1. Chapter 13: Stress, Coping, and Health

2. Stress
Stress – the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging
We can appraise stress as a threat or a challenge, and we will respond accordingly
Stress can aid us, or hinder us

3. Stress is the physical pressure and strain that result from demands or changes in the environment.
The term stress can refer to certain life events (stressors) or how we react to these changes in the environment (stress reactions).

4. Types of Stress EUSTRESS DISTRESS -Bad stress -Good stress
-Any type of stress that motivates us to do something that is desirable.
DISTRESS
-Bad stress
-Stress that is so overwhelming, that it causes us problems.

5. The Process of Stress Components of the stress process:
Stressors
Stress reactions
Stress mediators
These components affect one another

6. Stress Response System
Fight or flight – sympathetic nervous system response. It can be triggered by physical stimuli that threaten our survival
Withdraw – Pull back, conserve energy; when faced with loss or extreme disaster, people become paralyzed by fear
Tend and befriend – respond to stress of loss by nurturing and banding together. Hormone oxytocin is released.
Men are more likely to withdraw and women to befriend

7. General Adaptation Syndrome (GAS)
Phase 1 – Alarm reaction: sudden activation of the sympathetic nervous system fight or flight. You get ready for phase 2
Phase 2 – Resistance: you face the challenge. Body temp, blood pressure, and respiration stay high. Can wear oneself out if maintained for too long.
Phase 3 – Exhaustion: you are more vulnerable to illness, collapse, or even death

8. What is Stress? General Adaptation Syndrome
resistance
Phase 1
Alarm
reaction
(mobilize
resources)
Phase 2
Resistance
(cope with
stressor)
Phase 3
Exhaustion
(reserves
depleted)
The body’s resistance to stress can only
Last so long before exhaustion sets in
Stressor
occurs
General Adaptation Syndrome
Selye’s concept of the body’s adaptive response to stress as composed of three stages

9. ALARM REACTION:
The body sends out emergency signals that stir it up in preparation for an attack-whether it be physical or physiological. The heart rate increases, blood is diverted away from other bodily functions and sent to the muscles needed to react. The organism readies itself to meet the challenge through the activation of the sympathetic nervous system.

10. RESISTANCE
The organism tries to fight back against the attack. The body remains physiologically ready. Hormones are released to maintain this state of readiness. This stage can last for weeks. If the resistance stage lasts for too long, the body can delete its resources. The parasympathetic nervous system returns our physiological state to normal. Thus if the threat is removed, the body and psyche restore themselves back to a normal chemical & emotional balance.

11. EXHAUSTION
If the stress does not let up, continuous “fight or flight” becomes impossible. We become more vulnerable to disease, especially if our resources were depleted by an extended time in the resistance stage.

12. Excessive stress can contribute to both physical diseases and psychological problems.
Our bodies can remain ready for a challenge so long before our resources are depleted and we are vulnerable to disease due to exhaustion.

13. Effects of Stress
People can cope with temporary stress, but prolonged stress can lead to physical deterioration.
Severe stress ages people.
Presidents have always been evident of this

14. Major Sources of stress
Hassles
Change
Pressure
Frustration

15. Stress Provoking Events
Catastrophes – Unpredictable large scale events that everyone appraises as threatening: War, natural disasters, etc.
Following disasters, psychological disorders such as depression and anxiety rise about 17% in the effected area

16. Stress Provoking Events Cont’d
Life Changes – Life transitions increase stress: Moving, new job, marriage, children born, divorce, death of loved one, etc.
Young adulthood is where these stresses are most often felt.
People recently widowed, fired, or divorced are more vulnerable to disease
A study involving 96,000 widows found that the risk of death doubled in the week following their partner’s death.

17. Stress Provoking Events Cont’d
Daily Hassles – Everyday annoyances may be the most significant sources of stress.
Over time, little stressors add up to have a major impact on health and well being
High blood pressure rates are the highest in areas where people express the least satisfaction with their lives due to stress

18. Stress and the Heart
Coronary Heart Disease – the clogging of the vessels that nourish the heart muscle; the leading cause of death in North America
Became the leading cause of death by the 1950’s in North America
Along with hypertension and family history, there are now believed to be other behavioral and physiological factors
high-fat diet, physical inactivity, elevated cholesterol, stress, and personality

19. Friedman-Rosenman Study
Type A – competitive, hard-driving, impatient, verbally aggressive, and anger prone people.
Type B – easy going, relaxed people
3,000 healthy men ages were interviewed, then followed for a time of 9 years
257 men suffered heart attacks. 69% of them were type A. None were purely type B.

20. Susceptibility to Disease
Stress can make us physically sick and inhibit our ability to fight off illness
Psychophysiological illness – stress related physical illness; hypertension and some headaches
Psychoneuroimmunology (PNI) – the study of how psychological, neural, and endocrine processes together affect the immune system and resulting health.

21. Psychoneuroimmunology
Lymphocytes – two types of white blood cells that are part of the body’s immune system.
B lymphocytes: made in marrow and attack bacterial infections
T lymphocytes: made in lymph nodes and attack cancer, viruses, and foreign substances

22. Psychoneuroimmunology Cont’d
Age, nutrition, genetics, body temperature, and stress all influence the immune system
Stress hormones suppress the release of lymphocytes, making it more difficult to ward off infection
Stress takes up energy that the body needs to keep us healthy

23. Stress and AIDS Stress and negative emotions correlate with:
the progression of HIV to AIDS
the speed of the decline of those infected
Stress reducing activities have shown to have a positive effect in the treatment of AIDS

24. Stress and Cancer
Stress helps speed up the growth rate of tumors in animals.
Studies have not yet found a correlation between cancer and stress in humans

26. Stress and Health Behavioral Medicine Health Psychology
interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease
Health Psychology
subfield of psychology that provides psychology’s contribution to behavioral medicine

27. What is Frustration?
Frustration occurs when we are blocked or hindered from reaching our goal.
Most frustrations are minor. They are the frustrations of daily life: busy signals, or being stuck in traffic. These frustrations are not good for us because they gradually wear us down. Each time we experience a frustration, there is a physiological response” clenched teeth or tightened muscles.

28. What Is Conflict?
Conflict is a situation in which we have to make a choice between alternatives.
For example: you want to buy 2 CD’s, but only have enough money to buy one, so you must make a choice.

29. Four Types of Conflict APPROACH-APPROACH CONFLICT (++)
This is a conflict between two attractive alternatives.
What examples can you think of?

30. APPROACH-AVOIDANCE CONFLICT (+-)
-This is a conflict involving a situation with both good & bad features. This type of conflict can be very distressing.
What examples can you think of?

31. Avoidance-Avoidance Conflict (--)
-This is a conflict involving a choice between two unattractive alternatives. You can’t win, no matter which side you choose.
What examples can you think of?

32. Double Approach-Avoidance Conflict
(+-+-)
This is a conflict involving a choice between alternatives, both of which have good & bad parts to them. This is the type of conflict that we experience most often.

33. All of these conflicts are quite normal.
However a steady diet of conflicts, especially if you are all alone and have no support system or are feeling hopeless, can cause you to make an incorrect or a poor or no decision, which could then lead to physical & psychological illness.

34. WHAT IS ANXIETY?
Anxiety is the feeling that something is wrong & disaster is imminent.
Anxiety results when frustration builds too high or when we are unable to resolve a conflict.
Severe attacks of anxiety can cause: rapid heartbeat, fatigue, chest pain, breathlessness, dizziness, fainting, headaches and feelings of doom.

35. Burn-out refers to being worn down from the never ending stress on the job. Certain professions are known to cause burnout.
What examples can you think of?
Stress becomes worse when viewed as a negative & uncontrolled. This will lead to ill health.

36. Stressors are unavoidable
Stressors are unavoidable. You can’t eliminate stress, but you can manage your reaction to stress by
a) confront the stress
b) handle the problem
c) prevent its reoccurrence

37. Techniques To Reduce Stress
Exercise - serves to increase levels of energy & serotonin
Relaxation
Develop a support system
Biofeedback – is a system for electronically recording & feeding back information on your physiological state so can learn to control reactions & increase your alpha waves & lower blood pressure.

38. MEASURING STRESS
Psychologists Thomas Holmes & Richard Rahe designed one of the first instruments to measure stress.
(SRRS) or Social Readjustment Rating Scale measured stress using (LCU) or Life Change Units.
A person taking the SRRS reported changes in his/her life. Different changes were assigned LCUs. Any major life change would increase the score. A person with a high score on the SRRS is more likely to have a stress related illness.

39. Managing Everyday Stress
We cope with our stress in one of two ways:
REGRESSIVE COPING-sleep too much, avoid or deny a problem, take it out on family & friends, adopt bad habits: drinking, smoking or doing drugs
TRANSFORMATIONAL COPING-creating something good out of something bad. Admit our anger, address the problem, adjust our priorities and explore solutions.

40. Responding to Stress
A – affective (emotional) response
B – behavioral response
C – cognitive response

41. Psychological Responses to Stress
Affective (emotional) Responses
Annoyance, anger, rage
Apprehension, anxiety, fear
Dejection, sadness, grief
Positive emotions
Usually stops soon after stressors disappear
If stressors are persistent or close together
Emotional reactions may persist
May develop into severe problems such as:
Generalized anxiety disorder
Major depression
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). “performance improves as arousal levels increase up to an optimum point, beyond which, it deteriorates”

42. Psychological Responses to Stress
Behavioral Responses
Coping
Frustration-aggression hypothesis
Catharsis
Defense mechanisms
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…Dollard’s frustration-aggression hypothesis), self-indulgent (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly).

43. Psychological Responses to Stress:
Cognitive Responses
Reductions in the ability to concentrate, think clearly, or remember accurately
Include:
Ruminative thinking
Catastrophizing
Mental sets
Functional fixedness
Impaired decision making

44. “Stress is the spice of life
“Stress is the spice of life.” “There are two main types of human beings: ‘racehorses,’ who thrive on stress and are only happy with a vigorous fast-paced lifestyle; and ‘turtles,’ who in order to be happy require peace, quiet, and a generally tranquil environment.
Hans Selye
Identity confusion…

45. Effects of Stress: Behavioral and Psychological
Impaired task performance
Burnout
Psychological problems
& disorders
Positive effects
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.

46. Figure 13.7 The antecedents, components, and consequences of burnout

47. Factors Moderating the Impact of Stress
Social support
Increased immune functioning
Optimism
More adaptive coping
Pessimistic explanatory style
Conscientiousness
Fostering better health habits
Autonomic reactivity
Cardiovascular reactivity to stress
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.

48. Health-Impairing Behaviors
Smoking
Poor nutrition
Lack of exercise
Alcohol and drug use
Risky sexual behavior
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.
Alcohol and drug use carry the immediate risk of overdose and the long-term risk of many diseases.
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.

49. Communication with health care providers Following medical advice
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.

50. Figure 13.16 Biopsychosocial factors in health

51. Richard Lazarus Theory of Stress
First step to experiencing stress is an appraisal
Threat appraisal- when the harm or loss has not yet occurred but the individual will know it will happen in future
Challenge appraisal- based on one’s potential for future success when the proper tools are used
Harm/loss appraisal- implies that an individual has already sustained some injury
Primary appraisal- when we balance demands of potentially stressed situations with our ability to meet these demands