NANTAI NVERSTES HEALTH PSYCHOLOGY ktisadi dari ve Sosyal

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NİŞANTAŞI ÜNİVERSİTESİ HEALTH PSYCHOLOGY İktisadi, İdari ve Sosyal Bilimler Fakültesi iisbf. nisantasi. edu. tr

NİŞANTAŞI ÜNİVERSİTESİ HEALTH PSYCHOLOGY İktisadi, İdari ve Sosyal Bilimler Fakültesi iisbf. nisantasi. edu. tr NİŞANTAŞI ÜNİVERSİTESİ ©

CHAPTER 12 STRESS AND ILLNESS MODERATORS

CHAPTER 12 STRESS AND ILLNESS MODERATORS

LEARNING OUTCOMES By the end of the chapter, you should have an understanding of:

LEARNING OUTCOMES By the end of the chapter, you should have an understanding of: • coping theory, definitions and the distinction between coping styles, strategies, and goals • how coping responses influence the manner in which stress may affect health outcomes • influences of stress appraisal, coping response and illness outcomes including: – aspects of personality – aspects of individual cognitions – aspects of emotion • The nature and function of social support and how it influences stress appraisal, coping responses and illness outcomes

COPING Coping is a dynamic process involving a constellation of cognitions and behaviour that

COPING Coping is a dynamic process involving a constellation of cognitions and behaviour that arise from the primary and secondary appraisals of events, and the emotions attached to them. Coping is anything a person does to reduce the impact of a perceived or actual stressor. Coping can operate to alter or reduce negative emotion(s) attached to the stressor, or it can directly target the stressor. Coping may or may not succeed, but it is concerned with trying to achieve adaptation.

STRESS AND COPING Cohen and Lazarus (1979) described five main coping functions, each of

STRESS AND COPING Cohen and Lazarus (1979) described five main coping functions, each of which contribute to successful adaptation to a stressor: 1. reducing harmful external conditions; 2. tolerating or adjusting to negative events; 3. maintaining a positive self-image; 4. maintaining emotional equilibrium and decreasing emotional stress; 5. maintaining a satisfactory relationship with the environment or with others.

COPING TAXONOMIES Table 12. 1 Coping dimensions

COPING TAXONOMIES Table 12. 1 Coping dimensions

COPING: STYLE VS. STRATEGY Style e. g. monitor vs. blunter (Miller 1987) • Monitors

COPING: STYLE VS. STRATEGY Style e. g. monitor vs. blunter (Miller 1987) • Monitors generally tend to approach problems, seek out threat relevant information • Blunters generally tend to avoid or distract themselves from threatrelevant information Strategy • Situation-specific coping varied to context, the stressor, and the person’s personality, mood, etc. • Coping may include opposite strategies i. e. passive coping and problem-focused coping Both coping style and coping strategies can be seen in an individual’s response to events, they are not mutually exclusive.

THE COPING PROCESS Figure 12. 1 The coping process Source: adapted from Lazarus (1999:

THE COPING PROCESS Figure 12. 1 The coping process Source: adapted from Lazarus (1999: 198).

ADAPTIVE COPING To be effective, coping has to be amenable to change. Problem-focused and

ADAPTIVE COPING To be effective, coping has to be amenable to change. Problem-focused and emotion-focused strategies may be used together – problem-focused or approach coping tends to be more adaptive when something can be done to alter or control the stressor event; – emotion-focused coping tends to be more adaptive, where control of the event, or resources, are low. Context, stressor and individual characteristics all interact.

THE ‘BIG FIVE’ THEORY (COSTA AND MCCRAE 1992) The ‘Big Five’ personality dimensions are:

THE ‘BIG FIVE’ THEORY (COSTA AND MCCRAE 1992) The ‘Big Five’ personality dimensions are: • Agreeableness – i. e. cooperative; • Conscientiousness – i. e. responsible; • Extroversion – i. e. sociable; • Neuroticism – i. e. tense, anxious; • Openness – i. e. imaginative, open to new experiences. Each of the above have differential associations with health behaviour, symptom perception, stress, coping and illness behaviour.

STRESS, PERSONALITY AND ILLNESS There are various possible models of association between personality variables

STRESS, PERSONALITY AND ILLNESS There are various possible models of association between personality variables and health and illness: – Personality may promote unhealthy behaviours predictive of disease (e. g. smoking) – an indirect link on disease risk. – Personality may indirectly influence illness progression or outcome by influencing individual appraisals. – Personality may be predictive of disease onset via ‘disease prone personality’ - stems from psychosomatic tradition. – Personality traits may predispose to specific illnesses (Type A behaviour and CHD) – physiological e. g. angry personalities may be more physiologically stress-reactive.

PERSONALITY AND ILLNESS Neuroticism – related to attention to internal states and increased somatic

PERSONALITY AND ILLNESS Neuroticism – related to attention to internal states and increased somatic complaints; – related to negative affectivity which reflects a generally negative outlook. Associated with subjective, rather than objective, illness experience. Optimism – reflects a positive outlook and positive outcome expectancies; – significantly associated with coping, reduced symptom reporting, reduced negative mood or depression and increased well-being; – influences appraisals, making problem-focused coping more likely. Hardiness – arises from rich, varied and rewarding childhood experiences; – manifest in feelings of commitment, control and challenge; – thought to ‘buffer’ the experience of stress; but evidence is mixed.

THE BUFFERING EFFECT OF HARDINESS Figure 12. 3 The buffering effects of hardiness Source:

THE BUFFERING EFFECT OF HARDINESS Figure 12. 3 The buffering effects of hardiness Source: adapted from Kobasa et al. (1982).

TYPE A BEHAVIOUR (TAB): CORONARY HEART DISEASE TAB is a multidimensional concept combining action

TYPE A BEHAVIOUR (TAB): CORONARY HEART DISEASE TAB is a multidimensional concept combining action and emotion and is manifest in individuals showing the following (Friedman and Rosenman 1959, 1974; Rosenman 1978): • Competitiveness; • Time-urgent behaviours (trying to do too much in too little time); • Easily annoyed/aroused hostility and anger; • Impatience; • Achievement-oriented behaviour; • A vigorous speech pattern.

ANGER AND HEALTH BEHAVIOUR Hostility and Anger Hostility an important predictor of illness. Hostile

ANGER AND HEALTH BEHAVIOUR Hostility and Anger Hostility an important predictor of illness. Hostile individuals are likely to: • engage in health-risk behaviour; • have lower capacity to benefit from psychosocial resources; • be more stress-reactive.

PERSONALITY AND ILLNESS Type C personality (Temoshok and Fox 1984; Temoshok 1987) • cooperative

PERSONALITY AND ILLNESS Type C personality (Temoshok and Fox 1984; Temoshok 1987) • cooperative and appeasing; • compliant and passive; • stoic; • unassertive and self-sacrificing; • tendency to inhibit negative emotions, particularly anger. Type C personality types was found to have an elevated cancer risk but evidence is mixed. Type D personality (Denollet and Potter 1992; Denollet 1998) A ‘distressed’ personality with high negative affectivity and social inhibition. Limited research but suggested links with increased mortality following a heart attack/cardiac event, even when controlling for biomedical risk factors.

STRESS AND COGNITIONS: PERCEIVED CONTROL Locus of Control (Rotter 1966); Health Locus of Control

STRESS AND COGNITIONS: PERCEIVED CONTROL Locus of Control (Rotter 1966); Health Locus of Control (Wallston et al. 1978) Various types of control have been described: • Behavioural: belief that one can perform behaviours to reduce the negative impact of a stressor (e. g. using breathing techniques during a painful event); • Cognitive: belief that one has certain thought processes or strategies available that would reduce the negative impact of stressor (e. g. distracting oneself from pain by focusing on pleasant thoughts); • Decisional: having opportunity to choose between options (e. g. having anaesthetic prior to a tooth extraction or not); • Informational: opportunity to find out about the stressor, i. e. the what, why, when, where, likely outcomes, possibilities, etc. , information allows preparation; • Retrospective: attributions of cause or control over an event made after it happens: i. e. searching for event meaning can give sense of order in life; e. g. blaming a birth defect on a defective gene (internal) may be more adaptive than attributing blame externally, although this is not clear-cut.

STRESS AND COGNITIONS: HOPE ‘a positive motivational state that is based on an interactively

STRESS AND COGNITIONS: HOPE ‘a positive motivational state that is based on an interactively derived sense of successful (a) agency (goal-directed energy) and (b) pathways (planning to meet goals)’ Snyder et al. 1991: p 287 – Conceptual overlap between hope and other constructs such as selfefficacy and dispositional optimism, due to focus on an individual’s ‘resources’. Hope highlights motivation and route to achieving goals. – Differences have not been fully tested empirically and thus is unclear whether hope adds to the explanation of health outcomes offered by optimism and self-efficacy. – Increased interest given the growth of “positive psychology”.

STRESS AND EMOTIONS: DEPRESSION AND ANXIETY Significant associations reported between depression and CHD incidence

STRESS AND EMOTIONS: DEPRESSION AND ANXIETY Significant associations reported between depression and CHD incidence and prognosis: Depression and anxiety has predicted 20 -year incidence of hypertension (Markovitz et al. 1993). A significant association has been found between depressed mood and mortality from heart disease (Surtees et al. 2008), but evidence from stroke populations is less consistent (Morrison et al. 2005). Depression and anxiety have been shown to influence the appraisals that individuals make when facing stressful events. Depression and anxiety influence coping (Lowe et al. 2003). Depression is seen to reduce the likelihood of healthy behaviour or cessation of unhealthy behaviour (Lane et al. 2001; Wing et al. 2002). Depression may interfere with a person’s ability to seek, or benefit from social support and supportive interactions.

SOCIAL SUPPORT AND STRESS • Sources can include support from partners, close family and

SOCIAL SUPPORT AND STRESS • Sources can include support from partners, close family and friends, colleagues, health and social care professionals and support groups; • Social support is considered in terms of two interacting components: ‒ Structure – i. e. type of support, size of networks ‒ Function(s) they serve (Uchino 2006); • Social networks facilitate the provision of goods, services and mutual defence in times of need or danger (Cobb 1976); • Individuals who perceive high social support are likely to appraise events as less stressful than individuals who do not perceive support (i. e. social support acts as a ‘buffer’ against stress) (Rosengren et al. 1993); • Low social support implicated in death from ischaemic heart disease, cancer and stroke (Vogt et al. 1992).

SOCIAL SUPPORT AND STRESS (CONT. ) Table 12. 3 Types and functions of social

SOCIAL SUPPORT AND STRESS (CONT. ) Table 12. 3 Types and functions of social support

SOCIAL SUPPORT AND DISEASE Social support as a moderator of effects of life stress

SOCIAL SUPPORT AND DISEASE Social support as a moderator of effects of life stress on health (Rosengren et al. 1993) Among middle-aged men, the association between an accumulation of critical life changes and subsequent heart attack was moderated by the quality of social support. Social support may buffer the impact of depression on mortality following a heart attack (Frasure-Smith et al. 2000). Social support as a predictor of illness experience (Evers et al. 2003) Among individuals suffering from RA, a limited social network was predictive of disease activity 3 years later, even when coping behaviours was controlled for (Penninx et al. 1999).

DOES SOCIAL SUPPORT INFLUENCE HEALTH STATUS? Direct effects hypothesis: social support is beneficial regardless

DOES SOCIAL SUPPORT INFLUENCE HEALTH STATUS? Direct effects hypothesis: social support is beneficial regardless of amount of stress and a lack of social support is detrimental to health even in the absence of stress. • Greater social support provide greater sense of belongingness and self-esteem, thus producing a positive outlook and healthier lifestyles. • Social support has physiological route to health by reduced blood pressure reactivity, arising from positive stress appraisals and emotions. Social support effects may be enhanced via endocrine or immune system functions, although inconsistent (Uchino et al. 2006). • Buffering hypothesis: social support protects the person against negative effects of high stress. • • either by influencing the person’s cognitive appraisals of a situation, so they perceive their resources as greater to meet threat; or by modifying the person’s coping response to stressor after it has been appraised as stressful (i. e. they do not cope alone).