Methods of measuring stress and their effectiveness

23 Mar 2015

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Firstly introduced by Hans Selye (1950), the term stress is more used to describe an individual's state of tension which is often seen as being related to modern life. However, stress assessment is made using different method which includes:

Self report

Biomedical

Physiological

Self report: Life events (Holmes and Rahe 1976)

The most common way of assessing stress is by self-report questionnaires, in which individuals answer questions about their mental or physical state. As a result, two medical doctors, Holmes and Rahe (1976) suggested that major life events, whether good or bad, were potentially stressful. Holmes and Rahe were the first to record the effects of life events in a systematic way. By their study, they observed that patients often experienced several life events in the months before the onset of illness, and as a result, these life events seemed to be associated with poor health and stress. They suggested that, stress is caused by change that can lead to greater susceptibility to physical and mental health disorders. They demonstrated the associations between life events, stress and illness by developing some method of measuring life events. Accordingly, they compiled the ''Social Readjustment Rating Scale'' (SRRS) by examining 5000 patient records and making a list of 43 life events both positive and negative that seemed to precede illness . Approximately 400 participants were involved in the rating of each item in terms of the quantity of stress produced, out of which 500 was assigned to marriage as a reference point. The averaged results were then divided by 10 to get a measure of the individual events in terms of life change units (LCU).

An example of Social Readjustment Rating Scale (SRRS)

LIFE EVENTS

Rank

Life Event

Stress Value

1

Death of a spouse

100

2

Divorce

73

3

Marital separation

65

4

Jail term

63

5

Death of a close family member

63

6

Personal injury or illness

53

7

Marriage

50

8

Fired at work

47

9

Marital reconciliation

45

10

Retirement

45

13

Sex difficulties

39

23

Son or daughter leaving

29

38

Change in sleeping habits

16

40

Change in eating habits

15

41

Vacation

13

42

Christmas

12

43

Minor violations of the law

law

11

Reference

Adapted from Holmes, T., & Rahe, R. (1967). The social readjustment rating scale. Journal of psychosomatic research, 11, 213-218.

Doctors, Holmes and Rahe (1967) findings suggested that the stress of life events is correlated with physical illness; hence experiencing life events increases the chances of stress-related health breakdown. They were however criticised for being bias by investigating only American men and using only correlational methods.

 

Assessing the effectiveness of the ''Self report'' as a method of stress measurement

The SRRS provides the basis for perhaps the most active current area of stress research and also retrospective investigation using either the SRRS or SRE (Schedule of Recent Experience) have demonstrated a linear relationship between mounting life change, cardiac death, accidents, diabetes, leukaemia and infectious disease (Holmes& Masuda, 1974).

Using the research questionnaire, Holmes & Rahe (1950) tested various sub-groups to see if the ratings were consistent, e.g. male and female, single and married and so on. As there was strong agreement between different groups, it seemed that the SRRS was a valid measure for all types of people regardless of their backgrounds. This contributes to the effectiveness of the self report method of stress measurement.

This SRRS questionnaire (Holmes and Rahe, 1976) has served as a well-known tool for measuring the amount of stress one has experienced within the past year. Taking the test can help one see clearly if they're at risk of illness due to stress.

The method provided some of the first evidence that there is a genuine association between stressful life events and physical illness.

Also, the fact that physical health was assessed after life events increases the chances that life events were helping to cause problems with physical health, rather than the other way round

The Social Readjustment Rating Scale (SRRS) and the research associated with it represent a major breakthrough, this is because, it is now generally accepted that life events of various kinds can influence our psychological well-being and our physical and mental health.

The development of the SRRS has made it easier to carry out research to test these ideas. This in turn has led to a clearer understanding of the ways in which life events affect us.

Indirect evidence that stressful life events play a role in life threatening diseases was reported by Selye, Tache and Day (1979).According to these researchers, cancer was more common among adults who divorced, widowed or separated than among those who were married. The most likely explanation is that, those who were not married were stressed because of lack of social support. It is however hard to establish causal relationships from such data (SSRS data). Perhaps those who were divorced or separated were more vulnerable to stress than those who were married; hence, this stress vulnerability played a role in the collapse of their marriages

One of the limitations to this method is that, it has often been assumed that almost any serious life can help to produce any type of illness. This has led to a relative ignoring of more specific effects. Supporting evidence to this effect was where, two men, Finlay -Jones and Brown (1981) found that anxious patients were more likely than depressed patients to have experienced danger events(involving future threats), whereas depressed patients were more likely to have experienced loss events (involving past loses). More research into such studies will however be useful.

Another negative side of the SRRS is that, a number of studies have shown that people's illness rates increase following increase rates in stress scores. However, a number of items on the scale are vague e.g. 'personal injury or illness' appears to suggest that someone could have the same stress score for flu and cancer. Second, there is no general failure to consider the impact of an event on an individual. Christmas is considered to be a mildly stressful event, yet to some people, Christmas may seem extremely stressful, as it may emphasize their loneliness.

The SRRS has face validity because many of the events listed are easily recognisable as stressful events. The values Allocated to each stress event have been carefully calculated from data provided by the opinions of many people. The survey form can be filled out easily and quickly.

With reference to Raphael et al. (1991), Self-report measures of life events are unreliable. A study had subjects fill out a scale regarding life events they experienced during the prior year. The subjects then filled out the same Questionnaire every month for a year. Towards the end of the year the reports were quite different from the ones made at the beginning of the year (Raphael, et al. 1991). The questionnaire or scale also ignores chronic stresses such as money problems, general hassles etc. Taking this into account, the measure could be considered invalid.

Biomedical: Stress and ulcers (Brady 1958)

One of the biomedical methods of measuring stress is the evidence that stress may be a causal factor in stomach ulcers. This research was first described by Joseph Brady (1958). Brady did classic studies linking high levels of stress to increased hormone production and the development of ulcers. Brady did this by placing monkeys in ''restraining chairs'' and conditioned them to press a lever. The monkeys were then given shocks every 20 seconds unless the lever was pressed during the same time. This experiment however came to an abrupt halt when unexpectedly many of the monkeys died because of ulcers caused by raised gastrointestinal hormone levels. The question put forward was whether the ulcers resulted from the electric shock or the stress. To enhance his results, Brady and his mates used yoked controls where one monkey called ''executive'' was liable for controlling the lever while a second monkey received the shocks but had no control over the lever. Thus, only the ''executive'' monkey had the physiological stress of having to press the lever, but both animals received shocks. After 23 days of 6 hours on and off schedule, the executive monkey died because of perforated ulcer. Brady initially thought that the stress might be related to the reinforcement schedule. He also tried several other routines such as 18 hours on and 6 hours off and tested the executive monkey to find out that stomach acidity was greatest during this period.

After the experiment, Brady concluded that it was clearly stress, not the shocks that created the ulcers. Having said that, he also concluded that the greatest danger happened while the sympathetic arousal stopped and the stomach was flooded with digestive hormones, which is a parasympathetic rebound linked with hypothalamic-pituitary-adrenocortical axis, hence HPA.

Assessing the effectiveness of the ''biomedical '' as a method of stress measurement

The research carried out by Brady (1958) proved effectively that stress may be a causal factor in stomach ulcers. Stress often increases the secretion of hydrochloric acid, which plays in the development of some ulcers. Stress also weakens the defences of the gastrointestinal tract against this acid, thereby permitting gastric ulcers to develop. (Pinel, 1997).

Supporting evidence to the effectiveness of Brady's experiment is Weiner et al. (1957) findings in support to Brady's experiment. Weiner et al. (1957) used army recruits to test for the effectiveness of Brady's experiment. Prior to basic training, the soldiers were tested and classed on the basis of their release of digestive enzymes as over-secretors or under -secretors. After four months of stressful training, 14% of the over-secretors had developed ulcers, whereas none of the under-secretors had. This suggests not only that the same principles apply to humans, but also that individual differences may be important in view of the fact that not all of the over-secretors developed ulcers.

Biochemical method of measuring stress involves adrenaline and noradrenalin hormones. These hormones provides effective measures of stress

The research also suggested that too much stress at work can lead to development of ulcers.

Brady's experiment was however criticised for not randomly selecting the monkeys and also, using non-human samples

Subsequent research has also demonstrated that ulcers are not always stress related, there could be an underlying biological cause. E.g. fungi

Brady's experiment is associated with the Hypothalamic -Pituitary-Adrenocortical Axis, this in effect elevates levels of glucose and some hormones including the ACTH (Acetylcholine) and the body continues to use its resources at an accelerating rate.

Stress-triggered increases in heart rate and blood pressure. This may result in the deterioration and blocking of blood vessels thereby increasing cardiovascular disorders and chronic stress.

Many physical, organisational and social factors in the workplace can become sources of stress, usually exerting a relatively long-term, stable and chronic influence. Work overload, lack of control, and poor interpersonal relations at work may all lead distress, ill health and eventual burnout. Hence, ''biomedical'' serves as a suitable method for assessing stress at a work place

Physiological: Biofeedback

Physiological measures in stress provide indications of the level of sympathetic nervous arousal. This can include a person's heart rate, blood pressure, and respiration rate and so on. One of the common physiological methods used in measuring stress is ''biofeedback''.

Biofeedback is a technique which involves recording the activity of the physiological systems of the body's stress response, that is the heart rate, blood pressure or tension in the neck muscles. This enables the individual to monitor their own physiological arousal in real times and develop control over it (Gatchel, 1997). During the process, the individual is attached is attached to a machine which produces feedback about some physiological activity such as an auditory or visual signal to indicate whether his / her heart rate is too high or moderate. The individual is also trained in techniques to reduce physiological aspects of stress such as relaxation training. One of the common ways humans can learn to control their brain-waves is by using electroencephalogram (EEG) biofeedback.

Electroencephalogram (EEG)

An EEG involves placing electrodes on a person's scalp to record the small changes in electrical activity of the brain. These changes are displayed on a computer screen. EEGs are often used to measure changes in brain activity during the different stages of sleep; however, in biofeedback EEG is used to give visual feedback of the activity of the waking brain. Biofeedback training however involves three stages, they include:

Developing an awareness of the particular physiological response such as the heart rate

Learning ways of controlling that physiological response in quiet conditions. This can include providing rewards for successful control in addition to no feedback

Transferring that control into the conditions of everyday life.

Assessing the effectiveness of biofeedback as a method of measuring stress

This method has been effective in significant long-term reductions in stress in everyday life and has also led to benefits by producing a sense of control rather than purely psychological methods. Attanasio et al (1985) researched and found that biofeedback helped teenagers and children with stress related disorders to gain control over the symptoms of migraine headaches. The approach was however criticised that it treated symptoms rather than underlying conditions.

Biofeedback has enjoyed a brief surge of popularity since its inception in the late 1960's. It has successfully treated many medical problems, particularly stress related illnesses such as incontinence, anxiety, hypertension, circulatory problems, irritable bowel syndrome and so on.

Since its inception, it has produced significant long term reductions in stress in everyday life without any side effects unlike the other physiological approach (drugs)

Biofeedback may lead to benefits by producing a sense of control rather than purely psychological methods. It is however not invasive, but rather voluntary.

Arguably, the benefits of biofeedback could be gained from another relaxation technique and so biofeedback is an unnecessary expense. This serves as a limitation to biofeedback as a method of measuring stress.

Recommendation of one way of stress measurement for use by the company

Above all these methods of measuring stress, I will recommend ''life events'' which falls under ''self report'' because it is by this way that the individual can fully express his/her feelings and pain through subjective questionnaire about their mental and physical state.

Criteria 3.1

Physiological approach to stress management and control

Stress control and management is the attempt that is made to cope with stress through reduction of the of the stress response. There are many approaches to reducing a person's stress levels, but usually, it is aimed at the physiological and psychological effects of stress. The basic target for stress management is usually based on changing the individual's perception of the stressor.

Physiological approaches to stress management are techniques that try to control the body's response to stress by reducing physiological activity. The physiological components of stress can include physiological arousal, sleep disturbance, fatigue, gastrointestinal disturbances, headaches, concentration problems, increased expression of irritability and anger, agitation, increased likelihood for illness, and reduced productivity. The impact and the expression of these stress symptoms vary with the individual and the stressful event. Two physiological methods for controlling stress include biofeedback and stress. However, I am going to evaluate one out these two, which is Anti-anxiety drugs technique.

Anti-anxiety drugs

Anti-anxiety drugs are medicines that are used calming and relaxing severe stress cases. They can also be used to calm nervousness, tension or for specific phobia disorder. The human body produces chemicals such as hormones and neurotransmitters that create anxiety, which can be countered using other chemical substances such as drugs that reduce anxiety. There are different types of anti- anxiety that work through different mechanisms. The most common drugs are:

Beta-blockers

Benzodiazepines

Alcohol (rarely used)

Beta-blockers

Beta-blockers are one of the drugs used control stress by reducing activity in the sympathetic nervous system. They have a direct action on the heart and circulatory system hence; they decrease the heart rate and lower peripheral blood pressure. Their effects are on the body however, they do not have direct effects on brain activity. Lau et al. (1992) considered the findings from numerous studies in a meta-analysis hence combining data from several studies. Thus, beta-blockers have proved useful in reducing blood pressure and in treating patients with heart disease. Psychological research also concludes that, the drug reduced the risk of death by about 20% in patients suffering from heart disease. It also enhances performance in musicians and public speakers (Taylor 1995). However, one disadvantage of beta-blockers is that, they target symptoms rather than causes of anxiety and stress hence providing only temporary improvement.

Benzodiazepines

Sometimes when drugs are taken, they elapse in natural processes by controlling the action of neurotransmitters. Types of benzodiazepines include ''Valium'' and Librium which are used for increasing the neurotransmitter GABA, which decreases serotonin activity, which eventually reduces arousal. Benzodiazepines are very effective and used worldwide by approximately hundred million people. Despite its effectiveness, benzodiazepines have got some side effects which are linked to low levels of serotonin. Common effects can include drowsiness, causing of cognitive and memory impairments, feelings of depression, and interacting unpredictably with alcohol Ashton (1997). Another effect of the drug is that, it is more likely to be involved with accident.

Strengths of Anti-anxiety drugs

Anti-anxiety drugs can be very effective in controlling severe feelings of stress. Beta blockers for instance act on the autonomic nervous system to reduce heart rate/blood pressure physiological stress arousal.

Anti-depressant drugs, less often used, can be appropriate for severe anxiety

Benzodiazepines such as Valium increase the activity of the inhibitory neurotransmitter GABA in the brain.

Anti-anxiety drugs decrease arousal and relax the body by reducing tension in the muscles. Since stress response involves high arousal, tranquillizers may in some cases reduce stress

Weaknesses of Anti-anxiety drugs

Anti-anxiety drugs like benzodiazepines work by reducing brain activity. While this temporarily relieves anxiety, it can also lead to unwanted side effects.

The higher the dose, the more pronounced these side effects typically are. But some people feel sleepy, foggy, and uncoordinated even on low doses of benzodiazepines, which can cause problems with work, school, or everyday activities such as driving. Some even feel a medication hangover the next day.

Because benzodiazepines are metabolized slowly, the medication can build up in the body when used over longer periods of time. The result is over sedation. People who are over sedated may look like they're drunk.

Anxyolitic drugs can cause psychological and physical dependence, tolerance and addiction.

Psychological approach to stress management and control

Psychological approach to stress control and management are the techniques that try to control the cognitive, social, and emotional responses to stress. They do this by addressing the underlying cause of stress such as faulty thinking. This approach works by changing the person's perception of the stressor and increasing their perception control. One psychological approach to stress control and management is the cognitive-behavioral therapy.

Cognitive-behavioral therapy

Cognitive-behavioral therapy to controlling stress is based on the cognitive appraisal definition of stress and aims to change a person's perceptions and thoughts relating to, and dealing with stressful disorders. This therapy is appropriate for dealing with stress hence the assumption behind the cognitive approach is that, it is the way one thinks about the problem that is maladaptive. Thus, if an individual can be trained to reorganize their thinking and self-beliefs, the underlying problem itself may simply disappear. This approach to managing stress involves: stress inoculation training and hardiness training.

Stress inoculation training

Stress inoculation training (SIT): Unlike many cognitive therapies, stress inoculation training (SIT) is a more problem-focused coping strategy. It was developed by Donald Meichenbaum (1977, 1985) and the basic idea was to prepare individuals to cope with potential stressors. According to Meichenbaum (1985), the best way to cope with ''stressors'' is to go on the offensive and try to pre-empt them. People should try to anticipate sources of stress and have effective coping strategies ready to put in place. Meichenbaum (1985) describes SIT as:

"Analogous to the concept of medical inoculation against infectious diseases… It is designed to build 'psychological antibodies' or coping skills, and to enhance resistance through exposure to stimuli that are strong enough to arouse defences without being so powerful as to overcome them." (Meichenbaum 1985)

There are three main phases in stress inoculation training:

1. Assessment: with this training, the therapists discuss the nature of the problem with the individual, and solicit the individual's perception of how to eliminate it. Meichenbaum (1985) considers this relationship to be very important as it provides the 'glue' that allows the various aspects of the therapy to work together.

2. Stress reduction techniques: the individual learns various techniques for reducing stress, such as relaxation and self instructional training, communication, assertion, problem solving, anger control, parenting, study skills and using social support by using coping self statements.

3. Application and follow through: In this final phase, the individual imagines using the stress reduction techniques learned in the second phase in difficult situations and engages in role play of such situations with the therapists, before using the techniques in a real life situations.

Strengths of stress inoculation training

One important strength of Stress Inoculation Training (SIT) is that, it is very flexible. This is because, it consists of a wide variety of cognitive and behavioural techniques tailored to the individual needs of the client, which can be used to deal with many types of stressor (e.g., time-limited/persistent, controllable/uncontrollable, predictable/unpredictable, current/in the past).

It has been found to be successful in helping people deal with the stress of chronic pain, performance anxiety, specific phobias and work related stress (Meichenbaum, 1977, 1985). This training has also helped athletes deal with the stress of competition (Mace, Eastmen & Carroll, 1986) and helping patients prepare for surgery (Langer, Janis & Wolfer, 1975).

Weakness of stress inoculation training

Stress inoculation training is however of less value when treating individuals who are highly stressed or exposed to very stressful situations. Most individuals differ in how easy they find it to use coping self statements in stressful situations.

Hardiness training

Over these years, much research into stress has shown that there are significant individual differences in the way that people respond to stress. Since some individuals seem to cope better than others do, it makes sense to try to isolate the reasons why they can do so. The hope is that more effective ways of coping can be passed on to help those who are not as well prepared. Suzanne Kobasa (1986) has identified such individuals, who she describes as hardy, as those whose cognitive strategies are better suited to dealing with stress. For example, they are more able to identify the symptoms of stress hence avoiding action can be taken in time. They make more realistic assessments of stressors, including being aware of the positive aspects of stressful situations, opportunities and new challenges. Kobasa suggests that hardiness can be improved with appropriate training. Her programme consists of three techniques:

1. Focusing: This explains that one should focus on the physical signs of stress and beware when further attention is needed.

2. Reconstructing stress situations: This technique the individual to think about recent stressful situations and note how it might have turned out both better and worse, hence becoming aware that things could have been worse enables you to feel more positive.

3. Compensation through self-improvement: If an individual is affected by a stressor that cannot be changed or avoided, then it may be helpful to take on another challenge that can be mastered. Consequently, this assures you that you can hope.

Strengths of hardiness training

There is little direct research evidence on the effectiveness of hardiness training and what research there is, however, Fischman taught a small number of executives these strategies and they had greater job satisfaction, fewer headaches, and better sleep patterns

Weaknesses of hardiness training

Reports were made that people who have followed this kind of programme do score higher on a test of hardiness, report feeling less stressed, and have lower blood pressure than before, Sarafino (1990).

The study was done on a small scale and there was no follow-up, so results may have been due to increased attention and communication only

Summary

Both Meichenbaum (1985) and Kobasa's(1986) approaches to stress management place great emphasis on the individual gaining control of a stressful situation because it is more often the sensation of being 'out of control' that takes a situation beyond a person's ability to cope.



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