Stress and health

Chapter 63 Stress and health


Anything from major trauma to the experience of working in a noisy room might be described as stressful. ‘Stress’ is used as shorthand for feeling anxious or suffering physical symptoms and has become a convenient diagnosis for a range of somatic and psychological symptoms. It has proved difficult to define ‘stress’ precisely, but a widely accepted view is that it arises from a mismatch between our perceptions or appraisals of environmental demands and our assessment of our own resources and abilities to cope with these demands (Folkman et al., 1986). Thus the same event may be stressful to one person but not to another and our experience of stress does not necessarily correspond to others’ assessment of the demands we face. For example, gifted students who have always done well in the past may still feel stressed before an examination. Nonetheless, we can characterize events that are related to many instances of stress (Box 1).



Box 1 What kinds of events create stress?



image Major life events, such as being diagnosed with a major illness, a bereavement or job loss

image Chronic stressors, such as long-term unemployment or caring for relatives

image Daily hassles, e.g. the accumulation of minor daily stressors such as being stuck in traffi c jams, arguments

image Work stressors, which include a wide range of chronic and acute aspects of work such as high workload (Fig. 1), lack of job control and conflicts with colleagues

image

Fig. 1 Work-related stress is common.



Measuring stress


Holmes & Rahe (1967) developed the first life events scale (Miller & Rahe, 1997). This approach involves asking people to list events in their recent past that might be expected to be stressful and adding up the burden. For example, death of a close family member warrants a high score (100), as does losing one’s job (47), while trouble with one’s boss attracts a lower score (23). This scale also acknowledges that changes in general, even those that seem positive, can increase stress. For example, 12 points are added just after Christmas! Psychologists have also measured the occurrence of more minor daily hassles, such as taking examinations or getting a low grade in a test (Holm & Holroyd, 1992). Measures of work demands, support and control have also been developed (Jackson et al., 1993). An important limitation of such measures is that they do not measure the particular appraisals made by different people. They measure potential stressors, rather than stress. Such measures can be supplemented with measures of individual stress responses, including assessments of anxiety or general psychological well-being. In addition, since stress affects the sympathetic nervous system (SNS), measures of SNS activity can be used as indicators of stress response. These include blood pressure, heart rate and skin conductance (which changes when we sweat), as well as concentrations of corticosteroids (e.g. cortisol) and catecholamines (e.g. adrenaline and noradrenaline) in the blood.



Factors influencing the experience of stress


Our experience of stress depends on objective, demanding situations and on our individual reactions. When we feel confident in our abilities and resources and perceive demands as challenges rather than burdens we are better able to cope. We are also less likely to experience stress if we are familiar with an event or well prepared for it. For example, a doctor who has previous experience of preparing a patient for surgery (pp. 104–105) or has been well trained in breaking bad news (pp. 98–99) is less likely to feel stressed. Patients are also likely to experience stress if they are unsure of their diagnosis and treatments. Ensuring patients have the information they require (pp. 96–97) and that they have their questions answered can reduce the stress of undergoing medical procedures.

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Jun 10, 2016 | Posted by in PSYCHOLOGY | Comments Off on Stress and health

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