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 • • • • • Interaksjonsmodell Transaksjonsmodell Helseatferdsmodell Predisposisjonsmodell Sykdomsatferdsmodell HEALTH PSYCHOLOGY Psychological factors and specific behavior both have health consequences Personality and health models • • • • • 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 • • • • • Økt puls Svette i håndflatene og fotsålene Høyere blodtrykk Økt oppmerksomhet mot omgivelsene Fight/flight-reaksjon STRESS RESPONSE Increase in sympathetic nervous system activity • • • • • 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 • • • • • • 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 • • • • • • 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