In the 1950's Freidman and Rosenman developed a theory of personality based on observations of peoples behaviours whilst waiting in a waiting room. They noticed some individuals seemed tenser and exhibited certain behaviours such as not being able to sit still for long periods of time, while others seemed more relaxed. This led Freidman and Roseman to make a distinction between two types of personality. Type A individuals are competitive and hostile, whilst Type B individuals are calmer and more able to express their feelings.

Link between Type A and stress related illnesses It has been suggested that those with a Type A personality are more likely to experience the fight or flight response and therefore more likely to have stress hormones such as adrenaline released on a regular basis. This leads to higher blood pressure and heart rate, which causes wear and tear in the blood vessels, increasing the likelihood of coronary heart disease and also stroke.

The Western Collaborative Group Study (Roseman 19776) was a prospective longitudinal study of 3,154 men aged between 39 and 59 at the start of the study in 1960-61. The men were categorised as Type A or Type B personality using an interview task. The interview consisted of 25 questions about how they responded to everyday pressures. For example, respondents were asked how they would cope with waiting in a long queue. The interview was conducted in a provocative manner to try to elicit Type A behaviour. For example, the interviewer might speak slowly and hesitantly, so that a type A person would want to interrupt. Observations were carried out in a way they answered the questions such as volume of their voice and their pace of their speech.

EVALUATION Conflicting evidence Ragland and Brand (1988) followed up 257 of the original cohort of the Western Collaborative group study after 22 years to look at longer-term effects. They found that, although behaviours such as smoking and cholesterol level were important predictors of CHD mortality, Type A behaviour didn't show a significant correlation with it. Although type A individuals were more likely than Type B to suffer from heart disease , they were more likely to survive CHD such as heart attacks.

EVALUATION Culture bias Helman (1987) argues that the concept of a Type A personality is culture biased. It was developed on a sample from the USA and the values of being a workaholic and competitive seem to embody Western ideals and norms, and would not suit non-western cultures. Therefore he suggests that the concept may only be useful when looking at the response of certain cultures to stressful situations.

EVALUATION Supporting evidence There is supporting evidence for the variation in physiological response to stress between Type A and Type B individuals. Friedman et al (1975) asked ppts to complete and unsolved puzzle in a noisy environment, offering a reward if the puzzle was completed. The Type A individuals appeared outwardly more stressed and annoyed by the task compared to the Type B's. They also showed higher levels of adrenaline during the competition, despite showing no difference when resting under normal conditions. This provides support for the fact that the physiological response to stress of Type A individuals will make them prone to long-term problems such as CHD

Measuring life events Holmes early research with TB patients showed that people who became ill had experienced an increase in 'disturbing occurrences' in two years prior to admission to a TB hospital (Hawkins et al 1957). This led Holmes, together with Rache, to develop the idea life of life changes. In order to conduct research on life changes they first needed to develop a standard measuring tool that could be used to carry out research into his field. Using their clinical experiences as doctors they drew up a list of life events that might lead to illness. Then they asked 394 ppts to rate each item on the list in terms of how much readjustment it would require in someone's life, taking marriage as an arbitrary baseline value of 50.

SSRS After analysing the data they developed the SRRS. The scale consisted of 43 items that were each assigned a value known as the life changing unit (LCU). The death of a spouse was given the highest score of 100 and other items were given a values relative to this, for example divorce (73), marriage (50), pregnancy (40). A value for stressful life events n then be calculated in any research study by asking ppts to tick off how many of the event they have experienced within a certain time period. The higher the score, the more changes they had experienced. In turn the higher the score, the more likely a person is to suffer from stress and therefore illness. It was suggested that a score of 150 or more increased the chances of a stress-related illness by 30% and a score of 300 by 50%.

EVALUATION Supporting evidence In an effort to assess the relationship between life events and stress in a more controlled way, Cohen et al (1993) gave 394 ppts a variety of questionnaires to complete including a life events scale. Ppts were then exposed to the common cold virus, quarantined and monitored for signs of infection. Higher life events sores were positively correlated with an increased risk of getting a cold. This suggests that there are biological changes linked to the experience of stressful life events that lead us to be more susceptible to infection.

EVALUATION Cultural differences and bias As the scale was developed in the USA, it is possible that different cultural groups might react differently to different life events. Zheng and Lin (1994) looed at the SRRS using Chinese ppts. Although death of a spouse was still rated as the most significant life change, there were differences. For example, Chinese ppts rated death of a close family member more stressful than divorce, whereas in the original SRRS they were the other way round. Perhaps the events seen as stressful by one culture group are not perceived in the same way as others due to differences in cultural beliefs and expectations, meaning that the scale is cultural bias.

EVALUATION Issues in recall The validity of the research using the SRRS relies on people accurately recalling what has happened to them over a certain period of time, usually at least a year. However, it is possible that the recollections are not accurate. Raphael et al (1999) tested this by asking a group of women to report on the life events they had experienced in a series of monthly interviews. At the end of the 10-month period they were asked to recall again what had happened yet only a quarter of events appeared on both lists.

Research into the impact on stress and health Research has shown a close relationship between daily hassles and illness, and this relationship appears stronger than that found between life events and illnesses. Kanner et al (1981) conducted a longitudinal study to compare the impact of life events and daily hassles as a source of stress. There were 100 ppts aged between 45 and 64 who completed the Hassles and Uplifts Scale (HSUP), for events over the previous month and continued to do this once a month for nine months. Questionnaires were also used to measure ppts mental health status and emotional response. The researchers found a significant negative correlation between frequency of hassles and psychological wellbeing, in other words those ppts with fewest hassles showed highest levels of wellbeing. Most importantly, Kanner et al found that hassles showed were better predictor of well-being than life events.

Accumulation effect A build up of stressors over time leads to the negative effects. Each hassle on its own might not be that stressful but if lots are experienced close together this might lead to an ongoing feeling of stress and therefore the negative effects associated with it. Hassles are often experienced almost daily, for example those associated with work or family, and therefore it is likely that they can be difficult to avoid which will further exacerbate the problem.

Amplification It is also possible that chronic stress as a result of life changes makes people more vulnerable to the effects of daily hassles. As the person is already experiencing stress and their resources are deleted, they may find usually minor irritations more difficult to cope with. For example, if someone is going through a divorce they might find it harder to cope with a usually minor work problem. In addition life events can often create hassles, such as someone who is getting divorced having to manage finances and care for children of their own.

Lack of social support Fleet et al (1995) asked 320 students to read a story describing an individual who had experienced either a life event or a daily hassle. The student ppts were then asked to rate the amount of social support the person would seek and receive from others. The individuals who had experienced the life events were rated as being more in need of and seeking out more social support from others. Therefore, perhaps one of the reasons daily hassles cause so many issues that we do not seek out or receive adequate social support to deal with them.

Supporting evidenceFurther research has demonstrated a strong relationship between hassles and negative health effects. For example, Bouteyre et al (2007) studied a cohort of 233 French students as they moved from school to university. The researchers found that 41% of the sample suffered from depression symptoms and that a significant risk factor was the daily hassles they had experienced.

Age differences Aldwin et al (2014) used data from a longitudinal study of 1,389 male ppts ranging from48 tot 101 years. Between the ages of 48 and 70 the ppts experienced fewer hassles, perhaps they became more settled and more used to dealing with such situations. However, as the ppts got older they showed an increase in the number of hassles and a decrease in the number of uplifts. In addition, any hassles that were experienced seemed to have more of an impact. This suggests that as people age they adapt to dealing with hassles.

Issues with self-report There are a number of issues with self - report measures such as questionnaires assessing the number of hassles experienced over a particular time frame; in this case there may be an issue with social desirability. Hassles are obviously negative and therefore people may feel reluctant to indicate that they have experienced them. In particular this may be true with some of the hassles relating to social relationships such as arguing with family members, as people may be unwilling to admit that there is an issue. This problem is further cofounded by the response options in the hassle scale.

How they work Beta blockers have an antagonist action, meaning that they work by reducing the activity of the sympathetic nervous system therefore reducing the subsequent symptoms. They are beta adrenoceptor blocking agents, meaning that they block receptor sites for the hormones adrenaline and noradrenaline. When adrenaline binds a target receptor it stimulates the associated muscle, thus causing, for example, the heart muscles to increase beating. Therefore the usual physical reaction to stress is dampened. Breathing and heart rate do not increase and the person feels a lot calmer and less anxious. Beta blockers do not completely stop anxiety but mask the outward signs of it. Therefore they are particularly useful in acute stress situations such as giving a public speech. Someone giving a speech will no longer experience the outward signs of anxiety such as shaking, changes to the pitch of their voice or sweat on their forehead. Thus the negative effects of stress are reduced.

Non-selective beta blockers such as propranolol block adrenaline and noradrenaline in other areas of the body as well as the heart. They block both beta 1 and beta 2 receptors and will therefore effect the heart, kidneys, liver and a number of other areas.

Selective beta blockers such as atenolol, affect mostly the heart and therefore they have less effect on other parts of the body. They block only beta 1 receptors and as such will affect mostly the heart and cause reduced cardiac output.

Off label use Beta blockers are primarily prescribed and approved for use for conditions such as high blood pressure and angina.. However, they are prescribed 'off label' for anxiety conditions. This means that the manufacturer has not applied for license for beta blockers to be used to treat anxiety. Therefore the drug will not have undergone clinical trials to test whether it is safe and effective when being used for that particular condition. However, if a doctor feels that prescribing beta blockers for anxiety has benefits that outweigh any risk than they can do so. It is usually prescribed as a lower does than that used for cardiac problems.

Used by musicians Due to the calming effects of beta blockers, a number of musicians have reported using them to help them overcome stage fright and make them more able to perform under pressure. Lockwood (1989) studied over 2,000 musicians in major US symphony orchestras and found that 27% used beta blockers and 19% used it on a daily basis. More up to date research is limited but anecdotal evidence suggests that the number today might even be higher Tindall 2004)

EVALUATION Social Lin et al (2006) reported that the proportion of off-label beta blocker use was an average of about 52% of beta blocker prescriptions. The use of drugs in this way creates a dilemma for health professionals. Wittich et al (2012) noted that there are potential issues with lawsuits against doctors and drug companies should there be any adverse effects and there may be an issue of valid consent if the off-label use is not explained to people using them.

EVALUATION Ethical Generally side effects from beta blockers tend to be mild and temporary. For example, individuals may experience dizziness, diarrhoea and nausea, blurred vision, cold hands and feet. Beta blockers may cause issues with sleep and shortness of breathe in asthmatics but overall, compared with other anti-anxiety drugs like benzodiazepines, the effects are minimal.

Meichenbaum (1985,2007) first described the process of SIT, suggesting that an individual should develop a form of coping before a problem arises so they are protected.

Inoculation Inoculation means to try and prevent a disease by vaccinating against it. SIT works on a similar principle; it gives individuals experience of minor stressors that make them prepared and resilient. By exposing people to milder forms of stress it can help them to develop coping mechanisms and confidence in their ability to deal with stressful situations in the future. The thing they encounter as part of the inoculation process needs to be strong enough to make the person's defences aroused but not so strong that it causes negative psychological effect.

Importance of perception The theoretical background to this approach to stress management consists of two main areas. The first is the transactional model that identifies the importance of how a person perceives the stressor and also how a person sees the ability to cope with it. SIT aims to give people the tools to perceive the stressor in a different way and therefore deal with it more effectively. Also important is the idea of of a constructive narrative perspective (CNP). In this theory, individuals are story tellers who construct tales about themselves and others. The nature of the stories will influence how they cope with stress. SIT can be used to help people become more aware behaviours that may be hindering rather than helping them cope with stress. This helps them to adopt a more constructive narrative when faced with a stressful situation.

Skills acquisition In this stage clients are helped to acquire coping skills and consolidate those they already have. It is also important that any barriers that might prevent them from being able to use the strategies effectively are removed. Once they have been taught the strategies in a clinical setting they need to be practiced and then generalised to other real life settings to make them more useful.

Application In this stage the client will practice applying coping skills to a variety of situations that become increasingly demanding. They will use techniques such as imagery, modelling and role play and are taught to prevent relapse by rehearsing situations in which their stress symptoms might reappear. In particular, they are taught to see relapses as learning opportunities rather than as problems. Booster sessions might also be organised to ensure the techniques are being used appropriately.

Conceptualisation In this phase, the relationship is established between the client and trainer. Open questions are used to help increase the clients awareness of the nature and impact their stress and their existing coping strategies and resources. The trainer may also help the client to reconceptualise their problem by breaking down a stressor into smaller and more manageable components.

EVALUATION Effectiveness Foa et al (1991,1999) have carried out a series of studies comparing effectiveness of SIT with other methods of treatment of female victims of sexual assault. In particular they have considered the use of Prolonged exposure as an alternative. In PE, clients relive traumatic memoires by recalling them in a session and are taught how to confront situations that may remind them of the trauma they experienced. Foa et al's research found that, although both SIT and PE were effective in reducing the symptoms of PTSD and depression, PE was more effective in reducing general levels of anxiety, suggesting it was a more useful therapy.

EVALUATION Ethical It is possible that some of the processes of SIt might cause distress. For example, being asked to rehearse situations that the client might find stressful could cause a form of psychological harm to the individual. However, compared to drug therapies for example, the effects may be more long lasting and therefore the benefits might outweigh the the costs. The small amount of stress experienced in the therapeutic setting may be offset by much bigger gains in everyday life.

EVALUATION Social As SIT has shown to be useful across a range of stressors this is potentially of benefit to society. Meichnbaum (2007) highlights the need for effective interventions to combat stress given the increase range of stressor society noe encounters, such as terrorist attacks, increased poverty and violence.