Lecture 5/6 Notes: Stress and Illness

Stress and Illness — Lecture Notes

• Lecture context

  • Health Psychology focus: stress, coping, social support, personality, coping strategies, clinical health psychology

  • Topics covered: stress as a stimulus, stress as a cognitive process consequence, stress as a bodily and psychological response, measurement, and research methods

  • Key models: Lazarus’ transactional model of stress, General Adaptation Syndrome (GAS), Tend-and-Befriend (Taylor), cognitive appraisal, and measurement tools (SRRS, PSS)

Stress is a Stimulus

• Stressors are events or circumstances that trigger stress

• Daily hassles are minor stressful events (e.g., traffic jams, waiting in line, small decisions)

  • Effects: reduce psychological well-being in the short term, produce physical symptoms, worsen symptoms in the ill, associated with distress, negative mood, diminished life satisfaction

  • Anticipation can be as stressful as actual occurrence

• Chronic stress: a stressful experience that is a usual but ongoing aspect of life

• Holmes & Rahe (1967): The Life Stress Inventory / Social Readjustment Rating Scale (SRRS)

  • Instructions: mark life events that happened in the previous year, total the points

  • Life events (sample with mean values):

  • Death of spouse — $100$

  • Divorce — $73$

  • Marital separation from mate — $65$

  • Detention in jail or other institution — $63$

  • Death of a close family member — $63$

  • Major personal injury or illness — $53$

  • Marriage — $50$

  • Being fired at work — $47$

  • Marital reconciliation with mate — $45$

  • Retirement from work — $45$

  • Major change in health or behavior of a family member — $44$

  • Pregnancy — $40$

  • Sexual difficulties — $39$

  • Gaining a new family member (birth, adoption, etc.) — $39$

  • Major business readjustment — $39$

  • Major change in financial state — $38$

  • The SRRS is used to predict illness, but has weaknesses (see below)

  • Mean values provide a sense of the relative stress load associated with different events

Stress is a Consequence of a Cognitive Process

• Stress is not just a stimulus; events acquire cognitive meaning through appraisal

• Transactions involve assessing demands, resources, and discrepancies

• Factors affecting appraisal include past transactions and individual differences

• Discrepancies and resources

  • Stress arises when demands exceed resources (e.g., three exams in one day)

  • Discrepancies can also occur when resources exceed demands (e.g., doing an easy, boring task)

  • Inaccurate assessment of demands/resources can create discrepancies (e.g., studying for an exam only a day before)

• Lazarus’ transactional model (early version)

  • Stimulus event -> Appraisal processes

  • Primary appraisal: threat, loss, or challenge; can be positive/negative/neutral/irrelevant

  • Secondary appraisal: coping resources; usually follows primary appraisal

  • Coping behavior follows appraisal

  • Diagram reference: Figure 11.1

• Primary appraisal details

  • Meaning of the situation for wellbeing

  • Judgements: Positive, Negative, Neutral, Irrelevant

  • Implications:

  • Challenge: ability to benefit from a situation by using more than routine resources to meet demand

  • Threat: expectation of future harm

  • Harm-loss: amount of damage that has already occurred

• Secondary appraisal details

  • Ongoing assessment of resources available for coping

  • Usually follows primary appraisal but not necessarily

  • Overall subjective stress experience is a balance between primary and secondary appraisal

• Personal factors affecting appraisal

  • Self-efficacy: confidence in ability to solve problems

  • Motivation: importance of goal increases perceived stress

  • Belief system: attitudes toward encountering stress

  • Hardiness: resilience to stress

• Situational demands that influence appraisal

  • Strong demands and imminent events increase stress

  • Ambiguity (lack of clarity in a situation) increases stress

  • Desirability of the situation

  • Controllability: real or perceived ability to modify/terminate the stressor

  • Change: whether the change is good or bad

Stress is a Response

• Cannon’s Fight-or-Flight theory (1932)

  • Perceived threat triggers arousal of the sympathetic nervous system and endocrine system

  • Fight or flight response prepares to attack or flee

  • Adaptive for rapid responses; harmful if prolonged

• Tend-and-Befriend (Taylor, 2000)

  • Response pattern especially among young and vulnerable individuals

  • Befriend: seek social group support during threat

• General Adaptation Syndrome (GAS) (Selye, 1956)

  • Nonspecific pattern of physiological response to stress

  • Stages of prolonged stress:

  • Alarm reaction: intense, emergency reaction, increased arousal

  • Resistance: body adapts; arousal remains above normal; immune function may be impaired

  • Exhaustion: energy reserves depleted; prolonged stress can cause serious damage or death

  • The “stress triad”: affected organs during stress

  • Adrenal glands enlarged

  • Thymus (immune tissue) shrinks

  • Bleeding ulcers in the stomach

• Criticisms of GAS

  • Limited role for psychological factors; cognitive appraisals influence physiological response

  • Stress as outcome rather than precursor; anticipatory stress not captured

• Criticisms of non-specificity of GAS

  • Psychological factors (e.g., challenge vs threat) modulate physiological responses

  • Controllable threat associated with less severe physiological changes

  • Key references: Blascovich & Tomaka (1996); Kemeny (2003)

Acute vs Chronic Stress; Physiological Consequences

• Acute vs chronic stress

  • Time course: short-term vs long-term

  • Variation in intensity and duration

• Moderate level of stress physiology

  • Hippocampus: increased blood flow, energy, and glutamate (neural activity under moderate stress)

  • Sympathetic nervous system activation

  • Moderate glucocorticoids

• Long-term effects of chronic stress

  • Endocrine system: cortisol patterns often elevated chronically; morning peaks may be higher, later decreases less pronounced; post-meal elevations possible; evening levels lower

  • Catecholamines: higher levels linked to atherosclerosis risk

  • Cardiovascular: altered heart and blood vessels function; uncertainty about direct causality with CHD; correlations observed; high job stress associated with hypertension; changes in platelets and lipids increase atherosclerosis risk

  • Immune system: suppression of lymphocyte production due to catecholamines and corticosteroids; increased infection risk; reduced immune surveillance against carcinogens and mutant cells; sleep quality can be affected

• Stress and pregnancy

  • Stress can affect immune and endocrine systems and the fetus; associated with preterm birth and low birth weight

  • Greater vulnerability observed in African-American women

• Individual differences in stress reactivity

  • Variability due to genes, environment, and prior experiences

  • Supporting reference: Cohen et al. (2002)

Cognitive and Emotional Impacts of Stress

• Cognitive impacts

  • Stress can distract attention or sharpen focus on the stressor

  • May impair cognitive functions including short- and long-term memory and motivation

  • Ruminative thoughts about stressful events

  • Severe stress linked to Acute Stress Disorder

• Emotional impacts

  • Appraisals shape emotional reactions

  • Infants: distress or anger responses; adults: fear, anxiety, anger

  • Chronic stress as a strong predictor of depressive symptoms (e.g., McGonagle & Kessler, 1990)

• Social impacts

  • Tend-and-befriend can foster cooperation in some contexts

  • Stress can lead to hostility, social withdrawal, and reduced helping behaviors

Adaptation, Habituation, and Moderators

• Habituation and adaptation to stress

  • Most people adapt to moderate or predictable stressors (e.g., noise, crowding)

  • Vulnerable populations (children, elderly, the poor) may experience less control and adverse effects

  • Physiological adaptation can occur via habituation or chronic strain; immune system may be compromised by long-term stress

• Can people adapt to stress?

  • Mixed evidence; some adaptation occurs, but chronic stress can lead to ongoing strain and health consequences

Conducting Stress Research and Measures

• Manipulation of stress in experiments

  • Impromptu speech tasks (e.g., Gramer & Reitbauer, 2010)

  • Mental arithmetic tasks (e.g., Kamarck et al., 1995)

  • Cold pressor task

  • Anger recall task

  • Example study: Gramer & Reitbauer – social support influences cardiovascular responses during stressor anticipation and active coping

• Assessing stress: measurement approaches

  • Self-reports:

  • Perceived stress, life change, emotional distress

  • Perceived Stress Scale (PSS) by Cohen (1994)

  • Behavioral measures: task performance under stress

  • Life events inventory: SRRS (Holmes & Rahe, 1967) – list of life events with scores predicting illness; weaknesses include subjective interpretation and not accounting for individual impact

• Specific scales and measures

  • Perceived Stress Scale (PSS): Cohen et al. (1983)

  • Questionnaire assesses how often in the last month you felt or thought certain ways (0 = Never to 4 = Very Often)

  • Example items include loss of control, coping capabilities, and feelings of overwhelm

  • SRRS (Holmes & Rahe, 1967): life event list with associated point values; scores predict illness but do not capture individual differences in impact

  • Stress/Arousal Adjective Checklist (King et al., 1983)

  • Self-report checklist of adjectives to rate current arousal and emotional state (0–4 scale per item)

  • Physiological and biochemical measures (assessing stress responses)

  • Physiological: blood pressure, heart rate, respiration, galvanic skin response

  • Biochemical: hormonal markers such as cortisol; catecholamines (epinephrine, norepinephrine)

• Stress and illness: experimental evidence

  • Cohen et al. (1999): Stress-illness association

  • Procedure: measure psychological stress, expose to a virus, observe illness outcomes

  • Result: higher life stress leads to greater expression of illness upon exposure

Key Terms and Concepts Summary

• Stressor: an external event or circumstance that can provoke stress

• Stress: the overall experience resulting from the interaction of a stressful event with the person (cognitive appraisal, coping, and physiological response)

• Primary appraisal: evaluation of whether an event is a threat, loss, or challenge

• Secondary appraisal: evaluation of available coping resources

• Transactional model: stress as a product of ongoing appraisal and coping processes

• Coping: behavioral and cognitive efforts to manage demands

• Challenge vs Threat vs Harm-Loss: types of primary appraisal implications

• Controllability: perceived ability to modify or terminate the stressor

• GAS: a three-stage model of physiological stress response (Alarm, Resistance, Exhaustion)

• Tend-and-Befriend: social support as a coping mechanism, particularly for vulnerable individuals

• Perceived Stress Scale (PSS): a measure of subjective stress perception over the past month

• SRRS: a life events scale with weighted scores predicting illness, but with interpretive and individual-difference limitations

• Cortisol and catecholamines: key biochemical mediators of stress with broad health implications

• Immune function: suppression under stress increases infection risk and may influence cancer surveillance

• Sleep: stress can disrupt sleep, which in turn worsens health outcomes

• Individual differences: genetics, environment, prior experiences shape stress reactivity

Connections to Real-World Relevance

• Understanding daily hassles helps target short-term well-being improvements and prevent escalation into illness, especially in already ill populations

• Workplace and academic stress management programs can address appraisal processes and controllability to reduce perceived demands or improve resources

• Social support interventions may mitigate cardiovascular and hormonal stress responses during anticipation and coping

• Public health focus on pregnant individuals and at-risk populations may reduce adverse outcomes related to stress (e.g., preterm birth, low birth weight)

Foundational and Ethical Considerations

• Ethical measurement of stress in research: ensure minimal harm when exposing participants to stressors or pathogens

• Distinguishing subjective stress from objective stressors is crucial; both should be considered in research and practice

• Generalization limits: SRRS predictions vs individual experiences; need for multi-method assessment (self-report, behavioral, physiological)

Formulas and Numerical References

• Life Event mean values from SRRS (selected):

  • Death of spouse: $100$

  • Divorce: $73$

  • Marital separation: $65$

  • Detention in jail: $63$

  • Death of a close family member: $63$

  • Major personal injury or illness: $53$

  • Marriage: $50$

  • Being fired at work: $47$

  • Marital reconciliation: $45$

  • Retirement from work: $45$

  • Major health/behavior change of a family member: $44$

  • Pregnancy: $40$

  • Sexual difficulties: $39$

  • Gaining a new family member: $39$

  • Major business readjustment: $39$

  • Major change in financial state: $38$

• Physiological response concepts (notation):

  • Cardiac output: $CO$

  • Total peripheral resistance: $TPR$

  • Cortisol (glucocorticoids): elevated in stress

  • Catecholamines: $epinephrine, norepinephrine$

• Key model relationships (conceptual, not symbolic equations)

  • Stress exposure + appraisal + coping resources → subjective stress level and physiological activation

  • GAS: Alarm → Resistance → Exhaustion, with immune and endocrine involvement

Health Psychology focuses on understanding how psychological factors like stress, coping, and social support affect health. We'll cover stress as an external event (stimulus), how our thoughts influence it (cognitive process), and how our body and mind react to it. We'll also look at how to measure stress and research methods. Key models include Lazarus' transactional model, Selye's General Adaptation Syndrome (GAS), Taylor's Tend-and-Befriend response, and measurement tools like SRRS and PSS.

Stress is a Stimulus

• Stressors are events or situations that cause stress.

• Daily hassles are small, everyday stressors (like traffic or waiting in line).

• Effects: Daily hassles can quickly lower your mood, cause physical symptoms, make existing illnesses worse, and lead to general unhappiness.

• Just thinking about a stressful event can be as stressful as the event itself.

• Chronic stress: Long-term stress that's a regular part of someone's life.

• Holmes & Rahe (1967): The Life Stress Inventory / Social Readjustment Rating Scale (SRRS):

  • This scale asks people to mark major life events from the past year and then adds up points for each event.

  • The SRRS aims to predict illness, but it has limitations.

  • The average scores show how impactful different life events are.

Stress is a Consequence of a Cognitive Process

• Stress isn't just caused by events; it's also shaped by how we think about those events (appraisal).

• This involves looking at what a situation demands, what resources we have to deal with it, and any gaps (discrepancies) between them.

• Our past experiences and personal traits influence how we appraise situations.

• Stress happens when the demands of a situation are more than the resources we have (e.g., three exams on one day).

• You can also feel stress when you have more resources than a situation demands (e.g., a very easy, boring task).

• Misjudging what a situation needs or what you can offer (e.g., studying for a big exam only a day before) can create stress.

• Lazarus’ transactional model (early version) explains stress as a process:

  • A stressful event occurs.

  • We appraise it:

  • Primary appraisal: We quickly decide if the event is a threat, a loss, or a challenge, or if it's neutral/irrelevant.

  • Secondary appraisal: We then evaluate our ability and resources to cope with the event. This usually happens after primary appraisal.

  • Finally, we engage in coping behaviors based on our appraisal.

  • Diagram reference: Figure 11.1

• Primary appraisal details:

  • We quickly judge if a situation is good, bad, neutral, or doesn't matter for our well-being.

  • It can be seen as:

  • Challenge: A chance to grow or gain something by using extra effort.

  • Threat: Expecting something bad to happen in the future.

  • Harm-loss: Damage or loss that has already happened.

• Secondary appraisal details:

  • We assess what resources and abilities we have to handle the situation.

  • This usually comes after primary appraisal, but not always.

  • Our overall feeling of stress comes from balancing how we see the situation (primary appraisal) with our ability to cope (secondary appraisal).

• Personal factors influencing appraisal:

  • Self-efficacy: How confident you are in your ability to solve problems.

  • Motivation: The more important a goal is, the more stress you might feel trying to reach it.

  • Belief system: Your general outlook on stressful situations.

  • Hardiness: Your ability to cope well with stress and bounce back.

• Situational factors influencing appraisal:

  • Highly demanding or urgent situations increase stress.

  • Unclear situations (ambiguity) also increase stress.

  • Whether the situation is desirable or not.

  • Controllability: How much you believe you can change or end the stressor.

  • Whether the change is positive or negative.

Stress is a Response

• Cannon's Fight-or-Flight theory (1932):

  • When we perceive a threat, our body's sympathetic nervous system and hormone (endocrine) system become highly active.

  • This prepares us to either fight the threat or run away.

  • This response is good for immediate dangers but can be harmful if it lasts too long.

• Tend-and-Befriend (Taylor, 2000):

  • This is a stress response mainly seen in women, and young or vulnerable individuals.

  • Instead of fighting or fleeing, they "tend" (nurture offspring) and "befriend" (seek support from others).

• General Adaptation Syndrome (GAS) (Selye, 1956):

  • Describes a general physical response pattern to long-term stress.

  • It has three stages:

  • Alarm reaction: The body's immediate emergency response with high arousal (like initial shock).

  • Resistance: The body tries to adapt to the ongoing stress; arousal stays high, and the immune system might weaken.

  • Exhaustion: The body's resources are used up, leading to serious health issues or even death if stress continues.

• Selye identified the "stress triad" of organs affected by prolonged stress:

  • Enlarged adrenal glands.

  • Shrinking thymus gland (part of the immune system).

  • Bleeding ulcers in the stomach.

• Criticisms of GAS:

  • It doesn't consider how psychological factors (like our thoughts) can affect the body's response.

  • It describes stress as something that happens after the stressor, not accounting for stress felt before an event (anticipatory stress).

• More criticisms: GAS is not always "non-specific":

  • Our psychological view (e.g., viewing something as a challenge vs. a threat) changes how our body reacts.

  • If we feel we can control a threat, our body's stress response can be less severe.

• Key references: Blascovich & Tomaka (1996); Kemeny (2003)

Acute vs Chronic Stress; Physiological Consequences

• Acute vs. Chronic Stress:

  • Acute stress is short-term.

  • Chronic stress is long-term.

  • They differ in how strong and how long they last.

• With moderate stress, the body shows:

  • Increased blood flow, energy, and neural activity (glutamate) in the hippocampus (brain area related to memory).

  • Activation of the sympathetic nervous system.

  • Moderate levels of stress hormones (glucocorticoids).

• Long-term effects of chronic stress:

  • Hormone (Endocrine) system: Cortisol levels often stay high; morning peaks might be higher, and levels might not drop as much later in the day.

  • Catecholamines: Higher levels are linked to a higher risk of atherosclerosis (hardening of arteries).

  • Cardiovascular system: Changes in heart and blood vessel function. High job stress is linked to high blood pressure (hypertension). Changes in blood components (platelets and lipids) increase atherosclerosis risk.

  • Immune system: Stress hormones (catecholamines and corticosteroids) reduce the production of lymphocytes (immune cells), leading to a higher risk of infections and less protection against cancer cells. Sleep quality can also suffer.

  • Stress and pregnancy: Stress can impact the mother's immune and hormonal systems and affect the fetus, increasing risks for preterm birth and low birth weight. African-American women may be more vulnerable.

• Everyone reacts to stress differently due to their genes, environment, and past experiences.

  • Supporting reference: Cohen et al. (2002)

Cognitive and Emotional Impacts of Stress

• Cognitive (thinking) impacts:

  • Stress can either make it hard to focus or make you hyper-focused on the stressor.

  • It can harm thinking skills, including short-term and long-term memory, and reduce motivation.

  • You might have repetitive, negative thoughts (rumination) about stressful events.

  • Very severe stress can lead to Acute Stress Disorder.

• Emotional impacts:

  • How you appraise a situation affects your emotions.

  • Infants often show distress or anger; adults might feel fear, anxiety, or anger.

  • Chronic stress is a strong predictor of symptoms of depression (e.g., McGonagle & Kessler, 1990).

• Social impacts:

  • The "tend-and-befriend" response can encourage cooperation in certain situations.

  • However, stress can also make people hostile, withdraw from others, and be less willing to help.

Adaptation, Habituation, and Moderators

• Adapting to stress:

  • Most individuals can adapt to mild or expected stressors like noise or crowded places.

  • However, vulnerable groups (children, elderly, poor) might have less control over stress and experience worse effects.

  • Your body can adapt to stress (habituation or chronic strain), but long-term stress can still weaken your immune system.

• While some adaptation to stress happens, long-term (chronic) stress can still cause continuous strain and health problems.

Conducting Stress Research and Measures

• How stress is studied in experiments:

  • Researchers use tasks like:

  • Giving an impromptu speech.

  • Doing mental math quickly.

  • The cold pressor task (putting your hand in ice water).

  • Recalling an angry memory.

  • An example study by Gramer & Reitbauer showed that social support affects heart responses both before and during active coping with stress.

• Ways to measure stress:

  • Self-reports: People describe their own stress, including how much stress they feel (Perceived Stress Scale or PSS), major life changes, and emotional distress.

  • Behavioral measures: Observing how someone performs tasks when stressed.

  • Life event inventories: The SRRS lists major life events with scores, used to predict illness. Its weaknesses include that people interpret events differently and it doesn't account for how each event uniquely affects an individual.

• Specific tools for measuring stress:

  • Perceived Stress Scale (PSS) (Cohen et al., 1983): A questionnaire asking how often in the past month you've felt things like loss of control, ability to cope, or feeling overwhelmed (rated 0-4).

  • SRRS (Holmes & Rahe, 1967): A list of life events with points assigned to them. While it predicts illness, it doesn't capture how individuals uniquely react to these events.

  • Stress/Arousal Adjective Checklist (King et al., 1983): A self-report list where you rate adjectives (0-4) to describe your current arousal and emotions.

• Physical and chemical ways to measure stress responses:

  • Physiological: Measuring things like blood pressure, heart rate, breathing, and skin conductivity.

  • Biochemical: Measuring stress hormones like cortisol, epinephrine, and norepinephrine in the body.

• Experimental evidence for stress and illness:

  • Cohen et al. (1999) studied the link between stress and illness.

  • Procedure: They measured people's psychological stress, then exposed them to a virus, and observed who got sick.

  • Result: People with higher life stress were more likely to get sick when exposed to the virus.

Key Terms and Concepts Summary

• Stressor: An external event or circumstance that can cause stress.

• Stress: The overall experience from a stressful event, including how you think about it, how you cope, and your body's reaction.

• Primary appraisal: Deciding whether an event is a threat, a loss, or a challenge.

• Secondary appraisal: Evaluating your available coping resources.

• Transactional model: States that stress comes from an ongoing process of appraising a situation and coping with it.

• Coping: The behavioral and cognitive efforts used to manage demands.

• Challenge vs Threat vs Harm-Loss: Different ways of interpreting the implications during primary appraisal.

• Controllability: Your belief in your ability to change or end a stressor.

• GAS: A three-stage model of the body's physical stress response (Alarm, Resistance, Exhaustion).

• Tend-and-Befriend: Seeking social support as a coping mechanism, especially for vulnerable individuals.

• Perceived Stress Scale (PSS): A measure of how much subjective stress someone perceives over the past month.

• SRRS: A life events scale with weighted scores to predict illness, but with limitations in interpretation and individual impact.

• Cortisol and catecholamines: Key hormones involved in stress with wide-ranging health impacts.

• Immune function: Stress can weaken the immune system, raising infection risk and possibly affecting the body's ability to monitor for cancer.

• Sleep: Stress can disrupt sleep, which then negatively affects health.

• Individual differences: Your genes, environment, and past experiences influence how you react to stress.

Connections to Real-World Relevance

• Understanding daily hassles helps improve short-term well-being and prevents minor stress from leading to illness, especially in people who are already sick.

• Stress management programs for work or school can teach people to change how they appraise situations and increase their sense of control, reducing felt stress.

• Getting social support can help reduce heart and hormone responses to stress, both when anticipating stress and when coping with it.

• Public health efforts for pregnant women and other vulnerable groups can lessen negative health outcomes from stress, such as premature birth and low birth weight.

Foundational and Ethical Considerations

• When researching stress, it's crucial to ethically measure it and ensure participants face minimal harm, even when exposed to stressors or viruses.

• It's important to differentiate between subjective stress (what someone feels) and objective stressors (the actual events). Both should be considered in studies and practical applications.

• The SRRS may not apply to everyone; individual experiences vary. We need to use multiple ways to measure stress (self-reports, behavior, physical measures).

Formulas and Numerical References

• Life Event mean values from SRRS (selected):

  • Death of spouse: $100$

  • Divorce: $73$

  • Marital separation: $65$

  • Detention in jail: $63$

  • Death of a close family member: $63$

  • Major personal injury or illness: $53$

  • Marriage: $50$

  • Being fired at work: $47$

  • Marital reconciliation: $45$

  • Retirement from work: $45$

  • Major health/behavior change of a family member: $44$

  • Pregnancy: $40$

  • Sexual difficulties: $39$

  • Gaining a new family member (birth, adoption, etc.): $39$

  • Major business readjustment: $39$

  • Major change in financial state: $38$

• Physiological response concepts (notation):

  • Cardiac output: $CO$

  • Total peripheral resistance: $TPR$

  • Cortisol (glucocorticoids): Elevated in stress

  • Catecholamines: $epinephrine$, $norepinephrine$

• Key model relationships (concepts, not math equations):

  • Stress exposure + how you appraise it + coping resources → how much stress you feel and your body's physical response.

  • GAS proceeds in stages: Alarm → Resistance → Exhaustion, affecting your immune and hormone systems.