By Elisabeth Brookes, published 2021 Download Notes
WHAT YOU NEED TO KNOW
The physiology of stress, including general adaptation syndrome, the hypothalamic pituitary-adrenal system, the sympathomedullary pathway and the role of cortisol. The role of stress in illness, including reference to immunosuppression and cardiovascular disorders. Sources of stress: life changes and daily hassles. Workplace stress, including the effects of workload and control. Measuring stress: self-report scales (Social Readjustment Ratings Scale and Hassles and Uplifts Scale) and physiological measures, including skin conductance response. Individual differences in stress: personality types A, B and C and associated behaviors; hardiness, including commitment, challenge and control. Managing and coping with stress: drug therapy (benzodiazepines, beta blockers), stress inoculation therapy and biofeedback. Gender differences in coping with stress. The role of social support in coping with stress; types of social support, including instrumental, emotional and esteem support.In application questions, examiners look for “effective application to the scenario” which means that you need to describe the theory and explain the scenario using the theory making the links between the two very clear. If there is more than one individual in the scenario you must mention all of the characters to get to the top band.
Difference between AS and A level answers
The descriptions follow the same criteria; however you have to use the issues and debates effectively in your answers. “Effectively” means that it needs to be clearly linked and explained in the context of the answer.Read the model answers to get a clearer idea of what is needed.
In the exam, you will be asked a range of questions on the topic of stress, which may include questions about research methods or using mathematical skills based on research into relationships.
As in Paper One and Two, you may be asked a 16-mark question, which could include an item (6 marks for AO1 Description, 4 marks for AO2 Application and 6 marks AO3 Evaluation) or simply to discuss the topic more generally (6 marks AO1 Description and 10 marks AO2 Evaluation).
There is no guarantee that a 16-mark question will be asked in this topic though so it is important to have a good understanding of all of the different areas linked to the topic.
There will be 24 marks for stress questions, so you can expect to spend about 30 minutes on this section, but this is not a strict rule.
Stress is a pattern of negative physiological states and psychological responses occurring in situations where people perceive threats to their well being which they may be unable to meet.
The level of stress depends on the individual’s perception of the event and their perception of their ability to cope with the event.
For example, taking an exam might not be perceived as a stressor by someone who has had good results at their test (they feel they can cope) but might be seen as a stressor by another individual who has failed all their tests (they feel they can’t cope this leads to a stress response).
In this model, Seley describes the process of responding to a stressor in three stages:
Stage 1: alarm Once the stressor is perceived, the physiological responses to deal with it are activated.
Stage 2: resistance If the threat does not subside, the body tries to cope. Hormones are released to provide the body with the energy needed to deal with the stressor. If the stressor persists and becomes chronic the elevated levels of hormones could be damaging the cardiovascular system. However, the individual appears to be coping.
Stage 3: exhaustion The resources needed are becoming drained; the individual is experiencing the same symptoms than in the alarm stage e.g. fast heart rate. The immune system is weakened and diseases are likely to develop e.g. infections and cardiovascular disorders such as raised blood pressure.
Selye’s model was the first to accurately describe the physiological changes that occur during the stress response. This later led to further research in the negative effects of stress on health.
Selye assumes that the response remains the same to all stressors, which was supported by his research with rats. However, when the experiments were replicated on monkeys by Mason (1971) he found that the response varied with the type of stressors e.g. cold temperatures lead to an increase in cortisol but heat did not.
This challenges the GAS model. Furthermore, these experiments were carried out on animals who are different from humans cognitively and emotionally. According to the transactional model, in humans the individual’s perception of the stressor and their perception of their ability to cope with it influence the stress response. This is unlikely to be the same in animals.
Another difference is that animals are also more passive in the way they respond to stress; humans are likely to take measures to escape the stressor or at least reduce its impact whereas animals are unlikely to do so.
The GAS model suggests that human responses to stressors are the same for all people; however, Mason (1975) argued that when we are presented with a stressor, we make an assessment of the situation. This influences the physiological response we produce (transactional model).
Furthermore, gender influences the physiological response to stress so do individual characteristics such as personality type and locus of control. rmal/desirable.
One response is responsible for acute stress. It uses the sympathomedullary pathway (SAM). The acute stress response aims at enabling us to escape danger so it has to be fast therefore it, initially, uses nerve impulses rather than hormones to produce changes.
The other is responsible for chronic stress. It uses the hypothalamic-pituitary-adrenal system (HPA). It is slower to produce a response but the response lasts for a longer period of time.
The aim of this response is to provide oxygen and glucose to the skeletal muscles (the muscles which enable us to “fight or flight”).
When a stressor is perceives the hypothalamus activates the sympathetic branch of the autonomic nervous system. This, in turn, causes the adrenal medulla to release adrenaline into the bloodstream. This prepares the body for “fight or flight”. The adrenaline and noradrenaline increase the heart rate and the breathing rate, the blood circulation is redirected to the skeletal muscles and the digestion stops.
When the stressor subsides the parasympathetic branch of the nervous system is activated and the heart and breathing rate decrease, the digestion restarts and all other functions go back to their normal level.
This response occurs when the stressor is chronic; the aim of this response is to provide energy for a long period of time. It does not need to be fast so it uses hormones as a way of transmitting signals.
When a chronic stressor is perceived, the hypothalamus releases Corticotrophin Releasing Factor (CRF) and this is transported by the blood stream to the pituitary gland which then produces Adrenocorticotrophic hormone (ACTH). This is also transported by the bloodstream to the adrenal glands. The cortex of the adrenal glands produces corticosteroids, the most important being cortisol.
Cortisol mobilises glucose stored in the liver, this provides a constant supply of energy for the body to deal with the stressor.
Kevin has been looking after his disabled wife and their young daughter for the last two years as well as working full-time. He was coping very well to start with but he is now feeling ill and his doctor found that he has high blood pressure. Kevin also seems to catch colds and other minor infections easily.
Make sure you link the theory to the scenario by linking every point to the behavior described in the stem.
Cortisol plays an important role in the stress response as cortisol provides the body with glucose by tapping into the reserves stored in the liver. This energy can help an individual fight or flee a stressor.
Cortisol also has an anti-inflammatory role however; it also leads to a weakening of the immune system. This increases the likelihood of infections.
Cortisol constricts blood vessels and increases blood pressure to enhance the delivery of oxygenated blood. This is advantageous for fight-or-flight situations but over time, such arterial constriction and high blood pressure can lead to vessel damage and plaque build-up, this can lead to cardiovascular disorders.
Men tend to respond to stress by the fight or flight response whereas women are more likely to produce the “tend and befriend” response. This is thought to be caused by a higher level of oxytocin hormone in women than in men. So gender influences the activation of the SAM pathway.
Most of the studies carried out on stress were done on men. The results cannot be generalised to women as gender influences the response to stressors. However, psychologists assume that the “fight or flight” response apply to all humans, this shows a gender bias.
Psychological factors are not taken into account. People carry out appraisal of the stressors and their response will vary depending on whether they think they have the resources to cope with the stressors (transactional model).
The studies carried out on the stress response scientific, they used objective data e.g. the amount of adrenaline.
Application: based on our knowledge of the stress response, people who suffer from Addison’s disease are given cortisol to cope with stress. Although this remains a serious condition requiring with cortisol treatment and frequent medical monitoring, people can lead a fairly normal life, whereas previously Addison’s disease was fatal.
The main systems affected are the immune system and the cardiovascular system.
Then they injected rats whose adrenal glands had been removed with a mixture of stress hormones observed in the rats in the previous experiment and found the same effect.
Conclusion:
Short-term stress enhances the immune system; this is due to the action of adrenaline, noradrenalin and cortisol.
A volunteer sample was used: 75 American medical students. She took a blood sample from Ps 1 month before an important exam (low stress) and during the exam (high stress). The NK cells activity was measured.
The Ps also completed questionnaires to assess psychological factors such as psychiatric symptoms, life events and loneliness. Results: the NK cells activity was lower* in the second sample (high stress). This was particularly true for those Ps who a high score on life events and reported feeling lonely.
* Low activity of the NK cells means that the immune system is weakened.
Some cancers are known to be affected by the functioning of the immune system, cervical cancer is such as example. Perira et al. (2003) carried out a study on HIV positive women comparing women who experienced high chronic stress and those who did not. One year later those with high stress were more likely to have developed pre cancerous lesions of the cervix.
However, this was not a representative sample (HIV weakens the immune system significantly). The link between stress and cancer is weak and difficult to establish, according to Kissane, compared to the influence lifestyle and genetic factors.
Stefan and Marcus went skateboarding last week and as usual sustained a few cuts and bruises. Stefan cuts still look red and inflamed whereas Marcus’s cuts are healed. Stefan is preparing for his final exams in chemistry whereas Marcus completed his course last year and has a job.
Use your knowledge of the relationship between stress and illness to explain the different outcomes. (6 marks)
Make sure you link the theory to the scenario by linking every point to the behavior described in the stem.
The prolonged exposure to stress causes hardening of the arteries through deposit of plaque, this results in high blood pressure and coronary heart disease (CHD).
This can be through the direct action of the stress hormones but also, because of the change of lifestyle often associated with chronic stress e.g. poor diet, excessive drinking, smoking and lack of exercise.
Yusuf et al. (2004) carried out a study of patients who had suffered heart attacks (myocardial infarction) in 52 countries, with a sample of 15152 cases and 14820 controls.
They found that, although lifestyle factors such as smoking were influential, stress including workplace stressors and life events had a significant impact on the rate of heart attacks. This impact was greater than obesity.
Major life events are significant events that change the way we live our daily lives. These events disrupt our normal routine. If our normal routines are disrupted we have to think about how to do things that we normally do on ‘auto-pilot’. This means we have to use much more mental energy – what Holmes & Rahe called ‘psychic energy’.
Constantly having to think, and use up energy, leaves us feeling exhausted and less able to cope with other parts of our lives. Since stress is caused by a mismatch between our perceived ability to cope with the perceived demands of a situation, (transactional model) this will unavoidably create stress.
The bigger the change, the more adjustment has to be made; therefore the more energy has to be used. The effects of life changes are cumulative. According to Rahe (1972) people who stay under 150 LCU in a year stay in good health, however, over 150 LCU the likelihood of illness increases by 30% and over 300 LCU, it increases by 50%.
Both positive and negative events require adjustment so they are both considered as sources of stress.
To measure the effect of life changes Homes and Rahe (1967) developed the Social Readjustment Rating Scale (SRRS). 43 life events were taken from 5000 patient records, 400 participants scored the life events in terms of the readjustment needed i.e. marriage = 50. Scores for individual life events were added and averaged to produce a life change unit (LCU) for each event.
Application questions Sophie and Daniel have been made redundant. Sophie is quite depressed and does not see any future for herself, whereas Daniel is starting his own business and is looking forward to getting his first order.
Explain how this scenario highlights a weakness of the life changes as a source of stress. (4 marks)
Make sure you link the theory to the scenario by linking every point to the behavior described in the stem.
Although Rahe is not a key study you could be asked to describe a study on this topic.
Rahe et al.(1967): The aim of the study was to find out if life changes correlated with illness. Rahe used a ‘normal’ population – not those who were already suffering of any known disorders. His sample consisted of 2700 members of US navy. All life events of previous 6 months recorded – before a tour of duty using a questionnaire and a LCU score was calculated for each participant.
During the tour of duty, every illness no matter how minor had to be reported. The participants were unaware of the aim of the study.
On their return, after 6 months of active duty, an illness score was calculated and correlated with the LCU score by an independent researcher. Result: a positive correlation ( .118) between the two sets of data supported the hypothesis that life changes cause stress and increase the likelihood of illness.
Lazarus focused on everyday life stresses.
Daily hassles accumulate over the course of the day and therefore provide a more significant source of stress than life changes. (accumulation effect)
Severe life changes may make participants more susceptible to daily hassles. (amplification effect)
Khanner et al. (1981) created a hassles scale containing 117 items covering all aspects of life including work, family and friends. The respondent rates the severity of the hassle on a three points scale. The uplifts scale contains 135 positive items such as getting a good night sleep. The individual indicates how often they have experienced these events over a particular period of time.
Although Kanner is not a key study you could be asked to describe a study on this topic. Daily hassles: Kanner et al (1981)
Aim: To investigate an association between daily hassles, uplifts and symptoms of stress and compare the outcome with the use of the SRRS as a predictor of stress symptoms. Procedure: 100 American white, middle class men and women, aged 45-64 were studied. They completed the “Hassles & Uplifts” questionnaire once a month, for 10 months. They also completed a version of the SRRS one month before the start of the study and another one during the study. The participants completed a further questionnaire measuring the psychological symptoms of depression and anxiety.
Findings: Daily Hassles were positively correlated with psychological symptoms associated with stress such as anxiety and depression. There was a negative correlation between uplifts and stress symptoms in women but not in men. Daily Hassles was found to be a better predictor of stress symptoms than life events.
Daily uplifts: Gervais et al. (2005), nurses were asked to keep diaries for a month, recording daily hassles and uplifts connected with their job. They were also asked to rate their own performance over the same period. Results showed that nurses felt the uplifts usually counteracted the negative effects of their daily hassles, and also improve their performance.Workplace stressors are aspects of the workplace environment which elicit a stress response therefore which we experience as stressful. There are many workplace stressors but the syllabus focuses on:
Control: In many organisations, other people determine workload, work patterns and limit the number and type of decisions employees can make. Workload: How much work and the type of work a person does. Too much and too little can lead to stress.
According to Karasek (1979)
Although neither Marmot et al. or Johansson et al. (1978) are mentioned as key studies you could be asked to describe a study on this topic. So you need to learn one of them in detail and use the other one as support for the other.
The aim was to investigate the relationship between control in the workplace and the incidence of coronary heart disease (CHD). Sample: 7372 both male and female British civil servants, aged between 35-55. Longitudinal prospective study over a 5 years period. The participants were sent a questionnaire and asked to take part in a screening examination for cardiovascular disease at the beginning of the study. Their employment grades were grouped into three categories: administrators, executive and clerical/support staff. Job control and workload was measured by self-completed questionnaire. CHD was measured by a qualified doctor. Findings: After taking age into account, both men and women reporting having the least control over their job were three times more likely to develop CHD after 5 years. However, there was no correlation between workload and illness.
*Prospective study watches for outcomes e.g. the development of a disease, during a period and relates this to other factors. It involves taking a sample of participants and observing them over a long period.
It was a natural experiment, comparing two groups of employees in a Swedish sawmill. Procedure: Group 1: 14 “finishers” , their work was highly repetitive and they had no control over the pace at which their work was carried out (machine paced). The pay of all other employees depended on their productivity. Group 2: 10 cleaners who had more control over their workload, less responsibility and more opportunities for social contacts. The levels of adrenaline and noradrenalin in their urine were measured both at work and in their free time, and the number of illnesses and absences from work were recorded. Findings: The finishers had higher levels of stress hormones even before starting work and it increased during the day than those in the low stress group. Their levels of illness and absenteeism were also higher. Conclusions: Repetitiveness, high demand/workload and lack of control chronic stress and the development of stress-related illnesses.
SCR measures the skin’s resistance to electricity. When people are stressed they sweat this lowers the skin’s resistance to electricity. People have a higher SCR when they are stressed than when they are not as their damp skin conducts electricity better. A measurement of SCR is made when people are in low stress condition, this measure is then compared to another measurement made when the same person is in a high stress condition, and this shows the intensity of the stress response.
In the 1960s Friedman and Rosenman (both were cardiologists) studied the behavior of the patients suffering from coronary heart disease, they found that they displayed some distinctive behavioral patterns.
Although Rahe is not a key study you could be asked to describe a study on this topic. Friedman and Rosenman (1974)
They used a prospective study, their aim was to investigate the links between type A behavior patterns and cardiovascular disease.
Procedure: Using structured interviews, 3200 men aged 39-59 were categorised as type A, type B or type X (balanced between A and B). The men were healthy (no CHD) at the start of the research. The assessment was based on answers to an interview and behavior during interview. (Researcher provoked Ps by being aggressive and interrupting them).The Ps were classified as type A or type B according to their observed behavior. The sample was followed up for 8.5 years to assess lifestyle and health outcomes.
Findings: At the end of the study 257 men had developed CHD, 70% of those were from the type A group. These results were significant even when risk factors such as smoking and obesity were taken into account. Conclusions: Type A behavior pattern is risk factor for heart disease.
Later personality type C was identified by Temoshok (1987)
Type C personalities are detail oriented, people pleasers, passive and patient. They suppress wants, needs and feelings. The repression of anger is thought to make them more prone to developing cancer. Dattore et al. (1980) carried out a prospective study on 200 veterans of the Vietnam War. The participants completed scales measuring repression of feelings and symptoms of depression.
By the end of the study, 75 of the participants were diagnosed with cancer; these typically had reported significantly more repression of feelings and less symptoms of depression than the other participants. This supports a link between Type C personality and cancer. However, the findings are inconsistent and Nakaya et al. (2002) did not support this link.
Kobasa and Maddi (1979) identified a personality structure consisting of three aspects:uote>
Control is one of the factors of hardiness. Hardy people see themselves as being in charge of their life, not controlled by outsides factors which they cannot control.
Commitment is one of the factors of hardiness. Hardy people are involved in the world around them and have a sense of purpose.
Challenge is one of the factors of hardiness. Hardy people see challenges as problems to be overcome rather than as stressors. They see change as a challenge and stressful situations as opportunities to learn rather than as a source of stress.
The physiological methods of stress management involve the use of drugs to target the stress response systems.
Benzodiazepines enhance the action of a neurotransmitter, GABA that inhibits the activity of neurons in most areas of the brain. GABA allows more chlorine ions to enter the neurons, this makes it more difficult for other neurotransmitters to stimulate them. BZs boost this action, allowing an even greater number of chlorine ions into the neurons. This reduces the effect of excitatory neurotransmitters such as serotonin and the person feels calmer.
When the acute stress response occurs the adrenal medulla produces adrenaline. This is transported to the heart where it stimulates the beta receptors thus increasing the heart rate and blood pressure. Beta-blockers are used to block the receptors which prevent the rise of the heart rate and the blood pressure. They also decrease sweating and shaking (tremors).
Stress inoculation therapy is a form of Cognitive Behavioral Therapy (CBT).
It involves a person identifying the causes of stress (e.g. the features of the stressful situation) and the irrational thoughts which accompany these before offering cognitive and behavioral skills which will help a person better cope with the demands of the situation.
The client learns to use these skills in a safe environment e.g. through visualising stressful situations, then they go out into the real world and put their training to the test. Part of this stage is also to learn to deal with setbacks (see them as challenges providing an opportunity to learn rather than as failures).
In most cases, SIT consists of between 8-15 sessions, plus follow-up sessions after a few months.
Psychiatric patients suffering from severe stress and anxiety disorders were divided in 3 groups : group 1-Patients received SIT only, group 2- Patients received SIT and drugs and group 3 -Patients were give drugs only. The results show that SIT was better than drugs in reducing the symptoms of anxiety and depression. This effect was maintained, after three years the patients in the SIT group required fewer admissions for psychiatric problems than the other treatment groups. This suggests that SIT is effective and that it has a long-term positive effect.
Biofeedback therapy involves training the client to control involuntary physiological processes such as muscle tension, blood pressure, or heart rate.
The reason why we cannot usually do this is because we are not aware of these processes. This therapy, therefore, makes these processes visible to the client through the use of technology such as heart monitors (electrocardiograms), the use of electromyograms (which shows the tension in the muscles) and skin conductance response (SCR) .
The type of social support an individual receives depends on the social network and individual has but also on their gender and their culture. Social support buffers the effects of stress in five different ways according to Stroebe (2000).
Problem-focused strategies: aim at changing or eliminating the source of the stress in practical ways which tackle the problem that is causing stress, therefore directly reducing the stress response.
Emotion- focused strategies: aim at reducing the negative emotional responses associated with stress by using methods such as meditation, comfort eating, keeping busy so as to avoid thinking about the situation.
Most people use both types of strategies but to various extents and in response to different stressors.
In response to acute stressors women are more likely to use the “tend and befriend” response than men. Men are more likely than women to respond to acute threat with the “fight or flight” response. The “tend and befriend” response is linked with the presence of oxytocin, a hormone involved in social bonding, formation of attachment and trust. Men also produce oxytocin but testosterone directly suppresses it whereas the oestrogens present in women enhance its effects. When in the presence of an acute stressor, men produce vasopressin; a hormone related to aggression, its action is enhanced by testosterone. This leads to an aggressive response.
This explains the difference in coping styles by proposing that men and women face different stressors for which different coping strategies are needed e.g. problem-focused strategies are more suitable for work stressors, whereas emotion-focused strategies are more suitable for relationship stressors.
Ptacek et al. (2014) found that men and women were similar in their appraisal of an identical stressor but they coped with it differently. Women reported seeking social support and using emotion-focused coping more than men; men reported using more problem-focused strategies than women.
Tamres et al. (2002) in a meta-analysis found women were more likely to engage in emotion-focused strategies such seeking social support and positive self-talk and ruminating about problems than men supporting the dispositional hypothesis. She also found support for the role constraint theory as other gender differences were dependent on the nature of the stressor.
The type of social support an individual receives depends on the social network and individual has but also on their gender and their culture. Social support buffers the effects of stress in five different ways according to Stroebe (2000).
Esteem support: when the individual feels that sources of support value them. This makes the individual feel valued and more competent in dealing with the stressor.
Emotional support: warmth and nurturance provided by sources of social support. It makes the individual feel that they can depend on others for sympathy and understanding.
Appraisal support: others help the individual to assess the stressor and its effects. This helps in establishing a realistic view of the situation.
Informational support: others give information and guidance on how to deal with the stressful situations or feedback on the strategies used.
Instrumental support: it can be indirect such as helping out in order for the individual to have more time and energy to deal with the stressor or direct such as lending money if the stressor is financial difficulties.
Orth-Gomer et al. (1993): In a sample of 700 50 years old Swedish men. She found that smoking and lack of social support were the two leading risk factors for CHD in these middle-aged men.
Stachour (1998) investigated the influence of the quantity and the quality of social support. The quantity was measured by the number of interactions; the quality was measured by questionnaires measuring the emotional, esteem and instrumental support. The results show that quality was related to better health but not quantity.
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