Stress Notes PDF

The physiology of stress Stress – An emotional response to situations of physical or psychological threat Acute and chronic stress Acute stress is short lived and can be beneficial. It has been developed through evolution and adaptive behaviour as part of the fight or flight mechanism. Chronic stre...

The physiology of stress Stress – An emotional response to situations of physical or psychological threat Acute and chronic stress Acute stress is short lived and can be beneficial. It has been developed through evolution and adaptive behaviour as part of the fight or flight mechanism. Chronic stress is long-term and is the result of problems that have not been resolved. This stress is a modern problem, and therefore we have not evolved to deal with these stressors. This makes our reaction to the stress maladaptive. Chronic stress is maladaptive as the stressors we face in modern life have changed, but the way our body reacts has not, meaning the fight or flight response that was appropriate for short term threats now lasts weeks, months, or longer until the chronic stressor is resolved. The fight or flight response is an extreme bodily state, and prolonged exposure to this state is harmful. Acute stress activates the sympathomedullary pathway (SAM), whereas chronic stress activates the hypothalamic-pituitary-adrenal system (HPA). This activation is decided by the hypothalamus. SAM pathway Hypothalamus activates the sympathetic branch of the ANS The adrenal medulla secretes adrenaline and noradrenaline into the blood stream This results in the physical symptoms of the fight or flight response After a few minutes, the parasympathetic branch of the ANS reactivates and reduces the fight or flight response, bringing the body back to normal HPA pathway Hypothalamus stimulates the release of the hormone CRF – corticotropin releasing factor The pituitary gland detects CRF and releases ACTH – adrenocorticotrophic hormone ACTH travels to the adrenal cortex and causes the release of corticosteroids such as cortisol Cortisol enables a steady stream of blood sugar, meaning increased energy High levels of cortisol trigger a reduction in CRF and ACTH release GAS – general adaptation syndrome GAS consists of three stages: Alarm reaction, resistance, and exhaustion. Alarm o Immediate response to stressor  o SAM Resistance o Attempt to adapt to stressor o HPA o Hormonal changes, conservation of resources, suppression of immune system, effected activity levels are all to adapt to the stressor o Not a necessarily harmful reaction Exhaustion o Total depletion of coping resources caused by severe long-term stress o Changes in metabolic function, decline in immune functioning, increased susceptibility to infection, non-functioning adrenal glands, and drops in blood glucose can be caused by this long-term coping o Can lead to illnesses such as hypertension, CHD, asthma, and peptic ulcers AO3 Gender bias – beta bias o Male bias in research on stress o Taylor suggested women with child caring duties 'tend and befriend' rather than fight or flight o Explanation of stress may only apply to males due to gender differences not being accounted for Physiological explanations are reductionist o Ignores psychological factors that may affect stress responses such as individual differences in personality and cognitive appraisal o e.g. Personality – optimism v pessimism, laid back nature, previous experiences o e.g. Cognitive appraisal – primary appraisal (is it a threat?) and secondary appraisal (can I cope? and have I got the resources to deal with it?) o Biological approach only focuses on physiological, but stress is affected by psychological factors Fight or flight response has negative consequences o While stressors present, FoF reaction stays turned on, moving from SAM to HPA o Long term activation moves through stages of GAS o Once stage 3 met, disruption of bodily processes and causing long term damage o FoF is a maladaptive response triggered by non-life-threatening situations GAS system research based on animals o Ethical issues from researching on rats from deliberate infliction of pain and stress o Generalisation issues due to higher level of thinking in humans, much of human stress is mediated by psychological factors, rather than life threatening situations The role of stress in illness The Immune System The immune system is a system of structures and mechanisms that allow the body to fight and resist infections from bacteria and viruses. It also helps to prevent the formation and growth of tumours. Structure Natural immunity – primitive system made up of white blood cells called leukocytes Attach viruses and bacteria quickly Also called natural killer (NK) cells Specific immunity – specific white blood cells called lymphocytes Recognises specific viruses or bacteria  Produce tailored antibodies to attack Takes longer but is more effective Lymphocytes are split into two types T Cells – Attack intracellular (within cells) pathogens like viruses B Cells – Attack extracellular (outside cells) pathogens such as bacteria or parasites Immunosuppression – weakening and suppression of the immune system Stress can affect the immune system by diverting energy away from it to deal with the stressor. Stress hormones also affect the immune process. Maladaptive coping behaviours with stress also impact the immune system negatively. All three factors play a part in immunosuppression. Immunosuppression from stress is due to high levels or cortisol, which inhibit the production of lymphocytes. This happens when the HPA system is activated due to chronic stress. This make a person more likely to become ill as the bacteria and viruses are not attacked. This is a maladaptive response to stress. Research support Kiecolt-Glaser et al Procedure and findings o Students had blood tests one month before exams and on day of exams o Fewer NK cells on day of exams o Loneliness, lots of life events, and depression associated with weak immune response Natural experiment o High ecological validity – real life stressors o Lack of validity – extraneous variables such as pre-existing stressors Individual differences o Fear of blood tests o Different stress levels for exams Scientific? o Objective blood tests o Subjective questionnaire and possible societal influences Research opposition Dharbhar Procedure and findings o Subjected rats to mild stressors o Stimulated immune system response as lymphocytes flooded their bloodstream Suggests relationship between stress and immune system more complex RLA o Patients given low doses of stress hormones before surgery to promote fast recovery after Animal study – generalisation, ethics Cardiovascular When the SNS is activated, adrenaline is released to prepare the body for fight or flight. High levels of adrenaline cause increased heart rate and constriction of blood vessels. Increased heart rate causes the heart to work harder Constriction of blood vessels raises blood pressure, which causes tension and wears away at the vessels Increased blood pressure can dislodge plaque in vessels and cause blocked arteries, causing heart attacks Increased stress levels may lead to unhealthy coping mechanisms, such as drinking, which can lead to cardiovascular disorders Heart disease risk factors Fixed factors Variable factors Genetics High LDL cholesterol Ethnicity Hypertension Sex Inactivity Age Obesity Diabetes High c-reactive protein AO3 There is research to support the link between acute stress and cardiovascular disorders. This can be seen in a study that found heart attacks more than doubled in frequency during German football matches. This suggests that emotional stress related to watching and supporting sports can lead to increased risk of CVD. However, this may not be generalisable to the wider population, as there are individual differences in people's reaction to sports. Additionally, this may be only a correlation, rather than the sports causing heart attacks. Despite these issues, the link between stress and CVD is strengthened by the findings from this study. There is also research to support the link between chronic stress and CVD. This can be seen in the InterHeart study, which found that workplace stress and stressful life events were strongly linked to heart attack frequency. This suggests that the more stressful your general life is, the more at risk you are of having a heart attack. Additionally, this meta-analysis found that stress also exacerbates existing problems, such as obesity, smoking and high cholesterol, which can then have knock on effects on the cardiovascular system. One weakness of the link between stress and CHD, is that it is hard to distinguish between issues caused directly by stress, and indirect factors impacted by stress. There is research support Rozanski who found that some people were hyperresponsive to stress and that their blood pressure and heart rate increased more than others in response to stress. These factors led to greater damage in the cardiovascular system. In addition to this, unhealthy coping mechanisms for stress such as diet, smoking and lack of exercise can impact CHD, which is not directly affected by stress, but indirectly. This shows that stress may increase risk of CVD, but it is often a correlation and is impacted by individual differences in response to stress. Life changes as a source stress Significant change in life --> Need to adjust to new life --> Stress --> Illness circumstances circumstances Life changes are major events that require significant psychological adjustment and cumulatively add to stress levels. These can be positive as well as negative and can occur predictably - such as holidays and moving house, or unpredictably - such as death of family member of financial difficulties. Holmes & Rahe (1967) Two doctors conducted a questionnaire of patients and reviewed medical records 5000 patients Found 43 major life events that were frequent Got 394 separate people to rate the life events by how much readjustment each event would lead to Averaged the scores and divided by 10 These events were called the SRRS scale (SRRS) and were measured in LCUs (life change unit) AO3 + Large sample size of patients contributing to events + Large sample size of participants to rate events - Subjective scale, meaning what may affect one person greatly, may not affect another person as much - Stressful events in person's life may not fit the criteria of an event, but may be just as stressful - Correlation - Temporal validity as 1967 would have different stressful events than present day Rahe et al (1970) 2700 navy personnel on 3 American cruisers Retrospective SRRS just before set sail on past 2 years During 6-8 months duty, all illnesses recorded Independent researcher reviewed medical records and calculated illness score for each participant No-one was aware of what the data was being used for Correlation of +0.118 between SRRS score and illness score Men who scored low on SRRS had low levels of illness Suggests stressful life events increase the likelihood of illness One limitation of the link between life changes and stress is the presence of individual differences. Byrne and Whyte found that they were only able to predict heart attacks based on the SRRS score if subjective interpretations of live changes were taken into account. This suggests that the levels of stress related illness are linked more to perception of stressful events, rather than the events themselves. Therefore, the life changes approach lacks validity as it does not consider individual differences in prediction of stress. Another limitation is that the SRRS groups positive and negative life changes together. This makes the assumption that all changes are stressful, however Turner and Wheaton found that undesirable life changes caused the most stress, and positive life changes may be less stressful or not stressful compared to negative changes. This challenges the validity of the approach as it wrongly assumes that all life changes have the same effect on stress. Daily hassles as a source of stress Daily hassles - Routine nuisances of day-to-day living that, when repeated over time, can impair health and wellbeing Lazarus suggested that we actively appraise stressors before acting, called cognitive appraisal. This is an unconscious process that allows the brain to determine the best path of action. Primary appraisal is where the brain determines if the stressor is a threat, and secondary appraisal is where the brain determines whether it has the resources to cope with the threat. If many daily hassles build up, the secondary appraisal tells us that we cannot cope and we succumb to stress, called the accumulation effect. Lazarus then devised the Daily Hassles and Uplifts Scale, a questionnaire that measures hassles and uplifts at the end of the day. These scores are used as an indicator of stress levels. De Longis used the hassles and uplifts scale, as well as a life events and health questionnaire, and asked 100 participants to complete them. She found that hassles correlated with ill-health, but uplifts and life events did not. Other studies agree that daily hassles are a bigger threat to health than big life events. Kanner conducted a similar study, where 100 participants completed a hassles questionnaire every month for 10 months, and life events measure at the beginning and end of the study. The participants also completed the Hopkins Symptom Checklist which measures anxiety. Kanner found that hassles were a stronger prediction of symptoms than life changes, suggesting that daily hassles are a more significant stressor than life changes. The amplification hypothesis suggests that daily hassles may contribute to ill-health when we are already experiencing significant life changes. This means that life changes may be stressful, but having daily hassles on top of it is what can cause ill-health and stress. AO3 Individual differences Strength Takes into account the level at which each item is a hassle of an uplift This can vary from person to person based on their natural approach to dealing with stress and their current ability to cope This means this scale can predict illness and stress based on our personal appraisal of stressors Correlational data Limitation Most research on daily hassles produces correlational data rather than valid causational data There are so many extraneous variables that impact daily levels of stress that these cannot be controlled or accounted for This means that the scale lacks validity as it is based on purely correlational data Research support Strength Ivancevich found that daily hassles were strong predictors of poor health, poor job performance, and absenteeism This suggests that daily hassles are a valid explanation of stress for many people However, many studies are retrospective, requiring participants to recall hassles over the past month This has an impact on the validity of results as hassles are minor events that are hard to recall Workplace stress Workplace stress – Stress caused by high demands, or perception of high demand, in a workplace and an inability to cope with demands due to external and internal factors, such as social support and control over work processes Demands-control model (Robert Karasek) Demands such as workload can lead to stress and ill health Control an employee has over their job can mediate this stress Likelihood to suffer from stress related illness with high demands can be minimized by having high control Marmot et al Researchers believed that control was negatively correlated with stress related illness Procedure o 10000 civil servants were investigated over 3 years o Level of job control assessed by self-report questionnaires and manager assessments o Levels of stress related illness measured o Job control levels compared with illness o EVs such as diet, smoking and social support were taken into account Findings o Workers with less control were 4 times more likely to die of heart attack o Workers with less control were more likely to suffer from stress related illness o Workers with more demanding jobs also suffered higher stress levels Conclusion – High demand and low control leads to stress and illness Strengths Very large sample size – more certainty and validity Sample of civil servants in London – very high demanding jobs Longitudinal – see long term effects of stress Control of EVs Multiple forms of data input – self-report and manager assessments Significant results – validity in proving hypothesis Weaknesses Self-report leading to possible social desirability responses Correlational data Further research showed that higher demand rather than control was not a contributory factor to stress, meaning there is contradictory evidence Johansson et al Procedure o Small sample of sawmill workers had their stress hormones and patterns of illness measured o These workers had high responsibility, low control, and their work impacted pay of other employees Findings o Higher levels of absenteeism due to illness that peers o Higher levels of adrenaline in their urine on work days Conclusion – High demand and low control leads to high stress hormones and high absenteeism from illness Strengths  Real life application to better working conditions Weaknesses Small sample lacks validity and generalisability Beta bias due to all male sample Assumptions of psychological stress, only biological data Natural experiment – low control of EVs Both Marmot and Johansson find high demand and low control lead to stress and illness. However, the sample sizes and demographic are very different. Johansson focuses on acute stress, whereas Marmot focuses on chronic stress. Consequences of workplace stress Real life applications through change in workplaces Isolation Noise reduction Conflict with colleagues Advice systems Poor home life balance Rotation of shifts/set shifts Disrupted bodily rhythms Inclusion of clubs or exercise into Depression companies CHD – cardiovascular heart Clear job roles disorder Measuring stress Psychological measures of stress SRRS Hassles and Uplift scale Physiological measures of stress Skin conductance Blood pressure Cortisol/adrenalin levels Name What and how Phys/Psych Development SRRS Significant life changes measured by a self- Psychological Holmes and Rahe (1967) report questionnaire that offers a correlation investigated 5000 patient between life changes and illness due to stress hospital records and identified 43 significant life changes. 349 participants then scored these changes by how much readjustment would be needed Hassles and Hassles and uplifts that occur throughout the Psychological Kanner (1981) compiled 117 Uplifts day are recorded by how much they affected hassles and 135 uplifts to rank that person, and this score correlated to on a 3-point scale illness from stress Skin When the body is stressed and the SAM Physiological N/A conductance system is activated, the amount of sweat increases. A sweat conducts electricity, the level of conductivity can correlate with stress levels. Electrodes are attached to the fingers of one hand, and conductance is measured. Tonic conductance is baseline, when the  person is not stressed. Phasic conductance is measured when a stimulus is presented in order to increase stress Blood Blood pressure and heart rate are measured Physiological Kamarck (1990) investigated the pressure during stressful and non-stressful bodily role of social support on stress states by measuring blood pressure and heart rate Hormones Cortisol and adrenaline levels measured in Physiological Gunnar (2010) assessed stress in saliva, blood or urine to measure bodily stress children by measuring salivary cortisol Name Strengths Weaknesses SRRS Adaptable to suit Results may reflect illness, rather than different participants predict it Credible due to ongoing use in studies Hassles and Uplifts Correlation is 0.6 for Very long questionnaire with over 250 uplifts items Adaptable to suit Lack of thoughtful focused attention over different participants long time Credible due to ongoing Correlation is only 0.48 for hassles use in studies Scores lack reliability Results may reflect illness, rather than predict it Skin conductance Objective measure Measures any physiological arousal, which Uses baseline can be any emotion measurement to control Cognitive perception of fairness can affect for individual difference physiological responses High validity May not be a valid measurement Other applications in lie detector or polygraph tests Avoids social desirability Blood pressure Avoids social desirability Measures any physiological arousal, which Objective measurements can be any emotion Increased internal validity Cognitive perception of fairness can affect physiological responses May not be a valid measurement Hormones Avoids social desirability Measures any physiological arousal, which Objective measurements can be any emotion Increased internal validity Cognitive perception of fairness can affect physiological responses May not be a valid measurement Personality type as differences in stress Personality Characteristics Link to stress and Research support type illness A Competitive Higher level of CHD Friedman and Rosenman found link Time urgency between type A and CHD in 39-59 year Hostility old men B Patient Relaxed Easy-going C Supresses emotion Higher level of cancer Morris found link between lack of Avoid conflict anger expression and breast cancer People pleasers D Obedient Higher level of Up to 53% of cardiac patients are Fear of rejection cardiovascular illness thought to be type D Doesn’t advocate and CHD Friedman and Rosenman AO3 Ignores type C and D Personality types formed in individualistic society and are beta biased Self-report RLA of behaviour modification programs for type A behaviour such as driving courses (is type A all bad?) Correlational data Psychological harm of labelling personality and prediction of CHD EVs controlled Individual differences in coping ignored Low reliability as future studies found low correlation rates Doesn’t determine which type A trait causes CHD Both Matthews and Carmelli found that hostility was strongly linked to CHD, which identifies the trait of type A that causes CHD AO3 Supporting evidence that Type A are more likely to suffer from stroke Contradictory evidence that Type B are more likely to experience a second heart attack, as Type A's change their behaviour after one heart attack Gender bias in all personality types, A and B based solely on males, C based on females Personality types are indirectly affecting CHD through other factors, rather than directly from traits Inconsistent results challenge the concept of Type C Hardiness as differences in stress Hardiness – A range of personality characteristics such as control, commitment, and challenge, which help prevent us feeling stressed Commitment – Sense of involvement in the world around you, engaging in stressful activities Control – Belief you have control over what happens to you, rather than external factors Challenge – Viewing problems as a challenge to overcome, rather than a threat Kobasa proposed that people who score highly on scales measuring hardiness (3Cs) are less likely to suffer from stress related illness, than those with low hardiness scores. This suggests that a positive approach to life events as challenges and opportunities to be overcome leads to less activation of the stress response and therefore less negative consequences of stress. Kobasa Aim – Identify personality factors that affect individual responses to stress Procedure o 670 managers aged 40-49 from the US o Completed a personality questionnaire o Listed illness and stressful events over the past 3 years o Participants grouped by illness score, above average and below average Findings o Both groups had high scores for stressful events, regardless of illness levels o However, those in the low illness group were more likely to feel in control, have more commitment and purpose, and embrace change o These participants were defined by Kobasa as having a hardy personality Conclusion – People with hardy personalities are better able to cope with stress and less likely to suffer from stress related illness AO3 Validity issues from retrospective data collection, along with issues from self-report of social desirability RLA in training soldiers for the army, those with higher hardiness are more able to cope in high stress situations Lifestyle choices may have indirect effects on hardiness, such as diet and blood pressure Assumes all Cs are equally as important and effect hardiness and stress response equally Supporting evidence where Bartone found that soldiers in the Gulf War were less likely to experience negative health from war if they presented with more characteristics of hardiness Issues with validity as ignores individual cognitive differences, as characteristics like dwelling on failure make people more likely to report distress, leading to potentially skewed results. High reliability from supporting research Maddi studied 400 telephone company employees and found 2/3 employees suffered stress related illnesses, whereas the remaining 1/3 showed more evidence of hardiness attributes Lifton et al studied students in universities and found that student with low hardiness were disproportionately represented in drop out numbers, and students with high hardiness were more likely to complete their degree Drug therapy as coping with stress Benzodiazepines are the most widely prescribed drug for treating clinical disorders. The most common are Librium and Valium. They slow down the activity of the CNS, and are very effective anti-anxiety drugs. They are often the starting point to treat stress related conditions. Gamma-aminobutyric acid (GABA) is a neurotransmitter that inhibits the activity of neurons by making it less likely the postsynaptic neuron will fire. Benzodiazepines bind with the GABA receptors, and enhance the efficacy of GABA neurotransmitters. This makes the neurons more responsive to GABA and less responsive to other neurotransmitters, inhibiting the neural activity. Beta-blockers (beta-adrenoceptor blocking agents) block sites which are normally activated by adrenaline and noradrenaline. It reduces the over-activity of the sympathetic ANS. This reduces heart rate and blood pressure by blocking the sympathomedullary pathway of stress. Common beta-blockers are propranolol and alprenolol. They work within the body where adrenaline and noradrenaline bind, rather than within the brain. Side effects Benzodiazepines Beta-blockers Increased aggression No severe side effects Depression Overly reduced heart rate Respiration problems Overly reduced blood Drowsiness pressure Memory loss Cognitive deficits Dependency Withdrawal symptoms such as sleeping issues, sweating and tremors Research support – BZ Baldwin conducted a meta-analysis of double-blind placebo controlled studies and found BZs had a significant effect in managing and coping with stress Kahn et al found BZs were significantly superior to placebo in 250 patients over 8 weeks Research support – BB Kelly reviewed studies and found that BBs were effective in dealing with anxiety, especially around public speaking and exams They were found to be even more effective in combination with other drugs like BZs Drug therapy AO3 Strengths Weaknesses Convenient, quick, and easy treatments Dependency, especially benzodiazepines, and that do not require motivation or effort therefore withdrawal symptoms Cheap and less time consuming than Severe side effects most therapy sessions Increased tolerance over period of time, meaning RLA of beta-blockers in reducing blood they become less effective pressure and heart rate rapidly for life- They target the symptoms, rather than the cause threatening hypertension of the problem, therefore once treatment stops, symptoms will reappear Stress inoculation therapy as coping with stress Stress inoculation therapy (SIT) is a form of CBT that aims to increase an individual's number of coping skills, and enable them to use pre-existing coping skills. It was developed specifically to deal with stress, and differs from other treatments by developing forms of coping before any stressful problems arise. It suggests that people should 'inoculate' themselves against stress in the same way they would an infectious disease, by acquiring skills through smaller, imaginative stressors. Although a person cannot normally change stressors, they can change the way the perceive and think about these stressors. This therapy usually consists of 9-12 sessions, once a week. Steps: 1. Conceptualisation Identify stressors, usual responses and success of responses Educate about stress, and shift view of stress to a problem to be solved Changeable and non-changeable aspects of stressors discussed Focus on avoiding stressors when possible, and accepting inevitable stressors 2. Skill acquisition and rehearsal Coping skills to deal with stressors that are tailored to the client taught and rehearsed  e.g. relaxation, positive thinking, social support systems, and time management Confidence in using skill increased Use of coping self-statements and positive thinking to encourage a replacement for cognitive distortions and a change in behaviour 3. Real life application and follow through Applying coping strategies to different stressful situations by using imagination, modelling, role play, and other forms of rehearsal Creation of practical action plans for common situations Application in real life experiments and acceptance of failure or reversal of cognitive thinking with support from therapist Aim is to shift client's locus of control Research support Saunders meta-analysis of 37 studies found that SIT was effective for reducing anxiety in performance situations and enhancing performance under stress, as well as being effective for both mild cases and extreme cases of stress Meichenbaum compared SIT with systematic desensitisation as treatment of phobia of snakes, and found that although both treatments helped, SIT was more effective in helping patients deal with other phobias Fontana et al found that college students who had undergone SIT had lower heart rates and anxiety levels both at the time, and 6 months later Jay and Elliot studied the parent of children undergoing medical procedures, the group that had undergone SIT therapy reported less anxiety than the group that had undergone a cognitive therapy programme These pieces of research support the reliability of SIT in managing stress in different situations, the concept that SIT inoculates against future stressors due to its flexibility, and the positive combination of cognitive and behavioural therapy Strengths Weaknesses - No side effects - Demanding and requires client to be highly motivated - Can deal with most forms of stress - Involves many sessions, self-reflection, and learning - Effective for acute and chronic stress new skills - Provides sense of control - Expensive - Individually tailored - Some people are less able to use coping self- - Suits a wide range of people and situations statements - Combines cognitive and behavioural therapy - Therefore, may not be effective for everyone - Therefore, helps combat both cognitive and - May be overcomplicated due to need to change and behavioural aspects of stress responses learn lots of strategies for many scenarios - Used with large business and corporations with - May be more effective to have positive outlook and employees in stressful jobs relax more - Can be used to help those stressed after terrorist - Ineffective with PTSD as focuses on future stress, attacks in a communal based setting rather than past - Highly flexible so can be used with a variety of clients and stressors - Focuses on inoculation against future stressors Biofeedback as coping with stress Biofeedback is a treatment of stress that targets the body's physiological response to stress. When the stress response is activated, bodily effects such as increased heart rate and blood pressure occur. These behaviours are not under our control, however behaviours such as muscle tension and breathing rate are under our control. Biofeedback is a method where the client learns to take control over these behaviours, and therefore can better cope with stress. Controlling these behaviours can also help to negate physical side effects from stress, such as headaches, muscle pain, and exhaustion. Steps: 1. Awareness The client is attached to biofeedback machines, and made aware of how their body reacts to stressful situations 2. Learning techniques The client is taught how to control these responses, by relaxing muscles, breathing slower and deeper, and other relaxation techniques During this the client is still attached to the machine, and has a visual representation of how the relaxation techniques affect their body 3. Transfer The client then practices these techniques and applies them to everyday life, including in actually stressful situations Study Aim Procedure Findings Budinsky Use biofeedback to Groups recorded headaches prior Group A reported headaches had reduce tension to biofeedback. Group A were reduced significantly headaches taught using biofeedback. Group B Group B did not have reduction were taught by watching a video of in headaches a biofeedback session. Group C was not given biofeedback. Davis Use biofeedback for After 8 months of sessions, patients with breast urinary cortisol and self-reported cancer anxiety lowered significantly Lemaire et Use biofeedback for The mean score for stress levels al medical doctors were reduced significantly, but objective biological measures were not reduced Greenhalgh Review of biofeedback Biofeedback did not perform studies on better or worse than drugs, CBT, hypertension self-monitoring or placebo Bussone et Use After 6 months both groups saw al relaxation/biofeedback significant reduction in and relaxation in headaches children with tension After 1 and 3 years, biofeedback headaches group had greater reduction in headaches Strengths - Effective in treating behaviour - Long term coping strategy - No side effects - Equipment has become more accessible - Significant benefits - Effective in treating heart rate problems and migraines Weaknesses - Client needs to understand the relationship between physiological symptoms and visual or auditory signals on machine - Must be motivated to apply skills after - Requires specialist equipment - More successful in children than adults Gender differences as coping with stress Physiological difference Research on the fight or flight process was conducted on only males Taylor et al suggested that the female response to stress is to 'tend and befriend' This involves nurturing offspring and creating social connections that can help protect offspring This draws on the attachment-caregiving system as it would have evolutionary benefits Oxytocin lowers cortisol levels in females, whereas the effect of oxytocin is limited by male sex hormones Psychological difference Lazarus and Folman suggested that there are two types of coping responses, emotion-focused and problem- focused. These types of coping responses are often associated with men or women. Emotion-focused coping Problem-focused coping Trying to reduce the negative emotional Trying to reduce the cause of stress responses Can include problem solving or time Can include distraction or avoidance management Realistic option when stressor is out of our Possibly unrealistic when stressor is out control of our control Drug therapy is an example as focuses on Tends to be used by men symptoms, not cause Tends to be used by women Peterson et al conducted a study on men and women seeking fertility treatment, where they completed several questionnaires, including the ways of coping questionnaire designed by Lazarus and Folkman. They found clear differences by gender, where women used confrontive coping (emotion-focused) and were more likely to seek social support, men were more engaged in problem solving (problem-focused). However, there were some emotion-focused coping techniques in men, showing that gender differences are not clear cut. Gender differences may be explained by the role constraint theory, which suggests that men and women face different stressors and therefore need different ways of coping. Matud's survey found men face more work stress and women face more family stress, and therefore men use problem-focused coping and women use emotion-focused coping. This means that coping strategies may be caused by situational factors rather than biological differences. One issue with gender differences in coping with stress is that it may be too simplistic, as it separates coping techniques into two clear types. However, when coping with a stressful situation, both men and women may use a combination of emotion-focused and problem-focused strategies. This highlights the fact that the strategies used to cope with stress are more complicated that initially thought, and that gender differences may be less important that situational differences. There is growing evidence for the existence of the tend and befriend process. Tamre conducted a meta-analysis of 26 studies and found that women use social support more than men, and Feldman found that women with higher oxytocin levels after birth formed stronger bonds with their babies. This suggests that women attempt to create and maintain friendships and support to cope with stress, and that when the SAM pathway is activated, they tend to their offspring to ensure their child's safety. Additionally, the physiological and psychological explanations for gender differences in coping with stress have the following issues: Reductionist Deterministic Culturally relative Alpha bias The role of social support as coping with stress Social support – the assistance you get from other people when encountering a stressful situation Type Explanation Examples Instrumental Tangible, practical and concrete help Taking on responsibilities support Helping manage the problem e.g. bringing food for sick people, helping find solutions to problem Emotional Empathy, not practical help Listening and empathizing support Physical comfort e.g. hugs, spending time with them Esteem Reinforcing a person's self-efficacy and Showing confidence or encouragement e.g. life support ability to cope coaches supporting clients to believe in themself Cohen et al Aim – to determine whether hugs could protect against stress-related infections Procedure Healthy adults completed a questionnaire to assess perceived social support and reported the number of hugs they received each day Their stress levels were measured by the frequency of interpersonal conflicts per day They were then placed into quarantine and exposed to the common cold virus Their signs of illness were measured Findings The participants who experienced the most interpersonal conflict were more likely to become ill The participant who perceived greater social support had a significantly reduced risk of illness Participants who had the most frequent hugs were less likely to become ill, and had less severe symptoms if they did This study suggests that perceived social support can act as a protection against stress, and therefore against stress-related illness Fawzy et al also conducted research based on social support. They allocated cancer patient to a support group, or to a control group who did not attend. After 6 years, those who attended the support group – meaning they had more social support – had better natural killer cell functioning than the control group. This suggests that social support can reduce the effects of stress on the immune system, therefore leading to possibly better outcomes in cancer or viral infections, as NK cells can fight tumours and virally infected cells. One limitation of social support in coping with stress is that it benefits men and women differently. Luckow et al reviewed studies about gender differences in social support, and found that women used emotional support to cope with stress much more than men, whereas men used instrumental support more. This suggests that men may only benefit from social support in certain situations and with certain types of support. Another limitation of social support is that it can have negative effects based on who gives it and what type of support they give. In certain circumstances, instrumental support may be unwelcome from anyone but professionals, or emotional support may create a more anxiety inducing situation, such as a relative insisting on going to a hospital appointment with you. This suggests that social support is not universally beneficial, and that the support being there when needed is the stress alleviating factor, rather than the support itself.