Stress

STRESS

Three Views of Stress

1. Focus on the environment: stress as a stimulus (stressors)

2. Reaction to stress: stress as a response (distress)

3. Relationship between person and the environment: stress as an interaction (coping)

Stressors

Some examples?

Stressors

War Overcrowding Deadlines Dense traffic Marital conflict Work stress

Acute vs. Chronic Stress

Acute stress Sudden, typically short-lived,

threatening event (e.g., robbery, giving a speech)

Chronic stress Ongoing environmental demand (e.g.,

marital conflict, work stress, personality)

Acute Stress

Acute Stress – Rozanski 1988 Subjects – 39 individuals with

coronary artery disease Stress tasks (0-5 minutes each):

Mental arithmetic Stroop-colour word conflict task Stress speech (talk about personal fault) Graded exercise on bicycle (until chest

pain or exhaustion)

Acute Stress – Rozanski 1988 Outcome – stress response

Myocardial ischemia determined by radionuclide ventriculography (measures wall motion abnormalities in the heart)

Acute Stress – Rozanski 1988Results Cardiac wall motion abnormalities were significantly greater with stress speech than other mental stress tasks (p < .05) and was of the same order of magnitude as that with graded exercise.

Wall motion abnormalities occurred with lower heart rate during stress than during exercise (64 vs. 94 beats/min, p < .001)

Chronic Stress – Frankenhauser, 1989 Subjects – 30 managerial and 30

clerical workers Equal number of men and women

Outcome: blood pressure, heart rate, and catecholamines measured throughout workday and non-workday.

Chronic Stress – Frankenhauser, 1989 No gender differences in the effect of

work on BP and HR. In both men and women, BP and HR

were higher on a workday than a non-workday.

Chronic Stress – Frankenhauser, 1989

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0.5

1

1.5

2

2.5

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10:00 12:00 14:00 16:00 18:00 20:00

WomenMen

Time of Day

Catecholamine Response

Three Views of Stress

1. Focus on the environment: stress as a stimulus (stressors)

2. Reaction to stress: stress as a response (distress)

3. Relationship between person and the environment: stress as an interaction (coping)

Fight or Flight Response

Increase in Epinephrine &

norepinephrine Cortisol Heart rate & blood

pressure Levels & mobilization

of free fatty acids, cholesterol & triglycerides

Platelet adhesiveness & aggregation

Decrease in Blood flow to the

kidneys, skin and gut

Selye’s General Adaptation Syndrome (1956, 1976, 1985)

PerceivedStressor

AlarmReaction•Fight orflight

Resistance•Arousal highas body triesdefend andadapt.

Exhaustion•Limitedphysicalresources;resistanceto diseasecollapses;death

If stress continues ….

Cognitive Model of StressLazarus & Folkman Potential stressor (external event) Primary appraisal – is this event

positive, neutral or negative; and if negative, how bad?

Secondary appraisal – do I have resources or skills to handle event?

If No, then distress.

Cognitive Model of StressLazarus & Folkman

Primary appraisal – Is there a potential threat?

Outcome – Is it irrelevant, good, or stressful?

If stressful, evaluate further: Harm-loss – amount of damage already

caused. Threat – expectation for future harm. Challenge – opportunity to achieve growth,

etc

Cognitive Model of StressLazarus & Folkman

Secondary appraisal – Do I have the resources to deal effectively

with this challenge or stressor?

Cognitive Model of StressLazarus & Folkman

High Threat

Low Resources

HighDemands

High Stress

High Threat

High Resources

High/low demands

Moderate Stress

Low Threat

Low Resources

Low demands

Some stress

Low Threat

High Resources

Low demands

Low or no stress

Personal Factors Affecting Stress Appraisal Intellectual Motivational Personality Beliefs

Situational Factors Affecting Stress Appraisals Strong demands

Imminent Life transition Timing Ambiguity – role or harm ambiguity Desirability Controllability

Behavioural control – perform an action Cognitive control – using a mental strategy

Learned Helplessness – Seligman, Peterson, et al. Dogs exposed to unavoidable shocks

Following exposure, when placed in a situation where they can now jump to avoid the shock, they fail to make the escape response.

Learned helplessness occurs when one perceives that one’s actions (e.g., working hard) does not lead to the expected outcome (e.g., high grade).

Job Strain – Karasek et al., 1981

Demands

High Low

ControlHigh

Low STRAIN

Job Stress – other aspects Physical environment Poor interpersonal relationships Perceived inadequate recognition or

advancement Unemployment (even anticipated) Role conflict High responsibility for others

Biopsychosocial Aspect of Stress

How stress affects health

Via behaviour Via physiology

Behavioural Aspects

Increased alcohol Smoking Increased caffeine Poor diet Inattention leading to carelessness

Physiological Aspects

Cardiovascular reactivity – increased blood pressure, platelets, lipids (cholesterol)

Endocrine reactivity – increased catecholamines and corticosteroids

Immune reactivity – increased hormones impairs immune function

Psychophysiological Disorders Digestive system – e.g., ulcers,

irritable bowel syndrome Respiratory system – e.g., asthma Cardiovascular system – e.g.,

hypertension, lipid disorders, heart attack, angina

Stress-Illness Relationship

Preexistingphysiologicalor psychologicalvulnerability

Exposureto stress

Physiological & psychologicalwear and tear

Behaviouralchanges &Coping efforts

Illnessprecursors,symptoms

Illness

Illnessbehaviour

MODERATORS OF THE STRESS EXPERIENCE

What is coping?

Process of managing the discrepancy between the demands of the situation and the available resources.

Ongoing process of appraisal and reappraisal (not static)

Can alter the stress problem OR regulate the emotional response.

Emotion-Focused Coping

Aimed at controlling the emotional response to the stressor.

Behavioural (use of drugs, alcohol, social support, distraction) and cognitive (change the meaning of the stress).

Often used when the person feels he/she can’t change the stressor (e.g., bereavement); or

Doesn’t have resources to deal with the demand.

Problem-Focused Coping

Aimed at reducing the demands of the situation or expanding the resources for dealing with it.

Often used when the person believes that the demand is changeable.

Coping responses – respond yes or no.

1. Tried to see the positive side of it.2. Tried to step back from the situation and

be more objective.3. Prayed for guidance or strength.4. Sometimes took it out on others when I

felt angry and depressed.5. Got busy with other things to keep my

mind off the problem.6. Read relevant material for solutions and

considered several alternatives.7. Took some action to improve the situation.

Problem-Focused Coping

Planful Problem-Solving – analyzing the situation to arrive at solutions and then taking direct action to correct the problem.

Confrontive Coping – taking assertive action, often involving anger or risk taking to change the situation.

Emotion-Focused Coping

Seeking social support – can be either problem or emotion-focused coping.

Distancing – cognitive effort to detach Escape-avoidance – wishful thinking or

taking action to escape or avoid it. Self-control – attempting to modulate one’s

feelings in response to the stressor. Accepting responsibility – acknowledging

one’s role in the situation while trying to put things right.

Positive reappraisal – create positive meaning.

Cognitive Re-structuring

Process by which stress-provoking thoughts are replaced with more constructive one.

Gender and Coping

Men generally employ problem-focused coping strategies more than emotional focused strategies.

Opposite for women, with women more often employing emotion-focused strategies.

If men and women in same occupation, gender differences disappear, suggesting that societal sex roles influence choice of coping strategies.

Socio-economic Status (SES) and Coping People with higher SES tend to use

problem-focused coping strategies more often (Billings & Moos, 1981).

Why do people who have lower SES use problem-focus coping strategies less often than those with high SES?

Personality or Coping Style

Negative affectivity Pessimism – optimism Hardiness

Life Orientation Test(Scheier & Carver)

1 In uncertain times, I usually expect the best.

2 If something can go wrong for me it will.3 I always look on the bright side.4 I’m always optimistic about my future.5 I hardly ever expect things to go my way.6 Things never work out the way I want

them to.7 I’m a believer in the idea that “every

cloud has a silver lining.”8 I rarely count on good things happening

to me.9 Overall, I expect more good things to

happen to me than bad.

Personality or Coping Style

Negative affectivity Pessimism – optimism Hardiness

Social Support

Emotional support – expression of empathy, understanding, caring, etc.

Esteem support – positive regard, encouragement, validating self-worth

Tangible or instrumental – lending a helpful hand.

Information support – providing information, new insights, advice.

Network support – feeling of belonging

Factors Influencing Utilization or Availability of Social Support

Temperament – people differ in their needs for social support. Social support can be detrimental if you are the type of person who likes to handle things on your own.

Previous experience with social support influences your likelihood of seeking out social support in the future.

Threats to Social Support

Stressful events can interfere with your ability to use social supports.

People under stress may become so focused on talking about their problems that they drive their support systems away.

Supports agents may react in a way that makes the problem worse.

Support providers may be adversely effected by providing support.

Alxheimer’s Disease (AD) – Effect on Caregivers

Subsample of the Cardiovascular (CVD) Health Study, a prospective study of risk factors for CVD in the elderly.

Excluded: disabled confined to wheel chair, unable to attend field centres, or undergoing cancer treatment.

Caregivers defined as those whose spouse had difficulty with one activity of daily living due to physical or mental health problem.

392 caregivers and 427 non-caregivers recruited.

AD – Effect on Caregivers

Caregivers were asked to rate the degree of mental and physical strain associated with caregiving (3-point response format).

Sample subdivided into four groups: non-caregivers; spouse disabled but not helping him/her; caregiver but no reports of strain; and caregiver with reports of strain.

Followed for 4.5 years (range 3.4 – 5.5 years).

Main outcome – mortality (100% follow-up achieved).

AD – Effect on CaregiversResults

81% of caregivers were providing care.

56% reported caregiver strain. Mortality – 9.4% in non-caregivers;

17.3% in ‘caregivers’ not providing care; 13.8% in non-strained caregivers; and 17.3% in strained caregivers.

Generally Social Support Associated with Good Effects Increase survival rates in women who have breast cancer.

Lower blood pressure Decrease risk of mortality

PSYCHOLOGICAL PREDICTORS OF SUDDEN CARDIAC DEATH IN CAMIAT

J. Irvine, A. Basinski, B. Baker, S. Jandciu, M. Pickett, J. Cairns, S. Connolly, M. Gent, R. Roberts, & P. Dorian,Psychos Med 1999Funded by Heart and Stroke Foundation of Ontario

Psychosocial Predictors of Sudden Cardiac Death in CAMIAT

Measures: Cook-Medley Index: measures of hostility,

anger, cynicism Beck Depression Inventory Symptom Checklist-90: psychological

distress Social Support: measures of social

participation, network and perceived social support

Psychosocial Predictors of Sudden Cardiac Death

Variable Relative Risk

95% CI p

Previous MI 2.86 1.37 – 5.99 0.005 Hx CHF 3.86 1.89 – 7.89 0.001 Depress. – P 2.48 1.14 – 5.35 0.02 Depress. - A 0.52 0.15 – 1.76 0.29 Network Cont. 1.04 1.00 – 1.06 0.01 Social Activities 0.98 0.96 – 1.00 0.05

STRESS MANAGEMENT

Stress Management – teaches coping techniques

Reduce harmful environmental conditions

Teaches techniques by which person can develop stress tolerance.

Helps client maintain a positive self-image.

Help maintain emotional equilibrium. Help client maintain or develop

satisfying relations with others.

Cognitive Therapy – Albert Ellis, Aaron Beck

Assumes that stress arises or is augmented by faulty or irrational ways of thinking. Catastrophizing – “It is awful if I get turned

down when I ask for a date”. Overgeneralizing – “I didn’t get a good grade

on this test. I can’t get anything right”. Selective abstraction – Only seeing specific

details of the situation (e.g., Seeing the negatives but missing the positive details).

Cognitive Therapy

Often these irrational beliefs or faulty thinking errors stem from past “programming”. E.g., Not receiving adequate love and

nurturance as a child may lead to feelings that loved ones in the present don’t “quite love you enough”.

Hypothesis testing – client is encouraged to test out these irrational beliefs by collecting evidence for or against the belief.

Cognitive Therapy

Errors in Information Processing - Irrational Thinking Errors include:

Emotional reasoning Overgeneralization Catastrophic thinking Mind reading Selective negative focus, etc.

Relaxation Therapy

Aims to either reduce hyperarousal or curb emotional-physiological reactivity. Progressive muscular relaxation Mental imagery Meditation Autogenic training

Time Management

Set short-term (e.g., daily) and long-term (e.g., yearly) goals.

Make daily to-do lists (prioritize each). Make a daily schedule for when and

where you will carry out your to-do list items (estimate time allocated for each to-do item).

Revise throughout the day as needed.