Can Stress Make You Ill?
Rona Moss-Morris
Professor of Health Psychology
DIVISION OF HEALTH PSYCHOLOGY
www.bps.org.uk/dhp
Email: dhp@bps.org.uk
Lecture outline

The Biopsychosocial Model of health and
illness
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What is stress and how do we measure it?

The Pittsburgh Common Cold Studies

Buffers between stress and illness
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Stress and coping model
-
Social support
The Biomedical Model
The Biopsychosocial Model
Illness
Stressors
Any circumstances that threaten or are perceived
to threaten one’s well-being and thereby tax
one’s coping ability
An upcoming exam
Attending a party where you don’t know anyone
Being diagnosed with a serious illness
Break up of a relationship
Stress


Our physiological & psychological
responses to conditions that threaten or
challenge us in some way
Psychological responses include:
–Emotions e.g. anxiety
–Thoughts e.g. ‘No-one will talk to me’
–Behaviours e.g. ‘ drinking too much’
Fight-or-Flight (Walter Canon, 1932)
“aggressive or withdrawal responses to stress”
Stress response controlled by the brain
Physiological Stress Response
Stimulates muscles
Stress and measurement

Environmental

Psychological

Biological
Measuring Stress
Social Readjustment Rating Scale
Events causing the greatest life changes
considered most stressful
–
–
–
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Death of a spouse
Divorce
Marriage
Fired from work
Holmes and Rahe, 1967
SRSS Scores & Health
(Rahe, et.al, 1964)
The Daily Hassles Scale

Measures irritating, daily demands as rated
by the person
–
concerns about weight
too many things to do
misplacing things
–
argument with family member,
–
–
 Stronger associations with illness better
than the SRRS
Kanner et al. (1981)
Cohen’s Perceived Stress Scale (PSS)
10 item questionnaire rated over past month
-
how often have you felt nervous or stressed
-
how often have you felt on top of things
-
how often have you been upset because of
something that happened unexpectedly
-
how often have you felt difficulties were piling
up so high that you could not overcome them
The Common Cold Studies
(Cohen et al 1991; 1993)
Large scale prospective experimental investigations
of stress and the common cold
•PSS
•Life events
•Mood
Exposed to
cold virus
•Replicated
virus
•Clinical
symptoms
Age, gender, weight, ethnicity, season, smoking, alcohol, diet
exercise, sleep not related to stress and illness
How many people developed colds?
Viral Infection

82% of the volunteers receiving virus were
infected.
Clinical Colds


Clinical Colds = both infected and diagnosed by
the clinician as having a clinical cold.
38% developed clinical colds.
Which stress factors predicted colds?

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Perceived Stress (PSS)
Life events
Negative mood
PSS & negative mood predicted actual viral
infection
Life events predicted development of clinical
symptoms
Associations between each of the stress
measures and rates of clinical colds
Does the type of stressor matter?
Cohen et al. (1998) Health psychology, 17, 214-223

Life Events and Difficulties Schedule (LEDS;
Brown & Harris, 1989)

Detailed interview schedule

Rates events in the last year as
-
severe acute events
severe chronic difficulty (stressor)
Relative risk of developing a cold by stressor
duration
Does the type of stressor matter?
Conclusions:


Longer, more chronic stress – more
infection
Interpersonal and work stress – more
infections
Explaining the relationship between
stress and illness

Direct effects hypothesis
 stress

impacts on our hormones and immune systems
Indirect effects hypothesis
 stress
impacts on health through changes in health
behaviour e.g. diet, exercise, smoking, drinking
Mediators or Mechanisms
Hormones?
Immune system?
Behaviours?
Stress
Common cold
Behaviour as a Mechanisms
Health behaviours
Stress
Common cold
Hormones as Mechanisms
Neuroendocrine hormones
e.g. adrenal, cortisol
Stress
Common cold
Immune System as a Mechanisms
Increase in IL-6 Cytokines
Stress
Common cold
Explaining the Cytokine pathways
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Acute stress related to more cortisol which can
suppress immune responsiveness
Chronic ongoing stress related to decreased
cortisol
Less cortisol may lead to inability to switch off
immune responsiveness
Body produces more IL-6 – therefore more
symptoms.
Stress and Stroke-Study


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2,303 Finnish middle-aged white men followed for
11 years
Measured blood pressure spikes (in anticipation of
an exercise test)
Men with above average blood pressure spikes had
a 72% greater risk of developing a stroke in the
following 11 years
Susan A. Everson et al., 2001
Moderators of Stress

Appraisal and Coping

Social Support
Stress and Coping Model
(Folkman & Lazerus, 1984)
Secondary Appraisal:
What resources do I
have to cope with this
threat?
Coping
Strategy
Emotion Focused Coping

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Coping through emotional approach involves
actively processing and expressing emotion
(Stanton et al. 2000).
The emotional approach scale
–
–
emotional processing - “I take time to figure out
what I’m really feeling”
emotional expression ( “I let my feelings come out
freely”)
Emotional Processing and Cancer


Study of women with stage I or II breast cancer over 3
months (Stanton et al. 2000)
coping through emotional expression associated with
improved
–
–
–

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decreased distress,
fewer medical visits
increased vigour at 3 months
Coping through emotional processing associated with
increases in distress
Emotional processing appears to be adaptive in the short
term
Over the longer term may become ruminative and
therefore less beneficial in terms of adjustment.
Coping Effectiveness
The contextual approach - no strategy is
inherently bad

Short term and long term effects

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Some strategies like avoidance, denial and emotional
processing may work well in short term but not in long term
Controllable stressors better linked to problem focused
coping and uncontrollable to emotion focused coping.
Appraisals of coping efficacy
What is social support (SS)?


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Social network
Perceived social support
(amount available)
Received social support
Pathways from SS to health/illness

Cardiovascular (heart) system
individuals with high SS at work have lower mean heart rate than
those with low SS (Unden et al., 1991)

Immune system
individuals with more social ties less susceptible to common cold
(Cohen et al., 1997); immunoglobin A (first line of defence) higher in
college students with high SS (Baron et al., 1990)

Neuroendocrine system (hormones)
presence of supportive companion during stress test lower cortisol
response (Kirschbaum et al., 1995)
Summary and Conclusions

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Stress is linked to increased illness particularly chronic
stress
This seems to occur through direct effects on immune
responsiveness (overactive rather than underactive)
Stress can be buffered through the way people perceive
situations, their coping style and social support
These buffers can be used in interventions to reduce
impact of stress.
DIVISION OF HEALTH PSYCHOLOGY
www.bps.org.uk/dhp
Email: dhp@bps.org.uk