1. Dr. Reem Al-Sabah
Faculty of Medicine
Psychology 220

2. “I'm stressed out” “don’t stress me”
“Don’t freak out” “I’m feeling stressed”
“I’m under a lot of pressure”
“My heart is racing” “My palms are sweating”
“I have a lot of deadlines”

3. Defining Stress
 Stress has no simple definition.
1. Environmental stimulus
“I have a high-stress job.”
2. Physical response
“My heart races when I feel a lot of stress.”
3. Interaction between environment and person
“ I feel stressed when I have to make financial
decisions at work, but other types of decisions
don’t stress me.”

4. Dictionary definition of stress
(Merriam-Webster’s Collegiate Dictionary, 2011)
 A bodily or mental tension resulting from
factors that tend to alter an existent equilibrium.
 The definition has several elements:
1. There is a tension (force pulling on the system)
2. The tension is a threat to the normal equilibrium
of the system
3. There is some compensation to reduce harm on the
system
4. Bodily or mental tensions

5. Bodily or mental tensions
 Physical stressors: ones that pose a direct threat
to our physical well-being.
E.g., cold, heat, infection, toxic substances
 Psychological stressors: events that challenge
our safety, not because they are physically
dangerous, but because of our thoughts,
perceptions, and interpretations.
E.g., failing a test, sound of footsteps on a dark street

6. Definitions
 Stress: experiencing events that are perceived as
endangering one’s physical or psychological
wellbeing.
 Stressors: are the events that cause the stress (e.g.,
car accidents, wars, exams…etc.).
 Stress response: people’s reactions to the stressors.
 Behavioral medicine (health psychology): the study of
how stress and other social, psychological, and
biological factors come together to contribute to
illness.

7. Mild Stress Little
Small Demand compensation
required
Moderate Stress
More
Moderate Demand compensation
required
Extreme Stress
Much
Severe Demand
compensation
required

8. Main Theories of Stress
 Canon’s Fight-or-Flight Theory
 Selye’s General Adaptation Syndrome
 Lazarus’ Cognitive Appraisal Model
 Taylor et al.’s Tend-and-Befriend Theory

9. Canon’s Fight-or-Flight Theory
 Studied how stressors affect the sympathetic nervous
system (SNS).
 “fight or flight” response (Physiological response to
stress):
perception of stress
activation of the SNS
body prepared for intense motor activity for attack,
defense, or escape.

10. Physiological reactions to stress
(activation of the SNS)
 Increased respiration rate
 Increased heart rate
 Higher blood pressure
 Increased metabolic rate
 Dilation of pupils
 Tensing of muscles
 Secretion of endorphins and ACTH
 Release of extra sugar from the liver

11. Fight or flight response
 Occurs through two routes:
1. Adrenomedullary axis
Sympathetic nervous system
Adrenal medulla
Catecholamines (containing epinephrine and
norepinephrine)
Cardiovascular, digestive, respiratory

12. 2. Hypothalamic-pituitary-adrenal axis
Hypothalamus
CRH
anterior pituitary
ACTH
Adrenal Cortex
Glucocorticoids (cortisol)

13. Figure 14.3 Fight-or-
Flight Response. The
body’s mobilization to
attack or flee from a
threatening situation.

14. Selye’s View
 Our innate response to stress was the same whether it
be a tiger in the trees, getting cut off in traffic, having to
sit for an exam or having an argument with your spouse.
 Stress is stress, and always triggers the same innate
survival mechanism.
 Stressor — any event or situation that triggers coping
adjustments (stimulus)
 Stress — the process by which we perceive and respond
to events that are perceived as harmful, threatening, or
challenging (response)

15. The General Adaptation Syndrome (GAS)
 A model of how the body defends itself in stressful
situations.
1. Alarm reaction: body’s defenses against a stressor
are mobilized through activation of SNS (preparing
for fight or flight).
2. Resistance: the organism adapts to the stressor
(HPA axis activation)
3. Exhaustion: organism’s ability to resist is
depleted and a breakdown results (diseases of
adaptation)

16. General Adaptation Syndrome

17. Lazarus’s Cognitive Appraisal Model
 Interpretation of the stressful event is more important
than the event itself.
 The individual’s perception of the psychological
situation is the critical factor.
 The first psychological model of stress.

18. Lazarus’s View (Cont.)
 Humans encounter stresses because they have
high-level cognitive abilities that animals lack.
 Psychological stress: “a particular relationship
between the person and the environment that is
appraised by the person as taxing or exceeding his
or her resources and endangering his or her well
being.” (Lazarus and Folkman).

19. Appraising Events
 Lazarus theory (Interpretation of stressful events is
more important than the events themselves)
 Primary appraisal — Determination of an event’s
meaning, it’s effects on their well being.
 Secondary appraisal — Evaluation of one’s ability
to control or cope with the event.
 Cognitive reappraisal — Process by which events
are constantly reevaluated.

20. Appraisals to assess situations
 Primary appraisal — Determination of an event’s
meaning, it’s effects on their well being (positive,
negative, or neutral)
 Stressful appraisal: event is seen as harmful,
threatening, or challenging.
 harm: when we lose/expect to lose something of value
to us (damage that has already been done)
 threat: believing an event is demanding and will put us
at risk for damage (anticipation of harm).
 challenge: believing that we will grow from the event;
we a person’s confidence in overcoming difficult
demands

21.  Secondary appraisal — Evaluation of one’s
ability to control or cope with harm, threat, or
challenge.
3 questions are asked:
1. What options are available to me?
2. What is the likelihood that I can successfully apply
the necessary strategies to reduce the stress?
3. Will this process work, will it alleviate my stress?
 Cognitive reappraisal: process by which events are
constantly reevaluated

22. Event
Primary appraisal:
Harm (damage)
Threat (future damage)
Challenge (slight positive)
Secondary appraisal:
Are my resources sufficient?
Yes No
No/Low stress High Stress

23. The Transactional
Model of Stress

24. Tend-and-Befriend Theory
 Stress response in females proposed by Shelly Taylor et al.,
2002.
 Females are more likely than males to respond to
stressors with additional stress responses:
 Women quiet, protect, and care for offspring
(tending)
 Women create and maintain social networks to
provide resources and protection for themselves
and their infants (befriending)

25. Psychological Factors and Stress Responses
Why are some people more likely than others to
appraise events as stressful:
 Psychoanalytic theory
 Most of what we think and do is driven by
unconscious processes
 Objective anxiety: a reasonable response to a
harmful situation
 neurotic anxiety: anxiety out of proportion to the
actual danger and which stems from unconscious
conflicts between unacceptable impulses and the
constraints imposed by reality

26.  Behavioral theory
 learned behavior, in which individuals learn to
associate stress responses with certain situations.
 People may react to situations with fear and anxiety
because those situations caused them harm or were
stressful in the past.
 Phobias (classical and operant conditioning).
 People may continue to have fears because they
always avoid the situation and never challenge their
fears.

27.  Cognitive theory
 attributions or causal explanations people give for
important events
Attributional styles: people's consistent styles of
making attributions for events in their lives.
 internal/external
 stable/unstable
 global/specific

28. Characteristics of Stressful Events
 Acute stressors: only last for a short time
 Chronic stressors: last for an extended period
of time
 What are some examples of acute and chronic
stressors?

29. Categories of Stressful events
1. Traumatic events that are outside the range of
usual human experience.
2. Uncontrollable or unpredictable events.
3. Major changes in life circumstances.
4. Internal conflicts.

30. Traumatic events
 Situations of extreme danger that are outside
the range of usual human experiences.
Examples:
disasters
man-made disasters
catastrophic accidents
physical assault

31. Psychological reaction after a traumatic event
 Survivors are usually stunned and dazed,
unaware of their injuries or danger.
 Passive, unable to initiate even simple tasks.
 Anxious and apprehensive, difficulty
concentrating, may continue to repeat the story
of the event.

32. Characteristics of Stressful Events
1. Controllability:
 The degree to which we can stop an event or bring it
about influences our perception of stressfulness.
The more controllable an event
Less likely to be perceived as stressful
 Important role of perception in our assessment of
controllability of stressful events.

33. 2. Predictability:
 The degree to which we know if and when an
event will occur.
 Ability to predict occurrence of event reduces
severity of stress.
 Research findings on predictability of events,
emotional arousal and stress.
People perceive predictable shocks as less
aversive than unpredictable ones.

34. HOW DO WE EXLPLAIN THESE RESULTS?
 You can prepare yourself for the shock (such as
by distracting yourself)
 There is no safe period with unpredictable shock
 Example: getting an injection; torture victims

35. 3. Major changes in life circumstances
 Any life change that requires numerous
readjustments can be perceived as stressful
 Negative events much greater impact on
physical & psychological health than positive
events
 Life Events Scale (Holmes and Rahe, 1967)
measures the impact of life changes, ranks
events from most stressful to least stressful

37. 4. Internal conflicts
 Unresolved issues that may either be conscious or
unconscious
 Conflict occurs when a person must choose between
incompatible, or mutually exclusive, goals or actions
 Conflict may arise when two inner needs or motives
are in opposition:
independence vs. dependence,
intimacy vs. isolation,
cooperation vs. competition,
expression of impulses vs. moral standards

38. Psychological reactions to stress
1. Anxiety
 The most common response to a stressor.
 PTSD: posttraumatic stress disorder.
 Severe anxiety-related symptoms occurs as a result of
living through events beyond the range of human
suffering (e.g. natural disasters, wars, rape)
 PTSD symptoms: DSM Diagnosis
 Survivor’s guilt.

39. DSM-IV diagnostic criteria for PTSD
A. The person has been exposed to a traumatic event.
B. The traumatic event is persistently re-experienced.
C. Persistent avoidance of stimuli associated with the
trauma and numbing of general responsiveness (not
present before the trauma).

40. D. Persistent symptoms of increased arousal (not
present before the trauma).
E. Duration of the disturbance (symptoms in
Criteria B, C, and D) is more than 1 month.
F. The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.

41. Figure 14.1 Post traumatic symptoms in rape. Almost all women
who have been raped show symptoms of post-traumatic stress
disorder severe enough to be diagnosed with PTSD in the first or
second week following the rape. Over the 3 months following the
rape, the percentage of women continuing to show PTSD declines.
However, almost 50% of women continue to be diagnosed with
PTSD 3 months after a rape.

42. Which is more traumatic, trauma caused by
humans or that which is caused by natural
disasters?
 Human-made disasters are more likely to cause
PTSD.
 It shatters our belief about the goodness of other
people.
 human-made disasters usually affect individuals
more than whole communities.

43. The Physiology of PTSD
 Trauma survivors experience physiological changes.
 People with PTSD are more physiologically reactive
to situations that remind them of their trauma.
 PET scans have shown soldiers with PTSD have
greater activity in areas of the brain that play a role
in emotion and memory (amygdala and cingulate
gyrus).

44. The Physiology of PTSD (Cont.)
 PTSD patients show damage to the hippocampus
(resulting in memory problems).
 Have lower baseline levels of cortisol before they
experience their trauma, that may help in the
development of PTSD.

45. 2. Anger and aggression
 Anger may lead to aggression
 Animals behave aggressively in response to
stress (overcrowding, electric shock…etc)
 Children become angry and aggressive when
frustrated
 Frustration-aggression hypothesis:
frustration (preventing a person from reaching
their goal)induces an aggressive drive, which, in
turn, motivates aggressive behavior.
 Displaced aggression: aggression is directed
toward an innocent person or object rather than
the actual cause of the frustration.

46. 3. Apathy and depression
 Opposite responses to aggression.
 When stressful conditions continue and the
individual is unable to cope with them.
 Apathy may become worse and turn into
depression
 Learned helplessness (Seligman, 1975):
uncontrollable negative events lead to apathy,
withdrawal, inaction, and depression

47. 4. Cognitive impairment
 Inability to think logically, difficulty concentrating
 May come from two sources:
1. High emotional arousal interferes with
information processing
2. Distracting thoughts that go through our heads
(e.g., excessive worrying during an exam)

49. Coping
 strategies that individuals use to manage the
distressing problems and emotions in their
lives.
 the process by which a person attempts to
manage stressful demands.

50. Sources of Stress
 Your environment bombard you with demands to
adjust.
 Social pressures (deadlines, competing priorities,
interpersonal conflicts, financial problems...etc).
 Physiological (inadequate sleep, illness, poor
nutrition, lack of exercise…etc).
 Your thoughts. Your appraisal of events either relaxes
or stresses you.

51. Personal resources that influence coping
1. Health and energy
2. A positive belief
3. Problem-solving skills
4. Material resources
5. Social skills
6. Social support: a variety of material and
emotional supports a person receives from others

52. Personal coping strategies
 Problem-focused coping: focuses on the
specific problem or situation, trying to find
ways of changing it or avoiding it in the future.

53.  Emotion-focused coping: focuses on alleviating
the emotions associated with the stressful
situation, even if the situation itself cannot be
changed
 Cognitive strategies (often involve a reappraisal
of the situation)
 Behavioral strategies (e.g., exercise, seeking
support, use of drugs)
 Avoidant coping: denying any negative
emotions and push them out of conscious
awareness.
 associated with health-related problems

55. Managing Stress
 Behavioral Techniques
 biofeedback
 relaxation training
 meditation
 aerobic exercise

56. Biofeedback
 Individuals receive information (feedback) about
an aspect of their physiological state and then
attempt to alter the state.
 A system that provides audible or visible feedback
on an involuntary physiological state

57. Relaxation Training
 People learn techniques to deeply relax muscles
and slow down and focus their thoughts.
 Progressive Muscle Relaxation — Form of
training that reduces muscle tension through
a series of tensing and relaxing exercises
 Deep Breathing and Visualization

58. Exercise
 Psychological Effects of Exercise
 Enhanced sense of well-being
 Decreased anxiety
 Exercise offers time out, change of pace, boost to
self-esteem (e.g., improves appearance)
 Reduces depression by elevating low serotonin
level — similar to effect of antidepressant drugs

59. Exercise
 Physiological Effects
 Enhanced blood flow to the brain
 Lower blood pressure and resting heart rate
 Reduced cardiovascular reactivity to stress
 Fewer stress-related health problems

60. Managing Stress (Cont.)
 Cognitive Techniques:
 teaches people new, more adaptive ways of
thinking and acting
 Cognitive behavior therapy (CBT)
helps people identify stressful situations that
produce their physiological or emotional
symptoms and alter the way they cope with
these situations

61. Cognitive Behavioral Therapy (CBT)
Thought Feeling
Situation
+ +
_ _

62. Cognitive Distortions
1. Polarized Thinking
2. Overgeneralization
3. Jumping to Conclusions
4. Catastrophizing
5. Personalization
6. Blaming
7. Shoulds
8. Emotional Reasoning
9. Global Labeling
10. Always Being Right

63. The Negative Stress Cycle

64. The Biopsychosocial Model