Stress and the Mind-Body Connection
A major risk factor for disease, stress influences both psychological and physical health. Various models exist which conceptualize stress differently, but the most widely accepted is that developed by Lazarus (Collins, Sorocco, Haala, Miller, & Lovallo, 2011). This model explains how the perception of stress will impact the meaning attached to a given situation, and subsequently, how the event can be navigated (Collins, et al., 2011; Van Den Wijngaart, Vernooij-Dassen, & Felling, 2006).
Lazarus viewed stress from an appraisal perspective (Collins, et al., 2011). Essentially, an individual will assess an event from three angles: 1) as harm or loss; 2) as a threat; or 3) as a challenge (Collins, et al., 2011). Based on this assessment, implementation of particular coping strategies occurs. Lazarus categorized coping in two ways. Problem-focused coping is a direct and active method of stress mitigation to remove the stressor, change the environment, and problem-solve to generate alternatives. Emotion-focused coping, on the other hand, exemplifies a psychological method of removing emotional distress and includes such behaviors as avoidance, distraction, or distancing (Collins, et al., 2011).
The appraisal of an event is dependent upon the resources of the individual, as well as those within the environment (Collins, et al., 2011; Van Den Wijngaart, et al., 2006). Such factors include age, personality characteristics, financial situation, and social and cognitive support (Van Den Wijngaart, et al., 2006). Take, Henry, for example, a 55-year old male. He has a demanding job, a happy marriage, and three grown children. His wife recently had a stroke, however, and while she recovered physically, she can no longer care for their home or Henry as she used to. Henry believes he needs help. Unfortunately, he is without many friends. His job as a postal worker, as well as time spent with his family resulted in a lack of social connections.
Significant stress can result from the burden of caring for a spouse, particularly if the caregiving spouse lacks confidence in the ability to care adequately (Van Den Wijngaart, et al., 2006). In this case, Henry may perceive the situation as a loss, much like that of a death. His wife is not herself, their marriage is not what it used to be, and he no longer has a mate whom he can interact with or share experiences. Psychologically, Henry is at risk of experiencing depressive symptoms, becoming isolated and listless, and experiencing increased stress at work due to the extra time devoted to caring for his wife. In turn, these factors could lead to immediate physical consequences including poor sleep and fatigue, unhealthy diet, and a decrease in physical activity (Collins, et al., 2011; Taylor, 2009; Van Den Wijngaart, et al., 2006).
The physical ramifications of stress are many. Dependent upon the severity of the stressor, as well as its duration, stress can result in significantly harmful conditions including cancer, heart disease, high blood pressure, gastrointestinal disturbances, suppressed immune system, poor recovery, insulin sensitivity, and muscle tension, just to name a few (Collins, et al., 2011, Taylor, 2000). Current conditions are exacerbated with increased stress, which can result in increased infection, higher pain sensitivity, and mental illness (Collins, et al., 2011, Taylor, 2000).
Henry, however, could respond in a more positive manner, and reduce his risk of such conditions. He might consider contacting his children for both instrumental and emotional support, which could result in less personal demands on his energy, and greater confidence in his ability to manage the household and his wife’s condition. Receiving assistance from his children could be crucial based on the research indicating that much of the burden experienced by a caregiver relates to the functional health status of the spouse (Van Den Wijngaart, et al., 2006). Withdrawal and apathy of the spouse have a significantly high negative impact on perceived burden, indicating caregiver need for interaction and reciprocity (Van Den Wijngaart, et al., 2006). In this case, Henry could be at risk for high distress. On the other hand, caregiver functional health status plays an even larger role in the perception of adequate instrumental support, and subsequently, the approach taken to cope with the stresses of caregiving itself (Van Den Wijngaart, et al., 2006). Those caregivers who are more confident often adopt a problem-focused coping method, and this approach in turn, increases self-efficacy. In essence, self-efficacy and problem-focused coping build on one another. For Henry, it might be important for him to preserve his energy and have social support from which to bolster his sense of power.
In essence, Henry’s experience has the potential to influence him in a positive manner. Post-traumatic growth, a concept defined in the literature as psychological development in response to stress (Loiselle, Deevine, Reed-Knight, & Blount, 2011) , could result in accordance with Henry’s approach to his wife’s condition and its effects on his new responsibilities. For example, Henry’s relationship with his children may grow stronger because of the contact he makes with them and the shared tasks associated with the care of their mother. Additionally, he may develop greater confidence in his abilities to manage a household without the assistance of his partner, and a greater appreciation for his abilities and personal strengths (Loiselle, et al., 2011). Problem-focused coping increases the potential for post-traumatic growth, as it encourages responsibility-taking as well as ongoing processing of the event or situation (Loiselle, et al., 2011).
Outside of the possible positive natural consequences of Henry’s stress experience, more intentional efforts for relief or management of stress could be made. While Henry does not appear to be having a strong central nervous system response, which can lead to significantly harmful long-term physical effects, his appraisal and coping strategies could be bolstered to improve his perception of his wife’s condition. Subsequently, the amount of arousal or tension he may experience as he transitions to a care-taking role would decline. In addition, evidence exists supporting a focus on empathic responding for maintenance of a spousal bond (O’Brien, DeLongis, Pomaki, Puterman, & Zwicker, 2009). Sustaining a connection with his wife through intentional practice of empathic responding, learned through cognitive restructuring (Collins, et al., 2011), might be a suitable method of coping for Henry. While the research on this concept incorporated couples who could reciprocate, Henry’s unemotional and non-reactive approach could positively influence his sense of well-being in light of his wife’s condition (O’Brien, et al., 2009).
Sarah’s story, while much different from Henry’s, exemplifies a case where cognitive restructuring could prove effective also. A divorced mother of two children, Sarah has a demanding job. Her responsibilities in her position recently increased as a result of company downsizing. As the sole provider for her family, she experiences stress regarding her ability to care for her children appropriately with the extra work demands, as well as her perceived need to augment her education and job skills to avoid replacement. Sarah is at risk of developing negative cognitions about her level of control in the workplace because of her additional duties, which can have significant consequences for her psychological state. In a constant state of reactivity, in addition to operating with faulty and distorted thinking, Sarah could develop hypermobilization of the voluntary and autonomic nervous systems (Collins, et al., 2011). Though Sarah is pressed for time, structuring brief personal check-ins periodically throughout her day and practicing deep breathing in tandem with cognitive reframing of negative thoughts could help her cope more effectively (Collins, et al., 2011).
Fortunately, Sarah appears to be using a problem-focused approach to coping with her job stress, as evidenced by her consideration of additional training. While studies assessing job stress demonstrate problem-focusing coping to be effective, its effects are limited unless combined with the emotion-focused coping approach of distraction (Shimazu & Schaufeli, 2007). The consequences of chronic job stress include a decrease in performance, lower affinity for helping others, and increased aggression and insensitivity (Shimazu & Schaufeli, 2007). Not only could Sarah’s stress affect her co-workers and her ability to keep her job, her children could be significantly impacted as well. Distraction would provide recovery from the resources Sarah has lost, including support from her husband and co-workers, giving her an opportunity to detach from her current stressors and engage in a pleasurable activity to strengthen the energy she will need to pursue training (Shimazu & Schaufeli, 2007).
Sarah is also at risk for poor sleep and nutrition, and subsequently, increased fatigue and difficulty concentrating. With lack of sufficient sleep, not only could she become increasingly distractible and irritable, the physical impact could be significant. While cortisol levels are always present, Sarah’s chronic stress levels as a result of poor sleep and negative perception of her situation could lead to elevated and chronic release of cortisol and a suppressed immune system, more sleep problems, and behavioral and mood struggles (Collins, et al., 2011).
Important in mitigating the detrimental effects of stress is the control Sarah feels she has over her work situation. Perceived control influences the effectiveness of problem and emotion focused coping, and both are necessary for long-term and short-term management of stress, respectively (Shimazu & Schaufeli, 2007). Sarah might benefit from progressive muscle relaxation or other stress reduction techniques like yoga or meditation to help enhance her ability to control her breathing and confidence in controlling her body, but also to develop greater awareness of her mind (Collins, et al., 2011). Additionally, Sarah may benefit from assessing her social supports and identify those who may provide opportunities for her to engage in emotional disclosure (Taylor, 2009). She is a single mom and spends most of her time with her young children, and she likely would find relief in adult interaction.
Stress is clearly a multifactorial phenomenon that is best understood from a biopsychosocial perspective. Health psychologists who work with individuals like Henry or Sarah, both suffering from stress but in very different contexts, must be adept investigators into the lives of their clients. The events themselves, client perceptions, coping approaches and skills, resources, environmental factors, cognitions and beliefs, as well as physiology all play a role in the impact of stress as well as the most effective treatment options.
References
Collins, F. L., Sorocco, K. H., Miller, B. I., & Lovallo, W. R. (2008). Stress and health. In L. M. Cohen, D. E. McChargue, & F. G. Collins, (Eds.). The health psychology handbook. Thousand Oaks, CA: SAGE Publications. http://sage-ereference.com.proxy1.ncu.edu/hdbk_healthpsych/Article_n10.html
Loiselle, K.A., Devine, K.A., Reed-Knight, B., & Blount, R.L. (2011). Posttraumatic growth associated with a relative’s serious illness. Families, Systems, & Health, 29(1), 64-72. Doi: 10.1037/a0023043
O’Brien, T.B., DeLongis, A., Pomaki, G., Puterman, E., & Zwicker, A. (2009). Couples coping with stress: The role of empathic responding. European Psychologist, 14(1), 18-28.
Shimazu, A. & Schaufeli, W.B. (2007). Does distraction facilitate problem-focused coping with job stress? A 1-year longitudinal study. Journal of Behavioral Medicine, 30, 423-434. Doi: 10.1007/s10865-007-9109-4.
Taylor, S.E. (2009). Health psychology. New York, NY: McGraw-Hill.
Van Der Wijngaart, M.A.G., Vernooij-Dassen, M.J.F.J., & Felling, A.J.A. (2007). The influence of stressors, appraisal, and personal conditions on the burden of spousal caregivers of persons with dementia. Aging & Mental Health, 11(6), 626-636.
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