STRESS

® Stress is the body’s reaction to pressure or threats, often arising when feeling
overwhelmed.

® Types of stress-
• POSITVE STRESS- can motivate us
• NEGATIVE STRESS- when excessive can overwhelm and harm physical and
mental health.

® Sarafino’s (2006) Three Definitions of Stress:

• Environmental Impact:
§ Stress is caused by external factors like major life events, disasters, or
ongoing stressors (e.g., poverty or poor housing).
• Bodily Response:
§ Focuses on how the body reacts to stress, considering physiological
responses to stressful events.
• Person-Environment Interaction:
§ Stress arises from the interaction between the individual and their
environment. It emphasizes that stress is not just a stimulus-response
process; individuals can choose how to cope, utilizing behavioral,
cognitive, and emotional strategies.
Sources of stress
The physiology of stress
The general adaptation syndrome (GAS)
® It is developed by HANS SELYE (1936), it studies the effect of prolonged stress on the
body.

® Three stages of GAS-

• ALARAM stage-
– It prepares the body for ‘fight or flight’ in response to perceived stress.
– Fight or Flight Response:
§ During fight or flight response CORTISOL and ADERNALINE is
released.
§ These hormones provide increased energy for immediate action.
§ It increases heart rate and faster breathing to circulate more
oxygen throughout the body.
§ The body prepare you to either flee(flight) from or defend
itself(fight) against the stressor.

• RESISTACNE stage-
– It follows the initial shock of a stressor, where the body begins to return
to normal but remains on high alert.
– If Stressor Has Passed:
§ The body repairs and recovers.
§ Heart rate and blood pressure return to normal.
 § No lasting damage occurs.
– If Stressor Continues:
§ The body adapts to maintain higher stress levels.
§ Cortisol continues to be secreted, and blood pressure remains
elevated.
§ Physiological changes may go unnoticed, but there are outward
signs like irritability, frustration, and poor concentration.
– If the resistance stage goes for too long, it can lead to the exhaustion
stage.

• EXHAUSTION stage
– Exhaustion stage occurs when prolonged or chronic stress depletes
emotional, mental, and physical resources, making it difficult for the
body to combat stress effectively.

– Signs of Exhaustion:
§ Emotional/Mental: Fatigue, depression, anxiety, and lower stress
tolerance.
§ Physical Effects:
o Minor issues:
o Headaches
o Insomnia
o Appetite changes
o Nausea
o Heartburn
o Muscle aches and pains
§ Serious health problems:
o Chronic conditions: Type 2 diabetes, high blood pressure
(increased risk of stroke/heart attack), and weakened
immune system.
o Weakened immunity: Increased susceptibility to infections
(e.g., colds, flu), slower recovery from illnesses or injuries.
o Risky behaviour- alcohol or substance abuse.
Causes of stress
Life events: Holmes and Rahe
® Life events are a major cause of stress.

® Life events require mental energy for adjustment, leading to stress.

® Life events can be positive (e.g. marriage, having a baby) or negative (e.g. illness,
loss of a loved one).

® The key feature of a life event is that is it involves a transition in life.

® Holmes and Rahe investigated the impact of life events on a daily life disruption.
• They constructed the SOCIAL READJUSTMENT RATING SCALE (SRRS)- it
measures the impact of life events on health.
• The SRRS concluded that as life changes increases, the frequency of illness also
rises.
Work
® Work related stress factors-
• Understimulation- boring or repetitive jobs.
• Low control- no freedom to make decisions about work or conditions.
• High workload- excessive work within limited time.
• Impacts- lower self-esteem, job dissatisfaction, and higher risk of ill health.

® Low control and high demand are significant predictors of workplace stress, with
potential links to serious health problems like CHD.

® Jobs that offer autonomy and varied tasks can mitigate stress effects.

® Example study- Chandola et al. (2008)

• AIM- To determine the biological and behavioural factors linking work stress
and coronary heart disease (CHD).
• METHODOLOGY-
– Participants: 10,308 London-based male and female civil servants (aged
35–66).
– Went on for 17 years, with data collected across seven phases.
– The final phase included clinical examination.
– Stress Assessment:
§ Tool: Job Strain Questionnaire.
§ Criteria for Job Strain: High job demands combined with low job
control.
§ Additional Factors: Work isolation was also measured.
§ Total Work Stress: Calculated by summing reports of job strain
and work isolation from Phases 1 and 2.
– Health Assessment:
§ CHD Incidents: Monitored from Phases 2–7.
 § Cortisol Levels: Measured via saliva samples on waking and 30
minutes later.
§ Behavioral Risk Factors: Assessed in Phase 3 (e.g., alcohol
consumption, smoking, diet, and exercise).
• RESULTS-
– Lowest levels of self-reported stress were found among those in the
highest grades of the civil service.
– Age and CHD Association:
§ Younger participants (aged 37–49 at Phase 2): Significant link
between work stress and incidents of CHD.
§ Older participants (aged 50–60): Little association found.
– Higher stress levels linked to poor health behaviors:
§ Eating less fruit and vegetables.
§ Reduced physical activity.
– Work stress was associated with an increased morning cortisol rise in
Phase 7.

• CONCLUSION- Work stress that is continuous over a period of time is a risk

factor for CHD. Approximately 32 per cent of the effect of work stress on CHD
can be explained by its impact on health behaviours, such as poor diet and low
levels of physical activity.

Type A personality: Friedman and Rosenman

® Type A Personality:
• Competitiveness:
§ Highly goal-driven but derive little joy from achievements.
§ Self-critical with work-life imbalance (work dominates home life).
• Time Urgency:
§ Constantly aware of time, impatient with delays, multitask frequently.
• Hostility:
§ Prone to anger, envy, and lack of compassion.
§ Anger may manifest as aggression or remain internalized.
§ Hostility is the strongest predictor of heart disease among type A traits.

® Type B Personality:
• Relaxed, patient, easy-going, and tolerant.
• Balanced focus on work and life, lower anxiety, and more creativity.

® Research by Friedman and Roseman suggests that over twice as many type A
individuals developed CHD compared to type B.

® The theory might lack validity due to its inability to isolate causative factors, as it was
correlational study.
Measures of stress
Biological measures
Recording devices for heart rate
® Functional magnetic resonance imaging (fMRI)- It tracks brain activity by
measuring changes in oxygenated blood flow
(cerebral blood flow).

® How it works-
• Active brain regions need more oxygen, resulting in increased blood flow.
• Images show which brain areas respond to stress-inducing tasks vs. rest
periods.
® Key Brain Areas:
• Amygdala: Processes emotional reactions to stress.
• Hippocampus: Involved in memory and stress regulation.
• Hypothalamus: Coordinates the body’s stress response.

® It provides with scientific, objective visuals of brain activity and can pinpoint brain
regions active during stress.

Pulse oximeter
® It measures heart rate and blood oxygen levels.

® It works when a small, painless device clips onto a finger and uses light beams to
detect oxygen saturation and pulse.

® Why is it used-
• Stress can increase heart rate, but the heart rate changes may also be caused
by other factors.
• Not all individuals experience an increase in heart rate under stress, making it
an INDIRECT MEASURE.

® It is non-invasive and east to use.

Sample tests: salivary cortisol

® Cortisol is a hormone released by the adrenal glands during the fight and flight
response to stress.

® It can be detected in urine and saliva.

® As it is non-invasive, it is a preferred method for stress measurement.

® HIGH CORTISOL LEVELS indicate physiological stress.

 ® EXAMPLE STUDY- Evans and Wener (2007)
• AIM- Investigated the effects of train crowding (overall and immediate) on
stress levels in commuters.
• METHODOLOGY-
– Sample: 139 adult commuters traveling from New Jersey to Manhattan.
– Stress Measures:
§ Salivary cortisol: Collected at the end of the commute and during
a weekend for comparison.
§ Motivation: Measured using a proofreading task (errors detected).
§ Mood: Assessed with two five-point scales: carefree–burdened and
contented–frustrated.
– Crowding Levels:
§ Distal: Density across the whole train carriage.
§ Proximal: Number of people in the participant’s immediate area
(same row).
• RESULTS-
– Distal crowding had no significant effect on stress measures.
– Proximal crowding had no significant effect on-
§ CORTISOL level, higher stress with more proximal crowding.

• CONCLUSION- Proximal crowding (immediate surroundings) has a greater

impact on stress than overall crowding in the train.

Psychological measure
Friedman and Rosenman’s Personality test
® It measures type A and type B personality traits.

® It has a series of questions aimed to classify individuals based on personality type.

® It focuses on behaviours indicating competitiveness, time urgency, and hostility.

® Sample questions-
• “Do you feel guilty if you use spare time to relax?”
• “Do you need to win to derive enjoyment from games and sports?”
• “Do you generally move, walk, and eat rapidly?”
• “Do you often try to do more than one thing at a time?”

® Responses determined whether a person exhibited traits of:

• Type A Personality: Competitive, impatient, and driven.
• Type B Personality: Relaxed and less competitive.

® STRENGTHS-
• Ease of Use: Simple to score and distribute to a larger sample, including online
methods.
• Reliability: Easier to test reliability and conduct cross-cultural research due
to wide distribution.
 • Anonymity: Anonymous responses may encourage honesty.

® WEAKNESSES-
• Social Desirability Bias: Participants may portray themselves more positively
(e.g., assertive instead of irritable).
• Validity Concerns: Responses may lack accuracy due to participants avoiding
negative self-assessment, reducing validity.

Life events questionnaire (Holmes and Rahe)

® Social readjustment rating scale (SRRS)- it measures life events to assess stress and
predict stress-related health issues.
® it ranks 43 life events by the degree of change they cause.
® Each event assigned Life Change Units (LCUs) (e.g., death of a spouse = 100 LCUs,
holiday = 13 LCUs).
® How it works-
• Respondents indicate which events they’ve experienced in a set time (e.g., past
year).
• Total LCUs are calculated.
• Higher total scores suggest a greater likelihood of stress-related health
breakdowns.
® STRENGTHS-
• Supported by Research: Scully et al. (2000) validated the SRRS as reliable
and relevant even decades later.
® WEAKNESSES-
• Correlation, Not Causation: Life events may not directly cause ill health;
other factors like poor nutrition could play a role.
• Lacks Individualization: Assumes everyone reacts to life events similarly,
reducing accuracy and reliability.

Managing stress
Psychological therapies
Biofeedback
® It is a psychological therapy enabling control over bodily functions, such as heart rate
or muscle tension.

® It is based on operant conditioning, using physiological and psychological

techniques.

® The technology provides real-time feedback on physiological reactions to stress.

® PROCESS-
• Relaxation Training: Individuals are taught relaxation techniques.
• The patient are then connected to monitoring devices- Measures muscle
tension (EMG), brain activity (EEG), and sweating (SCR).
 • Feedback Mechanism:
§ Feedback (e.g., sound or visual display) indicates increased physiological
activity.
§ Individuals apply relaxation techniques to reduce stress responses.
• Reinforcement: Seeing/hearing reduced stress indicators is rewarding,
reinforcing continued use of techniques.
• Skill Transfer:
§ Skills are practiced in real-world situations.
§ Portable devices can aid in managing stress outside of training sessions.

® It empowers individuals to manage stress effectively by recognizing and controlling

physiological responses, it also reduces stress, pain, high blood pressure, and anxiety.

Preventing stress
Three phases of stress inoculation training (SIT)
® It is a structured approach to reduce stress and improve coping mechanisms through
three overlapping phases.

1. CONCEPTUALIZATION PHASE
• Here a collaborative relationship is built between client and trainer.
• It helps increase understanding of stress responses and their impact.
• It educates clients about anxiety and its effects on daily life.
• It focuses on recognizing personal stress triggers and thoughts through
SOCRATIC QUESTIONING (open-ended questions to explore beliefs
about stress and reactions).

2. SKILL ACQUISITION PHASE

• It teaches new coping skills.
• It strengthens existing skills through awareness and practice.
• It develops self-awareness and self- monitoring skills to identify negative
thought patterns.
• Helps learn to replace negative self-talk with positive self-statements.
• It makes clients practice problem-solving, self-reward, and information
gathering on anxiety-provoking situations.

3. REHEARSAL & APPLICATION PHASE

• Here clients refine, apply and transfer skills to real-world stressors.
• It uses role plays, simulations, and imagery to rehearse coping strategies.
• It helps apply skills in daily life through graded homework assignments
and experiments.
• It provides feedback for refinement of techniques.
• It helps practice relapse prevention by simulating high-risk situations
and rehearsing coping strategies.

® SIT builds resilience against stress through gradual exposure and active coping skill
development.
® It helps clients manage stress effectively in real-world situations.

® STRENGTHS-
– Focus on Causes, Not Just Symptoms-
• SIT addresses the root causes of stress by exploring prior stress experiences
and associated emotions.
• Promotes long-term behavioural change as skills learned are transferable
to various everyday situations.
® WEAKNESSES-
– Expense and Accessibility
• Requires intensive, multi-session training with a professional, which can
be costly.
• In some countries, clients may need to pay out of pocket.
• Time commitment may require clients to take time off work, further
limiting accessibility.
– Complexity of the Process
• Perceived as more complicated than necessary, as simpler interventions
like relaxation techniques and positive thinking can yield similar results.
• Complexity adds to the time and financial burden, which may be
avoidable.

® KEY STUDY: Bridge et al.: Managing stress (1988) Relaxation and imagery in
reducing stress during medical treatment.

– AIM- To see whether stress could be reduced in patients who had been
diagnosed with early breast cancer and were being treated with radiotherapy.
Specifically, the researchers aimed to investigate whether patients who received
either of two relaxation treatments would show a more positive effect on their
mood states than a control group of similar, untreated women.

– HYPOTHESIS- The researchers hypothesised that the women who received

relaxation training with an imagery component would show more change than
the women given relaxation training alone.

– METHODOLOGY-
• The research method used was a randomised control trial with three
conditions. Questionnaires were used as methods of assessment
(dependent variables). The questionnaires used were:
§ Leeds General Scale for the Self-Assessment of Depression and
Anxiety: A self-report measure that has previously been used to
assess mood with cancer patients.
§ The Profile of Mood States questionnaire: A 65-item questionnaire
that measures aspects such as fatigue, anger, confusion and
depression. The questionnaires were chosen as the methods of
assessment as they were minimally disruptive and non-intrusive.
– SAMPLE-
• Opportunity sample of 139 women.
• Condition: Women who had undergone mastectomy or breast
conservation lumpectomy for early-stage breast cancer.
• Treatment: Completed a full treatment package and attended a six-week
outpatient radiotherapy course at Middlesex Hospital, UK.
• Inclusion Criteria: Participants were required to:
§ Understand English.
§ Be under the age of 70.
• Average Age: 53 years.

– PROCEDURE-
• All 139 women had completed at least one radiotherapy session before
being invited to the study.
• Informed Consent: Participants were informed about the study’s purpose,
confidentiality, and the fact that non-participation would not affect their
radiotherapy.
• Pre-study Assessments:
§ Completed Profile of Mood States and Leeds General Scales
Questionnaire at the start.
§ Seen individually by researchers once a week during the study.
• Experimental Conditions:
§ Three Conditions:
o Control group: No relaxation techniques, just discussion.
o Relaxation treatment group: Taught relaxation techniques
(muscle relaxation and diaphragmatic breathing).
o Relaxation + imagery group: Taught the same relaxation
techniques plus guided imagery (imagining a peaceful
scene).
§ Sessions:
o Duration: 30 minutes per session.
o Relaxation and Imagery Groups: Given audio tapes to
practice at home for 15 minutes/day.
o Control Group: Encouraged to talk about personal interests.
§ Post-study Assessments: All participants completed the Profile of
Mood States and Leeds General Scales Questionnaire again at
the end of the six-week study.
– RESULTS-
• Initial Questionnaire: No significant differences in mood were found
between the three groups at the start of the study.
• Chemotherapy Group: No significant differences between the 25 women
who had received chemotherapy and the 114 who had not.
• Age-Based Analysis:
§ Women were sub-divided into two groups: younger than 54 and
older than 54.
§ Older Women:
 § Both relaxation and relaxation + imagery groups showed
significantly lower scores for tension, depression, and total mood
disturbance compared to the control group.
§ Relaxation + imagery group showed the greatest effect.
• Combined Group Data:
§ Relaxation Group: No significant mood improvement (mean: 61.7
at onset, 61.9 at the end).
§ Relaxation + Imagery Group: Small improvement (mean: 59.6 at
onset, 53.9 at the end).
§ Control Group: Mood disturbance worsened (mean: 54.4 at onset,
64.1 at the end).

– CONCLUSIONS-
• Relaxation combined with imagery is effective at reducing mood
disturbances.
• Mood disturbances worsen in patients with no intervention.
• The treatments may be more effective in older women as they have more
time to focus on interventions as they are less likely to be working or
potentially have young children.

– STRENGTHS-
• Standardised Procedures:
§ Women in treatment groups were taught relaxation techniques in
the same way and given practice tapes for consistency.
§ Ensures that changes in results were due to the treatment
condition, not differences in procedure, increasing the study’s
validity.
• Randomised Controlled Trial (RCT):
§ Participants were randomly allocated to treatment or control
groups.
§ Reduces bias and participant variables (e.g., personality),
enhancing the validity of the results.
– WEAKNESSES-
• Self-Report Questionnaires:
§ Mood measures (e.g., Profile of Mood States) were based on self-
report.
§ Potential for socially desirable responses, as participants might not
want to appear tense or depressed, reducing the validity of the
findings.
• Small Sample Size:
§ Only 44-48 participants per group, with smaller subgroups when
divided by age (e.g., only 15 women over 54 in the Relaxation
group).
§ Limits the representativeness of the sample and makes
generalisation to a broader population difficult.
– ETHICS-
• Informed Consent: Participants were fully briefed about the study,
conditions, and what would be expected of them, ensuring valid consent.
• Confidentiality and Non-Penalisation: Participants were informed that
results would not appear in medical records, and refusal to participate
would not affect their radiotherapy treatment or result in penalties.
• No Drugs Administered: Assured that no drugs would be given during the
study, ensuring ethical treatment.
• Confidentiality Maintained: Participants were assured that their
information would be kept confidential throughout the study.