PAPER 3

• What is the definition of stress?

  . Stress can be defined as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives. Everyone experiences stress to some degree. The way we respond to stress, however makes a big difference to our overall well-being.
• THE PHYSIOLOGY OF STRESS

  What is the sympathomedullary pathway (SAM)/fight or flight response?

  . Used as a short-term stress response

  . This is part of the Autonomic Nervous system response

  . Remember this has 2 branches;

  . The sympathetic branch-arouses the body ready for fight or flight

  . The Parasympathetic branch-restores the body to a state of relaxation
• What is the process of the sympathomedullary pathway (SAM)?

  The Hypothalamus-->Activates-->The ANS (sympathetic branch)-->Causes-->The Adrenal Medulla-->To Release...-->Adrenaline and Nor-Adrenaline-->Gets body ready for fight or flight-->Physiological reactions e.g. increased HR, BR, dilated pupils, slowed digestion.

  . Don't forget once the stressor stops the parasympathetic branch is activated-the priority is now energy conservation, rest and digest response.
• What is the hypothalamic pituitary adrenal system (HPA)?

  . If the stressor continues the HPA is activated
• What is the process of the hypothalamic pituitary adrenal system (HPA)?

  Hypothalamus produces CRH-->Activates-->Pituitary Gland-->Causes the Release of...-->ACTH-->Which Acts on...-->Adrenal Cortex-->To Release...-->Cortisol and Glucose (corticosteroids)-->Liver releases energy, the immune system is suppressed (immunosuppression)
• How is cortisol involved in the hypothalamic pituitary adrenal system (HPA)?

  . Cortisol gives you a quick burst of energy along with the glucose

  . Cortisol is the major steroid stress hormone...it has positive effects such as bursts of energy/lower sensitivity to pain but also has other negative effects such as suppressing the immune system/impaired cognitive performance

  . The HPA is self-regulating via a negative feedback loop. Once the stress response has been initiated, and cortisol enters the circulation, cortisol itself is able to act on the hypothalamus and pituitary and inhibit production of CRF and ACTH.
• What is the evaluation of Physiological response to stress?

  -GENDER DIFFERENCES

  . Research into the stress response may reflect a male bias.

  . Taylor (2000) suggests that for females behavioural responses to stress are characterised by a 'tend and befriend' response.

  . During our evolutionary past this included protecting young and forming alliances with other women.

  . Therefore women may have a totally different system for coping with stress because their response evolved in terms of being a primary caregiver for children, fleeing too quickly would put her offspring at risk.

  
  

  -NEGATIVE CONSEQUENCES OF THE FIGHT OR FLIGHT RESPONSE

  . The physical responses linked to fight or flight may be adaptive for a stress response that needs energetic behaviour e.g., fleeing from a lion.

  . However, the stressors of modern life rarely require such levels of physical activity e.g., worrying about exams.

  . The problem arises when the stress response is repeatedly activated.

  . E.G., the increased BP can lead to physical damage in blood vessels and eventually heart disease.

  . Similarly, although Cortisol may help the body in fighting viral infection/healing damaged tissue, too much Cortisol suppresses the immune system.

  
  

  -THE TRANSACTIONAL MODEL OF STRESS

  . Lazarus (1999) argued that the physiological stress response was not inevitable, it depends on how the stressor is perceived, which determines how the body responds.

  . Lazarus and Folkman (1984) developed the transactional model, realising that cognitive appraisal was key, perceived demands and perceived ability to cope.

  . The emphasis is on what the individual thinks (cognitive), which moderates the way the individual responds to a stressor...

  . Speisman et al (1964) asked students to watch a primitive & gruesome medical procedure on film while their heart rates were measured. Changes to their heart rate depended on how the students
• interpreted what was happening in the film.

  . If they believed the procedure to be traumatic, their heart rate increased, but if they interpreted the procedure to be part of a joyful and voluntary rite of passage, their heart rates actually decreased.

  . It is difficult for a purely physiological explanation to account for this; it shows that humans are not as passive in the face of stressors as physiological theories assume.
• What is Selye's GAS-The General Adaptation Syndrome?

  . Much of our understanding of the nature of stress can be traced back to the pioneering work of Hans Selye (1930). His research led him to conclude that when animals are exposed to unpleasant stimuli, they display the universal response to all stressors.

  . He called this the general adaptation syndrome (GAS). It is 'general' because it is the same response to all agents; the term 'adaptation' is used because its adaptive-it is the bodies best way to cope with extreme stress. It is a 'syndrome' because there are several symptoms in the stress response.

  . It attempted to explain not only the short-term effects of exposure to stressors but also accounted for long-term stress related illnesses. It is a stage-based system-1 stage to the next to the next.
• What are the 3 stages of GAS?

  ALARM

  . Threats/stressor is recognised and response made to the alarm.

  . Sympathetic branch of ANS is activated by hypothalamus and Adrenaline/Noradrenaline and produced to preare body for fight or flight.

  . Increased HR, stored sugar released from the liver, blood directed to muscles, increased respiration, pupils dilate.

  . Typical response to situational stress

  RESISTANCE

  . Body adapts to the demands of the environment

  . Body appears to be coping with the appearance of returning to normal physiological function but, body's resources are being consumed at a harmful rate e.g. stress hormones become depleted.

  . Parasympathetic branch activated to conserve energy.

  EXHAUSTION

  . Reached when a stressor persists and the body can no longer cope anymore. Resources are drained.

  . The adrenal gland may be damaged from overactivity and cease to function.

  . The immune system is suppressed

  . Stress related illnesses now likely e.g. raised blood pressure, heart disease, depression.
• What is the evaluation of the General Adaptation Syndrome (GAS)?

  + Support for the GAS

  . Selye (1936) experimented with rats, subjecting them to stressors including extreme cold, excessive exercise, surgical injury, spinal shock (cut spinal cord) or sub-lethal doses of drugs-no matter what stressor, they always produced a similar response.

  . This supports his theory that there is a non-specific response of the body to any demand made upon it, i.e. the body responds in the same way to any stressor.

  
  

  -Is the GAS really general?

  * The key to the GAS ideas is that the stress response is non-specific however, Mason (1971) replicated Selye's procedure using 7 stressors in studies of monkeys rather thsn rats. He measured the monkey's level of urinary cortisol and found varied effects dependent on the stressor.

  . Extreme cold increased cortisol

  . Extreme heat decreased cortisol

  . Excessive exercise caused no changes in cortisol

  * These findings question the validity of the GAS-they challenge the central concept of Selye's theory by showing that specific stressors can produce specific patterns of responses not just a general one.

  
  

  -Reductionist...

  The GAS is reductionist. It focuses only upon physiological/biological reactions in the body and ignores the psychological responses to stress such as feelings of panic/fear that are often associated with stress. This suggests that the physiological approach to stress may be an oversimplification of the body's stress response.
• THE ROLE OF STRESS IN ILLNESS

  What is cardiovascular disorder?


  Refers to any disorder of the heart such as coronary heart disease (CHD) and circulatory system (high blood pressure) as well as strokes where blood flow is restricted to parts of the brain.
• What is immunosuppression?


  Means the suppression of the immune system-a system of cells within the body that is concerned with fighting intruders e.g. viruses/bacteria so they cannot infect the body. White blood cells (leucocytes) identify and eliminate foreign bodies (antigens).
• How can stress suppress the immune system?

  . Stress can suppress the immune system directly. Cortisol produced by the HPA inhibits the production of lymphocytes (B cells which protect healthy cells and T cells which destroy unhealthy cells). You also have natural killer cells (NK).

  . There are also some indirect immunosuppressive effects: stress can influence lifestyle behaviours (smoking, drinking, sleep patterns) that in turn have detrimental effects on the immune system.
• What was the Chronic stress & the immune system study-Exams study by Kiecolt-Glaser et al (1984)?


  Procedure

  . 75 medical students gave blood samples twice, one month before an exam period (low stress) and on the day of their first exam (high stress).

  . They also completed a questionnaire measuring sources of stress (SRRS) and lonelibess scale to assess how many interpersonal contacts they had.

  
  

  Findings

  . NK cell activity was significantly reduced in the 2nd blood sample-suggests ongoing stressors reduce immune functioning.

  . Further support comes from the fact that those students whose life stressors were general high (via SSRS) had the lowest NK cell levels.

  . Loneliness contributed to the effect-those with fewest fiends had the lowest NK cell activity
• What was the Chronic stress & the immune system study-Alzheimer's carers study by Kiecolt-Glaser et al (1991)?

  Procedure

  . Compared caregivers of of dementia sufferers & a matched control group of non carers

  . All pt.'s given a 'punch biopsy' below the elbow. This was dressed/treated by a nurse in the same way for each pt.

  . Researchers assessed levels of cytokines-chemical substances involved in the stress response.

  . Pt.'s given 10-item perceived stress scale to check how stressed they felt.

  
  

  Findings

  . Complete wound healing took longer in carers-9 days.

  . Cytokene levels lower in carers

  . On stress scale carers more stressed

  . Stress lowers immune system response.
• CARDIOVASCULAR DISORDERS

  How does immediate stress and adrenaline affect cardiovascular disorders?


  -Stress activates the synmpathetic branch of the ANS leading to the production of Adrenaline & noradrenaline. High levels of Adrenalin has the following effects:

  . Increased heart rate causes the heart to work harder and takes a toll over time.

  . Constriction of the blood vessels increases blood pressure, which puts tension on blood vessels causing them to wear away.

  . Increased pressure can also disoldge plaques on the walls of blood vessels, and this leads to blocked arteries. This may cause heart attacks or strokes.
• What is Ute Wilbert Lampen et als study into the World Cup?

  * Looked at incidences of heart attacks during football matches played in Germany during the 1996 World Cup.

  Findings

  . On the days when Germany played, cardiac emergencies increased by 2.66 times times compared with a control period.

  . It appears the acute emotional stress of watching your favourite football team can more than double your risk of suffering a cardiovascular event.
• What is Williams et al (200) longitudinal study to if anger was linked to heart disease?

  Procedure

  . Approximately 13,000 people completed a 19-question anger scale including questions on whether they were:

  . Hot headed if they felt like hitting someone when they got angry whether they got annoyed when not given recognition for doing good work

  . None suffered from heart disease

  
  

  Findings

  . 6 years later the health of participants was checked; 256 experienced heart attacks

  . Those who scored the highest on the anger scale were 2.5x more likely to have a heart attack.

  . Moderate score in anger ratings were 35% more likely to experience a coronary event than those with lower ratings.

  . Suggests that arousal of the sympathetic branch is closely associated with cardiovascular disorders.
• What is the evaluation of the role of stress in illness?

  + Support for effect of stress on cardiovascular disorders

  . Sheps et al (2002) used volunteers with reduced blood flow to the heart. they gave the 173 men and women a variety of psychological tests, including a public speaking test. Their blood pressure soared dramatically, and in half of them sections of the muscle of the left ventricle began to beat erratically.

  . Of all pt's 44% of those who showed erratic heart beats died within 4 years, compared to 18% who had not.

  . This shows that psychological stress can dramatically increase the risk of death in people with poor coronary artery circulation.

  
  

  -Self report

  . Exposure to stress and cardiovascular outcomes are often based on self-report-If an individual has a general tendency toward negative perceptions i.e. remembering unpleasant events rather than pleasant ones, this may lead to an exaggerated score on both measures. This in turn would lead to a significant correlation being more likely, resulting in an unjustified association between higher perceived stress and cardiovascular symptoms.

  
  

  -Individual differences in cardiovascular effects

  . Research has shown gender differences in the stress/immune relationship. Women show more adverse hormonal and immunological changes in the way they react to marital conflict (Kiecolt-Glaser et al, 2005)

  . Rozanski et al (1999) suggests that the sympathetic branches of the ANS is more reactive in some individuals than others. People described as 'hyperresponsive' respond to stress with greater increase in blood pressure and heart rate than others. This would lead to more damage to the cardiovascular system.
• -Stress does not always have a negative effect on the immune system

  In some situations, stress can enhance the activity of the immune system.

  Evans et al (1994) looked at activity of an antibody (slgA) which helps to protect against infection

  Arranged for students to give talks to other students (immediate stress).

  These students showed an increase in slgA

  However, there was a decrease in slgA during exam periods where the stress stretched over several

  weeks

  Evans proposes that stress has 2 effects on the immune system

  . Up-regulation/increased efficiency for short term/acute stress

  . Down-regulation/decreased efficiency for chronic/ongoing stress
• SOURCES OF STRESS: LIFE CHANGES

  What is the definition of life changes?

  . Events (positive & negative) in a persons life such as divorce/marriage/bereavement that require no significant adjustment in various aspects of a persons life. As such, they are significant sources of stress.
• What is the definition of life change units (LCUs)?


  . A number assigned to each life event to represent how much stress is created. The higher the number, the more stressful.
• What did Holmes and Rahe (1967) develop?

  . In order to conduct research on the effect of life changes on health Holmes and Rahe (1967) recognised that they needed a standard measurement tool.

  . They developed the Social Readjustment Rating Scale (SRRS) to do this, consisting of 43 life events.

  . An individual identifies which life changes occurred within a set time period. Each life change has a score in terms of life change units. A score can then be calculated for each individual.
• What is the key study by Rahe et al (1970)?

  * Rahe et al used the SRRS which aimed to measure life changes and then see who became ill

  
  

  Procedure

  . Studied male Navy personnel assigned to 3 ships. The pts completed a version of the scale called the Schedule of recent experiences. This covered the 6 months before their deployment on a tour of duty.

  . A total LCU score was calculated for each pt.

  . Once on board the ship for the tour of duty, every illness, no matter how trivial, had to be reported to the medical unit.

  . After the ships returned from their missions, an independent researcher reviewed all the medical records and calculated an illness score for each pt.

  . Neither the pt's nor the on-board medical staff were aware of the purpose of the study or what the data was being used for.

  
  

  Findings

  . Found a significant positive correlation of .118 between LCU scores for the 6 months before departure and scores for illness aboard the ship.

  . Those who had experienced the most stressful life changes in the final 6 months before leaving on active service, also had the most/most severe illnesses in the following 6 months aboard the ship.

  . Life changes are a reasonably robust predictor of later illness.
• What is the evaluation of life changes and stress?

  + Supporting research-Raija Lietzen et al (2011)

  . Used data from the Health and Social Support study (HeSSup) in Finland to follow over 160,000 adults who did not have asthma at the start of the study.

  . They found that a high level of life change stress was a reliable predictor of asthma onset. This link was not explained by other known risk factors such as having a cat/dog at home and smoking.

  
  

  -Correlation not causation

  . Most life changes research is correlational. It is therefore difficult to know what is the exact nature of the relationship between life changes and illness.

  . Because we are not justified in drawing conclusions about cause and effect based on correlations, we cannot claim that life changes cause illness.

  . There could be other factors influencing illness

  
  

  -Individual differences

  . The life changes approach ignores the fact that life changes will inevitably have different significance for different people. E.G. the death of a spouse will undoubtedly have a devastating effect on a spouse but the death of an elderly spouse after a long and painful illness may not be as stressful for the survivor.

  . Similarly, what are minor stressors for some people may be major stressors for others.

  
  

  -Richard Lazarus

  . Richard Lazarus and colleagues argue that daily hassles are more important sources of stress than life changes, especially when it comes to our health.

  . This is because the accumulative force of many everyday minor stressors is greater than that of a few relatively major events.

  
  

  -DeLongis et al (1988)

  . DeLongis et al (1988) studied the effects of daily hassles on 75 married couples over a 6-month period.

  . They found that the more hassles the pt's experienced, the more likely they were to suffer consequent health problems like headaches and flu.

  . They found no such relationship between LCUs+ill
• SOURCES OF STRESS:DAILY HASSLES

  What did Lazarus suggest it was better to focus on in terms of stress?


  . Richard Lazarus and colleagues suggested it may make more sense to focus on everyday stressors and the impact they have on us. These daily hassles have a more significant part to play as a source of stress and in our psychological wellbeing.
• What do we mean by daily hassles and uplifts?

  . Relatively minor events/irritations/frustrations that arise in the course of a normal day. They may involve everyday concerns of work, such as a disagreement with a colleague, or issues arising from family life.

  . The negative effects of daily hassles can in turn be offset to some degree by the minor positive experiences of everyday life (daily uplifts), such as a smile from someone in the street or an email from a long-lost friend.
• What are the two explanations of the effects of daily hassles?

  Accumulation

  . One explanation is that an accumulation of daily stressors creates persistent irritations, frustrations and overloads which results in more serious stress reactions such as anxiety and depression.

  
  

  Amplification

  . Chronic stress due to major life changes may make people more vulnerable to daily hassles. E.G. a husband trying to come to terms with a recent divorce may find the relatively minor squabbling of his children to be a major irritation.

  . As the person is already in a state of distress, the presence of associated minor stressors may amplify the experience of stress. The presence of a major life change may also deplete a persons resources so that they are less able to cope with minor stressors than they would be under normal circumstances.
• What is the key study by Kanner et al (1981)?


  Procedure

  . 100 pt's-48 men, 52 women aged 45-67

  . Each completed the hassles and uplifts scale for events over the previous month, and then once a month for 9 months.

  . Pt's also completed a life changes scale for the 6 months preceding the study and for the 2 yearly periods prior to that. They also completed it again at the end of the study.

  . To assess psychological wellbeing-the Hopkins symptom checklist (assess symptoms such as anxiety and depression) and the Bradburn morale scale (assesses positive and negative emotions) was used.

  . Pt's filled these out every month.

  
  

  Findings

  . There was a significant positive correlation between hassle frequency and psychological symptoms at the start and the end of the study, for both men and women.

  . So, the more hassles they experienced, the move severe their psychological symptoms of depression and anxiety.

  . Hassles were a stronger predictor of psychological symptoms than life changes.
• What is other supporting research into the effect of daily hassles on stress?

  . Bouteyre et al (2007) looked at the relationship between daily hassles and the mental health of French Psychology students during their initial transition period from school to university.

  . The students completed the hassles part of the hassles and uplifts scale and the Beck depression inventory as a measure of symptoms of depression

  . There was a positive correlation between scores on the hassles scale and the incidence of depressive symptoms.

  . This shows the transition to university is fraught with daily hassles, and that these can be considered significant risk factors for depression.
• What is the evaluation of daily hassles?

  + Support for the importance of daily hassles

  . Flett et al (1995) asked 320 students (160 men & 160 women) to read a scenario describing a male or female individual who had experienced either a major life event or daily hassles.

  . The pt's then rated the amount of support (both emotional and practical) that the person would receive and would seek from others.

  . Flett et al found that individuals who had suffered major life events were rated higher in both seeking and receiving support from significant others.

  . This suggests that the reason daily hassles may be a greater source of stress is because there is less social and emotional support received from others than for life events.

  
  

  -Issues with recall of data

  . Retrospective data-pt's are asked to rate hassles experienced over the last month-this may not be a reliable method-there could be issues with misremembering etc. Some researchers have therefore taken to using a daily diary method to report daily hassles.

  . The validity of data collected may also be an issue-pt's may not always answer truthfully and give socially desirable answers-e.g. they may not want to admit 'they have problems with their children'. In fact most of the hassles are quite negative, and therefore some people may play down their severity.

  
  

  -Individual differences

  . There are gender differences in what constitutes a hassle. E.G. when it comes to pets Miller et al (1992) found that pets appear to serve different roles for female and male pet owners.

  . For females, pets were commonly associated with uplifts (leisure and lack of psychological pleasure), but for males, pets were more likely to be associated with hassles (time and money necessary to take care for them).

  
  

  -What does the research tell us?

  . Most of the data is correlational and so we cannot draw causal conclusions about the
• relationship between daily hassles and illness.

  . Also its not clear what the direction of cause and effect is-would someone who is already depressed be more likely to think negatively and record higher severity of hassles? Or do the hassles cause the depression?

  . However, a study by Charles et al (2013) found that hassles predicted depression in some 10 years later suggesting that hassles cause depression.
• SOURCES OF STRESS: WORKPLACE STRESS

  What is the effect of workplace stress?

  . Workplace stress is a serious issue and of major economic importance: A report in the Huffington Post claimed that the cost in the UK reached £6.5 billion in 2021 because 10.4 million days were lost due to staff absenteeism related to stress.

  . Research also suggests that 'presenteeism' is on the rise-employees coming to work disengaged, tired, unmotivated and too stressed to work.
• What are the two key issues that psychologists have identified linked to workplace stress?

  workload and job control.
• What is the definition of workplace stress?

  Aspect of our working environment (such as work overload or impending deadlines) that we experience as stressful, and which cause a stress response in our body.
• What is the definition of workload?


  The amount of effort and/or activity involved in a job. It is quite often discussed as 'job demand' i.e. the amount required for a person to be doing during their working day.
• What is the definition of job control?

  The extent to which a person feels they can manage aspects of their work, such as deadlines and work environment.
• What is the job-strain model?

  . The issues of workload and control have jointly been combined in the job-strain model of workplace stress.

  . The model proposes that the workplace creates stress and illness in 2 ways:

  1. High workload creating greater job demands.

  2. Low job control e.g. over deadlines, procedures etc.
• What is the key study-The Whitehall study-Marmot et al (1997)

  Procedure

  . Followed over 10,000 UK civil servants (men & women) who have worked in Whitehall, London since 1985.

  . High grade employees e.g. professionals such as accountants have high levels of workload and control whereas low grade employees such as administration staff have less workload and control. Therefore, both are likely to experience stress but for different reasons.

  . At the start of the study pt's completed a range of questionnaires assessing their job workload, subjective sense of job control and the social support they had.

  . 11 years later CHD risk was assessed as a measure of the effects of stress.

  
  

  Findings

  . Highest grade workers tended to have the highest workload and also the highest sense of job control.

  . High workload was not associated with CHD whereas low job control was.

  . The combined effect of low control and high workload (the job strain model) was strongest among the younger workers and was not reduced by high levels of social support.