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п»ї<title>Chronic stress: definition, types and treatment</title>
There are phrases related to stress and chronic stress that we are all familiar with. Either from having said them or from having heard them. "What stress, I'm not going to make it on time!" "I'm so stressed lately, I don't have time for anything" or "my daughter is so stressed, she has two exams tomorrow".
If we were to ask the same people who have made any of these statements how they would define stress, the matter would be complex. Stress is one of those terms that is easy to experience, but very difficult to define.
One thing that does seem clear is the devastating role that has always been attributed to stress. Not only is it especially harmful to health, but some people also perceive it as something intrinsic to the person, which makes it harmful and not subject to change (when in fact it is not).
What do we mean by stress? First of all, approach it in a broad and not in a reductionist way. Thus, stress or stress response is nothing more than our way of coping and adapting to the various demands or situations we generate or encounter.
Our response to stress is not only key to this adaptation, but it is thanks to it that we have survived as a species for millennia. In this sense, the biological mechanisms involved are very complex. At the same time, it is important to highlight the management of energy by our organism to cope with perceived threats.
A stressful situation implies a demand on the part of our organism to cope with it. We will use this energy to face it, to endure it or to avoid it. In this channeling of energy some physiological systems are activated (glucose mobilization, heart rate, blood pressure, muscle tone, alertness...).
Systems related to expensive long-term construction projects are slowed down or paralyzed (digestion, sexual reproduction, immune system...). This leads us to deal more effectively with stressful situations that require an immediate response.
How many types of stress are there? Stress, depending on its evolution and duration, can be divided into several categories. Miller and Smith (1977) established different forms of stress, with differentiated characteristics and symptoms: acute stress, episodic stress and chronic stress.
Acute stressThis is the most common form of stress. It arises in the face of pressures and demands that are present or anticipated in the near future. Acute stress is exciting and thrilling in small doses. But in large proportions it can be exhausting. Symptoms of acute stress appear in different everyday situations. For example, meeting a deadline for a paper, preparing for a public presentation, an exam or an occasional discussion.
However, their course is usually brief, so they do not usually cause the extensive damage associated with long-term symptoms.
Acute episodic stressAppears when episodes of acute stress occur repeatedly and frequently. The person experiences his life as disordered, on the verge of chaos and in permanent crisis. They live in constant precipitation, in permanent acceleration, without these continuous changes of speed actually solving the problem.
This form of response is so embedded in the person's lifestyle that they often do not see it as a problem, attributing their afflictions and pain to external causes or to other people.
They often see their lifestyle, their pattern of interaction with others and their way of perceiving the world as part of themselves, of who they are.
Chronic stressThis is the routine stress that wears a person down day after day, year after year. Chronic stress wrecks the body, mind and life of those who suffer from it, wreaking long-lasting havoc.
Chronic stress appears when the person sees no way out of a miserable situation. It is the stress caused by very strong demands and pressures that are prolonged for seemingly endless periods of time. They lead the individual, without hope, to stop looking for a solution.
This type of stress appears in caregivers of the chronically ill, the elderly or the insane, people in a situation of social marginalization... However, some forms of chronic stress derive from traumatic events experienced in childhood, which are internalized and always remain present and painful.
In situations of chronic stress, people often end up "getting used to" it, so that they forget that it is there. Thus, for example, in caregivers of the sick, it has been found that the greatest deterioration occurs in the first moments, followed by stabilization and a certain adaptation to the situation.
Chronic stress seems to be related to the appearance of suicide attempts, violent behavior, heart attacks, strokes, and perhaps, although there is no definitive evidence in this regard, cancer.
Characteristics that make a situation stressfulIn general, a person is considered to be in a stressful situation when he/she has to cope with environmental demands that exceed his/her resources. The person perceives that he/she cannot respond to them effectively. There are a number of characteristics that seem to contribute to making a situation stressful:
Change or novelty in the situation. The mere change in a habitual situation can make it threatening, since it usually implies the appearance of new demands to which it is necessary to adapt.
Lack of predictability (degree to which it is possible to predict what will happen). Situations in which it is possible to predict what will happen generate lower stress responses.
Uncertainty about what may happen in a situation. For example, about the outcome of a competition or an exam. The greater the degree of uncertainty, the more stressful the situation.
Ambiguity. Occurs when any of the characteristics of the situation are unknown, making it difficult to respond effectively to it.
Situations that exceed the individual's resources. The person may be overwhelmed by multiple demands that he/she "cannot meet" due to lack of time, performance, support, etc.
Situations in which the person does not know what to do (either because nothing can be done, or because he/she does not know how to act in the situation, or because even if he/she does know how to act, he/she does not know how to implement it).
Symptoms of chronic stressDifferent scientific reviews show us the latest findings on how stress is related to different diseases or disorders:
Coronary disordersThe consequences of chronic stress on the cardiovascular system occur at several levels. One is damage to the branch points of the circulatory system. The thin inner lining of the blood vessels begins to tear and leak.
When fatty acids, circulating platelets and glucose pouring into the bloodstream make their way underneath this layer, they stick to it, thickening and clogging it. Thus, the blood flow through it decreases. This is called atherosclerosis.
Respiratory disordersThe bronchi undergo an important dilatation that favors the conduction of oxygen to the alveoli. This can lead to respiratory disorders such as bronchial asthma, hyperventilation syndrome, tachypnea, dyspnea and feelings of chest tightness.
Immune disordersProlonged stress causes a more potent reduction in the immune response than acute stress, although the latter is more intense. Diseases closely related to the immune system are often preceded by a period of intense stress.
In addition, people who are more stressed are more vulnerable or less resistant to infectious diseases, such as a cold or viral and/or bacterial diseases such as influenza.
Gastrointestinal disordersIn situations of prolonged stress, stomach pains, dyspepsia, nausea, flatulence, diarrhea and, in more sustained situations, ulcers may occur.
The stressors most commonly associated with psychophysiological disturbances of the gastrointestinal tract range from economic to family and/or health concerns. Other major gastrointestinal disorders associated with stress include functional dyspepsia and irritable bowel syndrome.
Psychopathological disorders associated with chronic stressThose that have been found to be most related to stress are anxiety, fears, phobias, depression, post-traumatic stress, schizophrenic disorders, addictive behaviors, obsessive-compulsive behaviors, insomnia, eating disorders and personality disorders.
They are also related to other problems such as relationship problems with family, friends, co-workers and even with the partner (Labrador, 1996).
Treatment of chronic stressIn addition to pharmacological treatment for the various conditions mentioned above, it is of paramount importance to follow a structured psychological program for stress management. This program should include the following contents:
Conceptualization of stress: basic knowledge necessary to understand stress.
Physiological deactivation techniques (diaphragmatic breathing, autogenic training, progressive muscle relaxation and thematic imagination, for example).
Cognitive restructuring: changing dysfunctional thoughts for more realistic ones.
Self-instructions: what can we tell ourselves in stressful situations?
Thought stopping: technique used when the same thought keeps appearing in our mind over and over again.
Assertiveness techniques: used to relate more effectively with others.
Time management and goal setting.
Personality characteristics and their relationship with stress and health.
Techniques to overcome difficult moments and stressful times.
Techniques to promote a sense of humor.
Integration of everything seen previously.
As we have seen, chronic stress has no single cause and is related to personality traits and to what we think and do. The consequences can be devastating for our health, to the point of causing chronic diseases. The psychological treatment of choice is cognitive-behavioral, where emphasis is placed on: physical symptoms, what we think and what we do.
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