Stress and Illness

Each and everyday we come in contact with billions of germs. Each germ is capable of bringing about illness. Although everyone comes in contact with germs, not everyone becomes ill. Some people come in contact with billions of germs and never become ill. It's as if they are totally immune to contracting any type of illness. Other people seem to become ill just at the mere thought of germs. Its almost as if they are a magnet for illness. Germs may be necessary in order for us to become ill, but are they sufficient to make us ill? It is not only necessary for a germ to be present; other factors are necessary in order for a person to become ill. What makes some people more susceptible to illness than others? Several factors are related to the development of illness. Among the factors related to the development of illness are stress, coping style, and social support. Stress Everyday we are confronted with problems. When we are confronted with a problem we must determine the seriousness of the problem and determine whether or not we have the resources (e.g., emotional resources) necessary in order to cope with problem. If we believe that the problem is serious and we also believe that we do not have the resources necessary to cope with the problem, we will perceive ourselves as being under stress (Cohen et. al., 1995). Stress can be defined as a process in which environmental demands strain an organisms adaptive capacity, resulting in both psychological as well as biological changes that could place a person at risk for illness (Cohen et. al., 1995). Things that cause us stress are called stressors (Rubin, Paplau, & Salovey, 1993). Many events can be thought of as stressors. These include disasters, life crises, life changes, and daily hassles (Rubin, Paplau, & Salovey, 1993). Examples of stressors include: hurricanes, earthquakes, disease, divorce, unemployment, marriage, and traffic jams. Stressors are things that interfere with an important personal goal (Rubin, Paplau & Salovey, 1993). The more important the goal is, the more stress a person will feel when that goal is threatened (Rubin, Paplau & Salovey, 1993). So for example, if it's important to a person to get to class on time, the person will feel stress if he gets caught in traffic. The goal is to get to class on time and the stressor is the traffic jam. The more important it is for the person to be on time, the more stressful the traffic jam will be. So, a person is likely to feel more stress on the day when an exam is given and there is a traffic jam, than he will feel when no exam is given and there is a traffic jam. Three Theories of Stress. Stress affects everyone, young and old, rich and poor. Life is full of stress. There is work stress, school stress, financial stress, and emotional stress, to name a few. There are three theories or perspectives regarding stress. There is the environmental stress perspective, the psychological stress perspective, and the biological stress perspective. The environmental stress perspective emphasizes assessment of environmental situations or experiences that are objectively related to substantial adaptive demands (Cohen et. al., 1995). The psychological stress perspective emphasizes people's subjective evaluations of their ability to cope with the demands presented to them by certain situations and experiences (Cohen et. al., 1995). Finally, the biological stress perspective emphasizes the activation of certain physiological systems in the body that have been shown time and time again to be regulated by both psychologically and physically demanding conditions (Cohen et. al., 1995). Stress and Biology. Stress is not necessarily a bad thing. A certain amount of stress is natural. None of us live stress free lives. However, while a certain amount of stress is normal, chronic negative stress may be harmful to our health. Thomas Holmes asserted that any and all change is stressful because it forces individuals to adapt to new, unfamiliar circumstances (Brehm & Kassin, 1993). Holmes acknowledged that some changes require more of an adjustment than other changes (Brehm & Kassin, 1993). Holmes believes that the change resulting from both positive (e.g., marriage, promotion, graduation) and negative (e.g., divorce, unemployment) life events are stressful and may possibly do harm to an individual's health (Brehm & Kassin, 1993). When an individual is faced with stress, his body mobilizes for action in what is called a fight or flight reaction (Rubin, Paplau, & Salovey, 1993). During a fight or flight reaction, the heart rate increases, breathing is accelerated, and the muscles tense up as if in preparation to throw something like a rock (fight) or to run away (flight) (Rubin, Paplau, & Salovey, 1993). For example, when approached by a thief, you can either fight him or you can try to run away from him. When an individual identifies a threat, activity in the sympathetic nervous system rises and the adrenal glands release the hormones epinephrine (or adrenaline) and norepinephrine into the blood stream (Rubin, Paplau, & Salovey, 1993). At the same time, corticosteriod hormones which release fatty acids for energy, are released by the adrenal glands (Rubin, Paplau, & Salovey, 1993). This nervous-system and hormonal activity causes digestion to stop, blood sugar levels to increase, and the heart to pump more blood to the muscles (Rubin, Paplau, & Salovey, 1993). All of these reactions are not unlike the physiological aspects of strong emotions, like fear and anger (Rubin, Paplau, & Salovey, 1993). Spangler and Schieche (1998) examined the biobehavioral organization of infants with various qualities of attachment. Quality of attachment (security & disorganization), emotional expression, and adrenocortical stress reactivity were investigated in 12-month-old infants observed during Ainsworth's Strange Situation. They found that securely attached infants did not show an adrenocortical response. However, interestingly, adrenocortical activation during the Strange Situation was found for the insecure-ambivalent group, but not for the insecure-avoidant group. Pruessner, Hellhammer, and Kirschbaum (1999) studied the effects of burnout and perceived stress on early morning free cortisol levels after awakening. They found that higher levels of perceived stress were related to stronger increases in cortisol levels after awakening after a low dose dexamethasone pretreatment the previous night. Stress and Illness. If stress persists after the initial fight or flight reaction, the body's reaction enters a second stage (Rubin, Paplau, & Salovey, 1993). During this stage, the activity of the sympathetic nervous system declines and epinephrine secretion is lessened, but corticosteriod secretion continues at above normal levels (Rubin, Paplau, & Salovey, 1993). Finally, if the stress continues and the body is unable to cope, there is likely to be breakdown of bodily resources (Rubin, Paplau, & Salovey, 1993). It is in this stage that there may be a reduction of the levels of epinephrine and norepinephrine in the brain, a state related to depression (Rubin, Paplau, & Salovey, 1993). Stressful life events are related to the risk of infected individuals developing an illness (Cohen et. al., 1998). Traumatic stressful events may trigger either behavioral or biological processes that contribute to the onset of disease. Chronic stress has been associated with increased reports of illness. Long-term exposure to chronic stress may facilitate the development of illness during exposure to stress (Cohen et. al., 1995). Exposure to chronic stress may results in permanent or at the very least long-term psychological, biological, or behavioral responses that alter the progression of illness (Cohen et. al., 1995). Cohen et. al. (1998) found that those who had either a work related or interpersonal chronic stressors (defined as stress lasting one month or longer) had an increased risk of developing colds compared to those who had no chronic stressor. In addition, the longer the stress endured, the more likely a person was to become ill. Cohen, Doyle, and Skoner (1999) found that psychological stress predicted a greater expression of illness and a greater production of interleukin-6 in response to an upper respiratory infection. Finally, Zarski (1984) found no correlation between life experiences and health status. However, life experiences were significantly correlated with somatic symptoms and energy level. Overall health status was highly correlated with somatic symptoms. Coping Style In addition to stress, coping style is also related to the development of illness. Coping has been defined as the behavioral and cognitive efforts a person uses to manage the demands of a stressful situation (Chang & Strunk, 1999). There are several methods of coping. Feeling in Control as a Way of Coping. Both animals as well as people cope better with a painful or threatening situation when they can exercise some sort of control over the situation (Rubin, Paplau, & Salovey, 1993). For example, suppose you are overweight and your doctor tells you that it is because you have a genetic disorder. You have no control over your situation. This may be very stressful for you. However, suppose now that you are overweight but your doctor tells you that with diet and exercise you can lose the weight. This situation may be less stressful for you because you know that you can do something about your weight. Just knowing that you can control your weight makes the situation less stressful than if you were unable to control your weight. Even when you can not control unpleasant events, they tend to be less stressful if they are predictable, that is if you know they are coming (Rubin, Paplau, & Salovey, 1993). So, knowing that traffic will be heavy on the 405 freeway at 8:00 am is less stressful than when traffic is heavy at 3:00 am because you expect traffic to be heavy at 8:00 am but not at 3:00 am. Optimism and Pessimism Coping Style. Some people seem predisposed to believe that they can maintain control over stressful situations. These people are said to have an optimistic coping style (Rubin, Paplau, & Salovey, 1993). Other people have a pessimistic coping style, they view the world as an uncontrollable, unpredictable place in which they will never be able to gain control over things that bother them (Rubin, Paplau, & Salovey, 1993). Approach and Avoidant Coping. Approach coping is when the person focuses on both the sources of the stress as well as the reactions to it (Chang & Strunk, 1999). Avoidant coping means that the person neither focuses on the source of the stress nor does the he focus on his reactions to stress (Chang & Strunk, 1999). Appraisal and Coping. A key component to people's reactions to stress is how they appraise or think about a potentially stressful situation (Rubin, Paplau, & Salovey, 1993). What may be stressful for one person may not be stressful for another person. For example, one person may see going to college as a stressful experience. He may be anxious about living away from home for the first time. He may be worried about making new friends and doing well in school. Another person may see going to college as the beginning of a new, fun adventure. He may be excited about living away from home for the first time and making new friends. He may confident that he can do very well in school. Both of these people experiences the same event (going to college), but for one person the event was stressful, while for the other it was not stressful. When faced with potential stressors (like going to college) we appraise the situation to determine if it is threatening to our well-being (Rubin, Paplau, & Salovey, 1993). If there is a threat, we need to evaluate the personal resources at our command in order to meet the demands of the situations (Rubin, Paplau, & Salovey, 1993). In other words, when faced with a stressful situation, we need to determine if we have the ability to cope or not. Primary and Secondary Appraisals. There are two types of appraisals, primary and secondary. Primary appraisals refer to a set of cognitions regarding the importance of a stressful situation for a person (Chang & Strunk, 1999). Secondary appraisals are a set of cognitions concerning an individual's resources for dealing effectively with situation (Chang & Strunk, 1999). Both appraisals affect a person's ability to cope and adjust to stressful situations. Chang and Strunk (1999) examined the direct and indirect influences of dysphoria (expressions of depressive symptoms) on primary and secondary appraisals, coping, and psychological and physical adjustment. They found that dysphoria was positively associated with primary appraisals, disengaged coping, and physical symptoms. In contrast, dysphoria was negatively associated with secondary appraisals and life satisfaction. Higher scores on primary appraisals were related to an increased use of engaged coping strategies. Primary appraisals were also positively associated with disengaged coping activities. In contrast, higher scores on secondary appraisals were related to an increased use of engaged coping activities and a decreased use of disengaged coping activities. Higher scores on secondary appraisals were related to greater life satisfaction and less physical symptoms. Similarly, increased use of disengaged coping was related to more physical symptoms. However, it is important to realize that engaged coping was not related to life satisfaction or to physical symptoms. Amirkhan (1998) examined attributions as predictors of coping and distress. He found that failures that were attributed to internal, unstable, and controllable factors lead to active efforts to resolve the problem or rally social support, responses that proved adaptive in lowering subjective distress and stress related pathology. On the other hand, failures attributed to external, stable, and uncontrollable forces lead to avoidant and escapist responses, which exacerbated distress and illness. Reappraisal as a Way of Coping. In order to cope effectively, it usually helps to reappraise a situation as a challenge or an opportunity rather than as a threat (Rubin, Paplau, & Salovey, 1993). For example, suppose you are on your was to a very important interview and you get stuck in traffic. You might think to yourself that this is terrible, this is a very important interview. If you miss it you won't get the job and you're life will be over. You should have left earlier. You should have checked the traffic report before you left. These types of appraisals are going to lead to stress. On the other hand, suppose that instead of thinking the worst, you had a more positive attitude. You night decide that this interview really isn't that important. Its only one interview, if you miss it, they'll be others. So what if you don't get this job, life will go on. You're going to be fine. If you appraise the situation this way, you're likely to feel a lot less stressed. Repressive Coping. Having a repressive coping style is also related to the development of illness. Events only influence people who appraise the events as stressful (Chang & Strunk, 1999). People with a repressive coping style neither experience nor express stressful events. They are less likely to report chronic stress and inadequacy of family and social support than those who do not have a repressive coping style (Jensen, 1987). Those with a repressive coping style consistently report good psychological reactivity to stress and greater health problems in some studies. For example, Jensen (1987) examined the relationship between psychological factors and the course of breast cancer. The study found that repressive coping style was more likely to be seen among those who had a history of cancer and was most likely to be seen among those whose cancer was advanced. Repressive copers reported little distress or emotional complications. Yet, they have the worst outcomes for cancer among the groups studied. Eleven participants died from breast cancer, eight of which were repressive copers. Social Support Social support can protect individuals from the effects of stress on health. Fukunishi et. al. (1999) examined coping with stress, including social support, dealing with illness, and mood states among people not yet diagnosed as having glucose tolerance abnormality. They found that that poor utilization of social support was related to the onset of glucose tolerance abnormality. It seems that patients with glucose tolerance abnormality are unable to adequately utilize social support to cope with stress, even though they receive and perceive social support. Glynn, Christenfeld, and Gerin (1999) examined gender, social support, and cardiovascular responses to stress. Male and female participants gave a speech and received either supportive or nonsupportive feedback form a male or female confederate. They found that social support from a female was more effective at lowering blood pressure responses to stress in both males and females than support from a male. Finally, Cohen et. al. (1997) conducted a study examining the relationship between diversity of social ties (having more than one type of social tie) and susceptibility to colds. They found that the rate of colds decreased with increased social diversity. In other words, the more diverse a person's social network was, the less likely that the person was to get a cold. Why might social networks protect people from the harmful effects of stress? One possible explanation lies in a person's ability to perceive stress. A person may not see a potentially harmful event as stressful if he believe that his social network will help him to cope (Cohen et. al., 1995). It is possible that having social ties reduces the amount of stress a person experiences and therefore, reduces his risk of infectious illness. Conclusions In conclusion, everyday we come in contact with billions of germs. Each one is capable of making us ill. Some people are more susceptible to illness than are others. Germs are necessary but not a sufficient cause of illness. Other factors are necessary in order for a person to become ill. Among the factors related to the development of illness are stress, coping style, and social support. Chronic negative stress increases our chances of becoming ill. Coping style can decrease or increase our risk of illness. Engaged coping can lead to a decrease in illness; whereas, disengaged coping can lead to an increase in illness (Chang & Strunk, 1999). Having an increased number of social ties lowers the risk of developing colds (Cohen et. al., 1997). In sum, stress can increase our susceptibility to illness. While coping style and social support can decrease our susceptibility to illness. References • • • • • • • • • Amirkhan, James H. (1998). Attributions as predictors of coping and distress. Personality and Social Psychology Bulletin, 24(9):1006-1018. Brehm, S. & Kassin, S. (1993). Health. In DeRocco, M.; Granoff, S.; & Horn, C. (Eds). Social Psychology, 2nd Edition. (pp. 647-680). Boston, MA: Houghton Mufflin Company. Chang, Edward & Strunk, Daniel R. (1999). Dsyphoria: Relations to appraisals, coping, and adjustment. Journal of Counseling Psychology, 46(1):99-108. Cohen, Sheldon; Doyle, William, J.; & Skoner, David P. (1999). Psychological stress, cytokine productions, and severity of upper respiratory illness. Psychosomatic Medicine, 61(2):175-180. Cohen et. al. (1998). Type of stressors that increase susceptibility to the common cold in healthy adults. Health Psychology, 17(3):214-233. Cohen, S. et. al. (1997). Social ties and susceptibility to the common cold. Journal of the American Medical Association, 277:1940-1944. Cohen, S.; Kessler, R.C.; & Gordon, L.U. (1995). Strategies for measuring stress in studies of psychiatric and physical disorders. In Cohen, S.; Kessler, R.C.; & Gorden, L.U. (Eds). Measuring Stress. A Guide for Health and Social Scientists. Oxford: Oxford University Press. Fukunishi et. al. (1998). Stress, coping, and social support in glucose tolerance abnormality. Journal of Psychosomatic Research, 45(4):361-369. Glynn, Laura; Christenfeld, Nicholas; & Gerin, William (1999). Gender, social support, and cardiovascular responses to stress. Psychosomatic Medicine, 61(2):234-242. • • • • • • Jensen, M.R. (1987). Psychobiological factors predicting the course of breast cancer. Journal of Personality, 55(2):317-342. Myers, Tricia Cook; Wittrock, David A.; & Foreman, Gregory W. (1998). Appraisal of subjective stress in individuals with tension-type headaches: The influence of baseline measures. Journal of Behavioral Medicine, 21(5):469484. Pruessner, Jens C.; Hellhammer, Dirk; & Kirschbaum, Clemens. (1999). Burnout, perceived stress, and cortisol responses to awakening. Psychosomatic Medicine,, 61 (2): 197-204. Rubin, Z.; Peplau, L.A.; & Salovey, P. (1993). Psychology and Health. In DeRocco, M.; Mancuso, T.; & Piland, S. (Eds). Psychology. (pp. 426-432). Boston, MA: Houghton Mufflin Company. Spangler, Gottfried & Schieche, Michael (1998). Emotional and adrenocortical responses of infants to the strange situation: The differential function of emotional expression. International Journal of Behavioral Development, 22(4):681-706. Zarski, J. (19984). Hassles and health: A replication. Health Psychology, 3(3):243-241.