Clinical Psychology: Anxiety and Stress (FSWP2062A)
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Summary - Clinical Psychology: Anxiety and Stress (FSWP2-062-A)
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Clinical Psychology: Anxiety and Stress (FSWP2062A)
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Erasmus Universiteit Rotterdam (EUR)
This is a summary of the literature on Clinical Psychology: Anxiety & Stress, additionally updated from the tutorial meetings. It is detailed but concise...all you'll need for the exam :))
Clinical Psychology: Anxiety and Stress (FSWP2062A)
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Problem 1: Stress, Illness, and Coping
(A)
What is Stress?
Þ Two Components
o physical – involving direct material or bodily challenge
o psychological – involving how individuals perceive circumstances in their lives
Þ Approaches to Stress
1. stress as a stimulus – focuses on the environment
• stressors: physically or psychologically challenging events or circumstances
2. stress as a response – focuses on people’s reactions to stressors
• strain: physiological (heart pounds) and psychological (feeling nervous) response
3. stress as a process – focuses on the relationship between the person and environment
• process involves continuous interactions and adjustment - called transactions -
with the person and the environment each affecting and being affected by the
other
• process in which the person is an active agent who can influence the impact of a
stressor through behavioural, cognitive, and emotional strategies
ð stress – circumstance in which transactions lead a person to perceive a discrepancy
between the physical or psychological demands of a situation and the resources of
their biological, psychological, or social systems
Measuring Stress
Þ Physiological arousal – stress produces physiological arousal
o polygraph: electrical/mechanical equipment to take measurements of blood pressure,
heart rate, respiration rate, or galvanic skin response (GSR)
o biochemical analyses of blood, urine, or salvia samples to assess the levels of
hormones that the adrenal glands secrete during stress
• test for two classes of hormones: corticosteroids (cortisol) & catecholamines
(epinephrine and norepinephrine)
ð evaluation
• reasonably direct and objective, quite reliable, easily quantified (+)
• expensive, measurement technique may itself be stressful (-)
• measures are affected by person’s gender, body weight, activity prior/during
measurement, and consumption of various substances
Þ Self-Report Method: Life events
ð List of events; major happenings that can occur in a person’s life that require some
degree of psychological adjustment ® assign each event a value that reflect its
stressfulness
o Social Readjustment Rating Scale (SRRS) - measures the amount of stress people
have experienced
• respondents are given a survey from listing these life events; asked to check off
the ones that happened to them during a given period of time ® researchers sum
the values of the checked items to get a total stress score
ð evaluation
• fairly wide range of events, values distinguish fairly well between stressors (+)
• survey form can be filled out easily and quickly (+)
, • main use relate stress and illness ® but correlation is only about 0.3
§ vague and ambiguous items reduce the precision of an instrument (-)
§ scale does not consider the meaning or impact of an event for an individual (-)
§ items do not consider the person’s subjective appraisal (-)
§ does not distinguish between desirable and undesirable events (-)
§ SRRS emphasises acute stressors (single events) rather than chronic stress, (-)
§ self-report checklist format is susceptible to respondent’s ability to recall
events accurately and their willingness to report them honestly (-)
Þ Hassles Scale - lists 117 events ® indicate which hassles occurred in the past 24 months
and rate each event
o Hassles Scale – more strongly associated with health status than life events
o Uplifts scales – lists 135 events that bring peace, satisfaction, or joy
Biological Aspects of Stress: What is the Effect of Stress on Body Reactions?
Þ Reactivity – physiological portion of the response to a stressor or strain
o measured by comparing reactivity against baseline or “resting level” of arousal
Þ Fight-or-Flight Response (Cannon): prepares the organism to attack the threat or to flee
Þ General Adaption Syndrome (GAS)
1. Alarm Reaction – like fight-or-flight response to an emergency; its function is to
mobilise the body’s resources
o fast-acting arousal results from the sympathetic nervous system (SNS)
• activates many organs through direct nerve connections, including the adrenal
glands, which when stimulated release epinephrine and norepinephrine into the
bloodstream, producing further activation
o somewhat less quickly, the hypothalamus-pituitary-adrenal axis (HPA) of the stress
response is activated
• hypothalamus triggers the pituitary gland to secrete ACTH, which causes the
adrenal gland to release cortisol into the bloodstream, further enhancing the
body’s mobilisation
2. Stage of Resistance – if strong stressor continues, the physiological reaction enters
the 2nd stage
o initial reaction of the SNS becomes less pronounced and HPA activation predominates
o body tries to adapt to the stressors: physiological arousal remains higher than normal,
and the body replenishes the hormones the adrenal glands released
o organism may show few outward signs of stress, but the ability to resist new stressors
may become impaired
• this impairment may eventually make the individual vulnerable to the health
problems called diseases of adaption (e.g.: ulcers, high blood pressure, impaired
immune system, asthma etc.)
, 3. Stage of Exhaustion – prolonged physiological arousal produced by severe long-term
or repeated is costly
o can weaken the immune system or deplete the body’s energy reserves until resistance
is very limited => 3rd stage begins
o if stress continues, disease and damage to internal organs are likely, and death may
occur
Þ Allostatic load
ð effect of the body’s having to adapt repeatedly to stressors that accumulate over time
called allostatic load, which creates wear and tear on the body and impairs its ability
to adapt to future stressors
o important factors
• amount of exposure: more frequent, intense, or prolonged stress ® greater total
amount of physiological activation
• magnitude of reactivity: some individual show larger increases in blood pressure
or stress hormones while others show much smaller changes
• rate of recovery: physiological responses return to normal quickly for some
people, but stay elevated for a longer time for others
• resource restoration: most important is sleep
ð when combined, the four factors determine our overall physiological stress burden
Þ Do all stressors produce the same physical reactions?
ð GAS is nonspecific with regard to the type of stressors; assumes that all stressors
produce the same physiological reactions, but fails to include the role of psychosocial
factors in stress
o pattern of physiological arousal under stress depends on: effort & distress
• effort with distress: increase of both catecholamine and cortisol excretion
• effort without distress: joyous state; increase of catecholamine secretion, and
cortisol secretion may be suppressed
• distress without effort: implies helpless, losing control, giving up; increased
cortisol section, but catecholamines may be elevated too
o cognitive appraisal processes plays a role in people’s physiological reaction to
stressors
Stress and Health
Þ H. Selye first described the stress response in the 1950s
ð emphasised on the dual nature of stress
• short-term (+): fight-or-flight response is adaptive ->
mobilises the organism to respond quickly to danger
• long-term (-): fight-or-flight response causes high arousal
which can be harmful to health if it is prolonged
ð assertion that both physical and psychological stressors
induce the same general stress response (partly correct)
• all kinds of common psychological stressors act like
physical stressors
• “there is only one stress response” has proven to be a
simplification
ð differs from GAS – Selye largely ignored the contributions of
the SNS to the stress response; however stressors activate the
, SNS thereby increasing the amounts of epinephrine and norepinephrine released form
the adrenal medulla
Þ The Stress Response
o stress response to the activation of the anterior-pituitary adrenal-cortex system
o stressors acting on neural circuits stimulate the release of adrenocorticotropic
hormone (ACTH) from the anterior pituitary that the ACTH in turn triggers the
release of glucocorticoids form the adrenal cortex, and that the glucocorticoids
produce many of the components of the stress response
(B)
Good Stress: Can stress be beneficial and in what kind of situations can stress be beneficial?
Þ Two kinds of stress:
o distress – stress if harmful and damaging
o eustress – stress is beneficial and constructive
Þ People function best/feel best at what is for them an optimal
level of arousal
o differ in the amount of arousal that is optimal; but too
much/little arousal impairs their functioning
How does coping with stress work?
Þ Cognitive Appraisal – mental process by which people assess 2 factors:
o whether a demand threatens their physical or psychological well-being
o the resources available for meeting the demand
I. Primary Appraisal – assess the meaning of the situation for our well-being
• harm-loss – amount of damage that has already occurred
§ e.g.: as when someone is incapacitated and in pain following serious injury)
• threat – involves the expectation of future harm
§ e.g.: when hospitalised patients contemplate their medical bills and loss of
income
• challenge – opportunity to achieve growth, mastery, or profit by using more than
routine resources to meet a demand
§ e.g.: worker might view an offer of a higher-level job as demanding, but see it
as an opportunity to expand her skills and make more money
ð stress appraisals depend heavily on harm-loss and threat
ð appraisal can influence stress even when the stressor does not relate to us directly ->
transaction is vicarious (e.g.: Subincision experiment)
II. Secondary Appraisal – assessment of the resources we have available for coping
• judge our resources as sufficient to meet the demands ® little or no stress
• appraise demands as greater than our resources ® great deal of stress
How does the acute stress reaction help us to get back on track after the stressful event?
Þ The stress hormone cortisol may facilitate effective coping after psychological stress.
o cortisol may strengthens cognitive inhibition of threatening information which is
distracting or irrelevant for task performance
• stress-released cortisol elevations may act to restore normal goal-directed
processing of emotional information after the emergence of stressors
o cortisol may enhance processing of task-relevant emotional cues; but differs across
individuals
• healthy subjects, neutral state ® not affecting people
• highly anxious subjects ® increase in emotional reaction
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