Stress and coping Flashcards
What is stress?
Psychological (ABC) state associated with physiological and hormonal changed caused by stressors
What are the different types of stress response?
Behavioural Emotional Cognitive Physiological Biochemical
What are behavioural stress responses?
Sleep disturbance Use of alcohol / drugs Absenteesism Social withdrawal Aggression
What are emotional stress responses?
Depression/anxiety Irritability Crying Suicide / DSH Loss of humour Loss of libido
What are physiological stress responses?
Higher BP Rapid shallow breathing Increased HR Dilation of pupils Muscle tension Dry mouth
What are biochemical stress responses?
Increased metabolic rate
Altered hormone levels
(A, NA, cortisol, ACTH)
What are cognitive stress responses?
Lack of concentration
Negative thoughts
Worrying
Poor memory
What events do stressors generally fall into?
- traumatic events
- uncontrollable events
- unpredictable events
- highly challenging events
- internal conflicts
- accumulation of daily hassles
What events come under traumatic events?
Natural disasters - earthquakes Disasters caused by human activity Catastrophic accidents Physical assaults Stress can be very long-lasting (PTSD)
What events come under uncontrollable events?
Death of a loved one Loss of job Serious illness, hospitalisation Burglary Extremes of weather - esp. hot and humid Noise pollution Air pollution
What events come under unpredictable events?
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
What events come under highly challenging events?
Job interviews Examinations Exams are a good example: - they challenge the limits of our intellectual capabilities - they carry the possibility of failure
What events come under internal conflicts?
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
What are the models of stress?
Response to stress
- fight-or-flight
- general adaptation syndrom
Life events model
Interaction models
What is the fight-or-flight response?
External threats elicit the response
Physiological response
Individual can escape stressor or fight
How does the fight-or-flight response work?
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
What is general adaptation syndrome?
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
What are some of the early warning signs of the exhaustion stage?
headaches, GI disturbances, skin rashes, dizziness, fatigue, hypertension, aggravation of arthritis, colitis, asthma, ulcers, diabetes
What are some of the problems with the response models?
Automatic response to stressor:
- doesn’t consider individual variation
- doesn’t recognise psychological factors
- response non-specific irrespective of stressor
What problems are there with the life events model?
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
What is the interaction model of stress?
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
What is the transactional model of stress?
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
What does person-environemt fit mean?
think of stress as a transaction between people and the environment
= good person-environment fit= low stress
= poor person-environment fit=high stress
What is the difference between type A and type B personalities?
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
What are some key attributes of type A behaviours?
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
What did Friedman & Rosenman propose about type A personalities?
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
What are the four fundamental personality types linked to the four humors?
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
What is the high N personality?
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
What are the characteristics of a highly neurotic person?
Worrying negative outlook introspective low self-concept social anxiety
What are the stressful cognitive styles (dysfunctional attitudes)?
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
What are the different ways of coping with stress?
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
What are some examples of emotion focused coping?
- Seeking emotional support from friends and relatives
- venting anger
- denial, avoidance, distraction
- praying
- exercise
- using alcohol, drugs or other treats
- humour
How can you measure stress?
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
How are stress and cancer linked?
they are not clearly associated with onset, but is associated with acceleration of the disease/relapse
How are coronary heart disease and stress linked?
Increased risk in high stress jobs
Increased risk among employed mothers
How are psychoneuroimmunology and stress linked?
- stress accelerates progression of HIV to AIDs (esp.low levels of social support)
- medical students have decreased immune function around exam period
What effects does bereavement have on people?
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)
What approaches are there to reduce stress?
Stress management training
Formal psychological therapy CBT
Psychotropic medication
What is stress management training?
problem-solving time management cognitive restructuring relaxation behavioural change plans positive self-talk
