Stress and Health

What is stress?

Stress is a noun! No, a verb!, No, an adjective! (Engle,1985)

Three broad perspectives can be used to understand the concept of

stress:
1. The Response-based perspective,
2. The Stimulus-based perspective, and
3. The Cognitive-transactional process perspective.
Response Based Perspective
• In this perspective, the focus is on the way an organism reacts.
• Hans Selye defined stress as ‘’nonspecific response of the body to any
demand’’.
• This response to a stimulus follows the same typical three-stage
pattern in humans and animals, called the general adaptation
syndrome (GAS).
Response Based Perspective
• According to GAS, the body initially defends itself against adverse
circumstances by activating the sympathetic nervous system. This has been
called the alarm reaction.
• In many cases, the stress episode is mastered during the alarm reaction
stage. Often, however, stress is a longer encounter, and the organism moves
on to the resistance stage, in which it adapts more or less successfully to
the stressor. Although the person does not give the impression of being
under stress, the organism does not function well and becomes ill.
• Finally, in the exhaustion stage, the organisms adaptation resources are
depleted, and a breakdown occurs. This is associated with parasympathetic
activation that leads to illness, burnout, depression, or even death
Response Based Perspective
Major Problems with Response based Perspective
1. First, the conditions eliciting stress responses were defined so widely
(as any demand) as to be virtually meaningless.
2. The second difficulty is that he introduced the idea of an
undifferentiated biological stress response, characterized principally
by release of the group of steroid hormones known as glucocorticoids
from the adrenal glands. He failed to appreciate that the activation of
neuroendocrine, autonomic, and immune pathways is delicately
patterned, depending on the precise demands on the organism and
the behavioral and cognitive coping responses that are mobilized.
Response Based Perspective
Further Weiner (1992) has eloquently deconstructed the background to Selye's model,
and argues that it arose from the type of animal experiment that utilized a variety of
intense aversive experiences.
They involved potentially life-threatening damage, isolated the organism from its social
context, and the stimuli were typically painful, unavoidable, and uncontrollable.
These intense experiences, which lacked ecological relevance, masked variations in
biological response produced by different contingencies and patterns of coping.
They also led to the belief that only very profound and overwhelming experiences were
likely to generate damaging physiological change.
The remnants of this concept persist in today's literature with the emphasis placed on
the study of major life events at the expense of milder everyday aversive experiences
that may be cumulatively more significant.
Stimulus Based Perspective
• The stimulus-based perspective pays more attention to the particular
characteristics of the stressor.
• It is argued that each critical episode has its unique demands, be it
social, physical, psychological, or intellectual, that specifically tax the
individual’s coping resources, thus triggering a particular stress
response.
• The research question establishes relationships between a variety of
distinct stressors and outcomes, including illness.
Stimulus Based Perspective
• This line of research emerged when Holmes and Rahe (1967)
attempted to measure life stress by assigning numbers, called life-
change units, to 43 critical life events. They assumed that the average
amount of adaptive effort necessary to cope with an event would be a
useful indicator of the severeness of such an event.
• One basic shortcoming is the use of average weights for events,
neglecting that different individuals may have a very different
perception of the same kind of event.
The Cognitive-transactional process
perspective
Cognitive-transactional theory (Lazarus, 1966, 1991) de“nes stress as a
particular relationship between the person and the environment that is
appraised by the person as being taxing or exceeding his or her resources and
endangering his or her well-being.
There are three metatheoretical assumptions: transaction, process, and
context. It is assumed that
1. Stress occurs as a specific encounter of the person with the environment,
both of them exerting a reciprocal influence on each other,
2. Stress is subject to continuous change, and
3. The meaning of a particular transaction is derived from the underlying
context.
The Cognitive-transactional process
perspective
• Hobfoll (1988, 1998, 2001) has expanded stress and coping theory with respect to
the conservation of resources as the main human motive in the struggle with
stressful encounters.
• COR theory follows from the basic motivational tenet that people strive to obtain,
retain, protect, and foster that which they value or that serve as a means of
obtaining what is valued by the individual.
• According to Hobfoll, such resources are objects (e.g., property, car), conditions
(e.g., close friendship, marriage, job security), personal characteristics (e.g., self-
esteem, mastery), or energies (e.g., money, knowledge).
• Stress occurs in any of three contexts: (a) when individuals resources are
threatened with loss, (b) when individuals resources are actually lost, and (c) when
individuals fail to gain resources.
The Cognitive-transactional process
perspective
• Resources were also important ingredients in Lazarus theory.
• The difference between the two views lies mainly in the status of
objective and subjective resources. Hobfoll, considering both
objective and subjective resources as components, lends more weight
to objective resources. Thus, the difference between the two
theories, in this respect, is a matter of degree, not a matter of
principle.
SUMMARY
• It is now recognized that stress is a biopsychosocial construct, and
cannot be defined purely in terms of physiological response.
• Most frameworks of contemporary research and clinical practice
therefore recognize that stress responses arise through interactions
between demands on the one hand, and psychosocial resources on
the other.
• Thus, Cohen, Kessler, and Gordon (1995a), have defined stress as a
process in which ‘’environmental demands tax or exceed the adaptive
capacity of an organism, resulting in psychological and biological
changes that may place persons at risk for disease(p. 3).
Concept of stress: HISTORY
• Stress has gained such widespread public attention. It can be
attributed to two major changes in the society:
• To rapid social change (e.g., Toffler, 1970), to growing anomie in an
industrial society in which people have lost some of their sense of
identity and traditional anchors and meaning (Tuchman, 1978),
• To growing affluence, which frees many people from concerns about
survival and allows them to turn to a search for a higher quality of life.
Brief History
• It was used as early as the 14th century to mean hardship, straits,
adversity, or affliction (cf. Lumsden, 1981).
• In the late 17th century Hooke (cited in Hinkle, 1973, 1977) used
stress in the context of the physical sciences, although it was not
systematic until the early 19th century.
• "Load" was defined as an external force; "stress" was the ratio of the
internal force (created by load) to the area over which the force
acted; and "strain" was the deformation or distortion of the object
(Hinkle, 1977).
‘’Living an intense life, absorbed in his work, devoted to his pleasures,
passionately devoted to his home, the nervous energy of the Jew is taxed
to the uttermost, and his system is subjected to that stress and strain
which seems to be a basic factor in so many cases of angina pectoris.’’ (p.
30)
Cont.
• Claude Bernard studied the role of the liver in secreting glucose formed
from glycogen stores and subsequently developed the concept that the
ability of an organism to maintain a constant fluid environment bathing
cells of the body—the “internal environment”—is essential for life
independent of the external environment.
• Walter Cannon (1929a,b, 1939) subsequently coined the term
“homeostasis” to describe the maintenance within acceptable ranges of
several physiological variables, such as blood glucose, oxygen tension and
core temperature.
• He considered stress a disturbance of homeostasis under conditions of
cold, lack of oxygen, low blood sugar, and so on.
Cont.
• By 1936, Hans Selye was using the term stress in a very special,
technical sense to mean an orchestrated set of bodily defenses
against any form of noxious stimulus (including psychological threats),
a reaction that he called the General Adaptation Syndrome.
• Stress was, in effect, not an environmental demand (which Selye
called a "stressor"), but a universal physiological set of reactions and
processes created by such a demand.
• Selye's work played a dominant role in the recent expansion of
interest in stress.
 Cont.
• Hinkle (1977) also accords an important role in the evolution of the
stress concept in medicine to Harold G. Wolff, who wrote about life
stress and disease in the 1940s and 1950s (e.g., Wolff, 1953).
• He wrote (as cited in Hinkle, 1973, p. 31):

‘’I have used the word [stress] in biology to indicate that state within a living creature which results from
the interaction of the organism with noxious stimuli or circumstances, i.e., it is a dynamic state within the
organism; it is not a stimulus, assault, load, symbol, burden, or any aspect of environment, internal,
external, social or otherwise.’’
Cont.
• Contemporary sociologists have tended to prefer the term strain
rather than stress, using it to mean forms of social disruption or
disorganization analogous to Wolff's view of stress in an individual as
a disturbed state of the body.
• Riots, panics, and other social disturbances such as increased
incidence of suicide, crime, and mental illness are consequences of
stress (strain) at the social level; they refer to group phenomena
rather than to phenomena at the individual psychological level.
CONT.
• The word stress did not appear in the index of Psychological Abstracts
until 1944.
• Stress was , for a long time, implicit as an organizing framework for
thinking about psychopathology, especially in the theorizing of Freud
and later psychodynamically. However, anxiety was used rather than
stress.
CONT.
• Freud gave anxiety a central role in psychopathology. Blockage or delay
of instinctual discharge of gratification resulted in symptoms; in later
Freudian formulations, conflict-induced anxiety served as a cue or
signal of danger and triggered defense mechanisms, unsatisfactory
modes of coping that produced symptom patterns whose
characteristics depended on the type of defense.
• Thus, If one recognizes that there is a heavy overlap between the
concepts of anxiety and stress, and does not feel it necessary to quibble
about which term is used, it could be said that the dominant view of
psychopathology thus formulated was that it was a product of stress.
CONT.
• World War II had a mobilizing effect on stress theory and research.
• World War II had a mobilizing effect on stress theory and research. Indeed,
one of the earliest psychological applications of the term stress is found in a
landmark book about the war by Grinker and Spiegel (1945) entitled Men
Under Stress.
• The military was concerned with the effect of stress on functioning during
combat; it could increase soldiers' vulnerability to injury or death and
weaken a combat group's potential for effective action. For instance,
soldiers became immobilized or panicked during critical moments under
fire or on bombing missions, and a tour of duty under these conditions
often led to neurotic- or psychotic-like breakdowns (see Grinker & Spiegel).
Cont.
• With the advent of the Korean War, many new studies were directed
at the effects of stress on adrenal-cortical hormones and on skilled
performance.
• Some of the latter were done with a view to developing principles for
selecting less vulnerable combat personnel, and others to developing
interventions to produce more effective functioning under stress.
• The war in Vietnam also had its share of research on combat stress
and its psychological and physiological consequences (cf. Bourne,
1969), much of it influenced by Selye.
Cont.
• A major landmark in the popularization of the term stress, and of
theory and research on stress, was the publication by Janis (1958) of
an intensive study of surgical threat in a patient under psychoanalytic
treatment.
• This was followed by an increasing number of books also devoted to
the systematization of stress theory and methodology, and an
increase in concern with the social sources of stress in the
environment. Examples are books by McGrath (1970) and Levine and
Scotch (1970).
Cont.
• Since the 1960s there has been growing recognition that while stress
is an inevitable aspect of the human condition, it is coping that makes
the big difference in adaptational outcome.
• In Psychological Stress and the Coping Process (Lazarus, 1966) the
emphasis began to shift somewhat from stress per se to coping.
MODERN DEVELOPMENTS
Five relatively recent developments have also stimulated interest in
stress and coping:
• the concern with individual differences,
• the resurgence of interest in psychosomatics,
• the development of behavior therapy aimed at the treatment and
• prevention of disease or life styles that increase the risk of illness, the
rise of a life course developmental perspective, and
• a mounting concern with the role of the environment in human
affairs.
TYPES OF STRESS
• Not all exposures to stressors are equal and it can probably be
assumed that more or worse exposures have more impact than fewer
or less severe exposures.
• Stressor intensity and duration likely interact to produce a range of
potential effects.
• The most common distinction between acute and chronic stress is
based on the duration of the stressor.
TYPES OF STRESS
• However, there is inter- and intraindividual variability in stress
responding even to the same stressor.
• Therefore, acute and chronic stress may best be conceptualized by
examining the interactions among the duration of the event itself
(acute or chronic), the duration of threat perception (acute or
chronic), and the duration of psychological, physiological, or
behavioral responses (acute or chronic; Baum, a 'Keeffe, & Davidson,
1990).
Acute stressor and Chronic stressor
A "perfect acute" stress situation would refer to a situation
characterized by an acute stressor duration, short-lived threat
perception, and an acute response, typical of most laboratory stress
situations.

A "perfect chronic" situation would refer to a chronic event, chronic

threat, and chronic responding.
Cont.
The changes seen in the physiological, cognitive, and behavioral response
systems are same in both acute and chronic stress situations, but where
acute stress occurs continuously, chronic stress does not appear to be a
steady-state phenomenon.
In chronic stress, responding is episodic, occurring repeatedly throughout
the day as reminders or unwanted intrusions accost an individual.
Episodes of stress may be triggered by exposures to the event, reminders
of the event, or anticipation of the event.
Thus, the experience of chronic stress may be best characterized as acute
episodes of stress related to an overarching stressor.
Intrusive thoughts and Chronic Stress
• One important element in understanding chronic stress is the
occurrence of stressor-related intrusive thoughts, especially in the
absence of an ongoing stressor (Baum, L. Cohen, & Hall, 1 993; Baum,
Schooler, & Dougall, 1998; Craig, Heisler, & Baum, 1996).
• Plenty of evidence suggests that stressor-related intrusive thoughts
are a common symptom following threatening event. For example:
Post traumatic disorder
Intrusive thoughts and Chronic Stress
• Intrusive thoughts are thought to be part of ongoing cognitive
processing of the event (Creamer, Burgess, & Pattison, 1 992;
Greenberg, 1995; Horowitz, 1 986).
• They help an individual work through the situation. Indeed, as
individuals recover, they report fewer stressor-related intrusions (e.
g., Delahanty, Dougall et aI., 1 997).
Intrusive thoughts and Chronic Stress
• However, intrusive thoughts tend to be unwanted, unbidden, and
uncontrollable, these characteristics of intrusive thoughts may make
them more stressful and are related to greater chronic stress (e.g.,
Dougall, Craig, & Baum, 1 999).
• Rather than being exclusively adaptive, these thoughts may serve as
stressors in their own right, possibly sensitizing individuals to other
reminiscent stimuli and may serve to perpetuate chronic stress by
eliciting the acute episodes described earlier.
Psychological Biological and Behavioral
Determinants of stress
• Stress and Health: Psychological, Behavioral, and
Schneiderman,G.,Ironson,G. and Siegal,S.D.(2005). Psychological,
Behavioural and Psychological Determinants. Annual Review of
Clinical Psychology,pp.607- 678
PSYCHOLOGICAL ASPECTS OF STRESS
Stressors During Childhood and Adolescence and Their Psychological Sequelae
• The most widely studied stressors in children and adolescents are exposure to
violence, abuse (sexual, physical, emotional, or neglect), and divorce/marital
conflict (see Cicchetti 2005). 
• McMahon et al. (2003) also provide an excellent review of the psychological
consequences of such stressors. Psychological effects of maltreatment/abuse
include the dysregulation of affect, provocative behaviors, the avoidance of
intimacy, and disturbances in attachment (Haviland et al. 1995, Lowenthal 1998).
• Survivors of childhood sexual abuse have higher levels of both general distress
and major psychological disturbances including personality disorders (Polusny
& Follett 1995). Childhood abuse is also associated with negative views toward
learning and poor school performance (Lowenthal 1998).
PSYCHOLOGICAL ASPECTS OF STRESS
Stressors During Childhood and Adolescence and Their Psychological Sequelae
• Children of divorced parents have more reported antisocial behavior, anxiety, and
depression than their peers (Short 2002). Adult offspring of divorced parents report more
current life stress, family conflict, and lack of friend support compared with those whose
parents did not divorce (Short 2002). Exposure to nonresponsive environments has also
been described as a stressor leading to learned helplessness (Peterson & Seligman 1984).
• Studies have also addressed the psychological consequences of exposure to war and
terrorism during childhood (Shaw 2003). A majority of children exposed to war experience
significant psychological morbidity, including both post-traumatic stress disorder (PTSD)
and depressive symptoms. For example, Nader et al. (1993) found that 70% of Kuwaiti
children reported mild to severe PTSD symptoms after the Gulf War. Some effects are long
lasting: Macksound & Aber (1996) found that 43% of Lebanese children continued to
manifest post-traumatic stress symptoms 10 years after exposure to war-related trauma.
PSYCHOLOGICAL ASPECTS OF STRESS
Stressors During Childhood and Adolescence and Their Psychological
Sequelae
• Exposure to intense and chronic stressors during the developmental
years has long-lasting neurobiological effects and puts one at
increased risk for anxiety and mood disorders, aggressive dyscontrol
problems, hypo-immune dysfunction, medical morbidity, structural
changes in the CNS, and early death (Shaw 2003).
PSYCHOLOGICAL ASPECTS OF STRESS
Stressors During Adulthood and Their Psychological Sequelae
LIFE STRESS, ANXIETY, AND DEPRESSION
• It is well known that first depressive episodes often develop following
the occurrence of a major negative life event (Paykel 2001).
• Furthermore, there is evidence that stressful life events are causal for
the onset of depression (see Hammen 2005, Kendler et al. 1999).
• A study of 13,006 patients in Denmark, with first psychiatric admissions
diagnosed with depression, found more recent divorces,
unemployment, and suicides by relatives compared with age- and
gender-matched controls (Kessing et al. 2003).
Cont.
• The diagnosis of a major medical illness often has been considered a
severe life stressor and often is accompanied by high rates of
depression (Cassem 1995).
• For eg;, a meta-analysis found that 24% of cancer patients are
diagnosed with major depression (McDaniel et al. 1995).
• Stressful life events often precede anxiety disorders as well (Faravelli
& Pallanti 1989, Finlay-Jones & Brown 1981).
Cont.
• Interestingly, long-term follow-up studies have shown that anxiety
occurs more commonly before depression (Angst &Vollrath 1991, 
Breslau et al. 1995).
• In fact, in prospective studies, patients with anxiety are most likely to
develop major depression after stressful life events occur (
Brown et al. 1986).
Cont.
DISORDERS RELATED TO TRAUMA
• Lifetime exposure to traumatic events in the general population is high, with
estimates ranging from 40% to 70% (Norris 1992).
• DSM 5 includes two primary diagnoses related to trauma: Acute Stress Disorder
(ASD) and PTSD.
• Both these disorders have as prominent features a traumatic event involving
actual or threatened death or serious injury and symptom clusters including re-
experiencing of the traumatic event (e.g., intrusive thoughts), avoidance of
reminders/numbing, and hyperarousal (e.g., difficulty falling or staying asleep).
Cont.
• The time frame for ASD is shorter (lasting two days to four weeks), with diagnosis
limited to within one month of the incident.
• Trauma and disasters are related not only to PTSD, but also to concurrent
depression, other anxiety disorders, cognitive impairment, and substance abuse (
David et al. 1996, Schnurr et al. 2002, Shalev 2001).
Cont.
• Other consequences of stress that could provide linkages to health have been
identified, such as increases in smoking, substance use, accidents, sleep
problems, and eating disorders.
• Populations that live in more stressful environments (communities with higher
divorce rates, business failures, natural disasters, etc.) smoke more heavily and
experience higher mortality from lung cancer and chronic obstructive pulmonary
disorder (Colby et al. 1994).
• A longitudinal study following seamen in a naval training center found that more
cigarette smoking occurred on high-stress days (Conway et al. 1981).
Cont.
• Life events stress and chronically stressful conditions have also been linked to
higher consumption of alcohol (Linsky et al. 1985).
• In addition, the possibility that alcohol may be used as self-medication for stress-
related disorders such as anxiety has been proposed.
• For example, a prospective community study of 3021 adolescents and young
adults (Zimmerman et al. 2003) found that those with certain anxiety disorders
(social phobia and panic attacks) were more likely to develop substance abuse or
dependence prospectively over four years of follow-up.
• 
Cont.
• Life in stressful environments has also been linked to fatal accidents (Linsky
& Strauss 1986) and to the onset of bulimia (Welch et al. 1997).
• Another variable related to stress that could provide a link to health is the
increased sleep problems that have been reported after psychological trauma (
Harvey et al. 2003). New onset of sleep problems mediated the relationship
between post-traumatic stress symptoms and decreased natural killer (NK) cell
cytotoxicity in Hurricane Andrew victims (Ironson et al. 1997).
• 
Variations in Stress Responses
• Certain characteristics of a situation are associated with greater stress responses.
• These include the intensity or severity of the stressor and controllability of the
stressor, as well as features that determine the nature of the cognitive responses
or appraisals.
• Life event dimensions of loss, humiliation, and danger are related to the
development of major depression and generalized anxiety (Kendler et al. 2003).
• Factors associated with the development of symptoms of PTSD and mental health
disorders include injury, damage to property, loss of resources, bereavement, and
perceived life threat (Freedy et al. 1992, Ironson et al. 1997, McNally 2003).
Cont.
• Recovery from a stressor can also be affected by secondary traumatization (
Pfefferbaum et al. 2003).
• Other studies have found that multiple facets of stress that may work
synergistically are more potent than a single facet; for example, in the area of
work stress, time pressure in combination with threat (Stanton et al. 2001), or
high demand in combination with low control (Karasek & Theorell 1990).
Cont.
• Recovery from a stressor can also be affected by secondary traumatization (
Pfefferbaum et al. 2003).
• Other studies have found that multiple facets of stress that may work
synergistically are more potent than a single facet; for example, in the area of
work stress, time pressure in combination with threat (Stanton et al. 2001), or
high demand in combination with low control (Karasek & Theorell 1990).
Cont.
• Stress-related outcomes also vary according to personal and
environmental factors.
• Personal risk factors for the development of depression, anxiety, or PTSD
after a serious life event, disaster, or trauma include prior psychiatric
history, neuroticism, female gender, and other sociodemographic
variables (Green 1996, McNally 2003, Patton et al. 2003).
• There is also some evidence that the relationship between personality
and environmental adversity may be bidirectional (Kendler et al. 2003).
Levels of neuroticism, emotionality, and reactivity correlate with poor
interpersonal relationships as well as “event proneness.”
Cont.
• Protective factors that have been identified include, but are not limited to, coping,
resources (e.g., social support, self-esteem, optimism), and finding meaning.
• For example, those with social support fare better after a natural disaster (Madakaisira
& O’Brien 1987) or after myocardial infarction (Frasure-Smith et al. 2000). Pruessner
et al. (1999) found that people with higher self-esteem performed better and had lower
cortisol responses to acute stressors (difficult math problems). Attaching meaning to
the event is another protective factor against the development of PTSD, even when
horrific torture has occurred.
• Finally, human beings are resilient and in general are able to cope with adverse
situations. A recent illustration is provided by a study of a nationally representative
sample of Israelis after 19 months of ongoing exposure to the Palestinian intifada.
Despite considerable distress, most Israelis reported adapting to the situation without
substantial mental health symptoms or impairment (Bleich et al. 2003).
Biological Aspects of Stress
Acute Stress Responses
• Following the perception of an acute stressful event, there is a cascade of changes in the
nervous, cardiovascular, endocrine, and immune systems.
• These changes constitute the stress response and are generally adaptive, at least in the short
term (Selye 1956).
• Two features in particular make the stress response adaptive.
• First, stress hormones are released to make energy stores available for the body’s immediate
use.
• Second, a new pattern of energy distribution emerges. Energy is diverted to the tissues that
become more active during stress, primarily the skeletal muscles and the brain. Cells of the
immune system are also activated and migrate to “battle stations” (Dhabar & McEwen 1997).
Less critical activities are suspended, such as digestion and the production of growth and
gonadal hormones.
Cont.
• Stress hormones are produced by the SNS and hypothalamic-pituitary
adrenocortical axis. T
• The SNS stimulates the adrenal medulla to produce catecholamines (e.g.,
epinephrine).
• In parallel, the paraventricular nucleus of the hypothalamus produces corticotropin
releasing factor, which in turn stimulates the pituitary to produce
adrenocorticotropin. Adrenocorticotropin then stimulates the adrenal cortex to
secrete cortisol.
• Together, catecholamines and cortisol increase available sources of energy by
promoting lipolysis and the conversion of glycogen into glucose (i.e., blood sugar).
Lipolysis is the process of breaking down fats into usable sources of energy (i.e.,
fatty acids and glycerol; Brindley & Rollan 1989).
Cont.
• Energy is then distributed to the organs that need it most by increasing
blood pressure levels and contracting certain blood vessels while
dilating others. Blood pressure is increased with one of two
hemodynamic mechanisms (Llabre et al.1998, 
Schneiderman & McCabe 1989).
• The myocardial mechanism increases blood pressure through
enhanced cardiac output; that is, increases in heart rate and stroke
volume (i.e., the amount of blood pumped with each heart beat).
• The vascular mechanism constricts the vasculature, thereby increasing
blood pressure much like constricting a hose increases water pressure.
Cont.
• Specific stressors tend to elicit either myocardial or vascular responses,
providing evidence of situational stereotypy (Saab et al. 1992, 1993).
• Laboratory stressors that call for active coping strategies, such as giving
a speech or performing mental arithmetic, require the participant
to do something and are associated with myocardial responses.
• In contrast, laboratory stressors that call for more vigilant coping
strategies in the absence of movement, such as viewing a distressing
video or keeping one’s foot in a bucket of ice water, are associated with
vascular responses.
Cont.
• From an evolutionary perspective, cardiac responses are believed to
facilitate active coping by shunting blood to skeletal muscles,
consistent with the fight-or-flight response. In situations where
decisive action would not be appropriate, but instead skeletal muscle
inhibition and vigilance are called for, a vascular hemodynamic
response is adaptive. The vascular response shunts blood away from
the periphery to the internal organs, thereby minimizing potential
bleeding in the case of physical assault.
Cont.
Activation of immune system
• Cells of innate immune system released into the blood stream raising
immune cells
• Immune cells migrate to tissue who are likely to suffer damage
• Battalion sites
• There they fight bacteria and promote healing.
Cont.
• The immune system is the body's primary defense against infection
and invading pathogens such as viruses, bacteria, and fungi.
• Some immunity is innate and is present from birth, acting
nonspecifically to protect against foreign materials.
• The skin and mucus membranes are part of this innate immune
defence, using autonomic and chemical methods to prevent invasion,
while cells such as macrophages are also involved.
Cont.
• Although the innate system is highly effective, it cannot cope with all
pathogens, so there is a second form of immunity which is acquired or
specific.
• Acquired immunity involves the recognition of substances (antigens) as
ªnonself,º and the destruction or elimination of these materials.
• The immune system has memory, reflected in the fact that secondary
exposure to antigens elicits a more vigorous immune response than the
initial reaction, although the mechanism is poorly understood (Ahmed &
Gray, 1996). The main organs of the immune system include the bone
marrow, thymus gland, spleen, and lymphatics, but there are also cells
active in the skin, lungs and gut.
Cont.
• There are two major arms of the immune system.
• Humoral immunity is involved in defense against bacteria and viruses in body fluids, while
cell-mediated immunity is relevant to intracellular viruses and fungi, and also to cancer cells
and transplanted tissue.
• Humoral immunity is mediated by serum antibodies or immunoglobulins. These are proteins
that derive from B-lymphocytes in the bone marrow, and react with specific antigens.
• There are five major classes of immunoglobulin, IgA, IgM, IgG, IgE, and IgD, and each has
unique characteristics. For example, IgE has a primary role in defense against parasites, and
elicits a range of responses designed to exclude these organisms including
bronchoconstriction, vomiting, inflammation, itching, and coughing. It also has a key role in
allergic responses which are generally caused by overproduction of IgE (Sutton & Gould,
1993). IgA is found in secretions such as saliva and tears, and is important in defense against
local infections in the gut and respiratory system
Cont.
• Cellular immunity involves T-lymphocytes that arise in the bone
marrow and mature in the thymus before circulating in the blood and
lymph.
• T-cells do not recognize antigens by themselves, so antigens are
usually presented to them by macrophages.
Cont.
• Cells of the innate immune system (e.g., macrophages and natural
killer cells), the first line of defense, depart from lymphatic tissue and
spleen and enter the bloodstream, temporarily raising the number of
immune cells in circulation (i.e., leukocytosis). From there, the
immune cells migrate into tissues that are most likely to suffer
damage during physical confrontation (e.g., the skin). Once at “battle
stations,” these cells are in position to contain microbes that may
enter the body through wounds and thereby facilitate healing (Dhabar
& McEwen 1997).
Cont.
• Chronic Stress Responses
• The acute stress response can become maladaptive if it is repeatedly or
continuously activated (Selye 1956). For example, chronic SNS stimulation of
the cardiovascular system due to stress leads to sustained increases in blood
pressure and vascular hypertrophy (Henry et al. 1975). That is, the muscles
that constrict the vasculature thicken, producing elevated resting blood
pressure and response stereotypy, or a tendency to respond to all types of
stressors with a vascular response. Chronically elevated blood pressure forces
the heart to work harder, which leads to hypertrophy of the left ventricle
(Brownley et al. 2000). Over time, the chronically elevated and rapidly shifting
levels of blood pressure can lead to damaged arteries and plaque formation.
Cont.
• The elevated basal levels of stress hormones associated with chronic stress also
suppress immunity by directly affecting cytokine profiles. Cytokines are
communicatory molecules produced primarily by immune cells (see Roitt et al.
1998).
• There are three classes of cytokines.
• Proinflammatory cytokines mediate acute inflammatory reactions.
• Th1 cytokines mediate cellular immunity by stimulating natural killer cells and
cytotoxic T cells, immune cells that target intracellular pathogens (e.g., viruses).
• Finally, Th2 cytokines mediate humoral immunity by stimulating B cells to
produce antibody, which “tags” extracellular pathogens (e.g., bacteria) for
removal.
Cont.
• In a meta-analysis of over 30 years of research, Segerstrom & Miller
(2004) found that intermediate stressors, such as academic
examinations, could promote a Th2 shift (i.e., an increase in Th2
cytokines relative to Th1 cytokines). A Th2 shift has the effect of
suppressing cellular immunity in favor of humoral immunity.
• In response to more chronic stressors (e.g., long-term caregiving for a
dementia patient), Segerstrom & Miller found that proinflammatory,
Th1, and Th2 cytokines become dysregulated and lead both to
suppressed humoral and cellular immunity.
Cont.
• Intermediate and chronic stressors are associated with slower wound healing and
recovery from surgery, poorer antibody responses to vaccination, and antiviral
deficits that are believed to contribute to increased vulnerability to viral infections
(e.g., reductions in natural killer cell cytotoxicity; see Kiecolt-Glaser et al. 2002).
• Chronic stress is particularly problematic for elderly people in light of
immunosenescence, the gradual loss of immune function associated with aging.
Older adults are less able to produce antibody responses to vaccinations or
combat viral infections (Ferguson et al. 1995), and there is also evidence of a Th2
shift (Glaser et al. 2001). Although research has yet to link poor vaccination
responses to early mortality, influenza and other infectious illnesses are a major
cause of mortality in the elderly, even among those who have received
vaccinations (e.g., Voordouw et al. 2003)