Stress

Dr.V.Subramanian.M.B.B.S.,D.
I.H
Dr.K.Dhamodharan.M.Sc.,Ph.
D
Three Views of Stress
1. Focus on the environment: stress
as a stimulus (stressors)
2. Reaction to stress: stress as a
response (distress)
3. 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
1988
Results
 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
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
3

2.5

2
Women
1.5
Men
1

0.5

0
10:00 12:00 14:00 16:00 18:00 20:00

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)
Fight or Flight Response
Increase in Decrease in
 Epinephrine &  Blood flow to the
norepinephrine kidneys, skin and gut
 Cortisol
 Heart rate & blood
pressure
 Levels & mobilization
of free fatty acids,
cholesterol &
triglycerides
 Platelet
adhesiveness &
aggregation
 Selye’s General
Adaptation Syndrome
(1956, 1976, 1985)

Alarm Resistance Exhaustion

Reaction •Arousal high •Limited
Perceived •Fight or as body tries physical
Stressor flight defend and resources;
adapt. resistance
to disease
collapses;
death

If stress continues ….
Cognitive Model of Stress
Lazarus & 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 & 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 & Folkman
 Secondary appraisal –
 Do I have the resources to deal
effectively with this challenge or
stressor?
 Cognitive Model of Stress
Lazarus & Folkman
High Low High High
Threat Resources Demand Stress
High High s
High/low Moderate
Threat Resources demands Stress
Low Low Low Some
Threat Resources demands stress
Low High Low Low or no
Threat Resources demands stress
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
 Job Strain – Karasek et al.,
1981
Demands

High Low

High
Control
Low STRAIN
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
physiological & psychological
or psychological wear and tear
vulnerability Illness
precursors,
symptoms
Exposure Behavioural
to stress changes & Illness
Coping efforts 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.
1. Tried to see the positive side of it.
2. Tried to step back from the situation and
be more objective.
3. Prayed for guidance or strength.
4. Sometimes took it out on others when I
felt angry and depressed.
5. Got busy with other things to keep my
mind off the problem.
6. Read relevant material for solutions and
considered several alternatives.
7. Took some action to improve the
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
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)
1 In uncertain times, I usually expect the
best.
2 If something can go wrong for me it will.
3 I always look on the bright side.
4 I’m always optimistic about my future.
5 I hardly ever expect things to go my way.
6 Things never work out the way I want
them to.
7 I’m a believer in the idea that “every
cloud has a silver lining.”
8 I rarely count on good things happening
to me.
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
 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
 AD – Effect on Caregivers
Results

 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
Variable Relative 95% CI p
Risk
Previous MI 2.86 1.37 – 5.99 0.005
Hx CHF 3.86 1.89 – 7.89 0.001
Depress. – P 2.48 1.14 – 5.35 0.02
Depress. - A 0.52 0.15 – 1.76 0.29
Network Cont. 1.04 1.00 – 1.06 0.01
Social Activities 0.98 0.96 – 1.00 0.05
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
 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.