PYA2 – Stress

1. PYA2 –Stress Critical Issue: Stress Management

2. Stress Management BATs AO1- Distinguish between Problem and Emotion focussed coping strategies -Outline psychological and physiological methods of stress management AO2 – Compare and evaluate different methods of stress management Homework: p155 q3 c (i) and (ii) Next week – recap of module and 30min mini mock!!

3. How do you cope with stress? • In groups brainstorm the ways you use to cope with different stressful situations

4. Approaches to coping with stress • Folkman and Lazarus (1980) – ‘cognitions and behaviours that a person uses to reduce stress and moderate its emotional impact.’ • Ways of Coping Questionnaire – found 2 ways people cope • Problem – focused coping • Emotion-focused coping Coping response varies with type of stressor

5. Problem - focused Coping Stress is treated as a problem to be solved. • Seeking social support – discussing a problem helps make more sense of it, puts problem in perspective. • Taking control – e.g taking steps to deal with debt, finding out about a disease, looking for a new job.

6. Problem Focused Coping • Evaluating the pros and cons of different ways of dealing with the stress – e.g. planning a new life after bereavement, choosing whether to have surgery, • Suppressing competing activities – e.g. avoiding the temptation to put off going to the dentist because of work commitments • Anticipatory coping – work out what triggers stress, train ourselves to anticipate and deal with it e.g working out your route to a new location, anticipating possible roads to avoid e.t.c

7. Problem Focused Coping These strategies are often achieved through Psychological Therapies • Cognitive Behavioural Therapy – CBT

8. Emotion – focused Coping Avoidant methods, used when a person feels there is nothing that can be done to change the problem. Treats the symptoms not the problem 1. Defence mechanisms – tend to be negative • Denial – e.g going on as if nothing has happened • Distancing/distraction – e.g just not thinking about it, See Lee et al p 146 • Focusing on and venting emotionse.g crying, anger, praying (seeking guidance and strength - +ve) • Wishful thinking –dwelling on what might have been if this hadn’t happened

9. Emotion – focused Coping 2. Reappraisal/reinterpreting – taking another look at the situation may change the way you feel about it. A positive approach. 3. Arousal reduction – heightened reactions associated with stress are reduced, so the person becomes less stressed e.g meditation, relaxation, exercise, biofeedback or drug therapy

10. Gender differences in coping • Do you think males and females may cope differently? 2 mins • Research has evidence that .. • Males more likely to use Problem-focused methods, whereas women use emotion-focused (Brady and Hall, 93)

11. Gender differences in coping • Rosario (88) – 2 theories to explain this.. • Socialisation theory – women taught to show emotions openly, men taught to approach stress in a more active way. • Role constraint theory – coping strategy matches roles males and females occupy. When males and females have same role – used same strategies to cope with stress

12. Can you distinguish between Emotion and Problem focused coping? • Look back at the coping strategies you put on the brainstorm • Decide whether each is an example of problem-focused or emotion-focused.

13. Plenary • Explain the difference between problem-focused and emotion-focused approaches to coping with stress. • For each approach give 2 examples and provide a piece of research evidence. (see pages 145-148) • Describe 2 strengths and weaknesses of each approach.

14. There is a very, very tall coconut tree, and there are 4 animals passing by: King Kong, Ape, Orangutanand MonkeyThey have a competition to see who is the fastest to get the banana. Who do you guess will win? Your answer will reflect your personality. Try and answer within 30 seconds Got your answer?

15. If your answer is ....Orangutan = Dumb Ape = Foolish Monkey = Idiotic King Kong = Stupid Why ????? A Coconut tree ........ doesn't have bananas!!   It's obvious you're stressed by your work. Go home!  

16. What is Stress Management? The process by which an individual attempts to cope with (manage) stressful demands. • Psychological – CBT (e.g Stress Inoculation, Hardiness training and REBT) • Physiological – Drug therapy, Biofeedback, exercise

17. Psychological Methods • Use techniques that help the person cope with the situation itself rather than just dealing with the symptoms. • Patients find ways of changing or avoiding stressful situations in the future. • Or learn techniques to minimise negative effects of stressful situations

18. Psychological Methods • Rational Emotive Behaviour Therapy (REBT) • Cognitive Behaviour Therapy (CBT) • SIT • Hardiness Training

19. Pages 148-50 You have 30 minutes Over to you… • In pairs or small groups you will be given one method of Psychological stress management to research. • The aim is to produce a fact sheet that.. • Outline the method • Studies/research that support the method • Studies/research that challenge the method • Strengths and weaknesses • The fact sheet will then be photocopied and used by the class for essay construction and revision, and each method discussed and evaluated.

20. Psychological Methods Stress Inoculation Training (SIT) Meichenbaum (1985) – cognitive-behavioural therapy – person can change way they think about certain stressors. Suggested client should develop a form of coping before the problem arises – inoculate yourself against the disease of stress like vaccinations to prevent infectious diseases! Use clients’ existing coping skills.

21. Stress Inoculation Training (SIT) Meichenbaum (1985) – 3 stages: • Conceptualisation – Therapist and client establish a relationship. Client taught to perceive threats as problems-to-be-solved. Stressors broken down into specific components that can be coped with. Thus helped to gain greater understanding of the nature of stress and their reactions to it.

22. Stress Inoculation Training (SIT) Meichenbaum (1985) – 3 stages: 2. Skills Training and Practice Client taught strategies to cope with stressful situations tailored to needs of client. E.g positive thinking, relaxation, social skills, ways of diverting attention, using social support systems, time management. Use of coping self statements (see p112) -encourage client to think in a different way (cognitive) and involves conditioning (behavioural).

23. Stress Inoculation Training (SIT) Meichenbaum (1985) – 3 stages: 3. Real-life Application (and follow through) Client goes out into the real world and puts training to the test in different situations, which become increasingly stressful. Techniques include – imagery, modelling and role playing and training others. Booster sessions offered later on (follow through) The reinforcement of successful coping in the real world becomes self sustaining.

24. Strengths It works! –Meichenbaum (1996) successful with acute and chronic stress. Combines cognitive and behavioural therapy – powerful method of stress management By gaining new skills gap betweendemands and coping resources narrows – more confidence in handling previously stressful situations Weaknesses Time consuming and high levels of motivation needed –only suits a small range of determined individuals. Expensive. Difficult to change some behaviour Complex – may not need to do all aspects of the therapy – e.g. may be sufficient to just talk more positively and relax more Evaluation of Research

25. Other supporting research Meichenbaum (1977) Compared SIT with another therapy – desensitisation to help clients with phobia of snakes. Both methods helped, but SIT better because helped them cope with other phobias too. Fontana et al (1999) - College students had lower heart rates and state anxiety levels than controls – this was also case 6 months later. Jay and Elliott (1990) – Parents of children undergoing medical procedures. The SIT group reported less anxiety than group observing their children in a cognitive therapy programme.

26. Psychological Method 2: Hardiness Training Kobasa and Maddi (1977) If some people are naturally resistant to stress (hardy personality), may be possible to teach others how to be ‘hardier’ and thus manage stress better. Suzanne Kobasa and Salvator Maddi founded Hardiness Institute in California. Aim of training programme is to increase confidence and sense of control to deal more successfully with change.

27. Psychological Method 2: Hardiness Training Kobasa and Maddi (1977) 1.Focusing – client taught to spot signs of stress (e.g. muscle tension, increased heart rate, anxiety). Allows client to recognise stressful situations and thus sources of stress. 2.Reliving Stress Encounters – clients analyse recent stressful situations in terms of how easily they were resolved and how they might have turned out better or worse. Gives client insight into their current coping strategies and how they might be better than they thought.

28. Psychological Method 2: Hardiness Training Kobasa and Maddi (1977) 3. Self-improvement – The key to hardiness is the belief that we can cope with life’s challenges. Client taught to focus on seeing stressors as challenges and thus learn to take control. Control, commitment and challenge are the basis of hardiness training.

29. Strengths Deals with the problem rather than the symptoms – teaches clients to manage all stressors in their life. More adaptable and effective than drugs Long-term effectiveness Weaknesses Much of research carried out on male executives or soldiers in US. Low ecological validity. High control can be stress inducing for some people. Difficult to modify learned habits. Does hardiness exist? – is it just being in control? Evaluation of Hardiness Training

30. Other Research on Hardiness • Fletcher (2005) – hardiness training effectively used on Olympic swimmers to ensure they are committed to challenge of increased performance levels and able to control stressful aspects of their daily lives that might interfere with training. • Funk (1992) argues that low hardiness is the same as being negative, and it is negativity not lack of hardiness that leads to the ill effects of stress.

31. Both treat the problem not the symptoms. Both teach clients skills to provide lasting and varied strategies to cope with stress Both teach clients to view stress as a problem to be solved Both require lengthy training and highly motivated clients. The success of SIT may be mainly due to positive thinking The success of hardiness training may be due to increased control Comparison of SIT and Hardiness Training

32. Presentation • Each group needs to briefly outline what they have found out about their method of stress management. • 5 mins max each please • Hand in sheet for photocopying

33. Plenary • Overall what are the advantages of Psychological methods of stress management? • Overall what are the disadvantages? • Are these methods problem-focused or emotion focused? Give a reason for your answer.

34. These methods focus on getting rid of the emotions associated with the stressful situation, but the situation may not be changed. They directly target the stress- response systems. Physiological approaches to stress management

35. 1.Enhance action of natural brain chemical, GABA. 2. GABA tells neurons to slow down or stop firing – general quietening influence on brain. Anxiolytic* Drug Therapy Benzodiazepines (BZ’s) Librium, Valium, Halcion, Xanax Short term relief of severe anxiety. 3. Action of GABA is supported by BZ’s to inhibit neuron activity even more 4. The brain’s output of excitatory neurotransmitters (e.g serotonin) is reduced and person feels calmer Anxiolytic – anti-anxiety drugs, GABA – gamma-amino-butyric acid

36. Anxiolytic* Drug Therapy Beta-blockers Treat high blood pressure • Reduce activity of adrenaline and noradrenaline, which are key agents in sympathetic (ANS) arousal. • By blocking ANS arousal, beta-blockers slow the heart beat, lessen the force with which the heart contracts and reduces blood vessel contraction. • This results in a fall in blood pressure and less stress on the heart. Also given to sportsmen and women to reduce arousal which can affect performance negatively.

37. Anxiolytic* Drug Therapy 1.What do you think are the advantages and disadvantages of using drug therapy to manage stress. 2. Do these methods really manage the stress? Explain.

38. SSRI’s • Selective Serotonin Reuptake Inhibitors • E.g Prozac • Prevent the recycling of Seratonin • Leads to more Seratonin in the synapses • Helps depression as people suffering this illness have low levels of Seratonin. Trivedi et al 2006 – 3000 depressed patients given Citalopram. 47% halved their depression score. BUT -Effectiveness did depend on type of person. See p151 Exploring Psychology

39. Strengths High efficacy (work on range of anxiety disorders) Kahn et al (1986) – BZs superior to placebo Work quickly to reduce disabling effects of stress related anxiety. Low toxicity Rai et al (2005) – Beta Blockers increased survival of patientswith certain serious heart problems. Can be prescribed immediately for acute stress Easy to take Weaknesses Addictive –BZs psychological and physical dependence can develop within a few weeks –Ashton 1997 – BZs limited to 4 weeks use Side effects –drowsiness, dizziness, tiredness, dry mouth, diarrhoea, changes in sex drive/ability, seizures, severe skin rash, irregular heartbeat Can prevent normal psychological adjustment –treats the symptoms not the problem Evaluation of Drug Therapy

40. Time to relax!! • Measure your pulse. Jot it down. • You may use a biodot. • Now lie down and get comfortable • Listen to the CD. • R E L L A A A X ! • Now retake your pulse and look at your biodot • Any change?

41. Biofeedback Person learns to exert voluntary control over involuntary (autonomic) behaviours Biofeedback involves 4 processes: • Feedback – patient attached to machines that give feedback about ANS activities – heartbeat, blood pressure • Relaxation – patient taught relaxation techniques – reduces activity of sympathetic nervous system and activates parasympathetic NS – reduced heart rate, blood pressure and symptoms related to stress

42. Biofeedback • Operant conditioning – relaxation leads to target behaviour e.g. reduced heart rate, which is rewarding. • This will increase likelihood of same behaviour being repeated. This learning (conditioning) takes place without conscious thought. • The reward results in an unconscious ‘stamping in’ of the behaviour. (Like Pavlov’s dogs) • Transfer – The patient transfers the skills learned to everyday situations.

43. Research on Biofeedback • Budzynski et al (1973) Biofeedback and tension headache • See p 152 of text book • This would be a good example to learn and use in essays and other answers about stress management • How effective was the biofeedback on relieving the headaches?

44. Research on Biofeedback • Miller and DiCara (1967) – paralysed 24 rats, kept alive by artificial respiration. Half rewarded when heart rate slowed down, other half rewarded when heart rate went up – reward was to stimulate pleasure centre in brain. ‘Fast’ group speeded up heart rate, ‘slow’ group slowed down. Learning was involuntary and ANS responses were conditioned as a result of operant conditioning. Explanations – Is it operant conditioning which provides the biofeedback or simply learning to relax? Alternatively this method may make patients feel more in control, producing beneficial effects – remember lack of control thought to be a source of stress Other supporting research includes Gruber and Taub (1998) and Attanasio et al (1985)

45. Strengths Non-invasive No negative side effects Provides patient with long lasting means of dealing with stress symptoms Weaknesses Expensive –the cost of equipment and time needed Treating the symptoms not the problem – does not treat the source of stress Evaluation of Biofeedback

46. Plenary • Which do you think is a more effective way of managing stress, drug therapy of biofeedback? Why? 2. Which is best Emotion-focused or problem-focused methods? Why?

47. Problem-focused Aim to remove problem No side effects Last longer Slower More expensive Ppts need to be motivated to stick with them Emotion focused Control symptoms – problem still there Quick and effective Relatively cheap May have side effects May cause addiction Biofeedback – no addiction or side effects, more expensive than drugs 3. Which is best Emotion-focused or problem-focused methods?

48. Homework • Homework: p155 q3 c (i) and (ii) • Next week – recap of module and 30min mini mock!! • So REVISE!!!!