Long term (chronic) stress
Pituitary - adrenal system pathway
Immediate (acute) stress
ANS (autonomic nervous system)
Sympathetic Nervous System (SNS)
Overview of Immune system
The immune system is our main defence against infection by foreign agents; it seeks and destroys invading antigens.
1. Non specific immunity - Macrophages surround and ingest foreign antigens.
2. Cell based immunity - T cells seek out and destroy any cells that are foreign or cells infected with antigens, e.g. bacteria.
3. Anti-body based immunity - Bcells destroy invading agents while they are still in the blood stream, before they enter tissue.
- Cortisol is released during long term stress, which shrinks the Thymus Gland and would inevitably prevent the growth of T cells.
- Keicolt-Glaser et al (2005) looked at married couples, conflicts and the impact of wound healing. They found that coupels who had been placed under stress during arguments took longer to heal than those who supported each other. Cannot establish causal relationships and it is unethical to cause harm to participants.
+ Evans et al (1994) looked at one antibody - sIgA, which coats the mouth, lungs and stomach in mucus and helps protect the body against disease. The study arranged for students to give speeches to other students (acute stress). These students showed an increase in sIgA, whereas levels of sIgA decreased during long term stress.
Lazarus (1992) suggests that there are various relations why a relationship between stress and illness is difficult to establish:
1. Health is affect by many factors, as a result, there may be little variance left that can be accounted for by stress.
2. Health is generally fairly stable and slow to change. makes it difficult to demonstrate that exposure to particular stressors that have caused a change in health.
3. To demonstrate how stress affects long term health would involve continious measurement over time. expensive and impractical.
- Hypertension = raised blood pressure due to excess hormone release. Stress--> Adrenaline--> Raise blood pressure--> oxygen to tissue--> energy
- Strokes = blocked vessels disrupts blood supply the brain. Stress--> adrenaline/cortisol--> release excess fats--> energy--> ^fight/flight^
- CHD = caused by narrowing of the cardiovascular arteries in release of fats.
CHD & Work related stress (chronic stressor): Russek (1962) looked at heart disease in medical professionals. 1 group of doctors was designated as high stress (gps) while others were classed as low stress (dermatologists). Russek found that heart disease was greatest among GPs (11.9%) and lowest in dermatologists (3.2%). Supporting the view that stress is linked to heart disease.
Effects of stress on existing conditions: Sheps et al (2002) focused research on volunteers with ischemia (reduced blood flow to the heart). They gave 173 men and women a variety of psychological tests including mild stress. Their blood pressure soared dramatically, and half of them experienced an irregular heartbeat in the left ventricle muscle. Of all participants, 44% of those with irregular heart beats died within 3 or 4 years, compared to just 18% who had not. This shows that psychological stress can dramatically increase the risk of death in people with poor coronary artery circulation.
Stress & Psychiatric Disorders
Brown & Harris (1978) found that women who suffered chronic stress conditions were more likely to develop depression. Also found that working class women were more prone to depression than the middle class because of the stress of having to leave hom to work and having to leave their children in the care of others.
The Diathesis-Stress Model : In order for a person to develop a psychiatric disorder, they must possess a biological vulnerability to that disorder, and stress can have an impact on that vulnerability, either triggering the disorder or worsening it.
- It is frequently not possible to assess whether the stressful events in the period before diagnosis of a psychiatric disoder have caused the disorder or have been a consequence of the person's deteriorating state.
- Most studies have made us of retrospective methodology, in whichrecall of events tends to be somewhat unreliable. Prospective studies, where people who have experienced a stressful event are followed over time, are rare.
- Although the relationship between stress and depression has been demonstrated by some researchers, others claim that the effects are small, accounting for less than 10% of the variance observed.
Holmes & Rahe (1967) developed the social readjustment rating scale (SRRS) which is a scale of 43 major life events that are both negative and positive. Each event is given a point score that reflect how much change it would require which is known as the LCU ( life change unit). To formulate these points scores 400 participants were asked to rate the 43 events in order of how stressful they were. The more change an event requires, the higher the LCU the more stressful the event is. They would ask a participant to check off the number of events they had experienced over a given period, usually 2 years. The LCU's were then totalled and a stress index formulated. The researchers suggest that a score of 150 or more increased the chances of stress related health breakdown by 30%, whilst a score of 300+ increased by 50%. They concluded that major life changes can cause stress related illnesses.
- Positive and negative life events - SRRS asuggests that any life changing event has the potential to damage health, by significant readjustment. Critics suggest that it is the quality of the event that is crucial, with undesired, unscheduled changes being the most harmful.
- Daily hassles - Lazarus (1990) suggests that as major life changes are relatively rare in life for most people, it is minor daily stressors of life that are the more significant readjustments.
- Individual Differences - SRRS ignores the fact that life changes will inevitably have difference significance for different people.
- Spurious Relationship - It is possible that an observed relationship may result from a third variable (anxiety). Brown (1974) suggests that people with high levels of anxiety would be more likely to report negative events and would also be more prone to illness.
Hassles - Bouteyre et al (2007) looked at first year students and asked them to rate the hassles they faced as part of their transition from school to university. They also asked them to fill in a questionnaire that investiaged symptoms of depression. There was a positive correlation between the number of hassles faced and the likelihood of having symptoms of depression.
Uplifts - Gervais (2005) asked nurses to keep a diary for a month of any daily hassles or uplifts they faced. They also had to rate their performance at work during this time. The more hassles the nurses faced the lower they rated their work performance. Uplifts they faced however counterbalanced most hassles and improved their job performance.
Daily Hassles vs Life changes - Ruffin (1993) daily hassles lead to greater physical and psychological dysfunction than major negative life events.
Flett et al (1955) Asked 320 students to read ana account of a woman who had faced either a major life change or daily hassles. They were then asked to rate how much practical and emotional support she would receive and seek from others. Daily hassles may lead to a greater negative impact as people do not receive the same level of support from those around them.
Evaluation of Daily Hassles
Explaining daily hassles
- The accumulation effect - An accumulation of minor daily stressors creates persistent irritations, frustrations and overloads which then result in more serious stress reactions such as anxiety and depression.
- The amplification effect - Chronic stress due to major life changes may make peopel more vulnerable to daily hassles. The prescence of a major life change may also deplete a person's resources so that they are less able to cope with minor stressors than they would be under normal circumstances.
- The problems with retrospective recall - For a measure which assensses daily hassles, particiapnts are usually asked to rate the hassles experienced over the previous month. The same problems with retrospective reporting apply. Some researchers have overcome this problem by using a diary method, where particiapnts rate minor stressors and feelings of well-being on a daily basis.
- What does research tell us? - Most of the data from research on daily hassles is correlational. This means we cannot draw a causal conclusion about the realtionship between daily hassles and well being. However, as with all correlations, they indicate that daily hassles in our lives can potentially have adverse effects on our health and well being. As a result, we would be unwise to ignore the message in such research.
Work Place Stress
- Workload and Control (Marmot 1997) - Proposed the job strain model; workplace stress came from two main areas, a lack of control overy oru workload and a high workload. Supported by Van der Doef & Maes (1998) High demands and low control leads to greatest risk of heart disease. Longitudinal study of 7372 civil servants over five years, using self report questionnaires.
- Control - Marmot found no significant link between workload and stress related illness. He found that the higher grades (high level of control & good social support) had the least stress related disease and the lower grades (less control and poorer social support) showed more signs of stress related illness. Johanssen et al (1978) Swedish saw mill, compared two groups of workers. Finishers = machine paced, repetitive, lower control. Cleaners = self-paced, varied and more control. Finishers secreted higher levels of stress hormones, had higher levels of illness and absenteeism.
- Role Conflict - When your work load interferes with your home life (having to take work home or being called in at short notice) or when yourh ome life interferes with work (having to take time off for sick children.) Pomaki (2007) 226 doctors, role conflict directly associated with emotional exhausstion and depressive symptoms.
- Physical Environment - Halpern (1995) shows an increased temperature can lead to stress and aggression. Glass et al (1969) suggests noise can also be a stressor. Other physical factors could be space, lighting and arrangement e.g. open plan or separate offices.
Type A personality
Describes a person who is involved in an incessant struggle to achieve more in less time. Friedman & Rosenman (1959) believed the type a indvidual possessed three major characteristics: competitiveness and achievement striving, impatience and time urgency, hostility and agressiveness. These characteristics would, lead to raised blood pressure and levels of stress hormones, both of which are linked to ill health, particularly the development of CHD. In contrast type b was propsed as a personality relatively lacking these characteristics, being patient, relaxed & easy going, therefore less vulnerable to stress related illness.
Research - Friedman & Rosenman set up the Western Collaborative Group Study in 1960, approximately 3000 men ages 39-59 living in california, were examined for signs of CHD, and personalities were assessed by a strucutred interview. The interview included questions about how they responded to everyday pressures. After 8.5 years, twice as many type a participants had died of cardiovascular problems. Over 12% of type a personalities had experienced a heart attack compared to just 6% of type b. Type a's had higher blood pressure, and higher cholesterol. They were also more likely to smoke and have a family history of CHD, both which would increase their risk.
Evaluation - Ragland & Brand (1988) carried out a follow up study of the Western Collaborative Group (1982-3) 22 years after the start of the study. They found that 214 (15%) of the men had died of CHD. This study confirmed the importance of CHD risk factors but found little evidence of a relationship between type a and mortality.
Many type a individuals appear resistant to heart disease. Kobasa & Maddi (1977) suggested that some people are more psychologically hardy than others. The Hardy Personality includes a range of characteristics , if present, provide defences against the negative effects of stress
- Control - Hardy people see themselves as being in control of their lives, rather than being controlled by external factors beyond their control.
- Commitment - Hardy people are involved with the world around them, and have a strong sense of purpose.
- Challenge - Hardy peopel see life challenges as problems to be overcome rather than as threats or stressors. They enjoy change as an opportunity for development.
Research = Kobasa (1979) studied about 800 american business execs, assessing stress using the SRRS. Approximately 150 of the participants were classed as high stress according to their SRRS score. Some had a low illness record whereas others had a high record. Kobasa proposed that the hardy personality encourages resilience. The individuals in the high stress/low illness group scored high on all three characterisitcs, whereas the high stress/high illness group scored lower. Maddi et al (1987) studied employees of a US company that was, over a year, dramatically reducing the size of its workforce. Two thirds of employees suffered stress related health problems over this period, but the remaining third thrived. This thriving group showed more evidence of hardiness attributes.
Evaluation of Hardy Personality
- Hardiness and negative affectivity (NA) - Some critics argue that the characteristics of the hardy personality can be mroe simply explained by the concept of negative affectivity. High NA individuals are more likely to report distress and dissatisfaction, dwell more on their failures and focus on negative aspects of themselves and their world. NA and hardiness correlate reasonably well, suggesting that hardy individuals are simply those who are low on NA.
- Problems with measurement - most of the research support for a link between hardiness and health was relied upon data obtained through self-report questionnaires. More recent efforts have led to the development of the Personal Views Study. This new questionnaire addresses many of the criticisms raied with respect to the original measue, such as long and awkward wording and negatively worded items. However, not all of the problems have been resolved. For example, some studies show low internal reliability for the challenge component of hardiness.
Approaches to coping with stress
Problem-focused coping - althoug the actual coping response would vary with the nature of a particular stressor, some common problem-focused strategies are: taking control of the stressful situation, evaluating the pros and cons of different options for dealing with the stressor & suppressing competiting activities. Some strategies can be both problem focused and emotional focused, such as social support, may feel able to engage in more problem-solving coping behaviours. The existence of social support may also decrease the amount of pscyhological distress.
Emotion-focused coping - Emotion focused copign will vary with the nature of the stressor, as different stressors create different type of emotion, examples are denial, focusing on and venting emotions and wishful thinking. Some forms of emotional-focused coping are positive, whereas some are negative. While positive emotion-focused coping can be helpful, negative emotion-focused coping tends to be associated with maldaptive health outcomes.
- Health outcomes - Penley et al (2002) did a study of nursing students, he found that problem focused copin was positively correlational with overall health outcmoes.
- Examination Stress - Folkman & Lazarus (1985) investigated the different coping responses used by students in the run up to exams and during the wait for results. They found that both problem & emotion focused strategies were used at both stages, but different forms dominated during each stage. Problem-focused coping with more evident before the exam, and emotion focused was more evident during the wait for results.
- Threat and Coping - Rukholm & Viverais (1993) examined the relationship between stress, threat and coping. They concluded that if a person feels a significant degree of threat when confronted by a stressor, they may need to deal with the resultant anxiety through emotion-focused coping first. Only when this is under control can they make up of problem-focused coping.
- Problems with measurement - Stone et al (1991) have argued that many of the items in the ways of coping measure are more appropriate to some types of stressors than others. They found that most of the scale was relevant to relationship stressor but approximately 3/4 of the items were inappropriate for health problems.
- Is emotion focused coping more maladaptive? - Lazarus suggests that emotion-focused copign may be unhelpful when experiencing serious ymptoms of ill health, as it delays the individual seeking appropriate treatment.
Cognitive Behavioural Therapy
A combination of cognitive therapy and behavioural therapy. Stress inoculation therapy is a type of CBT which trains people to cope with anxiety and stressful situations more effectively by learning skills to inoculate themselves against the damaging effects of future stress.
The cognitive approach is based on the belief that the biggest influence on a person's behaviour is the way they think about a situation. Therefore this therapoy agaims to change or adapt the way a person thinks. Behavioural therapy is based on a belief that all behaviour is learnt and therefore therapy aims to reverse the learning process of this particular behaviour.
Research: Meichenbaum (1985) says that we can not change the causes of things that stress us but we can change the way we think about it. (positive thinking may result in a positive outcome) This therapy is different from others as it suggests that we should develop a way of coping before the problems occur. There are three main stages of this process:
- Conceptualisation phase: the therapist and the client develop a relationship. The client is taught to see threates as problems to be solved and so changes their attitude to the problem
- Skills acquisition phase: coping skills are taught and practised, tailored to the individuals problems. e.g. postitive thinking, relaxation, social skills and attention diversion.
- Application phase: Clients are given the opportunity to apply the newly learned coping skills in different situations. Booster sessions follow.
Strengths and Weaknesses of CBT
- Effectiveness: Meichnebaum (1977) compared SIT with another form of treatment called Systematic Desensitization. Patients used one of these therapies to deal with a snake phobia. He found that SIT was better as it helped the patient to over come a second fear showing that SIT can inoculate future fears whilst offering help with current fears.
- Preparation for future stressors: This therapy gives patients the ability to cope with future stressors.
- Time consuming and requires high motivation: The therapy requies a lot of time, money and motivation in order to be successful. Because of the length it would only suit a limited amount of poeple.
The aim of hardiness training is to increase self-confidence and sense of control so that individuals can be more successfully navigate change in their lives. Maddi & Kobasa suggested three ways to train hardiness:
- Focusing: The client is taught how to recognise physiological signs of stress, such as muscle tension and increased heart rate, and also to identify the sources of stress.
- Relieving stress encounters: The client relives stress encounters and is helped to analyse these situations and their response to them. This gives them an insight into their current coping strategies and how they might be more effective than they thought.
- Self-improvement: The insights gained can now be used to move forward and learn new techniques of dealign with stress. In particular the client is taught to focus on seeing stressors as challenges that they can take control of, rather than problems that they must give in to.
Kobasa said that if some people were naturally resistant to stress then perhaps it would be possible to teach others how to be hardy. Hardiness training has been used effectively by Olympic swimmers to ensure that they are committed to the challenge of increased performance levels, and are able to control the stressful aspects of their daily lives that might otherwise interfere with their training. However, hardiness training has the problem that it mustfirst address basic aspects of personality and learned habits of coping that are notoriously difficult to modify. It cannot be seen as a rapid solution to stress management.
Physiological Methods of Stress Management
Benzodiazepines (BZs) is most commonly used to treat anxiety & stress. This is because it slows down the activity of the central nervous system. GABA is a neurotransmitter that is the body's natural form of anxiety relief. Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters which slows down its activity making the person more relaxed. Serotonin is a neurotransmitter that has an arousing effect in the brain, BZ's reduce any increased serotonin activity, which then reduces anxiety.
Beta Blockers (BBs)
Sympathetic arousal - stress leads to arousal of the sympathetic nervous system and this creates raised blood pressure, increased heart rate, elevated leavels of cortisol. These symptoms can lead to cardiovascular disorders and can reduce the effectiveness of the immune system. Beta blockers reduce the activity of adrenaline and adrenaline which are part of the Sympathomedullary response to stress. They bind to receptors on the cells of the heart etc, that are usually stimulated during arousal.
By blocking these receptors, its harder to stimulate cells in the heart, so it beats slower and with less force, and blood vessels don't contrast as easily. This results in a fall in blood pressure, and therefore less stress on the heart. The person feels less naxious and more calm
Strengths & Weaknesses of Drug Therapies
- Effectiveness - one way to assess the effectiveness is to compare outcomes, one group of patients is given the drug, and another is given a placebo. This determines if the drug works or whether people simply believe taking the drug will make them feel better.
- Kahn et al (1986) followed nearly 250 patients over 8 weeks and found thta BZs were significantly superior to the placebo. A meta-analysis of studies focusing on the treatment of social anxiety found that BZs were more effective at reducing this anxiety than other drugs such as antidepressants.
- Easy to use - The patient just has to remember to take the pills, this is much easier than the time and effort needed to use physicological methods, for example, SIT requires a lot of time, effort and motivation on the part of the client if it is to be effective.
- Addiction - Patients taking even low doses of BZs show marked withdrawal symptoms when they stopped talking to them. Because of such addiction problems there is a recommendation that use of BZs should be limited to a mximum of 4 weeks..
- Side effects - Most people who take beta blockers do not experience any side effects although some studies have linked them with an increased risk of developing diabetes.
- Drugs may be very effective at treating symptoms but the effect last while a person takes the drugs. As soon as the drugs are not being took, the effectiveness of them dies down. It may be preferable to seek a treatment that addresses the problem itself such as CBT.