Chapter Fourteen: Health and Well-Being

• Health Psychology: The application of psychology to the promotion of physical health and the prevention and treatment of illnesses
• Health is a joint product of biological, psychological, and social factors
• Illness patterns over the years have changed in significant ways
  • In 1900, the principal causes of death in the US were contagious diseases
  • Today, no infectious illnesses are leading illnesses
  • Americans today are most likely to die from heart disease, cancers, strokes, accidents, and chronic lower respiratory diseases
  • Can sometimes be prevented through changes in life-style, outlook, and behavior

Stress and Health

• Stress: An unpleasant state of arousal that arises when we perceive that the demands of a situation threaten our ability to cope effectively
• What stresses an entire generation or population can be influenced by world events

Some types of people are more likely to report feeling stressed than others

• More stress is consistently reported by women than men
• More stress is consistently reported by minorities than whites
• More in those who are employed vs the retired
• More in people in general who are younger, less educated, and have lower incomes

The stress-and-coping process is an ongoing transaction between a person and their environment

• Appraisal: The process by which people make judgements about the demands of potentially stressful events and their ability to meet those demands
• Coping: Efforts to reduce stress
• Our subjective appraisal of a situation determines how we’ll experience the stress and what coping strategies we’ll use
• Effective coping helps to maintain good health
• Ineffective coping can cause harm

What Causes Stress?

• Stressors: Anything that causes stress
• Physiological measures of analyzing stress: Analyzing stress hormone levels in blood, urine, or saliva, or recording autonomic arousal through heart rate, respiration rate, blood pressure, or sweat gland activity
• Assessing the effects of stress on the body over time: Accumulated levels of cortisol found in hair samples are associated with exposure to stress
• Hair cortisol may provide a biomarker for life stress

Crises and Catastrophes

• Natural and unnatural catastrophes can impose intense stress on a population

The harmful effects of catastrophic stressors on health have long been documented

• Increased calls made to mental health crisis lines
• Increased police reports of domestic violence
• Increased referrals to alcohol treatment centers
• Increased visits to the emergency room
• People who had initially been more distressed and those who encountered more danger experience the most psychological distress afterward

War leaves deep, permanent psychological scars

• Kill or be killed
• Intense anxiety
• See horrifying images, death, and destruction
• Posttraumatic Stress Disorder: A condition in which a person experiences enduring physical and psychological symptoms after an extremely stressful event
  • Anxiety, sleeplessness, nightmares, intrusive thoughts, flashbacks, attention problems, social withdrawal
  • Negatively affects families
  • Time alone doesn’t heal the wounds of war-induced PTSD
• War can traumatize civilian populations as well
• 8% of the population suffer posttraumatic stress disorder in the course of a lifetime
• Symptoms often persist for many years
• PTSD is more prevalent among women than among men, but men are more likely to experience potentially traumatic events

Major Life Events

• Change can cause stress by forcing us to adapt to new circumstances
• Social Readjustment Rating Scale (SRRS): A checklist of 43 major life events, each assigned with a numerical value based on the amount of readjustment it requires
• Research doesn’t support the claim that positive stressors are as harmful as negative stressors
• The impact of any change depends on who the person is and how the change is interpreted

Microstressors: The Hassles of Everyday Life

• The most common source of stress arises from the hassles that irritate us every day
• The accumulation of daily hassles contributes more to illness than major life events do
• Interpersonal conflicts are the most upsetting of our daily stressors
  • Have a particularly long-lasting impact

Occupational stress

• Burnout: A prolonged response to job stress that is characterized by emotional exhaustion, cynicism, disengagement, and a lack of personal accomplishment
  • Feel drained, frustrated, hardened, apathetic, and lacking in energy and motivation
  • Hard to distinguish from depression
  • Most likely to have this experience when they don’t have enough resources at work to meet the demands of the job
  • Emotional exhaustion: feeling overwhelmed and physically drained
  • Depersonalization as a result of workplace burnout: withdrawing and distancing from clients and coworkers
  • Symptoms are different based on gender
  • Female employees are more likely to become emotionally exhausted in the workplace
  • Male employees are more likely to become depersonalized in the workplace
• Commuting to and from work
  • Commutes in the US are ~25 min
  • Commuting long distances by train / driving to work often proves stressful
  • The longer one’s commute is, the more stress they reported feeling, the sloppier they were at simple tasks, and the higher their level of cortisol was
• Financial pressure
  • Those who are strained by a tight budget and have difficulty paying the bills experience more distress and conflict in their marriages
  • Economic hardship causes emotional distress for parents and adjustment problems for their children
• Socioeconomic status
  • Individuals who are less educated, have lower status jobs, and earn less or no income are more likely to suffer from health problems relative to those who are better off
  • Subject to more exposure to noise, crowding, crime, poor diet, and other stressors
  • Fewer tangible, medical, social, and psychological resources to help them meet daily challenges

How Does Stress Affect the Body?

The General Adaptation Syndrome

• General Adaptation Syndrome: A three-stage process (alarm, resistance, and exhaustion) by which the body responds to stress
• Alarm: Initial reaction to the recognition of a threat
  • Adrenaline and other hormones are poured into the bloodstream
  • Causes physiological arousal
  • Heart rate, blood pressure, and breathing rates increase
  • Slower, long-term functions are inhibited
  • The body mobilizes all of its resources to ward off the threat
• Resistance: The body remains aroused and on the alert
  • Continued release of stress hormones
  • Local defenses are activated
• Exhaustion: The body’s reaction to a prolonged stress response
  • Our antistress resources are limited
  • Occurs because overuse of our stress-fighting resources causes other systems in the body to break down
  • Puts us at risk for illness and death
• Stress is an adaptive short-term reaction to threat
• Over time, stress compromises our health and well-being
  • Stress is designed for acute physical emergencies
  • We turn stress responses on often and for prolonged periods of time
• All humans respond bodily to stress
  • Sympathetic nervous system is activated
  • More adrenaline is secreted
  • Increases the heart rate and heightens arousal
  • Liver pours extra sugar into the bloodstream for energy
  • Pupils dilate to let in more light
  • Breathing speeds up for more oxygen
  • Perspiration increases to cool frown the body
  • Blood clots faster to heal wounds
  • Saliva flow is inhibited
  • Digestion slows down to divert blood to the brain and skeletal muscles
• Fight or Flight: Men’s tendency to lash out aggressively when under siege
• Tend and Befriend: Women’s tendency to adapt to hardship by caring for one’s children and seeking out others who might help
  • Become more nurturing and affiliative than men
  • Exhibit elevated levels of oxytocin, which increases their tendency to seek out social contact

What Stress Does to the Heart

Coronary Heart Disease

• Coronary Heart Disease: A narrowing of the blood vessels that carry oxygen and nutrients to the heart muscle
• Leading cause of death in the US
• Heart Attack: When the blood supply to the heart is blocked, an uncomfortable feeling of pressure, fullness, and squeezing is experienced
  • 735,000 Americans / yr
  • ⅓ don’t survive
• Factors that increase the risk of CHD
  • Hypertension / high blood pressure
  • Cigarette smoking
  • High cholesterol
  • Psychological stress
• Type A personality: A pattern of behavior characterized by extremes of competitive striving for achievement, a sense of time urgency, hostility, and aggression
  • More evident from a person’s interview behavior than from self-reports
  • Linked to CHD
• Hostility: People are constantly angry, resentful, cynical, suspicious, and mistrustful of others
  • Quick to explode when besieged by stress
  • Chronic hostility and anger can be lethal
  • Less health-conscious
  • Physiologically reactive
  • In tense social situations, they exhibit greater increases in blood pressure, pulse rate, and adrenaline
  • Exhibit more intense cardiovascular reactions during the event and when reliving it
• Growing up poor during childhood and adolescence increases the risk of cardiovascular disease in adulthood
• Positive states of mind are associated with a reduction in the risk of cardiovascular disease
• Orienting people to think of their physiological arousal during a stressful task as adaptive can have beneficial effects on their cardiovascular stress responses

What Stress Does to the Immune System

Immune System

• Immune System: A biological surveillance system that detects and destroys “nonself” substances that invade the body
• Lymphocytes: Specialized white blood cells that circulate throughout the bloodstream and secrete chemical antibodies
• Large scavenger cells zero in on viruses and cancerous tumors
• Continually renews itself

Psychoneuroimmunology

• Psychoneuroimmunology: A subfield of psychology that examines the links among psychological factors, the brain and nervous system, and the immune system
• Methods
  • Take blood samples from participants exposed to varying degrees of stress and count the number of white blood cells circulating in the bloodstream
  • Extract blood, add cancerous tumor cells, and measure the extent to which the natural killer cells destroy the tumors
  • Inject a foreign agent into the skin and measure the amount of swelling that arises at the site of the injection
  • The more swelling there is, the more potent the immune reaction is assumed to be
• Stress can affect the immune system
  • Rats exposed to stress exhibit a drop in immune cell activity compared with non-exposed animals
  • Grief-stricken spouses exhibit a weakened immune system when compared with non-widowed controls
  • The more positive events participants experience in a day, the more antibodies produced. More negative events, less antibodies
• How does psychological state affect the immune system?
  • People who are under intense stress tend to smoke more, inject more drugs, sleep less, exercise less, and have poorer diets
  • These behaviors compromise the immune system
  • Stress triggers the release of adrenaline and other stress hormones into the bloodstream
  • Suppress immune cell activity
  • Temporarily lowers the body’s resistance
  • Brief stressors can enhance the immune system in ways that are adaptive in the short term
  • Chronic life stressors can suppress the immune response over time

Stress during pregnancy

• Pregnant women from diverse backgrounds deliver their infants sooner and at a lower birth weight when they’d endured pregnancy-specific stress
• Prospective mother’s level of stress during pregnancy can have adverse effects on her health
• Increases the likelihood of a preterm birth and the risks associated with it

The Links Between Stress and Illness

• People whose lives are filled with stress are particularly vulnerable to contagious illnesses
• Chronic types of stress are more toxic than acute short-term stresses
  • Over time, stress breaks down the body’s immune system
• Certain personal characteristics and life circumstances can buffer people against the adverse health effects
  • The more sociable people were in life, the more resistant they were to developing a cold
  • The more social support people have in life, the less likely they were to become infected with a virus
  • Psychological states such as a feeling of helplessness can influence the spread of cancer
  • Individuals who are clinically depressed or under great stress have weakened immune systems
• Divorce is an acute stressor that can have long-lasting effects on their physical and mental health
  • Associated with increased alcohol consumption, insomnia, and other negative health behaviors
  • 23% more likely to die early

Processes of Appraisal

Attributions and Explanatory Styles

• Depression: Mood disorder characterized by feelings of sadness, pessimism, and apathy and slowed thought processes
  • 6-7% of the US population experiences a major depression
  • Universal and widespread
  • About twice as many women as men seek treatment for being depressed
  • 12% American men and 21% American women will suffer from a major depression
• Martin Seligman: Depression results from a feeling of learned helplessness
  • Learned Helplessness: A phenomenon in which experience with an uncontrollable event creates passive behavior in the face of subsequent threats to well-being
  • People who are exposed to uncontrollable events become discouraged, pessimistic about the future, and lacking in initiative
  • Depression is a form of learned helplessness
• Lynn Abramson: Depression is a state of hopelessness brought on by the negative self-attributions people make for failure
  • Depressive Explanatory Style: A habitual tendency to attribute negative events to causes that are stable, global, and internal
  • Those who are depressed are more likely than others to blame factors that are within the self, unlikely to change, and broad enough to impair other aspects of life
  • May signal a vulnerability to future depression

The Human Capacity for Resilience

• Some of us are more resilient than others in the face of stress
• Hardiness
  • Commitment: A sense of purpose with regard to one’s work, family, and other domains
  • Challenge: An openness to new experiences and a desire to embrace change
  • Control: The belief that one has the power to influence important future outcomes
• Resilience, or hardiness, serves as a buffer against stress
• Most human beings are highly resilient and exhibit a remarkable capacity to thrive in the wake of highly aversive events
• People with different personalities cope with stress in different ways
• Resilience is more common among majority populations and among people with more education, money, and social support

Self-Efficacy

• The perception of control is important
• Elderly residents of nursing homes who were given more control over daily routines became happier and more active
• Self-Efficacy: A person’s belief that they are capable of the specific behavior required to produce a desired outcome in a given situation
• State of mind that varies from one specific task and situation to another
• The more self-efficacy you have at a particular task, the more likely you are to take on that task, try hard, persist in the face of failure, and succeed
• The higher their self-efficacy at the start of the study, the more likely they were to survive hospitalization years later

Dispositional Optimism

• A generalized tendency to expect positive outcomes is characterized by a nondepressive explanatory style
• Optimists tend to blame failure on factors that are external, temporary, and specific, and to credit success to factors that are internal, permanent, and global
• Optimism
  • Partly inherited
  • Shaped by personal experiences, social influences, and the course of development over the lifespan
  • Progressively increased from the age of 50 to 70, then declined
  • Even pessimists can retrain themselves to think in optimistic ways
• Optimism and health
  • Dispositional optimists reported fewer illness symptoms during the semester than did pessimists
  • Correlations between optimism and health
  • Optimists are more likely to take an active problem-focused approach in coping and stress
  • Those who had an optimistic outlook in their youth were healthier than their more pessimistic peers
• Explanations for the link between optimism and health
  • Optimists exhibit a stronger immune response to stress than pessimists do
  • Optimists were less likely to have died an accidental, reckless, or violent death
  • Positive expectations can be self-fulfilling

Ways of Coping With Stress

• Stress is inevitable
• People can use different coping strategies
• Problem-Focused Coping: Cognitive and behavioral efforts to reduce stress by overcoming the source of the problem
• Emotion-Focused Coping: Efforts to manage our emotional reactions to stressors rather than trying to change the stressors themselves
• We tend to take an active, problem-focused approach when we think that we can overcome a stressor
• We tend to take an emotion-focused approach when we perceive the problem to be out of our control
• Proactive Coping: Up-front efforts to ward off or modify the onset of a stressful event

Problem-Focused Coping

• Procrastination: A purposeful delay in beginning or completing a task, often accompanied by feelings of discomfort
  • Procrastinators are relatively stress-free in the beginning stages, but under greater stress and reported more symptoms of illness as the deadline approached
  • The short-term benefits of avoidance were outweighed by the long-term costs
• It is better to confront and control essential tasks than to avoid them, but this is not always a beneficial approach
  • Must stay vigilant and alert, which is physiologically taxing
  • Controlling orientation can cause problems if it leads us to develop an over controlling, stress-inducing pattern of behavior
  • Not all events are within our control or important enough to worry about

Forms of control

• Active efforts to manage something
• Knowledge - knowing why something happens increases your chance of making sure it goes your way

Self-blame

• Behavioral self-blame paves the way for control in an effort to reduce current stresses or avoid future omens
• It is not adaptive to blame your enduring personal characteristics
• Both behavioral and characterological self-blame are associated with an increase in distress
• Doesn’t give control over past or future, so it’s not adaptive
• The most useful sense of control is over the present time

Emotion-Focused Coping

Positive Emotions: Building Blocks of Emotion-Focused Coping

• People who cope well and are resilient tend to experience positive emotions in the face of stress
• Help people broaden their outlook in times of stress so they can cope with adversity
  • Provides a welcome distraction from anger, fear, and other negative states
  • Helps people build personal resources

Shutting Down: Suppressing Unwanted Thoughts

• Trying to deny or suppress the unpleasant thoughts and feelings
• When individuals have little actual control over events, distraction and other emotion-focused techniques were more effective in reducing distress than problem-focused efforts
• Sometimes, the harder you try not to think about something, the less likely you are to succeed
• Focused Distraction: Thinking of a specific image to counteract the rebound effect
• Distraction is a better coping strategy than mere suppression
• Keeping secrets and holding in strong emotions may be physically taxing
• Actively concealing your innermost thoughts and feelings can be hazardous to your health

Opening Up: Confronting One’s Demons

• Acknowledging and understanding our emotional reactions to important events
• Expressing inner feelings to ourselves and others
• Keeping personal secrets can be stressful and getting it off your chest can have true therapeutic effects on mental and physical health
• Catharsis: A discharge of tension
• Disclosure can bring emotional closure
• Talking about a problem can help you to sort out your thoughts, understand the problem better, and gain insight
• Opening up can also cause great distress when the people we confide in react with rejection, unwanted advice, or betrayal

Self-Focus: Getting Trapped vs Getting Out

• People spend little time actually thinking about the self, and when they do, they wish they were doing something else
• Self-Awareness Theory: Self-focus brings out our personal shortcomingS
• Self-focus seems to intensify some of the most undesirable consequences of emotion-focused coping
• Both positive and negative moods increase awareness of the self, so when a stressful event occurs, the negative feelings that arise magnify self-focus
  • In people with low self-esteem, this can worsen the mood
  • Self-Focusing Model of Depression: Coping with stress by attending to your own feelings only makes things worse
• Individuals who respond to distress by rumination and repetitive thought are more likely to become anxious and depressed than those who allow themselves to be distracted
• Girls and women have a tendency to ruminate, confront their negative feelings, and seek treatment for being depressed
• Boys and men resort to drugs, physical activity, antisocial behavior, and other means of distraction
• People who are in a bad mood felt better after performing a difficult task
• Meditation can have positive effects, as it calls on you to focus your attention on a chosen non-self object

Proactive Coping

• Coping is an ongoing process by which we try to prevent as well as react to the bumps and bruises of daily life

Social Support

• Social support has therapeutic effects on our physical and psychological well-being
• Social Support: The helpful coping resources provided by friends and other people
• The more social contacts people had, the longer they lived
• Social isolation is statistically just as predictive of an early death as smoking or high cholesterol
  • Having social support lowers blood pressure, lessens the secretion of stress hormones, and strengthens immune responses
  • People who are socially isolated are at risk to exhibit more behavioral problems and biological risk factors
  • Being isolated from other people can be hazardous to your health
• Participants accompanied by a supportive confederate exhibited lower blood pressure, lower heart rate, lower cortisol reactivity, and lower pain ratings

The Religious Connection

• Religion provides a deeply important source of social and emotional support for many people
• People who regularly attend religious services live longer than those who don’t
• Men and women who regularly attend religious services drink less, smoke less, and exercise more

Culture and Coping

• People from Asian cultures are less likely to seek out social support in times of stress
• Explicit social support: Disclosing one’s distress to others and seeking their advice, aid, or comfort
• Implicit social support: Merely thinking about or being with close others without openly asking for help
• Asian Americans reacted with more stress to the explicit social support situation, while European Americans found the more contained implicit situation more stressful

Treatment and Prevention

Treatment: The “Social” Ingredients

• All healers provide social support
• All therapies offer a ray of hope to people who are sick, demoralized, unhappy, or in pain
• Allowing patients to make meaningful choices increases the effectiveness of treatments

Prevention: Getting the Message Across

• Many of today’s serious health threats are preventable
• Heart attacks, cancer, strokes, and accidents are now more common causes of death than infectious diseases
• AIDS
  • First global epidemic
  • Spread at an alarming rate
  • Transmitted from one person to another in infected blood, semen, and vaginal secretions
  • Virus ravages the immune system by destroying lymphocytes that help ward off disease
  • There is no vaccine
  • Most effective way to slow the spread of AIDS is to alter people’s beliefs, motivations, and risk-taking behaviors
• HIV prevention model
  • Provide accurate information about HIV transmission and how to prevent it
  • Social and personal motivation to engage in HIV-preventative behaviors
  • Provide with the behavioral skills necessary to follow through (ex: provide condoms)
• It is necessary for prevention programs to attract the kinds of high-risk participants for whom they are designed
  • This is the group less likely to attend
• Also need to focus prevention efforts on HIV positive individuals who can transmit the virus