Stress

Stress

1. Daily Hassles

   • Minor day-to-day stressors
   • Uplifts
     • Small positive uplifts
   • Hassles and uplifts measured with Hassles and Uplifts Scale (HSUP)
   • Supporting Research
     • Bouteyre et al
       • Relationship between hassles and mental health during transition from school to university
       • First year students at French university to complete hassles part of HSUP & Beck Depression Inventory
       • 41% showed depressive symptoms > positive correlation between hassles score and depressive symptoms
     • Gervais
       • Nurses kept diaries for a month recording hassles and uplifts at work > Also asked to rate performance
       • After a month hassles had contributed to increased job strain & decreased performance > Uplifts counteracted some stress
   • Accumulation Effect
     • Persistent irritation
       • More serious reactions
         • Anxiety & depression
   • Amplification Effect
     • Major life change adds vulnerability to daily hassles
     • Major life change depletes resources needed to cope with minor stressors
     • Hassles cause stress because of stress from life change
   • Limitations
     • Retrospective Recall
       • Research involves asking ppts to rate hassles over time period
       • Overcome by using diary
     • Cause and Effect

2. Workplace Stress

   • Job-Strain Model
     • Workplace causes stress and therefore illness
     • Marmot et al
       • High grade civil servants=high workload > Low grade civil servants=low control
       • > 7372 in London assessed for factors/signs of cardiovascular disorder > checked 5 years later
   • Workload
     • Marmot et al
       • No link between workload and stress illness
     • Johansson et al
       • Responsibility for sawing felt responsibility for whole company
       • Stress measured=Self-report (feelings & caffeine use) > Regular urine samples
       • Responsibility for sawing=Higher stress levels
   • Control
     • Marmot et al
       • High link between control and stress illness
   • Role Conflict
     • Pomaki et al
       • High absentee levels, low performance levels, poor physical and mental health in those experiencing role conflict
         • Role conflict linked with emotional exhaustion, depressive symptoms and body complaints.

3. Stress and Illness

   • Immune system defends against antigens
     • Role of Cortisol
       • Immune system sensitive to cortisol
         • Under vigilant - letting infections enter without being dealt with effectively
         • Over vigilant - attacking cells which aren't antigens
     • Barrier created preventing entry for antigens
       • Eliminating antigens once they've entered the body
         • Eliminating antigens once they have started to reproduce
   • Acute Stressors
     • Marucha et al
       • Punch biopsies in mouths of students > Summer and 3 days before exams
         • Wounds near exam 30% longer to heal
     • Kiecolt-Glaser et al
       • Impact of important exams on medical students from French university
         • Blood samples analysed month before and during exams
           • NK cells reduced in second sample
   • Chronic Stress
     • Kiecolt-Glaser et al
       • Blister wounds on arms of married couples
         • Slower healing after conflicting discussions
     • Malarkey et al
       • 90 newlyweds over 24hrs > Asked couples to discuss and resolve martial issues
         • Leads to changes in adrenaline / noradrenaline > could lead to poor immune functioning
   • Stressors enhancing immune system
     • Evans et al
       • Activity of antibody sIgA > Students gave small talks to one another (mild acute stress)
         • Increase sIgA but decrease in same students during exams
   • Segerstrom and Millar
     • Meta-analysis of 2935 studies
       • Long term chronic stress suppresses immune system
       • Short term acute stress boosts immune system
   • Evaluation
     • Lazarus
       • Difficult to establish relationship between illness and stress
         • Showing long term effects requires longitudinal research
           • Expensive and time-consuming
       • Health affected by many factors
         • Problem with correlational data
       • Health is slow to change
         • Difficult to show effect of specific stressors

4. Stress and Life Changes

   • Holmes and Rahe
     • Saw link between stress and life changes
     • Social Readjustment Rating Scale (SRRS)
       • Rahe et al
         • Positive correlation between LCU and illness score
         • Ppts aboard US Navy Cruiser (2700) complete SRRS before tour of duty
           • Illness score calculated on number, type and severities of injuries on tour.
       • 43 life changes > asked 400 people to give numerical score
         • Marriage baseline at 50 LCU
           • High score if more readjustment required
             • Score totalled and averaged to create life change unit values.
   • Evaluation
     • Daily Hassles
       • Lazarus
         • Events in SRRS are fairly infrequent
     • Inclusion of positive and negative events
       • Event or quality of event causes stress
       • Undesired/unscheduled events are more harmful
     • Correlational data
       • Are people are ill more likely to report a life change?
       • Third variable may be cause
         • Brown
           • Anxious people more likely to report negative life events and prone to illness
     • Individual differences
       • Relates to quality of event

5. Personality Factor

   • Friedman and Rosenman
     • Type A
       • Impatience and Time-Urgency
       • Competitiveness and Achievement Striving
       • Hostility and Aggression
       • Lead to raised blood pressure and stress hormones
         • Linked to Coronary Heart Disease (CHD)
     • Type B
       • Patient
       • Relaxed
       • Easy-going
       • Less vulnerable to stress related ilness
     • Western Collaborative Group Study > Ppts examines for signs of CHD & assessed for personality
       • Relationship found between stress related illness and increased likelihood towards risk factors.
     • Evaluation
       • Ragland and Brand
         • Follow-up 22 yrs later > 15% of men died of CHD
           • Importance of risk factors but not link between Type A and mortality
       • Myrtek
         • Meta-analysis of 35 studies
           • Hostility linked to CHD > No link with other Type A factors
             • Undermines link between Type A and stress related illness

6. Hardy Personality

   • Control
   • Challenge
   • Commitment
   • Maddi et al
     • US company reducing size of workforce
       • 2/3 employees suffered stress related health problems over year
         • 1/3 thrived & showed Hardy traits
   • Lifton et al
     • Hardiness of students at 5 universities to see if linked with chances of completing degree
       • Students who scored high were more likely to complete their degree
   • Evaluation
     • Hardiness and Negative Affectivity
       • 3 C's not characteristics but way we think about success and failures
       • Some dwell on failure, report more distress and dissatisfaction
         • Referred to as 'High on Negative Affectivity'
       • Hardy Personality and NA negativly correlated

7. Psychlogical Methods of Stress Management

   • Cognative Behavioural Therapy
     • Challenging negative thoughts
     • Rewarding desirable behaviours
   • SIT
     • Conceptualistation Phase
       • Client and therapist establish relationship
       • Identify source of stress
     • Skills Acquisitions Phase
       • Skills taught to cope with stress
       • E.G. Positive thinking, social support
     • Application Phase
       • Client practises skills in real world
       • Monitor success/failure
     • Evaluation
       • Applied to many individuals and situations
       • Effective
       • Time, commitment and money
   • Hardiness Training
     • Focusing
       • Client taught to recognise symptoms of stress
       • Indentify source
     • Relievng stress encounters
       • Patient encouraged to think about recent stressful situations
       • Analyse response to situations
     • Self Improvement
       • Patients taught to see stressors as challenges
     • Evaluation
       • Targets perception and coping
       • Time, commitment and money
       • Teaches ability to cope with variety of situations

8. Biological Methods of Stress Management

   • Benzodiapines
     • Enhances GABA
     • Binds to special sites on receptors
     • Increase chloride ion flow
     • Strengths
       • Effective
         • Kahn et al
           • 250 patients over 8 weeks > Bzs superior to placebos
         • Hildalgo et al
           • Meta-analysis > Bzs more effective at reducing anxiety than other antidepressants
     • Weaknesses
       • Addictive
         • Ashton
           • Bzs should not be used for more than 4 weeks
       • Side Effects
         • Increased aggressiveness
         • Cognitive side effects
   • Beta-Blockers
     • Reduce activity of adrenaline and noradrenaline
     • Bond to cells on heart
     • Hard to stimulate cells
     • Less pressure on body
     • Strengths
       • Effective
         • Used in real life settings
     • Weaknesses
       • Side Effects
         • Linked to increased chance of developing diabetes