MODULE 12 (GEC 1: Less Stress, More Care)

LESSON 12: LESS STRESS, MORE CARE

LESSON OBJECTIVES
At the end of this lesson, you should be able to:
1. explain the effects of stress to one's health;
2. examine cultural dimension of stress and coping; and
3. design a self-care plan.

LEARNING CONTENT
INTRODUCTION
The American Psychological Association (2017) has these statements about stress: "Stress is
often described as a feeling of being overwhelmed, worried, or run-down. Stress can affect
people of all ages, genders, and circumstances and can lead to both physical and
psychological health issues. By definition, stress is any uncomfortable 'emotional experience
accompanied by predictable biochemical, physiological, and behavioral changes.' Some stress
can be beneficial at times, producing a boost that provides the drive and energy to help
people get through situations like exams or work deadlines. However, an extreme amount of
stress can have health consequences and adversely affect the immune, cardiovascular,
neuroendocrine and central nervous systems."
Since stress is inevitable to life, we have to learn how to handle and cope up with it. More so,
we have to be familiar with other approach to a healthy lifestyle, which is self-care.

ABSTRACTION
Stress and Human Response
The American Institute of Stress (AIS) has distinguished different •types of stress and the
human response to it.
Hans Selye defined stress as the body's nonspecific response to any demand, whether it is
caused by or results in pleasant or unpleasant stimuli. It is essential to differentiate between
the unpleasant or harmful variety of stress termed distress, which often connotes disease, and
eustress, which often connotes euphoria. Eustress is stress in daily life that has positive
connotations, such as marriage, promotion, baby, winning money, new friends, and
graduation. On the other hand, distress is stress in daily life that has negative connotations
such as divorce, punishment, injury, negative feelings, financial problems, and work
difficulties (AIS 2017).
During both eustress and distress, the body undergoes virtually the same nonspecific
responses to the various—positive or negative stimuli acting upon it. However, eustress
causes much less damage than distress. This demonstrates conclusively that it is how an
individual accepts stress that determines ultimately whether the person can adapt successfully
to change (AIS 2017).
Selye hypothesized a general adaptation or stress syndrome. This general stress syndrome
affects the whole body, Stress always manifests itself by a syndrome, a sum of changes, and
not by simply one change (AIS 2017).

The general stress syndrome has three components:

1. The alarm stage — represents a mobilization of the body's defensive forces. The
body is preparing for the "fight or flight" syndrome. This involves a number of
hormones and chemicals excreted at high levels, as well as an increase in heart rate,
blood pressure, perspiration, and respiration rate, among others.
2. The stage of resistance — the body becomes adåptive to the challenge and even
begins to resist it. the length of this stage of resistance is dependent upon the body's
innate and stored adaptation energy reserves and upon the intensity of the stressor.
Just as any machine wears out even if it has beenoroperly maintained, the same thing
happens with living organisms—sooner or later they become the victim of this
constant wear and tear process. The acquired adaptation is lost if the individual is
subject to still greater exposure to the stressor. The organism then enters into the third
and final stage.
3. The exhaustion stage — the body dies because it has used up its resources of
adaptation energy. Thankfully, few people ever experience this last stage.

Stress diseases are maladies caused principally by errors in the body's general adaptation
process. They will not occur when all the body's regulatory processes are properly checked
and balanced. They will not develop when adaptation is facilitated by improved perception
and interpretation. The biggest problems with derailing the general stress syndrome and
causing disease is an absolute excess, deficiency, or disequilibrium in the amount of adaptive
hormones. For example, corticoids, Adrenocorticotropic Hormone (ACTH), and growth
hormones are produced during stress. Unfortunately, if stress is induced chronically, our
defense response lowers its resistance since fewer antibodies are produced and an
inflammatory response dwindles (AIS 2017).
In the article "Understanding Stress Response" of the Health Harvard Journal (2017), it
further discussed chronic stress and human body response:
"Chronic stress is unpleasant, even when it is transient. A stressful situation—whether
something environmental, such as a looming work deadline, or psychological, such as
persistent worry about losing a job—can trigger a cascade of stress hormones that produce
well-orchestrated physiological changes. A stressful incident can make the heart pound and
breathing quicken. Muscles tense and beads of sweat appear."
This combination of reactions to stress is also known as the "fight-or-flight" response
because it evolved as a survival mechanism enabling people and other mammals to react
quickly to life-threatening situations. The carefully orchestrated yet near-instantaneous
sequence of hormonal changes and physiological responses helps someone to fight the threat
off or flee to safety. Unfortunately, the body can also overreact to stressors that are not life-
threatening, such as traffic jams, work pressure, and family difficulties. Over time, repeated
activation of the stress response takes a toll on the body. Research suggests that chronic stress
contributes to high blood pressure, promotes the formation of artery-clogging deposits, and
causes brain changes that may contribute to anxiety, depression, and addiction. More
preliminary research suggests that chronic stress may also contribute to obesity, both through
direct mechanisms (causing people to eat more) or indirectly (decreasing sleep and exercise)
(Health Harvard 2017).
The stress response begins in the brain. When someone confronts an oncoming car or
other danger, the eyes or ears (or both) send the information to the amygdala, an area of the
brain that contributes to emotional processing. The amygdala interprets the images and
sounds. When it perceives danger, it instantly sends a distress signal to the hypothalamus
(Health Harvard 2017).
When someone experiences a stressful event, the amygdala, an area of the brain that
contributes to emotional processing, sends a distress signal to the hypothalamus. This area of
the brain functions like a command center, communicating with the rest of the body through
the nervous system so that the person has the energy to fight or flee. (Health Harvard 2017).
The hypothalamus is a bit like a command center. This area of the brain communicates
with the rest of the body through the autonomic nervous system, which controls involuntary
body functions like breathing, blood pressure, heartbeat, and the dilation or constriction of
key blood vessels and small airways in the lungs called bronchioles. The autonomic nervous
system has two components, the sympathetic nervous system and the parasympathetic
nervous system. The sympathetic nervous system functions like a gas pedal in a car. It
triggers the fightor-flight response, providing the body with burst of energy so that it can
respond to perceived dangers. The parasympathetic nervous system acts like a brake. It
promotes the "rest and digest" response that calms the body down after the danger has passed
(Health Harvard 2017).
After the amygdala sends a distress signal, the hypothalamus aOtivates the sympathetic
nervous system by sending signals through the autonomic nerves to the adrenal glands. These
glands respond by pumping the hormone epinephrine (also known as adrenaline) into the
bloodstream. As epinephrine circulates through the body, it brings on a number of
physiological changes. The heart beats faster than normal, pushing blood to the muscles,
heart, and other vital organs. Pulse rate and blood pressure go up. The person undergoing
these changes also starts to breathe more rapidly. Small airways in the lungs open wide. This
way, the lungs can take in as much oxygen as possible with each breath. Extra oxygen is sent
to the brain, increasing alertness. Sight, hearing, and other senses become sharper.
Meanwhile, epinephrine triggers the release of blood sugar (glucose) and fats from temporary
storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all
parts of the body (Health Harvard 2017).
All of these changes happen so quickly that people are not aware of them. In fact, the
wiring is so efficient that the amygdala and hypothalamus start this cascade even before the
brain's visual centers have had a chance to fully process what is happening. That is why
people are able to jump out of the path of an incoming car even before they think about what
they are doing. As the initial surge of epinephrine subsides, the hypothalamus activates the
second component of the stress response system known as the hypothalamic pituitary adrenal
(HPA) axis. This network consists of the hypothalamus, the pituitary gland, and the adrenal
glands. The HPA axis relies on a series of hormonal signals to keep the sympathetic nervous
system— the "gas pedal"—pressed down. If the brain continues to perceive something as
dangerous, the hypothalamus releases corticotropinreleasing hormone (CRH), which travels
to the pituitary gland, triggering the release of ACTH. This hormone travels to the adrenal
glands, prompting them to release cortisol. The body thus stays revved up and on high alert.
When the threat passes, cortisol levels fall. The parasympathetic nervous system—the
"brake"— then dampens the stress response (Health Harvard 2017).
Persistent epinephrine surges can damage blood vessels and arteries, increasing blood
pressure and raising risk of heart attacks or strokes. Elevated cortisol levels create
physiological changes that help to replenish the body's energy stores that are depleted during
the stress response. But they inadvertently contribute to the buildup of fat tissue and to weight
gain. For example, cortisol increases appetite, so that people will want to eat more to obtain
extra energy. It also increases storage of unused nutrients as fat. Chronic low-level stress
keeps the HPA axis activated, much like a motor that is idling too high for too long. After a
while, this has an effect on the body that contributes to the health problems associated with
chronic stress (Health Harvard 2017).

Techniques to Counter Chronic Stress

Several techniques to counter chronic stress were presented in the same article (Health
Harvard 2017):
1. Relaxation response
Dr. Herbert Benson, director emeritus of the Benson-Henry Institute for Mind
Body Medicine at Massachusetts General Hospital, has devoted much of his career to
learning how people can counter the stress response by using a combination of
approaches that elicit the relaxation response. These include deep abdominal
breathing, focus on a soothing word (such as peace or calm), visualization of tranquil
scenes, repetitive prayer, yoga, and tai chi.
Most of the research using objective measures to evaluate how effective the
relaxation response is at countering chronic stress have been conducted in people with
hypertension and other forms of heart disease. Those results suggest the technique
may be worth trying, although for most people it is not a cure at all. For example,
researchers at the Massachusetts General Hospital conducted a double-blind,
randomized controlled trial:of 122 patients with hypertension, ages 55 and older, in
which half were assigned to relaxation response training and the other half to a control
group that received information about blood pressure control. After eight weeks, 34 of
the people who practiced the relaxation response—a little more than half—had
achieved a systolic blood pressure reduction of more than 5 mm Hg, and were
therefore eligible for the next phase of the study, in which they could reduce levels of
blood pressure medication they were taking. During that second phase, 50% were able
to eliminate at least one blood pressure medication—significantly more than in the
control group, where only 19% eliminated their medication.
 2. Physical activity
People can use exercise to stifle the buildup of stress in several ways. Exercise, such
as taking a brisk walk shortly after feeling stressed, not only deepens breathing but
also helps relieve muscle tension. Movement therapies such as yoga, tai chi, and qi
gong combined with fluid movements, with deep breathing, and mental focus, all of
which can induce calm.
3. Social support
Confidants, friends, acquaintances, co-workers, relatives, spouses, and companions all
provide a life-enhancing social net, and may increase longevity. It is not clear why,
but the bufféring theory holds that people who enjoy close relationships with family
and friends receive emotional support that indirectly helps to sustain them at times of
chronic stress and crisis.

The Cultural Dimension of Stress and Coping

Ben Kuo (2010) reviews studies on cultural dimensions of stress and coping. His
study, "Culture's Consequences on Coping: Theories, Evidences, and Dimensionalities,"
published in the Journal of Cross-Cultura/ Psychology had the following findings:
Stress and coping research constitutes one of the most intensively studied areas within
health, social, and psychological research because of its broad implications for understanding
human well-being and adaptation. Early thesis on stress and coping, the interwoven
relationship of culture and stress responses was implicated, conceptually. The thesis
postulated that a person's internalized cultural values, beliefs, and norms affect the appraisal
process of stressors and the perceived appropriateness of coping responses. Accordingly,
these cultural factors delimit the coping options available to an individual in the face of
stress. As follows, stress and coping are universal experiences faced by individuals regardless
of culture, ethnicity, and race, but members of different cultures might consider and respond
to stressors differently with respect to coping goa19, strategies, and outcomes.
Kuo's study identified and revealed compelling evidence for cultural variations and
specificities on coping based on theoretical and empirical findings generated over the last two
decades' cultural coping research. Based on the broad problem-versus-emotion-focused
coping nomenclature, repeated studies have pointed to the prevalence of "emotion-focused,"
"indirect," "passive," or "covert," "internally target," or "secondary control" coping among
individuals of Asian backgrounds, as well as, to a lesser extent, among individuals of African
and Latino backgrounds. Specifically, the avoidance, withdrawal, and forbearance coping
methods are common among Asians, while spiritual, religious, and ritualbased coping are
common among African-Americans and African-Canadians. Additionally, spiritual and
religious coping and coping through family support are common among individuals of
Latino/Latina backgrounds (Kuo 2010).
Furthermore, emotion-focused coping has been shown to be beneficial (e.g., reducing
distress) forAsian-Americans and Asian-Canadians in dealing with various stressors,
including family conflicts and racial discrimination. Problemfocused coping has also been
found to be effective for Asian-Americans and Asian-Canadians in responding to male
gender conflicts, racial discrimination, and cross-cultural adjustment. For non-Asians,
emotion-focused coping was shown to be negative in increasing stress for African-American
adult caregivers but problem-focused coping was shown to be negative in exacerbating stress
for Hispanic-American college students in facing family conflicts, As evident, the existing
knowledge on the adaptive quality of different coping strategies is currently incomplete and
inconclusive and necessitates further research (Kuo 2010).
The current review also highlighted the salience of "collective coping" approaches
among culturally diverse individuals, including Asians, AfricanAmericans, and Latino-
Americans, based on more recent research. This distinctive domain of coping represents the
collective and interdependent characteristics of many ethnic minorities which is a critical
aspect of coping, overlooked by both the extant coping and the cultural coping literature until
recently. As has already been demonstrated in a number of recent published studies, to fully
represent and account for the coping system of ethnic minority individuals, an integrated
approach incorporating conventional and culture-based collective coping measures is
imperative (Kuo 2010).
Finally, this review also points to coping's link to: (a) broad societal climate, such as
collectivism-individualism and independent-interdependent cultural norms; (b) individuals'
acculturation and ethnic identity; (c) primary/internally versus secondary/externally
controlled orientations; (d) accessibility and attitudes toward seeking social and family
support; and (e) degrees of religious/spiritual beliefs and identifications. Together, these
findings further underscore the significance of person-cultural environment interaction in the
coping process and provide corroborating evidence in support of the contextual and
transactional theories of coping (Kuo 2010).
However, the said syntheses need to be interpreted with caution in view of several
limitations. First, it should be noted that the way in which types of coping were defined,
categorized, and measured; varied quite significantly from study to study and would likely
have skewed the findings and the conclusions drawn and reduced the comparability across
studies.
Second, the relationship between coping methods and coping outcomes is not
straightforward but is moderated by a constellation of contextual and personal factors as
suggested by the theoretical models reviewed earlier. Empirical data, in fact, have evidenced
the effects ofa person's perceived "intensity" and "controllability" of the stressor and cultural
orientations (e.g., acculturation, self-construals) on coping. Lastly, it should be recognized
that an individual's actual coping system often comprises a complex and diverse range of
coping behaviors. For instance, Chinese-Canadian adolescents were found to engage in
collectivistically based coping, in conjunction with individualistically. based coping when
dealing with interpersonal conflict, adjustment stress, and gender role-related stress. Those
qualitatively and functionally opposite coping strategies should not automatically be
construed as mutually exclusive within culturally diverse individuals (Kuo 2010).

Self-care Therapy
A positive way to counter stress is self-care therapy. Nancy Apperson (2008) of Northern
Illinois University has provided steps for self-care:
Stop, breathe, and tell yourself: "This is hard and / will get through this one step at a time."
During an unexpected event or crisis, we are faced with dealing with a new reality and it
takes time to incorporate what happened into our everyday lives. Identify the steps you need
to take first, write them down, and focus on each step one at a time. If you look at everything
you have to do, you will become ovenNhelmed. Remember you can only do one thing at a
time and focus exclusively on that one thing.
Acknowledge to yourself what you are feeling. All feelings are normal so accept whatever
you are feeling. Once you recognize, name, and accept your feelings, you feel less out of
control. You can then find a comfortable place to express your feelings. During periods of
extreme stress and grief, it is very hard to hold back your feelings, particularly your tears and
anger. This is normal so describe this as grieving or sadness or anger. You are not falling
apart. You are grieving or feeling angry or sad. It is important during this time of intense
feelings to own your feelings and NOT hurt yourself or lash out at someone else.
Find someone who listens and is accepting. You do not need advice. You need to be heard.
Sharing our story is how we begin to accept whatever happened and integrate it into our new
reality. It may be that you just need to let go of your expectations of how things should be
and talking about your feelings and beliefs is the beginning of that process.
Maintain your normal routine as much as possible. Making everyday decisions—deciding to
get dressed, doing the dishes, or going to work—gives you a sense of control and feels
comforting as it is a familiar activity. Be realistic with what you can do and remember
everything right now will take you longer to do. Avoid making major decisions based on the
stress you feel right now.
Allow plenty of time for a task. You will not be as productive as you normally are. Accept
how much you are able to do right now and recognize it will not be this way forever. During
periods of extreme stress, prolonged stress, or after a crisis, your ability to concentrate and
focus on tasks is diminished and it will take time for your concentration to return so give
yourself extra time and be gentle and accepting of yourself and what you can do.
Take good care of yourself. Remember to:
a. Get enough rest and sleep. Sleep at least six hours and not more than nine hours. If
you are having difficulty sleeping, listen to peaceful or slow music and/or do
progressive relaxation before you go to sleep. Sleep helps our body heals and
strengthens our immune system.
b. Eat regularly and make healthy choices. Skipping meals, particularly breakfast,
contributes to fatigue, mood swings, and poor concentration. Healthy food choices
(not high in simple sugars) maintain blood sugar level, energy, and concentration of
the body.
c. Know your limits and when you need to let go. Some problems are beyond our
control. if something cannot be changed, work at accepting it for what it is. Resist the
urge to fix the unfixable or try to control the uncontrollable. Sometimes a mantra
helps: "It is what it is, I just need to accept it." For things within your control,
remember that change takes time. If you are holding on and need to let go, journal-
about it.
 d. Identify or create a nurturing place in your home. A rocking chair, a nice view, and a
soothing music are important components to a nurturing place. Twenty minutes of
spending in a rocking chair reduces both your physical pain and anxiety. It is like
giving yourself a hug. Music and nature sounds nurture our being and lifts our spirits.

e. Practice relaxation or meditation. Go to your nurturing place and listen to guided

relaxation tapes. Time spent in meditation or prayer allows your mind and body to
slow down and let go of the stress. Take a mental vacation in the midst of stress by
relaxing your body, shutting your eyes, and visualizing yourself in your favorite
vacation spot or quiet haven.

f. Escape for a while through meditation, reading a book, watching a movie, or taking a
short trip.

Self-compassion Therapy
Self-compassion is another way to counter stress. Kristin Neff (2012) has discussed
self-compassion in her article, "The Science of Self-Compassion."
"Self-compassion entails being warm and understanding toward ourselves when we
suffer, fail, or feel inadequate, rather than flagellating ourselves with self-criticism. It
recognizes that being imperfect and experiencing life difficulties is inevitable, so we soothe
and nurture ourselves when confronting our pain rather than getting angry when life falls
short of our ideals. We clearly acknowledge our problems and shortcomings without
judgment, so we can do what is necessary to help ourselves. We cannot always get what we
want. We cannot always be who we want to be. When this reality is denied or resisted,
suffering arises in the form of stress, frustration, and self-criticism. When this reality is
accepted with benevolence, however, we generate positive emotions of kindness and care that
help us cope. Self-compassion recognizes that life challenges and personal failures are part of
being human, an experience we all share. In this way, it helps us to feel less desolate and
isolated when we are in pain."

Self-compassion Phrases
Neff provided self-compassion phrases when feeling stress or emotional pain, perhaps
when you are caught in a traffic jam, arguing with a loved one, or feeling inadequate in some
way. It is helpful to have a set of phrases memorized to help you remember to be more
compassionate to yourself in the moment. You can take a deep breath, put your hand over
your heart, or gently hug yourself (if you feel comfortable doing so), and repeat the following
phrases:
 This is a moment of suffering.
 Suffering is a patt of life.
 May I be kind to myself.
 May I give myself the compassion I need.
 These phrases capture the essence of the three components of selfcompassion. The first
phrase helps to mindfully open to the sting of emotional pain. (You can also just simply say
"This is really hard right now" or "This hurts.") The second phrase reminds us that suffering
unites all living beings and reduces the tendency to feel ashamed and isolated when things go
wrong in our lives. The third phrase begins the process of responding with self-kindness
rather than self-criticism. The final phrase reinforces the idea that you both need and deserve
compassion in difficult moments. Be experimental with the phrases. Other phrases that may
feel more authentic in a given situation are: "May I accept myself as I am," "May I forgive
myself," or "May I learn to accept what I cannot change." (Neff 2012)

Self-compassion and Emotional Well-being

One of the most consistent findings in the research literature is that greater self-compassion is
linked to less anxiety and depression. Of course, a key feature of self-compassion is the lack
of self-criticism, and self-criticism is known to be an important predictor of anxiety and
depression. However, self-compassion still offers protection against anxiety and depression
when controlling for self-criticism and negative effect. Thus, self-compassion is not merely a
matter of looking on the bright side of things or avoiding negative feelings. Self-
compassionate people recognize when they are suffering, but are kind toward themselves in
these moments, acknowledging their connectedness with the rest of humanity. Self-
compassion is associated with greater wisdom and emotional intelligence, suggesting that
self-compassion represent' a wise way of dealing with difficult emotions. For instance, self-
compassionate people engage in rumination and think suppression less often than those low
in self-compassion. They also report greater emotional coping skills, including more clarity
about their feelings and greater ability to repair negative emotional states. Self-compassion
appears to bolster positive states of being as well. By wrapping one's pain in the warm
embrace of self-compassion, positive feelings are generated that help balance the negative
ones (Neff 2012).

Self-compassion, Motivation, and Health

Research supports the idea that self-compassion enhances motivation rather than self-
indulgence. For instance, while self-compassion is negatively related to perfectionism, it has
no association with the level of performance standards adapted for the self. Self-
compassionate people aim just as high, but also recognize and accept that they cannot always
reach their goals. Self-compassion is also linked to greater personal initiative—the desire to
reach one's full potential. Self-compassionate people have been found to have less
motivational anxiety and engage in fewer self-handicapping behaviors such as procrastination
than those who lack self-compassion. In addition, self-compassion was positively associated
with mastery goals (the intrinsic motivation to learn and grow) and negatively associated with
performance goals (the desire to enhance one's self-image) found on the study of Deck in
1986. This relationship was mediated by the lesser fear of failure and perceived self-efficacy
of self-compassionate individuals. Thus, selfcompassionate people are motivated to achieve,
but for intrinsic reasons, not because they want to garner social approval. (Neff 2012).
Self-compassion versus Self-esteem
Research indicates that self-compassion is moderately associated with trait levels of self-
esteem as one would expect, given that both represent positive attitudes toward the self.
However, self-compassion still predicts greater happiness and optimism as well as less
depression and anxiety when controlling for selfesteem. Moreover, the two constructs differ
in terms of their impact on well-being. Also, self-esteem had a robust association with
narcissism while self-compassion had no association with narcissism. In contrast to those
with high self-esteem, self-compassionate people are less focused on evaluating themselves,
feeling superior to others, worrying about whether or not others are evaluating them,
defending their viewpoints, or angrily reacting against those who disagree with them. Self-
esteem is thought to be an evaluation of superiority/inferiority that helps to establish social
rank stability and is related to alerting, energizing impulses and dopamine activation. While
self-esteem positions the self in competition with others and amplifies feelings of distinctness
and separation, self-compassion enhances feelings of safety and interconnectedness (Neff
2012).

Self-compassionate Letter
An example of a self-compassion exercise is the self-compassionate letter. This exercise has
been used in therapeutic programs. Below are the steps in doing the self-compassionate letter
exercise as provided by Neff (2012):
1. Candidly describe a problem that tends to make you feel bad about yourself, such as a
physical flaw, a relationship problem, or failure at work or school. Note what
emotions come up—shame, anger, sadness, fear—as you write.
2. Next, think of an imaginary friend who is unconditionally accepting and
compassionate; someone who knows all your strengths and weaknesses, understands
your life history, your current circumstances, and understands the limits of human
nature.
3. Finally, write a letter to yourself from that perspective. What would your friend say
about your perceived problem? What words would he or she use to convey deep
compassion? How would your friend remind you that you are only human? If your
friend were to make any suggestions, how would they reflect unconditional
understanding?
4. When you are done writing, put the letter down for a while and come back to it later.
Then read the letter again, letting the words sink in, allowing yourself to be soothed
and comforted.

Less Stress, Care More

We should be in control of the stress that confronts us every day. Otherwise, when we are
overwhelmed by stress, it can be detrimental to our health. Self-care and self-compassion are
two ways to positively confront stress. We should love and care for our self more and more
each day.
REFERENCES
 American Psychological Association. n.d. "Five TIPS to Manage Stress." Accessed
October 31 , 2017. http://www.apa.org/helpcenter/manage-stress.aspx.
 American Psychological Association. n.d. "Understanding Chronic Stress." Accessed
October 31 , 2017. http://www.apa.org/helpcenter/understandingchronic-stress.aspx.
 Apperson, Nancy. 2008. "Tips For Taking Care of Yourself During Stressful Times."
 In Faculty Development and Instructional Design Center, Northern Illinois University
(Online). Accessed October 31, 2017. https://www.niu.edu/
facdev/resources/crisis/tipsforstress.shtml.
 Harvard Health Publishing. n.d. "Understanding the Stress Response." Accessed
October 31, 2017. https://www.health.harvard.edu/staying-healthy/ understanding-
the-stress-response.
 Kuo, Ben. 2010. "Culture's Consequences on Coping: Theories, Evidences, and
Dimensionalities." In Journal of Cross-Cu/tural Psychology. Vol. 42 Issue 6, 1084—
1100. Accessed October 31, 2017. https://doi. org/10.1177/0022022110381126.
 Neff, Kristin. 2012. "The Science of Self-Compassion." In Compassion and Wisdom
in Psychotherapy edited by C. Germer and R. Siegel. New York: Gilford Press.
Accessed October 31 , 2017. http://self-compassion.org/wp-content/
uploads/publications/SC-Germer-Chapter.pdf.
 Roth, Susan, and Lawrence Cohen. 1986. "Approach Avoidance, and Coping with
Stress." In American Psychologist. Accessed October 31, 2017.
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.455.6019 &rep=repl
&type=pdf.
 Tan, Michael L. 2006. "Stress and Filipino." Philippine Center for Investigative
Journalism. Accessed October 31, 20M 7. http://pcij.org/stories/stress-andthe-
filipino/.
 The American Institute of Stress. n.d. "What is Stress?" Accessed October 31, 2017.
https://www.stress.org/what-is-stress/