Chapter 12: Stress and Health

Chapter 12: Stress and Health Unit 4 – AOS 2 Mental Health Pages 582-629

Study Design Content • application of a biopsychosocial framework to understanding the relationship between stress and physical and mental wellbeing: – physiological and psychological characteristics of responses to stress including fight-flight response, eustress and distress; strengths and limitations of Selyes’ General Adaptation Syndrome – psychological determinants of the stress response; strengths and limitations of Richard Lazarus and Susan Folkman’s Transactional Model of Stress and Coping – social, cultural and environmental factors that exacerbate and alleviate the stress response – allostasis (stability through change brought about by the brain’s regulation of the body’s response to stress) as a model that integrates biological, psychological and social factors that explain an individual’s response to stress – strategies for coping

Stress and Health • A stressor is any person, situation or event that produces stress; virtually anything can be considered a stressor and can therefore cause stress to an individual • Stressors can be organised in different ways • They can be described as a physical stimulus (extreme heat, loud noises etc.) • They can be described as a psychological stimulus (changing schools or jobs, having an argument with a friend etc) • A stressor can also be describes having an internal or external sources • An internal stressor originates form inside the individual • An external stressor originates from outside of the individual from situations and events in the environment • Stress is a state of physiological and psychological arousal produced by internal or external stressors that are perceived by the individual as being challenging or exceeding their ability to cope

Stress and Health

Physiological and Psychological Responses to Stress Stress can affect people in different ways and a stress response, or reaction, involves the physiological (bodily) and psychological (mental) changes that people experience when confronted by a stressor Any stress response is often classified in one of three categories A mild stress response can be stimulating or motivating, this elevated level of arousal can often enhance performance in both simple and complex tasks However an acute stress response, which produces a very high arousal level very suddenly, or a chronic stress response, which produces a high level of arousal over a long period of time can result in various physiological and psychological responses

Physiological Response to Stress • Two of the most widely used models for describing the physiological responses to stress are: • The fight-flight response and • The General Adaptation Syndrome (GAS)

Fight-Flight Response • Without our awareness or conscious control, our body responds to a perceived threat by automatically activating the ‘fight or flight’ response. • The ‘fight or flight’ response is a reaction that occurs automatically, resulting in a state of physiological arousal that prepares the body to deal with sudden threats by either: • Confronting them (fight) • Running away to safety (flight)

Fight-Flight Response • Cannon (1932) found that the fight-flight response involves both the sympathetic nervous system and the endocrine (hormone) system of the body • More recent research has clarified what happens in the brain and body during the fight-flight response, as well as when we face chronic stressors • When a threat is perceived, the hypothalamus is activated – this lower brain structure stimulates the pituitary gland which secretes a hormone (adrenocorticotropic hormone [ACTH]) which travels through the bloodstream to stimulate the adrenal glands • This chain of reactions is known as the HPA Axis – the Hypothalamus, Pituitary gland, Adrenal gland axis.

Fight-Flight Response When the adrenal glands are stimulated, they secret stress hormones namely adrenaline (or epinephrine) and noradrenaline (or norepinephrine) These hormones boost the activity of the sympathetic nervous system The adrenal glands also release cortisol, a hormone that increase metabolism and the concentration of glucose in the blood which makes fuel available to muscles

Fight-Flight Response The fight-flight response is viewed as adaptive in that it can help us ensure our survival when faced with a sudden life-threatening situation When exposure to this threat is unavoidably prolonged however, the response will also be prolonged – Cannon (1932) believed this prolonged response could be detrimental to health Learning Activity 12.1 – Review questions, pg. 588

General Adaptation Syndrome • In the 1930’s, Austrian endocrinologist Hans Selye investigated stress. • Selye used rats and exposed them to a number of stressors including tail pulling, electric shocks, extreme temperature and food deprivation. • He found that to most stressors, the same effects were apparent, which included enlarged adrenal glands, stomach ulcers, weight loss and a decreased immune system.

General Adaptation Syndrome • Selye concluded that stress is a condition that is nonspecific, and which can be brought on by either internal or external stressors. • On the basis of his observations Selye proposed that the sequence of responses that occurs in an organism follows a consistent pattern which he called the General Adaptation Syndrome (GAS). • The GAS consists of three stages – an alarm reaction, a stage of resistance and a stage of exhaustion.

Alarm Reaction • Alarm Reaction is the first stage of GAS: • When the person first becomes aware of the stressor. • The body goes into a temporary state of shock and its ability to deal with the stressor falls below its normal level. • Physiologically the body reacts as if it was injured (a drop in blood pressure and body temperature).

Alarm Reaction • The body then rebounds from this drop with a reaction called a ‘counter-shock’. • During counter-shock, the sympathetic nervous system is activated and the body’s resistance to the stressor increases. • Similar to a ‘fight or flight’ reaction, adrenalin is released and body systems increase. • The alarm reaction stage always results in a state of tension, alertness and readiness to respond to the stressor.

Resistance • According to Selye, if the source of the stress is not dealt with immediately, and the state of stress continues, the organism goes into a stage of resistance. • During the stage of resistance, the body’s resistance to the particular stressor rises above normal. • The intense arousal of the alarm reaction diminishes, but the physiological arousal remains at a level above normal.

Resistance • Hormones such as cortisol are released into the bloodstream (cortisol helps repair damage caused to the body). • Cortisol however interferes with the body’s ability to ward off disease and protect itself from further damage. • Therefore the body is able to build a resistance to the initial stressor, but its resistance to other stressors decreases.

Resistance • During VCE exams, students tend to cope with decreased sleep, exercise and nutrition. However as a result they may become ill towards the end of their exams. • Generally, if the effort to deal with the initial stressor is successful, the organism will eventually return to a normal state.

Exhaustion • According to Selye, if the stressor is not dealt with successfully during the resistance stage, and stress continues, the organism enters a stage of exhaustion. • Because the organism has been dealing with the stressor for some time, its resources have been depleted, its resistance to disease is very weak, and it becomes vulnerable to physical and psychological illnesses.

Exhaustion • The stage of exhaustion is characterised by extreme fatigue, anxiety, depression, nightmares and impaired sexual performance. • Illness and disease such as hypertension and peptic ulcers may also occur. • In extreme cases, if the stress continues, the organism may even die.

General Adaptation Syndrome

Strengths and Limitations of Selye’s GAS Selye’s ideas further developed those of Cannon and developed awareness of the link between stress and disease The GAS model also identifies some of the physiological mechanisms associated with the stress response – for example the role of the endocrine system in responses to stress A limitation of this model is that it is a ’one-size fits all’ approach – assuming that everyone has the same general response to any kind of stressor The GAS therefore does not fully take account of or explain individual differences in physiological responses to a stressor The GAS also does not take into account cognitive processes in dealing with stress – it tends to ignore psychological responses to stress, it is also criticised for basing much of its findings on research with animals

Eustress and Distress Stress is often thought of as being negative however Selye (1974) proposed that not all stress is negative and some stress can actually be positive Eustress is a positive psychological response to a stressor, as indicated by the presence of positive psychological states such as euphoria, enthusiasm or alertness Distress is a negative psychological response to a stressor as indicated by negative psychological states such as anger, anxiety or tension Whether a stressor is positive or negative is subjective – that is it depends on the individuals perception of that stressor and its effect on them Learning Activity 12.4 – Review questions, pg. 594

Psychological Responses to Stress • The psychological effects of prolonged stress are influenced by prior experience and are therefore said to be learned. • Psychological effects tend to depend on our personal interpretations of the stressor and also on our ability to deal with the resulting stress. • Psychological effects of stress can be classified into three main categories – behavioural, emotional and cognitive.

Behavioural Effects of Stress • Behavioural changes or effects of stress can be visible in the form of how a person looks, acts or talks. • Mild behavioural effects include: • Strained facial expressions • A shaky voice • Hand tremors • Muscle spasms • Jumpiness

Behavioural Effects of Stress • Significant behavioural responses to stress include: • Reduction in eating patterns • Sleeping problems • Aggression • Withdrawal • Some people as a way of escaping the behavioural effects of stress may turn to drugs such as alcohol, which in turn affect behaviour.

Emotional Responses to Stress • Some emotional responses to stress include: • Constant anxiety • Tension • Depression • Anger and irritability • A sense of hopelessness and helplessness • Negative self esteem

Cognitive Responses to Stress • Cognitive functions can also be adversely affected as a result of intense or prolonged arousal. • These include: • Difficulty in concentrating • Difficulty in maintaining focus • Forgetfulness • Indecision • Difficulty in thinking • Learning Activity – Review questions, pg. 596

Lazarus and Folkman’s Transactional Model of Stress and Coping The Lazarus and Folkmantransactional model of stress and coping proposes that stress involves an encounter (transaction) between an individual and their external environment, and that a stress response depends upon the individual’s interpretation (appraisal) of the stressor and their ability to cope with it According to Lazarus and Folkman (1984), stress is not a result of the individual alone or the environment alone – the environment can influence the individual but the individual can also influence the environment

Transactional Model of Stress and Coping

Transactional Model of Stress and Coping • The transactional model of stress and coping distinguishes between two different types of appraisal of a situation • In a primary appraisal we evaluate or judge the significance of a situation • The outcome of this appraisal is to decide whether the situation is irrelevant, benign-positive or stressful • If we decide the event is stressful then we engage in additional appraisals (harm/loss, threat, challenge) • In a secondary appraisal we evaluate our coping options and resources and our options for dealing with the stressful situation • The coping options and resources may be internal (strength and determination) or external (money or support from friends)

Transactional Model of Stress and Coping We may also engage in a reappraisal of a previous stressful situation – in a reappraisal we determine the extent in which additional resources are needed to cope with the situational Because we cant escape a stress response, we need to learn how to effectively cope with it – according to Lazarus and Folkman (1984) coping is the process of ‘constantly changing cognitive and behavioural efforts to manage specific internal and/or external stressors that are appraised as taxing or exceeding the resources of a person’

Transactional Model of Stress and Coping • Problem-focused coping involves efforts to manage or change the cause or source of the problem; that is, the stressor • This may include • Reappraising the stressor • Obtaining more information about the stressor • Redefining the stressor in a way that is more managable • Emotional-focused coping involves strategies to attend to our emotional responses to the stressor • This may include • Denial • Distancing • Avoiding

Transactional Model of Stress and Coping

Strengths and Limitations of the Model Unlike the fight-flight and GAS models which focus on involuntary physiological responses to stressors, the transactional model focuses on psychological determinants of the stress response over which we have control and emphasises the personal nature and individuality of the stress response By including a reappraisal process, the model also allows for the fact that stressors and circumstances can change over time – this can lead us to change our thinking about a stressor The major limitation of the transactional model is that it is difficult to test through experimental research due to the subjective nature, variability and complexity of individual responses to stressful experiences’ Learning Activity 12.8 – Review questions, pg. 601

Social, Cultural and Environmental Factors that Influence the Stress Response Social factors which can influence the stress response include our relationships and social reactions with others Social readjustment refers to the amount of change or ‘adjustment’ in lifestyle a person is forced to make following a specific event in their life This was identified by Holmes and Rahe (1967) who created a social readjustment scale based on how much influence certain life events would have on individuals and stress (pg. 603)

Social, Cultural and Environmental Factors that Influence the Stress Response For immigrants, refugees and asylum seekers, coming to Australia and other countries, departure can be a means of escaping poverty, famine etc and can aid with reducing stress A change of culture can be a means of increasing stress however – difficulties with adjusting to a new culture can be a big factor in stress and stress related disease

Social, Cultural and Environmental Factors that Influence the Stress Response Environmental factors that can influence the stress response can include overcrowding, pollution, loud noise or air temperature to name a few Crowding can be a big factor in stress – it is a subjective experience and can be associated with feeling stressed or anxious, fearful, unhappy, frustrated etc. Calhoun (1962) conducted research into crowding and stress by using mice (pg. 606) Learning Activity 12.10 – Review questions, pg. 611

Allostasis The biopsychosocial framework does not explain how factors from each domain come together and combine when exposed to a stressor – more recently theorists have used a construct known as allostasis to explain this Allostasis refers to the body’s ability to maintain a stable physiological environment by adjusting and changing to meet internal and external demands – allostasis therefore helps the body achieve stability by changing, the costs associated with this can have permanent damaging effects on the body Allostasis is different from homeostasis which is the body’s ability to maintain a stable physiological environment by keeping certain bodily conditions constant In contrast to homeostasis, allostasis emphasises that healthy functioning requires continual physiological fluctuations and adjustments – that is, in responding and adapting to internal and external demands, normally functioning physiological systems should exhibit fluctuating levels of activity

Allostasis According to Sterling and Eyer (1988), allostasis is achieved through the brain’s regulation of the activities of our allostatic systems – these systems include the HPA axis, the autonomic nervous system, and the immune and cardiovascular systems All of these systems act to protect the body by responding to internal and external stimuli When an individual perceives a situation as stressful and experiences a stress response, their brain activates, or ‘turns on’ their body’s allostatic response

Allostatic Load When the systems involved in allostasis are not ‘turned off’ after a stress-producing experience, or when they are overused, there is exposure to stress hormones – cumulative exposure to increased secretion of the stress hormones can lead to wear and tear on the brain and body known as allostatic load Increased allostatic load occurs with increased frequency of exposure to stressors, increased intensity of the stressors or decreased efficiency in controlling the allostatic responses Box 12.6 – Types of allostatic load, pg. 615 Learning Activity 12.11 – Review questions, pg. 616

Strategies for Coping with Stress Given the adverse effects stress can have on our physical and mental health, various types of strategies have been devised by health professionals to help cope with stress These include biofeedback, meditation or relaxation, physical exercise and social support

Biofeedback Physiological responses to stressors involve the coordinated interaction of numerous bodily processes which usually occur automatically (i.e. the fight-flight response) We are able to have some control over some responses (breathing rate for example) but other responses cannot be controlled as readily (hormone secretion or pupil dilation) With training we can learn to consciously control some of these automatically occurring processes, thereby minimising their potentially adverse effects Biofeedback is a technique that enables an individual to receive information (feedback) about the state of a bodily process, and with appropriate training, learn to control a related physiological response using thought processes

Biofeedback During biofeedback training, electrical or mechanical sensors are attached to the person These sensors respond to a particular physiological response such as muscle tension – these signals are amplified and displayed in a visual or auditory form to provide the individual with the relevant information The person is then taught a series of physical and mental exercises to help them learn how to gain control over the physiological response been measured

Biofeedback Biofeedback can be useful in helping people learn how to recognise and control specific physiological responses to stressors in their lives – it is often used to relieve stress induced problems related to blood flow such as headaches or hypertension A common criticism of biofeedback is that although it can be successful in a clinical or lab setting, its effects don’t always last outside of the setting where the person learnt the biofeedback

Meditation and Relaxation When used for stress management, meditation is an intentional attempt to bring about a deeply relaxed state in order to reduce one or more effects of stress-related symptoms Relaxation is any activity that brings about a state of reduced psychological/physiological tension – this could include reading a book, watching TV etc. When in a relaxed or meditative state, people typically report feeling less anxious, feeling calm, and lower physiological responses such as lower heart rate and reduced muscle tension

Meditation and Relaxation One common form of relaxation training is called progressive muscle relaxation where a person is taught to identify individual muscle groups, tense them, release the tension, and ultimately relax the whole body

Physical Exercise Physical exercise is physical activity that is usually planned and performed to improve or maintain ones physical condition There is worldwide acceptance among mental health professionals that physical exercise improve not only our physical wellbeing but our psychological wellbeing also Exercise can help reduce stress by reducing stress hormones in the blood, working out muscular tension, improving the efficiency of the cardiovascular system and increases strength, flexibility and stamina People also experience psychological benefits such as the release of endorphins into the brain which are chemicals producing a sense of relaxation and well-being Exercise can also remove the person from the stressor or stress producing situation Learning Activity 12.13 – Review questions, pg. 622

Social Support Social support is help or assistance from other people when needed The people who provide social support can vary and include anyone with whom we may have a relatively stable or ongoing interpersonal relationship According to Suls and Wallston (2003), social support can take four main forms; appraisal support, tangible support, information support and emotional support

Social Support Appraisal support is help from another person that improves the individual’s understanding of the stressful event and the resources and coping strategies that may be needed to deal with it Tangible support involves the provision of material support, such as services, financial assistance or goods, that may help offset the effects of a stressful event

Social Support Information appraisal about how to cope with a stressful event Emotional appraisal which targets these emotional reactions by reassuring a person under stress that they are an individual who is cared for and valued Learning Activity 12.14 – Review questions, pg. 624

Chapter 12: Stress and Health