STRESS MANAGEMENT

UNIT-3

Effects of Stress on Health

INTRODUCTION
When stress is severe or when demands pile up, stress may have long-lasting effects, often called
“adaptational outcomes.” Stress leads to illnesses in some individuals, but not others due to the
reason that forms the basis of ‘diathesis stress model’, the view that people’s vulnerability to a
physical or psychological disorder depends on the interplay of their predisposition to the disorder
and the amount of stress they experience.
The predisposition can result from organic structure and functioning, often genetically determined,
or from prior environmental conditions, such as living in a community that promotes tobacco use.
For example, chronically high levels of stress are especially likely to lead to CHD if the person’s
body produces high levels of cholesterol.
To determine the effects of stress on one’s illness, various research studies were conducted that
yielded the following results:
First, people under chronic, severe stress are more vulnerable to catching cold when exposed to
the virus than people under less stress.
Second, people who experience a lot of positive emotions, such as feeling energetic or happy, are
less likely to catch a cold or the flu when exposed to the viruses than people who have less of these
emotions.
Third, people who have sleep problems prior to their exposure to the virus are more likely to
develop colds.
The causal sequence through which stress leads to illnesses follows two routes: (1) a direct route,
resulting from changes stress produces in the body’s physiology, or (2) an indirect route, affecting
health through the person’s behavior.
BEHAVIOUR AND ILLNESS
Stress can affect behavior, which, in turn, can lead to illness or worsen an existing condition. The
behavioral links between stress and illness can be seen in many stressful situations, such as when
a family undergoes a divorce.
People who experience high levels of stress tend to behave in ways that increase their chances of
becoming ill or injured. For instance, compared with people with low stress, those with high stress
are more likely to eat higher fat diets with less fruit and vegetables, engage in less exercise, smoke
cigarettes, and consume more alcohol. These behaviors are associated with the development of
various illnesses.
Stress impairs sleep. And the resulting inattention and carelessness probably play a role in the
relatively high accident rates of people under stress. Studies have found that children and adults
who experience high levels of stress are more likely to suffer accidental injuries at home, in sports
activities, on the job, and while driving a car than individuals under less stress. Further, disrupted
sleep can itself be stressful, and poor sleep interferes with a key way that the body is restored
physiologically.

PHYYSIOLOGY AND ILLNESS

Stress produces many physiological changes in the body that can affect health, especially when
stress is chronic and severe. For instance, allostatic load is a physiological state in which the strain
involved in reacting repeatedly to intense stressors produces wear and tear on body systems that
accumulate over time and lead to illness.
Connections have been found between illness and the degree of reactivity people show in their
cardiovascular, endocrine, and immune systems when stressed.

Ɯ CARDIOVASCULAR SYSTEM REACTIVITY

Cardiovascular reactivity refers to physiological changes that occur in the heart, blood vessels,
and blood in response to stressors.
Before middle age, people’s degree of cardiovascular reactivity is generally stable, showing little
change when retested with the same stressors years later. In later years, cardiovascular
reactivity increases with age, which corresponds to increases in risk of cardiovascular illness.
Research has discovered links between high cardiovascular reactivity and the development of
CHD, hypertension, and stroke. For example, high levels of job stress are associated with high
blood pressure and abnormally enlarged hearts and people’s laboratory reactivity to stress in
early adulthood is associated with their later development of high blood pressure and
atherosclerosis.
The blood pressure reactivity that people display in laboratory tests appears to reflect their
reactivity in daily life. A metaanalysis found that greater cardiovascular reactivity and poor
cardiovascular recovery after stressors were associated with greater risk of cardiovascular
disease, including higher blood pressure, diagnosed hypertension, and atherosclerosis.
Stress produces several cardiovascular changes that relate to the development of CHD. For
instance, the blood of people who are under stress contains high concentrations of activated
platelets and clotting factors that thicken the blood, which can contribute to a heart attack.
Stress also produces unfavorable levels of cholesterol and inflammatory substances circulating
in the blood. These changes in blood composition promote atherosclerosis—the growth of
plaques within artery walls. These changes narrow and stiffen the arteries, thereby increasing
blood pressure and the risk of a heart attack or stroke.
Stephen Manuck and his colleagues have demonstrated this link between stress and
atherosclerosis in research with monkeys. Similar effects of experimentally manipulated
stressful living conditions on atherosclerosis have been demonstrated in rabbits.
Although human stress and cardiovascular disease probably differs somewhat from what occurs
in animals, the ability to perform true experiments in which chronic stress is manipulated over
long periods of time provides important converging evidence to the findings of observational
studies of human stress and cardiovascular disease.
The functioning of the stress-dampening system can be measured though increases and
decreases in heart rate that are due to respiration; changes in the activity of the
parasympathetic nervous system cause heart rate to slow down when we breathe out and sped
up when we breathe in. The magnitude of this change in heart rate—sometimes called ‘‘vagal
tone’’ is a good indicator of the strength of an individual’s parasympathetic stress dampening
system. Importantly, higher vagal tone is associated with lower risk of cardiovascular disease.

Ɯ ENDOCRINE SYSTEM REACTIVITY

Part of reactivity involves activation of the adrenal glands, both directly by sympathetic nervous
system stimulation of these glands and by the hypothalamus-pituitary-adrenal axis as described
previously. In this process, the adrenal glands release hormones—particularly catecholamines
and corticosteroids—during stress.
One way in which high levels of these hormones can lead to illness involves their effects on the
cardiovascular system. For example, an intense episode of stress with high levels of these
hormones can cause the heart to beat erratically and may even lead to sudden cardiac death.
In addition, chronically high levels of catecholamines and corticosteroids, such as cortisol, can
contribute the development and progression of atherosclerosis. However, social support may
help: people with high levels of social support tend to exhibit lower endocrine reactivity than
with those with lower levels.
Stress also seems to contribute to health through endocrine system pathways that involve fat
stored in the abdominal cavity.
The metabolic syndrome is a set of risk factors including high levels of cholesterol and other
blood fats; elevated blood pressure; high levels of insulin in the blood or impairments in the
ability of insulin to facilitate transportation of glucose out of the blood stream; and larger fat
deposits in the abdomen.
The metabolic syndrome seems to be made worse by exposure to stressors and the related
physiological stress responses, especially heightened neuroendocrine activity.
The metabolic syndrome also promotes chronic inflammation in the blood stream and
elsewhere, increasing the risk of cardiovascular disease and other serious conditions, such as
diabetes.

Ɯ IMMUNE SYSTEM REACTIVITY

The release of catecholamines and corticosteroids during arousal affects health in another way:
these stress responses alter the functioning of the immune system.
 Brief stressors typically activate some components of the immune system, especially non-
specific immunity, while suppressing specific immunity.
Chronic stressors, in contrast, more generally suppress both non-specific and specific immune
functions. Chronic stressors also increase inflammation, an important process that disrupts
immune function when it occurs on a long-term basis.
The effects of acute and chronic stress on the immune system can be measured in many ways,
such as the extent to which immune system cells multiply or proliferate in response to antigens,
or the ability of such cells to destroy foreign microorganisms or viruses.
Immune system functioning can also be measured in others ways, such as whether or not an
individual has a successful immune response to a flu vaccination.
For example, increases in cortisol and epinephrine are associated with decreased activity of T
cells and B cells against antigens.
This decrease in lymphocyte activity appears to be important in the development and
progression of a variety of infectious diseases and cancer.
Among people with cancer, those with high levels of killer-T-cell activity have a better
prognosis than those with low levels of activity.
Immune processes also protect the body against cancers that result from excessive exposure to
harmful chemical or physical agents called carcinogens, which include radiation. Carcinogens
can damage the DNA in body cells, which may then develop into mutant cells and spread.
Fortunately, people’s exposure to carcinogens is generally at low levels and for short periods of
time, and most DNA changes probably do not lead to cancer.
When mutant cells develop, the immune system attacks them with killer T cells. Actually, the
body begins to defend itself against cancer even before a cell mutates by using enzymes to
destroy chemical carcinogens or to repair damaged DNA. Research has shown that high levels of
stress reduce the production of these enzymes and the repair of damaged DNA.
If stress disrupts the immune system it can affect a great variety of health conditions from the
common cold to herpes virus infections to cancer.

PHYSICAL ILLNESS
Stress can also have an impact on one’s physical health. The idea that stress can contribute to
physical ailments is not entirely new. Evidence that stress can cause physical illness began to
accumulate back in the 1930s. By the 1950s, the concept of psychosomatic disease was widely
accepted.
Psychosomatic diseases were defined as genuine physical ailments thought to be caused in part by
stress and other psychological factors.
The classic psychosomatic illnesses were high blood pressure, peptic ulcers, asthma, skin disorders
such as eczema and hives, and migraine and tension headaches. These diseases were not regarded
as imagined physical ailments. Rather, psychosomatic diseases were viewed as authentic organic
maladies that were heavily stress related.
Since the 1970s, the concept of psychosomatic disease has gradually fallen into disuse because
research has shown that stress can contribute to the development of a diverse array of other
diseases previously believed to be purely physiological in origin.
Stress may influence the onset and course of heart disease, stroke, gastrointestinal disorders,
tuberculosis, multiple sclerosis, arthritis, diabetes, leukemia, cancer, various types of infectious
disease, and probably many other types of illnesses.
Stress is only one of many factors that may contribute to the development of physical illness. Some
of the physical effects of stress might be exacerbated by the risky behaviors people are more likely
to engage in when stressed. For example, stress appears to be related to increases in substance
abuse, including problematic drinking and cigarette smoking, and these behaviors come with their
own health hazards.

PSYCHONEUROIMMUNOLOGY
Psychological and biological systems are interrelated—as one system changes, the others are often
affected. The recognition of this interdependence and its connection to health and illness led
researchers to form a new field of study called psychoneuroimmunology.
This field focuses on the relationships between psychosocial processes and the activities of the
nervous, endocrine, and immune systems. These systems form a feedback loop: the nervous and
endocrine systems send chemical messages in the form of neurotransmitters and hormones that
increase or decrease immune function, and cells of the immune system produce chemicals, such as
cytokines and ACTH, that feed information back to the brain.
The brain appears to serve as a control center to maintain a balance in immune function, since too
little immune activity leaves the individual open to infection and too much activity may produce
autoimmune diseases.

Ɯ EMOTIONS AND IMMUNE FUNCTION

People’s emotions play a critical role in the balance of immune functions. Research has shown
that pessimism, depression, and stress from major and minor events are related to impaired
immune function.
For example, research compared immune variables of caregiver spouses of Alzheimer’s disease
patients with matched control subjects and found that the caregivers had lower immune
function and reported more days of illness over the course of about a year.
Positive emotions can also affect immune function, giving it a boost. In the study by Arthur
Stone and his coworkers, adult men kept daily logs of positive and negative events and gave
saliva samples for analyses of antibody content. Negative events were associated with reduced
antibodies only for the day the events occurred, but positive events enhanced antibody content
for the day of occurrence and the next two.
Some stressful situations start with a crisis, and the ensuing emotional states tend to continue
and suppress immune processes over an extended period of time. This was demonstrated with
healthy elderly individuals who were taking part in a longitudinal study of the aging process.
Similarly, a study found that people who become unemployed show impaired immune function
that recovers after they get a new job.
When people react to short-term, minor events, such as doing difficult math problems under
time pressure, changes in the number and activity of immune cells occur for fairly short periods
of time—minutes or hours. The degree of change depends on which immune system component
is measured and the event’s characteristics—long-lasting and intense interpersonal events seem
to produce especially large immune reductions.
Immune system reactivity varies from one person to the next, but a person’s degree of response
to a type of event seems to be much the same when tested weeks apart. This suggests that an
individual’s reaction to specific stressors is fairly stable over time.
One key process of the immune system— inflammation—is receiving increased attention
because it is implicated in a wide variety of serious medical conditions. Stress can evoke
increases in inflammatory substances in the blood, as can chronic levels of negative affect.
Inflammation, in turn, can contribute to atherosclerosis, rheumatoid arthritis and other chronic
conditions, and seems to generally accelerate age-related diseases.
Emerging perspectives suggest that under conditions of chronic stress the immune system
becomes less sensitive to the normal anti-inflammatory effects of cortisol, so that inflammatory
responses remain activated and can eventually damage health.

Ɯ PSYCHOSOCIAL MODIFIERS OF IMMUNE SYSTEM REACTIVITY

Psychosocial factors in people’s lives may modify the stress they experience. Such factors seem
to affect immune system responses, too. For instance, social support affects the immune
function of people under long-term, intense stress.
A related psychosocial modifier is disclosure— describing one’s feelings about stressful events.
An experiment with college students examined the effect of expressing such feelings on blood
levels of antibodies against the Epstein-Barr virus, a widespread virus that causes
mononucleosis in many of those who are infected. Research has found that describing feelings
about stressful events is more effective in enhancing immune function in cynically hostile people
than in nonhostile individuals.
The influence of optimism on immune function appears to depend on whether the stress is
short-term or chronic. Optimism is often associated with better immune functioning, but
sometimes worse, perhaps because optimists persist in physiologically taxing efforts to influence
or control stressful circumstances. Optimism has also been associated with lower levels of
inflammation.
Ɯ LIFESTYLES AND IMMUNE FUNCTION
People with generally healthful lifestyles—including exercising, getting enough sleep, eating
balanced meals, and not smoking—show stronger immune functioning than those with less
healthful lifestyles.
Other studies have found that sleeping poorly can impair immune function the next day, and
people who smoke are more susceptible than those who don’t to catching colds.

Ɯ CONDITIONING IMMUNE FUNCTION

Research on psychoneuroimmunology with animals has revealed that the influence of
psychological processes on immune function is not limited to the effects of stress. The impact
may be far more broad and pervasive.
Robert Ader and Nicholas Cohen have shown that immune suppression can be conditioned.

In their original research, they were actually studying how animals learn to dislike certain
tastes. The procedure used a single conditioning trial: the subjects (rats) received
saccharinflavored water to drink and then got an injection of a drug that induces nausea. To see
whether the rats’ subsequent dislike of the taste depended on its strength, some subjects
received more saccharin flavoring than others in this conditioning trial.

Over the next several weeks, the drug was not used, but the animals continued to receive
saccharin- flavored water. During this time, the researchers noticed a curious thing: a number
of rats had fallen ill and died—and these animals tended to be the ones that had consumed the
greatest amount of saccharin in the conditioning trial.

Since the nausea-inducing drug used in the conditioning trial was also known to suppress
immune function temporarily, Ader and Cohen hypothesized that the continued intake of
saccharin water served as a conditioned stimulus, suppressing the ability of the rats to fight
infection.
Subsequent experiments by these researchers and others confirmed this hypothesis and
demonstrated that conditioning can raise or lower immune function and can influence both
antibody-mediated and cell-mediated immune processes.
Similar conditioning effects have been demonstrated in humans, such as cancer patients who
receive medications that impair immune function.
IMPAIRED TASK PERFORMANCE
Stress often takes its toll on the ability to perform effectively on a task. For instance, Roy
Baumeister theorized that pressure to perform often makes people self-conscious and that this
elevated self-consciousness disrupts their attention, thereby interfering with performance.
He theorizes that attention may be distorted in two ways. First, elevated self-consciousness may
divert attention from the demands of the task, creating a distraction. Second, on well-learned tasks
that should be executed almost automatically, the self-conscious person may focus too much
attention on the task. Thus, the person thinks too much about what he or she is doing.
Baumeister found support for his theory in a series of laboratory experiments in which he
manipulated the pressure to perform on a simple perceptual-motor task. He found that many
people tend to “choke” under pressure. His theory also garnered some support in a pair of studies of
the past performance of professional sports teams in championship contests. These findings were
particularly impressive in that gifted professional athletes are probably less likely to choke under
pressure than virtually any other sample one might assemble. Laboratory research on “normal”
individuals suggests that choking under pressure is fairly common.
Recent studies suggest that Baumeister was on the right track in looking to attention to explain
how stress impairs task performance.
According to Beilock, choking under pressure tends to occur when worries about performance
distract attention from the task at hand and use up one’s limited cognitive resources. Consistent
with this analysis, one study found that chronic stress undermined participants’ performance on a
task requiring attention shifts.
It appears that personality might play role in one’s tendency to choke under pressure.
In a study of experienced basketball players, researchers found that athletes with a greater fear of
negative evaluation showed more choking and more anxiety in high-pressure situations than those
with less of that fear.

DISRUPTION OF COGNITIVE FUNCTIONING

The effects of stress on task performance often result from disruptions in thinking or in cognitive
functioning.
In a study of stress and decision making, Keinan measured participants’ attention under stressful
and nonstressful conditions and found that stress disrupted two specific aspects of attention. First,
it increased participants’ tendency to jump to a conclusion too quickly without considering all their
options. Second, it increased their tendency to do an unsystematic, poorly organized review of their
available options.
Brandes et al. examined trauma survivors within days of their experience and found that those
with severe stress levels had poorer attention levels than those with few distress symptoms.
Brandes speculates that poor attention might play an important role in shaping one’s memory for a
traumatic event.
Studies suggest that stress can have detrimental effects on certain aspects of memory functioning.
In order to affect memory, stressors do not have to be major; even minor day-to-day or anticipatory
stressors can have a negative impact.
Evidence suggests that stress can reduce the efficiency of the “working memory” system that allows
people to juggle information on the spot. Thus, under stressful situations, people may not be able to
process, manipulate, or integrate new information as effectively as normal.
Merz and colleagues demonstrated that stress disrupts memory for socially relevant information.
These researchers found that exposure to a stressful situation in a laboratory caused an increase in
production of cortisol, a more negative mood, and a reduction in social memory. Stress hormones
might play a role in the recall of certain memories.
Ironically, simply being in a situation where you need cognitive resources the most can produce
this resource-sapping stress effect. Stress has a complicated relationship with memory in that
short-term, mild-to-moderate stressors can actually enhance memory, especially for emotional
aspects of events.

BURNOUT

Burnout is a syndrome involving physical and emotional exhaustion, cynicism, and a lowered sense
of self-efficacy that is attributable to work-related stress.
Exhaustion, which is central to burnout, includes chronic fatigue, weakness, and low energy.
Cynicism is manifested in highly negative attitudes toward oneself, one’s work, and life in general.
Reduced self-efficacy involves declining feelings of competence at work that give way to feelings of
hopelessness and helplessness.
According to Maslach and Leiter “Burnout is a cumulative stress reaction to ongoing occupational
stressors”. The conventional wisdom is that burnout occurs because of some flaw or weakness
within the person, but Christina Maslach asserts that “the research case is much stronger for the
contrasting argument that burnout is more a function of the situation than of the person”.
Factors in the workplace that appear to promote burnout include work overload, interpersonal
conflicts at work, lack of control over responsibilities and outcomes, and inadequate recognition for
one’s work.
Physical conditions such as noise, light, and temperature can also contribute to workplace stress,
as can night and rotating shift work.
Burnout is associated with increased absenteeism and reduced productivity, as well as increased
vulnerability to a variety of health problems.
Decades of research have shown that burnout is found all over the world in a wide variety of
cultures.

PSYCHOLOGICAL PROBLEMS AND DISORDERS

Psychologists have long suspected that chronic stress might contribute to many types of
psychological problems and mental disorders.
Since the late 1960s, advances in the measurement of stress have allowed researchers to verify
these suspicions in empirical studies.
In the domain of common psychological problems, studies indicate that stress may contribute to
poor academic performance, insomnia and other sleep disturbances, sexual difficulties, and
substance abuse.
Stress often contributes to the onset of full-fledged psychological disorders, including depression,
schizophrenia, anxiety disorders, and eating disorders.
Daily hassles can be a huge source of stress for individuals. For instance, as the repercussions of
the worldwide recession continue to unfold, unemployment remains at historically high levels in
many nations, economic growth has given way to economic stagnation in most countries, and
economic instability continues to be a major concern around the world. These factors create stress
that takes a psychological toll.
Studies have found an association between unemployment and elevated suicide rates; one study
estimated that suicide rates are four times higher among those suffering through long-term
unemployment.
Some individuals are exposed to extremely stressful, traumatic incidents that can leave a lasting
imprint on their psychological functioning.

Ɯ POST-TRAUMATIC STRESS DISORDER

Posttraumatic stress disorder (PTSD) involves enduring psychological disturbance attributed to
the experience of a major traumatic event.
PTSD did not become an official psychological diagnosis until 1980, and since that time
researchers have studied the disorder extensively to better understand the long-term impact of
exposure to trauma.
Although PTSD is widely associated with the experiences of veterans, it is seen in response to
other cases of traumatic stress as well. It is frequently seen after a rape, a serious automobile
accident, a robbery or assault, or the witnessing of someone’s death. PTSD is also common in
the wake of major disasters, such as floods, hurricanes, earthquakes, fires, and so forth.
Research suggests that approximately 9% of people have suffered from PTSD at some point in
their lives, and it is twice as common in women as men. PTSD is seen in children as well as
adults, and children’s symptoms often show up in their play or drawings. In some instances,
PTSD does not surface until many months or years after a person’s exposure to severe stress.

✓ Symptoms
Common symptoms include reexperiencing the traumatic event in the form of nightmares
and flashbacks, emotional numbing, alienation, problems in social relations, and elevated
arousal, anxiety, and guilt. PTSD is also associated with an elevated risk for substance
abuse, depression, and anxiety disorders, as well as a great variety of physical health
problems.
The frequency and severity of posttraumatic symptoms usually decline gradually over time,
but in some cases the symptoms never completely disappear.

Although PTSD is fairly common in the wake of traumatic events, the vast majority of people
who experience such events do not develop PTSD. Thus, a current focus of research is to
determine what factors make certain people more (or less) susceptible than others to the ravages
of severe stress.

According to McKeever and Huff, this vulnerability probably depends on complex interactions
among a number of biological and environmental factors. One key predictor that emerged in a
recent review of the relevant research is the intensity of one’s reaction at the time of the
traumatic event.
 Individuals who have especially intense emotional reactions during or immediately after the
traumatic event go on to show elevated vulnerability to PTSD. Vulnerability seems to be
greatest among people whose reactions are so intense that they report dissociative experiences.

POSITIVE EFFECTS OF STRESS

Recent years have brought increased interest in positive aspects of the stress process, including
favorable outcomes that follow in the wake of stress.
Some influential theorists have argued that the field of psychology has historically devoted too
much attention to pathology, weakness, damage, and how to heal suffering. This approach has
resulted in an unfortunate neglect of the forces that make life worth living. The positive psychology
movement seeks to shift the field’s focus away from negative experiences.
Advocates of positive psychology argue for increased research on well-being, contentment, hope,
courage, perseverance, nurturance, tolerance, and other human strengths and virtues. One of these
strengths is resilience in the face of stress.
There appear to be at least three ways in which stress can have positive effects.
Ɯ First, stress can promote positive psychological change, or what Tedeschi and Calhoun call
posttraumatic growth. Experiences of posttraumatic growth are now well documented, and it
appears that this phenomenon is evident in people facing a variety of stressful
circumstances, including bereavement, cancer, sexual assault, and combat.
Stressful events sometimes force people to develop new skills, reevaluate priorities, learn
new insights, and acquire new strengths. In other words, the adaptation process initiated by
stress may lead to personal changes for the better.

Ɯ Second, stressful events help satisfy the need for stimulation and challenge. Studies suggest
that most people prefer an intermediate level of stimulation and challenge in their lives.
Although we think of stress in terms of stimulus overload, underload can be stressful as well.
Thus, most people would experience a suffocating level of boredom if they lived a stress-free
existence. In a sense, then, stress fulfills a basic need of the human organism.

Ɯ Third, today’s stress can inoculate and psychologically prepare individuals so that they are
less affected by tomorrow’s stress. Some studies suggest that exposure to stress can increase
stress tolerance—as long as the stress isn’t overwhelming.
Further, dealing with some adversity provides an opportunity to develop coping skills that
can decrease distress when new stressors arise. That is, it can build “mental toughness”.
In light of the negative effects that stress can have, improved stress tolerance is a desirable
goal.