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Is Nursing All About Stress?

Nurses Article   (9,730 Views 11 Replies 2,659 Words)
by Jerome Stone RN Jerome Stone RN (Member)

Jerome Stone RN has 33 years experience and specializes in Research, ICU, hospice, pain management.

5 Articles; 14,304 Visitors; 20 Posts

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In this three-part series we’ll look at the definition of stress and statistics on the causes of stress and its affects on us; how we usually deal with it and why we continue to be affected by stress; and how to change its affects us. Your feeback and comments are not only encouraged, but requested. I’d like to get an idea of what nurses need in terms of information, skills, and tools to deal with stress. Your input is important and vital! Thank you...

Is Nursing All About Stress?

PART ONE: IS NURSING ALL ABOUT STRESS?

As nurses, we know the meaning of stress. In fact, we may know its meaning more intimately than most of our peers who work in other professions. This is partially because we've seen the devastating effects that chronic stress has on the bodies of our patients. It's also because nursing is reported to be one of the most stressful professions. Why is it that when we enter into discussions on how to decrease stress in nursing, we usually point to changing things external to ourselves and that when we try to change how we deal with stress, we usually end up stressing out about that too?

I think that asking the question, "Is Nursing All About Stress?" is preposterous, don't you? Because, nursing isn't all about stress, right? It's about caring, compassion, kindness, clinical expertise, critical thinking and many more wonderful qualities embodied by thousands of nurses.

Why then does it seem that so many articles having to do with the nursing profession tend to segue into the challenging aspects of the profession, inevitably leading to a discussion about burnout and fatigue? In fact, these days there's so much written on the subject of burnout that you'd think that there's an epidemic happening in our profession. Is there?

The sources of this epidemic are varied but in general, the "all-inclusive" reason comes down to stress; stress due to workload, stress due to working nights, stress due to short staffing, the list goes on interminably. But, what's at the heart of this stress?

Many nurses will describe their work environment as "stressful." Does that mean that the environment is full of stress, or that the people who work there are all stressed? Let's look at definitions to make sure that we're talking about the same thing here.

DEFINITIONS

Many people use the word stress to describe both the external factors that are the cause of stress, as well as the physical experience of stress. Let's get on the same page here.

Definition of stress - (partially from Merriam Webster online, and partially my own definition) is a state resulting from a stressor; especially - one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium OR: a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances.

  • I think that the inclusion of the word equilibrium is very important. THAT is what we're working for with stress management, maintaining our equilibrium.
  • Let's remember the word "state;" it's key to learning how to decrease our experience of stress. If stress is just a state, then it's something that can be changed.
  • So, stress is the physiology that we experience when we're stressed, it's the "juice" that can get us going when something stresses us out. And it's what we're going to learn how to work with to decrease its impact on our lives.

Definition of stressor - (from Wikipedia) A stressor is a chemical or biological agent, environmental condition, external stimulus or an event that causes stress to an organism. AND: (My insertion here) In some cases, a stressor can also be an internal stimulus; an example of this would be chronic pain or illness.

  • So, stressors are the things in life, in our environment or internally, that cause us to experience stress.
  • I make the distinction because a lot of people will say things like, "There's so much stress at work..." when in fact, it's the stressors at work that are the triggers for us to experience stress.
  • I also make the distinction between stressor and stress because it's by learning what we can change, i.e., the stress that we experience in response to stressors, that we can manage it.

Stress management - (My definition) The ability to manage your body and mind, your internal environment, so that even while stressors may be present you're able to maintain internal and external integrity in a way that benefits not only yourself but those around you as well.

FEELINGS AND EMOTIONS

There are two more definitions that we need to include. Often times, these two terms are mixed up and confused with one another. *NOTE: I've even found differing definitions listed on the web, so for the purpose of this discussion, let's use the following ones.

The first term is emotions. Emotions are the physiology, the "juice," that we experience in our body and how our body interprets the input from the outer world, including how we interpret stressors. In many cases, our emotions determine how we experience stress.

Feelings, on the other hand, are how our mind interprets our emotions. We experience a rapid heart rate, or fast breathing, and "feel" (mentally and psychologically interpret these emotions) as excitement or anger. Or we experience a slowing or dampening of our senses and feel sadness or depression. We'll talk about this later, but it's often our feelings about something that cause us to perpetuate the stress in our body.

So, stress is the emotional component of our experience, and feelings are our interpretation of our emotions.

STATS ON STRESS

I'm all about facts. A facts-geek and researcher at heart, I love to hear about what other researchers have discovered about human nature and the mind-body interface. So, let's look at a few facts that can inform us about how prevalent stress is in the nursing population.

According to many reports, stress is the number one reason for nurse burnout. In fact, because of stress at work, 17% of all newly licensed nurses leave their first job within the first year, and up to 33% leave by the end of the second year. This costs an average teaching hospital up to $6.4M per year!

How about some stats on what stresses nurses out the most?

You probably have your own experience of stress at work, so what I'm about to share with you may not be a huge surprise...or it may. Let's take a look at the "top 10" stressors experienced by nurses and see how many of them are familiar in your work world[ii] [iii]:

  • Conflict with physicians.
  • Bullying.
  • Problems with peers.
  • Dealing with death and dying patients.
  • Problems with supervisors.
  • Discrimination.
  • Heavy workload.
  • Lack of balanced meals/mealtime at work.
  • Lack of rewards/poor reward system.
  • Physical stress of lifting and caring for heavy-care patients.
  • ...oh, I only said 10 right? That's enough; we could probably come up with a dozen more, but that's not the point of this article. The point of this article is for you to learn how to deal with stress so it doesn't keep your health and wellness. So...

And, here are just a few physical symptoms experienced by those who are stressed. There may be a chance that you've experienced one or two (or more?!) of the following:

  • Fatigue - 51%
  • Irritability - 50%
  • Feeling nervous - 45%
  • Lack of energy - 45%
  • Headache - 44%
  • Feeling as though you could cry - 35%
  • Upset stomach - 34%
  • Muscle tension - 30%
  • Change in appetite - 23%
  • Teeth grinding - 17%
  • Change in sex drive - 15%
  • Feeling dizzy - 13%

I'm sure that you could have told me many of these facts without relying on official statistics. Still, it's interesting (and alarming) to find out just how many nurses worldwide experience stress to the point where it affects their work quality and endangers their patients.

Now that we know what we're talking about, let's talk about what we usually do to deal with stress and what's at the heart of why we experience it (as well as how to relieve it)

HOW WE MIGHT DEAL WITH STRESS:

How do you normally deal with stress? There are many ways that we can deal with stress, both "positive" as well as "negative." However you deal with it, you're not going to hear any judgment from me. I've done IT both ways, positively and negatively. Besides learning how to deal with stress, there were many times in my past when I went out for (too many!) drinks after a nasty shift at work. I've also had my fill of acting out in ways that, looking back on them, probably hurt others as much as I hurt myself. Fortunately, I'm too old for that now and...I've got different skills.

What are some of the ways that we think that we control stress in our lives? Again, this isn't about judgment or right or wrong. Nothing that you think about while reading this article is going to leave this room.

  • Try to control our environment. Right? We can try to control all of the stressors in our lives, but does that work? Not really; there is an endless number of stressors available to test our patience. We could spend our entire lives trying to control our environment. It simply doesn't work.
  • Thinking that we can be happy and find relief from stress, we buy ourselves lots of new toys or gifts. This probably isn't going to work because eventually, the "toy" will break, or we'll get bored, and then we're stressed again.
  • We spend our time finding activities to keep ourselves distracted and find new "stress relievers" every day. Some of them are great, like spending time with our family or friends, yoga, exercise, or reading. Others, like impulse eating, consuming too much alcohol and arguing with our loved ones aren't as good.
  • We can think of meditation as a way to "bliss out" and shut the world out, trying to keep our mind free from thoughts - good luck! - and ending up just as stressed about our meditation as we were about the other stressors in our lives. We'll talk more about this later.
  • And I'm sure that there are more that we could mention.

THE EMOTIONAL COMPONENTS OF STRESS:

Remember when we defined stress and stressors, and emotions and feelings? Let's look a bit at the cycles of emotions and the responses that we usually have in trying to deal with them.

Sometimes, when I'm getting ready to present to an audience of new people, I'll experience a rapid heart rate, maybe sweat, feel a little "buzz" in my nervous system. There's no problem with this though; up to that point, it's all good. I've just got some physiology (emotions) bubbling away. BUT, when I take that emotion, interpret it as a "bad" feeling, and then start creating thoughts and ideas about it, that's where the slippery slope starts.

See, up to the part where we just experience the emotions, and maybe even after we've labeled them, we actually haven't gotten into any trouble. The trouble starts when, due to our habits of stress reactivity, we begin elaborating on what we're feeling and start labeling it "good," "bad," "pleasant," or "unpleasant." And where does that trouble start? In the mind.

THE STRESS-FREE "YOU":

Let me ask you a question:

Have any of you ever had a time in your life when you weren't stressed? Of course you have.

Well, let me ask you a really silly question; I'm sure you'll get this one right:

Was it you who wasn't stressed during these times or was it someone else?

You, right. So, what's the difference between that "you" and the "you" who gets stressed?

We all have the potential to not be stressed. The only difference between "who" we are when we are stressed and who we are when we're not is...what? Well, in one case we're reacting to a stressor, and in the other, we're not. Hmmmm...

So, how do you stay with the less-stressed you and not get caught up in the "stressed you?"

Here's something to keep in mind...literally:

That which is stress-free already resides within you; your process isn't about "becoming" less stressed, it's about recognizing the aspect of yourself that already is... stress-free, and reconnecting with that state of mind, or "state of being" repeatedly, until it becomes a habit.  <-- THAT is a very important point, so keep it in mind.  

What do I mean here?

Essentially it's this; if you can be stress-free some of the time, chances are, you can be stress-free most of the time. You're already wired to be stress-free right? I mean, if you weren't you wouldn't be able to experience that state of body and mind. So you've already got it within yourself. ß THAT is also a very important point, so keep it in mind.

Just take a moment to think about a time when things were going well and you weren't feeling any stress. Think about times, maybe even now, when you've been happy and you weren't worried. This "you" is the same you who's reading this article. Remember to connect with this aspect of yourself as much as you can.

Three things that you can do right now to begin to work with your stress reactivity:

  1. You already know things that stress you out. Now, begin to "grade" them; what is it in your work and home environment that pushes you the most?
  2. Where in your body do you experience stress? What are your emotional cues that you're experiencing stress? Begin tuning in to the more subtle expressions of stress in your body. Begin to develop an "early warning" system that you can use to warn yourself before you're actually "feeling" stressed.
  3. Is there anything that you're doing now to deal with stress that works well? Is there anything that you're doing now that helps you to short-circuit your normal stress reactivity?

In the next article, we'll begin to look at why we get stressed; what the sequence of thinking is that gets you into stress, and the way that you can start to circumvent your normal way of reacting. Until then, be well and enjoy each precious moment of stress-free life. And...share with others; what's your biggest stressor? Where in your body do you feel the stress? How do you deal with stress?

For the complete series, please see:

Part 1: Is Nursing All About Stress?

Part 2: Why Do You get Stressed? (hint: It's How You Think!)

Part 3: A New Way to Deal with Stress


References 

  1. Kovner, CT PhD, RN, PhD, FAAN. Nearly One in Five New Nurses Leave First Job Within a Year. RN Work Project, funded by the Robert Wood Johnson Foundation. September, 4 2014. 
  2. [ii] McVicar, A. Workplace stress in nursing: a literature review. Journal of Nursing, 44(6), 633-642. 2003.
  3. [iii] Roberts, R PhD, Grubb, PL PhD, Grosch, JW MBA, PhD. Alleviating Job Stress in Nurses. Medscape, June 25, 2012.

I've been an RN for over 30 years. I am an author, blogger, and keynote speaker. My site is: www.mindingthebedside.com

5 Articles; 14,304 Visitors; 20 Posts

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Been there,done that has 33 years experience as a ASN, RN.

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Whereas, I can appreciate your article.. the bottom line is nurses are CONSTANTLY bombarded with stressors from all angles.

Nursing brings a unique level of anxiety. The solutions you propose will not lessen that anxiety. Nobody's got time for that.

The only thing that will lessen a nurse's anxiety is manageable nurse -patient ratios, respect from hospital administration, respect from doctors, respect from the almighty corporations that work us like dogs to boost their bottom dollar.

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Jerome Stone RN has 33 years experience and specializes in Research, ICU, hospice, pain management.

5 Articles; 14,304 Visitors; 20 Posts

Hey BTDT (short for Been There Done That - hope that's okay?) -

I'd like to engage in some friendly and collegial dialogue here. Whatever I have to share is open for discussion, critique, or modification. And I do hope that you'll reply with your thoughts about what I have to share. With that in mind....

I completely appreciate what you're sharing in terms of the work environment being full of stressors. I've been an RN for over 33 years, and have spent - literally - tens of thousands of hours at the bedside, working within the stress-inducing environments of bedside care. AND...I've suffered due to the relentless pressures that are exerted on nurses.

Two responses; first off, I'm not implying that we need to "just learn how to deal with it," in terms of only working with our stress response without advocating for change. Far from it.

We owe it to ourselves and our profession to fight the good fight and demand safe/sane nurse-patient ratios, respect from our peers, and pay equity/parity. So, I'm completely with you on these points.

Second; because our environment, whether work, home, or...traffic, is bound to stress us, even under the best circumstances, we need to and can work with our most immediate locus of control which is...our mind and our physiology.

What I'm sharing and - to a certain extent - espousing, isn't theoretical; it's practical, it's doable and it works. Whereas you wrote that, "The solutions that you propose will not lessen that anxiety," TONS of research has been done showing that the solutions that I'll propose in the next two parts of this series do exactly that.

For almost all of us, anxiety or stress, is a physiological state, not a trait. As such, states can be mediated through a number of methods/means. And these means do positively impact stress reactivity and do reduce the perceived stress that we experience. I've been there and done that; I've allowed myself to drown in stress and have come damn near close to the edge of its precipice.

In terms of "Nobody's got time for that" I want to request that we all ponder the alternative; if we don't take time to learn how to deal with stress and anxiety, what else is there? A life full of stress? The inevitable list of diseases and disorders associated with chronic stress in nursing? A never-ending battle of fatigue and burnout while tilting at windmills of external stressors?

How better prepared can we be as we engage in culture change than to have our own act together, having managed our stress-reactivity. How much more effective will we be when one of the "corporations" who are working "...us like dogs.." comes to the bargaining table if we can address them without the burden of physiological and mental stress?

And here's the real cool thing; changing how we respond to stressors and their impact on us doesn't take a lot of time. Really? Yes.....

And that...is what I'll share in the next article (great segue eh?)

Please respond, comment, and help to continue this incredibly important discussion.

Take care,

Jerome Stone

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labordude has 13 years experience and specializes in Labor and Delivery, OBED, NICU, Lactation.

11,262 Visitors; 392 Posts

Whereas, I can appreciate your article.. the bottom line is nurses are CONSTANTLY bombarded with stressors from all angles.

Nursing brings a unique level of anxiety. The solutions you propose will not lessen that anxiety. Nobody's got time for that.

The only thing that will lessen a nurse's anxiety is manageable nurse -patient ratios, respect from hospital administration, respect from doctors, respect from the almighty corporations that work us like dogs to boost their bottom dollar.

While I do agree that better nurse-patient ratios and your other suggestions have merit, I wholeheartedly disagree that those are really the answers. As nurses and human being, we can't always control the external environment as much as we try, but we can control our internal reaction to such situations. As the OP also discussed internal locus of control is paramount in working through situations where external stressors are high and ability to control the external situation is low.

"Life is 10% what happens to you and 90% of how you react to it." - Charles Swindoll

Let's also examine my reality having worked in 10+ hospitals in multiple states. The majority of the nurses I have worked have either lost or choose not to use their ability to control themselves to help decrease the effect of the stressful situation. There are certainly those who just need a little time off to unwind, but so many people don't actually have real outlets today. Me? I play ice hockey AT least once a week which realistically takes two hours of my time but has innumerable benefits for my physical, emotional, and spiritual state. More people would benefit from having a physical outlet when working in a job such as nursing that does have many uncontrollable stressors on many sides (patients, physicians, administration, insurance, etc).

My argument in total is that the onus in on the individual to consider what their reaction to stress is and understand how to control that reaction rather than focusing on the stressor itself which often is truly out of their control. Though I'm almost certain I just paraphrased what Jerome Stone said.

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Jerome Stone RN has 33 years experience and specializes in Research, ICU, hospice, pain management.

5 Articles; 14,304 Visitors; 20 Posts

Hello NICUGUY (great name!)

Thanks for the comment. Also, thanks for the quote by Charles Swindoll:

"Life is 10% what happens to you and 90% of how you react to it." - Charles Swindoll

I hadn't read that one before; seems spot on in terms of what is being discussed here.

And thanks for your insights on the use of physical activity as a way to defuse the impact that stress can have on our body and mind. Hockey? What a great (and intense?) way to blow off a lot of energy!

NICU, L&D and Lactation; great clinical arenas. And so wonderful to see a "guy" in an arena that, for many years, was mostly women.

Take care,

Jerome

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My 2 cents. Stress (often) occurs because of a conflict (sheesh, sounds Freudian, but that's not where it came from, to the extent that I am aware of it . . . just digging myself in deeper.)

For example, I like having a job and I think that I need to do this, this, and that to keep the one I have. It's so anxiety provoking to be out of a job and to have to look for a new one and to try to make ends meet, so I'd like to keep this one. But, this policy or that law and that co-worker or this patient and the lack of appropriate resources are making it extremely difficult if not impossible to do this, this, and that, all the time, every time, and to follow this policy or that law etc etc. When is someone going to write me up, when am I going to get dinged in my performance review, when is someone going to layoff people and maybe I won't be in that someone's good graces.

It is not possible to control any of these things or to control anyone's perception. Anyone given a lot of responsibility that is measurable, such as nurses but not only nurses, but without authentic and significant input into legislating and executing policies, law, and compensation, is going to live with unreasonable stress.

The fact is there is a lot of unreasonableness in nursing and many other occupations/professions/positions where a person is being measured all the time (and many of the metrics are sick and subjective) and has little or no authentic and significant input/authority over the metrics and appraisal and compensation.

Given the realities, a person has to make a dignified peace, whatever that looks like to them, or suffer blindly and perpetrate that suffering on others. Blindness is ugly. If the article offers tools to help people make a dignified peace for themselves, great. The tools and people using them have to acknowledge the realities, both positive and negative, in order to be used successfully.

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Jerome Stone RN has 33 years experience and specializes in Research, ICU, hospice, pain management.

5 Articles; 14,304 Visitors; 20 Posts

Hey there bbyRN -

Eloquent! "a person has to make a dignified peace, whatever that looks like to them, or suffer blindly and perpetrate that suffering on others. Blindness is ugly" I couldn't have said it better myself...glad that you did!! :yes:

You contributed perfectly to this discussion and took it to a "bigger picture" level; thanks for your insights.

Take care, Jerome

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I work at a place where Management decides to make changes that affect my job without letting me know. Then all of a sudden when there is a problem, I am expected to clean up the mess that was created due to them not knowing what I do on my job or how I have been handling things which now has been totally turned upside down. Or all of a sudden get a call wanting to know where reports are that should have been sent a month ago, to which I had no idea they were needed due to the Physicians not informing me they were needed after they had seen the patient. Having a Physician that calls the Secretary to given her instructions to give me regarding procedures to start on a patient while he is on his way to the clinic. Yes all this can cause stress! Being responsible without knowing what is going on. That is the culture and has always been at the place I work. I called and spoke to the Nurse I replaced and she said it changed about 10 years ago. Has went downhill since then. I wish I had known would have left before I have to worry about jeopardizing my Nursing License.

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Jerome Stone RN has 33 years experience and specializes in Research, ICU, hospice, pain management.

5 Articles; 14,304 Visitors; 20 Posts

Hello she57 -

Ugh! The scene/situation that you've described is so prevalent in nursing isn't it? Very frustrating, sometimes even maddening. So, what do you do in these kind of situations?

In terms of jeopardizing your license; what have you done to protect yourself? Do you file occurrence or incident reports when things happen that aren't your fault but are due to policies? Have you voiced your concerns and offered solutions?

Sometimes it's so easy to get caught up in the whirlwind of the system that we forget that there are things that we can do to, if not solve the problem, at least address it and cover our own....license!

What causes us to get caught up in the whirlwind is our habit of stress-reactivity; we get so bound up because of the sheer numbers of stressors, that we forget that there are alternatives. That's why I wrote this series; because while we may not be able to change what's going on *out there*, we can change our own inner landscape. Yah!!

Take care,

Jerome Stone

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eroc has 2 years experience and specializes in CVICU.

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While I do agree that better nurse-patient ratios and your other suggestions have merit, I wholeheartedly disagree that those are really the answers. As nurses and human being, we can't always control the external environment as much as we try, but we can control our internal reaction to such situations. As the OP also discussed internal locus of control is paramount in working through situations where external stressors are high and ability to control the external situation is low.

"Life is 10% what happens to you and 90% of how you react to it." - Charles Swindoll

Let's also examine my reality having worked in 10+ hospitals in multiple states. The majority of the nurses I have worked have either lost or choose not to use their ability to control themselves to help decrease the effect of the stressful situation. There are certainly those who just need a little time off to unwind, but so many people don't actually have real outlets today. Me? I play ice hockey AT least once a week which realistically takes two hours of my time but has innumerable benefits for my physical, emotional, and spiritual state. More people would benefit from having a physical outlet when working in a job such as nursing that does have many uncontrollable stressors on many sides (patients, physicians, administration, insurance, etc).

My argument in total is that the onus in on the individual to consider what their reaction to stress is and understand how to control that reaction rather than focusing on the stressor itself which often is truly out of their control. Though I'm almost certain I just paraphrased what Jerome Stone said.

I agree with your post completely. I often wonder what types of lives most nurses have lived before choosing this career. For me I am new only being a nurse for two short years, but my past careers were even more stressful than being a nurse. Maybe I lived how to manage stress from previous experience? Stress depends on how you let it happen and is self-inflicted from an emotional standpoint. Everyone gets stressed, but so many do not know when to let it go and take a bigger look at the entire picture once the initial stimulator has past.

ANd I live by the entire quote:

The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, the education, the money, than circumstances, than failure, than successes, than what other people think or say or do. It is more important than appearance, giftedness or skill. It will make or break a company... a church... a home. The remarkable thing is we have a choice everyday regarding the attitude we will embrace for that day. We cannot change our past... we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% of how I react to it. And so it is with you... we are in charge of our Attitudes.”

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Jerome Stone RN has 33 years experience and specializes in Research, ICU, hospice, pain management.

5 Articles; 14,304 Visitors; 20 Posts

Hi eroc -

Thanks for getting engaged in this discussion.

You wrote that,

Stress depends on how you let it happen and is self-inflicted from an emotional standpoint.
My experience is that the emotion may not be self-inflicted, i.e., that an emotional response may be the involuntary physiological response to a stressor/trigger. What can be self-inflicted, and what we can work with, is the habitual tendency to create more trauma/drama around our perceptions and interpretations of those emotional/physiological responses.

And many times even the "self-infliction" of our habitual ways of doing things is completely unconscious! That's why beginning to work with our mind is such a powerful tool in learning to change our stress-reactivity.

Thanks for contributing to the discussion.

Take care,

Jerome Stone

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eroc has 2 years experience and specializes in CVICU.

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Hi eroc -

Thanks for getting engaged in this discussion.

You wrote that, My experience is that the emotion may not be self-inflicted, i.e., that an emotional response may be the involuntary physiological response to a stressor/trigger. What can be self-inflicted, and what we can work with, is the habitual tendency to create more trauma/drama around our perceptions and interpretations of those emotional/physiological responses.

And many times even the "self-infliction" of our habitual ways of doing things is completely unconscious! That's why beginning to work with our mind is such a powerful tool in learning to change our stress-reactivity.

Thanks for contributing to the discussion.

Take care,

Jerome Stone

IMO, I should have stated chronic stress is self-inflicted and specified not all stress can be avoided.

And I agree people do things unconsciously, yet I believe through will power and understanding that we are all flawed one can subdue stress. But self- reflection and understanding is a major barrier for many people.

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