Background and developments in stress theory

The term, „stress‟, was introduced in scientific scholarship by Hans Selye in the 1930. He used the term to refer to anything which causes attrition in body. He conducted experiments on animals, and he named extreme temperature change, overcrowded cages, and electric shocks as stressors (Selye, 1950; Selye, 1956). He argued that these stressors are detrimental to defense mechanisms of the body and the animals could not resist the disease or infection when they were exposed to it.

The biological stress model of Selye (1950; 1956) comprises of four stages: (1) stressors: a number of events or conditions which may result in threat or insult to an individual; (2) conditioning factors which may change the implication of stressors on the organism (3) the general adaptation syndrome, an interposing state of stress; and (4) responses; these may be adaptive or maladaptive in form of distress. Among these four stages, Selye specifically elaborated upon the third stage which came to be known as the General Adaptation Syndrome (GAS). The GAS delineated three stages which explained the individual response to stress. In the first stage i.e. alarm stage, the body responds to perceived threat (stressor) by releasing hormones such as adrenaline, noradrenaline and cortisol. These hormones enable the individual to do actions that may not be possibly done in ordinary circumstances. In the second stage i.e. resistance stage, the stress has been usually dealt with and the body directs its energy to revitalize damaged muscle tissues and release lesser hormones. Nonetheless, the body is still vigilant to act against the stressor especially if the stressor is still present, though the response is likely to be less intense than the response in the alarm stage. In the third stage i.e. exhaustion stage, the body is no longer able to respond to the stressor due to the exhaustion of its adaptive energy. In these circumstances, individual is likely to suffer from stress overload which may lead to health problems if not dealt with immediately. An illustration of GAS is given on next page in Figure 2.3:

22 To conclude, the biological model of stress by Selye (1956) presents a comprehensive view of stress ranging from the problem perception to the stress response and its outcomes. In this model, Seyle differentiated stress from distress and other behavioral responses. This model also retains its significance to date because it provides a continuum between the physiological responses to the stress and the use of coping resources.

After the relationship between continued stress and disease was established with animals in laboratory setting, concerns arose regarding the effects of stress on human beings. A research was conducted in 1967 which attempted to examine the influence of major life events and other stressors on human beings (Holmes & Rahe, 1967). In this research, the major life events were defined as comprising those changes which have long term implications on human behavior. It was argued that frequent readjustment of behavior due to stressors can result in the deterioration of coping abilities within the individuals, hence rendering them vulnerable to disease and illness. This research was conducted on Navy employees and delineated those life events which occurred before their visits to doctors or hospitalization (Holmes & Rahe, 1967) . A list of 43 such events was prepared and different people were asked to evaluate the extent to which each event required behavioral adjustment. In this way, Social Readjustment Rating Scale (SRRS) was devised which rank ordered the list of life events according to the extent of their impact on behavioral adjustment. This list served as a checklist for the researchers to assess whether exposure to these stressors or life events would play a role in health consequences. It was found that the frequency of life events in a given period of time as well as their readjustment rating was significantly associated with the tendency to develop disease and illness. Individuals with higher frequency of „life events‟

occurring within a specified period and especially those events which required greater Figure 2.3: Selye‟s general adaptation syndrome model

Source: Selye (1956)

23 behavioral readjustments were highly likely to fell prey to disease and even die (Cohen, Janicki-Deverts, & Miller, 2007; Cooper, 2005; Tennant, 1999).

Once the relationship between life events and health was established, the focus shifted towards the categorization of various stressors and their segregated impact on mental illness.

This was a significant development because Holmes and Rahe (1967) research had posited that all life events whether positive or negative require readjustment and hence increase the tendency towards the development of illness. The later research divided the stressors through the lens of culture and found that culturally undesirable events (negative events) were more likely to cause mental illness than the culturally desirable events (positive events) (Brown &

Harris, 1978; Ross & Mirowsky, 1979).

As a prominent illustration to the aforementioned categorization, Brown and Harris (1978) found that “severe” (the term they preferred to denote very serious negative events) life events were more likely to cause major depression to the individuals than mundane positive or even negative events (Brown & Harris, 1978). Further research also found the association of severe events and negative events with other mental illnesses such as anxiety, schizophrenia, and generalized distress (Thoits, 1995; Turner, 1995; Turner & Lloyd, 1999).

Therefore, it was well established that stressful life events as well as environmental stressors or chronic strains (which require subtle behavioral readjustments over a long period of time) may result in a number of mild or severe mental illnesses.

Various explanations of stress theories (Lazarus & Folkman, 1984; Pearlin, 1989; Pearlin, Menaghan, Lieberman, & Mullan, 1981) suggested that the strength of correlation between exposure to stress and symptoms of mental illness is mediated by coping strategies. Since human beings are not passive, they respond to the stressors in different ways so as to manage and reduce their negative effects on health and well-being. „Coping resources‟ is the term that has been used to refer to the range of capabilities which people may use to confront stressors (Pearlin & Schooler, 1978). Support networks in the social field (social support) are regarded as one of the most instrumental coping resources which people can deploy when faced with stressful circumstances. Social support refers to the material, cognitive, and emotional assistance which the people in immediate social proximity can provide to the individuals (Thoits, 1995). Additionally, people who feel competent to confront the stressors or who generally feel in control of their immediate environment are more likely to engage in aggressive or active coping strategies to deal with stress (Folkman, 1984; Pearlin et al., 1981;

24 Taylor & Aspinwall, 1996) or they may employ a number of coping strategies creatively to show resilience towards stressors (Folkman & Moskowitz, 2004; Mattlin, Wethington, &

Kessler, 1990; Pearlin & Schooler, 1978).

Coping strategies are cognitive or behavioral attempts to deal with circumstances which an individual perceive to be stressful or where the individual has difficulties to manage them with every day tactics (Lazarus & Folkman, 1984). Coping strategies are traditionally divided into problem-focused and emotion-focused strategies. Problem focused coping strategies are active coping strategies which are aimed at eliminating the stressors or altering the demands generated by stressful events. On the contrary, emotion-focused coping strategies are passive and they focus on changing the emotional response towards the stressors e.g. denial, avoidance, and retreatism. An important differentiation within the emotion-focused coping strategies has been proposed by Pearlin & Schooler, (1978). They introduced the concept of meaning-focused coping strategies which involved altering the self‟s perception towards the stressful circumstances so that circumstances seem less threatening and relatively manageable. In other words, the mind makes attempts to change the interpretation of the events to avoid distress which could be caused by the stressors. Meaning-focused coping strategies are considered a sub category of emotion-focused coping strategies because they tend to alter the internal consciousness about the events rather than the events themselves (Lazarus & Folkman, 1984).

In real life situations, most people are likely to use problem-focused, emotion-focused as well as meaning-focused coping strategies in most of the stressful circumstances (Folkman

& Lazarus, 1980; Taylor & Aspinwall, 1996). Although there are variations in the nature of coping strategies used by various people, it also depends on whether the stressor is perceived to be manageable or not. People tend to use problem-focused coping strategies for those problems which they think can be managed (Folkman, Lazarus, Pimley, & Novacek, 1987) e.g. financial loss due to a fire accident. On the other hand, people are most likely to use emotion-focused coping strategies for the problems which are not apparently resolvable such as the death of a loved one (Taylor & Aspinwall, 1996). The negative or emotion-focused coping strategies have been shown to be most significantly associated with mental illnesses (Folkman & Moskowitz, 2004). The major contribution to stress theory in this regard is illustrated in Figure: 2.4 on next page.

25 There are several strengths of stress theory, most of which are at the same time weaknesses of psychological and biological approaches. Firstly, the stress theory emphasizes social situations of people as relevant to the etiology of mental illness. Secondly, it provides a well-founded explanation of variation in the prevalence of mental issues among different groups i.e. on the basis of their coping resources. Thirdly, the stress theory follows a more empirical approach as opposed to its counterparts. The methodological rigor associated with the stress theory (using survey and interview techniques) allows the researchers to understand the relevance of various concepts to mental health and enables them to test the associations between key variables such as stressors, coping strategies, well-being etc.

Figure 2.4: The major contributions to stress theory

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