What are the bodily symptoms to stress? If a threat/stressor is detected the hypothalamus is alerted. Describe what happens in the SAM (sympathomedullary) pathway. Responsible for the body's fast response to stress. When the hypothalamus is alerted, electrical signals are sent down the autonomic branch (ANS) of the peripheral nervous system. Activity in the sympathetic branch of the ANS causes various things: - Fight or flight mode: Increased heart rate, dry mouth. - Stimulates the medulla of the adrenal glands ⇒ Adrenaline and noradrenaline released which prolong stress response. Describe what happens in the pituitary adrenal system. Slower than SAM pathway. When hypothalamus is alerted hormones are released ⇒ corticotrophin releasing hormone (CTR). CTR causes the release of ACTH (adrenocorticotrophic hormone) from pituitary gland. Release of ACTH stimulates adrenal cortex. Adrenal cortex releases corticosteroids (cortisol). Cortisol causes increased pain tolerance and hydrolysis of glycogen for energy. Prolonged cortisol release causes chronic stress, CVD, suppressed immune system.

How does the body return to normal? The parasympathetic nervous branch shuts down the production of adrenaline, cortisol and noradrenaline. How is stress related to the immune system? Immune system consists of phagocytes and lymphocytes. Lymphocytes include NK (natural killer) cells, T cells. Corticosteroids reduce size of thymus gland ⇒ produces T cells. ACTH inhibits immune cell function. How is the link investigated? Correlational studies Natural experiments Lab/field experiments Describe Kiecolt and Glaser's study. A: To determine the impact of real life stressors on immune function. P: Natural experiment Participants were 75 1st year medical students. Blood samples taken 1 month before exams and right after 1st exam. Participants given questionnaires to asses life events, loneliness and psychiatric symptoms. F: NK cell activity declined between two samples. Immune system most weak in students who felt lonely. C: Stress is associated with lowered immune response. There are different sources of stress factors. Evaluate Kiecolt and Glaser's study. ☑Natural experiment ⇒ ☑Less ethical issues ☒Not a true experiment ☒Can only assume that there exists a negative correlation. ☒NK cells only one aspect of immune system ☒Only medical students used: unrepresentative ☑Directly measured immune function. ☑Supported by Kiecolt-Glaser's wound-healing study. Describe Cohen et al's study. A: To investigate the effect of general life stress on vulnerability to the common cold virus. P: 400 participants completed questionnaires on stressful life events in past year. They rated the degree of stress and their levels of anxiety /depression. Were then exposed to common cold virus. 82% became infected. Tested again 7 days later to see if symptoms developed. F: Positive correlation between about of stress and developing cold. C: Life stress reduces effect of immune system. Evaluate Cohen et al. ☒Did not directly measure immune function. Assumed from symptoms. ☒No direct manipulation of IV - only a correlation. ☒Ethical problems with exposing people to viruses even if they have given informed consent. What are life events? And how are they measured? Life events are major events that dramatically change your life. A scale was created by Holmes and Rahe. It is the Social Readjustment Rating Scale (SRRS). The scores are measured in Life Changing Units (LCU). SRRS scale was created by making a list of 43 events that caused patients illness. Scale was given to participants to rate stressfulness of each in LCU's. Outline Rahe et al's study. A: To investigate whether scores on the Holmes and Rahe SRRS were correlated with illness. P: 2500 male US navy personnel given SRRS scale to measure life events in past 6 months. Medical records in last 6 months also accessed. Two covariables are LCU's and illness score. F: Weak but significant positive correlation between high LCU and illness. C: Experiencing stressful events leads to weak immune system. Evaluate Rahe at al's study. ☑Large sample = reliable ☒Naval personnel is unrepresentative of general population. Only males = bias. ☒Finding is only correlational not causational.Weak relationship shows that other factors are involved. ☒SRRS is self report = Unreliable. Exaggeration, some events may not have been on scale. What is a daily hassle and how are they measured? Daily hassles are small stressors encountered in daily life which cause irritation and stress. They are measured using Delongis' Hassles and Uplifts scale. This scale is a self-report method. Can lead to unreliable answers due to different perceptions of daily hassles. Outline Delongis' study. A: To see if life changes or daily hassles are more strongly correlated with health problems. P: 100 middle aged participants given 4 questionnaires throughout a months. Daily hassles and uplifts scale, life events and health questionnaire. F: Daily hassles show significant correlation with health score. Negative correlation. Life changes had no dramatic impact on health, unless they occurred in 2.5 years before the study. C: Daily hassles more strongly related to stress symptoms. Evaluate Delongis' study. ☑Supported by other evidence e.g. Assessment of Daily Experience scale. ☒Sample is not representative. Does not have population validity. ☒Rating scale didn't take into account chronic stressors. What are the sources of stress in the workplace? Control Demands Physical stressors Role conflict Psychosocial stressors Outline Johansson et al's study. A: To investigate weather machine-paced work, repetitiveness and responsibility increases stress. P: Research done on Swedish sawmill workers. Analysed 14 'finishers' whose job has high risk of stress. Compared them to low risk job - cleaners. Combined physiological (stress hormones) and behavioural responses (illness and absenteeism). F: Finishers secreted higher levels of adrenaline/noradrenaline and experienced more stress related illnesses compared to cleaners. C: Work stressors can lead to chronic stress. Evaluate Johansson's study. ☑Includes many different measures of stress; objective, physiological (hormones) = reliable. ☒Not clear what stressor is most important. Many differences between jobs. ☒Type A personalities might do finisher job, whereas type B might do cleaner = confounding variable. ☑Has useful applications and implications for the real world. Finishers offered less pressured work. Outline Marmot et al's study. A: Investigate relationship between job control and stress-related illness. P: 7500 male and female civil servants answered questionnaires and asked for signs of CVD. Longitudinal study. 5 years. Signs of CVD, presence of CHD risk factors, employment grade, job control, social support all measured. F: Low job control = 4x more likely to die from heart attack. Higher grades of job = less CVD problems. Lower grade workers more likely to smoke due to stress. Risk factors increase chance of CVD. C: Low control = risk of CVD, stress and illness. High job demand not linked to stress. and illness. Evaluate Marmot et al's study. ☑Huge sample with men and women. ☒Only civil servants - unrepresentative. ☒Socio-economic status was a confounding variable. More pay = less stress. What is the difference between Type A and Type B personality? Type A ☞ Ambitious Impatient Aggressive Irritable High stress levels Type B ☞ Low stress levels Creative/reflective Not competitive Laid back Poor sense of time schedule Outline Friedman & Rosenman's study. A: To test if Type A are more likely to develop CHD than type B. P: 3200 healthy men, aged 39 to 59. Categorised as type A(1/2) or type B based on responses in structured interviews. F: After 8.5 years, 257 developed CHD. 70% of CHD developers were Type A (twice as many as Type B). Effect still held if there were other risk factors. C: Type A = more chance of CHD. Evaluate Friedman & Rosenman's study. ☒Only consists of men = unrepresentative. ☑Findings supported by other research e.g. Framingham heart study. ☒Type A personality often drink, smoke = risk factors. ☑People who took part in behaviour modification had fewer second heart attacks. What is hardiness? And how is it measured? Hardiness is a type of personality which is very resilient to stress. It is measured with a questionnaire which measures: Control Commitment Challenge Hardy personalities score high. Outline Kobasas' study. A: Examine effects of protective factors on resistance to stress-related illness. P: A prospective study. Participants rated on presence or absence of; hardiness, social support, regular exercise. Followed participants for several years (longitudinal). Monitored presence of psychological and physical illness. F: Pp's with no protective factors = worse health outcomes. 2+ factors = less illness. Hardiness had best effect. C: Hardiness has greatest effect against prevention of stress related illness. Evaluate Kobasas' study. ☒Only used males - unrepresentative of females. ☒Concepts of control not well defined. Control could be part of commitment or challenge. ☒Other factors could have affected health e.g. smoking. How does stress inoculation therapy work? Conceptualisation: Analyse stressful elements in a stressful situation. Understand how person copes. Individually or in groups. Skills training and practice: Relaxation techniques, specific training e.g. exam technique, public speaking. Application with support: Patient applies learnt knowledge in 'role-play' with therapist. Then in real world. This is continued in next sessions. Evaluate stress inoculation therapy. ☑Targets both symptoms and causes of stress. ☑Clients learn new skills to help deal with stress in long term. ☒Few studies of effectiveness. ☒Expensive and requires time and commitment from patient. What are Benzodiazapenes and how do they work? Lower brain arousal associated with anxiety. Enhance action of brain chemical GABA. Blocks action by other neurotransmitters e.g serotonin ,which causes high arousal. What are beta blockers and how do they work? Act directly on bodily symptoms of stress. Reduce SAM pathway activity. Reduce activity of adrenaline and noradrenaline by blocking receptor sites in circulatory system. Lower heart rate and blood pressure. Have no effect on brain. Evaluate the use of drug treatments for stress management. ☑Large range, readily available, cheap. ☑Fast and effective, reduce anxiety and high blood pressure. Beta blockers can reduce formation of atherosclerosis. ☑BZP's more effective than antidepressants in most types of stress. ☒BZP's can cause dependency and addiction. ☑Beta blockers dont cause addiction. ☒Side effects of BZP's can include drowsiness, cognitive impairment. Beta blockers can affect circulatory system and cause breathing problems. ☒Does not treat the cause of the symptom. Only short relief, not long term.