Chapter 13

1. Chapter 13 Stress, Coping and Health

2. Principle types of stress include • a. conflict, fear, pressure • b. anxiety, conflict, change • c. change, frustration, pressure • d. frustration, conflict, anxiety • c. change, frustration, pressure

3. In avoidance-avoidance conflicts a choice must be made • a. whether to seek any goal • b. whether to pursue a single goal that has both attractive and unattractive aspects • c. between two attractive goal • d. between two unattractive goals • d. between two unattractive goals

4. An organism first recognizes the existence of a threat and physiological arousal occurs during the___ stage of the general adaptation syndrome • a. alarm reaction • b. resistance • c. exhaustion • d. flight-or-flight • a. alarm reaction

5. The Relationship Between Stress and Disease • Contagious diseases vs. chronic diseases • Biopsychosocial model • Health psychology • Health promotion and maintenance • Discovery of causation, prevention, and treatment

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

9. Responding to Stress Emotionally • Emotional Responses • Annoyance, anger, rage • Apprehension, anxiety, fear • Dejection, sadness, grief • Positive emotions • Emotional response and performance • The inverted-U-hypothesis

12. Responding to Stress Physiologically • Physiological Responses • Fight-or-flight response • Selye’s General Adaptation Syndrome • Alarm • Resistance • Exhaustion

14. Some Psychological Stressors for High School Students Life Event Stress Points Divorce of parents 98 Expulsion from school 79 Major injury or illness 77 Getting a job 62 Major illness of close friend 56 Peer difficulties 45 Moving away 41 Christmas 30 Vacation 25 Traffic ticket 22

16. Cerebral cortex (perceives stressor) Pituitary hormone in the bloodstream stimulates the outer part of the adrenal gland to release the stress hormone cortisol Thalamus Hypothalamus Pituitary gland Sympathetic nervous system releases the stress hormones epinephrine and norepinephrine from nerve endings in the inner part of the adrenal glands Adrenal glands

17. Fight or Flight (Walter Cannon) Sequence of Steps in the Fight or Flight Behaviors 1. The brain appraises a situation as threatening and dangerous. 2. The lower brain structure secretes a stress hormone. 3. The stress hormone signals the adrenal glands to secrete adrenaline. 4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.

18. The General Adaptation Syndrome (Hans Selye) Defined as a series of stages the body goes through when exposed to stressful situations. 1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical. 2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor. Exhaustion Alarm Resistance 3. The third stage is exhaustion. It is marked by body exhaustion and health problems.

19. The body’s resistance to stress can last only so long before exhaustion sets in Stress resistance Stressor occurs Phase 1 Alarm reaction (mobilize resources) Phase 2 Resistance (cope with stressor) Phase 3 Exhaustion (reserves depleted) Stress and Illness • General Adaptation Syndrome • Selye’s concept of the body’s adaptive response to stress in three stages

20. Responding to Stress Behaviorally • Behavioral Responses • Frustration-aggression hypothesis • catharsis • defense mechanisms • Coping - refers to active efforts to master, reduce, or tolerate the demands created by stress. These may involve giving up and blaming oneself (learned helplessness – passive behavior produced by exposure to unavoidable aversive events), striking out at others aggressively (usually the result of frustration…Dollard’s frustration-aggression hypothesis), self-indulgement (eating, drinking, smoking, shopping), defensive coping (erecting defense mechanisms), or constructive coping (realistically appraising situations and confronting problems directly).

22. Increased levels of the immune system are associated with

23. Research has demonstrated individuals with Type A personality

24. Of the following individuals, who would be least likely to develop heart disease?

25. ANSWERS • D - high levels of social support and optimism • C - have an increased risk of developing heart disease • B - Bill, who is a Type B personality

27. Effects of Stress: Behavioral and Psychological • Impaired Task performance - people under pressure to perform may feel self-conscious, which leads to disruption of attention and “choking” under pressure • Burnout - physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotionally demanding situations…loss of meaning. • Posttraumatic Stress Disorders (PTSD) - re-experiencing the traumatic event in the form of nightmares and flashbacks • Psychological problems and disorders • Positive effects - stress can promote personal growth or self-improvement, forcing people to develop new skills, reevaluate priorities, learn new insights

29. Effects of Stress: Physical • Psychosomatic diseases • Heart disease - accounts for nearly one-third of the deaths in the U.S. each year, and atherosclerosis, or gradual narrowing of the coronary arteries, is the principle cause of CHD. Risk factors for CHD include smoking, lack of exercise, high cholesterol levels, and high blood pressure. • 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

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

31. Research on type A Personality • Time urgency & competitiveness not associated with poor health outcomes • Negative emotions, anger, aggressive reactivity • High levels of hostility increase chance of all disease (e.g., cancer)

32. Explanatory style • Optimism • use external, unstable, & specific explanations for negative events • predicts better health outcomes • Pessimism • use internal, stable, & global explanations for negative events • predicts worse health outcomes

33. Stress and the Heart

37. Factors Moderating the Impact of Stress • Social support • Increased immune functioning • Optimism • More adaptive coping • Pessimistic explanatory style • Conscientiousness • Fostering better health habits • Autonomic reactivity • Cardiovascular reactivity to stress

39. Health-Impairing Behaviors • Smoking - A 25 year old male who smokes two packs a day has an estimated life expectancy 8.3 years shorter than that of a similar, nonsmoker. Health risks decline quickly for those who give up smoking, but quitting is difficult and relapse rates are high • Poor nutrition & Lack of exercise - have been linked to heart disease, hypertension, and cancer, among other things • Alcohol and drug use - carry the immediate risk of overdose and the long-term risk of many diseases • Risky sexual behavior • Transmission, misconceptions, and prevention of AIDS - is transmitted through person-to-person contact involving the exchange of bodily fluids, primarily semen and blood

40. Heart disease Persistent stressors and negative emotions Release of stress hormones Immune suppression Unhealthy behaviors (smoking, drinking, poor nutrition and sleep) Autonomic nervous system effects (headaches, hypertension) Stress and Disease • Negative emotions and health-related consequences

41. 14 13 12 11 10 9 8 7 6 5 4 3 Depression score No-treatment group Relaxation treatment group Aerobic exercise group Before treatment evaluation After treatment evaluation Promoting Health • Aerobic Exercise • sustained exercise that increases heart and lung fitness

42. Why Does Exercise Work? Exercise and Mood Releases chemicals -- norepinephrine -- serotonin -- endorphins Sense of accomplishment Improved physique

43. Why Does Exercise Work? Exercise and Health Strengthens heart Lowers blood pressure Lowers blood pressure reactivity to stress Moderate exercise adds two years to one’s expected life.

44. BMI Classifications – Slide 30 • 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

47. Reactions to Illness • Seeking treatment • Ignoring physical symptoms • Communication with health care providers • Barriers to effective communication • Following medical advice • Noncompliance

49. 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

50. Relaxation Response – Benson • “The relaxation response is perhaps best understood as a psycho-physiological state of hypoarousal engendered by a multitude of diverse technologies [techniques]” (Everly, 1989, p.149) • 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