A clinical paper written by Dr. Lynn Wilson Brallier featured in Dolores Krieger’s “Foundations for Holistic Health Nursing Practices: The Renaissance Nurse“
Holistic Health and Stress Management
People in all cultures throughout recorded time have had to deal with stress. Many factors, including the prevailing philosophy or religious beliefs of a culture, have interplayed in the development of methods of managing stress. In the history of health care in the United States, we can see shifts in attitudes toward stress illnesses and in the ways that the health care industry has responded to helping people cope with stress. Prior to the era of specialization, country doctors or lay healers in the community cared for people as they attempted to cope with stressful life events or with stress that was of genetic origin or born of peoples’ intrapsychic struggles. These helpers were often able to utilize a holistic approach when dealing with a person in distress because they knew the client’s personality, social situation, work situation, family life, belief system, and general physical condition. However, the age of health care specialization ushered in a more technological and less humanistic and comprehensive approach to helping people manage their dysfunctional reactions to stress. This situation has often led to fragmented treatment, which may or may not be effective in relieving symptoms of distress. The modern treatment philosophy which views a person as analogous to a motor vehicle and proceeds to “fix” one part or another does not usually allow a person to learn how to avoid creating similar symptoms in the future and does not help a person examine and use his or her experience of illness as a step in growth toward wholeness.
The contemporary holistic health movement embraces principles of humanistic psychology. This fits together perfectly with the knowledge that in order to be of significant and long-lasting help to someone who is dealing with a stress-induced or stress-related illness, one must be aware of the nature of that person’s body, mind, spirit, and environment. One must know how these parts of the person have interacted to create the distress. Psychophysiologic medicine, upon which much stress theory is based, has long paid attention to the interaction of body and mind. Emphasis in the past has been on how the mind has made the body ill. The holistic approach to stress management acknowledges this kind of interaction as valid and also helps people learn how their minds can heal their bodies. This approach also teaches people how to focus their minds in ways that help prevent their bodies from becoming so tense and distressed as to begin showing symptoms of disease. In a holistic approach to stress management, great emphasis is placed on the individual’s responsibility for his or her own state of health. That is, the locus of control over one’s health is within one’s self. An educational approach to stress management is favored so that the individual can see himself or herself as a student who is reeducating or retraining his or her body to respond in a way that counters exaggerated forms of the body’s distress response.
Use of the word “stress” in health care literature has been confusing because the term indicates both the cause and the result of trouble. For example, we say that stress is a factor in causing a heart attack and we also say that the heart attack itself is the stress. For the purposes of this discussion, we will use Hans Selye’s definition of stress, which is that stress is “the nonspecific response of the body to any demand made upon it.” Selye also defines “eustress” and “distress.” Eustress is the body’s response to a happy or pleasantly exciting event. Distress is a condition which comes about when someone is unhappy, frightened, or angry, or in some way unpleasantly excited. Besides these definitions of stress, it is important to recognize that there are both positive and negative effects of stress. The positive effects result from the fact that stress provides challenges for us, keeps us alert and interested in life, and occasionally stimulates large steps in personal growth and development. The negative effects of stress are experienced as unpleasant states of mind and body, usually having to do with a sense of being overwhelmed and not in full control of some aspect of life.
Another highly important aspect to know about stress is that stressors come in many forms. Varied events, ranging from a physical strain such as jogging or being physically injured to emotional strain such as hearing of the death of someone close or thinking a severely self-critical thought, can trigger a nonspecific bodily stress response. It is important to recognize that our own thoughts are a major source of stress for us. Ellis and Harper, in their writings on rational-emotive psychotherapy, have shown that many thoughts lead to arousal of the hypothalamus which is the center of emotions and influences the autonomic nervous system. Thoughts can be habitual and out of our awareness. They stem from what we were taught very early in life and also from our philosophy of life, our beliefs, and our attitudes. Thus, our storehouse of conditioned thoughts and thoughts stemming from our values have a significant influence on our level of distress.
Psychophysiology of Stress Responses
Hans Selye, who has probably contributed more research-based knowledge on stress than any other person in history, discovered a generalized response to stressors of all kinds which he calls the General Adaptation Syndrome. This syndrome is generalized because it involves the autonomic nervous system and the endocrine glands of the body. The General Adaptation Syndrome is apparently an adaptive attempt by the body to deal with stressors while keeping the body in a homeostatic state. Selye uses the word syndrome because the body’s reaction to stressors, no matter what their nature, is a rather orderly process with detectable stages. The exact nature of the General Adaptation Syndrome varies somewhat among individuals and also from one instance of stress to another owing to the presence of what Selye calls conditioning factors. These mediating conditioning factors may be genetically determined or they may be acquired.
The three stages of the General Adaptation Syndrome are (1) the stage in which there is an alarm reaction, (2) the stage of resistance, and (3) the stage of exhaustion. In other words, we may be somewhat shocked or alarmed by a stressor and at that time our nervous system and endocrine glands react quickly and predictably. If we survive the shock or alarm stage, we progress to the stage of resistance in which adaptation energy is utilized to cope with the stressor by returning the body to its normal homeostatic state. As exposure to the same stressor continues, our bodies enter a stage of exhaustion. Eventually, either our energy is depleted and death ensues or we replenish our energy and rebalance until the next stressor appears or is sought out. Figure 13-1 illustrates what is presently known about the steps involved in a generalized response to a stressor. This illustration is extreme in its simplicity but serves as a tool for basic understanding of this response. As can be seen on the diagram, the stressor stimulates the hypothalamus, which then activates both the anterior pituitary gland and the autonomic nervous system, causing the latter to release adrenaline and noradrenaline. The anterior pituitary gland releases two hormones. One is adrenocorticotropic hormone, or ACTH, which travels by way of the bloodstream to the adrenal cortex and helps signal this part of the adrenal gland to release syntoxic steroids or anti- inflammatory hormones such as cortisone. The other hormone released by the anterior pituitary is called somatotropin, or STH, which, in turn, stimulates the adrenal cortex and seems to cause the release of catatoxic steroids, or steroids which encourage an inflammatory response, such as aldosterone.

As was stated earlier, the General Adaptation Syndrome is apparently intended to help the organism maintain or quickly return to a homeostatic or balanced physiologic state. Under certain conditions such as when stressors are too intense or too frequent for the person to cope with, the body is unable to continue to effectively return to a normal state and a disease process is then likely to develop. For instance, too frequent an increase in the level of corticoids in the blood and in stimulation of the autonomic nervous system frequently creates peptic ulcers in the stomach and intestine. The corticoids also elicit thymus shrinkage and atrophy of lymph nodes as well as inhibition of inflammatory reactions. If all of these conditions become a chronic body state, a general depression of the efficacy of the immune system can result. This state of the immune system leaves a person vulnerable to many infectious diseases, probably including some types of viral cancers. Stressors, besides eliciting the General Adaptation Syndrome, can also influence the level of muscle tension in both striated and smooth muscles. This tension can eventually lead to problems such as tension headaches, back and neck pain, bruxism, and general pain and fatigue caused by muscles that are held in a chronic spastic state. Other typical stress responses involve the cardiovascular system and include hypertension, various forms of heart disease, strokes, and, in many cases, migraine headaches. Many allergic disorders may be seen as dysfunctional ways of coping with stressors.
Inability to cope well with stressors may also lead to accidents. Data from the field of biofeedback and from other relaxation therapies are making more clear the evidence that stressors are either causative or intimately related to nearly all nongenetically produced alteration in body structure and functioning. These data indicate that improvement or even cure of many disease processes can be brought about when a client is helped to learn a generalized relaxation response which seems to counter maladaptive features of the General Adaptation Syndrome. Clients with such illnesses as Raynaud’s disease, Buerger’s disease, and some forms of cancer-diseases that do not seem to be directly related to stressors have shown remarkable improvement or remission when careful stress management and relaxation therapy have been utilized.