Chapter 13: Stress, Coping, and Health

The Relationship Between Stress and Disease Contagious diseases vs. chronic diseases Prior to the 20th century, the principal threats to health were contagious diseases caused by infectious agents: smallpox, diphtheria, influenza, etc. Advances in nutrition, public hygiene, and medical treatment have obliterated many of these diseases. Today, many of the worst illnesses that beset humans are caused by lifestyle choices (smoking, alcohol & drugs, overeating, etc.). Biopsychosocial model - The traditional view of illness as a purely biological phenomenon has given way to a new model, which holds that physical illness is caused by a complex interaction of biological, psychological, and sociocultural factors. Health psychology - the field of study that seeks to determine the importance of psychological factors in illness, as well as in prevention and health maintenance.

Figure 13.1 Changing patterns of illness

Stress: An Everyday Event Stress is defined as any circumstances that either challenge or threaten someone or are perceived to threaten one’s well being, which taxes a person’s ability to cope. Researchers have discovered that a bunch of minor stresses can add up to be just as stressful as a major traumatic event, illustrating the cumulative nature of stress. The experience of feeling stressed depends largely on cognitive processes; going on a new date is exciting for some, terrifying for others. People’s appraisals of events are very subjective and influence the effect of the event.

Psychologists have outlined 4 principle types of stress: Frustration occurs in any situation where the pursuit of a goal is stopped somehow. Conflict occurs when two or more incompatible motivations or behavioral impulses compete for expression. Kurt Lewin, a mid 20th century psychologist, theorized several conflict scenarios: Approach-Approach Approach-Avoidance Avoidance Avoidance Multiple Approach and Avoidance scenarios Life changes are any noticeable alterations in one’s living circumstances that require readjustment. Holmes and Rahe (1967) developed their Social Readjustment Rating Scale to attempt to measure life change as a form of stress, giving higher points (life change units) for more stressful events. Pressure involves expectations or demands that one behave in a certain way…pressure to perform or to comply.

Figure 13.2 Types of conflict

Responding to Stress Emotionally Stress responses are multidimensional, including the emotional, psychological, and behavioral realms. Potential Emotional Responses Annoyance, anger, rage Apprehension, anxiety, fear Dejection, sadness, grief Positive emotions – happiness, enthusiasm

Responding to Stress Emotionally There are strong links between cognitive appraisals and what set of emotions one experiences. For example, self-blame leads to guilt, helplessness to sadness, etc. Positive emotions may also occur during periods of stress, especially when one views the stressor(s) as challenging rather than threatening. Optimism in outlook works to reduce stress, which then promotes creativity and flexibility in problem solving, facilitates the process of recovery and coping, and provides a way of learning about oneself. High emotional arousal can sometimes negatively influence task performance, more so for highly complex tasks and less so for simple ones (the inverted-u-hypothesis also known as the Yerkes-Dodson Law).

Figure 13.5 Arousal and performance

Appraisal Theory Appraisal theory in psychology states that emotions are extracted from our evaluations (appraisals or assessments) of events that cause specific reactions in different people. Essentially, our appraisal of a situation causes an emotional, and/or behavioral response. Richard Lazarus (1984) identified two essential appraisal factors: 1) primary appraisal, regarding the significance or meaning of the event to the organism, and 2) secondary appraisal, directed at the assessment of the ability of the organism to cope with the consequences of the event. These two types go hand in hand and determine the degree of stress one experiences in relation to the event. For example, let’s say you’re about to give a speech in front of 500 of your peers. Your mouth goes dry, your heart beat quickens, your palms sweat, and your legs begin to shake and at the same time you experience a high degree of fear. Why? More than likely, primary appraisal shows that this is a significant event for you, and secondary appraisal is such that you aren’t sure you’re up to this task – you perceive it as a threat.

Figure 13.4 Overview of the stress process

Responding to Stress Physiologically Physiological Responses Fight-or-flight response - discovered by Walter Cannon (1932); the FF response is a physiological reaction to a threat in which the autonomic nervous system (ANS) mobilizes the organism for attacking (fight) or fleeing (flight) an enemy. Selye’s General Adaptation Syndrome (GAS) - Selye formulated a theory about how stress reactions occur and how they affect one’s physiological health called the General Adaptation Syndrome (GAS). The GAS offers three stages: Alarm Resistance Exhaustion The fight-or-flight response is adaptive if one is faced with a predator; however, modern stressors are more long term (the checkbook, or your girlfriend’s mood swings).

Responding to Stress Behaviorally Coping refers to active efforts to master, reduce, or tolerate the demands created by stress. These may involve giving up and blaming oneself. Self-indulgence (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly). Learned helplessness refers to passive behavior causesd by exposure to seemingly unavoidable aversive events. Can end up with the victim striking out at others aggressively, usually the result of frustration. Dollard’s frustration-aggression hypothesis. States that frustration arouses aggressive thought and behavior, which seeks a target to be released. It attempts to explain scapegoating, by claiming that frustration causes aggression, but when the source of the frustration cannot be challenged, the aggression gets displaced onto an innocent target. ).

Behavioral and Psychological Effects Impaired task performance - people under pressure to perform may feel self-conscious, which leads to disruption of attention and “choking” under pressure. Burnout - involves physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotionally demanding situations. Psychological disorders - Chronic stress might contribute to many types of psychological problems and mental disorders, from sleep problems and unhappiness, to full-fledged psychological disorders such as schizophrenia and depression. Positive effects - effects of stress are not entirely negative. Recent research suggests that stress can promote personal growth or self-improvement, forcing people to develop new skills, reevaluate priorities, learn new insights, and acquire new strengths. Roy Baumeister’s work shows that people under pressure to perform may feel self-conscious, which leads to disruption of attention and “choking” under pressure. Burnout involves physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotionally demanding situations…loss of meaning. Chronic stress might contribute to many types of psychological problems and mental disorders, from sleep problems and unhappiness, to full-fledged psychological disorders such as schizophrenia and depression. From a positive psychology perspective, effects of stress are not entirely negative. Recent research suggests that stress can promote personal growth or self-improvement, forcing people to develop new skills, reevaluate priorities, learn new insights, and acquire new strengths. Conquering a stressful challenge may also lead to improved coping abilities and increases in self-esteem.

Figure 13.7 The antecedents, components, and consequences of burnout

Effects of Stress: Physical Psychosomatic diseases - Historically, psychosomatic diseases were defined as physical ailments with a genuine organic basis that were caused at least in part by psychological factors, especially emotional stress. Things like hypertension, ulcers, asthma, eczema, and migraine headaches are among the most common. Now we know that stress contributes to a diverse array of other diseases once thought to be completely physiologically based. As a result, the term psychophysiological disorders has replaced psychosomatic as the term used in mental health circles. Heart disease - Heart disease causes 1/3 of the deaths in the U.S. each year, and arteriosclerosis is the principle cause of CHD. Risk factors for CHD include smoking, lack of exercise, high cholesterol levels, and high blood pressure – all of which can be stress related.

Effects of Stress: Physical Personality factors have been linked to risk for coronary heart disease. These personality characteristics have been collectively labeled Type A personality and include 3 main elements (intense competitiveness, time urgency/being impatient, and quick to become angry/hostile). The impatience and the hostility factors have been indicated as the most important predictors in this cluster of behaviors. High autonomic emotional reactivity (high strung) can trigger cardiac symptoms in patients with stable coronary disease. Mood disorders (depressive disorders) may also be a risk factor for heart disease, with some studies showing that the risk of coronary heart disease (CHD) is doubled with depression. Stress has also been shown to decrease the immune response, the body’s defensive reaction to invasion by bacteria, viral agents, or other foreign substances…decreasing white blood cells called lymphocytes.

Figure 13.12 The stress-illness correlation

Factors Moderating the Impact of Stress Social support Fosters increased immune functioning Optimistic Explanatory Style Positivity is the most highly correlated factor with both mental and physical health Fosters more adaptive coping mechanisms As opposed to a pessimistic explanatory style Conscientiousness Fosters better life and health habits Low Autonomic Reactivity Where cardiovascular reactivity to stress is minor

Health-Impairing Behaviors Smoking Poor nutrition Lack of exercise Alcohol and drug use Risky sexual behavior In other words, all the fun stuff. JK!!!