Stress in health and disease
Literature week 1
Stress occurs when demands are appraised as exceeding a person’s resources to cope.
Stressors are external or internal events that may trigger stress responses.
Acute stressors vs chronic stressors, daily hassles, traumatic stressors and role strain
(balancing home and work roles).
Stress responses are the various ways we respond to a stressor; cognitive, affective,
behavioural and physiological responses. There is not always a strong correlation between
these responses.
Physical responses to stress
The fight-flight response involves the sympathetic branch of the autonomic nervous system
as a fast first wave response, and the endocrine pathways of the
hypothalamic-pituitary-adrenal HPA axis as a slower, second wave response.
First wave: sympathetic nervous system
Second wave: HPA
SNS: medulla stimulates hormones as adrenaline and noradrenaline > stimulation of the
cardiovascular system (diversion of energy).
HPA: hypothalamus releases corticotropin releasing factor > endocrine > cortisol and other
hormones from the adrenal cortex > elevate blood sugar and increase metabolic rate
Under long periods of stress, the HPA-axis can become dysregulated and result in
chronically elevated levels of cortisol (the negative feedback loop does not work correctly)
Stronger physiological stress responses occur in situations that are novel, unpredictable or
uncontrollable.
Stress responsivity : people vary in how they respond to stress physiologically, determined
by nurture and nature.
Babies of mothers who had high levels of stress and anxiety during pregnancy are more
responsive to stressors, show more anxiety and fearfulness and are more likely to have
cognitive and attentional problems = foetal programming
Children who are more responsive to their environment (orchid children) have the best or
worst (physical and psychological health) outcomes depending on whether they are raised in
a positive or negative environment.
Next to fight-flight there is tend and befriend; seeking comfort and safety with others. More
often done by females.
Also reduces the negative effects of stressors. Comfort seeking > ↑ oxytocin & endogenous
opioids > ↓ reduced physiological stress responses and psychological distress.
Oxytocin > decreased SNS and HPA activity. > tend and befriend responses can buffer
against long-term negative impact of stressors on health.
,Stress and the immune system
SNS increases immune system activity.
Prolonged HPA axis activation suppresses some immune activity through production of
cortisol, which has an anti-inflammatory effect and reduces both the number of white blood
cells and the release of cytokines. > immune dysregulation
So acute stress improves immune function, while chronic stress has a negative impact on
immune functioning.
Stress as a person-environment interaction
Appraisal processes are central and explain why there is so much variation in how different
people respond to stressors.
Interactional approach outlines 3 processes of appraisal:l
1. Primary appraisal
2. Secondary appraisal
3. Reappraisal
This constant interplay between appraisal, coping and reappraisal means stress is
conceptualised as a dynamic process.
Links between stress and health
It is difficult to establish the definitive pathways between stress and health. There are 3 main
issues.
1. the huge variation in how people respond to stressors
Allostasis: the process of regulating our physiological state to achieve stability, or
homeostasis.
Allostatic load: frequent or chronic activation of these systems result in a high allostatic
load (or strain) on the body. This can lead to an imbalance in allostatic systems and disease.
- Prolonged response
, Physiological systems remain in a continually high state which results in long-term
strain of the body.
- Inadequate response
One allostatic system does not respond adequately so other systems have to
overcompensate.
OR Lack of adaptation, with repeatedly high physiological stress responses.
Usually measured by a combination of biomarkers from the cardiovascular, metabolic,
immune and neuroendocrine systems.
Factors associated with allostatic load include: ethnicity, socioeconomic status, social
relationships, gender, lifestyle factors, exposure to stressors and genetic factors.
The concept of allostatic load is useful in that it provides a framework through which the
interaction between the environment and individuals’ bio behavioural responses can lead to
poor health outcomes.
2. it is usually not possible to say whether an illness is due (a) entirely to stress or (b)
entirely to other factors
3. The effect of stress on health can be due to behavioural, emotional or physical
responses to stressors.
The physical response to stressors is therefore not the only pathway between stress and
disease.
Vulnerability and resilience
vulnerability-stress model
Also clear that some people are very resilient (dandelion children).
Resilience: people showing swift recovery from stressful events, having sustainability of
purpose in the face of adversity, and growth or new learning from adversity.
Focus on a few factors associated with resilience:
1. Emotion and emotional disposition
, Positive emotional states and positive dispositions are associated with reduced mortality in
healthy people and in people with chronic illness.
Positive dispositions > better health
Negative emotions and emotional dispositions as a vulnerability factor is not as
straightforward. Depression is a clear vulnerability factor.
Neuroticism is also a vulnerability factor.
But: no consistent link.
2. Ways of coping
Emotion focused strategies : concentrate on reducing distress
VS
Problem-focused strategies : concentrate on dealing with the problem
Approach coping : try to deal with the situation proactively, predominantly active strategies
and share some overlap with the problem-focused strategies
VS
Avoidant coping : try to avoid the problem, so are predominantly emotion-focused.
For short term reduction of stress avoidant coping can be the best way to go, while for
chronic stressors, the approach coping is the best.
3. Social relationships and social support
Social relationships are critical to health, having a strong support network and relationships
has a direct positive impact on health and being socially isolated has a direct negative
impact on health.
Receiving support during a stressful event can buffer against the effects of stress, but this is
affected by a number of factors.
It is argued that the effect of support on health is due to knowing that other people are close
and available to support us, rather than due to actual support received during stressful
events.
Stress in medicine and healthcare
Stress burnout has 3 main symptoms:
1. Emotional exhaustion
2. Depersonalisation - having an unfeeling, impersonal approach to co-workers or
patients, cynicism, and a lack of engagement with the job or people
3. Reduced personal accomplishment - a poor sense of effectiveness, involvement,
commitment and engagement and a poor belief in one’s ability to change or improve
work patterns or environment.
Burnout
Poor performance, low job satisfaction, absenteeism, staff turnover. Headaches,
gastrointestinal disorders, hypertension, colds or flu, and sleep disturbances.
Literature week 1
Stress occurs when demands are appraised as exceeding a person’s resources to cope.
Stressors are external or internal events that may trigger stress responses.
Acute stressors vs chronic stressors, daily hassles, traumatic stressors and role strain
(balancing home and work roles).
Stress responses are the various ways we respond to a stressor; cognitive, affective,
behavioural and physiological responses. There is not always a strong correlation between
these responses.
Physical responses to stress
The fight-flight response involves the sympathetic branch of the autonomic nervous system
as a fast first wave response, and the endocrine pathways of the
hypothalamic-pituitary-adrenal HPA axis as a slower, second wave response.
First wave: sympathetic nervous system
Second wave: HPA
SNS: medulla stimulates hormones as adrenaline and noradrenaline > stimulation of the
cardiovascular system (diversion of energy).
HPA: hypothalamus releases corticotropin releasing factor > endocrine > cortisol and other
hormones from the adrenal cortex > elevate blood sugar and increase metabolic rate
Under long periods of stress, the HPA-axis can become dysregulated and result in
chronically elevated levels of cortisol (the negative feedback loop does not work correctly)
Stronger physiological stress responses occur in situations that are novel, unpredictable or
uncontrollable.
Stress responsivity : people vary in how they respond to stress physiologically, determined
by nurture and nature.
Babies of mothers who had high levels of stress and anxiety during pregnancy are more
responsive to stressors, show more anxiety and fearfulness and are more likely to have
cognitive and attentional problems = foetal programming
Children who are more responsive to their environment (orchid children) have the best or
worst (physical and psychological health) outcomes depending on whether they are raised in
a positive or negative environment.
Next to fight-flight there is tend and befriend; seeking comfort and safety with others. More
often done by females.
Also reduces the negative effects of stressors. Comfort seeking > ↑ oxytocin & endogenous
opioids > ↓ reduced physiological stress responses and psychological distress.
Oxytocin > decreased SNS and HPA activity. > tend and befriend responses can buffer
against long-term negative impact of stressors on health.
,Stress and the immune system
SNS increases immune system activity.
Prolonged HPA axis activation suppresses some immune activity through production of
cortisol, which has an anti-inflammatory effect and reduces both the number of white blood
cells and the release of cytokines. > immune dysregulation
So acute stress improves immune function, while chronic stress has a negative impact on
immune functioning.
Stress as a person-environment interaction
Appraisal processes are central and explain why there is so much variation in how different
people respond to stressors.
Interactional approach outlines 3 processes of appraisal:l
1. Primary appraisal
2. Secondary appraisal
3. Reappraisal
This constant interplay between appraisal, coping and reappraisal means stress is
conceptualised as a dynamic process.
Links between stress and health
It is difficult to establish the definitive pathways between stress and health. There are 3 main
issues.
1. the huge variation in how people respond to stressors
Allostasis: the process of regulating our physiological state to achieve stability, or
homeostasis.
Allostatic load: frequent or chronic activation of these systems result in a high allostatic
load (or strain) on the body. This can lead to an imbalance in allostatic systems and disease.
- Prolonged response
, Physiological systems remain in a continually high state which results in long-term
strain of the body.
- Inadequate response
One allostatic system does not respond adequately so other systems have to
overcompensate.
OR Lack of adaptation, with repeatedly high physiological stress responses.
Usually measured by a combination of biomarkers from the cardiovascular, metabolic,
immune and neuroendocrine systems.
Factors associated with allostatic load include: ethnicity, socioeconomic status, social
relationships, gender, lifestyle factors, exposure to stressors and genetic factors.
The concept of allostatic load is useful in that it provides a framework through which the
interaction between the environment and individuals’ bio behavioural responses can lead to
poor health outcomes.
2. it is usually not possible to say whether an illness is due (a) entirely to stress or (b)
entirely to other factors
3. The effect of stress on health can be due to behavioural, emotional or physical
responses to stressors.
The physical response to stressors is therefore not the only pathway between stress and
disease.
Vulnerability and resilience
vulnerability-stress model
Also clear that some people are very resilient (dandelion children).
Resilience: people showing swift recovery from stressful events, having sustainability of
purpose in the face of adversity, and growth or new learning from adversity.
Focus on a few factors associated with resilience:
1. Emotion and emotional disposition
, Positive emotional states and positive dispositions are associated with reduced mortality in
healthy people and in people with chronic illness.
Positive dispositions > better health
Negative emotions and emotional dispositions as a vulnerability factor is not as
straightforward. Depression is a clear vulnerability factor.
Neuroticism is also a vulnerability factor.
But: no consistent link.
2. Ways of coping
Emotion focused strategies : concentrate on reducing distress
VS
Problem-focused strategies : concentrate on dealing with the problem
Approach coping : try to deal with the situation proactively, predominantly active strategies
and share some overlap with the problem-focused strategies
VS
Avoidant coping : try to avoid the problem, so are predominantly emotion-focused.
For short term reduction of stress avoidant coping can be the best way to go, while for
chronic stressors, the approach coping is the best.
3. Social relationships and social support
Social relationships are critical to health, having a strong support network and relationships
has a direct positive impact on health and being socially isolated has a direct negative
impact on health.
Receiving support during a stressful event can buffer against the effects of stress, but this is
affected by a number of factors.
It is argued that the effect of support on health is due to knowing that other people are close
and available to support us, rather than due to actual support received during stressful
events.
Stress in medicine and healthcare
Stress burnout has 3 main symptoms:
1. Emotional exhaustion
2. Depersonalisation - having an unfeeling, impersonal approach to co-workers or
patients, cynicism, and a lack of engagement with the job or people
3. Reduced personal accomplishment - a poor sense of effectiveness, involvement,
commitment and engagement and a poor belief in one’s ability to change or improve
work patterns or environment.
Burnout
Poor performance, low job satisfaction, absenteeism, staff turnover. Headaches,
gastrointestinal disorders, hypertension, colds or flu, and sleep disturbances.
