WHAT IS STRESS?
The increase in press and television coverage of stress over the last few decades has
corresponded to a growth in research and public awareness. Indeed, stress is now the
most common cause of long-term sick leave and is frequently shown to be a very
important factor accounting for nearly 10 million working days lost per annum in the
UK (HSE, 2015). In 2014/2015, stress accounted for 35 per cent of all cases of work-
related illnesses in the UK (i.e. 440,000 cases). In the United States, the impact of stress
is also far reaching, with 66 per cent of Americans reporting that stress is impacting
on their physical health and 63 per cent believing the same for their mental health
(American Psychological Association, 2012).
We can all empathize with feeling stressed. However, it is not always clear what
we mean by ‘stress’ (Segerstrom and O’Connor, 2012). Over centuries, ‘stress’ has
come to mean pressure or strain (e.g. Cooper and Dewe, 2004). Scientific interest dates
back to the early part of the twentieth century. For example, World War I concerns
about industrial efficiency led to studies of fatigue in wartime munitions factories and
the war focused attention on ‘shellshock’, which was subsequently acknowledged as
a manifestation of post-traumatic stress disorder (Lazarus, 1999).
There have been three different approaches to the study of stress: the stimulus-based
or engineering approach; the response-based or medico-physiological approach; and
the psychological ‘interactional-appraisal’ approach (Cox, 1978). The engineering
approach views stress as a demand on an individual from their environment, which
produces a strain reaction: the greater the strain, the larger the reaction. This approach
assumes that undemanding situations are not stressful. However, monotonous
undemanding work environments very often are stressful. The engineering analogy is
also problematic because it makes the assumption that individuals function both uncon -
sciously and automatically; no consideration is given to the mediating psychological
processes (e.g. cognitive appraisal) but such processes are very important. The response-
based approach mainly considers stress in terms of the general physiological reaction
to noxious events in a person’s environment such as changes in blood pressure, heart
rate and stress hormones. Again this approach does not account for individual
psychological processes. More recent work has adopted an interactional-appraisal (or
transactional) approach in order to explain the stress process. Such theories have
contributed to our understanding of the variation in responses to similar noxious (or
stressful) stimuli by emphasizing the importance of the intervening psychological
processes.
The development of the transactional approach owes much to the work of Richard
Lazarus and his colleague Susan Folkman (Lazarus, 1966; Lazarus and Folkman, 1984).
They define stress as ‘a particular relationship between the person and the environment
that is appraised by the person as taxing or exceeding his or her resources and
endangering his or her well-being’ (Lazarus and Folkman, 1984: 19). This means that
researchers need to look at the environment, the individual’s reaction to the environ -
ment and the outcome (which might be in terms of physiological or psychological
well-being). Perhaps because of the breadth of issues encompassed within this concept
of stress, Lazarus also suggested that the most useful approach would be to regard stress
not as a single variable but as a ‘rubric consisting of many variables and processes’
(Lazarus and Folkman, 1984: 12). Thus stress may be viewed as an umbrella term
44 STRESS AND HEALTH