This is the Chapter 11 of the book Introduction to Health Psychology (Val Morrison_ Paul Bennett) 4th Edition. Which is content for the exam of the component Health Psychology of Module 5 (Health Psychology & Applied Technology) of the University of Twente, in the Netherlands. 

Ch.11: Stress, health and illness

Stress:

• Stimulus or event external to the individual
• Psychological transaction between the stimulus event and the cognitive and emotional characteristics of the individual
• Physical or biological reaction

Life events theory (Holmes and Rahe, 1967):

Naturally occurring life events --> unitary consequences + cumulative effects

• SRRS, Holmes and Rahe 1967: social readjustment rating scale, with values (life change units [LCU]) from 11 (minor violations of law) to 100 (maximum value was assigned to death of a spouse).
  • Social readjustment: intensity/length of time necessary to accommodate to a life event, regardless of the desirability of this event

Limitations of life events measurement:

• Retrospective assessment: ill people search for explanations for illness, which may include misattributions to past events.
• Items scale not globally appropriate --> depending on, events might not be applicable
• Items intertwined/interrelated: cancel out or enhance the effects of one another
• LCU system assumes people rank events in a similar way
• Inconsistencies reported with events rated as ‘severe’
• Life events approach: does not systematically address the many internal and external factors that may moderate the relationship event/outcomes.

Stress as a transaction:

• Psychological theories of stress: appraisal is central to whether or not an event is deemed to be a stressor or not.
  • Hans Selye (1974): physiological responses to stressful stimuli, and differentiates -->
    • ‘Eustress’: stress associated with positive feelings or healthy states
    • ‘Distress’: bad kind of stress associated with negative feelings and disturbed bodily states.
  • Cognitive Transactional Model of Stress (Lazarus and Folkman, 1984): participants exposed stressful films while monitoring self-reported stress levels and physiological arousal
    
    • Video about tribal initiation rites that included genital surgery. Intervention groups, with different introductions:
      
      • Distancing response: intellectual description of the rites from a cultural perspective --> taking a detached view  to reduce emotional activation
      • Denial response: lecture that de-emphasised the pain the ‘willing’ initiates were experiencing and emphasised the excitement they were feeling --> view that denies any negative implications of an event or stimulus
      • Emphasise perceived threat: narrative that emphasised the pain and trauma the initiates were undergoing
      • Control: no info
      • Introductions influenced the way in which the film was seen --> appraisal processes were mediating stress responses
    • Stress Lazarus: result of an interaction between:
      
      • Individual’s characteristics and appraisals
      • External or internal event (stressor) environment
      • Internal or external resources a person has available to them
      • When changing environment --> primary and secondary appraisal

Primary appraisal processes:

Considers the quality and nature of the stimulus event.

• Types:
  • Pose harm: damage that has already been done
  • Threaten: expectation of future harm
  • Set a challenge: results from demands that are appraised as opportunities for personal growth or opportunities
• Ego involvement: appraisals of threat to one’s sense of self or social esteem

Secondary appraisal processes:

Assesses one’s resources and abilities to cope with the stressor --> problem-focused or emotion-focused coping potential

• Dynamic process: stress arose from a mismatch between perceived demands and resources
• Smith: secondary appraisal became more complex, consisting of the following -->
  
  • Internal/external accountability (‘blame/credit’): attributing responsibility for the event
  • Problem-focused coping potential: extent situation is perceived as changeable by instrumental (practical, problem-focused) coping options.
  • Emotion-focused coping potential: perceiving an ability to cope emotionally with the situation
  • Future expectancy concerning situational change: refers to perceived possibilities of the situation being changeable, with perceptions of unchangeability also associating with sadness.

Factors influence appraisal:

Appraisal as stressful:

• Imminent: medical results due the next day
• Unexpected time: being widowed in one’s 40s
• Unpredictable
• Ambiguous: in terms of personal role (new job)/potential risk (surgery)/undesirable events (move house because of financial loss)
• No control over: noisy neighbours
• Life change: child birth
• physical stressor:  demand immediate physiological adaptation (e.g. being attacked)
• Chronic physical stressors: being ill
• Long-term physiological demands --> pain
• Psychosocial stressors: cognitions, emotions ­ and behavioural responses as well as the physiological arousal
• Acute-onset stressors: Natural disasters

Types of stress:

• ‘Conservation of resources’ model of stress: individuals are assumed to work to conserve or protect their valued resources. Stress will result --> actual/threatened loss of resources OR a lack of gain after investing resources

Acute stress:

Cataclysmic events:

Intense physical and psychosocial suffering

• Environmental stress theory (Fisher et al., 1984): considers stress to be a combined psychological and physiological response to demands
• Post­traumatic stress disorder: continuously relive the event in distressing dreams and/or suffer from ‘flashbacks’. Attempts at avoidance of such memories -->  raised level of arousal
• Study of lost resources: Resource loss was positively associated with long-term distress --> active coping efforts mediating this relationship

Exam stress:

• Yerkes–Dodson law (1908): key to good performance lies in not becoming over-aroused -->  optimum level of arousal necessary to maintain attention and memory
  • • Stress reactivity: exam stress --> affect bodily responses (blood pressure)
      • Some individuals seem to inherently be more stress-reactive than others

Chronic stress:

Occupational stress:

• Person-environment fit theories/‘Goodness-of-fit’ approach: stress from mismatch between environmental variables (demands) and person variables (resources)
  • Job demand–control (JDC) model of occupational stress, or job strain by Karasek: job features identified as leading to stress -->
    • Demand
    • Controllability
    • Predictability
    • Ambiguity
    • Others have suggested adding a more general ‘resources’ component
      
      • Whereby resources could include social support, or aspects of personal control, etc…
  • Effort/Reward Imbalance model: highlights what the individual ‘puts in’ to their work and notes how a lack of recognition or return for effort can be stressful
  • ‘Burn-out’: syndrome of gradually developing emotional exhaustion, depersonalisation and reduced personal accomplishment

Stress as a physiological response:

• ‘Response’ model of stress: react situations  coordinated physiological and behavioural response
  • Event appraised --> central nervous system (CNS): where sensory information and the appraisal of the event combine to initiate autonomic and endocrine (hormone) responses.

Early work stress response:

When released from the adrenal glands of the sympathetic nervous system as hormones, heighten arousal in order to facilitate the ‘fight or flight’ response.

• Response of physical arousal --> release of adrenaline --> facilitates the release of stored fuels for energy, which enables either running away or fighting the threat
  • Adaptive: enabled quick responses to threat
  • Harmful: disrupted emotional and physiological functioning. If prolonged -->
    
    • General adaptation syndrome: sequence of physiological responses to prolonged stress.
      
      • Response to stress an innate drive of living organisms to maintain internal balance
        
        •  Alarm reaction: awareness of a stressor can cause a downturn in bodily defences --> activation of the anterior-pituitary–adrenal cortex system
          
          • Release glucocorticoids into the bloodstream regulates the levels of glucose in the blood from which energy can be drawn
          • Cortisol: inhibits glucose and fat uptake by tissue cells so that more can be drawn on for immediate energy
            
            • Prolonged release of cortisol -->
        • Stage of resistance: body mobilises bodily defences to try to adapt to a stressor that has not subsided in spite of resistance efforts of alarm stage
        • Stage of exhaustion: if the resistance stage lasts too long, bodily resources and energy would result in exhaustion --> increased likelihood of ‘diseases of adaptation’: cardiovascular disease, arthritis and asthma

Later work stress response:

• ‘Nonspecific response’: Different physiological responses associated with different kinds of stressor
• Evidence:
  
  • Stress responses result activation of anterior–pituitary–adrenal cortex system, but also from increased activity of the sympathetic branch of the autonomic nervous system (ANS):
    
    • Sympathetic nervous system (SNS) (arousal and expenditure of energy --> ‘fight–flight’ response)/Parasympathetic nervous system (PNS) --> exist in a state of dynamic but antagonistic tension
  • Sympathetic–adrenomedullary system (SAM): Activation release of the catecholamines adrenaline and noradrenaline from the adrenal medulla --> enables immediate response to a stressor
  • Hypothalamic–pituitary–adrenocortical (HPA): enables bodily organs to alter usual function to facilitate longer lasting adaptive response to both internal and external stresses.
    
    • Elevates the production of growth hormones and prolactin, beta endorphins and encephalin
      
      • Beta endorphins have a useful analgesic (painkilling) functions
  • ‘Wear and tear’ McEwen (2008): resulting from chronic or repeated stress
    
    • ‘Allostatic load’: process of physiological response and adaptation to changes overloaded, challenged and ultimately fails.
    • Increased or dysregulated allostasis (stressed out): indirectly lead to illness by virtue of behavioural and physiological responses to this state (e.g. smoking/excessive comfort eating)
  • SAM and HPA systems: total coverage with regards to the stress response
    
    • Acute responses --> via adrenaline
    • More sustained responses --> via cortisol
  • Immune cells: white blood cells
    
    • Lymphocytes:
      
      • Specific immunity:
        
        • Cell-mediated immunity: T cells
        • Humoral-mediated immunity: involving B cells --> invading antigens in order to identify them for destruction and also ‘remember’ the antigen to enable early detection of future attacks
    • Phagocytes: attracted to sites of infection, and when they reach their destination they destroy abnormal cells or antigens
      
      • Non-specific immunity: first general line of defence
  • Natural killer (NK): body plasma slows down the growth of abnormal cells, so that other immune responses can attack
    
    • Non-specific natural immunity: defend against a wide variety of antigens
    • Specific and acquired immunity: provided by B and T cells is to those antigens to which they have been sensitised to (humoral-mediated immunity)
  • T-helper: produce chemical messengers signal to the brain when injury or infection has occurred. Role in triggering inflammatory responses

Age & Immune function:

• ‘Immunosenescence’: innate system of immune response declines

Stress and cardiovascular reactivity:

• ‘Reactivity hypothesis’: stress can cause alterations in physiological responses
• ‘Occupational hazard’: exposure to potentially stressful patterns of assessment and examinations (e.g. students)

Stress & Illness:

Indirect routes:

• Behavioural responses to stress (e.g. smoking, eating habits and drinking)
• Personality traits  and specific manners to respond to stress

Stress and coronary heart disease:

• Coronary heart disease (CHD): disease of the cardiovascular system --> gradual narrowing of blood vessels that supply the heart
  • Situations of acute stress --> increased cardiac output --> blood vessels constrict --> blood pressure increases
• Repeated or chronic stress --> activates sympathetic nervous system’s release of fatty acids --> metabolised by the liver into cholesterol --> build-up of cholesterol
• Release of catecholamines during stress --> increases the stickiness of blood platelets --> elevates the risk adhere to the artery walls --> reduced blood flow --> stroke or a heart attack

Stress and bowel disease:

• Irritable bowel syndrome (IBS): disorder of the lower large intestine --> stressful episode --> reactivity of the gut is greater and symptoms increased and may be maintained
• Inflammatory bowel disease (IBD): stress exacerbates the condition
  
  • Crohn’s disease (CD): occur anywhere in the gastrointestinal tract and is seen as inflammation of the outer intestinal wall
  • Ulcerative colitis (UC): involves inflammation of the lower colon

Stress and HIV/AIDS:

• AIDS: lentivirus (slow-acting psychologically stressful due to the continued social stigma attached to the disease --> disease progression influenced by depression, social support and coping responses