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 The Oxford Handbook of Stress and Mental Health
Kate L. Harkness (ed.), Elizabeth P. Hayden (ed.)

https://doi.org/10.1093/oxfordhb/9780190681777.001.0001
Published: 2018 Online ISBN: 9780190681807 Print ISBN: 9780190681777

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FRONT MATTER

Acknowledgments 
Published: June 2018

Subject: Psychology
Series: Oxford Library of Psychology

I (Kate Harkness) would like to sincerely thank my dear friend and partner in this project, Elizabeth Hayden.
Working with Elizabeth is always fun and intellectually engaging, and this volume is greatly enriched by her
deep thinking and keen insights. We would both like to thank our Editor at Oxford University Press, Sarah
Harrington, for her tireless and enthusiastic support of this project from its very earliest stage through to
production. I would also like to thank my close colleague and mentor, Scott Monroe, for his un agging
encouragement and friendship, and for instilling in me a love of stress research. I would also like to
acknowledge the many gifted and committed students at Queen’s University who have enriched my thinking
about stress and made my job fun, especially Margaret Lumley, Jeremy Stewart, Raegan Mazurka, Cherie
Larocque, and Simone Cunningham. Finally, my deepest gratitude goes to my partner in all things, Mark
Sabbagh, and our children, Pablo and Ruby. I would not be the scientist or person I am without their
encouragement, support, and love.

I (Elizabeth Hayden) would like to express my gratitude to my very close friend and colleague, Kate
Harkness, for inviting me to work with her on this volume. This project has been an exceptionally rewarding
experience, and as always, my own scholarship has been enriched through collaboration with Kate. I would
also like to thank Dan Klein, Emily Durbin, Ted Beauchaine, Thomas Olino, and Lea Dougherty for their
long-standing support and friendship. In particular, not just my career but my life overall would be much
less rewarding and interesting without Dan’s un agging mentorship. I would also like to thank the
tremendously talented and dedicated young psychological scientists with whom I have had the pleasure to
work, especially Yuliya, Pan, Matt, Ola, Andrew, and Lindsay, given their dedication to the lab while this
book has been in production. Finally, I would like to thank my husband, Jeremy Hake, who has tirelessly
encouraged me to pursue my career goals. I wish all female academics and scientists had such supportive
p. vi partners.
 The Oxford Handbook of Stress and Mental Health
Kate L. Harkness (ed.), Elizabeth P. Hayden (ed.)

https://doi.org/10.1093/oxfordhb/9780190681777.001.0001
Published: 2018 Online ISBN: 9780190681807 Print ISBN: 9780190681777

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FRONT MATTER

About the Editors 

https://doi.org/10.1093/oxfordhb/9780190681777.002.0007 Pages xi–xii
Published: June 2018

Subject: Psychology
Series: Oxford Library of Psychology

Kate L. Harkness is a Professor in the Departments of Psychology and Psychiatry at Queen’s University. Her
research programme is focused on understanding how stress exposures throughout the lifespan lead to
critical changes in biological and psychological mechanisms that cause and maintain depression. She is an
associate editor for Journal of Abnormal Psychology. Her research has been funded by the Canadian Biomarker
Integration Network for Depression, the Canadian Institutes of Health Research, the Ontario Mental Health
Foundation, the Social Sciences and Humanities Research Council of Canada, and the Sick Kids Foundation.

Elizabeth P. Hayden is a Professor in Psychology at the University of Western Ontario and the Brain and
Mind Institute. Her research interests include understanding the developmental processes that lead to
mental health problems across the lifespan, as well as developing novel assessment and measurement
approaches to improve early identi cation of vulnerability to psychopathology. She is an associate editor for
Psychological Assessment. Her research has been funded by the Canadian Institutes of Health Research, the
Natural Sciences and Engineering Research Council of Canada, the Social Sciences and Humanities Research
p. xii Council of Canada, and the National Institute of Mental Health.
 The Oxford Handbook of Stress and Mental Health
Kate L. Harkness (ed.), Elizabeth P. Hayden (ed.)

https://doi.org/10.1093/oxfordhb/9780190681777.001.0001
Published: 2018 Online ISBN: 9780190681807 Print ISBN: 9780190681777

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FRONT MATTER

Contributors 
Published: June 2018

Subject: Psychology
Series: Oxford Library of Psychology

Lauren B. Alloy
Department of Psychology
Temple University

Elizabeth N. Aslinger
Department of Psychology
University of Pittsburgh

Gordon J. G. Asmundson
Department of Psychology
University of Regina

Deanna M. Barch
Departments of Psychological & Brain Sciences, Psychiatry, and Radiology
Washington University in St. Louis

Corinne P. Bart
Department of Psychology
Temple University

J. Gayle Beck
Department of Psychology
University of Memphis

Blessy Bellamy
Department of Psychology
University of Pittsburgh

George Bonanno
Department of Counseling and Clinical Psychology
Columbia University

Dante Cicchetti
Institute of Child Development
University of Minnesota

Bruce E. Compas
Department of Psychology
Vanderbilt University

Elisabeth Conradt
Department of Psychology

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University of Utah

Christopher C. Conway
Department of Psychology
Fordham University

Gail Corneau
Department of Psychology
University of North Carolina, Greensboro

Alexandra F. Corning
Department of Psychology
University of Notre Dame

Joanna Crawford
St. Vincent’s Urban Mental Health and Wellbeing Centre
St. Vincent’s Hospital

BreAnne A. Danzi
Department of Psychology
University of Miami

Terrence Deak
Department of Psychology
Binghamton University-State University of New York

Samantha Denefrio
The Graduate Center
The City University of New York

Tracy A. Dennis-Tiwary
Hunter College
The City University of New York

Philip A. Desormeau
Department of Psychology
University of Toronto Scarborough

Maria Ditcheva
Department of Psychology
University of North Carolina, Greensboro

Thomas S. Dodson
Department of Psychology
University of Memphis
 Jenalee R. Doom
Department of Pediatrics
University of Michigan

Elizabeth A. Edershile
Department of Psychology
University of Pittsburgh

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Reneé El-Gabalawy
Department of Psychology
University of Manitoba

Bruce J. Ellis
Department of Psychology
University of Utah

p. xiv Roberto España

Department of Psychology
Emory University

Katrina Goines
Department of Psychology
Emory University

Sherryl H. Goodman
Department of Psychology
Emory University

Bryan Grant
Department of Psychology
Western University

Megan R. Gunnar
Institute of Child Development
University of Minnesota

Meeka S. Halperin
Department of Psychology
Emory University

Constance Hammen
Department of Psychology
University of California, Los Angeles

Benjamin L. Hankin
Department of Psychology
University of Illinois, Urbana-Champaign

Kate L. Harkness
Department of Psychology
Queen’s University

Elizabeth P. Hayden
Department of Psychology, Brain and Mind Institute
Western University

Lauren Henry
Department of Psychology
Vanderbilt University

George F. Koob
Neurobiology of Addiction Section
National Institute on Drug Abuse

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National Institutes of Health

Annette M. La Greca
Department of Psychology
University of Miami

Keira B. Leneman
Institute of Child Development
University of Minnesota

Alexandra J. Lipinski
Department of Psychology
University of Memphis

Kan Long
Department of Counseling and Clinical Psychology
Columbia University

Nestor L. Lopez-Duran
Department of Psychology
University of Michigan

Allison LoPilato
Department of Psychology
Emory University

Dennis F. Lovelock
Department of Psychology
Binghamton University–State University of New York

Ashley N. Marchante-Ho man

Department of Psychology
University of Miami

Katie A. McLaughlin
Department of Psychology
Harvard University

Rebekah J. Mennies
Department of Psychology
Temple University

Valerie J. Micol
Department of Psychology
University of Michigan
 Jamie E. Mondello
Department of Psychology
Binghamton University–State University of New York

Scott M. Monroe
Department of Psychology
University of Notre Dame

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Sarah Myruski
The Graduate Center
The City University of New York

Richard W. J. Neufeld
Department of Psychology
Western University

Tommy H. Ng
Department of Psychology
Temple University

Derek Novacek
Department of Psychology
Emory University

Thomas M. Olino
Department of Psychology
Temple University

p. xv Thomas F. Oltmanns
Department of Psychological and Brain Sciences
Washington University in St. Louis

David Pagliaccio
Department of Psychiatry
Columbia University

Jenny E. Pak
Department of Psychology
Binghamton University–State University of New York

Allison M. Pickover
Department of Psychology
University of Memphis

Jens C. Pruessner
Department of Psychology
University of Constance

Andrea Roberts
Department of Psychology
University of Michigan

Tina H. Schweizer
Department of Psychology
University of Illinois, Urbana-Champaign

Zindel V. Segal
Department of Psychology
University of Toronto Scarborough

Nila Shakiba
Department of Psychology
University of Utah

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George M. Slavich
Cousins Center for Psychoneuroimmunology
University of California, Los Angeles

Catherine B. Stroud
Department of Psychology
Williams College

Naomi Tarlow
Department of Psychology
University of Miami

Madison K. Titone
Department of Psychology
Temple University

Han N. Tran
Department of Psychology
University of Memphis

Rudolf Uher
Department of Psychiatry
Dalhousie University

Leandro F. Vendruscolo
Neurobiology of Addiction Section
National Institute on Drug Abuse
National Institutes of Health

Isabella M. Viducich
Department of Psychology
University of Notre Dame

Kelsey D. Vig
Department of Psychology
University of Regina

Allison Vreeland
Department of Psychology
Vanderbilt University

Suzanne Vrshek-Schallhorn
Department of Psychology
University of North Carolina, Greensboro
 Elaine Walker
Department of Psychology
Emory University

Kathleen M. Walsh
Department of Psychology
University of Toronto Scarborough

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Christina Noel White
Department of Psychological and Brain Sciences
Washington University in St. Louis

Kay Wilhelm
St. Vincent’s Urban Mental Health and Wellbeing Centre
St. Vincent’s Hospital

Zuzanna K. Wojcieszak
Department of Psychology
Temple University

William C. Woods
Department of Psychology
University of Pittsburgh

Aidan G. C. Wright
Department of Psychology
University of Pittsburgh

Ellen Zakreski
Department of Psychology
p. xvi McGill University
 The Oxford Handbook of Stress and Mental Health
Kate L. Harkness (ed.), Elizabeth P. Hayden (ed.)

https://doi.org/10.1093/oxfordhb/9780190681777.001.0001
Published: 2018 Online ISBN: 9780190681807 Print ISBN: 9780190681777

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CHAPTER

Introduction 
Kate L. Harkness, Elizabeth P. Hayden

https://doi.org/10.1093/oxfordhb/9780190681777.013.36 Pages 1–6

Published: 12 August 2019

Abstract
In this introductory chapter, we provide an overview of The Handbook of Stress and Mental Health. We
begin by introducing the scope of the issue and critically operationally de ning the construct of stress.
We then provide a description of the chapters included in the volume, as well as an outline of the
purpose of each of the ve major sections: Assessment and De nitional Issues, Stress Exposure and
Mental Health, Psychological Models, Neurobiological Models, and Stress Resilience and Treatment.
The contributors represent international leaders in the eld of stress and provide authoritative and
integrative review and analysis of the evidence base in this crucial area of study.

Keywords: stress, mental health, development, assessment, etiology, treatment

Subject: Clinical Psychology, Psychology
Series: Oxford Library of Psychology

Exposure to stress is a ubiquitous feature of the human condition and has been throughout our evolution.
Physical anthropologists have provided extensive skeletal evidence of stress in prehistoric populations that
has been linked to environmental pressures, including nutritional deprivation, economic transition, and
intergroup con ict (Goodman, Thomas, Swedlund, & Armegalos, 1988). The sophist Gorgias’ (483–376 BC )
Encomium of Helen is credited as providing the earliest account in the West of psychological symptoms
resulting from exposure to stress. Gorgias’ detailed descriptions of Greek soldiers returning from combat
invoke symptoms consistent with the current diagnostic criteria for posttraumatic stress disorder: “the
sight inscribes in the mind images of objects seen. And the terrifying images often remain, and what
remains corresponds to words spoken” (cited in Ustinova & Cardeña, 2014). The Roman philosopher and
statesman Cicero (106–43 BC ) also attributed his recurrent episodes of depression and suicidality to
stressful events, such as his exile from Rome and the death of his daughter Tullia.

In the present day, stress has been implicated as an etiological factor in every psychiatric disorder in current
nosological systems. This extends from posttraumatic stress disorder, for which exposure to traumatic
stress is an explicit diagnostic criterion, to other disorders long understood to involve stress-related
etiologies, such as the anxiety and depressive disorders, to disorders that have traditionally been associated
 more strongly with neurobiological factors, such as bipolar disorder and the schizophrenia spectrum. The
extensive literature on stress and mental health merits an in-depth analysis of the role of stress in
psychopathology as well as the diverse mechanisms that mediate and/or moderate the e ect of stress
exposure. The current handbook, written by an international group of renowned experts in the eld of
stress, provides a scholarly, comprehensive volume that takes a multidisciplinary perspective on stress and
speci cally integrates issues of stress assessment, mechanisms, and treatment around the central theme of
mental health.

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Stress Defined

The term stress has two meanings, which are often con ated in the literature on the role of stress in mental
p. 2 health. The rst involves the events or challenges in the environment to which individuals are exposed
(i.e., stress exposure; e.g., Dohrenwend & Dohrenwend, 1974). These exposures can be acute (e.g., getting
red from a job) or chronic (e.g., ongoing arguments with a spouse), range from minor (e.g., getting a
speeding ticket) to severe (e.g., being diagnosed with a life-threatening disease) to traumatic (e.g., sexual
assault), and can occur throughout the life span. What de nes the construct of stress exposure is that it
comprises objectively observable external pressures on the individual. This meaning is distinguished from
the second, which focuses on the individual’s response to these external environmental exposures (i.e.,
stress response; e.g., Selye, 1955). These responses involve the internal perturbations and/or manifestations
of stressful exposures, which can be measured at multiple levels of analysis (e.g., psychological states of
fear, anxiety, or depression; sympathetic nervous system and hypothalamic-pituitary adrenal cortical
activation).

Stress exposures are typically and reliably associated with a stress response. However, the association is not
perfect, and measurement of the stress response cannot be taken as a proxy for the exposure (or vice versa).
Importantly, the response to any given stress exposure is in uenced by a wide variety of individual
di erence factors, including personality and temperament, cognitive style, previous and concurrent stress
exposure, genetic vulnerability, and so on (see Harkness & Monroe, 2016). Given the multidetermined
nature of stress responses, there is pronounced variation in responses to the same objectively de ned stress
exposures both across individuals as well as within individuals over time (e.g., Ellis, Boyce, Belsky,
Bakermans-Kranenburg, & van IJzendoorn, 2011).

Both exposure to stressful life events and the psychological and physiological responses to such
environmental exposures are highly relevant to mental health. As noted earlier, stress exposures,
independently and objectively de ned, contribute strongly to the etiology of mental disorders. Additionally,
individuals with mental disorders, and those prone to disorder, evidence stronger psychological,
physiological, and neurobiological responses to stress exposures, as well as higher levels of symptoms and
signs indicative of psychological stress, than healthy individuals. As we summarize next, the chapters in
this volume provide a comprehensive and authoritative review of the types of stress exposures most
strongly associated with each mental disorder. And, in separate analysis, they characterize in detail the
nature of the stress responses at multiple levels of analysis that are associated with disorder in the face of
exposure.
 Structure of the Handbook

This volume contains a total of 33 chapters. The rst three chapters address the de nition and assessment
of the main classes of stress exposures—major life events and chronic di culties (Chapter 1, Monroe &
Slavich), daily stressors and hassles (Chapter 2, Wright, Aslinger, Bellamy, Eckershile, & Woods), and the
broad category of adverse childhood experiences (Chapter 3, McLaughlin). All three of these chapters
address the crucial importance of distinguishing between stress exposure and the stress response both
conceptually and in measurement. They also each provide a critical review of the most methodologically

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rigorous tools in the eld for assessing stress exposures across several dimensions (e.g., chronicity,
severity, and developmental timing). Finally, in Chapter 4, Neufeld and Grant provide a comprehensive
analysis of strategies to model the relations of stress exposure, stress response (e.g., coping), and mental
health. The authors in these rst four chapters, then, provide a critical foundation in terms of the
operationalization of stress that can be used to evaluate the theoretical and empirical evidence provided in
the subsequent chapters linking stress to mental health.

The next 10 chapters focus on the association of stress exposure to the etiology and course of several mental
disorders. Each chapter focuses on a di erent disorder and, consistent with the introductory material,
reviews literature bearing on several dimensions of stress. Emphasis is placed on a review of studies using
methodologically rigorous methods that clearly measure the stress exposure unconfounded by the stress
response. Issues unique to each mental health condition are also highlighted.

Speci cally, in Chapter 5, Vrshek-Schallhorn, Ditcheva, and Corneau highlight the unique role of life events
involving themes of interpersonal loss, humiliation, and entrapment in triggering episodes of major
depressive disorder, as well as the very recent research on targeted rejection events as speci c risk
exposures for depression. In their chapter on bipolar disorder, Alloy, Titone, Ng, and Bart (Chapter 6)
expand upon the distinction between the types of life events just mentioned that trigger episodes of
depression and those that trigger manic episodes. Speci cally, consistent with the behavioral
p. 3 activation/reward hypersensitivity and circadian dysregulation theories of bipolar disorder, Alloy and
colleagues review evidence for the unique role of events involving reward and those involving the disruption
of social rhythms in triggering mania. In Chapter 7, Goines, LoPilato, Novacek, Epana, and Walker review
evidence for the role of early and proximal stress exposures in precipitating schizophrenia in those at
clinical high risk, and for the role of ongoing exposure to proximal life events in the exacerbation of
psychotic symptoms. These authors provide a comprehensive and rigorous account of the neurobiological
mechanisms that mediate the relation of stress exposure and psychosis, providing a rich integration of
stress exposure and the stress response in the etiology of this spectrum.

The personality disorders are covered in Chapter 8 by White, Conway, and Oltmanns. Here the authors focus
on the speci c role of adverse childhood exposures, including abuse and neglect, in the etiology of the
personality disorders, and in the development of maladaptive personality traits. A particularly unique
contribution of this chapter is the authors’ discussion of how to disentangle environmental and genetic
in uences in the research on adverse childhood events in personality pathology. In Chapter 9, using a
neurobiological model of alcohol addiction as their foundation, Vendruscolo and Koob provide a compelling
understanding of the e ect of alcohol on the body’s stress response system—the hypothalamic-pituitary-
adrenal (HPA) axis—thereby intriguingly positing alcohol as the stress exposure that initiates a stress
response cascade that maintains that exposure and leads to addiction. In Chapter 10, Corning and Viducich
integrate the most common stress antecedents of the eating disorders and obesity, including childhood
trauma, and particularly sexual trauma, and traumatic illness, with prevailing etiological models of eating
disorders (sociocultural drive for thinness; negative appearance-related feedback). In so doing, they put
forth the novel proposal that negative a ect may act as a speci c mediator of the relation between stress
and eating disorders.
 While the aforementioned disorders can all be linked to stressful life events to varying degrees,
posttraumatic stress disorder is unique as the only mental disorder that explicitly includes the etiological
role of a traumatic stress exposure as a diagnostic criterion. While stress exposure is linked to posttraumatic
stress disorder by de nition, LaGreca, Danzi, Marchante-Ho man, and Tarlow (Chapter 11) provide a deep
and exhaustive exploration into the wide variability of traumatic exposures—from large-scale natural
disasters to personal assaults—and the di erential implications of this variability for the development of
posttraumatic stress disorder and acute stress disorder across the life span. Finally, using posttraumatic
stress disorder as an anchor, Vig, El-Gabalawy, and Asmundson (Chapter 14) review in fascinating detail an

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integrative psychobiobehavioral model for the comorbidity of trauma-related psychopathology and medical
conditions ranging from cardiovascular disease and diabetes to respiratory and musculoskeletal diseases.

A developmental perspective lays the foundation for a richer and deeper understanding of the processes by
which stress exposure relates to (mal)adaption. Stress exposure in early life is covered in Chapters 12 and 13,
as well as in Chapters 20 and 24. Doom and Cicchetti (Chapter 12) provide a de nitive characterization of the
eld of developmental psychopathology, as well as a comprehensive review of stress in a developmental
psychopathology framework. A particularly important contribution of this chapter is the integration of the
moderating and mediating in uences of genetic, neuroendocrine, and other individual di erence factors in
the relation of stress to psychopathology in children, thereby presaging discussion of these factors in future
chapters, but again through the unique lens of development. Complementing Doom and Cicchetti’s analysis
is the authoritative contribution of Leneman and Gunnar (Chapter 25) in which they review in exquisite
detail the state of the current evidence on brain development and the e ects on the brain of stress exposure
during speci c developmental periods, from exposure prenatally through to adolescence. Pagliaccio and
Barch (Chapter 20) hone in speci cally on the neuroimaging literature to provide a deep analysis of the
e ects of early life stress on brain structure and function. Finally, Goodman and Halperin (Chapter 13)
explore maternal perinatal depression as a unique stress exposure on the developing fetus and infant that
has signi cant implications for development and future psychopathology in these o spring. Important
issues of timing of exposure are covered, as well as outcomes across several domains.

The volume then provides a detailed review of the prevailing theories and mechanisms that have been
proposed to account for the etiological relation of stress to mental disorder. The mechanisms, while
reviewed separately, are by no means mutually exclusive and instead likely work together to drive the onset
and course of mental disorders. For example, a history of depression is associated with both the generation
p. 4 of (Chapter 15, Hammen), and sensitization to (Chapter 16, Stroud), stressful life events, and these two
mechanisms working together have been proposed to drive a recurrent course in the disorder (e.g.,
Hammen, 2006). Olino, Wojcieszak, and Mennies (Chapter 18) provide an integrative analysis explicitly
when they discuss models by which particular personality traits may be linked to psychopathology through
the mechanism of stress generation (Chapter 15). On the neurobiological side, Slavich (Chapter 23) provides
direct evidence for a mechanistic link between the hypothalamic-pituitary-adrenal (HPA) axis (Chapter 21,
Lopez, Roberts, Foster, & Mayer) and the immune system. Speci cally, he explains that prolonged release of
the stress hormone cortisol as a result of chronic stress exposure can make immune cells less sensitive to
the anti-in ammatory e ects of glucocorticoids, resulting in HPA-axis-related increases in in ammation
that have been associated with a variety of mental and physical health disorders. Similarly, Pruessner’s
(Chapter 22) detailed and comprehensive review provides the psychophysiological level of analysis of the
major neurobiological stress response systems to complement the neurohormonal and neuroin ammatory
mechanisms discussed in Chapters 21 and 23.

We also emphasize that the distinction between psychological and neurobiological explanatory mechanisms
is a false dichotomy, and it is widely understood that the e ects of stress can be observed at multiple levels
of analysis simultaneously. Lopez-Duran and colleagues (Chapter 21) explicitly provide this integration
when they review the role of the HPA axis, and the stress hormone cortisol speci cally, in regulating
 attentional vigilance to threat (Chapter 17, Hankin & Schweizer), as well as emotional regulation (Chapter
19, Dennis-Tiwary, Denefrio, & Myruski) and interpersonal behavioral responsivity (Chapter 15, Hammen)
in the face of stress. Similarly, Uher (Chapter 24) discusses in detail the role of genetic factors in
predisposing to particular temperaments and personality traits (Chapter 18), as well as cognitive processes
such as attentional bias to threat (Chapter 17), that heighten sensitivity to the stressful life event exposures
that trigger mental disorder. Uher also reviews the fascinating evidence implicating genes in the generation
of stress (i.e., gene–environment correlation). That is, individuals with at-risk genetic predispositions may
select themselves into environments that are associated with heightened exposure to stress. Further,

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Shakiba, Conradt, and Ellis (Chapter 27) integrate across genetic, neuroendocrine, cognitive, and
personality levels of analysis to present their comprehensive biological sensitivity to context model of
susceptibility to mental health disorders as a result of early life stress. Finally, it is important to note that
the list of mechanisms included here is not exhaustive. There are several mechanisms and theoretical
perspectives that we have not included because of space constraints (e.g., evolutionary and sociocultural
theories, the role of neurotransmitters such as dopamine and serotonin).

The nal chapters examine factors that mitigate the e ects of stress, including internal psychological
factors such as coping and resilience, as well as treatments for stress-related disorders. The terms “coping”
and “resilience” have been de ned and operationalized in many di erent ways, leading to inconsistencies
and confusion in the literature linking these constructs to mental health outcomes. The chapters in this
volume provide much-needed and authoritative clarity. In Chapter 26, Compas, Vreeland, and Henry review
in detail the structure of coping and emphasize the importance of conceptualizing coping as a strategy that
can adapt exibly to changing environmental demands. It is this coping exibility, according to the authors,
that may most strongly predict psychological adjustment. Long and Bonanno take up this same theme in
presenting their uni ed framework of resilience (Chapter 28). Speci cally, they too assert that resilience
should be conceptualized not as a static personality trait but as a process that unfolds dynamically and
exibly over time.

Ideally, both theoretical models and descriptive work characterizing linkages between stressors and
outcomes contribute to the development of prevention and intervention e orts. Using depression as their
prototypical stress-related disorder, Mondello, Pak, Lovelock, and Deak (Chapter 29) review evidence for
exciting new drug development targets in the in ammatory (Chapter 23) and HPA axis (Chapter 21)
systems. Taking cognitive-behavioral (CB) theories of stress-related disorder as their foundation, Beck,
Pickover, Lipinski, Tran, and Dodson (Chapter 30) review psychological treatments for acute stress disorder
and posttraumatic stress disorder, with a particular focus on comparing and contrasting cognitive
processing therapy (CPT) and prolonged exposure (PE). Desormeau, Walsh, and Segal (Chapter 31) integrate
CB therapy with the practice of mindfulness, de ned by Jon Kabat-Zinn (2003) as “the awareness that
p. 5 emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the
unfolding of experience moment to moment” (p. 145). They provide compelling evidence that mindfulness
reduces the ruminative and elaborative cognitive processes (e.g., Chapter 17) that underlie and maintain
stress-related disorders. Finally, Wilhelm and Crawford (Chapter 32) explore the fascinating e ect that
writing about stress and trauma has on physical and mental health outcomes. Importantly, they provide
evidence for situations in which expressive writing is not an e ective stress-reduction strategy and may
even be harmful. In the nal chapter of the volume (Chapter 33, Hayden and Harkness), we provide an
integrative discussion of the common and unique themes presented, with a particular eye to guiding future
research in this exciting and evolving eld.

Over 1 billion people worldwide su er from a mental or substance use disorder, and these disorders are the
leading worldwide cause of disability (Institute for Health Metrics and Evaluation, 2018). As should be clear
by the breadth of coverage in this volume, stressful environments, and individual di erences in responses
to these environments, are key to understanding the etiology and course of all mental disorders. Further,
 stress mechanisms provide a robust theoretical and empirical framework upon which to focus prevention,
intervention, and novel treatment development priorities. Our goal in preparing this volume was to provide
in one authoritative work an overview of the most important and timely theory and research regarding the
role of stress in mental health. To the extent that we were successful in achieving this goal, it is because of
the authors who contributed their deep and broad knowledge of the eld to create expertly written chapters.
We extend our deepest gratitude to all of these contributors. We genuinely appreciate the time and
commitment that they have made to providing integrative summaries and, in many cases, major updates of
their previous work. We are also grateful to Oxford University Press, and in particular Sarah Harrington, for

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providing a vision for this volume and supporting this work from its inception through to publication.

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 The Oxford Handbook of Stress and Mental Health
Kate L. Harkness (ed.), Elizabeth P. Hayden (ed.)

https://doi.org/10.1093/oxfordhb/9780190681777.001.0001
Published: 2018 Online ISBN: 9780190681807 Print ISBN: 9780190681777

Downloaded from https://academic.oup.com/edited-volume/28307/chapter/214997930 by University of Edinburgh user on 09 September 2022

CHAPTER

1 Major Life Events: A Review of Conceptual, De nitional,

Measurement Issues, and Practices 
Scott M. Monroe, George M. Slavich

https://doi.org/10.1093/oxfordhb/9780190681777.013.1 Pages 7–26

Published: 08 January 2019

Abstract
The purpose of the present chapter is to provide an overview of key issues involving the de nition and
assessment of major life events for researchers interested in the e ects of life stress on a wide range of
disorders. General conceptual and de nitional issues are addressed initially, and a conceptual heuristic
is proposed for guiding inquiry on major life stress and human disorder. This heuristic is drawn upon
to develop principled practices for assessing, operationalizing, and nally quantifying major life
events. Throughout the chapter, contemporary approaches for research on major life events are
evaluated, their relative merits and shortcomings discussed, and their psychometric credentials
formally compared. In closing, we consider future directions for research on major life events and their
implications for health and disease.

Keywords: life stress, stressful life events, assessment, human disorder, health, disease
Subject: Clinical Psychology, Psychology
Series: Oxford Library of Psychology

Central to the concept of natural selection (Darwin, 1859)—the struggle for existence—is the idea
that the dynamic physical and social environments are full of obstacles, dangers, challenges, and
threats. They must be met with appropriate, discriminated, integrated (organismic) responses that
protect the organism. They must be overcome so that the organism survives to reproduce.

—Herbert Weiner (1992, p. 2)

The purpose of the present chapter is to provide an overview of key issues involving the de nition and
assessment of major life events, which we consider to be the “obstacles, dangers, challenges, and threats”
that are imposed by the dynamic physical and social environments people must overcome throughout their
lives. Although there are many types of circumstances that are more or less stressful, we focus on major life
events given that they typically impose substantial acute, adaptive demands upon the individual and can
have signi cant implications for mental and physical health. Other forms of life stress, such as early life