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chapter thirteen Stress and health 425

Bengt Arnetz of Harvard University (Arnetz & others, 1987) conducted a clas- Key Terms
sic study of the effects of psychological stress on the body’s ability to fight disease.
approach-approach conflict 429
Arnetz studied a large group of Swedish women who had lost their jobs and been
approach-avoidance conflict 429
unemployed for many months. Compared with women with secure jobs, women avoidance-avoidance conflict 429
who had lost their jobs had white blood cells that were less reactive to infec- conflict 428
tions. Similarly, Janice Kiecolt-Glaser and colleagues (1987) of Ohio State Univer- coping 444
sity compared the immune system functioning of married and divorced women. defense mechanisms 445
The immune systems of recently divorced women functioned less well than those frustration 428
of married women, but with gradual improvements occurring over the first year general adaptation syndrome
(GAS) 432
after divorce. Within the group of married women, furthermore, immune func-
health psychology 447
tioning was poorest for those women with the unhappiest marriages.
immune system 434
Many other studies have confirmed findings that stress influences the
multiple approach-avoidance
functioning of the immune and cardiovascular systems (Chida & others, 2010; conflict 430
Cohen & others, 2007; Robles, Glaser, & Kiecolt-Glaser, 2005). These studies person variables 439
offer strong evidence for the intimate relationship between our psychological pressure 430
lives and our physical health. It now seems clear that psychological stressors progressive relaxation training 447
can diminish the body’s ability to fight disease. social support 438

If stress is inevitable, and if too much stress is a threat to our psychological stress 425
Type A personality 439
and physical well-being, then coping well with stress is of paramount impor-
tance. A healthy and happy person is someone who can enjoy the good times
and cope with the bad. Sometimes we can cope with stress by removing it—by
changing jobs or filing a complaint against a sexually harassing boss. We can-
not remove all the stress from our lives, however, and will inevitably have
to cope with some of it (Davydov & others, 2010; Taylor & Stanton, 2007).
Generally, we are better able to cope with the kinds of stress with which we
have previous experience and that we can control somewhat. Good social sup-
port also improves our ability to cope with stress. Simply disclosing our nega-
tive experiences and feelings to friends (or to a psychotherapist) can improve
immune system functioning and reduce need for medical care in many cases
(Lyubomirsky & others, 2006; Richards & others, 2000).

Stress: Challenges to Coping

The stressful events that we all experience are sometimes important challenges to our
health and happiness. Stress can be thought of as any event that strains or exceeds an stress Any event or circumstance
individual’s ability to cope (Ellis & Boyce, 2008; Lazarus, 1999). We discuss stress that strains or exceeds an individual’s
here to provide you with a new perspective on both stress and your health. The extent ability to cope.
to which stress is related to many of our most serious medical conditions was greatly
underestimated until research dramatically altered our perceptions of our own health.
Leading causes of death and disability such as heart disease and stroke are almost cer-
tainly linked to stress (Aboa-Éboulé & others, 2007), and as we saw in the prologue
to this chapter, immunity to infections is greatly affected by stress (Cohen & others,
2007; Robles & others, 2005). This makes the interface with psychology one of the
most important frontiers in medicine today.

Sources of Stress
We need to begin our discussion of stress by looking at its causes. Most sources of
stress are obvious to us all—they rip and tear at our lives—but other sources of stress

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426
Figure 13.1
The percentage of women who
experience serious levels of stress
symptoms following the traumatic
stress of assault is very high one
month after the assault but declines
gradually over the first year. Some
women still show serious levels of
stress symptoms a year after being
assaulted, however, particularly if the
assault was sexual.
(Foa & Riggs, 1995).
life events Psychologically significant
events that occur in a person’s life,
such as divorce, childbirth, or change
in employment.
lah35163_ch13_424-457.indd 426
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part six Health and Adjustment
100
Percent with serious stress symptoms
80
60
Sexual assault
40
20 Nonsexual assault
0
1 2 3 4 5 6 7 8 9 10 11 12
Months since assault
are quite surprising. Knowing what causes stress is the first step in understanding and
coping with it. The major sources of stress include the following factors.
Life Events. The most obvious sources of stress are major life events that create
stress because they require adjustment and coping (Dohrenwend, 2006; Monroe &
others, 2007). Although we mostly discuss negative life events in this section, keep
in mind that even positive life changes, such as getting married or entering graduate
school, also can be stressful.
Negative life events that create stress for us include such things as the loss of
employment and being in an automobile crash. The most stressful negative life events
that have been studied by psychologists include the following:
1. Violence, war, and sexual assault. Many studies document that being in
a war (Bayer & others, 2007; Neuner & others, 2008; Ramchand & others, 2008;
Vinck & others, 2007) and being the victim of a sexual assault or other violent crime
are profoundly stressful experiences (Dohrenwend, 2006; Hedtke & others, 2008).
For example, in a classic study Edna Foa and David Riggs (1995) interviewed a
group of women who were the victims of assault. They asked them if they were
experiencing high levels of irritability and anxiety, upsetting memories or dreams
about the assault, and distressing flashbacks in which they had the illusion of being
assaulted again. As shown in figure 13.1, the great majority of women experienced
high levels of such stress symptoms one month after the assault, with the percent-
age declining gradually over the course of the first year. Over 40% of the women in
this study who had been sexually assaulted still experienced serious levels of post-
traumatic stress symptoms a year after the sexual assault.
2. Loss of a family member. The death of a spouse or a child can be tremen-
dously stressful (Dohrenwend, 2006). For example, Sidney Zisook and Stephen
Schuchter (1991) examined the stressful effects of the death of a spouse in a large
sample of women and men. As shown in figure 13.2, widowed women and men were
more likely to exhibit serious depression during the first year after the death of their
spouse than were married women and men who had not lost their partners.
3. Natural disasters. Natural disasters also can be powerfully stressful nega-
tive life events (McFarlane & van Hooff, 2009). For example, the 1980 Mount Saint
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chapter thirteen Stress and health 427

30 Figure 13.2
The death of a spouse is a severe

Percent of seriously depressed

stressor that leads to serious
depression in some widowed men and
widows and widowers women.
20
(Zisook & Schuchter, 1991).

Widowed

10

Not widowed

0
2 7 13
Number of months since the death of a spouse

Helens volcanic eruption was extremely stressful to the residents of nearby Othello,
Washington. Compared with the preceding year, the residents of Othello had 200%
more stress-related physical illnesses and psychological disorders, and the town
police responded to 45% more reports of family violence. Indeed, the number of
deaths in Othello increased by 19% in the year following the eruption (Adams &
Adams, 1984). Similar effects have been reported for persons who were in the direct
path of hurricanes, earthquakes, tsunamis, and other natural disasters (Asarnow &
others, 1999; La Greca, Silverman, & Wasserstein, 1998; Roussos & others, 2005).
For example, Hurricane Katrina in 2005 resulted in high levels of stress-related prob-
lems among the residents of New Orleans and nearby coastal areas (Galea & others,
2007).
4. Terrorism. For many years, people in many troubled parts of the world have
had to cope with the stress of terroristic attacks. Since the close of the 20th century,
terrorism has become a sadly common source of intense stress for Americans as well.
The bombing of the federal building in Oklahoma City in 1995 killed 148 adults and
19 children. The attacks on the World Trade Center and the Pentagon on Septem-
ber 11, 2001, killed thousands more and shocked the world. Not surprisingly, many
studies have found that anxiety, depression, sleep problems, and intrusive flashback
thoughts about the disaster were common long after the attacks, particularly for those
who were near the attack or who lost loved ones or possessions (Druss & Marcus,
2004; Holman & others, 2008; Ramchand & others, 2008).
5. Daily hassles. It is not surprising that major negative events are stressful, but
the small hassles of daily life are also important sources of stress. The pressures at
work, getting a speeding ticket, losing your glasses, having your friend arrive an hour
late for dinner, and countless other daily irritants can grate abrasively on mind and
body (Ben-Ari & Lavee, 2004; Monroe & others, 2007).
6. Positive life events. Even positive life events can be stressful under some cir-
cumstances (Dohrenwend, 2006; Shimizu & Pelham, 2004). College graduation, the
birth of a child, job promotion, and the purchase of a house are examples of events
that most people think of as positive, but they may also require stressful adjustments
in patterns of living. Hence, positive life changes can be another source of stress of
which we are typically unaware.
The relationship between life events and physical illness has been the subject of
research for over 40 years. This research began when United States Navy physicians
Thomas Holmes and Richard Rahe (1967) developed a scale to measure the amount
of stress on sailors in terms of the “life change units.” Table 13.1 (on p. 428) shows
this scale of stress of events and the amount of stressful impact that Holmes and Rahe

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428 part six Health and Adjustment

Table 13.1 The Social Readjustment Rating Scale

Life Event Mean Value Life Event Mean Value

Death of spouse 100 Son or daughter leaving home 29

Divorce 73 Trouble with in-laws 29
Marital separation 65 Outstanding personal achievement 28
Jail term 63 Spouse begins or stops work 26
Death of close family member 63 Begin or end school 26
Personal injury or illness 53 Change in living conditions 25
Marriage 50 Revision of personal habits 24
Fired at work 47 Trouble with boss 23
Marital reconciliation 45 Change in work hours or conditions 20
Retirement 45 Change in residence 20
Change in health of family member 44 Change in schools 20
Pregnancy 40 Change in recreation 19
Sex difficulties 39 Change in church activities 19
Gain of new family member 39 Change in social activities 18
Business readjustment 39 Mortgage or loan for lesser purchase (car, TV, etc.) 17
Change in financial state 38 Change in sleeping habits 16
Death of close friend 37 Change in number of family get-togethers 15
Change to different line of work 36 Change in eating habits 15
Change in number of arguments with spouse 35 Vacation 13
Mortgage or loan for major purchase (home, etc.) 31 Christmas 12
Foreclosure on mortgage or loan 30 Minor violations of the law 11
Change in responsibilities at work 29

Reprinted from Journal of Psychosomatic Research, Vol. 11 by Thomas H. Holmes and R. H. Rahe, “The Social Readjustment Scale,” 1967, with permission from Elsevier Science.

believed each event has on our lives. The individual filling out this scale indicates
which events have happened to him or her during the past year and adds up the units of
impact. Holmes and Rahe (1967) found that Navy personnel who had recently expe-
rienced unusually high levels of life stress were more likely to develop medical prob-
lems while on sea duty than were individuals with fewer life change units.
One lesson from studies of life events is to space out your life changes when you
can. Try not to graduate from college, move to a new city, take a new job, buy a new
house, get married, and have a baby all in one year. If you do, don’t be surprised if you
are moody, have stomachaches, and have more colds.

frustration The result of being
unable to satisfy a motive.
conflict The state in which two or
more motives cannot be satisfied
because they interfere with one
another.
Frustration. When we are not able to satisfy a motive, frustration results. You
see frustration in the face of a child who cannot reach the toy he’s dropped or in the
exasperation of the college senior who finds that she cannot register for the one class
she needs to graduate. When frustrations are serious, as in the case of underpaid work-
ers who are denied raises, or when individuals experience the limits imposed by racial
discrimination, they can be a major source of stress (Gallo & Matthews, 2003; Mays
& others, 2007).
Conflict. Conflict is closely related to the concept of frustration. Conflict occurs
when two or more motives cannot be satisfied because they interfere with one another.

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chapter thirteen Stress and health 429

Suppose you have been invited to spend a week skiing

with friends, and then your car breaks down. You check
your budget and find that you can afford either to fix your
car or go skiing—that is a conflict. Psychologists use the
terms approach and avoidance in discussing conflicts. In
this sense, we “approach” things that we want and “avoid”
things that we do not want. There are four major kinds of
conflicts involving approach and avoidance (Lewin, 1931;
Miller, 1944):
1. Approach-approach conflict. In approach-
approach conflict, the individual must choose between
two positive goals of approximately equal value. Suppose
that when you finish school you are fortunate enough to
Frustration results when we are unable to satisfy a motive.
be offered two attractive jobs. Both seem to offer good
working conditions, good prestige, and reasonable salary.
If both jobs are so good, why do you feel so anxious? Why are you having stom- approach-approach conflict
achaches and trouble sleeping? Even though both goals are positive—you would be Conflict in which the individual must
choose between two positive goals of
happy with either job—the choice between these two goals can be very stressful.
approximately equal value.
This is an example of a hidden source of stress. Because everything looks so posi-
tive, it’s often difficult to see that you are in a serious conflict. The choice between avoidance-avoidance conflict
two colleges, two roommates, or two ways of spending the summer can be similarly Conflict in which the individual
stressful. must choose between two negative
outcomes of approximately equal
2. Avoidance-avoidance conflict. This type of conflict involves more obvi- value.
ous sources of stress. In avoidance-avoidance conflict, the individual must choose
between two or more negative outcomes. The person with a toothache must choose approach-avoidance conflict
between the pain of the tooth and the anticipated discomfort of going to the dentist. Conflict in which achieving a positive
goal will produce a negative outcome
3. Approach-avoidance conflict. Approach-avoidance conflict arises when as well.
obtaining a positive goal necessitates a negative outcome as well. A student who is
accepted to college in another state will be in a stressful conflict if she knows that
it will mean being separated from her serious boyfriend, who works in his family’s
business in her hometown. Attending the college will have both positive and nega-
tive consequences, so she may experience considerable stress, especially as the time
grows nearer for beginning school (Eyal & others, 2004).
Note that I said the student would especially experience stress as the time grows
nearer for her to attend college. There is an important and interesting fact about
approach-avoidance conflict behind that statement. As the positive and negative out-
comes grow nearer (attending college and leaving the boyfriend, respectively), either
in distance or time, the relative strength of the motives to approach and avoid them
changes. This change has been described graphically in terms of the gradients of
approach and avoidance. The strength of the motive to approach the positive goal of
attending college increases slowly (has a gradual gradient). At any particular distance
from the goal, the effective amount of motive to approach or avoid is the remainder
when the motive to avoid is subtracted from the motive to approach.
At greater distances, there is a stronger motive to approach than avoid, so the net
motive is to approach. At shorter distances, the motive to avoid is stronger than the
motive to approach, so there is a net motive to avoid. Let’s look at what this means in
terms of our example.
The student who had been accepted to college began to experience a high level
of stress about the time that the strength of the approach and avoidance motives In an avoidance-avoidance conflict,
were about equal. If the motives to approach and avoid were actually about equal the individual must choose between
in strength as diagrammed in figure 13.3 (p. 430), she might have even changed her two or more negative outcomes,
mind and given up her admission to college as the time to attend college came nearer such as the pain of the tooth or the
and the net motive switched strongly in favor of avoidance. After turning down her expected discomfort of going to the
admission, however, she would have again been at a great “distance” from college. dentist.

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430 part six Health and Adjustment

She might again feel a motive to approach and wish

Strength of motive to approach or avoid

Avoidance
gradient she had not decided against going.
Strong Have you ever found yourself in such a con-
flict? Did you find yourself going back and forth
Approach on a decision? If so, you have had a very common
gradient human experience. The actual outcome of such a
conflict depends on many factors, particularly the
relative strength of the two motives.
Researcher Seymour Epstein vividly demon-
strated the stressfulness of approach-avoidance
conflicts in his classic study of parachute jumpers
Weak (Epstein, 1982). Epstein views parachute jumping
as an approach-avoidance conflict because the jump
entails both dangerous risks and exhilarating thrills.
Far Near
In his research, inexperienced jumpers were rigged
Distance from goal with devices to measure the amount of sympathetic
autonomic arousal by monitoring changes in skin
Figure 13.3 sweat. As shown in figure 13.4, the autonomic reac-
Gradients of approach and avoidance in an approach-avoidance conflict. tion of the jumpers mounted dramatically to a peak
at the moment of the jump, then returned to normal
60 levels immediately after they landed. Although
Midpoint altitude

55 few of us face such obvious approach-avoidance

conflicts, the more subtle conflicts in our lives affect
50
us in similar ways.
45
Final altitude
Conductance in microohms

4. Multiple approach-avoidance conflict.

1,000 feet

40 Sometimes the conflicts that we face are complex

Airborne
Engine warmup, end
Engine warmup, begin

35 combinations of approach and avoidance conflicts.

A multiple approach-avoidance conflict requires
30
the individual to choose between alternatives that
Reaching airport

Takeoff

25 contain both positive and negative consequences.

Pre-checkout

Taxi, begin

Taxi, end
Control day

In aircraft

20 Imagine that you are a promising high school

athlete and you have been offered athletic scholar-
15
ships to two colleges. One is from a strong school
10 that won its conference championship in basketball
Landing

5 last season, but you dislike the coach and several of

the players on the team. The other is from a weaker
0 school that has had an embarrassing record of
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Jump sequence performance in recent years, but you like the coach
and the players. What do you do? Do you go to the
Figure 13.4 stronger college, where there are people you do not
The amount of sympathetic autonomic arousal (as measured by changes like, or do you go to the weaker school, where you
in the electrical conductance of the skin caused by changes in skin sweat)
like the people with whom you would be playing?
in inexperienced parachutists at different “distances” from the approach-
avoidance goal of jumping. This is a multiple approach-avoidance conflict
because both choices involve both positive and
Source: Data from S. Epstein and W. D. Fenz, “Steepness of Approach and Avoidance Gradients in negative outcomes.
Humans as a Function of Experience: Theory and Experiment,” Journal of Experimental Psychology,
70:1–12, 1965. Copyright 1965 by the American Psychological Association.

multiple approach-avoidance Pressure. Does the pressure of working for good

conflict Conflict that requires grades ever get to you? If you have been employed,
the individual to choose between was it a high-pressure job? Have you ever had problems paying your bills? The term
two alternatives, each of which
pressure is used to describe the stress that arises from threats of negative events. In
contains both positive and negative
school, there is always the possibility that you will not perform well and you will fail.
consequences.
Some jobs are loaded with possibilities for making a mess of things and getting fired
pressure Stress that arises from the (Melamed & others, 2006). Some unhappy marriages are sources of pressure because
threat of negative events. one spouse always seems to displease the other, no matter how hard he or she tries to

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chapter thirteen Stress and health 431

avoid it. Trying to balance the usual demands of our lives with the demands of taking
care of a family member who needs special care also can be stressful for some people
(Vitaliano, Young, & Zhang, 2004).

Environmental Conditions. There is growing evidence that aspects of the envi-

ronment in which we live (temperature, air pollution, noise, humidity, and so on) can
be sources of stress (Staples, 1996). For example, urban riots have occurred much
more frequently on hot (mid-80s Fahrenheit) than cool days, although they have been
rare on extremely hot days, perhaps because extreme heat leads to lethargic lack of
energy (Baron & Ramsberger, 1978). Visits to the psychiatric emergency room of
California’s Sacramento Medical Center were found to be related to environmental
conditions (Briere, Downes, & Spensley, 1983). Similarly, figure  13.5 shows that
visits to emergency rooms in Canada for depression—usually involving a risk of
suicide—are more common on days with greater air pollution. This increase in risk
is greater in warm than cold weather and is greater among older adults (Szyszkowicz
& others, 2009). The types of pollutants measured in this study come primarily from
the unsustainable burning of oil and coal products in motor vehicles and power plants. The term pressure is used to describe
the stress that arises from threats,
such as the possibility of poor
performance on an exam.
General Aspects of Stress Reactions
Now that we have looked at the causes of stress, let’s examine our reactions to it.
When we are under stress, we feel it—we react to it. To fully benefit from the les-
sons that recent research has taught us about stress reactions, we must understand two
important insights about stress:
1. First, we react to stress as a whole. That is, stress usually produces both psy-
chological and physiological reactions—not one or the other, but both. If we remem-
ber from chapter 3 that several key aspects of the nervous system—the hypothalamus
and the autonomic nervous system—control key aspects of both psychological
functioning (emotions and motives) and body functioning, including the endocrine
glands, this concept is easier to understand. It is through these joint systems that
stress affects both our physical and psychological selves.
20
2. Second, our psychological and bodily reactions to stress are highly Warm
similar, whether the stress is physical or psychological. Although each 18 months
Percent change in relative risk

source of stress evokes coping reactions that are specific to it, a general 16 Cold
reaction to all types of stress also occurs, based largely on the interlinked months
14
responses of the hypothalamus, the sympathetic division of the autonomic
nervous system, and the adrenal glands. 12

10

8
Psychological Reactions to Stress. Stress leads to changes in many
6
aspects of our psychological states and process—changes in our emotions,
motivations, and cognitions. Under stress, we feel some combination of the 4
emotions of anxiety, depression, anger, and irritability (Cano & O’Leary, 2
2000). We experience changes in our energy, appetite for food, and inter-
0
est in sex. Cognitive changes occur as well: we may have difficulty con- CO NO2 SO2
centrating, lose our ability to think clearly, and find that our thoughts keep
returning to the source of the stress. In most cases, these changes in our Figure 13.5
psychological states and processes are temporary. In some cases, however, Visits to the emergency rooms for depression
are higher on days when air pollution is higher,
stress leads to long-lasting changes in emotions, motivations, and cognition. particularly during warm months (Szyszkowicz
We will have more to say on this topic in the next chapter, on abnormal & others, 2009). CO 5 carbon monoxide; NO2 5
behavior. nitrogen dioxide; SO2 5 sulphur dioxide.

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432
general adaptation syndrome
(GAS) According to Selye, the
mobilization of the body to ward off
threats, characterized by a three-stage
pattern of the alarm reaction, the
resistance stage, and the exhaustion
stage.
Figure 13.6
Changes in resistance to stress during
the three stages of the general
adaptation syndrome. Note that a
second stress produces a more rapid
dissipation of resistance.
Source: Data from H. Selye, The Stress of Life.
Copyright 1976 McGraw-Hill Book Company.
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part six Health and Adjustment
Physical Reactions to Stress and Health
Although nearly everyone knows that stressful events influence our emotions, they
may be surprised to learn that stress can influence the physical functioning of our
bodies. To understand the effects of stress on our health, we first examine general
aspects of the body’s response to stress, look at some specific ways in which stress
affects health, and then see how psychological and social factors affect our responses
to stress.
The General Adaptation Syndrome. Canadian medical researcher Hans Selye
first gave us the insight more than 70 years ago that the body reacts to psychological
stress in much the same way as it reacts to infection or injury. Regardless of the threat,
the body mobilizes its defenses to ward off the threat in a pattern referred to by Selye
as the general adaptation syndrome (GAS). Three stages can be distinguished in this
syndrome, as shown in figure 13.6 (Ganzel & others, 2010).
1. Alarm reaction. As shown in figure 13.7, the body’s initial response to
any threat, including psychological stress, is to mobilize its stored resources. The
sympathetic division of the autonomic nervous system increases heart rate and
blood pressure, diverts blood away from digestion and into the skeletal muscles,
increases perspiration, and in other ways prepares the body for a physical struggle.
The endocrine glands pump epinephrine and other hormones into the bloodstream
that aid the actions of the autonomic nervous system and increase levels of blood
sugar. The immune cells in the body that fight infection also are activated by these
hormones.
When stress is intense or prolonged, these body changes give rise to conscious
feelings of general muscle tension, stomachaches, headaches, and other feelings of
“sickness” (Maier & Watkins, 2000). In the early stages of the general adaptation
syndrome, it’s often difficult to know if you are catching a cold or stressed. During
the alarm reaction stage, the rapid mobilization of resources leaves the individual
temporarily less resistant to the stress than originally. This state of affairs is quickly
changed as the next stage is entered.
2. Resistance stage. During the second stage of the GAS, the body’s resources
have been fully mobilized, and resistance to the stress is high (Segerstrom & Miller,
2004). This resistance is costly in terms of resources, however. If new stress is
encountered, the body is less able to deal with it. Moreover, if the stress continues,
the individual’s resources will eventually become depleted, leading to the third stage
of the GAS (Segerstrom & Miller, 2004).
First stress reaction
Resistance to stress
Normal
level
Second stress reaction
Alarm Resistance Exhaustion
reaction stage stage
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chapter thirteen Stress and health 433

Figure 13.7
The body mobilizes its resources
Hypothalamus for “fight-or-flight” in the general
adaptation syndrome in response to
Pituitary stress.

Sympathetic
outflow

Heart

Liver

Adrenal
gland

Cortisol Epinephrine
Norepinephrine

3. Exhaustion stage. If the stress continues, the individual’s resources may

become exhausted, and resistance to the stress and infection is lowered (Ray, 2004).
In cases of prolonged exposure to severe physical stress (such as prolonged exposure
to very cold temperatures), death can occur during the exhaustion stage. Psychologi-
cal stress is rarely able to precipitate death, but it can severely disrupt body function-
ing (Selye, 1976).
Note in figure 13.6 that if a second stressor is encountered when the individual
has already entered the GAS, the progress toward exhaustion is much more rapid.
Keep in mind two additional points as you think about the GAS. First, not all stress-
ors overwhelm and exhaust the body; obviously, we cope effectively with most stress.
Second, emotional and other psychological reactions to stress follow roughly the
same GAS pattern, sometimes resulting in “emotional exhaustion” when coping fails.

Healthy and Unhealthy Aspects of the GAS. As Selye (1976) helped us see, the gen-
eral adaptation syndrome is the body’s protective response to dangers. Without the
GAS, we humans would be very frail creatures indeed. Then the body’s complex reac-
tion to stress—the GAS—is a blessing, right? Unquestionably, but it is a very mixed
blessing. The GAS can be our best defense at times but our own worst enemy at other
times (Ganzel & others, 2010).

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434
Natural disasters can be potent sources of stress.
Modern-day stressors, such as
preparing forms for tax deadlines,
call for all of the body’s reactions of
the general adaptation syndrome.
Although the GAS is a lifesaver
in emergencies, it can be life-
threatening if stress is prolonged.
immune system The complex body
system of defenses to illness, such as
white cells and natural killer cells of
the blood.
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part six Health and Adjustment
The GAS does its best work during emergen-
cies. Whether suddenly exposed to a deadly virus or
being lost on a freezing ski trail, we need our bodies
to respond with an alarm reaction to such emergen-
cies. Our physical ability to endure such threats is
enhanced for a while by the GAS.
Even our ability to cope behaviorally is helped
by the GAS at times. I once narrowly missed step-
ping on a poisonous water moccasin, and my body
responded with a GAS alarm reaction. My auto-
nomic nervous system went into screaming sympa-
thetic arousal and produced a multitude of changes in
my body that prepared me to respond behaviorally to
the snake. For purposes of simplicity, let’s look only
at changes in my cardiac system during the moments
that followed. Sympathetic arousal of the autonomic
nervous system caused my adrenal glands to pump
epinephrine, norepinephrine, and other stress hor-
mones into my bloodstream. These, in turn, increased my blood pressure and caused
my blood to create substances that make the blood clot faster. My heart beat faster,
rushing oxygen to my muscles, and blood flow was diverted from my liver and diges-
tive organs to the muscles in my legs and arms. Those physiological changes that we
call the alarm phase of the GAS were very welcome indeed as I jumped, turned tail,
and ran from the water moccasin. My legs were supplied with the necessary oxygen to
run to the next county, and I didn’t mind one bit that my lunch was not being digested
properly. Because blood flow to my liver was diminished during the GAS, it was not
filtered as usual and my cholesterol levels probably rose, but I didn’t mind that, either.
And, if I had fallen and cut my knee, I would have been glad that hormones had pre-
pared my blood to clot quickly.
Most of the stressors that we face in contemporary society, however, are not
snakes, bears, or avalanches. More often, they are the day-to-day stresses of school,
work, and families. Remember, however, that the body’s reaction is much the same
regardless of the source of stress. As a result, the GAS is not only unnecessary for
some stressors, it can be dangerous if it is prolonged.
Take the example of preparing your income taxes—an annoying stress, but not
one requiring speedy legs, high blood pressure, or fast-clotting blood. Nonetheless,
a group of accountants was given repeated blood tests for several months and found
to have normal levels of blood-clotting factors and cholesterol, until the April 15
deadline for filing tax returns grew near; then their cholesterol and clotting fac-
tors shot up (Friedman & Rosenman, 1974). Unfortunately, elevated levels of blood
pressure, cholesterol, and blood-clotting factors are a potentially deadly combina-
tion, because they cause the formation of the “clots” of cholesterol inside arteries,
called plaque, that clog and harden blood vessels. When the affected blood vessels
are those that supply the heart muscles with oxygen, a heart attack can result. Since
the time of this original study, many other studies have been conducted that suggest
that many kinds of stressful life events affect blood clotting, blood pressure, and
other aspects of the functioning of the heart that increase the risk of heart attack
(Ganzel & others, 2010; Kubzansky & others, 2007; Matthews, 2005; Slavich &
others, 2010; Taylor, 2010). Thus, although the GAS is a lifesaver in the face of
emergencies, it can paradoxically affect the cardiac system in ways that can be quite
dangerous to our hearts.
Stress, the GAS, and the Immune System. As we saw in the prologue to this chap-
ter, another negative aspect of stress is that it decreases the effectiveness of the
body’s natural disease-fighting system, the immune system. Many studies now
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 Confirming Pages

chapter thirteen Stress and health 435

show that stress reduces the effectiveness of the immune system (Cohen & others, 40

Percent with upper respiratory infections

2007; Robles, Glaser, & Kiecolt-Glaser, 2005; Segerstrom & Miller, 2004). For
35
example, Sheldon Cohen (1996) conducted a classic experiment on the effects of
stress on immunity to the common cold virus. Volunteers completed questionnaires 30
that measured stressful life events and were interviewed about a variety of health
practices. Then they were exposed to live cold viruses and were watched to see who 25
developed a cold. Even after the effects of poor health practices (smoking, drink-
20
ing, poor eating, poor exercising, and poor sleeping) were considered, life events
were associated with less immunity to the cold virus. As shown in figure 13.8, more 15
volunteers with above-average numbers of life events developed upper respiratory
infections than did volunteers with below-average numbers of life events. I am 10
sorry to tell you that even the stress of studying for college examinations temporar- 5
ily suppresses the immune system (Segerstrom & Miller, 2004). Unfortunately, the
older you become, the more stress takes a toll on your immune system (Segerstrom 0
Below average Above average
& Miller, 2004).
Number of life events

Depression, Anxiety, and Health. Stress gives rise to depression and anxiety Figure 13.8
Volunteers with above-average
in some persons (Beck, 2008; Monroe & others, 2007) and persons with high levels numbers of stressful life events were
of depression and anxiety have impaired immune system functioning, poorer health, more likely than volunteers with
and higher rates of death from cardiac disease (Barnes & others, 2006; Irwin & below-average numbers of life events
Miller, 2007; Mykletun & others, 2009; Robles, Glaser, & Kiecolt-Glaser, 2005). to develop upper respiratory infections
Indeed, the increased risk for early mortality due to depression is as great as that (“colds”) after being experimentally
exposed to live cold viruses.
caused by cigarette smoking (Mykletun & others, 2009). Depression influences
health through its effects on inflammation, heart functions, and the immune sys-
tem (Cohen & others, 2007; Padmos & others, 2008). Conversely, people who are
generally happy people tend to be healthier (Cohen & Pressman, 2006; Roysamb &
others, 2003).

A human life that was completely free of stress would be pretty dull, but excess stress can
take a toll. Stress comes from a variety of sources in our lives. Frustration over not being
Review
able to satisfy a motive, conflicts arising from mutually incompatible motives, pressure, and
unpleasant environmental conditions are all sources of stress. Similarly, life events, both
negative ones such as the loss of employment and positive ones such as marriage, can be
potent sources of stress. These sources of stress lead to stress reactions. People react to
stress in both psychological and physical ways. Stress brings anxiety, anger, and depression
but also body changes such as increased appetite, headaches, and difficulty sleeping. Under
some circumstances, stress even leads to high blood pressure, increased blood cholesterol,
and decreased efficiency of the body’s immune system. The body tends to react to all stress-
ors, psychological and physical ones, in much the same way. This nonspecific response to
stress has been called the general adaptation syndrome.

To be sure that you have learned the key points from the preceding section, cover the list
of correct answers and try to answer each question. If you give an incorrect answer to any
Check Your
question, return to the page given next to the correct answer to see why your answer was Learning
not correct. Remember that these questions cover only some of the important information
in this section; it is important that you make up your own questions to check your learning
of other facts and concepts.

1. can be thought of as any event that strains or exceeds an individual’s

ability to cope.

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