Section 1 - Stress and Coping
MAIN IDEA QUESTIONS
How is health psychology a union between medicine and psychology?
What is stress, how does it affect us, and how can we best cope with it?
VOCABULARY
health psychology - the branch of psychology that investigates the psychological factors related to wellness and illness, including the prevention, diagnosis, and treatment of medical problems.
psychoneuroimmunology (PNI) - the study of the relationship among psychological factors, the immune system, and the brain
stress - a person's response to events that are threatening or challenging
cataclysmic events - strong stressors that occur suddenly and typically affect many people at once (e.g., natural disasters)
personal stressors - major life events, such as the death of a family member, that have immediate negative consequences that generally fade with time
posttraumatic stress disorder (PTSD) - a phenomenon in which victims of major catastrophes or strong personal stressors feel long-lasting effects that may include re-experiencing the event in vivid flashbacks or dreams
background stressors ("daily hassles") - everyday annoyances, such as being stuck in traffic, that cause minor irritations and may have long-term ill effects if they continue or are compounded by other stressful events
psychophysiological disorders - medical problems influenced by an interaction of psychological, emotional, and physical difficulties
general adaptation syndrome (GAS) - a theory developed by Seyle that suggests that a person's response to a stressor consists of three stages: alarm and mobilization, resistance, and exhaustion
coping - the efforts to control, reduce, or learn to tolerate the threats that lead to stress
learned helplessness - a state in which people conclude that unpleasant or aversive stimuli cannot be controlled - a view of the world that becomes so ingrained that they cease trying to remedy the aversive circumstances even if they actually can exert some influence on the situation
hardiness - a personality characteristic that is associated with a lower rate of stress-related illness and consists of three components: commitment, challenge, and control
social support - a mutual network of caring, interested others
STRESS: REACTING TO THREAT AND CHALLENGE
Most of us need little introduction to the phenomenon of stress - people's response to events that threaten or challenge them. Life is full of circumstances and events known as stressors that produce threats to our well-being. EX: paper, exam deadline, family problem, threat of a terrorist attack. Even pleasant events can produce stress - planning a party, beginning a sought-after job - although negative events result in greater detrimental consequences than positive ones.
~All of us face stress in our lives. Ultimately, our attempts to overcome stress may produce biological and psychological responses that result in health problems.
The Nature of Stressors: My Stress is Your Pleasure
Stress is a very personal thing. Although certain events - such as death of a loved one or participation in military combat - are universally stressful, other situations may or may not be stressful to a specific person. EX: bungee jumping. Whether bungee jumping is stressful or not depends on a person's perception of the activity.
~For people to consider an event stressful, they must consider it threatening of challenging and must lack all the resources to deal with it effectively. Consequently, the same event may be stressful some of the time and at other times provoke no stressful reaction at all. EX: A young man may experience stress when he is turned down for a date - if he attributes the refusal to his unattractiveness or unworthiness. But if he attributes it to some factor unrelated to his self-esteem, such as a previous commitment of the woman he asked, the experience of being refused may create no stress at all. Hence, a person's interpretation of events plays an important role in the determination of what is stressful.
Categorizing Stressors
There are three general types of stressors: cataclysmic events, personal stressors, and background stressors.
~Cataclysmic events are strong stressors that occur suddenly and typically affect many people simultaneously. Disasters such as plane crashes and tornadoes as well as terrorist attacks are examples of cataclysmic events that can effect hundreds or thousands of people simultaneously. Although it might seem that these would produce potent, lingering stress, most often they do not. One reason is that such an event, like a natural disaster, has a clear resolution. Once they are over, people can look to the future knowing the worst is behind them. Moreover, others share in the stress and such sharing permits people to offer one another social support and a firsthand understanding of the difficulties others are going through. In contrast, cataclysmic events like the attack on the World Trade Center produce considerable stress. Terrorist attacks are deliberate and victims (and observers) know that future attacks are likely. Government warnings in the form of heightened terror alerts may further increase the stress (VID).
~The second major category of stressor is the personal stressor. These include major life events such as the death of a parent or spouse, the loss of one's job, a major personal failure, or even something positive such as getting married. Typically, they produce an immediate major reaction that soon tapers off. EX: Stress rising from the death of a loved one tends to be greatest just after the time of death, but people begin to feel less stress and are better able to cope with the loss after the passage of time. Some victims of major catastrophes experience posttraumatic stress disorder, or PTSD, in which a person has experienced a significantly stressful event that could cause re-experience through vivid dreams or flashbacks. An episode may be triggered by an otherwise innocent stimulus such as the sound of a honking horn, that leads a person to re-experience a past event that produced considerable stress. Symptoms also include emotional numbing, sleep difficulties, interpersonal problems, alcohol and drug abuse, and in some cases suicide. EX: Suicide rate for military veterans is twice as high as nonveterans. Around 16% of soldiers returning from Iraq show symptoms of PTSD. Furthermore, those who have experienced child abuse or rape, rescue workers facing overwhelming situations, and victims of sudden natural disasters or accidents that produce feelings of helplessness and shock may suffer from the same disorder.
~Background stressors, or daily hassles, are the third major category. EX: Standing in a long line at a bank, getting stuck in a traffic jam. These stressors are minor irritations of life that we all face time and again. Another type is a long-term chronic problem, such as experiencing dissatisfaction with school or a job, being unhappy about a relationship, or living in crowded quarters without privacy. By themselves, daily hassles do not require much coping or even a response on the individual's part, although they produce unpleasant emotions and moods. Still, daily hassles add up - and ultimately they may take a great toll as a single, more stressful incident. The number of daily hassles a person faces is associated with health problems such as flu, sore throat, and backaches. The flipside of hassles is uplifts, the minor positive events that make us feel good - even if only temporarily. EX: Relating well to a companion, finding one's surroundings pleasing. The greater number or uplifts we are involved with, the fewer psychological problems we report later.
Percentage of people experiencing the following daily hassles...
86% - Not enough time
81% - Too many things to do
77% - Troubling thoughts about the future
72% - Too many interruptions
68% - Misplacing or losing things
56% - Health of a family member
54% - Social obligations
50% - Concerns about standards
50% - Concerns about getting ahead
50% - Too many responsibilities
Percentage of people experiencing uplifts...
74% - Relating well with spouse or lover
70% - Relating well with friends
67% - Feeling healthy
65% - Completing a task
61% - Getting enough sleep
60% - Visiting, phoning, or writing someone
59% - Meeting responsibilities
58% - Going out for a meal
57% - Spending time with family
56% - Home (inside) pleasing to you
THE HIGH COST OF STRESS
Stress can produce both biological and psychological consequences. Often the most immediate reaction is biological... rise in hormone secretions, increase in heart rate and blood pressure, changes in how well the skin conducts electrical impulses. Continued exposure to stress results in a decline in the body's overall level of biological functioning because of the constant secretion of stress-related hormones. Over time, this can promote deterioration of body tissue such as blood vessels and the heart. We become more susceptible to disease as our ability to fight off infection is lowered.
~An entire class of physical problems, known as psychophysiological disorders, often result from or are worsened by stress (formerly known as psychosomatic disorders). These disorders are actual medical problems that are influenced by an interaction of psychological, emotional, and physical difficulties. EX: High blood pressure, headaches, backaches, skin rashes, indigestion, fatigue, and constipation. Stress is even linked to the common cold.
~High levels of stress prevent people from adequately coping with life. Their view of the environment can become clouded (EX: a minor criticism by a friend is blown out of proportion).
~In short, stress affects us in multiple ways. It may increase the risk that we will become ill, it may directly cause illness, it may make us less able to recover from a disease, and it may reduce our ability to cope with future stress.
The General Adaptation Syndrome Model: The Course of Stress
The effects of long-term stress are illustrated in a series of stages proposed by Hans Selye. This model, the general adaptation syndrome (GAS), suggests the physiological response to stress follows the same set pattern regardless of the cause of stress.
PHASE 1 - Alarm and mobilization --- Meeting and resisting stressor. (Sympathetic nervous system becomes energized)
PHASE 2 - Resistance --- Coping with stress and resistance to stressor. (Student works long hours to study for an exam)
PHASE 3 - Exhaustion --- Negative consequences of stress (such as illness) occur when coping is inadequate. (Illness or psychological symptoms in the form of an inability to concentrate, heightened irritability, or disorientation and a loss of touch with reality.
Psychoneuroimmunology and Stress
Focusing on the outcomes of stress, PNI psychologists have taken a broader approach to stress, identifying three main consequences of it;
Direct physiological effects --- elevated blood pressure / decrease in immune system functioning / increased hormonal activity / psychophysiological conditions
Harmful behaviors --- increased smoking, alcohol use / decreased nutrition / decreased sleep / increased drug use
Indirect health-related behaviors --- decreased compliance with medical advice / increase in delays in seeking medical advice / decrease in likelihood of seeking medical advice
COPING WITH STRESS
Stress is a normal part of life - and not necessarily a bad part of it. Without stress, for example, we may lack sufficient motivation to complete tasks. However, it is clear that stress can take a toll on physical and psychological health. Efforts to control, reduce, or learn to tolerate the threats that lead to stress are known as coping. We have two ways of coping with stress;
Emotion-focused coping - people try to manage their emotions in the face of stress by seeking to change the way they feel about or perceive a problem. EX: Accepting sympathy from others and looking at the bright side of a situation.
Problem-focused coping - attempts to modify the stressful problem or source of stress. This form of coping leads to changes in behavior or the development of a plan of action. EX: Starting a study group or taking a day off from caring for a relative with a serious illness to go to health club or spa.
~People often apply several types of coping strategies simultaneously. In avoidant coping, a person may use wishful thinking to reduce stress or use mroe direct escape routes, such as drug use, alcohol use, or overeating. EX: "Maybe it will snow so hard tomorrow that the test will be canceled."
~Another way of coping is the use of defense mechanisms (unconscious strategies that people use to reduce anxiety by concealing this source from themselves and others). People act as if the stress were not even there. Another defense mechanism is emotional insulation, in which a person stops experiencing any emotions at all and thereby remains unaffected and unmoved by both positive and negative experiences.
~The problem with defense mechanisms is that they hide the problem and do not deal with reality.
Learned Helplessness
Have you ever faced an intolerable situation that you just couldn't resolve, gave up, and accepted thing the way they were. This is learned helplessness, and it occurs when people conclude that an unpleasant or aversive stimuli cannot be controlled.
Coping Styles: The Hardy Personality
Among those who cope with stress most successfully are people who are equipped with hardiness, a personality characteristic associated with a lower rate of stress-related illness. Hardiness has three components;
Commitment - a tendency to throw ourselves into whatever we are doing with a sense that our activities are important and meaningful
Challenge - people believe that change rather than stability is the standard condition of life - anticipation of change is an incentive, not a threat
Control - the perception that people can influence the events in their lives
Social Support: Turning to Others
Researchers have found that social support, the knowledge that we are part of a mutual network of caring, interested others, enables us to experience lower levels of stress and better cope with the stress we do undergo. People offer others support, value, and advice. They may also provide actual goods and services to help others in stressful situations (living quarters, study help, etc.).
How can we deal with stress in our lives?
-Turn a threat into a challenge
-Make a threatening situation less threatening
-Change your goals
-Take physical action
-Prepare for stress before it happens
Section 2 - Psychological Aspects of Illness and Well-Being
MAIN IDEA QUESTION
How do psychological factors affect health-related problems such as coronary heart disease, cancer, and smoking?
VOCABULARY
Type A behavior pattern - a cluster of behaviors involving hostility, competitiveness, time urgency, and feeling driven
Type B behavior pattern - a cluster of behaviors characterized by a patient, cooperative, noncompetitive, and nonaggressive manner
THE As, Bs, AND Ds OF CORONARY HEART DISEASE
The Type A Behavior pattern is a cluster of behaviors involving hostility, competitiveness, time urgency, and feeling driven. In contrast, Type B behavior pattern is characterized by a patient, cooperative, noncompetitive, and nonaggressive manner.
~Type A is linked to coronary heart disease. Type A results in males being twice as likely to suffer fatal heart attacks. Hostility produces physiological arousal in stressful situations, leading to the increased production of the hormones epinephrine and norepinephrine as well as increases in heart rate and blood pressure.
PSYCHOLOGICAL ASPECTS OF CANCER
Although the processes involved in the spread of cancer are basically physiological, some research suggests that emotional responses of cancer patients to their disease may affect its course. EX: A "fighting" spirit leads to better coping versus patients with a less positive attitude. Helath psychologists believe that patients emotions may at least partially determine the course of their disease.
SMOKING
Despite clear, well-publicized evidence that smoking is linked to cancer, heart attacks, strokes, bronchitis, emphysema, and a host of other serious illnesses... millions purchase cigarrettes everyday. Close to 5 million people die each year from smoking... includign one in five U.S. deaths.
Why People Smoke
Most smokers agree with the negative statements attached to smoking. Most say they would like to quit. Still, 700,000 a year take up smoking. Genetics influences addiction rates as well as how people are affected. African Americans suffer an almost 50% higher rate of lung cancer than white smokers. This is partially due to genetically produced variations in the efficiency of enzymes which reduce the effects of cancer causing chemicals.
~Smoking may be seen as "cool," or sophisticated, rebellious, or as facilitating calm performance in stressful situations. It is sometimes seen as a "rite of passage" among adolescents.
~Smoking becomes a habit, and an easy one to pick up. Nicotine, a primary ingredient, is highly addictive. Nicotine levels become associated with a positive emotional state. People then smoke to regulate both nicotine levels and emotional states.
Quitting Smoking
Long-term successful quitting occurs in just 15% of those who try to stop smoking. Many people try to quit, but fail. The average smoker tries to quit 8 to 10 times before being successful, and still many relapse. ABout 10% relapse after quitting for a year.
~Among the most effective tools are drugs that replace nicotine (gum, nasal sprays, patches, inhalers). Other drugs such as Zyban and Chantix reduce the pleasure from smoking and suppress withdrawal symptoms. Counseling can help to produce behavioral changes. The least effective approach is quitting cold turkey, with only a 5% success rate.
~Social support from friends is key, and other societal policies can assist; banning smoking in public places, classrooms, buildings, etc. Overall, smoking has declined over the last two decades, and has been on a steady decline among high schoolers since 1997.
Section 3 - Promoting Health and Wellness
MAIN IDEA QUESTIONS
How do our interactions with physicians affect our health and compliance with medical treatment?
How does a sense of well-being develop?
VOCABULARY
reactance - a negative emotional and cognitive reaction that results from the restriction of one's freedom
subjective well-being - people's own evaluation of their lives in terms of both their thoughts and their emotions
FOLLOWING MEDICAL ADVICE
-As many as 85% of patients do not fully comply with a physician's recommendations.
-Between 14-21% of patients don't ever fill their drug prescriptions.
-Some 10% of adolescent pregnancies result from noncompliance with birth control practices.
-Sixty percent of all patients cannot identify their own medicines.
-From 30-50% of all patients ignore instructions or make errors in taking medication.
Noncompliance can take many forms; failing to show up for scheduled appointments, not follow diets or not give up smoking, or discontinue medication during treatment. In some cases, they fail to take prescribed medicine at all.
~Noncompliance is sometimes a result of psychological reactance - a negative emotional and cognitive reaction that results from the restriction of one's freedom. People who experience reactance feel hostility and anger.
Communicating Effectively With Health-Care Providers
Lack of communication between patients and medical care providers can lead to poor medical care. SUch communication failures occur for several reasons;
1) Physicians make assumptions about what patients prefer, or push a specific treatment without consulting patients
2) Patients may also be reluctant to volunteer information that might cast them in a bad light
3) Physicians can dominate an interview with questions of a technical nature
4) Many patients hold that physicians are "all knowing"
5) Patients do not understand treatments and fail to ask questions
6) The sex of physician/patient may also hamper communication
7) Cultural values and expectations contribute to communication barriers (language, medical practices, religion, etc.)
Increasing Compliance With Medical Advice
Complying with medical advice does optimize the possibility that the patient's condition will improve. What can be done to fix the compliance problem? One strategy is for health care providers to give clear instructions to patients regarding drug regimens. Also, the maintenance of good, warm relations with patients also leads to increased compliance. Honesty, as well as the way in which a message is framed, are also very important.
WELL-BEING AND HAPPINESS
What makes for a good life? This is a question that has been pondered by philosophers and theologians for centuries. Health psychologists are investigating sibjective well-being - people's evaluation of their lives in terms of both their thoughts and their emotions. Subjective well being, in other terms, is the measure of how happy people are.
What Are The Characteristics of Happy People?
-Happy people have high self-esteem
-Happy people have a firm sense of control
-Happy individuals are optimistic
-Men and women generally are made happy by the same sorts of activities - but not always. EX: Women get less pleasure from being with their parents than men.
-Happy people like to be around other people
Does Money Buy Happiness?
If you were to win the lottery, would you be happier?
Probably not. That is the implication from health psychologists' research on subjective well-being. Although there would be an initial surge of happiness, winners' level of happiness a year later seems to return to what it was before they won. The same happens in reverse to those who experience a quick decline in happiness after a major accident or illness.
Why is the level of happiness so stable?
One explanation is a happiness set point, a marker that establishes the tone for one's life. Although events may elevate or depress one's mood, ultimately people return to their general level of happiness. Some evidence shows the set point being determined by genetic factors... identical twins born into different environments typically test out at the same level of happiness.
~Most people's well-being set point is very high... some 30% of people in the United States rate themselves as "very happy," and only one in ten rates himself or herself as "not too happy."
~The bottom line: Money does not seem to buy happiness. Despite the ups and downs of life, most people tend to be reasonably happy, and they adapt to the trials and tribulations - and joys and delights - of life by returning to a steady-state level of happiness. That habitual level of happiness can have profound - perhaps life-prolonging - implications.