CHAPTER 13: STRESS, COPING, AND HEALTH - Biopsychosocial model: physical illness is caused by a complex interaction of biological, psychological

and sociocultural factors - Healthy psychology: concerned with how psychosocial factors relate to the promotion and maintenance of health and with the causation, prevention and treatment of illness A) THE NATURE OF STRESS - stress: any circumstances that are deemed to threaten ones well being hence tax ones coping abilities A.1) Stress as an Everyday Event - individuals response to stress may depend on: 1) type of stressor and its controllability 2) biological factors (age and gender) 3) individuals previous experience with stress - research: routine hassles may have significant harmful effects on mental and physical health A.2) Appraisal: Stress Lies in the Eye of the Beholder - Primary appraisal: an initial evaluation of whether an event: 1) irrelevant 2) relevant but not threatening 3) stressful When view an event as stressful, - Secondary appraisal: evaluation of your coping resources and options for dealing with the stress B) Major Type of Stress - acute stressors: threatening events that have a relatively short duration and a clear endpoint - chronic stressor: have long duration and no apparent time limit Major Type of Stress 2) Conflict 3) Change - two or more - noticeable life changes incompatible that require readjust. motivations compete - Type: - SRRS measurement 1) approach-approach 2) avoid-avoid 3) approach-avoid

1) Frustration - occurs in any situation

4) Pressure - expectation to behave in a certain way

B.1) Frustration - occurs in any situation where the pursuit of goals is thwarted

B.2) Conflict - two or more incompatible motivations or behavioral impulses compete for expression - approach- approach: choice between 2 attractive goals (least stressful) - avoidance-avoidance: choice between 2 unattractive goals (highly stressful) - approach-avoidance: choice of whether or not to pursue a single goal with both attractive and unattractive aspects (quite stressful) > often produce vacillation: indecisive when making decision (yes and then no) B.3) Change - noticeable alterations in ones living circumstances that require readjustment - can be caused by +ve events - Holmes and Rahe developed: Social Readjustment Rating Scale (SRRS) > High score: vulnerable to many kinds of physical and psychological problems > critics: lists are dominated by highly negative events > SRRS doesnt only measure life changes but also wide range of stressful experiences B.4) Pressure - expectations or demands that one behave in a certain way - increased pressure is related to increased risk for heart disease C) RESPONDING TO STRESS 1) Emotional Responses 1) annoyance, anger, rage 2) apprehension, anxiety, fear 3) dejection, sadness, grief Figure: 4)Barbara Fredrickson (positive emotion) RESPONDING TO STRESS 2) Physiological Responses Figures: 1)Walter Cannon (flight-or-fight responses) 2) Hans Selye (General adaption) - alarm, resistance, exhaustion 3) Brain-body pathways - hypothalamus activates: 1) sympathetic ANS (catechola) 2) endocrine system (corticote) 3) Behavioral Responses - mostly involves coping Responses: 1) Giving Up and Blaming Onesel. 2) Striking Out at Others 3) Indulging Oneself 4) Defensive Coping 5) Constructive Coping

The Stress Process - Event Stressful events

- Evaluation Cognitive Appraisal

- Action 1) Emotional response 2) Physiological response 3) Behavioral response

C.1) Emotional Responses C.1.1) Emotions Commonly Elicited - specific cognitive reactions to stress (appraisals) and specific emotions

- Commonly Elicited: 1) annoyance, anger and rage 2) apprehension, anxiety and fear 3) dejection, sadness and grief - Positive emotions may appear in times of stress and promote resilience in the face of stress - Explained by Barbara Fredericksons broaden-and-build theory of positive emotion: 1) +ve emotions alter ones mindsets, broadening scope of attention and increase creativity and flexibility in problem solving 2) undo the lingering effects of negative emotions, thus short-circuit the potentially damaging physiological responses to stress 3) promote rewarding social interactions that help to build valuable social support, enhanced coping strategies, and other enduring personal resources - Proofs: +ve emotions and low level of stress hormones and reduced mortality, enhanced immune response, protective against heart disease C.1.2) Effects of Emotional Arousal - high emotional arousal can interfere with attention and memory retrieval and can impair judgment and decision making - inverted U-hypothesis: increased arousal improves task performance up to a point and then disrupts it - optimal level of arousal: performance peak > depends on the complexity of the task C.2) Physiological Responses C.2.1) The Flight-or-Fight Response - physiological response to threat where autonomic nervous system mobilizes the organism for attacking (fight) or fleeing (flight/escape) > ANS controls: blood vessels, smooth muscles and glands > flight or fight response is initiated by sympathetic division C.2.2) The General Adaptation Syndrome - patterns seen in animals as the same, regardless they type of stress - Hans Selye: General adaptation syndrome- model of bodys stress response consisting 3 stages: 1) alarm organism recognizes the existence of a threat (fight-or-flight response) 2) resistance physiological changes stabilize as coping efforts get under way 3) exhaustion bodys resources are depleted to overcome MORE stress C.2.3) Brain-Body Pathways - endocrine system: glands located at various sites in the body > secrete hormones - hypothalamus: brain structure that initiates action

- There are 2 pathways: 1) hypothalamus activates sympathetic division of ANS > keypart of action involves stimulating the central part of the adrenal glands(adrenal medulla) to release large amount of catecholamines into the bloodstream > net result: body is mobilized for action > heart rate and blood flow increase, more blood pumped into brain and muscle, respiration and oxygen consumption speeds up, digestive processes are inhibited to conserve energy, pupils dilate increasing visual sensitivity 2) direct communication between the brain and the endocrine system > hypothalamus sends signals to master gland of the endocrine system: pituitary > pituitary secretes a hormone (ACTH) that stimulates the outer part of the adrenal glands to release corticostreroids > these hormones increase energy and help inhibit tissue inflammation in case of injury - stress can interfere with neurogenesis D) Behavioral Responses - mostly involves coping: active efforts to master, reduce or tolerate the demands created by stress - maybe adaptive or maladaptive - Coping Inventory for Stressful Situations (CISS) measures: 1) task-oriented coping 2) emotion-oriented coping 3) avoidance-oriented coping D.1) Giving Up and Blaming Oneself - Learned helplessness (Behavioral Disengagement) : passive behavior produced by exposure to unavoidable aversive events > when events are beyond control > increases when stress increases - Catastrophic thinking: causes aggravates, perpetuates emotional reactions to stress that are often problematic > becomes highly self-critical - Excessive self-blame is unhealthy D.2) Striking Out at Others - Aggression: behavior intended to hurt someone physically or verbally - Frustration-aggression hypothesis: aggression is always caused by frustration > Freud defense mechanism recognizes it as displacement D.3) Indulging Oneself - when people are stress: tend to engage in excessive consumption (unwise pattern of drinking, eating, smoking etc)

D.4) Defensive Coping - Originated from Freud - Defense mechanism: unconscious reactions that protect a person from unpleasant emotions such as anxiety and guilt > mostly distorts reality but excessive distortion are maladaptive, small illusions are beneficial D.5) Constructive Coping - healthy efforts that people make to deal with stressful events - The elements that make the coping constructive: 1) confronting problems directly 2) based on reasonably realistic appraisals of stress and coping resources 3) learning to recognize, regulate, potentially disruptive emotional reactions to stress EFFECTS OF STRESS ON. 1) PSYCHOLOGICAL FUNCTIONING 2) PHYSICAL HEALTH 1) Impaired task performance - mostly heart disease 2) Burnout 3) Post-traumatic stress disorder 4) Psychological problems and disorder 5) Positive effects

E) THE EFFECTS OF STRESS ON PSYCHOLOGICAL FUNCTIONING E.1) Impaired Task Performance - pressure to perform makes people self-conscious and disrupts their attention which then uses ones limited working memory capacity E.2) Burnout - involves physical and emotional exhaustion, cynicism, and a lowered sense of self-efficacy that can be brought on gradually by chronic work-related stress > includes: chronic fatigue, weakness and low energy > caused by work overload, interpersonal conflicts at work, lack of control over work responsibilities, inadequate recognition for ones work E.3) Post- Traumatic Stress Disorder - involves enduring psychological disturbance attributed to the experience of a major traumatic event > e.g: the aftermath of a suicidal case E.4) Psychological Problems and Disorders - poor academic performance, insomnia, sleep disturbance - also: schizophrenia, anxiety disorder E.5) Positive Effects - Resilience: successful adaptation to significant stress and trauma > promotes personal growth and self-improvement > improve coping abilities and reduced reactivity to future stressful events

F) THE EFFECTS OF STRESS ON PHYSICAL HEALTH - continuos stress weakens the resistance to disease and disrupts the functioning of the hormonal and metabolic system - Psychosomatic disease: physical ailments that were thought to be caused in part by stress and other psychological factors (makan hati (; ) > heavily related to stress F.1) Type A Personality, Hostility and Heart Disease - coronary heart disease: reduction in blood flow in the coronary arteries - Atherosclerosis: principal cause of coronary heart disease, gradual narrowing of the coronary arteries - risk factors: older age, smoking, lack of exercise, high cholesterol level, high blood pressure - Meyer Friedman and Ray Rosenman: Type A personality possesses 3 elements: 1) strong competitive orientation 2) impatience and time urgency 3) anger and hostility > strong relation with heart disease (hostility) - Type B- relatively relaxed, patient, easygoing, amicable behavior - Stewart McCann: Precocity-longevity hypothesis: early peaks and success in an individuals career achievements may be the very factors that set the conditions for the early death of those who have this early success F.2) Emotional Reactions, Depression and Heart Disease - brief period of mental stress can trigger acute symptoms of heart disease - mental stress may trigger inflammation that is thought to cause cardiovascular risk F.3) Stress, Other diseases and Immune Functioning - researchers have found an association between life stress and the course of rheumathoid arthritis, back pain, diabetes, herpes, flare-ups of irritable bowel syndrome, high-blood pressure > partial answer: immune functioning - immune response: bodys defensive reaction to invasion by bacteria, viral agents or other foreign substances - stress suppresses immune system - other theory: > when immune system responds to infection or injury it may release proinflammatory cytokines > cytokines: proteins that orchestrate a number of the immune activities that plays a role in killing the pathogen and repairing damaged tissue > but persistent stress will overproduce cytokine that would cause chronic inflammation (then heart disease) F.4) Sizing Up the Link between Stress and Illness - subjects elevated levels of stress and illness could both be due to a third variable

G) FACTORS MODERATING THE IMPACT OF STRESS 1) social support 2) optimism 3) conscientiousness G.1) SOCIAL SUPPORT - various types of aid and emotional sustenance provided by members of ones social networks - increased social support reduces mortality. ve effect of inadequate social support is greater than obese - explicit social support: overt emotional solace and instrumental aid from others - implicit social support: comfort that comes from knowing that one has access to close others who will be supportive G.2) OPTIMISIM AND CONSCIENTIOUSNESS - optimism: tendency to expect good outcomes > optimists are more likely to engage in action-oriented, problem-focused coping, more willing to seek social support, more likely to emphasize +ve appraisals in stressful events - conscientiousness: better physical health > tend to gravitate to healthy environments and may show less reactivity to stress > key: they foster better health habits H) HEALTH-IMPAIRING BEHAVIOR HEALTH-IMPAIRING BEHAVIOR 1) smoking 2) lack of exercise 3) alcohol and drug use 4) Behavior and AIDS H.1) Smoking - smokers ingest more than 7000 chemicals - life expectancy: 13-14 years shorter - risk for: oral, bladder and kidney cancer, larynx, esophagus, pancreas, arteriosclerosis, hypertension, stroke heart disease -also endangered other people: secondhand smoke or environmental tobacco smoke H.2) Lack of Exercise - regular exercise is associated with increased longevity because it can: 1) reduce susceptibility to heart disease 2) reduce risk of wide variety of obesity-related health problems 3) reduce chronic inflammation 4) potentially damaging physical effects of stress - exercises also facilitates neurogenesis H.3) Alcohol and Drug Use

- drugs can immediately kill if taken overdose or at least impairs the individuals H.4) Behavior and AIDS - AIDS (acquired immune deficiency syndrome): disorder for which the immune system is gradually weakened and eventually disabled by the human immunodeficiency virus (HIV) - potential solution: Highly Active Antiretroviral Therapy (HAART) may allow longer survival H.4.1) Transmission - through person-to-person contact involving the exchange of bodily fluids, mainly semen and blood > sharing needles > among gay and bisexual men > virus can be found in tears and saliva H.4.2) Prevention - the more sexual partners that a person has, the higher the risk that the person will be exposed to the virus - so, have fewer sex partners H.5) How Does Health-Impairing Behavior Develop 1) the habits slowly creeps up on people 2) health-impairing activities usually involve activities that are pleasant 3) the disease takes 10-30 years to appear 4) people have a curious tendency to underestimate the risks that accompany their own healthimpairing behaviors while viewing other much more accurately I) REACTION TO ILLNESS I.1) Deciding to Seek Treatment - Reasons people delay seeking doctors: 1) misinterpret and downplay the significance of their symptoms 2) worried about looking silly if the problems turn out to be nothing 3) worry about bothering their physician 4) reluctant to disrupt their plans I.2) Communicating with Health Providers - little time for discussion, medical jargons - solution: dont be a passive consumer of medical services, arrive on time and be accurate in describing own problem I.3) Adhering to Medical Advice 1) patients fail to understand the given instruction (using medical jargon) 2) difficult instruction (the more it interferes with daily routine, the less cooperation it is) 3) patients negative attitude towards a physician