Chapter 12: Stress, Coping, and Health

The Relationship Between Stress and Disease Contagious diseases vs. chronic diseases Biopsychosocial model- 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 Discovery of causation, prevention, and treatment

Stress as an Everyday Event Stress- any circumstances that threaten or are perceived to threaten one’s well being and that thereby tax one’s coping ability Major stressors vs. routine hassles Cumulative nature of stress Cognitive appraisals 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

Major Types of Stress Frustration: blocked goal (Ex. traffic jams) Conflict: occurs when two or more incompatible motivations or behavioral impulses compete for expression Approach-approach- when a person has a choice between two attractive goals Avoidance-avoidance- when a person has a choice between two undesirable alternatives Approach-avoidance- when a choice must be made about whether to pursue a single goal that has both attractive and unattractive aspects

Major Types of Stress Change: having to adapt- any noticeable alterations in one’s living circumstances that require readjustment Social Readjustment Rating Scale- measures life change as a form of stress, giving higher points (life change units) for more stressful events Life Change Units Pressure: involves expectations or demands that one behave in a certain way, pressure to perform or to comply.

Figure 12.2 Types of conflict

Responding to Stress Emotionally Emotional responses Annoyance, anger, rage Apprehension, anxiety, fear Dejection, sadness, grief Positive emotions There are strong links between cognitive appraisals and which set of emotions one experiences as a function of a stressor; self-blame leads to guilt, helplessness to sadness, etc. Effects of emotional arousal The inverted-U-hypothesis-High emotion can sometimes negatively influence task performance, more so for highly complex tasks and less so for simple ones

Figure 12.3 Overview of the stress process

Figure 12.4 Arousal and performance

Responding to Stress Physiologically Selye’s General Adaptation Syndrome Alarm (fight-or-flight response)- occurs when an organism recognizes a threat and mobilizes resources Resistance- stage occurs when the stress is prolonged. This is a period when physiological arousal stabilizes but is still above baseline, as the organism copes with the stressor Exhaustion- occurs when the body’s resources are depleted. Selye believed that this is where diseases of adaptation come in Physiological effects of stress include the fight-or-flight response, discovered by Walter Cannon (1932). The FF response is a physiological reaction to threat in which the autonomic nervous system (ANS) mobilizes the organism for attacking (fight) or fleeing (flight) an enemy. The fight-or-flight response is adaptive if one is faced with a predator; however, modern stressors are more long term (the checkbook). Hans Selye began studying stress in the 1930s to determine the effects of these chronic stressors. He used an animal model, exposing them to both physical and psychological stressors to determine effects, which were nonspecific. That is, the reactions did not relate to the type of stress. Selye formulated a theory about how stress reactions occur called the general adaptation syndrome. The alarm stage occurs when an organism recognizes a threat and mobilizes resources – essentially enters the FF response. The resistance stage occurs when the stress is prolonged. This is a period when physiological arousal stabilizes but is still above baseline, as the organism copes with the stressor. The exhaustion stage occurs when the body’s resources are depleted. Selye believed that this is where diseases of adaptation come in. Psychologists have also identified two major brain-body pathways by which stress affects the body. First, the hypothalamus signals the adrenal glands to produce catecholamines, which ready the body for action. The second pathway is from the hypothalamus to the pituitary gland, which produces corticosteroids.

Responding to Stress Physiologically Brain-body pathways First, the hypothalamus signals the adrenal glands to produce catecholamines, which ready the body for action The second pathway is from the hypothalamus to the pituitary gland, which produces corticosteroids

Figure 12.5 Brain-body pathways in stress

Responding to Stress Behaviorally Coping- active efforts to master, reduce, or tolerate the demands created by stress Styles of coping Learned helplessness- passive behavior produced by exposure to unavoidable aversive events Frustration-aggression hypothesis- aggression is always caused by frustration Self-indulgence-eating, drinking, smoking, shopping Defensive coping-erecting defense mechanisms Constructive coping-realistically appraising situations and confronting problems directly

Stress and Physical Health Psychosomatic diseases- as physical ailments with a genuine organic basis that are caused in part by psychological factors, especially emotional distress…things like hypertension, ulcers, asthma, eczema, and migraine headaches Heart disease- accounts for nearly one-third of the deaths in the U.S. each year, and atherosclerosis, or gradual narrowing of the coronary arteries, is the principle cause of CHD Type A behavior—three elements strong competitiveness impatience and time urgency anger and hostility

Stress and Physical Health Emotional reactions and depression reactions can trigger cardiac symptoms in patients with stable coronary disease. Depressive disorders may also be a risk factor for heart disease, with some studies showing that the risk of CHD is doubled with depression Stress and immune functioning 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, and decreasing white blood cells called lymphocytes. The featured study in the text explores the effects of stress on contracting the common cold

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

Factors Moderating the Impact of Stress Social support- provided by members of one’s social network, appear to decrease the negative impact of stress Increased immune functioning Optimism More adaptive coping Pessimistic explanatory style Positive effects the 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

Health-Impairing Behaviors Smoking- health risks decline quickly for those who give up smoking, but quitting is difficult and relapse rates are high Poor nutrition and lack of exercise- poor nutritional habits and lack of exercise have been linked to heart disease, hypertension, and cancer, among other things Transmission, misconceptions, and prevention of AIDS- Misconceptions about AIDS are common, either overestimations or underestimations of risk. Many young heterosexuals downplay their risk for HIV, causing them not to adopt the behavioral practices that minimize risk

Figure 12.8 The prevalence of smoking in the United States

Communication with health care providers Reactions to Illness Seeking treatment Ignoring physical symptoms Many reactions to illness are not conducive to health. For example, many people ignore physical symptoms, resulting in delay in medical treatment Communication with health care providers Barriers to effective communication Even when they seek medical help, communication between patients and health care providers is not always honest or efficient Many reactions to illness are not conducive to health. For example, many people ignore physical symptoms, resulting in delay in medical treatment. Even when they seek medical help, communication between patients and health care providers is not always honest or efficient. Noncompliance with medical advice is a serious issue. Noncompliance is more likely if instructions are hard to understand, when they are difficult to follow, and when patients are unhappy with their doctor.

Reactions to Illness Following medical advice Noncompliance Noncompliance with medical advice is a serious issue. Noncompliance is more likely if instructions are hard to understand, when they are difficult to follow, and when patients are unhappy with their doctor