rona moss-morris professor of health psychology can stress make you ill?
TRANSCRIPT
Rona Moss-MorrisProfessor of Health Psychology
Can Stress Make You Ill?
Lecture outline The Biopsychosocial Model of health and
illness
What is stress and how do we measure it?
The Pittsburgh Common Cold Studies
Buffers between stress and illness
- Stress and coping model
- Social support
The Biomedical Model
The Biopsychosocial Model
Illness
StressorsAny circumstances that threaten or are perceived
to threaten one’s well-being and thereby tax one’s coping ability
An upcoming exam
Attending a party where you don’t know anyone
Being diagnosed with a serious illness
Break up of a relationship
Stress Our physiological & psychological
responses to conditions that threaten or challenge us in some way
Psychological responses include:
–Emotions e.g. anxiety
–Thoughts e.g. ‘No-one will talk to me’
–Behaviours e.g. ‘ drinking too much’
Fight-or-Flight (Walter Canon, 1932)“aggressive or withdrawal responses to stress”
Stress response controlled by the brain
Physiological Stress Response
Stimulates muscles
Stress and measurement
Environmental
Psychological
Biological
Measuring StressSocial Readjustment Rating Scale
Events causing the greatest life changes considered most stressful
– Death of a spouse– Divorce– Marriage– Fired from work
Holmes and Rahe, 1967
SRSS Scores & Health
(Rahe, et.al, 1964)
The Daily Hassles Scale
Measures irritating, daily demands as rated by the person
– concerns about weight – too many things to do– misplacing things– argument with family member,
Stronger associations with illness better than the SRRS
Kanner et al. (1981)
Cohen’s Perceived Stress Scale (PSS)
10 item questionnaire rated over past month
- how often have you felt nervous or stressed
- how often have you felt on top of things
- how often have you been upset because of something that happened unexpectedly
- how often have you felt difficulties were piling up so high that you could not overcome them
The Common Cold Studies (Cohen et al 1991; 1993)
Large scale prospective experimental investigations of stress and the common cold
Age, gender, weight, ethnicity, season, smoking, alcohol, diet exercise, sleep not related to stress and illness
•PSS•Life events•Mood
Exposed to cold virus
•Replicated virus
•Clinical symptoms
How many people developed colds?
Viral Infection 82% of the volunteers receiving virus were
infected.
Clinical Colds Clinical Colds = both infected and diagnosed by
the clinician as having a clinical cold. 38% developed clinical colds.
Which stress factors predicted colds?
Perceived Stress (PSS) Life events Negative mood
PSS & negative mood predicted actual viral infection
Life events predicted development of clinical symptoms
Associations between each of the stress measures and rates of clinical colds
Does the type of stressor matter? Cohen et al. (1998) Health psychology, 17, 214-223
Life Events and Difficulties Schedule (LEDS; Brown & Harris, 1989)
Detailed interview schedule
Rates events in the last year as - severe acute events- severe chronic difficulty (stressor)
Relative risk of developing a cold by stressor duration
Does the type of stressor matter? Conclusions:
Longer, more chronic stress – more infection
Interpersonal and work stress – more infections
Explaining the relationship between stress and illness
Direct effects hypothesis
stress impacts on our hormones and immune systems
Indirect effects hypothesis
stress impacts on health through changes in health behaviour e.g. diet, exercise, smoking, drinking
Mediators or Mechanisms
Hormones?Immune system?
Behaviours?
Stress Common cold
Behaviour as a Mechanisms
Health behaviours
Stress Common cold
Hormones as Mechanisms
Neuroendocrine hormonese.g. adrenal, cortisol
Stress Common cold
Immune System as a Mechanisms
Increase in IL-6 Cytokines
Stress Common cold
Explaining the Cytokine pathways
Acute stress related to more cortisol which can suppress immune responsiveness
Chronic ongoing stress related to decreased cortisol
Less cortisol may lead to inability to switch off immune responsiveness
Body produces more IL-6 – therefore more symptoms.
Stress and Stroke-Study
2,303 Finnish middle-aged white men followed for 11 years
Measured blood pressure spikes (in anticipation of an exercise test)
Men with above average blood pressure spikes had a 72% greater risk of developing a stroke in the following 11 years
Susan A. Everson et al., 2001
Moderators of Stress
Appraisal and Coping
Social Support
Stress and Coping Model(Folkman & Lazerus, 1984)
Coping Coping StrategyStrategy
Secondary Appraisal:Secondary Appraisal:What resources do I What resources do I
have to cope with this have to cope with this threat?threat?
Emotion Focused Coping
Coping through emotional approach involves actively processing and expressing emotion (Stanton et al. 2000).
The emotional approach scale– emotional processing - “I take time to figure out
what I’m really feeling”– emotional expression ( “I let my feelings come out
freely”)
Emotional Processing and Cancer Study of women with stage I or II breast cancer over 3
months (Stanton et al. 2000) coping through emotional expression associated with
improved – decreased distress,– fewer medical visits– increased vigour at 3 months
Coping through emotional processing associated with increases in distress
Emotional processing appears to be adaptive in the short term
Over the longer term may become ruminative and therefore less beneficial in terms of adjustment.
Coping Effectiveness
The contextual approach - no strategy is inherently bad
Short term and long term effects
Some strategies like avoidance, denial and emotional processing may work well in short term but not in long term
Controllable stressors better linked to problem focused coping and uncontrollable to emotion focused coping.
Appraisals of coping efficacy
What is social support (SS)? Social network
Perceived social support (amount available)
Received social support
Pathways from SS to health/illness Cardiovascular (heart) system
individuals with high SS at work have lower mean heart rate than those with low SS (Unden et al., 1991)
Immune systemindividuals with more social ties less susceptible to common cold (Cohen et al., 1997); immunoglobin A (first line of defence) higher in college students with high SS (Baron et al., 1990)
Neuroendocrine system (hormones)presence of supportive companion during stress test lower cortisol response (Kirschbaum et al., 1995)
Summary and Conclusions
Stress is linked to increased illness particularly chronic stress
This seems to occur through direct effects on immune responsiveness (overactive rather than underactive)
Stress can be buffered through the way people perceive situations, their coping style and social support
These buffers can be used in interventions to reduce impact of stress.
