Stress & Coping Dr L Jones Department of Psychiatry
Learning Outcomes <ul><li>At the end of this lecture, you will be able to: </li></ul><ul><li>Define stress, and describe c...
What is Stress? <ul><li>Psychological state associated with physiological and hormonal changes caused by conflict, trauma,...
Stressors <ul><li>Usually fall into one or more of: </li></ul><ul><li>Traumatic events outside the usual range of human ex...
<ul><li>Natural disasters (e.g., flood, earthquake) </li></ul><ul><li>Disasters caused by human activity (e.g., war, terro...
Uncontrollable Events <ul><li>Examples include: </li></ul><ul><li>Death of a loved one </li></ul><ul><li>Loss of job </li>...
Unpredictable Events <ul><li>Predictability helps to reduce stress, e.g.,: </li></ul><ul><li>Hurricane/flood warnings </li...
<ul><li>Finals exams are a good example: </li></ul><ul><li>they challenge the limits of our intellectual capabilities </li...
Internal Conflicts <ul><li>Incompatible beliefs or courses of action, e.g., smoking behaviour </li></ul>
Everyday Hassles <ul><li>These can accumulate and create an overall feeling of stress that we can’t blame on one thing </l...
Reactions to stress differ widely <ul><li>POTENTIAL STRESSOR </li></ul><ul><li>OVERWHELMING INTERESTING </li></ul><ul><li>...
Stress Responses STRESS Behavioural Sleep disturbance Use of alcohol/drugs Absenteeism Aggression Emotional Depression/anx...
Post-Traumatic Stress Disorder <ul><li>Numbness to world, estrangement from others, lack of interest in activities </li></...
PTSD  <ul><li>50% holocaust survivors suffer PTSD 40 yrs later </li></ul><ul><li>35% Vietnam veterans suffer PTSD </li></u...
The Fight-or-Flight Response STRESSOR HYPOTHALAMUS SYMPATHETIC  NERVOUS SYSTEM PITUITARY GLAND ADRENAL  MEDULLA ADRENAL  C...
<ul><li>Our stress response is ill-equipped to deal with modern stressors </li></ul>
General Adaptation Syndrome Hans Selye (1978) <ul><li>Alarm Reaction Stage (SNS activation and stress hormone discharge) <...
Early Warning Signs of Exhaustion Stage <ul><li>Headaches </li></ul><ul><li>GI disturbances </li></ul><ul><li>Skin rashes ...
How Stress Affects Health <ul><li>Cancer </li></ul><ul><ul><li>Not clearly associated with onset, but is associated with a...
Cohen at al (1991)
Bereavement <ul><ul><li>3-fold increase in non-psychiatric hospital admissions (mainly osteoarthritis) </li></ul></ul><ul>...
Stress & Health Related Behaviours EXAM  PERIOD = STRESS SMOKE  MORE POOR  DIET MORE  ALCOHOL LESS SLEEP LESS  EXERCISE
<ul><li>The important factor seems to be  how well  a person copes with stress rather than  how much  stress they face </l...
Personality & Stress Friedman & Rosenman, 1959 <ul><li>Type A </li></ul><ul><li>Competitive, achievement-oriented, sense o...
Examples of Type A Behaviours <ul><li>Thinking of, or doing, two things at once </li></ul><ul><li>Hurrying the speech of o...
Type A Personality <ul><li>Twice as likely to develop CHD </li></ul><ul><li>SNS is hyper-responsive to stressful situation...
Measuring Stress <ul><li>Measure number & type of stressors, e.g., Life Events Scale </li></ul><ul><li>Measure psychologic...
The Life Events Scale Holmes & Rahe, 1967 Life Event   Value   Death of spouse 100 Divorce 73 Death of close relative 63 M...
Stress & 4 th  Year Medical Students Stressor % Reporting Relations with consultants 34 Effects on personal life 31 Too li...
Coping With Stress <ul><li>Problem-focused coping </li></ul><ul><li>Emotion-focused coping </li></ul><ul><ul><li>Behaviour...
Behavioural Stress Management <ul><li>Progressive relaxation </li></ul><ul><li>Yoga </li></ul><ul><li>Meditation </li></ul...
Cognitive Stress Management <ul><li>Psychological defence mechanisms, e.g., </li></ul><ul><ul><li>Denial: denies existence...
Personal Coping Strategies <ul><li>Trust in time </li></ul><ul><li>Gather all necessary information </li></ul><ul><li>Do n...
<ul><li>Stress can be a positive thing </li></ul><ul><li>Stress is likely to be detrimental to health only if it is unreso...
Further Reading <ul><li>Chapter on Stress in Health Psychology textbooks </li></ul><ul><li>Taylor, S. (2002) Health Psycho...
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Stress

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Stress

  1. 1. Stress & Coping Dr L Jones Department of Psychiatry
  2. 2. Learning Outcomes <ul><li>At the end of this lecture, you will be able to: </li></ul><ul><li>Define stress, and describe common stressors </li></ul><ul><li>Describe biological, psychological, and behavioural responses to stress, including post-traumatic stress disorder </li></ul><ul><li>Understand the relationship between stress and physical illness </li></ul><ul><li>Describe models of coping with stress </li></ul>
  3. 3. What is Stress? <ul><li>Psychological state associated with physiological and hormonal changes caused by conflict, trauma, or other disruptive influences (stressors) </li></ul>
  4. 4. Stressors <ul><li>Usually fall into one or more of: </li></ul><ul><li>Traumatic events outside the usual range of human experience </li></ul><ul><li>Uncontrollable events </li></ul><ul><li>Unpredictable events </li></ul><ul><li>Events that challenge the limits of our capabilities & self-concept </li></ul><ul><li>Internal conflicts </li></ul>
  5. 5. <ul><li>Natural disasters (e.g., flood, earthquake) </li></ul><ul><li>Disasters caused by human activity (e.g., war, terrorism, nuclear accident) </li></ul><ul><li>Catastrophic accidents (e.g., car/plane crash) </li></ul><ul><li>Physical assaults (e.g., rape/physical assault) </li></ul><ul><li>Stress can be very long-lasting </li></ul>Traumatic Events Outside the Usual Range of Human Experience
  6. 6. Uncontrollable Events <ul><li>Examples include: </li></ul><ul><li>Death of a loved one </li></ul><ul><li>Loss of job </li></ul><ul><li>Serious illness, hospitalisation </li></ul><ul><li>Burglary </li></ul><ul><li>Extremes of weather </li></ul><ul><li>Noise pollution </li></ul>
  7. 7. Unpredictable Events <ul><li>Predictability helps to reduce stress, e.g.,: </li></ul><ul><li>Hurricane/flood warnings </li></ul><ul><li>Knowing that a loved one will die </li></ul><ul><li>Noise pollution on bonfire night </li></ul><ul><li>Unpredictable jobs (e.g., A&E) are considered very stressful </li></ul>
  8. 8. <ul><li>Finals exams are a good example: </li></ul><ul><li>they challenge the limits of our intellectual capabilities </li></ul><ul><li>they carry the possibility of failure </li></ul>Highly Challenging Events
  9. 9. Internal Conflicts <ul><li>Incompatible beliefs or courses of action, e.g., smoking behaviour </li></ul>
  10. 10. Everyday Hassles <ul><li>These can accumulate and create an overall feeling of stress that we can’t blame on one thing </li></ul>
  11. 11. Reactions to stress differ widely <ul><li>POTENTIAL STRESSOR </li></ul><ul><li>OVERWHELMING INTERESTING </li></ul><ul><li> CHALLENGE </li></ul>
  12. 12. Stress Responses STRESS Behavioural Sleep disturbance Use of alcohol/drugs Absenteeism Aggression Emotional Depression/anxiety Irritability Crying Suicide Loss of humour Cognitive Lack of concentration Negative thoughts Worrying Poor Memory Biochemical Increased metabolic rate Altered hormone levels (adrenaline, cortisol, ACTH) Altered endorphin levels Physiological Higher blood pressure Rapid shallow breathing Increased heart rate Dilation of pupils Muscle tension Dry mouth
  13. 13. Post-Traumatic Stress Disorder <ul><li>Numbness to world, estrangement from others, lack of interest in activities </li></ul><ul><li>Relive trauma repeatedly in memories and dreams </li></ul><ul><li>Sleep disturbance, decreased concentration, over-alertness </li></ul><ul><li>Can last for years </li></ul><ul><li>Correlates = substance abuse, violence, interpersonal problems </li></ul>
  14. 14. PTSD <ul><li>50% holocaust survivors suffer PTSD 40 yrs later </li></ul><ul><li>35% Vietnam veterans suffer PTSD </li></ul><ul><li>Vietnam veterans – 45% higher death rate during first 5 yrs post-service (suicide, RTAs) </li></ul><ul><li>16% Vietnam veterans misuse alcohol & 16% arrested at least once </li></ul><ul><li>13% Gulf War (1991) combat soldiers suffer PTSD </li></ul><ul><li>44% Bosnian refugees suffer PTSD 1 yr after resettlement </li></ul><ul><li>WWI & WWII – shell-shock & combat fatigue </li></ul>
  15. 15. The Fight-or-Flight Response STRESSOR HYPOTHALAMUS SYMPATHETIC NERVOUS SYSTEM PITUITARY GLAND ADRENAL MEDULLA ADRENAL CORTEX Neural impulses activate various glands and smooth muscles Stress hormones carried via blood stream to relevant organs and muscles FIGHT-OR-FLIGHT Sympathetic System Adrenal-Cortical System
  16. 16. <ul><li>Our stress response is ill-equipped to deal with modern stressors </li></ul>
  17. 17. General Adaptation Syndrome Hans Selye (1978) <ul><li>Alarm Reaction Stage (SNS activation and stress hormone discharge) </li></ul><ul><li>Resistance Stage (‘full war effort’) </li></ul><ul><li>Exhaustion Stage (resistance fades as adaptive processes fail) </li></ul><ul><li>“Diseases of Adaptation” </li></ul>
  18. 18. Early Warning Signs of Exhaustion Stage <ul><li>Headaches </li></ul><ul><li>GI disturbances </li></ul><ul><li>Skin rashes & hives </li></ul><ul><li>Dizziness </li></ul><ul><li>Fatigue </li></ul><ul><li>Hypertension </li></ul><ul><li>Aggravation of: arthritis, colitis, asthma, ulcers, diabetes </li></ul>
  19. 19. How Stress Affects Health <ul><li>Cancer </li></ul><ul><ul><li>Not clearly associated with onset, but is associated with acceleration of the disease </li></ul></ul><ul><li>Coronary Heart Disease </li></ul><ul><ul><li>Increased risk in high stress jobs (Pickering et al, 1996) </li></ul></ul><ul><ul><li>Increased risk among employed mothers (Haynes et al, 1980) </li></ul></ul><ul><li>Psychoneuroimmunology </li></ul><ul><ul><li>Animal studies </li></ul></ul><ul><ul><li>Medical students have decreased immune function around exam periods (Glaser et al, 1986) </li></ul></ul>
  20. 20. Cohen at al (1991)
  21. 21. Bereavement <ul><ul><li>3-fold increase in non-psychiatric hospital admissions (mainly osteoarthritis) </li></ul></ul><ul><ul><li>Mortality increased (mainly cardiac and CV diseases, esp. coronary thrombosis) </li></ul></ul><ul><ul><li>7-fold mortality increase in 1 st year after death of close relative </li></ul></ul><ul><ul><li>Greatest mortality among spouses (esp. young and male) </li></ul></ul>
  22. 22. Stress & Health Related Behaviours EXAM PERIOD = STRESS SMOKE MORE POOR DIET MORE ALCOHOL LESS SLEEP LESS EXERCISE
  23. 23. <ul><li>The important factor seems to be how well a person copes with stress rather than how much stress they face </li></ul>
  24. 24. Personality & Stress Friedman & Rosenman, 1959 <ul><li>Type A </li></ul><ul><li>Competitive, achievement-oriented, sense of time urgency, difficulty relaxing, impatient, angry, hostile, outwardly confident but full of self-doubt </li></ul><ul><li>Type B </li></ul><ul><li>Relaxed, easy-going, unpressured </li></ul>
  25. 25. Examples of Type A Behaviours <ul><li>Thinking of, or doing, two things at once </li></ul><ul><li>Hurrying the speech of others </li></ul><ul><li>Unduly irritated by queues </li></ul><ul><li>If you want something done you have to do it yourself </li></ul><ul><li>Frequent knee jigging or rapid finger tapping </li></ul><ul><li>Frequent use of obscenities </li></ul><ul><li>Playing every game to win, even with children </li></ul><ul><li>Impatience when watching someone else do something you think you could do better or faster </li></ul><ul><li>Rapid blinking or tic-like eyebrow lifting </li></ul>
  26. 26. Type A Personality <ul><li>Twice as likely to develop CHD </li></ul><ul><li>SNS is hyper-responsive to stressful situations </li></ul><ul><li>Personality is not the whole story - CHD is multifactorial </li></ul>
  27. 27. Measuring Stress <ul><li>Measure number & type of stressors, e.g., Life Events Scale </li></ul><ul><li>Measure psychological responses to stress, e.g., Perceived Stress Scale </li></ul><ul><li>Measure psychological symptoms of stress, e.g., Stress/Anxiety Scales </li></ul><ul><li>Measure physiological symptoms of stress, e.g., GSR, blood pressure, heart rate, hormone levels, immune response </li></ul>
  28. 28. The Life Events Scale Holmes & Rahe, 1967 Life Event Value Death of spouse 100 Divorce 73 Death of close relative 63 Marriage 50 Fired from job 47 Pregnancy 40 Sex difficulties 39 Change in finances 38 Death of close friend 37 Son/daughter leaving home 29 Trouble with in-laws 29 Begin/end school 26 Change in living conditions 25 Revision of personal habits 24 Trouble with boss 23 Change in residence 20 Change in school 20 Change in recreation 19 Change in sleeping habits 16 Change in eating habits 15 Holiday 13 Christmas 12
  29. 29. Stress & 4 th Year Medical Students Stressor % Reporting Relations with consultants 34 Effects on personal life 31 Too little responsibility 28 Too much responsibility 25 Talking with terminally ill patients 24 Relations with academic staff 13 Physical examinations of patients 11 Relations with ward staff 11 (Firth-Cozens, 1986, BMJ)
  30. 30. Coping With Stress <ul><li>Problem-focused coping </li></ul><ul><li>Emotion-focused coping </li></ul><ul><ul><li>Behavioural </li></ul></ul><ul><ul><li>Cognitive </li></ul></ul><ul><ul><li>Psychopharmacological </li></ul></ul>
  31. 31. Behavioural Stress Management <ul><li>Progressive relaxation </li></ul><ul><li>Yoga </li></ul><ul><li>Meditation </li></ul><ul><li>Hypnosis </li></ul><ul><li>Biofeedback </li></ul>
  32. 32. Cognitive Stress Management <ul><li>Psychological defence mechanisms, e.g., </li></ul><ul><ul><li>Denial: denies existence of stressor </li></ul></ul><ul><ul><li>Reaction Formation: exhibit conscious feelings opposite to those at the unconscious level </li></ul></ul><ul><li>Cognitive therapy </li></ul><ul><li>Cognitive restructuring </li></ul>
  33. 33. Personal Coping Strategies <ul><li>Trust in time </li></ul><ul><li>Gather all necessary information </li></ul><ul><li>Do not isolate yourself </li></ul><ul><li>Think positively </li></ul><ul><li>Keep a sense of humour </li></ul><ul><li>Think of yourself as relaxed </li></ul><ul><li>Exercise </li></ul><ul><li>Get a pet (Culliton, 1987) </li></ul>
  34. 34. <ul><li>Stress can be a positive thing </li></ul><ul><li>Stress is likely to be detrimental to health only if it is unresolved & long-lasting </li></ul>
  35. 35. Further Reading <ul><li>Chapter on Stress in Health Psychology textbooks </li></ul><ul><li>Taylor, S. (2002) Health Psychology. McGraw-Hill </li></ul><ul><li>Sapolsky (1998) Why Zebras Don’t Get Ulcers. Freeman </li></ul>

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