IV Semester – HEALTH PSYCHOLOGY

Unit III - A

STRESS, COPING AND PAIN

A. What is stress?; Theories of stress (Selye, Lazarus); Stress and health;
sources of stress; coping

What is stress?
Stress is a negative emotional experience accompanied by predictable
biochemical, physiological, cognitive, and behavioural changes that are directed
either toward altering the stressful event or accommodating its effects (Baum,
1990).
Stress comes from the Latin word strictus, which means ‘tightened’. Several
other terms like strain, pressure, hassle, frustration, irritation, tension, anxiety,
worry, etc., are commonly used to refer to stress. When people feel pressure due
to something happening to them or around them, they normally refer to it as
stress. What causes stress may be different for different people; the intensity and
impact may also differ. For students it may be the heavy syllabus, home
assignments, examination performance and less leisure time. For parents, it may
be their career, bringing up children, running the house and managing finances.
For teachers, it could be preparing for classes, maintaining class discipline,
completing the curriculum, evaluating exam papers etc. Thus, everyone
experiences stress, only the stressor (cause of stress) and the magnitude of stress
vary. Although mild amount of stress is necessary and acts as a motivator and help
us to perform better, it is the acute and prolonged stress that has a debilitating
effect on us.
Stress is a consequence of a person’s appraisal processes: the assessment
of whether personal resources are sufficient to meet the demands of the
environment. Stress, then, is determined by person-environment fit (Lazarus &
Folkman, 1984; Lazarus & Launier, 1978). Stress results from the process of
appraising events as harmful, threatening, or challenging; of assessing potential
responses, and of responding to those events.

Theories of stress
1. Hans Selye’s General Adaptation Syndrome
Early research on stress examined how an organism mobilizes its
resources to fight or flee from threatening stimuli. Hans Selye (1956, 1976) based
on this model proposed the General Adaptation Syndrome, arguing that reactions
go through three phases – alarm, resistance and exhaustion. Selye in an attempt to
study sex hormones effect on the physiological functioning, he became interested in
the stressful impact his interventions seemed to have. Accordingly, he exposed rats
to a variety of stressors – such as extreme cold and fatigue – and observed their
physiological responses. He found that all stressors, regardless of type, produced
essentially the same pattern of physiological changes. They all led to an enlarged
adrenal cortex, shrinking of the thymus and lymph glands and ulceration of the
stomach and duodenum.
According to Selye, when an organism confronts a stressor, it mobilizes
itself for action. The response itself is nonspecific with respect to the stressor; that
is, regardless of the cause of the threat, the individual will respond with the same
physiological pattern of reactions. Overtime, with repeated or prolonged exposure
to stress, there will be wear and tear on the system.
The general adaptation syndrome consists of three phases. In the first phase, the
organism becomes mobilized to meet the threat. In the second phase, resistance,
the organism makes an effort to cope with the threat as through confrontation.
The third phase, exhaustion, occurs if the organism fails to overcome the threat
and depletes its physiological resources in the process of trying.

A B C
ALARM RESISTANCE EXHAUSTION

Selye’s model continues to have an impact on stress research as it provides

a way of thinking about the interplay of physiological and environmental factors.
It also posits a physiological mechanism for the stress-illness relationship. Selye
believed that repeated or prolonged exhaustion of resources is responsible for the
physiological damage that lays the groundwork for diseases such as
cardiovascular disease, arthritis, hypertension and immune-related deficiencies.

However, Selye’s model has also been criticized on several grounds:-

a) It assigns a very limited role to psychological factors as many
researchers now believed that psychological appraisal plays an
important role in the determination of stress;
b) In terms of the uniform physiological response to stress, it has
been now believed that how people respond to stress is
substantially influenced by their personalities, perceptions and
biological constitutions.
c) Selye assessed stress as an outcome; however, people
experience many of the debilitating effects of stress while a
stressful event is going on and even in anticipation of its
occurrence.

2. Cognitive Appraisal Theory

According to Richard Lazarus and his colleagues, stress involves an
assessment process, which they call Cognitive Appraisal. Cognition is
defined as the process that involves thinking, reasoning, and deciding. It
also include attention, perception, memory, problem solving and creativity
and is associated with intelligence. It is a mental process that people use,
when faced with a stress-causing stimulus. People tend to evaluate the
situation by taking into consideration two main factors:
a) Primary appraisal – When people face a potentially stressful event, they
first assess and evaluate it from the point of view of their wellbeing.
They try to mentally calculate whether it will affect their happiness,
security, health, comfort, prestige, interests or anything else that they
value. Primary appraisals seek answers to these questions. Events
therefore may be perceived as positive, neutral or negative in their
consequences. Negative or potentially negative events are further
appraised for their possible harm, threat, or challenge.
 b) Secondary appraisal – When people experience stress, they assess the
resources available for coping with the situation. They search their
social network to find people who can help, assess their physical
condition and financial position that may come handy in overcoming
the situation. In other words, secondary appraisal is the assessment of
one’s coping abilities and resources; whether they will be sufficient to
meet the harm, threat and challenge of the event.
Ultimately, the subjective experience of stress is a balance between
primary and secondary appraisal. When harm and threat are high and
coping ability is low, substantial stress is felt. When coping ability is high,
stress may be minimal. Potential responses to stress are many and include
physiological, cognitive, emotional and behavioral consequences. Some of
these responses are involuntary reactions to stress, whereas others are
voluntarily initiated in a conscious effort to cope.
Cognitive responses to stress include beliefs about the harm or threat an
event poses and beliefs about its causes or controllability. They also include
involuntary responses such as distractibility and inability to concentrate,
disruptions on cognitive tasks, and intrusive, repetitive, or morbid thoughts.
Potential emotional responses to stressful events range widely; they
include fear, anxiety, excitement, embarrassment, anger, depression and even
stoicism or denial. Emotional responses can be quite insistent, prompting
rumination over a stressful event, which, in turn, may keep biological stress
responses elevated.
Potential behavioral responses are virtually limitless depending on the
nature of the stressful event.

Sources of Chronic Stress

Usually people can adapt to mild stressors, but severe stressors may cause
chronic problems for health and mental health. Stress can have disruptive
aftereffects, including persistent physiological arousal, psychological distress,
reduced task performance, and, over time, declines in cognitive capabilities.
Various populations – such as children, the elderly, and the poor – may be
particularly adversely affected by stress. Stress researchers are coming to the
conclusion that the chronic stressors of life may be more important than major life
events in the development of illness.

1. Post-traumatic stress disorder – One type of chronic stress results from

severely traumatic or stressful events whose residual effects may remain
with the individual for years. Childhood sexual abuse, rape, and exposure
to natural and human-made disasters may produce chronic mental and
physical health effects that maintain the virulence of the initial experience.
2. Long -term effects of early stressful life experiences – The long term effects
of early stressors, including those experiences in early childhood, has been
shown to have high correlation with disease developed later in life .
Chronic physical or sexual abuse in childhood or adulthood has long been
known to increase a broad array of health risks because it results on
intense, chronic stress that taxes physiological systems. It has also been
shown by research studies that ‘risky families’ i.e. families that are high in
conflict or abuse and low in nurturance and warmth – produce offspring
 with problems in stress regulatory systems leading to a broad array of
diseases including depression, lung cancer, heart disease, and diabetes.
3. Chronic stressful conditions – Chronic stress such as living in poverty,
being in a bad relationship, remaining in high stress job, stress relating
with parenting, household functioning, finances, and even as mundane as
commuting can be an important contribute to psychological distress and
physical illness.
4. Chronic stress and health – Chronic stress has been shown to have a strong
relation with illness. Research studies have shown that poverty, exposure
to crime, and other chronic stressors vary with socioeconomic status (SES)
and are tied to risk of poor health.
5. Stress in the workplace –
(i) Work and sedentary lifestyle – Many jobs today have lesser
requirement for physical energy, which thereby leads to a decline in
the amount of exercise one gets from work-life. Because activity
level is related to health, this nature of work creates the possibility
of vulnerability to illness.
(ii) Overload – Work overload is a chief factor in producing high levels
of occupational stress. Workers who feel required to work too long
and too hard at too many tasks feel more stressed, practice poorer
health habits, sustain more health risks than do workers not
suffering from overload. Work overload is a subjective as well as an
objective experience. The sheer amount of work that a person does
is not consistently related to poor health and compromised
psychological well-being. The perception of work overload shows a
stronger relationship to physical problems and psychological
distress.
(iii) Ambiguity and role conflict – Role ambiguity occurs when a person
has few clear ideas of what is to be done and no idea of the standards
used for evaluating work. It occurs when a person received
conflicting information about work tasks or standards from
different individuals. Chronically high blood pressure and elevated
pulse, as well as other illness precursors, have been tied to role
conflict and role ambiguity.
(iv) Social relationships – The inability to develop satisfying social
relationships at work has been tied to job stress, to psychological
distress at work, and to poor physical and mental health.
Conversely, men and women who are able to develop socially
supportive relationships at work have enhanced well-being.
(v) Control – Lack of control over work has been related to a number of
stress and illness indicators, including heightened catecholamines
secretion, job dissatisfaction, absenteeism, and the development of
coronary artery disease.
(vi) Unemployment – Unemployment can produce a variety of adverse
outcomes such as psychological distress, physical symptoms,
physical illness, alcohol abuse, difficulty achieving sexual arousal,
low birth weight of offspring, and compromised immune
functioning.
COPING WITH STRESS
 Since stress causes physical and emotional distress, natural tendency of
people is to somehow reduce or eliminate it. Stress occurs when there is a
mismatch between the demands of the environment and the resources available
with the individual to deal with it. Therefore, the actions that are taken by the
individual to manage the mismatch are what coping strategies are made of. People
use many different ways to tackle the perceived mismatch and the same person
may use different methods to tackle problems at different times.
Coping is defined as the thoughts and behaviours used to manage the
internal and external demands of situations that are appraised as stressful. Coping
has several important characteristics. First, the relationship between coping and
a stressful event is a dynamic process. Coping is a series of transactions between
a person who has a set of resources, values, and commitments and a particular
environment with its own resources, demands, and constraints (Folkman &
Moskovitz, 2004). Thus, coping is not a one-time action that someone takes but
rather a set of responses, occurring over time, by which the environment and the
person influence each other. A second important characteristic is its breath
wherein coping efforts are moderated by the resources available to the individual;
and so therefore in emotional reactions even anger and depression can be a part
of the coping process.
According to Folkman and Lazarus (1980), coping has been defined as all
cognitive and behavioral efforts to master, reduce, or tolerate demands that could
be external or internal. Internal demands may reflect the outcome of cognitive
appraisals or emotional conflicts. According to this definition, there are two types
of coping – Instrumental coping such as problem solving that is directed at the
source of threat and palliative coping such as emotional regulations that is
achieved through cognitive reappraisal of the situation which alters the meaning
of an event or tries to reduce the emotional pain and distress that the event causes.
In essence, coping can serve as two main functions. It can either alter the problem
causing the distress or it can regulate the emotional response to the problem.
Coping Styles
Coping style represents specific individual differences in how people
respond to stress. It is a general propensity to deal with stressful events in a
particular way. As an example, some people may deal with stress by talking a lot
about it; however some other may deal with it by keeping their problems to
themselves. Coping styles have their origin both in genes and personal
experiences.
1. Approach Versus Avoidance – Some people cope with a threatening
event by using an avoidant (minimizing) coping style, whereas others use
an approach (confrontative, vigilant) coping style, by gathering
information or taking direct action. Approach related coping is most
successful when one can focus on the information present in the situation
rather than on one’s emotions and if specific actions can be taken to reduce
the stressor. Whether avoidant or approach related coping is successful
depends on how long tern the stressor is. People who cope with stress by
minimizing or avoiding threatening events may deal effectively with short-
term threats. However, if the threat is repeated or persists over time, a
strategy of avoidance is not so successful. Substantial evidence have now
indicates that approach coping is generally associated with beneficial
outcomes, such as less psychological distress and lower stress-related
 biological responses, whereas avoidance is typically associated with
adverse psychological and health outcomes.
2. Problem-focused Versus Emotion-focused coping – Problem-focused
coping targets the causes of stress and practically, it involves directly
dealing with the stressful situation. It involves attempts to do something
constructive about the stressful conditions that are harming, threatening,
or challenging an individual. Emotion-focused coping involves efforts to
regulate emotions experienced because of the stress. It is used when it is
not possible to change the situation, and is more used by women than men.
Problem-focused coping skills appear to emerge during childhood;
emotion-focused coping skills develop somewhat later, in late childhood or
early adolescence. Typically, people used both types of coping style during
stressful events; however, the nature of the event also contributes to what
coping strategies will be used. Situations in which something constructive
can be done will favor problem-focused coping, whereas those situations
that simply must be accepted favor emotion-focused coping. Emotion-
focused coping includes two kinds. One involves emotional distress, as may
be experienced in rumination (negative recurrent thoughts) and the other
type is emotional-approach coping, which involves clarifying, focusing on,
and working through the emotions experienced in conjunction with a
stressor. This type of coping improves adjustment to many chronic
conditions, including chronic pain, cancer and medical conditions such as
pregnancy.
Although different coping styles have been highlighted, when the stresses
of life comes, we use several of these coping styles at different times and in various
combinations. Certain coping styles become our typical personalized responses.
Some individual coping style may prove to be effective while some others are
found to be counterproductive. And what works as ‘effective coping’ may be
different for different people, so it helps to know what makes individuals differ in
their coping strategies and style.
Individual difference in Coping
Research has found that factors like personality, attitudes towards events, and
tolerance of stimulating experience as well as gender play a significant role in
coping efficacy of people.
1. Personality – Personality traits and types not only predetermine the
individual’s response to stress but also the way he/she would cope with
stress. An aggressive and excitable person, for example, may be more prone
to stress and also have inadequate coping skills. A shy person who is
chronically low on self-esteem may respond with undue biological arousal
when forced to work with a group of people and the coping style adopted
would be to choose jobs that lets him/her be alone, which in itself may
prove to be maladaptive. On the other hand, more sociable and optimistic
persons by virtue of being exposed to more people and situations may
experience more stress in dealing with relationships and their optimism
may undermine actual dangers and land them in more distressed
situations. Yet, optimism becomes a buffer against stress making them
perceive stress as short lived and hence more tolerable and their sociable
nature helps them to cope by seeking social support from their social
network. It has also been found that people high in negative affectivity or
 neuroticism express distress, discomfort and dissatisfaction across a wide
range of situations. They are also more prone to heavy drinking, depression
and engage in suicidal gestures or even suicide. Neuroticism has a high
correlation with poor health including diabetes, kidney problems, liver
problems and stomach or gallbladder problems.
2. Psychological hardiness/Resilience – Suzanne Kobasa (1979)
developed the concept of hardiness, which refers to a personality construct
of a person’s typical, stable, characteristic way of responding to life events.
Although stressful life events increased illness, both hardiness and exercise
brought down incidents of illness. Resilience is a term frequently used to
mean hardiness. Hardiness involves three interlinked components namely
commitment, control and challenge:
a) Hardy people have a deep sense of commitment to their values, beliefs,
sense of identity and work life and are willing to make sacrifices and
deal with situations. And as such, the hardships they face do not seem
as stressful as others might view it.
b) Hardy people feel they are in control of the situation and their lives.
This sense of personal control reduces the impact of stressful
situations.
c) Hardy people perceive stress causing events as challenges that need to
be faced rather than a problem to be feared. They are often viewed as
an opportunity for personal growth and therefore, their thinking is
more flexible and are able to adjust to various situations.
3. Tolerance for stimulation – Some people crave for new experiences and
variety in situations in order to experience more challenges, making them
achieve a sense of happiness, while there are others who find even a minor
shift from familiar routine distressful. It has been found that people with
high need for stimulation cope better with stressful life events than people
who have low need for stimulation. This may be because stressful life
events bring to the forefront their self-efficacy which enables them to see
the event as less stressful than they really are. It may also be possible that
the regular unpredictability in such people’s lives make them more
experienced in dealing with such situations and thus better able to cope
with stress.
4. Attributional style – Attributions for stress are reasons people give for a
particular stressful situation to have occurred. Pessimistic attributional
style has been linked to heightened illness and such people may have
reduced immune-competence and thus be vulnerable to diseases.
Optimistic personality predisposition, on the other hand, has the ability to
cope with stress effectively and thereby reduce their vulnerability to
illness. Optimists experience more positive emotions and moods which
may lead to a state of resilience and allow them to use healthy coping
strategies such as problem-focused coping and seeking social support. An
optimist seems to be protected against the risk of coronary disease in older
men; they have a faster rate of recovery during hospitalization as well.
Pessimism has been linked to the onset of depression in middle age, and to
cancer mortality in older population.
5. Learned helplessness – learned helplessness is a sense of giving up and
perceiving that nothing can be done about the situation. When situations
 are not under our control, we perceive more stress. When an individual fail
to bring some control over a situation even after repeated efforts, one tends
to give in to a feeling of helplessness. Learned helplessness has several
health implications. According to Maier & Seligman (1976), helplessness
occurs in three specific spheres;
a) Motivational – an individual stops putting efforts and does not have
the drive to change the outcome of a situation.
b) Cognitive – individual fails to learn new ways that could help in
avoiding negative events and protect them in future.
c) Emotional – depression sets in when the individual resigns to his/her
fate or destiny.
6. Sense of coherence – There has been several incidences where people
who have faced terrible oppressive situation managed to cope well and
maintain their physical and psychological health. According to Antonovsky
(1998), stressful life events are not inherently negative; they may cause a
state of tension, however, the physical outcome of that tension is
dependent on the tension management ability of the person. Sense of
coherence is a significant determinant of the ability to maintain healthy life
and avoid illness. People with sense of coherence valued life on a deep
emotional level, sought to find meaning in life and mostly believed that the
problem and demands brought by life were worth trying and investing
one’s energy in.
7. Gender and Coping – The type of stress faced by men and women are
different and so are their reactions to stress. Women are more likely than
men to engage in nearly all coping strategies such as seeking support,
rumination and positive self-talk. Because of cultural expectations of men
to be brave and bold, they are encouraged to react aggressively when faced
with life’s frustrations and difficulties. However, when they feel inadequate
to live up to such expectations, they often resort to alcohol or drug
dependency. Women are however expected to be more fearful and sad, and
are freer to express their emotions. Thus they develop a trait of
dependency which serves as an effective coping strategy. Stress response
has been described as ‘fight or flight’ from earlier times; however, this
applies more to men, and women’s response can be described as ‘tend and
befriend’. Women seeking social support is indicative of this kind of coping
strategy.
Goals of coping
Coping is not just about taking some actions in response to a problem that
has cropped up, but it is aimed at achieving certain long term goals. Coping efforts
consists mainly of the following five tasks:
1. To soften the harmful environmental conditions and enhance the
prospects of recovery.
2. To tolerate or adjust to negative events or realities.
3. To maintain a positive self-image.
4. To maintain the emotional equilibrium.
5. To continue satisfying relationship with others.
Reference:

Ghosh, M. (2015). Health Psychology: Concepts in Health and Well-being.

Pearson Education.

Sarafino, E. P., & Smith, T. W. (2012). Health Psychology: Bio psychosocial

interventions. New Delhi: Wiley.

Taylor, S. E. (2012). Health Psychology (7th Edn). New Delhi: Tata McGraw-
Hill.