From Distressed to De-Stressed
(Excerpts from the presentation to the National Respite Conference, Australia)

by Judy Esmond, Ph. D.

It has been said that in this Century, the greatest threat to the health of our society, will not be cancer or heart disease, it will be that of 'chronic stress'. 

Let's begin and set the scene by examining some of the literature and theoretical background to the concepts of stress and burnout. 

There are numerous definitions of stress in the literature.  Hans Selye, the pioneer of modern-day stress research, developed an understanding of our 'fight' or 'flight' response and defined stress as "the nonspecific response of the body to any demand made upon it." (Selye, 1980:127).  Other authors, also focusing on the body's physiological reaction, included definitions of stress as "a response that links a stressor stimulus to any stress-related disease, symptom or dysfunction" (Girando, Everly & Dusek, 1993:7), or "a chemical reaction within the body that occurs when there is a basic need to maintain life and to resist or adapt to changing external or internal influences" (Youngs, 1985:4).

In the 1960s, Lazarus and Folkman, expanded our understanding of stress to include the environment and defined psychological stress as "...a particular relationship between the person and the environment that is appraised by the individual as taxing or exceeding his or her resources and endangering his or her well-being" (Lazarus & Folkman, 1984:19).  McGrath (1970:17), saw stress as a "substantial imbalance between environmental demand and the response capability of the focal organism".

Further, Sachs (1998:5) suggests that "stress is our perception of an event or experience as difficult, threatening, unpleasant or challenging" and Saunders (1992:175) considers "stress is a cause and a consequence.  It has a circular effect and is very insidious.  Its harmful effects accumulate unseen..."

Finally, Olshevski, Katz, and Knight (1999:36) in their book 'Stress Reduction for Caregivers' suggest that "stress is a response to change...[this definition] allows caregivers to understand that stress can be either positive or negative, and it also suggest that, although caregivers may not be able to control the care giving situation, they can control their reaction to change."

Whatever the definition of stress, it remains a part of our everyday life.  It can be both good and bad and Selye (1946, 1956) identified four kinds of stress:

1. Eustress - often understood as good stress.   This recognizes that as human beings we need and thrive on some degree of stress in our lives.  It is often seen as a motivating factor that stimulates us to greater accomplishments or better performance and is often associated with the exciting things in our lives (e.g., sporting events, being in love or winning the lottery). 

2. Understress - which is often described as 'rustout'.  It is where we experience situations of under stimulation and has a very negative effect, often resulting in boredom, fatigue and dissatisfaction.

3. Overstress - where we push ourselves beyond our limits.

4. Distress - which involves unresolved feelings of fear, anxiety and frustration.

When overstress and distress combine we often experience what is known as 'extress' or 'burnout'.  It is seen as the result of both physical and emotional exhaustion.  As stress increases and is prolonged over a period of time, the result can be burnout and is often experienced by those who have been placed in care-giving roles for many years.  In simplistic terms burnout is about taking on too much, too intensely and for too long!  The actual term 'burn-out' was introduced in the mid-1970s by Herbert Freudenberger (1974,1975).  He found in his research involving the observation of volunteers working in an alternative care setting (i.e., a 'Free Clinic'), that they showed signs and symptoms of a loss of motivation and commitment and great emotional depletion. 

Today, there are numerous definitions of burnout but as Janssen, Schaufeli & Houkes (1999:74) explain, "most authors describe burnout as a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment".  Emotional exhaustion relates to feeling totally depleted of emotional energy and resources and often experiencing associated physical illnesses.  Depersonalization relates to becoming completely detached emotionally in your responses to people.  And reduced personal accomplishment means a decreasing interest in achieving goals and increased feelings of incompetence, lack of creativity and irrational problem-solving techniques (Maslach, 1993).  Certainly, for those in caring roles who have experienced burnout these symptoms are all too vivid!

Davis, Robbins-Eshelman and McKay (1995) in their book 'The Relaxation & Stress Reduction Workbook' suggest that there are four basic sources of stress that we experience, that can contribute to burnout:

Environmental - as we are bombarded by demands from the environment around us - traffic, noise, pollution and the weather.

Social - which includes deadlines, money worries, job issues, relationships with significant others and other demands on our time and attention.

Physiological - life changes such as adolescence, menopause, illness, aging and also lack of exercise, sleep and adequate diet.  It also includes our body's reaction to environmental or social threats producing headaches, muscle tension and anxiety.

Psychological - our thoughts and how we interpret them and translate experiences and reactions in relation to stress.

Interestingly, although stress and burnout have received increasing academic attention, our society tends to deal with stress by ignoring early symptoms and warning signs and often promoting the 'brave face' ethic.  This is particularly true of caregivers, for as Kilty & Bond (1991:14) explain:  "in our culture the ability to cope with stress is admired.  Therefore, as stress spirals towards burnout individuals continue to put on a 'brave face' making it very difficult to ask for and receive help."  Davis, Robbins-Eshelman and McKay (1995:4) comment that in fact "our society rewards people who deal with stress by working harder and faster to produce more in a short time."

But is society as a whole becoming more or less stressed?  It seems that the former may be the case.  There continues to be an increase in those experiencing stress both in terms of numbers and across the age ranges, from childhood, through adolescence and into adulthood.

It seems that childhood stress is increasing in both its frequency and severity.  Some factors that may contribute to this stress include:  the pressure on children to mature emotionally and psychologically at increasingly earlier ages, a decrease in the number of caring adults living with children and the subsequent reduction in adult love and support.  Irvine (2000) also identifies a range of stressors for children from parental divorce and separation, through to academic and social failure.  Throughout the adolescent years, stressful experiences are also considered to be increasing in intensity, as prominent stressors involving family dysfunction, peer demands and academic concerns are faced by adolescents (Frydenberg, 1991).

In adulthood it seems that stress levels have also continued to increase.  Youngs (1985) suggests that the availability of multiple life options and the necessity to choose between them, the emphasis on self fulfillment and focus on self and individuality, are three factors that have contributed our increasingly stressed society. 

Further, it seems that the promises of the 'technological age' have not resulted in increased leisure time, reduced stress and a more relaxed lifestyle.  In fact, in some ways almost the opposite has occurred as we have become 'the land of the lost weekend'.  Mobile phones, computers, the internet and email facilities have made us both instantly 'contactable' and also instantly 'reactable', often experiencing information overload.  For many people, technology has become a source of greater stress rather than a means of reducing stress.  As Weil and Rosen (1997:22) explain:  "because technology is being thrust upon them at a pace and volume greater than they desire, this vast majority of the populace is also experiencing techno-stress." 

For those in the workforce, the level of job-related stress and burnout also continues to increase. Maslach and Lieter (1997:2) in their book 'The Truth About Burnout' explain that this is an important barometer of a major social dysfunction in the work place and is the result of "organizational downsizing, outsourcing and restructuring."  Wilson (1997) suggests that the workplace has become a soulless place as creativity has been destroyed through cost cutting, competitiveness, and the fear of redundancy, constant changes, deadlines, time constraints and lack of job security.

But what specifically is the experience for individuals in helping and caring roles predominant in the non-profit sector?  For those in 'helping based' professions, an array of studies (Jayaratne, Chess & Kunkel, 1986; Fimian, Fastenau & Thomas, 1988; Revicki & May, 1989; Karasek & Theorell, 1990) have recognised that these professionals have a heightened vulnerability to experiencing negative stress and burnout in their lives.

For caregivers, previous studies by Rabins, Mace and Lucas (1982) found the symptoms of emotional distress in 85% of caregivers and Snyder and Keefe (1985) determined that 70% of the caregivers surveyed considered their decline in health was directly attributable to their caregiving role.  Haley, Levine, Brown and Bartolucci (1987) found that caregivers displayed more symptoms of depression, felt higher rates of burden and perceived hassles.   In recent times, the link between stress and caregivers is best summed up by Olshevski, Katz and Knight (1999:4), who state that those in caring roles are "at higher risk of emotional distress, perceive their health as being impaired, and experience changes in immune functioning and a higher prevalence of infectious diseases".

Therefore, as experiences of stress and burnout increase in our society and are further intensified for those involved in caring and helping roles, how do we respond to these stressors in our lives?   As Davis, Robbins-Eshelman and McKay (1995:1) explain "stress is an everyday fact of life.  You can't avoid it.  Whether the stress you experience is the result of major life changes or the cumulative effect of minor everyday worries, it is how you respond to these experiences that determines the impact stress will have on your life."  We certainly don't have to succumb to stress, in fact we can learn to master it.

Join in one of our "Stress Less" workshops to see how you can learn to go from Distressed to De-stressed.  Email judy@mtd4u.com to discuss a tailor-made workshop for your organization.

References

Davis, M., Robbins-Eshelman, E., & McKay, M. (1995). The relaxation and stress reduction workbook. Oakland: New Harbinger.

Fimian, M.J., Fastenau, P.S., & Thomas, J.A. (1988).  Stress in nursing and intentions of leaving the profession. Psychological Reports, 62, 499-506.

Freudenberger, H.J. (1974).  Staff burnout. Journal of Social Issues, 30, 159-165.

Freudenberger, H.J. (1975). The staff burnout syndrome in alternative institutions. Psychotherapy, Theory, Research and Practice, 12, 73-82.

Frydenberg, E. (1991b). Adolescent coping: The different ways in which boys and girls cope. Journal of Adolescence, 14, 119-133.

Girdano, A., Everly, G., & Dusek, D. (1993). Controlling stress and tension:  A holistic approach. New Jersey: Prentice Hall.

Hayley, W., Levine, E., Brown, S., & Bartolucci, A. (1987). Stress, appraisal, coping and social support as predictors of adaptational outcome among dementia caregivers. Psychology and Aging, 2, 323-330.

Irvine, J. (2000). Thriving at school. New South Wales: Simon & Schuster.

Janssen, P.P.M., Schaufeli, W.B., and Houkes, I. (1999). Work-related and individual determinants of the three burnout dimensions. Work and Stress, 13, 74-86.

Jayaratne, S., Chess, W.A.,  & Kunkel, D.A. (1986).  Burnout: Its impact on child welfare workers and their spouses. Social Work, 31, 53-58.

Karasek, R.A., & Theorell, T. (1990). Healthy work: Stress, productivity and the reconstruction of working life.  New York: Basic Books.

Kilty, J., & Bond, M. (1991). Practical methods of dealing with stress. Surrey: University of Surrey.

Lazarus, R.S., & Folkman, S. (1984).  Stress, appraisal, and coping.  New York: Springer.

Maslach, C. (1993).  Burnout: a multidimensional perspective.  In W.B. Schaufeli, C. Maslach, & T. Marek (Eds.), Professional burnout: Recent developments in theory and research. (pp 19-31). Washington: Taylor & Francis.

Maslach, C., & Leiter, M. (1997). The truth about burnout:  How organizations cause personal burnout and what to do about it. San Francisco: Jossey-Bass Publishers.

McGrath, J.E. (1970). A conceptual formulation for research on stress.  In J.E.McGrath (Ed.), Social and psychological factors in stress. (pp. 10-21).  New York: Holt, Rinehart & Winston.

Olshevski, J.L., Katz, A.D., & Knight, B.G. (1999). Stress reduction for caregivers. Philadelphia: Brunner/Mazel,

Rabins, P., Mace, N.L., & Lucas, M.J. (1982).  Impact of dementia on the family.  Journal of the American Medical Association, 248, 333-335.

Revicki, D.A., & May, H.J. (1989).  Organizational characteristics, occupational stress, and mental health in nurses.  Behavioral Medicine, 15, 30-36.

Sachs, J. (1998). Break the stress cycle! 10 steps to reducing stress for women. Massachusetts: Adams Media Corporation

Saunders, C. (1992). Teenage stress:  A guide for teenagers/ Teenage stress: A guide for parents. New South Wales: Sally Milner

Selye, H. (1946). Stress in health and disease. Boston: Butterworth.

Selye, H. (1956). The stress in life. New York: McGraw-Hill.

Selye, H. (1980). The stress concept today.  In I.L. Kutash, & L.B. Schlesinger (Eds.), Handbook on stress and anxiety:  Contemporary knowledge, theory, and treatment. (pp.127-143). San Francisco: Jossey-Bass.

Snyder B., & Keefe, K. (1985).  The unmet needs of family caregivers for frail and disabled adults.  Social Work in Health Care, 19, 1-13.

Weil, M.M. & Rosen, L.D. (1997). Technostress: Coping with technology @ work @home @play. New York: John Wiley & Sons.

Wilson, P. (1997). Calm at work. Melbourne: Penguin Books.

Youngs, B.B. (1985). Stress in children:  How to recognize and overcome it. New York: Arbour House.