Stress Coping and Health Chapter 14 The Relationship

Stress, Coping and Health Chapter 14

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 promotion and maintenance Health psychology 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 Table of Contents

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 no cure Table of Contents

Figure 13. 1 Changing patterns of illness Table of Contents

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 Change – having to adapt Holmes and Rahe – Social Readjustment Rating Scale – Life Change Units – Table 13. 1 Pressure – expectations to behave in certain ways Approach-approach, approach-avoidance, avoidance-avoidance – Figure 13. 2 Perform/conform Figure 13. 3 – pressure and psychological symptoms – Weiten (1988) Overview of Stress Process – Figure 13. 4 Table of Contents

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. Table of Contents

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

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Responding to Stress Emotionally Emotional Responses Annoyance, anger, rage Apprehension, anxiety, fear Dejection, sadness, grief Positive emotions After 9/11 – correlations between emotion and resilience Emotional response and performance The inverted-U-hypothesis –performance and task complexity Table of Contents

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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) Table of Contents

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”. Table of Contents

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 hypothalamic pituitary adrencortical (HPA) system with the secretion of cortisol. ” Table of Contents

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 Table of Contents

Table 13. 2 XXXXXX Table of Contents Table 13 -3, p. 523

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) Table of Contents

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 Contents

Figure 13. 7 – The antecedents, components, and consequences of burnout Table of Contents

Effects of Stress: Physical Psychosomatic Heart diseases 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 Table of Contents

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Table of Contents Table 13. 3 a Health Problems that may be Linked to Stress

Table of Contents Table 13. 3 b Health Problems that may be Linked to Stress

XXX 13. 12 Table of Contents

Factors Moderating the Impact of Stress Social support 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 The perceived comfort, caring, esteem or help received from others. Types: emotional, belongingness, instrumental (tangible), informational, esteem/relational, and network (Facebook and My. Space? ) 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 Fostering better health habits Autonomic reactivity Cardiovascular reactivity to stress Table of Contents

Health-Impairing Behaviors Smoking – prevalence in U. S. Smoking cessation Poor nutrition – obesity – “Super Size” generation Cholesterol and coronary risk High fructose corn syrup effects Lack of exercise – increased T. V. watching effects study Obesity – BMI – United States 2005 & 2008 data – CDC – changes over the years Alcohol and drug use Risky sexual behavior Transmission, misconceptions, and prevention of AIDS – AIDS Risk Knowledge Test Table of Contents

BMI Classifications 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 Table of Contents

BMI Classifications 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 Table of Contents

Reactions to Illness Seeking treatment Ignoring physical symptoms Communication Barriers with health care providers to effective communication Following medical advice Noncompliance Biopsychosocial factors in health Table of Contents

Figure 13. 17 – Biopsychosocial factors in health Table of Contents

Stress Management Relationship to coping to self-esteem Cognitive reappraisal – Ellis’s model Humor Relaxation Response – Benson Stress Inoculation Training Physical fitness and mortality Table of Contents

Figure 13. 18 – Albert Ellis’s A-B-C model of emotional reactions Table of Contents

Figure 13. 19 – Possible examination for the link between humor and wellness Table of Contents Fig. 13 -18, p. 543

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 Table of Contents

Relaxation Response – Benson – 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 Table of Contents

Stress Inoculation Training developed 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 Table of Contents