1. Psychology AS Revision STRESS

2. Stress definitions  A lack of fit between the perceived demands of the situation and the perceived ability to cope with those demands.  The result of an interaction between the individual and his/her environment.  A stressor is anything that activates the stress response.

3. The pituitary adrenal system  The body’s response to long term (chronic) stress.  The hypothalamus (part of the brain) registers the presence of a continuing stressor and stimulates the pituitary gland to release the stress hormone adrenocorticotrophic (ACTH).  This activates the adrenal cortex (the outer layer of the adrenal gland).  Releases corticosteroids such as cortisol.  Cortisol maintains a steady supply of energy (blood sugar), but also suppresses the immune system.  Adequate and steady blood sugar levels helps the person to cope with the prolonged stressor, and helps the body to return to normal.

4. The sympathetic medullary system  The body’s response to short term (acute) stress.  The hypothalamus (area of the brain) activates the adrenal medulla – part of the autonomic nervous system (ANS).  The adrenal medulla secretes adrenaline – gets the body ready for a fight or flight response. Physiological reaction includes increased heart rate.  Adrenaline leads to the arousal of the sympathetic nervous system and reduced activity in the parasympathetic nervous system.  Adrenaline creates changes in the body such as decreases (digestion) and increases (sweating, pulse, blood pressure).  Once the ‘threat’ is over the parasympathetic branch (associated with a relaxed state) takes control and brings the body back into a balanced state.

5. How stress affects the immune system The immune system is a complex collection of biological structures and processes which protect the body from disease by identifying and destroying viruses, bacteria and cancer cells (collectively known as antigens). When we are chronically stressed, cortisol is released as a part of the pituitary adrenal system. One of the effects of extra cortisol is a reduction in white blood cells, including killer T cells, which are important in fighting antigens. This means that the immune system does not work as effectively, so that we are more prone to colds, flu and other viral and bacterial illnesses.

6. Exam stress and the immune system – Kiecolt-Glaser et al (1984) Aim: To investigate the effect of exam stress on the immune system. Procedure: Blood samples were taken from 75 first year medical students a month before their exams and again on the day of their first exam. The level of killer T cells (a type of white blood cell) in the blood was measured. The students also filled in questionnaires to measure psychological factors such as social support and life events. Results: There were significantly fewer killer T cells in the second sample compared to the first. This was especially true for students who reported loneliness and a high number of recent life events. Conclusions: Even the relatively short term stress of exams can be damaging to health, especially if experiencing other stressors such as loneliness.

7. Exam stress and the immune system Kiecolt-Glaser et al (1984) – AO2  Natural experiment – used a real life stressful situation so it was high in ecological validity.  However, we cannot establish cause and effect (between stress and a weakened immune system) using a natural experiment.  Measuring killer T cell activity is an objective way of measuring immune system functioning so investigator effects shouldn’t be a problem.  Participants were all students, results may not be generalizable to the general population.  However, other studies have shown similar effects with other sections of the population.

8. Stress and the common cold – Cohen et al (1993) Aim: To investigate the role of general life stress on vulnerability to the common cold. Procedure: 394 healthy participants completed questionnaires to assess their perceived levels of current stress and the number of life events experienced in the previous year that they felt had a negative effect. They were then exposed to the common cold virus (via nasal drops). Results: 82% of participants developed the common cold. Those with higher stress scores were most likely to develop a cold. This was true even when other possible contributing factors such as the time of year, diet and amount of sleep were taken into account. Conclusions: Life stress increases vulnerability to the common cold.

9. Stress and the common cold Cohen et al (1993) – AO2  Natural experiment – high in ecological validity  However, this means that cause and effect (between stress levels and the development of the common cold) cannot be established.  Stress levels were measured using a self report method so participants may not have been honest about how stressed they felt (social desirability) or they may not have remembered all life events in the previous year.

10. Sources of Stress – Life Changes – The Social Readjustment Rating Scale (SRRS)  Developed in 1967 by doctors Holmes and Rahe. They wanted to investigate whether stressful life experiences had an effect on health.  They compiled a list of stressful events using the medical records of their patients and then asked hundreds of men and women of various ages and backgrounds to rate each event on the amount of readjustment they would require (how stressful they thought they would be).  Participants judged the death of a spouse as the most stressful event so this was given a Life Change Unit (LCU) score of 100. Other events, such as divorce and moving house, were then assigned an LCU score based on this.  They then carried out a number of studies (e.g. Rahe et al 1970) to test whether life events in the past year correlated with illness. They believed that a score of 300 or more would increase the odds of stress related illness by 50%.

11. Evaluation of the SRRS  The SRRS assumes that all changes are stressful, even if they are positive (e.g. marriage)  Some of the items are ambiguous/unclear e.g. revision of personal habits – people taking the questionnaire may not know what this means.  Does not consider individual differences in how people perceive events e.g. change of a job could be positive or negative.  Most of the events on the SRRS are not every day experiences, so a person could have not experienced any of them in the past year but still feel stressed. This has been investigated by later research on daily hassles.

12. Research into the effect of Life Events on Health – Rahe et al (1970) Aim: To investigate whether scores on the SRRS correlate with subsequent illness. Procedure: 2500 male American sailors completed the SRRS to assess how many life events they had experienced in the last 6 months. They then went on a 6 month tour of duty and a record was kept of their health during this time. Instances of illness were correlated with their scores on the SRRS. Results: A positive correlation was found between the score on the SRRS and the number of illnesses during the 6 month period. Conclusions: Experiencing a high number of life events can cause illness.

13. Evaluation of Rahe et al  Uses a correlation, means that although we can establish a link between life events and illness, we cannot establish a cause and effect relationship.  Although the correlation was positive, it was very small (0.118).  A good sample size was used (2500).  All the participants were male American sailors, so the results may not be generalizable to other sections of the population.

14. Sources of Stress – Daily Hassles and Uplifts  Daily hassles are relatively minor events that happen during the course of a normal day e.g. too many things to do, concerns about weight etc.  Daily uplifts are positive everyday experiences that are thought to counteract the effects of daily hassles e.g. completing a task or talking to friends.  DeLongis, Lazarus and Folkman compiled a list of 117 daily hassles and 135 daily uplifts which formed the Hassles and Uplifts Scale.  The link between stress and daily hassles and the possible positive effect of daily uplifts have been investigated by a number of studies including DeLongis et al (1982).

15. Research into the effect of Daily Hassles and Uplifts on Health – DeLongis et al (1998) Aim: To investigate the effect of daily hassles and uplifts on health, and to compare this to the effect of life events. Procedure: 100 American men and women aged 45-64 were asked to complete four questionnaires once a month over a one year period: Daily hassles scale Daily uplifts scale Life events questionnaire Health questionnaire Results: There was a significant correlation between the number of daily hassles recorded and ill health, but there was no effect from daily uplifts. There was a significant effect from life events, but this was not as strong was daily hassles. Conclusions: Daily hassles are more stressful than life events. This is likely to be because they happen more often and have a cumulative effect. Daily uplifts do not moderate the effect of daily hassles.

16. Evaluation of DeLongis et al  The study used correlational data so cause and effect (between stress and illness) cannot be established.  The sample was made up of mostly well educated, high income, middle aged Americans. This means that the results may not be generalizable to other countries, age groups, etc.  Questionnaires used – social desirability/bias.

17. Workplace stress – Civil Servants – Marmot et al (1977) Aim: To investigate the effects of high demand and low control on stress and illness. In context of the sample used (civil servants) it was assumed that high grade employees would experience high demand and low grade employees would experience low control. Procedure: Civil service employees in London were invited to take part and 7372 agreed to take part by filling in a questionnaire (asking about their grade, sense of control, social support etc.) and by having a health check to assess signs of cardiovascular disease. They were reassessed five years later. Results: 1.Higher grade workers developed fewer cardiovascular problems 2.Lower grade workers expressed a weaker sense of job control and less social support. 3.Workers with cardiovascular disorders were more likely to be low grade workers but they were also more likely to be smokers and be overweight. Conclusions: Low control is related to higher stress and greater risk of cardiovascular disease, but high job demand is not linked to greater stress and illness.

18. Evaluation of Marmot et al  Sample was biased (only London based civil servants), so it may not be generalizable to other cultures/countries or professions.  Lower grade workers are also more likely to smoke, live in stressful environments and have poor diets (due to their lower socioeconomic status). These factors could have contributed to their higher risk of developing cardiovascular disease, rather than their level of control at work.  However, further research (e.g. Johansson et al 1978) does support a lack of control as a risk factor for high stress levels.

19. Workplace stress (Swedish Sawmill) – Johansson et al (1978) Aim: To investigate the effect of repetitiveness, high demand and lack of control on levels of stress at work. Procedure: 14 employees in a Swedish sawmill were studied. Their work was highly repetitive and they had no control over the pace at which their work was carried out (machine paced). They were compared with a group of 10 low stress workers who had more control over their workload. Their levels of adrenaline and noradrenaline (stress hormones) in their urine was measured both at work and in their free time, and their number of illnesses and absences from work were recorded. Results: The people in the high stress group had higher levels of stress hormones whilst at work than those in the low stress group, and their levels of illness and absenteeism were also higher. Conclusions: Repetitiveness, high demand and lack of control were linked to higher levels of stress, which increased illness and absenteeism.

20. Evaluation of Johansson et al  Measure of stress hormones in urine is an objective measure of stress levels – reduces the chance of investigator effects and has higher validity than self report measures of stress levels.  The results of the study were useful to real life – the researchers made practical suggestions to lower absenteeism and reduce workload – they suggested job rotation and allowing workers a higher level of control.  Natural experiment using correlational data – cause and effect cannot be established.  Biased sample – may not be generalizable to other groups.  Population validity – small sample size.

21. Personality factors and stress – Type A and B behaviour There is some evidence to suggest that some people are more sensitive to the effects of stress than others. Friedman and Rosenman identified what they called a Type A personality – this refers to a behavioural style which is characterised by high levels of competitiveness, time urgency and anger or hostility. People with Type A personalities are often high-achieving workaholics who multi-task, push themselves to meet deadlines and hate delays. In contrast, Type B personality types are generally patient, relaxed, easy-going and at times lacking an overriding sense of urgency. Friedman and Rosenman believed that Type A personalities were more likely to develop stress related conditions such as heart disease, and carried out further research to test this.

22. Type A personality & heart disease – Friedman and Rosenman (1974) Aim: To investigate whether there’s a link between Type A personality and the development of heart disease. Procedure: Developed a questionnaire to distinguish between the 2 personality types. Also had an interview. Categorized over 3200 male volunteers from San Francisco between 39-59 into type A and type B. In the beginning, all participants were free from heart disease. Longitudinal study, followed up 8 and a half years later and their health was assessed. Results: After 8 and a half years, 257 men (from the original 3000+) had developed heart disease. 70% of these were from the Type A group. Conclusions: Type A’s are more vulnerable to heart disease and stress related illnesses.

23. Evaluation of Friedman and Rosenman  Correlation – no control over extraneous variables – cannot conclude that it’s due to type A.  Population validity – men from San Francisco – cannot generalise.  It was a longitudinal study which does give us a good idea of the long term effect of personality factors on stress related illness.  Friedman & Rosenman did not specify what aspect of type A behaviour might be responsible for heart disease. Later researchers reviewed the original data and found that it was ‘the negative behaviours’ such as hostility that seemed to be responsible.

24. Hardiness Whereas people with Type A personality are likely to suffer more from a stress related illness, hardiness is thought to be a 'protective' factor - meaning that those with hardy personalities may be less likely to suffer from stress related conditions. Hardiness was proposed by Kobasa and Maddi (1977) and is made up of 3 characteristics:  Control: Those with hardy personalities feel that they are in control of stressful situations - this is very similar to having an external locus of control - they do not feel that their level of stress is controlled by external factors.  Challenge: They see potentially stressful situations as opportunities for personal growth and development, rather than threats or stressors.  Commitment: They put 100% into whatever they do and do not give up easily. They feel a strong sense of involvement in the world.

25. Evaluation of Hardiness  Kobasa did not state whether all three factors (control, challenge, commitment) were equally important, and further research has concluded that control is probably the most important factor.  Much of Kobasa's research into the link between hardiness and stress related illness used a white male middle class sample, so it is difficult to say whether her results are generalizable to other populations.  Research has only shown a correlation between hardiness and stress related illness, so we cannot establish a cause and effect relationship.

26. Cognitive Behavioural Therapy – Stress Inoculation Training - Psychological Stress Inoculation Therapy (SIT) is a form of cognitive behavioural therapy. The aim is to replace irrational and negative thoughts with more positive ways of thinking about a problem. There are three stages to the therapy: Conceptualisation - The therapist helps the individual to identify their stressors and how they respond to these and how successful these responses have been. Patterns of self-defeating internal dialogue (i.e. negative thoughts) are identified. Skill acquisition and rehearsal - The therapist teaches the client coping skills that may be general or event focused. For example replace negative thoughts with positive ones. Application and follow through - The client applies what they have learned to real life situations.

27. Evaluation of Stress Inoculation Training  Deals with the underlying cause of stress – i.e. why the client is stressed as opposed to just the symptoms - the cause is dealt with.  Flexible – can change from person to person, the subjective nature of stress is taken into account – not generalized.  Time consuming and expensive – can only work if the client is determined – can take months.  Does not have undesirable side effects, unlike drug therapy.

28. Drugs – Biological (with AO2) Drugs can be used to combat stress by reducing or eliminating the symptoms of the stress such as fast heart rate. Today there are two main categories: Benzodiazepines (BZs)Beta blockers (BBs) Most commonly used to treat stress and anxiety e.g. Valium. Work directly on the dream. Slows down activity of the central nervous system (e.g. the brain and the spinal chord) by increasing activity of GABA. Feeling of relaxation. Slow down activity in the sympathetic branch of the ANS, reduces levels of adrenaline and noradrenaline. Reduces blood pressure, heart rate etc. and produces a feeling of calmness. No fight or flight.  Quick – guaranteed to reduce stress – patient is sure it will work.  Effortless – quick and economical - only take a tablet – cheaper than therapies.  Serious side effects – addictiveness.  Not suitable for children.  Real life application – effective in reducing stress – e.g. in sport – steadies nerves.  Acts rapidly – quicker and more effective than therapies.  Link with diabetes. Overall evaluation:  Quick acting in comparison to other treatments (e.g. CBT/SIT).  Treat the symptoms and not the problem itself – symptoms may reappear when treatment is stopped.  Side effects – BZ’s can reduce serotonin, causing depression. Aggression, short term memory loss and mental confusion are also possible.  Long-term use can result in tolerance (higher doses are eventually needed to produce the same effect) and dependence.

29. Coping with stress – Problem Focused Approach Problem-focused coping targets the causes of stress in practical ways which tackles the problem or stressful situation that is causing stress, consequently directly reducing the stress. Problem focused strategies aim to remove or reduce the cause of the stressor. Problem-focused strategies include:  Taking Control – this response involves changing the relationship between yourself and the source of stress. Examples: escaping from the stress or removing the stress.  Information Seeking – the most rational action. This involves the individual trying to understand the situation (e.g. using the internet) and putting into place cognitive strategies to avoid it in future. Information seeking is a cognitive response to stress.  Evaluating the pros and cons of different options for dealing with the stressor.

30. Evaluation of the Problem Focused Approach  In general problem-focused coping is best, as it removes the stressor, so deals with the root cause of the problem, providing a long term solution.  However, it is not always best, or possible to use problem-focused strategies. For example, when someone dies, problem-focused strategies may not be very helpful for the bereaved. Dealing with the feeling of loss requires emotion-focused coping.  Problem focused approaches will not work in any situation where it is beyond the individual’s control to remove the source of stress. They work best when the person can control the source of stress (e.g. exams, work based stressors etc.).  It is not a productive method for all individuals. For example, not all people are able to take control of a situation. People with low self esteem typically use emotion focused coping strategies.

31. Coping with stress – Emotion Focused Approach Emotion-focused coping involves trying to reduce the negative emotional responses associated with stress such as embarrassment, fear, anxiety, depression, excitement and frustration. This may be the only realistic option when the source of stress is outside the person’s control. Drug therapy can be seen as emotion focused coping as it focuses on the arousal caused by stress not the problem. Emotion-focused strategies include  Keeping yourself busy to take your mind off the issue  Letting off steam to other people  Praying for guidance and strength  Ignoring the problem in the hope that it will go away  Distracting yourself (e.g. TV, eating)  Building yourself up to expect the worse

32. Evaluation of the Emotion Focused Approach  Emotion-focused strategies are often less effective than using problem-focused methods. For example, Epping-Jordan et al (1994) found that patients with cancer who used avoidance strategies, e.g. denying they were very ill, deteriorated more quickly then those who faced up to their problems. The same pattern exists in relation to dental health and financial problems.  It does not provide a long term solution. However, they can be a good choice if the source of stress is outside the person’s control (e.g. terrorist attack).  Gender differences: women tend to use more emotion-focused strategies than men (Billings and Moos, 1981). It also may have negative side effects as it delays the person dealing with the problem.