Coping with Stress

Stress has become a major issue in recent years and few topics have received so much attention, either in serious scientific journals or in popular publications such as magazines.  Recently there has been TV series such as ‘Stressed Eric’ and the paperback ‘Little book of calm’ that sold over 2 million copies in 2000.  In the workplace stress has become a major concern of managers and Company bosses following successful litigation by employees claiming harm done by unnecessary exposure to stress.  Stress management or stress reduction is now a multi-million pound business and many methods of coping have been devised, some with more success than others. 

At the outset it is important to make a distinction between various approaches.  Methods of coping could, for example, be split between:

Emotion-focussed is a palliative approach that tries to improve the way we feel about the stress but without tackling the problem head on.  These include denial that a problem exists or pretending an event never happened, displacement of anger in other directions or venting emotions through crying for example.  Alcohol is also an emotion-focused approach.

Problem-focussed methods deal with the root causes of stress and attempt to improve the stressful environment the person is experiencing, for example speaking to the boss who is making life difficult or by time management. 

Main effects hypothesis

Generally it seems to be assumed that problem-focused is the more effective method of coping.  Penley et al 2002, in a study of nurses, found that those using problem-focused techniques were generally blessed with better health.

Goodness of fit hypothesis

If the stressor is perceived as controllable then we are indeed likely to prefer problem-focused methods.  Not surprising really I suppose; we can do something about it so we do!  However, if the stressor is perceived as being beyond our control then we fall back on emotion-focused methods.  We can’t tackle the issue head on so we make the best of a bad deal!

Research tends to favour the more flexible goodness of fit hypothesis:

Folkman and Lazarus found that students use problem-focused methods when preparing for exams but are more likely to rely on emotion-focused methods when waiting for results. 

A study of people living close to the Three Mile Island nuclear power station, that almost went into meltdown in the early 1980s found that those using emotion-focused methods coped much better, presumably because it was completely out of their control.

Evaluation of research

Unfortunately it isn’t always possible to separate the two coping strategies.  Making a plan for example would seem at first glance to be an example of problem-focused coping, but making a plan also makes you feel better, as though you are doing something useful.  This presumably would be classed as emotion-focused.

Much of the research is also correlational so it is difficult to assume cause and effect.  It is very difficult to randomly allocate participants to two categories since people have their own way of dealing with stress.

Following on from this and perhaps not surprising, hardy personalities prefer the head on problem-focused methods whereas less hardy tend to plump for emotion-focused.

Physiological methods (all the Bs)

Drugs

A number of categories have been used.  In the olden days the drugs of choice were barbiturates but these had a number of side effects. 

Today there are two main categories (and also begin with ‘B’):

Benzodiazepines (Librium and valium)

Benzodiazepines (BZs) increase the activity of a chemical called GABA.  GABA increases the uptake of chlorine ions at the synapse which prevents other neurotransmitters being so effective.  This acts to reduce the activity of other neurotransmitters such as serotonin.  By increasing the activity of GABA, BZs therefore dampen activity and arousal of neurons in the CNS. 

Unfortunately GABA reduces activity in about 40% of the brain’s neurons so doesn’t just effect stress pathways.  As a result BZs have a number of side effects.

Side effects include increased aggression, depression, drowsiness, memory loss (particularly laying down new memories in LTM) and various other cognitive deficits such as learning.  Fortunately, many of these effects are only temporary.

Beta blockers

BBs slow down activity in the sympathetic branch of the ANS by reducing levels of adrenaline and noradrenaline.  This has two positive effects; it reduces heart rate and blood pressure etc. and because it is difficult to feel stressed when your heart isn’t pumping away like a mad ‘un, it helps to make us feel calm.

Because they have fewer side effects they tend to be the drug of choice for sports people and especially musicians.  Lockwood found that 27% of musicians had used BBs and generally found them useful.  

Evaluation

Drugs are convenient being quick and easy to take.  Compared to lengthy sessions of therapy they are cheap and far less time consuming. 

However, they can be addictive.  BZs especially can induce withdrawal symptoms even when taken in small doses.  There is also the issue of tolerance with greater and greater quantities needed to gain the same stress reduction when they are taken for any length of time.

Busiprone

New kid on the block and works by increasing the effects of serotonin.  It has fewer side effects than benzodiazepines; fewer headaches, less drowsiness but it can cause headaches!  It also begins with B!

Biofeedback

The body is not designed to allow us to be consciously aware of subtle changes in our bodies such as blood pressure.  Biofeedback aims to provide this information allowing us to take steps to reduce heart rate etc. by relaxation.  A biofeedback machine produces precise information (or feedback) about bodily processes such as heart rate and/or blood pressure.  This may be presented in visual or auditory form (or both).  For example, a tone whose pitch varies and/or a line on a television monitor that rises or falls when heart rate increases or decreases may indicate heart rate changes.

The fact that some people can apparently regulate some bodily processes has led to biofeedback being used with many types of stress-related disorders.  These include migraine headaches, tension headaches and high blood pressure.

Bradley (1995) compared patients who were receiving biofeedback for muscle contraction headaches with patients on a waiting list for such treatment.  Biofeedback was in the form of feedback about muscle tension (provided by EMG).  Significant reductions in the number of headaches was found in patients undergoing the feedback treatment.