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Medicine in Society > Stress and coping > Flashcards

Stress and coping Flashcards

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1
Q

What is stress?

A

Psychological (ABC) state associated with physiological and hormonal changed caused by stressors

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2
Q

What are the different types of stress response?

A 
Behavioural
Emotional 
Cognitive 
Physiological 
Biochemical
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3
Q

What are behavioural stress responses?

A 
Sleep disturbance 
Use of alcohol / drugs 
Absenteesism 
Social withdrawal 
Aggression
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4
Q

What are emotional stress responses?

A 
Depression/anxiety 
Irritability 
Crying 
Suicide / DSH 
Loss of humour 
Loss of libido
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5
Q

What are physiological stress responses?

A 
Higher BP 
Rapid shallow breathing 
Increased HR
Dilation of pupils 
Muscle tension 
Dry mouth
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6
Q

What are biochemical stress responses?

A

Increased metabolic rate
Altered hormone levels
(A, NA, cortisol, ACTH)

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7
Q

What are cognitive stress responses?

A

Lack of concentration
Negative thoughts
Worrying
Poor memory

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8
Q

What events do stressors generally fall into?

A
  • traumatic events
  • uncontrollable events
  • unpredictable events
  • highly challenging events
  • internal conflicts
  • accumulation of daily hassles
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9
Q

What events come under traumatic events?

A 
Natural disasters - earthquakes
Disasters caused by human activity 
Catastrophic accidents
Physical assaults
Stress can be very long-lasting (PTSD)
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10
Q

What events come under uncontrollable events?

A 
Death of a loved one 
Loss of job 
Serious illness, hospitalisation 
Burglary 
Extremes of weather - esp. hot and humid
Noise pollution 
Air pollution
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11
Q

What events come under unpredictable events?

A

Predictability helps to reduce stress:

  • hurricane and flood warning
  • knowing that a loved one will die
  • noise pollution on bonfire night

Unpredictable jobs are considered very stressful e.g. A&E

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12
Q

What events come under highly challenging events?

A 
Job interviews 
Examinations 
Exams are a good example:
- they challenge the limits of our intellectual capabilities 
- they carry the possibility of failure
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13
Q

What events come under internal conflicts?

A

incompatible beliefs or courses of action:
- “torn” between what you want to do and what you should do
- cognitive dissonance: fox and the grapes
E.g. Smoking

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14
Q

What are the models of stress?

A

Response to stress

  • fight-or-flight
  • general adaptation syndrom

Life events model

Interaction models

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15
Q

What is the fight-or-flight response?

A

External threats elicit the response
Physiological response
Individual can escape stressor or fight

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16
Q

How does the fight-or-flight response work?

A

Stressor activates the hypothalamus

  • this activates the SNS and the adrenal-cortical system (HPA axis)
  • SNS activates adrenal medulla and various other glands and smooth muscle
  • The HPA axis activates the pituitary gland which activates the adrenal cortex causing release of stress hormone
17
Q

What is general adaptation syndrome?

A

3 stages of response after exposure to stressor:

1) alarm stage - activation of the SNS and HPA axis
2) Resistance stage - attempts to cope and resist the stressor, and actions of cortisol
3) Exhaustion stage - if resistance does not end the stressor, adaptive processes fail

18
Q

What are some of the early warning signs of the exhaustion stage?

A

headaches, GI disturbances, skin rashes, dizziness, fatigue, hypertension, aggravation of arthritis, colitis, asthma, ulcers, diabetes

19
Q

What are some of the problems with the response models?

A

Automatic response to stressor:

  • doesn’t consider individual variation
  • doesn’t recognise psychological factors
  • response non-specific irrespective of stressor
20
Q

What problems are there with the life events model?

A

Variation in individual response to the event
- what is stressful for one person, is not for another (divorce/marriage)

Accumulation of stressors can have different effects - marriage, new home, new job, pregnancy

No recognition of time scale, short lived or on-going event

21
Q

What is the interaction model of stress?

A

incorporates both response and life events models

emphasis on how internal psychological factors interact with external factors

important factors seems to be how well a person copes with stress rather than how much stress they face

22
Q

What is the transactional model of stress?

A

Stress is a transaction between the individual and the environment
Appraisal is crucial
- stress response only elicited if the individual appraises the potential stressor as stressful

Primary and secondary appraisal

  • Primary: individual firstly appraises the event
  • Secondary: individual evaluates their coping strategies
23
Q

What does person-environemt fit mean?

A

think of stress as a transaction between people and the environment

= good person-environment fit= low stress

= poor person-environment fit=high stress

24
Q

What is the difference between type A and type B personalities?

A

Friedman and Rosenman developed these categories to investigate risk of CHD

TYPE A: competitive, achievment-orientated, sees of time, urgency, difficult relaxing, impatient, angry, hostile, outwardly confident but full of self-doubt

TYPE B: relaxed, easy going, unpressured

25
Q

What are some key attributes of type A behaviours?

A

Thinking of, or doing, two things at once
hurrying speech of others
unduly irritated by queues
if you want something done, d it yourself
frequent knee jigging or rapid finger tapping
playing to win, even against children
impatience when watching someone else do something you think you could do better
rapid blinking or tic-like eyebrow lifting
eating and speaking very fast

26
Q

What did Friedman & Rosenman propose about type A personalities?

A

Type A doubles the risk of CHD
- suggested that SNS is hyper-responsive to stressful situations

HOWEVER, subsequent research has not consistently supported this and there are many confounders that should be considered

27
Q

What are the four fundamental personality types linked to the four humors?

A

Phlegmatic (phlegm): calm, thoughtful, private, peaceful

Melancholic (black bile): serious, quiet, analytical

Sanguine (blood): lively, sociable, optimistic, courageous

Choleric (yellow bile): impulsive, restless, excitable, leadership

28
Q

What is the high N personality?

A

personality along 2 dimensions:

  • neuroticism
  • extraversion

LOW N and LOW E = phlegmatic

LOW N and HIGH E =Sanguine

HIGH N and LOW E = Melancholic

HIGH N and HIGH E =Choleric

29
Q

What are the characteristics of a highly neurotic person?

A 
Worrying 
negative outlook 
introspective 
low self-concept 
social anxiety
30
Q

What are the stressful cognitive styles (dysfunctional attitudes)?

A

Pessimistic attribution style = negative events are internal, stable and global

Characteristic of learned helplessness = associated with depression and a risk factor for physical illness

Learned helplessness

31
Q

What are the different ways of coping with stress?

A

Approach vs Avoidance

Problem focused vs Emotion focused
- Problem: directly deal with stressor
- Emotion: alter/reduce negative emotions that result from the stressor
Coping is dependent on the context and can be dynamic

32
Q

What are some examples of emotion focused coping?

A
  • Seeking emotional support from friends and relatives
  • venting anger
  • denial, avoidance, distraction
  • praying
  • exercise
  • using alcohol, drugs or other treats
  • humour
33
Q

How can you measure stress?

A

Measure number and type of stressors
= life events scale

Measure psychological responses to stress
= perceived stress scale

Measure psychlogical symptoms of stress
= anxiety/depression scales

Measure physiological symptoms of stress
= blood pressure, heart rate, hormone levels, immune response

Measure coping styles/strategies
= COPE

34
Q

How are stress and cancer linked?

A

they are not clearly associated with onset, but is associated with acceleration of the disease/relapse

35
Q

How are coronary heart disease and stress linked?

A

Increased risk in high stress jobs

Increased risk among employed mothers

36
Q

How are psychoneuroimmunology and stress linked?

A
  • stress accelerates progression of HIV to AIDs (esp.low levels of social support)
  • medical students have decreased immune function around exam period
37
Q

What effects does bereavement have on people?

A

3 fold increase in non-pyschiatric admissions (mainly osteoarthritis)

Mortality increased (mainly cardiac and CV disease, esp. coronary thrombosis)

7-fold mortality increase in 1st year after death of close relative

Greatest mortality among spouses (esp. young and male)

38
Q

What approaches are there to reduce stress?

A

Stress management training
Formal psychological therapy CBT
Psychotropic medication

39
Q

What is stress management training?

A 
problem-solving 
time management 
cognitive restructuring
relaxation 
behavioural change plans 
positive self-talk

Medicine in Society (29 decks)

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