Stress as It Relates to Health - Coursework Example

Stress and Health Research Paper of Introduction The usual assumption about the concept of stressis that it remains a topic of scientific discourse. However, contemporary scholars argue that stress concerns both body and mind, suggesting a more holistic analysis and explanation of the phenomenon. It is also an intersecting mechanism, affecting a broad range of health aspects and diseases. In spite of the broad absence of an agreement on an exact explanation of stress or the most appropriate method of measuring it, there is a huge volume of findings to verify that stress has major impacts on physical and psychosocial conditions. Key developments have occurred in recent times, especially in knowledge about pathophysiological processes and disease mechanisms that bring about the link between stress and health. Stress has traditionally been the key emphasis among scholars focused on psychosocial and environmental effects on health. Unfortunately, the manner in which the concept of ‘stress’ has been handled in the literature has been inconsistent. In fact, several scholars have even argued that the concept of stress has too many definitions that it has become meaningless. A wide array of definitions has been given, disagreeing in the degree to which they underline stressful episodes or responses as the core feature of stress (Richard & Huprich, 2011). In a deeper analysis, there is an obvious similarity among the various definitions that makes it possible to consolidate them into a theoretical account of the relationship between stress and health. They all have in common an interest in a mechanism where in “environmental demands tax or exceed the adaptive capacity of an organism, resulting in psychological and biological changes that may place persons at risk for disease” (Richard & Huprich, 2011, 375). Findings about health effects of daily stress dominate advice articles of lifestyle magazines. It has become widely known that stress can have detrimental impacts on physical and psychological wellbeing. There is currently a broad range of findings indicating that psychosocial stress leads to health problems. To a certain extent such health impacts of stressful life episodes are moderated by similar adjustments in endocrine, autonomic nervous and immune systems (Lovallo, 2005). Nevertheless, the development of psychosocial stress also brings about adverse changes in health patterns that heighten the relationship between stress and illness, such as substance abuse, frequent smoking, and eating disorders (Contrada & Baum, 2011). Moreover, according to McDonald-Fletcher (2008), stress is also frequently an outcome of an individual’s lifestyle. Theories of Stress and Health The assumption that psychosocial stress and lifestyle aspects are major sources of health and disease is hard to recognize within the biomedical perspective which has been the prevailing disease model for hundreds of years. This perspective states that for every illness there is a major biological source that is scientifically detectable. However, by concentrating only on biological sources of disease, the biomedical perspective discounts the fact that majority of diseases are the outcome of an interplay of biological, psychological, and social episodes (Hamilton-West, 2011). The obvious assumption of this biological view of illness is that doctors do not have to take into consideration psychosocial factors because they are already beyond their task and expertise. Hence, the perspective has very little to contribute to the effort of building the form of preventive measures that are required to decrease the prevalence of chronic illnesses by modifying health behavior, attitudes, and values. Engel (1977 as cited in Hamilton-West, 2011, 5), in response to these limitations, suggested an enlargement of the biological perspective which integrates psychosocial aspects into the scientific model. The biopsychosocial framework states that social, psychological, and biological aspects are all major sources of health and disease. This model assumes that clinical diagnosis should constantly take into account the interplay between social, psychological, and biological aspects to evaluate health and formulate suggestions for treatment. The increasing awareness that psychosocial stress and lifestyle aspects affect considerably mortality and morbidity from cancer, cardiovascular disease, and other fatal illnesses in developed nations was one of the aspects which in the latter part of the 1970s resulted in the growth of health psychology as a discipline which incorporates psychological factors related to disease prevention and health maintenance (Mishra, 2008). Social psychology has a vital role to play in this effort, for lifestyles are likely to be influenced by health assumptions and health behaviors. As argued by Folkman (2010), useful preventive measures have to bring about major adjustments in lifestyles and these efforts should depend on mass communication and hence on an administration of social psychological methods of behavioral and attitudinal modifications. The attention given by social psychologists to the concept of stress grew only in recent times, because most stressful life episodes, such as death of a loved one and divorce, entail a disintegration of social relationships. Moreover, the health effect of stressful episodes is not entirely determined by the nature of such episodes but also by the person’s capacity to deal with the stress and by the amount of social support s/he gets from his/her loved ones and other significant others (Folkman, 2010). Ultimately, the effect of stress on health, even though partially determined by the role of the brain in physiological mechanisms like the immune reaction of the body, is also influenced by the use of health-damaging routines, like substance abuse and smoking. Hence, social aspects are not just essential in identifying the stressful features of numerous life episodes but also as mediators of the relationship between stress and health. In addition, social psychologists have contributed much to another important field of health psychology, specifically the study and development of health care systems (Richard & Huprich, 2011). This included concerns like burnout among healthcare providers, depression and anxiety in relation to medical processes, and relationships between patients and physicians. One of the first theories of stress was introduced in the 1920s by Walter Cannon. He observed that people and animals go through particular physical changes when they are in danger and that such changes comprise physiological stimulation (Harari & Legge, 2001, 75). Basically speaking, they provide life forms with the physical means to cope with the dangerous state, either by wrestling the danger or by fleeing—the fight or flight response. Such changes consist of (Harari & Legge, 2001, 75): increased heart rate and breathing rate (to get more oxygen to the muscles and brain) improved blood clotting (in case of injury) dilation of pupils (to improve eyesight) hair stands on end (this makes cats, for example, look bigger and more frightening; in humans, this response manifests itself as goose-pimples). Individuals repeatedly encounter threatening situations that cannot be handled successfully by enhanced physical movement. If the fight or flight response results in enhanced physiological stimulation, and this is not drained by intensified physical movement, it can make a person ‘nervous’ (Janowski, 2009). Hans Selye, in the 1930s, expanded the theory of Cannon to cover the physical damage brought about by excessive stimulation. He introduced the ‘general adaptation syndrome’ theory, which is composed of three phases: the alarm reaction, the resistance stage, and the exhaustion stage (Harrari & Legge, 2001, 75). The first stage is similar to the fight or flight response of Cannon. Selye discovered that the intensified physical stimulation that takes place during this phase is associated with the endocrine system’s hormonal release. A hormone called ACTH is discharged by the pituitary gland and this pushes the discharge of cortisol, norepinephrine, and epinephrine by the adrenal glands. When such hormones enter the bloodstream, the alarm reaction is set off (Sanders & Suls, 2013). By conducting lab tests on rats, Selye found out that life forms are not able to sustain a stable alarm reaction for long durations; they expire quickly. To survive, life forms go into a second phase—the resistance stage. In the resistance stage, the physiological stimulation that exists during the first stage is overturned to let the body recuperate, prepared to confront another threat. Still, this mechanism also cannot be sustained without end, resulting in a third phase—the exhaustion stage. In the third stage, the body is not capable of recuperating anymore from the alarm reaction. Selye illustrates it as “at the end of a life under stress, this was a kind of premature ageing due to wear and tear” (Harari & Legge, 2001, 75). Essential to the fight or flight theory of Cannon is the evolutionary model. This model assumes that genetic features that make survival possible are more likely to be transmitted to future generations. Hence, life forms that have a naturally unsound fight or flight response are more likely to die when in danger, and hence likely to produce offspring. Organisms with a sturdy fight or flight response are more likely to reproduce and transmit their genes to their offspring, in order that, in due course, the fight or flight response becomes reinforced (Sanders & Suls, 2013). The ‘general adaptation syndrome’ and ‘fight or flight’ theory both view stress as a mechanical physiological reaction to an outside stressor. However, these theories disregard social and psychological aspects. For instance, not everybody displays a similar degree of physiological stimulation when confronted with a particular stressor; it is probable that a person’s cognitive reaction to a condition, or what s/he believes the possible consequence is, will influence the strength of his/her stress response. Moreover, individuals usually feel anxious even though they are not confronted with a directly dangerous situation that would necessitate a fight or flight response (Cox et al., 2000). Also, it is likely to encounter stress even without any real outside stressor; if a person recognizes some sort of danger, then this is sufficient, and different individuals recognize danger to varying levels. There are a number of theories that view stress as a psychological reaction, instead of an entirely physiological response. Heider (1946 as cited in Perrig & Grob, 2012, 245), for instance, introduced ‘balance theory’ where in he states that individuals have a tendency to structure the world into components and are driven toward making sure these components work in a cognitively balanced way (Perrig & Grob, 2012, 245). Take for instance a component composed of a person, his physician and a bottle of liquor; if the person trusts the physician’s counsel and the physician is persuading the person to ignore the bottle of liquor, but the person wants to drink it instead, there is an absence of balance. To bring back balance, the person may alter his thoughts toward the physician, or toward the bottle of liquor. A related theory is ‘cognitive dissonance’, where in contradictions in an individual’s cognitions result in a negative psychological response, which consequently can stimulate change in attitude (Janowski, 2009, 90). For instance, if a person believes he should quit drinking but keeps on consuming alcohol instead, this will result in a sense of dissonance. The person is encouraged to weaken this negative response by either modifying their attitude or behavior. These two theories view stress as a negative psychological response induced by discrepancies in an individual’s cognitions. Stress is a psychological occurrence, brought about by mental inconsistencies. So why do individuals feel troubled by cognitive inconsistencies? It might be that individuals’ aversion toward contradictions has progressed, just like how individuals developed a fight or flight response. If individuals do not feel troubled by these inconsistencies, they would not be encouraged to modify their behaviors or attitudes in ways that could really improve their survival chances (Janowski, 2009). Theories of stress merely rooted in cognitive dissonance put in a psychological factor absent from earlier theories, but they still fail to explain the entire phenomenon of stress. The cognitive appraisal theory introduced in the 1970s by Richard Lazarus considers social, psychological, and biological aspects. An example of an ‘external stressor’ is a discovery of a disease. ‘Primary appraisal’ engages the person in making a decision whether the illness is a danger to his/her wellbeing (Mishra, 2008, 466). It is likely that the person will exercise ego defense mechanisms to convince him/herself that s/he is not actually sick; thus, the stressor is not viewed as a danger, and the person will not feel stressed. If a person does not view a danger to their wellbeing, then they will refuse to change their attitude or behavior. Nevertheless, if an illness is viewed as a danger, the next phase is secondary appraisal, where the person assesses whether s/he is capable of dealing with the situation (Mishra, 2008, 466). A person with a well-developed self-efficacy and a solid composure is less likely to be stressed about the situation. On the other hand, if the person has a poor self-efficacy or does not trust his/her capacity to handle the situation, that person will encounter the stress-related psychological and physiological reactions. The cognitive appraisal theory of Lazarus supports a biopsychosocial model (Ayers, 2007)—specifically, stress is not only an involuntary biological reaction or the outcome of mental mechanisms, but develops from the interplay between a person’s understanding of threat, his/her environment, and of the social, psychological, and physical means the person capable of using so as to cope with the threatening situation. Another psychosocial model of stress broadly views it in terms of the active relationship between the individual and his/her environment. When analyzed or researched, stress is either deduced from the presence of complicated interactions between the individual and his/her environment or evaluated in terms of the emotional and cognitive mechanisms that strengthen such relationships (Kassin, Fein, & Markus, 2010). This model has been called the psychological approach. Two different classifications can be derived from this psychological model: the transactional and the interactional. The latter refers to the structural attributes of the individual’s relationship with his/her environment, while the former is more focused on the psychological mechanisms supporting that relationship. Transactional approaches are largely interested in cognitive assessment and coping (McDonald-Fletcher, 2008, 61). To a certain extent they embody an expansion of interactional approaches, and contribute little which is incompatible with these approaches. Interactional stress theories place emphasis on the structural attributes of an individual’s relationship with his/her environment. The interactional theories of Karasek (1979) and French and colleagues (1982) are among the most popular (as cited in McDonald-Fletcher, 2008, 61). These two interactional theories concentrate on the work setting, but may be applied to non-work circumstances, and have definite repercussions for health psychology. A number of researchers have reported that the strength of the person-environment relationship often provides a more accurate account of behavior than situational or individual differences. Mostly as an outcome of such arguments, French and his associates developed a work-related stress theory derived from the precise notion of the fit between the individual and the environment (Stroebe, 2011). Two central features of fit were specified: the level to which the attitudes and capabilities of the worker to satisfy work demands, and the level to which the work environment satisfies the demands and needs of the worker, and particularly the level to which the person is allowed and motivated to apply their abilities and knowledge in the work environment (Kassin et al., 2010). It has been assumed that stress is likely to happen, and health is likely to be distressed, when there is an absence of fit in both or either. ‘Decision latitude’ is characterized by Karasek (1979) as “the working individual’s potential control over his tasks and his conduct during the working day” (Broome, 1995, 25), and described ‘job demands’ as “the psychological stressors involved in accomplishing the workload” (Broome, 1995, 25). In addition, he has developed a structural approach to work-related stress which focuses on these two important domains of the fit between the individual and his/her environment. He has argued that these work features could be indirectly related to health, and that they could merge directly with regard to health. He illustrated this model through a study of workers in Sweden and the United States, discovering that workers in occupations believed to have increased job demands and poor decision latitude were especially likely to experience poor satisfaction and ill health (Broome, 1995, 25-26). Subsequent studies supported this argument. For instance, a large number of male Swedish workers were tested for mortality, cardiovascular illness, too much fatigue, and depression. The workers whose occupations have high job demands and low decision latitude were represented excessively on every resulting variable. The least likelihoods for fatality and sickness were discovered among workers with reasonable workloads alongside high decision latitude (Broome, 1995, 25-26). The joint impact of job demands and decision latitude is generally illustrated as a real interaction, but in spite of the broad recognition of this argument there is unsound evidence to substantiate it. Even the research of Karasek (1979) shows an additive instead of an interactive effect, and he has claimed that “there is only moderate evidence for an interaction effect, understood as a departure from a linear additive model” (as cited in Broome, 1995, 25). On the other hand, majority of transactional stress theories places emphasis on the cognitive mechanisms underlying the individual’s relationship with his/her environment, and this is largely evident with regard to appraisal and coping theories. As stated by transactional theories, stress is a psychological condition concerning both emotional and cognitive factors (McDonald-Fletcher, 2008). They perceive stress as the inner indication of a specific and a pathological transaction between the individual and his/her environment, but the concept of ‘psychological stress’ is not clear. Even though stress is naturally psychological, its causes and consequences are not confined to any specific area, psychological or else. Appraisal is the process of assessment that endows these transactions between the individual and his/her environment their importance or essence. It involves primary and secondary mechanisms (Folkman, 2010). As regards primary processes, a person asks him/herself, is this experience essential to health and how? If the experience is essential and is described as stressful instead of mild or unimportant, then more detailed or precise appraisals are performed. Primary appraisal is related to the emotional attributes of stressful encounters. In contrast, secondary appraisal refers to the issue of coping (Ayers, 2007). Stress occurs when the individual believes that s/he cannot effectively handle the demands or threats to his/her health, when coping is of essence to him/her, and when s/he is worried or unhappy about it. Stress is hence characterized first by the individual’s recognition that s/he is having problems coping with threats or pressures to their health, and then, by the fact that coping is essential and his/her problems with coping troubles or discourages him/her (Kassin et al., 2010). This assumption creates a definite differentiation between, for instance, the impacts of the absence of skill on performance or functioning and effects of stress. If an individual does not have the needed understanding or degree of ability to accomplish a job, then his/her outcomes will be of low quality. S/he may not recognize this, or if s/he does, it may not be considered important. Therefore, this is not a ‘stress’ situation. Nevertheless, if the individual does recognize that s/he is unable to cope with the requirements and demands of a job, and feels worried about that inability, then this is a ‘stress’ situation (Lovallo, 2005). The consequences of this stress could therefore lead to increased weakening of performance on top of that brought about by the absence of capability. It is helpful to visualize this stress condition as entrenched in a continuous process which includes the individual transacting or relating with his/her environment, carrying out appraisals of such interaction and trying, and at times unable, to handle the difficulties that come up. Cox (1978 as cited in Cox et al., 2000, 42) illustrated the stress mechanism in a five-phase framework. The first phase refers to the roots of demands confronted by the individual and is a component of his/her environment. How the individual views these demands as regards his/her capacity to deal with them embodies the second phase. Stress was defined as the psychological condition that surface when there was an individually considerable discrepancy between the individual’s analysis of the demands on him/her and his/her capacity to tackle those demands. The changes in the physiological and psychological state which are related to the experience of stress, and which involve coping, correspond to the third phase. The fourth phase refers to the outcomes of coping. The last phase is the overall response which takes places with regard to all other phases (Cox et al., 2000, 42-44). The Contribution of Social Psychology to Stress Research For social psychologists, the early attempts to understand the relationship between stress and health were interesting but disappointing. They discovered environmental links to disease that classified illness as an appropriate topic for the discipline. By showing that life episodes that bring about changes, such as death of a loved one or divorce, raises the possibility of the person becoming ill, Holmes and his associates introduced the idea of a stress-health relationship outside the biochemical and physiological mechanisms, and within the sociological and psychological mechanisms (Sanders & Suls, 2013). However, these early studies were not able to lay out the characteristic of the psychosocial domains. Numerous investigations were conducted that merely measured the prevalence of stressful life episodes. Psychosocial factors that worked either to weaken or reinforce the direct correlation between stress and health were overlooked. Individual differences in stress responses were disregarded. Another source of disappointment was the assertion of stress researchers of a naturally reactive and reflexive perception of human behavior. Stress studies depicted individuals as victims of environmental changes. Adopting several components of Selye’s theory, Holmes argued that major and minor, negative and positive episodes would suggest “adaptive efforts by the human organism that are faulty in kind or duration, lower ‘bodily resistance’ and enhance the probability of disease occurrence” (Sanders & Suls, 2013, 4). For social psychologists, the negative perception of stress with that which only occurs to and injures the individual raises the issue of psychological models that underline the resilience and initiative of individuals (Stroebe, 2011). The range of social psychological theories presupposes that individuals produce and respond to the stressful life episodes that they encounter and successfully cope with stressful events. However, studies on stress and health also gave way to psychological researchers. For social psychologists focused on personality, it provided a means for studying situational attributes. After the debate over the individual and situation triggered by the release of Personality and Assessment of Mischel (1968) and stimulated by numerous social psychologists, researchers saw themselves seeking out circumstances where in they could study individual tendency toward feeling, thinking, and acting in certain ways—person factors—in relation to environmental components—situation factors (as cited in Sanders & Suls, 2013, 4-5). Stressful life episodes manifested themselves as major, identifiable, and assessable situation factors. As argued by Holmes and Rahe (1967), a life episode may be considered stressful if it brings about changes in an individual’s typical routine (as cited in Sanders & Suls, 2013, 5). This description was supported in their empirical conclusion that there is a broad agreement about which specific life events bring about changes, and the extent to which they do so. Another prospect offered by stress analysis to social psychologists was the opportunity to verify several of their more positive explanations of human processes. Maintaining good health despite stressful life episodes is simply viewed as a sign of successful adjustment and best behavior. It is very improbable that a person will be capable of living a fruitful, healthy life in the absolute difficulty of contemporary society without experiencing numerous stressful life episodes (Hamilton-West, 2011). In this case, it may be argued that the identification of those attributes that keep individuals hale and hearty despite stress broadens knowledge of human health and growth. The discovery of the sources of stress resilience may be very helpful as well. The pioneering effort to understand the relationship between stress and illness was immediately and deliberately occupied by mass media. Numerous television and radio programs, newspapers, and magazines declared the reminder ‘avoid stress if you want to stay healthy’ (Sanders & Suls, 2013, 194). This reminder was both dispiriting—avoiding stress may involve sacrificing favorable changes—and impractical—nobody can avoid the death of a loved one. Stories about people who have good health in spite of stress and depictions of their distinctive attributes in a way that encourages emulation should promote more practical and positive suggestions. Even though environmental factors contribute much to the psychological and health process, earlier variables in these processes have mostly been ignored in health psychology. Rather, the emphasis has been on a range of health indicators, with significant emphasis on stress-related processes, mediating between health and the environment (Broome, 1995). Another emphasis in health psychology that has largely ignored environmental variables is coping resources, with the analysis of coping mechanisms, personality, and social support that influence the effect of environmental pressures on health (Janowski, 2009). But the major question is what environmental features are likely to affect psychological and health mechanisms? In health psychology the environment has been conceptualized largely in relation to social phenomenon. Social environments, economic, and sociocultural circumstances dominate environmental considerations in health psychology (Perrig & Grob, 2012). From a range of psychosocial factors associated with the relationship between stress and health, including norms, childhood experiences, and social supports influencing health behavior, personality was chosen for research. The central assumption has been that individuals’ broad perception of life or distinguishing motivations and goals would determine how a particular stressful life episode will be understood and tackled and, thus, the effect of the episode on the biological and physiological processes (Kassin et al., 2010). Research on personality has tried to identify the conscious psychological mechanisms by which individuals capably identify and respond to their circumstances. An existential view of personality has been fundamental in this area. This theory became known as more pertinent to stress research than more established personality theories. The focus of existentialism on individuals as beings-in-the-world who are not stagnant beings carrying clusters of fixed natural attributes, but instead persistently and forcefully create personality through their behavior, matches the personality-in-situation model of the stress and personality analysis (Sanders & Suls, 2013). Furthermore, existentialism depicts life as constantly evolving or changing and thus unavoidably stressful. The task of proponents of existentialism has been to explain how to successfully cope with, use, and construct one’s life. Sadly, greater attention has been given to portraying how individuals have been unsuccessful in the struggle. However it is distinguished, on psychological and philosophical bases, that individuals can effectively cope with their environment and transform stressful life episodes into opportunities or prospects for personal development and progress (Richard & Huprich, 2011). Three notions in existentialism seem particularly important to this positive outlook (Sanders & Suls, 2013, 10): challenge, control, and commitment. In concert these encompass the personality mode of stress resilience. One potential connection between the findings of empirical research and future studies arises from intervention efforts based on existential therapy. The field of stress management and therapy is presently flourishing. Most people believe that stress results in ill health and guide individuals toward effective stress avoidance. However, most people overlook the cultural, social, and psychological settings where in stress are taking place. Existential psychotherapy provides another solution: It aims to enhance individuals’ orientations and views of themselves and their intricate environments; to modify behavior and attitudes so that individuals become highly conscious of, and capable of affecting, stressful life episodes (Lovallo, 2005). A primary objective in this therapy is the perception of change as unavoidable and as a prospect for the development and progress of the individual and the society at large. Conclusions Stress research in social psychology, particularly studies on the relationship between stress and health, has evolved from a purely biomedical model to a psychosocial framework. It is widely recognized by social psychologists that stress influences health, especially the onset of disease, in a number of ways. Some of the most popular theories of stress explaining the stress-health correlation are the fight and flight response, the general adaptation syndrome theory, balance theory, cognitive dissonance, cognitive appraisal theory, and interactional and transactional theories. The interplay between biological, psychological, and social factors is taken into consideration in more contemporary theories of stress. Early and contemporary social psychologists agree that stress results in illness when an individual fails to cope with it; however, there are still instances where stress is helpful and makes an individual more stress resilient. References Ayers, S. (2007). Cambridge Handbook of Psychology, Health and Medicine. UK: Cambridge University Press. Broome, A.K. (1995). Health Psychology: Processes and Applications. London: Nelson Thornes. Contrada, R.J. & Baum, A. (2011). The Handbook of Stress Science: Biology, Psychology, and Health. New York: Springer Publishing Company. Cox, T. et al. (2000). Research on work-related stress. UK: Office for Official Publications of the European Communities. Folkman, S. (2010). The Oxford Handbook of Stress, Health, and Coping. Oxford: Oxford University Press. Hamilton-West, K. (2011). Psychobiological Processes in Health and Illness. London: Sage. Harari, P. & Legge, K. (2001). Psychology and Health. Oxford: Heinemann. Janowski, K. (2009). Biopsychosocial Aspects of Health and Disease, Vol. 2. Lublin, Poland: CPPP Scientific Press. Kassin, S., Fein, S., & Markus, H.R. (2010). Social Psychology. Mason, OH: Cengage Learning. Lovallo, W. (2005). Stress and Health: Biological and Psychological Interactions. London: Sage. McDonald-Fletcher, V. (2008). The Impact of Stress and Social Support on Burnout. Ann Arbor, MI: ProQuest. Mishra, B.K. (2008). Psychology: A Study of Human Behavior. New Delhi: PHI Learning Pvt. Ltd. Perrig, W. & Grob, A. (2012). Control of Human Behavior, Mental Processes, and Consciousness. Mahwah, NJ: Psychology Press. Richard, D. & Huprich, S. (2011). Clinical Psychology: Assessment, Treatment, and Research. Burlington, MA: Academic Press. Sanders, G. & Suls, J. (2013). Social Psychology of Health and Illness. Hillsdale, NJ: Psychology Press. Stroebe, W. (2011). Social Psychology and Health. New York: McGraw-Hill International. . Read More