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Chapter 13

Chapter 13. Stress, Coping and Health – 8 th Edition. 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

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Chapter 13

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  1. Chapter 13 Stress, Coping and Health – 8th Edition

  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. – F 13.1

  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. Figure 13.1 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 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

  6. Psychological Stress Richard Lazarus (1966) (p. 512) 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.

  8. Figure 13-3 – Pressure and psychological symptoms (Weiten, 1988, 1998)

  9. 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 13.5 – performance and task complexity

  10. XXXXXXXX Slide 12 Table 13-2, p. 518

  11. 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)

  12. 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”.

  13. 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.”

  14. 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

  15. Table 13.2 XXXXXX Table 13-3, p. 523

  16. 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)

  17. 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)

  18. Figure 13.7 – The antecedents, components, and consequences of burnout

  19. XXXXXX Slide 22

  20. 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

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

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

  23. XXX 13.12

  24. 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

  25. Health-Impairing Behaviors • Smoking – prevalence in U.S. - Figure 13.13 • Smoking cessation – Figure 13.14 • Poor nutrition – obesity – “Super Size” generation • Cholesterol and coronary risk – Figure 13.15 • High fructose corn syrup effects • Lack of exercise – increased T.V. watching effects study • Obesity – BMI – United States 2005 & 2008 data – CDC – Slide 33 & 34 – changes over the years • Alcohol and drug use • Risky sexual behavior • Transmission, misconceptions, and prevention of AIDS – AIDS Risk Knowledge Test - Figure 13.16

  26. Figure 13.13 The prevalence of smoking in the United States

  27. Figure 13.14 Quitting smoking and cancer risk

  28. Figure 13.15 – The link between cholesterol and coronary risk Fig. 13-14, p. 535

  29. 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

  30. BMI Classifications – Slide 31 • 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

  31. 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 – Figure 13.17

  32. Figure 13.17 – Biopsychosocial factors in health

  33. Stress Management • Relationship to coping to self-esteem • Cognitive reappraisal – Ellis’s model – Figure 13.18 • Humor – Figure 13.19 • Relaxation Response – Benson – Figure 13.20 and Slide 41 • Stress Inoculation Training – Slide 42 • Physical fitness and mortality – Figure 13.21

  34. Figure 13.18 – Albert Ellis’sA-B-C model of emotional reactions

  35. Figure 13.19 – Possible examination for the link between humor and wellness Fig. 13-18, p. 543

  36. 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

  37. Relaxation Response – Benson – Slide 41 • “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

  38. Stress Inoculation Trainingdeveloped by Donald Meichenbaum – Slide 42 • 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

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