Stress

In the acute stress response, which pathway is activated first to produce the rapid 'fight or flight' reaction?

• AThe hypothalamic-pituitary-adrenal (HPA) axis releasing cortisol
• BThe parasympathetic branch (rest-and-digest), releasing acetylcholine to slow the heart, breathing and gut
• CThe sympathomedullary pathway (SAM), via the sympathetic nervous system and adrenal medulla releasing adrenaline✓
• DThe pituitary gland releasing growth hormone, prolactin and oxytocin

Answer: Acute stressors trigger the sympathomedullary (SAM) pathway: the sympathetic branch of the autonomic nervous system stimulates the adrenal medulla to release adrenaline (and noradrenaline), producing the rapid fight-or-flight changes. The HPA axis governs the slower, chronic response.

Which sequence correctly describes the pituitary-adrenal (HPA) response to chronic stress?

• AAdrenal medulla releases ACTH (adrenocorticotropic hormone), which travels to the hypothalamus to trigger cortisol
• BThe anterior pituitary releases adrenaline, which stimulates the hypothalamus to release CRH, and this CRH then acts on the adrenal medulla directly
• CThe adrenal cortex releases CRH, which triggers the posterior pituitary to release noradrenaline, and this in turn acts back on the hypothalamus
• DHypothalamus releases CRH, which stimulates the anterior pituitary to release ACTH, which stimulates the adrenal cortex to release cortisol✓

Answer: In the HPA axis the hypothalamus secretes CRH, prompting the anterior pituitary to release ACTH, which acts on the adrenal cortex to release cortisol. Cortisol then feeds back to regulate the system. The other options scramble the glands and hormones.

Prolonged elevation of cortisol during chronic stress is associated with which effect relevant to health?

• AEnhanced immune function and faster wound healing
• BSuppression of the immune system, increasing vulnerability to illness✓
• CPermanent removal of the fight-or-flight response, so that heart rate, breathing and blood pressure no longer rise
• DIncreased adrenaline production, driven by the pituitary gland

Answer: Chronically high cortisol suppresses immune activity (e.g. reducing the action of lymphocytes), leaving the individual more susceptible to infection and illness. Short-term cortisol can mobilise resources, but sustained elevation is immunosuppressive.

Kiecolt-Glaser et al.'s (1984) study of medical students taking exams supported a link between stress and the immune system because:

• ANatural killer cell activity was higher during the exam period than a month before
• BCortisol levels rose during the examination period while natural killer (NK) cell activity stayed just as it had been a month earlier
• CNatural killer cell activity was lower in the high-stress exam period than in a lower-stress baseline taken a month earlier✓
• DThe reduction in natural killer cell activity appeared in the students with a Type B personality but not in those classified as Type A

Answer: Kiecolt-Glaser et al. found natural killer (NK) cell activity was significantly reduced during the stressful examination period compared with a baseline sample taken about a month earlier. This natural-experiment evidence indicates that acute stress can lower immune functioning.

Holmes and Rahe's Social Readjustment Rating Scale (SRRS) measures stress from life changes using which unit?

• ALife change units (LCUs)✓
• BDaily hassles points
• CGalvanic skin response scores
• DCortisol micrograms per decilitre

Answer: The SRRS rates 43 life events in life change units (LCUs), with higher totals reflecting greater required readjustment and higher predicted stress-related illness risk. Daily hassles are measured by a different scale, and the other options are physiological measures, not the SRRS.

What is the central claim of the 'daily hassles' approach to sources of stress?

• AStress-related illness is traced back to major life events (bereavement, divorce and redundancy) rather than everyday demands
• BHassles reduce stress by distracting people from illness, debt and other larger problems
• CThe minor, everyday irritations and demands of daily life accumulate and can be a better predictor of stress and ill health than major life events✓
• DHassles matter for retired people over the age of 65 but not for those in work

Answer: The daily hassles approach (e.g. Kanner et al.) argues that accumulated minor stressors of everyday life have a measurable, often greater, impact on wellbeing than infrequent major life events, with uplifts potentially buffering their effect.

Marmot et al.'s Whitehall studies of British civil servants found that workplace stress and cardiovascular risk were most strongly linked to:

• AHigh job demands alone, regardless of seniority
• BWorking too few hours each week, so that civil servants at the lowest grades became bored and unwell
• CHaving a Type B personality (relaxed and easy-going), found by the Whitehall team in the senior grades
• DLow job control (low decision latitude), with lower-grade staff showing higher illness rates✓

Answer: The Whitehall research found that lower-status civil servants, who had less control (low decision latitude) over their work, had higher rates of stress-related cardiovascular disease. Low job control, rather than demand by itself, was the key factor in this job-strain model.

Friedman and Rosenman characterised the Type A behaviour pattern, linked to coronary heart disease, as involving:

• ARelaxed, patient and easy-going behaviour
• BCompetitiveness, time urgency and hostility✓
• CHigh openness and creativity
• DLow arousal with indifference to deadlines

Answer: Friedman and Rosenman described Type A individuals as competitive, hostile and time-pressured; their large prospective study linked this pattern to a raised risk of coronary heart disease. Type B individuals are the relaxed, easy-going contrast. Hostility is now seen as the most cardiotoxic component.

Kobasa's concept of 'hardiness' as a moderator of stress comprises which three components?

• ACortisol, adrenaline and ACTH
• BCommitment, challenge and control (the 3 Cs)✓
• CCompetitiveness, hostility and urgency
• DCompliance, conformity and obedience

Answer: Kobasa proposed that hardiness, an individual difference buffering the effects of stress, consists of commitment (involvement in life), challenge (seeing change as opportunity) and control (belief in influencing events). The other options confuse hardiness with stress hormones, Type A traits or social-influence terms.

Meichenbaum's Stress Inoculation Training (SIT) is best described as a cognitive-behavioural technique with which three phases?

• AAlarm, resistance and exhaustion
• BPrecontemplation, contemplation and action
• CSensitisation, generalisation and extinction, the behaviourist learning terms, applied to the stress response
• DConceptualisation, skills acquisition (and rehearsal), and application (real-life follow-through)✓

Answer: SIT proceeds through conceptualisation (understanding the stressor), skills acquisition and rehearsal (learning and practising coping strategies such as positive self-talk and relaxation), and application/follow-through (using the skills in real situations). 'Alarm, resistance, exhaustion' are Selye's GAS stages, not SIT.

What are the stages of Selye's General Adaptation Syndrome?

• AAlarm, resistance and exhaustion in that fixed order✓
• BAlarm, adaptation and recovery in that fixed order
• CAppraisal, coping and re-appraisal in a repeating cycle
• DDenial, anger, bargaining and acceptance in sequence

Answer: Selye argued the response is non-specific: the same physiological sequence follows any stressor. Critics note the model underplays psychological appraisal and was based largely on research with rats.

What does the sympathomedullary pathway respond to?

• AChronic stressors, releasing cortisol from the adrenal cortex
• BAcute stressors, releasing adrenaline from the adrenal medulla✓
• CAcute stressors, releasing cortisol from the adrenal cortex
• DChronic stressors, releasing adrenaline from the adrenal medulla

Answer: The SAM pathway acts within seconds for fight or flight. The slower HPA axis handles ongoing stress by releasing cortisol, which is useful short-term but damages immune function when sustained.

How does chronic stress affect the immune system?

• ASustained cortisol suppresses immune function over time✓
• BSustained cortisol enhances immune function over a long time
• CAdrenaline permanently destroys all of the white blood cells
• DStress has no measurable effect on immune function

Answer: Kiecolt-Glaser found slower wound healing in carers under chronic stress, and medical students showed reduced natural killer cell activity during exams. Short-term stress may briefly boost immune activity.

What did the Social Readjustment Rating Scale measure?

• ADaily hassles accumulated over the whole previous month
• BPerceived control over the most stressful workplace demands
• CThe physiological arousal produced by a stressor
• DLife change units accumulated from major life events✓

Answer: Holmes and Rahe scored 43 events, with scores above 300 linked to raised illness risk. It counts positive events as stressful too, but ignores individual differences in how events are appraised.

What is the difference between problem-focused and emotion-focused coping?

• AOne manages the response, the other avoids the stressor entirely
• BOne is conscious and deliberate, the other entirely unconscious
• COne tackles the stressor, the other manages the response to it✓
• DOne is used by men and the other predominantly by women

Answer: Problem-focused coping is more effective where the stressor is controllable; emotion-focused coping suits situations that cannot be changed, such as bereavement. Neither is superior in the abstract.

What characterises Type A behaviour?

• APatience, cooperation and emotional stability
• BCompetitiveness, time urgency and hostility✓
• CEmotional suppression and conflict avoidance
• DHigh conscientiousness and low neuroticism

Answer: Friedman and Rosenman's study linked Type A to roughly double the coronary heart disease risk. Later work suggests hostility specifically, rather than the whole pattern, carries most of the risk.

What is the role of social support in managing stress?

• AIt increases stress by creating additional social obligation
• BIt replaces the need for any individual coping strategy
• CIt buffers the effects through emotional and practical help✓
• DIt has an effect only when provided by family members

Answer: Emotional, esteem and instrumental support each contribute, and perceived availability may matter more than support actually received. Unwanted support can undermine self-efficacy, so it is not universally helpful.

How does biofeedback aim to reduce stress?

• ABlocking the physiological stress response by using medication
• BReplacing stressful thoughts with rather more rational alternatives
• CGradually exposing the person to the source of the stress
• DMaking physiological activity visible so it can be controlled✓

Answer: Monitoring heart rate or muscle tension lets a person learn voluntary control through operant conditioning. It has no side effects but is expensive, time-consuming and treats symptoms rather than the source.

What is stress inoculation training?

• AConceptualisation, skills acquisition and real-life application✓
• BAlarm, resistance and exhaustion managed across three separate stages
• CSystematic desensitisation applied directly to workplace stressors
• DMedication combined with relaxation to reduce arousal

Answer: Meichenbaum's cognitive approach reframes the stressor, teaches coping skills, then practises them under increasing pressure. It builds lasting resilience but demands considerable time and commitment.