Chapter 13

Stress, Coping and Health

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The Relationship Between Stress and Disease

Contagious diseases vs. chronic diseases – Biopsychosocial model– Health psychology

• Health promotion and maintenance– Discovery of causation, prevention, and treatment

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Fig 13.1 – Changing patterns of illness. Trends in the death rates for various diseases during the 20th century reveal that contagious diseases (shown in blue) have declined as a threat to health. However, the death rates for stress-related chronic diseases (shown in red) have remained quite high. The pie chart (inset) shows the results of these trends: three chronic diseases (heart disease, cancer, and stroke) account for 61.9% of all deaths.

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Stress: An Everyday Event

Major stressors vs. routine hassles– Cumulative nature of stress– Cognitive appraisals

Major types of stress– Frustration – blocked goal– Conflict – two or more incompatible motivations

• Approach-approach, approach-avoidance, avoidance-avoidance– Change – having to adapt

• Holmes and Rahe – Social Readjustment Rating Scale – Life Change Units

– Pressure – expectations to behave in certain ways• Perform/conform

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Fig 13.2 – Types of conflict. Psychologists have identified three basic types of conflict. In approach-approach and avoidance-avoidance conflicts, a person is torn between two goals. In an approach-avoidance conflict, there is only one goal under consideration, but it has both positive and negative aspects.

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Responding to Stress Emotionally

Emotional Responses– Annoyance, anger, rage– Apprehension, anxiety, fear– Dejection, sadness, grief– Positive emotions

Emotional response and performance– The inverted-U-hypothesis

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Fig 13.4 – Overview of the stress process. A potentially stressful event, such as a major exam, elicits a subjective appraisal of how threatening the event is. If the event is viewed with alarm, the stress may trigger emotional, psychological, and behavioral reactions, as people’s response to stress is multidimensional.

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Fig 13.5 – Arousal and performance. Graphs of the relationship between emotional arousal and task performance tend to resemble an inverted U, as increased arousal is associated with improved performance up to a point, after which higher arousal leads to poorer performance. The optimal level of arousal for a task depends on the complexity of the task. On complex tasks, a relatively low level of arousal tends to be optimal. On simple tasks, however, performance may peak at a much higher level of arousal.

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Responding to Stress Physiologically

Physiological Responses– Fight-or-flight response– Selye’s General Adaptation Syndrome

• Alarm

• Resistance

• Exhaustion

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Responding to Stress Behaviorally

Behavioral Responses– Frustration-aggression hypothesis– catharsis– defense mechanisms

Coping

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Effects of Stress: Behavioral and Psychological

Impaired Task performanceBurnoutPosttraumatic Stress Disorders (PTSD)Psychological problems and disordersPositive effects

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Fig 13.8 – The prevalence of traumatic events. People tend to think that traumatic events are relatively unusual and infrequent, but research by Stein et al. (1997) suggests otherwise. They interviewed over 1000 people in Winnipeg, and found that 74.2% of the women and 81.3% of the men reported experiencing at least one highly traumatic event. The percentage of respondents reporting specific types of traumatic events are summarized in this graph.

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Effects of Stress: Physical

Psychosomatic diseasesHeart disease

– Type A behavior - 3 elements• strong competitiveness• impatience and time urgency• anger and hostility

– Emotional reactions and depressionStress and immune functioning

– Reduced immune activity

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Fig 13.10 – Anger and coronary risk. Working with a large sample of healthy men and women who were followed for a median of 4-5 years, Williams et al (2000) found an association between anger and the likelihood of a coronary event. Among subjects who manifested normal blood pressure at the beginning of the study, a moderate anger level was associated with a 36% increase in coronary attacks and a high level of anger nearly tripled participant’s risk for coronary disease. (Based on data in Williams et al., 2000)

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Fig 13.12 – The stress-illness correlation. One or more aspects of personality, physiology, or memory could play the role of a postulated third variable in the relationship between high stress and high incidence of illness. For example, neuroticism may lead some subjects to view more events as stressful and to remember more illness, thus inflating the apparent correlation between stress and illness.

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Factors Moderating the Impact of Stress

Social support– Increased immune functioning

Optimism– More adaptive coping– Pessimistic explanatory style

Conscientiousness– Fostering better health habits

Autonomic reactivity– Cardiovascular reactivity to stress

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Health-Impairing Behaviors

SmokingPoor nutritionLack of exerciseAlcohol and drug useRisky sexual behaviorTransmission, misconceptions, and prevention of AIDS

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Fig 13.13 – The prevalence of smoking in the United States. This graph shows how the percentage of U.S. adults who smoke has declined steadily since the mid-1960’s. Although considerable progress has been made, smoking still accounts for about 400,000 premature deaths each year. (Based on data from the Centers for Disease Control and Prevention)

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Fig 13.14 – Quitting smoking and cancer risk. Research suggests that various types of health risks associated with smoking decline gradually after people give up tobacco. The data shown here, from the U.S. Surgeon General’s (1990) report on smoking, illustrate the overall effects on mortality rates. (Source: U.S. Department of Health Services, 1990)

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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

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Fig 13.17 – Biopsychological factors in health. Physical health can be influenced by a remarkably diverse set of variables, including biological, psychological, and social factors. The host of factors that affect health provide an excellent example of multifactorial causation.