40-1 What events provoke stress responses, and how do we respond and adapt to stress?

Stress is a slippery concept. We sometimes use the word informally to describe threats or challenges (“Ben was under a lot of stress”), and at other times our responses (“Ben experienced acute stress”). To a psychologist, the dangerous truck ride was a stressor. Ben’s physical and emotional responses were a stress reaction. And the process by which he related to the threat was stress. Thus, stress is the process of appraising and responding to a threatening or challenging event (FIGURE 40.1). Stress arises less from events themselves than from how we appraise them (Lazarus, 1998). One person, alone in a house, ignores its creaking sounds and experiences no stress; someone else suspects an intruder and becomes alarmed. One person regards a new job as a welcome challenge; someone else appraises it as risking failure.

489

When short-lived, or when perceived as challenges, stressors can have positive effects. A momentary stress can mobilize the immune system for fending off infections and healing wounds (Segerstrom, 2007). Stress also arouses and motivates us to conquer problems. In a Gallup World Poll, those who were stressed but not depressed reported being energized and satisfied with their lives. This is the opposite of the lethargy reported by those who were depressed but not stressed (Ng et al., 2009). Championship athletes, successful entertainers, and great teachers and leaders all thrive and excel when aroused by a challenge (Blascovich & Mendes, 2010). Compared with nonleaders, military and business leaders produce lower-than-average levels of stress hormones and report lower anxiety levels (Sherman et al., 2012). Having conquered a major stressor, some people emerge with stronger self-esteem and a deepened spirituality and sense of purpose. Indeed, experiencing some stress early in life builds resilience (Seery, 2011). Adversity can beget growth.

But extreme or prolonged stress can harm us. Demanding jobs that mentally exhaust workers also damage their physical health (Huang et al., 2010). Pregnant women with overactive stress systems tend to have shorter pregnancies, which pose health risks for their infants (Entringer et al., 2011).

So there is an interplay between our heads and our health. That isn’t surprising. Behavioral medicine research provides a reminder of one of contemporary psychology’s overriding themes: Mind and body interact; everything psychological is simultaneously physiological. Before exploring that interplay, let’s look more closely at stressors and stress reactions.

Stressors fall into three main types: catastrophes, significant life changes, and daily hassles. All can be toxic.

CatastrophesCatastrophes are unpredictable large-scale events, such as earthquakes, floods, wildfires, and storms. After such events, damage to emotional and physical health can be significant. In the four months after Hurricane Katrina, New Orleans’ suicide rate reportedly tripled (Saulny, 2006). And in surveys taken in the three weeks after the 9/11 terrorist attacks, 58 percent of Americans said they were experiencing greater-than-average arousal and anxiety (Silver et al., 2002). In the New York area, people were especially likely to report such symptoms, and sleeping pill prescriptions rose by a reported 28 percent (HMHL, 2002; NSF, 2001). Extensively watching 9/11 terrorist attack television footage predicted worse health outcomes two to three years later (Silver et al., 2013).

490

For those who respond to catastrophes by relocating to another country, the stress may be twofold if the trauma of uprooting and family separation combine with the challenges of adjusting to a new culture’s language, ethnicity, climate, and social norms (Pipher, 2002; Williams & Berry, 1991). In the first half-year, before their morale begins to rebound, newcomers often experience culture shock and deteriorating well-being (Markovizky & Samid, 2008). In years to come, such relocations may become increasingly common due to climate change.

Significant Life ChangesLife transitions—leaving home, becoming divorced, losing a job, having a loved one die—are often keenly felt. Even happy events, such as getting married, can be stressful. Many of these changes happen during young adulthood. One survey, in which 15,000 Canadian adults were asked whether “You are trying to take on too many things at once,” found the highest stress levels among young adults (Statistics Canada, 1999). Young adult stress appeared again when 650,000 Americans were asked if they had experienced a lot of stress “yesterday” (FIGURE 40.2).

Some psychologists study the health effects of life changes by following people over time. Others compare the life changes recalled by those who have or have not suffered a specific health problem, such as a heart attack. In such studies, those recently widowed, fired, or divorced have been more vulnerable to disease (Dohrenwend et al., 1982; Strully, 2009). One Finnish study of 96,000 widowed people found that the survivor’s risk of death doubled in the week following a partner’s death (Kaprio et al., 1987). A cluster of crises—losing a job, home, and partner—puts one even more at risk.

Daily HasslesEvents don’t have to remake our lives to cause stress. Stress also comes from daily hassles—spotty phone connections, aggravating housemates, long lines at the store, too many things to do, e-mail and text spam, and loud talkers behind us (Lazarus, 1990; Pascoe & Richman, 2009; Ruffin, 1993). Some people shrug off such hassles. For others, the everyday annoyances add up and take a toll on health and well-being.

Many people face more significant daily hassles. As the Great Recession of 2008– 2009 bottomed out, Americans’ most oft-cited stressors related to money (76 percent), work (70 percent), and the economy (65 percent) (APA, 2010). In impoverished areas—where many people routinely face inadequate income, unemployment, solo parenting, and overcrowding—such stressors are part of daily life.

Daily economic pressures may be compounded by anti-gay prejudice or racism, which—like other stressors—can have both psychological and physical consequences (Lick et al., 2013; Pascoe & Richman, 2009; Schetter et al., 2013). Thinking that some of the people you encounter each day will dislike you, distrust you, or doubt your abilities makes daily life stressful. When prolonged, such stress takes a toll on our health, especially our cardiovascular system. For many African-Americans, stress helps drive up blood pressure levels (Mays et al., 2007; Ong et al., 2009).

491

Medical interest in stress dates back to Hippocrates (460–377 b.c.e.). In the 1920s, Walter Cannon (1929) confirmed that the stress response is part of a unified mind-body system. He observed that extreme cold, lack of oxygen, and emotion-arousing events all trigger an outpouring of the stress hormones epinephrine and norepinephrine from the core of the adrenal glands. When alerted by any of a number of brain pathways, the sympathetic nervous system arouses us, preparing the body for the wonderfully adaptive response that Cannon called fight or flight. It increases heart rate and respiration, diverts blood from digestion to the skeletal muscles, dulls feelings of pain, and releases sugar and fat from the body’s stores.

Since Cannon’s time, physiologists have identified an additional stress response system. On orders from the cerebral cortex (via the hypothalamus and pituitary gland), the outer part of the adrenal glands secrete glucocorticoid stress hormones such as cortisol. The two systems work at different speeds, explained biologist Robert Sapolsky (2003): “In a fight-or-flight scenario, epinephrine is the one handing out guns; glucocorticoids are the ones drawing up blueprints for new aircraft carriers needed for the war effort.” The epinephrine guns were firing at high speed during an experiment inadvertently conducted on a British Airways San Francisco to London flight. Three hours after takeoff, a mistakenly played message told passengers the plane was about to crash into the sea. Although the flight crew immediately recognized the error and tried to calm the terrified passengers, several required medical assistance (Associated Press, 1999).

Canadian scientist Hans Selye’s (1936, 1976) 40 years of research on stress extended Cannon’s findings. His studies of animals’ reactions to various stressors, such as electric shock and surgery, helped make stress a major concept in both psychology and medicine. Selye proposed that the body’s adaptive response to stress is so general that, like a single burglar alarm, it sounds, no matter what intrudes. He named this response the general adaptation syndrome (GAS), and he saw it as a three-phase process (FIGURE 40.3). Let’s say you suffer a physical or an emotional trauma.

492

Selye’s basic point: Although the human body copes well with temporary stress, prolonged stress can damage it. Childhood stress gets under the skin, leading to greater adult stress responses and disease risk (Miller et al., 2011). The brain’s production of new neurons also slows and some neural circuits degenerate (Dias-Ferreira et al., 2009; Mirescu & Gould, 2006). One study found shortening of telomeres (DNA pieces at the ends of chromosomes) in women who suffered enduring stress as caregivers for children with serious disorders (Epel et al., 2004). Telomere shortening is a normal part of the aging process; when telomeres get too short, the cell can no longer divide and it ultimately dies. The most stressed women had cells that looked a decade older than their chronological age, which helps explain why severe stress seems to age people. Even fearful, easily stressed rats have been found to die sooner (after about 600 days) than their more confident siblings, which average 700-day life spans (Cavigelli & McClintock, 2003).

There are other ways to deal with stress. One option is a common response to a loved one’s death: Withdraw. Pull back. Conserve energy. Faced with an extreme disaster, such as a ship sinking, some people become paralyzed by fear. Another option (found often among women) is to give and seek support (Taylor et al., 2000, 2006). This tend-and-befriend response is demonstrated in the outpouring of help after natural disasters.

Facing stress, men more often than women tend to withdraw socially, turn to alcohol, or become aggressive. Women more often respond to stress by nurturing and banding together. This may in part be due to oxytocin, a stress-moderating hormone associated with pair bonding in animals and released by cuddling, massage, and breast feeding in humans (Campbell, 2010; Taylor, 2006). Brain scans reflect such stress-response differences: In women, areas important for face processing and empathy become more active; in men, these areas become less active (Mather et al., 2010).

It often pays to spend our resources in fighting or fleeing an external threat. But we do so at a cost. When stress is momentary, the cost is small. When stress persists, the cost may be much higher, in the form of lowered resistance to infections and other threats to mental and physical well-being.