A Psychological Approach to Chronic Stress

As a trauma psychologist, I've witnessed first-hand the profound impact chronic stress can have on individuals. Over the years, I've worked within an excellent psychological formulation model known as the ‘5P's’, developed by psychologist Dr Jacqueline Adshead, who highlights assessing 5 key areas in order to develop an understanding of an individual's clinical presentation. These are: Presenting, Precipitating, Predisposing, Perpetuating, and Protective factors. In writing this blog, I have distilled my insights and observations into how each of these factors plays a crucial role in understanding and managing chronic stress.

1: Presenting Factors - Recognising the Immediate Symptoms

Chronic stress often presents itself through immediate and noticeable symptoms. These presenting factors are the first indicators that something is amiss. Common symptoms include anxiety, fatigue, irritability, difficulty concentrating and maybe even increased alcohol use. These symptoms may not necessarily initially be considered as linked to stress, but it’s essential to recognise these signs early on, as they can significantly impact daily life and wellbeing should they build up.

Understanding the presenting factors is the first step towards addressing chronic stress. By acknowledging these symptoms, individuals can begin to take proactive steps towards managing their stress levels. It's then helpful to determine whether there might be a specific event linked to these symptoms, which leads us to the next section: precipitating factors.

2: Precipitating Factors - Identifying the Triggers

Precipitating factors are the events or situations that trigger or worsen chronic stress. These can include significant life changes such as job or life stress, or perhaps a sudden, stressful event that has been overwhelming. These are the acute or (more often) cumulative events that have happened along the way to lead individuals to their current psychological state. We explore any specific stressors or events we can identify to try and explain the trajectory to the presenting symptoms, as well as looking at their history to see whether there may be any underlying reasons for them. Identifying these triggers is crucial in understanding the root causes of stress.

Recognising what triggers stress can empower individuals to develop strategies to mitigate their impact. It's about understanding the 'why' behind the stress and taking steps to manage these triggers effectively.

3: Predisposing Factors - Uncovering the Underlying Vulnerabilities

Predisposing factors are the underlying vulnerabilities that increase the likelihood of developing chronic stress. These can include genetic predispositions and early childhood experiences. Hidden in an individual's history may lie the links between their current symptoms and historical context. When individuals have experienced chronic stress over a long period, for example, through childhood trauma, their nervous systems become adjusted to high levels of cortisol, which can make them vulnerable to stress-related conditions later in life.

By uncovering these underlying vulnerabilities, individuals can better understand their stress responses and work towards building resilience.

4: Perpetuating Factors - The Maintenance Cycle of Chronic Stress

Perpetuating factors are the behaviours, thoughts, and environmental conditions that sustain chronic stress. These can include avoidance behaviour, negative thinking patterns, and unsupportive environments. Here is where we explore the factors in an individual’s environment that may be maintaining the cycle of stress and how we might be able to address these to break the cycle. Addressing aspects such as sleep, nutrition, and physical activity, for example, could help develop a more resilient foundation.

Understanding perpetuating factors empowers individuals to take control of the factors maintaining their stress and implement effective interventions to break free from its grip.

5: Protective Factors - Building Resilience Against Chronic Stress

Protective factors are the elements that help mitigate or buffer against chronic stress. These include strong social support networks, healthy coping mechanisms, and a positive mindset, building resilience to buffer against the other areas we have explored thus far. The aim is to develop insight into their wellbeing and healthy coping mechanisms that will prevent symptoms from escalating. In my experience, this is the key area that will help people understand themselves and what they might need to maintain their wellbeing for the long-term.

By focusing on protective factors, individuals can build resilience and enhance their ability to cope with stress. It's about creating a supportive environment and adopting practices that promote mental wellbeing.

Conclusion

Understanding chronic stress through the lens of the 5P's – Presenting, Precipitating, Predisposing, Perpetuating, and Protective factors – provides a comprehensive framework for managing and overcoming it. Each factor plays a critical role in the complex interplay of stress, and addressing them holistically can lead to profound improvements in mental health and wellbeing.

Building resilience is a journey that involves developing a positive mindset, healthy coping strategies, and emotional intelligence. By focusing on these protective factors, we can enhance our ability to manage stress and prevent it from escalating in the future. It's about creating an environment that supports our mental wellbeing and adopting practices that promote a balanced and fulfilling life.