Critical Issue: Stress Management

How do you cope with stress? Brainstorm the ways you use to cope with different stressful situations

Problem - focused Coping Stress is treated as a problem to be solved. Seeking social support – discussing a problem helps make more sense of it, puts problem in perspective. Taking control – e.g taking steps to deal with debt, finding out about a disease, looking for a new job.

Problem Focused Coping Evaluating the pros and cons of different ways of dealing with the stress – e.g. planning a new life after bereavement, choosing whether to have surgery, Suppressing competing activities – e.g. avoiding the temptation to put off going to the dentist because of work commitments Anticipatory coping – work out what triggers stress, train ourselves to anticipate and deal with it e.g working out your route to a new location, anticipating possible roads to avoid e.t.c

Problem Focused Coping These strategies are often achieved through Psychological Therapies Cognitive Behavioural Therapy – CBT

Emotion – focused Coping Avoidant methods, used when a person feels there is nothing that can be done to change the problem. Treats the symptoms not the problem 1. Defence mechanisms – tend to be negative Denial – e.g going on as if nothing has happened Distancing/distraction – e.g just not thinking about it Focusing on and venting emotions e.g crying, anger, praying Wishful thinking – dwelling on what might have been if this hadn’t happened

Emotion – focused Coping 2. Reappraisal/reinterpreting – taking another look at the situation may change the way you feel about it. A positive approach. 3. Arousal reduction – heightened reactions associated with stress are reduced, so the person becomes less stressed e.g meditation, relaxation, exercise, biofeedback or drug therapy

Gender differences in coping Do you think males and females may cope differently? Research has evidence that ... Males more likely to use Problem-focused methods, whereas women use emotion-focused

Gender differences in coping Socialisation theory – women taught to show emotions openly, men taught to approach stress in a more active way. Role constraint theory – coping strategy matches roles males and females occupy. When males and females have same role – used same strategies to cope with stress

There is a very, very tall coconut tree, and there are 4 animals passing by: King Kong, Ape, Orangutan and Monkey   They have a competition to see who is the fastest to get the banana. Who do you guess will win? Your answer will reflect your personality. Try and answer within 30 seconds Got your answer?

If your answer is .... Orangutan = Dumb Ape = Foolish Monkey = Idiotic King Kong = Stupid Why ????? A Coconut tree ........ doesn't have bananas!!   It's obvious you're stressed by your work. Go home!    

What is Stress Management? The process by which an individual attempts to cope with (manage) stressful demands. Psychological – CBT (e.g Stress Inoculation, Hardiness training and REBT) Physiological – Drug therapy, Biofeedback, exercise

Psychological Methods Use techniques that help the person cope with the situation itself rather than just dealing with the symptoms. Patients find ways of changing or avoiding stressful situations in the future. Or learn techniques to minimise negative effects of stressful situations

Psychological Methods Stress Inoculation Training (SIT) Meichenbaum (1985) – cognitive-behavioural therapy – person can change way they think about certain stressors. Suggested client should develop a form of coping before the problem arises – inoculate yourself against the disease of stress like vaccinations to prevent infectious diseases! Use clients’ existing coping skills.

Evaluation of Research Strengths It works! –Meichenbaum (1996) successful with acute and chronic stress. Combines cognitive and behavioural therapy – powerful method of stress management By gaining new skills gap between demands and coping resources narrows – more confidence in handling previously stressful situations Weaknesses Time consuming and high levels of motivation needed –only suits a small range of determined individuals. Expensive. Difficult to change some behaviour Complex – may not need to do all aspects of the therapy – e.g. may be sufficient to just talk more positively and relax more

Psychological Method 2: Hardiness Training Kobasa and Maddi (1977) 1.Focusing – client taught to spot signs of stress (e.g. muscle tension, increased heart rate, anxiety). Allows client to recognise stressful situations and thus sources of stress. 2.Reliving Stress Encounters – clients analyse recent stressful situations in terms of how easily they were resolved and how they might have turned out better or worse. Gives client insight into their current coping strategies and how they might be better than they thought.

Psychological Method 2: Hardiness Training Kobasa and Maddi (1977) 3. Self-improvement – The key to hardiness is the belief that we can cope with life’s challenges. Client taught to focus on seeing stressors as challenges and thus learn to take control. Control, commitment and challenge are the basis of hardiness training.

Evaluation of Hardiness Training Strengths Deals with the problem rather than the symptoms – teaches clients to manage all stressors in their life. More adaptable and effective than drugs Long-term effectiveness Weaknesses Much of research carried out on male executives or soldiers in US. Low ecological validity. High control can be stress inducing for some people. Difficult to modify learned habits. Does hardiness exist? – is it just being in control?

Comparison of SIT and Hardiness Training Both treat the problem not the symptoms. Both teach clients skills to provide lasting and varied strategies to cope with stress Both teach clients to view stress as a problem to be solved Both require lengthy training and highly motivated clients. The success of SIT may be mainly due to positive thinking The success of hardiness training may be due to increased control

Physiological approaches to stress management These methods focus on getting rid of the emotions associated with the stressful situation, but the situation may not be changed. They directly target the stress- response systems.

Anxiolytic* Drug Therapy Benzodiazepines (BZ’s) Librium, Valium, Halcion, Xanax Short term relief of severe anxiety. 1.Enhance action of natural brain chemical, GABA. 2. GABA tells neurons to slow down or stop firing – general quietening influence on brain. 3. Action of GABA is supported by BZ’s to inhibit neuron activity even more 4. The brain’s output of excitatory neurotransmitters (e.g serotonin) is reduced and person feels calmer Anxiolytic – anti-anxiety drugs, GABA – gamma-amino-butyric acid

Anxiolytic* Drug Therapy Beta-blockers Treat high blood pressure Reduce activity of adrenaline and noradrenaline, which are key agents in sympathetic (ANS) arousal. By blocking ANS arousal, beta-blockers slow the heart beat, lessen the force with which the heart contracts and reduces blood vessel contraction. This results in a fall in blood pressure and less stress on the heart. Also given to sportsmen and women to reduce arousal which can affect performance negatively.

Anxiolytic* Drug Therapy 1.What do you think are the advantages and disadvantages of using drug therapy to manage stress. 2. Do these methods really manage the stress? Explain.

SSRI’s Selective Serotonin Reuptake Inhibitors e.g Prozac Prevent the recycling of Seratonin Leads to more Seratonin in the synapses Helps depression as people suffering this illness have low levels of Seratonin. Trivedi et al 2006 – 3000 depressed patients given Citalopram. 47% halved their depression score. BUT - Effectiveness did depend on type of person.

Evaluation of Drug Therapy Strengths High efficacy (work on range of anxiety disorders) Kahn et al (1986) – BZs superior to placebo Work quickly to reduce disabling effects of stress related anxiety. Low toxicity Rai et al (2005) – Beta Blockers increased survival of patients with certain serious heart problems. Can be prescribed immediately for acute stress Easy to take Weaknesses Addictive –BZs psychological and physical dependence can develop within a few weeks – Ashton 1997 – BZs limited to 4 weeks use Side effects – drowsiness, dizziness, tiredness, dry mouth, diarrhoea, changes in sex drive/ability, seizures, severe skin rash, irregular heartbeat Can prevent normal psychological adjustment –treats the symptoms not the problem

Biofeedback involves 4 processes: Person learns to exert voluntary control over involuntary (autonomic) behaviours Biofeedback involves 4 processes: Feedback – patient attached to machines that give feedback about ANS activities – heartbeat, blood pressure Relaxation – patient taught relaxation techniques – reduces activity of sympathetic nervous system and activates parasympathetic NS – reduced heart rate, blood pressure and symptoms related to stress

Biofeedback Operant conditioning – relaxation leads to target behaviour e.g. reduced heart rate, which is rewarding. This will increase likelihood of same behaviour being repeated. This learning (conditioning) takes place without conscious thought. The reward results in an unconscious ‘stamping in’ of the behaviour. (Like Pavlov’s dogs) Transfer – The patient transfers the skills learned to everyday situations.

Evaluation of Biofeedback Strengths Non-invasive No negative side effects Provides patient with long lasting means of dealing with stress symptoms Weaknesses Expensive –the cost of equipment and time needed Treating the symptoms not the problem – does not treat the source of stress

3. Which is best Emotion-focused or problem-focused methods? Aim to remove problem No side effects Last longer Slower More expensive Ppts need to be motivated to stick with them Emotion focused Control symptoms – problem still there Quick and effective Relatively cheap May have side effects May cause addiction Biofeedback – no addiction or side effects, more expensive than drugs