Stress Flashcards
what are the three theories that explain stress?
Stress as a stimulus
Stress as a response
Stress as a transaction
Describe stress as a stimulus
• Focus on the environment
• Event or circumstance is the cause of stress
• Events or circumstances are known as ‘stressors’
Example: ‘working with chronically ill pts is stressful’ ‘my illness is causing me stress’
Describe stress as a response
• Focus on individual’s reaction to stressors
• Psychological response
• Physiological response
• Responses are known as ‘strain’
Example: ‘I feel a lot of stress just before my OSCE’
‘I find breaking bad news to a patient stressful’
Describe stress as a transaction
• Focus on stress as a process
• Relationship between the person and environment
• Continuous interactions and adjustments – ‘transactions’
Example: person is the active agent who can influence impact of stressor
‘stress // challenge before the OSCE ??’ – coping
Define stress
Med school lol
‘The perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation’
(Lazarus & Folkman, 1984)
- feeling of lack of control
- unpredictability
N.B: for Post Traumatic Stress Disorder, see DSM 5 criteria (link on galen)
How is stress appraised?
• ‘Stress - coping’ paradigm (Lazarus, 1980)
• Cognitive appraisal Primary appraisal (danger?) Secondary appraisal (coping)
Summarise stress
- Demands are greater than ability to cope
- Consequence of the cognitive/ thinking process
- Cognitive appraisal – primary and secondary
- Feeling of lack of control, unpredictability
- Individual/ situational differences
- Process – continuous interactions and adjustments
What are 3 things stress impacts on
Physiological system
Psychological aspect
Social Aspect
What are the physiological modes of stress?
• Fight or flight response (Cannon 1932)
– acute/ short term
• General Adaptation Syndrome (Selye, 1956)
– chronic/ long term
Describe fight or flight response due to stress
Physiological reaction to emergencies - ‘adaptive’ response
• Homeostasis threatened, disrupted
• Response to acute, short lived stress
• External threats elicit fight or flight response
• greater physiological arousal
• Enable fight or flight response and restore homeostasis
• BUT prolonged state of high arousal harmful to health
Describe the different aspects of general adaptation syndrome
Chronic/long term
Stressor ->
Alarm! mobilisation against stressor->
Resistance continued fight against stressor ->
Exhaustion - depletion of resources, ability to resist may collapse
What is the two step physiological response of the stress response
• Sympathetic activation
– under stress: sympathetic nervous system stimulated – catecholamines produced (adrenalin & noradrenalin) – quick response system (within seconds)
• Hypothalamic-pituitary-adrenocortical (HPA) activation
– raised levels of corticosteroids (glucocorticoids e.g. cortisol) – raised levels of brain opioids beta endorphin & enkephalin – slower response system (minutes to hours)
What is the impact of long term stress response from the cortex?
• retention of sodium & water by kidneys
• increased blood vol, BP
• P, F converted to glucose/ broken down for energy
• increased blood sugar
• decreased immune system
Neuroendocrine cascade: stress and the adrenal gland
What is the impact of short term stress response in the medulla
- increased heart rate
- increased BP
- increased metabolic rate
- changes in blood flow
- dilation of bronchioles
What are the typical categories of signs of stress?
- biochemical
- physiological
- behavioural
- cognitive
- emotional
Why do responses to stress vary?
Stress moderators such as: • coping strategy • social support • beliefs and attitudes • personality • individual differences.... • sense of control • stress reactivity • genetic predisposition (PTSD – see galen) • gender • certainty / uncertainty • lifestyle
Are junior doctors stressed?
Ye
What impacts can stress have in junior docs?
Most mistakes are stress related so a lot, mostly moderate mistakes
What is burnout?
Symptomatically similar to stress, attributed to occupational stressors
(Maslach et al., 1996)
What are some reasons that long term stress should carry a health warning?
• Health behaviour
– risk behaviours, health compromising behaviours, cognitive,
emotional
• Physiology
– ↑SNS, catecholamine, corticosteroid release
CHD, MI, hypertension, compromised immune function, depression, asthma, peptic ulcer, headache, eczema, growth problems…
Is stress implicated in coronary heart disease?
Ye
How is stress linked to cardiovascular reactivity?
• Individual’s exhibit stable cardiovascular reactivity
• But individual variation in ‘reactivity’
• Stress induced increase in catecholamine and corticosteroid release can damage the arteries and heart
– promote atherosclerosis, increased heart rate
– lead to development of hypertension, CHD
What are three stress factors that impact the immune system?
• Physiological response to stress
– increased catecholamine & corticosteroid release
– decreased immune cell activity (T and B cells) against antigens
– linked to development of infectious disease, cancer
• Psychological state, emotion, beliefs
– depression, optimism also influence immune response
– denial, fighting spirit predicted survival breast cancer pts(Greer1979)
• Psychosocial factors
– life events, social support, exercise, lifestyle
Does stress impact wound healing?
Ye
• Wound healing took 24% longer in caregivers c.f. controls
• Caregivers reported > stress c.f controls p< 0.002
What are some indirect effects of stress on health?
• Health-related behaviours:
– increased substance abuse (alcohol, drugs)
– increased smoking
– poor diet
– lack of sleep
– lack of exercise
– poor adherence to treatment
– less likely to take preventative health measures
– increased engagement in reckless behaviour -> injury
What are the key points of stress in health?
Stress is the perceived discrepancy between the demands and resources appraised by the individual
Cognitive appraisal of a threat involves primary and secondary appraisal
Stressors are events or circumstances that we perceive as threatening or harmful
Stress leads to changes in biochemistry, physiology, behaviour, cognition and emotional state
IMPLICATIONS: stress has been linked directly and indirectly to health outcome
