STRESS:

Health psychology is concerned with the effects of stress and other psychological
factors in the development and maintenance of physical problems. Is a subspecialty within
behavioral medicine (concerned with psychological factors that may pre dispose an individual
to medical problems). Stress affects the mind as well as body. Exposure to extreme and
traumatic stress may over whelm the coping resources of otherwise apparently healthy people,
leading to mental disorders such as posttraumatic stress disorder (PTSD).

WHAT IS STRESS?

When we experience or perceive challenges to our physical or emotional well-being

that exceed our coping resources and abilities, the psychological condition that results is typi
cally referred to as stress. The exteral demands are stresors, the effect they create in the
organism is stress, and the efforts to deal with it are coping strategies. Stress reflects the
interaction between the organism and the environment.

All situations that requiare adjustment can be regarded as potentially strssful. Stress
can occur in negative and positive situations as well. Bad stress is call distress.

The role of stress is recognized in diagnostic formulations. There are disorders that
involve patterns of psychological and behavioral disturbances that occur in response to
identifiable stressors. The key differences among them lie not only in the severity of the
disturbances but also in the nature of the stressors and the time frame during which the
disorders occur.

FACTORS PREDISPOSING A PERSON TO STRESS:

People perceive and interpret similar situations differently and also because,
objectively, no two people are faced with exactly the same pattern of stressors. . This may be
linked, in part, to coping skills and the presence—or absence—of particular resources.

Individual characteristics that have been identified as improving a person’s ability to

handle life stress include higher levels of optimism, greater psychological control or mastery,
increased self-esteem, and better social support. These stable factors are linked to reduced
levels of distress.

Our genetic makeup can render us more or less “stress sensitive”. The 5HTTLPR gene
was linked to how likely it was that people would become depressed in the face of life stress.
The amount of stress we experience early in life may also make us more sensitive to stress later
on, the effects of stress may also be cumulative. Some experiments suggest that prior stressfyl
experiences may sensitize us biologically, making us more reactive to later stressful
experiences. Stressful experiences may also create a self- perpetuating cycle by changing how
we think about, or appraise, the things that happen to us (may change our cognitions). *
people with a history of depression tend to experience neg ative events as more stressful than
other people do.
CHARACTERISTICS OF STRESSORS:

Key factors involved: severity, its chronicity (hoy it lasts), its timing, how closely it
affects our own lives, if it was expected and how controllable it is. The longer a stressor
operates, the more severe its effects. Encautering a number of stressors also makes a
difference.

Events that are unpredictable, and for which the person has not developed coping
strategies, are likely to place a person under severe stress. With uncontrollable stressor, there
is no way to reduce its impact, such as by escape or avoidance. In general, both people and
animals are more stressed by unpredictable and uncontrollable stressors than by stress ors that
are of equal physical magnitude but are either pre dictable or controllable or both.

The term crisis is used to refer to times when a stressful situation threatens to exceed
or exceeds the adaptive capacities of a person or a group. Crises are often especially stressful,
because the stressors are so potent that the coping techniques we typically use do not work.

MEASURING LIFE STRESS: The Social Readjustment Rating Scale is a self-report checklist
of common stressful life experiences.

RESILIENCE:

After experiencing a potentially traumatic event, some people function well and
experience very few symptoms in the following weeks and months. This kind of healthy psy
chological and physical functioning after a potentially traumatic event is called resilience. It is
the most common reaction following a trauma. No single factor predicts resilience, it is linked
to a variety of different characteristics and resources. It also helps to be a positive person.
People who are self-confident also tend to cope remarkably well in the face of trauma.

STRESS AND PHYSICAL HEALTH:

The biological cost of adapting to stress is called the allostatic load. When we are
relaxed and not experiencing stress, our allostatic load is low. When we are stressed and
feeling pressured, our allostatic load is higher.

Any stress may tend to aggravate and maintain certain dis orders, such as migraine
headaches. Stress also increases the risk of having a heart attack or catching a cold. Mental
stress is known to raise blood pressure and also to cause an elevation in epinephrine. Mental
stress may also reduce the oxygen supply to the heart muscle.

THE STRESS RESPONSE.

Faced with the threat of a perceived stressor, the body undergoes a cas cade of
biological changes. Two distinct systems are involved here.

The sympathetic-adrenomedullary (SAM) system is designed to mobilize resources and

prepare for a fight-or-flight response. The stress response begins in the hypothalamus, which
stimulates the sympathetic nervous system (SNS) and causes to secrete addrenaline and
noradrenaline. This at the same time cause an increase in heart rate (the body metabilize
glucose more rapidly).

The second system is hypothalamic-pituitary-adrenal system. In addition to stimulating

the SNS, the hypothalamus releases a hormone called corticotropin-releasing hormone (CRH).
Traveling in the blood, this hormone stimulates the pituitary gland. The pituitary then secretes
adrenocorticotropic hormone (ACTH). This induces the adrenal cortex (the outer por tion of the
adrenal gland) to produce the stress hormones called glucocorticoids (produce corticol). This
hormone prepares the body for fighting and inhibits the innate immune respose, escape has
priority over healing. This has survival value. But there is also a downside to cortisol. If the
cortisol response is not shut off, cortisol can damage brain cells, especially in the hippocampus.
Although short-term cortisol production is highly adaptive, a chroni cally overactive HPA axis,
with high levels of circulating cortisol, may be problematic.

THE MIND-BODY CONNECTION:

Stress may cause an overall vulnerability to disease by compromising immune

functioning. Psychoneuroimmunology is the study of the interactions between the nervous
system and the immune system. A person’s behavior and psychological state can affect immune
functioning. We have already seen that glucocorticoids can cause stress-induced
immunosuppression. It makes sense that longer-term stress might create problems for the
immune system.

IMMUNE SYSTEM:

The immune system protects the body from such things as viruses and bacteria. The
front line of defense in the immune system is the white blood cells. There are tow types B-cell,
produces specific antibodies that are designed to respond to specific antigens (foreign bodies,
viruses, bacteria, tumors, cancer cells); and T-cell (circulates through the blood in an unactive
form, they have to recognise the antigens by the macrophages on their surface) . When the
immune system is stimulated, B-cells and T-cells become activated and multiply rapidly,
mounting various forms of counterattack. When a B-cell recognizes an antigen, it begins to
divide and to pro duce antibodies that circulate in the blood. This process is facilitated by
cytokines (produce by T-cells).

- STRESS AND IMMUNE SYSTEM FUNCTIONING:

Stress slows the heal ing of wounds by as much as 24 to 40 percent. Although short-
term stress compromises the immune system, it is the more enduring stressors which
are associated with the most global immunosuppression.

- STRESS AND CYTOKINES:

Cytokines are small protein molecules that are an important component of the
immune system. Cytokines serve as chemical messengers and allow immune cells to
communicate with each other. Moreover, they influences the brain, when we are sick,
come symptoms of illness result, at least in part, from the effects of specific cytokines
on the brain. Researchers have now identified a previously unknown “highway” that
 connects the brain directly to the peripheral immune system. This allows immune cells
to travel from the brain to the peripheral immune system and back again.

In the opposite direction, chronic problems at the level of the immune system may
lead to behavioral changes or even to psychiatric problems. For example, as we men
tioned earlier, patients who have cancer are sometimes treated with cytokines to
activate their immune systems.

Under conditions of stress, the production of proin f lammatory cytokines is disrupted.

This affects the healing of wounds.

CHRONIC STRESS AND INFLAMMATION:

Evidence is growing that inflammation—increased levels of proinflammatory cytokines

—is increased in peo ple who are under prolonged stress. Long term stress seems to interfere
with the body’s ability to turn off cytokine production. Under ordinary conditions, IL-1 and
other cytokines stimulate the HPA axis (refer back to Figure 5.3), leading to an increase in
cortisol (which is supposed to regulate cytokine production). Cytokine production sets off a
negative feedback loop that is designed to prevent an excessive or exaggerated immune or
inflammatory response. Chronic stress, however, seems to impair the body’s ability to respond
to the signals that will terminate immune system reactivity. The result is inflammation, and is a
risk factor for a wide range of health problems and diseases.

STRESS AND PREMATURE AGING:

Traumatic stressors that are experienced during childhood seem to increase risk of
premature death in later life. there is reason to suspect that early life stress may have biological
consequences that advance aging, making it more likely that people will die earlier from the
kinds of diseases (cancer, heart disease) that are associated with increased age. Telomeres may
be parto f the answer. They shorten with age, if they get to short, cells do not function
correctly and the risk of disease is increased. Stress shorten the lenght of telomeres. We know
that telomere length is maintained by an enzyme called telomerase and that the stress
hormone cortisol can reduce the activity of this enzyme.

EMOTIONS AND HEALTH:

Type A behavior is characterized by excessive competitive drive, extreme commitment

to work, impatience or time urgency, and hostility. Early findings suggested that Type A
personality was associated with a twofold increased risk for coronary artery disease and an
eightfold increased risk of having a heart attack. It is the hostility component of the Type A
construct (including anger, contempt, scorn, cynicism, and mistrust) that is most closely
correlated with coronary artery deterioration.
 People with Type D personality have a ten dency to experience negative emotions and
also to feel insecure and anxious. Men with CHD who scored high on measures of chronic
emotional distress were more likely to have fatal and nonfatal heart attacks.

DEPRESSION:

Like stress, depression is associated with disrupted immune function. The state of
being depressed adds something beyond any negative effects of the stressors precipitating the
depressed mood. Depression also appears to be a risk factor for the devel opment of CHD. The
link between depression and future heart problems also remained even when other potential
confounding variables such as lifestyle were taken into account. . Depression may then interact
with stress to further enhance the inflammatory responses that are naturally triggered by
stress exposure, rather like putting gasoline on a fire. New findings also suggest that people
who are depressed have shorter telomeres.

ANXIETY:

Research has also demonstrated a relation ship between phobic anxiety and increased
risk for sud den cardiac death.

SOCIAL ISOLATION AND LACK OF SOCIAL SUPPORT:

Lonely people are also at increased risk of developing heart disease. Women who
report feelings of loneliness are more likely to develop heart disease. It may be that the stress
that comes from marital tension or from a lack of social support triggers an inflammatory
response in the immune system, causing depression and heart prob lems as a result. It may
also be that depression, which is linked to relationship problems, could trigger an inflam
matory response in its own right.

POSITIVE EMOTIONS:

On the other hand, an optimistic outlook on life, as well as an absence of negative

emotions, may have some beneficial health consequences. Although f leeting feelings of anger
probably do us no real harm, peo ple who have a tendency to brood about the wrongs that
other people have done to them may be doing themselves a major disservice. To the extent
that perpetuating feelings of anger and increasing cardiovascular reactivity have con sequences
for heart disease and immune system functioning. Being forgiving also acts as a buffer against
the effects of stress on mental health, although no similar association was found for physical
health.

EMOTION REGULATION:

It was found that it was the people who were least able to control their anger who
developed more heart prob lems during the next 10 to 15 years. In an experimental study
involving 37 healthy females, these researchers were able to show that people who had better
cognitive control (which was assessed via a laboratory task) had a less pronounced increase in
pro-inflammatory cytokine production in response to watching an emotionally stressful video.

Self-regulation skills may be very important for our psychological and physical well-
being.
TREATMENT TO STRESS-RELATED PHYSICAL DISORDERS:

Once an illness has developed and physical changes have taken place, removal of the
stressor may not be enough to bring about recovery and restore health.

- BIOLOGICAL INTERVENTIONS: serious physical diseases require medical treatment. For

CHD patients, surgical proce dures as well as medications to lower cholesterol or
reduce the risk of blood clots. Treating depression is also of the utmost importance.
Physicians often fail to treat depression in their cardiac patients. Research shows that
thousands of lives can be saved each year by giving antidepressant medications to
patients who have suffered a myocardial infarction and who are depressed. (the
cognitive therapy did not have effect on reducing mortality for heart disease).
- PSYCHOLOGICAL INTERVENTIONS: emotional disclosure, writing expressively about life
problems in a systematic way does seem to be an effective therapy for many people
with illnesses. Expressive writing also seems to provide some modest benefits for
people who have been diagnosed with autoim mune illnesses. Another possibility is
that writing gives people an opportunity to rethink their problems or reduce how
threatening these problems seem. Biofeedback, aim to make patients more aware of
such things as their heart rate, level of muscle tension, or blood pressure. This is done
by con necting the patient to monitoring equipment and then providing a cue. Over
time, patients become more con sciously aware of their internal responses and are
able to modify them when necessary. Relaxation and meditation, evidence suggests
that relaxation techniques can help patients with essential hypertension. Meditation
may be helpful in reducing blood pressure. Cognitive-behavior therapy, effective
intervention for headache.

STRESS DISORDERS:

Although stress is a necessary cause, meaning that it has to be present for these
disorders to develop, it is not a sufficient cause. Not every one who experiences stress will
develop a stress-related disorder.

ADJUSTMENT DISORDER:

Is a psychological response to a common stressor that results in clinically signidicant

behavioral or emotional symptoms. In adjustment disorder, the person’s symptoms lessen
or disappear when the stressor ends or when the person learns to adapt to the stressor. In
cases where the symp toms continue beyond 6 months.

*Adjustment disorder caused by unemployment.

POSTTRAUMATIC STRESS DISORDER:

The experience of major stress is central to the development of all of these conditions.
Disorder that has a clear and explicit cause (trauma). Traumatic stressors include combat,
rape, being con fined in a concentration camp, and experiencing a natural disaster such as
a tsunami, earthquake, or tornado. Natural recovery with time is therefore a common
pattern. In the case of PTSD, however, the stress symptoms fail to abate even when the
 traumatic event has passed and the danger is over. This makes PTSD a disorder of
nonrecovery. What becomes established is a memory of the traumatic event that results in
the traumatic event being reexperi enced involuntarily and with the same full emotional
force that characterized the original experience.

ACUTE STRESS DISORDER:

Those who had symptoms within 2 weeks of the assault would not be diagnosed with
PTSD. Instead, the diagnosis would be acute stress disorder. Acute stress disorder is a
diagnostic category that can be used when symptoms develop shortly after experiencing a
traumatic event and last anywhere between 3 days to one month.

PTSD, CAUSES AND RISK FACTORS:

A traumatic evento is thought to cause a pathological memory that is at the center of

the characteristic clinical symptoms associated with the disorder. These memories are often
brief fragments of the experience and typically concern events that happened just before the
moment with the largest emotional impact. There are four main areas of symptoms: intrusion,
avoidance, negative alterations in cognitions and mood, and arousal and reactivity.

Causal factors:

Not everyone who is exposed to a traumatic evento will develop PTSD, some people
are more vulnerable tan others. The nature of the traumatic stressor and how directly it was
experienced can account for many of the differences in stress response.

Individual Risk Factors. There is risk for experiencing trauma and there is also risk for
PTSD given that there has been exposure to trauma. Risk factors that increase the likelihood of
being exposed to trauma include being male, having less than a college education, having had
conduct problems in childhood, having a family history of psychiatric disorder, and scoring high
on mea sures of extraversion and neuroticism. Low levels of social support have also been
noted as a risk factor.

On the other side of the coin, are there factors that may be protective and buffer
against PTSD? Good cognitive ability seems to be important here. Perhaps people with higher
cognitive abilities are more naturally able to incorporate their trau matic experiences into their
life narratives in ways that are ultimately adaptive and emotionally protective.