What is Distress?

Introduction

In medicine, distress is an aversive state in which a person is unable to completely adapt to stressors and their resulting stress and shows maladaptive behaviours.

It can be evident in the presence of various phenomena, such as inappropriate social interaction (e.g., aggression, passivity, or withdrawal).

Distress is the opposite of eustress, a positive stress that motivates people.

Risk Factors

Stress can be created by influences such as work, school, peers or co-workers, family and death. Other influences vary by age.

People under constant distress are more likely to become sick, mentally or physically. There is a clear response association between psychological distress and major causes of mortality across the full range of distress.

Higher education has been linked to a reduction in psychological distress in both men and women, and these effects persist throughout the aging process, not just immediately after receiving education. However, this link does lessen with age. The major mechanism by which higher education plays a role on reducing stress in men is more so related to labour-market resources rather than social resources as in women.

In the clinic, distress is a patient reported outcome that has a huge impact on patient’s quality of life. To assess patient distress, a Hospital Anxiety and Depression Scale (HADS) questionnaire is most commonly used. The score from the HADS questionnaire guides a clinician to recommend lifestyle modifications or further assessment for mental disorders like depression.

Management

People often find ways of dealing with distress, in both negative and positive ways. Examples of positive ways are listening to music, calming exercises, colouring, sports and similar healthy distractions. Negative ways can include but are not limited to use of drugs including alcohol, and expression of anger, which are likely to lead to complicated social interactions, thus causing increased distress.

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Who was Hans Selye?

Introduction

János Hugo Bruno “Hans” Selye CC (Hungarian: Selye János; 26 January 1907 to 16 October 1982) was a pioneering Hungarian-Canadian endocrinologist who conducted important scientific work on the hypothetical non-specific response of an organism to stressors.

Although he did not recognise all of the many aspects of glucocorticoids, Selye was aware of their role in the stress response. Charlotte Gerson considers him the first to demonstrate the existence of biological stress.

Hans Selye in the 1970s
Hans Selye in the 1970s.

Biography

Selye was born in Vienna, Austria-Hungary on 26 January 1907 and grew up in Komárom (the town with Hungarian majority in present day Slovakia was cut by the Treaty of Trianon in 1920). Selye’s father was a doctor of Hungarian ethnicity and his mother was Austrian. He became a Doctor of Medicine and Chemistry in Prague in 1929 and went on to do pioneering work in stress and endocrinology at Johns Hopkins University, McGill University, and the Université de Montréal. He was nominated for the Nobel Prize in Physiology or Medicine for the first time in 1949. Although he received a total of 17 nominations in his career, he never won the prize.

Selye died on 16 October 1982 in Montreal, Quebec, Canada. He often returned to visit Hungary, giving lectures as well as interviews in Hungarian television programs. He conducted a lecture in 1973 at the Hungarian Scientific Academy in Hungarian and observers noted that he had no accent, despite spending many years abroad. His book The Stress of Life appeared in Hungarian as Az Életünk és a stressz in 1964 and became a bestseller. Selye János University, the only Hungarian-language university in Slovakia, was named after him. Selye’s mother was killed by gunfire during Hungary’s anti-Communist revolt of 1956.

Stress Research

Selye’s interest in stress began when he was in medical school; he had observed that patients with various chronic illnesses like tuberculosis and cancer appeared to display a common set of symptoms that he attributed to what is now commonly called stress. After completing his medical degree and a doctorate degree in organic chemistry at the German University of Prague, he received a Rockefeller Foundation fellowship to study at Johns Hopkins in Baltimore and later moved to the Department of Biochemistry at McGill University in Montreal where he studied under the sponsorship of James Bertram Collip. While working with laboratory animals, Selye observed a phenomenon that he thought resembled what he had previously seen in chronic patients. Rats exposed to cold, drugs, or surgical injury exhibited a common pattern of responses to these stressors (A stressor is a chemical or biological agent, environmental condition, external stimulus or an event seen as causing stress to an organism).

Selye initially (circa 1940s) called this the “general adaptation syndrome” (at the time it was also called “Selye’s syndrome”), but he later rebaptised it with the simpler term “stress response”. According to Selye the general adaptation syndrome is triphasic, involving an initial alarm phase followed by a stage of resistance or adaptation and, finally, a stage of exhaustion and death (these phases were established largely on the basis of glandular states). Working with doctoral student Thomas McKeown (1912-1988), Selye published a report that used the word “stress” to describe these responses to adverse events.

His last inspiration for general adaptation syndrome came from an experiment in which he injected mice with extracts of various organs. He at first believed he had discovered a new hormone, but was proved wrong when every irritating substance he injected produced the same symptoms (swelling of the adrenal cortex, atrophy of the thymus, gastric and duodenal ulcers). This, paired with his observation that people with different diseases exhibit similar symptoms, led to his description of the effects of “noxious agents” as he at first called it. He later coined the term “stress”, which has been accepted into the lexicon of most other languages.

Selye argued that stress differs from other physical responses in that it is identical whether the provoking impulse is positive or negative. He called negative stress “distress” and positive stress “eustress“.

The system whereby the body copes with stress, the hypothalamic-pituitary-adrenal axis (HPA axis) system, was also first described by Selye.

Selye has acknowledged the influence of Claude Bernard (who developed the idea of milieu intérieur) and Walter Cannon’s “homeostasis”. Selye conceptualised the physiology of stress as having two components: a set of responses which he called the “general adaptation syndrome”, and the development of a pathological state from ongoing, unrelieved stress.

While the work attracted continued support from advocates of psychosomatic medicine, many in experimental physiology concluded that his concepts were too vague and unmeasurable. During the 1950s, Selye turned away from the laboratory to promote his concept through popular books and lecture tours. He wrote for both non-academic physicians and, in an international bestseller entitled The Stress of Life (1956). From the late 1960s, academic psychologists started to adopt Selye’s concept of stress, and he followed The Stress of Life with two other books for the general public, From Dream to Discovery: On Being a Scientist (1964) and Stress without Distress (1974).

He worked as a professor and director of the Institute of Experimental Medicine and Surgery at the Université de Montréal. In 1975 he created the International Institute of Stress, and in 1979, Selye and Arthur Antille started the Hans Selye Foundation. Later Selye and eight Nobel laureates founded the Canadian Institute of Stress.

In 1968 he was made a Companion of the Order of Canada. In 1976, he was awarded the Loyola Medal by Concordia University.

Controversy and Involvement with the Tobacco Industry

Although it was not widely known at the time, Selye began consulting for the tobacco industry starting in 1958; he had previously sought funding from the industry, but had been denied. Later, New York attorney Edwin Jacob contacted Selye as he prepared a defence against liability actions brought against tobacco companies. The companies wanted Selye’s help in arguing that the recognized correlation between smoking and cancer was not proof of causality. The firm offered to pay Selye $1000 to make a statement supporting this claim. He agreed but refused to testify. Tobacco industry lawyers reported that Selye was willing to incorporate industry advice when writing about smoking and stress. One lawyer advised him to “comment on the unlikelihood of there being a mechanism by which smoking could cause cardiovascular disease” and to emphasize the “stressful” effect that anti-smoking messages had on the US population.

Publicly, Selye never declared his consultancy work for the tobacco industry. In a 1967 letter to “Medical Opinion and Review”, he argued against government over-regulation of science and public health, implying that his views on smoking were objective: “I purposely avoided any mention of government-supported research because, being too largely dependent upon it, I may not be able to view the subject objectively. However, I do not use … cigarettes so let these examples suffice.” In June 1969, Selye (then director of the Institute of Experimental Pathology, University of Montreal) testified before the Canadian House of Commons Health Committee against anti-smoking legislation, opposing advertising restrictions, health warnings, and restrictions on tar and nicotine. For his testimony Selye was funded $50 000 per year for a 3-year “special project”, by William Thomas Hoyt (executive of Council for Tobacco Research) with another $50,000 a year pledged by the Canadian tobacco industry. His comments on smoking were used worldwide, Philip Morris (Tobacco company) used Selye’s statements on the benefits of smoking to argue against the use of health warnings on tobacco products in Sweden. Similarly, in 1977 the Australian Cigarette Manufacturers quoted Selye extensively in their submission to the Australian Senate Standing Committee on Social Welfare.

In 1999, the United States Department of Justice brought an anti-racketeering case against 7 tobacco companies (British American Tobacco, Brown & Williamson, Philip Morris, Liggett, American Tobacco Company, RJ Reynolds, and Lorillard), the Council for Tobacco Research, and the Tobacco Institute. As a result, the industry’s influence on stress research was revealed.

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What is Eustress?

Introduction

Eustress means beneficial stress – either psychological, physical (e.g. exercise), or biochemical/radiological (hormesis).

The term was coined by endocrinologist Hans Selye, consisting of the Greek prefix eu- meaning “good”, and stress, literally meaning “good stress”.

It is the positive cognitive response to stress that is healthy, or gives one a feeling of fulfillment or other positive feelings. Selye created the term as a subgroup of stress to differentiate the wide variety of stressors and manifestations of stress.

Eustress is not defined by the stress or type, but rather how one perceives that stressors (e.g. a negative threat versus a positive challenge). Eustress refers to a positive response one has to a stressor, which can depend on one’s current feelings of control, desirability, location, and timing of the stressor. Potential indicators of eustress may include responding to a stressor with a sense of meaning, hope, or vigour. Eustress has also been positively correlated with life satisfaction and well-being.

Refer to Distress.

Definition

Eustress occurs when the gap between what one has and what one wants is slightly pushed, but not overwhelmed. The goal is not too far out of reach but is still slightly more than one can handle. This fosters challenge and motivation since the goal is in sight. The function of challenge is to motivate a person toward improvement and a goal. Challenge is an opportunity-related emotion that allows people to achieve unmet goals. Eustress is indicated by hope and active engagement. Eustress has a significantly positive correlation with life satisfaction and hope. It is typically assumed that experiencing chronic stress, either in the form of distress or eustress, is negative. However, eustress can instead fuel physiological thriving by positively influencing the underlying biological processes implicated in physical recovery and immunity.

Measurement

Occupational eustress may be measured on subjective levels such as of quality of life or work life, job pressure, psychological coping resources, complaints, overall stress level, and mental health. Other subjective methodological practices have included interviews with focus groups asking about stressors and stress level. In one study participants were asked to remember a past stressful event and then answer questionnaires on coping skills, job well-being, and appraisal of the situation (viewing the stressful event as a challenge or a threat). Common subjective methodologies were incorporated in a holistic stress model created in 2007 to acknowledge the importance of eustress, particularly in the workplace. This model uses hope, positive affect, meaningfulness, and manageability as a measure of eustress, and negative psychological states, negative affect, anxiety, and anger as a measure of distress. Objective measures have also been used and include blood pressure rate, muscle tension, and absenteeism rates. Further physiological research has looked for neuroendocrine changes as a result of eustress and distress. Research has shown that catecholamines change rapidly to pleasurable stimuli. Studies have demonstrated that eustress and distress produce different responses in the neuroendocrine system, particularly dependent on the amount of personal control one feels over a stressor.

Compared with Distress

Distress is the most commonly referred to type of stress, having negative implications, whereas eustress is usually related to desirable events in a person’s life. Selye first differentiated the two in an article he wrote in 1975. In this article Selye argued that persistent stress that is not resolved through coping or adaptation should be known as distress, and may lead to anxiety, withdrawal, and depressive behaviour. In contrast, if stress enhances one’s functioning it may be considered eustress. Both can be equally taxing on the body, and are cumulative in nature, depending on a person’s way of adapting to the stressor that caused it. The body itself cannot physically discern between distress or eustress. Differentiation between the two is dependent on one’s perception of the stress, but it is believed that the same stressor may cause both eustress and distress. One context that this may occur in is societal trauma (e.g. the black death, World War II) which may cause great distress, but also eustress in the form of hardiness, coping, and fostering a sense of community. The Yerkes–Dodson model demonstrates the optimum balance of stress with a bell curve (shown in the image in the top right).[17] This model is supported by research demonstrating emotional-coping and behavioural-coping strategies are related to changes in perceived stress level on the Yerkes-Dodson Curve. However, the Yerkes-Dodson Curve has become increasingly questioned. A review of the psychological literature pertaining work performance, found that less than 5% of papers supported the inverted U-shaped curve whereas nearly 50% found a “negative linear” relationship (any level of stress inhibits performance).

Occupational

Much of the research on eustress has focused on its presence in the workplace. In the workplace, stress can often be interpreted as a challenge, which generally denotes positive eustress, or as a hindrance, which refers to distress that interferes with one’s ability to accomplish a job or task.

Research has focused on increasing eustress in the workplace, in an effort to promote positive reactions to an inevitably stressful environment. Companies are interested in learning more about eustress and its positive effects to increase productivity. Eustress creates a better environment for employees, which makes them perform better and cost less. Occupational stress costs the United States somewhere in between 200 and 300 billion dollars per year. If this were eustress instead of distress, these companies would retain this money and the US economy could improve as well. Stress has also been linked to the six leading causes of death: “disease, accidents, cancer, liver disease, lung ailments, suicide.” If workers get sick and/or die, there is obviously a cost to the company in sick time and training new employees. It is better to have productive, happy employees. Eustress is necessary for achievement. Eustress is related to well-being and positive attitudes and thus increases work performance.

Techniques such as Stress Management Interventions (SMI) have been employed to increase occupational eustress. SMI’s often incorporate exercise, meditation, and relaxation techniques to decrease distress and increase positive perceptions of stress in the workplace. Rather than decrease stress in the workplace, SMI techniques attempt to increase eustress with positive reactions to stressful stimuli.

Self-Efficacy

Eustress is primarily based on perceptions. It is how you perceive your given situation and how you perceive your given task. It is not what is actually happening, but a person’s perception of what is happening. Eustress is thus related to self-efficacy. Self-efficacy is one’s judgement of how they can carry out a required task, action or role. Some contributing factors are a person’s beliefs about the effectiveness about their options for courses of action and their ability to perform those actions. If a person has low self-efficacy, they will see the demand as more distressful than eustressful because the perceived level of what the person has is lower. When a person has high self-efficacy, they can set goals higher and be motivated to achieve them. The goal then is to increase self-efficacy and skill in order to enable people to increase eustress.

Flow

When an individual appraises a situation as stressful, they add the label for distress or eustress to the issue at hand. If a situation induces eustress, the person may feel motivated and can experience flow. Positive psychologist, Mihaly Csikszentmihalyi, created this concept which is described as the moments when one is completely absorbed into an enjoyable activity with no awareness of surroundings. Flow is an extremely productive state in which an individual experiences their prime performance. The core elements are absorption, enjoyment and intrinsic motivation.

Flow is the “ultimate eustress experience – the epitome of eustress”. Hargrove, Nelson and Cooper described eustress as being focused on a challenge, fully present and exhilarated, which almost exactly mirrors the definition of flow. Flow is considered a peak experience or “the single most joyous, happiest, most blissful moment of your life.”

Factors

There are several factors that may increase or decrease one’s chances of experiencing eustress and, through eustress, experiencing flow:

  • Stress is also influenced by hereditary predispositions and expectations of society. Thus, a person could already be at a certain advantage or disadvantage toward experiencing eustress.
  • If a person enjoys experiencing new things and believes they have importance in the world, they are more likely to experience flow.
  • Flow is negatively related to self-directedness, or an extreme sense of autonomy.
  • Persistence is positively related to flow and closely related to intrinsic motivation.
  • People with an internal locus of control, have an increased chance of flow because they believe they can increase their skill level to match the challenge.
  • Perfectionism, however, is negatively related to flow. A person downplays their skill levels therefore making the gap too big, and they perceive the challenge to be too large to experience flow. On the opposite end of perfectionism, however, there are increased chances of flow.
  • Active procrastination is positively related to flow. By actively delaying work, the person increases the challenge. Then once the challenge is matched with the person’s high skill levels, the person can experience flow. Those who passively procrastinate or do not procrastinate do not have these same experiences. It is only with the purposeful procrastination that a person is able to increase the challenge.
  • Mindset is a significant factor in determining distress versus eustress. Optimistic people and those with high self-esteem contribute to eustress experiences. The positive mindset increases the chances of eustress and a positive response to stressors. Currently, the predominant mindset toward stress is that stress is debilitating. However, mindsets toward stress can be changed.

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What is Weathering Hypothesis?

Introduction

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic and political adversity.

It is well documented that minority groups and marginalised communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is “weathering,” and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalised communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, and telomere shortening.

Origins

The weathering hypothesis was initially formulated by Dr. Arline T. Geronimus to explain the poor maternal health and birth outcomes of African American women that she observed in correspondence with increased age. While working part-time at a school for pregnant teenagers in Trenton, New Jersey, Geronimus first noticed that the teens who came to the school tended to have far more health problems than her classmates at Princeton University. She thus began to wonder whether the health conditions of the teens at that clinic may have been caused by their environment. Subsequent research on the disparity in maternal health between African American and white women led Geronimus to propose the weathering hypothesis. She proposed that the accumulation of cultural, social and economic disadvantages may lead to earlier deterioration of health among African American women compared to their non-Hispanic, white counterparts. Geronimus specifically chose the term weathering as a metaphor for the effects she perceived that exposure to stress was having on the health of marginalised people. While the weathering hypothesis was initially proposed based on observations of patterns in maternal health, academics have expanded its application as a framework to examine other health disparities as well.

Geronimus’ Research

While conducting research in the Department of Public Health Policy and Administration as a graduate student at the University of Michigan in 1992, Geronimus noticed a trend in disparities between the fertility of African American women versus their white counterparts. She noted that while the average white woman experiences her point of highest fertility and lowest risk of pregnancy complications or neonatal mortality between her 20’s and 30’s, this generalisation did not apply to African American women. Instead, among African American women, teen mothers are most likely to have healthy pregnancies and offspring. The data indicated a widening disparity in black-white infant mortality as maternal ages increase. Subsequently, Geronimus proposed the “weathering hypothesis,” which she initially conceived as a potential explanation for the patterns of racial variation in infant mortality with increasing maternal age.

Health Disparities

In the context of the weathering hypothesis, individual health is dynamic and shaped over time by social, economic, and environmental influences. These social determinants dictate what different demographics are exposed to as they develop and age. Racism and discrimination are two specific social determinants that lay the foundation for systemic inequality in access and upward mobility. This entrenchment of social inequities disproportionately impacts minorities and communities of colour, who remain in environments of poverty that have significantly more stressors than those of wealthier, predominantly white communities. These stressors – and the associated burden of coping with them – manifest as physiological responses that have detrimental effects on individual health, often leading to a disproportionately high occurrence of chronic illness and shorter life expectancy in minority communities. Multi-ethnic studies have yielded significant data demonstrating that weathering – accumulated health risk due to social, economic and environmental stressors – is a manifestation of social stratification that systemically influences disparities in health and mortality between dominant and minority communities.

Maternal Health

Maternal mortality is three to four times higher for Black mothers than white mothers in the United States. Infant mortality is also twice as high for infants born to non-Hispanic Black mothers compared to infants born to non-Hispanic white mothers. Additionally, there are racial disparities for negative birth outcomes like low birth weight, which has been found to influence risk of infant mortality and developmental outcomes after birth, and preterm birth. Across all women, older maternal age is associated with higher rates of these negative outcomes during pregnancy, but studies have consistently found that rates rise more rapidly for Black women than white women. The weathering hypothesis proposes that the accumulation of racial stress over Black women’s lives contributes to this observed pattern of racial disparities in maternal health and birth outcomes that increase with maternal age. Research has consistently identified an association between preterm birth and low birth weight in Black women and maternal stress caused by experiences of racism, systemic bias, socioeconomic disadvantage, segregated neighbourhoods, and high rates of violent crime. There is biological evidence of weathering, including the finding that Black women have shorter telomeres, a biological indicator of age, when compared with white women of the same chronological age. Though increased socioeconomic status serves as a protective factor against negative birth outcomes for non-Hispanic white mothers, disproportionate rates of preterm birth and low birth weight for non-Hispanic Black mothers have been found at every education and income level. The weathering hypothesis has also been used to explain this trend because upward socioeconomic mobility is associated with increased exposure to discrimination for women of colour.

There is modest evidence supporting the effects of weathering on mothers from other minority groups, including for high birth weight outcomes among American Indian/Alaska Native women. Research has started to explore whether the weathering hypothesis could also explain racial disparities in the outcomes of assisted reproductive technologies, but so far the findings are inconsistent.

Mental Health

Research shows that mental health disparities among marginalized communities exist. Daily discrimination faced by marginalised groups have been found to be associated with increased depressive symptoms and feelings of loneliness. Low-income communities are more likely to have severe mental illnesses, which is frequently heightened by the inaccessibility to quality healthcare. Researchers found that persisting epigenetic changes lead to increased risk of postpartum depression as a result of adverse life events and cumulative life stress among Black, Latinx, and low-income women. In a study assessing African American men, experiences of racism were linked to a poorer mental health state.

Intersectionality of Systems of Oppression

Intersectionality is a term coined by Kimberlé Crenshaw to describe the interconnected nature of different systems of oppression, the layered effects of which can be seen in the healthcare system. Research indicates that lower class status and increased depressive symptoms are associated with higher levels of biological weathering among Black individuals in comparison to white individuals. In a study exploring disparities in mental health, researchers found that Black sexual minority women reported higher frequencies of discrimination and decreased levels of social and psychological well-being than their white sexual minority women counterparts. Black sexual minority women had decreased levels of social well-being and increased levels of depressive symptoms in comparison to Black sexual minority men. African American women are also more likely to contract COVID-19 than African American men and white women. The prevalence of medical racism and sexism (lack of quality healthcare, harmful experimentation, etc.) has led to negative relationships with healthcare systems and increased risk of negative sexual and reproductive health outcomes among African American women. Existing research show how systems of oppression work together to oppress marginalized groups within the healthcare system and, as a result, these groups disproportionately experience negative health effects.

Criticism and Related Theories

Arline Geronimus faced significant pushback for the weathering hypothesis, including from members of the medical community who believed there was a genetic or evolutionary explanation for racial differences in health outcomes. There was some early criticism regarding the quality of her data, though the evidence of weathering and health disparities has grown since. Others pushed back against the weathering hypothesis because its application to racial disparities in maternal health seemed to contradict what advocacy groups had been saying about the negative consequences of teen pregnancy on young mothers. A further criticism of this theory believes that Geronimus and others have not sufficiently demonstrated a link between weathering and racial and gender disparities in life expectancy.

The weathering hypothesis was initially proposed as a sociological explanation for health disparities, but it is closely related to biological theories like the allostatic load model, which proposes that an individual’s exposure to repeated or chronic stress over their lifetime has physiological consequences which can be measured through various biomarkers. Research has tended to discuss allostasis and allostatic load as the molecular mechanism behind the weathering hypothesis, and Geronimus herself went on to study racial differences in allostatic load. Another related theory is the life course approach, which emphasizes focus on cumulative life experiences rather than maternal risk factors as an explanation for birth outcome disparities. Researchers have also been interested in studying the possibility of children inheriting the epigenetic changes which result from their mother’s cumulative life stress, which could relate the weathering hypothesis with transgenerational trauma.

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What is Inner Peace?

Introduction

Inner peace (or peace of mind) refers to a deliberate state of psychological or spiritual calm despite the potential presence of stressors such as the burden arising from pretending to be someone.

Refer to Ataraxia.

Background

Being “at peace” is considered by many to be healthy (homeostasis) and the opposite of being stressed or anxious, and is considered to be a state where our mind performs at an optimal level with a positive outcome. Peace of mind is thus generally associated with bliss, happiness and contentment.

Peace of mind, serenity, and calmness are descriptions of a disposition free from the effects of stress. In some cultures, inner peace is considered a state of consciousness or enlightenment that may be cultivated by various forms of training, such as breathing exercises, prayer, meditation, tai chi or yoga, for example. Many spiritual practices refer to this peace as an experience of knowing oneself.

People have difficulties embracing their inner spirituality because everyday stressors get the best of them; finding peace and happiness in the little joys of life can seem difficult, and results do not seem all that gratifying. Achieving spirituality is a step-by-step process; there are ways through which one can become more spiritual every day.

Tenzin Gyatso, the 14th Dalai Lama, emphasizes the importance of inner peace in the world:

The question of real, lasting world peace concerns human beings, so basic human feelings are also at its roots. Through inner peace, genuine world peace can be achieved. In this the importance of individual responsibility is quite clear; an atmosphere of peace must first be created within ourselves, then gradually expanded to include our families, our communities, and ultimately the whole planet.

What is Allostatic Load?

Introduction

Allostatic load is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress.

The term was coined by Bruce McEwen and Stellar in 1993. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response which results from repeated or prolonged chronic stress.

Regulatory Model

The term allostatic load is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress. It was coined by McEwen and Stellar in 1993.

The term is part of the regulatory model of allostasis, where the predictive regulation or stabilisation of internal sensations in response to stimuli is ascribed to the brain. Allostasis involves the regulation of homeostasis in the body to decrease physiological consequences on the body. Predictive regulation refers to the brain’s ability to anticipate needs and prepare to fulfil them before they arise.

Part of efficient regulation is the reduction of uncertainty. Humans naturally do not like feeling as if surprise is inevitable. Because of this, we constantly strive to reduce the uncertainty of future outcomes, and allostasis helps us do this by anticipating needs and planning how to satisfy them ahead of time. But it takes a considerable amount of the brain’s energy to do this, and if it fails to resolve the uncertainty, the situation may become chronic and result in the accumulation of allostatic load.

The concept of allostatic load provides that:

“the neuroendocrine, cardiovascular, neuroenergetic, and emotional responses become persistently activated so that blood flow turbulences in the coronary and cerebral arteries, high blood pressure, atherogenesis, cognitive dysfunction and depressed mood accelerate disease progression.”

All long-standing effects of continuously activated stress responses are referred to as allostatic load. Allostatic load can result in permanently altered brain architecture and systemic pathophysiology.

Allostatic load minimises an organism’s ability to cope with and reduce uncertainty in the future.

Types

McEwen and Wingfield propose two types of allostatic load with different aetiologies and distinct consequences:

  • Type 1 allostatic load occurs when energy demand exceeds supply, resulting in activation of the emergency life history stage. This serves to direct the animal away from normal life history stages into a survival mode that decreases allostatic load and regains positive energy balance. The normal life cycle can be resumed when the perturbation has passed. Typical situations ending up in type 1 allostasis are starvation, hibernation and critical illness. Of note, the life-threatening consequences of critical illness may be both cause and consequences of allostatic load.
  • Type 2 allostatic load results from sufficient or even excess energy consumption being accompanied by social conflict or other types of social dysfunction. The latter is the case in human society and certain situations affecting animals in captivity. In all cases, secretion of glucocorticosteroids and activity of other mediators of allostasis such as the autonomic nervous system, CNS neurotransmitters, and inflammatory cytokines wax and wane with allostatic load. If allostatic load is chronically high, then pathologies may develop. Type 2 allostatic overload does not trigger an escape response, and can only be counteracted through learning and changes in the social structure.

Whereas both types of allostatic load are associated with increased release of cortisol and catecholamines, they differentially affect thyroid homeostasis: Concentrations of the thyroid hormone triiodothyronine are decreased in type 1 allostasis, but elevated in type 2 allostasis. This may result from an interaction of type 2 allostatic load with the set point of thyroid function.

Measurement

Allostatic load is generally measured through a composite index of indicators of cumulative strain on several organs and tissues, primarily biomarkers associated with the neuroendocrine, cardiovascular, immune and metabolic systems.

Indices of allostatic load are diverse across studies and are frequently assessed differently, using different biomarkers and different methods of assembling an allostatic load index. Allostatic load is not unique to humans and may be used to evaluate the physiological effects of chronic or frequent stress in non-human primates as well.

In the endocrine system, the increase or repeated levels of stress results in the increased levels of the hormone Corticotropin-Releasing Factor (CRH), which is associated with activation of hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is the central stress response system responsible for modulating inflammatory responses throughout the body. Prolonged stress levels can lead to decreased levels of cortisol in the morning and increased levels in the afternoon, leading to greater daily output of cortisol which in the long term increases blood sugar levels.

In the nervous system, structural and functional abnormalities are a result of chronic prolonged stress. The increase of stress levels causes a shortening of dendrites in a neuron. Therefore, the shortening of dendrites causes the decrease in attention. Chronic stress also causes greater response to fear of the unlearned in the nervous system, and fear conditioning.

In the immune system, the increase in levels of chronic stress results in the elevation of inflammation. The increase in inflammation levels is caused by the ongoing activation of the sympathetic nervous system. The impairment of cell-mediated acquired immunity is also a factor resulting in the immune system due to chronic stress.

Relationship to Allostasis and Homeostasis

The largest contribution to the allostatic load is the effect of stress on the brain. Allostasis is the system which helps to achieve homeostasis. Homeostasis is the regulation of physiological processes, whereby systems in the body respond to the state of the body and to the external environment. The relationship between allostasis and allostatic load is the concept of anticipation. Anticipation can drive the output of mediators. Examples of mediators include hormones and cortisol. Excess amounts of such mediators will result in an increase in allostatic load, contributing to anxiety and anticipation.

Allostasis and allostatic load are related to the amount of health-promoting and health-damaging behaviours like for example cigarette smoking, consumption of alcohol, poor diet and physical inactivity.

Three physiological processes cause an increase in allostatic load:

  • Frequent stress: the magnitude and frequency of response to stress is what determines the level of allostatic load which affects the body.
  • Failed shut-down: the inability of the body to shut off while stress accelerates and levels in the body exceed normal levels, for example, elevated blood pressure.
  • Inadequate response: the failure of the body systems to respond to challenge, for example, excess levels of inflammation due to inadequate endogenous glucocorticoid responses.

The importance of homeostasis is to regulate the stress levels encountered on the body to reduce allostatic load.

Dysfunctional allostasis causes allostatic load to increase which may, over time, lead to disease, sometimes with decompensation of the allostatically controlled problem. Allostatic load effects can be measured in the body. When tabulated in the form of allostatic load indices using sophisticated analytical methods, it gives an indication of cumulative lifetime effects of all types of stress on the body.

Causes of Allostatic Load

Type 1 allostatic load represents the adaptive response to an absolute lack in energy, glutathione and several macronutrients. It also includes predictive responses, e.g. in hibernation, infection and depression.

Type 2 allostatic load results from an expected mismatch of energy demand and supply. It is triggered by psychosocial stress, e.g. due to low socioeconomic status, major life events and environmental stressors. This association explains the increased risk for cardiovascular disease and chronic conditions like obesity, diabetes, hypertension and psychotic conditions in subjects that were exposed to psychosocial trauma, social disadvantage and discrimination. Socio-cultural mechanisms tend to augment this relation by perpetuating disparity even in the quality of health care, which tends to be inferior in socially disadvantaged population strata.

Implications of Allostatic Load on Health

Increased allostatic load constitutes a significant health hazard. Several studies documented a strong association of allostatic load to the incidence of coronary heart disease, to surrogate markers of cardiovascular health and to hard endpoints, including cause-specific and all-cause mortality. Mediators connecting allostatic load to morbidity and mortality include the function of the autonomic nervous system, cytokines and stress hormones, e.g. catecholamines, cortisol and thyroid hormones.

Reducing Risk

To reduce and manage high allostatic load, an individual should pay attention to structural and behavioural factors. Structural factors include the social environment, and access to health services. Behavioural factors include diet, physical health and tobacco smoking, which can lead to chronic disease. Actions such as tobacco smoking are brought about from the stress levels that an individual experiences. Therefore, controlling stress levels from the beginning, for example by not leading to tobacco smoking, will reduce the chance of chronic disease development and high allostatic load.

Low socio-economic status (SES) affects allostatic load and therefore, focusing on the causes of low SES will reduce allostatic load levels. Reducing societal polarisation, material deprivation, and psychological demands on health helps to manage allostatic load. Support from the community and the social environment can manage high allostatic load. In addition, healthy lifestyle that encompasses a broad array of lifestyle change including healthy eating and regular physical exercise may reduce allostatic load. Empowering financial help from the government allows people to gain control and improve their psychological health. Improving inequalities in health decreases the stress levels and improves health by reducing high allostatic load on the body.

Interventions can include encouraging sleep quality and quantity, social support, self-esteem and wellbeing, improving diet, avoiding alcohol or drug consumption and participating in physical activity. Providing cleaner and safer environments and the incentive towards a higher education will reduce the chance of stress and improve mental health significantly, therefore, reducing the onset of high allostatic load.

Allostatic load differs by sex and age, and the social status of an individual. Protective factors could, at various times of an individual’s life span, be implemented to reduce stress and, in the long run, eliminate the onset of allostatic load. Protective factors include parental bonding, education, social support, healthy workplaces, a sense of meaning towards life and choices being made, and positive feelings in general.

What is Triangulation (Psychology)?

Introduction

Triangulation is a term in psychology most closely associated with the work of Murray Bowen known as family therapy.

Bowen theorised that a two-person emotional system is unstable, and that when under stress it forms itself into a three-person system or triangle.

Refer to Karpman Drama Triangle.

Family Theory

In the family triangulation system, the third person can either be used as a substitute for direct communication or can be used as a messenger to carry the communication to the main party. Usually, this communication is an expressed dissatisfaction with the main party. For example, in a dysfunctional family in which there is alcoholism present, the non-drinking parent will go to a child and express dissatisfaction with the drinking parent. This includes the child in the discussion of how to solve the problem of the alcoholic parent. Sometimes the child can engage in the relationship with the parent, filling the role of the third party, and thereby being “triangulated” into the relationship. Alternatively, the child may then go to the alcoholic parent, relaying what they were told. In instances when this occurs, the child may be forced into a role of a “surrogate spouse” The reason that this occurs is that both parties are dysfunctional. Rather than communicating directly with each other, they utilise a third party. Sometimes this is because it is unsafe to go directly to the person and discuss the concerns, particularly if they are alcoholic and/or abusive.

In a triangular family relationship, the two who have aligned risk forming an enmeshed relationship.

Good versus Bad Triangulation

Triangulation can be a constructive and stabilising factor. Triangulation can also be a destructive and destabilising factor. Destabilising or “bad triangulation” can polarise communications and escalate conflict. Understanding the difference between stabilising triangulation and destabilising triangulation is helpful in avoiding destabilising situations. Triangulation may be overt, which is more commonly seen in high-conflict families, or covert.

A 2016 longitudinal study of adolescent relationship skills found that teens who were triangulated into parental conflicts more frequently used positive conflict resolution techniques with their own dating partner, but were also more likely to engage in verbally abusive behaviours.

The Perverse Triangle

The Perverse Triangle was first described in 1977 by Jay Haley as a triangle where two people who are on different hierarchical or generational levels form a coalition against a third person (e.g. “a covert alliance between a parent and a child, who band together to undermine the other parent’s power and authority”). The perverse triangle concept has been widely discussed in professional literature. Bowen called it the pathological triangle, while Minuchin called it the rigid triangle. For example, a parent and child can align against the other parent but not admit to it, to form a cross-generational coalition. These are harmful to children.

Child Development

In the field of psychology, triangulations are necessary steps in the child’s development. When a two-party relationship is opened up by a third party, a new form of relationship emerges and the child gains new mental abilities. The concept was introduced in 1971 by the Swiss psychiatrist Dr. Ernst L. Abelin, especially as ‘early triangulation’, to describe the transitions in psychoanalytic object relations theory and parent-child relationship in the age of 18 months. In this presentation, the mother is the early caregiver with a nearly “symbiotic” relationship to the child, and the father lures the child away to the outside world, resulting in the father being the third party. Abelin later developed an ‘organiser- and triangulation-model’, in which he based the whole human mental and psychic development on several steps of triangulation.

Some earlier related work, published in a 1951 paper, had been done by the German psychoanalyst Hans Loewald in the area of pre-Oedipal behaviour and dynamics. In a 1978 paper, the child psychoanalyst Dr. Selma Kramer wrote that Loewald postulated the role of the father as a positive supporting force for the pre-Oedipal child against the threat of re-engulfment by the mother which leads to an early identification with the father, preceding that of the classical Oedipus complex. This was also related to the work in Separation-Individuation theory of child development by the psychoanalyst Margaret Mahler.

Destabilising Triangulation

Destabilising triangulation occurs when a person attempts to control the flow, interpretation, and nuances of communication between two separate actors or groups of actors, thus ensuring communications flow through, and constantly relate back to them. Examples include a parent attempting to control communication between two children, or a relationship partner attempting to control communication between the other partner and the other partner’s friends and family. Another example is to put a third actor between them and someone with whom they are commonly in conflict. Rather than communicating directly with the actor with whom they are in conflict, they will send communication supporting his or her case through a third actor in an attempt to make the communication more credible.

What is the Diathesis-Stress Model?

Introduction

The diathesis-stress model, also known as the vulnerability-stress model, is a psychological theory that attempts to explain a disorder, or its trajectory, as the result of an interaction between a predispositional vulnerability, the diathesis, and a stress caused by life experiences. The term diathesis derives from the Greek term (διάθεσις) for a predisposition, or sensibility. A diathesis can take the form of genetic, psychological, biological, or situational factors. A large range of differences exists among individuals’ vulnerabilities to the development of a disorder.

The diathesis, or predisposition, interacts with the individual’s subsequent stress response. Stress is a life event or series of events that disrupts a person’s psychological equilibrium and may catalyse the development of a disorder. Thus the diathesis-stress model serves to explore how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia. The diathesis-stress model asserts that if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder. The use of the term diathesis in medicine and in the specialty of psychiatry dates back to the 1800s; however, the diathesis-stress model was not introduced and used to describe the development of psychopathology until it was applied to explaining schizophrenia in the 1960s by Paul Meehl.

The diathesis-stress model is used in many fields of psychology, specifically for studying the development of psychopathology. It is useful for the purposes of understanding the interplay of nature and nurture in the susceptibility to psychological disorders throughout the lifespan. Diathesis-stress models can also assist in determining who will develop a disorder and who will not. For example, in the context of depression, the diathesis-stress model can help explain why Person A may become depressed while Person B does not, even when exposed to the same stressors. More recently, the diathesis-stress model has been used to explain why some individuals are more at risk for developing a disorder than others. For example, children who have a family history of depression are generally more vulnerable to developing a depressive disorder themselves. A child who has a family history of depression and who has been exposed to a particular stressor, such as exclusion or rejection by his or her peers, would be more likely to develop depression than a child with a family history of depression that has an otherwise positive social network of peers. The diathesis-stress model has also served as useful in explaining other poor (but non-clinical) developmental outcomes.

Protective factors, such as positive social networks or high self-esteem, can counteract the effects of stressors and prevent or curb the effects of disorder. Many psychological disorders have a window of vulnerability, during which time an individual is more likely to develop disorder than others. Diathesis-stress models are often conceptualised as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. The differential susceptibility hypothesis is a recent theory that has stemmed from the diathesis-stress model.

Refer to Differential Susceptibility Hypothesis.

Diathesis

The term diathesis is synonymous with vulnerability, and variants such as “vulnerability-stress” are common within psychology. A vulnerability makes it more or less likely that an individual will succumb to the development of psychopathology if a certain stress is encountered. Diatheses are considered inherent within the individual and are typically conceptualised as being stable, but not unchangeable, over the lifespan. They are also often considered latent (i.e. dormant), because they are harder to recognise unless provoked by stressors.

Diatheses are understood to include genetic, biological, physiological, cognitive, and personality-related factors. Some examples of diatheses include genetic factors, such as abnormalities in some genes or variations in multiple genes that interact to increase vulnerability. Other diatheses include early life experiences such as the loss of a parent, or high neuroticism. Diatheses can also be conceptualised as situational factors, such as low socio-economic status or having a parent with depression.

Stress

Stress can be conceptualised as a life event that disrupts the equilibrium of a person’s life. For instance, a person may be vulnerable to become depressed, but will not develop depression unless they are exposed to a specific stress, which may trigger a depressive disorder. Stressors can take the form of a discrete event, such the divorce of parents or a death in the family, or can be more chronic factors such as having a long-term illness, or ongoing marital problems. Stresses can also be related to more daily hassles such as school assignment deadlines. This also parallels the popular (and engineering) usage of stress, but note that some literature defines stress as the response to stressors, especially where usage in biology influences neuroscience.

It has been long recognised that psychological stress plays a significant role in understanding how psychopathology develops in individuals. However, psychologists have also identified that not all individuals who are stressed, or go through stressful life events, develop a psychological disorder. To understand this, theorists and researchers explored other factors that affect the development of a disorder and proposed that some individuals under stress develop a disorder and others do not. As such, some individuals are more vulnerable than others to develop a disorder once stress has been introduced. This led to the formulation of the diathesis-stress model.

Genetics

Sensory processing sensitivity (SPS) is a temperamental or personality trait involving “an increased sensitivity of the central nervous system and a deeper cognitive processing of physical, social and emotional stimuli”. The trait is characterised by “a tendency to ‘pause to check’ in novel situations, greater sensitivity to subtle stimuli, and the engagement of deeper cognitive processing strategies for employing coping actions, all of which is driven by heightened emotional reactivity, both positive and negative”.

Sensory processing sensitivity captures sensitivity to environment in a heritable, evolutionary-conserved trait, associated with increased information processing in the brain. Moderating sensitivity to environments in a for-better-and-for-worse fashion. Interaction with negative experiences increases risk for psychopathology. Whereas interaction with positive experiences (including interventions), increases positive outcomes. Mast cells are long-lived tissue-resident cells with an important role in many inflammatory settings including host defence to parasitic infection and in allergic reactions. Stress is known to be a mast cell activator.

There is evidence that children exposed to prenatal stress may experience resilience driven by epigenome-wide interactions.” Early life stress interactions with the epigenome show potential mechanisms driving vulnerability towards psychiatric illness. ancestral stress alters lifetime mental health trajectories via epigenetic regulation.

Carriers of congenital adrenal hyperplasia have a predeposition to stress, due to the unique nature of this gene. True rates of prevalence are not known but common genetic variants of the human Steroid 21-Hydroxylase Gene (CYP21A2) are related to differences in circulating hormone levels in the population.

Psychological distress is a known feature of generalised joint hypermobility (gJHM), as well as of its most common syndromic presentation, namely Ehlers-Danlos syndrome, hypermobility type (a.k.a. joint hypermobility syndrome – JHS/EDS-HT), and significantly contributes to the quality of life of affected individuals. Interestingly, in addition to the confirmation of a tight link between anxiety and gJHM, preliminary connections with depression, attention deficit (and hyperactivity) disorder, autism spectrum disorders, and obsessive-compulsive personality disorder were also found.

Protective Factors

Protective factors, while not an inherent component of the diathesis-stress model, are of importance when considering the interaction of diatheses and stress. Protective factors can mitigate or provide a buffer against the effects of major stressors by providing an individual with developmentally adaptive outlets to deal with stress. Examples of protective factors include a positive parent-child attachment relationship, a supportive peer network, and individual social and emotional competence.

Throughout the Lifespan

Many models of psychopathology generally suggest that all people have some level of vulnerability towards certain mental disorders, but posit a large range of individual differences in the point at which a person will develop a certain disorder. For example, an individual with personality traits that tend to promote relationships such as extroversion and agreeableness may engender strong social support, which may later serve as a protective factor when experiencing stressors or losses that may delay or prevent the development of depression. Conversely, an individual who finds it difficult to develop and maintain supportive relationships may be more vulnerable to developing depression following a job loss because they do not have protective social support. An individual’s threshold is determined by the interaction of diatheses and stress.

Windows of vulnerability for developing specific psychopathologies are believed to exist at different points of the lifespan. Moreover, different diatheses and stressors are implicated in different disorders. For example, breakups and other severe or traumatic life stressors are implicated in the development of depression. Stressful events can also trigger the manic phase of bipolar disorder and stressful events can then prevent recovery and trigger relapse. Having a genetic disposition for becoming addicted and later engaging in binge drinking in college are implicated in the development of alcoholism. A family history of schizophrenia combined with the stressor of being raised in a dysfunctional family raises the risk of developing schizophrenia.

Diathesis-stress models are often conceptualised as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. For example, a child with a family history of depression likely has a genetic vulnerability to depressive disorder. This child has also been exposed to environmental factors associated with parental depression that increase their vulnerability to developing depression as well. Protective factors, such as strong peer network, involvement in extracurricular activities, and a positive relationship with the non-depressed parent, interact with the child’s vulnerabilities in determining the progression to psychopathology versus normative development.

Some theories have branched from the diathesis-stress model, such as the differential susceptibility hypothesis, which extends the model to include a vulnerability to positive environments as well as negative environments or stress. A person could have a biological vulnerability that when combined with a stressor could lead to psychopathology (diathesis-stress model); but that same person with a biological vulnerability, if exposed to a particularly positive environment, could have better outcomes than a person without the vulnerability.

What is Salutogenesis?

Introduction

Salutogenesis is the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis).

More specifically, the “salutogenic model” was originally concerned with the relationship between health, stress, and coping through a study of holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky, a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, “How can this person be helped to move toward greater health?”

Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum”. Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions. A comparison of the salutogenic model with the traditional pathogenic model is provided in the below video.

Derivation

The word “salutogenesis” comes from the Latin salus = health and the Greek genesis = origin. Antonovsky developed the term from his studies of “how people manage stress and stay well” (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: “this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the ‘salutogenic model’.”

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalised resource deficits (GRDs). On the other hand, there are generalised resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

Generalised resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalised resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.

Antonovsky’s formulation was that the generalised resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was “in itself the essential tool for coping”.

Sense of Coherence

The “sense of coherence” is a theoretical formulation that provides a central explanation for the role of stress in human functioning. “Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence.” Antonovsky defined Sense of Coherence as:

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”

In his formulation, the sense of coherence has three components:

  • Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
  • Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
  • Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that “salutogenesis” depends on experiencing a strong “sense of coherence”. His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of Application

Health and Medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioural medicine, and the sociology of health. It has been adopted as a term to describe contemporary approaches to nursing, psychiatry, integrative medicine, and healthcare architecture. The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care and for healthcare architecture.

Workplace

The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work. The meaningfulness component has also been linked with Job control and with task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves “the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement”.

The manageability component is considered to be linked to job control as well as to access to resources. It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.

The comprehensibility component may be influenced by consistent feedback at work, for example concerning the performance appraisal.

Salutogenics perspectives are also considered in the design of offices.

Book: Resilience – How We Find New Strength at Times of Stress

Book Title:

Resilience – How We Find New Strength at Times of Stress.

Author(s): Fredric Flach (MD).

Year: 2020.

Edition: First (1st).

Publisher: Hatherleigh Press.

Type(s): Paperback.

Synopsis:

Make stress your ally in the pursuit of happiness and personal fulfillment.

There’s no escaping stress. It appears on our doorstep uninvited in the shattering forms of death, divorce, or job loss. Stress even comes in the pleasant experiences of promotion, marriage, or a long-held wish fulfilled.

So why do some people come out of a crisis feeling better than ever, and others never seem to bounce back?

You will discover:

  • How to develop the 14 traits that will make you more resilient.
  • Why “falling apart” is often the smartest step to take on the road to resilience.
  • When the five-step plan for creative problem solving can help.
  • What essential steps you can take to strengthen your body’s resilience.
  • How to redefine your problem and restructure your pain to create a life you can handle, a life you can learn from and enjoy!

Drawing on more than thirty years of case studies from his own psychiatric practice, Dr. Frederic Flach reveals the remarkable antidote to the destructive qualities of stress – physical, mental, and emotional resilience.