STRESS

Asim Masood
asimmm196@[Link]
+923002626209
Sources of stress
PHYSIOLOGY OF STRESS
 Selye describes stress as the nonspecific response of the body to any
demand

 The General Adaptation Syndrome (GAS) is a three stage process

described by Selye (1936) that looks at biological changes the body goes
through during stress

 GAS can occur with any type of stress, and this was first observed by Selye
when observing lab rats that were exposed to stress, and they displayed
physiological changes

 The three stages are alarm, resistance, and exhaustion

 Alarm Stage: refers to the initial symptoms the body experiences when faced with a
stressful situation, as it releases hormones such as cortisol (stress hormone) and
adrenaline to prepare the body to deal with the stressor

 This gives the body energy to active the fight or flight response which is the body’s
natural initial response to a stressor, which leads to physiological changes in the body so
you are prepared to either flee or defend yourself, for example, a student’s assignment
is due the next day and they have yet to get started on it, this will lead to them
experiencing stress, and they will either work hard all night to complete it (fight) or
decide to not do it and worry about the consequences later (flight

 During this stage, the heart rate can increase, along with breathing becoming faster

 This disrupts the homeostasis of the body (when organs are functioning at a neutral
level)
 Resistance Stage: refers to the stage after the initial shock of the stressor has
passed, and the body begins to return to normal and repair itself, however, still
on high alert for a while

 If the stressor has completely passed, the body continues to repair itself and
recover, for example, the student whose assignment deadline is the next day,
and hasn’t yet started working on it, finds out that he has received an extension
in the deadline, his stress levels begin to decline and his breathing and heart
rate gradually begin to go back to normal (homeostasis)

 If a stressful event is still ongoing however, the body will remain on high alert
and release cortisol, and though the individual may not be aware of these
physiological changes, signs may appear through frustration and irritability
 Exhaustion Stage: If the resistance stage continues for too long, it can lead to
the exhaustion stage

 This is when an individual is exposed to chronic and prolonged stress, which can
drain them emotionally, physically, and mentally

 The body will no longer be able to fight back the stressor, and your body’s
resources and organs begin to deplete or give up

 The individual can experience fatigue, depression, and anxiety, and in some
cases, it can lead to serious health implications such as potentially developing
a risk of heart related problems such as CHD or CVD
 There are many effects of stress on health including minor problems such as
 Insomnia
 Headaches
 Changes in appetite
 Nausea
 Heartburn
 Muscle aches and pain

 Chronic stress however can lead to serious health problems such as Type 2
diabetes, alcohol or substance abuse, high blood pressure leading to the risk of
stroke or heart attack, and an overall weakened immune system
CAUSES OF STRESS
 Life events (Holmes and Rahe, 1967) are a main cause of stress, and can
include both positive or negative life events

 In order to test the effect of different life events on health, due to stress, Holmes
and Rahe created the Social Readjustment Rating Scale (SRRS) which includes
43 life events that are ranked according to the amount of change they cause

 Each life event is given a score in terms of how much of an impact or change it
has, and this score is referred to as a Life Changing Unit (LCU), with the death of
a spouse being given an LCU of 100, and minor violations of the law an LCU of
11
 Holmes and Rahe gave the SRRS to 2500 male American sailors to assess how
many life events they had experienced in the past six months

 During the following six months, their health status was recorded

 Results showed a significant positive correlation between LCU scores and illness
scores, suggesting that as life change scores increased, so did the frequency of
illness
 Work as a cause of stress by Chandola et al. (2008), investigated the link
between workplace stress and coronary heart disease (CHD)

 This was a longitudinal study conducted on 10,000 male and female civil
servants from the UK from 1985 to 2004

 There were seven phases during this time which involved postal questionnaires
and clinical examinations

 Work stress was assessed through a job strain questionnaire

 Job strain is recorded as high job demands but low control

 Iso-strain was also recorded which refers to social isolation at work

 A total work stress score was assigned to each participant based on the total
number of reported incidents of work strain or iso-strain in phases 1 and 2 of the
study

 For those aged 37-49 years, at phase 2, there was a significant association
between greater reports of work stress and higher risk of CHD

 There was little association between work stress and CHD for those aged 50 and
over
 For the younger age group, greater work stress was associated with poorer
health behaviours such as eating less fruit and vegetables, drinking more
alcohol, and being less physically active

 Approximately 32% of the effect of work stress on CHD can be explained by the
effect of work stress on unhealthy behaviours

 To conclude, work stress is a significant indicator of CHD in those under the age
of 50, partly due to unhealthy behaviours, and partly due to physiological
changes such as increased cortisol and higher blood pressure
 Personality type is a third cause of stress where Friedman and Rosenman (1978)
identified two personality types

 One personality type is a Type A personality which includes three main traits:
competitiveness, time urgency, and hostility

 The other type is Type B personality, who is more relaxed, patient and easy-
going, and these people do not become over focused on work, but rather
work towards goals steadily

 The researchers developed a series of questions to assess an individual’s

personality type
 Examples of questions include: “Do you feel guilty if you use spare time to
relax?” and “Do you generally move, walk and eat rapidly?” etc.

 They conducted a longitudinal study to test whether Type A personality

individuals are more at risk of heart disease

 Questionnaires were given to 3000 men aged 39 – 59, and based on their
responses, they would be classified as having either a Type A or Type B
personality

 Approximately half were Type A and half were Type B

 The men were followed for 8.5 years with 257 participants developing CHD
during this time

 From these, 70% were those with Type A personality

 When the results were adjusted to account for smoking and other lifestyle
factors, the results still showed those with Type A were almost twice as likely to
develop CHD
MEASURES OF STRESS
BIOLOGICAL MEASURES
 Recording devices for heart rate and brain function are forms of biological
measures of stress

 One such recording device is an fMRI which is a scanning technique used to

measure activity in the brain through cerebral blood flow

 Pulse oximeters are also a way to measure stress as they measure heart rate

 This is a small clip that is placed on the finger to measure the amount of oxygen
in the blood, with a higher heart rate being an indication of stress, however, this
is not necessarily the most accurate measure of stress
 Wang et al. (2005) conducted a study to measure stress levels through the use
of and fMRI

 Aim: to use an fMRI to measure cerebral blood flow changes in response to mild
to moderate stress as a result of a math task

 Sample: 30 American participants, with an even number of males and females,

aged 23 – 24 years

 Procedure: 23 participants (11 females, 12 males) were allocated to the

experimental group, and 7 (4 females, 3 males) were allocated to the control
group
 The participants went through four MRI scans of 8 minutes each with the first
and last ones being used as baselines

 The second scan was done during a low-stress task, and the third scan being
done during the high-stress task

 The low stress task involved counting aloud backwards from 1000

 The high stress task required the participant to subtract 13 from a four digit
number, and they had to answer aloud, along with being prompted to answer
faster, and start again if an error was made
 Self-reported stress and anxiety was measured through a scale rated from 1 – 9
along with saliva samples being collected to test for cortisol levels, which were
taken right after entering the scanner, and after each scan

 Participants also reported their level of effort, frustration and difficulty for each
task on scale of 1 – 9

 Heart rate was recorded through a pulse oximeter

 The control group were not required to perform any task, but had their cortisol
and heart rate tested, along with filling the self report scales, to test for any
stress caused by the MRI scanning
 All participants took part in the study between 3 to 5 pm to control for
fluctuations in cortisol levels throughout the day

 Results: Self report scores, heart rate and cortisol levels were higher for the high
stress task compared to the low stress task

 A positive correlation was found between cerebral blood flow activity in the
ventral right prefrontal cortex (RPFC), and the participants’ subjective ratings as
this is the part of the brain associated with negative emotions

 This suggests that stress is linked to activity in the RPFC with an increase in
cerebral blood flow in this region, and this would be higher for a higher stress
task
 There was also higher levels of cerebral blood flow in the RPFC with higher levels
of salivary cortisol levels and also with higher levels of self reported anxiety levels

 The activity in the RPFC remained higher even after the stressful activity ended
suggesting that psychological stress leads to a prolonged state of heightened
vigilance and emotional arousal

 However, difficulty and effort were not associated with RPFC changes
 Sample tests for salivary cortisol can also be used as a measure of stress, as
cortisol is a stress hormone

 Evans and Wener (2007) used salivary cortisol tests to measure stress in
commuters who were faced with crowding in a train

 Aim: to investigate the effect that overall crowding of the train (distal crowding)
and crowding in immediate space surrounding the participant (proximal
crowding) had on stress levels

 Sample: 139 adult commuters travelling from New Jersey to Manhattan, for
work every day
 Procedure: saliva samples were collected from participants at the end of their
morning trip to work, and at the same time at home on the following weekend

 Motivation was measured as well in the form of a proofreading task (measured

by the number of errors detected) towards the end of the commute

 Mood was also measured during the commute by the completion of two 5 –
point scales

 Crowding was assessed through distal levels (density of crowding across the
whole train carriage) and proximal levels (number of people sitting on the same
row as the participant)
 Results: distal crowding did not have a significant effect on any of the measures
of stress

 Proximal crowding, however, did have a significant effect on stress in terms of

all three levels (cortisol levels, motivation, and mood)

 Conclusion: Crowding in the immediate area around your seat has a significant
effect on stress, not the number of people in the carriage as a whole
PSYCHOLOGICAL MEASURES
 Life Events (Holmes and Rahe) – REFER TO NOTES ON CAUSES OF STRESS

 Personality (Friedman and Rosenmann) – REFER TO NOTES ON CAUSES OF

STRESS
MANAGING STRESS
PSYCHOLOGICAL THERAPIES
 Biofeedback is a technique that uses electrical sensors to allow you to receive
information about different functions of your body by changed on a monitor or a
beeping sound

 Receiving this feedback allows you to make changes such as relaxing muscles or
slowing down your breathing

 Budzynski et al. (1969) carried out a study to test the effectiveness of

biofeedback as a way of managing stress

 Aim: To investigate the effectiveness of biofeedback through an analogue

monitor to measure muscle tension caused due to stress
 Sample: 15 participants

 Procedure: The study took place over 20 one – minute trials, with trials between
one and three days apart, at the same time each day

 Participants were randomly assigned to one of three experimental conditions,

and were all told to relax deeply, especially the forehead muscle

 The first group was the Feedback Group, for whom the monitor would sound
different pitched tone to indicate muscle relaxation with a low tone
representing muscle relaxation, allowing the participant to know they were
doing the right thing and would be able to repeat the behaviour to master
muscle relaxtion
 The second group was the Irrelevant Feedback Group for whom the monitor
would give a constant low tone and were told the constant tone would help
them relax

 The third group was the No Feedback Group for whom there was no tone
given, and they were told to relax in silence

 Results: Those in the feedback group showed less muscle tension than the other
two groups throughout the trial with a mean decrease of 50%, followed by the
no feedback group with a mean decrease of 24%, while the irrelevant
feedback group actually saw an increase in stress levels with a mean of 28%

 One participant from the irrelevant feedback group was then made to go
through three feedback sessions, and his muscle tension decreased by 60%
RELAXATION AND IMAGERY IN THE TREATMENT OF BREAST CANCER
 Key study: Bridge et al. (1988)

 Imagery is a technique to reduce stress an involves imagining a peaceful scene which

leads to a sense of calm and relaxation, combined with the use of muscle relaxation to
reduce stress levels

 Aim: to find out the effect of relaxation and imagery on the stress experienced by
cancer patients

 Hypothesis: relaxation and imagery would both lead to a reduction in stress compared
to those who did not undergo either, and women who underwent relaxation and
imagery would have more of a positive effect than those who only had relaxation
 Sample: 139 women who were outpatients undergoing a 6 week course of
radiotherapy

 The were under the age of 70 and all attending a hospital in London, UK

 Procedure: The women were randomly assigned to one of three conditions

 The groups were: a control group (no treatment given), a relaxation group, and
a relaxation plus imagery group

 Those receiving relaxation or relaxation plus imagery were taught a relaxation

technique involving directing sensory awareness to muscle groups, as well as
instructions for deep breathing
 Those in the relaxation plus imagery group were also taught to imagine a
peaceful scene as a way of enhancing relaxation

 The women were given a tape to listen to for 15 minutes every day which
repeated the instructions that had been given to them

 All women were seen by a researcher for half an hour once a week for the six
weeks during which the treatment groups practiced their exercises, while the
control group were encouraged to talk about themselves and their interests

 Two questionnaires were used to assess mood of the patients, and their anxiety
and depression levels
 These were the profile of mood states questionnaire which was a 65 item self
report measuring several aspects such as tension, fatigue, anger etc. resulting in
a total mood disturbance score

 The other was the Leeds general scale which was a self report that measures
severity of anxiety and depressive symptoms and contains 6 items for anxiety
and depression each, rated on a four – point scale

 Results: Mood states for women in the relaxation group and relaxation plus
imagery group improved after 6 weeks, with the latter seeing a greater
improvement

 The mood states of those in the control group worsened during the same period
 These scores were higher for the relaxation and relaxation plus imagery group
women aged 55 compared to younger patients, particularly for depression and
tension scores

 Women who scored high on anger however, did not respond well to relaxation
or relaxation plus imagery

 There was no significant difference in the scores on the Leeds general scale for
the three groups
PREVENTING STRESS
 Meichenbaum designed the Stress Inoculation Training (SIT) which is a form of
CBT to help people cope with stress

 The idea behind this form of therapy is to expose people to increasing levels of
perceived stress so they can practice coping skills and develop an increased
tolerance for stress

 Sessions can be anywhere between 8 to 40 depending from patient to patient

 There are three phases to SIT

 Conceptualisation: during this stage, the client and therapist work together to
get an understanding of the client’s source of stress

 The clients talks through their experiences and current method of dealing with
stress

 The therapist then shows the client how to rethink of a stressor as a problem that
needs to be solved

 This is important to help the client understand that there are aspects of a
stressor that can be changed, and some parts that cannot
 Skills acquisition and rehearsal: clients learn new coping skills that are designed
to suit their unique set of circumstances

 These coping skills are initially practiced at therapy, and eventually, the client is
encouraged to practice them in the real world

 The clients are taught problem solving skills, relaxation techniques, mindfulness
training, and diversion techniques

 Application and follow through: this is the stage where the client will apply what
they have learned in the real world
 They will apply this with increasingly stressful situations

 Techniques such as visualizing a stressful situation or role-playing may be

practiced or used during therapy to help better prepare the client to be able
to apply these techniques in the real world, particularly, for highly stressful
situations