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The concept of stress has come into increasing prominence in the biological and social sciences since World War ii. As in the use of the term in engineering, where it is applied to forces exerted on inorganic objects, “stress” suggests excessive demands made on men and animals, demands that produce disturbances of physiological, social, and psychological systems. The important biological, social, and psychological consequences of stress galvanize scientific interest and mobilize efforts to understand and control them. The entire subject has been reviewed and analyzed recently by Lazarus (1966).

”Stress,” as the term is used in the social sciences, has been applied to phenomena as diverse as metabolic imbalance following surgery, failure to succeed in an experimental task, personal bereavement, psychopathological reactions connected with military combat or life in a concentration camp, and the societal disruptions produced by naturally occurring disasters. The term “stress” is thus loose, in that it is applied to a host of phenomena related only by their common analogy with the engineering concept, and, at the same time, exceedingly broad, in that it covers phenomena at the physiological (Selye 1956), social (Smelser 1962), and psychological (Lazarus 1966) levels of analysis that may be described in a common theoretical language of causes, intervening processes, and effects. Whether phenomena as different as metabolic imbalance, symptoms of psychopathology, and social disturbance have anything in common beyond this loose analogy is an open issue, but the idea of stress as applied to a host of biological and social phenomena has intuitive appeal to laymen and scientists alike and gives the appearance to many of permitting the synthesis of these phenomena within, some common system of thought. The term “stress” has, at the very least, the value of being a generic one, unifying a wide variety of phenomena, concepts, and empirical research.

This article deals with psychological stress. Within the field of psychological stress there are several distinct problem areas. One concerns the processes and conditions that produce stress reactions. A second has to do with the ways in which the conditions resulting in psychological stress are coped with. A third deals with the measurement of the reactions and with the links between these reactions and the intervening stress processes postulated by theory.

Psychological stress phenomena. Before we deal with key theoretical and methodological issues, let us consider the phenomena that define the subject matter of psychological stress so that we have some common empirical bases for a discussion of concepts and findings. What kinds of stimulus conditions have been studied as determinants of psychological stress reactions, and what reactions in response to these stimuli define the field?

Stimuli eliciting psychological stress . The following stimulus conditions are typical of research into stress under natural circumstances: military combat, imprisonment in concentration camps, isolation as produced, for example, by shipwreck, the imminence of death from such diseases as cancer and heart attack, the prospect of major surgery, the anticipation of a crucial scholastic examination, the death of close family members, the onslaught of and adaptation to such crippling diseases as paralytic polio, and warnings or actual impacts of various disasters, such as floods, tornadoes, and explosions. [See Disasters.]

Many types of experimentally produced, laboratory stimulus situations have also been employed in the study of psychological stress. Some typical ones are making the subject believe he has neurotically misperceived reality, producing failure on the part of the subject in the performance of some skilled or intellectual task, ridiculing or verbally assaulting the subject, creating the belief in the subject that he is in danger of electrocution or likely to sustain severe bodily injury, creating in the subject the anticipation of painful electric shock, and having the subject watch a disturbing motion picture.

These stimulus conditions have been chosen by research workers mainly because of the psychological and physiological disturbances they are known to create and not because the researchers want to test a controversial theoretical analysis of psychological stress processes. They are worthy of study for their own sake as well as aiding in the general understanding of how people react to various forms of stress. Experimental work on stress is designed to create laboratory analogues of processes or effects that are observed in natural situations, in order to study those processes and effects under better controlled conditions (see Lazarus & Opton in Spielberger 1966).

Characteristics of the person that interact with the stimulus conditions have been heavily emphasized in both the naturalistic and the experimental approaches. A frequent observation under all these conditions is that individual differences in reaction loom very large, and personality variables that account for this have been sought with rather limited success (Opton et al. 1967).

Response variables indicating stress . With regard to response, four classes of measures have been employed as indicators of stress reaction. Three of these are the classical, defining attributes of (negatively toned) emotional states: disturbed affect as reported by the individual (for example, fear, anxiety, anger, and depression); motor-behavioral patterns that permit the observer to make inferences about such emotions (for example, postures, facial patterns, flight and attack); and physiological correlates of emotion (for example, secretions of adrenal hormones, such as epinephrine, norepinephrine, and hydrocortisone, and autonomic nervous system reactions, including increased skin conductance, heart rate, blood pressure, and skin temperature, to name a few of the most common).

Cognitive functioning. The fourth category of stress-reaction measure, disturbance in cognitive functioning, has been employed to indicate stress reactions because impairment of skilled performance and of perception, learning, and judgment is often observed under stress-producing conditions. However, impairment is by no means inevitable; many studies have revealed significant improvement in functioning under stress. Thus, paradoxically, conditions of stress can be viewed as being damaging to performance but as also being capable of improving performance. The conceptual and methodological aspects of this problem have been discussed at considerable length by Lazarus, Deese, and Osier (1952) and more recently by Sarason (1960).

One of the generalizations usually accepted is that the disruption or facilitation of performance appears to depend on such factors as the nature of the task, the characteristics of the individual who is exposed to the stress conditions, and the intensity of stress. Specifically, difficult or complex tasks requiring great concentration or abstraction are more vulnerable to the effects of stress than simple, repetitive tasks; some individuals appear more vulnerable to impairment than others, although it is not at all clear which personality variables are involved; and only under mild or moderate degrees of stress does facilitation of performance appear to take place.

Attempts at understanding impaired functioning . The problem of accounting for impairment of functioning under stress conditions poses controversial questions that have prompted much theorizing and empirical research. Two contrasting points of view are examples of attempts to understand the principles underlying performance changes with stress.

One of these positions is represented by Farber (1955), who emphasizes the drive properties of the anxiety that is produced by stress conditions. Following Hullian reasoning, he argues that high drive, or high anxiety, will increase the strength of all responses, correct as well as incorrect ones, in task performances connected with learning. If the task is difficult or complex—that is, if it contains many competing responses—high drive will impair performance, because a larger number of incorrect, competing responses will be facilitated. If the task is simple and contains small numbers of competing responses, performance will be facilitated by high drive, since comparatively fewer incorrect responses will be strengthened. An active controversy over this view exists. Sarason (1960) has reviewed the literature and the arguments, citing studies with findings not consistent with this formulation and noting critiques of the drive viewpoint. [See Drives.]

An alternative class of viewpoints about the effects of stress on performance is represented by Korchin (1964) and Easterbrook (1959), who have argued that impairment of performance results from the narrowing or restricting of perception that occurs under stress. Just why this restriction of the perceptual field occurs is not entirely clear. An interpretation can be made in terms of interference or in motivational terms. In terms of motivation, the individual is motivated under stress to select from the environment only that which is relevant to the danger. Thus, he may ignore features of the situation that seem momentarily irrelevant, ultimately narrowing his perceptions to a damaging extent. The experimental task may also decrease in importance in the face of other problems that are posed by the stress conditions. Although to the experimenter the performance of the task may be the central criterion of adaptation, to the subject it may be comparatively unimportant.

In any event, a central concern is the mechanism or mechanisms underlying impairment and improvement in functioning under stress. And since it is difficult, without further knowledge of the determining conditions, to predict which way, if at all, performance will be affected, inferences about psychological stress from changes in performance contain unresolved difficulties.

Some key theoretical issues in the field of psychological stress may be expressed by the questions: What are the antecedents of stress reactions? What processes of coping are generated and by what conditions are they produced? What observable consequences do each of the coping processes have? These issues are complex. Let us consider some of the main ones.

Threat, frustration, and conflict. The terminological confusion that exists in the area of threat, frustration, and conflict has already been touched upon. Theoretical solutions, of course, carry with them terminological conventions upon which there is not necessarily wide agreement (see Lazarus 1966). Still, we must seek some sort of clarity. The word that most clearly connotes the psychological aspects of stress is “threat.” The characteristics of threat must be defined and differentiated from other similar or overlapping concepts, such as frustration and conflict.

Threat refers to the anticipation of harm of some kind, an anticipation that is created by the presence of certain stimulus cues signifying to the individual that there is to be an experience of harm. This experience of harm may be called the “confrontation” (researchers into the psychological aspects of disaster call it the “impact”). Threat refers not to this confrontation but rather to the anticipation of it. The immediate stimulus configuration resulting in threat merely heralds the coming of harm. Threat is thus a purely psychological concept, an interpretation of a situation by the individual. Although the anticipated harm could be some physical injury, the meaning of the term “harm” is usually broadened to include damage to important goals and values.

Both frustration and conflict are concepts often confused with threat, even though they have specific meanings of their own. All three have been considered as antecedents of aggression, regression, anxiety, and defense. When these terms are used loosely, their distinctive features and their possibly different roles in behavior tend to be obscured.

Frustration is the actual blockage of some goal-oriented behavior. We speak of a motive‘s being frustrated or thwarted when a goal cannot be attained or when gratification is delayed. In such cases, frustration refers to a present or continuing confrontation with harm in the form of a goal that has already been blocked. The reasons for frustration are multiple; one of them is the presence of motivational conflict.

Conflict occurs when two goals are incompatible —that is, require contradictory behavior—or when the gratification of one goal frustrates the other. By definition, when conflict exists, then frustration is inevitable. Conflict is therefore one antecedent of frustration. If “conflict” is defined more broadly, to include the opposition between an external force or obstacle and the motive, then “conflict” and “frustration” tend to be interchangeable terms, although their emphases are slightly different. Conflict focuses on the motives involved, frustration on the blockage of motive gratification. From the point of view of psychological stress theory, it is the threatening and frustrating aspects of conflict that are important. [See Conflict, article on psychological aspects.]

Threat in its anticipatory sense is not routinely distinguished from frustration. Most experiments or naturalistic observations in the field of psychological stress have not clearly isolated these elements. For example, the classic observations of Grinker and Spiegel (1945) on war neuroses and Bettelheim (1960) on the concentration camp found that there is great frustration or confrontation with harm in the form of social degradation, hunger, physical injury, isolation from loved ones, and so forth. But there is also threat, in the sense that the present conditions signify continuing or future harm, perhaps even death. Grinker and Spiegel appear to emphasize the threat aspect of military combat. The emphasis on anticipation of harm is nowhere more clearly emphasized than in the literature on disaster (for example, Janis 1962). Psychologists and sociologists in their work on disaster distinguish a warning period in which the individual anticipates the impact of a disastrous storm or flood. Reactions that are observed include anxiety, defense mechanisms, disorganized thinking, and so on—in other words, the same consequences that are commonly attributed to frustration.

Failure to consider the separate aspects of threat and frustration is widespread in the experimental literature on aggression, where the emphasis is placed on frustration as the antecedent of aggression. The same trend has been followed by recent analytic writers on aggression, such as Berkowitz (1962). The threat and frustration components are never isolated in such research. Therefore, it is not clear to what extent anticipation or confrontation accounts for the observed stress reactions.

There are some observations in which threat alone has been isolated and in which the very reactions usually attributed to frustration have been observed. Some of the work on disaster mentioned above constitutes one example, especially where a warning period is distinguished before the calamity has actually happened. An experiment by Shannon and Isbell (1963) is another example. These authors exposed several groups of dental patients to varying procedures connected with the injection of an anesthetic, sometimes employing no anesthetic and sometimes merely going through all the motions of an injection short of actual needle insertion. Following their carefully designed procedures, they found that stress response consisting of an elevated level of hydrocortisone (an adrenal cortical hormone associated with stress) in the blood followed the anticipation of the injection and was as great as that found when the needle was actually inserted and the drug actually injected. In effect, it was not the actual physical pain, tissue damage, or drug effects that produced the stress reaction but merely the realization that an injection would be experienced. There appears to be a sound basis for viewing the various stress reactions as based on threat. There is no clear agreement among researchers about what aspects of the stimulus condition produce the stress reaction. Sometimes threat is emphasized and sometimes frustration. Often the distinction is simply overlooked. It is clearly an unresolved issue in stress research.

Threat and anxiety. The tendency to treat anxiety as the only intervening variable in psychological stress analysis poses some theoretical difficulty in which controversial issues reside. Conflict, or the frustration produced by conflict, is commonly said to result in anxiety, which in turn triggers some form of defense. This analysis is confusing for two reasons. First, it is often implied that the defense is activated by the pain or discomfort of anxiety. But if this is the case, why is the responsibility for defense placed exclusively on anxiety and not, for example, on anger or depression, which are also distressing affects? Actually, in the clinical literature the assumption that anger and depression may lead to defense is common, as when manic states are considered to be defenses against “underlying” depression or when positive feelings are treated as reaction formations against anger. But this view provides a plurality of intervening variables. Anxiety cannot then be considered to be the intervening variable promoting defenses.

The second problem with treating anxiety as the only intervening variable is that when such affective disturbances as anxiety are taken as the “cause” of defense, the actual cognitive processes producing it are underemphasized. If anxiety is the reaction to anticipated harm as heralded by stimulus cues, then it is not the pain or discomfort of the anxiety that generates the defense but rather the recognition by the individual that there is danger. Indeed, Freud, whose analyses of these problems have most influenced later researchers, shifted his views about anxiety during the course of his prolific career and finally regarded anxiety as the signal of danger. But to what psychological structure or agency is the signal useful? In Freud‘s analysis, anxiety signals the ego about the danger. But the main function of the ego is to distinguish safe from unsafe conditions. Why then should the structure which already has the function of interpreting reality need to be informed about what it already “knows” to be harmful? The role of anxiety, both as the intervening variable in psychological stress analysis and as an affective response, remains the subject of intense disagreement. The role of anxiety touches on the problem of consciousness or awareness, about which there is also continuous debate. [See Anxiety.]

Cognitive processes and threat. There is an increasing realization that cognitive processes are involved in threat and in the production of anxiety and other affects. Some of the difficulties inherent in the treatment of anxiety as the intervening variable in psychological stress can be resolved by regarding it entirely as a response to threat and by making threat itself the intervening variable. This has the virtue of emphasizing the cognitive activity preceding anxiety. Anxiety then becomes an affective response to the anticipation of harm (which is the definition of threat). Whether the response is anxiety, fear, anger, depression, guilt, or shame depends on the way the individual evaluates the situation and on the consequences of any form of adaptive response he might make.

Cognitive processes and emotion . The role of cognitive processes in emotion in general is becoming increasingly emphasized in present day psychological thought and research. An example is the major work of Arnold (1960), in which emotion is understood in terms of the individual‘s evaluation or appraisal of the personal significance of the stimulus. If the stimulus is appraised as beneficial, a positive emotion, such as joy or contentment, will ensue. If it is appraised as harmful, a negatively toned emotional state, such as fear or anger, will result. Emotion itself consists of an action tendency with respect to the stimulus, an action tendency that has motor and physiological correlates. In this way, Arnold links emotion to the cognitive process of appraisal. Appraisal means the evaluation of the significance of the cues at hand. If they are taken to signify the imminence of harm, threat and stress reactions are produced. [See Emotion.]

Experimental study. One important and widely cited piece of recent research (Schachter & Singer 1962) highlights the importance of cognitive processes in the production of different kinds of emotion. Some subjects were given epinephrine injections and others given a placebo under various experimental conditions. The epinephrine produced the expected sympathetic nervous system activation. By means of trained “stooges,” two different social atmospheres were created. In one, a euphoric condition was created by having the stooge act in an appropriate fashion. In the other, an anger condition was produced by having the stooge react with anger about the injection procedure, so that he gradually went into a rage. Based on behavioral ratings and self-report data, the findings clearly indicate that the quality of the emotion experienced by the experimental subject as a result of the physiological arousal was dependent on the nature of the social atmosphere and the cognitions created by this atmosphere. Anger occurred when the social situation stimulated anger, and euphoria occurred in the euphoric social situation. The social atmosphere thus yielded a conception that shaped the actual emotional effects of the epinephrine injection.

The experiment conducted by Schachter and Singer is important because it turns attention to the neglected cognitive determinants of emotion and provides a clear refutation of the widespread assumption that emotion can be conceptualized purely in terms of physiological arousal. This assumption has now been effectively challenged, emphasizing a theoretical issue of great importance. As Arnold (1960) has insisted, the quality of emotional states depends on appraisal of the personal significance of the situation. The argument can easily be extended to stress reactions that include negatively toned emotional states like fear and anger.

Relevant dimensions of cognitive appraisal . If the concept of appraisal in the production of threat is to have more than merely subjective referents, then we must be able to specify the necessary and sufficient conditions of threat and nonthreat appraisals. There is little systematic work along these lines. The factors determining appraisal are classifiable into those that reside in the external stimulus configuration and those that are within the psychological structure of the individual, as traits or dispositions. A few examples will be suggested.

Ratio of harm-producing to harm-combating aspects. Relevant to the stimulus configuration is something that might be referred to as the balance of power between the harm-producing stimulus and the counterharm resources of the individual. Threat is aroused when the former heavily outweighs the latter. If the individual believes that he can readily overcome or reverse the danger, threat is minimal or absent. Empirical examples can be found in which, for example, the casualty rates in military combat are positively correlated with incidence of psychological breakdown or where the experience and skill of the individual minimizes or reduces the threat that originally existed in his early states of contact with the dangerous conditions (Epstein 1962). Jam‘s (1958) and Mechanic (1962) have each emphasized this line of reasoning.

Imminence of harm. Another, less emphasized factor in the stimulus configuration is the imminence of the confrontation with harm. Threat is more intense when the harm is more imminent. For example, Epstein (1962) has evaluated approach and avoidance tendencies of parachute jumpers during the twenty-four-hour period preceding the jump, leading up to it, and culminating in the landing. As the time of final commitment to the jump approached, avoidance tendencies (evidence of threat) increased to a maximum, until they actually exceeded the approach (positive) tendencies.

Another example of the role of imminence of confrontation comes from Mechanic‘s study (1962) of the reactions of a group of graduate students facing a crucial examination. More students reported anxiety and more symptoms of anxiety were observed as the date of the examination grew nearer. Changes were also noted in the type of adaptive solutions displayed by the students as the deadline neared.

Another, more anecdotal example of the role of the imminence of confrontation with harm in determining the degree of threat may be found in people‘s reactions to the prospect of their own deaths. Even though the prospect itself may be exceedingly threatening, the fact that it may be regarded as long distant (not imminent) greatly reduces the intensity of the threat. Under conditions that make it appear imminent, threat is greatly intensified.

Ambiguity of cues. The role of ambiguity of the stimulus cues has been dealt with at some length by Janis (1962). As in projective stimuli, ambiguity encourages the operation of factors within the psychological structure of the individual. In Janis‘ terms, the new and ambiguous information will be assimilated to the previously existing psychological set or expectation of the person. If he has previously interpreted the situation as benign, an ambiguous cue will be interpreted in a way that is consistent with this idea; similarly, if he has previously interpreted the situation as dangerous, ambiguous information will become part of his fearful outlook and be assimilated to it.

Motives and beliefs. Concerning factors within the psychological structure, patterns of motivation and belief systems are fundamental to threat appraisal. Studies may be found (for example, Vogel et al. 1959) which demonstrate that threat is minimal when the stimulus conditions occur in the presence of a weak motive and greater when a powerful motive is engaged. In effect, what is threatening depends on the motive characteristics of the individual. In the absence of individually oriented assessments of motivation, researchers in the field of psychological stress have tended to emphasize shared or widespread sources of threat, sometimes recognizing that the conditions employed were not of equal threat value to all individuals studied. Sources of threat are universal or widespread because of shared cultural or experiential factors. Even such widespread threats as death are subject to motivational and cognitive factors as sources of individual differences. For example, recent researchers have noted wide variations in what it is about death that is actually feared, and there are great individual variations in conceptions of what will happen to the person after death.

Belief systems about the nature of one‘s transactions with the environment appear to play an interesting part in the appraisal of threat. We can regard the individual who is, for example, chronically anxious as believing that the environment is hostile or dangerous or that his own resources are too limited to cope with danger. Questionnaires about anxiety often contain items reflecting such beliefs. Observations by Persky and his associates (Persky et al. 1959) show that subjects with such beliefs (identified by measures of chronic anxiety) are more readily threatened by a strange experimental situation (as measured by the amount of increase of hydrocortjsone in the blood) than non-anxious subjects. Yet the latter react more to specific threats within the total experimental situation. The former subjects are threatened by any new situation, whereas the latter are comfortable in novel situations but are threatened by specifically harmful features of the situation. [See Attitudes; Thinking, article oncognitive organization and processes.]

Not everyone would agree with this particular interpretation of the effects of measured anxiety on threat appraisal in novel situations. For example, there are questions about the actual meaning of scales presumably measuring anxiety and about the conceptualization of the processes that underlie the reaction patterns just described. But regardless of theory and current difficulties concerning the assessment and labeling of personality variables, the facts appear to be that certain people are likely to appraise new situations as threatening and in fact give stress reactions almost chronically to many types of situations that do not especially disturb others. On the basis of personality measures like anxiety scales, it is possible to predict with some success the level of stress reaction the individual will show in social contexts to which he has not yet become accustomed.

Coping processes and reactions to threat. The patterns of reaction that define the presence of threat are variable and complex. They are often not in agreement with each other, as, for example, when the individual denies any affective distress but gives evidence of it in behavioral or physiological changes. The same condition that produces stress reaction in one individual results in no evidence of threat in another. Furthermore, one individual will react with anger and attack, while another will show fear and flee. Some of these variations represent individual differences in the psychodynamics of threat production. Other disagreements arise from difficulties of measurement.

The concept of reaction . A major source of variation in reaction has to do with the kinds of coping processes that are generated by threat. In introducing the concept of coping process, the term “reaction” to threat requires some additional comment. Unfortunately, “reaction” usually connotes a passive and automatic state not necessarily involving active efforts to master or cope with a danger. This passive implication is not at all intended here, nor is it implied in any of the theory and research on coping processes. It is precisely because threat must be coped with and the individual must employ his experience and resources to meet it that the prediction of stress reactions is so complex. Different individuals bring different resources to the situation, and processes of coping are required that sensitively reflect the options available to the individual and the consequences of any action taken. In a valuable study of psychological stress in graduate students brought about by doctoral examinations, Mechanic (1962) examines in some detail the strategies of adaptation that are selected. The focus in this work is on how the student deals or copes with threat. But an additional principle that makes the study of coping processes valuable is that the stress reaction as observed in behavior depends on the kind of coping process the individual adopts. For example, attack as a means of coping with threat will appear behaviorally, and perhaps even physiologically, to be different from flight or avoidance. Thus, to understand the observed reaction we must correctly identify the active choices that the individual makes in coping with threat.

Evaluation of coping processes . There is a strong tendency in the literature to distinguish between various types of coping processes—for example, those in which the individual attempts directly to alter the threatening conditions themselves and those in which he attempts to change only his appraisal of them so that he need not feel threatened. The former are often referred to as adaptive behavior or as coping devices, whereas the latter are usually called defenses. It is generally assumed that coping devices are healthier, since they offer some means of actually mastering or changing the situation. By using defenses, the individual may become more comfortable but remain vulnerable to external danger. A persistent issue in the discussion of this problem relates to what is healthy and what is not. Some theorists point out that defensive processes may be adaptive, at least in preventing psychological disorganization where no adaptive solution is really possible. Others regard coping processes as healthy and defenses as pathological. The problem of criteria for healthy or effective processes of coping as opposed to pathological ones remains an important and controversial issue within psychological stress theory and research. There is little agreement among the experts about this issue.

Aggression—cognitive aspects of coping. If we are to understand the observable reaction pattern to stress it is important to consider the coping processes that produce it. Perhaps more research has been performed on aggression than on any other threat reaction, making it a fine illustration of the type of issue that arises in this work.

The trend toward postulating and investigating cognitive processes as antecedents of threat may be found in the research on aggression. The earlier conception of aggression as an instinctual drive has fallen out of favor even among orthodox psychoanalysts because of the circularity of this approach. In its place is the view that aggression is a response to frustration. Aggression or attack may be regarded as a form of coping with the conceived source of the harm. But attack is one of many coping reactions, and it is necessary to specify the conditions that determine attack as the coping process rather than avoidance or defense mechanism.

The role of cognitive processes in the production of aggression as a means of coping with threat is illustrated in some of the findings of research reviewed by Berkowitz (1962). For example, when the antecedent frustrating condition created by the experimenter is not arbitrary or capricious and appears to the subject to occur through no fault of the frustrating agent, aggression will not occur as readily as when the frustration appears arbitrary. Either it is inhibited or it is weaker, an issue on which much research centers (see Berkowitz 1962). Furthermore, if the social sanctions against attack are weakened, aggression will be more apt to occur. And if there are strong internal moral sanctions against aggression, direct, behaviorally expressed aggression is also less likely, presumably because it is inhibited from expression. Finally, if the frustrating agent is powerful or prestigious and capable of harmful retaliation against any attack, direct aggression is also less likely on the part of the threatened or frustrated individual. These findings support the concept of an evaluating individual who perceives the social forces of a situation and his own place within it and whose behavior is shaped by this appraisal. [See Aggression.]

Defense mechanisms as a form of coping. The concept of defense mechanism has been widely accepted and applied in psychological stress theory and in clinical practice. Fundamentally, defense is regarded as consisting of a variety of psychological processes that have in common the distortion of reality as a means of reducing threat (or anxiety, in the typical formulation). Defense is contrasted with more active forms of coping in which the actual conditions of threat are altered. For example, when the individual who is threatened with failure attempts to learn what he must know to pass an examination, he is attempting to influence the actual forces involved in the threat. But when he distorts the actual realities, by convincing himself that he cannot fail, he is engaging in defense. [See Defense mechanisms.]

There has been comparatively little progress in the theory of defense since its basic outlines were expounded in Freudian theory. Theories of defense are largely descriptive; that is, they specify the types of strategies but do not specify the processes and conditions that determine them. Or if they do, they are not stated in ways that lend themselves to clear empirical testing. Thus, much controversy centers on the details of the concept of defense. For example, there is little agreement about patterns of defenses within the same individual or about which ones underlie each type of psychopathology. Unresolved is the question of whether a given defense is a general trait of the personality that can be activated by any threat or whether it is linked to a specific kind of threat. Psychologists who attempt to measure “defense preferences” assume the former position, whereas Freudian theory appears to take the latter position. In the latter viewpoint each defense is related to a particular stage of psychosexual development (and its particular instinctual drive—for example, oral, anal aggressive, or Oedipal) and to a particular set of symptoms of psychopathology. But this conceptual neatness is not readily supported by the observable patterns with which the clinician deals. It remains an assumption that is often challenged. Also unresolved is the matter of distinguishing such defense behaviors as those associated with denial from instances where threat is absent. In both cases the individual says, “I am not angry or distressed,” but in one case this report reflects a defense against threat, while in the other the statement correctly describes an internal state. The observable signs that permit the identification of these inferred processes are not well established.

Contributing stimulus conditions . Some interesting efforts have been made to pin down the stimulus conditions under which one or another defense will occur.

Projection. A study by Bramel (1962) is illustrative. He found that projection as a defense does not occur as readily when the person who might be the object of the projection is negatively evaluated by the threatened individual. Ratings of desirable and undesirable characteristics of experimental partners were made before the experiment proper began by a group of male subjects. Then while a fake physiological indicator, supposedly indicating their sexual arousal, was attached to them, the subjects observed photographs of men. By manipulating the indicator, the experimenter in effect was able to convincingly suggest that the subject had homosexual impulses. The indicator was made to rise sharply when the subject looked at pictures of the most provocative males. Following this threatening information, the subject was asked to evaluate homosexual tendencies in the original partner, a task which permitted the projection or attribution of the undesirable impulse to another individual like himself. Control subjects not having the threatening experience showed no tendency to project the homosexuality on the other person. Where the partner had been evaluated in positive terms, threatened subjects attributed homosexuality to him with significantly larger frequency. Bramel concludes that projection, as a defense against threat, requires a positively regarded object and will not be useful in reducing threat if the object is seen as an undesirable character. Moreover, Bramel argues, projection occurs in his study because the threatening information was so convincing that it could not readily be denied.

Denial. Clinical research also points to situational determinants of denial defenses. Research with the patient who is dying of cancer shows him to be under great social pressure to accept the myth that he will recover. Relatives and friends and other visitors to the patient are extremely uneasy about facing openly with the patient the dreadful outlook. In their hospital visits they encourage the denial of the truth. The patient, fearful of losing contact with his loved ones, who appear to withdraw uneasily when the terminal nature of the disease is faced, is pressured into a denial process both by his own wish and by the social pressure, although often he gives evidence that the defense is not fully successful and that below the surface of awareness he recognizes the truth. The work cited above points up more recent efforts to pin down some of the external situational factors that determine which defense is selected as a means of coping with threat. There is as yet only a trickle of data on this very important problem.

Personality factors . Personality factors also determine the choice of defenses. Defenses may be treated as personality dispositions, traits which operate to some extent in spite of situational variations. Studies have demonstrated that such dispositions operate to determine the success of a defense-oriented communication in reducing threat. For example, Lazarus and Alfert (1964) utilized a disturbing motion picture depicting a primitive ritual of adolescence called “subincision,” in which a series of genital operations with a flint knife is shown. If nothing is said about the film events, autonomic and subjective evidence of disturbance rises dramatically during the operation scenes and falls during benign scenes. If the threatening events of the film are pointed up in an orientation passage or sound track, the level of stress reaction is even greater. If the pain or other dangers of the operation are denied convincingly in an orientation passage prior to the film presentation, or if an attitude of intellectualized detachment is presented, the over-all level of stress reaction is markedly lowered. But the effectiveness of these defensive orientation passages in reducing the stress reaction depends on measured defensive dispositions. Subjects typically disposed to denial as a preferred defense get more relief from the denial orientation than from the intellectualized detachment. They seem better able to adopt the attitude presented. Similarly, subjects inclined to deal with threat by intellectualization gain most from the intellectualization passage and little from the denial statements. The utilization of defensive orientations to reduce threat appears to depend, in part, on defensive dispositions within the personality.

Comparatively little research has been done on the conditions that determine particular strategies of coping with threat. Naturalistic observation in the field provides abundant hypotheses about these conditions. If we are to extend our knowledge beyond the point of mere ability to describe the psychological strategies of defense, it will be necessary to employ effective laboratory analogues of these processes to test the often contradictory assumptions about these forms of coping with threat.

Methodological issues. One difficult methodological problem concerns the setting in which stress reactions and their causes occur.

Naturalistic observations . A considerable literature exists in which naturalistic observations have been made of people in real life stress situations. While there are many examples, the work of Grinker and Spiegel (1945) on battle, that of Janis (1958) on the threat of surgery, and that of Bettelheim (1960) on the concentration camp are classic ones. Although these studies offer rich hypotheses about the sources of stress and the mechanisms of stress production and reduction, it is difficult to isolate systematically the variables that are operating, since the situations studied are enormously complex, the measurement of reactions comparatively informal, and the assessment of causes often retrospective.

Laboratory studies . In contrast are the laboratory studies of stress in which control and measurement of the variables are comparatively precise. However, levels of stress are usually mild or moderate, since ethical and practical considerations limit the extent and the range of situations that are possible with human subjects. Moreover, the very fact that a subject conceives of the situation as experimental raises the question whether laboratory analogues are good models of real life situations. What is gained in control may be lost in artificiality of the setting. The issue is basic to all experimentation and generates protagonists for either the naturalistic or the laboratory orientation. The difficulties of each cannot be wholly eliminated. Therefore, the fullest theoretical analysis of psychological stress will ultimately derive from the wise integration of both kinds of data.

Measurement . It is difficult to discuss the field of psychological stress without touching on the measurement of such key variables as threat. The experimenter must be able to infer degree of threat and the nature of the coping process on the basis of the pattern of reaction that he observes. As previously noted, the response variables in psychological stress analysis include different levels—for example, subjectively reported affect, observed motor-behavioral adjustments, and physiological reactions that may include a dozen or so different autonomic nervous system response variables and a number of adrenal hormones found in the blood or urine. Investigators have differed widely over the kinds of response variables they have emphasized and over the number they have observed.

Problem of agreement among measurements. One fundamental problem in measurement has been the low order of correlation that is found between different measures presumably indicating stress reaction. Even within a response class (for example, among different autonomic nervous system measures, such as heart rate, electrical conductivity of the skin, respiration, blood pressure, and so forth), the correlation is low to moderate at best. Sometimes this poor correlation may be attributed to methodological errors or technological limitations. For example, it has been shown that particular procedures for measuring heart-rate variations will increase the agreement between heart rate and the level of skin conductance above what is usually obtained, and Lazarus and his associates (Lazarus et al. 1963) have demonstrated that intraindividual approaches yield higher agreement between measures than interindividual approaches do. Intraindividual analysis has made it possible to show considerable agreement between autonomic measurement and self-report ratings of disturbance. But even if all the methodological and technical difficulties of measurement were overcome, it is doubtful that very high correlations would ever be found between the different stress-response indicators. And if the measures employed to index stress reaction do not agree substantially, theoretical as well as methodological questions may be raised about the justification of treating any one of them as a stress-response measure.

There are excellent theoretical reasons why disagreement exists between stress indicators. These reasons can be summarized by the general statement that each indicator, while indeed dependent on threat appraisal, is also dependent on different specific psychological and physiological intervening processes. In any study, some of these processes are not relevant to the investigator‘s concern and constitute a kind of nuisance variance in the system, while other processes convey important information about psychological stress mechanisms.

Response specificity. An example of variance that can be a nuisance in some cases is based on response specificity in psychophysiology and psychosomatic medicine (Engel 1960). This concept was introduced partly to explain the absence of correlation between autonomic nervous system indicators. Each indicator involves some particular tissue system—for example, the sweat glands, the heart muscle, the blood vessels, and so on. It has been shown that certain individuals may be consistently more reactive in one measure—say, blood pressure—than in another. In effect, subjects are constitutionally different, and if the investigator is measuring only one indicator he may overestimate reactivity in one subject and underestimate it in another, depending on whether he has chosen the sensitive or insensitive measure. Naturally, then, two different indicators may not agree very well with each other. From the point of view of measuring stress reaction, this constitutional variation is a nuisance that interferes with accurate inferences. From the point of view of psychosomatic disease, however, it is of the utmost importance, since one individual may develop the disorder of hypertension rather than some other disease just because of this constitutional quirk that makes him respond to threat with heightened blood pressure. [See Psychosomatic Illness.]

Stimulus specificity. The concept of stimulus specificity, in contrast to response specificity, suggests that the pattern of autonomic reaction will be different for different sources of threat or in different kinds of emotional reactions (Lacey et al. 1963). Recent evidence, for example, suggests that the physiological patterns of fear and anger may be different. Thus, from the point of view of measurement of stress reaction, stimulus specificity requires that we employ the appropriate indicators in order to identify the particular pattern that is generated by the specific threat; otherwise, it might be missed or the degree of threat incorrectly estimated. Moreover, if our interest lies in identifying the process of coping with threat, the precise nature of the response is important since it will tell us something about the coping process. Yet both stimulus specificity and response specificity, however they are ultimately defined and understood, occur at the expense of agreement among autonomic indicators of threat. The more response variation depends on the stimulus or the physical constitution of the individual, the less agreement can we expect to find among indicators.

Individual differences and environment. On the psychological side, the pattern of reaction of the individual across different types and levels of response reveals something about the nature of his transactions with the environment, his particular psychodynamics. And different kinds of measures reveal different features of these transactions. For example, if the individual wishes to create the impression that he is brave, he may refuse to admit to fear in military combat even though he is very frightened. Or, in other contexts, he may deny anger. In such a situation, autonomic and adrenal evidence of stress reaction will probably be found. The pattern of evidence may appear different if the reaction is fear than if the reaction is anger. Here we have lawful disagreement between two legitimate response indicators of stress reaction, reported disturbances of affect and physiological arousal. Sometimes psychologists have relied on expressive indicators of emotion to correct for the lack of candidness of the individual. But even expressive indicators such as gestures, facial expressions, and body postures may be employed by the individual to conceal how he feels or to create a social impression he thinks is desirable, since the individual also knows that his styles and expressive movements contain socially relevant information.

The point is that no single class of indicators, behavioral or physiological, is free from the influence of other variables that have nothing to do with threat. For example, adrenal cortical hormonal substances are increased in the blood as a result of psychologically based threats as well as physical assaults. Thus, walking up a hill on the golf course in exuberance will result in some of the same kinds of physiological arousal as sitting quietly and experiencing anxiety. Similarly, autonomic nervous system measures are also subject to such irrelevant influence. Temperature and humidity changes, and indeed even air pollution, will have substantial effects. In other words, the indicators we use physiologically to measure stress reaction also tend to vary with anything that makes the individual more aroused or activated.

The dilemma posed here is that the measurement of stress relevant processes is exceedingly complex, and no simple, single class of measurement device can solve the problem adequately. The clinician knows this when he carefully observes many features of a reaction: subjective report, gestures, the goal directedness of acts, the consistency over time of what the individual reports, and evident signs of physiological reactions, such as flushing or pallor. The pattern of these reactions provides the basis of inferences about internal psychological activity.

It has been suggested that the shortcomings of one measuring device should be compensated for by the simultaneous use of others. Then, only where there is agreement between a number of indicators can we afford to make an inference about anxiety (or threat or defense). But we can not expect the various indicators to be always in high agreement, especially if we recognize that each approach reveals something different about the individual‘s psychodynamics. It is only through these very disagreements that we recognize efforts on the part of individuals to present themselves socially in a certain way or to utilize defenses or other forms of coping. When irrelevant artifacts in our measurement techniques have been ruled out, then the apparent contradictions between stress-response indicators are no longer necessarily contradictory but serve as crucial sources of inference about the underlying processes relevant to psychological stress.

Richard S. Lazarus

[See also Anxiety; Fatigue. Other relevant material may be found in Aggression; Defense Mechanisms; Motivation; Psychology, article onconstitutional psychology; Space, outer, article onsocial and psychological aspects.]


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The concept of stress as a change in the environment that results in an internal response in living organisms can be traced to the nineteenth-century ideas of the physiologist Claude Bernard (18131878). Initially, the stress response involves important adaptive changes throughout an organism that are necessary to restore homeostasis, a term coined by Walter Cannon (18711945) to describe the internal bodily balance in physiological systems. Living organisms make adjustments within their cells to internal and external sources of stress in order to adapt, maintain function, and survive challenges to homeostasis. In contrast to the adaptive role of the stress response, Hans Selye (19071982) discovered that stress-related diseases were often the result of chronic effects of stress. Thus, the stress response is a double-edged sword with both beneficial and detrimental effects for the whole organism. Failure to mount an adequate stress response, or to terminate the stress response, or unrelenting stress results in additional threats to homeostasis over and above the stress that elicited the response in the first place. This is especially true during aging, when it becomes more difficult to maintain homeostasis due to accumulated damage and inadequate repair of molecules and cells. In his 1992 book on stress and aging, Robert Sapolsky pointed out that theorizing by gerontologists about stress focuses on both the decreased ability of older organisms to respond to stress and an increased incidence of stress-related diseases during aging.

Different stressful conditions produce a similar stress response, which Selye named the general adaptation syndrome. The ability of organisms to adapt to stress is regulated by the integration of the nervous, immune, and endocrine systems; is mediated by hormones; and is ultimately played out at the level of cells and molecules. Hence, stress has a prominent role in cellular aging. Cells have to withstand and respond to major types of stress in their environment, including genotoxic, heat shock, and oxidative stress. Old cells are more vulnerable than young cells to stresses in their environment. Lower organisms with short life spans serve as experimental models to study the effects of stress on cellular responses in relation to aging. In 2001, a Swedish group using fruit flies to screen for bacterially induced genes found a new humoral factor, Turandot A, that is released systemically in response to many types of stress and also at advanced ages. Overexpression of Turandot A helps adult fruit flies to survive heat stress without inducing heat shock or immune genes or its own synthesis, and therefore may act through a separate pathway or at a point where many types of stress converge. Cellular defense mechanisms important in aging include DNA repair, detoxification of chemicals, production of antioxidants and heat shock proteins, and even cell suicide as a result of initiating a cell death program. The effects of the major types of stress on cellular aging will be taken up in succeeding sections, following a general discussion of the stress response in relation to development of disease and altered function during aging.

Stress response

The actions of counterregulatory hormones that are released as part of the stress response are important in restoring the balance in physiological systems. Stress increases the release of physiological mediators from the autonomic nervous system and adrenal glands, including fast-acting catecholamines and slow-acting steroids (mainly glucocorticoids), that participate in the adaptive response. The signal to release stress mediators into the blood is first transmitted from a physical (e.g., heat) or psychological (e.g., predator odor) stress through the nervous and immune systems to the brain. These signals are integrated in the brain, where they are converted into defensive behaviors (reflex withdrawal of a limb or running away from a predator) and hormonal responses that are important for survival. For example, glucocorticoids mobilize energy (glucose) stored in the liver for use by muscle, and they inhibit processes (e.g., growth and reproduction) that are not necessary for adaptation. Glucocorticoids are essential for surviving severe stress, but their effects exerted throughout the body can be damaging if the stress is prolonged, and may eventually result in disease. There are controls in place to prevent excess secretion of glucocorticoids, called a negative feedback loop. After the stress-induced increase in glucocorticoids in the blood, these hormones turn down their own production by decreasing the synthesis of factors made in the hypothalamus of the brain and in the pituitary gland that promote their synthesis and secretion from the adrenal gland.

Age-related changes in the adrenal glands and nervous system contribute to a decreased ability of elderly individuals to adapt to stress. Since glucocorticoids regulate natural defense mechanisms (e.g., immunity and inflammation) with both permissive and suppressive actions to protect against stress, decreased sensitivity to glucocorticoids may increase vulnerability to stress. Excess production of glucocorticoids by the adrenal glands could also be a culprit, as proposed by Sapolsky in his glucocorticoid cascade hypothesis, since elevated levels of this steroid hormone do not always return to baseline as quickly in older individuals after stress. Therefore, catabolic effects of glucocorticoid excess may contribute to the development of conditions that are prevalent in elderly persons, including immune suppression and cancer, muscle atrophy, osteoporosis, diabetes, and memory decline. An association between reduced negative feedback regulation of the hypothalamic-pituitary-adrenal axis during aging, especially in the face of stress, disease, and other forms of challenge (exercise, driving test) supports this hypothesis. Based on studies supported by the John D. and Catherine T. MacArthur Foundation through its Research Networks on Successful Aging and on Socioeconomic Status and Health, the interplay of these same factors is also associated with cognitive decline (learning, memory, and language loss).

Since the findings of neuron loss by Philip Landfield in the late 1970s, much has been made of the harmful effects of glucocorticoids in the hippocampus, a part of the brain that is involved in learning and memory. Follow-on studies by Robert Sapolsky and Michael Meaney beginning in the middle 1980s, when they were doctoral students in Bruce McEwens laboratory at the Rockefeller University, suggested that chronic stress and excess production of glucocorticoids resulted in the death of hippocampal neurons during aging, thus contributing to age-related memory loss. However, memory impairment in old rats correlates better with loss of connections between neurons than with the loss of principal neurons in the hippocampus. Studies performed by McEwens group between 1995 and 2000 demonstrate that chronic stress induces synaptic loss and atrophy of the hippocampus similar to that which occurs during aging. The reversibility of these effects in rodents may help to explain how humans who are routinely treated with high doses of glucocorticoids for long periods do not seem to have extensive hippocampal damage and memory impairment. Beginning in 1987, researchers at McGill University in Canada conducted a longitudinal study sampling individuals over a three- to six-year period, and found that memory impairment occurred only in a sub-group of healthy elderly individuals with both a high and an increasing cortisol (glucocorticoid) level. The increasing inability of these individuals to decrease their hormone level over time is an indication of failure in the nervous and endocrine systems. Together with the MacArthur Foundation studies conducted by Teresa Seeman, this work highlights the importance of individual variability in response to stress. The good news is that some deleterious effects of stress may be reversible even in elderly persons. Since psychosocial factors are important in how an individual responds to stress, it may be possible, with effective stress management, to decrease excess glucocorticoid production in humans.

Glucocorticoid excess and chronic stress are unlikely to be the only factors that result in an inability to adapt to stress during aging. In a 1998 article published in the New England Journal of Medicine, McEwen suggests a revision in the approach to understanding the relationship between changes in the environment and biological responses to emphasize both beneficial and detrimental effects of stress mediators and, in particular, the costs of adaptation to stress. Short-term beneficial effects result in allostasis, which means the capacity to adapt or restore homeostasis through change, whereas long-term detrimental effects constitute an allostatic load (the cost of having to adapt to challenges and changes in the environment). By measuring allostatic load at earlier ages, it may be possible to identify risk factors (e.g., overactivity of the hypothalamic-pituitary-adrenal axis) that result in late onset diseases (e.g., Type II diabetes, dementia). Since cellular responses are of primary importance in adaptation to stress, it is necessary to determine how stress mediators regulate cellular responses to achieve allostasis during aging. Age-related changes in cellular constituents involved in these responses may result in an increased allostatic load, thus contributing to a reduced capacity of older organisms to adapt and restore homeostasis. Three major types of stress are discussed in the following sections in relation to cellular aging changes.

Genotoxic stress

The integrity of the genome and the faithful transmission of the genetic material it contains to the next generation are important for survival of species. Similarly, the integrity of genomic and mitochondrial DNA and the transmission of the information they contain are important for the survival of individuals. DNA damage in the form of mutations or genomic instability result from genotoxic stress caused by exposure to toxic agents, including the suns ultraviolet rays, background ionizing radiation, chemicals in food and the environment, and highly reactive molecules produced within cells during metabolism. Similar types of DNA damage occur in response to various agents and include mutations, removal of bases and nucleotides, formation of dimers, strand breaks, cross-links, and chromosomal aberrations. Some of these types of damage accumulate in nuclear or mitochondrial DNA during aging (e.g., point mutations, single-strand breaks, DNA cross-links, additions/deletions, oxidative damage, and methylated bases). In a chapter in Hormones and Aging (1995), Suresh Rattan reviews DNA damage and repair and the evidence for genomic instability, loss of cell proliferation, production of altered proteins, and altered cellular responsiveness as a result of damage to DNA in cells and genes during aging. The ability to repair DNA damage may be related to length of the life span, since humans repair DNA faster than mice, but is not always related to maximum life span because premature aging is not always associated with a reduced capacity to repair DNA. Although there is little evidence to suggest an overall decline in the capacity of cells to repair DNA during aging, thus far only a few DNA repair pathways have been studied in any detail.

The sensitivity of cells to genotoxic stress increases during aging. Age-related deficits in protein synthesis and the responsiveness of cells to stress, decreased cell-cell communication, and inefficient signal transduction may render old cells less able to withstand stress. The ability to repair DNA may be compromised by other toxic agents, leading to loss of function in molecules and cells and shortening of life span. A decrease in the ability to repair genomic DNA may lead to increased incidence of cancer in elderly persons. Similarly, mitochondrial DNA damage and mutations increase with aging, as does susceptibility to age-related diseases such as diabetes, Parkinsons, and Alzheimers disease. In 2000, Jay Robbins and colleagues at the National Cancer Institute and a European group independently established a link between faulty DNA repair caused by defects in nucleotide excision repair and neurodegeneration, a link that was proposed by Robbins twenty-five years previously. Some patients with xeroderma pigmentosum show, in addition to greatly exaggerated risks of skin cancer, premature neuron death and DNA lesions similar to those in Alzheimers disease. Although cancer susceptibility and neuron death can both result from defects in DNA repair, the precise mechanisms may differ. Mouse models that are deficient in nucleotide excision repair also show increased incidence of tumors in response to genotoxic stress and a decreased life span, but they have reduced neurological deficits compared with human syndromes. These mice are being used to understand the involvement of DNA repair in genotoxic sensitivity and cancer susceptibility and in the process of aging.

Studies pioneered by Richard Setlow in the 1970s showed a correlation between DNA repair and species life span, but were largely based on crude measures of DNA repair. In 1998, using improved techniques that allowed specific genes to be assessed, Arlan Richardsons group in San Antonio, Texas, demonstrated that nucleotide excision repair of DNA in liver cells from old rats challenged with UV irradiation depended on whether the strand was actively transcribed or silent. The rate of repair of the transcribed strand of albumin DNA (transcription-coupled repair) was 40 percent less compared with young rats, but the extent of repair was not different at the end of the experiment. This was in contrast to the extent of repair of the silent strand, which was 40 percent less in old rats compared with young rats. Thus accumulation of DNA damage and mutations during aging may occur in nontranscribed regions of the genome. Richardsons studies also showed that both age-related deficits in DNA repair could be reversed by caloric restriction, which retards aging by increasing life span and reducing or delaying many of the diseases associated with aging.

Beginning in the 1990s, modern approaches to screening for changes in the expression of genes and proteins have fueled searches for cellular responses to genotoxic stresses, which may hold clues for understanding the process of aging. Hundreds of genes are induced in mammalian cells, most of which represent general responses to cell injury (e.g., induction of the immediate early genes, c-fos and c-jun ). Many DNA-damaging agents and their activated signaling pathways converge on the transcription factor p53, which functions as a sensor for DNA damage and regulates the transcription of hundreds of genes. However, changes in a few critical genes, such as those involved in DNA repair or information transfer, may underlie genomic instability during aging. Candidates are poly(ADP-ribose polymerases, or PARPs, a family of nuclear enzymes, some of which bind nicked DNA and guard the genome by regulating DNA repair and cell death. The activity of PARPs in white blood cells from thirteen mammalian species correlates with life span, yet knockout of the PARP-1 gene confers resistance to stroke and diabetes. Other candidates are helicases (DNA unwinding enzymes) or their associated proteins. Helicases are involved in DNA repair and regulation of transcription, and are mutated in premature aging syndromes. Overlapping aging phenotypes in some helicase disorders and normal aging implicate common pathways, especially transcriptional regulation. Further studies of PARPs and helicase enzymes and their functions during aging could establish a stronger link with cellular or organismal aging. Mouse models that are deficient in nucleotide excision repair also show increased incidence of tumors in response to genotoxic stress and a decreased life span, although they have reduced neurological deficits compared with human syndromes. These mice are being used to understand the involvement of DNA repair in genotoxic sensitivity and cancer susceptibility, and in the process of aging.

Heat shock stress

Nonlethal heat stress induces a characteristic set of proteins in cells that are called heat shock proteins. This stress response is ancient and highly conserved throughout living organisms. Many types of stress in addition to mildly elevated temperature can induce heat shock proteins. Heat shock proteins act as molecular chaperones by helping cells to repair or remove damaged proteins and by participating in the intracellular transport of newly synthesized proteins. Therefore, they are important regulators of cellular adaptation to stress. An important function of heat shock proteins in relation to aging is their ability to confer resistance or tolerance to future insults. The mechanisms for protection against future stresses are poorly understood but may involve the ability of heat shock proteins to promote cell survival by interfering with a cell death program that leads to cell suicide. The synthesis of heat shock proteins is also linked to neuroendocrine responses to stress. For example, elevated glucocorticoid secretion can induce specific heat shock proteins in different cells as a beneficial effect of the stress response. Their role in protein degeneration and the stress response is highlighted by their accumulation in plaques and tangles, the brain deposits associated with Alzheimers disease pathology.

In the 1990s, researchers in the field of aging, including Richardson, Nikki Holbrook, and Marcelle Morrison-Bogorad, thought that the decreased ability of aged individuals to maintain homeostasis in the face of insults could be due to inadequate cellular responses to stress like the heat shock protein response. They found that the induction of heat shock proteins in response to stress decreases with age. Richardsons group found that the induction of heat shock protein 70 by heat stress in liver cells cultured from old rats was reduced by 50 percent compared with young rats. Furthermore, the decrease in heat shock protein 70 induction occurred at the transcriptional level of regulation and was dependent on reduced binding of a transcription factor to the promoter of the heat shock protein 70 gene. Holbrooks group at the National Institute of Aging used transplantation studies to determine whether the deficit in heat shock protein 70 response in blood vessels was due to the age of the tissue or to the environment. Transplantation of old vessels to a young host restored their response, and transplantation of young vessels to an old host resulted in a reduced response. In the case of blood vessels, heat exposure produced less of an increase in blood pressure in old rats than in young rats, which resulted in less heat shock protein 70 induction. In other circumstances, hormonal or metabolic changes that occur during aging could result in aged cells receiving less of a stimulus to induce the response. Age-related changes could also reduce the effectiveness of the heat shock proteins. For example, genotoxic stress can damage heat shock proteins in the cells of aged individuals due to mutated DNA, errors in translation of mRNA into protein, or reduced repair, and also diminish their role in stress tolerance. Therefore, the environment is a factor that should be considered in interpreting age-related differences in the response of cells to stress.

Richardson and Holbrook proposed in a 1996 review that the widespread reduction in stress-induced heat shock protein 70 expression in aged organisms indicates the importance of this response in both cellular and organismal aging. Consistent with this hypothesis is the ability of caloric restriction to restore the stress-induced heat shock response during aging. Furthermore, mutants that increase life span in nematodes also overexpress heat shock proteins in response to stress, and overexpression of heat shock protein 70 sometimes results in increased life span in fruit flies. Basal levels of heat shock protein 70 are usually not different between young and old individuals, but other members of the heat shock protein family do increase during aging in mice, fruit flies, and nematodes. Age-related increases in basal heat shock protein expression may be a response to accumulated damage and oxidative stress. Therefore, as proposed by Gordon Lithgow and Tom Kirkwood in 1996, heat shock proteins that function as molecular chaperones may regulate organismal aging.

Oxidative stress

Oxidative stress occurs when highly reactive molecules called free radicals overwhelm the cells natural defenses against their attack. It is a battle that is fought in cells every day. Each cell in the body produces billions of free radicals a day, and some of them are used in physiological relevant reactions; oxygen itself is a free radical. Free radicals derived from oxygen are formed in the course of aerobic life when chemical bonds are broken during the production of energy in the mitochondria. Usually free radical reactions are controlled by free radical scavenging molecules that remove excess free radical scavenging molecules and antioxidants that neutralize free radicals. Chemical reactions with free radicals occur in all living organisms and can amplify their effects in the cell. Under conditions of oxidative stress, free radicals attack other molecules and form molecules that are foreign to cellular machinery (e.g., cross-linking of proteins makes them resistant to proteases), so they fail to turn over, accumulate, and eventually impair function by slowing down physiological processes. Free radicals are also produced in response to genotoxic stress by exposure to ionizing radiation from ultraviolet rays of the sun, chemical pollutants, and smoking.

Denham Harman first proposed the role of oxygen-derived free radicals in the aging process in 1956. An introduction to the concepts of free radical production and oxidative stress during aging is presented in a 1992 Scientific American article titled Why Do We Age? A more in-depth review by Toren Finkel and Nikki Holbrook appeared in Nature in 2000 as part of a series titled Ageing. During aging an imbalance occurs between production of free radicals and antioxidant defenses, resulting in an accumulation of free radicals and oxidative attack or damage to DNA, protein, lipids, membranes, and mitochondria. Although enzymes that repair proteins, lipids, and DNA are produced, the ability to repair cellular oxidative damage decreases with age, resulting in a reduced ability of old cells to withstand oxidative stress. The repair enzymes may be less efficient because they, too, are attacked or cross-linked and the whole system breaks down, resulting in impaired function and susceptibility to disease. Furthermore, free radicals build up over time and can damage the mitochondria, resulting in less energy production. The decrease in energy results in oxidative stress and a further increase in free radicals, which eventually damage other cellular components. Oxidative damage to organelles results in cellular injury and cell death. Free radical reactions with cellular components and cross-linking of proteins and DNA increase with aging. In addition, various types of stress, including injury and disease, amplify these reactions during aging. An effect of aging on oxidative damage to nuclear and mitochondrial DNA was first reported by Bruce Amess laboratory. Richardsons group showed that the increase in DNA oxidative damage during aging was not due to inability to repair the damage but, rather, to increased sensitivity to oxidative stress. Richardsons group also showed that caloric restriction could reduce the levels of DNA oxidative damage in aged rats, supporting the role of oxidative stress in the process of aging.

Evidence from mutants in fruit flies and nematodes, reviewed by Finkel and Holbrook, supports a role for molecules that are capable of scavenging free radicals or of decreasing the accumulation of free radicals and oxidative stress in extension of life span. Surprisingly, mutants with altered life span can have their normal life span restored by expression of the normal protein specifically in neurons, suggesting that neurons control how long an organism can live. Overexpression of superoxide dismutase, an enzyme that neutralizes the superoxide free radical, in motor neurons can extend life span by up to 48 percent in fruit flies that also exhibit resistance to oxidative stress, and partially rescues the normal life span of a short-lived superoxide dismutase null mutant in a dose-responsive manner. The long life span of age-1 and daf-2 mutants rescued with expression of these genes only in neurons is also associated with higher levels of free-radical scavenging enzymes and protection of neurons from oxidative damage. According to Gabrielle Bouliame, whose group performed the experiments on fruit fly motor neurons, it is possible that these neurons, through neuroendocrine signals, regulate the functional reserve or adaptive capacity of tissues in the organism, which in turn influences life span.

Theories of aging

The process of aging is characterized by imbalances that result in dysfunction manifested at different biological levels and culminate in death of the organism. Some of these changes are programmed and begin from within the cell, and others occur in response to the intrinsic or extrinsic environment. Stress is an important concept in many theories of aging, including systemic, cellular, and molecular theories, and especially in those which explain aging in terms of ability to maintain and restore homeostasis. However, the effects of prolonged stress on an individual may be due to the development of disease and not a result of normal aging process. Questions that remain are whether the effects on aging are due to stress or to stress-induced disease processes that overwhelm the defense or repair systems, and are then life-threatening in old individuals. With these caveats in mind, the stress response is important in the neuroendocrine theory of aging and oxidative stress is important in the free radical theory of aging.

New humoral or systemic factors are being described that differentially regulate the cellular stress response during aging. As shown by studies from Dan Hultmarks group in Sweden, a humoral factor that increases heat shock protein 70 prevents cell death and restores stress resistance in old cells. These factors implicate neural and endocrine signals in the control of aging. The neuroendocrine theory of aging proposes that the ability to respond to stress is an important factor in reduced ability to maintain homeostasis during aging. Furthermore, the control of homeostasis becomes disorganized during aging, resulting in loss of adaptive capacity, decreased resistance to stress, and increased allostatic load. Thus, aging is the price the organism has to pay for surviving stress. Convincing evidence supports the theory that free radicals and oxidative stress play an important role in the aging process, and indicates that oxidative damage to neurons may be related to life span and aging, as well as to neurodegeneration. This knowledge may be used to find ways of slowing aging and increasing average life span in humans.

Rate of Aging

Aging is a complex process and is unlikely to result from a single cause or a single gene. Conditions that slow or accelerate aging and genes that control the rate of aging provide clues about what causes aging. Although aging is not equal to life span, genes that regulate life span are often important in resistance to stress and may be able to slow aging: superoxide dismutase prevents the accumulation of free radicals, and nucleotide excision repair enzymes repair DNA. Furthermore, cell stress resistance is correlated with maximum life span across species. Based on the evolutionary theory of aging, Thomas Kirkwood and Steven Austad predict that key enzymes that regulate the rate of aging are those involved in maintenance and repair. A gene involved in maintenance and repair that can regulate the rate of aging is exemplified by stress-induced p53. Free radicals, oxidative stress, DNA-damaging agents, and environmental stresses (including heat) result in increased activation of p53. The activation of p53 can lead to DNA repair, to cell cycle arrest in order to limit DNA replication (cellular replicative senescence), or to cell death, which is how it acts as a tumor suppressor to prevent cancer. In a study published in Nature in January 2002, transgenic mice that express mutant-activated p53, which augments wild-type p53 activity, show a resistance to tumors and early signs of some aging phenotypes, including reduced life span, osteoporosis, and multiple organ atrophy. Importantly, these mice also display a reduced ability to tolerate stress, as shown by delayed wound healing and reduced recovery from stress in old mice. These data suggest a role for the stress-induced cellular p53 response in organismal as well as cellular aging and in acceleration of some aging changes.

Caloric restriction not only retards aging but also reverses the effects of stress during aging by putting cells in a survival mode. It decreases free radical production and oxidative stress, reduces the load of damaged molecules, decreases sensitivity to genotoxic stress, and postpones declines in DNA repair. Caloric restriction also alters the expression of genes that regulate damage and stress-response pathways. Both heat shock stress and exposure to mild oxidative stress can result in hormesis, a beneficial effect that occurs in response to very low doses of agents that are toxic at higher doses. Minimal stress not only increases survival in fruit flies and nematodes but also increases life span. Caloric restriction also results in hormesis and may slow the aging process by inducing a mild stress response, including increases in heat shock protein 70 and glucocorticoids that afford protection against stress. In contrast, premature aging syndromes with shortened life spans result from single gene mutations that result in genomic instability, inability to repair DNA, and some of the phenotypes of aging.

The psychosocial environment determines how an individual perceives stress, and coping ability plays a role in age-associated functional decline. Few studies of stress focus on the oldest old (greater than eighty-five years), although they have frequent physical, emotional, and social changes that decrease their sense of control and require adaptation to stress. It is interesting that within this group are centenarians who have greater functional reserve and adaptive capacity, enabling them to overcome a disease or injury or to cope with stresses more effectively.

Nancy R. Nichols

See also Nutrition: Caloric Restriction; Theories of Biological Aging: DNA Damage;


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Stress research includes attention to events or conditions that may cause harm and to the responses aroused by those stressful events or conditions. These outcomes include felt distress, disrupted interaction, and poorer health. The overall stress process includes both stressful agents and stress outcomes (see Pearlin et al. 1981). This process also includes two other major sets of variables: social factors that influence exposure to stressful conditions, and individual and group resources that shape efforts to cope with stressors.

Although early stress research focused on unpleasant physical stressors (Selye 1982), social scientists studying families have been particularly interested in social stressors—events or conditions that are linked to individuals' and families' social characteristics, positions, and roles.

The concept of social stress calls attention to both environmental/social demands and individual/family capacities or resources; stress occurs when there is a discrepancy between these capacities and demands. Such stressors can come from external demands on families and family members, or they can arise within family roles themselves. Theoretically, a discrepancy can be in either direction: demands could be greater than a person's capacities, or demands could be far below individual capacities. Thus, restricted opportunities can be at least as stressful as high demands: Carol Aneshensel (1999; see also Wheaton 1999) calls attention to stressors that occur when aspects of the social environment obstruct an individual's ability to attain sought-after ends.

One early and influential approach to studying social stressors focused on change per se as stressful. Thomas A. Holmes and Richard H. Rahe (1967) developed a checklist of stressful life events aimed at capturing the set of events that had happened to an individual. These checklist approaches to the measurement of social stress were based on two key assumptions. First, they assumed that one could calculate a standard estimate of the amount of change demanded by a specific event, such as divorce or the birth of a child, and that this amount would be generally the same for all who experienced that event. Second, they assumed that one could capture the effects of the accumulation of several events in a short period of time by summing the amount of change implied by each, and that this total amount of change was the critical dimension linked to stress outcomes.

Subsequent research, however, has cast doubt on each of these assumptions. Change per se does not seem to be the key dimension producing negative outcomes: changes that are undesired, involuntary, unexpected, and involve role losses generally have more negative effects than other changes. Nor is it the case that the same event has uniform effects on different people. Consistent with the concept of stress as a discrepancy between demands and capacities, much depends on the resources and coping repertoires that individuals and families possess.

In addition, the impact of transitions and eventful changes depends in part on the circumstances prevailing prior to a specific life event. A notable example is marital termination: although the end of a marriage is generally viewed as a stressful event, termination of a conflict-filled or unsatisfying relationship may actually improve well-being. And because spouses may differ in how satisfied they are, this example also suggests that the same family event will not necessarily affect all members of a family in the same way. In an influential analysis, Blair Wheaton (1990) has shown that in the case of role exits, including retirement, widowhood, divorce, and a child's move away from home, the more stressful prior conditions in that role, the less the impact on mental health. Similarly, Susan Jekielek (1998) finds that children's response to parental divorce is less adverse when there has been more marital conflict.

Effects of specific life events also depend in part on the subsequent level of chronic problems. It is largely because major life events typically result in an enduring alteration in social circumstances, thereby increasing chronic problems, that they affect individual and family outcomes.

Chronic problems in any given role can also lead to other stressors, in a process that Leonard Pearlin and his colleagues describe as stress proliferation—the tendency of stressors to beget other stressors (Pearlin, Aneshensel, and LeBlanc 1997). They illustrate this process in a study of informal caregivers to people with acquired immunodeficiency syndrome (AIDS). As the illness progresses, the difficulties faced in the role of caregiver expand, straining one's capacities to manage those demands. Moreover, these strains affect the caregiver's ability to enjoy the opportunities, and manage the stressors, embedded in other roles such as work roles and social and leisure activities. Once these are affected, the altered conditions in these other roles can have an additional, independent effect on the caregiver's health and well-being.

Thus, the concept of social stressors reaches beyond the notion of discrete life events to include chronic or persisting circumstances, such as low income, unpleasant working conditions, role strains, and conflicts among multiple social roles, as well as the resources that individuals and families are able to bring to bear in their efforts to deal with their circumstances. Because both those circumstances and resources are likely to be linked to social position—as indicated by one's race, gender, marital status, and economic position—this broad definition of social stress brings stress research closer to traditional sociological topics such as social stratification and race and gender discrimination. It offers a more comprehensive way of thinking about the way that social circumstances, including normatively structured family and occupational social roles, shape individual opportunities, individual distress, and family well-being.

Research analyzing the connection between social contexts and stress outcomes for individuals and families has examined several key links. First, research has examined how stressors originating outside the family can affect individual family members' emotional well-being (see, for example, Windell and Dumenci 1999). Second, researchers have investigated how each individual's emotional well-being in turn affects family interaction; these studies find that individuals who are struggling with emotional turmoil or depression are less available for satisfying interaction and more prone to become aggressive and argumentative (Elder 1974). Third, studies also examine how and whether one family member's emotional state can be transmitted to other family members (Larson and Almeida 1999); initial results from these studies suggest that fathers' negative emotions aroused in the workplace "spill over" and affect both spouses and children, but mothers' work-linked emotions are less apt to adversely affect other family members. In turn, of course, negative emotions aroused by difficult family conditions can spill over and affect workplace interaction and performance.

Exposure and Responses to Stressors

As family stress researchers study the resourceful ways in which individuals and families resist stressors, they have also called attention to the ways that social and economic factors shape both their exposure to stressors and their abilities to respond.

In considering the relationship between stressful circumstances on the one hand and family members' individual well-being and overall family functioning on the other, research has tended to focus on two main questions: How can variations in exposure to social stressors explain variations in individual and family outcomes? How, in a group of individuals or families who have been exposed to the same stressor, can variations in individual and family capacities, resources, and coping efforts explain variations in outcomes?Exposure to social stressors. An example of the former is the investigation conducted by Pearlin and his colleagues (1981) into the effect of occupational disruptions on emotional distress. They compared those who had faced recent disruptions with respondents who had not, with statistical controls for other variables known to affect both the likelihood of disruption and the levels of emotional distress, and traced the effects of disruption through diminished self-esteem and compromised sense of mastery to increased distress. Similarly, early family stress research examined exposure to stressors linked to social organization and societal crises, such as widespread male unemployment and extended separations brought on by World War II (see Hill 1949).

These early studies focused on men's unemployment as a social stressor for themselves and their families. As women's employment increased, studies began to examine whether women's holding multiple social roles—both family roles as spouse and mother and work roles as employee—operated as a social stressor, with adverse consequences for themselves and other family members, particularly children. This research has generally been inconclusive: simple cross-sectional contrasts between employed and not-employed mothers have found, if anything, an average benefit of employment for women and little significant differences in their children's outcomes. Ingrid Waldron and her colleagues (1998) provide an example of this line of research, as well as an overview of theoretical arguments regarding how combinations of marriage, mothering, and employment may affect women's health. They find little evidence that combining employment and mothering has adverse effects on physical health. They suggest that marriage and employment each provide similar resources to women, namely income and social supports, and that they can substitute for one another in having a beneficial impact on health. Conversely, these findings suggest that the absence of both marriage and employment will be associated with more negative outcomes.

In extensions of this line of research, researchers have argued that the effects of having a particular role or role combination are not uniform, but depend on the role conditions one encounters. For example, research in this tradition focused on employment emphasizes that for men as well as for women, employment in occupations that are free from close supervision and provide opportunities for substantively complex and self-directed work will yield benefits, whereas employment in dull, repetitive, and closely supervised work will not (Kohn and Schooler 1983; Menaghan 1991). Similarly, all marriages are not equal in their costs and benefits, with high-conflict, hostile, or distant relationships more distressing than their counterparts. In support of these arguments, Elizabeth Menaghan and her colleagues (1997) show that the quality of mothers' employment, as well as the quality of their marital relationships, affect mother-child interaction and adolescent children's academic and behavior outcomes.

Variations in response to stressors as a function of resources. An example of the latter question is Glen Elder's (1974) study of families who faced serious economic decline during the Great Depression. Elder investigated whether couples with more cohesive marital bonds at a prior point were better able to respond to the economic difficulties they faced. Here, the cohesion of marital bonds is conceptualized as a family-level resource that accounted for a difference in outcomes among couples all facing the same economic stressor. In general, family stress researchers have conceptualized stressful outcomes as a function of three major factors: the stressor, family resources, and appraisal or interpretation (Hill 1949). Extending this model, Yoav Lavee and his colleagues emphasized potential changes over time in each of these factors (see Lavee, McCubbin, and Patterson 1985). Work by Pauline Boss (1999) calls attention to the critical role of appraisal in influencing family members' responses to ambiguous or incomplete losses, including family members who are missing, suffering from dementia, or geographically or emotionally distant.

These same factors are also central to studies of stress at the individual level. Pearlin and his colleagues (1981) stress how material, social, and psychosocial resources, including optimistic appraisals, help to account for variations in the individual distress aroused by stressful circumstances in normative adult roles such as marriage, employment, and parenting. In both literatures, economic resources, social supports from others, coping strategies, and individual levels of self-esteem and mastery are viewed as central resources that can reduce the negative impact of social stressors (Mirowsky and Ross 1986; Turner 1999).

One of the pathways by which social stressors may create adverse impacts is by reducing resources themselves. For example, a period of involuntary unemployment may have a less disastrous impact on families with greater savings. If the period of unemployment is prolonged, however, or if unemployment recurs, families may literally "spend down" their resources. This is probably easiest to measure in terms of tangible resources like savings, but the general argument holds as well for more subtle resources like a sense of mastery over one's circumstances. At any single time point, having more optimistic and internal attitudes may help one to manage potential stressors. But over time, exposure to stressors may cumulatively reduce those feelings of control. Thus, current levels of resources may partially reflect the cumulative history of encounters with social stressors.

Who is exposed to social stressors? To fully understand the processes by which stressors affect families, we also need to consider how social stressors are distributed in populations. Exposure to difficult life events or constraining social circumstances is not a random process, and it is important to view variations in exposure to stressors as a phenomenon that itself needs to be explained. For example, Jay Turner and colleagues (1995) study what they call the epidemiology of social stress. They find that the distribution of exposure to social stressors varies significantly by age, gender, marital status, and occupational status, and this distribution parallels the distribution of depressive symptoms and major depressive disorder across the same factors. Catherine Ross and Marieke Van Willigen (1997) also point to educational attainment as a crucial resource that shapes subsequent exposure to more or less stressful circumstances.

Turner and Lloyd (1999) extend this analysis, and find that exposure to social stressors, as well as levels of personal resources and social supports, can explain, on the one hand, observed links between age, gender, marital status, and socioeconomic status, and mental health outcomes on the other. In particular, the linkage between lower socioeconomic status and higher depressive symptoms is completely accounted for by the greater exposure to stressors and fewer resources and social supports of those with lower educations, occupations, and incomes.

Effects of Economic Stressors on Marital Behaviors

Social stress research has repeatedly identified low income and income loss as a major social stressor (see for example, Elder 1974; McLloyd 1990). Given the importance of family income, and its links to both employment and family composition, researchers in the United States have sought to understand how economic circumstances and family formation and stability are linked. As Scott South and Kim Lloyd (1992) have documented, higher rates of male nonemployment have been shown to be associated with reduced marriage rates and higher rates of births to unmarried women for both African-American and white population groups. Women's economic resources also matter: Diane McLaughlin and Daniel Lichter (1999) comment that marriage can provide a route out of poverty for some, but find that poor women, especially those who do not hold jobs, are less likely to marry than are more advantaged women.

Marriages stressed by economic uncertainties have also been more likely to be disrupted. When financial pressures are high, husbands and wives treat each other more negatively, quarrel more, and feel increasingly distant; thoughts of divorce become more common. And as wives' greater employment and earnings prompt them to question disproportionate female responsibility for housework and childcare, conflict between partners is apt to increase. Donald Hernandez (1993) has found that married-couple families below the poverty level are more likely to disrupt their marriages than are couples who have greater economic resources. Among married couples, husbands' nonemployment increases the likelihood of marital disruption (South and Spitze 1986). This occurs in part because men react to employment loss and associated economic hardship with anger, irritability, and withdrawal from interaction (Conger et al. 1990).

Lower likelihood of marital formation and higher rates of marital disruption clearly affect children's life chances as well. In the absence of marriage or after its end, U.S. fathers have been relatively unlikely to share income or time with their biological children, and single-mother families are most vulnerable to economic problems.

Societal Differences, Demographic Factors, and Family Stressors

Much social stress research has focused on differences in exposure and response to social stressors within a single nation, typically the United States. We can gain additional insights if we broaden our perspective to consider differences between nations around the globe. One example is the link between single mothering and low income just noted. In the United States, children living with never-married and formerly married parents, particularly mothers, are disproportionately likely to have low incomes. But in a comparative perspective, it becomes clear that this is not an inevitable consequence of single-mothering: the proportion in poverty varies dramatically across the developed countries, with U.S. rates much higher than in such countries as France or the Netherlands (see Lichter 1997). Lynne Casper and colleagues' (1994) examination of poverty among men and women across Western industrialized countries suggests that much of the explanation lies in differing national policies regarding income transfers and income floors for all citizens, as well as differing supports for employment. Thus, how employment affects families, and how family composition affects family income, varies across nations.

An international perspective also suggests other demographic factors that figure importantly into the kinds of social stressors that families encounter. For example, both within the United States and across the globe, race and ethnic groups vary in their social advantage/disadvantage, exposure to social stressors, and access to resources. These studies suggest that when economic problems become pervasive in a community, overall community levels of family violence and child abuse rise. To the extent that discriminatory labor-market practices compromise minority members' access to income, job security, and occupational quality, racially segregated communities will lack the resources families need to resist stress, and the families living with them may be exposed to greater social stressors as well (see, for example, McLloyd 1990).

As nations and regions become increasingly interconnected, migration across communities, states, and national borders presents an increasingly common social stressor for individuals and families. Min Zhou (1997) summarizes the family and intergenerational stressors that immigrants to the United States face, as family ties are stretched across national borders, and suggests that the success of various family adaptations strategies varies depending on the socioeconomic and ethnic composition of the communities into which they move. Samuel Noh and William Avison (1996) study the experiences of Korean immigrants to Canada, and link increases in depression over time to more undesirable life events, more chronic stressors, and less mastery and sense of support.

Migration may be permanent or temporary, and may involve whole families or individual members. The consequences of migration are likely to vary depending on the circumstances one is leaving behind, the extent of family resources that can be retained, and the conditions faced in one's new environment. Much migration is intentional, as individuals and families seek to improve their circumstances. But war, ethnic violence, crop failures and economic conditions also combine to create huge flows of political and economic refugees; these streams are apt to have fewer resources and greater difficulties.

Changing mortality patterns across populations and across the world also suggest new sources of social stress for families, particularly in the direction and duration of caregiving across generations. In the developed world, increasing life spans may present increased demands for caregiving by adult family members to their elders. In sharp contrast, in many areas of Africa and Asia, increases in sexually transmitted diseases, particularly AIDS-related diseases, have resulted in declining average life expectancies and the deaths of parents in early adulthood. These new mortality patterns create a generation of orphans and present increased demands for caregiving by elder family members and others.

Finally, studies of stress in families, and gender differences in average levels of well-being, call attention to differences in stress processes within families. Societies differ significantly in the extent to which male dominance and female subordination are accepted as part of the normative order. To the extent that male and female family members have strikingly different rights, freedoms, and responsibilities, it is reasonable to expect that they will be exposed to differing stressors, have differing access to social resources, and be differently affected by stressors. Thus, the study of stress in families, both within and across nations, must encompass both individual and family stressors and individual and family outcomes, without assuming that stressors affect male and female family members, or members of different societies, equally.


The study of social stressors affecting families draws attention to the linkages between social factors such as race, gender, education, occupation, and income, and how they shape both exposure to stressors and the possession of resources with which to deal with them. We have noted that greater levels of resources can keep potential social stressors from exerting adverse effects, but over time resources themselves can be whittled away by chronic or recurring exposure to social stressors. Despite much popular concern about role conflicts, particularly between work and family roles for women, studies suggest that more and less stressful conditions within roles may be more consequential than the simple presence or absence of a particular social role. This review of social stress research draws heavily on research conducted in the United States, but it suggests that the stress paradigm can provide a conceptual lens through which one can begin to explore variations in stressful exposure and outcomes across nations as well.

See also:Acquired Immunodeficiency Syndrome (AIDS); Boundary Ambiguity; Caregiving: Informal; Chronic Illness; Conflict: Family Relationships; Conflict: Marital Relationships; Conflict: Parent-Child Relationships; Death and Dying; Depression: Adults; Depression: Children and Adolescents; Disabilities; Divorce: Effects on Children; Divorce: Effects on Couples; Divorce: Effects on Parents; Elder Abuse; Family Development Theory; Family Roles; Family Strengths; Fatherhood; Gender; Health and Families; Marital Quality; Migration; Motherhood; Poverty; Power: Marital Relationships; Resource Management; Retirement; Single-Parent Families; Social Networks; Spouse Abuse; Theoretical Explanations; Transition to Parenthood; Unemployment; War/Political Violence; Widowhood; Work and Family


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Stress is a term that refers to the sum of the physical, mental, and emotional strains or tensions on a person. Feelings of stress in humans result from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality as well as differences in physical strength or health.

A stressor is defined as a stimulus or event that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR ) defines a psychosocial stressor as "any life event or life change that may be associated temporally (and perhaps causally) with the onset, occurrence, or exacerbation [worsening] of a mental disorder."

Stress affects the lives of most adults in developed countries in many ways. It is a major factor in rising health care costs; one public health expert maintains that 90% of all diseases and disorders in the United States are stress-related. Stress plays a part in many social problems such as child and elder abuse , workplace violence, juvenile crime, suicide , substance addiction , "road rage," and the general decline of courtesy and good manners. Stress also affects the productivity of businesses and industries. One nationwide survey found that 53% of American workers name their job as the single greatest source of stress in their lives. Furthermore, the overall cost of medical care, time lost from work, and workplace accidents in the United States comes to over $150 million per year.

The neurobiology of stress

One way to understand stress as a contemporary health problem is to look at the human stress response as a biologically conditioned set of reactions that was a necessary adaptation at earlier points in human evolution, but is less adaptive under the circumstances of modern life. Hans Selye (1907-1982), a Canadian researcher, was a pioneer in studying stress. Selye defined stress, in essence, as the rate of wear and tear on the body. He observed that an increasing number of people, particularly in the developed countries, die of so-called diseases of civilization, or degenerative diseases, which are primarily caused by stress. Selye also observed that stress in humans depends partly on people's evaluation of a situation and their emotional reaction to it; thus, an experience that one person finds stimulating and excitingfor example, bungee jumpingwould produce harmful stress in another.

The stress response

In humans, the biochemical response to acute stress is known as the "fight-or-flight" reaction. It begins with the activation of a section of the brain called the hypothalamic-pituitary-adrenal system, or HPA. This system first activates the release of steroid hormones, which are also known as glucocorticoids. These hormones include cortisol, the primary stress hormone in humans.

The HPA system then releases a set of neurotransmitters known as catecholamines, which include dopamine, norepinephrine, and epinephrine (also known as adrenaline). Catecholamines have three important effects:

  • They activate the amygdala, an almond-shaped structure in the limbic system that triggers an emotional response of fear.
  • They signal the hippocampus, another part of the limbic system, to store the emotional experience in longterm memory.
  • They suppress activity in parts of the brain associated with short-term memory, concentration, and rational thinking. This suppression allows a human to react quickly to a stressful situation, but it also lowers ability to deal with complex social or intellectual tasks that may be part of the situation.

In reaction to stress, heart rate and blood pressure rise, and the person breathes more rapidly, which allows the lungs to take in more oxygen. Blood flow to the muscles, lungs, and brain may increase by 300400%. The spleen releases more blood cells into the circulation, which increases the blood's ability to transport oxygen. The immune system redirects white blood cells to the skin, bone marrow, and lymph nodes; these are areas where injury or infection is most likely.

At the same time, nonessential body systems shut down. The skin becomes cool and sweaty as blood is drawn away from it toward the heart and muscles. The mouth becomes dry, and the digestive system slows down.

The relaxation response

After the crisis passes, the levels of stress hormones drop and the body's various organ systems return to normal. This return is called the relaxation response. Some people are more vulnerable to stress than others because their hormone levels do not return to normal after a stressful event. An absent or incomplete relaxation response is most likely to occur in professional athletes and in people with a history of depression.

Physical effects of chronic stress

In chronic stress, the organ systems of the body do not have the opportunity to return fully to normal levels. Different organs become under- or overactivated on a long-term basis. In time, these abnormal levels of activity can damage an organ or organ system.

Cardiovascular system

Stress has a number of negative effects on the heart and circulatory system. Sudden stress increases heart rate, but also causes the arteries to narrow, which may block the flow of blood to the heart. The emotional effects of stress can alter the rhythm of the heart. In addition, stress causes the release of extra clotting factors into the blood, which increases the risk of a clot forming and blocking an artery. Stress also triggers the release of fat into the bloodstream, which temporarily raises blood cholesterol levels. Lastly, it is thought that people who regularly have sudden increases in blood pressure due to mental stress may over time suffer injuries to the inner lining of their blood vessels.

Gastrointestinal system

The effects of chronic stress on the gastrointestinal system include diarrhea, constipation, bloating, and irritable bowel syndrome. Although stress is not the direct cause of either peptic ulcers or inflammatory bowel disease, it may predispose people to develop ulcers and worsen flareups of inflammatory bowel disease.

Stress is the cause of abnormal weight loss in some people and of weight gain in others, largely from stress-related eating. It is thought that stress related to the physical and emotional changes of puberty is a major factor in the development of eating disorders.

Reproductive system

Stress affects sexual desire in both men and women and can cause impotence in men. It appears to worsen the symptoms of premenstrual syndrome (PMS) in women. Stress affects fertility, in that high levels of cortisol in the blood can affect the hypothalamus, which produces hormones related to reproduction. Very high levels of cortisol can cause amenorrhea, or cessation of menstrual periods.

Stress during pregnancy is associated with a 50% higher risk of miscarriage. High stress levels on the mother during pregnancy are also related to higher rates of premature births and babies of lower than average birth weight; both are risk factors for infant mortality.

Musculoskeletal system

Stress intensifies the chronic pain of arthritis and other joint disorders. It also produces tension-type headaches, caused by the tightening of the muscles in the neck and scalp. Research indicates that people who have frequent tension headaches have a biological predisposition for converting emotional stress into muscle contraction.


The physical effects of stress hormones on the brain include interference with memory and learning. Acute stress interferes with short-term memory, although this effect goes away after the stress is resolved. People who are under severe stress become unable to concentrate; they may become physically inefficient, clumsy, and accident-prone. In children, however, the brain's biochemical responses to stress clearly hamper the ability to learn.

Chronic stress appears to be a more important factor than aging in the loss of memory in older adults. Older people with low levels of stress hormones perform as well as younger people in tests of cognitive (knowledgerelated) skills, but those with high levels of stress hormones test between 20% and 50% lower than the younger test subjects.

Immune system

Chronic stress affects the human immune system and increases a person's risk of getting an infectious illness. Several research studies have shown that people under chronic stress have lower than normal white blood cell counts and are more vulnerable to colds and influenza. Men with HIV infection and high stress levels progress more rapidly to AIDS than infected men with lower stress levels.

Stress and mental disorders

DSM-IV-TR specifies two major categories of mental disorders directly related to stressthe post-traumatic syndromes and adjustment disorders. Stress is, however, also closely associated with depression, and can worsen the symptoms of most other disorders.

Post-traumatic disorders

Post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) are defined by their temporal connection to a traumatic event in the individual's life. The post-traumatic disorders are characterized by a cluster of anxiety and dissociative symptoms, and by their interference with the patient's normal level of functioning. Magnetic resonance imaging (MRI) studies have shown that the high levels of sustained stress in some PTSD patients cause demonstrable damage to the hippocampus. Excessive amounts of stress hormones in brain tissue cause the nerve cells, or neurons, in parts of the hippocampus to wither and eventually die. One group of Vietnam veterans with PTSD had lost as much as 8% of the tissue in the hippocampus.

Substance abuse disorders

Stress is related to substance abuse disorders in that chronic stress frequently leads people to self-medicate with drugs of abuse or alcohol. Substance abuse disorders are associated with a specific type of strategy for dealing with stress called emotion-focused coping. Emotion-focused coping strategies concentrate on regulating painful emotions related to stress, as distinct from problem-focused coping strategies, which involve efforts to change or eliminate the impact of a stressful event. Persons who handle stress from a problem-oriented perspective are less likely to turn to mood-altering substances when they are under stress.

Adjustment disorders

DSM-IV-TR defines adjustment disorders as psychological responses to stressors that are excessive given the nature of the stressor; or result in impairment of the person's academic, occupational, or social functioning. The most important difference between the post-traumatic disorders and adjustment disorders is that most people would not necessarily regard those stressors involved in the latter disorder as traumatic. Adjustment disorder appear to be most common following natural disasters, divorce, becoming a parent, and retirement from work.

Causes of stress

The causes of stress may include any event or situation that a person considers a threat to his or her resources or coping strategies. A certain amount of stress is a normal part of life; it represents a person's response to inevitable changes in his or her physical or social environment. Moreover, positive events can generate stress as well as negative events. Graduating from college, for example, is accompanied by stress related to employment or possible geographical relocation and the stress of saying good-bye to friends and family, as well as feelings of positive accomplishment. Some researchers refer to stress associated with positive events as eustress.

Acute stress is defined as a reaction to something perceived as an immediate threat. Acute stress reactions can occur to a falsely perceived danger as well as to a genuine threat; they can also occur in response to memories. For example, a war veteran who hears a car backfire may drop to the ground because the noise triggers vivid memories, called flashbacks, of combat experience. Common acute stressors include loud, sudden noises being in a crowded space such as an elevator, being cut off in heavy traffic; and dangerous weather. Chronic stress is a reaction to a situation that is stressful but ongoing, such as financial worries or caring for an elderly parent. Modern life is stressful because changes in various areas of life have increased the number of acute and chronic stressors in most people's lives at the same time that they have weakened certain buffers or protections against stress.

Social changes

Social changes that have increased the stress level of modern life include increased population mobility and the sprawling size of modern cities. It is not unusual for adults to live hundreds of miles away from parents and siblings; and it is hard to make and keep friendships when people move every few years. In most large cities, many people live in apartment buildings where they do not know their neighbors. Social isolation and loneliness can produce chronic stress. A study done in Norway between 1987 and 1993 found that social support networks made a significant difference in lowering the impact of both acute and chronic stress on mental health.

Social scientists have observed that the increased isolation of married couples from extended families and friendship networks increases strains on the marriage. The rising divorce rate in the United States has been attributed in part to the loss of social supports that once helped to keep married couples together. The experience of divorce then adds to the stress level on the former spouses and the children, if any. A long-term study at the University of Pittsburgh has found that divorce is associated with a higher rate of premature death in men.

Economic changes

The rapid pace of change in manufacturing and other businesses means that few people will work at the same job for their entire career. In addition, corporate mergers and downsizing have weakened job security, thus producing chronic anxiety about unemployment in the minds of many employees. Many people work two jobs in order to make ends meet; and even those who work only one job often have to commute by car or train to their workplace. In many large American cities, traffic jams, cost of gasoline, and other problems related to commuting are a major factor in job-related stress. Another stress factor is sleep deprivation. Many people get only six or less hours of sleep each night even though the National Sleep Foundation estimates that most adults need 88-1/2 hours per night for good health. Fatigue due to sleep deprivation causes additional stress.

Lastly, economic trends have produced a "winner-take-all" economy in which the gap between the well-off and the average family is constantly widening. Socioeconomic status (SES) affects health in a number of ways. Persons of higher SES can afford better health care, are less likely to suffer from exposure to environmental toxins, and generally lead healthier lifestyles. In addition, chronic stress associated with low SES appears to increase morbidity and mortality among persons in these income groups.

Technological changes

Technology has proved to be a source of stress as well as a solution to some kinds of stress. Machines that help workers to be more productive also make their jobs more complicated and raise the level of demands on them. An office clerk in 2002 can produce many more letters per day than one in 1952, but is often expected to produce more elaborate, professional-looking documents as well as a higher number of them.

One specific technological development that has been singled out as a major stressor in modern life is the evolution of news reporting. For most of human history, people had to wait several days or even weeks to hear about the outcome of an election, a battle, or some other important event. Moreover, they usually heard only the news that affected their region or their country. Today, however, news is reported as soon as it happens, it is broadcast 24 hours a day, and it covers events around the world. This "communications overload," as it has been termed, is a source of genuine stress to many people, particularly when the newscast emphasizes upsetting or frightening events. It is not surprising that a common recommendation for lowering one's stress level is to cut down on watching television news programs. A team of physicians conducted telephone interviews following the events of September 11, 2001, in order to assess stress reactions in the general American population. The team found that the single most important factor was not geographical location relative to the attacks or educational level, but the amount of time spent watching televised reports of the attacks. The interviewers discovered that 49% of the adults had watched at least eight hours of television on September 11, and also that "extensive television viewing was associated with a substantial stress reaction."

Environmental changes

One significant source of stress in modern life is the cumulative effect of various toxic waste products on the environment. Studies of the aftermath of such environmental disasters as Three Mile Island and Chernobyl found that not only evacuees and people living in the contaminated area had high levels of emotional distress, but also cleanup workers and people living in nearby noncontaminated areas. In the case of Chernobyl, Russian physicians have reported a psychoneurological syndrome with several unexplained symptoms, including fatigue, impaired memory, muscle or joint pain, and sleep disturbances. The syndrome appears to be due to chronic emotional stress rather than radiation exposure.

Changes in beliefs and attitudes

Changes in beliefs that influence stress levels include the contemporary emphasis on individualism and a corresponding change in attitudes toward trauma. A number of observers have remarked that Western culture has moved away from its traditional high valuation of the family and community toward an increased focus on the individual. Some have called this trend the "Me First!" societyit emphasizes personal rights and entitlements rather than duties and responsibilities to others. It has, in the view of some physicians, encouraged people to dwell on trauma and its effects on them as individuals rather than to live up to more traditional ideals of composure and resilience in the face of distress.

Risk factors

Research indicates that some categories of people have a higher risk of stress-related illnesses and disorders:

  • Children have very little control over their environments. In addition, they are often unable to communicate their feelings accurately.
  • In elderly adults, aging appears to affect the body's response to stress, so that the relaxation response following a stressful event is slower and less complete. In addition, the elderly are often affected by such major stressors as health problems, the death of a spouse or close friends, and financial worries.
  • Caregivers of mentally or physically disabled family members.
  • Women in general.
  • People with less education.
  • People who belong to racial or ethnic groups that suffer discrimination.
  • People who live in cities.
  • People who are anger-prone. Chronic anger is associated with narrowing of the arteries, a factor in heart disease.
  • People who lack family or friends.
  • People who are biologically predisposed to an inadequate relaxation response.

Coping with stress

Coping is defined as a person's patterns of response to stress. Many clinicians think that differences in attitudes toward and approaches to stressful events are the single most important factor in assessing a person's vulnerability to stress-related illnesses. A person's ability to cope with stress depends in part on his or her interpretation of the event. One person may regard a stressful event as a challenge that can be surmounted while another views it as a problem with no solution. The person's resources, previous physical and psychological health, and previous life experience affect interpretation of the event. Someone who has had good experiences of overcoming hardships is more likely to develop a positive interpretation of stressful events than someone who has been repeatedly beaten down by abuse and later traumas.

Coping styles

The ways in which people cope with stress can be categorized according to two different sets of distinctions. One is the distinction between emotion-focused and problem-focused styles of coping, which was described earlier in connection with substance abuse. Problem-focused coping is believed to lower the impact of stress on health; people who use problem-focused coping have fewer illnesses, are less likely to become emotionally exhausted, and report higher levels of satisfaction in their work and feelings of personal accomplishment. Emotion-focused coping, on the other hand, is associated with higher levels of interpersonal problems, depression, and social isolation. Although some studies reported that men are more likely to use problem-focused coping and women to use emotion-focused coping, other research done in the last decade has found no significant gender differences in coping styles.

The second set of categories distinguishes between control-related and escape-related coping styles. Control-related coping styles include direct action, behavior that can be done alone; help-seeking, behavior that involves social support; and positive thinking, a cognitive style that involves giving oneself pep talks. Escape-related coping styles include avoidance/resignation, as in distancing oneself from the stressful event, and alcohol use. There appears to be no relationship between gender and a preference for control-related or escape-related coping.

Stress management

Stress management refers to a set of programs or techniques intended to help people deal more effectively with stress. Many of these programs are oriented toward job- or workplace-related stress in that burnout is a frequent result of long-term occupational stress. Most stress management programs ask participants to analyze or identify the specific aspects of their job that they find stressful, and then plan a course of positive action to minimize the stress. In general, the severity of job-related stress appears to be related to two factors: the magnitude of the demands being made on the worker, and the degree of control that she or he has in dealing with the demands. The workers who are most vulnerable to stress-related heart disease are those who are subjected to high demands but have little control over the way they do their job. In many cases, stress management recommendations include giving an employee more decision-making power.

Treatments for stress

There are a number of allopathic and alternative/complementary treatments that are effective in relieving the symptoms of stress-related disorders:

  • Medications may include drugs to control anxiety and depression as well as drugs that treat such physical symptoms of stress as indigestion or high blood pressure.
  • Psychotherapy, including insight-oriented and cognitive/behavioral approaches, is effective in helping people understand how they learned to overreact to stressors, and in helping them reframe their perceptions and interpretations of stressful events. Anger management techniques are recommended for people who have stress-related symptoms due to chronic anger.
  • Relaxation techniques, anxiety reduction techniques , breathing exercises, yoga , and other physical exercise programs that improve the body's relaxation response.
  • Therapeutic massage, hydrotherapy, and bodywork are forms of treatment that are particularly helpful for people who tend to carry stress in their muscles and joints.
  • Aromatherapy , pet therapy, humor therapy, music therapy, and other approaches that emphasize sensory pleasure are suggested for severely stressed people who lose their capacity to enjoy life; sensory-based therapies can counteract this tendency.
  • Naturopathic recommendations regarding diet, exercise, and adequate sleep, and the holistic approach of naturopathic medicine can help persons with stress-related disorders to recognize and activate the body's own capacities for self-healing.



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"Psychosomatic Medicine (Biopsychosocial Medicine)." Section 15, Chapter 185 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2000.

Selye, Hans. The Stress of Life. Revised edition. New York: McGraw-Hill Book Company, Inc., 1976.


Adler, N. E., and K. Newman. "Socioeconomic Disparities in Health: Pathways and Policies. Inequality in Education, Income, and Occupation Exacerbates the Gaps Between the Health 'Haves' and 'Have-Nots.'" Health Affairs (Millwood) 21 (March-April 2002): 60-76.

Evans, O., and A. Steptoe. "The Contribution of Gender-Role Orientation, Work Factors and Home Stressors to Psychological Well-Being and Sickness Absence in Male- and Female-Dominated Occupational Groups." Social Science in Medicine 54 (February 2002): 481-492.

Levenstein, Susan. "Stress and Peptic Ulcer: Life Beyond Helicobacter." British Medical Journal 316 (February 1998): 538-541.

Lombroso, Paul J. "Stress and Brain Development, Part 1." Journal of the American Academy of Child and Adolescent Psychiatry 37 (December 1998).

McEwen, Bruce. "Stress and Brain Development, Part 2." Journal of the American Academy of Child and Adolescent Psychiatry 38 (January 1999).

Matthews, K. A., and B. B. Gump. "Chronic Work Stress and Marital Dissolution Increase Risk of Posttrial Mortality in Men from the Multiple Risk Factor Intervention Trial." Archives of Internal Medicine 162 (February 2002): 309-315.

Mayer, Merry. "Breaking Point (Job Stress and Problem Employees)." HR Magazine 46 (October 2001): 79-85.

Olstad, R., H. Sexton, and A. J. Sogaard. "The Finnmark Study: A Prospective Population Study of the Social Support Buffer Hypothesis, Specific Stressors and Mental Distress." Social Psychiatry and Psychiatric Epidemiology 36 (December 2001): 582-589.

Pastel, R. H. "Radiophobia: Long-Term Psychological Consequences of Chernobyl." Military Medicine 167 (February 2002): 134-136.

Schuster, Mark A., Bradley D. Stein, Lisa H. Jaycox, and others. "A National Survey of Stress Reactions After the September 11, 2001, Terrorist Attacks." New England Journal of Medicine 345 (November 15, 2001): 1507-1512.

Summerfield, Derek. "The Invention of Post-Traumatic Stress Disorder and the Social Usefulness of a Psychiatric Category." British Medical Journal 322 (January 13,2001): 95-98.

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The American Institute of Stress. 124 Park Avenue, Yonkers, NY 10703. (914) 963-1200. Fax: (914) 965-6267. <>.

Anxiety Disorders Association of America. 11900 Parklawn Drive, Suite 100, Rockville, MD 20852-2624. (301) 231-9350. <>.

Stress and Anxiety Research Society (STAR). <>.

See also Creative therapies; Diets; Nutrition and mental health

Rebecca J. Frey, Ph.D.

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Workplace Violence

As the pace at which our society operates increases, the pressures for every member of society to keep up with this pace also increase. Many of these pressures affect people through their jobs. Stress has become the buzzword that many people use to describe the impact that these

pressures cause. In the short-term, stress can enable individuals to meet high levels of demand or pending deadlines. Prolonged stress, however, has been shown to cause illness and other conditions that can have detrimental effects on an employer's workforce.


Leon Warshaw noted in his 1979 book on dealing with stress in the workplace: Stress affects personality, modifying our perceptions, feelings, attitudes and behavior. And it reaches beyond its immediate victims to affect the political, social and work organizations whose activities they direct and carry out. In other words, the increasing rate of stress at work has wide-ranging effectsabsenteeism, impaired teamwork, workplace violence, decreased efficiency, increased rates of physical and mental illness, employee burnout, risk of discrimination, and growth in early retirement.

This phenomenon has only increased in intensity and societal concern over the past three decades. The American Psychological Association (APA) reported in October 2007 that one-third of Americans are living with extreme stress; work was the most commonly cited source of stress at 74 percent, a drastic increase from 59 percent the previous year. It has been widely noted that workplace stress can exact a high toll on businesses. A 2007 report by the British Health and Safety Commission concluded that in 2006, work-related stress had cost Great Britain over of £530 million.

In his 2004 article Workplace Stress Sucks $300 Billion Annually from Corporate Profits, Ron Ball cites a recent study by Ravi Tangi that establishes a formula for measuring the hard costs of stress on business as whole. This formula quantified stress as causing the following:

  • 19 percent of absenteeism
  • 40 percent of turnover
  • 55 percent of employee assistance programs
  • 30 percent of short- and long-term disability
  • 10 percent of drug plan costs
  • 60 percent of total workplace accidents

There are many factors that contribute to making a workplace stressful. Research clearly indicates that certain jobs are more stressful than others. For example, people who work as police officers, fire fighters, air traffic controllers, and elected officials are exposed to higher levels of stress than people who work as janitors, florists, medical records technicians, forklift operators, librarians, and musical instrument repairers. The factors that contribute to making some jobs more stressful include: level of decision making required; level of monitoring workers must endure; unpleasant or dangerous physical or emotional conditions; repeated exchange of information with

others; and whether job tasks are generally structured or unstructured.

Understanding the factors that contribute to creating stress in the workplace can help employers begin to manage stress among the workforce. The rest of this section will describe some of the detrimental effects of stress on the workplace and offer potential solutions for employers to minimize the potential harm to employees and to the work environment as a whole.


In increasing numbers, employees are calling in sick when they are really suffering from stress. A 2005 survey reported in the Silicon Valley/San Jose Business Journal found that only 38 percent of the employees who called in sick were actually suffering from a physical illness. The other 62 percent of these workers who failed to show up were dealing with stress, family issues, morale issues, motivational issues, etc. These results indicate a need for employers to implement some type of absence control measures.

Research from a wide range of organizations from around the world indicates that about 5 percent of the workforce accounts for about one-third of the absences, or lost days of work. This same research indicates that younger workers often have more absence patterns than older workers. Also, workers with the best attendance records are not always the healthiest or most fit employees. In many instances, the workers with poor attendance records demonstrate poor irregular attendance problems at previous jobs, and within the first six months of any new job. Therefore, employers must take note of attendance patterns of prospective workers (when available) and pay close attention to attendance issues during probationary periods for new hires. Second, employers must set clear rules for attendance at work and identify disciplinary rules that will be enforced if workers fail to comply with the attendance rules. Supervisors must be adequately trained to set these rules and enforce them for the employer. Further, the employer could examine monthly or quarterly budget reports that review the absenteeism statistics for each department of the company. If there is one department that seems to be experiencing higher-than-normal rates of absenteeism, it could be indicative of stress or morale problems that the employer may need to address.


Traditional research has taught us that teamwork in the workplace is generally desirable and tends to produce positive results. It is important to note, however, that many workplace teams fail to produce positive results because people often prefer to work with other people who are similar to them. These teams are often comprised of workers who come from diverse backgrounds, and they bring their own biases and cultural perceptions to the team dynamic. On some teams, this diversity can add richness and depth, and on other teams, this diversity facilitates the creation of barriers between team members. Employers can avoid breakdowns in teams by assigning manageable tasks to teams and setting reasonable deadlines for completion of these tasks. Also, employers should clearly define the charge and expectations for the team project and how it should undertake its mission. The less time teams have to get mired down in harmful in-fighting, the greater the chance of success.

Workplace Violence

The following scenario is becoming increasingly typical: In December 2000, Michael McDermott, a software engineer at Edgewater Technology, selects and shoots co-workers in his Wakefield, Massachusetts, office. Seven people die. Employers at the Internet solution provider had recently told McDermott that wages would be garnished from his paycheck to pay the IRS for back taxes.

Because of their increasing frequency, violent acts are now considered a major workplace safety and health threat. A 1999 study by Yale University's School of Management, which surveyed workers throughout the country asked, How often are you angry at work? and more than 20 percent of respondents answered, All the time. That seed of dissatisfaction often grows as time passes. The Occupational Safety and Health Administration estimates that two million workers are victims of violent workplace acts each year. Additionally, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries reported that the U.S. had 564 workplace homicides in 2005, making homicide the fourth-leading cause of workplace fatalities. Such alarming statistics led many organizations to initiate programs aimed at reducing workplace violence. To a certain extent, these programs have succeeded. The BLS reported in 2006 that work-place homicides had decreased 9 percent to 516 and that the 2006 figure was the lowest annual homicide total reported since the BLS began keeping count in 1992.

Organizational interventions aimed at preventing workplace violence satisfy employers' moral and ethical obligations to provide their employees with safe work environments. Moreover, such interventions also help companies reduce their costs and comply with the law. Workplace violence can cost employers large sums of money. Employers must pay for victims' medical and psychiatric care, repairs and clean-up, insurance rate hikes, and increased security measures. Additional costs are incurred as the result of absenteeism, as the average victim misses 3.5 days of work following an incident.

Employers must also be concerned about workplace violence for legal reasons. The General Duty Clause of the Occupational Safety and Health Act states that employers can be cited for a violation if there is a recognized danger of workplace violence in their establishment, and they do nothing to prevent it. In addition to being fined by OSHA, employers can also be sued by victims of violence. The legal test for determining employer liability for violent acts committed by non-employees is as follows. The employer is liable if:

  • It knew or should have known that a criminal act was probable (e.g., it was warned about threats made to an employee).
  • It could have reasonably protected the employee from criminal assault, but failed to do so.
  • Its failure to protect the employee caused the subsequent injuries to occur (in other words, had the employer done its part, the injury would not have happened).

A similar legal test is used to determine employer liability for violent acts committed by employees. An employer is liable for negligent hiring if it knew or should have known of the applicant's violent tendencies, yet decided to hire that person anyway. In a similar vein, successful negligent retention suits can be filed when an employer retains a current employee despite knowledge of violent tendencies. Employers are liable in these situations if they had (or should have had) information signaling the danger of future violent acts, yet ignored this danger.

So what can a company do to minimize the occur-rences of violent acts? In 2002, OSHA issued a set of guidelines listing some of the security measures that can be implemented to reduce the threat of violence. These measures include:

  • Provide improved lighting and employee escort services to and from parking lots.
  • Ensure reception areas can be locked when no one is on duty.
  • Create a policy stipulating that there are always at least two people on duty.
  • Provide security systems, such as electronic access control systems, silent alarms, metal detectors, and video cameras.
  • Establish policies regarding visitor access (sign-in, identification badges).
  • Equip field staff with cellular phones.
  • Install curved mirrors at hallway intersections or concealed areas as well as bullet-proof glass.
  • Provide safety education for employees, so they know what conduct is unacceptable and what to do if they witness or are subjected to workplace violence.
  • Provide drop safes to limit the amount of cash on hand.
  • Instruct employees not to enter any location where they feel unsafe.

An employer should consider these measures in light of the level of risk at a particular worksite. For example, metal detectors and bullet-proof glass would be appropriate for inner-city emergency departments, abortion clinics, and psychiatric facilities where violence is highest. In addition to implementing OSHA recommendations, an

employer can further minimize violent acts through the use of pre-employment screening, strict anti-violence and anti-drug/alcohol policies, and training. All workers should be taught how to recognize early signs of a troubled or potentially violent person and how to respond to such persons. Managers should be further trained on how to properly handle terminations since such acts often trigger violence.


Excessive amounts of stress can have debilitating health effects, such as ulcers, colitis, hypertension, headaches, lower back pain, carpal tunnel syndrome, and cardiac conditions. Stressed workers may perform poorly, quit their jobs, suffer low morale, generate conflicts among coworkers, miss work, or exhibit indifference toward coworkers and customers. These stress-induced outcomes now cost U.S. businesses somewhere between $200 and $500 billion per year.

Stress can sometimes cause workers to turn to drugs and alcohol. The use of drugs and alcohol is pervasive in the United States. For instance, nearly 10 percent of all full-time employees use illicit drugs (primarily marijuana and cocaine), and another 10 percent are alcoholics. An increasing number of U.S. workers are taking some type of stimulantbeyond caffeine. A 1999 Drug Enforcement Agency survey estimated that at least 15 percent of U.S. adults had tried methamphetamines. Substance abuse costs U.S. employers an estimated $75 billion a year in terms of lost productivity, accidents, workers' compensation, health insurance claims, and theft of company property.

While most organizations are taking steps to keep their workplaces drug-free voluntarily, government contractors are required to take such steps. The 1988 Drug-Free Workplace Act states that government contractors must ensure a drug-free workplace by notifying employees about the following:

  • The dangers of drug abuse in the workplace
  • Its policy of maintaining a drug-free workplace
  • Any available drug counseling, rehabilitation, and employee assistance programs
  • The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace

Employers can combat substance abuse at the work-place by screening out applicants and discharging employees who have been identified as substance abusers. Substance abuse is most commonly detected through urine and blood tests. About two-thirds of all corporations presently require drug testing of current or future employees. Supervisors can also detect substance abuse by observing their employees' behavior. Some of the symptoms to look for are mood swings, slurred speech, flushed cheeks, frequent absences on Mondays and Fridays, missing deadlines, and overreacting to criticism.

Detecting substance abuse early can be quite useful to a company, as illustrated by the findings of a U.S. Postal Service study. The Postal Service tested 5,465 applicants for drugs, but did not use these results in hiring decisions. About 4,000 of these applicants were eventually hired. In a three-year follow-up, employees who tested positive had a 66 percent higher absenteeism rate and a 77 percent greater termination rate than those testing negative. The Postal Service now estimates that had it not hired the drug-positive group, it could have saved $150 million in absenteeism, rehiring, retraining, and injury compensation costs.

When dealing with current employees with drug problems, some employers take a rehabilitative approach: they help abusers overcome their problem through remedial counseling. Employee assistance programs (EAPs) employ mental health professionals (usually on a contract basis) to provide services to workers who are experiencing substance abuse or other personal problems. For example, the EAP at the Chase Manhattan Bank helps employees resolve problems of drug or alcohol abuse, child care, elder care, marital or family relationship concerns, emotional distress, anxiety, depression, or financial difficulties. Employees may seek help on a voluntary, confidential basis, or may be referred by a supervisor who suspects that the employee's declining job performance is being caused by personal problems.

Many companies currently use EAPs. The potential payoff of an EAP is evidenced by a study that found that every dollar spent on an EAP returned an estimated $3 to $5 in lower absenteeism and greater productivity.

Employers must develop written substance abuse policies that specify their approach to handling these problems. The policy should specify the prohibited behaviors and note the consequences employees will face if they break the rules. Such policies serve two purposes: (1) to act as a deterrent and (2) to establish a sound legal basis for taking punitive action (e.g., suspension or discharge).


Employee wellness is a relatively new human resource management focus that seeks to eliminate certain debilitating health problems (e.g., cancer, heart disease, respiratory problems, hypertension) that can be caused by a person's poor lifestyle choices (e.g., smoking, poor nutrition, lack of exercise, obesity). Such health problems have become quite prevalent: cancer, heart, and respiratory

illnesses alone account for 61 percent of all hospital claims. These ailments can cause workplace problems such as absenteeism, turnover, lost productivity, and increased medical costs. For instance, people who have high blood pressure are 70 percent more likely than others to have medical claims of more than $5,750 per year, and the cost of medical claims for smokers is 22 percent higher than it is for nonsmokers.

Many organizations attempt to help employees improve or maintain their overall health by offering them employee wellness programs. Such programs provide employees with physical fitness facilities, on-site health screening, and programs to help them quit smoking, manage stress, and improve nutritional habits. Employee wellness programs can be quite effective. Research indicates that participation in a wellness program reduces both absenteeism and turnover, and increases productivity. A study conducted at Mesa Petroleum, for example, found that the productivity difference between participants and non-participants amounted to $700,000 in the first year, and $1.3 million in the second year.

If they are to work, wellness programs must successfully enlist high-risk individualsthose in greatest need of the program. Unfortunately, most employees who participate in wellness programs are those who fall into a low-risk category. Because at-risk individuals do not seek help, many employee wellness programs fail to meet their objectives. Employers must, then, find some way to motivate high-risk individuals to participate. Some companies offer positive inducements (e.g., cash bonuses) to individuals who participate; other companies focus their efforts on non-participants by imposing certain penalties. For example, they may increase insurance premium contributions of non-participants or raise their deductible levels.

Companies can help eliminate, or at least minimize, job stress. A firm can eliminate many sources of employee stress by implementing effective HRM practices. For instance, the implementation of effective selection and training procedures can help ensure that workers are properly suited to the demands of their jobs. Providing clearly written job descriptions can reduce worker uncertainty regarding job responsibilities. The use of effective performance appraisal systems can relieve stress by clarifying performance expectations. And the implementation of effective pay-for-performance programs can relieve stress by reducing worker uncertainty regarding rewards.

Unfortunately, companies cannot always eliminate all sources of job stress; some stress may be inherent in the job. For instance, some jobs are dangerous (e.g., logging, police work, firefighting), and some place the worker in demanding interpersonal situations (e.g., customer relations specialists). When job stresses cannot be relieved, the worker must learn to cope with them. A firm can help by offering employees stress counseling or by providing them the opportunity to work off their stress through physical exercise. Some of the organizational interventions described earlier, such as the use of EAPs and wellness programs, can be helpful in this regard.

SEE ALSO Employee Assistance Programs; Human Resource Management


Asworth, Susan. Low Morale, Other Issues Push Absences to Five-Year High. Silicon Valley/San Jose Business Journal, 4 March 2005.

Ball, Ron. Workplace Stress Sucks $300 Billion Annually From Corporate Profits. Customer Inter@ction Solutions 23, no. 5 (November 2004): 62.

Barling, Julian, E. Kevin Kalloway, and Michael Robert Frone. Handbook of Work Stress. Thousand Oaks, CA: Sage Publications, 2005.

Cooper, Cary L., and Roy Payne. Stress at Work. John Wiley & Sons, 1978.

Frost, Peter J., Walter R. Nord, and Linda A. Krefting. HRM Reality: Putting Competence in Context. Prentice Hall, Upper Saddle River, New Jersey, 2002.

Gunch, D. Employees Exercise to Prevent Injuries. Personnel Journal, July 1993, 5862.

Health and Safety Commission. Workplace stress costs Great Britain in excess of £530 million. Available from:

Jex, Steve M. Stress and Job Performance: Theory, Research and Implications for Managerial Practice. SAGE Publications, 1998.

Kleiman, L.S. Human Resource Management: A Tool for Competitive Advantage. 4th ed. Cincinnati: South-Western College Publishing, 2006.

Newell, Sue. Creating the Healthy Organization: Well-Being, Diversity and Ethics at Work. Thomson Learning, Cincinnati, 2002.

U.S. Occupational Safety and Health Administration. Workplace Violence. Available from:

Warshaw, Leon J. Managing Stress: Addison-Wesley Series on Occupational Stress. Reading, MA: 1979.

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Stress is an individual's physical and mental reaction to environmental demands or pressures.


When stress was first studied, the term was used to denote both the causes and the experienced effects of these pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. Is it primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both?

Stress was first studied in 1896 by Walter B. Cannon (18711945). Cannon used an x-ray instrument called a fluoroscope to study the digestive system of dogs. He noticed that the digestive process stopped when the dogs were under stress. Stress triggers adrenal hormones in the body and the hormones become unbalanced. Based on these findings, Cannon continued his experimentation and came up with the term homeostasis, a state of equilibrium in the body.

Hans Selye, a Canadian scientist (19071982), noticed that people who suffered from chronic illness or disease showed some of the same symptoms. Selye related this to stress and he began to test his hypothesis. He exposed rats to different physical stress factors such as heat, sound, poison, and shock. The rats showed enlarged glands, shrunken thymus glands and lymph nodes, and gastric ulcers. Selye then developed the Three Stage Model of Stress Response. This model consisted of alarm, resistance, and exhaustion. Selye also showed that stress is mediated by cortisol, a hormone that is released

Death of spouse
Marital separation
Jail term or death of close family member
Personal injury or illness
Loss of job due to termination
Marital reconciliation or retirement
Change in financial state

from the adrenal cortex. This increases the amount of glucose in the body while under stress.

Stress in humans results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health.

Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others.

Causes & symptoms


The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organism's response to the inevitable changes in its physical or social environment, and that positive as well as negative events can generate stress. Stress-related disease, however, results from excessive and prolonged demands on an organism's coping resources. It is now believed that 8090% of all disease is stress-related.

Recent research indicates that some vulnerability to stress is genetic. Scientists at the University of Wisconsin and King's College, London, discovered that people who inherited a short, or stress-sensitive, version of the serotonin transporter gene were almost three times as likely to experience depression following a stressful event as people with the long version of the gene. Further research is likely to identify other genes that affect susceptibility to stress.

One cause of stress that has affected large sectors of the general population around the world since 2001 is terrorism. The events of September 11, 2001, the sniper shootings in Virginia and Maryland, the Bali nightclub bombing in 2002, and the suicide bombings in the Middle East in 2003 have all been shown to cause short-term symptoms of stress in people who read about them or watch television news reports as well as those who witnessed the actual events. Stress related to terrorist attacks also appears to affect people in countries far from the location of the attack as well as those in the immediate vicinity. It is too soon to tell how stress related to episodes of terrorism will affect human health over long periods of time, but researchers are already beginning to investigate this question.


The symptoms of stress can be either physical and/or psychological. Stress-related physical illnesses, such as irritable bowel syndrome , heart attacks, and chronic headaches, result from long-term overstimulation of a part of the nervous system that regulates the heart rate, blood pressure, and digestive system. Stress-related emotional illness results from inadequate or inappropriate responses to major changes in one's life situation, such as marriage, completing one's education, the death of a loved one, divorce, becoming a parent, losing a job, or retirement. Psychiatrists sometimes use the term adjustment disorder to describe this type of illness. In the workplace, stress-related illness often takes the form of burnouta loss of interest in or ability to perform one's job due to long-term high stress levels.


When the doctor suspects that a patient's illness is connected to stress, he or she will take a careful history that includes stressors in the patient's life (family or employment problems, other illnesses, etc.). Many physicians will evaluate the patient's personality as well, in order to assess his or her coping resources and emotional response patterns. There are a number of personality inventories and psychological tests that doctors can use to help diagnose the amount of stress that the patient experiences and the coping strategies that he or she uses to deal with them. Stress-related illness can be diagnosed by primary care doctors as well as by those who specialize in psychiatry. The doctor will need to distinguish between adjustment disorders and anxiety or mood disorders, and between psychiatric disorders and physical illnesses (e.g. thyroid activity) that have psychological side effects.


Relaxation training, yoga, t'ai chi , and dance therapy help patients relieve physical and mental symptoms of stress. Hydrotherapy, massage therapy , and aromatherapy are useful to some anxious patients because they can promote general relaxation of the nervous system. Essential oils of lavender, chamomile , neroli, sweet marjoram, and ylang-ylang are commonly recommended by aromatherapists for stress relief.

Meditation can also be a useful tool for controlling stress. Guided imagery , in which an individual is taught to visualize a pleasing and calming mental image in order to counteract feelings of stress, is also helpful. Many individuals may find activities such as exercise , art, music, and writing useful in reducing stress and promoting relaxation.

Sometimes the best therapy for alleviating stress is a family member or friend who will listen. Talking about stressful situations and events can help an individual work through his or her problems and consequently reduce the level of stress related to them. Having a social support network to turn to in times of trouble is critical to everyone's mental and physical well-being. Pet therapy has also been reported to relieve stress.

Herbs known as adaptogens may also be prescribed by herbalists or holistic healthcare providers to alleviate stress. These herbs are thought to promote adaptability to stress, and include Siberian ginseng (Eleutherococcus senticosus ), ginseng (Panax ginseng ), wild yam (Dioscorea villosa ), borage (Borago officinalis ), licorice (Glycyrrhiza glabra ), chamomile (Chamaemelum nobile ), milk thistle (Silybum marianum ), and nettle (Urtica dioica ).

Practitioners of Ayurvedic, or traditional Indian, medicine might prescribe root of winter cherry, fruit of emblic myrobalan, or the traditional formulas geriforte or mentat to reduce stress and fix the imbalance in the vata dosha.

It is also said that stress reduces the body's immune response, therefore vitamin supplementation can be helpful in counteracting the depletion. Diet is also importantcoffee and other caffeinated beverages in high doses produce jitteriness, restlessness, anxiety, and insomnia . High-protein foods from animal sources elevate brain levels of dopamine and norepinephrine, which are associated with higher levels of anxiety and stress. Whole grains promote production of the brain neuro-transmitter serotonin for a greater sense of well-being.

Allopathic treatment

Recent advances in the understanding of the many complex connections between the human mind and body have produced a variety of mainstream approaches to stress-related illness. Present treatment regimens may include one or more of the following:

  • Medications. These may include drugs to control blood pressure or other physical symptoms of stress as well as drugs that affect the patient's mood (tranquilizers or antidepressants).
  • Stress management programs. These may be either individual or group treatments, and usually involve analysis of the stressors in the patient's life. They often focus on job- or workplace-related stress. A number of studies have found that good stress management programs significantly reduce absenteeism from work and visits to the doctor. They also improve immune system function and overall well-being in patients with such chronic disorders as HIV infection and diabetes.
  • Behavioral approaches. These strategies include relaxation techniques, breathing exercises, and physical exercise programs including walking.
  • Biofeedback . Biofeedback is a technique in which patients are taught to interpret and respond to signals from their own bodies. It can be taught by doctors, dentists, nurses, and physical therapists as well as by psychologists or psychiatrists. Biofeedback is often recommended as a treatment for chronic tension-type headaches.
  • Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs. It is particularly helpful for people who tend to convert stress into muscle tension.
  • Cognitive therapy. These approaches teach patients to reframe or mentally reinterpret the stressors in their lives in order to modify the body's physical reactions.

Expected results

The prognosis for recovery from a stress-related illness is related to a wide variety of factors in a person's life, many of which are genetically determined (race, sex, illnesses that run in families) or beyond the individual's control (economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress and change their experiences of it. A person's ability to remain healthy in stressful situations is sometimes referred to as stress hardiness. Stress-hardy people have a cluster of personality traits that strengthen their ability to cope. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life's changes as positive opportunities rather than as threats.


Complete prevention of stress is neither possible nor desirable because stress is an important stimulus of human growth and creativity, as well as an inevitable part of life. In addition, specific strategies for stress prevention vary widely from person to person, depending on the nature and number of the stressors in an individual's life, and the amount of control he or she has over these factors. In general, however, a combination of attitudinal and behavioral changes work well for most patients. The best form of prevention appears to be parental modeling of healthy attitudes and behaviors within the family.



Clark, R. Barkley. "Psychosocial Aspects of Pediatrics and Psychiatric Disorders." Current Pediatric Diagnosis &Treatment. Edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.

Eisendrath, Stuart J. "Psychiatric Disorders." Current Medical Diagnosis & Treatment. Edited by Lawrence M. Tierney, Jr., Stephen J. McPhee, and Maxine A. Papadakis. Stamford, CT: Appleton &Lange, 1997.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I, "Spirituality and Healing." New York: Simon & Schuster, 2002.

"Psychiatry in Medicine." Section 15, Chapter 185 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Selye, Hans, MD. The Stress of Life. New York, Toronto, and London: McGraw-Hill Book Company, 1956.


Antoni, M. H., D. G. Cruess, N. Klimas, et al. "Stress Management and Immune System Reconstitution in Symptomatic HIV-Infected Gay Men Over Time: Effects on Transitional Naive T Cells (CD4(+)CD45RA(+)CD29(+))." American Journal of Psychiatry 159 (January 2002): 143-145.

Blumenthal, J. A., M. Babyak, J. Wei, et al. "Usefulness of Psychosocial Treatment of Mental Stress-Induced Myocardial Ischemia in Men." American Journal of Cardiology 89 (January 15, 2002): 164-168.

Cardenas, J., K. Williams, J. P. Wilson, et al. "PSTD, Major Depressive Symptoms, and Substance Abuse Following September 11, 2001, in a Midwestern University Population" International Journal of Emergency Mental Health 5 (Winter 2003): 1528.

Gallo, L. C., and K. A. Matthews. "Understanding the Association Between Socioeconomic Status and Physical Health: Do Negative Emotions Play a Role?" Psychological Bulletin 129 (January 2003): 1051.

Hawkley, L. C., and J. T. Cacioppo. "Loneliness and Pathways to Disease." Brain, Behavior, and Immunity 17 (February 2003) (Supplement 1): S98S105.

Latkin, C. A., and A. D. Curry. "Stressful Neighborhoods and Depression: A Prospective Study of the Impact of Neighborhood Disorder." Journal of Health and Social Behavior 44 (March 2003): 3444.

Ottenstein, R. J. "Coping with Threats of Terrorism: A Protocol for Group Intervention." International Journal of Emergency Mental Health 5 (Winter 2003): 3942.

Rahe, R. H., C. B. Taylor, R. L. Tolles, et al. "A Novel Stress and Coping Workplace Program Reduces Illness and Healthcare Utilization." Psychosomatic Medicine 64 (March-April 2002): 278-286.

Solomon, G. D. "Chronic Tension-Type Headache: Advice for the Viselike-Headache Patient." Cleveland Clinic Journal of Medicine 69 (February 2002): 173-174.

Surwit, R. S., M. A. van Tilburg, N. Zucker, et al. "Stress Management Improves Long-Term Glycemic Control in Type 2 Diabetes." Diabetes Care 25 (January 2002): 30-34.

West, P., and H. Sweeting. "Fifteen, Female and Stressed: Changing Patterns of Psychological Distress Over Time." Journal of Child Psychology and Psychiatry 44 (March 2003): 399411.


The American Institute of Stress. 124 Park Avenue, Yonkers, NY 10703 (914) 963-1200. Fax: (914) 965-6267. <>.

National Institute of Mental Health (NIMH). 6001 Execut Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. <>.

Stress and Anxiety Research Society (STAR). STAR is an international multidisciplinary organization of researchers that began in the Netherlands in 1980. <>.


National Center for Post-Traumatic Stress Disorder, Department of Veterans Affairs. Fact Sheet: Survivors of Human-Caused and Natural Disasters. <>.

National Institute of Mental Health (NIMH) news release, July 17, 2003. "Gene More Than Doubles Risk of Depression Following Life Stresses." <>.

Paula Ford-Martin

Rebecca J. Frey, PhD

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"Stress." Gale Encyclopedia of Alternative Medicine. . 19 Jan. 2018 <>.

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Stress is defined as an organism's total response to environmental demands or pressures. When stress was first studied in the 1950s, the term was used to denote both the causes and the experienced effects of these pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. Is it primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both?


Stress in humans results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health.

Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others.

Causes and symptoms


The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organism's response to the inevitable changes in its physical or social environment, and that positive, as well as negative, events can generate stress as well as negative occurrences. Stress-related disease, however, results from excessive and prolonged demands on an organism's coping resources. It is now believed that 80-90% of all disease is stress-related.

Recent research indicates that some vulnerability to stress is genetic. Scientists at the University of Wisconsin and King's College London discovered that people who inherited a short, or stress-sensitive, version of the serotonin transporter gene were almost three times as likely to experience depression following a stressful event as people with the long version of the gene. Further research is likely to identify other genes that affect susceptibility to stress.

One cause of stress that has affected large sectors of the general population around the world since 2001 is terrorism. The events of September 11, 2001, the sniper shootings in Virginia and Maryland and the Bali nightclub bombing in 2002, the suicide bombings in the Middle East in 2003, have all been shown to cause short-term symptoms of stress in people who read about them or watch television news reports as well as those who witnessed the actual events. Stress related to terrorist attacks also appears to affect people in countries far from the location of the attack as well as those in the immediate vicinity. It is too soon to tell how stress related to episodes of terrorism will affect human health over long periods of time, but researchers are already beginning to investigate this question. In 2004 the Centers for Disease Control and Prevention (CDC) released a report on the aftereffects of the World Trade Center attacks on rescue and recovery workers and volunteers. The researchers found that over half the 11,700 people who were interviewed met threshold criteria for a mental health evaluation. A longer-term evaluation of these workers is underway.

A new condition that has been identified since 9/11 is childhood traumatic grief, or CTG. CTG refers to an intense stress reaction that may develop in children following the loss of a parent, sibling, or other loved one during a traumatic event. As defined by the National Child Traumatic Stress Network (NCTSN), "Children with childhood traumatic grief experience the cause of [the loved one's] death as horrifying or terrifying, whether the death was sudden and unexpected (for example, due to homicide, suicide, motor vehicle accident, drug overdose, natural disaster, war, terrorism, and so on) or due to natural causes (cancer, heart attack, and so forth). Even if the manner of death does not appear to others to be sudden, shocking, or frightening, children who perceive the death in this way may develop childhood traumatic grief. In this condition, even happy thoughts and memories of the deceased person remind children of the traumatic way in which the deceased died." More information on the identification and treatment of childhood traumatic grief can be obtained from the NCTSN web site,

Top Ten Stressful Life Events

Death of spouse


Marital separation

Jail term or death of close family member

Personal injury or illness


Loss of job due to termination

Marital reconciliation or retirement


Change in financial state


The symptoms of stress can be either physical or psychological. Stress-related physical illnesses, such as irritable bowel syndrome, heart attacks, arthritis, and chronic headaches, result from long-term overstimulation of a part of the nervous system that regulates the heart rate, blood pressure, and digestive system. Stress-related emotional illness results from inadequate or inappropriate responses to major changes in one's life situation, such as marriage, completing one's education, becoming a parent, losing a job, or retirement. Psychiatrists sometimes use the term adjustment disorder to describe this type of illness. In the workplace, stress-related illness often takes the form of burnouta loss of interest in or ability to perform one's job due to long-term high stress levels. For example, palliative care nurses are at high risk of burnout due to their inability to prevent their patients from dying or even to relieve their physical suffering in some circumstances.


When the doctor suspects that a patient's illness is connected to stress, he or she will take a careful history that includes stressors in the patient's life (family or employment problems, other illnesses, etc.). Many physicians will evaluate the patient's personality as well, in order to assess his or her coping resources and emotional response patterns. There are a number of personality inventories and psychological tests that doctors can use to help diagnose the amount of stress that the patient experiences and the coping strategies that he or she uses to deal with them. A variation on this theme is to identify what the patient perceives as threatening as well as stressful. Stress-related illness can be diagnosed by primary care doctors, as well as by those who specialize in psychiatry. The doctor will need to distinguish between adjustment disorders and anxiety or mood disorders, and between psychiatric disorders and physical illnesses (e.g., thyroid activity) that have psychological side effects.


Recent advances in the understanding of the many complex connections between the human mind and body have produced a variety of mainstream approaches to stress-related illness. Present treatment regimens may include one or more of the following:

  • Medications. These may include drugs to control blood pressure or other physical symptoms of stress, as well as drugs that affect the patient's mood (tranquilizers or antidepressants).
  • Stress management programs. These may be either individual or group treatments, and usually involve analysis of the stressors in the patient's life. They often focus on job or workplace-related stress.
  • Behavioral approaches. These strategies include relaxation techniques, breathing exercises, and physical exercise programs including walking.
  • Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs.
  • Cognitive therapy. These approaches teach patients to reframe or mentally reinterpret the stressors in their lives in order to modify the body's physical reactions.
  • Meditation and associated spiritual or religious practices. Recent studies have found positive correlations between these practices and stress hardiness.

Alternative treatment

Treatment of stress is one area in which the boundaries between traditional and alternative therapies have changed in recent years, in part because some forms of physical exercise (yoga, tai chi, aikido) that were once associated with the counterculture have become widely accepted as useful parts of mainstream stress reduction programs. Other alternative therapies for stress that are occasionally recommended by mainstream medicine include aromatherapy, dance therapy, biofeedback, nutrition-based treatments (including dietary guidelines and nutritional supplements), acupuncture, homeopathy, and herbal medicine.


The prognosis for recovery from a stress-related illness is related to a wide variety of factors in a person's life, many of which are genetically determined (race, sex, illnesses that run in families) or beyond the individual's control (economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress and, thus, change their experiences of it. A person's ability to remain healthy in stressful situations is sometimes referred to as stress hardiness. Stress-hardy people have a cluster of personality traits that strengthen their ability to cope. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life's changes as positive opportunities rather than as threats.


Complete prevention of stress is neither possible nor desirable, because stress is an important stimulus of human growth and creativity, as well as an inevitable part of life. In addition, specific strategies for stress prevention vary widely from person to person, depending on the nature and number of the stressors in an individual's life, and the amount of control he or she has over these factors. In general, however, a combination of attitudinal and behavioral changes works well for most patients. The best form of prevention appears to be parental modeling of healthy attitudes and behaviors within the family.


Adjustment disorder A psychiatric disorder marked by inappropriate or inadequate responses to a change in life circumstances. Depression following retirement from work is an example of adjustment disorder.

Biofeedback A technique in which patients learn to modify certain body functions, such as temperature or pulse rate, with the help of a monitoring machine.

Burnout An emotional condition, marked by tiredness, loss of interest, or frustration, that interferes with job performance,. Burnout is usually regarded as the result of prolonged stress.

Stress hardiness A personality characteristic that enables persons to stay healthy in stressful circumstances. It includes belief in one's ability to influence the situation; being committed to or fully engaged in one's activities; and having a positive view of change.

Stress management A category of popularized programs and techniques intended to help people deal more effectively with stress.

Stressor A stimulus, or event, that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism.



Beers, Mark H., MD, and Robert Berkow, MD., editors. "Psychiatry in Medicine." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I, "Spirituality and Healing." New York: Simon & Schuster, 2002.


Blumenthal, J. A., M. Babyak, J. Wei, et al. "Usefulness of Psychosocial Treatment of Mental Stress-Induced Myocardial Ischemia in Men." American Journal of Cardiology 89 (January 15, 2002): 164-168.

Cardenas, J., K. Williams, J. P. Wilson, et al. "PSTD, Major Depressive Symptoms, and Substance Abuse Following September 11, 2001, in a Midwestern University Population" International Journal of Emergency Mental Health 5 (Winter 2003): 15-28.

Centers for Disease Control and Prevention. "Mental Health Status of World Trade Center Rescue and Recovery Workers and VolunteersNew York City, July 2002August 2004." Morbidity and Mortality Weekly Report 53 (September 10, 2004): 812-815.

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Hawkley, L. C., and J. T. Cacioppo. "Loneliness and Pathways to Disease." Brain, Behavior, and Immunity 17, Supplement 1 (February 2003): S98-S105.

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The American Institute of Stress. 124 Park Avenue, Yonkers, NY 10703 (914) 963-1200. Fax: (914) 965-6267.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311.

National Child Traumatic Stress Initiative. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, 5600 Fishers Lane, Parklawn Building, Room 17C-26, Rockville, MD 20857. (301) 443-2940.

National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513.


National Center for Post-Traumatic Stress Disorder, Department of Veterans Affairs. Fact Sheet: Survivors of Human-Caused and Natural Disasters.

National Institute of Mental Health (NIMH) news release, July 17, 2003. "Gene More Than Doubles Risk of Depression Following Life Stresses."

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Stress is often used to describe overwhelming or threatening situations or the pressure that human beings encounter when experiencing such circumstances. The American physiologist Walter Cannon introduced the term stress in 1929 as an acute emergency reaction that could help the organism mobilize energy for fight-or-flight responses in dangerous situations. In 1936, the Austrian-born Canadian endocrinologist Hans Selye first used the term stress when describing threatening conditions capable of producing chronic changes in the homestatic balance of an organism if lasting long enough. It is now known that stress and stressor exposure can elicit a complex array of physiological changes. Stress can be physical or psychological, controllable or uncontrollable, acute or chronic, and the word stress is often used imprecisely referring either to a stressor or a stress response.

Originally, the main stressors for human beings related to physical injury, predators, and starvation. Acute physical stressors required emergency reactions helping the organism mobilize energy for fight-or-flight responses, that is, physiological reactions that prepare an individual for the strenuous efforts required by fighting or running away. Threatening situations usually call for vigorous activity, and the autonomic and endocrine responses that accompany them help mobilize the bodys energy responses. During emergencies, the sympathetic branch of the autonomic nervous system is activated to help mediate arousal, activation, and mobilization. The activated sympathetic nervous system speeds up the heart rate and diverts blood flow to the muscles, and the adrenal glands release epinephrine.

This type of acute mobilization of biological resources is clearly advantageous during short-term physical emergencies. In the contemporary world, however, people often react in this acute manner to stressor exposure that does not involve life-endangering situations. When encountering psychological or social stressors, the same physiological responses may be activated, which is likely not adaptive or appropriate. For example, the acute stress response can occur in relation to academic exams, traffic jams, relationship breakups, family feuds, or simply worrisome situations. Such activations are likely harmless in the short term but can potentially be harmful when chronically provoked. Physiological reactions to stressor exposure are also often accompanied by psychological reactions such as anxiety, worry, anger, inability to relax, and poor concentration, which again may be harmless in the short term but potentially detrimental in the long run.


The sources of stress can be infinite. Research has often focused on major life events, job-related stress, daily hassles, environmental stress, and sociocultural factors as sources of stress, among others. Major life events such as changing careers, getting married, or losing a loved one can entail a serious challenge. Such events luckily rarely occur, but everyday hassles such as having car trouble, getting to work late, missing a deadline, or having to run in order to catch the bus can obviously happen more frequently. Environmental stress such as pollution, noise, or natural disasters can also take its toll on people, as can job-related stress such as an unhappy boss, a manipulating co-worker, or simply a stressful and demanding working environment.

Because of evidence that stress responses are specific and may vary based on how a particular stressor is perceived, researchers have proposed models highlighting the interaction of biological and psychological factors in health and illness. One such model, the diathesis-stress model, proposes that two continuously interacting factors jointly determine an individuals susceptibility to stress and illness. One factor involves predisposing (diathesis) factors establishing a persons vulnerability to illness, for example, genetic vulnerability, and the other involves precipitating factors from the environment, such as traumatic experiences. The diathesis-stress model highlights the fact that different people have different vulnerabilities, resulting in possible health consequences because of stress combined with diathesis. Other models have proposed that how people perceive themselves and the stressor at hand may impact how they react mentally as well as physiologically when exposed to stressors. For example, if a stressor is perceived as a serious threat, this will elicit more complex reactions than if the stressor is perceived as a daily event. Another model, the stress-buffering model, posits that certain factors, such as individual differences or social support, may protect, or buffer, people from the impact of stressful events. In this model, individuals under stress with little or no social support, for example, experience negative health effects, whereas the negative effects of stress for individuals with high levels of social support are reduced or eliminated. Clearly, a number of factors can affect how people perceive and react to stressor exposure.


Stressors are part of daily life. However, when energy is constantly mobilized at the cost of energy storage, one can never store any surplus energy. If stressor exposure is long term or overtaxes coping resources, stress can have adverse impact on health. For example, the long-term effects of prolonged secretion of glucocorticoids have been shown to involve increased blood pressure, damage to muscle tissue, growth inhibition, and suppression of the immune system. Research has also found links between stressor exposure and physiological health issues such as heart disease and cancer. This is not to say that stress causes heart disease or cancer; it is possible, however, that prolonged stressor exposure may be a contributing factor in the development of a number of physiological problems. Research has also found an effect on wound healing: Studies have found, for example, that stressor exposure can slow the healing of wounds significantly (Glaser et al. 1999), which supports the hypothesis that prolonged stressor exposure may suppress the immune system.

Stressor exposure may also contribute to psychological disorders such as post-traumatic stress disorder (PTSD). PTSD is caused by exposure to a situation of extreme danger and stress, such as acts of war, assault, injury, death of a loved one, and so on. Symptoms of PTSD include recurrent dreams or recollections, and the disorder can interfere with social activities and produce a feeling of hopelessness. Research has also indicated a link between stress and depression, as stress and glucocorticoids appear to be intertwined with the biology of depression. Sympathetic arousal is a relative marker of anxiety and vigilance, while heavy secretion of glucocorticoids is more a marker of depression, and statistically, people who are undergoing significant life stressors are more likely to become depressed, and people who are depressed are more likely to have undergone a recent significant stressor. Symptoms of PTSD as well as depression are often treated with medication to adjust the serotonin and/or epineph-rine systems, either alone or in combination with some form of psychotherapy. PTSD and depression can also be treated with some form of psychotherapy alone.

Despite the impact that stressors can have on health, research has not established a clear connection between stressor exposure and health-related issues. In fact, when exposed to the same type of stressor, one person might get sick while another will not. Apparently, stress and the consequences of stress may arise from how people appraise the events rather than from the events themselves. How people appraise and cope with stressor exposure may again depend on factors such as individual differences, coping styles, perception of control, and social support. Individual differences such as dispositional optimism and explanatory style have been linked to better psychological and physiological adjustment to stressors. Dispositional optimists generally expect positive outcomes in life, while explanatory style refers to a persons general propensity to always attribute outcomes either to positive or negative causes. A persons resilience may also impact how stressors are perceived and met. Resiliency often refers to a persons ability to develop coping strategies despite being in a difficult situation or the ability to bounce back when bad things happen. In general, it appears that people who see stressors as challenges to be overcome rather than insurmountable problems tend to cope with stressors in the most adaptive way.


Coping usually refers to the cognitive, behavioral, or emotional way that people deal with stressful situations and is seen as a dynamic process involving a series of responses entailing the interaction of a person and the environment. In general, coping styles that approach the problem in order to deal with it have been found to be more adaptive than coping styles avoiding the problem. People with a strong sense of personal control are also more likely to engage in adaptive problem-focused coping. Personal control is the belief that people make their own decisions and also that an individual determines what others do to that person or what the person does him- or herself. The opportunity to control aversive events or the belief that aversive events can be controlled may play a crucial role in determining how a person might react during stressor exposure.

The degrees of social support people receive or perceive may also play an important role in how people cope with stressors. Social support is the companionship of others and the emotional or practical support of others. Research has shown social support to be important for faster recovery and fewer medical complications from surgery or illness, for lower mortality rates, for less distress in the face of terminal illness, and for reduced vulnerability to illness and mortality. It appears that peoples outcome expectancies, their coping strategies, their sense of control, and their perceived or actual social support act as factors in how they appraise stressors or as buffers against the impact of the stressor exposure.

Stress appears to be an unavoidable part of life in the contemporary world. Stressor exposure is not necessarily harmful; nevertheless, depending on the characteristics of the stressor, the length of exposure, individual differences, and coping strategies, stressors may have adverse physiological and psychological impacts on a persons life.

SEE ALSO Coping; Diathesis-Stress Model; Hypertension; Life Events, Stress; Optimism/Pessimism; Psychoneuroimmunology; Psychosomatics, Social; Resiliency; Stress-Buffering Model; Trauma


Cannon, Walter B. 1929. Bodily Changes in Pain, Hunger, Fear, and Rage. An Account of Recent Researches into the Function of Emotional Excitement. 2nd edition. New York: D. Appleton.

Carver, Charles S., and Michael F. Scheier. 1998. On the Self-Regulation of Behavior. Cambridge, U.K.: Cambridge University Press.

Glaser, Ronald, Janice K. Kiecolt-Glaser, Philip T. Marucha, et al. 1999. Stress-Related Changes in Proinflammatory Cytokine Production in Wounds. Archives of General Psychiatry 56 (May): 450456.

Lazarus, Richard S. 1990. Stress, Coping, and Illness. In Personality and Disease, ed. Howard S. Friedman, 97120. New York: Wiley.

Rabin, Bruce S. 1999. Stress, Immune Function, and Health: The Connection. New York: Wiley-Liss.

Sapolsky, Robert M. 2004. Why Zebras Dont Get Ulcers. 3rd edition. New York: Times Books.

Segerstrom, Suzanne C. 2000. Personality and the Immune System: Models, Methods, and Mechanisms. Annals of Behavioral Medicine 22 (3): 180190.

Segerstrom, Suzanne C., and Gregory E. Miller. 2004. Psychological Stress and the Human Immune System: A Meta-analytic Study of Thirty Years of Inquiry. Psychological Bulletin 130 (4): 601630.

Selye, Hans, A. 1936. A Syndrome Produced by Diverse Nocuous Agents. Nature 138: 32.

Lise Solberg Nes

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Stress has been defined in a number of ways by a number of different individuals, but everyone agrees that stress is experienced by all workers in the business world no matter what their position. Stress is the body's reaction to any demand placed on it, and health experts agree that some stress is essential for human survival. As demands are placed on a person's body, there will be some kind of automatic reaction. When this reaction is positive, the stress helps individuals perform their jobs better. Positive stress, called eustress, can lead individuals to a new awareness of their abilities and a completely new perspective on their jobs. Negative stress, called distress, upsets individuals and can make them physically sick. It can lead to feelings of distrust, rejection, anger, and depression, which may lead to a number of medical problems, including stroke, heart disease, high blood pressure, cancer, and ulcers.


Because everyone is different, the symptoms of stress are varied and numerous. The symptoms of stress have been placed in different categories, the most common being physical, psychological, behavioral, and mental. Headache, fatigue, grinding teeth, clenched jaws, chest pain, shortness of breath, insomnia, nausea, high blood pressure, muscle aches, constipation or diarrhea, and heart palpitations are all physical symptoms of stress. Anxiety, nervousness, depression, anger, defensiveness, hypersensitivity, apathy, feelings of helplessness, impatience, and short temper are symptoms of psychological stress. Behavioral symptoms include overeating or loss of appetite, procrastination, increased use of alcohol or drugs, pacing, nervous habits (nail-biting, foot-tapping), crying, swearing, poor personal hygiene, and withdrawal or isolation from others. Individuals who experience a decrease in concentration and memory, indecisiveness, confusion, loss of sense of humor, and mind going blank or racing may have mental stress.

Many of these symptoms, when not treated, can lead to serious medical problems as well as loss of time on the job. When individuals experience stress, they often miss work because of illness or arrive late because they dread coming to work. When on the job, they may not performing up to their ability.


When individuals perceive or anticipate a threatening or stressful situation, part of the nervous system, the sympathetic nervous system, becomes activated and releases a number of chemicals. One of these chemicals, adrenaline, is a stimulant hormone and is released into the bloodstream. Adrenaline and other hormones, including nora-drenaline, produce changes in the body that get the individual geared up for action.

David Posen (1995), who specializes in stress management, indicates that gearing up for action is often called "the fight-or-flight response" because it provides the strength and energy to either fight or run away from danger. These responses increase heart rate and blood pressure in order to get more blood to the muscles, brain, and heart, the organs that are the most important in dealing with danger. This increase in blood flow to the brain, heart, and muscles means that there is a decrease in the blood flow to the skin, digestive tract, kidneys, and liver, where it is least needed in a time of crisis. Individuals will also begin to breathe faster to take in more oxygen, and their muscles will tense so that they are prepared for action. An increased mental alertness and sensitivity of sense organs occurs. As these reactions are taking place, there is also an increase in the blood sugar, fats, and cholesterol and a rise in platelets and blood-clotting factors.

Repeated release of chemicals as a reaction to stress can, over time, cause wear and tear on the heart and blood vessels, eventually leading to heart disease and stroke. Because adrenaline and the other hormones released during stress increase muscle tension, slow digestion, and constrict and dilate arteries, the liver may deliver cholesterol and fat into the bloodstream. The hormone testosterone may increase, which can reduce the levels of high-density lipoproteins (HDL), the good cholesterol.


There are a number of life events, experienced at one time or another by everyone, that cause stress. Some of these are family-related, such as marriage, death of a family member or close friend, divorce or separation, birth or adoption of a child, a personal major illness or illness of a family member, and a major change in a spouse's job or income. An individual's control over the situation will determine the amount of stress these events will cause.

Physical stressors include pollution, excessive noise, physical disability or handicap, weather extremes, smoking, excessive drinking, obesity, overeating, poor nutrition, and lack of rest or relaxation. Many of these physical stressors are beyond an individual's control.

Common workplace stressors include the possibility of dismissal, time pressures, too many responsibilities, unreasonable deadlines, disorganization, adapting to new technology, conflicts with co-workers, information over-load, and major changes in job responsibilities.


The use of computers in the workplace has introduced new sources of stress. One of the most frequent computerrelated stressors is repetitive strain injury (RSI), which occurs when the employee is overworked or when the working environment is not physically conducive to work. Causes of RSI may be repetitious actions such as typing or using a mouse, poor lighting, and poor posture. Another computer-related problem is carpal-tunnel syndrome (CTS), which occurs when the person typing has bad posture and uses incorrect hand movements on the keyboard. Hands and eyes are the main source of communication with the computer. When bad posture and incorrect hand movements are too prevalent, the result is tingling and numbness of the fingers.

Extended time spent working before a computer monitor can produce eye irritation, fatigue, and difficulty focusing, all of which are symptoms associated with eye-strain. Nearsightedness has been associated with eye strain caused by working at a computer monitor.


Job pressures are a major source of stress. Several job conditions have been identified as increasing stress in most employees. Job overload is one such condition. Although some employees may have the ability to do the job, they may not have enough time to do the amount of work necessary. Other employees lack the ability to do the job, being unable to meet the performance standards or expectations set by the employer. Clear job objectives are necessary, and when employees do not know what specific job performance is expected of them, they begin to develop stress.

When jobs are too boring or employees are not challenged to use their abilities, stress occurs. Stress also results from undesirable physical working conditions. Employees experience stress when the work environment is too noisy, too hot, too cold, or too crowded.

A major source of stress involves frequent or significant changes that have a direct effect on the individual's job. These changes can include changes in management, management style, equipment, or job location.


Just as there are a number of causes for and symptoms of stress, there are a number of ways to manage stress. Individuals vary in their ability to manage stress, and the same techniques do not work for every person. Individuals need to become aware of the stressors they experience and how they react to these stressors.

One stress-management technique that can apply to almost all individuals is learning to manage time more effectively. Managing time more effectively means that individuals learn to prioritize and plan so that they have time for themselves, thus leaving time for listening to music, exercising regularly, mediating, or engaging in whatever type of activity that they find relaxing. Developing an organized time schedule helps ward off tension, which helps reduce stress.

When on the job, employees and managers need to match individual abilities with workload. Managers should be sure that the job objectives are clear so that there is no role ambiguity or role conflict. As employees' work responsibilities change, managers should keep them informed of what is going to happen, why it is going to happen, and when it will happen.

When individuals cannot manage stress on their own or with the help of their managers, medication may be necessary. These medications can, in the short term, moderate physical reactions to stress. Doctors usually prescribe Valium and Xanax for relief from stress. Tranquilizers are suggested for only short periods of time, because individuals can become dependent on them.

see also Employee Assistance Programs ; Workers' Compensation


"Ever Thought of Calling in Well?" (1998, November 9). U.S. News & World Report, 82-83.

Keita, Gwendolyn Puryear, and Hurrell, Joseph J., Jr., eds. (1994). Job Stress in a Changing Workforce. Washington, DC: American Psychological Association.

Losyk, Bob (2005). Get a Grip!: overcoming stress and thriving in the workplace. Hoboken, NJ: John Wiley & Sons.

Moore, Jo Ellen (1999, January). "Are You Burning Out Valuable Resources?" HR Magazine, 1:93-98.

Newton, Tim (1995). Managing Stress: Emotion and Power at Work. Thousand Oaks, CA: SAGE Publications.

Posen, David B. (1995). "Stress Management for Patient and Physician." Canadian Journal of Continuing Medical Education.

Seaward, Brian Luke (2006). Managing Stress: principles and strategies for health and wellbeing (5th ed.). Sudbury, MA: Jones and Bartlett Publishers.

Stranks, Jeremy (2005). Stress at Work: management and prevention. Oxford; Boston: Elsevier/Butterworth-Heinemann.

Timm, Paul R., and Peterson, Brent D. (1993). People at Work: Human Relations in Organizations (5th ed.). Cincinnati, OH: South-Western College Pub.

Jim D. Rucker

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stress is a word derived from the Latin word stringere, meaning to draw tight, and was used in the seventeenth century to describe hardship and affliction. During the late eighteenth century (as Hinkle records), stress denoted ‘force, pressure, strain, or strong effort’, referring primarily to an individual, or to the individual's organs or mental powers.

Definitions of strain and load used in physics and engineering eventually began to influence our understanding of how stress affects individuals and their health. Under this concept, external forces (load) are seen as exerting pressure upon an individual, producing strain. Proponents of this view felt that they could measure the stress to which an individual is subjected, in the same way we can measure physical strain on a machine. While this concept looks at stress as an outside stimulus, an alternative concept defines stress as a person's response to a disturbance. As early as 1910, Sir William Osler explored the idea of stress and strain causing ‘disease’, when he saw a relationship between chest pains (angina pectoris) and a hectic pace of life. The idea that environmental forces could actually cause disease rather than just short-term ill health effects, and that people have a natural tendency to resist such forces, was seen in the work of Walter B. Cannon in the 1930s. Cannon studied the effects of stress in animals and people, and in particular studied the ‘fight or flight’ reaction. Through this reaction, people, as well as animals, will choose whether to stay and fight or try to escape when confronting extreme danger. Cannon observed that when his subjects experienced situations of cold, lack of oxygen, or excitement, he could detect physiological changes such as emergency adrenaline secretions. Cannon described these individuals as being ‘under stress’.

One of the first scientific attempts to explain the process of stress-related illness was made in 1946 by physician Hans Selye, who described three stages an individual encounters in stressful situations: (i) alarm reaction, in which an initial phase of lowered resistance is followed by countershock, during which the individual's defence mechanisms become active; (ii) resistance, the stage of maximum adaption and, hopefully, successful return to equilibrium for the individual. If, however, the stress agent continues or the defence mechanism does not work, he will move on to a third stage; (iii) exhaustion, when adaptive mechanisms collapse.

Critics of Selye's work say it ignores both the psychological impact of stress on an individual, and the individual's ability to recognize stress and act in various ways to change his or her situation.

Newer and more comprehensive theories of stress emphasize the interaction between a person and his or her environment, describing it as a response to internal or external pressures which reach levels that strain physical and psychological systems beyond their coping capacities.

In the 1970s Richard S. Lazarus suggested that an individual's stress reaction ‘depends on how the person interprets or appraises (consciously or unconsciously) the significance of a harmful, threatening, or challenging event.’ Lazarus' work disagrees with those who see stress simply as environmental pressure. Instead, the intensity of the stress experience is determined significantly by how well people feel they can cope with an identified threat. Any person who is unsure of his or her coping abilities, or is likely to feel helpless and overwhelmed.

Similarly, Tom Cox and colleagues in the late 1970s rejected the idea of looking at stress as simply either environmental pressures or physiological responses; they suggest that it can best be understood as ‘part of a complex and dynamic system of transaction between the person and his environment’ and criticize the mechanical model of stress: ‘Men and their organizations are not machines … Stress has to be perceived or recognized by man. A machine, however, does not have to recognize the load or stress placed upon it.’

By looking at stress as resulting from a misfit between an individual and his/her particular environment, we can begin to understand why one person seems to flourish in a certain setting, while another suffers. Tom Cummings and Cary Cooper in 1979 explored the stress process in a cybernetic framework as follows:(i) Individuals, for the most part, try to keep their thoughts, emotions, and relationships with the world in a ‘steady state’.(ii) Each factor of a person's emotional and physical state has a ‘range of stability’, in which that person feels comfortable. On the other hand, when forces disrupt one of these factors beyond the range of stability, the individual must act or cope to restore a feeling of comfort.(iii) An individual's behaviour aimed at maintaining a steady state makes up his or her ‘adjustment process’, or coping strategies.Accordingly, a stress is any force that puts a psychological or physical factor beyond its range of stability, producing a strain within the individual. Knowledge that a stress is likely to occur constitutes a threat to the individual. A threat can cause a strain because of what it signifies to the person.

Stress certainly involves a range of bodily reactions. Man is the product of many thousands of years of evolution, and to survive required a quick physical response to dangers. The body developed the ability to ‘rev-up’ for a short time. Cannon described this mobilization of forces as the ‘fight or flight’ reaction mentioned earlier. Primitive man expended this burst of energy and strength in physical activity, such as a life and death struggle or a quick dash to safety.

Modern man has retained his hormonal and chemical defence mechanisms through the millenia. But for the most part, the lifestyle in the Western world today does not allow physical reaction to the stress agents we face. As Albrecht pointed out, attacking the boss, hitting an insolent customer, or smashing an empty automatic cash dispenser are not solutions allowed by contemporary society. Even the non-aggressive ‘flight’ reaction would hardly be judged appropriate in most situations. The executive who flees from a tense meeting, and the assembly worker who dashes out in the middle of a shift, will likely suffer the consequences of their actions. Our long-evolved defence mechanisms prepare us for dramatic and rapid action, but find little outlet. The body's strong chemical and hormonal responses are then like frustrated politicians: all dressed up with nowhere to go, as Melhuish describes it.

It is this waste of our natural response to stress which may actually harm us. Although scientists do not fully understand this process, our thought patterns regarding ourselves and the situations we are in can trigger widespread physiological changes, acting through the hypothalamus — the part of the brain which co-ordinates a complexity of neural and hormonal mechanisms for taking care of bodily functions. In a situation of challenge, tension, or pressure, the hypothalamus activates both the sympathetic branch of the autonomic nervous system and certain hormone secretions from the pituitary gland. The resulting release of adrenaline and other hormones, together with other actions of sympathetic nerves, enhances the level of arousal and stimulates the cognitive, neural, cardiovascular, and muscular systems, whilst also mobilizing metabolic fuels to provide energy for an increase in muscular activity. These physiological changes are designed to improve the individual's performance: the heart speeds up and beats more strongly; this and widening of muscle blood vessels increase the blood supply of the muscles; breathing rate and depth increase. Blood pressure rises, and less blood flows to the stomach and the intestines, as well as the skin, resulting in the cold hands and feet often associated with a nervous disposition.

All of the body's ‘rev-up’ activity is designed to improve performance. But if the stress which launches this activity continues unabated, researchers believe, the human body begins to weaken as it is bombarded by stimulation and stress-related chemicals. As stress begins to take its toll on the body and mind, a variety of symptoms can result. We have identified physical and behavioural symptoms of stress occurring before the onset of serious stress-related illnesses; these include: insomnia, eating difficulties, breathlessness without exertion, a tendency to sweat with no good reason, frequent intestinal difficulties, loss of sense of humour, constant irritability with people, difficulty with making decisions, suppressed anger, difficulty in concentrating, the inability to finish one task before rushing on to the next, and so on. Many of these symptoms are the prelude to more serious illnesses, in which stress is one of the risk factors. Recent research has shown that the psycho–social or stress risk factors can be found in hypertension, chronic fatigue syndrome, coronary artery disease, mental disorders, and a range of other illnesses; also suppression of immune responses by the stress-related hormones may provide chemical explanations of links between environmental and emotional pressures and susceptibility to diseases.

Cary L. Cooper


Albrecht, K. (1979). Stress and the manager. Making it work for you. Prentice-Hall, New Jersey.
Cooper, C. (ed.) (1996). Handbook of stress, medicine and health. CRC Press, Boca Raton, Florida.
Hinkle, L. E. (1973). The concept of stress in the biological social sciences. Stress medicine and man 1, 31–48.
Lazarus, R. E. (1976). Patterns of adjustment. McGraw-Hill, New York.
Melhuish, A. (1978). Executive health. Business Books, London.

See also autonomic nervous system.

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1. In general usage, a word associated with emphasis, significance, tension, and strain.

2. Also ACCENT. In poetics and phonetics, a term for the property by means of which syllables and words become prominent: that is, they are made to stand out from their background.

Phonetic prominence

Stress is not a single phonetic feature, stressed syllables having different kinds of phonetic prominence: (1) Prominence of pitch. A syllable is made prominent by a pitch movement on the syllable or by a pitch discontinuity involving a jump from the immediately preceding pitch. (2) Prominence of duration. Stressed syllables have full duration and may be prolonged, whereas unstressed syllables are likely to be shortened. (3) Prominence of vowel quality. Stressed syllables retain full vowel quality, whereas unstressed syllables may have weak vowels. (4) Prominence of loudness. Stressed syllables are generally said to be loud (although this is probably the least important kind of prominence for the recognition of stress in English). Stressed syllables with pitch prominence are said to be accented and a pitch contour or tone is associated with each accent.

Word stress

A property which makes some syllables in a word stand out. In writing and print, a stressed syllable is conventionally marked with the stress mark (ˈ) placed immediately before the syllable in phonetics and most contemporary dictionaries (but placed after it in many older works). The word ˈforeign is stressed on the first syllable, and deˈscribe on the second. Longer words may have two or more stresses, in which case the main stress is referred to as primary stress and others as secondary stress. Secondary stress is marked with the stress mark (ˌ). The word phoˈtography has just one stress on the second syllable, but ˌphotoˈgraphic has primary stress on the third syllable and secondary stress on the first, while ˈphotoˌgraph has primary stress on the first syllable and secondary stress on the third.

It is rare for unrelated English words to be distinguished solely by stress, as in beˈlow, ˈbillow. More commonly, related disyllabic words are stressed on different syllables, and the unstressed syllables may be reduced, for example, the verb construct is /kənˈstrʌkt/ and the noun construct is /ˈkɔnstrʌkt/. When a word is pronounced in isolation, it is treated as a tone group. The primary stress is the nucleus, and in isolation it is given a falling tone: ←foreign, describe. A secondary stress before the primary stress is the onset, which normally takes a level tone: photographic. A secondary stress after the primary stress is an unreduced syllable in the tail of the tone group. See TONE.

Sentence stress

The process whereby some words in an utterance are made prominent while others remain in the background, as in: THAT is the END of the NEWS. In strict phonetic terms, sentence stress is a misnomer, as the domain of these patterns is not the sentence but the tone group. In general, lexical words (nouns, verbs, adjectives, adverbs in -ly) have sentence stress, unless they refer to information already provided, in which case the resulting pattern is contrastive stress. Grammatical words are more likely to be unstressed, and may be reduced to weak forms.

Contrastive stress

The process by which stress is used to imply a contrast, as in MARY can go (not Susan) and Mary CAN go (she is free to do so). A fall-rise tone with a wide pitch range is often associated with contrast: I can't go onMONday leads to the implication ‘but I can go some other day’. Whole words can be contrasted in a similar way in many languages, but English is unusual in that parts of words can be contrasted: I wouldn't say she's an emploYEE she is actually an emplo YER. In such cases, the normal pattern of word stress is overridden. The term is also used to refer to a stress pattern relating a sentence to its context: without preceding information, the sentence Ram's got a motorbike is likely to be stressed on the first and last words, RAM'S got a MOTorbike. On the other hand, RAM'S got a motorbike belongs to a context where possessing a motorbike is already under discussion and motorbike is not given sentence stress because it is not in contrast with anything else (bicycle, car).

Stress and weak forms

The RHYTHM of English leads to special reduced forms in some monosyllabic grammatical words in unstressed contexts: in isolation, the words an, from, his are pronounced /æn, frɔm, hɪz/, but in context are usually reduced to /ən, frəm, əz/. The process of reduction includes replacing the vowel with a weak vowel, usually schwa, and dropping an initial /h/. If the vowel is lost altogether, the result is a contraction, represented in informal writing by an apostrophe replacing the missing vowel: she's here. Although a consonant may also have been dropped (for example, the h of has in She's arrived), this is not normally indicated. Weak forms are natural in all native varieties of English, even in slow, careful speech. This also applies to the dropping of /h/ from weak forms, which is different from the dropping of h from accented syllables, which is not normal in some varieties, such as RP, and is widely stigmatized in BrE.

Stress shift

It is a common feature of English that when derivative words are formed by means of certain suffixes, the (primary) stress shifts from a particular syllable in the base word to a new syllable in the derived word: átom/atómic, cómplex/compléxity, devélopment/developméntal (with appropriate adaptations in the fullness or weakness of the vowels). Such stress shift or accent shift occurs only in words of French, Latin, and Greek background, in terms of particular suffixes, such as -ic, -ity, -al, and not in words of vernacular Germanic background.

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The physiological and psychological responses to situations or events that disturb the equilibrium of an organism.

While there is little consensus among psychologists about the exact definition of stress, it is agreed that stress results when demands placed on an organism cause unusual physical, psychological, or emotional responses. In humans, stress originates from a multitude of sources and causes a wide variety of responses, both positive and negative. Despite its negative connotation, many experts believe some level of stress is essential for well-being and mental health .

Stressorsevents or situations that cause stress can range from everyday hassles such as traffic jams to chronic sources such as the threat of nuclear war or over-population. Much research has studied how people respond to the stresses of major life changes. The Life Events Scale lists these events as the top ten stressors: death of spouse, divorce , marital separation, jail term, death of close family member, personal injury or illness, marriage, loss of job through firing, marital reconciliation, and retirement. It is obvious from this list that even good thingsmarriage, retirement, and marital reconciliationcan cause substantial stress.

When presented with a stressful event or situation, the process of cognitive appraisal determines an individual's response to it. One optionto judge the stressor as irrelevantwould cause little disturbance and thus little stress. For example, a high school student who does not plan to attend college will experience much less stress during the Scholastic Assessment Test (SAT) than a student who wants to attend a top university, even though both are in the same situation. Another option is recognizing the stressor as disturbing, yet positive. Retirement or marriage could fit into this category. The judgment that a situation truly is stressful would cause the most disturbance and thus the most stress. For example, few people would consider a serious traffic accident as anything less than stressful. The magnitude of resulting stress from any

Source: "What Are the Leading Causes of Stress?" In Science and Technology Desk Reference. Edited by The Carnegie Library of Pittsburgh Science and Technology Department. Detroit: Gale Research, Inc. 1993, p. 415. (Stanley Publishing. Reproduced with permission.)
Death of spouse
Marital separation
Jail term or death of close family member
Personal injury or illness
Loss of job due to termination
Marital reconciliation or retirement
Change in financial state

situation generally depends upon a person's perceived ability to cope with it. If the stress is predictablea scheduled dentist appointment, for exampleit usually causes less stress. A person's ability to control the stressor also can mitigate its effects. A strong network of social support undermines the magnitude of stress in most situations.

Reactions to stress, then, vary by individual and the perceived threat presented by it. Psychological responses may include cognitive impairmentas in test anxiety, feelings of anxiety, anger , apathy, depression , and aggression . Behavioral responses may include a change in eating or drinking habits. Physiological responses also vary widely. The "fight or flight" response involves a complex pattern of innate responses that occur in reaction to emergency situations. The body prepares to handle the emergency by releasing extra sugar for quick energy; heart rate, blood pressure, and breathing increase; muscles tense; infection-preventing systems activate; and hormones are secreted to assist in garnering energy. The hypothalamus , often called the stress center of the brain , controls these emergency responses to perceived life-threatening situations.

Research has shown that stress is a contributing factor in a majority of disease cases. A relatively new area of behavioral medicine, psychoimmunology, has been developed to study how the body's immune system is affected by psychological causes like stress. While it is widely recognized that heart disease and ulcers may result from excess stress, psychoimmunologists believe many other types of illness also result from impaired immune capabilities due to stress. Cancer, allergies, and arthritis all may result from the body's weakened ability to defend itself because of stress.

Coping with stress is a subject of great interest and is the subject of many popular books and media coverage. One method focuses on eliminating or mitigating the effects of the stressor itself. For example, people who experience extreme stress when they encounter daily traffic jams along their route to work may decide to change their route to avoid the traffic, or change their schedule to less busy hours. Instead of trying to modify their response to the stressor, they attempt to alleviate the problem itself. Generally, this problem-focused strategy is considered the most effective way to battle stress. Another method, dealing with the effects of the stressor, is used most often in cases in which the stress is serious and difficult to change. Major illnesses, deaths, and catastrophes like hurricanes or airplane crashes cannot be changed, so people use emotion-focused methods in their attempts to cope. Examples of emotion-focused coping include exercise, drinking, and seeking support from emotional confidants. Defense mechanisms are unconscious coping methods that help to bury, but not cure, the stress. Sigmund Freud considered repressionpushing the source of stress to the unconscious one way of coping with stress. Rationalization and denial are other common emotional responses to stress.

Further Reading

Tanner, Ogden. Stress. New York: Time-Life Books, 1976.

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Over the course of evolution, the human mind and body have developed means of handling stressful situations. Over the short term, such stress response pathways are highly adaptive, allowing a person to manage his or her resources in order to navigate the crisis; in some cases, however, these processes go awry and result in pathology. Chronic stress is becoming increasingly problematic in the United States as workers work longer and harder hours. Approximately one-third of all workers report that they are in high-stress jobs, and that not only is stress implicated in 15 percent of all disability claims, the number of stress-related absences is increasing. Such prolonged exposure to stress can also result in consequences in the form of physical illness. Alternatively, a severe acute stressor may result in a stress-response syndrome such as an acute stress disorder or a post-traumatic stress disorder.

In acute stress, the mind and body respond with a fight or flight response that involves activation of the sympathetic nervous system and release of stress hormones such as cortisol. Psychologically, this increases the organism's alertness and response time. Physiologically, these changes provide the organism with the energy needed to meet the emergency. Such intense activation helps the organism in the short term, but prolonged activation of this system creates problems in that it may increase the risk of certain disease states, and, once set into motion, chronic stress responses may be difficult to extinguish. This has led some researchers to investigate potential mediating factors such as personality. For example, a correlation has been established between a personality characterized by hostile competitiveness (type A) and increased risk of myocardial infarction (heart attack).

An acute stressor or psychological trauma, such as a life-threatening circumstance, presents a person with new information that may be difficult to assimilate. In an attempt to adapt, the person will typically alternate between contemplation of the stressor and avoidance of reminders of the event. Such a cycle allows for dose-by-dose psychological processing of the event. Difficulties in adaptation may present as an acute stress disorder that manifests itself as an extreme version of this cycle. People with such a disorder may have intrusive remembrances, nightmares, or even flashbacks of the stress event. These can alternate with emotional numbing, interpersonal alienation, and extreme avoidance of traumatic reminders. A diagnosis of postraumatic stress disorder (PTSD) is made if these symptoms persist longer than one month. Studies suggest that approximately 0.5 percent of men and 1.3 percent of women meet criteria for PTSD over their lifetime. A larger percentage (approximately 15%) of subjects were found to have some symptoms but did not meet criteria for the full disorder.

At present, psychotherapy is the mainstay of treatment for stress response syndromes. A variety of approaches exist, but they share a common goal of assisting the patient with conscious contemplation of the event in such a way that it may be assimilated and anxiety responses extinguished. Care must be taken to create an environment of safety and to avoid retraumatization, which may occur with overly rapid exposure to traumatic memories. Patients experience decreased feelings of guilt and shame as they learn that they responded to the trauma as adequately as possible. Contemplation of the event in therapy may lead to further benefits, including an enhanced understanding of the meaning of the event in the larger context of the individual's life.

Psychopharmacologic treatment may be a useful adjunct for specific symptom clusters such as associated anxiety, depression, and insomnia. The prognosis for treatment is good and is improved if the patient was without preexisting psychiatric comorbidity and if the treatment occurs in close proximity to the event. Brief treatment is frequently helpful in restoring a patient to a baseline level of functioning, but longer-term treatment may be necessary if exposure to the stressor was chronic or occurred in childhood.

Stress response systems have developed in humans as an adaptive mechanism to assist individuals in times of crisis. These systems, however, may also result in physical or psychological pathology. Chronic overactivation of the stress response may predispose an individual to greater risk for physical illnesses such as heart disease. Overly intense exposure to an acute stressor may result in a stress response syndrome with potentially disabling consequences. Treatment is, however, available and may return individuals to their previous level of functioning. A subset of patients even report a sense of enhanced insight into their lives as a result of the trauma.

James Powers

Stuart J. Eisendrath

(see also: Mental Health )


Eisendrath, S. J., and Feder, A. (1995). "The Mind and Somatic Illness: Psychological Factors Affecting Physical Illness." In Review of General Psychiatry. ed. H. H. Goldman. Norwalk CT: Appleton & Lang.

Horowitz, M. J. (1997). Stress Response Syndromes: PTSD, Grief and Adjustment Disorders, 3rd edition. Northvale, NJ: Aranson.

Van der Kolk, B. A.; McFarlane, A. C.; and Weisaeth, L. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society. New York: Guilford Press.

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Stress is mental or physical tension brought about by internal or external pressures. The feeling of stress may be mild or severe and it can last a short time or over a longer period. Many events may cause stress. They range from everyday occurrences such as taking a test or driving through rush-hour traffic to more traumatic experiences such as the death of a loved one or a serious illness.

Stress may be a factor in causing disease. Researchers believe that stress disrupts the body's homeostasis or balanced state, which leads to a weakening of the body's immune system. Chronic (frequently occurring) stress can thus bring about serious illnesses.

People who experience severe traumas, such as soldiers during combat, may develop a condition called post-traumatic stress disorder (PTSD). This condition was called shell shock during World War I (191418) and battle fatigue during World War II (193945). Sufferers of PTSD experience depression, nightmares, feelings of guilt for having survived, and flashbacks to the traumatic events. They may be excessively sensitive to noise and may even become violent.

Until the twenty-first century, scientists believed humans and animals reacted to stress in a common manner, by preparing to do battle or to flee. This syndrome is known as "fight or flight." In 2000, however, a group of researchers issued a report asserting that females (both human and animal) often show a different reaction to stress. Instead of aggression and escape, their reaction is one of nurturing and seeking the support of others. The researchers believe this response, called "tend and befriend," is the result of either hormonal differences between the sexes or learning and cultural conditioning experienced long ago in our evolutionary history. When human were first evolving, the "tend-and-befriend" response would have reduced the risk to females and their offspring posed by predators, natural disasters, and other threats.

Stress and illness

Some of the physical signs of stress are a dry mouth and throat; tight muscles in the neck, shoulders, and back; chronic neck and back problems; headaches; indigestion; tremors; muscle tics; insomnia; and fatigue. Emotional signs of stress include tension, anxiety, depression, and emotional exhaustion.

During stress, heart rate quickens, blood pressure increases, and the body releases the hormone adrenaline, which speeds up the body's metabolism. If the stress continues over a period of time and the body does not return to its normal balanced state, the immune system begins to weaken.

Words to Know

Adrenaline: Chemical released from the adrenal gland in response to stress, exercise, or strong emotions.

Atherosclerosis: Disease of the arteries in which fatty material accumulates on the inner walls of the arteries, obstructing the flow of blood.

Homeostasis: State of being in balance.

Post-traumatic stress disorder (PTSD): Condition developed as a response to traumatic events such as those experienced in combat.

Medical researchers have determined that chronic stress causes the accumulation of fat, starch, calcium, and other substances in the linings of the blood vessels. This can lead to atherosclerosis, a condition in which blood flow through the arteries is obstructed. This condition ultimately results in heart disease. Other diseases associated with stress are adult diabetes, ulcers, high blood pressure, asthma, migraine headaches, cancer, and the common cold. While both sexes can suffer greatly from stress, men seem to experience more stress-related illnesses like hypertension and alcohol and drug abuse.

Treatments for stress reduction

Some psychiatrists and therapists treat patients suffering from stress with medications such as antianxiety or antidepressant drugs. Other therapists help patients develop coping strategies to reduce or eliminate stress from their lives. Some life-style changes are often recommended. These include adopting a healthy diet, quitting smoking, increasing exercise activity, developing relaxation techniques (such as deep breathing and meditation), and taking part in group discussions. Knowing the causes of stress and being able to talk about them are considered important for reducing or eliminating stress.

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stress An imprecise concept, popular in everyday and academic discourse. It may refer to external situational pressures (stressors) or to the responses to them (stress reactions)—responses usually assumed to have physical and psychological components, such as raised pulse-rate and adrenalin levels, and feelings of anxiety and discomfort. In either usage it is commonly invoked as a key factor in explanations of bodily and mental ill-health, various forms of under-performance, and deviant behaviour. Its attraction to social scientists lies in its potential to link features of the individual's present or recent social situation to some specified outcome.

Much of the sociological debate focuses on identifying and measuring the domain of the stressful. Some researchers assume only negative occurrences like divorce or unemployment are stressful, others any situation involving significant change (for example marriage, job promotion, or moving house); some incorporate only life-events, others include ongoing difficulties; some employ standardized measures (for example the Social Readjustment Rating Scale), others assess subjective meanings, arguing that what is stressful for one may not be stressful for another. However, subjective assessments of stressful experiences are problematic since they may be contaminated by the very feelings generated by that experience, as for example in the case of clinically depressed individuals who retrospectively identify a particular life-event as stressful in order either to co-operate in treatment or to facilitate self-understanding of their (otherwise mysterious) illness. George Brown and Tirril Harris, in their influential study Social Origins of Depression (1978), measure meaning not by direct subjective evaluations but through contextual evidence about values, objectives, and circumstances.

Of increasing interest in the field is the identification of factors such as social support that mediate between stressful situations and responses to them. Brown and Harris term these ‘vulnerability’ or, conversely, ‘coping’ factors, examining situationally generated rather than biological vulnerability.

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stress / stres/ • n. 1. pressure or tension exerted on a material object: the distribution of stress is uniform across the bar. ∎  the degree of this measured in units of force per unit area. 2. a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances: he's obviously under a lot of stress| [in comb.] stress-related illnesses. ∎  something that causes such a state: the stresses and strains of public life. 3. particular emphasis or importance: he has started to lay greater stress on the government's role in industry. ∎  emphasis given to a particular syllable or word in speech, typically through a combination of relatively greater loudness, higher pitch, and longer duration: normally, the stress falls on the first syllable. • v. 1. give particular emphasis or importance to (a point, statement, or idea) made in speech or writing: [tr.] they stressed the need for reform | she was anxious to stress that her daughter's safety was her only concern | [with direct speech] “I want it done very, very neatly,” she stressed. ∎  [tr.] give emphasis to (a syllable or word) when pronouncing it. 2. [tr.] subject to pressure or tension: this type of workout does stress the shoulder and knee joints. 3. [tr.] cause mental or emotional strain or tension in: I avoid many of the things that used to stress me before | [as adj.] (stressed) she should see a doctor if she is feeling particularly stressed out. ∎  [intr.] inf. become tense or anxious; worry: don't stress—there's plenty of time to get a grip on the situation. DERIVATIVES: stress·less adj. stres·sor / -ər/ n. (in senses 2 and 3 of the verb ).

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Good Stress and Bad Stress

What Is the Stress Response?

What Happens with Too Much Stress?

What Is the Antidote for Too Much Stress?


Stress is the bodys natural response to demands placed upon it. This response affects children, teenagers, and adults. Relaxation and stress management techniques help people deal with stress.


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Post-traumatic stress



Stress inventories

Stress management


Good Stress and Bad Stress

Everyone experiences stress, which is the bodys general response to any event, real or imagined, that requires an adaptation or extra effort. In most cases, an event or situation is not stressful by itself. Rather, it is how people view the event and what they believe about their own ability to respond to it that create stress. About 10 percent of modern stress can be linked to actual physical threats to life or safety, such as being threatened with a weapon or needing to slam on the brakes to avoid an accident. The other 90 percent of stress seems to result from our perceptions of life events, such as fights with friends or family, worries about school or work, or problems we do not know how to solve. The majority of doctor visits are believed to be stress-related.


Stressors are the triggers for the bodys stress response. These triggers are unique to each person. An event that one person finds relaxing may create tension in another. Stressors fall into several different categories:

  • Physical stressors affect a persons body. These biological stressors may include exercise, illness, or disabilities.
  • Environmental stressors include noise, overcrowding, poverty, natural disasters, or even technology that causes too much change in too short a period of time.
  • Life situations create both good and bad stressors. These may include moving to a new home, changing schools or jobs, or experiencing changes in the family structure, such as marriage, divorce, the birth or adoption of a new sibling, or the death of a friend or family member.
  • Behaviors also can be stressors. These may include smoking cigarettes, taking drugs, not sleeping enough, eating too little or too much, or exercising too little or too much.
  • Certain patterns of thinking (cognitive actions) can be stressors, too. These may include fearing change or challenge, remembering hard times that have passed, interpreting minor losses as catastrophes, or having too little self-esteem.

Stress and anxiety (distress)

Most often, stress is associated with negative events or thoughts, which are difficult experiences that most people find unpleasant, frightening, or anxiety-producing. Stress may result from teasing by peers, being bullied, anxiety about homework or tests, disappointment about not achieving a goal, encountering unfamiliar people or places, or efforts to cram too many activities into too little time. Job stress and caregiver stress often fall into this category. So does being a pessimist and worrywart who believes that whenever something can go wrong, it will go wrong. Stress is the bodys natural response to the difficult demands it encounters everyday.

Coping with Stress

Tips for coping with stress:

  • Be realistic.
  • Dont try to be perfect.
  • Dont expect others to be perfect.
  • Take one thing at a time.
  • Be flexible.
  • Share feelings.
  • Maintain a healthy lifestyle.
  • Meditate.
  • Ask for help when necessary.

Tips for helping others cope with stress:

  • Pay attention.
  • Take them seriously.
  • Be patient.
  • Offer help when necessary.

Stress and excitement

Take a deep breath when faced with stress, and sometimes anxiety turns into excitement. That is because some stressors are positive. An audition, a stage performance or applause (instead of stage fright), an A grade or a game point (instead of anxiety), or a date to the prom with someone brand-new are positive stressors. Stress also is the bodys natural response to the exciting new challenges it encounters everyday.

Trauma and stress

Some events are so stressful that they overwhelm us, and no amount of deep breathing or positive thinking can help. Accidents, injuries, abuse, violence, war, serious threats to physical safety, or the sudden death of a loved one are examples of traumas that cause a stress response within the body.

What Is the Stress Response?

Stressors good and bad set off a series of events within the bodys neuroendocrine system. Often called the fight or flight response, these events are triggered by the brain, which alerts the bodys autonomic nervous system to prepare all systems to react to an emergency. The autonomic nervous system sends a message in a split second through nerve fibers, which signal all the other body systems.

During this alarm period, many different hormones are activated with many dramatic effects on other body systems. The heart beats faster, blood pressure is raised, and blood vessels dilate (open wider) to increase blood flow to the muscles. The pupils dilate to aid vision. The digestive system slows down so that the bodys resources and energy can be used wherever else they are needed, and the production of saliva decreases. The bronchi dilate to aid breathing. The skin sweats to cool the body, and the liver releases its stores of glucose, the major fuel of the body, to increase the persons energy level. The body stays in overdrive until the brain tells it that the emergency has ended.

Events that trigger the stress response usually are emergencies that do not last for very long. This allows the body to relax and recover after the emergency has ended so that it can respond correctly the next time its emergency response system is needed.

Long-term stress (chronic stress), frequently recurring stress, or extreme stress from trauma or a life-threatening event can keep the bodys stress response system activated at too high a level or for too long a period of time. This may interfere with the bodys ability to recover from the stress response. Chronic stress or post-trauma stress also may lead to physical, emotional, or behavioral problems, post-traumatic stress disorder, or even the development of stress-related illnesses.

The bodys stress hormone response: When the brain perceives stress, the hypothalamus releases corticotropinreleasing factor (1), which triggers the release of adrenocorticotropin (ACTH) (2) from the pituitary gland. ACTH (2) travels through the bloodstream and (along with signals from the brain sent through the autonomic nervous system) stimulates the adrenal glands to release cortisol and epinephrine into the bloodstream (3). Cortisol and epinephrine (3) help provide energy, oxygen, and stimulation to the heart, the brain, and other muscles and organs (4) to support the bodys response to stress. When the brain perceives that the stress has ended, it allows hormone levels to return to their baseline values.

What Happens with Too Much Stress?

Researchers have found that chronic stress and post-trauma stress can suppress the immune system, interfering with the bodys natural ability to defend itself against infection. Chronic stress also may contribute to many other problems of mind and body, including:

  • headaches or stomachaches
  • allergic responses, such as skin rashes or asthma
  • irritability, aggression, or conduct disorders
  • bruxism (grinding the teeth)
  • sleep disorders
  • eating disorders
  • alcoholism or substance abuse
  • anxiety
  • phobias
  • depression

Hans Selye and Stress Research

Dr. Hans Selye (19071982) is considered the founder of modern stress research. He authored 39 books, wrote more than 1,700 scholarly papers, and was cited as a source in more than 362,000 scientific papers, not to mention countless articles in magazines and newspapers around the world. He also established the International Institute on Stress at the University of Montreal. The bodys general adaptation syndrome often is called Selye syndrome.

Dr. Selye defined stress as the nonspecific response of the body to any demand, which means the bodys reaction to any change in its environment. Dr. Selye linked physical illnesses not just to bacterial and viral infections, but also to hormones within the body that become activated whenever the body responds to external stressors, such as temperature extremes, pain, and threats to safety. Dr. Selye determined that many of the bodys hormonal responses to stress were helpful andadaptive,but others weremaladaptiveand placed physical demands on the body that could result in disease.

Still, Dr. Selye described stress as the spice of life, which might make one person sick while invigorating another. In one of his best-selling books, The Stress of Life, Dr. Selye offered this rhymed advice:Fight for your highest attainable aim/But never put up resistance in vain.By choosing wisely where we invest effort and emotional energy, we can reduce the damaging side effects of stress, keep distress to a minimum, and increase our enjoyment of life.

Chronic stress is believed to be a factor in many cases of abuse, violence, and suicide. Over the long term, chronic stress also may contribute to the development of cardiovascular problems, such as high blood pressure, heart disease, and stroke. People who experience chronic stress can benefit from working with a doctor or therapist to learn stress management techniques.

Dr. Hans Selye of the University of Montreal is considered the founder of modern stress research. Bettmann/Corbis

What Is the Antidote for Too Much Stress?

The antidote for stress is relaxation, creating a state of ease, rest, and repose within the body. Taking a deep breath almost always is the first step toward relaxation, allowing us to figure out that the emergency that triggered the bodys stress response has ended.

Relaxation response

At the end of a stress response cycle, the body begins a relaxation response: Our breathing slows down, our hearts stop racing, our muscles stretch out, our minds become quieter, and levels of stress hormones in our bodies return to their baseline values. Techniques for achieving a relaxation response are many and varied. Some people listen to music or sing, go for a long walk or a run in the park, or practice meditation. Other techniques that promote a relaxation response include yoga, abdominal breathing, progressive muscle relaxation, biofeedback, guided imagery or visualization, hypnosis, prayer, support groups, or spending time with pets or loved ones. Because stress is an inevitable part of living, the long-term antidote for stress is to learn coping strategies that allow us to live with it successfully.

The Relaxation Response

Dr. Herbert Benson of Harvard coined the termrelaxation responsefor the bodys antidote to its stress response. Triggered by a 20-minute period of meditation, the relaxation response leads to decreases in heart rate, breathing rate, blood pressure, muscle tension, metabolic rate, oxygen consumption, lactic acid production, and anxious thoughts.

To achieve the relaxation response, Dr. Benson recommended a quiet environment, a comfortable position, a focal point (a repeated word or sound, such asOm), and a passive attitude toward distracting thoughts that enter the mind.


Resilient people who experience high levels of stress but recover quickly and show low levels of illness often are referred to asstress-resistant personalities.According to researchers, such resilient people seem to have several common characteristics:

  • They view change as a challenging and normal part of life, rather than as a threat.
  • They have a sense of control over their lives, they believe that setbacks are temporary, and they believe that they will succeed if they work toward their goals.
  • They have commitments to work, family, friends, support networks, and regular activities that promote relaxation, including hobbies, vacations, sports, yoga, and meditation.

Some people seem to be born with resilient personalities and good stress management skills. They know instinctively how toget by with a little help from their friends.However, at times when a little help is not enough and only extra-strength help will do, or when a person needs some coaching to improve coping skills, it is always a good idea to turn to a doctor, counselor, or therapist.

See also

Anxiety and Anxiety Disorders

Chronic Illness



Post-Traumatic Stress Disorder





American Institute of Stress, 124 Park Avenue, Yonkers, NY 10703. This organization publishes the newsletter Health and Stress and provides informational packets about job stress, holiday stress, stress management, and other topics. Telephone 914-963-1200

International Stress Management Association. This organization publishes the International Journal of Stress Management for professionals. Its website features stress inventories, Internet links, and other resources.

Stress Management Briefs. These fact sheets on children and stress, coping with change and loss, occupational stress, identifying stress factors, and other topics are provided by the University of Minnesota Extension Service.

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"Stress." Complete Human Diseases and Conditions. . 19 Jan. 2018 <>.

"Stress." Complete Human Diseases and Conditions. . (January 19, 2018).

"Stress." Complete Human Diseases and Conditions. . Retrieved January 19, 2018 from


stress †hardship, affliction; †force, pressure XIV; physical strain; legal distraint XV; overpowering adverse force XVI; emphasis, spec. of utterance XVIII. Aphetic of DISTRESS or, in part, of OF. estrece, -esse narrowness, straitness, oppression :- Rom. *strictia, f. L. strictus STRAIT, STRICT.
So stress vb. †constrain, restrain XIV; †distress; overstrain XVI; lay stress on XIX. In earliest use aphetic — OF. estrecier :- Rom. *strictiāre. Later senses are f. the sb.

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"stress." The Concise Oxford Dictionary of English Etymology. . 19 Jan. 2018 <>.

"stress." The Concise Oxford Dictionary of English Etymology. . (January 19, 2018).

"stress." The Concise Oxford Dictionary of English Etymology. . Retrieved January 19, 2018 from


stress A measure of the intensity of a force (F) acting upon a body as a function of its area (A), such that stress = F/A, in units of N/m2. Stress can be resolved into two important components. Compressive (tensile) stress (σ) acts normal to the surface (see NORMAL STRESS) and changes the volume of the body; shear stress (τ) acts parallel to the surface and changes the shape of the body. See also STRAIN.

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"stress." A Dictionary of Earth Sciences. . 19 Jan. 2018 <>.

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stress (stres) n. any factor that threatens the health of the body or has an adverse effect on its functioning, such as injury, disease, or worry. Constant stress brings about changes in the balance of hormones in the body. s. fracture see fracture. s. incontinence see incontinence.

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"stress." A Dictionary of Nursing. . 19 Jan. 2018 <>.

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stress In medicine and psychology, mental or physical strain brought on by pressures from the environment. Stress caused by frustrating and difficult work; family or social situations may be a factor in many mental and physical disorders.

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"stress." World Encyclopedia. . 19 Jan. 2018 <>.

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stress In physics, internal tension in a material. Tensile stress stretches an object, compressive stress squeezes it and shearing stress twists it. Fluid stresses are called pressure.

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"stress." World Encyclopedia. . 19 Jan. 2018 <>.

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STRESS / stres/ • n. Comput. a language designed for use in solving civil engineering structural analysis problems.

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"STRESS." The Oxford Pocket Dictionary of Current English. . 19 Jan. 2018 <>.

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stress A physiological condition, usually affecting behaviour, produced by excessive environmental or psychological pressures.

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"stress." A Dictionary of Ecology. . 19 Jan. 2018 <>.

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stress A physiological condition, usually affecting behaviour, produced by excessive environmental or psychological pressures.

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"stress." A Dictionary of Zoology. . 19 Jan. 2018 <>.

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Stress is best thought of as a negative emotional statea psychophysiological experience that is both a product of the appraisal of situational and psychological factors as well as an impetus for coping (Baum, 1990). Stressorsevents posing threat or challenge or otherwise demanding effort and attention for adaptationare judged in terms of the situational variables and one's personal attributes and assets. Negative affect may ensue; and stress responses, which appear directed at the mobilization of bodily systems as a means of coping, strengthen specific problem solving aimed at eliminating the sources of threat or demand and at reducing emotional distress (Baum, Cohen, & Hall 1993).

(See also: Vulnerability As Cause of Substance Abuse )


Baum, A. (1990). Stress, intrusive imagery, and chronic stress. Health Psychology, 1, 217-236.

Baum, A., Cohen, L., & Hall, M. (1993). Control and intrusive memories as determinants of chronic stress. Psychosomatic Medicine, 55, 274-286.

Lorenzo Cohen

Andrew Baum

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"Stress." Encyclopedia of Drugs, Alcohol, and Addictive Behavior. . 19 Jan. 2018 <>.

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stress: see strength of materials.

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"stress." The Columbia Encyclopedia, 6th ed.. . 19 Jan. 2018 <>.

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stressacquiesce, address, assess, Bess, bless, bouillabaisse, caress, cess, chess, coalesce, compress, confess, convalesce, cress, deliquesce, digress, dress, duchesse, duress, effervesce, effloresce, evanesce, excess, express, fess, finesse, fluoresce, guess, Hesse, impress, incandesce, intumesce, jess, largesse, less, manageress, mess, ness, noblesse, obsess, oppress, outguess, phosphoresce, politesse, possess, press, priestess, princess, process, profess, progress, prophetess, regress, retrogress, stress, success, suppress, tendresse, top-dress, transgress, tress, tristesse, underdress, vicomtesse, yes •Jewess • shepherdess • Borges •battledress • Mudéjares • headdress •protectress • egress • ingress •minidress • nightdress • congress •sundress • procuress • murderess •letterpress • watercress • shirtdress •access

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"stress." Oxford Dictionary of Rhymes. . 19 Jan. 2018 <>.

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