Stress

Stress

1. Response

   • acute stress
     • activates the autonomic nervous system
     • ANS split into sympathetic nervous system and parasympathetic pathway
       • SNS prepares body for fight/flight
       • parasympathetic returns body to relaxation
     • sympathetic adrenal medullary + SNS = sympathomedullary pathway
     • SNS sends messages via neurons to organs, alerting of actute stressor
       • releases noradrenaline
     • noradrenaline = increased heart rate/pupil size and it mobilises fat+glycogen for energy
     • SAM is regulated by SNS and adrenal medulla
       • releases adrenaline
     • adrenal gland has adrenal medulla and adrenal cortex
     • adrenaline boosts oxygen + glucose to the body and supresses non-urgent bodily functions
   • chronic stress
     • pituitary adrenal system is the HPA axis
     • HPA axis controls cortisol levels
       • activated by physical and emotional stressors
     • chronic stressor = activates the hypothalamus
     • part of hypatholamus is the paraventricular nucleus
       • releases CRF
     • CRF travels in bloodstream to pituitary gland
       • releases ACTH
     • ACTH travels in bloodstream to adrenal gland
     • part of adrenal gland is adrenal cortex
       • releases cortisol
     • cortisol is responsible for stress effects on the body
       • +less pain, more energy -lower immunity, cognitive impair, high blood pressure
     • cortisol takes 20 minutes to take effect
     • feedback system regulates hormones, hyptholamus and pituitary glands have receptors to detect cortisol levels and monitor the CRF and ACTH release
   • immune system
     • creates a barrier to prevent antigens entering
     • eliminates antigens before it has started to reproduce
     • eliminating antigen after it has started to reproduce
     • cortisol
       • fluctuations alter the immune system as it is sensitive to it
     • under vigilance
       • letting infections enter without being dealt with
     • over vigilance
       • mistakenly attacking cells which are not antigens, causing illness
   • Ilness
     • acute stressors
       • Kiecolt-Glaser 1984
         • A: investigated impact of exams on medical students
         • M: blood spamples taken 1 month before and during exams
         • R: NK cell activity reduced in 2nd sample
         • C: short term stressors reduce immune functioning
       • Marucha 1998
         • punch biposies of students
         • took 40% longer to heal during 3 days before exams
       • Lazarus 1992
         • health can be affected by many factors
         • health is slow to change, difficult to show stressor effects
         • not causal
         • longitudinal research needed
         • expensive
         • time consuming
     • chronic stressors
       • Kiecolt-Glaser 1987
         • blister wounds on married couples healed slower after conflicting discussions
       • Kiecolt-Glaser 2005
         • women had poor immune functioining if recently separated
       • Malarky 1994
         • M: studied 90 newlyweds over 24hrs discussing marital issues
         • R: led to changes in noradrealine and adrenaline, which can lead to poor immune functioning
       • Evans 1994
         • A: looked at activity of antibody SlgA
         • M: asked students to prepare small talks and studied them during exams
         • R: increase in SlgA for talks, decrease during exams
         • C: stress increases efficency in acute stress, but down regulates for chronic stress
       • Segerstorm & Miller 2004
         • found acute stressors boost immune system
         • chronic stressors suppress immune system
         • longer stress = more immune system shifts from adaptive to detrimental

2. Personality Factors

   • Type A
     • Friedman & Rosenman 1960
     • characteristics
       • impatient and time urgent
       • competitive and achievemennt driven
       • hostile and aggressive
       • F & R believed these factors would lead to raised blood pressure and CHD
     • western collaborative group study
       • participants first examined for signs of CHD
       • assessed for personality type in a provocative interview
     • Ragland & Brand 1988
       • follow up on F & R
       • 15% of men had CHD, but no link between mortality and type A
     • Myrtek 2001
       • meta analysis of 35 studies into type A and CHD
       • only hostility can be linked to CHD
   • Hardy personality
     • characteristics
       • in control of their lives
       • involved in world around them
       • overcoming challenges and enjoying change
     • Maddi 1987
       • studied US employees that was cutting workforce
       • 2/3 suffered stress related health problems
       • 1/3 thrived, evidence for hardy personality
     • Lifton 2006
       • measured hardiness of US students in 5 unniversities
       • students scoring low on 3 C's disportionatley represented among dropouts
       • students scoring high were more likely to complete degree
     • some people focus on negative characteristics
       • negative affectivity and hardy are negatively correlated
       • hardy individuals just low on negative affectivity
     • 3 C's may be ways of thinking of success/failures, not characteristics

3. Workplace

   • Job-strain model
     • Marmot 1997
       • workplace causes stress/illness due to workload and low job control
       • 7372 civil servants assessed in London and checked for cardivascular disease 5 years on
       • found no link between workload and stress related illnesses
       • high grade civil servants had fewest cardiovascular problems
         • they had more control and reported good social support
   • Johansson 1978
     • found people responsible for sawing not maintenance felt responsible for whole company
     • stress measured by self-report and urine
     • responsible = higher levels of stress and adrenaline
   • Role conflict
     • experiences at work interfere with life outside of work
     • Pomaki 2007
       • high levels of absents = lower performance, poor physical and mental health
       • role conflict directly linked with emotional exhaustion, depressive symptoms and somatic complaints

4. Daily hassles

   • minor day stresses
   • also experience minor uplifts
     • measured on HSUP scale by Delongis 1982
   • Bouteyre 2007
     • A: relationship between daily hassles and stress
     • M: psychology students at french uni completed HS and Beck's depression inventory
     • R: 41% showed depressive symptoms and +correlation between scores on HS and incidence of depressive symptoms
     • C: daily hassles can be risk factor for depression
   • Gervais 2005
     • A: relationship between daily hassles and stress
     • M: nurses kept diaries for a month, recording daily hassles/uplifts at work, asked to rate work performance
     • R: negative entries
     • C: daily hassles increased job strain and decrease performance
   • Accumulation effect
     • daily hassles more significant for stress than life events
     • build up of daily hassles leads to serious reactions
   • Amplification effect
     • life events may make you vulnerable to daily hassles
     • life events may decrease resources needed to cope with minor stress
   • Evaluation
     • retrospective recall
       • often forget emotional state and daily routine hassles
     • not causal
     • personality may affect stress
     • diary method
       • overcomes retrospective recall
       • social desirability/demand characteristics

5. Life Changes

   • events that necessiate major transitions
   • Holmes and Rahe 1967
     • noted life events occured before physical illness
     • developed social readjustment scale to measure changes
       • patients identified 43 life changes and asked 400 people to give numerical score
       • marriage given 50 units as guideline
   • Rahe 1970
     • tested SRRS
     • 2700 men on US navy completed SRRS before duty, noting all events 6 months prior
     • illness score- number & severity
       • positive correlation between life changes units and illness score +118
   • Evalutation
     • if ill, more likely to report changes
       • Brown: anxious people more likely to report negative life events
     • quality of event can cause stress
     • uncontrolled events more stressful
     • unexpected death more stressful than expected death
     • Lazarus: life events in SRRS unfrequent
     • Validity
       • inaccurate as retrospective
       • Brown: ill people feel pressure to provide reason for illness = more likely to report events
     • Reliability
       • Rahe: test retest reliability of SRRS depended on lenght of time between the two
       • Hardt: asked about childhood experiences with 2.2 years difference, found reliable

6. Methods of stress management

   • Psychological
     • Stress inoculation training
       • Michenbaum suggested people should form a way of coping before stress arises
       • 1) therapist & client gain relationship + identify stress sources
       • 2) coping skills taught and practised
       • 3) therapist monitors client use of skills in real life
       • Evaluation
         • teaches techniques
         • can be generalised
         • found more effective than other methods
         • Sheeky & Horan
           • found those with SIT sessions had lower anxiety and higher academic performance
         • takes time, commitment and money
     • Hardiness training
       • 1) taught how to recognise stress signs and gain coping skills
       • 2) analyses past stressful situations
       • 3) taught to see stressors as challenges to control
       • Evaluation
         • targets perception and coping
         • client has ability to cope with a variety of situations
         • takes time, commitment and money
   • Physiological
     • Beta blockers
       • reduce activity of adrenaline and noradrenaline
         • bind to receptors on stimulated cells during arousal
         • harder to stimulate cells
       • puts less pressure on body and person feels calmer
     • Evaluation
       • used in real life settings to reduce anxiety
       • research linked BBs with diabetes
     • Berizodiapines
       • slow CNS activity, enhance natural action of GABA
         • GABA natural form of anxiety relief
         • locks onto receptors on neuron surface, increasing Cl ion flow
       • Cl ions slow CNS activity = relaxed
       • Bzs bind to GABA sites, allowing more Cl ions to flow into neuron
       • Evaluation
         • Kahn: 250 patients, found Bzs significantly superior to placebo
         • Hildago: meta analysis found Bzs more effective reducing anxiety than antidepressants
         • withdrawal symptoms
         • Ashton: Bzs should not be used for more than 4 weeks
         • negative side effects; aggressiveness/cognitive