What the board expects you to know

Our stress response which today causes so many problems would have been a life saver in our early development

Stress as a bodily response (physiological model)

Let’s get something straight right from the start.  The body’s reaction to stress is old fashioned.  In the modern World, in the vast majority of stress situations the body’s response to stress causes more harm than good.  However, in the olden days, before even Mrs Ashton, Mrs Wilson and I were born (though perhaps not Mr Marshall), like tens or hundreds of thousands of years ago, our present day response to stress would have been a lifesaver. 

Faced with danger such as a sabre tooth tiger or a warring tribe down the road then a sudden mobilisation of energy in the body was useful.  Consider the typical response to stress:

• Increased heart rate
• Increased blood pressure
• Relaxation of the lung’s bronchi (air channels widen)
• Release of glucose into the blood
• Dilation of pupils (letting more light into the eye)
• Slowing of digestion (allowing blood to flow to muscles, heart etc).

This is referred to as the 3fs response (fright: flight or fight) and serves a simple purpose.  It is pumping oxygen and glucose around the body providing energy to the areas where it’s most needed.  If the danger persists we can fight or we can turn and run.  If danger passes then very quickly the body can return to normal and primitive man can return to taking Dino for a walk!

BUT

Although our minds and behaviour have evolved since then (I speak for the majority of us here), our bodies and our biology have hardly evolved at all.  Today a typical stressor is likely to be examinations, bills, relationships, work etc.  However, our body does not distinguish between stressors, it reacts to them all in a very similar way, i.e. the way it would have done thousands of years ago faced with life threatening stressors.  (This is why Selye called it the GENERAL adaptation response).  Exams therefore cause us to mobilise energy reserves, heart rate increase etc, as I’m sure you’ve noticed.  Unfortunately the response that was supposed to last seconds or minutes now lasts for the time of the exam stress, possibly weeks or months.  It now wears the body down and becomes a life threatener rather than a lifesaver.

The nervous system

I could bore you for hours here (as I’m sure some of you have noticed), but instead I’ll stick to the essentials. 

The Autonomic Nervous System (ANS).

This controls the functions that we have no conscious control over such as digestion, temperature and heart rate.  It can be split into two parts:

It’s obvious from this that the sympathetic nervous system is responsible for the stress response!  The Parasympathetic is left to return the body to normal when the threat has passed; it recharges the batteries for the next alert if you like.

The biology of the stress response

Sounds complicated, lots of scientific words AND all joined up together.  It’s more straightforward than it seems.  I’ll assume that you’ve heard of the pituitary and adrenal glands, though the hypothalamus may be new to you. 

The important bits.

An area in the brain called the hypothalamus controls the body’s response to stress.  This is situated right next to the pituitary gland (sometimes referred to as the master gland because it controls the others) and both are located in the middle of the brain just behind the upper part of your nose!

In the stress response the Pituitary gland does two things. 

1. It sends nerve messages to the adrenal medulla (part of the adrenal gland)
2. It sends a chemical ACTH to the adrenal cortex (another part of the adrenal gland).

Which of these is designed for an immediate response to stress and which looks as though it’s designed for longer tem stress?

Short lived or persistent stress?

The way the body responds to stress depends in part on how persistent the stress is likely to be. 

Sympatho-medullary pathway

As the name suggests this is a sympathetic response (as we’d expect) that triggers activity in the adrenal medulla (the area in the middle of the adrenal gland).

Following a sudden stress such as physical threat our sympathetic nervous system immediately prepares us for action.  It triggers the release of adrenalin from the adrenal medulla which acts on many organs and tissues in the body resulting in the 3Fs response as outlined in the table above.

This system is designed to deal immediately with short-lived stress.

Pituitary adrenal system

This was formerly known as the hypothalamic-pituitary-adrenal axis or HPA (if you look in older text books). 

This all sounds complex but in fact both names are descriptive and tell us exactly what body bits are involved!

Research evidence

People without adrenal glands die when stressed unless they receive injections of cortisol (a steroid).  They have to be given training in avoiding or minimising stress!

Brady’s executive monkeys also supports the theory since the ‘executives’ died as a result of ulcers caused by long term disruption of digestion.  (See the key study later).

Remember that Brady’s study is flawed methodologically (in its methods) as well as being ethically very dubious.

Evaluation of the Physiological Model

This is clearly a very biological approach to stress.  It only considers events inside the body and sees stress as a purely physical response.  It does not consider differences between people, for example why one person’s stress is another person’s pleasure. 

Mason (1975) measured the levels of adrenaline produced by stressors in different people.  The same stressors produce different levels of adrenaline in different people depending on how they interpret the stress.  The physiological model does not consider people’s interpretations or perceptions of stress.

Gender

There does appear to be a sex difference in both the ways in which stress is experienced physically and the way it is experienced psychologically.  Certainly men are far more likely to die from CHD than women.

Johansson & Post (1972): Men and women were moved from a non-stressful situation into a more stressful one; they were given an intelligence test.  Men showed a much higher increase in adrenaline than did the women. 

There could be a number of reasons for this:

• Biological differences between the sexes for example testosterone and other hormones
• Personality differences with men being more physically aggressive
• Traditional roles of the sexes with women being more caring

As women take on more traditionally male roles it could be that the situation will change.   There has been evidence of this in the past 30 years.  Frankenhauser et al (1983) found that adrenaline levels in female engineering students and bus drivers were just as high as their male counterparts. 

It could simply be that women engage in fewer dangerous activities.  In the past women smoked less and drank fewer units of alcohol so would be less likely to suffer from CHD.  However, you are probably aware that this is changing too.

More recent research (Taylor et al 2000), suggest a biological reason for this added protection from stress for women.  The hormone oxytocin makes us less anxious.  It seems to do this by reducing cortisol levels in the body.  However, male hormones like testosterone seem to reduce the effectiveness of oxytocin whereas oestrogen (female hormone) seems to make oxytocin more effective.  This would result in men being more sensitive to the stress hormone cortisol and women less so.

General Adaptation Syndrome

Selye, during his research on rats, noticed that their response to stress was always the same, regardless of the cause of the stress.  So whether the stress was caused by another male or by electric shocks to the feet, their response was indistinguishable.  This led Selye to conclude that there was just one response (General Adaptation Response) in rats and in other species including humans.  Selye further believed that a short-term response was harmless whereas a longer-term response could be dangerous.

Evaluation of GAS

The theory is seen as influential and provided a basis for lots of later research into the adverse effects of stress on human health

However, there are a number of issues with it, some obvious and others not so!

The initial research was carried out on rats so clearly there are issues of generalising to humans.  In particular the human response almost certainly involves a much greater emotional content and cognitive appraisal of the stress being experienced which is likely to alter our perception and physiological response.

Following of from this; the rat response to stress is mostly passive, they sit back and take it.  This is clearly not the case with the human response.  We are more likely to engage in a fuller cognitive appraisal, for example, considering our ability to cope.  In an inventive, shall we say, study by Symingon et al (1955), the physiological responses of two sets of dying patients were compared.  Fully conscious patients showed a much greater physiological response to the stress than those in a coma.  Symington attributed this difference to the cognitive appraisal by the conscious group.  There are clearly other possible explanations of this finding however!

The name of the theory ‘general adaptation’ also summaries Selye’s view of the body’s response.  He believed the body responded in exactly the same way, regardless of the nature of the stress being experienced.  So for example the same pattern of adrenaline and cortisol would be released regardless of whether the threat was physical or financial.  We now know this not to be the case.  Different stressors produce similar but subtly different patterns of chemical response.

Stress and Physical illness

Stress can cause ill health in a number of ways:

It is also vital to mention that many of these effects could be attributable to habits taken up by stressed people.  Much of the evidence outlined below is correlational so does not imply cause and effect!!!  More on this later.

Stress and the immune system

We have already seen that during times of stress the adrenal cortex produces steroids (called corticosteroids since they’re produced by the adrenal cortex).  These stop the body producing lymphocytes (white blood cells) that attack foreign bodies such as viruses, in the bloodstream.

Research evidence

There’s lots of it.  Choose the ones you prefer or think you’re most likely to remember.  Kiecolt-Glaser et al (1984) is a good one to use as key study.  Note: it’s Janice Kiecolt-Glaser so refer to her as ‘she.’

In a more recent study Kiecolt-Glaser et al (2005) looked at the effects of marital arguments on the immune system and wound healing.

Method

42 couples who had been married for an average of 12 years had small suction devices placed on their arms to deliberately create eight small blisters.  The tops of these were removed and a small bubble placed over the top allowing fluids to be withdrawn.

On their first such visit the couples were drawn into a positive discussion about behaviours they’d like to change.

Two months later the couples returned and the procedure repeated.  This time however, they were drawn into a more negative discussion about areas of disagreement which often provoked very strong feelings.

Findings

When tested it was found that on the second visit the blisters took a whole day longer to heal (60% longer) and that levels of the hormone interleukin-6 that controls wound healing was much higher. Women seemed to be particularly prone to the effect.

Conclusion

The researchers believe that stress can significantly slow down the immune response and particularly lengthen the time for healing.

Consider the implications of this research on the effects of stress following major surgery!

Other studies suggesting a negative effect of stress on immunity

·         Riley (1981) placed mice on a turntable at 45 rpm; (they must be single mice.  I’ll try this ‘joke’ again and see if you get it this year!).  This induced stress and decreased their number of lymphocytes.

·         Kimzey (1975) found that American astronauts who had just gone through the stress of re-entry had a lower white blood cell count.  However, Fischer et al (1972) found that astronauts had more lymphocytes (type of white blood cell) on splashdown.  (Astronauts in the olden days used to land in the sea!).

·         Sweeney (1995) took biopsies from the arms of volunteers.  It was found that participants who were stressed by caring for elderly relatives took longer to heal.  Think of the practical implications of this for people recovering from major surgery!

·         Cohen et al (1991) carried out an impressive study on 394 participants.  They each had their stress index measured using a questionnaire that also took into account their ability to cope and their feelings about their stress.  They were then given nasal drops that infected them with cold viruses.  When tested by doctors there was a direct correlation between their stress index and the probability that they developed a cold.

However, some research suggests that stress, particularly acute, short-lived stress can boost the immune response:

Evans et al (1994) got students to give brief talks to other students, inducing short lived acute stress.  They then measured the levels of an antibody (sigA) that coats the mucous (snotty) membranes of the mouth, nose and lungs.  Following the talk the students had increased levels of this antibody suggesting increased immunity.

Segerstrom and Miller (2004) carried out a meta-analysis of other studies and concluded pretty much the same thing.  Short term stress boosts immunity whereas long term, chronic stress suppresses immunity.  The longer the stress continues the weaker the immune response becomes leaving us more and more prone to infection.

Stress and cancer

The link is by no means proven, but there is some evidence.

·         Jacobs & Charles (1980) found that children who had developed cancer have often been exposed to above average levels of stress in the previous year..

·         Tache et al (1979) found that cancer is more likely in single, separated or divorced people.  This was put down to lack of social support in reducing the effects of stress.

·         Levy (1993) believed that immune suppression might again be to blame.  It is thought that the immune system produces chemicals that fight cancer.  As with CHD it may be behaviours associated with stress, such as smoking, that cause cancer, not the stress itself.

Stress and coronary heart disease (CHD)

CHD is caused by a narrowing of the arteries supplying blood to the heart caused by a build up of fats in the vessels (similar to the furring up of hot water pipes).  There are two types:

·         Angina: in which blood flow is restricted.  This results in chest pains particularly following exercise.

·         Myocardial infarction: in which blood flow to part of the heart is completely blocked and can result in death.

Causes of CHD

Gender (men are far more susceptible), age (guess!), cholesterol, high blood pressure, smoking, genetics, diabetes…

Stress and CHD

Studies have suggested a link between negative life events, such as divorce, and CHD and stress at work and higher incidence of CHD, particularly in men.  Occupational factors tend to include lack of control, low job satisfaction and monotony.

As pointed out in the table above there is a clear physiological link between stress and CHD.  The 3Fs response has the following adverse effects on the circulatory system:

·         Constriction of the arteries increasing blood pressure.

·         Increased blood flow wearing down the arteries

·         Release of fats into the bloodstream increasing the risk of blockage (artherosclerosis).

Evidence for a link between stress and coronary heart disease (CHD)

Cobb and Rose (1973) analysed medical records and found that air traffic controllers (considered to be an extremely stressful occupation) were at significantly greater risk of developing hypertension (long term high blood pressure).  In fact there was a positive correlation with those working in airports with greatest airplane activity suffering the highest levels of hypertension.

However, hypertension can be caused by a variety of factors such as obesity, too much salt, lack of exercise and genetic inheritance as well as social factors such as stress and anxiety.  Therefore we can’t rule out other possible causes in ATCs and other high stress occupations.  Perhaps people in such jobs tend to leave unhealthier lives and as a result of lifestyle put themselves at greater risk.

Type A behaviour and CHD

Examples of questions asked by Friedman & Rosenman

Do you feel guilty if you use spare time to relax?

Do you need to win in order to derive enjoyment from games and sports?

Do you generally move, walk and eat rapidly?

Do you often try to do more than one thing at a time?

Do you have an intense desire to better your position in life and impress others?

Try to guess what a type A person would answer to each of these.

If you’re type B you might try the exercise tomorrow instead!

As mentioned above, Friedman and Rosenman didn’t consider what aspect of the type A personality was responsible for the increased risk.  More recent research has shed light on this. 

Cynical hostility

Recent research has found a link between cynically hostile people and CHD.  A cynically hostile person is one who has a negative view of others, seeing people as basically selfish.  They adopt a ‘dog eat dog’ attitude to life being prepared to cheat to gain an advantage, assuming that others will do the same to them.  (Phil Mitchell if you like).  Taylor (1995) found that people who score highly on cynical hostility have higher heart rate and blood pressure and produce higher levels of adrenaline

Anger

Williams (2000) gave anger questionnaires to 13,000 participants asking 10 questions such as ‘do you feel like hitting someone when you get angry?’

This was a six year study, at the start none of the participants having been diagnosed with heart disease.  However, six years later 256 of the original ample had suffered a heart attack, and yes you’ve guessed, the majority of these, (over two thirds) had originally been labelled the more angry.

Although this is clearly a very similar study to the original, it does focus specifically on anger rather than the broader, poorly defined ‘type A.’

We shall return to these studies later when we look at the effects of personality on the stress response.

Indirect affects of stress on health.

It is essential that this be considered in any part c question on stress and physical health as it will guarantee AO2 marks.

Stress is associated with all manner of bad habits, for example smoking, drinking alcohol to excess, poor diet due to lack of time, lack of exercise for the same reason, lack of sleep etc…  All of these are likely to have an adverse effect on a person’s health so could cause some of the ill-effects attributed to stress per se.

Cohen & Williamson (1991) found that people who are stressed tend to smoke more, take less exercise, drink more alcohol and sleep less than others.  All of these habits can lead to ill health. 

Wills (1985) found that stressed teenagers were more likely to start smoking.  Similarly, Carey et al (1993) found that adults who had given up smoking were more likely to take it up again when stressed.

Brown (1991) found that life events were more likely to cause students to seek medical advice if the students were low in physical fitness, as compared to students high in physical fitness.

Conclusion

It may not be stress itself that causes ill health but the behaviours that stressed people tend to engage in.

Unhealthy behaviours associated with stress:

Stress and Stomach ulcers     

	Executive 'monkey?'   In fact an executive chimpanzee!

Other research:

Weiner et al (1957) examined the gastric secretions of army recruits!  (What would you like to do when you grow up?).  They found that after 4 months of stressful training 14% of those who produce a lot of stomach acid developed ulcers, whereas none of those who produce little acid developed them.  From this they concluded:

1.       there may be a link between stress and ulcers

2.       stress could not be the only cause since 86% of over-secretors did not develop ulcers.

Sources of Stress

This section can loosely be split into two sections:

• “Causes of stress” (or stressors as they are known), such as life events, hassles, occupational stress etc.
• “Individual differences in the stress response” looks at factors that may effect how we cope with stress such as personality and culture.

Causes of stress

Life events (Social Readjustment Rating Scale: SRRS)

Holmes and Rahe (1967) were two hospital doctors who noticed that many of the patients that they visited on their rounds had suffered life events causing disruption to their lives in the previous year.  They decided to construct a questionnaire to examine the possible link between life changing events and physical ill-health. 

1. They examined the medical records of over 5000 patients
2. They compiled a list of 43 life events
3. They rated these in order of the time it would take to get your life back to some semblance of normality following the event
4. They gave ‘marriage’ an arbitrary score of 500 and got others to rate the other events in comparison to this.  They averaged out the scores and divided them by 10, so in the final scale ‘marriage’ has a score of 50.
5. The scale starts at 100 LCUs (Life Change Units) for ‘death of a spouse and ends with 11 LCUs for ‘minor violation of the law.’

The scale was tested on different groups of people to determine its relevance.  Patients would add up the score for each life event and this would be their total LCU.  They believed that a score of over 300 meant an 80% chance of developing a serious physical illness in the following year. 

Testing the SRRS

Rahe et al (1970) tested 2700 naval personnel on board three American cruisers just before they set sail.  During their seven months tour of duty the sailors kept health records.  A correlation of  +0.118 was found between LCUs and ill-health.  This is relatively low; however, because of the size of the sample (2700) it is statistically significant.

You may have noticed that the SRRS contains potentially positive life events such as Christmas, holidays and change in personal finances (which could be positive as well as negative).  It therefore seems fair to assume that what the SRRS is measuring is change in a person’s life that is leading to stress. 

Michael and Ben Zur (2007) looked at 130 people who had recently divorced or been widowed.  Levels of ‘life satisfaction’ had not surprisingly dipped following death of the spouse in the widowed group.  However, in the divorced group the opposite was recorded with people reporting an increase in ‘life satisfaction.’  This would seem to support the idea that the scale is measuring change rather than negative issues following life events. 

Not surprisingly however, it does seem that negative or unpredicted life events are most harmful.

Some examples of Life events with their corresponding LCU:

Evaluation of the SRRS

Individual differences: the life events in the list will have different meaning and cause different amounts of disruption to different people.  For example the effects of divorce will depend on how long the couple have been married, whether or not children are involved, whether the person is escaping a violent partner etc…

Cause and effect: the scale implies a correlation between stress and ill-health, however, as I’m sure you must have realised by now correlations do not prove cause and effect.  All manner of other reasons could be used to explain the link.  Ill-health could be causing the stress, or the life events.  For example a heart attack could cause loss of job, major changes in standard of living resulting in break up of marriage etc. 

Positive life events: Martin (1989) found no correlation between positive life events such as ‘outstanding personal achievement’ and ill-health.

There are other problems as you would have found when you did the test, such as not relevant to people your age and does not consider other forms of stress such as hassles.  However, it is unlikely that you would be expected to mention more than two.

On a positive note: the SRRS was the first of its type and inspired many others to follow and devise more relevant and useful tests.  The scale is rarely used in serious psychological research today.

2. Hassles and Uplifts

Generally our everyday feeling of being stressed can probably be attributed more to minor, irritating problems than to the rarer major life events.  Some research has found that hassles have a greater correlation with ill-health than do the seemingly more serious life events.

Examples of hassles and uplifts (Kanner et al 1981)

Studies into the effects of hassles on stress and health

De Longis et al (1982)

100 participants (all over 45) were asked to complete four questionnaires each:

1. Hassles scale

2. Uplifts scale

3. Life events questionnaire

Each of these was then assessed and compared in turn to the results of the fourth questionnaire:

4. Health questionnaire.

The results were probably not expected: hassles correlated with ill- health whereas uplifts and most surprisingly life events did not.

However, it has been shown by others that older people (if we class over 45 as older) tend to suffer less from hassles than younger people so the findings are difficult to generalise.

Bouteyre et al (2007) got first year French University students to complete two questionnaires, one measuring life events, the other symptoms of depression (Beck’s Inventory).

It was found that students showing the most depressive symptoms were also likely to be suffering from the most hassles. 

Clearly this is a correlational study so cause and effect cannot be established.  Of course it could be that feeling depressed and having negative thoughts makes us focus more on negative events such as hassles.

However, most studies do seem to agree that hassles are a bigger threat to our health than the much bigger life events.

Possible reasons for hassles being a bigger issue than life events:

Social and emotional support

It seems likely that people going through major life events will be more likely to seek help and support than people merely suffering from hassles.  It could therefore be that hassles are a greater issue because we try and work through them on our own.  See later notes on social support and coping.

Accumulation effect

Lazarus (1999) suggests that hassles tend to build up and act as a source of persistent irritation which can then lead to anxiety and even depression.

Amplification effect

It could be that big events make us more susceptible to the effects of trivial hassles so the two work hand in hand to create stress.  Having suffered a major event we are left feeling more vulnerable to hassles and problems multiply.  Think back to the transactional model.  Perhaps life events alter our perception of our ability to cope.

Evaluation of hassles research

As with life events, individual differences are not considered.  We all perceive and react to stress differently, some people seemingly being able to cope better than others, and again these are not considered.

Cause and effect.  Yet again the studies are correlational so do not prove that the stress is causing the illnesses.  For example just before a cold we may feel more hassled, but this could be because the virus is already having its effect, leaving us tired and less able to cope with everyday events.  That is the illness is actually causing the hassle!

Retrospective: much of the research ask participants to think back over the hassles that they’ve faced in the past month.  As we saw with the ‘love quiz’ in unit one, this is very unreliable method of gathering data.

The studies tell us there’s a correlation but not why.  What is it specifically about hassles that make them so harmful?  A few ideas in the section above however.

Occupational stress

This is a favourite topic for examination questions as well as being an important issue for workers around the World.  Recently stress has overtaken the common cold as the main reason for absence from work.

Causes of stress in the workplace:

Work overload

Breslow and Buell (1960) found that employees working more than 48 hours a week were twice as likely to develop CHD than those working 40 hours a week.

However, it is probably the perception of long hours that is more important than the number of hours per se.

Environmental factors

These include any aspect of the working environment that is likely to cause stress; most obvious examples include noise, temperature, vibration, lighting and overcrowding.

Although people can cope reasonably well with noise it does appear to cause some impairment in performance, particularly if the noise is unpredictable.  Glass et al got 60 participants to complete cognitive tasks such as word searches under one of four conditions:

The researchers concluded that we can adapt to high noise levels but this is more difficult if the noise is not constant or is unpredictable.

The stress of overcrowding has been studied in other species particularly rats where it has lead to bizarre behaviours such as parents eating their offspring.  Freedman et al (1975) found a correlation between high density living conditions such as inner cities, and admissions to psychiatric hospitals.  Yet again this is a correlation so does not prove c_____ and e_____.  Perhaps you could think of some other reasons, other than overcrowding to explain why inhabitants of inner cities are more likely to be diagnosed with mental illness.  Clues perhaps in the next topic!

Role ambiguity

To some extent we all play roles, particularly in the work situation.  You may have noticed that some teachers behave very differently out of work when playing a different role!  Role ambiguity is likely to occur when a person is unsure of their precise responsibilities within an organisation and has been reported as a major source of stress by 35% of workers in the USA. 

Role conflict

This is a common form of stressor and arises when the job requires you to behave in a way that is at odds with your own desires or beliefs.  For example working overtime may be at odds with your role as parent.  Similarly someone in middle management may find it difficult to balance the needs of their superiors for higher output with the needs of their staff for a shorter working week.

Pomaki et al (2007) found that role conflict was responsible for emotional exhaustion, depressive symptoms and even some physical illnesses in a study of hospital doctors.

There are other forms of workplace stress including burnout, repetitive work, isolation, lack of control etc.; some of these are addressed by the key studies of Johansson et al and Marmot that follow.

They found that workers with less control were four times more likely to die of heart attack than their colleagues with more control.  In addition they were more likely to suffer from other stress related illnesses such as cancers, ulcers, stomach disorders and strokes.  Even when other possible contributory factors such as diet, smoking, social support etc. had been taken into account the additional risk remained! 

The conclusion was obvious, that lack of control seemed to be associated with illness and they recommended that employers gave their staff more autonomy and control.

The initial study also found that the mandarins at the top of the tree (nothing to do with citrus fruit) also suffered higher levels of stress which was attributed to workload rather than issues of control.  However, in a follow up study five years after the first, this was seen not to be an issue or contributory factor to stress. 

Criticisms of this study:

Since the method is correlational it can only be said that there appears to be an association between low control and stress-related illness.  It cannot be assumed that low control is causing illness!   It could be that workers with poor health are less likely to achieve the higher grades where control is greater.  This would explain the findings just as well.

Workers filled in self-report questionnaires which are notoriously inaccurate and prone to participant reactivity (see notes on research methods).  Basically, if the workers suss what the researchers are looking to find they may answer questions accordingly.  Similarly the personnel managers assessing people’s jobs may do the same!

It is also worth pointing out that control was not the only variable separating lower grades from those higher up.  Typically those higher up the scale have more interesting jobs with greater variety of tasks.  There are also greater opportunities for contact with others so social support could be an issue. 

Although Marmot concluded that workload was not an issue, other studies seem to disagree.  For example the Johansson sawmill study outlined below:

Sawmill finishers and repetitive work

Findings:  They had much higher levels of absenteeism due to illness and higher levels of adrenaline in their urine, but only on work days. 

Conclusion:  The researchers recommended that the finishers should move to a salary structure (i.e. pay not based upon output) and should be allowed to rotate jobs with other workers.

Effort-reward imbalance

Ever got that feeling that all your hard work isn’t being recognised or that you don’t feel you’re getting the rewards that you deserve?

Kivimaki et al (2002) published the results of a 25 year study of 812 workers.  Those with an effort-reward imbalance were twice as likely to suffer from cardiovascular disorders such as CHD than those who felt that they were being recognised for their efforts.

Smith et al (2005) got similar findings and put the results down to increased anger caused by the feelings of injustice.  This could be compared to Friedman and Rosenman’s findings of hostility and anger being related to CHD with type A behaviour.

Few overall points to conclude this section:

Changing places

The modern workplace is a rapidly changing and evolving environment due largely to advances in technology which have created different working practices such as virtual environments, conferencing etc.  As a result, research becomes outdated very quickly.

Individual differences

Again we come back to the transactional model of stress.  This emphasises the importance of individual differences, especially In our perception of stress and our ability to cope.  One person’s stress is the thrill seeker’s pleasure.  We all react differently and have different perceptions of our ability to cope.  This tends not to be considered in the above studies. 

This brings us nicely to the next section.

Individual Differences in the stress response

We will look at individual differences in detail in the next topic (abnormality), but you have had a brief introduction to them in attachments (Ainsworth in case you’d forgotten).  Individual differences, as the title suggests looks at ways in which we differ from one another, rather than the ways in which we are similar. 

Generally we could differ because of personality, gender, social class, ethnicity, age, genes, life experiences etc.  In terms of our response to stress we’ll concentrate on:

• Personality and behaviour (Type A or B and Hardiness)
• Gender (There appears to be a difference in our biological response to stress)
• Culture (Why do some ethnic groups seem to be less stressed?)

Personality and behaviour

A quick reminder of the study that we looked at earlier.

Type A behaviour and CHD (See earlier notes for fuller details)

Strictly speaking the researcher spoke of type A and Type behaviour but is widely viewed now as a personality type as well. 

In 1982 Ragland and Bland carried out a follow up study to Friedman and Rosenman.  Since the start of the study back in 1959 a total of 214 men had died of CHD.  However, this was attributed mostly to lifestyle issues such as poor diet, smoking and lack of exercise.  This study found no link between type A ‘personality’ and CHD.

One final meta analysis that hopefully settles this once and for all: Myrtek (2001) found that only the hostility component of the type A’s behaviour was linked to CHD. 

Hardiness

According to Kobasa there are three characteristics of the hardy personality:

1.       Control: hardy individuals see themselves as being in charge of their environment

2.       Commitment: hardy individuals get involved and tackle problems head on

3.       Challenge: hardy individuals see change as a challenge rather than as a threat

Evaluation

Methodology: The research was based upon self-report questionnaires which are not always reliable and are often completed retrospectively.

Cause and effect: yet again because the study is correlational can we be sure that it was hardiness that had the beneficial effects on the managers’ health?  Perhaps as (Alfred & Smith 1989) have suggested, hardy people are more likely to look after their health.

Hardiness can help students too.  Lifton et al (2005) found that university students who were high in hardiness were far more likely to complete their courses.

Culture

Culture is no longer specified by AQA but this might be useful for background reading and additional information.  At a cultural level the best study is Weg’s (1983) study of a Georgian tribe who have a particularly impressive life-expectancy; they are more than 100 times more likely to reach a ton than people in the UK!  Weg attributed this to their relatively stress-free lifestyle, particularly the high level of social support available to individuals within the communities. However, there could be many other reasons for their longevity, such as lack of alcohol and tobacco, diet of fresh meat and veg., social support and lots of exercise.  Genes could also be a major factor. 

Cooper et al (1999) looked at why black Americans suffer more from CHD than either white Americans or the black Africans from whom they are descended.  They found that there had been inadvertent genetic selection on board the slave ships bringing the first generation black Americans to the New World.  Many of the slaves had died form diarrhoea during the journey.  Those able to retain water would have been most likely to survive and create the black American population of today. 

Since water retention and salt retention are linked, and salt retention is a causal factor in high blood pressure and CHD, the high incidence of CHD in today’s population could be due to this selection of the original population.

However, in any discussion of this area it is crucial not to overlook how the possible social and psychological factors could also contribute to the stress related illnesses of Black Americans.  Rates of unemployment amongst Black Americans are twice those of the white population and on average their incomes significantly lower.  Black children typically receive a poorer education resulting in fewer job prospects later in life.  As a result of this blacks are more likely to suffer poverty-related stress and have more repetitive, stressful jobs.  In addition to this, discrimination per se is a major stressor, (Anderson 1991).   All of these factors could add to the increased risk of stress related illnesses.

Stress, gender and positive attitude

Greer et al (1979) looked at the way in which women’s attitudes towards discovering they had breast cancer influenced the outcome and prognosis.

Method

Patients were interviewed regarding their attitude towards their recent diagnosis.

Findings

Four kinds of attitude were recorded:

Follow up studies 5 years and 15 years later found that women with the first two attitudes were significantly more likely to fight ff the cancer.

Conclusions

A positive attitude and adapting to our situation is more beneficial than giving in.  The cognitive approach to stress management teaches people how to do this.
 

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 and psychological methods of stress reduction

If problem-focused and emotion-focused coping fails there are always more interventionist treatments that the patient can turn to.  These can be split into physiological and psychological:

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

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.

Evaluation

Although biofeedback appears to be effective in treating some stress-linked disorders the way in which it works is in doubt.  It may not be the biofeedback per se but other related factors that cause the improvements:

1.       Relaxation techniques taught with the biofeedback.

2.       The feeling of being in control that the biofeedback encourages.

3.       Placebo effect.  Holroyd et al (1984) found that tension headaches improved in patients who thought they’d received muscle relaxation even when they hadn’t!

Biofeedback has several disadvantages associated with it. 

1.       It requires physiological measuring devices.  These are both expensive and too bulky to be easily transported.

2.       Regular practice appears to be needed for the development and maintenance of any beneficial effects (although this is also true of some other methods). 

3.       Biofeedback may eventually enable a person to learn to recognise the symptoms of, say, high blood pressure without the need for the biofeedback machine, but it is not known exactly how biofeedback works.  Some sceptics argue that biofeedback itself exerts no effects, and that the important thing is a person's commitment to reducing stress and the active involvement of a stress therapist!

Patients practise using the equipment in hospital before taking it home.  Feedback may be given on pulse, muscle tension etc. and patients then perfect techniques for lowering these.

Psychological methods of stress reduction

Relaxation

Physiological responses to stress may also be reduced through relaxation. Jacobson (1938) observed that people experiencing stress tended to add to their discomfort by tensing their muscles.  To overcome this, Jacobson devised progressive relaxation.  In this, the muscles in some area of the body are first tightened and then relaxed.  Typically the patient starts with their feet and gradually works their way up the body, relaxing each set of muscles in turn.

Once a person becomes aware of muscle tension and can differentiate between feelings of tension and relaxation, the technique can be used to control stress-induced effects. Progressive relaxation lowers the arousal associated with the alarm reaction and reduces a number of recurrent heart attacks.  However, progressive relaxation only has long-term benefits if it is incorporated into a person's lifestyle as a regular procedure (Green, 1994).

But relaxation techniques of this sort are not easy to carry out when stuck in a traffic jam etc.

Meditation

Is similar to muscle relaxation but involves the repetition of a mantra or number, for example saying ‘one’ when breathing in and ‘two’ on expiration.  The person is encouraged to concentrate on their breathing and take steps to reduce it.  Try it.  ‘In… out’, slowly, ‘in… out’…. No need to shake it all about!!!  It isn’t easy to feel stressed when breathing very deeply and slowly!  The repetition also acts to remove all distracting thoughts from the mind.  Some of you will find this easier than others!

Physical activity and exercise

Morris (1953) conducted (pardon the pun) a study of London bus drivers and conductors, (people that used to collect tickets on buses in the good old days.  See an episode of ‘On the Buses’ for further information).  He found that the conductors, who moved around the bus collecting fares, were far less likely to suffer from cardiovascular disorders than the sedentary drivers.  An obvious criticism of the study is that many other factors may result in drivers being more stressed than conductors.  Although Morris' study was correlational, subsequent research has confirmed that   physical activity and exercise are beneficial in stress reduction (Anshel, 1996). 

As with laughing, mentioned at the start, exercise also releases endorphin into the body.  This is a natural opiate like morphine and reduces our pain and stress levels.  This probably explains why it is possible to become ‘addicted’ to exercise.

Exercise almost certainly reduces some of the more dangerous effects of stress.  Remember that the 3Fs response is preparing the body for action.  By taking action in the form of exercise you are burning off some of the energy the body is mobilising.  High blood sugar levels are therefore reduced, circulation is improved and the heart muscles strengthened.  Psychologically, exercise might also be therapeutic, since sustained exercise can reduce depression and boost feelings of self-esteem (Sonstroem, 1984).

Cognitive techniques for stress reduction (psychological)

These are called ‘cognitive’ since they concentrate on people’s perceptions of stress and the way they think about the stressful situation and their ability to cope.  Hardiness and stress inoculation encourage patients to recognise their irrational or negative thoughts and perceptions and replace them with more positive and realistic ideas.

In recent years cognitive therapies have evolved into CBT (cognitive behaviour therapies) with a greater emphasis on changing unwanted behaviours.

Increasing Hardiness

People clearly differ in their abilities to resist a stressor's effects.  One characteristic that apparently helps resist stress is hardiness (Kobasa, 1979).  According to Kobasa, 'hardy' individuals differ in three main ways (see your earlier notes on this).

1.       Commitment: they have more direction to their lives.

2.       Challenge: interpreting any stress as making life more interesting, and

3.       Control, the amount of stress experienced can be regulated. 

Those higher in hardiness tend to be healthier even though the levels of stress that they’ve suffered have been similar to less hardy individuals.  (Pine 1994).  Maddi, a colleague of Kobasa, has devised a series of programmes for increasing hardiness.  These include ‘HardiTraining’ and HardiWorkshops.’

Kobasa’s suggestions for increasing hardiness:

1.       Focusing.  Patients are taught to recognise the symptoms of stress such as heightened heart rate and muscle tension.

2.       Reliving stressful encounters.  Patients are asked to think about recent stressful situations that they’ve overcome and to consider better ways of dealing with similar situations in future.

3.       Self-improvement.  Emphasises that challenges can be coped with.  Suggests that circumstances that we feel are beyond us should be avoided!  (At last sensible advice!).  However she does propose that in this situation we take on a different challenge that is within our capabilities so that we experience the positive aspects of dealing with stress.

Maddi’s procedure has been used to reduce drop out rate and increase levels of graduation in university students and on Olympic swimmers to ensure higher levels of commitment and reduce stress.

However, the process is notoriously slow since it’s first necessary to tackle long standing habits and make alterations to personality.

Exam advice

If the question asks for psychological methods concentrate on the cognitive methods above and below.  There’s far more to describe and discuss than there is with relaxation, meditation etc.

Stress inoculation therapy

Meichenbaum's (1976, 1985) stress inoculation therapy assumes that people sometimes find situations stressful because they think about them in catastrophising ways.  Stress inoculation therapy aims to train people to cope more effectively with potentially stressful situations.  It is similar to hardiness and has three stages.

1.       Cognitive preparation (or conceptualisation) involves the therapist and patient exploring the ways in which stressful situations are thought about.  Typically, people react to stress by offering negative self-statements like 'I can't handle this'.  This makes the situation worse. 

2.       Skill acquisition and rehearsal, attempts to replace negative self-statements with incompatible positive coping statements.  These are then learned and practised.  (See examples that follow, practise a few if you so desire).

3.       Application and follow through involves the therapist guiding the person through progressively more threatening situations that have been rehearsed in actual stress-producing situations. Initially the person is placed in a situation that is moderate to cope with.  Once this has been mastered, a more difficult situation is presented.

According to Meichenbaum et al (1982), the 'power of positive thinking' approach advocated by stress inoculation therapy can be successful in bringing about effective behaviour change, particularly in relation to anxiety and pain

Some coping and reinforcing self-statements used in stress inoculation therapy

Sheehy and Horan (2004) reported the case of law students who received 4 weekly sessions of SIT each lasting 90 minutes.  They recored lowered levels of anxiety and an improvement in the grades of weaker students.

SIT is seen as particularly effective since it provides patients with techniques that can be used on future stressors and anxieties. 

Evaluation of cognitive methods

Some methods have been successful in reducing the ill effects of stress, for example Carver & Humphries (1982) showed that they reduced the incidence of CHD. 

Their main advantage over other interventions such as drugs is that they try to deal with the problem of stress directly, teaching people how to identify stress and develop effective techniques for dealing with it.

Cognitive methods also consider the needs of the individual and if used properly can be tailored to a person’s specific situation.

However, some stressful situations are completely out of the control of the individual for example a repetitive job or having to travel to work or traffic jams etc.  In such cases stress reduction is the best that can be hoped for.

In some cases companies have been criticised for setting up such stress management courses as a cheap or easy option rather than trying to tackle the real causes of the stress.  In so doing they are laying the blame squarely on their employees rather than facing up to their own responsibilities.

Social support

Anecdotally it seems that having lots of friends that we can share our problems with does help us to reduce and minimise the negative effects of stress.  For example work related stress tends to be lower in organisations where there is lots of support from co-workers.  However, this is not an easy one to prove experimentally.

·         Karmack et al (1998) found a reduction in heart rate when difficult tasks could be completed with a friend nearby.

·         Kulik & Mahler (1989) found that recovery from heart disease is faster when social support is available.

Watson et al (1998) carried out research on the cynomolgus monkey.  Apparently this species is famed for its ‘very social behaviour.’  Apparently David Attenborough never misses their fancy dress parties and they regularly occupy the pages of Hello magazine.  I digress!  Anyway the researchers found that when kept in isolation they show obvious signs of stress, such as increased heart rate.  When returned to their colony these symptoms disappear and the parties continue late into the night. 

Gender differences

Research suggests (phrase to use when you either can’t remember the researchers’ names or, as in this case, none are provided) that men tend to have larger networks of friends but that it’s women that use them more in times of need.

Schaeffer et al (1981) think social support has two different meanings:

1.       Social network represents the number of people available to provide support

2.       Perceived support is the strength of social support they are able to provide.

Clearly it is the second one that is most important.  Having many friends is not particularly useful if they are unable to offer support in times of stress.

Brown & Harris (1978) found:

ü Stressful life events can trigger depression in women.  (61% of depressed women had experienced a major life event in the previous 12 months).

ü Close friends can alleviate the effects of stressful events.  Only 10% with a close friend in whom they could confide became depressed, compared to 37% who had no such intimate friend. (aargh!).

Tache et al (1979) found that cancer is more common in the single, divorced or separated.  This was put down to the lack of social support these have compared to married couples or those living together.

But as a general evaluation point to most of these studies, they are all correlations.  As such it is impossible to infer cause and effect:  i.e. can we assume that being single causes a worsening of stress?  Could it be that being stressed makes us more difficult to live with, resulting in us staying single?  Perhaps being lonely means we drink or smoke more and as a result are more likely to develop cancer etc.

This is a general criticism to bear in mind whenever a study is correlational.  Add it to your repertoire of evaluation points such as ‘lacks ecological validity’ or ‘ethical concerns.’  As with these you will need to back it up by explaining what you mean!