Stress - AQA Psychology A-level Notes

Stress Part 1 — The Physiology of Stress:

• Selye (1936) and the General Adaptation Syndrome (GAS):
  • Stress helps us adapt to new situations.
  • Involves three stages:
    • Alarm Reaction: Immediate physiological response upon perceiving a stressor.
      • Increased activity of the sympathetic branch of the autonomic nervous system (ANS), dictated by the hypothalamus.
    • Resistance: Short-term stress response where the body tries to resist the stressor.
      • Rapidly consumes energy resources.
      • If stressor becomes chronic, increased activity in the parasympathetic branch to reduce physiological responses.
    • Exhaustion: Original physiological symptoms return.
      • The body's energy resources become drained, leading to immunosuppression and 'diseases of adaptation' (e.g., CVD and hypertension).
• Animal Study Evidence (Seyle, 1936):
  • Exposed rats to stressors (e.g., forced extreme exercise).
  • Within 6-48 hours, all rats responded similarly to initial and prolonged stressors.
    • Alarm reaction to initial stressor.
    • Resistance and exhaustion to chronic stressor.
  • Provides evidence for the stages of stress, despite physiological differences between rats and humans (nervous system complexity, hormone concentrations like cortisol).
• Physiological Responses to Stress: Acute vs. Chronic
  • Acute Stress:
    • The body perceives an immediate stressor.
    • Sensory neurons transmit information to the hypothalamus.
    • The hypothalamus triggers increased sympathetic branch activity in the ANS.
      • Produces physiological arousal for fight or flight response/sympathomedullary pathway.
    • Examples: Adrenaline and noradrenaline release from the adrenal medulla, causing:
      • Vasoconstriction
      • Pupil dilation
      • Rectum contraction
    • Once the stressor is no longer an immediate threat, the parasympathetic branch increases activity.
      • 'Rest and digest' response decreases activity increased by the sympathetic branch.
  • Chronic Stress:
    • Activation of the hypothalamic-pituitary-adrenal system (HPA) produces longer-lasting effects.
    • Release of CRF (corticotropin-releasing factor) increases pituitary gland activity.
      • The pituitary gland releases ACTH.
    • Cortisol (the 'stress' hormone) is released by the adrenal cortex, depending on ACTH and CRF levels.
      • Maintains fight or flight response for a longer time than the acute response.
    • Cortisol levels are reduced through negative feedback, reducing ACTH and CRF output from the HPA system.
      • Prevents unnecessary physiological damage.
• Beta Bias in Early Fight or Flight Research:
  • Early research minimized differences between males and females.
  • Often used male lab mice due to lower hormone fluctuations.
  • Assumed the same response in females and generalized as such.
  • Taylor et al. (2006) supported the 'tend and befriend' approach as an alternative in females, reducing the risk of abandoning their young.
  • Indicates a beta bias in psychological stress research.
• Real-Life Applications:
  • Improved treatments for Addison’s Disease: Inability of adrenal glands to secrete cortisol.
  • Patients cannot deal with highly stressful situations, often resulting in an ‘Addisonian crisis’.
  • Understanding cortisol's role in negative feedback systems and the SAM may result in effective cortisol replacement treatments.

Stress Part 2 — The Role of Stress in Illness:

• Immunosuppression:
  • Continuous cortisol release from the HPA system results in immunosuppression.
  • Can also occur indirectly through affecting life factors (e.g., insomnia, disrupted eating, drug abuse).
• Acute Stress Example: Examinations:
  • Kiecolt-Glaser et al. (1984) found a reduction in natural killer cells and T killer cells in medical students' blood samples on the first day of exams compared to one month before.
  • Supports the idea that extended HPA activity may result in immunosuppression, due to the role of T killer cells in identifying and engulfing foreign pathogens.
  • Kiecolt-Glaser et al. (1991) found that carers of patients with Alzheimer’s Disease reported higher susceptibility towards EBV and 26% higher rates of depression compared to a non-caregiver control group.
  • Supports the role of acute stressors in increasing the risk of mental health disorders and raising overall stress levels.
• Chronic Stress Example:
  • Wilbert-Lampen et al. (2008) reported a 2.66 increase in the likelihood of suffering from a myocardial infarction during the 1996 World Cup.
  • Yusuf et al. (2004) suggested that chronic stress might be a more serious risk factor in the development of a myocardial infarction than obesity, based on data from 15,000 MI patients from an INTERHEART study.
• Acute vs. Chronic Stressors:
  • Dharbhar (2008) found that exposing rats to an acute stressor benefited immune functioning through an increase in T lymphocytes in their blood, demonstrating an ‘immunoenhancing’ effect.
  • Indicates that occasional, moderate exposures to acute stressors may be beneficial.
• Role of Stress in Disease Progression:
  • Pereira et al. (2003) found that pre-cancerous cervical lesions were more likely to develop in HIV-positive women if they had experienced stressful events one year prior to their diagnosis.
  • Public health services offering guidelines on lowering stress may reduce disease progression (and treatment) and prevent initial development.
• Issues with Stress Research:
  • Most research is based on non-human animals exposed to stressors like electric shocks or food deprivation.
  • These stressors are different from those humans experience.
  • Effects in humans may vary more due to personality differences.
  • May lack mundane realism and have low ecological validity.

Stress Part 3 — Sources of Stress: Life Changes:

• Stressful Life Changes:
  • Life changes (negative and positive) can be stressful because they require physical and/or psychological adaptations, supported by stress.
  • A positive correlation exists between adaptation required and stress levels.
  • Experiencing several life changes can lead to a 'cumulative effect' of stress.
• Measuring Stress of Life Changes:
  • Social Readjustment Rating Scale (SRRS) is used to quantify stress objectively.
  • Each stressful event is given a different Life Change Unit (LCU).
    • Example: Divorce (LCU = 73), Marriage (LCU = 50).
  • Holmes and Rahe (1967) found a positive correlation between increasing LCU scores and the likelihood of developing an illness.
    • The risk increasing by 50% once the 300 LCU threshold had been reached.
  • Rahe et al. (1970) found that US Navy personnel who experienced highly stressful life events 6 months before deployment were significantly more likely to experience illness during their deployment.
  • Life changes may be able to predict the likelihood, and even types, of falling ill.
• Individual Differences:
  • Researchers who attempt to quantify stress associated with each life change may be ignoring individual differences, as suggested by Byrne and Whyte (1980).
  • Varying circumstances of each life event can make it more or less stressful.
    • Example: Reasons for divorce are important (e.g., abusive relationship).
  • Cannot make universal assumptions; each life event affects each person differently, alongside changing circumstances unrelated to the original life change.
  • Question the validity of life changes as a source of stress.
• Methodological Issues:
  • Reliance on correlational studies cannot demonstrate 'cause and effect' relationships.
  • Correlational studies do not account for the 'third variable problem'.
  • It is difficult to make causal conclusions, reducing the validity of life changes as a source of stress.
• Daily Hassles vs. Life Changes:
  • DeLongis et al. (1988) suggested that daily hassles may have a greater effect on stress development.
  • Studied 75 married couples and found that the accumulative effect of 'minor' daily hassles produced greater stress than life changes.
  • Studies investigating life changes may not have accounted for the confounding variable of daily hassles.

Stress Part 4 — Sources of Stress: Daily Hassles (Lazarus, 1980):

• Comparison:

  • Daily hassles are frequent and predictable, opposite life changes (unexpected and rare).
  • Daily hassles are distal causes of stress (directly cause stress), life changes are proximal causes (indirectly cause stress).
  • A major life change brings with it many daily hassles, such as arguments over finances, learning that your partner is very untidy and changing social arrangements.

• Appraisal Processes:

  • Lazarus suggested we go through two processes each time we experience a daily hassle:
    • Primary appraisal: Assess the severity of the hassle.
    • Secondary appraisal: Consider whether we can cope with the hassle on this basis.

• Research Evidence:

  • Kanner et al. (1981) investigated whether daily hassles were a larger or smaller source of stress compared to major life changes.
  • 100 participants independently completed the Hassles Scale every month for three-quarters of a year, and then self-reported any major life changes one month before and after the main study, using a measure similar to the SRRS.
  • Any signs of mental illness or disturbance were then measured using the Hopkins Symptoms Checklist.
  • Overall, reported that despite there being a positive correlation between daily hassles and stress, daily hassles proved to be significantly more stressful than major life changes.
  • Supports the ideas of DeLongis et al, where the cumulative effect of many ‘minor’ daily hassles are more difficult to adjust to, and therefore are more stressful, compared to life changes.

Stress Part 5 — Sources of Stress: Workplace Stress:

• Interactionist Approach:

  • Suggests that adopting an interactionist approach to explaining the sources of stress may be more beneficial than looking at daily hassles or life changes in isolation.

• Amplification Hypothesis:

  • According to the amplification hypothesis, the severity of daily hassles may become ‘amplified’ or over-exaggerated when accompanied by major life changes, as suggested by Li (1991), where such hassles may therefore be enough to push us over the edge.
  • It may be more useful to study how these two factors interact!
    • An example: the daily hassle of losing a set of keys is amplified when a new mother has to pick up her child from the nursery.

• Gender Differences:

  • Just as there are individual differences between different people as to how daily hassles affect them, the same differences can be applied to men and women, as suggested by Helms et al (2010), due to varying gender roles.
  • Suggests that we cannot and should not generalise the severity of daily hassles to both genders, thus being an example of alpha bias.
    • An example: running out of washing powder or bin liners may be perceived as a far greater and stressful daily hassle for women, compared to men, whose typical gender role is to look after the home.

• Retrospective Research Issues:

  • Suggests that the validity and reliability of such studies is compromised, and that prospective studies may be a more reliable alternative e.g. Rahe et al (1970).
  • Most of the research carried out into the effects of daily hassles are retrospective, meaning that they rely on the accuracy of participant’s memory and recall.
    • This may become particularly problematic when participants are asked to recall all of the daily hassles experienced during the past year, many of which are seemingly trivial (such as losing your keys) and so are far more likely to be forgotten.

• Workload and Control:

  • According to this model, the degree of control that an individual has over their work is more important than workload in terms of determining stress levels
    • Therefore, if two individuals have the same workload, if one is less stressed than the other, then this suggests that they have a higher degree of control over their work e.g. greater flexibility etc.
  • It has been suggested that workload and control are the two main factors associated with workplace stress, as depicted by the job demand-control model (Karasek, 1979).

• Research Evidence:

  • Bosma et al (1997) may have incorrectly assumed that maintaining a higher degree of control over your work is less stressful - the converse may be true, as suggested by Meiser et al (2008).
  • This was demonstrated by Bosma et al (1997) who found that there was no correlation between stress-related illnesses and workload in a sample of 10,000 Whitehall civil servants, but rather a strong negative correlation between a decreasing degree of control over work and increasing levels of stress/incidence of stress-related diseases.
    • This stood true even when accounting for lifestyle and personality factors, using a statistical averaging technique
    • Therefore, this confirms the original prediction made by Karasek’s job demand-control model

• Self-Efficacy:

  • Meiser et al (2008) suggested that more emphasis should be brought upon self- efficacy, which is an individual’s perception about how well-equipped they are to complete the task at hand.
    • There was a negative correlation between decreasing self-efficacy and increasing stress associated with increased control.
      • A person with high levels of self-confidence in their own abilities may struggle with having little control over their work and making few decisions, because they feel that they are capable of more.
    • Therefore, self-efficacy should be emphasised as being a subjective perception but also influential in the development of stress.

• Limitations:

  • The Whitehall studies in particular suffer from a lack of control over confounding variables.
    • Workload and control are not the only two factors associated with a job - pay, conditions, colleagues, the insistence of a boss to complete tasks and subjective feelings of responsibility all contribute towards the stress felt by the individual.
    • Therefore, this reduces the validity of Kas arek’s job demand-control model as an explanation for sources of stress because it only focuses on a very narrow part of working life.
    • Many other confounding variables are not accounted for within the model and so it is unknown whether these factors have a greater impact on the development of stress compared to workload and control.

Stress Part 6 — Measuring Stress:

• Key Points:

  • The two main self-report measures of stress are the Social Readjustment Rating Scale (SRRS) and the Hassles and Uplift Scale.

• Social Readjustment Rating Scale (SRRS):

  • Comprised of 43 items ranked on a scale of 1 to 43 (1 = most stressful).
  • Each 'item' represents a stressful life event.
  • Assigned a Life Change Unit (LCU) based on Holmes and Rane's original sample.
  • Participants recall major life changes over a set time period.

• Hassles Scale:

  • Developed by Kanner et al. (1981).
  • Made up of 117 items of different severity in terms of provoking stress.
  • Severity measured (by Kanner’s original sample) on a three-point Likert-like scale.

• Uplift Scale:

  • Uses the same methodology as the Hassles Scale, but with positive, stress-reducing events.
  • Includes 135 items like getting enough sleep and being amicable with work colleagues.
  • DeLongis et al. combined the Hassles and Uplifts Scales in 1988 for a more balanced measure of stress contributors and detractors.

• Skin Conductance Response (SCR):

  • Physiological stress measure.
  • Electrodes are attached to index and middle fingers.
  • Increase in sweat (due to increased sympathetic activity) coincides with increased conductance.
  • Readings on a 'polygraph' are compared against a baseline measure.

• Limitations:

  • Skin Conductance Responses ignore individual differences, such as the variability of SCRs between individuals at rest.

• Global vs Specific Approach of Assessing Stress:

  • Global Measures of Stress Have Little Predictive Value of the Likelihood of Developing Specific Illnesses.

• Validity Issues:

  • All three types of stress measurement scales suffer from validity issues, as suggested by Dohrenwend et al (1990) because different participants may understand each item in different ways.
  • The phrasing of certain items is not clear in all cases, and would need to be further clarified to increase the validity of these methods.

Stress Part 7 — Individual Differences in Stress - Personality Type:

• Type A Personality:

  • Associated with hostility, competitiveness, and time urgency.
  • Espeically likely to develop CHD.
  • Friedman and Rosenman found that 70% of individuals who developed CHD in their study had Type A personalities.
  • May be too board and general because it includes vastly different traits i.e. competitiveness, time urgency and hostility.

• Type B Personality

  • Opposite traits to Type A: casual, slow-paced attitude, accepting of competition, amicable.

• Type C Personality:

  • Linked with an increased risk of developing depression.
  • Keen to please others but often suppress their own emotions.
  • Dattore et al (1980) found that 75 cancer patients reported significantly greater levels of emotional suppression and fewer depressive symptoms, compared to a control group of non-cancer patients.
  • It could be that age is a more reliable predictor of the development of cancer compared to the incidence of individuals with Type C personalities
    As suggested by Greer and Morris (1975).

• Evidence Supporting of Type A Personality
  Out of a sample of 150 Spanish men and women below the age of 65, Type A personalities were at a significantly larger risk of developing a stroke, even when lifestyle factors (e.g. diet and alcohol consumption) had been accounted for.
  As suggested by Edigo et al (2012).

• Focus on Specific Elements:

  • Dembrowski (1989) found a strong positive correlation between CHD incidence rates and hostility ratings.
  • More focus is required on the individual elements of each personality type, whilst making links between each element and the incidence of specific stress-related disorders.
  • Hostility element analysis by Carmelli et al (1991) support the above Dembrowski claim

Stress Part 8 — Individual Differences in Stress: Hardiness:

• Hardiness Definition:

  • Resilience and adaptability to everyday changes, providing 'existential courage.'
  • According to Kobasa (1979) and Maddi (1986).

• Hardiness Dimensions:

  • Commitment: Submerging oneself in new tasks, viewing challenges as opportunities for self-improvement.
  • Challenge: Taking a positive outlook on stressful situations, seeing them as opportunities to adapt.
  • Control: Believing in and taking responsibility for life events, believing one has a high degree of control.

• Research Support:

  • Kobasa (1979) found those who coped best with stress displayed the highest levels of resilience (commitment, challenge, control).

• Additional Support:

  • Maddi (1987) found that those that who showed improved productivity and a decreased likelihood of developing stress-related illnesses i.e. a negative correlation.

• Limitations:

  • Bartone’s ‘Dispositional Resilience Scale’ (2000) may be a more accurate measure of hardiness
    Neuroticism is a confounding variable in most current used scales.
  • The implication is that hardy people are also neurotic, which may not always be the case.
    Thus, the removal of this confounding variable is required to increase the validity of the measurement of hardiness

• Benefits of Increased Hardiness:

  • Contrada (1989), found reduced blood pressure fluctuations and reduced physiological changes in response to stressors

• Correlational

  • Could be that hardy people maintain their low stress levels through making good lifestyle choices, such as regularly exercising and avoiding excessive alcohol consumption.
  • It could also be the case that hardy people may find certain stressors less stressful than the neurotypical population, and so experience reduced physiological arousal.
  • draws into the question the validity of hardiness as an explanation for individual differences in stress

Stress Part 9 — Managing and Coping with Stress: Drug Therapy:

• Drug Therapies:

  • Include Benzodiazepines (e.g., Xanax) and Beta Blockers (e.g., Propranolol).

• Benzodiazepines:

  • Molecules attach to GABA neurotransmitters, which then bind to GABA-A receptors on the post-synaptic neuron.
  • This triggers the opening of voltage-dependent chloride is channels in the postsynaptic neuron, resulting in a decreasing frequency of nervous impulse transmission within the synapses of the brain, thus reducing the psychological (stress) effects associated with the fight or flight response.
  • Decrease the likelihood of an action potential in the postsynaptic neuron.

• Beta Blockers:

  • Bind to beta-adrenergic receptors on the postsynaptic membrane, preventing depolarisation
  • Therefore, this results in reducing the frequency of nerve impulse along motor neurons to the effector muscles or glands, this weakening the physiological effects of the fight or flight response.

• Differences:

  • Area of the body upon which they act (i.e. either the brain or the sympathomeduallary pathways
  • The neurotransmitters or hormones they affect (i.e. wither GABA or adrenaline/noradrenaline)
    Whether this causes unconsciousness (as is the case with benzodiazepines due to acting on the brain

• Double blind and placebo test suggest evidence of support for effectiveness of benzodiazepines.
  As reviewed by Baldwin et al (2013).

• Limitations:

  • Drug therapies can only treat the proximal symptoms of stress i.e. anxiety, therefore, such therapies do not address the main cause of stress.
  • A major issue associated with the use of drug therapies is the risk of dependency and side- effects, as suggested by Gaind and Jacoby (1978).
  • Dependency can lead to tolerance( synapses, specifically the voltage-dependent calcium ion channels embedded in the postsynaptic membrane, become less responsive to the effects of the drug).

Stress Part 10 — Managing and Coping with Stress: Stress Inoculation Therapy

• Stress Inoculation Therapy - SIT:

  • Based on the cognitive approach to managing stress.
  • Changing the way we think about and anticipate stress, we can decrease negative and irrational/catastrophic thinking and implement more effective behaviours.

• Three stages

  • Conceptualisation

• Skills acquisition and rehearsal
  Reale life application and follow-through phase.

• Conceptualisation

  • The patient and therapist clarify the patient’s stressors, focusing on minimising the sources of stress which they can change, whilst developing new strategies to deal with the sources of stress which they cannot change.
  • change cognitive appraisals from negative to positive

• Skills Acquisition and Rehearsal

  • Therapist teaches skills to manage anxiety (e.g., breathing techniques, meditation).
  • Emphasize Cognitive Aspects

• coping self-statements’ i.e. encouraging statements which the patient can use to reinforce the effectiveness of their stress management

• Real-Life Application and Follow-Through

  • Put skills learned in stage 2 into practice, through the use of role-play and potentially virtual reality systems.
  • Personal experiments’ are assigned, whereby the patient deliberately puts themselves into stress-provoking situations, in an attempt to implement the skills they have learnt
    • Relapse prevention is acknowledged as inevitable and seen as an opportunity to further the skills of inoculation that the patient has i.e. the way they anticipate and deal with future stressors

• Flexibility (Advantage)

  • The flexibility of SIT is a important advantage, as programmes can be tailor-made for individuals
    • Additionally, SIT should not be limited to face to face interactions with therapists as it could be adapted as part of online therapies

• Limitations

  • In an multidisciplinary approach towards managing and coping with stress, SIT may have not focused enough on each element of stress and so reduced the effectiveness of such a treatment for others
    • A patient who feels that they have little control over their stress responses may only aggravate their stresses further, through negative cognitive appraisals of stress
    • SIT may be less effective for torture survivors for this exact reason - the lack of control perceived by patients means that their stress is prolonged, continuous and so more likely to be chronic

Stress Part 11 — Managing and Coping with Stress: Biofeedback:

• Biofeedback

  • The aim of biofeedback is to increase the level of control that patients have over their physiological processes that are associated with stress.
  • Physiological activity in the brain, for example, can be measured using an EEG whilst respiration rates can be measured using a spirometer, which makes recordings on a kymograph.

• Process

  • Transfer (to real life) the learned changes to their physiological responses to stressors, main process of biofeedback
    The patient recognises their physiological responses to stressors through an auditory or visual signal.

• successful biofeedback responses result in, for example, the patient successfully completing a game or maze

• Repetitive successful biofeedback responses are positively reinforced, and so lead to an increase in the frequency of such behaviour through operant conditioning.

• Effectiveness

  • SIt has effects of lowering stress through the stabilisation of the HPA system (hypothalamic-pituitary-adrenal system)
  • achieved through biofeedback using the mechanisms of operant conditioning
    • As Davis (1986) Suggests, biofeedback effectiveness by reporting in breast cancer patiens with less cortisol.

• utility of biofeedback

  • These doctor who practiced more biofeedback had better resutls with a sample of doctors practicing biofeedback over 28 days, fell substantially more compared to a control group

• Limitations

  • May not be appropriate stress treatment for all individuals- requires high levels of motivation!
    Also an unnecessary combination, as relaxation is not needed along with biofeedback in most cases.

Stress Part 12 — Gender Differences in Coping with Stress:

• Copings and Approach

  • Men take a problem-solving approach
  • Women take an emotional-focused approach, Lazarus and Folkman (1984).

• Demonstrations

  • Solutions To alleviate the stressor for Man, while woman blamed themselves more.
    *Peterson at el (2006) show in infertile couples that men approach their problems with practical solutions while women blame themselves more.

• Technique
  tend and befriend’, is particularly used by women, Taylor et al (2000).
  forming social networks with other women from whom emotional support can be found, as well as caring and nurturing others through blending into’ the current stressful environment, is a method of managing stress used by women as an alternative to the fight or flight response
  -Taylor et all- Enhanced enhanced effects for 'tend and befriend’.

  • Social Support
    Luckow et al (1998), women have a preference the seeking of social support than men.

• Gender Specific Copings and Constraint Role
  *May be reflective of different stressors each are exposed to

  • Matud 2004, woman report more family issues , and men, work related

• Cognitive Biases Limitiations

  • De Ridder (2000), , recall Women appear to recall significantly more instances where they have used emotion-focused techniques to deal with stress, and men as well.
    Retrospective research is a problem, there may be other differences and memory issues among researchers, it seems to be there may other factor for gender difference.

• Support
  enhanced levels for 'tend and befriend’ for Woman.
  May have a neurochemical basis, due to the action of oxytocin.
  -Tamres et al (2002), women use high levels of stress reduction using emotion focused systems
  This warm and nurturing element is reflected in correlations with post natal levels with a between a mother-infant attachment
  -Feldman et al (2007).

# Stress Part 13 — The Role of Social Support in Coping with Stress:

• Intensity and amount of support
  -Key to this idea is the degree of integratedness’ may provide great social support compared to having a wider circle with less intense attachment and friendships

• The three basic types of social support:

• instrumental (practical) support

• emotional support (improves the person’s mood)

• esteem support (increases the person’s self-esteem and self-efficacy
  (Schaefer et al 1981)

• **the person providing the support does not need to be physically present **
  -For example sending a get well card
  *

Cohen et al (2015).**demonstrated immunoenhancing effects on the average person, with a social support in the form of hugs

• social differences
  -Men do not use social support as much as women

**buffered ** buffering hypothesis’.
stress during stressful situations and a lack of support is unwelcome and may produce more stress compared to the actual stressor

• Research support for emotional support/Buffer
• Fzwy et al (1993)-Cancer patients with better support reported with support groups reported higher survival and natural T killer cell counts