Stress and Health/Physical Activity Flashcards
What is Exercise?
people ‘exercise’ in many different ways. some exercise is a discrete activity and takes time, such as running a marathon, going to the gym and playing team sports. in contrast, exercise can also just be part of daily life such as walking to work, mowing the lawn or doing housework. further, whilst some exercise is strenuous and generates a sweat and change in heart rate - such a playing tennis - other forms of exercise are less noticeable - for example, going upstairs to get a jumper or even getting off the sofa to change the TV channel. these different aspects of exercise have been defined in different ways according to intention, outcome and location. most research use the term ‘exercise’ to reflect discrete episodes of activity and ‘physical activity’ to describe all levels of non-sedentary behaviour.
- Physical Activity: Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that requires energy expenditure (WHO)
- Exercise: PA that is planned, structured, and repetitive for the purpose of conditioning the body.
Developing the Contemporary Concern with Exercise Behaviour:
Until the 1960’s exercise was done by the young and talented and the emphasis was on excellence. However, at the beginning of this era there was a shift in perspective. initiatives for sports in Europe suggested a move towards exercise for everyone. more recently, there has been an additional shift. exercise in no longer for the elite, nor does it have to be intensive and often impossible levels. now the emphasis is no longer on fitness, but on improving general wellbeing and making people less inactive.
MEASURING EXERCISE
measuring exercise in not simple as all methods have their strengths and limitations.
subjective self-report measures ask people to record how much exercise they do using either retrospective questionnaires or daily diaries. they ask about specific activities or target a specific intensity of exercise. they may also ask about the location of exercise. such subjective measures are useful for large-scale surveys but are liable to error due to problems with recall bias, social desirability and individual variability in the interpretation of the terms (e.g. ‘feeling breathless’).
objective measures of exercise include pedometers and rate monitors. these produce more detailed physiological data and are good for small-scale studies. however, they are not feasible for large-scale surveys. they might change exercise behaviour as participants are aware that they are being monitored.
laboratory measures can include bringing people into the laboratory to use exercise bikes or treadmills. these obviously produce reliable objective data but cannot be used on a large-scale and also have limited ecological validity as the setting is controlled.
as a alternative solution, some studies measure sedentary (inactive) behaviour as a means to measure the converse to exercise. this can be done particularly with children. this approach is problematic as a very active person could also be very sdentary during the day.
CURRENT RECOMMENDATIONS
The current UK Department of Health (DH 2011) recommends the following;
adults - minimum of 150mins of moderate exercise in a week in bouts of 10mins or more OR 75mins of vigorous intensity activity spread across the week OR a combination of moderate and vigorous. adults should exercise to improve muscle strength on at least 2 days a week and should minimise the time spent being sedentary for extended periods.
children - every day should include at least 60mins of at least moderate intensity physical activity with at least two sessions including activities to improve bone health, muscle strength and flexibility.
Who Exercises?
A large survey in the UK in 2010 also asked about exercise but this time the data were explored in terms of occupational activities (e.g. sitting or standing, walking around, climbing stairs or ladders, lifting or carrying loads) or non-occupational activities (i.e. heavy housework or walking). the results for men and women for occupational activities demonstrate that the most common activity was sitting or standing and the least common was lifting or carrying loads. the only main difference between men and women was that men spent more time carrying loads than women.
The data from this survey were also analysed to explore differences in non-occupational activities and changes over the lifespan. the results show that both men and women get less active in terms of non-occupational activities as they get older and that while men are more active than women in 16-24, 25-34, and 75+ age bands, there are only marginal sex differences in the middle age bands. this is cross-sectional data, therefore age differences do not necessarily reflect changes overtime but could indicate cohort effects, with those who are older now coming from a more sedentary history than those who are younger. only longitudinal data accurately tell us changes over time.
In the UK, an estimated 29% of adults do not achieve 30mins of moderate intensity exercise each week. research has also explored whether or not people reach the target of 150 minutes of moderate intensity activity per week set by the DH.
Measuring exercise or physical activity is difficult as people tend to not remember small tasks such as walking up stairs or moving around the house or workplace and it is quite possible for two people to spend the same amount of time on any given activity but for one to use up much more energy than the other. an alternative approach is to ask people how sedentary they are and in the UK this was done in terms of watching TV and being sedentary in general. the data showed men and women across the lifespan on weekdays and weekends.
the results showed a U-shaped curve with people being most sedentary in the youngest age band and the oldest age bands. Overall, data seem to indicate that the majority of people do not meet the recommended targets for activity, that generally people get more sedentary and less active as they get older and that men are more active than women particularly when young, but watch more TV than women as they get older.
The Benefits of Exercise?
THE PHYSICAL BENEFITS
Longevity:
Jefferis et al. (2018) carried out a cohort study over 30 years in the UK and reported that light physical activity was protective against all-cause mortality in older men. over recent years, evidence has illustrated the impact of sedentary lifestyles, indicating that prolonged sitting is related to reduced life expectancy (Buckley et al. 2015). Being sedentary even effects children, with research indicating that watching more than 2hrs of TV per day is associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement in those aged 15-17yrs old (Trembley et al. 2011).
Blair et al. (1989, 1996) reported that increases in fitness and physical activity can result in significant reductions in the relative risk of disease and mortality. People who are active on a regular basis live longer (Paffenbarger et al., 1986). Inactivity is one of the leading causes of death. It does not need to be much PA, weekly energy expenditure of 2000 kcal goes along with living 2.5 years longer on average; compared to those who had an energy expenditure of less than 500 kcal per week. Light PA protective against all-cause mortality (Jefferies et al., 2018), even 15 min. per day (Wen et al., 2011)
Chronic Illness:
In 2004 the Department of Health completed a report exploring the evidence for physical activity as a cause or prevention for physical health problems (DH 2004). the conclusions is that increased physical activity as a treatment for physical illness and the conclusions were less clear. It would seem that there is medium evidence for a moderate effect of physical activity for treating CHD, peripheral vascular disease, obesity, and osteoarthritis and strong evidence for a strong effect for lower back pain. However, there was insufficient data or only weak evidence for the remaining conditions.
Exercise may also influence physical health in the following ways (DESCRIBED IN PAGE 114)
Subjective Health Status:
Subjective health is the self-reported evaluation of one’s overall health status. Health has a very broad definition as it is left to respondents in surveys to apply their own interpretation of (general) health. Subjective health may be correlated with particular objective health indicators, but this need not be the case. The self-evaluation considers a person’s overall health status. There is no single clinical indicator for overall health (except perhaps mortality, but its threshold is too extreme) nor is there a generally accepted index of the many possible clinical measures. Each individual may attach different weights to objective indicators of specific aspects of health (i.e., blood pressure, mobility, grip strength) (see, for instance, Manderbacka, 1998).
Some of the most well-known indicators for self-reported health used throughout the social sciences are the SF-36 (and its shorter variants such as the SF-12 or SF-6) which aims to capture domains of both mental and physical health, and the CES-D and GHQ which are used to measure depressive symptoms or mental health status. Instruments like these are often used in research in subpopulations, for instance, patient groups. In population-based research, however, the most frequently used indicator of general health is a one-item question on the evaluation of one’s overall health status. This entry focuses on the evaluation of general or physical health and its relationship with SWB.
research has addressed the impact of the activity on subjective health. for example, Parkes (2006) carried out a large-scale longitudinal study of 314 industry employees to explore the role of both job activity and leisure activity on self-rated health (SRH) at 5yrs follow-up. the results showed that an interaction between both job activity at baseline was only predictive of lower SRH although the author argued that this could be due to the confounding effect of adverse work conditions. People who have higher levels of PA also reported higher levels of subjective health in a follow up.
Treatment for Chronic Fatigue Syndrome (CFS):
exercise is used to manage obesity in rehabilitation programmes for people with CHD. it is also used in varying degrees of intensity to help treat a number of other health problems such as back pain, injury, constipation, headaches and diabetes. one area that has received much interest over recent years is the use of exercise in the treatment of CFS. CFS is characterised by chronic disability fatigue in the absence of any alternative diagnosis and prognosis is poor if it not treated.
the preferred treatment approach by patient groups is called adaptive pacing therapy (APT) which sees CFS patients as having a finite and reduced amount of energy (an envelope) which must be carefully used. therefore APT encourages patients to limit their activity so as not to exhaust their energy supplies, to detect early warning signs as to when they might be becoming fatigued and to plan regular rest and relaxation and limit demands placed upon them.
CBT and graded exercise therapy (GET)is also recommended despite of reports from patients that these approaches can be harmful. GET believes that CFS patients have become ‘deconditioned’ and intolerant of exercise and they therefore need to build the strength and improve their energy levels through exercise. APT, CBT and GET have all been associated with less fatigue and better physical function.
THE PSYCHOLOGICAL BENEFITS
Depression:
it has been said the physical activity has been shown to improve depression in patients diagnoses with depression, however the results should be treated with an element of cuation given the methodological problems with some of the studies. Sedentary Behaviour - increased risk of depression (Zhai et al., 2015). Can exercise alone used as a therapy for depression? Mixed results: for example when compared with no treatment groups, then exercise intervention groups show moderate clinical effect of exercise. However, when compared to CBT, then no added benefit of exercising (Rimer et al., 2012)
Positive and Negative Mood:
Crush et al. (2018) study showed that moderate intensity exercise had a beneficial effect on feelings of depression, hostility, and fatigue regardless of exercise duration and recovery period. Hall et al. (2002) study showed however, a brief deterioration in mood mid-exercise, therefore although prolonged exercise may improve moode, this dip in mood may explain why people fail to adhere to exercise programmes. people pushing too far may be detterent to exercise and that self-selected levels may be the most effective way to promote continued physical activity. Mixed results for mood as outcome variable regarding exercise intensity: when it gets too intense then positive feelings seem to drop (e.g. Parfitt et al., 2006), especially for people who start exercising. More research is needed to determine under which circumstances
Response to Stress:
exercise may influence stress either by changing an individuals appraisal of a potentially stressful event by distraction or diversion or may act as a potential coping strategy to be activated once an event has been appraised as stressful. The relationship of stress to exercise can be uni- or bi-directional and varies from person to person (Burg et al., 2017)
Body Image and Self-Esteem:
Hausenblas and Fallon (2006) results indicated small effect sizes indicating a moderate impact of exercise. However, exercisers had a more positive body image than non-exercisers, exercise resulted in improved body image compared to a control group and body image improved from before to after exercise. there are many possible explanations for this effect, including the impact of exercise on mood, changes in actual body shape and size and changes in energy levels. No clear direction for the results here, but several explanations for this effect (e.g. changes in mood could be associated with changes in body image).
Smoking Withdrawal:
withdrawal symptoms can include agitation, irritability and restlessness when they have stopped smoking. Studies have explored the effectiveness of exercise in reducing withdrawal symptoms (Daniel et al., 2006; Ussher et al., 2001), over other techniques such as cognitive distraction. evidence has shown that physical activity reduced cigarette craving (Haasova et al. 2013).
What Factors Predict Exercise?
DEMOGRAPHIC DETERMINANTS
determinants of exercise (categories):
- demographics
- social benefits
- affect
- cost of exercise
- benefit of exercise
- exercise self-efficacy
- planning
- past behaviour (habit)
Dishman (1982) reported that non-modifiable factors such as age, education, smoking, ease of access to facilities, body fat/weight and self-motivation were good predictors of exercise. King et al. (1992) described an active person as younger, better educated, more affluent and more likely to be male. Agio et al. (2018) showed that participants who became less active as they got older was predicted by being older, having w manual occupation, having never married/had children, residing in the Midlands/North of England, suffering from a range of health conditions, being a smoker/ex-smoker and never consuming breakfast cereal.
SOCIAL DETERMINANTS
- exercise and beliefs that it is enjoyable and provides social contact
- the role of people helping others keep motivated
- need for a sense of purpose and a source of personal challenge
Social Network:
•quantitative aspects of social relationships,
•number of people that an individual has contact with
•mainly covers aspects such as the size (number of network members), density, and connectedness of social network (e.g. Berkman, Glass, Brissette, & Seeman, 2000; House, Umberson, & Landis, 1988)
Social Control:
•imposing demands, threats, requests, or rewards to influence another persons health behaviour (Umberson 1992)
•numerous studies have addressed how heterosexual couples attempt to influence their spouse’s health behaviours
• these studies show that women are more likely than men to impose control over their spouse’s health behaviours (e.g., Lewis et al. 2004; Rook et al. 2011)
•“Same-sex spouses, like heterosexual spouses, actively work to influence and improve each other’s health habits, and they, like their heterosexual counterparts, do even more of this work when their spouse’s health habits are worse than their own habits”. (Umberson et al, 2018)
Companionship:
•Feeling of friendship or fellowship
•Three relevant components:
- Friendship: availability of companions with whom to interact or affiliate
- Intimacy: availability of people with whom one feels emotionally close or connected
- Loneliness: perception that one is lonely or socially isolated from others.
COGNITIVE AND EMOTIONAL DETERMINANTS
Costs and Benefits of Exercise: Costs - - not any reason to do so Benefits - - health value - enjoyment - programmes more easily available - implicit attitudes (favourable)
Self-Efficacy:
- best predictor of initiation and maintenance of vigorours/moderate exercise for one year (Sallis et al., 1986)
- best predictors in intentions to participate in exercise programmes (Jonas at el. 1993)
- predictor for intentions to exercise and actual exercise at four months follow-up of cardiac rehabilitation patients (Sniehotta et al. (2005)
Past Behaviour and Habit:
much exercise is habitual and Norman and Smith (1995) found that, although most of the TPB variables were related to exercise, the best predictor of future behaviour was past behaviour. furthermore, implementation intentions only predicted future behaviour in those who showed low levels of activity in the past. therefore, past behaviour predicts future behaviour, but implementation intentions can help break this pattern in those who haven’t done much exercise before. this links in with research on planning.
Planning:
in one with much research on bridging the intention behaviour gap (see chapter 2), research has addressed the role of planning and implementation intentions in predicting and promoting exercise and consistently shows that both spontaneous and researcher prompted plans to do exercise are good predictors of physical activity.
Affect:
one version of emotion that has been studied is the construct ‘affective judgement’ which relates to feelings such as pleasure, enjoyment or feeling happy. Rhodes et al. (2009) review showed a significant relationship between affective judgements and physical activity that was consistent regardless of sample, measures used or the quality of the study.
Improving Exercise Behaviour
SOCIAL AND POLITICAL FACTORS
an increased reliance on technology and reduced daily activity in paid and domestic work has resulted in an increase in the number of people having relatively sedentary lifestyles. in addition, a shift towards a belief that exercise is good for an individuals wellbeing and is relevant for everyone has set the scene for social and political changes in terms of emphasising exercise. since the late 1960s many government initiatives have aimed to promote sport and exercise.
some of these approaches encourage exercise through the use of sports facilities. many, however, attempt to make small changes to peoples daily lives that can be sustainable, such as walking or changing a persons usual mode of transport. evidence for the effectiveness of these approaches is still forthcoming but any effort to make people less sedentary and more active in their daily lives would predictably be of benefit.
Exercise Prescription Schemes:
one recent approach to increasing exercise uptake is the exercise prescription scheme whereby GP’s refer targeted patients for exercise. this could take the form of vouchers for free access to the local leisure centre, an exercise routine with a health and fitness adviser or recommendations from a health and fitness advisor to follow a home-based exercise programme, such a walking.
Stair Climbing:
an alternative and simpler approach involves the promotion of stair rather than escalator or lift use. interventions to promote stair use are cheap and can target a large population. in addition, they can target the most sedentary members of population who are least likely to adopt more structured forms of exercise. has been shown to lead to weight loss, improved fitness and energy expenditure and reduced risk of osteoporosis in women (e.g. Boreham et al. 2000).
BEHAVIOURAL STRATEGIES
Social Support:
research indicates that local support groups, ‘buddy’ systems, walking groups and exercise contracts can promote exercise (Kahn et al. 2002).
•resources provided by others in order to help someone (Schwarzer & Knoll, 2007, 2010)
•social support (e.g., family and friends) crucial role in adoption & maintenance of physical activity/exercise (Courneya, Plotnikoff, Hotz, & Birkett, 2000; Lippke, 2004; Trost, Owen, Bauman, Sallis, & Brown, 2002; Spanier & Allison, 2001)
•social support from significant others and having a sports partner is positively associated with the initiation of physical activity (van Straalen, De Vries, Mudde, Bolman, and Lechner, 2009)
Study: intervention that tested if exercising together with a new sports partner helps to exercise more over the course of 8 weeks
Beneficial effects of social support on exercising •Intervention and control group could both increase exercising over the course of 8 weeks. (Rackow et al., 2014)
•Intervention group did sign. more exercise after 8 weeks
•This was driven by self-efficacy as a mediating process between social support and exercising (Rackow et al., 2015)
•On weeks with more emotional social support, participants report higher values of positive affect (Rackow et al., 2017)
Learning and Social Cognition Strategies:
planning, goal-setting, self-reward schemes, relapse prevention and tailoring interventions to the needs of the individual can be effective approaches (Sniehotta et al. 2006; Connor et al. 2010).
Self-Monitoring:
the use of pedometers is a simple and easy to use form of self-monitoring and may promote exercise.
School-Based Interventions:
evidence shows that simply increasing time spent on physical exercise at school can increase activity without damaging academic achievement. been shown to improve daily step counts, cardiovascular fitness, decline in the prevalence of overweight and obesity. However, whether or not this influences activity outside school remains unclear.
Work-Based Interventions:
useful way to target large numbers of the population, improve the wellbeing of a workforce and promote social support. Keller et al. (2016) seen an increase in self-efficacy, planning and physical activity following the intervention. some interventions, however, show improvements in absenteeism and productivity but no significant improvements in fitness or physical activity (reference in pg122)
Mass Media Campaigns:
social marketing approaches have been used to change exercise behaviour via TV, billboards and magazines. Reviews show although people can recall the messages, they have little impact on actual behaviour.
Exercise Adherence
which variables predict exercise adherence?
- younger, healthier with fewer chronic health conditions, less depressed, had less severe mobility limitations, had higher exercise self-efficacy and exercise outcome expectations (Jefferis et al. 2014)
- local environment high for social activities and leisure facilities
- enjoyment
- social support
- free time
- belief in the value of good health
- history of past participation
- high self-motivation
Thinking Critically about Exercise
- measurement
- research synthesis
- are we in control?
What is Stress?
the term ‘stress’ means many things to different people. A layperson may define stress in terms of pressure, tension, unpleasant external forces or an emotional response. Psychologists have defined stress in a variety of different ways. Contemporary definitions regard stress from the external environment as a stressor (e.g. problems at work), the response to the stressor as stress or distress (e.g. the feeling of tension), and the concept of stress as something that involves biochemical, physiological, behavioural and psychological changes.
Researchers have also differentiated between stress that is harmful and damaging (distress) and stress that is positive and beneficial (eustress). in addition, researchers differentiate between acute stress, such as an exam and chronic stress, such as poverty. the most commonly used definition of stress was developed by Lazarus and Launier (1978), who regarded stress as a transaction between people and the environment and described stress in terms of ‘person-environment fit’.
Useful definition of stress:
Stress is the condition that results when person-environment transactions lead the individual to perceive a discrepancy (difference) between the demands of the situation and the person’s resources.
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Signs & Symptoms of Stress
•Biochemical (e.g. raised cortisol levels)
•Cognitive (e.g. poor memory and concentration)
•Behavioral (e.g. irritability, withdrawal, violence, sleep problems)
•Emotional (e.g. fear, anxiety, depression, fatigue, mood swings, irritability)
Physiological
- Increased BP, HR, Respirations, etc
- Somatic symptoms
- Decreased immune response
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MEASURING STRESS
Laboratory Setting:
many stress researchers use an acute stress paradigm to assess stress reactivity and the stress response. this involves taking people into the laboratory and asking them either to complete a stressful task such as an intelligence test. the acute stress paradigm has enabled researchers to study gender differences in stress reactivity, the interrelationship between acute and chronic stress, the role of personality in the stress response and the impact of exercise on mediating stress-related changes.
Naturalistic Setting:
some researchers study stress in a more naturalistic environment. this includes measuring stress responses to specific events such as a public performance, before and after an examination, during a job interview or while undergoing physical activity. Naturalistic research also examines the impact of ongoing stressors such as work-related stress, normal ‘daily hassles’, poverty or marriage conflicts. these types of study have provided important information on how people react to both acute chronic stress in their everyday lives.
Costs and Benefits of Different Settings:
1) the degree of stressor delivered in the laboratory setting can be controlled so that differences in stress response can be attributed to aspects of the individual rather than to the stressor itself.
2) researchers can artificially manipulate aspects of the stressor in the laboratory to examine corresponding changes in physiological and psychological measures.
3) laboratory researchers can artificially manipulate mediating variables such as control and the presence or absence of social support to assess their impact on the stress response
4) the laboratory is an artificial environment which may produce a stress response that does not reflect that triggered by a more natural environment. it may also produce associations between variables (i.e. control and stress) which might be an artefact of the laboratory.
5) naturalistic settings allow researchers to study real life stress and how people really cope with it
6) however, there are many uncontrolled variables which may contribute to the stress response that the researcher needs to measure in order to control for it in the analysis
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MEASURING STRESS
Physiological Measures:
mostly used in the laboratory as they involve participants being attached to monitors or having fluid samples taken. however, some ambulatory machines have been developed which can be attached to people as they carry on with their normal activities. to assess stress reactivity from a physiological perspective, researchers can use a polygraph to measure heart rate, respiration rate, blood pressure and the galvanic skin response (GSR), which is affected by sweating. they can also take blood, urine or saliva to test for changes in catecholamine and cortisol production.
Self-Report Measures:
to assess both chronic and acute stress. some of these focus on life events and include the original Social Readjustment Rating Scale (SRRS) (Holmes and Rahe 1967) which asks about events such as death of a spouse, changing to a different line of work, and change of residence. other measures focus more on an individuals own perception of stress such as The Perceived Stress Scale (PSS) by Cohen et al. (1983). some researchers such as Kanner et al. (1981) assess minor stressors in the form of ‘daily hassles’ by using the Hassles Scale. Self-report measures have been used to describe the impact of the environmental factors on stress whereby stress is seen as the outcome variables. they have also been used to explore the impact of stress on the individuals health status whereby stress is seen as an input variable (i.e. ‘high stress causes poor health’).
Costs and Benefits of Different Measures:
1) physiological measures are more objective and less affected by the participants wish to give a desirable response or the researchers wish to see a particular result
2) self-report measures can be influenced by problems with recall, social desirability, and different participants interpreting the questions in different ways
3) self-report measures reflect the individuals experience of stress rather than just what their body is doing
4) self-report measures are based upon the life events or hassles that have been chosen by the author of the questionnaire. one persons hassle, such as ‘troublesome neighbours’ which appears on the Hassles Scale, may not be a hassle for another, whereas worries about a child’s school might be, which doesn’t appear on this scale.
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EARLY STRESS MODELS
Cannon’s Fight-or-Flight Model:
one of the earliest models was developed by Cannon (1932) who took a more biomedical model approach to stress. his approach suggested that external threats elicited the fight-or-flight response involving an increased activity rate and increased arousal (saliva flow decreases, pupils dilate, muscles more tense etc.). he suggested that these physiological changes enabled the individual to either escape from the source of stress or fight. within Cannon’s model, stress was defined as a response to external stressors, which was predominantly seen as physiological. Cannon considered stress to be an adaptive response as it enabled the individual to manage a stressful event. However, he also recognised that prolonged stress could result in medical problems.
Selye’s General Adaptation Scheme (GAS):
was developed in 1956 and describes 3 stages in the stress process. the ‘alarm’ stage (the stressor) involves an increase in activity and occurred as soon as the individual was exposed to a stressful situation. the resistance stage involved coping and attempts to reverse the effects of the alarm stage. then the exhaustion stage which was reached when the individual had been repeatedly exposed to the stressful situation and was incapable of showing further resistance.
Problems with these models:
1) both regarded the individual as automatically responding to an external stressor and described stress within a straightforward stimulus-response framework. they therefore did not address the issue of individual variability and psychological factors were given only a minimal role.
2) both described the physiological response to stress as consistent. this response is seen as non-specific in that the changes in physiology are the same regardless of the nature of the stressor. this is reflected in the use of the term ‘arousal’ which has been criticized by more recent researchers. therefore these two models described individuals as passive and a responding automatically to their external world.
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EARLY STRESS MODELS
How Do We Assess Stress?
Life Events Theory:
in an attempt to part from Selye and Cannon models of stress which emphasised physiological changes, this theory was developed to examine stress and stress-related changes as a response to life experiences. Holmes and Rahe (1967) developed the Schedule of Recent Experiences (SRE), which provided respondents with an extensive list of possible life changes or life events. originally the SRE arbritary scale was scored by simply counting the number of actual recent experiences as it was assumed that this score reflected an indication of their level of stress. However, this obviously crude method of measurement was later replaced by a variety of others, including a weighting system whereby each potential life event was weighted by a panel, creating a degree of differentiation between the different life experiences.
Problems with Life Events Theory:
1) the individuals own rating of the event is important
2) the problem of retrospective assessment (at the time when the individual has become ill or has come into contract with the health profession), has implications for understanding causal link between life events and subsequent stress and stress related illnesses.
3) life experiences may interact with each other
4) stressors may be short term or ongoing
The Transaction Model of Stress
THE ROLE OF APPRAISAL
Lazarus and Folkman (1984) argued that stress involved a transaction between the individual and their external world, and that a stress response was elicited if the individual appraisal a potentially stressful event as actually being stressful. Lazarus’s Psychological (transactional) model therefore described individuals as psychological beings who appraised the outside world, rather than simply passively responding to it. According to Lazarus, the individual initially praises the event itself defined as primary appraisal. there are four possible ways the event can be appraised;
- irrelevant
- benign and positive
- harmful and a threat
- harmful and a challenge
therefore is it a challenge or threat?
if its a challenge, that’s a more positive thing as a potential for gain or growth. if its a threat, it can lead to harm, loss, or negative consequences.
Lazarus then described secondary appraisal which involves the individual evaluating the pros and cons of their different coping strategies. therefore primary appraisal involves an appraisal of the outside world (‘is this stressful?’) and secondary involves an appraisal of the individual themselves (“Can I cope with this?”). the form of the primary and secondary appraisals determines whether the individual shows a stress response or not. according to Lazarus’s model this stress response can take different forms;
1) direct action
2) seeking information
3) doing nothing
4) developing a means of coping with the stress in terms of relaxation or defence mechanisms.
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DOES APPRAISAL INFLUENCE THE STRESS RESPONSE?
in the early study by Speisman et al. (1964), subjects were shown a film depicting an initiation ceremony involving unpleasant genital surgery. the film was shown with three different soundtracks.
- condition 1 (trauma) emphasised pain and the mutilation
- condition 2 (denial) emphasised being willing and happy
- condition 3 (intellectual) emphasise an anthropological interpretation of the ceremony.
the study therefore manipulated the subjects appraisal of the situation and evaluated the effect of the type of appraisal on their stress response.
the results showed that subjects reported that the trauma condition was the most stressful which suggests that it is not the events themselves that elicit stress. but the individuals’ interpretation or appraisal of those events.
WHICH EVENTS ARE APPRAISED AS STRESSFUL?
salient events:
people often function in many different domains such as work, family and friends. for one person, work might be more salient, while others such as family life might be more important. Swindle and Moos (1992) argued that stressors in salient domains of life are more stressful than those in more peripheral domains.
Overload:
Multitasking seems to result in more stress than the chance of focus on fewer tasks at any one time (Lazarus and Folkman, 1987). Therefore a single stressor which adds to a background of other stressors will be appraised as more stressful than when the same stressor occurs in isolation - commonly known as the ‘straw that broke the camel’s back’
Ambiguous events:
if an event is clearly defined, then the person can efficiently develop a coping strategy. if, however, the event is ambiguous and unclear, then the person first has to spend time and energy considering which coping strategy is best. this is reflected in the work stress literature which illustrates that poor job control and role ambiguity in the workplace often result in a stress response (e.g. Karasek and Theorell, 1990).
In summary, most current stress researchers consider stress as a result of a person-environment fit and emphasise the role of primary appraisal (‘is the event stressful?’) and secondary appraisal (‘can i cope?’). psychological factors are seen as a central component to the stress response. however, they are always regarded as co-occuring with physiological changes.
Stress and Changes in Physiology and Behaviour
CHANGES IN PHYSIOLOGY
the physiological consequences of stress have been studied extensively, mostly in labs using the acute stress paradigm which involves bringing individuals into a controlled environment, putting them into a stressful situation such as counting backwards. this research has highlighted two main groups of physiological changes;
1) sympathetic activation (also known as Sympathetic Adreno-Medullary system (SAM)); when an event has been appraised as stressful it triggers (the hypothalamus in our brain) responses in the sympathetic nervous system and then activates the adrenal medulla. this results in the production of stress hormones known as catecholamines (adrenaline and noradrenalin, known as epinephrine and norepinephrine) which cause changes in factors such as blood pressures, heart rate, sweating, pupil dilation, and immune function. this is experienced as a feeling of arousal. this process is similar to the fight-or-flight response. Catecholamines also have an effect on a range of the body tissues and can lead to changes in immune function.
CHANGES IN BEHAVIOUR
Smoking:
Wills (1985) reported that smoking initiation in adolescents was related to the amount of stress in their lives. in terms of relapse, Lichtenstein et al. (1986) and Carey et al. (1993) reported that people who experience high levels of stress are more likely to start smoking again after a period of abstinence than those who experience low stress. Metcalfe et al. (2003) used the Reeder Stress Inventory which showed that higher levels of perceived stress were linked to smoking more cigarettes.
Alcohol:
the tension-reduction theory suggests that people drink alcohol for its tension-reducing properties (Cappell and Greeley 1987). this theory has been supported by some evidence of the relationship between negative mood and drinking behaviour (Violanti et al. 1983), suggesting that people are more likely to drink when they are feeling depressed or anxious. Sacco et al. (2014) conducted a large-scale national survey in the USA and discovered that whereas greater stress was associated with lower alcohol consumption among women, it was associated with increased chances of alcohol use disorder in men.
Eating:
Greeno and Wing (1994) proposed two hypothesis; (1) the general effect model, which predicts that stress changes food intake generally (2) the individual difference model which predicts that stress only causes changes in eating in vulnerable groups of individuals. there has been more research on the individual differences model, for example, Michard et al. (1990) reported that exam stress was related to an increase in eating in girls but not in boys, Michaud et al. (1990) reported that exam stress increased eating in girls but not in boys, and Baucom and Aiken (1981) reported stress increased eating in dieters only. However, there are several inconsistencies in the literature described by Stone and Brownell (1994) as the ‘stress eating paradox’ to explain how at times stress causes overeating and at others it causes undereating without any clear pattern emerging.
Exercise:
research indicates that stress may reduce exercise (Heslop et al. 2001) whereas stress management, which focuses on increasing exercise, has been shown to result in some improvements in coronary health. there is a bi-directional relationship; stress reducing exercise and exercising reducing stress (Burg et al. 2017).
Accidents:
correlational research suggests that individuals who experience high levels of stress show a greater tendency to perform behaviours that increase their chances of becoming injured (Wiebe and McCallum 1986).
Does Stress Cause Illness?
two approaches to understanding the link between stress and illness;
1) The direct/Indirect Pathways
stress can cause illness through either a direct pathway (via changes in physiology) or an indirect pathway (via changes in behaviour). this can create illness such as cancer, CHD and general physical symptoms such as tiredness, headaches, and bowel problems. it can also lead to accidents.
the direct pathway - stress causes changes in sympathetic activation (e.g. heart rate, sweating, blood pressure) via the production of stress hormones (i.e. the catecholamines adrenaline and noradrenaline) and causes the experience of arousal. stress also causes changes in hypothalamic-pituitary-adrenocortical (HPA) activation via the production of cortisol. impairs the immune system, cardiovascular system (increased blood pressure) and endrocrine system (catecholamine and corticosteroid release).
the indirect pathway - for example, stress may increase smoking and alcohol intake, reduced exercise levels, an unhealthy diet change, forgetting to take medication, not practicing safe sex or taking risks such as driving too fast. this could increase the chances to conditions such as cancer, CHD, obesity, or reduce life expectancy.
inter-related pathways - stress can therefore influence health and illness by changing behaviour or by directly impacting upon an individuals physiology. these two pathways also inter-relate.
2)The Chronic/Acute Stress Model
chronic stress is more likely to involve HPA activation and the release of cortisl. this results in ongoing wear and tear and the slower process of atherosclerosis and damage to the cardiovascular system. acute stress operates primarily through changes in sympathetic activation with changes in heart rate and blood pressure. this can contribute to atherosclerosis and kidney disease but is also related to sudden changes such as heart attacks. these processes may also be nter-related.
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IN SUMMARY
stress has been shown to cause illness and is linked to problems such as colds, flu, cancer, heart attacks, hypertension, and physical symptoms such as tiredness and headaches. there are two approaches to understanding the stress-illness link. the first focuses on the indirect pathway and the direct pathway. the second focuses on the impact of the role of physiological and psychological moderators.
Physiological Moderators of the Stress-Illness Link
not everyone who experiences stress becomes ill. research indicates that some of this variability is due to individual differences in physiological factors such as stress reactivity, stress recovery, the allostatic load, and stress resistance.
STRESS REACTIVITY
some individuals show a stronger physiological response to stress than others. which is known as their level of ‘cardiovascular reactivity’ or ‘stress reactivity’. this means that when given the same level of stressor and regardless of their self-percieved stress, some people show greater sympathetic activation than others (e.g. Vitaliano et al. 1993). research suggests that greater stress reactivity may make people more susceptible to stress-related illnesses. for example, individuals with both hyper-tension and heart disease have higher levels of stress reactivity (e.g. Frederickson et al. 1991, 2000).
However, these studies used a cross-sectional design which raises the problem of causality. some research has therefore used a prospective design. for example, Keys et al. (1971) assessed baseline blood pressure reaction to a cold pressor test and found that higher reactivity predicted heart disease at follow-up 23 years later. this does not mean that individuals who show greater responses to stress are more likely to become ill. it means that they are more likely to become ill if subjected to stress, particularly if this pattern of responding to stress is maintained over a long period of time.
some studies show that whilst some individuals show high levels of stress reactivity when under stress, those who have experienced a lifetime of ongoing and chronic stress, or childhood trauma or abuse may show a blunted reaction to stress, showing lower than expected arousal and reduced production of cortisol (Carpenter et al. 2007, 2009, 2011). the impact of blunted stress reactivity on health is unclear but there is some evidence that it may be linked to substance abuse and depression (Carroll et al. 2009; Heim et al. 2008).
STRESS RECOVERY
after reacting to stress the body recovers and levels of sympathetic and HPA activation return to baseline. however, some people recover more quickly than others and some research indicates that this rate of recovery may relate to a susceptibility to stress-related illness. this is reflected in Selye’s (1956) notion of ‘exhaustion’ and the general wear and tear caused by stress. some research ahs focused on changes in cortisol production, suggesting that slower recovery from raised cortisol levels could be related to immune function and a susceptibility to infection and illness (e.g. Perna and McDowell 1995).
ALLOSTATIC LOAD
McEwan and Stellar (1993) described the concept of ‘allostatic load’ to reflect the wear and tear on the body which accumulates over time after exposure to repeated or chronic stress. they argued that the obdy’s physiological systems constantly fluctuate as the individual responses and recovers from stress - a state of allostasis - and that as time progresses, recovery is less complete and the body is left increasingly depleted. therefore id exposed to a new stressor the person is more likely to become ill if their allostatic load is quite high.
STRESS RESISTANCE
to reflect the observation that not all individuals react to stressors in the same way, researchers have developed the concept of stress resistance to emphasise how some people remain healthy even when stressors occur (e.g. Holahan and Moos 1990). Stress resistance includes adaptive coping strategies, certain personality characteristics and social support. these factors are dealt with in detail later on as they reflect psychological moderators.
THE IMMUNE RESPONSE
Immune system- your body’s first line of defence against invading bacteria, viruses and other pathogens.
Psychoneuroimmunology (PNI is the field concerned with the relationship among mind (psycho), the nervous and endocrine systems (neur) and the immune system (immunology).
The Physiological effects of stress - Pathways from Stress to suppressed immune system activity:
Stress can lead to unhealthy behaviours and trigger the release of hormones that suppress immune system activity:
•Wounds heal more slowly
•More vulnerable to infections
Vedhara et al. Lancet (1999)
•50 spousal carers of dementia patients compared with 67 controls
•Anxiety, depression, perceived stress, salivary cortisol and antibody response to influenza vaccine were measured
•All participants were seen at baseline, 3 months and 6 months
•Emotional distress was significantly higher in carers at all 3 time-points
Increased levels of distress in carersIncreased levels of distress in carers. This was associated with significantly raised cortisol levels and impaired antibody response to flu vaccinationresponse to flu vaccination. Chronically stressed elderly carers may be at higher risk from viral disease because of an inability to mount an appropriate immune response. There is a well recognised increased morbidity and mortality in elderly groups after exposure to flu viruses.
Slowing on wound healing by caregiver stress (Kiecolt-Glaser et al. 1995)
•13 women caring for a relative with senile dementia compared with 13 matched control
•All subjects underwent a 3.5 mm punch biopsy wound on the forearm
•Outcome variable: healing time
•Healing was assessed by a) photography and b) response to hydrogen peroxide (no foaming)
using a simple self-rating scale, the stress was higher in the crers than the match controls. however, when you compare the percentage with subjects of fully healed wounds by weeks, about 15% of the carershad fully healed wounds compared to 55% of match controls. the carers had significantly slower wound healing, so the stress of caring directly lead to slowly healing of wounds. after 35 days, the wound was significantly bigger in the carers as the wound hadn’t healed quickly..
Marucha et al (1998). Mucosal wound healing is impaired by examination stress
•11 healthy dental students were given oral punch wounds on the hard palate 3.5 mm wide, 1.5 mm deep
•This was done on two occasions-end of summer vacation and 3 days before the first major academic examination of the term
•Findings: students took on average 3 days longer to heal wound during exams (i.e. by 40% longer)
The impact of stress on catching a cold
Cohen et al (1998)
•276 volunteers injected with cold virus
•Stress = life events (severe acute vs severe chronic difficulty) in different domains (interpersonal, work)
•Immune function = natural killer (NK)-responsible for supressing viruses and destroying tumour cells + total white cell count
•Self-report symptoms
•Infection measures: antibody culture from nasal washes and mucus weight
•As length of stress increased, so did the likelihood of catching the cold
Sergerstrom & Miller (2004): a meta-analysis (293 studies, 20,0000 participants):
•Short-term (acute) stress produced a short-lived fight or flight type response that boosted the immune system.
•Long-term (chronic) stress resulted in the greatest suppression of the immune system (i.e. healing and inability to fight infection were affected)
•Age and an existing problem with the immune system were significant risk factors for susceptibility to stress-related suppression of the immune system.
Psychological Moderators of the Stress-Illness Link
Moderators:
- Health behaviours (exercise, smoking, alcohol, eating)
- coping styles
- social support
- personality (e.g. type A behaviour/personality)
- actual or perceived control
COPING
what is coping?
coping has been defined by Lazarus and his colleagues as the process of managing stressors that have been appraised as taxing or exceeding a person’s resources and as the ‘efforts to manage…environmental and internal demands’ (Lazarus and Maunier 1978). in the context of stress, coping reflects the ways in which individuals interact with stressors in an attempt to return to some sort of normal functioning. this might involve correcting or removing the problem, or changing the way a person thinks about the problem or learning to tolerate and accept it. in contrast it could involve lowering one’s expectations of what a relationship should be like. coping is seen as an interaction between the person and their environment as well as the person and the stressor.
Cohen and Lazarus (1979) defined the goals of coping as:
- to reduce stressful environmental conditions and maximise the chance of recovery
- to adjust or tolerate negative events
- to maintain a positive self-image
- to maintain emotional equilibrium
- to continue satisfying relationships with others
Approach vs. Avoidance:
approach coping involves confronting the problem, gathering information and taking direct action. avoidance coping is minimising the importance of the event (Roth and Cohen, 1986). people tend to show one form of coping, although it is possible for someone to manage one type of problem by denying it and another by making specific plans. some researchers have argued that approach coping is consistently more adaptive, however, research indicates that the effectiveness of the coping style depends on the nature of the stressor.
Problem-Focused vs. Emotion-Focused Coping (Instrumentality-Emotionality):
the problem- and emotion-focused dimensions reflect types of coping strategies rather than opposing styles. people can show both when facing a stressful event. problem-focused involves taking action to reduced the demands of the stressor or to increase the resources available to manage it (e.g. devising a revision plan and sticking to it). Emotion-focused involves the regulation of distressing emotions evoked by the stressful event (e.g. talking to friends about the problem, turning to drink or smoking more, distraction by shopping or watching TV). sometimes we use distraction coping as well or denial which can be adaptive or maladaptive. each of these can buffer the effects of stress.
Several Factors that influence coping strategy:
- type of problem
- age
- gender
- controllability
- available resources
- coping training
Coping and the Stress-Illness Link:
some research indicates that coping styles may moderate the association between stress and illness. for some studies the outcome variable has been more psychological in its emphasis and has taken the form of wellbeing, psychological distress, or adjustment. For example, Kneebone and Martin (2008) explored coping in carers of persons with dementia and concluded from reviewing cross-sectional and longitudinal studies that problem-solving and acceptance styles of coping seemse to be more effective at reducing stress and distress.
Coping and Positive Outcomes:
this phenomenon has been given a range of names including stress-related growth, benefit-finding, meaning-making, growth-orientated functioning and crisis growth. this finds reflection in Taylors’ (1983) cognitive adaptation theory and is in line with a new movement called ‘positive psychology’ (Seligman and Csikszentmihalyi 2000). though a new field of study, research indicates that coping processes that involve finding meaning in the stressful event, positive reappraisal and problem-focused coping are associated with positive outcomes (Folkman and Moskowitz 2000).
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SOCIAL SUPPORT
What is Social Support?
the term ‘social support’ is generally used to refer to the perceived comfort, caring, esteem or help one individual receives from others (e.g. Wallston et al. 1983).
Does Social Support Affect Health?
Lynch (1977) reported that widowed, divorced or single individuals have higher mortality rates from heart disease than married people and suggested that heart disease and mortality are related to lower levels of social support. however, problems with this study include the absence of a direct measure of social support and the implicit assumption that marriage is an effective source of social support.
Berkman and Syme (1979) found in their prospective study that increased social support predicted a decrease in mortality rate for men and women aged 30-69yrs old. this indicates a role for social support in health. there have also been research discovering lower birth rates in women who have high levels of social support (Oakley 1992). Graven and Grant (2014) found that increased social support increased heart failure self-care behaviours with a key role for patients families helping individuals to maintain these behaviours. social support has also been related to impacting the immune functioning and health.
How Does Social Support Influence Health?
1) the main effect hypothesis suggests that social support itself is beneficial and that the absence of social support is itself stressful. this suggests that social support mediates the stress-illness link, with its very presence reducing the effect of the stressor and its absence acting as a stressor (e.g. Wills, 1985).
PERSONALITY
Type A:
Friedman and Rosenman (1959) initially defined type A behaviour in terms of excessive competitiveness, impatience, hostility, and vigorous speech. using a semi-structured interview, three types of type A behaviour were identified. Type A1 reflected vigour, energy, alertness, confidence, loud speaking, rapid speaking, tense clipped speech, impatience, hostility, interrupting, frequent use of the word ‘never’ and frequent use of the word ‘absolutely’. Type A2 was defined as being similar to type AL, but not as extreme, and type B was regarded as relaxed, showing no interruptions, procastinator, non-competitive, no sense of urgency and quieter (e.g. Rosenman 1978). support for a relationship between type A behaviour and CHD had been reported by a number of studies (Rosenman et al. 1975; Haynes et al. 1980). however, research has also found no relationship (e.g. Johnstons et al. 1987).
Conscientiousness:
O’Connor et al. (2009) explored the role of conscientiousness in employees on moderating the link between daily hassles and changes in health behaviours. the results showed that greater daily hassles were linked to a higher intake of high fat snacks, a greater consumption of caffeinated drinks, higher levels of smoking but lower intakes of alcohol, vegetables and less exercise. Furthermore, the results indicated that these associations were influenced by conscientiousness.
Hostility:
hostility is most frequently measured using the Cook Medley Hostility Scale (Cook and Medley 1954) which asks people to rate statements. agreement to such statements is an indication of high hostility. hostility is higher in men, those of lower socioeconomic status, and seems to run in families. much research has shown an association between hostility and CHD (see page 279).
The Big 5 Personality Types:
extraversion, agreeableness, openness, conscientiousness, and neuroticism. many papers have shown a link between the Big 5 and health. Strickhouser et al. (2017) found in his meta-synthesis that when entered simultaneously, the Big 5 traits were moderately associated with overall health; however, personality-health relationships were stronger for mental health than physical health outcomes.
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CONTROL
What is Control?
control has been studied within a variety of different psychological theories.
1) attributions and control - Kelley’s (1967) attributional theory examines control in terms of attributions for causality (see Ch2). if applied to a stressor, the cause of a stressful event would be understood in terms of whether the cause was controllable by the individual or not.
2) self-efficacy and control - control has been discussed by Bandura (1977) in his self-efficacy theory. self efficacy refers to an individual’s confidence to carry out a particular behaviour. control is implicit in this concept.
3) categories of control - 5 different types of control have been defined by Thompson (1986); behavioural control (e.g. avoidance), cognitive control (e.g. reappraisal of coping strategies), decisional control (e.g. choice over possible outcome), informational control (e.g. ability to access info about the stressor) and retrospective control (e.g. ‘could i have prevented that event from happening?’).
4) the reality of control - control has been subdivided into perceived control and actual control. the discrepancy between these two factors has been referred to as illusory control (e.g. i control whether the plan crashes by counting throughout the journey). however, within psychological theory, most control relates to perceived control.
Does Control Affect the Stress Response?
research has examined the extent to which the controllability of the stressor influences the stress response to this stressor, both in terms of the subjective experience of stress and the accompanying physiological changes.
1) subjective experience - Corah and Boffa (1970) examined the relationship between the controllability of the stressor and the subjective experience of stress. subjects were exposed to a loud noise (the stressor) and were either told about the noise (stressor predictable) or not (not predictable). they found that if a noise was predictable, there was a decrease in subjective experiences of stress. they argue that predictability allows the feeling of control over the stressor which reduces the stress response.
2) physiological changes - research has also examined the effect of control on the physiological response to stress. Meyer et al. (1985) reported that if a stressor is regarded as uncontrollable, the release of corticosteroids is increased.
Does Control Affect Health?
human research - the job strain model was developed to examine the effects of CHD (e.g. Karasek and Theorell 1990). the three factors involved in the model are,
1) psychological demands of the job in terms of workload
2) the autonomy of the job, reflecting control
3) the satisfaction with the job
the results from the studies that have used this model suggest that a combination of high workload, low satisfaction and low control are the best predictors of CHD. external locus of control is also associated with greater disease severity in those with Parkinson’s disease (Rizza et al. 2017) although this was a cross-sectional study limiting conclusions about causality.
How does Control Mediate the Stress-Illness Link?
a number of theories have ben developed to explain how control influences health and mediates the stress-illness link;
- control and preventive behaviour
it has been suggested that high control enables the individual to maintain a healthy lifestyle by believing that ‘i can do something to prevent illness’.
- control and behaviour following illness
it has also been suggested that high control enables the individual to change behaviour after illness. for example, even though an individual may have the illness, if they believe there is something they can do about their health, they will change their behaviour.
- control and physiology
it has been suggested that control directly influences health via physiological changes
- control and personal responsibility
it is possible that high control can lead to a feeling of personal responsibility and consequently personal blame and learned helplessness. these feelings could lead either to no behaviour change or to unhealthy behaviours resulting in illness.
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STRESS AS A COMPLEX PSYCHO-PHYSIOLOGICAL PROCESS
Psycho-Physiological Model of Stress
illustrates complexity;
1) potential stressor
2) appraisal
3) stress
4) changes in behaviour or physiology
5) changes in psychological/physiological moderators
5) Illness
Stress and Coronary Heart Disease (CHD)
Stress and Coronary Heart Disease (CHD)
•CHD-the clogging of the vessels that nourish the heart
•Increased risk in high stress jobs (Pickering et al 1996)
•Increased risk among employed mothers (Hayners et al 1980)
•Risk factors for heart disease:
- Non-modifiable (increasing age, male gender, family history and genetic abnormalities)
- Modifiable (smoking, hypertension, diabetes, sedentary lifestyle, obesity, diet)
The Physiological Effects of Stress - Pathways from Stress to Coronary Heart Disease:
•Acute and chronic stress can lead to coronary heart disease:
•Physiological reactivity:
- Increased heart rate and blood pressure
- Impact of stress hormones on immune processes–corticosteroids supresses immune system
- Disturbance of the digestive system
•Unhealthy behaviours (e.g. smoking, drinking alcohol to excess, poor diet lack of exercise)
Personality Type and Heart Disease:
Friedman and Rosenman (1974)
•Nine-year study of 3000+ men, aged 35-39
•At start, they were interviewed and categorised:
•Type A: competitive, hard-driving, impatient, verbally aggressive, anger-prone, combat-ready
•Type-B: Easy-going and relaxed
•At the end of the study, 257 heart attacks
•69% were Type A
therefore Type A has increased risk of having a heart attack.
BUT – Type A findings have not been replicated.
The key factor that may make a person more susceptible to heart disease is:
•Competition
•Ambition
•Hostility
•Fast pace
•Upset easily
•Chida & Steptoe (2009): Anger and hostility constitute serious long-term risk factors for adverse cardiovascular outcomes among both healthy individuals and those already suffering from heart problems
•Niaura et al (2002): 200 females over 10 years, high initial hostility linked to a higher risk of developing CHD 10 years later
therefore there has been evidence that hostility can result in having an increased risk of heart problems.
Depression and the Heart:
•People with heart disease are more likely to develop depression
&
•People with depression are more likely to have heart disease than healthy individuals (Hare et al 2013)
•Ösby, et al (2001) found that death rates from cardiovascular problems was substantially higher in depressed people.
•Individuals with elevated depressive symptoms have a 64% greater risk of CHD than do those with fewer symptoms (Wulsin & Singal, 2003).
also seen in Frasure-Smith N, et al. (1993)
Stress Management
What does it do? 1) Identify, manage or alleviate sources of stress 2) Focus on mediators or moderators of stress • Control • Coping • Social support 3) Control stress response alleviate strain - symptoms or outcomes • Somatic, cognitive, behavioural, e.g. • muscular tension • headaches • control blood pressure • cardiovascular disease • anxiety and depression
Techniques anyone can use to cope with stress: Arousal reduction •Relaxation techniques •Muscle relaxation •Deep breathing Cognitive interventions •Cognitive restructuring •Self-talk Behavioural-skills training •Time management, prioritizing, assertiveness Environmental-change •Workplace alterations, increase social support
Relaxation Techniques: •Deep breathing •Progressive muscle relaxation •Mindful meditation •Yoga •Visualisation meditation •Laughing •Exercise •Journaling •Music therapy •Etc.
Practice progressive muscle relaxation:
•While sitting or lying down, tense the muscles of your feet (curling your toes) as hard as you can
•Then relax them
•Do this once or twice for each part of the body •Continue this process for each muscle group all the way up to your body until you reach your head
•When finished remain relaxed for a few minutes
Cognitive Techniques:
“Men are not troubled by things, but by the view which they take of them”
Epictetus, 4th century B.C.
therefore its not the situation or event that’s out there, its what we make of them in terms of our appraisal and perception.
Cognitive stress management approaches often work on helping the individual identify automatic dysfunctional thoughts and challenge these with evidence.
Common cognitive errors:
1.Mindreading
2.Fortune telling
3.Catastrophising
