Stress og mestring

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STRESS AND
HEALTH
STRESS MODELS
COPING STRATEGIES
TYPE A PERSONALITY
Cato Grønnerød
PSY2600
STRESS, MESTRING,
TILPASNING OG
HELSE
MESTRINGSSTRATEGIER
TYPE A PERSONLIGHET
Cato Grønnerød
PSY1006
HELSEPSYKOLOGI
 Psykologiske faktorer og spesifik atferd har
konsekvenser for vår helse
 Personlighet og helse-modeller
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Interaksjonsmodell
Transaksjonsmodell
Helseatferdsmodell
Predisposisjonsmodell
Sykdomsatferdsmodell
HEALTH PSYCHOLOGY
 Psychological factors and specific behavior
both have health consequences
 Personality and health models
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Interactional model
Transactional model
Health behavior model
Predisposition model
Illness behavior model
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
DIREKTEEFFEKTMODELL
Objektive
hendelser
Fysiologisk
aktivering
Sykdom
DIRECT EFFECTS MODEL
Objective
events
Physiological
activation
Illness
INTERAKSJONSMODELL
Objektive
hendelser
Mestringsresponser
Personlighet
Fysiologisk
aktivering
Sykdom
INTERACTION MODEL
Objective
events
Coping
responses
Personality
Physiological
activation
Illness
TRANSAKSJONSMODELL
Sykdom
Fysiologisk
aktivering
Objektive
hendelser
Vurdering
som truende
Mestringsresponser
Personlighet
TRANSACTIONAL MODEL
Illness
Physiological
activation
Objective
events
Appraisal as
threatening
Coping
responses
Personality
HELSEATFERDSMODELL
Personlighet
Objektive
hendelser
Vurdering
som truende
Helseatferd
Sykdom
Mestringsresponser
Fysiologisk
aktivering
HEALTH BEHAVIOR MODEL
Personality
Objective
events
Appraisal as
threatening
Health
behavior
Illness
Coping
responses
Physiological
activation
PREDISPOSISJONSMODELL
Sykdom
Predisposisjon
Fysiologisk
reaktivitet
Personlighet
PREDISPOSITION MODEL
Illness
Predisposition
Physiological
reactivity
Personality
SYKDOMSATFERDSMODELL
Symptomrapport
Normal kroppsoppmerksomhet
Forhøyet
oppmerksomhet
Sykdomsoppfatning
Personlighet
Helseatferd
ILLNESS BEHAVIOR MODEL
Symptom
report
Normal
physiological
sensations
Heightened
awareness
Labeling as
illness
Personality
Health
behavior
FELLESFAKTORER
 Inkluderer stress som faktor
 Stress er ikke ”noe der ute”, noe som skjer
med oss
 Stress er hvordan vi fortolker og reagerer
på livshendelser
 Stress er en interaksjon mellom person og
hendelse
A COMMON THEME IN THE
MODELS
 Most models of personality and illness
include a key variable of stress
 Stress is not “out there”, something that
just happens to us
 Instead, stress lies in part in how we
interpret and respond to those events
 Thus, stress lies “in between” the event and
the person
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
BEGREPET STRESS
 Stress er en subjektiv følelse som følger av
hendelser som oppfattes som
ukontrollerbare og truende
 Stressorer: hendelser som er
• Ekstreme, overveldende
• Fører til motstridende tendenser: lyst/ulyst
• Oppfattes som ukontrollerbare
THE CONCEPT OF STRESS
 Stress is a subjective feeling produced by
events perceived as uncontrollable and
threatening
 Stressors: events that are
• Extreme in some manner, in that stressors produce a
state of feeling overwhelmed
• Produce opposing tendencies in us, such as wanting
and not wanting some activity or object
• Perceived as uncontrollable
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
STRESSREAKSJON
 Aktivitet i det sympatetiske nervesystemet
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Økt puls
Svette i håndflatene og fotsålene
Høyere blodtrykk
Økt oppmerksomhet mot omgivelsene
Fight/flight-reaksjon
STRESS RESPONSE
 Increase in sympathetic nervous system
activity
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Startle
Heart beats fast
Blood pressure increases
Sweaty palms and soles of feet
Fight-or-flight response
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
STRESSREAKSJON
 Generelt tilpasningssyndrom
• General Adaption Syndrome (GAS)
• Alarmstadiet
• Fight/flight-respons
• Motstand
• Kroppen bruker fysiologiske ressurser for å takle
situasjonen
• Utmattelse
• Mer mottakelig for sykdom pga. nedsatt fysiologisk
fungering
STRESS RESPONSE
 General Adaptation Syndrome (GAS)
• Alarm stage
• Fight-or-flight response
• Stage of resistance
• Body uses resources at above average rate, even though
fight-or-flight response subsided
• Stage of exhaustion
• More susceptible to illness, because physiological
resources are depleted
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
STORE LIVSHENDELSER
 Holmes & Rahe (1967)
 Både positive og negative stressorer
• Dødsfall i familien, miste jobben, fengslet
• Gifte seg, starte ny utdanning
 Økt sannsynslighet for sykdom i påfølgende
år
• Dårligere immunforsvar gir økt sannsynlighet for
infeksjoner
MAJOR LIFE EVENTS
 Holmes & Rahe (1967)
 Both positive and negative stressors
• Death in the family, lose job, imprisonment
 More likely to have a serious illness over
the next year
• People under chronic stress deplete bodily resources
and become vulnerable to infections
 Stress lowers the functioning of immune
system, leading to lowered immunity to
infection and resulting in illness
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
DAGLIGE TRASSIGHETER
 Daglige trassigheter er hovedårsak til det
meste av stress i de flestes liv
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For mye å gjøre
Bli sittende fast i trafikken
Ugreie sjefer
Pengeproblemer
Problemer i parforhold
Familiekonflikter
DAILY HASSLES
 Major events stress, but infrequent
 Daily hassles provide most stress in most
people’s lives
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Too many things to handle
Stuck in traffic
Difficult bosses
Financial trouble
Interpersonal problems
Family conflicts
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
TYPER STRESS
 Akutt stress
• Plutselig hendelse
 Episodisk akutt stress
• Gjentakende hendelser
 Traumatisk stress
• Svært belastende akutte hendelser
• PTSD
 Kronisk stress
• Vedvarende situasjon
VARIETIES OF STRESS
 Acute stress
• Sudden event
 Episodic acute stress
• Repeating events
 Traumatic stress
• Highly disturbing sudden events
• PTSD
 Chronic stress
• Lasting situation
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
SITUASJONSVURDERINGER
 Primærvurdering (Primary Appraisal)
• Personen vurderer om hendelsen er en trussel mot
oppsatte mål
 Sekundærvurdering (Secondary Appraisal)
• Personen vurderer om det fins ressurser til å
håndtere hendelsen
 Lazarus (1991): stress oppstår når begge er
negative
EVENT APPRAISALS
 Primary appraisal
• Person perceives an event as a threat to important
goals
 Secondary appraisal
• Person concludes they do not have resources to cope
with demands of the threatening event
 Lazarus (1991): both events must occur
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
POSITIVE EMOSJONER OG
STRESS
 Positive emosjoner kan føre til lavere
stressnivå
 Tre mekanismer
• Positiv revurdering
• Fokusere på det gode som skjer
• Problemfokusert mestring
• Tanker eller atferd som håndterer eller løser det
underliggende problemet
• Skape positive hendelser
POSITIVE EMOTIONS IN
COPING WITH STRESS
 Positive emotions and appraisals may lead
to a lowered impact of stress on health
 Three coping mechanisms
• Positive reappraisal
• Focusing on the good in what is happening
• Problem-focused coping
• Thoughts and behaviors that manage or solve an
underlying cause of stress
• Creating positive events
• Creating positive time-out from stress
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
ATTRIBUSJONSSTIL
 Pessimistisk
• Stabile, generelle og indre forklaringer
 Optimistisk
• Ustabile, spesifikke og ytre forklaringer
 Disposisjonell optimisme
• Forventning om gode hendelser
 Self-efficacy
• Tro på at man kan oppnå mål man setter
 Optimistisk bias
• Undervurderer risiko
ATTRIBUTIONAL STYLE
 “Where does the person typically place the
blame when things go wrong?”
 Three dimensions of attribution
• External versus internal
• Unstable versus stable
• Specific versus global
 Different measures
• Attributional Style Questionnaire
• Content Analysis of Verbatim Explanations (CAVE)
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
REFINEMENTS TO THE
ATTRIBUTIONAL STYLE
CONSTRUCT
 Optimism-pessimism (Peterson, 2000)
• People who make stable, global, and internal
explanations for bad events termed “pessimists,”
• People who make unstable, specific, external
explanations for bad events termed “optimists”
 Pessimism
• Lifelong vulnerability to illnesses
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
REFINEMENTS TO THE
ATTRIBUTIONAL STYLE
CONSTRUCT
 Dispositional optimism (Scheier & Carver,
2000)
• Expectation that good events will be plentiful and bad
events rare in future
 Self-efficacy (Bandura, 1986)
• Belief that one can do behaviors necessary to
achieve desired outcome
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
REFINEMENTS TO THE
ATTRIBUTIONAL STYLE
CONSTRUCT
 Optimistic bias
• People generally underestimate their risks, with the
average person rating risks as below true average
 Optimism and Physical Well-Being
• Optimism predicts good health and health promoting
behaviors
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
OPTIMISME OG HELSE
 Optimisme henger sammen med
• God helse
• Bedre immunforsvar
• Positiv helseatferd
• Mer trening, spiser sunnere
• Lengre liv
• Færre ulykker og voldelige dødsfall
• Pessimister dras mer til farlige situasjoner
HOW DOES OPTIMISM
PROMOTE HEALTH?
 Through the effects on the immune system
 Through an emotional mechanism
 Through a cognitive process
 Through effects on social contacts
 Through direct behavioral mechanism
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
HÅNDTERING AV EMOSJONER
 Fortrengning fører til uønskede
konsekvenser
 Undertrykking av følelser fører til forhøyet
sympatetisk aktivitet
• Stressreaksjon
 Hindrer kommunikasjon
 Å gi uttrykk for emosjoner kan knyttes til
bedre tilpasning og helse
MANAGEMENT OF EMOTIONS
 Emotional inhibition leads to undesirable
consequences
• Other theorists see emotional inhibition more positively
 Chronically inhibited emotion may lead to
effects of chronic sympathetic nervous system
arousal
 Emotional expression facilitates
communication
• Tied to better adjustment and good health
• Expressive writing
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
ILLUSORY MENTAL HEALTH
 Shedler, Mayman & Manis (1993)
• The illusion of mental health
 Two subgroups of those who appear
“healthy” on mental health scales
• Psychologically “healthy”
• Illusory mental health: appear “healthy” by way of
defensive operations and denial of dysfunction
ILLUSORY MENTAL HEALTH
Method
Clinical
Evaluation
Good
Poor
Good
Good mental
health
Illusory mental
health
Poor
Poor self
representation
Poor mental
health
Self report
ILLUSORY MENTAL HEALTH
ILLUSORY MENTAL HEALTH
 Many psychological processes are not
available for conscious cognition
 Some protect themselves against
unpleasant thoughts and feelings
 Supression of emotion is linked to
increased risk of disease
TYPE A OG
HJERTE-/KARSYKDOM
 Atferdsmønster
• Konkurranseorientert prestasjonsmotivasjon
• Hastverk
• Fiendtlighet og aggressivitet
 Fiendtlighet viktigste prediktor for hjerte/karsykdommer
TYPE A ATFERDSMØNSTER
 Høy på prestasjonsbehov og
konkurranseorientering
 Liker å jobbe hardt og oppnå mål
 Hastverksfølelse
• Hater å kaste bort tid
 Fiendtlighet og aggressivitet
• Lett frustrert, lett sint
• Uvennlig og kanskje ondsinnet
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
TYPE A BEHAVIORAL PATTERN
 High achievement motivation and
competitiveness
• Like to work hard and achieve goals
 Time urgency
• Hates wasting time
 Hostility and aggressiveness
• Easily frustrated, easily angered
• Becomes unfriendly and even malicious
© 2008 The McGraw-Hill Companies, Inc. All rights reserved.
TYPE A ATFERDSMØNSTER
 Leger observerte at menn med
hjerteproblemer oppførte seg annerledes
 Intervjuvurdering
• Observasjon av atferd
 Spørsmålsskjemaer
• Jenkins Activity Survey
• Mindre sannsynlighet for å predikere helseproblemer
TYPE A BEHAVIORAL PATTERN
 Physicians observed that men with heart
diseases were behaving differently
 Interview assessment
• Observation of behavior
 Questionnaires
• Jenkins Activity Survey
• Less likely to predict health problems
TYPE A ATFERDSMØNSTER
 Kardiovaskulære sykdommer
• Dobbelt så høy risiko for Type A-personer
 Fiendtlighet og aggressivitet
• Forakt, mistenkelighet, antagonisme, mistro, sinne
• Viktigste prediktor for kardiovaskulære sykdommer
• Oftere engstelig og deprimert
TYPE A BEHAVIORAL PATTERN
 Cardiovascular disease
• Double risk for Type A-persons
 Hostility and aggressiveness
• Resentment, suspiciousness, antagonism, distrust,
anger
• Most important predictor of cardiovascular disease
• More often anxious and depressed
TYPE A ATFERDSMØNSTER
 Skade på arteriene
• Høyere nivåer av katecholaminer
• Høyere blodtrykk og innsnevring av arteriene
• Slitasje gjør at kolesterol fester seg lettere på
arterieveggene og forårsaker arteriosclerose
 Kjønnsforskjeller
• Menn har høyere risiko
• Kvinner uttrykker vanligvis ikke aggresjon så mye
som menn
TYPE A BEHAVIORAL PATTERN
 Arterial damage
• Higher levels of catecholamines
• Higher blood pressure and arterial constriction
• Wear and tear makes cholesterol attach easier and
cause arteriosclerosis
 Gender differences
• Men have a higher risk
• Women tend not to express aggression as much as
men
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