Edvard Munch: The Scream




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Stress and illness
Stress and CHD
Brady's Executives
Sources of stress
Individual differences
Stress management
Cognitive reduction







Stress and Physical illness

Stress can cause ill health in a number of ways:

Effect on the body

Possible effect on health

Research evidence

Increased heart rate

Increased blood pressure

Coronary Heart Disease (CHD)

Hypertension (high blood pressure)

Friedman & Rosenman (1974)

Cobb & Rose (1973)

Suppression of the immune system

Colds, flu, cold sores, other viral infections. 

Possible links with cancer

Riley (1974), Kiecolt-Glaser (1984)

Visintainer et al (1983)

Disturbance of the digestive system

Stomach (gastric) ulcers

Brady’s executive monkeys

It is also vital to mention that many of these effects could be attributable to habits taken up by stressed people.  Much of the evidence outlined below is correlational so does not imply cause and effect!!!  More on this later.



Stress and Stomach ulcers     


Brady’s executive monkeys (1958).


Brady yoked two monkeys together and administered electric shocks every 20 seconds for six-hour periods.  One of the monkeys, the ‘executive,’ was able to press a lever that delayed the shocks for 20 seconds.  However, it was unable to stop all shocks.


Many of the ‘executives’ died of stomach ulcers.


Brady concluded it was the stress of being in control that had caused the ulcers.  It couldn’t have been the shocks per se since the other monkey got the same number of shocks to its feet but didn’t get ulcers.


Where do you start?

Ethics: this is one of the cruellest experiments carried out in Psychology and would not be possible today.  Relatively intelligent creatures were subjected to the pain and stress of foot shocks and died slow, painful deaths.

Method: The experiment appears to have been flawed.  Weiss (1972) repeated the experiment on rats (these lack the aaahhh value of monkeys).  He found no difference between ‘executives’ and ‘controls.’  The researchers noticed that in the original study Brady had used the most active and ‘extrovert’ monkeys as executives.  They concluded that it wasn’t being in control that had killed the monkeys but their ‘personality’ or behaviour type.’

In another study Weiss preceded the shock with a warning tone.  These executives were far less likely to develop ulcers which Weiss put down to the rats being able to ‘chill’ for some of the time.  The effects of continual stress seemed far more damaging.  This could be compared to some jobs such as air traffic controllers who need to maintain constant vigilance.



The University of Plymouth has an excellent section on this study and the follow ups.  See link:


Other research:

Weiner et al (1957) examined the gastric secretions of army recruits!  (What would you like to do when you grow up?).  They found that after 4 months of stressful training 14% of those who produce a lot of stomach acid developed ulcers, whereas none of those who produce little acid developed them.  From this they concluded:

1.       there may be a link between stress and ulcers

2.       stress could not be the only cause since 86% of over-secretors did not develop ulcers.


Stress and the immune system

We have already seen that during times of stress the adrenal cortex produces steroids (called corticosteroids since they’re produced by the adrenal cortex).  These stop the body producing lymphocytes (white blood cells) that attack foreign bodies such as viruses, in the bloodstream.

More detail for those who are comfy with it.

Viruses have antigens on their surface.  In order to neutralise the effects of a virus the body must produce antibodies.  Antibodies need to be specific to the antigens present and are produced by white blood cells.  There are different types of white blood cell, e.g. T-cells, B-cells and natural killer cells (not to be confused with a film by Quentin Tarantino!).  B-cells have antibodies on their surface.  These lock onto antigens.  When a B-cell is mature it can produce thousands of antibodies an hour.  Importantly, the cells appear to ‘remember’ previous attackers so that a future infection can be fought off quickly.  Unfortunately, B-cells only ‘live’ for two days so need to be continually replaced.  Increased levels of steroids, caused by stress, slows down the production of B-cells, leaving us more susceptible to infection

T-cells attack infections while they’re in the body, rather than the blood.  Cortico-steroids shrink the thymus gland and slow down the production of T-cells.



Research evidence

There’s lots of it.  Choose the ones you prefer or think you’re most likely to remember.  Kiecolt-Glaser et al (1984) is a good one to use as key study.  Note: it’s Janice Kiecolt-Glaser so refer to her as ‘she.’

Kiecolt-Glaser et al (1984)


They took blood samples from 75 student volunteers

1.  One month before examinations (control reading).

2.  On the first day of their exams (stress reading).

They also completed a questionnaire to assess their psychiatric state, their level of loneliness and number of life events.


In the stressed condition, on the day of their finals, they had significantly fewer natural killer cells. 

They also found that loneliness, lots of life events and problems such as depression were all associated with a weak immune response.


Good points (This is an excellent piece of research!)

It is a natural experiment since it took advantage of a naturally occurring event; examinations.

The independent variable (IV) was exam stress, a long-term form of stress.  Most studies have concentrated on short-term stress.  Note: natural experiments are high in ecological validity!


Because this was a natural experiment confounding variables are difficult to control.  As a result we cannot be certain that stress led to the immune suppression.  Other factors that were not controlled could be responsible.



Other studies

·     Riley (1981) placed mice on a turntable at 45 rpm; (they must be single mice.  I’ll try this ‘joke’ again and see if you get it this year!).  This induced stress and decreased their number of lymphocytes.

·     Kimzey (1975) found that American astronauts who had just gone through the stress of re-entry had a lower white blood cell count.

·     Sweeney (1995) took biopsies from the arms of volunteers.  It was found that participants who were stressed by caring for elderly relatives took longer to heal.  Think of the practical implications of this for people recovering from major surgery!

·     Cohen et al (1991) carried out an impressive study on 394 participants.  They each had their stress index measured using a questionnaire that also took into account their ability to cope and their feelings about their stress.  They were then given nasal drops that infected them with cold viruses.  When tested by doctors there was a direct correlation between their stress index and the probability that they developed a cold.


Stress and cancer

The link is by no means proven, but there is some evidence.

·      Jacobs & Charles (1980) found that children who had developed cancer have often been exposed to above average levels of stress in the previous year.

·      Visintainer et al (1983) injected cancerous cells into animals.  Those that were then stressed were less able to fight the cancer.

·      Tache et al (1979) found that cancer is more likely in single, separated or divorced people.  This was put down to lack of social support in reducing the effects of stress.

·      Levy (1993) believed that immune suppression might again be to blame.  It is thought that the immune system produces chemicals that fight cancer.  As with CHD it may be behaviours associated with stress, such as smoking, that cause cancer, not the stress itself.

Indirect affects of stress on health.

It is essential that this be considered in any part c question on stress and physical health as it will guarantee AO2 marks.

Stress is associated with all manner of bad habits, for example smoking, drinking alcohol to excess, poor diet due to lack of time, lack of exercise for the same reason, lack of sleep etc…  All of these are likely to have an adverse effect on a person’s health so could cause some of the ill-effects attributed to stress per se.

Cohen & Williamson (1991) found that people who are stressed tend to smoke more, take less exercise, drink more alcohol and sleep less than others.  All of these habits can lead to ill health. 

Wills (1985) found that stressed teenagers were more likely to start smoking.  Similarly, Carey et al (1993) found that adults who had given up smoking were more likely to take it up again when stressed.

Brown (1991) found that life events were more likely to cause students to seek medical advice if the students were low in physical fitness, as compared to students high in physical fitness.


It may not be stress itself that causes ill health but the behaviours that stressed people tend to engage in.



b. Sources of Stress

This section can loosely be split into two sections:

  • “Causes of stress” (or stressors as they are known), such as life events, hassles, occupational stress etc.
  • “Individual differences in the stress response” looks at factors that may effect how we cope with stress such as personality, culture and gender.

Causes of stress

1. Life events (Social Readjustment Rating Scale: SRRS)

Holmes and Rahe were two hospital doctors who noticed that many of the patients that they visited on their rounds had suffered life events causing disruption to their lives in the previous year.  They decided to construct a questionnaire to examine the possible link between life changing events and physical ill-health. 

  1. They examined the medical records of over 5000 patients
  2. They compiled a list of 43 life events
  3. They rated these in order of the time it would take to get your life back to some semblance of normality following the event
  4. They gave ‘marriage’ an arbitrary score of 500 and got others to rate the other events in comparison to this.  They averaged out the scores and divided them by 10, so in the final scale ‘marriage’ has a score of 50.
  5. The scale starts at 100 LCUs (Life Change Units) for ‘death of a spouse and ends with 11 LCUs for ‘minor violation of the law.’

The scale was tested on different groups of people to determine its relevance.  Patients would add up the score for each life event and this would be their total LCU.  They believed that a score of over 300 meant an 80% chance of developing a serious physical illness in the following year. 

Evaluation of the SRRS

Individual differences: the life events in the list will have different meaning and cause different amounts of disruption to different people.  For example the effects of divorce will depend on how long the couple have been married, whether or not children are involved, whether the person is escaping a violent partner etc…

Cause and effect: the scale implies a correlation between stress and ill-health, however, as I’m sure you must have realised by now correlations do not prove cause and effect.  All manner of other reasons could be used to explain the link.  Ill-health could be causing the stress, or the life events.  For example a heart attack could cause loss of job, major changes in standard of living resulting in break up of marriage etc. 

Positive life events: Martin (1989) found no correlation between positive life events such as ‘outstanding personal achievement’ and ill-health.

There are other problems as you would have found when you did the test, such as not relevant to people your age and does not consider other forms of stress such as hassles.  However, it is unlikely that you would be expected to mention more than two.

On a positive note: the SRRS was the first of its type and inspired many others to follow and devise more relevant and useful tests.  The scale is rarely used in serious psychological research today.


Use of the SRRS

Rahe et al (1970) tested 2500 naval personnel on board 3 ships just before they set sail.  During their six months tour of duty the sailors kept health records.  A correlation of 0.118 was found between LCUs and ill-health.  This is relatively low; however, because of the size of the sample (2500) it is statistically significant.


2. Hassles and Uplifts

Generally our everyday feeling of being stressed can probably be attributed more to minor, irritating problems than to the rarer major life events.  Some research has found that hassles have a greater correlation with ill-health than do the seemingly more serious life events.

Examples of hassles and uplifts (Kanner et al 1981)



Rising price of goods

Home maintenance

Too many things to do

Misplacing or losing things


Physical appearance

Weight problems

Completing a task

Feeling healthy

Getting sufficient sleep

Eating out

Spending time with the family

Meeting your responsibilities



De Longis et al (1982) Key Study


To see if life events of hassles were better predictors of ill health



100 participants completed 4 questionnaires every month for one year:

  1. Hassles scale (117 items)
  2. Uplifts scale (135 items)
  3. Life events questionnaire (24 events)
  4. Health questionnaire



Daily hassles were correlated with ill health, but neither uplifts nor life events were.


Daily hassles are more likely to cause stress related illnesses than life events.


Evaluation of this study

Many of the earlier problems still exist:

  1. There are still many examples of stressor not considered such as so called chronic stressors such as poverty, poor housing, overcrowding in inner cities etc.
  2. Individual differences are still not considered.  We all perceive and react to stress differently, some people seemingly being able to cope better than others, and again these are not considered.
  3. Cause and effect.  Yet again the study is a correlation so does not prove that the stress is causing the illnesses.  For example just before a cold we may feel more hassled, but this could be because the virus is already having its effect, leaving us tired and less able to cope with everyday events.  That is the illness is actually causing the hassle!

3. Occupational stress

This is a favourite topic for examination questions as well as being an important issue for workers around the World.  Recently stress has overtaken the common cold as the main reason for absence from work.

Causes of stress in the workplace:

Work overload

Breslow and Buell (1960) found that employees working more than 48 hours a week were twice as likely to develop CHD than those working 40 hours a week.

However, it is probably the perception of long hours that is more important than the number of hours per se.

Environmental factors

These include any aspect of the working environment that is likely to cause stress; most obvious examples include noise, temperature, vibration, lighting and overcrowding.

Although people can cope reasonably well with noise it does appear to cause some impairment in performance, particularly if the noise is unpredictable.  Glass et al got 60 participants to complete cognitive tasks such as word searches under one of four conditions:


Unpredictable noise

Predictable noise

Loud noise

Made more mistakes and were less persistent on the task.


Participants adapted to the noise and made fewer mistakes.  Had lower arousal levels (GSR).

Soft noise

Coped with task okay in both conditions.


The researchers concluded that we can adapt to high noise levels but this is more difficult if the noise is not constant or is unpredictable.

The stress of overcrowding has been studied in other species particularly rats where it has lead to bizarre behaviours such as parents eating their offspring.  Freedman et al (1975) found a correlation between high density living conditions such as inner cities, and admissions to psychiatric hospitals.  Yet again this is a correlation so does not prove c_____ and e_____.  Perhaps you could think of some other reasons, other than overcrowding to explain why inhabitants of inner cities are more likely to be diagnosed with mental illness.  Clues perhaps in the next topic!

Role ambiguity

To some extent we all play roles, particularly in the work situation.  You may have noticed that some teachers behave very differently out of work when playing a different role!  Role ambiguity is likely to occur when a person is unsure of their precise responsibilities within an organisation and has been reported as a major source of stress by 35% of workers in the USA. 

Role conflict

This is a common form of stressor and arises when the job requires you to behave in a way that is at odds with your own desires or beliefs.  For example working overtime may be at odds with your role as parent.  Similarly someone in middle management may find it difficult to balance the needs of their superiors for higher output with the needs of their staff for a shorter working week.

There are other forms of workplace stress including burnout, repetitive work, isolation, lack of control etc.; some of these are addressed by the key study of Johansson et al (1978)


1. Civil Servants

Marmot et al (1997) began with the hypothesis that control was negatively correlated with stress-related illness; that is as control decreases the level of illness increases.

Over 10,000 civil servants were investigated over a period of three years.  Researchers assessed the level of job control by self report questionnaires and by assessments by personnel managers and this was then compared to levels of stress related illness. 

They found that workers with less control were four times more likely to die of heart attack than their colleagues with more control.  In addition they were more likely to suffer from other stress related illnesses such as cancers, ulcers, stomach disorders and strokes.  Even when other possible contributory factors such as diet, smoking, social support etc. had been taken into account the additional risk remained!

The conclusion was obvious, that lack of control seemed to be associated with illness and they recommended that employers gave their staff more autonomy and control.


Criticisms of this study:

Since the method is correlational it can only be said that there appears to be an association between low control and stress-related illness.  It cannot be assumed that low control is causing illness!   It could be that workers with poor health are less likely to achieve the higher grades where control is greater.  This would explain the findings just as well.

Workers filled in self-report questionnaires which are notoriously inaccurate and prone to participant reactivity (see notes on research methods).  Basically, if the workers suss what the researchers are looking to find they may answer questions accordingly.  Similarly the personnel managers assessing people’s jobs may do the same!


2. Sawmill

Johansson et al studied a small group of workers in a large sawmill.  Their job was ‘finishers’, i.e. they were the final link on a conveyer belt system.  The rate at which they worked determined the output of the mill so their job was very responsible. 

Sources of stress included: responsibility for the mill’s output, responsibility for the pay of other employees (since pay was linked to productivity), working in isolation, so didn’t have others to share problems with, little control (since they worked on a conveyor belt), highly skilled but repetitive work.

The researchers’ measured their stress hormones (adrenaline and noradrenaline) and patterns of illness. 

Findings:  They had much higher levels of stress than other workers in the mill and, presumably as a result, had more stress related illnesses and days off work.

Conclusion:  The researchers recommended that the finishers should move to a salary structure (i.e. pay not based upon output) and should be allowed to rotate jobs with other workers.


Individual Differences in the stress response

We will look at individual differences in detail in the next topic, but you have had a brief introduction to them in attachments (Ainsworth in case you’d forgotten).  Individual differences, as the title suggests looks at ways in which we differ from one another, rather than the ways in which we are similar.  Generally we could differ because of personality, gender, social class, ethnicity, age, genes, life experiences etc.  In terms of our response to stress we’ll concentrate on:

  • Personality and behaviour (Type A or B and Hardiness)
  • Gender (There appears to be a difference in our biological response to stress)
  • Culture (Why do some ethnic groups seem to be less stressed?)


Personality and behaviour

A, B or C

A famous longitudinal study carried out by Friedman & Rosenman (1974).  The researchers had earlier identified two basic behaviour types:

Type A

Type B

Intense desire to achieve goals

Tendency to compete

Desire for recognition and advancement

Tendency to rush to finish tasks

Mental and physical alertness

A noticeable lack of:




         Desire to compete

Being a bit of a saddo, I think of these things in terms of Eastenders’ characters, for example Phil Mitchell (type A) and Patrick, (Paul’s dad, (type B).  Perhaps you can think of your own to help you remember the characteristic traits of each.


Type A behaviour and CHD (See earlier notes for fuller details)

Friedman & Rosenman’s longitudinal study (1974). 


3200 participants (all men) were given questionnaires.  From their responses, and from their manner, each participant was put into one of three groups

Type A behaviour:  competitive, ambitious, impatient, aggressive, fast talking.

Type B behaviour:  relaxed, non-competitive.

Type C behaviour:  ‘nice,’ hard working but apathetic when faced with stress


Eight years later 257 of the participants had developed CHD. 

70% of these had originally been classed as type A.




Suzanne Kobasa believed that people with a hardy personality were less likely to see events as stressful.  Managers of a large US company were tested using the SRRS.  Those who scored highly were then examined and split into two groups; those who were frequently ill and those who were rarely ill.  She found a difference in personality between the two with those reporting few illnesses being described as hardy.

According to Kobasa there are three characteristics of the hardy personality:

1.       Control: hardy individuals see themselves as being in charge of their environment

2.       Commitment: hardy individuals get involved and tackle problems head on

3.       Challenge: hardy individuals see change as a challenge rather than as a threat


  1. Methodology: Kobasa’s original study used only white middle class males so is both androcentric and biased in terms of sub-culture.
  2. Cause and effect: yet again because the study is correlational can we be sure that it was hardiness that had the beneficial effects on the managers’ health?  Perhaps as (Alfred & Smith 1989) have suggested, hardy people are more likely to look after their health.


There does appear to be a sex difference in both the ways in which stress is experienced physically and the way it is experienced psychologically.  Certainly men are far more likely to die from CHD than women.

Johansson & Post (1972): Men and women were moved from a non-stressful situation into a more stressful one; they were given an intelligence test.  Men showed a much higher increase in adrenaline than did the women.  Generally women do appear to show a greater increase in their physiological response to stress.

There could be a number of reasons for this:

  • Biological differences between the sexes for example testosterone and other hormones
  • Personality differences with men being more physically aggressive
  • Traditional roles of the sexes with women being more caring

Hastrup et al (1980) provided evidence for the hormonal theory.  Women appear to have marked changes in their response to stress throughout their menstrual cycle, showing the least response when their oestrogen levels were highest.

As women take on more traditionally male roles it could be that the situation will change.   There has been evidence of this in the past 30 years.  Frankenhauser et al (1983) found that adrenaline levels in female engineering students and bus drivers were just as high as their male counterparts.  .



At a cultural level the best study is Weg’s (1983) study of a Georgian tribe who have a particularly impressive life-expectancy; they are more than 100 times more likely to reach a ton than people in the UK!  Weg attributed this to their relatively stress-free lifestyle, particularly the high level of social support available to individuals within the communities. However, there could be many other reasons for their longevity, such as lack of alcohol and tobacco, diet of fresh meat and veg., social support and lots of exercise.  Genes could also be a major factor. 

Cooper et al (1999) looked at why black Americans suffer more from CHD than either white Americans or the black Africans from whom they are descended.  They found that there had been inadvertent genetic selection on board the slave ships bringing the first generation black Americans to the New World.  Many of the slaves had died form diarrhoea during the journey.  Those able to retain water would have been most likely to survive and create the black American population of today. 


However, in any discussion of this area it is crucial not to overlook how the possible social and psychological factors could also contribute to the stress related illnesses of Black Americans.  Rates of unemployment amongst Black Americans are twice those of the white population and on average their incomes significantly lower.  Black children typically receive a poorer education resulting in fewer job prospects later in life.  As a result of this blacks are more likely to suffer poverty-related stress and have more repetitive, stressful jobs.  In addition to this, discrimination per se is a major stressor, (Anderson 1991).   All of these factors could add to the increased risk of stress related illnesses.

Stress and positive attitude

Greer et al (1979) looked at the way in which women’s attitudes towards discovering they had breast cancer influenced the outcome and prognosis.


Patients were interviewed regarding their attitude towards their recent diagnosis.


Four kinds of attitude were recorded:




I’m being treated for a lump but it isn’t serious.’

Fighting spirit

‘This is not going to get me’

Stoic acceptance

‘It’s God’s will!’

Giving up

‘Well there’s no hope with cancer is there?’

Follow up studies 5 years and 15 years later found that women with the first two attitudes were significantly more likely to fight ff the cancer.


A positive attitude and adapting to our situation is more beneficial than giving in.  The cognitive approach to stress management teaches people how to do this.


Critical issue:  Stress Management

Stress has become a major issue in recent years and few topics have received so much attention, either in serious scientific journals or in popular publications such as magazines.  Recently there has been TV series such as ‘Stressed Eric’ and the paperback ‘Little book of calm’ that sold over 2 million copies in 2000.  In the workplace stress has become a major concern of managers and Company bosses following successful litigation by employees claiming harm done by unnecessary exposure to stress.  Stress management or stress reduction is now a multi-million pound business and many methods of coping have been devised, some with more success than others. 

At the outset it is important to make a distinction between various approaches.  Methods of coping could, for example, be split between:

·         Emotion-focussed methods that seek to temporarily help people cope with the symptoms but do little to tackle the root causes.  These methods include alcohol, drugs, social support.

·         Problem-focussed methods deal with the root causes of stress and include time management.


Methods can also be split between:

·         Physiological methods that seek to reduce the bodily symptoms of stress such as arousal and increased heart rate.

·         Psychological methods that help people cope with the subjective feelings of stress such as anxiety and lack of control.

One way to reduce stress is to eliminate the factors causing it.  However, since so many factors can cause stress this is not always realistic.  Many ways of managing and reducing stress have been devised.  Dixon (1980) suggested that humour can help because it stimulates the output of endorphins.  This section examines some more orthodox approaches to the management and reduction of stress.


Physiological methods of stress reduction


1. Drugs

There are several methods for reducing the physiological effects of stress.  One is the use of drugs which act directly on the ANS to reduce our level of arousal.

Benzodiazepines or anti-anxiety drugs (e.g. Librium and Valium). These reduce the physiological effects of stress.

But they lead to physical dependence in at least some people and also have unpleasant side effects such as drowsiness.  

Beta blockers

These reduce activity in the sympathetic nervous system so reduce heart rate, blood pressure etc. 

Antidepressants such as Prozac and Tofranil can help people to cope more effectively with their symptoms of stress but again do have side effects.

All drug therapies are only providing symptomatic relief; they do nothing to tackle the root causes of stress.


2. Biofeedback

The body is not designed to allow us to be consciously aware of subtle changes in our bodies such as blood pressure.  Biofeedback aims to provide this information allowing us to take steps to reduce heart rate etc. by relaxation.  A biofeedback machine produces precise information (or feedback) about bodily processes such as heart rate and/or blood pressure.  This may be presented in visual or auditory form (or both).  For example, a tone whose pitch varies and/or a line on a television monitor that rises or falls when heart rate increases or decreases may indicate heart rate changes.

The fact that some people can apparently regulate some bodily processes has led to biofeedback being used with many types of stress-related disorders.  These include migraine headaches, tension headaches and high blood pressure.

Bradley (1995) compared patients who were receiving biofeedback for muscle contraction headaches with patients on a waiting list for such treatment.  Biofeedback was in the form of feedback about muscle tension (provided by EMG).  Significant reductions in the number of headaches was found in patients undergoing the feedback treatment.


Although biofeedback appears to be effective in treating some stress-linked disorders the way in which it works is in doubt.  It may not be the biofeedback per se but other related factors that cause the improvements:

1.   Relaxation techniques taught with the biofeedback.

2.   The feeling of being in control that the biofeedback encourages.

3.   Placebo effect.  Holroyd et al (1984) found that tension headaches improved in patients who thought they’d   received muscle relaxation even when they hadn’t!

Biofeedback has several disadvantages associated with it. 

1.   It requires physiological measuring devices.  These are both expensive and too bulky to be easily transported.

2.   Regular practice appears to be needed for the development and maintenance of any beneficial effects (although this is also true of some other methods). 

3.    Biofeedback may eventually enable a person to learn to recognise the symptoms of, say, high blood pressure without the need for the biofeedback machine, but it is not known exactly how biofeedback works.  Some sceptics argue that biofeedback itself exerts no effects, and that the important thing is a person's commitment to reducing stress and the active involvement of a stress therapist!



Psychological methods of stress reduction


Physiological responses to stress may also be reduced through relaxation. Jacobson (1938) observed that people experiencing stress tended to add to their discomfort by tensing their muscles.  To overcome this, Jacobson devised progressive relaxation.  In this, the muscles in some area of the body are first tightened and then relaxed.  Typically the patient starts with their feet and gradually works their way up the body, relaxing each set of muscles in turn.

Once a person becomes aware of muscle tension and can differentiate between feelings of tension and relaxation, the technique can be used to control stress-induced effects. Progressive relaxation lowers the arousal associated with the alarm reaction and reduces a number of recurrent heart attacks.  However, progressive relaxation only has long-term benefits if it is incorporated into a person's lifestyle as a regular procedure (Green, 1994).

But relaxation techniques of this sort are not easy to carry out when stuck in a traffic jam etc.


Is similar to muscle relaxation but involves the repetition of a mantra or number, for example saying ‘one’ when breathing in and ‘two’ on expiration.  The person is encouraged to concentrate on their breathing and take steps to reduce it.  Try it.  ‘In… out’, slowly, ‘in… out’…. No need to shake it all about!!!  It isn’t easy to feel stressed when breathing very deeply and slowly!  The repetition also acts to remove all distracting thoughts from the mind.  Some of you will find this easier than others!

Physical activity and exercise

Morris (1953) conducted (pardon the pun) a study of London bus drivers and conductors, (people that used to collect tickets on buses in the good old days.  See an episode of ‘On the Buses’ for further information).  He found that the conductors, who moved around the bus collecting fares, were far less likely to suffer from cardiovascular disorders than the sedentary drivers.  An obvious criticism of the study is that many other factors may result in drivers being more stressed than conductors.  Although Morris' study was correlational, subsequent research has confirmed that   physical activity and exercise are beneficial in stress reduction (Anshel, 1996). 



Exercise almost certainly reduces some of the more dangerous effects of stress.  Remember that the 3Fs response is preparing the body for action.  By taking action in the form of exercise you are burning off some of the energy the body is mobilising.  High blood sugar levels are therefore reduced, circulation is improved and the heart muscles strengthened.  Psychologically, exercise might also be therapeutic, since sustained exercise can reduce depression and boost feelings of self-esteem (Sonstroem, 1984).


Cognitive techniques for stress reduction (psychological)

These are called ‘cognitive’ since they concentrate on people’s perceptions of stress and the way they think about the stressful situation and their ability to cope.  Hardiness and stress inoculation both encourage the patient to view their stressors differently and increase their perceived ability to cope with the stress.

Increasing Hardiness

People clearly differ in their abilities to resist a stressor's effects.  One characteristic that apparently helps resist stress is hardiness (Kobasa, 1979).  According to Kobasa, 'hardy' individuals differ in three main ways (see your earlier notes on this).

1.       Commitment: they have more direction to their lives.

2.       Challenge: interpreting any stress as making life more interesting, and

3.       Control, the amount of stress experienced can be regulated. 


Those higher in hardiness tend to be healthier even though the levels of stress that they’ve suffered have been similar to less hardy individuals.  (Pine 1994).  Maddi, a colleague of Kobasa, has devised a series of programmes for increasing hardiness.  These include ‘HardiTraining’ and HardiWorkshops.’

Kobasa’s suggestions for increasing hardiness:

1.   Focusing.  Patients are taught to recognise the symptoms of stress such as heightened heart rate and muscle tension.

2.   Reliving stressful encounters.  Patients are asked to think about recent stressful situations that they’ve overcome and to consider better ways of dealing with similar situations in future.

3.   Self-improvement.  Emphasises that challenges can be coped with.  Suggests that circumstances that we feel are beyond us should be avoided!  (At last sensible advice!).  However she does propose that in this situation we take on a different challenge that is within our capabilities so that we experience the positive aspects of dealing with stress.


Stress inoculation therapy

Meichenbaum's (1976, 1985) stress inoculation therapy assumes that people sometimes find situations stressful because they think about them in catastrophising ways.  Stress inoculation therapy aims to train people to cope more effectively with potentially stressful situations.  It is similar to hardiness and has three stages.

1.    Cognitive preparation (or conceptualisation) involves the therapist and patient exploring the ways in which stressful situations are thought about.  Typically, people react to stress by offering negative self-statements like 'I can't handle this'.  This makes the situation worse. 

2.    Skill acquisition and rehearsal, attempts to replace negative self-statements with incompatible positive coping statements.  These are then learned and practised.  (See examples that follow, practise a few if you so desire).

3.    Application and follow through involves the therapist guiding the person through progressively more threatening situations that have been rehearsed in actual stress-producing situations. Initially the person is placed in a situation that is moderate to cope with.  Once this has been mastered, a more difficult situation is presented.

According to Meichenbaum et al (1982), the 'power of positive thinking' approach advocated by stress inoculation therapy can be successful in bringing about effective behaviour change, particularly in relation to anxiety and pain.


Some coping and reinforcing self-statements used in stress inoculation therapy

Preparing for stressful situation

What is it I have to do?

I can develop a plan to deal with it.

Don’t worry.  Worry won’t help anything.

No negative thoughts; just think rationally.

Handling a stressful situation

One step at a time, you can deal with it.

Relax, you’re in control, you can deal with it.


Coping with the feeling of being over-whelmed.

It will be over shortly.

It’s not the worst thing that can happen.

Label your fear from 0 to 10 and watch it change.

Just keep the fear manageable.

                                          From Zimbardo et al 1995

Reinforcing self statements

It worked, you did it!

You can be pleased with the progress you’re making.

It wasn’t as bad as you expected!

I was able to do it because I was well prepared.


Evaluation of cognitive method:

Some methods have been successful in reducing the ill effects of stress, for example Carver & Humphries (1982) showed that they reduced the incidence of CHD. 

Their main advantage over other interventions such as drugs is that they try to deal with the problem of stress directly, teaching people how to identify stress and develop effective techniques for dealing with it

Cognitive methods also consider the needs of the individual and if used properly can be tailored to a person’s specific situation.

However, some stressful situations are completely out of the control of the individual for example a repetitive job or having to travel to work or traffic jams etc.  In such cases stress reduction is the best that can be hoped for.

In some cases companies have been criticised for setting up such stress management courses as a cheap or easy option rather than trying to tackle the real causes of the stress.  In so doing they are laying the blame squarely on their employees rather than facing up to their own responsibilities.


Social support

Anecdotally it seems that having lots of friends that we can share our problems with does help us to reduce and minimise the negative effects of stress.  For example work related stress tends to be lower in organisations where there is lots of support from co-workers.  However, this is not an easy one to prove experimentally.

·         Karmack et al (1998) found a reduction in heart rate when difficult tasks could be completed with a friend nearby.

·         Kulik & Mahler (1989) found that recovery from heart disease is faster when social support is available.


Watson et al (1998) carried out research on the cynomolgus monkey.  Apparently this species is famed for its ‘very social behaviour.’  Apparently David Attenborough never misses their fancy dress parties and they regularly occupy the pages of Hello magazine.  I digress!  Anyway the researchers found that when kept in isolation they show obvious signs of stress, such as increased heart rate.  When returned to their colony these symptoms disappear and the parties continue late into the night. 

Gender differences

Research suggests (phrase to use when you either can’t remember the researchers’ names or, as in this case, none are provided) that men tend to have larger networks of friends but that it’s women that use them more in times of need

Schaeffer et al (1981) think social support has two different meanings:

1.       Social network represents the number of people available to provide support

2.       Perceived support is the strength of social support they are able to provide.


Clearly it is the second one that is most important.  Having many friends is not particularly useful if they are unable to offer support in times of stress.

Brown & Harris (1978) found:

  • ü Stressful life events can trigger depression in women.  (61% of depressed women had experienced a major life event in the previous 12 months).

  • ü Close friends can alleviate the effects of stressful events.  Only 10% with a close friend in whom they could confide became depressed, compared to 37% who had no such intimate friend. (aargh!).

Tache et al (1979) found that cancer is more common in the single, divorced or separated.  This was put down to the lack of social support these have compared to married couples or those living together.

But as a general evaluation point to most of these studies, they are all correlations.  As such it is impossible to infer cause and effect:  i.e. can we assume that being single causes a worsening of stress?  Could it be that being stressed makes us more difficult to live with, resulting in us staying single?  Perhaps being lonely means we drink or smoke more and as a result are more likely to develop cancer etc.

This is a general criticism to bear in mind whenever a study is correlational.  Add it to your repertoire of evaluation points such as ‘lacks ecological validity’ or ‘ethical concerns.’  As with these you will need to back it up by explaining what you mean!


Evaluation of Social Support

Social support can be useful in alleviating the effects of stress but the assistance provided needs to be measured and appropriate. 

Cancer patients need different kinds of support from different people:

·         Family and friends needed for emotional support

·         Doctors and nurses needed for informational support

This may seem obvious but informational support from family and friends was seen by the patients as unhelpful, as was overly positive comments from anyone.

And finally…

Pets have long been associated with lower stress levels (in their owners, not in them!).  Baun et al (1994) found that pet owners were more likely to survive long term following a heart attack and that stroking a pet dog was more likely to reduce your blood pressure than stroking a strange dog!