Chronic Stress & Progress Cancer
Chronic stress has been shown to increase the distribution of tumours and progress cancer, by changing the lymphatic system which is caused by the Sympathetic Nervous System. Stressful encounters or threats send one’s body out of homeostasis, a constant environment causing physiological change. Thus, constant exposure to these threats and stress levels can make the body more inflamed which promotes the onset and dissemination of disease like cancer. However, some people are considered to be more stressed naturally and thus psychological intervention will help to slow down the rate of lymphatic dissemination.
It is apparent that stress can cause the onset of physical illness and thus Anderson et al (2008) indicated that psychological intervention is required so that individuals are abler to cope with the demands. Their study assessed the psychological state and behaviour of 227 participants as well as taking a blood sample from them. The patients were all surgically tested for regional breast cancer and before beginning adjuvant cancer therapies, patients were assessed with psychological and behavioural measures to evaluate their mental health, and a 60‐mL blood sample was drawn. Patients were randomized to Psychological Intervention plus assessment in order to lower stress condition or to an Assessment only one.
The intervention was psychologist led, conducted in small groups and included strategies to reduce stress, improve mood, alter health behaviours, and maintain adherence to cancer treatment and care. The patients in the intervention condition had an improved immune response, a lower risk of developing breast cancer with a hazards ratio (HR) of 0.55; P=0.034 and death from breast cancer (HR) of 0.44; P=0.016 in comparison to the group of participants who were solely assessed. The fact that P=0.016 means there is a significant relationship between intervention and death from breast cancer. Although it could be argued that if the researcher is aware that intervention will have a profound impact on one’s psychological state it is unethical to have a condition without intervention. Although if there are no previous studies to suggest a relationship then there is nothing to compare it to and small scale control experiments should be used to make sure the new therapy is not harmful. However, it could be better to use another intervention as the placebo effect could occur???
Stress and cognition
Although stress clearly causes the onset of illness, as shown through its impact on the immune system and progression of malignant tumours, it can be argued that some people are exposed to the same stressors but do not become ill. The Cognitive Appraisal Theory is based around ‘emotion which implicates people’s personal interpretations of an event in determining their emotional reaction’. Thus, it suggests that individuals will interpret an event in different ways, which infers that their stress responses will also differ.
Differing personalities have different resilience levels and are thus more likely to develop physical illness. Hence stress responses differ due to individual differences such as: genetic makeup, personality type, culture, the environment, social background or religion. Certain individuals are more susceptible as their perceived demands of stress are more severe, a concept also supported by the transactional model. Although it is challenging to state the physical costs of stress, it has been identified that particular personalities are more resistant to stress when suffering from cardiovascular disease. The role of personality on stress was tested by Friedman and Rosenman (1974) by developing the ‘Type’ theory. Individuals were categorized based on their traits whilst they were studying people with heart disease.
The two main categories identified were:
Type A which classes people as having attributes of competiveness, determination and are punctual;
Type B people were considered good listeners, late, slow and easy-going.
The concept of personality types was further enhanced by Grossarth-Maticek & Eysenck (1990), as they used the Short Interpersonal Reactions Inventory to determine personality type. stating some individuals have disease prone personalities through addressing the personality stress inventory. Type 1 was classed as the cancer prone type, Type 2 the coronary heart disease prone type, Type 3 had combining attributes from types 1,2 and 4, Type 4, the healthy and autonomous group, Type 5 was classed as having combined attributes from Types 1,2 and 6. Finally, Type 6 were said to have tendencies towards drug addiction and AIDS. However, a limitation when comparing personality types, is that different levels of emotions might be expressed when recalling stressful events thus mistakes might be made which is known as recall bias.
Furthermore, confirming this a review from Booth-Kewley and Friedman (1987) suggesting correlations between coronary heart disease and Type A personality. Thus, the personality type theory supports that different perceptions of stressful events exist causing different thought and decision making processes and different stress responses: some more negative than others.
Additionally, Friedman and Rosenman (1959) made an association between overt behaviours and higher blood cholesterol. These studies are correlational meaning there is no distinct cause and effect relationship. Additionally, there are multiple extraneous variables and so succinct relationships are hard to establish. Kobasa (1979) argued that some individuals have the capacity to resist stress based on their level of hardiness, these individuals are likely to change their cognitive behaviour in situations as a means of coping. As they deem these environments as an opportunity to prove themselves and consider them beneficial in the long run. A person who scores highly on the hardiness scale will incorporate control, commitment and challenge. The Conor-Davidson resilience scale has 25 items and is a measure of coping ability, by testing resilience.
Thus, cognition plays a role in portrayed behaviours although any personality can change their characteristics and employ control, commitment and challenge to resist it. Thus, this idea shows that people are capable of changing their characteristics which links the idea that Cognitive Behavioural Therapy (CBT) can change people’s thought processes. It does not merely change people’s personality but their outlook on life, cognitive processes and thus physiology; although in extreme cases medication is subscribed by psychiatrists.
In a study by Granath et al (2003) they compared 26 women and 7 men in different groups, yoga was used for one condition and the other being CBT. Psychological and physical states were compared before and after the intervention and stress was found to be more manageable with these techniques. Moreover, Varvoli (2011) stated that CBT and Diaphragmatic Breathing were particularly effective. Although Cognitive Behavioural therapy cannot completely change someone’s negative view of the world around them and other interventions may be just as effective in the treatment of stress. Mindfulness is an alternative which involves remaining silent in a spiritual manner and it is able to adapt cognitive processes and has been found to be effective among University Students, Palmer (2009).
It is supported by Nyklicek et al’s (2008) study, which consisted of a sample of 40 women and 20 men to determine the impact of Mindfulness Based Stress Reduction (MBSR) on their psychological well-being, with all participants displaying symptoms of distress. Questionnaires were completed before and after the intervention time determining the impact of MBSR on one’s psychological well-being and quality of life. MBSR was shown to reduce stress levels as p=.009 clearly indicates mindfulness can be effective at changing people’s cognitive processes.
Moreover, Ramel et al (2004) examined the impact of mindfulness on patients with depression in the past, to see if people’s perspective can change. There were 23 candidates examined before and after completing a MBSR course and it was shown that it impacts the mind and decreases their chances of a relapse for those suffering from severe depression. There is empirical evidence confirming stress changes cognition, emotion and general psychological state thus impacting one’s physiological stress response. This shows that workplaces and schools should educate people about Mindfulness as it is able to change someone’s outlook on stress and lower their stress levels. However, the relationship between stress and illness could be due to extraneous variables. Cancer development is a likely cause of immuno-suppression that might be determined by personality type.
One’s psychophysiological responses (immuno- suppression) exhibited could link to the onset of cancer, indicating that external or extraneous variables might not impact stress responses. It might not be possible to ever completely eliminate cancer cases as internal attitudes and beliefs are almost impossible to change. However, as it is almost impossible to control all variables only a correlational relationship not a cause and effect relationship can be established.
Stress is entirely genetic
Although it has been argued that it is entirely genetic as some people are physiologically predisposed to stress meaning their stress response is not entirely adaptable and their appraisal cannot be changed. These individuals are genetically predisposed to displaying stress and this could suggest that past experiences might not be the cause all cases of extreme stress; it might be merely due to their genetic makeup. Experiments have shown that the gene, neuropeptide y plays a role in the resilience of stress. Moreover, chronic stress has been proven to damage the dendrites of nerve cells, thereby damaging areas of the hippocampus. This clearly indicates that one’s physiological makeup and genetics changes someone’s resilience and that potentially psychological intervention will not have a distinct impact. However, a new stressor could cause the already predisposed nature to stress which was previously dormant to be displayed making it hard calculate.
This concept is nearly impossible to calculate due to extraneous variables, for example some decisions are based on cultural norms and people are forced to hold certain views which is not due to their genetics. Additionally, in some societies obesity is more prevalent and considered more acceptable. This there might be other sources of information which the individuals are conditioned to believe, which is not in their genetic makeup, meaning their individual beliefs do not play a role. However, it can be argued that stress is not entirely genetic and that the environment also plays a significant role.
This concept derives from the Nature- Nurture debate, how vital the environment and one’s genes are on the predisposition to stress. This theory suggests there is a relationship between one's environmental surroundings and one’s genes on behaviour. Despite the idea that some people would argue that stress’ onset is entirely genetic as people are naturally more susceptible to stress due to their childhood, impacting their epigenetics which can be passed on to their offspring. Moreover, genetics play a role as people have different experience-dependent maturation levels of stress that will naturally develop in later life regardless of their environmental setting. However, this debate suggests that stress is also caused by the environment and exposure to stress and a finding suggests early exposures impact cognitive development and the likelihood of developing a mental disorder despite children being more vulnerable than adults.
This could also indicate that stress is not entirely genetic as unfavourable childhood encounters like maternal separation can cause anxiety so the HPA system becomes overactive and there is a cognitive non-genetic aspect. Although in order for a cause and effect relationship to be established further studies must support this concept, as currently it is simply a correlational relationship. Although this correlation could simply have been down to chance, due to other extraneous variables. However, there are only adequate studies for extreme childhood experiences: physical mistreatment, maternal separation and not sufficient evidence for the impact of urban stressors in childhood which is now known to have an impact. Kune (1993) suggested that there is a relationship between stressful life events and cancer thus supporting the idea that maternal separation or difficulty in childhood can lead to cancer.
A particular association has been found between stressful life events and gastric, breast, lung and colorectal cancer. Stress is an evolutionary response, for example the threat of a bear to our ancestors would have evoked a HPA response, although nowadays with exam pressures our body responds in a similar way. This is the case as cognition means that we interpret stimuli and re-interpret the situation as being more stressful yet it is less threatening that a bear attack. The body is evolved to respond to immediate stressors however long-term stress is detrimental to both one’s physiology and psychology. Therefore, suggesting that this phenomenon is entirely due to cognition, rather than one’s genome.
Conclusion
Having weighted up all the arguments there is a distinct correlation between stress and the onset of illness, whether that be a mental feeling of being ‘overwhelmed or exhausted’ or the physical symptoms including a supressed immune system or the concept that different cognitive appraisals can determine tumour growth. Within the essay it has been identified that both cognition and anatomy are impacted during stress which can lead to the onset of illness. The impact of stress on the immune system was remarkable as demonstrated by Kiecolt-Glaser, Cohen and Adli. However, Friedman and Rosenman’s personality theory suggested that cognition also plays a role, alongside the Cognitive appraisal theory. However, it is compelling from the research analysed that the mental symptoms of stress need to be carefully controlled as they lead to the onset of physical disease. This concept infers that there is no mind and body distinction, rather they work in unison.
Therefore, a cognitive overload of stress will be displayed in a physical sense due to hormones and neuronal changes in the amygdala which impact one’s physical and emotional state. Someone’s genetics also play a role in hormonal regulation and thus cognitive processes and appraisals of stress, which mean that certain individuals are more predisposed to developing illness. However, it could be argued that stress could be caused due to extraneous variables that cannot be controlled. It could also be considered that humans have the physical capability and free will to control their mind thereby they can prevent the physical symptoms from causing ill health.
Additionally, from Kobasa’s study it is clear that cognition does not necessarily cause stress as people are able to adapt their behaviour in order to manage it. Also it can be argued that stress is not based on one’s cognitive state but on the number of neuropeptide y’s they have and people which indicates that people are only predisposed to stress. It can also be argued that stress is a necessary evolutionary phenomenon which can benefit the human body, both physically and mentally which is known as eustress. Little doses of stress can be positive due to its motivational nature which can aid the completion of tasks. Sometimes, stress can even improve memory recall by providing a spike of energy which can be advantageous. Stress has been demonstrated by our ancestors as being beneficial in the early stages, as they used it to chase a threat. The changes that occur in the brain when experiencing a threat, for example an animal running towards you, cause the heart rate to increase and mean you can run faster.
Despite the volume of research examined there are flaws with some of the studies used due to the nature of ethics, others are flawed on the methodology they use. Some have problems with the type of stress that they investigate, for example in Segerstorm and Miller’s experiment the distinction between brief naturalistic stressors and chronic stressors, whilst Cohen’s study is not clear on the type of pathogen monitored.
Additionally, studies have linked to the diathesis stress model as it is clear that the cognitive perception of stress leads to illness. However, this research is flawed with errors and difficult to resolve and so more studies with fewer flaws are necessary. However, with the body of research evidence used there is gripping evidence to show the role of cognition in stress and illness and the fact that cognitive behavioural therapy seems to reduce stress in a significant number of patients. Although stress is hard to define as it involves a complex group of symptoms meaning it is almost impossible to calculate various causes and consequences on cognition and physiology.
Additionally, there are many different types and strengths, making it a subjective concept. However, it must be recognised that stress causes ill health and people must be educated within the work-place and at schools and the ways to manage stress should be targeted. A recommendation is that people should all be aware of mindfulness and it can be particularly employed during stressful periods including exams or the loss of a loved one. As the state of family life is a key indicator of one’s stress levels as it can increase vulnerability to stress employers must examine this for their employers. Additionally, Jackson and Schuler (1985) classed job satisfaction as a good measure of work-related stress.
