Chapter 13 Health, Stress, and Coping

Health Psychology Uses behavioral principles to prevent illness and death, and promote health Behavioral medicine: Applies psychology to manage medical problems (e.g., asthma and diabetes) Lifestyle diseases: Diseases related to health-damaging personal habits (e.g., strokes and lung cancer)

Behavioral Risk Factors Actions that increase the chances of disease, injury, or premature death Disease-prone personality: Personality type associated with poor health; person tends to be chronically depressed, anxious, hostile, and frequently ill

Ways to Promote Health and Early Prevention Refusal skills training: Program that teaches young people how to resist pressures to begin smoking (can also be applied to other drugs) Life skills training: Teaches stress reduction, self-protection, decision making, self-control, and social skills

Community Health Campaign Community-wide education program that provides information about how to decrease risk factors and promote health

More Ways to Promote Health Role model: Person who serves as a positive example of good and desirable behavior Wellness: Positive state of good health and well-being; more than the absence of disease

Table 13-1, p. 427

Table 13-2, p. 428

General Adaptation Syndrome (GAS, Selye) Series of bodily reactions to prolonged stress; occurs in three stages:

Alarm Reaction Body resources are mobilized to cope with added stress

Stage of Resistance Body adjusts to stress but at a high physical cost; resistance to other stressors is lowered

Stage of Exhaustion Body’s resources are drained and stress hormones are depleted, possibly resulting in psychosomatic disease, loss of health, or complete collapse

Figure 13.2 The General Adaptation Syndrome. During the initial alarm reaction to stress, resistance falls below normal. It rises again as bodily resources are mobilized, and it remains high during the stage of resistance. Eventually, resistance falls again as the stage of exhaustion is reached. (From The Stress of Life by Hans Selye. Copyright © 1978 by Hans Selye. Used by permission of McGraw-Hill Book Company.) Fig. 13-2, p. 431

Video: Hans Selye and His Research Apparatus

Stress Stress: Mental and physical condition that occurs when a person must adjust or adapt to the environment Includes marital and financial problems Eustress: Good stress Stress reaction: Physical reaction to stress Autonomic nervous system is aroused

Stressor Condition or event in environment that challenges or threatens the person Pressure: When a person must meet urgent external demands or expectations

Figure 13.2 The General Adaptation Syndrome. During the initial alarm reaction to stress, resistance falls below normal. It rises again as bodily resources are mobilized, and it remains high during the stage of resistance. Eventually, resistance falls again as the stage of exhaustion is reached. (From The Stress of Life by Hans Selye. Copyright © 1978 by Hans Selye. Used by permission of McGraw-Hill Book Company.) Fig. 13-2, p. 431

Immunity Immune system: Mobilizes bodily defenses, like white blood cells, against invading microbes and other diseases Psychoneuroimmunology: Study of connections among behavior, stress, disease, and immune system

Stress Management Use of cognitive behavioral strategies to reduce stress and improve coping skills Progressive relaxation: Produces deep relaxation throughout the body by tightening all muscles in an area and then relaxing them Guided imagery: Visualizing images that are calming, relaxing, or beneficial in other ways

Avoiding Upsetting Thoughts Stress inoculation: Using positive coping statements internally to control fear and anxiety Designed to combat negative self-statements (self-critical thoughts that increase anxiety and lower performance) Coping statements: Reassuring, self-enhancing statements used to stop self-critical thinking

Figure 13.9 The stress game. (Adapted from Rosenthal and Rosenthal, 1980.) Fig. 13-9, p. 455

Signs and Symptoms of Ongoing Stress Emotional signs: Anxiety, apathy, irritability, mental fatigue Behavioral signs: Avoidance of responsibilities and relationships, extreme or self-destructive behavior, self-neglect, poor judgment Physical signs: Excessive worry about illness, frequent illness, overuse of medicines

Burnout Job-related condition (usually in helping professions) of physical, mental, and emotional exhaustion; has three aspects: Emotional exhaustion: Feel “used up” and apathetic toward work Cynicism: Detachment from the job Feeling of reduced personal accomplishment

Appraising Stressors Primary appraisal: Deciding if a situation is relevant or irrelevant, positive or threatening Secondary appraisal: Assess resources and decide how to cope with a threat or challenge Perceived lack of control is just as threatening as an actual lack of control

Table 13-3, p. 433

Figure 13.3 Stress is the product of an interchange between a person and the environment. Fig. 13-3, p. 434

Video: Health and Stress

Threats Emotion-focused coping: Trying to control one’s emotional reactions to the situation Problem-focused coping: Managing or remedying the distressing situation Traumatic stresses: Extreme events that cause psychological injury or intense emotional pain

Frustration Negative emotional state that occurs when one is prevented from reaching desired goals External frustration: Based on external conditions that impede progress toward a goal Personal frustration: Caused by personal characteristics that impede progress toward a goal

Reactions to Frustration Aggression: Any response made with the intention of harming a person, animal, or object Displaced aggression: Redirecting aggression to a target other than the source of one’s frustration Targets tend to be safer, less likely to retaliate Scapegoating: Blaming a person or group for conditions they did not create; the scapegoat is a habitual target of displaced aggression

Reactions to Frustration (cont) Escape: May mean actually leaving a source of frustration (dropping out of school) or psychologically escaping (apathy) Conflict: Stressful condition that occurs when a person must choose between contradictory needs, desires, motives, or demands

Figure 13.4 Frustration and common reactions to it. Fig. 13-4, p. 436

Conflicts

Approach-Approach Conflicts Having to choose between two desirable or positive alternatives (e.g., choosing between a new BMW or Mercedes)

Avoidance-Avoidance Conflicts Being forced to choose between two negative or undesirable alternatives (e.g., choosing between going to the doctor or contracting cancer) NOT choosing may be impossible or undesirable

Approach-Avoidance Conflicts Being attracted (drawn to) and repelled by the same goal or activity; attraction keeps person in the situation, but negative aspects can cause distress

Ambivalence Mixed positive and negative feelings; central characteristic of approach-avoidance conflicts Can also be simultaneous attraction and repulsion

Figure 13.5 Three basic forms of conflict. For this woman, choosing between pie and ice cream is a minor approach-approach conflict; deciding whether to take a job that will require weekend work is an approach-avoidance conflict; and choosing between paying higher rent and moving is an avoidance-avoidance conflict. Fig. 13-5, p. 438

Figure 13.6 Conflict diagrams. As shown by the colored areas in the graphs, desires to approach and to avoid increase near a goal. The effects of these tendencies are depicted below each graph. The “behavior” of the ball in each example illustrates the nature of the conflict above it. An approach conflict (left) is easily decided. Moving toward one goal will increase its attraction (graph) and will lead to a rapid resolution. (If the ball moves in either direction, it will go all the way to one of the goals.) In an avoidance conflict (center), tendencies to avoid are deadlocked, resulting in inaction. In an approach-avoidance conflict (right), approach proceeds to the point where desires to approach and avoid cancel each other. Again, these tendencies are depicted (below) by the action of the ball. (Graphs after Miller, 1944.) Fig. 13-6, p. 438

Multiple Conflicts Double approach-avoidance conflicts: Each alternative has both positive and negative qualities Vacillation: When one is attracted to both choices; seeing the positives and negatives of both choices and going back and forth before deciding, if deciding at all Multiple approach-avoidance conflicts: When several alternatives have positive and negative features

Anxiety Feelings of tension, uneasiness, apprehension, worry, and vulnerability We are motivated to avoid experiencing anxiety

Freudian Ego Defense Mechanisms Habitual and unconscious mental processes designed to reduce anxiety Work by avoiding, denying, or distorting sources of threat or anxiety If used in the short term, can help us get through everyday situations If used in the long term, we may end up not living in reality

Freudian Ego Defense Mechanisms: Some Examples Denial: Most primitive; refusing to accept or believe reality; usually occurs with death and illness Repression: When painful memories, anxieties, and so on are unconsciously held out of our awareness Reaction formation: Impulses are repressed and the opposite behavior is exaggerated

More Freudian Ego Defense Mechanisms Projection: When one’s own feelings, shortcomings, or unacceptable traits and impulses are seen in others; exaggerating negative traits in others lowers anxiety Rationalization: Justifying personal actions by giving “rational” but false reasons for them

Table 13-4, p. 441

Learned Helplessness (Seligman) Acquired (learned) inability to overcome obstacles and avoid aversive stimuli; learned passivity Occurs when events appear to be uncontrollable May feel helpless if failure is attributed to lasting, general factors

Figure 13.7 In the normal course of escape and avoidance learning, a light dims shortly before the floor is electrified (a). Because the light does not yet have meaning for the dog, the dog receives a shock (noninjurious, by the way) and leaps the barrier (b). Dogs soon learn to watch for the dimming of the light (c) and to jump before receiving a shock (d). Dogs made to feel “helpless” rarely even learn to escape shock, much less to avoid it. Fig. 13-7, p. 443

Depression State of despondency defined by feelings of powerlessness and hopelessness One of the most common mental problems in the world Childhood depression is dramatically increasing Some symptoms: Loss of appetite or sex drive, decreased activity, sleeping too much

Mastery Training Responses are reinforced that lead to mastery of a threat or control over one’s environment One method to combat learned helplessness and depression

How to Recognize Depression (Beck) You have a consistently negative opinion of yourself You engage in frequent self-criticism and self-blame You place negative interpretations on events that usually would not bother you The future looks grim You can’t handle your responsibilities and feel overwhelmed

Stress and Health Social Readjustment Rating Scale (SRRS): Rates the impact of various life events on the likelihood of contracting illness Not a foolproof method of rating stress Are positive life events (getting married, having a child) always stressful? People also differ in their reactions to stress

Microstressors (Hassles) Any distressing day-to-day annoyance

Acculturative Stress Caused by many changes and adaptations required when a person moves to a foreign culture

Psychosomatic Disorders Psychological factors contribute to actual illnesses (bodily damage) or to damaging changes in bodily functioning Hypochondriacs: Complain about diseases that appear to be imaginary Certain kinds of ulcers are not psychosomatic Most common complaints: respiratory and gastrointestinal

Biofeedback Applying informational feedback to bodily control Aids voluntary regulation of activities such as blood pressure, heart rate, and so on Helpful but not an instant cure May help relieve muscle-tension headaches, migraine headaches, and chronic pain

Figure 13.8 In biofeedback training bodily processes are monitored and processed electronically. A signal is then routed back to the patient through headphones, signal lights, or other means. This information helps the patient alter bodily activities not normally under voluntary control. Fig. 13-8, p. 449

Cardiac Personalities Type A personality: Personality type with elevated risk of heart disease; characterized by time urgency and chronic anger or hostility Anger may be the key factor of this behavior Type B personality: All types other than Type As; unlikely to have a heart attack

Hardy Personality Personality type associated with superior stress resistance Sense of personal commitment to self and family Feel they have control over their lives See life as a series of challenges, not threats