1. PSYCHOLOGY Chapter 14 Stress and Health

2.  Behavioral Medicine  interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease  Health Psychology  subfield of psychology that provides psychology’s contribution to behavioral medicine

3. Stress and Illness  Leading causes of death in the US in 1900 and 2000

4. Stress and Illness  Stress  the process by which we perceive and appraise and cope with environmental threats and challenges, called stressors

5. Stress Appraisal 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

6. 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 )

7. Stress and Illness  GAS  Hans Selye’s concept of the body’s adaptive response to stress in 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 last only so long before exhaustion sets in Stressor occurs

8. General Adaptation Syndrome zAlarm Reaction - Any physical or mental trauma will trigger an immediate set of reactions that combat the stress. zResistance - Eventually, sometimes rather quickly, we adapt to stress, and there's actually a tendency to become more resistant to illness and disease. zExhaustion - Because our body is not able to maintain homeostasis and the long-term resistance needed to combat stress, we invariably develop a sudden drop in our resistance level

9. Stressful Life Events  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

10. Stressful Life Events  Chronic Stress by Age

11. Perceived Control zStressors are more powerful when they are perceived as both negative and uncontrolled zWe are more vulnerable to ill health zHaving a sense of control over their work environment is sufficient in most cases to cause workers less stress

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

13. Perceived Control zPoverty and Inequality yPeople who live in areas of large differences between income levels die earlier yPoorer people are more at risk for premature death zOptimism vs. Pessimism yThose who have a more positive attitude about life live longer than those with a negative one

14. Stress and the Heart  Coronary Heart Disease  Elevated stress causes clogging of the vessels that nourish the heart muscle  leading cause of death in many developed countries

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

16. Stress and the Heart

17. Stress and Disease  Psychophysiological Illness  “mind-body” illness  any stress-related physical illness  some forms of hypertension  some headaches  distinct from hypochondriasis - misinterpreting normal physical sensations as symptoms of a disease

18. Stress and Disease  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

19. 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)

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

21. Promoting Health  Modifying Type A life-style can reduce recurrence of heart attacks Percentage of patients with recurrent heart attacks (cumulative average) 65432106543210 Year 1978 1979 1980 1981 1982 Life-style modification patients Control patients Modifying life-style reduced recurrent heart attacks

22. Life events Tendency toward HealthIllness Personal appraisal ChallengeThreat Personality type Easy going Nondepressed Optimistic Hostile Depressed Pessimistic Personality habits Nonsmoking Regular exercise Good nutrition Smoking Sedentary Poor nutrition Level of social support Close, enduringLacking

23. Promoting Health  Predictors of mortality 1 0.8 0.6 0.4 0.2 0 Men Women Not smoking Regular exercise Weekly religious attendance Relative risk of dying

24. Promoting Health  Religious Attendance

25. Promoting Health  The religion factor is multidimensional Religious involvement Healthy behaviors (less smoking, drinking) Social support (faith communities, marriage) Positive emotions (less stress, anxiety) Better health (less immune system suppression, stress hormones, and suicide)

26. Promoting Health  Smoking-related early deaths 40,000 30,000 20,000 10,000 0 33,348 1,6861,135 556202 Smoking Suicide Vehicle HIV/ Homicide crash AIDS Cause of death Number of deaths per 100,000

27. Smoking Gun zEvery year tobacco kills some 4 million of its 1.2 billion customers (25 loaded jumbo jets DAILY!) zThe numbers are on the rise and could reach 10 million annually zEliminating smoking would have the single most important impact on improving life expectancy

28. The Physiological Effects of Nicotine

29. Obesity and Weight Control  Obesity and body mass index

30. Obesity and Weight Control  Obesity and mortality 18.5 18.5- 20.5- 22.0- 23.5- 25.0- 26.5- 28.0- 30.0- 32.0- 35.0- 40 20.4 21.9 23.4 24.9 26.4 27.9 29.9 31.9 34.9 39.9 Body-mass index (BM I) MenWomen 2.8 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 Relative risk of death

31. Weight Discrimination  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 ) 0 1 2 3 4 5 6 7 WomenMen NormalOverweight

32. Weight Control  Effects of a severe diet Caloric intake in calories per day Body weight in kilograms Metabolism: Oxygen consumption in liters per hour 3000 2000 1000 0 8 16 24 32 Days 165 160 155 150 145 140 Days 26 25 24 23 22 21 8 16 24 32

33. Weight Control  Thinning of Miss America

34. Weight Control  Most lost weight is regained -20 -15 -10 -5 0 5 10 12345 Weight change in pounds Post treatment Years of follow-up Starting point Normal trend for untreated obese people: Gradually rising weight After participation in behavioral Program: Much of initial weight loss regained

35. Weight Control  Obesity was more common among those who watched the most television 4 Hours of television watched per day in 1990s study BoysGirls 32 30 28 26 24 22 20 Skinfold fat measure (mm)

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

37. Susceptibility to Stress z1= Almost Always 3=about ½ the time 5=Never z 1. I eat at least one hot, balanced meal a day. z 2. I get 7-8 hours sleep at least 4 nights a week. z 3. I give and receive affection regularly. z 4. I have at least one relative within 50 miles on whom I can rely. z 5. I exercise to the point of perspiration at least twice a week. z 6. I avoid tobacco use. z 7. I consume fewer than 5 alcoholic drinks per week. z 8. I am appropriate weight for my height. z 9. I have an income adequate to meet the basic expenses. z10. I get strength from my religious beliefs. z11. I regularly attend club or social activities. z12. I have a network of friends and acquaintances. z13. I have one or more friends to confide in about personal matters. z14. I am in good health. z15. I am able to speak openly about my feelings when angry or worried. z16. I regularly have conversations with the people I live with about domestic problems. z17. I do something for fun at least once a week. z18. I am able to organize my time effectively. z19. I drink fewer than three cups of coffee, cola or tea per day. z20. I take quiet time for myself during the day. z21. I have an optimistic outlook on life.

38. Type A/Type B Personality z1. Is your everyday life filled mostly by: z A. problems needing solutions? C. a rather predictable routine of events? z B. challenges needing to be met? D. Not enough things to keep you interested or busy? z z2. When you are under pressure or stress do you usually : z A. Do something about it immediately? z B. Plan carefully before taking any action? z3. Ordinarily how rapidly do you eat? z A. I’m usually the first one finished. C. I eat about the same as other people z B. I eat a little faster than average. D. I eat more slowly than most people. z4. When you listen to someone talking and this person take too long to come to the point do you feel like hurrying him/her along? z A. FrequentlyB. OccasionallyC. almost never z5. Do most people consider you to be: z A. Definitely hard-driving and competitive.C. Probably more relaxed and easy going. z B. Probably hard-driving and competitive.D. Definitely more relaxed and easy going. z6. Would people who know you well agree that you have less energy than most people? z A. definitely yesB. Probably yesC. probably no d. definitely no z7. Do you ever set deadlines or quotas for yourself in courses or other things z A. NoB. Yes, but only occasionallyC. Yes, once per week or more often z8. Do you maintain a regular study schedule during vacations such as Thanksgiving, Christmas, Easter? z A. YesB. NoC. Sometimes z9. When you are in a group, do the other people tend to look to you to provide leadership? z A. YesB. NoC. Sometimes z10. Compared with the average student at this school, I am: z A. Much more responsibleB. A little more responsibleC. A little less responsibleD. Much less responsible