Stress, Health, and Coping

Stress and Health Psychology

  • Key Theme: Stress occurs when events are perceived as exceeding your ability to cope.

What Is Stress?

  • Stress: A negative emotional state in response to events seen as taxing or exceeding a person's resources or ability to cope.

  • Cognitive Appraisal Model of Stress (Richard Lazarus): Emphasizes the role of an individual’s evaluation (appraisal) of events and situations and the resources they have to deal with them.

  • Health psychology: Studies how biological, behavioral, and social factors influence health, illness, medical treatment, and health-related behaviors.

  • Biopsychosocial model: Physical health and illness are determined by the complex interaction of biological, psychological, and social factors.

Sources of Stress: Life Events and Change

  • Stressors: Events or situations perceived as harmful, threatening, or challenging.

  • Early stress researchers (Holmes & Rahe, 1967): Believed any change requiring adjustment of behavior and lifestyle causes stress.

  • Developed the Social Readjustment Rating Scale (SRRS).

The SRRS: Sample Items

  • Lists various life events and their corresponding Life Change Units, such as:

    • Death of spouse (100)

    • Divorce (73)

    • Marital separation (65)

    • Death of close family member (63)

    • Major personal injury or illness (53)

    • Marriage (50)

    • Fired at work (47)

    • Retirement (45)

    • Pregnancy (40)

    • Change in financial state (38)

    • Death of close friend (37)

    • Change to different line of work (36)

    • Mortgage or loan for major purchase (31)

    • Foreclosure on mortgage or loan (30)

    • Change in work responsibilities (29)

    • Outstanding personal achievement (28)

    • Begin or end school (26)

    • Trouble with boss (23)

    • Change in work hours or conditions (20)

    • Change in residence (20)

    • Change in social activities (18)

    • Change in sleeping habits (16)

    • Vacation (13)

    • Christmas (12)

    • Minor violations of the law (11)

Life Events Approach

  • Any event requiring a person to change or adjust their lifestyle produces significant stress (positive or negative, planned or unexpected).

  • Revised scales weigh influences of gender, marital status, and other individual characteristics.

  • Scales developed for specific groups and cross-cultural factors.

Sources of Stress: Traumatic Events

  • Traumatic events: Negative, severe events far beyond normal expectations.

  • Intense or repeated traumas can lead to posttraumatic stress disorder (PTSD) in vulnerable individuals.

Developing Resilience

  • Seery and others found high and low levels of cumulative adversity were associated with poor health outcomes. Experiencing some stress was healthier than experiencing no stress at all.

  • People who cope with a moderate level of adversity develop resilience.

Major Life Events and Stress

  • The birth of a child or losing your home in a fire can produce damaging levels of stress.

Daily Hassles

  • Everyday minor events that annoy and upset people are an important source of stress.

  • The number of daily hassles is a better predictor of physical illness and symptoms than the number of major life events.

  • Women report daily stressors associated with friends and family more often.

  • Men more often feel hassled by school- or work-related stressors.

Examples of Daily Hassle Scale

  • Concern about weight

  • Concern about health of family member

  • Not enough money for housing

  • Too many things to do

  • Misplacing or losing things

  • Too many interruptions

  • Don’t like current work duties

  • Traffic

  • Car repairs or transportation problems

Examples of College Daily Hassles Scale

  • Increased class workload

  • Troubling thoughts about your future

  • Fight with boyfriend/girlfriend

  • Concerns about meeting high standards

  • Wasting time

  • Computer problems

  • Concerns about failing a course

  • Concerns about money

Examples of Acculturative Daily Hassles for Children Scale

  • It bothers me when people force me to be like everyone else.

  • Because of the group I’m in, I don’t get the grades I deserve.

  • I don’t feel at home here in the United States.

  • People think I’m shy, when I really just have trouble speaking English.

  • I think a lot about my group and its culture.

Gender Differences in Daily Hassles

  • Interpersonal conflict is the most common source of daily stress for both sexes.

  • Women: More likely to report daily stress from friends and family; stress spills over into partner interactions.

  • Men: More likely to feel hassled by school- or work-related stressors; stress linked to withdrawal.

  • Stress at work or school affects home life for both sexes.

Major Life Events, Daily Hassles, and Stress: The COVID Pandemic

Work Stress and Burnout

  • Burnout: An unhealthy condition caused by chronic, prolonged work stress.

    • Characterized by exhaustion, cynicism, and a sense of failure or inadequacy.

    • Sources of burnout:

      • Exhaustion: Depletion of emotional and physical resources.

      • Cynicism: Negative or detached attitudes.

      • Sense of failure or inadequacy

  • Causes:

    • Overload

    • Lack of control

  • Solution:

    • Sense of community

    • Job crafting: Proactively changing job demands or personal resources.

Social Sources of Stress

  • People living under difficult conditions experience chronic stress.

  • Lower socioeconomic status (SES) is correlated with more negative life events and daily hassles.

  • Low perceived social status is associated with poorer physical health.

  • Disadvantaged groups have fewer resources to cope with stressors.

  • Examples include: crowding, crime, poverty, and substandard housing.

Cultural Sources of Stress

  • Racism and discrimination are significant sources of chronic stress.

  • Disproportionate levels of violence and police brutality affect Black Americans.

  • Subtle instances of racism (microaggressions) contribute to chronic stress.

  • Culture clashes can cause stress.

Subjective Socioeconomic Status and Health

The Stress of Adapting to a New Culture

  • Acculturative stress: Results from the pressure of adapting to a new culture.

  • Reducing stress:

    • Acceptance of ethnic and cultural diversity by the new society

    • Familiarity with the new language and customs

    • Advanced education

    • Social support from friends, family, and cultural associations

    • Similarity of the new culture to the old culture

Entering a New Culture

  • Two questions people face:

    • Should I seek positive relations with the dominant society?

    • Is my original cultural identity of value, and should I maintain it?

Possible Patterns of Acculturation

  • Four possible patterns:

    • Integration: Low stress

    • Assimilation: Moderate stress

    • Separation: High stress

    • Marginalization: Greatest stress!

Physical Effects of Stress: The Mind–Body Connection

  • Key Theme: Stress affects physical health through its effects on the endocrine system, the immune system, and chromosomes.

Understanding the Physical Effects of Stress

  • Stress indirectly affects health by prompting behaviors that jeopardize physical well-being.

  • Stress directly affects physical health by altering body functions, leading to symptoms of illness or disease.

Walter Cannon: Stress and the Fight-or-Flight Response

  • Fight-or-flight response: Rapidly occurring chain of internal physical reactions that prepare people either to fight or take flight from an immediate threat.

Stress and the Endocrine System

  • Endocrine response:

    • Threat perceived (amygdala), hypothalamus, and lower brain structures activate the sympathetic nervous system.

    • The sympathetic nervous system stimulates the adrenal medulla to secrete hormones called catecholamines.

  • Catecholamines:

    • Secreted by the adrenal medulla.

    • Cause rapid physiological arousal.

    • Include adrenaline and noradrenaline.

    • Trigger rapid and intense bodily changes associated with the fight-or-flight response.

Stress and the General Adaptation Syndrome

  • Hans Selye researched the effects of exposure to extreme stress in rats.

  • Adrenal glands became enlarged.

  • Stomach ulcers and loss of weight occurred.

  • The thymus gland and lymph glands shrank.

Understand Stress and the Endocrine System

  • Corticosteroids: Hormones released by the adrenal cortex that play a key role in long-term stress response.

  • General adaptation syndrome: Hans Selye’s term for the 3-stage progression of physical changes during intense and prolonged stress.

Progression of Physical Change

  • Devastating effects of prolonged stress develop in 3 progressive stages:

    • Alarm:

      • Intense arousal.

      • Mobilization of physical resources (release of catecholamines).

      • Arousal remains above normal.

    • Resistance:

      • The body actively tries to resist or adjust to the continuing stress.

    • Exhaustion:

      • Leads to physical exhaustion and physical disorders.

      • Symptoms of the alarm stage reappear, only now irreversibly.

      • Energy reserves depleted and adaptation begins to break down, leading to death.

Stress, Chromosomes, and Aging: The Telomere Story

  • Telomeres: Repeated DNA sequences at the tips of chromosomes that protect genetic data during cell division.

  • Telomeres shorten with each cell division.

  • Shorter telomeres are linked with aging, age-related diseases, and mortality.

  • Elevated levels of cortisol and catecholamines are linked to shorter telomeres.

  • People under chronic stress have shortened telomeres.

Stress and the Immune System

  • Immune system: Produces specialized white blood cells that protect the body from viruses, bacteria, and tumor cells.

  • Lymphocytes: Specialized white blood cells that fight bacteria, viruses, and other foreign invaders.

  • Psychoneuroimmunology: Studies the interconnections among psychological processes, the nervous system, and the immune system.

  • The central nervous system and the immune system are directly linked via the sympathetic nervous system.

  • Lymphocytes have receptor sites for neurotransmitters and hormones, including catecholamines and cortisol.

  • Lymphocytes produce neurotransmitters and hormones.

Stressors That Can Influence the Immune System

  • Highly stressful events and common stresses are associated with reduced immune system functioning.

  • Examples:

    • End or disruption of important interpersonal relationships

    • Caring for a family member with Alzheimer’s disease

    • Marital arguments

    • Pressure of exams

Stress and Infection

  • Cohen demonstrated that people experiencing high stress levels are more susceptible to the cold virus.

  • Subjects experiencing chronic stressors are most likely to develop a cold after exposure (corticosteroid secretions).

  • Short-term stress may enhance the immune system.

  • Physical health is influenced by multiple factors.

  • Individual differences in vulnerability occur.

Stressors and the Common Cold

  • Sheldon Cohen and colleagues measured stress levels and then exposed volunteers to a cold virus.

  • A higher psychological stress level correlated with a higher rate of respiratory infection.

Mysterious Placebo Effect

  • Painkilling drugs and placebos activate the same brain area—the anterior cingulate cortex.

  • The anterior cingulate cortex contains many opioid receptors.

  • Placebo treatment activates opioid receptors in brain regions associated with pain.

  • Cognitive expectations, learned associations, and emotional responses can have a profound effect on pain perception.

Individual Factors That Influence the Response to Stress

  • Key Theme: Psychological factors can modify an individual’s response to stress and affect physical health.

Psychological Factors

  • Personal control: Control of a stress-producing event often reduces psychological distress or physical arousal.

  • The perception of personal control must be realistic to be adaptive.

  • Personal control is more valued in individualistic cultures.

  • Nursing-home residents with choices (high control) were more active, alert, and healthier than those without (low control).

Explanatory Style: Optimism Versus Pessimism

  • Martin Seligman explained that how people explain their failures and defeats makes a difference.

  • Optimistic explanatory style:

    • Uses external, unstable, and specific explanations for negative events.

    • Predicts better health outcomes and a strong immune system.

  • Pessimistic explanatory style:

    • Uses internal, stable, and global explanations for negative events.

    • Predicts worse health outcomes.

Chronic Negative Emotions

  • There is a strong link between negative emotions and poor health.

  • People who are habitually anxious, depressed, angry, or hostile are more likely to develop a chronic disease.

  • Positive emotions are associated with increased resistance to infection, decreased illnesses, fewer reports of illness symptoms, less pain, and increased longevity.

Type A Behavior and Hostility

  • Type A behavior pattern (Meyer Friedman and Ray Rosenman, 1974):

    • Exaggerated sense of time urgency, trying to do more in less time.

    • General sense of hostility, displaying anger and irritation; associated with heart disease.

    • Experience greater increases in blood pressure and heart rate.

  • Type B behavior pattern:

    • More easygoing, relaxed, and laid back.

    • Not associated with heart disease.

Do Personality Factors Cause Disease?

  • Psychologists are cautious about the connections between personality and health.

  • Many studies are correlational.

  • Personality factors might indirectly lead to disease via poor health habits.

  • Disease may influence a person’s emotions, rather than the other way around.

Social Factors

  • Key Theme: Social support refers to the resources provided by other people.

The Importance of Social Support

  • Socially isolated people were twice as likely to die over a given period as people with good social relationships.

  • Chronic loneliness predicts poorer physical and mental health, higher death rates, and decreased cognitive functioning.

Diverse Social Networks

  • A positive effect of diverse social networks is:

    • Greater resistance to upper respiratory infections

    • Lower incidence of stroke and cardiovascular disease among women in a high-risk group

    • Lower incidence of dementia and cognitive loss in old age

Social Support and Health

  • How social support benefits health:

    • Can modify our appraisal of a stressor’s significance.

    • Seems to decrease the intensity of physical reactions to a stressor.

    • Makes people less likely to experience negative emotion.

    • Provides direct assistance (money, meals, trips to the doctor, referrals).

  • Negative interactions can create psychological distress.

  • Unwanted or inappropriate social support can increase stress.

Social Support and Gender Differences

  • Men: Rely on close relationships with a spouse or partner and are particularly vulnerable to social isolation.

  • Women: List close friends along with their spouse as confidants, serve as providers of support (which can be stressful), and suffer from the stress contagion effect (become more upset about negative events that happen to relatives and friends).

Effective Strategies

  • Listening well and showing concern.

  • Asking questions that encourage the stressed person to express feelings and emotions.

  • Expressing affection and understanding about why the person is upset.

  • Investing time and attention in helping.

Unhelpful Strategies

  • Giving advice that the person under stress has not requested.

  • Saying “I know exactly how you feel.”

  • Talking about yourself or your own problems.

  • Minimizing the importance of the person’s problem.

  • Joking or acting overly cheerful.

  • Offering your philosophical or religious interpretation.

Coping: How People Deal with Stress

  • Key Theme: Coping refers to the ways in which we try to change circumstances, or our interpretation of circumstances, to make them less threatening.

Coping

  • Coping consists of behavioral and cognitive responses used to deal with stressors; efforts to change circumstances, or our interpretation of them to make them more favorable and less threatening.

Adaptive and Maladaptive Coping

  • Adaptive coping: A dynamic and complex process that realistically evaluates the situation and determines what can be done to minimize the impact of the stressor, while also dealing with the emotional aspects of the situation.

  • Maladaptive coping: Involves thoughts and behaviors that intensify or prolong distress, or that produce self-defeating outcomes.

Problem-Focused Coping Strategies: Changing the Stressor

  • Problem-focused coping: Aimed at managing or changing the stressor and is most effective when control can be exercised.

  • Planful problem solving: Analyzes situations rationally, identifies solutions, and implements solutions.

  • Confrontational coping: Uses aggressive or risky tactics and is ideal if direct and assertive, but not hostile.

Emotion-Focused Coping Strategies: Changing Your Reaction to the Stressor

  • Emotion-focused coping: Occurs when people believe nothing can be done to alter a situation; directs effort toward relieving or regulating the emotional impact of a stressful situation.

  • Emotion-focused coping strategies:

    • Escape–avoidance

    • Seeking social support

    • Distancing

    • Denial

    • Positive reappraisal

    • Positive religious coping

    • Negative religious coping

Culture and Coping Strategies: Individualistic Cultures

  • Emphasize personal autonomy and personal responsibility in dealing with problems.

  • Emphasize the importance and value of exerting control over circumstances.

  • Are less likely to seek social support than members of collectivistic cultures.

  • Favor problem-focused strategies, such as confrontive coping and planful problem-solving.

Culture and Coping Strategies: Collectivistic Cultures

  • Are oriented toward the social group, family, or community, and toward seeking help with problems.

  • Place greater emphasis on controlling personal reactions.

  • Are more likely to rely on emotional coping strategies than people in individualistic cultures.

Minimizing the Effects of Stress

  • Suggestion 1: Avoid or minimize the use of stimulants.

  • Suggestion 2: Exercise regularly.

  • Suggestion 3: Get enough sleep.

  • Suggestion 4: Practice a relaxation or meditation technique (mindfulness of breathing).


Term: Stress
Definition: A negative emotional state in response to events seen as taxing or exceeding a person's resources or ability to cope.


Term: Stressors
Definition: Events or situations perceived as harmful, threatening, or challenging.


Term: Burnout
Definition: An unhealthy condition caused by chronic, prolonged work stress, characterized by exhaustion, cynicism, and a sense of failure or inadequacy.


Term: Acculturative stress
Definition: Results from the pressure of adapting to a new culture.


Term: Fight-or-flight response
Definition: Rapidly occurring chain of internal physical reactions that prepare people either to fight or take flight from an immediate threat.


Term: Corticosteroids
Definition: Hormones released by the adrenal cortex that play a key role in long-term stress response.


Term: General adaptation syndrome
Definition: Hans Selye’s term for the 3-stage progression of physical changes during intense and prolonged stress (alarm, resistance, exhaustion).


Term: Telomeres
Definition: Repeated DNA sequences at the tips of chromosomes that protect genetic data during cell division; shorten with each cell division and are linked with aging and mortality.


Term: Psychological Factors
Definition: Psychological factors can modify an individual’s response to stress and affect physical health.


Term: Social support
Definition: The resources provided by other people.


Term: Coping
Definition: Behavioral and cognitive responses used to deal with stressors; efforts to change circumstances, or our interpretation of them to make them more favorable and less threatening.


Term: Adaptive coping
Definition: A dynamic and complex process that realistically evaluates the situation and determines what can be done to minimize the impact of the stressor, while also dealing with the emotional aspects of the situation.


Term: Problem-focused coping
Definition: Aim aimed at managing or changing the stressor and is most effective when control can be exercised.


Term: Emotion-focused coping
Definition: Occurs when people believe nothing can be done to alter a situation; directs effort toward relieving or regulating the emotional impact of a stressful situation.