235. CCA Study Notes: Stress, Stress Responses, Management, and Burnout

The Big Picture

Stress is a normal part of life. It is an emotional, behavioural, or physical response to an event or situation.

Stress is not always negative. Some stress produces positive feelings and a sense of fulfillment. Stress also differs in length, from short periods to ongoing stress.

People do not all react to stress in the same way. For CCA work, an important skill is noticing changes in a client, describing what you observe, and reporting those changes without trying to diagnose the cause.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Understanding Stress and Stressors

Stress is the emotional, behavioural, or physical response to an event or situation.

A stressor is an event or situation that causes stress.

Stress affects the whole person. Its effects are positive or negative across five dimensions:

• physical
• emotional
• social
• intellectual, also called cognitive
• spiritual

Stress also differs by type.

Term	Meaning
Eustress	Healthy stress associated with fulfillment ⓘ or other positive feelings
Acute stress	Stress that lasts for a short time
Chronic stress	Ongoing stress that sometimes leads to burnout
Burnout	Physical, emotional, and mental exhaustion associated with discouragement, negativity, and powerlessness

For some people with underlying mental health issues, severe or prolonged stress may trigger the onset of mental health symptoms, especially when the client has changes in eating or sleeping, increases drug or alcohol use, or feels impulses to engage in reckless behaviour.

How the Length and Frequency of a Stressor Matter

The effect of a stressor is related to how often it occurs and how long it lasts.

Stressors lasting a few minutes or hours, such as daily irritations, usually produce mild stress. Stressors lasting months or years, such as persistent illness, disability, or family relationship problems, sometimes produce severe stress.

Changes as Stressors

Positive and negative changes are sources of stress. People differ in how they respond to change.

Common life changes linked with stress include:

• death of a loved one
• divorce
• loss of a job
• increased financial obligations
• marriage
• moving to a new home
• chronic illness or injury
• emotional problems such as depression, anxiety, anger, grief, guilt, or low self-esteem
• caring for a sick or aging family member
• traumatic events such as natural disasters, theft, rape, or violence against the person or a loved one

Age alone does not determine how well someone handles change. Many older people adapt well after major changes and losses, while some younger adults experience strong negative reactions to change and personal loss.

Emotional Pressure

Emotional pressure means feeling pushed beyond your limits or abilities.

Sources of emotional pressure include:

• feeling rushed
• facing too many demands
• feeling unable to meet another person’s expectations
• setting personal goals that are too difficult or impossible to reach

One example is a person who becomes frustrated and stressed after failing to lose 15 pounds in 1 month because the goal was too difficult to achieve.

Lack of Control

Some people feel stress when they believe they have little control over what happens to them or their surroundings.

Examples include:

• loss of work
• economic hardship
• violence
• illness
• discrimination
• death of a loved one
• difficulty controlling one’s own behaviour

Difficulty controlling one’s own behaviour can also be a stressor. For example, a person who tries and fails to quit smoking may become angry about the lack of self-control, feel stressed, and respond by smoking.

Conflict

Conflict is a clash between opposing interests and ideas.

Conflict with a partner, friend, child, co-worker, or client is a serious source of stress. Conflict also happens within a person while making decisions or working through problems.

School Stress

Students often face stress from:

• assignments
• tests and exams
• clinical placements
• family responsibilities
• employment
• other responsibilities outside school

Family members sometimes struggle to understand why a student no longer handles everything the person handled before returning to school.

Daily Frustrations

Small frustrations also create stress. Examples include losing keys, traffic delays, and oversleeping.

Support workers face workplace frustrations too. Examples include insufficient staffing for required care or being assigned to an unfamiliar floor to cover for another worker.

People react differently to these situations. An unexpected event causes significant stress for some people and little stress for others.

What Influences a Person’s Stress Response

People respond differently to the same stressor.

Factors that influence stress responses include:

• gender
• age
• culture
• feelings of personal control and competence
• available social support
• cognitive awareness
• health
• temperament or personality
• past experience with the same or similar stressors
• the number of other stressors happening at the same time
• the nature, severity, and duration of the stressor

Physical responses are the same for most people, while emotional and behavioural responses vary among individuals.

Physical Signs and Symptoms of Acute Stress

Acute stress is short in duration. Physical signs and symptoms include:

• rapid pulse
• rapid respirations
• increased blood pressure
• rapid speech or a higher-pitched voice
• a lump-like feeling in the throat
• a feeling of butterflies in the stomach
• dry mouth
• sweaty palms
• sore muscles in the neck, arms, and back
• perspiration
• nausea
• diarrhea
• urinary frequency
• urinary urgency
• difficulty sleeping
• changes in appetite
• changes in weight

Physical Signs and Symptoms of Chronic Stress

Chronic stress is ongoing.

Signs and symptoms include:

• chronic headache
• mood swings
• anxiety, a vague and uneasy feeling that often includes a sense of approaching danger or harm
• substance abuse
• memory disturbances
• weakened immune system function, sometimes followed by frequent colds and flu
• cardiovascular diseases ranging from heart attacks to strokes, along with increased blood pressure
• bowel disorders
• decreased sexual drive
• sleeplessness

Emotional and Behavioural Signs of Stress

Stress also appears through emotions and behaviour.

Signs include:

• anxiety
• depression
• anger
• worry
• fear
• burnout
• irritability
• loss of self-esteem ⓘ
• fatigue
• dissatisfaction
• forgetfulness
• poor concentration
• difficulty focusing or following directions
• emotional outbursts, including yelling or crying
• smoking
• drinking
• talking about the stressor

Some coping behaviours relieve stress. Crying and talking are examples.

Other coping behaviours are unhealthy. Smoking and drinking sometimes increase stress instead of reducing it.

Stress in Older Persons

Older people face stressors such as:

• loss of a spouse, family members, friends, or grandchildren
• health problems
• economic worries linked with limited, fixed income
• increased dependence on another person for personal care, finances, or housekeeping
• loneliness and isolation
• declining abilities associated with normal aging

Older people cope with stress as well as other adults. Many older people use spirituality to cope with illness or severe stress.

Stress in Infants and Children

Infants and children also react to stressors. Their stress signs sometimes resemble those seen in adults.

Examples include:

• stomach aches
• irritability
• appetite changes
• sleep changes

Children sometimes struggle to explain their feelings in words. Their actions often show how they feel.

A behaviour that is unusual for the child may signal stress. Examples include a normally content baby crying for an hour after overstimulation, a fully toilet-trained 4-year-old suddenly wetting the bed after the child’s mother becomes seriously ill, or a usually calm adolescent beginning physical fights with peers after the parents’ divorce.

Defence Mechanisms During Stress

Defence mechanisms help a person delay or avoid uncomfortable feelings such as anxiety, guilt, stress, or embarrassment. They reduce stress by helping the person avoid facing a troubling reality.

For example, a person who feels disappointed with a family member might focus anger on something else rather than face the disappointment directly.

Recognizing defence mechanisms helps a support worker understand feelings that might sit behind a client’s behaviour.

Validate means to acknowledge, recognize, or confirm the client’s feelings. A support worker helps by showing empathy ⓘ, trying to validate the client’s feelings, and providing compassionate care.

The CCA Role When a Client Shows Stress

A support worker must recognize common stress responses in clients.

Report: Tell your supervisor when you notice signs such as:

• loss of appetite
• loss of sleep
• changes in behaviour
• changes in mood
• increased use of alcohol or other substances

Role limit: Your role is to observe and report. Diagnosing the client with stress or using defence mechanism or diagnostic labels is outside the support worker’s scope of practice.

Describe the behaviour you observe when reporting it.

Do not assume that headache and nausea mean a client is experiencing stress. Those complaints also occur with physical conditions. Note what you observe and report it.

Professionals such as nurses and social workers can help clients cope with stress.

Stress in Support Work

Support work places physical, cognitive, and emotional demands on workers.

Physical stress comes from work such as lifting, moving, and carrying.

Cognitive stress develops when a worker tries to manage many demands at the same time.

For example, cognitive stress can occur when one client asks for the bedpan every time you walk by the room while another needs to be turned and repositioned every 15 minutes.

Emotional stress comes from working with clients who are sick, lonely, frail, or dying. Angry or distressed clients and family members also create emotionally stressful situations.

Do not ignore your own signs of stress. Allowing stress to build sometimes results in burnout or illness.

Poor stress management also creates a serious care risk. A worker must not direct frustration toward clients or people in their personal life in ways that lead to abuse or neglect.

Develop Self-Awareness

Learn what causes your stress.

Think about:

• when you feel stressed
• what caused the stress
• how often the stressor occurs

After identifying your stressors, decide how to eliminate them, avoid them, or cope with them. Avoid people who cause you stress.

Take Care of Your Needs

A healthy mind and body support better stress management.

Important habits include:

• getting enough sleep
• exercising regularly
• eating a nutritious diet
• caring for social, cognitive, and spiritual needs
• balancing family, work, relaxation, and recreation
• making time for fun and relaxation

Sleep matters. Mild irritations sometimes feel like serious problems when you lack enough sleep.

It also helps to look at how you spend your time. Notice which parts of life receive too much attention and which parts receive too little.

Keep Stress in Perspective

A positive attitude can help you manage stress.

Focus on what you do well and what remains within your control. Remember that people perceive stress differently.

Try to keep a minor stressor from becoming a major one in your thinking. Look at whether the situation will still matter in a month or a year. If it will not, direct your time and energy elsewhere.

A sense of humour also helps reduce tension. Looking for a positive outcome from a stressor helps change your perspective.

Be Assertive

A nonassertive person often agrees to things despite wanting to say no. The person takes on tasks without enough time and gives in to other people’s demands without considering personal needs.

Safety: Never agree to do more than you are able to do safely.

Ask for Help and Support

Accept that you do not have to do everything yourself.

At work, tell your supervisor when you need help with an assignment.

At home, tell family members or others in your household what help you need. Share household responsibilities, explain what needs to be done, and avoid criticizing people when their work differs from your standard.

Calming Yourself When Stress Starts

Use calming exercises when you first notice stress.

For slow breathing:

1. Close your eyes if doing so is safe.
2. Take deep, slow breaths.
3. Relax your stomach muscles.
4. Breathe in through your nose and out through your mouth.
5. Let your stomach rise about 3 cm, or 1 inch, while breathing in.
6. Count slowly up to 4 while inhaling.
7. Count slowly back down to 1 while exhaling.
8. Pause between breaths.
9. Continue the slow, rhythmic breathing until you feel yourself relaxing.

If your muscles become tense, relax them. Stress often involves clenching the jaw or tightening the neck and back. Relax the muscles from your face down to your feet.

If possible, take a few minutes away from the stressful situation.

Safety: Never leave a client unless it is safe to do so.

Meditation

Some people use daily meditation to cope with stress.

The following meditation routine is intended for use at home:

1. Sit comfortably in a quiet place and turn off the phone.
2. Choose a word to repeat. A single-syllable word such as “one” works well.
3. Relax each muscle group, starting at the head and moving down toward the feet.
4. Breathe in slowly through the nose and breathe out slowly through the mouth.
5. Silently repeat the chosen word while breathing in and out.
6. Focus on the rhythmic word repetition and breathing for 10 minutes.
7. Let thoughts and images flow freely.

Healthy Lifestyle Habits

Stress management also includes:

• healthy eating habits
• enough sleep
• avoiding smoking
• minimizing alcohol intake
• avoiding drug abuse
• regular exercise
• reducing caffeine and sugar intake

Accept What You Do Not Control

You do not control other people’s behaviour. You choose how you respond to that behaviour.

Workplace changes also create stress. Examples include budget cuts, changing technology, and staffing issues.

If workplace change is causing stress, identify the problem and discuss your feelings with your supervisor or a counsellor. Ask about ways to adapt to the change.

Laughter and Stress

Laughter has psychological and physical effects linked with stress relief.

Benefits listed with laughter include:

• relaxation and restful sleep
• improved mood
• reduced stress
• improved resiliency ⓘ
• improved brain function
• helping counter depression

Social Media and Mood

Social media can cause anxiety and depression when people compare how their lives measure up to their friends’ social media pages.

Social media posts often show people having fun, dressed well, and surrounded by friends. A person comparing a complicated life with those posts might feel less glamorous, less popular, lonelier, or more isolated.

When social media affects mood in this way, limiting access is one stress-management option.

Job Burnout

Burnout is common among health care workers because helping professions place physical, emotional, and mental demands on workers.

Severe or prolonged stress sometimes leads to burnout. Burnout is a state of physical, emotional, and mental exhaustion caused by long-term exposure to demanding work situations.

Burnout is associated with feelings of discouragement, negativity, and powerlessness.

Health effects linked with burnout include:

• insomnia
• weight gain or weight loss
• depression
• anxiety
• other emotional difficulties

Signs of burnout include:

• increasing criticism of others
• sarcasm at work
• changed sleep habits
• changed appetite
• fatigue, including trouble getting the day started
• less patience with clients and co-workers
• self-medicating with food, drugs, or alcohol to feel better

Do not ignore signs of burnout. Talk with your supervisor, doctor, or employee assistance program counsellor.

Recovery takes time for some people. Keep an open mind and consider the available options.

Common Mix-Ups

Wrong Idea	Better Idea
Stress and stressor mean the same thing.	Stress is the response. A stressor is the event or situation causing it.
All stress is negative.	Stress has positive and negative forms. Eustress is healthy stress.
Acute stress and chronic stress describe the same length of time.	Acute stress is short. Chronic stress is ongoing.
A CCA should label a client’s defence mechanism when reporting.	The CCA describes the observed behaviour and reports it.
Headache and nausea prove that a client is stressed.	Do not assume the cause. Observe and report the complaints.
Burnout means ordinary short-term stress.	Burnout involves physical, emotional, and mental exhaustion linked with long-term demanding work situations.