STRESS, PHYSIOLOGICAL ILLNESS AND COPING

Question 1

what is stress?

Answer 1

the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable.

Question 2

what is the body’s way to respond to stress?

Answer 2

sympathetic nervous system activation which results in the fight-or-flight response.

Question 3

what could be some life events which can trigger stress?

Answer 3

work problems, debts, relationship difficulties, extended family problems, house move, diagnosis of physical illness

Question 4

what is primary appraisal?

Answer 4

an assessment of how significant an event is for a person, including whether it is a threat or opportunity

Question 5

what Is secondary appraisal?

Answer 5

one’s ability to cope or take advantage of the situation.

Question 6

what are internalising behaviours?

Answer 6

that is focused inward. People with internalising behaviours have difficulty coping with negative emotions or stressful situations, so they direct their feelings inside.

Question 7

what are externalising behaviours?

Answer 7

externalising behaviours are focused outside oneself. They include physical aggression, destruction of property, underage drinking, and running away from home.

Question 8

what is the emotional response to stress?

Answer 8

• Feeling on edge
• Feeling sad
• Irritability
• Tearful
• Over-reacting

Question 9

what is the cognitive response to stress?

Answer 9

• Difficulty concentrating
• Difficulty ‘switching off’
• Sensitive to criticism
• Self-critical
• Difficulty making decisions

Question 10

what is the behavioural response to stress?

Answer 10

• Comfort eating/loss of appetite
• Excess drinking/smoking
• Excess activity/underactivity
• Disturbed sleep

Question 11

what is the physiological response to stress?

Answer 11

• Increased heart rate
• Increased rate of breathing
• Muscles tense for movement
• Increased perspiration

Question 12

what are some individual factors which influence their response to stress?

Answer 12

• Premorbid personality – if youre a natural worrier or tend to be obsessional
• Prior experience of illness
• Mental state
• Childhood difficulties - e.g. early trauma/chaotic backgrounds, cope less well with difficult treatment regimes, difficult interactions with health professionals
• Appraisal and coping styles

Question 13

what are some illness factors which influence ones response to stress?

Answer 13

• Immediacy - life threatening
• Uncontrollability - painful
• Ambiguity - regarding outcome/treatment
• Undesirability - unpleasant treatment regimes or disfiguring treatments

Question 14

what is illness cognition?

Answer 14

a patient’s own implicit common-sense beliefs about their illness. They provide a framework around which a patient understands and copes with their illness.

Question 15

what are the 5 domains of illness cognition?

Answer 15

the identity (what does the illness mean for the patient and symptoms), the timeline, the consequences, the cause, and the control/cure.

Question 16

what are the 2 coping strategies?

Answer 16

• Problem solving - Controlling the problem and reconstructing it as manageable.
• Emotion focused coping - managing emotions and maintaining emotional equilibrium.

Question 17

what do problem-focussed coping strategies include?

Answer 17

• Seeking information
• Seeking support
• Learning new procedures and behaviours e.g. appropriate participation in treatment/lifestyle changes.
• Identifying alternative rewards/new activities
• Developing a realistic action plan

Question 18

what do emotion-focussed coping strategies include?

Answer 18

• Emotional discharge - Talking about the problem
• Making and maintaining supportive friendships
• Gaining emotional support from e.g. religion
• Resigned acceptance - Coming to terms with the inevitable

Question 19

when is it likely that a patient would misinterpret physiological symptoms?

Answer 19

when they have a tendency to worry, a mental illness, a previous illness or have illness beliefs from friends/family/media

Question 20

what are medically unexplained symptoms?

Answer 20

Physical symptoms not explained by organic disease which cause distress and impair functioning and for which there is positive evidence or a strong assumption that the symptoms are linked to psychological factors

Question 21

why do MUS arise?

Answer 21

• Some MUS may arise from ‘normal’ bodily sensations (physiological processes) with misinterpretation.
• Some MUS may arise from minor pathology and are exaggerated at times of stress.
• Other mechanisms at a neurobiological level.

Question 22

how can stress impact existing physical illnesses?

Answer 22

stress can cause relapses, loss of control of chronic disease and therefore morbidity

Question 23

describe the direct impact of stress on existing physical illnesses?

Answer 23

• Stress activates the hypothalamic-pituitary-adrenocortical axis (HPA) causing cortisol secretion and the sympathetic-adrenal-medullary system (SAM) causing cathecholamines secretion.

Question 24

describe the indirect impact of stress on existing physical illnesses?

Answer 24

• Poor compliance with medication
• Increased alcohol intake
• Increased smoking
• Reduced exercise
• Poor diet

Question 25

describe the relationship between stress and heat disease?

Answer 25

Acute bereavement associated with heightened sympathetic activation resulting in haemodynamic changes which can cause increased vascular resistance leading to ischaemia, especially in susceptible patients (e.g. heart disease).

Question 26

describe the relationship between stress and mental illness?

Answer 26

In the 3-6 months preceding the onset of a depressive illness 50-80% of patients will have experienced a significant life event compared to 20-30% of non depressed patients.