HLTHPSYC 122 Stress, health and illness

LO’s:

• Define stress, and describe the role of appraisals in our experience of stress.

• Explain the physiological stress response.

• Describe Selye’s General Adaptation Syndrome (GAS).

• Explain how stress can impact our health.

• Describe the concept of ‘burnout’, and what techniques are used to reduce burnout in medical professionals

Stress

• how much force a material can take

• psychology - emotional response when situation demeans exceed resources

• when exceeds perceived ability to cope

• inherently linked to cope

• ability to cope individualised - differed between people

• cope ability exceeded - physiological effects of stress, long term impacts

Stress and stressors

• stressor = evolutionary predators to money, conflicts, exams = situation putting demand to cope

• appraisal = what does this stressor mean to us - interpretation

• stress response = emotional and physical response to stress

• stress is individualised - what stressed others differs - appraisal

Transaction between individual and environment

Primary appraisal

• deciding whether or not situation is dangerous

• see potential harm or loss, threat, challenge

• more stress characteristic = uncontrollable, unpredictable, central value e.g. survival needs (Maslow’s hierarchy)

• don’t get stressed over what we inherently don’t care about

• already overloaded - piled up, something not normally appraised as stressful, suddenly stressed

• 
  

Secondary appraisal

• how do we cope with this?

• capable of managing, see situation different form someone overwhelmed

• ‘don’t know what I’m doing…’

• How view situation may be the same (primary), how deal with situation different (secondary)

• secondary can change over time - how we learn to deal with things, calmer over time

• How we experience and react an event

• in western world - stress inherently a bad thing

• not the case - stress can be adaptive and enhancing

• embracing enhancing mindset help adapt better, beneficial effects on performance - physiological performances

Yerkes-Dodson law - how anxiety affects performance

• bell shaped distribution

• optimal stress - optimal performance

• no stress - no motivation = stress about things we care about

• not perform well if no stress no motivation = not studying

• closer to exams = stress builds, peak performance where studying effectively, take info well, learning content, perform well

• beyond and continue stress = performance drops, so stressed border on panic, students stay up late for exams

Fight or flight response

• physiological response to stretch

• autonomic nervous system - unconscious processes (HR, digestion)

• broken to sympathetic (on), parasympathetic (off)

• flight and fight - sympathetic

• constant balance onn system s

• stress = over activation of sympathetic ‘on’ state

How stress works in body

• stressor sensed by amygdala - fear

• activation of three systems

• SNS

• S adrenal medullary system

• Hypothalamic pituitary adrenal

SNS

• target organs release noradrenaline (adrenaline precursor)

• goes to eyes = pupillary dilation - can see more, take in more visual info (see predators)

• lungs = dilation of airways, more oxygen around body cardiac contractility, increase heart rate

SAM

• gland on top of kidney

• electrolyte homeostasis and cortisol release

• adrenal medulla - adrenal gland releases activation hormone - adrenaline

• result in release noradrenaline and adrenaline direct to blood stream

• adrenaline around to sympathetic nervous response

HPA axis

• hormone rather than nerve impulses - slower response

• amygdala activate hypothalamus - hormone to pituitary gland

• release hormone to circulation to adrenal cortex, adrenal gland

• release of cortisol - stress hormone, blunt inflammatory response, glucose transport

• big boost of energy to escape stressor

• injure yourself, not wide inflammatory response as lots of pain impact getting away

• amygdala increased to response helpful for survival - nature of stress changed, but amygdala still there

• still produce fear - alarm, door

• smaller stressor - inappropriate activation

• constant worries that dont deist - chronic activation of systems

• no longer short activatio - always active - negative health outcomes

Measuring stress

Physiological markers

• HR

• BP

• Cortisol and other hormones

• stress not only what increases these things

• changes often

• expensive and time consuming to measure

Psychological markers

• social readjustment rating scale

  • write down what occured - les than 150 (mean value) low levels of stress

  • higher 300 - high levels of stress - at risk stress related disorders

  • depth of spouse no.1 = score of 100

  • no. 7 = top 10 most stressful

  • issue is that rating are subjective, cannot put set number on how much stress event causes on each indiviudal

  • good support system differ to low support system

• perceived stress scale

  • preferred method

  • considers appraisals - can decide how you’ve been feeling

  • 2, 2, 3, 1, 3, 2, 3, 1, 1, 3 - moderate stress

General adaptation syndrome

• alarm stage = SNS response - short term stressor, PSMS can balance

• in days following - prolonged stress, stress maintained, response heightened = resistance

• following days, tired sick days = stage 3 exhaustion

• burnout

• no longer put resistance to stressor

• impacts on stress on body

Physiological pathways

• insulin - diabetes

• increase fat molecules circulation - high cholesterol - risk of cardiovascular disease

• cortisol heart = reactive mroe senstaive to adrenaline, upregulate receptors in heart

• hyperactive heart, increased risk high blood pressure

• impact on anti inflammatory - immunosuppressive action, vulnerable to illness

• increase appetite, higher guard foods, increase mental performance in moment but decriminalised long term memory retrieval

• ability to recalll things

• wide range of impacts

Pathways between stress and illness

• visceral fat - around organ s

• - Contribute to the development of cardiovascular disease

  • Increase risk of T2DM

  • Accelerate formation of atherosclerotic plaques

  • Increase resting blood pressure (i.e. hypertension)

  • Increase deposition of visceral fat

  - Increase the likelihood of contracting infectious diseases

  - Slow wound healing

• longer to heal in exams - 40% longer, significant!! (not examinable)

  - Reduce our response to immunisation

  - Influence the progression of cancer and HIV

Pathways between stress and illness

Direct effects

• physiology

Indirect effects

• perform maladaptive behaviours e.g. smoking, drinking

• negative reinforcement

Psychosocial issues

• perseverance cognition - repeatedly think abotu stressors

• anticipatory - what if… don’t get into med-school, injury, mainly aspirational things in our control

• retrospective stress - thinking about past ‘overthinking interactions’, we generally skew them and remember them as worse

• high stress - chronic activation physiological response

• brain can’t tell different between vivid imagination adn things that happen in real life

• rumination and anticipation = also high stress

Clinical burnout

• burnout

• physiological stress, impact boyd, engage in maladaptive behavour

• vital exhaustion - burnout

• state of botal exhaustion - nothing left

• depersonalisation - cynical, negative

• clinicians - dangerous as can compromise patient care and safety

Managing burnout

• self-care

• holiday - time away from work, establishing boundaries

• learn to ask for help

• non-clinical - not having contact with patient = better to have split

• more sick days, tiredness

Pathways between stress and illness

• change aspects of system

• shouldn’t all be indiviudal issue - work towards steric change

• overstretched healthcare system,

• system change is hardest and slowest

•