Class 13 Hostile Personality Adjustment to Threatening Events

1. Class 13 Hostile Personality Adjustment to Threatening Events Announcements: Midterm Review: Thursday Midterm: Tuesday, March 11

2. Hostile Personality

3. Hostility as a Health Threat Selye: A person confronted with major stressor goes into one of two modes: Fight Flight OR Anxious, pessimistic, low efficacy will tend to which response? Flight Imagine someone in chronic “fight” mode, always ready for attack or defense How would he/she perceive situations? Interpret other people? More threatening, as self-serving, un-trustworthy, dog-eat-dog world How would this person behave toward others? Socially abrasive, smaller social network, avoid others when in need

4. Hostility Defined Hostility is considered to be an attitudinal set—perhaps a personality trait—which stems from an absence of trust in the basic goodness of others and centers around the belief that others are generally mean, selfish, and undependable. Williams, Barefoot, & Shekelle, 1985

5. Case Study of Hostile Personality http://www.youtube.com/watch?v=78b67l_yxUc

6. Hostility Scale (Cook and Medley, 1954)

7. Qualities of Type A Personality 1. Hostile 2. Competitive 3. Work-a-holic 4. time-pressed X Which component the most important?

8. Health Correlates of Hostility Blockage of blood vessels Coronary Heart Disease (CHD) (1.5 time greater odds) 20-year increased risk of death due to: * CHD * Malignant Neoplasms (cancer) * All causes of death combined

9. Is Relation Between Hostility and Heart Disease Linear or Catastrophic? Linear Catastrophic

10. Hostility and Coronary Heart Disease Among MDs Barefoot, et al., 1983

11. MD Survival Rates Over 25 Years: Low Hostile vs. High Hostile

12. How Is the Hostile Personality Formed Ken Dodge Research on Hostile Children Parental disciplinary style: 1. Punishment is severe, often disproportionate to offense 2. Punishment is not accompanied by explanation Sibling bullying: Learn to read hostile signals quickly, and respond quickly. Hostile attributional style: 1. Regard ambiguous negative events as intentionally hostile 2. Believe it is essential to retaliate quickly

13. Pathway From Hostility to Heart Disease Appraisal of threat higher  defensive mode (fight)  more cardiac output  ↑ cortisol  atherosclerosis What seems to be common physio culprit in link between stress, depression, hostility and health risks? Cortisol

14. Adjusting to Threatening Events

15. Misfortune: Bad and Badder WHO IS MORE DISTURBED: ___A. Person poisoned by meds that oddly conflict with her chemistry ___B. Person poisoned by meds her MD is using to test his new theory. X ___A. Train passenger injured b/c of failed train brakes ___B. Train passenger injured, but cause of crash never determined X ___A. Person who’s child gets cancer due to second-hand smoke in home ___B. Person who’s child gets cancer due to heredity X

16. Fundamental Beliefs 1. World is just. 2. World is sane, well ordered, non-random 3. The self is good Traumas: Events that seriously violate one or more of these beliefs.

17. Fundamental Beliefs and Misfortune Which belief has been violated: The Self is Good, The World is Well Ordered, The World is Just ___A. Person poisoned by meds that oddly conflict with her chemistry ___B. Person poisoned by meds her MD is using to test his theory. X The world is just ___A. Train passenger injured b/c of failed brakes ___B. Train passenger injured, but cause of crash never determined X The world is orderly, not random ___A. Person who’s child gets cancer due to second-hand smoke in home ___B. Person who’s child gets cancer due to heredity X The self is good

18. Strategies for Overcoming Threatening Events 1. Achieve a sense of meaning out of the event. 2. Regain mastery over the event, or over life in general 3. Enhance self-esteem

19. How People Restore Sense of Meaning Following Trauma 1. Seek out causes of event. 2. Re-adjust way of seeing life, and themselves. Victor Frankl

20. Taylor Article: Adjusting to Threatening Events Meaning is key to coping. But what about bad situations where there is no clear cause? Subjects in Taylor article are: _______________________ women with breast cancer No Is cause of breast cancer (on individual level) known? ____ Do women with breast cancer typically accept that there is no single, diagnosable cause? ____ Why is this? No

21. Self-Identified Causes of Breast Cancer Taylor, et al., 1983 a. Stress, esp. relationship 41% b. Carcinogen 32% c. Hereditary 26% d. Diet 17% e. Freak event 10% Note: Some women listed multiple causes, thus total more than 100%

22. Adopting New Meanings About Life a.New attitude toward life I feel as if I were for the first time really conscious. I have much more enjoyment each day, each moment. All those things you get entangled with don’t seem to be part of my life right now. b. Self knowledge It’s a bit like holding up a mirror to one’s face when one can’t turn around.

23. Patients’ Responses to Their Cancer Change diet Quit meds. maybe associated with cancer Educate self on cancer Control side effects: * Imaging: Chemo as cannons * Instruction to body: "Cut this shit out“ Not clear any of these responses actually cure cancer—why do them?

24. Bad Events Threaten Self Esteem When people suffer bad events, they feel bad about selves, even if they are not responsible. Why? Just world beliefs: Good things happen to good people, bad things happen to bad people. Therefore... People very good at finding way to restore sense of self worth. Cancer patients do so even after disfiguring surgery, painful treatment, constant threat of cancer recurrence. How do they do it?

25. Downward Social Comparison Among Breast Cancer Patients Woman who underwent lumpectomy I had a comparatively small amount of surgery. How awful it must be for women who have had a mastectomy. I just can’t imagine, it would seem so difficult. Woman who had a mastectomy It was not tragic. It worked out okay. Now if the thing had spread all over, I would have had a whole different story for you. An older woman The people I really feel sorry for are these younger gals. To lose a breast when you’re so young must be awful. I’m 73; what do I need a breast for? A young woman (apparently having lost a breast) If I hadn’t been married, I think this thing would have really gotten to me. I can’t imagine dating or whatever knowing you have this thing and not knowing how to tell the man about it.

26. Nature and Benefits of Illusions Methods 1. Downward social comparison 2. Unsupported causal explanations * Cancer due to diet * “Cells have re-aligned. Now I'm safe.” * Can stop cancer via imaging, positive thinking 3. Denial Benefits? 1. Enhance control 2. Enhance self-worth 3. Enhance persistence 4. Encourage coping behaviors

27. "Undoing": The Toxic Aspect of Illusions of Control Two Olympic sprinters lose in finals; one comes in second to last, the other second to first. Who has done better? Who feels worse? Why? Undoing: AKA "counterfactuals"--the mental process of thinking how negative outcomes could have been prevented. Parents of Sudden Infant Death Syndrome (SIDS) infants (Davis, Silver, et al., PSPB, 1995). Undoing related to: SCL, Guilt, Anger, Depression, Anxiety 18 mos later "I thought about maybe if I'd stayed awake, or woke up more frequently [to] check on the baby. I keep thinking of different ways..."

28. Coping = Illusions? Is coping all about self-serving "spin"? Is avoiding reality the best way to cope with uncontrollable negative events?

29. Kriegel: "Falling into Life"

30. Kriegel: "Falling into Life" Every time I was removed from the hot water and placed on a stretcher by the side of the pool, ... , I was fed salt tablets. Even today, more than four decades later, I shiver at the mere thought of those salt tablets. ...To be an eater of salt was far more humiliating than to endure pain. ...we dreaded eating salt. It was that, rather than the pain we endured, that anchored our sense of loss and dread. What aspect of trauma does this passage reflect? MEANING

31. Kriegel: "Falling into Life" I suppose we have been told that our fall from grace was permanent. But I am still grateful that no one—told me that my chances of regaining the use of my legs were nonexistent. At the age of 11 I needed to weather reality, not face it. What aspect of trauma does this passage reflect? DENIAL

32. Kriegel: "Falling into Life" 1. I hungered for the approval of those in authority. 2. I wanted to do whatever was supposed to be "good" for me. I believed absolutely as I have ever believed in anything that rehabilitation would finally placate the hunger of the virus. 1. Self-Esteem 2. Just World What aspects of trauma do these passage reflect?

33. Kriegel: "Falling into Life" As my "normal" past grew more and more distant, I reached out for it more and more desperately. Why? And then, terror simply evaporated. It was as if I had served enough time in that prison. "That's it" my therapist triumphantly shouted. "You let go! and there it is!" Yes, and you discover not terror but the only self you are going to be allowed to claim anyhow. You fall free, and then you learn that those padded mats hold not courage but the unclaimed self. What has happened here? What’s changed? What is the “prison”? What is the “unclaimed self”?

34. Kriegel: "Falling into Life" To create an independent self, a man had to rid himself of both the myths that nurtured him and the myths that held him back. ... I understood that the most dangerous threat to the sense of self I needed was an inflated belief in my own capacity. What does Kriegel mean by “myths”? What was the “sense of self [he] needed”? Why was inflated belief “the most dangerous threat” to that sense of self?