Stress and health

Question 1

What is the fight or flight model?

Answer 1

Cannon’s fight or flight model (1932)

• The body goes into this state due to perception of the threat
• NOT just the presence of the threat, it must be perceived

Question 2

What does the exhaustion period of the flight or flight model indicate?

Answer 2

That we cannot stay in that state forever. It has to change and return to a resting period/period of homeostasis

Question 3

What is meant by stress?

Answer 3

o ‘… the condition that results when person-environment transactions lead the individual to perceive a discrepancy - whether real or not - between the demands of a situation and the resources of the person’s biological, psychological, or social systems’. (Lazarus & Folkman, 1984)
- ‘person-environment fit’
o ‘… when demands imposed by events exceed an individual’s ability to cope’ (Cohen & Herbert, 1996)

Question 4

How may perception of the threat influence ability to cope?

Answer 4

• The threat can be perceived as high or the resources available may seem low
  o Its based on the discrepancy in perception between the treat and your ability to cope with it

Question 5

What is the transactional model and role of appraisal?

Answer 5

Perceiving if something if stressful is on one end and assessing whether I can cope on the other. Between these continuum is:
External stressor –> Primary and secondary appraisal –> stress and coping

Question 6

Within the transactional model and role of appraisal, what is more important?

Answer 6

The role of appraisal is more important than the stressor (Can I cope?)

Question 7

What is the role of appraisal in the transactional model?

Answer 7

o Individuals differ in the meaning they ascribe to appraised events and their perceived coping resources.
o Such individual differences may be linked to corresponding differences in stress reactions and health-related outcomes
o Much historical attention has focused on the biological mechanisms by which threat appraisals might affect health via two primary stress-response systems: the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis

Question 8

What are the two parts of the biology of stress?

Answer 8

Autonomic nervous system and the HPA axis

Question 9

What is the autonomic nervous system?

Answer 9

Fight or flight response - sympathetic nerves

Rest and digest - parasympathetic nerves

Question 10

What does HPA stand for?

Answer 10

Hypothalamic-pituitary-adrenal (HPA)

Question 11

What is the HPA axis?

Answer 11

o Hypothalamic-pituitary-adrenal (HPA) axis part of neuroendocrine system, controls reactions to stress and regulates various body processes
 Cortisol – stress hormone
• Used as a measurement of stress
o Amygdala, hippocampus and hypothalamus (lower circuit of limbic system) facilitate activation of HPA axis, which leads to the release of cortisol
o Prolonged high levels of cortisol have been associated with suppressed immune function and risk of various chronic diseases
- Stress is biological, but it depends on our mood

Question 12

What is the psychological aspects of stress?

Answer 12

• It is not consistent
  o It is dependent on mood – not just physical aspects, it is a state, a feeling
  o Repetti (1993) explored subjective and objective measures of stress in 52 air traffic controllers
  o Higher workload (worse visibility, more planes) = lower mood.
  o Low mood predicted psychological distress & minor illness

Question 13

How is stress measured?

Answer 13

• Measuring cortisol, Galvanic skin response, breathing rate, heart rate, blood pressure
• Stress features in a lot of psychology research – what are some of the common measurements?
• Physiological vs. self-report measures
• Lab settings vs. naturalistic settings (and challenges of measurement in both)

Question 14

In what 2 ways can we measure the physiological aspects of stress?

Answer 14

Sympathetic nervous system activation

Hypothalamic pituitary adrenocortical activation (HPA axis)

Question 15

How do we measure sympathetic nervous system activation?

Answer 15

o Ephinephrine & norephinephrine

o Blood pressure, heart rate, sweating, pupil dilation

Question 16

How do we measure - hypothalamic pituitary adrenocortical activation (HPA axis) activation?

Answer 16

o Cortisol production
o Quicker breakdown of energy
o Increased inflammation
o Changes in immune function

Question 17

What are the pros and cons of physiological measurement?

Answer 17

o More objective (less desirable responses)
o Not influenced by recall
o Mean the same thing to different people
o Don’t necessarily represent subjective experience (appraisal)
 As psychologists, we work with thoughts and feeling and so we need to link the biology to subjective experience

Question 18

What is cortisol?

Answer 18

The stress hormone

Question 19

How would one measure cortisol (linked with stress)?

Answer 19

o Individual points in day
o Rate of change across the day
o Amount of cortisol produced across the day
o Cortisol Awakening Response (CAR)

Question 20

What is the cortisol awakening response?

Answer 20

There’s always a spike in cortisol when individuals have woken up and then it falls to more of a resting level

Question 21

What is the ‘downstream’ effect?

Answer 21

When a method of stress reduction only works on one of the two types of stress

Question 22

How does stress change across the lifespan (a lifecourse approach to stress)?

Answer 22

• Development varies across range of dimensions: cognitive and intellectual functioning, language and communication skills, illness understanding, response to and perception of symptoms, and attention to health care and health behaviours
• Throughout the lifespan, the biological, psychological and social factors affecting the health of an individual change
• Health risks and problems alter –> change in preventive needs and goals and in responsibility for preventive action

Question 23

What is the lifespan approach to stress?

Answer 23

Consideration of previous development, current development and likely future development
- Types of illness change (cold vs CHD, cancer, stroke)

Question 24

What are the biological considerations of the biopsychosocial approach to the lifespan development and health?

Answer 24

• Physical growth (size, strength, efficiency) of bodily systems increases from childhood to adulthood; declines with old age (slowing down, reduced stamina, illness, injury recovery slower) due to less efficient heart and lungs, muscles weakening

Question 25

What are the psychological considerations of the biopsychosocial approach to the lifespan development and health?

Answer 25

• Cognitive processes increase across childhood, especially later childhood; understanding of illness develops; cognitive capacities decline in older age

Question 26

What are the social considerations of the biopsychosocial approach to the lifespan development and health?

Answer 26

• Education, career, retirement
• Parenting, grand-parenting
• Responsibility for health changes; from parent/caregiver to parents and teachers, peers, individual, autonomy

Question 27

How does early life impact stress?

Answer 27

• Early life adversity
• Person-environment transactions during childhood
• Prenatal exposure to stress
• Conditioning of the endocrine and immune system
• Development of coping responses and resilience
• E.g. the Romanian orphan study – how life stressors in childhood can influence adulthood
• E.g. mothers with anxiety when pregnant can influence the predisposition to anxiety in the child

Question 28

Which methods of childcare have been found to predict cortisol response in children?

Answer 28

• Dettling et al (2000)
  o Out of home childcare
  o Centre based

Question 29

What important variables within childcare methods influence stress?

Answer 29

o Quality of care received
o Child temperament: higher negative affectivity (greater fear, anger, discomfort) and lower effortful control (impulse control) related to increases in cortisol across the day
o Independent of family characteristics

Question 30

When have levels of cortisol levels been shown to increase/decrease (environmental conditions)?

Answer 30

Elevated or depressed cortisol levels observed in environmental conditions such as unstable, difficult living environments, family conflict and traumatic events (parent absence or residence change) (Flinn, 1997)

Question 31

In which environments has cortisol been shown to be disrupted?

Answer 31

Disruptions in circadian cortisol detected in:
o children of clinically depressed mothers (Ashman et al, 2002);
o physically abused and maltreated children (Kaufman, 1991; Hart, 1996)
o children reared in orphanages of substandard quality (Carlson & Earls, 1997; Fisher, 2000)
o children with PTSD symptoms (Carrion et al, 2002).

Question 32

What does The General Adaptation Syndrome claim about stress in the real world?

Answer 32

3 stages:
o Alarm - In response to a stressor the body prepares for physical action. Stress hormones (e.g. cortisol) are releases in large quantities “Fight or Flight”
o Resistance - The body tries to adapt to the new situation of the stressor and attempts to restore homeostasis. Blood pressure and glucose are high, but cortisol decreases. Shift from alertness to repair.
o Exhaustion - The body has depleted resources in trying to repair itself. In this stage the individual is susceptible to illness

Question 33

What is allostasis?

Answer 33

Stability through change (Sterling & Eyer, 1988). Adaptive systems enable response to different physical states, cope with noise, overcrowding, extremes of temperature, infection …

Question 34

What is allostatic load?

Answer 34

Accumulated lifetime stress – leads to imbalance in allostatic systems: overworked; fail to shut off; fail to respond to initial challenge (McEwen, 1998).

Question 35

What do stress, allostasis and allostatic load join together to create?

Answer 35

Theory of adaptation and resistance
or
A tale of two important concepts: vulnerability versus resilience

Question 36

What does a normal allostatic response look like?

Answer 36

Where a response occurs due to a stressor and then is turned off after an appropriate interval

Question 37

What four different types of conditions lead to allostatic loads?

Answer 37

1. Lots of hits from multiple stressors
2. No adaptation
3. No ‘shutdown’ after appropriate amount of time
4. Compensation from other mediators / hormones to reduce stress response that stop ‘adaptive’ responses.

Question 38

Can you get used to a stressor?

Answer 38

• Yes, you can get used to a stressor, with the stress response lessening each time
  o Cannot remain stressed constantly – not healthy – but you cant not get stressed either

Question 39

What are the psychological moderators of stress?

Answer 39

• Personality – higher levels of neuroticism are associated with increased stress and anxiety (Strickhouser et al., 2017)
• Emotion – people with an anxious disposition are more likely to be stressed.
  o May have attentional biases towards threatening stimuli which increases stress.
• Coping – 2816 men and women rated daily hassles and stress (Matud, 2004).
  o Same number of hassles but women rated them as more –ve and less controllable
  o This was associate with more avoidance coping

Question 40

What are the environmental moderators of stress?

Answer 40

• Peer support – lack of peer support can increase stress during life events
  o Workers who received peer support were more likely to report increases in perceived general health and reduced perceived work load.
• Changing role in life (e.g., child to teenager, moving home, retirement)
  o Different for each individual
• Work-related stress
  o On average, each person suffering took around 17 days off work. This varies as follows:
   9.1 days for injuries
   19.8 days for ill health cases
   23.8 days for stress, depression or anxiety
   17.6 days for musculoskeletal disorders
  o Stress is clearly an important issue in the modern world – it severely impacts health and days taken off work

Question 41

What physical health conditions and diseases can stress be linked to?

Answer 41

o Common cold & flu (contraction & symptoms)
o Allergic responses, asthma, eczema
o Autoimmune disease e.g. diabetes; rheumatoid arthritis
o Fibromyalgia, chronic fatigue
o Cancer
o HIV/AIDS

Question 42

What is PNI? Definition?

Answer 42

Psychoneuroimmunology
o The scientific field that investigates linkages between the brain, behaviour, and the immune system and the implications of these linkages for physical health and disease. [Kemeny & Gruenewald, (1999)]
- Not a new idea! – been around since the 70s
- Is a bit non-specific on what the linkages are

Question 43

What 3 cells does the immune system consist of?

Answer 43

T cells
B cells
Natural killer cells
 All white blood cells (lymphocytes)

• T cells seek out and destroy infected cells (eg bacteria, viruses)
• B cells produce antibodies that attack infection
• NK cells continuously circulate body and kill antigens when they come into contact

Question 44

How have the immune system and psychological predictors been linked to stress?

Answer 44

o Positive mood associated with better inflammatory markers / negative mood associated with worse inflammatory markers (Newman & Stone, 1996)
o Some evidence that hopelessness (eg Pessimistic approach) associated with poorer immune function (Gideon, 2001)
o Wound healing
o Interventions focusing on improving emotional expression have improved wound healing (marker of immune function; Weinman et al. 2008)
- Wound healing is slower in people with increased stress

Question 45

What psychological factors are found to be linked with diabetic foot ulcers?

Answer 45

• Ulcers hugely impact quality of life for people with diabetes (but do often heal over time)
• Coping style is a major predictor of whether an ulcer would heal inside 24 weeks (confrontational or not)
• More than other clinical/demographic determinants except for ulcer size

Question 46

How may interventions be linked with psychological factors and the immune system functioning?

Answer 46

• 103 adults randomized to 15-minute positive or neutral video package
  o People in the positive video package improved the immune response to the vaccination and they therefore had a greater level of immunity
• Positive indications of vaccination response to most strains at 4 and 16 weeks.
• Subsequent systematic review was inconclusive (heterogeneity of intervention) but noted that most effects are seen in behaviour vs biology
  o Systematic reviews tend to find inconclusive results, but there was evidence found here to suggest that it works

Latest project (REDUCE) by colleagues in Southampton aims to provide psychological and behavioural support to delay ulcer reoccurrence
o Used the Person Based Approach to identify guiding principles:
 Reduce feelings of hopelessness
 Build confidence
 Acknowledge physical limitations regarding physical activity
 Support emotional management for those who need it

Question 47

Definition of stress:

Answer 47

Can be defined as a negative emotional experience accompanied by biological/physiological, psychological and social changes directed toward adaptation either by manipulating the situation to alter the stressor or by accommodating its effects (Baum, 1990)