Stress Flashcards
(259 cards)
1
Q
What is stress?
A
A state of stress is defined as existing when there is an imbalance between perceived demands and perceived coping responses.
2
Q
What is a stressor?
A
A stimulus or situation imposing demands on an individual.
3
Q
What is a transactional model?
A
A model of stress that defines stress as an imbalance between perceived demands on an individual and their perceived coping resources.
4
Q
What is primary appraisal?
A
The person appraises or assesses the situation to identify potential threats or demands.
5
Q
What is secondary appraisal?
A
The person appraises their ability to cope with a threatening situation.
6
Q
Where was the term ‘stress’ introduced into psychology?
A
From mechanical engineering, where it referred to the tension placed on metals by heavy loads.
7
Q
What did Selye (1956) study on stress do?
A
He first noted that rats given repeated daily injections developed gastric (stomach) ulcers. He then wondered whether it was the stress of the injections themselves or what was injected that produced the ulceration. In a series of careful studies Selye confirmed that it was the stress of the injections themselves.
8
Q
What did Selye develop as the stress response?
A
He mapped out the body’s physiological responses to stressful stimuli, or stressors, and eventually concluded that different stressors all produced the same pattern of physiological responses. This is called the stress response.
9
Q
How did Selye using the stress response develop a definition for stress?
A
He could argue that any stimulus producing the physiological stress response was by definition a stressor. This is a response-based definition of stress.
10
Q
What is a stimulus-based view of stress?
A
We could probably agree that certain events, such as physical injury or the death of someone close to us, can be considered stressful. This is a stimulus-based view of stress, where certain events of stimuli by their very nature are defined as stressful
11
Q
What is the problem with the stimulus-based view of stress and the response-based view of stress?
A
Both of these approaches ignore the vital factor of individual differences. Some people with phobias will show the physiological stress response when faced with a tiny house spider, whilse others will not react to events others would find stressful.
12
Q
What is the current approach to how we see stress?
A
The transactional model
13
Q
Who developed the transactional model?
A
Cox and Mackay (1978) and Lazarus and Folkman (1984)
14
Q
What is the transactional model?
A
It emphasises individual differences. It does this by giving a major role to the individual’s cognitive processes. This transactional model sees stress as depending upon the person’s perception of themselves and the world around them. The key process is appraisal, and this is divided into primary and secondary appraisal. Primar and secondary appraisals are based on our perception of ourselves and the world around us. Putting these two processes together leads to a definition of stress “When an imbalance of discrepancy exists between perceived demands and perceived coping resources, then a state of stress exists.”
15
Q
What is the transactional model of stress (diagram)?
A
The words actual coping ability and actual demands at the top. From these are arrows that lead to perceived coping ability and perceived demands. They both have arrows pointing to ‘cognitive appraisal’. Then there is an arrow down pointing to ‘Mismatch between demands and coping ability’. Two arrows come out from this that say ‘feelings of stress’ and ‘bodily stress response’
16
Q
What is a neuron?
A
The basic unit of the nervous system. Neurons are cells specialised to conduct electrical impulses.
17
Q
What is action potential?
A
The technical term for nerve impulses. Pulses of electrical activity conducted along the neuron, action potentials represent coding of information in the nervous system.
18
Q
What are dendrites?
A
Part of the neuron, dendrites are short processes connecting to the cell body. Nerve impulses are often triggered on dendrites.
19
Q
What are axons?
A
Part of the neuron, the axon is an elongated process running from the cell body. Axons can have up to 1000 branches connecting via synapses to other neurons.
20
Q
What is the structure of neurons?
A
Neurons are covered in a complex cell membrane made up of several layers. The biochemical structure of this membrane allows it to conduct or transmit pulses of electrical activity known as action potentials or nerve impulses. Nerve impulses begin on the dendrites and then travel across the cell body and along the axon.
21
Q
Describe the neuron (diagram)?
A
The is the cell body, which appears like a ‘head’ with a nucleus inside it. Connected to the cell body are loads of scriggly and thin lines which are the dendrites. From the cell body, is the ‘tail’ like part which is called the axon. From this there are branches that come off that are called the axon branches. The end of the axon branches are called axon terminals.
22
Q
What is between the axon terminal and the next neuron?
A
A tiny gap called the synapse.
23
Q
How do nerve impulses cross the synapse?
A
Stored within the axon or presynaptic terminal are packets or chemicals known as neurotransmitters. As nerve impulses travelling down the axon reach the axon terminal they stimulate the release of neurotransmitter molecules into the synapse. The synaptic gap is so small that the molecules can diffuse over to the postynaptic membrane of the following neuron. Located on this membrane are synaptic receptors. As the neurotransmitter molecule reaches the postsynaptic membrane it binds to the receptor for a brief period of time. This combination of neurotransmitter with receptor alters the biochemical characteristics of the postsynaptic membrane; this makes a nerve impulse more likely to be triggered at that point on the membrane.
24
Q
What is an axon terminal?
A
The end of a neuronal axon, also known as the presynaptic terminal
25
What is a synapse?
A tiny gap separating the presynaptic terminal of one neuron and the postsynaptic terminal of the following neuron. Transmission across the synpase is chemical, suing neurotransmitters.
26
What is a presynaptic terminal?
The axon terminal leading into a synapse. Neurotransmitters are released from the presynaptic terminal.
27
What is a neurotransmitter?
A chemical stored in the presynaptic terminal. Nerve impulses stimulate the release of neurotransmitter molecules into the synapse, where they diffuse over to the postsynaptic membrane and combine with receptors.
28
What is the postsynaptic membrane?
The neuronal cell membrane on which synaptic receptors are located. The neurotransmitter released from the presynaptic terminal combines with these receptors and this combination makes a nerve impulse more likely to occur in the postsynaptic neuron.
29
What are synaptic receptors?
Molecules located on the postsynaptic terminal that combine with neurotransmitter molecules in a lock-and-key fashion.
30
What is the all-or-none principle?
Applied to the nerve impulse. Combination of neurotransmitter with synaptic receptors disturbs the postsynaptic membrane and makes a nerve impulse more likely. If a threshold disturbance is reached, a nerve impulse is triggered.
31
Describe how a nerve impulse crosses the synapse (diagram)?
The last part of the first neuron is called the pre-synaptic terminal. WIthin the pre-synaptic terminal and blobs called neurotransmitters. On the end of the pre-synaptic terminal are the pre-synaptic membrane Then there is the gap called the synaptic gap or cleft. The top of the next neuron is called the post-synaptic terminal, and the rest of it is called the post-synaptic terminal. On the post-synaptic membrane there were little boxes called the post-synaptic receptors.
32
What is the feature of the nerve impulse as an all-or-none principle?
Either it occurs or it doesn't. For a nerve impulse to be triggered on the postsynaptic membrane sufficient neurotransmitter molecules must be released from the presynaptic terminal. Once triggered, the nerve impulse will be conducted along the postsynaptic nuron, along the axon to the axon terminals, where the process is repeated at the next set of synapses.
33
What is the purpose of the synapse?
To allow for information processing. To cross the synapse, enough nerve impulses must arrive at the presynaptic terminal in a short space of time to release sufficient neurotransmitter molecules to fire the postsynaptic membrane. If only a few impulses arrive, the amount of neurotransmitter released will not be sufficient, and the postsynaptic membrane will not fire. The information coded by those impulses will be lost.
34
How can different synapses be defined?
By the neurotransmitter they release.
35
What is GABA?
A synaptic neurotransmitter involved in the action of anti-anxiety drugs such as Librium and Valium.
36
What is Dopamine?
Synaptic neurotransmitter involved in the action of anti psychotic drugs used in schizoprenia
37
What is serotonin?
Synaptic neurotransmitter involved in the action of antidepressant drugs
38
What is Noradrenaline?
A hormone released from the adrenal medulla, which acts on heart and circulatory system to increase heart rate and blood pressure. Noradrenaline is also a synaptic neurotransmitter in the brain and other parts of the nervous system.
39
What is the central nervous system?
The major part of the nervous system, made up of the brain and the spinal cord.
40
What are spinal nerves?
Nerves are bundles of neuronal processes, mainly axons, travelling around the body. The spinal nerves radiate from the spinal cord. They carry sensory information into the central nervous system, and motor commands out to muscles and glands. The spinal nerves make up the peripheral nervous system.
41
What are sensory pathways?
Pathway in spinal nerves running from sensory receptors into the central nervous system, carrying sensory information.
42
What are motor pathways?
Pathways in spinal nerves carrying commands from the brain out to muscles and glands.
43
What is the autonomic nervous system?
Part of the peripheral nervous system concerned with the regulation of internal structures and systems. It is vital in maintaining physiological regulation of the body.
44
What is homeostasis?
Regulation of a constant internal environment. The best example is our constant body temperature. Homeostasis is heavily reliant on the autonomic nervous system.
45
What is the sympathetic nervous system?
One of the two branches of the autonomic nervous system. Sympathetic dominance leads to a pattern of bodily arousal and preparation for energy expenditure.
46
What is the parasympathetic nervous system?
One of the two branches of the autonomic nervous system Parasympathetic dominance leads to a pattern of physiological calm.
47
What is the hypothalamus?
Part of the the diencephalon in the forebrain. COntrols the HPA and SAM pathways involved in responses to stress.
48
What does the autonomic nervous system play a central role in?
In states of bodily arousal associated with stress.
49
Where is the autonomic nervous system and what does it do?
ANS centres are located in the brainstem. From here ANS pathways run down through the spinal cord and are distributed throughout the body by the spinal nerves; in this way the ANS is classified as a component of the peripheral nervous system. It is concerned with the regulation of our internal environment, controlling such vital functions as body temperature, heart rate and blood pressure. The ANS is central to homeostasis.
50
What two separate divisions does the autonomic nervous system have?
The sympathetic branch and the parasympathetic branch. Nerve fibres from both branches connect with internal structures such as various glances (.e.g the adrenal medulla, pancreas and salivary glands), the heart and circulatory system and the digestive system. Usually the two branches are in balance, but under certain circumstances the balance shifts and once branch becomes dominate.
51
What happens when the sympathetic branch is dominant?
Sympathetic arousal or dominance leads to a pattern of bodily arousal, with increases in heart rate and blood pressure.
52
What happens when the parasympathetic branch is dominant?
Parasympathetic dominance leads to a pattern of physiological calm.
53
What can cause the sympathetic branch to become dominant?
The shifts are determined by the body's physiological requirements. Physical exercise needs energy, and this is provided by sympathetic arousal. Similarly, if a dangerous or threatening situation is perceived, higher brain centres signal the hypothalamus to activate the sympathetic branch of the Autonomic nervous system.
54
What is the pituitary-adrenal system?
One of the two key pathways involved in the body's response to stress. The hypothalamus stimulates release of adrenocorticotrophic hormone (ACTH) from the pituitary gland and triggers release of cortisol and other corticosteroids into the bloodstream.
55
What is the sympathomedullary pathway?
One of the two key components of the body's response to stress. Activated by the hypothalamus, nerve pathways of the sympathetic branch of the autonomic nervous system stimulate the adrenal medulla to release adrenaline and noradrenaline into the bloodstream.
56
How does the hypothalamus affect the pituitary-adrenal system as a response to stress?
The pituitary gland releases hormones, ultimately controlled by the hypothalamus. The hypothalamus stimulates the release of adrenocoricotrophic hormone (ACTH) from the pituitary into the bloodstream. The hormone travels to the adrenal cortex, part of the adrenal gland; we have two adrenal glands, located close to the kidney on each side of the body. When ACTH reaches the adrenal cortex it stimulates the release of corticosteroids such as cortisol and corticosterone into the bloodstream.
57
How does the sympathomedullary pathway operate?
The sympathetic nervous system is one part of the autonomic nervous system that controls our internal organs, such as various glands, the heart and the circulatory system and the digestive system. Nerve pathways of the SNS originate in the brainstem and travel via the spinal cord and spinal nerves to the various body organs. One of these pathways runs to the adrenal medulla, which along with the adrenal cortex makes up the adrenal gland. When activated, the SNS stimulates the adrenal medulla to release the hormones adrenaline and noradrenaline into our bloodstream.
58
How does the sympathomedullary pathway respond to stress?
When appraisal processes in higher brain centres detect a stressful situation, the hypothalamus is instructed to stimulate ACTH release from the pituitary. In addition, the hypothalamus also commands the autonomic nervous system centres in the brainstem to activate the sympathetic nervous system pathways running to the adrenal medulla (sympathomedullary pathway). This results in the increased release of adrenaline and noradrenaline into the bloodstream.
59
What does the reaction of the sympathomedullary pathway do to the body?
The SNS itself has direct connections to the heart and activation speeds up heart rate and raises blood pressure. These effects are increased and sustained by the release of adrenaline and noradrenaline from the adrenal medulla via the sympathomedullary pathway; these act on heart muscle to increase heart rate, and also on blood vessels to constrict them and so raise blood pressure. The end result is that oxygen is rapidly pumped to the muscles allowing for increased physical activity.
60
How does the release of corticosteroids in response to stress affect the body?
The body's energy reserves are largely in the form of glycogen stored in the liver and fat reserves in fatty tissues. A major effect of corticosteroids released in response to pituitary-adrenal system activation is the increased release or mobilisation of these energy reserves; this is in the form of raised blood levels of glucose and fatty acids. Also, raised levels of corticosteorids, if sustained over a long period also suppress the body's immune system.
61
How does the activation of the pituitary-adrenal system and the sympathomedullary pathway in response to stress affect the body?
These systems are extremely old in evolutionary terms, and their main effect is to allow for energy expenditure in times of stress-related emergencies. This makes sense when stressors, such as predators, required a physical response. However, in modern life, a physical response isn't usually an effective coping response. In these cases it is thought that the body's response to stress can become pathological, i.e. may lead to illness.
62
What is the adrenocoricotrophic hormone (ACTH)?
A hormone released from the pituitary gland. ACTH stimulates the adrenal cortex to release corticosteorids as part of the body's response to stress.
63
What is the adrenal cortex?
Part of the adrenal gland. It releases corticosteroids into the bloodstream as part of the body's response to stress.
64
What is the adrenal gland?
The two adrenal glands are located just by the kidneys. The adrenal gland is made up of the cortex and the medulla. The cortex releases corticosteroids and the adrenal medulla releases adrenaline and noradrenaline. These hormones have important roles in the body's response to stress.
65
What are corticosteroids?
Hormones released from the adrenal cortex as part of the stress response. They include cortisol and corticosterone.
66
What is the adrenal medulla?
It is part of the adrenal gland. Under control of the sympathetic nervous system, it releases noradreanline and adrenaline into the bloodstream as part of the stress response.
67
What is adrenaline?
A hormone released from the adrenal medulla, acts on heart and circulatory system to increase heart rate and blood pressure.
68
What does Chronic mean?
Long-lasting.
69
What is the general adaptation syndrome (GAS)?
Selye's model of the body's response to stress. COnsists of three stages: alarm, resistance and exhaustion.
70
What are the three stages of the general adaptation syndrome for how the body responds to stress?
1. Alarm
2. Resistance
3. Exhaustion
71
What happens during the alarm stage of the general adaptation syndrome?
A stressor is perceived and the pituitary-adrenal system and the sympathomedullary pathway are activated. Levels of stress-related hormones surge, heart rate and blood pressure increase, and energy reserves are mobilised.
72
What happens during the resistance stage of the general adaptation syndrome?
If the stressor persists the body's response systems maintain their activation, with levels of stress-related hormones and bodily arousal remaining high.
73
What happens during the exhaustion stage of the general adaptation syndrome model?
Long periods of stress (chronic stress) eventually exhaust the body's defence systems and its ability to maintain high levels of circulating stress hormones. This is the stage when stress-related illnesses may develop.
74
What are the strengths of Selye's general adaptation syndrome model?
His work has been extremely influential in developing the whole area of research into stress. He emphasised the central roles of the pituitary-adrenal system and the sympathomedullary pathway, and the links between chronic stress and illness.
75
What are the weaknesses of Seyle's general adaptation syndrome model?
- He emphasised that the GAS was a common response to all stressors i.e. he took a response-based approach to stress, which as we have seen ignores individual differences and the cognitive elements of perception and appraisal. His early work was based on rats and a narrow range of physical stressors.
- It is now thought that stress-related illnesses are not caused by exhaustion of the body's physiological stress responses. Rather it is the effect of long-lasting raised levels of stress hormones that can eventually lead to illness.
76
What is the immune system?
A complex network of interacting components that provides the body's defences against infection by pathogens such as viruses and bacteria. It is divided into natural and specific immunity.
77
What are acute time-limited stressors?
These are usually studied under laboratory conditions and include experiences such as public speaking or during mental arithmetic. They usually last for between 5 and 100 minutes.
78
What is a brief naturalistic stressor?
Everyday stressors of limited duration. The situation most often studied is that of students taking examinations.
79
What are chronic stressors?
Long-lasting stressors. They include caring for dementia patients, coping with long-term illness or disability, or long-term unemployment.
80
What is atherosclerosis?
The furring up and narrowing of blood vessels through deposits of fatty material. It can lead to strokes and heart disease.
81
What different types of stressors were identified by Segerstorm and Miller (2004)?
Acute time-limited stressors, brief naturalistic stressors, and chronic stressors.
82
How can stress increase the likelihood of strokes and heart disease?
The increased heart rate and blood pressure can lead to physical damage to the lining of blood vessels or to the muscles of the heart. In cases of prolonged or chronic stress blood levels of glucose and free fatty acids an remain high and contribute to the 'furring up' of arteries- called atherosclerosis- and this can result in heart disease and strokes.
83
What is natural immunity?
One component of the body's immune system. It is a more primitive system and is made up of cells in the bloodstream (white blood cells or leukocytes) These non-specifically attack and ingest invading pathogens such as viruses and bacteria. These natural immunity cells include macrophages, phagocytes and natural killer cells. It is a rapid response.
84
What is specific immunity?
A division of the body's immune system. It is based on cells known as lymphocytes. It is a more sophisticated system than non-specific natural immunity, as the cells that make it up have the ability to recognise invading pathogens and produce specific antibodies to destroy them. Specific immunity is divided into cellular and humoral immunity.
85
What is cellular immunity?
A division of the body's immune system. Cellular immunity involves a number of different cells called T lymphocytes, as they grow in the thymus gland; these include killer T cells, memory T cells and help T cells. In combination these T cells attack intracellular (withing cells) pathogens such as viruses.
86
What is humoral immunity?
A devision of the body's immune system. Humoral immunity is coordinated by another subset of lymphocytes called B cells, as they grow and mature in the bone marrow. The end produce of humoral immunity is the secretion of antibodies from these B lymphocytes that attack and destroy extracellular (outside cells) pathogens such as bacteria and parasites.
87
How do the components of the immune system function?
They do not function independently of each other. Lymphocytes release a variety of chemicals that can act as signals activating other parts of the immune system as part of a coordinated response to pathogens.
88
What is the main difference between specific immunity and natural immunity?
- Natural immunity processes act quickly in response to any challenge (within minutes or hours) and are our first line of immune defence
- Specific immunity develops over days as the components recognise the invading pathogens and mobilise cellular and humoral immune systems.
89
What are the possible ways that stress can affect the immune system?
Stress may have general effects on the immune system, i.e. leading to overall suppression of immune function. Alternatively it may affect natural immunity more than specific, or may even alter the balance between cellular and humoral immunity.
90
What are immunodeficiency diseases?
Illnesses caused by long-term problems with the body's immune system. Examples include AIDS.
91
What are autoimmune diseases?
Illnesses caused by the immune system's failure to recognise host tissues, and attacking them. Examples include some forms of cancer, diabetes and rheumatoid arthritis.
92
What are pathogens?
Invading organisms such as viruses, bacteria and parasites.
93
What are natural killer (NK) cells?
Part of the body's natural immunity system, NK cells destroy invading pathogens. They are also a popular dependent variable in studies of stress and the immune system.
94
What are lymphocytes?
Cells that are the basis of specific immunity. Lymphocytes develop in lymph system structures such as the spleen and the thymes gland.
95
What are antibodies?
Chemicals released from lymphocytes that recognise and destroy pathogens such as viruses and bacteria. A key component of humoral immunity.
96
What is the thymus gland?
The key structure of the immune system. T lymphocytes, the basis of specific immunity, develop in the thymus gland. The thymus gland can also be damaged by chronic high levels of circulating corticosteroids.
97
What study did Cohen et al (1993) do on stress and its effect on developing a cold?
They investigated the role of general life stress on vulnerability to the common cold virus. 394 participants completed questionnaires on the number of stressful life events they had experienced in the previous year. THey also rated their degree of stress and their level of negative emotions such as depression. The three scores were combined into what Cohen et al called a stress index. The participants were then exposed to the common cold virus, leading 82% to become infected with the virus. After 7 days the number whose infection developed into clinical colds were recorded.
98
What were the results of Cohen et al (1993) study on stress and its effect on developing a cold?
The findings were that the chance of developing a cold, i.e. failing to fight of the viral infection, was significantly correlated with stress index scores. They concluded that life stress and negative emotions reduce the effectiveness of our immune system, leaving participants less able to resist viral infections.
99
What did Evans and Edgerton (1991) study on stress find?
That the probability of developing a cold was significantly correlated with negative events in the preceeding days.
100
What are the strength of Cohen et al (1993) study on stress and its effect on developing a cold?
1. Supported by Evans and Edgerton (1991) study.
2. It did measure health outcomes (development of clinical colds), showing a relationship between life stress and illness. This can be compared with studies that use measures of imune function rather than illness outcomes.
101
What are the weaknesses of Cohen et al (1993) study on stress and its effect on developing a cold?
1. It was an indirect study in that there was no direct measures of immune function
2. There was no direct manipulation of the independent variable (the stress index), and so a cause and effect relationship cannot be confirmed.
3. The study does not tell us which element of the stress index is most important.
102
What are the ethical issues of Cohen et al (1993) study on stress and its effect on developing a cold?
- Participants should be in good health with no illnesses or infections prior to the study
- Participants should be able to give fully informed consent, with debriefing afterwards
- During the study participants should be constantly monitored to check for any reactiosn to the viral challenge.
- THe scientific value of the study should be balanced against any psychological or physical distress to participants.
103
What is Alzheimer's disease?
A progressive degeneration of brain tissue leading to memory loss and dementia (confusion, loss of contact with reality.) Associated with age, the full name is senile dementia, Alzheimer type.
104
What was Kiecolt-Glaser et al (1984) study on naturalistic life stressors and their impact on measures of immune function?
They used 75 medical students preparing for final examinations. As an index of immune function they used natural killer (NK) cell activity, part of our natural immunity system. Measures of NK cell activity were recorded from blood samples taken one month before exams (low stress) and during the exam period (high stress) Participants also completed questionnaires on experience of negative life events and social isolation.
105
What were the findings of Kiecolt-Glaser et al (1984) study on naturalistic life stressors and their impact on measures of immune function?
Findings were that NK cell activity was significantly reduced in the high stress samples, compared to the low stress samples. In addition, the greatest reductions were in students reporting higher levels of social isolation. They concluded that examination stress reduces immune function, making people potentially more vulnerable to illness and infections. The effects are more noticeable in students experiencing high levels of isolation.
106
What study did Kiecolt-Glaser et al (1995, 1991) do stress and wound healing and immune function?
In the 1995 study that have shown that small wounds take longer to heal in highly stressed groups such as carers for Alzheimer patients. In their 1991 study they also showed that the highly stressed group have reduced immune function.
107
What study did Malarkey et al (1994) do on stress and immune function?
They showed that short-term marital conflict also reduces immune function, with this effect being more noticeable in women than men.
108
What are the strengths of Kiercolt-Glaser et al (1984) study on naturalistic life stressors and their impact on measures of immune function?
1. Supported by other research, including their 1995 study, their 1991 study their 1987 study, and Malarkey et al, 1994 study.
109
What are the weaknesses of Kiercolt-Glaser et al (1984) study on naturalistic life stressors and their impact on measures of immune function?
1. Although reductions in immune function should make people more vulnerable to illness, it might be that the significant reductions seen in this study are still too small to increase the chance of stress-related illness.
2. Natural killer cell activity is only one component of a highly complex and sophisticated system. Stress may alter the pattern of immune responses, such as reducing natural immunity but leaving specific immunity unchanged or increased, or shifting the ballane from cellular to humoral immunity.
3. The independent variable (examination stress) was not manipulated so a cause and effect relationship cannot be confirmed.
110
What are the ethical issues attached to Keicolt-Glaser's studies on stress?
1. They usually measure immune function in people experiencing natural life stressors, so they are not exposed to further stressors.
2. Need to give fully informed consent, be debriefed and be aware of the mild stress of having their immunse function measured
3. Studies where small wounds are inflicted and healing rates measured need full approval by ethics committee, plus informed consent from participants as a degress of pain and distress is involved. Medical supervision would also be essential.
111
What is a meta-review?
A research technique in which results from all papers studying a similar problem are statistically analysed together to provide a more reliable overview of findings. A meta-review uses both quantitative and qualitative data.
112
What is upregulation?
It refers to an improvement or increase in immune functioning.
113
What meta-review did Segerstrom and Miller (2004) carry out on the effect of stress on immune system?
They performed a meta-review on 293 studies that have looked at the effects of different stressors on measures on immune system functioning.
114
What were the results of Segerstrom and Miller's (2004) meta-review in regards to acute time-limited stressors?
Overall, these lead to an upregulation of natural immunity, measured for instance as an increase in the numbers of natural killer cells.
115
What were the results of Segerstrom and Miller's (2004) meta-review in regards to brief naturalistic stressors?
The meta-analysis showed no overall effect on immune function. However, there was evidence for a shift from cellular immunity towards humoral immunity.
116
What were the results of Segerstrom and Miller's (2004) meta-review in regards to chronic stressors?
Chronic or long-lasting stressors have the most consistent effects on immune function. Virtually all measures of natural and specific immunity showed a significant downregulation. These suppressive effects of chronic stress were consistent across gender and age groups.
117
What were the results of Segerstrom and Miller's (2004) meta-review in regards to non-specific life events?
In the meta-review they also analysed studies using a life event questionnaire. These assess the frequency and intensity of a range of life events over, for instance, the previous year. Overall there were no significant chances in immune function. However, when studies using participants aged over 55 were looked at, there was a significant relationship between life event stress and reductions in natural killer cell activity i.e life events produced a reduction in immune function in older participants.
118
What were the conclusions drawn from Segerstrom and Miller's (2004) meta-review on stress and its effect on the immune system?
1. The acute time-limited stressors reduce an upregulation in natural immunity, and that chronic stressors produce a general downregulation in immune function.
2. Acute time-limited stressors are the type that stimulate the fight of flight response and Selye's GAS. Rapidly occuring natural immunity responses can be seen as part of our adaptive response to these situations, preparing the body to fight off infection.
3. Chronic stress mean the immune system is activated beyond the 'adaptive time frome. Person is left vulnerable to pathogens.
4. The immune response to stress may involve shifts from natural towards specific immunity, and within specific immunity perhaps a shift in the balance between cellular and humoral immunity.
5. No general evidence for gender differences
119
What gender differences did Kiecolt-Glaser et al (1998) highlight between stress and immune function?
They showed that women showed greater reductions in immune function than men in response to marital conflict.
120
What is downregulation?
It refers to an impairment or reduction in immune function.
121
What is global immunosuppression?
The downregulation of all components of the immune system. It can be caused by chronic stress.
122
How could the hormones released as part of the HPA activation affect the immune system?
There is clear evidence that high levels of corticosteroids in the bloodstream reduce production of T lymphocytes and lead to shrinkage of the thymus gland. This gland is a key component of the immune system.
123
What are life events classed as?
Major life events include marriage, death of a partner, redundancy, moving house, etc.
124
What is important to remember about stress when studying it?
- Everyone is under some stress most of the time, but most people do not develop stress-related illness
- Stress is an unavoidable fact of life; life is always making demands on us that we have to cope with.
- Stress exists only when perceived demands outstrip our perceived resources and ability to cope.
125
How can we measure stress?
- Self-report questionnaires on frequency of life stress, e.g. in relation to major life events or to minor daily stressors
- Self-report questionnaires on perceived or subjective stress, i.e. how stressed do you feel?
- Semi-structured interviews, in which the participant talks through their life stressors and the trained interviewer assesses the impact of the stressors. This is a qualitative approach.
126
What are life change units?
Major life events can be rated in terms of life change units (LCU) using Holmes and Rahe's social readjustment rating scale. High LCU scores have been linked to stress-related illness.
127
What research study did Holmes and Rahe (1967) do on measuring stress?
They noticed that many patients in hospitals reported significant life events in the preceding year. To rate the impact of different events they asked 394 people to compare 43 life events with marriage in terms of the degree of adjustment necessary. Marriage was given an arbitrary value of 500 and other events were scored high or lower. The the final scale scores were divided by 10 and referred to as life change units. The whole scale was called the social readjustment rating scale (SRRS)
128
How did Holmes and Rahe (1967) define a life event when making the social readjustment rating scale?
They introduced the concept of a life event as a change in life circumstances requiring a degree of adjustment on the part of the individual.
129
What were the major methodological issues with Holmes and Rahe's (1967) social readjustment rating scale?
The main issue is that this study was carried out in the US and so the events and how they were rated would have been culturally specific, as well as time specific (in the 60's). In addition there was no objective assessment of the degree of adjustment necessary; they relief on participants' opinions.
130
How do you use the social readjustment rating scale?
You add up the LCU's for life events occuring during the preceding year. A score of over 150 is classified as a life crises and according to Holmes and Rahe increases the chances of a stress-related illness by 30%. A score over 300 is a major crisis and increases the illness risk by 50%.
131
What did the studies by Holmes and Masuda (1974), and Rahe and Lind (1971) support?
These were retrospective studies, where they asked people already undergoing treatment for heart disease and other stress-related illnesses to remember life events from the previous year. These studies found support for a significant relationship between LCU scores and stress-related diseases.
132
What study did Rahe et al (1970) do to investigate the link between life change units and illness?
He followed 2500 male US navy personnel, who filled in the SRRS for the previous 6 months. He followed them for the seven-month tour of duty, and all stress-related illnesses were recorded and rated for number and severity, producing an overall illness score. They found a positive correlation of 0.118 between LCU scores and illness scores. Although it is a small correlation it is statistically significant. They concluded that there is a relationship between life events and the development of stress-related illness, but as the correlation was low, other factors must be involved.
133
What are the issues of Rahe et al (1970) study on the link between LCU and illness?
- It was gender and cultural specific so it is difficult to generalise it.
- All illness outcomes were recorded. There were no specific hypothesis about which illnesses should be related to life event stress.
- Correlations do not imply causality, only an association.
- There may be some distress in recalling traumatic life events.
134
What does appraisal refer to?
The perceiving and evaluating of a situation as positive or negative
135
What does the term hassles refer to?
The stresses of everyday life, as opposed to major life events.
136
What are the issues with the nature of the SRRS itself?
- No account is taken of the emotional impact of the event, i.e. positive or negative? Holmes and Rahe assumed all events involved readjustment and were therefore stressful.
- Does not take into account individual differences
- Retrospective self-report of life events over the proceeding year can be unreliable, especially when people are already ill and may be looking for explanations. (Raphael et al- 1991)
- The results are usually in the form of correlation, which does not imply causation.
137
What did Raphael et al (1991) discover?
That asking people several times to recall events from the same time periods reveals surprisingly variability in accounts of the same period.
138
What is the life events scale?
It was developed by Sarason et al (1978), and allows people to rate 57 life events in terms of severity of impact and whether the impact is positive or negative. In addition specialised sections can be added for particular groups, such as students. The life events scale produces there scores- negative change, positive change and total change (similar to the SRRS). In general negative life change scores correlate more highly with illness outcomes.
139
What are uplifts?
It refers to everyday positive events as opposed to hassles,
140
What did Lazarus believe impacted health?
He felt that the regular sources of stress in people' lives tend to arise from the ongoing problems of day to day living, and that these hassles as they became to be known, had a more significant impact on health than major life events. He also felt that life contained positive events, known as uplifts that could counteract the negative effects of daily hassles.
141
What two scales did Lazarus et al develop?
His research group (Kanner et al 1981) devised the hassles scale specifically to assess these sources of stress. The original scale had 117 items covering all aspects of daily life. It could be modified for special groups such as students, where items such as study problems and unfriendly tutors were particularly relevant. He also developed an uplifts scale with 136 positive items, such as getting good grades or getting on well with friends. Scores on the hassles scales correlate with stress-related problems.
142
What study did De Longis et al (1982) do on measuring stress and its effect on illness?
They did a study comparing scores on both the hassles scale and a life event scale and found that correlations with health outcomes were greater for the hassles scores. Uplifts were unrelated with health out
143
What study did Jandorf et al (1986) do on stress and illness?
He used the assessment of daily experience scale (stone and Neale 1984) and found higher positive correlations between daily events and health outcomes than between major life events and health.
144
What is meant by home-work interface?
It is a source of stress in the workplace, in which employees try to balance the competing demands of home and work responsibilities.
145
What is meant by home-life balance?
This is the idea that in a civilised society everyone should strive for a healthy balance between work responsibilities and life outside work.
146
What is decision latitude?
The sense of control an individual has over their workload and how it is organised. High decision latitude is associated with a lower vulnerability to stress-related illness.
147
What factors can cause stress at work?
Environment
Home-work interface
Control
Workload
148
How can the environment in the workplace effect stress?
Heating, lighting and the physical arrangement of the workplace are all potential sources of stress. Many studies have shown that intense noise and increases in temperature can lead to frustration, stress and, in some cases, aggression. The physical layout of the workplace can affect the psychological well-being of the employee in terms of 'personal space' and privacy.
149
How can the home-work interface affect stress?
With many people having to balance the competing demands of home and work, in particular parents with small children, this potentially very stressful area has become the subject of much debate. The concept of work-life balance refers to the ideal situation where an individual has time for both work and home responsibilities, leading to less stress and better psychological
150
How can control effect stress in the workplace?
This has been the central focus of research into workplace stress. The degree of control a person has over their workload (sometimes referred to as decision latitude) has been shown to directly affect the level of stress experienced. High levels of control lead to lower levels of stress, while low levels of control, typically experienced by workers lower down the organisation hierarchy, can increase stress levels.
151
How can workload effect stress in the workplace?
This is one of the most obvious factors in workplace stress, but research shows that it is not just overload that can be stressful (Dewe, 1992), but that having too little to do can have similar effects.
152
What is Karasek's (1979) model on relationship between workload and levels of ctonrol?
Karasek has a model of the relationship between demand (workload), control (decision latitude) and job strain (stress). He suggests that the most stressful jobs involve high demand and low control, and the least stressful involve low demand and high control.
153
What were the Whitehall studies? (1960's)
A series of long-term studies on relationship between workplace stress and health. They also included various individual and social risk factors such as smoking, blood pressure and cholesterol levels, obesity and socioeconomic status. Participants were from London-based government civil servants, In Whitehall I (first study), clear differences between workers were found with regard to heart problems and mortality rates: workers in lower-paid grades had twice the illness rate of workers in highest-paid grade. Differences in risk factors (e.g. workers in lower grades tend to smoke more) accounted for about 1/4 of this difference.
154
What did Marmot et al (1997) do in regard to Whitehall II?
They analysed data from over 7000 participants in the Whitehall II study. Participants were followed up over 5 years. All were free of heart problems when the study began. The data showed similiar differences in heart disease to Whitehall I, with the rate in the lowest grades being 1.5. times the rate in the highest grades. They found risk factors such as smoking, obesity and hypertension could account for some of the increase in lower grades. However, the most significant factor was the degree of 'decision latitude' or control that participants felt they had.
155
What are the issues with the Whitehall studies?
1. Mainly self-report questionnaires so possible biased responding from participants, for instance underestimating risk factors such as smoking.
2. Some factors were not measured that may have contributed to the results. For example, workers in lower grades may have in common some characteristics that makes them vulnerable to heart disease but this was not measured
3. The sample was government civil servants, so it is difficult to generalise.
156
What did Johannson et al (1978) discover about workplace stress which supported the findings of the Whitehall studies?
In a very different workplace setting, they found higher levels of stress hormones and stress-related illness in a group of highly skilled sawmill employees whose work was machine-paced, i.e. giving them little or no control over their work rate.
157
What did Fox et al (1993) find about stress in the workplace?
They found that a combination of low control and high demands was related to higher blood pressure in nurses. High blood pressure is a major risk factor for heart disase.
158
What did Van Der Doef and Maes (1998) conclude about stress in the workplace?
In a review of this area of research, Van der Doef and Maes concluded that substantial evidence from a range of studies supports the hypothesis that a combination of high demand and low control increases the risk of heart disease.
159
What is the occupational stress indicator (Cooper et al 1998)?
A questionnaire package to assess workplace stress and employee characteristics. It uses self-report questionnaires to measure the sources of stress as perceived by the employee. In addition it measures characteristics such as social support, Type A behaviour and coping strategies. The eventual outcome is a profile of the individual and the organisation in terms of sources and degree of stress in its workforce. THese findings are then used to devise strategies to reduce the negative effects of stress on the individual and the organisation.
160
How can workplace stress be reduced?
Methods include individually tailored stress management programmes for employees and changes to the way the organisation is structures and managed. Psychological methods of stress management may also be made available.
161
What is meant by Type A behaviour?
A behaviour pattern characterised by time pressure, competitiveness and hostility. It has been suggested that high levels of TAB increase vulnerability to heart disease.
162
Who developed the concept of Type A and Type B behaviour?
It evolved from the work of Friedman and Rosenman in the 1950's and 1960's. They studied the characteristics of patients with coronary heart disease and decided that a particular pattern of behaviour seemed to be associated with a vulnerability to heat disease. They also defined a Type B pattern that was essentially the opposite of Type A, I.e. relaxed, not competitive, not hostile. Early studies by their research group suggested that a Type A person was around twice as likely to develop CHD as a Type B.
163
What are the behaviour patterns of Type A behaviour?
1. Time pressures; Always working to deadlines, unhappy doing nothing, multitasking
2. Competitive; always orientated towards achievement, plays to win whether at work or on the sports field
3. Hostility; Becomes easily irritated and impatient with co-workers, easily angered, anger can be directed inwards
164
What study did Rosenman et al (1976) do on behaviour type and CHD?
They studied 3,154 middle-aged men on the West Coast of the US. They were catergorised as either Type A or Type B by structured interview. They were followed up for 8.5 years. There were 257 heart attacks, 69% were in the Type A group. This was a significant effect even when lifestyle risk factors such as obesity and smoking were controlled for. They concluded that the high TAB individual was vulnerable to heart disease.
165
How did they assess the behavioural pattern of the participants in Rosenman et al (1976) study?
Through a structured interview. As the participant answers the questions the trained interviewer also notes behavioural signs of Type A pattern. These could be rapid finger tapping on the table, restlessness and the pace of talking. Answers to the questions and the general behaviour are put together to provide an overall assessment of TAB.
166
What does Hardiness mean?
It is a personality type described by Kobasa, consisting of high levels of control, commitment and challenge. Evidence suggests that high levels of hardiness protext against the negative effects of stress.
167
What are the issues with Rosenman et al (1976) study on behaviour pattern and CHD?
1. The study is culturally and gender specific, and findings should be generalised with caution. Even the definition of TAB is based on Western cultural concepts.
2. There are many individual and lifestyle variables that can affect vulnerability to heart disease. Although some of these were controlled for, it is possible that some important variable was missed. It has high ecological validity, but it does not have perfect control over all variables.
168
What did Shekelle et al (1985) discover about TAB and CHD?
They studied over 12,000 male participants, with TAB assessed by a self-report questionnaire and structured interview. They found over seven years that there was no difference in the incidents of heart disease between the Type A and the Type B groups.
169
What did Matthews and Haines (1986) review on TAB and CHD suggest?
That only about half the studies on TAB and CHD find a significant link. The general picture that emerged was that TAB was not a strong predictor of heart disease. TAB is a complex combination of many characteristics and one interesting question is whether particular characteristics are more important than others.
170
What did Booth-Kewley and Friedman (1987) review on TAB and CHD suggest?
They reviewed a number of studies in this area and concluded that the component of hostility and other negative emotions was a key element in linking TAB and CHD.
171
What did Dembroski et al (1989) discover about TAB and CHD?
They found that hostility was more strongly linked to CHD than the overall TAB score.
172
What did Miller et al (1996) identify as a risk factor for CHD?
They did a meta-review and identified hostility as a risk factor, independent of TAB.
173
Who introduced the concept of hardiness?
Kobasa (1979), who was interested in factors that might protect or buffer people against the effects of stress.
174
What are the three basic elements to hardiness?
1. Control: this is the idea that you can influence events in your life, including stressors
2. Commitment: this is the individual's sense of involvement and purpose in life
3. Challenge: This refers to the idea that changes in life should be viewed as an opportunity rather than a source of stress.
175
What study did Kobasa do on hardiness and stress?
They devised a questionnaire to assess control, commitment and challenge, and in her early studies found that people with high scores on these dimensions reported fewer stress-related symptoms. However, this work could lack ecological validity as it was mainly on male white-collar workers.
176
What did Beasley et al (2003) study on hardiness and stress?
They investigated the effects of life stress in university students. Students who scored more highly on hardiness showed reduced levels of psychological distress.
177
What are some of the links between work on TAB and Kobasa's concept of hardiness?
According to Kobasa, high levels of hardiness protect against the harmful effect of stress, whilst research into TAB suggests that Type A people are less vulnerable to the effects of stress than originally thought.
178
What can be concluded about TAB and stress?
1. Some characteristics of TAB such as time pressure and hostility may increase vulnerability to stress
2. Other characteristics such as commitment and challenge may increase resistance to stress.
3. The TAB pattern is made up of factors, some of which increase and some of which decrease resistance to stress
4. This mixed pattern might explain why the results of studies trying to link Type A behaviour and heart disease are inconsistent.
179
What did Eysenck (1988) propose?
They proposed two types of personality; the first was a personality type vulnerable to Cancer, and this personality was associated with difficulties in expressing emotions and with social relationships. The second was a personality type vulnerable to CHD. This was similiar to the TAB. These people were characterised by high levels of anger and hostility. However, there is no consistent evidence for linking these personality types to cancer or CHD.
180
What personality types did Denollet (2000) propose?
A personality type that in his view is vulnerable to heart disease. This is the Type D personality where the D stands for 'distressed.' People with this personality type experience high levels of negative emotions (note that this is similar to the hostility dimension of TAB) and social inhibition, i.e. they tend to avoid social interactions. Denollet and his group have shown in a number of studies (denollet et al,. 1996; Denollet and Van Heck 2001) that high levels of negative emotions combined with social inhibition are associated with increased risk of heart disease.
181
What can be conclude about aspects of personality in relation to stress-related illness?
1. Negative emotions such as anger and hostility do seem to increase stress-related vulnerability to heart disease.
2. However, there are other factors that influence the results. For instance, high levels of hostility and anger may be associated with smoking and drinking and other dysfunctional lifestyles. They may also lead to social isolation, which Denollet's work suggests is another important factor in the stress/illness relationship.
182
What is the COPE scale?
A questionnaire used to assess an individual's copping strategies. It provides ratings on 15 different strategies, such as denial, turning to religion, active coping, using emotional support, turning to alcohol, etc..
183
What is approach coping?
Coping with stress by tackling the situation directly. It is more adaptive with long-term stressors.
184
What is avoidant coping?
Coping with stress by denying the significance of stressful situations and pretending they don't exist.
185
What is problem-focused coping?
A coping style that tries to target the causes of stress in practical ways that directly reduce the impact of the stressor.
186
What is emotion-focused coping?
A coping style that targets the emotional impact of stressors. Strategies include denial and seeking support from friends.
187
Who created the COPE scale?
Carver et al (1989)
188
Who developed the idea of approach and avoidant coping?
Roth and Cohen (1986)
189
What did Holahan and Moos (1986) suggest about approach and avoidant coping?
That avoidant coping might be more adaptive for short-term stressors and approach coping for long-term stressors.
190
What can problem-focused coping involve?
- Reducing the demands of the stressor by active coping, for instance, systemically planning a revision schedule for an important examination.
- Improving your coping resources by, for instance, using your social network for informational and practical support.
191
What can emotion-focused coping involve?
- Cognitive emotion-focused coping, such as denial of the severity of an illness (this is a form of avoidant coping, or distraction by thinking about other things
- Behavioural emotion-focused coping, such as becoming angry ('venting emotion'), drinking and smoking more, or seeking emotional support from friends.
192
What did Carver et al (1993) discover about coping strategies?
They found that the emotion-focused strategy of denial led to better adjustment in women with breast cancer.
193
What did De Boer et al (1999) discover about coping strategies?
That emotional social support can help in coping with cancer.
194
What factors affect the type of coping response shown?
- The stressor itself: (Vitaliano et al (1990)
- Whether the stressor is controllable or not: (Lazarus and Folkman, 1987)
- Gender (maybe) (Stone and Neale, 1984) and (Hamilton and Fagot, 1988)
195
What did Vitaliano et al (1990) discover about coping strategies?
They concluded that problem-focused coping was used more often with work problems. Emotion focused coping was used when there were problems with personal relationships.
196
What did Lazarus and Folkman (1987) suggest about coping strategies?
They suggested that people use more problem-focused coping when they see a situation as controllable, and as emotion-focused when they see it as out of their control. Problems at work and examinations could be seen as more controllable than life-threatening illness and relationships.
197
What did Stone and Neal (1984) discover about coping strategies?
Their findings suggest that women use more emotion-focused strategies and men more problem-focused.
198
What did Hamilton and Fagot (1988) discover about coping strategies?
They found no differences between the genders in coping styles.
199
What did Tennen et al (2000) study about coping strategies?
They studied daily coping styles in patients with chronic pain, in a longitudinal study. Each day, participants completed a coping-style questionnaire and assessed their level of pain. Individual patients used different strategies simultaneously; emotion-focused strategies were used 4.4 times more on days when problem-focused strategies were not used. They different styles of coping interact. An increase in pain associated with problem-focused coping would be followed by the next day by an increase in emotion-focused coping. This shows that we constantly assess the success of a particular strategy and modify our coping techniques accordingly.
200
What is cognitive-behavioural therapy?
A therapeutic approach to stress and psychological disorders that aim to alter irrational thoughts and cognitive biases that are assumed to be the cause of the problem.
201
What is stress inoculation training? (SIT)
A cognitive behavioural approach to managing the negative effects of stress.
202
Who developed stress inoculation training?
Meirchenbaum
203
What are the three stages of stress inoculation training?
1. Conceptualisation
2. Skills training and rehearsal
3. Application in the real world
204
What does conceptualisation in stress inoculation training involve?
The client works with the therapist to identify the sources of stress in their lives. This may involve thinking back to stressful encounters and trying to identify the key features of these encounters. They would be encourages to keep a diary to record stressful experiences during the daytime. The therapist may also challenge some of the client's appraisals of stressful situations if they seem exaggerated.
205
What does skills training and rehearsal in stress inoculation training involve?
For a number of stressors in people's lives it is possible for them to acquire specific social skills to address those situations. A background issue in most stressful situations is physiological arousal, therefore, regardless of the particular source of stress training in relaxation is always useful.
206
What does application in the real world in stress inoculation training involve?
After practising specific skills and relaxation techniques in the therapeutic setting the client is then encourages to apply them in the real world. The client and therapist continue monitoring the success or failure of the therapy. A key to this approach is that the client should learn from experience, by reflecting on the success or failure of their new skills. If necessary, there would be opportunities for further training and rehearsal.
207
What are the strengths of stress inoculation training?
1. It is a cognitive-behavioural approach that focuses on identifying the sources of stress and assessing how well you have dealt with them in the past.
2. The cognitive element of SIT is aimed at producing a realistic appraisal of demands, while the training in relevant skills is aimed at increasing resources to cope with demand.
3. Training in relaxation technique gives clients some control over any stressful situation.
4. It has been shown to be effective in a variety of situations, including examination stress in students (Berger 2000) and as a treatment for the stress associated with snake phobia (Meichenbaum, 1985)
208
What are the weaknesses of stress inoculation training?
SIT, like more CBT programmes, takes time, commitment and money. It is not, therefore suitable or available to everyone.
209
What is Hardiness training?
A programme to increase people's level of hardiness (control, commitment, challenge) and so improve their ability to deal with sress.
210
What are the three stages of Hardiness training?
1. Focusing
2. Reconstructing stressful situations
3. Self-improvement
211
What does focusing in hardiness training involve?
The therapist encourages the client to focus on the physiological symptoms associated with stressful situations. This helps them identify sources of stress. The therapist will also help them acquire new skills and strategies for coping with stress.
212
What does reconstructing stressful situations in hardiness training involve?
The client is encourages to think about recent stressful situations, and in particular how they might have turned out better and how they might have turned out worse. This is a cognitive strategy to encourage the client towards a realistic appraisal of life stress and how they cope with it. Realising that things could have been worse should help them feel more positive and optimistic.
213
What does self-improvement in hardiness training involve?
To improve the client's sense of self-efficacy the therapist will suggest taking on manageable sources of stress. This may involve skills training similar to stage 2 of stress inoculation training. The experience of coping with these will increase the sense of self-efficacy, and even though there will always be stressors around, the client should feel more optimistic about dealing with them.
214
What is the strength of hardiness training?
1. It targets the appraisal of sources of stress and, through training, the resources available for dealing with them. In this way it theoretically reduces the gap between demands and coping resources.
2. It should provide the client with an increases sense of self-efficacy and this should enable them to deal with future stressful situations more effectively.
3. Studies have shown the effectiveness of hardiness training in improving health and performance in working adults and in students (maddie, 1987; Maddie et al, 2002)
215
What are the weaknesses of hardiness training?
It involves time, commitment and money. It is therefore not appropriate for everybody.
216
What is self-efficacy?
The sense of personal effectiveness and control over one's life.
217
What is anxiolytics?
The drugs used in the treatment of anxiety states and stress.
218
What are benzodiazepines?
A class of drugs used in the treatment of stress and anxiety, which was introduced in the 1960's.They are the most prescribed of the drugs used to treat clinical disorders.
219
What was used before benzodiazepines?
Up to the 1960's anxiety was treated with drugs from the barbiturate family. Although these could be effective, they are lethal in overdose and also produce high levels of physical dependency.
220
What are some of the best-known examples of benzodiazepines?
Librium, Valium and Mogadon.
221
Why are benzodiazepines popular?
One reason is that some bezodiazepines such as Librium and Valium can be effective anti-anxiety drugs (or anxiolytics), while others such as Mogadon are effective sleeping pills.
222
How do benzodiazepines work?
They act in the brain, increasing the action of the neurotransmitter GABA; GABA is an inhibitory neurotransmitter meaning that its role is to reduce the activity of other neurotransmitter pathways throughout the brain. By increasing this inhibitory action of GABA, they therefore produce greater inhibition of neurotransmitter activity in the brain, and there is some evidence that the inhibition of noradrenaline and serotonin is particularly important for the anti-anxiety and antistress effects of benzodiazepines.
223
What are the strengths of the use of benzodiazepines?
1. Compared with barbiturates they are relatively safe in overdose
2. Effective stress management should specifically target sources of stress in one's life and/or one's available coping resources. This reduces the gap between perceived demands and perceived resources. The use of benzodiazepines are therefore most effective if combined with psychological and alternative methods that address the causes of stress.
224
What are the weaknesses of the use of benzodiazepines?
1. Range of side effects, such as tiredness/sedation, impaired motor coordination, and some evidence for memory impairment in long-term use.
2. Can lead to a state of physical dependence, which makes the person go into a withdrawal syndrome if the drug is stopped. Symptoms include sleeping problems, sweating, tremors and raised heart rate. They should therefore only be prescribed for short periods.
3. They do not target the sources of stress or help the individual develop more effective coping strategies.
4. Ethical issues, as they can lead to dependence and side effects, fully informed consent should be obtained, but some people with severe stress-related anxiety would not be fully competent to give informed consent.
225
What is the cardiovascular system?
The heart and blood vessels
226
What are beta-blockers?
Drugs used in the treatment of the bodily arousal associated with stress. They act directly on the cardiovascular system of the body rather than in the brain.
227
What drugs do beta-blockers include?
Drugs such as Propranolo and Alprenolol.
228
How do beta-blockers work?
They act directly on the heart and circulatory system of the body. They reduce activation of the cardiovascular system by sympathetic fibres of the autonomic nervous system. In this way they directly reduce increases in heart rate and blood pressure that are associated with stressful situations, and are also used in the management of chronic hypertension (raised blood pressure)
229
What are the strengths of using beta-blockers?
1. They can act rapidly and have a life-saving function in people with life-threatening hypertension (hypertension is not always related to stress)
2. They do not have severe side effects, partly because their main action is in the body and they do not penetrate the brain easily.
3. They target the physiological stress response, which can reduce this response in stressed individuals and lower stress-related bodily arousal.
230
What are the weakness of using beta-blockers?
1. They can interact with other drug treatments, especially those for asthma.
2. THey are not targeting the sources of stress but only the physical symptoms. THerefore they are inappropriate for long-term management of stress-related arousal, which is more effectively treated with psychological methods.
231
WHat is biofeedback?
It is a technique that combines both physiological and psychological techniques. The aim is for the individual to develop their own psychological techniques to lower heart rate and blood pressure, using the biofeedback as a guide to when they are successful.
232
How does biofeedback work?
The individual is wired up to machines that provide feedback on their physiological processes. For instance, heart rate might be recorded and displayed on a monitor. Or perhaps a buzzer might sound if heart rate goes above a certain level. The person is then helped to develop techniques for reducing physiological arousal, such as the progressive muscle relaxation, or perhaps visualisation of calm scenes and mediation. After training they should be able to apply these techniques in real life and be confident that even without immediate biofeedback they are reducing their physiological arousal.
233
What are the strengths of using biofeedback?
1. There is evidence that biofeedback is effective for controlling heart rate and in the treatment of headaches caused by muscles tension (Attanasio et al, 1985)
2. Biofeedback on breathing patterns has been found to be effective in people with panic disorder (Meuret et al, 2004). The biofeedback helps them maintain a regular breathing pattern.
3. Attanasio et al (1985_ showed that biofeedback for tension headaches was especially effective in children, probably because of the exciting machinery involved.
4. It is harmless and has no side effects
234
What are the weaknesses of using biofeedback?
1. It requires motivation and commitment for the training programme to be successful.
2. As biofeedback involves relaxation, a stress management technique in itself, it is possible that biofeedback may be no more effective than relaxation techniques used on their own (Masters et al, 1987)
235
What is progressive muscle relaxation?
Muscle relaxation is not seen as a stress management technique in its own right, but it is a common component of, for instance, CBT approaches. One of the main features of the body's stress response is an increase in general physiological arousal. One way to exert some control over this is to have available a reliable technique for relaxing body muscles and reducing general arousal.
236
What is the most common produce taught for progressive muscle relaxation based on?
Jacobson (1938)
237
What is Jacobson (1938) method for progressive muscle relaxation?
Muscles are alternately tensed and relaxed in a systematic fashion, i.e. beginning with toes and feet and working up to arms and hands, shoulders, muscles of the lips and forehead. As the person becomes more practised they should be able to achieve a state of relaxation without going through the full tense/relax procedure. Once acquired , this fairly rapid method of achieving bodily relaxation can be used in times of stress. Along with, perhaps, cognitive reappraisal taught through CBT, this gives the individual an increased sense of control over stressful situations.
238
What is mediation?
It has similarities with muscle relaxation, in that it has the the immediate effect of reducing bodily arousal. There are a number of different approaches, but they all essentially involve focusing away from the immediate situation and instead dwelling on neutral or relaxing stimuli. This may be helped by having a mantra- a single word of sound repeated over and over- and concentrating on steady and deep breathing. As with muscle relaxation, mediation works against the bodily arousal associated with stress.
239
What are the strengths of using progressive muscle relaxation and meditation?
1. Studies have shown (Murphy, 1996) that meditation can be an effective stress management technique in the workplace, leading to reductions in blood pressure and anxiety.
2. Both of these techniques reduce the arousal associated with stress and give the individual an increased sense of control over stressful situations.
3. They can be extremely useful in combination with more systematic and focused methods.
240
What are the weaknesses of using progressive muscle relaxation and meditation?
1. Neither technique targets the sources of stress, or provides specific skills for dealing with stress.
241
How can physical exercise help to reduce the physiological arousal associated with chronic stress?
Chronic stress can result in high levels of energy reserves such as glucose and free fatty acids in the bloodstream. This contributes to the development of circulatory problems such as atherosclerosis. It would seem logical that physical exericse would help burn up these energy reserves and present these stress-related conditions developing. In fact the evidence is quite mixed and it is not clear that regular exercise does reduce physiological reactivity to stressors. However there is evidence that regular exercise reduces resting levels of heart rate and blood pressure, so that while stress-related increases may occur, they are starting from a low level and should not be so harmful.
242
How can stress aid psychological factors associated with stress?
There is clear evidence that exercise can low levels of stress and have very positive effects on mood (Biddle, 2000). Throne et al (2000) found that regular exercise reduced levels of stress in fire fighters. Additionally, exercise makes people feel better and can lead to reductions in clinical states such as depression (Mutrie, 2000). In relation to personality and stress, negative mood states are associated with vulnerability to stress-related illness, and so the positive effects of exericse on mood may indirectly help in coping with stress.
243
What are the explanations for the effects of exercise on mood?
There is no clear explanation for the effects of exercise on mood. It may be the effect of taking positive action and exerting some control over this area of life, so increasing self-efficacy. Alternatively, it has been proposed that chemicals called enkephalins are released during exercise and act in the brain to directly improve mood. However, there is very little direct evidence for this idea.
244
What are enkephalins?
Neurotransmitters in the brain involved in emotion circuits. Their release may be associated with improvements in mood.
245
What are the strengths of using physical exercise?
1. It lowers resting heart rate and blood pressure.
2. It has positive effects in raising mood, possibly through the actions of enkephalins in the brrain.
3. It can also reduce reported levels of stress and depression.
246
What are the weaknesses of using physical exercise?
1. It may not affect physiological reactivity to stress.
| 2. There is some risk of injury, especially if exercising too vigorously or when starting an exercise programme.
247
How can social alleviate the effects of stress?
Social support is not technically a method of stress management. However many studies over the last 40 years have shown that the level of social support can be a critical factor in reactions to stress. These studies cover a variety of different situations, ranging from physiological reactions to stress, to patients coping with life-threatening illnessess such as cancer and heart disase.
248
What is social support?
On the commonsense level, social support simply refers to the network of family, friends and co-workers on whom you rely on in times of stress.
249
What four main categories can the functions of social support be divided into?
1. Emotional support
2. Practical or instrumental support
3. Informational support
4. General network support
250
What does the function of emotional support of social support involve?
This is where your social network shows concern for your situation and provides reassurance.
251
What does the function of practical or instrumental support of social support involve?
This is where your support group may provide practical advice or help, for instance lending you money.
252
What does the function of information support of social support involve?
Your support group may be the source of valuable advice on how to deal with particular stressors. Some of the group may have been through the same situation previously and you can benefit from their experience.
253
What does the function of general network support of social support involve?
Being part of a network of people provides a sense of belonging and social identity, and improves self-esteem.
254
What research has consistently shown that social support reduces vulnerability to stress related arousal?
Mortality from heart disease has been shown to be closely related to social support (as rated by size of network and number of categories covered; Vogt et al, 1992), while social support in the workplace reduces job-related stress (constable and Russell, 1996)
255
What meta-review did Uchino, Cacioppro and Kiecolt-Glaser (1996) do on social support and the body's physiological processes?
They concluded that across 28 different studies degrees of social support showed a consistent relationship with reduces blood pressure and across 19 studies there was a significant association between level of social suppport and immune function, for instance ccarers for dementia patients showed reduced immune function, and this was particularly marked in those reporting the lowest levels of social support.
256
What study did Kamarck et al (1998) do on social support and stress?
In a labortory experiment heart rate and blood pressure during a difficult arithmetic task were lower in women with a companion than those who did the task along
257
What study did Cohen et al (1997) do on social support and stress?
They found that vulnerability to the common cold was greatest in participants who reported having the fewest social roles (i.e. friend, brother, parent, etc.) and hence the smallest social network.
258
What study did Allen et al (2002) do on social support and stress?
They found that the presence of a pet lowered heart rates during the performance of stressful tests.
259
What study did Watson et al (1998) do on social support and stress?
They showed that social isolation in monkeys leads to increases in heart rate and blood pressure and eventually to heart disease.
