应激管理
应激管理（英语：Stress management）是减轻身心应激的方法和应对策略的统称。当人们的复原力和自我修复能力由于内部和外部应激，而不足以维持表现或身心健康时，应激管理方法可能会有所帮助。应激管理是为了增进日常生活功能，使用不同技巧或进行心理治疗来控制一个人的应激水平，尤其针对慢性应激的处理。在许多实用的应激管理技术中，有些由卫生专业人员施作，有些借由自行操作来帮助减轻应激，提高人生掌控感与促进整体健康。
应对策略涉及资源的保护和促进，以及应激的心智、情绪和身体方面的管理。心理学家 Gert Kaluza 将应对策略分为三组：工具性应激管理（影响应激源）、心智应激管理（改变加剧应激的想法）、姑息—再生（英语：palliative-regenerative，姑息意指缓解疼痛，但不处理状态起因）应激管理（影响应激反应）。<ref>{{
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应激管理策略由心理学家、心理治疗师等相关领域专业从业者传授。除了身体活动和健康饮食外，通常还建议使用放松技巧和正念练习以及时间管理来进行自助。
根据个人状况的不同，应激会产生许多身体和心理症状，包括身体不适以及忧郁症。应激管理是现代社会成功和幸福的一项关键所在<ref>Paul Susic MA Licensed Psychologist Candidate. Stress Management: What can you do?. St. Louis Psychologists and Counseling Information and Referral. [February 5, 2013]. （原始内容存档于2013-01-24）.</ref>。纵使生命中有许多难以处理的课题，应激管理可以提供多种治疗焦虑和维持个人健全的方法。尽管应激常被认为是主观经验，使用各种生理仪器可以很容易地测量应激水平，例如测谎机中使用的那些工具。因为目前相关研究仍有限，评估各种应激管理技术的有效性是相当困难的。因此，不同技术的证据数量和品质差别很大。有些被认可为专业心理治疗的有效方法，而其他证据较少者则被认为是替代疗法。这些技术有着不同应激控制机转的解释模型，未来仍需要有更多的研究以便清楚了解哪些机转为真并在实作中可行。许多专业组织从事促进和培训这些疗法的运用。
历史基础[编辑 | 编辑源代码]
美国心理学家沃尔特·迦农和加拿大心理学家汉斯·塞利使用动物实验建立了最早的应激研究科学基础。他们测量动物对外部应激（如热、冷、持续约束和外科手术）的生理反应，然后从这些研究中推导出人类的状态<ref>Cannon, W. (1939). The Wisdom of the Body, 2nd ed., NY: Norton Pubs.</ref><ref>Selye, H. Stress and the general adaptation syndrome. Br. Med. J. 1950, 1 (4667): 1383–92. PMC 2038162 可免费查阅. PMID 15426759. doi:10.1136/bmj.1.4667.1383.</ref> 。
理查德·拉赫以及其他人对人类应激的后续研究确立了应激是由不同且可测量的应激因子所引起的，可以透过所产生的应激程度中位数值来排列这些生命应激因子（随后发明了何慕斯与拉赫应激量表）。因此，传统上应激被形塑为超出当事者控制的外部干扰结果。然而，最近研究认为外部环境没有任何能力产生应激，而是由个人看法、能力和理解不同所产生的结果。
模型[编辑 | 编辑源代码]
推得的模型有下列五种：
- 沃尔特·迦农提出的“紧急反应／战斗或逃跑反应”
- 汉斯·塞利提出的“一般适应综合症”
- “亨利应激模型”
- 砬撒稑提出的“应激交流（或认知）模型”／拉撒路应激模型<ref name="Lazarus" />
- 斯蒂文·哈孚提出的“资源保存理论”
应激交流模型[编辑 | 编辑源代码]
[[:{{#if:||Richard Lazarus}}|理查德·砬撒稑]]和苏珊·福克曼在1981年提出，应激可被看作是由于“需求与资源之间的不平衡”或“应激超过人们自觉的应对能力”所产生的结果。应激管理的前提与发展建立在应激不是人对应激因子的直接反应，而是拥有的处理资源和应对能力，且这些资源能力是可以改变的，从而使得应激可以控制。<ref name="Lazarus">Lazarus, R.S., & Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer.</ref>
在雇员提到的许多应激之中，下列是最常见的： {{#if:* 公司内的冲突
- 老板／主管或公司对待员工的方式
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- 老板／主管或公司对待员工的方式
- 缺乏工作保障
- 公司政策
- 同事没有公平分担劳务
- 期望不明
- 没有足够的分配控制权
- 薪酬或福利不足
- 紧急期限
- 太多工作
- 长工时
- 身体不适
- 关系不佳
- 同事粗心犯错
- 处理粗鲁的客户
- 缺乏合作
- 公司如何对待同事<ref>Somaz, Wenk Heidi & Tulgan, Bruce (2003). Performance Under Pressure: Managing Stress in the Workplace.Canada. HRD Press Inc.p 7-8. {{#if:0-87425-741-7|[[{{#ifeq:{{safesubst:#switch:
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为了制订有效的应激管理计划，首先要确定应激控制的核心影响因素，并针对这些因素拟定有效介入方法。砬撒稑和福克曼对应激的解释主要集中在人与外部环境之间的互动交流（因此被称为交流模型），并认为如果人不将应激因子视为威胁而是正向或具有挑战性的，应激因子就不会是个应激。此外，如果人拥有或能使用合适的应付技巧，那么应激可能不会出现或发展。该模式主张，可以教导人们来管理自己的应激并妥善应对应激。他们能学习去改变自己对应激的观点，并拥有改善生活和处理应激的能力和信心。
健康实现／天生健康模型[编辑 | 编辑源代码]
健康实现／天生健康模型也建立在应激不一定随潜在应激因子而存在的观念上。然而，相较于应对能力的自我评估（如交流模型），健康实现模型强调个人思维会决定对应激环境的反应。这种模型认为，透过消极无安全感的心理过滤机制来评估自己与环境才会产生应激，而以“安静的心智”接触世界能产生幸福健全感<ref>Mills, R.C. (1995). Realizing Mental Health: Toward a new Psychology of Resiliency. Sulberger & Graham Publishing, Ltd. {{#if:0-945819-78-1|[[{{#ifeq:{{safesubst:#switch:
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}}|ISBN]]{{#if:||{{{arg}}}}}}}参数错误：ISBN缺失。}}</ref><ref>Sedgeman, J.A. (2005). Health Realization/Innate Health: Can a quiet mind and a positive feeling state be accessible over the lifespan without stress-relief techniques? Med. Sci. Monitor 11(12) HY47-52. [43] {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>。
这个模式提出，帮助有应激的人理解思想本质会减轻他们的应激，特别是透过使他们有能力分辨何时受到无安全感思维的束缚，学会放下它，以及获得正向自然的感觉。
技术[编辑 | 编辑源代码]
高要求水平会使人需要额外的工作和努力。新的时间表应运而生，直到异常高的要求过去前，原有时间表的正常频率和工时都受到限制。许多技巧可以应付生活带来的这类应激，应激管理技术将根据不同模型而有所不同<ref>Dubbed "Destressitizers" by The Journal of the Canadian Medical Association</ref><ref>Spence, JD; Barnett, PA; Linden, W; Ramsden, V; Taenzer, P. Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. Canadian Medical Association Journal. 1999, 160 (9 Suppl): S46–50. PMC 1230339 可免费查阅. PMID 10333853.</ref>。以下的方法可以暂时降低轻微应激：
{{#if:* [[:{{#if:||Autogenic training}}|自律训练]]
- 社会关系
- 认知疗法
- [[:{{#if:||Conflict resolution}}|冲突处理]]
- 按摩
- 兴趣
- 冥想
- 正念疗法
- [[:{{#if:||Music as a coping strategy}}|音乐疗法]]
- [[:{{#if:||Deep breathing}}|深呼吸]]
- [[:{{#if:||Yoga Nidra}}|瑜珈]]
- 益智药
- 读小说
- 祷告
- [[:{{#if:||Relaxation technique}}|放松技巧]]
- 创造力
- 幽默
- 体能锻炼
- [[:{{#if:||Progressive relaxation}}|渐进放松]]
- Spa
- 身心训练
- [[:{{#if:||Attention Restoration Theory}}|到大自然中]]
- 应激球
- 自然医学
- 替代医学
- 时间管理
- 计划与做决策
- 听放松音乐<ref>Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime. Principles and Practice of Stress Management, Third Edition. 2007: 46–47. ISBN 1-59385-000-X.</ref><ref>Leubner, D., and Hinterberger, T. (2017). “Reviewing the Effectiveness of Music Interventions in Treating Depression.” {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} Front Psychol.eCollection 2017 Jul 7;8:1109. PMID 28736539 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} doi: 10.3389/fpsyg.2017.01109 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>
- 与宠物相处3|<div class="div-col {{#ifeq:|yes|div-col-small}} {{#ifeq:|yes|div-col-rules}} " {{#if:{{#if:* [[:{{#if:||Autogenic training}}|自律训练]]
- 社会关系
- 认知疗法
- [[:{{#if:||Conflict resolution}}|冲突处理]]
- 按摩
- 兴趣
- 冥想
- 正念疗法
- [[:{{#if:||Music as a coping strategy}}|音乐疗法]]
- [[:{{#if:||Deep breathing}}|深呼吸]]
- [[:{{#if:||Yoga Nidra}}|瑜珈]]
- 益智药
- 读小说
- 祷告
- [[:{{#if:||Relaxation technique}}|放松技巧]]
- 创造力
- 幽默
- 体能锻炼
- [[:{{#if:||Progressive relaxation}}|渐进放松]]
- Spa
- 身心训练
- [[:{{#if:||Attention Restoration Theory}}|到大自然中]]
- 应激球
- 自然医学
- 替代医学
- 时间管理
- 计划与做决策
- 听放松音乐<ref>Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime. Principles and Practice of Stress Management, Third Edition. 2007: 46–47. ISBN 1-59385-000-X.</ref><ref>Leubner, D., and Hinterberger, T. (2017). “Reviewing the Effectiveness of Music Interventions in Treating Depression.” {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} Front Psychol.eCollection 2017 Jul 7;8:1109. PMID 28736539 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} doi: 10.3389/fpsyg.2017.01109 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>
- 与宠物相处|3|}}auto|style="{{#if:{{#if:* [[:{{#if:||Autogenic training}}|自律训练]]
- 社会关系
- 认知疗法
- [[:{{#if:||Conflict resolution}}|冲突处理]]
- 按摩
- 兴趣
- 冥想
- 正念疗法
- [[:{{#if:||Music as a coping strategy}}|音乐疗法]]
- [[:{{#if:||Deep breathing}}|深呼吸]]
- [[:{{#if:||Yoga Nidra}}|瑜珈]]
- 益智药
- 读小说
- 祷告
- [[:{{#if:||Relaxation technique}}|放松技巧]]
- 创造力
- 幽默
- 体能锻炼
- [[:{{#if:||Progressive relaxation}}|渐进放松]]
- Spa
- 身心训练
- [[:{{#if:||Attention Restoration Theory}}|到大自然中]]
- 应激球
- 自然医学
- 替代医学
- 时间管理
- 计划与做决策
- 听放松音乐<ref>Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime. Principles and Practice of Stress Management, Third Edition. 2007: 46–47. ISBN 1-59385-000-X.</ref><ref>Leubner, D., and Hinterberger, T. (2017). “Reviewing the Effectiveness of Music Interventions in Treating Depression.” {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} Front Psychol.eCollection 2017 Jul 7;8:1109. PMID 28736539 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} doi: 10.3389/fpsyg.2017.01109 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>
- 与宠物相处|3|}}|column-count:{{#if:* [[:{{#if:||Autogenic training}}|自律训练]]
- 社会关系
- 认知疗法
- [[:{{#if:||Conflict resolution}}|冲突处理]]
- 按摩
- 兴趣
- 冥想
- 正念疗法
- [[:{{#if:||Music as a coping strategy}}|音乐疗法]]
- [[:{{#if:||Deep breathing}}|深呼吸]]
- [[:{{#if:||Yoga Nidra}}|瑜珈]]
- 益智药
- 读小说
- 祷告
- [[:{{#if:||Relaxation technique}}|放松技巧]]
- 创造力
- 幽默
- 体能锻炼
- [[:{{#if:||Progressive relaxation}}|渐进放松]]
- Spa
- 身心训练
- [[:{{#if:||Attention Restoration Theory}}|到大自然中]]
- 应激球
- 自然医学
- 替代医学
- 时间管理
- 计划与做决策
- 听放松音乐<ref>Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime. Principles and Practice of Stress Management, Third Edition. 2007: 46–47. ISBN 1-59385-000-X.</ref><ref>Leubner, D., and Hinterberger, T. (2017). “Reviewing the Effectiveness of Music Interventions in Treating Depression.” {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} Front Psychol.eCollection 2017 Jul 7;8:1109. PMID 28736539 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} doi: 10.3389/fpsyg.2017.01109 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>
- 与宠物相处|3|}}; column-width:auto;}}{{#if:auto|column-width:auto;}}{{#if:|column-gap:{{{gap}}};}}{{#if:|}}"}}>{{#if:{{#if:|3|* [[:{{#if:||Autogenic training}}|自律训练]]
- 社会关系
- 认知疗法
- [[:{{#if:||Conflict resolution}}|冲突处理]]
- 按摩
- 兴趣
- 冥想
- 正念疗法
- [[:{{#if:||Music as a coping strategy}}|音乐疗法]]
- [[:{{#if:||Deep breathing}}|深呼吸]]
- [[:{{#if:||Yoga Nidra}}|瑜珈]]
- 益智药
- 读小说
- 祷告
- [[:{{#if:||Relaxation technique}}|放松技巧]]
- 创造力
- 幽默
- 体能锻炼
- [[:{{#if:||Progressive relaxation}}|渐进放松]]
- Spa
- 身心训练
- [[:{{#if:||Attention Restoration Theory}}|到大自然中]]
- 应激球
- 自然医学
- 替代医学
- 时间管理
- 计划与做决策
- 听放松音乐<ref>Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime. Principles and Practice of Stress Management, Third Edition. 2007: 46–47. ISBN 1-59385-000-X.</ref><ref>Leubner, D., and Hinterberger, T. (2017). “Reviewing the Effectiveness of Music Interventions in Treating Depression.” {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} Front Psychol.eCollection 2017 Jul 7;8:1109. PMID 28736539 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} doi: 10.3389/fpsyg.2017.01109 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>
- 与宠物相处}}|{{#if:|3|* [[:{{#if:||Autogenic training}}|自律训练]]
- 社会关系
- 认知疗法
- [[:{{#if:||Conflict resolution}}|冲突处理]]
- 按摩
- 兴趣
- 冥想
- 正念疗法
- [[:{{#if:||Music as a coping strategy}}|音乐疗法]]
- [[:{{#if:||Deep breathing}}|深呼吸]]
- [[:{{#if:||Yoga Nidra}}|瑜珈]]
- 益智药
- 读小说
- 祷告
- [[:{{#if:||Relaxation technique}}|放松技巧]]
- 创造力
- 幽默
- 体能锻炼
- [[:{{#if:||Progressive relaxation}}|渐进放松]]
- Spa
- 身心训练
- [[:{{#if:||Attention Restoration Theory}}|到大自然中]]
- 应激球
- 自然医学
- 替代医学
- 时间管理
- 计划与做决策
- 听放松音乐<ref>Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime. Principles and Practice of Stress Management, Third Edition. 2007: 46–47. ISBN 1-59385-000-X.</ref><ref>Leubner, D., and Hinterberger, T. (2017). “Reviewing the Effectiveness of Music Interventions in Treating Depression.” {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} Front Psychol.eCollection 2017 Jul 7;8:1109. PMID 28736539 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}} doi: 10.3389/fpsyg.2017.01109 {{#if:||（}}页面存档备份，存于互联网档案馆{{#if:||）}}</ref>
- 与宠物相处}}}}}}
应激预防和复原力[编辑 | 编辑源代码]
虽然传统上有许多技术可以处理应激产生的结果，但也有大量研究探讨应激该如何预防，这是与建置心理复原力密切相关的主题。不少应激预防和复原力建置的自助方法已经出现，其依照认知行为治疗的理论和实践模式进行<ref name="Robertson_2012">Robertson, D. Build your Resilience. London: Hodder. 2012 [2017-09-05]. ISBN 978-1444168716. （原始内容存档于2020-08-19）.</ref>。
应激测量[编辑 | 编辑源代码]
应激水平是可以测量的，其中一种方法是使用心理量表：何慕斯与拉赫应激量表用于评估生活应激事件，忧郁焦虑应激测量表是包含自我评估项目的应激量表。还可以用血压和皮肤电流活动的变化来测量应激水平及改变。數字温度计可用于评估皮肤温度的变化，这可以显示因战斗或逃跑反应而驱使血液从四肢流向中央的状况。皮质醇是在应激反应期间释放的主要激素，从头发测量皮质醇可显示个体在60至90天内的基础应激水平。这种测量应激的方法是目前诊所最流行的方法。
效果[编辑 | 编辑源代码]
应激管理有助于生理和免疫系统<ref>Bower, J. E. & Segerstrom, S.C. Stress management, finding benefit, and immune function: positive mechanisms for intervention effects on physiology. Journal of Psychosomatic Research. 2004, 56 (1): 9–11. PMID 14987958. doi:10.1016/S0022-3999(03)00120-X.</ref>。使用以下非药物的组合可观察到有效结果<ref>Wolfgang Linden; Joseph W. Lenz; Andrea H. Con. Individualized Stress Management for Primary Hypertension: A Randomized Trial. Arch Intern Med. 2001, 161 (8): 1071–1080 [2017-09-05]. PMID 11322841. doi:10.1001/archinte.161.8.1071. （原始内容存档于2011-09-16）.</ref>：
- 愤怒或敌意的治疗处理
- 自律训练
- 会谈治疗（针对关系或存在问题）
- 生物回馈
- 焦虑或临床忧郁症的认知治疗
应激类型[编辑 | 编辑源代码]
急性应激[编辑 | 编辑源代码]
急性应激是全世界人类最常见的应激形式。起因于短期内事务或刚发生的事情，这种应激往往被误解为消极内涵，但在某些情况下，生活中急剧的应激也是件好事。跑步或其他形式的运动是一种急性应激因子，令人兴奋或愉快的经历，如乘坐云霄飞车，也是一种急性应激，但通常是非常享受的。急性应激是短期的，因此没有足够的时间来造成如长期应激导致的伤害<ref name="acute">McGonagle, Katherine; Ronald Kessler. Chronic Stress, Acute Stress, Depressive Symptoms. American Journal of Community Psychology. October 1990, 18 (5): 681–706. doi:10.1007/BF00931237.</ref>。
慢性应激[编辑 | 编辑源代码]
慢性应激与急性应激不同，如果持续很长时间，慢性应激对身体会造成严重的危害。慢性应激可导致记忆丧失、空间识别能力减损，与进食欲望减少。严重程度因人而异，性别也可能是潜在差异原因。女性常能承受比男性更长时间的应激，而不会出现相同的适应不良现象。男性比女性更能处理短期应激，一旦达到特定阈值，他们出现心理问题的机会就会急剧增加<ref name="hormones">Bowman, Rachel; Beck, Kevin D; Luine, Victoria N. Chronic Stress Effects on Memory: Sex differences in performance. Hormones and Behavior. January 2003, 43 (1): 48–59. doi:10.1016/S0018-506X(02)00022-3.</ref>。
工作场所[编辑 | 编辑源代码]
工作场合的应激举世皆然，管理这种应激对于保持工作绩效以及维系与同事和雇主的关系相当重要<ref name="Dailybsness.com">存档副本. [2016-03-09]. （原始内容存档于2016-03-10）.</ref>。改善工作环境会减轻某些人的工作应激，例如降低员工之间的竞争可以降低应激。然而，每个人都是不同的，有些人喜欢应激来促进工作表现。工资是某些员工关切的议题，工资可以影响人们的工作方式，因为目标是获得升职来提高薪水，容易导致慢性应激。
为了管理工作场所的应激，雇主可以提供应激管理方案<ref>存档副本. [2017-09-05]. （原始内容存档于2016-03-27）.</ref>， 如医疗措施、沟通管道与更灵活的工作进度<ref>Nordic Labour Journal: Avoiding change-induced stress in the workplace. [2017-09-05]. （原始内容存档于2013-08-24）.</ref>。
参考文献[编辑 | 编辑源代码]
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维基教科书中的相关电子教程：[[b:{{#if:|{{{3}}}:}}超普通心理学/应激与健康|超普通心理学/应激与健康]] |
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