Objectives of course overall:
1. To know the biological and psychological processes involved in stress and how it is experienced.
2. To know the phenomenology, symptomatology and the DSM classification of the anxiety disorders.
3. To have knowledge of psychological as well as neurobiological factors underlying the development and
maintenance of these disorders.
4. To have knowledge of the psychological treatment of anxiety disorders.
5. To be able to critically read and summarise scientific articles on these disorders.
6. In addition, the DSM V criteria for the disorders discussed in this course should be studied.
7. Make sure to practice with the mock exam on Canvas!
Problem 1 – Stress – March 2023
Learning Goals
1. What is (psychological) stress?
2. How do we react to it, which systems are involved? Key word: startle reflex.
3. How do pp cope with stress
4. Why do pp react diff to stressors? What causes it? Personality, temperament, exercise, meditation, experience?
5. Is there something like positive stress? Are there any good effects of stress?
6. What are the effects of diff mindsets/appraisals?
7. Differences between psychological or physiological stress.
8. Nature of stressor: frequency, recurring, chronic, cognition.
In Depth questions:
A) Your body under stress
1. What is stress and how can we measure its psychological and physiological correlates?
Sarafino:
When people (pp) say they’re ‘under a lot of stress’, it means they feel unable to deal with the demands of their
environment, and they feel tense and uncomfortable.
Tutor: Stress is the circumstance in which transactions lead a person to perceive a discrepancy between the physical or
psychological demands of a situation and the resources of their biological, psychological or social systems.
Keep in mind: a demand, resource or discrepancy may be either real or just believed to exist.
, The condition of stress has two components:
physical, involving direct material or bodily challenges psychological, how individuals perceive circumstances in
their lives.
Stress components can be examined in 3 ways:
1. Stimulus – stressors: one approach focuses on the environment: stress is a stimulus e.g. a demanding job.
Physically or psychologically challenging events are called stressors.
2. Response – strain: second approach treats stress as a response, focusing on pp’s reactions to stressors e.g.,
when person refers to stress as a state of tension. These responses can be psychological (thought patterns &
emotions) and physiological (when your heart pounds, mouth goes dry, and you perspire). These psychological
and physiological response to a stressor is called strain.
3. Process: third approach describes stress as a process that includes stressors and strains but adds an important
dimension: the relationship between person and environment. This process involves continuous interactions
and adjustments- transactions- between the person and environment affecting or being affected by each
other. According to this view, stress is not just a stimulus or response, but a process in which the person is an
active agent who can influence the impact of a stressor through behavioral, cognitive, and emotional
strategies. Pp differ in the amount of strain they experience from the same stressor.
Researchers have used several diff approaches for measuring stress.
Commonly used approaches involve assessing pp’s:
1. Physiological arousal: use electrical/mechanical equipment to take measurement of blood pressure, heart rate,
respiration rate or galvanic skin response (GSR). These indexes can be measured and recorded separately or altogether
by a polygraph (incorrectly referred to as lie detector test).
- Another way is biochemical analyses of blood, urine or saliva to assess the level of hormones that the adrenal glands
secrete during stress. Can test for two classes of hormones: corticosteroids (most important is cortisol) and
catecholamines (incl. epinephrine and norepinephrine).
+ Physiological measures are reasonably direct and objective, quite reliable, and easily quantified.
- Can be expensive, measuring technique on itself can be stressful.
- Measures of physical arousal are affected by gender, body weight and activity prior to measurement,
consumption of various substances.
2. Social Readjustment Rating Scale (SRRS): using a self-report measure. One approach many scales have used is to
develop a list of life events – list major happenings in one’s life where the scale assigns a value to the stressfulness of
each event. Widely used scale of life events is the Social Readjustment Rating Scale (SRRS) by Holmes & Rahe.
Constructed a list of events and assigned values to each event and constructed a scale where the values for life events
range from 100 points for death of a spouse to 11 points for minor violations of the law. Respondents then check off
the life events that happened during a period of time. The sum of the checked values = total stress score.
+ Represents a wide range of events that most pp in fact find stressful.
+ Values assigned to the events were carefully determined from the ratings of a broad sample of adults.
+ Survey can be filled out easily and quickly.
+ Correlation, but weak (check lecture)
- Items can seem vague/ambiguous, therefore not sensitive enough → reduces precision of instrument and the
correlation it’s likely to have with other variables.
- Depending on the age and cause of ‘death of spouse’ pp feel diff stress levels → doesn’t take pp subjective
appraisal into account, reducing the precision of the scale.
- Does not distinguish between (un)desirable events. ‘Change in financial state’ could be positive or negative but
either way, pp get the same score when checked.
- Emphasizes acute stressors involving single events rather than chronic stress.
- Susceptible to difficulties surrounding pp’s ability to recall events accurately and social desirability/
malingering.
3. Daily hassles HASS/Col: Lazarus et al. developed a scale to measure pp’s experiences with day to day unpleasant or
potentially harmful events. Hassles Assessment Scale/Col – lists 117 events that range from minor annoyances (silly
practical mistakes) to major problems or difficulties e.g., not enough money for food. Pp indicate which hassles
occurred in the past month and rate each event as ‘somewhat’, ‘moderately’ or ‘extremely’ severe.
, Also developed the Uplifts scale: cos having desirable experiences may make hassles more bearable and reduce their
impact on health. This scale lists 135 events that bring peace, satisfaction, or joy.
+ More sensitive, rating from ‘somewhat’ to ‘extremely’
+ Events from the past months, not whole life
All measures have strengths and shortcoming, but they have generally been effective in demonstrating that stress is
linked to an increased risk of future (major) health problems.
Draw a schematic diagram of the stress reaction in your body including the autonomic nervous system (ANS)
and the HPA axis. Then discuss the various parts and the effects and function of both systems.
Sarafino:
HPA Axis: Hypothalamus signals the anterior pituitary gland to secrete
ACTH which signals the adrenal cortex that releases cortisol (slow – helps
with restore/cope with stress later in time) enhancing the body’s
mobilization.
ANS/SNS: adrenal medulla – releases epinephrine/norepinephrine (faster
route – fight or flights).
Fight-or-flight response: the perception of danger causes the sympathetic
nervous system (SNS) to stimulate many organs, such as the heart directly,
and stimulates the adrenal glands of the endocrine system, which secrete
epinephrine, arousing the body still further. This response is adaptive
because it mobilizes the organism to respond quickly to danger, but this
high arousal can be harmful to health if it is prolonged.
https://www.youtube.com/watch?v=QAeBKRaNri0&t=18s
3. What is the general adaptation syndrome
and allostatic load?
Sarafino: General Adaptation Syndrome (GAS) by
Selye (1956): when stress is strong and prolonged,
the physiological reaction goes through 3 stages:
1. The alarm reaction: fight or flight response
to an emergency – its function is to
mobilize the body’s resources. Acts from
the sympathetic nervous system, which
activates many organs through direct
nerve connections incl. adrenal glands,
which when stimulated release
epinephrine and norepinephrine into the
bloodstream, producing further activation.
Somewhat less quickly the HPA axis of the
stress response is activated which trigger
the pituitary gland to secrete ACTH, which
causes the adrenal gland to release
cortisol into the bloodstream, further
enhancing the body’s mobilization.
https://www.youtube.com/watch?v=QAeBKRaNri0
2. Stage of resistance: if a strong stressor
continues, the initial reaction of the
sympathetic nervous system becomes less
pronounced and important, and HPA
activation predominates. Physiological arousal remains higher than normal, and the body replenishes the
hormones the adrenal glands released. The organism may show few outwards signs of stress, but the ability to
, resist new stressors may become impaired. This impairment may eventually make the individual vulnerable to
health problems called diseases of adaptation incl. ulcers, high blood pressure, asthma.
3. Stage of exhaustion: prolonged physiological arousal produced by severe long-term or repeated stress is costly
and can weaken the immune system and deplete the body’s energy reserves until resistance is very limited. At
this point → stage of exhaustion, if stress continues, disease and damage to internal organs are likely and death
may occur.
4. Allostatic load is "the wear and tear on the body" which accumulates as an individual is exposed to repeated or
chronic stress with fluctuations in levels of hormones like cortisol and epinephrine, blood pressure and immune
function, that accumulate over time. Impairs body’s ability to adapt to future stressors. The concept of allostatic
load highlights the importance of considering the overall accumulations of physiological strain over time.
Tutor: Four factors are important in the overall amount of bodily activation/ physiological stress:
1. Amount of exposure: when we encounter more 2. Magnitude of reactivity: some pp will show large
frequent, intense, or prolonged (continuing for a long increases in blood pressure or stress hormones while others
time) stressors, we are likely to respond with greater show much smaller changes. This depends on cognitive
total amount of physiological activation. appraisal and past experiences.
3. Rate of recovery: once the encounter with a stressor 4. Resource restoration: resources used in physiological
is over, physiological responses return to normal quickly strain are replenished by various activities and sleep may be
for some pp, but stay elevated for a longer time for the most important of them. Sleep deprivation can be a
others. Continuing to think about a stressor after it is source of stress and contributes to allostatic load directly.
over, revisiting it mentally, or worrying about it recurring The restoration of stress resources has a major impact on
in the future can delay physiological recovery and add to allostatic load and related health consequences. When
the accumulated toll through prolonged physiological combined, the aforementioned factors determine our
activation. overall physiological stress burden.
Do all stressors produce the same physical reactions?
The physiological reactions GAS describes will occur regardless of whether the stress results from e.g., very cold
temperature, physical exercise, illness etc. So, they are non-specific according to Selye (1956): he assumes that all
stressors produce the same physiological reactions and fails to include the role of psychosocial factors in stress.
Criticism:
Marianne Frankenhaeuser: pattern of physiological arousal under stress depends on two factors:
1. Effort involves the person’s interest, striving and determination,
2. Distress involves anxiety, uncertainty, boredom, and dissatisfaction.
Effort with distress: accompanied Effort without distress: joyous. Characterized Distress without effort: feeling
by an increase of both by active and successful coping, high job helpless, losing control, giving
↗ catecholamine* and ↗ cortisol involvement, and a high degree of personal up. Generally accompanied
excretion. Common among pp control. Increased ↗ catecholamine primarily by increased ↗ cortisol
engaged in repetitive machine- secretion but suppressed ↘ cortisol secretion. Catecholamines may
paced jobs. secretion. be elevated.
*Catecholamine: type of neurohormone (a chemical that is made by nerve cells and used to send signals to other cells). Catecholamines are important in stress
responses. High levels cause high blood pressure which can lead to headaches, sweating, pounding of the heart, pain in the chest, and anxiety.
