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Chapter 14Stress, Coping and Health
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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. – F 13.1
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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 nocure
Table of ContentsFigure 13.1 Changing patterns of illness
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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 Figure 13.3 – pressure and psychological symptoms – Weiten
(1988) Overview of Stress Process – Figure 13.4
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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.
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Table of ContentsFigure 13-3 – Pressure and psychological symptoms (Weiten, 1988, 1998)
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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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Table 13-2, p. 518
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Slide 12
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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)
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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”.
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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.”
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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
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Table 13-3, p. 523
Table 13.2
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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)
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Effects of Stress: Behavioral and Psychological
Impaired Task performance Burnout – antecedent-components-
consequences – Figure 13.7 Posttraumatic Stress Disorders (PTSD) – effects
on hippocampus (cortisol) – prevelance of traumatic events – Slide 22
Reaction to traumatic stress – Figure 13.8 Psychological problems and disorders – more
in Chapter 14 Positive effects – eustress – Positive
Psychology – Flow (Csikszentmihalyi)
Table of ContentsFigure 13.7 – The antecedents, components,and consequences of burnout
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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 (note in F 13.10 most related
to cornary events) Emotional reactions and depression – Figure 13.11 –
study by Pennix et al. (2001) – anger and coronary risk
Stress and immune functioning Reduced immune activity Possible health problems linked to stress – Table 13.3 Stress-illness correlation – Figure 13.12
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Table of ContentsTable 13.3a Health Problems that may be Linked to Stress
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Table 13.3b Health Problems that may be Linked to Stress
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XXX 13.12
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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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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
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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
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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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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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Figure 13.17 –Biopsychosocial factors in health
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Stress Management Relationship to coping to self-esteem Cognitive reappraisal – Ellis’s model Humor Relaxation Response – Benson Stress Inoculation Training Physical fitness and mortality
Table of ContentsFigure 13.18 – Albert Ellis’s A-B-C model of emotional reactions
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Fig. 13-18, p. 543
Figure 13.19 – Possible examination for the link between humor and wellness
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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
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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
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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