1. Class 9 Stress II, Continued and Psychoneuroimmunology

2. Checking In and Updates Daily Diaries: Complete this start of class Mid-term: 1. ONLY covers what we covered in class. 2. Midterm format: Multiple Choice, Short Answer 3. How to study: a. Power Point Slides b. Use slides to structure readings/studying 4. Dates: a. Midterm Review: March 6 b. Midterm:March 11

3. Measuring Stress How could stress be measured?

4. Over the past 12 months, how much stress did you experience, overall? ___ 1.None or almost none ___ 2. Far less than usual ___ 3. Somewhat less than usual ___ 4. Same as usual ___ 5. More than usual ___ 6.Far more than usual ___ 7.An extreme amount Stress Over the Past Year Problems with this measure? Stress Over the Past Year (A Home Grown Scale for This Class)

5. Definitions of “House” House as objectHouse as place 2400 sq feet, large back lot, aged heating and plumbing Colonial style Where grandparents settled after WW II Where mom and Uncle Joe were born Where we had 4 th of July every year Where Suzy learned to drive. Point: How a thing is defined affects how it is understood. Defining stress in terms of events (Holmes & Rahe) vs. in terms of how people feel about events (Cohen, et al). Definitions of “Stress” Stress as EventStress as Experience Number of tasks due Clarity re. stressors Degree of control Consequences of failure How confident I feel. How overwhelmed I feel

6. Social Readjustment Scale Holmes & Rahe, 1967 In the past year, have you experienced: 1. __ Death of a spouse/partner 10026. __ Wife starting/ending work 26 2. __ Divorce 7329. __ Change in personal habits 24 3. __ Marital separation 6532. __ Change in residence 20 7. __ Marriage 5033. __ Change to a new school 20 8. __ Being fired 4735. __ Change in church activities 19 17.__ Death of a close friend 3736. __ Change in social activities 18 18.__ Changing to different work 3638. __ Change in sleeping habits 16 19.__ Change in # spouse arguments 3541. __ Vacation 13 20.__ Taking a loan on house 3143. __ Minor law issue (ticket, etc.) 11

7. 1. Vague terms 2. Numeric values 3. Relevance across populations 4. Doesn’t distinguish between pos and neg events 5. Doesn't consider how well event was resolved 6. Individual diffs. in propensity to mark events 7. Memory lapses CRITIQUE OF SOCIAL READJUSTMENT RATING SCALE (Holmes & Rahe, 1967)

8. 1. In the past month, how often have you been upset because of something that happened unexpectedly? 2. In the last month, how often have you felt nervous and “stressed”? 3. In the last month, how often have you found that you could not cope with all the things that you had to do? 4. In the last month, how often have you been angered because of things that were out of your control? For each question, choose from the following alternatives: 0Never 1 Almost never 2Sometimes 3 Fairly often 4 Very often SUBJECTIVE STRESS MEASURE Cohen, Kamarck, & Mermelstein, (1983)

9. Hassles

10. 1. Misplacing or losing things.123 2. Troublesome neighbors.123 3. Social obligations.123 4. Inconsiderate smokers.123 5. Thoughts about death.123 6. Health of a family member.123 Severity 1. somewhat severe 2. moderately severe 3. extremely severe The Measurement of Hassles Kanner, et al. 1981

11. “Unspoken” Danger of Hassles? Joey, did Gramps tell you about the Great Flood of 1934? Joey, did Gramps tell you about the day the cable guy never came? Disclosing major events health benefit—but normal “hassles” don’t merit disclosing.

12. ChronicAcute On-going illnessNatural disaster Family responsibilitiesChildhood sexual abuse WorkloadAuto accident Environmental noiseJob loss Financial worriesLoss of loved one Chronic Stress and Acute Stress

13. Workplace Stress Workplace stress is most common, most preventable, chronic stressor What are elements of workplace stress? Overload: perception more important than total hours. Time pressure: Time pressed 3X more likely to die early Role conflict /ambiguity: Japanese baseball interpreters Social isolation: Higher catecholamines, higher BP Lack of control: Person/environment fit. Leads to coronary heart disease

14. Class 9 Psychoneuroimmunology

15. The relationship between psychological processes and the activities of the nervous, endocrine, and immune systems. Psychoneuroimmunology

16. Immune System Review Primary function: Distinguish self from non-self, attack foreign elements. Main components: Humoral response – anti-bacterial, prevent viral re-infection Cell-mediated response – T cells from Thymus gland, Tc respond to specific antigens, produce anti-antigen toxins. Other blood components

17. Immunocompetence and Immunocompromise Immunocompetence : How well immune system is working Assessment: a. Quantities of immune agents (T cells, white blood cells) b. Functioning of immune agents 1. Activity 2. Proliferation 3. Transformation 4. Cytotoxicity Immunocompromise: When immune system is impaired Key Point: Stress can lead to immunocompromise

18. Stress and Immune Functioning Stress and immunocompetence shown in: Animal studies: stressed rats display immune dysfunction Observations: TB pats’ white blood cells less robust after stress Accumulated Research: 38 studies show more stress  immunocompromise The bigger the stressor, the worse the compromise. Hurricane Andrew (1992), NK cell cytotoxicity decreases. Tied to lack of sleep. NOTE: This outcome fits which with measure ____Holmes & Rahe ___ Cohen et al. X

19. Stress-Induced Immunocompromise and Illness Stress  Immunocompromise  colds, flu, herpes flare-ups Daily hassles  reduced NK activity Anticipatory stress  less robust T H cells. Mt. St. Helens/Pennebaker School stress: 5 yr olds show increased cortisol, immunocompromise, upon starting kindergarten. Esp. if earthquate co-occurs!

20. Social Relations, Stress, and Illness Personal relationships are key moderators of stress/illness connection. (More on this when we discuss Social Support ) Rat pups separated from mothers show immunocompromise Social Conditions linked to illness? Bereavement (but mainly if linked to depression) Loneliness Marital separation

21. Spitz Foundling Home Studies René Spitz Orphaned babies, in foundling homes, all material needs met Do not have an emotional care-giver Tragically high levels of grief Highly susceptible to disease High mortality rate

22. DEPRIVATION DWARFISM

23. Social Connections as a Health Risk Newlyweds Study 90 newlywed couples, discuss marital problems Style of discussion coded as: a. Negative/hostile b. Positive/collaborative Assessed immune functioning after discussions. Which group shows immunocompromise? ____ Neg/hostile ___ Pos/collaborative X Caregivers of chronically ill Produce fewer immune agents, wounds heal slowly, weaker reaction to flu vaccine. Why?

24. Relation Between Stress and Health Not Perfect

25. Mediator: If A  B  C, then “B” is what mediates the relation between A and C. Mediators AC B StressIllness Immunocompromise

26. Moderators A B A * B C Stress Social Isolation Stress * Social Isolation Illness

27. Physical Constitution 1. Genetic make-up 2. Age 3. Material resources Behavior 1. Sleep 2. Diet 3. Substance abuse 4. Isolation 5. Exercise Personality Moderators of the Stress and Health Connection

28. 1. Negative affect 2. Optimism and pessimism 3. Hardiness 4. Self-efficacy 5. Hostility 6. Depression 7. Coping styles Personality Moderators of the Stress  Illness Connection

29. The Coping Sequence Stressor Primary Appraisal (Harm, Threat, Challenge) External Resources and Impediments Tangibles Social Support Other life stressors Internal Resources and Impediments Typical coping style Other personality factors Secondary Appraisal Coping Tasks/Goals Coping Outcomes Moderators

30. Negative Affect (Watson, Clark, & Tellegen) Defined: Pervasive negative mood marked by anxiety, depression, and hostility. Find many situations difficult to manage Resort to unhealthy coping behaviors (such as?) Related to poor health: asthma, arthritis, ulcers, headaches, CHD Related to excess complaining: a. More symptoms b. Higher use of health services c. Higher rates of self-reported illness d. These people may compromise validity of self-reported illness