Cohen S, Kessler RC, Underwood Gordon L, editors
New York: Oxford University Press; 1997. 236 pp. with index
ISBN 0-19-512120-1 (paper)
“Stress” has become such an overused word that it is now almost a cliché. The Oxford English Dictionary has 10 different meanings for it. Because of these terminological difficulties, some consider that it should be discarded from the medical lexicon altogether. Nevertheless, “stress” has developed a widely understood meaning in common parlance, and it would appear acceptable to use the word technically as long as clear definitions are followed. In the psychosocial and biological sciences it has come to refer to the external events and changes that impinge on an individual and the reaction of the individual to those events. Over the last 50 years a huge volume of psychobiological research has been carried out on stress and its effects on health. It is ironic that, despite mounting clinical, epidemiological and pathophysiological evidence that stress has adverse effects on health, there still are sceptics who doubt the connection or — worse — fail to recognize and assist patients whose clinical problems are caused or aggravated by stress.
A probable reason for the existence of such scepticism is the very real difficulty in measuring stress in a valid and replicable way. This book tackles this problem in a pragmatic and comprehensive manner. Stress is defined as “a process in which environmental demands tax or exceed the adaptive capacity of an organism, resulting in psychological and biological changes that may place persons at risk for disease.” This process is examined from 3 perspectives: environmental, subjective and biological. The “environmental” perspective includes the external life events that impinge on an individual; the “subjective” factors are the psychological and emotional perception and evaluation of those events; and the “biological” factors refer to the physiological responses induced by these environmental and psychological changes. There are helpful introductory and summary chapters to each of the sections.
Two types of tests are used to measure the intensity of environmental events: those that depend on self-report ratings and those that depend on interviewer ratings. Self-report ratings have the major advantage of simplicity and efficiency of administration. However, some environmental events may not be listed in the inventories given to the patient, and earlier stressful events may be poorly remembered and evaluated. Interview methods have the advantages of being able to measure the timing and intensity of life events more accurately, and are also more comprehensive. However, they are much more expensive and time-consuming to administer.
The chapters on psychological response describe the measurement of stress “appraisal” and the measurement of the “affective response.” The book describes a variety of questionnaire-type tests that measure each of these responses. Two final fascinating chapters deal with physiological reactions to stress. These reactions affect 3 systems: the sympathetic-adrenal medullary system, the hypothalamic-pituitary-adrenocortical axis, and the immunological response. Each is important, because each is a likely means by which environmental events cause pathophysiological reactions.
This book is a must-read for those involved or wishing to be involved in stress research. The authors are all actively engaged in experimental research in this area or have helped to develop many of the tests in use. The chapters are comprehensive and well written and referenced. Although the book is expensive, it can be highly recommended as a compendium to those with an interest in this field.
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