Chapter 13. Stress and Illness. Key Terms. Health Psychology and Behavioral Risk Factors (cont.)

Transcription

1 Chapter 13 Health, Stress, and Coping Key Terms Stress: any real or imagined threat to one s wellbeing. Frustration: state in which the pursuit of one s goals is thwarted. Conflict: when 2 or more incompatible motivations occur. Change: noticeable alteration in one s life that require one to adjust their lives Pressure: Expectatrions or demands to behave in a certain way. Coping: mechanisms used to deal with all the above (like defense mechanisms) Health Psychology and Behavioral Risk Factors Health Psychology: Uses behavioral principles to prevent illness and promote health Behavioral Medicine: Applies psychology to manage medical problems e.g., asthma and diabetes Lifestyle Diseases: Diseases related to health-damaging personal habits Health Psychology and Behavioral Risk Factors (cont.) Behavioral Risk Factors: Behaviors that increase the chances of disease, injury, or premature death Disease-Prone Personality: Personality type associated with poor health; person tends to be chronically depressed, anxious, hostile, and frequently ill Ways to Promote Health and Early Prevention Stress and Illness Refusal Skills Training: Program that teaches young people how to resist pressures to begin smoking Life Skills Training: Teaches stress reduction, self-protection, decision making, self-control, and social skills Role Model: Person who serves as a positive example of good and desirable behavior Wellness: Positive state of good health and well-being Leading causes of death in the US in 1900 and

2 Promoting Health Smoking-related early deaths Number of deaths per 100,000 40,000 30,000 33,348 The Physiological Effects of Nicotine 20,000 10,000 1,686 1, Smoking Suicide Vehicle HIV/ Homicide crash AIDS Cause of death But as smoking declines, obesity increases Trading risks Obesity and Weight Control Obesity and mortality Relative risk of death Body-mass index (BM I) Men Women Stressful Life Events Chronic Stress by Age Perceived Control Equality and Longevity 2

3 Stress Mental and physical condition that occurs when a person must adjust or adapt to the environment Includes marital and financial problems Stress Reaction: Physical reaction to stress Autonomic Nervous System is aroused Stressor: Condition or event that challenges or threatens the person Pressure: When a person must meet urgent external demands or expectations Fig Stress is the product of an interchange between a person and the environment. Burnout Burnout: Job-related condition (usually in helping professions) of physical, mental, and emotional exhaustion Emotional Exhaustion: Feel used up and apathetic toward work Cynicism: Detachment from the job Feeling of reduced personal accomplishment Stress and Health Sources of Stress: Don t t Hassle Me? What Are the Relationships Among Daily Hassles, Life Changes, and Physical Illness? Appraising Stressors Threat: Event or situation perceived as potentially harmful Primary Appraisal: Deciding if a situation is relevant or irrelevant, positive or threatening Secondary Appraisal: Assess resources and decide how to cope with a threat or challenge Perceived lack of control is just as threatening as an actual lack of control Perceived Control Health consequences of a loss of control Executive rat Subordinate rat Control rat To shock control To shock source No connection to shock source 3

4 Stress and the Heart Stress and the Heart Hopelessness scores Men who feel extreme hopelessness are at greater risk for heart attacks and early death Heart attack Death Low risk Moderate risk High risk Threats and Frustration Reactions to Frustration Problem-Focused Coping: Managing or altering the distressing situation Emotion-Focused Coping: Trying to control one s emotional reactions to the situation Frustration: Negative emotional state that occurs when one is prevented from reaching desired goals External Frustration: Based on external conditions that impede progress toward a goal Personal Frustration: Caused by personal characteristics that impede progress toward a goal Aggression: Any response made with the intention of harming a person, animal, or object Displaced Aggression: Redirecting aggression to a target other than the source of one s frustration Scapegoating: Blaming a person or group for conditions they did not create; the scapegoat is a habitual target of displaced aggression Reactions to Frustration (cont.) Escape: May mean actually leaving a source of frustration (dropping out of school) or psychologically escaping (apathy) Conflict: Stressful condition that occurs when a person must choose between contradictory needs, desires, motives, or demands Fig Frustration and common reactions to it. 4

5 Defense Mechanisms (again) Denial Fantasy Intellectualization Undoing: Atonement, or ritual acts that fix the quilt ridden act. Overcompensation: overdoing a desirable characteristic (body building) or overdoing a non-desirable trait out of frustration (overeating for an obese person). Models for Conflict Sources of Stress: Don t t Hassle Me? Conflicts Approach-Approach Conflicts: Having to choose between two desirable or positive alternatives (e.g., choosing between a new BMW or Mercedes) Avoidance-Avoidance Conflicts: Being forced to choose between two negative or undesirable alternatives (e.g., choosing between going to the doctor or becoming ill) NOT choosing may be impossible or undesirable Conflicts (cont.) Approach-Avoidance Conflicts: Being attracted (drawn to) and repelled by the same goal or activity; attraction keeps person in the situation, but negative aspects can cause distress Ambivalence: Mixed positive and negative feelings; central characteristic of approach-avoidance conflicts Fig Three basic forms of conflict. For this woman, choosing between pie and ice cream is a minor approach-approach conflict; deciding whether to take a job that will require weekend work is an approach-avoidance conflict; and choosing between paying higher rent and moving is an avoidance-avoidance conflict. Fig Conflict diagrams. As shown by the colored areas in the graphs, desires to approach and to avoid increase near a goal. The effects of these tendencies are depicted below each graph. The behavior of the ball in each example illustrates the nature of the conflict above it. An approach conflict (left) is easily decided. Moving toward one goal will increase its attraction (graph) and will lead to a rapid resolution. (If the ball moves in either direction, it will go all the way to one of the goals.) In an avoidance conflict (center), tendencies to avoid are deadlocked, resulting in inaction. In an approach-avoidance conflict (right), approach proceeds to the point where desires to approach and avoid cancel each other. Again, these tendencies are depicted (below) by the action of the ball. (Graphs after Miller, 1944.) 5

6 Multiple Conflicts Fig Frustration and common reactions to it. Double Approach-Avoidance Conflicts: Each alternative has both positive and negative qualities Vacillation: When one is attracted to both choices; seeing the positives and negatives of both choices and going back and forth before deciding, if deciding at all! Multiple Approach-Avoidance Conflicts: When several alternatives have positive and negative features Anxiety Feelings of tension, uneasiness, apprehension, worry, and vulnerability We are motivated to avoid experiencing anxiety Learned Helplessness (Seligman) Acquired (learned) inability to overcome obstacles and avoid aversive stimuli; learned passivity Occurs when events appear to be uncontrollable May feel helpless if failure is attributed to lasting, general factors Depression State of feeling despondent defined by feelings of powerlessness and hopelessness One of the most common mental problems in the world Childhood depression is dramatically increasing Some symptoms: Loss of appetite or sex drive, decreased activity, sleeping too much Fig In the normal course of escape and avoidance learning, a light dims shortly before the floor is electrified (a). Since the light does not yet have meaning for the dog, the dog receives a shock (non-injurious, by the way) and leaps the barrier (b). Dogs soon learn to watch for the dimming of the light (c) and to jump before receiving a shock (d). Dogs made to feel helpless rarely even learn to escape shock, much less to avoid it. 6

7 Depression 14 score Exercise reduces Depression Aerobic exercise group No-treatment group Relaxation treatment group Aerobic Exercise sustained exercise that increases heart and lung fitness Coping Coping: Responses are reinforced that lead to mastery of a threat or control over one s environment One method to combat learned helplessness and depression 3 Before treatment evaluation After treatment evaluation How to Recognize Depression (Beck) Stress and Health You have a consistently negative opinion of yourself You engage in frequent self-criticism and selfblame You place negative interpretations on events that usually would not bother you The future looks grim You can t handle your responsibilities and feel overwhelmed Catastrophizing: Making mountains out of molehills - - Constantly Social Readjustment Rating Scale (SRRS): Rates the impact of various life events on the likelihood of contracting illness Not a foolproof method of rating stress Are positive life events (getting married, having a child) always stressful? People also differ in their reactions to stress Microstressors (Hassles): Minor but frequent stresses Psychosomatic Disorders Psychological factors contribute to actual illnesses (bodily damage) or to damaging changes in bodily functioning Hypochondriacs: Complain about diseases that appear to be imaginary Certain kinds of ulcers are not psychosomatic Most common complaints: respiratory and gastrointestinal Gate Control Theory of Pain 7

8 Biofeedback Applying informational feedback to bodily control Aids voluntary regulation of activities such as blood pressure, heart rate, and so on Helpful but not an instant cure May help relieve muscle-tension headaches, migraine headaches, and chronic pain Fig In biofeedback training, bodily processes are monitored and processed electronically. A signal is then routed back to the patient through headphones, signal lights, or other means. This information helps the patient alter bodily activities not normally under voluntary control. Cardiac Personalities Hardy Personality Type A Personality: Personality type with elevated risk of heart attack; characterized by time urgency and chronic anger or hostility Anger may be the key factor of this behavior Type B Personality: All types other than Type A s; significantly less likely to have a heart attack Personality type associated with superior stress resistance Sense of personal commitment to self and family Feel they have control over their lives See life as a series of challenges, not threats Health Locus of Control 1. If I take care of myself, I can avoid illness (Internal) 2. Whenever I get sick it is because of something I ve done or not done (Internal) 3. Good health is largely a matter of good fortune (External) 4. No matter what I do, if I am going to get sick I will get sick (External) 5. Most people do not realize the extent to which their illnesses are controlled by accidental happenings (External) 6. I can only do what my doctor tells me to do (External) 7. There are so many strange disease around that you can never know how or when you might pick one up (External) 8. When I feel ill, I know it s because I have not been getting the proper exercise or eating right (Internal) 9. People who never get sick are just plain lucky (External) 10.People s ill-health results from their own carelessness (Internal) 11.I am directly responsible for my health (Internal) Effects of Stress: a dual system a. activation of the sympathetic nervous system; b. the HPA Axis 8

9 Elevated cortisol: is linked to increased levels of depression, memory problems and The General Adaptation Syndrome is directly related to impairment of immune system functioning; A suppressed immune system leaves the body vulnerable to disease. General Adaptation Syndrome (GAS; Selye) Immunity (yeah just like the stupid show Survivor?) Series of bodily reactions to prolonged stress; occurs in three stages Alarm Reaction: Body resources are mobilized to cope with added stress Stage of Resistance: Body adjusts to stress but at a high physical cost; resistance to other stressors is lowered Stage of Exhaustion: Body s resources are drained and stress hormones are depleted, possibly resulting in psychosomatic disease, loss of health, or complete collapse Immune System: Mobilizes bodily defenses, like white blood cells, against invading microbes and other diseases Psychoneuroimmunology: Study of connections among behavior, stress, disease, and immune system Stress and Disease Stress Management UCS (drug) CS (sweetened water) CS (sweetened water) UCR (immune suppression) UCS (drug) CR (immune suppression) UCR (immune suppression) Conditioning of immune suppression at the physiological level Use of behavioral strategies to reduce stress and improve coping skills Progressive Relaxation: Produces deep relaxation throughout the body by tightening all muscles in an area and then relaxing them Guided Imagery: Visualizing images that are calming, relaxing, or beneficial 9

10 Stress and Health Coronary Heart Disease The Job- Strain Model Stress and Disease Avoiding Upsetting Thoughts Negative emotions and health-related consequences Persistent stressors and negative emotions Unhealthy behaviors (smoking, drinking, poor nutrition and sleep) Release of stress hormones Heart disease Immune suppression Autonomic nervous system effects (headaches, hypertension) Stress Inoculation: Using positive coping statements internally to control fear and anxiety; designed to combat: Negative Self-Statements: Self-critical thoughts that increase anxiety and lower performance Coping Statements: Reassuring, selfenhancing statements used to stop negative self-statements Resources for Healthy Living 1. Health & exercise 2. Positive beliefs 3. Social skills 4. Social support 5. Material resources 6. Personal control Internal locus of control 7. Relaxation 10

11 The Health Belief Model (HBM) (HBM) An individual will take preventative health action if: They feel susceptible to disease through genetic factors They believe an illness could have serious consequences They think preventative action will be beneficial They believe the costs (such as pain) do not outweigh the benefits of the health action Theory of Planned Behaviour Theory of Planned Behaviour Health intentions are determined by: Personal attitudes towards a behaviour (e.g. I will enjoy giving up smoking because I will save money) Beliefs about what is an acceptable way to behave Beliefs about whether the behavioural goals can be achieved Promoting Health Religious Attendance Promoting Health The religion factor is multidimensional Religious involvement Healthy behaviors (less smoking, drinking) Social support (faith communities, marriage) Better health (less immune system suppression, stress hormones, and suicide) Positive emotions (less stress, anxiety) 11

12 Meditation Meditation (cont.) Mental exercise designed to focus attention and interrupt flow of thoughts, worries, and analyses Concentrative Meditation: Attention is paid to a single focal point (i.e., object, thought, etc.) Produces relaxation response and thus works to reduce stress Receptive Meditation: Based on widening attention span to become aware of everything experienced at a given moment Mantra: Word(s) or sound(s) repeated silently during concentrative meditation Relaxation Response: Occurs at time of relaxation; innate physiological response that opposes fight or flight responses 12