Biological psychology: Stress (Studies)

Kiecolt-Glaser et al. (1984)

• Carried out a natural experiment investigating whether the stress of short-term, stressors had an effect on immune system functioning in medical students.
• Blood samples were taken one month before and during the exam period.
• Immune system functioning was assessed by measuring NK (Natural Killers) cll activity i blood samples.
• Participants also completed a questionnaire to measure other life stressors.
• It was found that NK cell activity was significantly reduced in the second blood sample compared to the sample taken one month before.
• This suggests that short-term, predictable stressors reduce immune system functioning, increasing vulnerability to illness.
• Kiecolt-Glaser et al. also found that those students who reported the highest levels of loneliness had the lowest NK cell activity.

Most studies of the relationship betweens stress and immune system functioning have focused on acute stressors and have found a decrease in immune cell function (Kiecolt-Glaser et al. 1984). However other studies ahve shown an incresase (see next slide).

Fischer et al. (1972)

• Shows an increase in in immune cell function.
• Found no decrease in overall immune system activity and actually higher lymphocyte counts in Apollo astronauts during the stress splashdown.

Arnetz et al. (1887)

• Focuses on the effects of chronic (long-term) stressors.
• Studied the effect of unemployed women in Sweden. 
• They found a decrease in lymphocyte response to antigens after nine months of unemployment.

Marucha et al. (1988) - Wound Healing

• Exam-related immune changes have also been shown to have a dramatic effect on the rate at whcich wounds heal.
• Inflicted a 'punch biopsy' in the mouth of students either during the summer holdiays or three days before an exam.
• The wounds given before the exam took 40% longer to heal than the wounds during the holidays.

Lazarus (1992)

• Suggests there are various reasons why a relationship between stress and illness is difficult to establish.
• Health is affected by many different factors (genetic influences, lifestyle etc.). As a result, there may be little variance left that can be accounted for by stress.
• Health is generally fiarly stable and slow to change. As a result, it makes it difficult to demonstrate that exposure to particular stressors have caused a change in health.
• To demonstrate how stress affects long-term health would involve continuous measurement over time. This would be expensive and impractical, therefore most research has concentrated on relatively short periods of time.

Stress can sometimes enhance the immune system

• Research has supported the observaton that short-term stress does not always decrease immune system functioning, but can also ehnhance it in some circumstances.
• Evans et al. (1994) looked at the activity of an antibody - slgA - which helps protect against infection.
• Arranged for students to give talks to other students (mild but acute stress).
• These students showed an increase in slgA , whereas levels of slgA decreased during examination periods which stretched over several weeks.
• Evans et al. (1997) proposed that stress may have two ffects on the immune system: upregulation (i.e. increased efficiency) for short-term acute stress and down-regulation for chronic stress.

Research support (Segerstrom and Miller, 2004)

• A meta-analysis of 293 studies conducted over the past 30 years found:
• Short-term, acute stressors can boost the immune system, prompting it to ready itself for infections or other challenges to the integrity of the body.
• Long-term, chronic stressors led to suppression of the immune system - the most chronic stressors were associated with the most global suppression of immunity.
• The longer the stress, the more the immune system shifted from potentially adaptive changes to portentially detrimental changes.

Individual Differences

• Consistent gender and age differences in the stress/immune system relationship. Women show more adverse hormonal and immunological changes in the way they react to marital conflict.
• As people age, stress has a greater effect on immune system functioning.

• Acute and chronic stress may affect many different aspects of the cardiovascular system (i.e. the heart and circulatory system) for example:

* Hypertension (high blood pressure)
* Coronary heart diseas (CHD) caused by atheroscerosis (the narrowing of the coronary arteries).
* Stroke (damage caused by disruption of blood supply to the brain).

• Although disorders are affeccted by lifestyle, diet, smoking, etc., stress has become increasingly implicated in the development of all the disorders listed above.
• Some examples to explain how stress might cause cardiovascular problems are;

* Stress activates the sympathetic branch (SNS) of the autonomic nervous system, leading to a         constriction of the blood vessels and a rise in blood pressure and heart rate.
* An increase in heart rate may wear away the lining of the blood vessels.
* Stress leads to increased glucose levels, leadng to clumps blcoking the blood vessels                     (atheroschlerosis) 

Cardiovascular disorders and anger (an acute stressor)

• Williams et al. (2000) conducted a study to see whether anger was linked to heart disease: 13,000 people completed a 10-question anger scale, including questions on whether they were hot-headed, if they felt like hitting someone when they got angry, or whether they got annoyed when not given recognition for doing good work.
• None of the participants suffered from heart disease as the outset of the study.
• Six years later, the health of participants was checked; 256 had experienced heart attacks.
• Those who had scored highest on the anger scale were over two-and-a-half times more likely to have a heart attack than those with the lowest anger ratings.
• People who scored 'moderate' in the anger ratings were 35% more likely to experience a coronary event.
• This suggests that anger may lead to cardiovascular disorders.
• Williams concluded that 'individuals' who find themselves prone to anger might benefit from anger management training. 

Cardiovascular disorders and work-related stress (a chronic stressor)

• Russek (1962) looked at heart disease in medical professionals.
• One group of doctors was designated as high-stress (GPs and anaesthetists) while others were classed as low-stress (pathologists and dermatologists).
• Russek found heart disease was greatest among GPs (11.9% of the sample) and lowest in dermatologists (3.2% of the sample).
• Supports the view that stress is linked to heart disease.

The effects of stress on existing conditions

• Sheps et al. (2002) conducted a landmark study, which supports the claim that stress can be fatal for people with existing coronary artery disease - focused their research on volunteers with ischemia (reduced blood flow to the heart). 
• They gave 173 men and women a variety of psychological tests, including a public speaking test.
• Their blood pressure typically soared dramatically, and in half of them, sections of the muscle of the left ventrical began to beat erratically.
• Of all the participants, 44% of those who had shown the erratic heartbeats died within three to four years, compared to just 18% who had not.
• This shows that physchological stress cand dramtically increase the risk of death in eople with poor coronary artery circulation.
• Orth-Gomer et al. (2000) showed that marital conflict was associated with 2.9 in recurrent events for women with existing coronary heart disease.

Stress and depression

• Brown and Harris (1978) found that women who suffered chronic stress conditions were more likely to develop depression.
• They also reported that working-class women were more prone to depression than middle-class women because of the stress of having to leave home to work, and having to leave their children in the care of others.
• Melchior et al. (2007) carried out a survey over a period of one year among 1000 people in a wide range of occupations in New Zealand.
• They found that 15% of those in high-stress jobs, suffered a first episode of clinical depression or anxiety during that year, copared with 8% in low-stress jobs.
• Women were generally worse affected than men.

Stress and other disorders

• After Vietnam war ended 1975, psychiatric symptoms among war veterans led to the discovery of Post Traumatic Stress Disorder.
• PTSD has been observed in war veterans and rap victims, as well as the victims of chronic stressors such as poverty and abuse.
• Perpetration Induced Traumatic Stress (PITS) (MacNair, 2002) is a form of PTSD caused by being an active participant in causing trauma.
• Rohlf and Bennet (2005) found that 1 in 10 workers, whose occupations required euthanising animals, experienced moderate levels of PITS symptoms.
• The evidence for stress being linked to other psychiatric conditons is less strong.
• Stueve et al. (1998) compared the role of stressful life vents in causing depression, schizophrenia and other disorders.
• They found that stressful events were only associated with depression, and not with the other disorders.

The diathesis-stress model

• Proposes that in order for a person to develop a psychiatric disorder, they must possessa biological vulnerability to that disorder (the diathesis).
• An individual's vulnerability is determined by genetic or early biological factors.
• Stress can have an impact on that vulnerability, either triggering the onset of the disorder of worsening its course.
• If the person is not capable of adapting to the stressful situation, psychiatric symptoms will develop or worsen.
• In the Brown and Harris study, for example, stressful experiences alone did not predict the onset of depression.
• Rather it was the absence of a close confiding relationship in the women's lives that made them more vulnerable to life stressors, and therefore more vulnerable to depression.

Research on Life Changes

• Holmes and Rahe (1967), two medical doctors, played a key role in developing the idea that life changes are linked to stress and illness.
• In the course of treating patients, they observed that it was often the case that a range of major life events seemed to precede physical illness.
• These changes were both positive and negative events that had one thing in common - they involved change.
• Change require psychic energy to be expended.

Using life changes to measure stress

• Holmes and RAhe (1967) developed the Social Readjustment Rating Scale (SRRS) based on 43 life events taken from their analysis of over 5000 patient records.
• To establish the stressfulness of each event they enlisted the help of about 400 participants.
• The participants were asked to score each event in terms of how much readjustment would be required by the average person.
• The participants were asked to provide a numerical figure for this readjustment, taking marriage as an arbitrary baseline value of 50.
• If an event would take longer to reajust to than marriage, then they were told to give the event a larger score.
• Scores for all participants were totalled and averaged to produce Life Change Units (LCUs) for each life event.

Key Study: Rahe et al. (1970)

• Used this technique to test Holmes and Rahe's hypothesis that the number of live events on a person experienced would be positively correlated with illness.
• They aimed to study a 'normal' population as distinct from the opopulations previously studied of individuals who were already in hospital.
• A military version of the SRRS (the SRE) was given to all the men aboard three US Navy ships - a total of over 2700 men.
• The men filled the questionnaire in just before a tour of duty, noting all the life events experienced over the previous six months.
• An illness score was calculated on the basis of the number, type and severity of all illnesses recorded during the toru of duty.
• They found a positive correlation between LCU score and illness score of +.118.
• Those men who scored low in terms of their SRE scores also had low levels of illness while at sea. Those with high SRE scores experienced correspondingly high levels of illness.

Key Study: Rahe et al. (1970)

• As both positive and negative events are included in the SRRS, it appears that it is change rather than the negativity of change that is important.
• It is the overall amount of 'psychic energy' required to deal with a life event that creates the stress.

Recent research on life changes

• Michael and Ben-Zur (2007) studied 130 men and women, half who had divorced and half who were widowed.
• Looked at levels of satisfaction, widowed group - higher before bereavement than after loss + divorced individuals showed the opposite pattern after separation form their partners - they had higher levels of satisfaction after separation than before.
• Explanation suggests - living with partner caused greater satisfaction. They had changed life change into positive rather than a negative experience.

Positive and Negative events

• Research using SRRS suggests that life-changing events have potential to damage health because of the significant readjustment it entails.
• Some critics now suggest that it is the quality of the event that is crucial, undersired, unscheduled and uncontrolled changes being the most harmful.

Life changes and daily hassles

• Lazarus (1990) suggests that as major life changes are rare in lives of most people, it is the mindor daily stressors that are more significant sources of stress.
• DeLongis et al. (1988) studied stress in 75 married couples.
• They gave ppts a life event questionnaire and a Hassles and Uplifts scale.
• No relationship was found but did find a positive correlation of +.59 between hassles and next-day health problems.

Individual differences

• SRRS ignores fact that life changes will have different significance for different people.
• What are relatively minor stressors for some people, would be major stressors for other people.

Spurious relationship

• Most studies of relationship between life changes and illness have produced correlational data, i.e. they do not tell us about any possible causal relationship between the two.
• 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 likel to report negative life events and would also be more prone to illness.

• LC approach relies on people's memory for events in their life being accurate and consistent.
• Concerns that retrospective reports may not be particularly accurate.
• Brown (1974) suggests that people who are unwell may feel they have to explain their illness, and therefore are more likely to report stressful events than those who are not ill.
• Reliabilty of retrospective reports also questioned. 
• Rahe (1974) found that test-retest reliability varies depending on the time interval between testing.
• Most researchers have reported acceptable levels of reliability for rsr of life events.
• Hardt et al. (2006) interviewed 100 patients with a history of childhood abuse with time lag of 2.2 years between interviews.
• Reliability were assessed as well as physcial and sexual abuse.
• The results show moderate to good reliability for most childhood experiences.

Measuring hassles and uplifts

• Hassles and uplifts scales (HSUP) (Delongis et al., 1982), measures respondent's attitudes toward daily situations.
• Instead of focusing on the more highly stressful life events, the HSUP provides a way of evaluating both the positive and negative sevents that occur in each person's daily life.

Daily Hassles

• Bouteyre et al. (2007) investigated relationships between daily hassles and the mental health of students during transition from school to university.
• First year psychology students at French University complete the hassles part of HSUP and the Beck Depression Inventory as a measure of any symptoms of depression that may link to transition.
• Results showed 41% of students suffered from depressive symptoms - positive correlation between scores on the hassles scale and the incidence of dpressive symptoms.

Daily uplifts

• Gervais (2005) asked nurses to keep dairies for a month, recording all daily hassles and uplifts at work. Also asked to rate their own performance over the same period.
• Typical entries said that they were left to sort out people's anger due to irresponisbility.
• Also about staff that weren't in work and didn't pull their weight.
• It was clear that daily hassles were found to increase job strain and decrease job performance.
• Nurses felt that some uplifts counteracted the negative effects of their daily hassles.
• As well as overcoming the stress associated with their daily hassles, daily uplifts also improved their performance on the job.

Daily hassles versus life changes

• Daily hassles are now broadly accepted as comparable to life changes as a significant source of stress.
• Austrailian study (Ruffin, 1993) daily hassles were linked to greater psychological and physical dysfunction than major negative lie events.
• Flett et al. (1995)  found major life-changing events may differ from daily hassles in the extent to which a person would recieve and/or seek social support.
• 320 students, half women the other men, read a scenario describing a male or female individual who had experienced either a major life event or daily hassles.
• They then rated the amount of support (both emotional and practical) that the person would receive and would seek from others.
• Individuals who had suffered major life events, the greater negative influence of daily hassles on psychological adjustment may be due, to reduced social and emotional support from others. 

The accumulation effect

• Daily hassles provide a more significant source of stresss for most people than major life events.
• One explanation is that 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 (Lazarus, 1999).

The amplification effect

• Alternative explanation is that chronic stress due to major life changes may make people more vulnerable to daily hassles.
• As the person is already in a state of distress, the presence of associated minor stressors may amplify the experience of stress.
• The presence of a major life change may also deplete a person's rescources so they are less able to cope with minor stressors than they would under normal circumstances.

The problems of retrospective recall

• Participants are asked to rate hassles experienced over the previous month.
• The same problems with retrospective reports on life changes also apply here.
• Some researchers have overcome this problem by using a diary method, where participants rate minor stressors and feelings of well-being on a daily basis.

What the research shows...

• Most of the data from the research on daily hassles is correlational.
• This means that causal relationships cannot be drawn about the relationship 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.

Workload and control

• Marmot et al. (1997) investigated the job-strain model of workplace stress.
• The model proposes that the workplace creates stress and illness in two ways: 1. high workload (creating greater job demands) and 2. low job control (e.g. over deadlines, procedures, etc.)
• Suggested that in the civil service, higher-grade employees would experience high workload whereas low-grade civil servants would experience low job control.
• Therefore, both grades are likely to experience high levels of stress, but for different reasons.
• 7372 civil servants working in London agreed to answer a questionnaire on workload, job control and amount of social support, and to be check for signs of cardiovascular disease.
• The researchers also obtained an independent assessment of workload and control by checking job specification and role responsibilities with personnel management.
• Five years later participants were reassessed.

Workload

• Found no link between high workload and stress-related illness, and therefore concluded that job demand was not a significant factor in stress.
• However, other studies have examined different aspects.
• Johansson et al. (1978) looked at effects of performing repetitive jobs.
• The sawyers in a Swedish sawmill (high-risk group) have a stressful job - repetitive tasks, with an unrelenting pace and a sense of responsibility for the whole company - if they fall behind the whole company does too.
• Found to have higher illness rates and higher levels of adrenaline in their urine than a low-risk group.
• They also had higherlevels of stress hormones on work days than on rest days.

Control

• Five years after assessment, they found that those men and women who had initally reported low levels of job control were more likely to have developed heart disease than were those who had reported high levels of job control.
• This association did not appear to be linked to employment grade, neither could it be explained in terms of toher risk factors.
• The critical factor in determining the onset of heart disease, therefore, was the level of control regardless of the grade of job.
• Other factors, such as workload or the degree of social support recieved at work did not appear to be associated with the risk of heart disease.

Research support on the harmful effects of work stress

• Kivimaki et al. (2006) carried out a meta-analysis of 14 studies looking at the relative risk of coronary heart disease (CHD) in association with work stress.
• The analysis, which involved over 83,000 employees across Europe, the US and Japan, found that employees with high levels of job strain were 50% more likely to develop CHD.

Work underload

• Most research on work-related stress has focused on work overload, or having too many job demands, as opposed to work underload.
• Work underload refers to situations where people are employed in jobs that are beneath their capcities or where they are given tasks that are lacking in any creativity or stimulation.
• Shultz et al. (2010) gathered data from 16,000 adult employees across 15 European Countries.
• Discovered that those reporting work overload had highest level of stress-releated illness.
• Those reporting underload had low job satisfaction and more absences from SRI.

Workplace stress and mental health

• Work is generally good for our mental health, but it can be harmful at times.
• Workplace stress may not cause depressive illness directly, high levels of stress combined with other problems can make depression much more likely to occur.
• Warr (1987) used the analogy of 'vitamins' to explain how certain features of the workplace might contribute to the mental health of a worker.
• Low levels of vitamins lead to poor physical health, so low levels of these work-related features may lead to poor mental health.

The impact of workplace stressors

• Lazarus (1995) claims that the study of stressful factors in the workplace misses the point that there are wide individual differences in the way people react to and cope with individual stressors.
• Lazarus' transactional apporach emphasises that the degree to which a workplace stressor is perceived as stressful depends largely on the person's perceived ability to cope.
• Therefore, high job demands and role ambiguity may be perceived as stressful to one person, but not ot another.

The evolution of work and work stressors

• The changing nature of the work environment, with the advent of new technology, virtual offices and the blurring of home/work environments means our current knowledge of workplace stressors rapidly becomes out of date.
• Ultimate purpose of research is to help people manage the stressors of their working day.

Type A

• Describes a person who is involved in an incessant struggle to achieve more and more in less and less time.
• Friedman and Rosenman (1959) believed the Type A individual possessed three major characteristics;

* Competitiveness ad achievement striving
* Impatience and time urgency
* Hostility and aggressiveness

• These characteristics were believed to raise blood pressure and levels of blood hormones - linked to ill health, particularly development of coronary heart desease.
• Type B was proposed as lacking these characteristcs, being patient, relaxed and easy going.
• These behaviours decrease risk of stress-related illness. 

Research on Type A behaviour

• Friedman and Rosenman set up the Western Collaborative Group Study in 1960.
• Approximately 3000 men aged 39 to 59, living in California, were examined for signs of CHD and their personalities were assessed by interview.
• The interview included questions about how they responded to everyday pressures.
• The interview was conducted in a provocative manner to try to elicit type a behaviour.
• After 8 and a half years, twice as many Type A participants had died of cardiovascular problems.
• 12% of ppts had experienced a heart attack, compared to just 6% of Type Bs.
• Type As also had higher blood pressure and higher cholesterol.
• They were also more likely to smoke and have a family history of CHD, both of which would increase their risk.

Research support for the Type A/CHD link

• Ragland and Brand (1988) carried out a follow-up study of the Western Collaborative Group partcipants in 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 the CHD risk factors, but found little evidence of a relationship between Type A behaviours and mortality, therefore challenging the earlier conclusion that Type A behaviours was a significant risk factor for CHD mortality.
• Myrtek (2001) carried out a meta-analysis of 35 studies on this topic, and found an association between CHD and a componenet of Type A personality - hostility.
• Other than this, there was no evidence of an association between Type A personality and CHD.

• Kobasa and Maddi (1977) suggested that some people are more psycholigically 'hardy' than others.
• The hardy personality includes a range of characteristics which, 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 witht he world around them, and have a strong sense of purpose.
• Challenge - Hardy people see life challenges as probelms to be overcome rather than as threats or stressors. They enjoy change as an opportunity for development.

Research on the hardy personality...

• Kobasa (1979) studied about 800 American business executives assessing stress using Holmes and Rahe's SRRS.
• Approximately 150 of the participants were classified as high stress according to their SRRS scores.

• Of these, some had a low illness record whereas others had a high illness record which suggests that something else was modifying the effects  of stress because individuals experiencing the same stress levels had different illness records.
• Kabasa proposed that a hardy personality type encourages resilience.
• The individuals in the high-stress/low-illness group scored high on all three characteristics of the hardy personality, whereas the high-stress/high-illness group scored lower on these variables.
• 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.
• Lifton et al. (2006) measured hardiness in students at five US universities to see if hardiness was related to the likelihood of their completing their degree.
• The results showed that students scoring low in hardiness were disproportionately represented among the drop-outs, and students with a high score were most likely to complete their degree.

Hardiness and negative affectivity (NA)

• Some critics argue that characteristics of the hardy personality can be more simply explained by the concept of negative affectivity (NA) (Watson and Clark, 1984).
• 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 reasonable well, suggesting that 'hardy individuals' are simply those who are low on NA.

Problems of measurement

• Research that supports a link between hardiness and health has relied upon data obtained through self-reports. More recent efforts have led to the development of the Personal Views Survey.
• This new questionnaire addresses many of the criticisms raised with respect to the original measure, such as long and awkward wording and negatively worded items.

• Meichenbaum (1985) believed that although we cannot usually change the causes of stress in our life, we can change the way we think about these stressors.
• Meichenbaum's therapy, called SIT, is a form of cognitive behavioural therapy developed specifically to deal with stress.
• It is different from other stress treatments because Meichenbaum suggested that an individual should develop a form of coping before the problem arises.
• He suggested that a person could inoculate themselves gainst the 'disease' of stress in the same way that they would receive inoculations against infectious diseases such as measles.
• Meichenbaum proposed three main phases to this process:

Stage 1 - Conceptulisation phase

• The therapist and client establish a relationship, and the client is educated about the nature and impact of stress.
• This enables the client to think idfferently about their problem.

Stage 2 - Skills acquisition phase (and rehearsal)

• Coping skills are taught and practise primarliy in the clinic and then gradually rehearsed in real life.
• A variety of skills are taught and tailored to the individual's own specific problems.
• These include; positive thinking, relaxation, social skills, methods of attention diversion, using social support systems and time management.
• Client may be taught to use self-statements.

Stage 3 - Application phase (and follow through)

• Clients are given opportunities to apply the newly learned coping skills in different situations, which become increasingly stressful.
• Various techniques may be used such as imagery, modelling and role playing.
• Clients may even be asked to help train others.
• Booster sessions are offered later on.

Strengths of SIT - Effectiveness

• Meichenbaum compared SIT with systematic de-sensitisation.
• Patients used SIT or de-sensitisation to deal with their snake phobias.
• Although both therapies helped the client deal with the phobia, SIT was better as it helped with a second, non treated phobia.
• This shows that SIT can inoculate against future stressful situations aswell as offering help in coping with current problems.
• Sheehy and Horan (2004) examined effects of SIT on the anxiety, stress and academic performance of first year law students.
• Ppts recieved four weekly sessions of SIT, each lasting 90 minutes.
• Results showed that all ppts who recieved SIT displayed lower levels of anxiety and stress over time.
• The academic ranks of ppts predicted to finish in the bottom 20% of their class also reflected conspicuous and significant improvement. More than half improved grade.

Preparation for future stressors

• A major advantage of this method of stress management is that it doesn't just deal with current stressors, but also gives the client the skills and confidence to cope with future probelms. 
• The foucs on skills acquisition provides long-lasting effectiveness so that the individual is less adversely affected by stressors in the future.

Limitations - Time-consuming and requires high motivation

• SIT requires a lot of time, effort, motivation and money.
• However, Meichenbaum has also demonstrated the effectiveness of even relatively brief periods of therapy.

Unnecessarily complex

• It may be that the effectiveness of SIT is due to certain elements of the training rather than all of it.
• This means that the range of activities (and time) could be reduced without losing much of the effectiveness.

How can you teach hardiness?

• Salvatore Maddi, who worked with Kobasa, founded the Hardiness Institue in California.
• The aim of hardiness training is to increase self-confidence and sense of control so that individuals can more successfully navigate change.
• Focusing - the client is taught how to recognise the biological signs of stress, such as muscle tension and increased heart rate, and also to identify the sources of this stress.
• Reliving 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 become more effective than they thought.
• Self-improvement - the insights gained can now be used  to move forward and learn new techniques of dealing with stress. In particular the client is taught to focus on seeing stressors as challenges that they can take control of, rather than problems they must give in to.