Seminar 3

Stress: definition, various types of stressors agents. Theoretical models of stress (classical meanings vs.moderne).

Agents stressors: types, features of AS psychological stressors to other agents.

Major life events scale and Raheem Holmes: an attempt to quantify the potential pathogenic agents of different types of stressors.

Relativity of perception and evaluation (Appraisal) stressors agents.Personality traits related to stress response types (A, C, D).

Protective traits and cognitive styles.

Definition of stress• Total nonspecific response to any request amount of the body

(Selye) • General adaptation syndrome (SGA), evolves in distinct stages:

– the alarm stage, involves mobilization of defense forces of the body with physiological and biochemical changes, caused by sympathetic action and elimination of adrenal cortical hormones. Includes two forms of shock (with hypotension, hypothermia, increased vascular permeability) and contra shock phase with different endocrine responses (increase in ACTH, cortisol, adrenaline, blood sugar)

– resistance stage corresponds to an apparent adaptations, but are forced above average the adaptive body resources with a high level of corticosuprarenalian hormones

– exhaustion stage appears if stressor continues to act and adapt can not be maintained. Symptoms resemble those of the reactions of alarme stage but the resistance of bodyis below average and if stress energy is depleted, the life ceases.

Psychic stressor agents

• Threats• Conflict • Solving difficult problems • Frustration • Strain• Underrequest • Overuse of negative emotional states

Major features of life scale (Holmes and Rahe)

• Any change of lifestyle that requires numerous modification may be perceived as generating stress

• Rahe și Holmes tried to measure the impact of changes in lifestyle that occur

• They analyzed the correlation between recent changes of life and the emergence of diseases and found that certain events have definite influence in the pathogenesis of these events

• These events were ranked according to the increased possibility of developing the disease

• There were evaluated main events, grouped into four categories (health, work, home and family and personal and social) and give each a score that indicates the potential pathogenic event.

• Examples: Death of spouse -100, loss of reputation - 60, change of residence - 40, problems with the boss 25, etc..

Holmes and Rahe scale limits• Even if events create positive changes and so are stressful, most

research shows that negative events have a greater impact on the individual's physical and mental health than positive ones.

• Scale means that all people respond to a given event in the same way, but there are differences in how people are affected by events, age differences, cultural backgrounds, personality , immunogenic or disimmunogenic traits) and individual experience.

• The scale has an indicative value, its results should be discussed in the context of perceived stress, minor daily, type of personality, somatic and psychic vulnerability.

• The impact of events should be analyzed according to the time when the stressor agent is acting and to the existence of social support and other protective factors (faith, the balance between the aspirations and possibilities, providing basic psychological needs / need for affiliation, need for long term security and need for new experiences - Linton, etc.)

Type A of psychic behavior• Rosenman, Friedman, Jenkins (1974) have related this type of

psychic behavior with the predisposition for cardiovascular diseases

• Type A – collector of stresses• Thorp (1992) – characteristics:

• Excessive competitiveness• Irritability• Aggressiveness and hostility (interiorized)• Obsession of the time urgency• Insecurity• Thirst for revenge the injustice• The economic success is his/her permanent goal• Excessive ambition and the impulsive behavior makes him/her to fulfil as

much as possible and to enjoy as little as possible• Unlimited desire for being approved and recognized

Type A of psychic behavior• Effects in biological plane:

• Increased values of triglycerides and plasmatic cholesterol• Extreme high production of insulin as response to glucose

administration• Increased secretion of noradrenalin• Diminishing the time of coagulation• Increase of the corticotropin level• Diminshing the STH concentration in serum

• Effects in psychological plane:• Anxiety• Depression• Frustration• Hostility• Lack of mind peace

• Relation between the type A of psychic behavior and the coronarian affections can be explain by:

• Increased reactivity to stress (doubled increase of the hormon of stress) and the way the sympathetic nervous system responds to stress (the persons of type A react through fury, irritation and tensions when they are threatened by a failure, a harassment or a competitive atmosphere)

• Increased flow of blood to the skeleton-like muscles, not consumed, with consequent depositing of cholesterol

• Weakening of the immunity system• Higher frequency of inter-personal conflicts, as a consequence of

the hostility, with the diminishing of the social support• Predisposition to adopt risky behavior for health (lack of a

consistent breakfast, smoking, excessive consumption of alcohol, sedentariness etc.).

The toxic core of the type A

• A – maximum ambition, need of time• S – disquiet, impatience• H – competitiveness, cognitive and behavioral

hostility• J – major professional involvement

(“workaholic”)

Type C of psychic behavior• Described by Temoshock (1990) upon the basis of

the dimension repressing/vigilance, named also anger-in or repressive.

• It is characterized by:• Strong mechanism of defense, going to the incapacity to verbalize

and acknowledge the own emotions, especially of the negative ones.

• A complex of secondary negative reactions, as self-devaluation, feelings of helplessness and losing the control

• Type C represents in behavioral plane a true illustration of the coping centered upon emotion.

• To the type C it is possible to associate also the notion of alexithymia, characterized by an incapacity of self-knowing and expression, manifested clinically through:

• Scarcity of the imaginative life• Incapacity of self-examination• Stiffness and constriction of the emotional life• Incapacity of an adequate and nuanced expression, with a view to

communicate the disposition• Hipo-symbolism– diminished capacity to symbolize

• A connex notion is the alexithymia – the incapacity of the somatic patients to express their corporal suffering.

• From the neuro-hormonal and immunitar point of view, both the type C, and the alexithymia are frequently associated with the decrease of the secreting catecolamines and the activity of the NK cells and with the hyperfunction of the axis hypotalamus-hypophysis-corticosuprarenal, this increasing the inhibition of the NK cells.

Type C of psychic behavior• Retrospective studies – type C:

• Reserved, stoic, compliant, passive persons• They make efforts in order to maintain the emotional control• Have pleasant inter-personal relations despite the interior

desperation, which they are not exteriorizing• Chronic feeling of lacking hope• Repression and denial of expressing their own negative emotions

(suffering, sadness, fury, anxiety).• Prospective studies – type C

• Chronic lack of hope resulted from painful events of life• Lacunary /incomplete expression of the emotionality• An acute need of being next to a very important person from the

emotional point of view or to achieve an important goal.

Type D of psychic behavior• Predisposed type to stress (Denollet, 1996),

characterized through:• Negative affectivity, expressed in the tendency to live negative

emotions• Social inhibition, namely blocked emotions and behaviors within

the social interactions.• The D type is associated with the decrease of the

quality of life and with the increased frequency of adverse clinical events for the patients suffering of cardiac insufficiency and ischemic coronary disease

• The D type has the most impact over the social, emotional functionality, over the mental health and vitality.

Strategies of coping

• There are two important categories of mechanisms of coping– Direct coping, for solving the problem, which

includes the concrete efforts for the elimination of the stressing circumstances

– Indirect coping, emotional one, which involves the efforts to adjust the emotional consequences of the stressing or potentially stressing events.

The coping centered upon the problem- vigilant

• It is used in case SP generated by potentially reversible situations

• Includes the valuation on mental plane of the possibilities the subject has at hand

• It is oriented upon the analysis, solving and minimizing the stressing situation

• Supposes behaviors of accepting the confrontation with the stressing agent, within which the subject:

• Remembers the previous experience• Depends upon the social support (affective, material and

motivational)• Requires information and seek means• Set up a plan of action

• The persons resorting to coping centered upon the problem in situations generating stress have lower levels of depression, both during and after surpassing the stressing situations.

• The direct, active coping is specific for people with locus of internal control

• Because of their convictions regarding the possibilities to control the environment, they will have in the plane of sanogenetic behaviors a better attitude related to visiting a physician and an increased therapeutic compliance

• The vigilant coping is counter-indicated in situations of irreversible loss, when a better strategy is that of avoiding coping.

Coping centered upon emotion-avoiding

• Generated by hopeless, irreparable and irreversible situationswithout

• Is centered upon person, his/her capacity to cope with stress• Includes modalities of self-deceiving, through which o

decisive confrontation with the stressing agent is not accepted, on contrary, is postponed or annulled

• Supposes the adjustment of the emotional consequences generated by the stressing events and not the concrete action on them.

• Has a positive role when does not surpass a reasonable period of time.

• Represents a passive strategy, the subject trying an emotional relaxation by abandoning the attempts to solve the problem.

• Among the characteristic behaviors of this type of strategy can be mentioned:

• The premeditated postponing of the action, when the subject realizes the momentary impossibility to solve the task

• Giving up to the initial action and its replacement with another, easier to be carried out and which offers a similar satisfaction

• Repression, as modality to voluntary rejection of certain pressures or tendencies to satisfy certain desires, the denial of the negative emotions and their sending beyond the awareness.

• The avoiding coping leads to the diminishing the catecholamines, reduction of the NK cells activity and to the hyper-function of the axis hypotalamus-hypophisis-corticosuprarenal, this amplifying the inhibition of the NK cells

• These consequences represent conditions that favor the falling ill

• Moreover, the strategies of avoiding coping lead the people also towards harmful behaviors (for example the consumption of alcohol), which generates, on short term, the idea of moving away the stressing event but can create serious problems on long term.

Immunogen and non-immunogen features of

personality

Non-immunogen features• Anxious mind

• Depressive mind

• Nevrosism

Anxiety• Associated with a vigilant-avoidant perceptive

style.

• Features: state of disquiet, fear, even fright, not justified by the existence of a real, identificable danger. (“fear without object”) ≠ phobia.

• Anxiety, angst, angoisse.

Anxiety• Lader – anxiety - normal

- pathological (“neurotic”).• Reactive anxiety - motivated by a well

justified cause.• Spielberger - anxiety of character –

“pessimistic mind”.• Anxiety ≠ restlessness – introduces mainly

the somatic plan ( neurovegetative manifesting).

Anxiety

• The anxiety: – feature of character– symptom of an illness or which is

accompanying the illness ( somato-psychic kick)

– independent illness.

Anxiety

• The feeling of the imminence of an indeterminate danger

• State of attention as against a danger, a real psychic alert that seizes fully the subject

• The conviction of absolute helplessness, accompanied by the feeling of disorganization and becoming nothing in face with the danger.

Anxiety• Moderate anxiety – role of “buffer” against the

stressing agents.• A state of disquiet allows to the subject to

realistically anticipate an adverse situation he/she must confronte – the uneasiness acts as a alarm system with beneficial effects. It is negative when sets without reason or lasts too much having a disorganizing role for the behavior and represents an important source of an excess of distressing hormones.

Depressive personality• Accompanies certain illnesses – somato-psychic kick• Etiologic role in certain illnesses- the immunodepressive

effect against the NK cells.• Features: state of dysphoria

• Feelings of helplessness• Absence of interest• Sentiments of self-upbraiding• Disregard of own value.

• Somatic correlated: • diminishing of appetite, • insomnia or hypersomnia,• numerous and varied form of pains.

Nevrosism• Features:

• anxiety, • hostility, • solitude, • impulssivity, • guiltiness,• low self-esteem,• timidity.

• Frequently associated with somatic illnesses.• Amplifier of symptoms – personality prone to stress.

Nevrosism• Eysenck – emotional instability.• Description: person under average as

intelligence, will, emotional control, sensorial acuity and capacity to affirm and to adapt. Suggestible, without persistency, slowly thinking and acting, unsociable and tends to repress the unpleasant acts.

• Hypersensitiveness, with difficulties in recovering the psychic balance, after an emotional chock.

Concept Importance for health Form of investigation

Anxiety Intenssily somatizesFavors the informational contagionCan precipitate the appearance before a physician but, also, the recourse to alternative medicine.

HAD

Depression Lack of interest and motivation in following the therapy, assuming the suffering as being well deserved, low therapeutic compliance (lack of energy to continue the treatment), favors the pathogenesis through behaviors of associated risks ( smoking, consumption of alcohol).

HAD

Nevrosism Intense preoccupations for the functioning of own body, cenestopaties, anxiety, insomnia.

EPI

Immunogen features

• Self-eficacity• Locus of internal control• Robustness• Feeling of coherence• Self-esteem• Optimism

Self-eficacity• Persuading a person of his/her capacities to

mobilize the cognitive and motivational resources for carrying out successfully the given tasks.

• AE (+) - higher motivation, centering upon problem

• AE (-) - assigning the failures to causes connected with the own incompetence, predisposition to anxiety and depression.

Locus of control• The way a person explains the success or the failure,

through causes of internal or external type, verifiable or not verifiable.

• LCI – the conviction that the responsibility for the failure, the merit for the success respectively resides in defects, errors, aptitudes and person’s qualities respectively and has a too small connection with the occurence.

• LCE – the conviction that the source of events exists in fate or others’ power.

Hardiness

• Illustrative variable for the resistance to the psychic stress.

• It has three components:• LCI• Involvement and persistence in the proposed

goal• Perceving the changes of life as being normal

or even challenges.

Feeling of coherence• It is structured since the childhood and

adolescence and it is stabilized around the age of 30 years.

• It has three components:• The comprehension• The control• The goal

Self-esteem• The relation between the own value of the

individual, perceived by this and his/her abilities to reach the desired goals.

• Self-esteem (-) – associated with an increased vulnerability to depression of it can be an indicator of this.

The optimism• Minimizing the gravity of events;• Overrating the own resource to cope with them.• The humor – strategy of adjusting able to diminish

the impact of the stressing events.• Predictive role for longevity, prognostic for the

favorable evolution of certain illnesses.( cancer, for example)

Concept Importance for health Form of investigation

Self-eficacity High level of the T lymphocites immuno-competence

Schwarzer & Jerusalem

Locus of internal control

Increased resistance to stress, direct coping

Lumpkin

Robustness Effect of mediation concerning the events valuation, role in modeling the consequences of the psychic stress

Funk

Coherence Increased resistance in conditions of acute psychic stress

Antonovsky

Self-esteem Diminished vulnerability to depression, increased resistance to stress

Rosenberg

Optimism Increased attention given to the factors of risk, active coping, positive disposition

Scheier & Carver