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Stress. Three Views of Stress. Focus on the environment: stress as a stimulus (stressors) Reaction to stress: stress as a response (distress) Relationship between person and the environment: stress as an interaction (coping). Stressors. Some examples?. Stressors. War Overcrowding

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Stress

Stress


Three views of stress

Three Views of Stress

  • Focus on the environment: stress as a stimulus (stressors)

  • Reaction to stress: stress as a response (distress)

  • Relationship between person and the environment: stress as an interaction (coping)


Stressors

Stressors

  • Some examples?


Stressors1

Stressors

  • War

  • Overcrowding

  • Deadlines

  • Dense traffic

  • Marital conflict

  • Work stress


Acute vs chronic stress

Acute vs. Chronic Stress

  • Acute stress

    • Sudden, typically short-lived, threatening event (e.g., robbery, giving a speech)

  • Chronic stress

    • Ongoing environmental demand (e.g., marital conflict, work stress, personality)


Acute stress

Acute Stress


Acute stress rozanski 1988

Acute Stress – Rozanski 1988

  • Subjects – 39 individuals with coronary artery disease

  • Stress tasks (0-5 minutes each):

    • Mental arithmetic

    • Stroop-colour word conflict task

    • Stress speech (talk about personal fault)

    • Graded exercise on bicycle (until chest pain or exhaustion)


Acute stress rozanski 19881

Acute Stress – Rozanski 1988

  • Outcome – stress response

    • Myocardial ischemia determined by radionuclide ventriculography (measures wall motion abnormalities in the heart)


Acute stress rozanski 1988 results

Acute Stress – Rozanski 1988Results

  • Cardiac wall motion abnormalities were significantly greater with stress speech than other mental stress tasks (p < .05) and was of the same order of magnitude as that with graded exercise.

  • Wall motion abnormalities occurred with lower heart rate during stress than during exercise (64 vs. 94 beats/min, p < .001)


Chronic stress frankenhauser 1989

Chronic Stress – Frankenhauser, 1989

  • Subjects – 30 managerial and 30 clerical workers

  • Equal number of men and women

  • Outcome: blood pressure, heart rate, and catecholamines measured throughout workday and non-workday.


Chronic stress frankenhauser 19891

Chronic Stress – Frankenhauser, 1989

  • No gender differences in the effect of work on BP and HR.

  • In both men and women, BP and HR were higher on a workday than a non-workday.


Chronic stress frankenhauser 19892

Chronic Stress – Frankenhauser, 1989

Catecholamine Response

Time of Day


Three views of stress1

Three Views of Stress

  • Focus on the environment: stress as a stimulus (stressors)

  • Reaction to stress: stress as a response (distress)

  • Relationship between person and the environment: stress as an interaction (coping)


Fight or flight response

Increase in

Epinephrine & norepinephrine

Cortisol

Heart rate & blood pressure

Levels & mobilization of free fatty acids, cholesterol & triglycerides

Platelet adhesiveness & aggregation

Decrease in

Blood flow to the kidneys, skin and gut

Fight or Flight Response


Selye s general adaptation syndrome 1956 1976 1985

Selye’s General Adaptation Syndrome (1956, 1976, 1985)

  • Resistance

  • Arousal high

  • as body tries

  • defend and

  • adapt.

  • Exhaustion

  • Limited

  • physical

  • resources;

  • resistance

  • to disease

  • collapses;

  • death

  • Alarm

  • Reaction

  • Fight or

  • flight

Perceived

Stressor

If stress continues ….


Cognitive model of stress lazarus folkman

Cognitive Model of StressLazarus & Folkman

  • Potential stressor (external event)

  • Primary appraisal – is this event positive, neutral or negative; and if negative, how bad?

  • Secondary appraisal – do I have resources or skills to handle event?

  • If No, then distress.


Cognitive model of stress lazarus folkman1

Cognitive Model of StressLazarus & Folkman

  • Primary appraisal – Is there a potential threat?

  • Outcome – Is it irrelevant, good, or stressful?

  • If stressful, evaluate further:

    • Harm-loss – amount of damage already caused.

    • Threat – expectation for future harm.

    • Challenge – opportunity to achieve growth, etc


Cognitive model of stress lazarus folkman2

Cognitive Model of StressLazarus & Folkman

  • Secondary appraisal –

    • Do I have the resources to deal effectively with this challenge or stressor?


Cognitive model of stress lazarus folkman3

Cognitive Model of StressLazarus & Folkman


Personal factors affecting stress appraisal

Personal Factors Affecting Stress Appraisal

  • Intellectual

  • Motivational

  • Personality

  • Beliefs


Situational factors affecting stress appraisals

Situational Factors Affecting Stress Appraisals

  • Strong demands

  • Imminent

  • Life transition

  • Timing

  • Ambiguity – role or harm ambiguity

  • Desirability

  • Controllability

    • Behavioural control – perform an action

    • Cognitive control – using a mental strategy


Learned helplessness seligman peterson et al

Learned Helplessness – Seligman, Peterson, et al.

  • Dogs exposed to unavoidable shocks

  • Following exposure, when placed in a situation where they can now jump to avoid the shock, they fail to make the escape response.

  • Learned helplessness occurs when one perceives that one’s actions (e.g., working hard) does not lead to the expected outcome (e.g., high grade).


Job strain karasek et al 1981

Job Strain – Karasek et al., 1981


Job stress other aspects

Job Stress – other aspects

  • Physical environment

  • Poor interpersonal relationships

  • Perceived inadequate recognition or advancement

  • Unemployment (even anticipated)

  • Role conflict

  • High responsibility for others


Biopsychosocial aspect of stress

Biopsychosocial Aspect of Stress

  • How stress affects health

    • Via behaviour

    • Via physiology


Behavioural aspects

Behavioural Aspects

  • Increased alcohol

  • Smoking

  • Increased caffeine

  • Poor diet

  • Inattention leading to carelessness


Physiological aspects

Physiological Aspects

  • Cardiovascular reactivity – increased blood pressure, platelets, lipids (cholesterol)

  • Endocrine reactivity – increased catecholamines and corticosteroids

  • Immune reactivity – increased hormones impairs immune function


Psychophysiological disorders

Psychophysiological Disorders

  • Digestive system – e.g., ulcers, irritable bowel syndrome

  • Respiratory system – e.g., asthma

  • Cardiovascular system – e.g., hypertension, lipid disorders, heart attack, angina


Stress illness relationship

Stress-Illness Relationship

Illness

Preexisting

physiological

or psychological

vulnerability

Physiological

& psychological

wear and tear

Illness

precursors,

symptoms

Behavioural

changes &

Coping efforts

Exposure

to stress

Illness

behaviour


Moderators of the stress experience

Moderators of the Stress Experience


What is coping

What is coping?

  • Process of managing the discrepancy between the demands of the situation and the available resources.

  • Ongoing process of appraisal and reappraisal (not static)

  • Can alter the stress problem OR regulate the emotional response.


Emotion focused coping

Emotion-Focused Coping

  • Aimed at controlling the emotional response to the stressor.

  • Behavioural(use of drugs, alcohol, social support, distraction) and cognitive (change the meaning of the stress).

  • Often used when the person feels he/she can’t change the stressor (e.g., bereavement); or

  • Doesn’t have resources to deal with the demand.


Problem focused coping

Problem-Focused Coping

  • Aimed at reducing the demands of the situation or expanding the resources for dealing with it.

  • Often used when the person believes that the demand is changeable.


Coping responses respond yes or no

Coping responses – respond yes or no.

  • Tried to see the positive side of it.

  • Tried to step back from the situation and be more objective.

  • Prayed for guidance or strength.

  • Sometimes took it out on others when I felt angry and depressed.

  • Got busy with other things to keep my mind off the problem.

  • Read relevant material for solutions and considered several alternatives.

  • Took some action to improve the situation.


Problem focused coping1

Problem-Focused Coping

  • Planful Problem-Solving – analyzing the situation to arrive at solutions and then taking direct action to correct the problem.

  • Confrontive Coping – taking assertive action, often involving anger or risk taking to change the situation.


Emotion focused coping1

Emotion-Focused Coping

  • Seeking social support – can be either problem or emotion-focused coping.

  • Distancing – cognitive effort to detach

  • Escape-avoidance – wishful thinking or taking action to escape or avoid it.

  • Self-control – attempting to modulate one’s feelings in response to the stressor.

  • Accepting responsibility – acknowledging one’s role in the situation while trying to put things right.

  • Positive reappraisal – create positive meaning.


Cognitive re structuring

Cognitive Re-structuring

  • Process by which stress-provoking thoughts are replaced with more constructive one.


Gender and coping

Gender and Coping

  • Men generally employ problem-focused coping strategies more than emotional focused strategies.

  • Opposite for women, with women more often employing emotion-focused strategies.

  • If men and women in same occupation, gender differences disappear, suggesting that societal sex roles influence choice of coping strategies.


Socio economic status ses and coping

Socio-economic Status (SES) and Coping

  • People with higher SES tend to use problem-focused coping strategies more often (Billings & Moos, 1981).

  • Why do people who have lower SES use problem-focus coping strategies less often than those with high SES?


Personality or coping style

Personality or Coping Style

  • Negative affectivity

  • Pessimism – optimism

  • Hardiness


Life orientation test scheier carver

Life Orientation Test(Scheier & Carver)

  • In uncertain times, I usually expect the best.

  • If something can go wrong for me it will.

  • I always look on the bright side.

  • I’m always optimistic about my future.

  • I hardly ever expect things to go my way.

  • Things never work out the way I want them to.

  • I’m a believer in the idea that “every cloud has a silver lining.”

  • I rarely count on good things happening to me.

  • Overall, I expect more good things to happen to me than bad.


Personality or coping style1

Personality or Coping Style

  • Negative affectivity

  • Pessimism – optimism

  • Hardiness


Social support

Social Support

  • Emotional support – expression of empathy, understanding, caring, etc.

  • Esteem support – positive regard, encouragement, validating self-worth

  • Tangible or instrumental – lending a helpful hand.

  • Information support – providing information, new insights, advice.

  • Network support – feeling of belonging


Factors influencing utilization or availability of social support

Factors Influencing Utilization or Availability of Social Support

  • Temperament – people differ in their needs for social support. Social support can be detrimental if you are the type of person who likes to handle things on your own.

  • Previous experience with social support influences your likelihood of seeking out social support in the future.


Threats to social support

Threats to Social Support

  • Stressful events can interfere with your ability to use social supports.

  • People under stress may become so focused on talking about their problems that they drive their support systems away.

  • Supports agents may react in a way that makes the problem worse.

  • Support providers may be adversely effected by providing support.


Alxheimer s disease ad effect on caregivers

Alxheimer’s Disease (AD) – Effect on Caregivers

  • Subsample of the Cardiovascular (CVD) Health Study, a prospective study of risk factors for CVD in the elderly.

  • Excluded: disabled confined to wheel chair, unable to attend field centres, or undergoing cancer treatment.

  • Caregivers defined as those whose spouse had difficulty with one activity of daily living due to physical or mental health problem.

  • 392 caregivers and 427 non-caregivers recruited.


Ad effect on caregivers

AD – Effect on Caregivers

  • Caregivers were asked to rate the degree of mental and physical strain associated with caregiving (3-point response format).

  • Sample subdivided into four groups: non-caregivers; spouse disabled but not helping him/her; caregiver but no reports of strain; and caregiver with reports of strain.

  • Followed for 4.5 years (range 3.4 – 5.5 years).

  • Main outcome – mortality (100% follow-up achieved).


Ad effect on caregivers results

AD – Effect on CaregiversResults

  • 81% of caregivers were providing care.

  • 56% reported caregiver strain.

  • Mortality – 9.4% in non-caregivers; 17.3% in ‘caregivers’ not providing care; 13.8% in non-strained caregivers; and 17.3% in strained caregivers.


Generally social support associated with good effects

Generally Social Support Associated with Good Effects

  • Increase survival rates in women who have breast cancer.

  • Lower blood pressure

  • Decrease risk of mortality


Psychological predictors of sudden cardiac death in camiat

Psychological Predictors of Sudden Cardiac Death in CAMIAT

J. Irvine, A. Basinski, B. Baker, S. Jandciu, M. Pickett, J. Cairns, S. Connolly, M. Gent, R. Roberts, & P. Dorian,

Psychos Med 1999

Funded by Heart and Stroke Foundation of Ontario


Psychosocial predictors of sudden cardiac death in camiat

Psychosocial Predictors of Sudden Cardiac Death in CAMIAT

Measures:

  • Cook-Medley Index: measures of hostility, anger, cynicism

  • Beck Depression Inventory

  • Symptom Checklist-90: psychological distress

  • Social Support: measures of social participation, network and perceived social support


Psychosocial predictors of sudden cardiac death

Psychosocial Predictors of Sudden Cardiac Death


Stress management

Stress Management


Stress management teaches coping techniques

Stress Management – teaches coping techniques

  • Reduce harmful environmental conditions

  • Teaches techniques by which person can develop stress tolerance.

  • Helps client maintain a positive self-image.

  • Help maintain emotional equilibrium.

  • Help client maintain or develop satisfying relations with others.


Cognitive therapy albert ellis aaron beck

Cognitive Therapy – Albert Ellis, Aaron Beck

  • Assumes that stress arises or is augmented by faulty or irrational ways of thinking.

    • Catastrophizing – “It is awful if I get turned down when I ask for a date”.

    • Overgeneralizing – “I didn’t get a good grade on this test. I can’t get anything right”.

    • Selective abstraction – Only seeing specific details of the situation (e.g., Seeing the negatives but missing the positive details).


Cognitive therapy

Cognitive Therapy

  • Often these irrational beliefs or faulty thinking errors stem from past “programming”.

    • E.g., Not receiving adequate love and nurturance as a child may lead to feelings that loved ones in the present don’t “quite love you enough”.

  • Hypothesis testing – client is encouraged to test out these irrational beliefs by collecting evidence for or against the belief.


Cognitive therapy1

Cognitive Therapy

  • Errors in Information Processing -

  • Irrational Thinking Errors include:

    • Emotional reasoning

    • Overgeneralization

    • Catastrophic thinking

    • Mind reading

    • Selective negative focus, etc.


Relaxation therapy

Relaxation Therapy

  • Aims to either reduce hyperarousal or curb emotional-physiological reactivity.

    • Progressive muscular relaxation

    • Mental imagery

    • Meditation

    • Autogenic training


Time management

Time Management

  • Set short-term (e.g., daily) and long-term (e.g., yearly) goals.

  • Make daily to-do lists (prioritize each).

  • Make a daily schedule for when and where you will carry out your to-do list items (estimate time allocated for each to-do item).

  • Revise throughout the day as needed.


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