Stress: revision summary

Transcription

1 1 Stress: revision summary Sympathomedullary pathway: acute stress Pituitary-adrenal system: chronic stress Hypothalamus Hypothalamus Sympathetic nervous system CRF (Corticotrophin releasing factor) Pituitary gland (master gland) Adrenal medulla ACTH (adrenocorticotrophic hormone) Release of catecholamines (adrenaline / noradrenaline hormones) Adrenal cortex Release corticosteroids (cortisol) Body prepared for energy expenditure. Sympathomedullary pathway: energy stores mobilized/ faster heart rate/ higher blood pressure/ digestive activity slowed down. Pituitary adrenal system: immune system supressed. The effects of short-term stressors on the immune system Kiecolt-Glaser et al. (1984) Kang et al. (1997) Marshall et al. (1998) Students were experiencing stress as they were preparing for exams. This exam stress was found to reduce immune function where the number of T cells was low. This makes them more vulnerable to illness. A decrease in natural killer cell activity was found in students who were taking exams. If a person is in an elevated level of stress, they will experience greater immune system dysfunction if they have additional daily hassles.

2 2 The effects of chronic stress on the immune system Cohen (2005) Kiecolt-Glaser (2005) Gerra et al. (2003) Kiecolt-Glaser (2000) Cohen et al. (1993) Kiecolt-Glaser (2003) Mayne (1997) Segerstrom and Miller (2004) Consistent conflict in relationships increases the risk of developing illness Wounds heal more slowly when chronic stress is experienced The experience of a husband/wife dying leads to stress which lowers Natural Killer Cell and lymphocyte activity. The stress experienced from working as a caregiver to an ill person, results in lower levels of Natural Killer Cell activity. The risk of infection is positively correlated with a person s stress index score. Women have more adverse hormonal and immune system changes as a result of chronic stress There are gender differences, where women experience greater immune suppression as a result of chronic stress. Elderly individuals are more vulnerable to decreases in immune function as a result of stress. The effects of life changes on the immune system Social Readjustment Rating Scale (SRRS) The more stressful an event is the more we have to adjust Rahe et al. (1970) Stone et al. (1987) Michael and Benz-Zur (2007) Life change units on the scale were positively correlated with illness scores. The experience of stressful life events increases the chances of stress-related health breakdown. Prior to illness, the number of undesirable events experienced increased, suggesting that these are responsible for the illness. Widowed individuals scored higher on life satisfaction before incident. Divorced individuals scored higher on life satisfaction after divorce because they were going out and meeting new people again. Evaluation of life changes stress research Factor Individual differences Causality Positive life events Self-report methodology Dated and androcentric Effects The scale values from SRRS for different events are arbitrary and vary between individuals, where the stressfulness of an event depends on a person s perception of it. The relationship between SRRS score and health is correlational. It doesn t display the direction of causality, where illness may lead to certain undesirable life events instead. Some events may be positive but SRRS doesn t distinguish and the scale assumes that all life events are stressful without evidence for this. This is unreliable as when some of the research is repeated over different years (Raphael 1991), the differences between first and later reports are inconsistent. The SRRS is based on ratings from over 40 years ago and based mainly on life change events concerning men.

3 3 Daily Hassles Kanner et al. (1981) DeLongis et al. (1982) Ruffin (1993) Bouteyre et al. (2007) Lazarus (1999) Daily hassles scores correlate with levels of depression, anxiety and health problems. Hassles scores correlated with health outcome, more so than life events scores. Daily hassles were found to produce greater psychological and physiological dysfunction than major negative life events. A relationship was found between hassles and depressive symptoms Minor daily stressors can affect wellbeing, where they can build up in numbers until an overload occurs, which results in a serious stress reaction leading to depression and anxiety. Evaluation of daily hassles research Research Kim and McKenry (1998) Sim (2000) Cultural differences: White Americans were found to use social support from their spouses significantly less than other ethnic American minorities. Cultural differences: It was found that in Korean adolescents, if they received social support then daily hassles had less of a harmful effect. Workplace stress Factor Physical environment Overload Lack of control Motivation Lack of space / temperature / lighting / arrangements these can act as stressors Dewe (1992)- spending too much time at work leads to family and individual stress Working under others leads to increased stress Stress can lead to decreased motivation which then leads to further stress due to work build-up. Research on workplace stress Key study: Johansson et al. (1978) Aim Procedure Conclusion Evaluation To determine the effects of work stressors on health High risk stress group were compared to control group of cleaners. Urine samples were taken to test for stress-related hormone levels. Records of stress related illness and absenteeism were taken. High risk group were found to have higher stress hormone levels and more stress related illness/ absenteeism compared to control group. Combination of work stressors results in chronic physiological arousal and then to stress-related illness. Managers should attempt to reduce work stressors to prevent stress-related illness and absenteeism. Causality is difficult to determine as there were numerous work stressors involved, so the separate effects of each stressor can t be seen. There is a small sample size.

4 4 Further research into workplace stress Marmot et al. (1991) Van der Doef and Maes (1998) 3 year longitudinal study where a relationship was found between low job control and higher rates of heart attacks. High job demands and low sense of control leads to increased risk of heart disease. Evaluation of work place stress research Schaubroeck et al. (2001) Culture Personality Those with high levels of perceived control, but have low confidence would also experience stress e.g. they may blame themselves for negative business occurrences. Similar results for work place stress studies have been found in other cultures, however not all demonstrate that high demands and low control result in stress. The influence of personality hasn t been considered in these studies. Type A personality Type A behaviour includes competitiveness, low self-esteem, hostility and a strong sense of time pressure. Williams et al. (2003) Kirkaldy et al. (2002) Friedman and Rosenman (1974) [Key study] Myrtek (2001) Hostility increases the risk of high blood pressure which leads to heart attacks, strokes and other symptoms of cardiovascular disease Type A + external locus of control (believe circumstances are outside their control) = higher perceived levels of stress / lower job satisfaction and poorer physical and mental health in comparison to Type B personality (a more relaxed individual with patience) + internal locus of control (where they believe circumstances to be within their control) This study investigated Type A behaviour and cardiovascular disease 3200 American men aged were interviewed in which they were categorised as having Type A or Type B personalities. They were followed over 8.5 years. 257 were found to have developed coronary heart disease, 70% of which had Type A personality. This finding was independent of lifestyle factors e.g. smoking and obesity. Type A behaviour increases vulnerability to heart disease. Behaviour modification programmes to reduce Type A behaviour should result in reduced risk of heart disease Found a significant relationship between Type A behaviour and angina (type of CVD)

5 5 Evaluation of Type A personality research Lack of consistent research support Role of hostility Hardiness Correlations are found, but are never very high. Type A concept has been questioned by Evans (1990). Matthews and Haynes (1986): High levels of Type A behaviour correlations with CHD are increased where hostility is high. Those who attempt to repress high levels of hostility are more personally affected than those who express it. The role of hardiness isn t considered in Type A personality research that is presented here. The hardy personality (Kobasa & Maddi, 1977) Commitment: stay involved with the people and events Control: keep trying to influence the outcomes of events Challenge: view the task as a way to develop as a person Kobasa and Maddi (1977) Kobasa et al. (1985) High scores on hardiness measures indicate that people are less likely to suffer stress-related physical and mental illness. Protective factors were tested for including hardiness, social support and regular exercise.those with no protective factors had higher scores on illness severity scales. Protective factors were associated with decreasing illness scores, of which hardiness had the greatest impact. Problem- focused coping Emotion-focused coping Involves an active approach for dealing with Involves a regulation of emotions, where only potentially controllable events. feelings are changed in a passive and internal way. Can be effective for less controllable events, in reducing arousal temporarily (Ben-Zur & Zeidner, 1995). Penley et al. (2002): problem-focused coping positively correlated with good health. Emotion-focused coping negatively correlated with good health. Park et al. (2004): Problem focused coping positively related to positive mood when dealing with perceived highly controllable stressors. Fang et al. (2006): Female cancer patients who felt they were in control and engaged in problem-focused coping strategies suffered more distress over time than a group of women who didn t use problem-focused coping. This was because the feeling of control that they had didn t reflect reality so they became distressed as their efforts didn t lead to actual changes. Rukholm and Viverais (1993): Examined relationship between stress and coping. People need to use emotion-focused coping first and then problem-focused coping.

6 6 Evaluation of the different coping styles Stanton et al. (2000) Baker and Berenbaum (2007) Emotional-approach coping were better able to deal with stress of infertility. Actively identifying and expressing emotions, becoming aware of a stressful event allows us to identify the best course of action. Problem focused coping is counterproductive if a person doesn t recognise their emotions first. Learning to appropriately express emotions is a more effective way of solving the problems posed by a stressful event, especially where men are taught how to express themselves properly. Gender differences in coping styles Men Men engage in direct action when dealing with stressful events Nolen-Hoeksema (1994): Men take more active problem-focused coping concerning drinking alcohol and exercising. Socialisation theory: men approach stressful situations in a more active problem-focused way. Gender differences in coping are found across different situations regardless of societal role. Women Stone and Neale (1984): Women more likely to use relaxation, catharsis and distraction Rosario et al. (1988) women consistently made more use of social support than did men when dealing with stressful situations. Nolen-Hoeksema (1994): Women ruminate as a form of emotion-focused coping, where depressive symptoms are maintained. Socialisation theory = Woman are socialised in a way that causes them to develop less effective coping strategies e.g. women taught to express emotions openly but act in a more passive manner. Role constraint theory : Rosario found that males and females in the same social roles didn t differ in their reported use of problem-focused or emotion-focused coping strategies. Ptacek et al. (1992): no gender differences in the use of problem-focused coping because students also shared the same social role. It is possible, therefore that men and women have begun to adopt similar coping strategies, due at least in part to the fact that they were taking on more similar roles.

7 7 Methods of stress management Drugs: Benzodiazepines (BZ) BZ react with GABA receptors on the receiving neuron ( GABA usually allows negative chloride ions to pass inside a receiving neuron The ions make the neuron less responsive to neurotransmitters that usually excite it and therefore reduction in nerve impulses ) BZ boosts actions of GABA so more chloride ions enter neuron, making it more resistant to excitation Brain output of excitatory neurotransmitters (serotonin) is reduced, so person feels calmer Beta-blockers Reduce activity in pathways of the sympathetic nervous system Beta-blocker binds to adrenergic receptors and blocks receptor from being stimulated. This prevents the activity of adrenaline and noradrenaline e.g. binds to adrenergic receptors on heart to prevent raised heart rate and blood pressure Advantages Speed and effectiveness - Hedblad et al. (2001) regular low doses of beta-blockers reduce progression of mental illness. Availability:drugs can be prescribed immediately Hidalgo (2001) BZs were found to be effective. Psychological and physical dependency may occur. Side effects. BZ: drowsiness and poor memory Beta-blockers: tiredness Tolerance: drug dose is less effective after repeated use Gelpin: BZs are not effective for post-traumatic stress disorder. NICE report (2006) other drugs better than beta blockers e.g. ACE inhibitors and diuretics Biofeedback Physiological signals recorded including blood pressure and muscle tension. These are recordings of stress-related physiological effects. Signals are amplified and displayed to client (biofeedback) Client is taught how to use relaxation and imagery to reduce blood pressure or muscle tension (stress management techniques) Advantages Attanasio et al. (1985) Biofeedback has been found to be an effective treatment for stress in children Masters et al. (1987) Biofeedback has been found to be no more effective than relaxation. The treatment is also expensive and timeconsuming

8 8 Psychological methods of stress management Meichenbaum and Cameron (1983) - Stress-inoculation training as a form of cognitive behavioural therapy. 1) Conceptualisation: people relive stressful situations they have experienced and develop realistic understanding of stress causes. They identify key elements of stressful situations. 2) Skills training and practise: teaching of relaxation techniques to help patient cope with the arousal effects of stress. 3) Real-life application: patient tests their training after experiencing a stressful event. The effectiveness of the conceptualisation and relaxation techniques provides reinforcement and so the stress-relieving process becomes self-sustaining. Advantages Meichenbaum and Turk (1982): positive results have been found, noted to be the result of the combination of cognitive and behavioural techniques. Practicality: requires a lot of time and money, where high levels of motivation and commitment are required. The stress-managements techniques require changes of habit, which are difficult changes to make. Progressive muscle relaxation Control over tensing and relaxation of muscles allows the patient to learn how to consciously reduce bodily arousal Mental relaxation allows stress-response systems to deactivate and for heart rate and blood pressure to fall with the activation of the parasympathetic system. Advantages Targeting symptoms: reduces activity of stressresponse systems Impractical: muscle tensing and relaxation takes time and space meaning that it is inconvenient and not always possible to do when a person is stressed. Chronic stressors need more than non-specific Relaxation. There needs to instead be a focus on the causes of the stress. Hardiness training 1)Focusing : taught to identify signs of stress and recognise stressful situations / sources of stress 2)Reliving stressful encounters: understand how they were resolved and evaluate them how the situation could have been handled better. 3)Self-improvement : help them believe that they can cope with life s challenges to develop a sense of personal control. Kobasa s support for developing Hardiness training was based on white middle class business men, therefore it is difficult to generalise. The concepts of control and challenge are also not clear.