Research roundup: Stress
By Practice Research & Policy staff
April 25, 2013–Following the publication of APA’s annual Stress in America survey, this research roundup highlights current research that may have clinical relevance for practitioners. Stress has well-studied biological and psychological effects. Here we share some findings with implications ranging from interpersonal relationships and addiction to comorbidity and telepsychology.
Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., & Baime, M. (2012). Effective and viable mind-body stress reduction in the workplace: A randomized controlled trial. Journal of Occupational Health Psychology, 17(2), 246-258. doi: 10.1037/a0027278
Psychological stress, in general, is an important predictor for a large variety of health problems, as well as a concern for workplace productivity and general employee wellbeing. Implementation of organization-wide stress reduction or stress management courses may be beneficial, due to reduced health care costs and improved productivity. The study’s randomized controlled trial attempted to assess the best possible delivery method for a stress management program, and which stress management methodology (online, in person or yoga instruction) led to the best individual outcome, as well as which methodology held the largest financial benefit. Organizational financial benefit was measured in terms of reduced absenteeism, reduced staff turnover and improved morale.
After intervention, individuals in all three groups (in person, online and yoga) showed improved sleep patterns and decreased levels of self-reported stress. Participants in all groups also showed improved biological markers of health, including breathing rate and heart rhythm. The attrition rate was lower for the online instruction as compared to the in person instruction group. Mood and productivity benefits were not statistically significant.
This study suggests that online and in person stress management classes are equally effective in improving sleep quality and reducing perceived stress levels, regardless of attrition rates. Yoga instruction also provides similar benefits. Psychologists may want to consider augmenting treatment by directing clients to quality online instruction when available and appropriate.
The reduced attrition associated with online instruction suggests such courses may be a useful adjunct for psychologists to recommend, if they are not able to offer such classes themselves but may have clients who are self-motivated and would benefit from participation.
Buck, A. A., & Neff, L. A. (2012). Stress spillover in early marriage: The role of self-regulatory depletion. Journal of Family Psychology, 26(5), 698-708. doi:10.1037/a0029260
Stressful experiences outside of interpersonal relationships are often correlated with poor satisfaction within relationships. For example, financial distress can cause difficulties within marriages. This phenomenon is called “stress spillover.”
This study attempts to model how stress results in lowered relationship satisfaction by having newly married couples keep a 14 day diary of self-reported stress and relationship well-being. Participants recorded their daily marital behaviors, self-reported stress levels and level of self-regulation. “Stress spillover” was discovered in the sense that on days when self-reported stress levels were higher, participants engaged in more negative behaviors toward their spouses and had less positive opinions of their relationships.
This article suggests that stress may inhibit self-control, preventing participants from self-regulating negative actions toward their spouses, or may lower the amount of self-control available to prevent such negative attitudes and actions.
Clinicians may wish to consider how patients experiencing chronic stress may struggle with close interpersonal relationships and may experience a less positive view of their interpersonal relationships. Treatment interventions that support patients and their relationships may help combat the damage stress can cause to close interpersonal relationships.
Yoon, K. L., & Joormann, J. (2012). Stress reactivity in social anxiety disorder with and without comorbid depression. Journal of Abnormal Psychology, 121(1), Feb 2012, 250-255. doi: 10.1037/a0025079
Perceived stress results in the release of cortisol, which means individuals with social anxiety disorder (SAD) might have heightened cortisol activity, especially in the face of social situations. Heightened levels of cortisol are linked to suppressed immune system activity. Research has not found consistent patterns of cortisol response in individuals with social anxiety disorder.
This study compared salivary cortisol responses to a psychological stressor (being asked to prepare and present a five-minute speech) among a healthy control group, people with SAD and people with SAD and comorbid major depressive disorder (MDD). Individuals with SAD had greater cortisol stress reactivity than either the control group or individuals with SAD and comorbid MDD. However, individuals with comorbid SAD and MDD self-reported more nervousness in response to the task. Control participants had both lowest stress reactivity and self-reported nervousness.
These findings suggest that individuals with SAD and individuals with SAD and comorbid MDD experience stressors differently. The results indicate that SAD is associated with increased cortisol responses when the individual is faced with a stressor. When individuals have comorbid MDD and SAD, there is no increased cortisol response. Clinicians concerned with the physiological responses to stressors in individuals with anxiety or mood disorders should carefully distinguish the presence of one or multiple disorders.
The physiological response to stress appears to be different for individuals with different disorders. The study only investigated individuals with SAD, either with or without comorbid MDD but not individuals with MDD alone. This study suggests that individuals with SAD and MDD may be more likely to have a muted cortisol response to whereas those with SAD alone will have increased cortisol levels. Increased cortisol levels can weaken the effectiveness of the immune system, and therefore have obvious health implications.
Clinicians may wish to consider the possibility that other co-occurring disorders may result in muted responses to stressors. This muted response may have varied cognitive, emotional and therapeutic impacts and may explain differential responses to treatment interventions among individuals with the same diagnosis (but different co-morbid diagnoses).
Erblich, J., Bovbjerg, D. H., & Diaz, G. A. (20120). Genetic predictors of cue- and stress-induced cigarette craving: An exploratory study. Experimental and Clinical Psychopharmacology, Vol 20(1), 40-46. doi: 10.1037/a0025369
Given the well-established negative health effects of smoking and the difficulty of defeating nicotine addiction, researchers continue to attempt to discover more efficient cessation strategies. Failure to quit smoking is often associated with cravings induced either from stress or smoking-related cues (such as seeing others smoking or touching cigarettes).
This study attempts to establish whether or not stress or cue-related cravings rely on the same motivational system or process. Nicotine-addicted smokers were exposed to neutral, smoking related (cue) or stressful stimuli. Participants then completed a questionnaire assessing nicotine craving. Participant’s susceptibility to specific stimuli that induce nicotine craving was not dependent on other biographical factors. Both stress and cue stimuli induced strong urges to smoke; however, smoking cue imagery induced significantly greater urges to smoke than stress imagery.
Cue- and stress-related cravings were correlated with one another, suggesting that they may share certain genetic indicators and chemical pathways. However, separate genetic markers were involved with each type of stimuli, suggesting individuals have greater susceptibility to one smoking craving stimulus as opposed to the other.
Individuals appear to be genetically predisposed to having greater difficulty combatting either smoking cue or stress-related stimuli, suggesting the need to individualize therapeutic guidance to identify and target the most problematic craving-inducing cue or behavior, and develop a plan of action.
Pharmacological treatments coupled with behavioral changes that combat specific (smoking) cues or stress-related nicotine addiction may be appropriate, as well. While cue- and stress-related smoking share similarities, recognizing them as distinct predispositions may serve to more efficiently focus treatment.