1. Stress, Health, and Human Flourishing
Chapter 11
Stress, Health, and Human Flourishing
PowerPoint® Presentation
by Jim Foley

2. Stress and Health Topics that hopefully won’t become stressors
Stress: a Process of perceiving and responding to stressors
Stressors:
Catastrophes,
Life Changes,
Daily Hassles
The stress response system: General Adaptation Syndrome
Psychoneuroimmunology:
Stress and Illness
Stress and AIDS, cancer, Heart Disease
Personality Factors and stress: Type A, pessimism
The role of hormones and inflammation
No animation.

3. Health Psychology the phases of stress response and adaptation
how stress and health are affected by
appraisal of stressors
severity of stressors
personality types
perceived control
emotion or problem focus
optimism
social support
exercise
relaxation
religious faith and participation
Emotions, as well as personality, attitudes, behaviors, and responses to stress, can have an impact on our overall health.
Health psychology studies these impacts, as part of the broader field of behavioral medicine.
Topics of study in health psychology include:
Click to reveal bullets and topics of study.

4. Stress: A Focus of Health Psychology
Many people report being affected by “stress.”
Some terms psychologists use to talk about stress:
Stress refers to the process of appraising and responding to events which we consider threatening or challenging.
a stressor is an event or condition which we view as threatening, challenging, or overwhelming.
Examples include poverty, an explosion, a psychology test, feeling cold, being in a plane, and loud noises.
appraisal refers to deciding whether to view something as a stressor.
stress reaction refers to any emotional and physical responses to the stressor such as rapid heartbeat, elevated cortisol levels, and crying.
Click to reveal bullets.

5. Clarifying the Components of Stress
Stress isn’t something that happens to you; it’s a process in which you participate.
The process includes the stressor (event or condition), cognitive appraisal, body response, and coping strategies.
The advantage of breaking “stress” into these components is that we can see options for altering each of these different factors.
Click to reveal bullets.
The answer to the slide question will develop over the course of the this section. However, what we’re looking for here is student’s ability to separate the factors, to see that the stressor (whatever’s on his laptop) could be addressed, or his appraisal and other parts of his stress reaction could be changed.
What could this person do to reduce his level of suffering from stress?

6. Appraisal: Choosing How to View a Situation
Questions to ask yourself when facing a possible stressor: Is this a challenge, and will I tackle it? Is it overwhelming, and will I give up?
There are few conditions* that are inherently and universally stressful; we can often choose our appraisal and our responses. *extreme, chronic physical threats or challenges (such as noise or starvation)
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7. Beneficial and Harmful Stress Effects
A brief experience of stress can be beneficial:
improving immune system response
motivating action
focusing priorities
feeling engaged, energized, and satisfied
providing challenges that encourage growth, knowledge, and self-esteem
Extreme or prolonged stress, causes problems:
mental and physical coping systems become overwhelmed and defeated rather than strengthened
immune functioning and other health factors decline because of damage
Click to reveal bullets.
The key factor is whether there is a chance for recovery and healing.

8. Stressors
Stressors refer to the events and conditions that trigger our stress response, because they are perceived/ appraised as overwhelmingly challenging, threatening, and/or harmful.
There may be a spectrum of levels of intensity and persistence of stressors.
We can also see stressors as falling into one of four* categories:
catastrophes.
significant life changes.
chronic daily hassles.
low social status/power.
Click to reveal bullets.
Instructor: the fourth category refers to the daily challenge of managing poverty, powerlessness, being a persistent target for injustice, discrimination, bullying, other low social/economic freedom, or facing oppression as a society or as a subgroup. For example, some readers of this text live under regimes or with competing groups that monitor and control their lives, lacking freedom and risking unexpected violence.
*the text focuses on the first three.

9. Catastrophic Events/Conditions
Short-term effects include increased heart attacks on the day of the event.
Long term effects include depression, nightmares, anxiety, and flashbacks.
Bonding: both the trauma and the recovery are shared with others.
Appraisal is not essential in a catastrophic event. Most people agree that the event is harmful and overwhelming.
Examples include earthquakes, floods, hurricanes, war/combat, and wildfires.
It can be one single event or chronic harmful conditions.
Click to reveal bullets.

10. Major Life Events/Changes
Even supposedly “happy” life changes, such as marriage, starting college or a new job, or the birth or adoption of a child, can bring increased challenge and stress.
Change is often challenging.
New roles, new priorities, and new tasks can put a strain on our coping resources.
The challenge, and the negative impact on health, increases when:
the changes are painful, such as a death in family, loss of job, or heart attack.
the changes are in a cluster, and there are too many at once.
Click to reveal bullets.

11. Chronic Daily Difficulties
Daily difficulties can be caused by facing too many tasks, too little time, and too little control.
Daily difficulties can be caused by the lack of social power and freedom:
being bullied
living in poverty
living under oppressive political conditions
Click to reveal text boxes.
Instructor: here again is a more complete list of the proposed fourth category, which has been combined with “Daily Hassles” to become “Chronic Daily Difficulties.” The fourth category refers to the daily challenge of managing poverty, powerlessness, being a persistent target for injustice, facing oppression as a society or as a subgroup, discrimination, bullying, or other low social/economic freedom.

12. The Body’s Stress Response System
When encountering a sudden trauma or other stressor, our body acts to increase our resistance to threat and harm.
Phase 1: The “fight or flight” sympathetic nervous system responds, reducing pain and increasing the heart rate.
The core of the adrenal glands produces norepinephrine and epinephrine (adrenaline).
This system, identified by Walter Cannon ( ), gives us energy to act.
Phase 2: The brain sends signals to the outer part of the adrenal glands to produce cortisol and other stress hormones. These focus us on planning adaptive coping strategies and resisting defeat by the stressor.
Hans Selye ( ) indentified this extended “resistance” phase of the stress response, followed by:
Click to reveal the three phases.
Phase 3: Exhaustion.

13. General Adaptation Syndrome [GAS] (Identified by Hans Selye): Our stress response system defends, then fatigues.
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14. Effects of Prolonged Stress
The General Adaptation Syndrome [GAS] works well for single exposures to stress.
Repeated and prolonged stress, with too much Phase 3 time, leads to various signs of physical deterioration and premature aging:
the production of new neurons declines
neural circuits in the brain break down
DNA telomeres (chromosome tips) shorten,  cells lose ability to divide,  cells die,  tissue stops regenerating,  early aging and death
Click to reveal bullets.

15. Female and Male Stress Response
In response to a stressor such as the death of a loved one, women may “tend and befriend”: nurture themselves and others, and bond together.
The bonding hormone oxytocin may play a role in this bonding.
Women show behavioral and neurological signs of becoming more empathetic under stress.
Men under stress are more likely to socially withdraw and numb themselves with alcohol.
Men are also more likely to become aggressive under stress.
In either case, men’s behavior and brains show LESS empathy and less tuning in to others under stress.
Click to reveal bullets under each picture.

16. Studying the Stress-Illness Relationship
How does stress increase our risk of disease?
This is the subject of a new field of study: psychoneuroimmunology, the study of how interacting psychological, neural, and endocrine processes affect health.
Psychologists no longer use the term “psychosomatic” because it has come to mean an imagined illness.
We now refer to psychophysiological illness, a real illness caused in part by psychological factors such as the experience of stress.
Click to reveal bullets.

17. How the immune system works, before stress plays a role:
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18. Stress Increases The Risk of Illness
Stressors
Appraisal
Thoughts
Feelings
Brain signals
Hormonal action
Immune suppression
Risk of illness
Stress Increases The Risk of Illness
Here we see psycho- neuroimmunology in action:
psychological factors, such as appraisal, thoughts, and feelings.
neurological factors, such as brain signals engaging the stress response system.
immunology, such as stress hormone exposure which suppresses the immune system.
Click to reveal bullets.

19. Psychoneuroimmunology Example: The Impact of Stress on Catching a Cold
In a group exposed to germs, those experiencing stress were more likely to catch a cold.
This tradeoff between stress response and immune response may help our bodies focus energy on managing stress.
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Stress exposure has also been found to delay the healing of wounds.

20. This does NOT mean that stress causes cancer or AIDS.
Stress, AIDS, and Cancer
AIDS = Acquired Immune Deficiency Syndrome
Cancer: the stress link is not as clear
Because the stress response suppresses the immune response, exposure to stress obviously worsens the development of AIDS in those exposed to HIV.
Reducing stress slows the progression of AIDS.
Stress may weaken the body’s defenses against the replication and spread of malignant cells.
Click to reveal bullets.
By next edition of this text, there will probably also be a slide about stress and neurological decline; research in 2011 and 2012 shows an impact of stress on factors related to Alzheimer’s and Parkinson’s disease.
Implication of the relationship between stress and AIDS: reducing fearful avoidance of people with AIDS and discrimination against populations seen as being at risk of AIDS might reduce the stress of these populations and prevent or slow the progression of the disease. This is something to consider when one’s fearful or discriminatory impulses kick in, for those people not part of these populations.
This does NOT mean that stress causes cancer or AIDS.

21. Stress and Heart Disease
Many factors contribute to heart disease.
Biological: genetic predisposition to high blood pressure and high cholesterol
Behavioral: smoking, inactivity, and high-fat diet
Psychological: chronic stress, and personality styles that worsen the experience of stress
In coronary heart/artery disease, the blood vessels that provide oxygen and nutrients to the heart muscle itself become clogged, narrowed, and closed.
Click to reveal sidebar bullets.
Stress increases the risk of heart disease over decades and causes immediate heart attacks. However, stress can also increase cholesterol levels and artery clogging factors in the space of weeks (the accountant study in the text) and prevent the liver from filtering cholesterol and fat from the blood.
Clogging of the coronary artery

22. Type A PersonalityStressHeart Disease
People with a type A personality are impatient, verbally aggressive, and always pushing themselves and others to achieve.
People with a type B personality are more relaxed and go with the flow.
In one study, heart attacks ONLY struck people with Type A traits.
Accomplishing goals is healthy, but a compulsion to always be working, with little time spent “smelling the flowers,” is not.
Click to reveal bullets.
Also a problem: ANGER. To reduce anger-related stress: defuse anger with exercise, talking, forgiveness, NOT “letting it out” (catharsis) by screaming, punching.

23. Pessimism and Heart Disease
It can be helpful to realistically anticipate negative events that may happen, and to plan how to prevent or cope with them.
Pessimism refers to the assumption that negative outcomes will happen, and often facing them by complaining and/or giving up.
Click to show text boxes.
Suppressing negative emotions only worsens the risk of heart disease. Reducing risk comes from a genuine change in attitude and treatment of factors related to negative emotions.
Men who are generally pessimistic are more likely to develop heart disease within ten years than optimists.

24. Depression and Heart Disease
Why does depression appear so often with heart disease? Does one cause the other?
One possible answer is that the two problems are both caused by chronic stress.
There may be an intervening variable: excessive inflammation.
Click to reveal bullets.
The role of this intervening variable may explain why increasing levels of Omega-3 fatty acids seems in some reports to have an impact on the incidence of both depression and heart disease.

25. Health Consequences of Chronic Stress: The Repeated Release of Stress Hormones
The stress hormone cortisol helps our bodies respond to brief stress.
Chronically high cortisol levels damage the body.
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26. Coping with Stress and Promoting Health
How to go from coping to thriving
Problem-focused and emotion-focused coping
Perceived control and learned helplessness
Benefits of Optimism, Social support
Reducing stress effects with Aerobic Exercise
The power of Faith communities
Complementary and Alternative Medicine
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27. Promoting Health
Ways that help some people to reduce levels of stress, and to improve health:
aerobic exercise
relaxation and meditation
participation in communities of faith
alternative medicine
Some ways to reduce the health effects of stress include:
address the stressors.
soothe emotions.
increase one’s sense of control over stressors.
exchange optimism for pessimism.
get social support.
Click to reveal bullets.
Instructor: this can serve as an overview of the rest of the chapter, though the topics coming up won’t always tie this well to the theme of promoting health. One section, on optimism, does not have its own slide; this is because the section does not offer new material except for some correlational studies that don’t provide evidence that improving optimism causes improvements in health.

28. Coping with Stress
Problem-focused coping means reducing the stressors, such as by working out a conflict, or tackling a difficult project.
Emotion-focused coping means reducing the emotional impact of stress by getting support, comfort, and perspective from others.
Risk: ignoring the problem.
We might focus on this style of coping when we perceive the stressor as something we cannot change.
Risk: magnifying emotional distress, especially if trying to change something that’s difficult to change (e.g. another person’s traits).
Click to reveal bullets.

29. Learned Helplessness vs. Personal Control
Normally, most creatures try to escape or end a painful situation. But experience can make us lose hope.
Experiment by Martin Seligman: Give a dog no chance of escape from repeated shocks. Result: It will give up on trying to escape pain, even when it later has the option to do so.
Learned Helplessness: Declining to help oneself after repeated attempts to do so have failed.
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Personal Control: When people are given some choices (not too many), they thrive.

30. Stress factor: Perceived Level of Control
Experiment: the left and middle rats below received shocks. The rat on the left was able to turn off the shocks for both rats. Which rat had the worst stress and health problems?
Only the middle, subordinate rat had increased ulcers.
It is not the level of shock, but the level of control over the shock, which created stress.
Click to reveal bullets.

31. External vs. Internal Locus of Control
Locus of control: Our perception of where the seat of power over our lives is located.
Internal locus of control: we feel that we are in charge of ourselves and our circumstances.
External locus of control: we picture that a force outside of ourselves controls our fate.
Click to reveal all text.
Too much internal locus of control: We blame ourselves for bad events, or have the illusion that we have the power to prevent bad events.
Too much external locus of control: We lose initiative, lose motivation to achieve, have more anxiety about what might happen to us, don’t bother developing willpower.

32. Self-Control: Resource, Skill, Trait
The ability to control impulses and delay gratification, sometimes called “willpower”
This is a finite resource, an expenditure of brain energy, which is replenished but can be depleted short-term: People asked to resist eating cookies later gave up sooner on a tedious task
With practice, we can improve our self- control
There seem to be individual differences in this trait in childhood
The Marshmallow study: Kids who resisted the temptation to eat marshmallows later had more success in school and socially
Click to reveal bullets.

33. Optimism vs. Pessimism
We can be optimistic or pessimistic in various ways:
Prediction: We can expect the best or the worst. At the extremes, we can get ourselves overconfident or simply depressed or anxious about the future.
Focus of attention: We can focus on what we have (half full) or what we don’t have (empty).
Click to reveal bullets.
Attribution of intent: We can assume that people meant to hurt us or that they were having a bad day.
Valuation: We can assume that we or others are useless, or that we are lovable, valuable.
Potential for change: We can assume that bad things can’t be changed, or have hope.

34. Excessive Pessimism vs. Excessive Optimism
Realism
It will be easy, I won’t think about it.
I can’t do it, might as well forget it.
It might be hard; I’d better plan.
I’m trapped, can’t get out of this
I want to make changes or get out.
Someone will rescue me.
Click to reveal examples. In each row, they appear one at a time: Pessimism, then Optimism, then Realism.
I’m sure he just wants what’s best for me, I’ll trust him.
That person hates me, he is against me.
I should ask what he feels about me, what he wants.
Excessive pessimism can leave us depressed, inactive.
Excessive optimism can leave us unprepared, unsafe.

35. Promoting Health: Social Support
Having close relationships is associated with improved health, immune functioning, and longevity.
Social support, including from pets, provides a calming effect that reduces blood pressure and stress hormones.
Confiding in others helps manage painful feelings.
Laughter helps too.
Click to reveal bullets.
“Well, I think you’re wonderful.”

36. Aerobic Exercise and Health
Aerobic exercise triggers certain genes to produce proteins which guard against more than 20 chronic diseases and conditions.
Aerobic exercise reduces the risk of heart disease, cognitive decline and dementia, and early death.
Aerobic exercise refers to sustained activity that raises heart rate and oxygen consumption.
Ultimate (Frisbee): you must run often to “get open” for a pass, then run more to cover the other team and block their passes.
Click to reveal bullets and text box.
Instructor: if you are not familiar with the sport of “Ultimate,” here’s a two-sentence summary. You and up to six teammates make passes (with a disc, usually not a “Frisbee” brand) to each other down a field to score by catching the disc in an end zone. Any incomplete pass is a turnover and the defense instantly picks up the disc and becomes the offense, making passes to move the disc toward the other end zone.
Another comment to make about aerobic exercise in Ultimate: you can’t run with the disc, so catching the disc and looking for a teammate to throw to gives you a running break of about two to ten seconds (the time limit for making the next pass).

37. Aerobic Exercise and Mental Health
Aerobic exercise reduces depression and anxiety, and improves management of stress. How do we know?
Aerobic exercise is correlated with high confidence, vitality, and energy, and good mood.
Is there causation? Perhaps depression simply reduces exercise.
One study establishing causation: mildly depressed young women randomly assigned to an exercise group showed reduced depression caused by exercise alone.
Click to reveal bullets.

38. Lifestyle Modification
In one study, a control group was given diet, medication, and exercise advice.
An experimental group practiced lifestyle modification, a plan to slow down the pace of one’s life, accept imperfection, and renew faith.
Click to reveal bullets and graph.
Result: modifying lifestyle led to reduced heart attack rates.

39. Relaxation and Meditation
Use of relaxation techniques can reduce headaches, high blood pressure, anxiety, and insomnia, and improve immune functioning.
People who meditate can learn to create a relaxation response: relaxed muscles, lower blood pressure, and slowed heart rate and breathing.
Meditation also increases brain activity associated with positive emotions.
Steps to get the relaxation response: focus attention on breathing, a focus word, and relaxing muscles from toes upward.
Click to reveal bullets.
Instructor: before clicking to make any bullets appear, you might make an introductory comment to connect to the previous slide, such as “One component of healthy lifestyle modification is spending more time in relaxation.”

40. Faith Communities and Health
While attendance at religious services may not directly save lives, it may make other healthy practices more likely.
Religious attendance seems to have results, especially for men, comparable to the benefit of physically healthy lifestyle choices.
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41. Faith Communities and Health: Intervening Factors
The health impact of religious involvement may be indirect. Health may improve because of the lifestyle and emotional factors associated with religious involvement, and not [just] the faith.
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42. Closer Look at a Particular Emotion: Happiness
Happiness is:
a mood.
an attitude.
a social phenomenon.
a cognitive filter.
a way to stay hopeful, motivated, and connected to others.
The feel-good, do-good phenomenon: when in a good mood, we do more for others. The reverse is also true: doing good feels good.
Click to reveal bullets.

43. A More Positive Psychology
Martin Seligman, who earlier kept dogs from escaping his shocks until they developed learned helplessness.
Developed Positive Psychology, the “scientific study of optimal human functioning,” finding ways to help people thrive.
Focus: building strengths, virtue, emotional well-being, resilience, optimism, sense of meaning.
Click to reveal bullets.
Three pillars of Positive Psychology:
Emotions, e.g. engagement
Character, e.g. courage
Groups, Culture, Institutions

44. Happiness has its ups and downs.
Over the Course of a Week
Happiness has its ups and downs.
Levels of happiness, as well as other emotions, can vary over the course of a week (we like the weekend), and even over the course of a day (don’t stay awake too long!).
Over the Course of a Day
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45. Wealth and Well-Being: A Change in Goals
In the late 1960s, students entering college had a primary goal of developing a meaningful life philosophy.
Since 1977, being very well-off financially has become more of a primary goal for first year students.
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Instructor: the goal of students in the past decade may not ensure their well-being, or at least not their happiness. Evidence seems to show that striving for wealth is less likely to lead to happiness than striving for intimacy, contribution to society, and personal growth (Kasser, 2011, cited by Myers on page 482).
You can invite students to interpret this data. Note that it applies to college first-year students. Is it possible that this reflects changing attitudes about what college is about? Maybe in the 1960’s, college students were there as more of a luxury, and were spending time searching for a new set of guidelines for life. Perhaps in the 1980’s, students may have entered college more pragmatically, thinking about how they need to earn enough after graduation to pay for the inflated cost.

46. Can Money Buy Happiness?
Money seems to buy happiness when it lifts people out of extreme poverty. Otherwise, money doesn’t seem to help our mood much.
The average level of income (adjusted for inflation) and purchasing power has increased in the United States.
The percentage of people feeling very happy, though, has not followed the same trend of improvement.
Click to reveal bullets.
Instructor: this graph and its comments can be explained in part by two upcoming concepts, adaptation and relative deprivation. You can add that this pattern of increased wealth not correlating with increased happiness applies when comparing nations as well comparing different time periods.

47. Adaptation-Level Phenomenon
When we step into the sunshine, it seems very bright at first. Then our senses adapt and we develop a “new normal.” If a cloud covers the sun, it may seem “dark” in comparison.
The “very bright” sensation is temporary.
The adaptation-level phenomenon: when our wealth or other life conditions improve, we are happier compared to our past condition.
However, then we adapt, form a “new normal” level, and most people must get another boost to feel the same satisfaction.
Click to reveal bullets.

48. Adapting Attitudes Instead of Circumstances
Because of the adaptation-level phenomenon, our level of contentment does not permanently stay higher when we gain income and wealth; we keep adjusting our expectations.
It is also true that misfortune, disability, and loss do not result in a permanent decrease in happiness.
In both cases, humans tend to adapt.
Click to reveal bullets.

49. Relative Deprivation
If the average income has risen by 10 percent in your area, it might be hard to feel great about a 5 percent rise in your income because of
People who were satisfied with their own lives might become less satisfied if other people get more power, recognition, and income.
We can affect our happiness by choosing the people to whom we compare ourselves.
However, the tendency is to compare ourselves to people who are more successful.
Relative deprivation:
feeling worse off by comparing yourself to people who are doing better.
Click to reveal bullets.

50. Correlates of Happiness
There are behaviors that seem to go with happiness. Whether they are the cause or the effect of happiness is not clear, but it can’t hurt to try them.
Researchers have found that happy people tend to:
Happiness seems not much related to other factors:
Have high self-esteem (in individualistic countries)
Be optimistic, outgoing, and agreeable
Have close friendships or a satisfying marriage
Have work and leisure that engage their skills
Have an active religious faith
Sleep well and exercise
Age (example: the woman at the laptop in the picture)
Gender (women are more often depressed, but also more often joyful)
Parenthood (having children or not)
Physical attractiveness
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There also may be a genetic basis for a predisposition to happiness. Whether because of genes, culture, or personal history, we each seem to develop a mood “set point,” a level of happiness to which we keep returning.

51. Possible Ways to Increase Your Chances at Happiness
Look beyond wealth for satisfaction.
Bring your habits in line with your goals; take control of your time.
Smile and act happy.
Find work and leisure that engages your skills.
Exercise, or just move!
Focus on the needs and wishes of others.
Work, rest, …and SLEEP.
Notice what goes well, and express gratitude.
Nurture spirituality, meaning, and community.
Make your close relationships a priority.
Click to reveal bullets.
Instructor, you could introduce this slide by saying, “If you are stuck in depression, you may need treatment. However, in general, there are steps you can take to maximize your likelihood and degree of feeling content, satisfied, and even having more days of feeling joy.”
Brainstorm other ideas for happiness. One omission that might not come up: have an appropriate locus of control, not assuming either powerlessness or total ability to prevent bad things from happening. A related idea, which some students may know as part of the “Serenity Prayer”: know what you’re able to change/influence and focus on what you’re able to do, rather than focusing your attention on roadblocks, limitations, and other factors you can’t change.