Stress
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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


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

  • Deadlines

  • Dense traffic

  • Marital conflict

  • Work 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 – 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 1988

  • Outcome – stress response

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


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

  • 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, 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, 1989

Catecholamine Response

Time of Day


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)


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)

  • 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 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 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 StressLazarus & Folkman

  • Secondary appraisal –

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


Cognitive Model of StressLazarus & Folkman


Personal Factors Affecting Stress Appraisal

  • Intellectual

  • Motivational

  • Personality

  • Beliefs


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.

  • 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 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

  • How stress affects health

    • Via behaviour

    • Via physiology


Behavioural Aspects

  • Increased alcohol

  • Smoking

  • Increased caffeine

  • Poor diet

  • Inattention leading to carelessness


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

  • 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

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


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

  • 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

  • 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.

  • 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 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 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

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


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

  • 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

  • Negative affectivity

  • Pessimism – optimism

  • Hardiness


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 Style

  • Negative affectivity

  • Pessimism – optimism

  • Hardiness


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

  • 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

  • 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

  • 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

  • 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 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

  • Increase survival rates in women who have breast cancer.

  • Lower blood pressure

  • Decrease risk of mortality


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

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


Stress Management


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

  • 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

  • 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 Therapy

  • Errors in Information Processing -

  • Irrational Thinking Errors include:

    • Emotional reasoning

    • Overgeneralization

    • Catastrophic thinking

    • Mind reading

    • Selective negative focus, etc.


Relaxation Therapy

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

    • Progressive muscular relaxation

    • Mental imagery

    • Meditation

    • Autogenic training


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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