1. Medical Psychology 10.03.2011 Coping with Stress and Illness

2. Stress and physiological changes

3. The „discovery” of stress: Hans Selye (1956) Endocrinological experiments: injected mice with extracts of different organs Each extract caused the same symptoms: ► swelling of the adrenal cortex, ► atrophy of the thymus, ► gastric and duodenal ulcers Noxious agents: STRESSORS

4. The General Adaptation Syndrome (H. Selye)

5. Are all stressors stressful? Negative stress: distress Positive stress: eustress The body copes with stress, through the hypothalamic-pituitary- adrenal axis (HPA axis) system (H. Selye)

6. Stress and health ► Stress is linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide ► 43% of all adults suffer adverse health effects from stress (WHO) ► 2/3 of all office visits to family physicians are due to stress-related symptoms (American Academy of Family Physicians)

7. Do stressful life events CAUSE illness? The Holmes-Rahe study (1967): ► 5000 medical patients’ records ► 43 life events ► Positive correlation of 0.118 between life events and illness

8. Life event Life change units Death of a spouse100 Divorce73 Marital separation65 Imprisonment63 Death of a close family member63 Personal injury or illness53 Marriage50 Dismissal from work47 Marital reconciliation45 Retirement45 Change in health of family member 44 Pregnancy40 Sexual difficulties39 Gain a new family member39 Social Readjustment Rating Scale (Stress Scale) Holmes & Rahe (1967) First part of the scale

9. Change in working hours or conditions 20 Change in residence20 Change in schools20 Change in recreation19 Change in church activities19 Change in social activities18 Minor mortgage or loan17 Change in sleeping habits16 Change in number of family reunions15 Change in eating habits15 Vacation13 Christmas12 Minor violation of law11 Social Readjustment Rating Scale (Stress Scale) Holmes & Rahe 1967 Last items of the scale

10. Scoring of the Holmes/Rahe Scale ► Score of 300+: At risk of illness ► Score of 150-299+: Moderate risk of illness ► Score 150-: Slight risk of illness.

11. Many situations are not inherently stressful! Stress depends on appraisal: Primary appraisal determination of an event’s meaning. Secondary appraisal evaluation of one’s ability to meet the demands of a challenging event.

12. The Cognitive Appraisal Model of Stress (Lazarus & Folkman, 1984)

13. Cognitive appraisals are extremely susceptible to one’s ► current state of mood (adverse effect of negative affectivity) ► health status (healthy or sick) ► motivation (wants to get better or not)

14. Ways of Coping Questionnaire (Folkman et al, 1986) ► Confrontive : „Stood my ground and fought for what I wanted” ► Distancing : „Went on as if nothing had happened.” ► Self-controlling : „I tried to keep my feelings to myself” ► Seeking social support: „Talked to someone to find out more about the situation” ► Accepting responsibility: „Criticised or lectured myself” ► Escape avoidance: „Wished the situation would go away” ► Planful problem solving: „Made a plan of action and followed it” ► Positive reappraisal: „Changed or grew as a person in a good way” Folkman et al. (1986). Journal of Personality and Social Psychology, 50, 992- 1003.

15. Coping strategies in different medical conditions ► Avoidance coping strategies were associated with statistically significantly lower quality of life following renal transplantation (White & Gallagher, 2010) ► Patients with type II diabetes had relatively higher scores on the problem- focused strategies than those with type I. Patients with type I diabetes used humour, venting and self-blame more than those with type II diabetes. (Tuncay, 2008).

16. Information seeking as a coping strategy in breast cancer ► 146 breast-cancer patients ► Completed measures of problem-focused coping and quality of life at the end of early stage breast cancer treatment. ► Quality of life was reassessed six months later. ► Women more likely to seek out information about their illness experienced greater physical quality-of-life improvement. (Ransom et al, 2005)

17. ► 259 businessmen - two year period of job stress ► 1st group: became increasingly symptomatic. More medical and psychological problems and more doctors visits. ► 2nd group: no difference in symptoms during this stressful period as compared to before its' onset. They seemed healthier and more robust ( Kobasa et al, 1982 ) Living under stress WITHOUT symptoms?

18. The „hardy” personality “Hardy" attitudes were associated with a reduction of illness: ► CHALLENGE ► CONTROL ► COMMITMENT These attitudes helped people to handle stress better

19. Quick recovery: The importance of RESILIENCE ► The ability to recover quickly from illness, change, or misfortune ► The positive capacity of people to cope with stress and catastrophe. It also includes the ability to bounce back to homeostasis after a disruption. (Luthar et al, 2000)

20. Factors promoting resilience (Matthew, 2007) ► Having good problem-solving skills ► Seeking help ► Perceived control ► Having social support ► Being connected with others, such as family or friends ► Self-disclosure of the stress / trauma to loved ones ► Spirituality ► Having an identity as a survivor as opposed to a victim ► Helping others ► Finding positive meaning in the stress/trauma

21. A resilient cancer patient „I have traveled many miles, and my physical and emotional work is ongoing. I continue to struggle with sleepless nights, fatigue, and cognitive dysfunction. Whether related to chemotherapy, chemical menopause, or post-treatment hormonal therapy, I struggle with tasks that I once took for granted. I remain on medication, see a therapist regularly, and I am learning to practice what I have taught: self-care, wobbling on the exercise equipment, and venturing out more socially. I am beginning to regain confidence and to integrate my cancer experiences into my "new" but more blessed self. The journey continues.” (Bush, Oncol. Nurse. Forum, 2009)

22. Seven Learnable Skills of Resilience (Reivich, 2005) 1. Emotion awareness or regulation Ability to identify and to control your feelings. 2. Impulse control Ability to tolerate ambiguity. To look at things in a thoughtful way before acting. 3. Optimism Optimistic explanatory style 4. Causal analysis Ability to think comprehensively. Look at problems from many perspectives. 5. Empathy The ability to read and understand the emotions of others. It helps build relationships with others. 6. Self-efficacy Knowing what your strengths and weaknesses are and relying on your strengths to cope. 7. Reaching out Being prepared to take appropriate risk. Try things and think failure is a part of life.