Chapter 13

Stress, Coping and Health

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Principle types of stress include a. conflict, fear, pressure b. anxiety, conflict, change c. change, frustration, pressure d. frustration, conflict, anxiety

– c. change, frustration, pressure

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In avoidance-avoidance conflicts a choice must be made a. whether to seek any goal b. whether to pursue a single goal that has

both attractive and unattractive aspects c. between two attractive goal d. between two unattractive goals

– d. between two unattractive goals

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An organism first recognizes the existence of a threat and physiological arousal occurs during the___ stage of the general adaptation syndrome a. alarm reaction b. resistance c. exhaustion d. flight-or-flight

– a. alarm reaction

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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

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Stress: An Everyday Event

Major stressors vs. routine hassles– Cumulative nature of stress– Cognitive appraisals (Lazarus)

Major types of stress– Frustration – blocked goal– Conflict – two or more incompatible motivations

• Approach-approach, approach-avoidance, avoidance-avoidance– Change – having to adapt

• Holmes and Rahe – Social Readjustment Rating Scale – Life Change Units

– Pressure – expectations to behave in certain ways• Perform/conform

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Responding to Stress Emotionally

Emotional Responses– Annoyance, anger, rage– Apprehension, anxiety, fear– Dejection, sadness, grief– Positive emotions

Emotional response and performance– The inverted-U-hypothesis

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Responding to Stress Physiologically

Physiological Responses– Fight-or-flight response– Selye’s General Adaptation Syndrome

• Alarm

• Resistance

• Exhaustion

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Some Psychological Stressors for High School StudentsLife Event Stress Points

Divorce of parents 98

Expulsion from school 79

Major injury or illness 77

Getting a job 62

Major illness of close friend 56

Peer difficulties 45

Moving away 41

Christmas 30

Vacation 25

Traffic ticket 22

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Pituitary hormone in the bloodstream stimulatesthe outer part of the adrenalgland to release the stress hormone cortisol

Sympathetic nervoussystem releases the stress hormonesepinephrine andnorepinephrinefrom nerve endings in the inner part ofthe adrenal glands

Thalamus

Hypothalamus

Pituitary gland

Adrenal glands

Cerebral cortex(perceives stressor)

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Sequence of Steps in the Fight or Flight Behaviors

1. The brain appraises a situation as threatening and dangerous.

2. The lower brain structure secretes a stress hormone.

3. The stress hormone signals the adrenal glands to secrete adrenaline.

4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.

Fight or Flight (Walter Cannon)

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The General Adaptation Syndrome (Hans Selye)

Defined as a series of stages the body goes through when exposed to stressful situations.

1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical.

2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor.

3. The third stage is exhaustion. It is marked by body exhaustion and health problems.

Alarm Resistance Exhaustion

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Stress and Illness

General Adaptation Syndrome Selye’s concept of

the body’s adaptive response to stress in three stages

Stressresistance

Phase 1Alarm

reaction(mobilize

resources)

Phase 2Resistance(cope with stressor)

Phase 3Exhaustion(reservesdepleted)

The body’s resistance to stress canlast only so long before exhaustion sets in

Stressoroccurs

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Responding to Stress Behaviorally Behavioral Responses

– Frustration-aggression hypothesis

– catharsis

– defense mechanisms 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-indulgement (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly).

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a increases in stress

b the Type A personality

c low levels of social support and pessimism

d high levels of social support and optimism

Increased levels of the immune system are associated with

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a.

have an increased risk of developing cancer

b.

have a decreased risk of developing cancer

c.

have an increased risk of developing heart disease

d.

have a decreased risk of developing heart disease

Research has demonstrated individuals with Type A personality

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a.

Andrew, who is a Type A personality

b.

Bill, who is a Type B personality

c.

Charles, who has high blood pressure and smokes

d.

Dennis, who is depressed

Of the following individuals, who would be least likely to develop heart disease?

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ANSWERS– D - high levels of social support and optimism– C - have an increased risk of developing heart disease– B - Bill, who is a Type B personality

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Effects of Stress: Behavioral and Psychological

Impaired Task performance - people under pressure to perform may feel self-conscious, which leads to disruption of attention and “choking” under pressure

Burnout - physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotionally demanding situations…loss of meaning.

Posttraumatic Stress Disorders (PTSD) - re-experiencing the traumatic event in the form of nightmares and flashbacks

Psychological problems and disorders Positive effects - stress can promote personal growth or

self-improvement, forcing people to develop new skills, reevaluate priorities, learn new insights

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Effects of Stress: Physical Psychosomatic diseases 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.

Type A behavior - 3 elements• strong competitiveness• impatience and time urgency• anger and hostility

– Emotional reactions and depression Stress and immune functioning

– Reduced immune activity

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Stress and the Heart

Type A Friedman and Rosenman’s term for competitive, hard-

driving, impatient, verbally aggressive, and anger-prone

people Type B

Friedman and Rosenman’s term for easygoing, relaxed people

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Research on type A Personality

Time urgency & competitiveness not associated with poor health outcomes

Negative emotions, anger, aggressive reactivity

High levels of hostility increase chance of all disease (e.g., cancer)

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Explanatory style

Optimism – use external, unstable, & specific explanations for negative

events– predicts better health outcomes

Pessimism– use internal, stable, & global explanations for negative

events– predicts worse health outcomes

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Stress and the Heart

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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

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Health-Impairing Behaviors Smoking - 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 nutrition & 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

Risky sexual behavior Transmission, misconceptions, and prevention of

AIDS - is transmitted through person-to-person contact involving the exchange of bodily fluids, primarily semen and blood

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Stress and Disease Negative emotions and health-related

consequences

Unhealthy behaviors(smoking, drinking,

poor nutrition and sleep)

Persistent stressorsand negative

emotions

Release of stresshormones

Heartdisease

Immunesuppression

Autonomic nervoussystem effects

(headaches,hypertension)

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Promoting Health

Aerobic Exercise sustained

exercise that increases heart and lung fitness

Depressionscore

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3 Before treatmentevaluation

After treatmentevaluation

No-treatmentgroup

Aerobicexercise

group

Relaxationtreatment

group

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Why Does Exercise Work?

Exercise and MoodReleases chemicals

-- norepinephrine

-- serotonin

-- endorphins

Sense of accomplishment

Improved physique

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Why Does Exercise Work?

Exercise and Health

Strengthens heart

Lowers blood pressure

Lowers blood pressure reactivity to stress

Moderate exercise adds two years to one’s expected life.

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BMI Classifications – Slide 30 BMI = 19-25; Normal; Low Risk BMI = 25-30; Moderately overweight; Some Risk BMI = 30-35; Class 1 obesity; High Risk BMI = 35-40; Class 2 obesity; Very High Risk BMI> 40; Class 3 obesity; Extreme Risk

BMI > 30, or ~ 30 lbs. overweight for 5'4" person for 2005 - CDC

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Reactions to Illness

Seeking treatment– Ignoring physical symptoms

Communication with health care providers– Barriers to effective communication

Following medical advice– Noncompliance

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Stress management techniques -adapted from Monat & Lazarus (1991)

Environment/Lifestyle: time management, proper nutrition, exercise, finding alternatives to frustrated goals, stopping bad habits

Personality/Perception: assertiveness training, thought stopping, refuting irrational ideas, stress inoculation, modifying type A behavior

Biological responses: progressive relaxation, relaxation response, meditation, breathing exercises, biofeedback, autogenics

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Relaxation Response – Benson

“The relaxation response is perhaps best understood as a psycho-physiological state of hypoarousal engendered by a multitude of diverse technologies [techniques]” (Everly, 1989, p.149)

Meditation - a self-generating practice of a variety of techniques designed to induce the relaxation response by use of a repetitive focal device

Progressive relaxation - relax selected muscles by first tensing then relaxing the muscles

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Stress Inoculation Trainingdeveloped by Donald Meichenbaum

Stage 1 - education - the person is given a framework for understanding his/her stress response

Stage 2 - rehearsal - the person learns to make cognitive self-statements as a form of coping and problem solving

Stage 3 - application - the person uses the information and skills learned in the first two stages in actual stress situations, moving from lower to higher stress situations