Stress and Mental Illness – Comprehensive Study Notes (Slide-based)

Psychological Effects of Stress

• Thoughts, concentration, and memory can be affected by stress
• Emotional and cognitive responses include anxiety, feeling overwhelmed, fear, irritability, pessimism, guilt, sadness, and distressing dreams
• Physical and physiological responses include headaches, high blood pressure, insomnia, exhaustion, and general bodily strain
• Brain regions implicated include the prefrontal cortex and hippocampus, with trauma and stress influencing neural functioning
• Trauma exposure can trigger acute arousal and long-term mental health problems; stress can lead to avoidance, panic, and hypervigilance
• Coping and intervention options referenced include counselling and other support (psychiatric/psychological care) to manage stress and its effects on mood and functioning
• Stress can lead to a cascade of mental health issues, including depression, anxiety, substance use, and behavioural changes
• The content links stress to motivation, life functioning, and overall mental health, including mood and self-efficacy

Stress and Risk of Mental Illness

• Stress is a risk factor for the development of many mental health disorders
• What is a risk factor? A characteristic or exposure that increases the likelihood of developing a disorder
• Disorders commonly linked to stress include:
  • Mood Disorders
  • Anxiety Disorders
  • Trauma- and Stressor-Related Disorders
  • Somatic Symptom and Related Disorders
  • Substance-Related and Addictive Disorders
  • Eating Disorders
• Heightened rates of stressful life events raise the likelihood of experiencing these outcomes
• Important caveats:
  • Not all individuals with heightened stress develop a mental health disorder
  • Not all mental health disorders are precipitated by stress, with the exception of PTSD and related disorders

Preliminary Small Group Discussion (Study Prep)

• Consider why stress and stressful life events increase risk for mental health disorders
• Reflect on how stress might affect thinking, behavior, mood, self-beliefs, and physical health
• Use this discussion to set up the exploration of the relationship between stress and depression and various theoretical models

Depression

• Depression is one of the most common forms of psychopathology
• It is often recurrent
• Understanding the relationship between stress and depression is key to understanding duration, relapse, and recurrence (Liu & Alloy, 2010)
• Central question: In what ways might stress and depression be related?

Associations between Stress & Depression

• Four main conceptual links:
  • Stress → Depression (Causation/Exposure)
  • Depression → Stress (Stress Generation)
  • Stress → Maladaptive Coping → Subsequent Depressive Episodes
  • Stress → Stress Sensitization
• These pathways can operate in combination across the lifespan

Stress Causation / Exposure

• Stressful life events are associated with an increased risk for depression
• Types of stress that increase risk include:
  • Acute stressors
  • Chronic stress
  • Recent stressful events
  • Childhood stressful events
  • Interpersonal stressors
• Key researchers: Gibb, Butler & Beck (2003); Hammen et al. (2009); Hammen (2005); Kendler, Karkowski, & Prescott (1998)
• Stress increases risk of depression across the lifespan:
  • Children
  • Adolescents
  • Young adults
  • Older adults
  • Noted studies: Cole & Turner (1993); Tram & Cole (2000); Hankin, Kassel, & Abela (2005); Moos et al. (2005)
• Stress has been implicated in various aspects of depression, including:
  • First onset
  • Relapse
  • Recurrence
  • Exacerbation of symptoms
• Lifespan impact and symptom dynamics have been observed in multiple cohorts
• In numerical terms, stress precedes many depressive episodes in a sizable portion of cases

Mechanisms: How Stress Increases Depression Risk

• Psychological pathways:
  • Changing one’s views about oneself or the world (self-concept, pessimism, hopelessness)
• Physiological pathways:
  • Inflammation and other physiological processes
• Behavioral pathways:
  • Maladaptive health behaviors or disengagement from activities
• Notable statistic: ~70% of first Major Depressive Episodes (MDEs) and ~40% of recurrent MDEs are preceded by a stressful life event
  • $ext{Proportion}_{ ext{first MDE}} \,=\, 0.70$
  • $ext{Proportion}_{ ext{recurrent MDE}} \,=\, 0.40$ (Monroe & Harkness, 2005)
• Why stress might increase risk: cognitive distortions, maladaptive coping, and alterations in neurobiological processes

Stress Generation

• Concept: Depression can increase the likelihood of encountering stressful life events
• Characteristics:
  • Dependent (internally influenced) vs Independent (external) events
• Evidence: Depression is associated with dependent but not independent stressful life events (Hammen, 1991; Hammen, 2006)
• Populations studied: Children, Adolescents, College Students, Adults, Older Adults
• Gender considerations: Across genders, depressive symptoms can generate stress
• Mechanisms include:
  • Withdrawal and isolation → interpersonal conflict
  • Impairments in concentration/attention → academic or vocational stress
  • Cognitive-affective symptoms (low self-esteem, guilt, self-blame, pessimism, sadness, hopelessness) → stress across domains
  • Development of maladaptive coping and problem-solving skills
• Why depression generates stress: behaviors and cognitions associated with depression increase exposure to stressors

Stress Generation: Why It Happens Across Development

• Occurs in multiple life stages: Children, Adolescents, College Students, Adults, Older Adults
• Observed across genders
• Interaction with cognitive-affective symptoms and coping styles

Stress Sensitization

• Definition: Individuals with a history of depression become more sensitive to stress, reacting strongly to less severe stressors over time
• Implication: People with a history of depression are about 2x more likely than those without to develop depression after a non-severe stressful event
  • This is supported by Post (1992); Monroe & Harkness (2005); Stroud et al. (2010)
• Question posed: Why might stress sensitization occur? (consider neurobiological changes, learned helplessness, altered stress-response systems)

Transactional Relationships

• Conceptual model showing reciprocal influence between depression and stress:
  • Depression ↔ Stress
  • Stress → Stress Generation
  • Stress → Stress Sensitization
  • Depression ↔ Stress (reciprocal processes reinforce each other)

Stress-Related Clinical Pain and Mood

• Relationship among mental illness, pain, coping, mood, and stress
• Maladaptive coping can worsen pain and mood outcomes
• Stress sensitivity interacts with depression to influence pain experience and recovery
• The model suggests pain experiences and interpersonal stressors can influence mood and vice versa

Research Study: Davis, Thummals, & Zautra (2014)

• Article: Stress-related clinical pain and mood in women with chronic pain: Moderating effects of depression and positive mood induction
• Journal: Annals of Behavioral Medicine, 48, 61-70
• Population of interest: Chronic pain patients in primary care; about 27% of pain patients have Major Depressive Disorder (MDD)
• Hypotheses:
  1) Depressed patients show stronger stress-induced increases in pain and low mood
  2) Depressed patients show worse recovery from stress-induced pain and low mood
  3) Activating positive affect (joviality) will help depressed patients recover
• Key idea: Examine how mood states and stress interact to influence pain and mood in chronic pain populations

Research Study: Methods

• Design elements described in slides:
  • Describe a recurring conflict scenario
  • Rest vs. Stress vs. Lab Period conditions
  • Measures included pain, mood, and attentiveness
  • Repeated measures across different periods to track changes

Research Study: Results

• Despondency (Mean rating 1-5) across conditions:
  • Rest, Stress, Lab Period; Mood conditions included Depressed/Positive, Depressed/Neutral, Non-Depressed/Positive, Non-Depressed/Neutral
  • Mean despondency values around the mid-2s to 3s range, with higher scores under stress and in depressed mood conditions
• Joviality (Mean rating 1-5) across conditions:
  • Similar pattern with lower joviality under stress and in depressed mood states; positive mood conditions showed relatively higher joviality
• Clinical Pain (Mean rating 0-100) across conditions:
  • Pain ratings tended to rise under stress and/or in depressed mood states; positive mood induction appeared to mitigate some of the pain increase
• Overall pattern:
  • Stress increases negative mood and pain, with stronger effects in those with depression
  • Positive affect induction (joviality) can buffer some of the adverse effects, especially on mood and pain recovery

Research Study: Discussion

• Key takeaways:
  • Both depressed and non-depressed pain patients showed stress-related mood and pain changes, but depressed patients showed less rebound in neutral mood conditions after stress
  • Activation of positive mood helped depressed patients recover more effectively
• Implications:
  • Positive affect interventions may be a useful adjunct in managing pain and mood in patients with chronic pain and depression
  • Mood induction or cognitive strategies that elevate positive affect could support functioning during stress

Discussion Questions

• Would these study results generalize to non-pain populations?
• How might a real-life implementation of positive mood induction look (e.g., activities, social engagement, cognitive strategies)?
• How might cognitive reappraisal or cognitive restructuring relate to these findings?

Group Presentations: Planning and Deadlines

• Students will meet in assigned groups for 5-10 minutes on Wednesday 9/17 to discuss and submit topics for a stress management presentation
• Each group must submit:
  • Top three preferred topics (in order; 1 = first choice)
  • List of all group members
  • Any dates when the group cannot present (dates: M 10/13, W 10/15, M 10/20, W 10/22)
• If a group does not submit, a topic will be assigned by the instructor

Group Assignments (Overview)

• Groups and members listed for organization and topic assignment
• Group connections cross-listed to facilitate collaboration and topic distribution
• Note: This section provides the roster of groups 1–11 and their members for coordination

Reminders and Course Logistics

• Reminders:
  • CBL Agreement Forms due 9/22
  • CBL Journal #2 due 10/1
• Course aims and outline (Lecture Aims & Outline):
  • Understand different ways stress is associated with mental illness
  • Become familiar with research on the connectedness between stress and depression
• Dr. Dalton, Elizabethtown College, PSY 360: Psychology of Stress, Fall 2025