CHW Self-Care Curriculum: Understanding Stress

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Understanding Stress & How to Manage It

Stress is a term coined by scientist Hans Selye in 1936 and now defined by the National Center for Complementary and Integrative Health (NCCIH) as above. It is a feeling or condition experienced due to ‘stressors’ which are events or environments that are demanding, challenging and causes strain and tension to an individual. Stressful events are a fact of life. Stressors can derive from daily life and busyness, personal relationships, work-related issues, financial problems, personality, or parenting to name a few.

Stress is a physical and emotional reaction that people experience as they encounter changes in life. Stress is a normal feeling.

Although stress is commonly seen negatively, it can also be a great motivator to accomplish tasks. However, long-term stress may contribute to or worsen a range of health problems including digestive disorders, headaches, sleep disorders, and other symptoms. Stress may worsen asthma and studies show that it is linked to depression, anxiety, and other mental illnesses (How Can Stress, Strong Emotions, And Depression Affect Asthma?).

It is important to have a clear understanding of the difference between acute and chronic stress and the stress response.

Acute Stress

  • short-term when stress response system is activated
  • swiftly returns to normal

Chronic Stress

  • long term, ongoing, repetitive
  • occurs with such frequency that the body does not get an opportunity to return to normal or activate the relaxation response
  • hormone levels remain high 
  • buildup of neurochemicals of cortisol and norepinephrine that impacts our physical and mental health

Exercise 6
Name at least three acutely stressful situations for you.

Exercise 7
Name at least three chronically stressful situations for you.

The first, and most important thing to remember, is that stress impacts our physical and psychological health because the body reacts to each situation by releasing hormones controlled by the hypothalamus in the brain. Anything that is deemed a threat, activates the stress response system, and the heart rate, blood pressure, and blood sugar levels increase, decreasing our immune responses. This is commonly known as fight-or-flight, a state of physiological arousal. A more in-depth understanding of stress can be found at Center on Studies on Human Stress.

The long-term activation of the stress response system and the overexposure to cortisol and other stress hormones that follows can disrupt almost all your body's processes. This puts you at increased risk of many health problems, including:

  • Anxiety
  • Depression
  • Digestive problems
  • Headaches
  • Muscle tension and pain
  • Heart disease, heart attack, high blood pressure and stroke
  • Sleep problems
  • Weight gain
  • Memory and concentration impairment

"Anything that is deemed a threat, activates the stress response system, and the heart rate, blood pressure, and blood sugar levels increase, decreasing our immune responses."

The pandemic has intensified the health disparities and inequities seen and experienced in communities of color. Therefore, establishing a consistent and regular practice of self-care is a healthy way to combat chronic stress.

Incorporating a practice of self-care is one of the best means of positively reframing surroundings to combat chronic stress!

The pandemic can be and is considered chronically stressful and traumatic. Many have experienced loss or multiple losses and continue to deal with the socioeconomic and health aftermath. Acknowledging the need to heal especially after a loss is an integral part of self-care that allows one to reflect and learn new coping skills. El Sol Neighborhood Resource Center has created an incredible Time to Heal COVID-19 Healing Song +Tool-Kit guide to deal with the trauma of COVID-19 in addition to an emotional healing map.

Millions of Americans have experienced a devastating toll during the coronavirus pandemic, and the loss of loved ones has disproportionately impacted communities of color and other vulnerable populations. Dealing with a loss can be incorporated in one’s self-care action plan; however, it’s critical to acknowledge and understand the grieving process. Although throughout life's journey the experiences of loss result in grief, the loss of a loved one can be more devastating. The greater the loss the greater the tremor to our physical and emotional foundation. 

Grief is a natural part of the human experience and is a normal reaction to a loss. Grief does not discriminate nor insulate us from pain. It is profoundly personal and highly individualized, challenges our faith, and even questions our relationship with God, family, and friends. However, an individual needs to go through the grieving PROCESS that involves many different feelings and emotions, ultimately experiencing emotional growth from healthy grieving. In healthy grieving the following must be kept in mind to move from mourning to an appreciation for life again:

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Grieving is a process and there is no timeline!

Grief is not an enemy or a sign of weakness but is the cost of loving someone that tears a hole in your soul.

Grief is painful and affects our entire being.

It can be intense and chaotic and is never orderly or predictable. The physical as well as psychological is impacted and healing may require a support group, counselor/therapist, or a medical professional. Good selfcare during grieving is to recognize and accept help when overwhelmed by the grief.

There is no right or wrong way to grieve and no two individuals grieve alike.

In addition, our age, gender, culture, and religious beliefs influence how we grieve.

Grief is not linear.

The stages of grief (shock, denial, anger, bargaining, depression, acceptance) are only a standard way of understanding the range of feelings and emotions, but the reality of daily life and how one mourns is convoluted.

Knowing the facts about grief is critical.

Knowing the facts about grief is critical because there are many myths and superstitions that can impede your healing process.

Grief creates a new normal after a loss.

The death of a loved one disrupts the flow of routines and creates an enormous void. It is unlikely to return to “normal,” but creating a new normal is an opportunity to acknowledge the loss in order to celebrate life again while holding in balance the pain of the loss and hope for the future.

Your loved one is not forgotten.

Your loved one is not forgotten because of the lasting memories you and the family have of their lives. Additionally, you carry the DNA of your loved one that you can pass on, and they will always be part of your family history. Part of your healing process and self-care could be creating a family tree and even incorporating the character of that individual.

Creating a memorial in honor of your loved one.

There are a vast number of ways to remember your loved one: plant a tree, using favorite clothing or items to make a quilt or ornaments for a Christmas tree, lighting a candle, a special prayer, dedicate a day of service in honor of that person, begin a scholarship in their name, a bench or chair dedicated to your loved one and many more.

Exercise 8
What is the most memorable thing about your loved one?
What kind of memorial would you like to create for your loved one?

Another area of stress that must not be overlooked, especially since the majority of CHWs are from underserved communities, is racial stress or race-based traumatic stress. Racial stress impairs our perceptions, decisions, behaviors, and ultimately our relationships. In the U.S., racism is the root cause of health inequities and disparities seen in the underserved communities. The most vulnerable people experiencing intense racist encounters producing emotional pain and chronic stress are Black peoples of African heritage and Indigenous, and People of Color. In addition, the COVID-19 pandemic has further exposed the longstanding inequities in our healthcare system, and the recent racial unrest prompts an urgent need to not only address but also acknowledge the racial stress that contributes to chronic stress. This further elevates the necessity for CHWs to institute the practice of self-care as they live and work in a society of continued and persistent daily microaggressions.

In the Medical News Today Joanne Lewsley says, “Racism, or discrimination based on race or ethnicity, is a key contributing factor in the onset of disease.” Racism is associated with higher rates of stress, and stress is known to elevate blood pressure, weaken the immune system, and increase chronic diseases. Furthermore, research has shown that discrimination is linked to higher rates of smoking, alcohol use, drug use, and unhealthful eating habits and linked to infant mortality. Recent studies in epigenetics have also revealed that the impact of racism is enduring and shows durable, major adverse effects on the biological cells and structures of the human body, (Study of Holocaust survivors finds trauma passed on to children's genes | Genetics | The Guardian).

"Racism is associated with higher rates of stress, and stress is known to elevate blood pressure, weaken the immune system, and increase chronic diseases."