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Flashcards in Stress - Methods of Modifying Deck (34):

What are the Methods of Modifying Stress?

1. Beta Blockers
2. Stress Inoculation Training


Why are Beta Blockers Needed?

- Key aspect of body's response to stress arousal of sympathetic nervous system - match physical symptoms use experience- increased blood pressure/heart rate - symptoms can cause long-term negative health effects (e.g. cardiovascular disorder)


How do Beta Blockers Work?

- BBs have a antagonist action - work by reducing activity in sympathetic nervous system + reducing subsequent symptoms
- Beta Adrenoceptor Blocking Agents = block receptor sits for the hormones adrenaline + noradrenaline
- Adrenaline binds with target receptors stimulates associated muscles (causing heart to beat faster) - usual physical reaction to stress is dampened - breathing + heart rate doesn't increase + person feels calmer + less anxious
- Beta blockers don't completely stop anxiety but mask outward signs
- Useful for acute stress


What are the Types of Beta Blockers?

1. Non-Selective
2. Selective


Describe Non-Selective Beta Blockers

- Propanlol
- Block adrenaline + nurodrenaline
- Block beta 1 (B1) + beta 2 (B2
- Affects heart/kidneys/liver/etc


Describe Selective Beta Blockers

- Atenolol
- Affects mostly the heart + therefore has less effect on the rest of the body
- Only blocks Beta 1 (B1) - cause reduced cardiac output


Describe the Off-Label Use of Beta Blockers

- Primarily prescribed + approved for high blood pressure + angina
- Prescribed off-label for anxiety conditions
- Manufacturer has not applied for licence for Beta Blockers to be used to treat anxiety - drug will not have gone under clinical Trial
- Doctors feels prescribing Beta Blockers for anxiety has benefits outweigh any risk
- Prescribed as a lower dose than that used for cardiac conditions


How Do Some Musicians use Beta Blockers?

- Use to overcome stage fright + more able to perform under pressure
- Lockwood (1989) = 2000 musicians in major Us orchestra - 27% use Beta Blockers for performance + 19% used it everyday


How are Beta Blockers Used in Sport?

- Since 2010 all Beta Blockers have been banned by the World Anti-Doping Agency for all Olympic sports
- In Golf 2015 Christian Bezuidenhout tested positive for BBs + faced a 2 year ban from golf - appealed as he was taking them for anxiety - ban was reduced to 9 months


What are Benzodiazepines?

- Increase activity of gamma-aminobutyric acid (GABA) - increases serotonin - reduces arousal
- BZs only used to help those suffering from severe stress in a short term crisis - HIGHLY ADDICTIVE
- Causes drowsiness/impaired judgement - individuals need to be weaned off


Beta Blockers Evaluation
Benefits On Performance + Self-Reported Levels of Stress

- Positive
- Neftel (1982) = gave string players atenolol (BBs) or placebo 6 1/2 hours before performing - atenolol group had lower heart rates + were more able yo play complex parts of the music accurately - also reported less stage fright after performance compared with placebo
- Schweizer (1991) = compared effects of different types of BBs in maths test - all BBs had expected physical effects there were differences in subjective ratings of stress amougst groups


Beta Blockers Evaluation
Benefits for Other Aspects of Stress

- Schwabe 2011 study
- Negative effects of stress is stressed people falling into bad habits (e.g. addiction) rather than focusing on important goals
- Lab experiment concerning food rewards - 3 groups
1. No Stress
2. Stressed + BB
3. Stressed + placebo
- Findings - stress + placebo continued with habits formed
- Stress + BBs just as goal directed as those that had received no stress - BBs prevented the stress induced bias towards habit behavior
- Although research was in an artificial environment - potentially useful application of BBs for dealing with psychological effects of stress


Beta Blockers Evaluation
Long Term Effectiveness

- BBs criticised for their long term effectiness
- BBs don't address the psychological + emotinal side
- Root cause of stress + individual's reaction to it may not be addressed
- SIT may be more appropriate in giving individuals long term coping strategies to use across a range of situations
- BBs may only be useful for specific performance based scenarios + may not work for chronic stress


Beta Blockers Evaluation
Ethical Issues
Side Effectiveness

- Side effects tend to be mild + temporary (e.g. dizziness/diarrhoea/nausea/blurred vision/cold feet/cold hands/issues with sleep/shortness of breath)
- Compared with BZs effects are minimal
- Stopping taking BBs suddenly could cause problems (e.g. heart palpitations/higher blood pressure) as body will be so used to drug's effects in slowing down sympathetic response - individual may become psychological dependent, feeling as they cannot cope without it


Beta Blockers Evaluation
Ethical Issues
Use of Beta Blockers to Enhance Performance

- Ethical question
- BBs are banned in most sports- suggesting that its unethical
- Key parts of high level performance in sport is the ability to perform under pressure - providing an unfair advantage
- BBs specifically don't enhance performance - simply stop any anxiety interfering with performance


Beta Blockers Evaluation
Social Implications
Off Label Use

- Due to off label use prescribing of BBs they're well controlled + long term research is limited
- Lin (2006) = proportion of off label BBs was an average of aprox. 52% of all BBs prescribed - creates a dilemma for health health professionals


Beta Blockers Evaluation
Social Implications
Possible Over Prescriptions

- Statistics from prescribing +primary health + social care information centre (2014) = prescriptions of BBs (proponlol) rose by 7% between 2012/13
- 7% increase may be due to an increase use for heart problems, medical professionals are concerned that they're being over prescribed for stress
- Anxiety becoming a bigger issue + treatment are limited - psychological therapists are more expensive - prescribing BBs may be more cost effective - unlikely to deal with root cause


How did Meichenboum Describe SIT?

- Individual should develop a form of coping before a problem arises so they are protected


What is Inoculation?

- Gives individuals experience of minor stressor that makes them more prepared + resilient
- Help person develop coping mechanism + confidence in their ability to deal with stressful situation
- The thing they encounter as part as inoculation process needs to be strong enough to make person's deference aroused but not so strong that causes negative psychological effects


Describe the Transactional Model

- Identifies the importance of how person perceives the stressor + how the person sees these ability to cope with it
- SIT aims to give people the tools to perceive stressor in different ways + therefore deal with it more effectively


What is Constructive Narrative Perspective (CNP)

- Individual are storytellers who construct tales about themselves
- Nature of stories influence how they cope
- Help people become more aware of behavior that may be hindering rather than helping
- Helps person adopt a more constructive narrative when stressed


What is SIT?

- Flexible - exact nature is customised to individual
- Therapy depends on stressor being experienced + tailored to clients exisiting coping abilities
- Carried out over 8-15 sessions + follow up
- Employed in a wide variety of settings


What are the Stages of SIT?

1. Conceptualisation
2. Skills Acquisition + Rehearsal
3. Application + follow through


What is Concepualisation?

- Relationship between client + trainer established
- Open questions used to help increase the clients awareness of the nature + impact of stress + their existing coping strategies
- Trainer also helps the client to reconceptualise their problems be breaking down stressor into smaller. more manageable amounts


What is Skills Acquisition + Rehearsal?

- Clients helped to acquire coping skills + consolidate those they have already
- Important that any barriers that prevent them from being able to use strategies are removed
- Once participant taught they need to be practiced + generalised to everyday settings


What is Application?

- Client practises applying coping skills in a variety of different situations that become increasingly more demanding
- Techniques such as role play/modelling/imagine used
- Taught to prevent relapse by rehearsing situations in which Stressors might reappear
- Booster sessions used to make sure coping skills are being applied properly


Stress Inoculation Training Evaluation
Supporting Evidence

- Effective regardless of trainer experience
- Saunders (1996) = reviewed 37 studies into effectiveness of SIT in workplace - concluded that effective enhancing performance under stress + reducing anxiety - improvements for high + low anxiety groups
- Sheehy + Horon (1984) = SIT + effective on academic performance- 4 (90 minutes) sessions - lowered anxiety levels


Stress Inoculation Training Evaluation
Determining Which Part is Effective

- Difficult to pinpoint which component is effective part - all overlap with each other
- Moses + Hollandsworth (1985) = randomly allocated 24 dental phonics to 4 conditions - some given only stage 1 while others given later stages - found no significant difference in terms of anxiety levels between groups - however more patients who received coping skills training went to their appointments - stage 1 alone was not effective


Stress Inoculation Training Evaluation
Comparison to Other Methods

- A point to consider
- Foa (1991/99) = carried out a series of studies comparing SIT + prolonged exposure - SIT + PE were both effective in reducing symptoms of PTSD + depression
- Meichenbaum (2007) = Highlighted that in order to carry out their research som elements of SIT process were removed - not a fair compassion


Stress Inoculation Training Evaluation
SIT in the Military

- A point to consider
- Driskell + Johnstone (1998) = adopted SIT could be very useful in military
- Stage 1 = aware of stress training + Stressors - appreciable physical response
- Stage 2 = Control cognitive skills, focus on task - acquire skills in practical setting that resembles active service setting = intensity increases - improved performance
- SIT = performance better in flight task
- Assessing impact in real life situation is difficult


Stress Inoculation Training Evaluation
Ethical Implications
Risk of Harm

- Process = cause distress??
- Rehearse situation = cause a form of psychological harm
- Compared to drug therapies the effect may be more long lasting - benefits outweigh costs


Stress Inoculation Training Evaluation
Ethical Implications
SIT in the Military (pt.2)

- Stressor too intense = counter productive
- Directly exposed to stressor
- Special forces = prepared for Acute but chronic stress
- Trainers experienced feelings of despair
- Prevent effective acquisition


Stress Inoculation Training Evaluation
Social Implication
Stress in Society

- SIT shown to be useful across a larger range Stressors
- Meichenbaum (2007) = highlights need for effective interactions to combat stress - given an increased range of stressor in society


Stress Inoculation Training Evaluation
Social Implications
Impact on the Economy

- Effects of Stress + mental health has a cost on the NHS
- Blumenthal (2002) = long-term effectiveness of stress management techniques- men with coronary heart disease given stress management training + compared to control (exercise regularly) - SMG experienced less health problems over 5 year follow up + health care costs were significantly less