Stress Psychology Revision Notes

Exam Paper Advice

In the exam, you will be asked a range of questions on the topic of stress, which may include questions about research methods or using mathematical skills based on research into relationships.

As in Paper One and Two, you may be asked a 16-mark question, which could include an item (6 marks for AO1 Description, 4 marks for AO2 Application and 6 marks AO3 Evaluation) or simply to discuss the topic more generally (6 marks AO1 Description and 10 marks AO2 Evaluation).

There is no guarantee that a 16-mark question will be asked in this topic though so it is important to have a good understanding of all of the different areas linked to the topic.

There will be 24 marks for stress questions, so you can expect to spend about 30 minutes on this section, but this is not a strict rule.

Stress is a pattern of negative physiological states and psychological responses occurring in situations where people perceive threats to their well being which they may be unable to meet.

The level of stress depends on the individual’s perception of the event and their perception of their ability to cope with the event.

For example, taking an exam might not be perceived as a stressor by someone who has had good results at their test (they feel they can cope) but might be seen as a stressor by another individual who has failed all their tests (they feel they can’t cope this leads to a stress response).

General Adaptation syndrome (GAS)-Seley (1936) AO1

In this model, Seley describes the process of responding to a stressor in three stages:

Stage 1 : alarm
Once the stressor is perceived, the physiological responses to deal with it are activated.

Stage 2 : resistance
If the threat does not subside, the body tries to cope. Hormones are released to provide the body with the energy needed to deal with the stressor. If the stressor persists and becomes chronic the elevated levels of hormones could be damaging the cardiovascular system. However, the individual appears to be coping.

Stage 3 : exhaustion
The resources needed are becoming drained; the individual is experiencing the same symptoms than in the alarm stage e.g. fast heart rate. The immune system is weakened and diseases are likely to develop e.g. infections and cardiovascular disorders such as raised blood pressure.

AO3

Selye’s model was the first to accurately describe the physiological changes that occur during the stress response. This later led to further research in the negative effects of stress on health.

Selye assumes that the response remains the same to all stressors, which was supported by his research with rats. However, when the experiments were replicated on monkeys by Mason (1971) he found that the response varied with the type of stressors e.g. cold temperatures lead to an increase in cortisol but heat did not.

This challenges the GAS model. Furthermore, these experiments were carried out on animals who are different from humans cognitively and emotionally. According to the transactional model, in humans the individual’s perception of the stressor and their perception of their ability to cope with it influence the stress response. This is unlikely to be the same in animals.

Another difference is that animals are also more passive in the way they respond to stress; humans are likely to take measures to escape the stressor or at least reduce its impact whereas animals are unlikely to do so.

The GAS model suggests that human responses to stressors are the same for all people; however, Mason (1975) argued that when we are presented with a stressor, we make an assessment of the situation. This influences the physiological response we produce (transactional model).

Furthermore, gender influences the physiological response to stress so do individual characteristics such as personality type and locus of control .
rmal/desirable.

Acute stress response: Sympathomedullary Pathway (SAM) (AO1)

The aim of this response is to provide oxygen and glucose to the skeletal muscles (the muscles which enable us to “fight or flight”).

When a stressor is perceives the hypothalamus activates the sympathetic branch of the autonomic nervous system. This, in turn, causes the adrenal medulla to release adrenaline into the bloodstream. This prepares the body for “fight or flight” . The adrenaline and noradrenaline increase the heart rate and the breathing rate, the blood circulation is redirected to the skeletal muscles and the digestion stops.

When the stressor subsides the parasympathetic branch of the nervous system is activated and the heart and breathing rate decrease, the digestion restarts and all other functions go back to their normal level.

Chronic stress response: hypothalamic-pituitary-adrenal system ( HPA ) (AO1)

This response occurs when the stressor is chronic; the aim of this response is to provide energy for a long period of time. It does not need to be fast so it uses hormones as a way of transmitting signals.

When a chronic stressor is perceived, the hypothalamus releases Corticotrophin Releasing Factor (CRF) and this is transported by the blood stream to the pituitary gland which then produces Adrenocorticotrophic hormone (ACTH). This is also transported by the bloodstream to the adrenal glands. The cortex of the adrenal glands produces corticosteroids, the most important being cortisol.

Cortisol mobilises glucose stored in the liver, this provides a constant supply of energy for the body to deal with the stressor.

Role of cortisol (AO1)

Cortisol plays an important role in the stress response as cortisol provides the body with glucose by tapping into the reserves stored in the liver. This energy can help an individual fight or flee a stressor.

Cortisol also has an anti-inflammatory role however; it also leads to a weakening of the immune system. This increases the likelihood of infections.

Cortisol constricts blood vessels and increases blood pressure to enhance the delivery of oxygenated blood. This is advantageous for fight-or-flight situations but over time, such arterial constriction and high blood pressure can lead to vessel damage and plaque build-up, this can lead to cardiovascular disorders.

AO3

Men tend to respond to stress by the fight or flight response whereas women are more likely to produce the “tend and befriend” response. This is thought to be caused by a higher level of oxytocin hormone in women than in men. So gender influences the activation of the SAM pathway.

Most of the studies carried out on stress were done on men. The results cannot be generalised to women as gender influences the response to stressors. However, psychologists assume that the “fight or flight” response apply to all humans, this shows a gender bias.

Psychological factors are not taken into account. People carry out appraisal of the stressors and their response will vary depending on whether they think they have the resources to cope with the stressors (transactional model).

The studies carried out on the stress response scientific, they used objective data e.g. the amount of adrenaline.

Application: based on our knowledge of the stress response, people who suffer from Addison’s disease are given cortisol to cope with stress. Although this remains a serious condition requiring with cortisol treatment and frequent medical monitoring, people can lead a fairly normal life, whereas previously Addison’s disease was fatal.

How does stress affect health?

• Directly through the action of stress hormones such as cortisol.
• Indirectly through the use of coping strategies such as smoking, lack of exercise and poor diet.

The main systems affected are the immune system and the cardiovascular system.

Stress and immunosuppression AO1

• Cortisol weakens the immune system by reducing the production of lymphocytes (white blood cell) and affecting other types of white blood cells such as the NK cells.
• Diversion of energy resources away from maintaining immunity
• Maladaptive coping behaviors (smoking, lack of exercise)

However, it is not a straightforward relationship:

Stress and cancer

Some cancers are known to be affected by the functioning of the immune system, cervical cancer is such as example.
Perira et al. (2003) carried out a study on HIV positive women comparing women who experienced high chronic stress and those who did not. One year later those with high stress were more likely to have developed pre cancerous lesions of the cervix.

However, this was not a representative sample (HIV weakens the immune system significantly). The link between stress and cancer is weak and difficult to establish, according to Kissane, compared to the influence lifestyle and genetic factors.

Stress and the cardiovascular system AO1

The prolonged exposure to stress causes hardening of the arteries through deposit of plaque, this results in high blood pressure and coronary heart disease (CHD).

This can be through the direct action of the stress hormones but also, because of the change of lifestyle often associated with chronic stress e.g. poor diet, excessive drinking, smoking and lack of exercise.

Yusuf et al. (2004) carried out a study of patients who had suffered heart attacks (myocardial infarction) in 52 countries, with a sample of 15152 cases and 14820 controls.

They found that, although lifestyle factors such as smoking were influential, stress including workplace stressors and life events had a significant impact on the rate of heart attacks. This impact was greater than obesity.

Evaluation of the effect of stress on health: AO3

• The research done on humans was natural experiments or correlational studies. There was no control of extraneous variables such as lifestyle e.g. smoking, lack of exercise or poor diet; therefore we cannot establish a causal link between stress and immunosuppression or the incidence of cardiovascular disorders. There are also difficulties with measuring stress. This is usually done through the use of questionnaires and the answers could be affected by social desirability. Also, if the SRRS questionnaire is used the participants are asked to recall events from the previous year which might be inaccurate so this way of measuring stress is very unreliable and the validity of the measure is questionable.
• Some of the research was done on animals but animals are different from humans cognitively and physiologically. According to the transactional model, in humans the individual’s perception of the stressor and their perception of their ability to cope with it influence the stress response. This is unlikely to be the same in animals. Another difference is that animals are also more passive in the way they respond to stress; humans are likely to take measures to escape the stressor or at least reduce its impact whereas animals are unlikely to do so. This makes the results difficult to extrapolate to humans. However for practical and ethical reasons we cannot carry out some of the studies on humans.
• A further problem is that the studies have been carried out in Western countries which make the samples ethnocentric. We do not know if individuals from other cultures would respond in the same way.
• A further problem is that the studies fail to disentangle the effects of stress and other factors such as diet, exercise and alcohol use. This limits their usefulness as we cannot see which factor could be altered to prevent immunosuppression or cardiovascular disorders.
• Furthermore, these studies do not allow us to make prediction for any single individual’s health as the effects of stress are mediated by personality type and coping style. Moreover, the functioning of the immune system and the cardiovascular system is also influenced by genetic factors which are not taken into account in these studies.
• However, the knowledge of the possible effects of stress on health has been widely publicised and has raised the awareness of the general public, it has led some people to take action to prevent these problems from developing e.g. taking regular exercise, attending yoga classes, having a healthier diet.

Life changes AO1

Major life events are significant events that change the way we live our daily lives. These events disrupt our normal routine. If our normal routines are disrupted we have to think about how to do things that we normally do on ‘auto-pilot’. This means we have to use much more mental energy – what Holmes & Rahe called ‘psychic energy’.

Constantly having to think, and use up energy, leaves us feeling exhausted and less able to cope with other parts of our lives. Since stress is caused by a mismatch between our perceived ability to cope with the perceived demands of a situation, (transactional model) this will unavoidably create stress.

The bigger the change, the more adjustment has to be made; therefore the more energy has to be used. The effects of life changes are cumulative. According to Rahe (1972) people who stay under 150 LCU in a year stay in good health, however, over 150 LCU the likelihood of illness increases by 30% and over 300 LCU, it increases by 50%.

Both positive and negative events require adjustment so they are both considered as sources of stress.

Measuring stress: the Social Readjustment Rating Scale (SRRS)

To measure the effect of life changes Homes and Rahe (1967) developed the Social Readjustment Rating Scale (SRRS). 43 life events were taken from 5000 patient records, 400 participants scored the life events in terms of the readjustment needed i.e. marriage = 50. Scores for individual life events were added and averaged to produce a life change unit (LCU) for each event.

Research of the effects of the effects of life events on health

Although Rahe is not a key study you could be asked to describe a study on this topic.

Rahe et al.(1967): The aim of the study was to find out if life changes correlated with illness.
Rahe used a ‘normal’ population – not those who were already suffering of any known disorders. His sample consisted of 2700 members of US navy.
All life events of previous 6 months recorded – before a tour of duty using a questionnaire and a LCU score was calculated for each participant.

During the tour of duty, every illness no matter how minor had to be reported.
The participants were unaware of the aim of the study.

On their return, after 6 months of active duty, an illness score was calculated and correlated with the LCU score by an independent researcher.
Result: a positive correlation ( .118) between the two sets of data supported the hypothesis that life changes cause stress and increase the likelihood of illness.

AO3

• The sample was all male (andocentric), we cannot generalise the results to women who respond differently to stress.
• The sample was ethnocentric, it was drawn from an individualist culture we cannot generalise to individual from collectivist cultures who might respond differently in a similar situation.
• The PS were sailors on tour of duty, the conditions in which they lived was very different from normal circumstances e.g. they did not have social support from their family and friends. Social support buffers the effect of stress.
• The data about life events was obtained by questionnaires so the answers might have been influenced by social desirability. For example, people might not have wanted to report some of the life events because they might consider them as too personal and sensitive. The questionnaire also relied on retrospective data, the participants might not have remembered or might have distorted events which occurred over the last six months.
• It was a correlational analysis therefore other factors could be involved such as diet and exercise which also influence health in a significant way.

Evaluation of life events as a source of stress: AO3

• Individual differences – what is stressful for one person might not be as stressful for another (transactional model). Byrne and White (1980) tried to predict who would experience a heart attack using life change score but they found that it worked only if they took into account the interpretation each participant gave to the events.
• Supported only by correlational studies so cannot derive a cause and effect relationship between the co-variables as other factors could be involved such as diet.
• Life events may not affect health because they are too rare. Daily hassles may be more important to health as they occur more often.
• The questionnaire used to measure life events relies on retrospective data therefore validity and reliability of people’s memory of past events has been questioned.
• The answers to the questionnaires could be influenced by social desirability.
• The events listed in the SRRS focus on adult life, it does not include some events affecting children and adolescents such as starting university or failing exams. Furthermore, they do not include items such as famine and civil wars which affect millions of people. Additionally it could be argued that it is gender bias as events such as having an abortion which is a potential source of stress in women’s lives, are not included.
• Not all of the events on the SRRS may affect health; what is more important is how ‘undesired, unscheduled and uncontrolled’ changes are. For example, a divorce might be a traumatic event for some people but a relief to others especially if domestic abuse was involved.
• Make the assumption that positive events have the same impact on health than negative events. This is challenged by Turner & Wheaton who found that undesired/undesirable life events caused most of the stress.
• These last two points, therefore, question whether we can measure stress in a standard for everybody.
• Rahe et al.(1967) supports the relationship between life events and illness however the correlation is weak(0.118) (see evaluation of this study)
• The research was carried out in Western cultures; this is ethnocentric and might not reflect the way would respond in other cultures. Furthermore, the SRRS consist mainly of events which are likely to affect westerners, factors such as famine and civil wars are not listed as life events and yet they affect millions of people.

Hassles and uplifts AO1

Lazarus focused on everyday life stresses.

• Hassles: Minor events that arise throughout the course of the day which cause stress.
• Uplifts: Small positive experiences that counteract stress.

How do they lead to stress?

Daily hassles accumulate over the course of the day and therefore provide a more significant source of stress than life changes. (accumulation effect)

Severe life changes may make participants more susceptible to daily hassles. (amplification effect)

Measuring stress: the Hassles and Uplifts scale

Khanner et al. (1981) created a hassles scale containing 117 items covering all aspects of life including work, family and friends. The respondent rates the severity of the hassle on a three points scale. The uplifts scale contains 135 positive items such as getting a good night sleep. The individual indicates how often they have experienced these events over a particular period of time.

Research of the effects of the effects hassles and uplifts on health

Although Kanner is not a key study you could be asked to describe a study on this topic.
Daily hassles: Kanner et al (1981)

Aim: To investigate an association between daily hassles, uplifts and symptoms of stress and compare the outcome with the use of the SRRS as a predictor of stress symptoms.
Procedure: 100 American white, middle class men and women, aged 45-64 were studied. They completed the “Hassles & Uplifts” questionnaire once a month, for 10 months. They also completed a version of the SRRS one month before the start of the study and another one during the study. The participants completed a further questionnaire measuring the psychological symptoms of depression and anxiety.

Findings: Daily Hassles were positively correlated with psychological symptoms associated with stress such as anxiety and depression. There was a negative correlation between uplifts and stress symptoms in women but not in men. Daily Hassles was found to be a better predictor of stress symptoms than life events.

Daily uplifts:
Gervais et al. (2005), nurses were asked to keep diaries for a month, recording daily hassles and uplifts connected with their job. They were also asked to rate their own performance over the same period.
Results showed that nurses felt the uplifts usually counteracted the negative effects of their daily hassles, and also improve their performance.

Evaluation of hassles as a source of stress AO3

• Research is correlational, so we cannot draw causal conclusions. It might be because a person is depressed that they report an event as a hassle rather than the hassles causing depression.
• Individual differences in what is considered as a hassle or uplift. Some uplifts can become a hassle if we experience too often. Also it depends on the situation, if we are pressed for time a friendly colleague can be seen as hassle distracting us from an urgent task.
  Use of self-report questionnaires; participants may be influenced by social desirability.
• Participants may not correctly remember the hassles they have experienced as these are minor events.
• The studies supporting the effect of daily hassles used participants from Western societies, these are ethnocentric. Social support is a protective factor against stress and it varies amongst different cultures so we cannot generalise the results of these studies to individuals from collectivist cultures.
• The effect of daily hassles could be due to the fact that whereas we are more likely to get social support when life changes support, this is rarely the case when we face daily hassles so it could be the lack of social support rather than the daily hassles in themselves that cause the psychological symptoms observed in Kanner (1981) and Bouteyre (2007).

Comparing life changes and daily hassles AO3

• Life changes are but require major readjustment when they occur whereas daily hassles are frequent requiring only minor readjustment.
• Both have support from research: the effects of life changes are supported by Rahe et al. (1967) and the effects of daily hassles are supported by Kanner et al. (1981).
• We usually get more social support when a life event occurs (this protects against the negative effects of stress) than when we face daily hassles.
• Both rely on questionnaires, therefore problems of social desirability.
• Both rely on retrospective data therefore memory of events might be inaccurate which puts in question the validity of findings.
• Both have support but they are correlational studies (no cause and effect relationship).

Workplace stress AO1

Workplace stressors are aspects of the workplace environment which elicit a stress response therefore which we experience as stressful.
There are many workplace stressors but the syllabus focuses on:

Control: In many organisations, other people determine workload, work patterns and limit the number and type of decisions employees can make.
Workload: How much work and the type of work a person does. Too much and too little can lead to stress.

According to Karasek (1979)

• The most stressful jobs involve high demand and low control.
• The least stressful jobs involve low demand and high control.

The effects of control and workload

Although neither Marmot et al. or Johansson et al. (1978) are mentioned as key studies you could be asked to describe a study on this topic. So you need to learn one of them in detail and use the other one as support for the other.

Whitehall study Marmot et al. (1997)

The aim was to investigate the relationship between control in the workplace and the incidence of coronary heart disease (CHD).
Sample: 7372 both male and female British civil servants, aged between 35-55.
Longitudinal prospective study over a 5 years period.
The participants were sent a questionnaire and asked to take part in a screening examination for cardiovascular disease at the beginning of the study.
Their employment grades were grouped into three categories: administrators, executive and clerical/support staff.
Job control and workload was measured by self-completed questionnaire.
CHD was measured by a qualified doctor.
Findings:
After taking age into account, both men and women reporting having the least control over their job were three times more likely to develop CHD after 5 years. However, there was no correlation between workload and illness.

* Prospective study watches for outcomes e.g. the development of a disease, during a period and relates this to other factors. It involves taking a sample of participants and observing them over a long period.

Johansson et al. (1978)

It was a natural experiment, comparing two groups of employees in a Swedish sawmill.
Procedure:
Group 1: 14 “finishers”, their work was highly repetitive and they had no control over the pace at which their work was carried out (machine paced). The pay of all other employees depended on their productivity.
Group 2: 10 cleaners who had more control over their workload, less responsibility and more opportunities for social contacts.
The levels of adrenaline and noradrenalin in their urine were measured both at work and in their free time, and the number of illnesses and absences from work were recorded.
Findings: The finishers had higher levels of stress hormones even before starting work and it increased during the day than those in the low stress group. Their levels of illness and absenteeism were also higher.
Conclusions: Repetitiveness, high demand/workload and lack of control chronic stress and the development of stress-related illnesses.

Evaluation of workplace stress

• Many studies use self-report methods (questionnaires and interviews) to gather data therefore the answers might be influenced by social desirability.
• The link between workplace stress and illness is purely correlational, correlation do not show a cause and effect relationship between the variables as other factors could be involved.
• Individual differences are not taken into account some occupations might attract certain types of personality and this could in turn affect vulnerability to stress, persons with type A personality might be attracted to demanding and stressful jobs, therefore it could be that personality type leads to health problems not low job control.
• It does not consider individual differences in the response to stress; individuals have different coping styles which mediate the effects of stress.
• Other possible causes for the differences in the rate of CHD are that those who give the order are usually better paid so they have a different and maybe less stressful lifestyle e.g. more holidays, better diet and less money worries. This has an impact on the health outcome.
• The lack of control might not have the same effect on all as having control might be a source of stress for those with low-self-efficacy. Self-efficacy is defined by Bandura as “one’s belief in one’s ability to succeed in specific situations or accomplish a task.”
• The studies of the relationship between control at work and CHD have been mostly carried out in individualist cultures, however, Gyorkos et al (2012) carried out a cross-cultural study and found that control was less desirable in collectivist cultures such as China so it is less likely to be a source of stress in these cultures.
• These studies are important from an economic point of view as their results could be used to decrease the rate of absenteeism which is a very significant drain on the national economy; the annual cost of sickness absence was £29 billion in lost revenue for UK organisations in 2013.
• These studies were carried out over 20 years ago and the workplace stressors may have changed since they were carried out workplace stressors might be different for example a possible source of stress is the use of new technology which was not available when these studies took place or worries about job security.

• Social Readjustment Rating Scale (see previous section)
• Hassles and uplift scale (see previous section)

Skin Conductance Response (SCR)

SCR measures the skin’s resistance to electricity. When people are stressed they sweat this lowers the skin’s resistance to electricity.
People have a higher SCR when they are stressed than when they are not as their damp skin conducts electricity better.
A measurement of SCR is made when people are in low stress condition, this measure is then compared to another measurement made when the same person is in a high stress condition, and this shows the intensity of the stress response.

AO3

• SCR can tell us the intensity of the stress response but it cannot differentiate between stress and other emotional states which produce the same reaction (extreme happiness or sadness).
• It is cheap and easy to use however the readings can be affected by external factors such as degree of atmospheric humidity and internal factors such as alcohol consumption.
• The readings can be inconsistent, with different reading being obtained when the same person is presented with the same level of stimulus suggesting that it is not a reliable form of measurement.
• It is used in some experiments such as a replication of Asch when the participants’ SCR was measured and showed that the participants who did not conform had higher results than the participants who did conform.
• It is also used in biofeedback (see coping with stress) where it helps people to control their stress levels.

Personality types AO1

In the 1960s Friedman and Rosenman (both were cardiologists) studied the behavior of the patients suffering from coronary heart disease, they found that they displayed some distinctive behavioral patterns.

Type A personality

• Competitive: they are driven individuals, set themselves targets, ambitious.
• Time urgent and impatient: they have little time for creative pursuits, multitasking and fast-talking.
• Hostile and aggressive: intolerant, inflexible and get angry quickly.

Type B personality

• Relaxed
• One thing at a time
• Patient
• Express feelings

Although Rahe is not a key study you could be asked to describe a study on this topic.
Friedman and Rosenman (1974)

They used a prospective study, their aim was to investigate the links between type A behavior patterns and cardiovascular disease.

Procedure:
Using structured interviews, 3200 men aged 39-59 were categorised as type A, type B or type X (balanced between A and B). The men were healthy (no CHD) at the start of the research.
The assessment was based on answers to an interview and behavior during interview. (Researcher provoked Ps by being aggressive and interrupting them).The Ps were classified as type A or type B according to their observed behavior.
The sample was followed up for 8.5 years to assess lifestyle and health outcomes.

Findings:
At the end of the study 257 men had developed CHD, 70% of those were from the type A group.
These results were significant even when risk factors such as smoking and obesity were taken into account.
Conclusions: Type A behavior pattern is risk factor for heart disease.

Type C personality

Later personality type C was identified by Temoshok (1987)

Type C personalities are detail oriented, people pleasers, passive and patient. They suppress wants, needs and feelings. The repression of anger is thought to make them more prone to developing cancer.
Dattore et al. (1980) carried out a prospective study on 200 veterans of the Vietnam War. The participants completed scales measuring repression of feelings and symptoms of depression.

By the end of the study, 75 of the participants were diagnosed with cancer; these typically had reported significantly more repression of feelings and less symptoms of depression than the other participants.
This supports a link between Type C personality and cancer. However, the findings are inconsistent and Nakaya et al. (2002) did not support this link.

AO3

• The sample of the Friedman and Rosenman’s study consisted only of males therefore we cannot generalise the results to women who have different ways to deal with stress and might be less vulnerable.
• Both the Dattore et al. (1980) and the Friedman and Rosenman study clearly show that personality type can affect our health. This supports the transactional model as it shows that events are not stressors by themselves but that their effects are mediated by psychological factors.
• Most studies focus on men; this shows a gender bias in psychology.
• The Friedman and Rosenman study does not show which trait of personality type A leads to CHD. Matthew and Haynes (1996) found that hostility was most associated with CHD. This is supported by Dembroski et al. (1989) reanalysed the results of the study and found that ratings on hostility were good predictors of CHD. Furthermore, the participants of the original study were followed up by Carmelli (1991) and she found a very high rate of death caused by CHD in the participants with high hostility scores.
• Myrtek (2001) meta-analysis of 35 studies found an association between hostility and coronary heart disease supporting Friedman and Rosenman’s findings. However, Ragland and Brand (1988) found little evidence of a relationship between personality type and coronary heart disease.
• We are not pure type A or type B we tend to vary along the continuum depending on the circumstances and the situation we are in.
• Some individual with type A personality are driven and well-balanced individuals unlikely to develop CHD while some type Bs are in fact suppressing their hostility and their ambitions, these people are likely to develop CHD despite being classified as type B.
• In individualist cultures, men are socialised to display Type A behavior.
• The personality type A could be the result of prolonged exposure stress.
• Knowing that Type A behavior pattern is risk factor for heart disease could lead to behavior modification programmes to reduce Type A behavior should result in a reduce risk of heart disease. This would be a beneficial outcome for the individuals concerned but also for society as they will take less absence leave and will require less medical care.

Hardiness AO1

Kobasa and Maddi (1979) identified a personality structure consisting of three aspects:uote>

Control is one of the factors of hardiness. Hardy people see themselves as being in charge of their life, not controlled by outsides factors which they cannot control.

Commitment is one of the factors of hardiness. Hardy people are involved in the world around them and have a sense of purpose.

Challenge is one of the factors of hardiness. Hardy people see challenges as problems to be overcome rather than as stressors. They see change as a challenge and stressful situations as opportunities to learn rather than as a source of stress.

AO3

• The studies carried out were correlational studies so they do not show a cause and effect relationship between the variables, other factors could be involved such as exercise and social support.
• The sample used are mostly American males therefore there is a gender bias and ethnocentrism which means that the results cannot be generalised to women or people from other cultures. Furthermore, Maddi and Kobasa studied managers, these people have different living conditions from people in lower positions so they do not represent people from lower social classes or unemployed. They might have better diet and more holidays; these factors would have an influence on the health outcomes.
• Application: this has given rise to a therapy to help with stress control, hardiness training, where people learn to see stressors as challenges that they can take control of, rather than overwhelming problems over which they have no control.
• It is not clear which of the factors –control, challenge and commitment – have is most influential. Recent research focuses on control and commitment. Furthermore it is unclear how these factors affect health, it could be that people with high level of hardiness do not respond to stressors as intensely as people with low level of hardiness e.g. they do not produce as much stress hormones or that they engage in healthier activities.

Physiological methods of stress management: drugs AO1

The physiological methods of stress management involve the use of drugs to target the stress response systems.

AO3

• Drugs are cost-effective and easy to take therefore they are popular with patients.
  Drugs act faster than psychological therapies so they are useful in emergency situations.
• Short-term solution, as soon as the drugs are stopped the symptoms reappear if the causes of the stress are not dealt with. However, they can improve the patients’ symptoms enough for them to start psychological therapies.
• BZs have serious side-effects.
• Unlike psychological therapies, drug treatment does not give patients skills to learn to cope with stress.
• The use of drugs might decrease the amount of time people take in sickness leave thus being beneficial to the economy.

Psychological therapy: Stress Inoculation Therapy (SIT) AO1

Stress inoculation therapy is a form of Cognitive Behavioral Therapy (CBT).

It involves a person identifying the causes of stress (e.g. the features of the stressful situation) and the irrational thoughts which accompany these before offering cognitive and behavioral skills which will help a person better cope with the demands of the situation.

It takes place in stages:

1. Conceptualisation :
   Clients are encouraged to relive the stressful event and analyse different features of the situation. From this the clients get a better understanding of the nature of the stress and their reactions to it.
   It focuses on the cognitive appraisal of the stressor and the client’s ability to cope with it.
2. Skills training :
   Clients are taught specific strategies for coping with stressful situations. This might include relaxation, increased control and social skills.
3. Real-life application :
   The client learns to use these skills in a safe environment e.g. through visualising stressful situations, then they go out into the real world and put their training to the test. Part of this stage is also to learn to deal with setbacks (see them as challenges providing an opportunity to learn rather than as failures).

The client learns to use these skills in a safe environment e.g. through visualising stressful situations, then they go out into the real world and put their training to the test. Part of this stage is also to learn to deal with setbacks (see them as challenges providing an opportunity to learn rather than as failures).

In most cases, SIT consists of between 8-15 sessions, plus follow-up sessions after a few months.

AO3

• By acquiring new skills, an individual can reduce the gap between demands and coping resources and so gain more confidence to handle previously stressful situations in the future.
• It is very flexible, it can be applied to many individuals and all types of stressful situations (e.g. examination stress, Berger, 2000)
• It is an expensive treatment as it is done by qualified psychologists.
• It is time consuming for the client who might stop before the end of the treatment reducing its effectiveness. It also requires the client to be able and willing to be involved in a lot of self-reflection and accept potential failures.
• The effectiveness of SIT is supported by Holcom (1986)
• Unlike drugs, the strategies and skills learnt by the client can be used in future situations so it should prevent developing the same problems in the future. Also unlike drugs, SIT has no side-effects.

Biofeedback AO1

Biofeedback therapy involves training the client to control involuntary physiological processes such as muscle tension, blood pressure, or heart rate.

The reason why we cannot usually do this is because we are not aware of these processes. This therapy, therefore, makes these processes visible to the client through the use of technology such as heart monitors (electrocardiograms), the use of electromyograms (which shows the tension in the muscles) and skin conductance response (SCR) .

It takes place in 3 stages:

1. 1. The client learns to become aware of their physiological responses and how they can be adjusted e.g. reducing the heart rate.
   2. The client learns techniques to control their physiological responses e.g. abdominal breathing, muscles relaxation.
   3. The client learns to use these techniques in their everyday life especially in stressful situations.

Sessions are usually an hour long, most people will start to see positive results after 10 sessions. However, some patients may need many more sessions.

AO3

• Biofeedback is expensive as it is a one to one therapy and requires specialised equipment.
• Clients learn skills that can be used in the future so it is a preventative therapy.
• Unlike drugs, biofeedback is not a “quick fix” as it takes time to learn the strategies required to control the physiological responses so it is not suitable for emergency situations. However unlike drugs it has no side effects.
• It requires commitment from the clients as it takes many sessions to see improvement of the symptoms and it requires motivation as the client has to be willing to practice the skills learnt in the clinic in their real life.
• Greenhalgh(2009) carried out a meta analysis of 36 studies with a total sample of 1660 patients who had used biofeedback as treatment for hypertension. She concluded that there is no evidence that biofeedback is effective in reducing the negative effects of stress. However some people report feeling better and this might, in itself, be a positive outcome.

Gender differences in coping with stress AO1

The type of social support an individual receives depends on the social network and individual has but also on their gender and their culture. Social support buffers the effects of stress in five different ways according to Stroebe (2000).

Problem-focused strategies : aim at changing or eliminating the source of the stress in practical ways which tackle the problem that is causing stress, therefore directly reducing the stress response.

Emotion- focused strategies : aim at reducing the negative emotional responses associated with stress by using methods such as meditation, comfort eating, keeping busy so as to avoid thinking about the situation.

Most people use both types of strategies but to various extents and in response to different stressors.

In response to acute stressors women are more likely to use the “tend and befriend” response than men. Men are more likely than women to respond to acute threat with the “fight or flight” response. The “tend and befriend” response is linked with the presence of oxytocin, a hormone involved in social bonding, formation of attachment and trust. Men also produce oxytocin but testosterone directly suppresses it whereas the oestrogens present in women enhance its effects. When in the presence of an acute stressor, men produce vasopressin; a hormone related to aggression, its action is enhanced by testosterone. This leads to an aggressive response.

The role constraint theory: Males and females face different stressors

This explains the difference in coping styles by proposing that men and women face different stressors for which different coping strategies are needed e.g. problem-focused strategies are more suitable for work stressors, whereas emotion-focused strategies are more suitable for relationship stressors.

Ptacek et al. (2014) found that men and women were similar in their appraisal of an identical stressor but they coped with it differently. Women reported seeking social support and using emotion-focused coping more than men; men reported using more problem-focused strategies than women.

Tamres et al. (2002) in a meta-analysis found women were more likely to engage in emotion-focused strategies such seeking social support and positive self-talk and ruminating about problems than men supporting the dispositional hypothesis. She also found support for the role constraint theory as other gender differences were dependent on the nature of the stressor.

AO3

• Most studies use questionnaires so the answers could be influenced by social desirability.
• They use retrospective data which might be forgotten or distorted. De Ridder (2000) found that women reported using emotion-focused strategies more than men only when they recalled past events but not when they reported “live” (at regular intervals during the day).
• The coping style could be the result of difference in socialisation of men and women rather than purely biological factors. It could also be the result of self-fulfilling prophecy.
• There are wide differences in the way people respond to stress so gender may only be one of the individual characteristics influencing the coping style used.
• The role constraint theory is gender biased as it assumes that women are not subject to work whereas men are not stressed by relationships and family problems. This is a stereotypical view which does not relate to reality as women hold very responsible and stressful jobs (i.e. G.P. lawyers) and men take responsibility for elderly relatives or children.

The role of social support in coping with stress AO1

The type of social support an individual receives depends on the social network and individual has but also on their gender and their culture. Social support buffers the effects of stress in five different ways according to Stroebe (2000).

Esteem support : when the individual feels that sources of support value them. This makes the individual feel valued and more competent in dealing with the stressor.

Emotional support : warmth and nurturance provided by sources of social support. It makes the individual feel that they can depend on others for sympathy and understanding.

Appraisal support : others help the individual to assess the stressor and its effects. This helps in establishing a realistic view of the situation.

Informational support: others give information and guidance on how to deal with the stressful situations or feedback on the strategies used.

Instrumental support : it can be indirect such as helping out in order for the individual to have more time and energy to deal with the stressor or direct such as lending money if the stressor is financial difficulties.

Orth-Gomer et al. (1993): In a sample of 700 50 years old Swedish men. She found that smoking and lack of social support were the two leading risk factors for CHD in these middle-aged men.

Stachour (1998) investigated the influence of the quantity and the quality of social support. The quantity was measured by the number of interactions; the quality was measured by questionnaires measuring the emotional, esteem and instrumental support. The results show that quality was related to better health but not quantity.

AO3

• The way social support helps combat stress is not understood, it may be that it helps the individual in many way e.g. feeling more competent in dealing with the stressor or reappraising the stressor “putting the stressor in perspective”.
• Cohen and Wills (1985) propose the buffering hypothesis which suggests that social support protects against the negative effects of stress by creating a psychological distance with the stressor.
• It is difficult to isolate and test which of the form of social support is the most helpful; however it could be that different types of social support are helpful in different situations.
• The role of social support is supported by Orth-Gomer et al. (1993) and Stachour (1998).
• Men and women use social support in different ways; women have smaller social networks but they are more willing than men to use them for support when facing stressful situations.
• Most of the research is ethnocentric as it was done in individualist cultures, collectivist cultures have different social networks as they live in extended families and work more as groups than in individualist cultures. This influences the social support they get from their social network.