CHAPTER 2 LETERATURE REVIEW

The contents in this chapter were divided into five parts as follows: 1. Data from Aranyaprathet Customs House 2. A description of Ban Klongluek Border Market 3. Stressor 4. Stress 4.1 Definition of stress 4.2 The concept of stress 4.3 Stress evaluation 4.4 Stress related outcomes 5. Stress management 5.1 The concept of coping 5.2 The concept of stress management

Data from Aranyaprathet Customs House The data from Information and Communication Technology, by the cooperation of Custom House indicates that overall business on the borderland of Thailand have increased every year by millions of baht since 1997. Comparison between all Thailand - business shows borderland International business is 75% of all International business between Thailand and Cambodia as show table 2-1. Borderland businesses are mainstays of economy in this area of country. Sakaeo Province is an eastern province of Thailand where has the boundary contacts with the Cambodia. In 2007, Aranyaprathet Custom House and Chanthaburi Custom House had total trade value 18,468 and 14,432 million baht, respectively. This market has a lot of tourists, about 10,000 persons per day, circulating funds of about 100-200 million baht as show table 2-2 and table 2-3.

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Table 2-1 Comparison between International business is Thailand-Cambodia business and Thailand -Cambodia business borderland (1997-2007)

Year International Border Line Amount* % Amount* % 1997 11,825 100 8,271 70 1998 13,413 100 10,041 75 1999 13,939 100 10,496 75 2000 14,230 100 11,250 79 2001 21,316 100 15,743 74 2002 22,621 100 18,850 83 2003 29,184 100 17,782 61 2004 30,204 100 23,530 78 2005 38,138 100 31,128 82 2006 48,326 100 36,022 75 2007 48,406 100 37,354 77 *(million baht)

Table 2-2 Statistic export-import of Aranyaprathet Customs House (2005-2007)

Year Amount* 2005 2006 2007 Total Value 15,541 17,837 18,468 Export value 14,712 16,642 17,162 Import value 829 1,195 1,307 Balance of Trade +13,883 +15,448 +15,855 *(million baht)

Table 2-3 Statistic export-import of Chanthaburi Customs House (2005-2007)

Year Amount* 2005 2006 2007 Total Value 10,105 13,275 14,432 Export value 10,069 13,230 14,380 Import value 36 45 52 Balance of Trade +10,033 +13,185 +14,328 *(million baht)

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Channel for import and export borderline 1. Check Point For Border Trade has eight places 2. Temporary Crossing Point has six places 3. Permanent Crossing Point has six places 3.1 Ban Klongluek, Aranyapathet district, Sakaeo province contact with Poypet, Ojow district, Banteay Meanchey province 3.2 Ban Hadlek, Klong Yai district, Trad province 3.3 Chongjom, Kap Choeng district, 3.4 Ban Lam, Pong Nam Ron district, Chanthaburi province 3.5 Ban Puk Kad, Pong Nam Ron district, Chanthaburi province 3.6 Chongsangum, Phu Sing district, province 4. Geography Crossing Point

A description of Ban Klongluek Border Market

Ban Klongluk Border Parking

Primary Care Unit

Golderngate market

Rongkaue market

Benjawun market C A Detthai market M B O D I A Parking

Figure 2-1 Ban Klongluek Border Market Map

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Ban Klongluek Border Market or Rongklua Market, , Sakaeo province is shown in figure 2-1. Distance across the district is approximately 6 kilometers, in contact with border of Thailand - Cambodia. This market is the biggest Border Line trade market and produces the most income of Sakaeo province. Most people in Ban Klongluek Border Market are Cambodian, Vietnamese and Chinese that emigrate from Phnom Penh, Patdambang and Siemreab but Thai people is only 10-20%.

Stressor Stress is caused by a multitude of demands (stressors), such as an inadequate fit between what we need and what we are capable of, and what our environment offers and what it demands of us. We need a certain amount of responsibility, but our job offers less or demands more. We need a certain amount of work, but get either none at all- unemployment-or too much (Cary Cooper, 2005). Another cause of stress lies in role conflicts. We all play several roles. We are husbands or wives, parents to our children, children to our parents, brothers and sisters, friends and bosses, peers and subordinates-all at the same time. And the ingredients of conflict are easy to find in try on to fill these multiple and sometimes conflicting roles (Cary Cooper, 2005). Stress is cause by many reasons. It maybe caused by persons who get stimulation from objects, persons or environment. The stress is perceived differently by each person. An event getting same stressor is different for many subjects, depending on development of physical, mind, social, and culture of that person. Some academicians mentioned the root cause of stress which is divided into many types. Lazarus (1971) divided causes of stress into two types: 1. Environmental Factor: social, nature, events related health, family and relationship. 2. Individual Factor depends on 2.1 Personality and Trait 2.2 Temperament 2.3 Past Experience 13

Farmer (1962) divided causes of stress into four types: 1. Personal Source: personality, experience and self-concept 2. Financial Source 3. Relational Source 4. Occupational Source Boonhhung (1990) and Keangkeaw (1986) divided cause of stress is 2 groups. 1. Internal force is inside motivation such as physiology change, body structure, and heredity characteristic, stress related with age. 2. External force or said that cause by environment such as physical environment, social, relationship, event related change. Luckmann & Sorenson (1987) mentioned factors of stressor including the following 10 items: 1. Factor of heredity related transition which effect development and growth. 2. Factor of physical and chemical, nature environment such as heat, cool, voice, radiation, pressure of atmosphere as well as chemical in physical, defective of hormone level. 3. Microbe and Parasite cause of disease 4. Factors of mind and emotion caused by the need of person, pan of age, sex, mind impact, injury. 5. Factor of culture, traditional, conflict in value which effect way of life. 6. Emigration or job change, person has to adept with new social. 7. Factor of ecology such as environment changed cause by war that person may not be spend normal life. 8. Factor of occupation, high responsibility, repeatedly, boring easily stressor. By job requirement, working problem and pressure of work related with level of stress which bring about boring of occupation. 9. Technology advancement effect to people in that social face pollution, danger of machine, hazardous as well as some drug interaction may cause of disease. 10. Rapidly change in the future effect to person who could not prepare or adapt well follow changing, getting too many information or many decisions ways. 14

Panpreecha (1991) said that there are many factors that cause of stress such as 1. Internal forces mean the stress that cause of various factors from the body. Two kinds of internal forces are physical and mental. 1.1 Physical cause could be some condition of body that makes stress. The body and mind cannot be separated, so when the body is stressful, the mind is also stressful. Various conditions are the causes, such as: 1.1.1 Exhausted physical, be the condition of incomplete body or had worked hard and a long time. 1.1.2 The body had not enough time to rest, be coming the condition of body that caused of working for a long time 1.1.3 Have meal not enough and do not have the hygienic condition that make exhausted body and caused of stress 1.1.4 Physical sickness 1.1.5 Alcoholic and narcotic condition, alcohol and narcotic effect the nerve that cause the body burn more energy and be exhausted 1.2. Mental cause 1.2.1 Fright or fear, anxiety, anger, sadness, and sorrow; these feelings cause stress 1.2.2 Some feeling, such as feeling of losing fame, honor, pride, making a mistake, fear others, etc. 1.2.3 Anger or spiritual conditions that happen when person is interrupted and confront the problem affect the feeling such as dissatisfied, angry and anxious. 2. External forces mean the factors of outside body that cause the stress. 2.1 Lose a beloved thing such as lose the lover, assets, work, unemployment or discharge, decrease the position, a business becomes bankrupt 2.2 The change of life; in transition, everybody’s life, and mind will vary and be stressful. The transition distance of life such as start school the first time, give first birth, menopause including environmental change make must oneself to adapt, change suddenly that is unexpected or unprepared such as school moving, work moving, migrates, etc. 15

2.3 The harm that menaces the life and assets, both the harm from human and nature, such as living in the area where there are many criminals, being threatened, being in a battlefield, flood, and a fire, etc., these conditions cause the pressure and stress severely. 2.4 Working that causes the stress, such as no safety at work, risks taken while working, unsatisfactory working, not seeing the importance of the work, etc. 2.5 The economic depression, poverty, getting in debt that cause imperfect progress, lack of nutrition, incomplete of studying, stay in the slum, have no safety in life and assets can cause the anxiety, fear, thinking over, force the mind, these cause the stress. 2.6 The state of city social, a lot of people coming to the city to look for job that cause competitive life, compete for a better position, inconvenient travel because of traffic jam, the married life is not warm, individual staying, lack of pure breathe, these conditions cause the stress.

Stress Definition of stress Although several definitions of stress have been developed over the years, this research viewed stress as general consensus. Selye (1978) stated that stress refers to physical and psychological that reaction to threats, both internal and external, that make a result of the changes in the body, causing physical and psychological conditions, on lack of balance. Lazarus (1976) stated that stress is a reaction between individuals and environment that may affect the working of body and mind. Lazarus & Folkman (1984) stated that stress is a reaction between individuals and environment that may affect with their welfare and must use existing resources in the best adaptation. Evidence depends on balancing of demand and supply then stress status depends on each person. Steers (1984) stated that stress is the reaction of people to the stimulus or threat from the environment. 16

Luckman (1987) stated that stress is caused by the internal and external environment of person, disturbing basic needs and balance. Sarafino (1990) state that stress is a condition that results from interactions between people and environment and make people realize the difference between the needs of the situation of people with biological, psychology or social system. Cassemeyer (1995) stated that stress is response in the human body and mind and shown to end the adjustment of a trigger. Rogers (1951:531-532) told that a person feels the self is menaced, causing the anxious feeling, shaking, confusion and be not sure in behavior direction of the self that effected from a person has the inconsistence between human structure which means perception that how oneself is being with the experiences that happen in fact and cause mental procedure to pull out of oneself a prevention mechanism which distorts inflexible perception. Stress is caused by making a mistake, anxiety, refusing in some part of oneself behavior which effects to feel more and more of being menaced. The Department of Mental Health, Ministry of Public Health results (1997) says stress is the changing of mind condition and body which results from adaptation to the stimulant or various motivations in the environment that forces or indicates we should be unhappy and sorrowful. The stress as in the Rachabanditstan Dictionary, 1982 means the symptoms that the brain is not relaxed because of too much in seriousness with the events. Coyne and Holroyd (1982) cited in Kanchanawong (2002) explained that the stress might be interpreted in the way of the motivation. They said the stress might be defined in a form of event especially including 1) The events that effect to disaster (Catastrophic events) such as a fire, boat sinkage, building falling down, storm, earthquake or tornado 2) Important events in life (Major life events), such as losing person that one loves, sickness of person that one loves, unemployment, and 3) The unpleasant environment (Chronic circumstances) such as living in crowed place or having loudness disturbance all the time. 17

Gatchel, Baum, and Krantz (1989) cited in Kanchanawong (2002) explained about the stress that the tension might mean generally that there is pressure. Stress is the serious effect from the pressure that is unsatisfactory, therefore if general people mentions the tension, most of them like to mean two items; the first if we emphasize the pressure a person confronts, show that focus on the stress that is surrounded with events and pressure on a person but if being at the pressure results in a focus on response of the body and mind. In fact, the stress means two items and the stress is complicated because organisms must respond to surrounding events or any psychological events. This is called the motivation effects the stress and feels that, there is challenging or dangerous to the organism. Job stress is the pattern of person that from imbalance between job and knowledge, attitude or ability. It has many the causes, but severe stress indicates that a person can not win the pressure from the work, lack of the ability, cooperation in the work. On the contrary, the worker who gets support from coworkers and supervisors will make the equilibrium, motivation and good health in the future (Houtman,2007). The idea that more of the above can be concluded that stress means the person's reaction to those threats from the environment that affect the work of body and mind. The concept of stress 1. Biological concept of stress Selye (1978) proposed that stress was a biological response: “the state manifested by a specific syndrome which consists of all the non-specifically-induced change within a biological system” He pointed out that a state could be recognized only by its manifestations: for instance, the state of stress by the manifestations of the stress syndrome. He defined stress as an adaptive or defensive reaction to an event or stimulus. With long-term stress exposure, the individual will enter into the third stage, the stage of exhaustion. If the stressor is extremely intense and persists over a long period of time, the exhaustion stage sets in, and the risk of emotional and physical problems increase. In this stage, the individual experiences symptoms of exhaustion, such as loss of morale and feelings of loss of control (Rice, 1999), and a final collapse will occur. 18

2. Cognitive concept of stress In contrast to the biological response definition of stress, Lazarus and Folkman (1984) proposed that an individual’s perception of an event was a direct result of their cognitive appraisal of the event. Two cognitive process, appraisal and coping, are important to the person/environment transaction. From this point of view, cognitive appraisal is a process of either consciously or unconsciously evaluation one’s performance while interacting with the environment (Lazarus, 1999). According to Lazarus and Folkman (1984), cognitive appraisal is the evaluative process used by individual to determine why and to what extent a particular transaction or series of person-environment transactions result in stress. Lazarus (1999) proposed that increasing levels of dysfunctional stress occur when an individual perceives that they do not have the necessary interpersonal and/or physical resources to successfully negotiate or cope with the demands or pressures emanating from the environment. From Lazarus (1999) perspective, cognitive appraisal essential for understanding stress for two reasons: to understand the difference in factors among individuals under an event and the factors affecting this interaction, and secondly to distinguish between normal and dangerous situations in which individuals survive and flourish. Before proceeding, some appraisal-related terminologies in the cognitive appraisal of stress should be clarified. Lazarus (1999) described three types of cognitive appraisal-primary- secondary and reappraisal-that individuals use to evaluate their situation. Primary appraisal is an evaluation of what is at stake. Primary appraisal describes the way people evaluate a potentially stressful situation in relation to their own goals, commitments, values and beliefs about self and the word, and situational intentions. Goal commitment has been found to be a stronger factor influence on action than values (Lazarus, 1999). One can have values without acting in their interest, but in terms of their goal commitment, a stress reaction will not occur because there is nothing of adaptation important to interrupt the individual’s routine. In contrast, if an individual perceives a situation as harmful, threatening or challenging, stress and its related emotions will occur. Lazarus (1999) concluded that as a result, when the condition of stress is occurring, an individual would make an appraisal. 19

The view of stress from both Cox (1987) and Lazarus and Folkman (1984) focuses on the concept of demand. A demand in their point of view means a request or requirement for physical or mental action, and implies some time constraint (Cox, 1987). A demand is an important concept and as Cox (1987) pointed out, stress may arise when there is an imbalance the perceived demand and the person’s perception of his capability to meet the demand. 3. Social concept of stress Slavin, Rainer, McCreary, and Gowda (1991) extended the cognitive appraisal theory of Lazarus and Folkman (1984) into a social stress theory by proposing a multicultural model of stress. Salvin et al. argued that the Lazarus and Folkman (1984) theory reflected a white or Euro-centric culture bias in its basic assumption by emphasizing individual goals and achievement. In contrast, other cultures focus on harmony and the well-being of the family, tribe, or group affects the nature and frequency of stressful events. Secondly, a member of oppressed groups has an increased likelihood of experiencing acts of discrimination. Thirdly, those who are of lower socio-economic status, poor, or lack political power face greater stress than advantage groups due to monetary and lifestyle restraints. Finally, a social custom unique to the person’s culture can result in prolonged perceived threat of discrimination and the stressful conditions of poverty and racism can lead to a chronic state of hyper-attention and hyper-sensitivity to events. This model is offered as an extension to the cognitive appraisal theory, and may be useful in terms of conceptualizing the individual’s interpretation of stressful events in relation to socio- culture factors. To sum up, Selye (1978) clearly focused in stress as a biological response of an individual to a wide range of stimuli. Selye emphasized the non-specific nature of the stress response. In Selye’s system, the precise nature of the source of stress is unimportant, as the physiological stress response does not depend on the nature of stressors. The psychological approach to stress is the best represented by the work of Lazarus and Folkman (1984). They claimed that cognitive appraisal is the key to stress response. Lazarus and Folkman argued that it is the individual’s perception of an event that plays major role in the stress response. Individual perception is a combination the perception of threatening model of stress. They suggested that 20 membership of culture groups can affect the nature and frequency of certain stressors and that a member of an oppressed groups has increased likelihood of experiencing acts of discrimination. Also, those of lower socio-economic status, or who lack political power, or have social costumes unique to the person’s culture, can have alternative forms of stress coping. Stress evaluation 1. Self-report; Cohen & Kessler (1995) said that taking notes for what is express by the emotion i.e. Speech, behavior such as being upset, complaining, being exhausted, sighs, agitation, anorexia, weight decreases, insomnia or sleeping too much is the focus of the observation. Taking notes makes us understand oneself more. That can show us how the tensions occur. 2. Using questionnaire or interview created to detect the tension by calculation to compare with standard points of the test that show how much of tensions such as 2.1 Stress Inventory; developed by the Department of Mental Health, Ministry of Public Health, it has 4 ordinal rating scales and 20 items to inquire about the symptoms, behavior or unusual feeling in the past. Points interval aim 0 to 3 as following, 0 as never, 1 as occasionally, 2 as often and 3 as regularly, 6-17 points translations are in the normal level of tension, 18-25 points are in the little higher than normal level of tension , 26-29 points are in the medium higher than normal level of tension, 30-60 points are in high-level more than normal level of tension (Department of Mental Health ,2003) which assessment form are established as tension conceptual frame of Selye, 1976. 2.2 Health Opinion Survey (HOS); This is to explore reaction behavior when a person receives the tension. Seubsaman had modified from McKillion’s exploration form established in 1957 by calculating of content validity which value 0.86 and accuracy which value 0.87 (Seubsaman cite in Upala ,1999). Three ordinal rating scales 20 of items ask about unusual symptoms, physical symptoms are 18 items and the mind 2 items about that express of the adapting to tension. Scoring is 1 to 3 interval as following; 1 as no symptoms, 2 as little, 3 as often (Pattrayuttawat, 2002), which assessment form established follow tension conceptual frame of Selye. 21

2.3 Symptom of Stress Inventory (SOS); This is the exploration form to assess the tension of the Social-Mind. The Nurse Department at Washington University, United States of America, developed 107 items suitable for using to study in the crowd that work in offices and are the responsibility such as business officer, finance, bank, police, and nurse for serious patient ward (Santuankaew, 2003). 2.4 Daily Hassles Scale; Created by Lazarus and colleagues, developed from daily crisis meter of Kanner and colleagues, there are 53 questions, reflecting the tension of a person from the 8 daily events, for example, occupation, housework, environment, health, the stability of social position, finance responsibility, the rush time, and individual symptoms, Questionnaire of physical and mind, (Lazarus et al., cite in Wongkampin, 2000). 2.5 Perceived Stress Scale (PSS); Developed by Cohen Caremark, it follows the theory of tension conceptual framework of Lazarus, Tension measurement is interaction character between a person and the environment. It was translated to Thai by Mingkwan and reflects the tensions that happen and strategy to adapt. It is composed of questions about feelings regarding the events in person’s life in 1 month ago. There are 14 items scored on 5 levels, interval 1-5 translation divides as follows, 14-32 as low level of tension, 33-51 as medium level of tension, and 52-70 as high level of tension (Mingkwan cited in Santeunkaew, 2003). 2.6 Thai Stress Test (TST); built by Pattrayuttawat in 2002, there are 3 ordinal rating scales of 24 items. There are questions about feeling in daily life for screening stress condition. Content validity is 0.88. 2.7 Life Distress Inventory 2.8 The Adolescent Inventory of Life Events and Changes 2.9 The Suanprung Stress Test (SPST) created by Mahutnirunkun (1997) follows a conceptual framework of Miller et al. (1993). Cronbach’s Coefficient Alpha is more than 0.70 and significance relate to EMG. In this study used SPST - 20. Stress related outcomes When an individual makes the assessment that a stress situation can not be managed, it affects the change of body (Miller et al., 1993). Selye (1976) pointed out that stress may arise when there is an imbalance the perceived demand and the person’s perception of his capability to meet the demand. He has labeled the defense 22 reaction or body’s response to stress as the General Adaptation Syndrome (G.A.S), which occurs in three stages: the alarm reaction (A.R.), the alarm resistance (A.R.), and the stage of exhaustion (S.E.). The alarm reaction is a physiological response for alerting the defensive forces in the organism. In this stage, blood is diverted toward the skeletal muscles in order to prepare them for action. If the stress exposure remains, the stage of resistance or adaptation will follow. This stage is quite different or sometimes the opposite of the alarm reaction. The longer this stage lasts the greater the danger to the person. If an individual accepts the source of stress as necessary part of life, the stressor may persist indefinitely. The person then gradually becomes more susceptible to a wide range of stress-related problems and diseases, such as headaches, asthma, hypertension, and cardiovascular disease excess hormone such as adrenaline, cortisol (Magill, 1993). Notwithstanding these variations in the definition of stress, the consensus is that an excessive or ongoing level of stress significantly increase the individual’s risk of health related symptoms and vulnerability to psycho physiological illness (Kenny, Carlson, McGuigan & Sheppard, 2000). As noted by Kenny et al. (2000) and others (e.g., Dinan, 2001; Hong & Chongde, 2003; Sharpley & Scuderi,1990), stress-related illness can manifest within one or a combination of three primary areas, the systemic or physical, the psychological or emotional, and the behavioral/social. Physical stress is primarily concerned with the biological response. Psychological stress focuses on cognitive and affective responses to the evaluation of threat, while social stress focuses on the resultant disruption of one’s social system following an event. 1. Systemic or physical stress – related responses Stress can be seen as a positive effect in terms of being a motivational force for individuals in meeting new challenges. However, persistently high and unrelieved stress can lead to physical ill health (Sordi, 2004). Selye’s (1978) concept of stress strongly supports the proposal that stress could be involved in a variety of physical illness. Indeed, the literature does provide strong empirical support for Selye’s stress concept (e.g. Waldie, 2001; Sordi, 2004). Both direct stress and indirect stress influence physical health outcome. Directly, stress can impact on the functioning of the nervous endocrine, and the immune system. Indirectly, high levels of stress can lead to other health risk behaviors such as smoking, and alcohol use. 23

Interestingly, the literature suggests that stress is the most frequently identified cause of tension-type headache, particularly when a high number of minor, everyday stressors have been identified. From study from Degges-White, Myers, Adelman, and Pastoor. (2003) supported the hypothesis that high levels of stress are associated with headache problems. Degges-White et al. studied the differences between the perceived stress of clinical headache patient group and norm group. Not surprisingly, the results indicated that the clinical participants reported greater levels of perceived stress that the norm group (the PSS4 norm group (Cohen et al., 1983)). However, the study could not demonstrate directionality that is, whether stress caused the headaches or whether the headaches caused the stress. A study from Reynolds et al. (2001) supported the hypothesis that headaches are a common outcome of stress. Reynolds and colleagues examined the impact of stressful life experience on low-income urban youth. The results indicated that heightened rates of stressful life experiences were associated with heightened rated of somatic complaints among low-income urban youth. The results also indicated that the most frequently endorsed somatic symptom in this group was headaches and stomachaches. In addition, a longitudinal cohort studies from Waldie (2001) has found further support for the relationship between stress and headache problems. Infectious disease can also affect people who are under stress. Stone, Reed, and Neale (1987) supported the hypothesis that stressful life events are related to infectious illness. These authors studied the relationship between daily events and physical symptoms. The results indicated that a stressful life event often predicted infectious illness. In addition, many authors have a proposed that life stress is positively associated with common colds and upper respiratory illness (e.g. Cohen, Frank, Doyle, Skoner, & Rabin, 1998: Reid, Mackinnon, & Drummond, 2001). For example, a study of stressors that increase susceptibility to the common cold in health adults by Cohen et al. (1998) indicated that severe chronic stressors were associated with a substantial increase in risk of upper respiratory disease. Based on a sample of 276 volunteers (125 men and 151 women) who were side based on examination and laboratory testing, participants had to return to the hospital at both 4 and 5 weeks after screening to have a variety of assessment, (i.e., blood drew for assessment of cell 24 activity and antibody to the challenge virus, the Bedford College Life Events and Difficulties Schedule questionnaire (LEDS: Brown & Harris, 1991)). This study indicated that the participants who reported chronic stress were more likely to have a greater susceptibility to common colds. Moreover, there were some indications that the longer the duration of stressors, the greater the risk for colds. Interestingly, recent research has suggested that as well as direct stress an interaction between stress and risky health behaviors can lead to severe physical illnesses such as cardiovascular disease (Sordi, 2004). For example, Byrne (2000) indicated that a combination of smoking and stress elevates cardiovascular disease to a degree greater than either smoking or stress alone. Thus, the risks of physiological stress outcomes are greater when combined with negative health behaviors. Similarly, Dinan (2001) suggested that depression was a common outcome from chronic stress and can lead to cardiovascular disease, as well as a 4-5 fold increase in the risk of myocardial infarction. Moreover, Sharpley and Scuderi (1990) reported that subjects with high levels of stress were at risk of developing atherosclerosis. 2. Psychological or emotional stress – related responses As noted physiological and psychological stress-related outcomes may overlap. Many studies show that stress can negatively affect psychological well-being (e.g. Hong & Chongde, 2003; Lange & Byrd, 1998). For example, a study from Hong & Chongde (2003) supported the hypothesis that stress can have a negative affect on psychological well-being. They studied the impact of college stress on psychological well-being. The results showed that the level of daily financial stress was associated with individuals’ perception of manage-ability and internal control regarding their financial situation. Moreover, Beasley et al. (2002) indicated that negative life events directly affected psychological well-being. They tested the relationship between negative life events or traumatic events (life stress) and psychological and somatic distress. The results clearly supported a significant associated between the negative life events and psychological symptoms. According to Schafer (1996), the eight common symptoms of emotional stress are anxiety, depression, anger, fear, sadness, frustration, guilt, and 25 shame. Anxiety and depression are the most common outcome of ongoing emotional stress (McNamara, 2000; Rice, 1999). Chaisaena (1998) found that the stress of people living at the Thailand- Kingdom of Cambodia border in Sakaeo province was at low level, the psychological self-care behaviors of people was at moderate level and the psychological self-care behavior at high level, moderate and low level revealed that the mean score of stress in three group significant different. 3. Behavioral and social stress - related response Behavioral stress is the response or reaction of behavior generated by the stressor. The stressful experience motivates the individual to engage in a variety of behavioral coping methods. Schafer (1996) divided the behavioral stress symptoms into two types, direct and indirect symptoms. The examples of direct symptoms are as follows: irritability, compulsive behaviors, not staying with one activity too long, talking faster than usual, being short-tempered, difficulty sitting still, and being withdrawn. Indirect symptoms such as health risk behaviors may also arise from the stressful event. A study by Haddad and Malak (2002) supported the hypothesis that the reason for smoking and to describe the habits, attitudes, and practices related to smoking among students of Jordan University of Science and Technology. They found that the main reasons for starting smoking were pleasure, stress, and curiosity. Moreover, Watson and Sinha (2000) investigated the relationship between personality disorders and coping with stressful situations across a variety of life events. The result indicated that stress and negative emotional were associated with personality disorders. Stress of people who live in border As motioned above, we knew factor of stressors after reviewing documents and found that when people got motive which created stress. Symptoms appeared in many types, body, emotion, thought, behavior (Taylor, 1995, Sukhakongka, 1994) People who live in border of Thailand-Cambodia also will express through body, emotion, thought and behavior as per Bernard (1995). As with people or military that live in war area, stress reactions are similar to combat, as the following,

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1. Conscience, punishment myself. 2. Ashamed of failure. 3. Drug abuse and drinking more than usual. 4. Uncontrolled the cried and often 5. Having trouble sleeping, sleepless or sleeping too much 6. Depression, anxiety and angry. 7. Physical expression cause by stress as a headache, peptic ulcer, back pain and deterioration of physical. 8. Inability to forget the horrible events of war. 9. No meditation, ideas passed back and forth. 10. Personality separate from society 11. Lingering feeling lazy non-active. 12. Suicide. Moreover, Solomon, et al., (1994) said that stress response from war or stay in conflict area could not apply a physiological prevention mechanism effectively to manage threats which express in many types and usually change. Resulting restless, disordered movement, more sympathetic, nausea and vomiting, separated will lead to mental disorders. Personality and stress Personality reflects personal character totally. The character that can be visible, tactile and recognized with the senses, is called outside personality and is judged by body structure, movement, dressing, and tone of voice or speech patterns. The character that is judged with the feeling is called inside personality, such as spiritual condition, emotion, intelligence, innate character, etc. (Pheungpakdee, 1997). The sum of whole strength personality related positively with confronting whole stress, solving problem field, emotional management field and stress relieve stress field (Wongnunta, 2003). The research of Jalowiec (1981) found that the factors which affected selection and efficiency of confronting stress condition were personal factors, for example personality, thinking format, problem solving skill, as well as environment factors such as social support or place. Anything that makes stress in life includes the factor of the person’s appraisal of the situation. 27

Wongnunta, 2003 explained that personality cause the stress such as 1. Be the serious person that did everything perfectly, be methodical, be straight person, have high standard of living, the ability in working higher than others so that the person has worked hard through life that cause the stress easily. 2. Be impatient person, severe, aggressive can not control emotion, sensitive changing of physiology. 3. Be a person dependent on others. This person has no confidence, has bad feelings, do not dare decide, and do not dare to do anything by oneself. Thawara, (2000) mentioned 5 elements of personality field which be accepted as model of personality element summarized as following. 1. Personality of unstable emotion field (Neuroticism), composed of personality such as anxiety, anger, lifeless, bashfulness, weakness in stress, the person who has highly personality of unstable emotion field will have problem with adaptation , unreasonable thinking, can’t control hungriness or motivation in mind of oneself, lowly potential in stress management that be opposite with the person who has lowly personality of unstable emotion field or called that the person who has highly personality of stable emotion that will have calm character, well control emotional condition, relaxing and well confront with the stressful situation thus the person who has highly personality of stable emotion field will get stress less than the person who has highly personality of unstable emotion field. 2. Personality of oneself revelation field (Extroversion) composed of 6 characters such as warm manner, social-minded, expression, be energetic and quick, seeking for excitement and be cheerful, the person who has highly personality of oneself revelation field will get obvious character such as social-minded besides other character such as be crowded, be in group, like to chat, expression, be energetic, like excitement, amusing, good sense of perspective then these did not affect to stress in the opposite with the person who has personality of introvert field will have no character of oneself revelation that is alone but did not mean no have friends, like to be oneself more than the follower, there is the rhythm of oneself in the way of life but not lazy, like to be alone but did not fears the social and did not the person who had not be prudent or bad sense of perspective, these personalities effected the stress. 28

3. Personality of experience adapting field (Openness to experience) composed of 6 characters such as have imagination, aesthetics, oneself sensibility, willingness to innovate, concept and value adapting that the person who highly got points of experience adapting field, will have a curious habit that make a full life of experience, willingness to adapt new concept and value, do not adhere to tradition, ready to learn new concept of the morality, social and politics, these characters related with education intelligence however experience adapting did not conform to intelligence and cleverness totally because of a lot of intelligent persons did not adapt experience while a lot of persons who has personality of experience adopting have limit intelligence, in order that many psychologists told that the personality of experience adopting showed the better healthy character or the maturity that didn't effect to stress. However Costa and McCrae expressed that both persons with experience adapting and persons with no experience adapting, do not have an advantage. Reaction depended on the situation and both groups of persons could make benefit for society. The person who has no personal experience adapting will have behavior that adheres to the tradition, will not like the change, will like familiar things more than innovation, will not show the temper, get interested in the minor topics and shown less interest than the person who has personality of experience adapting. These aforementioned characters might effect to stress when oneself confronted with the things that had no interest. 4. Personality of understanding others field (Agreeableness) composed of 6 characters such as trustworthiness others, frankness, willingness to help others, yielding, be modest and gentleness. The person who has personality of understanding others field will understand and sympathize others, enthuse to help others and believe that others would react to help, the person who has this personality will focus on oneself , be doubtful in the intention others. However the merit of who has this personality is who fully fights in interesting matter, in order that if we consider in the way of mental health, two types of above mentioned personality, no one is better. 5. Personality of responsibility field (Conscientiousness) composed of 6 characteristics such as: have capacity, be orderly, persist in responsibility, focus in the success , oneself discipline and consideration ,the person who has highly personality of responsibility field will live objectively , determined intention, carefulness, on 29 time, trusting, this personality field related with success in education and occupation which opposite with the person who has lowly personality of responsibility field. This is not the person who has no principle but rarely apply to do the advantage, be the one who did not work to achieve the target, These aforementioned characters might effect stress. Social, environment and stress Engel (1962) referred to in Malarat (2000) summarized that there are 3 points that cause the stress as following, 1. Losing or might lose valuable things, the things that love, e.g. one might lose an organ, role in social, occupation, work, etc. 2. Receiving dangerous or might receive dangerous such as responsibility distribution, being in new surroundings. 3. Anger when a person gets reaction with body, mind, temper and social. Starefos & Prater (1990) mentioned stressor that be the demand both inside and outside person including mind body field or culture social, or the environment that influence a person to adapt for that demand. Lazarus & Cohen, 1997 cited in Sheridan & Radmacher, 1992 classified stressors as follow: 1. The factor that cause the stress from the events with the severe change. Cataclysmic stressors mean the events that happen to many persons or a community at the same time unexpectedly, affecting them severely, such as a danger from the nature, war, laid off the work in a big group at the same time and the harm that is the effect from the advance of technology. A person that faces a problem with this condition has a feeling being in the same boat, problem solving depend on assistance from the community or government. 2. Personnel stressors effect from a person faces with various events such as failing in the examination, unemployment, get divorce which might be the events that can predict or not but be the severe effect and want a place in the assistance, the factor that causes this stress sometimes will make a person confronts in more difficulty than the factor from the events changed severely caused of lack in the assistance because of the social support is the thing that helps person to confront the stress well. 30

3. Background stressors mean the stress that happens from permanent disturbance (daily hassles) which be the little stress but happens regularly, affected chronic mind to a person such as sound problem at work, have not enough light or the boss has no reason if we do not have a place to help in problem solving, might be a spread problem for a long time more than the factor that cause the stress from the events changed severely and the factor from a person. Stressors can also be divided into 4 categories as per the concept of Benard & Krupat (1994), summarized as following. 1. Personal; Stressor can result from the conflict in a person role and having high personal success intention, because this person usually has high internal conflict that can cause stress, anxiety and physical sickness. Thus, having an ambiguous target and unsteady progress can cause stress. 2. Family and Social; to normally co-exist in society, a person must have friends or relations with others. Sometimes the relations in family and social might not be convenient and cause the stress, the pressure and the anger that can bring about to the tension, and the important events in life that started and ended in social such as wedding, divorce, and the death, will cause the effect which cause the stress. Also having a sick person or cripple in family be the cause of stress and responsibility for a caregiver in a long time because this condition will eradicate the free choice and doing other activities in life. Then these bring to the pressure and the anger, and while the anger increases, bad feelings increase also, then cause more stress. 3. Work; There will be many reasons that cause stress such as responsibility changing in the work, which might be a promotion or decreased the level of activity, getting into trouble with the colleague, employment cancellation, be expelled from the work, be assessed in working, work with responsibility for life of others, unsafely work and besides be hoped in quantity of work, these cause to stress. 4. Environment; Physical conditions can cause stress such as the loudness, the light and dark, the inappropriate weather, etc. Besides, being in the environment or the events that is undesirable make a person get stress. Condition such as those of a soldier who was the war surrounding cause stress condition. Stress after events can affect the mind severely. Post traumatic stress disorders, will have various symptoms such as having a bad dream, be upset, be serious, can not concentrate, over 31 reaction truthfully to the similar experience faced in the war, be careful abnormally, no interest in all activity and might behave secluded from the social. Farmer, Monohan & Hakeler (1984) divided stress as economic, social and the environmental states as following. 1. The cause of person (Personal source). These are causes that are related to the ways of other persons such as personality structure, experience in the life, concept of a person, health and others related in the character. 2. The cause of finance (Financial source). These causes are from concern about economics such as financial state, income, the ability in seeking food arrangement, clothing, and residence, including what one’s financial state should be. 3. The cause of relations (Relational source). These stressors are the result of associating from spouse, a person in a family, a friend, the colleague, etc. 4. The cause of work occupation (Occupational source). These are stressors to feeling and experience in present work and the expectation in the future.

Stress management Stress management, there are three basic paths to consider: (Cooper, 2005) 1. Eliminate or modify the stress-producing situation or remove the individual from it; find “the right shoe for the right foot,” or allow the person concerned to adjust the shoe to fit his or her foot. 2. Adjust the shoe- that is; change the social situation- to fit the individual’s foot. 3. Strengthen the person’s resilience to stress, for example, through physical exercise, meditation and relaxation techniques, and social support. Stress management has traditionally focused on individual approaches, usually by counseling individuals as small groups on ways to adapt to, or cope with, various stressors and their consequences. More recently, approaches have started to encourage the individual to adjust his environment to his abilities and needs, improving the person- environment fit, and to advise decision makers and administrators to allow or even promote such adjustments. According to Lazarus and Folkman (1984), stress management referred to the formal programs to prevent or ameliorate debilitating stress for people in general. 32

Monat and Lazarus (1991) described stress management as a general treatment approach to a wide variety of adaptations and health problems. Stress management, as a treatment, is universal with no one for whom treatment is unneeded or inappropriate. Sutherland and Cooper (2000) described a tripartite approach to stress management within an organization. Primary level stress management is “stress directed” and aims to prevent stress by controlling the source of stress, such as engaging in sporting activities. Secondary level stress management is a “response directed” strategy that helps individuals respond to stress in a way that is not harmful to them. It suggests that using techniques aimed at improving stress coping processes could minimize stress. Tertiary level stress management is “symptom directed” and aims to rehabilitate the stressed person. Tertiary level stress management is a curative approach for individuals that are suffering from the effects of exposure to stress, which might involve counseling services. Stress is an individual perception of adverse events and perceived ability to cope with these events in their environment. Stress management, there are three basic paths to consider: Lazarus & Folkman (1984) as follow: 1. Problem focused coping method 2. Emotional focused coping method Lazarus and Folkman (1984) defined coping as an individual’s effort to manage internal/external demands from the environment that are appraised as taxing or exceeding their resources. The coping process is complex, and an important ingredient in Lazarus’s theory of stress is the ability or inability to cope with a stressful situation. Generally, a stressor must be appraised before selecting a coping strategy. This cognitive process of appraisal consists of a continuous and evaluating the stressful encounter (Lazarus & Folkman, 1984). After evaluating the stressful encounter, coping attempts to psychological stress negatively influences cognitive functioning, and may lead to a reduced capacity to deal effectively with the stressor. According Monat and Lazarus (1991), coping aims to change the conditions of the emotion or the emotion itself and affects the emotion process in two ways. First, the coping process changes the actual relationship. Coping occurs when an 33 individual obtains information about the resource and mobilizes to change the troubled person-environment relationship. If the coping process can solve the problem, the emotional distress should reduce. Sometimes the coping activity fails to reduce the source of stress and this leads to further stress. This type of coping has been described as problem-focused coping (approach-oriented coping), which aims at changing the source of the stress. Nou (2002) studied the stress, social support, coping, and psychological adjustment of the college students in Khmer University, Cambodia. The results showed that using an emotional-focused coping style was related to psychological symptoms, lower psychological well-being, somatic symptom, and lower quality of life. Pilakanta (1998) studied Factors Affecting Work Stress and Stress coping of Traffic Police in Chiang Mai Province, found that the stress of traffic police was at low level that work and total life space, future opportunity for continued growth and security and the social relevance of work life were the factors affecting work stress of traffic police and stress coping behaviors of traffic police were problem-focused and emotion-focused which were practiced at the low to medium and the low level respectively. Phunpae (2001) revealed that most of the child-caretakers having stress from the stress sensitivity at a serious level. When considering coping with stress behavior, Child-Caretakers performed both stress reduction behavior and problem solving behavior at the same time. Duangtham (2004) founded that most of the nurses had the stress mostly at the middle, low and high level respectively and factors that aspect would perform more other works than their main responsibilities, take care of the additive patients who had the unusual emotion and behavior. Nurses performed both stress reduction behavior and problem solving behavior at the same time but nurses’ stress-facing behavior had more solving the problems than reducing the emotion. Watson and Sinha (2000) investigated the relationship between personality disorder and coping strategies across a variety life event. Interestingly, the results indicated that stress and negative emotional were associated with personality disorder. The results also indicated that a personality disorder was positively related to escape 34 avoidance and negatively associated with problem-solving and positive reappraisal. In examining these two kinds of coping strategies, it appears that the problem-focused coping approach is generally more effective than emotional-focused coping. More importantly however, the effectiveness or functionality of the coping strategy used is most important in determining stress and health outcomes. Coping strategies aim to treat the stress problem by managing internal/ external demands from environment, which individual’s appraisal as endangering their resources. In McNamara’s conception (2000), coping strategies are defined as the defense mechanisms aimed at resolving internal conflicts. According to Lazarus and Folkman (1984), stress management referred to the formal programs to prevent or ameliorate debilitating stress for people in general. Monat and Lazarus (1991) described stress management as a general treatment approach to wide variety of adaptations and health problems. Stress management, as a treatment, is universal with no one foe that treatment is unneeded or inappropriate. Edelman and Mandle (1998) stated that stress management is a critical component of a healthy lifestyle. They stated that healthy behaviors, such as good nutrition and exercise, might help strengthen individuals’ resistance to stress. Peiffer (2001) indicated that dealing with stress in a positive way is another way for managing stress. From all of the viewpoints, coping strategies are focused on reactions to stressed outcomes. In contrast, stress management is focused on not only dealing with stress as it occurs but also building resilience and preventing stress. There are a wide variety of stress management strategies for individuals to use. Sutherland and Cooper (2000) described a tripartite approach to stress management within an organization. Primary level stress management is “Stress directed” and aims to prevent stress by controlling the source of stress, such as engaging in sporting activities. Secondary level stress management is a “response directed” strategy that helps individuals respond to stress in a way that is not harmful to them. It suggests that using techniques aimed at improving stress coping processes could minimize stress. This level is concerned with increasing self-awareness, improving stress management skills, such as education, training to develop stress resistance, and coping strategies. Tertiary level stress management is “symptom directed” and aims to rehabilitate the stressed person. Tertiary level stress 35 management is a curative approach for individuals that are suffering from the effects of exposure to stress, which might involve counseling services. Pender (1996) divided the primary modes of intervention for stress management into three groups: minimizing the frequency of stress-inducing situation, increasing resistance to stress, and counter conditioning to avoid physiological arousal. 1. Minimizing the frequency of stress-inducing situation Minimizing the frequency of stress-inducing situation consists of four subcategories, namely: changing the environment, avoiding excessive change, time blocking, and time management. Many environmental conditions are hazardous to individuals’ health with direct physiological and psychological effects that lead to stress. If possible, environmental management is the best approach to minimize the frequency of stress-inducing situations. According to World Health Organization (WHO, 1988), a commitment at all levels of government is required to ensure achieving a supportive environment. Avoiding excessive change means that any unnecessary changes should be avoided during a period of life change means that any unnecessary changes should be avoided during a period of life change as this can result in a negative tension state. Time blocking technique is a set time for an individual to adapt to various stressors. Individuals use this time to consider specific changes and to develop strategies to modify it. Sutherland and Cooper (2000) indicated that in the concept of stress management, developing a personal sense of time was important. 2. Increasing resistance to stress In these strategies, Pender (1996) focused on both physical and psychological conditions. Physical condition focuses on promoting exercise and psychological health. Many researchers indicated that exercise gives rise to positive effects, such as better health, higher quality of life, lower distress, and control of stress (e.g. Edilman & Mandle, 1998; Schafer, 1996). According to Pender (1996), there are three ways that exercise promotes positive effects. First, cardio-respiratory fitness improvement can promotes psychological changes. Secondly, “changes in exercise-related self-efficacy and mastery generalize to other situations, resulting in improvements in the self-concept and coping ability” (Pender, 1996 p.243). Finally, 36 exercise can reduce a stress response by blunting a person’s psychophysiology responsiveness to stressors. The author state that further research is needed to determine in what conditions exercise can actually enhance stress-resistance. Besides promoting exercise, promoting psychological well-being indicators, such as enhancing self-esteem, enhancing self-efficacy, increasing assertiveness, developing goal alternative, and building coping resources are other important strategies for preventing stress (Pender, 1996). For example, self-efficacy is a better predictor of performance than efforts are. Bandura (1977) indicated that the stronger the efficacy is, the more active the efforts are. Bandura pointed out that enhancing self-efficacy could be achieved through facilitating performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal. Pender (1996) indicated that assertive behaviors could increase the individual capacity for psychological stress resistance. During assertiveness behavior, individuals can share their perceptions and feeling with other people that are facilitating personal or group productivity. In developing goal alternatives, individuals should develop goals in which accomplishment will be rewarded. They also should be flexible so if one goal is not completed; other options are available to permit achievement. 3. Counterconditioning to avoid physiological arousal. Counterconditioning aims to assist individuals to attain willing control of physiological responses to stressful events. By providing a set of stress management strategies, counterconditioning’s target is to relax muscle tension and increase are regularly used, relaxation training, biofeedback, and imagery. According to Pender (1996), deep relaxation slows the metabolism and all physical processes related to it, including a decrease in the body’s oxygen consumption, a decreased respiration rate, a decreased heart rate, decreased muscle tension, decreased blood pressure, increased that this technique creates a physiological response directly opposite to the stressful situation. Biofeedback can help individuals to learn to lower their arousal. Health professionals frequently utilize techniques such as electromyography feedback (EMG), electroencephalograph (EEG), galvanic skin response (GSR), while individuals can use more simple devices. Schafer (1996) described imagery (visualization or guided daydreaming) as a method of using image 37 to reduce rational mental activity and induce deep relaxation. This stress management technique involves imaging something very pleasant as a way of relaxing the mind. Reports of increasing stress, ignorance of stress management, and a marked reluctance to visit a doctor have all led to a growing debate about the state of health. Three causes (biological, cognitive, and society/environment factors) were discussed as predisposing factor that play a major role in stress and engaging in risk talking behavior. As stress in people have increased dramatically, three categories of people’s stressors (normative, non-normative, and daily stressors) were discussed Sarafino, 1990. Lazarus and Folkman (1984) state that stress management is Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resource of the person or a strategy, method for encounter with problem such as anxiety, depression etc. and Gould, Finch, & Jackson (1993) add that include order to meet a commitment to the cause of the stress from the assessment. Managing the stress response to their efforts such as relax, social support, increasing effort or focus on the problem. Lazarus and Folkman can divide as two concepts: 1. Problem-focused Coping Strategies; deal with stress by changing the relationship between people and environment better. Efforts aimed at solving problems or stress situations by information seeking, analysis problem, goal setting and try out different way for stress management appropriate to problems or situation. 2. Emotional-Focused Coping Strategies; the efforts of individuals committed to deal with emotions and feelings that occur because of a stress scenario, without focus or cause problems. For example, denial, avoidance, isolation, repression, shared concern, relaxation.