Hostility as a Health Threat Selye: A person confronted with major stressor goes into one of two modes: Fight Flight OR Anxious, pessimistic, low efficacy will tend to which response? Flight Imagine someone in chronic “fight” mode, always ready for attack or defense How would he/she perceive situations? Interpret other people? More threatening, as self-serving, un-trustworthy, dog-eat-dog world How would this person behave toward others? Socially abrasive, smaller social network, avoid others when in need
Hostility is considered to be an attitudinal set—perhaps a personality trait—which stems from an absence of trust in the basic goodness of others and centers around the belief that others are generally mean, selfish, and undependable. Williams, Barefoot, & Shekelle, 1985 Hostility Defined
http://www.youtube.com/watch?v=78b67l_yxUc Case Study of Hostile Personality
YESNO 1No one cares much what happens to you 2I have often met people who were supposed to be experts who were no better than I. 3Some of my family have habits that bother and annoy me very much. 4I often have to take orders from someone who did not know as much as I did. 5It makes me feel like a failure when I hear of the success of someone I know well. 6People often disappoint me. 7It is safer to trust nobody. 8I have often felt that strangers were looking at me critically. 9I tend to be on my guard with people who are somewhat more friendly than I expected. 10My way of doing things is apt to be misunderstood by others. Hostility Scale (Cook and Medley, 1954)
1. Hostile 2. Competitive 3. Work-a-holic 4. time-pressed Qualities of Type A Personality Which component the most important? X
Blockage of blood vessels Coronary Heart Disease (CHD)(1.5 time greater odds) 20-year increased risk of death due to: * CHD * Malignant Neoplasms (cancer) * All causes of death combined Health Correlates of Hostility
Is Relation Between Hostility and Heart Disease Linear or Catastrophic? LinearCatastrophic
Hostility and Coronary Heart Disease Among MDs Barefoot, et al., 1983
MD Survival Rates Over 25 Years: Low Hostile vs. High Hostile
How Is the Hostile Personality Formed Ken Dodge Research on Hostile Children Parental disciplinary style: 1. Punishment is severe, often disproportionate to offense 2. Punishment is not accompanied by explanation Sibling bullying : Learn to read hostile signals quickly, and respond quickly. Hostile attributional style: 1. Regard ambiguous negative events as intentionally hostile 2. Believe it is essential to retaliate quickly
Appraisal of threat higher defensive mode (fight) more cardiac output ↑ cortisol atherosclerosis Pathway From Hostility to Heart Disease What seems to be common physio culprit in link between stress, depression, hostility and health risks? Cortisol
Misfortune: Bad and Badder ___A. Person poisoned by meds that oddly conflict with her chemistry ___B. Person poisoned by meds her MD is using to test his new theory. WHO IS MORE DISTURBED: ___A. Person who’s child gets cancer due to second-hand smoke in home ___B. Person who’s child gets cancer due to heredity X X X ___A. Train passenger injured b/c of failed train brakes ___B. Train passenger injured, but cause of crash never determined
Fundamental Beliefs 1. World is just. 2. World is sane, well ordered, non-random 3. The self is good Traumas: Events that seriously violate one or more of these beliefs.
Fundamental Beliefs and Misfortune ___A. Person poisoned by meds that oddly conflict with her chemistry ___B. Person poisoned by meds her MD is using to test his theory. Which belief has been violated: The Self is Good, The World is Well Ordered, The World is Just ___A. Train passenger injured b/c of failed brakes ___B. Train passenger injured, but cause of crash never determined ___A. Person who’s child gets cancer due to second-hand smoke in home ___B. Person who’s child gets cancer due to heredity X X X The self is good The world is orderly, not random The world is just
Strategies for Overcoming Threatening Events 1. Achieve a sense of meaning out of the event. 2. Regain mastery over the event, or over life in general 3. Enhance self-esteem
How People Restore Sense of Meaning Following Trauma 1. Seek out causes of event. 2. Re-adjust way of seeing life, and themselves. Victor Frankl
Taylor Article: Adjusting to Threatening Events Meaning is key to coping. But what about bad situations where there is no clear cause? Subjects in Taylor article are: _______________________ women with breast cancer Is cause of breast cancer (on individual level) known? ____ Do women with breast cancer typically accept that there is no single, diagnosable cause? ____ Why is this? No
Self-Identified Causes of Breast Cancer Taylor, et al., 1983 a. Stress, esp. relationship41% b. Carcinogen32% c. Hereditary26% d. Diet17% e. Freak event 10% Note: Some women listed multiple causes, thus total more than 100%
Adopting New Meanings About Life a. New attitude toward life I feel as if I were for the first time really conscious. I have much more enjoyment each day, each moment. All those things you get entangled with don’t seem to be part of my life right now. b. Self knowledge It’s a bit like holding up a mirror to one’s face when one can’t turn around.
Patients’ Responses to Their Cancer Change diet Quit meds. maybe associated with cancer Educate self on cancer Control side effects: * Imaging: Chemo as cannons * Instruction to body: "Cut this shit out“ Not clear any of these responses actually cure cancer—why do them?
Bad Events Threaten Self Esteem When people suffer bad events, they feel bad about selves, even if they are not responsible. Why? Just world beliefs: Good things happen to good people, bad things happen to bad people. Therefore... People very good at finding way to restore sense of self worth. Cancer patients do so even after disfiguring surgery, painful treatment, constant threat of cancer recurrence. How do they do it?
Woman who underwent lumpectomy I had a comparatively small amount of surgery. How awful it must be for women who have had a mastectomy. I just can’t imagine, it would seem so difficult. Woman who had a mastectomy It was not tragic. It worked out okay. Now if the thing had spread all over, I would have had a whole different story for you. An older woman The people I really feel sorry for are these younger gals. To lose a breast when you’re so young must be awful. I’m 73; what do I need a breast for? A young woman (apparently having lost a breast) If I hadn’t been married, I think this thing would have really gotten to me. I can’t imagine dating or whatever knowing you have this thing and not knowing how to tell the man about it. Downward Social Comparison Among Breast Cancer Patients
Methods 1. Downward social comparison 2. Unsupported causal explanations * Cancer due to diet * “Cells have re-aligned. Now I'm safe.” * Can stop cancer via imaging, positive thinking 3. Denial Benefits? 1. Enhance control 2. Enhance self-worth 3. Enhance persistence 4. Encourage coping behaviors Nature and Benefits of Illusions
"Undoing": The Toxic Aspect of Illusions of Control Two Olympic sprinters lose in finals; one comes in second to last, the other second to first. Who has done better? Who feels worse? Why? Undoing: AKA "counterfactuals"-- the mental process of thinking how negative outcomes could have been prevented. Parents of Sudden Infant Death Syndrome (SIDS) infants (Davis, Silver, et al., PSPB, 1995). Undoing related to: SCL, Guilt, Anger, Depression, Anxiety 18 mos later "I thought about maybe if I'd stayed awake, or woke up more frequently [to] check on the baby. I keep thinking of different ways..."
Coping = Illusions? Is coping all about self-serving "spin"? Is avoiding reality the best way to cope with uncontrollable negative events?
Every time I was removed from the hot water and placed on a stretcher by the side of the pool,..., I was fed salt tablets. Even today, more than four decades later, I shiver at the mere thought of those salt tablets....To be an eater of salt was far more humiliating than to endure pain....we dreaded eating salt. It was that, rather than the pain we endured, that anchored our sense of loss and dread. Kriegel: "Falling into Life" MEANING What aspect of trauma does this passage reflect?
I suppose we have been told that our fall from grace was permanent. But I am still grateful that no one—told me that my chances of regaining the use of my legs were nonexistent. At the age of 11 I needed to weather reality, not face it. Kriegel: "Falling into Life" DENIAL What aspect of trauma does this passage reflect?
1. I hungered for the approval of those in authority. Kriegel: "Falling into Life" 1. Self-Esteem 2. Just World What aspects of trauma do these passage reflect? 2. I wanted to do whatever was supposed to be "good" for me. I believed absolutely as I have ever believed in anything that rehabilitation would finally placate the hunger of the virus.
Kriegel: "Falling into Life" As my "normal" past grew more and more distant, I reached out for it more and more desperately. Why? And then, terror simply evaporated. It was as if I had served enough time in that prison. "That's it" my therapist triumphantly shouted. "You let go! and there it is!" Yes, and you discover not terror but the only self you are going to be allowed to claim anyhow. You fall free, and then you learn that those padded mats hold not courage but the unclaimed self. What has happened here? What’s changed? What is the “prison”? What is the “unclaimed self”?
Kriegel: "Falling into Life" To create an independent self, a man had to rid himself of both the myths that nurtured him and the myths that held him back.... I understood that the most dangerous threat to the sense of self I needed was an inflated belief in my own capacity. What does Kriegel mean by “myths”? What was the “sense of self [he] needed”? Why was inflated belief “the most dangerous threat” to that sense of self?