Stress, happiness and health

What is stress?

  • Stessor - something in the environment that causes stress
  • Distress - harmful response to stressor
  • Eustress - positive response to stress
  • Acute stress - short-term
  • Chronic stress - long term stress
  • Appraisal - event and personal resources

Historical models of stress -

  • Fight or flight - Cannon, 1932
  • General adpatation syndrome (Seyle, 1956)
    -> Alarm -> resistance -> exhaustion
  • But - not all stressors are the same, and not all people respond the same

Life events theory -

  • list of life events - different events allocated 'life changing units' in social readjustment scale
  • Different life events are given different numbers, and then calculate the life stress

Measuring stress

Self-report -

  • Social readjustment rating scale (Homes and Rahe, 1967)
  • Perceived stress scale (Cohen et al, 1983)
  • Hassles and Uplifts Scale (DeLongis, Folkman and Lazarus, 1988)
    -> Hassles are irritants - things that annoy or bother, they can make you upset or angry
    -> Uplifts - events that make you feel good, joyful or satisfied
    -> Some hassles and uplifts occur regularly and some are rare, some only have small effects and others have large effects
    -> This questionnaire lists things that can be hassles or uplifts - some are both
    -> directed to mark each event on a hassle or uplift scale

In the lab -

  • Physiology - heart rate, respiration and blood pressure
  • Biomarkers - blood, urine, saliva and hair (stress hormone)

Transactional model of stress - primary appraisal -> potential stressor -> stress -> coping

  • Secondary appraisal - reassess the stressor -> coping
  • Primary appraisals are -
    -> Irrelevant
    -> Benign or positive
    -> Harmful and a threat
    -> Harmful and a challenge
  • Coping - direct action, seeking information, doing nothing, coping in some way, trying to relax and defence mechanisms

What is stressful - salient events (present events), overload, ambigious events and uncontrollable events

Stress and illness

Stress and the body -

  • blood pressure (awake and asleep)
  • heart rate variability
  • dysregulation of the immune system - increased activation and decreased activation

Stress and the sympathetic adrenal medullary system - catecholamines (adrenaline and noradrenaline)

  • Blood pressure, heart rate, sweating, pupil dilation and tissues and immune function

Stress and the hypothalamic-pituitary-adrenal medulla system - HPA axis

  • Corticosteroids (e.g. cortisol)
  • Increases access to energy stores
  • Tissue damage
  • Pressure on bodily systems

Inverted U theory of arousal - Caroll et al, 2017

Stress and viruses - Common cold, Cohen et al, 1991 -

  • measure stress
  • Give virus via nasal drops
  • Quarantine
  • Infection rates increased with stress
  • Clinical cold increased with stress
  • Stress caused infection more infection than the ones influenced by illness

Stress and wound-healing - Walburn et al, 2009 -

  • a systematic review and meta-analysis
  • 22 studies
  • There was a negative relationship in all studies between recovery (wound healing) and stress and/or mood
  • For example - students took longer to heal during exams - holidy v exam times
  • Carers took longer than controls to heal
  • Greater levels of psychological stress were associated with impaired wound healing

Stress and cardiovascular disease (Kivimaki and Steptoe, 2018)

  • Pooling data across studies
  • Adults with stress - increased risk of CHD and stroke
  • Risk from adult stress not as high from smoking, high blood pressure, cholesterol, obesity or childhood stress
  • Stress plays a role as a disease trigger in those with atherosclerotic plaque
  • Stress influences outcomes in those with CVD
  • Need scalable, evidence-based interventions

Moderators of stress

Changes in behaviour -

  • Smoking - initiation, relapse and amount smoked linked to stress
  • Alcohol - people drink more when stressed
  • Eating - some people eat more, some eat less when stressed
  • Exercise - lower when stressed
  • Accidents - higher when stressed
  • If habits of bad behaviour have been formed, it is much harder to break these responses to stress

Physiological moderators -

  • Higher stress reactivity leads to poorer health if exposed to stress (e.g. hypertension, coronary artery calcification, cellular ageing)
  • Blunted stress reactivity in those chronically stressed also leads to negative health outcomes
  • Slower stress recovery related to poorer health
  • Allostatic load builds over time as experience more stressors and recover less completely

Psychological moderators

Health behaviours -

  • Wouldn't want to promote smoking - people report smoking decreases anxiety and stress, but it increases heart rate
    -> Does reduce late positive potential (brain activation shows arousal induced by emotional stimuli) - Choi et al, 2015
  • Would want to promote physical activity - physical activity leads to lower depression, anxiety and fatigue, and ability to cope with stressful encounters

Coping styles - efforts to manage environment or internal demands (Lazarus and Laurnier, 1978)

  • Can involve re-appraisal and re-evaluation
  • Try to change the external stressor or internal resources
  • Aim of coping -
    -> Reduce stressful environmental conditions
    -> Adjust or tolerate negative events
    -> Maintain positive self image
    -> Maintain emotional equilibrium
    -> Continue satisfying relationships with others

Approach - confront the problem, gather information, direct action
Avoidant - minimise event
Problem focused - action to reduce demands of stressor or increase resources available
Emotion focused - try to change emotions evoked by the event (behavioral or cognitive)
Benefit finding - finding meaning in stressful events

Social support - perceived comfort, caring, esteem or help one individual receives from another

  • Decreased mortality rates, improved immune functioning, improved health behaviours
  • Direct effect - lack of social support is stressful
  • Buffering - social support influences appraisal of stressor

Hugging (Cohen et al, 2015) - N = 404 - perceived social support (interpersonal support evaluation list)

  • Daily interpersonal conflict v hugs received
  • Exposed to virus and quarantine
  • Perceived social support protected against conflict - infection association
  • Hugs protected against conflict -> infection association
  • Hugs explained 32% of stress effect
  • In those infected, support and hugs reduced illness signs

Personality -

  • Type A - excessive competitiveness, impatience, hostility, vigorous speech (Friedman and Rosenman, 1959) - conflicting results linking to CHD
  • Type D - negative emotions, inhibit emotions and avoid social contact - CVD mortality - poor physical and mental health and poor self-management of disease
  • Hostility - links to CHD and overall poorer health (physiological stress reactivity, behaviour and other moderators e.g. social support)

Control -

  • attributions (Kelley, 1967)
  • self-efficacy (Bandura, 1977)
  • Categories of control (Thompson, 1986) - behavioural, cognitive, decisional and information
  • Reality control
  • Job strain model -
    -> Low job demands + high job control = low strain
    -> High job demands + high job control = active jobs
    -> Low job demands + low job control = passive jobs
    -> High job demands + low job control = high strain

Stress management -

  • Physical activity
  • Arts interventions (Martin et al, 2018)
  • Mindfulness (Sharma et al, 2014)
  • Cognitive behavioural therapy (Nakao et al, 2021)

Happiness

Happiness (Steptoe, 2015) -

  • Affective wellbeing - positive feelings
  • Eudaimonic well being - meaning and purpose
  • Evaluative well-being - appraisals of satisfaction

Not just the absence of negative states, and many experiences are bittersweet


Positive psychology - focuses on optimal functioning of people, what makes life worth living, focuses on strengths not weaknesses

Happiness and health (2019) -

  • Subjective wellbeing - mortality, often independent of negative affect
  • Happiness and morbidity - hedonic and eudaimonic wellbeing -> CHD, Stroke, Diabetes, Arthiritis and prognosis

Happiness -> health pathways - behaviour and biological processes - cortisol, inflammation, cardiovascular effects e.g. blood pressure, metabolic effects e.g. cholestreol

Happiness and inflammatory responses (Panagi et al, 2018) - N = 140, adults with Type 2 diabetes

  • Daily diaries 7 days, assess daily happiness and sadness
  • Blood tests (Markers of inflammation, IL-6, IL-1RA, MCP-1)
  • Mental stress tests
  • Blood tests immediately after, 45 mins after and 75 mins after
  • Lower baseline stress in those happier, for IL-6 this was independent of sadness
  • No association between happiness and response to stress

Factors that contribute to happiness - marital status, family, stress exposure, time use and activities, social network, socioeconomic status, education, genetics and personality

Molinger, 2019 -

  • Focus on time - when value time over money, you are happier
  • Amount of time - having too much or too little limits happiness
  • Spending time - people are happiest when engaged in active leisure - socialising, volunteering, exercising
    -> Connecting with others is essential
    -> Quality time - focusing on doing

Stress in research

Evaluation of stress, burnout and hair cortisol levels in health workers during the COVID-19 pandemic - Ibar et al, 2021

  • First study in which a stress biomarker such as hair cortisol evaluated in this population
  • Healthcare workers subjected to increased levels of stress and burnout
  • High depersonalisation, emotional exhaustion and decreased personal sense of accomplishment characterise the population
    -> It is the responsibility of the health authorities to implement strategies to manage the psychological emergency

Psychological stress and susceptibility to the common cold (Cohen, Tyrell and Smith, 1991)

  • Psychological stress associated with a dose-response manner with an increased risk of acute infectious rates of infection rather than to an increased frequency of symptoms after infection

Happiness and inflammatory responses to acute stress in people with Type 2 Diabetes (Panagi, 2019)

  • Happier individuals with T2D have lower inflammatory markers before and after acute stress responsivity - findings could provide a protective physiological pathway linking daily happiness with better health in people with T2D