Stress

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  • Created by: alex
  • Created on: 09-03-13 12:05

What is stress?:

Stress - (According to Selye) is the individual’s psychophysiological response, mediated largely by their autonomic nervous system and the endocrine system, to any demand made on the individual.  Stress as a stimulus - the characteristics of an environmental event or situation that causes us stress. Stress as a response - the physiological responses as a result of environmental events or situations. Stress as an interaction - between an individual and his/her environment. We experience stress when we believe we don’t have what is needed to meet the demands of a particular situation.

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The autonomic nervous system (ANS):

  • The autonomic nervous system (ANS):
    • ANS centres are located in the brainstem.
    • from here, ANS pathways run down the spinal cord and throughout the body, therefore, ANS is classified as part of the PNS
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The chronic stress response (HPA pathway):

  • Occurs in response to ongoing stress situations.
  • When stressors are perceived by the higher centres of the brain, a message passes to the hypothalamus.
  • This activates the PVN leading to the production of a chemical messenger (CRF), which is released into the bloodstream.
  • CRF causes the pituitary gland to produce and release ACTH which is transported into the bloodstream to the adrenal glands.
  • Corticosteroids (including cortisol) is released by the adrenal cortex, responsible for stress-related effects on the body (e.g. a quick burst of energy or lower sensitivity to pain (positive) and high blood pressure and lowered immune response (negative).
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The acute stress response (SAM pathway):

  • When the body is threatened by an immediate danger, higher brain areas (Cortex) detect and perceive something as a stressor
  • this triggers the Hypothalamus, which activates the Sympathetic branch of the ANS, stimulating the Adrenal Medulla
  • this produces two hormones, Adrenaline and Noradrenaline, which cause the Fight or Flight response, which causes bodily changes and has evolved for survival.
    • Bodily changes may include:
    • increase in heart rate (to carry oxygen around the body quicker)
    • increase in blood pressure (veins and arteries narrow so blood pumps faster)
    • an increase in muscle tension (which increases reaction time)
    • the dilation of pupils (helps one to be more aware of one’s surroundings)
  • When there is no longer any danger, adrenaline stops being released and the body slowly returns to normal over the next few minutes.
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General Adaptation Syndrome (GAS): 1

General Adaptation Syndrome (GAS): (Selye)

  • Alarm stage:
    • an individual is confronted with a stressor and signals are sent through the brain to the hypothalamus along two axes:
      • The hypothalamic pituitary axis - releases CRH which in turn releases ACTH which acts upon the adrenal cortex to produce corticosteroids for energy mobilisation
      • The Hypothalamic ANS axis - the autonomic nervous system and this sends signals to the adrenal medulla to produce adrenaline (increases the heart rate and blood pressure) and noradrenaline which constricts the arteries.
    • If danger passes then the body quickly returns to normal.
    • If danger persists then the body goes into resistance stage.
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General Adaptation Syndrome (GAS): 2

  • Resistance stage:
    • The level of stress drops, as a result:
      • The body appears to be coping with the stress.
      • The body repairs damage caused by the alarm response.
      • Adrenaline levels fall back to normal.
      • Our level of arousal is still higher than normal but not as high as in alarm phase.
      • Adrenal glands return to their normal size.
    • If stress disappears the body returns to normal.
    • If stress continues steroids start to interfere with the immune response and we are less able to fight infection.
    • If a second stressor occurs we may become exhausted
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General Adaptation Syndrome (GAS): 3

  • Exhaustion stage:
    • Adrenal glands enlarge again to respond to the new stress.  Unfortunately our levels of adrenaline are depleted and we are unable to respond with arousal:
      • Immune system fails leaving us prone to infections.
      • We become tired, apathetic, irritable and unable to concentrate.
      • Muscles tire and kidneys may be damaged.
      • Blood sugar levels may fall to fatally low levels (hypoglycaemia)
    • If the stage persists we suffer diseases of adaptation, e.g. ulcers, CHD, headache and insomnia.
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Evaluation of GAS:

:) Selye’s model was the first to accurately depict the physiological changes that occur in the short term response to a stressor. The theory is seen as influential and provided a basis for lots of later research into the adverse effects of stress on human health.

:( Selye’s research is seen as unethical as he subjected the rats to horrific forms of treatment including, exposure to extreme and rapidly altered temperatures, heavy exercise, surgical injury and sub lethal doses of drugs.

:( The initial research was carried out on rats so clearly there are issues of generalising to humans.  In particular the human response almost certainly involves a much greater emotional content and cognitive appraisal of the stress being experienced which is likely to alter our perception and physiological response. In a study by Symington et al, the physiological responses of two sets of dying patients were compared.  Fully conscious patients showed a much greater physiological response to the stress than those in a coma.  Symington attributed this difference to the cognitive appraisal by the conscious group.

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Stress and CHD:

  • Stress and CHD:
    • Stress activates the sympathetic branch of the autonomic nervous system, leading to the constriction of the blood vessels and a rise in blood pressure and heart rate.
    • A prolonged increase in heart rate may wear away the lining of the blood vessels.
    • Stress leads to increased glucose levels which clump together and block blood vessels.
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Research into stress and CHD:

  • Williams:
    • conducted a study to see whether anger was linked to heart desease
    • 13,000 people completed a 10 question anger scale
    • 6 years later, the health of the participants was checked: 256 had experienced heart attacks and those who scored highest on the anger scale were 2^1/2 times more likely to have a heart attack than those with the lowest ratings.
    • This suggests that anger may lead to cardiovascular disorders.
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Research into stress and CHD:

  • Friedman and Rosenman:
    • found that men were far more likely than women to develop CHD. Since at the time most men worked whilst most women did not, they suggested that work-related stress could also be a factor in CHD.
    • carried out a longitudinal study in USA following 3000 men aged 39-59 for a period of 8.5 years.
    • all were healthy at the start of the study but as time went on, they saw that the participants fell into two groups:
      • Type A: competitive, ambitious, impatient, aggressive, fast talking.   
      • Type B: relaxed, non-competitive.
    • of the 257 men who died during the study, 70% were Type A.
    • men who were Type A were almost 2.5 times as likely to develop CHD than those who were Type B even when other factors were taken into account.
    • They concluded that Type A individuals are significantly more likely to develop stress related illness than Type B.
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Evaluation of research into stress and CHD:

  • Evaluation:

:( Friedman & Rosenman did not specify what aspect of type A behaviour might be responsible for CHD.  Matthews et al reviewed the original data and found that it was ‘the negative behaviours’ such as hostility that seemed to be responsible.  They put this down to the increased activity of the sympathetic nervous system that weakens the heart and arteries.

:( People who demonstrate type A behaviour are more likely to smoke, drink excessively and lead generally less healthy lifestyles.  Perhaps this, rather than the behaviour type itself causes CHD.

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Stress and the immune system:

  • Stress and the immune system:
    • during times of stress, the adrenal cortex produces corticosteroids.


  •  
    • These stop the body producing lymphocytes (white blood cells) that attack foreign bodies such as viruses, in the bloodstream, making us more susceptible to infection.
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Research into Stress & immune system:

  • Kiecolt-Glaser et al 
    • The aim of this study was to see if exam stress may affect the functioning of the immune system
    • it was a natural experiment, using a volunteer sample of 75 first-year medical students
    • blood samples were taken from the students one month before their exams (this was defined as a low stress period) and again on the first day of their exams (this was defined as a high stress period).
    • these blood samples measured the participants’ immune functioning by counting the number of leucocytes - if there was a high number, this meant a strong immune system
    • it was found that in the high stress period, the number of leucocytes were low, whilst in the low stress period, the number was high
    • there was, therefore, a negative correlation between exam stress and immune functioning, exam stress is associated with immunosuppression
    • however, stress is only one factor that may affect the immune system
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Evaluation of research into Stress & immune system

Kiecolt-Glaser:

:) it is also a natural experiment; therefore the study has high ecological validity

:) Kiecolt-Glaser has carried out research using Alzheimer’s carers and married couples and found similar results – this makes the findings of this study more reliable and is in fact can be generalised to slightly more groups

:( they were all first year medical students – this is not representative as the group cannot be generalised to other students, ages or groups

:( they are volunteers – the sample is therefore biased as volunteers are ‘extra-motivated’ – it lacks population validity, which in turn leads to an inability to generalise

:( the findings of this experiment were merely a correlation, therefore it only proves that there may be a relationship between the two co-variables. It doesn’t prove that exam stress caused the change in immune functioning due to other confounding variables that have not been controlled or taken into account such as medical conditions and lifestyle

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Research into Stress & immune system:

  • Cohen et al 

    • a lab experiment and 394 volunteers were exposed to the cold virus

    • their level of stress was then assessed via a questionnaire. It was found that there was a positive correlation between stress level and the likelihood of developing a cold.

:( questionnaires were used – these may be unreliable as participants are liable to giving socially desirable answers which therefore questions the validity of the results generated by the questionnaire

:( the findings were only a correlation, so it cannot be proved that stress caused the cold as there are other variables that were not controlled

:( Volunteers were also used, so the study is lacking in population validity and is not representative

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Research into Stress & immune system:

  • Brady’s executive monkeys:

    • Brady put two monkeys together and administered electric shocks every 20 seconds for six-hour periods.

    • One of the monkeys, the ‘executive,’ was able to press a lever that delayed the shocks for 20 seconds.  However, it was unable to stop all shocks

    • He found that many of the ‘executives’ died of stomach ulcers.

    • Brady concluded it was the stress of being in control that had caused the ulcers. It couldn’t have been the shocks since the other monkey got the same number of shocks to its feet but didn’t get ulcers.

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Evaluation of research into Stress & immune system

  • Brady’s executive monkeys:

:( This is one of the cruellest experiments carried out in Psychology and would not be possible today.  Relatively intelligent creatures were subjected to the pain and stress of foot shocks and died slow, painful deaths.

:( The experiment appears to have been flawed. Weiss (1972) repeated the experiment on rats and found no difference between ‘executives’ and ‘controls.’  The researchers noticed that in the original study Brady had used the most active and ‘extrovert’ monkeys as executives.  They concluded that it wasn’t being in control that had killed the monkeys but their ‘personality’ or behaviour type.’

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Indirect effects of stress on health:

  • Stress is associated with all manner of bad habits, for example smoking, drinking alcohol to excess, poor diet due to lack of time, lack of exercise for the same reason, lack of sleep etc…  All of these are likely to have an adverse effect on a person’s health so could cause some of the ill-effects attributed to stress.
  • Cohen & Williamson found that people who are stressed tend to smoke more, take less exercise, drink more alcohol and sleep less than others.  All of these habits can lead to ill health.

  • Wills found that stressed teenagers were more likely to start smoking.  Similarly, Carey et al found that adults who had given up smoking were more likely to take it up again when stressed.

  • Therefore, it may not be stress itself that causes ill health but the behaviours that stressed people tend to engage in.
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The SRRS:

  • The Social Readjustment Rating Scale (The SRRS)
    • Developed by Holmes & Rahe, this scale was designed to measure life changes as to how stressful they are
    • it contains 43 life events which all have a score
    • Participants normally have to “tick” all the events that have happened to them in the past year and add up the scores
    • if the life change unit was above 150, it was predicted a 30% increase in the likelihood of developing a stress-related illness
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Evaluation of the SRRS:

:( individual differences are not taken into account at all; how stressful an event is may be subjective. For example, making an “Outstanding Achievement” was given a score of 25, yet many would not find this stressful at all. Just the opposite in fact, they may find it elating. However, the scale insists this is stress anyway – it cannot be applied to all people. Also, for example the effects of divorce will depend on how long the couple have been married, whether or not children are involved or whether the person is escaping a violent partner.

:(  The scale implies a correlation between stress and ill-health, however, it does not prove cause and effect.  Other factors could be used to explain the link.  Ill-health could be causing the stress, or the life events.  For example a heart attack could cause loss of job, major changes in standard of living resulting in break-up of marriage etc. and not the other way around.

 

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Rahe’s naval study

  • Rahe’s naval study
    • Rahe et al investigated the link between life change unit scores on the SSRS scale and illness
    • an opportunity sample of 2,664 American naval personnel that were about to go on a 6 month tour of duty
    • the participants carried out the SRRS before their tour, noting the events that had happened in the last six months
    • whilst the participants were on their tour, detailed medical records were kept and were given illness score
    • these illness scores were then correlated with their life change unit scores. A weak, positive correlation (+0.118) between life change unit scores and illness scores was found
    • it was concluded that there was a relationship between the two but as it is so weak, there are other important factors.
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Evaluation of Rahe’s naval study

:( We cannot generalise to other groups, as participants were all American, male and members of the navy. It therefore lacks population validity and cannot be generalised. 

:( A self-report measure (questionnaire) was used – these may be unreliable as participants are subjected to giving socially desirable responses – they may have been reluctant to admit to an event on the SRRS scale that was overly personal and sensitive that may cause embarrassment.

:( The study relies on retrospective information – participants had to recall past events, therefore relying on memory which may be interchangeable, inaccurate or unreliable.

The findings are merely a correlation, and a weak one at that – it cannot prove that stress causes illness, there are many other factors involved, such as genetics or personality.

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Research into daily hassles and stress-related ill

    • De Longis et al carried out a study in which 100 participants (all over 45) were asked to complete four questionnaires each: Hassles, Uplifts, Life events, Health.
    • He found that hassles correlated with ill- health whereas uplifts and most surprisingly life events did not.
    • Bouteyre et al. got first year French University students to complete two questionnaires, one measuring life events, the other symptoms of depression.
    • It was found that students showing the most depressive symptoms were also likely to be suffering from the most hassles.
    • Clearly this is a correlational study so cause and effect cannot be established as it could be that feeling depressed and having negative thoughts makes us focus more on negative events such as hassles.
    • De Longis et al compared scores on the SSRS and Hassles and Uplifts scale.
    • She found no link between life events and illness but found a positive correlation between daily hassles and next day ill health.
    • It was concluded that daily hassles may be more important than life events as a source of stress.
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Reasons for hassles being a bigger issue than life

  • Social and emotional support:
    • It seems likely that people going through major life events will be more likely to seek help and support than people merely suffering from hassles.  It could therefore be that hassles are a greater issue because we try and work through them on our own.
  • Accumulation effect:
    • Lazarus suggests that hassles tend to build up and act as a source of persistent irritation which can then lead to anxiety and even depression.
  • Amplification effect:
    • It could be that big events make us more susceptible to the effects of trivial hassles so the two work hand in hand to create stress. Having suffered a major event we are left feeling more vulnerable to hassles and problems multiply.
    • they may have an accumulating effect in which they build up and as the stress response is triggered so many times, it may lead to illness
    • they may also have an amplification effect - daily hassles can ‘tip you over the edge’ if you are trying to cope with a major life event
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Evaluation of hassles research:

Evaluation of hassles research:

:( As with life events, individual differences are not considered.  We all perceive and react to stress differently, some people seemingly being able to cope better than others, and again these are not considered.

:( The studies are correlational so do not prove that the stress is causing the illnesses.  For example just before a cold we may feel more hassled, but this could be because the virus is already having its effect, leaving us tired and less able to cope with everyday events.  That is, the illness is actually causing the hassle.

:( Much of the research is retrospective as it involves participants to think back over the hassles that they’ve faced in the past month. This can be unreliable and therefore could affect the findings of the research.

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Occupational stress:

Work overload: Breslow and Buell found that employees working more than 48 hours a week were twice as likely to develop CHD than those working 40 hours a week.

Job control: Marmot et al began with the hypothesis that control was negatively correlated with stress-related illness; that is as control decreases the level of illness increases.

Over 10,000 civil servants were investigated over a period of three years.  Researchers assessed the level of job control by self report questionnaires and by assessments by personnel managers and this was then compared to levels of stress related illness. 

They found that workers with less control were four times more likely to die of heart attack than their colleagues with more control.  In addition they were more likely to suffer from other stress related illnesses such as cancers, ulcers, stomach disorders and strokes.  Even when other possible contributory factors such as diet, smoking, social support etc. had been taken into account the additional risk remained! 

The conclusion was obvious, that lack of control seemed to be associated with illness and they recommended that employers gave their staff more autonomy and control.

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Evaluation on Occupational stress research:

:( Since the method is correlational it can only be said that there appears to be an association between low control and stress-related illness.  It cannot be assumed that low control is causing illness. It could be that workers with poor health are less likely to achieve the higher grades where control is greater. This would explain the findings just as well.

:( Individual differences are not taken into account - people may react differently to stress and control according to factors such as personality, gender, age and culture – Schaubroeck found that workers responded differently to lack of control. Some may see it positively, as they do not have to think for themselves nor take responsibility.

:( Although Marmot concluded that workload was not an issue, other studies seem to disagree. Johansson studied a small group of workers in a large sawmill. Their job was ‘finishers’ and the rate at which they worked determined the output of the mill so their job was very responsible. He found that they had much higher levels of absenteeism due to illness and higher levels of adrenaline in their urine, but only on work days. Showing that workload is a factor which contributes to occupational stress.

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Occupational stress and CHD:

Dr Michelle Albert: Over 17,000 women in Boston, USA were studied over a period of ten years. Those in high strain occupations had a 40% greater risk of cardiovascular disorders and 88% increased risk of suffering a heart attack.  She also reported that job insecurity and the worry of unemployment increases the chances of CHD and hypertension.

Cobb and Rose: analysed medical records and found that air traffic controllers (considered to be an extremely stressful occupation) were at significantly greater risk of developing hypertension (long term high blood pressure). In fact there was a positive correlation with those working in airports with greatest airplane activity suffering the highest levels of hypertension.

Karasek et al: followed 900 workers for ten years.  A combination of job titles and self-report questionnaires were used to measure job demand and control. High job strain was considered to be the result of high demand jobs but with low control. Those workers with high job strain were 1 ½ times more likely to develop CHD during the study.those involved in high demand/low control jobs were most likely to develop cardiovascular problems.

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Evaluation on Occupational stress and CHD research

:( The data is also largely correlational with all manner of variables, such as life outside of work, not being considered.  It is therefore impossible to be certain that job strain per se is the cause of the increased levels of CHD.

:( However, hypertension can be caused by a variety of factors such as obesity, too much salt, lack of exercise and genetic inheritance as well as social factors such as stress and anxiety.  Therefore we can’t rule out other possible causes in ATCs and other high stress occupations.  Perhaps people in such jobs tend to leave unhealthier lives and as a result of lifestyle put themselves at greater risk.

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Personality and behaviour on Stress:

  • Friedman and Rosenman developed a questionnaire to distinguish between the two personality types
  • They also used structured interviews and observations (in which they looked for signs of impatience, anger and fidgeting).

  • At the beginning of the study, all the participants were free from heart disease and other lifestyle factor.

  • As this was a longitudinal study, the participants were followed up 8.5 years later and their health was assessed.

  • It was found that in the time away, there had been 257 heart attacks, and 70% of these were Type As.

  • Type As were also twice as likely to develop coronary heart disease than type Bs, they also had the highest level of adrenaline, noradrenaline and cholesterol (brought about by the recurrent triggering of the SAM and HPA responses).

  • It was concluded that Type As were more vulnerable to heart disease.

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Evaluation on Personality and behaviour on Stress:

:( However, the findings only found a correlation so we cannot conclude that if an individual has heart disease, it is because ‘they are type A”, there may have been events or changes over the 8.5 years which may have played a part.


:( Self-report measures were used and as people are always liable to giving socially desirable answers it makes the findings unreliable


:( the study is androcentric as only men were used and therefore we cannot generalise to females. It is also ethnocentric (culture-biased) as only men from San Francisco were used and so it may only represent Western cultures, or merely the USA. Therefore, the sample lacks population validity.

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Personality: Hardiness on stress:

  • Maria Kobasa suggests that ‘hardiness’ helps us to understand why some are resistant to stress. 800 business executives of a large US company were tested using the SRRS.  Those who scored highly were then examined and split into two groups; those who were frequently ill and those who were rarely ill.  She found a difference in personality between the two with those reporting few illnesses being described as hardy.
    • There are three characteristics (known as ‘the 3 Cs’):

  1. Control – An individual believes that they are the sole influential factor in their life – that is to say, they feel they have complete control over their lives and its events. This belief is empowering and enables one to defend himself against stress.

  2. Commitment – An individual’s awareness of their own purpose and sense of involvement in the world and of their own life. They see the world as something they should connect with rather than avoid. They are unlikely to give up in stressful situations and display perseverance.

  3. Challenge – An individual may see changes or events in life as obstacles that they are able to overcome, even as opportunities that will enable them to grow as a person instead of threats/stressors. It is seen as a learning experience.

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Gender on stress:

Johansson & Post: Men and women were moved from a non-stressful situation into a more stressful one; they were given an intelligence test.  Men showed a much higher increase in adrenaline than did the women. There could be a number of reasons for this:

  • It could simply be that women engage in fewer dangerous activities.  In the past women smoked less and drank fewer units of alcohol so would be less likely to suffer from CHD.  However, this is changing.
  • Taylor et al suggest a biological reason for this added protection from stress for women.  The hormone oxytocin makes us less anxious.  It seems to do this by reducing cortisol levels in the body.  However, male hormones like testosterone seem to reduce the effectiveness of oxytocin. This would result in men being more sensitive to the stress hormone cortisol and women less so.
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Emotion-focused approach to coping with stress:

  • an approach that tries to improve the way we feel about the stress but without tackling the problem head on.
  • These include denial that a problem exists or pretending an event never happened, displacement of anger in other directions or venting emotions through crying for example.
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Problem-focused approach to coping with stress:

  •  
    • This is an active coping strategy which deals with the actual stressor, aiming directly to alleviate the stressful situation and targets the causes of the stressor – it is used when the stressor is/seems controllable.

    • Strategies include taking control of the stressful situation

    • evaluating the pros and cons of different options to deal with the stressor

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Evaluation of coping strategies:

  •  
    • Penley found that problem focused coping was associated with better health whereas emotion focused coping was associated with poor health.

    • the younger you are, the less effective a problem focused approach will be for you. In 2006, Lee found that children who needed blood tests were less stressed if they were distracted (an emotion focused approach) by given a toy to play with whilst their blood was taken than if there were no distractions.

    • Problem focused and emotion focused approaches are most effective when used together as they both are important in helping us cope. Lazarus explained this with the example of coping with the death of a loved one - at first, we would be sure to display emotion-focused coping strategies (e.g. crying and releasing all the emotions), but over time problem focused will be increasingly effective as it will enable you to build your life again without that person.

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Physiological Methods of coping with stress:

Benzodiazepines (BZs) - Increase the activity of a chemical called GABA which increases the uptake of chlorine ions at the synapse which prevents other neurotransmitters being so effective.

:) they are very quick in relation to some therapies – they are guaranteed to immediately reduce stress, as they prevent the stress response occurring.

:) Another advantage is that there is evidence for their effectiveness – Kahn investigated 250 patients over 8 weeks and found that benzodiazepines were more effective at reducing stress than placebos and other drugs. Such research gives the drug scientific credibility.

:( A disadvantage of Benzodiazepines is that Unfortunately GABA reduces activity in about 40% of the brain’s neurons so doesn’t just effect stress pathways.  As a result BZs have a number of side effects including sedation, tiredness, motor coordination impairment, memory impairment, reduced concentration and lack of energy – all these side effects interfere with the patient’s ability to function adequately and therefore it is important that these are not used as a long-term solution.

:( These cure symptoms rather than treat the cause. They do not deal with the underlying problems; if you were to stop taking the drug, your stressful symptoms would surely return. These drugs are best used in combination with therapies.

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Physiological Methods of coping with stress:

  • Beta-Blockers (BBs)  - reduce adrenaline and noradrenalin; it reduces heart rate and blood pressure etc. and because it is difficult to feel stressed when your heart isn’t pumping fast, it helps to make us feel calm.

:) An advantage of Beta-Blockers is that there have been many instances - Lockwood investigated 2000 musicians (27% took Beta-Blockers and received better reviews from critics).

:) They also act rapidly – they are quicker, more effective and cheaper than therapies. They also have a life saving function to those suffering of hypertension (high blood pressure) in that they reduce blood pressure, preventing stroke.

:) They are also better than Benzodiazepines in the sense that there are no serious side effects – most people who take these are able to function normally. They act on the body rather than the brain and so there are no problems of dependency or addiction.

:( However, a disadvantage of Beta-Blockers is that recently they have been shown to have a link with diabetes when taken for a long time, so like Benzodiazepines there are only a short term measure.

:( Beta-blockers also cure symptoms rather than treat the cause. They do not deal with the underlying problems; if you were to stop taking the drug, your stressful symptoms would surely return. They are best used in combination with therapies.

 

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Psychological Methods of coping with stress:

  • Stress Inoculation Therapy (SIT): Meichenbaum designed to prepare people for future stressors by making them resilient to these. There are three phases:

  1. Conceptualisation – a relationship is established between the therapist and the client so that there is trust between them. The client mentally relives stressful situations, analysing how s/he normally deals with them and tries to reach a realistic understanding of what is expected of them. The client is taught to see stressors as ‘problems to be solved’ and to break them down into more manageable components – the client thinks over typical stressors again.

  2. Skills training and practice – the client is taught both specific and non-specific (relaxation techniques) coping strategies to help him/her cope with stressors more effectively. These skills are practised until the client has mastered them and can use them confidently.

  3. Real life application & Follow up – the therapist takes the client through stressful situations by teaching them to apply the skills to these new stressors. The client maintains contact with the therapist and if there are further problems, the client returns back to training. This reinforcement of positive behaviour means that resilience to stress is sustained.

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Evaluation of Stress Inoculation Therapy (SIT):

:) An advantage of SIT is that it deals with the underlying causes of a person’s stress rather than dealing with the symptoms alone.

:) It is a long-term, long-lasting solution – the techniques and skills the individual learns in SIT stay with them for life and can apply it to any stressor – it gives an individual the ability to control their stress in the present and future whereas with drugs once you stop taking them, the stress returns.

:) SIT is extremely flexible in that it can be adapted to deal with acute and chronic stressors – a wide variety – daily hassles, work stress, public speaking, exams etc – whereas drugs are temporary and limited.

:) Also, the effectiveness of SIT is supported by research, studies on law students and athletes have found that this therapy boosted their performance and reduced their anxiety. This gives it scientific credibility.

:( Weaknesses of SIT include the fact that it requires a lot of time, effort, motivation and money on the patient’s part – the therapy will only work if the patient is determined to cure their stress. It can take weeks and months for the therapy to complete – it is costly, and requires commitment – some may turn to drugs as it is simply more convenient to take these

:( Also, it is not possible for SIT to work for all clients – it is difficult or often near impossible to change aspects of one’s personality or their ways of thinking – this can be problematic as some people will always react badly to stressors and the therapy may even make them worse.

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Physiological Methods of coping with stress:

Increasing Hardiness:

  • Maddi & Kobasa believed that having traits associated with this type could make people practically immune to stress and devised a way to teach it to individuals.
    • There are three stages:

  1. Focusing – the client is trained to spot and stop physical signs of stress (such as muscle tension, anxiety) so that the individual can identify when they are stressed. By doing this, clients have more control over their stressors.

  2. Reliving stressful situations – the client analyses stressful events and how they were resolved, thinking up better ways and worse ways that they could have been dealt with. This provides the client with valuable insight into the effectiveness of their current coping strategies and once this has been done, the client is able to change their strategies.

  3. Self-improvement – the client learns to build their confidence by taking on new challenges which increase in difficulty but the client will be able to cope with. By completing challenges, they experience positive outcomes and so feel more control and confidence over their lives.

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Evaluation of increasing hardiness:

:) An advantage of ‘Increasing Hardiness’ is that it has been found to be successful with various groups including failing students and Olympic swimmers – the therapy had enabled to them to commit completely to their challenges (exams/sports, etc) and suppress distractions.


:) Another advantage is that it deals with the underlying causes of a person’s stress rather than dealing with the symptoms alone. For this reason the skills can be adapted to cope with any stressor and has a long term effect.


:( Weaknesses of this therapy include the fact that it requires a large deal of time, effort, motivation and money on the patient’s part – the therapy will only work if the patient is determined to cure their stress. It can take weeks and months for the therapy to complete – it is costly, and requires commitment – some may turn to drugs as it is simply more convenient to take them.


:( Another disadvantage is that this therapy seems to be predominantly successful with white, middle-class, businessmen, meaning its effectiveness is limited as it may not work with others.


:( Also, it very difficult to change basic aspects of one’s personality – therefore despite this therapy, some people may always be susceptible to stress and it may even make them worse.

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