Stress has been viewed in three ways:

1. Stimulus
2. Response
3. Process.

Stimulus refers to stress, which can be categorised as emanating from three sources:

1. Catastrophic events, such as Tornadoes and earthquakes
2. Major life events
3. Chronic circumstances, such as living in crowded or noisy conditions.

Response refers to how somebody responds to a particular stress, for example sitting an examination. There are two components:

1. Physiological, heightened bodily arousal-your heart pounds, mouth goes dry your stomach feels tight and you perspire.
2. Psychological, involving behaviour, thought patterns, and emotions. Feeling nervous.

Process views stress as a series of interactions and adjustments between the person and the environment. These interactions and adjustments are called transactions. Stress is not seen as a stimulus or a response, but rather as a process. The person suffering stress is seen as an active agent who can influence the impact of a stressor through behavioural, cognitive and emotional strategies.

A good definition of stress would be that stress is the condition that results when the person/environment transactions lead the individual to perceive a discrepancy-whether real or not-between the demands of a situation and the resources of the persons biological, psychological, or social systems.

Success and failure in previous transactions would determine the amount of stress perceived.

Lazarus and Folkman (1984) propose a model that emphases the transactional nature of stress.  Stress is a two way process; the environment produces stressors and the individual finds ways to deal with these.

Cognitive appraisal is a mental process by which people assessed two factors:

1. Whether a demand threatens their well being
2. Whether a person considers that they have the resources to meet the demand of the stressor

There are two types of appraisal:

1. Primary
2. Secondary.

During the primary appraisal stage a person will be seeking answers as to the meaning of the situation with regard to their well being. One of three types of appraisals could be made:

1. It is irrelevant
2. It is good (benign-positive)
3. It is stressful.

Imagine there was a snow blizzard. You might consider that the blizzard would not affect you, as you do not have to go to work the following day. You might consider the blizzard a blessing because this means that your college exam would be postponed or you can go skiing! The situation could be stressful because you have few supplies and you need to get to the shops and driving would be hazardous.

Further appraisal is made with regard to 3 implications:

1. Harm-loss
2. Threat
3. Challenge.

Harm-loss refers to the amount of damage that has already occurred. There may have been an injury. The seriousness of this injury could be exaggerated producing a lot of stress.

Threat is the expectation of future harm, for example the fear of losing one's job and income. Much stress depends on appraisals that involve harm-loss and threat.

Challenge is a way of viewing the stress in a positive way. The stress of a higher-level job could be seen as an opportunity to expand skills, demonstrate ability, and make more money.

The stress transaction can be vicarious. Empathising with others who are in stress. An example of vicarious stress is a study, which involved showing college-student subjects a film, called "Sub-incision" (Speisman et al, 1964). The film showed a right of passage for young adolescent boys in a primitive society in which the underside of the penis is cut deeply from the tip to the scrotum using a sharp stone. The subjects were divided into four groups. One group saw the film with no sound. Another group heard a soundtrack with a "trauma" narrative emphasising the pain, danger, and primitiveness of the operation. A third group heard a "denial" narration that denied the pain and potential harm to the boys, describing them as willing participants in a joyful occasion who "look forward to the happy conclusion of the ceremony." The fourth group heard a " scientific" narration that encouraged viewers to watch in a detached manner-for example, the narrator commented, "as you can see, the operation is formal and the surgical technique, while crude, is very carefully followed." Physiological and self-report measures of stress were taken. The physiological measure was of the heart rate during the viewing of the film. The self-report measures were questionnaires that evaluated feelings of stress immediately after the film was shown. Those who heard the trauma narration reacted with more stress than the control group (no sound); those who heard the denial and scientific narrations reacted with less stress than the control group.

Secondary appraisals occur at the same time as primary appraisals. A secondary appraisal can actually cause a primary appraisal. Secondary appraisals include feelings of not being able to deal with the problem such as:

• I can't do it-I know I'll fail
• I will try, but my chances are slim
• I can do it if I get help
• If this method fails, I can try a few others.
• I can do it if I work hard.
• No problem-I can do it.

Stress can occur without appraisal such as when your car is involved in an accident and you haven't had time to think about what has happened. Accidents can often cause a person to be in shock. It is difficult for people to make appraisals whilst in shock as their cognitive functioning is impaired.

Events are stressful depending on two types of factors:

1. Those that relate to the person
2. Those that relate to the situation (Cohen and Lazarus, 1983).

Personal factors include intellectual, motivational, and personality characteristics. People who have high self-esteem are likely to believe they have the resources to meet demands. Stressful events are seen as challenges rather than as threats (Cohen and Lazarus, 1983).

The application of this theory to understanding stress in streetwalkers

With regard to motivation: the more important the threatened goal is, the more stress the person is likely to perceive (Patterson and Neufeld, 1987). Many people have irrational beliefs. If somebody strongly desires to have a safe, comfortable, and satisfying life which they believed is achieved by everything being absolutely easy, convenient and gratifying then the slightest inconvenience would be seen as harmful or threatening.

Events that involve very strong demands and are imminent tend to be seen as stressful (Kelly and Lazarus, 1983).

Life transitions tend to be stressful (Moos and Schaefer, 1986). Changing from one phase to another in life is called a transition; examples include:

• Starting school
• Moving home
• Reaching puberty
• Starting college, especially away from home
• Starting a career
• Getting married
• Becoming a parent
• Losing a spouse through divorce or death
• Retiring.

Becoming a parent can be stressful before and after the birth (Miller and Sollie, 1986). Before birth there is the physiological burden of pregnancy on the mothers body and concern about the babies and mothers health. After birth, stress can result from the parents feeling tied down, having a less orderly and predictable lifestyle, and having their sleep interrupted often, among other things.

The timing of a life transition can affect the stress it produces. If a life events occur as at a time when it is not expected then this is stressful. One reason could be that having an event too early or too late could mean that one is deprived of the support of peers. An example of this would be having a baby at the age of 38 or later. Achieving life events late in life could be seen as failing. Some people who graduated late or were promoted late in life feel as though they have failed.

Ambiguity can cause stress. Two types of ambiguity are:

1. Role ambiguity
2. Harm ambiguity.

Role ambiguity can occur in the workplace, for instance when there are no clear guidelines, standards for performance and no clear consequences. Role ambiguity is stressful because people are uncertain about what actions and decisions to make.

Harm ambiguity occurs when people are not sure what to do to avoid harm. Stress will depend upon the person's personality, beliefs and general experience (Lazarus and Folkman, 1984). A person who is seriously ill and has no clear information might draw hope from this ambiguity, believing that they will get well. Another person in the same situation may believe that people are deliberately giving ambiguous information because the prognosis is poor.

The desirability of the situation is also another important factor. An event like losing your home is undesirable and therefore stressful. Buying and selling a house could be because one is moving to a more desirable house but still there will be many demands that tax or exceed the individuals resources. Many of life's events, whether desirable or undesirable, can produce stress (for example getting a parking ticket or preparing to throw party). Generally, undesirable events are more likely to be appraised as stressful (McFarlane et al., 1980)

Controllability is another factor that will affect the perception of stress. People tend to appraise uncontrollable events as being more stressful than controllable events (Miller, 1979). There are two types of control:

1. Behavioural
2. Cognitive.

Behavioural control means performing some action. For example, being unable to take a tablet for a headache will make experiencing a headache less stressful. In the case of cognitive control, we can affect the impact of the events by using some mental strategy, such as distraction or by developing a plan to overcome the problem.

Walter Cannon (1929) describes the fight or flight response of the body after perceiving danger or stress. This response mobilises the organism to respond quickly to danger but the state of higher arousal can be harmful to health if it is prolonged.

Selye (1956) observed in laboratory animals and in human patients the body's reaction to stress. He found that the fight or flight response was only the first in a series of reactions, which he called the general adaptation syndrome (GAS). The GAS consists of three stages:

1. Alarm reaction
2. Stage of resistance
3. Stage of exhaustion.

The alarm reaction is like the fight or flight response to an emergency. The body is mobilised. At the beginning of the arousal blood pressure drops below normal for a moment, but then quickly rises to above normal. This arousal is produced by the release of hormones by the endocrine system: the pituitary glands secrete ACTH, which causes a heightened release of adrenaline, noradrenaline, and cortisol by the adrenal glands into the bloodstream. The body cannot stay in this state for long without serious consequences. Some organisms in a continuous state of alarm have died within hours or days

Stage of resistance. If the reaction continues and is not strong enough to cause death the physiological reaction enters the stage of resistance. The body tries to adapt to the stressor. Physiological arousal declines but remains higher than normal and the body replenishes the hormones released by the adrenal glands. The organism may show few outward signs of stress. However, the body may not be able to resist new stresses. The body becomes increasingly vulnerable to health problems. These health problems include ulcers, high blood pressure, asthma, and illnesses that result from impaired immune function.

Stage of exhaustion. Severe long-term or repeated stress will cause the organism to enter the third stage, the stage of exhaustion. The immune system and the body's energy reserves are weakened until resistance is very limited. If the stress continues, disease and physiological damage become increasingly likely and death may result.

A problem for GAS is that some stressors elicit a stronger emotional response than others do. The theory does not take account of psychosocial processes. A sudden increase in temperature, for example, would produce more emotion than a gradual increase.

Another problem for GAS is that cognitive appraisal is not taken account of. A study by Katherine Tennes and Maria Kreye (1985) found that intelligent schoolchildren experienced more stress on the day of an exam than unintelligent schoolchildren. Cortisol levels were measured in urine samples taken on regular school days and on days when tests were given. Intelligence test scores were obtained from school records. The results suggest that brighter children are more concerned about academic achievement.

To summarise, the GAS incorrectly assumes that all stressors produce the same physiological reactions and fails to take account of psychosocial factors in stress. Even so the GAS is basically a valid model of stress.

A high level of stress impairs people's memory and attention during cognitive activities such as when taking examinations (Cohen et al 1986).

Noise can be a stressor, for example when people live next to a busy railway or motorway. People cope by tuning out the noise. Cohen (1980) has proposed that children who tried to tune out chronic noise may develop generalised cognitive deficits because they have difficulty knowing which sounds to attend to and which to tune out (see my web-page on classroom design).

One study tested primary school children who lived in a block of flats that was built on bridges spanning a busy highway. The children in the noisy flats had more difficulty discriminating between pairs of words (for example, house and mouse) (Cohen et al., 1973).

People living near the three mile island nuclear power plant in Pennsylvania who had difficulty in coping with the stress that was produced by the fear that the nuclear emissions would affect their health, found it difficult to keep their minds from thinking about the accident. Thoughts can perpetuate stress and make it chronic.

Cognitive appraisal processes can influence both the stress and the emotional experience (Maslach, 1979; Schachter and Singer, 1962) for example, one person coming across a poisonous snake might be frightened whereas another person, who studied poisonous snakes, would be excited.

Fear is a common emotional reaction that can be classified into two categories:

1. Phobias
2. Anxiety.

Phobias are intense and irrational fears that are associated with specific events and situations. An example of this would be claustrophobia, a fear of being enclosed in small rooms.

Anxiety is a vague feeling of uneasiness or apprehension. A gloomy anticipation of impending doom caused by a relatively uncertain or unspecific threat. People may not be aware of the situations that seem to arouse anxiety or to know how the "doom" will manifested itself. Patients awaiting surgery or the outcome of diagnostic tests generally experience high levels of anxiety. Anxiety may result from appraisals of low self-worth and the anticipation of a loss of self-esteem.

The things children fear tend to become less concrete and more abstract and social as they get older (Sarafino, 1986). A study of children's fears of dental treatment found that the most frightened children were those who had not experienced invasive procedures, such as having a tooth extracted during the prior few years (Murray et al., 1989). Children who see themselves as less able than their peers are likely to appraise their own resources as insufficient to meet the demands of stressors.

Stress can lead to feelings of depression. Depression is quite normal, but severe and prolonged depression is a serious disorder. Symptoms of clinical depression are:

• A generally unhappy mood
• Feelings of helplessness about the future
• They appear listless and passive
• Disrupted eating and sleeping habits
• Low self-esteem (Rosenhan & Seligman, 1984).

A long-term disabling health problem, such as being paralysed, often leads to depressive disorders. There is controversy over whether the type of disorder seen in adults ever develops before adolescence (Quay & La Greca, 1986). Assessing depression in children is difficult because they are unable to express their feelings very well.

Another emotional reaction to stress is anger. This often occurs when the person perceives the situation as harmful or frustrating. Anger can produce aggressive behaviour.

In some stressful situations, such as train crashes, earthquakes, etc. people may work together to help each other survive. This could be because they have a common goal that requires co-operative efforts (Sherif & Sherif, 1953).

When stress is accompanied by anger, negative social behaviours tend to increase. Stress-produced anger increases aggressive behaviour, and these negative effects continue after the stressful event is over. Child abuse is often related to parental stress (Kempe, 1976). Prior to a parent battering their child the parent usually has experienced a stressful crisis, such as the loss of a job. At high levels of stress the parent is at risk of losing control. If a child is running around making a lot of noise in the house the parent could become very angry and lose control.

Stress affects helping behaviour. An experiment was conducted in a shopping centre (Cohen & Spacapan, 1978). The subjects either had a difficult shopping task or uneasy one and the shopping centre was either crowded or uncrowded. The difficult shopping task as well as the crowded shopping centre therefore produced stress. After completing the shopping task, each subject walked through a deserted hallway to meet with the researcher. In the hallway the subjects encountered a woman who pretended to have dropped a contact lens. Subjects who had experienced a lot of stress did not help as much as those that had completed an easy shopping task in uncrowded conditions.

Social support refers to the perceived comfort, caring, esteem, or help the person receives from other people or groups (Cobb, 1976).

There are five basic types of social support:

1. Emotional support. The expression of empathy, caring and concern toward the person.
2. Esteem support. This occurs through people's expression of positive regard for the person, encouragement or agreements with the individual's ideas or feelings, and positive comparison of the person with others such as people who are less able or worse off. This kind of support serves to build the individuals feeling of self-worth, competence and of being valued. Esteem support is especially important during the appraisal of stress, when the individual is assessing whether the demands exceed their personal resources.
3. Tangible or instrumental support involves direct assistance.
4. Informational support includes giving advice, suggestions or feedback.
5. Network support provides a feeling of membership in a group of people who share interests.

The type of support depends upon the stressful circumstances, for instance, emotional and informational support is particularly important for people who are seriously ill. Students who received more frequent esteem support tended to report less depression following stressful experiences.

People are unlikely to receive support if they are unsociable, don't help others, and don't let others know that they need help. Some people are not assertive enough to ask for help. Providers of support may not themselves have the resources needed, or may be under stress and in need of help themselves. One way of measuring social support is to use the "social support Questionnaire" (Sarason et al. 1983). It consists of 27 items, such as, "who helps you feel that you truly have something positive to contribute to others?" For each item, the respondents list the people they can rely on and then indicate the overall degree of satisfaction with the support available.

Think of the ten people to whom you feel closest. For each of the following questions rate each person on a 5-point scale, where 1 = "not at all" and 5 = "extremely."

1. How reliable is this person; is this person there when you need him or her?
2. How much does this person boost your spirits when you feel low?
3. How much does this person make you feel he or she cares about you?
4. How much do you feel you can confide in this person?

Add together all of these scores. Atypical score lies between 120 & 150. This would suggest that you have a reasonably good level of emotional support (source: Sarafino, 1994, based on material in Schaefer, et al, 1981).

People who have a strong sense of personal control report experiencing less strain from stressors.

1. Behavioural control involves the ability to take concrete action to reduce the impact of a stressor. An example of this would be special breathing techniques that reduce the pain of Labour
2. Cognitive control is the ability to use thought processes or strategies to defy the impact of a stressor. Such strategies would be thinking about the event differently or focusing on a pleasant or neutral thought or sensation.
3. Decisional control is the opportunity to choose between alternative procedures or courses of action. This would occur when the patient is allowed to make a decision between alternative treatments.
4. Informational control involves the opportunity to get knowledge about the stressful event.
5. Retrospective control involves reflecting upon what caused the stressful event. An example of this would be blaming somebody.

The most effective type of control is cognitive control (Cohen et al., 1986).

Lundberg (1976)
Using urine samples
Commuters on crowded trains more stressed than in empty trains, but those that had been on the train since the start, showed less stress, even though they had been exposed to the crowded condition longer.

Being able to choose seat, control the situation, reduced the stress.

People who believe they have control over their successes and failures are described as possessing an internal locus of control. Other people believe that their lives are controlled by forces outside themselves, for example, by luck; they have an external locus of control (Rotter, 1966). The I-E scale measures locus of control. This scale presents a series of paired items, such as: "the average citizen can have an influence in government decisions," and, "this world is run by a few people in power, and there is not much the little guy can do about it." The respondent selects the one with which he or she most agrees. Most people fall within the mid-range.

Self-efficacy is the belief that we can succeed at something we want to do (Bandura, 1977). People estimate their chances of success and failure on the basis of their prior experiences. A decision to attempt an activity depends on:

• A belief that their behaviour would produce a favourable outcome
• A belief that they are able to perform the behaviour properly.

People with a strong sense of self-efficacy shown less psychological and physiological strain in response to stressors (Bandura et al, 1982).

Experiencing stress over a long period of time can produce a feeling of helplessness. As a result of this people may stop striving for goals. This condition is called learned helplessness (Seligman, 1975).

Hiroto and Seligman (1975) demonstrated learned helplessness in an experiment. Students were assigned to one of three training groups. They all experienced an unpleasant loud noise. In one group, the controllable-noise condition, the subjects were told the noise would come on from time to time and " there is something you can do to stop it." Subjects were able to press a button to stop the noise, which they did. The uncontrollable-noise group had the same instructions and apparatus, except the button was ineffectual in stopping the noise. In a comparison group, the subjects were simply told "from time to time a loud tone will come on for a while. Please sit and listen to it." After this all of the subjects were tested for helplessness: they were told that the noise would come on and off and that "there is something you can do to stop it." The subjects were presented with a different apparatus that had a sliding knob that, when manipulated correctly, would stop the noise. Students in the uncontrollable-noise group performed much more poorly than those in the other two groups.

1. Competitive, achievements orientation. Self-critical. No joy in accomplishments.
2. Time urgency. Impatient. Always on the go. Do several things at once.
3. Anger/hostility easily aroused to anger, which may be overt or covert.

Personal qualities affecting appraisal of stress.

Suzanne Kobasa (1979)
People who can handle stress possess 'hardiness'.
There are three components

1. Control - can you control events? (See Locus of control)
2. Commitment - Sense of purpose, involvement.
3. Challenge - problems seen as an opportunity for personal growth.

Kobasa (1979) - High stress executives
2 groups - high illness Vs low illness.
Using questionnaire, the low illness group had more hardiness.

Problems

1. People vary with their personality. Unlikely to be one type of person all of the time.
2. Only looked at white professional American men - may not be true of other groups.
3. Hardiness and social support correlate so what is attributed to hardiness could really be the effect of social support (Blaney & Ganellen, 1990).

Other factors

Resilience (Garmezy, 1983)

Some people may have terrible things happened to them in their lives and remain relatively un-scarred. They tend to have the following characteristics:

• good social skills
• friendly
• at ease with peers and adults
• high esteem
• personal control
• could have compensating skills to become absorbed in

Moos and Moos (1981) looked at a number of social climates, including psychiatric wards, college dorms, prisons, work groups, families.

Positive environments - reduce recovery time from illness.

Responsibility, work pressure and change increase the likelihood of illness or subjective distress.

Click here for excellent site covering Stress

Notes from Canberra University

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