{"id":507,"date":"2020-02-03T14:56:10","date_gmt":"2020-02-03T14:56:10","guid":{"rendered":"http:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/?post_type=chapter&p=507"},"modified":"2021-09-12T18:58:15","modified_gmt":"2021-09-12T18:58:15","slug":"2-8-2-about-stress","status":"publish","type":"chapter","link":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/chapter\/2-8-2-about-stress\/","title":{"raw":"2.10.2. The Study of Stress","rendered":"2.10.2. The Study of Stress"},"content":{"raw":"

Introduction<\/h1>\r\n
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Figure 2.10.2.1<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"975\"]\"Three <\/b> Exams are a stressful, but unavoidable, element of college life. Source: \u201cleft\u201d: modification of work by Travis K. Mendoza; credit \u201ccenter\u201d: modification of work by \u201calbertogp123\u201d\/Flickr; credit \u201cright\u201d: modification of work by Jeffrey Pioquinto, SJ.[\/caption]<\/figure>\r\n

Few would deny that today\u2019s college students are under a lot of pressure. In addition to many usual stresses and strains incidental to the college experience (e.g., exams, term papers, and the dreaded freshman 15), students today are faced with increased college tuitions, burdensome debt, and difficulty finding employment after graduation. A significant population of non-traditional college students may face additional stressors, such as raising children or holding down a full-time job while working toward a degree.<\/span><\/div>\r\n<\/div>\r\nOf course, life is filled with many additional challenges beyond those incurred in college or the workplace. We might have concerns with financial security, difficulties with friends or neighbors, family responsibilities, and we may not have enough time to do the things we want to do. Even minor hassles\u2014losing things, traffic jams, and loss of internet service\u2014all involve pressure and demands that can make life seem like a struggle and that can compromise our sense of well-being. That is, all can be stressful in some way.\r\n\r\nScientific interest in stress, including how we adapt and cope, has been longstanding in psychology; indeed, after nearly a century of research on the topic, much has been learned and many insights have been developed. This chapter examines stress and highlights our current understanding of the phenomenon, including its psychological and physiological natures, its causes and consequences, and the steps we can take to master stress rather than become its victim.\r\n

What is Stress?<\/h1>\r\nWe often use the term loosely in describing a variety of unpleasant feeling states; for example, we often say we are stressed out when we feel frustrated, angry, conflicted, overwhelmed, or fatigued. Despite the widespread use of the term, stress is a fairly vague concept that is difficult to define with precision.\r\n\r\nResearchers have had a difficult time agreeing on an acceptable definition of stress. Some have conceptualized stress as a demanding or threatening event or situation (e.g., a high-stress job, overcrowding, and long commutes to work). Such conceptualizations are known as stimulus-based definitions because they characterize stress as a stimulus that causes certain reactions. Stimulus-based definitions of stress are problematic, however, because they fail to recognize that people differ in how they view and react to challenging life events and situations. For example, a conscientious student who has studied diligently all semester would likely experience less stress during final exams week than would a less responsible, unprepared student.\r\n\r\nOthers have conceptualized stress in ways that emphasize the physiological responses that occur when faced with demanding or threatening situations (e.g., increased arousal). These conceptualizations are referred to as response-based definitions because they describe stress as a response to environmental conditions. For example, the endocrinologist Hans Selye<\/span>, a famous stress researcher, once defined stress as the \u201cresponse of the body to any demand, whether it is caused by, or results in, pleasant or unpleasant conditions<\/b>\u201d (Selye, 1976, p. 74). Selye\u2019s definition of stress is response-based in that it conceptualizes stress chiefly in terms of the body\u2019s physiological reaction to any demand that is placed on it. Neither stimulus-based nor response-based definitions provide a complete definition of stress. Many of the physiological reactions that occur when faced with demanding situations (e.g., accelerated heart rate) can also occur in response to things that most people would not consider to be genuinely stressful, such as receiving unanticipated good news: an unexpected promotion or raise.\r\n\r\nA useful way to conceptualize stress <\/span>is to view it as a process whereby an individual perceives and responds to events that he appraises as overwhelming or threatening to his well-being (Lazarus & Folkman, 1984). A critical element of this definition is that it emphasizes the importance of how we appraise\u2014that is, judge\u2014demanding or threatening events (often referred to as stressors<\/span>); these appraisals, in turn, influence our reactions to such events<\/b>. Two kinds of appraisals of a stressor are especially important in this regard: primary and secondary appraisals. A primary appraisal <\/span>involves judgment about the degree of potential harm or threat to well-being that a stressor might entail. A stressor would likely be appraised as a threat\u00a0<\/b>if one anticipates that it could lead to some kind of harm, loss, or other negative consequence; conversely, a stressor would likely be appraised as a challenge\u00a0<\/b>if one believes that it carries the potential for gain or personal growth. For example, an employee who is promoted to a leadership position would likely perceive the promotion as a much greater threat if she believed the promotion would lead to excessive work demands than if she viewed it as an opportunity to gain new skills and grow professionally. Similarly, a college student on the cusp of graduation may face the change as a threat or a challenge (Figure 2.10.2.2).\r\n
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Figure 2.10.2.2<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"325\"]\"A <\/b> Graduating from college and entering the workforce can be viewed as either a threat (loss of financial support) or a challenge (opportunity for independence and growth). Source: Timothy Zanker. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

The perception of a threat triggers a <\/span>secondary appraisal<\/span>: <\/span>judgment of the options available to cope with a stressor<\/b>, as well as perceptions of how effective such options will be (Lyon, 2012) (<\/span>Figure 2.10.2.3). As you may recall from what you learned about self-efficacy, an individual\u2019s belief in his ability to complete a task is important (Bandura, 1994). A threat tends to be viewed as less catastrophic if one believes something can be done about it (Lazarus & Folkman, 1984). Imagine that two middle-aged women, Robin and Maria, perform breast self-examinations one morning and each woman notices a lump on the lower region of her left breast. Although both women view the breast lump as a potential threat (primary appraisal), their secondary appraisals differ considerably. In considering the breast lump, some of the thoughts racing through Robin\u2019s mind are, \u201cOh my God, I could have breast cancer! What if the cancer has spread to the rest of my body and I cannot recover? What if I have to go through chemotherapy? I\u2019ve heard that experience is awful! What if I have to quit my job? My husband and I won\u2019t have enough money to pay the mortgage. Oh, this is just horrible\u2026I can\u2019t deal with it!\u201d On the other hand, Maria thinks, \u201cHmm, this may not be good. Although most times these things turn out to be benign, I need to have it checked out. If it turns out to be breast cancer, there are doctors who can take care of it because the medical technology today is quite advanced. I\u2019ll have a lot of different options, and I\u2019ll be just fine.\u201d Clearly, Robin and Maria have different outlooks on what might turn out to be a very serious situation: Robin seems to think that little could be done about it, whereas Maria believes that, worst case scenario, a number of options that are likely to be effective would be available. As such, Robin would clearly experience greater stress than would Maria.<\/span><\/div>\r\n<\/div>\r\n
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Figure 2.10.2.3<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"731\"]\"A <\/b> When encountering a stressor, a person judges its potential threat (primary appraisal) and then determines if effective options are available to manage the situation. Stress is likely to result if a stressor is perceived as extremely threatening or threatening with few or no effective coping options available. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

To be sure, some stressors are inherently more stressful than others in that they are more threatening and leave less potential for variation in cognitive appraisals (e.g., objective threats to one\u2019s health or safety). Nevertheless, appraisal will still play a role in augmenting or diminishing our reactions to such events (Everly & Lating, 2002).<\/span><\/div>\r\n<\/div>\r\nIf a person appraises an event as harmful and believes that the demands imposed by the event exceed the available resources to manage or adapt to it, the person will subjectively experience a state of stress. In contrast, if one does not appraise the same event as harmful or threatening, she is unlikely to experience stress. According to this definition, environmental events trigger stress reactions by the way they are interpreted and the meanings they are assigned. In short, stress is largely in the eye of the beholder: it\u2019s not so much what happens to you as it is how you respond\u00a0<\/b>(Selye, 1976).\r\n

Good Stress?<\/h2>\r\nAlthough stress carries a negative connotation, at times it may be of some benefit. Stress can motivate us to do things in our best interests, such as study for exams, visit the doctor regularly, exercise, and perform to the best of our ability at work. Indeed, Selye (1974) pointed out that not all stress is harmful. He argued that stress can sometimes be a positive, motivating force that can improve the quality of our lives. This kind of stress, which Selye called eustress<\/span>(from the Greek eu<\/em>= \u201cgood\u201d), is a good kind of stress associated with positive feelings, optimal health, and performance<\/b>. A moderate amount of stress can be beneficial in challenging situations. For example, athletes may be motivated and energized by pregame stress, and students may experience similar beneficial stress before a major exam. Indeed, research shows that moderate stress can enhance both immediate and delayed recall of educational material. Male participants in one study who memorized a scientific text passage showed improved memory of the passage immediately after exposure to a mild stressor as well as one day following exposure to the stressor (Hupbach & Fieman, 2012).\r\n\r\nIncreasing one\u2019s level of stress will cause performance to change in a predictable way. As shown in Figure 2.10.2.4, as stress increases, so do performance and general well-being (eustress); when stress levels reach an optimal level (the highest point of the curve), performance reaches its peak. A person at this stress level is colloquially at the top of his game, meaning he feels fully energized, focused, and can work with minimal effort and maximum efficiency. But when stress exceeds this optimal level, it is no longer a positive force\u2014it becomes excessive and debilitating, or what Selye termed distress<\/span>(from the Latin dis<\/em>= \u201cbad\u201d). People who reach this level of stress feel burned out; they are fatigued, exhausted, and their performance begins to decline. If the stress remains excessive, health may begin to erode as well (Everly & Lating, 2002).\r\n
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Figure 2.10.2.4<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"731\"]\"A <\/b> As the stress level increases from low to moderate, so does performance (eustress). At the optimal level (the peak of the curve), performance has reached its peak. If stress exceeds the optimal level, it will reach the distress region, where it will become excessive and debilitating, and performance will decline (Everly & Lating, 2002). Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

The Prevalence of Stress<\/span><\/div>\r\n<\/div>\r\nStress is everywhere and, as shown in Figure 2.10.2.5, it has been on the rise over the last several years. Each of us is acquainted with stress\u2014some are more familiar than others. In many ways, stress feels like a load you just can\u2019t carry\u2014a feeling you experience when, for example, you have to drive somewhere in a crippling blizzard, when you wake up late the morning of an important job interview, when you run out of money before the next pay period, and before taking an important exam for which you realize you are not fully prepared.\r\n
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Figure 2.10.2.5<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"649\"]\"A <\/b> Nearly half of U.S. adults indicated that their stress levels have increased over the last five years (Neelakantan, 2013). Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

Stress is an experience that evokes a variety of responses, including those that are <\/span>physiological\u00a0<\/b>(e.g., accelerated heart rate, headaches, or gastrointestinal problems), cognitive (e.g., difficulty concentrating or making decisions), and behavioural (e.g., drinking alcohol, smoking, or taking actions directed at eliminating the cause of the stress). Although stress can be positive at times, it can have deleterious health implications, contributing to the onset and progression of a variety of physical illnesses and diseases (Cohen & Herbert, 1996).<\/span><\/div>\r\n<\/div>\r\nThe scientific study of how stress and other psychological factors impact health falls within the realm of health psychology<\/span>, a subfield of psychology devoted to understanding the importance of psychological influences on health, illness, and how people respond when they become ill (Taylor, 1999). Health psychology emerged as a discipline in the 1970s, a time during which there was increasing awareness of the role behavioural and lifestyle factors play in the development of illnesses and diseases (Straub, 2007). In addition to studying the connection between stress and illness, health psychologists investigate issues such as why people make certain lifestyle choices (e.g., smoking or eating unhealthy food despite knowing the potential adverse health implications of such behaviours). Health psychologists also design and investigate the effectiveness of interventions aimed at changing unhealthy behaviours. Perhaps one of the more fundamental tasks of health psychologists is to identify which groups of people are especially at risk for negative health outcomes, based on psychological or behavioural factors. For example, measuring differences in stress levels among demographic groups and how these levels change over time can help identify populations who may have an increased risk for illness or disease.\r\n\r\nFigure 2.10.2.6\u00a0depicts the results of three national surveys in which several thousand individuals from different demographic groups completed a brief stress questionnaire; the surveys were administered in 1983, 2006, and 2009 (Cohen & Janicki-Deverts, 2012). All three surveys demonstrated higher stress in women than in men. Unemployed individuals reported high levels of stress in all three surveys, as did those with less education and income; retired persons reported the lowest stress levels. However, from 2006 to 2009 the greatest increase in stress levels occurred among men, Whites, people aged 45\u201364, college graduates, and those with full-time employment. One interpretation of these findings is that concerns surrounding the 2008\u20132009 economic downturn (e.g., threat of or actual job loss and substantial loss of retirement savings) may have been especially stressful to White, college-educated, employed men with limited time remaining in their working careers.\r\n
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Figure 2.10.2.6<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"975\"]\"Graphs <\/b> The charts above, adapted from Cohen & Janicki-Deverts (2012), depict the mean stress level scores among different demographic groups during the years 1983, 2006, and 2009. Across categories of sex, age, race, education level, employment status, and income, stress levels generally show a marked increase over this quarter-century time span. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

Early Contributions to the Study of Stress<\/span><\/div>\r\n<\/div>\r\nAs previously stated, scientific interest in stress goes back nearly a century. One of the early pioneers in the study of stress was Walter Cannon<\/span>, an eminent American physiologist at Harvard Medical School (Figure 2.10.2.7). In the early part of the 20th century, Cannon was the first to identify the body\u2019s physiological reactions to stress.\r\n
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Figure 2.10.2.7<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"244\"]\"A <\/b> Harvard physiologist Walter Cannon first articulated and named the fight-or-flight response, the nervous system\u2019s sympathetic response to a significant stressor. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

Cannon and the Fight-or-Flight Response<\/span><\/div>\r\n<\/div>\r\nImagine that you are hiking in the beautiful mountains of Colorado on a warm and sunny spring day. At one point during your hike, a large, frightening-looking black bear appears from behind a stand of trees and sits about 50 yards from you. The bear notices you, sits up, and begins to lumber in your direction. In addition to thinking, \u201cThis is definitely not good,\u201d a constellation of physiological reactions begins to take place inside you. Prompted by a deluge of epinephrine (adrenaline) and norepinephrine (noradrenaline) from your adrenal glands, your pupils begin to dilate. Your heart starts to pound and speeds up, you begin to breathe heavily and perspire, you get butterflies in your stomach, and your muscles become tense, preparing you to take some kind of direct action. Cannon proposed that this reaction, which he called the fight-or-flight response<\/span>, occurs when a person experiences very strong emotions\u2014especially those associated with a perceived threat (Cannon, 1932). During the fight-or-flight response, the body is rapidly aroused by activation of both the sympathetic nervous system and the endocrine system(Figure 2.10.2.8). This arousal helps prepare the person to either fight or flee from a perceived threat.\r\n
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Figure 2.10.2.8<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"975\"]\"A <\/b> Fight or flight is a physiological response to a stressor. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

According to Cannon, the fight-or-flight response is a built-in mechanism that assists in maintaining homeostasis\u2014an internal environment in which physiological variables such as blood pressure, respiration, digestion, and temperature are stabilized at levels optimal for survival. Thus, Cannon viewed the fight-or-flight response as adaptive because it enables us to adjust internally and externally to changes in our surroundings, which is helpful in species survival.<\/span><\/div>\r\n<\/div>\r\n

Selye and the General Adaptation Syndrome<\/h2>\r\nAnother important early contributor to the stress field was Hans Selye<\/span>, mentioned earlier. He would eventually become one of the world\u2019s foremost experts in the study of stress (Figure 2.10.2.9). As a young assistant in the biochemistry department at McGill University in the 1930s, Selye was engaged in research involving sex hormones in rats. Although he was unable to find an answer for what he was initially researching, he incidentally discovered that when exposed to prolonged negative stimulation (stressors)\u2014such as extreme cold, surgical injury, excessive muscular exercise, and shock\u2014the rats showed signs of adrenal enlargement, thymus and lymph node shrinkage, and stomach ulceration. Selye realized that these responses were triggered by a coordinated series of physiological reactions that unfold over time during continued exposure to a stressor. These physiological reactions were nonspecific, which means that regardless of the type of stressor, the same pattern of reactions would occur. What Selye discovered was the general adaptation syndrome<\/span>, the body\u2019s nonspecific physiological response to stress.\r\n
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Figure 2.10.2.9<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"325\"]\"A <\/b> Hans Selye specialized in research about stress. In 2009, his native Hungary honored his work with this stamp, released in conjunction with the 2nd annual World Conference on Stress. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

The general adaptation syndrome, shown in <\/span>Figure 2.10.2.10, consists of three stages: (1) alarm reaction, (2) stage of resistance, and (3) stage of exhaustion (Selye, 1936; 1976). <\/span>Alarm reaction <\/span>describes the body\u2019s immediate reaction upon facing a threatening situation or emergency, and it is roughly analogous to the <\/span>fight-or-flight response\u00a0<\/b>described by Cannon. During an alarm reaction, you are alerted to a stressor, and your body alarms you with a cascade of physiological reactions that provide you with the energy to manage the situation. A person who wakes up in the middle of the night to discover her house is on fire, for example, is experiencing an alarm reaction.<\/span><\/div>\r\n<\/div>\r\n
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Figure 2.10.2.10<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"649\"]\"A The three stages of Selye\u2019s general adaptation syndrome are shown in this graph. Prolonged stress ultimately results in exhaustion. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

If exposure to a stressor is prolonged, the organism will enter the <\/span>stage of resistance<\/span>. During this stage, the initial shock of alarm reaction has worn off and the body has adapted to the stressor. Nevertheless, the body also remains on alert and is prepared to respond as it did during the alarm reaction, although with less intensity. For example, suppose a child who went missing is still missing 72 hours later. Although the parents would obviously remain extremely disturbed, the magnitude of physiological reactions would likely have diminished over the 72 intervening hours due to some adaptation to this event.<\/span><\/div>\r\n<\/div>\r\nIf exposure to a stressor continues over a longer period of time, the stage of exhaustion <\/span>ensues. At this stage, the person is no longer able to adapt to the stressor: the body\u2019s ability to resist becomes depleted as physical wear takes its toll on the body\u2019s tissues and organs. As a result, illness, disease, and other permanent damage to the body\u2014even death\u2014may occur. If a missing child still remained missing after three months, the long-term stress associated with this situation may cause a parent to literally faint with exhaustion at some point or even to develop a serious and irreversible illness.\r\n\r\nIn short, Selye\u2019s general adaptation syndrome suggests that stressors tax the body via a three-phase process\u2014an initial jolt, subsequent readjustment, and a later depletion of all physical resources\u2014that ultimately lays the groundwork for serious health problems and even death<\/b>. It should be pointed out, however, that this model is a response-based conceptualization of stress, focusing exclusively on the body\u2019s physical responses while largely ignoring psychological factors such as appraisal and interpretation of threats. Nevertheless, Selye\u2019s model has had an enormous impact on the field of stress because it offers a general explanation for how stress can lead to physical damage and, thus, disease. As we shall discuss later, prolonged or repeated stress has been implicated in development of a number of disorders such as hypertension and coronary artery disease.\r\n

The Physiological Basis of Stress<\/h1>\r\nWhat goes on inside our bodies when we experience stress? The physiological mechanisms of stress are extremely complex, but they generally involve the work of two systems\u2014the sympathetic nervous system <\/span>and the hypothalamic-pituitary-adrenal (HPA) axis<\/span>. When a person first perceives something as stressful (Selye\u2019s alarm reaction), the sympathetic nervous system triggers arousal via the release of adrenaline from the adrenal glands. Release of these hormones activates the fight-or-flight responses to stress, such as accelerated heart rate and respiration. At the same time, the HPA axis, which is primarily endocrine in nature, becomes especially active, although it works much more slowly than the sympathetic nervous system. In response to stress, the hypothalamus (one of the limbic structures in the brain) releases corticotrophin-releasing factor, a hormone that causes the pituitary gland to release adrenocorticotropic hormone (ACTH) (Figure 2.10.2.11).The ACTH then activates the adrenal glands to secrete a number of hormones into the bloodstream; an important one is cortisol, which can affect virtually every organ within the body. Cortisol <\/span>is commonly known as a stress hormone and helps provide that boost of energy when we first encounter a stressor, preparing us to run away or fight. However, sustained elevated levels of cortisol weaken the immune system.\r\n
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Figure 2.10.2.11<\/b><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"731\"]\"A This diagram shows the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. The hypothalamus activates the pituitary gland, which in turn activates the adrenal glands, increasing their secretion of cortisol. Source: What is Stress?<\/a>[\/caption]<\/figure>\r\n

In short bursts, this process can have some favorable effects, such as providing extra energy, improving <\/span>immune system <\/span>functioning temporarily, and decreasing pain sensitivity. However, extended release of cortisol\u2014as would happen with prolonged or chronic stress\u2014often comes at a high price. High levels of cortisol have been shown to produce a number of harmful effects. For example, increases in cortisol can significantly weaken our immune system (Glaser & Kiecolt-Glaser, 2005), and high levels are frequently observed among depressed individuals (Geoffroy, Hertzman, Li, & Power, 2013). In summary, a stressful event causes a variety of physiological reactions that activate the adrenal glands, which in turn release epinephrine, norepinephrine, and cortisol. These hormones affect a number of bodily processes in ways that prepare the stressed person to take direct action, but also in ways that may heighten the potential for illness.<\/span><\/div>\r\n<\/div>\r\nWhen stress is extreme or chronic, it can have profoundly negative consequences. For example, stress often contributes to the development of certain psychological disorders, including post-traumatic stress disorder, major depressive disorder, and other serious psychiatric conditions. Additionally, we noted earlier that stress is linked to the development and progression of a variety of physical illnesses and diseases. For example, researchers in one study found that people injured during the September 11, 2001, World Trade Center disaster or who developed post-traumatic stress symptoms afterward later suffered significantly elevated rates of heart disease (Jordan, Miller-Archie, Cone, Morabia, & Stellman, 2011). Another investigation yielded that self-reported stress symptoms among aging and retired Finnish food industry workers were associated with morbidity 11 years later. This study also predicted the onset of musculoskeletal, nervous system, and endocrine and metabolic disorders (Salonen, Arola, Nyg\u00e5rd, & Huhtala, 2008). Another study reported that male South Korean manufacturing employees who reported high levels of work-related stress were more likely to catch the common cold over the next several months than were those employees who reported lower work-related stress levels (Park et al., 2011). Later, you will explore the mechanisms through which stress can produce physical illness and disease.","rendered":"

Introduction<\/h1>\n
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Figure 2.10.2.1<\/b><\/p>\n

\"Three
<\/b> Exams are a stressful, but unavoidable, element of college life. Source: \u201cleft\u201d: modification of work by Travis K. Mendoza; credit \u201ccenter\u201d: modification of work by \u201calbertogp123\u201d\/Flickr; credit \u201cright\u201d: modification of work by Jeffrey Pioquinto, SJ.<\/figcaption><\/figure>\n<\/figure>\n
Few would deny that today\u2019s college students are under a lot of pressure. In addition to many usual stresses and strains incidental to the college experience (e.g., exams, term papers, and the dreaded freshman 15), students today are faced with increased college tuitions, burdensome debt, and difficulty finding employment after graduation. A significant population of non-traditional college students may face additional stressors, such as raising children or holding down a full-time job while working toward a degree.<\/span><\/div>\n<\/div>\n

Of course, life is filled with many additional challenges beyond those incurred in college or the workplace. We might have concerns with financial security, difficulties with friends or neighbors, family responsibilities, and we may not have enough time to do the things we want to do. Even minor hassles\u2014losing things, traffic jams, and loss of internet service\u2014all involve pressure and demands that can make life seem like a struggle and that can compromise our sense of well-being. That is, all can be stressful in some way.<\/p>\n

Scientific interest in stress, including how we adapt and cope, has been longstanding in psychology; indeed, after nearly a century of research on the topic, much has been learned and many insights have been developed. This chapter examines stress and highlights our current understanding of the phenomenon, including its psychological and physiological natures, its causes and consequences, and the steps we can take to master stress rather than become its victim.<\/p>\n

What is Stress?<\/h1>\n

We often use the term loosely in describing a variety of unpleasant feeling states; for example, we often say we are stressed out when we feel frustrated, angry, conflicted, overwhelmed, or fatigued. Despite the widespread use of the term, stress is a fairly vague concept that is difficult to define with precision.<\/p>\n

Researchers have had a difficult time agreeing on an acceptable definition of stress. Some have conceptualized stress as a demanding or threatening event or situation (e.g., a high-stress job, overcrowding, and long commutes to work). Such conceptualizations are known as stimulus-based definitions because they characterize stress as a stimulus that causes certain reactions. Stimulus-based definitions of stress are problematic, however, because they fail to recognize that people differ in how they view and react to challenging life events and situations. For example, a conscientious student who has studied diligently all semester would likely experience less stress during final exams week than would a less responsible, unprepared student.<\/p>\n

Others have conceptualized stress in ways that emphasize the physiological responses that occur when faced with demanding or threatening situations (e.g., increased arousal). These conceptualizations are referred to as response-based definitions because they describe stress as a response to environmental conditions. For example, the endocrinologist Hans Selye<\/span>, a famous stress researcher, once defined stress as the \u201cresponse of the body to any demand, whether it is caused by, or results in, pleasant or unpleasant conditions<\/b>\u201d (Selye, 1976, p. 74). Selye\u2019s definition of stress is response-based in that it conceptualizes stress chiefly in terms of the body\u2019s physiological reaction to any demand that is placed on it. Neither stimulus-based nor response-based definitions provide a complete definition of stress. Many of the physiological reactions that occur when faced with demanding situations (e.g., accelerated heart rate) can also occur in response to things that most people would not consider to be genuinely stressful, such as receiving unanticipated good news: an unexpected promotion or raise.<\/p>\n

A useful way to conceptualize stress <\/span>is to view it as a process whereby an individual perceives and responds to events that he appraises as overwhelming or threatening to his well-being (Lazarus & Folkman, 1984). A critical element of this definition is that it emphasizes the importance of how we appraise\u2014that is, judge\u2014demanding or threatening events (often referred to as stressors<\/span>); these appraisals, in turn, influence our reactions to such events<\/b>. Two kinds of appraisals of a stressor are especially important in this regard: primary and secondary appraisals. A primary appraisal <\/span>involves judgment about the degree of potential harm or threat to well-being that a stressor might entail. A stressor would likely be appraised as a threat\u00a0<\/b>if one anticipates that it could lead to some kind of harm, loss, or other negative consequence; conversely, a stressor would likely be appraised as a challenge\u00a0<\/b>if one believes that it carries the potential for gain or personal growth. For example, an employee who is promoted to a leadership position would likely perceive the promotion as a much greater threat if she believed the promotion would lead to excessive work demands than if she viewed it as an opportunity to gain new skills and grow professionally. Similarly, a college student on the cusp of graduation may face the change as a threat or a challenge (Figure 2.10.2.2).<\/p>\n

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Figure 2.10.2.2<\/b><\/p>\n

\"A
<\/b> Graduating from college and entering the workforce can be viewed as either a threat (loss of financial support) or a challenge (opportunity for independence and growth). Source: Timothy Zanker. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
The perception of a threat triggers a <\/span>secondary appraisal<\/span>: <\/span>judgment of the options available to cope with a stressor<\/b>, as well as perceptions of how effective such options will be (Lyon, 2012) (<\/span>Figure 2.10.2.3). As you may recall from what you learned about self-efficacy, an individual\u2019s belief in his ability to complete a task is important (Bandura, 1994). A threat tends to be viewed as less catastrophic if one believes something can be done about it (Lazarus & Folkman, 1984). Imagine that two middle-aged women, Robin and Maria, perform breast self-examinations one morning and each woman notices a lump on the lower region of her left breast. Although both women view the breast lump as a potential threat (primary appraisal), their secondary appraisals differ considerably. In considering the breast lump, some of the thoughts racing through Robin\u2019s mind are, \u201cOh my God, I could have breast cancer! What if the cancer has spread to the rest of my body and I cannot recover? What if I have to go through chemotherapy? I\u2019ve heard that experience is awful! What if I have to quit my job? My husband and I won\u2019t have enough money to pay the mortgage. Oh, this is just horrible\u2026I can\u2019t deal with it!\u201d On the other hand, Maria thinks, \u201cHmm, this may not be good. Although most times these things turn out to be benign, I need to have it checked out. If it turns out to be breast cancer, there are doctors who can take care of it because the medical technology today is quite advanced. I\u2019ll have a lot of different options, and I\u2019ll be just fine.\u201d Clearly, Robin and Maria have different outlooks on what might turn out to be a very serious situation: Robin seems to think that little could be done about it, whereas Maria believes that, worst case scenario, a number of options that are likely to be effective would be available. As such, Robin would clearly experience greater stress than would Maria.<\/span><\/div>\n<\/div>\n
\n
\n

Figure 2.10.2.3<\/b><\/p>\n

\"A
<\/b> When encountering a stressor, a person judges its potential threat (primary appraisal) and then determines if effective options are available to manage the situation. Stress is likely to result if a stressor is perceived as extremely threatening or threatening with few or no effective coping options available. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
To be sure, some stressors are inherently more stressful than others in that they are more threatening and leave less potential for variation in cognitive appraisals (e.g., objective threats to one\u2019s health or safety). Nevertheless, appraisal will still play a role in augmenting or diminishing our reactions to such events (Everly & Lating, 2002).<\/span><\/div>\n<\/div>\n

If a person appraises an event as harmful and believes that the demands imposed by the event exceed the available resources to manage or adapt to it, the person will subjectively experience a state of stress. In contrast, if one does not appraise the same event as harmful or threatening, she is unlikely to experience stress. According to this definition, environmental events trigger stress reactions by the way they are interpreted and the meanings they are assigned. In short, stress is largely in the eye of the beholder: it\u2019s not so much what happens to you as it is how you respond\u00a0<\/b>(Selye, 1976).<\/p>\n

Good Stress?<\/h2>\n

Although stress carries a negative connotation, at times it may be of some benefit. Stress can motivate us to do things in our best interests, such as study for exams, visit the doctor regularly, exercise, and perform to the best of our ability at work. Indeed, Selye (1974) pointed out that not all stress is harmful. He argued that stress can sometimes be a positive, motivating force that can improve the quality of our lives. This kind of stress, which Selye called eustress<\/span>(from the Greek eu<\/em>= \u201cgood\u201d), is a good kind of stress associated with positive feelings, optimal health, and performance<\/b>. A moderate amount of stress can be beneficial in challenging situations. For example, athletes may be motivated and energized by pregame stress, and students may experience similar beneficial stress before a major exam. Indeed, research shows that moderate stress can enhance both immediate and delayed recall of educational material. Male participants in one study who memorized a scientific text passage showed improved memory of the passage immediately after exposure to a mild stressor as well as one day following exposure to the stressor (Hupbach & Fieman, 2012).<\/p>\n

Increasing one\u2019s level of stress will cause performance to change in a predictable way. As shown in Figure 2.10.2.4, as stress increases, so do performance and general well-being (eustress); when stress levels reach an optimal level (the highest point of the curve), performance reaches its peak. A person at this stress level is colloquially at the top of his game, meaning he feels fully energized, focused, and can work with minimal effort and maximum efficiency. But when stress exceeds this optimal level, it is no longer a positive force\u2014it becomes excessive and debilitating, or what Selye termed distress<\/span>(from the Latin dis<\/em>= \u201cbad\u201d). People who reach this level of stress feel burned out; they are fatigued, exhausted, and their performance begins to decline. If the stress remains excessive, health may begin to erode as well (Everly & Lating, 2002).<\/p>\n

\n
\n

Figure 2.10.2.4<\/b><\/p>\n

\"A
<\/b> As the stress level increases from low to moderate, so does performance (eustress). At the optimal level (the peak of the curve), performance has reached its peak. If stress exceeds the optimal level, it will reach the distress region, where it will become excessive and debilitating, and performance will decline (Everly & Lating, 2002). Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
The Prevalence of Stress<\/span><\/div>\n<\/div>\n

Stress is everywhere and, as shown in Figure 2.10.2.5, it has been on the rise over the last several years. Each of us is acquainted with stress\u2014some are more familiar than others. In many ways, stress feels like a load you just can\u2019t carry\u2014a feeling you experience when, for example, you have to drive somewhere in a crippling blizzard, when you wake up late the morning of an important job interview, when you run out of money before the next pay period, and before taking an important exam for which you realize you are not fully prepared.<\/p>\n

\n
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Figure 2.10.2.5<\/b><\/p>\n

\"A
<\/b> Nearly half of U.S. adults indicated that their stress levels have increased over the last five years (Neelakantan, 2013). Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
Stress is an experience that evokes a variety of responses, including those that are <\/span>physiological\u00a0<\/b>(e.g., accelerated heart rate, headaches, or gastrointestinal problems), cognitive (e.g., difficulty concentrating or making decisions), and behavioural (e.g., drinking alcohol, smoking, or taking actions directed at eliminating the cause of the stress). Although stress can be positive at times, it can have deleterious health implications, contributing to the onset and progression of a variety of physical illnesses and diseases (Cohen & Herbert, 1996).<\/span><\/div>\n<\/div>\n

The scientific study of how stress and other psychological factors impact health falls within the realm of health psychology<\/span>, a subfield of psychology devoted to understanding the importance of psychological influences on health, illness, and how people respond when they become ill (Taylor, 1999). Health psychology emerged as a discipline in the 1970s, a time during which there was increasing awareness of the role behavioural and lifestyle factors play in the development of illnesses and diseases (Straub, 2007). In addition to studying the connection between stress and illness, health psychologists investigate issues such as why people make certain lifestyle choices (e.g., smoking or eating unhealthy food despite knowing the potential adverse health implications of such behaviours). Health psychologists also design and investigate the effectiveness of interventions aimed at changing unhealthy behaviours. Perhaps one of the more fundamental tasks of health psychologists is to identify which groups of people are especially at risk for negative health outcomes, based on psychological or behavioural factors. For example, measuring differences in stress levels among demographic groups and how these levels change over time can help identify populations who may have an increased risk for illness or disease.<\/p>\n

Figure 2.10.2.6\u00a0depicts the results of three national surveys in which several thousand individuals from different demographic groups completed a brief stress questionnaire; the surveys were administered in 1983, 2006, and 2009 (Cohen & Janicki-Deverts, 2012). All three surveys demonstrated higher stress in women than in men. Unemployed individuals reported high levels of stress in all three surveys, as did those with less education and income; retired persons reported the lowest stress levels. However, from 2006 to 2009 the greatest increase in stress levels occurred among men, Whites, people aged 45\u201364, college graduates, and those with full-time employment. One interpretation of these findings is that concerns surrounding the 2008\u20132009 economic downturn (e.g., threat of or actual job loss and substantial loss of retirement savings) may have been especially stressful to White, college-educated, employed men with limited time remaining in their working careers.<\/p>\n

\n
\n

Figure 2.10.2.6<\/b><\/p>\n

\"Graphs
<\/b> The charts above, adapted from Cohen & Janicki-Deverts (2012), depict the mean stress level scores among different demographic groups during the years 1983, 2006, and 2009. Across categories of sex, age, race, education level, employment status, and income, stress levels generally show a marked increase over this quarter-century time span. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
Early Contributions to the Study of Stress<\/span><\/div>\n<\/div>\n

As previously stated, scientific interest in stress goes back nearly a century. One of the early pioneers in the study of stress was Walter Cannon<\/span>, an eminent American physiologist at Harvard Medical School (Figure 2.10.2.7). In the early part of the 20th century, Cannon was the first to identify the body\u2019s physiological reactions to stress.<\/p>\n

\n
\n

Figure 2.10.2.7<\/b><\/p>\n

\"A
<\/b> Harvard physiologist Walter Cannon first articulated and named the fight-or-flight response, the nervous system\u2019s sympathetic response to a significant stressor. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
Cannon and the Fight-or-Flight Response<\/span><\/div>\n<\/div>\n

Imagine that you are hiking in the beautiful mountains of Colorado on a warm and sunny spring day. At one point during your hike, a large, frightening-looking black bear appears from behind a stand of trees and sits about 50 yards from you. The bear notices you, sits up, and begins to lumber in your direction. In addition to thinking, \u201cThis is definitely not good,\u201d a constellation of physiological reactions begins to take place inside you. Prompted by a deluge of epinephrine (adrenaline) and norepinephrine (noradrenaline) from your adrenal glands, your pupils begin to dilate. Your heart starts to pound and speeds up, you begin to breathe heavily and perspire, you get butterflies in your stomach, and your muscles become tense, preparing you to take some kind of direct action. Cannon proposed that this reaction, which he called the fight-or-flight response<\/span>, occurs when a person experiences very strong emotions\u2014especially those associated with a perceived threat (Cannon, 1932). During the fight-or-flight response, the body is rapidly aroused by activation of both the sympathetic nervous system and the endocrine system(Figure 2.10.2.8). This arousal helps prepare the person to either fight or flee from a perceived threat.<\/p>\n

\n
\n

Figure 2.10.2.8<\/b><\/p>\n

\"A
<\/b> Fight or flight is a physiological response to a stressor. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
According to Cannon, the fight-or-flight response is a built-in mechanism that assists in maintaining homeostasis\u2014an internal environment in which physiological variables such as blood pressure, respiration, digestion, and temperature are stabilized at levels optimal for survival. Thus, Cannon viewed the fight-or-flight response as adaptive because it enables us to adjust internally and externally to changes in our surroundings, which is helpful in species survival.<\/span><\/div>\n<\/div>\n

Selye and the General Adaptation Syndrome<\/h2>\n

Another important early contributor to the stress field was Hans Selye<\/span>, mentioned earlier. He would eventually become one of the world\u2019s foremost experts in the study of stress (Figure 2.10.2.9). As a young assistant in the biochemistry department at McGill University in the 1930s, Selye was engaged in research involving sex hormones in rats. Although he was unable to find an answer for what he was initially researching, he incidentally discovered that when exposed to prolonged negative stimulation (stressors)\u2014such as extreme cold, surgical injury, excessive muscular exercise, and shock\u2014the rats showed signs of adrenal enlargement, thymus and lymph node shrinkage, and stomach ulceration. Selye realized that these responses were triggered by a coordinated series of physiological reactions that unfold over time during continued exposure to a stressor. These physiological reactions were nonspecific, which means that regardless of the type of stressor, the same pattern of reactions would occur. What Selye discovered was the general adaptation syndrome<\/span>, the body\u2019s nonspecific physiological response to stress.<\/p>\n

\n
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Figure 2.10.2.9<\/b><\/p>\n

\"A
<\/b> Hans Selye specialized in research about stress. In 2009, his native Hungary honored his work with this stamp, released in conjunction with the 2nd annual World Conference on Stress. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
The general adaptation syndrome, shown in <\/span>Figure 2.10.2.10, consists of three stages: (1) alarm reaction, (2) stage of resistance, and (3) stage of exhaustion (Selye, 1936; 1976). <\/span>Alarm reaction <\/span>describes the body\u2019s immediate reaction upon facing a threatening situation or emergency, and it is roughly analogous to the <\/span>fight-or-flight response\u00a0<\/b>described by Cannon. During an alarm reaction, you are alerted to a stressor, and your body alarms you with a cascade of physiological reactions that provide you with the energy to manage the situation. A person who wakes up in the middle of the night to discover her house is on fire, for example, is experiencing an alarm reaction.<\/span><\/div>\n<\/div>\n
\n
\n

Figure 2.10.2.10<\/b><\/p>\n

\"A
The three stages of Selye\u2019s general adaptation syndrome are shown in this graph. Prolonged stress ultimately results in exhaustion. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
If exposure to a stressor is prolonged, the organism will enter the <\/span>stage of resistance<\/span>. During this stage, the initial shock of alarm reaction has worn off and the body has adapted to the stressor. Nevertheless, the body also remains on alert and is prepared to respond as it did during the alarm reaction, although with less intensity. For example, suppose a child who went missing is still missing 72 hours later. Although the parents would obviously remain extremely disturbed, the magnitude of physiological reactions would likely have diminished over the 72 intervening hours due to some adaptation to this event.<\/span><\/div>\n<\/div>\n

If exposure to a stressor continues over a longer period of time, the stage of exhaustion <\/span>ensues. At this stage, the person is no longer able to adapt to the stressor: the body\u2019s ability to resist becomes depleted as physical wear takes its toll on the body\u2019s tissues and organs. As a result, illness, disease, and other permanent damage to the body\u2014even death\u2014may occur. If a missing child still remained missing after three months, the long-term stress associated with this situation may cause a parent to literally faint with exhaustion at some point or even to develop a serious and irreversible illness.<\/p>\n

In short, Selye\u2019s general adaptation syndrome suggests that stressors tax the body via a three-phase process\u2014an initial jolt, subsequent readjustment, and a later depletion of all physical resources\u2014that ultimately lays the groundwork for serious health problems and even death<\/b>. It should be pointed out, however, that this model is a response-based conceptualization of stress, focusing exclusively on the body\u2019s physical responses while largely ignoring psychological factors such as appraisal and interpretation of threats. Nevertheless, Selye\u2019s model has had an enormous impact on the field of stress because it offers a general explanation for how stress can lead to physical damage and, thus, disease. As we shall discuss later, prolonged or repeated stress has been implicated in development of a number of disorders such as hypertension and coronary artery disease.<\/p>\n

The Physiological Basis of Stress<\/h1>\n

What goes on inside our bodies when we experience stress? The physiological mechanisms of stress are extremely complex, but they generally involve the work of two systems\u2014the sympathetic nervous system <\/span>and the hypothalamic-pituitary-adrenal (HPA) axis<\/span>. When a person first perceives something as stressful (Selye\u2019s alarm reaction), the sympathetic nervous system triggers arousal via the release of adrenaline from the adrenal glands. Release of these hormones activates the fight-or-flight responses to stress, such as accelerated heart rate and respiration. At the same time, the HPA axis, which is primarily endocrine in nature, becomes especially active, although it works much more slowly than the sympathetic nervous system. In response to stress, the hypothalamus (one of the limbic structures in the brain) releases corticotrophin-releasing factor, a hormone that causes the pituitary gland to release adrenocorticotropic hormone (ACTH) (Figure 2.10.2.11).The ACTH then activates the adrenal glands to secrete a number of hormones into the bloodstream; an important one is cortisol, which can affect virtually every organ within the body. Cortisol <\/span>is commonly known as a stress hormone and helps provide that boost of energy when we first encounter a stressor, preparing us to run away or fight. However, sustained elevated levels of cortisol weaken the immune system.<\/p>\n

\n
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Figure 2.10.2.11<\/b><\/p>\n

\"A
This diagram shows the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. The hypothalamus activates the pituitary gland, which in turn activates the adrenal glands, increasing their secretion of cortisol. Source: What is Stress?<\/a><\/figcaption><\/figure>\n<\/figure>\n
In short bursts, this process can have some favorable effects, such as providing extra energy, improving <\/span>immune system <\/span>functioning temporarily, and decreasing pain sensitivity. However, extended release of cortisol\u2014as would happen with prolonged or chronic stress\u2014often comes at a high price. High levels of cortisol have been shown to produce a number of harmful effects. For example, increases in cortisol can significantly weaken our immune system (Glaser & Kiecolt-Glaser, 2005), and high levels are frequently observed among depressed individuals (Geoffroy, Hertzman, Li, & Power, 2013). In summary, a stressful event causes a variety of physiological reactions that activate the adrenal glands, which in turn release epinephrine, norepinephrine, and cortisol. These hormones affect a number of bodily processes in ways that prepare the stressed person to take direct action, but also in ways that may heighten the potential for illness.<\/span><\/div>\n<\/div>\n

When stress is extreme or chronic, it can have profoundly negative consequences. For example, stress often contributes to the development of certain psychological disorders, including post-traumatic stress disorder, major depressive disorder, and other serious psychiatric conditions. Additionally, we noted earlier that stress is linked to the development and progression of a variety of physical illnesses and diseases. For example, researchers in one study found that people injured during the September 11, 2001, World Trade Center disaster or who developed post-traumatic stress symptoms afterward later suffered significantly elevated rates of heart disease (Jordan, Miller-Archie, Cone, Morabia, & Stellman, 2011). Another investigation yielded that self-reported stress symptoms among aging and retired Finnish food industry workers were associated with morbidity 11 years later. This study also predicted the onset of musculoskeletal, nervous system, and endocrine and metabolic disorders (Salonen, Arola, Nyg\u00e5rd, & Huhtala, 2008). Another study reported that male South Korean manufacturing employees who reported high levels of work-related stress were more likely to catch the common cold over the next several months than were those employees who reported lower work-related stress levels (Park et al., 2011). Later, you will explore the mechanisms through which stress can produce physical illness and disease.<\/p>\n","protected":false},"author":9,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-507","chapter","type-chapter","status-publish","hentry"],"part":500,"_links":{"self":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/507","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/users\/9"}],"version-history":[{"count":21,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/507\/revisions"}],"predecessor-version":[{"id":2034,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/507\/revisions\/2034"}],"part":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/parts\/500"}],"metadata":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapters\/507\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/media?parent=507"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/pressbooks\/v2\/chapter-type?post=507"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/contributor?post=507"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbooks.concordia.ca\/fundamentalsofhealthandphysicalactivity\/wp-json\/wp\/v2\/license?post=507"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}