"Stress and coping: Cause
Department of Community
• distinguish between the different models
• 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”
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
• 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
• 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
• Secondary appraisal: The evaluation of
coping effectiveness: coping appraised
– 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,
• 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
– 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
Indicators of stress
– concentration/memory difficulties
– disruption of cognitive performance
– fear/anxiety, depression, fatigue
– irritability, withdrawal, vegetative disturbances
– cvs, immunological, dermatological, hormonal,
GI, GU changes
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
• 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
• Staff : When…
– risk of harm (in form of error) is high,
– demands exceed resources.
Effect of stress on CVS
• In situations appraised as borderline
coping, cardiovascular changes are
• 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
• High levels of demand can disintegrate
normal activity and are pathogenic.