The document discusses stress adaptation and crisis intervention models. It defines stress, stressors, and different types of stress such as acute, episodic, and chronic stress. It describes coping strategies and adaptation. It then outlines Stuart's stress adaptation model, including its assumptions, concepts, and predisposing biological, psychological, and sociocultural factors. Finally, it discusses crisis types, stages of a crisis, goals of crisis intervention, and its assessment, implementation, and termination stages.

1. STRESS ADAPTATION MODEL
STRESS & STRESSOR, COPING RESOURSES MACHANISM,
CIRSIS TYPES & CRISIS
INTERVENTION
PRESENTED BY
SHIV PRAKASH
PhD RESEARCH SCHOLAR
IMS, BHU

2. Stress is an individual’s response to a disturbing factor in the environment, and
consequence of such reaction. Stress involves interaction of the person and
environment. To quote a definition: “Stress is an adaptive response to an external
situation that results in physical, psychological and / or behavioral deviations for
organizational participants” (Fred Luthans, 1998).
Concept of Stress
Stress is defined either as a reaction or as a stimulus. As a reaction the meaning of
stress is consubstantial with specific changes that human biological system is
experiencing .As stimulus, the definition of stress is related to environmental events
that cause those changes. The stressful events can be acute, chronic, remitting and
continuous chronic form .

4. The physical or psychological demands from the environment
that cause stress are called stressors. They create stress or the
potential for stress when an individual perceives them as
representing a demand that may exceed that person’s ability to
respond. How an individual experiences stress depends on
(i) The person’s perception of the situation,
(ii) The person’s past experience,
(iii) The presence or absence of social support, and
(iv) Individual differences with regard to stress reactions
(Don Hellriegel, et. al., 2001)

5. Eustress & Distress

6. Acute stress is a physical response to a perceived threat to your well being, and
constitutes the most common form of stress. This is the classic “flight-or-flight”
reaction. Acute stress can actually be helpful by keeping you alert, focused, and
energetic. Acute stress takes place over a short duration, thus it usually doesn’t have
enough time to do the kinds of extensive damage associated with long-term stress.
Episodic Stress occurs when we experience acute stress too frequently. It often
hits those who take on too much―those who feel they have both self-imposed
pressure and external demands vying for their attention. In such cases, hostility and
anger frequently result. Episodic stress also commonly afflicts those who worry a lot
of the time, in turn resulting in anxiety and depression.
Chronic Stress leads to serious health problems, because it disrupts nearly every
system in your body. Part of what makes chronic stress so insidious is its ability to
become “normal” feeling. This pattern of enduring is what makes chronic stress such a
serious health issue. Poverty, trauma, general pressure from the demands of life, and
more can all cause chronic stress. Chronic stress can lead to cancer, strokes, and heart
attacks, as well as violent behavior and even suicide. Though one of the most difficult
issues to treat, it’s never too late to start undoing the damage.

7. Coping strategies refer to the specific efforts, both behavioral and
psychological, that people employ to master, tolerate, reduce, or minimize stressful
events. Two general coping strategies have been distinguished: problem-solving
strategies are efforts to do something active to alleviate stressful circumstances,
whereas emotion-focused coping strategies involve efforts to regulate the emotional
consequences of stressful or potentially stressful events. Research indicates that people
use both types of strategies to combat most stressful events (Folkman & Lazarus,
1980)
Adaptation is the consequence of coping efforts and denotes mastery and
adjustment resulting from responses to problems or new challenges (Mechanic, 1974;
Moos, 1977). Adaptation results when the individual is able to effect a series of
behaviors and mental processes to neutralize the stress experience and reestablish
integrity of function. Adaptation involves achieving a balance between perceived
demands (stress) and marshalled resources (coping), a state of reduced anxiety and
enhanced well-being.

8. Stuart Stress Adaptation
Stuart Stress Adaptation Model is a model of of psychiatric nursing care, which
integrates biological, psychological, sociocultural, environmental, and legal-ethical
aspects of patient care into a unified framework for practice. The Stuart Stress Adaptation
Model of health and wellness provides a consistent nursing-oriented framework (Stuart,
2009).
"Nature is ordered as a social hierarchy from the simplest unit to the most
complex and the individual is a part of family, group, community, society, and
the larger biosphere."
"Nursing care is provided within a biological, psychological, sociocultural,
environmental, and legal-ethical context."
 Health/illness and adaptation/maladaptation (nursing world view) are two
distinct continuums.
Assumptions

9. The model includes the primary, secondary, and tertiary levels of prevention by
describing four discrete stages of psychiatric treatment: crisis, acute, maintenance,
and health promotion.
Nursing care is based on the use of the nursing process and the standards of care
and professional performance for psychiatric nurses.
Concepts
Biopsychosocial approach - a holistic perspective that integrates
biological, psychological, and sociocultural aspects of care.
Predisposing factors -risk factors such as genetic background.
Precipitating stressors - stimuli that the person perceives as challenging such as
life events.
Appraisal of stressor - an evaluation of the significance of a stressor.
Coping resources - options or strategies that help determine what can be
done as well as what is at stake.
Adaptation/maladaptation -
Levels of Prevention
Primary
Secondary
Tertiary

10. 10
Stuart Stress Adaptation Model
10

11. 11
Predisposing Factors: Biological
• Genetic background
• Nutritional status
• Biological sensitivities
• General health
• Exposure to toxins
11

12. 12
Predisposing Factors: Psychological
• Intelligence
• Verbal skills
• Morale
• Personality
• Past experiences
• Self-concept
• Motivation
• Psychological defenses
• Locus of control (sense of control over fate)
12

13. 13
Predisposing Factors: Sociocultural
• Age
• Gender
• Education
• Income
• Occupation
• Social position
• Cultural background
• Religious
upbringing and
beliefs
• Political affiliation
• Socialization
experiences
• Level of social
integration or
relatedness
13

14. 14
Precipitating Stressors
• Stimuli that are challenging, threatening, or
demanding to individual
• Require increased energy
• Produce tension and stress
• May originate in person’s internal or external
environment
• Timing, duration, number, frequency of
stressors significant
14

15. A "crisis" involves a disruption of an individual's normal or stable state. More
specifically, a crisis occurs "when a person faces an obstacle to important life goals that
is, for a time, insurmountable through the utilization of his customary methods of problem
solving" (Caplan, 1961).
Crises are usually categorized as being either situational or maturational. Situational
crises involve an unexpected event that is usually beyond the individual's control.
Examples of situational crises include natural disasters, loss of a job, assault, and the
sudden death of a loved one. Maturational crises occur when a person is unable to cope
with the natural process of development. Maturational crises usually occur at times of
transition, such as when the first child is born, when a child reaches adolescence, and
when the head-of-the-household retires.

16. Stages of Crises
A crisis situation involves a sequence of events that leads individuals from "equilibrium to
disequilibrium and back again" (Golan, 1978). This sequence generally involves five
components:
The Hazardous Event: The hazardous event is a stressful circumstance that disrupts an
individual's equilibrium and initiates a series of actions and reactions. The hazardous event
may be anticipated (e.g., divorce, retirement) or unanticipated (e.g., the sudden loss of a
family member).
The Vulnerable State: An individual's reaction to the hazardous event is ordinarily linked
to his/her subjective interpretation of the event. Most commonly, a hazardous event is
perceived either as a threat, a loss, or a challenge. The vulnerable state is characterized by
an increase in tension which the individual attempts to alleviate by using one or more of
his/her usual coping strategies. If these strategies are unsuccessful, the individual's tension
continues to increase and, as a result, he/she eventually becomes unable to function
effectively.

17. The Precipitating Factor: The precipitating factor is the event that converts a
vulnerable state into a crisis state. In some situations, the hazardous event and
precipitating factor are identical; in other situations, the precipitating factor follows the
hazardous event (i.e., the precipitating factor acts as the "last straw"). The precipitating
factor may produce a variety of responses including, for example, a suicide attempt or,
more constructively, a desire to seek help.
Active Crisis State: The active crisis state is characterized by disequilibrium and
normally involves the following: physical and psychological agitation (e.g., disturbed
appetite and/or sleep, impaired concentration and problem-solving ability, anxiety, or
depression), preoccupation with the events that led to the crisis, and, finally, a gradual
return to a state of equilibrium. The individual ordinarily recognizes during the active
crisis stage that his/her usual coping mechanisms are inadequate and, thus, is usually
highly motivated to seek and accept outside help.
Reintegration: Successful reintegration (restoration of equilibrium) is dependent on a
number of factors including the individual's ability to objectively evaluate the crisis
situation and to develop and utilize effective coping strategies.

18. Crisis intervention is an immediate and short term psychological care
aimed at assisting individuals in a crisis situation to restore equilibrium to their
biopsychosocial functioning and to minimize the potential for long-
term psychological trauma.
Crisis Intervention Goals
The precise goals of a crisis intervention depend, of course, on the specific nature of
the crisis. However, crisis-oriented treatments do share a number of common goals.
For example, the general goals of crisis intervention are:
Relieving the client's symptoms;
Restoring the client to his/her previous level of functioning;
Identifying the factors that led to the crisis state;
Identifying and applying remedial measures;
Helping the client connect current stresses with past life experiences; and
Helping the client develop adaptive coping strategies that can be used in the current
situation as well as in any future situation

19. Principles of Crisis Intervention
Immediate Intervention
Action: The therapist actively participates in and directs those activities that help
the client resolve the crisis.
Limited Goals: While long-term forms of therapy may address a number of goals,
crisis intervention focuses on goals that are clearly related to the
crisis situation.
 Hope And Expectation:
Support:
Focused Problems Solving:
Self Image: Increase the Self Esteem of the client.
Self Reliance: Balance between Support & client’s self independence.

20. Stages of Crisis Intervention
ASSESSMENT (Session 1)
The assessment stage of crisis intervention entails:
Identifying the precipitating factor ("what happened?");
Determining the client's subjective reactions to the precipitating factor ("how did you
respond?");
Defining the context of the crisis situation including the hazardous event ("can you
remember what started this?");
Assessing the client's present state ("what is happening now?"); and
Precisely defining, in conjunction with the client, the current problem ("we agree that the
most important problem is your anxiety about getting along without your husband")
IMPLEMENTATION (Sessions 1-4)
The implementation phase involves obtaining relevant background information
(e.g., information on the client's pre-crisis functioning, previously used coping
strategies, the client's strengths and weaknesses, and available resources and
support systems), setting immediate goals, and identifying tasks that allow the
client to achieve those goals.
TERMINATION (Sessions 5-6)
During the termination phase, the client and therapist review the client's progress
in terms of the goals of the intervention, arrive at a decision to terminate, and
discuss the client's plans for the future.