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Health problem: Stress

Are university applications due Friday? Need to have a difficult conversation with your parents about a situation in one of your classes? Does a recent text message seem to indicate that the love of your life wants to break up after lunch today? Any of these experiences may make you feel rather stressed - your heart races, you feel weak in the knees, and you have problems concentrating. 

Any adverse or challenging event could be labeled a stressor. According to Professor of Neurology Robert Sapolsky of Stanford University, humans are the only species that can imagine stressors. People react in exactly the same way physiologically and psychologically if they think that their boss will fire them as if they were actually facing the stressful situation of losing their job. We can also experience stress about the future - for example, fear of global warming, potential financial problems, or fear of aging.

Types of stress

One of the difficulties of studying and managing stress is that "stress" is not a single phenomenon. Stress management can be complicated and confusing because there are different types of stress - acute stress, episodic acute stress, and chronic stress -- each with its own characteristics, symptoms, duration, and treatment approaches.

Acute Stress

Acute stress is the most common form of stress. It comes from the demands and pressures of day-to-day life. The demands can be actual or perceived. For example, there may be a deadline that you have to meet for your EE to be submitted to the IB. That is an actual demand. You may also feel that you need to get all 7's this semester in order to please your family. This is a perceived demand. Acute stress is short-term and has a foreseeable end in sight.

Because it is short-term, acute stress doesn't cause the damage associated with long-term stress. The most common symptoms are:

  • emotional distress - some combination of anger or irritability, anxiety, and depression
  • muscular problems including tension headache, back pain, jaw pain, and the muscular tensions that lead to pulled muscles
  • stomach, gut, and bowel problems such as heartburn, acid stomach, flatulence, diarrhea, constipation, and irritable bowel syndrome;
  • Over-arousal leads to an elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath, or chest pain.

We all experience acute stress at some time in our life. It is highly treatable and manageable, as we will see later in this unit.

Episodic Acute Stress

There are those, however, who suffer acute stress frequently, whose lives are so disordered that they are studies of chaos and crisis. They're always in a rush, but always late. They take on too much and can't manage their time or meet all the commitments that they have made. This is the "over-extended" person or the "over-achiever." Unlike acute stress, episodic acute stress is a lifestyle choice.

It is common for people with acute stress reactions to be over-aroused, short-tempered, irritable, anxious, and tense. Often, they describe themselves as having "a lot of nervous energy." Always in a hurry, they tend to be abrupt and sometimes come across as hostile. Interpersonal relationships suffer. Friedman and Rosenman labeled this pattern of behavior as Type A personality.

ATL: Reflection

Watch the following video where Stanford professor Robert Sapolsky speaks about Type A personality and toxic hostility.

After watching the video, take the Type A personality test.

After you have received your results, consider the following questions:

  • What types of behavior was the test looking for? How do you think that this fits with the description of Type A personality discussed in Sapolsky's video?
  • What are the problems with such a test? (Especially after being primed by such a video).
  • Why do you think that these behaviors are ultimately dangerous to our health?
  • Why do you think that people develop this personality type?
 Teacher only box

What types of behavior was the test looking for? How do you think that this fits with the description of Type A personality discussed in Sapolsky's video?

The test looks for behaviors that are competitive, seeking external rewards, unable to relax, perfectionism, judgmental, highly conscious of time, and prone to anger.

What are the problems with such a test? (Especially after being primed by such a video).

There are a few problems with this test.  First, if you don't want to be labeled as a type-A personality, then you can be self-deceptive and are more likely to gravitate to the mean in your responses. Secondly, if you are concerned that others may judge your results, there may be social desirability bias.  Finally, the test is only taken on a single occasion.  This means that the context in which the test is taken may influence the way the questions are answered. The results may differ if taken during a summer holiday vs in the worst word crunch of the year.

Why do you think that these behaviors are ultimately dangerous to our health?

The traits are all linked to stress - and this means that stress hormones are released, increasing blood pressure.

Why do you think that people develop this personality type?

Students may have different responses to this.  Theoretically, this could be genetic, but the research on the genetics of personality traits is rather ambiguous and the theory is not well supported, although there is some research that has shown a correlation between some genes and certain personality types.  One of the problems with arguing that Type A is genetic is that this is no longer how psychologists think about personality - instead, the Five-Factor Model is the modern nomenclature.

A stronger argument can be made that the traits are based on social learning - that is, learning through interaction with one's environment and culture.

Another form of episodic acute stress comes from ceaseless worry. Pessimists often see disaster around every corner and forecast catastrophe in every situation. The world is a dangerous, unrewarding, punitive place where something awful is always about to happen. This perception of the world leads to hyperarousal which is characteristic of episodic stress.

The symptoms of episodic acute stress are the symptoms of extended over-arousal: persistent tension headaches, migraines, hypertension, chest pain, and heart disease.

Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months. Often, lifestyle and personality issues are so ingrained and habitual that they see nothing wrong with the way they conduct their lives. They also tend to attribute their stress to other people and external events. Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as who and what they are. They also often feel that this is the way that "the world works" and how they are supposed to be in order to be successful. There is a strong argument that cultural norms may actually encourage these behaviors in some people. Often people who experience episodic acute stress resist treatment until a health problem forces them to confront reality.

Chronic Stress

Chronic stress is the stress that wears people away day after day, year after year. Chronic stress has a serious effect on our health - both physically and psychologically. It also takes its toll on relationships. Chronic stress very often is a response to something that an individual cannot change in his/her life. Chronic stressors include poverty, dysfunctional families, domestic violence, chronic illness, institutionalized discrimination, and war/conflict. As a result, the problem-focused coping strategies that are often used in acute stress situations - that is, moving away from a stressor or changing the nature of the stressor - are not possible. A person suffering from chronic stress often feels a sense of hopelessness and despair.

Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful. Some experiences profoundly affect personality. A view of the world is created that causes unending stress for the individual.

Chronic stress kills through suicide, violence, heart attack, stroke, and, perhaps, even cancer. It also has a negative effect on memory and attention. The symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.

ATL: Thinking critically

Is it possible that there are also some good sides to stress?

There is also something that is called eustress. This term was first used by Hans Selye. He differentiated between distress - that is, negative stress - and eustress, which is the positive response to stress that makes one feel a sense of pride and accomplishment. Eustress is not about the stressor, but about how one perceives stress. The following Ted Talks with Kelly McGonigal looks at how stress can actually be a positive factor in one's life.

What do you think about McGonical's argument?  Do you think that the research that she describes is strong evidence that stress is not bad for you?  Why or why not?

 Teacher only box

McGonigal's argument was met with a lot of negative reactions from psychologists because her opening to this talk is rather deceptive. Her comment that she was wrong to teach people that "stress is bad for you" is an overstatement and is misleading.  The research she outlines shows that stress can be controlled by the way we think about stress - and that when we see it as empowering, then it is helpful.  But, this does not mean that chronic stress, which is beyond the control of the individual, is not bad for one's health.  Some have also accused McGonical of classicism in her presentation, focusing on people applying for a job and citing research studying student populations at one of the top US universities.  Her discussion shows that perhaps students could turn their IB stress into something positive - but it is hard to imagine that they could turn stress from ACEs (for example) into something positive.

ATL: Reflection

What are two stressors that you have encountered in the past year?

How did you react to each of these events, physiologically and psychologically?

Why did you think that you experienced these events as stressful?

How did you deal with the stressors? Did it work?

 Teacher only box

This reflection is to get students thinking about their own levels of stress and how they are affected by stress. Most importantly, it gets them to think about how they can cope with stressors.  Sharing their reflections can lead to a helpful discussion of ways to manage stress.

You may want to share the following videos with them as part of a class discussion.

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