Managing and coping with stress: drug therapy (benzodiazepines, beta blockers), stress inoculation therapy and biofeedback.

Description, AO1 – Managing and Coping with Stress – Physiological (Biological) Methods of Stress Management

Drug Therapies for Stress:

(1) Anti-anxiety drugs: (E.g. Benzodiazepines)

Examples of Anti-anxiety drugs include; Librium and Valium (these are the most common drugs to treat anxiety and stress).

How do they work?

  • Slows down the activity in the central nervous system.
  • Enhances the action of GABA which is a neurotransmitter. GABA (the body’s natural form of anxiety release) has a natural ‘quieting’ effect on many of the neurons (around 40%) in the brain.
  • BZ’s enhance the action of GABA by binding to receptors on the outside of the post-synaptic neuron.
  • When GABA locks into these receptors, it opens a channel that increases the flow of chloride ions into the post-synaptic neuron to be stimulated by other neurotransmitters, thus slowing down its activity and making the person feel more relaxed and less anxious.
  • BZs enhance the action of GABA by binding to special sits on the GABA receptor and boosting the actions of GABA. This allows more chloride ions to enter the neuron, making it even more resistant to excitation – the person therefore feels calmer.
  • BZ’s also reduce increased serotonin levels (serotonin has an arousing effect in the brain so a reduction in this neurotransmitter has a calming effect on the body).

 

(2) Beta-blockers (BB’s)

As mentioned earlier in this booklet, stress leads to the arousal of the sympathetic nervous system which in turn produces physiological arousal (e.g. raised blood pressure, increased heart rate, increased levels of cortisol etc…). As a result, Beta-blockers aim to reduce the activity of adrenaline and noradrenaline (the two hormones which bring about these physiological changes).

How do Beta-blockers work?

  • Reduce the activity of adrenaline and noradrenaline.
  • Beta-blocked bind to receptors on the cells of the heart and other parts of the body that are usually stimulated during arousal. By blocking these receptors, it is harder to stimulate cells (for example, in the heart) as a result, the heart beats slower and withless force.

This results in;

  • Fall in blood pressure (so there is less pressure on the heart)
  • The person feeling calmer and less anxious.

 

Evaluation,AO3 of Drug Treatments for Stress:

Strengths:

(1) Point: Research has demonstrated that drug treatments are extremely effective in treating the negative effects of stress. Evidence: For example, Kahn et al (1986) compared placebos and anti-anxiety drugs in 250 patients. The experimental group of patients were given an anxiety drug and however the control group of patients were given a placebo. Kahn et al found that BZs were significantly superior to placebos in treating the symptoms of anxiety which has been caused by stress. Evaluation: This is a strength as physiological/biological treatments of stress (e.g. drugs) can be seen to be just as effective as psychological treatments (e.g. CBT).

Weaknesses

(1) Point: Drug treatments of stress have been criticised for having a number of negative side effects. Evidence: For example, patients taking medication for stress (e.g. Beta-blockers and anti-anxiety drugs) have reported many side effects including; drowsiness, dizziness, tiredness, dry mouth, diarrhoea, loss of appetite. Evaluation: This is a weakness as it could cause more harm than good and other treatments (e.g. psychological treatments such as CBT) may be more effective at elevating the negative symptoms of stress.

 

(2) Point: Drug treatments of stress can be criticised for treating the symptoms and not the cause of the stressor. Evidence: For example, drug treatments such as anti-anxieties and Beta-blockers will only remove the negative symptoms associated with stress (e.g. increased heart rate, blood pressure) they will not help the individual deal effectively to remove the stressor. Evaluation: This is a problem because in the cases of chronic stress it may not be appropriate to simply mange the symptoms and so it may be preferable to seek a treatment that addresses the problem itself (e.g. CBT).

 

Description, AO1 – Psychological Methods of Stress Management

Cognitive Behavioural Therapy (CBT):

Meichenbaum’s Stress Inoculation Training (SIT): a cognitive behavioural approach to managing the negative effects of stress.

Meichenbaum (1985) believed that although we cannot usually change the causes of stress in our life (e.g. stressful job, AS level exams), we can change the way in which we think about these stressors. Meichenbaum believed that;

(1) Negative thinking (e.g. ‘I failed to hit a deadline, people must think I’m hopeless’) may lead to negative outcomes such as anxiety and depression.

(2) Positive thinking (e.g. ’my boss will still be delighted by what I achieved) leads to more positive attitudes and feelings. These reduce the stress response and help us to cope better in the future.

Meichenbaum (1985) proposed three main phases to the stress inoculation process:

1. Conceptualisation phase:

  • The therapist and client establish a relationship.
  • Client is encouraged to talk about their stressors (to tell their story)
  • The client should be helped to see what current strategies are maladaptive and to identify the things that can be changed.
  • Client is taught to break down global stressors into specific components that can be coped with (re-conceptualise their problems) and to think about stressors as problems that can be solved

2. Skills and acquisition phase (and rehearsal):

  • Coping skills are taught and practiced (first in the clinic and then in real-life situations).
  • A variety of skills are taught and tailored to the individual’s own specific problems (e.g. relaxation, positive thinking, social skills, methods of attention diversion and time management).
  • Client taught to use coping self-statements (e.g. ’relax, you’re in control’).
  • Both cognitive (encouraging the client to think in a more positive way) and behavioural (learning more adaptive behaviours) skills are taught.

3. Application phase (and follow through):

  • Clients are given the opportunity to apply newly learned coping skills in different situations that become increasingly stressful (various techniques may be used (e.g. imagery and role playing)
  • Clients may be asked to train others to deal with stress (to practice what they have learnt).
  • Booster sessions (follow through) are offered later on.

 

Evaluation, AO3 of Stress Inoculation Training (SIT):

Strength:

(1) Point: Further research has supported the effectiveness of SIT in comparison to other treatments for stress (e.g. systematic desensitisation). Example: For example, Meichenbaum (1977) conducted an investigation comparing SIT and systematic desensitisation for treatment of a snake phobia, it was found that although both treatments worked but that SIT helped clients deal with a second, non-treated phobia. Evaluation: This is a strength because the research demonstrates that individuals using SIT develop skills that can be actively applied to everyday life situations and that the technique is effective in dealing with the negative effects of stress.

Weaknesses:

(1) Point: It is difficult to assess the effectiveness of therapy such as SIT because psychologists depend on subjective reports from clients. Example: For example, Clients often exaggerate their problems when they first consult a therapist because they wish to convince the therapist that they really do need help. When discussing their initial problem during the conceptualisation phase, the client may make it look like their problem is worse than it actually is. At the end of the therapy, patients are grateful for the help that they were given and therefore may minimise any remaining issues. Evaluation: This is a weakness because it means that measuring the effectiveness of SIT is extremley difficult, it is likely that research conducted into this matter has low internal validity and (as a result of participant effects and demand characteristics) may not be measuring what it intends to measure.

 

(2) Point: Stress inoculation training has been criticised for being unnecessarily complex. Example: For example, it has seen suggested that the 3 stages of SIT are not required and that the same effectiveness could be achieved by just helping the clients to think more positively and learns to relax more. Evaluation: This is a weakness as the additional stages within SIT are perhaps unnecessary and as a result lead to clients paying more money than needed for the training.

 

Description, AO1 – Managing and Coping with Stress – Biofeedback

Biofeedback is a method of stress management that comes from both the biological and psychological approached.

  • Biofeedback is considered partly a biological management method because it involves paying attention to physical information from your body about heartbeat and blood pressure.
  • It is part psychological as it involves conditioning; successful behaviour is rewarded and therefore continued.

Biofeedback, like drug therapy, also deals with the body’s physiological response to stress – the arousal of the sympathetic nervous system which leads to, for example, increased heart rate and blood pressure. Heart rate and blood pressure are not under our voluntary control –controlled by ANS. Biofeedback is a method whereby an individual learns to exert voluntary control over involuntary (automatic) behaviours by being made aware of what is happening in the ANS.

How Biofeedback Works: the four processes –

(1) Relaxation: The client is taught relaxation techniques (these have the effect of reducing the activity of the SNS and activate the parasympathetic nervous system). This means that adrenaline and noradrenaline are no longer produced, this results in reduced heart rate, blood pressure and all other symptoms associated with stress.

(2) Feedback: The client is attached to varies machines which provides information (feedback) about the activity of the ANS (e.g. the client can hear their heart beat/given a signal to indicate an increase/decrease in blood pressure or muscle tension). Other ANS activities that can be monitored include; heart rate, breathing patterns and sweat gland activity. The machines that are used include; * EMG (highlight changes in muscle activity/skin conductance response (measures sweat), * EEG (measures electrical activity in the brain). The client then practices relaxation while seeing/listening to the feedback. The aim is to hear/see a change in the feedback and to respond by relaxing (and activating the activity of the parasympathetic response). For example, heart rate should decrease because of the relaxation techniques.

(3) Operant Conditioning: (this stage take place without any conscious thought).

When relaxation leads to a decrease in heart rate (for example), this is experienced as rewarding because the person has achieved their goal and this reinforces their behaviour. This increases the likelihood of the same behaviour being repeated.

Transfer The client needs to learn how to transfer the skills learned the real world, using the relaxation techniques in response to stressful situations that they encounter.

Managing and Coping with Stress – Biofeedback – A Demonstration (Description, AO1):

The biofeedback technique was based in the study by Miller and DiCara (1967). They used curare to paralyse 24 rats, keeping the rats alive using artificial respiration. Half of the rats were rewarded whenever their heart rates slowed down, the other half were rewarded when their heart rates increased. The reward was ‘a sense of pleasure’ – this was achieved by electrically stimulating part of the brain known as the pleasure centre. The outcome was that the heart of the rats in the ‘fast group’ increased and the hearts of the rats in the ‘slow group’ slowed down. Two things are important – first, the learning that took place was entirely involuntary, as the rats were paralysed. It was the automatic (ANS) responses (heart rate) there were conditioned. Second, the learning was the result of operant condsitioning – the behaviour stamped in because it was rewarded.

Evaluation, AO3 of Biofeedback:

Strengths:

(1) Point: Further research has supported the successfulness of biofeedback as a way of managing stress. Example: For example, Gruber and Taub (1998) successfully trained four monkeys to raise and lower body temperature and to reduce muscle tension using biofeedback. Evaluation: This is a strength because the research demonstrates that biofeedback learning does not rely on conscious thought because non-human animals cannot be using the ‘power of thought.’

 

(2) Point: However, further research from human participants has highlighted the successfulness of biofeedback. Example: For example, Lewis et al (2015) showed that biofeedback training with military personnel led to a decreased heart rate Evaluation: This is a strength because such research illustrates a specific link between biofeedback and the human sympathetic nervous system illustrating that such a method of stress management is effective for humans.

 

Weaknesses:

(1) Point: A weakness is that much research has failed to replicate the findings from Miller and DiCara which questions whether or not biofeedback is successful as a method of managing stress. Example: For example, Di Cara continued to research the successfulness of biofeedback however, subsequent attempts at research failed to replicate previous findings. In addition, DiCara (when pressed by other psychologists) was reluctant to supply the data obtained from research into biofeedback which lead other psychologists to believe the validity of DiCara’s findings (psychologists were convinced he had made results and data up). Evaluation: This is a weakness because such evidence leads psychologists to conclude that the successes reported for biofeedback may actually be more to do with relaxation than any unconscious operant conditioning. The success of biofeedback may simply be due to the fact that relaxation reduces sympathetic activity. Or it may be that the method offers clients a sense of increased control and this makes people feel better.

 

(2) Point: A weakness is that biofeedback can be a time consuming and lengthy process which relies on a lot of effort on the part of the client. Example: For example, biofeedback requires specialist equipment which means that the process is expensive and can only be undertaken with supervision. In addition, the treatment is not a fast acting method of managing stress and can often take a month (at least) in order to help a client deal effectively with stress. Evaluation: This is a weakness because working with such a time consuming therapy which doesn’t yield instant results could lead clients to giving up on biofeedback and moving to an alternative therapy/treatment. Such a potential highlights the fact that biofeedback may not be highly successful.

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