C h a p t e r 9
Stress and Adaptation
219
(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
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
worries and is under a lot of stress.
A.
Relate the effects stress has on the
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?
SUMMARY CONCEPTS
■■
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.
