1. Stress—Current Concepts Anna Nagy, M.A. Doctoral Candidate, Psychology

2. Background Many unanswered questions Cumulative effects of stress? Individual differences in stress response; vulnerability to disease and psychological disorder How can we quantify changes? Adaptive mechanisms? Damage?

4. Stress and its Mediators Stress includes major life events, trauma, abuse (work, home, or environment), daily hassles, physical challenges Coping Both acute and chronic stress can have long term consequences (severity)

5. Individual Responses Determined by: –Perception of the situation & coping Crucial in determining behavioural and physiologic responses Affects ability to adjust to chronic or repeated stress –General state of physical health (includes behavioural and lifestyle choices) May be genetic component

6. Coping—Effects of Social Support

7. Current Concepts Not Sufficient Individual variability –Not explained by genetics –Gradients of health across socioeconomic levels in Western societies not explained by genetics –PTSD (across population; emergency workers/paramedics)

8. Stress Affects Health Physical condition affects ability to respond to stress Stress linked to various physical conditions: –Family instability linked to incidence & severity of insulin dependent diabetes (Hagloff et al., 1991) –Chronic stress linked to insulin resistance (risk factor for non-insulin dependent diabetes) (Raikkonen & Adlercreutz, 1996) –Stress linked to deposition of abdominal fat (risk factor for coronary heart disease and diabetes) (Bjorntorp, 1990)

9. Stress Affects Health Acute Stress Enhances Immunity— –Enhances traffic of lymphocytes and macrophages to the area of need (‘delayed-type hypersensitivity’) –Dependent on adrenal secretion; last 2-5 days –Enhances responses for which there is an immunologic memory (beneficial for cancer or tumour cell, but pathologic for autoimmune or allergic responses) Can you think of any diseases where this might be a factor?

10. Stress Affects Health Chronic Stress Suppresses Immunity— –Delayed hypersensitivity response severely inhibited (Poteliakhoff, 1981; Ur, White & Grossman, 1992; Buske-Kirschbaum et al., 1997) Increased severity of common cold Recurrent endotoxemia (increases HPA activity and decreases production of cytokines) (See McEwen, 1998; 2003 for review)

11. Stress and Immune Function Stone & Neale, 1984

12. Stress and Health Cardiovascular disorders –Diseases involving the heart and blood- circulation system Essential hypertension –Physical stress and blood-pressure increase Predisposing factors

13. Allostasis Allostasis: ability to achieve stability through change—crucial to survival Accommodation: Body protected by various systems including ANS, HPA, cardiovascular, metabolic and immune systems

14. Allostatic Load Allostatic Load: long term effects of the physiologic response to stress. –Wear and tear from chronic over-activity or under-activity of systems

16. The Stress Response and the Development of Allostatic Load Stress Response and Development of Allostatic Load. (McEwen, 1998)

17. Current Topics Effects on Cognition/Learning and Memory –Animal research—How stress affects the brain Hippocampus—high concentration of GC receptors Stress=Increased cortisol secretion in most cases Atrophy of dendrites/Effects on neurogenesis –Sex differences –Suggestive Evidence in humans Hippocampal volume loss? (Cushings, Depression, PTSD) prevent access to contextual info (may lead to enhanced fear based memory (PTSD)) Caregiver study Aging Studies Allostatic Load

18. Four Situations Associated With Allostatic Load Frequent Stress –Surges in blood pressure related to myocardial infarction in susceptible persons –Lack of adaptation to frequent stressor of the same type (ie public speaking) –Inability to shut off responses

19. Four Situations Associated With Allostatic Load No Adaptation to Repeated Stressors in Some Individuals –Fear of public speaking –Phobias

20. Four Situations Associated With Allostatic Load Failure to shut off stress response after stressor abates -evidence in aging animals -allostatic systems may eventually wear out or become exhausted -hippocampus vulnerable link in HPA regulation and in cognition -“glucocorticoid-cascade hypothesis”

21. HPA

22. Four Situations Associated With Allostatic Load Inadequate responses in some allostatic systems=compensatory responses in other systems (disruption of counter-regulatory mechanisms) –Eg. Cort secretion not increased in response to stress=increase in secretion of inflammatory cytokines (autoimmune diseases/inflammatory diseases)] –Hyporesponsiveness (fibromyalgia, chronic fatigue syndrome, PTSD)

23. Discussion Implications for Health –Stigma? –Social Change? –McArthur Studies –Duxbury Study –Groupwork (if time permits)

24. Summary Effects of Stress—Current Concepts: –Cognition/learning and memory –Allostatic Load –Implications for health