Page 88 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

62 Chapter 3. Stress

This prolonged experience of stress can significantly
lower the immune functioning and the lower levels of vari-
ous inflammatory cytokines and enzymes that are influential
in tissue repair (Upton 2011a , b ), and in the case of wound
care, delayed wound healing. Such changes in cytokine and
enzyme levels could explain the relationship between
reduced wound healing and stress (Marucha et al. 1998 ).
Physiologically, prolonged stress can lead to raised levels of
the hormone cortisol. Although stress isn’t the only reason
that cortisol is secreted into the bloodstream, it has been
termed “the stress hormone” because it is secreted in higher
levels during the body’s ‘fight or flight’ response to stress
(Ebrecht et al. 2004 ). Higher and more prolonged levels of
cortisol in the bloodstream have been shown to have nega-
tive effects on the body including, increased heart rate,
higher blood pressure and lowered immunity and inflamma-
tory responses in the body.
Psychologically, stress can increase the likelihood of
patients making cognitive errors or negative appraisals, for
example perceiving a dressing removal as an unpleasant
experience, which can result in detrimental effects to the
wound healing process and/or avoidance of treatment. Thus
negative emotional responses affect biological and behav-
ioural responses which feed back to further negatively affect
the emotional response to pain, producing a continuous cycle
(Adams et al. 2006 ) with delayed wound healing as a conse-
quence. It is important for clinicians to recognise that pain
and stress are both comprised of complex interactions
between physiological, psychological and social factors (see
Table 3.1 ).
Although the GAS model provided an insight into the
physiological stress process, it regards the individual as
responding to a stressor, with stress being a linear stimulus-
response framework. In doing so it ignores the role of psy-
chological factors and individual differences. Hence, Lazarus
and Folkman ( 1984 , 1987 ) developed an alternative model
that integrated the potential for psychological variables: the
interactional model of stress.