what is stress?
the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable.
what is the body’s way to respond to stress?
sympathetic nervous system activation which results in the fight-or-flight response.
what could be some life events which can trigger stress?
work problems, debts, relationship difficulties, extended family problems, house move, diagnosis of physical illness
what is primary appraisal?
an assessment of how significant an event is for a person, including whether it is a threat or opportunity
what Is secondary appraisal?
one’s ability to cope or take advantage of the situation.
what are internalising behaviours?
that is focused inward. People with internalising behaviours have difficulty coping with negative emotions or stressful situations, so they direct their feelings inside.
what are externalising behaviours?
externalising behaviours are focused outside oneself. They include physical aggression, destruction of property, underage drinking, and running away from home.
what is the emotional response to stress?
- Feeling on edge
- Feeling sad
- Irritability
- Tearful
- Over-reacting
what is the cognitive response to stress?
- Difficulty concentrating
- Difficulty ‘switching off’
- Sensitive to criticism
- Self-critical
- Difficulty making decisions
what is the behavioural response to stress?
- Comfort eating/loss of appetite
- Excess drinking/smoking
- Excess activity/underactivity
- Disturbed sleep
what is the physiological response to stress?
- Increased heart rate
- Increased rate of breathing
- Muscles tense for movement
- Increased perspiration
what are some individual factors which influence their response to stress?
- Premorbid personality – if youre a natural worrier or tend to be obsessional
- Prior experience of illness
- Mental state
- Childhood difficulties - e.g. early trauma/chaotic backgrounds, cope less well with difficult treatment regimes, difficult interactions with health professionals
- Appraisal and coping styles
what are some illness factors which influence ones response to stress?
- Immediacy - life threatening
- Uncontrollability - painful
- Ambiguity - regarding outcome/treatment
- Undesirability - unpleasant treatment regimes or disfiguring treatments
what is illness cognition?
a patient’s own implicit common-sense beliefs about their illness. They provide a framework around which a patient understands and copes with their illness.
what are the 5 domains of illness cognition?
the identity (what does the illness mean for the patient and symptoms), the timeline, the consequences, the cause, and the control/cure.
what are the 2 coping strategies?
- Problem solving - Controlling the problem and reconstructing it as manageable.
- Emotion focused coping - managing emotions and maintaining emotional equilibrium.
what do problem-focussed coping strategies include?
- Seeking information
- Seeking support
- Learning new procedures and behaviours e.g. appropriate participation in treatment/lifestyle changes.
- Identifying alternative rewards/new activities
- Developing a realistic action plan
what do emotion-focussed coping strategies include?
- Emotional discharge - Talking about the problem
- Making and maintaining supportive friendships
- Gaining emotional support from e.g. religion
- Resigned acceptance - Coming to terms with the inevitable
when is it likely that a patient would misinterpret physiological symptoms?
when they have a tendency to worry, a mental illness, a previous illness or have illness beliefs from friends/family/media
what are medically unexplained symptoms?
Physical symptoms not explained by organic disease which cause distress and impair functioning and for which there is positive evidence or a strong assumption that the symptoms are linked to psychological factors
why do MUS arise?
- Some MUS may arise from ‘normal’ bodily sensations (physiological processes) with misinterpretation.
- Some MUS may arise from minor pathology and are exaggerated at times of stress.
- Other mechanisms at a neurobiological level.
how can stress impact existing physical illnesses?
stress can cause relapses, loss of control of chronic disease and therefore morbidity
describe the direct impact of stress on existing physical illnesses?
• Stress activates the hypothalamic-pituitary-adrenocortical axis (HPA) causing cortisol secretion and the sympathetic-adrenal-medullary system (SAM) causing cathecholamines secretion.
describe the indirect impact of stress on existing physical illnesses?
- Poor compliance with medication
- Increased alcohol intake
- Increased smoking
- Reduced exercise
- Poor diet
