Topic G: Health psychology A2

The hypothalamic-pituitary-adrenal (HPA) axis is a hormone pathway that sustains the body's response when a stressor is appraised as threatening.

The sequence is: (1) the hypothalamus releases corticotropin-releasing factor (CRF); (2) CRF stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH) into the blood; (3) ACTH reaches the adrenal cortex; and (4) the adrenal cortex releases cortisol. Negative feedback normally reduces further CRF and ACTH when cortisol is sufficient.

This pathway is slower than the immediate sympathetic-adrenal response, but it supports a longer-lasting mobilisation of energy. It links a perceived stressor to measurable endocrine change, so researchers can study cortisol in saliva, blood or urine as one indicator of HPA activity.

Cortisol is a glucocorticoid released by the adrenal cortex after activation of the HPA axis.

During an acute stress response, cortisol helps make energy available by increasing glucose in the bloodstream and changing how the body allocates resources. This can support alertness and action while the stressor continues. Cortisol also participates in negative feedback to the hypothalamus and pituitary, helping the response return towards baseline.

A short-lived rise can be adaptive. Repeated or prolonged elevation is different: it can disrupt immune function, metabolism, sleep and cognitive processes, and can contribute to wear on the body. The consequence depends on dose, duration, timing and individual context rather than cortisol being simply a 'bad hormone'.

Stress changes a network of brain processes: the amygdala detects emotional significance, the prefrontal cortex (PFC) regulates thought and action, and the hippocampus supplies memory and context.

These regions work together rather than acting as separate switches. An ambiguous event may activate the amygdala, while the PFC reappraises it and the hippocampus signals whether the context has been safe before. Strong or persistent cortisol exposure can shift this balance towards rapid emotional or habitual responding.

General Adaptation Syndrome (GAS) describes a three-stage physiological response to a persistent stressor: alarm, resistance and exhaustion.

Selye developed the model largely from animal research. Brady's executive monkeys later linked prolonged responsibility-related stress with severe physical deterioration, which is consistent with an exhaustion effect. Controlled physiological evidence gives GAS scientific value and a clear time course.

Major life events require substantial readjustment, whereas daily hassles are smaller recurring irritations; either can contribute to stress.

Holmes and Rahe's Social Readjustment Rating Scale (SRRS) lists 43 events, each assigned life-change units. A person marks events experienced in the previous 12 months and totals their units; a higher score predicts greater risk of stress-related illness. Standard items and fixed scoring make administration replicable and provide quantitative comparisons.

Personality can influence which situations a person enters, how they appraise demands and which coping strategies they use.

Associations between Type A behaviour—especially hostility—and stress-related illness suggest a risk pathway. Hardy people have sometimes reported less illness after negative life events, consistent with protective appraisal. These findings can guide personalised coping: a highly time-urgent person may engage better with active exercise or structured planning than an unpaced relaxation task.

Social support is comfort or practical assistance from other people that can change how a stressor is appraised and managed.

Support may operate as a buffer: the same life event is appraised as less threatening when help is available. Positive social situations can also dampen HPA activity. Nakonz and Shik found that Filipino migrant workers used church relationships, shared coping and religious meaning to adjust emotionally to difficult circumstances.

Coping strategies differ in what they try to change: the interpretation of a stressor, the stressor itself, or the emotional response.

No strategy is universally best. Preparing a timetable may directly reduce an avoidable workload, while accepting grief cannot remove the loss but can make its emotions tolerable. Reappraisal can reduce threat when a belief is distorted, but it should not deny a genuine danger.

A coping technique is positive when it reduces stress without creating disproportionate harm; a negative technique may bring short-term relief while increasing later risk.

The effect should be judged over time and for this person. A weekly self-report such as a positive-and-negative-affect measure can track mood alongside the technique, while behavioural or physiological data can strengthen the picture. Personality and situation can alter whether the same strategy is usable.

Selective serotonin reuptake inhibitors (SSRIs) increase serotonin availability at synapses by blocking its reuptake into the presynaptic neuron.

SSRIs are usually taken as tablets, beginning at a low clinically appropriate dose. Although synaptic effects begin earlier, symptom improvement commonly takes about two to four weeks. Reduced anxiety can make ordinary functioning or psychological therapy more manageable. Treatment must be prescribed and monitored because dose, other medicines and underlying health conditions matter.

Controlled trials and reviews have found SSRIs superior to placebo for some anxiety disorders. In Walkup et al.'s trial with 488 young people aged 7–17, sertraline improved more cases than placebo, while combined sertraline and CBT produced the strongest response. This supports effectiveness without implying that medication works for everyone.

Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine, block transporters for both serotonin and norepinephrine, increasing their availability in the synapse.

SNRIs are pharmacological treatments used for disorders including generalised anxiety disorder. Early in treatment anxiety can temporarily increase; beneficial change may begin after roughly one to two weeks and continue with sustained treatment. Clinical monitoring is needed because norepinephrine as well as serotonin is affected.

Silverstone and Ravindran reported that venlafaxine was effective and generally tolerated among 359 outpatients, while broader trial evidence supports SNRIs as one evidence-based option. A medication can be practical and less resource-intensive than repeated therapy sessions, and another agent may be tried when a first treatment is ineffective.

Cognitive Behavioural Therapy (CBT) treats anxiety by identifying how interpretations, feelings, physical reactions and avoidance reinforce one another, then changing that cycle.

The client and therapist agree clear goals, identify triggers and record automatic thoughts. They examine the evidence for threatening interpretations, develop more balanced alternatives and practise different behaviour through tasks such as role play or graded real-life activities. A reflective diary and standardised measures can track change between sessions and after treatment.

If a person assumes two neighbours are criticising them, anxiety and avoidance prevent disconfirmation. CBT separates fact from prediction, tests a less threatening explanation and rehearses a manageable conversation. New experience can weaken the original belief and avoidance loop.

Brady tested whether the responsibility for controlling an aversive event, rather than exposure alone, was associated with stress-related physical damage.

Eight rhesus monkeys formed four yoked pairs. In each pair, the executive monkey could press a lever to postpone shocks delivered on a 20-second schedule; its yoked partner received the identical shocks but had no control. Sessions lasted six hours, followed by six hours off. The executive role was assigned after avoidance training rather than randomly.

The executive monkeys deteriorated and died between 9 and 48 days with severe stomach ulcers, whereas the yoked controls did not. Because shock exposure was matched, Brady interpreted responsibility and the associated stress as the critical difference. The standardised yoked design supports replication and isolates one contrast.

Nakonz and Shik explored how Filipino migrant workers in Hong Kong used religious belief and church communities to cope with hardship.

After a pilot with 20 Filipino migrants, the researchers studied active church groups through three months of ethnography. They used participant observation at Sunday services and related activities, field notes, open individual interviews with 10 people and four focus groups. Interviewees were female Filipino domestic workers from their mid-twenties to late forties.

Participants described loneliness, homesickness and work or family pressures. Religious reappraisal gave events meaning; handing burdens to God supported acceptance; worship offered distraction; and the group supplied emotional, social and sometimes material help. These strategies mainly supported emotional adjustment rather than removing the employment conditions.

Avdagic et al. used a randomised controlled trial to compare group Acceptance and Commitment Therapy (ACT) with group CBT for generalised anxiety disorder (GAD).

Fifty-one participants meeting GAD criteria—34 women and 17 men aged 19–69—were randomly allocated to ACT (25) or CBT (26). Each group received two-hour sessions across six weeks. Measures were collected before treatment, after treatment and three months later, including worry, depression/anxiety/stress, quality of life and therapy-process questionnaires.

Both treatments produced significant improvement, maintained or extended at follow-up. ACT showed some faster change in distress and its proposed processes, but the groups did not differ significantly at three months. Nine people left therapy and four more supplied no post-treatment questionnaires, leaving complete post-treatment data for 38.

Russell et al. adapted the Responses to Stress Questionnaire (RSQ) so that adolescent coping could be measured in outdoor adventure and therapeutic recreation settings.

An exploratory group of 35 adolescents identified and rated 56 adventure-related stressors. The ten highest-rated stressors were incorporated into the RSQ with the original authors' permission, creating the RSQ-OAV. An expert panel checked content validity before the revised instrument was administered.

The main sample contained 144 adolescents aged 13–17 from public school (49%), private therapeutic settings (42%) and adventure programmes (9%). The sample was mainly White (49.3%) or Asian (36.1%). The 59-item instrument combined Likert-scale items, checklists and open-ended responses and showed moderate-to-high content, convergent and discriminant validity.

A health-psychology method should match the question: measure change reliably, capture lived experience validly, or test a causal contrast.

Operationalise the construct, sample the target population, standardise what should be constant and select evidence that answers the hypothesis. Reliability can be checked through consistent administration or scoring; validity improves when measures actually represent stress or anxiety and when self-report is triangulated with behaviour, physiology or another source.

The Animals (Scientific Procedures) Act 1986 regulates protected procedures on living vertebrates and requires scientific benefit to be weighed against animal harm.

Animals can permit tight control of environment, exposure and physiological measurement where deliberately stressing humans would be unacceptable. Biological similarity may make some mechanisms informative, and a yoked design can separate exposure from control. These advantages do not remove the obligation to justify the species and harm.

Analyse health data by matching the research question and level of measurement to a descriptive display or inferential test, then keep the conclusion within the design.

Choose directional or non-directional hypotheses, significance level and the correct critical value before comparing it with the observed statistic. Rejecting the null means the result is unlikely under the null at that threshold; retaining it means the evidence was insufficient.

Evaluation explains how a specific design feature strengthens or limits the exact conclusion, then states what can still be justified.

A feature can strengthen one inference while weakening another: Nakonz and Shik gain ecological richness but lose standardisation; Avdagic gains experimental control but attrition narrows the analysed sample. Evidence should be triangulated when methods answer different parts of the problem.