Rona Moss-MorrisProfessor of Health Psychology

Can Stress Make You Ill?

www.bps.org.uk/dhpEmail: dhp@bps.org.uk

DIVISION OF HEALTH PSYCHOLOGY

Lecture outline The Biopsychosocial Model of health and

illness

What is stress and how do we measure it?

The Pittsburgh Common Cold Studies

Buffers between stress and illness

- Stress and coping model

- Social support

The Biomedical Model

The Biopsychosocial Model

Illness

StressorsAny circumstances that threaten or are perceived

to threaten one’s well-being and thereby tax one’s coping ability

An upcoming exam

Attending a party where you don’t know anyone

Being diagnosed with a serious illness

Break up of a relationship

Stress Our physiological & psychological

responses to conditions that threaten or challenge us in some way

Psychological responses include:

–Emotions e.g. anxiety

–Thoughts e.g. ‘No-one will talk to me’

–Behaviours e.g. ‘ drinking too much’

Fight-or-Flight (Walter Canon, 1932)“aggressive or withdrawal responses to stress”

Stress response controlled by the brain

Physiological Stress Response

Stimulates muscles

Stress and measurement

Environmental

Psychological

Biological

Measuring StressSocial Readjustment Rating Scale

Events causing the greatest life changes considered most stressful

– Death of a spouse– Divorce– Marriage– Fired from work

Holmes and Rahe, 1967

SRSS Scores & Health

(Rahe, et.al, 1964)

The Daily Hassles Scale

Measures irritating, daily demands as rated by the person

– concerns about weight – too many things to do– misplacing things– argument with family member,

Stronger associations with illness better than the SRRS

Kanner et al. (1981)

Cohen’s Perceived Stress Scale (PSS)

10 item questionnaire rated over past month

- how often have you felt nervous or stressed

- how often have you felt on top of things

- how often have you been upset because of something that happened unexpectedly

- how often have you felt difficulties were piling up so high that you could not overcome them

The Common Cold Studies (Cohen et al 1991; 1993)

Large scale prospective experimental investigations of stress and the common cold

Age, gender, weight, ethnicity, season, smoking, alcohol, diet exercise, sleep not related to stress and illness

•PSS•Life events•Mood

Exposed to cold virus

•Replicated virus

•Clinical symptoms

How many people developed colds?

Viral Infection 82% of the volunteers receiving virus were

infected.

Clinical Colds Clinical Colds = both infected and diagnosed by

the clinician as having a clinical cold. 38% developed clinical colds.

Which stress factors predicted colds?

Perceived Stress (PSS) Life events Negative mood

PSS & negative mood predicted actual viral infection

Life events predicted development of clinical symptoms

Associations between each of the stress measures and rates of clinical colds

Does the type of stressor matter? Cohen et al. (1998) Health psychology, 17, 214-223

Life Events and Difficulties Schedule (LEDS; Brown & Harris, 1989)

Detailed interview schedule

Rates events in the last year as - severe acute events- severe chronic difficulty (stressor)

Relative risk of developing a cold by stressor duration

Does the type of stressor matter? Conclusions:

Longer, more chronic stress – more infection

Interpersonal and work stress – more infections

Explaining the relationship between stress and illness

Direct effects hypothesis

stress impacts on our hormones and immune systems

Indirect effects hypothesis

stress impacts on health through changes in health behaviour e.g. diet, exercise, smoking, drinking

Mediators or Mechanisms

Hormones?Immune system?

Behaviours?

Stress Common cold

Behaviour as a Mechanisms

Health behaviours

Stress Common cold

Hormones as Mechanisms

Neuroendocrine hormonese.g. adrenal, cortisol

Stress Common cold

Immune System as a Mechanisms

Increase in IL-6 Cytokines

Stress Common cold

Explaining the Cytokine pathways

Acute stress related to more cortisol which can suppress immune responsiveness

Chronic ongoing stress related to decreased cortisol

Less cortisol may lead to inability to switch off immune responsiveness

Body produces more IL-6 – therefore more symptoms.

Stress and Stroke-Study

2,303 Finnish middle-aged white men followed for 11 years

Measured blood pressure spikes (in anticipation of an exercise test)

Men with above average blood pressure spikes had a 72% greater risk of developing a stroke in the following 11 years

Susan A. Everson et al., 2001

Moderators of Stress

Appraisal and Coping

Social Support

Stress and Coping Model(Folkman & Lazerus, 1984)

Coping Coping StrategyStrategy

Secondary Appraisal:Secondary Appraisal:What resources do I What resources do I

have to cope with this have to cope with this threat?threat?

Emotion Focused Coping

Coping through emotional approach involves actively processing and expressing emotion (Stanton et al. 2000).

The emotional approach scale– emotional processing - “I take time to figure out

what I’m really feeling”– emotional expression ( “I let my feelings come out

freely”)

Emotional Processing and Cancer Study of women with stage I or II breast cancer over 3

months (Stanton et al. 2000) coping through emotional expression associated with

improved – decreased distress,– fewer medical visits– increased vigour at 3 months

Coping through emotional processing associated with increases in distress

Emotional processing appears to be adaptive in the short term

Over the longer term may become ruminative and therefore less beneficial in terms of adjustment.

Coping Effectiveness

The contextual approach - no strategy is inherently bad

Short term and long term effects

Some strategies like avoidance, denial and emotional processing may work well in short term but not in long term

Controllable stressors better linked to problem focused coping and uncontrollable to emotion focused coping.

Appraisals of coping efficacy

What is social support (SS)? Social network

Perceived social support (amount available)

Received social support

Pathways from SS to health/illness Cardiovascular (heart) system

individuals with high SS at work have lower mean heart rate than those with low SS (Unden et al., 1991)

Immune systemindividuals with more social ties less susceptible to common cold (Cohen et al., 1997); immunoglobin A (first line of defence) higher in college students with high SS (Baron et al., 1990)

Neuroendocrine system (hormones)presence of supportive companion during stress test lower cortisol response (Kirschbaum et al., 1995)

Summary and Conclusions

Stress is linked to increased illness particularly chronic stress

This seems to occur through direct effects on immune responsiveness (overactive rather than underactive)

Stress can be buffered through the way people perceive situations, their coping style and social support

These buffers can be used in interventions to reduce impact of stress.

www.bps.org.uk/dhpEmail: dhp@bps.org.uk

DIVISION OF HEALTH PSYCHOLOGY