Health Pscyh Paper 2

Discuss one or more biological explanations to one or more health problems

• Kiecolt-Glaser(1984)

• Newcomer

-cortisol effects the bio process of memory

-biological explanation is stress (cortisol) explained by general adaptation model

-health problem is immune suppression and stress effect on hippocampal activity

Discuss one or more cognitive explanations to one or more health problems

• Marmot et al (1997) Whitehall Study

• Speisman et al (1984)

-cognitive explanation —>cognitive appraisal theory

-how we perceive & interpret stressors

-health problem —> heart disease

Discuss one or more social-cultural explanations of one health problem

• Kiecolt-Glaser (1984)

• Marmot et al (1997) Whitehall Study

-similar to cognitive

-focus on the role of social hierarchies and/or control

-also social aspects as a protective factor (moderating stress) —>social support as a buffer & improves survival to serious illness

Discuss prevalence rates of one health problem

• Curran and Hill (2017)

• Shapiro et al (1998)

-operationalize stress to smth that causes health problem —>perfectionism

-health problem is depression

Biological Explanations Discussion

Strength of explaining health problems through stress and the G.A.S model- provides a clear 3 stage physiological framework to explain how prolonged stress leads to physical illness. It establishes a predictable and measurable pattern that can be measured in individuals. It also identifies the specific biological processes and physiological changes associated with the body's stress response.

Limitation- psychological and situational factors are not often considered as it mainly focuses on biological processes such as cortisol release and immune suppression. Individual differences like coping strategies are not considered even though they can influence how stress affects health and also doesn't consider participants' perception of the stressor. It also doesn't distinguish between gender differences in stress and coping. 

It's difficult to study the physiological effects of stress ethically and accurately in humans. Researchers can’t purposely expose participants to prolonged or extreme stress, meaning that much of the evidence relies on animal studies or self reported stress levels, which may not fully reflect real life human stress responses. Also, the G.A.S. model was developed and based on studies conducted on rats which may not accurately represent the complex or physiological stressors examined by humans.

Cognitive Explanations Discussion

Limitation- difficulty of studying stress in a controlled and ethical way. Stress is a subjective experience and it’s difficult to operationalize and measure objectively. While laboratory studies allow researchers to control variables and isolate the role of cognitive appraisal, they often rely on artificial stressors that may not accurately reflect real life stress experiences. Real world stressors such as financial issues or chronic work stress stress are prolonged, complex, and influenced by multiple factors which makes it difficult to establish clear cause and effect relationships between cognitive appraisals and health outcomes. 

-population validity, many studies on cognitive appraisal and stress use limited representative samples such as students or specific occupational groups.The sample was mainly college students which means they may be more resistant to heart problems than older individuals. Similarly, Marmot focused on British civil servants, which limits the generalizability of the findings to other populations. Cultural values, social norms, and access to coping resources can influence appraisal processes which suggests that cognitive explanations of stress may not apply equally to everyone.

Further issue-whether there’s a difference in the appraisal process for acute and chronic stressors. But chronic stressors are ongoing and may lead to repeated or continuous appraisals. Over time, people may experience fatigue where stress responses remain even when the person recognizes the situation as uncontrollable. This suggests that cognitive appraisal theory may be more effective at explaining response to acute stressors. 

S-C Explanation Discussion

Western culture bias- possible findings may not apply to other cultures due to power distance.

Social stressors- poverty and how that affects the s-c explanations of stress. Social stressors can threaten social status, relationship, and health issues and could lead to decreased job satisfaction.

Those at the bottom were the most stressed because of a lack of control of their environment and had the most negative health effects. This challenged the idea that  those at the top of the hierarchies must be the most stressed. Even though the individuals had stable jobs and access to healthcare, they still had higher rates of heart disease. This reinforces the idea that one's place in the social hierarchy and their level of control influence health outcomes instead of other factors like income.

Prevalence Rates Discussion

Data collection problematic- reliance on self-reported data, operationalization of variables, and obtaining a valid sample with enough participants. Self-reported questionnaires are vulnerable to social desirability bias and can be distorted by the mood of the participant that can influence how past events or personality traits are perceived. Small sample size reduces accuracy of results and in determining a true effect. 

Comparing prevalence rates over time is problematic-there’s many variables that could account for any difference over time. It is possible the increased prevalence rates of depression in young adults is the result of better awareness and acceptance of stress and mental illness and only appears as an increase due to reporting bias. Increased public awareness of mental health issues may lead more people to recognize and report  depression which makes it difficult to determine whether depression prevalence is due to perfectionism or if it just reflects improved diagnosis. Increased reports of depression over time may not actually reflect an increase but instead changes in how it is diagnosed.
Cross sectional nature of the studies on prevalence makes it difficult to determine if perfectionism increases the chance of developing  depression or if experiencing depression increases perfectionism thinking through self-criticism. It is not certain if perfectionism leads up to depression or emerges due to depressive symptoms without any  longitudinal evidence to check on individuals over time. 

Bio Thesis

Therefore, chronic stress has been shown to suppress immune system functioning and impair hippocampal activity, increasing vulnerability to illness and cognitive problems. 

Cog Thesis

Cognitive processes play a significant role in determining whether stress leads to negative health consequences.

S-C Thesis

These factors increase the chance of stress related illness as individuals lower in the social hierarchy and low social support are likely to be affected by chronic stress, negatively impact their immune system and lead to cardiovascular disease. 

Prevalence Thesis

By exploring the prevalence rates of depression, it can demonstrate the increasing impact stress has on the mental health of university students. 

Research Method Question

• Kiecolt-Glaser

-Natural experiment—>naturally ocuring things so high ecological validity

• Marmot et al

-prospective longitudinal study

• Speisman

-true experiment

Ethical Consideration Question

• Kiecolt-Glaser

-undue stress & harm—>how to study stress ethically to not cause harm—>exams are naturally occurring so don’t need to create stress

• Newcomer

-undue stress & harm—>dangerous intake of cortisol, so need to reverse

-informed consent—>participants really know the effects of cortisol?

• Speisman

-undue stress & harm—>watching video was highly stressful, how to reverse?

Possible: Compare and Contrast biological & cognitive explanations of one health problem

• Kiecolt-Glaser

• Newcomer

• Marmot

• Speisman

?

Stress

process by which a person perceives and responds to events (stressors) that are judged to be challenging or threatening

responds—> fight or flight (Canon)

Chronic Stress

stressors that last long time. Difficult to remove or change by lifestyle choice.

Acute Stress

Stressors that appear suddenly, don’t last long, & demand immediate attention, the day to day stuff (assignments)

Hans Selye- GAS

Model of stress & illness. Animals respond to a range of different stressors (general) with the same pattern (adaptation)

1. Alarm stage

- hypothalamus responds to stressors by activating the fight or flight response. Assists in coping w/ the stressors

2. Resistance stage

-adrenal cortex releases glucocorticids to help the body react to stressors until the stress is resolved or body can’t resist anymore

3. Exhaustion stage

-stress has been persistent for long period. Body’s ability to cope w/ it is depleted (energy reserves used up). Immune system is depleted & major health effects seen.

Health and illness are shaped by interactions between:

Biology (cortisol, immunity)

-stressors can raise cortisol

Psychology/Cognitive (beliefs, appraisal)

-interpretation of stressor changes the response

Social Cultural (social support, social hierarchy)

-social support can buffer feelings and bodily effects

Stressor

Demanding events or situations that trigger coping adjustments in a person, adverse or challenging event

can trigger stress response bc perceived as demanding or threatening

Risk of chronically elevated cortisol

contribute to immune suppression and increased illness vulnerability

Appraisal

the process of perceiving and interpreting the event (stressor)

Stress occurs (cog)

when there’s disparity between the demands of the stressor and the available coping resources

Richard Lazarus Cognitive Appraisal Theory

• Stress depends on how you interpret a situation. how we perceive & interpret stressor is what matters.

-same event can feel highly stressful to one but manageable to another depending on their thoughts abt what’s happening

• mental process by which ppl assess 2 factors, 2 stages of appraisal—>

• Primary appraisal: threat, challenge, or neutral? Evaluate what the event means to you

• Secondary: focuses on what you can do abt it. Both influence intensity of stress u experience

Social Support

Protective factor for stress

Resources provided by other ppl that help you cope with stress

Kiecolt-Glaser

• lower immune functioning during exam period than during less stressful times

• strong support networks—>less harmful, physiological impact

Social hierarchies and/or control (S-C)

Our place within them can affect our health.

It appears that those at the bottom were the most stressed bc of lack of perceived control of their environment and had the most negative health effects.

Prevalence of Health Problems (Stress)

when we discuss how common a problem is

May focus on ways the rates are used (to evaluate a health program) or factors that may affect prevalence rates such as does a particular health program increase/decrease the health problem

Incidence:# of new cases diagnosed in a certain period of time within a population

(incidence) rates can be used to indicate if a behavior is increasing in a society- if so, what are the factors that may be responsible

Kiecolt-Glaser (84)

Aim: see if the stress of important exams could lead to a decrease in immune function

Procedure: Natural experiment. 1st yr med students volunteered and were tested for their level of stress before it began using Social Readjustment Rating Scale to account for life changing events in the past year that would raise their level of stress. They were divided to high or low stress groups. Levels of loneliness measured to put in to high and low loneliness groups. Blood sample taken and another after 2 examinations completed. Natural Killer cell measured in their blood, lymphocytes which provide rapid response to viral-infected cells.

Results: Significant decrease in NK activity between 1st & 2nd blood test, which was given during stress of examinations. HIgh stress group more likely to have lower levels of NK, so stress experienced previous to exams played a role in their immune systems ability to cope w/ stress of exams. High loneliness group had lower levels of NK, confirms role of social support as a protective factor for better health. Concluded that stress has direct effect on immune system by suppressing NK activity.

Strengths of Kiecolt-Glaser

• Ability to study stress’s role on the immune system on humans in a way that was ethically sound since before studies on stress were carried out on animals.

• Naturalistic, so there wasn’t need to create any stress for participants as they studied naturally occurring events, high ecological validity.

• Repeated measures design as an individual's NK cell count was compared before and after the stress of exams. This got rid of participant variability as each person’s “post-stress” NK cell count was compared to their “low-stress” baseline NK cell count

Limitations of Kiecolt-Glaser

• Natural experiment, the controls over the experiment weren’t as good as they would have been in a laboratory experiment. Some participants may have better coping strategies which would regulate their stress response, affecting the results.

• Younger people usually have stronger immune systems which would make it difficult to generalize findings to older people.

• Stress of exams is an acute stressor so more research needs to be done to the extent to which the nature of the stressor may have an effect on the immune system. 

Newcomer

Aim: investigate whether high levels of the stress hormone cortisol interfere with verbal declarative memory

Procedure: students & employees of University Medical Center were given clinical interview w/ physician to make sure they were free of any illnesses that would affect study. 3 experimental conditions:

• high cortisol group given a tablet containing cortisol each day of 4 day experiment

• Low cortisol group given tablet containing cortisol per day.

• Placebo group given placebo tablets w/ no active ingredient (control group)

Matched-pairs design for gender & age. Double-blind control. Listened & recall parts of prose paragraph to test verbal declarative memory since it is often affected during long-term stress & cortisol involved in memory impairment.

Results: Errors tended to be omission rather than commision, results due to impairment of recall. Placebo group improved paragraph recall performance over 4 days. Cortisol treated group no improvement. High cortisol levels impaired performance in memory task since participants in highest cortisol showed worst performance.

Link? Demonstrate clear link between levels of cortisol & remembering. Appears cortisol interferes w/ transfer of short term memory to long-term memory that takes place in hippocampus. Bc several cortisol receptors on the hippocampus.

Newcomer Strengths

• Established a clear cause and effect relationship between the independent variable and the dependent variable.

• Clear relationship between the amount of cortisol ingested and the performance on the memory test.

Newcomer Limitations

• Experiment ran over several days but the participants weren’t in the lab the whole time, the researchers didn’t have full control over extraneous variables.

• Memorizing a piece of prose isn’t really the most authentic memory experience even though it could explain student exam stress, the ability to transfer the results to other situations may be limited.

• Ethical considerations since participants ingested cortisol which affected their memory negatively. 

Marmot

AIm: if those in the lower position jobs (less control over work environment) would develop heart problems over the 5 year period

Procedure: Prospective longitudinal study. Analyzed data from over 7k participants of civil servants. Used series of questionnaires and health screenings to get data. Participants Invited to research clinic & questionnaire sent home @ 5yr intervals. Self-reported nonfatal heart problems & cases of cancer & diabetes confirmed by hospital records.

Results: similar correlation between heart disease & status found in 1st Whitehall study. Rate of heart problems in the lowest levels of the system were 1.5x the rate in the highest levels. Most significant factor was the degree of control participants felt they had.

Marmot Strengths

• Alot of studies and evidence that support findings of the connection between workplace hierarchy and health outcomes.

• Everyone in Britain receives the same quality of healthcare, the level of health care isn’t a confounding variable.

• Prospective longitudinal study is a strength as it allows researchers to track health outcomes over time and provide strong evidence for cause and effect relationships.

Marmot Limitations

• Mainly relying on self-report questionnaires could be influenced by social desirability effects in individual responses regarding risk factors.

• Not all participants may have been conscious of or honest about their health over the five year period even though hospital records were used, but access to these records were not always available.

• Sample was taken from the British government's civil servants and the hierarchy could be more rigid than in other large employers. May not be representative of conditions experienced in the average workplace. 

Speisman

Aim: test role of cognitive appraisal on the stress response.

Procedure: Undergraduate psych students & middle-level airline executives watched film of indigenous circumcision ceremony w/ different soundtracks. Trauma condition could hear noises of the surgery & told how painful it is. Intellectualization condition heard voice-over by anthropologist explaining the history tradition. Denial condition where celebration tone of boy becoming men (control group-no sound). Participants heart rate & galvanic skin responses measured. Right after film they filled out questionnaires that evaluated feeling of stress.

Results: Trauma condition showed much higher physiological measures of stress than other conditions. Self-reported emotional responses in questionnaire were stronger for those in either control group or trauma group. Shows we gather info from environment to determine how we react to a situation.

Speisman Strengths

• True experiment was highly controlled and established a cause and effect relationship between the cognitive label and the displayed stress response, making it have high internal validity.

• Random allocation is also a strength to control for participant variability.

• Physiological measures and the questionnaire response were compared using a single blind design which eliminated research bias.

Speisman Limitations

• Ethical problems as watching the film was highly stressful for the participants.

• Highly artificial, it may not represent how individuals experience and appraise stressful events in real natural settings and therefore lack ecological validity.

• Self-reported emotional responses were also not objectively measured and are open to demand characteristics

Curran & Hill (2017)

Aim: How levels of perfectionsim had changed over 27 yr period in cohort groups w/ same age & generally same environment.

Procedure: Meta-analysis

Curran & Hill Strengths

• Includes data collected over a long period of time and collected from different laboratories.

• Highly standardized nature increases its reliability and minimizes external factors.

• Meta-analysis allows researchers to observe a very large sample size which can provide more accurate results and strengthens the ability to generalize findings to the target population. 

Curran & Hill Limitations

• Meta Analysis can be open to researcher bias

• Correlational and establishes a trend, but it isn’t able to fully explain the nature of the trend

• No measures of stress obtained and no measure of physiological indicators of stress or self-reported levels of stress.

• Findings are restricted to a sample of white university students from higher socioeconomic backgrounds so it's difficult to generalize to all young people.

• Cross sectional nature of the study makes it unknown if students in the 80s now have higher levels of perfectionism. If society is the root of this stress, it would be important to know if other generations are also increasing their scores of perfectionism or if it's only limited to university students.  

Shapiro et al (98)

Aim: Evaluate effectiveness of Mindfulness-Based Stress Reduction in reducing stress in premed students.

Procedure: carried out control group w/ pre-med students offered MBSR course randomly assigned to the course or waiting list. Filled out self-report questionnaire assessing stress before the course & during exams.

Results: No difference in stress levels between 2 groups at beginning of the term. Ppl in waiting list expressed more stress during exams compared to other group, who showed less levels of stress than at start of study. Suggest MBSR applied on a larger societal level could help people cope w/ stress decreasing health related problems. Course group were less depressed & less symptoms of psychological distress.

Shapiro Strengths

• Random allocation since it reduces participant variability and increases internal validity.

• Highly standardized in its psychological measures as standardized questionnaires ensure reliability and validity across participants.

• Able to ethically introduce stress since the stress was not artificially produced and took place in a real university setting, meaning the study has high ecological validity.

Shapiro Limitations

• Reliance on self-reported questionnaires and didn’t include physiological stress measures, which could introduce demand characteristics. For example, they may report improvement because they believe they should feel better.

• As participants volunteered for the mindfulness course, it could mean they were already more motivated and open to improve their well being than the general population which could mean the sample is unrepresentative.

• The sample only included university students dealing with academic stress which could mean the findings may not apply to older adults. 

Risk Factor

characteristic or exposure that increase the chance of developing health problem