Chapter 2. Stress and Coping. Learning Objectives

Transcription

1 Chapter 2 Stress and Coping Learning Objectives After studying this chapter, you will be able to 1. define stress and coping. 2. understand the physiology of stress. 3. understand the cognitive components of stress. 4. appreciate the role of personality in stress and coping. 5. identify different coping styles. 6. identify strategies for coping with stress.

2 John, a young business executive, is awakened by his alarm. He hits the snooze button, but his relief lasts only 10 minutes. He snaps to attention, realizing that he is now running late. He was out until 1:00 a.m. at a social function, and although he understands that these events are important for his work, he wishes he had not had so much to drink and had come home earlier. He rushes to shower and shave and in his haste cuts his chin. Leaving his apartment, he runs to his car through heavy rain only to discover that he has left his briefcase back inside his apartment. Once on the road, he aims for his local coffee shop for his morning dose of caffeine. He arrives to find a long lineup, but the alternative a commute without coffee is not an option he would even consider. This is the first of approximately 20 cups of coffee he will have today, and he wants it to be a good one. His impatience is visible, and he curses under his breath at the woman at the head of the line who he feels is taking too long to order. As he jumps back into his car he spills coffee on his pants. He endures the heavy rush hour by riding the bumper of the car in front of him and yelling at those around him who seem oblivious to his urgency. His cell phone is in constant use. Periodically, he has to slam on the brakes in order to avoid rear-ending the vehicle ahead of him. He has difficulty finding a parking spot and, after running through the rain, he arrives at his office 45 minutes late for an important meeting. His boss tells him not to bother coming into the meeting and suggests that he should attend instead to some of the accumulated work on his desk. He pours himself another coffee and sneaks a doughnut from a box in the coffee room. As he sits down at his desk his heart is racing, his stomach is churning, his jaw is clenched, he is sweating profusely, he is hyperventilating, and he feels a muscletension headache coming on. He is so angry, frustrated, and worried by his boss s response to his lateness that he has difficulty focusing on the tasks in front of him. His enthusiasm for his work has decreased dramatically. He longs to return home and curl up in his bed. There is nowhere to run to and no one to fight. Issues of Definition stress: the non-specific mental or somatic result of any demand upon the body. coping: strategies that an individual employs to deal with stresses caused by the everchanging demands of the environment. Throughout this text, we provide many definitions for the terms we use. This is to ensure clarity regarding the meaning of the concepts presented. There is usually considerable agreement concerning the correct definition for a particular term. However, when it comes to the topics of this chapter, stress and coping, this is not the case. If we compared your definition of these terms with those of other students, there would likely be considerable variability. Definitions of stress and coping are highly personalized and reflect an individual s unique life experiences. Brannon and Feist (2000) have compared the concept of stress to that of love. Everyone seems to know what the word means and the role it plays in their lives, and they are sure they know it when they feel it. Yet the concept is difficult to define. We do, however, have a commonsense understanding of these terms. When someone tells us they feel stressed, we empathize because we believe we have experienced similar feelings. Some of us would even describe ourselves as being experts in the field. We believe we have 26 Chapter 2 Stress and Coping

3 attained a high level of stress competency through one of the acknowledged avenues by which this can occur personal experience. A similar inconsistency exists with regard to how we define coping. To say we cope with stress is a highly individualized statement that reflects the variability of human experience. There is obviously no right way to cope with stress, there are many different ways. Our stress is not your stress, and our coping strategies are not yours. Answers to questions such as the following demonstrate that we do not experience stress in the same way: Is stress always a bad thing? How stressful are positive events, such as getting married or having a child? How much more stressful is it to lose a close relative than to receive a speeding ticket? Are the strategies one person uses to cope with stress applicable to another? Can some coping strategies actually increase the stress we experience? Why do we continue to use coping strategies that appear to be quite ineffective? Given the number of times we use the terms stress and coping in describing our daily activities, it is remarkable how little consensus exists as to how to define them. Our opening vignette reminds us that while stress and coping are concepts that have always existed, sabre-toothed tigers have been replaced by the paper tigers of today s world. Only recently, however, have they been the object of research and systematic efforts at conceptualization. What we are struggling with is what Smith (1993) has described as stress literacy. He considers this an issue of considerable importance, as the alternative is confusion, and he suggests that the popular culture provides volumes of conflicting bits of stress wisdom (p. 5). For example, is it better to face your problems or ignore them? Do we perform better when we are psyched up or when we are relaxed? The contradictions are many, and Smith suggests that stress literacy begins with a useful definition of stress (p. 6). One might expect that, in an empirical world, this issue would be somewhat more straightforward; however, considerable confusion exists. Haan (1993) addresses this concern directly. She believes that those studying stress are handicapped by a lack of consensus on the meaning of these terms. The concept of stress is used and understood by laypersons, but its scientific study has proven difficult (p. 256). She suggests that this same level of controversy and confusion is attached to definitions of coping. She argues that if we acknowledged that our knowledge of stress arises from common, shared understandings and not from objective reality, the insight would be liberating (p. 260). The lack of consensus in defining these terms has led some researchers to ask if the concept of stress is worth retaining. Pearlin (1993) believes that the very nature of stress dictates that it is a diffuse, multidimensional phenomenon that cannot be reduced to one element. He believes that our efforts should be directed toward examining the interconnections among its multiple dimensions. This process is proceeding slowly, as it requires an interdisciplinary focus that is difficult to create. Pearlin laments that firmly and actively engaged in his chosen research, each investigator is convinced that the manifestation of stress that he is examining represents real stress (p. 305). He argues that we should, instead, work with the concept of stress in an interdisciplinary fashion. Aldwin (1994) suggests that even through stress is difficult to define, the term should be retained. She states that stress refers to that quality of experience, produced through a person-environment transaction that, through either overarousal or stress literacy: the degree to which an individual (or community) understands the effects of stress. Chapter 2 Stress and Coping 27

4 eustress: a positive, yet stressful, experience. homeostasis: the dynamic physiological response on the part of the body to maintain a stable internal state in spite of the demands of the environment. fight-or-flight response: the body s complex autonomic reaction when faced with a perceived threat. underarousal, results in psychological or physiological distress (p. 22). DiMatteo and Martin (2002) conclude that as the concept of stress has developed and become more popular it has also become more imprecise. Marks, Murray, Evans, and Estacio (2011) review a literature that suggests that stress is an umbrella term that has been applied to so many quite different phenomena as to become virtually meaningless from a scientific point of view (p. 282). Clearly this debate continues as Schwarzer and Luszczynska (2013) conclude that while it is a universal component of daily life there is little agreement among researchers about the definition of stress (p. 29). They identify three approaches that can be taken in the study of stress: response based, stimulus based and cognitive-transactional. Hans Selye, the originator of the biological concept of the term stress (see Focus on Canadian Research 2-1), defined it as the nonspecific result of any demand upon the body, be the effect mental or somatic (1993, p. 7). He recognized that, for most people, stress is viewed as a negative experience that is equated with distress. To counter this position, he coined the term eustress to reflect a positive yet stressful experience. Eustress (like its related word, euphoria) is a state of physical and psychological well-being that is associated with increased motivation and the acceptance of challenge. Perhaps the ultimate expression of this positive state is found in the title of a book by the Canadian physician Peter Hanson, The Joy of Stress (1986). Selye argued that a sense of balance is essential, that we function best when stress is used to produce an optimal level of arousal. The implication is that too little stress can be as harmful as too much, that distress can result from being over- or understimulated. Selye described stress as the spice of life (1974, p. 83). Lazarus and Folkman (1984), and more recently Lazarus (1999), have provided us with descriptions of stress and coping that have received wide acceptance in the field. Stress is described in terms of a relationship that exists between a person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being (1984, p. 21). An individual s cognitive appraisal of a situation will determine the level of stress he or she will experience. It is interesting to note that Lazarus (2006), in discussing the development of stress as an interdisciplinary concept, suggests that overlapping terms such as anxiety, frustration, conflict, trauma, and emotional distress are unified under this rubric. He states that stress became the dominant term for uniting these concepts, and for identifying the causes and emotional consequences of the struggle to manage the pressures of daily living (p. 30). Coping is defined as constantly changing cognitive and behavioral efforts to manage specific external and/ or internal demands that are appraised as taxing or exceeding the resources of the person (Lazarus & Folkman, 1984, p. 141). Central to our understanding of stress are the contributions of Walter Cannon. In 1939, he introduced the concept of homeostasis, which describes the body s attempt to maintain a stable internal state. This is a dynamic physiological response on the part of the body to the demands of the environment. The body seeks balance, and stress presents a challenge to homeostasis. It was Cannon who articulated the concept of the fight-orflight response, which describes a complex autonomic reaction. The sympathetic nervous system and hormones secreted by the adrenal glands interact in an adaptive response developed through evolution. This response helps us to cope with potential attacks from a threatening world. 28 Chapter 2 Stress and Coping

5 Focus on Canadian Research 2-1 A Great Canadian Hans Selye has been described as the grand master of stress research and theory. Born in Vienna in 1907, Selye lived and worked in Montreal for 50 years until his death in He first used the term stress in 1936 to describe the non-specific result, either mental or physical, of demands placed on the body. Close to 40 years later, Selye indicated that, if his English had been better at the time, he would probably have chosen the word strain to describe this response. He had taken the idea of stress from the field of physics, where it describes the force exerted by one body against another. The response to this tension is strain and, as what Selye was describing was a response, he acknowledged that he probably should have used this term. Rather than correct him, we have adjusted our definition to fit his model. Selye initially observed a consistent pattern of responses in rats when these animals were exposed to diverse noxious stimuli. He called this a stereotypic response, which he had first observed in human patients some 10 years earlier (the general adaptation syndrome or biologic stress syndrome ) and for which he now had experimental evidence. He also identified an initial alarm reaction in which the organism s defences were activated. If the organism survived this initial attack, Selye identified an adaptive phase or rebound effect that occurs, which he called the the stage of resistance. Eventually, if the demands on the organism were of sufficient severity or length, a stage of exhaustion occurred. In 1956, Selye published The Stress of Life, in which he translated the concept of stress for the layperson. He dedicated his life to the study of stress and wrote more than 1700 articles and 39 books on the topic. He was a scientist, trained as both a physician and an endocrinologist. He served as a professor and director of the Institute of Experimental Medicine and Surgery at the University of Montreal. He also served the non-scientific world through texts such as that mentioned above and Stress without Distress (1974), which he wrote to help us better understand the impact of the stress response on humans throughout their lifespans. He was made a Companion of the Order of Canada, the highest honour this country can bestow upon an individual, and has been described as a Canadian resource to the world. Cannon (1939) expressed concern about the implications for physical illness through the continuous activation of the fight-or-flight reaction in response to the chronic pressures and demands of the contemporary world. The actions implied by the term fight-orflight are simply not always appropriate in our contemporary world. In fact, to engage in either of these responses in today s world could have disastrous consequences. Our young businessman could neither fight nor flee. He had to sit at his desk while his body experienced the same physiological responses as his ancestors (churning stomach, tightening muscles, pounding heart, soaring blood pressure, grinding teeth, hyperventilation, profuse sweating) while his emotions were running wild. It is not difficult to understand how the continual stimulation of this response could eventually result in physical illness. A challenge to the universality of the fight-or-flight response has been made by Taylor et al. (2000), who propose that although the physiological component of the fight-or-flight response may be common to both males and females, the female behavioural component will also involve social and nurturant behaviours. These responses are described as tend and befriend behaviours. The implication is that the female response to stress has evolved to increase the likelihood of survival of both the self and offspring. Tending is associated with nurturing activities, and befriending involves establishing social networks. This attachment caregiving response in females may be triggered by neuroendocrine responses to stress. This theory is described as a biobehavioural alternative to the fight-or-flight Chapter 2 Stress and Coping 29

6 nervous system: one of two major components of the physical response to stress; made up of the central nervous system and the peripheral nervous system. endocrine system: a system of the body that controls glandular responses to stress; responds more slowly than the nervous system but the effects can persist for weeks. central nervous system: division of the nervous system that is composed of the brain and the spinal cord. peripheral nervous system: division of the nervous system that is made up of the somatic nervous system and the autonomic nervous system (which is further divided into the sympathetic and parasympathetic nervous systems). response (Cannon, 1932), which has dominated stress research for the past five decades and has been disproportionately based on studies of males (Taylor et al., 2000, p. 422). Taylor and Sirois (2012) state that this approach emphasizes social behaviour in the stress process as we are affiliative creatures who respond to stress collectively, as well as individually, and these responses are characteristic of men as well as women (p. 157). Rice (1999) describes several distinct meanings attached to stress. One has to do with external causes. These are the environmental demands placed upon us that cause us to feel stressed. As such, these should be described as stressors, rather than stress. It is in response to these external stressors that we invoke coping strategies to reduce their impact. Stress is concerned with subjective responses and refers to the interpretive mental state of the individual. Stress allows us to react cognitively to diminish, augment, or distort the impact of external events. Another term used in this context is strain, which describes the long-term consequences of exposure to stress and can result in physiological problems, such as cardiovascular disease; psychological concerns, such as depression; and cognitive concerns (Francis & Barling, 2005). The belief that stress is somehow all in our minds has been expressed by writers and philosophers throughout history. Epictetus, for example, said some 2000 years ago that Humans are not disturbed by events, but by the view they take of them. Shakespeare wrote in Hamlet that There is no such thing as good or bad, but thinking makes it so. Milton suggested in Paradise Lost that The mind is its own place, and in itself can make a Heaven of Hell, a Hell of Heaven. And Mark Twain said, I am an old man and have known a great many troubles but most of them never happened. Rice (1999) points out that even though stress may be a subjective experience, we frequently use physical terms to explain its impact. We speak of being on the edge of a breakdown, of feeling the weight of the world, of not being sure that we can cope with the pressure or of exploding if we are exposed to any more stress, and we use phrases such as it was the straw that broke the camel s back to describe the precarious balance we maintain with the stress in our lives. Regardless of our personal views of what stress feels like, the fact is that stress imposes a physiological challenge which, if prolonged, can result in a decreased capacity to cope physiologically (Rice, 1999). The Physiology of Stress There are two major components of the physical response to stress the nervous system and the endocrine system. The nervous system is composed of two divisions, the central nervous system and the peripheral nervous system. The former is made up of the brain and the spinal cord, while the latter is made up of the somatic nervous system and the autonomic nervous system, which is further divided into the sympathetic and parasympathetic nervous systems. The physiology of stress creates a highly complex response that begins when an individual perceives a threat, real or imagined. The perception of stress mobilizes the body to act through two interrelated systems (Kemeny, 2005). One is the sympathetic adrenomedullary (SAM) system, in which the sympathetic nervous system and the adrenal medulla are most important. The second is the hypothalamic-pituitaryadrenal (HPA) axis, which initiates a response in the hypothalamus. The SAM system initiates the body s rapid fight-or-flight response to stress through the release of adrenaline and noradrenaline from the adrenal medulla as mediated by the sympathetic nervous 30 Chapter 2 Stress and Coping

7 system. The HPA system, on the other hand, is a delayed response to stress that attempts to minimize the initial impact of stress and restore the body to a balanced state. It involves activation of the adrenal cortex and the secretion of corticosteroids, the most important of which is cortisol. The levels of circulating cortisol in the blood and saliva frequently serve as a physiological indicator of stress. Prolonged or repeated activation of the HPA system can lead to dysregulation in the body s responses to stress, which can have both physical and psychological consequences. More specifically, the stress response begins in the hypothalamus, which is located in the central core of the brain. It initiates the stress response in both the nervous system and the endocrine system. The hypothalamus helps maintain homeostasis in the body through its many regulatory functions. As well, it controls activities such as eating, drinking, and sexual behaviour, all of which are greatly affected by stress. The activities of the hypothalamus increase arousal in the sympathetic nervous system in the form of the previously described fight-or-flight response (Cannon, 1939). The heart beats faster and blood pressure increases at the same time as peripheral blood vessels, in areas such as the hands and feet, constrict to ensure sufficient blood supplies for the brain and skeletal muscles. Stored fats and glucose flow into the bloodstream to provide fuel for necessary actions. Respiration rate increases and the bronchial tubes dilate to help increase oxygen flow for the metabolism of fuel. Pupils dilate to allow more light to enter the eyes and improve vision. The efficiency of the process is demonstrated when non-essential activities, such as digestion, decrease. As a part of this response, the hypothalamus causes the adrenal medulla, located above the kidneys, to secrete catecholamines, which contain the hormones adrenaline and noradrenaline (also known as epinephrine and norepinephrine). Catecholamines affect the response of the sympathetic nervous system, and the level of these two hormones increases with the severity of the stress. The actions of adrenaline and noradrenaline are different, however. The former is fast-acting and increases with mental stress; the effect of the latter is more prolonged and increases with physical activity. Adrenaline has a powerful impact on heart function and blood pressure. Presumably it is this experience that finds popular expression in the phrase adrenaline rush. It is interesting that this phrase is usually viewed in positive terms as something that people seek. We even go so far as to ascribe an addictive quality to it by describing people who purposefully seek the physiological high that adrenaline brings as adrenaline junkies. These stimulation seekers may engage in extreme activities to purposefully initiate the fight-or-flight response and the flow of adrenaline. Also involved in the stress response is the limbic system of the brain, which adds an element of emotion to the response that goes beyond the identified dimensions of fight-orflight. The feelings triggered by the limbic system include aggression, anger, fear, anxiety, sexual arousal, and pain. In addition, the reticular formation is a complex system running through the middle of the brain stem that performs several functions during the stress response. It serves as a communication network that filters messages between the brain and the body, which is most important when we consider the impact that the brain s perception of psychosocial stressors can have on physical systems in the body. The reticular formation receives input from all the sensory systems and influences which sensory information is processed or blocked. Such selectivity results in increased efficiency in the system, which can become apparent to us in quite dramatic ways. For example, in high-arousal situations we may find hypothalamus: a portion of the brain that initiates the stress response in both the nervous system and the endocrine system. adrenal medulla: the central portion of the adrenal gland; secretes catecholamines ( containing both adrenaline and noradrenaline) when the hypothalamus initiates the stress response. sympathetic nervous system: the system responsible for the fight-or-flight response when triggered by the hypothalamus (faster heartbeat, increased blood pressure). limbic system: a system of the brain that is responsible, in part, for emotion in the stress response. reticular formation: complex system running through the middle of the brain stem that serves as a communication network to filter messages between the brain and the body. Chapter 2 Stress and Coping 31

8 parasympathetic nervous system: the component of the autonomic system that re-establishes homeostasis in the system and promotes the reconstructive process following a stressful experience. pituitary gland: a gland in the brain described as the master gland because it controls other glands through the hormones it secretes; most of these hormones have an indirect impact on stress. adrenal cortex: the outer portion of the adrenal gland; at times of stress supplies hormones to the body that provide energy and increase blood pressure, but that can adversely affect the body s ability to resist and recover from disease. glucocorticoids: substances released by the adrenal glands upon stimulation from the sympathetic division when one is under stress. thyroid gland: an important gland in the stress response because it produces thyroxine, which increases blood pressure and respiration rate, and affects mental processes. pancreas: a gland that secretes insulin and glucagon in response to blood sugar levels. General Adaptation Syndrome (GAS): the three-stage response of the body to stressors as identified by Selye: alarm, resistance, and exhaustion. alarm: the initial phase of Selye s General Adaptation Syndrome in which the body mobilizes its defences against a stressor. ourselves remarkably able to selectively attend to a specific task while ignoring irrelevant distractions. A basketball player, given the opportunity to win a game by sinking a lastsecond foul shot, needs to focus his attention on the front rim of the hoop. He does not want to be distracted by the noise of the crowd and the movement of those behind the basket, who will often go to considerable extremes in an attempt to distract him. The reticular formation helps us attend to what matters and ignore that which doesn t. It also serves an important role in modulating the brain s levels of arousal or alertness in preparation for action. In contrast to the sympathetic nervous system, the parasympathetic component of the autonomic system is activated by the hypothalamus to re-establish homeostasis in the system and to promote the reconstructive process following a stressful experience. It is associated with a relaxed or hypometabolic state in which the heart rate slows and blood pressure drops. Muscle tension decreases and respiration is slow and easy. The endocrine system responds to stress more slowly than does the nervous system, but the effects associated with it can persist for weeks. The pituitary gland, which is located in the brain close to the hypothalamus, is described as the master gland because of its controlling effect on other glands. Most of the hormones secreted by the pituitary gland have an indirect impact on stress. The most important of these is adrenocorticotropic hormone (ACTH), which acts on the adrenal glands and is eventually involved in the release of up to 30 stress hormones (Smith, 1993). The adrenal cortex secretes glucocorticoids and mineralocorticoids. One of the glucocorticoids is cortisol, an important stress hormone that provides energy to the system by converting stored protein and fats into glucose. If stress is prolonged, glucocorticoids can adversely affect the body s ability to resist disease and recover from injury. Cortisol levels are often used as an index of stress. Aldosterone is an important mineralocorticoid that regulates minerals in the body during stress by increasing blood pressure. The thyroid gland functions in the stress response by producing thyroxine, which increases the release of fatty-acid fuels that are metabolized in the stress process. Elevated thyroxine levels increase blood pressure and respiration rate. Mental processes are also affected, in that individuals feel more anxious or agitated. The pancreas, which lies close to the stomach, secretes insulin and glucagon in response to blood sugar levels. Insulin decreases blood sugar by storing it, whereas glucagon stimulates increases in blood sugar, which is an energy source during times of stress. The autonomic nervous system responds rapidly in response to stress and the endocrine system responds more slowly, although its impact usually continues much longer. Acting together, these two systems provide a physiological response to stress that can be both adaptive and maladaptive. The General Adaptation Syndrome Initially, Selye conducted his research on laboratory animals. He observed that animals exposed to chronic stress demonstrated physical distress that included organic pathology and, ultimately, death. This work and that of others, such as Brady s work on executive monkeys (Brady, Porter, Conrad, & Mason, 1958), resulted in Selye s conceptualization of the General Adaptation Syndrome (GAS) (Selye, 1956). This is a three-stage response of the body to stressors. In the initial phase, the body goes into alarm as it mobilizes its 32 Chapter 2 Stress and Coping

9 defences against the stress. This involves many of the processes involved in the fight-orflight response. As experience will often confirm, this acute response is usually enough to allow us to deal successfully with the impact of a stressor and then allow homeostasis to be re-established. If a source of stress moves from acute to chronic, the body enters the second phase of adaptation, which Selye called resistance. Here the body mobilizes its resources over an extended period of time. Initially, the individual will appear as normal. If the stress continues for too long, however, the body s resources are depleted and resistance decreases. The result of neurological and hormonal changes can be what Selye described as diseases of adaptation, which includes cardiovascular disease, hypertension, peptic ulcers, bronchial asthma, and the increased risk of infection. The resources our bodies use to resist stress are clearly finite. Eventually, if the stressor is too severe or too long, the body enters what Selye called exhaustion. This is an endpoint at which the body s ability to resist the stressor breaks down and might even result in death if a return to homeostasis is not possible. An extension of the body s attempt to maintain homeostasis is the concept of allostatic load as described by McEwen and Stellar (1993). This refers to the price the body pays for being forced to adapt to adverse psychosocial or physical situations, and it represents either the presence of too much stress or the inefficient operation of the stress hormone response system (McEwen, 2000, p. 110). In this context, homeostasis is seen as a mechanism that functions within an optimal physiological set point that is critical for survival, whereas allostasis promotes coping and adaptation by maintaining stability through change. If this adaptive process is called upon too frequently, or is not managed well, the consequence is allostatic load. Criticisms of Selye s theory centre on its narrowness because it is concerned only with physical responses to stress and does not account for psychosocial factors that influence the human stress response. This emphasis may have derived from his initial work with animals; his critics suggest that he neglected the emotional and cognitive processes unique to humans (Brannon & Feist, 2007; Schwarzer & Luszczynska, 2013). Other biologically based models have been proposed to explain our ability to resist the impact of stress. The emphasis may be placed on genetic influences that predispose an individual to increased risk for specific diseases or to vulnerabilities or reductions in resistance that may be expressed under certain conditions. Closely linked to this is the stress-diathesis model, which examines the interaction between the environment and heredity, often referred to as nature versus nurture. This model proposes that people may be predisposed to experience a physical effect in the presence of stressful events. Thus, individuals with a genetic predisposition for a particular condition may never display signs of that condition if they are not exposed to the precipitating stress. However, high levels of stress may test the limits of invulnerability even in those who are genetically robust. This evokes a sense of adaptability or survival of the fittest. The implication is that stress forces an individual to adapt and evolve or run the risk of being selected against. Certainly many of us, when we consider our own vulnerability to disease, are quick to blame or flaunt our genes. We boast to others that we will never develop cardiovascular disease no matter how much we abuse our bodies with environmental stressors such as a poor diet or lack of exercise, as we are blessed with good genes. We may develop an inappropriate sense of invulnerability. The stress-diathesis model (or resistance: a set of physiological responses that allow a person to deal with a stressor; the second phase of Selye s General Adaptation Syndrome in which the body mobilizes its resources if the source of stress moves from acute to chronic. diseases of adaptation: health problems that are the result of long-term neurological and hormonal changes caused by ongoing stress. exhaustion: the third stage in Selye s General Adaptation Syndrome; the body experiences fatigue and immunocompromise because of the severity or duration of a stressor. allostatic load: the long-term physiological impact of chronic exposure to stress. stress-diathesis model: model that examines the interaction between the environment and heredity, often referred to as nature versus nurture; this model proposes that predisposing factors in an individual may determine whether or not a physical effect is experienced in the presence of stressful events. Chapter 2 Stress and Coping 33

10 diathesis-stress model, as Grossarth-Maticek & Eysenck, 1990, call it) is also discussed in chapter 3 in our examination of psychoneuroimmunology. cognitive transactional models: models that emphasize the relationship between a person and his or her environment and the appraisal that the individual makes of the situation. cognitive appraisal: assessment of whether or not an event is stressful. primary appraisal: the initial evaluation of a situation. secondary appraisal: an individual s evaluation of their ability to cope with a situation following the primary appraisal. reappraisal: a continuous experience in which existing appraisals of situations are changed or modified on the basis of new information. irrelevant appraisal: a cognitive process by which an event is appraised as having no implications for the individual s wellbeing. benign-positive appraisal: a cognitive process by which an event is appraised to involve outcomes that are positive and may enhance well-being. stressful appraisal: a cognitive process by which an event is appraised to involve harm/loss, threat, or challenge at the time of the primary appraisal. harm/loss appraisal: a type of stressful appraisal at the time of primary appraisal that involves significant physical or psychological loss. threat appraisal: an appraisal at the time of the primary appraisal that involves the anticipation of harm or loss. challenge appraisal: appraisal in which, though an event is perceived to be stressful, the focus is one of positive excitement and the potential for growth. Cognitive Transactional Models Selye s popularization of the idea of stress can t be underestimated. It s hard to imagine where we would be today without the contributions he made to the field. However, as we have indicated, his theory is limited by its reliance on physiological processes based on an animal model of behaviour. In this regard, his theory fails to take into account the higherlevel cognitive abilities that are distinctly human and allow us to interpret our vulnerability to a particular stressor both now and in the future. Compared to Selye s model, cognitive transactional models of stress hold far more appeal for psychologists. As indicated in the definition provided by Lazarus and Folkman earlier in this chapter (Lazarus & Folkman, 1984), these models, described more recently by Lazarus (2006), emphasize the relationship existing between individuals and the environment and the appraisals individuals make of that relationship. Personal cognitive appraisals determine whether or not an event will be perceived as stressful. These are based on an individual s unique social learning history. Lazarus and Folkman (1984) describe the process of cognitive appraisal as one that is largely evaluative, focused on meaning or significance, and takes place continuously during waking hours (p. 31). They distinguish among three forms of appraisal which influence the coping process: primary appraisal, secondary appraisal, and reappraisal. They acknowledge that these are somewhat unfortunate terms, as one form of appraisal (e.g., primary as compared to secondary) is neither superior to, nor precedes, the other. Primary appraisals are concerned with the initial evaluation of a situation. Three kinds of primary appraisal are identified irrelevant, benign-positive, and stressful. The first involves a cognitive process by which an event is appraised as having no implications for the individual s well-being; it is irrelevant and requires no response. Benign-positive appraisals involve outcomes appraised to be positive and that may increase well-being. They are associated with pleasurable emotions, such as happiness, joy, or love. The only demand benign-positive appraisals place on the individual is the awareness that these feelings will end. There are three types of stressful appraisal harm/loss, threat, and challenge. Harm/ loss appraisals involve the possibility of significant physical or psychological loss, such as might be experienced through a serious illness or the loss of one s job. Threat involves the anticipation of situations of harm or loss. When an individual has experienced harm/loss, threat is involved, as it has implications for the future. Perceptions of threat allow a person to anticipate and prepare for the impact of an event. Challenge appraisals involve events perceived to be stressful, but the focus is one of positive excitement and anticipation of the potential for growth contained in the situation. Having to speak in front of a class may be perceived as threatening by a person with anxieties about public speaking but as an opportunity to test one s public-speaking abilities by an individual who has worked on these skills. Clearly, it is possible to experience threat and challenge in the same situation. The confident speaker may experience some threat in the speaking opportunity, which is expressed in the form of anxiety and some fear; however, the dominant emotions are confidence and anticipation. The overall emotional tone is positive, and the 34 Chapter 2 Stress and Coping

11 individual actively employs available resources in preparing to meet the demands imposed by the presentation. Secondary appraisal is concerned with people s evaluations of their ability to cope with a situation. After the initial evaluation of the nature of the event, which is primary appraisal, individuals consider their options. As Lazarus and Folkman (1984) make clear, this is not simply an intellectual exercise. It is a complex evaluative process that takes into account which coping options are available, the likelihood that a given coping option will accomplish what it is supposed to, and the likelihood one can apply a particular strategy (p. 35). They point out that this is very similar to the distinction Bandura (1986) makes between outcome and efficacy judgments. Bandura states that efficacy and outcome judgments are differentiated because individuals can believe that a particular course of action will produce certain outcomes, but they do not act on that outcome belief because they question whether they can actually execute the necessary activities (1986, p. 392). The interaction between secondary appraisals of coping options and primary appraisals of the situation will determine an individual s emotional reaction to the event. If the consequences of an event are perceived as important, individuals may experience considerable stress if they believe they cannot cope with the event; a state of helplessness may result. Conversely, challenge appraisals are more likely to result when an individual feels in control of the situation, even if this means overcoming extreme adversity. We are all aware that some individuals, when faced with a devastating situation such as an illness or loss of a relationship, articulate their efforts to cope in very positive ways. They describe the challenge of confronting through their own behaviour what others would perceive as overwhelming odds. They know they may not ultimately have an outcome others would consider desirable, but they focus their attention on elements of the situation that are under their control. For example, they may talk of the challenge of coping with pain, either physical or psychological, to the best of their ability while recognizing that there are elements of the situation that are outside their control. Even though a situation may appear hopeless, they search for challenges. Reappraisal is a continuous experience in which existing appraisals are changed or modified on the basis of new information. Reappraisal simply follows an earlier appraisal of an event and results in a new appraisal. What may vary is the direction of the outcome of the appraisal. For example, an irrelevant situation may now be perceived in terms of threat, or a harm/loss situation may now be appraised as a challenge. Lazarus and Folkman (1984) also identify what they call a defensive reappraisal. They describe this as a selfgenerated coping strategy in which an attempt is made to reinterpret past events more positively or to view current threats or losses as being less threatening. Also of importance in the cognitive appraisal process is the concept of vulnerability, which reflects the adequacy of an individual s resources. This is a concept that, like so many in this context, is defined within a relationship. With regard to physical issues, it is possible to think of vulnerability only in terms of resources. A physical injury can increase vulnerability to further injury. However, deficiencies in resources will result in a psychological vulnerability only when resource deficiency threatens which is valued by the individual. Therefore, an individual may have resource deficiencies but not experience vulnerability, if the deficiencies do not threaten domains that are important to him or her. vulnerability: physically, the adequacy of an individual s resources; psychologically, a threat to something that an individual values. Chapter 2 Stress and Coping 35

12 person variables: variables, particularly commitments and beliefs, that interact with situation variables to affect the appraisal of a situation s stressfulness. situation variables: variables that interact with person variables to influence the appraisal of a situation. commitments as person variables: values that influence appraisal by determining the importance of a particular encounter and that affect the choices made to achieve a desired outcome. beliefs as person variables: pre-existing notions, both personal and cultural, that influence appraisal, and thus stress, by determining the meaning given to the environment. novelty: the extent to which an individual s previous experience with a situation influences the appraisal process. predictability: a characteristic of the environment that allows an individual to prepare for an event and therefore reduce the stress involved. event uncertainty: the inability to predict the probability of an event, which, as a result, increases the stress response. imminence: interval during which an event is being anticipated; the more imminent an event, the more intense the appraisal. duration: situational factor involved in stress appraisal. temporal uncertainty: lack of knowledge about when an event will occur, which can result in stress. The cognitive transactional model also identifies person and situation variables that influence appraisal. The impact of these variables is in the individual s assessment of the salience of an event, an individual s understanding of the event, the possible consequences of an event, and ultimately, the possible outcomes (Lazarus & Folkman, 1984). Person and situation variables are interdependent and involve transactions between individuals and their environments. The person variables of importance are commitments and beliefs. Commitments are concerned with what is important to an individual. Commitments influence appraisal by determining the importance of a particular encounter and will affect the decisions made to achieve a desired outcome. As well, they interact with concepts we discussed in the context of primary appraisal, such as challenge, threat, benefit, or harm, to determine if an individual will engage in or avoid an encounter. Beliefs are pre-existing notions that determine the meaning given to the environment. They can be both personal and cultural. Their impact, which is often difficult to observe, is most obvious when there is a sudden change in the belief system. Numerous factors influencing the appraisal process have been identified. Novelty refers to an individual s previous experience with a situation. Predictability identifies characteristics of the environment that can be learned or discerned, which allows an individual to prepare for an event and therefore reduce the stress involved. Of more relevance to appraisal is the concept of event uncertainty, which involves issues of probability. High levels of uncertainty can be extremely stressful. Temporal situational factors are also important in stress appraisal. Imminence concerns the time interval during which an event is being anticipated. Typically, the more imminent an event, the more intense the appraisal. Duration refers to the time period during which a stressful event occurs. The implication is that the longer the duration, the more stressful the event. This concept is reminiscent of Selye s General Adaptation Syndrome, in which the duration of stress plays an important role; continued exposure to stress compromises resistance and leads ultimately to exhaustion. Temporal uncertainty is concerned with the stress involved in not knowing when an event will occur. A final concern here relates to the timing of stressful events in the context of the life cycle. The implication is that there are appropriate or usual times for events to occur over one s lifespan. If these expectations are violated, it may result in the event being appraised as more stressful. We have a sense of an order as we move through our lives, and this master calendar allows us to develop expectations and prepare for events. When the timing is wrong, normal life events may become sources of stress. We all know individuals who have been affected by life events in this way, such as the couple who have a child later in life, the athlete whose career comes to an abrupt end due to injury or the individual who is unexpectedly terminated in what they had perceived to be their life s work. The model developed by Lazarus and his colleagues views stress as a complex, dynamic process in which individuals experience of stress is determined by their own unique cognitive appraisal of the event and their ability to cope with it. Recent research by Keller et al. (2012) provides intriguing support for this position that it is the perception that stress affects one s health that is most important. Specifically, they found that there was a synergistic effect in individuals who reported high levels of stress combined with the perception that stress affects health. This resulted in an increased risk for premature mortality over those who did not display this form of stress appraisal. They state that reporting a lot of 36 Chapter 2 Stress and Coping

13 stress and perceiving that stress affected one s health a lot increased the risk of premature death by 43% (p. 681). This finding may have extremely important clinical implications. As Schwarzer and Luszczynska (2013) indicate, stress has to be analyzed and investigated as an active, unfolding process (2013, p. 30). The Role of Personality in Stress and Coping If a particular temperament or set of personality traits predisposed an individual to a specific disease, then given the stable, enduring qualities of personality it might be possible to intervene and reduce the risk. There are a number of ways these interactions might occur (Rice, 1999). A specific personality profile might predispose one to the development of a specific disease, as is indicated with Type A personality and coronary heart disease (CHD). A second possibility is that a particular disease process may result in a particular personality profile as when depression follows the diagnosis of a serious illness. A third possibility is that personality affects or filters the response to an illness. An individual receiving the news of a serious illness might respond in an optimistic and active manner compared to another person who responds passively and pessimistically. In a fourth possibility, personality may interact with the disease process in a feedback loop that affects the individual s physiology and influences the disease process itself. Ultimately, the question centres on whether there are personality traits that predict behaviours, such as smoking or alcohol use, or disease processes, such as cancer or coronary disease. The most extensively studied set of personality traits in connection with disease is the Type A behaviour pattern which was first described by two cardiologists, Meyer Friedman and Ray Rosenman, in They identified patients they saw frequently in their medical practice whom they believed were at a much higher risk for cardiovascular disease. Such Type A individuals display a sense of time urgency, are impatient and very competitive, and can be aggressive and hostile. They exhibit behavioural characteristics such as rapid, explosive, clipped speech; frequent interruptions of another speaker; speech-hurrying techniques (e.g., nodding the head while another person speaks); vehement reactions to time impedance; emphatic one-word responses; and finger-pointing to emphasize speech. They stand in comparison to Type B individuals, who give the impression of being relaxed and calm, are less competitive, are not overly reactive to time impediments, and rarely display hostility. Powerful empirical support has emerged for the suggestion that Type A behaviours are linked to an increased risk for coronary disease. Indeed, this set of behaviours has been identified as a risk factor for all forms of morbidity (Shoham- Yakubovich, Ragland, Brand, & Syme, 1988). However, some inconsistencies in the findings have led to a search for the toxic core of Type A behaviours. This work initially identified the components of hostility and anger to be the crucial elements. Wright (1988) expanded it to describe a multi-causal pathway that identifies Type A behaviour in combination with family history, lifestyle risks, and anger as being the core risk factors. Williams et al. (2000) report that individuals with high anger-scale scores have a greatly elevated risk of heart attack in comparison to those with low scores. Also of interest is work summarized by Smith and Ruiz (2002) that has identified social dominance as a risk factor for coronary disease that is independent of hostility. Social dominance is described as a set of controlling behaviours, including the tendency to cut off and talk over the interviewer (p. 552). Type A behaviour pattern: behaviours include impatience, time urgency, aggressiveness, hostility, and competitiveness; originally believed to be predictive of coronary heart disease. social dominance: a risk factor for coronary disease that is independent of hostility; social dominance is described as a set of controlling behaviours, including the tendency to cut off and talk over the interviewer. Chapter 2 Stress and Coping 37