ReviewThe cognitive activation theory of stress
Introduction
Stress is an old term, in English used for pressure or distress at least from the 13th century, and related to sources of strain. The purpose of this paper is to present a cognitive activation theory of stress (CATS). Over the last 30 to 40 years a considerable empirical basis has been established for the role of cognitive factors for ‘stress’ in man and animals. Ignoring this results in many claims of relationships between ‘stress’, strain, and health and are simply not true. We believe that a more precise and formal set of definitions may reduce the bewildering use of terms, which may cover the same phenomena. Therefore, CATS offers definitions formulated in symbolic logic presented separately at the end of this paper.
This is ‘cognitive’ stress theory because CATS assumes that the stress response depends on acquired expectancies of the outcomes of stimuli and available responses. We regard these as acquired (learned) relations between stimuli, and between responses and stimuli. We will deal with these phenomena as information-handling systems of the brain, and will accept that all advanced brains have such properties. It is an activation theory since it is based on neurophysiological activation and arousal concepts. It is a stress theory since it aims at explaining the psychobiology of conditions where people use the term ‘stress’, and are worried about possible health consequences.
Section snippets
Historical background
Hans Selye is frequently claimed to be the father of the stress concept. However, in his pioneer 1936 paper (Selye, 1936), a brief note in Nature, the term ‘stress’ was not used. According to tradition, this was because the medical establishment (and the referees in Nature?) found the term too unspecific, and too much used as a nonscientific attribution concept by the lay public. In his original 1936 paper, Selye simply described general, non-specific adaptation and maladaptation phenomena in
Four aspects of ‘stress’
Stress is defined and operationalized by stimuli (‘stressors’), subjective reports of an experience (humans only), a general non-specific increase in arousal (activation, and the feedback to the brain from this response (Levine and Ursin, 1991) (Fig. 1
Measurement of ‘stress’
The four aspects of stress offer four ways of measuring ‘stress’. Current methods may cover one of the meanings, sometimes more than one meaning. The load (stimulus or ‘stressors’) (aspect 1) may be easy to measure, and often impress as the most objective way of measurement. However, even if it is easy to quantify external factors, it is the social and emotional factors that may determine survival in extreme environments (Ursin et al., 1991).
The experience or feeling of stress (aspect 2) is
When does the alarm occur?
The stress response is a general, unspecific alarm response occuring whenever there is a discrepancy between what is expected or the ‘normal’ situation (set value) and what is happening in reality (actual value) (Table 1
For all variables controlled by the brain, at any point in time: ‘Set value’ (SV): the value brain is ‘set’ on for that particular variable ‘Actual value’ (AV): the real value of that variable. Statement 1a: (SV≠AV)⇒Activation and Statement 1b: (SV=AV)⇒No
Expectancy: what does the stimulus mean, what can I do about it?
All brains store the relations between stimuli, and between responses and stimuli. This stored (learned) information is referred to as expectancy (Table 2
Stimulus expectancy: Statement 3 When the subject has learned that one stimulus (S1) predicts the occurrence of another event (S2) this is referred to as stimulus expectancy: Statement 3: S1ES2=(S1⇒S2) Statement 3 is to be read: The stimulus expectancy S1–S2 means that S1 implies S2. In classical conditioning, S1 is the
Dimensions of expectancy
Expectancies are quantified by three dimensions: acquisition strength, perceived probability, and affective value (Table 3
Acquisition strength Acquisition strength is referred to as H (‘habit value’), which is assumed to have values between 0 (minimum) and 1 (maximum). Formally, the strength of S1⇒S2 is expressed by H (S1ES2) and has values between 0 and 1: Statement 5a: H(S1ES2)∈(0,1). Or, in more detail: Statement 5b: ∀S1ES2∃H(S1ES2)∈(0,1){0}. Statement 5b is to
The CATS coping concept: positive response outcome expectancy
Coping is the acquired expectancy that most or all responses lead to a positive result. This leads to a reduced arousal level (Table 4
Coping is a positive response outcome expectancy (Approach learning: A(S2)→1): Statement 11: H(R1ES2)→1, PP(R1ES2)→1, A(S2)→1 Statement 11 is to be read: The habit value of R1 leading to S2 is high, the perceived probability of R1 leading to S2 is high, and the affective value of S2 is high. (Avoidance learning: A(
Helplessness
Helplessness is the acquired expectancy that there are no relationships between responses and reinforcement (Table 5
Helplessness exists when: Statement 13: Statement 13 is to be read: Helplessness exists when the perceived probability of avoiding an unpleasant stimulus approaches zero. (Detailed readout: see Statement 11) Comment: From Statement 1a the arousal level is
Hopelessness: negative response outcome expectancy
Hopelessness is the acquired expectancy that most or all responses lead to a negative result (Table 5).
Hopelessness is more directly opposite of coping than helplessness, since it is a negative response outcome expectancy. There is control, responses have effects, but they are all negative. The negative outcome is his or her fault since the individual has control. This introduces the element of guilt, which may make hopelessness a better model for depression than helplessness (Prociuk et al.,
Coping with coping concepts
Many concepts cover coping strategies and the expectancy attached to such responses.
Predictability, fear and anxiety
Predictability is used both for the true relations between events, and the subjective or learned (perceived) relation. Only the acquired (learned) relation is related to internal state of the organism. Perceived predictability offers formal definitions of fear and anxiety.
A highly probable, as well as a highly improbable, event are both predictable, and are concurrent with low arousal. Uncertainty produces high arousal. However, predictability in itself is not enough to predict the internal
Set values, expectancies, and access to the activation of the arousal system
Stress (alarm) occurs when something is missing, i.e. when there is a discrepancy between goals (SV) and reality (AV). The probability of eliminating such discrepancies influences access to the arousal system (Table 6
Access to the activation and arousal system depends on the perceived probability of success Low probability: Statement 15: Activation→0 if SV1≠AV1, and if PP((SV1−AV1)→0)→0 Statement 15 is to be read: For any particular motivational system with a
Activation and arousal theory
Stress is an adaptive response
The ability to respond to changes and challenges in the environment with a general alarm response should be regarded as an essential element in the total adaptive and self-regulating system of the organism (Levine and Ursin, 1991). Since arousal and ‘stress’ are essential elements in all complex brains—in fish, birds, and mammals—the activation response must be assumed to be ‘adaptive’. The response is uncomfortable and drives the organism to provide specific
Psychological defense
Stress may be reduced by distortion of stimulus expectancies.
Within traditional ego psychology or psychodynamic theory coping was one of many ways to defend (Haan, 1977). This is still influential in literature on stress, and in many animal studies. Toates (1995) defined stress as a ‘chronic state that arises only when defense mechanisms are either being chronically stretched or are actually failing’. To Folkman and Lazarus (1990) defense is a coping strategy.
Within ego psychology, the first
Sustained high levels of arousal and health
Only sustained high arousal levels constitute a potential health risk.
Weiss, 1968, Weiss, 1972 claimed that numerous coping attempts, in the absence of feedback, would result in stomach ulcers and a depletion of noradrenaline in the brain. We have regarded this as sufficiently analog to the situation in humans, as described by Karasek and Theorell (1990), to produce a composite figure comprising both sets of data (see Fig. 3). The model predicts disease, especially related to cardiovascular
Coping and social status
Social order is related to expectancies, coping and health.
In animals and human societies social order reduces hostility and conflict. Ptarmigans (willow grouse), an arctic bird, establish order during winter. The dominating male has low cortisol, high testosterone, high secondary sexual features, and lower body temperature than subordinate males. Once order has been established, fighting decreases. The catabolic stress responses decreases in the whole flock, most in the dominating male, but
Brain mechanisms
A prerequisite for the CATS position on stress is a general, non-specific brain stem activation concept.
The concept of arousal entered psychology from neurophysiology, with the documentation of a mesencephalic brain stem system for evoking and maintenance of wakefulness (Moruzzi and Magoun, 1949). The concept has been controversial, but seems to us to be necessary in physiological, psychological, and clinical science, in man and animals. In a Science commentary Steriade (1996) stated that it
Conclusions
CATS differs from many other approaches to ‘stress’ in the emphasis on the positive health consequences of the normal alarm response, occurring whenever the organism is lacking an essential factor. The theory is an expansion of general arousal and activation theory from neurophysiology. The stress responses are normal activation responses leading to an increase in arousal, and corresponding changes in behaviour as well as in most or all parts of the body. These somatic changes are mediated
Acknowledgements
The authors are grateful for research support from The Norwegian Research Council and the Norwegian Department of Health and Social Affairs. Many of our colleagues have helped with the manuscript and the development of the ideas behind it. In particular, we want to thank Jos F. Brosschot, Gary D. Coover, Seymour Levine, Robert Murison, Miranda Olff, J.B. Overmier, and Frederick Toates.
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