Stress

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A Contemporary Look at Stress and Burnout: Clarifying the Nuances. Stress is a part of everyday life. All people experience stress at some point in their lives. It is no longer a question of whether people are stressed, but how much stress they are willing to tolerate. The word stress has many different meanings. However, today's theorists and researchers subscribe to a complex reaction that affects people's physiology, behaviour, thinking and emotions. It arises in situations where people believe that their demands are greater than their abilities to handle those demands. When people believe that they are unable to handle their demands, this triggers a stressful experience.

From a transactional perspective, cognitive appraisal plays a central role in people's stressful experiences. Stress can result from appraisal errors, where people assess a situation incorrectly. Stress can also result when people accurately judge a situation as one that will overtax their ability and lead to an unpleasant consequence. Also, people who believe that they are dealing with things adequately, even though they are messing up, will likely experience relatively little stress. A person's perspective on a situation is the largest factor influencing the degree of stress that will be experienced. For school counsellors and other professionals dealing with children, this is an extremely important concept to keep in mind. As far as children's experience of stress is concerned, it is their perspective on the demands in the situation and their ability to deal with those demands that determine how much stress they will experience.

Even though people may intuitively embrace a transactional view of stress, the legacy of older conceptualizations is still found, especially in lay circles. Common phrases like, "I've been under so much stress lately" and "My job/child/spouse makes me stressed" tend to equate stress with demand and imply that stress is inherent in situations. Such language describes people as passive recipients of the stress they experience and makes it difficult to help people both own their emotional reactions and view themselves as active agents in their experiences.

On reflection, people may realize that while their language patterns may equate stress and demand, their personal experience does not support such a view. For example, if stress was inherent in particular situations, then everybody should be stressed in the same situations. However, they are not. Different people react differently to the same situation. Furthermore, people do not even react to the same situation in the same way on different occasions. If stress was inherent in a situation, the same person should at least react the same way to that situation whenever it was encountered. Most people's personal evidence suggests that this is not the case.

To create a context for people to begin to manage stress, counsellors must model language that is consistent with a transactional view and encourage clients to revise the way they describe their stressful experiences. Many other subtle but important concepts are embedded in a transactional view of stress. These are elaborated on in this article in a manner that will help counsellors examine their own stressful experiences and help attune them to factors that need to be examined when working with clients who have concerns about stress-related problems.

Stressors and Coping Resources

An assumption underlying transactional conceptualizations of stress is that people innately strive for balance. As long as there is perceived balance between demands and resources for dealing with the demands, stress levels will be low. People who have an adequate repertoire of coping resources experience relatively little stress. This is because their repertoire of skills, knowledge and/or other backup resources is adequate for dealing with the demands they face. It is not so much the quantity of coping resources that is important, but the extent to which the coping resources are adequate for the demand being encountered. For example, a person may have extensive skill and knowledge but encounter a demand that lies outside of their area of expertise. In such situations, the person will likely experience stress. The important variable to consider is the perceived appropriateness of the coping resources for dealing with the demand.

Lazarus (1993, 1999) and his colleagues (Lazarus and Folkman 1984) use the term coping neutrally to refer to people's attempts to deal with a situation. There can be productive coping (an attempt to deal with the demand is successful) and unproductive coping (an attempt to deal with the situation is not as successful as one would like). In common parlance, coping often implies that a person is already in deficit mode or barely keeping up with a situation. For Lazarus and other transactional theorists, coping does not include such a negative view. Coping simply means attempts to deal with demands. Thus, coping resources refer to all of the resources available for dealing with a situation. This includes the skills a person possesses, others who might be recruited to help and even people or agencies that a person might not be aware of.

There are numerous examples in schools and in business of the interplay between demands and coping resources. Classroom teachers who have excellent skills for dealing with students might be "promoted" to administration, where a different skill set is required to succeed. Without further education, new administrators may begin to experience stress because their coping resources are inadequate for the nature of the new demands they encounter. Many business organizations recognize this principle when they promote people to supervisory positions. These people are immediately enrolled in training programs covering supervision skills and interorganization communication to provide them with the knowledge and skills necessary to be successful supervisors.

Physical and Emotional Stressors

The bulk of the literature on transactional approaches to stress control focuses on emotional stressors; however, the model is easily generalized to include physical situations. The key factor to remember is the adequacy of a person's resources for dealing with the demands encountered. For example, a person might have a heart attack while shovelling snow. Inevitably, this happens because the person is engaging in physical activity that exceeds his or her physical capability. People, who realize this, adjust their level of exertion to match their level of fitness.

I have a friend who illustrates this point. Seven years ago, he regularly shovelled snow from his driveway in about 15 minutes. At that time, he was running and lifting weights three times a week, cycling on the days when he wasn't ainning, and weighed 180 pounds. Today, he works out once every 2-3 months and weighs 210 pounds. If he tried to shovel the snow from his driveway in 15 minutes in his present condition, there is a substantial risk that he would overtax his system. The simple fact is that he has less personal coping ability for handling those types of demands. (Incidentally, his way of increasing his pool of coping resources was to hire the teenager next door to do the task for him.)

Cognitive appraisal plays a central role in the experience of emotional stress. It is not the physical, objective properties of the situation that are responsible for stress, but rather people's appraisal of the nature and intensity of the demands, their resources for dealing with the demands and the consequences likely to result in the situation. Obviously, cognitive appraisal plays a less central role in the experience of physical stress, such as that associated with shovelling snow. When people overexert themselves, perhaps to the point where they have a heart attack while shovelling snow, their appraisal of the situation is less central, compared to the fact that the physical demand substantially overtaxed their physical capability. However, even in these sorts of situations, appraisal errors may be a factor in that, if the person had more accurately assessed his physical capability and the enormity of the demand, he would have approached the task differently (for example, shovel more slowly, doing part of the task now and the rest later, getting some help) and not overtaxed their system.

When working with clients, be aware that transactions occur between people's personal system and the environment in which they operate. I have another friend who works in a photo lab and quite often has a headache when he finishes work. He refuses to wear a respirator, even though he spends most of the day working with toxic chemicals. From a stress-control perspective, his headaches result from the chemical smells overtaxing his body's natural capability for absorbing the smells. If he had less exposure to the chemicals (for example, by working in the lab for shorter hours or wearing a respirator), he likely would not end up with headaches. There is an interactive effect with his emotional system as well. When he has lots of hassles with customers, his headaches occur sooner in the day and are usually stronger. The emotional demands required for dealing with customer hassles reduce his ability to deal with the noxious smells. The reciprocal is undoubtedly true as well; the fact that his body is trying to deal with the noxious smells reduces his ability to deal effectively with customer hassles.

The important point in these examples is that people's environmental, physiological, cognitive, behavioural and emotional systems interact and draw on their coping resources to achieve a balanced system (homeostasis). Most people encounter demands that lie within their expertise, deal with the situation satisfactorily and continue. Sometimes they encounter a situation that overtaxes their coping resources, and they feel stressed. But the situation either goes away or they recruit additional resources to deal with it, and thus regain balance in their life. Simply put, people who test their limits or attempt innovative projects sometimes get themselves into situations that are beyond their depth. Most people experience this as part of "variety is the spice of life." The stress they experience is referred to as transitory stress, and it rarely has negative medical implications.

Summary

When people encounter a situation they must deal with, they make an initial appraisal or misappraisal of the demand characteristics, the resources for dealing with the demand and the consequences of how the situation will be handled. As they remain engaged in the situation, there is ongoing appraisal (reappraisal) of the nature of the demand and the adequacy of their coping attempts. Regardless of the accuracy of their appraisal of the situation and the coping resources available, a perceived inequity between demand and coping resources produces an increase in stress level. As stress levels increase, there typically is increasing interference with their abilities to assess the situation accurately. Thus, when people feel stressed, they exaggerate the nature and/or intensity of the demands, denigrate their coping abilities and catastrophize about the consequences of not responding optimally. This unproductive thinking often is accompanied by excessive rumination and cognitive self-flagellation (putting yourself down and then proceeding to kick yourself after you are down). This type of cognitive activity interferes with performance, and the resulting less-than-optimal performance sparks further exaggeration, catastrophization and selfdenigration. This is sometimes referred to as a vicious stress cycle.

Stress and Medical Disorders

Stress reactions are usually transitory. When people encounter a demand, they react and see that the coping attempt is working, or the demand is abating and their system returns to normal with little harm done to their body. However, if the demand persists and/or if a person's coping attempts continue to be perceived as inadequate, a chronic stress reaction develops.

Chronic stress develops when the stress response is repeatedly activated, often because people remain in intensely demanding situations for a prolonged time. People's coping resources are more likely to be overtaxed if they experience prolonged periods of intense demand. This is somewhat akin to setting a furnace thermostat to a high level while keeping all the windows open. The furnace continues to work to reach the preset temperature but never quite makes it.

Chronic stress is characterized by sustained hyperarousal, a preponderance of dysfunctional cognitive activity, various inappropriate behaviour patterns and a multitude of medical disorders. The list of medical problems is long and includes gastrointestinal problems, sleep disorders, headaches, heart attacks, flu, frequent colds, cancer, skin problems, depression and chronic pain. Every incidence of heart attack, for example, is not caused by stress, but the bulk of evidence suggests that stress is at least an important factor for many people who experience the above problems. The bottom line is that evidence linking stress to various medical disorders refers to a link between the disorders and chronic stress.

In recent years, an increase in stress-related medical problems has been reported. Several possible explanations for this observation follow:

1. The intensity and frequency of demands that people face are increasing, thereby increasing the probability that people will be overtaxed.

2. People's knowledge and skill levels have not kept pace with the changing demands they face, thereby increasing the probability that they will be overtaxed.

3. Keeping in mind that stress results from perceived threat (the actual degree of danger is not an important factor in triggering a stress response), the vast amount of media attention being given to catastrophic world events and national and local problems may be creating a greater tendency to perceive threat in situations that logically are quite benign. The heightened sense of perceived threat may in fact be leaving people more vulnerable to experiencing stress on a chronic basis.

4. The nature of the stress response is not well matched to the types of demands people face. The characteristics of the stress response are akin to the flight-orfight response identified by Walter B Cannon in the mid-1940s. That response is ideally suited for dealing with physical stressors. Even two generations ago, most of the demands people faced were physical demands. The stress response helped them deal with the physical demand, and in the resulting physical activity helped to restore homeostasis. However, most of the demands people face today are cognitive demands, and the stress response is not ideally suited for dealing with cognitive demands. For most of the demands people face daily, fighting or running away is not an adaptive or even socially acceptable response. Furthermore, the decreased cognitive functioning that is part of the stress response is not helpful in dealing with cognitive stressors.

Stress and Burnout

Stress and burnout are two constructs that are not well understood by the general population, and in many circles these words are used interchangeably. Even in the professional literature, burnout and stress are treated in inconsistent and even contradictory ways. However, when working with clients, it is important to appreciate that stress and burnout are qualitatively different. Burnout is not just severe stress. People can reach a state of burnout without ever having felt particularly stressed. In fact, people with large coping repertoires are relatively less likely to experience stress, but because they successfully deal with a multitude of demands, they are often called on to do more and to address the more difficult demands. In some respects, this makes them prime candidates for experiencing burnout.

In the 1970s, burnout became a popular term used to refer quite literally to a state of being used up or exhausted (Freudenberger 1975; Maslach 1976, 1982, 1993; Maslach and Schaufeli 1993). Many medical conditions associated with stress are also associated with burnout, thereby adding to the potential for confusion. The definitive paper on the relationship between the two constructs has yet to be written. However, in the interim, some observations are provided below to help counsellors deal with these two constructs.

Stress and burnout stem from different situations. Stress results from a perceived imbalance between demands and coping resources. On the other hand, burnout results from being in a state of chronic over demand. People who experience burnout feel that they never get a reprieve from their demands. Regardless of how well they deal with the situations they face and how efficiently they handle the demands they encounter, more demands are always waiting for them. This never-ending supply of demanding situations, persisting over a long time, is the primary cause of burnout.

Figure 1 depicts a typical burnout sequence. A person may begin in a balanced state, coping well with the demands they face, and the demands are not excessive. Frequently, when people are recognized as being successful in their job, their reward is to receive more tasks. If people are efficient, they deal with the increased demand and are consequently rewarded with additional responsibilities. They may acquire additional skills or knowledge to help them deal with the additional demands, thereby maintaining a balance between demands and coping resources. However, all people have limits, and over time their system may begin to bend. Balance is maintained and stress levels are low, but the overall load on the system is greater. People who are not aware of this or who incorrectly believe that stress is a precursor to burnout, may continue accepting more tasks and may deal with those tasks effectively, but over time the unrelenting chronic demand begins to take its toll. If people are not careful, the strain on the overall system may become so great that the system breaks and they experience burnout. Those with an extensive coping repertoire can get burned out without having experienced a lot of stress.

Stress can occur gradually, with people being aware that they are becoming increasingly stressed. However, burnout is more often a threshold experience. People reach their threshold, their capacity is exceeded and the system breaks down. This phenomenon is referred to in the literature as role overload. Qualitative role overload refers to situations in which people do not have the knowledge and/or skills to accomplish the tasks before them. Quantitative role overload refers to situations in which people have the requisite knowledge and/or skills to successfully complete tasks, but there are just too many tasks to complete. Burnout frequently results when quantitative role overload becomes a chronic state. Realizing that burnout and stress are qualitatively different phenomena helps people spot the early warning signals (see Figure 2) and take preventive action.

Controlling Stress and Burnout

The comprehensive stress control model presented in Malec et al (2000) provides a useful context for approaching stress control with clients, in addition to being useful in helping counsellors understand their own stressful experiences and acting appropriately. The model incorporates both stressormanagement and stress-management approaches. Stressor-management approaches focus on creating greater balance between the demands people face and the resources available for dealing with those demands. Stress-management approaches help to calm people when they are in overtaxing situations. Most counsellor training programs contain topics, such as relaxation training, positive self-talk and other procedures for helping people feel calmer; that is, the focus is on stress management. Thus, most counsellors are familiar with these approaches to controlling stress. Not covered as thoroughly are the more contextually based approaches to stress control that help people manage their demands and/or recruit adequate resources for dealing with those demands satisfactorily; that is, stressor-management approaches. Therefore, the remainder of this article will focus on stressor management to deal with stress and burnout.

Stresser Management

One bias built into the Malec et al (2000) approach is that it is useful to explore taking preventive action before proceeding with other alternatives. People can do this by managing their demands or increasing their coping resources or a doing a combination of both. When approaching stressor management with clients, counsellors should be aware that the literature identifies three types of situations that typically overtax people's coping resources.

1. Unpleasant events. Natural disasters, other catastrophic events and loss of loved ones, occur infrequently in this part of the world and, as a result, most people have not developed good skills for dealing with these types of events. Extremely unpleasant events, especially if they occur over a prolonged time, usually will overtax people's coping resources and result in them being stressed.

2. Uncertain consequences. Most people have trouble dealing with situations in which the consequences of their action are unclear. In such situations, clarifying the consequences associated with various courses of action reduces the stress. For example, many students are concerned about grades in university. Making the percentage-grade cut-offs explicit helps to reduce the stress that students may feel associated with grades. When people clearly understand the likely results of their action in a situation, they feel less stressed, even if the consequence is not pleasant.

3. Ambiguous expectations. Most people have difficulty dealing with situations in which the expectations for their performance are unclear. In such situations, clarifying the performance expectations usually results in people feeling less stress. Thus, when professors set specific criteria for marking term papers (or when students lobby for these criteria to be set) the term paper usually becomes a less demanding task. When the content areas and other factors of an exam, such as the length, question format, raw score cut-offs for letter grades, are specified in advance, some of the demand involved in writing the exam is reduced. Similarly, when the criteria used to evaluate job performance are made explicit, some of the demand characteristics of being evaluated are removed. Usually, when performance expectations are made more explicit, situations become less ambiguous and people being evaluated find it easier to handle the demand and, therefore, experience less stress.

Some people view these examples as offering proof that stress comes from the environment, not from people's interaction with the environment. However, the prevailing view in most of the literature is that these examples are best thought of as situations for which people usually have not developed adequate coping abilities. When approaching stress control with clients, it is useful to check for the extent to which these three factors may be operating in the client's experience.

A sensible place to begin controlling stress is to examine ways to reduce the demand characteristics of the situation so that they will lie within a person's coping repertoire. For example, students anxious about writing exams frequently register in courses with no exams. Students who have difficulty focusing on study material remove distractions from their study environments. People whose jobs are unduly demanding, request a transfer or reassignment, or even change employers. Sometimes demands in the workplace can be reduced by improving lighting or reducing background noise.

It also is good preventive stress control to examine the adequacy of people's skills (or other resources) for dealing with the demands they face. Many of the skill-training programs that counsellors are familiar with make excellent stressor-management strategies. For example, teachers find that acquiring a good repertoire of instructional skills reduces their stress in the classroom. Similarly, given that student misbehaviour continues to be a commonly reported stressor for teachers, learning classroom-management skills can be a good stressor-management strategy. Frequently it might be more advantageous to deal with this stressor by learning more effective ways to establish and maintain a cooperative working relationship with students rather than learning self-hypnosis or some other way of remaining calm in the midst of bedlam. Parallel cases can be made for teaching parenting skills to parents who identify interactions with their children as a stressor, teaching supervisory skills to supervisors who experience stress when interacting with their supervisors, or teaching money-management skills to people who feel stressed by financial concerns.

It is important to approach coping resources from a broad perspective that includes more than just a client's skill repertoire. For example, a survey of women school teachers in Ontario (Earl 1986) revealed that "hiring a housekeeper" was one strategy frequently used to help cope with the competing demands of work and home. The peace of mind resulting from having someone else look after routine household demands more than compensated for the expense of hiring a housekeeper. The housekeeping demands remained unchanged; however, now there were additional resources for meeting those demands. Such solutions represent legitimate stress control approaches. When people acquire new or better resources for dealing with situational demands, even though the demands might remain relatively unchanged, the person will feel less stressed because the situation is dealt with more effectively.

Treating Burnout

Because burnout results from chronic over-demand, the only sound method for treating burnout is demand management. This can be approached by exploring ways to reduce a client's demands, perhaps by delegating some of the demands to others, or learning to be more assertive in saying no to additional demands. For people to feel less burned out, they need to get some reprieve from the demands they are facing. When a person has reached or passed the breaking point, the only real intervention is rest and recuperation to allow the person's body to heal. However, once a person has recovered sufficiently to return to work, it is important to avoid placing the person back into the same situation that initially led to burnout. If a person returns to the same poisonous environment after recovery, it will only be a matter of time until he or she is back on sick leave. Furthermore, it typically takes less time to reach a burned out state the next time. The resulting crash is more severe, and recovery is much longer.

A Reminder to Explore Beyond the Obvious

It is appropriate to reiterate a caution expressed earlier. When helping clients identify stressors; that is, the situations in which they perceive a demand-coping inequity, it is important to probe beneath the surface to explore the existence of stressors that may not be obvious at first glance. For example, the client's presenting situation might be associated with job loss; however, the real demand might stem from concern over paying the rent or having the car repossessed. Similarly, there might be self-esteem problems, family conflict or a feeling of loneliness resulting from less frequent contact with friends at the workplace. These examples illustrate the importance of probing beneath the obvious demand when designing a comprehensive stress-control program. After the nature of the specific stressors has been determined, a comprehensive stress-control program can be started, ideally incorporating both stress-management and stressor-management techniques.

Concluding Thoughts

Stress continues to be a prevalent problem in society today. The effects of stress in schools are experienced by students, support staff and educators. School counsellors have a multifaceted role to play in the area of stress control. They must deal with their own stress, help students deal with stress and frequently work with other staff members as well. School counsellors can be advocates for creating a school climate that is characterized by reasonable demands, clear and consistent expectations and explicit consequences both for meeting and for missing expectations. An old adage states: "If you have a sliver in your finger, before you sign up for a pain control program, try removing the sliver." This article has focused on more effectively managing the input side of the stress-control equation. By creating a healthy and wellness-oriented workplace environment, it is possible to avoid burnout and make it easier for people to avoid being stressed.

How to relax and keep your sanity in times of stress

Almost all of us experience some kind of stress on a regular basis. We work too hard, we spread ourselves too thin, or we suffer from relationship problems, sudden losses, or unexpected upheavals. We also experience stress, however, when we fall in love, win the lottery, or purchase a new home.

In other words, stress is such a broad term and comes in so many guises, that it is sometimes difficult to know one is affected by it. Moreover, everyone has a different degree of vulnerability to stress, different ways of responding to certain life events, and a different stress tolerance point.

Common stress symptoms may include anxiety, uncertainty, forgetfulness, lack of concentration, panic, excitement or exhilaration. Often there are also stress signals in the body: stomach aches, heart palpitations, nausea, diarrhea, migraines, changes of eating and sleeping patterns, exhaustion, or irritability. Although some stress can be good when it motivates us to get things done, stress turns into distress when there is too much of it.

When our stress tolerance point has been reached and we continue to live under too much stress, burnout may follow. Some significant signs of burnout are: an increasing sense of loss of control, negative and irrational thinking, withdrawal from social interactions, as well as loss of motivation, interest and joy in one's life.

Many health professionals believe that too much stress can contribute to depression, anxiety disorders, digestive maladies, heart disease, cancer, and an increased chance of accidents.

There are two major kinds of stress: acute stress and chronic stress. Acute stress has to do with sudden changes in our habitual life patterns. It could be caused by any kind of loss (i.e. separation, illness, death, job loss), gain (i.e. marriage, birth of a child, promotion), or other eventful occasion (your vehicle getting stalled on the bridge, discovering you forgot your passport at home while checking in for your flight abroad).

Chronic stress has the same long-term effects on mind and body as acute stress, but has nothing to do with change. People who experience chronic stress may for instance live under constant pressure, endure continuous abuse, or feel stuck in bad relationships or situations they cannot get out of. Whether you are experiencing acute or chronic stress, here are some tips that may help you to eliminate excess stress and regain some control over your life:

- Put on some comfortable shoes and take a brisk walk. Chances are you don't get enough exercise and that you worry way too much. While taking deep breaths during your walk, try to think of all the things that are good in your life.

- Do something practical, with your hands (creating, cooking, gardening, home repairs) when your mind gets too overburdened. Meditation, yoga, muscle relaxation, breathing exercises, massage, facial, sauna, or hot tub will also give you some relief.

- Get into the habit of keeping a stress journal. Record your sources of stress as well as ways you manage your stress. In doing so, you become better aware of your triggers and patterns of responding. Based on that awareness, you could set yourself some stress management goals. Could you develop better health habits? Improve time management or delegate more? Have more open communication with family, friends or co-workers? Build in some form of exercise?

- Be assertive and say "no" to activities that have become more of a hassle than a joy, or that are really not that important

- Does nature affect you positively? If so, surround yourself with natural (green!) beauty as often as you can: work in your yard, walk, ski, snow-shoe through the forest, cultivate a herb garden, go for a picnic, take the scenic route to work, read books on gardens and landscapes, watch Discovery channel, take care of your house plants, or browse through enticing brochures and plan a trip.

- Take half an hour to complete at least one of the items on your long list of never finished chores: clean out that messy cupboard, balance your checkbook, or finally make that dreaded call you had a hard time getting around to. Don't forget to reward yourself afterwards!

- Surround yourself with positive people and make sure you have a constructive support system in place that can now and then function as a sane and sympathetic audience. In the absence of somebody you can talk to in confidence, consider a wellness or brainstorm session with a therapist.

- Expand your horizon and find new challenges by doing something different and out of the ordinary. Become a coach or board member, sign up for a course, join the choir, learn to play an instrument, or take on a new hobby. New activities can be great opportunities to recharge your batteries and provide a new focus, away from your worries and troubles.