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Chapter 12: Stress, Coping, and Health

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1 Chapter 12: Stress, Coping, and Health

2 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 Prior to the 20th century, the principal threats to health were contagious diseases caused by infectious agents: smallpox, diphtheria, etc. Nutrition, public hygiene, and medical treatment have obliterated many of these diseases. Unfortunately, chronic diseases such as heart disease and cancer, diseases that develop gradually, continue to increase. The traditional view of physical illness as a purely biological phenomenon has given way to a new model, the biopsychosocial model, which holds that physical illness is caused by a complex interaction of biological, psychological, and sociocultural factors. Health psychology is the field of study that seeks to determine the importance of psychological factors in illness, as well as in prevention and health maintenance.

3 Health and Illness Wellness Biomedical Model Biopsychosocial Model
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. WWB Copyright © Allyn & Bacon 2006 ST

4 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. WWB Copyright © Allyn & Bacon 2006

5 Stress as an Everyday Event
Major stressors vs. routine hassles Cumulative nature of stress Cognitive appraisals Stress is defined in the text as any circumstances that threaten or are perceived to threaten one’s well being and that thereby tax one’s coping ability. Researchers have discovered that minor stresses (Lazarus – daily hassles) like moving, experiencing changes in household responsibilities, etc. can add up to be as stressful as a major traumatic event like a divorce or disaster; 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.

6 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 foreclosure on a mortgage or loan 29      Change in responsibilities   29      Son/daughter leaves home   Trouble with in-laws   Outstanding personal achievement   26     Partner begins/stops work   Starting or finishing school   Change in living conditions   Revision of personal habits   Trouble with boss   20      Change in working hours or conditions   20       change in residence   20       change in schools   19       Change in recreational habits   Change in church activities   Change in social activities   Major purchase such as a new car   Change in sleeping habits   Change in number of family gatherings Change in eating habits Vacation Christmas or holiday observance minor violation of the law WWB Copyright © Allyn & Bacon 2006 ST

7 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 WWB Copyright © Allyn & Bacon 2006 ST

8 Daily Hassles and Uplifts
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 Troubling thoughts about future Not getting enough sleep Wasting time Inconsiderate Smokers Physical Appearance Too many things to do Misplacing or losing things Not enough time to do the things you need to do Concerns about meeting high standards Being Lonely WWB Copyright © Allyn & Bacon 2006 ST

9 Frustration: blocked goal Conflict: incompatible motivations
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 Psychologists have outlined four principle types of stress: Frustration, which occurs in any situation in which the pursuit of some goal is thwarted. Ex. traffic jams. Conflict occurs when two or more incompatible motivations or behavioral impulses compete for expression. Three types of conflict have been studied extensively: approach-approach – when a person has a choice between two attractive goals; avoidance-avoidance—when a person has a choice between two undesirable alternatives; and approach-avoidance – when a choice must be made about whether to pursue a single goal that has both attractive and unattractive aspects. This results in vacillation, or going back and forth: rats actually run up and down a ramp in this type conflict. Life changes are any noticeable alterations in one’s living circumstances that require readjustment. Holmes and Rahe (1967) developed the Social Readjustment Rating Scale 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.

10 Making Choices Approach-Approach   Avoidance-Avoidance:  
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 WWB Copyright © Allyn & Bacon 2006 ST

11 Figure 12.2 Types of conflict

12 Figure 12.3 Overview of the stress process

13 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 Stress responses are multidimensional, including emotional, psychological, and behavioral realms. Emotions commonly elicited by stress are listed on the slide. Apparently 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. Positive emotions may also occur during periods of stress, with positive emotions experienced while under duress having adaptive significance, promoting creativity and flexibility in problem solving, facilitating the processing of important information about oneself, and reducing the adverse physiological effects of stress. High emotion can sometimes negatively influence task performance, more so for highly complex tasks and less so for simple ones (the inverted-u-hypothesis).

14 Figure 12.4 Arousal and performance

15 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 WWB Copyright © Allyn & Bacon 2006 ST

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

17 General Adaptation Syndrome
Stress Resistance figure adapted from figure 17.4, Myers text, taken from CD Rom Phase 1: Alarm Reaction Phase 2: Resistance (cope) Phase 3: Exhaustion

18 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

19 Figure 12.5 Brain-body pathways in stress

20 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 WWB Copyright © Allyn & Bacon 2006 ST

21 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 WWB Copyright © Allyn & Bacon 2006 ST

22 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 Historically, psychosomatic diseases were defined 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. Now we know that stress contributes to a diverse array of other diseases once thought to be completely physiologically based and using the term psychosomatic disease as a separate category has fallen into disuse. 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. Risk factors for CHD include smoking, lack of exercise, high cholesterol levels, and high blood pressure. Recently, researchers have shown that inflammation may contribute to atherosclerosis, as well. Personality factors have been linked to risk for coronary heart disease. These personality characteristics have been collectively labeled Type A personality and include three main elements (listed on the slide). The hostility factor has been indicated as the most important predictor in this cluster of behaviors. Emotional 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 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.

23 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. WWB Copyright © Allyn & Bacon 2006 ST

24 Figure 12.6 Anger and coronary risk

25 Table 12.3 Health Problems that may be Linked to Stress

26 Figure 12.7 The stress-illness correlation

27 Responding to Stress Behaviorally
Coping Styles of coping Learned helplessness Frustration-aggression hypothesis Self-indulgence Defensive coping Constructive coping Behaviorally people respond to stress at different levels. Coping refers to active efforts to master, reduce, or tolerate the demands created by stress. These may involve giving up and blaming oneself (learned helplessness – passive behavior produced by exposure to unavoidable aversive events), striking out at others aggressively (usually the result of frustration, as in Dollard’s frustration-aggression hypothesis), self-indulgement (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly).

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

29 Factors Moderating the Impact of Stress
Social support Increased immune functioning Optimism More adaptive coping Pessimistic explanatory style Positive effects Many factors moderate the effects of stress on illness, and individual differences in impact appear to be related to these moderating variables. Social support, or the various types of aid and succor provided by members of one’s social network, appear to decrease the negative impact of stress. Having an optimistic style also appears to lead to more effective coping with stress, while pessimistic styles have been related to passive coping and poor health practices. Conscientiousness also appears to be related to increased longevity, possibly because being conscientious leads to better health habits. Finally, physiological factors, such as cardiovascular reactivity to stress, appear to play a role in how significant the impact of stress is on an individual. However, it is helpful to keep in mind that 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.

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

31 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 WWB Copyright © Allyn & Bacon 2006 ST

32 Health-Impairing Behaviors
Smoking Poor nutrition Lack of exercise Transmission, misconceptions, and prevention of AIDS Self-destructive behavior is surprisingly common. Take smoking, for example. A 25 year old male who smokes two packs a day has an estimated life expectancy 8.3 years shorter than that of a similar nonsmoker. Health risks decline quickly for those who give up smoking, but quitting is difficult and relapse rates are high. Poor nutritional habits and lack of exercise have been linked to heart disease, hypertension, and cancer, among other things. Acquired Immune Deficiency Syndrome (AIDS) is clearly influenced by behavior. AIDS is transmitted through person-to-person contact involving the exchange of bodily fluids, primarily semen and blood. 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. So why do people engage in health impairing behavior? Most of these develop gradually and often involve pleasant activities. Risks lie in the distant future, and people tend to underestimate risks that apply to them personally.

33 Figure 12.8 The prevalence of smoking in the United States

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


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