{{Short description|Feeling of strain and pressure}} {{hatnote group| {{About||other kinds of stress|Stress (disambiguation)}} {{Redirect|Stressed out||Stressed Out (disambiguation)}} }} {{Infobox medical condition | name = Psychological stress | image = File:Headache-1557872 960 720.jpg | caption = A man expressing stress | symptoms = Anxiety, worry, paranoia, anger, burnout, compassion fatigue, sleep disturbances, hypervigilance, impatience, derealization, dissociation, changes in volition }}
In psychology, '''stress''' is a feeling of emotional strain and pressure.<ref>{{Cite news|url=http://www.mentalhealthamerica.net/conditions/stress|title=Stress|date=2013-11-18|work=Mental Health America|access-date=2018-10-01|language=en}}</ref> Stress is a form of psychological and mental discomfort. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excessive amounts of stress, however, can increase the risk of strokes, heart attacks, ulcers, and mental illnesses such as depression<ref>{{cite book| vauthors = Sapolsky RM |author-link= Robert Sapolsky|title= Why Zebras Don't Get Ulcers|date= 2004|publisher= St. Martins Press|location= New York|isbn= 978-0-8050-7369-0|pages= 37, 71, 92, 271}}</ref> and also aggravate pre-existing conditions.
Psychological stress can be external and related to the environment,<ref>{{cite book | vauthors = Jones F, Bright J, Clow A | url = https://books.google.com/books?id=QGsX-N28wjkC&dq=%22Stress%22&pg=PA4 | title = Stress: myth, theory, and research | publisher = Pearson Education | date = 2001 | page = 4 | isbn=978-0-13-041189-1 }}</ref> but may also be caused by internal perceptions that cause an individual to experience anxiety or other negative emotions surrounding a situation, such as pressure, discomfort, etc., which they then deem stressful.
Hans Selye (1974) proposed four variations of stress.<ref name= Selye>{{cite book| vauthors = Selye H |title= Stress without distress|url= https://archive.org/details/stresswithoutdis00sely|url-access= registration|year= 1974|publisher= J.B. Lippincott Company|location= Philadelphia|page= [https://archive.org/details/stresswithoutdis00sely/page/171 171]|isbn= 978-0-397-01026-4}}</ref> On one axis, he locates good stress (eustress) and bad stress (distress). On the other is over-stress (hyperstress) and understress (hypostress). Selye advocates balancing these: the ultimate goal would be to balance hyperstress and hypostress perfectly and have as much eustress as possible.<ref name = "Selye 1983">{{cite book | vauthors = Selye H |date= 1983 |title= Stress Research Issues for the Eighties | chapter-url= https://archive.org/details/stressresearchis00cooprich| chapter-url-access= registration|chapter= The Stress Concept: Past, Present and Future | veditors = Cooper CL | location= New York, NY|publisher= John Wiley & Sons |pages= [https://archive.org/details/stressresearchis00cooprich/page/1 1–20]|isbn= 978-0-471-10246-5 }}</ref>
The term "eustress" comes from the Greek root ''eu-'' which means "good" (as in "euphoria").<ref name="Selye 1975">{{cite journal | vauthors = Selye H | title = Implications of stress concept | journal = New York State Journal of Medicine | volume = 75 | issue = 12 | pages = 2139–2145 | date = October 1975 | pmid = 1059917 }}</ref> Eustress results when a person perceives a stressor as positive.<ref name=Fevre>{{cite journal| vauthors = Fevre ML, Kolt GS, Matheny J |title= Eustress, distress and their interpretation in primary and secondary occupational stress management interventions: which way first?|journal= Journal of Managerial Psychology|date= 1 January 2006|volume= 21|issue= 6|pages= 547–565|doi= 10.1108/02683940610684391}} </ref> "Distress" stems from the Latin root ''dis-'' (as in "dissonance" or "disagreement").<ref name = "Selye 1975"/> Medically defined distress is a threat to the quality of life. It occurs when a demand vastly exceeds a person's capabilities.<ref name= Fevre />
== Causes{{anchor|Causes_of_stress}} ==
===Neutrality of stressors=== Stress is a non-specific response.<ref name = "Selye 1983"/> It is neutral, and what varies is the degree of response. It is all about the context of the individual and how they perceive the situation. Hans Selye defined stress as "the nonspecific (that is, common) result of any demand upon the body, be the effect mental or somatic."<ref name = "Selye 1983"/> This includes the medical definition of stress as a physical demand and the colloquial definition of stress as a psychological demand. A stressor is inherently neutral meaning that the same stressor can cause either distress or eustress. It is individual differences and responses that induce either distress or eustress.<ref name = "HNC">{{cite journal | vauthors = Hargrove MB, Nelson DL, Cooper CL |date= 2013 |title= Generating eustress by challenging employees: Helping people savor their work |journal= Organizational Dynamics|volume=42 |pages= 61–69 |doi=10.1016/j.orgdyn.2012.12.008}}</ref>
===Types of stressors=== A stressor is any event, experience, or environmental stimulus that causes stress in an individual.<ref>{{cite web |title=stressor |url=http://www.collinsdictionary.com/dictionary/english/stressor |publisher=Collins English Dictionary{{snd}} Complete & Unabridged 11th Edition. Retrieved September 20, 2012, from CollinsDictionary.com |url-status=live |archive-url=https://web.archive.org/web/20120620123917/http://www.collinsdictionary.com/dictionary/english/stressor |archive-date=June 20, 2012 }}</ref> These events or experiences are perceived as threats or challenges to the individual and can be either physical or psychological. Researchers have found that stressors can make individuals more prone to both physical and psychological problems, including heart disease and anxiety.<ref name="pastorino">Pastorino, E. & Doyle-Portillo, S. (2009). What is Psychology?. 2nd Ed. Belmont, CA: Thompson Higher Education.</ref>
Stressors are more likely to affect the health of an individual when they are "chronic, highly disruptive, or perceived as uncontrollable".<ref name="pastorino" /> In psychology, researchers generally classify the different types of stressors into four categories: 1) crises/catastrophes, 2) major life events, 3) daily hassles/microstressors, and 4) ambient stressors. According to Ursin (1988), the common factor between these categories is an inconsistency between expected events ("set value") and perceived events ("actual value") that cannot be resolved satisfactorily,<ref>{{cite book | vauthors = Ursin H |chapter= Expectancy and activation: An attempt to systematize stress theory |year=1988 | veditors = Hellhammer DH, Florin I, Weiner H |title= Neuronal Control of Bodily Function: Basic and Clinical Aspects, Vol. 2: Neurobiological Approaches to Human Disease |pages=313–334 |location= Kirkland, WA |publisher=Huber }}</ref> which puts stress into the broader context of cognitive-consistency theory.<ref name=":Kampen">{{cite journal | vauthors = van Kampen HS | title = The principle of consistency and the cause and function of behaviour | journal = Behavioural Processes | volume = 159 | pages = 42–54 | date = February 2019 | pmid = 30562561 | doi = 10.1016/j.beproc.2018.12.013 | s2cid = 56478466 }}</ref>
====Crises/catastrophes==== This type of stressor is unforeseen and unpredictable and, as such, is completely out of the control of the individual.<ref name="pastorino" /> Examples of crises and catastrophes include: devastating natural disasters, such as major floods or earthquakes, wars, pandemics, etc. Though rare in occurrence, this type of stressor typically causes a great deal of stress in a person's life. A study conducted by Stanford University found that after natural disasters, those affected experienced a significant increase in stress level.<ref name="pastorino" /> Combat stress is a widespread acute and chronic problem. With the rapid pace and the urgency of firing first, accidental killings of friendly forces (or fratricide) may occur. Prevention requires stress reduction, emphasis on vehicle and other identification training, awareness of the tactical situation, and continual risk analysis by leaders at all levels.<ref>Headquarters, Department of the Army (1994). Leader's Manual for Combat Stress Control, FM 22–51, Washington DC.</ref>
====Major life events==== Common examples of major life events include: marriage, going to college, death of a loved one, birth of a child, divorce, moving houses, etc. These events, either positive or negative, can create a sense of uncertainty and fear, which will ultimately lead to stress. For instance, research has found the elevation of stress during the transition from high school to university, with college freshmen being about two times more likely to be stressed than final year students.<ref>{{cite journal | vauthors = Teo LY, Fam JY |title=Prevalence and determinants of perceived stress among undergraduate students in a Malaysian University |journal=Journal of Health and Translational Medicine |volume=21 |issue=1 |year=2018 |pages=1–5 |url=https://mjes.um.edu.my/index.php/jummec/article/view/11016 }}</ref> Research has found that major life events are somewhat less likely to be major causes of stress, due to their rare occurrences.<ref name="pastorino" />
The length of time since occurrence and whether or not it is a positive or negative event are factors in whether or not it causes stress and how much stress it causes. Researchers have found that events that have occurred within the past month generally are not linked to stress or illness, while chronic events that occurred more than several months ago are linked to stress and illness<ref name=pmid9619470>{{cite journal | vauthors = Cohen S, Frank E, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM | title = Types of stressors that increase susceptibility to the common cold in healthy adults | journal = Health Psychology | volume = 17 | issue = 3 | pages = 214–223 | date = May 1998 | pmid = 9619470 | doi = 10.1037/0278-6133.17.3.214 | s2cid = 15175643 }}</ref> and personality change.<ref name="Jeronimus2014">{{cite journal | vauthors = Jeronimus BF, Riese H, Sanderman R, Ormel J | title = Mutual reinforcement between neuroticism and life experiences: a five-wave, 16-year study to test reciprocal causation | journal = Journal of Personality and Social Psychology | volume = 107 | issue = 4 | pages = 751–764 | date = October 2014 | pmid = 25111305 | doi = 10.1037/a0037009 }}</ref> Additionally, positive life events are typically not linked to stress{{snd}} and if so, generally only trivial stress{{snd}} while negative life events can be linked to stress and the health problems that accompany it.<ref name="pastorino" /> However, positive experiences and positive life changes can predict decreases in neuroticism.<ref name="Jeronimus2014" /><ref name="Jeronimus2013">{{cite journal | vauthors = Jeronimus BF, Ormel J, Aleman A, Penninx BW, Riese H | title = Negative and positive life events are associated with small but lasting change in neuroticism | journal = Psychological Medicine | volume = 43 | issue = 11 | pages = 2403–2415 | date = November 2013 | pmid = 23410535 | doi = 10.1017/S0033291713000159 | s2cid = 43717734 }}</ref>
====Daily hassles/microstressors==== This category includes daily annoyances and minor hassles.<ref name="pastorino" /> Examples include: making decisions, meeting deadlines at work or school, traffic jams, encounters with irritating personalities, etc. Often, this type of stressor includes conflicts with other people. Daily stressors, however, are different for each individual, as not everyone perceives a certain event as stressful. For example, most people find public speaking to be stressful, but someone who has experience with it will not.
Daily hassles are the most frequently occurring type of stressor in most adults. The high frequency of hassles causes this stressor to have the most physiological effect on an individual. Carolyn Aldwin, Ph.D., conducted a longitudinal study on older men (mean age ca. 66 years at the time of first stress assessment) at the Oregon State University that examined the perceived intensity of daily hassles on an individual's mortality. Aldwin's study concluded that there is a strong correlation between individuals who rate their hassles as very intense and a high level of mortality. One's perception of their daily stressors can have a modulating effect on the physiological impact of daily stressors.<ref>{{cite journal | vauthors = Aldwin CM, Jeong YJ, Igarashi H, Choun S, Spiro A | title = Do hassles mediate between life events and mortality in older men? Longitudinal findings from the VA Normative Aging Study | journal = Experimental Gerontology | volume = 59 | pages = 74–80 | date = November 2014 | pmid = 24995936 | pmc = 4253863 | doi = 10.1016/j.exger.2014.06.019 }}</ref>
There are three major psychological types of conflicts that can cause stress. * The approach-approach conflict, occurs when a person is choosing between two equally attractive options, i.e. whether to go see a movie or to go see a concert.<ref name="pastorino" /> * The avoidance-avoidance conflict, occurs where a person has to choose between two equally unattractive options, for example, to take out a second loan with unappealing terms to pay off the mortgage or to face foreclosure on one's house.<ref name="pastorino" /> * The approach-avoidance conflict,<ref name="pastorino" /> occurs when a person is forced to choose whether or not to partake in something that has both attractive and unattractive traits{{snd}} such as whether or not to attend an expensive college (meaning taking out loans now, but also meaning a quality education and employment after graduation).
Travel-related stress results from three main categories: lost time, surprises (an unforeseen event such as lost or delayed baggage) and routine breakers (inability to maintain daily habits).<ref>{{cite web|title=CWT rolls out solution to tackle cost of travel stress|url=http://www.ttgmice.com/article/cwt-rolls-out-solution-to-tackle-cost-of-travel-stress/|publisher=TTGmice|access-date= 31 Jan 2019 |date=2013-04-25}}</ref>
====Ambient stressors==== As the name implies, these are global (as opposed to individual) low-grade stressors that are a part of the background environment. They are defined as stressors that are "chronic, negatively valued, non-urgent, physically perceptible, and intractable to the efforts of individuals to change them".<ref name=campbell>{{cite journal |doi=10.1177/0013916583153005 |title=Ambient Stressors |journal=Environment and Behavior |volume=15 |issue=3 |pages=355–80 |year=2016 | vauthors = Campbell JM |s2cid=220442210 }}</ref> Typical examples of ambient stressors are pollution, noise, crowding, and traffic. Unlike the other three types of stressor, ambient stressors can (but do not necessarily have to) negatively impact stress without conscious awareness.<ref name = campbell/>
====Organisational stressors==== Studies conducted in military and combat fields show that some of the most potent stressors can be due to personal organisational problems in the unit or on the home front.<ref>Headquarters, Department of the Army (2006). Combat and Operational Stress Control, FM 4-02.51, Washington, DC, p. 9</ref> Stress due to bad organisational practices is often connected to "toxic leadership", both in companies and in governmental organisations.<ref>Whicker, Marcia Lynn. Toxic leaders: When organizations go bad. Westport, CT. Quorum Books. 1996.{{page needed|date=May 2018}}</ref>
===Stressor impact=== Life events scales can be used to assess stressful things that people experience in their lives. One such scale is the Holmes and Rahe Stress Scale, also known as the Social Readjustment Rating Scale, or SRRS.<ref name="holmes">{{cite journal | vauthors = Holmes TH, Rahe RH | title = The Social Readjustment Rating Scale | journal = Journal of Psychosomatic Research | volume = 11 | issue = 2 | pages = 213–218 | date = August 1967 | pmid = 6059863 | doi = 10.1016/0022-3999(67)90010-4 }}</ref> Developed by psychiatrists Thomas Holmes and Richard Rahe in 1967, the scale lists 43 stressful events.
To calculate one's score, add up the number of "life change units" if an event occurred in the past year. A score of more than 300 means that individual is at risk for illness, a score between 150 and 299 means risk of illness is moderate, and a score under 150 means that individual only has a slight risk of illness.<ref name="pastorino" /><ref name="holmes" />
{| class="wikitable sortable" |- !Life Event !Life Change Units |- |Death of a spouse || 100 |- |Divorce || 73 |- |Marital separation || 65 |- |Imprisonment || 63 |- |Death of a close family member || 63 |- |Personal injury or illness || 53 |- |Marriage || 50 |- |Dismissal from work || 47 |- |Marital reconciliation || 45 |- |Retirement || 45 |- |Change in health of family member || 44 |- |Pregnancy || 40 |- |Sexual difficulties || 39 |- |Gain a new family member || 39 |- |Business readjustment || 39 |- |Change in financial state || 38 |- |Death of a close friend || 37 |- |Change to different line of work || 36 |- |Change in frequency of arguments || 35 |- |Major mortgage || 32 |- |Foreclosure of mortgage or loan || 30 |- |Change in responsibilities at work || 29 |- |Child leaving home || 29 |- |Trouble with in-laws || 29 |- |Outstanding personal achievement || 28 |- |Spouse starts or stops work || 26 |- |Begin or end school || 26 |- |Change in living conditions || 25 |- |Revision of personal habits || 24 |- |Trouble with boss || 23 |- |Change in working hours or conditions || 20 |- |Change in residence || 20 |- |Change in schools || 20 |- |Change in recreation || 19 |- |Change in church activities || 19 |- |Change in social activities || 18 |- |Minor mortgage or loan || 17 |- |Change in sleeping habits || 16 |- |Change in number of family reunions || 15 |- |Change in eating habits || 14 |- |Vacation || 13 |- |Minor violation of law || 10 |}
A modified version was made for non-adults. The scale is below.<ref name="pastorino" />
{| class="wikitable sortable" |- !Life Event !Life Change Units |- |Unwed pregnancy || 100 |- |Death of parent || 100 |- |Getting married || 95 |- |Divorce of parents || 90 |- |Acquiring a visible deformity || 80 |- |Fathering an unwed pregnancy || 70 |- |Jail sentence of parent for over one year || 70 |- |Marital separation of parents || 69 |- |Death of a sibling || 68 |- |Change in acceptance by peers || 67 |- |Pregnancy of unprepared for sibling || 64 |- |Discovery of being an adopted child || 63 |- |Marriage of parent to stepparent || 63 |- |Death of a close friend || 63 |- |Having a visible congenital deformity || 62 |- |Serious illness requiring hospitalization || 58 |- |Failure of a grade in school || 56 |- |Not making an extracurricular activity || 55 |- |Hospitalization of a parent || 55 |- |Jail sentence of parent for over 30 days || 53 |- |Breaking up with partner || 53 |- |Beginning to date || 51 |- |Suspension from school || 50 |- |Becoming involved with drugs or alcohol || 50 |- |Birth of a sibling || 50 |- |Increase in arguments between parents || 47 |- |Loss of job by parent || 46 |- |Outstanding personal achievement || 46 |- |Change in parent's financial status || 45 |- |Accepted at college of choice || 43 |- |Being a senior in high school || 42 |- |Hospitalization of a sibling || 41 |- |Increased absence of parent from home || 38 |- |Sibling leaving home || 37 |- |Addition of third adult to family || 34 |- |Becoming a full-fledged member of a church || 31 |- |Decrease in arguments between parents || 27 |- |Decrease in arguments with parents || 26 |- | Parent beginning work || 26 |}
The SRRS is used in psychiatry to weight the impact of life events.<ref name="Riese2013">{{cite journal| vauthors = Riese H, Snieder H, Jeronimus BF, Korhonen T, Rose RJ, Kaprio J, Ormel J |year=2014|title=Timing of Stressful Life Events Affects Stability and Change of Neuroticism|journal=European Journal of Personality|volume=28|issue=2|pages=193–200|doi=10.1002/per.1929|s2cid=142517975}}</ref>
== Measurement == Modern people may attempt to self-assess their own "stress-level"; third parties (sometimes clinicians) may also provide qualitative evaluations. Quantitative approaches such as Galvanic Skin Response<ref name=":2">{{cite journal | vauthors = Yang X, McCoy E, Anaya-Boig E, Avila-Palencia I, Brand C, Carrasco-Turigas G, Dons E, Gerike R, Goetschi T, Nieuwenhuijsen M, Pablo Orjuela J, Int Panis L, Standaert A, de Nazelle A | display-authors = 6 | title = The effects of traveling in different transport modes on galvanic skin response (GSR) as a measure of stress: An observational study | journal = Environment International | volume = 156 | article-number = 106764 | date = November 2021 | pmid = 34273874 | doi = 10.1016/j.envint.2021.106764 | s2cid = 236035129 | doi-access = free | bibcode = 2021EnInt.15606764Y | hdl = 10230/53035 | hdl-access = free }}</ref> or other measurements giving results which may correlate with perceived psychological stress include testing for one or more of the several stress hormones,<ref>{{cite book | vauthors = Lundberg U | chapter = Neuroendocrine Measures | veditors = Contrada R, Baum A | title = The Handbook of Stress Science: Biology, Psychology, and Health | url = https://books.google.com/books?id=EXVlk8pnEKIC | location = New York | publisher = Springer Publishing Company | date = 2010 | page = 531 | isbn = 978-0-8261-1771-7 | access-date = 30 November 2020 | quote = [...] epinephrine, norepinephrine, and cortisol are considered the most important 'stress hormones,' although a number of other hormones are also influenced by stress [...]. }}</ref> for cardiovascular responses,<ref>{{cite book | vauthors = Krantz DS, Falconer JF | chapter = Measurement of cardiovascular responses | veditors = Cohen S, Kessler RC, Underwood Gordon L | editor1-link = Sheldon Cohen | editor2-link = Ronald C. Kessler | title = Measuring Stress: A Guide for Health and Social Scientists | url = https://books.google.com/books?id=Xy_r37l0qzIC | series = A project of the Fetzer Institute | year = 1997 | location = New York | publisher = Oxford University Press | publication-date = 1997 | pages = 193–212 | edition = revised | isbn = 978-0-19-512120-9 | access-date = 30 November 2020 }}</ref> or for immune response.<ref>{{cite book | vauthors = Kiecolt-Glaser J, Glaser R | author-link1 = Janice Kiecolt-Glaser | chapter = Measurement of immune response | veditors = Cohen S, Kessler RC, Underwood Gordon L | editor1-link = Sheldon Cohen | editor2-link = Ronald C. Kessler | title = Measuring Stress: A Guide for Health and Social Scientists | url = https://books.google.com/books?id=Xy_r37l0qzIC | series = A project of the Fetzer Institute | year = 1997 | location = New York | publisher = Oxford University Press | publication-date = 1997 | pages = 213–230 | edition = revised | isbn = 978-0-19-512120-9 | access-date = 30 November 2020 }}</ref> There are some valid questionnaires to assess stress level such as, Higher Education Stress Inventory (HESI) is a valid questionnaire used in many communities for assessment the stress level of college students.<ref>{{cite journal | vauthors = Dahlin M, Joneborg N, Runeson B | title = Stress and depression among medical students: a cross-sectional study | journal = Medical Education | volume = 39 | issue = 6 | pages = 594–604 | date = June 2005 | pmid = 15910436 | doi = 10.1111/j.1365-2929.2005.02176.x | s2cid = 9575988 }}</ref><ref>{{cite journal | vauthors = Shim EJ, Jeon HJ, Kim H, Lee KM, Jung D, Noh HL, Roh MS, Hahm BJ | display-authors = 6 | title = Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students | journal = BMC Medical Education | volume = 16 | issue = 1 | article-number = 302 | date = November 2016 | pmid = 27881178 | pmc = 5121937 | doi = 10.1186/s12909-016-0824-9 | doi-access = free }}</ref> There are many (psycho-)physiological measurement methods that correlate more or less well with psychological stress (mental or emotional) and are thus used as a possible indicator.<ref name="pmid42620">{{cite journal | vauthors = Klimmer F, Rutenfranz J, Rohmert W | title = [Investigations on physiological and biochemical indicators for differentiation of mental and emotional strain in psychical efforts (author's transl)] | language = German | journal = International Archives of Occupational and Environmental Health | volume = 44 | issue = 3 | pages = 149–63 | date = 1979 | pmid = 42620 | doi = 10.1007/BF00381130 | s2cid = 116086089 }}</ref><ref>{{cite book | vauthors = Gopher D, Donchin E | date = 1986 | chapter = Workload: An examination of the concept | veditors = Boff KR, Kaufman L, Thomas JP | title = Handbook of perception and human performance. 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Speichelparameter und kardiovaskuläre Parameter in Feld- und Experimentaluntersuchungen | title = Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin | id = FB 12.001 | location = Bremerhaven | publisher = Wirtschaftsverlag NW }}</ref><ref>{{cite thesis | vauthors = Ribback S | date = 2005 | title = Psychophysiologische Untersuchung mentaler Beanspruchung in simulierten Mensch-Maschine-Interaktionen | degree = Ph.D. | publisher = Universität Potsdam | url = https://publishup.uni-potsdam.de/frontdoor/index/index/docId/79 }}</ref><ref>{{cite book | vauthors = Schlick C, Bruder R, Luczak H | date = 2018 | title = Arbeitswissenschaft. 4. Aufl. | location = Berlin, Heidelberg | publisher = Springer | doi = 10.1007/978-3-662-56037-2 | isbn = 978-3-662-56036-5}}</ref><ref>{{cite book | vauthors = Stanton NA, Hedge A, Brookhuis K, Salas E, Hendrick HW | editor-first1 = Neville Anthony | editor-first2 = Alan | editor-first3 = Karel | editor-first4 = Eduardo | editor-first5 = Hal W. | editor-last1 = Stanton | editor-last2 = Hedge | editor-last3 = Brookhuis | editor-last4 = Salas | editor-last5 = Hendrick | date = 2005 | title = Handbook of human factors and ergonomics methods | location = Boca Raton | publisher = CRC Press | doi = 10.1201/9780203489925 | isbn = 978-0-429-20571-2 }}</ref>
In the physiological domain of oculomotor function alone, several physiological responses are suspected to detect different stress situations in a person-specific and objective manner (not by means of a survey). For example, via eye movement and gaze behavior,<ref name="Galley, Niels 1993">{{cite book | vauthors = Galley N | date = 1993 | chapter = Augenbewegungen, Antizipation und Leistung: Auf dem Wege zu einem neuropsychologischen Konzentrationsmodell | veditors = Beckmann J, Strang H, Hahn E | title = Aufmerksamkeit und Energetisierung. Facetten von Konzentration und Leistung | location = Göttingen, Bern, Toronto, Seattle | publisher = Hogrefe Verl. für Psychologie | pages = 229–245 | isbn = 978-3-8017-0421-6 }}</ref><ref>{{cite journal | vauthors = Biswas P, Dutt V, Langdon P | title = Comparing ocular parameters for cognitive load measurement in eye-gaze-controlled interfaces for automotive and desktop computing environments | journal = International Journal of Human-Computer Interaction | date = January 2016 | volume = 32 | issue = 1 | pages = 23–38 | doi = 10.1080/10447318.2015.1084112 | s2cid = 1770764 }}</ref><ref>{{cite thesis | vauthors = Schneider M | date = 2019 | title = Blickbasierte Beanspruchungsmessung: Entwicklung und Evaluation eines Kalibrierungssystems zur individuellen Bewertung der mentalen Beanspruchung in der Mensch-Technik-Interaktion | degree = Ph.D. | isbn = 978-3-7315-0809-0}}</ref> via pupil behavior<ref>{{cite journal | vauthors = Brunn WV, Falk R, Matthes K | title = Untersuchungen über die Pupillenreflexe beim Menschen | journal = Pflügers Archiv für die gesamte Physiologie des Menschen und der Tiere | date = January 1941 | volume = 244 | issue = 5 | pages = 644–658 | doi = 10.1007/BF01756035 | s2cid = 12285684 }}</ref><ref>{{cite thesis | vauthors = Kerkau F | date = 2005 | title = Biosignale der Pupille zur Steuerung intelligenter User Interfaces. Untersuchung von Pupillenbewegungen zur Realisierung einer biopsychologischen Computerschnittstelle für die Mensch-Computer-Interaktion. Dissertationsschrift | publisher = Freie Universität Berlin, Berlin. Fachbereich Erziehungswissenschaft und Psychologie | url = http://docplayer.org/3196391-Biosignale-der-pupille-zur-steuerung-intelligenter-user-interfaces.html }}</ref><ref>{{cite book | vauthors = Beatty J, Lucero-Wagoner B | date = 2000 | chapter = The pupillary system | veditors = Cacioppo JT, Tassinary LG, Berntson GG | title = Handbook of psychophysiology | publisher = Cambridge University Press | pages = 142–162 | isbn = 0-521-84471-1}}</ref><ref>{{cite journal | vauthors = Chen S, Epps J | title = Using task-induced pupil diameter and blink rate to infer cognitive load | journal = Human–Computer Interaction | date = July 2014 | volume = 29 | issue = 4 | pages = 390–413 | doi = 10.1080/07370024.2014.892428 | s2cid = 13871681 }}</ref> and via eyelid blink behavior (Blinking).<ref>{{cite journal | vauthors = Ponder E, Kennedy WP | title = On the act of blinking | journal = Quarterly Journal of Experimental Physiology | date = July 1927 | volume = 18 | issue = 2 | pages = 89–110 | doi = 10.1113/expphysiol.1927.sp000433 | doi-access = free }}</ref><ref name="pmid6701241">{{cite journal | vauthors = Stern JA, Walrath LC, Goldstein R | title = The endogenous eyeblink | journal = Psychophysiology | volume = 21 | issue = 1 | pages = 22–33 | date = January 1984 | pmid = 6701241 | doi = 10.1111/j.1469-8986.1984.tb02312.x }}</ref><ref name="Galley, Niels 1993"/><ref>{{cite journal | vauthors = Reßut N, Hoppe A | title = Erfassung von individuellem Beanspruchungserleben bei kognitiven Belastungssituationen mittels Mustererkennung im Lidschlagverhalten | journal = Zeitschrift für Arbeitswissenschaft | date = December 2020 | volume = 74 | issue = 4 | pages = 249–261 | doi = 10.1007/s41449-019-00165-y | s2cid = 203468950 }}</ref><ref>{{cite book | vauthors = Reßut N | date = 2021 | title = Das Lidschlagverhalten als Indikator psychischer Belastung | location = Wiesbaden | publisher = Springer Vieweg | doi = 10.1007/978-3-658-36052-8 | isbn = 978-3-658-36051-1 | s2cid = 245646463 }}</ref>
==Physical effects== To measure the body's response to stress, psychologists tend to use Hans Selye's general adaptation syndrome. This biological model, often referred to as the "classic stress response", revolves around the concept of homeostasis. General adaptive syndrome, according to this system, occurs in three stages:
# '''The alarm reaction'''. This stage occurs when the stressor is first presented. The body begins to gather resources to deal with the stressor. The hypothalamic-pituitary-adrenal axis and sympathetic nervous system are activated, resulting in the release of hormones from the adrenal gland such as cortisol, adrenaline (epinephrine), and norepinephrine into the bloodstream to adjust bodily processes. These hormonal adjustments increase energy-levels, increase muscle tension, reduce sensitivity to pain, slow down the digestive system, and cause a rise in blood pressure.<ref name="GottliebBenjaminCoping">Gottlieb, Benjamin."Coping with Chronic Stress". Plenum Press. 1997.</ref><ref name="General Adaptive Syndrome">{{cite book| vauthors = Mitterer J, Coon D |title= Introduction to Psychology|date= 2013|publisher= Jon-David Hague|pages= 446–447}}</ref> In addition, the locus coeruleus, a collection of norepinephrine-containing neurons in the pons of the brainstem whose axons project to various regions of the brain, is involved in releasing norepinephrine directly onto neurons. High levels of norepinephrine acting as a neurotransmitter on its receptors expressed on neurons in brain regions, such as the prefrontal cortex, are thought{{by whom|date=November 2020}} to be involved in the effects of stress on executive functions, such as impaired working memory. # '''The stage of resistance'''. The body continues building up resistance throughout the stage of resistance, either until the body's resources are depleted, leading to the exhaustion phase, or until the stressful stimulus is removed. As the body uses up more and more of its resources, it becomes increasingly tired and susceptible to illness. At this stage psychosomatic disorders first begin to appear.<ref name="General Adaptive Syndrome" /> # '''The stage of exhaustion'''. The body is completely drained of the hormones and resources it was depending on to manage the stressor. The person now begins to exhibit behaviors such as anxiety, irritability, avoidance of responsibilities and relationships, self-destructive behavior, and poor judgment. Someone experiencing these symptoms has a much greater chance of lashing out, damaging relationships, or avoiding social interaction at all.<ref name="General Adaptive Syndrome" />
This physiological stress response involves high levels of sympathetic nervous system activation, often referred to as the "fight or flight" response. The [http://oregonstate.edu/instruct/dce/hhs231_w04/nine/studyguide.htm response] {{Webarchive|url=https://web.archive.org/web/20121010135321/http://oregonstate.edu/instruct/dce/hhs231_w04/nine/studyguide.htm |date=2012-10-10 }} involves pupil dilation, release of endorphins, increased heart and respiration rates, cessation of digestive processes, secretion of adrenaline, arteriole dilation, and constriction of veins.<ref name="oregonstate.edu">{{cite web|url=http://oregonstate.edu/instruct/dce/hhs231_w04/nine/studyguide.htm|title= HHS 231 – Extended Campus – Oregon State University|url-status= live|archive-url= https://web.archive.org/web/20121010135321/http://oregonstate.edu/instruct/dce/hhs231_w04/nine/studyguide.htm|archive-date= 2012-10-10}}</ref>
===Cancer=== Psychological stress does not appear to be a risk factor for the onset of cancer,<ref name=Cohen2019>{{cite journal | vauthors = Cohen S, Murphy ML, Prather AA | title = Ten Surprising Facts About Stressful Life Events and Disease Risk | journal = Annual Review of Psychology | volume = 70 | pages = 577–597 | date = January 2019 | pmid = 29949726 | pmc = 6996482 | doi = 10.1146/annurev-psych-010418-102857 | quote = the strongest conclusion derived from decades of research on stressors and cancer is that stressful events may be associated with decreased cancer survival but are probably not associated with disease incidence (Chida et al. 2008). }}</ref><ref name="pmid23393080">{{cite journal | vauthors = Heikkilä K, Nyberg ST, Theorell T, Fransson EI, Alfredsson L, Bjorner JB, Bonenfant S, Borritz M, Bouillon K, Burr H, Dragano N, Geuskens GA, Goldberg M, Hamer M, Hooftman WE, Houtman IL, Joensuu M, Knutsson A, Koskenvuo M, Koskinen A, Kouvonen A, Madsen IE, Magnusson Hanson LL, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Salo P, Rugulies R, Steptoe A, Suominen S, Vahtera J, Virtanen M, Väänänen A, Westerholm P, Westerlund H, Zins M, Ferrie JE, Singh-Manoux A, Batty GD, Kivimäki M | display-authors = 6 | title = Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116,000 European men and women | journal = BMJ | volume = 346 | pages = f165 | date = February 2013 | pmid = 23393080 | pmc = 3567204 | doi = 10.1136/bmj.f165 }}</ref> though it may worsen outcomes in those who already have cancer.<ref name=Cohen2019/> Research has found that personal belief in stress as a risk factor for cancer was common in England, though awareness of risk factors overall was found to be low.<ref>{{cite journal | vauthors = Shahab L, McGowan JA, Waller J, Smith SG | title = Prevalence of beliefs about actual and mythical causes of cancer and their association with socio-demographic and health-related characteristics: Findings from a cross-sectional survey in England | journal = European Journal of Cancer | volume = 103 | pages = 308–316 | date = November 2018 | pmid = 29705530 | pmc = 6202672 | doi = 10.1016/j.ejca.2018.03.029 }}</ref>
=== {{anchor|Impact on health}}Other effects === <!-- This Anchor tag serves to provide a permanent target for incoming section links. Please do not remove it, nor modify it, except to add another appropriate anchor. If you modify the section title, please anchor the old title. It is always best to anchor an old section header that has been changed so that links to it will not be broken. See Template:Anchor for details. This template is {{subst:Anchor comment}} --> thumb|right |A stressed woman waiting in line at a medical centre
There is likely a connection between stress and illness.<ref>{{Cite web |date=2022 |title=How stress affects your health |url=https://www.apa.org/topics/stress/health |access-date=2024-01-25 |website=www.apa.org}}</ref> Theories of a proposed stress–illness link suggest that both acute and chronic stress can cause illness, and studies have found such a link.<ref>{{cite journal | vauthors = Schneiderman N, Ironson G, Siegel SD | title = Stress and health: psychological, behavioral, and biological determinants | journal = Annual Review of Clinical Psychology | volume = 1 | pages = 607–628 | year = 2005 | pmid = 17716101 | pmc = 2568977 | doi = 10.1146/annurev.clinpsy.1.102803.144141 | quote = Both epidemiological and controlled studies have demonstrated relationships between psychosocial stressors and disease. The underlying mediators, however, are unclear in most cases, although possible mechanisms have been explored in some experimental studies. }}</ref> According to these theories, both kinds of stress can lead to changes in behavior and in physiology. Behavioral changes can involve smoking and eating habits and physical activity. Physiological changes can be changes in sympathetic activation or hypothalamic pituitary adrenocorticoid activation, and immunological function.<ref>{{cite journal | vauthors = Herbert TB, Cohen S | title = Stress and immunity in humans: a meta-analytic review | journal = Psychosomatic Medicine | volume = 55 | issue = 4 | pages = 364–379 | year = 1993 | pmid = 8416086 | doi = 10.1097/00006842-199307000-00004 | s2cid = 2025176 | citeseerx = 10.1.1.125.6544 }}</ref> However, there is much variability in the link between stress and illness.<ref name="Ogden">Ogden, J. (2007). Health Psychology: a textbook (4th ed.), pages 281–282 New York: McGraw-Hill {{ISBN|0335214711}}</ref>
There is some evidence that stress can make the individual more susceptible to physical illnesses like the common cold. "Although chronic (but not acute) stressful events are associated with greater susceptibility, the association between social diversity and colds is not altered after controlling for life events."<ref>{{cite journal | vauthors = Edmunds WJ, Medley GF, O'Callaghan CJ | title = Social ties and susceptibility to the common cold | journal = JAMA | volume = 278 | issue = 15 | pages = 1231; author reply 1232 | date = October 1997 | pmid = 9333253 | doi = 10.1001/jama.1997.03550150035018 }}</ref> Stressful events, such as job changes, correlate with insomnia, impaired sleeping, and health complaints.<ref>Compare: {{cite journal | vauthors = Greubel J, Kecklund G | title = The impact of organizational changes on work stress, sleep, recovery and health | journal = Industrial Health | volume = 49 | issue = 3 | pages = 353–364 | date = March 2011 | pmid = 21372437 | doi = 10.2486/indhealth.ms1211 | quote = [...] organizational changes, which include a change in job tasks or downsizing, lead to a somewhat increased stress level as well as slightly increased health problems. This study added that complaints about poor sleep, sleepiness and incomplete recovery also increased in connection with extensive organizational changes. Another key finding was that this is even true for the anticipation of such changes | doi-access = free | bibcode = 2011IndHe..49..353G }}</ref> Research indicates the type of stressor (whether it is acute or chronic) and individual characteristics such as age and physical well-being before the onset of the stressor can combine to determine the effect of stress on an individual.<ref name="Schneiderman, N. 2005">{{cite journal | vauthors = Schneiderman N, Ironson G, Siegel SD | title = Stress and health: psychological, behavioral, and biological determinants | journal = Annual Review of Clinical Psychology | volume = 1 | pages = 607–628 | year = 2005 | pmid = 17716101 | pmc = 2568977 | doi = 10.1146/annurev.clinpsy.1.102803.144141 }}</ref> An individual's personality characteristics (such as level of neuroticism),<ref name="Jeronimus2014" /> genetics, and childhood experiences with major stressors and traumas<ref name="Jeronimus2013" /> may also dictate their response to stressors.<ref name="Schneiderman, N. 2005" /> Stress may also cause headaches.<ref>{{cite journal | vauthors = Chen Y | title = Advances in the pathophysiology of tension-type headache: from stress to central sensitization | journal = Current Pain and Headache Reports | volume = 13 | issue = 6 | pages = 484–494 | date = December 2009 | pmid = 19889292 | doi = 10.1007/s11916-009-0078-x | s2cid = 36447117 }}</ref>
Chronic stress and a lack of coping resources available or used by an individual can often lead to the development of psychological issues such as depression and anxiety.<ref>Schlotz W, Yim IS, Zoccola PM, Jansen L, Schulz P (2011). "The perceived stress reactivity scale: Measurement invariance, stability, and validity in three countries". ''Psychol Assess.'' (pp. 80–94).</ref> This is particularly true regarding chronic stressors. These are stressors that may not be as intense as an acute stressor like a natural disaster or a major accident, but they persist over longer periods of time. These types of stressors tend to have a more negative impact on health because they are sustained and thus require the body's physiological response to occur daily. This depletes the body's energy more quickly and usually occurs over long periods of time, especially when such microstressors cannot be avoided (for example: stress related to living in a dangerous neighborhood). Chronic stress may lead to allostatic load, a biological process affecting many physiological systems. For example, studies have found that caregivers, particularly those of dementia patients, have higher levels of depression and slightly worse physical health than non-caregivers.<ref>{{cite journal | vauthors = Pinquart M, Sörensen S | title = Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis | journal = Psychology and Aging | volume = 18 | issue = 2 | pages = 250–267 | date = June 2003 | pmid = 12825775 | doi = 10.1037/0882-7974.18.2.250 }}</ref>
Studies have also shown that perceived chronic stress and the hostility associated with Type A personalities are often correlated with much higher risks of cardiovascular disease.<ref>{{cite journal | vauthors = Huang CJ, Webb HE, Zourdos MC, Acevedo EO | title = Cardiovascular reactivity, stress, and physical activity | journal = Frontiers in Physiology | volume = 4 | page = 314 | date = November 2013 | pmid = 24223557 | pmc = 3819592 | doi = 10.3389/fphys.2013.00314 | doi-access = free }}</ref> This occurs because of the compromised immune system as well as the high levels of arousal in the sympathetic nervous system that occur as part of the body's physiological response to stressful events.<ref>{{cite journal | vauthors = Kemeny ME |title= The Psychobiology of Stress |journal= Current Directions in Psychological Science |volume= 12|issue= 4 |pages= 124–129 |date= August 2003 |doi= 10.1111/1467-8721.01246 |s2cid= 145293197 }}</ref> However, it is possible for individuals to exhibit hardiness{{snd}} a term referring to the ability to be both chronically stressed and healthy.<ref>Kobasa, S. C. (1982). "The Hardy Personality: Toward a Social Psychology of Stress and Health". In G. S. Sanders & J. Suls (Eds.), ''Social Psychology of Health and Illness'' (pp. 1–25). Hillsdale, NJ: Lawrence Erlbaum Assoc.</ref> Chronic stress can correlate with psychological disorders such as delusions.<ref>{{cite journal | vauthors = Kingston C, Schuurmans-Stekhoven J | title = Life hassles and delusional ideation: Scoping the potential role of cognitive and affective mediators | journal = Psychology and Psychotherapy | volume = 89 | issue = 4 | pages = 445–463 | date = December 2016 | pmid = 26846698 | doi = 10.1111/papt.12089 }}</ref> Pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus.<ref>{{cite journal | vauthors = Mah L, Szabuniewicz C, Fiocco AJ | title = Can anxiety damage the brain? | journal = Current Opinion in Psychiatry | volume = 29 | issue = 1 | pages = 56–63 | date = January 2016 | pmid = 26651008 | doi = 10.1097/YCO.0000000000000223 | type = Review | s2cid = 17911798 | quote = Pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus and the PFC, which may account for the increased risk of developing neuropsychiatric disorders, including depression and dementia. }}</ref>
It has long been believed that negative affective states, such as feelings of anxiety and depression, could influence the pathogenesis of physical disease, which in turn, have direct effects on biological process that could result in increased risk of disease in the end. However, studies done by the University of Wisconsin-Madison and other places have shown this to be partly untrue; although perceived stress seems to increase the risk of reported poor health, the additional ''perception'' of stress as something harmful increases the risk even further.<ref>{{cite journal | vauthors = Keller A, Litzelman K, Wisk LE, Maddox T, Cheng ER, Creswell PD, Witt WP | title = Does the perception that stress affects health matter? The association with health and mortality | journal = Health Psychology | volume = 31 | issue = 5 | pages = 677–684 | date = September 2012 | pmid = 22201278 | pmc = 3374921 | doi = 10.1037/a0026743 | quote = High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health <u>''and''</u> reported a large amount of stress had an increased risk of premature death. }}</ref><ref name="blog.ted.com">{{cite web|url= https://blog.ted.com/could-stress-be-good-for-you-recent-research-that-suggests-it-has-benefits/|title= Stress as a positive: Recent research that suggests it has benefits|date= 4 September 2013|archive-url= https://web.archive.org/web/20160911215227/http://blog.ted.com/could-stress-be-good-for-you-recent-research-that-suggests-it-has-benefits/|archive-date= 11 September 2016|url-status= live}}</ref> For example, when humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral responses are most likely to occur.<ref name="Jeronimus2014" /> Such changes could lead to disease.<ref name="Cohen2007">{{cite journal | vauthors = Cohen S, Janicki-Deverts D, Miller GE | title = Psychological stress and disease | journal = JAMA | volume = 298 | issue = 14 | pages = 1685–1687 | date = October 2007 | pmid = 17925521 | doi = 10.1001/jama.298.14.1685 | bibcode = 2007JAMA..298.1685C }}</ref> Chronic stress results from stressful events that persist over a relatively long period of time, such as caring for a spouse with dementia, or results from brief focal events that continue to be experienced as overwhelming even long after they are over, such as experiencing a sexual assault.
Experiments show that when healthy human individuals are exposed to acute laboratory stressors, they show an adaptive enhancement of some markers of natural immunity but a general suppression of functions of specific immunity. By comparison, when healthy human individuals are exposed to real-life chronic stress, this stress is associated with a biphasic immune response where partial suppression of cellular and humoral function coincides with low-grade, nonspecific inflammation.<ref>{{Cite web|url= http://www.natap.org/2007/HIV/101107_02.htm|title= Psychological Stress and Disease (HIV/AIDS)|website= www.natap.org|access-date= 2018-10-01}}</ref>
Even though psychological stress is often connected with illness or disease, most healthy individuals can still remain disease-free after confronting chronic stressful events. Also, people who do not believe that stress will affect their health do not have an increased risk of illness, disease, or death.<ref name="blog.ted.com" /> This suggests that there are individual differences in vulnerability to the potential pathogenic effects of stress; individual differences in vulnerability arise due to both genetic and psychological factors. In addition, the age at which the stress is experienced can dictate its effect on health. Research suggests chronic stress at a young age can have lifelong impacts on the biological, psychological, and behavioral responses to stress later in life.<ref> {{cite journal | vauthors = Miller G, Chen E, Cole SW | title = Health psychology: developing biologically plausible models linking the social world and physical health | journal = Annual Review of Psychology | volume = 60 | pages = 501–524 | year = 2009 | pmid = 19035829 | doi = 10.1146/annurev.psych.60.110707.163551 | doi-access = free }} </ref>
==Social impact==
===Communication=== When someone is stressed, many challenges can arise; a recognised challenge being communication difficulties. Here are some examples of how stress can hinder communication.
The cultures of the world generally fall into two categories; individualistic and collectivistic.<ref name="Sleep">{{cite book|title=Fundamentals of Nursing: Human and Health Function| vauthors = Craven R, Hirnle C, Jensen S |date=2013|publisher=Lippincott Williams & Wilkins|edition=7|location=Philadelphia|page=1319}}</ref> * An individualistic culture, like that of the United States, where everyone is an independent entity defined by their accomplishments and goals. * A collectivistic culture, like that of many Asian countries, prefers to see individuals as interdependent on each other. They value modesty and family.
These cultural differences can affect how people communicate when they are stressed. For example, a member of an individualistic culture would be hesitant to ask for pain medication for fear of being perceived as weak. A member of a collectivistic culture would not hesitate. They have been brought up in a culture where everyone helps each other and is one functional unit whereas the member of the individualistic culture is not as comfortable asking others for aid.<ref name=Sleep/>
====Language barriers==== Language barriers can cause stress, and sometimes this stress adds to language barriers. People may feel uncomfortable with the difficulties caused by differences in syntax, vocabulary, ways of showing respect, and use of body language. Along with a desire for successful social interactions, being uncomfortable with the communication around a person can discourage them from communicating at all, thus adding to the language barrier.
The System 1 – System 2 model of Daniel Kahneman's Thinking, Fast and Slow and others{{who|date=June 2023}} distinguishes between automatic responses, such as those one's native language provides, and a foreign language that requires System 2 work to translate. System 2 can become "depleted" by conscious mental effort, making it more difficult and stressful.<ref name="Cultural Differences">{{cite book|title=Foundations of mental health care| vauthors = Morrison-Valfre M |date=2009|publisher=Mosby/Elsevier|isbn=978-0-323-05644-1|edition=4th|location=St. Louis, Mo.}}</ref>
====Changes in the home==== Divorce, death, and remarriage are all disruptive events in a household.<ref name=Sleep /> Although everyone involved is affected by events such as these, it can be most drastically seen in children. Due to their age, children have relatively undeveloped coping skills.<ref>{{Cite web|url=https://medlineplus.gov/ency/article/002059.htm|title=Stress in childhood: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2018-10-01}}</ref> For this reason a stressful event may cause some changes in their behavior. Falling in with a new crowd, developing some new and sometimes undesirable habits are just some of the changes stress may trigger in their lives.<ref name=Sleep />
A particularly interesting response to stress is talking to an imaginary friend. A child may feel angry with a parent or their peers who they feel brought this change on them. They need someone to talk to but it definitely would not be the person with whom they are angry. That is when the imaginary friend comes in. They "talk" to this imaginary friend but in doing so they cut off communication with the real people around them.<ref name=Sleep />
===Social support and health=== Researchers have long been interested in how an individual's level and types of social support impact the effect of stress on their health. Studies consistently show that social support can protect against physical and mental consequences of stress.<ref>{{cite journal | vauthors = Uchino BN | title = Understanding the Links Between Social Support and Physical Health: A Life-Span Perspective With Emphasis on the Separability of Perceived and Received Support | journal = Perspectives on Psychological Science | volume = 4 | issue = 3 | pages = 236–255 | date = May 2009 | pmid = 26158961 | doi = 10.1111/j.1745-6924.2009.01122.x | s2cid = 17551921 | citeseerx = 10.1.1.713.8624 }}</ref><ref>{{cite journal | vauthors = Berkman LF, Glass T, Brissette I, Seeman TE | title = From social integration to health: Durkheim in the new millennium | journal = Social Science & Medicine | volume = 51 | issue = 6 | pages = 843–857 | date = September 2000 | pmid = 10972429 | doi = 10.1016/s0277-9536(00)00065-4 }}</ref> This can occur through a variety of mechanisms. One model, known as the "direct effects" model, holds that social support has a direct, positive impact on health by increasing positive affect, promoting adaptive health behaviors, predictability and stability in life, and safeguarding against social, legal, and economic concerns that could negatively impact health. Another model, the "buffering effect", says that social support exerts greatest influence on health in times of stress, either by helping individuals appraise situations in less threatening manners or coping with the actual stress. Researchers have found evidence to support both these pathways.<ref>{{cite journal | vauthors = Cohen S, Wills TA | title = Stress, social support, and the buffering hypothesis | journal = Psychological Bulletin | volume = 98 | issue = 2 | pages = 310–357 | date = September 1985 | pmid = 3901065 | doi = 10.1037/0033-2909.98.2.310 | s2cid = 18137066 }}</ref>
Social support is defined more specifically as psychological and material resources provided by a social network that are aimed at helping an individual cope with stress.<ref name="Cohen, S. 2004">{{cite journal | vauthors = Cohen S | title = Social relationships and health | journal = The American Psychologist | volume = 59 | issue = 8 | pages = 676–684 | date = November 2004 | pmid = 15554821 | doi = 10.1037/0003-066x.59.8.676 | bibcode = 2004AmPsy..59..676C }}</ref> Researchers generally distinguish among several types of social support: instrumental support – which refers to material aid (e.g., financial support or assistance in transportation to a physician's appointment), informational support (e.g., knowledge, education or advice in problem-solving), and emotional support (e.g., empathy, reassurance, etc.).<ref name="Cohen, S. 2004"/> Social support can reduce the rate of stress during pregnancy. Studies have found that those who had a large change in their life with a small amount of social support has a higher chance of complications. Whereas those with a larger support system would have a chance for less complications.<ref>{{cite journal | vauthors = Orr ST | title = Social support and pregnancy outcome: a review of the literature | journal = Clinical Obstetrics and Gynecology | volume = 47 | issue = 4 | pages = 842–855 | date = December 2004 | pmid = 15596938 | doi = 10.1097/01.grf.0000141451.68933.9f }}</ref>
==Management== {{Redirect|Stress Relief|The Office episode|Stress Relief (The Office)}} {{Redirect|Stress Reliever|the track|R.E.D. (Ne-Yo album)}}{{Main|Stress management}} Stress management refers to a wide spectrum of techniques and psychotherapies aimed at controlling a person's levels of stress, especially chronic stress, usually for the purpose of improving everyday functioning. It involves controlling and reducing the tension that occurs in stressful situations by making emotional and physical changes.
===Prevention and resilience building=== Decreasing stressful behaviors is a part of prevention. Some of the common strategies and techniques are: self-monitoring, tailoring, material reinforcement, social reinforcement, social support, self-contracting, contracting with significant other, shaping, reminders, self-help groups, and professional help.<ref>{{cite book|author=Greenberg|title=Comprehensive Stress Management 10E|url=https://books.google.com/books?id=D6Xr2waR9UEC&pg=PA261|publisher=McGraw-Hill Education|isbn=978-0-07-067104-1|pages=261–|url-status=live|archive-url=https://web.archive.org/web/20170218174937/https://books.google.com/books?id=D6Xr2waR9UEC&pg=PA261|archive-date=2017-02-18}}</ref>{{Explain |date=September 2018| reason = Some of these terms are probably unclear to the non-experts.}}
Although many techniques have traditionally been developed to deal with the consequences of stress, considerable research has also been conducted on the prevention of stress, a subject closely related to psychological resilience-building. A number of self-help approaches to stress-prevention and resilience-building have been developed, drawing mainly on the theory and practice of cognitive-behavioral therapy.<ref name="Robertson_2012">{{Cite book| author=Robertson, D | title=Build your Resilience| year=2012| publisher=Hodder| location=London| isbn=978-1-4441-6871-6 |url=https://books.google.com/books?id=QwIstsEgkBMC}}</ref>
Biofeedback may also play a role in stress management. A randomized study by Sutarto et al. assessed the effect of resonant breathing biofeedback (recognize and control involuntary heart rate variability) among manufacturing operators; depression, anxiety and stress significantly decreased.<ref name="Sutarto2012">{{cite journal | vauthors = Sutarto AP, Wahab MN, Zin NM | title = Resonant breathing biofeedback training for stress reduction among manufacturing operators | journal = International Journal of Occupational Safety and Ergonomics | volume = 18 | issue = 4 | pages = 549–561 | year = 2015 | pmid = 23294659 | doi = 10.1080/10803548.2012.11076959 | doi-access = free }}</ref>{{Primary source inline|date=January 2013}}
=== Exercising to reduce stress === Studies have shown that exercise reduces stress.<ref name=":0">{{cite web | work = Anxiety and Depression Association of America | title = Exercise for Stress and Anxiety | url = https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety }}</ref><ref name=":2"/> Exercise effectively reduces fatigue, improves sleep, enhances overall cognitive function such as alertness and concentration, decreases overall levels of tension, and improves self-esteem.<ref name=":0" /> Because many of these are depleted when an individual experiences chronic stress, exercise provides an ideal coping mechanism. Despite popular belief, it is not necessary for exercise to be routine or intense in order to reduce stress; as little as five minutes of aerobic exercise can begin to stimulate anti-anxiety effects.<ref name=":0" /> Further, a 10-minute walk may have the same psychological benefits as a 45-minute workout, reinforcing the assertion that exercise in any amount or intensity will reduce stress.<ref name=":0" /> Cycling and walking activities have lower stress scores when compared to other modes of transport or commuting.<ref name=":2"/>
==== Theoretical explanations ==== A multitude of theories have been presented in attempts to explain why exercise effectively reduces stress. One theory, known as the time-out hypothesis, claims that exercise provides distraction from the stressor. The time out hypothesis claims that exercise effectively reduces stress because it gives individuals a break from their stressors. This was tested in a recent study of college women who had identified studying as their primary stressor.<ref name=":1">{{cite journal | vauthors = Breus MJ, O'Connor PJ | title = Exercise-induced anxiolysis: a test of the "time out" hypothesis in high anxious females | journal = Medicine and Science in Sports and Exercise | volume = 30 | issue = 7 | pages = 1107–1112 | date = July 1998 | pmid = 9662680 | doi = 10.1097/00005768-199807000-00013 | doi-access = free }}</ref> The women were then placed under four conditions at varying times: "rest," "studying," "exercising," and "studying while exercising." The stress levels of the participants were measured through self-assessments of stress and anxiety symptoms after each condition. The results demonstrated that the "exercise" condition had the most significant reduction in stress and anxiety symptoms.<ref name=":1" /> These results demonstrate the validity of the time-out hypothesis.<ref name=":1" /> It is also important to note that exercise provided greater stress reduction than rest.
===Coping mechanisms=== {{Main|Coping (psychology)}} The Lazarus and Folkman model suggests that external events create a form of pressure to achieve, engage in, or experience a stressful situation. Stress is not the external event itself, but rather an interpretation and response to the potential threat; this is when the coping process begins.<ref name="Coping With Stress">{{cite book| vauthors = Snyder CR, Lefcourt HM |title=Coping With Stress|date=2001|publisher=Oxford University|location=New York|pages=68–88}}</ref>
There are various ways individuals deal with perceived threats that may be stressful. However, people have a tendency to respond to threats with a predominant coping style, in which they dismiss feelings, or manipulate the stressful situation.<ref name="Coping With Stress"/>
There are different classifications for coping, or defense mechanisms, however they all are variations on the same general idea: There are good/productive and negative/counterproductive ways to handle stress. Because stress is perceived, the following mechanisms do not necessarily deal with the actual situation that is causing an individual stress. However, they may be considered coping mechanisms if they allow the individual to cope better with the negative feelings/anxiety that they are experiencing due to the perceived stressful situation, as opposed to actually fixing the concrete obstacle causing the stress. The following mechanisms are adapted from the DSM-IV Adaptive Functioning Scale, APA, 1994.
While the DSM-IV (1994) categorized defense mechanisms on an "Adaptive Functioning Scale," this multi-axial system was removed in the DSM-5 (2013) and its subsequent revision, the DSM-5-TR (2022). Contemporary psychological models, while still acknowledging defense mechanisms, often classify coping strategies based on their function. A widely accepted model categorizes coping into three main styles:<ref>{{cite journal |last1=Carver |first1=C. S. |last2=Scheier |first2=M. F. |last3=Weintraub |first3=J. K. |title=Assessing coping strategies: a theoretically based approach |journal=Journal of Personality and Social Psychology |date=February 1989 |volume=56 |issue=2 |pages=267–283 |doi=10.1037/0022-3514.56.2.267 |pmid=2926629 |bibcode=1989JPSP...56..267C }}</ref><ref>{{cite book | vauthors = Folkman S, Lazarus RS |title=Stress, appraisal, and coping |publisher=Springer Publishing Company |year=1984 |isbn=978-0-8261-4191-0}}</ref> * '''Problem-focused coping:''' This style involves directly addressing the stressor or the situation that is causing stress. Strategies include active problem-solving, planning, seeking instrumental support (e.g., asking for tangible help or information), and time management. * '''Emotion-focused coping:''' This style focuses on regulating the negative emotions associated with the stressor, rather than changing the situation itself. Strategies include seeking emotional support (e.g., talking to friends), reframing the problem positively, practicing mindfulness or relaxation, and using humor. * '''Avoidance-focused coping (or dysfunctional coping):''' This style involves avoiding the stressor and the associated emotions. While it can be useful for short-term relief from overwhelming threats, it is generally considered counterproductive long-term. Strategies include denial, substance use, disengagement, and wishful thinking.
Another way individuals can cope with stress is by the way one perceives stress. Perceptions of stress are critical for making decisions and living everyday life. The outlook or the way an individual perceives the given situation can affect the manner to which the individual handles stress, whether it be positive or negative. Too much stress can be detrimental to the individual and can cause negative psychological and physical health effects.<ref>{{cite journal |last1=Keller |first1=Abiola |last2=Litzelman |first2=Kristin |last3=Wisk |first3=Lauren E. |last4=Maddox |first4=Torsheika |last5=Cheng |first5=Erika Rose |last6=Creswell |first6=Paul D. |last7=Witt |first7=Whitney P. |title=Does the perception that stress affects health matter? The association with health and mortality |journal=Health Psychology |date=September 2012 |volume=31 |issue=5 |pages=677–684 |doi=10.1037/a0026743 |pmid=22201278 |pmc=3374921 }}</ref>
====Highly adaptive/active/problem-focused mechanisms==== These skills are what one could call as "facing the problem head on", or at least dealing with the negative emotions experienced by stress in a constructive manner. (generally adaptive) * '''Affiliation''' ("tend and befriend") – involves dealing with stress by turning to a social network for support, but an individual does not share with others in order to diffuse or avoid the responsibility.<ref name="Levo, Lynn M. 2003">{{cite journal | vauthors = Levo LM | date = September 2003 | title = Understanding Defense Mechanisms. | journal = Lukenotes | volume = 7 | issue = 4 | publisher = St. Luke Institute | location = Silver Spring, Maryland }}</ref><ref name="DSM-IV Adaptive Functioning Scale 1994">Adapted from DSM-IV Adaptive Functioning Scale, APA, 1994.</ref> * '''Humour''' – the individual steps outside of a situation in order to gain greater perspective, and also to highlight any comic aspect to be found in their stressful circumstances.<ref name="Levo, Lynn M. 2003"/> [[File:Two people laughing.jpg|thumb|Coping through laughter ]] ::"The Association for Applied and Therapeutic Humour defines therapeutic humour as 'any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity of or incongruity of life's situations. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping whether physical, emotional, cognitive, or spiritual".<ref name="Communication in Nursing">{{cite book| vauthors = Riley J |title=Communication in Nursing|date=2012|publisher=Mosby/Elsevier|location=Missouri|pages=160–173|edition=7}}</ref>
::Sigmund Freud, suggested that humour was an excellent defensive strategy in emotional situations.<ref name="Coping With Stress"/> When one laughs during a tough situation they feel absent from their worries, and this allows them to think differently.<ref name="Communication in Nursing"/> When one experiences a different mind set, they feel more in control of their response, and how they would go about dealing with the event that caused stress.
::Lefcourt (2001) suggests that this perspective-taking humour is the most effective due to its ability to distance oneself from the situation of great stress.<ref>{{cite book| vauthors = Lefcourt HM | veditors = Snyder CR |title=Coping with Stress: Effective People and Processes.|date=2001|publisher=Oxford University Press|location=New York|isbn=978-0-19-802995-3|pages=68–92|chapter=The Humour Solution}}</ref> Studies show that the use of laughter and humour creates a sense of relief of stress that can last up to 45 minutes post-laughter.<ref name="Communication in Nursing"/>
::Also, most hospitalized children have been seen to use laughter and play to relieve their fear, pain and stress. It has been discovered that there is a great importance in the use of laughter and humour in stress coping.<ref name="Communication in Nursing"/> Humans should use humour as a means to transcend their original understanding of an external event, take a different perspective, in which their anxiety may be minimized by. * '''Sublimation''' – allows an "indirect resolution of conflict with neither adverse consequences nor consequences marked by loss of pleasure."<ref>{{cite journal | vauthors = Vaillant GE | title = Adaptive mental mechanisms. Their role in a positive psychology | journal = The American Psychologist | volume = 55 | issue = 1 | pages = 89–98 | date = January 2000 | pmid = 11392869 | doi = 10.1037/0003-066x.55.1.89 }}</ref> Essentially, this mechanism allows channeling of troubling emotions or impulses into an outlet that is socially acceptable. * '''Positive reappraisal''' – redirects thoughts (cognitive energy) to good things that are either occurring or have not occurred. This can lead to personal growth, self-reflection, and awareness of the power/benefits of one's efforts.<ref>{{cite journal | vauthors = Folkman S, Moskowitz J | year = 2000 | title = Stress, Positive Emotion, and Coping | journal = Current Directions in Psychological Science | volume = 9 | issue = 4| pages = 115–118 | doi=10.1111/1467-8721.00073| s2cid = 1288773 }}</ref> For example, studies on veterans of war or peacekeeping operations indicate that persons who construe a positive meaning from their combat or threat experiences tend to adjust better than those who do not.<ref name="pmid17532104">{{cite journal | vauthors = Schok ML, Kleber RJ, Elands M, Weerts JM | title = Meaning as a mission: a review of empirical studies on appraisals of war and peacekeeping experiences | journal = Clinical Psychology Review | volume = 28 | issue = 3 | pages = 357–365 | date = March 2008 | pmid = 17532104 | doi = 10.1016/j.cpr.2007.04.005 | type = Review }}</ref>
Other adaptive coping mechanisms include anticipation, altruism, and self-observation.
====Mental inhibition/disavowal mechanisms==== These mechanisms cause the individual to have a diminished (or in some cases non-existent) awareness about their anxiety, threatening ideas, fears, etc., that come from being conscious of the perceived threat.{{Citation needed|date=May 2024}} * '''Displacement''' – This is when an individual redirects their emotional feelings about one situation to another, less threatening one.<ref>"displacement n." A Dictionary of Psychology. Edited by Andrew M. Colman. Oxford University Press 2009. Oxford Reference Online. Oxford University Press.</ref> * '''Repression''' – Repression occurs when an individual attempts to remove all their thoughts, feelings, and anything related to the upsetting/stressful (perceived) threat out of their awareness in order to be disconnected from the entire situation. When done long enough in a successful way, this is more than just denial. * '''Reaction formation''' – An attempt to remove any "unacceptable thoughts" from one's consciousness by replacing them with the exact opposite.<ref>{{cite journal | vauthors = Baumeister RF, Dale K, Sommer KL | title = Freudian defense mechanisms and empirical findings in modern social psychology: Reaction formation, projection, displacement, undoing, isolation, sublimation, and denial | journal = Journal of Personality | date = December 1998 | volume = 66 | issue = 6 | pages = 1081–124 | doi = 10.1111/1467-6494.00043 | url = https://www.secretintelligenceservice.org/wp-content/uploads/2016/02/Freudian-defense-mechanisms.pdf }}</ref>
Other inhibition coping mechanisms include undoing, dissociation, denial, projection, and rationalization. Although some people claim that inhibition coping mechanisms may eventually increase the stress level because the problem is not solved, detaching from the stressor can sometimes help people to temporarily release the stress and become more prepared to deal with problems later on.
====Active mechanisms==== These methods deal with stress by an individual literally taking action, or withdrawing. * '''Acting out''' – Often viewed as counter-normative, or problematic behavior. Instead of reflecting or problem-solving, an individual takes maladaptive action.<ref name="DSM-IV Adaptive Functioning Scale 1994"/> * '''Passive aggression''' – When an individual indirectly deals with their anxiety and negative thoughts/feelings stemming from their stress by acting in a hostile or resentful manner towards others. Help-Rejecting Complaining can also be included in this category.
====Health promotion==== There is an alternative method to coping with stress, in which one works to minimize their anxiety and stress in a preventative manner.
Suggested strategies to improve stress management include:<ref>{{cite book| vauthors = Potter P |title=Canadian Fundamentals of Nursing|date=2014|publisher=Elsevier|location=Toronto|pages=472–488|edition=5th }}</ref>
# Regular exercise – set up a fitness program, 3–4 times a week # Support systems – to listen, offer advice, and support each other # Time management – develop an organizational system # Guided imagery and visualization – create a relaxing state of mind # Progressive muscle relaxation – loosen tense muscle groups # Assertiveness training – work on effective communication # Journal writing – express true emotion, self-reflection # Stress management in the workplace – organize a new system, switch tasks to reduce own stress.
Depending on the situation, all of these coping mechanisms may be adaptive, or maladaptive.
== History == Prior to the introduction of the concept "stress" in the psychological sense {{circa}} 1955,<ref>{{Cite OED2 | stress }} - "1955 H. Basowitz et al. Anxiety & Stress i. 7 Anxiety has been defined in terms of an affective response; stress is the stimulus condition likely to arouse such response."</ref><ref>{{OEtymD| stress| access-date=2019-04-19 | name-list-style = vanc }} - "stress (n.) [...] The purely psychological sense is attested from 1955."</ref> people already identified a range of more nuanced ideas to describe and confront such emotions as worry, grief, concern,<ref>{{cite book | vauthors = Linn MW | year = 1986 | chapter = Elderly Women's Health and Psychological Adjustment: Life Stressors and Social Support | veditors = Hobfoll SE | title = Stress, Social Support, And Women | url = https://books.google.com/books?id=BJYiAwAAQBAJ | series = Clinical and Community Psychology | location = Abingdon | publisher = Taylor & Francis | publication-date = 2014 | page = 233 | isbn = 978-1-317-77060-2 | access-date = 20 July 2020 | quote = Although the SRRS identified women with high and low stress, it also appeared limited in covering certain areas of stress currently felt by these women. For example, worry and concern about events that have not happened, or in some cases did happen but were not included on the scale, were common. }}</ref> obsession, fear, annoyance, anxiety, distress, suffering and passion.<ref> Once widely recognised, passion appears to wane in importance as the concept of "stress" becomes popular. See [https://books.google.com/ngrams/graph?content=passion%2Cstress&year_start=1750&year_end=2019&corpus=26&smoothing=3 a usage Ngram for the two terms].</ref> By the 19th century, the popularisation of the nascent science of neurology made it possible to group some undifferentiated combination of one or more of these with an informal diagnosis such as "nerve strain".<ref> For example: {{cite book |last1 = Pinkham |first1 = Lydia E. |author-link1 = Lydia Pinkham |year = 1876 |title = Nerve Strain: The Busy Lives of American Women, the Cause of Their Ill Health, and the Remedy |url = https://books.google.com/books?id=zm2pwwEACAAJ |access-date = 24 May 2023 }} </ref>
"Stress" has subsequently become a mainstay of pop psychology.<ref> For example: {{cite book | vauthors = Carr A | title = Clinical Psychology: An Introduction | url = https://books.google.com/books?id=u4aDPdw0Fi4C | location = London | publisher = Routledge | date = 2012 | page = 22 | isbn = 978-0-415-68397-5 | access-date = 2019-04-19 | quote = This stress-induced focus on the self is compounded by exposure to 'pop-psychology' advice to use selffocused stress management techniques during interviews. }}</ref><ref>{{cite book | vauthors = Cohen LJ | chapter = Mental Health and Mental Illness | title = The Handy Psychology Answer Book | chapter-url = https://books.google.com/books?id=7MYDiuupuhYC | series = The Handy Answer Book Series | location = Detroit | publisher = Visible Ink Press | date = 2011 | page = 401 | isbn = 978-1-57859-354-5 | access-date = 2019-04-19 | quote = Popular or ''pop psychology'' is aimed at a popular audience and communicated through the mass media. It addresses topics related to psychology—such as romantic relationships, stress management, child rearing, and sexuality [...] }}</ref> Though stress is discussed throughout history from many distinct topics and cultures, there is no universal consensus over describing stress.<ref name="Monroe 2008 33–52">{{cite journal | vauthors = Monroe SM | title = Modern approaches to conceptualizing and measuring human life stress | journal = Annual Review of Clinical Psychology | volume = 4 | issue = 1 | pages = 33–52 | date = 2008 | pmid = 17716038 | doi = 10.1146/annurev.clinpsy.4.022007.141207 }}</ref> This has led to multiple kinds of research, looking at the different aspects of psychological stress and how it changes over a lifespan.<ref name="Monroe 2008 33–52"/>
== See also == {{Portal|Medicine|Psychology}} {{Columns-list|colwidth=30em| * Academic stress * Acute stress reaction * Adaptive performance * Cognitive behavioral therapy * Complex post-traumatic stress disorder * Conservation of resources theory, stress theory * Exhaustion disorder * Henry Murray extreme stress experiments at Harvard 1960s * Incident stress * Maladaptation * Melancholia * Mental breakdown * Mindfulness-based stress reduction * Minority stress * Occupational stress * Occupational burnout * Posttraumatic stress disorder * Psychological trauma * Psychoneuroimmunology * Social stress * Stress (biology) }}
== References == {{Reflist}}
== Further reading == * {{cite book |title=The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It |author=Kelly McGonigal |year=2015 |isbn=978-1-58333-561-1 |publisher=Avery }} * {{cite book |title=The Stress Test: How Pressure Can Make You Stronger and Sharper |year=2017 |publisher=Bloomsbury USA |isbn=978-1-63286-729-2 |author=Ian Robertson}}
== External links == {{Commons}} * {{Cite web|url=https://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/manage-stress|title=Manage Stress - healthfinder.gov|website=healthfinder.gov|access-date=2019-07-22}}
{{Medical resources | ICD10 = <!--{{ICD10|Xxx.x}}--> | ICD10CM = <!--{{ICD10CM|Xxx.xxxx}}--> | ICD9 = <!--{{ICD9|xxx}}--> | DiseasesDB = | MedlinePlus = 003211 | eMedicineSubj = | eMedicineTopic = | PatientUK = | MeshID = D013315 | NORD = | NCI = | Scholia = | SNOMED CT =73595000 }} {{Authority control}}
Category:Psychological stress Category:Stress (biological and psychological)