Stress

Key Points

-Stress is the perceived discrepancy between the demands and resources appraised by the individual -Cognitive appraisal of a threat involves primary and secondary appraisal -Stressors are events or circumstances that we perceive as threatening or harmful -Stress leads to changes in biochemistry, physiology, behaviour, cognition and emotional state -IMPLICATIONS: stress has been linked directly and indirectly to health outcome.

Stress

Physiological and psychological components Theories that explain stress: -stimulus -response -transaction

The stress response

2 step Physiological response Sympathetic activation: -under stress: sympathetic nervous system stimulated -Catecholamines produced (adrenalin and noradrenalin) -Quick response system (within seconds) Hypothalamic-pituitary-adrenocortical (HPA) activation: -Increased levels of corticosteroids (glucocorticoids eg cortisol) -Raised levels of brain opioids beta endorphin and enkephalin (related to immune response) -Slower response system (minutes to hours)

Primary Appraisal

A cognitive evaluation of a potentially stressful event to determine whether its effect is positive, irrelevant, or negative. 1. Benign appraisal - no further coping 2. Irrelevant appraisal - no further coping 3. Positive appraisal - no further coping 4. Stimulus appraised as harm, loss or threat - stimulus appraised as a stressor. Leads to secondary appraisal.

General Adaption Syndrome

A sequence of physical responses to any stressor. Alarm(ready self for fight or flight), Resistance(fight or flight response) and Exhaustion(no defenses left) 1. Stressor 2. Alarm - mobilisation to fend off threat/stressor 3. Resistance - continued fight against stressor if stress prolonged. Body becomes weakened. 4. Exhaustion - Depletion of resources, ability to resist may collapse if stress continues.

Burnout

A state of physical, emotional, and mental exhaustion created by long-term involvement in an emotionally demanding situation and accompanied by lowered performance and motivation. Depersonalisation and lack of accomplishment/interest in work. Attributed specifically to occupational stressors.

Stressors

Any factor that can cause stress in an organism, potentially affecting the body's proper functioning and its homeostasis. Has effects on Physiological, psychological and social aspects

Stress and myocardial infarction

Association of psychological risk factors with risk of acute MI. Stresses at work, home, finance, major life events in past year. Evidence for association between psychosocial stress and increase risk of acute MI. Effect of stress is independent of SES, smoking Effect of stress is consistent across geographical regions in different age groups and in men and women. Approaches needed to modify stress factors.

Typical signs of stress

Biochemical Physiological Behavioural (crying, eating, not sleeping) Cognitive (distraction, forgetfulness, memory loss) Emotional (anxiety, worry)

Secondary Appraisal

Deciding how to deal with a potentially stressful situation. Deciding how to cope with a threat or challenge. 1. Seeking information 2. Taking direct action 3. Doing nothing 4. Worrying

Stress as a stimulus

Focus on environment Event of circumstance is the cause of stress Events of circumstances known as 'stressors' Eg my illness is causing me stress

Stress as a response

Focus on individual's reaction to stressors -Psychological response -Physiological response -Responses known as strain Eg I feel a lot of stress just before my OSCE

Stress as a transaction

Focus on stress as a process (stressors and strain) Relationship between the person and environment Continuous interactions and adjustments - dynamic Eg person is the active agent who can influence impact of stressor

Health effects of long term stress

Health behaviours - risk behaviours, health compromising behaviours, cognitive, emotional. Physiology - CHD, MI, hypertension, immune function, depression, asthma, headache etc

Long-term stress response

Hypothalamus produces Corticotropin (CRF) which causes Anterior Pituitary Gland to release ACTH which stimulates adrenal cortex to produce glucocorticoids -Retention of sodium and water by kidneys -Increase blood volume and BP -PF converted to glucose/broken down for energy -Increase blood sugar -Decrease immune system

Stress and immune functioning

Impaired by: Physiological response to stress -increase catecholamine and corticosteroid release -Decrease in immune cell activity (T and B cells) against antigens -Linked to development of infectious disease, cancer Emotion -Depression, optimism also influences immune response Psychosocial factors -Life events, social support, exercise, lifestyle

Health-related behaviours

Increase substance abuse Increase smoking Poor diet Lack of sleep Lack of exercise Poor adherence to treatment Less likely to take preventative health measures Increase engagement in reckless behaviour leading to injury Direct link to health outcomes.

Stress Moderators

Internal and external resources and vulnerabilities that modify how stress is experienced and its effects. How people view and cope, and individual differences, including their financial and social support resources.

CHD

Leading cause of death in scotland: -highest death rates from CHD in world -Smoking, poor diet, physical inactivity, obesity, increased BP, poverty. Prevention: treatment of CHD - health priority for scotland. Stress is implicated in CHD.

Short-term stress response

Neurons of SNS stimulated Adrenal Medulla drives short term response: Epinephrin and Norepinephrine produced Increase - heart rate, BP and metabolic rate Changes in blood flow Dilation of bronchioles

Fight or flight response

Physiological model of stress Acute/short term Physiological reaction to emergencies - adaptive response • Homeostasis threatened • Response to acute, short lived stress • External threats elicit fight or flight response • Increase physiological arousal • Enable fight or flight response • BUT prolonged state of high arousal harmful to health

Neuroendocrine cascade

Releases stress hormone (cortisol) into blood stream. Stress and the adrenal gland

Social stress and atherosclerosis

Social instability and coronary artery atherosclerosis in monkeys. Stable groups had the least occlusion. Dominant monkeys are subjected to stress of living in unstable groups and had the greatest occlusion of arteries.

Stress and wound healing

Stress slows wound healing Effects of stress in carers on wound healing. Rate of wound healing was a lot slower if a carer.

Stress appraisal

Stress-coping paradigm Cognitive appraisal - primary and secondary appraisals

Stress definition

The perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation. -feeling lack of control -unpredictability

Stress and CVD reactivity

• Cardiovascular reactivity is linked to illness • Individual's exhibit stable cardiovascular reactivity • But individual variation in 'reactivity' • Stress induced increase in catecholamine and corticosteroid release can damage the arteries and heart - promote atherosclerosis, increase the heart rate - lead to development of hypertension, CHD

Summary

•Demands are greater than ability to cope •Consequence of the cognitive/thinking process • Cognitive appraisal-primary and secondary •Feeling of lack of control, unpredictability • Individual/situational differences • Process -continuous interactions and adjustments