Stress

Question 1

definitions

Answer 1

• Stress = A cognitive perception of uncontrollability and/or unpredictability that is expressed in a physiological and behavioural response.
  
  • Stressor = An unpredictable and/or uncontrollable stimulus.
    Stress response = The array of physiological responses activated to help the body return to its normal state.

Question 2

psychological stressors

Answer 2

• Most animals respond to external stressors. For example, prey escaping predator.
  
  • Humans now have a variety of stressors, most of which are exacerbated by internal psychological processes e.g., rumination.
    We anticipate threat as well as face it.

Question 3

types of stressor

Answer 3

Lazarus (1966): Stress is the relationship between the person and the environment that is appraised as personally significant and as taxing or exceeding resources for coping.
acute short term stressor: stuck in traffic, argument with partner
chronic (long term) stressor: chronic health condition, unsatisfied with career

Question 4

stress responses

Answer 4

physical: back pain, breathing problems, dizziness, fatigue
emotional and cognitive: apathy, anger, forgetfulness, depression
behavioural: chain smoking, excessive drinking, teeth grinding

Question 5

general adaptation syndrome

Answer 5

• identified by Hans Selye
• our stress response system defends then fatigues
• phase 1: alarm reaction (mobilise resources)
• phase 2: resistance (cope with stressor)
• phase 3: exhaustion (reserves depleted)
• body reacts with a flight or flight response
• body then resists and compensates- tries to return to normal state
• resources are then exhausted- body is susceptible to disease/death

Question 6

does the body respond to physical and psychological stress in the same way?

Answer 6

• Hans Selye (1907-1982) is widely credited with defining the concept of “stress” through his General Adaptation Syndrome theory
  
  • Central arguments = psychological stressors induce the same general stress response as physical stressors
  • This is partially correct, lots of different psychological stressors (e.g. losing a job) can act like physical stressors
  • However, stress responses are complex and varied
  • Exact responses depend on the stressor, it’s timing and how the stressed person reacts to the stressor
    Social support may have a ‘stress buffering’ effect (Hostinar, Sullivan & Gunnar, 2014)

Question 7

stress response- phase 1

Answer 7

• distress signal to the hypothalamus
• sympathetic nervous system triggers fight-flight-freeze response
  -adrenal glands pump epinephrine and norepinephrine
• heart beats faster to pump blood to vital organs, epinephrine causes the release of glucose and fates to supply to muscles

Question 8

stress response- phase 2

Answer 8

• HPA axis is activated
  -CRH travels to the pituitary gland, triggering the release of ACTH
  -ACTH reaches the adrenal glands and prompts the continued release of cortisol
• the body stays on high alert until the threat passes
• cortisol levels fall so that the parasympathetic nervous system can re regulate the body

Question 9

maintaining balance

Answer 9

Homeostasis = a self-regulating process whereby an organism tries to maintain stability, while adjusting to conditions. If homeostasis is successful, life continues.

Question 10

allostasis and allostatic load

Answer 10

• Allostasis = the process of maintaining homeostasis through the adaptive change of the organism’s internal environment to meet perceived and anticipated demands.
  
  • Where homeostasis is about static regulation (e.g. around a fixed set point), allostasis is about dynamic adjustment and how the body changes its internal environment to cope with external demands
    Allostatic load = the price the body pays for being forced to adapt to stressors, and it represents either the presence of too much stress or the inefficient operation of the stress hormone response system (McEwen, 1998).

Question 11

allostatic load

Answer 11

• Allostatic systems are:
  ○ Overworked.
  ○ Fail to shut off after stressful occasions.
  ○ Fail to respond adequately to challenge.
  
  • Other systems have to react.
  • An important aspect of allostasis and allostatic load is the notion of ANTICIPATION [worry and/or anxiety].
  • Cardiovascular system, metabolic machinery, immune system and central nervous system – large range of activity (allostasis).
  • Most useful when they can be rapidly mobilised and turn off suddenly (when not needed).
  • Inability to activate is also a problem – doesn’t offer protection afforded by the system
    Wear and tear on the body and brain resulting from chronic over activity or inactivity of physiological systems that are normally involved in adaptation to environmental challenge.

Question 12

psychosomatic ulcers

Answer 12

• Psychological causal role. Gastric ulcers one of the first classified as psychosomatic.
  
  • However, are these caused by bacteria; Helicopter pylori?
  • Helicopter pylori alone insufficient to produce ulcer (see Plummer et al. 2014; Testerman & Morris, 2014).
    ○ Antibiotics and psychological treatments improve gastric ulcers; so stress must be important?
    ○ Also, stomach wall more damaged from Helicopter pylori in presence of stress.
    More common in people living in stress situations + evidence in laboratory rats.

Question 13

other health effects of stress

Answer 13

• survivors of concentration camps (long term stress)- poorer health than others further down the line
• air traffic controls (especially busy airports) greater incidence of high blood pressure
• subway train drivers more likely to suffer illness after tragedy

Question 14

why do we get sick?

Answer 14

• Most basic level - inefficient. Lose chunk of potential energy.
  
  • Muscles can waste away (rare). Muscle full of protein – constant break down of protein never allows muscle to repair.
    Tonnes of fat and glucose perpetually circulating in your bloodstream.

Question 15

psychoneuroimmunity

Answer 15

• Stress can increase susceptibility to infectious disease. Led to a new field (1970’s).
  
  • Emotion, immunity and disease (Soloman & Moss, 1964)
    ○ Psycho – psychological processes
    ○ Neuro – neuroendocrine system (i.e., nervous and hormonal systems)
    ○ Immunology – immune system
    Interaction between nervous and immune systems and relations with behaviour + health

Question 16

stress and immune function

Answer 16

• Acute stress
  ○ Can boost some immune functions temporarily.
  ○ Example: immune cell redistribution to sites of potential infection (an evolutionary adaptation to injury or infection
  
  • Chronic stress
    ○ Leads to suppressed overall immune function
    ○ Alters cytokine production, potentially worsening allergic and autoimmune diseases and reducing defence against viruses and cancer cells
    Common in situations like caregiving, chronic illness or unemployment

Question 17

what affects cognitive appraisal

Answer 17

mood
motivation
personality

Question 18

is optimism always protective?

Answer 18

• Studies have found that optimism is correlated with better physical health compared to pessimism (Conversano et al, 2010)
  
  • Giltay et al (2004) found that older adults (aged 65+) with higher dispositional optimism had lower all-cause mortality and cardiovascular mortality
  • Optimism did not predict lower mortality among lung cancer patients (Schofield et al, 2004)
  • When stressors are more complex or uncontrollable, optimism may lead to poorer immune function (Segerstrom, 2006)
    Higher effort and energy that optimists invest in overcoming these challenges may drain their resources, leading to immune suppression

Question 19

pathways from stress to disease- lifestyle mediators (smoking to cope with stress)

Answer 19

• Fidler and West (2009)
  ○ Enjoyment and stress relief were the most reported motives (51% and 47%, respectively).
  ○ Women reported stress relief and weight control more often than men, whereas men were more likely to report enjoyment and liking being a smoker.
  ○ Older smokers reported enjoying smoking and liking being a smoker more than younger smokers.
  
  • Osman et al. (2018)
    ○ The intensity of cigarette smoking is correlated with job stress.
    ○ It is hypothesised that unfavourable work environments and adverse psychosocial work conditions may play important roles in increasing smoking intake.
    ○ This increase in smoking was associated with reduced sperm quality.
  • Smoking may also worsen stress (Parrott, 1999)
    ○ Smoking is reliably associated with poor mental health
    Nicotine withdrawal can cause irritability, anxiety and depression, which are relieved by smoking

Question 20

pathways from stress to disease- lifestyle mediators (drinking to cope with stress)

Answer 20

• Rice and Van Arsdale (2010)
  ○ Drinking was found to be a coping mechanism for stress.
  ○ This result was specific to maladaptive perfectionists.
  ○ Higher stress was associated with fewer alcohol-related problems among non-perfectionists.
  
  • Wardell et al. (2020)
    ○ Looked at alcohol to cope during COVID-19.
    ○ Having at least 1 child under the age of 18, greater depression, and lower social connectedness each predicted unique variance in past 30-day coping motives.
    ○ Income loss was associated with increased alcohol use
  • Alcohol (and other drugs) can increase biological stress responses (Wemm and Sinha, 2019)
    ○ Acute alcohol consumption stimulates the HPA axis, increasing cortisol and ACTH
    ○ Alcohol also increases ANS activity, leading to elevated epinephrine and norepinephrine
    ○ Persistent binge drinking can alter stress systems causing elevated basal cortisol
    Lower heart rate variability indicates less adaptability

Question 21

pathways from stress to disease- lifestyle mediators (poor sleep)

Answer 21

• Dhalgren et al. (2005)
  ○ Participants in a high stress week (HS) vs. a low stress week (LS).
  ○ In the HS condition, participants reported a decrease in total sleep time which was mediated by cortisol levels.
  
  • Kloss et al. (2015)
    ○ Stress and sleep dysregulation lead to circadian misalignment.
    This misalignment can lead to infertility in women.

Question 22

poverty, stress and disease

Answer 22

• income, occupation, housing conditions, education: lack of control and predictability, career spent taking orders/ temporary work
• manual labour and a greater risk of work related accidents: unemployment
• 2/3 exhausting jobs: no resources in reserve (no buffer- reactive)

Question 23

social support

Answer 23

• (Hostinar, Sullivan & Gunnar, 2014)
  
  • Social support (e.g. social integration, perceived emotional support, positive interactions) can buffer stress responses
  • Seen in both animal and human studies
  • Sources of support (caregivers, peers, partners) can:
    ○ Dampen stress responses
    ○ Reduce cortisol levels
    ○ Reduce stress-related behaviours
  • Examples of stress buffering
    ○ Clear examples – financial help from a friend can remove stressors
    ○ Less understood phenomena – the mere presence of a peer or conspecific can reduce stress hormones, when confronted with a stressor
  • Gaps in research
    Mechanisms behind positive outcomes are not fully understood, more research is needed to clarify how and why social support works at a biological level

Question 24

other theories of stress

Answer 24

• Diathesis-stress model (Zuckerman, 1999)
  ○ interacting factors jointly determine susceptibility to stress and illness.
  ○ Predisposing factors (person’s vulnerability; genetic).
  Precipitating factors (environmental).
  
  • Tend-and-befriend theory (Taylor, 2012)
    ○ Humans, particularly females often respond to stress by protecting offspring (tending) and seeking others for mutual defense (befriending)
    ○ When social interactions are comforting, stress levels decrease
    ○ Men (fight-flight, hunting and defending against danger).
  • Criticism
    ○ Oversimplification of gender differences? Both men and women can exhibit fight or flight and tend-and-befriend responses (context-dependent?)
    ○ Cultural and social influences – in societies where caregiving and nurturing are more strongly associated with female roles

Question 25

coping- problem based vs emotional based

Answer 25

• directly confront the demands
• problem diagnosis/solution generation e.g. changing goals, seeking advice, effective time management
• manage/ regulate the emotional response
• behavioural strategies e.g. venting anger, drinking, seeking emotional support, accepting responsibility
• cognitive strategies e.g. reappraisal, acceptance, denial, reality distortion

Question 26

coping- self awareness

Answer 26

• Becoming self-aware of your responses to stress can help with cognitive re-appraisal.
  ○ For example, keeping a stress diary.
  
  • Other methods include meditation and mindfulness.
  • Szabo & Hopkinson (2007)
    ○ 15-minute news broadcast; next, 15 mins of either
    ○ progressive relaxation exercise OR
    ○ lecture (attention diverting distraction)
    ○ After news broadcast: Higher state anxiety and total mood disturbance; positive affect lower.
    Relaxation reduced levels to baseline. Lecture didn’t.

Question 27

summary

Answer 27

• Allostasis and allostatic load
  ○ The body’s attempt to maintain stability through change
  ○ Allostatic load = the physiological wear and tear due to repeated stress exposure
  
  • Negative health effects associated with chronic stress
    ○ Cardiovascular disease and hypertension
    ○ Gastric ulcers
  • Direct and indirect pathways of how stress influences health outcome
    ○ Direct = elevated stress can suppress immune function, wound healing, cardiovascular disease
    ○ Indirect = elevated stress can lead to changes in behaviour (smoking, poor diet, alcohol consumption, reduced sleep, reduced exercise)
    ○ These indirect effects can also worsen stress (e.g. smoking and alcohol consumption can actually worsen stress)
    ○ They can also potentially improve stress (increased exercise improves stress responses)
  • Psychoneuroimmunology and mechanisms
    ○ Interaction between nervous and immune systems and relations with behaviour and health
    ○ Acute stress can temporarily boost immune function, chronic stress generally suppresses it
    ○ Immune responses vary based on individual factors e.g. coping strategies, optimism, age, pre-existing health conditions
    ○ Context matters – different types of stressors (e.g. bereavement, trauma) can produce different immune responses.
  • Factors moderating individual stress responses, who might be more vulnerable to experiencing stress?
    ○ Cognitive appraisal – interpretation of stressor (Lazarus and Folkman, 1984)
    ○ Individual differences can influence cognitive appraisal – e.g. optimism
    ○ Optimism may not be protective when stressors are complex or uncontrollable
    ○ People with different behavioural risk factors may be more susceptible to stress, and associated health outcomes e.g. smoking, sleep, alcohol consumption
    ○ Some behavioural factors might be protective – e.g. exercise can reduce stress
    Social support may also ‘buffer’ the stress response e.g. social integration, perceived emotional support, positive interactions

Question 28

ways of measuring allostatic load

Answer 28

• Markers of physiological dysregulation
  
  • Each marker serves a distinct functional purpose in the calculation of allostatic load as a measurement for the burden of stress on the body
    Rodriquez, E. J., Kim, E. N., Sumner, A. E., Nápoles, A. M., & Pérez-Stable, E. J. (2019). Allostatic load: importance, markers, and score determination in minority and disparity populations. Journal of Urban Health, 96, 3-1

Question 29

discrimination and stress

Answer 29

• Discrimination = the unjust or prejudicial treatment of different categories of people, especially on the groups of race, ethnicity, age, sex, or disability.
  
  • Discrimination can be a stressor, and often exceeds the individuals coping resources leading to psychological and physical stress
    Cognitive appraisal plays a key role in determining how stressful a discriminatory event is perceived. Appraising discrimination as central to self-concept (or feeling personally targeted), amplified stress responses (King, 2005).

Question 30

race based discrimination

Answer 30

• Geronimus et al., 2005
• Weathering hypothesis = chronic exposure to social and economic adversity and political marginalisation leads to early health deterioration.
  
  • Primarily affects Black individuals due to persistent stress from living in a race conscious society.
    Racial disparities in allostatic load scores are not fully explained by poverty. Non poor Black individuals have higher allostatic load scores than poor White individuals
• strengths: longitudinal design, controlled for sociodemographic measures
• limitations: small sample, underlying mechanisms unclear

Question 31

weight based discrimination

Answer 31

-Vadiveloo & Mattei
- Results:
- Individuals who experienced weight discrimination had twice the risk of high allostatic load compared to those who did not.
- This effect persisted after controlling for obesity.
- Small (5%) mediation effect of physical activity.
- Conclusion: Weight stigma may contribute to physiological dysregulation and increase risk of chronic diseases.
- Limitations:
- Lack of dietary data
Sample was majority white (93%) and female (57%)

Question 32

sexual minority discrimination

Answer 32

Juster et al
Aim: Investigate how state-level policies related to sexual minorities (structural stigma) are associated with allostatic load in lesbian, gay and bisexual (LGB) individuals
- Strengths
○ Focused on structural stigma, an underexplored area
○ Largest representative national survey in the United States that measures sexual orientation and biomarkers
- Limitations
○ Sample size for analysis – relatively few sexual minority women, potentially underpowered
○ Structural stigma measured dichotomously, may reduce sensitivity of the analysis
○ No direct measurement of experiences of stress or discrimination

Question 33

indirect pathways- are discrimination and stress related to coping behaviours?

Answer 33

• As discrimination increases, alcohol consumption, drinking-related problems and risk of disorders tends to increase.
  
  • Largest proportion of papers looked at racial discrimination
  • Sexual orientation discrimination was the second most frequently studied topic
  • Several studies found gender moderates the relationship between discrimination and alcohol outcomes
    Studies on structural and systemic discrimination and alcohol consumption are an important gap in the literature

Question 34

alcohol use among minority groups

Answer 34

• Patterns of alcohol use among racial and ethnic minorities in the United States do not correspond to what would be predicted in a straightforward way
  This is an ongoing area of research!
• Although Black Americans consume less alcohol overall compared to White Americans, they face higher risks for severe alcohol related problems including Alcohol Use Disorder symptoms and related medical illnesses
• This study shows that more frequent experiences of racism predicted greater alcohol-related problems, and this relationship was mediated by emotional distress from racism and drinking to cope
  First study to evaluate the impact of negative emotionality in response to racism with coping behaviours (links to core lecture topics about individual differences in appraisal of stress)