Psychology and Physiology of Stress and its Impact on Health

Question 1

What is the Curve of Human Function?

Answer 1

It was based on Yerkes-Dodson (1908) and was a curve describing eustress and distress.

Eustress is healthy amounts of stress and can lead to perfomance improvent.

When stress gets too much it is known as distress and can lead to fatigue, exhaustion, panic and breakdown and burnout.

Question 2

What are the 3 main types of physiological stress response?

Answer 2

the sympathetic nervous system response
the neuroendocrine response
the immune system response

they’re all highly complex and interrelated when we experience stressful event

Question 3

What is the amygdala and hypothalamus’ role in the stress response?

Answer 3

Sensory information from the eyes and ears stimulate the amygdala which interprets images and sounds.

This area of the brain contributes to emotional processing particularly emotions like fear and anxiety.

The amygdala then sends a distress signal to the hypothalamus which is a small area in the brain about the size of an almond and this is responsible for learning and memory.

Among other things anything that’s interpreted as a challenge or a threat can trigger a stress response and this response is extremely fast

The wiring is so efficient that the amygdala and hypothalamus start this cascade even before the brains visual centres have had a chance to fully process what’s happening, that’s why people are able to jump out of the path of an oncoming car even before they think about what they’re doing

Question 4

Describe the autonomic nervous system’s role in the stress response.

Answer 4

• stress response is controlled by the autonomic nervous system which has 2 branches - sympathetic and parasympathetic
• the sympathetic nervous system is responsible for rapidly preparing our bodies for response to threat and the parasympathetic nervous system which generally has the opposite effect and calms everything down again
• sympathetic - fight or flight response

Question 5

What happens in the fight or flight response physiologically?

Answer 5

• heart beats faster than normal pushing blood into the muscles and other vital organs
• pulse rate and blood pressure go up
• we start to breathe more rapidly small
• Airways in the lungs open wide this way the lungs can take in as much oxygen as possible with each breath extra oxygen is sent to the brain increasing alertness
• sight, hearing and other senses become sharper
• our pupils dilate to maximise our visual ability
• saliva is inhibited as the body shuts down the digestive system
• reproductive functioning is inhibited
• the temporary storage sites in the body released blood sugar ie glucose and fats which flood into the blood stream and there is vast increase in energy production and utilisation of nutrients to accommodate the increased energy demands

Question 6

Describe the sympathetic adreno-medullary (SAM) axis.

Answer 6

• perception of stress starts in amygdala (interprets sensory info) –> alerts hypothalamus
• HT stimulate pituitary gland which controls the release of hormones
• PG activates adrenal medulla just above the kidneys
  
  • secrete adrenaline and noradrenaline (epinephrine and norepinephrine) –> physiological stress response
• Once the ‘threat’ is over the parasympathetic branch takes control and brings the body back into a balanced state (homeostasis).

Question 7

What do adrenaline and noradrenaline cause?

Answer 7

↑ heart rate and blood pressure
↑ sweating, 
↑ respiratory rate & oxygen to brain
↑ alertness
↑ glucose metabolism

Question 8

What other catecholamines are released by the adrenal medulla and what do they do?

Answer 8

DOPAMINE: it has effect on regulating blood pressure by contracting smooth muscle in vasculature however it also has an effect on mood motivation and emotion reward
- it’s often known as the pleasure hormone and so up regulation or down regulation has an impact on emotional state

SEROTONIN:
this is known as the happy hormone and it has an active role in constructing smooth muscles but also contributes to the emotional regulation specifically to well being and happiness and social behaviours
- as the precursor of melatonin it also helps regulate the body’s sleep wake cycles and internal Clock whenever endocrine response is focused on the release of hormones which assist this process so the hypothalamus simultaneously activates the neuroendocrine cascade

Question 9

Describe the neuroendocrine cascade (HPA axis)

Answer 9

• HT produces CRH
• CRH promotes ACTH production in anterior part of pituitary gland
• ACTH stimulates adrenal glands to produce glucocorticoids e..g cortisol and mineralocorticoids e.g. aldosterone
• also release androgens too

Question 10

What do glucocorticoids and mineralocorticoids do?

Answer 10

GLUCOCORTICOIDS:

• they regulate blood sugar and help the body adjust to physical stress
• help us fight infections by regulating the magnitude and duration of the inflammatory response and maturation of lymphocytes
• reduce our sensitivity to pain and moderate mood specifically anxiety

MINERALOCORTICOIDS: regulate BP and sodium levels

Question 11

Describe the acute immune response’ role in stress.

Answer 11

The acute immune response in the first few minutes or hours prepares the body to fight off infection or deal with injury and one outcome of this is that production of white blood cells like T lymphocytes and phagocytes are increased

• however there are some negative aspects of this as it can lead to oxidative and free radical damage, tissue degeneration and cell death
• in order to control this the body also increases its production of anti inflammatory cytokines to aid healing and remove pathogens

Question 12

What is cortisol’s role?

Answer 12

• often known as stress hormone.
• utilization, storage and regulation of glucose
• regulation of BP
• learning, memory and emotion and immune function
• is a potent anti-inflammatory

Question 13

What is the effect of glucocorticoids in the instance of chronic stress?

Answer 13

in a long term situation where we face chronic stresses they can cause maladaptive responses and chronically high levels of glucocorticoids can lead to ill health

• the immune response can be compromised and dysregulated it may be upregulated or downregulated shutting down the immune response so you can’t fight off infection and you’re more susceptible to illness
• if the levels of stress hormones are too low the immune response may go unchecked and you could get an inflammatory disease high levels of cortisol can also inhibit healing and increase the impact of other damaging events like stroke prolonged epileptic seizures due to interference with calculation and inflammatory pose
• consistently raised levels of adrenaline can lead to increased anxiety depression or hypertension
• a person who is stressed may experience emotional responses like depression anxiety irritability and anger hostility and this may make them more likely to develop unhealthy behaviours to cope with the stress like smoking drinking addictions unhealthy eating etc
  
  • • may further compromise the immune system and make rules other health conditions like headaches infections illnesses like flu cardiovascular disease diabetes asthma gastric ulcers so stress has a physiological impact

Question 14

What is the link between stress and health?

Answer 14

• too much stress causes ill health and reduces quality of life
• illness often increases perception of stress
• stress leads to seeking medical treatment
• stress is an important cause of absence from work

Question 15

What are some statistics on stress as a work related illness?

Answer 15

Stress is the most common work related illness.
In 2018-19, 602,000 workers suffering from work-related stress (new or long-standing)

12.8 million (54%) working days lost to work-related stress, depression or anxiety

60% of absences extend to 7 days+ and the average absence is 21 days.

Women report 33% higher rates of stress than men, particularly in age groups 34- 44 and 45-55
Health professionals, public admin, defence & teachers have the highest prevalence of self reported work stress

In 2018 estimated over 165,000 NHS bed days per year with a cost to the public of £71.1 million
Costs to tax payer estimated to be £71.1 million in 2016/17.
UK economy - Lost output to employers £33-43 billion per year & lost tax/ national insurance £10-14 bilion per year to public purse.

Health and Safety Executive - Labour Force Survey 2018 -19 Great Britain http://www.hse.gov.uk/statistics/causdis/stress/

Question 16

What are the percentages of causes of stress, depression or anxiety?

Answer 16

• workload - 44%
• lack of support - 14%
• violence, threats or bullying - 13%
• changes at work - 8%
• other - 22%

(Labour Force Survey 2009/10-2011/12)

Question 17

What is the definition of (dis)stress?

Answer 17

a physical and emotional response to any situation that may be perceived as threatening or exceeding a persons ability to cope with it

(Lazarus & Folkman, 1984)

Question 18

Describe the study by Lazarus et al., 1965.

Answer 18

Cognitive appraisal of stressors

• measured how three different groups participants responded to film showing real life very gruesome industrial accidents in a sawmill (several other studies that have been done since they have replicated these findings)

Group 1 - shown film without any guidance or instructions
Group 2- told the film was based on real events but used actors
Group 3 - although events were real, they were shown for educational purposes.

Group 1 had the largest stress response

Question 19

What does appraisal do in terms of stress and what are the different types?

Answer 19

Appraisal moderates the threat.

Primary appraisal - external appraisal of outside world, assessing the stressor itself and demands it makes and examine it in the meaning of our welfare.

Secondary appraisal - involves our assessment of the resources we perceive we have available to manage for demands

primary and secondary pricing do not necessarily occur one after the other in a linear fashion they may influence each other and occur in parallel

depending on how successful my coping strategy has been the threat will either be reduced or increased

Question 20

What are problems with theory of appraisal?

Answer 20

Do we always appraise situations?
Traumatic incidents

Can we experience a stress response without
appraisal ?

Physiological indicators of stress present but subject
denies feeling stressed (denial or suppression)
negative health consequences

Question 21

What events can cause stress?

Answer 21

Traumatic –real threat of serious injury, accident, murder, rape, assault, abuse, war & combat, natural disasters, terrorist incidents – absolute stressors

Internal conflicts - relationship problems, abuse of power, jealousy, role changes, imaginary stressors (what if…) – relative stressors

Life events – marriage, bereavement, house move, important exams, change of job, going to University, birth of a child, sudden illness

Unpredictable events – getting fired, accidents

Everyday events – daily hassles, mishaps, loss of a wallet/keys, commuting, exams, social gatherings – low level stressors

Environmental - loud noise, high temperatures, increased levels of risk e.g. car crime, mugging, graffiti, litter

Question 22

What psychosocial demands can cause stress?

Answer 22

Threats to social status – public speaking, (fear of) failing exams, unemployment, divorce, retirement, experiencing a disability, mental health issues

Social esteem & respect – social position, professional status, class, retirement, carer

Self-worth – change in role motherhood/empty nest, change in employment – part time

Acceptance within a group – peer pressure, adolescence, bullying, stigma, diagnosis of a chronic illness (HIV)

Threats that we feel we have no control over - antisocial behaviour, neighbourhood noise, stalking, internet bullying, domestic violence

Question 23

What factors affect the level of stress?

Answer 23

Physical state – tiredness, illness, hunger, pain

Psychological – personality (agreeable, neurotic, openness, extrovert, conscientious) self-esteem, self confidence, shyness, hostility, resilience.

Social - gender, socio-economic group, education, support from family and friends, experience of abuse or neglect, deprivation.

Cultural - socially accepted behaviours, family values, religious values, cultural expectations.

Stress does not affect all people equally

Question 24

What characteristics make a situation more stressful?

Answer 24

Stressors increase when they are:

Uncontrollable

Unpredictable

Novel (new)

Have a social evaluative component

(Mason, 1968; Lupien, 2006)

Question 25

Give example of perception of control study.

Answer 25

Glass & Singer, 1972

2 groups of participants were asked to complete a set of problem solving tasks while exposed to a loud, very unpleasant noise:

Group 1 - could terminate the noise by pressing a button but asked not to unless absolutely necessary.

Group 2 - no control over the noise.

Results:
None of Group 1 pressed the button so exposure to the noise was the same for both groups.

Performance in subsequent problem-solving tasks was significantly worse for the group with no control indicating a higher level of disturbance by the noise.

Question 26

Describe Evans et al., study on Environment and Behaviour (2002)

Answer 26

Train commuters - suburban New Jersey to New York City during the morning rush hour.
Completed a questionnaire about stress
Salivary cortisol measured at baseline & on leaving train.

Commuters who rated aspects of their journey
as unpredictable reported more stress
and had higher cortisol levels

Question 27

What are the different approaches to stress?

Answer 27

Stress can be viewed as:

A response : General Adaptation Syndrome
Stress viewed as a response - the way we react to stressful stimuli.

A stimulus: Life Change Model
Stress viewed as something we encounter in our environment, something that happens to us

A process: Transactional Model
Stress viewed as series of continuous interactions
between an individual and the environment.

Question 28

Describe General Adaptation Syndrome (GAS)

Answer 28

Hans Selye (1956, 1976, 1985)

organisms display a series
of automatic, non-specific, universal,
physiological responses to stressors.

• focuses on the physiological response to stressors
• said that non specific physiological responses were displayed by all humans in response to stressors.
• deteremined that there are 3 stages:
  1. ALARM REACTION: physiological response, helps body to adapt to emergency stressors, but cannot maintain for very long because it’s physiologically expensive.

2. RESISTANCE: if stressor isn’t severe enough and remains, we start to adapt to it. Physiological arousal stays higher than normal, ability to withstand new stressors may be impaired. Therefore, become more vulnerable to other diseases - diseases of adaptation e.g. hypertension, heart disease.
3. EXHAUSTION: if we cannot escape the stressors, exhausrion occurs which may ultimately lead to death.

Question 29

What are the limitations of GAS?

Answer 29

Assumes an automatic response to an external stressor

All stressors do not produce the same uniform, physiological
responses. They are not non-specific.

Individual variability - No consideration to the influence of individual psychosocial factors

Question 30

Expand on different types of stressors causing different responses.

Answer 30

There are different types of stressors will produce different responses, short term stressors such as giving a presentation or a car crash will produce a acute response which will quickly return to homeostasis.

Stressors that continue for a few days (moderate term), like studying for exams, have a different effect and will influence functioning more. This may explain why students often become sick after exams because during the stressful revision period they have increased immunity which then largely disappears when the exams are over.

In the context of chronic stress such as a difficult long term relationship the body is unable to go back to homeostasis and the prolonged stress response has a negative impact on almost all aspects of immune functioning. This makes the individual more likely to get ill, particularly if they are already vulnerable (elderly) or have pre-existing disease.

We haven’t evolved yet to survive psychological stress so our current stress response, which is very adaptive to escape predators, becomes maladaptive. This is especially true when stressors go on for significant periods of time.

Question 31

What are some research findings of stress impact on physiology and immune response?

Answer 31

• Stress and cardiovascular disease (2012) Steptoe & Kivimaki Nat Rev Cardiol 9: 360-370
• Permanent ‘stress’ at work or home associated with >2.1 times the risk of Myocardial Infarction (Interheart study 2004)
• Increased blood pressure reactions to acute mental stress are associated with 16‐year cardiovascular disease mortality Carroll D et al (2012) Psychophysiology 49 (10): 1444-1448
• Stress, memory and the hippocampus Lupien & Lepage (2001) Behav Brain Res 127:137-158 Learning under stress: how does it work? (Joels et al, 2006) Trends in cognitive sciences 10(4):152-158
• Delayed wound healing - Medical student volunteers received small wound to the roof of the mouth - healed more slowly during exams than during holiday periods (Marucha et al, 1998 Psychsom Med 60:362-5)
• Poorer antibody responses to influenza virus vaccine compared to matched controls in longterm carers of Alzheimer’s patients (Kiecolt-Glaser JK et al (1996)
• Dose dependent relationship between stress and clinical symptoms in healthy volunteers inoculated with respiratory viruses Cohen et al (1991) N Eng J Med 325:606-612
• Stress and social support affected virus specific antibody and T-cell responses in medical students inoculated with Hep B vaccine taking exams (Glaser R et al, 1992, Psychsom Med 54:22-29)

Question 32

What has research found about oxytocin and stress?

Answer 32

Fight-Flight response may be more relevant to males
than females.

Females are more likely to show tend and befriend responses
Turning to the group for safety – importance of close social
network, bonding, protection of young, nurturing behaviour.
Biological mechanism - Oxytocin (Taylor et al (2000))

Charitable behaviour -Role of oxytocin in buffering stressful
events (Poulin & Holman, Horm Behav. 2013 Mar;63(3):510-7)

Volunteering has stress buffering effects for those with positive
views of others (Poulin, M. J., & Holman, E. A. Health Psychol. 2014 Feb;33(2):120-9.

Question 33

What is the Diathesis-Stress model?

Answer 33

DIATHESIS - genes

• abnormalities of brain structure of functioning
• neurotransmitters (all lead to vulnerability to psychological disorders)

STRESSORS:

• noxious physical stressors
• trauma, abuse, neglect
• relationships - loss, turbulence
• culture related stressors

This model is used to explain behaviour as a result of biological (nature) and life experiences (nurture).

vulnerability or predisposition interacts with the environment and life events or stresses the trigger behaviours will cycle
- the greater the genetic vulnerability, the less stress needed to trigger behaviour

Question 34

What did Brummett et al find (2013)?

Answer 34

About one in 10 people have a genetic change linked to being more sensitive to stress

A stress gene has been linked to having a higher risk of dying from a heart attack or heart disease.

Heart patients with the genetic change had a 38% increased risk of heart attack or death, say US researchers.

Personalised medicine may lead to better targeting of psychological or drug treatment to those most at risk, they report in PLOS ONE.

The study adds to evidence stress may directly increase heart disease risk, says the British Heart Foundation.

Question 35

Describe the Life Change Model.

Answer 35

Stress = the amount of adjustment or number of life changes a person is faced with in a certain timeframe e.g. moving house, bereavement, a new job.

Measured using checklists
of life events occurring within a specified
timeframe.

Question 36

What are some research findings that mortality increases following bereavement?

Answer 36

Death of a child aged 10-17 years was associated with 31% increase in mother’s
subsequent risk of all cause mortality (Rostila et al, J Epidemiol Community Health2012;66:927-933)

Anniversary reactions - Increased mortality risk among mothers who lost a child
aged 1 – 17yrs during anniversary of week of death CVD and suicide most common cause of death. ( Rostila et al, Eur J Epidemiol (2015) 30:239–247)

Spousal mortality increases following bereavement, particularly if the death was unexpected (Shah et al, 2013)

Frequency of life events and stress load associated with all cause mortality (Phillips et al, 2008, Health Psychol 3(4); 647-657)

Stressful life events are associated with changes in immune response (Philips A et al, 2005, Brain, Beh Immun 20:191-197, Phillps A et al 2006, Brain, Beh Immun 20:279-289)

Chronic illness: In individuals with Multiple Sclerosis (MS) the greater the number of acute life stressors the more likely the relapse (Brown, Tennant, Sharrock, Hodgkinson, Pollard, 2006; Buljevic D et al, 2003, BMJ 327:646-650)

Life event stress was associated with more depressive symptoms and worse quality of life in individuals with Chronic Obstructive Pulmonary Disease (Lu Y, BMJ Open, 2012;2)

Question 37

How is the Life Change Model limited?

Answer 37

People react differently to similar events - Can we say a stimulus (e.g. divorce) is always stressful?

Recall - People who are ill are more likely to look for a cause and attribute it to stress.

Severity - e.g. death – sudden or expected? circumstances

Restricted range – disasters omitted, non-events (e.g. not becoming pregnant, being overlooked for promotion)

Moderating variables (e.g. social support, economic situation) are not considered

Ignores relationship between stressors (major events can trigger minor ones and vice versa). Difficult to establish causality – life event result from illness or vice versa

Ignores role of psychological processes (coping) – people are not passive.

Question 38

Describe The Transactional Model of stress.

Answer 38

(Lazarus & Folkman, 1984)

Stress is a process/series of transactions

Appraise stressor – primary & secondary appraisal

Adopt a coping strategies

Re- appraise stressor in the light of the coping strategy

Assumption: Stress results if the perceived demands outweigh the perceived coping resources

Question 39

What is coping defined as?

Answer 39

An attempt to manage perceived demands that cause stress. (Lazarus & Folkman &, 1980)

Aim is to reduce stress and maximise chances of recovery

Question 40

What the two ways coping can be split up into?

Answer 40

1- Coping styles - seen as a trait (Roth & Cohen, 1986)

  - important medically
  - approach (where someone wants tp know everything about the illness) vs avoidance (if you tell them too much too soon, may go into denial or become confused)
  - people have a tendency to use one style or another 

2- Coping strategies - seen as a state

  - can be emotion-focused - when situation can't be changed
  - problem-focused (action coping) - in a changing situation

Question 41

How can coping strategies be split and give examples?

Answer 41

Both problem focussed and emotion focussed can be split into behavioural and cognitive

PROBLEM FOCUSSED - 
- BEHAVIOURAL:e.g. 
Attempts at control
Pro & cons 
Time management
Confrontation
Escape/Avoid
Assertiveness training
- COGNITIVE:
e.g. 
Information seeking/avoiding Positive reappraisal
Goal setting
Catastrophising Over-generalising
Selective attention

EMOTION FOCUSSED - 
- BEHAVIOURAL: 
e.g. 
Seeking support 
Emotional expression
Distancing 
Distraction by activity
Journaling 
Alcohol, exercise
Eating, alcohol, drugs

• COGNITIVE
  e.g.
  Denial
  Inhibition
  Suppression
  Cognitive re-appraisal
  Praying
  Drug therapy
  Suppression

Question 42

What do adaptive coping strategies do?

Answer 42

Reduce demands (e.g. problem solving, adjust/change goals, improve time management)

Increase resources (e.g. social support, skills, finance, confidence)

Dampen the physiological stress response (e.g. relaxation, meditation, exercise)

Psychological processes (e.g. re-structuring, appropriate goal setting, rehearsal/preparation, short term denial and avoidance can avoid feeling overwhelmed)- improve mood.

Question 43

What are the strengths of The Transactional Model?

Answer 43

Cognitive approach – not limited to physiological processes
Takes psychological and emotional responses into account
Dynamic – we can evaluate and change coping strategies
Allows individuals to change their minds and find alternative strategies
Allows for circumstances and situations to change
Acknowledges individual differences
Suggests individual have control over the response

Question 44

What are the limitations of the Transactional Model?

Answer 44

Lack of empirical evidence – difficult to test - subjective

Variability and complexity of individual stress – subjective
perception

Difficulty differentiating factors that determine stress - subjective

Pre-existing factors may influence appraisal (depression, anxiety)

Primary and secondary appraisals may interact and overlap

Stress response may not depend on appraisal

Question 45

How is social support related to stress and what are the different types?

Answer 45

It increases resilience to stress

Emotional

Esteem support (feel better about ourselves)

Informational

Companionship (prevents isolation and inactivity)

Instrumental (practical help)

– important moderating factor