Stress and Health: Understanding the Relationship and Coping Strategies

1. Chapter 13 Stress, Coping and Health

2. 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 • Failures to account for many psychological factors and health • 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. 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. Changing patterns of illness

5. 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 • Change – having to adapt • Holmes and Rahe – Social Readjustment Rating Scale – Life Change Units – • Pressure – expectations to behave in certain ways • Perform/conform • Figure – pressure and psychological symptoms – Weiten (1988) • Overview of Stress Process –

6. Psychological Stress Richard Lazarus (1966) defined psychological stress as “…a generic term for the whole area of problems that includes the stimuli producing stress reactions, the reactions themselves, and the various intervening processes.” Lazarus and Folkman (1984) define psychological stress as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being.”

7. Appraisal Process • The primary appraisal process determines whether the environment is perceived as psychologically threatening, harmful, or challenging to the person. • The secondary appraisal process is a complex evaluative process in which a person considers resources available to cope with the primarily appraised stressor.

9. Pressure and psychological symptoms (Weiten, 1988, 1998)

11. Responding to Stress Emotionally • Emotional Responses • Annoyance, anger, rage • Apprehension, anxiety, fear • Dejection, sadness, grief • Positive emotions • Slide 12, after 9/11 – correlations between emotion and resilience • Emotional response and performance • The inverted-U-hypothesis – Figure – performance and task complexity

12. Table 13-2, p. 518

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

15. Physiological Stress Hans Selye first introduced the term stress to medicine in 1936. He noted that animals were induced by a variety of stimuli to show the “syndrome of just being sick” which resulted in adrenal enlargement, gastrointestinal ulcers, shrinkage of the thymus and lymph nodes. This reaction was termed the “general adaptation syndrome” and “stress is the nonspecific response of the body to any demand made upon it”.

16. 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.”

17. Responding to Stress Behaviorally • Behavioral Responses: Coping – emotion focused • Frustration-aggression hypothesis • catharsis • Defensive Coping – ego defense mechanisms –Freud – • Constructive Coping – problem focused

18. Table 13-3, p. 523

19. 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 “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

20. 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 – more in Chapter 14 • Positive effects – eustress – Positive Psychology – Flow (Csikszentmihalyi)

21. The antecedents, components, and consequences of burnout

23. Effects of Stress: Physical • Psychosomatic diseases • Heart disease • Cholesterol and inflammation (C-reactive protein) and risks –Type A behavior - 3 elements • strong competitiveness • impatience and time urgency • anger and hostility (most related to cornary events) • Emotional reactions and depression –study by Pennix et al. (2001) – anger and coronary risk • Stress and immune functioning • Reduced immune activity • Possible health problems linked to stress • Stress-illness correlation

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

26. Table 13.3b Health Problems that may be Linked to Stress

28. 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

29. 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 -

30. The prevalence of smoking in the United States

31. Quitting smoking and cancer risk

32. The link between cholesterol and coronary risk Fig. 13-14, p. 535

33. 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

34. 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

35. 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

36. Biopsychosocial factors in health

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

38. Albert Ellis’sA-B-C model of emotional reactions

39. Possible examination for the link between humor and wellness Fig. 13-18, p. 543

40. 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

41. 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) • 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

42. Stress Inoculation Trainingdeveloped 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