What is STRESS? Stress theories and theorists Measuring stress
Stress and disease
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Textbook definition a negative emotional experience accompanied
by a predictable biochemical, physiological, cognitive and
behavioural changes
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Flight or fight Threat perceived Nervous stem arousal Response
(f or f)
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Stimulus - Response Selye General Adaptation Syndrome
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Non specific stress response which disrupts homeostasis the
natural balance Alarm reaction- initial stage in response to
immediate danger Hypothalamic cells alerted to state of emergency
ANS stimulation temporary breakdown of resistance Duration =
mins-hours depending on intensity of stressor and vulnerability of
individual Characteristic of fight or flight response
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Resistance dramatic reduction in alarm reaction Full resistance
to stressor is established Attempt to maintain higher level
functioning Coping mechanisms mobilized Attempt at survival
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Inability to return to normal level of resistance (pre alarm
reaction homeostasis) Cortisol exerts destructive effects
(circulatory, digestive, immune) Defense resources depleted intense
prolonged stress results in physical consequences (wear and
tear/death)
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Limited role of psych factors Assumes uniform responses to
stress Failed to clarify sociological and psychological processes
Assessed stress as an outcome Effects of stress are experienced in
anticipation of an event
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Transactional Model Critical aspect the persons perception of
his/her stressors Components: Primary Appraisal Secondary
Appraisal
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situation assessed Irrelevant no implications therefore no
investment in possible outcomes benign positive positive
interpretation of outcome - characterized by pleasurable emotions,
(joy, happiness, excitement) Stressful harm, loss, threat
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capability to respond is evaluated what might or can be done?
Determines degree of stress and strength/quality of the emotional
reaction Sense of control Coping options
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Is all stress negative No! EUSRESS!!! In the face of challenge
stress can be motivational
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Cognitive Beliefs about harm, controllability Emotional fear,
anxiety, excitement, embarrassment Behavioural confrontational
versus withdrawal
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What makes stress stressful? Negative Events More likely to
produce stress Uncontrollable Events Unpredictable events increase
stress Ambiguous Events Time/ resource heavy Must
interpret/understand stressor Must determine if situation is benign
or dangerous
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Environmental context Stress is a response to some
environmental demand or pressure Variable timing Proximal and
distal factors childhood experiences (trauma, abuse)
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Daily hassles minor stressful events Reduce psychological well
being & produce physical symptoms Stressful life events Minor
(moving) to devastating (death of a spouse) which disrupts all
aspects of life
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Self report inventories Life events Emotional distress
Behaviour measures Performance under stress Physiological measures
of arousal Biochemical markers
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Stress is distinguished from distress or psychopathology
However, depression inventories commonly used in clinical settings
to assess stress Do not detect small improvements Are inventories
of mood disorders effective surrogate measure of the stress
construct?
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paper and pencil instrument based on aspects of stress seen by
gastroenterologists and patients as relevant to UC activity
completed monthly at home (subjects instructed not to complete
retrospectively) completed Recent and General version of PSQ at 6
month visits
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Short term stressors some events may tap into ongoing life
strain Vague inventory of events injury/illness Subjectivity of
stressful events +/- Ex. Divorce Timing of events determining
temporality and establishing causal relationship is difficult Over
reporting more intense experiences are remembered
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Stress can initiate, exacerbate or impair recovery of health
conditions It is a predictor of disease STRESSOR STRESS DISEASE
APPRAISAL DISEASE PROCESSES
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Ways in which psychological stress influences disease risk
Physiological changes result in disruption to health Behaviour
changes in response to stress Smoking decreased exercise decreased
sleep poor adherence to medical regimes
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Can we cope? Managing stress is a balancing act Dependent upon
resources and affect Disposition can affect stress response
Optimism versus pessimism External coping mechanisms time, $,
education, social support Sense of control Self efficacy
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Stressors Stress IBD Inflammatory Bowel Disease IMID Immune
mediated inflammatory diseases Disease state Chronic Disease
Autoimmu ne Disease/ IMID IBD
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Inflammatory Bowel Disease Abnormal response of bodys immune
system Causes intestinal inflammation and ulceration Lifelong and
chronic remitting and relapsing NOT IBS Irritable Bowel Syndrome (a
functional disease)
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Behaviour and central nervous system function can influence the
immune system and inflammation Occurs at systemic and local tissue
levels Acute stress and immune function HPA cortisol ANS activation
increase in proinflammatory cytokines Chronic Stress Parts of
immune system downregulate - CD8 cells, natural killer cells and
macrophages
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Lenenstein et al perceived stress, depressive symptoms and
stressful life events measured high perceived stress among patients
with inactive disease will increase the risk of subsequent
exacerbation (flare up) high long-term stress tripled the risk of
exacerbation during the next 8 months short-term stress does not
trigger exacerbation in ulcerative colitis
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Animal models indicate probable biological mechanisms by which
stress exacerbates disease by altering immune function Research
need to clarify role of stress in development of IDB (stress as
causal vs stress as trigger for symptoms) Research is accumulating
on the role of stress in the severity of IBD and other autoimmune
diseases (RA, psoriasis) Psychoneuroimmunology offers humoral
routes by which the HPA axis and the nervous system can alter the
inflammatory immune response
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Therapy included CBT & solution focused therapy to address
IBD related and external events IBD-focused counseling may not only
psychological well-being, but also the course of IBD in individuals
with psychosocial stress
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Stroop colour word interference task to elicit psychological
stress Observe BOLD responses Stress evoking tasks show activity in
the dorso-lateral prefrontal cortex and activity in a network of
limbic structures Triggers behavioural, neuroendocrine and
autonomic responses to stress Allows for adaptation to stress
(rapid mobilization and termination of response) Habituation to
stress is adaptive and minimizes stress evoked response and
inflammatory responses RESULTS: BOLD response observed in CD
patients opposite to controls suggests impaired habituation
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Chicken or Egg? It is difficult to prove psych stress causes
IBD because: difficult to completely eliminate the possibility that
Crohns disease may have predated the onset of the mood
disorder/stress Because some patients have subclincal Crohns
disease for an extended period of time before symptoms begin, and
it is not uncommon to have a delay in diagnosis even after the
onset of symptoms Prospective studies offer the advantage that one
can confirm that the psychological condition preceded the onset of
IBD but require large populations to be followed for long periods
of time Retrospective studies can suffer from recall bias that
leads to the difficulty of differentiating whether IBD or the
psychological disorder was present first
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Would you prefer to see physiological/biological measures or
self report measures used for stress assessment? Chronic disease
and life stressors? Are those who develop disease simply more prone
to adverse effects of stress? How does the chronic nature of
disease increase the difficulty of parsing of the effects of
stress/ relating stress to disease? What do you think of
therapeutic implications should future research indicate the
benefit of psychological interventions for ADs?