Stress

• Stress is a biological response to the fight or flight mechanism
• The body's stress response causes an increase in blood pressure, reduction in blood flow to the peripheral blood vessels (hands and feet) and an increase in adrenaline, noradrenalin and corticosteroids to be released into the blood stream.
• Over a long period of time this stress response causes the body's immune system to eventually break down.

• Causes psychological problems such as anxiety and depression.
• Causes everyday illnesses such as coughs and colds by lowering the effectiveness of the immune system.
• Can cause heart disease and strokes by increasing build up of cholesterol.
• May cause illnesses such as cancer.
• Causes millions of sick days from work across the country.
• Increases accidents and injuries at work due to a lack of concentration.

• Life Event scales were devised to demonstrate how major life events such as death, divorce, unemployment and severe illness could be used to calculate levels of stress and consequently to predict illness (Holmes and Rahe 1967). However, even when we do not experience major stressors such as these we still end up feeling stressed!
• Kanner 1981- Minor stressors can combine to become large stressors.

• Holmes and Rahe (1967) - Social Re-adjustment Rating Scale (SRRS)
• Holmes and Rahe defined stress in terms of the change caused to a person's life (change can be positive, negative or neutral, but would still cause stress according to their definition). Holmes and Rahe argued that whenever an individual had to make "substantial adjustment to the environment, the likelihood of stress is high". 
• Holmes and Rahe first examined the medical records of over 5000 people. They found that, in many cases, significant life changes occurred in the months preceding the onset of illness. They selected 43 of these life events and asked a sample of 394 people to rate the degree of "social readjustment" required for each event (death of a spouse was given the arbitrary value of 100 and marriage the arbitrary value of 50). Based on the results they constructed the Social Re-adjustment Rating Scale.
• Each life event was ranked and assigned a number of Life Change Units (LCUs) from 100 - 11. A person's stress score is the sum of all the life change units for events they have experienced within the last 12 months.

1. Death of a spouse

2. Divorce

3. Marital separation

4. Jail term

5. Death of a close family member

6. Personal illness or injury

7. Fired at work

8. Retirement

9. Change in health of a family member

• Kanner used hassles as a predictor of stress and illness. Holmes and Rahe's Life Events Scale, which had previously been popularly used to predict stress, was compared to relatively minor events, namely, the hassles and uplifts of daily life. Hassles and uplifts scales were administered once a month for ten consecutive months to a community sample of 100 middle-aged adults in California.
• A longitudinal study with repeated measures design was used as participants filled out both the Life Events Scale and the Hassles and Uplifts Scale. They then had their psychological symptoms of stress assessed using the Hopkins Symptom Checklist and the Bradburn Morale Scale. 9 subjects dropped out.
• It was found that the Hassles Scale was a better predictor of psychological and physiological symptoms than were the life events scores. Hassles also seemed to be consistent from month to month. Hassles and symptoms of stress were significantly correlated. The more hassles the participant reported the more symptoms they reported. Uplifts were positively related to reduce symptoms for women but not for men.
• It was concluded that the assessments of daily hassles and uplifts may be a better approach to the prediction of stress and ill health than the life events approach.
  

Daily Hassles: 1. Concerns about weight 2. Health of a family member 3. Rising price of common goods 4. Home maintenance 5. Too many things to do 6. Misplacing or losing things 7. Outside home maintenance 8. Property, investment or taxes 9. Crime 10. Physical appearance.

Daily Uplifts: 1. Relating well to a spouse or partner 2. Relating well to friends 3. Completing a task 4. Feeling healthy 5. Getting enough sleep 6. Eating out 7. Meeting your responsibilities 8. Visiting, phoning or writing to someone 9. Spending time with family 10. Finding your home a pleasant environment.

Aim: To investigate whether work stressors such as repetitiveness, machine regulated pace of work and high levels of responsibility increase stress-related physiological arousal and stress-related illness.

Method:The researchers identified a high-risk group of 14 "finishers" in a Swedish saw mill. Their job was to finish off the wood at the last stage of processing timber. The work was machine regulated, isolated, very repetitive yet highly skilled, and the finishers' productivity determined the wage rates for the entire factory. The 14 "finishers" were compared to a low-risk group of 10 cleaners, whose work was more varied, largely self-paced and allowed more socialising with others. Levels of stress-related hormones (adrenaline and noradrenaline) in the urine were meaured on work days and rest days. Records were kept of stress-related illness and absenteeism.

Findings: The high risk group of 14 finishers secreted more stress hormones (adrenaline and noradrenaline) on work days than on rest days, and higher levels than the control group. The high-risk group of finishers also showed significantly higher levels of stress-related illness such as headaches and higher levels of absenteeism than the low-risk group of cleaners.

Conclusions: A combination of work stressors - especially repetitiveness, machine regulated pace of work and high levels of responsibilty - lead to chronic (long term) physiological arousal. This leads to stress related illness and absenteeism. If employers want to reduce stress and absenteeism in their workforce, they need to find ways of reducing these stressors e.g. introduce variety into their work.

• Each participant had to give a urine sample four times a day so their adrenaline levels could be measured.
• Their body temperatures were measured at the same time as this gives an indication of how alert a person is.
• These two physiological measures were combined with self-report where each participant had to say how much caffeine and nicotine they had consumed since the last urine test. They also had to report on a range of emotions and feelings as well as sleepiness, well-being, calmness, irritation and efficiency etc. They had to scale these feelings on a continuum from minimum to maximum using a scale with millimetres. The score was how many millimetres from the base point the participant had marked themselves to be feeling.
• This combined approach gave both qualitative and quantitative measures, enabling Johansson to compare the two groups of workers and understand the impact of higher stress levels on the participants.

Numerous studies show that job stress is the major source of stress for American adults and that it has escalated progressively over the last few decades. Increased levels of job stress as assessed by the perception of having little control but lots of demands have been associated with increased rates of heart attack, hypertension and other disorders.

In New York, Los Angeles and other municipalities, the relationship between job stress and heart attacks is so well acknowledged, that any police officer who suffers a coronary event on or off the job is assumed to have a work related injury and is compensated accordingly.

Tangible stressors are one cause of stress, but we can also consider situations that might contribute to our stress. E.g. If your neighbors were playing loud music whilst you were trying to get to sleep, there are two possible reasons for that situation to be stressful; the level of noise itself, or, more likely, your lack of control over the noise. 

Aim: To see if perceived control or actual control can reduce stress reactions to averse stimuli 

Method: Lab experiment in which participants were shown photographs of dead car crash victims and their stress levels were measured. Independent measures design with participants randomly assigned to three conditions. 

Participants: 60 undergraduates enrolled in a Psychology course at a New York university.

Procedure: The participants were randomly assigned to three conditions: 

• Group 1: Were given control over how long the images were presented for. They could press a button to terminate the image and were told a tone would precede each new image (predictability and control) 

• Group 2: Were warned the photos would be 60 seconds apart and a 10 second warning tone would precede each photo. Length of exposure was controlled by group 1. The group had no control but did know what was happening (predictability but no control)
• Group 3: Were told that from time to time they would see photos and hear tones but were not given timings or any control. Again linked to group 1 who controlled length of exposure (no predictability, no control)

Each participant was seated in a sound-proof room and wired up to the GSR and ECG machine. The PP relaxed and a baseline measurement was taken. Instructions read over an intercom. Each photo was preceded with a 10 second tone and then flashed up for 35 seconds (only one group could terminate the photo and move on) GSR taken at the onset of the tone, during 2nd half of the tone + in response to the picture. 

Findings: ECG recordings were discarded as appeared inaccurate. Group 1 experienced the least stress. Group 2 showed the highest levels of stress, as they knew what was coming but had no control over the photographs. Group 3 also showed high stress levels. 

Conclusion: Having control over your environment can reduce stress response.

Michenbaum's stress inoculation therapy (SIT) uses a cognitive approach. The underlying assumption is that stress is caused by faulty processing of information e.g. we might be stressed by exams because we think we won't do well. There are 3 components of SIT: 

• Insight - The patient with the stress has to identify what it is about the situation that they find stressful 
• Coping strategies - the patient is given coping strategies to help them. They are helped to restructure their thoughts and use positive statements. They are also helped with relaxation techniques like deep breathing and muscle relaxation. 
• Finally, the person puts what they have learned into practice in a real-life stressful situation.

Aim: To compare SIT with standard behavioral systematic desensitization and a group control waiting list. 

Methodology: A field experiment where students were assessed before and after treatment using self-reports and average grades. The design was matched pairs with random allocation to conditions (although groups were balanced for gender). The assessors did not know which condition the participant had been in. 

Participants: 21 students aged 17-25 who responded to an advert for treatment of exam anxiety. 

Procedure: Researchers tested all participants with an exam anxiety questionnaire while they did some IQ tests. This gave them a baseline measure of their anxiety while doing tests, Participants were then allocated to one of the three groups. In the SIT groups pps received 8 therapy sessions using the "insight" approach with positive statements and relaxation techniques to use in test situations. In the systematic desensitisation group, pps were given 8 therapy sessions with relaxation training to use with progressively more anxiety-provoking situations. The control group were told they were on a waiting list and that they would receive therapy in the future. 

Findings: Performance on tests improved in both the treatment groups compared to the control group. PPs in the SIT group showed more reported improvement in their anxiety levels, although again both treatment groups showed overall improvement compared to the control group. 

Conclusion: SIT is an effective way of reducing anxiety in students who are prone to exam stress. It is more effective than behavioral techniques such as systematic desensitization.

Biofeedback deals with the physiological symptoms of stress. These physiological symptoms such as raised blood pressure and increased muscle tension are involuntary, we are unable to control them consciously because they are governed you our autonomic nervous system (ANS) 

Biofeedback is a method by which an individual learns to exert voluntary control over involuntary (autonomic) behaviours by being made aware of what is happening in the ANS. Biofeedback involves four processes: 

• Feedback: The patient is attached to various machines which provide information (feedback) about various ANS activities e.g. heart rate can be monitored and displayed visually on a computer screen. 
• Relaxation: The patient i taught techniques of relaxation in order to reduce activity of the sympathetic nerve system, The result should be reduced heart rate, blood pressure etc. 
• Successful behaviours are repeated because they are rewarding. 
• The patient then needs to transfer the skills learned to the real world. 

Bydzynski et al (1970) - Biofeedback and reduction of tension headaches

Aim: To see if biofeedback was effective in reducing headaches or really just had a placebo effect 

Methodology: Lab experiment with patients being trained in a lab and data being collected using EMG (measuring muscle tension) & psychometric tests of depression and also answered questionnaires on their headaches. Independent measures design used with 3 conditions. Group A had biofeedback, Group B had relaxation training and pseudo-feedback and Group C were the control group.

Participants: 18 participants who replied to an advert, screened by phone, then psychiatric and medical exam to ensure headaches were not due to other reasons. 2 males and 16 females aged 22-44. 

Procedure: For 2 weeks patients kept record of headaches rating them 0-5 (mild to severe) This gave baseline headache reading, also complete psychometric test on depression, hysteria and hypochondria. Group A given biofeedback, involved being taught relaxation techniques and receiving feedback from biofeedback machine. Group B received relaxation training and pseudo feedback. This was tape recording of feedback from another session not linked to their levels of relaxation. Both practised relaxation at home. Group C told on a waiting list but asked to come to lab. All recorded headache activity. After 3 months Groups A & B given EMG test & completed questionnaire and psychometric measures. 

Findings: Group A muscle tension & headaches sig. lower than B. After 3 months A's tension still lower than B's. Group A decrease in depression, apathy & drug use 

Conclusion: Biofeedback effective in reducing tension headaches, relaxation more effective than monitoring

Social support is used for a variety of problems e.g. slimming clubs and Alcoholics Anonymous. Social support networks have been used to try and reduce stress caused by illness. Research suggests that individuals with wide support networks experience less stress in response to a stressor and can cope with stressful situations more successfully than individuals without this network. 

Cohen and Willis (1985) claim there are for types of Social Support: 

• Esteem Support: When people are suffering from stress they can suffer from low self-esteem. Attention, love, care and being held in high regard can raise self-esteem. This can help the individual to overcome stress. 
• Informational support: When individuals are suffering from stress it often helps if they can get useful information from other people. Information from others can be used to help the individual suffering from stress to reassess the situation that is causing the problem, especially if the person giving the information has faced a similar situation. 
• Instrumental support: Where individuals are suffering from stress, they often need practical support, this can alleviate some of the stress that the individual is under and help them to cope. 
• Social companionship: Interpersonal interaction can help the individual who is suffering from stress in that they often feel less stressed after spending time with and talking to other people.