1. Chapter 14 Stress, Coping and Health

2. Table of Contents The Relationship Between Stress and Disease  Contagious diseases vs. chronic diseases  Biopsychosocial model  Why?  The Biomedical Model is unable to fully account for health  Mind-body question  Biomedical treatments only  Placebo effects – how to explain  Health psychology  Health promotion and maintenance  Discovery of causation, prevention, and treatment  Primary prevention, secondary prevention, tertiary prevention  Changing pattern of what is the primary cause of death in last 100+ years

3. Table of Contents Levels of Prevention Primary Prevention Prevent disease Identify causes Promote health behaviors Secondary Prevention Catch disease in early stages Prevent further deterioration Tertiary Prevention Manage illnesses with no cure

4. Table of Contents Figure 13.1 Changing patterns of illness

5. Table of Contents Stress: An Everyday Event  Major stressors vs. routine hassles  Cumulative nature of stress  Psychological Stress - Lazarus  Cognitive appraisals: primary and secondary  Major types of stress  Frustration – blocked goal  Conflict – two or more incompatible motivations  Approach-approach, approach-avoidance, avoidance- avoidance – Figure 13.2  Change – having to adapt  Holmes and Rahe – Social Readjustment Rating Scale – Life Change Units – Table 13.1  Pressure – expectations to behave in certain ways  Perform/conform

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8. Responding to Stress Emotionally  Emotional Responses  Annoyance, anger, rage  Apprehension, anxiety, fear  Dejection, sadness, grief  Positive emotions  After 9/11 – correlations between emotion and resilience  Emotional response and performance  The inverted-U-hypothesis –performance and task complexity

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10. Responding to Stress Physiologically  Physiological Responses  Fight-or-flight response  Selye’s General Adaptation Syndrome  Alarm  Resistance  Exhaustion  Brain-body pathways in stress – Figure 13.6  sympathetic adrenal medullary (SAM)  hypothalamic pituitary adrencortical (HPA)

11. Table of Contents Figure 13.6 – Brain-body pathways in stress: SAM and HPA systems Lundberg (2002), “[Two] neuroendocrine systems have been of particular interest in the study of stress; the sympathetic adrenal medullary (SAM) system with secretion of the two catecholamines, epinephrine and norepinephrine, and the the hypothalamic pituitary adrencortical (HPA) system with the secretion of cortisol.”

12. Table of Contents 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 )

13. Table of Contents Responding to Stress Behaviorally  Behavioral Responses: Coping – emotion focused  Frustration-aggression hypothesis  catharsis  Defensive Coping – ego defense mechanisms –Freud – Table 13.2  Constructive Coping – problem focused

14. Table of Contents Table 13-3, p. 523

15. Table of Contents Emotion-focused coping and Problem-focused coping  “Emotion-focused (or palliative) coping refers to thoughts or actions whose goal is to relieve the emotional impact of stress. These are apt to be mainly palliative in the sense that such strategies of coping do not actually alter the threatening or damaging conditions but make the person feel better.” Monat and Lazarus (1991, p. 6)  “Problem-focused coping refers to efforts to improve the troubled person-environment relationship by changing things, for example, by seeking information about what to do, by holding back from impulsive and premature actions, and by confronting the person or persons responsible for one’s difficulty.” Monat and Lazarus (1991, p. 6)

16. Table of Contents Effects of Stress: Behavioral and Psychological  Impaired Task performance  Burnout – antecedent-components-consequences  Posttraumatic Stress Disorders (PTSD) – effects on hippocampus (cortisol) – prevelance of traumatic events Reaction to traumatic stress  Psychological problems and disorders  Positive effects – eustress – Positive Psychology – Flow (Csikszentmihalyi)

17. Table of Contents Figure 13.7 – The antecedents, components, and consequences of burnout

18. Table of Contents Effects of Stress: Physical  Psychosomatic diseases  Heart disease  Cholesterol and inflammation (C-reactive protein) and risks – Figure 13.9  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  Possible health problems linked to stress  Stress-illness correlation

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21. Table 13.3a Health Problems that may be Linked to Stress

22. Table of Contents Table 13.3b Health Problems that may be Linked to Stress

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24. Factors Moderating the Impact of Stress  Social support  The perceived comfort, caring, esteem or help received from others.  Types: emotional, belongingness, instrumental (tangible), informational, esteem/relational, and network (Facebook and MySpace?)  The existence or quantity of social relationships  the amount of assistance individuals believe is available to them  the amount of assistance individuals receive  Alameda County Study in 1965 – related to health outcomes, tend to live longer  Increased immune functioning  Optimism  expectation of good things will happen and bad things will not happen, contrasted to pessimism  Related to psychological well-being, physical well-being  More adaptive coping  Pessimistic explanatory style  Conscientiousness  Fostering better health habits  Autonomic reactivity  Cardiovascular reactivity to stress

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27. 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

28. Table of Contents Health-Impairing Behaviors  Smoking – prevalence in U.S.  Smoking cessation  Poor nutrition – obesity – “Super Size” generation  Cholesterol and coronary risk  High fructose corn syrup effects  Lack of exercise – increased T.V. watching effects study  Obesity – BMI – United States 2005 & 2008 data – CDC – changes over the years  Alcohol and drug use  Risky sexual behavior  Transmission, misconceptions, and prevention of AIDS – AIDS Risk Knowledge Test

29. Table of Contents BMI Classifications  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 BMI > 30, or ~ 30 lbs. overweight for 5'4" person for 2005 - CDC

30. Table of Contents BMI Classifications  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 BMI > 30, or ~ 30 lbs. overweight for 5'4" person for 2008 - CDC

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32. Reactions to Illness  Seeking treatment  Ignoring physical symptoms  Communication with health care providers  Barriers to effective communication  Following medical advice  Noncompliance  Biopsychosocial factors in health

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34. Stress Management  Relationship to coping to self-esteem  Cognitive reappraisal – Ellis’s model  Humor  Relaxation Response – Benson  Stress Inoculation Training  Physical fitness and mortality

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36. Fig. 13-18, p. 543

37. Table of Contents 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

38. Table of Contents Relaxation Response – Benson  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

39. Table of Contents 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

40. Table of Contents 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