has just launched its fully updated site as of May 27, 2024. Please contact us at for any questions or need for user support.

STM8282 - Understanding Stress: An In-depth Guide for the Mental Health Clinician


by Charles D. Safford, LCSW

Charlie Safford is the president and owner of
Mr. Safford has over twenty years of post-masters experience as a clinical therapist. In addition to his work as a therapist, he has been a trainer and training developer for over twenty years. Copyright Notice

This course is the copyrighted property of and may not be copied in part or in entirety without the express written permission of For information on how to secure permission to use this course or any part of this course, contact us at




The objectives of this course are to provide the trainee with an in-depth understanding of stress and stress management. When the trainee completes this course, he or she will understand:

- the physiological mechanisms behind the stress response,
- the effects of stress over time
- both theoretical and practical solutions to stress management.

This beginning-intermediate level course is primarily designed for clinicians in the early to intermediate stages of their career, or for clinicians seeking a detailed review of the basic concepts in this area.


Section I: Introduction - What is Stress?
Section Two: The Stress Information Processing System
Section Three: The Response Evaluation Process
Section Four: The Physiology of Stress
Section Five: The Physiology of Stress Over Time
Section Six: Managing Stress
Section Seven: Practical Approaches to Stress Management
Section Eight: Internal Approaches to Stress Management
Section Nine: Stress Management with Deeper Levels of Stress
Section X: Stress Management Handouts
References and Test


Scenario for Analysis

Gloria P. is a 26 year-old, single white female who has come to the emergency room. She reports that she fears she is having a heart attack. Gloria states that she began to feel “awful” when dressing for work this morning -- like she may be having a heart attack and dying. When the physician asks for details, she describes her symptoms as shortness of breath, rapid heart rate, chest pains, sweating, shaking, nauseous, and fear that she is going to die. She says that she was so frightened that she asked her family to bring her to the ER. She also explains that she has had three of these “attacks” in the past month, but never before the last month and now she is really worried.

She tells the physician that she does not understand what is happening to her and feels very scared. Gloria also explains that she is going through a break-up with her boyfriend and has been very upset. She tells the physician that she works full-time and also attends college, but that she has not been concentrating very well lately. She describes a lifestyle of healthy eating, intense exercise, and a drive to be successful.

She reports that she tries to live up to her and her family’s expectations for success, which she admits is sometimes hard. She reports that she feels stressed out all the time, and has been feeling stressed out for much of the last several years. She reports that she had been successful in holding things together through exercise, meditation, and prayer, but with the ending of her relationship, it seemed to throw her over the edge. After a late night at work, drinking coffee to stay focused, she started to feel a slight sense of panic come over her. She thought a good night's sleep would solve that problem and she would be able to move things forward - until this morning when her panic exploded full force and she was no longer able to contain it.


Section I: Introduction - What is Stress?

All mental health clinicians are familiar with stress. We see it in our clients and experience it in our own lives. Most mental health clinicians have had some training or education concerning stress. For this reason, this training program will assume some degree of knowledge on the part of the trainee.

However, the capacity to provide good information and skilled psychoeducation on stress is a foundational skill for any clinician in the 21st century. Even if stress is not the primary problem that is being addressed in clinical work, it is almost always a component of treatment. It can be a significant impediment to addressing other problems in treatment, as the presence of stress almost inevitably serves as a drain on emotional resources that could otherwise be applied to the other work of treatment.

The trouble in providing good psychoeducation on stress is that stress is not a simple thing. It involves many parts of each person's brain and body, bringing in different response mechanisms at different points in time. While clinicians may reasonably expected to have some level of knowledge of the science behind stress and stress management, clients will generally not have the background to absorb information on stress management presented as a course in neuroscience. Clients will be much better served with practical information that they can use in their lives.

For this reason, the approach of this course will be to find a successful bridge between 1) the best and most current information on the science of stress and 2) ways of discussing stress that can be easily translated into useful psychoeducational approaches for our clients. When pressed, clinicians must be prepared to present and defend the science – with a solid understanding of the systems and chemistry involved. After all, some of our clients may have a background that allows them to challenge the expert knowledge we bring to the table.

On the other hand, good stress management science will not be helpful to our clients if it is presented in a manner that is over their head. Accordingly, we should be prepared to translate the science into something that is more easily digestible and more readily applied. This will take the form of some relatively practical tips to help clients conceptualize some changes that can be utilized fairly quickly and with good effect.

The starting point for all of this is to create a clear definition of what stress is and why it has such important effects. Stress is anything that is perceived as a threat, a challenge, or, in some cases, an opportunity, as well as the physical, psychological and emotional response to the perceived threat, challenge, or opportunity. (NIMH, 2016)

The challenge, threat or opportunity can come from outside a person, or from inside a person, but until the person perceives the precipitant as being stressful, and has a response, it is not considered stress. This is to say that stress occurs in a system involving Perception, Evaluation, and Response.

The precipitant needs to be perceived, it needs to be evaluated as being worthy of being responded to, and a physiological response needs to be generated in order for it to be considered stress. The perceptual equipment that a person has in this system is complicated. It includes, of course, the five senses that receive input from the external world.

It also includes other input systems that are internal in nature, occurring in the complex regions of a person's own mind. When a person's self-esteem is threatened, for instance, the threat is within one's own mental processes.

There is an important consideration here. Perceiving is different from seeing, or hearing, or smelling. There is an experience to perceiving that is different for everyone. When two people see the same flower, or same attractive person, they are not seeing that thing in exactly the same way. When two people see a spider, and evaluate whether it is a threat, they may have very different ideas, and very different resulting responses.

In working with stress in clients, or in understanding it inside yourself, you need to be aware of this individual aspect of it. You must also be aware that because stress is perceived, it does not necessarily have to be evoked by things or events that are real. It can be evoked by items that exist only in the mind or imagination of a person. Because of the way the brain is constructed and organized, a precipitating event or item that isn't real can create just as powerful a stress reaction as one that is real.

Furthermore, it is often much easier to make something real go away than it is to make something go away that wasn't there in the first place. This can have a tremendous impact on how well stress can be managed.

The beginning section of our training on stress will cover three important areas. The first will be concerned with the different ways that we receive and evaluate information as part of perceiving whether any event is a threat, a challenge, or an opportunity.

The second area will look at the different kinds of internal and external events that can cause us to perceive something as stressful.

The third part will look in some depth and detail at the body's stress response. We'll see what the body does to bring different resources to bear on handling the challenge or threat over time.

This comprehensive look at the systems that are involved in perceiving, evaluating, and responding to stress will prepare us for greater understanding of how to manage stress.

Review Questions for Section I

At this point in the training, the trainee should be able to answer the following questions:

In addition to response, what are the components of the stress reaction?

Why is perception important to understand in terms of stress?