Health Psychology
Lecture 3
Stress and Stress Management
Lecture 3 - Outline
• Part 1
– What is stress?
– What causes stress?
– How do we measure stress?
• Part 2
– What are the effects of stress on mental/physical health?
– Moderating variables
– Stress management
• Part 3
– Anna Nagy (stress researcher)
Question
What is stress?
Question
What is stress? …
Any circumstances that threaten or are perceived to
threaten one’s well-being and that thereby tax one’s
coping abilities.
Question
What is stress? …
Any circumstances that threaten or are perceived to
threaten one’s well-being and that thereby tax one’s
coping abilities (?)
A state of heightened mental and physical arousal
in response to a demand (?)
Perceived inability to adjust to, meet demands (?)
… the text book definition
What is stress? …
“The condition in which person-environment
transactions lead to a perceived discrepancy
between the physical and psychological demands of
a situation and the resources of the individual’s
biological, psychological, or social systems”
(Sarafino, p. 71)
What is Stress?
Stress as an event
Controllability
Predictability
Stress as a response
Physiological
Emotional
Psychological
Behavioral
Physiological features
Sympathetic Nervous System
– Arouses the body for action in the event of a threat
– “fight or flight”
–  heart rate,  blood pressure,  blood to heart and voluntary
muscles, dilates airways
Hormones
– SNS stimulates release of adrenalin and noradrenalin
– Similar effects to SNS but more enduring
– Corticosteroids (cortisol) -  blood glucose,  immune system
activity.
Emotional features
Fear and anxiety
– Uneasiness and apprehension
– Strain and tension
– E.g., waiting for surgery, exam result
Depression
– Sad, blue, unhappy (not clinical = severe, long lasting)
Anger
– Particularly when the situation is harmful or frustrating
Cognitive features
Attention and Memory
– Stress occupies attention and other cognitive resources
– Impaired encoding and retrieval of information (learning)?
Performance
– Yerkes-Dodson Law
Performance
Perception of events
Arousal
Cognitive features
Memory for Stressful Events (p. 78)
Attention and Memory
Stress
enhance
our attention
attention and
toward
thecognitive
stressor. resources
– can
Stress
occupies
other
– Impaired
encodingsee
and
retrieval
information
Experiment:
participants
pictures
of of
a boy
going to (learning)?
hospital.. Some
hear an emotional story (terrible accident) others hear neutral (going to
watch activities)
Concentration
Performance
Performance
Before the story, participants received an injection (placebo or drug that
inhibits adrenalin).
One –week
later, participants
Yerkes-Dodson
Law with the placebo (more aroused) remembered
more of the story than participants who received the drug (less aroused)
No difference for recall of neutral story
Arousal
Adrenalin enhances the memory of stressors we experience
Behavioral features
Changes in health-related behaviors
–
–
–
–
–
–
Sleep
Diet
Drugs
Social behavior (can help each other, or  hostile/insensitive)
 risk taking
 health care (don’t notice symptoms)
Coping
– Any attempt to deal with the stressor or stress response
– May be adaptive or maladaptive
What is Stress?
Stressor
Intervening
Factors
Appraisal
Perceived
Control /
Predictability
Personality
Social Support
Coping Skills
Stress
Reactions
What is Stress?
PRIMARY APPRAISAL
+ve, -ve, or neutral.
Degree of threat.
POTENTIAL
STRESSOR
STRESS
RESPONSE
SECONDARY APPRAISAL
Resources / abilities
Can I cope?
Lazarus (1968)
Stress Appraisal Model
The “stress process”
Stress Appraisal Model
Stress and the appraisal process
What is Stress?
Stress as a Process
•
The process by which we appraise and cope with
environmental threats and challenges
Sources of Threat and Challenge
– Frustration (unable to reach a desired goal)
– Conflict (decision making, e.g., approach-avoidance)
– Change (adapting to new circumstances)
– Pressure (expectations to behave in a certain way)
Vicarious Stress?
Does the threat need to relate to us directly to elicit stress?
Subincision (Lazarus et al., 1964)
–
Film of young boys from a primitive culture “in which the underside of
the penis is cut deeply from the tip to the scrotum” (p. 73)
–
Participants viewed the film in one of 4 ways (no narrator, narrator
emphasizes pain, narrator denies pain, narrator describes in detached
scientific tone)
–
Stress: trauma narration > no narration > denial, scientific narration
–
Results show that people can experience stress vicariously, and that
reactions depend on the process of primary appraisal.
Measurement of Stress
• Physiological
– Blood concentration of catecholamines (adrenaline,
NA) and cortisol
– Blood pressure, pulse rate, breathing rate, galvanic skin
response.
– Problems…
• Taking blood may be a stressor itself
• Reactive to factors other than stress
– Gender, body weight, caffeine, activity level
• Costly
Measurement of Stress
• Self-report
– Life Event Scales
• List of potentially stressful ‘major’ events
• Ss indicate which they’ve experienced during xx
• Events are weighted to reflect stressfulness
– Daily Hassle Scales
• Considers individual values/meaning of events
• Problems - reliable recall of events
43
Minor violations of the law
11
How have you been lately?
For each question, estimate how often it occurred
during the past month (p. 93)
0 = never
1 = rarely
2 = occasionally
3 = often
4 = very often
5 = extremely often
How have you been lately?
For each question, estimate how often it occurred
during the past month (Sarafino, p. 93)
1 = somewhat often
2 = moderately often
3 = extremely often
Gender Differences in Response
Women
• Report greater number of major and minor stresses
Men
• Greater reactivity when stressed
• Find different things stressful (competence challenged)
• Longer to return to baseline
Stress and Mental Health
Detrimental effects of too much stress…
Single episode of extreme stress:
Post-traumatic stress disorder (PTSD)
–
–
–
Re-experience a traumatic event
Avoid associated stimulus
Persistent anxiety/arousal
Chronic/prolonged stress:
–
–
–
–
Psychological difficulties = insomnia, sexual difficulties, problems
concentrating, unhappiness, alcohol and drug use
Psychological disorders = depression, anxiety, schizophrenia
burnout
response to treatment
Stress and Physical Health
Selye’s 3-Stage General Adaptation Syndrome
Theory of Stress and Illness
Selye’s General Adaptation Syndrome
•
Physiological
1.
Alarm
- body mobilized to resist the stressor (“fight or flight”)
2.
Stage of Resistance
- body tries to adapt to the stressor (body getting tired)
3.
Stage of Exhaustion
- weakened immune system, depleted energy reserves
- damage and disease to body (body loses the fight against stressor)
Stress and Physical Health
What are the effects of stress on physical health? (pp. 118-131)
Acute illnesses
•
 colds, flu
Psychophysiological disorders
•
Physical symptoms from psychosocial processes (psychosomatic)
•
 digestive system illnesses (ulcers, inflammatory bowel disease),
asthma, recurrent headache
Chronic illness
•
 cancer, hypertension, coronary heart disease (CHD)
Death (?) … see case study on page 120 of your text!
Stress and Physical Health
Ulcers
- the effects of stress on physical health? (pp. 118-131)
What are
A break in the skin or mucosa caused by the loss of dead tissue.
Acute
illnesses
Common
belief that stress is major cause of gastric or peptic ulcers.
•
 colds, flu
However, 90-100% with duodenal ulcers have a helicobacter pylori
infection
(i.e., bacterial
infection)
Psychophysiological
disorders
•Eradicating
Physical
helicobacter
symptoms-from
recurrence
psychosocial
rate of 4%
processes
compared
(psychosomatic)
to 80% in
those
whose
ulcerssystem
heal but
infection
persists
•
 digestive
illnesses
(ulcers,
inflammatory bowel disease),
asthma, recurrent headache
Helicobacter infection alone does not explain ulcers - also depends on
acid secretion which appears related to stress.
Chronic illness
Anda
et al
(1992)hypertension,
- longitudinalcoronary
study - those
reported
•

cancer,
heart who
disease
(CHD)high levels of
stress slightly more likely to develop ulcers (7%) than those with low
Death
(?) … (4%)
see case
study may
on page
120 ofto
your
text!
stress levels
… stress
be related
relapse.
Suspected Stress-Related Diseases
Stress and Physical Health
How does stress affect physical health?
Direct Effects
•
Stress can cause changes in the body’s physiology
–
–
–
Cardiovascular system ( blood pressure)
Endocrine system (Catecholamine and Corticosteroid release)
Immune system (immunosupression)
Indirect Effects
•
Stress can affect behavior; behavior can affect health
–
–
stress related to  car accidents; car accidents related to health
stress related to  coffee, alcohol, cigarettes; use related to health
Immune System
Antigens (e.g., bacteria, virus, fungi) compete with cells for nutrients,
destroy cells, disrupt metabolic processes
Immune system defends the body against antigens.
White blood cells (produced in bone marrow)
•
Phagocytes engulf and ingest antigens
•
lymphocytes (Killer T) destroy cells already invaded by antigens
Stress lowers the concentration and activity of Killer T cells (p. 62)

More susceptible to disease when under chronic stress
[Antigen = anything that triggers an immune response (e.g., donor organ)]
Moderators of the Stress-Illness Relationship
• What is a moderator?
Moderators of the Stress-Illness Relationship
Diathesis-Stress Model
–
Diathesis = vulnerability (genetic, psychological, social)
–
Stress = traumatic experience (environmental)
Vulnerability (diathesis) + Stressor  Illness
(poor social support is an example of a diathesis)
Moderators of the Stress-Illness Relationship
• Nature of the stressor
– Unpredictability, uncontrollablity, severity, duration
• Personal characteristics and resources
– Personality (e.g., the hardy personality)
– Coping skills
• External Resources
– Social support
Moderators of the Stress-Illness Relationship
• Hardy Personality (Kobasa, 1977)
Control = belief in one’s ability to influence events
Commitment = an approach to life marked by curiosity
and a sense of meaning
Challenge = a belief that change is normal and stimulating
(also conscientiousness and optimism)
Moderators of the Stress-Illness Relationship
• Coping Style
– Cognitive and behavioral efforts to manage specific
demands (see Sarafino, p. 134)
• Problem-focused coping = controlling the emotional
response to the stressor (e.g., drinking alcohol)
• Emotion-focused coping = reducing the situation’s
demands or gaining new resources (e.g., information
seeking, breaking aversive relationships)
Moderators of the Stress-Illness Relationship
•
Assessing Coping Style (Sarafino, p. 135)
–
–
–
–
–
–
–
–
–
–
–
Tried to see a positive side
Tried to step back from the situation and be more objective
Prayed for guidance and strength
Took it out on other people when I felt angry or depressed
Got busy with other things to keep my mind off the problem
Decided not to worry about it because I decided everything would work out fine
Took things one step at a time
Read relevant material for solutions and considered several alternatives
Drew on my knowledge because I had a similar experience before
Talked to a friend or relative to get advice on handling the problem
Talked with a professional person (doctor, clergy, lawyer, teacher, counselor) about
ways to improve the situation
– Took some action to improve the situation
Moderators of the Stress-Illness Relationship
• Social Support
– aid and encouragement people receive from their interactions with
others (functional social support)
• Instrumental support (money, labor, time)
• Informational support (advice, suggestions, info)
• Appraisal support (affirmation, social comparison)
• Emotional support (affection, concern, listening)
• Pets (?)
• Social support appears able to reduce the impact of a stressor.
Moderators of the Stress-Illness Relationship
• Social support and dying!
(p. 102)
40%
60-69 yrs
20%
50-59 yrs
30-49 yrs
low
medium
high
Moderators of the Stress-Illness Relationship
• Two ways social support may benefit health
Low
support
High
support
low
high
Stressor intensity
High
support
Health
Health
Low
support
low
high
Stressor intensity
Stress and Illness
Summary and Conclusions
• The relationship between stress and illness is a modest one,
but stress can contribute to some illnesses
• The effects of stress are dependent on a number of other,
moderating factors
• The fact that stress only explains a modest amount (10%)
of the variance in health change does not mean that it is
trivial (health is complex, multiple causes)
• “evidence is less clear and fully spelled out than is
generally realized” (Lazarus)
Stress Management
•
Medication
–
•
Benzodiazepines (valium), Beta-blockers (Inderal)
Cognitive restructuring
–
•
Turning a threat into a challenge
Humor
–
•
Release built-up emotion, reappraise
Relaxation
–
•
Reduce heightened arousal
Minimize physiological vulnerability
–
i.e., preventative (healthy behavior) …. Exercise!