3.4 Stress
- Syllabus
- 9990–2028–2029
- Topic
- 3.4
- Level
- A2
Learning objectives
3.4.1Sources of stress• 3.4.1 Sources of stress- physiology of stress: the General Adaptation Syndrome (GAS) and the effects of stress on health.- causes of stress:- - Holmes and Rahe's life events- - work including a study, e.g. Chandola et al. (2008)- - Friedman and Rosenman's Type A personality.- Relevant issues and debates and methodology for this topic include: individual and situational explanations, reductionism versus holism, determinism versus free-will, idiographic versus nomothetic, generalisations.3.4.2Measures of stress• 3.4.2 Measures of stress- biological measures:- - recording devices for heart rate and brain function (fMRI), including a study, e.g. Wang et al. (2005)- - sample tests for salivary cortisol, including a study, e.g. Evans and Wener (2007).- psychological measures: self-report questionnaires, including tests of Friedman and Rosenman's Type A personality and Holmes and Rahe's life events questionnaire.- Relevant issues and debates and methodology for this topic include: questionnaires, psychometrics, subjective and objective data, validity, reliability.3.4.3Preventing and managing stress• 3.4.3 Preventing and managing stress- psychological therapy: biofeedback, including a study, e.g. Budzynski and Stoyva. (1969).- use of imagery to reduce stress (exemplified by the following key study).- Key study on relaxation and imagery in reducing stress during medical treatment: Bridge et al. (1988).- preventing stress: three phases of stress inoculation training.- Relevant issues and debates and methodology for this topic include: application to everyday life, individual and situational explanations, determinism versus free-will, generalisations, ethics.
Stress links prolonged demands to physiological and behavioural health risk
| GAS stage | Adaptive response | If demand persists |
|---|---|---|
| Alarm | Sympathetic/adrenal activation releases adrenaline and cortisol; heart rate, breathing, glucose and alertness rise for fight-or-flight | Repeated activation increases physiological load |
| Resistance | Overt alarm falls while the body maintains resources and remains ready; the person may appear to cope | Irritability, poor concentration, sleep/appetite disturbance and sustained cardiovascular/endocrine activity can emerge |
| Exhaustion | Resources and recovery capacity are depleted after prolonged demand | Fatigue, anxiety/depression, weakened immunity and increased hypertension/metabolic/CHD risk—not an inevitable fixed endpoint |
| Source model | Stress mechanism | Boundary |
|---|---|---|
| Holmes & Rahe life events | Social Readjustment Rating Scale sums life-change units: greater accumulated readjustment predicts higher illness risk | Events differ in meaning, desirability, culture and coping; correlation does not prove events caused illness |
| Work stress | High demands with low control/justice and sustained effort can activate physiology and encourage unhealthy coping | Job, grade, prior health and personality confound associations |
| Friedman & Rosenman Type A | Time urgency, competitiveness, hostility and control orientation increase frequent threat/challenge appraisal | Nomothetic label varies within people; hostility may be more relevant than the whole type |
| Chandola et al. (2008) Whitehall II | Evidence map |
|---|---|
| Sample/design | Longitudinal cohort of 10,308 London civil servants aged 35–55 at baseline; repeated work-stress exposure and CHD outcomes across phases |
| Outcomes | CHD death/non-fatal myocardial infarction/angina, health behaviour, metabolic syndrome, heart-rate variability and morning cortisol rise |
| Results | Chronic work stress predicted CHD, especially under age 50 (RR 1.68); it also related to poorer behaviour, metabolic risk, lower HR variability and higher morning cortisol. About 32% of the association was attributed to behaviour/metabolic syndrome |
| Inference/limit | Supports behavioural and neuroendocrine pathways, but an observational civil-service cohort cannot establish manipulation-level causality or represent every occupation/culture |
Use a person–situation account: demands and life change create conditions, while control, appraisal, coping, resources and personality alter response. GAS describes a broad physiological trajectory; it does not decide which source is stressful for one individual.
Stress can raise probability of illness without making illness inevitable. Life-event scores, Type A and work strain are risk explanations; they do not diagnose a person or prove a single cause.
Stress measures capture arousal, brain response, hormones or appraisal
| Measure | Proxy | Strength | Validity limit |
|---|---|---|---|
| Heart rate/device | Autonomic arousal over moments/time | Objective, continuous, repeatable | Exercise, caffeine, illness and excitement also raise rate |
| Perfusion fMRI | Regional cerebral blood-flow change during/after task | Spatially localises stress-related brain response | Indirect, expensive, artificial and motion-sensitive; does not read thoughts |
| Salivary cortisol | HPA-axis hormone in saliva | Non-invasive, quantitative, repeatable in field settings | Strong circadian/food/medication differences; sampling time matters |
| Type A questionnaire | Self-reported time urgency/competitiveness/hostility | Standardised trait comparison | Response bias and broad labels reduce construct validity |
| Holmes–Rahe questionnaire | Weighted recent life change | Fast nomothetic risk index | Weightings omit appraisal, context, culture and positive/negative meaning |
| Wang et al. (2005) | Evidence map |
|---|---|
| Method | Perfusion fMRI measured cerebral blood flow while participants completed a psychologically stressful arithmetic/performance task and comparison periods; behaviour and physiological responses were also recorded |
| Finding | Ventral right prefrontal activation was specifically associated with psychological stress and persisted beyond the task; a wider network supported stress responses |
| Evaluation | Repeated objective brain-flow measurement links task and response, but small controlled samples and scanner/task artificiality restrict generalisation; activation is a correlate, not a unique stress centre |
| Evans & Wener (2007) | Evidence map |
|---|---|
| Sample/procedure | 139 urban rush-hour train commuters; saliva collected after the journey and at home on a comparison weekend, alongside self-report and performance aftereffects |
| Result | Overall carriage density did not predict stress indices, but immediate seating density/personal-space invasion significantly affected cortisol, self-report and aftereffect performance |
| Evaluation | Natural commute and converging measures improve ecological/construct validity; no random allocation, self-selection/routine differences and sampling timing constrain causality |
Match measure to the claim: momentary arousal (heart rate), regional task response (fMRI), HPA activity (cortisol), personality style or accumulated life change (questionnaires). Convergence across physiology, self-report and behaviour is stronger than treating any one proxy as ‘stress itself’.
Biological data are more objective in recording, not automatically more valid for the person's experience. Standardisation supports reliability; validity still depends on timing, confounds, construct definition and ecological context.
Stress management makes arousal, imagery and coping skills controllable
| Biofeedback loop | Learning job |
|---|---|
| 1 Measure | Sensor records a normally hidden response such as forehead EMG, heart rate or skin conductance |
| 2 Translate | Device gives immediate sound/display proportional to the response |
| 3 Try strategy | Person relaxes muscles/breathing and observes whether feedback falls |
| 4 Reinforce/transfer | Successful control is practised until it can be used without the device |
| Budzynski & Stoyva (1969/1970) | Evidence map |
|---|---|
| Design | 15 tension-headache patients randomly allocated to contingent forehead-EMG tone, constant irrelevant tone or silent relaxation; all tried to relax forehead muscles over five sessions |
| Result | Contingent-feedback group significantly reduced muscle tension relative to controls; early patients also showed reduced headache activity |
| Evaluation | Contingent versus irrelevant/silent controls support feedback-specific learning, but tiny specialised sample, expectancy and muscle tension as a proxy limit generalisation to all stress |
| Bridge et al. (1988) | Evidence map |
|---|---|
| Sample/design | 154 women under 70 receiving six weeks of early breast-cancer radiotherapy at one London hospital; 139 completed; randomised relaxation (47), relaxation+peaceful imagery (44), supportive talking control (48) |
| Procedure/outcomes | Weekly ~30-minute sessions; interventions practised from tapes ≥15 minutes daily. POMS and Leeds depression/anxiety scales measured mood |
| Results | Six-week total mood disturbance was lower in interventions; combined group was more relaxed, control worsened and women ≥55 benefited most. No group difference on Leeds depression/anxiety scales |
| Boundary | Supports mood benefit during treatment—not cancer cure or direct proof that ‘stress’ fell. Field realism/randomisation are strengths; self-report, demand/practice and one female clinical sample limit transfer |
| Stress inoculation training phase | What happens |
|---|---|
| 1 Conceptualisation | Collaboratively identify stressors, thoughts, physiological/behavioural responses and explain the stress model |
| 2 Skills acquisition/rehearsal | Learn and practise relaxation, coping self-statements, cognitive restructuring, problem-solving/assertiveness matched to the person |
| 3 Application/follow-through | Rehearse increasingly realistic stressors, use skills between sessions, review outcomes and adapt/maintain the plan |
The device does not relax muscles by itself, imagery did not improve every measure, and SIT is more than relaxation. All require active practice/free choice within situational constraints; evaluate benefit, distress during therapy, access, maintenance and population fit.