Stress

Stress

1. Life changes

   • A life change is an event in life requiring a major transition or change. These events disrupt our normal routine. This major change then leads to stress. The bigger the change the more adjustment has to be made.
     • Holmes and Rahe (1967)
       • Examined medical records of 5000 patients. A list of 43 life changes were complied which occurred in the months prior to the onset of illness. 100 judges had to assign a 'value' to each life change. These values were complied and divided by ten to get the life change unit.
         • People with a higher LCU score in the past 12 months were more likely to experience physical illness in the following year.
           • Stress can be measured objectively and can be quantified. Stress can also lead to illness.
             • They put these life events into a questionnaire, giving each a unit out of 100 they decided was stressful.
               • This questionnaire was called the social readjustment rating scale (SRRS).
     • Rahe (1970)
       • To investigate whether scores on the SRRS were correlated with the subsequent onset of illness.
         • 2500 male American sailors were given the SRRS to assess how many life events they have experienced in the previous 6 months. The total score on the SRRS was recorded for each ppt. Over the 6 month tour of duty, detailed records were kept of each sailors health status. The recorded number of life change units were correlated with the sailors illness scores.
           • There was a small positive correlation of 0.0118 between life change and and illness scores. Although the positive correlation was small it still shows that there was a relationship between LCU and health. As life change events increased, so did the frequency of illness. However it's only a small factor.

2. Daily hassles

   • Hassles are everyday, occurring frustrating things that happen. They are not major life events but they can build up if they happen often.
     • Daily hassles are meant to cause more stress than life events because they are frequent. This means there should be a higher correlation between illness and daily hassle scores.
       • Delongis et al (1982)
         • Compared the two measures: a life events scale and their own hassles scale to see which was a better predictor of later health problems. They also considered the effects of 'uplifts'. Uplifts are events that make you feel good.
           • Ppts were asked to complete 4 questionnaires once a month for a year:
             • Hassles scale - 117 hassles
             • Uplifts scale - 135 uplifts
             • Life events - 24 major events
             • A health status questionnaire consisting of questions on overall health status, bodily symptoms and energy levels
             • There were 100 ppts from around San Francisco, aged between 45-64. They were predominantly well educated and had high income.
               • They found that daily hassles had a higher correlation with illness than life events and that uplifts had little effect on health.
       • Workplace stressors
         • Aspects of the workplace environment that elicts a stress response which we therefore experience as stressful.
           • Role ambiguity: Uncertainty about what your roll is - no clear guideline, jobs can overlap unclearly meaning you have more work or you do the wrong work
             • Physical environment: Noise and heat make work more difficult and more energy as to be expended to overcome them
               • Workload: How much work and the type of work a person does. Too much and too little can lead to stress. It can be repetetive and lead to family problems if it has to be brought home.
                 • Lack of control: In most organisations other people determine the amount of work and patterns for others
         • Johanson et al (1978)
           • To investigate work stressors such as repetativeness and high workload affecting illness from stress hormones in urine.
             • The experimental group was 14 sawmill finishers in Sweden. If they did not work fast they would slow down the whole factory, the machines allocated their pace and their pay was determined by how well their job was done.
               • The control group were cleaners in the same factory. They experienced less work load and were flexible.
                 • Adrenaline was measured in the urine and records were kept of stress related illness. Samples were also taken on their days off. They also completed self report scales for their stress.
                   • The exp group showed more adrenaline and higher rates of stress related illness. The finishers were much more rushed and irritated than then control group.
                     • The combination of workload, repetition and responsibility leads to chronic physiological arousal and this then leads to illness.
         • Marmite et al (1997)
           • Investigate the relationship between control in the workplace and the incidence of CHD
             • 7300 civil servants, british male and females aged 35-55. Longitudinal study over a 5 year period. The ppts were sent a questionnaire and asked to take part in a screening exam for CD in the beginning of the study.
               • Their employment were grouped into 3 categories:
                 • Administrators (high control- gave workload)
                 • Executice
                 • Clinical/ support staff (low control)
                 • Job control was measured by self-completed questionnaire. CHD was measured by a qualified doctors.
                   • After taking age into account, both men and women in the support staff group with least control were 3 times more likely to develop CHD. Higher job control means less risk of CHD.

3. Personality

   • Stress effects people differently. Personality is a set of characteristics and behaviours and general temprement that remains relatively stable.
     • Friedman and Rosenman studied the behaviour of patients suffering from CHD and they found they displayed the same distinctive behaviour patterns. They grouped them into type A and B personalities.
       • Type A
         • Competetive
         • Time urgent
         • Impatient
         • Hostile and aggressive
         • Risk factors:
           • Drink and smoke more, sleep less
           • Less conscious of their health
           • More prone to stressful events because they get stressed and aggressive more easily
       • Type B
         • Relaxed
         • One thing at a time
         • Patient
         • Express feelings
       • Friedman and Rosenman
         • The link between type A behaviour patterns and if they're linked with CD
           • Using standard interviews, 3200 Calefornian men aged 39-59 were categorised as type A,B or X (in the middle). Assessment based on answers to interviews and behaviour during interviews. The sample was followed up for 8.5 years and info on lifestyle was collected.
             • 257 men had CHD and 70% were type A. They were significant even after risk factors were taken into account.
               • Type A behaviour pattern is a risk factor for CHD
   • Hardiness
     • Not all type A individuals experience stress. Kobasa came up with a theory that some people are more hardy than others. A hardy personality includes a range of characteristics which if are present provides defence against negative effects of stress
       • Commitment: being involved in the world with a sense of purpose
       • Control: being in charge of themselves and their lives
       • Challenge: see life challenges as problems to overcome
       • Kobasa (1985)
         • To investigate the links between hardiness and stress related illness
           • 161 male business executives took a modified SRRS questionnaire to measure stress and a health questionnaire to assess their illnesses over the past 3 years.
             • Ppts were split into 2 groups:
               • group one: classified as having high stress - low illness (89 ppts)
               • group two: classified as having high stress - high illness
               • Personality questionnaires were completed to assess hardiness.
                 • Executives in the HS-LI group scored higher on the hardiness scale then the HS-HI group.
                   • Stressful life events cause more harm to people with low hardiness than high hardiness
                     • Kobasa's theory had led to development of the hardiness training (increasing the 3 C's within you)

4. Stress therapies

   • CBT
   • Stress inoculaion training (SIT) - type of CBT which trains people to cope with stressful situations by learning skills against stress
     • Meichenbaum (1977) believed a person could protect (innoculate) themselves against the disease of stress and suggests an individual should develop a form of coping before the problem arises.
       • Consists of:
         • Conceptualisation phase
           • Therapist and client establish relationship and identify sources of stress in lives.
             • Encouraged to keep a diary of stressful experiences
               • Therapist may challenge clients approval of stressful situations if they seem exaddurated
         • Skills aquisition
           • Coping skills are taught and practiced and primarily at the clinic and then gradually rehearsed in real life.
             • The individual then learns cognitive skills (self-coping) and behavioural skills (relaxation). Skills are taght and tailored to the patients own problems.
               • Includes postive thinking, relaxation, social skills, method od diversion, time management and social support
         • Application phase
           • Clients are encouraged to use their skills in the real world
             • The client and therapist continue to monitor the success or failure of the treatment
         • Strengths
           • deals with the problems directly
           • no physiological side effects that are caused by drug therapy
           • SIT is effective and helps clients cope with with current stressors and adapt to future ones
         • Weaknesses
           • expensive and time consuming and requires motivation
           • difficult to see which part of the training is most effective
   • Hardiness training- aims to increase CONTROL, COMMITMENT and CHALLENGE
     • Kobasa wanted people to develop the 3 c's to cope better:
       • Focusing
         • Client is taught how to recognise the physical symptoms of stress and to identify it's source. Also how to acquire skills for coping.
       • reconstructing stress development
         • Client reconstructs a stressful situation by thinking about a recent stressful episode they had and evaluate coping strategies to see how effective they were. Also taught a range of coping skills by therapist.
       • self improvement
         • Clients are encouraged to take on new challenges. The aim is to continue to develop effective coping techniques- increases feeling of control and confidence
       • Strengths
         • good amount of research supporting the link between HT and lower stress
         • provides client with future ability to cope
       • Weaknesses
         • Kobasa can't be generalised
         • Takes time, commitment and money
         • Hardiness could not actually exist. It's not physical and could just be an idea.

5. physiological stress management

   • Stress can lead to a number of physical and emotional symptoms. Drug therapy can reduce this
     • Benzodopamines
       • Work by acting on the brain and reducing brain arousal decreasing serotonin which sows down the sympathetic nervous system
         • The drug works by increasing the action of GABA in the brain which slows the activity of serotonin
           • This decreases physiological arousal meaning the person feels calmer and less anxious
             • Bz's direct effect on brain activity, commonly given to reduce the feeling of being anxious.
     • Beta-blockers
       • Work by having stress increase the activity of the sympathetic nervous system which leads to faster heart rate and increased blood pressure. They work on the sympathetic nervous system by slowing down it's activity.
         • They block the receptors to the heart which prevents noradrenaline and adrenaline from stimulating the heart to increase the rate and force which the heart pumps blood around the body. This results in a drop in blood pressure and heart rate which means less anxiety.
           • BBs direct the effect on the sympathetic nervous system and are commonly used to reduce physical symptoms of anxiety (shaking)
   • Strengths
     • cheap and easy to take
     • effective for acute stressors, quick acting and effective for sudden situations
     • Real life application
   • Weaknesses
     • side effects such as dizzyness, nausea and depression
     • Addictive- can lead to dependency
     • Only deals with responses and isn't long term