PYA2 Stress Critical Issue: Stress Management Stress

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PYA2 Stress

• Critical Issue
• Stress Management

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Stress Management

• BATs
• AO1- Distinguish between Problem and Emotion
  focussed coping strategies
• -Outline psychological and physiological
  methods of stress management
• AO2 Compare and evaluate different methods of
  stress management

Homework p155 q3 c (i) and (ii) Next week
recap of module and 30min mini mock!!
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How do you cope with stress?

• In groups brainstorm the ways you use to cope
  with different stressful situations

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Approaches to coping with stress

• Folkman and Lazarus (1980)
• cognitions and behaviours that a person uses to
  reduce stress and moderate its emotional impact.
• Ways of Coping Questionnaire found
• 2 ways people cope
• Problem focused coping
• Emotion-focused coping
• Coping response varies with type of stressor

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Problem - focused Coping

• Stress is treated as a problem to be solved.
• Seeking social support discussing a problem
  helps make more sense of it, puts problem in
  perspective.
• Taking control e.g taking steps to deal with
  debt, finding out about a disease, looking for a
  new job.

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Problem Focused Coping

• Evaluating the pros and cons of different ways of
  dealing with the stress e.g. planning a new
  life after bereavement, choosing whether to have
  surgery,
• Suppressing competing activities e.g. avoiding
  the temptation to put off going to the dentist
  because of work commitments
• Anticipatory coping work out what triggers
  stress, train ourselves to anticipate and deal
  with it e.g working out your route to a new
  location, anticipating possible roads to avoid
  e.t.c

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Problem Focused Coping

• These strategies are often achieved through
  Psychological Therapies
• Cognitive Behavioural Therapy CBT

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Emotion focused Coping

• Avoidant methods, used when a person feels
  there is nothing that can be done to change the
  problem. Treats the symptoms not the problem
• 1. Defence mechanisms tend to be negative
• Denial e.g going on as if nothing has happened
• Distancing/distraction e.g just not thinking
  about it, See Lee et al p 146
• Focusing on and venting emotions e.g crying,
  anger, praying (seeking guidance and strength -
  ve)
• Wishful thinking dwelling on what might have
  been if this hadnt happened

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Emotion focused Coping

• 2. Reappraisal/reinterpreting taking another
  look at the situation may change the way you feel
  about it. A positive approach.
• 3. Arousal reduction heightened reactions
  associated with stress are reduced, so the person
  becomes less stressed e.g meditation, relaxation,
  exercise, biofeedback or drug therapy

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Gender differences in coping

• Do you think males and females may cope
  differently? 2 mins
• Research has evidence that ..
• Males more likely to use Problem-focused methods,
  whereas women use emotion-focused (Brady and
  Hall, 93)

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Gender differences in coping

• Rosario (88) 2 theories to explain this..
• Socialisation theory women taught to show
  emotions openly, men taught to approach stress in
  a more active way.
• Role constraint theory coping strategy matches
  roles males and females occupy. When males and
  females
• have same role used same
• strategies to cope with stress

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Can you distinguish between Emotion and Problem
focused coping?

• Look back at the coping strategies you put on the
  brainstorm
• Decide whether each is an example of
  problem-focused or emotion-focused.

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Plenary

• Explain the difference between problem-focused
  and emotion-focused approaches to coping with
  stress.
• For each approach give 2 examples and provide a
  piece of research evidence. (see pages 145-148)
• Describe 2 strengths and weaknesses of each
  approach.

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There is a very, very tall coconut tree, and
there are 4 animals passing by King Kong, Ape,
Orangutan and Monkey   They have a competition
to see who is the fastest to get the banana. Who
do you guess will win? Your answer will reflect
your personality. Try and answer within 30
seconds Got your answer?
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If your answer is .... Orangutan Dumb Ape
Foolish Monkey Idiotic King Kong Stupid
Why ????? A Coconut tree ........ doesn't have
bananas!!   It's obvious you're stressed by your
work. Go home!    
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What is Stress Management?

• The process by which an individual attempts to
  cope with (manage) stressful demands.
• Psychological CBT (e.g Stress Inoculation,
  Hardiness training and REBT)
• Physiological Drug therapy, Biofeedback,
  exercise

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Psychological Methods

• Use techniques that help the person cope with the
  situation itself rather than just dealing with
  the symptoms.
• Patients find ways of changing or avoiding
  stressful situations in the future.
• Or learn techniques to minimise negative effects
  of stressful situations

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Psychological Methods

• Rational Emotive Behaviour Therapy (REBT)
• Cognitive Behaviour Therapy (CBT)
• SIT
• Hardiness Training

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Over to you
You have 30 minutes
Pages 148-50

• In pairs or small groups you will be given one
  method of Psychological stress management to
  research.
• The aim is to produce a fact sheet that..
• Outline the method
• Studies/research that support the method
• Studies/research that challenge the method
• Strengths and weaknesses
• The fact sheet will then be photocopied and used
  by the class for essay construction and revision,
  and each method discussed and evaluated.

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Psychological Methods

• Stress Inoculation Training (SIT)
• Meichenbaum (1985) cognitive-behavioural
  therapy person can change way they think about
  certain stressors.
• Suggested client should develop a form of coping
  before the problem arises inoculate yourself
  against the disease of stress like vaccinations
  to prevent infectious diseases!
• Use clients existing coping skills.

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Stress Inoculation Training (SIT)

• Meichenbaum (1985) 3 stages
• Conceptualisation
• Therapist and client establish a
  relationship. Client taught to perceive threats
  as problems-to-be-solved. Stressors broken down
  into specific components that can be coped with.
• Thus helped to gain greater understanding of
  the nature of stress and their reactions to it.

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Stress Inoculation Training (SIT)

• Meichenbaum (1985) 3 stages
• 2. Skills Training and Practice
• Client taught strategies to cope with stressful
  situations tailored to needs of client. E.g
  positive thinking, relaxation, social skills,
  ways of diverting attention, using social support
  systems, time management.
• Use of coping self statements (see p112)
  -encourage client to think in a different way
  (cognitive) and involves conditioning
  (behavioural).

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Stress Inoculation Training (SIT)

• Meichenbaum (1985) 3 stages
• 3. Real-life Application (and follow through)
• Client goes out into the real world and puts
  training to the test in different situations,
  which become increasingly stressful. Techniques
  include imagery, modelling and role playing and
  training others.
• Booster sessions offered later on (follow
  through)
• The reinforcement of successful coping in the
  real world becomes self sustaining.

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Evaluation of Research

• Strengths
• It works! Meichenbaum (1996) successful with
  acute and chronic stress.
• Combines cognitive and behavioural therapy
  powerful method of stress management
• By gaining new skills gap between demands and
  coping resources narrows more confidence in
  handling previously stressful situations

• Weaknesses
• Time consuming and high levels of motivation
  needed only suits a small range of determined
  individuals. Expensive.
• Difficult to change some behaviour
• Complex may not need to do all aspects of the
  therapy e.g. may be sufficient to just talk
  more positively and relax more

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Other supporting research

• Meichenbaum (1977)
• Compared SIT with another therapy
  desensitisation to help clients with phobia of
  snakes. Both methods helped, but SIT better
  because helped them cope with other phobias too.
• Fontana et al (1999) - College students had lower
  heart rates and state anxiety levels than
  controls this was also case 6 months later.
• Jay and Elliott (1990) Parents of children
  undergoing medical procedures. The SIT group
  reported less anxiety than group observing their
  children in a cognitive therapy programme.

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Psychological Method 2 Hardiness Training

• Kobasa and Maddi (1977)
• If some people are naturally resistant to stress
  (hardy personality), may be possible to teach
  others how to be hardier and thus manage stress
  better.
• Suzanne Kobasa and Salvator Maddi founded
  Hardiness Institute in California.
• Aim of training programme is to increase
  confidence and sense of control to deal more
  successfully with change.

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Psychological Method 2 Hardiness Training

• Kobasa and Maddi (1977)
• 1.Focusing client taught to spot signs of
  stress (e.g. muscle tension, increased heart
  rate, anxiety). Allows client to recognise
  stressful situations and thus sources of stress.
• 2.Reliving Stress Encounters clients analyse
  recent stressful situations in terms of how
  easily they were resolved and how they might have
  turned out better or worse. Gives client insight
  into their current coping strategies and how they
  might be better than they thought.

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Psychological Method 2 Hardiness Training

• Kobasa and Maddi (1977)
• 3. Self-improvement The key to hardiness is the
  belief that we can cope with lifes challenges.
• Client taught to focus on seeing stressors as
  challenges and thus learn to take control.
• Control, commitment and challenge are the basis
  of hardiness training.

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Evaluation of Hardiness Training

• Strengths
• Deals with the problem rather than the symptoms
  teaches clients to manage all stressors in their
  life.
• More adaptable and effective than drugs
• Long-term effectiveness

• Weaknesses
• Much of research carried out on male executives
  or soldiers in US. Low ecological validity.
• High control can be stress inducing for some
  people.
• Difficult to modify learned habits.
• Does hardiness exist? is it just being in
  control?

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Other Research on Hardiness

• Fletcher (2005) hardiness training effectively
  used on Olympic swimmers to ensure they are
  committed to challenge of increased performance
  levels and able to control stressful aspects of
  their daily lives that might interfere with
  training.

• Funk (1992) argues that low hardiness is the
  same as being negative, and it is negativity not
  lack of hardiness that leads to the ill effects
  of stress.

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Comparison of SIT and Hardiness Training

• Both treat the problem not the symptoms.
• Both teach clients skills to provide lasting and
  varied strategies to cope with stress
• Both teach clients to view stress as a problem to
  be solved

• Both require lengthy training and highly
  motivated clients.
• The success of SIT may be mainly due to positive
  thinking
• The success of hardiness training may be due to
  increased control

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Presentation

• Each group needs to briefly outline what they
  have found out about their method of stress
  management.
• 5 mins max each please
• Hand in sheet for photocopying

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Plenary

• Overall what are the advantages of Psychological
  methods of stress management?
• Overall what are the disadvantages?
• Are these methods problem-focused or emotion
  focused? Give a reason for your answer.

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Physiological approaches to stress management

• These methods focus on getting rid of the
  emotions associated with the stressful situation,
  but the situation may not be changed.
• They directly target the stress- response systems.

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Anxiolytic Drug Therapy
Benzodiazepines (BZs) Librium, Valium, Halcion,
Xanax Short term relief of severe anxiety.

• 1.Enhance action of natural brain chemical, GABA.
• 2. GABA tells neurons to slow down or stop firing
  general quietening influence on brain.

3. Action of GABA is supported by BZs to inhibit
neuron activity even more 4. The brains output
of excitatory neurotransmitters (e.g serotonin)
is reduced and person feels calmer
Anxiolytic anti-anxiety drugs, GABA
gamma-amino-butyric acid
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Anxiolytic Drug Therapy

• Beta-blockers
• Treat high blood pressure
• Reduce activity of adrenaline and noradrenaline,
  which are key agents in sympathetic (ANS)
  arousal.
• By blocking ANS arousal, beta-blockers slow the
  heart beat, lessen the force with which the heart
  contracts and reduces blood vessel contraction.
• This results in a fall in blood pressure and less
  stress on the heart.
• Also given to sportsmen and women to reduce
  arousal which can affect performance negatively.

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Anxiolytic Drug Therapy

• 1.What do you think are the advantages and
  disadvantages of using drug therapy to manage
  stress.
• 2. Do these methods really manage the stress?
  Explain.

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SSRIs

• Selective Serotonin Reuptake Inhibitors
• E.g Prozac
• Prevent the recycling of Seratonin
• Leads to more Seratonin in the synapses
• Helps depression as people suffering this illness
  have low levels of Seratonin.
• Trivedi et al 2006 3000 depressed patients
  given Citalopram. 47 halved their depression
  score. BUT -Effectiveness did depend on type of
  person.

See p151 Exploring Psychology
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Evaluation of Drug Therapy

• Strengths
• High efficacy (work on range of anxiety
  disorders)
• Kahn et al (1986) BZs superior to placebo
• Work quickly to reduce disabling effects of
  stress related anxiety.
• Low toxicity
• Rai et al (2005) Beta Blockers increased
  survival of patients with certain serious heart
  problems.
• Can be prescribed immediately for acute stress
• Easy to take

• Weaknesses
• Addictive BZs psychological and physical
  dependence can develop within a few weeks
  Ashton 1997 BZs limited to 4 weeks use
• Side effects drowsiness, dizziness, tiredness,
  dry mouth, diarrhoea, changes in sex
  drive/ability, seizures, severe skin rash,
  irregular heartbeat
• Can prevent normal psychological adjustment
  treats the symptoms not the problem

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Time to relax!!

• Measure your pulse. Jot it down.
• You may use a biodot.
• Now lie down and get comfortable
• Listen to the CD.
• R E L L A A A X !
• Now retake your pulse and look at your biodot
• Any change?

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Biofeedback

• Person learns to exert voluntary control over
  involuntary (autonomic) behaviours
• Biofeedback involves 4 processes
• Feedback patient attached to machines that give
  feedback about ANS activities heartbeat, blood
  pressure
• Relaxation patient taught relaxation techniques
  reduces activity of sympathetic nervous system
  and activates parasympathetic NS reduced heart
  rate, blood pressure and symptoms related to
  stress

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Biofeedback

• Operant conditioning relaxation leads to target
  behaviour e.g. reduced heart rate, which is
  rewarding.
• This will increase likelihood of same behaviour
  being repeated. This learning (conditioning)
  takes place without conscious thought.
• The reward results in an unconscious stamping
  in of the behaviour. (Like Pavlovs dogs)
• Transfer The patient transfers the
• skills learned to everyday situations.

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Research on Biofeedback

• Budzynski et al (1973) Biofeedback and tension
  headache
• See p 152 of text book
• This would be a good example to learn and use in
  essays and other answers about stress management
• How effective was the
• biofeedback on relieving the
• headaches?

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Research on Biofeedback

• Miller and DiCara (1967) paralysed 24 rats,
  kept alive by artificial respiration. Half
  rewarded when heart rate slowed down, other half
  rewarded when heart rate went up reward was to
  stimulate pleasure centre in brain. Fast group
  speeded up heart rate, slow group slowed down.
  Learning was involuntary and ANS responses were
  conditioned as a result of operant conditioning.

Explanations Is it operant conditioning which
provides the biofeedback or simply learning to
relax? Alternatively this method may make
patients feel more in control, producing
beneficial effects remember lack of control
thought to be a source of stress Other
supporting research includes Gruber and Taub
(1998) and Attanasio et al (1985)
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Evaluation of Biofeedback

• Strengths
• Non-invasive
• No negative side effects
• Provides patient with long lasting means of
  dealing with stress symptoms

• Weaknesses
• Expensive the cost of equipment and time needed
• Treating the symptoms not the problem does not
  treat the source of stress

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Plenary

• Which do you think is a more effective way of
  managing stress, drug therapy of biofeedback?
  Why?
• 2. Which is best Emotion-focused or
  problem-focused methods?
• Why?

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3. Which is best Emotion-focused or
problem-focused methods?

• Problem-focused
• Aim to remove problem
• No side effects
• Last longer
• Slower
• More expensive
• Ppts need to be motivated to stick with them

• Emotion focused
• Control symptoms problem still there
• Quick and effective
• Relatively cheap
• May have side effects
• May cause addiction
• Biofeedback no addiction or side effects, more
  expensive than drugs

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Homework

• Homework p155 q3 c (i) and (ii)
• Next week recap of module and 30min mini mock!!
• So REVISE!!!!