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Basic notes Stress and coping

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					                          Basic notes Stress and coping




What do you think stress is?



Why is it important? Does it cause or worsen diseases? It has long been accepted

that stress can cause and worsen anything from allergic responses to heart disease.



There has and continues to be a great deal of research into stress using
questionnaires which we might look at in the seminars.



The word ‘stressed’ which engineers use to describe an overloaded bridge is the

same as the psychologist‟s description of the overtaxed individual. It comes from the

same Latin root strictus which means stretched out or drawn tight.        In fact the

common rather than the technical usage came first.



The word stress can be a noun or a verb and the noun can refer to situations or

responses. Because this can create confusion,



Authors have differentiated between stressors (stressful stimuli) and a stress

response (the reaction to a stressor). The word stress refers to the overall process.



Ultimately, stress is an umbrella term for an increasingly wide variety of conditions,

responses, and experiences.      However, stress can be examined using particular

models, which take a relatively singular view.


The stimulus model
The first model can view stress as „out there‟; external; a condition of the

environment. An independent variable if you like.



In this model, stress is seen as a stimulus in terms of stressors, within this model

there are two types of stressors.



A. Environmental stress

Stress here is assumed to be a condition of the environment. E.g. a noisy workplace,

difficult neighbours.


Occupational literature looks at noise, heat, light, air quality workload etc. Do you

think excess heat for example in intensive care units can have a stressful effect on

the staff who have to work under these conditions?



In this sort of model stress is an intensive level of stimulation, the level or intensity is

the distinguishing factor. This works quite well when these stressors are incredibly

extreme, but not otherwise.         It does not account for the fact that absence of

stimulation might be stressful. Also, people react differently to extremes. Some

people work well in a noisy environment. They are, perhaps able to switch off to

what is going on around them (students and teenagers often work with the radio at

full blast. This could drive someone else crazy.       Environmental factors, which are

potential stressors - heat light, smells and workload may not be experienced in the

same way by any two people. One of you might be very stressed by having to write 3

or 4 assignments at the same time, another might find it challenging rather than

stressful.


B. Life event stress
(Homes and Rahe)

This takes the view that some events are likely to be stressful for everyone e.g. death

of a close family member, going on holiday, and Christmas. However, these life

events vary in their stressfulness. Getting a divorce may alleviate the stress of living

with someone cruel. If you hate your job being made unemployed might not be so

bad for you if you loved it losing your job could be very stressful. Moving house is not

stressful if you stay at the office while the move is happening. (I've got one at home

like that). Is Christmas stressful if you are Muslim or Jewish?        A study by Israeli

sociologist Antonovsky 1979 found that over 25% of the survivors of German
concentration camps emerged without physical or emotional impairment. Obviously

these settings are the worst living conditions imaginable yet they were not uniformly

destructive. Also concentration camp and other survivors of world war two and their

children do not show serious psychological impairment. Somehow they have been

able to cope with this terrible life event. Some relationship between life events and

health seem to have been established but they have not been shown to predict the

probability of future illness. (Sabkin and Struening 1976) this is by way of a critique

of the life events scales which I will also be looking at with you after the break.



The response model

This views stress as the dependent variable if you like. It relates to the internal

factors, the reactions of the person.

Medically trained people are often familiar with this, the (physical) model known as

Selye’s General Adaptation Syndrome (GAS).



Selye used rats in his studies and found the same responses no matter what stressor

was used on the rats, cold, heat, infection, trauma, fear, loss of blood and pain etc.
He went on to study soldiers in the trenches during the war.
The initial response is an alarm reaction -flight or fight (adrenaline, nor adrenaline

and cortisol pump into the system).

Disruption in the homeostasis of the organism causes excitation of the hypothalamus.

The hypothalamus is the bridge between the brain and endocrine system.             The

pituitary is caused to discharge into general circulation the adrenocorticotrophic

hormone (known as ACTH). This has been called the „stress hormone' and is often

used to assess stress. As the ACTH reaches the adrenal cortex, the cortex becomes

enlarged and hyperactive, secreting corticoids, which supply a ready source of
energy for the adaptive, demands being made on the organism. This is a good thing

in the short term.



Incidentally, I was told recently that a cat plays with its prey, mouse bird to get the

stress hormones going in the circulation to make them juicier. What do you think?



In the medium or long term with continuing exposure to the stressor, there is a stage

of resistance. During the resistance stage, because of adaptation, apparently no

physical changes occur; the changes that occurred during the alarm reaction cease

and often the opposite of those occur e.g. hemodilution. The organism appears to be

well adapted to the stressor. It is however taking its toll. Resistance and adaptation

seems to be okay but better and more sophisticated measurements of e.g. stress

hormones now show it not to be very limited.



If stress is prolonged, allowed to continue unabated or additional stress is added

during the adaptive state then there is a return to the initial response and collapse.

This is a stage of exhaustion and death follows if the stressor is not terminated. In
Selye‟s study, half the rats died and some of the trench soldiers suffered from shell

shock.



Selye defined stress by virtue of the organism/s response: - where there is gas there

is stress; he also believed that we are born with genetically determined and finite

adaptive resources.




Specificity

The response model may be challenged by the specificity of responses to stressors.

Different stressors along with different physical and psychological predispositions

tend to lead to different types of physical problems. There is an individual response

stereotype - hypertensives will respond with a rise in blood pressure and ulcer

patients with a change in gastric secretions (Whitehead et al 1979)



Selye viewed stress as within the individual, not the environment because he found

that any stressor would produce the same response pattern. You will see later, from

Frankenhauser’s data that this is not true.



Strain

Strain is the psychological response. Many questionnaires focus on this aspect of

stress e.g. general health questionnaire, hospital anxiety and depression

questionnaires.   These include anxiety and depression at sub-clinical levels at

irritability and sleeplessness, inability to concentrate and „psychosomatic‟ symptoms
such as headaches.
Again here the focus is on individuals not environmental sources of stress.



The consequences can be dangerous - ignore environmental sources, so you don‟t

need to do anything about them; blame the individual for „not being able to cope'

being over-sensitive etc.
                          The Interaction Model of Stress.

The third model is interactional. In this model, stress as seen as interaction between

environment and the individual‟s perception of it. It suggests that the appraisal of the

event and of your resources for dealing with it are important in determining the level

of stress experienced.



The dominant stress model just now is the Cognitive Appraisal Model {see

research by - Folkman and Lazarus (1984) (Holroyd and Lazarus (1982)}.


In this model, stress depends on the individual‟s appraisal of



A. How threatening an event could be. Is this a threat e.g. a life event, an exam.

(Some may see an exam as very threatening and some may see it a challenge, a

way to show what they know).      In a medical situation what do you know about what

is going to happen to you; how big a threat to you is this surgery, procedure?



One example of this has been related to the fact that most patients know little about

what to expect during major medical interventions except from e.g. casualty or other

patients accounts. It has been argued that one reason which medical procedures

induce high levels of stress is because this lack of accurate information affects the

appraisal process and leads the patient to view the impending procedure as more

threatening and frightening than it need be. The threat is greater than in reality.



And
B. Whether or not he/she is able to cope with it. This depends on experience, do

you know how to? Do you have resources?



So, the cognitive appraisal model, which operates, like this



Primary appraisal- 'Is this a threat?’



Secondary appraisal - ‘Have I some control and can I cope?’


Decreasing the threat- increasing coping strategy e.g. stress management may help

here. Boosting social support can increase self-efficacy, “of course, you can do it”.

Also, increasing information may decrease if a threat is perceived as a result of

appraisal and you can cope then the event (threat) is not stressful.



If you cannot cope and have no resources then the threat is stressful.
                                          Coping



Coping may be seen in two parts.



Problem focussed coping and Emotion focussed coping.



1. Problem focussed coping

This is a cognitive, practical method. It looks at practical ways of dealing with, coping

with, the threat.
For example, in an exam situation, you can study hard, can make out timetables for

studying, get help, cheat, go off sick and resit it later.



If none of the above options, practical solutions is available or possible or desirable

and you fear you may not pass the exam then you can use



2. Emotion focussed coping to change or lessen the emotion.



For example,

You can tell yourself it is not important to pass the exam,

You can remind yourself that you are quite good at sitting exams,

You can moan to your friends,

Cry on someone‟s understanding shoulder, become very busy doing something else.

You can use positive self-efficacy/positive thinking: - believe that you will cope

somehow.

You can also use exercise or relaxation techniques to cope.
This theory is the dominant theory. It gets round individual differences, which can be

where other models can fall down. This is in fact, the model.



However, it is very hard to research due to its variability and its complexity. Both

complex appraisals of threat and of coping have to be examined as they interact.

But, for example, life event scales which you saw last week are not terrific in their

basic state, can be modified by asking subjects to appraise the stressfulness of an

event, not just report that it occurred.


It is good for understanding someone‟s stress and a good model to use when talking

to someone about their stress.



You might think of family, friends, and colleagues and see some clues - predictors as

to who might be suffering from stress.



It is important to remember. In the context of this model that two clients suffering the

same threat may experience different stress as a result.



The Frankenhauser approach

Another model, which is an Interactional model, looks at the individual consequences

of stress. This is Frankenhauser‟s model.



If you remember this physiological model of reactions to stress is Selye‟s. However

Frankenhauser uses this type of physiological reaction to explain stress and the

effects of stress. You will get more information from the activity affect model of stress

offprint in the library.
For Frankenhauser, unlike Selye, the pathways activated when stress is experienced

depend on the situation and are not as in Selye‟s model just reactions.



For example, if you have a very busy day at work i.e. high activity then the pathways

on the left will be activated but if you are okay feeling you have some control over the

situation and feel you can cope, there will be few, if any, pathways open on the left.



If you feel that things are too busy and getting out of control and you are feeling

distress then the pathways on the right will be opened as well as the ones on the left
which are related to high activity.



Alternatively, if you have low activity but trauma for example bereavement, then there

will be low activity on the left but open pathways on the right.



If you have are busy and have high activity and low distress you have control if you

have low control then you will have high activity and high distress.



This is a good model as it includes physiology and psychology.



The model goes on to explain the outcome of stress which affects these different

pathways.



The high activity side will produce high blood pressure, high cholesterol,



This other side is different and will produce low immunity function, spots, colds and

cancer.
Coronary heart disease requires the operation of both sets of pathways.



Control

For Frankenhauser the key to alleviation of stress is related to good balance in the

cognitive assessment of the demands being made in relation to personal resources.

A good balance induces positive affects, a bad balance negative affects. Personal

control is seen as a mediator of the quality of the experience: low control invariably

inducing negative affects, high control generally inducing positive affects. However,

there are pronounced individual and sex differences in the ability to benefit from
control and it is not a universal antidote to stress.



Control, (is it internal or external) is complex.       One may act helpless and get

someone else to do it for you, in which case you still control the situation albeit

appear not to. You are, in effect, manipulating the situation.



In health you can access „powerful others‟. Give control to the doctors.



Folkman found that decision-making by parents re what‟s happening increased

stress. Would you like to take the decision to switch off ventilatory support for your

child?



In the case of tragedy‟s, litigation may be pursued. This may give some measure of

control but can go on for years prolonging stress.



                                     Consequences

There are various studies related to consequences of stress.
General

A good study to look it is the one done after the eruption of the volcano in Mount

Saint Helens, in the state of Washington State. 1980. Despite warnings beforehand

50 people died some more than 20 miles away from the explosion.



In Othello which was a town in the path of the ash 137 miles away, there was no lava

flow or deaths but the ash covered everything and the small agricultural community

was completely disrupted by this event. No one knew how to deal with the ash,

whether it might effect health and worse still, might there be more eruptions.


Psychologists found that many residents of Othello were affected by symptoms of

stress.   Hospital and emergency room visits were increased by 21%, death rate

increased 18.6 %; psychosomatic illness and mental illness more than doubled, child

abuse and divorce increased as did alcohol abuse, aggression and violence (Adams

and Adams, 1984) other nearby communities showed similar increases in stress

related disorders which were in direct relation to the distance from the explosion.



Other studies, for example those of veterans returning from Vietnam have found that

long-term stress has been found to be linked to their exposure to combat rather than

personality or behavioural characteristics.      Thirty-five percent of heavy combat

veterans fit the profile for post-traumatic stress disorder. You‟ll all know a little about

that. I won‟t be discussing it just now.



2. Schizophrenia.

It has been suggested that the consequences some form of stress in a genetically

vulnerable individual either cause or trigger the manifestation of schizophrenia. The
stressors, which have been held to be implicated, have been numerous. (Brown and
Birley (1968) have shown that 60% of individuals who suffered an acute episode of

schizophrenia had experienced at least one stressful life event (e.g. death in the

family) in the three weeks prior to onset, compared within 19% of a „normal‟ British

sample. However, the role of stressful is generally held to be a triggering factor for a

specific episode of acute illness rather than a causal factor.




3. Heart disease - Type A Personality
It has also been suggested Type A personality may be related to a stressful approach

to life, one of the major the consequences of which is heart disease.



The Type A behaviour pattern was characterised as

“aggressively involved in a chronic, incessant struggle to achieve more and more in

less and less time‟ (Friedman & Rosenman, 1974). At work they are likely to rake on

more tasks than necessary, without realistically assessing time and other constraints

and in leisure time, they continue to display a pervasive inability to relax, competitive

striving, and a low sense of security (Glass 1977)



Glass (1977) presented evidence from work with Type A and Type B individuals to

suggest that Type A individuals exert greater effort to control stressful events. If the

event is objectively uncontrollable then relentless striving and time urgency of type

individuals leads to frustration and „psychic‟ exhaustion.       It is then; perhaps not

surprising that the consequences of stress on type a personality has been related to

coronary heart disease.
Evidence relating type behaviour to heart disease has been provided most

convincingly by the western collaborative group study who found that men with the

type a behaviour pattern experienced twice as much coronary heart disease than

those without this pattern. This relationship existed even when the influence of other

risk factors was taken into account.



However, the apparent strength of early evidence linking type a behaviour and

coronary heart disease was reflected in the consensus report (Review Panel, 1981)

where type a behaviour was accorded equivalent status to traditional risk factors
such as high cholesterol and hypertension.        Since then, though, there has been

increasing controversy. In non-USA studies, using non middle class class subjects,

the effect of type a personality on heart disease disappears. Research continues in

this field.



Some stress reductors (other than coping and control)

External, environmental; you can try to avoid or reduce it (turn noise heat down, get

the rota the way you feel it will work best.)



In the case of life events, don‟t put yourself under extra pressure, don‟t move house,

and get pregnant take on a new course of study.



There are physical ways of reducing stress e.g. relaxation and, of course, exercise

itself. It stands to reason that indulging in exercise is likely to be related to physical

fitness exercise is after all likely to develop to develop muscles including the heart

muscle and if exercise is aerobic, lowering of heart rate and blood pressure

associated with exercise are probable measures of cardiac efficiency improvement.
However, exercise doesn‟t always improve physical fitness or at least improve it in

measurable ways and a number of studies suggest it improves psychological well

being, Doyne 1987 found that there was less depression even if no fitter and it does

seem to lessen or ameliorate the effects of stress, Steptoe l989, Moses et al 1989

Plante and Ropin l990.



The improvements therefore, in coronary heart disease may be due to psychological

mechanisms operating in association with exercise as well as or instead of

physiological mechanisms. The extent to which this is true is yours to evaluate.


Why exercise may have psychological effects may be related to; -



1. Bandura improved physical fitness gives people a sense of mastery, control that

from Frankenhauser‟s model is important.          The „ I can cope' is related also to

cognitive appraisal and the effects of control.



2.   Endorphin theory (Howlett et al (984).        The stress of running etc induces

endorphin production, which has mood altering ‟ opiate „ effects, which are short

lasting only.



3. Distraction or „ time out‟ theory (Simons et al l985). Exercise takes your mind off

stressful situations/problems etc for the duration and gives you time out, which

reduces the physiological response and alters psychological state. Again it may only

be temporary in effect but break can be important like sleeping?



4. Exercise is often a group activity there may be group dynamics involved e.g.
social support may be involved (Berger & Owen l988).
There is evidence, therefore, of direct and indirect effects related to exercise and

stress. High blood pressure can be reduced and mood can be improved.



Social support is also considered to be important in relation to stress.



The content of social support is



1. The structure of relations - the size of the social network. Are you married or
single, divorced or individual?



The assumption is that more is better; the more relationships you have the better.

But this may be untrue more may mean more chance to be undermined, criticised

etc.    Marital relationships may be like this and they are linked to kids who are

dependants                         and                  not                  givers.
The function provided by social supporters is

1. Practical - money, advice, practical help (this is problem focussed)

2. Emotional - distractions, relaxation, laughs, cries, cuddles, someone on you side

and self-efficacy. (This is emotion focussed)

In criticism of this lots of social support should mean good health and little social

support should mean bad health but while social undermining, mental disruption or

breakdown of relationship may cause bad health it may also be caused by bad

health.


Stress management, which I have mentioned before, is a method, which is better left

to the experts.

				
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