Chapter 13
Stress, Coping and Health
The Relationship Between Stress and
Disease
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Contagious diseases vs. chronic diseases
Biopsychosocial model
Why?
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The Biomedical Model is unable to fully account for health
Mind-body question
Biomedical treatments only
Failures to account for many psychological factors and health
Placebo effects – how to explain
Health psychology
– Health promotion and maintenance
• Discovery of causation, prevention, and treatment
– Primary prevention, secondary prevention, tertiary prevention
– Changing pattern of what is the primary cause of death in last 100+
years.
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Levels of Prevention
Primary Prevention
•Prevent disease
•Identify causes
•Promote health behaviors
Secondary Prevention
•Catch disease in early stages
•Prevent further deterioration
Tertiary Prevention
•Manage illnesses with no
cure
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Changing patterns of illness
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Stress: An Everyday Event
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Major stressors vs. routine hassles
– Cumulative nature of stress
– Psychological Stress - Lazarus
– Cognitive appraisals: primary and secondary
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Major types of stress
– Frustration – blocked goal
– Conflict – two or more incompatible motivations
• Approach-approach, approach-avoidance, avoidance-avoidance –
Figure
– Change – having to adapt
• Holmes and Rahe – Social Readjustment Rating Scale – Life
Change Units –
– Pressure – expectations to behave in certain ways
• Perform/conform
• Figure – pressure and psychological symptoms – Weiten (1988)
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Overview of Stress Process –
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Psychological Stress
Richard Lazarus (1966) defined psychological stress as “…a
generic term for the whole area of problems that includes the
stimuli producing stress reactions, the reactions themselves,
and the various intervening processes.”
Lazarus and Folkman (1984) define psychological stress as “a
particular relationship between the person and the
environment that is appraised by the person as taxing or
exceeding his or her resources and endangering his or her
well being.”
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Appraisal Process
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The primary appraisal process determines whether
the environment is perceived as psychologically
threatening, harmful, or challenging to the person.
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The secondary appraisal process is a complex
evaluative process in which a person considers
resources available to cope with the primarily
appraised stressor.
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Pressure and psychological symptoms (Weiten, 1988,
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1998)
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Responding to Stress Emotionally
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Emotional Responses
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Annoyance, anger, rage
Apprehension, anxiety, fear
Dejection, sadness, grief
Positive emotions
Slide 12, after 9/11 – correlations between emotion and
resilience
Emotional response and performance
– The inverted-U-hypothesis – Figure – performance and task
complexity
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Table 13-2, p. 518
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Responding to Stress Physiologically
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Physiological Responses
– Fight-or-flight response
– Selye’s General Adaptation Syndrome
• Alarm
• Resistance
• Exhaustion
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Brain-body pathways in stress –
– sympathetic adrenal medullary (SAM)
– hypothalamic pituitary adrencortical (HPA)
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Physiological Stress
Hans Selye first introduced the term stress
to medicine in 1936. He noted that animals
were induced by a variety of stimuli to
show the “syndrome of just being sick”
which resulted in adrenal enlargement,
gastrointestinal ulcers, shrinkage of the
thymus and lymph nodes. This reaction
was termed the “general adaptation
syndrome” and “stress is the nonspecific
response of the body to any demand made
upon it”.
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Brain-body pathways
in stress: SAM and HPA systems
Lundberg (2002), “[Two]
neuroendocrine systems have
been of particular interest in the
study of stress; the sympathetic
adrenal medullary (SAM) system
with secretion of the two
catecholamines, epinephrine and
norepinephrine, and the the
hypothalamic pituitary
adrencortical (HPA) system with
the secretion of cortisol.”
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Responding to Stress Behaviorally
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Behavioral Responses: Coping – emotion focused
– Frustration-aggression hypothesis
– catharsis
Defensive Coping – ego defense mechanisms –
Freud –
 Constructive Coping – problem focused
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Table 13-3, p. 523
Emotion-focused coping and
Problem-focused coping
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“Emotion-focused (or palliative) coping refers to
thoughts or actions whose goal is to relieve the
emotional impact of stress. These are apt to be
mainly palliative in the sense that such strategies of
coping do not actually alter the threatening or
damaging conditions but make the person feel
better.”
Monat and Lazarus “Problem-focused coping refers
to efforts to improve the troubled person-environment
relationship by changing things, for example, by
seeking information about what to do, by holding
back from impulsive and premature actions, and by
confronting the person or persons responsible for
one’s difficulty.” Monat and Lazarus
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Effects of Stress: Behavioral and
Psychological
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Impaired Task performance
 Burnout – antecedent-components-consequences –
 Posttraumatic Stress Disorders (PTSD) – effects on
hippocampus (cortisol) – prevelance of traumatic
events –
 Reaction to traumatic stress –Psychological problems
and disorders – more in Chapter 14
 Positive effects – eustress – Positive Psychology –
Flow (Csikszentmihalyi)
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The antecedents, components,
and consequences of burnout
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Effects of Stress: Physical
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Psychosomatic diseases
 Heart disease
– Cholesterol and inflammation (C-reactive protein) and risks –
Type A behavior - 3 elements
• strong competitiveness
• impatience and time urgency
• anger and hostility (most related to cornary events)
– Emotional reactions and depression –study by Pennix et al.
(2001) – anger and coronary risk
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Stress and immune functioning
– Reduced immune activity
– Possible health problems linked to stress
– Stress-illness correlation
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Table 13.3a Health Problems that may be Linked to Stress
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Table 13.3b Health Problems that may be Linked to Stress
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Factors Moderating the Impact of Stress
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Social support
– The perceived comfort, caring, esteem or help received from others.
– Types: emotional, belongingness, instrumental (tangible),
informational, esteem/relational, and network (Facebook and
MySpace?)
– The existence or quantity of social relationships
– the amount of assistance individuals believe is available to them
– the amount of assistance individuals receive
– Alameda County Study in 1965 – related to health outcomes, tend
to live longer
– Increased immune functioning
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Optimism
– expectation of good things will happen and bad things will not
happen, contrasted to pessimism
– Related to psychological well-being, physical well-being
– More adaptive coping
– Pessimistic explanatory style
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Conscientiousness
– Fostering better health habits
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Autonomic reactivity
– Cardiovascular reactivity to stress
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Health-Impairing Behaviors
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Smoking – prevalence in U.S. – Smoking cessation –
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Poor nutrition – obesity – “Super Size” generation
– Cholesterol and coronary risk –
– High fructose corn syrup effects
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Lack of exercise – increased T.V. watching effects study
Obesity – BMI – United States 2005 & 2008 data – CDC –
changes over the years
Alcohol and drug use
Risky sexual behavior
Transmission, misconceptions, and prevention of AIDS – AIDS
Risk Knowledge Test Table of Contents
The prevalence of smoking in the United States
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Quitting smoking and cancer risk
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The link between
cholesterol and
coronary risk
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Fig. 13-14, p. 535
BMI Classifications
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BMI = 19-25; Normal; Low Risk
BMI = 25-30; Moderately overweight; Some Risk
BMI = 30-35; Class 1 obesity; High Risk
BMI = 35-40; Class 2 obesity; Very High Risk
BMI> 40; Class 3 obesity; Extreme Risk
BMI > 30, or ~ 30 lbs. overweight for
5'4" person for 2005 - CDC
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BMI Classifications
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BMI = 19-25; Normal; Low Risk
BMI = 25-30; Moderately overweight; Some Risk
BMI = 30-35; Class 1 obesity; High Risk
BMI = 35-40; Class 2 obesity; Very High Risk
BMI> 40; Class 3 obesity; Extreme Risk
BMI > 30, or ~ 30 lbs. overweight for
5'4" person for 2008 - CDC
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Reactions to Illness
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Seeking treatment
– Ignoring physical symptoms
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Communication with health care providers
– Barriers to effective communication
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Following medical advice
– Noncompliance
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Biopsychosocial factors in health
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Biopsychosocial
factors in health
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Stress Management
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Relationship to coping to self-esteem
Cognitive reappraisal – Ellis’s model –
Humor –Relaxation Response – Benson
Stress Inoculation Training –Physical fitness and
mortality –
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Albert Ellis’s A-B-C model of emotional
reactions
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Possible examination for the link between humor
and wellness
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Fig. 13-18, p. 543
Stress management techniques adapted from Monat & Lazarus (1991)
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Environment/Lifestyle: time management, proper
nutrition, exercise, finding alternatives to frustrated
goals, stopping bad habits
Personality/Perception: assertiveness training,
thought stopping, refuting irrational ideas, stress
inoculation, modifying type A behavior
Biological responses: progressive relaxation,
relaxation response, meditation, breathing exercises,
biofeedback, autogenics
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Relaxation Response – Benson
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“The relaxation response is perhaps best understood
as a psycho-physiological state of hypoarousal
engendered by a multitude of diverse technologies
[techniques]” (Everly, 1989)
Meditation - a self-generating practice of a variety of
techniques designed to induce the relaxation
response by use of a repetitive focal device
Progressive relaxation - relax selected muscles by
first tensing then relaxing the muscles
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Stress Inoculation Training
developed by Donald Meichenbaum
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Stage 1 - education - the person is given a framework
for understanding his/her stress response
Stage 2 - rehearsal - the person learns to make
cognitive self-statements as a form of coping and
problem solving
Stage 3 - application - the person uses the
information and skills learned in the first two stages in
actual stress situations, moving from lower to higher
stress situations
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