Chapter 13

Stress, Coping and Health – 8th Edition

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The Relationship Between Stress and Disease

Contagious diseases vs. chronic diseases Biopsychosocial model Why?

– The Biomedical Model is unable to fully account for health– Mind-body question– Biomedical treatments only– Failures to account for many psychological factors and health– Placebo effects – how to explain

Health psychology– Health promotion and maintenance

• Discovery of causation, prevention, and treatment– Primary prevention, secondary prevention, tertiary prevention– Changing pattern of what is the primary cause of death in last 100+

years. – F 13.1

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Levels of Prevention

Primary Prevention•Prevent disease•Identify causes•Promote health behaviors

Secondary Prevention•Catch disease in early stages•Prevent further deterioration

Tertiary Prevention•Manage illnesses with nocure

Table of ContentsFigure 13.1 Changing patterns of illness

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Stress: An Everyday Event

Major stressors vs. routine hassles– Cumulative nature of stress– Psychological Stress - Lazarus– Cognitive appraisals: primary and secondary

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

• Approach-approach, approach-avoidance, avoidance-avoidance – Figure 13.2

– Change – having to adapt• Holmes and Rahe – Social Readjustment Rating Scale – Life Change

Units – Table 13.1– Pressure – expectations to behave in certain ways

• Perform/conform• Figure 13.3 – pressure and psychological symptoms – Weiten (1988)

Overview of Stress Process – Figure 13.4

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Richard Lazarus (1966) (p. 512) defined psychological stress as “…a generic term for the whole area of problems that includes the stimuli producing stress reactions, the reactions themselves, and the various intervening processes.”

Lazarus and Folkman (1984) define psychological stress as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being.”

Psychological Stress

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Appraisal Process

The primary appraisal process determines whether the environment is perceived as psychologically threatening, harmful, or challenging to the person.

The secondary appraisal process is a complex evaluative process in which a person considers resources available to cope with the primarily appraised stressor.

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Table of ContentsFigure 13-3 – Pressure and psychological symptoms (Weiten, 1988, 1998)

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Responding to Stress Emotionally

Emotional Responses– Annoyance, anger, rage– Apprehension, anxiety, fear– Dejection, sadness, grief– Positive emotions– Slide 12, after 9/11 – correlations between emotion and

resilience

Emotional response and performance– The inverted-U-hypothesis – Figure 13.5 – performance and

task complexity

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Table 13-2, p. 518

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Slide 12

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Responding to Stress Physiologically

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

• Alarm

• Resistance

• Exhaustion

Brain-body pathways in stress – Figure 13.6– sympathetic adrenal medullary (SAM)– hypothalamic pituitary adrencortical (HPA)

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Physiological Stress

Hans Selye first introduced the term stress to medicine in 1936. He noted that animals were induced by a variety of stimuli to show the “syndrome of just being sick” which resulted in adrenal enlargement, gastrointestinal ulcers, shrinkage of the thymus and lymph nodes. This reaction was termed the “general adaptation syndrome” and “stress is the nonspecific response of the body to any demand made upon it”.

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Figure 13.6 – Brain-body pathways in stress: SAM and HPA systems

Lundberg (2002), “[Two] neuroendocrine systems have been of particular interest in the study of stress; the sympathetic adrenal medullary (SAM) system with secretion of the two catecholamines, epinephrine and norepinephrine, and the the hypothalamic pituitary adrencortical (HPA) system with the secretion of cortisol.”

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Responding to Stress Behaviorally

Behavioral Responses: Coping – emotion focused– Frustration-aggression hypothesis– catharsis

Defensive Coping – ego defense mechanisms –Freud – Table 13.2

Constructive Coping – problem focused

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Table 13-3, p. 523

Table 13.2

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Emotion-focused coping and Problem-focused coping “Emotion-focused (or palliative) coping refers to

thoughts or actions whose goal is to relieve the emotional impact of stress. These are apt to be mainly palliative in the sense that such strategies of coping do not actually alter the threatening or damaging conditions but make the person feel better.” Monat and Lazarus (1991, p. 6)

“Problem-focused coping refers to efforts to improve the troubled person-environment relationship by changing things, for example, by seeking information about what to do, by holding back from impulsive and premature actions, and by confronting the person or persons responsible for one’s difficulty.” Monat and Lazarus (1991, p. 6)

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Effects of Stress: Behavioral and Psychological Impaired Task performance Burnout – antecedent-components-consequences –

Figure 13.7 Posttraumatic Stress Disorders (PTSD) – effects on

hippocampus (cortisol) – prevelance of traumatic events – Slide 22

Reaction to traumatic stress – Figure 13.8 Psychological problems and disorders – more in

Chapter 14 Positive effects – eustress – Positive Psychology –

Flow (Csikszentmihalyi)

Table of ContentsFigure 13.7 – The antecedents, components,and consequences of burnout

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Effects of Stress: Physical

Psychosomatic diseases Heart disease

– Cholesterol and inflammation (C-reactive protein) and risks – Figure 13.9

– Type A behavior - 3 elements• strong competitiveness• impatience and time urgency• anger and hostility (note in F 13.10 most related to cornary

events)

– Emotional reactions and depression – Figure 13.11 – study by Pennix et al. (2001) – anger and coronary risk

Stress and immune functioning– Reduced immune activity – Possible health problems linked to stress – Table 13.3– Stress-illness correlation – Figure 13.12

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Table of ContentsTable 13.3a Health Problems that may be Linked to Stress

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Table 13.3b Health Problems that may be Linked to Stress

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XXX 13.12

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Factors Moderating the Impact of Stress

Social support– The perceived comfort, caring, esteem or help received from

others.– Types: emotional, belongingness, instrumental (tangible),

informational, esteem/relational, and network (Facebook and MySpace?)

– The existence or quantity of social relationships– the amount of assistance individuals believe is available to them– the amount of assistance individuals receive– Alameda County Study in 1965 – related to health outcomes, tend

to live longer– Increased immune functioning

Optimism– expectation of good things will happen and bad things will not

happen, contrasted to pessimism– Related to psychological well-being, physical well-being– 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 – prevalence in U.S. - Figure 13.13– Smoking cessation – Figure 13.14

Poor nutrition – obesity – “Super Size” generation– Cholesterol and coronary risk – Figure 13.15

– High fructose corn syrup effects Lack of exercise – increased T.V. watching effects study Obesity – BMI – United States 2005 & 2008 data – CDC – Slide

33 & 34 – changes over the years Alcohol and drug use Risky sexual behavior Transmission, misconceptions, and prevention of AIDS – AIDS

Risk Knowledge Test - Figure 13.16

Table of ContentsFigure 13.13 The prevalence of smoking in the United States

Table of ContentsFigure 13.14 Quitting smoking and cancer risk

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Fig. 13-14, p. 535

Figure 13.15 – The link between cholesterol and coronary risk

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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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BMI Classifications – Slide 31 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 2008 - 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

Biopsychosocial factors in health – Figure 13.17

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Figure 13.17 –Biopsychosocial factors in health

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Stress Management

Relationship to coping to self-esteem Cognitive reappraisal – Ellis’s model – Figure 13.18 Humor – Figure 13.19 Relaxation Response – Benson – Figure 13.20 and

Slide 41 Stress Inoculation Training – Slide 42 Physical fitness and mortality – Figure 13.21

Table of ContentsFigure 13.18 – Albert Ellis’s A-B-C model of emotional reactions

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Fig. 13-18, p. 543

Figure 13.19 – Possible examination for the link between humor and wellness

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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 – Slide 41

“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 – Slide 42

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