Porth's Essentials of Pathophysiology, 4e

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Stress and Adaptation

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(or interval) between the musical tones. The melody con- tributes to the listener’s emotional response to the music. Harmony results from the way pitches are blended together, with the combination of sounds described as consonant or dissonant by the listener. Music usually is selected based on a person’s musical preference and past experiences with music. Depending on the setting, headphones may be used to screen out other distract- ing noises. Radio and television music is inappropriate for music therapy because of the inability to control the selection of pieces that are played, the interruptions that occur (e.g., commercials and announcements), and the quality of the reception. Music therapy has been effec- tive for reducing anxiety in many patient populations across the life span, including critical care, 93 palliative care, 94 and the perioperative arena. 95 MassageTherapy Massage is the manipulation of the soft tissues of the body to promote relaxation and relief of muscle ten- sion. The technique that is used may involve a gentle stroking along the length of a muscle (effleurage), appli- cation of pressure across the width of a muscle (pétris- sage), deep massage movements applied by a circular motion of the thumbs or fingertips (friction), squeezing across the width of a muscle (kneading), or use of light slaps or chopping actions (hacking). 96 Massage may be administered by practitioners who have received spe- cial training in its use, and it can be delivered by less prepared persons such as parents of small children 97 or caregivers of confused elders. 98 It often is used as a means of physiologic relaxation and stress relief in critically ill patients, 99,100 cancer patients, 101 and persons with dementia. 102 Biofeedback Biofeedback is a technique in which an individual learns to control physiologic functioning. It involves electronic monitoring of one or more physiologic responses to stress with immediate feedback of the specific response to the person undergoing treatment. Several types of responses are used: electromyographic (EMG), elec- trothermal, and electrodermal. 103 The EMG response involves the measurement of electrical potentials from muscles, usually the forearm extensor or frontalis. This technique is used to gain control over the contraction of skeletal muscles that occurs with anxiety and tension. The electrodermal sensors monitor skin temperature in the fingers or toes. The SNS exerts significant control over blood flow in the distal parts of the body such as the digits of the hands and feet. Consequently, anxiety often is manifested by a decrease in skin temperature in the fingers and toes. Electrodermal sensors measure conductivity of skin (usually the hands) in response to anxiety. Fearful and anxious people often have cold and clammy hands, which lead to a decrease in conductivity. Biofeedback has been used successfully to reduce anxi- ety in nursing students with test anxiety, 104 patients with functional constipation, 105 and those with cyclic vomit- ing syndrome. 106

SUMMARY CONCEPTS

R E V I EW E X E R C I S E S 1. A 21-year-old college student notices that she frequently develops “cold sores” during the stressful final exam week. A. What is the association between stress and the immune system? B. One of her classmates suggests that she listen to music or try relaxation exercises as a means of relieving stress. Explain how these interventions might work in relieving stress. 2. A 75-year-old woman with congestive heart failure complains that her condition gets worse when she neuroendocrine control of cardiovascular function and its possible relationship to a worsening of the woman’s congestive heart failure. B. She tells you that she dealt with much worse stresses when she was younger and never had any problems. How would you explain this? ■■ Stress, in and of itself, is neither negative nor deleterious to health.The stress response is designed to be time limited and protective. However, in situations of prolonged activation of the response because of overwhelming or chronic stressors, it can be damaging to health.The acute stress reaction and stress-induced hyperglycemia are of particular concern in persons with critical injuries or illness. ■■ Post-traumatic stress disorder (PTSD) is an example of chronic activation of the stress response as a result of experiencing a traumatic event that involved actual or threatened death or serious injury. Essential features of PTSD include a constellation of symptoms that are experienced as states of intrusion (flashbacks of the event), avoidance (emotional numbing), and hyperarousal (intense activation of the neuroendocrine system). ■■ Treatment of stress should be aimed at helping people avoid coping behaviors that can adversely affect their health and providing them with other ways to reduce stress. Some popular evidence- based non-pharmacologic methods used in the treatment of stress include progressive muscle relaxation techniques, guided imagery, music therapy, massage therapy, and biofeedback. worries and is under a lot of stress. A. Relate the effects stress has on the