 Health Psychology- psychology’s contribution to behavioral medicine  Stress - the process by which we appraise and cope with threats and challenges  How a person perceives and evaluates and event makes a difference - the cognitive model of stress ▪ Cognitive- thinking and understanding

 Stress  the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging Stressors Catastrophes Life changes Hassles Intervening factors Appraisal Perceived control Personality Social support Coping behaviors Stress reactions Physiological Emotional Behavioral

Stressful event (tough math test) Threat (“Yikes! This is beyond me!”) Challenge (“I’ve got to apply all I know”) Panic, freeze up Aroused, focused Appraisal Response

 Distress and Eustress  Catastrophic Events  earthquakes, combat stress, floods  Life Changes  death of a loved one, divorce, loss of job, promotion  Daily Hassles  rush hour traffic, long lines, job stress, burnout  Gradually weaken the body’s defense system and can lead to hypertension

▪ Leading causes of death in the US in 1900 and 1991 Percentage U.S.deaths Tuber- culosis Pneu- monia Diarrhea/ enteritis Heart disease 1900 Percentage U.S.deaths Heart disease CancerStrokes Chronic lung disease 1991 Unlike many leading killers a century ago, today’s major killers are more lifestyle-related

 When faced with a stressor, the body reacts with immediate arousal. ▪ Hormones are produced that increase the amount of blood sugar for extra energy ▪ Adrenaline is produced, causing rapid heartbeat and breathing and enabling the body to use energy more quickly  Used to prepare a person or animal for self-defense  Left over from the past; doesn’t work for most of today’s stress

 General Adaptation Syndrome  Selye’s concept of the body’s adaptive response to stress as composed of three stages Stress 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 only Last so long before exhaustion sets in Stressor occurs

1) Alarm Mobilization of fight or flight defenses Exceptional alertness 2) Resistance Find means to cope with the stressor, at least superficially May suffer psychosomatic symptoms from pretending strain is nonexistent 3) Exhaustion Reaching the breaking point Exhaustion and disorientation may develop Responses that were good for immediate resistance to stress are detrimental in the long run

 The SRRS- Holmes and Rahe › Measured stress using LCU (life-change units) › Higher score = higher likelihood of stress-related diseases › PERCEPTION MATTERS!

 Health consequences of a loss of control No connection to shock source To shock controlTo shock source “Executive” rat“Subordinate” ratControl rat

 All are most stressful when perceived as negative and uncontrolled  The result is vulnerability to ill health and often earlier death  Losing control provokes an outpouring of stress hormones  Examples: poverty, optimism

 Burnout  physical, emotional and mental exhaustion brought on by persistent job-related stress  Coronary Heart Disease  clogging of the vessels that nourish the heart muscle  leading cause of death in the United States

Hopelessness scores Heart attack Death Low riskModerate riskHigh risk Men who feel extreme hopelessness are at greater risk for heart attacks and early death

 Type A- in a chronic state of stress; almost constant flow of adrenaline into the blood stream  Type B- generally relaxed and patient  Type A people are more prone to heart disease ▪ They are more likely to smoke more, sleep less, and drink more caffeine ▪ Their temperament may contribute directly- more physiologically reactive when threatened with a lack of control

 Lymphocytes  two types of white blood cells that are part of the body’s immune system ▪ B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections ▪ T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses and foreign substances

 Psychophysiological Illness  “mind-body” illness  any stress-related physical illness ▪ some forms of hypertension ▪ some headaches  Different from hypochondriasis ▪ misinterpreting normal physical sensations as symptoms of a disease

 Conditioning of immune suppression; sweetened water alone could trigger immune suppression in rats UCS (drug) UCR (immune suppression) UCS (drug) UCR (immune suppression) CS (sweetened water) CS (sweetened water) CR (immune suppression)

Doesn't mind leaving things temporarily unfinished Must get things finished once started 2. Calm and unhurried about appointments Never late for appointments 3. Not competitive Highly competitive 4. Listens well; lets others finish speaking Anticipates others In conversation (nods, interrupts) 5. Never in a hurry, even when pressured Always in a hurry 6. Able to wait calmly Uneasy when waiting 7. Easygoing Always going full speed ahead 8. Takes one thing at a timeTries to do more than one thing at a time; thinks about what to do next 9. Slow and deliberate in speech Vigorous and forceful in speech (uses a lot of gestures) 10. Concerned with satisfying him/herself, not others Wants recognition by others for a job well done 11. Slow doing thingsFast doing things (eating, walking) 12. Serene Hard Driving 13. Expresses feelings openly Holds feelings in 14. Has a large number of interests Few interests outside work 15. Satisfied with job Ambitious; wants quick advancement at job 16. Never sets own deadlines Often sets own deadlines 17. Feels limited responsibility Always feels responsible 18. Never judges things in terms of numbers Often judges performance in terms of numbers 19. Casual about work Takes work very seriously (works weekends, bring home work) 20. Not very precise Very precise (careful about detail)

 If you scored over 110 you are a Type A1 If you are in this category and especially if you are over 40 and smoke, you have a high risk of developing cardiac illness and other stress-related illnesses.  If you scored 80 – 109 you are a Type A2 You are also a cardiac-prone personality but your risk of heart disease is not quite as high as a Type A1  If your score is , you are a Type AB You are a mixture of Type A and Type B patterns. This is a healthier pattern than either A1 or A2, but you have the potential for slipping into Type A behavior and you should recognize this.  If your score is under 59, you are a Type B  : Type B2 0 – 29: Type B1  This personality complex is characterized by general relaxation and coping adequately with stress. You express few of the reactions associated with cardiac disease.

 Aerobic Exercise  sustained exercise that increases heart and lung fitness  may also alleviate depression and anxiety Depression score Before treatment evaluation After treatment evaluation No-treatment group Aerobic exercise group Relaxation treatment group

 Biofeedback  system for electronically recording, amplifying, and feeding back information regarding a subtle physiological state ▪ blood pressure ▪ muscle tension

 Modifying Type A life-style can reduce recurrence of heart attacks Percentage of patients with recurrent heart attacks (cumulative average) Year Life-style modification patients Control patients Modifying life-style reduced recurrent heart attacks

 Social support across the life span Age in years 100% Percentage with high support

 Obesity and mortality Body-mass index (BM I) MenWomen Relative risk of death

 When women applicants were made to look overweight, subjects were less willing to hire Willingness to hire scale (from1: definitely not hire to 7: definitely hire ) WomenMen NormalOverweight

 7) Excessive time spend in the resistance phase of Selye’s general adaptation syndrome can contribute to › Increased time needed to adapt to new emotional situations › Decreased motivation to perform novel taskes › Stress-related diseases like ulcers or heart conditions › A reduction in the drive to achieve goals › Resistance to learning skills needed for novel tasks

 8) Perceived control over a stressful event tends to result in  Less reported stress  More frustration regarding the stressful event  More motivation to solve the stressful problem  Increased arousal  Higher hear and respiration rates

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