CHAPTER OUTLINE 13
I. Introduction: What Is Stress?
Definitions
1. Stress is widely defined as a negative emotional state occurring in
response to events that are perceived as taxing or exceeding a person’s
resources or ability to cope. Whether we experience stress
depends largely on our cognitive appraisal of an event and the
resources we have to deal with the event.
2. Health psychology (also sometimes referred to as behavioral
medicine) is the branch of psychology that studies how biological,
behavioral, and social factors influence health, illness, medical
treatment, and health-related behaviors.
3. Health psychologists are guided by the biopsychosocial model,
which is the belief that health and illness are determined by the
complex interaction of biological factors, psychological and behavioral
factors, and social conditions.
A. Sources of Stress
Life is filled with potential stressors, which are events or situations
that produce stress.
1. Life Events and Change: Is Any Change Stressful?
a. To measure the amount of stress people experienced, early stress
researchers Thomas Holmes and Richard Rahe developed the
Social Readjustment Rating Scale, which included 43 life events
that require some level of adaptation. Each life event was
assigned a numerical rating that estimates its relative impact in
terms of life change units.
4 Chapter 13 Stress, Health, and Coping
b. Holmes and Rahe found that people who had more than 150 life
change units within a year had an increased rate of physical or
psychological illness.
c. Several problems with the life events approach have been
identified.
(1) The link between scores on the Social Readjustment Rating
Scale and the development of physical and psychological
problems is relatively weak.
(2) The Social Readjustment Rating Scale does not take into
account a person’s subjective appraisal of an event, response
to that event, or ability to cope with the event.
(3) The life events approach assumes that change in itself,
whether good or bad, produces stress.
d. Today, most researchers agree that undesirable events are significant
sources of stress but that change in itself is not necessarily stressful.
2. Daily Hassles: That’s Not What I Ordered!
a. Stress researcher Richard Lazarus and colleagues developed a
scale to measure daily hassles—everyday occurrences that
annoy and upset people.
b. There are gender differences in the frequency and experience of
daily stress.
(1) One study of married couples found that the women experienced
both more daily hassles and higher levels of psychological
stress than their husbands did.
(2) The most common sources of daily stress for men are financial
and job related; for women, the most common sources are
family demands and interpersonal conflict.
(3) When women experience stress, it is more likely to spill over
into interactions with their family; men tend to withdraw.
c. The number of daily hassles is linked to both psychological distress
and physical symptoms, and it is a better predictor of physical
illness than is the number of major life events experienced.
d. One reason that daily hassles can take a toll on us is that such
minor stressors are cumulative.
3. Social and Cultural Sources of Stress
a. When people live in an environment that is inherently stressful,
they often experience ongoing, or chronic, stress. People in the
lowest socioeconomic levels of society tend to have the highest
levels of psychological distress, illness, and death.
4. Culture and Human Behavior: The Stress of Adapting to a New
Culture
a The process of changing one’s values and customs as a result of
contact with another culture is referred to as acculturation.
Acculturative stress is the stress that results from the pressure
of adapting to a new culture.
b There are four possible patterns of acculturation:
(1) Integrated individuals continue to value their original cultural
customs but also seek to become part of the dominant society;
this results in low acculturative stress.
(2) Assimilated individuals give up their old cultural identity
and try to become part of the new society; this results in
moderate acculturative stress.
(3) Some individuals follow the separation pattern—they maintain
their cultural identity and avoid contact with the new
Chapter 13 Stress, Health, and Coping 5
culture. This pattern, which may be self-imposed or the
result of discrimination, results in high acculturative stress.
(4) Marginalized individuals lack cultural and psychological contact
with both cultural groups. This results in the highest
level of acculturative stress.
4. Conflict: Torn Between Two Choices
Conflict is the feeling of being pulled between two or more opposing
desires, motives, or goals. Three basic types of conflicts are described
in terms of approach and avoidance. An individual is motivated to
approach desirable or pleasant outcomes and to avoid undesirable or
unpleasant outcomes.
a. An approach–approach conflict represents a win–win situation—
you’re faced with a choice between two equally appealing outcomes.
Such conflicts are usually easy to resolve and don’t produce
much stress.
b. More stressful are avoidance–avoidance conflicts—choosing
between two unappealing or undesirable outcomes.
c. Most stressful are approach–avoidance conflicts—a single goal
has both desirable and undesirable aspects. People often vacillate,
unable to decide whether to approach or avoid the goal.
II. Physical Effects of Stress: The Mind–Body Connection
Stress can affect a person’s health either indirectly by prompting behaviors
that jeopardize physical well-being or directly by altering bodily functions,
leading to symptoms, illness, or disease.
A. Stress and the Endocrine System
1. Walter Cannon: Stress and the Fight-or-Flight Response
a. The fight-or-flight response is a rapidly occurring chain of
internal physical reactions that prepare people either to fight or
take flight from an immediate threat.
b. It was first described by American physiologist Walter Cannon,
who found that the fight-or-flight response involves both the
sympathetic nervous system and the endocrine system.
c. With the perception of a threat, the hypothalamus and lower
brain structures activate the sympathetic nervous system, which
stimulates the adrenal medulla to secrete hormones called
catecholamines, including adrenaline and noradrenaline.
2. Hans Selye: Stress and the General Adaptation Syndrome
a. Canadian endocrinologist Hans Selye was a pioneer in stress
research. He found that rats exposed to a variety of prolonged
stressors had the same pattern of physical changes: the adrenal
glands became enlarged; stomach ulcers and loss of weight
occurred; and there was shrinkage of the thymus gland and
lymph glands, two key components of the immune system.
b. The general adaptation syndrome is Selye’s term for the
three-stage progression of physical changes that occurs when an
organism is exposed to intense and prolonged stress.
(1) During the initial alarm stage, intense arousal occurs as the
body mobilizes internal physical resources to meet the
demands of the stress-producing event.
(2) In the resistance stage, the body actively tries to resist or
adjust to the continuing stressful situation.
(3) If the stress-producing event persists, the exhaustion stage
may occur, leading to exhaustion, physical disorders, and,
potentially, death.
c. Selye found that prolonged stress activates a second endocrine
pathway that involves the hypothalamus, the pituitary gland,
and the adrenal cortex.
(1) In response to a stressor, the hypothalamus signals the pituitary
gland to secrete a hormone called adrenocorticotropic
hormone (ACTH).
(2) ACTH stimulates the adrenal cortex to release stress-related
hormones called corticosteroids, the most important of
which is cortisol.
(3) In the short run, the corticosteroids help protect the body
against the harm caused by stressors. Continued high levels
of corticosteroids can lower immunity, increase susceptibility
to illness.
(4) Chronic stress or repeated episodes of acute stress can lead
to cardiovascular disease, including atherosclerosis. Chronic
stress can also lead to depression and other psychological
problems.
3. Focus on Neuroscience: The Mysterious Placebo Effect
a. The placebo effect refers to the benefits that research participants
derive from placebos—inactive substances with no known
effects.
b. To test why placebos reduce pain, researchers placed painfully
hot metal on the back of each volunteer’s hand and then injected
either an actual opioid painkiller or a saline solution placebo.
c. Both groups reported pain relief, and, on PET scans, both groups
showed activation of the anterior cingulate cortex, which is
known to contain many opioid receptors.
d. This study shows that cognitive expectations, learned associations,
and emotional responses can have a profound effect on the
perception of pain.
B. Stress and the Immune System
The immune system is the body’s surveillance system that detects and
battles foreign invaders. The most important elements of the immune
system are lymphocytes—the specialized white blood cells that fight
bacteria, viruses, and other foreign invaders.
1. Psychoneuroimmunology
a. Psychologist Robert Ader teamed up with immunologist
Nicholas Cohen and demonstrated that the immune system
response in rats can be classically conditioned.
b. Ader and Cohen’s research helped establish a new interdisciplinary
field called psychoneuroimmunology, which studies the
interconnections among psychological processes (psycho-), the
nervous system (-neuro-), and the immune system
(-immunology).
c. There are many interconnections among the immune, endocrine,
and nervous systems.
(1) The central nervous system and the immune system are
directly linked via sympathetic nervous system fibers, which
influence the production and functioning of lymphocytes.
(2) The surfaces of lymphocytes contain receptor sites for neurotransmitters
and hormones, including catecholamines and
cortisol.
(3) Lymphocytes themselves produce neurotransmitters and hormones,
which influence the nervous and endocrine systems.
Chapter 13 Stress, Health, and Coping 7
2. Stressors That Can Influence the Immune System
a. Psychologist Janice Kiecolt-Glaser and her husband, immunologist
Ronald Glaser, have found that even commonplace negative
life events can adversely affect the immune system.
b. Their studies investigated the relationship between stress and
infection. They found that people who are experiencing high
levels of stress were more susceptible to infection by a cold virus
than people who were not under stress. Those who experienced
chronic stressors were most susceptible.
c. Health psychologists have found that a wide variety of stressors
are associated with diminished immune-system functioning,
increasing the risk of health problems and slowing recovery
times.
d. Physical health is affected by the interaction of many factors,
including heredity, nutrition, health-related habits, access to
medical care, and exposure to sources of infection and disease.
III. Individual Factors That Influence the Response to Stress
A. Psychological Factors
1. Personal Control
Research consistently shows that having a sense of control over a
stressful situation reduces the impact of stressors and decreases
feelings of anxiety and depression.
a. If you feel that you can control a stressor by taking steps to minimize
or avoid it, you will experience less stress, both subjectively
and physiologically.
b. In contrast, feeling a lack of control over events produces all the
hallmarks of the stress response.
c. The perceptions of personal control in a stressful situation must
be realistic to be adaptive.
d. The benefits of a sense of control are influenced by culture. A
sense of control is more highly valued in individualistic, Western
cultures than in collectivist, Eastern cultures.
2. Explanatory Style: Optimism Versus Pessimism
a. Psychologist Martin Seligman found that how people characteristically
explain their failures and defeats makes a difference.
(1) People who have an optimistic explanatory style tend to
use external, unstable, and specific explanations for negative
events.
(2) People who have a pessimistic explanatory style use
internal, stable, and global explanations for negative events.
b. Studies have shown that a pessimistic explanatory style is associated
with poorer physical health.
3. Chronic Negative Emotions: The Hazards of Being Grouchy
a. Howard S. Friedman and Stephanie Booth-Kewley reported that
people who are habitually anxious, depressed, angry, or hostile
are more likely to develop a chronic disease.
b. Such people experience more stress than do happier people. They
also report more frequent and more intense daily hassles, and
they react much more intensely, and with far greater distress, to
stressful events.
4. Type A Behavior and Hostility
a. Cardiologists Meyer Friedman and Ray Rosenman described the
Type A behavior pattern as a behavioral and emotional style characterized by a sense of time
urgency, hostility, and intense ambition and competitiveness.
b. In contrast, people who were more relaxed and laid back were
classified as displaying the Type B behavior pattern.
c. Friedman and Rosenman classified over 3,000 middle-aged,
healthy men, then tracked their health for eight years. They concluded
that Type A behavior was a significant risk factor for
heart disease.
d. Later studies showed that the most critical component of Type A
behavior for predicting cardiac disease was hostility, which refers
to the tendency to feel anger, annoyance, resentment, and contempt,
and to hold negative beliefs about human nature in general.
e. High hostility levels increase the likelihood of dying from all
natural causes, including heart disease and cancer.
(1) Hostile Type As tend to react more intensely to a stressor
than other people do.
(2) Because of their attitudes, hostile men and women tend to
create more stress in their lives.
5. Critical Thinking: Do Personality Factors Cause Disease?
a. Psychologists and scientists are cautious in their statements
about connections between personality and health, because
(1) many studies investigating the role of psychological factors
in disease are correlational,
(2) personality factors might indirectly lead to disease via poor
health habits, and
(3) it may be that disease influences a person’s emotions, rather
than the other way around.
b. Prospective studies are studies that track the health, personal
habits, health habits, and other factors of initially healthy subjects
over a long period of time. They provide more compelling
evidence than do correlational studies.
B. Social Factors: A Little Help from Your Friends
Social support refers to the resources provided by other people in
times of need.
1. How Social Support Benefits Health
Social support may benefit our health and improve our ability to
cope with stressors in several ways.
a. The social support of friends and relatives can modify our
appraisal of a stressor’s significance, including the degree to
which we perceive it as threatening or harmful.
b. The presence of supportive others seems to decrease the intensity
of physical reactions to a stressor.
c. Social support can influence our health by making us less likely
to experience negative emotions.
2. Relationships with others also can be a significant source of stress.
a. When other people are perceived as being judgmental, their
presence may increase the individual’s physical reaction to a
stressor.
b. Stress may also increase when well-meaning friends or family
members offer unwanted or inappropriate social support.
3. In Focus: Providing Effective Social Support
a. There are three broad categories of social support: emotional,
tangible, and informational.
b. There are several support behaviors that have been identified as
helpful; likewise, there are several behaviors perceived as
unhelpful.
c. Although social support is helpful, it is not a substitute for counseling
or psychotherapy.
4. Gender Differences in the Effects of Social Support
a. Women may be particularly vulnerable to some of the problematic
aspects of social support.
(1) Women are more likely than men to serve as providers of
support, which can be a very stressful role.
(2) Women may be more likely to suffer from the stress
contagion effect, becoming upset about negative life events
that happen to other people they care about.
b. Men tend to rely heavily on a close relationship with their
spouse, placing less importance on relationships with other people.
Because of their smaller social network, men are more vulnerable
to social isolation, especially if their spouse dies.
IV. Coping: How People Deal with Stress
Coping refers to the ways in which we try to change circumstances, or
interpretations of circumstances, to make them more favorable and less
threatening.
A. Two Ways of Coping: Problem-Focused and Emotion-Focused Coping
1. Coping tends to be a dynamic, ongoing process.
2. When coping is effective, we adapt to the situation and stress is
reduced. Maladaptive coping can involve thoughts and behaviors
that intensify or prolong distress or that produce self-defeating
outcomes.
3. Adaptive coping responses serve many functions.
a. They involve realistically evaluating the situation and determining
what can be done to minimize the impact of the stressor.
b. They involve dealing with the emotional aspects of the situation.
c. They are directed toward preserving important relationships
during stressful experiences.
4. Psychologists Richard Lazarus and Susan Folkman described two
basic types of coping.
a. Problem-focused coping is aimed at directly changing or managing
a threatening or harmful stressor. Problem-focused coping
strategies tend to be most effective when you can exercise some
control over the stressful situation or circumstances.
b. Emotion-focused coping is aimed at relieving or regulating
the emotional impact of a stressful situation.
5. In Focus: Gender Differences in Responding to Stress: “Tend-andBefriend” or “Fight-or-Flight”?
a. Physiologically, men and women show the same hormonal and
sympathetic nervous system activation in response to stress.
b. Behaviorally, men usually fight or flee and women usually tend
and befriend.
c. According to the evolutionary perspective, the most adaptive
response is one that promotes the survival of the individual and
his or her offspring.
6. The hormone oxytocin is higher in females than in males. Oxytocinrelated
changes seem to help turn down the physiological intensity
of the fight-or-flight response for women.
7. Problem-Focused Coping Strategies: Changing the Stressor
Problem-focused coping strategies represent actions that have the
goal of changing or eliminating the stressor.
a. When people use aggressive or risky efforts to change the situation,
they are engaging in confrontive coping.
b. Planful problem solving involves efforts to rationally analyze the
situation, identify potential solutions, and then implement them.
8. Emotion-Focused Coping Strategies: Changing Your Reaction to the
Stressor
a. The escape–avoidance strategy involves shifting your attention
away from the stressor and toward other activities.
b. Seeking social support involves turning to friends, relatives, or
other people for emotional, tangible, or informational support.
c. In distancing, you acknowledge the stressor but attempt to minimize
or eliminate its emotional impact.
d. Denial is a refusal to acknowledge that the problem even exists.
Like the escape strategy, denial can compound problems in
situations that require immediate attention.
e. The most constructive emotion-focused strategy, positive
reappraisal, occurs when you not only try to minimize the negative
emotional aspects of the situation but also try to create positive
meaning by focusing on personal growth.
f. The most effective coping is flexible, that is, fine-tuning one’s
coping strategies to meet the demands of a particular situation.
g. People often use multiple coping strategies in stressful
situations, combining problem-focused and emotion-focused
strategies.
B. Culture and Coping Strategies
1. Members of individualistic cultures tend to emphasize personal
autonomy and personal responsibility in dealing with problems;
thus, they are less likely to seek social support in stressful situations
than are members of collectivistic cultures; they favor problemfocused
strategies.
2. In collectivistic cultures, however, a greater emphasis is placed on
controlling personal reactions to a stressful situation than on trying
to control the situation itself; thus, people in these cultures favor
emotion-focused strategies.
V. Application: Minimizing the Effects of Stress
A. Exercise Regularly
B. Avoid or Minimize the Use of Stimulants
C. Get Enough Sleep
D. Practice a Relaxation Technique