Definitions of Stress

Stress has been variously defined as an environmental event, a response to an event or circumstances, and a process. One approach defines stress in terms of life events—as a stimulus—circumstances or events that require the person to adapt produce feelings of tension. These stressors may be major catastrophic events (e.g., natural disaster), major life events (e.g., death of a loved one), or recurrent daily hassles (e.g., need to manage a chronic medical condition).

Stress can also be seen as a response. For example, a person with a social phobia feels stressed in a social setting such as a party, experiencing a psychological state of nervousness with associated physical symptoms of dry mouth, palpitations, and sweating. This physiologic and psychological response to a stressor is often called strain.

A third approach emphasizes stress as a process in which "environmental demands tax or exceed the adaptive capacity of an organism, resulting in psychological and biologic

Figure 3-1 Stress, life events, and coping. (From Tunks E, Bellissimo A. Behavioral medicine: concepts and procedures. Boston, Allyn & Bacon. Copyright © 1991 Person Education.)

changes that may place persons at risk for disease" (Cohen et al., 1995). Within this approach, stress includes stressors and strains, along with the relationship between the person and the environment. The process involves transactions between the person and the environment, with each affecting and being affected by the other (Sarafino, 1990). "Adaptive capacity" is operationalized in terms of resilience and vulnerability; the physician considers aspects of a person's psychological makeup and social world that may render the patient more susceptible or more resilient (Steptoe, 1998).

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