1. Stress, Coping and Health
Chapter 13
Stress, Coping and Health

2. Principle types of stress include
a. conflict, fear, pressure
b. anxiety, conflict, change
c. change, frustration, pressure
d. frustration, conflict, anxiety

3. In avoidance-avoidance conflicts a choice must be made
a. whether to seek any goal
b. whether to pursue a single goal that has both attractive and unattractive aspects
c. between two attractive goal
d. between two unattractive goals

4. An organism first recognizes the existence of a threat and physiological arousal occurs during the___ stage of the general adaptation syndrome
a. alarm reaction
b. resistance
c. exhaustion
d. flight-or-flight

5. The Relationship Between Stress and Disease
Contagious diseases vs. chronic diseases
Biopsychosocial model
Health psychology
Health promotion and maintenance
Discovery of causation, prevention, and treatment
Prior to the 20th century, the principal threats to health were contagious diseases caused by infectious agents: smallpox, diphtheria, etc. Nutrition, public hygiene, and medical treatment have obliterated many of these diseases. Unfortunately, chronic diseases such as heart disease and cancer, diseases that develop gradually, continue to increase.
The traditional view of physical illness as a purely biological phenomenon has given way to a new model, the biopsychosocial model, which holds that physical illness is caused by a complex interaction of biological, psychological, and sociocultural factors.
Health psychology is the field of study that seeks to determine the importance of psychological factors in illness, as well as in prevention and health maintenance.

7. Stress: An Everyday Event
Major stressors vs. routine hassles
Cumulative nature of stress
Cognitive appraisals (Lazarus)
Major types of stress
Frustration – blocked goal
Conflict – two or more incompatible motivations
Approach-approach, approach-avoidance, avoidance-avoidance
Change – having to adapt
Holmes and Rahe – Social Readjustment Rating Scale – Life Change Units
Pressure – expectations to behave in certain ways
Perform/conform
Stress is defined in the text as any circumstances that threaten or are perceived to threaten one’s well being and that thereby tax one’s coping ability.
Researchers have discovered that minor stresses (Lazarus – daily hassles) like moving, experiencing changes in household responsibilities, etc. can add up to be as stressful as a major traumatic event like a divorce or disaster; the cumulative nature of stress. The experience of feeling stressed depends largely on cognitive processes; going on a new date is exciting for some, terrifying for others. People’s appraisals of events are very subjective and influence the effect of the event.
Psychologists have outlined 4 principle types of stress:
Frustration, which occurs in any situation in which the pursuit of some goal is thwarted. Ex. traffic jams.
Conflict occurs when two or more incompatible motivations or behavioral impulses compete for expression. 3 types of conflict have been studied extensively: approach-approach – when a person has a choice between 2 attractive goals, approach-avoidance – when a choice must be made about whether to pursue a single goal that has both attractive and unattractive aspects…results in vacillation, or going back and forth…rats actually run up and down a ramp in this type conflict.
Life changes are any noticeable alterations in one’s living circumstances that require readjustment. Holmes and Rahe (1967) developed the Social Readjustment Rating Scale to measure life change as a form of stress, giving higher points (life change units) for more stressful events.
Pressure involves expectations or demands that one behave in a certain way…pressure to perform or to comply.

9. Responding to Stress Emotionally
Emotional Responses
Annoyance, anger, rage
Apprehension, anxiety, fear
Dejection, sadness, grief
Positive emotions
Emotional response and performance
The inverted-U-hypothesis
Stress responses are multidimensional, including emotional, psychological, and behavioral realms.
Emotions commonly elicited by stress are listed on the slide.
Apparently there are strong links between cognitive appraisals and which set of emotions one experiences as a function of a stressor; self-blame leads to guilt, helplessness to sadness, etc. Positive emotions may also occur during periods of stress, with positive emotions experienced while under duress having adaptive significance, promoting creativity and flexibility in problem solving, facilitating the processing of important information about oneself, and reducing the adverse physiological effects of stress.
High emotion can sometimes negatively influence task performance, more so for highly complex tasks and less so for simple ones (the inverted-u-hypothesis).

12. Responding to Stress Physiologically
Physiological Responses
Fight-or-flight response
Selye’s General Adaptation Syndrome
Alarm
Resistance
Exhaustion
Physiological effects of stress include the fight-or-flight response, discovered by Walter Cannon (1932). The FF response is a physiological reaction to threat in which the autonomic nervous system (ANS) mobilizes the organism for attacking (fight) or fleeing (flight) an enemy.
The fight-or-flight response is adaptive if one is faced with a predator; however, modern stressors are more long term (the checkbook).
Hans Selye began studying stress in the 1930’s to determine the effects of these chronic stressors. He used an animal model, exposing them to both physical and psychological stressors to determine effects, which were nonspecific. That is, the reactions did not relate to the type of stress.
Selye formulated a theory about how stress reactions occur called the general adaptation syndrome.
The alarm stage occurs when an organism recognizes a threat and mobilizes resources – essentially enters the FF response.
The resistance stage occurs when the stress is prolonged. This is a period when physiological arousal stabilizes but is still above baseline, as the organism copes with the stressor.
The exhaustion stage occurs when the body’s resources are depleted…Selye believed that this is where diseases of adaptation come in.

14. Some Psychological Stressors for High School Students
Life Event Stress Points
Divorce of parents 98
Expulsion from school 79
Major injury or illness 77
Getting a job
Major illness of close friend 56
Peer difficulties 45
Moving away
Christmas
Vacation
Traffic ticket

16. Pituitary hormone in the
bloodstream stimulates
the outer part of the adrenal
gland to release the stress
hormone cortisol
Sympathetic nervous
system releases the
stress hormones
epinephrine and
norepinephrine
from nerve endings
in the inner part of
the adrenal glands
Thalamus
Hypothalamus
Pituitary gland
Adrenal glands
Cerebral cortex
(perceives stressor)

17. Fight or Flight (Walter Cannon)
Sequence of Steps in the Fight or Flight Behaviors
1. The brain appraises a situation as threatening and dangerous.
2. The lower brain structure secretes a stress hormone.
3. The stress hormone signals the adrenal glands to secrete adrenaline.
4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.

18. The General Adaptation Syndrome (Hans Selye)
Defined as a series of stages the body goes through when exposed to stressful situations.
1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical.
2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor.
Alarm
Resistance
Exhaustion
3. The third stage is exhaustion. It is marked by body exhaustion and health problems.

19. Stress and Illness General Adaptation Syndrome
resistance
Phase 1
Alarm
reaction
(mobilize
resources)
Phase 2
Resistance
(cope with
stressor)
Phase 3
Exhaustion
(reserves
depleted)
The body’s resistance to stress can
last only so long before exhaustion sets in
Stressor
occurs
General Adaptation Syndrome
Selye’s concept of the body’s adaptive response to stress in three stages

20. Responding to Stress Behaviorally
Behavioral Responses
Frustration-aggression hypothesis
catharsis
defense mechanisms
Coping - refers to active efforts to master, reduce, or tolerate the demands created by stress. These may involve giving up and blaming oneself (learned helplessness – passive behavior produced by exposure to unavoidable aversive events), striking out at others aggressively (usually the result of frustration…Dollard’s frustration-aggression hypothesis), self-indulgement (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly).
Behaviorally people respond to stress at different levels.
Coping refers to active efforts to master, reduce, or tolerate the demands created by stress. These may involve giving up and blaming oneself (learned helplessness – passive behavior produced by exposure to unavoidable aversive events), striking out at others aggressively (usually the result of frustration…Dollard’s frustration-aggression hypothesis), self-indulgement (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly).

22. Increased levels of the immune system are associated with
increases in stress b
the Type A personality c
low levels of social support and pessimism d
high levels of social support and optimism

23. Research has demonstrated individuals with Type A personality
have an increased risk of developing cancer b.
have a decreased risk of developing cancer c.
have an increased risk of developing heart disease d.
have a decreased risk of developing heart disease

24. Of the following individuals, who would be least likely
to develop heart disease? a.
Andrew, who is a Type A personality b.
Bill, who is a Type B personality c.
Charles, who has high blood pressure and smokes d.
Dennis, who is depressed

25. ANSWERS D - high levels of social support and optimism
C - have an increased risk of developing heart disease
B - Bill, who is a Type B personality

27. Effects of Stress: Behavioral and Psychological
Impaired Task performance - people under pressure to perform may feel self-conscious, which leads to disruption of attention and “choking” under pressure
Burnout - physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotionally demanding situations…loss of meaning.
Posttraumatic Stress Disorders (PTSD) - re-experiencing the traumatic event in the form of nightmares and flashbacks
Psychological problems and disorders
Positive effects - stress can promote personal growth or self-improvement, forcing people to develop new skills, reevaluate priorities, learn new insights
Roy Baumeister’s work shows that people under pressure to perform may feel self-conscious, which leads to disruption of attention and “choking” under pressure.
Burnout involves physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotionally demanding situations…loss of meaning.
PTSD involves enduring psychological disturbance attributed to the experience of a major traumatic event…seen after war, rape, major disasters, etc. Symptoms include re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relations, and elevated arousal, anxiety, and guilt.
Chronic stress might contribute to many types of psychological problems and mental disorders, from sleep problems and unhappiness, to full-fledged psychological disorders such as schizophrenia and depression.
From a positive psychology perspective, effects of stress are not entirely negative. Recent research suggests that stress can promote personal growth or self-improvement, forcing people to develop new skills, reevaluate priorities, learn new insights, and acquire new strengths. Conquering a stressful challenge may also lead to improved coping abilities and increases in self-esteem.

29. Effects of Stress: Physical
Psychosomatic diseases
Heart disease - accounts for nearly one-third of the deaths in the U.S. each year, and atherosclerosis, or gradual narrowing of the coronary arteries, is the principle cause of CHD. Risk factors for CHD include smoking, lack of exercise, high cholesterol levels, and high blood pressure.
Type A behavior - 3 elements
strong competitiveness
impatience and time urgency
anger and hostility
Emotional reactions and depression
Stress and immune functioning
Reduced immune activity
Historically, psychosomatic diseases were defined as physical ailments with a genuine organic basis that are caused in part by psychological factors, especially emotional distress…things like hypertension, ulcers, asthma, eczema, and migraine headaches. Now we know that stress contributes to a diverse array of other diseases once thought to be completely physiologically based and using the term psychosomatic disease as a separate category has fallen into disuse.
Heart disease accounts for nearly one-third of the deaths in the U.S. each year, and atherosclerosis, or gradual narrowing of the coronary arteries, is the principle cause of CHD. Risk factors for CHD include smoking, lack of exercise, high cholesterol levels, and high blood pressure. Recently, researchers have shown that inflammation may contribute to atherosclerosis, as well. Personality factors have been linked to risk for coronary heart disease. These personality characteristics have been collectively labeled Type A personality and include 3 main elements (listed on the slide). The hostility factor has been indicated as the most important predictor in this cluster of behaviors.
Emotional reactions can trigger cardiac symptoms in patients with stable coronary disease. Depressive disorders may also be a risk factor for heart disease, with some studies showing that the risk of CHD is doubled with depression.
Stress has also been shown to decrease the immune response, the body’s defensive reaction to invasion by bacteria, viral agents, or other foreign substances…decreasing white blood cells called lymphocytes. The featured study in the text explores the effects of stress on contracting the common cold.

30. Stress and the Heart Type A Type B
Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people
Type B
Friedman and Rosenman’s term for easygoing, relaxed people

31. Research on type A Personality
Time urgency & competitiveness not associated with poor health outcomes
Negative emotions, anger, aggressive reactivity
High levels of hostility increase chance of all disease (e.g., cancer)
graph from Hockenbury text, figure 13.5, taken from CD Rom

32. Explanatory style Optimism Pessimism
use external, unstable, & specific explanations for negative events
predicts better health outcomes
Pessimism
use internal, stable, & global explanations for negative events
predicts worse health outcomes

33. Stress and the Heart

37. Factors Moderating the Impact of Stress
Social support
Increased immune functioning
Optimism
More adaptive coping
Pessimistic explanatory style
Conscientiousness
Fostering better health habits
Autonomic reactivity
Cardiovascular reactivity to stress
Many factors moderate the effects of stress on illness, and individual differences in impact appear to be related to these moderating variables.
Social support, or the various types of aid and succor provided by members of one’s social network, appear to decrease the negative impact of stress.
Having an optimistic style also appears to lead to more effective coping with stress, while pessimistic styles have been related to passive coping and poor health practices.
Conscientiousness also appears to be related to increased longevity, possibly because being conscientious leads to better health habits.
Finally, physiological factors, such as cardiovascular reactivity to stress, appear to play a role in how significant the impact of stress is on an individual.

39. Health-Impairing Behaviors
Smoking - A 25 year old male who smokes two packs a day has an estimated life expectancy 8.3 years shorter than that of a similar, nonsmoker. Health risks decline quickly for those who give up smoking, but quitting is difficult and relapse rates are high
Poor nutrition & Lack of exercise - have been linked to heart disease, hypertension, and cancer, among other things
Alcohol and drug use - carry the immediate risk of overdose and the long-term risk of many diseases
Risky sexual behavior
Transmission, misconceptions, and prevention of AIDS - is transmitted through person-to-person contact involving the exchange of bodily fluids, primarily semen and blood
Self-destructive behavior is surprisingly common. Take smoking, for example. A 25 year old male who smokes two packs a day has an estimated life expectancy 8.3 years shorter than that of a similar, nonsmoker. Health risks decline quickly for those who give up smoking, but quitting is difficult and relapse rates are high.
Poor nutritional habits and lack of exercise have been linked to heart disease, hypertension, and cancer, among other things.
Alcohol and drug use carry the immediate risk of overdose and the long-term risk of many diseases.
Acquired Immune Deficiency Syndrome (AIDS) is clearly influenced by behavior. AIDS is transmitted through person-to-person contact involving the exchange of bodily fluids, primarily semen and blood.
Misconceptions about AIDS are common, either overestimations or underestimations of risk. Many young heterosexuals downplay their risk for HIV, causing them not to adopt the behavioral practices that minimize risk.
So why do people engage in health impairing behavior? Most of these develop gradually and often involve pleasant activities. Risks lie in the distant future, and people tend to underestimate risks that apply to them personally.

40. poor nutrition and sleep)
Stress and Disease
Negative emotions and health-related consequences
Unhealthy behaviors
(smoking, drinking,
poor nutrition and sleep)
Persistent stressors
and negative
emotions
Release of stress
hormones
Heart
disease
Immune
suppression
Autonomic nervous
system effects
(headaches,
hypertension)

41. Promoting Health Aerobic Exercise
Depression
score 14 13 12 11 10 9 8 7 6 5 4 3
Before treatment
evaluation
After treatment
No-treatment
group
Aerobic
exercise
Relaxation
treatment
Aerobic Exercise
sustained exercise that increases heart and lung fitness

42. Exercise and Mood Why Does Exercise Work? Releases chemicals
-- norepinephrine
-- serotonin
-- endorphins
Sense of accomplishment
Improved physique

43. Why Does Exercise Work? Exercise and Health Strengthens heart
Lowers blood pressure
Lowers blood pressure reactivity to stress
Moderate exercise adds two years to one’s expected life.

44. BMI Classifications – Slide 30
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
A rating of 25 or higher is considered overweight, 30 or higher is obese, and 40 or higher is extremely obese. For example, a 5-foot-8-inch person who weighs 190 pounds would be overweight; a person at the same height who weighs 230 pounds is obese.
- Americans are even fatter than they think they are, with nearly a third of all adults - almost 59 million people - rated obese in a disturbing new government survey based on actual body measurements.
One in five Americans, or 19.8 percent, had considered themselves obese in a 2000 survey based on people's own assessments of their girth.
The new survey puts the real number at 31 percent - a doubling over the past two decades. The new number is considered more reliable since people consistently underestimate their weight.
BMI > 30, or ~ 30 lbs. overweight for 5'4" person for CDC

47. Reactions to Illness Seeking treatment
Ignoring physical symptoms
Communication with health care providers
Barriers to effective communication
Following medical advice
Noncompliance
Many reactions to illness are not conducive to health. For example, many people ignore physical symptoms, resulting in delay in medical treatment.
Even when they seek medical help, communication between patients and health care providers is not always honest or efficient.
Noncompliance with medical advice is a serious issue. Noncompliance is more likely if instructions are hard to understand, when they are difficult to follow, and when patients are unhappy with their doctor.

49. 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

50. 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

51. 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 self-statements 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