Stress, Health, and Lifestyle

Reading Week 4 focuses on stress, burnout, and managing life's challenges.
Figure 14.1 illustrates exams as a stressful but unavoidable element of college life.
College students face numerous pressures, including exams, term papers, increased tuitions, debt, and difficulty finding employment.
Non-traditional students face additional stressors like raising children or working full-time while pursuing a degree.
Life challenges encompass financial security, relationship difficulties, family responsibilities, and time constraints.
Minor hassles such as losing things or traffic jams can also compromise well-being.
Scientific interest in stress and coping mechanisms has grown over the past century.
This chapter examines the psychological and physiological natures of stress, its causes, consequences, and ways to manage it.
The term "stress" emerged in scientific literature in the 1930s and became popular in the 1970s (Lyon, 2012).

What Is Stress?

Stress is vaguely defined and difficult to define precisely; researchers struggle to agree on a definition.
Stimulus-based definitions characterize stress as a demanding or threatening event (e.g., high-stress job).
Stimulus-based definitions do not account for individual differences in reactions to challenging events.
Response-based definitions describe stress as a physiological response to environmental conditions (e.g., increased arousal).
Hans Selye defined stress as the body’s physiological reaction to any demand, pleasant or unpleasant (Selye, 1976).
Response-based definitions do not account for situations that cause physiological reactions but are not stressful.
A useful definition of stress is the process by which individuals perceive and respond to events they appraise as overwhelming or threatening (Lazarus & Folkman, 1984).
Appraisals of stressors involve judging demanding or threatening events.
Primary appraisal involves judging potential harm or threat to well-being.
Stressors are appraised as threats if they could lead to harm or loss, or as challenges if they carry potential for gain or growth.
Secondary appraisal involves judging available options for coping with a stressor and their effectiveness (Lyon, 2012).
Self-efficacy, an individual’s belief in their ability to complete a task, is important (Bandura, 1994).
Threats are viewed as less catastrophic if one believes something can be done about them (Lazarus & Folkman, 1984).
Stress is augmented or diminished by appraisal, even for inherently stressful events (Everly & Lating, 2002).
Stress is subjectively experienced when an event is appraised as harmful and the demands exceed available resources to manage it.
Stress reactions are triggered by environmental events based on how they are interpreted (Selye, 1976).
Stress is largely influenced by individual perception; it is how you respond, not so much what happens to you (Selye, 1976).

Good Stress?

Stress can motivate us to act in our best interests (e.g., studying, exercising).
Eustress, termed by Selye (1974), is a positive, motivating stress associated with positive feelings, health, and performance.
Moderate stress can be beneficial in challenging situations (e.g., pregame stress for athletes).
Moderate stress can enhance immediate and delayed recall of educational material (Hupbach & Fieman, 2012).
The relationship of stress and performance follow a predictable pattern. As stress increases to an optimal level, performance reaches its peak. But performance declines when stress exceeds this level.
Distress is excessive and debilitating stress that leads to burnout, fatigue, and declining performance (Everly & Lating, 2002).

THE PREVALENCE OF STRESS

Stress is pervasive and has been increasing (Neelakantan, 2013).
Stress evokes physiological, cognitive, and behavioral responses.
Health psychology studies the impact of stress and psychological factors on health (Taylor, 1999).
Health psychologists examine lifestyle choices and interventions aimed at changing unhealthy behaviors (Straub, 2007).
Health psychologists identify at-risk groups for adverse health outcomes based on psychological or behavioral factors.
Stress levels are higher in women than men and in unemployed individuals (Cohen & Janicki-Deverts, 2012).
Stress levels increased from 2006 to 2009 most notably among men, Whites, people aged 45–64, college graduates, and those with full-time employment.
The 2008–2009 economic downturn may have affected White, college-educated, employed men with limited time left in their working careers.

EARLY CONTRIBUTIONS TO THE STUDY OF STRESS

Walter Cannon identified the body’s physiological reactions to stress in the early 20th century.
The fight-or-flight response occurs when facing strong emotions associated with a perceived threat (Cannon, 1932).
Epinephrine and norepinephrine prompt physiological reactions such as pupil dilation, increased heart rate, and muscle tension.
Arousal from the sympathetic nervous system and endocrine system prepares the person to fight or flee.
Fight-or-flight is a built-in mechanism that maintains homeostasis (Cannon, 1932).
The fight-or-flight response is adaptive because it enables internal and external adjustments to changes, aiding species survival.
Hans Selye discovered the general adaptation syndrome, which is the body’s nonspecific physiological response to stress.
The general adaptation syndrome consists of three stages: alarm reaction, stage of resistance, and stage of exhaustion (Selye, 1936; 1976).
Alarm reaction is the body’s immediate reaction to a threatening situation.
Stage of resistance occurs with prolonged exposure to a stressor, where the body adapts but remains on alert.
Stage of exhaustion occurs when the body’s ability to resist becomes depleted, leading to illness or permanent damage.
Selye’s model is a response-based conceptualization of stress, focusing on physical responses and ignoring psychological factors.
Selye’s model has had a significant impact by explaining how stress can lead to physical damage and disease.

THE PHYSIOLOGICAL BASIS OF STRESS

The physiological mechanisms of stress involve the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis.
The sympathetic nervous system triggers arousal via adrenaline release from the adrenal glands.
The HPA axis releases corticotrophin-releasing factor, causing the pituitary gland to release adrenocorticotropic hormone (ACTH).
ACTH activates the adrenal glands to secrete hormones, including cortisol.
Cortisol provides a boost of energy but can weaken the immune system with sustained elevated levels.
Stress often contributes to psychological disorders, including PTSD and major depressive disorder.
Stress is linked to physical illnesses and diseases, such as heart disease (Jordan et al., 2011) and musculoskeletal disorders (Salonen et al., 2008).
High levels of work-related stress correlated with increased susceptibility to the common cold (Park et al., 2011).

Stressors

A stressor is a trigger for stress, and these can be chronic (long-term) or acute (short-term) (Cohen, Janicki-Deverts, & Miller, 2007).
Stressors can include traumatic events, significant life changes, daily hassles, and challenging working conditions.

TRAUMATIC EVENTS

Traumatic events involve actual or threatened death or serious injury (American Psychiatric Association [APA], 2013).
Examples include military combat, physical assaults, terrorist attacks, natural disasters, and car accidents.
Men, non-Whites, and individuals in lower SES groups report experiencing more traumatic events (Hatch & Dohrenwend, 2007).
Post-traumatic stress disorder (PTSD) is a chronic stress reaction with intrusive memories, jumpiness, negative emotional states, detachment, and avoidance (APA, 2013).

LIFE CHANGES

Life changes can be stressors, whether desirable or undesirable (Holmes & Rahe, 1967).
The Social Readjustment Rating Scale (SRRS) consists of 43 life events requiring varying degrees of personal readjustment.
Life change units (LCUs) quantify readjustment required for each event (Rahe, McKeen, & Arthur, 1967).
Death of a spouse is ranked highest with 100 LCUs, and minor violations of the law are the lowest with 11 LCUs.
Accumulating a high number of life change units is related to physical illnesses and mental health problems (Monat & Lazarus, 1991; Scully, Tosi, & Banning, 2000).
The SRRS provides a simple way of assessing stress, but it has been subject to criticism (Thoits, 2010).
Criticisms include vague items, equal weighting of desirable and undesirable events, and failure to consider appraisals of events (Derogatis & Coons, 1993; Dohrenwend, 2006).

HASSLES

Daily hassles are minor irritations that can build up and cause stress (Kanner, Coyne, Schaefer, & Lazarus, 1981).
The frequency of daily hassles is a better predictor of health than life change units (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982).
Cyber hassles on social media may represent a new source of stress (Campisi et al., 2012).

OTHER STRESSORS

Stressors can include demanding or unsafe working conditions (Sulsky & Smith, 2005).
Job strain combines excessive job demands with little job control (Karasek & Theorell, 1990).
Job strain is associated with increased risk of hypertension, heart attacks, weight changes, and major depressive disorder (Kivimäki et al., 2006; Schnall & Landsbergis, 1994; Stansfeld, Shipley, Head, & Fuhrer, 2012; Theorell et al., 1998).
Job burnout is a sense of emotional exhaustion and cynicism in relation to one’s job (Maslach & Jackson, 1981).
Job burnout consists of exhaustion, depersonalization, and diminished personal accomplishment.
Job strain is a great risk factor in leading to job burnout (Ahola, et al., 2006).
Feelings of not being appreciated in their work is another factor in leading to job burnout (Tatris, Peeters, Le Blanc, Schreurs, & Schaufeli, 2001).
Negative aspects of close relationships can be a source of stress (De Vogli, Chandola & Marmot, 2007).

Stress and Illness

Stress-related diseases emerge from activating a physiological system evolved for physical emergencies for extended periods of time (Sapolsky, 1998).

PSYCHOPHYSIOLOGICAL DISORDERS

Chronic stress reactions can lead to cumulative wear and tear on the body (McEwen, 1998).
Psychophysiological disorders are physical disorders worsened by stress and emotional factors. The symptoms are real and they can be exacerbate these conditions
Disease-prone personality characteristics include depression, anger, and anxiety (Friedman & Booth-Kewley, 1987).
Neuroticism is a risk factor for chronic health problems and mortality (Ploubidis & Grundy, 2009).

STRESS AND THE IMMUNE SYSTEM

The immune system protects the body from invading toxins and microorganisms (Everly & Lating, 2002).
Autoimmune diseases occur when the immune system attacks the body’s own healthy cells (National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS], 2012).
Immunosuppression is the decreased effectiveness of the immune system.
Acquired immune deficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV), which weakens the immune system (Powell, 1996).
Psychoneuroimmunology studies how psychological factors influence the immune system (Zacharie, 2009).
Stressors are associated with poor or weakened immune functioning (Glaser & Kiecolt-Glaser, 2005; Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002; Segerstrom & Miller, 2004).
Stress hormones released during HPA axis activation can adversely impact immune function by inhibiting lymphocyte production (Everly & Lating, 2002).
Chronic stressors increase susceptibility to illness, especially in work or relationship issues (Cohen et al., 1998).
Stress slows down wound healing by impairing immune responses (Glaser & Kiecolt-Glaser, 2005).
Stress can shorten telomeres, leading to more rapid aging (Sapolsky, 2004).
Childhood exposure to violence accelerates telomere erosion (Shalev et al., 2013).
Adverse experiences during childhood are associated with shortened telomere length (Surtees et al., 2010).

CARDIOVASCULAR DISORDERS

Cardiovascular disorders involve the heart and blood circulation system (Everly & Lating, 2002).
Heart disease is a leading cause of death in the developed world (Centers for Disease Control and Prevention [CDC], 2011; Shapiro, 2005).
A major risk factor for heart disease is hypertension, high blood pressure (AHA, 2012b).
Risk factors include aging, income, education, employment status, unhealthy diet, tobacco use, physical inactivity, and alcohol consumption (WHO, 2013).
Stress and other psychological factors, including job strain, natural disasters, marital conflict, and traffic noise, are linked to cardiovascular problems (Nusair, Al-dadah, & Kumar, 2012).

ARE YOU TYPE A OR TYPE B?

Type A behavior pattern includes an aggressive and chronic struggle to achieve more in less time (Friedman & Rosenman, 1974).
Characteristics of Type A include competitive drive, time urgency, impatience, and hostility.
Type B individuals are characterized as laid-back and relaxed.
Anger/hostility may be one of the most important factors in the development of heart disease (Haynes, Feinleib, & Kannel, 1980).
Anger/hostility creates social strain, leading to disease-promoting cardiovascular responses (Vella, Kamarck, Flory, & Manuck, 2012).
Negative affectivity, a tendency to experience distressed emotional states, is linked to hypertension and heart disease (Watson, Clark, & Tellegen, 1988).

DEPRESSION AND THE HEART

A connection between moods and the heart has been recognized (Glassman & Shapiro, 1998).
Depression is a risk factor for heart disease and cardiac death (Glassman, 2007).
Patients with heart disease have more depression than the general population, and depressed people are more likely to develop heart disease (Hare, Toukhsati, Johansson, & Jaarsma, 2013).
Depression screening is recommended for all heart disease patients (Lichtman et al., 2008).
Depression may increase the likelihood of living an unhealthy lifestyle, predisposing people to an unfavorable cardiovascular disease risk profile (Rottenberg et al., 2014).
Experiencing several negative emotional states may be especially important in elevating the risk for heart disease.

ASTHMA

Asthma is a chronic disease in which the airways become obstructed, leading to difficulty expelling air from the lungs (American Lung Association, 2010).
Psychological factors appear to play an important role in asthma (Wright, Rodriguez, & Cohen, 1998).
Some people with asthma will experience asthma-like symptoms if they expect to experience such symptoms (Sodergren & Hyland, 1999).
Stress and emotions directly affect immune and respiratory functions, psychological factors likely serve as one of the most common triggers of asthma exacerbation (Trueba & Ritz, 2013).
People with asthma report high levels of negative emotions, and asthma attacks have been linked to periods of high emotionality (Lehrer, Isenberg, & Hochron, 1993}.
Exposure to stressful experiences has been linked to the development of asthma throughout the lifespan (Kilpeläinen, Koskenvuo, Helenius, & Terho, 2002; Klinnert et al., 2001; Loerbroks, Apfelbacher, Thayer, Debling, & Stürmer, 2009).

TENSION HEADACHES

Tension headaches are triggered by tightening of facial and neck muscles (Stovner et al., 2007).
Stress has been demonstrated to increase sensitivity to pain (Caceres & Burns, 1997; Logan et al., 2001).

Regulation of Stress

When we experience events that we appraise as stressful, it is essential that we use effective coping strategies to manage our stress.

COPING STYLES

Problem-focused coping involves managing or altering the problem causing stress (Lazarus & Folkman, 1984).
Emotion-focused coping involves changing or reducing negative emotions associated with stress (Lazarus & Folkman, 1984).
Problem-focused coping is more likely when encountering controllable stressors, while emotion-focused coping predominates when faced with uncontrollable stressors (Folkman & Lazarus, 1980).

CONTROL AND STRESS

The desire and ability to enact control in our lives is a basic tenet of human behavior (Everly & Lating, 2002).
Perceived control is people’s beliefs about their capacity to exert influence over outcomes (Infurna & Gerstorf, 2014).
Greater personal control is associated with lower reactivity to stressors (Neupert, Almeida, & Charles, 2007; Ong, Bergeman, & Bisconti, 2005).
Albert Bandura (1997) stated that “the intensity and chronicity of human stress is governed largely by perceived control over the demands of one’s life” (p. 262).

SOCIAL SUPPORT

The need to form and maintain strong relationships with others is a fundamental human motive (Baumeister & Leary, 1995).
Social support is the soothing impact of friends, family, and acquaintances (Baron & Kerr, 2003).
Social support can take many forms, including advice, guidance, encouragement, acceptance, emotional comfort, and tangible assistance.
Social support reduces mortality and improves health outcomes (Holt-Lunstad, Smith, & Layton, 2010).
Social support works by boosting the immune system (Uchino, Vaughn, Carlisle, & Birmingham, 2012).
Social support reduces blood pressure during stressful tasks (Lepore, 1998).

Coping with Prejudice and Discrimination

Being the recipient of prejudicial attitudes and discriminatory behaviors is associated with a number of negative outcomes.
Racism is associated with increased rates of depression, lowered self-esteem, hypertension, and cardiovascular disease (Brondolo, Brady, Pencille, Beatty, and Contrada 2009).
Focusing on racial identity may increase a sense of pride associated with group membership (Brondolo et al., 20090.
Racism-related stress is a complex issue and each of the coping strategies discussed here has strengths and weaknessed (Brondolo et al., 2009).

STRESS REDUCTION TECHNIQUES

Exercise is a common technique people use to combat stress (Salmon, 2001).
Physically fit individuals are more resistant to the adverse effects of stress and recover more quickly (Cotton, 1990).
Exercise decrease hypothalamic-pituitary-adrenal responsiveness to mild stressors (Campeau et al., 2010).
Exercise prevents telomere shortening (Puterman et al., 2010).
The relaxation response technique combines relaxation with transcendental meditation (Benson & Proctor, 1994).
Biofeedback enables voluntary control over involuntary bodily processes (Schwartz & Schwartz, 1995).

HAPPINESS

America’s founders declared that its citizens have an unalienable right to pursue happiness.

Elements of Happiness

Happiness consists of the pleasant life, the good life, and the meaningful life (Seligman, 2002; Seligman, Steen, Park, & Peterson, 2005).
The pleasant life is realized through the attainment of day-to-day pleasures.
The good life is achieved through identifying and engaging unique skills and abilities.
The meaningful life involves using talents in the service of the greater good.
The happiest people pursue the full life—they orient their pursuits toward all three elements (Lyubomirsky, 2001).

Factors Connected to Happiness

Happiness is an enduring state of mind consisting of joy, contentment, and other positive emotions, plus the sense that one’s life has meaning and value (Lyubomirsky, 2001).
The average person in the world tends to be relatively happy and experiences more positive than negative feelings (Diener, Ng, Harter, & Arora, 2010).
Age is related to happiness, with life satisfaction increasing for older people (Diener, Suh, Lucas, & Smith, 1999).
Married people report being happier than single, divorced, or widowed people (Diener et al., 1999).
Happy people tend to have more friends, high-quality social relationships, and strong social support networks (Lyubomirsky et al., 2005).
Income is associated with happiness up to a point (Kahneman & Deaton, 2010).
Happy people are more likely to graduate from college and secure meaningful jobs (Lyubomirsky et al., 2005).
Religiosity is correlated with happiness (Hackney & Sanders, 2003).
Culture can also greatly influence one's happiness (Diener, 2012).
People are often poor at affective forecasting: predicting the intensity and duration of their future emotions (Wilson & Gilbert, 20030.

Efforts to Increase Happines

Experiments can have real and lasting changes in happiness levels when properly developed (Diener et al., 2006).
Average national happiness scores relate strongly to per capita gross domestic product, social support, freedom to make important life choices, healthy life expectancy, and freedom from perceived corruption in government and business (Helliwell et al., 2013).

POSITIVE PSYCHOLOGY

Positive psychology is the science of happiness; it seeks to identify and promote qualities that lead to greater fulfillment (Compton, 2005).
Seligman urged psychologists to focus more on building human strength and psychological well-being (Seligman & Czikszentmihalyi, 2000).
Positive psychology at the subjective level is about valued subjective experiences and at the individual level, it is about positive individual traits: the capacity for love.
Qualities such as positive affect, optimism, and flow are the focus point behind positive psychology (Compton, 2005).
Researchers at the Center for Investigating Healthy Minds conduct rigorous scientific research on aspects of the mind, such as kindness, forgiveness, compassion, and mindfulness (Center for Investigating Health Minds, 2013).
Qualities that help promote psychological well-being are linked with a range of favorable health outcomes, mainly through their relationships with biological functions and health behaviors (Boehm & Kubzansky, 2012).
Optimism is a significant predictor of positive health outcomes (Rasmussen & Wallio, 2008).
People who frequently possess flow feel they lose themselves in said activities (Csikszentmihalyi, 1997).
People who tend to possess flow believe nothing matters except that particular experience.