Chapter 14 Health and Well-Being

Health Psychology The application of psychology to the promotion of physical health and the prevention and treatment of illness. But isn’t physical illness a purely biological event?

Stress and Health

Stress An unpleasant state of arousal that arises when we perceive that the demands of an event threaten our ability to cope effectively. Subjective appraisal of the situation determines: How we will experience the stress What coping strategies we will use

Stress (cont’d) Appraisal is the process by which people make judgments about the demands of potentially stressful events and their ability to meet those demands. Coping is an effort to reduce stress.

What Americans Cite as Top Stressors

The Stress and Coping Process This process involves a potentially stressful event, the appraisal of that event, and attempts to cope. Played out against a variety of background factors unique to each individual, the stress-and-coping process influences health outcomes. c Cengage Learning

What Causes Stress?

Crises and Catastrophes Stressors: Anything that causes stress. Posttraumatic Stress Disorder (PTSD): A person experiences enduring physical and psychological symptoms after an extremely stressful event.

Major Life Events Change itself may cause stress by forcing us to adapt to new circumstances. Is change, positive or negative, necessarily harmful? No support that positive “stressors” are as harmful as negative stressors. Impact of change depends on person and how change is interpreted.

Microstressors: The Hassles of Everyday Life Most common source of stress arises from the daily hassles that irritate us. e.g., environmental factors. “Microstressors” place a constant strain on us. The accumulation of daily hassles contributes more to illness than do major life events – e.g., job, commuting, paying the bills, etc.

How Does Stress Affect the Body?

General Adaption Syndrome Three-stage bodily response to stress Alarm Resistance Exhaustion Stress may be a short-term reaction to a threat, but over time it compromises health and well-being.

The General Adaptation Syndrome According to Selye (1936), the human body responds to threat in three phases: alarm, resistance, and exhaustion. c Cengage Learning

What Stress Does to the Heart Type A Behavior Pattern: Characterized by extremes of competitive striving for achievement, a sense of time urgency, hostility, and aggression. A risk factor for coronary heart disease (CHD)? Hostility appears to be the main toxic ingredient in CHD.

Why Is Hostility and CHD Linked? Cardiovascular system becomes overworked. Hostile people are less health conscious. Hostile people are physiologically reactive. In tense social situations, they exhibit more intense cardiovascular reactions. Psychocardiology is a new field that has emerged from this research that attempts to merge the heart and the mind

How “Hostile” Is Your Pattern of Behavior?

What Stress Does to the Immune System Stress compromises the body’s immune system. Psychoneuroimmunology (PNI): A subfield of psychology that examines the links among psychological factors, the brain and nervous system, and the immune system.

Pathways From Stress to Illness Hostility, stress, and other negative emotional states may cause illness in two ways: (1) by promoting unhealthful behaviors (more alcohol, less sleep, and so on) and (2) by triggering the release of hormones that weaken the immune system. © Cengage Learning

Links Between Stress and Illness Research has shown that stress breaks down a body’s immune system The longer a stressor persists, the more likely the person is to get sick Personal characteristics can buffer adverse effects

Stress Duration and Illness Two hundred seventy-six volunteers were interviewed about recent life stress, then infected with a cold virus. As shown above, the more months a stressor had lasted, the more likely a person was to catch the cold. Over time, stress breaks down the body’s immune system. Cohen et al., 1998. c Cengage Learning

Process of Appraisal

Attributions and Explanatory Styles Seligman (1975): Depression results from learned helplessness. Abramson et al. (1989): Depression is a state of hopelessness brought on by the negative self-attributions people make for failure. Depressive explanatory style

Using Attributional Styles to Predict Depression In this study, researchers measured the explanatory styles of first-year college students. As juniors 2 years later, those with a negative rather than positive style in their first year were more likely to suffer from a major or minor depressive disorder. Alloy et al., 2006. © Cengage Learning

The Human Capacity for Resilience Individuals exhibit three characteristics: Commitment Challenge Control Hardiness serves as a buffer against stress. Perception of control is most important factor.

Self-Efficacy The expectation that our behaviors can produce satisfying outcomes Self-efficacy: Feelings of competence A state of mind that varies from one specific task and situation to another Research has shown the more self-efficacy one has, the more willing to take on a task, persist, and succeed

Self-Efficacy: A Matter of Life or Death? One thousand and twenty-four heart disease patients varying in “cardiac self-efficacy” were tracked over time. As shown, the higher their cardiac self-efficacy scores were at the start of the study, the more likely they were to survive hospitalization up to 78 months later. From Sarkar, U., Ali, S., & Whooley, M. A., "Self‐efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: Findings from the Heart and Soul Study," Health Psychology vol 28 (pp. 166–173). Copyright c 2009 by the American Psychological Association. Reprinted by permission.

Dispositional Optimism Optimism is a generalized tendency to expect positive outcomes. How can optimism promote positive health outcomes? Biological – blood samples show optimists exhibit stronger immune response to stress Behavioral – explanatory style

Hopelessness and the Risk of Death Among middle-aged men in Finland, those who were initially high rather than low in hopelessness were more likely to die within 6 years—overall, from cancer, and from cardiovascular disease. Those who were moderate in hopelessness fell between the two extremes. From Everson, S. A., et al., “Hopelessness and risk of mortality and incidence of myorcardial infarction and cancer,” Psychosomatic Medicine vol 58 (pp. 121–133). Copyright c 1996 Wolters Kluwer Health. Reprinted by permission.

Pollyanna’s Health Positive thinking cannot guarantee good health. Victims of illness do not just have a “bad attitude.” Limits to positive thinking. Especially if it leads us to see ourselves and events in ways that are not realistic.

Ways of Coping with Stress

How Americans Manage Stress There is no single way to manage stress. When American men and women were asked to indicate how they do it, the list that emerged was quite varied. From American Psychological Association (October 7, 2008). Stress in America. Copyright c 2009 by the American Psychological Association. Reprinted by permission.

Ways of Coping with Stress

Coping Strategies Problem-focused coping Emotion-focused coping Proactive coping

Problem-Focused Coping In dealing with essential tasks, it is better to confront and control than to avoid. Why is it not always a beneficial approach? Can be physiologically taxing Can lead to development of an over-controlling, stress-inducing Type A pattern of behavior

Emotion-Focused Coping Positive Emotions Broaden Build Shutting down and trying to deny or suppress the unpleasant thoughts and feelings. Distraction can be an adaptive form of avoidance coping. Concealing one’s innermost thoughts and feelings can be physiologically taxing.

Emotion-Focused Coping: Opening Up Two aspects to opening up as an emotional means for coping with stress: One must acknowledge and understand one’s emotional reactions to important events. One must express those inner feelings to themselves and others. Why might opening up be helpful? Cathartic experience? Helps to gain insight into the problem?

Self-Focus: Getting Trapped vs. Getting Out Self-awareness theory revisited. A self-perpetuating feedback loop can occur: Being in a bad mood triggers self-focus. Self-focus in people with low self-esteem further worsens the mood.

Self-Focus: Getting Trapped vs. Getting Out (cont’d) Gender differences: Women brood and men act out. Healthier alternatives: Getting absorbed in difficult, demanding, and fully engaging activity E.g., aerobic exercise, writing, reading, gardening

Proactive Coping The helpful coping resources provided by friends and other people. Has therapeutic effects on both our psychological and physical health. Social support and contact related to longevity.

Aspinwall and Taylor’s Model of Proactive Coping Coping can be seen as an ongoing, multi-step process by which people try to prevent, not just react to, life’s daily stressors. From Aspinwall and Taylor, “A stick in time: self-regulation and proactive coping,” Psychological Bulletin vol 121 (pp. 417–436). Copyright c 1997 by the American Psychological Association. Reprinted by permission.

Social Support Simple social contact model How many social contacts does a person have? Diversity of person’s social network Intimacy model Does the person have a close relationship with a significant other? Perceived availability Does the person believe that ample support is available when needed?

Does Being Popular Always Promote Health? Young adults were asked about recent stressful events and about their social lives—and then kept a health diary for 3 months. As you can see, social contact made no difference for people under low stress. For people under high stress, however, those with active social lives were more likely to get sick. Social contact increases exposure to infectious agents—and can bring illness for those whose resistance is compromised by stress. From Hamrick, N., Cohen, S., and Rodriguez, M. S., “Being popular can be healthy or unhealthy: Stress, social network diversity, and incidence of upper respiratory infection,” Health Psychology vol 21 (pp. 294–298). Copyright c 2002 by the American Psychological Association. Reprinted by permission.

The Religious Connection Religion provides an important source of social and emotional support for many. Only 15-20% of the world’s population have no religious affiliation. Is there a link between religiosity and health? Research is suggestive that there is, but not yet conclusive

Culture and Coping

Culture and Coping Do people in all cultures solve problems and cope in the same ways? Collectivist vs. Individualist cultures Implicit social support vs. explicit social support

Collectivist Coping Styles

Culture and Social Support From Chen, J. M., Kim, H. S., Mojaverian, T., & Morling, B., “Culture and social support provision: Who gives what and why,” Personality and Social Psychology Bulletin vol 38 (pp. 3–13). Copyright c 2012 Sage Publications, Inc. Reprinted with permission.

Treatment and Prevention

Treatment: The “Social” Ingredients All healers provide social support. All therapies offer a ray of hope. All therapies communicate and instill positive expectations. Patients can make meaningful choices about the treatment.

Prevention: Getting the Message Across We live in what could aptly be described as the era of prevention in that many serious health threats are preventable.

Aiming For Good Health Several major factors help convince people to engage in healthy practices. Recognition that a threat to health exists is a necessary first step. Positive models and healthy subjective norms encourage people to adopt health-protective behaviors. A sense of self-efficacy about being able to carry out healthy behaviors and the belief that such behaviors will be effective increase the likelihood of active efforts. c Cengage Learning

The Pursuit of Happiness

Subjective Well-Being One’s happiness, or life satisfaction, as measured by self-report. In self-reports, 75% of American adults describe themselves as happy. What predicts happiness? Social relationships Employment status Physical health

National Happiness Rankings

Does Money Buy Happiness? Perceptions of wealth are not absolute but relative to certain standards. Social comparison theory revisited. People use their own recent past as a basis of comparison. Adaptation-level theory revisited.

Wealth and Subjective Well-Being Over a period of more than 40 years, Americans became twice as wealthy, as measured by adjusted per person income—but they were no happier, as measured in public opinion polls. From Kassin, S., Psychology, 3rd ed. Copyright c 1997. Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ.

A Set Baseline Level of Happiness? Ratings of happiness are higher among identical twins than among fraternal twins. Fluctuations in mood that accompany positive and negative life events wear off over time. Happiness levels are relatively stable over time and place.

Emerging Science on How to Increase Happiness The pursuit of happiness is a powerful human motive that is still not fully understood. The research described in this section offers some concrete advice on how people can maximize their levels of happiness

What Yields More Happiness: Experiences or Material Objects? After recalling a time when they spent money on an experience or a material object, people in general said that the experiences they purchased made them happier than the material objects. From Van Boven, L., “Experientialism, materialism, and the pursuit of happiness,” Review of General Psychology vol 9 (pp. 132–142). Copyright c 2005 by the American Psychological Association. Reprinted by permission.

Bhutan’s Gross National Happiness (GNH) Indicators From Ura, K., Alkire, S., & Zangmo, T. “Case study: Bhutan: Gross National Happiness and the GNH index,” in J. Helliwell, R. Layard, & J. Sachs (Eds.) World Happiness Report (p. 115). Copyright c 2012 Columbia University (The Earth Institute). Reprinted with permission.