Health Psychology

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Health Psychology

• Lecture 3
• Stress and Stress Management

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Lecture 3 - Outline

• Part 1
• What is stress?
• What causes stress?
• How do we measure stress?
• Part 2
• What are the effects of stress on mental/physical
  health?
• Moderating variables
• Stress management
• Part 3
• Anna Nagy (stress researcher)

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Question

• What is stress?

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Question

• What is stress?
• Any circumstances that threaten or are
  perceived to threaten ones well-being and that
  thereby tax ones coping abilities.

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Question

• What is stress?
• Any circumstances that threaten or are
  perceived to threaten ones well-being and that
  thereby tax ones coping abilities (?)
• A state of heightened mental and physical
  arousal in response to a demand (?)
• Perceived inability to adjust to, meet demands
  (?)

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the text book definition

• What is stress?
• The condition in which person-environment
  transactions lead to a perceived discrepancy
  between the physical and psychological demands of
  a situation and the resources of the individuals
  biological, psychological, or social systems
• (Sarafino, p. 71)

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What is Stress?

• Stress as an event Stress as a response
• Controllability Physiological
• Predictability Emotional
• Psychological
• Behavioral

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Physiological features

• Sympathetic Nervous System
• Arouses the body for action in the event of a
  threat
• fight or flight
• ? heart rate, ? blood pressure, ? blood to heart
  and voluntary muscles, dilates airways
• Hormones
• SNS stimulates release of adrenalin and
  noradrenalin
• Similar effects to SNS but more enduring
• Corticosteroids (cortisol) - ? blood glucose, ?
  immune system activity.

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Emotional features

• Fear and anxiety
• Uneasiness and apprehension
• Strain and tension
• E.g., waiting for surgery, exam result
• Depression
• Sad, blue, unhappy (not clinical severe, long
  lasting)
• Anger
• Particularly when the situation is harmful or
  frustrating

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Cognitive features

• Attention and Memory
• Stress occupies attention and other cognitive
  resources
• Impaired encoding and retrieval of information
  (learning)?
• Perception of events
• Performance
• Yerkes-Dodson Law

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Cognitive features

• Attention and Memory
• Stress occupies attention and other cognitive
  resources
• Impaired encoding and retrieval of information
  (learning)?
• Concentration
• Performance
• Yerkes-Dodson Law

Memory for Stressful Events (p. 78) Stress can
enhance our attention toward the
stressor. Experiment participants see pictures
of a boy going to hospital.. Some hear an
emotional story (terrible accident) others hear
neutral (going to watch activities) Before the
story, participants received an injection
(placebo or drug that inhibits adrenalin). One
week later, participants with the placebo (more
aroused) remembered more of the story than
participants who received the drug (less
aroused) No difference for recall of neutral
story Adrenalin enhances the memory of stressors
we experience
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Behavioral features

• Changes in health-related behaviors
• Sleep
• Diet
• Drugs
• Social behavior (can help each other, or ?
  hostile/insensitive)
• ? risk taking
• ? health care (dont notice symptoms)
• Coping
• Any attempt to deal with the stressor or stress
  response
• May be adaptive or maladaptive

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What is Stress?
Stress Reactions
Intervening Factors
Stressor

• Appraisal
• Perceived Control /
• Predictability
• Personality
• Social Support
• Coping Skills

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What is Stress?
Lazarus (1968)
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Stress Appraisal Model
The stress process
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Stress Appraisal Model
Stress and the appraisal process
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What is Stress?

• Stress as a Process
• The process by which we appraise and cope with
  environmental threats and challenges
• Sources of Threat and Challenge
• Frustration (unable to reach a desired goal)
• Conflict (decision making, e.g.,
  approach-avoidance)
• Change (adapting to new circumstances)
• Pressure (expectations to behave in a certain
  way)

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Vicarious Stress?

• Does the threat need to relate to us directly to
  elicit stress?
• Subincision (Lazarus et al., 1964)
• Film of young boys from a primitive culture in
  which the underside of the penis is cut deeply
  from the tip to the scrotum (p. 73)
• Participants viewed the film in one of 4 ways (no
  narrator, narrator emphasizes pain, narrator
  denies pain, narrator describes in detached
  scientific tone)
• Stress trauma narration gt no narration gt denial,
  scientific narration
• Results show that people can experience stress
  vicariously, and that reactions depend on the
  process of primary appraisal.

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Measurement of Stress

• Physiological
• Blood concentration of catecholamines
  (adrenaline, NA) and cortisol
• Blood pressure, pulse rate, breathing rate,
  galvanic skin response.
• Problems
• Taking blood may be a stressor itself
• Reactive to factors other than stress
• Gender, body weight, caffeine, activity level
• Costly

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Measurement of Stress

• Self-report
• Life Event Scales
• List of potentially stressful major events
• Ss indicate which theyve experienced during xx
• Events are weighted to reflect stressfulness
• Daily Hassle Scales
• Considers individual values/meaning of events
• Problems - reliable recall of events

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43 Minor
violations of the law
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How have you been lately?

• For each question, estimate how often it
  occurred during the past month (p. 93)
• 0 never
• 1 rarely
• 2 occasionally
• 3 often
• 4 very often
• 5 extremely often

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How have you been lately?

• For each question, estimate how often it
  occurred during the past month (Sarafino, p. 93)
• 1 somewhat often
• 2 moderately often
• 3 extremely often

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Gender Differences in Response

• Women
• Report greater number of major and minor stresses
• Men
• Greater reactivity when stressed
• Find different things stressful (competence
  challenged)
• Longer to return to baseline

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Stress and Mental Health

• Detrimental effects of too much stress
• Single episode of extreme stress
• Post-traumatic stress disorder (PTSD)
• Re-experience a traumatic event
• Avoid associated stimulus
• Persistent anxiety/arousal
• Chronic/prolonged stress
• Psychological difficulties insomnia, sexual
  difficulties, problems concentrating,
  unhappiness, alcohol and drug use
• Psychological disorders depression, anxiety,
  schizophrenia
• burnout
• response to treatment

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Stress and Physical Health
Selyes 3-Stage General Adaptation Syndrome
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Theory of Stress and Illness

• Selyes General Adaptation Syndrome
• Physiological
• Alarm
• - body mobilized to resist the stressor (fight
  or flight)
• Stage of Resistance
• - body tries to adapt to the stressor (body
  getting tired)
• Stage of Exhaustion
• - weakened immune system, depleted energy
  reserves
• - damage and disease to body (body loses the
  fight against stressor)

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Stress and Physical Health

• What are the effects of stress on physical
  health? (pp. 118-131)
• Acute illnesses
• ? colds, flu
• Psychophysiological disorders
• Physical symptoms from psychosocial processes
  (psychosomatic)
• ? digestive system illnesses (ulcers,
  inflammatory bowel disease), asthma, recurrent
  headache
• Chronic illness
• ? cancer, hypertension, coronary heart disease
  (CHD)
• Death (?) see case study on page 120 of your
  text!

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Stress and Physical Health
Ulcers - A break in the skin or mucosa caused by
the loss of dead tissue. Common belief that
stress is major cause of gastric or peptic
ulcers. However, 90-100 with duodenal ulcers
have a helicobacter pylori infection (i.e.,
bacterial infection) Eradicating helicobacter -
recurrence rate of 4 compared to 80 in those
whose ulcers heal but infection
persists Helicobacter infection alone does not
explain ulcers - also depends on acid secretion
which appears related to stress. Anda et al
(1992) - longitudinal study - those who reported
high levels of stress slightly more likely to
develop ulcers (7) than those with low stress
levels (4) stress may be related to relapse.

• What are the effects of stress on physical
  health? (pp. 118-131)
• Acute illnesses
• ? colds, flu
• Psychophysiological disorders
• Physical symptoms from psychosocial processes
  (psychosomatic)
• ? digestive system illnesses (ulcers,
  inflammatory bowel disease), asthma, recurrent
  headache
• Chronic illness
• ? cancer, hypertension, coronary heart disease
  (CHD)
• Death (?) see case study on page 120 of your
  text!

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Suspected Stress-Related Diseases
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Stress and Physical Health

• How does stress affect physical health?
• Direct Effects
• Stress can cause changes in the bodys
  physiology
• Cardiovascular system (? blood pressure)
• Endocrine system (Catecholamine and
  Corticosteroid release)
• Immune system (immunosupression)
• Indirect Effects
• Stress can affect behavior behavior can affect
  health
• stress related to ? car accidents car accidents
  related to health
• stress related to ? coffee, alcohol, cigarettes
  use related to health

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Immune System

• Antigens (e.g., bacteria, virus, fungi) compete
  with cells for nutrients, destroy cells, disrupt
  metabolic processes
• Immune system defends the body against antigens.
• White blood cells (produced in bone marrow)
• Phagocytes engulf and ingest antigens
• lymphocytes (Killer T) destroy cells already
  invaded by antigens
• Stress lowers the concentration and activity of
  Killer T cells (p. 62)
• More susceptible to disease when under chronic
  stress
• Antigen anything that triggers an immune
  response (e.g., donor organ)

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Moderators of the Stress-Illness Relationship

• What is a moderator?

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Moderators of the Stress-Illness Relationship

• Diathesis-Stress Model
• Diathesis vulnerability (genetic,
  psychological, social)
• Stress traumatic experience (environmental)
• Vulnerability (diathesis) Stressor ? Illness
• (poor social support is an example of a
  diathesis)

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Moderators of the Stress-Illness Relationship

• Nature of the stressor
• Unpredictability, uncontrollablity, severity,
  duration
• Personal characteristics and resources
• Personality (e.g., the hardy personality)
• Coping skills
• External Resources
• Social support

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Moderators of the Stress-Illness Relationship

• Hardy Personality (Kobasa, 1977)
• Control belief in ones ability to influence
  events
• Commitment an approach to life marked by
  curiosity and a sense of meaning
• Challenge a belief that change is normal and
  stimulating
• (also conscientiousness and optimism)

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Moderators of the Stress-Illness Relationship

• Coping Style
• Cognitive and behavioral efforts to manage
  specific demands (see Sarafino, p. 134)
• Problem-focused coping controlling the
  emotional response to the stressor (e.g.,
  drinking alcohol)
• Emotion-focused coping reducing the situations
  demands or gaining new resources (e.g.,
  information seeking, breaking aversive
  relationships)

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Moderators of the Stress-Illness Relationship

• Assessing Coping Style (Sarafino, p. 135)
• Tried to see a positive side
• Tried to step back from the situation and be more
  objective
• Prayed for guidance and strength
• Took it out on other people when I felt angry or
  depressed
• Got busy with other things to keep my mind off
  the problem
• Decided not to worry about it because I decided
  everything would work out fine
• Took things one step at a time
• Read relevant material for solutions and
  considered several alternatives
• Drew on my knowledge because I had a similar
  experience before
• Talked to a friend or relative to get advice on
  handling the problem
• Talked with a professional person (doctor,
  clergy, lawyer, teacher, counselor) about ways
  to improve the situation
• Took some action to improve the situation

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Moderators of the Stress-Illness Relationship

• Social Support
• aid and encouragement people receive from their
  interactions with others (functional social
  support)
• Instrumental support (money, labor, time)
• Informational support (advice, suggestions, info)
• Appraisal support (affirmation, social
  comparison)
• Emotional support (affection, concern, listening)
• Pets (?)
• Social support appears able to reduce the impact
  of a stressor.

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Moderators of the Stress-Illness Relationship

• Social support and dying! (p. 102)

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60-69 yrs
20
50-59 yrs
30-49 yrs
low
medium
high
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Moderators of the Stress-Illness Relationship

• Two ways social support may benefit health

Low support
Low support
High support
Health
Health
High support
low
low
high
high
Stressor intensity
Stressor intensity
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Stress and Illness

• Summary and Conclusions
• The relationship between stress and illness is a
  modest one, but stress can contribute to some
  illnesses
• The effects of stress are dependent on a number
  of other, moderating factors
• The fact that stress only explains a modest
  amount (10) of the variance in health change
  does not mean that it is trivial (health is
  complex, multiple causes)
• evidence is less clear and fully spelled out
  than is generally realized (Lazarus)

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Stress Management

• Medication
• Benzodiazepines (valium), Beta-blockers (Inderal)
• Cognitive restructuring
• Turning a threat into a challenge
• Humor
• Release built-up emotion, reappraise
• Relaxation
• Reduce heightened arousal
• Minimize physiological vulnerability
• i.e., preventative (healthy behavior) .
  Exercise!