General Adaptation Syndrome (GAS) Model

• Centers on the sources of stress, its measurement, and management techniques.

Physiology of Stress: The General Adaptation Syndrome (GAS) Model

• The GAS Model outlines the physiological changes in response to stress, aiding in restoring homeostasis through short-term and long-term adaptations.
• The GAS model has three stages in response to stress.

Alarm Stage

• Characterized by the fight or flight response.
• There is an increased release of cortisol and adrenaline.
• It results in increased heart rate and faster breathing.

Resistance Stage

• If the stressor disappears, the body begins to recover, returning heart rate and blood pressure to normal.
• If the stressor continues, the body remains on high alert, with continued cortisol secretion and high blood pressure. People adapt to living with high stress.

Exhaustion Stage

• Prolonged or chronic stress drains emotional, mental, and physical resources.
• The ability to effectively combat stress diminishes.
• It results in fatigue, anxiety, and depression.
• Can lead to insomnia, heartburn, type 2 diabetes, substance abuse, increased risk of stroke and heart attack, weakened immune system, difficulty concentrating, and aches and pains.

Causes of Stress: Life Events

• Life events disrupt usual activities, causing significant change and requiring readjustment.
• Events like marriage, divorce, illness, or job changes/loss are considered stressors.

Social Readjustment Rating Scale (SRRS)

• Holmes and Rahe developed the SRRS to rank life events by the amount of stress they induce.
• It typically covers a one-year period.
• It includes 43 life events, each assigned a score out of 100 life change units (LCUs).
• An individual's stress level is calculated by totaling the LCUs for experienced life events within a year.
• The death of a spouse is rated at 100 LCUs, while Christmas is rated at 12. Marriage is rated at 50.

SRRS Development

• 394 patients who rated the 43 life events through a questionnaire.
• Marriage was given an arbitrary value of 500.
• Patients were asked to compare each event to marriage, rating proportionally higher or lower based on required readjustment.
• Scores over 300 LCUs in a year indicate a higher likelihood of illness
• Scores less than 150 LCUs indicate slight risk, while 150-299 LCUs indicate moderate risk

Holmes and Rahe Study

• American sailors were given the SRRS to assess life events experienced in the past 6 months.
• Sailors' health was recorded over the following 6 months whilst on tour.
• A significant positive correlation was found between life change scores and illness scores.

Causes of Stress: Personality (Type A)

• Friedman and Rosenman's theory suggests that internal factors, specifically personality, determine susceptibility to stress.
• Type A Personality: highly competitive, strong desire to succeed but are critical of themselves, has time urgency, and a high level of anger and hostility.
• Type B Personality: less competitive, less time-urgent, and less hostile.
• Type X Personality: those that do not fall into Type A or B.

Friedman & Rosenman’s Longitudinal Study

• Tested the hypothesis that Type A personality predicts heart disease.
• 3000 men between 39 and 59 were given a questionnaire and classified as Type A or B.
• The participants were followed for 8.5 years.
• Twice as many Type A men developed CHD compared to Type B men.
• Of the 257 participants who developed CHD, 70% were Type A.

Causes of Stress: Work

• Workplace stress arises from a conflict between job demands and an employee's control to meet those demands.
• High demands coupled with low control lead to stress.
• Job related stress is associated with an increased risk of coronary heart disease (CHD).
• Coronary Heart Disease (CHD): Plaque builds up inside the coronary arteries that reduces the flow of oxygen rich blood to the heart

Chandola Study

• The purpose of the study was to investigate biological and behavioral factors linking work stress to CHD.
• The participants included 10308 British Civil Service workers in London, aged 35-55 (6895 men, 3413 women).
• Job strain was measured using a questionnaire at phases 1 and 2, operationalized as high demand and low personal control.
• The number of non-fatal heart attacks and deaths due to heart disease were recorded during the study.
• There were 6484 attendees at the final clinical examination.
• Work stress was associated with a higher risk of CHD.
• The link between work stress and CHD was stronger for younger workers.
• Work stress was associated with low physical activity, poor diet, metabolic syndrome, low heart variability, and a high morning rise in cortisol.
• 32% of the effect of work stress on CHD was attributed to its effects on biological factors (metabolic syndrome) and behavioral factors (low physical activity & poor diet).

Measures of Stress

• Recognizing early symptoms of stress allows for coping strategies and prevents unhealthy methods like drinking or smoking.

Biological Measures of Stress: Recording Devices

• Urine and blood tests: measure cortisol levels.
• Blood pressure monitor: measures systolic and diastolic pressure.
• Galvanic Skin Response: measures electrical resistance in the skin. High electrical resistance means high stress
• Functional Magnetic Resonance Imaging (fMRI): Brain imaging technique that measures the impact of stress on the brain, measuring brain activity by detecting changes associated with cerebral blood flow (CBF).
• A fMRI identifies brain areas in which the cerebral blood flow had changed between an activity and rest state
• Brain areas most active in response to stress: amygdala, hippocampus, hypothalamus.
• Pulse oximeter: Measures heart rate by passing small beams of light through the finger to measure the amount of oxygen in the blood, revealing oxygen saturation.

Wang Study

• The aim was to use fMRI to measure cerebral blood flow changes in response to stress as a result of a maths task.
• 32 patients split into a stress condition (25, including 12 females) and a control condition (7).
• Participants were given four MRI scans (8 minutes each): first and last baselines, a low-stress task (counting backwards from 1000 around), and a high-stress task (verbal and serial subtraction of 13 from a 4-digit number)
• Perfusion fMRI scans lasting 8 minutes each, and an anatomical scan for 6 minutes after all tasks were completed.
• Heart rate and salivary cortisol were taken as patients entered the scan and after each scan.
• Stress ratings and stress level of tasks showed a positive correlation.
• Positive correlation between change in cerebral blood flow of ventral right prefrontal cortex (associated with negative emotions), subjective stress ratings, and objective stress measures.
• The ventral right prefrontal cortex showed sustained activity after the high-stress task, indicating a prolonged state of emotional arousal due to stress.
• The ventral right prefrontal cortex plays a key role in the central stress response, and it is possible to use a physiological scale to measure the influence of stress on blood flow in the brain.

Biological-Physiological Measures of Stress: Sample Tests of Salivary Cortisol

• Cortisol: Hormone released by the adrenal glands in response to fear or stress, as part of the fight or flight response.
• A salivary sample is collected in a salivate.

Evans and Wener Study

• The purpose was to examine the effects on commuters during rush hour on a crowded train and to see personal space intrusions as the key processes that underline stressful experiences while traveling.
• 139 commuters participated, and they were commuting to work by passenger train from New Jersey to Manhattan, NYC.
• Each participant given a free monthly rail pass for participation.
• Participants had been on the same commuting route for an average of 82 months.
• The study measured the two types of crowding: Car density and Seat density.
• Saliva samples were taken at the end of the journey and measured for cortisol levels.
• Salivary cortisol was also measured once at a weekend at home, as baseline measure for cortisol.
• Motivation measured at the end of the commute by persistence with a proofreading task
• Mood was measured using semantic differential items.
• Density of train carriage was inconsequential for levels of stress
• Seat density had a significant effect on all 3 stress measures
• Passengers with personal space intrusions around the passenger lead to increased stress
• It is possible to measure stress by taking a sample of saliva and measure levels of cortisol.

Psychological measure of stress: Self report questionnaires

• Type A Personality Questionnaire: The Jenkins Activity Survey, Framingham Type A Behavior Pattern Scale
• Holmes and Rahe life events questionnaire

Psychological Method of Managing Stress: Visual Imagery (Bridge Study)

• Visualization and imagery: a systematic practice of creating a detailed mental image of an attractive and peaceful setting or environment to promote relaxation, lower blood pressure and stress, help reach goals and manage pain.
• One can imagine situations to help calm down and take control of their physiological state or use relaxation techniques to help with the visualization and imagery.

Steps to Visualize

• Find a private, calm space and make yourself comfortable.
• Focus on the sensory attributes present in the scene to make the scene more detailed.
• While relaxed, assure yourself that you can return to this place whenever you want.

Bridge Study

• The aim of this study was to investigate the effect of relaxation and imagery on the stress levels of women who were undergoing cancer treatments (to test whether stress could be reduced in patients being treated with radiotherapy for early breast cancer).
• There were 139 women outpatients at Middlesex Hospital, London, under 70.
• Patients completed the Leeds General Scales Measure to measure severity of depressive and anxiety symptoms before and after trial and a mood scale to gather scores on subscales for tension, depression, vigor, fatigue, anger, and confusion.
• Women were randomly allocated to 3 conditions:
  • relaxation taught breathing techniques
  • relaxation plus imagery taught to imagine a peaceful scene of her own choice
  • control, where women talk about themselves and their interests.
• Relaxation positively affects mood states, and enhanced by relaxation plus imagery.
• Interventions were more effective in women aged 55+.
• Imagery can be completed by everyone & made patients smile

Psychological Method of Managing Stress: Biofeedback (Budzynski Study)

• Biofeedback: A technique in which information is immediately shared back to the individual about their physiological status.
• Patient can then learn to do relaxation that reduce the physical processes and reinforce them to reduce stress.
• Galvanic Skin Response is a type of negative reinforcement, where a tone or meter reading shows stress level. When stress is reduced by relaxation, the tone or lowered, so the individual learns to repeat the relaxation method to reduce stress in the future.
• Electromyography electrodes (EMG) are attached to the skin surface of a particular muscle, where the patients hears a tone with a pitch proportional to the EMG activity in a given muscle group.
• The patients must then maintain a higher level of relaxation to hear a lower tone.

Budzynski Study

• The aim was to assess the effect of biofeedback in reducing tension headaches
• There were 15 patients who were suffering from tension headaches.
• Relaxing the frontal muscle (from the top of the skull to the muscle) will reduce suffering
• Participants had electrodes attacked to their head one inch above the eye across the forehead
• The study had three conditions:
  • Experimental group with variable pitch, correct feedback: told that the pitch would vary with the level of muscle tension in the forehead. They were told to relax as deeply as possible to keep the tone low pitched
  • Constant low tone irrelevant feedback condition (control group): to relax deeply, especially forehead muscle. Told that the constant low tone help them relax.
  • Control group: told to relax as deeply as possible, in silence
• Participants were instructed to lie on a bed in a dimly lit room.
• Each session consisted of 20 trials for 1 minute per trial.
• DV: mean level of muscle tension
• The experimental group saw a mean decrease of 50%. People can be trained to voluntarily lower their muscle tension to reduce tension headaches through biofeedback.

Managing Stress - Stress Inoculation Training (SIT)

• A cognitive behavioral intervention that proposes that stress occurs when the perceived demands of a situation exceed the perceived resources that are available to the individual.
• Aims to get the patient to recognize the cognitions that trigger a stressful experience and then skill them with intervention strategies to help relieve the stressful experience.
• SIT attempts to inoculate people against stress by equipping patients with a variety of coping strategies that they can implement when they have stress
• SIT has overlapping phases:
  • Conceptualization- patients and therapists develop collaborative relationship by teaching the concept of stressors and how they affect lives and how to see stressors as problems to be solved rather than negative experiences
  • Skill acquisition and rehearsal- Skills and copings traits are acquired and rehearsed for emotion regulation, cognitive restructuring, and interpersonal communication skills. Coping skills are practiced in the therapy setting before the real world, which improves patient confidence.
  • Application and follow through - transfer coping skills to real life to prevent relapse with increasingly more stressful situations. Imagery and role playing help to cope with various stressors
• Duration: 20 min for beginners, several weekly sessions (8 to 40 1 hour sessions)
• It is effective as it tailored to individual needs but needs lots of time.