Example questions

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 Dodd), 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 exactly the same 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 Hypothalamic-Pituitary–Adrenal Axis

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).

Note: a common measure of stress is skin conductance or Galvanic Skin Response (GSR).  This basically measure how moist your fingertips are.  The release of energy associated with stress causes sweating and increases the electrical conductivity of the skin.

That’s all there is to it.  The complicated bit done!!!

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.
 

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.

Good points:

1.       Influential: it provided a basis for other theories and triggered lots of research into stress.

2.       Simple: the model is easy to understand, and its ideas and phrases are widely used by people studying stress.

Bad points

1.       Rats: Much of Selye’s work was based on rats.  There are two issues here

a.       Can we generalise the findings to humans?

b.       Ethical considerations since the rats died.

2.       Simplistic: GAS only considers the body’s response to stress, (physiological model).  As Psychologists we know that stress is not that simple.  It does not consider individual differences such as personality (hardiness, type A or B) or other factors such as culture and gender.

Note: criticisms of the GAS is a common exam question!

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.

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).

Type A behaviour and CHD

We will return to this study when we look at individual differences in the stress response.

Stress and Stomach ulcers     

The University of Plymouth has an excellent section on this study and the follow ups.  See link:

http://salmon.psy.plym.ac.uk/year1/psy128coping_with_stress/psy128coping_with_stress.htm

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.

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.’

Other studies

·     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.

·     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.

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.

·      Visintainer et al (1983) injected cancerous cells into animals.  Those that were then stressed were less able to fight the cancer.

·      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.

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.

b. 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, culture and gender.

Causes of stress

1. Life events (Social Readjustment Rating Scale: SRRS)

Holmes and Rahe 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. 

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.

Use of the SRRS

Rahe et al (1970) tested 2500 naval personnel on board 3 ships just before they set sail.  During their six 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 (2500) it is statistically significant.

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)

Evaluation of this study

Many of the earlier problems still exist:

1. There are still many examples of stressor not considered such as so called chronic stressors such as poverty, poor housing, overcrowding in inner cities etc.
2. Individual differences are still 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.
3. Cause and effect.  Yet again the study is a correlation so does 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!

3. 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.

There are other forms of workplace stress including burnout, repetitive work, isolation, lack of control etc.; some of these are addressed by the key study of Johansson et al (1978)

1. Civil Servants

Marmot et al (1997) began with the hypothesis that control was negatively correlated with stress-related illness; that is as control decreases the level of illness increases.

Over 10,000 civil servants were investigated over a period of three years.  Researchers assessed the level of job control by self report questionnaires and by assessments by personnel managers and this was then compared to levels of stress related illness. 

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.

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!

2. Sawmill

Johansson et al studied a small group of workers in a large sawmill.  Their job was ‘finishers’, i.e. they were the final link on a conveyer belt system.  The rate at which they worked determined the output of the mill so their job was very responsible. 

Sources of stress included: responsibility for the mill’s output, responsibility for the pay of other employees (since pay was linked to productivity), working in isolation, so didn’t have others to share problems with, little control (since they worked on a conveyor belt), highly skilled but repetitive work.

The researchers’ measured their stress hormones (adrenaline and noradrenaline) and patterns of illness. 

Findings:  They had much higher levels of stress than other workers in the mill and, presumably as a result, had more stress related illnesses and days off work.

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.

Individual Differences in the stress response

We will look at individual differences in detail in the next topic, 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 famous longitudinal study carried out by Friedman & Rosenman (1974).  The researchers had earlier identified two basic behaviour types:

Being a bit of a saddo, I think of these things in terms of Eastenders’ characters, for example Phil Mitchell (type A) and Patrick, (Paul’s dad, (type B).  Perhaps you can think of your own to help you remember the characteristic traits of each.

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

Hardiness

Suzanne Kobasa believed that people with a hardy personality were less likely to see events as stressful.  Managers of a large US company were tested using the SRRS.  Those who scored highly were then examined and split into two groups; those who were frequently ill and those who were rarely ill.  She found a difference in personality between the two with those reporting few illnesses being described as hardy.

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

1. Methodology: Kobasa’s original study used only white middle class males so is both androcentric and biased in terms of sub-culture.
2. 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.

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.  Generally women do appear to show a greater increase in their physiological response to stress.

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

Hastrup et al (1980) provided evidence for the hormonal theory.  Women appear to have marked changes in their response to stress throughout their menstrual cycle, showing the least response when their oestrogen levels were highest.

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.  .

Culture

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. 

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 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.

Critical issue:  Stress Management

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 methods that seek to temporarily help people cope with the symptoms but do little to tackle the root causes.  These methods include alcohol, drugs, social support.

·         Problem-focussed methods deal with the root causes of stress and include time management.

Methods can also be split between:

·         Physiological methods that seek to reduce the bodily symptoms of stress such as arousal and increased heart rate.

·         Psychological methods that help people cope with the subjective feelings of stress such as anxiety and lack of control.

One way to reduce stress is to eliminate the factors causing it.  However, since so many factors can cause stress this is not always realistic.  Many ways of managing and reducing stress have been devised.  Dixon (1980) suggested that humour can help because it stimulates the output of endorphins.  This section examines some more orthodox approaches to the management and reduction of stress.

Physiological methods of stress reduction

Beta blockers

These reduce activity in the sympathetic nervous system so reduce heart rate, blood pressure etc. 

Antidepressants such as Prozac and Tofranil can help people to cope more effectively with their symptoms of stress but again do have side effects.

All drug therapies are only providing symptomatic relief; they do nothing to tackle the root causes of stress.

2. 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!

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). 

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 both encourage the patient to view their stressors differently and increase their perceived ability to cope with the stress.

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.

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

Evaluation of cognitive method:

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!

Evaluation of Social Support

Social support can be useful in alleviating the effects of stress but the assistance provided needs to be measured and appropriate. 

Cancer patients need different kinds of support from different people:

·         Family and friends needed for emotional support

·         Doctors and nurses needed for informational support

This may seem obvious but informational support from family and friends was seen by the patients as unhelpful, as was overly positive comments from anyone.

And finally…

Pets have long been associated with lower stress levels (in their owners, not in them!).  Baun et al (1994) found that pet owners were more likely to survive long term following a heart attack and that stroking a pet dog was more likely to reduce your blood pressure than stroking a strange dog!