STRESS AND HEALTH CHAPTER 16 LEARNING GOALS Discuss the definition of stress and how it is experienced Describe the stress response and explain how it is adaptive Discuss Selyé s General Adaptation Syndrome Explain the role of cognitive appraisals in stress Specify the relationship between personality, self-control, and stress Identify the role stress in disease Describe the effects on the cardiovascular system and the immune system Discuss how to cope with stress 1 2 THINK Pet Peeves Everyone has minor annoyances in life List your favorite Top 3 pet peeves Rate how much stress you feel when you encounter each one of the peeves 0 = no stress 100 = highest stress possible What patterns do you see? INTRODUCTION The Mystery of Mr. X 53 year old patient admitted for asthma Treated and discharged to mother s house Returned a few hours later in critical condition Phoned his mother 2 months later and was found gasping for air and died Autopsy cited heart damage secondary to lack of oxygen So what killed Mr. X? Voodoo death? 3 4 1
INTRODUCTION Can the mind affect the body to the point of death? Walter Cannon reviewed reports from around the world Physical trauma can cause death, why not psychological trauma? Profound link between the mind and the body This research is just one part of a larger area looking into the relationship between mind-body-health Health psychology (a part of behavioral medicine) is interested in how various factors (biological, psychological, and social) are related to the development and maintenance of disease, as well as the promotion of health. EXPERIENCING STRESS The term stress means different things to different people Lay person tension and unpleasant feelings Athlete training before a contest Business work load and time pressure Psychologists use different definitions and measure it in different ways Major life events Daily hassles Biological measures Most common definition focuses on the Person-Environment Fit, where poor fit results in stress 5 6 DEFINITIONS OF STRESS DEFINITIONS OF STRESS Stress as a physical force Most simplistic view Emphasis on external events Need to simply resist external pressure Stress as an internal tension Psychodynamic Internal war to cope with the overwhelming May eventually lead to physical disease Stress as body arousal Medical research shows that people react physiologically the same way regardless of stress in the environment Sympathetic nervous system ACTH Demands of the environment Hypothalamus CRF Pituitary Adrenal Cortex Higher brain regions Corticosteroids Non-CNS tissue Adrenal Medulla Catecholamines 7 8 2
MODELS OF STRESS MODELS OF STRESS Fight or Flight Oldest model, proposed by Walter Cannon Physiological response is necessary for survival General Adaptation Syndrome Selyé was not the first to use the term stress Is more known for his work on the link between stress and disease Started with environmental focus Non-specific response to the environment Homeostasis 9 10 MODELS OF STRESS Not all people respond to the same stressor in the same way Stress Reactivity People vary in physiology Stress Recovery Slow to return to baseline HPA Allostatic Load Recovery may be less complete over time Stress Resistance Some people remain healthy under stress and others succumb pretty quickly 11 MODELS OF STRESS Cognitive Transactional Model Theories up to now assume a common definition of stress Does everyone have the same reaction to the same stressor? Theory proposed by Richard Lazarus and Susan Folkman Emphasis on perceptions and interpretations of the event. The model takes into consideration that how you view or appraise the situation makes all the difference in terms of stress Faced with the same situation, two people will react completely differently Premised on the idea that stress is not a direct response to a stressor but rather one's resources and ability to cope mediate the stress response and are amenable to change, thus allowing stress to be controllable. 12 3
MODELS OF STRESS STRESS AND DISEASE Primary Appraisal: Am I in trouble? Is this a problem Not stressful Stressful Irrelevant Challenge (Forward, Positive) Benign (Backward, Positive) Threat (Forward, Negative) Harm-Loss (Backward, Negative) Coping YES Secondary Appraisal: Can I cope with this? NO NO STRESS STRESS 13 Exams can be dangerous to your health After exam cold or flu? Not everyone gets sick Exposure Contraction Stressor Contraction Symptoms or illness Hardy Personality Type Commitment Control Challenge Physiological Change Stress Reactivity Stress Recovery Allostatic Load Stress Resistance Behavioral change Illness 14 STRESS AND DISEASE STRESS AND DISEASE Link between immune system and nervous system Ader and Cohen: conditioning of immune response Little girl with autoimmune disorder Cod liver oil steroid (Prednisone) 50% reduction in steroid James Pennebaker: disclosure Interviewed 33 Holocaust survivors Hypothesized that short-term SNS activation was better in the long-term Results different depending on whether they had told their story before or not 15 16 4
COPING WITH STRESS Coping definition Constantly changing cognitive and behavioral efforts to manage the specific internal and external demands that are appraised as taxing or exceeding the resources of the individual Approach versus Avoidance Approach: Confronting problem, gathering information, taking direct action Avoidance: Minimize importance of event Problem-focused versus Emotion-focused Problem-focused: proactive attempt to reduce demands, increase resources Emotion-focused: Manage emotions evoked by event COPING WITH STRESS Social Support Push (constant support) versus Pull (demand from others) Informational support: Others who have had similar experiences provide information Emotional support: Warmth and nurturance, single confidant, more important for men Appraisal support: Helping others understand and identify coping strategies Tangible support: Provision of material support, services, financial assistance, or goods 19 17 18 CONTROL AND STRESS Attributions of control over the environment are important in the experience of stress Andy Baum and Three Mile Island Three Mile Island was a nuclear power plant near Harrisburg, PA that had a core meltdown in 1979 Many people started to report illnesses and moved away from Harrisburg Health effects or lack of control? Compared people with radon gas in basement to people who stayed near the power plant More stress with TMI accident compared with people who were exposed to radon gas CONTROL AND STRESS Langer and Rodin (1976) Nursing home residents One group was given more control: move furniture, choose menu items, sit with different people, take care of a plant Control group: no change in routine, were given a plant but were not asked to care for it Overall results showed that having more control and more responsibility was very beneficial for the first group Results were maintained for 18 months after the study 20 5
Sir William Osler (1892): Concept of coronary-prone personality Rosenman and Friedman Personality factors in heart disease Type A: excessive competitive drive, impatience, hostility and vigorous speech patterns Type B: lack of these characteristics, easy going coping style Early studies revealed a positive association between Type A and CHD comparable to other known risk factors However, later studies failed to find predicted relationship Hostility Emotional component: anger, contempt, scorn Behavioral component: verbal and physical aggression, cause harm Cognitive component: cynicism, mistrust, interpret aggressive intent in others Review of all studies published prior to 1995 found that Ho predicted CHD Predict incidence of CHD in healthy adults, and is associated with severity and progression of CAD Social support does not help Conflict and social isolation 21 22 Angriest Cities (Men s Health, 2006) Men s Health (Men s Health, 2010) Women s Health (Women s Health 2010) Orlando, FL Detroit, MI St. Petersburg, FL St. Petersburg, FL Jacksonville, FL Birmingham, AL Detroit, MI Riverside, CA Modesto, CA Baltimore, MD Bakersfield, CA Cleveland, OH Nashville, TN Memphis, TN Detroit, MI Wilmington, DE Birmingham, AL Charleston, WV Miami, FL St. Petersburg, FL Toledo, OH Memphis, TN Las Vegas, NV Memphis, TN Jacksonville, FL St. Louis, MO St. Louis, MO St. Louis, MO Charleston, WV Bakersfield, CA 23 Angriest Cities (Men s Health, 2006) Men s Health (Men s Health, 2010) Women s Health (Women s Health 2010) Orlando, FL Detroit, MI St. Petersburg, FL St. Petersburg, FL Jacksonville, FL Birmingham, AL Detroit, MI Riverside, CA Modesto, CA Baltimore, MD Bakersfield, CA Cleveland, OH Nashville, TN Memphis, TN Detroit, MI Wilmington, DE Birmingham, AL Charleston, WV Miami, FL St. Petersburg, FL Toledo, OH Memphis, TN Las Vegas, NV Memphis, TN Jacksonville, FL St. Louis, MO St. Louis, MO St. Louis, MO Charleston, WV Bakersfield, CA 24 6
Angriest Cities (Men s Health, 2006) Men s Health (Men s Health, 2010) Women s Health (Women s Health 2010) Orlando, FL Detroit, MI St. Petersburg, FL St. Petersburg, FL Jacksonville, FL Birmingham, AL Detroit, MI Riverside, CA Modesto, CA Baltimore, MD Bakersfield, CA Cleveland, OH Nashville, TN Memphis, TN Detroit, MI Wilmington, DE Birmingham, AL Charleston, WV Miami, FL St. Petersburg, FL Toledo, OH Memphis, TN Las Vegas, NV Memphis, TN Jacksonville, FL St. Louis, MO St. Louis, MO St. Louis, MO Charleston, WV Bakersfield, CA 25 Social Dominance Controlling behaviors, including cutting people off during a conversation Houston et al. (1997) found dominance to be independent predictor of CAD Animal studies Macaque monkeys Only top ½ in social dominance displayed CAD Reversed with beta-blockers 26 STRESS MANAGEMENT STRESS MANAGEMENT What to do about stress? Gain control over your environment Need to find ways to decrease stress after it happens Time management Relaxation techniques Progressive muscle relaxation Meditation Holidays Exercise Aerobic exercise is very effective in improving mood and decreasing stress Ongoing study in Alameda County CA (Berkley) Identified health related behaviors (More the better, >6) Getting 7-8 hours of sleep a night Breakfast Rarely eat between meals Drinking moderate amounts 1 drink a day better than 0 and more than 2 No smoking Exercise regularly Maintain healthy weight 27 28 7