5.1: Stress and Illness Flashcards
Stress and Physical Illness
Stress Activation:
Activates HPA axis & SNS (sympathetic nervous system).
Hypothalamus → CRH → Pituitary → ACTH → Adrenal glands → Cortisol.
Chronic Stress:
Sustained cortisol elevation disrupts homeostasis.
Inflammation: Glucocorticoid resistance → Chronic inflammation → ↑ Cardiovascular risk.
Brain Impact: Affects hippocampus & prefrontal cortex (PFC).
SNS Overactivation: Hypertension, atherosclerosis, metabolic syndrome, suppressed NK cells.
Oxidative Stress & Telomeres:
Oxidative stress damages telomerase → Telomere shortening.
Cortisol contributes to telomere damage → Links to aging & age-related diseases.
Key Consequences:
Chronic inflammation, immune dysfunction, oxidative damage.
Accelerated biological aging → Earlier disease onset.
Pyschosomatic Link: stess and disease
- physical symptoms such as headaches, fatigue and gastrointestinal issues are often stress induced.
- conditions like hypertension, diabetes, and cardiovascular disease can be exacerbated by stress.
Reverse relationship (physical illness and stress).
Physical illness can induce psychological stress due to pain, functional limitations, or uncertainty about prognosis, further activating the stress-response system.
Impact of Illness
Acute illness: sudden onset of the illness- ie. Stroke or heart attack
Insidious illness: gradual onset of illness – ie. Cancer or dementia
- High prevalence of both anxiety and depression in individuals with illnesses. For example, 33% of TBI injury patients have depression, and up to 41% suffer with generalised anxiety.
Emotional response to illness
- Diagnosis often evokes catastrophic responses (ie. Fear of death).
- Diagnosis linked to high distress.
- PTG: early stress response to diagnosis can lead to positive growth.
- Chronic illness impacts identity due to: social isolation, perceived stigma struggles with pre-illness role and capabilities).coping strategies involve maintaining pre-illness identity, and accommodating illness without full integration into self-concept.
Illness centrality: the extent to which illness is incorporated into self-concept, higher centrality often correlated with poorer outcomes. - High centrality correlated with poorer adjustment and increased distress
research into visible/ invisible illness- visibility impacts illness centrality and therefore emotional response
fatigue
: is linked to neurological, immunological and inflammatory processes.
Fatigue is common in post stroke, MS, and long covid.
- Fatigue impairs physical and mental performance and created a ‘self-perpetuating cycle’ of inactivity and weakned capacity.
- Emotional distress and intrusive treatments exarcebate fatigue.
- Assessed through subjective tools like fatigue assessment scale.
The effect of emotions on illness management:
Impact of depression: depressed individual’s are less likely to:
- Adhere to medication
- Cease harmful behaviours
- Participate in rehabilitation
Depression also infleunces disease cource and recovery as seen in strokes and HIV patients.
Impact of anxiety: anxiety impairs illness self-management, associated with poorer treatment responses
Positive emotional wellbeing: positive affect contributes to better recovery and survival outcomes across physical illness.
Emotion regulation and adaptation:
Maladaptive coping: avoidance and repression of emotions hinder adjustment
Adaptive coping: acknowledging and expressing emotions improves outcomes
PTG: illness adversity can foster resilience and a refined sense of purpose.
Coping and its role:
- Lazarus’ transactional model of stress:
Primary appraisal: assessing the stressor (is it a threat, challenge, or benign?)
Secondary appraisal: evaluating available resources (ie. personality, support systems) to manage the stressor.
- effective coping determines the impact on quality of life and psychological
outcomes
It emphasises that stress arises not from the event itself but from the individual’s cognitive appraisal of it.
The model involves two key processes:
1. Primary Appraisal: The individual evaluates whether an event is irrelevant, benign, or stressful (e.g., a threat, challenge, or harm/loss).
- Secondary Appraisal: The individual assesses their resources and ability to cope with the perceived stressor.
Stress results if the demands of the situation exceed the perceived coping resources. The model highlights the importance of perception, context, and coping strategies in managing stress.
Positive appraisal and positive emotions
Role of optimism: optimist and positive appraisal and considered linked to better illness outcomes.
- Ie. Elderly (85+): optimism predicts higher survival likelihood over 5 years.
- Cancer patients: optimism and mastery beliefts associated with reduced pain and fatigue after chemotherapy.
- Pessimism linked to maladaptive coping and higher emotional morbidity.
Benefits of Positive Emotions (Fredrickson’s Broaden-and-Build Theory):
o Promotes psychological resilience and effective problem-solving.
o Dispels negative emotions.
o Triggers upward spirals of positive emotions (Fredrickson, 1998, 2001).
o Example: Hip fracture patients with high positive affect during hospitalisation showed better functional recovery over two years (Fredman et al., 2006).
task/events in case of illness
physical:
- symptoms and disabilities
- medication adherence
- strict rules
psychological/spiritual:
- finding emotional balance
- maintaining self-esteem &self control
- living with an uncertain future
- search for meaning
social:
- check-ups & communication with medical staff
- changes in role patterns, activities, contact with others, hobbies
coping strategies:
Crisis theory: links to Lazarus model
By Moos and Schaefer.
- Illness seeing as a crisis leading to:
- Cognitive appraisal: assessing illness implications (primary appraisal in Lazarus model)
- Adaptive tasks: managing symptoms, emotional balance and relationships – what they need to do.
- Coping skills: utilising strategies to navigate challenges (secondary appraisal in Lazarus model)
types of coping skills:
Appraisal focused coping: includes denial (only when denial involves cognitive reappraisal, ie. Minimising the severity of stressor), positive reappraisal and mental preparation.
Cognitive strategies that focus on altering how the stressor is interpreted or perceived.
Problem-focuses coping: actively addressing the stressor (ie. seeking information or solutions)
- Seeking support, planning and direct action, acceptance, planning to improve adaptation.
- Emotion modulation (reframing) reduces stress.
Emotion-focuses coping: managing emotional responses (ie. positive reappraisal or seeking emotional support)
- Mood regulation, venting, or passive acceptance.
distracting oneself or denying the issue, which may provide short-term relief but has potential long-term drawbacks.
o Venting: Excessive venting without constructive outcomes may increase emotional distress.
o Passive acceptance: Can be maladaptive if it prevents problem-solving or constructive action.
o Distraction: Useful for short-term relief but may be maladaptive if it leads to avoidance of the issue.
Religious Coping and Spirituality:
Includes beliefs in a supportive god or participation in prayer groups.
Associated with: greater optimism and meaning making. Better emotional and physical adjustment.
Challenges:
- Negative RC (e.g., belief in a punishing God) correlates with poorer mental health
o Studies report mixed outcomes:
- 7/17 studies found benefits for distress and adjustment
-
Spirituality:
Contrasts with religion:
Personal, individualistic, and inward-focused.
Concerned with self-actualisation and anti-authoritarian principles.
Often integrated into modern therapeutic practices, e.g., mindfulness
Adaptive coping:
Flexibility in coping strategies is crucial. For example:
- denial may help immediately after cancer diagnosis
- acceptance and problem-focuses strategies are vital during ongoing treatment.
What is adaptive coping?
- Problem/ emotion focused approach to coping- they go together.
- Adaptive coping = flexible, depending on the context, controllability, and timing.
- ‘Grant me the serenity to accepts the things I cannot change, the courage to change the things I can, and the wisdom to know the difference’
Coping by Denial or Avoidance
avoidant coping, maladaptive.
Characteristics: common as an initial response but often counterproductive long-term.
Associated with higher distress and maladjustment.
- Ie. Avoidant coping linked to higher depression in HIV-positive med. Avoidance predicts poorer adjustment in breast cancer and prostate cancer patients
Psychosocial influences on coping
personality traits (optimism promotes resilience, neuroticism increases stress perception)
There is limited evidence that personality plays a direct role in the development of illness-
More evidence that:
- Personality affects acting in risky situations, having (un)healthy behaviours, (mal)adaptive coping with stress, (less) social support > indirect effect on disease risk and outcomes
- social support provides emotional and instrumental resources buffering stress (buffer effect hypothesis)
Illness Outcomes: Benefit Finding and Post-Traumatic Growth (PTG)
positive psychological change resulting from struggling with significant stressor or trauma.
Associated with life-altering events, including illness, that shifts perspectives, priorities and self-concept.
Five Domains of Positive Change:
o Enhanced personal relationships.
o Greater appreciation for life.
o Increased personal strength.
o Greater spirituality.
o Valued changes in life priorities and goals
Personal Resources:
Self-efficacy facilitates PTG, particularly when mediated by coping strategies.
Social Support
High social resources consistently promote PTG, independent of coping mechanisms.
Illness acceptance
recognising the need to adapt to chronic illness while tolerating its unpredictable nature and handling its consequences.
- Visibility of illness can make acceptance less likely/ more challenging.
