Health and Well-being

1. Health and Well-being Stress Coping

2. Health Psychology • Health psychology is the examination and application of psychological factors to • Treatment of physical illness • Prevention of physical illness • Promotion of physical health • There are three classes of illness in which physical symptoms are partially or totally caused by psychological factors. • Somatoform disorders • Psychosomatic illnesses • Heart disease, cancer, and other minor illnesses

3. Brief list of disorders targeted by health psychology • Typically, somatoform disorders fall outside the interests of health psychologists. • Conversion disorders have an exclusively psychogenic origin • Psychosomatic illnesses have both an organic and a psychological basis • Traditionally, these are asthma, ulcers, headaches, and constipation • Perhaps, chronic fatigue syndrome and Gulf War syndrome are more recent examples of psychosomatic illnesses • Recently, it’s increasingly clear that many other illnesses, once thought to be caused exclusively by biological factors, are also affected by psychological factors • Minor illnesses, such as colds • Heart disease • Cancer

4. Causes of Death, 1900-1995 • Since 1900, heart disease, cancer, and stroke have replaced infectious diseases as the major causes of death • Behavioral and psychological factors contribute to both of these leading causes of death

5. Behavior affects health • We greatly fear causes of death that capture our imagination (e.g., plane crash) • However, statistically the most common cause of death is heart disease • Obesity, lack of exercise, smoking, and high fat diets all contribute to heart disease • All of these contributing factors are under our behavioral control

6. Placebos Can Be Powerful Medicine • The placebo effect • Believing that you will get better can lead to improved health even if the treatment is inert • Functional MRI results indicate that when patients have a positive expectation about a placebo, the neural processes involved are the same ones that are activated in response to a biologically active treatment

7. Stress • Experiencing of external or internal events that • challenge a person’s capacity to adapt to the point that • these challenges are viewed as a threat to one’s physical or psychological well-being and • such threat elicits acute and/or chronic physiological and emotional responses that may, in turn, elicit • cognitive and behavioral coping responses that may or may not be adequate for coping with the event. • “Fight or flight” is the traditional view of how people respond physiologically to threat (see slide 12)

8. Sources of stress I • Daily hassles (microstressors) • Children • Having to clean your room • Getting punished • College students • Conflicts w/ boyfriend or girlfriend • Having your trust betrayed by a friend • Adults • Concerns about weight • Social obligations

9. Sources of Stress II • Catastrophes • Traumatic events – either manmade or natural – that affect many people • Suicide rate increases by 63% in the year after an earthquake • Post-traumatic Stress Disorder (PTSD) • Any trauma (including rape and torture) can precipitate it’s symptoms, which include flashbacks, recurrent and intrusive thoughts of the traumatic event, nightmares, hypervigilance, increased arousal and irritability, autonomic activation when exposed to stimuli associated with the traumatic event, retreat from normal activities and emotions, and self-medication with drugs and/or alcohol. • Life events: major stressors (see next slide)

10. Life Events Rating Scale: Top 10 stressors

11. The HPA system • In response to stress, the hypothalamus (H) – pituitary gland (P) – adrenal gland (A) system is engaged • H releases a hormone that causes P to release a hormone that causes A to release the so-called “stress hormones” into the blood stream • There are two classes of stress hormones • Catecholamines: adrenalin and noradrenaline • Glucocorticoids: The most important of these is cortisol • In turn, • Adrenalin and noradrenalin support many of the other “fight or flight” responses in the sympathetic nervous system • Cortisol converts protein to glucose for more energy and deals with inflammation • See slides 14-17 for some negative consequences of the release of stress hormones

12. The Autonomic Nervous System “Fight or Flight” Restore Calm

13. Sex Differences in Our Physiological Responseto Stressors • Shelley Taylor’s “tend-and-befriend” model questions the cross-sex generality of the “fight-or-flight”model • Instead females respond to stress by protecting/caring for their young and by forming alliances with other groups to reduce individual risk • Some evidence for this idea is that the hormone oxytocin is released in women in response to stress • Oxytocin plays an important role in maternal behavior, as well as in feelings of relaxation and love • In men, testosterone is released in response to stress • In women, the release of oxytocin may promote nurturing behaviors during stressful periods

14. General Adaptation Syndrome Generally, there are three phases in the body’s physiological response to stress: alarm, resistance, and exhaustion

15. Stress and Health I • Short-term stress boosts the immune system, but chronic, long-term stress compromises the immune system • This is another direct way in which stress affects health • The immune system is made up of three types of specialized white blood cells known as lymphocytes • Lymphocytes destroy invaders, like bacteria or viruses, or mark them for destruction • Both catecholamines (adrenaline, noradrenaline) and glucocorticoids (cortisol) suppress lymphocyte production • Psychoneuroimmunology (PNI) • A new subfield of psychology that examines the interactions among psychological factors, the nervous system, and the immune system.

16. Stress and Health I continued • And a weakened immune system can lead to • Greater vulnerability to bacterial and viral infections (see next slide) • Greater vulnerability to cancer, although this is a bit controversial • Some positive evidence • Growth of tumors in rats leading to death were 23% more likely after inescapable shock • 1,958 men who were low in self-esteem, unhappy, and depressed were more likely to have died of cancer than their coworkers • Interesting fact • Half of all men and 1/3 of all women will have cancer sometime in their lifetime, according to the American Cancer Society

17. Stress and Illness: Cohen et al. (1991)

18. Stress and Health II • Stress affects your health, both indirectly and directly • Stress instigates pathogenic coping behaviors (the indirect route) • Drinking, smoking, less sleep, and high risk behaviors • Coronary Heart Disease (CHD) can lead to heart attacks • CHD is the narrowing of arteries leading to the heart • This narrowing is caused by the deposit of fat (known as plaque) in the arteries • When the narrowing is sufficient to make it difficult for the heart to pump blood, this leads to hypertension (high blood pressure) • When a piece of plaque breaks off and blocks an artery near the heart, this causes a heart attack • When a piece of plaque blocks an artery near the brain, this causes a stroke • Stress, along with cigarette smoking, high cholesterol, and overeating, are all risk factors in CHD • Stress causes the release of stress hormones (see slide 9), which in turn increase the buildup of plaque in the arteries and thereby increase the risk of heart attack (one direct route)

19. Stress and Health III • Of those with CHD, 69% are Type A personalities, whereas only 31% are Type B personalities • Type A: impatient, hard-driving, ambitious, competitive, and quick-to-anger • Especially, at risk is a Type A person that is prone to hostility (chronically angry, cynical, and mistrustful of others) • Type B: more relaxed, easy-going, and less prone to anger

20. Lazarus’s Transaction Theory • Stress is jointly determined by • An environmental event • The individual’s perception of that event • The individual’s resources for coping with that event • An event that is a challenge for one person may be stressful for another person

21. Coping with Stress • Although stressful events have effects on the body, the way we cope with stress can promote health or invite illness.

22. Coping Strategies I • Emotion-focused strategies • Trying to change one’s perception of a stressor in order to prevent having feelings about it, rather than tackling the stressor itself • Typically, these strategies are effective only in the short run • Rationalization, denial, distancing, and suppression are all emotion-focused strategies • Often used when a stressor is viewed as overwhelming or uncontrollable • Problem-focused strategies • Tackling the stressor itself by removing it, seeking advice or assistance in dealing with it, or avoiding it by planning ahead • The last of these is similar to one of the strategies for dealing with negative emotions

23. Coping Strategies II • Other strategies • Many of these strategies can also be found in the section on regulation of negative emotions • Positive reappraisal (finding the “silver lining”) • This is much like the reframing strategy for dealing with negative emotions • Often involves making downward comparisons • That is, comparing oneself to someone that is worse off • Creation of positive events • Infusing ordinary events with positive meaning, like taking note of a beautiful sunset • Finding humor in the situation • Again, this was also applicable to dealing with negative emotions • Focused self-distraction • It’s better to think about something else than it is to try to suppress one’s feelings • See regulation of negative emotions for a similar claim

24. Coping Strategies III • Hardiness - Resilience Under Stress (p. 443) • Commitment • Sense of purpose in work, family, and life • Challenge • Openness to new experiences and change • Control • Belief that one has the power to influence important future outcomes

25. Smoking Is a Leading Cause of Death • Starting smoking: • Social influences are the most powerful explanation for why people begin to smoke • The false consensus effect • Smoking conveys a certain image of being “cool” or “tough” • Once smoking has begun, the addictive properties of tobacco maintain the behavior • Some individuals may be genetically susceptible to the addictive effects of nicotine

26. Fitness, Stress, and Health • Life stress was linked with increased visits to the health center for low-fitness students • High-fitness students handled the stress with less illness • Regardless of age, exercise • Reduces depression • Enhances memory and cognition • Promotes neurogenesis

27. Being Positive Has Health Benefits • Happiness has three components • Positive emotion and pleasure • Engagement in life • Having a meaningful life • In a study of 1000 medical patients • Higher hope was associated with lower risk for disease • Higher levels of curiosity were associated with lower levels of hypertension and diabetes • In several studies • More optimistic individuals have been found to have enhanced immune systems, lower levels of common diseases such as colds, and greater longevity

28. Lack of Optimism and Risk of Death • In Finland, middle-age men were rated for hopelessness • Six years later, higher ratings had predicted risk of cancer, heart attack, and death

29. The Self-Esteem Cycle High Self-Esteem Self-Credit Positive Expectations High Effort Success Low self-esteem and negative self-evaluations are related to pessimistic explanatory styles, which in turn are related to negative consequences for the immune system.

30. Social Support I • Workers with little control over their jobs were over 1.5 times more likely to die of heart disease than comparable subjects with more control over their jobs • However, those who had little control AND low social support were 2.5 times more likely to die of heart disease (Johnson et al., 1996)

31. Social Support II • Emotional disclosure has positive health effects • Pennebaker & Beall, 1986 • Marriage can be good for your health: • Single women have a 50% greater mortality than married women and single men have a 250% greater mortality than married men • But troubled relationships are associated with increased stress, decreased immune system functioning, and negative health outcomes

32. Trust • An important component of building social relationships is trust • When one person – whether male or female – trusts another, oxytocin is released, suggesting that people who release more of this chemical may be more trusting • However, when men and women are in situations where they do not trust another person, men – but not women –release relatively large amounts of the chemical testosterone • Correlational studies are already suggesting that trust is found to be associated with positive health outcomes

33. Spirituality Contributes to Well-Being • Numerous studies have found that religious individuals, regardless of their particular faith, report greater well-being than those who are not religious • This effect appears to be due to spirituality’s effect as a buffer against stressful events • Faith may provide a sense of meaning in one’s life, a supportive community, and restrictions on unhealthy lifestyle factors such as drinking alcohol

34. Relaxation and the Heart • Heart attack patients were taught how to relax • A control group received standard medical care • After 3 years, relaxation-trained patients suffered 50% fewer second heart attacks