Dr. Reem Al-Sabah

Faculty of Medicine

Psychology 220

“I'm stressed out” “don’t stress me”

“Don’t freak out” “I’m feeling stressed”

“I’m under a lot of pressure”

“My heart is racing” “My palms are sweating”

“I have a lot of deadlines”

Defining Stress Stress has no simple definition.

1. Environmental stimulus “I have a high-stress job.”

2. Physical response “My heart races when I feel a lot of stress.”

3. Interaction between environment and person “ I feel stressed when I have to make financial

decisions at work, but other types of decisions don’t stress me.”

Dictionary definition of stress (Merriam-Webster’s Collegiate Dictionary, 2011)

A bodily or mental tension resulting from factors that tend to alter an existent equilibrium.

The definition has several elements:

1. There is a tension (force pulling on the system)

2. The tension is a threat to the normal equilibrium of the system

3. There is some compensation to reduce harm on the system

4. Bodily or mental tensions

Bodily or mental tensions Physical stressors: ones that pose a direct threat

to our physical well-being.

E.g., cold, heat, infection, toxic substances

Psychological stressors: events that challenge our safety, not because they are physically dangerous, but because of our thoughts, perceptions, and interpretations.

E.g., failing a test, sound of footsteps on a dark street

Definitions Stress: experiencing events that are perceived as

endangering one’s physical or psychological wellbeing.

Stressors: are the events that cause the stress (e.g., car accidents, wars, exams…etc.).

Stress response: people’s reactions to the stressors. Behavioral medicine (health psychology): the study of

how stress and other social, psychological, and biological factors come together to contribute to illness.

Little compensation required

Small Demand

Mild Stress

Much compensation required

Severe Demand

Extreme Stress

Moderate Demand

Moderate Stress

More compensation required

Main Theories of Stress Canon’s Fight-or-Flight Theory

Selye’s General Adaptation Syndrome

Lazarus’ Cognitive Appraisal Model

Taylor et al.’s Tend-and-Befriend Theory

Canon’s Fight-or-Flight Theory

Studied how stressors affect the sympathetic nervous system (SNS).

“fight or flight” response (Physiological response to stress):

perception of stress

activation of the SNS

body prepared for intense motor activity for attack, defense, or escape.

Physiological reactions to stress (activation of the SNS)

Increased respiration rate

Increased heart rate Higher blood pressure

Increased metabolic rate

Dilation of pupils

Tensing of muscles

Secretion of endorphins and ACTH

Release of extra sugar from the liver

Fight or flight response

Occurs through two routes:

1. Adrenomedullary axis

Sympathetic nervous system

Adrenal medulla

Catecholamines (containing epinephrine and norepinephrine)

Cardiovascular, digestive, respiratory

2. Hypothalamic-pituitary-adrenal axis

Hypothalamus CRH anterior pituitary ACTH Adrenal Cortex Glucocorticoids (cortisol)

Figure 14.3 Fight-or-Flight Response. The body’s mobilization to attack or flee from a threatening situation.

Selye’s View Our innate response to stress was the same whether it

be a tiger in the trees, getting cut off in traffic, having to sit for an exam or having an argument with your spouse.

Stress is stress, and always triggers the same innate survival mechanism.

Stressor — any event or situation that triggers coping adjustments (stimulus)

Stress — the process by which we perceive and respond to events that are perceived as harmful, threatening, or challenging (response)

The General Adaptation Syndrome (GAS)

A model of how the body defends itself in stressful situations.

1. Alarm reaction: body’s defenses against a stressor are mobilized through activation of SNS (preparing for fight or flight).

2. Resistance: the organism adapts to the stressor (HPA axis activation)

3. Exhaustion: organism’s ability to resist is depleted and a breakdown results (diseases of adaptation)

General Adaptation Syndrome

Lazarus’s Cognitive Appraisal Model

Interpretation of the stressful event is more important than the event itself.

The individual’s perception of the psychological situation is the critical factor.

The first psychological model of stress.

Lazarus’s View (Cont.) Humans encounter stresses because they have

high-level cognitive abilities that animals lack.

Psychological stress: “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being.” (Lazarus and Folkman).

Appraising Events Lazarus theory (Interpretation of stressful events is

more important than the events themselves)

Primary appraisal — Determination of an event’s meaning, it’s effects on their well being.

Secondary appraisal — Evaluation of one’s ability to control or cope with the event.

Cognitive reappraisal — Process by which events are constantly reevaluated.

Appraisals to assess situations

Primary appraisal — Determination of an event’s meaning, it’s effects on their well being (positive, negative, or neutral)

Stressful appraisal: event is seen as harmful, threatening, or challenging. harm: when we lose/expect to lose something of value

to us (damage that has already been done) threat: believing an event is demanding and will put us

at risk for damage (anticipation of harm). challenge: believing that we will grow from the event;

we a person’s confidence in overcoming difficult demands

Secondary appraisal — Evaluation of one’s ability to control or cope with harm, threat, or challenge.

3 questions are asked:

1. What options are available to me?

2. What is the likelihood that I can successfully apply the necessary strategies to reduce the stress?

3. Will this process work, will it alleviate my stress?

Cognitive reappraisal: process by which events are constantly reevaluated

Event

Primary appraisal: Harm (damage)

Threat (future damage) Challenge (slight positive)

Secondary appraisal:

Are my resources sufficient? Yes No

No/Low stress High Stress

The Transactional Model of Stress

Tend-and-Befriend Theory Stress response in females proposed by Shelly Taylor et al.,

2002.

Females are more likely than males to respond to stressors with additional stress responses:

Women quiet, protect, and care for offspring (tending)

Women create and maintain social networks to provide resources and protection for themselves and their infants (befriending)

Psychological Factors and Stress Responses

Why are some people more likely than others to appraise events as stressful:

Psychoanalytic theory Most of what we think and do is driven by

unconscious processes

Objective anxiety: a reasonable response to a harmful situation

neurotic anxiety: anxiety out of proportion to the actual danger and which stems from unconscious conflicts between unacceptable impulses and the constraints imposed by reality

Behavioral theory learned behavior, in which individuals learn to

associate stress responses with certain situations.

People may react to situations with fear and anxiety because those situations caused them harm or were stressful in the past.

Phobias (classical and operant conditioning).

People may continue to have fears because they always avoid the situation and never challenge their fears.

Cognitive theory

attributions or causal explanations people give for important events

Attributional styles: people's consistent styles of making attributions for events in their lives.

internal/external

stable/unstable

global/specific

Characteristics of Stressful Events

Acute stressors: only last for a short time

Chronic stressors: last for an extended period of time

What are some examples of acute and chronic stressors?

Categories of Stressful events

1. Traumatic events that are outside the range of usual human experience.

2. Uncontrollable or unpredictable events.

3. Major changes in life circumstances.

4. Internal conflicts.

Traumatic events

Situations of extreme danger that are outside the range of usual human experiences.

Examples: disasters man-made disasters catastrophic accidents physical assault

Psychological reaction after a traumatic event

Survivors are usually stunned and dazed,

unaware of their injuries or danger.

Passive, unable to initiate even simple tasks.

Anxious and apprehensive, difficulty concentrating, may continue to repeat the story of the event.

Characteristics of Stressful Events 1. Controllability: The degree to which we can stop an event or bring it

about influences our perception of stressfulness.

The more controllable an event Less likely to be perceived as stressful

Important role of perception in our assessment of

controllability of stressful events.

2. Predictability:

The degree to which we know if and when an event will occur.

Ability to predict occurrence of event reduces severity of stress.

Research findings on predictability of events, emotional arousal and stress.

People perceive predictable shocks as less aversive than unpredictable ones.

HOW DO WE EXLPLAIN THESE RESULTS?

You can prepare yourself for the shock (such as by distracting yourself)

There is no safe period with unpredictable shock

Example: getting an injection; torture victims

3. Major changes in life circumstances

Any life change that requires numerous readjustments can be perceived as stressful

Negative events much greater impact on physical & psychological health than positive events

Life Events Scale (Holmes and Rahe, 1967) measures the impact of life changes, ranks events from most stressful to least stressful

4. Internal conflicts Unresolved issues that may either be conscious or

unconscious

Conflict occurs when a person must choose between incompatible, or mutually exclusive, goals or actions

Conflict may arise when two inner needs or motives are in opposition:

independence vs. dependence,

intimacy vs. isolation,

cooperation vs. competition,

expression of impulses vs. moral standards

Psychological reactions to stress 1. Anxiety

The most common response to a stressor.

PTSD: posttraumatic stress disorder. Severe anxiety-related symptoms occurs as a result of

living through events beyond the range of human suffering (e.g. natural disasters, wars, rape)

PTSD symptoms: DSM Diagnosis Survivor’s guilt.

DSM-IV diagnostic criteria for PTSD A. The person has been exposed to a traumatic event.

B. The traumatic event is persistently re-experienced.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma).

D. Persistent symptoms of increased arousal (not present before the trauma).

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Figure 14.1 Post traumatic symptoms in rape. Almost all women who have been raped show symptoms of post-traumatic stress disorder severe enough to be diagnosed with PTSD in the first or second week following the rape. Over the 3 months following the rape, the percentage of women continuing to show PTSD declines. However, almost 50% of women continue to be diagnosed with PTSD 3 months after a rape.

Which is more traumatic, trauma caused by humans or that which is caused by natural disasters?

Human-made disasters are more likely to cause

PTSD.

It shatters our belief about the goodness of other people.

human-made disasters usually affect individuals

more than whole communities.

The Physiology of PTSD

Trauma survivors experience physiological changes.

People with PTSD are more physiologically reactive to situations that remind them of their trauma.

PET scans have shown soldiers with PTSD have greater activity in areas of the brain that play a role in emotion and memory (amygdala and cingulate gyrus).

The Physiology of PTSD (Cont.)

PTSD patients show damage to the hippocampus (resulting in memory problems).

Have lower baseline levels of cortisol before they experience their trauma, that may help in the development of PTSD.

2. Anger and aggression

Anger may lead to aggression

Animals behave aggressively in response to stress (overcrowding, electric shock…etc)

Children become angry and aggressive when frustrated

Frustration-aggression hypothesis: frustration (preventing a person from reaching their goal)induces an aggressive drive, which, in turn, motivates aggressive behavior.

Displaced aggression: aggression is directed toward an innocent person or object rather than the actual cause of the frustration.

3. Apathy and depression

Opposite responses to aggression.

When stressful conditions continue and the individual is unable to cope with them.

Apathy may become worse and turn into depression

Learned helplessness (Seligman, 1975): uncontrollable negative events lead to apathy, withdrawal, inaction, and depression

4. Cognitive impairment

Inability to think logically, difficulty concentrating

May come from two sources:

1. High emotional arousal interferes with information processing

2. Distracting thoughts that go through our heads

(e.g., excessive worrying during an exam)

Coping

strategies that individuals use to manage the distressing problems and emotions in their lives.

the process by which a person attempts to manage stressful demands.

Sources of Stress

Your environment bombard you with demands to adjust.

Social pressures (deadlines, competing priorities, interpersonal conflicts, financial problems...etc).

Physiological (inadequate sleep, illness, poor nutrition, lack of exercise…etc).

Your thoughts. Your appraisal of events either relaxes or stresses you.

Personal resources that influence coping

1. Health and energy

2. A positive belief

3. Problem-solving skills

4. Material resources

5. Social skills

6. Social support: a variety of material and emotional supports a person receives from others

Personal coping strategies

Problem-focused coping: focuses on the specific problem or situation, trying to find ways of changing it or avoiding it in the future.

Emotion-focused coping: focuses on alleviating the emotions associated with the stressful situation, even if the situation itself cannot be changed

Cognitive strategies (often involve a reappraisal of the situation)

Behavioral strategies (e.g., exercise, seeking support, use of drugs)

Avoidant coping: denying any negative emotions and push them out of conscious awareness.

associated with health-related problems

Managing Stress

Behavioral Techniques

biofeedback

relaxation training

meditation

aerobic exercise

Biofeedback

Individuals receive information (feedback) about an aspect of their physiological state and then attempt to alter the state.

A system that provides audible or visible feedback

on an involuntary physiological state

Relaxation Training

People learn techniques to deeply relax muscles and slow down and focus their thoughts.

Progressive Muscle Relaxation — Form of

training that reduces muscle tension through a series of tensing and relaxing exercises

Deep Breathing and Visualization

Exercise Psychological Effects of Exercise

Enhanced sense of well-being

Decreased anxiety

Exercise offers time out, change of pace, boost to self-esteem (e.g., improves appearance)

Reduces depression by elevating low serotonin level — similar to effect of antidepressant drugs

Exercise Physiological Effects

Enhanced blood flow to the brain

Lower blood pressure and resting heart rate

Reduced cardiovascular reactivity to stress

Fewer stress-related health problems

Managing Stress (Cont.)

Cognitive Techniques:

teaches people new, more adaptive ways of thinking and acting

Cognitive behavior therapy (CBT)

helps people identify stressful situations that produce their physiological or emotional symptoms and alter the way they cope with these situations

Cognitive Behavioral Therapy (CBT)

Situation

Thought

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Feeling

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Cognitive Distortions

1. Polarized Thinking

2. Overgeneralization

3. Jumping to Conclusions

4. Catastrophizing

5. Personalization

6. Blaming

7. Shoulds

8. Emotional Reasoning

9. Global Labeling

10. Always Being Right

The Negative Stress Cycle

The Biopsychosocial Model