Chapter 13: Stress, Coping, and Health

The RelationshipBetween Stress and Disease

• 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 RelationshipBetween Stress and Disease

– Biopsychosocial model: holds that physical illness is caused by a complex interaction of biological, psychological, and sociocultural factors

– Health psychology: seeks to determine the importance of psychological factors in illness• Health promotion and maintenance

–Discovery of causation, prevention, and treatment

Figure 13.1 Changing patterns of illness

Stress: An Everyday Event

• 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.

• Major stressors vs. routine hassles– Cumulative nature of stress: minor stresses 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

– Anxious-neurotic people feel more stress– The experience of feeling stressed depends

largely on cognitive processes; • People’s appraisals of events are very

subjective and influence the effect of the event.

Major Types of Stress

• Acute stressors: – Threatening events with a clear endpoint

and are rather short in duration (speeding ticket)

• Chronic Stress– Long in duration with no clear endpoint

(neg. boss, mortgage loan)

Major Types of Stress

• Psychologists have outlined 4 principle types of stress

• Frustration: blocked goal– Very common in every day life– Ex. traffic jams, waiting for ACT scores or college

admittance papers, breaking up

Major Types of Stress

• Conflict: two or more incompatible motivations or behavioral impulses compete for expression (Lewin and Miller)– Approach-approach: when a person has a choice

between 2 attractive goals (least stressful- go on vacation or buy a new TV)

– Approach-avoidance: when a choice must be made about whether to pursue a single goal that has both attractive and unattractive aspects…results in vacillation, or going back and forth (college in new city)

– Avoidance-avoidance: caught b/w a rock and a hard place; choice between 2 unattractive choices (Most stressful) (back surgery vs. back pain)

Figure 13.2 Types of conflict

Major Types of Stress

• Change: any noticeable alterations in one’s living circumstances that require readjustment; – Change events seen as ‘positive’ can

produce as much stress as negative– Social Readjustment Rating Scale: Holmes

and Rahe (1967)• measure life change as a form of stress,

giving higher points (life change units) for more stressful events

• Does not measure change exclusively• Focuses on neg. events

Major Types of Stress

• Pressure– expectations or demands that one behave

in a certain way– pressure to perform or to comply

• Weiten Developed a Pressure Index with a higher correlation than the SRRS to psychological problems associated with stress

Responding to Stress Emotionally

• Stress responses are multidimensional, including emotional, psychological, and behavioral realms.

• Emotional Responses– Annoyance, anger, rage– Apprehension, anxiety, fear– Dejection, sadness, grief– Positive emotions: promoting creativity and

flexibility in problem solving, facilitating the processing of important information about oneself, and reducing the adverse physiological effects of stress.

Responding to Stress Emotionally

• Emotional response and performance– The inverted-U-hypothesis:

• The higher the difficulty a task is, lower levels of emotional arousal are needed

• More simple tasks require a higher level of emotional arousal

Figure 13.5 Arousal and performance

Stress and Positive Emotions?

• Do positive emotions disappear during times of great stress?– No, often times they increase (9/11

example)– Moreover, the more positive emotions you

are able to exhibit, the greater resilience to stress

Responding to Stress Physiologically

• Physiological Responses– Fight-or-flight response: 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

• modern stressors are more long term (the checkbook)

– Higher physiological reactions include: higher consumption of oxygen, higher blood pressure, dilated pupils, reduction in digestive processes

Responding to Stress Physiologically

– Selye’s General Adaptation Syndrome: theory about how stress reactions occur • Alarm: an organism recognizes a threat

and mobilizes resources – essentially enters the FF response

• Resistance: physiological arousal stabilizes but is still above baseline, as the organism copes with the stressor

• Exhaustion: the body’s resources are depleted…Selye believed that this is where diseases of adaptation come in.

Responding to Stress Physiologically

• Stress and the Brain– Primary Path: Stress causes the

hypothalamus to activate the sympathetic part of the ANS (main part are the adrenal glands which release catecholamine to cause the F-F response)

– Secondary Path: the hypothalamus causes the pituitary gland to activate the adrenal glands which secrete corticosteroids to increase energy and reduce inflammation

Responding to Stress Behaviorally

• Behavioral Responses– Frustration-aggression hypothesis: striking

out at others aggressively,usually the result of frustration…(Dollard)

– Catharsis: purging of emotions (venting), aggressive behavior leads to more aggression

– defense mechanisms• Coping: refers to active efforts to master,

reduce, or tolerate the demands created by stress (can be positive or negative)

Responding to Stress Behaviorally

• Coping Mech:– Giving up on oneself: passively accepting

setbacks that might be dealt with effectively • learned helplessness – passive behavior

produced by exposure to unavoidable aversive events

• Blaming oneself: perpetuates negative reactions and behaviors toward stress

• Neg. self-talk can lead to depression

Responding to Stress Behaviorally

• Coping Mech:– self-indulgent (eating, drinking, smoking,

shopping, internet, pornography) • Trying to solve problems by immersing

yourself in sub. forms of satisfaction– defensive coping (erecting defense

mechanisms)• Denial of Reality, Fantasy, isolation,

Undoing, Overcompensation• Use the principle of self-deception

Responding to Stress Behaviorally

• Coping Mech:– constructive coping

• confronting problems directly• realistically appraising situations• recognize and inhibit disruptive

emotional responses• ensuring your body is not especially

vulnerable to stress

Figure 13.4 Overview of the stress process

Effects of Stress:Behavioral and Psychological

• 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– Impaired task performance– Burnout: physical, mental, and emotional

exhaustion that is attributable to long-term involvement in emotionally demanding situations…loss of meaning.

Figure 13.7 The antecedents, components, and consequences of burnout

Effects of Stress:Behavioral and Psychological

• Keinan (1987) also did stress studies– He found that stress disrupts peoples

ability to focus attention– They jump to decisions too quickly– Unsystematically review options– Basically, it is harder for people to

suppress competing thoughts

Effects of Stress:Behavioral and Psychological

• Psychological problems and disorders: from sleep problems and unhappiness, to full-fledged psychological disorders such as schizophrenia and depression

• Positive effects: – 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.

– What school of psyc?

                                   

                                

Effects of Stress: Physical

• Psychosomatic diseases: physical ailments with a genuine organic basis that are caused in part by psychological factors, especially emotional distress– hypertension, ulcers, asthma, eczema, and

migraine headaches– Heart disease accounts for nearly one-third

of the deaths in the U.S. each year– Atherosclerosis, or gradual narrowing of

the coronary arteries, is the principle cause of CHD

Effects of Stress: Physical

• Heart disease– Type A behavior - 3 elements

• strong competitiveness• impatience and time urgency• anger and hostility (most important)

– Type B Behaviors (less likely)• Relaxed• Patient• Easy going• Amicable behavior

• One study found that patients with high hostility ratings are twice as likely to develop Atherosclerosis

Figure 13.9 Anger and coronary risk

Effects of Stress: Physical

• Stress and immune functioning– 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…decreasing white blood cells called lymphocytes

Featured Study

• Used a longitudinal study (over 4 years)– Does depression increase the risk of

cardiac mortality?• Minor depression: 60% increase in heart

disease• Major depression tripled the risk of

cardiac death–Recent studies have found

depression doubles the chance of heart disease and changes how it develops

Table 13.4 Health Problems that may be Linked to Stress

Figure 13.11 The stress-illness correlation

Factors Moderating the Impact of Stress

• Social support– Increased immune functioning– decrease the negative impact of stress

• Optimism– More adaptive and more effective coping

• Pessimistic explanatory style– related to passive coping and poor health

practices.

Factors Moderating the Impact of Stress

• Conscientiousness– Fostering better health habits– related to increased longevity, possibly

because being conscientious leads better preventive medicine

• Autonomic reactivity (physiological factors)– Cardiovascular reactivity to stress

– appear to play a role in how significant the impact of stress is on an individual.

Figure 13.12 The prevalence of smoking in the United States

Health-Impairing Behaviors

• Smoking– A 25 year old male who smokes two packs a day

has an estimated life expectancy 13-14 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– linked to heart disease, hypertension, and cancer,

among other things• Lack of exercise (same as poor nutrition)

Figure 13.13 Quitting smoking and cancer risk

Health-Impairing Behaviors

• 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– HIV is transmitted through person-to-person

contact involving the exchange of bodily fluids, primarily semen and blood

– Many young heterosexuals downplay their risk for HIV, causing them not to adopt the behavioral practices that minimize risk.

Development of Health-Impairing Behavior

• 1) Health-Impairing Behaviors creep up slowly

• 2) Many Health-Impairing Behaviors are quite pleasurable

• 3) Most risks associated with Health-Impairing Behaviors are a long way off

• 4) People underestimate how these behaviors will affect them and overestimate their effect on others

Reactions to Illness

• Many reactions to illness are not conducive to health– Seeking treatment

• Ignoring physical symptoms– Communication with health care providers

• Barriers to effective communication– Following medical advice

• 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

Figure 13.16 Biopsychosocial factors in health