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257 Cards in this Set
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What is Stress (1) |
Stress is a concept - there is not 1 set definition Stress is defined as how the body & mind react to demands. Stressors are causes of stress. |
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Good Stress vs. Bad stress - Yerkes-Dodson law (1908) |
(Normal curve) High stress = impaired performance |
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Fight/Flight Response |
Evolutionary stress response to fears/danger/stress Response varies in people |
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Major Stress Types |
1) Frustration: blocked goal 2) Conflict: Incompatible motivations Approach-Approach/ Approach-Avoidance/Avoidance-Avoidance 3)Change: Having to adapt 4) Pressure: Perform/conform |
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Stressors- Categories (4) |
Catastrophes Sig life changes Ambient (environmental) Daily hassles |
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Stress as a Stimulus |
If we think about stress as a stimulus, focus is on the events and on the external environment. Researchers taking this approach have studies a wide variety of stressors on individuals and groups e.g catastrophic events, major life event (positive & negative) |
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Life Events Theory: Holmes & Rahe 1967 |
Life events accumulate- the more life events you experience, the gretaer likelihood of physical health problems Produced the Social Readjustment Rating Scale (SRRS) Life change units LCU - highest rating 100 (death of spouse) Found that a score of +300 events in preceding YR predicted ill health in over 70% of cases. |
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Order life events |
Divorce Personal illness/injury Pregnancy Change in Residence Death of close family member |
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Limitations of life events measurement |
Some researchers have questioned the link between LCU's and ill health (physical and mental) - Dohrenwend & Dohrenwend 1982 Retrospective assesment Scale items- age Vague and ambiguous Assumes that all people rank in same way |
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Daily Hassles |
Troubling thoughts about future Not getting enough sleep Physical appearance Too many things to do Misplacing/losing things Concerns about meeting high standard Loneliness |
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Uplifts |
Completing a task Relating well with friends Having fun Being visited/phoned Laughing Entertainment Music |
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Hassles and Uplifts Scale DeLongis et al. 1982 |
Believed daily hassles were related to a higher level of stress than life events. Uplifts also taken into account. Investigated 100 adults aged 45-64 Negative correlation found between daily hassles and health status and much weaker correlation between uplifts and health status. Almost no correlation between life events and health status. |
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Stress as a Transaction/ appraisals Richard Lazarus |
Stressor -------------- Stress reaction Appraisal: Primary Appraisal 'what's happening now?' - is it relevant/benign/stressful. Secondary Appraisal: 1.Harm 2.Threat 3.Challenge |
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Appraisal Vs. Emotion |
Which comes first? Think of recent event that made you happy - were the thought's 'attached' to happiness? Did feelings about the event change over time, and if so did thoughts also change? |
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Overview of stress process: |
1) potentially stressful objective event (major exam/financial setback) 2) subjective cognitive appraisal- personalised perceptions of threat which are influenced by familiarity with event, its controllability, predictablty and so so on 3)Emotional response (anger/fear) Physiological response (neurochemical changes, arousal) Behavioural response (coping efforts) |
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Symptoms of stress |
Short temper Tension & migraine Loss of memory Moodiness Anger Weight gain Nervousness High cholestrol Paranoia Colds.flus, viruses,asthma Anxiety Overuse of drugs Muscle spasms . Chronic illness Boredness |
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Conclusion of lecture 1 |
Stress is a fluid concept Can be positive and negative Can be measured as a stimulus or as a transaction (appraisal) Measurement of stress is subjective- can be based on stress as a stimulus, as a cognitive appraisal or as a physiological response. |
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Stressor events (2) |
Fall into two categories: 1)Psychosocial (reside in the eye of the beholder) 2) Biogenic stressors (cause elicitation of the stress response, bypass cognitive appraisal) |
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Biogenic Stressors |
Amphetamine Caffeine Nicotine Extreme heat/cold Guarana Ginseng |
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Fight/Flight response Walter Bradfrord Cannon 1871-1945 |
Homeostasis Fight/flight response Toxic factor |
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Homeostasis Canon, 1929 |
The maintenance within acceptable ranges of several physiological variables e.g blood glucose, oxygen & core temp. Cannon proposed that changes in adrenal gland secretion were assoc with the fight/flight response. Sympathoadrenal (adrenal medulla and sympathetic nervous system) functioning preserves homeostasis. |
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Allostasis |
Levels of physiological activity required to reestablish or maintain homeostasis differ (e.g running, standing, lying down) Allostasis refers to levels of activity required to 'maintain stability through change'. During stress, short term changes in homeostasis settings generally enhance the long term wellbeing of organism (e.g exercise). |
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Allostatic Load McEwan & Stellar 1993 |
Allostatic load refers to prolonged continuous or intermittent activation of allostasis. Long term allostatic load = wear and tear cost of adaptation - provides a conceptual basis for studying long term health consequences of stress. |
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Stress as a Nonspecific response Hans Selye 1956 |
Every stress leaves an indelible scar and the organism pays for its survival after a stressful situation by becoming a little older. |
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The general Adaptation syndrome |
1) Alarm- perception of stressor. Slight drop in homeostasis as the mind & body temporarily lose balance. 2) Resistance- adaptation sources are mobilised to combat stressor. Endocrine system comes to play. 3) Exhaustion- adaptation energy stores are depleted. 4) Restoration of Homeostasis- Replenish and body will return to homeostatic state. Death- Stressor is too traumatic (injury/illness) or stressors cause wear & tear on the body over long term without management. |
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The brain |
Divided into 3 levels: 1) Vegetative level: Autonomic responses (breathing, heart rate etc.) 2) Limbic system: Emotional though processing. 3) The neocortical level: Human consciousness (rational thought processing). |
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The Limbic system (emotional brain) |
Hypothalamus:Linking the nervous system to the endocrine system via the pituitary gland. Amygdala: Processing of memory, decisions & emotional reactions. Thalamus: Relaying sensory & motor signals to the cerebral cortex- regulates consciousness, sleep & alertness. Hippocampus: Consolidation of ST & LT Memory |
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6 basic emotions |
Happiness Sadness Fear Anger Surprised Disgust |
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The neocortical level |
The neocortex is the highest level of the brain. This is split into 4 lobes: Frontal, Parietal, Occipital & Temporal. This higher level of the brain can override a lower level and can influence emotional responses. |
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Frontal lobes |
Are involved in : problem solving, memory, language, judgement & social behaviour. Reaches maturity at 25YRS age. May rely on amygdala (emotions, impulses, aggression & behaviour). |
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Physiology of the stress response |
The nervous system The endocrine system The immune system |
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The nervous system |
Split into 2 - Central NS & Peripheral NS: |
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Central NS |
Processes, interprets, stores info; issues orders to muscles, glands & organs..Through the brain and spinal cord. |
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Peripheral NS |
Transmits info to & from CNS. Split in 2: Somatic NS & Autonomic NS Somatic NS: Controls skeletal muscles.. Autonomic NS: Regulates glands, blood vessels & internal organs - Sympathetic NS: Mobilises body for action, energy output. - Parasympathetic NS: conserves energy, maitains quiet state. |
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Autonomic NS |
Sympathetic NS Arouses fight/flight (e.g raised heart beat) Parasympathetic NS Calms (rest & digest) |
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The Endocrine system |
Consists of a series of hormonal glands located throughout the body which regulate metabolic functions that require endurance rather than speed. The endocrine system is a network of components: glands, hormones, circulation & target organs. |
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Endocrine system - glands assoc with stress response: |
Somatotropic Pituitary Thyroid *Adrenal |
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Hypothamamic-Pituitary- Adrenocortical HPA System |
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Neuroendocrine System |
The bridge between the NS and endocrine system. (electrical, chemical and hormonal). Initiates the fight/flight response. |
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Sympathetic- Adrenomedullary System SAM system slide 1 page 9 & HPA System... |
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Distress |
Cognitive recognition of a condition that is aversive to organism. Motivation to escape/avoid the stressor Requires consciousness/ interpretation Selye (1974) characterised distress as unpleasant & harmful. Homeostasis responses do not necassarily cause distress , but distress can be part of a positive feedback loop. |
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Effects of glucocorticoid hormones & HPA activity |
Increased glucose production gastric irritation increased urea production release of fatty acids suppression of immune system appetite suppression assoc feelings of depression, hopelessness & control. |
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Health consequences of chronic stress page 10 |
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Stress and immune system |
psychoneuroimmunology (PNI) - study of relationships between psychosocial processes & nervous, endocrine & immune systems. Nervous, endocrine & immune systems operate in feedback loops within each system & interact/communicate in numerous complex ways. |
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Immune system |
1) presence of antigen (e.g fungus, bacteria, foreign cell, virus) 2) recognition of antigen (macrophages, t helper cells, cytokines) 3) immune system defence response (cytotoxix t cels, lymphocytes, NK cells) 4) antigen defeated 5) immune system 'remembers' (specific antibodies , B cells) |
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Stress & immune fuction |
Acute stressors aid the immune response, Chronic stressors impair the response. Like on other systems, chronic stress drains the resources of the immune system to respond. Chronic stress can impair ability of immune system to reproduce necessary cells & can interfere with cell effectiveness. Chronic stress impairs systems ability to repair damaged DNA. |
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Stress & Immune response Vaccination |
1 way to study the effects of stress on the immune system is by seeing the body's reaction to vaccination. In flu vacc's the immune system is challenged with small dose of the virus & responds by creating antibodies to prepare a more effective response to threatening exposures to the virus in future. Measuring the amount of antibodies in the bloodstream is a way of gauging performance of immune system.. |
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Burns et al 2003 study |
Examined the effects of life event stressors & perceived stress on immune response to a vaccine. 21 undergrads received vaccine. Completed measures on perceived stress & life events. Students were categorised as 'protected' if their immune system responded adequetely or unprotected if they had not. |
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PNI :from stressor to illness |
People differ as to pattern and freq of stressors to which we are exposed. Variations determine the magnitude & freq which we turn on the stress response. The magnitute & freq of the stress response regulate immune competence (e.g via glucocorticoids) Level of immune competence determines susceptibility to disease. |
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PNI studies |
Immunosuppression has been linked to divorce, bereavement, unemployment, exam, occupational stress & stressful bouts of exercise. (life stress & exposure to cold viruses) Wound studies (Kiecolt-Glaser) Animal studies show that tumor cells grow quicker in animals exposed to electric shock, loud noise or other stressors. |
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Stress, physiology & illness key point: |
If you repeatedly turn on the stress response or you cannot appropiately turn off the stress response at end of stressful event - the stress response eventually becomes as damaging as some stressors themselves. Large % of stress related diseases are disorders of excessive stress response. |
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Stress & Illness (3) The direct route |
Stress & physiological changes Chronic effect over time |
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The indirect route |
Behavioural responses Personality traits Worried well |
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Immune response |
Phagocytes (Macrophages): large white blood cells that surround & engulf invading substances while summoning helper T cells. Helper T: Identify invader & stimulate the multiplication of killer t cells. Killer T: puncture invaders cell walls & kill them. B cells: produce antibodies and tag and help kill invaders. Suppressor T cells- call off the attack when the invaders are being defeated. Memory T & Bs: left in bloodstream to identify the foreign invaders quickly if they return. |
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Influence of stressors |
Stressors negatively influence several components of the immune system as well as: the no of immune cells in circulation the cytotoxicity (killing potential) of T and nk cells multiplication of immune cells upon being challenged immune responses to bacteria & viruses susceptibility to experimentally administered cold viruses time taken for wound to heal |
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Acute v Chronic challenges |
Some stressors of moderate intensity may enhance immunity, wheras chronic stressors are more likely to be immunosuppressive (Dhabhar, 2009). Clear threats to organisms wellbeing should encourage enhanced immunity in order to maintain that organisms wellbeing (from adaptive perspective) However, as stressors continue, availability of biological resources decline. |
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Why is immunity suppressed during stress? |
In 1st few mins, approx 30 after onset of stressor, you don't uniformly suppress immunity- you enhance many aspects of it. Psychological & physical stressors appear to cause this early immune activation. The SNS and glucocorticoids play a major role here. After 1 hour of continued stress, more sustained glucocoticoid & SNS activation begins to have the opposite effect- suppressing immunity. |
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potent stressors |
Social disruption/defeat/isolation is considered most potent stressor for social animals. Its effects have marked effect on immune system functioning and susceptibility to infectious diseases. Social stressors are not an occasional occurrent but the norm for communal animals. Persistent/repeated social stressor experience give rise to changes that could promote serious health complications. |
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Glucocorticoids- Cortisol |
Crucial in regulation of key physiological systems and the stress response- activated by stressors & inflammatory stimuli. They inhibit pro inflammatory cytokine production - reducing immunity. Stimulate celluar release of specific compounds involved in the inflammatory response. Cytokines are produced by the B and T helper cells of the immune system. However cortisol production LT- Can damage immunity. |
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Wound healing |
Reduced immunity can impact our wound healing ability. Kiecolt Glaser et al 2002, demonstrated that elderly carers of people with alzheimers disease that healing of experimentally induced tissue wounds took sig longer to heal than age matched controls. Vehhara et al 2003, examined healing rates of foot ulcers among adults with type2 diabetes- healing reduced in those with high anxiety. |
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Allergies- hay fever-asthma |
When there is chronic stress, the immune system is weakened. With weakened immune system, body has more difficulty to withstand antigen (invaders) This increases allergic responses. A strong immune system creates antibodies to fend off antigens abilities to release histamines (mucus & cell swelling causing chemicals). |
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Asthma |
Asthmatic children can be helped by family therapy - reducing interaction with parents that produced freq stressful interactions. Liu et al 2002, provide evidence that stress can enhance allergic inflammatory responses. 20 students with mild asthma- low & high stress conditions (examination) Anxiety & depression scores correlated with increased inflammatory response. |
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Stress and common cold |
Lab studies show that those reporting more chronic life events, perceived stress, negative affect and poor coping = more likely to develop signs of respiratory infection & colds than control group (cohen et al;stone et al 1993) Greater evidence for impact of chronic stress rather than severity on susceptibility to cold anf influenza. |
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Autoimmune disorders |
Stressful events assoc with a variety of immunologically related disorders. Some illnesses are those in which stressors might weaken immune functioning, therby allowing viruses to flourish. Other instances- stressors influence disorders in which aspects of the immune system attacks self. Little evidence that stressors cause these illnesses but they do aggrevate symptoms of illnesses present. |
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Multiple Sclerosis (MS) |
In MS the immune responses are directed towards fatty sheaths (myelin) surrounding the brain and spinal cord axons, leading to scarring. Axons are responsible for conducting nerve signals between neurons, brain and periphery. Disease most commonly occurs in young adults, most often women. |
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MS Symptoms |
Include: changes to physical sensations problems with coordination balance visual disturbance depression is often comorbid |
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MS- Impact of stressors |
It has been shown that stressful experiences contribute to the exacerbation of MS symptoms as well as presence of new brain lesions. Reported that distressing events were more likely to occur during period prior to relapse of MS symptoms. Frequency of stressful experiences and not the severity of acute stressors were implicated in predicting worsening MS symptoms. |
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Lupus |
Systematic Lupus Erythematosus (SLE) is an autoimmune disease where the immune system attacks any of several parts of the body - heart,joints,NS,liver,kidneys.. Such an attack results in damage & inflamation to organ tissue. The disease is most common in women-90% of cases, and usually manifests between 15-35YRS |
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Lupus Symptoms |
Symptoms vary but usually include: joint pains fatigue muscle pain fever |
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Lupus |
Stressors provoked immune & cytokine responses that were readily distinguishable to healthy controls. SLE symptoms (as in MS) were not exagerated in response to major life stresses, wheras daily hassles particularly those assoc with social relationships were predictive of flares. As in many ither illnesses, living with SLE can promote stress related disorders- there is evidence that depression (often comorbid of SLE) is as a result of neurological consequences, not the impact of the condition itself. |
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Arthritis |
A disorder which entails inflamation of a single/multiple joints. Females more commonly effected than males. Symptoms include: joint pain, fatigue, poor sleep, difficulty moving/walking. Osteoarthritis (degenerative) Rheumatoid (auto-immune) |
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Rheumatoid Arthritis |
Straub et al, 2005- conducted a diary based analysis of workers with RA and revealed an increase in pain levels on days with more undesirable work events. |
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Rheumotoid Arthritis |
Affleck et al. 1987- found 22% of RA patients attributed their illness to stressful experiences. 45% believed stressful experiences excerberated their illness/provoked flairs. 21% attributed improvements in their condition to stress decline. |
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Cancer |
Stress might contribute to the emergence or exacerbation of certain cancer types (Costanzo et al,2011) Although there is evidence in animal research of a link between enviormental stressors and increased susceptibility to tumor development- human evidence is limited. |
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Cancer progression |
Research evidence that suggests that stressors could negatively influence tumour growth. This was hypothesised as result from damage to endocrine functioning/diminished cytotoxic responses against these tumour cells. Several human studies have indicated that stressful life events were assoc with increased cancer progression and increased cancer related mortality. |
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Cancer progression |
Its been reported that breast cancer patients with high psychological stress , NK natural killer cell functioning is impaired relative to low levels of psychological stress. 1 job of NK is to destroy tumour cells at early stage. Varker et al 2007- followed women post operatively for 18 months & those who indicated greater distress levels exhibited diminished NK cell activity & reduced lymphocyte proliferative responses. |
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Cancer progression |
Chida et al 2008- extensive meta analysis of stress-related psychosocial factors & cancer exacerbation. The study suggested that survival was poorer as stress increased. Outcomes were tied to several fundamental features that were relevent across diff types of cancer. Individual differences factors were predictive of outcoe e.g stress prone personality, poor coping, poor Q of life. |
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Cancer- Remember |
Stress does not cause cancer- suggested contributary factor & little evidence to support the lit. Research primarily been correlational and often rely on retrospective analyses that attempted to tie a current cancer state to past stressful events. Accuracy could be influenced by age/secondary cancer effects. |
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Psycho-oncology |
Was one considered a ridiculous notion that stressful events might influence the cancer process- now its common to acknowledge the fact that life event/lifestyle/patient comfort could influence cancer progression & considering them as part of t'ment regimen may have positive effects on patients psychological wellbeing. |
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Stress stemming from cancer |
Following initial shock of diagnosis, there come a series of invasive/demoralising /humanising tests.. T'ments themselves are an added source of stressors - chemo/amputation. Even if outcome is succesful there's + stressors from physical/occupational rehab and anticipatory stress from uncertanty of whether cancer will return. |
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Stress & cancer t'ment |
Being informed of a malignant tumour & having to undergo t'ment may be assoc with states such as depression, anxiety & PTSD.. These symptoms are freq evident when family members are affected, & are particularly severe when patient is individuals child. Results- mixed whether stress reduction measures enhance survival times/impact of the illness. |
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Stress & Coronary Heart Disease - CHD |
A disease of the cardiovascular system which develops over time in response to a range of factors. This causes gradual narrowing of blood vessels that supply the heart. Acute stress results in activation if the sympathetic NS which increases cardiac output & causes the blood vessels to constrict which increases blood pressure. This causes damage to artery walls which is exaberated by stress induced adrenaline and nonadrenaline output. |
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Inflammatory processes in CHD |
Inflammatory factors can influence cardiac problems including MI, heart failure, atherosclerosis & viral myocarditis. Several immune related disorders, including RA & HIV are assoc with negative cardiovascular outcomes. Removal of the spleen (a major warehouse for immune cells) can lead to increased risk of MI. |
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Stress & CHD |
Repeated & chronic stress also activates the SNS's release of fatty acids into the bloodstream= high cholestrol. Release of catecholamines during stress process increases the stickiness of the blood platelets (thrombocytes)- increased risk of thrombosis-possible of stroke/heart attack |
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Does stress precipitate a heart attack |
Work & home stress, financial problems and past year major life evnts were sig assoc with <3 attack in huge cross cultural- 52 country study of more than 11,000 <3 attack survivors. Acute stressors such as anger outburts may trigger rupture of atherosclerotic plaques which disrupts blood flow & causes <3 attack/stroke. |
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Stress and development of CHD |
STRESS CAN APPEAR TO CONTRIBUTE TO VARIOUS RELATED CONDITIONS SUCH AS HYPERTENSION, ELEVATED SERUM LIPIDS (FATS IN BLOOD) & SMOKING BEHAVIOUR. Cardiovascular reactivity during acute stress has been implicated in various disease processes e.g cartoid artery atherosclerosis & CHD. Reactivity in itself is not a disease but a risk factor. |
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Cardiovascular reactivity |
Experimental studies have used rewarding & aversive stimuli to study reactivity. Participants who responded to aversive tasks with sizable <3 rate & pressure increases but who showed no differences in their subjective ratings of the task from controls, had greater activation of the hypothalamic sytem & neuroendocrine responses. Higher cortisol & nonadrenaline release was also assoc with participants who had high reactivity. |
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HIV/AIDS |
Aids- Aquired deficiency syndrome) is characterised by opportunistic infections & other malignant diseases which is caused by HIV (human immunodeficiency virus) identified in 1984. Living with this illness is inheritantly stressful & although evidence is weak for the influence of stress on infection occurring following exposure. Theres evidence to suggest that stress plays an influential role in disease progression. |
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HIV/AIDS |
Evidence for role of stress in progression of HIV/AIDS is particularly strong when moderating variables such as depression, social support and coping responses taken into consideration. A meta analysis suggest that depressive symptoms but not stress experience were assoc with increased speed of symptom onset in HIV positive individuals & stress, not depressive symptoms were assoc with reduced NK cell count. Another study- a build up of stressful life events, depressive symptoms & low social support led to quicker progression to aids. |
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HIV/AIDS & Social support |
Social support- particularly relevent due to Stigma attached to disease (homosexuality/drug abuse/sexual promiscuity) impact of self disclosure loss of partner |
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Curious case- lose sight due to stress |
lost sight but there were no physical evidence |
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Psychosomatic disorder-PD |
Term PD is used to mean a physical disease thought to be cause/made worse by psychologicl factors. Term can also be used to describe physical symptoms which occurr as result of psychological factors where there is no physical disease - known as Somatic symptom disorder. |
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Somatic symptom disorders |
A group of disorders-all of which fit the defintion of physical symptoms with no identifiable physical cause. Conversion disorder- loss of bodily function Illness anxiety disorder-worry of developing illness. Body dysmorphic disorder-body image Pain disorder |
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Somatic symptom disorders |
Symptoms are similar tot hose of other illnesses and may last years. Usually the symptoms begin appearing in adolescence and patients are diagnosed before 30. Symptoms occurr across cultures & gender They not a result of conscious malingering (fabricating/exagerating) or factitious disorders (deliberately producing/faking/exagerating symptoms) |
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Somatic symptom disorder DSM-5 |
Medical tests either normal/do not explain persons symptoms & history physical examination do not indicate presence of a known medical condition. Patient must be worried about the symptoms and must be judged to be out of proportion to severity of physical complaints themselves. Diagnosis requires complaints for at least 6months. |
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T'ment of somatic disorders |
Patients with SDS cling ro belief that their symptoms have an underlying physical cause. Are likely to dismiss any suggestion that psychiatric factors are playing a role in the symptoms. Focus of t'ment is on improving daily functioning not on managing symptoms. Stress reduction is important oart of recovery. Counselling for family & friends may be useful. CBT can help in tackling distorted thoughts, unrealistic beliefs and behaviors that prompt health anxiety. |
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Why the impact/outcome of stress differs across lifetime- (5) |
Brain development in childhood Decline of cognitive functions as we age At both these points- brain is sensitive to stress |
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Lifecycle model of stress- physical challenges |
amygdala, prefrontal cortex and hippocampus very sensitive prenatally & in childhood up until teens. also old age- hippocampus very sensitive |
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Prenatal stress |
During pregnancy a fetus is learning about how to respond to the outside world. If the fetus is exposed to certain types of stressors, some of these decisions cause a lifelong increase in the risk of certain diseases. e.g- famine: the fetus 'learns' that there's little food to be had so is programmed to use its metabolism in the most thrifty way. As a result, the individual is at greater risk of obesity, hypertension, diabetes & cardiovascular disease. |
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The dutch hunger winter |
When WW2 was nearing its end, and the nazis were being pushed back on all fronts, the dutch were aiding the allies in order to liberate them. As punishment for this, the nazis cut off all food transport. People consumed less than 1000 calories per day and were reduced to eating tulips (16,000 people starved to death) This resulted in a cohort of people with thrifty metabolisms (which can be transmitted across generations) |
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Prenatal stress- animal studies |
Early exposure to stress has a programming effect on the HPA axis. The single/repeated exposure of a pregnant rat/guinea pig to stress/glucocorticoid increase maternal glucocorticoid secretion. A portion of these glucocorticoids passes through the placenta to reach the fetus which modifies brain development. |
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Prenatal stress- animal studies |
Exposure to prenatal stress has 3 major effects on adult behavior;learning impairments, especially in aged rats; enhanced sesitivity to drugs and increase in anxiety & depression related behaviours. The impaired learning is thought to result from the effects of prenatal stress on hippocampal function whereas the effects on anxiety are thought to be mediated by prenatal stress induced increases in CRH in the amygdala. |
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Prenatal stress- human studies |
Retrospective studies with human subjects have found similar findings to studies on animals. Human mothers who experience psychological stress/adverse events/received exogenous glucocorticoids during pregnancy may impact on the LT neurodevelopment of their offspring: including: Lower birth weight/small in size Increased basal HPA axis activity in the offspring at diff ages inc. 6months, 5yrs + 10yrs. |
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Prenatal stress-human studies |
Disturbances in child development (neurological & cognitive) + behaviour have been assoc with maternal stress & depression during pregnancy. The behavioural alterations inc unsociable = inconsiderate behaviour, ADHD, sleep disturbances, psychiatric disorders such as depression, drug abuse & mood/anxiety disorder. Low birth weight combined with lower levels of maternal care are assoc with reduced hippocampal volume in adulthood. |
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Postnatal stress- animals |
In rats, maternal deprivation causes similar consequences as prenatal stress: increased levels of glucocorticoids during stress + an impaired recovery at the end of stress. In monkeys, repeated unpredictable seperations from mother, unpredictable feedings or abuse behaviour increased CRH concentrations + alters diurinal activity of the HPA axis for months or even years afterwards |
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Postnatal stress- humans |
Human children who have been abused have elevated glucocorticoid levels + decreased size and activated the most highly evolved part of the brain - the frontal cortex. |
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Postnatal stress- humans |
A less severe form of maternal seperation is daycare/childcare Studies - glucocorticoid levels rise in children over the day, more so in toddlers. Less supportive care produces larger increases, especially for children who are emotionally negative + behaviourally disorganised. No evidence that day care affects development;however poor care for long hours in early development result in increased risk of behavior problems later on. |
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Postnatal stress |
Parent child interactions + the psychological state of the mother also influence the child's HPA axis activity. Maternal depression often interferes with sensitive supportive care. There is increasing evidence that the children of depressed mothers (esp. clinical depression) are at risk of heightened HPA axis activity. In contrast studies of human children exposed to extreme deprivation show lower basal levels of glucocortisoids- downregulation of HPA axis or tissues hypersensitivity to glucocorticoids. |
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Effects of childhood stress across the lifespan |
Intensive + prolonged stress can lead to a variety of short & long term negative health effects. We have already seen how this can disrupt early brain development & compromise functioning of the nervous & immune systems. In addition, childhood stress can lead to health problems later in life including alcoholism, depression, eating disorders, heart disease, cancer & other chronic disorders. 3 Types of stress have been identified - toxic/tolerable/positive. |
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Positive |
moderate, short lived increases in heart rate, blood pressure & stress hormone levels. Precipitants: include the challenges of dealing with frustration, receiving an injected immunization + other normative experiences. Key features: important aspect of healthy development. Experienced in the context of stable of stable + supportive relationships that facilitate adaptive responses. Adaptive responses restore the stress response system to baseline status & help person to handle future challenges. |
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Tolerable: |
A physiological state that could potentially disrupt brain architecture (eg. through cortisol induced disruption of neural circuits or neuronal death in hippocampus) but is buffered by supportive relationships that facilitate adaptive coping. Precipitants: include death/serious illness of loved one, homelessness/natural disaster. Key features: occurs within time limited period. protective relationships help bring the body's stress response systems back to baseline, thereby giving the brain time to recover from potentially damaging effects. |
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Toxic |
Strong, frequent &/ prolonged activation of the body's stress-response systems in the absence of the buffering protection of adult support. Precipitants/major risk factors: poverty, recurrent physical/emotional chronic neglect, severe maternal depression, parental substance abuse & family violence. Key features: disrupts brain architecture, affects organ systems, biological changes increased risk of stress related disease and cognitive impairment well into adult years. |
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Adverse childhood experiences |
ACE. 17,000 participants. Compute an ACE score to calculate early life adversity. 6+ is assoc with 20 yr reduction in life span 4+ assoc with no of health conditions. |
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ACE |
Abuse: emotional, physical, sexual Household dysfunction: mother treated violently, household mental illness, parental seperation or divorce, incarcerated household member. Neglect: emotional, physical |
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ACE Study findings |
Childhood abuse, neglect + exposure to other adverse experiences are common.. Almost 2/3 of study participants reported at least 1 ACE. More than 1/5 reported 3/3+ As the number of ACEs increases, risk of outcomes also increase. |
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ACE-Risks |
Alcoholism/drug abuse COPD Depression Fetal death Illicit drug use Heart/liver disease risk of STI partner violence multiple sexual partners smoking suicide attempts unintended pregnancies |
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Stress in adolescence |
It is in adolescence that the long lasting effects of earlier exposure to stress becomes evident. Alterations in grey matter volume + the neuronal integrity of the frontal cortex have been reported in adolescents exposed to early and continued adversity. Suggested that frontal lobe continues to develop during adolescence and is particularly vulnerable to the effects of stress. |
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Stress in adolescence |
This period is assoc with heightened basal + stress induced activity of the HPA axix. This is thought to be related to the sex steroid levels during this period Adolescent brain might be especially sensitive to effects of elevated levels of glucocoticoids- stress Anxiety & depression increase in prevelence in adolescence. |
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Adolescencse STATS |
3 kids in every classroom have a diagnosable mental health disorder. Roughly 725,000 people in UK suffer from eating disorders- 86% of these will have shown symptoms before age 19. 1 in 10 delibarately self harm regularly and 15,000 hospitalised. nearly 80,000 suffer from severe depression |
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STATS continued |
Half of all lifetime cases of mental illness begin by age 14 45% of kids in care have a mental health disorder Nearly 300,000 young people in UK have anxiety 95% of imprisoned young offenders have a mental health disorder, many struggle with more than 1. |
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Gender differences- Adolescence |
Gender diffs occur in emotional distress during adolescence. Girls experience higher levels of interpersonal stress than boys. |
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Puberty, stress & gender |
Before onset of puberty, there are limited diffs between Ms & Fs in their physiological stress response. However rise in testosterone in male adolescents has a blunting effect on HPA axis. The balance of estrogen & progesterone across the menstrual cycle regulates stress responsitivity (cortisol responses are blunted during luteal phase- just before period starts) It is during luteal phase of cycle that salivary cortiosol response is most similar. |
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Interpersonal relationships & gender differences |
Rudolph 2002: Early teen girls have a greater emotional investment in interpersonal success. Girls more likely to blame themselves for relationship problems. girls with high need of peer approval are more susceptible to self esteem deficits and anxiety. Once distressed there is greater likelihood of generating further interpersonal problems. |
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Stressors in adulthood: Causes of stress |
1) money 2) work 3) economy 4) relationships 5) health 6) job stability 7) safety |
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Stress in psychologial professions |
BPS survey showed: 46% report depression 49.5% report feeling a failure 70% state they find job stressful Overall- burnout, low morale & worrying levels of stress |
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Work related stress |
Stress, depression & anxiety continue to represent a sig ill health condition in UK workforce. Work related stress accounts for 37% of ill health & 45% of days lost in 2015/16 The health & public sectors report highest rates of work rel stress. Precipitating event inc. job factors, changes at work, interpersonal relationships, personal development and traumatic events. |
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Adulthood - Acute stress |
Studies of the effects of acute stress report the presence of an inverted U shaped relationship (yerkes-dodson) between cortisol levels and cognitive performance. Studies show- cortisol elevations sig increase memory for emotional info whereas they impair the retrieval of neutral info. Sugested that the increased attention to emotional info when faced with acute stressor is adaptive- using vigilance and learning processes. |
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Adulthood- chronic stress |
Most studies on chronic stress effects on the adult human brain have concentrated either on stress related psychopathologies / the impact of early life stress on adult psychopathology. Smaller hippocampal vol been found in major depression with childhood trauma - maj depression without childhood trauma does not show same effect. Similarly decreased hippocampal vol is a feature of PTSD- believed to be a pre existing risk factor (genetic/rooted in early life) rather than a consequence. |
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Adult mental health prevalence |
Rise in no of adults experiencing mental problems. UK- Eng pop diagnosed with mental health disorder increased from 15.5% in 1993 to 17.6% in 2007 (1 in 6) |
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Access to mental health services |
The aviva health of the nation index 2013- in 2012 total of 202 GPs reported that 84% of appointments were attributed to issues with stress & anxiety, with 55% reporting mental health issues. Currently, mental health research is only receiving 5.5% of the total UK health research spending. Accord to 2014 survey by we need to talk coaltion- out of 2000 who tried to access talking therapies in 2014, only 15% were offered the full range recommended by NICE. |
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Older adults: Stressors |
Being widowed/divorced Being retired/unemployed Physical disability or illness Loneliness/isolation Neurological biological changes of aging Prescribed meds for other conditions |
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Declining cognition/dementia |
Estimated 44million worldwide predicted to double by 2030. Estimated total cost of dementia in UK is £26.3 bill, with average of £32,000 per person. 1 of biggest worries in older adults..- some memory loss is normal but anything over above what is expected accomp by functional difficulties can be cause for concern |
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Depression in older adults |
127 community dwelling older people diagnosed as having depression from sample of 1232 3 yr follow up 30.2% dead, 34.9%persistent/relapsed depression, 25.4% other case/sub case mental illness, 10.4% complete recovery. Poor outcome predicted by physical ill health, chronic medical conditions, bereavement, family history of depression. Good outcome predicted by anti depressant meds |
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Depression in residential homes |
High rates 40% + Not simply enviourmental response lack of activity sense of control rates of depression related to staff awareness of physical health issues |
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End of life- impact |
Types of death: untimely, long illness, multiple losses, violence Predisposing factors: poor physical/mental health Relation to deceased: loss of close relative/loved one Social supports |
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The aging brain |
Aging healthy humans exibit higher mean levels of cortisol than younger individuals Individuals with alzheimers present both memory impairments + hippocampal atrophy; studies have found this pop has higher basal cortisol levels than controls Frontal lobes have an increased sensitivity to cortisol effects |
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Programmed to die? |
Does stress accelarate aspects of aging? : Evidence to suggest that stress can increase some diseases of aging In more than a dozen species, cortisol excess is the cause of death during aging Salmon who return to their birth place where they spawn their eggs - after which most die over following weeks - is due to cortisol excretion. |
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Stress , personality & illness (6) What is personality ? - |
Dynamic organisation within the individual of those psychosocial systems that determine his characteristic behaviour & thought - Allport, 1961 |
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Types & Traits |
A typology - looks for a small number of dispositional clusters that occur with some frequency. A trait theory - looks for a large number of dispositions that allows description if an individual on each of the dispositions. People may have many traits, but only fit one type. |
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Personality typlogies |
Extroverted type Sociable, adventurous & impulsive traits. Psychotic type Egocentric, aggressive, cold, & manipulative characteristics Impulsivity is a feature of both types but differ in terms of clustered traits. |
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Biotypes |
Stress & health research - attempted to relate certain personality traits to particular diseases. What comes first - personality / disease? Can personality change? |
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Personality change ? |
Personality stability from age 14 - 77. (Harris, Brett, Johnson & Deary, 2016) The scottish mental survey (1947)- N=1208 (follow up = 174) 6 personality characteristics (self confidence, perserverence, stability of moods, conscientiousness, originality & desire) No sig correlations found. |
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Biopsychosocial approaches to personality |
Biological influence: genetically determined temperment, autonomic nervous system reactivity, brain activity. Psychological influence: learned responses, unconscious thought processes, expectations & interpretations. Social cultural influene: childhood experience, influence of the situation, cultural expectation, social support. |
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The personality stress-health connection |
Personality may promote unhealthy behavior Personality can influence how we appraise/cope Personality may predict disease 'disease prone personalities' Specific clusters of personality traits may predispose to specific illnesses (e.g type A-CHD). |
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Brain pathways - introvert v extrovert |
Introverts process stimulations via a different pathway than extroverts. Longer introvert acetylcholine pathway, Shorter extrovert dopamine pathway. |
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Eysenck Personality q'aire Eysenck & Eysenck (1975) |
100 item q'aire yes/no responses fill in the mini EPQ not a clinical toll but gives idea of types of Q's on original q'aire. Psychoticism: aggressive, assertive, egocentric, unsympathetic, manipulative, achievement orientated, dogmatic, masculine, tough minded. Extroversion: sociable, irresponsible, dominant, lack of reflection, sensation seeking, impulsive, risk taking, expressive, active. Neuoticism: anxious, depressed, guilt feelings, low self esteem, tense, moody, hypochondriac, lack autonomy, obsessive. |
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The big 5 theory: Costa & McCrae , 1992) |
Agreeableness (cooperative) Conscientiousness (responsible) Extroversion (sociableness) Neuroticism (tense/anxious) Openness (imaginative, open to new experiences) |
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Neuroticism: |
Eysenk (1985) & the big 5 most research attention in relation to illness tend to experience neg emotions & to exhibit assoc beliefs & behaviors Anxious beliefs: notable: disproportionate to situation Exposure to more neg stressors? |
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Negative affectivity (Watson & Clark, 1984) |
Related to neuroticism Central role in stress-health relationship Generalised negative outlook, greater introspection, low affect (mood) & low self concept Assoc with lower self rated health & greater health complaints |
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Mortality |
21 yr prospective cohort study Death was predicted by neuroticism, specifically death from cardiovascular diseases even when controlling for known risk factors. Partially mediated by sociodemographic, health behaviour & physiological factors & lessened when mood state was considered Close assoc between neuroticism and mood |
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Neuroticism, Negative affectivity & outcomes |
Little understanding of the mechanisms of how N and NA affect outcomes, they have been described as nuisance factors. Self-reported stress/distress should be viewed with caution However some evidence link with immune suppression |
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Conscientiousness |
A responsible, dependable character following social norms, having foresight , being persistent and self disciplined Consistent relationship with positive health outcomes Modest but nontheless sig correlation of 0.11 between conscientiousness & longevity. General effect across range of samples and cultures. |
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Big 5 & Associations |
Neuroticism - emotional well-being Conscientiousness - cognitive evaluation of well being Agreeableness - flexible coping responses to stressors Extraversion - active coping v risky behaviour |
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The 5 factor model of personality disorder |
Personality traits are enduring patterns of perceiving, relating to & thinking about the enviourenment & oneself that are exhibited in a wide range of social & personal contexts. Only when personality traits are inflexible & maladaptive and cause sig functional impairement/subjective distress do the constitute personality disorders (APA). |
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Borderline PD |
A pervasive pattern of instability of interpersonal relationships, self-image & affects & marked impulsivity beginning by early adulthood & present in a variety of contexts. |
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Borderline PD |
'hyper reactivity' to stress longer time to recover from stressful events those with BPD WHO ARE SYMPTOMACTIC ARE MORE LIKELY TO : SUFFER WITH FOLLOWING CONDITIONS: chronic fatigue, fibromyalgia, diabetes, obesity, osteoarthritis, hypertension Stress related / lifestyle choice related ? |
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Optimism |
A protective disposition A generally positive outlook & expectation Thought to cope more effectively and persistently with stress & illness events Less likely to think 'its my fault' Appraise stress as changeable & coming from external sources |
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Optimism- positive outcomes |
Fibromyalgia patients kept going despite the pain More positive adjustment following a cancer diagnosis Optimistic children report better goal attainment, self-competence & fewer depressive symptoms Optimistic law students exhibited less avoidance coping than non optimistic law students. |
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The life orientation test (Scheier & Carver, 1985) |
1. in uncertain times I expect the best 2. its easy for me to relax 3. if something can go wrong for me - it will 4. i always look at the bright side 5. I'm always optimistic about my future 6. I enjoy my friends a lot 7.Its important for me to stay busy |
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Hardiness |
Identified by Kobasa (1979) as a potential answer to why some people get ill as a result of stress and why others stay healthy. Belief system more than personality? Manifest in feelings of commitment, control & challenge. Based on these characteristics, a hardy person would be buffered against the experience of stress. - remain healthy. |
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Personality types Type A behaviour pattern |
Myer Friedman & Ray Rosenman 1974. The cardiologists office chair... Competitive, overachieving, time pressured, impatient & hostile |
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Type A & Coronary risk |
A large body of lit provided early evidence of a link. Several risk factors for coronary disease - none predictive of new cases Rosenman & Friedman 1961 - reported: Hypertension in type A women ; Type A men 6.5 more likely to have a heart attack. |
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The changing face of type A |
Alleged relationship between type A personality & coronary disease began to evaporate after 1977. There have been unexpected findings thattype As had lower mortality after a 1st coronary event than did type Bs. Raglan & Brand showed that type Bs had twice the mortality rate of type As after a 1st coronary attack |
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Type A anger |
So if type A isn't the whole answer - what is? Taking type As appart. Toxic ingredient = anger/hostility Hostility leads to health risk behavior Hostility also results in a lower capacity for the buffering effects of psychosocial resources or social support |
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Type C personality |
Cancer prone personality Characterised by suppression of emotion and inability to cope with interpersonal stress. Feelings of hopelessness/helplessness. 15yr follow up of women with breast cancer- found assoc between coping style and poor prognosis. Cooperative & appeasing, compliant, stoic, unassertive, repression of negative emotion. |
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Type D personality |
Characterised by high negative affectivity and social inhibition Best described as distressed personality People with this personality score highly on negative affectivity and social inhibition Considered to be detrimental to cardiovascular disease and outcomes. |
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Personality types and anxiety |
Type A's are susceptible to stress, worry and fear of failure. The B's are at risk for the anxiety that comes when deadlines loom and go unmet With their fears of failure/criticism, C's can experience social anxiety disorder. The type D's as they're prone to stress and pessimism are at risk of GAD. |
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Trait & State anxiety |
Spielberger - 1966 - trait v state anxiety. Trait anxiety tends to be relatively stable - greater tendency to be anxious, less externel stress to trigger a stress reaction. State anxiety is specific to a situation- anxiety producing situations, changes according to situation.. |
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(8) Social relationships Meaning of self |
FMRI Study - 22 scanned participants (11 F & 11 M) - opposite gender friend, mean age 23.5 Found that the defining features of human social bonding may be increasing levels of overlap between neural representations of self and other. People we care for literally become a part of who we are. |
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Circle of acquaintances |
Most intimate space Your friends Friends Aquaintances |
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Social group size |
Xmas card research (2002) Max of 150 |
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Social relationships & health |
Individuals with lowest level of involvement is social relationships are more likely to die. Impact on mortality hold even when socioeconomic status, health behaviours, & other variables were taken into account. Social ties also reduce mortality risk amongst adults with documented medical conditions e.g CHD- social isolated adults 2.4 times greater risk of cardiac arrest. |
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Physiological impact of social isolation |
A low quantity/low quality of social ties has been linked with: progression of cardiovascular disease myocardial infarction atherosclerosis autonomic dysregulation high blood pressure cancer and delayed cancer recovery slower wound healing |
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Physiological impact continued |
Marital history over life course shapes a range of health outcomes: cardiovascular disease chronic conditions mobility limitations self rated health depressive symptoms Poor quality/low quant - assoc with inflammatory biomarkers & impared immune function |
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How relationships benefit health? |
1.behavioural 2.psychosocial 3.physiological direct effect v buffering hypothesis |
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1.Behavioural explanations |
More positive ties = more positive health behaviors (good diet, adhering to medical regimes, exercise promote good health) Negative behaviours such as smoking, excessive weight gain, drug abuse, alcohol consumption undermine health. Creating norms, monitor, inhibit, regulate & facilitating Sense of responsibility/concern for others. |
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2.Psychosocial explanations |
Social support Personal control Symbolic meanings and norms Mental health |
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Social support defined |
The functional component of relationships |
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Perceptions of social support |
3 classes of info lead to the perception of social support: 1. one is cared for and loved 2. one is esteemed and valued 3. one is part of a social network of communication and mutual obligations |
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Symbolic meanings of social ties |
Meanings attached to marriage + relationships with children may foster a greater sense of responsibility to stay healthy.. Adolescence - peer group (what it means to be popular) Greater social connection may foster a sense of coherence or meaning + purpose in life |
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Stress buffering hypothesis |
Serves as a framework for undrstanding the relationship between stress, social support and well being. Most commonly used construct in the social support literature Theoretically similar to proactive coping. Social support is established during periods of non crisis in prep for times of crisis. |
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Transactional model Lazarus & Folkman, 1984 |
*cognitive appraisal - support over chosen response - willingness to help - shared experience |
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Relationships across the lifespan |
Parents Adolescent peers Intimate partners Children becoming caregivers |
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Stress buffering in childhood & adolescence |
The formation of primary attachments Secure attachment relationship with the parent who was present during stressor exposure (loud noise, vaccination) completely block increase in cortisol (infants and toddlers) in middle childhood, the parent does not eed to be present to reduce the hpa axis response Loss of parental social buffer in adolescece (puberty) may be assoc with emergence of mental health problems |
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Stress buffering in adult relationships |
quality of attachment is assoc with romantic relations in adulthood.. Romantoc partners should therefore act as HPA axis buffering, however this seems only true for men. Among adult men, support by a romantic partner/best friend reduced cortisol response prior to giving a speech. Social buffering by friend was effective as nasal oxytocin in buffering HPA axis in men. |
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Stress buffering for adult women |
there is little evidence that for women the HPA axis is buffered by presence/verbal support of an opposite sex partner. Only when provided physical touch was the presence of a womens partner a buffer for the HPA axis. Both verbal/physical touch by partner during speech preperation elevated oxytocin equally, while only touch reduced HPA response. Is oxytocin critical in mediating the social buffering of the HPA axis for women? |
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Dark side of relationships |
Marriage is most salient source of support and stress for many. Poor marital quality has been linked with compromised immune & endocrine function and depression. Negative effect of marital strain on health becomes greater with advancing age. Social contagion of negative health outcomes Caring for ones social ties. |
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Forgiveness |
Interpersonal relationships can provide the most potent stressors In form of disputes/letdowns/transgressions between family members/close friends, traditional enemies, authority fig, between groups of individuals. Apologising serves the purpose of rebuilding the relationship Who benefits from forgiveness? More beneficial for forgiver - limits adverse impact of events on wellbeing, not same as forgetting. |
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When not to forgive |
Although typically assoc with positive psychological outcomes, it sometimes results in the opposite In abusive relationship, forgiveness can prepetuate victims illusion of LT safety which keeps them in abusive enviourenment Also serves to undermine individuals LT wellbeing Alters appraisals and coping efforts - results in stress related symptoms |
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Trust |
Forgiveness depends on there being trust in relationship Conflict resolution requires that there be trust that a similar transgression will not occurr An essential component in politics + in commerce Breach of trust can have exceptionally stressful/damaging effects (seperation/divorce) |
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Unsupportive interactions |
Too much support - erode self esteem Being in debt to support provider - additional stress Attempt to gain social support may elicit incorrect advice What if friends dont appear to support us/disagree with us Such situations can result in neg repercussions - far exceeding situations where there is no social support |
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Unsupportive responses |
Minimising Blame Bumbling Distancing/disconnecting |
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Support & illness |
Some progressive & chronic illnesses can be devastating emotionally & financially but social support may not be as forthcoming as when a person is diagnosed with cancer Support tends to be less for MS/Lupus and particularly mental health conditions May be a period of support- until they are no longer want to / able to help. This can be seen as withdrawal of support which exacerbate illness & contribute to development of comorbid conditions eg depression. |
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Support & getting older |
Lack of support is notable for older adults Especially among those with sev neurological problems Elder abuse can result from carer frustration Lack of reciprocity can result in these relationships Older adults have smaller social network |
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Social rejection |
Groups of individuals can be rejected e.g gender, sexual orientation, race, religion This can occur at a group/individual level - The black sheep effect A fear of social rejection has been linked to elevated cortisol 'cyperball' experiment - shown to influence brain processes assoc with appraisals (same brain activation as pain) |
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Facebook paradox Is wider connection good? |
Mixed empirical evidence of the influence of FB on social relationships and psychological wellbeing. Intensity of FB use is positively linked to students life satisfaction, social trust, civic engagement & political participation. 3 types of social capital - bonding, bridging & maintenence. Updating FB status - found to reduce loneliness by increasing daily social connectedness. |
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Negative links to FB |
The number of FB friends you have is: neg linked to self esteem & academic adjustment in college pos related to romantic jealousy & relationship dissatisfaction greater use predicts decline in cog & affective wellbeing over time Freq use assoc with greater stress directly & indirectly as a result of info overload & reduced self esteem |
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Conclusion |
Across lifespan - individuals may face similar stressors + have similar risk of developing certain illness as a result However some people seem to escape the . impact of stressors unscathed Presence of social support may be part of the answer |
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(8) Coping and resilience Defining coping |
Constantly changing cognitive and behavioural efforts to manage specific external/internal demands that are appraised as taxing or exceeding the resources of the person. So a mismatch between demands and resources |
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Defining coping |
Coping is a process of constant evaluation of the success of one's strategies Coping is learned as one encounters situations. Coping requires effort Is an effort to manage - success is not contingent on mastery - just good enough. |
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Conceptualising coping strategies |
Biological/physical- fight/flight Cognitive- how we think about a situation Behavioural- behaviour related to mental process Learned- strategies learned from modelling/observation Intentioned- voluntary/involuntary |
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Transactional model of coping |
Core assumptions: - stressful experiences are construed as person-enviorment transactions -transactions depend on the impact of the external stressor - impact is mediated individual/envourmental antecedent by the person's repeated appraisal of the stressor & coping responses -the system changes from moment to moment |
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Transactional model concepts Glanz, Rimer & Lewis , 2002 |
- primary appraisal - secondary appraisal - coping efforts - problem management - emotional regulation - meaning based coping - outcomes of coping -dispositional coping styles - optimism - info seeking |
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Emotion focused coping |
Coping efforts that are directed toward regulating emotional states - denial/avoidance - distraction/minimisation - wishful thinking - self-control of feelings - seeking meaning - self-blame -expressing feelings |
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Problem focused coping |
Efforts to act on the source of stress to change the person, the environment or the relationship between: 1. Planned problem solving 2. Confrontation |
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Common aspects of coping |
- strategies/patterns: 4 common types - flexibility: strategies - effectiveness: perception of whether it worked - self efficacy: sense of competence - coping assistance: external sources (formal/informal) - coping resources: individual characteristics |
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What helps us cope effectively ? |
-Health & energy -Positive belief- ability to cope is enhanced when people believe they can succesfully bring about desired consequences -problem solving skills - having specific knowledge/abilities related to specific problem Social skill- ability to get other people to cooperate Social support- feeling of acception, love, prized by others Material resources |
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Maladaptive coping |
- Dissociation (assoc with ptsd) - Sensitisation - Safety behaviours - Anxious avoidance - Escape (panic attacks/phobias) |
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Coping across the lifespan |
- emotion focused (increases with age) - problem solving skills (mixed findings) - negative appraisal (varies in dimensionality) - avoidant physical/cognitive responses (increase w/age) -attention (increases w age) - sense of competence (younger over estimate/older perceive competence as enduring) - locus of control- (increases w age) |
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Gender + coping |
Mixed overall findings Vary by context |
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Culture + coping |
Connection between culture + coping Individualism vs. collectivism |
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Coping + cultural beliefs |
World view is culturally based: - utility of effort - religious beliefs - belief in entity view of the world - belief in benevolent purpose for events - values - belief in ubiquity of change - belief in utility of personal preparation |
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Coping + cultural beliefs |
- Discrimination + stigma erode resilience - Gender constraints are problematic - Guilt + shame - Meaning - Mastery + control - Help seeking, stigma + mistrust |
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Resilience |
Derived from latin word 'salire' which means to jump. The prefix 're' means back/again, Thus, resilience literally means jumping back "a pattern of positive adaptation in the context of past/present adversity" |
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Bouncing back |
People can bounce back psychologically after being knocked out of shape, just like in nature. - Bouncing back is ability to cope with adversity/hardship -- It means that people can carry on, even flourish after setbacks. |
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Judging adaptation |
1. There has been a sig threat/risk to the development/adaptation of the individual and 2. The individuals functioning is satisfactory according to selected criteria. |
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Resilience Adversity + Risk |
Adversity: Enviourmental conditions that interfere with/threaten accomplishment of age appropiate developmental tasks. Risk: An elevated probability of an undesirable outcome. Risk factor: A measurable characteristic in a group of individuals or their situation that predicts negative outcome on specific criteria. |
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Resilience Cumulative risk + Vulnerability |
Cumulative risk: Increased risk due to a) multiple risks present b) multiple occurances of same risk factor c) accumulating effects of ongoing adversity Vulnerability: Individual susceptibility to undesirable outcomes. |
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Resilience Proximal risk + distal risk |
Proximal risk: risk factors experienced directly Distal risk - Risk related to ecological context, but mediated via proximal processes |
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Resilience Compensatory + protective factors |
Asset/Resource/Compensatory factor: a measurable characteristic in a group of individuals or their situation that predicts general/specific positive outcomes Protective factor: quality of person/context or their interaction that predicts better outcomes |
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Research into resilience |
Studies since 1970s- considered resilience in terms of individual invulnerability and focused characteristics such as temperment, intelligence, problem solving, stress resilience which would harden children and enable them to achieve success. These studies suggested that there was something remarkable about children who overcame great adversity. |
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Research into resilience |
Later studies in this notion of 'invulnerability' gave way to that of resilience and the earlier focus on individual characteristics changed to the identification of protective factors- that reduce impact of risk factors. Researchers have found that protective factors a stronger impact on children's development than risk factors. |
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Resilience & childhood |
- Children may demonstrate resilience at 1 point in life and not another. - Children may demonstrate resilience in only some aspects of life; There are linkages among the multiple domains of adaptation, positive + negative. |
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Building resilience |
Personal coping skills can be taught Environmental factors can be changed |
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Positive psychology |
- Positive psychology is the new science of optimal human functioning: what makes people happier, more productive and more succesful. - It focuses on what works by studing success and strenghths rather than weaknesses and failure. - Impact on resilience research - risk and challenge are good for us - focus on inner strenghths and enviourmental support factors, rather than concentrating solely on wekanesses, protection and vulnerability. |
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Risks pile up |
Risks pile up Transitions (school entry, divorce, leaving home, war) pile risk on children within a short timeframe Emotional, behaviourL, EDUCATIONAL AND HEALTH PROBLEMS INCREASE AS TOTAL RISK LEVEL INCREASES. Developmental cascades can occur - 1 problem leads to another. |
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Correlates of resilience: Personality characteristics |
- social/adaptable temperment - strong cognitive abilities - effective emotional & behavioural regulation strategies - positive view of self - positive outlook - faith/sense of meaning in life - characteristics valued by society and self - talents, humours, appearance |
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Correlates resilience : Community characteristics |
- good quality neighbourhood - effective schools - employment opportunities for parents/teens - good public health care - access to emergency services - connections to caring adult mentors & pro-social peer associations |
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Adaptive systems in communities |
- attachment relationships - moral + ethical development - self regularatory systems - mastery + motivational systems - neurobehavioural + info processing systems |
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Culture + resilience |
Extended family networks Religious organisations Other social systems |
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Culturally relevant risk + protective factors |
Socioeconomic status Social support Prejudice + discrimination Acculturation stress |
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(9) Psychological interventions |
Which therapy to use? - NICE guidelines is very good |
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Therapeutic universals - good |
-Most therapists get good results consistently -Patients who drop out do so because they have met their goals -Different schools of therapy are equally effective |
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Therapeutic universals- bad |
-Therapists are poor judges of their success/failures -Therapy can and does hurt people -40% of patients would get better without therapy |
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Therapeutic universals |
-Who the patient is is the most salient factor affecting outcome -Empathy, warmth and positive regard are central to success of whatever school of therapy -Therapeutic relationship is crucial to success -Therapist's credibility, skill, empathetic understanding & affirmation of patients capacity to engage with patients focus on their problems. - Succesful repair of ruptures to the therapeutic alliance -Dual process in therapy - learning and unlearning both go on |
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Factors determining success in therapy |
Technique - 5% Therapist factors - 15% Patient factors - 40% Common factors - 40% |
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Therapists/Patient differences |
-Therapists typically think that more sessions will be required than patients do -70% of patients said that they wanted 10 sessions or fewer -50% of patients expected 5 sessions or less -Most patients seek advice, problem definition/problem solving and lots of therapist interactivity -70% of change occurs by 7th session -Most patients want it short, sweet and effective. |
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Historical development of CBT |
1900-1930s- behaviorism (Pavlov, Watson & Skinner) 1950-1960s- behaviour therapy (Wolpe) 1970s- Rational emotive therapy (Ellis) 1980s- Cognitive therapy (Beck) - DBT, MBCBT, TFCBT |
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Core Concepts of CBT |
Cognitive refers to all our conscious mental event or processes such as attitudes, ideas, impressions, image, beliefs, memories, perception, assumptions, values, attention, reasons etc. Behaviour refers to what we do and what we avoid especially safety seeking behaviours. Therapy refers to particular approach used to deal with a problem. |
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Core Concepts of CBT |
-our thoughts influence our emotions which in turn influence behaviour -it is not what happens in life but how we choose to interpret it |
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Model - past and present environment |
Thoughts- they will see how red I am. I might freeze, they will laugh Emotions- anxiety, panic, embarrasment, shame Behaviour- avoid, talk fast Physical sensations- racing heart, dry mouth, headache, sweaty .... |
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Core Concepts of CBT |
- Psychoeducation/info -Mindfulness inc. breathing -Cognitive distortions -Exposure/Desentisisation & Cog restructuring -Relapse prevention -NATs (neg auto thoughts) -Compassionate mind -Cognitive triad = neg view of self, current experience & the future |
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Core Concepts of CBT cont |
-Antecedent - Trigger - Interpretation - Danger -Behaviour - what it is we do or don't do -Consequences- feeling/emotion -Recording thoughts/feeling -Underlying beliefs/assumptions |
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Core Concepts of CBT cont |
-Beliefs 'I'm weird/odd/stupid/boring/useless' -There's no hope for me -What's the point -Assumptions = rules for living which develop early in life, possibly even before language/speech --I have to make others happy You must always obey rules |
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Core Concepts of CBT cont |
-Focus on thoughts, feelings & behaviours -Defines problem and goals -Formulation -Uses evidence -Collaborative -Structured -Encourages self help -Homework -Tests out new ideas & behaviours -Measures and records |
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Core Concepts of CBT cont |
-NATs hierachy: --responsibility/blame safety/danger choice/control self-detectiveness |
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Basic Assumptions |
The world is benevolent The world is meaningful The self is worthy Bad things don't happy to good people |
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General principles of CBT |
-Thorough behavioural assessment before treatment begins -Main goal of CBT is to help patients bring about desired changes in their lives -Treatment focuses on new learning and generalisation outside the therapy room -Problem solving - important element in CBT |
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General principles of CBT |
All aspects of therapy are made explicit to patient Collaborative effort between patient and therapist CBT is time limited with explicit goals Emphasis on here and now Patient is helped to recognise patterns of distorted thinking and dysfunctional behaviour |
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Language and CBT |
Language is neutral - statement f fact v. statements of value Certain kinds of words = emotional & judgemental eg mistake/error Absolute words (eg always/never)lead to feelings and leave little room to manoveure, rmotionally speaking Socratic questioning Sensations v feelings v emotions (catch all type words eg upset, awful, terrible) Taking responsibility - encourages use of I Emotional illiteracy - person does not have words to express feelings/ emotions |
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Formulation in CBT |
'formulation provides an hypothesis about patient's difficulties which draws upon psychological theory' Its purpose is to relate all patients complaints to one another and explain how the person developed these difficulties It provides a plan of intervention based on psychological processes and principles |
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Formulation in CBT |
■ Draws on Cognitive &Behavioural theory ■ CollaborativeEmpiricism between Pt& Therapist ■ CBT Formulations arealways provisional ■ Formulation provides aframework forintervention ■ Good therapeuticrelationship with Pt isnecessary in CBT ■ Focus on currentproblems and mutuallyagreed goals ■ CBT Formulation is notDiagnosis under anothername |
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Formulation in CBT |
■ Presenting Issues – in terms of Emotions, Thoughts &Behaviours ■ Precipitating Factors – Proximal External & Internal triggers forthe PIs ■ Perpetuating Factors – Internal & External factors that maintainthe PIs ■ Predisposing Factors – Distal External & Internal factors thatincreased Pt’s vulnerability to current PIs ■ Protective Factors – Pt’s Resilience & Strengths and SocialSupports available |
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Resource building |
■ Very important to developPatient’s resources/copingskills for Affect Regulation ■ Deep Breathing ■ Safe Place exercise ■ Boundary Development ■ Compassionate Mind ■ Mindfulness/Present Focus ■ Grounding ■ Challenging your Thoughts ■ Re-framing ■ Normalizing thefeeling/sensation ■ Validating their experiences |
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CBT treatment of anxiety, panic and phobias |
■ Exposure to the feared stimulus – Encourage Disconfirmingexperiences & Self-Mastery ■ Discourage safety seeking behaviours in real life ■ Behavioural Experiments ■ Graduated Desensitization/Hierarchy of FearedSituations/Objects/Stimuli ■ Cognitive Re-Structuring/Interweave ■ Challenge Pt’s Thoughts/Beliefs/ Assumptions ■ Review each session with Pt ■ Begin next session with Review of past week ■ Relapse Prevention |
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CBT Treatment ofAnxiety (GAD & Social), Panic & Phobias |
■ Agree TreatmentGoals/Manage Pt’sExpectations ■ Case Formulation ResourceBuilding – see earlier slide ■ Deep Breathing ■ Log Recording ofAnxiety/Stress ■ Safe Place exercise ■ Thought Stopping ■ Ruminating V Reflecting ■ Psychoeducation onAnx/PAs – Hand-outs ■ Information onFlight/Fight/FreezeResponse ■ Compassionate Mind/Mindfulness ■ Use Stories wheneverpossible & appropriate ■ Identify NATs ■ Identify Beliefs/Assumptions ■ What's the worst that canhappen? ■ Normalize body sensations |
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Conclusions |
■ When working with anxiety disorders, CBT isthe favoured evidence based approach ■ There is a great deal of evidence of it’seffectiveness – although this is sometimesdisputed ■ Anxiety interventions can be challenging but areeffective |
