Stress and Stress Management: A Cognitive View
Pretzer, James L., Beck, Aaron T., Newman, Cory F., Journal of Cognitive Psychotherapy
Extreme variability has been observed in individual responses to stressors. It appears that a more detailed analysis of individual variation in cognitions related to stress may result in a greater understanding of their differential responses. An idiographic cognitive model of the psychological processes that mediate stress and that underlie stress management techniques is presented in the form of an illustrative series of hypotheses based on Beck's cognitive model (Beck, Rush, Shaw, & Emery, 1979). The model is presented in detail and is applied to a clinical case example in which traditional nomothetic stress management techniques were ineffective. The advantages and disadvantages of a more idiographic approach to stress are examined as are the implications of the cognitive view of stress for research and practice.
Recent evidence suggesting that stress contributes to the development of disorders ranging from depression (Beck, Rush, Shaw, & Emery, 1979, p. 222; Hammen & deMayo, 1982; Hammen, Mayol, deMayo, & Marks, 1986; Krantz, 1985; Nezu, Nezu, Saraydarian, Kalmar, & Roman, 1986) to cancer (Sklar & Anisman, 1981) to general immuno-Requests for reprints should be directed to James Pretzer, Ph.D., Family Practice Center, Bolwell Health Center, 2078 Abington Rd., Cleveland, OH, 44120. logical dysfunction (Borysenko, 1984; Zegans, 1982) makes it apparent that a clear understanding of stress and methods for managing and reducing stress are needed. Despite the contributions of a number of major theorists and researchers, the current theoretical models (e.g., Lazarus, 1975, 1977, 1982; Shontz, 1965, 1975; Klinger, 1975, 1977; Wortman & Brehm, 1975) have little predictive power when applied to individual cases (Silver & Wortman, 1980). Most of these theoretical models suggest that people will respond to stress with predictable, normative response patterns, and that these responses will occur in orderly sequences of stages. However, empirical studies of reactions to stressors find extreme variability in both the responses observed and the time periods over which these responses occur (see Silver & Wortman, 1980). Overall, leading theories of stress and their corresponding approaches to stress management have been criticized as paying insufficient attention to individual differences (Lazarus & Folkman, 1984).
One of the most basic difficulties in the field has been to adequately define and operationalize the concept of stress (Mason, 1975a). Part of the problem is that the term has been used alternately to describe environmental stimuli (i.e., stress = agent outside the person), the response of the person to environmental stimuli, and the interaction between the two. This lack of consensus on the meaning of stress has resulted in considerable confusion. However, the term has immense public and professional appeal and is therefore too firmly established to be abandoned. In keeping with Mason's (1975b) persuasive recommendations, stress will be used in this article as a collective term to refer to situations in which environmental demands, internal demands, or the combination of the two tax or exceed the person's adaptive capacity. Stressor will be used to refer to the environmental and internal stimuli that require an adaptive response from a person.
Stress researchers have gradually approached a consensus on the view that stress is cognitively mediated (Forsythe & Compas, 1987; Mason, 1975a, 1975b; Singer, 1986; Zegans, 1982). The most widely known view of the role of cognition in stress has been developed by Lazarus (Lazarus, 1975, 1977, 1982; Lazarus, Averill, & Opton, 1970; Lazarus & Folkman, 1984; Lazarus & Launier, 1978). He and his colleagues emphasize the impact that a person's appraisal of situational demands and of responses for coping has on both stress and coping. In this case, stress is seen as being related to a person's perceptions of the magnitude of environmental risks (e. …