Understanding Stress Response and Psychological Distress

Stress Response

• Stress is a normal physiological response to challenging situations with both physiological and psychological components
• Stressors can be external (environmental, psychological, or social) or internal (illness)
• A little stress can be beneficial for daily activities, while too much can cause physical and mental health problems
• Coping with stress can support overall well-being and prevent feeling overwhelmed

Theories of Optimal Stress

• Theories of optimal stress support performance in daily activities and address how stress affects physical and mental health
• Psychological distress includes physiological and psychological arousal, characterized by negative emotions like sadness, irritability, and anxiety.
• Hopelessness and helplessness can lead to mental health problems
• Psychological distress is a risk factor for mental disorders

Measuring Psychological Distress

• General Health Questionnaire: Detects distress, mental disturbances, and disorders in primary care settings

Mental Health Scales

• Kessler Psychological Distress Scale: A screening tool to identify adults with significant psychological distress through ten-item or six-item versions, which targets the experience of distress
• Distress Questionnaire: A five-item questionnaire based on DSM 5 criteria for seven common mental disorders, more accurate than the six-item Kessler scale, except for major depression

Biological Response to Stress

• Fight or flight response activates the sympathetic nervous system, resulting in physiological changes:
  • Sweating
  • Shaking
  • Increased heart rate
  • Breathing difficulties
  • Shallow breath
  • Pupil dilation
• Hearing does not improve but the detection of threats is optimized
• Unnecessary functions are suppressed or delayed
• The perception of threats can be physical, social, or cognitive, forming learned associations

Fight or flight responses

• Fight or flight responses can be triggered by threatening stimuli like dangerous animals
• False alarms occur when a stressor is real but not physically threatening, causing unnecessary sympathetic nervous system activation

General Adaptation Syndrome (GAS) Model

• Alarm Phase: The body activates the sympathetic nervous system and releases hormones like cortisol, increasing heart rate, blood sugar, and blood pressure
• Resistance Phase: The body returns physiological functions to normal, maintains elevated glucose and hormone levels while adapting to the stressor
• Exhaustion Phase: Prolonged stress leads to defense mechanisms breaking down, increasing vulnerability to infection and disease
• Susceptibility to disease and mortality explains the relationship between stress exposure and cardiovascular disease
• Stress reactions can cause headaches, loss of appetite, increased blood pressure, sexual dysfunction, and sleeping problems

Health Conditions Influenced by Stress

• Stress can influence cardiovascular disease, diabetes, IBS, and mental disorders

Stress Arousal and Performance Outcomes

• Increased stress and arousal can optimize performance up to a point, after which fatigue and poorer performance occur
• Optimal stress levels enhance performance; after the fatigue point, distress impairs performance
• Stress management is important for increasing performance

Yerkes-Dodson Law

• Optimal performance occurs at a moderate level of arousal
• Too low arousal results in a lack of motivation, boredom, and deviations in attention
• Too high arousal causes anxiety, overstimulation, and feeling overwhelmed
• It can lead to distraction or redirection of attention

Inverted U Theory of Arousal

• Optimal level of arousal depends on task complexity; simpler tasks can cope with higher arousal

Task Complexity and Arousal

• Complex tasks require more resources; increased arousal can lead to overstimulation more easily than with simpler tasks
• Sports requiring precision movements benefit from low arousal (target shooting)
• Sports relying on gross motor skills achieve optimal performance at higher arousal levels (grappling)

Challenge and Threat Model of Optimal Stress

• Challenge and threat model of optimal stress uses a biopsychosocial approach by integrating psychological, social, and physiological aspects of the stress response.
• Stress as a Threat: The task is seen as debilitating, impairing performance
• Stress as a Challenge: The task is seen as energizing, enhancing performance
• Cognitive Evaluation: A pre-task stress appraisal influences the cognitive evaluation very early in the stress response

Components of the Stress Response

• Stress reactivity is the physiological response from the body
• Performance is affected by the stress and the level of arousal

Cognitive Appraisal

• Post-task Stress Appraisal influences coping mechanisms
• Outcome Appraisal (post-task) affects pre-task appraisal in future stressful situations
• Coping outcomes dictate responses to future stressful events
• Optimal stress levels involve interpreting tasks as challenges, showing appropriate stress reactivity, and having positive evaluations

Positive Evaluations

• Feelings of calmness, success, and achievement influence behavior in future situations

Psychological Distress

• Psychological distress arises when stressors are seen as threats or when desired performance isn't achieved
• Stress Buffering Model: Available resources can dampen negative effects of stress
• Social support and a perceived sense of control can reduce psychological distress

Relationship Between Stress, Resources, and Distress

• Stress and distress have a positive relationship, as stress increases, distress increases
• Resources can negatively impact distress; higher resources reduce the strength of the stressor-distress relationship
• Resources directly reduce psychological distress, independently of the situation

Components of Stress Response

• Psychological, physiological, and behavioral components

Psychological Response

• Responses from the limbic system and the cerebral cortex
• Emotional reactions
• Cognitions (appraisal and evaluation)
• Arousal and motivations

Physiological Response

• Responses from the immune system and cardiovascular activity which leads to increased heart rate, blood pressure, and hormone circulation
• Digestive system is affected
• Heavily reliant on the autonomic nervous system & the hypothalamic pituitary adrenal axis (HPA)

Behavioral Components

• Reactions such as aggression to the stressor
• Withdrawal and escape
• Freezing
• Cognitive appraisal of the event is also important

Cognitive Appraisal

• Pre-task appraisal
• Post-task appraisal
• Important for repeated exposure to events
• Two types of appraisals:
  • Primary Appraisal (how the event directly affects you like your safety)
  • Secondary Appraisals (focus on the environment to guide how one should respond)

Coping Mechanisms

• Cognitive appraisal becomes important
• Appraisal of the environment as a threat can modulate pre/post-task appraisal
• When demands outweigh the ability to cope, stress occurs

Coping Styles

• Coping styles influence the way a situation is appraised
  • Downstream effect on how stressful the situation is

COPE Inventory

• Measures common coping styles
  • Problem-focused coping is an active approach to attempt to remove something stressful

Focused Coping

• Active Coping to remove the stressor and threats to well-being
• Planning regarding how to cope with the stressor
• Actions, strategies and thinking about ways to handle the stressor like it's a problem.
• Putting things aside
• Avoiding distractions to focus on the problem at hand.
• Restraint coping: waiting until there is an appropriate time to act.

Other Coping

• Seeking social support for emotional reasons.
• Positive reinterpretation by trying to construct a stressful transaction in a positive way or try to look for the positives that have come out of that situation
• There are gender differences in coping styles
  • A recent study shows that women showed more emotional and avoidance coping styles, while men displayed more emotional inhibition

Types of Stress

• Inputs include:
  • Stressful events from external events include chronic, social and environmental stress
• Inputs
  • Stressful events from internal world - Physiological stresses or physiological illnesses that change the body’s response system
  • Stressful events from memory - Past events and trauma
• Following stress, there is individual variation in responses
  • Increased vulnerability to stress comes from genetics and related/unrelated experiences
• Behavioral outputs
  • Avoidance based on coping styles
• Cognitive
  • Influences how we cope with the same stressors when re-experienced

Physiological aspects

• Acute stressors result from perceived threats or challenges, which can be resolved

Chronic Stressors

• Acute stressors result from perceived threats or challenges, which can be resolved

Traumatic Stressors

• Can be less associated with challenges and more with threats
  • Most common traumatic events in Australia are unexpected death of a loved one, witnessing a person critically injured, or getting injured in a car accident.
• Holmes Ray Social Readjustment Rating Scale - Contains 43 life events requiring change and adaptation
• Those who rate <150 points tend to have low induced health problems
• 150-299 have a 50% chance of health breakdown in 2 years
• 300 points have a correlation between that number and exposure to people and opportunities for problems with further health issues
• Study need to understand a complex relationship and dynamic relationship between stress and illness in order to help patients and develop treatments

Complex relationship between stress and mental illness

• Stress can increase the risk of mental illness.
• Mental Illness can lead to elevation in stress
  • These can exacerbate existing symptoms
• Acute, chronic both increase development of mental health
• Mental Illness lead to different physiological responses in stress sensitivity and disruptions in coping mechanisms