34.3 Factors Affecting Stress and Adaptation

Developmental Stress

There are certain developmental milestones anticipated in the normal human life cycle. Such events tend to be associated with stress, whether physiological, psychological, or both. The first exposures to stress appear during fetal development, with the fetus exposed to stressors of the uterine environment and to maternal emotional influences. Changes in levels of infant cortisol relate to prenatal exposure to factors, such as overall maternal emotional status with specific mention of the feelings toward the pregnancy, and factors after delivery, such as the maternal-infant bond (Hernández-Martinez et al., 2019).

Fetal exposure to stress, anxiety, and depression results in low levels of cortisol, while parental neglect, abuse, bonding disorders, mental health disorders in parent(s), and low socioeconomic status causes changes in cortisol levels to either higher or lower than normal (Hernández-Martinez et al., 2019). The relevance of these results is that psychopathological processes can be related to alterations from normal levels of cortisol.

Young children face other developmental milestones, with tremendous growth within the first year. During the first few years, children learn to sit up, eat, walk, talk, discover likes and dislikes, assert themselves, and interact with others. These are activities and events that involve stress. Frequently, this is the normal experience of eustress, with prompt return to normal hormones and positive adaptations.

As children start school, and their social circle broadens, more such encounters and challenges are likely, as well as exposure to distressful circumstances. Again, however, if their environment is supportive, the child is likely to establish positive coping adaptations. Similar to the fetus or neonate, though, if the surroundings are negative or even abusive, maladaptive techniques for coping are apt to be developed. Maladaptive physical results from adversity, stress, or trauma in early childhood have also been explored for their contributions as ACEs (Smith & Pollack, 2020). Because infants and young children are in stages of substantial brain development, they are particularly affected by prolonged exposure to stress hormones. The effects of exposures to ACEs can result in remodeling of the brain, with a detrimental lifelong impact on learning and behaviors.

Puberty and adolescence are later developmental milestones, during which inherent stressors such as major growth spurts are common, with accompanying hormonal changes. During these stages, social development continues and expands, with more social events, such as birthday parties, school dances, sporting events, dating, and intimate friendships, each with potential for exposure to eustress and distress and for learning to develop positive coping skills. Reactions to stress tend to be more acute and prevalent in early phases of development, with most exposure to stressors and heightened reactions occurring prior to age 30 years. In young adulthood, people noted fewer stress reactions, and continued passage of time demonstrated a stabilization of stress (Almeida et al., 2023).

Early adulthood tends to involve new experiences, including advancing education through training, college, or university, all of which have inherent stress, as decisions are made and new social groups and independence are established. This is frequently also a time of intimacy and perhaps marriage and parenthood, further developmental stressors.

For some, middle and later adulthood is rather a period of status quo and stability or homeostasis, but with human experiences, stress is apparent even during normal days. So, whether adults are simply facing the challenge of slow traffic during a commute or a minor argument with a child, there are developmental and situational stressors with which to cope. Older adults often trade work stress for changes relative to health, wellness, attitudes, and advancing age. Losing physical strength, losing abilities, and ultimately death, are all likely stressors for older adults, and share some common threads with situational stress. However, reactivity to stress tends to have plateaued by older adulthood (Almeida et al., 2023).

Situational Stress

Throughout a life span, there are countless circumstances and events that cause the stress response. Situational examples include a traumatic injury or accident, illness, losing a job and related financial burden, a divorce, or moving to a new area and home. Like all stressors, situational events begin the cascade of physiological responses that are the stress response, and the person adapts to the stress with positive or negative coping mechanisms.

As with developmental stress, responses to the situational stressor may range from very mild, with quick and positive resolution, to severe, with negative coping techniques leading to crisis. Unlike developmental stress, situations are typically not predictable. Where a person lands on such a continuum of responses (from very mild to very severe) is dependent on several factors. Such factors include internal skills, such as their own adaptation abilities, and their level of health and wellness. Also, availability of support and socioeconomic status influence abilities to cope. Discussion of these factors follows.

Ability to Adapt

The ability of a person to adapt to stress depends on multiple factors. During fetal development, if the fetus is exposed to elevated levels of anxiety, worry about the birth, or negative feelings about the pregnancy, levels of cortisol and subsequent brain development can be undesirably affected (Hernández-Martinez et al. 2019; Smith & Pollack, 2020). Neonates and young children exposed to these stressful situations, as well as additional factors including neglect, maltreatment or abuse, financial woes, and parental mental illness, are at risk for abnormal cortisol levels and related psychopathology in the future.

Considering the negative effects of ACEs, an environment that is positive and supportive, with well-adjusted family and others who have adapted to stress themselves in affirmative ways, using constructive coping mechanisms, tends to foster development of similarly functional coping skills. Even simply removing the chronic stress response associated with ACEs can reduce development of maladaptive stress and coping responses and decrease chronic physical and psychological ailments occurring over time.

While many coping mechanisms, adaptive or maladaptive, are established in early life, they are used, modified, or reinforced throughout a lifetime. Some people are more adaptable, more able to “go with the flow” without feeling stressed and/or anxious, while others are negatively affected and feel heightened levels of anxiety with minor inconveniences. An ability to recognize and control emotions, especially those in response to stress, can also prove helpful. An attitude of gratitude and enjoyment improves stress (Wilson, 2023). Statements to reassure oneself can improve coping; such a statement might be, “This is a challenge, but I have overcome such challenges before and can do it again.” In the longer term, positive self-talk involving writing positive statements and practicing them to improve self-esteem and counter negative thoughts can foster coping (Wilson, 2023). When a stressful, negative situation presents, one repeats the positive statement(s).

Improved self-awareness is a key factor in establishing positive coping techniques and reducing stress-related threats to homeostasis (Cherry, 2022). The following are some methods for enhancing self-awareness:

• Psychotherapy helps identify defense mechanisms and determine improved adaptive strategies.
• Relaxation, meditation, deep breathing, mindfulness, physical activity, and setting goals, helps reduce anxiety and improves focus on positive actions.
• Setting healthy boundaries fosters positive relationships and commitments.
• Reflection/journaling helps reduce anxiety and enhances focus.

Current Health State

The relationships of stress on health and of health on stress are intertwined or may be considered cyclical. This is because negative effects of stress, especially when persistent, accumulate over time and are identified as diseases and disorders. Diagnoses of health problems contribute to illness and therefore are themselves stressors. Stress impacts physiological changes through the actions of the SNS and the fight-or-flight response, resulting in release of cortisol and catecholamines. Immune responses, including inflammation and the potential for autoimmune implications, are also promoted by the renin-angiotensin-aldosterone system. Examples of diagnoses attributed to one or both of these stress pathways include HTN, HF, COPD, and DM.

Psychiatric disorders can also be affected by stress responses, and these may include depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD). These examples all decrease the ability to manage stressful circumstances, and measures used for coping may also be maladaptive, leading to worsening the situation rather than improving it. Additionally, PTSD symptoms may trigger the stress response and worsen anxiety; bipolar disorder, if not managed, results in volatile moods. Such ineffective adaptations easily swirl into the cycle of increasing stress and subsequent anxiety, with potential for crisis situations.

Support System

A supportive environment and being surrounded by a community of support should not be underestimated in regard to positive coping strategies and dealing with stressors. Children are less likely to be adversely affected by ACEs if they have support and help to counter the results of negative experiences. While an entirely optimistic environment of course offers the most protection from ACEs, at least if there are some ways for the effects to be minimized and alternatives offered, outcomes can be improved.

Beyond the early developmental years, support systems remain very important positive means of coping with stressful situations and avoiding long-term negative effects. Talking to a friend or family member may also help provide support, calm anxious emotions, and avert crises. Assistance may also come from nursing and counseling or therapy sessions, offering simple support or professional guidance to recognize and manage stressors.

It is sometimes helpful to have another perspective, especially if overwhelmed by a particularly stressful circumstance. Someone from outside the experience may be able to identify a less gloomy perspective and find something positive or funny in it; humor can be a good stress reliever (Wilson, 2023). Informal group support may come in the form of friends, or people may seek formal support groups based on a common interest or need, like Alcoholics Anonymous or a group of patients recovering from cancer. Such alliances of people can help a stressed individual feel validated and emotionally strengthened. Religious or spiritual communities provide support, encouragement, and purpose for many, with customs and prayers proving to assist with positive adaptive skills.

Socioeconomic Status

Socioeconomic status (SES) is societal standing based on factors such as occupation, education, and income. Other contributors to SES include availability of health care (ability to pay, e.g., insurance, group contributions, and access to providers), safe environments, and access to healthful activities and choices (e.g., nutritious foods, exercise, leisure activities). Subjective concepts, such as how a particular role is perceived (social class and/or status based on a position), are also part of SES. Sometimes, opportunities are based on perceptions of qualifications and abilities of those in a particular SES (American Psychological Association, 2024). Such opportunities can include the type of job a person is qualified for, the availability of employment, education and training, and pay.

The SES can be attributed to various psychopathologies (American Psychological Association, 2024). Previous topics within this chapter have alluded to factors that can be correlated to SES and their relationship to stress and adaptation. Examples have included stressors beginning with prenatal development, through early childhood (ACEs), and throughout the milestones and challenges of a life span. The SES, health and wellness, and the relationship to stress and adaptation may be best described as social determinants of health (SDOH), which group concepts mentioned earlier under the following categories/determinants (Healthy People 2030, n.d.):

• economic stability
• neighborhood and built environment
• education access and quality
• health care access and quality
• social and community context

Stressors can be found within all domains of the SDOH, including diagnoses impacting mental or physical health, adaptations and subsequent behaviors, financial worries, access to and preparation of nutritious food, transportation needs and access, and availability of affordable healthcare providers. Interactions between nurses and patients, including a thorough interview to identify applicable SDOH and any other influences from SES, can help identify stressors affecting individuals. Such assessment and care planning can assist with stress reduction, as well as establishing and fostering positive coping methods for people within their socioeconomic means.