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Chapter 15

Health, Stress, and Coping

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Health Psychology and Behavioral Risk Factors

Health Psychology: Uses behavioral principles to prevent illness and promote healthBehavioral Medicine: Applies psychology to manage medical problems e.g., asthma and diabetesLifestyle Diseases: Diseases related to health-damaging personal habits

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Health Psychology and Behavioral Risk Factors (cont.)

Behavioral Risk Factors: Behaviors that increase the chances of disease, injury, or premature death

Disease-Prone Personality: Personality type associated with poor health; person tends to be chronically depressed, anxious, hostile, and frequently ill

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Ways to Promote Health and Early Prevention

Refusal Skills Training: Program that teaches young people how to resist pressures to begin smokingLife Skills Training: Teaches stress reduction, self-protection, decision making, self-control, and social skillsRole Model: Person who serves as a positive example of good and desirable behaviorWellness: Positive state of good health and well-being

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Fig. 15.1 The nine leading causes of death in the United States are shown in this graph. As you can see, eight of the top nine causes are directly related to behavioral risk factors (infection is the exception). At least 45 percent of all deaths can be traced to unhealthful behavior. Although suicide is not shown here, it is the seventh most common cause of death. On this graph, suicides are included in the categories: death by toxic agents, firearms, motor vehicles, and drugs. (Data from McGinnis & Foege, 1993.)

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Table 15.2 – Major health-promoting behaviors

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Stress

Mental and physical condition that occurs when a person must adjust or adapt to the environment Includes marital and financial problems

Stress Reaction: Physical reaction to stress Autonomic Nervous System is aroused

Stressor: Condition or event that challenges or threatens the personPressure: When a person must meet urgent external demands or expectations

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Fig. 15.2. Stress is the product of an interchange between a person and the environment.

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CNN - Shrinking Brains

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Burnout

Burnout: Job-related condition (usually in helping professions) of physical, mental, and emotional exhaustionEmotional Exhaustion: Feel “used up” and

apathetic toward workCynicism: Detachment from the jobFeeling of reduced personal

accomplishment

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Appraising Stressors

Threat: Event or situation perceived as potentially harmful

Primary Appraisal: Deciding if a situation is relevant or irrelevant, positive or threatening

Secondary Appraisal: Assess resources and decide how to cope with a threat or challenge

Perceived lack of control is just as threatening as an actual lack of control

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Threats and FrustrationProblem-Focused Coping: Managing or altering the distressing situationEmotion-Focused Coping: Trying to control one’s emotional reactions to the situationFrustration: Negative emotional state that occurs when one is prevented from reaching desired goals External Frustration: Based on external conditions

that impede progress toward a goal Personal Frustration: Caused by personal

characteristics that impede progress toward a goal

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Reactions to Frustration

Aggression: Any response made with the intention of harming a person, animal, or object

Displaced Aggression: Redirecting aggression to a target other than the source of one’s frustration

Scapegoating: Blaming a person or group for conditions they did not create; the scapegoat is a habitual target of displaced aggression

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Reactions to Frustration (cont.)

Escape: May mean actually leaving a source of frustration (dropping out of school) or psychologically escaping (apathy)

Conflict: Stressful condition that occurs when a person must choose between contradictory needs, desires, motives, or demands

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Fig. 15.3 Frustration and common reactions to it.

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Conflicts

Approach-Approach Conflicts: Having to choose between two desirable or positive alternatives (e.g., choosing between a new BMW or Mercedes)Avoidance-Avoidance Conflicts: Being forced to choose between two negative or undesirable alternatives (e.g., choosing between going to the doctor or contracting cancer) NOT choosing may be impossible or undesirable

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Fig. 15.4 Three basic forms of conflict. For this woman, choosing between pie and ice cream is a minor approach-approach conflict; deciding whether to take a job that will require weekend work is an approach-avoidance conflict; and choosing between paying higher rent and moving is an avoidance-avoidance conflict.

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Fig. 15.5 Conflict diagrams. As shown by the colored areas in the graphs, desires to approach and to avoid increase near a goal. The effects of these tendencies are depicted below each graph. The “behavior” of the ball in each example illustrates the nature of the conflict above it. An approach conflict (left) is easily decided. Moving toward one goal will increase its attraction (graph) and will lead to a rapid resolution. (If the ball moves in either direction, it will go all the way to one of the goals.) In an avoidance conflict (center), tendencies to avoid are deadlocked, resulting in inaction. In an approach-avoidance conflict (right), approach proceeds to the point where desires to approach and avoid cancel each other. Again, these tendencies are depicted (below) by the action of the ball. (Graphs after Miller, 1944.)

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Conflicts (cont.)

Approach-Avoidance Conflicts: Being attracted (drawn to) and repelled by the same goal or activity; attraction keeps person in the situation, but negative aspects can cause distress

Ambivalence: Mixed positive and negative feelings; central characteristic of approach-avoidance conflicts

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Multiple Conflicts

Double Approach-Avoidance Conflicts: Each alternative has both positive and negative qualitiesVacillation: When one is attracted to both choices; seeing the positives and negatives of both choices and going “back and forth” before deciding, if deciding at all!Multiple Approach-Avoidance Conflicts: When several alternatives have positive and negative features

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Anxiety

Feelings of tension, uneasiness, apprehension, worry, and vulnerability We are motivated to avoid experiencing

anxiety

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Freudian Defense Mechanisms; Psychological Defenders of You!

Defense Mechanisms: Habitual and unconscious (in most cases) mental processes designed to reduce anxiety Work by avoiding, denying, or distorting sources of threat or

anxiety If used short term, can help us get through everyday

situations If used long term, we may end up not living in reality Most operate unconsciously Protect idealized self-image so we can live with ourselves

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Freudian Defense Mechanisms: Some Examples

Denial: Most primitive; refusing to accept or believe reality; usually occurs with death and illness

Repression: When painful memories, anxieties, and so on are unconsciously held out of our awareness

Reaction Formation: Impulses are repressed and the opposite behavior is exaggerated

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More Freudian Defense Mechanisms

Projection: When one’s own feelings, shortcomings, or unacceptable traits and impulses are seen in others; exaggerating negative traits in others lowers anxiety

Rationalization: Justifying personal actions by giving “rational” but false reasons for them

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Learned Helplessness (Seligman)

Acquired (learned) inability to overcome obstacles and avoid aversive stimuli; learned passivityOccurs when events appear to be

uncontrollableMay feel helpless if failure is attributed to

lasting, general factors

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Fig. 15.6 In the normal course of escape and avoidance learning, a light dims shortly before the floor is electrified (a). Since the light does not yet have meaning for the dog, the dog receives a shock (non-injurious, by the way) and leaps the barrier (b). Dogs soon learn to watch for the dimming of the light (c) and to jump before receiving a shock (d). Dogs made to feel “helpless” rarely even learn to escape shock, much less to avoid it.

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Depression

State of feeling despondent defined by feelings of powerlessness and hopelessness One of the most common mental problems in the

world Childhood depression is dramatically increasing Some symptoms: Loss of appetite or sex drive,

decreased activity, sleeping too much

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Mastery Training

Mastery Training: Responses are reinforced that lead to mastery of a threat or control over one’s environmentOne method to combat learned

helplessness and depression

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How to Recognize Depression (Beck)

You have a consistently negative opinion of yourselfYou engage in frequent self-criticism and self-blameYou place negative interpretations on events that usually would not bother youThe future looks grimYou can’t handle your responsibilities and feel overwhelmed

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CNN – Elderly Depression

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Stress and Health

Social Readjustment Rating Scale (SRRS): Rates the impact of various life events on the likelihood of contracting illness Not a foolproof method of rating stress Are positive life events (getting married, having a

child) always stressful? People also differ in their reactions to stress

Microstressors (Hassles): Minor but frequent stresses

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Psychosomatic Disorders

Psychological factors contribute to actual illnesses (bodily damage) or to damaging changes in bodily functioningHypochondriacs: Complain about diseases that appear to be imaginaryCertain kinds of ulcers are not

psychosomaticMost common complaints: respiratory and

gastrointestinal

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Biofeedback

Applying informational feedback to bodily controlAids voluntary regulation of activities such

as blood pressure, heart rate, and so onHelpful but not an instant cureMay help relieve muscle-tension

headaches, migraine headaches, and chronic pain

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Fig. 15.7 In biofeedback training, bodily processes are monitored and processed electronically. A signal is then routed back to the patient through headphones, signal lights, or other means. This information helps the patient alter bodily activities not normally under voluntary control.

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Cardiac Personalities

Type A Personality: Personality type with elevated risk of heart attack; characterized by time urgency and chronic anger or hostility

Anger may be the key factor of this behavior

Type B Personality: All types other than Type A’s; unlikely to have a heart attack

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Hardy Personality

Personality type associated with superior stress resistance

Sense of personal commitment to self and family

Feel they have control over their livesSee life as a series of challenges, not

threats

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General Adaptation Syndrome (GAS; Selye)

Series of bodily reactions to prolonged stress; occurs in three stages Alarm Reaction: Body resources are mobilized to

cope with added stress Stage of Resistance: Body adjusts to stress but at

a high physical cost; resistance to other stressors is lowered

Stage of Exhaustion: Body’s resources are drained and stress hormones are depleted, possibly resulting in psychosomatic disease, loss of health, or complete collapse

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Immunity (Similar to “Survivor”?)

Immune System: Mobilizes bodily defenses, like white blood cells, against invading microbes and other diseases

Psychoneuroimmunology: Study of connections among behavior, stress, disease, and immune system

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Stress Management

Use of behavioral strategies to reduce stress and improve coping skillsProgressive Relaxation: Produces deep relaxation throughout the body by tightening all muscles in an area and then relaxing themGuided Imagery: Visualizing images that are calming, relaxing, or beneficial

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CNN – Road Rage

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Avoiding Upsetting Thoughts

Stress Inoculation: Using positive coping statements internally to control fear and anxiety; designed to combat:Negative Self-Statements: Self-critical

thoughts that increase anxiety and lower performance

Coping Statements: Reassuring, self-enhancing statements used to stop negative self-statements

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Meditation

Mental exercise designed to focus attention and interrupt flow of thoughts, worries, and analysesConcentrative Meditation: Attention is paid to a single focal point (i.e., object, thought, etc.) Produces relaxation response and thus works to

reduce stress

Receptive Meditation: Based on widening attention span to become aware of everything experienced at a given moment

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Meditation (cont.)

Mantra: Word(s) or sound(s) repeated silently during concentrative meditation

Relaxation Response: Occurs at time of relaxation; innate physiological response that opposes fight or flight responses