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Psychology 3460: Stress and Disease
I. Introduction
II. What is Stress?
A. Response
1. Fight of flight response
2. General adaptation syndrome
B. Stimulus
C. Transactional model
D. Multidimensional nature of stress
III. Stress and Health
A. Animal models
B. Human models
IV. How is Stress Related to Disease
A. Health-related behaviors
B. Cognitive / Physiological processes
V. Moderators of Stress
A. Coping styles
B. Control
C. Personality
D. Social Support
VI. Managing Stress
A. Biofeedback
B. Exercise
C. Progressive relaxation
D. Meditation
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10/31/04
I. Introduction.
II. What is Stress?
Response. Historically, researchers defined stress as a response by focusing on the organism’s
physiological reactions to threat.
In the late 1920’s, Walter Cannon advanced the notion that in the face of threat, there is a
general sympathetic discharge to cope with the threat (i.e., the fight or flight response).
General adaptation syndrome. (OVH) In the 1950’s, Hans Selye extended Cannon’s flight
or fight model by examining the process of our reactions when confronted with a threat, especially a
chronic one.
Phase 1 is the alarm reaction characterized by increased ANS activity
Phase 2 is resistance characterized by increased pituitary-adrenal activity
Phase 3 is exhaustion characterized by decreased pituitary-adrenal activity and eventual system
failure.
Stimulus (stressors). One alternative approach is to view stress as a stimulus or stressor. One
example is to examine major life events. (OVH) The Holmes-Rahe social readjustment scale has a
rank ordering of major life events such as death of a spouse (1), son or daughter leaving home (23), and
minor violation of law (43).
An additional approach is to focus not on major events but on the daily hassles that we all experience.
Hassles are defined as the irritating, distressing, and frustrating demands that characterize everyday
transactions with our environment. Some evidence suggests that hassles may predict mental and
physical health more than major life events in the long-term.
One critique of this approach is that although some events are universally stressful, why do people
often react differently to the same stressor.
Transactional model. (OVH) The contemporary view is stress as a transactional process
between the person and the environment. Emphasis is placed both the on the stimulus and our
interpretation or appraisal of that event. Lazarus and Folkman define stress as a condition in which an
event is appraised as taxing or exceeding our resources and/or well-being. There are two types of
appraisal: primary appraisal is one’s assessment of potential danger, whereas secondary appraisal is
concerned with the evaluation of one’s coping resources.
III. What is the Relationship Between Stress and Health?
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Animal models. Manuck et al. (1983) found that monkeys who showed the greatest stress
response also developed greater coronary artery atherosclerosis. Rats exposed to uncontrollable stress
developed larger cancerous tumors. Mice exposed to stress develop a poorer antibody response to
challenges.
Human studies. Experimentally induced psychological stress associated with changes in
cardiovascular function that may be associated with disease. Epidemiological studies suggest that
stress may be associated with both the development and exacerbation of disease. In one of the largest
studies of its kind, the INTERHEART study found that across 52 countries using almost 25,000
participants, stress from work and home was associated with an increased risk for having a heart attack.
Studies of naturally occurring stressors, such as the OSU caregiver research project have found that
the chronic stress of caregiving is associated with a down-regulation of the immune system
compared to demographically similar control groups. In addition, such caregivers also had more days
of infectious illnesses.
(OVH) In an attempt to examine an ecologically valid outcome, Cohen et al. (1991) infected subjects
with the common cold virus and quarantined them over a 9 day period. Results revealed that
psychological stress was associated with increased infection rates is a dose response manner.
IV. How is stress related to disease.
Health behaviors. Earlier in the course, we talked about how health behaviors such as
smoking, alcohol consumption etc. can influence physical health. People under stress often change their
health behaviors. For instance, stress is sometimes associated with increased alcohol and drug abuse.
Therefore, some of the influence of stress on health may be due to its effects on health behaviors.
Direct Effects. Stress may also influence cognitive and brain processes that lead to direct
physiological changes that subsequently increases vulnerability to stress.
Stress components. There are at least four stress components that may increase risk for
disease. Exposure refers to the number of stressors that an individual experiences, reactivity refers to
the strength of an individual’s physiological reaction to any given event, whereas recovery refers to the
how long it takes an individual to return to “baseline” following stressful events. A final perspective is on
restorative processes that serve to refresh or repair the organism (e.g., cellular damage) because
stress may directly impede our ability to perform these functions (e.g., disturbed sleep, impaired wound
healing).
V. Moderators of stress.
Coping responses. (OVH) There is a distinction between problem-focused vs. emotionfocused coping. Problem focused coping is concerned with problem solving aimed at altering the
source of stress, whereas emotion focused coping is aimed at reducing the emotional distress of the
situation. Problem-focused strategies most effective when one has potential control over the
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stressor. Emotion-focused strategies most effective if the stressor is of relatively short duration
and of little consequence. Overall, individuals who are most flexible in utilizing these coping
strategies may be best off.
Perceived control. All in all, however, control appears to foster adjustment to stress. For
instance, controllable stress is not nearly as bad as stress that is uncontrollable (see Glass study on
predictable vs. unpredictable noise).
In one interesting study, Langer and Rodin (1977) instilled a sense of control in older nursing home
residents. Short-term analyses revealed that individuals in the control condition were happier and
engaged in more social activities than subjects not given control. More importantly, long-term analyses
revealed an impressive effect on mortality about 18 months later: only 15% of control subjects died
whereas 30% not given control had died.
Personality. The Type A behavior pattern is characterized by extreme competitive striving for
achievement, a sense of time urgency, hostility, and aggression. Interest in this personality trait was
fueled by research from the Western Collaborative Group Study that found that Type A individuals
were more than two times more likely to develop CHD compared to their Type B counterparts. Recent
reviews have indicated that one component may be especially unhealthy: hostility.
Hostility is a personality trait characterized by negative belief in others, feelings of distrust. Reviews
have indicated that hosility is most strongly associated with risk for all cause mortality.
We all know people who tend to look at the bright side of things, despite problems and
obstacles. Scheier & Carver have found that optimistic people tend to be characterized by better
psychological well-being. In addition, they appear to recover faster following coronary surgery. Finally,
the flip-side of optimism is pessimism and it has been related to poorer health in a longitudinal study
spanning about 35 years.
A common mechanism perhaps underlying all of these personality processes are the schemas
that guide information processing in these individuals. For instance, we know that schemas tend to
be confirmatory. As a result, hostile individuals are more likely to see interpersonal betrayal in their
lives, whereas optimistic individuals do just the opposite.
Social support. (OVH) There is an impressive body of literature indicating that individuals who
are more socially isolated or whose quality of social relationships are poor are less healthy (both
psychologically and physically) and more likely to die.
(OVH) Our important social relationships can influence stress in a variety of ways. Close network
members can provide tangible support (e.g., money, lend us their car), informational support (e.g.,
how to study for an exam, what that cold sore might mean), and emotional support (e.g., help us feel
better about ourselves – its that person’s loss because you’re a great person). One needs to carefully
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match the type of support with the situation if not an attempt to be supportive may also turn into a
source of stress for both parties.
VI. Managing stress.
Biofeedback. Although progressive relaxation and meditation tend to be quite general,
biofeedback focuses on specific physiological systems by providing a form of feedback on that systems
activity. For instance, a person may receive feedback in the form of an increasing tone whenever heart
rate increases. The assumption is that the feedback will allow and individual to discriminate these
changes and learn how to control it. In general, the results of biofeedback have been promising
including effects on muscle pain, tension headaches, and hypertension.
Exercise. It also appears as if exercise can help individuals cope with stress. In particular, a
moderate amount (not exhaustive) of exercise has been linked to better health in the face of stress. In
one study, Brown and Siegel (1988) found that high school girls who reported a high level of life stress
showed poorer health. The best effects of exercise seem to be obtained with (a) sustained heavy
breathing without exhaustion, (b) last between 20 min to 2 hrs, (c) engaged 3 or more times per week.
Meditation. Meditation comes in many forms but what they share is a conscious attempt to
focus attention in a nonanalytical way and an attempt to not dwell on ruminating thoughts. Focus is
directed away from the thoughts and on the process by which thoughts flow in and out of mind.
Meditation has helped people deal with phobias and anxieties and also appears to influence
physiological processes such as reduced heart rate, oxygen consumption, and blood pressure.
There are several important components to meditation. First, one needs to find a relatively quiet
environment and assume a comfortable position. Second, one may choose a mental device that
provides a constant environment (e.g., mantra or word, breathing). Third, one needs a passive,
uncritical attitude. During meditation you will find interruptions creeping into your concentration. Try to
maintain a passive attitude and let these interruptions flow in and flow out of your mind, try not to fight it
too much. Also, try not to do this just before bedtime as it may make you even more alert and awake.
Progressive relaxation. In this technique, a person is taught to relax by tensing and then
releasing specific muscles. This induces relaxation but also teaches the person to identify early signs of
muscular tension. Progressive relaxation has been shown to increase psychological well-being but
also appears to have effects on physiological processes as well. For instance, it appears to have
positive effects on hypertension and muscle tension headaches and immune system functioning.