Sport, Community and Mental Health PDF

‘Sport, Community and Mental health’ Dr Gavin Breslin  Session Overview Part 1: Highlight the benefits of how sport can enhance children’s wellbeing. Part 2: Describe physical activity interventions for children in primary schools. Part 3: Sport environments, community and mental health. Key...

‘Sport, Community and Mental health’ Dr Gavin Breslin  Session Overview Part 1: Highlight the benefits of how sport can enhance children’s wellbeing. Part 2: Describe physical activity interventions for children in primary schools. Part 3: Sport environments, community and mental health. Key Readings  S  Yet children are not achieving the physical activity levels (Verloigne et al., 2012; Breslin et al., 2012; Griffiths et al., 2013) and are spending greater time in sedentary pursuits (Colley et al., 2011). (Cited from the UK Chief Medical Officers' Physical Activity Guidelines report September 2019)  Benefits of Sport to Psychosocial Health in Children Positive engagement with sport is associated with an array of physical, emotional and psychosocial health benefits (Breslin et al, 2017: 2019). Involvement in school sport during adolescence is a predictor of lower depression symptoms, lower perceived stress, and higher self-rated mental health in young adulthood (n=853) at 5 year follow-up (Jewett et al. 2014). Years Participating in Sports During Childhood Predicts Mental Health in Adolescence: A 5-Year Longitudinal Study (Doré et al 2019). Higher participation in sport is associated with small gains in perceptions of social competence during late childhood to early adolescence (n=2278): 4 year follow-up study (Bedard, Hanna, & Cairney, 2019). Millennium Cohort Study Benefits of Physical Activity to Psychosocial Health in Children Less than a quarter of 9-11 year olds meet current recommended levels of physical activity, with boys being more likely to do so than girls (Breslin et al 2012). Achieving recommended levels of MVPA was associated with higher scores in: Satisfaction, Comfort, Resilience, Achievement, global self-esteem, social acceptance, and social support from peers. Benefits of Physical Activity to Psychosocial Health in Children Breslin et al. (2023) Benefits of Physical Activity to Psychosocial Health in Children Gender and Sport Participation “Gender is a psychosocial phenomenon based not only on biological sex, but also on cultural customs, social identities, roles, and expectations associated with being female or male”-American Psychological Society (See Gallucci, 2014). “Cultural institutions such as family, school, church and state shape gender roles” (Gill 2002). Physical Activity and Gender Physical Activity and Gender Children’s Sport Preference in NI Boys Girls 70 Boys Girls 60 football swimming 50 40 Gaelic netball 30 football 20 swimming football 10 rugby athletics 0 Team Individual golf Horse riding Physical Activity and Gender Fig 1: Influence of significant others in starting sport 40 boys girls 30 20 10 0 School Father Mother Peers Relative Self Fig 2: Influence of significant others in maintaining sport 30 boys 25 girls 20 15 10 5 0 Teacher Father Mother Relative No-one Physical Activity and Gender Development of physical activity levels of girls and boys in early school years: A psychosocial perspective (see Cheval, Chalabaev & Chanal, 2015).  Benefits of Physical Activity to Psychosocial Health in Children Biddle and Asare (2011) Physical activity and mental health in children: A review of reviews. Physical activity has potentially beneficial effects for reduced depression, a small beneficial effect for reduced anxiety, and improvements in self- esteem, at least in the short term. Kriemler et al. (2011) A review of reviews, found that 47-65% of the studies led to an increase in physical activity  Benefits of Physical Activity to Psychosocial Health in Children Demetriou & Höner. (2012) A further systematic review of school-based physical activity programmes- 56.8% of 74 studies reported significant increases in physical activity. Rafferty, Breslin, Brennan & Hassan (2016) Systematic review on physical activity and wellbeing in schools Physical activity led to an increase in wellbeing Critical evaluation: wellbeing measurement, variation in intensity and duration of interventions, sustainability.  Benefits of Physical Activity on Mental Health in Children Pascoe et al (2020) Scoping review of controlled trials testing the effect of physical activity and exercise interventions across mental health outcomes 30 articles included Participants aged 12 -25.9 years old Physical activity lead to a reduction in depression and anxiety symptoms. Limited evidence for other mental health issues as few studies  Benefits of Physical Activity on Mental Health in Children Knowles et al. (2023)  Benefits of Physical Activity on Mental Health in Children Neill et al. (2020) Effects of interventions with physical activity components on measures of anxiety, depression and stress in young people. A total of 13 studies (11 RCT and 2 Cluster RCT’s) 1928 participants 11 studies were eligible for meta-analyses. Meta-analyses showed no overall affect. High risk of bias in studies Part 2: Describe physical activity interventions for children in primary schools. Dr Gavin Breslin  Benefits of Physical Activity to Psychosocial Health in Children Breslin et al. (2017); Shannon et al (2018) 6.8% of 8-9 year olds from social disadvantage met the recommendations PA activity links with well-being are moderated by parental relatedness and athletic competence Benefits of Physical Activity to Psychosocial Health in Children Attendance at school is compulsory (Naylor et al., 2008) Provision of Active transport equipment to (walking and cycling) encourage activity to and from school (Jago et al., 2004), Why (Chillon et al., 2011), target the Break-, lunch- and school recess-time physical activity, the provision setting? Curriculum physical of playground education provision markings (Stratton et (Cale & Harris, 2006), al., 2005, Breslin et al., 2010), Classroom based physical activity breaks (Kriemler et al., 2010), (See Cotterill, Weston & Breslin 2016) Benefits of Physical Activity to Psychosocial Health in Children Five minute PA breaks x 3 led by the teacher (Drummy, Murtagh, McKee, Breslin, Davison & Murphy, 2015) Physical Activities To improve Children’s Health’ (P.A.T.C.H). (Breslin, Cunningham & Murphy, 2016) Stand Up for Children’s Health (S.U.C.H) Healthy Choices (Rafferty, Brennan & Breslin, 2016) (Shannon, Brennan & Breslin, 2018) Physical Activity Programme for Children Sport for LIFE, Sport for LIFE Legacy, with Intellectual Disability Sport for LIFE: All Island (Fitzpatrick, Breslin & Taggart, 2016) (Breslin et al, 2012, 2012, 2016, 2019, 2021) Case Study: Sport For Life Programme and associated research. What is the Sport for L.I.F.E Programme? 12 week physical activity and healthy lifestyle intervention 3,000 8-9 year old children from social disadvantage in NI 102 schools, 122 Ulster University student volunteers 102 Primary school teachers What Makes Sport For LIFE Unique?. Social Cognitive Theory Week Teaching Theme 1 Introduction: What is Physical Activity? What is Health? 2 Heart Health 3 60 minutes A Day of Active Play 4 Mr & Ms Muscles 1 5 Mr & Ms Muscles 2 6 Inside – Out Physical Activities for indoors and outdoors 7 Eat Smart 8 Drink Smart 9 Eat 4 Energy 10 Eat Smart, Move More 11 Feel Good 12 Team Building and Review What is Physical Activity? What is Health? Research Design- RCT 102 Schools (N=3000) Random sample of 24 Schools 12 Schools, Intervention 12 Schools, Non- group (N=248) intervention /control group (N=224) Pre Tests Pre Tests Receive the 12 week No Programme Programme Post Tests Post Tests End of Programme Programme Delivery and Research Team Some Sport for LIFE - Publications Some Sport for LIFE - Publications Markers Of Esteem Sport for LIFE All Island 4,000 children from social disadvantage 200 schools across Ireland (Ulster, Munster, Leinster & Connaght) 250 student volunteers 200 teachers Lessons Learned Children’s Behaviour Change Models-Motivation Holistic Multi-component Interventions Sedentary Behaviour & Health Well-Being & Physical Literacy Mass Participation Events Role of Government, Industry, Policy Part 3: Sport Environments, Community and Mental Health Dr Gavin Breslin Sport Clubs and the Community  Injury Sport and Mental Health Sport can have many psychological benefits (Breslin and Leavey 2019) Transition However, competitive sport, by nature, can also contribute to poor mental health, in particular when athletes experience insufficient support (Bauman 2016). Sport and Mental Health Donohue, Murphy and Breslin (2021) 19-27% experience mental health issues (Gulliver, 2015; Beable et al 2017) Across studies… 46% experience at least one symptom of illness/stress 30% Anxiety Disorders 27% Depression 23% Eating Disorders 16% Psychological Distress Unknown Bipolar & Psychosis, suicidality. 57% professional jockeys in Ireland depressed (Losty et al, 2018) 27% equestrian sport – clinical defined symptoms of depression (McGivern, Shannon and Breslin, 2020) Sport and Mental Health Section 1: Mental health awareness programmes for athletes and coaches Section 2: Mental health awareness programmes for the public delivered through sport Section 1: Mental health awareness programmes for athletes and coaches Section 2: Mental health awareness programmes for the public delivered through sport  Mental health awareness (Resilience, Stress, life challenges) Knowledge of Psychological Disorders Self-Management of mental health Willingness to support others Mindfulness exercises via mobile app* Integrated behaviour change theories (TPB, SDT) Wellbeing in Sport Action Plan 2019-2025 A PLAN TO IMPROVE MENTAL HEALTH AND WELL-BEING FOR PEOPLE INVOLVED IN SPORT IN NORTHERN IRELAND (Donnelly and Breslin 2018) Wellbeing in Sport Action Plan 2019-2025 A PLAN TO IMPROVE MENTAL HEALTH AND WELL-BEING FOR PEOPLE INVOLVED IN SPORT IN NORTHERN IRELAND (Donnelly and Breslin 2018) Wellbeing in Sport Action Plan 2019-2025 A PLAN TO IMPROVE MENTAL HEALTH AND WELL-BEING FOR PEOPLE INVOLVED IN SPORT IN NORTHERN IRELAND (Donnelly and Breslin 2018) Wellbeing in Sport Action Plan 2019-2025 A PLAN TO IMPROVE MENTAL HEALTH AND WELL-BEING FOR PEOPLE INVOLVED IN SPORT IN NORTHERN IRELAND (Donnelly and Breslin 2018) Why a Consensus Statement on Mental Health Awareness in Sport?  At the end of this session you should know more about Part 1: The benefits of how sport can enhance children’s wellbeing. Part 2: Physical activity interventions for children in primary schools. Part 3: Sport environments, community and mental health. Thank You For Listening… Stress and Health Lecture: Part 2  Recap on online videos… 2▹ Physiological mechanisms and function of stress ▹ Impact of prolonged stress on our mental and physical wellbeing Applied example of Cushing Syndrome…  Learning outcomes By the end of this lecture you should: 3 1. Recognise and understand early and core psychological theories of stress 2. Recognise and understand different forms of coping with stress 3. Understand the concept of illness as a stressor and the components of the Common Sense Model 4. Gain knowledge of different general stress reduction techniques and interventions  Early theories of stress Robert Hooke (1679) Law of Elasticity …the extension of an elastic object is directly proportional to the force applied to it. “Combat stress” WWII (Grinker & Spiegel 1945)… “aka “shell-shock” Walter Cannon’s Fight or Flight response theory (Cannon, 1932) Rapid response to emotional arousal via SNS Body’s inbuilt adaptive function… ‘homeostasis’ via PNS Harmful if homeostasis is not restored 4 Lazarus (1993, p.2)  Early theories of stress General Adaption Syndrome (GAS) (Hans Selye, 1956). Homeostasis occurs in 3 stages: Stage 1 – Alarm Reaction - Fight-or-flight response (SNS) - Unsustainable… 5  Early theories of stress Stage 2 – Stage of Resistance - Stressor still perceived…SNS decreases and cortisol and other hormones are secreted - Prolonged alertness, fight infection, healing - Unsustainable… 6  Early theories of stress Stage 3 – Stage of Exhaustion - Resources depleted - Nervous system and immune system cannot sustain elevated activation - Vulnerable 7  Early theories of stress General Adaption Syndrome (GAS) (Hans Selye, 1956): Highlighted the dual nature of stress: short-term adaptive (relates to eustress) versus long-term maladaptive (relates to distress and chronic stress). Claimed that stress is a universal & nonspecific bodily response to any exertion… criticised by later psychological theorists. 8  Yerkes-Dodson Human Performance and Stress curve The Yerkes-Dodson stress curve provides a helpful distinction between eustress/adaptive stress and distress/maladaptive stress. This law states that anxiety assists performance up to the point at which an optimum (i.e., medium) level of stress is achieved. Following this point performance will deteriorate (Yerkes & Dodson, 1908; Teigan, 1994) See Mellifont, Smith-Merry, and Scanlan, 2016 for an applied example of this – which also highlights the role of our environment in influencing experience of stress… https://www.tandfonline.com/doi/pdf/10.1080/15555240.2015.1119654 9  “cast iron is hard and brittle and breaks easily, but wrought iron is soft and malleable and bends without breaking” - Lazarus (1993) Adaptation to a stressor is important…but not always easy Lazarus (1993, p.3) 10 Psychological theories of stress 11 Transactional model of stress and coping (Lazarus, 1993; Lazarus & Folkman 1984) “psychological stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” - (Lazarus and Folkman, 1984, p. 19) Stress is a relational concept Lazarus explored the effect of cognitive appraisal on the stress response of participants who volunteered to watch video footage of a discomforting scene… each experimental condition differed depending on the voice narration paired with the same video footage. (Lazarus, 1993, p.6) C2: Denial C3: Trauma C1: Intellectualization Transactional model of stress and coping (Lazarus, 1993; Lazarus & Folkman 1984) Stress comprises 4 elements: 1. Internal or external trigger/stressor 2. Evaluation/cognitive appraisal 3. Coping processes used by mind/body 4. Effect on mind/body (impact)  Defining coping: coping with a stressor/stress “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing“ - (Lazarus & Folkman, 1984) Coping styles (Carver & Connor-Smith, 2010, p.685-686) Problem-focused versus emotion-focused 14 Coping styles (Carver & Connor-Smith, 2010, p.685-686) Engagement (aka approach) versus disengagement (aka avoidant) Other types: Meaning-focused coping or benefit finding Proactive coping Appraisal/evaluation of coping strategies: helpful or unhelpful? 15 Coping measures (see Carver, 1997) Ways of Coping (Lazarus & Folkman 1984) The Coping Strategies Inventory (Tobin, Holroyd, & Reynolds, 1984) The COPE Inventory (Carver, Scheier, & Weintraub, 1989) Multidimensional Coping Inventory (Enlder & Parker, 1990) The Brief COPE (Coping Orientation to Problems Experienced) (Carver, 1997) HOW DO YOU COPE? Brief COPE (miami.edu)l 16 Brief COPE (Carver, 1997) 28 items and 14 subscales 17  (Carver, Scheier, & Weintraub, 1989; Carver, 1997) 28 items and 14 subscales Active coping Problem-focused versus emotion-focused? Use of emotional social support Positive reframing Religion Engagement/approach Use of instrumental support OR disengagement/avoidant? Acceptance Planning Adaptive OR maladaptive? Self-distraction Self-blame Denial Substance use Behavioural disengagement But Carver (1997) presents no set guidance Humour regarding the categorisation of emotion- focused/problem-focused or Venting adaptive/maladaptive… will depend on interpretation based on the population and the context. COPE (complete version) (miami.edu) Coping styles in people with Multiple Sclerosis (Bassi et al., 2021) DOI: 10.1007/s10880-019-09692-6 Study of N=680 people with Multiple Sclerosis (MS) explored the relationship between illness perceptions, coping styles, social support, and perceived physical wellbeing. Factor analysis performed on six subscales from the Brief COPE: active coping, planning, positive reframing, acceptance, denial, and behavioral disengagement. Problem-focused: active coping and planning Meaning-focused: positive reframing and acceptance Avoidant: Denial behavioural disengagement Lower use of avoidant coping was associated with higher perceived physical wellbeing 19 20 Socrative activity (Stress and Health 2): https://b.socrative.com/login/student/ Room name: BERRY9392 https://b.socrative.com/teacher  Summary of learning so far…  Familiarity with early and core psychological theories of stress 21  Familiarity with different forms of coping with stress Next up… 3. Understand the concept of illness as a stressor and the components of the Common Sense Model 4. Gain knowledge of different general stress reduction techniques and interventions The Common-Sense Model of Self-Regulation (CSM): Illness as a stressor (Leventhal, Phillips, & Burns, 2016; Leventhal, Meyer, & Nerenz, 1980) The CSM of self-regulation by Leventhal and colleagues roots in Lazarus’ work on stress and 22 Illness perceptions (appraisals): coping, hence the focus on appraisals of the stressor, Chronic or short-term? coping strategies used to deal with the threat and the Frequency of symptoms? Consequences/impact? evaluation of the adequacy of coping strategies. Do I have control? Can treatment control my illness? Relating symptoms with illness Understanding of the illness What caused my illness? Illness outcomes: change monitoring Illness stressor (Diagnosis, context, Coping strategies exposure, Emotional outcomes: experience, affective response memory) Emotional illness representations Appraisal (evaluation) of coping strategies 23 How do we measure illness appraisals/beliefs? Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al., 2002): 9 Subscales (7 core) Illness perceptions (appraisals): TIMELINE ACUTE/CHRONIC Chronic or short-term? TIMELINE CYCLICAL Frequency of symptoms? CONSEQUENCES Consequences/impact? PERSONAL CONTROL Do I have control? TREATMENT CONTROL Can treatment control my illness? IDENTITY Relating symptoms with illness COHERENCE Understanding of the illness PERCIEVED CAUSE What caused my illness? PLUS: EMOTIONAL REPRESENTATIONS Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17, 1–16. 24 How do we measure illness appraisals/beliefs? Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al., 2002): 9 Subscales (7 core) My illness will last a short time TIMELINE CYCLICAL My illness is very unpredictable CONSEQUENCES My illness is a serious condition PERSONAL CONTROL I have the power to influence my illness TREATMENT CONTROL My treatment can control my illness IDENTITY I relate ???? (symptoms) to my illness COHERENCE I don’t understand my illness PERCIEVED CAUSE Poor dietary habits caused my illness EMOTIONAL REPRESENTATIONS My illness makes me feel angry TIMELINE ACUTE/CHRONIC Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17, 1–16.  The Common-Sense Model of Self-Regulation (CSM): Illness appraisals and coping (Leventhal, Phillips, & Burns, 2016; Leventhal, Meyer, & Nerenz, 1980) This is forever… I can’t predict what my bloods are going to do… This is really serious Its out of my control… My tablets don’t work! All those headaches are because of this I don’t know how to manage this… Runs in my family…I’m doomed Blood glucose increases Diagnosed with Type 2 diabetes (family I can’t cope history, negative thinking about experiences, little any of it… Fear Increases information via GP) I feel so frightened about it all… Ignoring it has caused my health to worsen and me to feel more afraid…this isn’t working Illness perceptions and coping styles in people with Multiple Sclerosis (Bassi et al., 2021) DOI: 10.1007/s10880-019-09692-6 Study of N=680 people with Multiple Sclerosis (MS) explored the relationship between illness perceptions, coping styles, social support, and perceived physical wellbeing. Stronger MS identity perceptions, stronger perception that MS has a cyclical disease course, and the perception that MS has negative consequences were significantly associated with lower perceived physical wellbeing. Stronger perception that treatment controlled the MS was associated with greater perceived physical wellbeing. Stronger/more intense emotional representations was associated with to lower perceived physical wellbeing through greater use of avoidant coping strategies. 26  Review of Illness perceptions and coping in physical health conditions (Dempster, Howell, & McCorry, 2015) Coping response Illness perceptions Psychological distress Perceived consequences was a reliably strong predictor of psychological distress Behavioural disengagement and denial (disengagement?) coping styles were most strongly related to greater psychological distress in people with chronic physical conditions Venting also predicted greater distress Interventions to reduce stress (McEwen, 2007, p.893-894) Drug-therapy Drug-therapies such as beta-blockers work to reduce the physiological stress response by blocking the receptors on the cells of the cardiovascular system that are stimulated by adrenalin and noradrenalin. - Anxiolytics increase gamma-aminobutyric acid (GABA) which reduces brain activity - Anti-depressants increase neurotransmitters serotonin, norepinephrine, and dopamine Physical Activity Physical activity is believed to increase neurogenesis of the hippocampal formation and is also believed to work in similar ways to that of anti- depressants on the hippocampus; improving memory and mood. Social support Social support can reduce the physiological stress response, hence allostatic load scores (physiological markers) and increase mood. - People with poor physical or mental health and caregivers E.g. Baltimore Experience Corps Trial (Carlson et al., 2015) 28 Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) Research rationale & aim: review of psychological interventions aimed to reduce stress in university student populations from across the world N= 1802 students across N=29 studies Moderate levels of stress-related MH issues in approximately 50% of student participants Primary outcome measures Secondary outcome measures - Self-reported stress - Self-reported depression - Self-reported anxiety - Biomarkers of stress Intervention types: 1. Psychoeducational (N=2 studies) 2. Arts-based (N=2 studies) 3. Cognitive, Behavioural &/or Mindfulness N= 24 studies) 4. Alternative therapies (Healing touch and Self-care Coaching) (N= 1 study)  Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) 30 (Cohen, Kamarck, & Mermelstein, 1994)  Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) 31 The State-Trait Anxiety Inventory (STAI)) (Spielberger, 1989) 40 items… Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) Key discussion points (Regehr et al., 2013, 7-9) Of the two psychoeducational intervention studies, one showed a significant reduction in stress. Of the two arts based intervention studies, Group Empowerment Drumming improved mood, and Poetry Therapy reduced stress, depression, and anxiety. Pooled analysis showed that interventions based on Cognitive behavioural and mindfulness approaches reduced: - Stress-related anxiety - Depression - Salivary cortisol Limitations of the review (Regehr et al., 2013, p.6 & 9) - Gender bias…majority of the students included in the review were female - Cultural bias… studies represented largely Western countries - Art-based and psycho-educational interventions not featured in the pooled analysis… lacked sufficient outcome data as they did not include a comparator group e.g. usual care  Summary of learning from this lecture…  Familiarity with early and core psychological theories of stress  Familiarity with different forms of coping with stress  Illness as a stressor and components of the Common Sense Model  Different general stress reduction techniques and interventions 34 Socrative activity (Stress and Health 3): https://b.socrative.com/login/student/ Room name: BERRY9392 https://b.socrative.com/teacher 35 Coping resources Get.gg - Getselfhelp.co.uk Online MBSR/Mindfulness (Free) (palousemindfulness.com) Psychology Tools | Deliver Effective Therapy 36  Stress and Health Lecture Part 1 Dr Emma Berry  Learning outcomes By the end of this lecture you should: 2 1. Recognise the physiological mechanisms of ‘stress’ in the body and understand the function of stress hormones 2. Gain knowledge about how prolonged stress impacts our mental and physical wellbeing  “Stress can be defined as a negative emotional experience accompanied by predictable biochemical, physiological, and behavioral changes that are directed toward adaptation either by manipulating the situation to alter the stressor or by accommodating its effects.” - Baum (1990) What constitutes stress? A stimulus A process A response 3 Baum, A. (1990). Stress, intrusive imagery, and chronic distress. Health psychology, 9(6), 653. Central Nervous System: spinal cord and brain Peripheral Nervous System: nerves and ganglia Autonomic Nervous System: regulated by the hypothalamus & two divisions Sympathetic Nervous Parasympathetic Nervous System: prepare body for System: return body to resting action state 4 Sympathetic-Adrenal- Stressor Hypothalamic Medullary (SAM) Pituitary system Adrenal (HPA) axis Hypothalamus CR acti s es F r vat ou ele es Ar (-) as … e& Negative feedback Sympathetic nervous system Pituitary gland (acute response) ACTH release & (-) activates… Adrenal medulla secretes catecholamines (adrenaline Adrenal cortex & noradrenaline) Secretes glucocorticoids (-) (cortisol) Heart rate, BP, & respiration, muscles Blood glucose and tense, blood vessels metabolism increases constrict More energy CRF= corticotrophin 5 ACTH= adrenocorticotrophic hormone  SSOR STRE Thala mus Amygdala Prefrontal cortex Hippocampus Rapid response SAM Hypothalamus Enduring stress HPA response 6 Functionality of stress response and adaption Performance and learning… glucose Adaption to change (internal and external) Initial physiological stress response (SAM) similar when excited, angry, nervous, as well as afraid … eustress Interpretation & regulation is key… *Allostasis* *Allostatic load* (McEwen, 2007, p.879) 7  *Allostatic load* (McEwen, 2007, p.880) 8 From McEwen (2007, 1998); p.875 9 “It’s not stress that kills us, it is our reaction to it” - Hans Selye 10 Chronic stress and health (McEwen, 2007, p.889-892) Body Cardiovascular system Immune system Neural atrophy/change Hippocampus Prefrontal cortex Amygdala Behaviour change Performance and learning Memory (degeneration) Appetite Mood Sleep and Restlessness Burnout 11 Chronic stress and health (McEwen, 2007, p.891 & 892) Cushing Disease (hypercortisolemia) - WHAT: ACTH secretion due to tumour of the pituitary gland… activates secretion of cortisol - IMPACT: Hypercortisolemia; fatigue, mood change, upper body fat, weakened muscles/bones, high blood pressure, diabetes (too MUCH cortisol) Addison's Disease (hypocortisolemia) - WHAT: most commonly an autoimmune condition, but also can be caused by long-term infection. Adrenal glands unable to produce cortisol. - IMPACT: Hypocortisolemia; fatigue, loss of appetite and weight loss, low blood pressure/sugar, low mood, blotchy/freckled skin (circulation) (too LITTLE cortisol) PTSD: can be the result of elevated or supressed HPA activation Chronic pain: pain symptomology associated with elevated emotionality as result of chronic distress (may be related to neural change as discussed) 12  Measuring stress Physiological: salivary cortisol, urine, allostatic load score (Regher et al., 2013; McEwan, 2007) Psychological/self-report: Perceived stress scale (PSS); Stressful situations questionnaire (SSQ); The State-Trait Anxiety Inventory (STAI)) (Regher et al., 2013) Are you stressed? https:// www.mindgarden.com/documents/PerceivedStressScale.pdf 13  Summary of learning from this lecture… ▹ Recognise physiological mechanisms and function of stress. ▹ Understand the impact of prolonged stress on our mental and physical wellbeing (the ‘wear and tear’). Stress and Health Lecture: Part 2  Recap on online videos… 2 ▹ Physiological mechanisms and function of stress ▹ Impact of prolonged stress on our mental and physical wellbeing Applied example of Cushing Syndrome…  Learning outcomes 3 the end of this lecture you should: By 1. Recognise and understand early and core psychological theories of stress 2. Recognise and understand different forms of coping with stress 3. Understand the concept of illness as a stressor and the components of the Common Sense Model 4. Gain knowledge of different general stress reduction techniques and interventions  Early theories of stress Robert Hooke (1679) Law of Elasticity …the extension of an elastic object is directly proportional to the force applied to it. “Combat stress” WWII (Grinker & Spiegel 1945)… “aka “shell-shock” Walter Cannon’s Fight or Flight response theory (Cannon, 1932) Rapid response to emotional arousal via SNS Body’s inbuilt adaptive function… ‘homeostasis’ via PNS Harmful if homeostasis is not restored 4 Lazarus (1993, p.2)  Early theories of stress General Adaption Syndrome (GAS) (Hans Selye, 1956). Homeostasis occurs in 3 stages: Stage 1 – Alarm Reaction - Fight-or-flight response (SNS) - Unsustainable… 5  Early theories of stress Stage 2 – Stage of Resistance - Stressor still perceived…SNS decreases and cortisol and other hormones are secreted - Prolonged alertness, fight infection, healing - Unsustainable… 6  Early theories of stress Stage 3 – Stage of Exhaustion - Resources depleted - Nervous system and immune system cannot sustain elevated activation - Vulnerable 7  Early theories of stress General Adaption Syndrome (GAS) (Hans Selye, 1956): Highlighted the dual nature of stress: short-term adaptive (relates to eustress) versus long-term maladaptive (relates to distress and chronic stress). Claimed that stress is a universal & nonspecific bodily response to any exertion… criticised by later psychological theorists. 8  Yerkes-Dodson Human Performance and Stress curve The Yerkes-Dodson stress curve provides a helpful distinction between eustress/adaptive stress and distress/maladaptive stress. This law states that anxiety assists performance up to the point at which an optimum (i.e., medium) level of stress is achieved. Following this point performance will deteriorate (Yerkes & Dodson, 1908; Teigan, 1994) See Mellifont, Smith-Merry, and Scanlan, 2016 for an applied example of this – which also highlights the role of our environment in influencing experience of stress… https://www.tandfonline.com/doi/pdf/10.1080/15555240.2015.1119654 9  “cast iron is hard and brittle and breaks easily, but wrought iron is soft and malleable and bends without breaking” - Lazarus (1993) Adaptation to a stressor is important…but not always easy Lazarus (1993, p.3) 10 Psychological theories of stress 11 Transactional model of stress and coping (Lazarus, 1993; Lazarus & Folkman 1984) “psychological stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” - (Lazarus and Folkman, 1984, p. 19) Stress is a relational concept Lazarus explored the effect of cognitive appraisal on the stress response of participants who volunteered to watch video footage of a discomforting scene… each experimental condition differed depending on the voice narration paired with the same video footage. C1: Intellectualization C2: Denial C3: Trauma (Lazarus, 1993, p.6) Transactional model of stress and coping (Lazarus, 1993; Lazarus & Folkman 1984) Stress comprises 4 elements: 1. Internal or external trigger/stressor 2. Evaluation/cognitive appraisal 3. Coping processes used by mind/body 4. Effect on mind/body (impact)  Defining coping: coping with a stressor/stress “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing“ - (Lazarus & Folkman, 1984) Coping styles (Carver & Connor-Smith, 2010, p.685-686) Problem-focused versus emotion-focused 14 Coping styles (Carver & Connor-Smith, 2010, p.685-686) Engagement (aka approach) versus disengagement (aka avoidant) Other types: Meaning-focused coping or benefit finding Proactive coping Appraisal/evaluation of coping strategies: helpful or unhelpful? 15 Coping measures (see Carver, 1997) Ways of Coping (Lazarus & Folkman 1984) The Coping Strategies Inventory (Tobin, Holroyd, & Reynolds, 1984) The COPE Inventory (Carver, Scheier, & Weintraub, 1989) Multidimensional Coping Inventory (Enlder & Parker, 1990) The Brief COPE (Coping Orientation to Problems Experienced) (Carver, 1997) HOW DO YOU COPE? https://local.psy.miami.edu/faculty/ccarver/sclBrCOPE.phtml 16 Brief COPE (Carver, 1997) 28 items and 14 subscales 17  (Carver, Scheier, & Weintraub, 1989; Carver, 1997) 28 items and 14 subscales Active coping Problem-focused versus emotion-focused? Use of emotional social support Positive reframing Religion Engagement/approach Use of instrumental support OR disengagement/avoidant? Acceptance Planning Adaptive OR maladaptive? Self-distraction Self-blame Denial Substance use Behavioural disengagement But Carver (1997) presents no set guidance Humour regarding the categorisation of emotion- focused/problem-focused or Venting adaptive/maladaptive… will depend on interpretation based on the population and the context. http://www.thecarlatcmeinstitute.com/complete/html/assess/COPE09.pdf Coping styles in people with Multiple Sclerosis (Bassi et al., 2021) DOI: 10.1007/s10880-019-09692-6 Study of N=680 people with Multiple Sclerosis (MS) explored the relationship between illness perceptions, coping styles, social support, and perceived physical wellbeing. Factor analysis performed on six subscales from the Brief COPE: active coping, planning, positive reframing, acceptance, denial, and behavioral disengagement. Problem-focused: active coping and planning Meaning-focused: positive reframing and acceptance Avoidant: Denial behavioural disengagement Lower use of avoidant coping was associated with higher perceived physical wellbeing 19 20 Socrative activity (Stress and Health 2): https://b.socrative.com/login/student/ Room name: BERRY9392 https://b.socrative.com/teacher  Summary of learning so far… 21 Familiarity with early and core psychological theories of stress  Familiarity with different forms of coping with stress Next up… 3. Understand the concept of illness as a stressor and the components of the Common Sense Model 4. Gain knowledge of different general stress reduction techniques and interventions The Common-Sense Model of Self-Regulation (CSM): Illness as a stressor (Leventhal, Phillips, & Burns, 2016; Leventhal, Meyer, & Nerenz, 1980) The CSM of self-regulation by Leventhal and 22 Illness perceptions (appraisals): colleagues roots in Lazarus’ work on stress and coping, hence the focus on appraisals of the stressor, Chronic or short-term? coping strategies used to deal with the threat and Frequency of symptoms? Consequences/impact? the evaluation of the adequacy of coping strategies. Do I have control? Can treatment control my illness? Relating symptoms with illness Understanding of the illness What caused my illness? Illness outcomes: change monitoring Illness stressor (Diagnosis, context, Coping strategies exposure, Emotional outcomes: experience, affective response memory) Emotional illness representations Appraisal (evaluation) of coping strategies 23 How do we measure illness appraisals/beliefs? Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al., 2002): 9 Subscales (7 core) Illness perceptions (appraisals): Chronic or short-term? TIMELINE ACUTE/CHRONIC Frequency of symptoms? TIMELINE CYCLICAL Consequences/impact? CONSEQUENCES Do I have control? PERSONAL CONTROL Can treatment control my illness? TREATMENT CONTROL Relating symptoms with illness IDENTITY Understanding of the illness COHERENCE What caused my illness? PERCIEVED CAUSE PLUS: EMOTIONAL REPRESENTATIONS Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17, 1–16. 24 How do we measure illness appraisals/beliefs? Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al., 2002): 9 Subscales (7 core) My illness will last a short time TIMELINE ACUTE/CHRONIC My illness is very unpredictable TIMELINE CYCLICAL My illness is a serious condition CONSEQUENCES I have the power to influence my illness PERSONAL CONTROL My treatment can control my illness TREATMENT CONTROL I relate ???? (symptoms) to my illness IDENTITY I don’t understand my illness COHERENCE Poor dietary habits caused my illness PERCIEVED CAUSE My illness makes me feel angry EMOTIONAL REPRESENTATIONS Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17, 1–16.  The Common-Sense Model of Self-Regulation (CSM): Illness appraisals and coping (Leventhal, Phillips, & Burns, 2016; Leventhal, Meyer, & Nerenz, 1980) This is forever… I can’t predict what my bloods are going to do… This is really serious Its out of my control… My tablets don’t work! All those headaches are because of this I don’t know how to manage this… Runs in my family…I’m doomed Blood glucose increases Diagnosed with Type 2 diabetes (family I can’t cope history, negative thinking about experiences, little any of it… Fear information via GP) Increases I feel so frightened about it all… Ignoring it has caused my health to worsen and me to feel more afraid…this isn’t working Illness perceptions and coping styles in people with Multiple Sclerosis (Bassi et al., 2021) DOI: 10.1007/s10880-019-09692-6 Study of N=680 people with Multiple Sclerosis (MS) explored the relationship between illness perceptions, coping styles, social support, and perceived physical wellbeing. Stronger MS identity perceptions, stronger perception that MS has a cyclical disease course, and the perception that MS has negative consequences were significantly associated with lower perceived physical wellbeing. Stronger perception that treatment controlled the MS was associated with greater perceived physical wellbeing. Stronger/more intense emotional representations was associated with to lower perceived physical wellbeing through greater use of avoidant coping strategies. 26  Review of Illness perceptions and coping in physical health conditions (Dempster, Howell, & McCorry, 2015) Coping response Illness perceptions Psychological distress Perceived consequences was a reliably strong predictor of psychological distress Behavioural disengagement and denial (disengagement?) coping styles were most strongly related to greater psychological distress in people with chronic physical conditions Venting also predicted greater distress Interventions to reduce stress (McEwen, 2007, p.893-894) Drug-therapy Drug-therapies such as beta-blockers work to reduce the physiological stress response by blocking the receptors on the cells of the cardiovascular system that are stimulated by adrenalin and noradrenalin. - Anxiolytics increase gamma-aminobutyric acid (GABA) which reduces brain activity - Anti-depressants increase neurotransmitters serotonin, norepinephrine, and dopamine Physical Activity Physical activity is believed to increase neurogenesis of the hippocampal formation and is also believed to work in similar ways to that of anti- depressants on the hippocampus; improving memory and mood. Social support Social support can reduce the physiological stress response, hence allostatic load scores (physiological markers) and increase mood. - People with poor physical or mental health and caregivers E.g. Baltimore Experience Corps Trial (Carlson et al., 2015) 28 Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) Research rationale & aim: review of psychological interventions aimed to reduce stress in university student populations from across the world N= 1802 students across N=29 studies Moderate levels of stress-related MH issues in approximately 50% of student participants Primary outcome measures Secondary outcome measures - Self-reported stress - Self-reported depression - Self-reported anxiety - Biomarkers of stress Intervention types: 1. Psychoeducational (N=2 studies) 2. Arts-based (N=2 studies) 3. Cognitive, Behavioural &/or Mindfulness N= 24 studies) 4. Alternative therapies (Healing touch and Self-care Coaching) (N= 1 study)  Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) 30 (Cohen, Kamarck, & Mermelstein, 1994)  Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) 31 The State-Trait Anxiety Inventory (STAI)) (Spielberger, 1989) 40 items… Interventions to reduce stress in students (Regehr, Glancy, & Pitts, 2013) Key discussion points (Regehr et al., 2013, 7-9) Of the two psychoeducational intervention studies, one showed a significant reduction in stress. Of the two arts based intervention studies, Group Empowerment Drumming improved mood, and Poetry Therapy reduced stress, depression, and anxiety. Pooled analysis showed that interventions based on Cognitive behavioural and mindfulness approaches reduced: - Stress-related anxiety - Depression - Salivary cortisol Limitations of the review (Regehr et al., 2013, p.6 & 9) - Gender bias…majority of the students included in the review were female - Cultural bias… studies represented largely Western countries - Art-based and psycho-educational interventions not featured in the pooled analysis… lacked sufficient outcome data as they did not include a comparator group e.g. usual care  Summary of learning from this lecture…  Familiarity with early and core psychological theories of stress  Familiarity with different forms of coping with stress  Illness as a stressor and components of the Common Sense Model  Different general stress reduction techniques and interventions 34 Socrative activity (Stress and Health 3): https://b.socrative.com/login/student/ Room name: BERRY9392 https://b.socrative.com/teacher 35 PSY7092 Stress and Health-20231004_131257- Meeting Recording October 4, 2023, 12:12PM 1h 55m 27s Emma Berry started transcription Emma Berry 0:11 OK. I'm just gonna start. Yep, it's recording. It's recording. Everyone can see that it's the paranoia. Whenever we started recording these and I was so always got so worried, I was back and forth. So all being well, that all continue to record. And so if I go back on to. It's crooking and get started. Wonder, actually. So I think it's going to anyway, it's fine. I'm just thinking out loud at this point, so, OK. Well, welcome to the series of lectures on stress and health, where I'm not stressed at all. I hope that yous are all doing OK and it's week three and you know, I guess it's kind of still familiarising with the course as well and it's probably, I always think it's a timely point to kind of learn a wee bit about stress and obviously I don't know what your backgrounds are. You mean many of you may know a lot more about the Physiology of stress in me. So that's why whenever I do the first video, it is just a real introduction and some of you might have a medical background and you know are a bit more you're probably like that's wrong Emma, you know, you know, actually that doesn't happen in the brain and I'm like, OK. But but anyway, so hopefully you got a chance to have a look at that first video and I thought it was really important because you know, stress and how I'm going to be talking about it today is is largely when we contextualise it to psychological theory. I talk a lot about stress appraisals and coping with stress and that might be of interest to you guys just in terms of kind of learning more about kind of how our brains respond to stress, but but also if you're interested particularly in health psychology and clinical health psychology and you can start to see how certain therapies kind of align with. This idea of understanding how our brains interpret something is stressful and kind of what what that looks like as we break it down, and how that informs how we cope with stress. So yeah, just a recap on the online video, this is really around the physiological mechanisms of stress. And so whatever our brain interprets something as stressful, stressful stimuli, or if there's a kind of an internal stressor occurring such as an infection, what actually happens in the body. And also the impact I talk a little bit about the the benefits of stress and how stress is really important to help it keeps us alive, you know, and there's a lot of think and there's a lot of maybe stress is stigmatised a little bit you know as it should be. But ultimately the stress hormones and the endocrine system all have a really big role in providing us with energy to perform and learning and so on. And but you also can see how the impact of prolonged stress and particularly when we've we've we've got elevated levels of cortisol. Can have a negative impact on on the body. The mind and I give the example of my my dog, Gus, who, who developed Cushing's syndrome or we we found he was diagnosed with Cushing's syndrome. And as you'll call from the first video, Cushing syndrome is where the body can't regulate cortisol. So it's producing too much. So he's just really stressed all the time. And every time I talk to family and friends about this, they're kind of like, I think I have that. I was like, I think we all have that. But you know what? We report an update on Gus and he's doing well. He does kind of send me a little bit because he's he's quite vocal, quite vocal. And he, you know, he needs a lot. He needs a lot of attention. He's 13. God love him, but he's doing well and he's kind of on tablets to regulate that cortisol and it's crazy the impact that that regulation had on his his wee body like he, his fur grew back after becoming really patchy and he was getting infections quite a lot. His behaviour was a lot different. He was drinking a lot more and having those tablets just really regulated. You know, his both behaviours and and kind of his physical appearance and well-being and it kind of was just a really. Important reminder that this kind of these hormones in our body have so much par over, you know, how it manifests in terms of our our you know, physical and mental well-being. And so yeah, so that's the kind of first video you know and and you know if you've got any questions about that and please you know post them up in the discussion forum. If you're not comfortable with that, you know I'm happy to to get an e-mail, but I'll also kind of hang around a little bit. But before the end of class, does anyone have anything in particular they like to ask about from that first lecture? That's OK if you've got anything again. Yeah. Can ask me later. So this lecture really kind of builds on that, you know, understanding of the Physiology of stress. And I'm going to introduce some of the early and core psychological theories around stress. And you'll kind of see how these grow and develop and how they become more closely aligned with, you know, theories that we use in, in health psychology and clinical psychology. And because, you know, theories help us get an understanding about the factors that influence influence people's stress response and adjustment. And so you can see how they land themselves to to different therapies. As I mentioned, for example, CBCBT cognitive behavioural therapy. But the the final review that I'll introduce provides some a variation of of interventions that. Researchers are interested in applying in the context of stress reduction. So I'm going to introduce as well as that some different forms of coping and these will be relevant. You know in your everyday life. So being LB, it will be good to kind of reflect on that and reflect on kind of what what tends to be your go to method for cope for coping. Now obviously we're going to have a range of of methods that we use in everyday life and we're not really consciously aware of it. So it's kind of an opportunity to do a bit of reflection on your own coping styles and so you know at this point we may well probably have a little bit of a break. Then I'm gonna introduce the common sense model of self regulation and this is really it expands on the transactional model of stress that I introduced because it can it places the places illness in the context of a stressor. So if you're diagnosed with an illness, that's a stressful situation and the management of of an illness is a continuous stressor. And so this kind of contextualises it to different types of illnesses. And then finally, I'm going to introduce some different general stress reduction techniques. And intervention interventions. And so this is one of, I suppose I wanted to introduce these because there were the earliest kind of forms or the earliest. Foundational theories around what we now know to be kind of psychological stress and thinking about stress as a psychological concept and. The the example of Rob Robert that Robert Hook provides a low Robert Hook was a physicist. I think it's a really nice metaphor to understand and the impact of stress on our bodies and on our minds. So you might have come across. I'm sure you have maybe years ago or or or whatever context, but hooks love elasticity says that the extension of an elastic object is directly proportional to the force applied to it. So according to Hooke's law an object an object will have. Some degree of flexibility so that if a force is applied to it, there's some sort of give, so it'll extend to a certain amount and there will be a certain amount of deformation. Now if if a force goes beyond an object's capacity to deal with that extension, then deformation can be permanent. And I suppose the analogy is that you know, if we're exposed to stress, then our bodies are built. They're they're built to adjust and adapt. You know, our bodies have a certain amount of dexterity and flexibility. But if we're prolonged to, if we are exposed to a prolonged stressor where it's unexpected, we we we lack the capacity or resources to deal with that stressor, then there's a potential that the stress, the stressor can have a damaging impact to our to our bodies and brains. So I thought that was a kind of a nice analogy to to think about, and you'll also have come across terminologies like Combat Stress, which is has given way to what we now know to be post traumatic stress, traumatic stress disorder and a lot of that came from studies of veterans and the prolonged impact of being in a highly stressful situation. And you know this really give way to a lot of research around what we know to happen to the body to to the body and the mind whenever. And, you know, a person is is is dealing with unexpected and highly traumatic situations. And what that does to the nervous system and the lasting impact of that. No, I'm not going to go into that in too much depth, but I know you have, you have some lectures on. Yeah, that so not going to go there. That's not my area but it's just to kind of put it in because it's it's relevant here. Then you'll also be familiar with the kind of fight or flight response you know it's something that we kind of use in an everyday life. And and this was borne out of theories from Walter Cannon and Walter Cannon had recognised that whenever animals were exposed to fearful or unexpected shocking environments or environments or or stimuli, this kind of fear reaction. Induced certain physiological reactions so you know he he measured things like. Adrenaline and cortisol and and the the animals. And it was it was through a kind of more physical science kind of lands. It was the physiological response. But what this kind of give way to for for Walter Khan and what this give way to was the idea that the body has an adaptive response to stressors. And this was by via the sympathetic nervous system. So you know I introduced that in the first video where you know if we're immediately kind of faced with a threat. On a kit or automatic response and that kind of idea of the Sam response. So the sympathetic adrenal medullary system and this is really where if the brain interprets something is stressful, it's an almost automatic reaction and that adrenaline and no adrenaline will be released. And this causes then the increase in. Heart rate and blood pressure and so on. It's really to kind of gear our bodies to fight or flight. So it's an adaptive function and and and but it's not meant to. Be lost over time, so it's it's kind of meant to be an acute response to deal with a a stressful stimuli. And if you think about, you know, if we're again thinking about kind of years and years ago, you know, whenever kind of humans were in their earliest forms and we're dealing with kind of live threats and the kind of wild environment and and they needed this energy. This our bodies have adapted to provide us with this energy to kind of get. Flat flat flee from a stressor or or tackle it. And, but Walter Cannon also realised from the studies with different animals and so on, was that the impact of the body, the body stress response, and that prolonged stress response could be harmful if homeostasis. So that kind of natural balance is is not restored. So. This kinda moves on to hand celiate general adoption syndrome, which is a bit of a weird. It's a bit of a weird name, but anyway whatever. So Hans Sallye claimed that or believed that there was three main phases that each every Organism goes through whenever it's experienced, experiencing a stressor, and particularly if the the stressor kind of continues or it's prolonged. And as an Organism kind of goes through those 3 phases. And it's it kind of maps out that process of establishing homeostasis. So in the first first phase is alarm reaction. So this is where if you can imagine something happens in your environment and that causes you to experience it as stressful and you get that kind of initial Sam system response. So you get an increase in heart rate and your your blood pressure increases. You get your breathing quickens, people's dilate, and so on. So your your body's. Your body's activating it's self to. Fight or flee from from the scenario. And so this is kind of an acute response, but as you can see from this kind of first phase, it's it's quite a, it's quite a short period. So it's not your body's not meant to kind of produce all that adrenaline for a long period of time. It's meant to be a short burst of energy. And so, if a stressor continues, this is the alarm reaction stage. If a stressor continues, it then moves on to the stage of resistance. And this is really where your brain interprets the stressor as stressor is continuing. But it moves on to that HPA axis. That response to that hypothalamic pituitary adrenal axis and this is really where you get that kind of your brain interprets something as as still the stressors still being there and you get the release of cortisol as it kind of goes through the pituitary gland and adrenal cortex. The adrenal cortex then activates the release of cortisol. So cortisol provides a little bit more energy, a little bit more. Increases your metabolism and so on. So it mobilises your body to, umm, provide umm, a greater degree of kind of, umm, performance in in light of that, uh, continued stressor. And it also enables your body to be more protective. You know of itself, and it can increase the rate of healing and fighting infection because of the impact of cortisol on your body's inflammatory response. And but again, this stage is unsustainable, so it provides longer and provides a longer degree of performance in the face of a stressor. But over time, your body, your body is going to start to burn out because it's, you know, it's resources aren't infinite and your body does need to reach that stage of homeostasis. So. If a stressor does continue beyond this, your body will start to burn out, and I'm sure you've experienced this, and particularly during times of stress, whenever you've been kind of feeling a little bit stressed out about work or, you know, family or whatever it is. And you'll notice that you get kind of sick more easily as well. But so, so really kind of important example of that. And so this is really where you're kind of nervous system, your immune system starts to kind of. Slow down as well, and because of the impact of cortisol and your immune system and it kind of increases and the likes of cytokines which increase the inflammatory response, it starts to kind of have a have the opposite effect and starts to kind of. Cause greater inflammation, which which in effect kind of harms your body, and so on. So at this point you're a lot more vulnerable to more infection. You're a lot more vulnerable to perceiving other stressful stimuli. You know a threat because of the impact on brain parts such as the amygdala, you know, which is the body's kind of are the brains kind of emotion system? So. So this is the kind of according to this theory. These are the kind of three stages that tend to happen if you're faced with a stressor and then it's prolonged and and you kind of don't achieve that kind of homeostasis. And This is why, I suppose looking at this, I'm going to critique the theory in a second, but looking at this, it's kind of you can. I'm sure you can kind of recognise that that response. And so this is really important theory. You know, it was it was kind of came out of the 50s. So it is quite a dated theory, but it was useful because it highlighted the dual function of stress. So you've got the positive impact of stress, but it also highlighted that the last help helpful and less healthy and impactive of prolonged stress. But I guess what psychologists critique this for mostly was that it was Hanseliak assumed that. And stress is universal and non specific bodily response to any exertion. And it was kind of Celia didn't quite differentiate between different types of stressor and also didn't kind of. Didn't. Go as too far go as so far to say that you know how our brains interpret different stresses are going to be different for every individual. So I guess it was just too general, too generalised the theory, and this is where. The likes of the transactional model comes in to acknowledge individual differences and how different people will interpret. Things as as you know, different things as stressful. And so this is kind of just another theory I wanted to introduce before we get into kind of the stress appraisal theory. So the Yorkies Dodson human performance and stress curve, it's maybe something you've come across before, it's quite commonly used in businesses and so on. But the whole idea is that. Again, you know a certain amount of stress and a certain amount of anxiety is benefits performance. So you've kind of got this stress this curve where we've got, you know, the green is kind of optimal optimal level of stress. But if it goes beyond that, it can have a negative impact and we go into that kind of feeling overwhelm feeling burnt out and so on. And so there is that it's the idea that there is an optimal point that you know if we have enough kind of when our body kicks into gear and we get a bit of adrenaline going a bit of cortisol and that it can increase performance and you'll see. Learn from the first lecture that in certain circumstances where we've got a little bit of increased stress, it could actually benefit memory acquisition and so on and learning. And I just put up a paper here if you're interested in reading a little bit more about it. And this is really where it's in a workplace. They've tried to make environmental changes. To optimise that kind of stress that stress experience, so it was in a sample of individuals who were experiencing high levels of anxiety. So they were trying to cultivate a work environment. Individuals where? Supported and kind of are sorry, the environment was was changed so that individuals felt a little bit supported in their their anxiety and but that they harnessed that a certain a certain degree of their anxiety to to to benefit their work at performance. So but you can have a look at that in a little bit more depth. And so I thought this was quite a nice quote by Lazarus and Lazarus developed the transactional model of stress and coping, which I'm going to introduce now. But the idea of this, so I'll read it out. So cast iron is hard and brittle and breaks easily. But wrought iron is soft and malleable, and it bends without breaking. So this kind of coins, that idea of the body as a, as a system that's that's built to adapt to, to stress, to stressors. And this idea of a kind of homeostasis to to restore that kind of natural balance. But I wanted to highlight this as well as, you know, adoption to a stressor is important, but it's not always easy. And so we'll see from the kind of the next series of theories that I introduce. How. Can make it so difficult to adapt to a stressor, particularly because of the the level of thinking that we do about different situations now in everyday life. And while the body physiologically is built to deal with the stressor, our brains have almost become developed so much that a lot of the stress is maintained up in our brains and that kind of reinforces it. So easier said than done, but it's I suppose it's just a point our bodies Once Upon a time, was meant to be very. Adaptive system and then we. We're too much up in our in our brains. I am anyway. OK. So let me just check time. OK. So introducing psychological theories of stress. And so this is the transactional model of stress and coping by Lazarus and Lazarus and Folkman. I'll just read out their definition so. Psychological stress is a particular relationship between a person and the environment that is appraised by the person. Or exceeding his or her resources and endangering his or her well-being. So it's that idea that transaction between an individual and their environment, so, so, and the person is going to be appraising their environments, they're going to be trying to make sense of their environment. And if they if, how they make sense of what's happening in their environment is this is something I'm afraid of. You know, there'll be an emotional emotional response and then they'll try and make sense of that emotional response. So it's that interpretation, and that's what we'll. Hiya. Yeah, I I totally get you. So. So it's almost the difference between, yeah, if, if, if if you see a car coming out. Yeah. And you've no idea? No, no previous knowledge about about cars. You know, I it's where the it's where I guess instincts comes into it as well. So I mean if you don't have any knowledge about something and you've no previous experience of it being you know fearful you haven't heard anything you know it's almost like you're you're you're a vacuum you know and then I mean the likelihood is that you're not going to necessarily experience stressful. But then again, this is where we've got our cognition. We've got the prefrontal cortex doing all its work. But then, but then there's there's instinct as well. And this is something that kind of. It's it really interests me as well because you know, when it I guess it's where it's where instincts and and you're kind of yeah, your direct appraisal. So I mean in that sense I think how we consciously make sense and appraise, appraise things is is based on our previous experience. You know it's it's it's a it's a bit like. You might have heard of some of the you know for for any of you who. Well, I suppose, just thinking, whatever your background is, you know there's lots of theories around develop child development and how fear is induced. And a lot of the time fear can come from parents fear, you know. So that's kind of. Yeah. Yeah. So you know, so. So a lot of how we Perce, a lot of what we interpret as being fearful and threatening is is from our learned experience. And. Yeah. Yeah. Yeah, yeah, yeah. Yeah, yeah, yeah, they haven't directly, but it's been through. Modelling, you know? And learning. Yeah. Yeah, it's complicated. And it's it just shows you how much of an impact we have on, you know, other people through through our discourse and through our own behaviours. But interesting and thanks for that question. So yeah, we've got kind of just the the demonstration of that kind of stress as a as a kind of relational concept. So that's where the transactional model is a transaction between an individual and their environment. And so I guess where just a bit of background where this model came from was that? In a in a one of the earlier studies. From Lazarus, so work was published in around the 90s. Lazarus conducted a study where he was interested in exploring the effect of cognitive appraisal on the stress on stress responses. So he had a larger group of participants and divided them into three kind of sub groups. So each subgroup watched the same video footage, and it was it was of quite a distressing kind of scene. But each grip was given a different briefing on a different kind of narrative overlaid. Over the the kind of video footage. So in the first group. Let me just put the first group had we're showing the the video footage, but the narrator was kind of just describing in a more intellectual level what's happening. Was relatively neutral. There was no kind of emotive language and it was all just very factual. In the second group, they were showing the same video footage, but the narrator was essentially saying this is all made-up. This is all fictional and so on. And in the third group, they watch the same video footage, but the narrator was quite emotive and saying, you know, this is something that happened in real life and it was very distressing. So there was a lot of emotive language and what they found was that, you know, despite each grip being shown the same video footage, the grip that where the narrator was kind of really highlighting the emotions of it and the kind of distressing nature they had, a greater and physiological and psychological stress response. The group where the narrator was essentially saying this saw made-up, had the lowest amount and then the group where. It's kind of very factual and and it was quite neutral, had you know, somewhere in between. I'm really what this showed. Lazarus was that depending on how the participants appraised the video footage, which was influenced by what the narrator was saying, it impacted their stress response. So it got Lazarus thinking, you know, there's something around, you know, how we're primed to interpret something that really matters in terms of our stress response. So this kind of then led to the development of the transactional model of stress and coping. And you'll see if you Google this model, you'll see different versions of different, you know, kind of figures and. It's all about just picking the nicest, the one that's more nicely coloured and you know a bit more clear, but here you'll kind of see the breakdown between you know, we've got the the initial kind of stressor in our environment and then you've got the perception philtre and you know in the first video I talk about like the hypothalamus, which really interpicks in all of that kind of perceptual information, whether it's through what we smell or what we hear or what we see. And but the first stage of appraisal is the primary appraisal, and this is really the interpretation of a stressor. And this happens so automatically, you know, it's all of these kind of theories are broken down, like we're all robots, but it happened so automatically. But so this is kind of the initial interpretation, you know, is whatever's happening to me. Is this something that, you know is is a threat to? Is this a threat to me? Is it kind of something that's positive or is it irrelevant? So. If a person perceives it as threatening. And it then moves. I guess the second tier is is the secondary appraisal and again this all happens so automatically, but just to break it down so. If the whatever's happening in the environment is appraised, the stressful and the person interprets it as dangerous. So is it a challenge? Is it a threat you know, is this going to cause harm to me? Or so on, and sometimes that can come through initially just that kind of initial emotional reaction. So before you even consciously kind of interpret something or reflect on something, it could cause that, you know. Adrenaline rush or, you know, feelings of like butterflies in your stomach or whatever it might be. But the second secondary tier of appraisal is tends to be whenever an individual thinks you know. Is this something I can deal with? And do I have the internal or external resources to deal with this? And and so this can be a big indicator in terms of you know what, what the actual stress response is. You know if you interpret something as stressful as threatening. But you feel like you have the resources to deal with it, so you you might get that initial stress response, but then are you able to be like, you know what? There's something I can do, whether it's talking to someone seeking help, whatever. And but if you appraise, something is stressful and you don't know how to deal with it, you just, you know, you're kind of at a loss as to. You know, I've never dealt with something like this before. I don't know who to talk to or, you know, whatever it is or I can't get out of this situation. Then the impact is is going to look like that kind of. Prolonged stress response that I have talked about. Umm. And then depending on how that how long that continues, yeah. The yeah. So I mean, it's difficult to know exactly. Again, it could be something that instinctually or more kind of subconsciously that you you're aware of. You know, if especially if it's through a smell, you know, a burning smell or something like that. Kind of come in tandem or in parallel so, but it would certainly be. It could come before any conscious appraisals, you know. Yeah, yeah, yeah, absolutely. So I think it could come before or after. It's a bit like, you know, whenever you have an emotional reaction to something and you're not even thinking about it. But it's almost just like. It's it's kind of imprinted on your your, your, your brain and on your memory system. So I think it could. It could definitely come before or or after. You know, it's a bit like you're, you know, if you kind of the more you think about something, the more you kind of start to worry about it, where that conscious appraisals happen first. But it could be more. Yeah. Instinctual. Yeah. Yeah. So. So yeah, so this this idea of kind of the secondary appraisal where you know an individual's kind of. Reflecting on the resources they have, the person has to to deal with the stressor that moves us on to thinking about coping and and coping as a as a broad concept. To ultimately overcome stressor or to proactively cope, the stressor should do something to avoid a potential stressor. But there's also this kind of idea of reappraisal. So if you have been faced with something stressful in your environment, or you know whether it's like work related, deadline related, something that's happened to you person to you personally or your family. And and you've kind of appraised that as threatening and you've kind of tried to, you know, find ways to cope with it and so on. We do have this, we we do, we're we're less conscious about it or maybe if you're a bit more reflective and and kind of reflect on on how you kind of manage in day-to-day life a bit more, especially if you're going to therapy and things like that where you're just actively reflecting on how you're managing day-to-day life. But we all go through this kind of reappraisal or evaluation and to a certain degree. And this is really where we contemplate whether something is working for us. You know is is you know, if we've tried to engage in some way of coping. And, you know, tends to be that kind of period of evaluation of, you know, is this something that's it's working? And OK. So yeah, so so I guess just to break this down into four kind of key components, we've got the external or internal trigger or stressor and an internal stressor can be something like if you remember something or you know could be a memory and it the memory could be aligned with a kind of an actual event that happened. But the stressful trigger does come. It is intrinsic in that sense. So that's kind of the the just a distinction between the two then we've got the evaluation or the cognitive appraisal and then the coping processes and then. If we consider. The impact on your mind and body and then after that there could be that kind of further stage of evaluation about you know? This is how I've coped. Did this actually did this impact me negatively or positively? So that's kind of a little bit about that appraisal of stress and how our brain interprets something is stressful or not. Just to define coping in a bit more detail. So again this is from Lazarus and Folkman and they said that constantly changing cognitive coping it can be defined as constantly changing cognitive and behavioural efforts to manage specific external and or internal demands that are appraised as taxing. So. So again, it's kind of doing something to take action to address a stressor or it could be cognitive effort. So it could be kind of changing your perspective on things or engaging in kind of cognitive skill acquisition. You and learn a bit more about kind of how you interpret things as stressful. And whatever you're kind of and coping style is and that's what I'm going to go into now. Different types of coping so. Broadly, coping styles can be broken down into problem focused or emotion focused, so an example of problem focus coping could be. If you notice that you have a sore throat and you think. All right, this this is a problem, this is something I want to deal with and you. Go to the GP and ask the GP to to check you and I. Obviously we all know this is easier said than done because you can't get AGP appointment but anyway so so that's an example problem. Focus was doing something to directly address the stressor and emotion focused is the efforts that we are the efforts or actions that we take to deal with the emotional impact of a stressor. So it's a little bit more indirect. And so where a kind of handling of stressful situation is more controllable, there's something tangible or something that you can do about it. Problem focused coping tends to be really useful, so you know it could be problem, problem solving, making certain decisions, taking certain actions and again that could be deciding to go to, to see the doctor seeking information so could be learning a bit more about what you're dealing with, yeah. Yeah. So so your, yeah, the the anxiety you can anxiety could be experienced because of the indecision and the uncertainty about. Yeah. Yeah, yeah, absolutely. So. So actually. Yeah. And that's a really good point because sometimes our emotions can make it really difficult to take actionable steps towards dealing with the stressor. Absolutely. And you know what? This is actually something quite relevant to my own research in diabetes, where there's a concept called diabetes related to stress. And it's really distress. That's that's related to the the difficult management and the emotional burden of diabetes. And they actually conducted a piece of research where they found that people weren't attending diabetes education and then weren't managing their their diabetes and weren't taking the medication, eating the right food and so on. But whenever they interviewed the sample of individuals who weren't turning up to the education, they found really high levels of emotional distress. And people just were so anxious about about the reality of living with diabetes that they just didn't want to face. They were they were just maybe avoiding it for a bit because they were just like, do you know what? And that was their way of coping. You know, point in time and I think whenever we think about like ways of coping, you hear about, you know, oh, they're in denial, they're avoiding and it's so stigmatising because that's that's our, you know automatic response that I need to protect my emotional well-being right now and I'll let myself you know deal with this so it's a really good point sometimes the emotions that we experience kind of make it really difficult for us to to actively engage in that coping so before we take tangible steps to directly address an assessor we need to just get ourselves our nervous system. Down to regulation again, I always say to myself, I've actually talked to myself more often than I would should admit, but I always say to myself, like Emma, don't communicate until you regulate. So that's my kind of we real doesn't always happen, but try and engage in those kind of practises. But no, that's thank you for that point. That was really it was a really, really nice point. So yeah, so so there there's the. Yeah, the idea that yeah. There's what's controllable we can engage in certain. Problem focus coping but. Raising that point, that's really important to Umm, manage our our emotional well-being and our nervous systems and so on BEF. But sometimes before we engage in that, but sometimes also if a stressor is uncontrollable, there's not, there's nothing really we can do about it and and you know it is around acceptance and and so on. Emotion, focused coping and managing how we make sense of what's happening in our the reality of it and and again it's it's it's the focus on finding other ways to to bring our bodies back to regulation and. To deal with the the negative emotions and so things like venting or talking to others, reframing the situation. Journaling. I've got really into journaling. I don't know if is is anyone else into into journaling and yeah, love that love that for all journaling is great. Although sometimes I just get really work. You know, I'll get kind of lost in it and so yeah journaling is another benefit. We've got also exercise and relax and relaxation. And meditation, other spiritual practises and pleasurable activities. Do you know what having fun as well? I think as adults we kind of forget that we, you know, can have fun and we should have fun. Fun is really important for our self-care. It's just really hard to kind of make time for it and yeah. Why is it secondary. Yeah. Yeah, yeah, I that's a really good point. Actually, it's not. I think it shouldn't be necessary 'cause even ev