Evaluation points for Stress

As requested, I've done some evaluation points for stress. They aren't the only ones, so if you think of any more, feel free to use those. 

Causes of Stress

• You could evaluate the extent to which each of these were nomothetic - does everybody have lack of control/work/daily hassles/life events? Does it cause each person stress?
• You could look at situational versus dispositional - all of these actually tend to favour situational explanations of stress, but the treatments tend to be dispositional, so this could be a good issue to look into. 
• You could maybe also look at how simple these causes would be to fix, and how the knowledge that they cause stress could be use. This leads you to evaluation issues such as usefulness and application. 

Measures of Stress

• Validity is a major issue here. You've got low construct validity in that it's hard to define stress and thus hard to know when you're measuring it, as well as face validity because the measures of stress can be affected by lying, memory, demand characteristics, illness, emotion, etc. Also, different people experience stress differently so using only one measure on participants may not be a valid approach.
• Reliability is also important. As different people experience stress differently, measures are unlikely to give consistent results if used again in similar situations. Too many things affect measures of stress and stress itself in order to give consistent results on physiological or self-report measures.
• Reductionism is a potential issue. Obviously, measures which are only self-report (e.g. SRRS) or only physiological (e.g. heart rate monitor) are reductionist and don't look at many features of stress response or the dynamic between them, whilst combined measures are holistic and thus may be more appropriate and useful.

Managing Stress

• Situational versus dispositional is also appropriate to evaluate here. Social support takes the situational approach whilst cognition is dispositional, as is behaviourism (biofeedback). Though, behaviourist ways of managing stress emphasise the role of positive reinforcement, so it has a situational element as well. You could obviously link this to reductionism and holism. 
• You could look at whether symptoms or causes of stress are targeted, and evaluate whether this is a good approach to managing stress. SIT attempts to prevent stress as well as help the individual overcome their current stress which Meichenbaum suggests is the actual cause of stress, thus it targets causes rather than symptoms. Biofeedback treats the symptoms of stress response rather than the causes as it teaches relaxation, though this may prevent stress too. Social support targets the symptoms and causes in that having strong social networks can provide support to prevent stress, and provide support once stress has onset. 
• You could also look at effectiveness by looking at whether research supports it, or by cost and time effectiveness. Biofeedback in the form of EMG machines are expensive and require a practitioner, it's somewhat difficult and expensive to get a therapist but once you've learned the skills it lasts a long time, and social support is free and lasts a long time, but is not instantaneous. 

Also, some of the studies are pretty unethical, such as Geer and Maisel, and those which put participants on waiting lists rather than giving them therapy. Though control groups help with internal validity checks, they aren't the most ethical. E.g. Meichenbaum's study had a control group of students who did worse on their exams than the experimental groups - if they were in the other group, they'd have benefited and thus they lost out. 

Reliability of Measures of Stress (Part B)

June 2011 - (b) Assess the reliability of methods of measuring stress (15)

Firstly, define the key terms in your introduction and outline the methods. You might also want to list some of the issues surrounding reliability.

"Stress is the body's response to when physical or perceived demands on an individual do not match their perceived or actual abilities to deal with a situation. It can manifest itself both physiologically and psychologically, and thus the most common approaches to measuring stress are physiological measures such as GSR, and self-report measures such as the Holmes and Rahe SRRS. However, the reliability of these measures is questionable, because of the changeable nature of stress, issues surrounding bias and standardisation, and confounding variables which mean that measures of stress may not always produce consistent results when the measure is replicated."

There's a lot of ways you could tackle the main body, such as doing one paragraph on internal reliability and one on external reliability, or going through different issues, but I prefer to go through measure by measure, and assessing each one's reliability. For example:

"One prominent measure of stress is the self-report method, which involves asking individuals to record either their stressors, such as their hassles and uplifts, or stress responses, as in the Bradburn Morale Scale. Whilst self-report appears to be an appropriate measures of psychological stress responses as it asks them about how they feel and what has bothered them, it is affected by many confounding variables that mean it's often not reliable. For example, two people may actually have the same number of hassles and uplifts, but individual differences such as the extent to which dishonesty, their mood, their memory, social desirability bias or interpretation affects their responses may result in them self-reporting different numbers of hassles. Thus, the measure may lack both internal and external reliability as well as internal validity for this reason. However, not all self-report methods lack reliability, and those with checklists or which ask closed questions may give more consistent results. For example, Holmes and Rahe's Social Readjustment Rating Scale (SRRS) involves a checklist, which is standardised and consists of the same life events. There is very little interpretation involved in answering the checklists which removes this confounding variable, and as stressors are listed in front of the individuals, poor memory is also less likely to affect the results. Thus, the measure is likely consistent over time, but may still have poor internal reliability due to the impact of mood and bias. Self-report measures are therefore variable in their reliability."

This paragraph includes examples, and a number of factors affecting reliability including standardisation, mood and subjectivitiy. It gives both strengths and weaknesses of the measure, thus fulfilling the "assess" part of the question, too. The result of my answer would consist of:

>> an assessment of physiological measures. I'd include objectivity as a strength, and that it's less affected by the user, but then say it's reliability is damaged by the fact that everybody experiences stress differently - some get headaches, some get muscle tension, others have increased heart rates, some do not experience it very much in terms of biology but their concentration lapses, etc. Also, different factors affect the physiological measures, such as in Geer and Maisel's study, GSR may not have merely measured stress response but other emotional responses, such as fear arousal or shock, and that heart rates as a measure can be affected by general health condition and exercise as well as weight, fitness, etc. 

>>briefly mention combined approach as seen in Johansson. Likely to share strengths and weaknesses of both, but may cancel out the influence of individual differences in terms of stress responses. 

>>Conclusion: both are replicable and thus should have external reliability, though stress is variable and thus the extent to which any measure can be considered to be consistent is questionable as it relies on a large number of variables to be controlled. 

All the studies and theories for G543 (the ones I'm using)

Some people have been asking how many studies I've learnt, so I've put them all down here. It's also a bit of a reference point to see whether you're familiar with them or if you need to revise some sections more than others.

Forensic Psychology

Turning to crime

Upbringing - disrupted families [Juby and Farrington], differential association theory (learning from others) [Akers], poverty and disadvantaged neighbourhoods [Wikstrom and Tafel]

Cognition – criminal thinking patterns, [Yochelson and Samenow] moral development, social cognition (attribution) [both use Palmer and Hollin]

Biology – brain dysfunction [Raine], genes and serotonin [Brunner], gender [Daly and Wilson]

Making a case

Interviewing witnesses – recognising faces [Bruce], influencing factors (weapon focus)[Loftus] , cognitive interview [Fisher]

Interviewing suspects – detecting lies [Mann], interrogation techniques [Inbau], false confessions [Gudjonsson]

Creating a profile – top down [Mokros and Alison], bottom up [Copson], case study of John Duffy [Canter]

After a Guilty Verdict

Imprisonment – Planned behaviours [Gillis and Nafekh], depression/suicide risk [Dooley], prison situation and roles [Haney and Zimbardo]

Alternatives to imprisonment – probation [Mair and May], restorative justice [Sherman and Strang], looking death worthy [Eberhardt]

Treatment programmes – cognitive skills [Friendship], anger management [Ireland] and ear acupuncture [Wheatley]

Health and Clinical Psychology

Stress

Causes of stress – work [Johansson], hassles [Kanner], lack of control [Geer and Maisel]

Measures of stress – self report [Kanner], physiological [Geer and Maisel], combined approach [Johansson]

Managing stress – stress inoculation therapy [Meichenbaum], biofeedback [Budzynski], social support [Waxler-Morrison]

Dysfunctional behaviour/Disorders

Diagnosing dysfunctional behaviour – definitions [Rosenhan and Seligman], DSM, gender bias [Ford and Widiger]

Explanations of dysfunctional behaviour/disorders – faulty thinking (cognitive) [Beck], learned/positive reinforcements (behavioural) [Lewinson], serotonin and genes (biological) [Wender]

Treatments of dysfunctional behaviour/disorders – rational emotive therapy (cognitive) [Beck], CBT/behavioural activation (behavioural) [Lewinson], drug therapy (biological) [Karp and Frank]

Note that the two Beck studies and two Lewinson studies are different studies. The explanations one refers to studies where Beck interviewed patients with depression to see what cognitive distortions they shared, and Lewinson looked at positive reinforcements in the lives of depressed participants. In the treatments studies, Beck compares drug therapy and cognitive therapies, whilst Lewinson sees whether a "coping with depression" course coupled with parents being taught how to reinforce good behaviour is studied. 

Lack of control (physiological measures)

The NHS has reported that one of the major causes of stress is feeling overwhelmed by a situation and thus feeling out of control.

It's important to recognise the applications of this explanation, because control is a part of so many activities relating to stress, including work, life events, and hassles. It also suggests why people with physical illnesses such as cancer feel more stressed, and why we get stressed when we're not sure what's going on. 

One study which looked at lack of control as a cause of stress was Geer and Maisel. The study was a laboratory experiment using a sample of 60 students, who were made to look at photographs of dead car crash victims. 

The sample was split into three conditions, each with a varying amount of control. Group 1 were told the timings of the photographs so they knew when they'd appear and disappear, and they were also told how to get rid of the photographs from the screen. Group 2 knew the timings only, and Group 3 were unaware of timings and how to stop the photographs remaining on-screen. 

Stress response was measured physiologically by two measures: an ECG machine measuring heart rate (though this measurement was discarded) and through galvanic skin response, which is essentially the change in your skin's ability to conduct electricity due to an emotional response, such as fear or stress.

Group 1 had the lowest stress according to the GSR, and Group 3 had the highest, suggesting that lack of control can increase stress, and that control over your environment could help to reduce stress. 

Hassles as a cause of stress (self-report measures)

Holmes and Rahe's Social Readjustment Rating Scale recognises the importance of life events in causing stress, and it is well-documented that major life events such as getting married, moving house or starting a new job are stressors. 

However, the effects of daily hassles on stress are often ignored. Hassles are minor irritating inconveniences that occur on a daily basis, such as losing keys, getting stuck in traffic, or the water running cold halfway through your shower. Hassles are individual to each person, because we're not all bothered by the same things. 

Psychologists believe that if you are subject to an overwhelming number of hassles, and these are not balanced by uplifts (little things that cheer you up, like listening to your favourite song or finding money in your jeans' pocket), then you're more likely to feel stressed. And, the more hassles, the more stress you'll feel. 

One study which looked into whether hassles and uplifts or life events were better indicators of stress was Kanner et al. It was a longitudinal study whereby 100 Californians were asked to record (self-report) their daily hassles and uplifts for nine months. At the end of ten months, they were asked to complete the Holmes and Rahe SRRS to measure their life events. 

Psychological stress response was measured by the Bradburn Morale Scale and the Hopkins' Symptom Checklist.

The findings suggested that hassles and uplifts more significantly correlated with stress response and thus were a better predictor of stress. Other findings included that for women, both hassles and uplifts correlated positively with life events, but for men, hassles correlated positively with life events whereas uplifts correlated negatively with life events. 

Work-related stress (Combined approach)

Work-related stress is generally caused by when the pressures or demands of a job are not suited to the employee. The daily pressures of work can consist of a lot of stressors, including responsibility, meeting deadlines, long hours, repetitiveness and lack of control. High stress can lead to both poor mental and physical health and can lead to heart problems and depression if a high stress response is maintained for a considerable length of time. 

Stress at work also costs businesses billions of pounds per year and is a common reason for sick leave from work. Thus, it's important that work as a cause of stress is considered.

One study which looked at work as a cause of stress was Johansson's Swedish Sawmill study. It was a quasi-experiment in a field setting which compared the stress experienced by maintenance workers and piece workers.

The first part of the sample was 14 "finishers", who completed piece work. The work was repetitive, mechanised, socially isolated, complex and pressured, and so this group was given the category of "high risk". Also in the sample were 10 maintenance workers, who were deemed as "low risk" workers; they worked as technicians or cleaners. 

Psychological and physiological measures were taken from the participants. Psychological measures included self-reported mood and wellbeing, as well as nicotine consumption, whilst physiological measures consisted of urine sample and body temperature checks. These measures were taken at various intervals throughout the day.

The results showed that the adrenaline levels of the high risk workers was 2x their baseline reading, and that this increased throughout the day, whilst the low risk workers had adrenaline 1.5x their baseline reading, and this dropped throughout the day. Thus, physiological measures suggested stress was more pronounced in the finishing group. Self-report measures showed similar findings; the finishers reported being more irritable, and having lower well-being.

Thus, it was concluded that work which is repetitive, mechanised and paid per piece may be more stressful than work which is paid per hour and is less pressured. 

Introduction to Stress

Stress is generally considered to be the psychological and physical response of the body that occurs when the (perceived or actual) demands of an individual do not match the perceived abilities of the individual. 

Stress consists of two parts: the stressor (what is causing the stress) and the stress response. 

Stressors may include part of the daily routine, such as work and daily hassles, or may be part of a larger feeling of being out of control. 

However, not all stress is bad and that's important to remember. Stress is what causes you to revise for your exams because you realise you don't know enough yet, and it's what makes you fight or flight when there's perceived danger. But, too much stress is damaging to both psychological and physical health, and can lead to heart problems, skin problems and psychological disorders such as depression.

Thus it's important that causes of and ways to manage stress are identified. 

Studies to use for "Causes of Stress" and "Measuring Stress"

The number of studies is one of the more daunting aspects of A2 psychology.

Some areas, though, allow you to use the same study for different areas, which can make quite a big difference to you. A couple less studies gives you more time to revise the rest, so it could be pretty useful. 

One area you can do this for is Stress. The causes of stress (work, hassles and lack of control)  studies obviously measure stress, so you can use these studies and their measuring technique for the second part of the subtopic.

Here's the studies I use:

Johansson (work as well as combined approach)
Kanner et al (hassles/life events as well as self-report measures)
Geer and Maisel (lack of control and physiological measures)

MANAGING STRESS: Social support networks [Waxler-Morrison et al.]

Many forms of dysfunctional behaviour are treated in group therapy and support sessions, such as alcoholism, drug addiction and anger management. Some stress management also emphasises the need for social support in coping with stressful situations.

Cohen and Willis argue that there are four types of social support (all of which we need):

1. Instrumental support; practical support such as help with taking care of loved ones or help with getting to where you need to be.

2. Informational support; advice on what to do and how to cope with different situations.

3. Esteem support; emotional support from friends, colleagues, loved ones and others which makes you feel valued, safe, loved and respected. 

4. Social companionship; general interaction with others for its own sake rather than functional relationships such as at work.

Study: Waxler-Morrison et al. 

Waxler-Morrison et al conducted a study on the impact someone's social support networks had on their ability to cope with the stress of and survive cancer. It used a sample of 133 Canadian women under the age of 55 who had been diagnosed with breast cancer. Data was taken from medical records as well as self-report methods (largely questionnaires but also some interviews). The findings suggested six aspects of social support were most closely associated with cancer survival:

1. Marital status (married women who survived tended to report supportive husbands)

2. Support from friends

3. Contact with friends

4. Employment (employed women found this important in coping with cancer as it was a source of information and social support).

5. Social network

6. Total support

A strong social support system was concluded to reduce the stress associated with life-threatening but not necessarily terminal illnesses such as breast cancer, and thus make survival more likely. Though, obviously the most important factor in survival is the diagnosis of the cancer (i.e. how developed the cancer is).

MANAGING STRESS: Behaviourist Approach and biofeedback [Budzynski et al]

The behaviourist approach to psychology assumes that we are all born as a blank slate, and we learn all of our behaviour. It's a very reductionist approach as it is purely on the nurture side of the nature-nurture debate, the situational side of the situational-dispositional debate, and deterministic on the freewill-determinism debate. 

It essentially works on the basis of three concepts: classical conditioning (learning via association), operant conditioning (learning via punishment and reinforcement) and social learning theory (learning via imitation and interaction with others).

In terms of stress management, the behaviourist approach takes the view that as behaviour is learned, you can be taught to manage stress through the same processes. Stress is often dealt with in behavioural therapies through the use of CBT (mentioned in this post on cognitive therapies) or through the use of positive reinforcements. This often involves direct positive reinforcement in terms of improved relaxation and reduced stress combined with feedback from a biodot (which shows you reducing your stress) or a monitor such as a heart rate monitor.

Study: Budzynski et al 

Budzynski et al conducted a study on the role of biofeedback in reducing stress management. It was a field experiment using 18 volunteers who had responded to an advert asking for people with tension headaches. They were split into 3 conditions. Group 1 were taught relaxation techniques during two weekly sessions for eight weeks, during which they had their muscle tension measured by an EMG machine. They were informed about the biofeedback in terms of clicks, (more clicks = more tension) and encouraged to relax. Group 2 had the same relaxation training but didn't know about the biofeedback and were given a false soundtrack of clicks, whilst Group 3 were not trained in the relaxation techniques nor taught about the biofeedback and so acted as a control group. The study showed that Group 1 had the lowest muscle tension, lowest levels of hysteria and depression and the fewest tension headaches by the end of the study, concluding that biofeedback combined with relaxation techniques help to significantly reduce stress-related illness. 

MANAGING STRESS: Cognitive Approach and SIT [Meichenbaum]

The cognitive approach works on the assumption that it is necessary to refer to internal mental processes such as thought, perception and language in order to understand and explain behaviour. 

It would thus view stress as the result of faulty thinking and poor perceptions, and as a form of dysfunctional and maladaptive behaviour which can be improved or cured via cognitive restructuring. This is the fundamental concept behind all forms of cognitive behavioural therapy (CBT).

One form of CBT specifically targeted at coping with stress is Stress Inoculation Therapy (or SIT). It was developed in the 1970s by Meichenbaum, and has three stages which aim to help clients to replace "self-defeating thoughts" which cause stress with more positive ones, which can help to reduce the effect of potential stressors, and thus reduce the overall stress response.

The three stages of SIT are:

1. Conceptualisation - the client and therapist work together to identify the nature of stress, and the therapist educates the client on the general effects of stress to help them understand what stress is and thus how it can be overcome

2. Skills acquisition - the therapist helps to train the client in relevant skills which will aid them to cope with and reduce their stress. This often includes monitoring their own internal dialogue and reassuring themselves that things are okay if not everything goes to plan.

3. Follow through/application - the patient has to apply their skills to real-life situations, and the therapist helps them with this. 

Study: Meichenbaum: comparing SIT to systematic desensitisation and a control group in reducing test anxiety (a major cause of stress)

The study consisted of 21 students aged 17 to 25, who had responded to an advert asking for participants in a study on test anxiety. It was a field experiment, where the IV was the type of therapy (if any) the participant received, and the DV was reduction in test anxiety, which was measured through the use of grade averages and self-reported measures. It was a matched pairs design with three conditions. Group 1 received eight therapy sessions where they were taught to identify stress, learn how to reduce thoughts which increased their stress, monitoring their internal dialogue, etc. Group 2 received the same number of sessions but were given the behavioural therapy of systematic desensitisation, whilst Group 3 were put on a waiting list. Both therapy groups had improved results, but Group 1 (SIT group) performed better in test conditions and had reduced anxiety levels than both other groups, and thus it was concluded that SIT helped to reduce the test-associated stress people felt and enabled them to perform better.