Stress & Health, Lecture notes
Tilburg University, Year 2020-2021
Overview of lectures
................................................................................................................................................................1
Lecture 1.................................................................................................................................................2
Lecture 2 part 1....................................................................................................................................11
Lecture 2 part 2....................................................................................................................................17
Lecture 3 part 1....................................................................................................................................20
Lecture 3 part 2....................................................................................................................................25
Lecture 4...............................................................................................................................................30
Lecture 5...............................................................................................................................................39
Lecture 6...............................................................................................................................................47
Lecture 7...............................................................................................................................................55
Lecture 8...............................................................................................................................................66
Lecture 9...............................................................................................................................................77
Lecture 10.............................................................................................................................................87
Lecture 11.............................................................................................................................................94
,Lecture 1
Evidence levels
- Which type of studies would be perceived as more reliable and thus should be used as more
support for your model
- Bottom: clinical observations
o Least reliable studies
o If you find a study describing one person receiving one type of treatment -> you
won’t be able to generalize the findings to the whole population
- Observational study
o Observe a larger group with the same type of treatment -> becomes more valid
- Systematic review of observational studies
o Treatment has been provided to different groups of people and various studies have
been written about it in different context and they all show the same result -> even
stronger evidence for your treatment
- Better to perform randomized control trial
o Ideally you want a group that receives a treatment vs. control group to compare the
outcomes
- Systematic review of RCT’s
o Compare the treatment in various groups -> all these interventions that have been
performed are written in different studies -> and they all report the same findings ->
strongest evidence level
Quite sure that what the studies found is reflecting what is actually
happening in the effectiveness of the treatment
5 steps of evidence based medicine
- Consensus on constructs
o Describing what you want to measure
Stress -> what is stress?
- When we look into the definition of stress, you notice that everyone will be able to say
something about it
o Description is more difficult
o Definitions
A condition or feeling experienced when a person perceives that demands
exceed the personal and social resources the individual is able to mobilize
About the perception of a person
More psychological component
A constellation of events, consisting of a stimulus (stressor) that precipitates
a reaction to the brain (stress perception), that activates physiological fight
or flight
More of a physiological description of what happens
o Ancient history
Related to physical crisis (acute or chronic)
Acute -> being attacked by a lion or being in immediate danger
Chronic -> more related to live a prolonged period of time without food
Still recognized in animals
, o Now
Psychological crisis or social crisis
Work related stress or stress because of all the demands since we live in a
fast moving environment
Why is it important to study stress & health?
- Clinical case (acute stress)
o 45-year old women
o Diagnosed with takotsubo cardiomyopathy
o Came home from day and found her husband dead (committed suicide)
o Didn’t feel well, and ambulance was called
Severe chest pain -> probably cardiovascular damage and experience a
myocardial infarction
Takotsubo syndrome -> heart dilates very fast (in case of severe
stress) and pump function of the heart goes down
Women didn’t have any other problems -> she was a healthy person
Induced by stress she developed this quite severe problem
- Clinical case (prolonged stress)
o 32 year old male
o Lost his job a year ago
o 6 months later his girlfriend left him
o 6 months after that, he was admitted to the hospital due to liver problems
o Experienced prolonged stress -> changed his lifestyle (drinking more) -> alcoholism ->
liver problems
Developed disease due to chronic exposure to stress
- Study: Look into patients who reported heart disease by stress level
o Little or none of the time felt calm and peaceful during the past 4 weeks -> 24.75%
o High percentage of patients with cardiovascular problems report stress related
symptoms
Stress and Health
- Stress can have an effect on our health in acute phase
- Stress can cause us to develop psychological problems (like depression or anxiety disorders)
- Stress -> psychological problems (like depression) -> isolate ourselves more and live
unhealthier (overeating, alcohol)-> effect on health
Stress in clinical practice
- Stress can make people sick without having a disease
o Without having a disease, it can’t be diagnosed -> coming back to hospital with
complaints that can’t be diagnosed
o (not perceived as part of a particular diagnosis)
- Increases the odds for development of mental and physical health problems that can be
diagnosed
- Can negatively affect the recovery after a disease or injury -> after surgery, people
experiencing stress recover slower
- Can negatively affect the effects of medical intervention -> less likely to be adherent to
intervention
, - Can negatively affect the patient-physician communication -> people who are stressed
communicate in a different way
o Also tend to forget more of the information that they receive from the physician ->
can be very stressful afterwards, since they don’t remember all the information, they
have been given
What is considered a ‘not done’ explanation?
- People want to know the reason for their health problems
- Depression and psychosomatic fatigue are causing that people don’t like to be told
o People don’t want to hear that the cause of their problems might be related to
psychological problem or psychological imbalance
- So, you have to keep in mind how to communicate this to the patient
Definition of stress for this course
- A condition or feeling experienced when a person perceives that demands exceed the
personal and social resources the individual is able to mobilize
Homeostasis
- Body’s ideal level of oxygen, temperature etc. that your brain seeks for
- Body and brain want this pleasurable state where everything is correct
- A stressor can be anything that disrupts the homeostasis
o Stress-response is body’s action to reestablish homeostasis
Is stress always a bad thing?
- Can be adaptive -> if we didn’t experience stress, it would be strange -> body couldn’t signal
you were in danger
o Acute -> happens at the time that a stressor is present
o Short duration -> only experience stress when in presence of the stressor
o Fast recovery -> after the stressor has passed
o Preparing the body for danger
o Signaling danger -> telling you that you have to do something, because otherwise
you will experience something horrible
- Disruptive
o Chronic -> when always feeling activated and aroused
o Long duration ->
o Slow recovery -> after stressor has occurred -> take you days to recover after a
stressful event
o Early onset -> anticipated stress before the stressor is to happen -> exam in 6 weeks
and already stressing about that
o Preparing the body for? -> nothing
o Signaling what? -> nothing -> doesn’t signal danger or anything that will help you
survive
- Study -> when is stress adaptive and when not?
o Upper bar -> stress is short term (minutes our hours), acute and ends nicely -> time
to recover between the stressors
We need to experience stressors, otherwise we are not told when in danger
Tilburg University, Year 2020-2021
Overview of lectures
................................................................................................................................................................1
Lecture 1.................................................................................................................................................2
Lecture 2 part 1....................................................................................................................................11
Lecture 2 part 2....................................................................................................................................17
Lecture 3 part 1....................................................................................................................................20
Lecture 3 part 2....................................................................................................................................25
Lecture 4...............................................................................................................................................30
Lecture 5...............................................................................................................................................39
Lecture 6...............................................................................................................................................47
Lecture 7...............................................................................................................................................55
Lecture 8...............................................................................................................................................66
Lecture 9...............................................................................................................................................77
Lecture 10.............................................................................................................................................87
Lecture 11.............................................................................................................................................94
,Lecture 1
Evidence levels
- Which type of studies would be perceived as more reliable and thus should be used as more
support for your model
- Bottom: clinical observations
o Least reliable studies
o If you find a study describing one person receiving one type of treatment -> you
won’t be able to generalize the findings to the whole population
- Observational study
o Observe a larger group with the same type of treatment -> becomes more valid
- Systematic review of observational studies
o Treatment has been provided to different groups of people and various studies have
been written about it in different context and they all show the same result -> even
stronger evidence for your treatment
- Better to perform randomized control trial
o Ideally you want a group that receives a treatment vs. control group to compare the
outcomes
- Systematic review of RCT’s
o Compare the treatment in various groups -> all these interventions that have been
performed are written in different studies -> and they all report the same findings ->
strongest evidence level
Quite sure that what the studies found is reflecting what is actually
happening in the effectiveness of the treatment
5 steps of evidence based medicine
- Consensus on constructs
o Describing what you want to measure
Stress -> what is stress?
- When we look into the definition of stress, you notice that everyone will be able to say
something about it
o Description is more difficult
o Definitions
A condition or feeling experienced when a person perceives that demands
exceed the personal and social resources the individual is able to mobilize
About the perception of a person
More psychological component
A constellation of events, consisting of a stimulus (stressor) that precipitates
a reaction to the brain (stress perception), that activates physiological fight
or flight
More of a physiological description of what happens
o Ancient history
Related to physical crisis (acute or chronic)
Acute -> being attacked by a lion or being in immediate danger
Chronic -> more related to live a prolonged period of time without food
Still recognized in animals
, o Now
Psychological crisis or social crisis
Work related stress or stress because of all the demands since we live in a
fast moving environment
Why is it important to study stress & health?
- Clinical case (acute stress)
o 45-year old women
o Diagnosed with takotsubo cardiomyopathy
o Came home from day and found her husband dead (committed suicide)
o Didn’t feel well, and ambulance was called
Severe chest pain -> probably cardiovascular damage and experience a
myocardial infarction
Takotsubo syndrome -> heart dilates very fast (in case of severe
stress) and pump function of the heart goes down
Women didn’t have any other problems -> she was a healthy person
Induced by stress she developed this quite severe problem
- Clinical case (prolonged stress)
o 32 year old male
o Lost his job a year ago
o 6 months later his girlfriend left him
o 6 months after that, he was admitted to the hospital due to liver problems
o Experienced prolonged stress -> changed his lifestyle (drinking more) -> alcoholism ->
liver problems
Developed disease due to chronic exposure to stress
- Study: Look into patients who reported heart disease by stress level
o Little or none of the time felt calm and peaceful during the past 4 weeks -> 24.75%
o High percentage of patients with cardiovascular problems report stress related
symptoms
Stress and Health
- Stress can have an effect on our health in acute phase
- Stress can cause us to develop psychological problems (like depression or anxiety disorders)
- Stress -> psychological problems (like depression) -> isolate ourselves more and live
unhealthier (overeating, alcohol)-> effect on health
Stress in clinical practice
- Stress can make people sick without having a disease
o Without having a disease, it can’t be diagnosed -> coming back to hospital with
complaints that can’t be diagnosed
o (not perceived as part of a particular diagnosis)
- Increases the odds for development of mental and physical health problems that can be
diagnosed
- Can negatively affect the recovery after a disease or injury -> after surgery, people
experiencing stress recover slower
- Can negatively affect the effects of medical intervention -> less likely to be adherent to
intervention
, - Can negatively affect the patient-physician communication -> people who are stressed
communicate in a different way
o Also tend to forget more of the information that they receive from the physician ->
can be very stressful afterwards, since they don’t remember all the information, they
have been given
What is considered a ‘not done’ explanation?
- People want to know the reason for their health problems
- Depression and psychosomatic fatigue are causing that people don’t like to be told
o People don’t want to hear that the cause of their problems might be related to
psychological problem or psychological imbalance
- So, you have to keep in mind how to communicate this to the patient
Definition of stress for this course
- A condition or feeling experienced when a person perceives that demands exceed the
personal and social resources the individual is able to mobilize
Homeostasis
- Body’s ideal level of oxygen, temperature etc. that your brain seeks for
- Body and brain want this pleasurable state where everything is correct
- A stressor can be anything that disrupts the homeostasis
o Stress-response is body’s action to reestablish homeostasis
Is stress always a bad thing?
- Can be adaptive -> if we didn’t experience stress, it would be strange -> body couldn’t signal
you were in danger
o Acute -> happens at the time that a stressor is present
o Short duration -> only experience stress when in presence of the stressor
o Fast recovery -> after the stressor has passed
o Preparing the body for danger
o Signaling danger -> telling you that you have to do something, because otherwise
you will experience something horrible
- Disruptive
o Chronic -> when always feeling activated and aroused
o Long duration ->
o Slow recovery -> after stressor has occurred -> take you days to recover after a
stressful event
o Early onset -> anticipated stress before the stressor is to happen -> exam in 6 weeks
and already stressing about that
o Preparing the body for? -> nothing
o Signaling what? -> nothing -> doesn’t signal danger or anything that will help you
survive
- Study -> when is stress adaptive and when not?
o Upper bar -> stress is short term (minutes our hours), acute and ends nicely -> time
to recover between the stressors
We need to experience stressors, otherwise we are not told when in danger
