being tested. In other words, a person gains information about changes in biological responses as they are taking place. This feedback allows the person to alter physiological responses that cannot voluntarily be controlled without the biofeedback information. The type of biofeedback most commonly in clinical use is electromyograph (EMG) biofeedback. EMG biofeedback reflects the activity of the skeletal muscles by measuring the electrical discharge in muscle fibers. The measurement is taken by attaching electrodes to the surface of the skin over the muscles o be monitored. The level of electrical activity reflects the degree of tension or relaxation of the muscles. The machine responds with a signal that varies "with the electrical activity of the muscle. The electrodes may be placed over any muscle group, but the forehead is the most common placement site.

A review by Andrasik, Blanchard, and Ediund (1985) indicated that research in this area has been quite consistent. Ps are able to significantly reduce muscle tension during EMG biofeedback training. These authors remained unconvinced, however, that these reductions resulted in significant clinical benefit and concluded that EMG feedback may not be better than alternative procedures, including relaxation training. Biofeedback therapy can be an effective mode of stress management for certain patients, but because it produces relaxation, some of its positive effects may be attributable to increases in relaxation rather than to the precise control of the physiology involved with responses to stress.

Stress Inoculation Techniques

One way of preventing illness is to inoculated against certain diseases. Meichenbaum and Cameron (1983) have argued that stress inoculation (being prepared for stress) can work in a similar way. Their theraputic intervention uses 3 stages -

The first stage, conceptualization, is oriented toward identifying the sources of the problem and enhancing the client's ability to do the same. Interviewing the client is one way of gathering information, but it is not the only technique used. Specific experiences may be created using guided imagery so the therapist can anayze the client's reaction. Direct behavioral observation and the client's written accounts of stressful events are also frequently used.

The second stage in stress inoculation uses both cognitive and behavioral techniques. Meichenbaum and Cameron call this stage skills acquisition and rehearsal. The client learns new coping skills and practices those already acquired. One of the goals of this stage is to improve self-instruction by changing cognitions. This process includes monitoring one's internal monologue (talking to oneself). The therapist develops a list of self-statements. For a student with test anxiety, for example, the therapist might suggest this self-statement: "Take this test one item at a time. I know the material, so I can answer these questions." The list ofselftements is to be repeated in the problem situation. Initially, the therapist may model this behavior, demonstrating how to repeat the statements and in what situations. Then the ;at these self-statements and work on internalizing the procedure, so that they will more readily appear when the therapist is not present, for example, when the student is taking a test.

The final stage of stress inoculation is application and follow-through. This stage is behavioral, and Meichenbaum and Cameron consider it essential to the completion of stress inoculation training. They do not assume that outcomes of therapy will be transfered into the client's everyday life. To achieve behaviour change the P needs to use techniques such as role playing under simulated stress situations.


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