Stress Flashcards
What are the compartments of stress ?
Stress has both physiological and psychological compartments
What is stress ?
(Lazarus and Folkman, 1984)
EXAM TYPE Q
The perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation.
Feelings associated with stress
Feeling of lack of control
Unpredictability
State the 3 major theories that explain stress
- Stimulus
- Response
- Transaction (person and environment)
Describe the theory of stress as a stimulus
Focus on the environment
Event or circumstance is the cause of stress
Event or circumstances are known as ‘stressors’
Give an example of stress as a stimulus
Working with chronically ill patients is stressful
OR
My illness is causing me stress
Describe the theory of stress as a response
Focus on individual’s reaction to stressors
Physiological response
Psychological response
Responses are known as ‘strain’
Give an example of stress as a response
I feel a lot of stress just before my OSCE
OR
I find breaking bad news to a patient stressful
Describe the theory of stress as a transaction
Focus on stress as a process
Relationship between the person and environment
Continuous interactions and adjustments
- ‘transactions’
Give an example of stress as a transaction
Person in the active agent who can influence the impact of stressor
‘Stress // challenge before the OSCE ??’ - coping
Stress Appraisal types
Cognitive Appraisal
- Primary appraisal (danger?)
- Secondary appraisal (coping)
What causes a primary appraisal ?
Stimulus
Pathways of primary appraisal
(LEADS TO NO FURTHER COPING)
Benign appraisal
Irrelevant appraisal
+ve Appraisal
(LEADS TO SECONDARY APPRAISAL - coping)
Stimulus appraised as harm, loss or threat
-> Stimulus appraised as a stressor
Results of secondary appraisal
Seeking information
Taking direct action
Doing nothing
Worrying
Who created the ‘Stress-coping’ paradigm ?
Lazarus, 1980
- uses cognitive appraisal
- primary and secondary appraisal
Key feature of stress
Demands are greater than the ability to cope
It is a consequence of the cognitive/thinking process
What do stressors impact ?
Stressors have an impact on the different systems
- Physiological system
- Psychological aspect
- Social aspect
Impact of stressors on physiological system
Sympathetics NS
Endocrine System
Fight or Flight response
General Adaptation Syndrome
Impact of stressors on psychological aspect
Cognitive functioning
Emotion
Impact of stressors on social aspect
Social behaviour
Gender
Socio cultural differences
State the 2 physiological models of stress
Fight or Flight response (Cannon 1932)
General Adaptation Syndrome (Seyle, 1956)
Fight or Flight response
Cannon 1932
- acute/ short-term
Physiological reaction to emergencies - ‘adaptive’ response
Describe features of the ‘Fight or Flight’ response
Homeostasis threatened, disrupted
Response to acute, short lived stress
External threats elicit fight or flight response
Increased physiological arousal
Enable Fight or Flight response and restore homeostasis
BUT prolonged state of high arousal harmful to health
General Adaptation Syndrome
Seyle, 1956
- chronic/ long-term
Describe General Adaptation Syndrome
Stressor results in:
- ALARM
(mobilisation to fend off threat/stressor) - RESISTANCE
(continued fight against stressor) - EXHAUSTION
(depletion of resources, ability to resist may collapse)
[chronic/long-term]
Stress Response features
2 Step Physiological response
- Sympathetic activation
- Hypothalamic pituitary adrenocortical (HPA) activation
Sympathetic activation
Under stress; SNS activated
- catecholamines produced (adrenalin / noradrenalin)
- quick response system (within seconds)
Hypothalamic pituitary adrenocortical activation
HPA activation
Increased levels of corticosteroids (cortisol)
Raised levels of brain opioids beta endorphin & enkephalin
Slower response system (minutes to hours)
Where does short-term stress response originate from ?
Medulla
- neuron of sympathetic nervous system
Where does long-term stress response originate from ?
Cortex
- anterior pituitary gland
Describe long-term stress response
Retention of sodium and water by the kidneys
- increased blood volume, BP
- Increased blood sugar
- Decreased immune system
Describe short-term stress response
Increased:
- Heart rate
- BP
- Metabolic rate
Changes in blood flow
Dilation of bronchioles
Neuroendocrine cascade
Stress and the Adrenal gland
State the typical signs of stress
Biochemical
Physiological
Behavioural
Cognitive
Emotional
Implications of stress
Stress has been linked directly and indirectly to health outcome.
Stressors
Stressors are events or circumstances that we perceive as threatening or harmful.
Why do responses to stress vary ?
Stress moderators
Stress moderators
Coping strategy
Social support
Beliefs and attitudes
Personality
Sense of control
Stress reactivity
Genetic predisposition (PTSD)
Lifestyle
Causes of stress in junior doctors
Long working hours
Work load
Feeling overwhelmed
Emotionally demanding patients
Results of junior doctor stress
Making mistakes
Serious treatment failures
Effects of work on personal life
Statistics related to stress in junior doctors
Proportion of medics showing high stress 28% compared to other occupational groups 18%.
Moderate mistakes caused due to stress related error (around 40%)
Burnout
Symptomatically similar to stress
Attributed to occupational stressors
Features of burnout
Emotional exhaustion
Depersonalisation
Personal Accomplishment
The Covid 19 pandemic and healthcare workers wellbeing
HCWs internationally experienced:
- Increased depressive symptoms
- Anxiety
- Psychological stress
- Poor sleep quality
Health effects of long term stress
CHD
MI
Hypertension
Compromised immune function
Depression
Asthma
Headache
Eczema
Peptic ulcer
Health behaviour
Risk behaviours
Health compromising behaviours
Cognitive
Emotional
What was the leading cause of death worldwide in 2019 ?
Coronary Heart disease
Stress is implicated to CHD
How is psychological stress assessed ?
Stress at work
Stress at home
Financial stress
Major life events in past year
Stress and MI study
INTERHEART study
Rosengren et al, Lancet 2004
Summary of results of stress and MI study
Evidence for association between psychosocial stress and increased risk of acute MI
Effect of stress is independent of SES, smoking
Consistent effect across geographic regions, in different age groups, and in men and women.
Risk factor for CVD - cardiovascular disease
Work stress
Risk factor for Coronary artery atherosclerosis
Social stress
Stress and cardiovascular reactivity
Stress induced increase in catecholamine and corticosteroid release
This can damage the arteries and heart
- promote atherosclerosis, increased HR
- leads to development of hypertension
- coronary heart disease
How is immune functioning impaired ?
Impaired by:
- Physiological response to stress
- Psychological state, emotion and beliefs
- Psychosocial factors
Physiological response to stress
Increased catecholamine and corticosteroid release
Decreased immune cell activity against antigens
Linked to development of infectious disease, cancer
Psychological state, emotion, beliefs
Depression, Optimism also influence immune response
Denial, Fighting spirit predicted survival breast cancer pts
Psychosocial factors
Life events, Social support, Exercise, Lifestyle…
Stress and wound healing
Slowing of wound healing by psychological stress
-wound healing took 24% longer in caregivers
-caregivers reported > stress
Keicolt-Glaser et al., Lancet 1995
Indirect effects of stress on health
Health-related behaviours:
- increased substance abuse
- increased smoking
- poor diet
- lack of sleep
- poor adherence to treatment
increased engagement in reckless behaviour
What is a peptic ulcer linked to ?
Psychosocial stress
