Chapter 14 OPENSTAX
Stress and Health: Comprehensive Notes
The contemporary college experience is associated with high pressure: tuition increases, debt, and employment difficulties after graduation; nontraditional students may also juggle parenting or full-time work while pursuing a degree. Life outside college adds concerns about financial security, relationships, family responsibilities, and time management.
Stress is pervasive and can affect well-being even when events are ordinary; scientific interest in stress spans nearly a century, focusing on psychological and physiological natures, causes, consequences, and coping strategies.
By the end of this section you should be able to:
differentiate stimulus-based and response-based definitions of stress;
define stress as a process;
distinguish good stress (eustress) from bad stress (distress);
describe early contributions of Walter Cannon and Hans Selye;
understand physiological bases of stress and the general adaptation syndrome (GAS).
What is Stress? Definitions and Perspectives
The term stress emerged in scientific literature in the 1930s, but entered popular vernacular in the 1970s. It is often used loosely to describe a range of unpleasant feelings (frustration, anger, conflict, overwhelm, fatigue).
Challenge with definition: stress is a vague concept that resists precise definition; researchers disagree on a universal definition.
Stimulus-based definitions of stress conceptualize stress as a demanding or threatening event (e.g., high-stress job, overcrowding, long commutes).
Problem: such views ignore individual differences in appraisal and response; two people can experience the same event very differently (e.g., a conscientious student vs. an unprepared student during finals).
Response-based definitions characterize stress as the body’s physiological response to a demand, not solely the event itself (e.g., Hans Selye’s definition: the body’s response to any demand, pleasant or unpleasant).
Critique: stress responses are not exclusive to negative events; positive news can trigger stress responses as well.
A widely accepted conceptualization: stress as a process in which an individual perceives and responds to events they appraise as overwhelming or threatening to well-being; appraisal plays a central role in determining stress, not merely the event itself.
Appraisal emphasizes cognitive evaluation of stressors, including how threatening or demanding they seem and what options exist to cope.
Appraisal and Coping: Primary and Secondary Appraisals
Primary appraisal: judgment about the potential harm or threat a stressor might entail.
Threat: anticipated harm, loss, or negative consequence.
Challenge: potential for gain or growth.
Example: A promotion can be seen as a threat if it implies excessive work, or as a challenge if it offers growth and new skills.
Secondary appraisal: assessment of available coping options and resources to manage the stressor.
The perception of threat triggers secondary appraisal; beliefs about the effectiveness of coping options influence stress experience.
Illustrative example: two individuals with a breast lump (Robin vs. Madhuri) both view it as potentially threatening, but their secondary appraisals differ; Madhuri believes that there are effective options and can be managed, whereas Robin feels less able to influence the outcome.
Overall: stress is largely in the eye of the beholder; it is not simply what happens to you but how you respond to it.
Good Stress and Bad Stress; The Stress-Performance Curve
Eustress: positive form of stress that can enhance performance and well-being (Sellier, 1974); associated with motivation, health, and peak performance.
Example: pre-exam arousal that improves recall and performance.
Distress: excessive stress beyond the optimal point that impairs functioning and health (Sellier, 1976); can lead to burnout and illness.
The relationship between stress and performance is not linear; there is an optimal level of stress that enhances performance, beyond which performance declines (a heuristic parallel to the Yerkes-Dodson concept).
A schematic: as stress increases, performance and well-being may rise to an optimal peak, but exceed this level and both performance and health deteriorate.
Real-world example: test anxiety can become a form of distress that impairs performance when excessive.
Prevalence and Demographics of Stress
Stress is widespread and increasing over recent decades.
Data summaries: nearly half of U.S. adults indicated their stress levels increased over the last five years (Cohen & Deveretz, 2012).
Stress responses are multi-faceted (physiological, cognitive, EEG, behavioral).
Health psychology emerged in the 1970s to study how psychological factors influence health and illness and to design interventions.
Sociodemographic patterns (from large national surveys): women report higher stress than men; unemployed individuals report higher stress; those with lower education and income report higher stress; retired persons report lower stress. From 2006 to 2009, greatest increases occurred among men, Hispanic individuals aged 45–64, college graduates, and full-time employed individuals.
Interpretation: economic downturns and time-related pressures may disproportionately affect certain groups (e.g., educated employed men in mid-to-late career stages).
Early Pioneers in Stress Research
Walter Cannon (Harvard): identified the fight-or-flight response as a central, rapid physiological reaction to strong emotion or perceived threat; sympathetic nervous system and endocrine activation prepare body to confront or escape danger.
Fight-or-flight is adaptive and helps maintain homeostasis during acute threats.
Hans Selye: described the general adaptation syndrome (GAS) as a non-specific, time-ordered physiological response to stress.
GAS stages: Alarm reaction → Resistance (or adaptation) → Exhaustion.
Alarm reaction: initial response to a stressor, energy mobilization; parallels early fight-or-flight.
Resistance: body adapts to continued stressor; remains on alert with reduced intensity.
Exhaustion: prolonged exposure depletes resources; illness or death may occur if stress persists.
Limitations of GAS: primarily a physiological, response-based model that underemphasizes psychological factors like appraisal and interpretation of threats.
Key takeaway: early work established that stress involves predictable physiological pathways and can affect health when chronic or excessive.
The Physiological Basis of Stress
Core systems involved: sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis.
Immediate response: SNS triggers rapid arousal via adrenaline (epinephrine) and noradrenaline (norepinephrine) release from adrenal glands; facilitates fight-or-flight responses (increased heart rate, respiration, pupil dilation, muscle tension, etc.).
HPA axis: hypothalamus releases corticotropin-releasing factor (CRF), stimulating pituitary to release adrenocorticotropic hormone (ACTH); ACTH prompts adrenal glands to secrete cortisol and other hormones.
Cortisol: a key stress hormone that temporarily boosts energy and modulates immune function; chronic elevation weakens immune defenses.
Acute benefits vs. chronic costs:
In short bursts, cortisol can enhance energy, immune response suppression is temporary, and pain sensitivity may decrease.
In prolonged exposure, cortisol elevations can impair immunity and contribute to health problems.
Consequences for health: chronic stress can contribute to psychological disorders (PTSD, major depression) and physical illnesses (hypertension, heart disease, immune-related issues).
Stress and Illness: Mechanisms and Evidence
Psychophysiological disorders: physical diseases whose symptoms are influenced or exacerbated by stress and emotional factors.
The immune system as a primary pathway linking stress and illness: brain, endocrine system, and immune system are interconnected (psycho-neuro-immunology).
Immune system functioning can be modulated by stress hormones (e.g., cortisol) and sympathetic activity; immune organs receive direct neural input.
Classical conditioning of immune responses: immune responses can be conditioned by environmental cues paired with immunosuppressive drugs (Eder & Cohen, 1975); later, immune responses can be elicited by cues alone.
Empirical findings:
Short-term stressors and chronic stressors are linked to weakened immune responses, poorer antibody responses to vaccines, slower wound healing, and increased infection risk.
Notable experiments: caregivers under chronic stress show poorer immune responses to vaccines; individuals experiencing chronic stress show higher incidence of colds after virus exposure.
Telomeres and aging: stress can accelerate cellular aging by shortening telomeres; maternal stress and caregiving burdens link to shorter telomeres in mothers of ill children; correlations observed: years of care and telomere length r = -0.40; perceived stress and telomere length r = -0.31.
Long-term stress exposure may have aging-like effects on biology; some childhood stress exposures also predict shorter telomeres in adulthood.
Cardiovascular system as a focal point of stress research due to direct links with stress responses.
Specific Health Connections: Cardiovascular, Asthma, and Related Conditions
Cardiovascular disorders are central in stress-health research; hypertension is a major risk factor for heart attack, stroke, and heart failure; often called the “silent killer” due to few symptoms.
Risk factors for cardiovascular disorders include aging, income, education, employment, diet, tobacco use, physical activity, obesity, and diabetes; stress adds to risk via job strain and other stressors.
Type A behavior pattern (Friedman & Rosenman): originally linked to higher heart disease risk; later research showed mixed replication; focus shifted to anger-hostility as a key predictive factor for cardiovascular risks.
Hostility and social strain can provoke cardiovascular responses and may contribute to disease risk.
Negative affectivity and depression are linked to cardiovascular risk; chronic negative mood states (anger, hostility, depression) correlate with higher rates of hypertension and heart disease.
The relationship between depression and heart disease is robust: depressed individuals have higher mortality and morbidity from cardiovascular disease; conversely, heart disease patients often exhibit higher rates of depression.
Anxiety, hostility, and other negative emotional states collectively contribute to cardiovascular risk; a broader psychological risk factor can predict heart disease more strongly than any single factor.
Asthma and stress: stress and emotions influence airway function; psychological factors can trigger asthma symptoms in some individuals; stressful life events and interpersonal conflicts increase asthma risk or exacerbate symptoms; social media and modern stressors may play a role in new stress-related asthma triggers.
Headaches: tension-type headaches and migraines are influenced by stress; psychological distress can heighten pain sensitivity and exacerbate headache frequency/intensity.
Types of Stressors: Acute, Chronic, Traumatic, and Life Changes
Stressors can be broadly categorized as:
Chronic stressors: long-lasting, such as caregiving for a parent with dementia, long-term unemployment, or imprisonment.
Acute stressors: short-term, focal events, such as a fall or a sudden job loss; even temporary events can have lasting emotional effects.
Traumatic events: exposure to actual or threatened death or serious injury (combat, assault, disasters); higher risk in certain groups; PTSD can develop.
Life changes and events: significant changes in life circumstances that require readjustment can be stressful even if desirable (e.g., marriage, divorce, moving).
Holmes & Rahe’s Social Readjustment Rating Scale (SRRS) quantifies life events by Life Change Units (LCUs). The SRRS includes 43 events with varying LCUs; examples:
Death of a spouse: LCUs
Divorce: LCUs
Personal injury or illness: LCUs
Marriage: LCUs
Job termination: LCUs
Change in residence: LCUs
Change in eating habits: LCUs
Vacation: LCUs
Minor violations of the law: LCUs
LCUs are summed over a period (e.g., last 12 months) to yield a total change score.
Accumulating many LCUs over a short period is related to a wide range of physical and mental health problems (Monat & Lazarus; Scully & colleagues).
Criticisms of SRRS:
Items are vague (e.g., death of a close friend could be a minor or major life change depending on context).
Assumes all life events are equally stressful, regardless of desirability; research suggests negative events are more strongly linked with poor outcomes than positive events, though positive events also contribute to stress in some cases.
Does not account for individual appraisal of events; coping and perception matter.
It is correlational and cannot establish causation between life events and illness; the direction of causality can be complex (stress may contribute to illness and illness may increase perceived stress).
Daily hassles: minor irritations and daily annoyances (traffic, lost keys, arguments) can accumulate and predict physical and psychological health problems more strongly than major life events.
Social readjustment and stress: SRRS established a framework for studying stress and health, and remains widely used, though complemented by appraisal-based approaches.
Occupational Stress, Job Strain, and Burnout
Workplace stressors include heavy workload, low job control, unsafe conditions, noise, harassment, irregular shifts, and high demands; occupation-specific stressors vary across fields (e.g., firefighters vs. florists).
Job strain (Karasek & Theorell): a work situation with high demands and low discretion or control; associated with higher risk of hypertension, heart attack recurrence, and depression.
Burnout (Maslach & Jackson): a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment, especially in helping professions.
Cumulative evidence links job strain to adverse health outcomes and explains why some workers (older, unmarried, manual labor) are more vulnerable to burnout.
Lifestyle factors often co-occur with burnout (heavy drinking, physical inactivity, obesity, preexisting mental disorders);
depression often co-occurs with burnout.Example: Tyre, a nursing assistant, experiences long hours, low pay, unsupportive supervision, and little autonomy, leading to burnout and eventual job change.
Disruption in close relationships and social support at work/home can contribute to stress and poor health outcomes.
Social networks and support can buffer health risks associated with work stress and can influence health behaviors (smoking, diet, exercise, adherence).
Psychological Factors and Health: Coping, Control, and Social Support
Coping consists of cognitive and behavioral efforts to manage stress; Lazarus & Folkman distinguish:
Problem-focused coping: actively addressing the stressor to reduce its impact (e.g., studying to improve grades, seeking tutoring).
Emotion-focused coping: regulating emotional responses to the stressor (e.g., seeking distractions, reframing the situation, seeking social comparison).
Controllability influences coping style: controllable stressors elicit problem-focused coping; uncontrollable stressors elicit emotion-focused coping.
Perceived control (Bandura) plays a central role in stress response:
Greater perceived control is linked to better physical and mental health and lower reactivity to stressors.
Higher perceived control associates with lower emotional and physical reactivity to interpersonal stressors and reduced daily stress and anxiety in some populations.
Learned helplessness (Seligman): when individuals are unable to escape aversive stimuli, they may conclude they have no control and stop attempting to change the situation, contributing to depression.
Classic animal experiments demonstrated that prior exposure to inescapable shocks led to passivity in the face of future shocks; later, Seligman emphasized attributional styles (internal, stable, global attributions) as a key factor in vulnerability to depression.
The concept has ethical implications: learned helplessness theory has been misused in unethical interrogation practices; emphasizes the need for ethical safeguards in research and applications.
Attributions and hopelessness theory: how people explain negative life events affects vulnerability to depression; internal, stable, global attributions predict higher risk; interventions can train healthier attribution styles to reduce vulnerability.
Social support: the buffering effects of supportive relationships on stress and health outcomes; social ties can influence health through emotional support, guidance, and practical aid, and via health behaviors (e.g., exercise, diet, medication adherence).
Social support and immune function: supportive social relationships can be associated with better immune responses and slower physiological deterioration during stress; mechanisms include reduced stress arousal and improved health behaviors.
Social support also reduces physiological arousal (e.g., lower blood pressure during stressful tasks when supported by friends) and can encourage healthier coping strategies.
Discrimination as a chronic stressor: stigmatized groups experience discrimination that compounds stress and undermines mental and physical health; buffers include social support and coping resources, but systemic remedies (policy protections) are necessary.
Practical implications: protecting vulnerable groups from discrimination, augmenting social support networks (e.g., college peer mentoring), and promoting coping strategies can mitigate stress-related health risks.
Stress Reduction Techniques and Interventions
Exercise: regular physical activity buffers the effects of stress; associated with improved physical and mental health; evidence from police/emergency personnel showing reduced stress with higher fitness; exercise can buffer hypothalamic-pituitary-adrenal (HPA) responsiveness to stress and may prevent telomere shortening.
Relaxation techniques: relaxation response (Herbert Benson) combines relaxation with elements of meditation; four components include quiet environment, passive repetition of a mantra, and comfortable posture; shown to reduce sympathetic arousal and aid in hypertension management.
Biofeedback: uses sensors to monitor physiological processes (facial muscles, skin temperature, brain activity) and provides feedback to enable voluntary control over autonomic functions; used to treat tension headaches, hypertension, asthma, and phobias.
Social and behavioral strategies: fostering social support networks, reducing discrimination, promoting well-being programs, and teaching coping skills can improve resilience and health outcomes.
Flow and positive engagement: finding activities that induce flow (deep absorption and enjoyment) is associated with well-being and life satisfaction; flow experiences are more likely in challenging activities that match one’s skill level; promoting flow can be a societal goal to enhance well-being.
Happiness and Positive Psychology: A Shift toward Well-Being
Positive psychology aims to understand and promote human flourishing, focusing on strengths, virtues, and well-being rather than pathology.
Happiness components (Seligman et al., 2000; 2005): the pleasant life (daily pleasures), the good life (using strengths to achieve meaningful engagement), and the meaningful life (contributing to the greater good).
Subjective well-being is an enduring state of happiness and life satisfaction, not just transient mood.
Global happiness measurements show variation across nations and cultures; average life satisfaction (0–10 scale) varies by region, with North America and parts of Europe scoring higher than Sub-Saharan Africa; Denmark, Norway, Switzerland, the Netherlands, and Sweden often rank among the happiest countries, while the U.S. ranks around 17th in some surveys.
The relationship between wealth and happiness is nuanced:
GDP per capita correlates with happiness, but increases in GDP do not always translate to proportional increases in happiness beyond a point (often cited around an annual income of ).
Wealth enables access to experiences but does not guarantee lasting happiness; the hedonic treadmill and adaptation reduce long-term impact of wealth shocks on happiness.
Education and employment are modestly related to happiness; religiosity shows positive association in more challenging living conditions but not necessarily in affluent contexts.
Culture matters: self-esteem and happiness relationships vary across individualistic vs collectivistic cultures; extroversion relates more to happiness in extroverted cultures.
Happiness interventions: simple practices like writing down three good things daily can produce lasting increases in happiness; well-being programs may yield lasting improvements if sustained.
The role of optimism and positive affect: positive affect and optimism are linked to longevity, better immune functioning, fewer post-surgical complications, better adherence to treatment, and overall better health outcomes; optimism is a generalized expectation that good things will happen and is linked to better health outcomes.
Flow as a pathway to well-being: engaging in meaningful, absorbing activities that provide intrinsic reward promotes flourishing and can contribute to sustained happiness.
Societal implications: policy initiatives can leverage well-being research to promote social conditions (e.g., social support, fair governance, healthy life expectancy, freedom from corruption, generosity) that support national happiness.
Integrating the Big Picture: Why This Matters
Stress is not inherently bad; a moderate amount can be motivating and improving (eustress), but chronic or extreme stress (distress) can undermine health and performance.
The stress response is a dynamic, biopsychosocial process involving appraisal, coping resources, social support, and lifestyle factors. It translates into physiological changes via SNS and HPA activation, with downstream effects on immune function, cardiovascular health, aging processes, and mental health.
Psychological factors (perceived control, coping style, attributional style, positive affect, optimism) interact with social contexts (support networks, discrimination, occupation) to shape health outcomes.
Coping strategies are not one-size-fits-all; problem-focused coping is more effective when stressors are controllable, while emotion-focused coping is more adaptive for uncontrollable stressors (e.g., bereavement).
Ethical considerations in stress research and applications include recognizing the potential for misuse of concepts like learned helplessness in coercive settings and ensuring protections for participants and vulnerable populations.
The interdisciplinary lens (psychology, physiology, public health, sociology) highlights how individual stress experiences connect to population-level health outcomes and informs interventions at individual, organizational, and societal levels.
Key Formulas, Numbers, and Concepts (LaTeX)
Life Change Units (LCUs) scale values in Holmes & Rahe SRRS:
Death of a spouse: LCUs
Divorce: LCUs
Personal injury or illness: LCUs
Marriage: LCUs
Job termination: LCUs
Change in residence: LCUs
Change in eating habits: LCUs
Vacation: LCUs
Minor violations of the law: LCUs
Correlations in telomere aging study:
Years of caregiving and telomere length:
Perceived stress and telomere length:
Learned helplessness attribution reformulation: internal, global, stable attributions predict greater risk of depression under negative life events.
Depression and cardiovascular risk: longitudinal studies show elevated risk; depression is linked with higher mortality and heart disease incidence.
Positive psychology variables: happiness correlations with well-being measures, longevity, and immune function; six key national well-being predictors include: per capita GDP, social support, freedom to make life choices, healthy life expectancy, freedom from corruption, and generosity.
Connections to Foundational Principles and Real-World Relevance
Stress intersects biology and behavior: cognitive appraisal triggers physiological responses; coping and social context shape health outcomes.
Health psychology: a discipline that studies how psychological factors influence health, illness, and health behavior change.
Societal implications: recognizing stressors beyond individual control (e.g., discrimination, economic shifts) can guide policy and interventions that improve population health and well-being.
Educational and workplace implications: coping strategies, social support programs, and wellness initiatives in schools and workplaces can reduce stress-related health risks and improve performance.
Ethical considerations: research and applied practices must consider potential harms (e.g., misapplication of learned helplessness, privacy concerns in stress monitoring) and aim to protect participants and patients.
Summary Takeaways
Stress is a process influenced by how we appraise events, not merely the events themselves.
There are two broad definitions of stress (stimulus-based and response-based), but both are incomplete without appraisal and coping context.
Eustress can enhance performance up to an optimal point; distress impairs performance and health.
Early theories (Cannon; Selye) provided foundational physiological models; modern perspectives emphasize appraisal, coping, and social context.
The physiology of stress involves SNS and HPA axis activation, with cortisol as a key mediator; chronic activation can impair immunity and contribute to disease.
Stress is linked to a wide range of health outcomes, including cardiovascular disease, asthma, infections, wound healing, and aging (telomeres).
Coping styles (problem-focused vs. emotion-focused), perceived control, and social support buffer stress’s negative effects and promote better health.
Positive psychology shifts the focus from pathology to flourishing, highlighting happiness, optimism, flow, and well-being as measurable, modifiable states with real health implications.
Practical strategies for reducing stress include exercise, relaxation techniques, biofeedback, social support, and fostering environments that promote flow and meaningful engagement.