Understanding stress (2003)

Understanding Stress
Dr Zahiruddin Othman
Jabatan Psikiatri, PPSP
Last updated 03/03/03

Fight Or Flight Phenomenon
 Cannon, 1939: stress as a "fight or flight"
phenomenon ... helps us to mobilize energy to
either defeat the stressor or to get away from it
 Modern stress has more social or psychological
stressors than physical stressors
 An ego-related stressor cannot be reduced by using a
physical response (e.g. fight)
 May also continue over a longer time than a physical
stressor
 An imagined stressor is impossible to fight via physical
means

Good And Bad Stress
 Hans Selye, 1956: stressors are part of normal
daily life and can be divided into the good and the
bad:
 Eustress
 Action-enhancing stress which can help in sport or in
motivating someone to get moving
 Distress
 Either over-reaction or under-reaction, but always associated
with confusion, lack of concentration and psychological
anxiety

Eustress is the action-enhancing stress that
gives athlete the competitive edge
EustressEustress DistressDistress
Optimal StressOptimal Stress
Health and
Performance

Stressors vary in severity and how
often they occur in our life

Catastrophes
 Are large-scale events
that disrupt the lives
of many people and
strain or overwhelm
community services.
 Examples include
natural disasters
such as hurricane,
floods, and famine
Meteor Collision

War is a man made disaster – water and sanitation, electricity,
food stores, and food supply routes are destroyed

Major Life Changes
 Are milestone events in a person's life,
which cause substantial change in one's
daily routine.
 Examples include graduating from college,
changing jobs, getting married or divorced,
breaking up a long-term relationship, having
a family member diagnosed with a chronic
disease, death of a loved one, moving,
becoming a parent, and so on.

Major life changes happen once or only a
few times in a person's life

Becoming a parent is one of the major life changes

Daily Hassles
 Are annoyances encountered in daily life.
 Examples include traffic problems,
differences in lifestyles between roommates,
deadlines, expectations of parents or teachers,
bills and money problems, bad weather, car
problems, and so on.

Daily hassles are not necessarily encountered everyday but
represent disruptions of or annoyances to one's daily routine

Intervening factors filter and modify
the stressors

Intervening Psychological Factors
 The way individuals perceive stressors can
influence physiological reactions and subsequent
development of real physical illness.
 Some examples of factors that influence how
people perceive stress, which in turn affect
health, include
 Perceived Control
 Type A Personality
 Social Relationships
 Lifestyle and Habits

Appraisals occur at subconscious and conscious level

The Triune Brain
 The Thinking Brain
 Intellectual
 Abstract imagery
 The Emotional Brain
 Emotional
 Dream imagery
 Metaphoric imagery
 The Physical Brain
 Physical input/ output
 Concrete imagery

Emotions, Thoughts And Beliefs
 Emotions
 Usually the result of thoughts
 e.g. anger, fear, joy, guilt, jealousy, love, courage, sadness
 Thoughts
 Conscious thought operates as a control system
 e.g. focus on some goal leads to action for accomplishment of the
goal
 Conscious mind chooses behaviors in order to handle overload
 e.g. withdrawing from a situation which is too difficult
 e.g. being depressed or miserable
 Beliefs
 Beliefs are thoughts which endure over time
 Learned early in life from others
 Help to what we do and how we evaluate what we do

Core Beliefs And
Negative Automatic Thoughts
 Core Beliefs + Stressor
 I am unlovable + break-up with boyfriend
 Automatic Thoughts + Thinking Errors =
Negative Automatic Thoughts
 Personalizing, magnifying & minimizing etc
 Negative Emotions
 Depression

Optimistic Explanatory Style
 Perceived control lead to longer life (Seligman's
study of baseball players) and greater job success
(Seligman's life insurance salesman study)
 Attributions (explanations about past events) &
optimism or expectations about the future
 Global, stable & internal dimensions
 Positive events with global stable, & internal attributions +
negative events with specific, unstable, and external
attributions seem to promote optimism

Perceived Control
 Attribution
 Internal or external
 Stable or unstable
 Global or specific
 Locus of control
 Internal or external

Attributions For Negative Events

Pessimistic Explanatory Style
 Seligman's executive
monkey, dog, rat studies
 Lack of control led to
ulcers, failure to learn in
new situation when
control was possible
 Loss of perceived control
leads to learned
helplessness

Coping Styles
 Emotional-based coping
 Focus on emotions due to stress
 i.e. stress reaction
 Problem-based coping
 Focus on the events causing stress
 i.e. stressors
 What happen in learned helplessness?
 Pessimism  no action
 GAS: alarm  resistance  exhaustion

Characteristics of a Type A
Behavior Pattern
 Hurry sickness
 A sense of time urgency; trying to accomplish too much in too
little time.
 Quest for numbers
 Preoccupied with ratings, being better than others, earning more
money, etc.
 Insecurity of status
 Strong need for "objective" measure of self-worth, pursues
achievement to get admiration from others.
 Aggression & hostility
 Competes with or challenges others continually; struggles to
beat others, quick-tempered and angry

Type A personality individual is preoccupied with ratings,
being better than others, earning more money, etc.

Aggressive or Passive
 Aggressiveness
 Demanding
 Does not consider the other person's self esteem
 Belittles the other person (e.g. they are "dumb" for not
agreeing)
 Usually results in counter-aggression
 Communication usually blocked ... everyone leaves dissatisfied
 Non-assertiveness = NOT saying what you feel ... being
passive
 Might sit back and hope that others will notice their needs
 Might use manipulation

Practice Assertiveness
 Being assertive (Albert & Emmons, 1995)
 OK to say no ... no guilt
 OK to change your mind
 OK to take your time before doing something
 OK to ask for further instructions
 OK to demand respect
 OK to do less than you can do
 OK to express your feelings
 OK to feel good about yourself ... whenever ...
wherever

Being assertive means saying what you feel but
not being aggressive

Psychosocial Factors
 Relations between people and other people
 Same events interpreted differently by
different individuals
 Adaptation
 Overload
 Frustration
 Deprivation
 Trauma

Social Readjustment Rating Scale
(Holmes & Rahe)
 Concept of a "life change unit" (LCU) which could be
large (e.g. death of a spouse = 100 LCU's) or small (e.g.
violation of the law = 11 LCU's)
 Any kind of change (good news or bad news) requires
adaptation
 NB: of course, bad news is generally harder to take because it
involves fear, self doubt and other emotions
 There are individual differences in the perception of
events (e.g. good or bad news):
 Since novelty is stressing, having had an experience before
helps one to adapt to it again
 However, some events are stressing regardless of previous
experience (e.g. moving)

LCU – Life Events Of A College Student
100100 – Death of a close family member
80 – Jail term
63 – Final year or first year in college
60 – Pregnancy (to you or caused by you)
53 – Severe personal illness or injury – 53
50 – Marriage
45 – Any interpersonal problems
40 – Financial difficulties
40 –Death of a close friend
40 – Arguments with your roommate (> EOD)

LCU – Life Events (2)
40 – Major disagreements with your family
30 – Major change in personal habits
30 – Change in living environment
30 – Beginning or ending job
25 – Problem with your boss or professor
25 – Outstanding personal achievement
25 – Failure in a course
20 – Final exams
20 – Increase or decrease dating
20 – Change in working conditions

LCU – Life Events (3)
20 – Change in your academic major
18 – Change in your sleeping habits –
15 – Several-day vacation –
15 – Change in eating habits
15 – Family reunion
15 – Change in recreational activities
15 – Minor illness or injury
11 – Minor violations of the law

Interpreting The Scale
 Predictor of physical and mental illness for
a-two year period after the accumulation of
the stressors
 i.e. Total LCU in 12 months
 Level of life change stress
 Low: < 150
 Moderate: 150 – 300
 High: > 300:

Frustration
 When we are prevented from achieving our goals,
we become frustrated
 Discrimination
 Bureaucracy
 Socioeconomic factors
 Responses to frustration
 Anger and aggression
 Nervous and hormonal response (i.e. the stress
response)

Overload
 Demands > capacity
 Can arise from a variety of sources:
 Time pressures
 Too much responsibility/accountability
 Lack of support
 Expectations which are too high

Occupational Overload
 Sources of occupational overload
 Responsibility/accountability
 Lack of managerial/subordinate support
 Unreasonably high role expectations
 Air traffic controllers
 Example too much occupational overload
 Stress-related diseases - hypertension, peptic ulcers,
diabetes
 Grayson, 1972: 32.5% suffering from gastrointestinal
ulcers

Deadlines are common source of
occupational overload

Academic Overload
 Demands on teachers (Cooper, 1995)
 Research, community service, teaching,
advising, parent-student counseling, etc.
 Demands on students
 Competition for entry into university (then
entry into graduate school)
 Admissions tests
 Need for mental health counseling in educational
institutions

Deprivational Stress
 Boredom
 Could be due to monotonous tasks, unchallenging
work
 Boredom and depression are major adolescent health
problems
 Loneliness
 Not enough care and attention to children  stimulus
deprivation
 Lynch, 1977: rate of heart disease, cancer and auto
accidents higher in single, widowed and divorced
individuals. Unmarried men 45-54 years = 123%
higher death rate than married men

Bioecological Factors
 Interpreted more or less the same by
different people
 Time and body rhythm
 Eating and drinking habit
 Drugs
 Noise pollution
 Climate and altitude

Stress reactions occur at various levels –
physiological, emotional, and behavioral

Physiological Reaction
 When people experience stressors, the typical
physiological reaction is a "fight-or -flight
response."
 The sympathetic nervous system (SNS) is
activated, arousing the body to either escape from
or defend against the stressor.
 With mild stressors, the "fight-or-flight" response
includes release of excitatory neurotransmitters
and hormones, increased heart rate and blood
pressure, more rapid and shallow respiration, and
perspiration on brow or palms.

Psychosomatic Health
 Control of the stress response
 Autonomic nervous system
 Endocrine system
 Control of health and disease
 Immune system
 Neuropeptide system

Sympathetic Nervous System
 Initiation of the stress response
 “Fight or flight" energizing
 increased HR
 increased stroke volume
 constriction of blood vessels in gastrointestinal tract
 deeper and faster breathing
 pupil dilation
 adrenalin release from adrenal glands
 fatty acid release from liver
 epinephrine, norepinephrine and dopamine release

Sympathetic nervous system is activated
during “fight or flight” response

Parasympathetic Nervous System
 Relaxation and termination of the stress
response
 slow down HR
 expansion of most blood vessels ... increased
gastrointestinal activity
 bronchial constriction
 pupil constriction
 salivary increase

Autonomic Control of the Stress
Response
 Hypothalamus coordinates the body's response to sight,
sound, touch, smell and taste
 i.e. the fact of the reaction
 Limbic system defines the sensation as being either
pleasurable or not pleasurable
 i.e. the direction of the reaction
 RAS defines the degree to which something is either
pleasant or unpleasant
 i.e. the degree of the reaction
 Cortex either boosts the present state, or attenuates it
 i.e. on the basis of what is reasonable or how it is related to
other memories

The Adrenal Glands
 Adrenal Medulla
 Neuronal stimulation from hypothalamus
 Secretes epinephrine (adrenalin), norepinephrine, dopamine
 Adrenal Cortex
 Stimulated by ACTH
 Secretes glucocorticoids (cortisol):
 Increases energy availability via gluconeogenesis in the liver
 Suppress immune system
 High levels of fatty acids contribute to atherosclerosis
 Secretes aldosterone:
 Sodium and water retention ... better heat/waste dissipation
 Problem - increased blood volume and BP ... more work for
the CV system

General Adaptation Syndrome
 Alarm Phase
 Initial response to a
stressor
 Increased ACTH
from pituitary gland
 Stimulation of
adrenal glands
 Fight or flight
response
 Generalized stress
arousal
 Resistance Phase
 Channeling of
arousal response to a
specific organ
 Decreases in ACTH
 Arousal of a specific
organ system ...
eventual fatigue and
malfunction
 Adaptation to stress
eventually becomes
a disease in itself

General Adaptation Syndrome
 Exhaustion Phase:
 Specific organ
system involved in
the resistance phase
breaks down
 Increased ACTH
again
 Exhaustion,
malfunction or death

Responses To Stress
 Body
 Psychosomatic illness
 e.g. essential hypertension, tension headache
 Mind
 Mental illness
 e.g. depression, anxiety etc
 Behavioral
 Ineffective coping styles
 e.g. conduct problem, drug addiction

Understanding stress (2003)

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