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PART IV. Stress Management
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Stress and Performance Seymour Levine Stanford University School of Medicine
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page ~ The literature concerning stress is extensive and complex, extending through fields as varied as clinical applied psychology, anthropology, sociology, psychosomatic medicine, industrial relations, and epidemiology. Not included in this list are, of course, the extensive studies dealing with the biochemical and physiological of the responses to stress. These responses have been involved in mechanisms as basic as immunological function, metabolic function, and fundamental psychological processes, such as memory and learning. Since one of the primary problems in stress research is conceptual, and this problem takes many forms, there is a great deal of confusion in the field. Because stress researchers lack a common vocabulary, each writer must define his/her own terms, and the reader must scrutinize each article carefully in order to understand the writer's vocabulary. The lack of a uniform and consistent vocabulary is a substantial impediment to progress and adds materially to the confusion in the field. Although the term "stress" is used throughout the literature, it is apparent that this term has multiple meanings, depending upon the particular field in which the concept is being investigated. Within the context of this report, we shall attempt to use one set of operational definitions to define stress, and at least to be consistent with our own definitions of the primary psychological variables that induce many of the profound long-term effects commonly attributed to stress. Stress can be approached from a purely behavioral perspective, and it effects studies on primarily behavioral outcomes. However, stress has also been viewed predominantly as a physiological and psychosomatic process, and the outcomes arestudies on either pathophysiological processes or basic biological processes. This report, however, will focus on an integration of these two perspectives and present a psychobiological view of stress.
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Page 3 It is important to note that, historically, the concept of stress has been predominantly implicated with changes in the endocrine systems. Initially, the changes were specifically related either to increased secretion of catecholamines or to activation of the pituitary-adrenal system. The problems are best illustrated by examining the concept of stress beginning with Selye's (1936) early work in which he defined a general adaptation syndrome (GAS) in rodents. This nonspecific response occurred after diverse noxious agents, such as exposure to cold, surgical injury, spinal shock, and muscular exercise. The essential argument was that the response did not depend upon the type of agent that produced it; rather, like inflammation, it was deemed as nonspecific. GAS was divided into three stages: an alarm reaction, a stage of resistance, and a stage of exhaustion. The initial stage included activation of the pituitary-adrenal system and eventually resulted in adrenal hypertrophy, thymicolymphatic involution, and gastric ulceration if the noxious stimuli persisted. If the response to the aversive situation was sustained, physiological resistance ultimately developed, and it was hypothesized that stressed subjects would enter a third stage--exhaustion--which occurred 1-3 months after the initial exposure. Problems with this view have occurred at several levels. First, there was an early emphasis on the physical and chemical aspects of the stressful stimuli, and we now know that psychosocial stimuli are also potent elicitors of the stress response. Second, Selye has received much criticism for the "nonspecificity" view because, with modern hormone assays, it is now possible to detect differential endocrine responses to certain stimuli. Further, the importance of the final stage of exhaustion has been questioned. Diseases due to exhaustion of this syndrome are rare, and, with the exception of a few animal models (e.g.,
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Page 4 intruders in wild rat colonies ), have not been demonstrated as a response deco psychosocial stimuli (Allen, 1972). Moreover, a number of physicians have studied moribund patients and have found that adrenal exhaustion did not occur even at death. Rather, there is usually increased adrenal output immediately before and after death (Sandberg et al., 1956~. The dramatic picture described by Selye is emphatically different from the present day concept of stress in the lay literature, which includes the daily troubles and anxieties of commuters and executives. The broader use of the term has resulted in an urgency to reduce or eliminate stress in both personal and professional arenas, even though Selye (1974) himself has minimized the significance of this type of stress and stated that its absence occurs only after death. This paradoxical situation reveals that we do not have a clear and generally accepted definition. As a consequence, there is a serious communication problem and increasing talk about a crisis in stress research (Wolf et al., 1979). At the very least, there is a growing impatience with the present state of vagueness in an area so vitally important for issues of health and quality of life. We believe that much of the controversy over stress theory can be eliminated through clarification of the "afferent limb," that is, by focusing on the nature of the stimuli that provoke physiological responses rather than on the physiological responses themselves. This type of investigation requires an unusual integration of physiology and psychology--disciplines which have traditionally been separated--and puts the major emphasis on psychological variables.
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Page 5 One of the purposes of this report is to examine the importance of psychological variables that have been determined to have profound endocrinological consequences both in animals and humans. In fact, the major conceptual framework pervading this report is that one of the primary aspects of stressful stimuli eliciting an endocrine response is psychological in nature. This perspective is derived from Mason's (1968, 1975a,b) review of psychoendocrine research, particularly involving the pituitary-adrenal cortical system. As mentioned above, much of the early stress research had emphasized the nonspecificity of the organism's response to a wide variety of physical stressors (Selye, 1950). However, even in the 1950s, it was becoming increasingly apparent that psychological factors were importantly involved. For example, in one study, Renold et al. (1951) examined the physiological response of participants in the Harvard Boat Race. Utilizing a traditional measure of that period, the decline in eosinophils following stress, they found that eosinophils in the crew members were markedly lower 4 hours after the race. This decline could have been attributed solely to the exercise and physical strain, but the investigators also discovered that the coxswains and coaches had similar eosinophil drops, even though their stress was purely psychological. In Mason's major review of the stress literature in 1968, he pointed out that much of the prior work, including the experiments on physical stimuli, shared one important characteristic, namely, that a typical aspect of the stressful experience was exposure to novel, strange, or unfamiliar environments. Therefore, the common thread that may have explained the animals' response was the psychological dimension of the stimuli, rather than the particular physical trauma to which they had been exposed. In subsequent research, Mason (1975a,b) was able to show that when animals are exposed to the
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Page 6 stimuli in such a way that they do not experience distress or novelty, then typical stressors such as heat or fasting do not necessarily result in activation of the pituitary-adrenal system. The concept that psychological variables can activate, and inhibit, the endocrine system has subsequently received much support in experimental studies on both animals and humans. PITUITARY-ADRENAL SYSTEM Although the response to stress can best be defined as a syndrome, which includes many changes in neurochemical and metabolic processes, for the purposes of this report we will focus on the response of the pituitary-adrenal system. It is important to remember, however, that we are utilizing this as a model system. There is abundant evidence indicating that the hormone function of other endocrine systems--including insulin, growth hormone, and prolactin--can also be influenced by psychological variables. In addition, it has been demonstrated recently that the endorphins are also extremely responsive to stress. In fact, it appears that almost all of the stimuli capable of eliciting an ACTH response from the pituitary are also capable of releasing beta endorphins (Guillemin et al., 1977). There are two reasons for focusing on the pituitary-adrenal system in illness. First, there is an extensive data base showing the effects of psychological variables on the pituitary-adrenal system. Second, and perhaps more important, is the profound influence that adrenal hormones have on many basic functions related to health. There have been many attempts in recent years to resolve the issue of the primary stimuli that elicit the endocrine response, in particular pituitary-adrenal responses, which occur under conditions of stress. As Mason
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Page 7 (1975a) pointed '.Ut , when the psychologically threatening or arousing aspects of the situation were altered, classical stresses such as fasting and heat no longer activated the pituitary-adrenal system. In the case of heat, there was, in fact, a reduction in the corticoids when the mode of presentation was gradual. The importance of the rate of presentation of a particular stimulus was also demonstrated in another experiment that used a potent physiological insult to induce adrenocortical activity. Hemorrhage in the magnitude of 10 ml/kg at the rate of 6.6 ml/kg/min actively stimulates the adrenal cortex of the dog. In contrast, if the same ultimate volume of blood loss is achieved at a much-slower rate of hemorrhage (i.e., 0.3 ml/kg/min), the pituitary-adrenal system does not activate (Gann, 1969). That rapid hemorrhaging induces adrenocortical activity, while slow rates of hemorrhaging do not, once again indicates that the rate of stimulus change is one important parameter for the induction of pituitary-adrenal activity. The fact that dexamethasone blocks the pituitary-adrenal response at a high rate of hemorrhaging clearly indicates that neuroendocrine systems are involved and that the effect was not mediated peripherally. Regardless of the specific explanation that accounts for these results, their general significance cannot be underestimated. More recent studies on psychoendocrine responses have indicated further that it may be possible to use adrenal activity as a measure of specific emotional responses, rather than simply as a reflection of undifferentiated arousal (Hennessy and Levine, 1979; Mason, 1975a,b). In addition, studies on psychological stress bring out one point quite clearly; the great individual differences typically observed in response to a given stressor can best be explained in terms of cognitive mechanisms . For example, a sub, echo s perception
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Page 8 of a stressor AS Z three_, or the coping responses that are available to the subject, may well determine the physiological response. It may be insufficient, therefore, to merely describe the stimulus operations involved in producing a stressor. A psychobiological approach to understanding endocrine function cannot escape making reference to cognitive processes. In his new description of arousal theory, Berlyne (1960, 1967) provides a framework for the description of the processes by which stimulators of arousal (and thus, activators of the pituitary-adrenal response) operate. Novelty, uncertainty, and conflict are considered primary determinants of arousal. These have been labeled by Berlyne as collative factors, because in order to evaluate them, it is necessary to compare similarities and differences between stimulus elements (novelty), or between stimulus-evoked expectations (uncertainty). The basic cognitive process involved in stimulation of the pituitary-adrenal system, then, is one of comparison. To a large extent, the cognitive processes of comparison can be best understood by adding the concept of uncertainty, although there are some differences between uncertainty and novelty. Uncertaintv seems to be a major factor underlying many psychological responses. The processes involving neuroendocrine activation under conditions of uncertainty are best explained by a model elaborated by Sokolov (1960) to account for the general process of habituation. The pattern of habituation is familiar to most people. A subject is presented with an unexpected stimulus and shows an alerting reaction. Physiological components of this orienting reaction are well known--general activation of the brain, decreased blood flow into the extremities, changes in electrical resistance of the skin, and increases in both adrenomedullary and cortical hormones. If the stimulus is frequently repeated,
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Page 9 all of these reactions gradually dominion and eventually disappear, and the subject is said to be habituated. It does appear, however, that physiological responses may habituate more slowly than the observed behavioral reactions. Sokolov's model, in essence, is based on a matching sys~ce~n in which new stimuli or situations are compared with a representation in the central nervous system of prior events. This matching process results in the development of expectancies whereby the organism is either habituated or gives an alerting arousal reaction (Pribram and Helges, 1969~. Thus, the habituated organism has an internal representation of prior events with which to deal with the environment--expectancies--and if the environment does not contain any new contingencies, the habituated organism no longer responds with the physiological responses related to the alerting reaction. Activation of the pituitary-adrenal system by any change in expectancy can also be accounted for by invoking the powerful explanatory capacity of the Sokolov model. NOVELTY AND UNCERTAINTY Exposure of an animal to novelty is one of the most potent experimental conditions leading to an increase in pi~cuitary-adrenal activity. Novelty can be classified as a collative variable, since the recognition of any stimulus situation as being novel requires a comparison between present stimulus events and those experienced in the past. Increases in pituitary-adrenal activity in response to novelty have been demonstrated in humans as well as animals. For example, increased adrenocortical activity, as evidenced by elevated levels of circulating cortisol, are observed in individuals during their first exposure to procedures involved in drawing blood at a blood bank. However, if they have had
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Stress R education , O Dohrenwend, B. S. (1978~. Social stress and community psychology. American Journal of Community Psychology, 6, ~-15. Dollard, J. & Horton, D. (1944~. Fear in battle. New York: ANT Press. Dubanoski. R. & McIntosh, S. R. (1984~. Child abuse and neglect in military and civilian families. Child Abuse and Neglect, 8, 55-67. Duffy, E. (1932~. The relationship between muscle tension and quality of performance. American Journal of Psychology, 44, 535-546. Duffy, E. (1957~. The psychological significance of the concept of "arousal" or "activation. " Psychological Review, 64, 26S-275. Dyer, G. (1985~. War. New York: Crown Publishers. Easterbrook, J. A. (1959~. The effect of emotion on cue utilization and the organization of behavior . Psychological Review, 66, 183 - 201 . Eisenhart, R. W . ( 1975 ~ . You can' Sac hack it little girl: A discussion of ache covert psychological agenda of modern combat ~craining. Journal of Social Issues, 31, 13- 23 . Ellis, A. (1962~. Reason and emotion in psychotherapy. New York: Stuart. Epstein, S. (1983~. Natural healing processes of the mind. In D. Meichenbaum and M. Jaremko (Eds. ), Stress reduction and pre~ren~cion. New York: Plenum Press. Fairbank, J. & Keane, T. (1982~. Flooding for combat-sela~ced stress disorders: Assessment of anxiety reduction across traumatic memories. Behavior Therapy, 13, 499- 510 . Figley, C. R. (1978~. Stress disorders among 11ie~cn~m veterans: Theory, research, and treatment. New York: Brunner/Mazel. Foy, D. W., Sipprelle, R. C., Rueger, D. B., & Carroll, E. M. (1984~. Etiology of postraumatic stress disorder in Vietnam veterans: Analysis of promilitary, military, and combat exposure influences. Journal of Consulting and Clinical Psychology, 52, 79-87. t !
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Stress Reduction 71 Frankenhauser, M. (1975). Experimental approaches to the study of catecholamines and emotion. In L. Levi (Ed.), Emotions -- Their parameters and measurement. New York: Raven Press. Funkenstein, D., King, S., & Drolette, M. (1957). Mastery of stress. Cambridge: Harvard University Press. Gabriel, R. (1986). Soviet military psychiatry. New York: Greenwood Press. Geron, E. & Dunkelman, N. (1982). The influence of war injury as a postwar stress factor and of sport rehabilitation on the personality of paraplegic war veterans. In N. Milgram (Ed.), Stress and anxiety, Vol. 8. Washington: Hemisphere. Ginzberg, E. (1959a). Patterns of performance. New York: Columbia University Press. Ginzberg, E. (1959b). Breakdown and recovery. University Press. Glass, D. C. & Singer, J. E. (1972). Urban stress. New York: Academic Press. Hall, E. G. & Erffmeyer, E. S. (1983). The effect of vi-quo-motor behavioral rehearsal with videotaped modeling on free-throw accuracy of intercollegiate female basketball players. Journal of Sports Psychology, 5' 343-346. Herrell, J. M. (1971). Use of systematic desensitization to eliminate inappropriate anger. Proceedings of the 79th Annual Convention, APA, 431- 432. Hibler, R. J. (1984). Battlefield stress: Management techniques. Military Medicine, 149, 5-~. .. _._. ~ Horowitz, M. J. & Soloman, G. F. (1975). A prediction of delayed stress response syndromes in Vietnam veterans. Journal of Social Issues, 197S, 31, 67-80. New York: Columbia
OCR for page 454
Stress Reduction ,2 Homer, S. O., Megtino, B. M., & Mobley, W. H. (1979~. An experimental evaluation of the effects of a realistic preview on Marine recruit affect, intentions and behavior (TR-9~. University of South Carolina, Center for Management and Organizational Research. Jacobson, E. (1938~. Progressive relaxation. Chicago: University of Chicago Press. Janis, I. L. (1951~. Air war and emotional stress. New York: McGraw-Hill. Janis, I. L. (1971~. Stress and frustration. New York: Harcourt, Brace, and Jovanovich. Janis, I. L. (1983~. Stress inoculation in health care. In D. Meichenbaum and M. Jaremko (Eds.), Stress reduction and prevention. New York: Plenum Press. Kanfer, F. (1970~. Self-monitoring: Methodological limitations and clinical applications. Journal o f Consulting and Clinical Psychology, 35, 148-152. Kardiner, A., & Spiegel, H. (1947~. War, stress, and neurotic illness. New York: Paul B. Hoeber. Deane, T. M., Scott, W. O., Chavoya, G. A., Lamparski, D. M., & Fairbank, J. A. (1985~. Social support in Vietnam veterans with posetraumatic stress disorder: A comparative analysis. Journal of Consulting and Clinical Psychology' 53, 95-102. Kendall, P. C. (1982). Advances i ~ therapy. Volume 1. New York: Academic Press Kendall, P. C. & Hollon, S. D. (1979). Coznitive-behavioral interventions. n Toni pier - _t~ri ^~1 IS __ New York: Academic Press. Kitchner, I. & Greenstein, R. (1985). Low dosage lithium carbonate in the treatment of posttraumatic stress disorder: Brief communication. Military Medicine 9 150' 378-381. ! 3
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Stress Reduction /3 Kormos, H. (1978~. The nature of combat stress. In C. R. Figley (Ed.), Stress disorders among Vietnam veterans. New York: Brunner/Mazel. Krantz, D., & Manuck, S. (1984). Acute psychopsysiologic reactivity and risk of cardiovascular disease: A review and methodologic critique. Psychological Bulletin, 96, 435-464. Kreuz, L., Rose, R., & Jennings, J. R. (1972). Suppression of plasma testosterone levels and psychological stress. Archives of General Psychiatry, 26, 479-482. Lacey, J. I. (1967). Somatic response patterning and stress: Some revisions of activation theory. In M. Appley & R. Trumbull (Eds.), Psychological stress. New York: Appleton-Century-Crofts. Lakein, A. (1973). How to get control of your time and Your life. New York: Peter H. Wyden. Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal, and coping. York: Springer. Lazarus, R. L. & Launier, R. (1978). Stress related transactions between person and enviornment. In L. A. Pervin & M. Lewis (Eds.), Perspectives in interactional psychology. New York: Plenum Press. Levi, L. (1971). Society, stress, and disease: The psychosocial environment and psychosomatic disease. London: Oxford University Press. Malloy, P. F., Fairbank, J. A., & Keane, T. M. (1983). Validation of a multimethod assessment of posttraumatic stress disorders in Vietnam veterans. Journal of Consulting and Clinical Psychology, _, 488-494. Marra, R. T. (1981). Stress, attention, and coping: Brief preventive intervention during a military medical examination. Dissertation Abstracts International, 42' 2068-B. 1984~. Stress, appraisal, and coping. New
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Stress R education 74 Mason, J . W. ( 1975 ~ . Emotion as reflected in patterns of endocrine integration. . In L. Levi (Ed. ), Emoting -- Their parameters and measurement. New York: Raven Press. McCabe, M. S . & Board, G. (1976) . Stress and mental disorders in basic training. Military Medicine, 141, 686 - 688 . ~ . Meichenbaum, D. (1977~. Cognitive-behavior modification. New York: Plenum Press. Meichenhaum, D. (1985~. Stress inoculation training. New York: Pergamon Press . Milgram, N. (1982~. Stress and anxiety. Vol. 8. Washington, D.C.: Hemisphere Publishing Co Mobley, U., Hand, H., Baker, R., & Meglino, B. (1979~. Conceptual and empirical analysis of military recruit training attrition. Journal of Applied Psychology, _, 10-18. Noel, R. C. (1980~. The effect of visuo -motor behavioral rehearsal on tennis performance. Journal of Sports Psychology, 2, 221-226. . Notterman, J. M. & Trumbull, R. (1950~. Note on self-regulating systems and stress. Behavioral Science, 4, 324-327. Novaco, R. W. (1985). Anger and its therapeutic regulation. In M. Chesney & R. Rosenman (Eds.), Anger and hostility in cardiovascular and behavioral disorders . Washington, D. C.: Hemisphere Publishing. Novaco, R. W., Cook, T. M. & Sarason, I. G. (1983~. Military recruit training : An arena for stress coping skills. In D. Meichenbaum & M. Jaremko (Eds.), Stress reduction and prevention. New York: Plenum Press. Novaco, R. W. & Robinson, G. L. (1984~. Anger and aggression among military personnel. In R. Kaplan, V. J. Konecni, & R. U. Novaco (Eds.), Aggression in children and youth. The Hague: Martinus Nijhoff.
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Stress Reduction 7: Novaco, R. W., & Sarson, I. G. (1986). Training unit environments, attrition' and performance in Marine Corps recruit training. Manuscript submitted for publication. Novaco, R. W., Sarason, I. G., Robinson, G., & Cunningham, F. (1982). Longitudinal analyses of stress and performance among Marine Corps drill instructors . Washington, D. C.: Office of Naval Research. Novaco, R. W., Sarason, I. G., Robinson, G., & Parry, C. (1983). Attributes of Drill Instructor School graduates: Stress-related factors. Washington, D.C.: Office of Naval Research. Novaco, R. W. ~ Vaux, A. (1985). Human stress: A theoretical model for the community-oriented investigator. In E. Susskind & D. Klein (Eds-.), Community research. New York: Praeger. Pavlov, I. (1927). Conditioned reflexes. London: Oxford University Press. Pavlov, I. P. (1941). Lectures on conditional reflexes. Vol. 2: Conditioned reflexes and psychiatry. New York: International Publishers. Pearlin, L. I. & Schooler C. (1978). The structure of coping. Journal of Health and Social Behavior 19 2-21. ,, _ . Perlmutter, A. (1977). The military and politics in modern times: On professional, praetorians, and revolutionary soldiers. New Haven: Yale University Press. Peters, R. K., Benson, H., & Peters, J. M. (1977). Daily relaxation response breaks in a working population: lI. Effects on blood pressure. American Journal of Public Health 67 954-959. , , Poe, R., Rose, R., & Mason, J. (1970~. Multiple determinants of 17- hydroxycorticosteroid excretion in recruits during basic training. Psychosomatic Medicine, _, 369-378.
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Stress Reduction ,6 Quick, J . C . & Quick, J . D . ( 1984~ . Organizational stress and preventive management. New York: McGraw-Hill. Rachman . S . J . ( 1978 ~ . Fear and courage San Francisco: W. H. Freeman. Rahe, R., Biersner, R., Ryman, D., & Arthur, R. (1972~. Psychosocial predictors of illness behavior and failure in stressful training. Journal of Health and Social Behavior, _, 393 - 397 . Rahe, R.9 Rubin9 R.' Arthur9 R., & Clark, B. (1968). Serum uric acid and cholesterol variability. Journal of the American Medical Association, 206, 2875-2880. Rose, R., Bourne, P., Poe, R., Mougey, E., Collins, D., & Mason, J. (1969). Androgen responses to stress. Psychosomatic Medicine, 3l, 418-436. Roth, R. (1980~. Child abuse and neglect among the military. National Technical Information Service, PB83-219097. Rubin, R., Rahe, R . , Arthur , R ., & Clark, B. (1969~. Adrenal cortical activity changes during underwater demolition training. Psychosomatic Medicine 31 553-564. . , Sandberg, B. & gliding, A. (1975~. Problems and symptoms in army basic trainees with stress-induced hypertensive reactions. Journal of Psychosomatic Research 20 51-59. . _, Sarason, I. G. (1975~. Anxiety and self-preoccupation. In. I. G. Sarason & C. D. Spielberger (Eds. ), Stress and anxie~cy, Vol. 2. Washing~con: Hemisphere . Sarason, I . G ., Levine, H . M ., Basham, R. B ., & Sarason, B . R. ( 1983 ~ . Assessing social support: The social support questionnaire. Journal of Personality and Social Psychology, 44, 127-139. Sarason, I. G., Novaco, R. 'I , Robinson, G., & Cook, T. attrition and the training uni t environment. Naval Research. (1981~. Recruit Washington, D.C.: Office of
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Stress R education Sarkesian> S · C . ( 1980) . Combat effectiveness: Cohesion, stress , and the volunteer military Beverly Hills: Same. Schachter, J. (1957). Pain, fear, and anger in hypertensives and normotensives: A psychophysiological study. Psychosomatic Medicine, 29, 17-29. Schneider, R. J. & Luscomb, R. L. (1984). Battle stress reaction and the United States Away. Military Medicine, 149, 66-69. Schneider, W. ~ Shiffrin, R. M. (1977). Controlled and automatic human information processing: I. Detection, search, and attention. Psychological Review, 84 9 1-66. Seegert, C. R. (1984). Group stress management treatment and the relationships between anxiety, coping styles, and ego defense mechanisms in a military setting. Dissertation Abstracts International, 4S, 1595-B. Selye, H. (1976~. The stress of life. New York: McOraw-Hill. Shatan, C. F. (1978). Stress disorders among Vietnam veterans: The emotional content of combat continues. In C. R. Figley (Ed.), Stress disorders among Vietnam veterans: Theory. research, and treatment. New York: Brunner/Mazel. Small, R. H. (1984). Practical training in the management of psychiatric combat casual~cies . Military Medicine, 149, 276-279. Spaulding, R. & Ford, C. (1972). The Pueblo incident: Psychological reactions to the stresses of imprisonment and repatriation. American Journal of Psychiatry, 129, 49-58. Steinberg, H. R. ~ Durell, J. (1968). A stressful social situation as a precipitant of schizophrenic symptoms: An epidemiological study. British Journal of PsYchiatrY' 114' 1097-1105.
OCR for page 460
S tress R educ ion , 3 Steiner, M. & Neumann, M. ( 1982~ . War neuroses and social support . In N. Milgram (Ed. ), Stress and anxiety' sol. 8. Washington, D. C.: Hemisphere . Stevens. R. J. (~979~. The effects of RET/ROT principles as an ins~crument for stress management at a USAF security service base. Dissertation Abstracts International, 41, 3892-A. - Stewart, G. T., Voors, A. W.9 Jenkins, C. D., Gutekunst, R. R., & Moldow, C. F. (1969~. Determinants of sickness in Marine recruits. American Journal of Epidemiology, 89, 254-263. Stokols, D. (1979~. A congruence analysis of human stress. In I. Sarason & C. Spielberger (Eds.), Stress and anxiety, Vol. 6. Washington, D.C.: Hemisphere Press. Stokols, D. & Novaco, R. W. (1981~. Transportation and well-being. In I. Alderman, J. Wohlwill, & P. Everett (Eds.), Transportation and behavior. New York: Plenum Press. Stouffer, S., Lumsdaine, A., Lumsdaine, M., Williams, R., Smith, M. B., Janis, I., Star, S., & Cottrell, L. (1949~. The American soldier: Combat and its afterma~ch. Princeton N.J. : Princeton University Press. Stress-management plans abound but not all programs are run well. The Wall Street Journal September 30 1982 p. 33. . , , Stretch, R. H. (1985~. Pos~crsumatic stress disorder among U.S. Army Reserve Vietnam and Vietnam-Era ve~cerans. Journal of Consulting and Clinical Psychoic~r, S3, 935-936. Stretch, R. H., Vail, J . D ., & Maloney, J . P . ~1985 ~ . Postraumatic stress disorder among Army Nurse Corps Vie~cnam ve~cerans. Journal of Consulting and Clinical Psychology, _, 704- 708 . Suinn, R. (1972~. Removing emotional obstacles to learning and performance by visuomotor behavioral rehearsal . Behavior Therapy, 3, 308 - 310 . 1 )
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S Mess R educ ion Turk, D . (1978 ) . Cognitive behavioral techniques in the management of pain. In J. P. Foreyt & D. P. Rathjen (Eds.), Cognitive behavior Cheap. New York: Plenum Press. Ursin, H., Basde, E., & Levine, S . (1978) . Psychobiology of stress : A study of coping men. New York: Academic Press. Wallace, R. K. (1910~. The physiological effects of transcendental meditation. Los Angeles: St ants International Meditation Society. Wasileski, M., Callaghan-Chaffee, M., & Chaffee, R. B. (1982). Spousal violence in military homes: An initial survey. Military Medicine, 147, 761 - 765 . We inberg, R. S ., Seabourne, T . G motor behavioral rehearsal, Washington: Wilkins, W. L. & Jackson, A. ( 1981~ . Effects of vi;suo- relaxation, and imagery on kara~ce performance . Journal of Sports Psychology, 3 ~ 228 - 238 . Weisman, G . ~ 1982 ~ . Wartime public feelings and their precursors: A case presen~ca~cion. In N. Milgram (Ed. ), Stress and anxiety, Vol. 8. Hemisphere . ( 1982~ . Psychophysiological correlates of stress asked human performance. In E. Alluisi & E. FIeishman (Eds. ), Human performance and producti~ri~cy : Stress and performance effectiveness . Hilisdale N. J .: Erlbaum. Wolf, S. & Wolff, H. G. ~1951~. A summary of experimental evidence relating life stress to the pathogenesis of essential hypertension in man. In E. T. Bell (Ed. ), Hypertension: A symposium. Minneapolis: University of Minnesota Press.
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Influence Strategies Dean G. Pruitt, Jennifer Crocker, and Deborah Hanes State University of New York at Buffalo