Can Stress Make You Ill?

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Can Stress Make You Ill?
Rona Moss-Morris Professor of Health Psychology
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DIVISION OF HEALTH PSYCHOLOGY
www.bps.org.uk/dhpEmail dhp_at_bps.org.uk
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Lecture outline

• The Biopsychosocial Model of health and illness
• What is stress and how do we measure it?
• The Pittsburgh Common Cold Studies
• Buffers between stress and illness
• Stress and coping model
• Social support

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The Biomedical Model
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The Biopsychosocial Model
Illness
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Stressors

• Any circumstances that threaten or are perceived
  to threaten ones well-being and thereby tax
  ones coping ability
• An upcoming exam
• Attending a party where you dont know anyone
• Being diagnosed with a serious illness
• Break up of a relationship

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Stress

• Our physiological psychological responses to
  conditions that threaten or challenge us in some
  way
• Psychological responses include
• Emotions e.g. anxiety
• Thoughts e.g. No-one will talk to me
• Behaviours e.g. drinking too much

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Fight-or-Flight (Walter Canon, 1932)aggressive
or withdrawal responses to stress
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Stress response controlled by the brain
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Physiological Stress Response
Stimulates muscles
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Stress and measurement

• Environmental
• Psychological
• Biological

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Measuring StressSocial Readjustment Rating Scale

• Events causing the greatest life changes
  considered most stressful
• Death of a spouse
• Divorce
• Marriage
• Fired from work
• Holmes and Rahe, 1967

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SRSS Scores Health
(Rahe, et.al, 1964)
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The Daily Hassles Scale

• Measures irritating, daily demands as rated by
  the person
• concerns about weight
• too many things to do
• misplacing things
• argument with family member,
• Stronger associations with illness better than
  the SRRS
• Kanner et al. (1981)

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Cohens Perceived Stress Scale (PSS)

• 10 item questionnaire rated over past month
• how often have you felt nervous or stressed
• how often have you felt on top of things
• how often have you been upset because of
  something that happened unexpectedly
• how often have you felt difficulties were piling
  up so high that you could not overcome them

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The Common Cold Studies (Cohen et al 1991 1993)

• Large scale prospective experimental
  investigations of stress and the common cold
• Age, gender, weight, ethnicity, season, smoking,
  alcohol, diet exercise, sleep not related to
  stress and illness

• PSS
• Life events
• Mood

• Replicated virus
• Clinical symptoms

Exposed to cold virus
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How many people developed colds?

• Viral Infection
• 82 of the volunteers receiving virus were
  infected.
• Clinical Colds
• Clinical Colds both infected and diagnosed by
  the clinician as having a clinical cold.
• 38 developed clinical colds.

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Which stress factors predicted colds?

• Perceived Stress (PSS)
• Life events
• Negative mood
• PSS negative mood predicted actual viral
  infection
• Life events predicted development of clinical
  symptoms

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Associations between each of the stress measures
and rates of clinical colds
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Does the type of stressor matter? Cohen et al.
(1998) Health psychology, 17, 214-223

• Life Events and Difficulties Schedule (LEDS
  Brown Harris, 1989)
• Detailed interview schedule
• Rates events in the last year as
• severe acute events
• severe chronic difficulty (stressor)

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Relative risk of developing a cold by stressor
duration
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Does the type of stressor matter? Conclusions

• Longer, more chronic stress more infection
• Interpersonal and work stress more infections

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Explaining the relationship between stress and
illness

• Direct effects hypothesis
• stress impacts on our hormones and immune
  systems
• Indirect effects hypothesis
• stress impacts on health through changes in
  health behaviour e.g. diet, exercise, smoking,
  drinking

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Mediators or Mechanisms

• Hormones?
• Immune system?
• Behaviours?
• Stress Common cold

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Behaviour as a Mechanisms

• Health behaviours
• Stress Common cold

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Hormones as Mechanisms

• Neuroendocrine hormones
• e.g. adrenal, cortisol
• Stress Common cold
• 
  

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Immune System as a Mechanisms

• Increase in IL-6 Cytokines
• Stress Common cold
• 
  

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Explaining the Cytokine pathways

• Acute stress related to more cortisol which can
  suppress immune responsiveness
• Chronic ongoing stress related to decreased
  cortisol
• Less cortisol may lead to inability to switch off
  immune responsiveness
• Body produces more IL-6 therefore more
  symptoms.

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Stress and Stroke-Study

• 2,303 Finnish middle-aged white men followed for
  11 years
• Measured blood pressure spikes (in anticipation
  of an exercise test)
• Men with above average blood pressure spikes had
  a 72 greater risk of developing a stroke in the
  following 11 years
• Susan A. Everson et al., 2001

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Moderators of Stress

• Appraisal and Coping
• Social Support

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Stress and Coping Model(Folkman Lazerus, 1984)
Secondary Appraisal What resources do I have to
cope with this threat?
Coping Strategy
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Emotion Focused Coping

• Coping through emotional approach involves
  actively processing and expressing emotion
  (Stanton et al. 2000).
• The emotional approach scale
• emotional processing - I take time to figure out
  what Im really feeling
• emotional expression ( I let my feelings come
  out freely)

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Emotional Processing and Cancer

• Study of women with stage I or II breast cancer
  over 3 months (Stanton et al. 2000)
• coping through emotional expression associated
  with improved
• decreased distress,
• fewer medical visits
• increased vigour at 3 months
• Coping through emotional processing associated
  with increases in distress
• Emotional processing appears to be adaptive in
  the short term
• Over the longer term may become ruminative and
  therefore less beneficial in terms of adjustment.

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Coping Effectiveness

• The contextual approach - no strategy is
  inherently bad
• Short term and long term effects
• Some strategies like avoidance, denial and
  emotional processing may work well in short term
  but not in long term
• Controllable stressors better linked to problem
  focused coping and uncontrollable to emotion
  focused coping.
• Appraisals of coping efficacy

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What is social support (SS)?

• Social network
• Perceived social support (amount available)
• Received social support

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Pathways from SS to health/illness

• Cardiovascular (heart) system
• individuals with high SS at work have lower mean
  heart rate than those with low SS (Unden et al.,
  1991)
• Immune system
• individuals with more social ties less
  susceptible to common cold (Cohen et al., 1997)
  immunoglobin A (first line of defence) higher in
  college students with high SS (Baron et al.,
  1990)
• Neuroendocrine system (hormones)
• presence of supportive companion during stress
  test lower cortisol response (Kirschbaum et al.,
  1995)

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Summary and Conclusions

• Stress is linked to increased illness
  particularly chronic stress
• This seems to occur through direct effects on
  immune responsiveness (overactive rather than
  underactive)
• Stress can be buffered through the way people
  perceive situations, their coping style and
  social support
• These buffers can be used in interventions to
  reduce impact of stress.

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DIVISION OF HEALTH PSYCHOLOGY
www.bps.org.uk/dhpEmail dhp_at_bps.org.uk