FINAL EXAM STRESS

Question 1

How would you define health?

Answer 1

a positive state of physical, mental, and social well being that moves over time along a continuum

Question 2

what is stress?

Answer 2

stress occurs when we experience a threatening stimulus (stressor) that we can’t cope withand it results in an emotional, behavioral, and biological stress response

Question 3

why is it important to study stress?

Answer 3

Stress is a determinant for both health and wellness, risk factor for obesity, substance abuse and other diseases
Persistent activation of the HPA axis
High Blood sugar, cholesterol, blood pressure, and levels of cortisol
Buildup of plaque in the arteries, leads to heart attacks, strokes, heart disease

Question 4

what are two ways to explain stress with a biological approach?

Answer 4

evolutions/genetics (COMT) and neurotransmitters/HPA axis

Question 5

explain how evolution/genetics (COMT) can explain stress

Answer 5

COMT enzyme breaks down neurotransmitters in the in the synapse
Depending on which variation of gene you have changes the levels of enzymes, therefore changes the levels of neurotransmitters in your brain
Warrior worrier hypothesis → response to stress is linked to COMT genotype
met/met (worrier, more stressed) or val/val (warrior, less stress)
Mets have higher levels of stress because they have lower COMT activity, less breakdown of noradrenaline in the synapse
Also linked to the hippocampus and the amygdala
Vals have a larger hippocampus compared to mets
Mets with ACEs also have smaller hippocampus
Mets have higher levels of amygdala activity → activates HPA axis and stress response
Talk about how these genes are passed down, and there may be an evolutionary/epigenetics aspect where people have had to adapt their genes to survive

Question 6

What is the study to use to support the evolutionary/genetic explanation of stress?

Answer 6

Walder et al (2010)
63 adolescents ages 12-18
Genetic testing using saliva samples revealed which variation of the COMT gene they had: Val/Val, Met/Met or Val/Met
Cortisol measured at 3 points throughout the year
After a year, mets had a higher average cortisol level than the val
Biggest increase between baseline cortisol levels compared to a year later, vals were quite stable
Supports worrier/warrior hypothesis

Evaluation of study:
Only looks at the biological aspect of stress
Does not take into account individual perceptions and differences when dealing with stress
Not generalisable to other age groups, only done on adolescents

Question 7

explain how neurotransmitters/HPA axis can explain stress

Answer 7

Fight or flight is linked to the HPA axis
Encounter environmental stressor
Hypothalamus stimulates pituitary gland to release hormones to adrenal gland on top of kidneys
Cortisol and adrenaline (norepinephrine) are released into the bloodstream
Adrenaline stimulates the sympathetic nervous system (difference between the sympathetic and parasympathetic nervous system)
Cortisol provides energy for fight or flight by breaking down glycogen in liver and converting to glucose → energy
Physiological effects of stress
Muscles tense
Shortness of breath
Increased heart rate
Release of cortisol
Stomach discomfort
Slow down of reproductive system

Question 8

study to support the neurotransmitter/HPA axis theory to explain stress

Answer 8

Newcomer et al (1999)
Investigate whether high levels of stress hormones interfere with verbal memory
All participants were employees/students at a university
Given a clinical interview with a physician, and were excluded from study if they were pregnant, or had a history of illness/mental illness
Double blind laboratory experiment, participants matched for age and gender in one of three conditions
High level of cortisol tablets → major stress event
Low level of cortisol tablets → minor stress event
Placebo group → placebo tablets to have a control group
Tested three times: asked to listen and recall a paragraph. Difference paragraph each time, same level of difficulty.
Tested before and after to establish baseline to eliminate the confounding variable of individual differences
High cortisol levels impair memory → highest level of cortisol, worst performance
Effect was not permanent
Moderate levels may have assisted in the recall → Cortisol receptor on the hippocampus

Evaluation of study:
Lab experiment → cause and effect established
Baseline test to eliminate confounding variables
Did not have control over external stressors over the course of the few days
Memorizing a text is not how memory would be displayed in real life contexts
Ethical considerations, but no permanent damage and consent forms signed

Question 9

evaluate the biological approach to explaining stress

Answer 9

Limitations:
Most studies done in labs, very artificial, lack ecological validity
Would these be scenarios that would happen in daily life?
Reductionist, without the consideration of cognitive and sociocultural factors
Does not account for personal differences between individuals
Need a more comprehensive understanding
Bidirectional ambiguity → does the biological factor cause the stress response or does the stress response cause the biological symptoms?

Strengths:
Scientific basis: empirical evidence, reliable and valid
Can lead to potential biological treatments of chronic stress/stress related health problems

Question 10

what are the two ways in which stress can have a cognitive explanation?

Answer 10

transactional model of stress and optimism/pessimism model

Question 11

explain how the transactional model of stress can explain stress

Answer 11

When studying stress, we must take into account how different people interpret stress
Stress is due to a transaction between the stressor and the individual that is confronted to the stressor
Cognitive appraisal how one interprets a certain situation, the relevance of a stressor and the ability to cope with it
Order of the transactional model, developed by Lazarus: stimuli → primary appraisal → secondary appraisal → stress response → coping → reappraisal
Primary appraisal stage: how we interpret the situation in terms of personal relevance (this is different for everyone). Five types of stressors
Irrelevant: will not cause a stress response
Harmless: will not cause a stress response
Dangerous
Threatening
Challenging (anticipated, may cause motivation to overcome the stressor)
Secondary appraisal stage: if we deem the stressor to be dangerous/threatening, in this stage we consider our ability to cope by assessing available resources (material, financial, emotional)
If there are not enough resources there will be a stress response
Individuals with low self esteem are more likely to appraise a situation as stressful rather than not
Cognitive reappraisal: when we re-appraise the stressor again, it is important because it can reduce your levels of stress

Question 12

what is the study to support the transactional model of stress?

Answer 12

Jamieson et al
50 participants (25M, 25F) from Cambridge in the USA
Participants with hypertension or heart problems were excluded from the study
a baseline cardiovascular recording was taken for all participants
Participants were assigned to one of three conditions
Reappraisal: participants read a script about the benefits of reappraising, asked to think about stress as adaptive
Ignore stress condition: read a script where it was said that the best way to overcome stress is to ignore it
No intervention: not asked to read anything, carried out a non demanding task
After reading article, asked questions to guarantee that they had read and understood
Completed the trier social stress test: gave a speech and do some mental arithmetic while being videotaped, and with evaluators providing negative feedback
Cardiovascular responses were recorded, and after the test were asked to fill a questionnaire to record subjective level of stress
Findings: participants instructed to think their stress as helpful exhibited better cardiovascular stress responses (more efficient and lower blood pressure)
Shows how cognitive reappraisal can shift stressful situations and show potential health benefits

Evaluation of study:
highly controlled with high internal validity. Not generalizable to all forms of stress. Studies acute stress, not chronic stress. No indication of long term effectiveness
Not clear how reappraisal would affect people with mental disorders

Question 13

evaluate the transactional model of stress

Answer 13

Doesn’t really consider physiological responses to a stressor
Argues that if we don’t have the resources, we automatically experience stress
Does not account for individual differences in our perception of stress
Assumes that everyone has the same ability to cognitively reappraise stressors
Biological and social factors might affect this process

Question 14

explain how pessimism/optimism can explain stress

Answer 14

psychological aspects of stress are bidirectional
Our cognition can impact our stress, and our stress can impact our cognition
Where things like optimism/pessimism come in, essentially our beliefs about stress and how we think about ourselves
Negative beliefs about stress affect our health because it changes our cardiovascular response to stressors
Appraising stress as being harmful → restrict arteries, lead to poor physiological and cognitive performance
Appraising stress as being beneficial → dilates arteries, increases blood flow, more beneficial response
On the long term, can have significant effects on our health
Optimists → more likely to recall positive strategies, greater belief in their ability to change negative situations
Optimisms make more efforts to maintain their health, lower stress levels
Pessimists also have higher levels of cortisol

Question 15

what is the study to support the pessimism/optimism model of stress

Answer 15

Study: Fischer et al (2016)
Aim: To see how stress beliefs (positive or negative) can affect physical symptoms of health.
Quasi experiment, sample of 216 students from a german university (mostly females of high economic status)
2 questionnaires measuring stress beliefs, stress levels, and somatic (physical) symptoms
Data gathered in april (low stress period) and again in september (high stress period)
Results show that negative stress beliefs (stress is bad for you) → more physical symptoms during a stressful period
Positive stress beliefs resulted in lower percepted levels of stress, with less manifestation of somatic symptoms
Longer activity of HPA axis → more cortisol → more health problems

Evaluation of study:
Low population validity
Quasi experiment, what changed was the time that the data was collected at
The high levels of stress might have been due to something else
Only considers one aspect of stress → academic stress
Doesn’t take into account individual differences, genetic predispositions etc

Question 16

evaluate the pessimism/optimism approach

Answer 16

Being an optimist/pessimist can have different meaning in different cultures
Hard to get empirical evidence
Perceived levels of stress are very subjective, does not take into account individual differences
Does not take into account genetics

Question 17

how does culture affect stress

Answer 17

Culture affects:
The types of stressor to which one is likely to be exposed
The way these stressors are perceived and understood
The extent of the physiological stress response produced
The coping mechanisms available to deal with the stressor

Question 18

social status and stress

Answer 18

Social status refers to someone’s rank in a social hierarchy. Socioeconomic status (SES) is a type of social status which is measured by income, education, and occupation.

People with higher social status have fewer health problems. They live longer and have lower rates of stress, cardiovascular disease and obesity.

Subjective social status (SSS) is a person’s individual evaluation of their social rank. It is used in studies of social status and stress in teenagers because SSS is a better predictor of health for teenagers compared to SES.
Generally speaking, higher SSS is associated with better health.
SSS is measured using the MacArthur Scale of Subjective Status. involves showing the participant a ladder with 10 rungs and asking them to place themselves on the ladder as compared to their peers.
People with low SSS tend to be exposed to more stressors like poverty, abuse and violence
They need a faster and more reactive fear response because they have to be more alert to potential threats. But this could cause long-term health problems because of the excess cortisol in the body.
One reason why people with lower social status (SES and SSS) have more health problems is because their stress responses are more reactive. This causes chronic release of stress hormones like cortisol which negatively affects health.

Question 19

study for social status and stress

Answer 19

Marmot et al for social status and stress

The aim was to investigate the impact of a range of stressors on biological, psychological and sociocultural outcomes.

The participants were 10,000 civil servants with different socio economic backgrounds.
Longitudinal design, over 3 years
7 questionnaires, each relating to a different stressor in the participant’s life, for example stress at work
This variable was also assessed by looking at job descriptions, responsibilities and work environment.
Researchers kept records of stress related and also checked for signs of any cardiovascular diseases.
Correlational analysis to test the link between job control and stress related illness
Biological measures were also used (cholesterol levels) as well as sociocultural measures, like environmental stressors (neighborhood, housing, loneliness, social support)
→ link back to say how sociocultural factors are made of multiple things

Results:
Links between particular stressors (low job control, inability to cope with work) with physiological conditions like heart attack, cancer, stroke and gastrointestinal problems
Four times more likely to die from stress related illness for those who were vulnerable participants
→ link back to how this demonstrates that this is truly a health problem

Strengths:
Using correlational study enabled researcher to look for clear link
Can be used by employers to protect their employees forms stress related illnesses
Could help better productivity and happiness in companies
Different methods and factors used
Large sample size

Questionnaires: lots of self reported data
Demand characteristics
No cause and effect, only correlation

Question 20

risk and protective factors of stress

Answer 20

Meta analysis that found these trends
Focus on where we learn those → socially learned behaviors
Social Coping Factors

We learn our coping strategies and the way we perceive/deal with stress from our parents and our environment, which represents our culture

The buffering model by Cohen and Wills argues that social support acts as a “buffer” against the negative pathological effects of stress.
Social support may prevent the appraisal of stress (prevents us from identifying an event as being stressful)
If the event is deemed as being stressful and there is a physical or behavioral change due to stress, social support can lead to reappraisal, inhibition of harmful responses or help with coping

The main effect model proposes that social integration influences wellbeing in ways that do not necessarily require improved means of coping with stressful events - just being part of a group IS the coping strategy (the “you’re not alone effect”

embeddedness in a social network and social resources that are responsive to perceived stressful events had beneficial effects on well-being

Question 21

study for risk and protective factors of stress

Answer 21

Coan, Schaefer & Davidson’s

How social support may play a key role in stress reduction.

The sample consisted of sixteen married couples.
recruited by newspapers advertisements
First, participants were given questionnaires to assess their level of satisfaction and happiness in their marriage. In addition, personality traits were assessed. Finally, they were asked to do a test run in an fMRI scanner. This was done to make sure that they were comfortable with the scanner and to show them how it works.
The wives were put in an fMRI with an electrode attached to one ankle. While in the fMRI the women were shown 12 non-threat indicating images (safety cues) and 12 threatening images (threat cues) - that is, images that when shown, indicated that an electrical shock was possible
after the cue was shown, there was up to a 10 second period when a shock could be administered. During the experiment, two shocks were administered. After the threat period was over, there was a rest period
. During the rest period, they were asked for their rate their level of stress and their feelings of unpleasantness on a 1 - 5 scale.
This experiment was a repeated measures design.
Each woman would undergo the tests in the fMRI under three conditions: holding their husband’s hand, holding the hand of a stranger (whom they did not meet until after the experiment), or not holding anyone’s hand.
Results showed that the women’s subjective sense of unpleasantness and arousal was lowest when holding their husband’s hand. In addition, the brain’s “threat response” was lowest when holding their husband’s hand. The threat response was strongest when no hand was held. Not only this, by there was a negative correlation between the reported marital quality and the threat response - that is, the higher the reported marital quality, the lower the brain’s threat response. It appears that social support is key to resilience.

The study was highly controlled. The study was counterbalanced so that order effects such as habituation - that is, getting used to the shocks - was most likely not a confounding variable. This means that the study had high internal validity.
The use of subjective ratings of unpleasantness was used to correlate with brain activity. This helped to improve construct validity.
In addition to the high level of control, the study was highly artificial and thus lacks ecological validity.
Very small sample, low generalizability, done in the USA, low cross cultural generalizability

Question 22

evaluate sociocultural explanation of stress

Answer 22

Limitations
On the one hand, the sociocultural approach is a more holistic approach to understanding the effects of stress on health; however, it is also the case that it is much more difficult to establish cause and effect relationships.
The use of etic vs emic approaches
The difficulty of measuring stress under naturalistic conditions
Reliance on self-reports rather than physiological measures.
Questionnaires: lots of self reported data
Demand characteristics
No cause and effect, only correlation
How can we distinguish between subjective and objective need and support? Do virtual social networks like Facebook fit into this model? Are these results stable across varying socioeconomic status or culture?

Question 23

what is prevalence rate

Answer 23

how common a certain phenomenon is in a specific population, expressed as a percentage

Question 24

what is incidence rate

Answer 24

new cases diagnosed in a certain period of time within a population

Question 25

why is it important to know the prevalence rate of stress

Answer 25

Significant public health concern
help healthcare professionals and policymakers to understand the scope of the problem
Develop strategies and prevention methods to reduce stress related disorders
Improve productivity in the workplace
Better understanding of it from mental health problems
Individual awareness about the prevalence of stress
can be used to indicate if a behaviour is increasing

Question 26

why is it hard to measure the prevalence rate of stress

Answer 26

Stress is expressed and felt differently by everyone, many different factors that come into play, also influenced by culture
That is why it is hard to measure its prevalence

Question 27

explain how gender can affect prevalence rate of stress

Answer 27

Higher prevalence of elevated stress levels in women compared to men
Higher perceived levels of stress
Higher levels of stress related health complaints
May it be reporting bias? Do they just report more stress
Has been shown that men rate their self esteem as higher in general
Greater amygdala reactivity in women
Locus of control (whether a person believes if they have control over their lives) women have a more external locus of control: feel less control over their stressors.
Girls have higher rates of self-reported stress, men experience higher levels of acute stress
Testosterone might be the reason men have increased physiological responses to stress
testosterone might increase acute stress responses to any stressor that threatens or challenges social status

Question 28

study to support gender and prevalence of stress

Answer 28

Klonoff et al

Aim: To explore whether reported differences in anxiety disorders, depression, and somatic symptoms/disorders between males and females are due to gender-specific stressors.

255 students, state university, wide age range
Anonymous questionnaire:
Hopkins Symptom Checklist
Gives scores on 5 disorders: anxiety, depression, OCD, interpersonal sensitivity and somatization
And a total symptoms score

Female participants completed schedule of sexist events questionnaire
to measure the frequency of discriminatory or sexist events experienced by women in their lives and in the past year

Results:
women scored significantly higher on average than men on all symptom measures except for the obsessive-compulsive measure
total-symptom score was significantly higher
Women with higher SSE scores had higher stress symptoms scores
Women with low SSE scores did not differ significantly from men
Therefore only the women who had a high SSE score had significantly larger scores

Evaluation:

Strengths:
Questionnaire was including specific questions on physical disorders unrelated to stress to filter out those inclined to report a higher frequency of everything → minimise reporting bias
researchers also controlled for ethnicity, marital status, age, education, and income differences, again, finding no significant effect on results
Results support prior research on the same topic, suggesting the results are reliable

Limitations:
All participants were from the same university, which is not necessarily representative of a larger population
More women than men participating in the study → could affect the results
The Schedule of Sexist Events scale is not made for men yet, so the research does not address sexist discrimination experienced by men
This does not replace any type of clinical diagnosis
Still a risk of reporting bias → self reported data
Demand characteristics, since it is a questionnaire

Question 29

explain how culture/location could affect prevalence of stress

Answer 29

Stress and culture/location

Style of life
Climate and weather → sunlight, temperature etc
Safety → crime, natural disasters
Economic safety (healthcare, retirement
etc)
Socioeconomic status
Cultural norms and values
Work culture
How tight the family dynamic is
Stigma around mental health in that particular country

Question 30

study to support prevalence of stress and culture/location

Answer 30

Faresjo et al

Aim: to investigate whether stress levels measured by cortisol concentrations in hair were different between comparable Greek and Swedish young adults, considering the fact that Greece had been significantly more affected by the recent economic and social crisis than Sweden.

Researchers conducted a cross-sectional study among young adults from Greece (124 people )and Sweden (112 people)
all university students recruited from their local university

All participants were required to answer a questionnaire and give hair samples.
The questionnaire included questions on drug use, medications, serious life events (i.e. divorce, death in the family, unemployment), health status, and hope for the future.
It also included translated versions of The Hospital Anxiety and Depression Scale (HAD) and the Perceived Self-Rated Stress Scale. Levels of cortisol in hair were measured in a laboratory.

Results:
The Greek sample reported significantly more experiences of serious life events, higher perceived stress, higher scores on the depression and anxiety scales, lower scores for hope for the future, and more daily smoking
no differences between the Greeks and Swedes were found concerning self-reported health
After adjustments for differences in sex and age distribution, it was found that Greek cortisol levels were significantly lower than comparable Swedish levels.

There is clearly a strong relationship between a number of social stressors in Greece and higher perceived levels of stress
For the lower levels of cortisol, that can be adapted to the GAS (general adaptation syndrome) (describes the physiological changes the body experiences when under stress: alarm, resistance and exhaustion)

Evaluation:

Strengths:
Results were significant after careful control of variables and procedures
Use two methods: questionnaire and use of empirical evidence
give traction to the hypothesis of a possible biological mechanism through which cortisol levels might be suppressed after living in a stressful economic and social environment

Limitations:
sample was not representative of the overall population of either country, as it was only college-aged students from a single university within that country
Not equal number of males and females within each sample
correlational nature of the data, no establishment of cause and effect
other possible explanations for lower levels of cortisol in the Greek participants: warmer climate, more sunlight and other

Question 31

explain how race can affect prevalence of stress

Answer 31

Stress and race:

Stereotypes
Race related violence
Minority feeling
Discrimination
Also depends on the country where the study is done
Socioeconomic factors

Question 32

study that investigates race and prevalence of stress

Answer 32

Chae et al

Aim:
To test whether the combination of more frequent reports of racial discrimination and holding a greater implicit anti-black racial bias is associated with shorter leukocyte telomere length (LTL) among African-American men
shorter LTL is associated with several chronic diseases of ageing and earlier mortality

Method:
92 African American men
From the San Francisco area in the United States
brief face-to-face interview and had a minimally invasive physical exam to gather a dried blood sample by blotting people’s fingers on a piece of paper multiple times
also took the IAT (Implicit Association Test) to identify possible implicit racial biases, and a computer-assisted self-interview that gathered information on experiences of racial discrimination, psychological factors, and socioeconomic measures
Telomere length was measured twice for each participant, from DNA extracted from the dried blood samples

Results:
Only six participants (6.5%) reported not experiencing discrimination in any of the situations presented in the interview, other instances included: police, court system, getting a job, discrimination at work itself

37% had IAT scores indicative of an implicit anti-black bias

participants with a pro-black bias as shown by the IAT, there was a slight positive correlation between racial discrimination and LTL

among those with an anti-black bias, there was a negative correlation between racial discrimination and LTL
high discrimination experienced was correlated with shorter telomere length.

supports the idea that African-American men who have internalised a negative racial self-view might have a harder time psychologically and physiologically coping with the stress of racial discrimination, which in turn, can have detrimental effects on their physical health

Evaluation:
Limitations:
Only applicable to that specific population in that specific are, low cross cultural validity
Cross sectional design: limited ability to infer cause and effect
Worse health associated with LTL could result in greater perception of racial discrimination → bidirectional ambiguity
Other socioeconomic/cultural factors cannot be accounted for

Strengths:
Supports theories about minority stress, discrimination and poor health
Socioeconomic factors affect biological ageing
Empirical evidence: measuring telomere length
Increase reliability

Question 33

what are the limitations of using prevalence rates?

Answer 33

Limitations of using prevalence rate:
By the time appropriate data is collected and analysed the conclusions recommendations derived from these analysis may be out of date
Sample sizes may not be large enough to compensate for error in measurement
Self reported data, as well as clinical diagnosis may not be reliable

Question 34

what studies to use if you get the question: “Discuss one or more research methods used in the study of health problems.”

Answer 34

Research studies to use (taken from the ones above):

Coan, Schaefer & Davidson’s
Experiment
Triangulation: questionnaire + experiment

Marmot et al
Huge questionnaire

Question 35

what studies to use if you get the question: “Discuss ethical considerations in the study of health problems.”

Answer 35

Chae et al:
Possible indue psychological harm (remembering traumatic events) and the thing with the finger and the blood

Coan, Schaefer & Davidson’s
Possible undue stress and harm (threat of electric shock)