Archive for Stress

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Anxiety, depression, Different Approaches, Mindfulness, Quit Smoking, Self Esteem, Stress, stressed out, Weight Losson February 6th, 20183 Comments

Vision Board workshop

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Stress treatment techniques

Stresson April 10th, 20141 Comment

Stress treatment can consist of psychotherapy techniques, pharmacotherapy in conjunction with psychiatric interventions, physiological techniques and a number of other complimentary therapies.

Psychotherapy

The aim of psychotherapy is to change an individual’s cognitive style in order to better function emotionally and more positively when exposed to stressful stimuli. For example, Costress-111426_640gnitive Behavioural Therapy (CBT) focuses on identifying irrational and therefore stress -inducing thought patterns and their modification into more rational constructs. Group CBT designed to treat Post Traumatic Stress Disorder in individuals has shown to yield effective results.

However in order to get better results from psychotherapeutic interventions a number of other psychological factors need also be considered. For instance Zinbarg and Uli (2008) identified personality factors as a significant contributor of how conditions such as anxiety, depression, and other stress related disorders should be diagnosed and consequently treated.

Everly (1987) too pointed out that an individual’s personality should be taken into consideration when designing psychotherapy strategies as a person’s distinctive style of personality can inform which kind of psychological stressors are most likely to cause distress. As such personality offers an opportunity to diagnose, monitor the progress and responsiveness to treatment strategies and subsequent recovery from stress related diseases in individuals (Everly 1987).

Pharmacotherapy

A number of studies suggest that hormone imbalances and imbalances in homeostasis can be instigated by a disruption in inhibitory factors which in turn could lead to a physiological positive feedback factor consequently causing stress related disorders to occur (Greengaard 1987).  A number of psychiatric medications have been developed to assist individuals regaining their homeostatic equilibrium suffering from this condition (Greengaard, 1987).

Physiological strategies

The hypersensitivity phenomenon within the limbic system has also been the focus of specific methods or techniques of physiologically based therapies aiming to reduce stress via exercise, nutrition, breathing, muscular relaxation, or massage for example.

Alternative therapies (Stress Treatment Techniques)

Other modes of therapies designed to tackle stress disorders include hydrotherapy, meditation, per- suggestion and prayer (Benson 1984).

The measurement of stress

The problem that comes with the measurement of stress is largely due to the often subjective variables aiming to define the construct. What is stressful to one person may not be so for another and so various definitions of what constitutes stress are the consequence. Thus, measurement tools designed to capture the construct are varied and plentiful and some argue that this has led to inconsistencies and consequently resulted in phenomenological and methodological mistakes in their design (Khoozani).  Monroe (2008) points out that especially some self-report measures specifically designed to measure stressful life events also ask participants to appraise their feelings of stress therefore bringing in an element of subjectivity which in itself constitutes a flaw in methodological design.

Generally speaking, there are three areas of measurement in stress research, measurement of life stressors, measurements of stress feelings and measurements of stress physiology.

Measurement of stressors

There are a number of tools designed to measure stress causing events in an individual’s life. For example Holmes and Rahe (1967)examined a sample of 5000 people by correlating their medical records to a rating list of 43 stressful life events in an investigation aiming to find out if these events could have caused  their medical condition and thus found that a significant positive correlation of 0.118 existed.

In 1970, in an attempt to test the reliability of the scale over time a further sample consisting of 2500 people was asked to rate their life events over the previous 6 months after which medical records were examined over the next 6 months following thereafter with the result that the hypothesis of a positive correlation of 0.118 between stress scale scores and illness could be confirmed  (Holmes & Rahe, 1967)

Since then many more have been designed notably the Hassles Scale (Lazarus 1985), the Life Stressor Checklist (Wolfe 1997), and the Stressful Life Experience Screening measure (Stamm 1996)

Measurement of stress feelings

As stress feelings are the response of subjective (perceived) cognitive and emotional processing some scales like the on interactional stress theory based Derogatis Stress Scale (DSS) (Derogatis 1994) evaluate a combination life events, personality factors, as well as emotional responses to capture the construct. The Perceived Stress Scale (PSS) (Cohen 1983) is perhaps one of the most widely used tools aiming to measure how certain situations are perceived as stressful or uncontrollable.

Measurement of stress physiology

The measurement of stress physiology based on its focus can be divided into four subclasses:

Neural axis

The measurement of the neural axis involve technologies such as for example electrodermal, electromyographic , or cardiovascular techniques to investigate the state stress response there and then instead of the long term effects of stress.

Neuroendocrine axis

Here urine, plasma and saliva are used to investigate the levels of the adrenal medullary catecholamines such as adrenaline or noradrenaline to find out how stress affects the organism.

Endocrine axis

The measurement of cortisol indicating the level of adrenocorticotropic hormone (ACTH) and catecholamines in the blood is considered one of the most effective measures of the organisms stress response. (Kirschbaum 1995)

Target organ

Other measurements of the stress response are focused on specific target organs, i.e. an investigation into how organs like the heart, stomach or intestines for example may be affected though exposure to stress.

 

 

Generalized Anxiety Disorder (GAD), Causes, Assessment and Treatment | Hypnotherapy Perth

Anxiety, Mindfulness, Stresson April 10th, 2014No Comments
Jorg Thonnissen | Hypnotherapy Perth

Jorg Thonnissen

    By Jorg  Thonnissen – Registered  Psychologist | Hypnotic Impact for Hypnotherapy In Perth

Generalized anxiety disorder (GAD) is a serious problem that affects a large cross section of society. According to Kessler, Chiu, Demler, Merikangas, & Walters (2005) it affects as many as 6.8 million Americans will be diagnosed every year with the condition with twice as many women being diagnosed than man. In Australia a large survey (10641 participants) found that 3·6% of the population experienced GAD for 12-months at the time of the study (Hunt, Issakidis, & Andrews, 2002). The onset of GAD in the American sample is reported as being between the ages of 31- 32 (Kessler, et al., 2005). What follows is a brief outline of the theory, assessment and treatment options used to address GAD and a number of closely linked anxiety disorders. In addition to this I will provide a brief explanation of how I apply some of these findings in my own clinical work as a psychologist in private practice.

Generalized Anxiety Disorder – Causes and Assessment

 

GAD is characterized by excessive worrying about everyday life events to an extent that can be defined as irrational(Comer, 2013). In GAD the anxiety provoking stimuli might be a lot less defined compared to other anxiety disorders such as:

  1. Post-Traumatic Stress Disorder where a specific traumatic event can later on lead to flash backs (Ozer, Best, Lipsey, & Weiss, 2008),
  2. Obsessive-Compulsive Disorder where the sufferer employs rituals to control persistent anxiety provoking thoughts (Abramowitz, Taylor, & McKay),
  3. Panic Disorder where symptoms are characterized as a sudden attack of terror and the sufferer then worries about that it might happen again (Westen & Morrison, 2001), and
  4. Social or specific phobias where the anxiety provoking cause is well defined to a particular stimulus (Comer, 2013)

This means sufferers of GAD usually anticipate the worse possible outcome when it comes to matters of health, work, family or relationships for example and thus find themself in a position where they have lost the ability to effectively control their worry (Comer, 2013; Fricchione, 2004).

The symptoms of generalized anxiety disorder can vary and besides psychological indicators include a whole rafter of physiological signs such as headaches, nausea, issues with breathing, muscle tension, numbness of limbs, irritability, agitation as well as insomnia, difficulties in maintaining focus and concentration (Fricchione, 2004) to name only the most common examples.  If these symptoms persist in excess of 6 months GAD is likely to be diagnosed (American Psychiatric Association, 2000).

To use examples from my own clinical experience, sufferers of GAD usually define themselves as constant worriers – sometimes more, sometimes less- who just can’t relax no matter how hard they try. They may worry about what to wear to a dinner party or what to buy for someone as a birthday present. They may worry about getting sick and then lose their job or that someone they care for will have an accident even though there is no real reason for this right there and the question of “what if?” is a constant chatter in the back of their minds.

Ironically, this constant worry may be so intense that sleep patterns are interrupted and so the elevated stress levels eventually contribute to the development of physiological symptoms described earlier and thus sufferers may indeed need to miss work, thus confirming their fear by living a life of self-fulfilling prophecy. Consequently they find themselves in a nightmarish cycle of negativity that greatly diminishes their pleasure of living a life with a sense that could offer any kind of positive aspiration.

This being said, GAD sufferers are capable of normal social and occupational functioning when their anxiety levels are low, however, when at any given time their anxiety levels are elevated even routine tasks can become an impossible chore due to overthinking and an ominous feeling that a disaster is about to happen at any time (Fricchione, 2004; Westen & Morrison, 2001).

According to statistics the typical demographics where GAD is most prevalent is defined as middle to low income earners with individuals experiencing separation, divorce or loss of partner being at increased risk of developing the disorder (Kessler, et al., 2005).

The diagnosis of GAD is defined by the DSM-IV-TR (American Psychiatric Association, 2000) as follows:

  1. Excessive anxiety and worry (apprehensive expectation), occurring more-days-than-not for at least 6 months, about a number of events or activities (such as work or school performance).
  2. The person finds it difficult to control the worry.
  3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more-days-than-not for the past 6 months).
    1. restlessness or feeling keyed up or on edge
    2. being easily fatigued
    3. difficulty concentrating or mind going blank
    4. irritability
    5. muscle tension
    6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
    7. The focus of the anxiety and worry is not confined to features of other Axis I disorder (such as social phobia, OCD, PTSD etc.)
    8. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    9. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism), and does not occur exclusively during a mood disorder, psychotic disorder, or a pervasive developmental disorder (American Psychiatric Association, 2000).

The causes for GAD are difficult to determine. However, Kendler (1992) believes that the increased propensity of women to suffer twice as much from the condition is due to the fact that they are more likely to be poorer and suffer from higher levels of abuse and discrimination than man. Others believe that the factors that can lead to GAD are linked to influences to do with environmental, genetic and brain chemistry (Etkin, Prater, Schatzberg, Menon, & Greicius, 2009; Fricchione, 2004; Westen & Morrison, 2001).

Thus, there are many causes that can lead to the condition.   For instance higher stress levels as a consequence of living in larger cities, an unsafe political climate, traumatic life experiences or trauma as a consequence of life changes that come with challenging circumstances such as job loss, loss of a significant other, physical illness or having a baby and the subsequent changes that take place can all be causes for GAD (Baker, 2010).  Drug use and withdrawal as well as excessive use of caffeine or other stimulants can also trigger anxiety (Farach et al., 2012). Drugs such as benzodiazepines as well as alcohol dependence have been implicated as anxiety triggers and so has been the dependence on tobacco (Cohen, 1995).

Considering nature versus nurture factors, even though one or any number of these external circumstances outlined above may lead to GAD researchers also found evidence that allows for the assumption that the disorder has a genetic link (Silberg, Rutter, & Eaves, 2001). In other words, a sufferer of the disorder may be biologically predisposed to the condition because of his or her family history. In terms of nurture, behavioral patterns can be learned from significant others (Tammen, Friso, & Choi, 2013).

Neurological research by Etkin, Prater,Schatzberg, Menon, & Greicius (2009) found that certain regions of the brain are linked to the development of anxiety.   The central nucleus of the amygdala especially has been identified as an important part in the regulation of anxiety. On the one hand it has been found that individuals suffering from GAD not only have greater gray matter in that area, but they also have less distinct neurological connections between amygdala, brainstem, cerebellum and hypothalamus which is suggesting a reduction in functionality. On the other hand the same research by Etkin et al. (2009) also found that in those individuals the neurological connectivity  between the amygdala, parietal cortex and prefrontal cortex is more pronounced. By the same token the neurological connectivity between amygdala, insula and cingulate brain regions are also decreased allowing for the assumption that individuals suffering from GAD aim for a reduction in emotional involvement through the utilization of cognitive strategies in an attempt to reduce anxiety (Etkin, et al., 2009).

The Treatment of Generalized Anxiety Disorders

Generally speaking, anxiety disorders are typically treated with psychotherapy, medication or a combination of the two (Comer, 2013). The good news is that GAD can be managed and greatly reduced if effectively treated with the proper methods (Comer, 2013). For example, even though in the initial phases of withdrawal from long term alcohol or benzodiazepines use anxiety levels might be heightened however, shortly thereafter they are likely to decline significantly, however in some cases this process may take up to 2 years (Cohen, 1995).

The treatment choices vary based on the kind of problem a person faces. Nevertheless, it is my view that those suffering from anxiety should make a medical professional their first port of call so that it can be determined whether the symptoms are in fact of psychological and not potentially of physiological origin. As such, the medical practitioner needs to investigate whether intervention in the form of medication might be warranted before referring his patient for psychological treatment to a mental health professional. It is important that the patient explains to the medical health professional whether he or she have had previous treatment for anxiety, and if, which therapeutic methods and type of medications  have been used, as well as how effective the approach has been so that the medical practitioner can determine the next step in therapy.

It is not uncommon that individuals suffering from GAD have to try several different approaches before finding the one that works for them and if coexisting conditions such as alcohol abuse or depression are prevalent for example then, depending on the severity, it may also be possible that such conditions need to be controlled first before the symptoms of the anxiety can be addressed (Evans et al., 2008).

The Role of Medication in Generalized Anxiety Disorder

The medications that doctors can prescribe for anxiety vary depending on the specifics of the condition. The most commonly prescribed are anti-anxiety drugs, antidepressants and beta blockers to bring the physiological symptoms under control (Rickels & Rynn, 2002) . There are three types of antidepressant medication that are most commonly prescribed, these are called tricyclics, selective serotonin reuptake inhibitors (SSRI’s), and monoamine oxidase inhibitors (MAOIs) and they all work rather uniquely in their own way, however, they usually have to be taken for at least a few weeks before their effectiveness becomes clear. Dosages typically start low and may be increased over time to get the desired effect (Rickels & Rynn, 2002).

For example, the SSRI’s work in the brain by altering the levels of the neurotransmitter serotonin which plays a key role in many aspects of mental health such as in depression, and anxiety which are associated with low levels of serotonin production. By increasing and sometimes decreasing the levels of serotonin these symptoms are counter balanced and anxiety levels should ideally decrease (Pum, Huston, & Müller, 2009). From my own clinical experience I know that typical medications in that class here in Australia would be known by the brands of Zoloft, Prozac and Paxil and there is Effexor which is commonly used to treat anxiety disorder.

Similarly, tricyclics are antidepressants that block the absorption of serotonin and norepinephrine therefore increasing levels of these chemicals available in the brain (Allgulander et al., 2003). However, these antidepressants are of an older generation and thus may have more side effects than the newer class of SSRI’s. Nevertheless, tricyclics may work where SSRI’s have failed to show the desired effects and thus they still have a place in the anxiety treatment arsenal (Allgulander, et al., 2003). From my own clinical experience some commonly prescribed medications for panic disorder and generalised anxiety disorder are known by the names of nortriptyline, desipramine, amitriptyline, doxepin, imipramine and trimipramine for example. Likewise, MAOIs by the brand names of Marplan, Nardil and Parnate are also often used to combat a variety of anxiety disorders such as social anxiety disorder and panic disorder. It is worth noting that medications will potentially have a variety of side effects, hence anxiety sufferers should always ensure observational vigilance when taking psychoactive drugs.

In comparison, anti-anxiety medications such as benzodiazepines have fewer side effects but a user might develop a dependence that could be difficult to manage as ever higher doses are required to get the desired anxiety reducing effect (Shorter & Tyrer, 2003). These drugs work by increasing the effects of what is called gamma-aminobutyric acid (GABA), a neurotransmitter responsible for the reduction of neurons that are associated with anxiety and stress. Benzodiazepines have a sedative effect and are known to be muscle relaxants, anticonvulsant and hence have the desired anxiety reducing effect (Shorter & Tyrer, 2003). Probably the most commonly used benzodiazepines containing brands used in Australia for panic disorder in my experience would be Ativan and Xanax the latter of which is also used to treat generalised anxiety disorder whereas the brand Klonopin is often prescribed for people suffering from social phobia.

The use of beta-blockers is also an option in the fight to reduce anxiety. Beta blockers, work by blocking norepinephrine and adrenaline from binding to beta receptors on nerves (Silvestri et al., 2003) – hence the name. Thus, even when facing an otherwise anxiety producing situation, the physiological responses of anxiety would be suppressed. One of the most commonly prescribed medications here in Australia in my view would probably be known by the brand name of Inderal.

However, utilizing medication alone will not be sufficient in dealing with the various symptoms of anxiety thus, one also needs to understand its causes and the way our perception influences our thoughts which in turn largely determines our behavior and its consequences. For instance, it is not hard to see how our perception gives rise to physiological factors. If we smell something delicious our body readies itself for food by producing saliva. If we believe that we are not able to deal with a situation at work or at home, we feel stressed and that has an effect on our cortisol levels in the blood. These examples show that there really is no disconnect between our belief and our physiology – between mind and body. This is where psychotherapy can make a real difference.

The Role of Psychotherapy in Anxiety Reduction

Psychotherapy aims to define the causes of the anxiety disorder and proposes techniques of how to deal with the symptoms. One of the most effective types of therapy in dealing with GAD and anxiety disorders generally has been cognitive behavioral therapy (CBT).  In fact, CBT has been found to be more effective than drug treatment in the treatment of anxiety (Otto, Smits, & Reese, 2004). As the name suggests, CBT involves 2 parts – a person’s cognition, and behavior.

As a therapist trained in CBT I have come to know over the years that people suffering from GAD may have a number of issues that need to be addressed such as for example past traumatic experiences, finding it hard to deal with uncertainty, lack of emotional understanding, interpersonal issues, they may practice cognitive as well as experiential avoidance or lack proper problem solving skills to name only a few. These issues may have to be addressed one by one. As such CBT is designed to challenge the anxiety supporting negative thought patterns a person may have into one that is conducive to a more positive mindset whereas the behavioral part is concerned with changing the way individuals react to anxiety provoking stimuli.

For instance sufferers of anxiety will come to understand the symptoms for what they are and also learn specific techniques such as breathing exercises that will enable them to take control of their fears and develop confidence. These techniques may involve making a person with social anxiety understand that the people they think have judgmental attitudes towards him or her are probably not thinking like this at all or a sufferer of post-traumatic stress might be asked to recall the traumatic disturbance under the guidance of the therapist which in turn will help lessening the negative effects that come from practicing avoidance.

Therapy may also include exposure strategies to the anxiety provoking stimulus so that the client has an opportunity to confront his or her anxieties gradually.  This in turn will not only enable the client to practice the learned techniques but also feel more and more confident in those anxiety-provoking situations.

In essence, the application of CBT for GAD would follow a number of steps and measures. For example the first step is usually psycho-education which basically involves informing the client about the epidemiology of the disorder and how treatment is going to address the various aspects of the condition. This gives the client an overview of how therapy will progress and hopefully enhances motivation to stay the course.

The client will find out that therapy will involve the daily monitoring of the anxiety provoking events and associated levels of anxiety in order to understand the cues that may provoke them. Once identified, the client will learn how to better control the anxiety stimulus with learned techniques such as deferring worrying about the anxiety provoking situation until sometime later where time has been allocated for focusing on problem solving.

Clients will be taught relaxation techniques such as deep breathing exercises that can be utilized in feared situations to shift attention away from worrying. Progressive muscle relaxation can also be introduced as part of relaxation techniques designed to lower the clients’ stress perception.

CBT also entails the use of desensitization techniques whereby clients are encouraged to imagine themselves vividly being in the anxiety provoking situation and then taking charge of it until the anxiety is reduced to manageable levels. This kind of cognitive restructuring teaches the client self-control and will consequently also increase levels of confidence as they become more adaptive to the anxiety provoking events around them. Clients will come to realize that they have the ability to utilize alternative modes of thinking instead of holding on to patterns that encourages negative thoughts that give rise to anxiety. This change of thought pattern will ultimately not only lead to better thinking styles, but more importantly, better feeling.


In conclusion it is my view that the above research is very relevant to my clinical practice as I am dealing daily with clients seeking to control their anxiety. Further to this in my many years of private practice I find the use of hypnotherapy in combination with CBT as outlined here the best approach as the use of hypnotherapy as a technique facilitates progressive muscle relaxation as well as desensitization and positive future projections all in one.  This strategy therefore represents in my view the superior method.

This holds especially true when this approach is supported by the use of client specific instructional hypnotherapy audio recordings to which my clients can listen to daily in their own time as part of their ‘homework’. This is a cost effective way for clients to take part in therapy as they have the added benefit of ‘doing therapy at home’. The ongoing instructional reminder of what needs to be done has shown remarkable success over the years and many of my clients have attested to the success of this method.  Some will need pharmacological support in the form of medication in addition to this method others don’t. It all depends on the individual and the type and duration of anxiety they are facing.

 


 

References

Abramowitz, J. S., Taylor, S., & McKay, D. Obsessive-compulsive disorder. The Lancet, 374(9688), 491-499.

Allgulander, C., Bandelow, B., Hollander, E., Montgomery, S. A., Nutt, D. J., Okasha, A., et al. (2003). WCA recommendations for the long-term treatment of generalized anxiety disorder. CNS spectrums, 8(8 Suppl 1), 53-61.

American Psychiatric Association, A. P. A. T. F. o. D. S. M. I. V. (2000). Diagnostic and statistical manual of mental disorders : DSM-IV-TR. Washington, DC: American Psychiatric Association.

Baker, D. (2010). Stress-Induced and Fear Circuitry Disorders: Advancing the Research Agenda for DSM-V. Am J Psychiatry, 167(3), 356-.

Cohen, S. I. (1995). Alcohol and benzodiazepines generate anxiety, panic and phobias. J R Soc Med, 88(2), 73-77.

Comer, R. J. (2013). Abnormal psychology. New York: Worth Publishers.

Etkin, A., Prater, K. E., Schatzberg, A. F., Menon, V., & Greicius, M. D. (2009). Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. Archives of General Psychiatry, 66(12), 1361-1372.

Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22(4), 716-721.

Farach, F. J., Pruitt, L. D., Jun, J. J., Jerud, A. B., Zoellner, L. A., & Roy-Byrne, P. P. (2012). Pharmacological treatment of anxiety disorders: Current treatments and future
directions. Journal of Anxiety Disorders, 26(8), 833-843.

Fricchione, G. (2004). Generalized Anxiety Disorder. New England Journal of Medicine, 351(7), 675-682.

Hunt, C., Issakidis, C., & Andrews, G. (2002). DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine, 32(04), 649-659.

Kendler, K., Neale M. C. Kessler R. C. Heath A. C. Eaves L. J. (1992). Generalized anxiety disorder in women: A population-based twin study. Archives of General Psychiatry, 49(4), 267-272.

Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62(6), 617-627.

Otto, M. W., Smits, J. A., & Reese, H. E. (2004). Cognitive-behavioral therapy for the treatment of anxiety disorders. The Journal of clinical psychiatry, 65 Suppl 5, 34-41.

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2008). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 3-36.

Pum, M. E., Huston, J. P., & Müller, C. P. (2009). The role of cortical serotonin in anxiety and locomotor activity in Wistar rats. Behavioral Neuroscience, 123(2), 449-454.

Rickels, K., & Rynn, M. (2002). Pharmacotherapy of generalized anxiety disorder. Journal of Clinical Psychiatry, 63(Suppl14), 9-16.

Shorter, E., & Tyrer, P. (2003). Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease. BMJ, 327(7407), 158-160.

Silberg, J. L., Rutter, M., & Eaves, L. (2001). Genetic and environmental influences on the temporal association between earlier anxiety and later depression in girls. Biological Psychiatry, 49(12), 1040-1049.

Silvestri, A., Galetta, P., Cerquetani, E., Marazzi, G., Patrizi, R., Fini, M., et al. (2003). Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. European Heart Journal, 24(21), 1928-1932.

Tammen, S. A., Friso, S., & Choi, S.-W. (2013). Epigenetics: The link between nature and nurture. Molecular Aspects of Medicine, 34(4), 753-764.

Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69(6), 875-899.

 


The Effects of Stress

Stresson April 10th, 2014No Comments

92296_8905By Jorg  Thonnissen – Registered  Psychologist | Hypnotic Impact for Hypnotherapy In Perth

In summary, the effects of stress are many and varied and as Koozani () pointed out lead to a number physiological or psychological problems categorized as:

1.Stress-related disorders – i.e. all stress disorders can be considered a consequence of the excessive arousal of the limbic system,

2. Neuro-physiological changes– i.e. stress via the limbic system pathway potentially affects organs through activating excitatory (Post, Rubinow…1986) or inhibitory (Cain, 1992) neurotransmitters.

Furthermore prolonged stress can also affect the micromorphological brain structures of hippocampus and amygdala (Cain, 1992), as well as the nucleus of neurons therefore potentially altering genetic messages (Cain, 1992),

3.Cognitive changes – i.e. all psychological mechanisms such as cognition, emotions, memory, and attention can be affected by stress. For example, studies show that cognition and information processing are affected when stress reaches a certain threshold ().

Perceptual narrowing by which an individual focuses entirely on the source of the distress to the relative exclusion of other stimuli is one such change that can take place (Wickens, Hollands, 2000) whereas the term cognitive tunnelling defines an individual’s focus on well learned and practiced material when faced with distress ().

Beversdorf, Hughes…(1999) have demonstrated that the experience of chronic stress effects the prefrontal cortex and so can lead to a reduction in creativity and flexible problem solving.

4. Similarly, stress has been linked to certain emotions such as surprise, fear or joy for example (Lupien, 2007). However, Lupien () points out that although all stressful experiences elicit an emotional response and concludes that these responses are overlapped, not all emotions cause the individual to have feelings of distress, hence, there is a clear distinction between the experience of stress and emotions under certain conditions and situations. Stress due to stressful life events too have been linked to mood fluctuations in individuals (Bolger, DeLongis…1989).

5. Stress significantly affects memory and learning as studies by Roozendaal (2000) show. Whereby the type of stressor, gender and emotional excitement are all factors that play part in how memory and learning are affected, it has been shown that stress experienced after a learning experience enhance memory retrieval however, if excessive feelings of stress are experienced before a learning experience memory retrieval can be negatively affected.

This is due to increased levels of cortisol in the hippocampus area of the brain where memory and learning processing takes place().

This follows that increases in glucocorticoids in the hippocampus area can not only affect an individual’s declarative memory (Lupien, McEwen, 1997) but also his or her working memory (Young, Sahakian…1999) as well as emotional memory (Buchanan & Lovallo, 2001).

There are a number of researchers who have also looked at the positive effects of stress and found that increases in glucorticoids can actually improve the encoding of emotionally loaded information with individual’s being able to better recall the information thus learned and processed at a later stage (Buchanan & Lovallo, 2001). However, Lemaire, Koehl….(2000) emphasise that intense experiences of stress early in life can lead to lasting learning deficits.

6. The effects of stress on attention have also been well researched. On the one hand Oitzel & De Kloet (1992) found that stress causes the activation of Type 1 receptors which in turn increases an individual’s ability to be more vigilant and focus his or her attention on the source of the stressful stimuli rather than on what is happening around it.

On the other hand chronic stress evident through high levels of cortisol can have the effect of significantly interfering with tasks that require focus and attention (Lupien et al 1994).

7. Similarly, interpersonal relationships can also be affected through stress as studies show that people experiencing stressful events together can form a long lasting strong bond with each other (Lindy,1985) whereas on the more negative side traumatic stress could lead to problems with intimacy or closeness with significant others (Escobar et al 1983).

If you would like to read more about how to Treat Stress please continue to our article Stress Treatment Techniques

 

The management of stress and anxiety with hypnosis or hypnotherapy

Stresson April 9th, 2014No Comments

by Jorg Thonnissen (2010) Registered Psychologist

We all have been ‘stressed out’ at some point in our lives. In fact, the term ‘stress management’ has gained much popularity over the last few decades. How to practice ‘stress reduction’ when anxiety seems to win the upper hand is a question that many seem to ask. But what is this condition that we call stress, and what does it do? Most importantly, what can we do about stress when we feel all ‘stressed out’?

Being “stressed out” covers a vast array of phenomena ranging from mild irritation to a level of problems that are so severe that they could result in a breakdown of an individual’s health.

The term stress in psychology is defined as the consequences of a person failing to respond appropriately to physical or emotional threats. Here it doesn’t really matter whether these threats are actual or imagined, either way they are real to the person suffering from stress.

There are a multitude of consequences resulting from stress. The most common symptoms include a feeling of a state of alarm, heightened adrenaline production, exhaustion, irritability and difficulties concentrating. There are also a whole range of physiological problems associated with stress such as tension headaches, aches and pains such as chest pain, increased blood pressure, dizziness and nausea as well as constipation and diarrhoea.

Besides the obvious physiological problems caused by stress there are cognitive as well as resulting behavioural signs that include excessive worrying and moodiness, agitation and irritability, feelings of depression, loneliness and isolation. All of these symptoms can typically result in social withdrawal, disrupted sleep patterns, eating excesses, neglect of responsibilities or procrastination. Consequently nervous habits such as nail biting and increased nicotine, alcohol or drug use can result as a coping mechanism to stress.

The effects of stress have been thoroughly researched and divided into three stages.

1.     The first stage is ‘alarm’. This is when we perceive a certain stressor as threatening and in response our body produces adrenaline to be ready for ‘fight or flight’. Consequently, our body produces cortisol which an anti-inflammatory.

2.     The second stage is defined as ‘resistance’. If we keep perceiving a certain situation as stressful, we will need to find ways of coping with the stress. However, even though our body aims to adapt to the situation, the continuous threat   eventually leads to a gradual depletion of resources which will eventually lead to the next stage.

3.     Thus, the third and final stage is ‘exhaustion’. This is the point where the body’s resources have run down to a point where it is unable to maintain its normal function.

It is in this stage that if extended for too long, long term damage may result as a consequence of stress. The exhausted immune system is impaired and illnesses such as digestive problems, ulcers, diabetes, cardiovascular problems or diabetes can occur as a result of prolonged stressors.

In other words, unresolved persistent stress that has not been successfully addressed through coping or adaptation could ultimately lead to anxiety or depressive (withdrawal) behaviours.

Studies indicate that the causes for stress can be manifold and varied. Stress can be caused by pain, relationships, unemployment, employment, insufficient sleep, project deadlines, poverty, exams, abuse, etc. to name only a few.

As mentioned earlier, the effects of chronic stress have been extensively researched and there seems to be no doubt that the body’s immune system can be severely affected by persistent stress. Studies have shown that chronic stress can significantly increase vulnerability to infections and skin disorders, impair developmental growth in children and may even affect the levels of visceral fat production in the body which in turn increases the chances of developing heart disease or other related health problems.

The diagnosis of post traumatic stress disorder is probably one of the most extreme types of diagnosis relating to severe stressors. As such it is a severe reaction to a traumatic experience or ongoing experiences.

Understanding the potential damaging effects of ongoing stress it is crucial to understand that stress must be managed if one wants to avoid increased propensity to psychological and physiological illness.

Stress management are techniques that can be learned and which have the purpose to equip people with effective coping skills when faced with psychological stress.

Hypnotherapy has much to offer in terms of stress management and in my experience I found that once a stressor has been removed or the perception of the stressor altered clients quickly find relieve from anxiety and the kind of doom and gloom feeling that hangs over their head most of the time.  Sometimes it really doesn’t take much and the world that looked so dark and heavy all of a sudden looks a lot brighter and lighter.

Stress management strategies and their effectiveness in the workplace

Stresson April 5th, 2014No Comments

Thus, a number of researchers have come to the conclusion that some stress management approaches do not yield outcomes that would warrant their use, such as organisation focused interventions (van der Klink, et al., 2001) and workplace counselling (McLeod & Henderson, 2003).  Whereas, others found evidence for the effectiveness of particular approaches, such as muscle relaxation techniques(Lahmann, Schoen, Henningsen, Ronel, Muehlbacher, Loew, Tritt,(2008))self-affirmations (Critcher, Dunning, & Armor, 2010)and cognitive-behaviour therapy (Haldane, 2007). In addition, (Gruzelier, Smith, Nagy, & Henderson, 2001) found that a relatively brief hypnotherapeutic intervention provided a low cost psychological intervention to mediate performance stress and (Whitehouse et al., 1996)found that self-hypnosis reduces distress in adults.

Given these conditions, it is not surprising that stress management programs can be difficult to implement, impractical to execute (McLeod & Henderson, 2003), too time consuming or costly (van der Klink, et al., 2001), and because of ambiguity in effectiveness, they may not attract the attention they deserve (Harris & Napper, 2005).(Edimansyah, Rusli, & Naing, 2008)identified that no study to date has tested the effects of a short duration, easy-to-implement stress management therapy that could reduce the effects of stress in an occupational setting.

According to (van der Klink, et al., 2001), interventions designed to reduce job stress and its health effects can be categorized into two basic approaches:

a)      organization-focused interventions, which aim to improve stressful work environments through organizational development and job redesign; and

b)      individual-focused approaches, which aim to increase individual psychological resources and responses.

 

Individual-focused approaches have been found to be more effective in reducing workers’ stress-related complaints(Edimansyah, et al., 2008).Yet,despite the relative effectiveness of the individual-focused approaches to stress management the underlying processes or mechanism by which these interventions work remains largely unexplained.

Cognitive behavioural programs (CBT) meanwhile, consistently produce larger effects than other types of interventions in stress management(Richardson & Rothstein, 2008). Modern hypnotherapy research has increasingly focused upon integrating hypnotherapy with CBT since the publication of Kirsch, Montgomery &Sapirstein’s(1995)influential meta-analysis which pooled data from 18 separate controlled studies (577 participants) comparing the efficacy of cognitive-behavioural hypnotherapy to CBT alone.  They concluded that for 70-90% of clients, CBT was more effectivewhen integrated with hypnosis, i.e., that for the vast majority of clients cognitive-behavioural hypnotherapy is superior to CBT alone.

 

The ‘non state’ cognitive behavioural theory of hypnosis literature proposes that a person’s level of positive expectations, attitudes, and motivation towards the intervention may be the mediating factors by which such psychological intervention is effective(Lynn, Fassler, & Knox, 2005). Contemporary research also suggests that the success of hypnotic interventions is due to a state of physical relaxation accompanied by mental concentration(Chapman, 2005).

 

These factors combined, appear to influence how much attention an individual directs towards the intervention. Attention here is defined as being the cognitive process of selectively concentrating on one aspect of the environment while ignoring other things(Anderson, 2004).  The ability of an individual to focus his or her attention appears to be an important construct and thus may even be the most significant mediating factor identifying success or failure of an intervention. The relationship between attention and other cognitive processes remains a major area of investigation within psychology (Anderson, 2004).

The Stress Article Series: 

The adverse effects of stress – a call for action

Stresson March 30th, 2014No Comments

Profile pic face and wideby Jorg Thonnissen, Psychologist & Hypnotherapist In Perth, Western Australia

According to Lifeline Australia 91% of adults reported feelings of stress in areas of health (55%), relationships (41%), work worries (72%), finances (67%) and thoughts about their future (65%) (Lifeline, 2008). Considering that prolonged stress is an overwhelming reality for Australians and is known to cause not only harm to mental, but also physical health the article suggests some urgency in addressing the issue through the development of effective coping strategies (Lifeline, 2008)

What is Stress?

“Stress results from an imbalance between demands and resources. It is a psychological, physiological and behavioural response by individuals when they perceive a lack of equilibrium between the demands placed upon them and their ability to meet those demands” Bakker, Terluin, van Marwijk, Gundy, Smit., van Mechelen&Stalman, (2006)

 

“Stress has been defined in different ways over the years. Originally, it was conceived of as pressure from the environment, then as strain within the person. The generally accepted definition today is one of interaction between the situation and the individual. Stress is the psychological and physical state that results when the resources of the individual are not sufficient to cope with the demands and pressures of the situation. Thus, stress is more likely in some situations than others and in some individuals than others” (Michie, 2002).

(Monroe, 2008) conceptualizes stress as the organisms response to challenging or harmful conditions.

Classification of stress in research

Put simply, researchers agree that stress has two components, one is psychological and the other is physiological in nature. It is commonly assumed that we respond to external events whether they are real or imagined with a set of responses that is referred to as General Adaptation Syndrome, also called the stress response which is adapted to the nature of the event.

Based on the notion that stress is a set of adaptive neurological and physiological reactions    stress research has been traditionally focused on studies investigating the organism’s response to stressful stimuli as well as cognitive processes influencing stress perception (Franken, 1994)

However, Seyle (1982) found that very few people can actually classify their experience of stress in the same way and even less are able to clearly define what exactly stress means to them. However, Seyle (1982) also found that not only pain, fear, fatigue or effort can cause stress but also success and these rather dissimilar stress producing aspects have led to a great variety of definitions of stress, causes, consequences and treatments in research.

Thus, there are a number of interpretations for the concept of ‘stress’ in psychology (Joshi, 2005).

(Khoozani & Hadzic, 2010) point out, that there is little agreement on the precise definition of the term, which in turn has led to a great degree of ambiguity in how to measure the various causes and corresponding effects of stress simply because researchers based their studies on different interpretations of stress (Monroe, 2008).

Realizing the need for better classification (Khoozani & Hadzic, 2010) proposed a human stress ontology model with the aim to define the concept in a way that would enable researchers to compare data collected on the basis of similar interpretations of the human stress concept. Their research led them to a model in which they defined the human stress concept by organizing it into 5 sub ontologies consisting of stress causes, stress treatment, stress measurements, stress mediators, and stress effects (see table below).

Stress causes

  1. a.        Psychological Relative
  2. b.       Biogenic Absolute
  3. c.        Objective
  4. d.       Subjective
  5. e.        Acute
  6. f.         Chronic
  7. g.       Psychological

Stress mediators

                                                               i.      Coping patterns

                                                             ii.      Cognitive factors

  1. 1.        Cognitive appraisal
  2. 2.        Dysfunctional beliefs
  3. 3.        Perceived control
  4. 4.        Perceived support

                                                           iii.      Personality patterns

  1. 1.        Type A personality
  2. 2.        Neuroticism
  3. 3.        Negative affect tendencies
  4. 4.        Trait anxiety
  5. 5.        Hardiness
  6. 6.        Conscientiousness

                                                            iv.      Developmental factors

  1. 1.        Childhood
  2. 2.        Adolescents
  3. 3.        Adulthood
  4. 4.        Elderly

                                                              v.      Gender related factors

  1. h.       Neurophysiological

                                                               i.      HPA axis

                                                             ii.      Limbic system reactions

  1. 1.        Limbic hypersensitivity

                                                           iii.      Stress hormones

  1. 1.        Glucocorticoi
  2. 2.        Catecholamine

                                                            iv.      Stress hormone receptors

  1. 1.        Type 1
  2. 2.        Type 2
    1. i.         Situational

                                                               i.      Socioeconomic factors

                                                             ii.      Cultural factors

Stress effects

  1. j.         Stress related disorders
  2. k.       Neurophysiological alterations

                                                               i.      Lymbic system hypersensitivity

                                                             ii.      Insulin secretion

  1. l.         Cognitive alterations

                                                               i.      Perceptual tunnelling

                                                             ii.      Creativity

                                                           iii.      Perceptual narrowing

                                                            iv.      Cognitive tunnelling

                                                              v.      Retrieval threshold

                                                            vi.      Cognitive activation

                                                          vii.      Flexible problem solving

                                                        viii.      Dysfunctional cognitive processing

  1. m.     Emotion alterations

                                                               i.      Mood fluctuations

                                                             ii.      Fear

                                                           iii.      Joy

                                                            iv.      Surprise

  1. n.       Memory and learning alterations

                                                               i.      Learning deficits

                                                             ii.      Memory consolidation

                                                           iii.      Memory retrieval

                                                            iv.      Declarative memory

                                                              v.      Working memory

                                                            vi.      Long term memory

                                                          vii.      Emotional memory

  1. o.       Attention alterations

                                                               i.      Arousal

                                                             ii.      Divided attention

                                                           iii.      Selective attention

                                                            iv.      Vigilance

  1. p.       Interpersonal relationships

                                                               i.      Emotional bonding

                                                             ii.      Sexual relationships

                                                           iii.      Intimacy relationships

Stress treatments

  1. q.       Psychotherapy
  2. r.        Pharmacotherapy
  3. s.        Physiological techniques
  4. t.         Alternative therapies
  5. u.       Measurement of stressors
  6. v.        Measurement of stress feelings
  7. w.      Measurement of stress physiology

Stress measurements

  1. a.        Measurement of stressors
  2. b.       Measurement of stress feelings
  3. c.        Measurement of stress physiology

by Jorg Thonnissen, Psychologist & Hypnotherapist In Perth, Western Australia

Stress defining factors – relativity, duration, and objectivity

Stresson May 11th, 2010No Comments

Based on the (Khoozani & Hadzic, 2010) ontology, the model identifies 3 general factors inducing stress based on relativity, objectivity and duration.

Relativity – psychological (perceived) versus biogenic (absolute) factors

Considering the relativity of perceived stress (Lupien, Maheu, Tu, Fiocco, & Schramek, 2007) separate stressors into psychological and biogenic (absolute) groups. Whereas biogenic stressors are defined as stimuli that produce effects regardless of a person’s perception (i.e. drugs or environmental stimuli that lead to physiological arousal such as temperature or… ), psychological stressors are very much of a perceptual nature (Lupien, et al., 2007). Put differently, whether an event is perceived as stressful and to which extend is largely dependent on the way we appraise or interpret it (Folkman & Lazarus, 1980). For example …

Objective versus Subjective stressors

Similarly, (Pervin, 1978) describes stressors either as subjective (i.e. the belief of a person perceiving an event as stressful) or objective (i.e. based on observable facts). For instance (Hamama-Raz, Solomon, Schachter, & Azizi, 2007) found that the lower the participants of a study appraise their situation as a threat and more as a challenge the better they would cope with stress.  This is in line with (Lazarus & Folkman, 1984) theory that stress results from an imbalance between demand and resources, or put differently, once a stressor exceeds ones perceived ability to cope with it we are experiencing stress.

Acute or Chronic stressors

(Khoozani & Hadzic, 2010) also found that stressors can be categorized as either chronic or acute based on of the length of time they are present. Whereas chronic stressors are defined as of long duration, less intense and ambiguous in nature, acute stressors are more intense, typically of short duration and for example can lead to symptoms such as post-traumatic stress disorder (PTSD) (Khoozani & Hadzic, 2010) or increases in asthma attacks in children already suffering from asthma (Sandberg et al., 2000).

Stress Mediators

There are a number of stress mediators. For instance whether people experience stress or not depends on situational factors (Lupien, et al., 2007), or the level to which presenting stimuli is perceived as uncontrollable, unpredictable or  unfamiliar(Mason, 1968) and to which extend a specific situation is perceived as threatening (Kemeny, 2003) are all thought to contribute to the stress experience.

Based on the interaction between stress cause, stress feeling and stress experience (Khoozani & Hadzic, 2010)classify stress mediators into three categories defined as psychological, neurophysiological and situational factors.

Psychological Mediators

Coping Patterns

Coping patterns are acknowledged as a person’s attempt to apply a strategy for the purpose to lessen the as stressful appraised adverse psychological or behavioural effects of a stimulus (Everly $ Lating, 2002). Arnold (1960) investigated the link between stress stimuli and emotional responses and found that an individual’s personality type, age or situational factors would determine which kind of coping strategies are likely to be employed. Lazarus (1966) via his transactional theory identified a two stage cognitive appraisal, stage one is concerned with how an individual may perceive a particular stimulus or event, such as threatening or harmless, and the second stage of the appraisal is concerned with the evaluation of his/her abilities to find a resolution to the source of the stress.

Although the majority of researchers tent to agree with Lazarus’s (1966) findings (Everly and Lating, 2002), some argue that coping patterns do not explain all the responses to stress(Keil, 2003) and others have proposed that emotional responses to stressful stimuli could occur without the employment of pre-defined cognitive constructs (Zajonc, 1984)

Cognitive Factors

Cognitive factors have been suggested to play the most crucial role in how individuals cope with stressors (Dunkel-Schetter).Foa&Rothbaum (1998) identified that sufferers from PTSD usually hold world views in which living is seen as a dangerous and unpredictable undertaking over which they have little control in addition to a lack of competencies to deal with stressful situations or events that could occur at any moment.

Hence Bandura (1997) too pointed out that an individual’s perceived control over life’s demands is the most relevant factor in controlling a stress response to environmental stimuli. In other words the greater the perceived control in a situation or event, the lower the levels of perceived stress. There are a number of studies that confirm this equation. For instance Johnston, Gilbert….1992) found that patients would recover faster from surgery when they perceived having greater control over their recovery.

These findings highlight why most cognitive behavioural strategies dealing with an individual’s stress perception are primarily focused on establishing levels of control (Khoozani & Hadzic, 2010).

Personality Factors

A number of researchers found a correlation between personality type and stress responses (Vollrad, 2001, Eyseneck&Eyseneck 1969, Friedman &Rosenman, 1974, Lazarus 1990). For example,personality traits such as hardiness (King, King, Fairbank, Keane, & Adams, 1998) and conscientiousness (Friedman et al.) have been identified as significantly correlating with lower levels of stress experiences in individuals, and neuroticism and trait anxiety in individuals is significantly correlated with greater susceptibility to stressful stimuli (Eyseneck&Eyseneck 1985).

Similarly, Millon’s (1996) biosocial learning theory of personality proposes that an individual’s susceptibility to different kinds of stressors is dependent on their coping styles, needs and reinforcement patterns.

Developmental factors

Seiffge-Krenke, Aunola…(2009) found that stress perception changes based on the developmental stages of an individual. For instance during the adolescents stage the perceived stress of an individual is more likely to be determined by identity issues and conflicts resulting from interaction with parents, peers  and  the opposite sex.

Check Ryan Wenger, 1992).

Gender related Factors

Billings and Moos (1991) found that males respond different to stress than females with males tending to either confront stress head on or deny it to be an issue compared to women who would tend to be more emotionally affected and are more likely to proactively talk through their issues (La France &Banaji, 1992).

 

Neurophysiological Mediators

HPA Axis

The hypothalamic-pituitary- adrenal axis (HPA) is responsible for the secretion of hormones that activate the bodies fight or flight response. This naturally occurring response of the organism can have adverse effects on an individual’s health if it remains active for too long, leading to adverse effects such as hypertension, or the suppression of the immune function (Avila, Morgan 2003; McEwen, 2003).

Limbic System Reactions

Exposure to consistent excitatory stressors or traumatic experiences have also been found to create a level of hypersensitivity which potentially causes the impulsive surpression of the convulsive threshold of the limbic system through endocrine and neuroendocrine arousal, which in turn could lead to a number of physiological or psychological disorders (Everly, 1985).

Stress Hormones

Stress hormones such as cortisol, adrenaline and noradrenaline can influence cognitive functioning due to their ability to pass through the blood brain barrier. This potentially affects memory and learning of an individual experiencing distress. There are a number of different areas in the brain that are known to be affected by distress, such as the amygdala, the frontal lobes and the hippocampus in particular. The amygdala has been identified as that part of the brain where fear response information is stored and thus it is believed to play a major part in the fight or flight response once a threat has been identified, consciously or subconsciously.  (Lupien, 2006).

Stress Hormone receptors

By observing how these various stress hormones affect neural functioning in the brain researchers () concluded that there are two types of receptors (Type 1 for mineralocorticoids and Type 2 for glucocorticoid) responsible for positive or negative effects on cognition or memory. For instance if there are more mineralocorticoids than glucocorticoids occupying receptors the effects are largely positive on cognitive functioning, however if this ratio should be reversed cognitive functioning is thought to be impaired.

Situational mediators

Different situations call for different coping strategies depending on which strategy is perceived as working best when it comes to stress according to Terry, (1991) and Keil (2003). Socioeconomic as well as cultural factors also play a major role in how stress is perceived by individuals belonging to that group. People living in poorer socioeconomic conditions have been found to have lower expectations of the future and are therefore also likely to be more vulnerable to stress (Kopp, Scrabski 1998).

Stress Effects

In summary, the effects of stress are many and varied and as Koozani pointed out lead to a number physiological or psychological problems categorized as:

1. Stress-related disorders – i.e. all stress disorders can be considered a consequence of the excessive arousal of the limbic system,

2. Neuro-physiological changes- i.e. stress via the limbic system pathway potentially affects organs through activating excitatory (Post, Rubinow 1986)  or inhibitory (Cain, 1992) neurotransmitters. Furthermore prolonged stress can also affect the micromorphological brain structures of hypocampus and amygdala (Cain, 1992), as well as the nucleus of neurons therefore potentially altering genetic messages (Cain, 1992),

3. Cognitive changes – i.e. all psychological mechanisms such as cognition, emotions, memory, and attention can be affected by stress. For example, studies show that cognition and information processing are affected when stress reaches a certain threshold. Perceptual narrowing by which an individual focuses entirely on the source of the distress to the relative exclusion of other stimuli is one such change that can take place (Wickens, Hollands, 2000) whereas the term cognitive tunnelling defines an individual’s focus on well learned and practiced material when faced with distress.  Beversdorf, Hughes (1999) have demonstrated that the experience of chronic stress effects the prefrontal cortex and so can lead to a reduction in creativity and flexible problem solving.

4. Similarly, stress has been linked to certain emotions such as surprise, fear or joy for example (Lupien, 2007). However, Lupien points out that although all stressful experiences elicit an emotional response and concludes that these responses are overlapped, not all emotions cause the individual to have feelings of distress, hence, there is a clear distinction between the experience of stress and emotions under certain conditions and situations. Stress due to stressful life events too have been linked to mood fluctuations in individuals (Bolger, DeLongis 1989).

5. Stress significantly affects memory and learning as studies by Roozendaal (2000) show.  Whereby the type of stressor, gender and emotional excitement are all factors that play part in how memory and learning are affected, it has been shown that stress experienced after a learning experience enhance memory retrieval however, if excessive feelings of stress are experienced before a learning experience memory retrieval can be negatively affected. This is due to increased levels of cortisol in the hippocampus area of the brain where memory and learning processing takes place. This follows that increases in glucocorticoids in the hippocampus area can not only affect an individual’s declarative memory (Lupien, McEwen, 1997) but also his or her working memory (Young, Sahakian…1999) as well as emotional memory (Buchanan & Lovallo, 2001).

There are a number of researchers who have also looked at the positive effects of stress and found that increases in glucorticoids can actually improve the encoding of emotionally loaded information with individual’s being able to better recall the information thus learned and processed at a later stage (Buchanan & Lovallo, 2001). However, Lemaire, Koehl (2000) emphasise that intense experiences of stress early in life can lead to lasting learning deficits.

6. The effects of stress on attention have also been well researched. On the one hand Oitzel & De Kloet (1992) found that stress causes the activation of Type 1 receptors which in turn increases an individual’s ability to be more vigilant and focus his or her attention on the source of the stressful stimuli rather than on what is happening around it.

On the other hand chronic stress evident through high levels of cortisol can have the effect of significantly interfering with tasks that require focus and attention (Lupien et al 1994).

7. Similarly, interpersonal relationships can also be affected through stress as studies show that people experiencing stressful events together can form a long lasting strong bond with each other (Lindy,1985)  whereas on the more negative side traumatic stress could lead to problems with intimacy or closeness with significant others (Escobar et al 1983).