"stress and coping: cause or consequence?" r. fielding department of community medicine,...
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"Stress and coping: Cause or consequence?"
R. FieldingDepartment of Community
Medicine, HKU.
Objectives:
• distinguish between the different models conceptualizing stress.
• demonstrate an understanding of the relationship between demands and resources in the generation of threat
• characterize those types of situations most likely to generate stress, giving a range of clinical examples.
The role of “threat”
Threat is the anticipation of harm.
Threat experience 1
Threat experience 2
• This harm can be physical, emotional, financial, social, or in any other form.
• Anticipated harm reflects some evaluation that the person has made. This evaluation is called Primary Appraisal.
Demands and resources
• Primary appraisal is the judgement of the potential mismatch between the perceived demands and perceived resources available to deal with those demands.
• If primary appraisal concludes that perceived demands exceed perceived resources, then threat of harm can cause the individual to experience the feelings sometimes referred to as “stress”.
Coping
• 2 major categories of coping :– coping to tackle demands (problem-focused)– coping to control emotional reactions (emotion-
focused).
• Coping may be effective and contribute to resolving the demands or emotions, when it is called “adaptive”.
• Coping may be effective but cause other problems, then it is said to be “maladaptive”.
Secondary Appraisal
• Secondary appraisal: The evaluation of coping effectiveness: coping appraised as.. – effective, then threat is avoided, and “stress”
symptoms not usually experienced (hassles)– marginally effective, increased or modified
coping efforts made, increased cost on resources, and/or high stress if harm great.
– ineffective, emotion-focused coping or passive withdrawal, e.g. helplessness, depression, “giving-up”.
Maladaptive coping• Sources of maladaptive coping:
– adopting harmful activities in response to demands during maturation(e.g. substance use)
– successful early coping and unwillingness to abandon coping that is no longer effective (immaturity)
– maladaptive coping patterns from parents/ peers/ society (e.g. aggression, striving to maintain control, coping over-exertion)
– maladaptive coping due to limited opportunity to learn more adaptive responses (dysfunctional social environment)
Indicators of stress• Cognitive:
– concentration/memory difficulties– disruption of cognitive performance
• Emotional:– fear/anxiety, depression, fatigue
• Behavioural: – irritability, withdrawal, vegetative disturbances– unpredictability
• Physiological:– cvs, immunological, dermatological, hormonal, GI, GU
changes
Arousal-performance curve
Determinants of stress• Which circumstances are most stressful?• Stimulus conditions:
- a stimulus’ potential for harm is great or lethal
- the stimulus impact imminent
- there is a high degree of ambiguity in significance of cues signaling stimulus impact
• Respondent conditions:
- motivational strength is low
- general beliefs about environment transactions reflect marginal perceived control
- available intellectual resources, education, etc
Stress in clinical situations
• Patients: When...– risk of harm and uncertainty are high, i.e.
demands are perceived as exceeding resources or are unknown, or;
resources are perceived as inadequate or unknown.
• Staff : When…– risk of harm (in form of error) is high, – demands exceed resources.
Effect of stress on CVS
• In situations appraised as borderline coping, cardiovascular changes are seen:
• Changes in heart-rate reactivity due to increased catecholamine production.
• Sensitization of cardiac tissue to catecholamines by corticosteroids
• Pressor changes
Summary
• Stress symptoms arise from appraised mismatch between perceived demands and perceived resources, the consequences of which indicate harm may occur (threat).
• Hassles (minor demands) are cumulative and can occupy significant coping capacity.
• Many important physiological systems can be influenced via hormonal and autonomic pathways.
• High levels of demand can disintegrate normal activity and are pathogenic.