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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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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)


  • Some examples?


  • 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 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


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



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 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




or psychological



& psychological

wear and tear





changes &

Coping efforts


to stress



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 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 Support

  • 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 Support

  • 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 Caregivers SupportResults

  • 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 Support

  • 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 Support

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 Support


  • 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

Stress management teaches coping techniques
Stress Management – teaches coping techniques Support

  • 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 Support

  • 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 Support

  • 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 Support

  • Errors in Information Processing -

  • Irrational Thinking Errors include:

    • Emotional reasoning

    • Overgeneralization

    • Catastrophic thinking

    • Mind reading

    • Selective negative focus, etc.

Relaxation therapy
Relaxation Therapy Support

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

    • Progressive muscular relaxation

    • Mental imagery

    • Meditation

    • Autogenic training

Time management
Time Management Support

  • 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.