Unit-II

● What is stress - Definition

● Physiology of stress
● Theories of Stress: 

           1. Cannon 
          2. Selye and 
          3. Lazarus

● Subjective correlates of stress

● Cognitive-behavioural approaches to health change
● Exercise
● Measuring Stress
● Sources of Stress

What is Stress

◼ Stress may mean many things to many different people.

◼ A layperson defines stress in terms of pressure, unpleasant feelings and an emotional response.

◼ Similarly, psychologist also have defined stress in many different ways.

◼ Different perspectives:

1. External environmental as a stressor (Eg: problems at work, university, home, etc)

2. The response to the stressor as stress or distress (Eg: feelings of tension or

unpleasantness)

3. Focus on biochemical, physiological, behavioural and psychological changes (Eg: Release

of cortisol, increased heart beat, etc)

4. Eustress and Distress

Stress models

◼ Cannon’s Fight-or-Flight Model

◼ Seyle’s General Adaptation Syndrome

◼ Lazarus’s Transactional Model

 Fight-or-flight model (Walter cannon)

◼ Cannon proposed that when an organism perceives a threat, the body is rapidly aroused and
motivated via the sympathetic nervous system and the endocrine system. This concerted
physiological response mobilizes the organism to attack the threat or to flee; hence, it is called
the fight-or-flight response.

◼ This model focused on the element of the stress response as a means for survival e.g.
evolutionary theory suggests that the stress response is necessary to prepare the body to meet
the physiological demands that are posed by a potential threat.

◼ Within this context it is considered to be short intense emergency reaction that enables the
organism to either flee or fight

Physiology of stress

Selye’s General Adaptation syndrome (GAS

◼ Selye first offered a definition of stress in which he described it as a general neuroendocrine

response. He challenged this definition later as he noticed that it affected systems beyond the
endocrine system such as the cardiovascular system.

◼ From observations on rats, which he injected with nocuous agents, he noticed a set of similar
effects which was initially called the General Adaption Syndrome (GAS), but later he called
‘stress’.
◼ These effects were assimilated into a series of three stages:

1. Alarm Stage

2. Resistance Stage

3. Exhaustion Stage

Alarm Stage

◼ The alarm reaction stage refers to the initial symptoms the body experiences when under stress.

◼ You may be familiar with the “fight-or-flight” response, which is a physiological response to
stress.

◼ This natural reaction prepares you to either flee or protect yourself in dangerous situations.
Your heart rate increases, your adrenal gland releases cortisol (a stress hormone), and you
receive a boost of adrenaline, which increases energy. This fight-or-flight response occurs in the
alarm reaction stage.

◼ Some physical signs to indicate alarm stage include:

❑ Dilated pupils

❑ Increased heart rate

❑ Rapid breathing

❑ Trembling

❑ Pale or flushed skin

❑ Heightened senses

resistance Stage

◼ After the initial shock of a stressful event and having a fight-or-flight response, the body begins
to repair itself. It releases a lower amount of cortisol, and your heart rate and blood pressure
begin to normalize. Although your body enters this recovery phase, it remains on high alert for a
while. If you overcome stress and the situation is no longer an issue, your body continues to
repair itself until your hormone levels, heart rate, and blood pressure reach a pre-stress state.

◼ Some stressful situations continue for extended periods of time. If you don’t resolve the stress
and your body remains on high alert, it eventually adapts and learns how to live with a higher
stress level. In this stage, the body goes through changes that you’re unaware of in an attempt
to cope with stress.
◼ Your body continues to secrete the stress hormone and your blood pressure remains elevated.
You may think you’re managing stress well, but your body’s physical response tells a different
story. If the resistance stage continues for too long of a period without pauses to offset the
effects of stress, this can lead to the exhaustion stage.

◼ Prolonged levels of high stress can cause disturbances in the immune, digestive, cardiovascular,
sleep, and reproductive systems. You might have symptoms such as:

◼ Bowel issues

◼ Headaches

◼ Sleeplessness

◼ Sadness

◼ Frustration

◼ Irritability

◼ Poor concentration

◼ Prolonged stress that is not resolved leads to the third stage (exhaustion).

exhaustion Stage

◼ This stage is the result of prolonged or chronic stress. Struggling with stress for long periods can
drain your physical, emotional, and mental resources to the point where your body no longer
has strength to fight stress. You may give up or feel your situation is hopeless.

◼ Signs of exhaustion include:

❑ Fatigue

❑ Burnout

❑ Decreased stress tolerance

◼ The physical effects of prolonged stress can weaken your immune system and increase your risk
of heart disease, high blood pressure, diabetes, and other chronic health conditions, including
mental health disorders such as depression or anxiety.
 Example of appraisals

◼ Using forthcoming exams as an example, various appraisal judgments may be made, for
example:
◼ ‘There is no way I can possibly deal with this. I simply know I will fail’ (threat + no resources =
stress).

◼ ‘This will be really hard. I just am not as clever as the other students’ (threat + limited internal
resources = stress).

◼ ‘Maybe I can manage this if I revise really hard’ (challenge + possible internal resources = less
stress).

◼ ‘I could perhaps do it if I get some help from my friends’ (challenge + external resources = less
stress).

◼ ‘This isn’t a problem. I know the material really well’ (benign).

◼ ‘I managed to pass the last time, I’ll be okay this time’ (benign).

Factors affecting appraisal

◼ While the nature of stimulus events/potential stressors varies hugely – from, for example,
receiving a final demand for an unpaid bill to being a victim of a natural disaster, from having a
head cold to receiving a diagnosis of a life-threatening illness – certain features of events have
been found to increase the likelihood of their being appraised as stressful.

◼ These are events that:

• are imminent (e.g. medical results due the next day; driving test that afternoon);

• occur at an unexpected time in life (e.g. being widowed in one’s 40s compared with when in
one’s 70s; the death of a child);

• are unpredictable in nature (e.g. being made redundant; sudden bereavement);

• are ambiguous in terms of:

• personal role (e.g. starting a new job);

⮚ potential risk or harm involved (e.g. undergoing surgery, taking new medication);

⮚ events are undesirable (e.g. having to move house because of financial loss);

• the individual perceives no control over (behavioural or cognitive, e.g. noisy neighbours);

• events that elicit high amounts of life change (e.g. childbirth, relocation).
 Physiological measures of stress

1. Heart Rate Variability (HRV)

2. EEG or brainwaves

3. Breathing assessment via capnometry

4. Adrenal assessment

5. Skin conductance and skin temperature

6. Sleep tracking

7. Resting heart rate or passive heart rate

1. Heart rate variability

Heart rate variability is where the amount of time between your heartbeats fluctuates slightly.
Even though these fluctuations are undetectable except with specialized devices, they can still
indicate current or future health problems, including heart conditions and mental health issues
like anxiety and depression.
 2. EEG
◼ EEG is a voltage measured from the scalp, and rhythms within the EEG are known as
brainwaves. Particular frequency bands have names like alpha and theta, and the relative
amounts of activity in each band correlate with mental and emotional state, to a degree.

◼ Example:

1. Theta to beta ratio at the back of the head – when this is low it suggests a busy, agitated mind,
racing thoughts that are difficult to switch off. It's probably the most commonly found stress
marker – though a lot of people show it and don't necessarily experience it as anxiety.

2. Left-right balance at the front of the head – imbalance tends to show up mood problems.
 3. Capnometer and capnograph

◼ A common facet of the stress response is a shift to faster, chest-based breathing and over-
breathing. Over-breathing is a matter of degree, and mild cases are largely unrecognised.

◼ A capnometer can assess degree of over-breathing by measuring carbon dioxide in exhaled air

◼ The capnometer is a powerful biofeedback device for optimal breathing training, and probably
my favourite because it can deliver significant changes relatively easily.

4. Adrenal assessment

◼ Yet another dimension of the stress response is hormonal. The best known stress hormones
are adrenalin and cortisol. You probably know that adrenalin creates a rush of energy to help
you deal with stress (it's part of “fight-or-flight”). Cortisol does something similar but it longer
acting. For example it increases blood sugar so that cells have more fuel available.

◼ When cortisol is chronically high it causes problems (it damages the brain, and the symptoms
tend to be anxiety and over-arousal, feeling wired and hyper-vigilant). Cortisol can also drop too
low – this tends to be seen in exhaustion and burn-out.
◼ Cortisol has – or should have – a daily rhythm: it should be high in the morning when you get up
(giving you energy) and drop over the course of the day so it's low at bedtime. Often this rhythm
is lost in chronic stress.

◼ To assess adrenal function you need a laboratory test. One easy way is to use dried urine
samples, which are easy to collect and transport. You ideally need four or more samples from
one day, so that you can see the daily rhythm.

◼ Adrenal lab tests also typically look at another adrenal hormone, DHEA – but not adrenalin
which is too short-lived to be meaningfully tested.

5. Galvanic Skin response and other electrodermal activity

◼ These two measures have the advantage that they can be easily measured from the skin.
Changes are driven by the sympathetic nervous system, mentioned earlier as a driver of the
fight-or-flight response. Both are responsive in the short term, especially skin conductance,
which makes them useful for demonstrating and learning about the stress response.

◼ Skin conductance, which is related to Galvanic Skin Response (GSR) and Electrodermal
Response, is used in the famous polygraph or “lie detector” test. It can't really detect lies but it
can detect the immediate spike in sympathetic activity which you'd expect from emotionally
significant goings on (e.g. denying you committed murder).

◼ Their disadvantage is that they're influenced by several other factors besides stress. This means
that while relative changes are useful, absolute measurements are less clear-cut: you can't say a
reading of X means a stress level of Y. For example, both skin conductance and skin
temperature are influenced by the ambient room temperature.

6. Sleep tracking

◼ Sleep is such a fundamental part of life – if we don't get enough, or perhaps even more
importantly sleep quality is lacking, then every aspect of physiological functioning is affected,
and thus so is every aspect of health and well-being.

◼ Ideally you would use a high-end EEG based sleep monitoring system to track sleep and sleep
quality: optimal sleep means the right amount of sleep but also the right proportions of deep
sleep, light sleep and REM sleep (the latter is related to dreaming and also to emotional stress).

◼ These days you can buy numerous consumer devices for relatively low cost, that claim to track
sleep, including at least one or two EEG based devices. Most of the others are based on heart
rate and heart rate variability analysis. Some claim to differentiate light sleep, deep sleep and
REM sleep.

7. Passive or Resting heart rate

 ◼ Passive or resting heart rate is measured by a lot of consumer products and becomes a good
data point to be considered in measuring stress.

◼ Strictly speaking resting heart rate is measured once per day just before you wake up. I think it is
a useful indicator of stress and overall fitness and health – the lower it is the better.

◼ But it's not ideal because again there are so many influences on it besides stress.

◼ An advantage is that many low-cost consumer devices can measure it.

Measurement of stress

1. Studying stress in laboratory

2. Inducing disease

3. Stressful life events

4. Daily stress

Laboratory versus naturalistic setting

1. The degree of stressor delivered in the laboratory setting can be controlled so that differences
in stress response can be attributed to aspects of the individual rather than to the stressor itself.

2. Researchers can artificially manipulate aspects of the stressor in the laboratory to examine
corresponding changes in physiological and psychological measures.

3. Laboratory researchers can artificially manipulate mediating variables such as control and the
presence or absence of social support to assess their impact on the stress response.

4. The laboratory is an artificial environment which may produce a stress response that does not
reflect that triggered by a more natural environment. It may also produce associations between
variables (i.e. control and stress) which might be an artefact of the laboratory.

5. Naturalistic settings allow researchers to study real stress and how people really cope with it.

6. However, there are many other uncontrolled variables which the researcher needs to measure
in order to control for it in the analysis.

Unit-I

Definition of health psychology

Need for health psychology

Biopsychosocial model in health psychology

Health Literacy

Health Behaviours

Factors influencing health behaviours

Health behaviour change models

Cognitive-behavioural approaches to health change

Health-enhancing and health-compromising behaviour

Research Methods

Venues for Health Behaviour Change

Unit1

Health psychology is a specialty area that focuses on how biology, psychology, behavior, and social
factors influence health and illness.

The field of health psychology is focused on promoting health as well as the prevention and treatment
of disease and illness. Health psychologists also focus on understanding how people react to, cope with,
and recover from illness.

Health psychologists work with individuals, groups, and communities to decrease risk factors, improve
overall health, and reduce illness. They conduct research and provide services in areas including:

● Stress reduction
● Weight management
● Smoking cessation
● Improving daily nutrition
● Reducing risky sexual behaviors
● Hospice care and grief counseling
● Preventing illness
● Understanding the effects of illness
● Improving recovery
● Teaching coping skills
 ● Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of
evolution. This revolutionary theory identified a place for man within nature and suggested that
we are part of nature, that we developed from nature and that we are biological beings. This
was in accord with the biomedical model of medicine, which studied man in the same way that
other members of the natural world had been studied in earlier years. This model described
human beings as having a biological identity in common with all other biological beings.

Biomedical model

● Focuses on the physical or biological aspects of disease and illness. It is a medical model
practiced by doctors and/or health professional and is associated with diagnosis, cure and
treatment of disease

The Biopsychosocial (BPS) Model

The biopsychosocial model of wellness and medicine examines how the three aspects – biological,
psychological and social – occupy roles in relative health or disease. The BPS model stresses the
interconnectedness of these factors.

A simple breakdown of this application may be as follows:

● The Biological (bio-) – often associated with the relationship of disease and bodily health. For
example, a patient may experience a hernia or lymphedema, which usually cause less severe but
long-term health problems that must be addressed by a physician. Acute and severe health
problems, like an aortic dissection, require immediate medical treatment and have a much more
disruptive effect on daily life.
● The Psychological (-psycho-) – the aspects of mental and emotional wellness that also relate to
behavior. In the pandemic, concerns about disease, quarantine and sudden lifestyle changes
have been detrimental for those have experienced mental illness conditions like anxiety or
depression. These new life dynamics have also impacted people who had not before
experienced mental health problems.
 ● The Social (-social) – these are interpersonal factors such as social interactions and community
activities. Seclusion, whether intentional or not (as in a result of activity-limiting illness), has
adverse impacts on a person’s ability to socialize or maintain healthy relationships with those
outside of one’s home. Such deficiencies in social life can lead to feelings of isolation and an
imbalanced lifestyle.

Health literacy

the degree to which an individual has the capacity to obtain, communicate, process, and understand
basic health information and services needed to make appropriate health decisions"

Sub-types

1. Health Behaviours Literacy

2. Health Insurance Literacy
3. Health Systems Literacy

Health Behaviours Literacy

"Refers to an individual's ability to obtain, process and understand health information related to
particular health conditions and to utilize this information to perform recommended health behaviours"

Health Insurance Literacy

"Refers to an individual's knowledge, ability and confidence to find and evaluate information about
health plans, select the best plan for their own (or their family's) financial and health circumstances, and
use the plan once enrolled"

Health Systems Literacy

"concerned with individual's ability to understand the different levels of care and the different ways in
which to access services, and to utilize this information to navigate the health care system"

Vulnerable population

1. Minority populations
2. Older adults (65 years and older)
3. Those with lower levels of educations
4. Those living below the poverty level
5. Those with limited proficiency in language especially English
6. Those with intellectual or developmental disabilities

Barriers to Health Literacy in India

● Illiteracy
● Uneducated
● Unqualified health professional
● Language
● Religion
● Poverty
● Inequality
● Unhealthy environment
● Distrust
● Politics