25th October 2023

Stress

Hans Selye defined stress as the ‘Non-specific response of the body to any demand placed upon it.’

Stress can be considered as both the psychological and physiological response to any actual or imagined life challenge. Stress can be positive or negative in its consequences for a person, and the terms ‘eustress‘, or positive stress and ‘distress’, or negative stress, were used by Selye to express this concept.

Eustress is the type of stress seen as manageable, productive, or even pleasurable. Distress is associated with overwhelming demands and can degrade mental and physical health. Gastrointestinal problems, cardiovascular disease, respiratory and a wide range of autoimmune conditions can all be evidenced as exacerbated by distress. Stress can cause uncomfortable physical symptoms itself, such as the fight or flight response mediated by the amygdala, hypothalamus, and adrenal glands. Stress can induce psychological reactions such as anxiety, anger, depression, and cognitive impairment. Shelley Taylor described four different routes by which stress can affect health:

• Direct route.
• Interactive route (also known as the stress-vulnerability model).
• Health behaviour route.
• Illness behaviour route.

Feeling that a stressful event is predictable or within control has been shown to decrease the level of distress caused. However, even if a stressor is well within a person’s resources to manage, if it challenges our core beliefs, it can cause significant distress. Objective external physical dangers can cause stress, or stress can be entirely internal and mental and generate negative emotions via an internal psychological conflict. In psychological terms, conflict is when two or more strong conscious or unconscious motives cannot be solved together.

Resilience and vulnerability

Vulnerability and lack of resilience are terms that are often used interchangeably; however, in psychological terms, these can be defined more precisely:

Resilience – The psychological process developed in response to life stressors that facilitates healthy functioning.

Vulnerability – Inability to withstand the effects of a hostile environment.

Vulnerability is a negative predictor of mental and physical health conditions and is correlated with a negative effect and low life satisfaction, whilst the opposite is true for resilience or psychological invulnerability.

The most interesting example of the above can be illustrated by the studies of Norman Garmezy, who published studies looking at the prognosis of patients diagnosed with schizophrenia. Garmezy noted that some patients with schizophrenia suffered remarkably poor long-term function following a psychotic episode, whilst others ‘recovered’ well and went on to re-establish previous employment and relationships. Garmezy wrote that those patients who recovered well had ‘A pattern of competency across different aspects of life and function.’

Further studies into children from high-risk socioeconomic classes who experienced early years trauma showed that many children demonstrated competence in relationship maintenance, academic achievement, and healthy life progression. He named these children ‘invulnerable.’ By analysing these children’s outcomes, ideas about protective factors enabling resilience were developed.

Factors proposed to enhance resilience:

• Autonomy.
• High self-esteem.
• Intelligence.
• Social skills.
• Social support outside the family.
• Warmth of family relationships.

Type A theory

The Type A theory, although largely considered to pertain to aspects of personality, has great significance with regard to stress and its impact on health. Originating from observations of patients by two cardiologists, Friedman and Rosenman. Type A theory describes type A people as high-achieving individuals who are easily aroused, prone to hostility, have exaggerated time urgency and impatience, and are highly organised and ambitious. Individuals who lacked these prominent characteristics were Type B people. Type A people were initially proposed to be at greater risk of heart disease as their need for control over their environment made them less resilient to external and internal stress. Although this idea has since been disputed, the rough consensus is that Type A people, whilst generally predisposed to high achievement, are also generally predisposed to be psychologically vulnerable to adverse impacts of stress.

Coping mechanisms

Coping strategies are behaviours or thought patterns people engage in to mitigate or relieve stress. Several types of coping mechanisms have been defined, such as:

• Appraisal-focused.
• Emotion-focused.
• Problem-focused.

These can further be subdivided into adaptive and maladaptive coping mechanisms.

Lazarus identified cognitive appraisal as a way of determining whether a stressor was such that an individual’s resources could adequately deal with it or it would overwhelm them. Appraisal-based coping techniques use this model to help individuals reframe their appraisal of their ability to cope with a stressor more positively. Positive appraisal style, or the tendency to appraise potentially threatening situations positively, is a vital resilience tool used in positive cognitive reappraisal-based therapies.

Emotion-focused strategies diminish negative feelings generated by stress, while problem-focused techniques diminish stress by working to correct or eliminate the source of the stressor.

Adaptive coping mechanisms help a person develop resilience to stress, while maladaptive coping strategies are unhealthy, unproductive, and harmful. Maladaptive coping mechanisms such as rumination, isolation or overeating may provide temporary relief, but the longer term can exacerbate stress.

Locus of control and learned helplessness

The locus of control can be considered part of personality and is a person’s perception of where control lies and what the causes of their life experiences are. An internal locus of control is when people view their actions as controlling their fate. An external locus of control is when someone attributes their fate to outside influences. Generally, maintaining an internal locus of control is considered a more psychologically protective process, although most people switch between different loci of control at different times.

Martin Seligman developed the concept of learned helplessness via experimentation on dogs. A group of dogs were given a series of electric shocks that they could not escape and, in turn, developed a conditioned feeling of helplessness. When the dogs were put in a new environment where they could escape electric shocks, they did not attempt to, as they had accepted their situation and ‘learned helplessness’. When a person or animal learns to endure adverse events and does not try to avoid these, even when able to, they are said to demonstrate learned helplessness.