Stress, Stress Adaptation Model & Crisis intervention

Concept of stress and Stress Adaptation Model and Crisis and Crisis Intervention. These topic should be clear for healt service providers like Psychiatric nurces, Psychiatric social workers. Withoung knowing and understanding about it we can't help our clients.

1. STRESS ADAPTATION MODEL STRESS & STRESSOR, COPING RESOURSES MACHANISM, CIRSIS TYPES & CRISIS INTERVENTION PRESENTED BY SHIV PRAKASH PhD RESEARCH SCHOLAR IMS, BHU

2. Stress is an individual’s response to a disturbing factor in the environment, and consequence of such reaction. Stress involves interaction of the person and environment. To quote a definition: “Stress is an adaptive response to an external situation that results in physical, psychological and / or behavioral deviations for organizational participants” (Fred Luthans , 1998). What is Stress? Concept of Stress Stress is defined either as a reaction or as a stimulus. As a reaction the meaning of stress is consubstantial with specific changes that human biological system is experiencing .As stimulus, the definition of stress is related to environmental events that cause those changes. The stressful events can be acute, chronic, remitting and continuous chronic form .

3. The physical or psychological demands from the environment that cause stress are called stressors. They create stress or the potential for stress when an individual perceives them as representing a demand that may exceed that person’s ability to respond. How an individual experiences stress depends on T he person’s perception of the situation, The person’s past experience, T he presence or absence of social support, and I ndividual differences with regard to stress reactions (Don Hellriegel , et. al., 2001) What is Stressor?

4. Types of Stress Eustress & Distress

5. Acute stress is a physical response to a perceived threat to your well being, and constitutes the most common form of stress. This is the classic “flight-or-flight” reaction. Acute stress can actually be helpful by keeping you alert, focused, and energetic. Acute stress takes place over a short duration, thus it usually doesn’t have enough time to do the kinds of extensive damage associated with long-term stress. Episodic Stress occurs when we experience acute stress too frequently. It often hits those who take on too much―those who feel they have both self-imposed pressure and external demands vying for their attention. In such cases, hostility and anger frequently result. Episodic stress also commonly afflicts those who worry a lot of the time, in turn resulting in anxiety and depression. Chronic Stress leads to serious health problems, because it disrupts nearly every system in your body. Part of what makes chronic stress so insidious is its ability to become “normal” feeling. This pattern of enduring is what makes chronic stress such a serious health issue. Poverty, trauma, general pressure from the demands of life, and more can all cause chronic stress. Chronic stress can lead to cancer, strokes, and heart attacks, as well as violent behavior and even suicide. Though one of the most difficult issues to treat, it’s never too late to start undoing the damage.

6. Coping strategies refer to the specific efforts, both behavioral and psychological, that people employ to master, tolerate, reduce, or minimize stressful events. Two general coping strategies have been distinguished: problem-solving strategies are efforts to do something active to alleviate stressful circumstances, whereas emotion-focused coping strategies involve efforts to regulate the emotional consequences of stressful or potentially stressful events. Research indicates that people use both types of strategies to combat most stressful events ( Folkman & Lazarus, 1980) Adaptation is the consequence of coping efforts and denotes mastery and adjustment resulting from responses to problems or new challenges (Mechanic , 1974; Moos, 1977). Adaptation results when the individual is able to effect a series of behaviors and mental processes to neutralize the stress experience and reestablish integrity of function. Adaptation involves achieving a balance between perceived demands ( stress) and marshalled resources (coping), a state of reduced anxiety and enhanced well-being.

7. Stress Adaptation Model Stuart Stress Adaptation Stuart Stress Adaptation Model is a model of of psychiatric nursing care, which integrates biological, psychological, sociocultural , environmental, and legal-ethical aspects of patient care into a unified framework for practice. The Stuart Stress Adaptation Model of health and wellness provides a consistent nursing-oriented framework (Stuart, 2009).   "Nature is ordered as a social hierarchy from the simplest unit to the most complex and the individual is a part of family, group, community, society, and the larger biosphere." "Nursing care is provided within a biological, psychological, sociocultural , environmental, and legal-ethical context."  Health/illness and adaptation/ maladaptation (nursing world view) are two distinct continuums.  Assumptions

8. The model includes the primary, secondary, and tertiary levels of prevention by describing four discrete stages of psychiatric treatment: crisis, acute, maintenance, and health promotion. Nursing care is based on the use of the nursing process and the standards of care and professional performance for psychiatric nurses. Concepts Biopsychosocial approach - a holistic perspective that integrates biological, psychological, and sociocultural aspects of care. Predisposing factors -risk factors such as genetic background. Precipitating stressors - stimuli that the person perceives as challenging such as life events. Appraisal of stressor - an evaluation of the significance of a stressor. Coping resources - options or strategies that help determine what can be done as well as what is at stake. Adaptation/ maladaptation - Levels of Prevention Primary Secondary Tertiary

9. 10 Stuart Stress Adaptation Model 10

10. 11 Predisposing Factors: Biological Genetic background Nutritional status Biological sensitivities General health Exposure to toxins 11

11. 12 Predisposing Factors: Psychological Intelligence Verbal skills Morale Personality Past experiences Self-concept Motivation Psychological defenses Locus of control (sense of control over fate) 12

12. 13 Predisposing Factors: Sociocultural Age Gender Education Income Occupation Social position Cultural background Religious upbringing and beliefs Political affiliation Socialization experiences Level of social integration or relatedness 13

13. 14 Precipitating Stressors Stimuli that are challenging, threatening, or demanding to individual Require increased energy Produce tension and stress May originate in person’s internal or external environment Timing, duration, number, frequency of stressors significant 14

14. A "crisis" involves a disruption of an individual's normal or stable state. More specifically, a crisis occurs "when a person faces an obstacle to important life goals that is, for a time, insurmountable through the utilization of his customary methods of problem solving" ( Caplan , 1961). Crises are usually categorized as being either situational or maturational. Situational crises involve an unexpected event that is usually beyond the individual's control. Examples of situational crises include natural disasters, loss of a job, assault, and the sudden death of a loved one. Maturational crises occur when a person is unable to cope with the natural process of development. Maturational crises usually occur at times of transition, such as when the first child is born, when a child reaches adolescence, and when the head-of-the-household retires. What is Crisis?

15. Stages of Crises A crisis situation involves a sequence of events that leads individuals from "equilibrium to disequilibrium and back again" (Golan, 1978). This sequence generally involves five components: The Hazardous Event: The hazardous event is a stressful circumstance that disrupts an individual's equilibrium and initiates a series of actions and reactions. The hazardous event may be anticipated (e.g., divorce, retirement) or unanticipated (e.g., the sudden loss of a family member). The Vulnerable State: An individual's reaction to the hazardous event is ordinarily linked to his/her subjective interpretation of the event. Most commonly, a hazardous event is perceived either as a threat, a loss, or a challenge. The vulnerable state is characterized by an increase in tension which the individual attempts to alleviate by using one or more of his/her usual coping strategies. If these strategies are unsuccessful, the individual's tension continues to increase and, as a result, he/she eventually becomes unable to function effectively.

16. The Precipitating Factor : The precipitating factor is the event that converts a vulnerable state into a crisis state. In some situations, the hazardous event and precipitating factor are identical; in other situations, the precipitating factor follows the hazardous event (i.e., the precipitating factor acts as the "last straw"). The precipitating factor may produce a variety of responses including, for example, a suicide attempt or, more constructively, a desire to seek help. Active Crisis State: The active crisis state is characterized by disequilibrium and normally involves the following: physical and psychological agitation (e.g., disturbed appetite and/or sleep, impaired concentration and problem-solving ability, anxiety, or depression), preoccupation with the events that led to the crisis, and, finally, a gradual return to a state of equilibrium. The individual ordinarily recognizes during the active crisis stage that his/her usual coping mechanisms are inadequate and, thus, is usually highly motivated to seek and accept outside help. Reintegration: Successful reintegration (restoration of equilibrium) is dependent on a number of factors including the individual's ability to objectively evaluate the crisis situation and to develop and utilize effective coping strategies.

17. Crisis intervention  is an immediate and short term   psychological  care aimed at assisting individuals in a crisis situation to restore equilibrium to their biopsychosocial functioning and to minimize the potential for long-term  psychological trauma . Crisis Intervention Goals The precise goals of a crisis intervention depend, of course, on the specific nature of the crisis. However, crisis-oriented treatments do share a number of common goals. For example, the general goals of crisis intervention are: Relieving the client's symptoms; Restoring the client to his/her previous level of functioning; Identifying the factors that led to the crisis state; Identifying and applying remedial measures; Helping the client connect current stresses with past life experiences; and Helping the client develop adaptive coping strategies that can be used in the current situation as well as in any future situation

18. Principles of Crisis Intervention Immediate Intervention Action: The therapist actively participates in and directs those activities that help the client resolve the crisis . Limited Goals: While long-term forms of therapy may address a number of goals, crisis intervention focuses on goals that are clearly related to the crisis situation. Hope And Expectation: Support: Focused Problems Solving: Self Image: Increase the Self Esteem of the client. Self Reliance: Balance between Support & client’s self independence.

19. Stages of Crisis Intervention ASSESSMENT (Session 1) The assessment stage of crisis intervention entails: Identifying the precipitating factor ("what happened?"); Determining the client's subjective reactions to the precipitating factor ("how did you respond?"); Defining the context of the crisis situation including the hazardous event ("can you remember what started this?"); Assessing the client's present state ("what is happening now?"); and Precisely defining, in conjunction with the client, the current problem ("we agree that the most important problem is your anxiety about getting along without your husband") IMPLEMENTATION (Sessions 1-4) The implementation phase involves obtaining relevant background information (e.g., information on the client's pre-crisis functioning, previously used coping strategies, the client's strengths and weaknesses, and available resources and support systems), setting immediate goals, and identifying tasks that allow the client to achieve those goals. TERMINATION (Sessions 5-6) During the termination phase, the client and therapist review the client's progress in terms of the goals of the intervention, arrive at a decision to terminate, and discuss the client's plans for the future.