Chapter 12: Stress, Coping, and Health

What is Stress ? Stress –the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging Stressors Catastrophes Life changes Hassles Intervening factors Appraisal Perceived control Personality Social support Coping behaviors Stress reactions Physiological Emotional Behavioral

The Relationship Between Stress and Disease Contagious diseases vs. chronic diseases –Biopsychosocial model –Health psychology Health promotion and maintenance Discovery of causation, prevention, and treatment

WWBCopyright © Allyn & Bacon 2006 The Biopsychosocial Model of Health and Stress Focuses on health as well as on illness Holds that both are determined by a combination of biological, psychological, and social factors. Most health psychologists endorse this model.

WWBCopyright © Allyn & Bacon 2006 Health and Illness Wellness –An approach encompassing Lifestyle preventive care the need to maintain wellness rather than thinking of health matters only after a sickness Biomedical Model –Explains illness solely in terms of biological factors Biopsychosocial Model –Focuses on health as well as illness –Both are determined by a combination of biological, psychological, and social factors Health Psychology –Devoted to understanding psychological influences on how people stay healthy why they become ill how they respond when they do get ill.

Major Types of Stress Frustration: blocked goal Conflict: incompatible motivations –Approach-approach –Avoidance-avoidance –Approach-avoidance Change: having to adapt –Social Readjustment Rating Scale –Life Change Units Pressure –Perform/conform

Stressful Life Events Catastrophic Events –earthquakes, combat stress, floods Life Changes –death of a loved one, divorce, loss of job, promotion Daily Hassles –rush hour traffic, long lines, job stress, burnout Perceived Control –loss of control can increase stress hormones

WWBCopyright © Allyn & Bacon 2006 Sources of Stress Social Readjustment Rating Scale (SRRS) –Outline of 43 life events from most to least stressful. –Point value assigned to each event. –Negative or positive events both cause stress. –Point totals describe impact of stress and chance of illness over a two year period. –Score have 50% chance of stress related illness within 2 years. –Score have 80% chance of stress related illness within 2 years. Shortcomings of SRRS include: –Individual’s coping styles not taken into account. –Good coping strategies reduce impact of each stressful event

WWBCopyright © Allyn & Bacon 2006 Holmes & Rahe’s Social Readjustment Scale 100 death of a spouse 73 divorce 65 marital separation 63 detention in jail or other institution 63 death of a close family member 53 major personal injury or illness 50 marriage 47 fired from work 45 marital reconciliation 45 retirement 44 change in health or behavior of family member 40 pregnancy 40 sex difficulties 39 gain of new family member through birth, adoption, or marriage 39 major business readjustment 38 change in financial state 37 death of close friend 36 change to a different line of work 35 change in number of arguments with partner 31 taking on a new mortgage 30 foreclosure on a mortgage or loan 29 Change in responsibilities 29 Change in responsibilities 29 Son/daughter leaves home 29 Son/daughter leaves home 29 Trouble with in-laws 29 Trouble with in-laws 28 Outstanding personal achievement 28 Outstanding personal achievement 26 Partner begins/stops work 26 Partner begins/stops work 26 Starting or finishing school 26 Starting or finishing school 25 Change in living conditions 25 Change in living conditions 24 Revision of personal habits 24 Revision of personal habits 23 Trouble with boss 23 Trouble with boss 20 Change in working hours or conditions 20 Change in working hours or conditions 20 change in residence 20 change in residence 20 change in schools 20 change in schools 19 Change in recreational habits 19 Change in recreational habits 19 Change in church activities 19 Change in church activities 18 Change in social activities 18 Change in social activities 17 Major purchase such as a new car 17 Major purchase such as a new car 16 Change in sleeping habits 16 Change in sleeping habits 15 Change in number of family gatherings 15 Change in number of family gatherings 15 Change in eating habits 15 Change in eating habits 13 Vacation 13 Vacation 12 Christmas or holiday observance 12 Christmas or holiday observance 11 minor violation of the law 11 minor violation of the law

WWBCopyright © Allyn & Bacon 2006 Daily Hassles and Uplifts Hassles –little stressors including irritating demands that can cause more stress than major life changes. –Irritating, frustrating, distress demands of daily life –Relationship troubles –Health problems –Hectic daily schedules Amount of stress from hassles can vary from person to person. Hassles are bettor predictors of psychological distress. Uplifts - positive experiences which may neutralize hassles. Uplifts for some are hassles for others Ten Most Common Hassles for College Students 1. Troubling thoughts about future 2. Not getting enough sleep 3. Wasting time 4. Inconsiderate Smokers 5. Physical Appearance 6. Too many things to do 7. Misplacing or losing things 8. Not enough time to do the things you need to do 9. Concerns about meeting high standards 10. Being Lonely

WWBCopyright © Allyn & Bacon 2006 Making Choices Approach-Approach –A choice between two positive alternatives. –Choosing a movie to see –Continuing a career or raising a child Avoidance-Avoidance:   –A forced choice between two negative alternatives. –Avoid studying for a test or failing a test Approach-Avoidance  –A choice that has both a good and bad alternative. –Drawn by a choice and repelled by a choice –Wanting to take a vacation but having to empty your savings account to do it

Figure 12.2 Types of conflict

Figure 12.3 Overview of the stress process

Responding to Stress Emotionally Emotional responses –Annoyance, anger, rage –Apprehension, anxiety, fear –Dejection, sadness, grief –Positive emotions Effects of emotional arousal –The inverted-U-hypothesis

Figure 12.4 Arousal and performance

WWBCopyright © Allyn & Bacon 2006 Responding to Stress The General Adaptation Syndrome –The predictable sequence of reactions (stages) that organisms show in response to stressors –Alarm Stage a burst of energy that aids in dealing with the stressful situation –Adrenal cortex releases hormones called glucocorticoids –Increases heart rate, blood pressure, and blood sugar levels –Resistance Stage Intense physiological efforts to either resist or adapt –Glucocorticoids continue to be released –Length of stage based on stressor intensity and ability to adapt –Exhaustion Stage Occurs if an organism fails in its efforts to resist the stressor –Stores of energy are depleted –Disintegration and death may follow

Responding to Stress Physiologically Selye’s General Adaptation Syndrome –Alarm –Resistance –Exhaustion Brain-body pathways –Adrenal gland and catecholamines –Pituitary gland and corticosteroids

General Adaptation Syndrome Phase 1: Alarm Reaction Phase 2: Resistance (cope) Phase 3: Exhaustion Stress Resistance

Endocrine Responses to Stress Fight or flight preparation of body Stress hormones—produced by adrenal glands –Adrenal medulla—catecholamines Epinephrine and norepinephrine Increases respiration, BP, heart rate –Adrenal cortex—corticosteroids Release stored energy Reduces inflammation and immune system responses

Figure 12.5 Brain-body pathways in stress

Stress and Disease Negative emotions and health-related consequences Unhealthy behaviors (smoking, drinking, poor nutrition and sleep) Negative emotions Stress hormones Heart disease Immune suppression Autonomic nervous system effects (headaches, hypertension)

WWBCopyright © Allyn & Bacon 2006 The Immune System and Stress Negative Effects on the Immune System –Periods of high stress are correlated with Symptoms of infectious disease Oral and genital herpes and mononucleosis Susceptibility to colds and flu –Stress may reduce the effectiveness of vaccines –Decrease levels of B and T cells –Can worsen autoimmune diseases –Increase illness behaviors, reporting and seeking medical care –Suppresses immune system long after a stressful event is over Increased academic pressures, poor marital relationships, severe depression, and sleep deprivation due to suppressed immune system Severe bereavement affects physical and mental ailments up to 2 years following a partner’s death

WWBCopyright © Allyn & Bacon 2006 The Immune System and Stress Psychoneuroimmunology –A field in which psychologists, biologists, and medical researchers combine their expertise to study the effects of psychological factors on the immune system Psychological factors are related to immune system functioning –Immune system exchanges information with the brain that can enhance or suppress it Good Effects on Immune System –Rich social life with frequent interaction others –Close social ties to family, friends, co-workers, religious and volunteer groups

Stress and Physical Health Psychosomatic diseases Heart disease –Type A behavior—three elements strong competitiveness impatience and time urgency anger and hostility –Emotional reactions and depression Stress and immune functioning –Reduced immune activity

WWBCopyright © Allyn & Bacon 2006 Coronary Heart Disease Personality Type Type A Behavior Pattern –Marked by a sense of urgency, impatience, excessive competitiveness, hostility, and anger –Involved in a chronic, incessant struggle to achieve more and more in less and less time –Considered a risk factor in heart disease Hostility is a key component of the Type-A behavior pattern.

Figure 12.6 Anger and coronary risk

Table 12.3 Health Problems that may be Linked to Stress

Figure 12.7 The stress-illness correlation

Responding to Stress Behaviorally Coping Styles of coping –Learned helplessness –Frustration-aggression hypothesis –Self-indulgence –Defensive coping –Constructive coping

Response to Stress Psychological Factors –Perception of control –Explanatory style –Chronic negative emotions –Hostility Social Factors –Outside resources –Friends and family –Positive relationships

Factors Moderating the Impact of Stress Social support –Increased immune functioning Optimism –More adaptive coping –Pessimistic explanatory style Positive effects

Coping Strategies Defensive coping Use of defense mechanisms as protection against the unpleasant emotions brought on by stress. Small illusions may be beneficial, large distortions are maladaptive. Constructive coping Confront problems directly Realistic appraisal of stress and coping resources Learn to recognize and stop disruptive emotional reactions Make efforts to protect the body from the damaging effects of stress

WWBCopyright © Allyn & Bacon 2006 Personal Support and Stress A strong social support network can help a person recover faster from an illness.

WWBCopyright © Allyn & Bacon 2006 Personal Factors Reducing The Impact of Stress and Illness Optimists –Cope more effectively with stress –Reduces risk of illness –Generally expect good outcomes –Find positives even in the darkest circumstances –Generally more stress resistant Pessimists –Expect bad outcomes –Hopelessness Moderate to high levels died from all causes at two to three times the rates

Health-Impairing Behaviors Smoking Poor nutrition Lack of exercise Transmission, misconceptions, and prevention of AIDS

Figure 12.8 The prevalence of smoking in the United States

Reactions to Illness Seeking treatment –Ignoring physical symptoms Communication with health care providers –Barriers to effective communication Following medical advice –Noncompliance