Stress

1. Stress

2. Three Views of Stress • Focus on the environment: stress as a stimulus (stressors) • Reaction to stress: stress as a response (distress) • Relationship between person and the environment: stress as an interaction (coping)

3. Stressors • Some examples?

4. Stressors • War • Overcrowding • Deadlines • Dense traffic • Marital conflict • Work stress

5. 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)

6. Acute Stress

7. 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)

8. Acute Stress – Rozanski 1988 • Outcome – stress response • Myocardial ischemia determined by radionuclide ventriculography (measures wall motion abnormalities in the heart)

9. 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)

10. 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.

12. 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.

13. Chronic Stress – Frankenhauser, 1989 Catecholamine Response Time of Day

14. Three Views of Stress • Focus on the environment: stress as a stimulus (stressors) • Reaction to stress: stress as a response (distress) • Relationship between person and the environment: stress as an interaction (coping)

15. 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 Fight or Flight Response

16. Selye’s General Adaptation Syndrome (1956, 1976, 1985) • Resistance • Arousal high • as body tries • defend and • adapt. • Exhaustion • Limited • physical • resources; • resistance • to disease • collapses; • death • Alarm • Reaction • Fight or • flight Perceived Stressor If stress continues ….

17. 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.

18. 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

19. Cognitive Model of StressLazarus & Folkman • Secondary appraisal – • Do I have the resources to deal effectively with this challenge or stressor?

20. Cognitive Model of StressLazarus & Folkman

21. Personal Factors Affecting Stress Appraisal • Intellectual • Motivational • Personality • Beliefs

22. 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

23. 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).

24. Job Strain – Karasek et al., 1981

25. Job Stress – other aspects • Physical environment • Poor interpersonal relationships • Perceived inadequate recognition or advancement • Unemployment (even anticipated) • Role conflict • High responsibility for others

26. Biopsychosocial Aspect of Stress • How stress affects health • Via behaviour • Via physiology

27. Behavioural Aspects • Increased alcohol • Smoking • Increased caffeine • Poor diet • Inattention leading to carelessness

28. Physiological Aspects • Cardiovascular reactivity – increased blood pressure, platelets, lipids (cholesterol) • Endocrine reactivity – increased catecholamines and corticosteroids • Immune reactivity – increased hormones impairs immune function

29. 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

30. Stress-Illness Relationship Illness Preexisting physiological or psychological vulnerability Physiological & psychological wear and tear Illness precursors, symptoms Behavioural changes & Coping efforts Exposure to stress Illness behaviour

31. Moderators of the Stress Experience

32. 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.

33. 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.

34. 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.

35. 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. • Prayed for guidance or strength. • Sometimes took it out on others when I felt angry and depressed. • Got busy with other things to keep my mind off the problem. • Read relevant material for solutions and considered several alternatives. • Took some action to improve the situation.

36. 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.

37. 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.

38. Cognitive Re-structuring • Process by which stress-provoking thoughts are replaced with more constructive one.

39. 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.

40. 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?

41. Personality or Coping Style • Negative affectivity • Pessimism – optimism • Hardiness

42. 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.” • I rarely count on good things happening to me. • Overall, I expect more good things to happen to me than bad.

43. Personality or Coping Style • Negative affectivity • Pessimism – optimism • Hardiness

44. 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

45. 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.

46. 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.

47. 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.

48. 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).

49. 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.

50. Generally Social Support Associated with Good Effects • Increase survival rates in women who have breast cancer. • Lower blood pressure • Decrease risk of mortality