Discuss theories of stress and the effects of stress on psychological and physical well-being.

Psychological stress is a popular term denoting processes believed to contribute to a variety of mental and physical conditions. Despite widespread interest in the construct and its consequences for health and well-being, there is little consensus on definitions for psychological stress. Three perspectives for defining and studying psychological stress are reviewed with respect to their history, development, and current status. The three perspectives on psychological stress differ in terms of the relative emphasis each places on the environment, the organism, and the interaction between organism and environment over time. Conceptual and methodological considerations and implications of the three perspectives are reviewed. Promising leads for future inquiry are addressed.

Biometric Fairness, Psychological Comfort and Safety

Biometrics should not cause undue psychological stress to subjects, and should not introduce unwarranted privacy issues. Some biometric controls, such as retina scans as we will see shortly, are rarely used, for this reason.

Biometric controls must be usable by all staff, or compensating controls must exist. In a large organization (10,000 or more employees), some staff may not have fingerprints, or eyes, etc. These issues must be considered, and fair controls must exist for all staff.

Notice that modern airports often have bathrooms with no doors? Entrance is now typically via a short corridor with multiple turns (which block open view from a concourse into the bathroom). This is done to avoid multiple people touching a door handle (and possibly spreading disease). Most airport toilets now flush automatically for the same reason.

Potential exchange of bodily fluid is a serious negative for any biometric control: this includes retina scans (where a user typically presses their eye against an eyecup), and even fingerprint scanning (where many subjects touch the same scanner). Fully passive controls, such as iris scans, may be preferable (there is no exchange of bodily fluid).

1.2 Psychological Stress: The Lazarus Theory

Two concepts are central to any psychological stress theory: appraisal, i.e., individuals' evaluation of the significance of what is happening for their well-being, and coping, i.e., individuals' efforts in thought and action to manage specific demands (cf. Lazarus 1993).

Since its first presentation as a comprehensive theory (Lazarus 1966), the Lazarus stress theory has undergone several essential revisions (cf. Lazarus 1991, Lazarus and Folkman 1984, Lazarus and Launier 1978). In the latest version (see Lazarus 1991), stress is regarded as a relational concept, i.e., stress is not defined as a specific kind of external stimulation nor a specific pattern of physiological, behavioral, or subjective reactions. Instead, stress is viewed as a relationship (‘transaction’) between individuals and their environment. ‘Psychological stress refers to a relationship with the environment that the person appraises as significant for his or her well being and in which the demands tax or exceed available coping resources’ (Lazarus and Folkman 1986, p. 63). This definition points to two processes as central mediators within the person–environment transaction: cognitive appraisal and coping.

The concept of appraisal, introduced into emotion research by Arnold (1960) and elaborated with respect to stress processes by Lazarus (1966, Lazarus and Launier 1978), is a key factor for understanding stress-relevant transactions. This concept is based on the idea that emotional processes (including stress) are dependent on actual expectancies that persons manifest with regard to the significance and outcome of a specific encounter. This concept is necessary to explain individual differences in quality, intensity, and duration of an elicited emotion in environments that are objectively equal for different individuals. It is generally assumed that the resulting state is generated, maintained, and eventually altered by a specific pattern of appraisals. These appraisals, in turn, are determined by a number of personal and situational factors. The most important factors on the personal side are motivational dispositions, goals, values, and generalized expectancies. Relevant situational parameters are predictability, controllability, and imminence of a potentially stressful event.

In his monograph on emotion and adaptation, Lazarus (1991) developed a comprehensive emotion theory that also includes a stress theory (cf. Lazarus 1993). This theory distinguishes two basic forms of appraisal, primary and secondary appraisal (see also Lazarus 1966). These forms rely on different sources of information. Primary appraisal concerns whether something of relevance to the individual's well being occurs, whereas secondary appraisal concerns coping options.

Within primary appraisal, three components are distinguished: goal relevance describes the extent to which an encounter refers to issues about which the person cares. Goal congruence defines the extent to which an episode proceeds in accordance with personal goals. Type of ego-involvement designates aspects of personal commitment such as self-esteem, moral values, ego-ideal, or ego-identity. Likewise, three secondary appraisal components are distinguished: blame or credit results from an individual's appraisal of who is responsible for a certain event. By coping potential Lazarus means a person's evaluation of the prospects for generating certain behavioral or cognitive operations that will positively influence a personally relevant encounter. Future expectations refer to the appraisal of the further course of an encounter with respect to goal congruence or incongruence.

Specific patterns of primary and secondary appraisal lead to different kinds of stress. Three types are distinguished: harm, threat, and challenge (Lazarus and Folkman 1984). Harm refers to the (psychological) damage or loss that has already happened. Threat is the anticipation of harm that may be imminent. Challenge results from demands that a person feels confident about mastering. These different kinds of psychological stress are embedded in specific types of emotional reactions, thus illustrating the close conjunction of the fields of stress and emotions.

Lazarus (1991) distinguishes 15 basic emotions. Nine of these are negative (anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust), whereas four are positive (happiness, pride, relief, and love). (Two more emotions, hope and compassion, have a mixed valence.) At a molecular level of analysis, the anxiety reaction, for example, is based on the following pattern of primary and secondary appraisals: there must be some goal relevance to the encounter. Furthermore, goal incongruence is high, i.e., personal goals are thwarted. Finally, ego-involvement concentrates on the protection of personal meaning or ego-identity against existential threats. At a more molar level, specific appraisal patterns related to stress or distinct emotional reactions are described as core relational themes. The theme of anxiety, for example, is the confrontation with uncertainty and existential threat. The core relational theme of relief, however, is ‘a distressing goal-incongruent condition that has changed for the better or gone away’ (Lazarus 1991).

Coping is intimately related to the concept of cognitive appraisal and, hence, to the stress-relevant person-environment transactions. Most approaches in coping research follow Folkman and Lazarus (1980, p. 223), who define coping as ‘the cognitive and behavioral efforts made to master, tolerate, or reduce external and internal demands and conflicts among them.’

This definition contains the following implications. (a) Coping actions are not classified according to their effects (e.g., as reality-distorting), but according to certain characteristics of the coping process. (b) This process encompasses behavioral as well as cognitive reactions in the individual. (c) In most cases, coping consists of different single acts and is organized sequentially, forming a coping episode. In this sense, coping is often characterized by the simultaneous occurrence of different action sequences and, hence, an interconnection of coping episodes. (d) Coping actions can be distinguished by their focus on different elements of a stressful encounter (cf. Lazarus and Folkman 1984). They can attempt to change the person–environment realities behind negative emotions or stress (problem-focused coping). They can also relate to internal elements and try to reduce a negative emotional state, or change the appraisal of the demanding situation (emotion-focused coping).

6 Combined Effects of Physical and Psychosocial Adversities at Work

Extensive research has been devoted to the disentanglement of physical from psychological stress in studies of health and disease. For instance, in the study of the importance of ergonomic load to the development of musculoskeletal disorders, it has been considered important to adjust for psychological stress. Extensive epidemiological studies of large samples of subjects have shown that ergonomic load contributes to the development of musculoskeletal disorder but that psychosocial factors at work may also contribute significantly (Kilbom et al. 1996). Recent studies have shown that combinations of physical and psychosocial factors may be of particular importance (Vingård et al. in press).

It has been pointed out by several authors (House and Cottington 1986) that combinations of physically adverse (chemicals, radiation, physical load, infections) and psychosocial conditions may be of particular importance to health in a changing world. It is not possible to monitor all new chemicals that are used, and our psychosocial conditions are changing. Accordingly, analyses of interactions will be of increasing importance (Rantanen 1999)

It has been important for the study of relationships between working conditions and health to have theoretical models which form the basis for hypothesis testing. The interplay between the individual and the environment has been an important point of departure in all theoretical modeling in this field. Some of the models have focused on environmental, for instance, the demand–control model, and some on individual aspects, for instance, the eustress–distress model. The person–environment fit (PE fit) and the effort–reward imbalance models are examples of models which take the interaction between the individual and the environment into account. These four models will be described briefly below.

4 Current Directions

Interest in the psychology of social settings has experienced a resurgence in contemporary research on psychological stress (Goldberger and Breznitz 1993). The social ecological principles that have guided the study of social settings are central to contemporary models of the stress and coping process. The social settings where individuals live, work, and learn can be significant sources of distress. Stressful settings, such as demanding work environments that allow little control, explain a wide range of behavioral and health outcomes. Moreover, linkages between settings can markedly increase stress responses, such as when a pileup of work demands exacerbates chronic family strains.

At the same time, an appreciation of the dynamic nature of the inter-relationship between people and social settings provides insight into some ways individuals can reduce or avoid distress. Social settings are sources of adaptive resources, such as social support from family members and colleagues at work, that can operate as stress resistance factors when stressors occur. In addition, stress-diathesis (vulnerability) models can help to educate individuals to seek settings where their adaptive capacities best match setting requirements. Finally, transactional models of coping (Lazarus and Folkman 1984) underscore how active, problem-focused coping strategies can help individuals to manage stressors successfully and even to grow psychologically through stressful encounters.

The definition and measurement of environmental stressors, including crowding, noise, and ambient air pollution, are described. Psychological stress is employed as a heuristic device to understand how the physical environment can influence human psychological functioning. Effects of each of these stressors on psychophysiological stress, cognitive performance, interpersonal relationships, and mental health are summarized. Methodological and conceptual limitations are briefly noted. Current research on underlying explanatory processes is discussed, focusing on the concepts of control and social support. Future needs for research on environmental stressors and human behavior include the following: prospective, longitudinal research designs with calculations of dose-response functions; more complete daily exposure estimation of stressor exposure; investigation of other underlying psychosocial processes in addition to control and social support; and examination of environmental stressors within the more ecologically valid, multiple stressor contexts in which they are situated.

The root of the problem

There is no doubt that the design of these do-it-yourself scales leads to cognitive load and to psychological stress. Nevertheless, even if this might apparently seem just a memory-related issue, its real cause lies elsewhere. The cognitive effort we exert in trying to remember the product number is mostly due to the difficulty of finding the matching icon or button on the scale's display. And if you think this is again just the result of having too many products from which to choose you are being misled. The cognitive load has not as much to do with the large numbers of options as with how these choices are organized and presented. Reduction is a way to address this design issue.

Reduction - The capability of an information space to minimize the cognitive load and frustration associated with choosing from an ever-growing set of information sources, services, and goods. It is also a set of strategies to address such an issue and has nothing to do with getting rid of choices: reduction is an organizational and presentational guideline.

3.3 Stress and the Immune System

A large amount of literature shows the impact of stress on changes in immune system functioning (cf. Biondi 2001). Chronic psychological stress or increased allostatic load is generally shown to be associated with decreased immune responses as well as enhanced severity of infections. Consequently, a stress-related suppression of cellular immune system functioning can, for instance, lead to increased susceptibility to or severity of the common cold (Cohen et al. 1991). While chronic stress seems to precede blunted immune response, acute stress may be potentially beneficial: experiencing acute stress can enhance the trafficking of immune cells to the site of acute challenge, resulting in an immune-enhancing effect over several days (cf. McEwen 2000). Acute stress may call immune cells ‘to their battle stations,’ thus enhancing short-term immunity (cf. Dhabar 2000, Dhabar and McEwen 1997).

Possible mechanisms involved in the relationship between psychological stress and immune function changes, covering the stress–disease connection, are discussed in Biondi (2001). There seems to be a complex connection between emotional stress and the development of cancer. In sum, human data on psychological factors and cancer are controversial, but apparently there is support that psychological stress may contribute to disease manifestation and progression. Concerning infectious diseases, some studies have reported negative findings. However, human data point to a possible role that stress plays in increasing the risk of tuberculosis, influenza, upper respiratory infections in children and adults, as well as recurrences of herpes labialis virus and genital herpes virus, or HIV progression. Biondi (2001) summarizes that psychological stress could act as a cofactor in the pathogenesis, course, and outcome of infectious diseases in animals and humans. The exact role of psychological factors in the pathogenesis and course of specific autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosis, multiple sclerosis, ulcerative colitis, Crohn's disease, joint inflammation, psoriasis) is still poorly understood. In view of the clinical complexity of these illnesses, a simple connection between psychological stress and the status of an autoimmune disease cannot be presumed. For asthma bronchiale, there appears to be some support for the assumption that this illness could be exacerbated by psychological stress via immune–inflammatory mechanisms. Finally, the process of wound healing appears to be impaired under chronic as well as minor psychological stress, a process which may be mediated by proinflammatory cytokines (Glaser et al. 1999).

Taxonomy of Defense

Unfortunately, there is as much disagreement about the taxonomy of defense mechanisms as about the taxonomy of personality types, but progress is being made. First, adaptation to psychological stress can be divided into three broad classes. One class consists of voluntary cognitive or coping strategies which can be taught and rehearsed; such strategies are analogous to consciously using a tourniquet to stop one's own bleeding. The second class of coping mechanisms is seeking social support or help from others; such support seeking is analogous to seeking help from a doctor in response to bleeding. The third class of coping mechanisms are the relatively involuntary defense mechanisms. Such coping mechanisms are analogous to depending on one's own clotting mechanisms in order to stop bleeding.

Anna Freud (1936), Sigmund Freud's daughter, was the first investigator to introduce a formal taxonomy of defenses. By the 1970s due to the protean and ephemeral nature of defensive mental phenomena, other competing taxonomies arose (e.g., Kernberg 1975, Thomae 1987, Beutel 1988, Lazarus and Folkman 1984).

Since the 1970s, several empirical studies have suggested that it is possible to arrange defense mechanisms into a hierarchy of relative psychopathology (e.g., projection (paranoia), to displacement (phobia), to sublimation (art)), and also place them along a continuum of personality development (Vaillant 1977, Perry and Cooper 1989). With the passage of decades, a sexually abused child's defenses could mature from acting out(e.g., rebellious promiscuity to reaction formation(?joining a convent where sex is bad and celibacy is good) to altruism (as a nun in midlife counseling pregnant teenage mothers). The most recent American diagnostic manual (American Psychiatric Association 1994) provides a glossary of consensually validated definitions and arranges defense mechanisms into seven general classes of relative psychopathology (Table 1).

Table 1. Defensive function scale

Source: Adapted from American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th edn. 1994 pp. 751–3 (APA Press Washington, DC); Used with permission.

All classes of defenses in Table 1 are effective in ‘denying’ or defusing conflict and in ‘repressing’ or minimizing stress, but the mechanisms differ greatly in the severity of the psychiatric diagnoses assigned to their users and in their effect on long-term psychosocial adaptation. At level I, the most pathological category, are found denial and distortion of external reality. These mechanisms are common in young children, in our dreams, and in psychosis. The definition of such denialin Table 1 is a far more narrow but more specific use of the term than many writers who use the term denialinterchangeably with defense mechanisms. Level I defenses rarely respond to simple psychological intervention. To breach them requires altering the brain by neuroleptics or waking the dreamer.

More common to everyday life are the relatively maladaptive defenses found in levels II–V. These categories are associated with adolescence, immature adults, and individuals with personality disorders. They externalize responsibility and allow individuals with personality disorders to appear to refuse help. Such defenses are negatively correlated with mental health. They profoundly distort the affective component of human relationships. Use of such defenses cause more immediate suffering to those in the environment than to the user.

Defenses in these categories rarely respond to verbal interpretation alone. They can be breached by confrontation—often by a group of supportive peers. These maladaptive defenses can also be breached by improving psychological homeostasis by rendering the individual less anxious and lonely through empathic social support, less tired and hungry through rest and food, less intoxicated through sobriety, or less adolescent through maturation.

Level VI defenses are often associated with anxiety disorders and with the psychopathology of everyday life. Level VI include mechanisms like repression (i.e., deleting the idea from a conscious emotion), intellectualization (i.e., deleting the emotion from a conscious idea), reaction formation, and displacement (i.e., transferring the emotion to a more neutral object). In contrast to the less adaptive defenses, the defenses of neurosis are manifested clinically by phobias, compulsions, obsessions, somatizations, and amnesias. Such users often seek psychological help, and such defenses respond more readily to interpretation. Such defenses cause more suffering to the user than to those in the environment.

High adaptive level (VII) defenses still distort and alter awareness of and emotional response to conscience, relationships, and reality, but they perform these tasks gracefully and flexibly—writing great tragedy (i.e., sublimation), for example, is financially rewarding, instinctually gratifying, and sometimes life saving for the author. The ‘distortion’ involved in stoicism (suppression), humor, and altruism seems as ethical and as mentally healthy to an observer as the immature defenses seem immoral and antisocial.

1 Introduction

This article examines how the concept of stress has been used to specify environmental characteristics that may lead to disturbances of intended behavior, psychological and physiological discomfort, and health aspects of residents living in the vicinity of noisy or toxical sources. The physical environments considered here have enduring characteristics and are not directly under the control of the residents. This fact constitutes one of the main characteristics of psychological stress: people may consider the environmental load to be harmful, but they usually cannot stop the emissions of the source directly. In addition, they often learn from authorities that the emissions are harmless, and yet they have to rely on authorities in order to reduce the environmental load. The focus of this article is on dose-response relationships between environmental characteristics and psychological reactions of the residents. The observed reaction-variance between residents is due partly to measurement errors both on the physical and the response side, and due partly to factors intervening between the physical characteristics and the responses. Nevertheless, in some cases there are clear dose-response relationships that can be used in order to predict the average main effects at given physical loads.