DRIVE When Eric Flansburg first enrolled in the police academy at Onondaga Community College in upstate New York, there were 21 students in his class. Of those 21, only 6 graduated. Eric was not among them. Why? Because he failed one very important test: the Emergency Vehicle Operations Course (EVOC).

The EVOC requires exceptional driving skills. The test involves weaving a police car in and out of a zigzag maze of cones and making superfast lane changes—just the kind of police chase maneuvering you see in the movies. Once you get to the end of the course, you have to do it all over again, but this time in reverse. Knock down one cone, or simply brush against it, and you fail. Exceed the allotted 2 minutes and 20 seconds, and you fail. “It’s pretty intense driving,” Eric says. “It’s also fun.”

Going into the test, Eric was well prepared. He had learned and rehearsed the steering and breaking techniques needed to succeed. But when the time came to put his hard-earned skills to work, he faltered. “It was all mental,” Eric says. “I totally psyched myself out. I was so scared of failing that I failed.” There are no two ways about it: Eric was feeling the stress of the situation.

Note: Quotations attributed to Eric Flansburg and Kehlen Kirby are personal communications.

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LO 1 Define stress and stressors.

We all have an intuitive sense of what stress is, and many of us are more familiar with it than we would like. But what exactly is stress, where does it come from, and how does it affect our physical and mental health? Some people report they experience the feeling of stress, almost as if stress were an emotion. Others describe stress as if it were a force that needs to be resisted. An engineer might refer to stress as the application of a force on a target, such as the wing of an airplane, to determine how much load it can handle before breaking (Lazarus, 1993). Do you ever feel you might “break” because the load you bear causes such great strain (Infographic 11.1)?

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Here, stress is defined as the response to perceived threats or challenges resulting from stimuli or events that cause strain, analogous to the airplane wing bending because of an applied load. For humans, these stimuli, or stressors, can cause psychological, physiological, and emotional reactions. As you read this chapter, be careful not to confuse how we react to stressors with the stressors themselves; stress is the response and stressors are the cause (Harrington, 2013). Hans Selye (sěl’yě; 1907–1982), an endocrinologist who studied the impact of hormones and stress, proposed that “stress is the nonspecific response of the body to any demand. A stressor is an agent that produces stress at any time” (1976, p. 53).

There are countless types of stressors. They can be events, such as police academy driving tests, or beliefs and attitudes, like Eric’s thoughts and worries about not passing the test. Stressors can even be people, like the drill instructors who run the police academy’s Saturday morning physical training. Starting at 6:00 A.M., these guys lead Onondaga’s aspiring police officers through 3 hours of running, push-ups, and other backbreaking exercises. If a student makes one mistake, the drill instructors are more than happy to point it out with the full force of their lungs. Mind you, this is all for the cadet’s own benefit. Police officers must learn how to brush off rude comments, maintain their composure, and carry on with their duties.

What are the stressors in your life? Some exist outside of you, like homework assignments, dirty dishes in the sink, and job demands. Others are more internal, like the anxiety stemming from a strained relationship or the pressure of wishing to excel. Generally, we experience stress in response to stressors, although there is at least one exception to this rule: People with anxiety disorders can feel intense anxiety in the absence of any apparent stressors (Chapter 12). Which brings us to another point: Stress is very much related to how one perceives the surrounding world.

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In many cases, stress results from a perceived threat, because what constitutes a threat differs from one person to the next. The police academy driving test might have been threatening to Eric because he felt anxious about failing, while another student viewed the test as an opportunity to shine. Similarly, Eric may have felt completely relaxed taking written exams that other students found highly threatening.

Remember that stress can have psychological, physiological, and emotional effects. Eric’s physiological reaction to the driving test may have included increased blood pressure and heart rate, but he was far more aware of the psychological and emotional components of his stress response. Bursting through the starting gates, his mind raced from one thought to the next. He was envisioning every little thing he needed to do to pass the exam and at the same time saying to himself, Eric, Eric, you can’t fail.

The very same day that Eric failed his driving test, he resolved to return to the academy and start the program again. This minor setback was not going to interfere with his childhood dream of becoming a police officer, and there was no way it was going to define his experience at the academy. “When you fall down, you have to get back up,” Eric says. “That’s the only way to move forward in life.”

Not all people would have responded this way; plenty would have viewed the test as the end of their journey. (I guess I was never meant to be a police officer.) As you will learn in this chapter, the ways people experience and cope with stressors are highly variable. The strategies used and the beliefs about one’s ability to cope have a profound impact on reactions to stress.

EUSTRESS AND DISTRESS Clearly, stressors cannot be avoided completely. And some stressors are enjoyable: we feel excitement before a big trip or the birth of a new baby. For Eric, getting married and witnessing the birth of his first child were among the most stressful and joyful events in life. “Oh man, you want to talk about sweaty palms, me shaking, and a whole lot of emotion?” he says, remembering the day he stood at the altar. And the birth of his son? “Unreal,” he says. Immediately after the delivery, doctors placed his son on his wife’s chest. The baby’s eyes were still closed, but when he opened them, Eric was the first person he saw. It was the proudest moment of Eric’s life. This “good” kind of stressor leads to eustress (yōōˈ-stres), which is the stress response to agreeable or positive events. Of course, most people associate stress with negative events. These types of undesirable or disagreeable occurrences lead to the particular stress response known as distress. Now let’s find out how eustress and distress might affect your health.

LO 2 Describe the Social Readjustment Rating Scale in relation to life events and illness.

Holmes and Rahe (1967) were among the first to propose that life-changing events are potentially stressors. In other words, any event that requires a life adjustment, such as marriage, the birth of a child, or a change in financial status, can cause a stress reaction. They also suggested that these life-changing events have a cumulative effect; the more events you experience in a row or within a brief period of time, the greater the potential for an increased stress reaction and negative health outcomes. Numerous studies have examined these types of events and the strain they cause. Think back to the analogy of applying a force to the wing of an airplane. The degree to which the wing bends (or breaks) indicates the strain it is under (Lazarus, 1993). Researchers have found links between certain life events (the force causing strain) and illnesses (the response) such as sudden cardiac death, heart attack, leukemia, diabetes, influenza, psychiatric disorders, and a variety of other conditions (Hatch & Dohrenwend, 2007; Rabkin & Struening, 1976).

SOCIAL READJUSTMENT RATING SCALE Illnesses can be clearly defined and identified, but how do psychologists measure life events? Holmes and Rahe (1967) developed the Social Readjustment Rating Scale (SRRS) to do just that. With the SRRS, participants are asked to read through a list of events and experiences, and determine which of these happened during the previous year and how many times they occurred. A score is then calculated based on severity ratings of events and the frequency of their occurrence. An event like the death of a spouse has a greater severity rating than something like a traffic violation. Participants are also asked to report any illnesses or accidents they experienced during the same period. Researchers then use this information to look at the correlation between life events and health problems (Kobasa, 1979). Correlations range between .20 and .78, although they are generally lower than .30 (Rabkin & Struening, 1976). But remember, a correlation between life events and illness (or any correlation for that matter) is no proof of causality. There is always the possibility that a third factor, such as poverty, may be causing both illnesses and major life-changing events. Someone who is impoverished might not have employment or access to good health care, nutrition, and so forth. In this case, poverty is leading to stressful life events and poor health outcomes.

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First used in the late 1960s, the SRRS has been updated over the years. (For example, the original scale included “mortgage over $10,000” as an event.) The rating scale has also been adapted to better match the life events of specific populations; an example is the College Undergraduate Stress Scale (CUSS; Renner & Mackin, 1998; Figure 11.1). Even with this degree of specificity, the scale may not be suitable for every person. In addition to dealing with term papers, midterms, and other college-related life events, many of today’s college students face a host of other potential stressors, such as making car payments and raising children.

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Another possible problem with self-report scales such as the SRRS and the CUSS is that people tend to forget events over time, or the opposite—they tend to focus more on past events than recent ones (Pachana, Brilleman, & Dobson, 2011). What’s more, not all negative life-changing events lead to bad outcomes. Some have even suggested that moderate exposure to stress makes us stronger, a view described as stress inoculation. Someone with a “low to moderate” degree of stress may end up with “better mental health and well-being” and a greater ability to cope with pain than those who either have faced no hardships or have had to handle an overwhelming level of adversity (Seery, 2011).

Looking across cultures, we see most people rate the weight of life-changing events very similarly (Leontopoulou, Jimerson, & Anderson, 2011; Scully, Tosi, & Banning, 2000). For example, people from France, Belgium, Switzerland, and Malaysia are similar to Americans in their views about the readjustment required for life events (Harmon, Masuda, & Homes, 1970; Woon, Masuda, Wagner, & Holmes, 1971).

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One type of event not included in the SRRS, but which is familiar to police officers and other first responders, is a major disaster experience. These cataclysmic events include natural disasters such as hurricanes, earthquakes, and tornadoes, as well as multicar accidents, war, and terrorist attacks. The emotional and physical responses to such occurrences can last for many years, manifesting themselves in nightmares, flashbacks, depression, grief, anxiety, and other symptoms related to posttraumatic stress disorder.

In order to be diagnosed with posttraumatic stress disorder (PTSD), a person must be exposed to or threatened by an event involving death, serious injury, or some form of sexual violence. Someone could develop PTSD after witnessing a violent assault or accident, or upon learning about the traumatic experiences of family members, close friends, perhaps even strangers. In some cases, the exposure to trauma is ongoing. First responders like Eric, for example, may witness disturbing scenarios on a weekly basis. For veterans and service members previously deployed to war zones in Afghanistan and Iraq, the estimated incidence of PTSD is 13.8%, based on a study of almost 2,000 participants questioned about their symptoms (Schell & Marshall, 2008). In contrast, around 3.5% of the general population is estimated to have received a PTSD diagnosis during the previous 12 months (American Psychiatric Association, 2013).

However, not everyone exposed to trauma will develop PTSD. Over the course of a lifetime, most people will experience an event that qualifies as a “psychological trauma,” but only 5–10% will actually develop PTSD as a result (Bonanno, Westphal, & Mancini, 2011). To be diagnosed with PTSD, a person must experience at least one of the following symptoms: (1) distressing, disturbing, and spontaneously recurring memories of an event; (2) dreams with content or emotions associated with the event; (3) “dissociative reactions” that include feeling as if the event is happening again (flashbacks); (4) extreme psychological distress when reminded of the event; or (5) obvious physical reactions to cues related to the event.

Many people with PTSD try to avoid environmental cues (people, places, or objects) linked to the trauma. If someone were involved in a serious car accident on U.S. Highway 101, then simply driving along that thoroughfare may trigger unwanted memories. Other symptoms include difficulty remembering the details of the event, unrealistic self-expectations, ongoing self-blame, and loss of interest in activities that once were enjoyable. Someone with PTSD might be irritable or aggressive, lashing out at loved ones for no apparent reason. She may have trouble sleeping and concentrating. Also associated with PTSD are dissociative symptoms, which may include distorted perceptions of the world, and the feeling of observing oneself from the outside (American Psychological Association, 2013d; Friedman, Resick, Bryant, & Brewin, 2011).

Among those at risk for PTSD are police officers (Berger et al., 2011), many of whom bear witness to bloody crime scenes, traumatized victims, and gun violence. But it is not just these types of traumas that impact police officers; just as important are the more chronic stressors, like being overworked, having unpleasant relationships with colleagues, and not getting enough time with family (Collins & Gibbs, 2003; Maguen et al., 2009).

You don’t have to be a police officer to appreciate the burden of everyday stress. For some of us, stressors come from balancing school and work, or taking care of young children. Many face the constant stressor of battling a chronic illness like diabetes, asthma, or cancer (Sansom-Daly, Peate, Wakefield, Bryant, & Cohn, 2012), or caring for an adult child with a severe mental disorder (Barker, Greenberg, Seltzer, & Almeida, 2012). For some 35 million people and their families (World Health Organization [WHO], 2015), living with HIV provides a host of different stressors.

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HIV AND AIDS One of the most feared sexually transmitted infections (STIs), human immunodeficiency virus (HIV) is spread through the transfer of bodily fluids (such as blood, semen, vaginal fluid, or breast milk). Often the virus does not show up on blood tests for up to 6 months after infection, so you cannot assume you are “safe” just because you receive a negative test result—hence, the importance of having protected sex. HIV eventually progresses to acquired immune deficiency syndrome (AIDS), which generally results in a severely compromised immune system. A weakened immune system makes the body much more susceptible to opportunistic infections caused by bacteria, viruses, or fungi, and this vulnerability increases as the disease progresses.

HIV has taken an enormous toll on human life. Since the virus was first identified in 1981, it has infected nearly 78 million people, about half of whom have died (WHO, 2015). Worldwide, HIV is a leading cause of death, and in sub-Saharan Africa it is the leading killer (Kendall, 2012, June). Approximately 1.2 million people in the United States have HIV, and some 20% of them likely do not know they are infected (Hoppel, 2012).

What comes to mind when you think of stressors associated with HIV? Perhaps you imagine receiving the diagnosis, sharing the news with loved ones, or facing the possibility of developing AIDS. Did you think about the cost of treatment? HIV medications are very expensive, approximately $20,000 per year per person in the United States. And because of funding shortfalls, some 2000 Americans may not be getting the therapies they need (Maxmen, 2012). The problem is global. In 2010, 7.6 million HIV sufferers around the world could not gain access to treatment (Granich et al., 2012). This inability to pay for proper medical treatment relates to a stressor that is even more widespread than HIV: poverty.

LO 3 Summarize how poverty, adjusting to a new culture, and daily hassles affect health.

POVERTY The number of Americans living at or below the poverty line is significant. As of 2011, 22% of children under 6 years in the United States were living below the poverty level (Addy, Engelhardt, & Skinner, 2013). People struggling to make ends meet experience numerous stressors, including poor health care, lack of preventive health care, noisy living situations, overcrowding, violence, and underfunded schools (Blair & Raver, 2012; Mistry & Wadsworth, 2011). The cycle of poverty is difficult to break, so these stressors often persist across generations. The longer people live in poverty, the more exposure they have to stressors, and the greater the likelihood they will become ill (Miller, Chen, & Parker, 2011). For children in particular, the impact of socioeconomic status (SES) can have lifelong repercussions because environmental stressors affect the developing brain. Some of the factors associated with low SES and permanent changes to the brain include poor nutrition, toxins in the environment, and abuse. In some cases, these irregularities in brain development may lead to differences in “adult neurocognitive outcomes” (D’Angiulli, Lipina, & Olesinska, 2012, September 6). Factors linked to poverty have been associated with “inequalities” in the development of cognitive and socioemotional abilities, which can impact performance in school and at work (Lipina & Posner, 2012, August 17).

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ACCULTURATIVE STRESS Another increasingly common source of stress is migration. As of 2013, there were 232 million migrants dispersed across the world (United Nations Population Fund, n.d., para. 1). These people may deal with varying degrees of acculturative stress (ə⌍kəl-chə⌏rā-tiv), or stress associated with adjusting to a new way of life. How would it feel to leave behind your extended family and close friends, and move to a foreign land where the language, customs, holidays, and belief systems are new and different? Perhaps you have had this experience; about 1 in 8 people living in the United States was born in another country (United States Census Bureau, 2013, February 13).

There are various ways people respond to acculturative stress (Berry, 1997). Some try to assimilate, letting go of old ways and adopting those of the new culture. But assimilation can cause problems if family members or friends from the old culture reject the new one, or have trouble assimilating themselves. Another approach is to cling to one’s roots and remain separated from the new culture. This can be very problematic if the new culture does not support this type of separation and requires assimilation. A combination of these two approaches is integration, or holding on to some elements of the old culture, but also adopting aspects of the new one.

The degree of acculturative stress varies greatly from one individual to the next. Some people thrive on new soil (a prime example being Mohamed Dirie from Chapter 9), while others struggle with the stress of starting over. What determines the intensity of acculturative stress, and why do some people seem to have an easier time with it than others?

across the WORLD

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The stresses of acculturation tend to be gnawing and constant, but some stressors are sudden and dramatic. These are the types that ambulance drivers and paramedics encounter every day. Welcome to the world of Kehlen Kirby.

Daily hassles are the minor problems or irritants we deal with on a regular basis, such as traffic, financial worries, misplaced keys, messy roommates—a list that does not seem to end. These hassles, although seemingly minor, are repetitive and ever present. The strain of dealing with them can add up, potentially taking a toll on our health and well-being (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; DeLongis, Folkman, & Lazarus, 1988). For example, research suggests that hassles are closely associated with short-lived illnesses, such as colds and headaches (Bottos & Dewey, 2004; DeLongis et al., 1988; Pedersen, Zachariae, & Bovbjerg, 2010). It’s a good thing that the weight of our daily hassles is counterbalanced by the uplifts in our lives.

Uplifts are positive experiences that have the potential to make us happy. Think about the last time you smiled; it was likely in response to an uplift, such as a funny text from a friend, a child presenting you with a handmade gift, or a congratulatory e-mail about one of your achievements. We all have hassles and uplifts, but how do they interact to affect our health and well-being? Researchers have been asking this question for decades.

DeLongis and colleagues (1988) developed a scale of daily hassles and uplifts, and used it to explore the relationship between stress and illness (Figure 11.2). They asked participants to read through a list of 53 items that could be either hassles or uplifts, such as meeting deadlines, maintaining a car, interacting with fellow workers, and dealing with the weather. Participants then rated these items on a 4-point scale indicating “how much of a hassle” and “how much of an uplift” each was on that particular day (0 = none or not applicable, to 3 = a great deal). They also asked participants to report any illness, injuries, or symptoms they experienced that same day. What did they find? Over a 6-month period, there was a significant link between hassles and health problems. The more daily stressors the participants reported, the more likely they were to suffer from sore throats, headaches, influenza, back problems, and other health issues. More recently, researchers uncovered a link between daily stressors and cardiovascular risk factors, such as high blood pressure (Uchino, Berg, Smith, Pearce, & Skinner, 2006). Daily hassles also increase the risk of catching contagious diseases and may prolong the course of illness (Glaser & Kiecolt-Glaser, 2005).

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How do hassles and uplifts affect psychological and social health? One group of researchers studied two Israeli populations (Jewish and Arab), exploring the similarities and differences within subgroups living in the same country. While differences existed, the researchers noted some important similarities. In both groups, for example, daily uplifts had a positive impact on “family satisfaction” and daily hassles had a negative impact on “life satisfaction,” though the meaning of “uplift” differed between the two groups (Lavee & Ben-Ari, 2008).

Now that we have explored various types of stressors, from major life events to everyday annoyances, let’s find out what occurs in the body and brain when we respond.

Question 1

Question 2

1. aging

2. levels of eustress

3. perceived threats

4. illness

Question 3

1. Eustress

2. Acculturative stress

3. Uplifts

4. Posttraumatic stress disorder

Question 4