Lecture 1: Overview of the course; Nature of stress 1

What is psychology?
Psychology is the science/scientific study of behavior and mental processes.

A scientific study/science uses scientific methods. The scientific method has characteristics such as systematic
observation/empiricism, objectivity, and replicability/verifiability.

Behaviors are actions that can be observed and measured.

Mental processes includes diverse activities of the mind such as perception, thinking, memory, imagination
etc.

Overview of the course

This course will systematically address the issues related to the psychology of stress, health, and well-
being.
In the initial level, this course will discuss the concepts of stress, health, and coping processes. Specifically,
following questions will be addressed-

What is the mechanisms by which our mind creates stress?

Is there a connection between our mind and body? Can stressful experiences cause physical diseases such as
heart diseases? Can stress influence our immune system?

Are there any positive dimensions of stress?

What are healthy and unhealthy coping strategies for stress management? Are there any evidence
based coping strategies that can be used by us?

In the next level, this course will then discuss what lies beyond stress and coping paradigm. In this context,
the idea of positive mental health, happiness and well-being will be discussed.

The psychology of happiness and well-being fills the gaps in the area of stress and health by providing
understanding how can we move beyond managing stress and achieve greater sense of happiness, well-
being, flourishing and a meaningful life.
In this connection, this course will address the following questions-
What is happiness? What makes us happy? Do we really know what will make us happy? Can we
become happier? What are the barriers in achieving sustainable happiness?
Are there any evidence based happiness enhancing strategies/activities/interventions?

Is happiness sufficient for our well-being? Are there other dimensions of human well-being
 The nature of stress
Key concepts:
Why stress related problems is a global epidemic? Why is it important to understand the dynamics of
stress in our life?

What is psychological stress? Is stress an environmental stimulus? Is it a reaction in our body and mind? Or is
it an interaction between the person and the environment?

What are the mental processes involved in the stress response? What are
the different characteristics, types, and sources of stress?

Have you ever experienced the following symptoms before or after an event?
(Symptoms of stress)

Forgetfulness, confusion
Inability to concentrate
Constant worrying
Irritability/moodiness
Loneliness/isolation
Sleeping too much or too little
Eating more or less

Procrastinating
Excessive drinking of alcohol or smoking or drugs. Frequent
cold/headache/chest pain

Stress: A global epidemic

WHO dubbed stress as the health epidemic of the 21st century.

In the context of America, stress is estimated to cost around 300 billion $ per year and there is an
increase in the stress level of about 10-30% between 1983 to 2009 (Fink, 2017).

Recently, in 2019, a global well-being study conducted by Cigna corporation reported that about
82% Indians are suffering from stress on account of work, health and finance-related concerns which
is higher than other developed and emerging countries such as the USA, UK, Germany, France and
Australia.

The consequences of this rapid increase in the stress level could be devastating in multiple dimensions of
our health, well-being and functioning such as physical and mental health, performance, productivity,
quality of personal and social life etc. and accounting for a significant burden of disability within
nations.
There may be multiple possible reasons behind the rise of stress and its related problems. One major
cause could be rapidly changing world increasing challenges and demands.
 Therefore, it is very important for all of us to understand the dynamics of stress in our life because of its
far reaching implications to our health and quality of life. Without understanding the dynamics of stress
in our life, we can not lead a productive and flourishing life.

Various perspectives on definition of stress

Although the word stress today is intuitively understood by most people, its precise definition is generally
elusive. Nevertheless, it is commonplace to regard stress as undesirable and harmful to one’s health and
well-being (Harrington, 2013).
There have been many and varied attempts to define stress. We can divide these definitions into various
categories. For example-

(1) Stimulus-based definitions of stress

Stimulus-based definitions define stress as an environmental stimulus which causes a strain reaction in the
individual exposed to the stressful stimulus.
This type of definition came from the physics and engineering where a substance is said to be under
the stress when an external load produces a distorting force inside the substance called strain.
Stress is viewed as a demand from the external environment.
“stress is that which happens to the man, not that which happens in him; it is a set of causes , not a set of
symptoms” (Symonds, 1947) .

Stimulus based definitions are not in popular use now as researchers found such definitions as very narrow
and limiting.

Response-based definition of stress

Response based definitions focus on the response to the stressful stimuli as the actual stress itself. The
response is primarily viewed in terms of the physiological response patterns in the body as a result
of stressful stimuli.

One of the most popular definition in this category is-

“stress is the non-specific response of the body to any demand made upon it” (Selye 1974).

Response-based definitions of stress are also no longer popular in use just like stimulus based definitions
because of its limitations.

Interactional definition of stress

Interactional definition of stress was developed as a response to the shortcomings of the stimulus and
response based definitions. Here stress is defined in terms of interaction between the environment
(stimulus) and the person (response).
One of the most popular definition of stress in this category is proposed by Richard Lazarus and Susan
Folkman (1984). It states that- “stress is a particular relationship between the person and the
environment that is appraised by the person as taxing or exceeding his or her resources and endangering
his or her well-being”
This definition is more process-oriented and takes account of the dynamic nature of the stress
relationship between the person and the environment.

Contemporary researchers’ views stress mostly in terms of interactional perspective.

This perspective look at stress as a subjective phenomenon which depends on the appraisals and perception of
the individual

What is stress?

Stress is the experience or condition that results (anxious or threatening feelings) when we
interpret or explain a situation being more than our coping resources can handle.

Stress=Perceived situation>Personal coping resources

Stress is an individual subjective experience

A given situation may be stressful for one person and not for another. We
are stressed by different kinds of things.
There is nothing wrong or bad to feel stressed in a situation when someone else doesn’t.

What makes something as stressful?

The amount of stress each person experiences depends on his or her understanding/belief about a
situation/event (dangerous, threatening etc.).

Different things are stressful for different people largely because- The
meaning of the event differs from person to person
People have different resources available for dealing with a stressful situation.

Cognitive appraisals of stress

Appraisals of stress explain how different individuals have different reactions to the same stimulus based
on their mental interpretations of the stimulus.

Some may find an event/action as stressful, others may find exciting, and yet others may be unaffected.

This difference may result from differences in the appraisals of the event.
Lazarus’s appraisal and coping model gives us more detail.
 Lazarus’s appraisal and coping model
Lazarus and Folkman (1984) proposed a three-process cognitive appraisals consisting of primary
appraisal, secondary appraisal, and reappraisal.
Primary Appraisal: Here people judge a particular event/situation as positive or negative.
According to Lazarus, events can be appraised during primary appraisal in three possible ways. They can
be seen as irrelevant, relevant but not threatening, or stressful.
Stressful reactions occur when the situation is judged as potentially involving harm-loss, threat, and/or
challenge.
-Harm-loss appraisals are past or present oriented and result from appraisals of loss or damage that is
happening or has already happened. The losses may include loss of money, job, or psychological loss such
as loss of self-esteem.
-Threat appraisals are future oriented. When the future suggests the possibility of harm or loss, the
person will experience threat.
-Challenge appraisals see the potential for gain or growth. Threat appraisals generally evoke negative
emotions such as anxiety, fear, and anger, but challenge appraisals evoke feelings of excitement,
eagerness, and exhilaration.

Secondary Appraisal: It occurs when a situation is judged as stressful and involves the evaluation of
personal resources or ability to cope. E.g. An interview situation.
Coping processes will be discussed in detail in the upcoming lectures.

Stress Reappraisals: Here the stressful situation is reappraised based on ongoing feedback from the
situation along with the person’s self-assessment of how well he or she is dealing with the situation.

A reappraisal is simply an appraisal that follows an earlier appraisal in the same encounter and modifies
it
 Module 1 (Lecture 2)
The Nature of Stress 2

Key Concepts:
Different characteristics of stress
Major types of stress
Sources of stress

Characteristics of stress Stress is

subjective and may be self created
People are not very objective in their appraisals of potentially stressful events. Some people are
more prone to feel threatened by life’s difficulties than others.
A large chunk of our stressful experiences could be self created by our pessimistic and maladaptive
thought processes.
A large chunk of our sufferings are self created.

Stress is an everyday event

Many everyday events such as waiting in line, having car trouble, misplacing things etc. can be stressful
and are called as daily hassles.

A major stressful events, such as divorce can trigger a cascade of many minor stressors such as taking new
responsibilities.

Daily hassles may have significant negative effects on a person’s mental and physical health
(Delongis, Folkman, & Lazarus, 1988).

Stress can have an additive/cumulative effects

Research shows that minor daily hassles can be more strongly related to mental health than major
stressful events (Kanner et al, 1981).

Many theorists believe that stressful events can have a additive or cumulative effects (Seta, seta, &
McElroy, 2002).

This additive effects may have serious negative consequences when an individual experiences multiple
stressors frequently in his/her life.

Stress may be influenced by culture

Culture includes shared ideas, beliefs, behaviors of a group.
The cultural background/norms of an individual could affect their experience of stress by influencing our
appraisal/perception of an event.

Some studies suggests that the Japanese and Korean students seem to suffer greater exam stress than British
suggests a possible cultural differences in beliefs lead to differences in the experience of exams as
stressful (Colby, 1987).

Stress can have Spillover effect

Stress spillover refers to the process where stress in one domain, such as workplace spill over to create stress
in another domain such as family relationships (Grzywacz, Almeida, & McDonald, 2002) such as
marital satisfaction.

There can be positive spillover effect also. For example, positive emotions experienced at workplace can
lead to positive mood and interactions with family members at home (Greenhaus & Powell, 2006).

Stress Contagion/Stress transfer

It refers to the process where one person’s reaction to stress affects the health of a significant other
such as spouse’s depression affects one’s well-being (Saxbe & Repetti, 2010).

In an interesting study by Waters, West, and Mendes (2014) found that mothers’ stressful experiences are
contagious to their infants and can reciprocally influence each other’s physiological reactivity.

Major types of stress

Acute vs chronic stress
Acute stress: Stressors that have a relatively short duration and a clear end point. E.g., waiting for the
result of a test.

Chronic stress: Stressors that have a relatively long duration without a clear end point. E.g., Poverty

Social Stressors
Social stressors can be divided into three major categories: Life events, chronic strains, and daily hassles
(Carr & Umberson, 2013).

Life events are acute changes that require adjustment within a relatively short time period such as job
loss. Unexpected (sudden death of loved one) and off-time (widowed prematurely) life events are
more distressing (George, 1999).
Traumatic life events such as sexual assault are extremely stressful and may have long lasting effects.

Chronic stress/strain

Daily hassles: These are minor events that require adjustment throughout the day such as traffic jams.
Distress vs Eustress
Eustress is a positive stress that can be beneficial for us. For example, various challenges that puts
pressure to grow, improve, achieve goals etc.

Distress is the negative stress that we generally refer to when we talk about stress.

Other sources of stress

Frustrations: It occurs in any situation in which the pursuit of some goal is thwarted such as traffic jams.
(Weiten & Lloyd, 2007). Some frustrations such as failures and losses can be very stressful.

Psychologists John Dollard and colleagues (1939) proposed “Frustration-Aggression” hypothesis by

suggesting that (a) frustration always produces an aggressive urge and (b) aggression is always the
result of prior frustrations.

Conflicts: It occurs when two or more incompatible motivations compete for expression. (Weiten &
Lloyd, 2007).

Kurt Lewin (1935) discussed three types of conflicts-

approach-approach-when one has to choose between two equally desirable but incompatible options.
Eg., want to stay healthy and also want to eat unhealthy fatty foods.

Avoidance-avoidance-when one has to choose between two equally undesirable options. E.g., a patient with
serious illness has to choose between having a traumatic surgery or long term therapy with unpleasant
side effects.

Approach-avoidance-when there are desirable and undesirable factors within a single option. E.g., A
person wants to go to the gym but also believes gym membership is unnecessary and extravagant
expense.

Life changes: these are any noticeable changes in one’s life circumstances that require readjustment.

Holmes and Rahe (1967) developed the social readjustment rating scale (SRRS) to measure life change
as a form of stress. This scale included 43 major life events such as death of a spouse, divorce personal
injury, retirement etc.

Interestingly, they also included positive events as a source of stress such as marriage.
 Pressure: It involves expectations or demands that one behave in a certain way. There can be two types
of pressures-the pressure to perform and the pressure to conform (Weiten & Lloyd, 2007).

One is under the pressure to perform when he/she is expected to perform tasks and
responsibilities quickly, efficiently and successfully.

Pressure to conform involves pressure to follow others’ expectations such as one is expected to follow
parents values and rules.

Lecture 3 (Module 1) Biology

Of Stress

Key concepts:

Fight-or-flight response

General adaptation syndrome

Stress-brain-body pathways

Gender difference in stress response

The physiology of stress

Stressful experiences are associated with various physiological changes in the body. Some of these include
the following-

The Fight-or-Flight Response

Walter cannon (1932) was the first person to describe body’s reaction to stress in terms of fight- or-flight
response.

It refer to physiological reaction of the body as a result to threat or stressor. It mobilizes and prepares body
either for the fight (stand) or flight (run away) when confronted by a threat.

The Fight-or-Flight Response reaction occurs in the sympathetic division of the autonomic nervous system.

General Adaptation Syndrome (GAS)

Hans Selye, an endocrinologists studies changes in the body’s physiology in reaction to stressors using rat
as his subjects in 1950s.
He summarized body’s short and long term reactions to stress as a three phased process termed as GAS.

Phase 1: Alarm Reaction. It occurs once a threat is recognized. Here essentially fight-or-flight
response occurs resulting in physiological arousal to master resources to deal with the threat.

Phase 2: Stage of Resistance. If the stress continues, one enters this stage. Here the body tries to adapt to the
stressor by making many changes in the body to reduce the effect of the stressor.

Phase 3: Stage of Exhaustion. If the stress is not resolved in the phase 2 and continues for a substantial
amount of time, one may enter this stage. Here the body’s resistance to the stress may gradually decrease or
collapse quickly particularly by reducing immune functions. This may lead to “disease of adaptation”
such as ulcers or high BP.

Stress-Brain-Body Pathways
The hypothalamus is the center of the brain in the context of stress response. It activates two
pathways leading to release of stress hormones. These are-
The sympathetic adrenal medullary (SAM) system, which leads to the secretion of the two
catecholamines-adrenaline (epinephrine) and noradrenaline (norepinephrine).
The hypothalamic pituitary adrenocortical (HPA) system, which leads to the secretion of corticosteroids
such as cortisol.

In the SAM pathway, the Sympathetic NS activates adrenal medulla, which secretes the stress hormones
catecholamines (adrenaline and noradrenaline) in the blood stream. Their release increases heart rate,
blood pressure, release of glucose and fatty acids from the liver thus increasing energy in the body. This is
a quick reaction (within a minute) and is significant for coping with acute stress.

In the HPA pathway, the hypothalamus activates anterior pituitary, which secretes adrenocorticotropic
hormone (ACTH) in the blood stream which reaches the adrenal cortex which releases cortisol in the
blood steam. Cortisol influences metabolism, storage of the fats and immune functions. This process is
much slower (may take 30 minutes) and is significant for coping with chronic stress.

The bodily consequences of chronic stress response is different from the acute stress response. The chronic
stress response adversely affects our physical health.

Stress and Brain

Stress, hippocampus, and pre-frontal cortex
Chronic release of stress hormone such as cortisol adversely influence two major areas of the brain i.e.
pre-frontal cortex (executive functions such as working memory and decision making, regulating
thoughts and emotions) and hippocampus (important in learning memory and emotions).

In a study by Justin B. Echouffo-Tcheugui and colleagues (2018) found that high level of blood cortisol
was associated with poorer memory and cognitive functioning particularly for the women. It was also
associated with lower total cerebral brain volume.
Chronic stress has a shrinking effect on the pre-frontal cortex
Stress hormones such as cortisol may adversely affect the functioning of pre-frontal cortex (executive
functions such as working memory and decision making) by making structural changes such as neural
atrophy in the region (Cook and Wellman, 2004).

Chronic stress also increases the activity of amygdala and make it hyperactive and may pre- dispose us
to be in a constant state of fight-or flight.

Stress can disrupt synaptic regulation (brain cell connectivity)

It can disrupt synapse regulation (van der Kooij et al, 2014), resulting in the loss of sociability and the
avoidance of interactions with others and memory.
They discovered an enzyme (MMP-9), when triggered by stress, that attacks a molecule in the
hippocampus which is responsible for regulating synapses. When the synapses are modified, fewer
neural connections are able to be made in the area.

Gender Difference in Stress Response

Fight-or-flight response may be a primary physiological response to stress. However, Taylor and
colleagues (2000) reported that female’s response to stress are more marked by a pattern called “Tend-
and-befriend”.

This theory suggests that under stress, females show more tending behavior by giving more attention to
nurturant activities such as caring for the offspring and dependents to protect and reduce distress. They
also show befriending behavior by creating and maintaining social network to aid in the process of
protection and reducing distress.

The biological support for this theory partially comes from the “oxytocin” hormone (mainly
produced in hypothalamus). Oxytocin is also released as a response to stress, but it is more
influential among females. Oxytocin calms the females by reducing anxiety, and promotes
affiliative behavior such as grooming, touching and bonding behavior.
 Lecture 4: stress and health (non-infectious diseases)

Stress and Health

Stress in itself is not an illness, despite being an unpleasant experience. However, stress may
lead to various physical and mental health consequences. Some surveys show that stress is the
number one threat for health in the USA and about 70-90% of doctor’s visits are related to
stress (Harvard business Review, 2011).

Mind-Body connections can explain the relationships between the stress and health. The
17th-century French philosopher René Descartes (1596–1650) proposed the idea of mind-
body dualism (separation between the mind and body). However, modern research clearly
indicate that the mind and body are closely connected to each other and can influence each
other.

The mind-body connection was evident when we discussed the biology of stress.

Psychosomatic diseases

Psychosomatic diseases are the physical diseases that are caused or deteriorated by mental
factors such as stress, anxiety, depression etc. In fact, a branch of psychology called health
psychology investigates the role of psychological factors such as stress, emotions, beliefs etc.
on physical health and illness.

Historical Background
Claude Bernard (1878) used the concept of “dynamic equilibrium” to understand the disease.
The dynamic equilibrium is the stability/consistency of the inner environment. The
disturbances of this equilibrium may adversely affect our health.

Walter Canon (1929) used the term “homeostasis” as an extension of Bernard’s concept of
dynamic equilibrium. It also means the maintenance of a constant inner condition. He further
stated that conditions such as stress can disrupt homeostasis and lead to fight-or-flight response.

Hans Selye (1956) in his model of general adaptation syndrome (GAS) described changes in
the physiological responses in the body as a result of chronic stress. Initially, Alarm stage is
associated with the activation of sympathetic NS. The resistance stage is associated with the
release of glucocorticoids (such as cortisol) from the HPA axis. The exhaustion stage is
associated with the diseases of adaption (psychosomatic diseases) due to chronic release of
stress hormones such as cortisol.
 Psychoneuroimmunology (PNI) is a relatively new field of study that revealed that there is a
constant interactions between our central nervous system (CNS) and immune system. Many
studies indicated that psychological factors such as stress can influence our central nervous
system and which in turn influences our immune functions.

Pathways linking stress and health

Infectious and non-infectious diseases
Stress can lead to both infectious and non-infectious diseases. Infectious diseases occur due
to the attack of an external gents such as bacteria, viruses etc. and can be transmitted by direct
physical contact. Non-infectious diseases occur due to internal factors such as wear and
tear/malfunctioning of an organ and is not transmitted by physical contact. E.g., cardiovascular
diseases. It was evident that the physiological responses to stress is very complex and is
primarily carried out by activating two major physiological pathways-

The sympathetic adrenal medullary (SAM) system which leads to the secretion of the two
catecholamines-adrenaline (epinephrine) and noradrenaline (norepinephrine).

The hypothalamic pituitary adrenocortical (HPA) system which leads to the secretion of
corticosteroids such as cortisol.

Stress and Non-infectious/Non-communicable Diseases

Stress can contribute to the development of diverse non-infectious diseases that were
believed to be purely physiological in origin such as cardiovascular diseases. Stress related
non-communicable diseases (NCDs) such as coronary heart diseases, diabetes, chronic
pulmonary diseases, neuropsychiatric diseases etc. are the major health crisis in the 21st
century (Narayan, Ali, & Koplan, 2010).

According to the Centers for Disease Control and Prevention (CDC) Division of Global Health
Protection, the NCDs are responsible for more than 68% of deaths worldwide, and 75% of
deaths in low- and middle-income countries. NCDs are generally preceded by stress-related
metabolic syndrome such as hypertension, high cholesterol, reduced responsiveness to insulin
(Fricchione, 2018). Stress-related chronic NCDs continue to plague primary care practitioners,
resulting in enormous mortality, morbidity, and suffering and contributes to the expanding of
health care costs (Fricchione, 2018).

Cardiovascular diseases

The cardiovascular system includes heart, blood and the blood vessels of the body and is
regulated by the autonomic nervous system. Cardiovascular diseases (CVDs) are the leading
cause of death globally and causing an estimated 17.9 million lives each year (WHO, 2020).
 The diseases related to cardiovascular system primarily include coronary artery disease
(CAD)/coronary heart diseases (CHD) and hypertension. CHD develops when the coronary
arteries (blood vessels that supply oxygen and blood to the heart) becomes narrow due to fatty
deposits/cholesterol in the arterial wall resulting in reduced blood flow to the heart. This
process is called as atherosclerosis.

Hypertension also called as high blood pressure is a condition in which the force of the blood
against the wall of the artery is higher than the usual and can lead to heart diseases, strokes,
kidney damage or death. The ideal blood pressure is usually considered to be between
90/60mmHg and 120/80mmHg whereas high blood pressure is considered to be 140/90mmHg
or higher.

How stress contributes to cardiovascular diseases?

The answer is still not completely clear. However, there are many possible pathways that can
be linked to cardiovascular diseases. Some are discussed below-

The experience of stress can cause high level of physiological arousal leading to erratic and
rapid heart beat, which can cause stroke, cardiac arrest or even death to a person especially to
individuals with pre-existing heart diseases (Herbert & Cohen 1994). Stress hormones that are
released during stressful situations (cortisol, epinephrine, and norepinephrine) promotes
atherosclerosis by increases the build up of fatty patches or plaques on arterial wall leading to
the narrowing down of the artery. This narrow artery decreases the blood flow resulting in the
increase of blood pressure. This decrease in flood flow causes less oxygen flow to the heart
muscle which may result in chest pain/angina and heart attack (Herbert & Cohen 1994).

Broken Heart Syndrome

Stress can cause “Broken Heart Syndrome”, particularly in women following a
stressful/traumatic event.

According to John Hopkins medicine website-

“the “broken heart syndrome,” is a condition in which intense emotional or physical stress can
cause rapid and severe heart muscle weakness (cardiomyopathy)….. With stress
cardiomyopathy, we believe that the heart muscle is overwhelmed by a massive amount of
adrenaline that is suddenly produced in response to stress. The precise way in which
adrenaline affects the heart is unknown. It may cause narrowing of the arteries that supply the
heart with blood, causing a temporary decrease in blood flow to the heart.”
Broken heart syndrome, also called stress-induced cardiomyopathy can strike even if you’re
healthy.

According to the American Heart association website (heart.org)-

 “Women are more likely than men to experience the sudden, intense chest pain-the reaction to
a surge of stress hormones-that can be caused by an emotionally stressful event. It could be the
death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic
rejection. It could even happen after a good shock (like winning the lottery.)…..Broken heart
syndrome may be misdiagnosed as a heart attack because the symptoms and test results are
similar. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart
syndrome.”

Stress and Cholesterol

Stress can increase the bad cholesterol level in the body directly or indirectly through
unhealthy behaviors. A study by Catalina-Romero et al. (2013) collected data from 91,593
participants and found a positive correlation between those who experienced job stress and
unhealthful cholesterol levels in their body. Another study by Assadi (2017) found that
psychological stress led to higher levels of bad cholesterol (low-density lipoproteins, LDL),
and decreasing levels of good cholesterol (high-density lipoproteins, HDL).
Stress hormones such as adrenaline and cortisol can trigger the production of cholesterol (a
waxy, fatty substance the liver makes to provide the body with energy and repair damaged
cells). However, excess cholesterol may gradually be accumulated as fats in the body and can
clog the arteries and cause heart attack (verywellhealth.com).

Stress may induce behavioral changes such as eating unhealthy foods (high carbohydrate)
which may further increase cholesterol levels.

Personality Traits and Cardiovascular diseases

Friedman and Rosenman (1974) suggested that people with certain personality traits are more
pre-disposed to suffer from stress than others. Consequently, they are more likely to have
coronary heart diseases. They identified two types of personality traits in this context-Type A
and Type B people.

They asked questions like-

Do you feel guilty if you use spare time to relax?
Do you need to win in order to derive enjoyment from games and sports?
Do you generally move, walk and eat rapidly?
Do you often try to do more than one thing at a time?

Type A: They exhibit following characteristics-

-Excessive competitiveness and achievement orientation leading to extreme self-criticism
-An exaggerated sense of time urgency leading to a constant struggle against the cloak and a
compulsion to try to do more than one thing at a time.
-Anger/hostility that may or may not be openly expressed.

Type B: They show opposite characteristics of Type A being more easygoing and much less
demanding of self and others and with no exaggerated sense of time urgency.

Friedman and Rosenman conducted a longit-udinal study over a period of eight and half years
with a sample of 3524 men aged 39-59 years. They found that Type A individuals were twice
as likely to develop CHD than Type B individuals in part due to the higher physiological
reactivity that type A people show.

Later research indicated that only some aspects of Type A behavior, especially anger/hostility
are more important for understanding the risk of heart diseases (McCann and Matthews 1988).
Some research also indicated that particularly anger which is suppressed rather than expressed
could be a significant risk factor for higher physiological reactivity and CHD. It was reported
that individuals who suppress their anger are twice vulnerable to mortality than who express
anger (Contrada, 1989).

Behavioral pathways
Stress can adversely affect health by increasing the frequency of unhealthy behaviors, or by
decreasing the frequency of health behaviors, or by disrupting prescribed healthy behavior
patterns (Herbert & Cohen 1994).

Stress may induce many behavioral changes and disruptions in life style and routines.
Common behavioral changes include-
-Disturbances in sleep
-Disturbances in food intake (unhealthy/over-eating)
-Excessive smoking
-Physical inactivity
- excessive drinking of alcohol and so on.

-Such behaviors can be especially problematic for the individuals having pre-existing illnesses
such as heart diseases. These behaviors can increase blood pressure and damage arteries of
the heart.
 Lecture 5: Stress and Infectious Diseases

Stress and Infectious Diseases

Stressful events such as the death of a loved ones can weaken immune system and lead to
various infectious diseases. An interdisciplinary field of study called
“Psychoneuroimmunology” studies this relationship between the psychological factors,
neurological factors, and immune system.

Classic experiment that led to the birth of psychoneuroimmunology

In the early 1970s, Ader and Cohen were studying taste aversion using rats as subjects. The
researchers had been giving rats a saccharin solution (sweet taste) accompanied by an
injection of cyclophosphamide, an immunosuppressive drug that also induces gastrointestinal
upset. When the injections stopped, the rats had become conditioned to avoid consuming the
sweet solution. To complete the experimental protocol, they forced the rats to take the
saccharin solution using eye droppers. A surprising observation they made was that some of
the animals they had force-fed with the saccharin later died. The magnitude of the avoidance
response and the mortality rate of the rats was directly related to the volume of solution
consumed.

They hypothesized-Conditioning of immunosuppressive effects (of cyclophosphamide) was

happening in addition to conditioning the taste avoidance response. They added that the taste of
saccharin alone was enough to stimulate neural signals that suppressed the rats' immune
systems, just as if they had been overdosed with the immunosuppressant. They later found that
behavioural conditioning process could suppress immune responses as measured by antibody
concentrations revealing connections between the brain and the immune system.

Immune System

The immune system protects us from infections and illness from outside microorganisms and
harmful substances. The immune system is very complex and carry out sophisticated
coordinated responses to protect our body. The Key player of immune system is white blood
cells specifically lymphocytes (one type of WBC). There are mainly two types of
lymphocytes: B and T cells.B cells secrete antibodies into the body fluids to destroy antigens.
Each B cells produce a specific antibody when triggered by an antigen. It can recognize free
floating antigens. T cells recognizes specific infected or cancerous cells. T cells are of two
types: helper and killer T cells. Helper T cells (also known as CD4 cells) coordinate immune
responses by communicating with other cells. Killer T cells (also called cytotoxic T
lymphocytes or CD8 cells) directly attack other cells carrying certain foreign or abnormal
molecules on their surfaces.

Other major components include natural killer cells (NK), phagocytes, and cytokines.
 Important organs which are store house of immune cells include bone marrow (soft tissue in
the hollow centers of bones), thymus (lies behind breastbone) and spleen (flattened organ at the
upper left of the abdomen).

Stress and Immune System

Hans Selye (1975) suggested that stress globally suppresses the immune system and proposed
one of the first model relating stress and immune response. He found that in the stage of
exhaustion of GAS, body runs out of reserve energy and immunity which may result in various
diseases and even death. Many early studies have supported Selye’s findings by reporting
association of chronic stress with decrease in natural killer cell, suppression of lymphocyte
responses (Herbert & Cohen, 1993).

In the early 1980s, psychologist Janice Kiecolt-Glaser and immunologist Ronald Glaser were
intrigued by animal studies that linked stress and infection. From 1982 through 1992, they
studied medical students. they found that the students' immunity went down every year under the
simple stress of the three-day exam period. The students had less number of natural killer cells,
which fight tumors and viral infections. They also had fewer infection-fighting T-cells.

Pressman and Cohen (2005) found that social isolation and feelings of loneliness each
independently weakened first-year students' immunity. Loneliness and social isolation may
lead to higher and more intense experience of stress.

Dhabhar and McEwen (1997, 2001) proposed a biphasic model which takes account of type of
stress (acute or chronic) and their affect on immune response. This model states that acute
stress enhances while chronic stress suppresses the immune response. They found that acute
stress increases the immune functions by helping in the redistribution of immune cells in the
body. However, chronic stress exhausts resources and weakens immune responses.

Segerstrom and Miller (2004) conducted an extensive meta-analysis on 293 independent

studies reported from 1960 to 2001 (N=18,941). Analysis of the results confirmed that stress
changes immune functions. Results of the meta-analysis was in line with the proposition of
biphasic model, i.e., the short term stress may enhance immune function as an adaptive
response, but chronic stress suppresses immune response as a result of too much exhaustion of
body resources.

More specifically they found that-

-Acute time limited stressors such as public speaking enhanced natural immunity (defense
against non-specific foreign invaders). However, some aspects of specific immunity (attacks
specific invaders) were suppressed.

-Focal stressful events such as natural disaster or loss of spouse was not strongly associated
with immune changes when taken as a whole. However, specific category such as loss of a
spouse was associated with a decline in natural immune responses.
-Chronic stressors such as living with a handicap, dementia care giving, and unemployment have
negative effects on almost all functional measures of the immune system (both natural and
specific immunity) irrespective of demographic variables such as gender and age.

Further, meta-analysis also showed that the older and sick people are more vulnerable to
stress related immune change.

Stress and Immune System: Mechanisms

Stress Hormones

The relationship between stress and immune function is very complex and many mechanisms
are yet to be discovered. However, research indicated that the stress hormones (pathways
already discussed) such as cortisol, epinephrine, and norepinephrine may make us more
resistant to stressors in short term, but are generally found to impair immune systems in long
term (Boneau et al. 1993). For example, Talbott and Kreamer (2007) found that cortisol-

-Hinder the production as well as activity of white blood cells.

-Suppresses white blood cells to produce chemical messenger that facilitate communication
with other immune cells.

-Can also signal many immune cells to shut and stop working

Behavioral pathways

Research also indicated that the behavioral component associated with stressful experiences has
detrimental effect on immune functions. For example-

excessive drinking of alcohol,

lack of exercise,
sleep difficulties

(Kiecolt-Glaser & Glaser, 1988; Venjatraman & Fernandes, 1997; Savard, Laroche, Simard,
Ivers, & Morin, 2003).

Implications

One important implications of of these findings are that the interventions aimed at stress
reduction (especially chronic stress) such as relaxation, emotion regulation, social support etc.
may attenuation of stress related immune suppression and may help to fight germs (Zakowski,
Hall, & Baum, 1992).
The relaxation response may elicit the secretion of health-promoting chemicals such as
dehydroepiandrosterone (DHEA) and which may lead to homeostatic physiologic changes.
Further, the use of self-regulation techniques that calms the mind lowers the activity of
sympathetic nervous system's response to stress and promotes healing process (Gertz &
Culbert, 2009).

In a recent metaanalysis by Shields, Spahr, and Slavich (2020) involving 56 unique

randomized clinical trials and 4060 participants found that-

-psychosocial interventions such as cognitive behavior therapy were associated with positive
changes in immunity over time, including improvements in beneficial immune system
function and decreases in harmful immune function.

-This enhanced immune functions persisted for at least 6 months following treatment for
participants.

Psychotherapies are aimed at reducing distress and enhancing emotional and mental health.
Therefore, this study indicates that stress management and working towards enhancing
emotional health can increase our immune functions that are long lasting.
 Lecture 6: Stress and Psychological Disorders

Stress and Psychological Disorders

Stress may contribute to the development of various psychological disorders such as depression,
Schizophrenia, anxiety disorders, eating disorders, and posttraumatic stress disorder (PTSD)
(Weiten and Lloyd, 2007). Acute stress disorder (ASD) and PTSD will be discussed in more
detail as it directly results from exposure to extremely stressful or traumatic events.

Traumatic events are life threatening events that may overwhelm the capacity to cope and
people generally responds with “intense fear, helplessness, and horror”.

Acute Stress Disorder (ASD)

“Acute stress disorder is an intense, unpleasant, and dysfunctional reaction beginning shortly
after an overwhelming traumatic event and lasting less than a month. If symptoms persist
longer than a month, people are diagnosed as having posttraumatic stress disorder (PTSD)”
(Barnhill, 2020). According to the American Institute of Stress, between 5 and 20 percent of
people exposed to trauma such as a car accident, assault, or witnessing a mass shooting
develop ASD. And approximately half of those go on to develop PTSD. ASD was
reclassified in the Trauma- and Stressor-Related Disorders in DSM 5.

Acute stress disorder (ASD) is a psychiatric diagnosis that may occur in patients after
witnessing, hearing about, or being directly exposed to a traumatic event, such as motor
vehicle crashes, acts of violence, work-related injuries, natural or man-made disasters, or
sudden and unexpected bad news. (Kavan & Elsasser, 2012).

Symptoms

It may occur in patients within four weeks of a traumatic event. Symptoms

include- anxiety,
intense fear or helplessness,
dissociative symptoms,
re-experiencing the event, and
avoidance behaviors.
Persons with this disorder are at increased risk of developing posttraumatic stress disorder.
(Kavan & Elsasser, 2012). Symptoms must be present for a minimum of two days, but not
longer than four weeks; patients with persistent symptoms may develop PTSD. Symptoms of
ASD typically peak in the days or weeks after a patient is exposed to trauma, then gradually
decrease over time (U.S. Department of Veterans Affairs)
PTSD

PTSD is a mental disorder that may occur among people after experiencing or witnessing
extremely stressful/traumatic events such as war, disasters, accidents, rape etc. PTSD had
many names. It was called as “shell shock” during the world war I and “combat fatigue”
during the world war II. Serious attention to PTSD was given after the end of Vietnam war in
1975 which resulted in return of many psychologically disturbed US military veterans. Some
studies suggested that about half million Vietnam veterans were suffering from PTSD even
after a decade of the end of war (Schlenger et al., 1992). The American Psychiatric
Association (APA) added PTSD to the third edition of its Diagnostic and Statistical Manual of
Mental Disorders (DSM-III) in 1980.

DSM-5 Criteria for PTSD

Criterion A (one required): The person was exposed to: death, threatened death, actual or
threatened serious injury, or actual or threatened sexual violence, in the following way(s):
Direct exposure
Witnessing the trauma
Learning that a relative or close friend was exposed to a trauma

Indirect exposure to aversive details of the trauma, usually in the course of professional duties
(e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently re-experienced, in the following
way(s):

Unwanted upsetting memories

Nightmares
Flashbacks
Emotional distress after exposure to traumatic reminders
Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the
following way(s):
Trauma-related thoughts or feelings
Trauma-related reminders

Criterion D (two required): Negative thoughts or feelings that began or worsened after the
trauma, in the following way(s):
 Inability to recall key features of the trauma

Overly negative thoughts and assumptions about oneself or the world

Exaggerated blame of self or others for causing the trauma
Negative affect
Decreased interest in activities
Feeling isolated
Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after
the trauma, in the following way(s):

Irritability or aggression
Risky or destructive
behavior Hypervigilance
Heightened startle reaction
Difficulty concentrating
Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social,
occupational).
Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

The symptoms of PTSD are very common after the exposure to a traumatic event. However,
the majority of the people do not develop clinical disorder. According to American
Psychiatric Association website, approximately 3.5% of US adults experiences PTSD and 1
in 11 people is likely to be diagnosed with PTSD in their life time and women are twice as
likely as men to have PTSD. PTSD can occur to people of any ethnicity, nationality, culture,
and age.

It is very common that many other conditions may co-occur with PTSD such as depression,
anxiety and substance abuse. PTSD can occur to children as well. In some cases, PTSD
symptoms may surface after many months or even years after the traumatic event (Holen,
2000).

PTSD can be treated with psychotherapies and medication. We will discuss few therapeutic
approaches while discussing coping strategies.
PTSD in children

When children experience severe stress may develop long term symptoms (longer than one
month) and can be diagnosed with PTSD. Studies indicate that children can develop PTSD
after exposure to traumatic events such as violent crime, sexual abuse, natural disasters, and
war (Kaminer, Seedat, & Stein, 2005) .

Diagnosis of PTSD in children

Diagnosis of PTSD in children is very difficult. Kaminer, Seedat, and Stein (2005) reported
following reasons-

(1) PTSD criteria require a verbal description of internal states and experiences, a task beyond
the cognitive and expressive language skills of young children. The clinician must infer from
behavioral observations.

(2) Traumatized children often display many other symptoms apart from the core PTSD
symptoms which are not assessed by standardized scales.
These additional symptoms may include-

-the loss of recently acquired developmental skills (regression),

-the onset of new fears or the re-activation of old ones,

-accidents and reckless behavior,

-separation anxiety (often manifested in anxious clinging), and

-psychosomatic complaints such as stomach aches and headaches

(3) Young children may sometime express post-traumatic anxiety through hyperactivity,
distractibility and increased impulsivity. These symptoms may be confused with
attention deficit/ hyperactivity disorder.
According to Center for disease control and prevention website, PTSD symptoms in children
may include-

Reliving the event over and over in thought or in play or drawings

Nightmares and sleep problems
Becoming very upset when something causes memories of the event Lack
of positive emotions
Intense ongoing fear or sadness
 Have trouble focusing
Irritability and angry
outbursts
Constantly looking for possible threats, being easily startled
Acting helpless, hopeless or withdrawn
Denying that the event happened or feeling numb
Avoiding places or people associated with the event

Acute stress disorder occurs immediately following the source of trauma, and post-
traumatic stress disorder occurs as a long-range effect of this trauma. ASD and PTSD share
many core symptoms, but ASD includes dissociative symptoms such as detachment, reduced
awareness of surroundings, derealization, depersonalization, and dissociative amnesia (APA,
2000)

Complex PTSD (C-PTSD)

CPTSD was originally formulated by Judith Herman, in 1992 to describe distinctive

psychological responses arising from events where an individual is under the sustained and
coercive control of a perpetrator (i.e., torture). Complex PTSD, which has been recently
introduced in the International classification of diseases (ICD)‐11. However, it has not found
place in DSM yet.

CPTSD was excluded from the DSM-5 following the argument of some commentators that the
symptoms of CPTSD can be accommodated within the framework of existing definitions of
PTSD (Resick et al., 2012). This assertion stems from the expansion of the diagnosis of PTSD
in the DSM-5 to encompass symptoms such as self-blame, negative beliefs about the self and
feeling alienated from others (American Psychiatric Association, 2013). CPTSD is considered
to be especially likely to occur following exposure to repeated, prolonged, interpersonal trauma
exposure (Nickerson, et al. 2016) rather than a single traumatic event.

The exposure to traumatic events could be over a period of months or even years such as
torture, prisoner of war situations, long term childhood sexual abuse, prolonged physical or
emotional abuse, or sex trafficking situations. Although most commonly seen in the wake of
prior prolonged childhood abuse, this disorder can also occur in survivors of other severe
traumas, such as torture (Bryant, 2019)

Symptoms
In addition to core PTSD symptoms, CPTSD may include (Bryant, 2019)-
experience disturbances in self‐identity (e.g., negative self‐concept),
emotional dysregulation (e.g., emotional reactivity, violent outbursts),
and
persistent difficulties in relationships

It may also include-

periods of amnesia or dissociation,

distorted perspective about the perpetrator, and feelings

of guilt, shame or lack of self worth.
 Lecture 7: Positive Effects of Stress and Trauma 1

Positive Effects of Stress and Trauma

Stress and trauma may have certain positive effects. With the growth of positive psychology,
the focus on the positive aspects of stress and trauma gained momentum.

There can be three possible ways by which stress can have positive effects (Weiten and
Lloyd, 2007). These are-
• Stressful events help us to satisfy the need for stimulation and challenge
• Stress can inoculate individuals for future stress. In other words, exposure to stress
increases our tolerance for similar events in future.
• Stress can promote/facilitate psychological growth and self-improvement.

Posttraumatic Growth (PTG)/Stress Related Growth

"that which does not kill us makes us stronger.”

-Friedrich Nietzsche

“The pain of yesterday is the strength of today.”

– Paulo Coelho

In addition to experiencing various negative symptoms of trauma and stress (such as PTSD),
many people also report various positive changes in their life as a result of facing traumatic
events. These positive psychological changes experienced by people as a result of the struggle
with highly challenging life circumstances is known as PTG (Tedeschi and Calhaoun, 2004).
The term ‘PTG was introduced by Tedeschi and Calhoun in 1995. ‘‘suffering and distress can
be possible sources of positive change’’ (Tedeschi and Calhaoun, 2004, p. 2).
 PTG is not a direct result of trauma but rather related to how the individual struggles as a
result of the trauma (Tedeschi and Calhoun, 2004). Coping is necessary but not sufficient to
achieve psychological thriving or PTG.

Thriving represents more than a return to equilibrium following challenge.

Research indicate that PTG experiences are fairly common and outnumbers the reports of
psychiatric disorders. For example, one study reported that approximately 30% - 90% of the
survivors of traumatic events report at least some positive changes following trauma
(Tedeschi, Park & Calhoun, 1998).

According to Tedeschi and Calhoun (2004) PTG include four specific criteria:

(1) it calls attention to major trauma disruptions instead of common stressors;

(2) those who experience growth after trauma describe the process as transformative;

(3) the growth is reported as an ongoing process versus being a coping mechanism;

(4) disruption of core beliefs that coexists with traumatic distress is required.

The concept of PTG is not a new concept. Various religions, philosophies, folklores have been
taking about this concept by emphasizing the transformative power of human sufferings.

The presence of PTG does not mean absence of distress. Both can occur simultaneously.

Post traumatic growth can be considered an outcome as well as a process.

PTG and related concepts

PTG is sometimes confused with some related concepts such as resilience, recovery, thriving,
and flourishing.

PTG vs Thriving

Thriving is defined as “the psychological state in which individuals experience both a sense of
vitality and a sense of learning” (Spreitzer et al. 2005, p. 538). Although thriving is associated
with growth, it is more often understood as an everyday occurrence and is not normally linked
to traumatic or significantly adverse experiences (Maitlis, 2019).
PTG vs Flourishing

As with thriving, flourishing is a broader term associated with well-being (Maitlis, 2019).
Flourishing individuals are “filled with emotional vitality…functioning positively in the
private and social realms of their lives” (Keyes & Haidt 2003, p. 6). Thriving, flourishing, and
posttraumatic growth all involve individuals’ positive functioning and experience above
normal levels. However, PTG occurs only occurs only after the traumatic events, whereas in
thriving and flourishing it may or may not occur after a negative event (Maitlis, 2019).

PTG involves transformation that comes through the struggle with posttraumatic situations.
The idea of transformation is less prominent in thriving or flourishing (Maitlis, 2019).

PTG vs Resilience vs Recovery

PTG is different from the concept of Resilience. Resilience is the ability to bounce back and go
on with life after a hardship. Resilient people return to their baseline level of functioning very
soon after the hardship. PTG on the other hand is not about returning to the baseline, rather it is
an experience of improvement that is deeply profound and significant for the concerned
person. Resilience can be seen to differ from posttraumatic growth in that it emphasizes
stability in the context of trauma, rather than a trajectory of increased positive functioning
(Maitlis, 2019). Recovery is also different in that it involves a return to prior levels of
functioning after a crisis, rather than a trajectory of increased functioning (Maitlis, 2019;
Bonanno et al. 2011).

Domains of PTG

Reports of PTG can be subsumed under 5 dimensions or domains (Tedeschi and Calhaun,
2004). They are-

(1) An increased appreciation for life in general (Finding joy in small things, feelings of
being lucky

(2) More intimate and meaningful relationship with others (realizing the importance
of relationships, finding the real friends, increased sense of compassion and empathy)

(3) Sense of personal strength (realizing your hidden capabilities and potentials, increased
ability to deal and handle things)

(4) New possibilities for one’s life (Finding new paths and career)

(5) Spiritual and existential growth (Greater engagement with the existential questions, newer
insights into the existential problems)
 Posttraumatic Stress and Posttraumatic Growth

The relationship between posttraumatic growth and posttraumatic stress seems to be very
complex. According to the theoretical model of PTG by Tedeschi and Calhaun, PTS and PTG
are not opposite ends of a spectrum and in fact some degree of PTS is pre-requisite for PTG as
growth comes through struggle with the highly distressing trauma (Tedeschi et al. 2018;
Tedeschi & Calhoun 1995).

Research on the relationship between posttraumatic stress and posttraumatic growth has
produced mixed findings-
-some studies showed greater posttraumatic stress is associated with greater posttraumatic
growth (Lowe et al. 2013).

-some studies reported a negative or an inverted U-shaped relationship, with the highest levels
of growth occurring at moderate levels of stress (Lowe et al. 2013).

-some recent longitudinal studies have found a positive relationship between posttraumatic
stress and posttraumatic growth over time, such that initial levels and increases in
posttraumatic stress predicted increases in posttraumatic growth (Dekel et al. 2012, Lowe et
al. 2013).

Types of Traumatic Events and PTG

Research suggests that PTG is a common experience for individuals after a traumatic event.
In general, it has been claimed that the nature of the event itself is less important for
posttraumatic growth than the way that an individual experiences it (Maitlis, 2019). Research
has indicated PTG resulting from diverse traumatic experiences-

Personal traumatic experiences and PTG

Research indicated reports of PTG after personal losses such as-

-bereavement (e.g., Davis et al. 1998);

-medical problems (e.g., Helgeson et al. 2006);

-interpersonal violations, such as rape and other forms of sexual assault (e.g., Frazier et al.
2001).

-community traumas, such as natural disasters (e.g., McMillen et al. 1997) and terrorism (e.g.,
Updegraff et al. 2008).
.
 Work related traumatic experiences and PTG

PTG research remains surprisingly small in the context of work and organizational life.
However, a small body of research explored PTG in certain job contexts which are vulnerable
to trauma (Maitlis, 2019).
Inherently traumatic work/job

PTG has been reported in many inherently traumatic work such as-

-military (e.g., Mark et al. 2018, Tsai et al. 2015),

-police (e.g., Chopko et al. 2018, 2019),

-emergency services (e.g., Sattler et al. 2014, Shakespeare-Finch et al. 2003), and

-disaster/rescue work (e.g., Paton 2006, Shamia et al. 2015).

Together, this research shows that although doing such work often leads to posttraumatic
stress and PTSD, it can also prompt posttraumatic growth (Maitlis, 2019).

Secondary trauma at work

Secondary or vicarious trauma is regular part of job of professionals whose work can be
traumatizing because it involves supporting others who have been traumatized.

Research indicated PTG among health professionals such as labor and delivery nurses,
psychotherapists, social workers, interpreters, clergy, and funeral directors (Cohen & Collens
2013; Manning-Jones et al. 2015).

In many of these cases, PTG is linked to the change and growth that workers witness in their
clients, which prompts in those workers a new appreciation of what is possible, in terms of the
difference they can facilitate, and in some cases it may prompt a spiritual broadening
(Manning-Jones et al. 2015, cited in Maitlis, 2019).

In such cases, empathetic engagement with the clients facilitated secondary PTG (Splevins et
al. 2010). Thus, witnessing posttraumatic growth in others can itself be positively
transformative (Maitlis, 2019).
 Lecture 8: Positive Effects of Stress and Trauma 2

Three Models Of PTG (Janoff-Bulman, 2004)

Janoff-Bulman (2004) in her commentaries on PTG article by Tedeschi and Calhaun (2004)
proposed three possible explanatory models of PTG.

Model 1: Strengths through suffering

This model is very apparent in our collective and cultural narratives. Phrases such as “no pain
no gain”; “That which does not kill us makes us stronger” are reflective of this idea. As a
result of struggle with traumatic experiences, many survivors become aware of their hidden
strengths and potentials and develop newer skills and coping abilities that can lead to new
sense of confidence, courage and possibilities in life. This painstaking exercise of self
reflection and rumination may result in new self perception that may be qualitatively different
from the pre-trauma self.

Model 2: Psychological preparedness

As a result of the struggle with the traumatic experiences, survivors are better prepared for the
subsequent hardships and is likely to be less traumatized by the future trauma. This may
happen by changes and rebuilding of the survivor’s assumptive world. Here PTG is seen as
rebuilding of the assumptive world that accounts the traumatic experiences and their future
possibilities resulting in more shockproof schemas.

This model is more in line with the stress inoculation model (Meichenbaum, 1985) and the
concept of vaccination.

Model 3: Existential Reevaluation

It involves meaning making process aftermath of a traumatic event. Human beings are
meaning making animals and a traumatic event may cause an existential crisis by threatening
the meaning of life. Janoff-Bulman (2004) discusses two types of meaning that define the
struggle of survivors aftermath of a traumatic event-Meaning as comprehensibility and
meaning as significance.

Immediately after the traumatic event, the survivors are concerned with meaning as
comprehensibility, i.e., they struggle to comprehend or make sense of the traumatic event.
They may ask why it happened? Consequently, the survivors may engage with the meaning
as significance, i.e., the survivor may question the significance of the event in their life.
They may ask why it happened to me?

This meaning making process may lead survivors to reevaluate their life and find newer
meaning when a survivor may paradoxically realizes the preciousness and meaning of life at
the face of loss and meaninglessness. Some may engage in spiritual/religious/existential
questions that may stimulate growth in certain dimensions.

The Process of PTG: The Functional Descriptive Model

Tedeschi and Calhoun (2004) proposed a Functional descriptive model of PTG to explain the
process of PTG.

They used a metaphor of earthquake to explain the process of PTG. They proposed that the
traumatic events are like seismic events that shatters our assumptive world just like earthquake
shatters physical structures. The “assumptive world” includes assumptions/beliefs about our
life and world which gives meaning and purpose and guides behavior. This threat and
shattering of assumptive world gives rise to significant psychological distress.
They extended this metaphor to the physical rebuilding that takes place after the trauma.
Generally, physical rebuilding are designed to be more resistant to shocks in the future as a
learning process. Similarly, the cognitive rebuilding that take place after the trauma produces
“schemas that incorporate the trauma and possible events in the future, and that are more
resistant to being shattered. These results are experienced as growth” (Tedeschi & Calhoun,
2004, p. 5).

PTG is not the direct outcome of trauma. It is the struggle with the new realities aftermath
of trauma that is crucial in determining the extent to which PTG occurs. Traumatic events
challenges/shatters assumptive world leading to distress and automatic intrusive ruminative
thoughts. Further, it leads to engagement in coping responses and intense cognitive
processing to manage overwhelming emotions.

Social support and self-disclosure supports the process of growth by reducing emotional
distress and automatic ruminative thoughts. Ruminative thoughts changes to reflective
thoughts (conscious and deliberate) leading to newer schema change and narrative
development and finally PTG.

PTG is closely connected to the development of wisdom.

PTG may not remove distress completely, but enduring distress may co-exist.

Organismic Valuing Theory Of PTG

Joseph and Linley (2005) proposed the organismic valuing theory of growth through adversity
based on the humanistic psychology. This model provides explanation for why some individual
are able to achieve high levels of growth after the trauma and some fail to do so.

Based on the principle of humanistic psychology, it suggests that human beings have inherent
tendencies towards growth and actualization. In consistency with these tendencies they show
intrinsic motive to rebuild their assumptive world in the aftermath of trauma.

This theory suggests that there can be three possible cognitive outcomes of traumatic
experiences-

Assimilation-help to return to pre-trauma baseline

Negative accommodation-result into psychopathology such as PTSD

Positive accommodation-result into PTG.

This theory has also laid emphasis on social environment as a facilitator of actualizing
tendency that is essentially needed for growth.

PTG and well-being

In general, it appears that reports of PTG, especially when maintained, predict better
subsequent well-being (Joseph & Hefferon 2013).

Disaster workers who experience posttraumatic growth tend to feel they have gained in self -
esteem, a sense of accomplishment and meaningfulness in their work, and a better
understanding of their work (Brooks et al. 2018).

In a meta-analysis of 87 cross-sectional studies relating PTG to health outcomes, growth was

found to be positively related to measures of well-being, including self-esteem and life
satisfaction and negatively related to depression (Helgeson et al. 2006).

PTG and wisdom

Wisdom is considered as psychosocial maturity that integrates cognitive, reflective, and

emotional personality traits (Karelitz et al., 2010). The concept of wisdom often invokes the
stereotypical image of the “old wise man” (Weststrate et al., 2016).
Wisdom accumulates through life experiences, and it has been reported that age affects the
depth of wisdom, and that life wisdom advances with aging (Ardelt, 2016).
Wisdom can be differentiated from PTG. Wisdom is a broader concept that can be found
across the life span of human development and is not restricted to the posttraumatic situations
(Linley, 2003). Wisdom may develop through traumatic experiences, but it need not be
restricted to it.

PTG was equated and covaried with the development of wisdom in the model of Tedeshi and
Calhaoun (2004). In fact, domains of PTG are aspects of wisdom only.

Although both PTG and wisdom have been conceptually linked, there is not much empirical
studies available linking PTG with wisdom. Few studies indicate positive relationship between
them (Webster & Deng, 2015).

Facilitating PTG

Tedeschi and Calhoun (2006) suggest that posttraumatic growth is facilitated by ‘expert
companionship.’

Expert companions are people who can listen for extended periods, and repeatedly, to stories
that can involve horror, fear, guilt, shame, and confusion. Expert companions cannot prescribe
posttraumatic growth. They facilitate it through kind and empathic listening. They may be
professionals, friends, or family.

Five Ways to Facilitate PTG

Calhoun and Tedeschi (1999, 2013) outlined five ways to facilitate posttraumatic growth

(1) Education

In order to facilitate growth, it is important to understand and educate oneself about the
trauma, how it is caused by disruption of core belief systems

It is important to make sense of trauma and understand that when a traumatic event shatters our
life assumptions, it is painful, confusing and frightening and may lead to anxiety and repetitive
thinking about the traumatic events such as why did this happen to me? What should I do now?

Processing trauma in this way is normal and may stimulate growth. Expert companion may
facilitate this education process.
(2) Emotion Regulation

Learning to regulate emotions and reduce psychological distress is crucial for PTG.

Managing negative emotions help us to come to our senses and right frame of mind for
deliberate and reflective thinking which is significant for PTG.

One needs to engage in constructive coping such as shifting thinking from loss, failures,
uncertainties to success, possibilities, available resources to deal with the situation and so on.

Coping strategies such as social support, breathing exercises and meditation also can be helpful
(3) Self-disclosure

It is always good to talk about what has happened and is happening, what are you struggling
with and so on. Such self-disclosure helps in processing of the trauma and help in finding
solutions to the problems and increases the possibility of receiving social support.

It facilitates meaning making and reflective thinking which are crucial for PTG.
An expert companion can facilitate this process by encouraging trauma survivors to disclose
details about their experience, so that they can begin to work together to understand what
happened and what potential meaning can be found.

Self-disclosure in the form of writing such as dairy writing or other forms of writing can also
facilitate PTG.

(4) Narrative Development

Re-building or reconfiguring core life assumptions and beliefs and life story into a coherent
narrative in crucial for PTG. This new version of the life narrative will incorporate one or more
domains of PTG.

Development of coherent life narrative is crucial in order to proceed to the next chapter of life.
Otherwise, we may be stuck with the event and older narratives.

(5) Service

PTG is facilitated by serving, benefiting, and helping other close people, community and
especially trauma victims similar to themselves.
 Lecture 9

Role of Personality Variables in Stress

Personality variables includes an individual’s unique and relatively consistent patterns of

behavior and style of response. Personality characteristics differentiates one individual from
another.

Personality traits may influence stress response. Some personality traits are more prone to
stress as compared to others.
Type A and Type B individuals
Type A individuals because of their competitive achievement orientation, time urgency and
anger/hostility are more likely to experience stress in their life as compared to Type B who show
opposite behavioral traits. (details about this personality type was discussed earlier)

Psychological Hardiness

Psychological Hardiness

The concept of psychological hardiness was introduced by Susan Kobasa (1979). She defines
hardiness as a set of characteristics that differentiates stress resistant people from those
vulnerable to stress. Hardiness is characterized by the combination of three characteristics called
3Cs: Commitment, control and challenge.
Commitment: People with strong commitment believe that it is important to remain involved
with people and events that are significant no matter how stressful things become. They don’t
waste time in withdrawal, alienation or isolation (Maddi, 2006).
Control: People with strong sense of control continue to have an influence on the outcomes of
significant events going on around them, no matter how difficult this becomes. They don’t let
themselves slip into powerlessness and passivity (Maddi, 2006).

Challenge: People with strong sense of challenge interprets stress as normal and regular part
of life and provides an opportunity to learn, grow, and develop. They believe that comfort and
security is not our birthright (Maddi, 2006).

These three characteristics provide hardy individuals the necessary courage to face stressful
situations and grow out of them (Maddi, 2006).

The initial research

The initial research on hardiness came from a 12 year longitudinal study on 450 male and
female supervisors, managers, and decision-makers of Illinois Bell Telephone (IBT) conducted
from 1975 through 1987 by Maddi and Kobasa. The objective of this study was to find out
individual differences in stress reaction that can be explained by the concept of hardiness.

At the start of the experiment the IBT was under the federal regulation. However, after the 6
year of the study in 1981 deregulation hit the company and created a lot of chaos such as the
company reduced its employees from 26000 to 14000 in just one year. The data collected 6
years after this event showed that about two third of the sample suffered and collapsed in
terms of performance problems, violence, absenteeism, divorces, health problems such as heart
attacks, mental problems etc. However, the other one third of the sample interestingly not only
survived but thrived also. For example, some of them rose up in the management, some joined
other companies and made significant contributions, some started their own firms etc.

This research indicated that psychological hardiness differentiated this two groups of sample.

Hardiness and stress

Hardiness has been found to be negatively related to both self-report and objective (blood
pressure) measures of stress (Maddi, 1999) and positively associated with psychological well-
being (Maddi & Kobasa, 1984).

Hardiness buffer against the development of anxiety or depression (Rhodewalt & Zone,1989).
Hardiness served as both a protective factor and a resource that promotes the ability to
experience psychological growth following stressful and traumatic events (Waysman,
Schwarzwald, & Solomon, 2001). Hardy individuals appraise stressful events less negatively
(Westman,1990)

Hardiness was associated with lower PTSD symptoms among Vietnam veterans (King et al.,
1998) and buffered the impact of combat exposure on PTSD development (Taft, Stern, King, &
King, 1999).

Psychological hardiness and performance under stress

Individuals high in hardiness have shown better performance under stress in diverse
environments and occupations such as-

-military (e.g., Maddi et al., 2012),

-academia (Maddi, et al., 2009),

-sport (Hanton, Neil, & Evans, 2013),

-fire-fightering (Maddi et al., 2007),

-business (Luszczynska & Cieslak, 2005).

Hardiness also predicts better performance longitudinally and helps to buffer stress within a
stressful environment (De La Vega, Ruiz, Gomez, & Rivera, 2013). People with high hardiness
respond in a facilitative way to the negative stressors in the environment (Mosley & Laborde,
2016)
 Hardiness training

Several studies have reported that hardiness can be taught.

Maddi (1987) developed a hardiness training program to enhance the quality of hardiness
among people.

They proposed that “hardiness training engages cognition, emotion, and action in coping
effectively with stressful circumstances and uses the feedback from this process to deepen
commitment and control and challenge beliefs about oneself in the world” (Maddi, Kahn, &
Maddi, 1998, p. 79).

They further said-

“hardiness training is to teach trainees the skills of transformational coping whereby one can
decrease the stressfulness of circumstances through cognitively and emotionally exploring
one's appraisals of them so as to reach broader perspective and deeper understanding and using
the information gained in this way to develop and carry out decisive, problem–
solving action plans. The second aim of hardiness training is to use the feedback obtained
through the first aim to deepen the motivational self–perceptions of commitment, control, and
challenge” (p. 79-80).

Maddi (1987) showed that hardiness training can increase personality hardiness and
decreased subjective (e.g., anxiety and depression) and objective (blood pressure) signs of
strain. They found that results persisted over the 6–month follow–up period.

Some later study also indicated that hardiness training is more effective than
relaxation/meditation and placebo/social support conditions in increasing self reported
hardiness and job satisfaction and decreased strain and illness severity (Maddi, Kahn, &
Maddi, 1998).

Locus of Control

Rotter (1966) proposed the concept of locus of control which was found to differentiate people
on stress vulnerabilities. He coined the term locus of control (LOC) to describe individuals’
generalized beliefs about causality and control

LoC includes our general expectancies about the connections between one’s action and its
outcomes.

Locus of control refers to the generalized expectancy to perceive outcomes in life as a result of
one’s own actions and within one’s own control (i.e., internal locus of control), as opposed to
being determined by external factors, such as chance or powerful others (i.e., external locus of
control) (Rotter, 1966)
 Internal vs external locus of control
Internal locus of control: People with ILoC generally expects that their actions will lead to
predictable outcomes and consequences. They tend to make internal attributions by explaining
what happens to them as due to their internal or personal factors.

External locus of control: People with ELoC generally expects that outcomes are more
influenced by external factors such as luck, chance etc. They tend to make external attributions
by explaining what happens to them as due to the external or circumstantial factors.

People with high internal locus of control generally try to master their environment, while
those with high external locus of control often perceive that outcomes in life are outside their
own control and feel helpless (Keenan and McBain, 1979).

Thousands of studies tend to indicate that the internal locus of control is more beneficial as
compared to the external locus of control in the context of stress and health. For example,

external locus of control are associated with ill health and the internal LOC acts as a buffer
against the effects of stress on health (Bartlett, 1998).

For example, an individual may make an external attributions by believing that there is no point
in joining a professional course as it is very less likely that he will get a job in future.
Consequently, he/she may feel stressed and helpless. Furthermore, job stress is often related to
lack of control over the nature of work.

However, it is fruitful to remember that extremes in either direction (internal or external)

could be maladaptive (Taylor & Cooper, 1989).

LoC and coping style

LoC has also been associated with coping style. External locus of control has been associated
with avoidance coping/ resignation, greater stress and poor health (Evers et al.,
2000; Gianakos, 2002; Gore et al., 2016). Internal locus of control, on the other hand, has
been associated with help-seeking and positive thinking, and lower levels of work stress in
general (Gianakos, 2002; Gore et al., 2016)

Weiner’s theory of LoC and attribution

Weiner (1979; 1986) incorporated the notion of internal and external locus of control into his
attribution theory. He proposed that in order to predict people’s expectancies and behaviors, it
is important to evaluate how the cause of the outcome (especially in success and failure
situation) is perceived in terms of its locus of causality (internal/external), controllability, and
stability.

This theory tries to identify how people explain or find causes of success and failure.

According to the Weiner’s model, success and failures can be analyzed in terms of following
characteristics-
(1) Locus of control (internal/personal or external/situational): We may believe a cause is
internal if its origin is within us or external if the cause originate in our environment.

(2) Stability (Stable or unstable): if we believe a cause is stable it is less likely to change over
time and unstable if it is likely to change over time.

(3) Control (Controllable or uncontrollable): This factor was added later. We can
voluntarily change a controllable factor while an uncontrollable factor is one that we
believe can not be changed easily.

According to Weiner, success or failure can be attributed to internal/personal causes (e.g.,

ability, motivation) or from external/situational causes (e.g., luck, task difficulty).

He also claimed that those internal/personal and external/situational causes could be either
stable (less likely to change over time) or unstable (more likely to change over time).

According to the theory, four causal factors play significant role in our motivation in
achievement situations: Ability, efforts/motivation, luck and task difficulty.

Stability attributions influence our expectancy or predictions about the future

Controllability influences our persistence on a task
Locus of control influences our emotional reactions

For example a student fail in an exam and he attributes the cause of failure to

(1) Lack of ability (internal, stable, uncontrollable factor)

Low expectancy of future success, low self-esteem/humiliation/shame, leaving or quitting the

setting

(2) Lack of efforts (internal, unstable and controllable

factor) Hopeful and positive anticipation, motivate to amend
past
 Lecture 10

What is Coping?
The concept of coping presumes that there is a condition of stress or adversity. Coping
includes ways to deal with those stress and adversity. Coping strategies include thoughts and
behaviors that we use to manage the demands of stressful situations (Folkman & Lazarus,
1980). Coping skills help us to tolerate and adjust to negative events or situations and to
maintain emotional equilibrium and positive self-image.

Why understanding about coping is Important?

It is significant that we have insights about coping and stress management strategies
because-

It is evident that stress accounts for a significant proportions of physical and mental disorders.
Unhealthy coping strategies are major contributors to these stress related diseases.
Stress cannot be removed from our life. It has to be managed properly to lead a healthy life.

Categories/groupings among coping responses

Coping is a very broad concept with a long and complex history (Folkman and Moskowitz
2004).
Many distinctions have been made within coping responses. Some of the more important
distinctions are-

(1) Problem focused vs Emotion focused coping

(2) Engagement vs Disengagement coping
(3) Adaptive vs Mal-adaptive coping

Emotion-focused vs Problem focused coping

Lazarus and Folkman (1984) suggest that there are two main forms of coping: emotion-
focused coping and problem-focused coping.
Problem focused coping involves tackling or dealing with the problem that is causing stress
such as generating options to solve the problem, implementing steps to solve the problem.
Emotion focused coping are aimed at managing the feelings of distress associated with the
stressful situations rather than the actual problem or the source of the stress such as positive
reappraisal, self controlling etc.
Emotion-focused coping includes a very wide range of responses (Carver, 2019), such as -
self-soothing (e.g., relaxation, seeking emotional support),
expression of negative emotion (e.g., yelling, crying),
focus on negative thoughts (e.g., rumination),
attempts to escape cognitively from the stressful situation (e.g., avoidance, denial, wishful
thinking)
Some behaviors can serve either a problem-focused or an emotion-focused function,
depending on the goal behind their use (Carver, 2019).

For example, seeking social support is emotion focused if the goal is to obtain emotional
support and problem focused if the goal is to obtain advice or instrumental help.
Problem-focused coping and emotion-focused coping also tend to facilitate one another
(Carver, 2019).

Effective problem-focused coping diminishes the distress generated by a threat. On the other
hand effective emotion-focused coping facilitate better problem focused coping by
diminishing emotions and helping solving problem more calmly.

Engagement vs Disengagement Coping

Engagement coping is aimed at actively dealing with the stressor or stress-related emotions
while disengagement coping is aimed at avoiding confrontation with the threat or avoiding
the stress-related emotions (Carver, 2019). Engagement coping may include problem focused
coping and forms of emotion-focused coping such as support seeking, emotion regulation,
acceptance, and cognitive restructuring.

Disengagement coping includes responses such as avoidance, denial, and wishful thinking.
Disengagement coping is often emotion focused, because it typically involves an attempt to
escape feelings of distress (Carver, 2019) and it is generally ineffective over long term.
One form of disengagement coping i.e., avoidance will be discussed in more details under
maladaptive coping.

Adaptive vs Maladaptive Coping

People may cope with stress with diverse strategies ranging from maladaptive (unhealthy) to
adaptive (healthy) strategies. Adaptive coping has been defined as an effective means of
coping that allows individuals to adequately address stressors (Brown, Westbrook, &
Challagalla, 2005). Adaptive or constructive coping involves confronting problems, realistic
appraisals of stress and coping resources, learning to recognize and manage disruptive
emotional reactions to stress, and learning to control harmful and destructive habitual
behaviors (Weiten and Lloyd, 2005). Maladaptive coping strategies are generally unhealthy
and has limited value and provide temporary relief.

Common Maladaptive Coping Strategies

Avoidance/Giving up

Avoidance coping represents one of several broad dimensions of coping strategies

characterized by efforts to escape or distance oneself from stressful events and associated
feelings of distress (Weibe, 2019). Many people use avoidance or simply withdrawing from a
stressful situation as a coping strategy. Here the person avoids the stressors rather than
actively deal with them. This may help in short term but apathy and inaction is likely to be
associated with the sadness and dejection and maladaptive in the long term. This may further
proliferate the problems and stress in future. Therefor it is a maladaptive coping strategy. For
example, procrastination. There is no active attempt to solve the problem causing stress or
reduce the distress associated with the stressful situation.
In many situations, the longer a person avoids dealing with the problem, the more difficult or
complex it becomes, and the less time is available to deal with it when one cannot avoid it any
longer. E.g., procrastination
Avoidance coping mostly include emotion focused coping strategies, which is aimed at
minimizing the emotional consequences of stressful events rather than to deal with the stressor
directly. The use of avoidance coping is influenced by both dispositional and situational
factors (Weibe, 2019).
Individuals who have personality traits that are linked to the behavioral inhibition system such
as neuroticism are more likely to use avoidance coping strategies than those who have traits
that are linked to the behavioral activation system such as optimism and extraversion. One’s
personal and environmental resources also influence the use of avoidance coping strategies.

Avoidance coping is more common among people with fewer personal, economic, and social
resources (Holahan & Moos, 1987).

Learned helplessness and avoidance coping

Avoidance coping is more common when one is dealing with situations that cannot be actively
altered (Weibe, 2019). Martin Seligman (1967) proposed the concept of “learned helplessness”
(LH) which is also related to the giving up/avoidance syndrome.Learned helplessness occurs
after an individual repeatedly experience negative uncontrollable situations and become
passive and unmotivated and stay that way even after the environment changes so that
success/control is possible. Learned helplessness was discovered accidently by psychologists
Martin Seligman and Steven Maier in 1967.
They were studying the effects of an inescapable shock upon subsequent escape and avoidance
learning in an animal model (dogs).Dogs that were classically conditioned to expect an
inescapable electrical shock after hearing a tone made no attempts to escape when later shifted
to an shuttle box even though simply jumping over the low barrier would provide them relief
from the shock. Here the individual believes that efforts are futile as failure is inevitable. Here
the individual learned to be helpless.
Uncontrollable and undesirable event ------> Perceived lack of control-----> Generalized
helpless behavior
LH may contribute to other psychological disorders such as depression and anxiety.
In general, avoidance coping is less adaptive than approach coping, and is associated with
poorer subjective well-being, psychological adjustment, and physical health (Weibe, 2019).
Giving up/avoidance could be adaptive in certain circumstances where it is pointless to keep
adjusting such as a job in which one is not equipped to handle even after repeated efforts or
one is faced with unattainable goals.
Avoidance coping that occur in the early stages of dealing with a stressful event appear to be
adaptive as it give time to develop skills and resources to manage stress (Suls and Fletcher
1985). Similarly, avoidance strategies such as distancing may be adaptive when dealing with
uncontrollable stressful events such as loss and bereavement (Carver, 2006)

Self-indulgence

It basically means excessive/unrestrained or impulsive satisfaction of ones desires, appetites, or

urges. For example, smoking, drinking, internet addiction etc. Stress may lead to reduced
impulse control and self-indulgence behavior (Tice, Bratslavsky, & Baumeister, 2001). As a
response to stress, people may develop alternative rewards as a compensation by substituting
forms of satisfaction such as eating, smoking or drinking (Moos & Billings, 1982). Here people
turn away from their negative feelings and try to escape by turning to something that feels
better. So, it gives temporary relief.
Self-indulgence has marginal value as a coping strategy and too much of this behavior may
pose serious risks and problems such as excessive drinking may be harmful to health. It may
feel good in short term but has negative health, economic and other consequences.
Nowadays, one of the most prevalent form of self-indulgence is internet addiction. In fact
because of its widespread prevalence, many researchers have been arguing to include internet
addiction disorder in the DSM. Its symptoms primarily include impulsive use of internet by
staying online longer than intended and experiencing moodiness, depression, irritability when
not online. Furthermore, such addiction adversely affects relationship, job and career (Cash,
Rae, Steel, & Winkler, 2012). Some people exhibit pathological specific type of internet
addiction when used for specific purpose such as gambling or pornography while others may
exhibit a general and global pattern of internet addiction (Davis, 2001; cited in Weiten &
Lloyd, 2007).

Self-blame and negative thoughts

In response to stress, people tend to engage in excessive negative thoughts and self-blame
which may be maladaptive and counterproductive. Realistic self-blame may be necessary in
many circumstances. However, many people tend to engage in irrational thoughts and self-
blame which are also called as catastrophic thinking. Such thought processes may have
adverse impact on our psychological and emotional health.
Albert Ellis and Aaron Beck did pioneering research in this direction. Beck (1987) proposed
that people with excessive negative thoughts often-

(1) irrationally attribute failures to personal shortcomings.

(2) Focus more on negative feedback from others and ignore positive feedback

(3) Make pessimistic projections about their future.

More detailed discussion will be made about the role of thoughts in coping while discussing
constructive coping.
 Lecture 11

Defensive Coping

Defense mechanisms are unconscious psychological responses that distorts reality to protect
people from being overwhelmed by the feelings of anxiety, painful emotions, ideas and drives.
These are unconscious ways of coping with anxiety. For example, sometimes people refuse to
admit some aspects of reality by denying or blocking it from experiencing it as accepting it
may cause anxiety. For example, a smoker may deny that smoking is bad causes cancer as
accepting this fact and smoking may cause anxiety.
The idea of defense mechanisms is one of the original contributions of Sigmund Freud who
proposed the theory of psychanalysis. His daughter Anna Freud further developed and
elaborated on these ideas.
Freud discovered five major properties of defense mechanisms (Vaillant, 1992)-

(a) Defense mechanisms are unconscious mental processes.

(b) They help us to manage instincts and affect.

(c) They are discrete from each other (there are varieties of defense mechanisms)
(d) They are dynamic and reversible

(e) They can be adaptive as well as pathological.

Basics of Freud’s theory

It is necessary to understand some of the basic ideas of Freud’s theory to understand defense
mechanisms.

Levels of mind

According to Freud, there are three levels of mind-Conscious, sub-conscious/pre-conscious,

and unconscious. This division is made based on the level of awareness each part of the mind
has. Each of these level plays their role in human behavior.

Conscious mind consists of all thoughts, memories, feelings that we are aware or conscious in
a moment.
Preconscious/subconscious mind consists of thoughts, feelings, and memories that are not
conscious at the moment but can be easily brought into the conscious mind.
This is neither fully conscious nor fully unconscious.

For example, you may not recall the name of a person you met in past immediately but with
some effort it is possible. This part of the mind is more like a mental waiting room.
Unconscious mind consists of all mental processes that are inaccessible and outside our
conscious mind.
However, it influence our behavior and thoughts continuously and is a major source of
behavior.
It mostly consists of repressed unpleasant and unacceptable experiences and feelings.
According to Freud, this is the largest part of our mind.
Iceberg analogy

Freud used the analogy of iceberg in water to explain these levels of mind. A small portion or
tip of the iceberg above water represents conscious mind. The part of the iceberg submerged
but visible represents preconscious mind. The largest part of iceberg lies below the water and
not visible represents our unconscious mind.

Structure of personality
Freud viewed human personality as energy system and the nature of personality is determined
by the distribution of energy among ID, EGO, and SUPER-EGO.
ID
It is the reservoir of psychic energy and operates on pleasure principle, i.e. it motivate us seek
pleasure and avoid pain. It is irrational, illogical, primitive and drives people to seek
immediate gratification of desires.
It is instinctual and immature component of our personality.
This is the primary component of personality and only component present from birth. It is
entirely unconscious. A baby after birth is entirely ruled by the ID component of the
personality.
EGO

The ego starts to develop at around the age of 3 years from the ID.
EGO operates on the reality principle, i.e. it ensures socially acceptable ways of ID impulses.
It is the rational part of our personality that postpones the gratification of ID impulses to a later
appropriate time. In order to deal with the reality, EGO resorts to defense mechanisms by
distorting reality.

SUPER-EGO

It is the last component of our personality that begins to develop at around the age of 5 years.
It operates on the moral principle, i.e. it internalizes moral standards of right and wrong from
the society and parents and directs our behavior and judgments.
It focuses on what is ideal rather than what is real.
ID, EGO, and SUPER-EGO continuously interacts with each other and a healthy personality
will have a balanced interaction between them and imbalances will lead to maladaptive
personality.
For example, a very dominant ID in a person may make him highly impulsive and may engage
in behavior without any concerns for appropriateness such as a criminal. On the other hand a
person with a very dominant SUPER-EGO may become overly idealistic, moralistic and
judgmental.
The EGO has a tough duty to balance the demands of both ID and SUPER-EGO. Therefore,
EGO sometimes resorts to various defense mechanisms to maintain this balance.

Various defense mechanisms

Following are some of the most common defense mechanisms used by people-
Repression and suppression

Repression is unconscious removing/blocking/forgetting unpleasant thought, impulses or

memories. For example, sometimes people are not able to remember traumatic memories that
happened in childhood.
Suppression is very similar to repression. Only difference is that in suppression people
consciously remove unpleasant feelings/thoughts/memories out of their awareness.

Denial

It is simply refusing to admit or accept a particular aspects of reality. People use denial when
they are unable to face or accept some aspect of reality of their life. For example, a person
addicted to drugs may deny that he/she is doing anything wrong.
Regression

When confronted with stress and anxiety, sometime people display immature behaviors that
have relieved anxiety in the past. Here people revert back to the behavior of earlier
developmental stages. For example, an adult might respond to a frustrations by crying or
throwing tantrums.
Rationalization

Here we give logical/rational or socially acceptable reasons for our unacceptable behaviors or
feelings. For example, people may rationalize their failure by blaming others or outside
situations.
Intellectualization

Here we reduce anxiety by reacting to an event or situation in a detached, cold ways. It helps
us to avoid thinking about emotional aspect of an event by focusing on the intellectual
components. For example, reacting to a death of loved one by saying that everybody will die
one day and we can not control death.
Displacement

It involves taking out our frustrations/aggressions/impulses on people or objects that are less
threatening. For example, displaced anger or aggression is very common where people express
take out their anger on spouse that actually originated after a bad interaction with their boss.

Projection

Here people attribute their own unacceptable characteristics or qualities to another person. For
example, a person with adulterous nature may blame his partner of cheating him.

Reaction formation

Here the person tries to deal with anxiety by behaving in opposite ways of his actual feelings
and thinking. By using this defense mechanisms people hide their true feelings about
something by showing exaggerated opposite behavior. For example, a person expressing
exaggerated sadness/crying on the death of a person who was disliked by him.
Compensation

It involves developing talents in one area to compensate for failure in other area. For example,
developing talents and skills in sports to overcome weakness in academics.

Sublimation

It involves expressing unacceptable impulses by converting them into a more acceptable form.
For example, a person with a lot of anger and aggressive impulse express his anger or aggression
by joining boxing. This is one of the most healthy and successful defense mechanism.

Are all defense mechanisms pathological?

Defense mechanisms vary in their adaptive functions and some are very commonly used by
people. However, excessive use of defense mechanism can be detrimental to our mental
health.
Vaillant (1986) proposed a hierarchical structure of defense mechanisms. He proposed that
there can be four levels of defense mechanisms-
Level 1: Psychotic/pathological defenses (denial, extreme projection)
Level 2: Immature defenses (Fantasy, projection)
Level 3: Neurotic defenses (Displacement, intellectualization, reaction formation, repression)
Level 4: Mature defenses (Sublimation, humor, suppression)
 Lecture 12

Constructive Coping

Constructive coping involves dealing with the stress in a relatively healthy and positive ways.
We are not born with the capability for coping and most of us are not exposed to the stress
management techniques. Consequently, we struggle in our life while dealing with difficulties of
our life.
Stress create tension which is not inherently bad (Antonovsky, 1987). Our quality of life
will depend on how we manage this tension.
Therefore, it is essential that we learn and develop coping skills that are constructive and
healthy for the management of stress.

Effective coping skills reduces distress and lead to positive, healthy outcomes.
Caplan (1964) identified seven characteristics of effective coping skills. They are-

(1) Actively exploring reality and being willing to seek out information

This is about realistic assessment of the situation by finding accurate information and it help us
to cope with the situation in much better way.
Often our fears, anxieties, and stress are result of exaggerated thoughts and beliefs.
(2) Frustration tolerance and a willingness to express both positive and negative
feelings freely

As coping involves managing emotions, expression of emotion both positive as well as

negative can be helpful in this direction especially in a safer way.
Bottling-up of emotions can complicate the process of emotion regulation.
(3) Actively seeking out help from others

Seeking social support is one of most significant coping resources and may provide resources
for both emotion focused and problem focused coping.
(4) Breaking problems into manageable parts and working through them
It is more stressful and difficult to deal with big problems. Breaking a big problem into smaller
manageable chunks is easier to deal with and is less stressful.
(5) Being aware of fatigue and pacing coping efforts while maintaining control in as
many areas of functioning as possible.

Coping with stress and crisis can lead to fatigue and exhaustion. Therefore, it is important to
recognize our limits and take care and pace coping efforts in such a way that we can maintain
control in as many areas as possible.
(6) Mastering feelings where possible, being flexible, and possessing a willingness to
change

it is necessary to accept that we feel the way we do and then to control our reactions and
 responses for better outcomes.
One need to be flexible in their approach and motivation to change.
(7) Having trust in oneself and others and maintaining a optimism on outcomes

By having trust in your ability to deal with your situation and having faith in the others who
are supporting you, it is easier to deal with the demands of your life.

It is also important to maintain an optimistic outlook on outcomes to succeed in coming out of

the crisis.

Coping Effectiveness Training (CET)

Chesney, Folkman, et al (1996, 2003) developed coping effectiveness training framework to

deal with the stressors more effectively.
The framework converts the major ideas of stress and coping theory into more practical
straightforward steps.

This framework includes three steps necessary for effective coping-

(1) Specificity of stressor: Identify stressors and break them from general to more specific
stressors.

(2) Changeability of stressors: Sort your stressors into changeable and unchangeable
aspects.

(3) Match strategies with the source of stressors

General vs specific stressors

Effective coping starts with breaking a large global stressful situation into more manageable
specific stressors that needs attention. This approach reduces our stress as we have to deal
with one chunk of stressor at a time.

Focus on more specific and recent event that needs attention rather than on large global
situation. Ask Who, What, Where and When to get to specific event or situation.

Focus more on specific recent situation that needs attention.

Changeable and unchangeable situations

Some situations can be changed while others can not be.

Changeable stressors- need to quit smoking Unchangeable
stressors-Loss of loved one

Many situations are complex in which some aspects can be changed but others cannot. What
one person sees as unchangeable, another person may consider to be changeable.
 Match the coping strategies with the situation

Effective coping involves using different types of coping while dealing with changeable and
unchangeable situations.
Changeable situation--------Problem focused coping (changing distress causing problem)
Unchangeable situation---------Emotion focused coping (managing distressing emotions)
Frustrations and maladjustment happens when people do not match appropriate coping to the
situation.

Physical ways of coping

Physical exercise

Most of us are aware of the physical health benefits of exercise. However, research indicate
that exercise also promotes mental health and reduces stress levels.
Physical exercise particularly aerobic exercises received attention in stress research such as
running, dancing, and other aerobics.
Studies indicated that people report feeling calmer after 20-30 minutes of aerobic exercise
which may last several hours after exercise (Jackson, 2013).

Possible mechanisms between exercise and stress reduction

Exercise and physiological changes

According to one Harvard medical school publication (2011), physiological impact of
exercise include-
-Reduction of stress hormones such as cortisol
-Release of endorphins which acts as painkiller and enhances mood (that’s why people feel
‘high’ after aerobic exercises.)
Other physiological benefits are-
-exercise-induces increases in hypothalamic temperature which promote tension reduction
following exercise (Breus & O'Connor,1998).

-anxiety and stress reduces following exercise may be caused by a post-exercise decrease in
brain cortical activity (Breus & O'Connor,1998).

Exercise and time out hypothesis

Exercise reduces stress and anxiety by giving a break from whatever is causing an individual
problems or worry. This is called as time out hypothesis (Breus & O'Connor,1998; Bahrke &
Morgan, 1978).

A study that tested the time-out hypothesis by measuring state anxiety in four conditions-quiet
rest, study, exercise, and studying while exercising.

They reported that the ‘‘exercise only’’ condition had the greatest calming effect. However,
when participants were not given a break from their stressor in the ‘‘studying while exercising’’
condition, exercise did not have the same calming effect (Breus & O'Connor,1998).

How much exercise is necessary?

Moderate to vigorous aerobic exercise program (150 minute moderate and 75 minute vigorous
per week) is sufficient to bring out necessary beneficial physiological effects. However, for
taking time out or break from stressors, a shorter duration activity can serve purpose especially
when lack of time or fatigue issues are there (Jackson, 2013).
 Lecture 13: Relaxation exercises for coping

Relaxation Exercises

Relaxation exercises are becoming increasingly popular as a method of teaching people to cope
with the stress and anxiety.
Relaxation response is opposite to stress response.

Deep Breathing/Diaphragmatic Breathing

Have you noticed how you breathe when you are relaxed and when you are anxious/tensed?
Our breathing pattern can influence our mental and physical state and health.
There are two basic patterns of breathing-

(1) Thoracic (Chest) breathing.

(2) Diaphragmatic (Abdominal) breathing.
Thoracic or chest breathing is shallow rapid breaths in the upper lungs (near chest). On the
other hand, diaphragmatic or abdominal breathing is deep, slow breathing in the lower lungs
(in abdomen). Our chest area moves during the chest breathing while abdomen or stomach
moves in diaphragmatic breathing. Deep breathing is fundamental of all relaxation exercises.
According to one Harvard medical school publication, deep breathing is becoming more and
more unnatural for todays generation. One major reason is related to our concept of ideal body
image. A flat stomach is considered attractive to both men and women and consequently we
hold in our stomach muscles. This may interfere with deep abdominal breathing and gradually
chest breathing becomes normal. In shallow breathing, the lowest part of the lungs doesn't get
proper share of oxygenated air.

Mind and Breathing Pattern

When we are anxious, stressed, or disturbed, our breathing pattern becomes rapid, shallow
and irregular, i.e, our breathing changes to thoracic breathing.
Interestingly, by changing breathing pattern we can change our mental experiences. If we
consciously change our breathing to slow, deep, and abdominal during anxiety or stress, it will
activate parasympathetic system and induce relaxation and calming effect.
Slow, deep breathing has been shown to increase parasympathetic activity (Pal, Velkumary, &
Madanmohan, 2004).
A growing number of empirical studies have revealed that diaphragmatic breathing may trigger
body relaxation responses and benefit both physical and mental health (Ma, yue, et. al., 2017)

A Simple Deep Breathing Exercise

 Sit or lie down in a comfortable position in a quite place.
 Put one hand on your belly and the other hand on your chest.

 Inhale, taking a deep breath through your nose. As you inhale feel your belly rise and push
 your hand out. Your hand on the chest should not move.

 After a short pause, exhale, breathe out through your pressed lips as if you were whistling. As
you exhale your hand on your belly should fall back, and use it to push all the air out.

 Do this breathing few times (5-10 times) until you feel relaxed. Take your time with each
breath.

Progressive Muscle Relaxation

One of the most popular relaxation exercise developed by Jacobson (1938) called progressive
muscle relaxation (PMR). Progressive Muscle Relaxation teaches you how to relax your
muscles through a two step process. First, you systematically tense particular muscle groups
in your body, such as your neck and shoulders. Next, you release the tension and notice how
your muscles feel when you relax them.

Mind-body connection

According to Dr. Jacobson, There is a direct relationship between tension in the mind and
tension in the body muscles. Anxiety and stress creates tension or tighten up muscles in the
body. This tightness in the muscle leads to various unpleasant feelings in the body such as
headache, pain in neck, chest, back etc. These unpleasant feelings in the body further
increases stress and anxiety that again increases muscle tensions. This is a vicious cycle.
Relaxation is the only way to break this vicious cycle. Relaxation is a skill that we need to
learn. PMR is one such skill that induces relaxation very easily and can be learned by
everybody.
PMR works based on the principle of one cannot feel anxious or stressed when physically
relaxed. (Jacobson, 1977).

Before You Start

Preparation

Set aside about 15 minutes for the exercise.

Find a quiet and comfortable place.
Remove your shoes and wear loose clothing.

Consult your doctor before performing PMR if you have any underlying medical conditions that
hinder physical activity.

Do not perform if you have broken bones or pulled muscles.

Avoid doing it immediately after heavy food.

General Instructions for PMR

Start with deep breathing

Before you begin, take few slow, deep breaths.
Tensing muscle group

As you breathe in, tense the first muscle group as hard as you can for five to ten seconds:
🢝 Feel the tension in your muscles.
🢝 It may cause some discomfort or shaking but not pain.
🢝focus and tense only the target muscle group.

Relaxing muscle group

Then while you exhale, fully release the tensed muscles and relax. Feel
how the stress leaving the target body part.
Notice the difference between tension and relaxation.
Fully immerse in the experience of relaxation.

Rest

Take 10-20 seconds rest and relax.

Repeat tensing and relaxing each of the muscle groups progressively from toe to head.

See video lecture for the detailed instructions and procedure of PMR

Lecture 14: Mental ways of coping

 Humans are imperfect information processors and we develop many distortions or
dysfunctional thinking patterns. These dysfunctional thinking patterns is common to all
psychological disturbances. A large percentage of our thoughts are not factual. They are
irrational and colored by our biases, negativities, insecurities and so on. Therefore, many
times symptoms of stress, anxiety, depression and other negative emotions are actually caused
by distorted/ dysfunctional thinking patterns. Therefore, one of the useful way of dealing with
stress and other emotional problems is to change our thinking patterns.

ABC Theory

Albert Ellis (1957) developed Rational emotive behavior therapy (REBT) that focus on
changing the thinking or beliefs pattern to reduce maladaptive emotions and behavior.
According to Ellis, you feel the way you think. Therefor, feelings can be changed by changing
our thinking patterns. Problematic emotional reactions are caused by negative self talk which
Ellis called as irrational/catastrophic thinking. Ellis used ABC sequence to explain this idea.

See video lecture for detailed description of ABC theory with examples

Irrational/Catastrophic Thinking

According to Ellis, an irrational idea or belief has following characteristics (Will Ross,
REBT network)-
 It distorts reality.
 It is illogical.
 It prevents you from reaching your goals.
 It leads to unhealthy emotions.
 It leads to self-defeating behavior.
We have many irrational ideas and beliefs. However, Ellis found out that there are three main
and core irrational beliefs. Others are variations of these beliefs. They are based on a demand
– about ourselves, others, or the environment. These are-

1. "I must be outstandingly competent, or I am worthless."

2. "Others must treat me considerately, or they are absolutely rotten.“
3. "The world should always give me happiness."
These catastrophic thinking are based on irrational assumptions, are automatic habitual and
unconscious.
These beliefs take the shape of absolute statements and has many thinking errors such as-
• ignoring the positive,
• exaggerating the negative, and
• overgeneralizing.

Reducing Catastrophic/Irrational Thinking

The major aim of the REBT is to reduce the irrational thinking using our logical and rational
faculties. In this way we will be able to change our emotional experiences in the positive
direction. There can be two major steps in the process-
 (1) Detecting irrational thoughts
(2) Disputing the irrational assumptions

Detecting Irrational Thoughts

Ask yourself “why am I getting upset or emotionally disturbed?”

Examine your self talk closely to find out irrational thoughts and expectations
Spot unrealistic pessimism and exaggeration in your thinking
See if you are using keywords such as never, must, always which are typical of catastrophic
thoughts.

Disputing Irrational Beliefs

For disputing irrational beliefs we should employ our reasoning process to remove the
irrationality.

Albert Ellis proposed asking following questions as a technique to dispute irrational beliefs-

(1) What is the self-defeating irrational beliefs do I want to dispute?

(2) What evidence exists of the falseness of this belief?

(3) Does any evidence exist of the truth of this belief?

(4) `What is the worst that can happen if you give up this belief?

(5) And what is the best that can happen if you give up this belief?

How to dispute irrational thoughts? An example

What is the self-defeating irrational beliefs do I want to dispute?
-I must receive love from someone for whom I really care.

Source: albertellis.org
What evidence exists of the falseness of this belief?
-No law of the universe exists that says that someone I care for must love me (although I would
find it nice if that person did!).

-If I do not receive love from one person, I can still get it from others and find happiness that
way

- If no one I care for ever cares for me, which is very unlikely, I can still find enjoyment in
friendships, in work, in books, and in other things

-If someone I deeply care for rejects me, that will be most unfortunate; but I will hardly die!
Source: albertellis.org

Does any evidence exist of the truth of this belief?

No, not really. Considerable evidence exists that if I love someone dearly and never am loved in
return that I will then find my-self disadvantaged, inconvenienced, frustrated, and deprived.
I certainly would prefer, therefore, not to get rejected. But no amount of inconvenience amounts
to a horror. I can still stand frustration and loneliness.

Source: albertellis.org
What is the worst that can happen if you give up this belief?
I would get deprived of various possible pleasures and conveniences.

I would feel inconvenienced by having to keep looking for love else-where.

Source: albertellis.org

What is the best that can happen if you give up this belief?
I could devote more time and energy to winning someone else’s love—and probably find some-
one better for me.

I could devote myself to other enjoyable pursuits that have little to do with loving or relating,
such as work or artistic endeavors.

I could find it challenging and enjoyable to teach myself to live happily without love.
Source: albertellis.org

Final Thought
Ellis reported that it takes time and practice in changing our beliefs. We need to continually
work on recognizing our irrational beliefs, disputing them, and transforming our negative
emotions into positive emotions.
 Lecture 15: coping with social support

Coping with Social Support

Human beings are social animal and we are programmed to bond with others. This is a
fundamental need which does not fade with age. It has a profound implications for our mental
and physical health
Social support can be defined as “information from others that one is loved and cared for,
esteemed and valued, and part of a network of communication and mutual obligations”.
(Taylor, 2011, page 180).
Social support can be thought of as the soothing impact of friends, family, and acquaintances
(Baron & Kerr, 2003).The need for stable and strong social relationships with others is a very
powerful, pervasive and fundamental motivation (Baumeister & Leary, 1995). It helps us to
establish a network of close, caring individuals who can provide social support in times of
distress, sorrow, and fear.
Social support is a particularly important personal resource because it helps provide access to
further resources beyond those already possessed by the individual (Hobfoll et al., 1990).
There can be several sources of social support such as parents, friends, relatives, loved ones.
Pets can also be a source of support for many (Allen, 2003).

Different Forms of Social Support

Social support can take different forms such as tangible support, informational support,
emotional support, invisible support (Taylor, 2011).
Tangible support: Material support such as services, financial or goods

Informational support: Information, advice, or suggestions during difficult or stressful times.

Emotional Support: Words or actions that make a person feel cared about, understood, and
affirmed. For example, emotional support may include empathy, caring, love and trust.
Invisible support: Receiving help from other but is unaware of it. This kind of help is most
likely to benefit the recipient (Bolger & Amarel, 2007) as there can be costs involved with
other types of supports.

Just as we sometimes need different types of support, some people are better at providing one
kind of support than another (although some people are good at more than one type). Social
support is beneficial when there is a match between what one needs and what one receives from
the support network is called as matching hypothesis (Cohen & McKay, 1984). For example,
when a person needs tangible support, providing emotional support may not be helpful and vice
versa.

Effects Of Social Support

Social support can be a good source of coping during the stress. People with high social
support experience less stress and cope more successfully (Taylor, 2010). Different types of
social support such as emotional, tangible, and informational support were found to lower
blood pressure when individuals were faced with short-term stressors (Bowen, Uchino, et al.,
2014).
In a classic study by Berkman and Syme (1979), on a sample of 6928 adults in Alameda
County, California who were followed over 9 years found that compared to those with the
most social contacts, isolated men and women were, respectively, 2.3 and 2.8 times more
likely to die even after controlling for a variety of health-related variables, such as smoking,
alcohol consumption, self-reported health at the beginning of the study, and physical activity.
In another meta-analysis of 148 studies conducted between 1982 and 2007 involving over
300,000 participants found that individuals with stronger social relationships have a 50%
greater likelihood of survival compared to those with weak or insufficient social
relationships (Holt-Lunstad, Smith, & Layton, 2010).

Studies have also shown that higher social support is linked to better survival rates following
cardio-vascular disorders (Brummett et al., 2001), breast cancer (Falagas et al., 2007), and
HIV infection (Lee & Rotheram-Borus, 2001).

Biological Pathways of Social Support

Social support has been found to have beneficial effects on cardiovascular, endocrine, and
immune system (Taylor, 2010). It slows down or reduces the physiological and
neuroendocrine response to stress (Taylor, 2011). Social support has been linked to boosting
the immune system, especially among people who are experiencing stress (Uchino, Vaughn,
Carlisle, & Birmingham, 2012). It is also linked to reduce blood pressure for people performing
stressful tasks (Lepore, 1998). Social support facilitates coping and health outcomes by having
beneficial physiological effects in stressful situations.

It is also possible that social support may lead to better health behaviors, such as a healthy
diet, exercising, smoking cessation, and cooperation with medical regimens (Uchino, 2009).

Stress Moderation by Social Support

There are two hypotheses have been explored to understand the role of social support in
moderating the effects of stress-
(1) Direct effects hypothesis: It predicts that the social support is generally beneficial in all
the time (both stressful and non-stressful times).
(2) Buffering hypothesis: It predicts that the social support is primarily beneficial during the
period of high stress. According to this hypothesis, social support acts as a buffer or protective
resource and mitigates the negative effects of stress during the time of high stress

Both the hypotheses were supported by research (Taylor, 2011). Social support has been
found to predict better health among the people in high stress (such as chronic diseases) as
well as among the people in general regardless of stress.

Social Support Network Analysis: A Convoy Model

A social convoy model: Social convoy model was developed by Toni Antonucci and Robert
Kahn of the University of Michigan in 1980. A convoy represents a group of people moving
together through life. According to the convoy model, individuals are surrounded by supportive
others who move with them throughout the life course. These relationships vary in their
closeness, their quality, their function (e.g., aid, affect, affirmation exchanges), and their
 structure (e.g., size, composition, contact frequency, geographic proximity) (Antonucci,
Ajrouch, & Birditt, 2014).

The convoy measure involves placing close and important individuals into three concentric
circles representing three levels of closeness: close, closer, closest. It is a simple way to
represent complex human relationships.

Example

People in convoy represents our social support network. These people support us and we
support them. It is essential that we maintain our convoy throughout the life particularly people
in our inner circles.

Social Convoy Exercise

You can analyze your social support network or convoy using this exercise-

Inner circle
List people in your inner circle who are very close to you, so close that it is hard to imagine your
life without them
Middle circle
List people in your middle circle who are close to you, but not as close as people of inner circle

Outer circle
List people in your outer circle who are less close but still important in your life.

See video lecture for social convoy exercise

Building Social Support Network

Building social support is an active process which needs active participation. Few suggestions
include-
 Identify and improve the problems in existing social network
 Build new connections by joining and participating in groups and communities that you like
 Altruistic and volunteer work
 Alternative sources of support: Pets etc.

(See video lecture for detailed explanation)

Lecture 16: Meditation and Mindfulness

Meditation practices are common to almost all religious and spiritual traditions. It has been
used for healing, insights, and enlightenment. It is during the 1960s that scientific studies
started focusing on the clinical effects of meditation on health after the reports of extraordinary
feats of bodily control and altered states of consciousness by eastern yogis and meditation
practitioners reached the west.

With the scientific advancement and refinement in instrumentation, scientific study of effects
of meditative practices became possible. A formal acknowledgement of the academic curiosity
within psychology came in 1977, when the American Psychological Association issued a
statement on meditation stating that-“meditation may facilitate the psychotherapeutic process.”
They also encouraged research “to evaluate its possible usefulness” (Kutz, Borysenko, &
Benson, 1985, p.1). As a result, both health care professionals and lay people embraced
meditation as a valuable tool for stress reduction and a device for healing both mental and
physical disorders.

What is Meditation?

The word “meditation” is derived from the Latin word “meditari”, which means “to engage in
contemplation or reflection.” The word meditation comes from the same Greek and Latin root
as the word medicine.

Manocha (2000) described meditation as a discrete and well-defined experience of a state of

“thoughtless awareness” or mental silence, in which the activity of the mind is minimized
without reducing the level of alertness.
Walsh and Shapiro (2006) defined meditation from cognitive and psychological perspective, as
a family of self-regulation practices that aim to bring mental processes under voluntary control
through focusing attention and awareness.

Types of Meditations

There are many diverse meditation techniques are practiced. All these practices can be
grouped into two basic approaches-

(1) concentrative meditations

(2) mindfulness/ insight meditations.

Concentration meditation aims at single pointed focus on some sound, image or sensation to
still the mind and achieve greater awareness (Hussain& Bhushan, 2010). For example,
Transcendental meditation of Mahesh Yogi.
Mindfulness “involves opening up or becoming more alert to the continuous passing stream of
thoughts, images, emotions and sensations without identifying oneself with them. Such
practice helps in developing non-reactive state of mind, which is the foundation for calm and
peaceful state of consciousness. Here instead of narrowing the focus (concentration)
practitioner becomes alert to the entire field of consciousness” (Hussain & Bhushan, 2010,
Page. 441). Example, Vipassana and Zen meditations belong to this category.

What is Mindfulness?

Jon Kabat-Zinn is one of the first academician to introduce and popularize mindfulness in the
academic and research circle. He is also the founder of mindfulness based stress reduction
(MBSR). He defined mindfulness as “Paying attention in a particular way: on purpose, in the
present moment, and non-judgmentally” (Kabat-Zinn, 1994, p. 4).
Based on this definition, Shapiro and her collegues (2006) proposed three components of
mindfulness-

1. “On purpose” or intention, 2. “Paying attention” or attention, 3. “In a particular way” or

attitude

(1) intention, (2) attention, and (3) attitude

Intention

Intention sets the stage for all human activities.People may intent to do mindfulness for various
reasons such as stress reduction, emotion regulation, self-exploration, enlightenment etc.
Intentions may change from time to time.

Research indicated that outcomes of mindfulness practice correlated with the intention
(Shapiro, 1992). For example, those who practiced for stress reduction attained better coping
with stress and those who practiced for self-exploration attained better insights into their self.

Attention

Paying attention is the core of mindfulness practice. Paying attention involves observing the
operations of one’s moment-to moment, internal and external experience i.e. all contents of
consciousness (Shapiro et al., 2006). Here paying attention includes attending to our present
experiences moment to moment here and now by suspending all interpretations and
judgments. Such attention takes us out of our non-stop wondering disturbed mind to our
senses in the present moment.

Attitude

Attitude here refers to the qualities of attention or how pay attention. This is also an important
aspect of mindfulness practice (Shapiro et al., 2006). Mindfulness also includes paying
attention to our internal and external experiences without evaluation or interpretations, but with
heart qualities such as acceptance, patience, kindness, openness even when there are
unpleasant experiences (Shapiro et al. 2006). Such qualities of attitude give us a break from
non-stop resistance by trying to push away unpleasant experiences and craving for pleasant
experiences. This may be called as peace and real happiness.
Therapeutic Effects of Mindfulness

Research on mindfulness has identified diverse benefits. Some of them are as follows-

Stress reduction (Hoffman et al., 2010; Coffey & Hartman, 2008; Ostafin et al., 2006)
Increases positive affect and decreases anxiety, depression, and negative affect (Farb et al.,
2010)

Improvements to working memory (Jha et al., 2010).

Increase in relationship satisfactory and decrease in conflicts (Barnes et al., 2007).

increased immune functioning and physical health (Davidson et al., 2003; Grossman,
Niemann, Schmidt, & Walach, 2004).

Improvement to well-being (Carmody & Baer, 2008).

Mechanisms for the Therapeutic Effects of Mindfulness

Reperceiving as a meta-mechanism: According to Shapiro et al. (2006) “intentionally

attending with openness and non-judgmentalness leads to a significant shift in perspective,
which we have termed reperceiving” (page 377).
Re-perceiving means shift in perception. Shapiro et al. (2006) define re-perceiving as de-
identifying with conditioned judgments, shifting focus instead to direct perception of sensations
in the current moment. This reperceiving helps us to dissociate or dis-identify from the non-
stop mental drama and to witness our experiences moment to moment with more clarity and
objectivity.

According to Shapiro et al. (2006), reperceiving is a meta-mechanism that leads to other

additional mechanisms that further contributes to the positive effects of mindfulness. They are-

(1) self-regulation and self-management,

(2) emotional, cognitive and behavioral flexibility,
(3) values clarification and,
(4) exposure

Self-regulation and Self-management

Mindfulness promotes self-regulation and management and other positive effects associated
with it. Reperceiving facilitates greater connection with our experiences. Consequently, we
have more access to experiential information and less experiential avoidance of unpleasant
feelings and emotions. It increases our degree of freedom. This reduces automatic, intrusive,
habitual, and maladaptive reaction patterns.

Values Clarification

Mindfulness helps people to identify the true values and meaning of their life. Ordinarily we
are identified and conditioned by the outside societal forces which dictates our values and
choices of life. Mindfulness helps us to break from the influences of these forces and
objectively look at our life, reflect and rediscover our true values and meaning of life.

Cognitive, Emotional and Behavioral Flexibility

Mindfulness enhances flexibility at all levels, i.e., mental, emotional and behavioral levels.
Reperceiving increases the clarity and objectivity to our moment to moment experiences.
Consequently, our degree of freedom and choice to respond in a situation increases either
mentally, emotionally or behaviorally. We become less and less victims of our environment,
thoughts and emotions.

Exposure

Exposure is a technique used in various therapies such as phobias. The basic idea is that
people gets desensitized when systematically exposed to an unpleasant emotions again and
again. Mindfulness brings about many positive changes by the principle of exposure. In
mindfulness, we connect directly with the moment to moment experiences including negative
emotions and observe them without avoidance and resistance. This approach reduces our
negative, maladaptive, and neurotic emotional patterns such as phobias, anxieties etc.

All these mechanisms may lead to may associated positive outcomes discussed earlier.

Instructions for Mindfulness Practice (See video lecture)

 Module 6: Beyond Stress And Recovery

Lecture 17: Positive Mental Health and Well-

being

Positive Mental Health and Well-being

The World Health Organization (WHO) defines health as:

… a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.

Mental health is clearly an essential part of this definition.

Mental health is described by WHO as:

… a state of well-being in which the individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to make a
contribution to his or her community.
This definition clearly indicates that the mental health is more than the absence of mental
illness. In a true sense, It is state of well-being beyond mental illnesses. In this positive sense
mental health is the foundation for well-being and effective functioning for an individual and
for a community.This definition also suggests that mental, physical and social functioning are
interdependent. Despite this, mental health is still thought of as a luxury and not a fundamental
aspect of our health.
Mental health is often used synonymously with mental health conditions or illnesses such as
depression, anxiety etc. However, the concept is more than that. In the broader sense, if a person
is not having mental illnesses does not necessarily mean that they are experiencing positive
mental health or flourishing. Therefore, it is a complex concept.
Mental health has two major dimensions-
-Mental health conditions/illness
-Positive mental health experiences such as happiness, life satisfaction, self-realization,
meaning in life etc.

Well-being is concerned primarily with the promotion of positive mental health experiences.

What Is Well-being?

Well-being refers to optimal functioning and experience (Ryan and Deci 2001). The Royal
Society in the UK (2004) defined wellbeing as a "positive and sustainable mental state that
allows individuals, groups and nations to thrive and flourish.” This means at the level of an
individual, wellbeing refers to psychological, physical and social states that are distinctively
positive (Huppert, Baylis and Keverne, 2004). It is about enriching human life and enhancing
human functioning.

Well-being Categories
 Well-being has been defined in diverse ways. However, most of these definitions falls under
four distinct categories (Huta, 2015). They are-
Orientations: What a person seeks in life and why (such as values, motives, ideals, and
goals.
Behaviors: The actual activities that a person does (e.g., attending parties, writing down
goals).
Experiences: Momentary or typical subjective feelings, emotions, and cognitive-affective
appraisals (e.g., positive affect).
Functioning: How well a person is doing in life in terms of abilities, accomplishments, health
habits etc. (such as being good at self-regulation, achieving maturity).

Hedonism vs Eudaimonism

Within each categories of well-being, researchers have focused on different contents of well-
being (Huta, 2015). For example, the contents of experience category may include positive and
negative affect, life satisfaction etc. Although there are numerous and complex definitions of
well-being, the majority of researchers agree that the contents of well-being fall under two
higher order philosophies or traditions – hedonia and eudaimonia (Huta, 2015).

Historical Roots of Hedonism and Eudaimonism

The debate between hedonism and eudaimonism has a long history. In the 4th century BC, this
debate was prominent between the two Greek philosophers-Aristotle and Aristippus. Aristotle
was the proponent of eudaimonism and suggested that a good life should be in accordance with
our true nature, virtue and reason. Aristippus on the other hand was the proponent of hedonism
and said that pleasure is the only good in life and pain only evil. The goal of life should be to
gain maximum pleasure.
Since then, many philosophers took side of both the traditions. For example, Hobbes, bentham
took the side of hedonism while plato, Kant took the side of eudaimonism.

Biological Roots of Hedonism and Eudaimonism

Pleasure seeking or hedonia is regulated by the hot systems of the brain (older subcortical
part of the brain) while self-reflective process akin to eudaimonic processes is related to the
cold systems (newer, complex, cerebral part) of the brain (Steger and Shin, 2012)
See video lecture for visual presentation
Huta (2015) suggested that
“people need both hedonia and eudaimonia to flourish... Hedonia and eudaimonia are not
opposites, nor are they mutually exclusive – they are complementary psychological functions.
Furthermore, a person may derive a hedonic benefit but a eudaimonic loss from an activity, and
vice versa. It is therefore important to assess both hedonic and eudaimonic variables when
studying well-being outcomes.”

Psychology of Hedonic Well-being/Subjective Well-being

Psychologists who have adopted the hedonic view have tended to focus on a broad conception
of hedonism. Hedonic well-being which is also called as “subjective well-being” captures the
presence of positive affect and life satisfaction as well as the absence of negative affect (Diener
et al. 1999). Subjective well-being also called as happiness is generally defined as an
experiential state that contains a globally positive affective tone.

Researchers have conceptualized and measured happiness in at least two quite different ways.
One is affect balance, indicating having more pleasant than unpleasant emotional states, and is
thus essentially an aggregate of how one feels at different moments. The other, life satisfaction,
goes beyond momentary feelings to invoke an integrative, evaluative assessment of one’s life
as a whole.
SWB consists of three components: life satisfaction, the presence of positive mood, and the
absence of negative mood, together often summarized as happiness.

Psychology Of Eudaimonic Well-being/Psychological Well-being

The hedonic approach of well-being has been criticized by many scholars as being incomplete
because well-being is more than emotion and life satisfaction. Eudaimonic well-being
addresses these criticism by conceptualizing well-being in terms of positive functioning,
meaning in life and pursuing worthwhile goals, actualization of inner potentials and so on. The
core of wellness is not how pleasantly or unpleasantly one feels but how one functions in
response to life challenges (Ryan, 1989).
Eudaimonic well-being which is also called as “psychological well-being.” One of the most
common way by which eudaimonic well-being is conceptualized and measured in psychology
is by using six dimensions of psychological functioning proposed by Ryff (1989). These are-
Autonomy
environmental mastery
personal growth
positive relations with
others purpose in life, and
self-acceptance.

Eudaimonic well-being will be discussed in more detail later in this course (last two modules).

Well-being as a Combination of Hedonism and Eudaimonism

There are models of well-being that combines the indicators of both hedonic and eudaimonic
well-being. Two such models will be discussed-
Keyes 13 dimensions of mental health as flourishing and
Martin Seligman’s model of flourish (PERMA)

(will be discussed in the next lecture in the context of well-being and resilience).

Keyes Model of Mental Health as Flourishing

According to Corey L. M. Keyes (2005, 2007), positive mental health includes hedonic well-
being and the psychological and societal aspects of eudaimonic well-being. Therefore, mental
health is a combination of emotional, psychological, and social well-being.
He distinguishes the state of flourishing from the state of languishing. The state of flourishing
is a combination of high level of subjective well-being with an optimal level of psychological
and social functioning. The state of languishing is a combination of low levels of subjective
well-being and low levels of psychological and social well-being. Keyes (2010) further stated
that those who are not languishing or flourishing are considered to be in moderate mental
health.

Keyes 3 factors and 13 Dimensions Of Mental Health As Flourishing

3 factors of positive mental health and flourish

(1) Positive Emotions (Emotional well-being)
(2) Positive psychological functioning (Psychological well-being)
(3) Positive social functioning (Social well-being)

The dimensions under each of these factors are as follows-

Positive Emotions (Emotional well-being)

Positive affect: Regularly cheerful, interested in life, in good spirits, happy, calm and
peaceful, full of life.
Avowed quality of life: Mostly or highly satisfied with life overall or in domains of life.

Source: Keyes (2007, Table 1, p. 98)

Positive psychological functioning (Psychological well-being)

Self-acceptance: Holds positive attitudes toward self, acknowledges, likes most parts of self,
personality.

Personal growth: Seeks challenge, has insight into own potential, feels a sense of continued
development.

Purpose in life: Finds own life has a direction and meaning

Environmental mastery: Exercises ability to select, manage, and mold personal environs to
suit needs.

Autonomy: Is guided by own, socially accepted, internal standards and values.

Positive relations with others: Has, or can form, warm, trusting personal relationships.
 Source: Keyes (2007, Table 1, p. 98)

Positive social functioning (Social well-being)

Social acceptance: Holds positive attitudes toward, acknowledges, and is accepting of

human differences.
Social actualization: Believes people, groups, and society have potential and can evolve or
grow positively.
Social contribution: Sees own daily activities as useful to and valued by society and others.
Social coherence: Interested in society and social life and finds them meaningful and
somewhat intelligible.
Social integration: A sense of belonging to, and comfort and support from, a community.
Source: Keyes (2007, Table 1, p. 98)
 Lecture 18: Well-being and Resilience

What is Resilience?

Resilience is another significant concept that is closely connected to well-being.

There are different definitions of resilience. Some are-
‘Dynamic process encompassing positive adaptation within the context of significant adversity’
(Luthar, Gicchetti, and Becker, 2000; p. 543)
Resilience is characterized by ‘good outcomes in spite of serious threats to adaptation or
development’ (Masten, 2001; p. 228).

There are two defining aspects to resilience (Toland and Carrigan, 2016):
Exposure to significant threat or adversity
Achievement of positive adaptation despite threats to the development process
Some researchers also distinguish between resilience as a trait and resilience as a process
(Harms, et al., 2018).
As a trait it is considered as an individual ability to resist being damaged by trauma and
adversities. As a process, it is considered as an outcome of dynamic process of bouncing back
or recovering from the trauma or adversities. It looks at how an individual recover from the
adversities. Most of the researchers consider it as process and believes that resilience involves
thoughts, actions and behaviors that one can learn. It is not necessarily a privilege of only
some people.

Relationship between Resilience and Well-being

Resilience and well-being are closely related concepts to the extent that some well-being
instruments measure resilience (Davydov et al., 2010; Windle, 2011). The relationship
between resilience and well-being is not straightforward.

Many research indicate that higher level of well-being leads to more resilience (Kuntz,
Näswall, & Malinen, 2016). It could be due to the fact that positive individuals may be more
resilient because they approach situations expecting better outcomes and tend to elicit more
positive responses (Wood, Harms, & Vazire, 2010). Positive emotions (component of hedonic
well-being) facilitates resilience (Fredrickson, Tugade, Waugh, & Larkin, 2003) as it helps in
adaptive coping.

It is also possible that resilience to predict a number of well-being outcomes such as

subjective well-being (Liu, Wang, Zhou, & Li, 2014). It is also possible that some antecedents
of well-being and resilience diminish the attainment of the other (Harms et al., 2018).
For example, few studies reported that the positive emotions associated with well-being, such as
joy and calmness, tend to generate a diffuse contentment rather than the sharp, vivid focus on
challenges associated with resilience (Fredrickson, 1998; Silard, 2016).
Therefore, well-being and resilience are closely connected. However, the relationship can be
complex and not straightforward.
 Seligman’s PERMA Model of Well-being

Martin Seligman, the founder of positive psychology proposed five components of well-being.
He conceptualized well-being as a combination of both hedonic and eudaimonic components.
They are-
Positive emotions (Feeling good)
Engagement (finding flow)
Relationships (authentic connections)
Meaning (purposeful existence)
Achievement (a sense of accomplishment).

Well-being, Resilience and PERMA

Professor Seligman’s research has proven that an increase in PERMA will result in an
increase in resilience and a boost to mental health and well-being.
All the components of PERMA will be discussed in detail in the upcoming lectures.
A summary of each components will be discussed here briefly.

Positive Emotions

Positive emotions may include emotions such as amusement, hope, interest, joy, love,
compassion, gratitude etc.
Positive emotions can broaden our thoughts-action repertoire and build physical, psychological
and social resources (Fredrickson, 2001).
Positive emotions enhances well-being and performance related outcomes and reduction in
negative emotions (Hart, Caballero & Cooper, 2010)

Building positive emotions

 Practice gratitude by reflecting on things for which you are thankful.

 Doing activities that you enjoy
 Spending time with loved ones
 Playing with children, pets, and friends
 Doing exercises particularly aerobic exercises
 Listening to uplifting music that you like.
Optimism is strongly connected to positive emotions and optimistic people are highly resilient to
stressful events.
Source: well-being and resilience center (SAHMRI)

Engagement

Engagement is about finding flow experience. The flow experience happens when we are
 intensely focused on the task at hand in the present moment that we lose track of time.
Professor Mihaly Csikszentmihalyi is a leading researcher in this area. He found that flow
happens when we perform a challenging task where we have the opportunity to use your
skills/strengths (Csikszentmihalyi, 1997).
Flow and engagement improve subjective well-being, happiness, life satisfaction and positive
affect (Chen, Wigand, & Nilan, 1999). It is also found to be correlated with increase
performance, higher motivation and engagement and positive mood in organization context
(Kasa & Hassan, 2013)

Building Engagement

 Identify and do activities that lead you experience flow and engagement

 Identify and use your signature strengths. Find challenging tasks where you can exercise
your strengths.
 Learn and practice mindfulness meditation techniques to increase focus in the present
moment.

Relationships

Relationships refer to the nature of connections and interactions we have with others. We are
social creatures and positive relationships have a significant impact on our wellbeing.”
(Seligman, 2012). Social support can be a good source of coping during the stress. People
with high social support experience less stress and cope more successfully (Taylor, 2010).
Social support is a particularly important personal resource because it helps provide access to
further resources beyond those already possessed by the individual (Hobfoll et al., 1990).
Therefore, our relationships and social support are one of the most significant source of well-
being and resilience.

Building Relationships

 Identify and improve the problems in existing social network

 Build new connections by joining and participating in groups and communities that you like
 Altruistic and volunteer work

Meaning in life

Meaning is about doing things that are valuable and worthwhile. This involves belonging to
and/or serving something that we believe is greater than ourselves (Seligman, 2012). The
search for meaning in life could an intrinsic motivation among human beings. An individual
achieves meaning in life when his or her life is experienced as purposeful, significant, and
understandable (Steger, 2009). This sense of purpose provides individuals with goals that guide
action and promote well-being. Finding meaning in one’s life is an important determinant of
psychological well-being (Frankl, 1997; Steger, Kashdan, Sullivan, & Lorentz, 2008).
Building meaning

People may find meaning in different things-professions, creative pursuits, hobbies,

volunteering for a cause etc. Find what's yours and devote more time to it.
Get involved in causes greater than your personal life.

Accomplishment

It is about things that we have done or accomplished in our life. It is about working and
reaching our goals. Even small goals such as doing half-an-hour exercise everyday and making
efforts to achieve them give us a sense of accomplishment, happiness and well-being. It
increases our self-esteem and confidence.

Grit is associated with the idea of accomplishment. It is about perseverance and passion for
long-term goals introduced by Angela Duckworth. People who exhibit ‘grit’ persevere at their
goals over time even at the face of failures and adversities. It is especially important to achieve
high and difficult goals where sustained application of talent over time is required.

Building accomplishment

Set achievable and realistic goals. Goals need not be very big and high all the time. Setting
and achieving small goals on a daily basis can increase our sense of accomplishment.
Set your goals by assess your talents, strengths, and skills and persevere at it even if you fail
few times.
Celebrate your achievements with yourself and others.
Achieving intrinsic goals (relating to growth and connection, rather than money and status),
produces larger gains in well-being (Sheldon 2004).

Building Resilience-Final thought

According to APA website (apa.org), there are four core components that can enhance our
resilience. They are-

Build connections
Foster wellness,
Embrace healthy thinking and
Find purpose and meaning

So, the crux is that any strategy that leads to healthy coping and fosters well-being can
increase our resilience also.