Stress

• Sypathetic Nervous System (SNS) prepares the body for action in conditions of acute stress
• SNS causes changes such as an increase in heart rate and blood pressure
• SNS causes the adrenal medulla to release adrenaline into the bloodstream
• Adrenaline boosts the supply of oxygen to the brain and suppresses non-emergency bodily processes
• Parasympathetic Nervous System (PNS) restores body to resting state once the stressor has passed
  • PNS slows down heartbeat and reduces blood pressure 

• Activated under conditions of chronic stress
• Hypothalamus activated when stressors are perceived by higher brain centres
• Activation of hypothalamus leads to release of CRF into the bloodstream
• CRF causes pituitary gland to release ACTH into the bloodstream which activates adrenal cortex
  • Prolonged release of ACTH causes the adrenal cortex to increase in size to cope with increased cortisol production
• Activation of adrenal cortex leads to release of the hormone cortisol
• Cortisol lowers sensitivity to pain, but also lowers the immune response

Kiecolt-Glaser et al

• Natural experiment with 75 medical students
• Researchers assessed immune system 1 month before an exam and then during exam period
  • By looking at NK cell activity
• Students also took a questionnaire to measure other life stressors being experienced at the time
• Found NK activity significantly reduced during exam period compared to one month before
• Found students reporting the highest level of loneliness had lowest immune system functioning

Kiecolt-Glaser et al

• Studied the effects of unhappy relationships on immune system functioning
• Involved a volunteer sample of married couples aged between 22 and 77 years
• Found that blister wounds healed more slowly on couples that showed high levels of hostile behaviour toward each other

• P - Research support from Segerstrom and Miller
• E - Meta-analysis of 293 studies conducted over a 30 year period found that short term stresors could boost the immune system whereas long term stressors suppress it
• E - Short term stressors promoted immune system to deal with potential challenges to body. Most chronic long-term stressors led to the most global suppression of immune system
• L - Suggests the more long-lasting the stressors, the more damaging effect on immune system

• P - Not a simple relationship as it is difficult to establish a causal relationship 
• E - Health is affected by several factors - hard to only observe specific possible causes of stress
• E - Health is slow to change, therefore it's difficult to demonstrate that exposure to particular stressors has caused a change in immune system functioning
• L - As a result, demonstrating a link over the long term is difficult, which is why researchers focus mainly on short term stressors.

Rahe et al 

• 2,664 US Navy sailors
• Completed SRE (military version of SRRS)
  • Measured life events experienced over the 2 years prior to 6-month tour of duty
• Recorded any illnesses over 6-month period
• Found a small but positive correlation between scores on the SRE and reported illnesses
• Relationship between life events and illness was more evident in married than single sailors

Holmes and Rahe et al

• SRRS was developed to test the idea that life changes are related to stress-related illnesses
• Based on 43 life events taken from an analysis of over 5000 patient records
• 400 participants rated each event in terms of the amount of readjustement would be required by an average person
• Marriage was the comparison point and was given a Life Change Unit (LCU) of 50
• Anything that requires more readjustment than marriage was given a higher LCU (vice versa)
• Highest LCU was 100 for death of a spouse

• P - Individual differences in the impact of life events
• E - Life change questionnaires ignore the fact that the impact of life changes such as divorce
• E - Sherbourne et al found that the impact of bereavement was greater for younger people that older.
• L - Although questionnaires may provide a quantative measure of life changes, they may not reflect the actual amount of stress resulting from specific life events for different individuals.

• P - Life changes as a source of stress may be less important than daily hassles
• E - Life-changing events are rare whereas daily hassles are commonplace e.g. missed bus
• E - DeLongis et al found no relationship between life events and health in a sample of married couples but found a significant correlation between hassles and next-day health problems
• L - Suggests that daily hassles may be more siginificant as a source of stress in their own right, or might amplify stress caused by major life events.

Bouteyre et al

• French psych. students making transition from school to uni
• 207 females and 26 males
• Students completed hassles questionniare & depression questionnaire
• Found 41% of students suffered from depressive symptoms
• Found a positive correlation between scores of the hassles scale and depressive symptoms

Gervais

• Asked nurses to keep diaries for a month recording all the daily hassles and uplifts experienced at work
• Also asked to rate their performance at work and to note any physical strain
• Found that daily hassles increased job strain and dereased job performance
• Daily uplifts appeared to counteract the stressful impact of daily hassles

• P - Studies such as the Bouteyre et al study only produce correlational data.
• E - Means we can't draw casual relationships between daily hassles and well-being.
• E - The Bouteyre et al research does not demonstrate that depression was directly attributable to hassles, as a third variable may have been the cause e.g. financial problems.
• L - But correlations do suggest that hassles have the potential to have adverse effects on people.

• P - Real-world appplications of research into daily hassles.
• E - 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.
• E - Gulian et al found that participants who reported a difficult day at work tended to report a higher levels of stress on their drive home.
• L - Shows that unresolved hassles during the day can be carried forward so that the behaviour of others are more likely to be interpreted negatively by the stressed driver.

Johansson et al

• Sawmill 'finishers' performed repetitive tasks that required high levels of attention and responsibility (high workload) and rated themselves on well-being and efficiency
• Cleaners used as a control group
• Adrenaline was measured several times a day at work and home
• Found finishers had higher illness rates and adrenaline levels
• Found that finishers adrenaline was twice as much at work than at home

Naylor and Malcomson

• 644 secondary English teachers in Canada
• Survey on their levels of stress and workload
• Asked to idnetify the most significant aspects of stress in their professional lives
• Found female and younger teachers reported the worst impact and least coping ability
• More than 85% reported that their work resulted in significant levels of fatigue 
• More than 1/3 reported health problems that related to their work life

• P - Research support from Kivimaki et al
• E - Meta-analysis of 14 studies found employess with high workload were 50% more likely to develop CHD.
• E - Choi et al argued that Kivimaki examined impact of only one factor yet other stressors are assoicated with CHD.
• L - Suggests tackling job strain alone without other factors may not dramatically reduce CHD levels.

• P - Other research disagrees that workload is a significant source of stress
• E - Marmot et al did a study on civil servants found workload was not a factor in stress-related ilness.
• E - Marmot et al's study found that it was job control rather than workload was the main factor.
• L - Suggests that although job strain is determinant of stress-related illness, control appears to be more influential than workload.

Marmot et al

• Longitudinal study of 10,308 civil servants aged 35-55
• Completed a questionnaire on job control, workload and level of social support
• Researchers checked for any symptoms of CHD in participants
• Found after 5 years those who reported low levels of job control were more likely to develop CHD
• Workload and social support at work were not related to risk of CHD

McCarthy et al

• 227 men who had experienced a first time coronary event
• Each man was matched with a man of a similar age and background
• Found a significant factor in the likelihood of a coronary event was low job control
• Older workers (over 50) reported a signifcantly lower levels of job control than younger workers did and were also more susceptible to coronary events
• Higher job control was seen as a potential protective factor of heart disea

• P - Individual differences in how wokers respond to lack of control
• E - Research into the impact of workplaces stressors misses the point that there are wide individual differences in how people react to and cope with individual stressors such as lack of control
• E - Schaubroeck 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 mmune responsibility in low rather than high control situations
• L - Suggests that lack of control may only be experienced as stressful by some individuals.

• P - Lack of control can be harmful as it can have adverse effects on mental health
• E - High levels of stress at work combined with other stressors (e.g. daily hassles) can make illnesses like depression more likely
• E - Melchior found that work stress, in particular low levels of job control, can precipiate depression and anxiety in previously healthy young workers
• L - Suggests that helping workers cope with work stress or reducing work stress levels can prevent the occurance of mental health problems

Friedman & Rosenman

• Studied 3,000 men aged 39-59 in California
• Men examined for sign of CHD - to exclude any that were already ill
• Interviewed an obsevered to see how they responded to everyday pressures
• Men were classfied Type A or Type B

Type A

• Competiveness & achievement striving
• Impatient & time urgency
• Hostility & aggressiveness
• It is also thought to increase risk of stress-related illness

Type B 

• Relaxed
• One thing at a time
• Expresses feelings
• It is also thought to decrease risk of stress-related illness

Friedman and Rosenman

• After 8 years twice as many Type A men had died of cardiovascular problems than Type B
• Over 12% of the Type A men had experienced a heart attack compared to 6% Type B men
• Type A men also had higher blood pressure and higher levels of cholesterol

Myrtek

• Meta-analysis covering all prospective studies carried out up to 1998
• Correlated the relationship Type A behaviour and development of CHD
• Relationship between Type A behaviour and CHD was not significant
• There was a significant relationship between hostility and CHD but it was so low that it was considered to have no practical meaning for the prevention and prediction of CHD

• P - Criticism of Friedman and Rosenman from Bunker et al
• E - They found no strong/consistent evidence for a casual relationship between Type A behaviour patterns and the development of CHD
• E - Bunker et al carried out a review and found Type A behaviour was no more significant than other risk factors
• L - Suggests although Type A behaviour is a risk factor, it has no causal relationship with CHD

• P - Type D is more important than Type A in predicting adverse health outcomes
• E - 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.
• E - Denollet et al studied 300 heart patients in a cardiac rehabilitation programme nd found that 27% of those classified as Type D died within 8 years compared to 7% of non-Type Ds
• L - Unlike Type As who end to vent their anger and impatience, Type Ds have no outlet for their stress, which ames it so harmful for them and CHD is more likey

Kobasa et al

• 259 business executives in a large utility company
• Questionnaires used to assess stressful life events and illness symptoms over a two-year period
• Separate scaes measured the three components of hardiness (contol, commitment, challennge)
• Found stressful life events, consitiutional predisposition and hardiness had an effect on illness
• Experiencing stressful life events with constitutional predisposition increases likelihood of illness
• Scoring high on 3 hardiness components appeared to decrease this likelihood

Maddi et al

• Natural experiment over 12-year period
• Company was reducing workforce dramatically over the period
• Each year data was collected from a sample of 450 male and female supervisors
• Found 2/3 of the sample suffered stress-related illness
• Found 1/3 showed no evidence of stress-related illness and appeared to thrive
• These hardy employees were more likely to face stressful circumstances rather than deny them and attempted to turn potential disasters into opportunities

• P - Research support from the study of soldiers undergoing the stress of military development
• E - In the 1990s Gulf War, the higher the hardiness level the less likely soldiers were to experience negative health consequences
• E - Bartone studied army soldiers on combat and peacekeeping missions. He found evidence that lower levels of hardiness were associated with greater likelihood of mental breakdown or PTSD
• L - As a result, hardiness training has become widespread in the US military

• P - Problems with the concept of hardiness as not all components (challenge, commitment and control) may be important
• E - Sheard examined whether all components of hardiness equally predicted university success
• E - Female students signigcantly outperformed males in their dissertations marks and final degree grade and also reported a significantly higher score on commitment compared to males (but not on other components)
• L - Therefore commitment was found to be the most significant positive correlate of academic achievement

• SIT helps people to cope with the afterath of exposure to stressful events and to 'inoculate' themselves against a stressor before it arises
• The aim of SIT is to enhance individuals' coping repertoires and enable them to use their already existing coping skills
• 3 phases of SIT are
  • Conceptualisation
    • Clients are taught to think differently about a stressor, and how to breakdown major stressors into specific short-term, intermediate and long-term coping goals
  • Skills acquistion
    • Coping skillls taught then rehearsed in real life. These include problem-solving and using social support systems
  • Application
    • Learned coping skills are applied in increasingly stressful situations. Relapse prevention procedures and bosster sessions built into SIT
• SIT usually consists of between 8-15 one-hour sessions, plus booster and follow-up sessions, conducted over a 3-12 month period.

• P - Research support for the effectiveness of SIT
• E - Meichenbaum used SIT to help individuals deal with stress linked to their snake phobia
• E - Both SIT and systematic desensitisation were effective in reducing snake phobia, but SIT also helped clients deal effectively with a different (untreated) phobia
• L - Shows that SIT not only deals with the stress of current problems but also inoculates against future stressors

• P - Research support that SIT also works with non-clinical populations such as students
• E - SIT has been shown to be effective for students when dealing with the stresses of academic life
• E - Sheehy and Horan found that law students who recieved SIT displayed lower levels of anxiety and stress over time, and improved academic performance
• L - Demonstrates that, although academic stress may be unadvoidable, the use of SIT can minimise its adverse effects

• P - It is time consuming and requires high levels of motivation
• E - This may limit its usefulness as a method of stress management becuase people are reluctant to invest sufficient time and effort
• E - Meichenbaum demonstrated the effectiveness of brief periods of therapy e.g. for victims of sexual assault
• L - Shows the effectiveness of SIT is not necessarily reduced when the time available for therapy is limited

• People can be trained in hardieness to help them manage stress better by becoming more resistant to its potentially harmful effects
• Involves 3 stages
  • Focusing
    • On the sources and signs of stress
  • Reliving stress encounters
    • The client is given an insight into their current coping strategies
  • Self-improvement
    • Learning new techniques e.g. stressors seen as challenges not problems

• P - It must first address learned habits of coping that are dificult to modify
• E - E.g. Lindquist et al found men tended to use more 'maladptive' coping strategies e.g. alcohol abuse or interpersonal withdrawal.
• L - Means that hardiness training cannot be seen as a rapid solution to stress mangement

Benzodiazepines (BZs)

• Used to treat anxiety that is a consequence of stress
• They slow down activity in the central nervous system (CNS) by enhancing the action of GABA
• Slows down activity in the CNS making the person feel more relaxed

Beta-blockers (BBs)

• Reduce the effects of adrenaline and noradrenaline in response to stress, to reduce anxiety levels
• Bind to cells of the heart and other parts of the body that are usually stimulated during arousal by blocking their activity
• Heart beats slower and with less force, blood pressure falls and the person feels calmer

• P - Effective in combating the effects of stress
• E - Kahn et al found that BZs were superior to a placebo in reducing the effects of patients' stress over an 8 week period
• E - Lockwood found BBs were also effective in reducing performance anxiety amoung musicians who felt less stressed when performing and as a result performed better
• L - Shows that reducing the anxiety associated with stressful situations is an effective form of stress management

• P - Drugs are easy to use compared to other forms of treatment
• E - Drug treatments require little effort fro the patient compared to the significant investment of time and motivation required in psychological methods e.g. SIT
• E - Patients need only to remember to take the drug whereas SIT involves a lengthy therapeutic process and a great deal of input from the client
• L - The easy use of drug treatments means that people are more likely to continue with treatment, increasing the effectiveness of their stress management

• P - It is addictive and can lead to withdrawal
• E - These occur when patients stop taking BZs, indicating psychological dependence
• E - Ashton found that with regular use the body comes to depend on BZs for normal function, tolerance develops so larger doses are needed to produce the same effects
• L - Means that the use of BZs tends to be limited to short-term treatment of stress only

• P - Drugs can have unpleasant side effects
• E - With BZs these include drowsiness, confusion and memory impairment
• E - By contrast there are no side effects associated with psychological methods of stress management such as stress inoculation
• L - Side effects make patients less likely to continue with the treatment, thus decreasing its effectiveness