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Transcript of 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
0
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 ResponseIncrease 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
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 in CAMIAT
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.