Stress, Health and Coping Sources of Stress Responding to Stress Health and Illness Lifestyle and Health Health and Stress notes: Health psychology is a multidimensional approach that emphasizes psychological factors, lifestyle, and the nature of the health-care delivery system.

Sources of Stress Hassles Choices Unpredictability and Lack of Control Stress in the workplace Catastrophic Events Posttraumatic stress disorder (PTSD) Racism SOURCES OF STRESS Stress is the physiological and psychological response to a condition that threatens or challenges an individual and requires some form of adaptation or adjustment. Everyone experiences stress differently, but it is usually felt in the body: headaches, ulcers, and heart palpitations can all be manifestations of stress. According to Lazarus, daily hassles typically cause more stress than major life changes. Little stressors, hassles, can add up to more stress then major live events. Thus the phrase, “That’s the straw that broke the camel’s back!” The choices available to us can cause stress. These can be positive or negative choices. Stressors that are unpredictable and uncontrollable are more stressful than those that are predictable and controllable. Think about the difference between moving to a new apartment that you carefully chose, and being evicted, forcing you into a new apartment that you would not have chosen. We spend most of our waking hours at work, so workplace stressors carry a lot of weight. Job stress can cause serious illnesses, such as depression, high blood pressure, and cardiovascular disease; it can also cause headaches, exhaustion, absenteeism, and reduced productivity. However, unemployment is also a significant source of stress for most people. Posttraumatic stress disorder (PTSD) is a prolonged, severe stress reaction to a catastrophic event. The event can be natural (earthquake, fire) or manmade (war,

Conflict with Choices Approach-Approach Avoidance-Avoidance Having choices is a good thing, right? But choices can also cause stress – how should we choose? Approach-Approach: A choice between two positive alternatives. Two cute guys asked me out for Friday night – how should I choose? Approach-Avoidance: A choice that has both a good and bad alternative. I want to go to India, but I don’t want to get shots first. Should I stay or should I go? Avoidance-Avoidance: A forced choice between two negative alternatives. I need to go my in-laws for dinner or I could stay home and argue with my husband about them. Should I stay or should I go? Overload is the occurrence of stimuli so intense that the person cannot cope with them. Ambivalence: Mixed positive and negative feelings; central characteristic of approach-avoidance conflicts. Most people think “ambivalence” is the same as “apathy” (literally: no feelings… “I don’t care.”), but the “ambi” in ambivalence means “both” – you have both positive and negative feelings.

Workplace Stress Factors Workload Clarity of job description Physical Job status Accountability Task variety Human contact Physical challenge Mental challenge Researchers have found that jobs with high demand but low control are most stressful. One study found that the most stressful occupations (using stress-related illness as the measure) include construction workers, secretaries, laboratory technicians, waiters and waitresses, machine operators, farm workers, and painters. Growing occupational stress is a problem of particular significance for women, in part, because of sex-specific stressors in the workplace, namely sex discrimination, sexual harassment, and problems in combining work and family. These additional stressors have been shown to have negative effects on the health and well-being of women beyond the ill effects of general job stressors (Swanson, 2000). Burnout is a hopeless, helpless feeling brought about by relentless work-related stress. It is a job-related condition (usually in helping professions) of physical, mental, and emotional exhaustion. Involves: Emotional exhaustion; feel used up and apathetic towards work Depersonalization: Detachment from others Feeling of reduced personal accomplishment An issue of the American Psychologist (Vol. 45, Oct. 1990) focused on stress in the workplace. One article (Sauter, Murphy, & Hurrell, 1990) discusses the National Institute for Occupational Safety and Health's proposal to address the effects of workplace stress. The report emphasizes improving working conditions and making

General Adaptation Syndrome Alarm Resistance Exhaustion The GAS The stages of the general adaptation syndrome (GAS) can be encoded with the acronym ARE (alarm, resistance, exhaustion). During the alarm stage, emotional arousal prepares the body to deal with a threat. The resistance stage is characterized by attempts to defend the body against the stressor. Finally, in the exhaustion stage, the body can no longer fight the stressor. Alarm – heart rate, blood pressure, and blood-sugar levels increase giving person energy to cope with stressful situation (“Red Alert!”). Resistance – the adrenal cortex continues to release glucocorticoids to help the body resist stressors. Exhaustion – all of the stores of deep energy are depleted. On the left side of the chart, you can see “Adaptive” and “Maladaptive”. The initial shock of the stressor initiates a maladaptive state, in which the body and mind feel out of balance. The Alarm is sounded and the body/mind begin to adapt to the stressor (which may mean fighting, choosing, or any number of appropriate responses). During the exhaustion stage, the body/mind has run out of energy and may return to a maladaptive state.

Lazarus’s Cognitive Theory of Stress Primary Appraisal Secondary Appraisal Hassles and Uplifts The Social Readjustment Rating Scale Lazarus's Cognitive Approach Lazarus proposed that the perception of a stressor is more important than the stressor itself. This approach suggests that we can control the effects of even unpredictable, uncontrollable stressors by controlling how we think about them. Cognitive Appraisal is an individuals’ interpretation of events in their lives as harmful, threatening, or challenging, and the determination of whether individual has the resources to effectively cope with the event. Primary Appraisal: Deciding if a situation is relevant to oneself and if it is a threat, irrelevant, or positive. Perceived lack of control is just as threatening as an actual lack of control. Secondary Appraisal: Deciding how to cope with a threat or challenge. If the situation is within the persons control they evaluate available resources to alleviate the stress. Hassles and Uplifts Lazarus's theory and research suggest that daily hassles and uplifts may be more important to the stress-health relationship than major life events. The Social Readjustment Rating Scale The SRRS embodies one approach to the study of stress. The underlying assumption is that the effects of stress on health result from an accumulation of life stressors within a fixed period of time. Some studies have found correlations between SRRS

Coping Strategies Problem-focused coping Emotion-focused coping Proactive coping Healthy vs. not healthy strategies Lots of terms! Coping Strategies Coping strategies are our various ways of managing taxing circumstances, expending effort to solve life’s problems, and seeking to master or reduce stress. Problem-focused coping: consists of reducing, modifying, or eliminating the source of stress itself. (“I can fix this problem.”) Emotion-focused coping: Trying to control one’s emotional reactions to the situation (“I won’t get mad.”) Proactive coping: consists of efforts or actions taken in advance of a potentially stressful situation to prevent its occurrence or to minimize its consequences. (“I can stop a problem before it starts.”) Determining whether a stressor calls for problem-focused or emotion-focused coping is the key to managing its effects. The changeable aspects of stressors are amenable to problem-focused coping, while those that cannot be altered require emotion-focused coping…in other words, if you can’t fix the problem, change your attitude about the problem. I like to believe that everything happens for a reason, even if I don’t know what that reason is at the time. For example, if I lose a job, there always seems to be a better one around the corner. Not-so-healthy coping strategies: Pessimism and negative thinking…the glass is half empty. Avoidance strategies and passive behavior…avoid making decisions, letting others make decisions

Personality types and stress Type A behavior pattern Type B behavior pattern Hardy behavior pattern Disease-prone behavior pattern In the next lesson, we’ll be discussing personality theories in depth, but here are some broad categories of personalities as they relate to stress: Type A behavior pattern: A person with this behavior pattern has a strong sense of time urgency and is impatient, excessively competitive, hostile, and easily angered, with a cluster of characteristics thought to be related to the incidence of heart disease. He/She is hard-driven, impatient, and hostile…Hostility is the aspect of the Type A pattern most clearly linked to coronary heart disease. Type B behavior pattern: A person with this behavior pattern is relaxed and easygoing and does not suffer from a sense of time urgency, and is less likely to have a heart attack. This behavior pattern is characterized by a relaxed, easygoing approach to life. Hardy behavior pattern: A person with this behavior pattern is characterized by commitment, control, and a perception of problems as challenges. He/She has superior stress resistance, a sense of personal commitment to self and family, and a feeling that they have control over their lives. They see life as a series of challenges, not threats. Disease-Prone behavior pattern: This behavior pattern is associated with poor health; this type of person tends to be chronically depressed, anxious, hostile and frequently ill.

Emotional Reactions Anxiety Depression Learned helplessness Defense mechanisms Sour grapes Sweet lemons Rationalization Projection Denial Stress consists of two components: the emotional and the physiological. This slide lists a few of the emotional reactions. Anxiety and depression are the most common reactions to stress; BUT they can also be caused by biological factors. More about this in the lesson on disorders. Anxiety: Feelings of tension, uneasiness, apprehension, worry and vulnerability. We are motivated to avoid experiencing anxiety. Some symptoms: unassigned fear, shortness of breath, social claustrophobia/demophobia (fear of crowds) Depression: State of feeling despondent defined by feelings of powerlessness and hopelessness Some symptoms: Loss of appetite or sex drive, decreased activity, sleeping too much Learned Helplessness: Acquired (learned) inability to overcome obstacles and avoid aversive stimuli; learned passivity Occurs when events appear to be uncontrollable May feel helpless if you attribute failure to lasting, general factors 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

Health and Illness Biomedical model Biopsychosocial model Psychoneuroimmunology Lymphocytes Immune system GAS and ARE HEALTH AND ILLNESS Does stress cause health problems, or do health problems cause stress? Yes and yes! In some cases, it’s difficult to determine if the stress caused the illness or the other way around. There are different models for examining the interaction of the immune system and stress: The biomedical model focuses on illness, rather than on health, and explains illness in terms of biological factors. The biopsychosocial model focuses on health, as well as on illness, and holds that both are determined by a combination of biological, psychological, and social factors. Psychoneuroimmunology: Study of connections among behavior, stress, disease, and immune system and explores the connections among psychological factors (such as attitudes and emotions), the nervous system, and the immune system. Lymphocytes are cells the body produces to fight off infection or antigens, which are bacteria, viruses, etc. B cells produce antibodies that fight antigens that are outside the cell. T cells produce antibodies that fight antigens inside the cell. Stress and depression have been associated with lowered immune response, and stress has been linked with increased symptoms of various infectious diseases. The

Behavioral Risk Factors Cause of death Tobacco Diet/Inactivity Alcohol Infection Toxic agents Firearms Sexual behavior Motor vehicles Illicit use of drugs Behavioral Risk Factors Lifestyle Disease: Diseases related to health-damaging personal habits Behavioral Risk Factors: Behaviors that increase the chances of disease, injury, or premature death Coronary Heart Disease Heart disease is the number one killer in the industrialized world. It accounts for about one-third of all deaths. There is some evidence that personality is related to heart disease. However, lifestyle factors, including diet and exercise, are probably more important. Cancer Cancer is a collection of diseases, not a single entity. Behavior can increase the risk of cancer, such as smoking for lung cancer, and chewing tobacco for mouth cancers. 5 10 15 20 Percentage of all deaths The nine leading causes of death in the United States are shown in this graph. As you can see, eight of the top nine causes are directly related to behavioral risk factors (infection is the exception). At least 45 percent of all deaths can be traced to unhealthful behavior. The percentage of day-to-day health problems related to unhealthful behavior is even higher. (Data from McGinnis & Foege, 1993.)

Personal Factors That Reduce Stress Optimism/pessimism Hardiness (commitment, control, & challenge) Social support Religious faith Four personal factors can reduce the impact of stress and illness: optimism and pessimism. Your attitude can go a long way toward reducing stress. psychological hardiness. How you approach life’s challenges can go a long way toward reducing stress, too. social support. Having a network of friends and family to lean on can reduce stress. religious involvement. According to a very large study completed in the year 2000, a meta-analysis (an analysis of many similar studies) of 42 different studies, involving data from some 126,000 individua1s, revealed that measures of religious involvement were reliable predictors of greater longevity when all causes of mortality were considered (McCullough et al., 2000). The specific measures of religious involvement most closely related to lower mortality rates were regular attendance at worship services, religious orthodoxy, and finding comfort and strength in one's religion. This study and others have found the association between religious involvement and lower mortality to be stronger for women than for men (Hummer, 1999: Strawbridge et al., 1997). I’m not suggesting that God is making people healthier – you can believe what you’re comfortable with – but that the BELIEF in a higher power gives comfort and reduces stress. Overall, the available evidence suggests that religious involvement is positively associated with measures of physical health and lower rates of cancer, heart disease, and stroke (McCullough, 2000).

Lifestyle and Stress Smoking Alcohol abuse Exercise Diet and nutrition If you need to quit: http://www.cdc.gov/tobacco/how2quit.htm Alcohol abuse If you need help: http://www.aa.org/ Exercise Diet and nutrition LIFESTYLE AND HEALTH Slightly over 50% of all deaths in this country can be attributed to unhealthy lifestyle factors, which include smoking, overeating, an unhealthy diet, too much alcohol, drug abuse, and/or too little exercise and rest. Smoking is considered the single most preventable cause of death, because it is directly related to 434,000 deaths each year, including deaths from heart disease, cancer, lung disease, and stroke. Alcohol abuse damages virtually every organ in the body, including the liver, stomach, skeletal muscles, heart, and brain; and it is involved in over 50% of motor vehicle accidents. Regular aerobic exercise reduces the risk of cardiovascular disease, increases muscular strength, moderates the effects of stress, makes bones denser and stronger, and helps one maintain a desirable weight. Smoking Smoking is responsible for more than 400,000 deaths each year in the U.S. Because people can choose to smoke or not to smoke, the US Surgeon General continues to warn that smoking remains the number one cause of preventable disease and death in the United States (Surgeon General's Report 2000). That message appears to be taking root because the percentage or Americans who smoke is decreasing. The prevalence of smoking among adults is now under 25% (CDC, 2000). But there are wide variations in smoking habits according to gender ethnic group. The highest rates