STRESS: DEFINITION, THEORIES, MEASUREMENT, SOURCES, & coping

FAREZADI ZAFRY SEMESTER 1 2009 FACULTY OF HEALTH SCIENCES, UiTM

LEARNING OUTCOMES

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Upon successful completion of this lesson students will be able to: Explain the physiological process of stress Discuss the theories that explain stress Describe the measurement of stress Discuss the sources that produce stress Explain factors that influence coping & effective strategies of coping

THE PHYSIOLOGY OF STRESS

The Peripheral Nervous System: autonomic nervous system (sympathetic & parasympathetic) - neurotransmitters (acetylcholine, norepinephrine) The Neuroendocrine System: hormones - pituitary gland adrenocorticotropic hormone (ACTH) adrenal glands (adrenal cortex & adrenal medulla) glucocorticoids (cortisol); catecholamines (epinephrine, norepinephrine)

THE PHYSIOLOGY OF STRESS

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Physiology of the Stress Response Cannons fight or flight Sympathetic division of the ANS (adrenomedullary response) Hypothalamic-pituitary-adrenal axis (HPA) (involves all the structures) Allostasis maintaining appropriate level of activation under changing circumstances Allostatic load due to prolonged activation of the Sympathetic NS Taylors tend-and-befriend

Physiological Effects of Stress

THEORIES OF STRESS
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There is no simple definition as to the term stress Stress can be defined in three ways; Environmental stimulus - I have a high-stress job Physical response - My heart races when I feel a lot of stress Interaction between environmental stimuli & the person - I feel stressed when I have to make financial decisions at work, but other types of decisions do not stress me Theories/views of stress;

THEORIES OF STRESS
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Hans Selyes View: stressor stimulus; stress response defined stress as a nonspecific or generalized physical response to a variety of environmental stressors whenever the body encounters disruptive stimulus, it mobilizes itself in a generalized attempt to adapt to that stimulus general adaptation syndrome (GAS)

THEORIES OF STRESS

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The General Adaptation Syndrome (GAS) whenever the body encounters disruptive stimulus, it mobilizes itself in a generalized attempt to adapt to that stimulus GAS 3 stages: Alarm reaction bodys defenses are mobilized through activation of the sympathetic NS (activates body systems to maximize strength, & prepares them for fight-or-flight response); increased arousal Resistance adapts to/cope with the stressor Exhaustion - body can no longer resist, results in physiological breakdown; activation of the

THEORIES OF STRESS

Potential for trauma or illness exists at all 3 stages e.g. resistance - ulcers, hypertension, CVD, asthma; exhaustion depression, death Selye concentrated on the physiological aspects of stress, downplaying the psychological ones (e.g. emotional component), & ignoring the perceptual & interpretative processes that can moderate human experience of stress

The three stages of Selyes general adaptation syndrome alarm, resistance, exhaustion and their consequences

THEORIES OF STRESS
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Richard Lazarus View: persons perception (interpretation) of an event is more important than the event itself emphasizes psychological factors e.g. cognitive mediation, appraisal, vulnerability, & coping Psychological stress: particular r/s between the person & the environment that is appraised by the person as taxing/exceeding his/her resources & endangering his/her well-being transactional/interactional view ; persons appraisal; & situation threatening, challenging, harmful

THEORIES OF STRESS
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Psychological factors people are harmed by ve life events only if they perceive those events as threatening, being personally important, are in vulnerable state, & believe that they lack the ability to successfully cope with those events e.g. ??? Appraisal 3 kinds of appraisal to assess situations; primary, secondary & reappraisal

THEORIES OF STRESS
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primary appraisal is ones initial judgment of an event (1st time), may be seen as (1) harmful damage that has been done e.g. illness, injury (2) threatening anticipation of harm, or (3) challenging confidence in overcoming demands harm, threat, or challenge generates emotion e.g. anger, fear, excitement secondary appraisal is ones perceived ability to cope with harm, threat, or challenge e.g. options available individual attempts to determine sufficient coping strategies and selects the best reappraisal of an event is ongoing as the situation

THEORIES OF STRESS
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Vulnerability stress is likely to be aroused when people are vulnerable; when they perceive a lack of resources (i.e. personal, social) to cope with a situation of some personal importance psychological factors Coping ability or inability to cope involves our constantly changing cognitive & behavioral efforts to manage specific internal and/or external demands that are appraised as taxing/exceeding our resources

THEORIES OF STRESS

a) a process, constantly changing, b) not automatic, c) requires effort, & d) effort to manage, not control thoughts & behaviors that enable a person to handle stress or anticipated stress is enhanced by resources such as health, energy, high self-efficacy, problem-solving skills, social skills, & social support

MEASUREMENT OF STRESS

(1) Physiological measures (2) Self-reports (life events & daily hassles scales) Physiological Measures some physiological/biochemical indexes used to assess stress: blood pressure, heart rate, galvanic skin response, respiration state, stress hormones, etc. disadvantage the equipment & the setting themselves may produce stress

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MEASUREMENT OF STRESS
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Life Events Scales Self-report instruments to measure stress Social Readjustment Rating Scale (SRSS) emphasizes change in a persons life; lists 43 events arranged in rank order from most to least stressful Undergraduate Stress Questionnaire (USQ) ask college students to check a list of sources of stress Perceived Stress Scale (PSS) 14-item scale attempts to measure the degree to which situations in peoples lives are appraised as unpredictable, uncontrollable, or overloading

MEASUREMENT OF STRESS
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Everyday Hassles Scales Daily Hassles Scale & Uplifts Scale emphasize persons view of event, 117 + 138 items Revised Hassles and Uplifts Scale shorter scale, 53 items

SOURCES OF STRESS
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Cataclysmic Events Sudden, unique, & powerful single life-events requiring major adaptive responses from population groups sharing the experience Affect large numbers of people May be unintentional major events e.g. natural disasters, or intentional major events e.g. terrorist attack More stressful when they are intentional acts & when people are in close proximity to the events People who experience cataclysmic events may develop posttraumatic stress disorder (PTSD)

SOURCES OF STRESS
B.

Life Events Everyone experiences life events that require change/adjustment e.g. death of a spouse, getting a divorce, being fired, moving to different country Can be +ve events e.g. getting married, starting a new job, becoming parent, & -ve events e.g. losing a job, being a victim of a violent crime, death of a family member Emphasize the importance of change Affect a few people or one only Usually evolve more slowly

SOURCES OF STRESS
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Daily Hassles Events that occur as part of everyday life that may arise from the physical or psychological environment Daily Hassles & the Physical Environment Environmental sources e.g. noise, pollution, crowding, crime, etc. Urban press sources of stress such as noise, pollution, crowding, & fear of crime are associated with urban living People may feel threats from environmental pollution, producing stress

SOURCES OF STRESS

Crowding, a psychological condition that arises from the perception of a high-density environment (population density physical situation), is a source of stress Noise & crowding are more stressful when people believe they have little control over the situation The environment of poverty presents an environment that adds fear of crime to the other hassles common in urban life

SOURCES OF STRESS
b) Daily

Hassles & the Psychosocial Environment From the everyday social environment e.g. community, workplace, family interactions, etc. Discrimination can create daily hassles in community & at work Ethnic groups & women also experience stress due to discrimination e.g. racism & sexism Other situations that produce stress at work include jobs with high demands & low control e.g. food servers, middle-level manager, secretary, construction worker, etc. Workplace stress may also affect personal relationships, producing conflict between work &

Job Strain Karasek et al., 1981 Demands

High
physician, police officer, bank officer

Low
architect, dentist, natural scientist

High

Control
Low

STRAIN food servers, secretary, construction worker

carpenter, bill clerk, truck driver

COPING WITH STRESS

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Coping strategies people use to manage distressing problems and emotions in their lives Personal resources that influence coping Lazarus & Folkman (1984) Health & energy; healthy, robust individuals are better in managing external & internal demands than sick, tired people Positive belief; ability to cope is enhanced when people believe they can successfully bring about desired consequences Problem-solving skills; e.g. knowledge Material resources; e.g. having the money to get

COPING WITH STRESS

Social support; a variety of material & emotional supports that people receive from others Differs from social contacts & social networks (number & types of ppl) in that it is a measure of the quality of ones social contacts Social isolation absence of meaningful personal relationship Can be linked to good health & decreased mortality May help peoples health by providing encouragement to adopt healthy habits or seek medical care, by helping people cope with stress, by changing the physiological responses to stress, or by buffering against stress

COPING WITH STRESS

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Personal control; confidence that you have some control over the events that shape your lives Rotters Locus of control (a continuum): Internal locus of control; people who believe that they control their own lives External locus of control; those who believe that luck, fate, or the acts of others determine their lives When people are allowed to assume even small amounts of personal control & responsibility, they live longer & healthier lives Personal control may help people cope with stress either by having an internal locus of control or by exerting control over ones environment

COPING WITH STRESS

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b.
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Personal hardiness; explanation for why some people are resilient to stress & others are not Individuals who are especially resistant to illness in spite of increased stress, different from other highly stressed people who become ill Kobasas hardy personality model: hardy individuals have a strong sense of commitment to self, demonstrate an internal locus of control, & are likely to see necessary adjustments as a challenge

COPING WITH STRESS

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Personal coping strategies Coping strategies may be classified in many ways, but generally can be divided into problem-focused & emotion-focused coping

COPING WITH STRESS

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Problem-focused coping is aimed at changing the source of the stress managing or changing the event/stressor is used if situation seems controllable and alterable confrontive coping generally more effective than emotion-focused coping examples: seeking information; think of options; devise plan; change job; etc.

COPING WITH STRESS

B.

Emotion-focused coping is oriented toward managing the emotions that accompany stress managing the response use if situation seems uncontrollable examples: talk to friends; going shopping; drinking; relaxing; avoidance; distancing; etc.

What strategy is more effective depends on the situation, & either problem-focused or emotionfocused coping can be effective

Theories of Coping: Problem- & Emotion-Focused

Lazarus & Folkman (1984) (Strategy)

ProblemFocused Resolve cause of problems Seeking info Think of options Devise plan Change job

Emotion-Focused Managing emotional impact of problem Talk to friends Going shopping Drinking Relaxing Avoidance

COPING WITH STRESS

Other categories: Social coping; e.g. seeking support from others Meaning-focused coping; person concentrates on deriving meaning from stressful experience Proactive coping; involves taking steps to avoid an anticipated stressor Culture might affect the choice of coping strategy The relationship between coping strategy and health is complex, involving an interaction between the type of coping strategy & whether the outcome is measured in terms of physical or mental health