AS Stress – Bigger Picture Thinking

In our lessons, we will concentrate on core text book research into stress. You will be looking at definitions, studies, strengths and limitations. Some of those studies are quite old. However, we can’t let the topic pass without looking at some of the research being done right now. This research both gives you a better understanding of the core text book research and also gives you something to write about as commentary. There will be some time in lessons as well as home learning time to look at some questions related to this contemporary research. Find answers to these questions and add them into your skeleton notes.

a) What are the broader questions about the relationship between stress and the immune system on which Janice Kiecolt-Glaser is now focusing?

Janice Kiecolt-Glaser has spent a career investigating the relationship between stress and illness. She currently works at the University Of Ohio. You can see her web profile here. You can see what research she is doing by clicking on the Research Studies and In The Media buttons. She is part of something called P4 medicine. The four Ps are “Personalized, Predictive, Preventive, Participatory”. She spoke at a conference about P4 medicine in autumn 2012. You can watch her and some of her research colleagues speak at this video here. Watch it carefully to understand the questions researchers are interested in and what answers they are starting to find. You might want to focus on nurses and physicians in intensive care, special forces troops and NFL quarterbacks, measuring stress, buffering stress.

b) How does how we think about stressful events and what we do about them have an impact on our experience of stress?

Stress research for the last sixty years has assumed that stress is necessarily a bad thing. It has also tended to assume that if you experience stressful life events or have the wrong sort of personality, it is inevitable that you will suffer the consequences. Researchers are now starting to challenge this assumption. There may be things about our stress response which have evolved to protect us. The way we think about stress may have more of an impact on us than the events which we experience themselves.

A key researcher in this area is Kelly McGonigal. She recently gave a TED talk which you can see here. What’s great about this link is that you can go to three of the studies and read first hand the research report. You don’t need to read the whole lot. Just look at the abstracts, the summary of key points which goes at the start of a research report. If you’re having trouble viewing this talk, go to the TED website to find it. You can download it here.

Another piece of research has recently been carried out by the BBC in association with Professor Peter Kinderman at Liverpool University. I have blogged about this research back in October. Follow this link and go down to item 9 on the post for that week. You can also listen to the radio feature about this research here.

You might also want to know more about the work of Anita DeLongis whose research we look at during the lesson. Follow this link for more information.

c) Does status syndrome remain a valid theory for the effect of work on health?

Michael Marmot has spent his career in medicine understanding the links between lifestyle and health. You can listen to him talking about his work on this BBC Radio programme, “The Life Scientific”. Marmot is best known for his Whitehall studies which looked at workers in government departments. Two extracts from this programme where Marmot talks about his Whitehall studies can be heard here and here.  You can read more about the Whitehall studies here. Marmot found that there was a clear link between low status at work and high risk of heart disease and other illnesses. He called this “status syndrome”. Later researchers have questioned the conclusions which Marmot has drawn from his findings. You can listen to a radio programme about this on the BBC website or follow this link. Here is the blog which Marmot runs now.

Two questions come to mind. The first is whether status syndrome remains a valid theory. This is a complex question with no clear right answer. Post a comment explaining your opinion when you have accessed all of the sources. The second, more general question is about Michael Marmot as a scientist. We spent some time at the start of the year identifying the defining features of a good scientist. In what ways do you think Michael Marmot matches these criteria? Post a comment with your views.

12A science

12C science

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15 comments

  1. b) Kelly McGonigal is a health psychologist
    Originally she thought stress was the body’s enemy, that it makes you sick and increases your risk of illness

    A study of 30.000 US adults took place over 9 years
    Participants were asked
    1) how much stress have you experienced over the past year?
    2) do you think stress is harmful for your health?
    It was found that people with a lot of stress who believed it was harmful had a 43% increased risk of dying
    However, people with a lot of stress who didn’t view it as harmful for their health and the lowest risk of dying, even compared to those in the study who rarely experienced stress

    Can changing what you think about stress make you healthier?
    Yes – changing your mind about stress changes the body’s response to stress
    Normal responses to stress: (the physical signs of anxiety)
    1) break into a sweat
    2) increased heart rate
    3) breathing is faster

    Instead of viewing these signs as stressful, view them as the body preparing you to rise to the challenge. View the body’s response as helpful, because the body will believe you.

    It was found that by taking this new approach, the body’s response to stress was healthier
    1) blood vessels remained relaxed, even though the heart rate was still increased
    This meant people were living longer instead of dying from stress-related heart attacks

    Stress makes you social
    There is a hormone called oxytocin which is a neurohormone that makes you act to strengthen relationships and crave physical contact from people you care about
    It’s also a stress hormone, which is released from the pituitary gland in the stress response
    (It motivates you to seek help and physical contact from someone)

    Oxytocin acts on the body as well as the brain
    It protects the cardiovascular system from an unhealthy response by helping heart cells to regenerate and repair from stress damage. This action is enhanced by social contact and support (as it encourages further release of oxytocin). Therefore this means the body recovers faster from stress.

    Another study studied 1,000 US adults between the ages of 34-93
    Participants were asked:
    1) how much stress have you experienced over the past year?
    2) how much time have you spent helping friends/neighbours/the community?

    It was found that for every major stressful life experience, there was a 30% increased risk of dying
    However if they had helped their friends, this decreased to 0 stress related increase

    Kelly McGonigal then concluded that the harmful effects of stress are in fact not inevitable
    If you view them as helpful, they create courage
    And by connecting with others, it creates resilience

  2. Thanks very much for this Mikaela. This is a great resource for people to gain a detailed knowledge of Kelly McGonigal’s theories and the evidence she quotes to support them. We can use these to evaluate the core, textbook evidence we’ll be working on in class.

  3. http://blog.bufferapp.com/the-science-of-stress-how-its-breaking-down-your-body

    There is a post on this link that suggests that stress affects the brain and when rats were put in a stressful situation, their hippocampus shrank.

    Ricki and Hannah

  4. Jo Ricks · · Reply

    Hi Mr Tombs, I love this website! It is a fantastic way to stretch and challenge our students largely because it is time restrictive, people can contribute and read as and when, and it doesn’t have to be during school time! The autism post??… About people with autism being too sensitive and taking in too much information this I believe is an interesting idea and definitely casts some very valued shadows on previous theories and thinking.

    Thanks for sharing this link with me. I have added to my favourites.

    Miss Ricks

  5. After listening to the first two audios about Marmot’s Whitehall studies, I was interested in the way he used elaborative interrogation – by asking what it was about your job status that led to the higher stress and risk of illness – to lead on to his second Whitehall study.
    I thought it was also interesting that men who lived in the poorest part of Glasgow only had a life expectancy of 54 but men in the richest part had a life expectancy of 82.

    1. Thanks Ricki. A few years ago, I heard someone quote similar figures for Plymouth. If you look at life expectancy in the most deprived part of Devonport and the most affluent part of Plympton, the difference is about the same. I’ve never seen these written down and have never been able to find them. I’d be pleased to hear from anyone who knows more.

  6. Two people of whom I’ve looked into regarding stress is Kelly McConigal and Michael Marmot.

    Kelly McConigal speaks in her TED talk of how she’s always preached about how stress was negative, and that we needed to fight it, but argues that in retrospect, this was causing us to have a negative outlook on stress, which was in itself causing illness. She’s now challenging the past 10 years of her career and telling us that instead of demonising stress, we have to make it our friend.

    A study tracked 30,000 adults in the US over 8 years. They were asked how much stress they’d experienced in the past year, and whether they believed stress to be bad for their health. They then used public records to find out who had died; people who experienced a lot of stress and saw this as a bad thing had a 43% increased risk of dying, but this was only true for those who believed stress to be bad. Those who experienced a lot of stress but didn’t think of it as a negative thing had no increased risk of death; even less than those who had moderately less stress.

    McConigal claims that it is estimated that 182,000 people in the US die each year from believing stress to be harmful; if that’s correct, it would be the 15th biggest killer in the US, above things such as homicide.

    In her TED talk, McConigal says that changing how you think about stress can change your body’s response to stress. She encourages people to use their body’s response and view it as their body preparing for the challenge; a positive thing. She speaks of how viewing stress as a positive thing can give you a better cardiovascular profile, causing you to be healthier, which was shown in the Social Stress Test.

    A factor which McConigal leaves off with is Oxytocin; the ‘hugging’ hormone, she says how oxytocin is a neurohormone which primes you to do things which wills you to improve relationships, and become more empathetic and compassionate; she also reveals that it, surprisingly, is a stress hormone – which when released, will will you to seek support. It helps blood vessels stay relaxed, and helps cells in the heart to regenerate and heal from stress induced damage. Seeking support or giving it releases oxytocin, making your stress response become healthier, as well as enabling you to recover faster from stress.

    She speaks of how it’s amazing that our stress response has a built in mechanism for stress resilience – this mechanism being to seek human contact. She finishes off her talk by saying that caring creates resilience, which I found revolutionary in the way we could potentially think about stress, compared to our old ways of thinking.

    Moving onto Sir Michael Marmot, he grew up in Australia and trained as a junior doctor. He speaks to Jim Al-Khalili about how he loved clinical medicine; the instant feeling of reward, of treating people and seeing them get better, however he was getting frustrated with seeing them return – this made him want to find out what the initial cause of the illness was, which led him to conduct the Whitehall studies as a very ambitious researcher.

    The Whitehall studies challenge the myth of ‘executive stress’ and reveals that it was much tougher for those lower down in the pecking order; the lower your status, the shorter your life span. However, it’s said that status syndrome isn’t confined to just civil servants or even the UK; it’s a worldwide phenomenon, which is why Marmot has been travelling the world and speaking to governments to hopefully tackle social injustices. He says how social injustice is killing on grand scale, and he wants to improve health for certain groups of people.

    Marmot moved from clinical medicine to epidemiology, which is the study of disease and distribution of disease within society, and speaks of his determination to discover the link between society and health. He is said to have blossomed in California, where his studies of Whitehall opened an entirely new way of thinking in regards to society and health.
    He thought, just as everyone else did at the time, that high status people got more heart disease because they were under stress, however says that; “To my amazement and to the amazement of everybody I showed these data to / we found the lower the status the higher the risk of heart disease, but it wasn’t just mortality from heart disease, it was mortality from a whole range of diseases, so that the lower the status the shorter the length of life.”

    He says that even without studying the rich and the poor, it showed that the lower you were in the hierarchy, the higher the chance from dying from heart disease, and the chance of mortality from heart disease increased as you stepped down the gradient. Marmot says how this is “not subtle – it’s life and death – and it’s having a profound impact on people’s health” in regards to status, and he claims that this is why he set up the Whitehall II Study.

    After talking for a while about ulcers and GCSE grades, Marmot says we’re failing children on a grand scale, and he wants the state to deliver, as a minimum, a decent education system. We have to reduce inequalities in society and provide children with the resources they need to be able to take control over their lives.

    He says that it’s important to make the gradient shallower, and that it would be unjust to see the results from these studies and not try to improve people’s lives, which has consequently led him to spend a lot of time travelling the world and talking to governments about how to reduce inequalities in health.

    Personally, I find Marmot’s work commendable, however slightly naïve. Of course his studies are ground breaking in showing a link between social status and health, and I fully support the evidence, but I don’t find it objective for him alone to be travelling the world and trying to preach his studies; for it to be effective, I find that Marmot has to make his studies more accessible to the public, teach society of the findings and allow change to happen that way, as one man alone can’t change the ways of the world!

    1. Thanks Seren. You’ve included a lot of valuable detail here which will help others access the arguments. I think Marmot himself would get close to admitting that his arguments from the Whitehall study were naive. He has moved on from there to understand that there is more to health than having a low status job with high demand and low control. The criticism some people level at him is whether he has moved far enough from that view. I think you’re right about making ideas accessible to the public. To be fair, I think Marmot is a better communicator of science than many other scientists whose work I have studied.

  7. From researching further into Marmot’s status syndrome theory I can definitely see validity in the theory; it seems sensible that high demand and low control would be more stressful than high demand and high control; and I find it very interesting that he has evidence to support that these higher stress levels contributed to a higher risk of heart disease and metabolic syndrome; the extreme control of the Whitehall Studies furthers the validity.
    However there are many people currently challenging Marmot that also have some valid theories, for example George Davey Smith makes a good point that the status syndrome may not be correct, it could well be that illness has a negative effect on workplace stress and he uses a good example to support this with the idea that the longer an actor lives, the higher chance they have of winning an Oscar, but winning the Oscar doesn’t cause the actor to live longer.
    Researchers such as Kerry McConigal also make a good point that stress may not have a negative impact on our health; that it is in fact the way in which we view stress which is harmful – and this theory challenges Marmots findings in a way as it would suggest that the higher demand low control worker would experience more stress but if they saw this as an obstacle to overcome they would have reduced health risks than perhaps workers in a high demand high control role.

    I think Marmot definitely shows examples of good science in the Whitehall studies. They are ethical as participants have the right to withdraw and ask questions at any point; although the dropout rate remained extremely low over a long time scale. The studies also have a very clear hypothesis. It is arguable as to whether he is objective as there’s lots of effect but only if you buy into it.

    1. Thanks for sharing this. I like the way you have brought in the Kelly McGonagal ideas into the debate. Marmot’s big idea, I think, is that society needs to change the way people are treated in work rather than change the way people think about the circumstances in which they work. On the other hand, he also thinks it is psychosocial processes which matter so he would agree with McGonagal about the importance of changing the way you think and the way you interact with others. It becomes a complex and interesting question.

  8. Millie B · · Reply

    Marmot showed form studies into British civil servants that those with lower status jobs were at higher risk of heart disease and had a lower life span. He looked at people within different statuses within jobs and showed how the effects of working in certain status had effects on the mind which caused other effects to the body such as in the immune system. He found that those who had higher status generally had high demand but yet they had control, where as those in low status had demands to fulfil, yet had little/no control suggesting this could be the factor that causes effect to the mind. He supported this by the idea that those in high status jobs get most stress when they are going to be in situations where they will be in less control.
    There were arguments against Marmots finding, one example was that, it doesn’t mean that all people in low status jobs will have a higher risk than in high status jobs and it doesn’t prove that it is the status of the job that is causing it, it may be other factor – we know that smoking causes lung cancer, but not everyone that smokes will get lung cancer.
    I think that Marmot did show examples of good science for example his study did benefit society in that knowing this information can help people to maybe change to have more control in jobs to able the to be less stress and try different ways to try reduce that risk to those in low status jobs. I think that he had a clear hypothesis and was open minded about his study, as he did not originally expect the findings that he got. I think he could have improved the science of his study by looking further in to the effects that the work place has on stress and the risk of serious illness.

    1. Thanks for this. I think you are right about the complexity of these issues and to ask some questions about cause and effect. You got me thinking about Marmot’s role in drawing attention to bad practices in the workplace. I’ve put a link below to the Panorama programme in which he appeared.

  9. Does the status syndrome still remain a valid theory?

    I’m on the fence about this one. At face value, the status syndrome theory seems to be supported by thorough evidence. The theory and other work of Marmot’s have been said to be influential and have been reflected in policy making circles on the need to empower people and has helped underpin the health policy of David Cameron’s coalition government. This gave me confidence that Marmot’s work was of good accuracy and validity, until I looked at opposing studies. Recent studies have found that the link between low status and cortical (a main aspect of the status syndrome theory) is weak. George Davie Smith argued material factors were somewhat ignored in the Whitehall studies, which helped form the status syndrome theory; he argued the participants material backgrounds was the main cause of differing health problems. Another opposing study was the study in which the team that conducted the Whitehall studies found the role of behaviours in creating health inequalities had been underestimated in previous studies, and could account for 70% of the health differences found in the original Whitehall studies. It was also argued whether health problems stem from status, or whether status stems from health problems; opposing economists and epidemiologists think status stems from health problems, so are against Marmot’s views. This evidence makes me unsure whether the status syndrome theory is actually valid, maybe in the Whitehall studies, participants were judged by face value too much.

    In what ways does Michael Marmot match the criteria of a good scientist?

    Firstly, he clearly intended for his work to benefit society and have an effect on the workplace, so his interests were genuine. He also seems very open-minded, in the first Whitehall study, the results were completely unexpected, but he went with it and conducted further studies stemming from it to provide further evidence. For each study there were clear hypotheses, which meant Marmot followed and kept to the purpose of the study and didn’t go off track. Marmot also designed his Whitehall studies in a way that avoided ethical issues, the low control that participants were experiencing was already there, so no manipulation or purposely causing stress to participants was needed.

    1. Thanks for this. I’ve only read it after I posted my own comment. I think the points you’ve picked up are really interesting. For me, part of that interest is whether you think of this as a psychologist or a sociologist. As a sociologist, you end up focusing more on the opposing studies you mention, as a psychologist you focus on the psychosocial processes at the heart of status syndrome. It’s the Psychology in what he says which impresses me as well as the open-mindedness which you identify but I recognise that’s a product of the biases in my own thinking and interests. You’re starting to convince me that the fence is the best place to be.

  10. Thank you to everyone who has contributed to this blog. It is really good to be able to reply to your comments.

    The arguments about status syndrome are quite complicated. The first is about lifestyle factors. The argument is that the health of high demand, low control is not negatively affected by the way these people think and feel about their jobs – the psychosocial processes which Marmot talks about – but because of the lifestyle choices which these people make. Because they are in high demand, low control, low status jobs, they are more likely to smoke, have an unhealthy diet and take less exercise than people with higher status jobs. It is these behaviours which matter, not their state of mind. Marmot argues that he has taken these factors into account but others disagree. This is a matter of statistics. Marmot and his colleagues make judgements about the importance of lifestyle factors based on previous studies. Not everyone agrees that he has got his statistics right.

    The second argument is about cause and effect. Marmot argues that low status causes chronic illness. His critics argue that it works the other way round. People who are ill are likely to miss out on significant chunks of education and end up in lower status jobs. Marmot claims that he has evidence which shows that job mobility predicts health. He admits however that economists would disagree with him.

    The third argument is about poverty. The argument is that poverty causes poor health. Poverty also leads to people missing out on educational opportunities. The reason why low status is linked to poor health is because poverty causes both of them: it acts as an extraneous variable. Marmot again claims to have taken account of this in his analysis and insists on the importance of psychosocial processes in the experience of workplace stress.

    Because I am interested in Psychology and in how science works, I find Michael Marmot’s work fascinating. As a scientist, I like the way in which he has found a way to get his ideas across and to be influential in shaping government policy. The radio programme explains that this has not been an easy process. It shows that science is not just about sitting in a laboratory and finding things but is about collaborating and communicating. If you’re not in my General Studies class, please have a look at the Panorama programme linked in this blogpost: https://tombssimon.wordpress.com/2013/11/28/post-of-the-week-thursday-29th-november/.

    As a psychologist, I like the way he defends the primacy of psychosocial processes. What you think has a direct impact on your health and well-being. This is an idea which is gaining ground at the moment through the work of Kelly McGonagal and Peter Kinderman which is linked on this blog. His message here is a subtle one. It is not just a question of telling people to think more positively and everything will be alright. He is interested in changing the environments in which people work so that thinking positively about yourself and your work has some grounding in reality.

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