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 1988
Results
 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
Catecholamine Response
3
2.5
2
Women
Men
1.5
1
0.5
0
10:00
12:00
14:00
Time of Day
16:00
18:00
20:00
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)
Perceived
Stressor
Alarm
Reaction
•Fight or
flight
Resistance
•Arousal high
as body tries
defend and
adapt.
If stress continues ….
Exhaustion
•Limited
physical
resources;
resistance
to disease
collapses;
death
Cognitive Model of Stress
Lazarus & 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 Stress
Lazarus & 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 Stress
Lazarus & Folkman
 Secondary appraisal –
 Do I have the resources to deal effectively with this
challenge or stressor?
Cognitive Model of Stress
Lazarus & Folkman
High Threat Low
Resources
High Stress
High Threat High
Resources
High
Demands
High/low
demands
Low Threat Low
Resources
Low
demands
Some
stress
Low Threat High
Resources
Low
demands
Low or no
stress
Moderate
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
High
Control
Low
STRAIN
Low
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
Illness
Preexisting
physiological
or psychological
vulnerability
Physiological
& psychological
wear and tear
Illness
precursors,
symptoms
Exposure
to stress
Behavioural
changes &
Coping efforts
Illness
behaviour
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.
Tried to see the positive side of it.
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.
1.
2.
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 problemfocused 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)
In uncertain times, I usually expect the best.
If something can go wrong for me it will.
I always look on the bright side.
I’m always optimistic about my future.
I hardly ever expect things to go my way.
Things never work out the way I want them to.
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.
1
2
3
4
5
6
7
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
Social– people
Support
 of
Temperament
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 (3point response format).
 Sample subdivided into four groups: noncaregivers; 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 Caregivers
Results
 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 nonstrained 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 1999
Funded 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
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
Previous MI
95% CI
p
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.