Lecture 2 Stress and Its Management

1. Lecture 2Stress and Its Management Dr. Antoinette Lee The University of Hong Kong

2. Lecture Outline • What is Stress? • Sources of Stress • Models/Theories of Stress • Stress Response • Assessing Stress • Adverse Effects of Stress • On psychological Functioning • On physical health • Moderators of the Stress-Illness Relationship • Coping • Stress Management Master of Behavioral Health Health Psychology Module, Spring 2005

3. Stress “Stress” may mean different things: 1. Stressor 2. Stress Master of Behavioral Health Health Psychology Module, Spring 2005

4. I. Stress: What Are We Referring To? • Stressors: • external environmental events that cause a person to feel stressful Master of Behavioral Health Health Psychology Module, Spring 2005

5. Stress • Stress: • Response to the stressor (physiological, psychological, and behavioral changes) • Person-environment fit : role of appraisal Master of Behavioral Health Health Psychology Module, Spring 2005

6. Definition of Stress • “Stress is a negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects” (Baum, 1990) • Consequence of a person’s appraisal processes • the assessment of whether personal resources are sufficient to meet the demands of the environment”. • Stress is determined by the person-environment fit: the Transactional Model of Stress (Lazarus & Folkman, 1984) Master of Behavioral Health Health Psychology Module, Spring 2005

7. II. Sources of Stress 1.) Life events/changes (Holmes & Rahe, 1967) • any noticeable alterations in one’s living circumstances that require readjustment • changes, both positive and negative, can be stressful • Social Readjustment Rating Scale (SRRS): 43 major life events • Events which force people to make greater changes in their lives cause more stressful • Modest prediction of both onset of acute illness and exacerbation of chronic illness Master of Behavioral Health Health Psychology Module, Spring 2005

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9. Sources of Stress 2.) Daily hassles(Lazarus et al., 1981) • minor everyday hassles / irritants can also be very stressful • cumulative effect • examples: • noise • misplacing or losing things • troublesome neighbours Master of Behavioral Health Health Psychology Module, Spring 2005

10. Sources of Stress • social obligations • traffic jam • concerns about owing money • hassles related to psychological symptoms especially depression and anxiety • hassles versus uplifts Master of Behavioral Health Health Psychology Module, Spring 2005

11. Sources of Stress • 5 most commonly reported hassles • concern about weight, health of family member, rising price of common good, home maintenance, too many things to do • 5 most commonly reported uplifts • relating well with spouse or lover, relating well with friends, completing a task, feeling health, getting enough sleep Master of Behavioral Health Health Psychology Module, Spring 2005

12. Survey on Common Hassles of University Students Graduating in 1996 • In decreasing order of intensity (frequency X severity): • Too many things to do • Not getting enough rest • Academic workload too heavy • Not getting enough sleep • Troubling thoughts about the future • Too many responsibilities • Concern about future career prospects • Concern about future career decision • Meeting deadlines • Feeling down Master of Behavioral Health Health Psychology Module, Spring 2005

13. Sources of Stress 3.) Frustration • occurs when the pursuit of some goal is hindered • e.g. traffic jams, failures, losses Master of Behavioral Health Health Psychology Module, Spring 2005

14. Sources of Stress 4.) Conflict • should I or shouldn’t I • conflict occurs when 2 or more incompatible motivations or behavioral impulses compete • King and Emmons (1990): related to anxiety, depression ,and physical symptoms Master of Behavioral Health Health Psychology Module, Spring 2005

15. Sources of Stress • Types of conflict: • (1) approach-approach • less stressful • (2) avoidance-avoidance • most unpleasant and stressful • (3) approach-avoidance • vacillation Master of Behavioral Health Health Psychology Module, Spring 2005

16. Sources of Stress 5.) Pressure • expectations or demands that one behave in a certain way • Expectations from self • Expectations from others • Weiten, 1988: strong relationship found between level of pressure and psychological symptoms; level of pressure was even more strongly related to mental health than SRRS Master of Behavioral Health Health Psychology Module, Spring 2005

17. Sources of Stress 6.) Poverty and powerlessness • those who are at the lower end of the socioeconomic ladder have worse health • many stressors: high crime rates, poor housing, less recreation 7.) Environmental stressors • e.g. noise, crowding, natural disasters, air pollution Master of Behavioral Health Health Psychology Module, Spring 2005

18. What Makes Events Stressful? • Characteristics of potential stressors that make them more likely to be appraised as stressful • 1.) Negative events • 2.) Unpredictability and uncontrollability • 3.) Ambiguity • 4.) Salient events • 5.) Overload Master of Behavioral Health Health Psychology Module, Spring 2005

19. III. Models/Theories of Stress 1.) Cannon (1932) • stress as physiological responses to stressors • Physiological arousal via the sympathetic division of the autonomic nervous system • e.g. increased heart beat, blood pressure, perspiration, respiration rate • fight-or-flight response • Supposed to be adaptive and protective, evolutionary value • But what about in face of modern day stresses? Master of Behavioral Health Health Psychology Module, Spring 2005

20. Models / Theories of Stress 2.) Selye (1956) • General Adaptation Syndrome (GAS) • Nonspecific; responses are the same across different stressors • Physiological pattern of reaction • Lays the foundation for understanding the stress-disease link • 3 stages Master of Behavioral Health Health Psychology Module, Spring 2005

21. General Adaptation Syndrome • Alarm Stage: initial physiological responses to stressors; the fight-or-flight response • Resistance stage: attempts to cope with the threats and restore equilibrium; ability to resist new stressors impaired • Exhaustion stage: depletion of resources as the individual fails to overcome the threat; symptoms and health problems occur - “diseases of adaptation” Master of Behavioral Health Health Psychology Module, Spring 2005

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23. Models/ Theories of Stress 3.) Tend-and-Befriend (Taylor et al. 2000) • affiliative response to stress • In addition to fight or flight • Embracing, finding support from family and friends, community cohesion in response to natural disasters……. • Normal sympathetic arousal associated with the fight-or-flight response downregulated in females, leading to social and nurturant behaviors Master of Behavioral Health Health Psychology Module, Spring 2005

24. Models/ Theories of Stress • Especially characteristic of females • Males and females faced different adaptive challenges during the evolvement of responses to stress • Female responses to stress evolved to protect not only the self but also offspring • Affiliating with others enhances female’s self-preservation and off-spring protection ability • Biological basis: oxytocin Master of Behavioral Health Health Psychology Module, Spring 2005

25. Models / Theories of Stress 4.) Transactional Model of Stress (Lazarus, 1968) • complex physiological and psychological reactions • “stress as a transaction between people and environment” (Lazarus and Launier, 1978) • Cognitive appraisal • consequence of a person’s appraisal (assessment) of whether personal resources are sufficient to meet the demands of the environment Master of Behavioral Health Health Psychology Module, Spring 2005

26. Transactional Model of Stress Primary appraisal: • To determine the meaning of the event • positive, neutral / irrelavant, or negative • how harmful, threatening or challenging? • Harm: assessment of damage that has already been done by the stressor • Threat: assessment of possible future damage • Challenge: assessment of potential to overcome and even profit from the event Master of Behavioral Health Health Psychology Module, Spring 2005

27. Transactional Model of Stress Secondary appraisal: • Initiated at the same time as primary appraisal is occurring • assessing if one’s coping abilities and resources are sufficient to deal with the stressor • e.g. “I can’t do it”, “I’ll try but my chances of success are slim”, “If this method doesn’t work, I can try a few others”, “I can do it if I work hard”, “No problem, I’ll make it” Master of Behavioral Health Health Psychology Module, Spring 2005

28. Experience of Stress Primary Appraisal: Positive, neutral, or negative? If negative, harmful, threatening, or potentially challenging? Stress: Physiological, cognitive, emotional, and behavioral responses Primary Stressor Secondary Appraisal: Are coping abilities and resources sufficient to overcome the harm, threat, or challenge? Master of Behavioral Health Health Psychology Module, Spring 2005

29. Transactional Model of Stress Stress • subjective experience as a result of the balance between primary and secondary appraisal • physiological, emotional, cognitive and behavioral responses • Some are involuntary, some are intentional as conscious efforts to cope Master of Behavioral Health Health Psychology Module, Spring 2005

30. IV. Stress Response Master of Behavioral Health Health Psychology Module, Spring 2005

31. Stress Response A) Physiological Responses • through two systems: • Sympathetic adrenomedullary (SAM) system • Hypothalamus activates the sympathetic division of the autonomic nervous system; adrenal glands stimulated to release the hormone catecholamines • Fight-or-flight response: Increased heart rate, increased breathing, sweating, increased blood flow, pupils dilate, digestive processes slow down, increased muscle strength, increased mental activity etc Master of Behavioral Health Health Psychology Module, Spring 2005

32. Stress Response • Hypothalmic-pituitary-adrenocortical (HPA) system • Hypothalamus signals pituitary gland to secrete the hormone ACTH which in turn stimulate the adrenal cortex to secrete the hormone corticosteroids • release of more protein and fat, increase of energy, inhibit tissue inflammation in case of injury • Increased level of opioids beta endorphins and enkaphalin • Immune function • Psychiatric problems Master of Behavioral Health Health Psychology Module, Spring 2005

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34. Physiological Changes and Their Functions Master of Behavioral Health Health Psychology Module, Spring 2005

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36. Stress Response B) Emotional Responses • Lazarus (1993): stress tends to elicit unpleasant rather then pleasant emotions • Study of relationship between stress and mood among 96 women over a 28-day period • emotions commonly elicited: • anxiety and fear • sadness and grief • Anger, annoyance, rage • depression • guilt • shame Master of Behavioral Health Health Psychology Module, Spring 2005

37. Stress Response • Emotional arousal • mild emotional arousal is useful • strong emotional arousal can interfere with efforts to cope with stress • impairs attention, memory retrieval, judgment, and decision making • the inverted-U hypothesis (Anderson, 1990; Mandler, 1993) • relationship between emotional arousal and task performance • optimal level of arousal • depends on task complexity Master of Behavioral Health Health Psychology Module, Spring 2005

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39. Stress Response C) Behavioral Responses • Coping efforts • active efforts to master, reduce, or tolerate the demands created by stress • can be healthy (adaptive) or maladaptive • positive: e.g. improving yourself, seeking help from others • negative: e.g. striking out at others, giving up, social withdrawal, indulging oneself, substance abuse Master of Behavioral Health Health Psychology Module, Spring 2005

40. V. Assessing Stress 1.) Physiological measures • acute stress paradigm • Polygraph to measure and record heart rate, blood pressure, respiration rate, and GSR (galvanic skin response) • Biochemical analyses: • Blood, urine or saliva samples to measure levels and changes in levels of catecholamines and cortisol Master of Behavioral Health Health Psychology Module, Spring 2005

41. Polygraph Calm Tense

42. Assessing Stress 2.) Self-Report Measures a.) Life Events: The Social Readjustment Rating Scale • 43 major life events • Life events in the past year • Numerical value for each type of life event • SRRS total score: An index of the amount of change-related stress the person has recently experienced • people with higher SRRS scores tend to be more vulnerable to many kinds of physical and psychological problems Master of Behavioral Health Health Psychology Module, Spring 2005

43. SRRS • 150 to 199: 33% chance of illness • 200 to 299: 50% chance of illness • 300+: 80% chance of illness Master of Behavioral Health Health Psychology Module, Spring 2005

44. SRRS • criticisms: • some items are vague • subjective experience • context • personal values and priorities • whether the event has been resolved • measuring change or negative experience? Master of Behavioral Health Health Psychology Module, Spring 2005

45. Assessing Stress b.) Hassles Scale (Kanner, Coyne, Schaeffer, & Lazarus, 1981) • Measure of daily hassles • Circle the hassles that have happened to you in the past month, then indicate the severity of each hassle using a scale of 1 (somewhat severe), 2 (moderately severe), or 3 (extremely severe) • Samples of items: misplacing or losing things, troublesome neighbors, social obligations, health of a family member, inconsiderate smokers, concerns about owing money Master of Behavioral Health Health Psychology Module, Spring 2005

46. Assessing Stress c.) Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983) • Measure of level of subjectively perceived stress • E.g. • “In the last month, how often have you been upset because of something that happened unexpectedly” • “In the past month, how often have you felt nervous and stressed” • “In the past month, how often have you found that you could not cope with all the things that you had to do?” Master of Behavioral Health Health Psychology Module, Spring 2005

47. VI. Adverse Effects of Stress • On Psychological Functioning • On Physical Health Master of Behavioral Health Health Psychology Module, Spring 2005

48. Adverse Effects of Stress on Psychological Functioning 1.) Psychological Problems and Disorders • stress related to insomnia, nightmares, sexual difficulties, substance abuse, and unhappiness • anxiety disorders, depression, schizophrenia, eating disorders etc • Learned helplessness and depression • When repeated efforts to exert control over situations fail to achieve desired effects, learned helplessness occurs Master of Behavioral Health Health Psychology Module, Spring 2005

49. Adverse Effects of Stress on Psychological Functioning 2.) Cognitive Impairment and Impaired Task Performance • Cognitive costs: • Less cognitive resources to deal with other aspects of life • Difficulty concentrating • Distraction: focuses on body response and worries instead of problems that need to be solved • Memory problems • Impaired judgment • Impaired problem-solving ability Master of Behavioral Health Health Psychology Module, Spring 2005

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