fifth edition mastering the world of psychology CHAPTER Health and Stress Copyright 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved

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1 fifth edition mastering the world of psychology CHAPTER 10 Health and Stress Copyright 2014, 2011, 2008 by Pearson Education, Inc. All Rights Reserved

2 Stress: The Life Events Approach Stress: the physiological and psychological response to a condition that threatens or challenges a person requiring some form of adaptation or adjustment. Stressor: any stimulus or event capable of producing physical or emotional stress Life Events Approach: a way of describing, explaining, and measuring stress; the view that a person's well-being can be threatened by major life changes. includes events most people experience as well as rare events

3 The Social Readjustment Rating Scale (SRRS) Developed by Holmes and Rahe (1967) The SRRS measures the impact of 43 life events that range from most to least stressful and assigns a point value to each of them The life events and changes can be positive or negative. Score ranges from 11 to 100 and correlate with a variety of health indicators. A score over 300 means a 50 percent chance of becoming ill within 2 years. Criticism of SRRS: The scale assigns point values without accounting for how an individual perceives or copes with a particular stressor.

4 Catastrophic Events Posttraumatic Stress Disorder (PTSD): a prolonged and severe reaction to catastrophic event or severe, chronic stress effects can linger for years, especially with personal connection PTSD can result in flashbacks, nightmares or intrusive memories that cause the person to feel as though they are actually reliving the traumatic event Living through a catastrophic event when other s have died can cause the person to feel survivor guilt Depression and alcoholism are more common in female survivors.

5 Everyday Stressors Hassles: irritating demands that occur daily and may cause more stress than major life changes (e.g., standing in line, traffic congestion) Uplifts: positive experiences in life that may neutralize effects of hassles uplifts for some individuals may be stressors for others

6 Stress of Making Choices Stress my be the result of being forced to choose between 2 equally desirable alternatives There are 3 Choice-Related Conflicts: 1. Approach-approach conflict: having to choose between equally desirable alternatives 2. Avoidance-avoidance conflict: having to choose between equally undesirable alternatives 3. Approach-avoidance conflict: The same choice has both desirable and undesirable features

7 Figure 10.1 Variables in Work Stress For a person to function effectively and find satisfaction on the job, these nine variables should fall within the person s comfort zone. Source: Albrecht (1979). Burnout: the lack of energy, exhaustion, and pessimism that results from a person experiencing chronic stress

8 Social Sources of Stress 1. Racism: discrimination based on the belief that one group is natural superior to another; results in the inferior group(s) being suppressed, maltreated or having their rights disenfranchised. historical racism: experienced by groups that have a history of repression (e.g, African Americans, Hispanic Americans, Native Americans) A higher incidence of high blood pressure may be related to historical racism. A strong sense of ethnic identity may offset the effects of racism.

9 Social Sources of Stress 2. Socioeconomic Status (SES): a collective term for the financial, educational, and occupational factors that influence a person s position/rank in society Low-SES associated with poor health (e.g., more colds, flu, higher LDL cholesterol, and higher levels of stress hormones) a person s perceived SES may be more predictive of health problems than actual their actual SES.

10 Social Sources of Stress 3. Unemployment: losing a job and income needed to meet needs People forced out of jobs experience heightened risks of stress-related illnesses in the months that follow job loss. Unemployment diminishes an individual's sense of control over what happens. 4. Acculturative Stress: adjustment to life within a new culture (e.g., a country, a job, a neighborhood) Immigrants with an integration orientation are more satisfied with their lives.

11 Biopsychosocial Model of Health and Illness Biomedical Model: explains illness solely in terms of biological factors focuses more on illness than on health Biopsychosocial Model: focuses on health as well as illness Both are determined by a combination of biological, psychological, and social factors. Health Psychology: subfield of psychology concerned with psychological factors contributing to health, illness, and recovery

12 Figure 10.2 The Biopsychosocial Model of Health and Illness According to the biopsychosocial model, the combined effects of risk and protective factors determine both health and illness. Risk factors move the system toward illness, while protective factors moderate the effects of risk factors and increase the chances that a state of health will be maintained.

13 Physiology of the Health-Stress Connection Fight-or-Flight Response: a response to stress in which the sympathetic nervous system and endocrine glands prepare the body to fight or flee. Maintaining the fight-or-flight response over time influences health in 2 ways. 1. Biochemicals associated with fight-or-flight response affect how the body functions. The body pumps out large amounts of neuropeptide Y (NPY). 2. Fight or flight suppresses body's immune system, affecting lymphocytes: white blood cells including B cells and T cells-that are the key parts of the body s defense system

14 Physiology of the Health-Stress Connection Psychoneuroimmunology: field of study in which psychologists, biologists, and medical researchers combine their expertise to study effects of psychological factors on the immune system. Stress can suppress the immune system long after the stressful experience is over. Periods of high stress are correlated with increased symptoms of many infectious diseases. Stress may decrease the effectiveness of certain vaccines. Academic pressures, poor marital relationships, and sleep deprivation have been linked to lowered immune response.

15 Theories of Stress Response: General Adaptation Syndrome (GAS) General Adaptation Syndrome (GAS): a predictable sequence of reactions organisms show in response to stressors. Theory developed primarily by Hans Selye ( ) There are 3 stages: 1. Alarm: the person/organism experiences a burst of energy to assist them in dealing with the situation 2. Resistance: there is an intense physiological effort to either resist or adapt to the stressor 3. Exhaustion: efforts to resist the stressor have failed and all of the person s/organism s energy ha been depleted causing disintegration or death Most harmful effects of stress are due to prolonged secretion of glucocorticords.

16 Figure 10.3 The General Adaptation Syndrome The three stages in Selye s general adaptation syndrome are (1) the alarm stage, during which there is emotional arousal and the defensive forces of the body are mobilized for fight or flight; (2) the resistance stage, in which intense physiological efforts are exerted to resist or adapt to the stressor; and (3) the exhaustion stage, when the organism fails in its efforts to resist the stressor. Source: Selye (1956).

17 Theories of Stress Response: Cognitive Theory of Stress Cognitive Theory of Stress: person/organism engages in various cognitive processes whenever the encounter stress Theory developed by Richard Lazarus (1966) Two cognitive processes are 1. Primary appraisal: cognitive evaluation to determine if the stressor is irrelevant, positive, or negative (e.g., harm/loss occurred, threat for potential harm/loss, or challenge/opportunity for growth) 2. Secondary appraisal: cognitive evaluation of the resources and options that are available to deal with the stressor Stress results from a person's perception of stress, not the stressors themselves.

18 Figure 10.4 Lazarus and Folkman s Psychological Model of Stress Lazarus and Folkman emphasize the importance of a person s perceptions and appraisal of stressors. The stress response depends on the outcome of the primary and secondary appraisals, whether the person s coping resources are adequate to cope with the threat, and how severely the resources are taxed in the process. Source: Folkman (1984).

19 Theories of Stress Responses

20 Risk and Resilience: Coping Strategies Risk/Resilience Model : analysis of how risk and protective factors interact to produce or protect us from illness. Stress Responses: 1. Physiological = arousal of the Autonomic Nervous System or Endocrine System 2. Emotional = anxiety, grief, resentment, excitement 3. Behavioral = use of coping strategies: efforts to deal with demands perceived as taxing or overwhelming Problem-focused coping: a direct response aimed at reducing, modifying, or eliminating source of stress Emotion-focused coping: reappraisal of a stressor to reduce its emotional impact A combination of strategies is the best approach.

21 Risk and Resilience: Coping Strategies Optimism: having a positive outlook and thinking Optimists are more stress-resistant than pessimists. lower death rates noted in a long-term study in Finland Hardiness: a combination of 3 physiological qualities (commitment, control, and challenge) that are common in people that can handle high levels of stress and yet stay healthy Hardy individuals tend to remain healthy despite high levels of stress.

22 Risk and Resilience: Coping Strategies Religious Faith: Involvement with religion has been associated with lower rates of cancer, heart disease, and stroke. Social Support: tangible and/or emotional support provided by family members, friends, and others Characteristics of People with High Levels of Social Support: Less likely to catch colds Lower levels of depression when suffering from chronic illnesses Recover faster from illness Have a higher probability of surviving a heart attack Perceived Control over situation

23 Factors That Promote Resilience

24 Health and Illness: Coronary Heart Disease Caused by narrowing or blockage of coronary arteries Responsible for 25 percent of all deaths Largely attributable to lifestyle A sedentary lifestyle (e.g., a job with most of the time spent sitting; less than 20 minutes of exercise 3 times per week) is primary modifiable risk factor Other modifiable risk factors are high serum cholesterol level, cigarette smoking, and obesity. Family history is also a risk factor.

25 Health and Illness: Personality Influence Type A Behavior Pattern: a behavior patter marked by a sense of time urgency, impatience, excessive competitiveness, hostility, and anger Associated with increased risk for coronary heart disease Type B Behavior Pattern: a behavior patter marked by a relaxed, easygoing approach to life, without time urgency, competitiveness, and hostility Associated with lower risk of coronary heart disease Type D Behavior Pattern: a behavior patter in people who exhibit chronic emotional distress (e.g., anger and hostility) combined with tendency to suppress negative emotions Associated with increased risk of coronary heart disease

26 Health and Illness: Cancer Cancer is the 2 nd leading cause of death in US It is a collection of diseases rather than a single entity Cancer cells do not stop dividing like normal cells so grow and spread disease rapidly. Avoidant coping strategies that increased distress are fantasizing, denial, and social withdrawal Psychological factors can improve quality of life and reduce distress in cancer patients. Maintaining an optimistic outlook Accepting the reality of the situation Keeping a sense of humor Social support

27 Health and Illness: Gender Factors Need to examine interactions in gender differences in physiological, psychological, and social domains Men have higher death rates from all causes, although women tend to be less healthy. Women's postsurgical mortality rate is higher than men's. Women have higher rates of postsurgical infection and stroke. A higher rate of blood transfusion may create these greater infection rates.

28 Health and Illness: Ethnic Group Differences Some racial and ethnic groups have higher incidences of chronic conditions than others. African Americans: higher rates of diabetes, arthritis, and high blood pressure than white Americans more likely to die from cancer and heart disease These differences cannot be explained by socioeconomic factors alone. The differences may result from racial patterning: the tendency of groups to maintain shared behavior patterns (e.g., diet)

29 Lifestyle and Health: Smoking Smoking is the number 1 cause of preventable diseases and deaths in US directly related to over 400,000 deaths each year Smoking related to heart disease, lung cancer, chronic bronchitis, low birth weight and retarded fetal development in babies born to smoking mothers Passive smoking (breathing in smoke-filled air) is related to an increased risk of heart attack.

30 Lifestyle and Health: Alcohol Abuse Since the late 1950s, the American Medical Association has referred to alcoholism as a disease. Excessive alcohol consumption can damage virtually every organ in the body but especially the liver, stomach, heart, and brain CT scans show brain shrinkage in alcoholics. Shrinkage is apparent even when cognitive loss is not yet noticeable. Brain-imaging techniques and genetic predisposition for alcoholism Brains of alcoholics respond differently to visual and auditory stimuli than those of non-alcoholics Compared to non-alcoholics, alcoholics:. Are 3 times more likely to die in car accidents Are twice as likely to die of cancer

31 Table 10.1 Alcohol Poisoning

32 Sexually Transmitted Diseases Sexually Transmitted Diseases (STDs): infections that are spread primarily through intimate sexual contact The incidence of STDs has greatly increased over the past 30 years due to: Greater sexual activity among young people More permissive attitudes toward sex Use of non-barrier methods of contraception Bacterial STDs: Sexually Transmitted Diseases that are caused by bacteria and can be treated/cured with antibiotics Transmitted through physical contact involving the genitals or intercourse Chlamydia, gonorrhea, syphilis * Viral STDs: Sexually Transmitted Diseases that are caused by viruses and are considered incurable Genital herpes, genital warts (human papilloma virus), HIV/AIDS

33 Sexually Transmitted Diseases: HIV/AIDS Acquired Immune Deficiency Syndrome (AIDS): caused by infection with the Human Immunodeficiency Virus (HIV). Progressively weakens the body s immune system leaving the person vulnerable to opportunistic infections which eventually cause their death (e.g., pneumonia, diarrhea) HIV is transmitted primarily through: Exchange of blood Semen Vaginal secretions during sexual contact IV (intravenous) drug users sharing contaminated needles or syringes

34 Sexually Transmitted Diseases: HIV/AIDS The number of new cases of HIV/AIDS in developing regions has leveled off due to 2 Major Advances in Treatment of AIDS are: 1. AZT can prevent the transmission of HIV from a pregnant woman to her fetus. 2. Antiretroviral drugs have prevented millions of deaths by interfering with HIV's ability to invade healthy cells Almost 1/3 of new HIV cases resulted from heterosexual contact. Circumcision reduces the risk of HIV transmission. Presence of another STD in an HIV-infected person causes higher levels of the communicable form of the virus in his or her bodily fluids. In AIDS-Related Dementia, the cortex of an AIDS victim gradually thins as the disease progresses.

35 Lifestyle and Health: Diet and Exercise Obesity increases the risk of chronic conditions. heart disease, high blood pressure, type 2 diabetes Insufficient amounts of particular nutrients contribute to health problems. anemia: caused by an iron-deficient diet causing; results in the blood not delivering the necessary amounts of oxygen to the cells. Regular Fast Food Consumption increases risk for obesity and nutritional deficiencies 5-a-Day Plan: Eat 5 servings of fruits and vegetables each day. Exercise has both mental and physical benefits. More than 1/3 of Americans get no exercise at all.

36 Lifestyle and Health: Diet and Exercise Strength training has been found to reduce sarcopenia: the age-related process of muscle deterioration Strength training also reduces the loss of bone mass to osteoporosis. Regular aerobic exercise has numerous health benefits. Improved mood Combats chronic diseases such as high blood pressure, diabetes, and osteoporosis Helps manage weight Boosts energy level Promotes better sleep Improves sexual intimacy Enhances enjoyment of life

37 Alternative Medicine Alternative Medicine: any treatments or therapy that has not been scientifically proven to be effective Some are effective at preventing and treating illness. Pharmacological effects of alternative treatments may interfere with those drugs prescribed by physicians. Alternative treatments may cause delays in seeking conventional treatment.

38 Figure 10.7 Alternative Therapies In the United States, 38% of adults and 12% of children use one or more alternative treatments to treat or prevent disease. The other category includes acupuncture, biofeedback, guided imagery, progressive relaxation, hypnosis, Pilates, traditional healers, and a host of other treatments. Source: Barnes et al. (2007).

39 Table 10.2 Benefits of Lifestyle Changes