Managing & Coping with Stress

Biofeedback attempts to give a client the skills to manage and control the physiological symptoms of stress. Usually these processes are involuntary, so biofeedback aims to provide information using technology to enable the client to see/hear the physiological processes that are occurring, in order to respond to them.

How it works: The client is connected to a machine which measures activity such as muscular tension (using an electromyogram- EMG), brain activity (electroencephalogram- EEG), and sweating (skin conductance response- SCR). When activity is increased, a tone or a display changes pitch or changes visually, allowing the client to hear or see their physiological response. Once this is done, the client is taught to use techniques such as relaxation techniques, for example, changing their breathing, in order to reduce the physiological arousal. The aim is to reduce the physiological response, for example by lowering the pitch of a tone. Learning to respond to physiological arousal by adjusting breathing, relaxing and contracting muscles, and so on, leads to praise from the therapist, and biofeedback from the machine, so reinforcing the actions (operant conditioning). Budzynski (1973) identified three key steps in biofeedback:

1. Become aware of physiological response and how it can be adjusted
2. Learn various techniques to control the response in a therapy situation
3. Practise the techniques used in everyday situations outside of the therapy situation

Research: Davis (1986): Breast cancer patients underwent thirteen 45-minute sessions of taught relaxation techniques over eight weeks. It was found that, after eight months, patients taught the techniques had lower levels of the stress hormone cortisol and reported lower anxiety levels than a control group, whose levels of cortisol increased over the same period. This suggests that biofeedback led to an ability to control, or at least stabilise, the HPA system.

Evaluation:

• Lemaire et al (2011) found that doctors who were taught biofeedback techniques and used them over 28 days reported much more reduced levels of stress (measured through a questionnaire) than a control group, supporting the effectiveness of biofeedback in managing stress.
• Lemaire et al (2011) also measured the physiological symptoms of stress, such as heart rate and blood pressure, in the same participants, and found no significant changes over the 28-day period. Greenhalgh et al (2009) concluded in a meta-analysis that biofeedback was no more effective at reducing hypertension (persistent high blood pressure) than CBT, placebo treatments, or no treatment. These findings weaken the use of biofeedback, as the effect on the physiological effect of stress seem to be very limited, or non-existent.
• Biofeedback may be best suited to people who are motivated to learn and practice the skills, and are able to understand the relationship between physiological functioning and the signals received through biofeedback. This weakens its use, as it may not be applicable to large numbers of people.

Gender Differences in Coping with Stress

Coping methods: Lazarus and Folkman (1984) argue that men and women tend to use different methods to cope with stress. Men are more likely to use problem-focused methods, meaning that the cause of the stress is addressed in a direct and practical way (for example, learning new time-management techniques). Women are more likely to use emotion-focused methods, meaning that stress is indirectly reduced by attempting to lower the anxiety resulting from a stressor (for example, trying to think about other things, trying to think about the stressor more positively).

Brennan Peterson et al (2006) assessed coping strategies of men and women who had been diagnosed with infertility. Both used a variety of strategies, but the key difference was that men were more likely to plan and problem solve (problem-focused), whilst women were more likely to use avoidance tactics (emotion-focused).

Physiological response: Taylor et al (2000) suggested that the ‘fight or flight’ response is more of a characteristic of males than females, and that responding in this way would not be evolutionarily beneficial for females, as the survival of their offspring would be put at risk. Instead, women are more likely to respond in a protecting, nurturing, calming way to a stressor, known as the tend and befriend response.

Luckow et al (1998) found that, in 25 of the 26 studies reviewed, women were more likely to ‘seek and use social support’ as a method of coping in stressful situations. Further research has shown that women prefer to use social support from other females, rather than males, potentially a result of an evolved mechanism to protect against threats from males.

Oxytocin: This hormone is produced in both sexes, and promotes feelings of goodwill, and affiliation towards others, so encouraging bonding behaviour. Taylor et al (2002) found that this hormone was linked with lower cortisol levels in female but not male participants. The female hormone oestrogen seems to increase the effect of oxytocin, with male hormones (androgens) reducing its effects. As a result, the stress response is reduced in women, and it the effects do not last as long as in men.

Evaluation:

• It has been argued by ‘role constraint theory’ that the reason for gender differences in coping strategies is due to the different types of stressors men and women face. Problems at work are better tackled by problem-focused techniques, whereas problems in the domestic sphere (such as relationships with family members) are better dealt with by emotion-focused techniques. Therefore, gender differences are a response to different types of stressor, rather than a fundamental difference in the way men and women cope with stress.
• There may be overlaps with problem-focused and emotion-focused methods. Seeking social support during times of emotional difficulty, for example, could be seen as both a problem-focused (seeking information from others) and an emotion-focused (seeking emotional support) technique. Therefore, the distinction between the two methods becomes blurred and hard to apply to the different sexes.
• Tamres et al (2002) found that, in a meta-analysis of 26 studies, women were significantly more likely to seek social support than men, supporting the tend and befriend prediction. Feldman et al (2007) found that women with the highest oxytocin levels formed the strongest bonds with their newborn babies, also supporting the predictions of the tend and befriend explanation.

Types of Social Support

Social support refers to the help given by friends and family members to assist a person in coping with a stressful situation. Schaefer et al (1981) identified three types of social support, which can be provided by a person’s social network of friends and family.

Instrumental support: Practical support, such as giving a lift to the hospital, lending some money, giving information to the person about an illness, and so on.

Emotional support: Providing comfort through statements such as ‘I’m really sorry for what you’re going through’, ‘if there’s anything you need, I’m here for you’. It means expressing empathy and warmth for the person in order to make them feel better.

Esteem support: Trying to raise the person’s self-confidence, so that they believe they can cope with the demands of the stressor. For example, saying things like ‘I know you can get through this’, or pointing out examples of times they have dealt with challenging situations in the past.

The three different types will overlap, depending on exactly what the friend or family member is doing to offer support (for instance, providing a ‘shoulder to cry on’). They can also be provided without physical presence, for example through social networks, talking on the phone, being sent gifts, and so on.

Research: Cohen_ et al_ (2015): The aim of the study was to see if physical contact (hugs) protected against stress-related health problems (infections). 404 healthy adult participants were contacted by phone each day for 14 days to measure the amount of hugs they received each day. They also completed a questionnaire to asses perceived social support, and stress was measured by assessing the daily personal conflict experienced by participants. Following this, participants were exposed to the common cold virus and were monitored for signs of illness. The findings were that participants who experienced more interpersonal conflict were more likely to get ill, however those who reported more social support had a reduced risk of illness. Participants who received hugs more frequently were less likely to get ill, and those who did get ill had less severe symptoms if they received more hugs. This suggests that social support does act as a protector against the effects of stress.

Evaluation:

• Fawzy Fawzy _et al _1993) found that cancer patients who were randomly allocated to a support group for six weeks, which provided emotional support, were more likely to have better NK cell functioning, and more likely to be free of cancer six years later, than a control group. This supports that social support helps to reduce the effects of stress and illness.
• Social support can potentially have a negative effect, for example if a relative insisted on coming to a hospital appointment, this may increase anxiety in the person rather than reduce it. It has been suggested that social support is most beneficial when it is sought by the individual, rather than being ‘imposed’ on them. This means that it would be misleading to conclude that social support reduces stress, as it depends on the type of support being offered.
• There are gender and cultural differences in social support. Research has found that men have larger social networks, but women are more likely to seek emotional support. Also, a study comparing Asian and European Americans found that Asian Americans were much less likely to seek social support when stressed (Tayler et al, 2004). This means that the role of social support may apply differently to different people.

What does GAS stand for?

Your answer should include: General / Adaptation / Syndrome

Is the HPA system the body’s response to acute or chronic stress?

Your answer should include: Chronic / Stress

Who studied to effects of chronic stress by testing students during exam season?

Your answer should include: Kiecolt-Glaser / Kiecolt / Glaser

What measure is used to calculate a person’s life change unit (LCU) score?

Your answer should include: Social / Readjustment / Rating / Scale

If someone has lost their keys, what source of stress is this an example of?

Your answer should include: Daily / Hassle

What type of profession did Marmot investigate when looking at workplace stress?

Your answer should include: Civil / Service

What does SCR stand for?

Your answer should include: Skin / Conductance / Response

Which personality type is associated with greater risk of cancer?

C

The three elements of hardiness are commitment, challenge and what?

Control

Which stress management technique attempts to give the client cognitive coping strategies to prevent the effects of stress?

Your answer should include: Stress / Inoculation / Therapy