CHAPTER 13 STRESS, COPING AND HEALTH

CHAPTER 13 STRESS, COPING AND HEALTH

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

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

Figure 13-1, Changing pattern of illness for 100+ years

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

Psychological Stress Richard Lazarus (1966) 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.

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.

APPROACH-APPROACH

AVOIDANCE-AVOIDANCE

APPROACH-AVOIDANCE

Figure 13-3 Pressure and psychological symptoms

1)Potentially stressful objective events 2)Subjective cognitive appraisal 3)Response 1)Emotional 2)Physiological 3)Behavioral

RESPONDING TO STRESS EMOTIONALLY Emotional Responses Annoyance, anger, rage Apprehension, anxiety, fear Dejection, sadness, grief Positive emotions Table 13.2, after 9/11 Emotional response and performance The inverted-u-hypothesis Figure 13.5

Table 13-2, p. 518

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) (fast) hypothalamic pituitary adrencortical (HPA) (slow, energy)

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.

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.

ALLOSTATIS AND ALLOSTATIC LOADS Allostatis - ability to achieve stability through change... (McEwen, 1998, p.171). Allostatic loads (McEwen, 1998) The first and most obvious is frequent stress (p. 172) Lack of adaptation to a repeated stressor can prolong exposure to stress hormones (p. 172) Inability to shut off allostatic responses after a stress is terminated (p.172) [I]nadequate responses by some allostatic systems trigger compensatory increases in others (p. 173)

RESPONDING TO STRESS BEHAVIORALLY Behavioral Responses: Coping emotion focused Frustration-aggression hypothesis catharsis Defensive Coping ego defense mechanisms Freud Table 13.3 Constructive Coping problem focused

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)

EFFECTS OF STRESS: BEHAVIORAL AND PSYCHOLOGICAL Impaired Task performance Burnout antecedent-componentsconsequences Figure 13.7 Posttraumatic Stress Disorders (PTSD) effects on hippocampus (cortisol) slide prevelance of traumatic events Psychological problems and disorders more in Chapter 14 Positive effects eustress Positive Psychology Flow (Csikszentmihalyi)

Figure 13.7 The antecedents, components, and consequences of burnout

EFFECTS OF STRESS: PHYSICAL Psychosomatic diseases Heart disease Cholesterol and inflammation and risks Figure 13.8 Type A behavior - 3 elements strong competitiveness impatience and time urgency anger and hostility (note in F 13.9 most related to cornary events) Emotional reactions and depression Figure 13.10 study by Pennix et al. (2001) Stress and immune functioning Reduced immune activity Possible health problems linked to stress Table 13.4 Stress-illness correlation Figure 13.11

Table 13-4a, p. 531

XXX 13.11

FACTORS MODERATING THE IMPACT OF STRESS Social support The perceived comfort, caring, esteem or help received from others. 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

HEALTH-IMPAIRING BEHAVIORS Smoking prevalence in U.S. - Figure 13.12 Smoking cessation Figure 13.13 Poor nutrition obesity (slide 30) Super Size generation Cholesterol and coronary risk Figure 13.14 Lack of exercise increased T.V. watching effects study Alcohol and drug use Risky sexual behavior Transmission, misconceptions, and prevention of AIDS Figure 13.15

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

Figure 13.12 The prevalence of smoking in the United States

XXX 13.13

Figure 13.14 The link between cholesterol and coronary risk Fig. 13-14, p. 535

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 13.16

Figure 13.16 Biopsychosocial factors in health

STRESS MANAGEMENT Relationship to coping to self-esteem Cognitive reappraisal Ellis s model Figure 13.17 Humor Figure 13.18 Relaxation Response Benson Figure 13.19 Stress Inoculation Training Physical fitness and mortality Figure 13.20

Figure 13.17 Albert Ellis s A-B-C model of emotional reactions

Figure 13.18 Possible examination for the link between humor and wellness 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

RELAXATION RESPONSE - BENSON 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

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 selfstatements 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