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A Level · Cambridge (CIE) · 9990

Explain sources of stress and effects on health

Compare physiological, life-event, work and Type A accounts of stress, then evaluate what the evidence can and cannot establish about health.

Section OPTION-HE-3.4.1 · 3.4.1 Sources of stress

Cambridge International AS & A Level Psychology 9990 · Health Psychology · 2028–2030 · Version 1 · OPTION-HE-3.4.1

Original StudyForA teaching mapped to Cambridge 9990 Health Psychology sections 3.4.1–3.4.3, 2028–2030 Version 1. Example studies illustrate the syllabus and are not official Cambridge materials or mark schemes. This is psychology education, not stress diagnosis or treatment advice.

Before you begin

  • This lesson covers Cambridge Psychology 9990 Health Psychology section 3.4.1. Stressor, appraisal, response and health outcome are distinct parts of an explanation.

Work on paper. Try each question before revealing help, and explain why your method works.

Quick readiness check

Which conclusion best follows from Chandola et al. (2008)?

What you will learn

  • General Adaptation Syndrome and effects of stress on health
  • Holmes–Rahe life events
  • Work-related stress; Chandola et al. (2008)
  • Friedman and Rosenman Type A personality

Stress can refer to a demand, an appraisal or a response

A stressor is a demand or event that may challenge a person. Stress can describe the situation, how a person appraises it, or the psychological and physiological responses that follow. These are related but not interchangeable. The same event need not be experienced in the same way by everyone, and a physiological response is not by itself a complete measure of a person’s experience.

Selye’s General Adaptation Syndrome (GAS) is a physiological model of a general response to sustained demands. The alarm reaction describes initial mobilisation; resistance describes continued adaptation while the demand persists; exhaustion describes reduced capacity after prolonged demand. It is a useful sequence for explaining a model, not a timetable that every person follows or a diagnosis of illness.

A strength of GAS is its clear account of physiological adaptation over time. A limitation is reductionism: it gives less attention to how people interpret stressors, social conditions and differences between individuals. The idea that the response is entirely nonspecific has also been questioned. Do not use the model to claim that every stressor has the same effects or that exhaustion inevitably causes a named disease.

Holmes and Rahe measure life changes with weighted events

Holmes and Rahe’s Social Readjustment Rating Scale (SRRS) lists life events and assigns each a Life Change Unit (LCU) weight. A respondent indicates which events occurred over a period, and weights can be summed to describe the amount of life change represented by the checklist. The approach makes events easier to compare and study across a group.

The score is not a direct reading of stress or an individual diagnosis. It assumes that listed events and their assigned weights fit the person being assessed. People can differ in the meaning of an event, whether it was wanted, the resources available to them and how they appraise it. A fixed checklist can miss ongoing demands and cultural or historical differences. A high total does not prove that illness will follow.

Treat the SRRS as a standardised self-report measure of reported life events, not as a causal test. It can be useful for a research question about life change, but appraisal, timing and context would need separate evidence.

Work stress can be situational and linked with health outcomes

Chandola et al. (2008) analysed 10,308 London-based male and female civil servants aged 35–55 at the start of the Whitehall II cohort. Chronic work stress was associated with coronary heart disease (CHD), and the authors examined behavioural, metabolic and neuroendocrine pathways. Their findings support studying work conditions and health together; they do not show that work stress alone caused an individual’s CHD.

The large cohort and follow-up offer evidence across many people and over time. Work stress and health behaviours were measured within a particular workforce and period, however, and observational associations can be affected by other differences between participants. The sample does not represent every occupation, age group or country. A situational explanation focuses on working conditions; a holistic account also considers personal appraisal, behaviour, physiology and wider support.

Type A is a measured behaviour pattern, not a fixed label

Friedman and Rosenman described a Type A behaviour pattern associated with time urgency, competitiveness and hostility. It offers an individual-differences account of how behaviour may relate to stress and health. The pattern should not be treated as a permanent personality type, a moral judgement or proof that a particular person will develop heart disease.

Their prospective research used a questionnaire-based assessment of Type A behaviour in employed men and followed coronary outcomes. In one report, higher scorers had about twice the incidence of new CHD over four years compared with lower scorers. The result is an association in a particular sample and measure; it does not establish that the pattern alone caused disease or generalise automatically to all people. Time urgency and hostility can also be separated conceptually rather than treated as one indivisible cause.

Compare individual and situational explanations rather than choosing one prematurely. A measure of behaviour can be correlated with a health outcome while work conditions, social resources, health behaviours and other factors also matter.

Sources for this lesson

Pause and explain

What does the Holmes–Rahe SRRS primarily summarise?

Put the idea to work

Worked example

A student reads that a high Holmes–Rahe total means a person will become ill. Improve the claim and explain what additional information would help.

Show the worked solution
  1. Identify what the scale records: reported events with assigned weights, not illness itself.
  2. Separate an association or risk estimate from a certain outcome for one person.
  3. Name appraisal, event context and other influences as information the checklist does not fully capture.

Answer The SRRS provides a weighted summary of reported life events, but a high score does not diagnose illness or prove that illness will occur. Appraisal, resources, health, timing and wider conditions may differ between people; those factors and actual health outcomes would need to be examined separately.

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From guided practice to a new situation

Write your answer and reasoning first. Use a hint only if you are stuck. The model solution is for self-checking; your written work is not automatically marked.

1 · Guided

A learner explains GAS using a prolonged-demand scenario. Identify the alarm reaction, resistance and exhaustion in the model, then give one limit.

Give me a hint

Describe the model’s phases as a theoretical sequence and avoid presenting it as a guaranteed outcome.

Compare my reasoning
  1. Alarm reaction: initial mobilisation in response to the demand.
  2. Resistance: continued adaptation while the demand persists.
  3. Exhaustion: reduced capacity in the model after prolonged demand; it is not a diagnosis or inevitable outcome.
  4. One limitation is that the physiological model gives less detail about appraisal and individual or social differences.

In the GAS model, a demand first produces an alarm reaction; continued exposure is associated with resistance, and prolonged demand may lead to exhaustion. This is a simplified physiological model, not a fixed path for every person, and it does not by itself explain how appraisal or social context shapes stress.

Look for these in your work

  • All three phases accurately identified
  • A limitation linked to the model
  • No guaranteed illness claim
2 · Independent

Compare the Holmes–Rahe life-event account with the Type A behaviour-pattern account as explanations of stress.

Give me a hint

One focuses on reported events; the other focuses on a measured pattern of behaviour.

Compare my reasoning
  1. The SRRS quantifies reported life changes using assigned LCU weights.
  2. Type A describes a cluster such as time urgency, competitiveness and hostility, measured through behaviour or questionnaires.
  3. Both can support comparisons, but neither captures every person’s appraisal or proves a health outcome for an individual.
  4. A useful comparison considers standardisation and also cultural, contextual and measurement limits.

The SRRS is a situational account based on weighted life events, whereas Type A emphasises individual behaviour patterns. Each can be measured systematically, yet event meanings vary and behaviour is not a fixed label. Neither score alone establishes illness or rules out other influences.

Look for these in your work

  • Accounts distinguished
  • A strength and limitation considered
  • No deterministic claim
3 · Transfer

A school finds that staff reporting heavier workloads also report poorer health. Design a follow-up that tests the relationship more carefully and state a causal limit.

Give me a hint

Define how workload and health will be measured, then choose a design that respects participants and time.

Compare my reasoning
  1. Specify a consistent workload measure and an appropriate health outcome rather than using vague labels.
  2. Follow a diverse staff sample over time and record baseline measures and relevant contextual factors.
  3. Use consent, confidentiality and a procedure that does not deliberately impose harmful workload.
  4. Even a longitudinal association cannot rule out every confound or prove that workload alone caused health changes.

A prospective study could measure defined workload and health indicators at baseline and follow-up across varied roles, while recording relevant contextual factors and protecting staff privacy. It could strengthen evidence about temporal relationships but, without random assignment, could not isolate workload as the only cause.

Look for these in your work

  • Variables operationalised
  • A feasible and ethical design
  • Causal limit explained

Common mistakes

  • Treating GAS as a universal sequence with a fixed duration
  • Using an SRRS total as a diagnosis or certain prediction for one person
  • Claiming the Whitehall II association proves that work stress caused CHD
  • Treating Type A as an immutable personality label or blaming people for illness
  • Ignoring the sample, measurements and alternative explanations in a study
Recall without your notes

What can you explain now?

What can a cohort association between chronic work stress and CHD establish?

Compare with the explanation

It can show that the measured variables were associated in that cohort and support further questions about possible pathways; by itself it cannot isolate work stress as the sole cause of an individual outcome.

Association is evidence of a relationship in a sample, not a complete causal explanation.

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Make it stick

Explain one physiological, one life-event, one work-related and one individual-difference account of stress, then state why none alone guarantees a health outcome.

If you needed the solution, close it and solve the problem again from a blank page. A correct answer is stronger when you can explain the reason for each step.

Keep learning Psychology

Check the official syllabus 2028–2030
Course scope and assessment

Seven original lessons map all 15 AS research-method and methodological-concept sections to explained Guided, Independent and Transfer practice. All 12 compulsory AS core studies have original study-specific teaching and staged practice; five additional A Level methodology lessons cover research design and validity. All 15 Clinical, all 15 Consumer (2.1.1–2.5.3) and all 15 Health (3.1.1–3.5.3) Psychology sections link to original teaching and staged practice. All 15 Organisational Psychology sections 4.1–4.5 now have original teaching and explained staged practice; the six new 4.4–4.5 lessons bring the planning map to 92 of 92 indexed sections. Consumer lessons cover physical and psychological environments; decision models, heuristics and mistakes; packaging, selling and buying; advertising, self-monitoring, product placement, brand recognition and slogans. Evaluation boundaries are explicit: studies use particular products, samples, tasks and settings; gaze, recall, self-report, EEG indices, ratings, choices and purchases are different outcomes. Health evidence is bounded: Laba et al. measured hypothetical preferences; Riekert and Drotar raise a non-response concern; Chung and Naya's cap tracked openings, not swallowing; Chaney et al. was a short caregiver-reported pilot; Yokley and Glenwick examined immunisation attendance in one public-health setting. MacLachlan et al. report one patient, not a controlled treatment effect; Brudvik et al. compared separate child, parent and physician ratings in one emergency department. Chandola et al. found a cohort association; Wang et al. measured responses during a monitored arithmetic task; Evans and Wener observed commuters; Bridge et al. found mixed self-rated outcomes in radiotherapy. Janis and Feshbach measured short-term self-reports in one school; Lewin et al. tested a rehabilitation package, not information alone. Tapper et al. and Fox et al. studied bounded school and worksite programmes; incentive effects do not establish transfer or rule out reporting effects. Weinstein measured comparative expectations, while Seligman’s framework is conceptual and Shoshani and Steinmetz used a school-level comparison. These findings do not establish universal health effects or diagnose individuals. Need-theory examples use a child measurement study, not a workplace test; SMART is a practical checklist, not a motivational theory. Landry et al. compared reward framing with student volunteers in a lab; this does not establish universal effects in workplaces. Cuadrado et al. (2008) measured undergraduate evaluations of presented leaders, not workplace performance or hiring; this does not establish a universal gender effect. The historical 1995 Munchausen criteria are not a current diagnostic checklist. Cambridge’s 2028–2030 Reference List treats Oruč et al. (1997) as an example of genetic explanation although its participants had bipolar I; gambling disorder is listed in Cambridge’s Clinical topic but classified under addictive behaviours in ICD-11. Candidates choose two options, but all four remain listed so schools can select a route. The 92-section count is a planning index, not a Cambridge score. Remaining work is deeper coverage review, separate-year syllabus reconciliation, timed-paper practice and human subject-expert review. The separate 2027 and 2024–2026 syllabuses are not reconciled into this route. Practice is not official grading, a timed-paper simulation or human subject-expert review.

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