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Stress
AQA Psychology
Paper 3
NAME_______________________________________________________________________________

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Stress Specification Details
Paper 3
Candidates should be able to: -
GREEN AMBER RED
4.3.7
Stress
1. The physiology of stress, including general
adaptation syndrome, the hypothalamic
pituitary-adrenal system, the sympathomedullary
pathway and the role of cortisol.
2. The role of stress in illness, including reference
to immunosuppression and cardiovascular
disorders.
3. Sources of stress: life changes and daily
hassles. Workplace stress, including the effects of
workload and control
4. Measuring stress: self-report scales (Social
Readjustment Ratings Scale and Hassles and
Uplifts Scale) and physiological measures,
including skin conductance response.
5. Individual differences in stress: personality
types A, B and C and associated behaviours;
hardiness, including commitment, challenge and
control.
6. Managing and coping with stress: drug therapy
(benzodiazepines, beta blockers), stress
inoculation therapy and biofeedback..
7. Gender differences in coping with stress. The
role of social support in coping with stress; types
of social support, including instrumental,
emotional and esteem support

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Possible Essay questions
Essay Title My Grade My
amended
grade
Discuss the physiology of stress. In your answer you should include
the general adaption syndrome, the hypothalamic pituitary-adrenal
systems and the sympathomedullary pathway (16 marks)
Discuss the role of stress in illness (16 marks)
Describe and evaluate research on life changes as a source of stress
(16 marks)
Discuss sources of stress. Include both life changes and daily hassles
in your answer (16 marks)
Discuss research related to workplace stress. Include the effects of
workload and control in your answer (16 marks)
Describe and evaluate the ways stress can be measured, ensure you
refer to self-report and physiological measures (16 marks)
Discuss the relationship between personality and stress (16 marks)
Discuss individual difference in stress (16 marks)
Discuss the use of drug therapy in managing and coping with stress
(16 marks)
Describe and evaluate the use of stress inoculation therapy in
managing and coping with stress (16 marks)
Describe and evaluate the use of biofeedback in managing and
coping with stress (16 marks)
Discuss gender differences in stress (16 marks)
Discuss research related to the role of social support in coping with
stress (16 marks)

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Key word glossary year 2 - Stress
Adrenaline
Noradrenalin
Cortisol
General Adaption
Syndrome
Hypothalamic
pituitary-adrenal
system
Sympathomedullary
Pathway
Cardiovascular disorder
Immunosuppression
Life Changes
Life Changes units
(LCU)
Daily Hassles
Daily Uplifts
Job Control
Workload
Workplace stress
Hassles and uplifts
scale (HSUP)

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Physiology of stress
Skin conductance
response
Social Readjustment
Scale (SRRS)
Type A
Type B
Type C
Hardiness
Benzodiazepines (BZs)
Beta Blockers (BBs)
Stress Inoculation
Therapy (SIT)
Biofeedback
Emotion-Focused
Coping
Problem-Focused
Coping
Tend-and-Befriend
response
Emotional Support
Esteem Support
Instrumental Support

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Stress
Stress is a common part of human life in todays
modern world. You may know of someone who has
been ‘stressed out’ at work, or of friends who have
told you they are stressed just before stitting
important exams.
Every week the media report
of high profile celebrities and
the like experiencing stress due to their hectic life styles and
thousands of professional and amateur psychologists making a
living out of helping people manage stress and its
consequences, sometimes using wierd and wonderful methods!
Make a note of 3 occasions when you have been stressed
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Do any of these photos show something that
you typically find stressful?

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Identify some other causes of stress that you experience in your life
 People
 Situation
 Environment
How do you know when you are stressed? What are the symptoms that you associate with the
experience of stress?
Compare you lists with those around you. Do they have different stressors? Are their symptoms the
same as yours?
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
What do you do when you are stressed?

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The Physiology of Stress
Stress is an emotional response to situations of threat. Such threats may be physical (a
spider is about to attack you) or psychological (worried about your exams). In both cases
your body produces a short-term (immediate) response and, should the stressor
continue, a long-term (ongoing) response.
The Sympatho-Medullary pathway
When faced with a stressful situation, an animal responds with an immediate fight or
flight response. As this was covered in year one this will be a brief recap.
The short term response is called the Sympathomedullary pathway or the SAM system.
1. (S) A signal sent down the sympathetic branch (SNS) of our Autonomic Nervous
System (ANS) which then stimulates our Adrenal Medulla.
2. (M) The signal is sent via our central nervous system to the two endocrine glands
located just above the kidneys. The middle part of the adrenal gland the Adrenal
Medulla responds by releases Adrenaline and smaller amounts of Noradrenaline
into our bloodstream.
3. (A) Adrenaline and noradrenaline circulate through our bodies and affect the key
target organs such as the heart and the muscles.
After a few minutes the parasympathetic branch of the ANS will start to work. This will
reduce the “flight or fight” response and bring the body back to normal.
The Pituitary-Adrenal system
The Pituitary-adrenal system (HPAC) is the second part of the stress response, this
system responds to chronic stressors such as psychological stress due to work issues,
family concerns or examinations.
1. (H) The hypothalamus is stimulated when the brain notices a stressor.
2. (P) A signal is then sent to the Pituitary gland in the brain which releases a
hormone called ACTH (adrenocorticotrophic hormone).
3. (A) ACTH travels through the bloodstream down to the
Adrenal Cortex (the outside of the adrenal gland) which
stimulates it to release Corticosteroids, such a cortisol, into
the bloodstream.
4. Corticosteroids are a vital part of the stress response and
have two major effects on the body;
a. They release glucose from the liver to be used by the
muscles as energy and,
b. They suppress the immune system to redirect energies to
other areas of the body i.e. Brain and muscles. This
process is called ‘Immunosuppression’

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Using the information from the previous page complete the following table
SympathoMedullary
System
Pituitary-Adrenal
System
Which parts of the
brain control the
reaction?
How does the brain
stimulate the adrenal
gland?
Which part of the
adrenal gland is
involved?
Which hormones are
released by the
adrenal gland?
What are the major
similarities and
differences between
the systems?

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General Adaption Syndrome (GAS)
Much of our understanding of the nature of stress can be traced back to the pioneering
work of Hans Selye (1930). His research led him to conclude that when animals are
exposed to unpleasant stimuli, they display the universal response to all stressors. He
called this the general adaption syndrome (GAS). It is ‘general’ because it is the same
response to all agents; the term ‘adaption’ is used because its adaptive – it is the bodies
best way to cope with extreme stress. It is a ‘syndrome’ because there are several
symptoms in the stress response.
Selye (1956) observed that in laboratory animals and human patients the fight or
flight response was only the first of a series of reactions.
 He reported that the rats that he was experimenting on showed physiological
changes that were directly linked to the injections that they received during the
experiments, but that what was actually being injected was less important than
the fact that they were getting an injection.
 The rats were then exposed to various types of nocuous (harmful) stimuli,
including extreme cold, surgical injury, excessive exercise, severing the spinal
cord, and nearly lethal doses of drugs.
 The rats developed the same physiological symptoms each time, including (over
time) the development of stomach ulcers.
This led him to make the statement that stress is “the non-specific response of the
body to any demand”.
The GAS consists of three stages, and these stages ARE… Alarm reaction, Resistance, and
Exhaustion.
ALARM REACTION
When we come across a stressor fight/flight reaction is triggered. This is part of the
sympathetic branch of the autonomic nervous system (ANS). This stage deals with
acute stressors. It is at this stage that the sympathetic adrenal-medullary system (SAM)
becomes activated. This is controlled by electrical impulses through nerves, making the
response fast.
RESISTANCE
If the stressor is not dealt with then the endocrine system helps us to maintain our
response, through the hypothalamic pituitary adrenocortical axis (HPA). This is a
hormonal response and travels through the blood, making this a slower response.
The hypothalamus sends a message to the pituitary gland, which releases
adrenocorticotrophic hormone (ACTH). This is what causes the adrenal cortex (part of
the adrenal gland) to release cortisol. This stimulates the liver to release glucose, and
also suppresses the immune system.

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EXHAUSTION
This stage occurs when the body can no longer keep up with the stressor, and the body’s
resources have become depleted. It is caused by severe long-term or repeated stress,
and it is in this stage that illness is most likely.
Once ACTH and cortisol are in the bloodstream the production of more is inhibited. The
adrenal glands no longer function properly and they actually increase in size. Blood
glucose levels tend to drop, which can result in death. Psychophysiological disorders
may develop, e.g. hypertension, CHD, asthma, and peptic ulcers
Task In the table below summarise the three stages of General Adaptation Syndrome.
Make sure to include some of the behaviours and emotions that a person may have at
each stage.
Identify the stage Body responses Behaviours/ emotions

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Evaluation of Short- and long-term stress
The transactional model of stress
Negative consequences of the fight-or-flight response
Gender Differences

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Stress-related illness may not be due to depletion of resources…..
Seyles model was based on his observations working with human patients – he
noticed that they all shared a common set of symptoms – aches, pains and loss of
appetite, no matter what was actually wrong with them. His work with rats, see
previous page also demonstrated that they produce a similar response.
How can these facts be used as an evaluation point?

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1. Outline the general adaption syndrome (6 marks)
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2. Outline the hypothalamic pituitary-adrenal system (4 marks)
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3. Outline the role of cortisol (3 marks)
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Essay title:
Discuss the physiology of stress.
Outline (Write for 7
minutes)
Evaluate (13 minutes)
Research support (+)
Research Challenge (-)
Issues or debates (+/-)
Methodology/approaches (+/-)
If you need an extra evaluation point due to not writing the above in enough
detail then add another issue/debate/methodology or approach evaluation.

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The role of stress in illness
In the previous section we learnt about short-term stressors lead to the production of
adrenaline and that (ongoing) long-term stressors result in the production of cortisol.
Each of these hormones can, in turn be linked to cardiovascular disorder.
Immediate stress: Adrenaline and cardiovascular disorder
Stress activates the SNS (sympathetic branch of the autonomic nervous system) leading
to the production of adrenaline (and noradrenaline). High levels of adrenaline will have
the following effects:
 Increased heart rate causes the heart to work harder and takes its toll over time
 Constriction of the blood vessels increases blood pressure, which puts tension on
the blood vessels, causing then to eventually wear away.
 Increased pressure can also dislodge plaque on the walls of the blood vessels,
and this can lead to blocked arteries (atherosclerosis) – this may cause a heart
KEY STUDY – Williams et al (2000)
Aim: Williams et al (2000) wanted to investigate whether anger is linked to heart disease
(anger, like stress activated the SNS)
Procedure: About 13,000 people completed a 10- question anger scale, including questions
on whether they were hot-headed, if they felt like hitting someone when they got angry, or
whether they got annoyed when they were not given recognition for doing good work. None
of the participants suffered from heart disease at the beginning of the study.
Findings: Six years later, the health of the participants was checked; 256 had experienced
heart attacks. Those that scored the highest on the anger scale were over two and half times
more likely to have had a heart attack than those with the anger ratings. People who scored
‘moderate’ in the anger ratings were 35% more likely to have experienced a coronary event
than those with a lower score.
Conclusion:

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Ongoing stress: Cortisol and immunosuppression
Ongoing stress activates the HPA system, which results in the production of various
hormones including cortisol. One of the effects of cortisol is to reduce the body’s
immune system response, making it more likely that a person will become ill, because of
invading viruses and bacteria are not attacked.
KEY STUDY –Kiecolt-Glaser et al (1984)
Aim: Kiecolt-Glaser et al (1984) wanted to demonstrate that natural stressors could lower the
immune system, which would in turn make people more likely to be ill.
Procedure: The researchers took blood samples from 75 first-year medical students (49
males and 26 females), all of whom volunteered. The samples were taken a month before the
exams (baseline sample) and on the day of the exam (stress sample). As an index of immune
functioning they looked at natural killer (NK) cell activity, part of our natural immune system.
The participants’ also completed the Social Readjustment Rating Scale (SRRS) to measure
other life stressors they were experiencing, the students also completed a ‘loneliness scale’
that asses how many interpersonal contacts they has i.e. their social support network.
Findings: They found that the immune system was reduced following the stressful exam.
Natural killer(NK) cell activity was significantly reduced in the high stress samples, compared
to the baseline samples. Also, the greatest reductions were in students reporting higher
levels of social isolation. They found that the immune systems were especially weak in those
who were experiencing other stressful life events and were lonely.
Conclusion:

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Evaluation of the role of stress in illness
Self-report
Supporting
research
Individual
Differences
Stress does not
always have a
negative effect
Stress and illness
– not as simple
as it sounds

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1. Evaluate research on the role of stress on immunosuppression (8 marks)
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2. Describe one study of the role of stress in cardiovascular disorder. In your
answer, explain what the researcher(s) did and what they found (4
marks)
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Essay title:
Discuss the role of stress in illness
minutes)

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Sources of stress: Life changes
Major life events may happen from time to time and cause an individual to experience
stress. These major life events may be positive ones, as well as negative ones both of
these have something in common – change. Changes requires psychic energyto be
expended i.e. it is stressful. Holmes and Rahe suggested that this psychic energy affects
health.
Measuring life change
In order research the effects of life changes on health, Holmes and Rahe (1967)
recognised they needed a standard measurement tool. They developed the Social
Readjustment Rating Scale (SRRS)to do this. The scale consisted of 43 life events, an
idvidual idenetifes which items occured within a specific time period (either 3 months, 6
months or a year). Each event has a score in terms of life change units (LRC). Death of a
spouse is the highest with 100 LRC, where as minor violations of the law is the lowest at
11 LRC.

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KEY STUDY –Rahe et al (1970)
Rahe et al (1970) used a slightly adapted version of the SRRS to investigate the
relationship between stress and illness. They called it the Schedule of Recent Experiences
(SRE). The study focussed on the ‘normal’ population, as opposed to previous studies
which focussed on people already ill in hospital.
Aim: To investigate the impact of life changes as a source of stress.
Procedure: The sample consisted of 264 men who were naval and marine personnel serving
aboard three US Navy cruisers. The men were asked to complete the SRE for events they had
experienced in the previous two years. The SRE was adapted to be more specific to military
experiences, such as including a life event for being promoted. This then produced their LCU
score. During the 6 – 8 month tour of duty, a record was kept of anytime one of the men
visited the sick bay on board the ship, as well as the type and severity of the illness. This then
produced an illness score.
Findings: Rage et al (1970) found a significant positive correlation between the LCU score and
the illness score of +.118. Those men who scored low in terms of their SRE also had low levels
of illness.
Conclusion: As both positives and negatives are included in the SRRS (even Christmas is
stressful for some), it appears that it is change rather than negativity of change that is
important in creating stress. It is the overall amount of psychic energy (mental and emotional
effort) required to deal with a life event that creates the stress.

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Additional Research on life changes
Cohen et al (1993)
Cohen et al out a study that measured the effect of stress on the body’s immune system.
154 men and 266 women were used. The level of stress in their lives was measured by;
1. A life event scale measuring the previous year,
2. A scale assessing the individuals perceived level of stress, and,
3. A scale that measured levels of anxiety, fear and depression.
The scores were combined to give a score for each individual. The participants were
given nose drops with the common cold virus in it. The participants were observed for
six days and blood samples were taken to see whether they developed a cold. The
participants with a high stress score were more likely to get a cold than those who had a
low stress score. They concluded stress increases vulnerability to infections.
TASK: 50 Word Wonder - Summarise the effect of life changes
TASK: 50 Word Wonder - Summarise the Rahe et al. (1970)
research study

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Evaluation of sources of stress: life changes
AO3 BOTTOM MARK BAND
(Grade U-D)
 A basic commentary. Evaluation
is only just discernible. (1 mark)
 Basic evaluation of research.
Superficial. Restricted range of
issues. (3 - 6 marks)
MIDDLE MARK BAND
(Grade C-B)
 Reasonable commentary, but
material not always used
effectively.
 Reasonable evaluation. Depth or
breadth acceptable - a few issues in
depth, or more issues at less depth.
( 6 – 8 marks)
TOP MARK BAND
(Grade A)
 An informed commentary.
 The evaluation is effective – makes
a good discussion.
 Again, accept breadth or depth in
answer. (8 - 10 marks)
Study Statement of criticism
(+ve or –ve)
Comment on statement Elaboration
Holmes
&
Rahe
(1967)
Rahe
et
al
(1970)

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1. Explain why life changes may be a source of stress (2 marks)
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2. Describe one study of the role of life changes. In your answer, explain
what the researcher(s) did and what they found (4 marks)
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3. Give one criticism of the role of life changes in stress (3 marks)
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Essay title:
Describe and evaluate research on life changes as a source of stres
minutes)

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Sources of Stress: Daily Hassles
Most of the 43 life changes in the SRRS are not everyday events. Kanner et al (1981) has
designed a Hassles and Uplift Scale (HSUP) which consists of 117 items. Daily hassles are
‘irritating, frustrating, distressing demands that to some degree characterise everyday
transactions with the environment’ (Kanner 1981) – i.e. the straw that broke the camel’s
back!
The negative effects of daily hassles cab in turn be offset to some degree by the more
positive experiences that we have every day, these are known as Daily Uplifts, these can
counteract the damaging effects of stress.
List as many daily hassles as you can think of….
List as many daily uplifts as you can think of….

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Explaining the effect of daily hassles
Accumulation
One explanation for this is that an accumulation of minor daily stressors creates
persistent irritations, frustrations an overloads which then result in more serious stress
reactions such as anxiety and depression (Lazarus, 1999)
Amplification
An alternative explanation is that chronic stress due to major life changes may make
people more vulnerable to daily hassles. As the person is already in a state of distress,
the presence of associated minor stressors may in fact amplify the experience of stress.
The presence of major life stress may also deplete a person’s resources s they feel
unable to cope with the minor stressors than they would under normal circumstances.
Kanner et al Daily Hassles and Uplift Scale (HSUP)
Examples of Daily hassles Examples of Daily uplifts
about weight recreation
rising prices relations with friends
home maintenance good weather
losing things job promotion
physical appearance eating out
crime Getting enough sleep
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Summary of research findings…
Research shows that there is a correlation between hassles and depression, anxiety and health
problems. Research using the scale has also shown that although life event scales and hassles both
correlate with health, the correlation is stronger for hassles.
KEY STUDY –Kanner et al (1981)
Aim: Kanner et al (1981) were interested in investigating whether it is daily hassles, rather
than major life events that are the most stressful. They developed a 117 item hassles scale
and a 135 uplifts scale to examine the relationship between hassles and health.
Procedure: An opportunity sample of 100 American participants, including 52 women and 48
men, all white, well-educated and middle class were asked to circle the events on both scales
that they had experienced the previous month and rate each according to severity (for the
hassles) and frequency (for the uplifts) and continue to do so once a month for nine months.
Each participant also completed a life events scale for the six months preceding the beginning
of the study and also for the two yearly periods prior to that. Finally they completed it again
at the end of the study.
Two measures were used to assess the psychological well-being of the participants the
Hopkins Symptom checker, which assess depression and anxiety, as well as the Bradburn
Morale Scale, which assesses positive and negative emotion, participants filled these out
every month.
Results: They found the hassles scale tended to be a more accurate predictor of stress
related problems, such as anxiety and depression, than the SRRS. Uplifts had a positive effect
on the stress levels of women, but not men.
Conclusion:

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Evaluation of the role of stress in illness
Self-report
Importance of
Daily Hassles
Reliability of
recall
Individual
differences
Correlation

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1. Explain why daily hassles may be a source of stress (2 marks)
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2. Describe one study of the role of daily hassles. In your answer, explain
what the researcher(s) did and what they found (4 marks)
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3. Give one criticism of the role of daily hassles in stress (3 marks)
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Essay title:
Discuss sources of stress, include both life changes and daily hassles
minutes)

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Sources of Stress: Workplace Stress
Think about a part time job you have (or once had). What issues/factors cause you to get stressed out
while working?
There are two causes of workplace stress that you
need to be aware of, these are;
(Lack of) Control - this means not managing your
own work load, it is a major source of stress. Many people’s
workload and pattern of work, e.g. shifts, are decided by
other people.
Workload (Overload) – this refers to the issue
of overload and is reported as one of the main forms of
stress in the workplace. It can include the number of
hours an individual spends working. Having too little to do
may also lead to individuals suffering from stress at work.
In your own words explain why these two factors may stress someone out at work:
These factors have now been combined to form the ‘job-strain model’ of workplace
stress. This model proposes that the workplace creates stress and illness in two ways
described above.

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Marmot et al. (1997) - Whitehall I and II
Marmot et al studied the relationship between stress in the workplace and illness. He
collected data from a sample of civil servants working at Whitehall in London since
1985. It was suggested low grade employees would experience low job control stress.
Whitehall I
Firstly, in the ‘Whitehall I’ study civil servants completed a questionnaire giving
information about their job role, lifestyle choices, socioeconomic status and physical
health. Clear differences were found between the workers pay grade type and mortality
rates. Those workers with lower pay grade had twice the illness rate of workers in the
higher pay grade.
Whitehall II
Secondly, a follow up study ‘Whitehall II’ by Marmot (1997) with over
7,000 male and female participants over a 5 year period also showed
those in the lower pay grades were 1.5 times more likely to show signs
of heart problems than those in the highest pay grades. Basically a lack
of control in the work place particularly for those in the lower pay grade
caused people to become stressed and ill.
Overall Marmot et al’s research found that a lack of control within the work place is
linked to stress related illness.
Think of two evaluation points for Marmot et al. (1997)’s study and write them here using the PEEL format:
Evaluation
Point
1
Point:
Evidence:
Explanation:
Link:
Evaluation
Point
2
Point:
Evidence:
Explanation:
Link:
An issue with these results is that those in the lower pay grades had higher risk factors
in their lifestyles. Many tended to smoke, be obese and had higher blood pressure
levels. These risk factors could be used to explain the increase in heart problems, not
simply the stress they may have experienced at work.

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Workplace stress – Work overload
Johansson et al (1978)
Johansson et al studied a group of 28 Swedish sawmill workers. The high risk group
(high workload and low control) were 14 sawyers, edgers and graders, who were
compared to low risk group of stickers, repair men and maintenance workers, they were
matched on factors such as education and job experience.
Johansson recorded daily levels of adrenaline and noradrenaline in the workers on work
days and weekends to assess stress.as well as obtained self-reprots of job satisfaction
and illness.
The high risk group, were found t have higher illness rates and also higher levels of
adrenaline in their urine compared to the low risk group. The self-report data obtained
from the high risk group confirmed that they had greater workload and a lowered sense
of control, they also reported a sense of social isolation.
Stress from being overloaded at work can make people ill. The implication is that if the
stress can be reduced then people will not get so ill and productivity of the company can
be improved.
Think of two evaluation points for Johansson et al (1978)’s study and write them here
using the PEEL format:
Evaluation
Point
1
Point:
Johansson et al’s research findings may not consider individual differences in
workers.
Evidence:
Explanation:
Link:
Evaluation
Point
2
Point:
Evidence:
Explanation:
Link:
What other evaluation point could be linked to both studies?

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1. Explain what is meant by workplace stress (3 marks)
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2. Explain what research has shown about the role of workload and control
as a source of stress (6 marks)
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3. Discuss one limitation of research into workplace stress (3 marks)
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Essay title:
Describe and Evaluate research related to workplace stress
minutes)

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Measuring Stress: Self-report scales and
physiological measures
Measure – explain
what they are
Evaluation
Social Readjustment Rating
Scale (SRRS)
Hassles and Uplifts Scale
(HSUP)
Skin Conductance Response
Other physiological measure
(blood pressure / cortisol
levels)

- 39 -
Individual Differences: Personality Factors and Stress
Two medical doctors, Friedman and Rosenman, asked people to identify what they
thought the major causes of coronary heart disease (CHD). The answer was that CHD
was due to exposure to chronic emotional trauma as a consequence of excessive drive
and competiveness, having deadlines, and economic frustration. This lead Friedman and
Rosenman to propose two key personality types: Type A and Type B.
Type A behaviour
Type A Behaviour
A behaviour pattern characterised by time pressure, competitiveness and
hostility. It has been suggested that high levels of TAB increase vulnerability to
heart disease.
These personalities have long been linked to a vulnerability to stress related
illnesses.
During the 1950s two heart specialists, Friedman and Rosenman, noticed that heart
patients seemed to have a particular behaviour type. They called this a Type A
behaviour. Type A people are likely to display the following behaviour patterns:
Behaviour Patterns Examples
Time Pressured  Always working to deadlines
 Unhappy doing nothing
 Multi-tasking; doing several jobs at the same
time
Competitive  Always orientated towards achievement
 Play to win, whether at work or on the sports
field
Hostile  Becomes easily irritated and impatient with co-
workers
 Easily angered
 Anger can be directed inwards
Type B behaviour
Friedman and Rosenman also identified a second behaviour type called the
Type B behaviour. Type B people are usually less competitive, less hostile
and more patient with others, easygoing and tolerant and they usually
move more, and speak more slowly.
Friedman and Rosenman (1974) found that people who were time
pressured, highly competitive and prone to anger and hostility were more
at risk of CHD than those who were more relaxed. 70% of those with CHD
were classified at Type A. Behaviour modification programmes to change
Type behaviours have been successful in preventing recurrence of CHD.

- 40 -
KEY STUDY – Friedman and Rosenman (1959, 1974)
Aim: They established the Western Collaborative Group (WCG) to investigate the link
between Type A personality and CHD
Procedure: At the beginning of the longitudinal study, approx. 3000 men aged 39 – 59, living
in California, were examined for signs of CHD (to exclude any individuals who were already
showing signs of CHD) and their personalities were assessed by interview. The interview
consisted of 25 questions about how they responded to everyday pressures. For example,
participants were asked how they would cope with having to wait in a long queue. The
interview was conducted in a provocative manner to try and elicit Type A behaviour. For
example, the interviewer would speak really slowly and hesitantly, so a Type A person would
want to interrupt them. On the basis of the interview the men were categorised as either
Type A or Type B.
Findings: After 8 and a half years, 257 of the original participants had developed CHD. Over
12% of Type A participants had experienced a heart attack, compared to jusy 6% of Type Bs.
Type As also had higher blood pressure and higher cholesterol. Most significant is that twice
as many Type A participants had died of cardiovascular problems.
Conclusion:

- 41 -
Type C and Type D personality
Type C individuals strongly suppress their emotions, particularly negative ones, and are
un assertive, likeable people who rarely get into arguments and are generally helpful to
others. They cope with stress in a way that ignores their own needs, even physical ones,
in order to please others, and this has a negative physiological consequence. Type C
behaviour has been linked to cancer, Temoshok (1987) suggests that this is because
some stressors activate the ANS, and this is related to CHD. More chronic stressors
affect the immune system and increase the risk of cancer.
Type D individuals are people who like routine and not change; they shun (shy away
from) responsibilities, are highly obedient and are prone to worry and becoming
irritable. Because of their lack of self – assurance and fear of rejection they tend not to
express their negative emotions and therefore become very stressed, making them
prone to cardiovascular disease. Up to 53% of cardiac patients are thought to have type
D personality.
KEY STUDY – Morris et al (1981)
Aim: to investigate the link between Type C personality and cancer
Procedure: Over a period of two years, women attending a cancer clinic in London were
asked to participate in a study. In total, 75 women were interviewed and asked about how
often they expressed their affection, unhappiness by crying or losing control when angry in
order to assess typical patterns of emotional behaviour. The interviewer was not aware of
the initial diagnosis of cancer.
Findings: Those women whose breast lumps were found to be cancerous were also found to
have reperoted that they both experienced and expressed far less anger (type C) than those
women whose lumps were found to be non-cancerous.
Conclusion: This therefore supports the idea of a link between cancer and suppression of
anger.

- 42 -
Evaluation of the role of individual differences in stess
Supporting
Evidence
Key component
of Type A
Gender Bias
Effects of
personality –
direct or
indirect??
Challenges the
concept of Type
C

- 43 -
1. Explain what is meant by Type A behaviour in relation to stress (2 marks)
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2. Outline research that investigates Type A and B behaviour (4 marks)
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- 44 -
Essay title:
Discuss the relationship between personality and stress
minutes)

- 45 -
Hardiness
The Hardy Personality
Kobasa and Maddi (1979) Hardiness is seen as a range of personality characteristics
which help prevent us feeling stressed. These characteristics are control, commitment
and challenge.
 Control is the belief that you have some
 control over what happens to you in life rather than
thinking it is caused by external factors.
 Commitment is your sense of involvement
in the world around you, including people as well as
jobs and careers. It describes people with a strong
sense of purpose in their activities.
 Challenge is whether you see the problems
that will face you as a challenge to be overcome or
as a threat or stressor.
Key Research Evidence
Kobasa (1979) studied around 800 American business executives by assessing stress
using the Holmes and Rahe’s SRRS. Approximately 150 of the participants were classified
as high stress according to their SRRS scores. Of these, some had a low illness record
whereas others had a high illness record.
The individuals in the high-stress/low-illness group scored high on all three
characteristics of the hardy personality, whereas the high-stress/high-illness group
scored lower on these variables. This suggests that something else was modifying the
effects of stress because individuals experiencing the same stress levels had different
illness records. Kobasa believed a hardy personality encourages resilience.
Further Supporting Research
Both Kobasa and Maddi have conducted other studies, continuing to demonstrate this
relationship. Maddi (1987) studied employees of a US telephone company that was,
over a period of a year, dramatically reducing its workforce. Two thirds of employees
suffered stress-related health problems, but the remaining third thrived, the thriving
group showed more evidence of hardiness attributes.
Lifton et al (2006) measured hardiness in students at five US universities to see if
hardiness was related to the likelihood of completing their degree, results showed that
students low in hardiness were disproportionally represented in the drop-outs and
students high in hardiness were more likely to succeed.

- 46 -
Think of four evaluation points for Kobasa (1979)’s research evidence and write them
here using the PEEL format:
Evaluation
Point
1
Point:
Kobasa’s Hardy personality is a reliable explanation of how personality
characteristics help people deal with stress.
Evidence:
Explanation:
Link:
Evaluation
Point
2
Point:
Evidence:
Explanation:
Link:
Evaluation
Point
3
Point:
Evidence:
Explanation:
Link:
Evaluation
Point
4
Point:
Evidence:
Explanation:
Link:

- 47 -
1. Explain the terms commitment, challenge and control in relation to
hardiness (3 marks)
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2. Outline one study of hardiness in relation to stress (6 marks)
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- 48 -
Essay title:
Discuss individual differences in stress
minutes)

- 49 -
Drug Therapies
Benzodiazepines
Benzodiazepines (BZs) are the most widely prescribed drug for treating clinical
disorders. The most common BZs are Librium and Valium. These drugs aim to slow
down the activity of the central nervous system. They are often the starting point to
treat stress related conditions. They are very effective anti-anxiety drugs.
How do they work?
Benzodiazepines (BZs) work by increasing a natural brain
chemical (neurotransmitter) called GABA, which has a
dampening or quieting the effect on many of the brain
neurons. 40% of neurons in the brain are affected by GABA.
 Benzodiazepines react with the GABA sites on the outside of
the receiving neuron.
 This opens a channel allowing chloride ions to enter the
neuron.
 Chloride ions make the neuron less responsive to other
neurotransmitters that would usually excite the neuron.
This will result in an individual feeling calmer and much less
anxious about things that would otherwise cause stress.
Imagine you are a doctor advising a client about drug treatments for stress. Briefly outline in your
own words how this drug works:

- 50 -
Beta-blockers
Beta-blockers are also called beta-adrenoceptor blocking agents. In other words, they
will block sites which normally are activiated by the hormones adrenaline and
noradrenaline. They reduce the over-activity in the sympathetic division of the ANS.
They reduce heart rate and blood pressure within the cardiovascular system, the two of
the key symptoms of stress. Examples of Beta-blockers are Propranolol and Alprenolol.
How do they work?
Beta-blockers act on the sympathetic nervous system around the body and work by
reducing the activity of adrenaline and noradrenaline, which are key agents in the
sympathomedullary response to stress.
 Beta-blockers bind to the receptors on the heart and blood vessels.
 The receptors are therefore not stimulated and adrenaline and noradrenaline
have no effect in increasing heart rate and blood pressure.
 This reduces a key part of the body’s response to stress. Heart rate and blood
pressure stays normal; fight or flight reactions do not occur.
Imagine you are a doctor advising a client about drug treatments for stress. Briefly outline in your
own words how this drug works:

- 51 -
EVALUATING PHYSIOLOGICAL METHODS OF STRESS MANAGEMENT
Strengths of drug treatments
Effectiveness:
Kahn et al. followed nearly 250 patients over eight weeks and found that BZ’s were
significantly superior to a placebo. A meta-analysis of studies focusing on the treatment
of social anxiety found that BZ’s were more effective at reducing this anxiety than other
drugs.
Beta-blockers have been found to significantly reduce the symptoms of anxiety that can
hinder some musicians playing. In a study of over 2000 musicians in an American
symphony orchestra, 27% of musicians reported taking beta-blockers. These people said
they felt better about their playing and their performances were judged to be better.
Ease of use (practicality):
One of greatest benefits of using drugs for stress is that very little effort or time from the
user. This is much easier than stress-inoculation, for example, which requires a lot of
effort, time and motivation form the client in order to be effective. By reducing heart
rate and blood pressure so rapidly, BB’s can have a life-saving effect in people with life-
threatening hypertension.
Weaknesses of drug treatments
Addiction
The major problem with BZ’s is that they can lead to physical dependence. Patients
taking even a low dose of BZ’s show marked withdrawal symptoms when they stop
taking them, such as sleeping problems, sweating, and tremors. This has lead to the
recommendation that they only be used for short periods.
Side effects
BZ’s have a range of side effects which include tiredness, memory impairment, increased
aggressiveness and sedation. Because of this fully informed consent must be gained
from the patient before prescription. As BB’s are not interfering with brain activity they
are not associated with any sever side effects.
Treating symptoms not the cause
Drugs may be effective at treating symptoms but as soon as the treatment stops
symptoms will often reappear. This is because drugs do not target the source of stress or
help the individual develop more effective coping strategies. It may not, therefore, be
appropriate to put a temporary bandage around the problem particularly if the
treatment produces further problems (addiction).

- 52 -
3. Long-term stress is often accompanied by psychological and physical changes.
Drug therapy is sometimes used to reduce these effects of stress.
Outline drug therapy as a method of stress management.
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4. Evaluate biological methods of stress management (6 marks)
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- 53 -
Essay title:
Discuss drug therapy in managing and coping with stress
minutes)

- 54 -
Managing and coping with stress: Stress Incoculation
Therapy (SIT)
SIT is a form of cognitive behavioural therapy (CBT) that was developed specifically to
deal with stress. It is different from other stress treatments because Meichenbaum
(1985) shoulddevelop a form of coping before the problem arises. He suggested that
people should ‘inoculate’ themselves against the ‘disease’ of stress in the same way as
they would againist infectious diseases such as measlses. Although a person cannot
(usually) change the causes of the stress in their life, they can change the way they think
about the stressors.
With S.I.T. a person learns techniques that will help them to cope with present and
future stressful situations. The aim is to change a client’s emotional and behavioural
responses before they become very anxious or depressed. It is thought people
experience stress because they interpret a situation in a negative way and this has a
negative effect on their thoughts. For example, an individual taking a driving test might
start the engine thinking ‘I just know I’m going to fail’ and this can have an impact on
their ability to pass.
Meichenbaum - S.I.T three phase process;
By learning and practicing these new coping strategies, individuals are able to
‘inoculate’ (manage and control) themselves against the harmful effects of future
stressful situations and therefore make themselves more resilient in their own lives.
Application and follow-through- The individual applies the newly-acquired skills to increasingly
difficult situations in the real world. The client may use imagery (imagining how to deal with the
stressful situation), modelling (watching someone else deal with the situation) and role playing
(acting out scenes involving stressors). The therapist may then provide support and further training
when necessary as this is an ongoing therapy process.
Skill acquisition and rehearsal – The therapist and client develop and practice coping skills to be used
in stressful situations, e.g. positive thinking ‘...relax you can deal with this situation....’ relaxation,
social skills, time management and using social support systems. These are tailored to the client and
are both cognitive (they learn to think in a different way) and behavioural (they learn new more
adaptive behaviours).
2
3
Conceptualisation - The therapist helps the client identify their stressors, their usual response and
the success of these responses. The therapist may also challenge some of the client’s interpretations
(known as appraisals) of stressful situations.
1

- 55 -
Think of five evaluation points for Meichenbaum’s - stress inoculation
training (SIT) and write them here using the PEEL format:
Evaluation
Strength
1
Point: Effectiveness
Evidence:
Explanation:
Link:
Evaluation
Strength
2
Point:
Evidence:
Explanation:
Link:
Evaluation
Limitation
1
Point: Unnecessarily complex
Evidence:
Explanation:
Link:
Evaluation
Limitation
2
Point:
Evidence:
Explanation:
Link:

- 56 -
Evaluation
point
Point:
Evidence:
Explanation:
Link:
Evaluation
point
-
IDA
Point:
Evidence:
Explanation:
Link:

- 57 -
1. Outline what is involved in stress inoculation therapy (3 marks)
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2. Kerry is a talented badminton player who has just been promoted to the first
division. However, she finds these top league games very stressful because
she thinks that she is not as good as the other players and she believes that
she is going to lose every point. Now her game is beginning to suffer. Explain
how stress inoculation therapy (SIT) could be used to help Kerry. In your
answer you must refer to details from the passage above. (4 marks)
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- 58 -
Essay title:
Discuss the use of SIT
minutes)

- 59 -
Managing and Coping with Stress: Biofeedback
Biofeedback, like drug therapy, also deals with the body’s physiological response to
stress – the arousal of the SBS. Heart rate and blood pressure are not under our control
they are part of the ANS – if these actions were controlled consciously, we would spend
all our time thinking about them and nothing else! Biofeedback is a method by which an
individual learns to exert voluntary control over involuntary behaviours by being made
aware of what is happening in the ANS.
Biofeedback involves four processes:
Relaxation
•The client is taught techniques of relaxtaion. these have the effect of reducing the activity of the SNSa nd activating
the PNS. This means that adrenaline and noradrenaline are no longer produced, and the result should be reduced
heart rate, blood pressure and asll other symptoms associated with stress
Feedback
•The cleint is then attached to various machines which provide informtion about theactivity of the ANS. For
Example, the client can hear his / her heartybeat or is given a signal (using light or sound) to show any increases or
decreases in blood pressure or changes in muscle tension. Machines used can include - EMG electromyograph,
which responds to changes in the muscles and EEG electrenchelpogra, which measure elctrical activity in the brain.
The client the practice teh aforemenion relaxation techniques whilst listening to or looking at the feedback.
Operant Conditioning
•When relaxation leads to a reduction in heart rate, this is experienced as rewarding because the person has
achieved their goal and this reinforces the behaviour. Therefore increasing the chances of it happening again. The
reward leads to an unconciuos 'stamping in' of the behaviour.
Transfer
•The client finally needs to learn to transfer the skills learned to real life situations, using their relation techniques in
repsosne to stressful situations.

- 60 -
Lemaire et al (2011)
Aim: To determine whether a biofeedback-based stress management tool, consisting of
rhythmic breathing, actively self-generated positive emotions and a portable
biofeedback device, reduces physician stress.
Procedure: Forty staff physicians (23 men and 17 women) from various medical
practices were recruited. Physicians in the intervention group were instructed to use a
biofeedback-based stress management tool three times daily. Participants in both the
control and intervention groups received twice-weekly support visits from the research
team over 28 days, with the intervention group also receiving reinforcement in the use
of the stress management tool during these support visits. During the 28-day extension
period, both the control and the intervention groups received the intervention, but
without intensive support from the research team.
Stress was measured with a scale developed to capture short-term changes in global
perceptions of stress for physicians (maximum score 200).
Results: The mean stress score declined significantly for the intervention group but not
for the control group which demonstrates that biofeedback-based stress management
tool may be a simple and effective stress-reduction strategy for physicians.

- 61 -
Evaluation of Biofeedback as a method for managing and coping
with stress
Research Support
Operant conditioning –
irrelevant?
Continued popularity
Strengths
Limitations
Real world applications

- 62 -
1. Explain how a psychologist might use biofeedback to treat a person with
stress (4 marks)
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2. Explain one criticism that has been made relating to biofeedback (4 marks)
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- 63 -
Essay title:
Describe and Evaluate the use of biofeedback in managing and coping with stress
minutes)

- 64 -
Gender differences in coping with stress
Physiological explanations for gender differences
The human stress response has been characterised, both
physiologically and behaviourally, as "fight-or-flight." Although fight-or-flight may
characterise the primary physiological responses to stress for both males and females,
Taylor et al (2000) proposes that, females' responses are more marked by a pattern of
"tend-and-befriend." Tending involves nurturing activities designed to protect the self
and offspring that promote safety and reduce distress; befriending is the creation and
maintenance of social networks that may aid in this process.
The biobehavioral mechanism that causes the tend-and-befriend pattern appears to
draw on the attachment-caregiving system, and hormonal evidence from animal and
human studies suggests that oxytocin (the love hormone), in conjunction with female
reproductive hormones may be at its core. Whereas males produce testosterone which
can lead to aggression, females seek closeness of others – hence tend-and-befriend.
Psychological explanation for gender differences
Lazarus and Folkman (1984) suggested there are two types of coping responses emotion
focused and problem focused:
Emotion-focused coping involves trying to reduce the negative emotional responses
associated with stress such as embarrassment, fear, anxiety, depression, excitement and
frustration. This may be the only realistic option when the source of stress is outside the
person’s control. Drug therapy can be seen as emotion focused coping as it focuses on
the arousal caused by stress not the problem.
Problem-focused coping targets the causes of stress in practical ways which tackles the
problem or stressful situation that is causing stress, consequently directly reducing the
stress. Problem focused strategies aim to remove or reduce the cause of the stressor,
including: problem-solving, time-management and obtaining instrumental social
support.
Other examples of emotion-focussed coping:

- 65 -
KEY STUDY – Peterson et al (2006)
Aim: To demonstrate that men use problem focus and women use emotional focus coping
strategies
Procedure: Just over 1000 men and women seeking fertility treatment at a hospital were
recruited for a study on coping styles and asked to complete several questionnaires, including
Ways of coping questionnaire designed by Lazarus and Folkman.
Findings: They found clear gender differences. Women used confrontive coping i.e. a style
where they try to alter the situation to reduce the emotional impact (emotion-focussed).
They were more likely to seek social support and avoidance when compared to men. In
contrast, men engaged in problem solving and also distanced themselves from the problem
(a kind of problem-focussed approach). There were some emotion-focussed coping
techniques in men demonstrating that gender differences are not that clear cut.

- 66 -
Evaluation of Gender Differences in coping with stress
Tend-and-befriend is it
that simple?
Lack of research
Confounding variables
Methodological issues
Changing roles of men
and women
Real world applications

- 67 -
1. Describe one gender difference in coping with stress (3 marks)
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2. Describe the differences between emotion and problem focussed coping (4
marks)
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- 68 -
Essay title:
Discuss gender differences in stress
minutes)

- 69 -
The role of social support in coping with stress
One important factor in how well individuals deal with stress is the degree of social
support they get from family, friends, work colleagues, therapist etc. The more support
an individual gets the better they are able to cope with stressful situations. A lack of
social support not only prevents individuals from dealing with stress, it can also lead to a
sense of isolation and mental illness, such as depression.
Nabi et al (2013) surveyed 400 undergraduate Facebook users and found that the
number of friends was associated with stronger perceptions of social support and lower
levels of stress and less physical illness. They concluded that ‘the more friends, the
better’ was the best predictor of stress. Dickinson et al (2011) found that older people
with less social support impacts on their mental health.
Different kinds of support
While there are many different ways that people can support one another,
much research has been done on the effects of four distinct types of social
support:
 Emotional Support: This type of support often involves physical
comfort such as hugs or pats on the back, as well as listening and
empathizing. With emotional support, a friend or spouse might give
you a big hug and listen to your problems, letting you know that
they’ve felt the same way, too.
 Esteem Support: This type of social support is shown in expressions
of confidence or encouragement. Someone offering esteem support
might point out the strengths you’re forgetting you have, or just let
you know that they believe in you. Life coaches and many therapists
offer this type of support to let their clients know that they believe in
them; this often leads to clients believing in themselves more.
 Informational Support: Those offering informational support do so in
the form of advice-giving, or in gathering and sharing information.
 Instrumental Support: Tangible support includes taking on
responsibilities for someone else so they can deal with a problem or
in other ways taking an active stance to help someone manage a
problem they’re experiencing. Someone who offers you tangible
support may bring you dinner when you’re sick, help you brainstorm
solutions (rather than telling you what you should do, as with
informational support), or in other ways help you actively deal with
the issue at hand.

- 70 -
Explaining the effects of social support
The buffering hypothesis – suggests that social support is especially important at times
of stress but not necessarily at other times. At times of stress, friends protect an
individual from the negative effects of stress; they help friends think about stress
differently. This kind of support is seen as the instrumental type because it is problem
focussed.
Direct physiological effects – A number of studies have demonstrated the direct effect
of social support on the activity of the ANS, possibly to increase relaxation.
KEY STUDY – Kamarck et al (1990)
Aim: To see if social support helped in stressful situations.
Procedure: 39 female psychology student volunteers who were recruited to perform a
difficult mental task (stressful) while their physiological reactions were monitored.
Participants either attended the lab session alone or they were asked to bring a same-sex
friend along with them. During the mental task the friend was told to simply touch the
participant on the wrist. In order to avoid the participant feeling evaluated by the friend they
also had the same task to do.
Findings: In general the participant who were with a friend showed lower physiological
reactions (lower heart rate) than those alone, demonstrating the importance of social
support.

- 71 -
In pairs think of evaluation points for the role of social supprt and write
them here using the PEEL format:
Evaluation
Strength
1
Point: Pets can provide support
Evidence:
Explanation:
Link:
Evaluation
Strength
2
Point:
Evidence:
Explanation:
Link:
Evaluation
Limitation
1
Point: Unnecessarily complex
Evidence:
Explanation:
Link:
Evaluation
Limitation
2
Point:
Evidence:
Explanation:
Link:

- 72 -
Evaluation
point
Point:
Evidence:
Explanation:
Link:
Evaluation
point
-
IDA
Point:
Evidence:
Explanation:
Link:

- 73 -
1. Explain the following kinds of social support – instrumental, emotional
and esteem support (2 marks each)
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2. Describe one study of the role of social support in coping with stress (4 marks)
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- 74 -
Essay title:
Discuss research related to the role of social support
minutes)

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