Drug Therapy and Biofeedback

Social Support and Stress

Social support — the resources provided by relationships with others — is consistently identified as one of the most powerful moderators of the stress-health relationship. Individuals with greater social support show better physiological and psychological outcomes under equivalent stress exposure, and social isolation is associated with substantially elevated mortality risk.

Types of Social Support

Cohen and Wills (1985) distinguished several types of social support:

• Emotional support: expressions of empathy, love, concern, and care — being heard and valued. The most universally appreciated form.
• Informational support: providing advice, information, and guidance relevant to the stressful situation — helping the person understand and manage the stressor.
• Instrumental (tangible) support: practical assistance — help with tasks, financial aid, physical resources.
• Appraisal support: information useful for self-evaluation — social comparison information, feedback about performance.

Mechanisms: Direct Effect and Buffering

Two models explain how social support protects health:

Direct effect hypothesis: social support has beneficial effects on health regardless of whether the person is under stress. Having social connections provides ongoing positive affect, a sense of belonging, access to health-relevant information and resources, and social norms that promote healthy behaviour. These benefits exist independently of stress exposure.

Buffering hypothesis (Cohen and Wills, 1985): social support specifically buffers the negative effects of stress — it moderates the stress-health relationship. When stress is high, those with high social support show much better outcomes than those with low support; when stress is low, the difference is smaller. The mechanism: social support may prevent the appraisal of situations as stressful (informational and emotional support shape primary and secondary appraisal), and may reduce the physiological stress response directly (the presence of a trusted person reduces cortisol release). Cohen and Wills (1985) found evidence for both mechanisms: direct effects were found for structural support (number of social contacts); buffering effects were found for functional support (quality and relevance of support).

Research Evidence

Berkman and Syme (1979) — Alameda County Study: a nine-year prospective study of approximately 7,000 Californian adults. Social connectedness — measured by an index including marital status, contacts with friends and relatives, church membership, and group membership — was significantly associated with mortality. People with fewer social ties were two to three times more likely to die during the follow-up period than those with extensive social connections, even after controlling for physical health status, health behaviours (smoking, exercise, diet), and socioeconomic status at baseline. This landmark study established social isolation as a major mortality risk factor.

Kiecolt-Glaser et al. (1984): in the medical student exam stress study, students who reported higher levels of loneliness showed lower NK cell activity — loneliness within a stress-exposed sample moderated immune competence.

Taylor et al. (2000) — Tend and Befriend

Taylor et al. (2000) proposed that the seek-social-support stress response may be particularly characteristic of females. Under stress, females may engage in 'tend-and-befriend' responses — tending to offspring and affiliating with social networks — rather than the fight-or-flight response associated with males. The mechanism may involve oxytocin (a social bonding hormone) — females' stress response may involve oxytocin release that promotes affiliation and social support-seeking, partially buffering the cortisol response. This is discussed further in B1583.