Stress

Actute Stress - SAM : Hypothalumus > sympathetic nervous system > Adrenal Mudella > Adrenaline & Noradrenaline > Fight or Flight.

Chronic Stress - PAS - Hypothalumus > Pituatry Gland > ACTH > Adrenal Cortex > Cortisol > Liver releases Glucose > Takes 20 mins 

Individual Differences - TAYLOR - Male hormones reduce effects of oxytocin. (Hormone making people less anxious) Oestrogen amplifies it. Men are more vulnerable to adverse health effects. 

Consequences:

• High blood pressure can lead to heart disease. 
• Too much cortisol can suppress immune system.

Problem Focused Coping - use of strategies to alleviate stressful situation. Taking control of situation, evluating pros and cons of options to deal with stressor, suppressing competing activities. 

Emotion Focused Coping - Strategies to deal with EMOTIONAL distress of situation. Denial and distancing, venting emotions, wishful thinking. 

• PENELY - Nursing students, found PFC posotively correleates with overall health. Negative EMFC associated with poor health.
• GILBAR-  Breast Cancer Patients, EFC associated with high psychological distress.
• FOLKMAN & LAZARUS - Students in run up to exams and wait for results, PFC more evident before and EFC evident after. 
• STONE -Argued that strategies for EFC more appropriate to relationship stressors and 3/4 irrelevant for health problems.
• LAZARUS - EFC unhelpful when experiencing serious symptoms of illhealth )delay and seeking treatment). But during recovary period may be a useful way of coping. 

The Immune System

• KIECOLT-GLASER - Killer and T Cells measured in 75 1sy year Med students, samples taken in low stress and high stress. Cells declines from Low > High. Most suppressed immune when particpants reported other stressors.
• +Natural, few ethical issues, exam stress isnt artificial
• - only correlational (natural), Functioning still in normal range immune system complex
• EVANS - Measured SlgA in students in high stress and low stress. Increased SlgA (enhancing immune functioning) in acute stress and decreased in exam period (high stress)
• SEGERSTRON & MILLER - Meta-analysis confirmed trend that acute stress enhances immune functioning and chronic long term stressors lead to suppression.

Cardiovascular Disorders

• Stress can cause : Hypertension, CHD, and Stroke
• This is because Stress > SNS > Constriction of blood vessels, rise in blood pressure and heart rate > reaing away lining of blood vessels. And, stress >  increases glucose > causing clumps > blocking blood vessels.
• RUSSEK - Chronic - Heart disease in medical proffesionals (1) high stress -GPs (2) low stress -Dermatologists. Heart diease greatest among GP's.
• WILLIAMS - Acute - Anger = Acute stressor. 13000 completed 10q anger scale. 6 years later 256 had had heart attacks. P's who scored highest on anger scale 2 1/2 times more at risk.
• SHEPS - Volunteers with reduced blood flow to th hears. Volunteers spoke publically. In half of particpants sections of the muscle in the left ventricle began to beat erratically. 44% of these died in 3 - 4 years  18% of volunteers who didnt beat. Stess can increase risk of death in people with existing cardio disorders.
• Indirect links? Stress > Smoke > CHD

• FRIEDMAN & ROSENMAN- type A is Competitive, impatient, aggressive. These lead to raised blood pressure and stress which are linked to CHD.
• Type B lacks these characteristics they are, patient, relaxed, easy going and therefore less vulnerable to stress related illness.
• F & R - Western Collab Grp Study - 3000 men, 39-59 from California examined for signs of CHD and personalities assessed in a structured interview to try and elict tyoe A (speaking slowly). 8 years later, twice as many type a's had died from cardiovascular problems. 12% compared to only 6%.
• REGLAND & BRAND - Follow up study of P's 22 years later. Found 15% had died of CHD, little evidenve for type a and mortality relationship.
• MYRTEY - Meta analysis - found an association between CHD and a componant between CHD and component of type A - HOSTILITY - other than that found no evidence for relationship

• KOBASA - Hardy personality provides defences against negative affects of stress. THREE C'S Control, Commitment and Challange.
• KOBASA - 800 American Business executives stress using SRRS. 150 p classified high stress. Of these some had low/high illness. Individuals in hih stress/low illness scored highest in all 3 hardy characteristics.
• MADDI - Employees of US company that was reducing its size of workforce. 2/3 suffered stress related health problems over this period. 1/3 thrived - this group showed more evidence of hardiness attributes.
• WATSON & CLARK - Charcteristics of Hardy can be more simple explained by the concept of negative affectivity. .High NA more likely to report distress/ dissatisfaction, dwell on failures and focus of negative aspects. NA and Hardiness correlate reasonably well.
• Most research is based on self-report questionairres.

• MARMOT ET AL - 10308 civil servants ages 35-55 over 3 years. Job control assessed 3 years apart through self report survey and observation. Records of stress related illness were kept. Found P's with low job control were 4 x more likelt to die of heart attack than those in high control.
• EVALUATIONS - Self report method - investigator effects and predictivity bias. Questions may give clues to aim of research creating expectancy effect. Correlational method means no control over th variable, only an association can be made.
• SCHAUBROEK - individual differences - Workers respond differently to alck of control. Measured saliva to assess immune functioning. Some P's had high immune responses in low control. These P's view negative work outcomes as ther problem, they can exarbate unhealthy effects of stress.
• POMAKI - ROLE CONFLICT. directly associated with emotional exhaustion, deppressive symptoms and somatic complaints.
• JOHANSSON - Repetative jobs, requiring continuous attention and some responsibility. Sawyers in Swedish Sawmill (high risk) were found to hvae higher illness rates and higher levels of stress hormones on weekdays.

Daily Hassles.

• DELONGIS -created the hassles and uplifts scale - HSUP
• BOUTEYRE-Hassles and mental health of students suring school to uni transition. Students completed Hassles part of HSUP and BECK's depression inventory. 41% suffered depressive symptoms. Posotive Correlation between hassles and depressive symptoms.
• GERVAIS- Asked nurses to keep diary for a month, recording uplifts and hassles at work. Also rating their performances. Daily hassles increased job strain, decrease job performance. Uplifts counteracted negative affects of hassles and improved their performance.

Life Changes.

• RAHE -Tested life events correlate with illness. 2500 male US Naval Personnel over 6 months. Self report questionairres, meauring life events based on SRRS. P's asked how many life events theyde had in the last 6 month. Health record also kept. Found significant posotive correlation os 0.018 - small but significant for 2500ps.
• EVALUATION -Info of link between stress & life events, we can teach stress management techniques. Cause and effect cant be identified, conclusions limitied. Sample is bias - American (ethnocentric) and male (andocentric)

• FLETT -suggested life changes differ to hasles in seeking/recieving social support. 320 students read scenario of life event/hassles and rated amount of social support recieved. Life events scored higher siggesting a greater negative influence of daily hassles on psychological adjustmet may be due to reduced social support. 
• ACCUMULATION EFFECT -Accumulation of minor dairy stressors creates persistant irratations, frustrations and overloads which result in more serious stress relations such as anxiety and depression.
• AMPLIFICATION EFFECT - Chronic stress from life changes make individual more vulnerable to daily hassles. As a person is already in a state of distress, presence of minor stressors may amplify the experience of stress. Less able to cope with mire stressors.

• FLETT -suggested life changes differ to hasles in seeking/recieving social support. 320 students read scenario of life event/hassles and rated amount of social support recieved. Life events scored higher siggesting a greater negative influence of daily hassles on psychological adjustmet may be due to reduced social support. 
• ACCUMULATION EFFECT -Accumulation of minor dairy stressors creates persistant irratations, frustrations and overloads which result in more serious stress relations such as anxiety and depression.
• AMPLIFICATION EFFECT - Chronic stress from life changes make individual more vulnerable to daily hassles. As a person is already in a state of distress, presence of minor stressors may amplify the experience of stress. Less able to cope with mire stressors.

Stress Inoculation Training

• MEICHENBAUM -SIT aims to increases ability to cope and use existing coping skills. 'Inoculates' against future stressors. 
• PROCESS -conceptualisation -establish relationship, informed of nature and impact of stress taught to view threats as problems to be solved and to break down stressors.
• Skills aquisation and pactise -taught skills behavioural and cognitive for example posotive thinking and social skills, pactised in clinic then gradually in real life. 
• Real life application 0apply skills in different situations, increasingly stressful using imagery, modelling and role play. Asked to help others and offer booster sessions. 
• STENGTHS - Deals with coping with future stressors, long lasting effectiveness.
• SHEEHY & HORAN -students given SIT improved their academic rank.
• WEAKNESSES -Requires alot of time, effort, motivation and money. Overcomplicated? effectiveness due to small factors (talking posotively and relaxation) rather than all elements.

Benziodiapines - BZ's

• Slow down central nervous system. Enhance action of GABA (anxiety relief). 
• GABA locks onto receptors on nuerons and opens a channel which increases flow of chloride ions into the nureon to be stimulted by other nuerotransmitters and so slows down activity > making person feel relaxed> reducing activity.
• KAHN -250 patients followed for 8 weeks, Bz's were significantly superior to placebo.
• Requires little time and effort. Addictive, withdrawal symptoms. Side effects - dizziness, constipation, diariah and loss of sex drive.

Beta Blockers - BB's

• Reduce activity of adrenaline and noradrenaline which prepare body for FOFR.
• BB's bind to receptors on the cells of the heart which are usually stimulated during arousal. By blocking receptors, harder to stimulate cells, begin to feel calmer and less anxious.
• LOCKWOOD -studied 200 musician in US orchestra, 27% took BB's - felt better about performance and get better reports from critics. 
• no side effects, however some studies have shown a link with the development of diabetes.