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"Stress and coping: Cause or consequence?". R. Fielding Department of Community Medicine, HKU. Objectives:. distinguish between the different models conceptualizing stress . demonstrate an understanding of the relationship between demands and resources in the generation of threat

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stress and coping cause or consequence

"Stress and coping: Cause or consequence?"

R. Fielding

Department of Community Medicine, HKU.

  • distinguish between the different models conceptualizing stress.
  • demonstrate an understanding of the relationship between demands and resources in the generation of threat
  • characterize those types of situations most likely to generate stress, giving a range of clinical examples.
the role of threat
The role of “threat”

Threat is the anticipation of harm.

Threat experience 1

Threat experience 2

  • This harm can be physical, emotional, financial, social, or in any other form.
  • Anticipated harm reflects some evaluation that the person has made. This evaluation is called Primary Appraisal.
demands and resources
Demands and resources
  • Primary appraisal is the judgement of the potential mismatch between the perceived demands and perceived resources available to deal with those demands.
  • If primary appraisal concludes that perceived demands exceed perceived resources, then threat of harm can cause the individual to experience the feelings sometimes referred to as “stress”.
  • 2 major categories of coping :
    • coping to tackle demands (problem-focused)
    • coping to control emotional reactions (emotion-focused).
  • Coping may be effective and contribute to resolving the demands or emotions, when it is called “adaptive”.
  • Coping may be effective but cause other problems, then it is said to be “maladaptive”.
secondary appraisal
Secondary Appraisal
  • Secondary appraisal: The evaluation of coping effectiveness: coping appraised as..
    • effective, then threat is avoided, and “stress” symptoms not usually experienced (hassles)
    • marginally effective, increased or modified coping efforts made, increased cost on resources, and/or high stress if harm great.
    • ineffective, emotion-focused coping or passive withdrawal, e.g. helplessness, depression, “giving-up”.
maladaptive coping
Maladaptive coping
  • Sources of maladaptive coping:
    • adopting harmful activities in response to demands during maturation(e.g. substance use)
    • successful early coping and unwillingness to abandon coping that is no longer effective (immaturity)
    • maladaptive coping patterns from parents/ peers/ society (e.g. aggression, striving to maintain control, coping over-exertion)
    • maladaptive coping due to limited opportunity to learn more adaptive responses (dysfunctional social environment)
indicators of stress
Indicators of stress
  • Cognitive:
    • concentration/memory difficulties
    • disruption of cognitive performance
  • Emotional:
    • fear/anxiety, depression, fatigue
  • Behavioural:
    • irritability, withdrawal, vegetative disturbances
    • unpredictability
  • Physiological:
    • cvs, immunological, dermatological, hormonal, GI, GU changes
determinants of stress
Determinants of stress
  • Which circumstances are most stressful?
  • Stimulus conditions:

- a stimulus’ potential for harm is great or lethal

- the stimulus impact imminent

- there is a high degree of ambiguity in significance of cues signaling stimulus impact

  • Respondent conditions:

- motivational strength is low

- general beliefs about environment transactions reflect marginal perceived control

- available intellectual resources, education, etc

stress in clinical situations
Stress in clinical situations
  • Patients: When...
    • risk of harm and uncertainty are high, i.e.

demands are perceived as exceeding resources or are unknown, or;

resources are perceived as inadequate or unknown.

  • Staff : When…
    • risk of harm (in form of error) is high,
    • demands exceed resources.
effect of stress on cvs
Effect of stress on CVS
  • In situations appraised as borderline coping, cardiovascular changes are seen:
  • Changes in heart-rate reactivity due to increased catecholamine production.
  • Sensitization of cardiac tissue to catecholamines by corticosteroids
  • Pressor changes
  • Stress symptoms arise from appraised mismatch between perceived demands and perceived resources, the consequences of which indicate harm may occur (threat).
  • Hassles (minor demands) are cumulative and can occupy significant coping capacity.
  • Many important physiological systems can be influenced via hormonal and autonomic pathways.
  • High levels of demand can disintegrate normal activity and are pathogenic.