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Chapter VII


Guillermo Varela Arjona, Jose Mª Salinero Aroca, Cándida Sevilla Solano, Francisco Javier Lemus Gallego and Cristina de las Heras Gómez.


The present module intends to present a wide panorama of stress, its sources, its consequences and the different ways to do well.

Stress is a current problem that we must know and try to avoid, since it is one of the worse feelings we can experience in our lives.

In the labour world, responsibility, decision-making, the dissatisfaction derived from the conditions or work organization, the “psychic charge” in short, can be stress sources. We must learn to identify its signs and learn how to avoid them for the development of our professional life.


  • To know the history of this phenomenon of the human beings nowadays.
  • To recognize which are the main sources of stress
  • To recognize which situations can be stressful, and the most stressful things.
  • To know the effects that stress provokes.
  • To learn how to avoid it and to confront stressful situations.
  • To learn how to relax in stressful situations
  • To recognize our erroneous thoughts and to change them.
  • To manage social abilities to know how to transmit their state of mind.


One of the current situations is stress. In the developed countries, more than half of the population suffers from stress. We belong to this region.

The origins of this notion are old; Hippocrates underlined the existence of a “vis medicatix naturae”, a healing power of the nature, that is to say to launch physiologic mechanisms, to defend oneself from external aggressions. But it is not until the XIXth century, that the first investigations on stress began (Bernard, Haldane and Hans Selye). The latter defined the characteristic symptoms and denominated it “General Syndrome of Adaptation”.

The term “stress” has its origin in physics, where it refers to a force or weight that produces different degrees of tension or deformation in different materials. When Selye in 1926 introduced the term stress in health sciences and gave it a new meaning. In this case, the term stress does not refer to the stimulus (weigh or charge), but to the answer of the organism. Selye uses the term stress to describe the addition of unspecified changes of the organism as a response to a stimulus or situation. It seems that this change of defining stress like an answer instead of a stimulus (weigh or charge) was due to their bad knowledge of English.

However, what is stress?

It is the answer of our organism to a state of excessive and permanent tension that goes beyond the own forces. Indeed, stressed people are located in some life conditions that lead them continually to exhaustion, an accumulation of constant superman effort, a strong motional or/and intellectual tension, with a lack of time.

Mc Grath (1970) defines stress: “Stress is a substantial imbalance (perceived) between the demand and the answer capacity (of the individual) under conditions in which failure facing this demand has great consequences (perceived).”

Other authors1 base their definition of stress on interaction. In their works, they reach the conclusion that psychological stress is the consequence of the imbalance there is between the demands of the environment and the resources that the individual has to satisfy them.

According to Lazarus and Folkman, it is necessary to take into account two keys questions: the evaluation of the situations and the confrontation of the individual to them. The evaluation is the process by which the individual values the situations depending on his abilities and his experiences about the event. The confrontation includes the cognitive and behavioural efforts, which has to carry out a person to face the external and internal events in a continuous way.

Stress is the answer that includes cognitive and physiologic aspects with a high degree of activation of the Autonomous Nervous System and motive aspects that usually imply unfitted and scarcely adaptive behaviours.

  1. Answers of the cognitive system: thoughts and feelings of concern, fear, insecurity, etc, that is to say, some recurrent thoughts that lead the individual to a state of alert, anxiety, tension, lack of concentration. They think that other people can feel their problems.
  2. Answers of the physiologic system: throbs, abnormally rapid heartbeat, mouth dryness, difficulty to swallow, chills, shivers, sweating, muscular tension, anxious breathing and breathlessness, stomach discomfort, sickness... We present in Appendix I a type of relaxation by Jacobson.
  3. Answers of the motive system: difficulty to speak, blocks or stammer, clumsy movements, answers to escape or avoid some subjects, they smoke, eat and drink more, cry, repetitive movements of feet and/or hands and strange behaviours that other people can perceive.

Each person has a stress response when facing a threatening situation. The three previous answer systems are not always present. Two of them can be more intensive and the other weaker. Alternatively, there can be one of high intensity or the three of an average, moderate or high intensity. We have a characteristic profile of anxiety and if we know our answers, we can begin to reduce stress with the strategies that we will study later on.

Anyway, we should say one thing; the answer to stress is not something bad in itself, but on the contrary, it helps having more resources to face situations that are supposed to be exceptional. However, since many extraordinary resources are activated, it represents an important weakening for our organism. If it is an isolated issue, there will be no problem, because the organism has the capacity for recovering. Nevertheless, if these stress answers are too frequent, intensive or long, the organism may not recover. Some problems may appear, known as disorders associated with stress.


Work stress is one of the most investigated issues since it can affect the activity and efficiency at work of any professional, and personal life.
Work stress is the result of the worker's perception: he or she thinks that the demands of its professional activity overcome his or her own capacities. It can be due to objective and subjective factors.

The International Labour Organization (ILO) refers to work stress as: “Dangerous illness of the developed and developing economies. It damages production because it affects the physical and mental health of the workers.

The ILO maintains that the companies that help their employees face stress and reorganize carefully the labour atmosphere in all its environments have more possibilities to achieve competitive advantages.

The expenses and losses derived from the cost of stress increase year after year: Absenteeism, low productivity, accidents at work, low motivation and what is more important, the incidence on mental and physic health, are some examples of its consequences.


The Burnout Syndrome or syndrome of “being burnt” is an alteration that appears in the workers because of their relationship with the labour market. Freudenberger first described it in 1974, although Malach and Jackson in 1986 define the concept more clearly. It is fundamentally present in professions where there is a direct attention to people or assistance.

The Burnout Syndrome has the following characteristics:

  1. Emotional exhaustion: a professional weakening that leads the worker to a psychic and physiologic exhaustion. There is a loss of energy, physical and psychical tiredness. It takes place when we have to carry out some labour functions daily and permanently with people that we have to assist as objects of our work.
  2. Depersonalisation: It takes place in negative attitudes in relation to users/clients. People are more irritable, and less motivated. This can lead to dehumanisation.
  3. Lack of personal fulfilment: Weakening of personal self-esteem, frustration of expectations and physiologic, cognitive and behavioural stress manifestations.

As we have said previously, the Burnout syndrome is a sort of specific stress that arises from the person's relationship with work. Its consequences are very similar to stress manifestations in the three answers levels. It appears in a progressive way because of the effort of inadequate adaptation from the worker to the reality that overcomes him. The quantity of work, its difficulty and the seriousness of the problems he must overcome show the evolution.


Before beginning with this point, let us try to write down all the situations that provoke stress.


Stress is impossible to avoid, people even increase frequently their own stress unnecessarily. The difference between the exigencies people have with themselves or perceive from other people, as well as the available resources to satisfy those requirements, can constitute a threat or a stress source.

Many stress sources can be classified into the following list:

  • Intense and extraordinary events: Changes in situations like matrimonial separation, work dismissals, death of relatives, etc.
  • Daily stressful events of small intensity: According to some authors, this sort of events can cause more important psychological and biological effects than more drastic events like the death of a relative can generate.
  • Events of maintained chronic tension: Those situations that generate maintained stress during short or long periods. The stress that implies having a son that has problems every day because of an illness, drug addiction, etc. These stressful situations are intensive, similar to vital events; they recur and last in time. This combination of high intensity and duration makes the effects of these events the most important.


  1. Stressful elements of the physical atmosphere, for example:
    • Illumination: It is not the same thing to work on the night shift than on the day shift.
    • Noise: When you continually work with alarms; it can affect ears, but also work: satisfaction, productivity, etc.
    • Polluted environments: The perception of risks can produce more anxiety in the professional, having repercussions on efficiency and on the psychological welfare.
    • Temperature: To work sometimes in a hot atmosphere generates a big discomfort.
    • Weight: For the professionals who must work in warehouses loading and unloading merchandise, tiredness can be double.
  2. Stressful elements of the task: Stress generation varies from one person to another, since the characteristics of each task and of what it generates in the professionals depend on what they like or do not like to do. When the task is adapted to the expectations and the professional's capacity, it contributes to the psychological welfare and it is an important motivation. Among these stressful elements, we can find:
    • The mental charge of work: The degree of energy and mental capacity that the professional sets in motion to carry out the task.
    • The control on task: When the task is not controlled, that is to say, when the activities we have to carry out overcome our knowledge.
  3. Stressful elements of organization: The most important stressful elements that appear in organization are the following:
    • Conflict and ambiguity of the Role: There are differences between what the professional expects and the reality of what demands the organization. There can be conflicts like for example: to receive contradictory orders from a manager or when desires and goals have nothing to do with what we are really doing. When you are not sure of what you have to do, work objectives and the inherent responsibility it has can stress us a lot.
    • The excessive working day: It produces physical and mental weakening and avoids the professional to face stressful situations. For example, a night shift can be longer than a day or afternoon shift; therefore, at the end of the day, the professional will be more tired and his or her physical and mental capacity can diminish.
    • The interpersonal relationships: They can become a source of stress. Think about an emotionally unbalanced professional that makes his or her colleagues’ life a misery. It is a continuous source of stress. On the contrary, when there is a good interpersonal communication and social support and help from the company, there are not so many negative effects on our health.
    • Promotion and professional development: If the professional aspirations do not correspond with reality for a lack of valuation, it can generate a deep frustration producing stress.

The influence also comes from breaks, interpersonal relationships, observations / criticism from the colleagues, communication difficulties and limited promotion possibilities. These factors can also generate work stress.

We present two ways of classifications of the possible stress situations that everybody has at work or as an analysis of stress prevention facing the organization situation and labour plan.

Stress scale: The objective is to identify the students’ stress, so that they begin to identify the possible stress sources.

Complete chart nº 1.

Sources of the students' stress:

Sources of work stress With what weekly frequency it takes place (5-4-3-2-1) What do I think when I am in stressful situation? What do I feel? What am I used to do?








Complete chart nº 2.

Choose a stress source that you enumerated in chart nº 1. Write, at least, two scripts for each stage of confrontation with the stress sources. The scripts should limit the perturbing emotions; provoke positive emotions that may place you in a good position to control this stressful situation.

Before the situation.  
During the stressful situation.  
After the stressful situation.  
If the results are positive.
If the results are negative.


Stress accumulation usually provokes different reactions. The quantity of stress people need before they show it varies depending on different factors related with the personality (insecurity, perfectionism), heritage, habits and defence mechanisms. Next, we expose the signs and symptoms associated to professional stress:


  • Chronicle tiredness
  • Dream agitation (insomnia, nightmares…)
  • Gastric ulcer and other gastrointestinal upsets (nauseas, vomits, diarrhoea, colitis)
  • Alimentary disorders
  • Loss of weight
  • Abnormally rapid heartbeat, throbs, hypertension
  • Frequent migraines
  • Allergy problems and dermatitis
  • Muscular aches (back, neck, shoulders)
  • Menstrual disorders


  • Inability to concentrate, problems for memorizing, forgetfulness and disorganization
  • Irritability, mistrust, criticism of other people
  • Affective distance, reserve
  • Low self-esteem, disappointment feelings, delusion and desires to give up the work
  • Depression and suicide ideas
  • Self-criticism, fault feelings and self-sacrifice: Work more to update.


  • Labour absenteeism: periods of sick leaves.
  • Increasing of violent behaviours as anger, aggressiveness and disproportionate answers to the external stimuli
  • Excessive use of substances like coffee, tobacco, alcohol, tranquillizers and sedatives
  • Personal abandon
  • Passivity facing the demands of other people
  • Impossibility to relax
  • Walks without direction


  • Negation of feelings
  • Effort to contain the feelings
  • Irony, rationalization
  • Selective attention regarding the patients
  • Changes in feelings

5.1. Stress effects:

Work stress will also have repercussions on personal life and on the efficiency and quality at work. When the worker comes back home after his or her working day, he or she carries all the accumulated tension and this has consequences on his or her family. That person will continually complain about his or her work, he/she will direct his or her dissatisfaction, laments and aggressiveness towards the partner, and it may lead to a crisis and rupture of the marriage.

The individual affected by professional stress is unable to develop his or her family role, he or she has fewer attention and dedication for his or her family. He says it is aimed at protecting them, although the only reason is that he or she does not want to relive his or her work problems. The effect of repressing his or her feelings will modify his or her personality in a negative way, for his or her own person and for the relationships with the others, suffering from the lack of communication at all levels.

In relation to work, the most evident result will be a lost of efficiency, smaller motivation, bigger frustration, dissatisfaction and disillusion, prevailing a dropout and non-participative attitude.


The prevention of stress is quite important and decisive. It is easier to face it in the initial phases than when it is already “established” in the person.

The others are very often those who observe the changes and attitudes in a stressed person. The people that surround us are those who can check the precocious diagnosis of stress, and therefore the professionals of the team should be aware of what they represent.

Once in our professional life stress can appear, and it is a risk for us, it is important to know it, to assume our limitations and to ask for help when we lose control.


Next, we detail some general advice when you are stressed.

  1. Stop and breath deeply
  2. Admit we are exceeded. It is important to recognise our feelings to face them.
  3. Keep a sense of perspective. If we have already experienced this situation previously and we have succeeded in overcoming it, we can also do it this time
  4. Make a mental list of the tasks you have to carry out and classify them, from the most important to the least, taking into account the most urgent.
  5. Complete only one task at the same time, and try to think only on this thing because if you don’t, the rest only steals time and energy that you need for the very task you are carrying out. If you get another task, classify them into your list. A professionalism sign is flexibility.
  6. Plan to save time. Take some cautions as a routine. We should check our resources to use them with efficiency.
  7. Ask for help to your colleagues or boss. It is necessary to admit that many times we cannot make everything alone. We have to learn how to ask for help.


8.1. Cognitive techniques

The cognitive techniques to reduce stress are more effective in individuals whose answer profile is predominantly cognitive. This type of techniques aims at modifying erroneous or negative evaluations with regard to the demands or of the individual’s own resources to confront them and facilitate the restructuring of the cognitive schemes.

Some distorted habits or thoughts are quite common and we can identify them to be able to modify them. We present the most representative elements to identify and face them:

  • Arbitrary inference: to establish conclusions or to be convinced of sources that have motivated the behaviour of other people, without having any data or information enough on that situation: “I have not achieved the position I requested, for sure somebody is trying to destroy me and they want to dismiss me”
  • Thought divination: to guess or invent the sources for the given behaviour of other people, without enough data, without any reason. “If I say something during the meeting, they will think I only speak nonsense and they will push me away...”
  • Generalisation: to reach conclusions about a person capacity or value, usually your own person, starting from vague and inexact data. Starting from certain behaviours or behavioural habits, we establish a global trial, for example: “I have not been able to answer to his criticism, I am useless.”
  • Magnification: to exaggerate the meaning of a negative event or of an error, and everything seems worse than it really is. “They will never forgive me since I could not be present the day of the company decision” “I arrived late they will not take me into account next time”
  • Minimisation: to give less importance to the meaning of a positive event, success or personal achievement than this it really has. “It is true that I solved the opening of this site, but I am not good at starting a business”
  • Imperatives: people own and even other people’s strict rules of behaviour. When somebody does not behave according to them, it can generate aggressiveness, for example: “it is necessary to be always on time...” “I have to do it well so that I make money”
  • Absolute thoughts: to think of everything or nothing, white or black, correct or incorrect.... this is this sort of dichotomic thought where there are no graduation possibilities, only absolute values. For example: “you have not been able to solve all the company documentation this week, it means that you do not know how to do it”.
  • Personalisation: You charge with responsibility of a negative event independently of the events that surround the event. For example: “if I don't get 20 clients in one week that because is I am not worthy”.
  • Emotional reasoning: You consider that the way we feel or the emotions we experience are the reality of what is happening. For example: “if I feel afraid to start a business, it must be dangerous “

These irrational thoughts or ideas can arise in 4 fundamental ways of distortion:

  1. Self-dialogue and terrifying self-affirmations: “it is terrible....” “it will be horrible....” “It can be catastrophic”
  2. Statements in terms of “it should be”, “it is necessary that...”
  3. Thoughts of “I cannot bear”, “I cannot stand”, “I cannot tolerate”
  4. Valuation of personal wealth taking as a reference other people, what leads to self-condemnation and self-disdain.

People with these types of thoughts may easily perceive reality in a distorted way and it is then difficult for them to reach any objective or personal goal, provoking a problem of adaptation to the environment.

To be able to modify the way they interpret reality or think about an event, we present the cognitive reorganization technique:

  1. Objective description of the event: Describe the event in the most possible objective way, emphasising on aspects like: how did it happen, who was there, for how long?
  2. “Today is the eve of a holiday in the supermarket where I am in charge and they have had to help me to solve a problem with a supplier because I was at the cash desk showing how to use the card”.

  3. Description of the emotional answers and behaviours that have arisen from the interpretation of that event:

    It is a description of how you felt and what behaviours have appeared during the event and after it.

    “I am angry”, “I feel rage and anger”, “I have not eaten anything since the event of the supermarket”

  4. Irrational ideas: “I have to work more quickly tomorrow”, “Today my bosses won't accept me, I have failed”, “I have to make everything well so that people I care for accept and consider me”
  5. Discussion of irrational ideas: This is the most important point in the process. The objective is to analyse each irrational idea, one by one to realise that they are distorted and erroneous ideas that avoid us achieving goals. We will follow the following steps:
    1. We choose an irrational idea
    2. “I have to make everything well so that people I care for accept and consider me”

    3. What reasons support this thought? Has this idea a real support?
    4. “No, there is nothing that can show me it is true”

    5. What proofs do we have?
    6. “Every day I work well, I assist all the suppliers and I carry out other tasks; moreover, there is no universal law that tells me that I must do everything well”

      “Why do I have to look at other people to valuate my acts?

    7. Possible effects of my thoughts

      In fact, I do not live better thinking, and it avoids me to solve other situations. So I only speak with myself, I interpret the reality erroneously.

      If I go on like this, I will have more breathlessness, will not eat and worsen my health.

    8. Substitution of these thoughts for other more rational or adaptive ones:

      Once you have detected and analysed these thoughts, you have to use some strategies to think rationally and adaptively.

      • Self-affirmations or self-instructions that generate automatic changes with these thoughts: “it is only a thought, it is stupid”, “there is no evidence that what I am thinking is true”, “I do it better and better...”, “I am getting more and more successes in my confrontation situations”
      • To focus on evaluating the situation more positively: “What steps have I made in this situation to be successful?” “What changes will help me carrying out things I could not do before?
      • Exaggeration of these thoughts: “it is true that I am useless at work, at home, crossing the street, cooking, as a friend, etc.”

To get success with this technique it is necessary to train; at the beginning, you should do it with a pencil and sheet of paper, until you do it well.

Practice 1

We are going to analyse the following irrational ideas, trying on the one hand to classify them and, on the other hand to modify them:

Irrational idea
Level of anxiety From 1 to 10
Alternative thought
“My friend doesn't want to meet me to have a coffee”        
“My boss believes I don't make any effort”        
“I am very slow, I should work quicker”        

How to confront with stress?

  • Establish realistic objectives
  • If you try to do more than it is humanly possible to do, this will send you beyond your limits and it will create unnecessary stress. We should leave our idealistic objectives behind and approach the real world having taken into account our capacity and limitations.
  • Maintain a realistic expectation of the relationships you have at work.
  • Nobody is perfect, nor you. There is always a risk of conflicts, it is necessary to accept the faults of other people and it is necessary to be kinder with oneself.
  • Practice of assertiveness, to learn how to say “no”

    This is one of the most difficult things, since everybody expects a lot from us and we try to satisfy their expectations. To say “no” politely and with a good reason does not mean we should feel guilty, and will not make the others move away from us neither.

  • To take regular rests

    Some minutes of relaxation with a cup of coffee can make us feel better and give us strength to face our work. Take one day free or some small vacations extra can be good for us. Everybody has a limit for the quantity of stress he can tolerate and we do not have to feel guilty.

  • Leave boredom and routine

    Look for new challenges and try to escape from the routine: it is always useful. Doing the things you usually do in a different way provides a bigger personal freedom and autonomy.

  • Continue your training

    In order to have your knowledge updated with the new advances in your profession, you can get it with off-the-job training, conferences and magazines; you will have more knowledge and will be able to apply them.

  • Take things with more distance

    It can really help us, especially when we get too involved in certain labour tasks. On the other hand, you should leave your work at work (“leave the uniform at work”).

  • Use a “relaxing routine”

    Participate in some activity after the working day, take a drink in a bar, practice some sport, go on foot to your house if possible, it will help you forget your work and relax, and there will be no tension with your family and friends.

  • Know yourself
  • Analyse your own reactions and meditate on them is important. The self-analysis should be constructive; Learning from our errors is not a self-condemnation but a step toward personal growth. It is essential to intensify our positive aspects, to think from time to time about the achievements and personal recompenses we obtain with our work because they can counterbalance with our frustrations and failures.
  • Learn how to relax and rest

    Many symptoms of stress are psychosomatic. It can be useful to learn how to relax physically and mentally. You have to relax but also identify and treat the symptoms to get rid of them.

    Many techniques as the abdominal breathing, the self-massage that can contribute to get rid of muscular tension, and the progressive relaxation can favour the dream and diminish the levels of anxiety.

Practice 2

Progressive relaxation by Jacobson

Now we will carry out a relaxation technique that will be we very useful in moments of excessive tension, anxiety, insomnia, depression, tiredness and whenever we want to relax. The progressive relaxation of Jacobson is based on the premise that the answers of the organism to anxiety. The deep muscular relaxation reduces physiologic tension and it is incompatible with anxiety: the habit of responding in a way annuls the habit of responding the other one.

The necessary time for its training is from one to two weeks, in sessions of 15 minutes everyday. The use of a tape recorder is recommended for its practice along with a soft and relaxing music.

Progressive relaxation involves first tensing your muscles and then letting the tension go. You might wonder why we first tense the muscles. Imagine a pendulum. In order for you to get the pendulum to swing furthest to one side, you have to pull it far along the other. Similarly, to relax your muscles, it can help to tense them first. As well, you become more aware of what each muscle feels like, where it is located in your body, and what to look for in the future when you are trying to determine whether muscles are relaxed or tense.

Read it over and give it a try. You can also read the instructions into a tape recorder and play it back to yourself as you relax. The key for success is practice. As you get better at progressive relaxation, you will consequently get better at relaxing.

  1. Find a comfortable position in a chair with good back support. You may also do this lying down.
  2. Loosen any restrictive clothing or jewelry that you are wearing.
  3. Close your eyes. Begin to focus on the feelings inside your body - mentally scan your entire body, from head to toe, and note any signs of tension that there may be.
  4. For each muscle group outlined below, first tense that area, hold the tension for 5 seconds, and all at once let go of the tension and say to yourself "relax." Notice the feelings of tension when you are tensing, and notice the feelings of warmth and relaxation as you let the muscle relax. Be sure to relax by letting the tension go all at once, releasing the muscle tension quickly.

    The first muscle groups to tense and relax are the hands and forearms. Starting with your right hand, make a fist and hold that fist for 5 seconds. Then, all at once, let go of your fist. Let your hand drop loosely into your lap or on to the support of your armchair.

    Notice the feelings of relaxation. Repeat this one more time - tense the hand, hold for 5 seconds...and relax. Proceed in this manner for each of the muscles groups outlined below:

    right hand and forearm
    right bicep
    left hand and forearm
    left bicep
    forehead (tense by making a frown, scrunching up the muscles above your eyebrows)
    cheeks and nose (tense by pretending you are smelling something awful)
    mouth (tense by pulling the corners of your mouth outwards)
    neck and shoulders (tense by shrugging)
    chest and stomach (pretend you are about to be hit in the stomach)
    right thigh
    right foot and calf
    right toes (press your toes down to the bottom of your shoes. Be careful not to make them too tense or else they may cramp)
    left thigh
    left foot and calf
    left toes

  5. Once you've relaxed your entire body, alternating tension and relaxation in each of the 15 muscle groups, allow yourself to enjoy the feelings of relaxation. Allow your mind to wander throughout your body, scanning for any tense areas. If you find one, repeat the exercise of tension and relaxation for that area. You may find that you cannot attain a relaxed state by doing this exercise the first few times. The more you practice the better and more proficient you will become.
  6. 6. Consider making a personalized tape of your own voice instructing yourself to relax each of the muscle groups as described above. This helps if you want to tailor progressive relaxation to your own needs. You may also buy a relaxation tape from your local bookstore. Sometimes it is helpful to listen to soft background music.

After two to four weeks of practicing Progressive Relaxation, you will be so proficient at relaxing your muscles that you can cause them to relax without first tensing them.

This technique is called Smooth Muscle Relaxation.

  1. Focus your attention upon one particular muscle area in your body.
  2. Say to yourself "relax" and allow that muscle group to relax and smooth out. Let the muscles in that area go.
  3. Continue with each of the muscle groups as above, or focus only on those that are tense in your body at that time.

This is a useful technique because it allows you to focus on particularly tense muscle areas and relax them without needing to first make them tense. The technique is only helpful if you have first become an expert at recognizing each of your muscle groups, recognize the difference between tension and relaxation in those muscle groups, and are able to allow the muscles to relax by focusing your efforts upon them. All of this is only achieved through thorough and effortful practice of Progressive Relaxation.

Practice 3

Stress Inoculation

Once we have learned how to relax and rationalize our thoughts, we will use a more specific technique to confront stress that shows us how to confront and to relax with many stressful experiences.

The stress inoculation includes to learn how to relax using deep breathing and progressive relaxation, so that every time you feel stressed you can get rid of the tension.

Basic procedure:

  1. Elaborate a personal list of stressful situations and classify them vertically from the less stressful elements to the most stressful ones. Then learn how to evoke each of these situations in your imagination and how to relax the tension while visualizing the stressful situation clearly. For this first part, you can use the stressful situations of the registration nº 1.
  2. Create your own arsenal of thoughts to face stress, which you will use to counterbalance with the old usual automatic thoughts. For this step, use the discursion of irrational ideas we saw in the point on cognitive techniques.
  3. Use your abilities to relax and confront stress “in vivo” to stress the stressful facts and breathe deeply, loosening your muscles and using thoughts to face your stress.


In situations of exhaustion, the family is the system of natural support, the primary group, but usually the help of the colleagues is even more useful, since they have similar experiences.

Our colleagues can help us diminish our emotional tension and guide us to face the situation with a more effective perspective.


  • Establish a support relationship: emotional (“sharing your sadness”), physical (“helping each other to carry out the stressful tasks”), and help the other to get out a difficult situation.
  • Be on the same level: listen to the others actively and ask them questions. This can help them express their feelings and concerns and see the situation in another way.
  • Accept what the people have to say without trying them, let them express their frustrations and feelings, so that they see the optimistic attitude come out by itself.
  • Encourage them and recognize their work, since it is a good habit we should encourage because it helps to create an atmosphere of fellowship and solidarity.


The group of support are other options when a person is “stressed”. A specialist in Mental Health guides the discussions of the group that are usually related with work concerns directs most of them.

These groups are based on synergy (people in the same situation), and provide new feelings: how to be accepted, valued, understood, respected, as well as the feeling of belonging to a group. They also help to get a social identity and constitute a source of information, services and help material.


The work place also has an influence in the appearance of stress. The decoration, the architecture, piped music and silence can even contribute to a calm atmosphere that favours work.

With more people and more means, there would be less stress, although many times, it is impossible and it would be convenient to analyse the way to improve the available resources.


The manager of the work team plays an important role in the stress prevention. This can improve the employees' mental health encouraging understanding, self-control and consequently their capacity to work in an effective way. This support relationship fulfil several functions aimed at the stress prevention, since it provides an opportunity to give advice, offers trust, improves communication, eases emotional tensions and clarifies your thoughts and it make orientation easier.

The manager/entrepreneur should make the staff aware about the risks of professional stress, indicating problematic factors as for example, situations of excessive emotional tension, and giving them advice about its signs. These can be the behaviours or the changes in behaviour related to stress. The valuation of the staff satisfaction is very important to identify their problems and to be able to solve them, since it will improve the quality of work and of cares.


  • Work stress can affect the activity and the worker's efficiency. It can have serious consequences, personally and professionally as well.
  • We, people, have some limits and we should accept them, nobody is perfect. When we cannot physically or emotionally tolerate what is happening, we should ask for help.
  • Fellowship and solidarity are very important. Our colleagues can help us and guide us to face the situation from another point of view.
  • The institutions and people in charge of the work teams should encourage stress prevention among the staff.



In the following chart, you will be able to consult significant changes in your life and see the stress value.. ANYTHING YOU HAVE EXPERIENCED IN YOUR LIFE FOR THE LAST 12 MONTHS SCORES. Then add it to the total.

Scale of stress for adults

Stress Value
1. Death of the couple 100
2. Divorce 60
3. Menopause 60
4. Separation of the couple 60
5. Imprisonment 60
6. Death of a close relative 60
7. Illness or inability 45
8. Marriage 45
9. Dismissal 45
10. Reconciliation of the couple 40
11. Retirement 40
12. Change in the health of a close relative 40
13. To work more than 40 hours a week 35
14. Pregnancy 35
15. Sexual problems 35
16. New member of the family 35
17. Change at work 35
18. Change in the financial state 35
19. Death of a friend (not a member of the family) 30
20. Change in the discussions with the couple 30
21. Mortgages or bank loan 25
22. Problems with mortgage or bank loan 25
23. To sleep less than 8 hours 25
24. Change of responsibilities at work 25
25. Problems with the family in-law or children 25
26. I achieve excellent personnel 25
27. The couple begins or she stops to work 20
28. To begin or to finish the school 20
29. Changes under the conditions of life (remodeling, visits etc...) 20
30. I change in personal habits 20
31. Chronic allergy 20
32. Problems with the boss 20
33. I change under the schedule or conditions de trabjo 15
34. Change of residence 15
35. Pre-menstrual syndrome 15
36. Change of school 15
37. Change of religious activity 15
38. I change in social activities 15
39. Smaller loan 10
40. I change in the frequency of family meetings 10
41. Vacations 10
42. Time of christmas vacations 10
43. Smaller infraction de the law 10

We have asked you you to observe the changes in the last 12 months of you life. This can surprise you. However, it is important to understand that the changes have effects along certain time. It is as throwing a stone in a lake. After the initial " chapuzón ", you will experience small stress waves at least one year after the incident.

Therefore, if you have experienced a level of stress of 250 or more in the last year, still with a normal tolerance you can be in a situation of on-stress. People with a low tolerance to the stress can be on-stresseds at levels of 150 or less.

The on-stress it sources illnesses. To load too much stress is as managing the car with alone the reservation of gasoline, to leave the fastened toaster, or to manage a nuclear reactor but there of the allowed level. Sooner or later something will stop to work, he/she will burn or it will explode.

What will break will depend on the person's weaker physical links. This is mainly a hereditary characteristic.

Scale of stress for young and / or adolescents

Stress Value
1. Death of the couple, father or boyfriend 100
2. Divorce (own or of the parents) 65
3. Puberty 65
4. I embarrass (or to source pregnancy) 65
5. Marital separation or termination of courtship 60
6. Prison 60
7. Death of some member family (that is not spouse, father or boyfriend) 60
8. Rupture of marital commitment 55
9. Commitment of marriage 50
10. Serious wound or personal illness 45
11. Marriage 45
12. To enter at university or following level (of secondary to preparatory etc.. 45
13. Change of independence or responsibility 45
14. Use of drugs or alcohol 45
15. To lose work or to be expelled of the school 45
16. Change in the use of drugs or alcohol 45
17.reconciliation with the couple, family or boyfriend 40
18. Problem at school 40
19. Serious problem of personal health or of some Member of the family 40
20. To work and to study at the same time 35
21. To work more than 40 hours a week 35
22. Change of career 35
23. Change in the frequency of social exits with Members of the contrary sex 35
24. Problems of sexual adjustments (confusion in the sexual identity ) 35
25. New member of the family (a new brother is born Or one parent marries again) 35
26. Change in the responsibilities at work 35
27. Change in the financial state 30
28. Death of a close friend (non member of the family)  30
29. Change the type of work 30
30. Change in the number of discussions with the Couple, parents or friends 30
31. To sleep less than 8 hours a day 25
32. Problems with the family-in-law 25
33. Achieve personal substitute (prizes etc..) 25
34. The couple or parents begins or stops working 20
35. Beginning or end of school 20
36. Changes of life conditions 20
37. Changes in personal habits (to begin or to leave one Diet, to smoke etc..) 20
38. Chronic allergies 20
39. Problems with the boss 20
40. Change of hours at work 15
41. Change of residence 15
42. Change to a new school (not for graduation) 10
43. Premenstrual period 15
44. Change of religious activity 15
45. Personal debt or of the family 10
46. Change in the frequency of family meetings 10
47. Holidays 10
48. Christmas holidays 10
49. Smaller violation de the law 5

We have asked you to observe the changes in the last 12 months of your life. This can surprise you. However, it is important to understand that the changes have effects in time. It is as throwing a stone in a lake. After the initial " dip ", you will experience small stress waves at least one year after the incident.

Therefore, if you have experienced a level of stress of 250 or more in the last year, still with a normal tolerance you can be in a situation of on-stress. People with a low tolerance to the stress can be on-stress at levels of 150 or less.

The on-stress causes illnesses. To load too much stress is as riding a car with only the last litres of petrol, or to manage a nuclear reactor. Sooner or later something will stop working, it will begin to burn and explode.

What will break will depend on the person's weaker physical links. This is mainly a hereditary characteristic.

(This scale has been adapted of The Scale of Social Readjustment of Thomas Holmes and Richard Rahe. This scale was published for the first time in the Journal of Psycomatic Investigations copyright 1967, vol II p.214. It has been used with the permission of Pergamon Press Ltd.)


[1] We quote Lazarus and Folkman (1984)

Work stress

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