Kardinia International College

1. Kardinia International College Unit 4 Psychology Final Review Series AOS 2: Applications of a Biopsychosocial framework 1. STRESS

2. Use of a Biopsychosocial Framework:To Considering Physical & Mental Health • The Biopsychosocial model (BPS) is based on the idea that illness does not have a single cause but is based on the close interaction between biological, psychological and social factors affecting both physical and mental health and wellbeing in positive and negative ways. • According to the Biopsychosocial model, diagnosis and treatment of illness not only focuses on the body but the whole person in his or her social context, and takes into account family and social support networks. • The Biopsychosocial clinician’s task is to develop a broader understanding of disease processes by assessing the interrelationships of multiple systems and working with the patient to choose appropriate interventions, knowing that all systems will then be further affected.

3. BPS: An overview

4. Applications of a Biopsychosocial Framework: Application 1. Understanding the Relationship between Stress and Physical & Mental Wellbeing: Key Definitions: • Stress: A change in the immediate environment which directly affects an organism requiring the organism to respond. • Stressor: A change in the immediate environment which directly affects an organism. • Stress Response: The organism responding to a change that directly affects it within the immediate environment which Characteristics of a Stressor: • Nature of the stressor: • Physical: e.g. lack of sleep or pollution • Psychological: e.g. anxiety,

6. Physiological and Psychological characteristics of responses to stress: Part A: Fight-flight response • A stressor is identified (alarm) and triggers the central command neurons to release noradrenaline and adrenaline by the higher brain regions (cortex & amygdala). • Specifically, neurons within the hypothalamus and brain stem are activated • Sympathetic-adrenal medullary system (SA) and hypothalamic-pituitary adrenal system (HPA Axis) are activated • SA system is responsible for noradrenaline (neurotransmitter that mediates physiological symptoms of fear and anxiety) • Sympathetic nerves activate the adrenal glands (which sit on top of each kidney) to release adrenaline (Adrenaline stimulates responses to stress). • Adrenaline and noradrenaline prime the body to ‘fight’ or flee (flight) the stressor.

7. HPA Axis (hypothalamus and brain stem) signals the pituitary gland to release amongst others 2 key hormones ACTH (adrenocorticotrophic hormone): travels through the blood stream and in the adrenal cortex triggers activation of other hormones – primarily cortisol. Cortisol: increases production of glucose, promotes the effects o noradrenaline & adrenaline and reduces inflammation & suppresses the immune system.

8. Fight and Flight Basics – Sympathetic NS

9. Positive and Negative StressDifferent types of stress: Eustress vs Distress – Selye: Not all stress is bad Eustress – Positive stress e.g. Excitement at first flying lesson. Distress – Negative stress e.g. Anxious before flying in a single engine plane • Which one we experience in a given situation depends on the individual what to one may be Eustress to another may be Distress • How would you feel in this situation?

10. Different Quantities of stress • Hyperstress – too much stress, negative outcomes • Hypostress - too little stress, become bored thus also leads to negative results • To perform at our best we need more Eustress than Distress and a balance between Hyper and Hypostress.

11. Summary of Selye’s General Adaptation Syndrome Selyeproposed that dealing with stress requires physiological responses (Sympathetic NS arousal) • Selyeproposed that the sequence of physiological responses to stress, which occur in an organism follow a consistent pattern – alarm reaction, resistance, exhaustion

12. Alarm reaction • Person first becomes aware of stress • Short period of shock (ability to deal with stressor falls below normal level), followed by countershock (sympathetic NS aroused)

13. Resistance • Bodies resistance to stress rises above normal, intense arousal of countershock subsides • Organisms ability to deal with stress is above normal • Hormones (cortisol) released into blood helping to repair body damage, however these hormones suppress immune system function.

14. Exhaustion -If stress not dealt with during resistance phase person enters phase of exhaustion • Person becomes vulnerable to physical and psychological illness • High levels of hormones released during resistance can damage body • Bodies resources have been all used up, defenses are now down

15. Strengths and Limitations of G.A.S.

16. Psychological determinants of the stress response • – Richard Lazarus and Susan Folkman’s Transactional Model of Stress and Coping • Stress is explained as a result of how a stressor is appraised and how a person evaluates his or her resources to cope with the stressor. • Primary Appraisal: Where an individual decides if a situation is possibly stressful, beneficial or irrelevant. • Secondary Appraisal: Where an individual takes into account the resources available to them – personal, environmental, social and cultural – and their own coping strategies to decide what way is best to cope with or address the stressor.

18. Transactional Model of Stress The individual then enacts a coping strategy or effort, which results in an outcome. This outcome is then reappraised by the individual to determine its success or otherwise, and the coping strategy is suitable modified. By improving coping skills or reappraising the stressor into a more positive light, the model makes it possible to avoid the negative stress response and the person can better cope with the challenge.

19. Types of Coping Strategies: • Problem-focussed coping: seeks to address the practical effects of the stressor and is aimed at reducing the effect of the stressor or adapting to its impact. • Emotion-focussed coping: seeks to primarily address the emotion elicited by the stressor. Denial or other psychological defence mechanisms, avoidance, use of drugs etc are used to cover anxiety symptoms in an attempt to reduce the emotional response – but none of these address the actual stressor. • Problem-focussed coping is only viable when solutions are available to the individual. In this situation emotion-focussed coping is often best.

20. Transactional Model of Stress & Coping Strengths: • Emphasis on the importance of cognitive appraisal of the stressor by an individual. • Factors in previous learning and experience on how a stressor is appraised by an individual. • The model explains how intervention can promote coping and adaptation to stressful environments (by perceiving stressors as challenges rather than threats, bolstering other supports). • 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 • It emphasizes the ‘active’ role individuals have in the stress process as opposed to the ‘passive’ one they play according to physiological models, e.g. GAS; • It emphasizes the personal and individual nature of cognitive appraisal and this helps explain why different individuals respond in different ways to the same types of stressors; • The inclusion of ‘coping’ methods has enhanced understanding of the importance of stress-management strategies.

21. Transactional Model of Stress & Coping Limitations: • The model has been developed as a linear model, with one step leading to another resulting in emotions and thoughts. However… • Pre-existing factors such as depression or anxiety have profound influences upon the appraisal of the stressor and subsequent emotions and thoughts. • The model is difficult to test through experimental research because of the subjective nature, variability and complexity of individual responses to stressful experiences; • primary and secondary appraisals can interact with one another and are often undertaken simultaneously not sequentially as the model suggests; • it is questionable whether we really need to cognitively and consciously ‘appraise’ something in order to have a stress response.

22. Factors that Exacerbate and Alleviate the Stress Response Social Factors • 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. • Social Capital: the amount of social exchange, solidarity, senses of community, that exists within a social group. • Social Deprivation: When someone is at a lower socio-economic level than others and believe they are being deprived in some way.

23. Cultural Factors Acculturation: Where one culture interacts with another

24. Accultural Stress: the stress associated with acculturation The role of expatriate or migrant support networks • Access to support networks where migrants cultural traditions and language are maintained suffer less stress-related health risks than compatriots without access. Acculturation to reduce stress: • 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 • Embracing a dominant culture through choice or not eliminates alienation and the feeling of being disconnected from society – thus reducing stress. Acculturation that increases 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.

25. Environmental Factors: Socio-environmental factors include: • Age: Stress reduces with age • Gender: Society dictates trends, but females generally experience more stress, but less trauma than males • Marital status: Married couples experience less stressful life events or chronic stress. • Race/ethnicity: Stress is higher for minority ethnic or racial groups where discrimination is present. • Employment: Employment is highly protective against mental illness and distress. Unemployment is linked with the following: • Financial hardship • Loss of role and status • Boredom and social isolation • Negative effects associated with marital and family conflict • Socio-economic level: High socio-economic status is protective against adverse life stressors – the reverse is also unfortunately true.

26. 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

27. Allostasis: The process of maintaining stability through change in the face of stressors. • Allostatic Response: The ongoing adaptive efforts of the body to deal with various challenges (or stressors) to our daily lives to fulfil our general biological functions. • Allostatic load: The cumulative wear and tear that the body experiences due to repeated cycles of Allostasis • Allostatic Overload: Where the stressor exceeds the capacity of the organism to adapt and therefore the organism must change its usual biological functions to survive. • Heterostasis: the overwhelming of the organism

28. Allostatic overload and Heterostasis are similar to the stages of resistance and exhaustion in the general adaptation syndrome. The distinction is that in Allostasis, the organism is adapting to the presence of a new stressor, whereas in the GAS it is attempting to maintain homeostasis. • Allostatic Overload (TYPE 1): Where the energy expenditure is greater than energy intake and the organism behaves in a manner to reduce the overload to facilitate balance or even surplus energy. • AllostaticOvderload (TYPE 2): Energy intake is in surplus to demand, but where social / environmental circumstances mean that a stress response is maintained because the stressor chronically persists and cannot be escaped. E.g. a relationship break-up, unemployment, poverty.

29. Allostatic overload occurs in four situations: • Frequent recurrent stressors • Failure of the organism to adapt or change in the face of the stressor • Failure of the body to swith off an allostatic response – even when the stressor has passed or reduced • One allostatic system response, e.g HPA axis, is inadequate and other systems, e,g, SA system becomes overactive to compensate.

30. Strategies for Coping with Stress • Biofeedback • Meditation/relaxation • Physical Exercise • Social support

31. Biofeedback:A mechanism by which physiological processes are brought to the attention of the individual through the use of sensors and other electrical instruments. • Electromyographic(EMG) Biofeedback: Measuring the amount of muscle tension present in a particular muscle group through a skin electrode. • Once a person knows when muscles associated with tension-related pain (e.g. muscles in the jaws, shoulders and scalp) are contracting they can identify what emotions or thoughts cause it. They can then either avoid the situations where this occurs or use muscle relaxation / cognitive strategies to relax the muscles. • Temperature Biofeedback: Activation of the SA system results in blood vessels constricting close to skin – to send blood to essential organs during times of stress. This reduces skin temperature. • Therefore reduction in skin temperature is linked with stress and a person can become aware of this trend and then identify the triggers to the response. Cognitive and relaxation strategies are then applied to reduce the level of the stress.

32. Biofeedback Uses: • 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 Criticism: • 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

33. Meditation: • A collection of different strategies that aim to direct a person’s focus away from current everyday concerns. • Concentration method: where the person focuses on a single thought or function, such as breathing, and dismisses all other thoughts, ideas, emotions or distractions. • Non-concentration meditation: where the person focuses on their current thought or emotion not directly, but observes it as if they were in someone else’s shoes. • Relaxation: The most commonly recognised way of dealing with chronic stress. • Advantages – Once learnt relaxation techniques can be used at any time, even in anticipation of a stress response. This give the individual a sense of control over themselves and their environment. • Progressive Relaxation: where the person sits comfortable in a space free from distraction and tightens and relaxes each muscle group. • Hypnosis: Where a therapist induces a state of relaxation through suggestion.

34. Physical Exercise: • Has been shown to reduce anxiety, tension, anger and reduced mood, even after a single session. Regular exercise leads to reduced anger, fatigue, sadness. • Anaerobic Exercise: Brief intense bursts of physical activity that do not utilise oxygen • Aerobic Exercise: Physical exertion that leads to a sustained increase in heart rate and output, and increased breathing rate and volume to increase blood flow and oxygenation to the muscles involved in the given activity.

35. Physical Exercise: • Why exercise helps: • Increases self-confidence through completion of physical challenges • Leads to a sense of mastery and reduces negative thoughts • Creates a meditative state while performing it • Works as a form of biofeedback with people concentrating on heart rate and breathing rates • Promotes positive social engagement and reinforcement (perceptions of body image). • Reduces stress by decreasing cortisol, noradrenaline and adrenaline levels & increases endorphins.

36. Social Support: • 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 • 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 • 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.