C H A P T E R
Stress, Coping, and Health
The blessings of life are not equal to its ills, though the number of the two may be equal; nor can any pleasure compensate for the least pain.
—Pliny the Elder, 77 A.D.
Life is not merely being alive, but being well. —Martial, 95 A.D.
■ Simply put, stress moves people into action. It motivates them to manipulate stressors so as to alter their impact. And it also motivates people to support behavior aimed at diminishing or removing stressors (Baum & Posluszny, 1999). This is the main theme of this chapter, and the following questions can help guide your understanding:
1. When are life events stressful, and when are they not?
2. How do stressors affect people physically, psychologically, and behaviorally?
3. Can the appraisal of life events alter their impact on a person’s well-being?
4. How can a person cope with life events and the stress they evoke?
5. Do people differ in the way they appraise and cope with stressors and stress?
Relationship between Life Events and Stress Have you ever had days like this?
If one more thing goes wrong today, I’ll scream. I overslept this morning because my alarm did not go off. Then I tried to make it to my first class but my car wouldn’t start. Conse- quently, I was late for my psychology exam and did poorly. I received an e-mail message stating “We need to talk,” which can only mean the end of my romantic relationship. A friend borrowed a textbook and has not returned it and I need to study from it tonight. Of course this may not matter, since my boss called to say I had to fill in this evening for a sick coworker. In addition, I’ve had this lingering cold and sore throat that I cannot seem to shake. I feel as if I am in a vicious cycle: the more things go wrong, the more frustrated, tense, irritable, and sick I become, and this in turn makes things go wrong even more. Things have got to get better; they cannot get any worse.
The purpose of this first section is to examine the nature of stress, the characteristics of the life events or stressors that are responsible, and the stressor-stress relationship.
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Demands, Strain, Coping, and Stress The previous tale of woe illustrates how life events make demands on an individual’s moti- vation and behavior. Completing projects, preparing for final exams, and considering career goals are examples of positive demands that motivate an individual to achieve them. A bro- ken printer and a car that needs repair are negative events that motivate a person to remedy them. The death of a friend, a “broken heart,” or being in a bad traffic accident are severe neg- ative events that require adjustment necessary for recovery. Background stimulation from noise, light, and overcrowding plus invisible germs motivate action that taxes the body’s adaptation energy. Action to meet the demands of life requires the appropriate resources. Does a person have enough time, tangible resources, adaptation energy, and motivation? Strain occurs when resources are not adequate for a person to achieve positive events or to avoid or escape negative events. For instance, a student runs out of time before assignments are due and a low grade results. Fixing the printer or car strains a person’s budget and means giving up buying other things. When family, friends, or counselors are not available for lis- tening and advice, the student may be unable to dispel grief or make career decisions. Strain also results, for example, when inadequate resources mean losing a romantic relationship, failing to recover from an accident, or being unable to fight off germs. Coping refers to be- havior that is motivated to meet life’s demands and their consequences. Stress results when life demands strain-coping resources either because the demand is too great or the resources are inadequate (Lazarus & Folkman, 1984). Stress endangers a person’s well-being and shows up as negative feelings, physiological arousal, psychophysiological disorders, illness, or maladaptive behaviors. For example, a person can feel depressed, have trouble sleeping, develop headaches, catch a cold, and drink too much alcohol trying to alleviate negative feel- ings and stress.
Characteristics of Stress Do you eat a lot of your favorite ice cream when you feel under pressure? Have you been troubled by the inability to sleep or to slow down? Have you felt anxious or depressed lately? Do you have a cold or flu? Are you trying to fight off various low-grade infections? A “yes” to any of these questions may indicate stress, which manifests in three domains: physical or psychological symptoms and maladaptive behaviors (see Table 7.1).
Physical Symptoms of Stress. Physical symptoms of stress involve a cold, influenza (flu), headache, sleep disturbance, and being unable to slow down (see Table 7.1). These symptoms are measured by inventories, such as the Cohen-Hoberman Inventory of Physical Symptoms (Cohen & Hoberman, 1983) and the Hopkins Symptom Checklist (Derogatis et al., 1974). In addition to these self-reports, studies are conducted of the lives of patients with actual physi- cal ailments, such as tuberculosis, heart problems, or skin diseases (Mittleman et al., 1995; Rahe et al., 1964). Visits to the campus health center or infirmary also serve as indicators of physical symptoms (Crandall et al., 1992), as do days absent from school or work.
Psychological Symptoms of Stress. Psychological symptoms of stress consist of nega- tive feelings like anxiety, depression, and hopelessness (see Table 7.1). These and other psychological symptoms are measured by self-report scales, such as the Positive and Negative Affect Scale, which measure the intensity of an individual’s positive and negative
Motivation: Biological, Psychological, and Environmental, Third Edition, by Lambert Deckers. Published by Allyn & Bacon. Copyright © 2010 by Pearson Education, Inc.
TABLE 7.1 Symptoms Indicating Stress
Physical Symptoms Psychological Symptoms Maladaptive Behaviors
Inability to slow down, relax
Infections (low grade)
Negative emotions (anger, disgust, fear, sadness)
Drinking more alcohol
Drinking more coffee, cola
Taking drugs (cocaine, heroin, marijuana)
Eating poorly (poor diet, too many sweets)
Resting badly (not enough rest, sleeping more than usual)
Filling time passively (too much TV watching, sitting and staring)
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mood (Watson et al., 1988). Positive mood reflects the degree to which a person feels alert and enthusiastic about life, while negative mood indicates feelings of subjective distress. The General Health Questionnaire measures depression, anxiety, insomnia, social functioning, and anhedonia, which is a lack of pleasure from things usually enjoyable (Goldberg et al., 1976). The Perceived Stress Questionnaire presented in Table 7.2 assesses the amount of stress a person experiences in general (Fliege et al., 2005). The questionnaire covers three components of psychological stress. One component refers to worries like anxi- ety about the future and feelings of desperation and frustration. A second refers to tension like uneasiness, exhaustion, and a lack of relaxation. A final component refers to a lack of joy as shown by the absence of energetic arousal and low feelings of security. In testing this ques- tionnaire, Fliege and coresearchers (2005) found, for example, that hospital patients with psy- chosomatic disorders, such as affective, eating, and personality disorders, experienced the most stress, followed by patients who suffered from tinnitus (hearing a ringing or buzzing). Medical students experienced the next most stress while healthy adults experienced the least stress. Finally, as the health of patients improved, their level of worries and tension decreased.
Behavioral Symptoms of Stress. Drinking to forget, seeing a funny movie to alleviate the blues, eating “comfort foods,” or talking to a sympathetic friend are behavioral indica- tors of stress and coping (see Table 7.1). In some instances, however, these behaviors can themselves be stressful. For instance, coffee drinkers and cigarette smokers increase their consumption when their job stress increases (Conway et al., 1981). Witnesses of terrorist attacks have reported an increase in their smoking, alcohol consumption, and marijuana use (Vlahov et al., 2002). Certain individuals, when faced with stress, tend to overeat
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TABLE 7.2 Perceived Stress Questionnaire
In general, rate the extent the following 15 statements apply to you using this 4-point scale:
1 � almost never, 2 � sometimes, 3 � often, 4 � usually
The extent of your worries You are afraid for the future. You have many worries. Your problems seem to be piling up. You fear you may not manage to attain your goals. You feel frustrated.
The extent you feel tension You feel tense. You feel rested. (R) You feel mentally exhausted. You have trouble relaxing. You feel calm. (R)
The extent you feel joy You feel you’re doing things you really like. (R) You enjoy yourself. (R) You are lighthearted. (R) You are full of energy. (R) You feel safe and protected. (R)
Note: To score, first reverse the numbers of the items designated with an (R) so that 1 � 4, 2 � 3, 3 � 2, and 4 � 1. Sum the numbers to obtain your level of stress. Higher scores mean more stress.
Source: Adapted from “The Perceived Stress Questionnaire (PSQ) Reconsidered: Validation and Reference Values from Different Clinical and Healthy Adult Samples” by H. Fliege et al., 2005, Psychosomatic Medicine, 67, table 1, p. 81. Copyright 2005 by Lippincott Williams & Wilkins. Reprinted by permission.
(Greeno & Wing, 1994). These coping behaviors are maladaptive and add to stress that is already there. For example, caffeine produces insomnia, cigarettes are linked to cancer, drugs produce addiction, and overeating leads to obesity.
Characteristics of Stressors Many demands in life motivate an individual to make adjustments. Passing university courses, fixing your car, and working are dealt with effectively by most people. Demands that are not dealt with effectively, however, become stressors; that is, they produce stress. In the words of Hans Selye (1976), one of the originators of the stress concept, “A stressor is naturally ‘that which produces stress’” (p. 78). If you lost sleep worrying about getting the money to fix your car, then the broken car is a stressor. If you lost no sleep, then the bro- ken car was not a stressor but merely a demand to be coped with. This definition is circu- lar, since the demand is defined as a stressor only after knowing that stress resulted. In spite of this circularity, however, certain characteristics are likely to make events stressful: when
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they have a negative valence, when too many have accumulated, when they are of a large magnitude, and when they are unpredictable or uncontrollable (Lazarus & Cohen, 1977; Perkins, 1982).
Negative Life Events as Stressors. Both positive and negative life events motivate coping actions. Repairing a printer, tolerating a neighbor’s noisy stereo, or suffering disappointment are negative events a person would like to escape. Starting a romance, accepting new respon- sibilities at work, or planning a surprise birthday party are positive events that motivate a per- son to act. Early stress researchers often disregarded whether an event was positive or negative; both were considered stressful (Holmes & Rahe, 1967; Selye, 1976). Physiological arousal that resulted from positive events was called eustress (Selye, 1976), especially if the level of arousal was just right—not too low or not too high. Eustress is a concept similar to the ideal level of arousal described in Zuckerman’s (1969) optimal level of stimulation theory (see Chapter 6). Distress, in contrast, is the opposite of eustress and occurs when arousal is too low or too high. Moreover, distress has additional symptoms consisting of negative feelings, phys- ical ailments, diseases, and maladaptive behavior. Thus, stress usually means distress. In com- paring positive and negative life events, Zautra and Reich (1983) found what they refer to as the same domain effect. Negative events produce distress and reduce the quality of life. Pos- itive events, however, increase positive feelings and increase the quality of life. For instance, Cohen and Hoberman (1983) discovered that positive events reduced students’ psychologi- cal and physical symptoms resulting from a number of negative events. Blair and associates (1981) showed that negative events in the lives of counselors and social workers increased job burnout, which is a form of occupational stress. Positive life events, in contrast, did not increase job burnout but instead reduced the likelihood of its occurrence. Finally, Myers and associates (1974) found that an increase in undesirable life events is associated with a wors- ening of physical and psychological symptoms. A decrease in negative events or an increase in positive events, however, is linked with a decrease in symptoms.
Predictability and Controllability of Life Events. Would you like to know when an im- portant exam is coming up, when a violent thunderstorm covers your campus, or when peo- ple will argue in your presence? Predictability, or lack thereof, is another life event characteristic that determines the severity of stress. Individuals prefer predictable over un- predictable stressors. Imagine taking part in the following experiment on how people deal with the predictability of an aversive event (Badia et al., 1974). Your task is to avoid an elec- tric shock to the forearm by pressing a button located on your right. When you do so the shock is postponed for 15 seconds; otherwise, it is delivered once every three seconds. This avoidance task can be carried out under one of two conditions: In the unsignaled avoidance condition you will not know when the shock will be delivered. In the signaled avoidance condition, a light comes on signaling the delivery of shock. You can trigger this signal by pressing a button on the left. Would you prefer to know when the shock is coming? Most participants in this experiment clearly favored signaled avoidance and pressed the left but- ton. In a second experiment, participants could only turn off (escape) but not avoid the shock. Again a participant could choose to be in an unsignaled escape or signaled escape condition. By pressing the right-hand button, a participant could turn off (escape) the shock. But by also pressing the left button, a light would come on signaling the delivery of shock. In this experiment, although nothing could be done to avoid shock, escape was possible. The results of this experiment also showed that participants preferred signaled shock overIS
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unsignaled shock (Badia et al., 1974). Most of the work on the predictability of stressful events like electric shock comes from animal research, which shows that rats, like humans, prefer knowing when they will be shocked even if they cannot do anything about it (Badia et al., 1979; Harsh & Badia, 1975).
Two hypotheses have been proposed to account for the preference of signaled shock over unsignaled shock. The preparatory response hypothesis states that a signal preced- ing a biologically relevant event allows the organism to prepare for that event (Perkins, 1955). By knowing when the shock is coming, an animal or person can prepare and thus re- duce the aversive event. In the college student experiment, knowing when the shock would be delivered helps a person avoid it. If the shock cannot be avoided, then knowing when it will be delivered allows a person to prepare, which may decrease its aversiveness and allow for more rapid escape. For instance, by knowing when an exam or storm is coming a per- son can prepare for it and thus reduce any stress that may result. As an alternative, the safety hypothesis maintains that it is crucial to distinguish safe intervals when shock is not being delivered from unsafe intervals when it is (Seligman, 1971). Thus, rats and humans choose signaled shock because it allows for discriminating safe periods from unsafe ones. In the college student experiment, participants could relax during the safe period and only worry about shock when the signal light came on. Thus, safe periods are those days when exams are not scheduled, when a tornado warning has not sounded, or when people indicate that they are not about to fight. A person can relax during these safe times. Unsafe periods con- sist of those intervals signaling an exam, a tornado, or a forthcoming argument. These in- tervals are times of stress and anxiety. In daily life perhaps both hypotheses can explain human behavior. If we know when a negative life event is coming, then perhaps we can do something about it. Perhaps we can avoid it or reduce the negative impact it will have. And according to the safety hypothesis, we can relax during those times when no negative life events are signaled.
Stressor-Stress Relationship In addition to magnitude, the effects of a life event also depend on its position in the accu- mulation of stressors. Was the event among the first or the last? Even a small stressor at the end of a line of stressors can act like “the straw that broke the camel’s back.” This occurs because the effects of stressors are cumulative (Singer & Davidson, 1986). If they keep coming, they eventually overtake the individual’s resources to cope. However, the cumula- tive effects of life events at the level of daily hassles may not be stressful until some thresh- old has been exceeded (Lloyd et al., 1980; Perkins, 1982). For example, for students this threshold may occur toward the end of the semester when projects and papers are due, final exams are to be studied for, and plans to vacate residence halls or apartments are made. Although the stress curve keeps rising, it eventually levels off, indicating that after a certain point additional stressors will not have much impact (Perkins, 1982).
Determining the Impact of Stressors. Life’s demands require adjustments. At what magnitude, however, do demands become so great that the required adjustments exceed a person’s coping resources? A serious car accident versus a fender bender, flunking out of university versus flunking an exam, or the end of a long versus a brief romantic relation- ship illustrate demands that involve different levels of adjustment. One assumption is that greater demands require more adjustment and potentially more stress. In order to determine
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the shape of the stressor-stress relationship, it is necessary to quantify the impact of life de- mands and any subsequent stress. To this end, psychologists have employed both objective and subjective measures of stressor magnitude. With both measures, individuals indicate if the event happened to them. In the case of objective measures, the degree of adjustment already has an assigned value. For subjective measures, however, individuals assign their own value to the degree of adjustment.
An example of an objective measure comes from early stress research performed by Holmes and Rahe (1967) when they developed their concept of the life change unit. Each unit equals a degree of adjustment considered necessary to cope with a life change event (Holmes & Masuda, 1974).Adjusting to different life events, however, requires different numbers of life change units. Holmes and Rahe (1967) had a large sample of participants rate various life events for the number of life change units they considered necessary for adjustment. These ratings were summarized into the Social Readjustment Rating Scale, which consists of 43 items rang- ing from death of a spouse (100 adjustment units) to minor violations of the law (43 adjustment units). (These point values were obtained by dividing the original ratings points by 10.) Since publication of this scale, several other life event rating scales have been developed (Miller, 1993).The Social Readjustment Scale contains many items pertinent to the general population, such as a mortgage, trouble with in-laws, change in line of work, being fired, or retirement. However, most of these items have little relevance to the life of college students. Life event items pertinent to university students can be found in the Undergraduate Stress Questionnaire (Crandall et al., 1992). It contains a number of items that have been rated for the severity of their stressfulness. Some example items, in order of decreasing stressfulness, are “had a lot of tests, had a class presentation, registration for classes, and got to class late.”
➣ A complete version of the Undergraduate Stress Questionnaire without the severity scores is available at http://www.utulsa.edu/cpsc/undergraduate_questionnaire.htm
Objective ratings scales, however, imply that the same life event is equally severe or stressful for every person.Yet, one life event may require a great deal of adjustment on the part of one individual and little adjustment for another. Being interrupted from studying might be very annoying for one student but be judged a welcome relief by another. Other stress scales take into account the possibility that the same stressor does not impact everyone the same. For instance, the College Students Life Events Scale in Table 7.3 requires a student to assign a numerical value to both the degree and duration of tension created by a particular demand. The combination of tension and duration indicates the subjective impact a demand has on an individual. The accumulation of a greater score on this scale implies more life demands and thus a greater likelihood of stress. Finally, most stress questionnaires like the one in Table 7.3 make hardly any reference to positive events. Most stressors have a negative valence, which supports the idea described earlier that stressors are composed mainly of negative, not positive, events.
Stressor Magnitude and Stress. A cataclysmic stressor or traumatic event that threatens a person or others with death or serious injury can result in an acute stress disorder and later a posttraumatic stress disorder (PTSD). With this disorder, a person reacts with in- tense fear and helplessness to a traumatic event and may continue to experience intrusive and distressing recollections, thoughts, dreams, and physiological reactivity after the event.
TABLE 7.3 College Students Life Events Scale
Tension: Indicate how much tension you felt while the most recent occurrence of the event was going on. By feelings of tension we mean feeling worried, anxious, irritable, or depressed. Such feelings may be accompa- nied by difficulty in sleeping or concentrating on other things. Use the following scale:
Duration: If there was tension associated with the event, think about how long the tension associated with the event lasted (or has lasted if it is still going on). Use the following scale:
1 Less than 1
2 More than 1 day, but less than 1 week
3 More than 1 week, but
less than 1 month
4 About 1 month
7 More than 2 months
1. Increase in normal academic course load (e.g., more academic work than previously, much harder work, etc.)
2. Increased conflict in balancing time for academic-social activities 3. Struggled with decision about major or career goal 4. Inability to get desired courses or program 5. Received much poorer grade than expected on a test or in a course 6. Repeated arguments, hassles with cohabitants (e.g., racial, sexual, religious,
personal idiosyncracies, financial, etc.) 7. Living arrangements consistently too noisy (to study, to sleep) 8. Moved to new quarters on or off campus 9. Realized that finances are increasingly inadequate to meet living expenses
10. Significant increase in level of debt (e.g., took out large loan, charged more than can easily pay, gambling debts, etc.)
11. Serious attempt to stop, decrease, or moderate use of drugs, alcohol, or smoking
12. Significant increase in use of alcohol, resulting in problems in school, work, or other areas of life
13. Increased attendance or participation in religious services or practices 14. Decreased attendance or participation in religious services or practices 15. Increased commitment or participation in political or social activism 16. Began sexual unfaithfulness to a partner to whom you are not married 17. Engaged in initial sexual intercourse 18. Engaged in sex act without use of birth control measures (i.e., feared
pregnancy) 19. Became pregnant out of wedlock or partner became pregnant out of
TABLE 7.3 (Continued)
20. Experienced rejection of a more than casual sexual overture 21. Unable to find a satisfactory sex partner 22. Divorce or separation of parents 23. Death of member of immediate family (e.g., parent, sibling, grandparent, etc.) 24. Parental remarriage 25. Decided for the first time not to go home for major holiday 26. Increased conflict with parent (e.g., sex, drug use, dress, religious practices,
lifestyle, sleeping out of home, etc.) 27. Increased peer pressure to experiment with sex, drugs, etc. 28. Lost a friend due to personal conflict 29. Lost a good friend or friends because you or they moved, or transferred, etc. 30. Realized necessity to make new friends 31. Got married 32. Entered new, serious relationship with boyfriend or girlfriend (e.g.,
engaged, living together, etc.) 33. Boyfriend or girlfriend broke up your relationship 34. You broke up with boyfriend or girlfriend 35. Increased conflict with boyfriend or girlfriend (e.g., over sex, drugs,
alcohol, independence, recreation, division of responsibilities, etc.) 36. Deeply attracted to someone who showed no interest in you 37. Important date was disappointing 38. Your friend went out with someone you were interested in 39. Struggled with decision to break up with boyfriend or girlfriend 40. Increased job responsibilities 41. Increased hassles on the job with boss or supervisor 42. Quit job 43. Realized job responsibilities interfered with academic work 44. Victim of assault 45. Busted for drug related activity 46. Victim of robbery or burglary 47. Involved in auto accident as driver, without injury 48. Involved in auto accident as passenger, without injury 49. Illness or injury kept you out of school for one week or more 50. Car broke down 51. Activity run by your group was a flop (e.g., play, team lost game, no one
came to your party, etc.) 52. Realized responsibilities in extracurricular activities interfered with school
work 53. Unable to find adequate recreational or athletic outlets
Source: Adapted from “College Students Life Events Scale” by Murray Levine, University at Buffalo, and David Perkins, Ball State University. Printed with their permission.
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Distance < 2 miles?
FIGURE 7.1 PTSD from Terrorist Attacks. The incidence of PTSD from the September 11th terrorist attack increased with closeness to the site, directly witnessing the attack, and losing possessions or employment as a consequence.
Source: Adapted from “Psychological Sequelae of the September 11 Terrorist Attacks in New York City” by S. Galea et al., 2002, New England Journal of Medicine, 346, table 1, p. 984.
The person also tries to avoid stimuli associated with the trauma, experiences persistent arousal symptoms (e.g., sleep difficulty), and suffers social impairment. In the case of acute stress disorder, the symptoms must occur and subside within four weeks of the traumatic stressor. If the symptoms continue, the diagnosis changes to PTSD (American Psychiatric Association, 2000).
Both acute and posttraumatic stress disorders resulted from the terrorist attacks per- petrated against the United States on September 11, 2001. Two airplanes crashed into the World Trade Center in New York City, a third airplane crashed into the Pentagon, and a fourth crashed in a Pennsylvania field. The combined terrorist attacks killed an estimated 3,000 people and destroyed billions of dollars worth of property. In addition, the attacks and media replays produced psychological havoc in the form of fear, anxiety, a sense of vulner- ability, and uncertainty about the future (Susser, Herman, & Aaron, 2002). In one nation- wide random telephone survey three to five days after the attack, respondents were asked the extent they felt the following stress reactions: (1) feeling very upset by reminders of the events, (2) disturbing memories, (3) difficulty concentrating, (4) trouble falling or staying asleep, and (5) feeling irritable or having angry outbursts (Schuster et al., 2001). The survey showed that 44% of the adults reported at least one of the stress symptoms, and 35% of their 5- to 18-year-old children did also. Even individuals thousands of miles from the attack site experienced stress symptoms, which may have resulted from the images being shown re- peatedly on televison (Schuster et al., 2001). Five to eight weeks after the attack, a random telephone survey of NewYork City adults living within eight miles of the World Trade Cen- ter showed that overall, 7.5% of the respondents experienced PTSD. Figure 7.1 shows that
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the likelihood of suffering PTSD increased with being close (< 2 miles) to the attack site, directly witnessing the attack, and losing one’s possessions or job (Galea et al., 2002).
Cumulative Effects of Stressors. Do demands pile up at the end of the semester? Does something need repair the same time you are low on money? Is there so much to do and too little time to do it? In order to determine the cumulative effects of stressors, Holmes and Masuda (1974) tabulated life changes for a large group of physicians and recorded the occurrence of illness or health changes that occurred within a two-year period following a cluster of such changes. Their results, in Figure 7.2, show that as life change units increase, health changes increase also. In a prospective study, life change scores of resident physicians covering the previous 18 months were correlated with illnesses occurring in the next 9 months. The relationship was positive: the percentage of individuals getting ill was greater for those with a larger number of life change units (Holmes & Masuda, 1974). Other research shows that as the number of life change units increases over a period of years, the likelihood of tuberculosis, heart disease, and skin diseases also increases (Rahe et al., 1964). In reviewing this research, Holmes and Masuda (1974) conclude that life change events require adaptive effort by the individual, or what Selye (1976) calls adaptation energy. A decline in adapta- tion energy lowers the body’s resistance and thereby increases the likelihood of disease.
In addition to affecting illness, life changes can also depress behavior such as academic performance and GPA. Lloyd and colleagues (1980) assessed life changes among college stu- dents by having them indicate what changes had occurred in their lives. For instance, students were asked if they had experienced changes in sleeping, eating, recreation and family get- togethers, living conditions, or moving; or injury, illness, or the death of a friend or family member. Students were also asked to subjectively weigh each life change in regard to the amount of adjustment each required. Two measures were of interest: the total number of events that occurred in the previous year and the subjective weighted event total, which involved the
Number of Life Change Units
Mild (150–199) Moderate (200–299) Major (300+) 0
FIGURE 7.2 Accumulated Stress and Health. As the number of life change units increases, the percentage of health changes also increases.
Source: Adapted from “Life Change and Illness Susceptibility” by T. H. Holmes and M. Masuda, 1974, in B. S. Dohrenwend and B. P. Dohrenwend, Eds., Stressful Life Events, table 1, p. 61, New York: John Wiley.
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subjective impact of a change. The life change measures were associated with a declining GPA: as life change scores went up, GPA went down. This finding was especially true for the sub- jective weighted event total. In addition, life changes in recreation, in work responsibilities, and in changing to a new line of work had a greater impact on students with lower GPAs.
The cumulative effects of traumatic stressors can be very detrimental for the mental health of people. One group of individuals to whom this has happened are soldiers and Marines, who have experienced ground combat or dangerous security duty in places of war. In one study, Hoge and coresearchers (2004) gave an anonymous survey to returning soldiers and Marines, who had experienced combat or other dangerous duty in either Afghanistan or Iraq. The survey included questions that covered depression, generalized anxiety, and PTSD. A checklist from the Department of Veteran Affairs was used to diag- nose PTSD. The checklist contained 17 items that were rated on a scale 1 � not at all to 5 � extremely. For example, how much in the past month have you been bothered by “Repeated, disturbing memories, thoughts or images of a stressful military experience?” Other ques- tions addressed stressful experiences that were of a noncombat origin (National Center for Posttraumatic Stress Disorder, 2008). In order to be diagnosed with PTSD, the individual had to score above the midpoint on the checklist. The survey examined a multitude of trau- matic stressors. These included being in firefights, which is an exchange of gunfire between combatants and can include being ambushed; shot at by artillery, rockets, or mortar fire; and shooting the enemy in return. Stressors also included killing enemy combatants, seeing and handling dead bodies, knowing someone who was killed or seriously injured. A final set of stressors included being wounded, injured, or having a close call with death, saving someone’s life, but also being unable to save the lives of others (Hoge et al., 2004).
The general results of the survey showed that mental health problems increased as a re- sult of being deployed in Afghanistan and Iraq. Furthermore, there was a direct relationship between the incidence of PTSD and the number of firefights. As Figure 7.3 indicates, the greater the number of firefights that individuals had experienced, the greater their likelihood of being diagnosed with PTSD. Even without participating in a firefight, 4.5% of the Marines and soldiers experienced PTSD as a result of their deployment in either Afghanistan or Iraq.
Racism as a Stressor. Stressors also accumulate by virtue of an individual’s minority group membership. Based on physical characteristics, people may be members of minorities, such as being an African American in the United States. As a member of a minority group, individuals often experience the stresses of discrimination and racism. Utsey and Ponterotto (1996) devel- oped the Index of Race-Related Stress, which measures the impact of four categories of racism (see Table 7.4). Cultural racism results from the practices of one group being imposed on another, while institutional racism stems from the policies ingrained in an organization. Indi- vidual racism is experienced personally, while collective racism occurs when an entire organi- zation discriminates against an individual (Utsey & Ponterotto, 1996). The stressful nature of racism, as measured by the index in Table 7.4, was demonstrated in two ways. First, cultural and individual racism scores on the Index of Race-Related Stress correlated positively with scores obtained with the Perceived Stress Scale (Cohen & Hoberman, 1983). In other words, the more upset individuals were as a result of cultural and personal racism, the more stress they experienced. Second, African Americans scored significantly higher on all four racism cate- gories measured by the index than did a group of nonblacks (whites and Asian Americans), which indicates African Americans experience more racism than do other groups.
0 0 1, 2 3, 4, 5 6+
Number of Firefights
FIGURE 7.3 Cumulative Effects of Traumatic Stressors. The likelihood of a soldier or Marine developing PTSD increased as their participation in firefights increased. Firefights refer to an ex- change in gunfire, artillery, rockets, or mortar fire between combatants.
Source: Adapted from “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care” by C. W. Hoge et al., 2004, The New England Journal of Medicine, 351, p. 17.
TABLE 7.4 Four Illustrations of Racism from the Index of Race-Related Stress
If the following events happened to you, to what extent were you upset by them (Not bother me, Slightly upset, Upset, Extremely upset)?
Cultural Racism “You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.”
Institutional Racism “You have discovered that the White/non-Black person employed in the same capacity as you with equal or less qualifications is paid a higher salary.”
Individual Racism “While shopping at a store or when attempting to make a purchase, you were ignored as if you were not a serious customer or didn’t have any money.”
Collective Racism “You were the victim of a crime and the police treated you as if you should just accept it as part of being Black.”
Source: Adapted from “Development and Validation of the Index of Race-Related Stress (IRRS)” by S. O. Utsey and J. G. Ponterotto, 1996, Journal of Counseling Psychology, 43, table 1, pp. 494–495.
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Experiencing racism is associated with psychiatric symptoms. Landrine and Klonoff (1996) developed the Schedule of Racist Events to assess the effects of racist discrimination in the lives of African Americans. A sample from this schedule is “How many times have you been treated unfairly by strangers because you are Black?” (Never, to Almost all of the time) (p. 162). Evidence for the stressful effects of racism came from examining the relationship between the schedule scores and stress-related psychiatric symptoms obtained from the Hopkins Symptoms Checklist (Derogatis et al., 1974).Analyses showed that the schedule scores were positively correlated with symptoms like obsessive-compulsive disorders, depression, anxiety, and physical symptoms. In addition, people who were more stressed from racist events, as measured by the schedule, were also more likely to use smoking as a stress reducer.
Finally, there are also ethnic differences in hypertension. For instance, African Amer- icans have a higher incidence of hypertension (high blood pressure) than white Americans. Racism is thought to be one factor responsible for this (Barnes et al., 1997). However, as a note of caution, it is not possible to say that perceived racism is a cause of stress, although the two variables are associated together. Perhaps laboratory research will allow psycholo- gists to determine whether one causes the other (for example, see Vrana & Rollock, 1998).
Section Recap At times a person is motivated to do too many things at once because of the many demands made on an individual. This can result in strain, which means that a person’s resources are inadequate to meet those demands. Stress is the reaction to strain. It is detrimental to a per- son’s well-being and is manifested by negative feelings, excessive physiological arousal, psychophysiological disorders, illness, and maladaptive behavior. Coping behaviors are motivated by the necessity of managing life’s demands and the resulting stress. Stressors consist mainly of negative life events that produce stress. Positive life events produce a type of arousal known as eustress, especially if the level of arousal is optimal. Stress usually means distress and is the opposite of eustress. According to the same domain effect, nega- tive events produce distress, while positive events produce positive feelings and increase the quality of life and eustress. Stressors vary in magnitude.
Both animals and humans prefer to know when a stressor, such as shock, is coming. According to the preparatory response hypothesis, knowing when a shock is coming allows the organism to prepare for it. According to the safety hypothesis, it is important to distin- guish shock from shock-free intervals, since a shock-free interval allows the person to re- lax and feel safe. In general, as the magnitude of the stressor increases and as stressors accumulate, stress increases. Scales have been developed to measure the impact of various stressors and the amount of adjustment they require. Some scales measure stress in terms of life change units, which refer to the amount of adjustment a stressor requires. Extremely traumatic events, such as the terrorist attacks of September 11, 2001, result in an acute stress disorder, which if it persists more than four weeks is diagnosed as a posttraumatic stress disorder (PTSD). These disorders are characterized by distressing dreams, flash- backs, psychological distress, and behaviors reminiscent of the original event. The effects of extreme stressors can accumulate as observed in the increased incidence of PTSD among soldiers and Marines who participated in more and more firefights. Finally, racism as experienced by African Americans and other minority groups is associated with stress and higher levels of psychiatric symptoms.
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Bodily Effects of Stress BODY: What a fine mess you’ve gotten me into. I’m stuck here in bed with a fever
and achy joints. Why didn’t you defend me?
IMMUNE SYSTEM: I did the best I could. Can I help it that you expose yourself si- multaneously to the viruses of many individuals? A drafty classroom on a winter’s day is really not the place for you to be when I am so weak. My defenders did the best they could, fighting the viruses when they invaded. But they were over- whelmed by the onslaught. Besides, you have only yourself to blame.
BODY: Now it’s my fault, is it? What did I do wrong?
IMMUNE SYSTEM: Yes it’s your fault. You are motivated in too many directions at once. You spend too many hours attending classes, studying, working, recreating while at the same time not getting enough sleep and not eating properly. As a result, I suffer. If you were a bit less active, I would be stronger and thus better able to fight off an attacking virus. Now you will just have to kill them off with heat by raising your temperature. If you decrease your activity level a bit, I will become stronger. However, do not become totally inactive because that will also decrease my strength below an optimal level.
This imaginary conversation shows that some stress is good for the immune system, while too little or too much is bad. The purpose of this section is to describe how stressors affect the physiological system, the immune system, and ultimately a person’s well-being.
Physiological Effects of Stressors GeneralAdaptation Syndrome. One of the earliest and major investigators of the phys- iological consequences of stressors was Hans Selye (1976, 1993). As a medical student in 1936, he discovered how a variety of different stressors produced similar physiological stress reactions. Regardless of whether the stressors included cold, heat, trauma, hemor- rhage, or nervous irritation, the body’s physiological reaction was the same. He coined the term general adaptation syndrome (GAS) to refer to the observation that stress involved the whole body as it went through three stages: alarm reaction, stage of resistance, and stage of exhaustion. The alarm reaction is the body’s first and generalized response to a stressor. During this phase sympathetic nervous system arousal increases, and stress hormones are released, such as epinephrine, norepinephrine, and glucocorticoid. These hormones can enlarge the adrenal glands, shrink the thymus gland, and produce stomach ulcers. In addition, there is a tendency to suppress the body’s immune system, thus making the body more susceptible to disease. The initial decrease in resistance to stressors is fol- lowed by the stage of resistance, during which the body is successfully controlling the stress. Stress hormone production is no longer necessary and drops back to normal. The body’s response to fighting stress also goes from being generalized to being localized to where the stressor impacts the body. At this stage the body is more resistant to the original stressor while at the same time being more vulnerable to new stressors. During this time, a person is using adaptation energy in defending against a stressor and adjusting to its ef- fect. In the final stage, the stage of exhaustion, a person runs out of adaptation energy, and the ability to combat stress becomes completely exhausted, resulting in death. During this
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stage, the level of stress hormones rises in the bloodstream, and they become sources of stress themselves (Selye, 1976).