The Biopsychosocial model of health looks at the physical factors of health, incorporating the psychological and social factors of health also (Brannon L. and Feist J. 1992). This is with the view to determining a holistic picture of the health of an individual. Biological(physical), social and psychological factors can all play a role in affecting an individual’s health, and particularly can all attribute or be a result of a person’s stress levels.
Stress is a ‘non specific response of the body to any demand made on it; the arousal, both physical and mental to situations or events that we perceive as threatening or challenging.’
Seyle identified different types of stress: eustress which is seen as beneficial or distress which is unpleasant. He also recognised that stress is an inevitable part of life, required by the body to function. The absence of stress would mean the absence of any stimuli in the body which would inevitably result in death.
Stress can be caused by: people i.e. conflict with others, situations i.e. work, exams or driving or it can be environmental i.e. high temperature or noise.
In addition, there are different situations which can be regarded as ‘stressful’. Life events such as marriage, divorce, death of a loved etc can be extremely stressful for a person; however this depends on how a person appraises the situation.
Daily hassles also contribute to an individual’s stress levels. Driving to work can be stressful if a person is stuck in traffic jams for the journey, or worrying about weight issues.
There are 3 general theories for Stress. Stress may be a stimuli, a response to a stimulus or a combination of both (Brannon L. and Feist J. 1992).
The Biological Model of Stress
Stress can be attributed to many health issues ranging from mild problems such as irritability, food cravings and loss of libido, through to severe health issues such as cardiovascular disease, panic attacks and bowel problems.
As early as 1914, Cannon suggested that emotional reactions may be involved in physical changes which relate to illness (Brannon L. and Feist J. 1992).
This notion was taken up by Hans Seyle who developed the term ‘stressor’ meaning the stimulus, and ‘stress’ to be the response to the stressor (stimuli).
Seyle also developed the ‘General Adaptation Syndrome Theory’ (GAS Theory) as a way of defining the bodies attempt to defend itself against a ‘stressor’. Seyle called it a non specific response. There are 3 stages of Seyles GAS Theory; the alarm reaction, resistance stage and exhaustion stage.
The alarm stage represents the initial physiological changes in the body as a response to a stressor. This is when the body prepares itself for ‘fight or flight’ by activating the sympathetic autonomic nervous system. The heart rate and blood pressure increase, sweat glands are activated, gastrointestinal activity decreases and adrenaline is released.
The resistance stage is where the body adapts to the stressor. This is where the person continues to function normally on the outside, however continuing exposure to the stressor causes internal problems as the body adapts neurologically and hormonally to the stressor. It is these demands which are put on the body which Seyle believes increase the likelihood of disease and illness.
The exhaustion stage occurs when the body is unable to cope with the stressors any longer and a breakdown occurs. The exhaustion stage can result in illness, depression or even death.
Mason J. (1975) disagreed with Seyles view that stress is a non specific response. Mason preferred to view stress like a pathogen; stress may have the potential to cause illness but individual factors need to be taken into account and a person may not always become ill due to stress.
The Psychological Model of Stress
Lazarus and Folkman (1984) noted that stress is:
‘…an inevitable aspect of life and what made the difference in human functioning is how people coped with it.’
Lazarus and Folkman (1984) recognise that different people and group react differently to different demands and pressures. Different people and groups also vary in their vulnerability and sensitivity to situations and in turn, their interpretations and reactions to the event also differ. They noted that a person’s cognitive appraisal of a situation reflects the relationship between an individual who has their own characteristics i.e. values, perceptions, thoughts, and the environment where the characteristics are unknown and need to be assessed and deduced. This is known as the Transactional Model of Stress which is the transaction between an individual and the stressor (environment)
Lazarus recognised that there are 2 basic forms of cognitive appraisal: primary and secondary.
Primary appraisal has 3 notable processes: irrelevant, benign-positive and stressful. Irrelevance is when the environment has no implications for the person’s well-being; they do not view the situation as a threat to them self. Benign-positive appraisal is viewed when the situation has a positive outcome. However Lazarus notes that it is unusual for a person to appraise a situation as totally benign-positive as many people recognise that happiness can be short-lived. Stress appraisals generally signify a negative situation; this may be loss, challenges or threats. Conversely, a challenge may also be viewed as a positive situation, in that there may be something to be gained by completing the challenge.
Secondary appraisal is important when dealing with any stressful environment (stressor) as it looks at the individual’s ability to cope with the situation. The person needs to look at their ‘coping potential’ and draw on their coping resources to deal with the stressor.
The way a person appraises a situation may largely depend on their personality type. People with a Type A personality are more easily aroused by hostility, are focused on achievements and very competitive. Type A personalities are more likely to be in a stressful job and be socially isolated which in turn causes stress (Scott, E 2007).On the contrary, a Type B personality is less likely to appraise a stressor as a negative situation. They are able to deal with situations calmly and rationally. People who have a Type A personality are more likely to suffer from coronary heart disease (CHD) than people with a Type B personality. This may be due to the physical nature of stress such as sustained increased blood pressure leading to conditions such arteriosclerosis or myocardial infarction. Alternatively, it could be related to the coping strategies used by the person such as comfort eating on fatty foods which clog arteries or a tendency to smoke more often and inhale the smoke for longer cause’s greater damage to the respiratory system.
Another personality type which may be linked to stress appraisal is the Type D personality. People with this personality type experience more negative emotions such as anger and anxiety. These characteristics of a Type D personality can make a person more socially inhibited, therefore leading to social isolation which in turn can cause a lack of social support. Lack of social support can be a stressor in itself, teamed with anxiety and anger will cause a stress reaction in the individual. As previous personality types, a prolonged exposure to a stressor can induce a physical response such as; elevated blood pressure, migraines, bowel problems and disturbed sleep. All these physical responses are symptoms of burnout when the body is no longer coping with the stressor.
It should be noted that not all personality types have a negative effect. People with an optimistic personality type have a more positive outlook on life and expect a more positive outcome (Scott, E 2008). One study carried out in America discovered that people with a pessimistic outlook on life in early adulthood were more likely to suffer poor health in later adulthood (Seligman, M.E.P Dr. 2009).
The way a person approaches stress psychologically, ultimately can impact on their physical and social health.
The Sociocultural Model
Culture has been shown to have a major impact on a persons’ emotional life, therefore is an important factor to consider in looking at how a person deals with and appraises stress (Lazarus and Folkman 1984).Lazarus also noted that as culture plays a large part in determining the way a person interprets a situation or stimuli i.e. important to them, desirable, damaging etc. then it will also be important in the way the stimuli affects them. A situation or stimulus may be culturally acceptable to one person, but not to another, therefore causing that person anxiety and anger amounting to stress. Prolonged exposure to the stimuli will have a physical impact on the body such as raised blood pressure, headaches, all of which are symptoms of burn out. In Lazarus and Folkman (1984), they also discuss how a culture affects the way in which emotions are displayed, such as crying. A common symptom of stress is withholding emotions, which in turn can lead to further stress and alienation from friends and family. Alienation from friends and family means the person may not have any outlet for their emotions and may lead to depression, or suicide.
Social structure is also important. Scotland has the highest rate of suicide amongst young men in the UK, the majority of who come from the lowest income families. Ian Banks of the Men’s’ Health Forum said:
‘These figures confirm that social class is the biggest single factor for suicide among young men.'(BBC, 2006)
Lazarus and Folkman (1984) also looks at the functionalist view of there being ‘social rules’ within society and specific ‘norms and values’ which a person should uphold to be viewed as ‘normal’. He criticises the view that if the ‘norms and values’ are not conformed to then that person if in the wrong.
Holmes T. H., and Rahe, R. H (1967) looked at the way in which life events are stressors e.g. divorce, child leaving home, moving house etc. Criticisms of this view include that if all life events are stressors, then change itself is a stressor which is not always the case. In many circumstances, change can help alleviate a stressor. Lazarus and Folkman argue that appraisal of a life event being stressful, or not depend on the circumstances surrounding the event. For example, a child moving out may be a welcome change for a person who is at the right stage in life to have their children leave home, for another it may be the wrong stage and life and be a stressor. Similarly, no change can be a stressor in that if the parent is ready for the child to move out, but the child isn’t then this may be stressful for the parent.
It is not just major life events which can be a stressor, daily hassles can be a constant stressor for a person. For example, if a person constantly has to sit in a traffic jam on their way home from work, this may be stressful as all they want to do is get home. Pancheri et al (1979) stated that:
…’micro events frequently repeated over long time spans have greater pathogenic potential…’ in comparison to major life events.
Lazarus and Folkman (1984) recorded in their research that life events and daily hassles supplement each other. A Life event causes changes daily living which sequentially causes a daily hassle. They also noted that a daily hassle is not only based on what is happening but also how the situation is appraised, and the person as an individual. If a person is stuck in a traffic jam on the way to an appointment then this may be viewed as extremely stressful, however if the person is merely going shopping, then being stuck in the traffic jam is not such a great hassle. It is also noted that the way a person copes with the hassles plays a role in how significantly daily hassles can affect a person’s health. There are a number of ways in which a person can deal with their stress and stressors to help minimise the impact on their health.
Coping with Stress
There are many ways in which a person can deal with their stress; this can also differ between males and females. In general, males are more likely to adopt the ‘fight or flight’ response, whereas females ‘tend and befriend’. Similarly, different people adopt different ways of managing their stress.
For example; many people chose to do exercise to de-stress. Adopting exercise to manage stress is beneficial due to the health benefits of exercise. As highly stressed people are more at risk of cardiovascular disease, increase blood pressure etc (as previously discussed) then exercise can help to counteract these health problems. Also, if a person ‘comfort eats’ to cope with stress, exercise will provide weight loss benefits which again can benefit cardiovascular health.
One study ‘links exercise habits to protection from harmful effects of stress on physical and mental health’ (Salmon, P. 2000) demonstrating that not only does exercise provide physical benefits to stress, but also psychologically.
In addition to the psychological and physical benefits of exercise, exercise can also be very social; that may be joining a fitness group or getting some friends together to play tennis or golf.
Likewise, relaxation may be preferential for another person. By taking some time out to fully relax, a person can lower their blood pressure, release anxiety and relieve physical symptoms of stress such as headaches or back pain. Not only will relaxation help with physical and psychological symptoms of stress but by relaxing the person, they will be less irritable and more sociable (Belmonte, J. 2008).
The bio psychosocial model of health looks at the way in which stress affects the body physically, psychologically and socially. Stress can negatively impact each of these areas in a person’s life and it important that appropriate coping strategies are put in place to work against this. As discussed, there are various ways which stress can be managed, and it is up to the individual how which way works best for them. Equally, stress affects everyone different, and how the situation is appraised is important to what sort of impact the stressor has on the individual. Essentially, the bio psychosocial model approach to stress makes an important contribution to understanding the stress and its impact on the body.