The Role of Stress
You know what it feels like to be stressed. Whether it’s from the upcoming exam in this course, the traffic jam you sat in on your way home yesterday, or the demands your children place on you, stress
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seems to be everywhere. There is plenty of scientific evidence that over the long term, stress is very bad for your health. But despite thousands of scientific studies, scientists still cannot agree on a formal definition of stress. To some, it involves specific physiological responses (Gewirtz et al., 2002). To others, stress results from people’s evaluation of events in the context of the various resources they have (Cohen et al., 1995; Lazarus & Folkman, 1984). This approach emphasizes that stress is defined by the person and that no two people experience the same event in exactly the same way. To still others, stress is a property of specific events, such as the death of a partner (McLeod, 1996). In this approach, events vary in how stressful they are, but everyone who experiences a particular event comes under the same level of stress.
Because the first and second views are the most widely used approaches for studying stress and the ways in which people deal with it, we examine them in more detail. For the first view, we focus on the roles played by the nervous system responses and the endocrine system’s hormones. For the second, we focus on Richard Lazarus and Susan Folkman’s framework as the best-researched representative of the view that whether a person feels stressed depends on how he or she evaluates the situation at hand.
Stress as a Physiological State. There is widespread agreement that people differ in their physiological responses to stress (Aldwin & Gilmer, 2004). Prolonged exposure to stress results in damaging influences from the sympathetic nervous system (which controls such things as heart rate, respiration, perspiration, blood flow, muscle strength, and mental activity); these bad effects include temporary increases in risk of cardiovascular disease (Black & Garbutt, 2000), impaired immune system function (Black & Garbutt, 2000), and some forms of cancer (Aldwin & Gilmer, 2004).
Taylor and colleagues (2000) have reported an interesting gender difference in physiological responses to stress. Men overwhelmingly choose to wait alone before a stressful procedure, whereas women want to be with other people. Taylor and
120 CHAPTER 4 colleagues believe that this difference may be due to the role that the hormone oxytocin plays in women and not in men. Oxytocin is the hormone important in reproductive activities, such as breast feeding, and for establishing strong bonds with one’s children (Campbell, 2008). The researchers speculate that when stressed, men opt for a “flight or fight” approach whereas women opt for a “tend and befriend” approach.
The Stress and Coping Paradigm. Suppose you are stuck in a traffic jam. Depending on whether you are late for an appointment or have plenty of time on your hands, you will probably feel very different about your situation. The stress and coping paradigm views stress not as an environmental stimulus or as a response but as the interaction of a thinking person and an event (Lazarus, 1984; Lazarus et al., 1985; Lazarus & Folkman, 1984). How we interpret an event such as being stuck in traffic is what matters, not the event itself or what we do in response to it. Put more formally, stress is “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus & Folkman, 1984, p. 19). Note that this definition states that stress is a transactional process between a person and the environment, that it takes into account personal resources, that the person’s appraisal of the situation is key, and that unless the situation is considered to be threatening, challenging, or harmful, stress does not result. A diagram of the transactional model is shown in Figure 4.4.
What exactly does this definition mean? Think about our traffic jam example. The transactional model of stress says that each time you are in a traffic jam you make a separate judgment as to whether it is stressful depending on the resources you have and your interpretation of them. The resources a person has include such things as the cumulative experience of dealing with similar situations (traffic jams) before, knowledge or access to information about the event, the ability to get help if necessary, and the time needed to engage in any actions necessary to address the situation. Clearly, these resources vary a great deal from person to person and reflect the
Figure 4.4 An example of a transactional model of stress.
Source: From Measuring Stress: A Guide For Health And Social Scientists, edited by Sheldon Cohen, Kessler & Gordon. Copyright © 1995 by Oxford University Press, Inc. Used with permission from Oxford University Press, Inc.
influence of biological (e. g., genetic), psychological (e. g., personality), sociocultural (e. g., ethnicity), and life-cycle (e. g., life-stage) forces. These differences in resources are extremely important in understanding why some people have little trouble dealing with very difficult events (e. g., a severe illness) whereas other people seem to have trouble with seemingly routine events (e. g., calming a crying child). Recognizing these differences, let’s begin a closer look at the stress and coping paradigm with the concept of appraisal.
Appraisal. Lazarus and Folkman (1984) describe three types of appraisals of stress. Primary appraisal categorizes events into three groups based on the significance they have for our well-being: irrelevant, benign or positive, and stressful. Irrelevant events are ones that have no bearing on us personally; hearing about a typhoon nowhere near land in the South Pacific while sitting in your living room in Boston is an example. Benign or positive events are ones that have good effects, such as a long-anticipated pay increase. Finally, stressful events are ones, such
as an upcoming operation or test, that are appraised as harmful, threatening, or challenging.
Primary appraisals act as a filter for events we experience. Specifically, any event that is appraised as either irrelevant or as benign or positive is not stressful. In a real sense, we decide which events are potentially stressful and which ones are not. This is an important point for two reasons. First, it means we can effectively sort out the events that may be problems and those that are not, allowing us to concentrate on dealing with life’s difficulties more effectively. Second, it means that we could be wrong about our reading of an event. A situation that may appear at first blush to be irrelevant, for example, may actually be very important, or a situation deemed stressful initially may turn out not to be. Such mistakes in primary appraisal could set the stage for real (or imagined) crises later on.
If a person believes that an event is stressful, a second set of decisions, called secondary appraisal, is made. Secondary appraisal evaluates our perceived ability to cope with harm, threat, or challenge. Secondary appraisal is the equivalent of asking three questions: “What can I do?” “How likely is it that I can use one of my options successfully?” and “Will this option reduce my stress?” How we answer these questions sets the stage for addressing them effectively. For example, if you believe there is something you can do in a situation that will make a difference, then your perceived stress may be reduced and you may be able to deal with the event successfully. In contrast, if you believe there is little that you can do to address the situation successfully or reduce your feelings of stress, then you may feel powerless and ineffective, even if others around you believe there are steps you could take.
What matters in secondary appraisals (and all other decisions in this framework) is what you think is true, not what others think. After you make a decision about an event and reach a preliminary conclusion about what you should do about it (if anything), the situation continues to play itself out. As the event continues to unfold, you begin to get an idea as to whether your primary (and secondary, if necessary) appraisal was accurate. If it was,
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then you would probably stick with your original evaluation.
However, sometimes you learn additional information or experience another situation that indicates you should reappraise the original event. Reappraisal involves making a new primary or secondary appraisal resulting from changes in the situation. For example, you may initially dismiss an accusation that your partner is cheating on you (i. e., make a primary appraisal that the event is irrelevant), but after being shown pictures of your partner in a romantic situation with another person, you reappraise the event as stressful. Reappraisal can either increase stress (if your partner had initially denied the encounter) or lower stress (if you discovered that the photographs were fakes).
The three types of appraisals demonstrate that determining whether an event is stressful is a dynamic process. Initial decisions about events may be upheld over time, or they may change in light of new information or personal experience. Thus different events may be appraised in the same way, and the same event may be appraised differently at any two points in time. This dynamic process helps explain why people react the way they do over the life span. For example, as our physiological abilities change with increasing age, we may have fewer physical resources to handle particular events. As a result, events that were appraised as not stressful in young adulthood may be appraised as stressful in late life.
Coping. During the secondary appraisal of an event labeled stressful in primary appraisal, we may believe there is something we can do to deal with the event effectively. Collectively, these attempts to deal with stressful events are called coping. Lazarus and Folkman (1984) view coping more formally as a complex, evolving process of dealing with stress that is learned. Much like appraisals, coping is seen as a dynamic, evolving process that is fine-tuned over time. Our first attempt might fail, but if we try again in a slightly different way we may succeed. Coping is learned, not automatic. That is why we often do not cope very well with stressful situations we are facing for the first time (such as the end of our first love relationship). The saying “practice makes
perfect” applies to coping, too. Also, coping takes time and effort. Finally, coping entails only managing the situation; we need not overcome or control it. Indeed, many stressful events cannot be fixed or undone; many times the best we can do is to learn to live with the situation. It is in this sense that we may cope with the death of a spouse.
The ways in which people cope can be classified in several different ways. At a general level we can distinguish between problem-focused coping and emotion-focused coping. Problem-focused coping involves attempts to tackle the problem head-on. Taking medication to treat a disease and spending more time studying for an examination are examples of problem-focused coping with the stress of illness or failing a prior test. In general, problem- focused coping entails doing something directly about the problem at hand. Emotion-focused coping involves dealing with one’s feelings about the stressful event. Allowing oneself to express anger or frustration over becoming ill or failing an exam is an example of this approach. The goal here is not necessarily to eliminate the problem, although this may happen. Rather, the purpose may be to help oneself deal with situations that are difficult or impossible to tackle head-on. Several other behaviors can also be viewed in the context of coping. Many people believe that their relationship with God is an important aspect of coping (Kinney et al., 2003). Psychoanalytic researchers point to Freud’s notion of defense mechanisms as behaviors that may be used to reduce stress. In short, people use many different types of behaviors when they feel stressed.
How well we cope depends on several factors. For example, healthy, energetic people are better able to cope with an infection than frail, sick people. Psychologically, a positive attitude about oneself and one’s abilities is also important. Good problemsolving skills put one at an advantage by creating several options with which to manage the stress. Social skills and social support are important in helping one solicit suggestions and assistance from others. Finally, financial resources are important; having the money to pay a mechanic to fix your car allows you to avoid the frustration of trying to do it yourself.
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Religiosity and spirituality are important aspects of a person’s lifestyle that must be considered in holistic approaches to health and wellness.
Aging and the Stress and Coping Paradigm. Two important age-related differences in the stress and coping paradigm are the sources of stress and coping strategies. Age-related differences have been described for the kinds of things people report as everyday stresses (Aldwin et al., 1996; Moos et al., 2006). Younger adults experience more stress in the areas of finance, work, home maintenance, personal life, family, and friends than do older adults. These differences probably exist because young adults are likely to be parents of small children and are likely to be employed; parenting and work roles are less salient to retired older adults. The stresses reported frequently by older adults may be more age related than role related. That is, environmental stress may be caused by a decreased ability to get around rather than by a specific role.
There is some evidence that the old-old report having fewer stressors in the past week than any other age group (Aldwin et al., 1996). Why this is so is unclear. Maybe in late life people begin to narrow their focus and thus have fewer areas of life that could produce stress. Or, as you will see in Chapter 10, the old-old may adopt a more philosophical outlook on life and not let things bother them as much. Age differences in coping strategies across the life span are striking and consistent (Martin et al., 2008). One key difference is that adults over age 80 are less likely to use active coping strategies and are more likely to use past experience in coping as a guide. Active coping styles are related to better health outcomes. Another important finding is that approaches to coping tend to be consistent across different domains, meaning that people tend to deal with stress related to family and health issues in roughly the same ways.
When combined with the earlier discussion that chronic stress has serious negative effects on health, the importance of age changes in coping styles becomes clearer. Two strategies become apparent: reducing stress or using more active coping. One way to interpret these findings is to focus on “management strategies” (Aldwin et al., 1996). As people age, some older adults become better at managing their lives so as to avoid problems in the first place, so they don’t need to cope with stress. And coping resources are better predictors of well-being in older adults than in younger and middle-aged adults (Hamarat et al., 2001; Martin et al., 2008). But becoming better at managing life does not mean that older adults are willing to give up meaningful roles when they encounter stressful events.
We explore the relation between age and stress in more detail in the How Do We Know? feature. Cairney and Krause (2008) use data from a large Canadian study to show that the experience of negative life events matters in the lives of older adults.
Effects of Stress on Health. How does stress affect us? If the stress is short, such as being stuck in a traffic jam for an hour when we’re already late in an otherwise relaxed day, the answer is that it probably will have little effect other than on our temper. But if the stress is continuous, or chronic, then the picture changes dramatically. Chronic stress has several potentially serious effects (Davis et al., 2000; Kemeny, 2003), including pervasive negative effects on the immune system that causes increased susceptibility to viral infections, increased risk of atherosclerosis and hypertension, and impaired memory and cognition (Webster-Marketon & Glaser, 2008). In women, chronic stress can also inhibit menstruation, and women react to a wider range of outside stressors than do men.
Research indicates that different types of appraisals that are interpreted as stressful create different
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HOW DO WE KNOW?
Negative Life Events and Mastery
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physiological outcomes (Kemeny, 2003; Webster – Marketon & Glaser, 2008). This means that different types of stress are associated with different emotions, which trigger different neural pathways. This may mean that how the body reacts to stress depends on the appraisal process; the reaction to different types of stress is not the same. In turn, this implies that changing people’s appraisal may also be a way to lower stress.
Additional research shows that the effects of coping strategies on physiological outcomes and health depend on whether they have affected a person’s sense of well-being (Aldwin & Yancura, 2004). To the extent that they do, the effects can be more negative. Coping strategies clearly affect the progress of disease, probably through the person’s compliance to medical regimens. Most important, as noted earlier, the ability to deal with the hormones produced by stress declines due to age changes in immune functioning (Webster-Marketon & Glaser, 2008). So coping may be a key; given the higher prevalence of chronic diseases in older adults, how well one copes may have important effects on the quality of life (Aldwin & Gilmer, 2004).
1. How do researchers define health? What problems do these definitions have?
2. How is quality of life defined?
3. What are the major age-related changes in immune system functioning?
4. What are the differences between chronic and acute diseases?
5. What is the stress and coping paradigm? What are the key age-related changes that occur?