PSYA2

• S -The Sympathetic nervous system(SNS) prepares the body for activity in conditions of immediate stress (acute).
• The SNS leads to changes such as an increase in heart rate and blood pressure.
• Noradrenaline is the neurotransmitter released by the SNS to activate these internal organs.
• The SNS causes the adrenal medulla to release adrenaline which boosts the supply of oxygen and glucose to the brain and suppresses non emergency bodily processes.
• The parasympathetic nervous system restores the body to a resting state after the stressor has passed, slowing down the heart beat and reducing the blood pressure.

• P - The hypothalamus is found deep in the brain.
• When physical or emotional stress is detected in the pituitary gland it causes this gland to release adrenocorticotrophic hormones (ACTH).
• ACTH travels in the blood to the adrenal glands ( found at the top of the kidneys).
• The outside of the gland, called the adrenal cortex, releases cortisol, which has a number of stress related effects in the body.
• We experience a quick burst of energy, a lowered sensitivity to pain but also a lower immune response.
• Prolonged release of ACTH causes the adrenal cortex to increase in size to enable it to cope with increased cortisol production.
• Long term ACTH deficiency causes it to shrink.

• Stress response can lead to cardiovascular problems because repeated activation of the stress response can affect the heart and blood vessels.
• For example, increased blood pressure associated with SNS activation can cause damage to the lining of blood vessels. Research by Orth – Gomer et al found that exposure to ongoing stressors, such as marital conflict, was associated with an increased likelihood of heart attack.
• This suggests that, although these bodily changes evolved as an adaptive response to stress among our distant ancestors, they may be unsuited to many modern stressors.
• Can lead to immune system problems because too much cortisol supresses the immune system which causes the process that fights infection to shut down, increasing the likelihood that the person will become ill.
• Kiecolt Glaser et al found that exposure to short term stressors such as examination caused a decrease in immune system functioning among medical students.
• This suggests that if short term stressors can lead to suppression of the immune system, long term stressors would have even more adverse effects.
• There are individual differences in how males and females display bodily responses to stress.
• Males tend to have fight or flight response, where as females often have a ‘tend or befriend’ response, regulated by the hormone oxytocin. Taylor et al found that females have higher levels of oxytocin, which is associated with reduced cortisol response to stress and faster recovery.
• This means that men are more vulnerable to the adverse effects of stress whereas the tend and befriend system may protect women against stress.

• Kiecolt Glaser et al 1984 carried out a natural experiment investigating whether the stress of short term stressors(important examinations) had an effect on immune system functioning in medical students.
• Immune system functioning was assessed by measuring NK cell activity in the blood samples.
• Blood samples were taken one month before (low stress) and during the exam period itself (high stress) Participants also completed a questionnaire to measure other life stressors being experienced at the time e.g. financial/relationship problems.
• Kiecolt Glaser et al 2005 tested the impact of interpersonal conflict on wound healing.
• She found that blister wounds on the arms of married couples healed slower after they had discussions which were conflicting rather than supportive.
• NK cell activity was significantly reduced during the exam period compared to one month before the exam period.
• Kiecolt Glaser et al also found that those students who also reported the highest levels of loneliness had the lowest NK cell activity.
• It can be seen that there is a link between stress related illness and the immune system.

• There is research support from Segerstrom and miller.
• A meta-analysis of 293 studies conducted over a 30 year period found that short term stressors could boost the immune system whereas long term stressors suppressed it. Short term stressors promoted the immune system to deal with potential challenges to the body. The most chronic long term stressors led to the most global suppressions of immune system functioning.
• This suggests that the more long lasting the stressor, the more damaging the effects on the immune system functioning. 
• Stress related illness and the immune system is not a simple relationship because it is difficult to establish causal relationships between stress and the immune system.
• Health is affected by many different factors e.g. genetics, lifestyle, so it is difficult to disentangle the specific effects that’s could be attributed to stress. Health is fairly stable and slow changing, therefore it is difficult to demonstrate that exposer to particular stressors has caused changes in the immune system. As a result, demonstrating a link over the long term is extremely difficult.
• Therefore researches have concentrated only on the impacts of relatively short term stressors.
• There are individual differences in immune system changes due to stress.
• Kiecolt Glaser et al found that women show more adverse immune system changes in how they reach to long term stressors, e.g. marital conflict. Older couples also showed more adverse immune systems changes in response to marital conflict than did younger couples.
• therefore critising research into stress related illness and the immune system.

• The SRRS was developed by Holmes and Rahe to test the idea that life changes are related to stress related illness such as anxiety and depression.
• The SRRS lists 43 life events taken from an analysis of over 500 patient records. Each event was rated in  terms of the amount of readjustment that would be required by an average person to cope with that life event.
• This was referred to by the LCU which stands for life changing units.
• Events that were potentially more stressful than marriage were given a higher LCU, those requiring loss of adjustment a lower LCU. The highest LCU for a life event was for death of spouse which was given an LCU of 100.
• A - After this they set out to test Holmes and Rahe’s hypothesis that the number of life experiences a person experienced would be positively correlated with illness
• P - A military version of the SRRS (SRE) was given to all men abroad three navy ships (2700 men).
• They did the questionnaire before their tour of duty.
• They were asked to note all life events in the last 6 months. Illness score was calculated on the basis of the number, type and severity of all illness recorded during the tour of duty.
• F - positive correlation between LCU scores and Illness score od +.118. Men who scored low in SRE had low illness at sea. High SRE scorers experienced correspondingly high levels of illness.
• C - it appears that it is change rather than the negativity of change that is important as both negative and positive are both in the SRRS. It is the overall amount of ‘psychic energy’ required to deal with a life event that creates stress.

• individual differences in the impact of life events. Life changing questions such as the SRE and SRRS ignore the fact that the impact of life changes such as divorce or retirement.
• For example the untimely death of a much loved spouse will undoubtedly have a devastating effect on the survivors partner, but the death of an elderly spouse after a long and painful illness may not be quite so stressful for the survivor. Similarly what are relatively minor stressors for some people, such as a son or daughter leaving home or even a particularly busy Christmas would be major stressors for some people. 
• Although questionnaires may provide a quantitative measure of life changes, they may not reflect the actual amount of stress.
• may be less important than daily hassles. Life changing events are relatively rare in the lives of most people, where as minor stressors such as a family argument or a missed bus are common.
• Delongis et al  studied stress in 75 married couples. They gave the participants a life events questionnaire, Hassles and uplifts scale. ound no relationships between life events and health, but found a significant positive correlation of+.59 between hassle and next day health problems such as flu,  headaches. 
• this suggests that daily hassles may be more significant as a source of stress in their own right, or alternatively may increase the stress caused by a major life event.
• Research does not show a casual relationship as studies such as Rahe et al have produced only correlational data. It is possible that as third variable such as anxiety may affect both the life changing event and any related stress related illness.
• E- Brown suggests that people with high levels of anxiety would be more likely to report negative life events and would also be more prone to illness.
• this means that although there may be a relationship between life changes and stress related illness, most research has failed to establish a casual relationship between the two.

• H-Bouteyea et al carried out a study using correlation data.
• Studies students in the first year of a psychology degree course at a French university.
• Samples were mostly female 207 with 26 males. Mean age was 20.48 years.
• Students completed beck depression inventory, daily hassles scales and social support questionnaires.
• Results show that 41% of those surveyed suffered from depression symptoms.
• There was a positive correlation of 0.33 between depression symptoms and scores on the hassle scale.
• Students with good social support (such as friends and peers) were less likely to develop depression when faces with daily hassles.
• U-Gervais (2005) asked nurses to keep diaries for a month, recording all their daily hassles and uplifts at work. They were also asked to rate their own performance over the same period. Typical entries were: "Lack of beds meant cancellation of elective admissions; this was left to me; I had to deal with peoples anger despite not being responsible. ““A bit of hassle at work today due to being on duty with staff who don’t pull their weight. Felt not appreciated today at work."
• At the end of the month it was clear that daily hassles were found to increase job strain and decrease job performance. Nurses felt that some of the uplifts experienced ( like a compliment from a patient) counteracted the negative effects of their daily hassles.
• As well as overcoming the stress associated with their daily hassles, these daily uplifts also improved their performance on the job.

• There are real world applications of research into daily hassles. For example, research has shown that an accumulation of daily hassles can mean that some people are more likely to experience road rage during their commute home.
• Gulian et al found that participants who responded a difficult day  at work tended to put higher levels of stress on their drive home.
• This shows that unresolved hassles during the day can be carried forward to that the behaviour of others are more likely to be interpreted negatively by there stressed driver.
• One limitation of this appears constant problems with retrospeture  recall, because participants have to rate hassles experienced over the prior month.
• The Bauteyere et al research doesn’t demonstrate that depression was directly attributed to hassles, as a third variable like finances may have been a cause for both.However correlations do suggest that hassles have the potential to have adverse effects on well being.
• This means that we cant draw causal relationships between daily hassles and our physical and psychological well being.
•  A second limitation for this approach is that studies such as Bauteyere et al study only produce correlational data.
• The accuracy of such memories tends to vary according to the time intervals involved, with no longer intervals associated with less accurate memories. For example Rubin and Baddeley refer to the phenomenon of ‘telescoping’ where events that occurred prior to the reference period like the previous month intruded into memory are recalled as being more recent than they actually were.
• However this problem can be overcome by using a dairy method, where stressors and feelings are recorded daily.

• Marmot et al investigated job strain model of work place stress.
• This model proposes that the workplace stress and illness in two ways; 1 is high workload and 2 is low job control.
• It was a longitudinal study of 10308 civil servants aged 33-55 (67% male and 33% females).
• Participants completed a questionaire on job control, workload and social support.
• Independent checks where made of independent roles and job specifications and role responsibilities.
• Johansson et al (1978) looked at the effects of performing repetitive jobs that require continuous attention and some responsibility e.g. High job demands.
• A group of sawmill ‘finishers’ performed repetitive jobs that require high levels of attention and responsibility – their job is at a unrelenting pace and they have a sense of responsibility for the whole company because if they fall behind on their work, the production of the whole company is slowed down.
• Workers who carried out maintenance at the mill or were cleaners were used as a control group.
• Adrenaline was measured several times a day, at home and at work, and participants rated themselves on wellbeing and efficiency.
• In the control group, adrenaline levels were less than 1.5 times higher than at home.
• The high risk group (the finishers) had higher illness rates and higher levels of adrenaline than a ‘low risk’ group within the sawmill.
• Finishers were more irritable, had lower feelings of well being and high absence rates than workers in the control group.
• Finisher’s adrenaline rates were over twice as high at work than at home. This suggests that workload does impact on work place stress.

• There is research support from Kivimaki et al.
• Their meta analysis of 14 studies found that employees with high levels of job strain (high workload, low levels of control) were 50% more likely to develop coronary heart disease (CHD) than those with low levels of job strain. Choi et al argue that Kivimaki examined the impact of only one work stressor(job strain) yet other several stressors (long working hours etc) are associated with CHD, independent of job strain.
• This suggests that tackling job strain alone without other risk factors may not dramatically reduce levels of CHD.
• Other research disagrees that workload is a significant source of stress.
• A study of civil servants (marmot et al) did not find that workload has a contributory factor in stress related illness. Marmot et al’s study found that it was job control rather than work load that was the main contributory factor in the development of coronary heart disease.
• This suggests that although ‘job strain’ appears to be a determinant of stress related illness, control appears to be more influential than work load.
• Work under load can also be stressful.
• Work under load occurs where people employed in jobs that are beneath their capacities or which lacks creativity or stimulation. Schultz et al found that employees reporting work overload had the highest levels of stress related illness but those who reported work under load also experienced significant levels of stress related illness.
• This suggests that work place stress may be determined by having too little work to do as well as having too much.

• Marmot eta la investigated job strain model of work place stress.
• This model proposes that the workplace stress and illness in two ways; 1 is high workload and 2 is low job control.
• It was a longitudinal study of 10308 civil servants aged 33-55 (67% male and 33% females).
• Participants completed a questionaire on job control, workload and social support.
• Independent checks where made of independent roles and job specifications and role responsibilities.
• Researchers checked for symptoms of CHD in participants.
• After 5 years those had reported high levels of job control where more likely to have developed CHD than those who had a low level of job control.
• This association was not linked to other risk factors such a smoking, physical category or employment grade.
• Workload and social support were not related to risk of CHD.
• This suggests that the critical factor in determining the onset of CHD was the level of control.

• There are individual differences in how workers respond to lack of control.
• Research into the impact of workplace stressors misses the point that there are individual differences in how people react to and cope with individual stressors such as lack of job control. Schaubreok et al found that some workers respond differently to lack of control- they are less stressed by having no control or responsibility in their work.
• They also had higher immune system responses in low rather than high control situations.
• Lack of control can be harmful as it can have adverse effects on mental health.
• High levels of stress at work as that caused by lack of control combined with other stressors such as problems at home or daily hassles can make illnesses such as depression  m ore likely. Melchior found that work stress, in particular low levels of job control, can cause depression and anxiety in previously healthy young workers.
• This suggests that helping workers with workplace stress and control could reduce there chances of mental health problems.
• Lack of control may have indirect effects such as diabetes as a consequence of stress.
• Smith eta la found that low levels of job control were related to an increased risk of contracting diabetes among women but not men. Smith et al claims that women react differently to stress, women are more likely to have unhealthy eating habits.
• As, a result this makes women more vulnerable when it comes to developing diabetes than men when faced with a lack of control.

• Friedman and Rosenham  in 1959 set up the Western Collaborative group study in 1960 to investigate hypothesis that CHD Is related to Type A personality.
• Approximately 3000 men aged 39-59, lived in California were examined for signs of CHD ( to exclude those who were already ill).
• Their personalities were assessed using a structured interview and they were observed to see how they responded to everyday pressures such as having to wait in a long queue.
• After 8 and a half years twice as many Type A had died for cardiovascular problems than type B men.
• 12.8% of the Type A men had experienced a heart attacked compared to 6% of Type B’s.
• The Type A men also had higher blood pressure, higher levels for cholesterol, more likely to smoke and have a family history pf CHD.
• Therefore suggesting Type A personality does relate to CHD.

• One criticism of this study comes from a research by Bunker et al.
• They had found no strong evidence for a causal relationship between Type A behaviour patterns and the development of CHD. Bunker et al carried out a review of research studies, although they found a relationship between some factors and the development of CHD, Type A behaviour was no more significant than other risk factors such as smoking.
• This suggest that although Type A behaviour is a risk factor, it has no causal relationship with CHD.
• There are real life applications to help people with extreme Type A behaviour patterns change them to more of  a Type B style.
• For example the Recurrent Coronary Prevention Project,. Which was conducted in the 1980s in San Francisco. Follow up studies of this project found that changes were achieved in many people. Heart attack rates were reduced in those who received the Type A reduction efforts.
• However intervention is difficult because the Type A behaviour style has many rewarding features for people who are motivated by career advancement.
• Type D is more important than Type A in predicting health outcomes.
• Type D individuals have increased levels of anxiety and depression. They overreact to stressful situations but conceal their feelings from others out of fear of rejection. Type D’s responds differently to stress, having raised levels of cortisol, which leads to an increased risk of |CHD. Denollet el at studied 300 heart patients in a cardiac rehabilitation programme and found that 27%n of those classified as Type D within 8 years, compared to 7% in non-Type D’s.
• Unlike Type A’s who tent to vent their anger and impatience, Type D’s have no outlet for their stress, which makes it so harmful for them and CHD is more likely.

• Aim – Kobasa et al investigated the relationship between stress and illness and the Hardy personality
• Procedure – Gathered data from a sample of 256 business executives in a large utility company. Questionnaires were used to assess stressful li9fe events and illness symptoms over a two year period (SRRS). Researchers also assessed constitutional predisposition (family history of illness). Separate scales measured the three components.
• Findings – The presence of a constitutional predisposition in someone experiencing  stressful life events increased the likelihood of the becoming ill. Scoring high on the three hardiness components  appeared to decrease this likelihood.  All three factors (stressful life events, constitutional predisposition, hardiness) had an effect on illness. Of the three, hardiness had the largest influence.
• Conclusion – this suggest6s hardiness does have an effect on stress and illness.

• There is research support from the study from the study of soldiers undergoing the stress of military deployment.
• In the 1990’0s gulf war, the higher the hardiness level, the less likely soldiers were to experience negative health consequences. Bartone studied US army soldiers on combat and peacekeeping missions. He found evidence that lower levels of hardiness were associated with greater likelihood of mental breakdown or posttraumatic stress disorder.
• As a result, hardiness training has become widespread in the US military.
• There is a real world application of Hardiness research in the development of hardiness training programme. It should be possible to increase hardiness in individuals and make them more resistant to stress.
• In hardiness training programme, individuals are coached in an attempt to strengthen hardy attitudes. Maddi et al used a hardiness training programme to help stressed out employees. Those that took part reduced their anxiety and other signs of strain, while increasing their job satisfactions.
• This shows that hardiness is important not only for coping with stressful conditions but also for thriving in those conditions. 
• One criticism of Kobasa’s study comes from the concept of negative affectivity.
• Individuals high in negative affectivity dwell more on their failures and on negative aspects of themselves and are more likely to report dissatisfaction and distress. This suggests hardy personalities are low in negative affectivity. 
• this is challenged by studies that do not involve self reports of health or performance. For example maddi found that hardiness levels were higher among employees whose blood pressure was normal compared to those with higher blood pleasure.
• this would be difficult to explain using the concept of negative affectivity, as this is a physiological measure.

• Meichenbaum (1985) believed we cannot change causes of stress but we can change the way we think.
• Negative thinking leads to negative outcomes such as anxiety and depression.
• Positive thinking leads to positive attitudes and feelings. These reduce stress response and help us cope better.
• Meichenbaum proposed the SIT which is a cognitive behavioural therapy developed to deal with stress.
• It is different because he said an individual should learn coping strategies before stress occurs.
• SIT consists of three stages;
• First the conceptual phase where trainer and client establish a relationship and client is educated about stress. For example the client is taught to view perceived threats as problems to be solved and to break them down.
• The next phase is Skill acquisition and rehearsal, the client learns coping strategies and practices them in the clinic and then real life. These include positive thinking, relaxation, social skills, methods of attention diversion and time management.
• The last stage is application, this gives clients the opportunity to apply the new skills to different situations. Various techniques may be used such as imagery, modelling and role play.

• There is research support for the effectiveness of SIT.
• Meichenbaum used SIT to effectively help individuals deal with stress associated with their snake phobia. Both SIT and systematic desensitisation were effective in reducing snake phobia, but SIT also helped clients deal effectively with different (untreated) phobia.
• This shows that SIT not only deals with the stress of current problems but also inoculates against future stressors.
• There is research support as SIT also works with non – clinical populations such as students.
• SIT has been shown to be effective for students when dealing with the stresses of academic life. Sheehy and Horan found that law students who received SIT displayed lower levels of anxiety and stress over time and improved academic performance.
• Demonstrates that, although academic stress may be unavoidable, the use of SIT can minimise its adverse effects.
• One problem with SIT is that it is time consuming and requires high levels of motivation. As a result this may limit its usefulness as a method of stress management because people are reluctant to invest sufficient time and effort.
• However Meichenbaum demonstrated the effectiveness of brief periods of therapy e.g. for victims of sexual assault or for preparing patient for surgery.
• This shows the effectiveness of SIT is not necessarily reduced when the time available for therapy is limited.

-If some people were naturally resistant to stress (because they were hardy) then perhaps it would be possible to teach others how to become more ‘hardy’, and thus manage stress better. -Kobasa, founded the hardiness institution in California. The aim of hardiness training is to increase self-confidence and sense of control so that individuals can more successfully navigate change.

• Stage 1 – Focusing. The client is taught how to recognise the biological signs of stress, such as muscles tension and increased heart rate, and also to identify the source of this stress

• Stage 2 – 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 be more effective than they thought.

• Stage 3 – 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.

• There are limitations of hardiness training.
• It must fist address learned habits of coping that are difficult to modify. For example, Lindquist et al found that men tend to use more maladaptive coping strategies e.g. alcohol abuse or interpersonal withdraws.
• This means that hardiness training cannot be seen as a rapid solution to stress management.
• Hardiness training has been used effectively by uk Olympic swimmer 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 within their training (Fletcher, 2005).
• Suggesting that Hardiness training has been used effectively in a real world situation.
• However, hardiness training has the problem of looking and changing certain aspects of an individual.
• Aspects such as personality and learn habits of coping that are notoriously difficult to modify.
• It cannot therefore, be seen as a rapid solution to stress management.

• BZ's-Valium and Librium belong to this group of drugs that are most commonly used to reduce anxiety and stress as they slow down the activity of the central nervous system.
• The action of this drug on the neurons reduce the brains output of excitory neurotransmitters which results in the person feels calmer.
• The neurotransmitter serotonin has an arousing effect in the brain.
• As the drug reduces and raised serotonin activity, the anxiety a person feels is reduced.
• The body produces its own form of anxiety relief, a neurotransmitter called GABA – 40% of the brains neurons respond to this neurotransmitter.
• GABA reacts onto neurons receptors and allows chloride ions into the neuron which makes it hard for the neuron to become excited.
• The drug enhances GABA’s action by increasing the flow of chloride ions into the neuron.
• Beta Blockers - The action of these drugs is to reduce the activity of adrenaline and noradrenaline which form part of the Sympathomedullary response to stress.
• When stress occurs, the sympathetic nervous system becomes aroused.
• This leads to an increase in blood pressure, heart rate and cortisol levels.
• These drugs work by binding to receptors on the cells of the heart and other parts of the body that are usually stimulated during arousal.
• As the receptors are now blocked, it becomes harder to stimulate the heart, so its beat slows and blood vessels do not contract as easily, so blood pressure is reduced.
• This reduces the strain on the heart, makes the person feel calmer and less anxious.
• These benefits mean this drug is often used by people who have to give a performance of some kind.

• One strength of drug therapies is that drugs are effective in combating the effects of stress.
• For example, Kahn et al found that BZ’s were superior to the placebo in reducing the effects of patients stress over an eight week period. BBs were also effective in reducing performance anxiety among musicians who felt less stressed when performing and performed better (Lockwood).
• This shows that reducing anxiety associated with stressful situations is an effective form of stress management.
• Asecond strength of drug therapies is that drugs are easy to use compared to other forms of treatment.
• Drug treatments require little effort from the patient compared to the significant investment in time and motivation required in psychological methods such as stress inoculation. Patients need only remember to take the drug whereas SIT involves a lengthily therapeutic process and a great deal of input from the client.
• The relative ease of use od drug treatments means the people are more likely to continue with treatment, increasing the effectiveness od their stress management.
• one limitations of drug therapies is that drugs can be addictive and can lead to withdrawal symptoms.
• these occur when patients stop taking BZs indicating psychological dependence With regular use the body comes to depend on BZs for normal function. Tolerance develop so larger doses are needed top produce the same effects (Ashton).
• this means that the use of BZs tend to be limited to short term treatments of stress only.