Abnormal Psych-Chap 9 (Stress-Related Disorders and Health Psychology)

The top health problems experienced by students in the National College Health Assessment in the past year were:

(1) allergy (47.9%), (2) back pain (46.1%), (3) sinus infection (30.7%), (4) depression (17.0%), and (5) strep throat (13.8%). About 1 in 10 students experienced asthma. The top health problems were comparable for men and women.

Describe the effect of prolonged rumination on people with a chronic illness:

-Prolonged rumination contributes to a heightened stress response, and, presumably, chronic rumination should translate into a chronic stress reaction that can take a long-term toll on the body (such as high blood pressure by prolonging cardiovascular activation following a stressful experience) -Other vulnerability factors such as perfectionism combine with a tendency to ruminate to produce not only mental health problems but also physical health problems

Describe findings on social support systems as well as emotional style and the immune system:

-Social support was found to moderate the relationship between viral exposure and colds; people with more diverse social networks were less likely to develop a cold following exposure to a virus -More recent work shows that a positive emotional style (i.e., being happy, calm, and full of vigour) protects people from illness after being exposed to a virus, and the presence of this positive emotional style is more predictive than the presence or absence of a negative emotional style (i.e., depressed, anxious, and hostile)

Which individuals are at risk for prolonged exposure to stress hormones?

-Some people may have consistently high levels of stress hormones because they experience frequent stress -Other people may have less difficulty in adapting to repeated exposure to stressful situations.

What is *stress* according to Selye?

-State of an organism subjected to a stressor. It can take the form of increased autonomic activity and in the long term can cause the breakdown of an organ or development of a mental disorder. -Selye is especially well-known for promoting the view that stress plays a role, for better or worse, in all diseases

Why is it important to be aware of hypertension?

Hypertension, commonly called high blood pressure, disposes people to atherosclerosis (clogging of the arteries), heart attacks, and strokes; it can also cause death through kidney failure

What do the major biological responses to stress involve?

Activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis (HPA). Under conditions of stress, catecholamines such as epinephrine are released from nerves and from the adrenal medulla and lead to secretion of corticotropin from the pituitary. Corticotropin then leads to the release of cortisol from the cortex of the adrenal gland.

Mechanism through which stress could increase risk for viral infection:

An increase in undesirable life events coupled with a decrease in desirable life events produces increased negative mood, which in turn depresses antibody levels in secretory sIgA. If during this period a person is exposed to a virus, he or she will be at increased risk for infection.

What is *behavioural medicine*?

An interdisciplinary field concerned with integrating knowledge from medicine and behavioural science to understand health and illness and to prevent as well as to treat psychophysiological disorders and other illnesses in which a person's psyche plays a role. See also health psychology.

Which trait of Type A behaviour predicts CHD?

Anger/hostility

What is *angina pectoris*?

Angina pectoris, chest pains caused by insufficient supply of blood and thus oxygen to the heart; and myocardial infarction, or heart attack, in which the blood and oxygen supply is reduced so much that heart muscles are damaged.

What is *coronary heart disease (CHD)*?

Angina pectoris, chest pains caused by insufficient supply of blood and thus oxygen to the heart; and myocardial infarction, or heart attack, in which the blood and oxygen supply is reduced so much that heart muscles are damaged.

What are low levels of social support related to?

Are related to an increase in negative emotions, which may affect some hormone levels and the immune system

The many demonstrations of the pervasive role of psychological factors in health form the basis for the fields of _____ and _____

Behavioural medicine, health psychology

What are the results of the studies that have tried to predict blood pressure from reactivity?

Blood pressure changes during a video game predicted coronary calcification of the arteries 13 years later-the reaction to the video game represents a general tendency to be physiologically reactive to stress and challenge

How may blood pressure be elevated?

Blood pressure may be elevated by increased cardiac output (the amount of blood leaving the left ventricle of the heart), by increased resistance to the passage of blood through the arteries (vaso-constriction), or by both

What is *systolic pressure*?

The systolic measure, the upper number, is the amount of arterial pressure when the ventricles contract and the heart is pumping

Which Individuals should be most prone to health problems as a result of brooding about negative social interactions?

The tendency to experience autonomic dysregulation occurred among participants who have personalities characterized by hostility, self-directed anger, depression, and anxiety

How does stress affect the immune system?

There is now extensive evidence that stress dysregulates the immune system, and work on psychoneuroimmunology shows that immune system responses to viral and bacterial vaccines can be delayed, weakened, and shorter in duration for stressed or distressed people

What have behavioural medicine/health psychology dealt with?

These fields have dealt with the role of psychological factors in all facets of health and illness-researchers in these fields study psychological treatments (e.g., biofeedback for headache) and the health care system itself (e.g., how better to deliver services to underserved populations)

Psychological approaches attribute particular psychophysiological disorders to what?

Unconscious emotional states, personality traits, cognitive appraisals, and specific styles of coping with stress

Several factors increase risk for CHD and the risk generally increases with the number and severity of these factors:

age sex (males are at greater risk) cigarette smoking elevated blood pressure elevated serum cholesterol an increase in the size of the left ventricle of the heart obesity long-standing pattern of physical inactivity excessive use of alcohol diabetes

The top five factors that undermined a students academic performance were:

Stress (33.9%), cold/flu/sore throat (28.8%), sleep difficulties (25.6%), concern for troubled friend or family member (18.8%), and Internet use/computer games (16.9%). Other specific sources of stress mentioned were relationship difficulties and death of a family member or friend.

Give examples of things that cause short-term elevation of blood pressure:

Stressful interviews, natural disasters such as earthquakes, and job stress

What are consequences of *job burnout*?

Job burnout has been linked with a vast array of physical problems including cardiovascular disease and psychological difficulties such as depression + vital exhaustion, a physical depletion that is also linked to cardiovascular disease

What is *health psychology*?

A branch of psychology dealing with the role of psychological factors in health and illness. See also behavioural medicine.

What is the *perseverative cognition hypothesis*?

The notion that rumination prolongs the stress response and thus contributes to health problems

Give an example of how biological changes that stress produces are adaptive in the short run:

The mobilization of energy resources in preparation for physical activity

What other negative emotions may influence the development of CHD?

-Anxiety has been shown to be related to CHD in humans and animal research demonstrates that inducing anxiety in animals with atherosclerosis can precipitate a heart attack -Depression -Type D personality →Many plausible biological mechanisms for these relationships have been proposed. Likely factors and processes include increased inflammation, increased susceptibility to blood clotting, oxidative stress, and increased activation of the HPA axis

Give examples of what ambulatory blood pressure monitoring studies have found:

-Both positive and negative emotional states are associated with higher blood pressure -Paramedics: the groups did not differ in blood pressure during the low-stress calls, but on the high-stress calls, paramedics high in anger and defensiveness had higher blood pressure -The overall amount of blood-pressure increase associated with emotional states or environmental conditions was rather small; but, only people who have some predisposition, or diathesis, will experience large blood-pressure increases that over time may lead to sustained hypertension

Describe how different stressors can have different physiological implications:

-Chronic, intermittent, and unpredictable stressors are less likely to result in neurochemical adaptation -Intense and prolonged demands on neurochemical systems may create a condition known as allostatic load, which can lead to a variety of pathological outcomes

What are other things that help moderate stress?

-Coping -Social support

Describe the Type D personality:

-D stands for "distressed" -Type D is defined as high scores on negative affectivity (a tendency to experience high levels of anxiety, anger, and depression) plus social inhibition, including inhibiting the expression of these emotions -Type D personality seems to be accompanied by a tendency to engage in fewer positive health behaviours and it is linked with negative appraisals of social support

What happens when the sympathetic nervous system is chronically activated (the person is chronically stressed)?

-Eventually, significant health problems may result from this activation and prolonged exposure to stress hormones -These health problems may reflect having a diminished immune system, given that the nervous system sends signals that influence the immune system (or hypertension)

Describe the Social Readjustment Rating Scale and how it relates to illness:

-Gave a list of life events to a large group of people and asked them to rate each item according to its intensity and the amount of time they thought they would need to adjust to it -Ratings are then totalled for all the events actually experienced to produce a Life Change Unit (LCU) score, a weighted sum of events -The original LCU score has been related to several different illnesses, including heart attacks, onset of leukemia, and colds and fevers -The results demonstrated a correlation between psychological stress and physical illness, but they do not necessarily mean that stress causes or contributes to illness

Describe Franz Alexander's view on psychophysiological disorders:

-He maintained that each of the various psychophysiological disorders is the product of unconscious emotional states specific to that disorder (ex. undischarged hostile impulses are believed to create the chronic emotional state responsible for essential hypertension) -Created anger-in theory: The view that psychophysiological disorders, such as essential hypertension, arise from a person's not expressing anger or resentment.

Describe a study done on social support:

-In one such study, university-aged women were assigned to high- or low-stress conditions, which they experienced alone or with a close friend -In one part of the study, stress was created by having the experimenter behave coldly and impersonally, telling participants to improve their performance as they worked on a challenging task -In each case where the woman had the social support of a close friend, the friend "silently cheered her on" and sat close to her, placing a hand on her wrist -The dependent variable was blood pressure, measured while participants performed the task. -As expected, high stress led to higher blood-pressure levels -The high-stress condition produced its effects on blood pressure primarily in those women who experienced the stress alone -Social support was thus shown to have a causal effect on a physiological process -Further laboratory research has shown that such results are produced only when the support comes from a friend and not when it comes from a stranger

Why should research on stress be longitudinal?

-It often takes many years for stress to contribute to illness -Longitudinal research offers several advantages; for instance, the biases of retrospective self-reports are minimized and changes in stress can be shown to precede changes in health

Describe how stress has been associated with both increased and reduced HPA axis activity:

-One key factor is the timing of the assessment: time elapsed following the stress was associated negatively with HPA activity; as the months go by, cortisol secretion eventually goes back to normal -The nature of the stressor is also important; as might be expected, prolonged high activation resulted from more traumatic stressors, stressors that threaten survival, and stressors involving a profound threat to the social self (e.g., a divorce) -Uncontrollable stressors are linked with persistent HPA axis activation

What kinds of factors can increase the risk of myocardial infarction?

-Physical exertion -Acute stress -Chronic stressors -Job strain -Workers in lower-status jobs (having little control on the job) -Highly demanding jobs have also been related to the progression of atherosclerosis, and to CVD mortality and morbidity

Describe the Assessment of Daily Experience (ADE) and how it relates to illness:

-The ADE allows individuals to record and rate their daily experiences in prospective or longitudinal investigations -There is now direct evidence that these minor events are related to illness -With an assessment of daily experiences in hand, examined the relationship between undesirable and desirable events and the onset of episodes of respiratory illness -Respiratory illness was selected as the criterion variable because it occurs with sufficient frequency to allow it to be analyzed as a distinct outcome -After reviewing the participants' data, the researchers identified 30 individuals who had experienced episodes of infectious illness during the assessment period -Next, they examined the daily frequency of undesirable and desirable events that occurred from 1 to 10 days before the start of an episode -For each person, a set of control days, without an episode, was also selected -The results showed that, for desirable events, there were significant decreases three and four days before the onset of respiratory infection; for undesirable events, there were significant increases at four and five days before the onset of the illness -Were the first to show a relationship between life events and health -Now come much closer to asserting that life events play a causal role in increasing vulnerability to episodes of infectious illness

Describe the coronary-prone behaviour pattern called Type A behaviour pattern:

-The Type A individual has an intense and competitive drive for achievement and advancement, an exaggerated sense of the urgency of passing time and of the need to hurry, and considerable aggressiveness and hostility toward others -Type A pattern predicts coronary heart disease

Give examples of how easy it is to produce increased blood pressure in the laboratory:

-The induction of various emotional states, such as anger, fear, and sadness, all increase blood pressure -Similarly, challenging tasks, such as mental arithmetic, mirror drawing, putting a hand in ice water (the cold pressor test), and giving a speech in front of an audience all lead to increased blood pressure

Give an example of how stress affects the immune system using antibodies:

-The secretory component of the immune system exists in the tears, saliva, and gastrointestinal, vaginal, nasal, and bronchial secretions that bathe the mucosal surfaces of the body-a substance found in these secretions, called secretory immunoglobulin A, or sIgA, contains antibodies that serve as the body's first line of defence against invading viruses and bacteria -They prevent the virus or bacterium from binding to mucosal tissues -Changes in the number of sIgA antibodies were linked to changes in mood -On days when the students experienced relatively high levels of negative mood, fewer antibodies were present than on days when the students had low levels of negative mood. Similarly, antibody level was higher on days with higher levels of positive mood.

Describe a study done by Obrist and his colleagues on blood pressure:

-Used a reaction-time task in which participants were told they would receive an electric shock if they did not respond quickly enough -Good performance led to a monetary bonus -The reaction-time task yielded significant increases in both heart rate and systolic blood pressure

Describe another study on stress and the immune system (nasal drops with cold virus):

-Volunteers took nasal drops containing a mild cold virus and completed a battery of questionnaires concerning recent stress -The advantage of this method was that exposure to the virus was an experimental variable under the investigators' control -Researchers found that stress was clearly linked to developing a cold -The stressors most often implicated were interpersonal problems and work difficulties

Give 8 important things to help you lessen stress and therefore live a healthier life:

1. Don't be poor: poverty is the number-one predictor of long-term health status 2. Get a good start in life: prenatal and early childhood experiences have a profound effect on many outcomes, including long-term health status 3. Graduate from high school (and preferably from college or university): as education level increases, so does health status 4. Get a job: unemployment is linked with lower levels of functional health and increased levels of stress 5. Choose your community: data on healthy vs. unhealthy communities illustrate that where you live matters as does the community's values and your sense of belonging and mattering in the community, and these can have a substantial impact on your health and well-being 6. Live in quality housing: exposure to environmental risks often translates into subsequent health problems 7. Look after yourself: much is to be gained by eating well, exercising, and not abusing alcohol or drugs. Self-care and knowing when to advocate for yourself are essential to your well-being. 8. Men and women are different: men do not live as long as women, on average, though women report poorer health status.

What are the 3 phases of general adaptation syndrome (GAS)?

1. During the first phase, the alarm reaction, the autonomic nervous system is activated by the stress. If the stress is too powerful, gastrointestinal ulcers form, the adrenal glands become enlarged, and the thymus undergoes atrophy (wasting away). 2. During the second phase, resistance, the organism adapts to the stress through available coping mechanisms. The length of resistance depends on the body's innate adaptability and the intensity of the stressor 3. If the stressor persists or the organism is unable to respond effectively, the third phase, a stage of exhaustion, follows, and the organism dies or suffers irreversible damage

What is job burnout?

A form of work-related stress. Burnout has three components: (1) emotional exhaustion; (2) depersonalization; and (3) a sense of a lack of personal accomplishment.

What is a possible biological mechanism for the stress-reducing effects of social support?

A hormone called oxytocin may be released during social interaction. Oxytocin decreases activity of the sympathetic nervous system and may thereby lessen the physiological effects of a stressor.

What is one theory of CHD?

Chronic stress activates the immune system and contributes to inflammation, which, in turn, produces CHD

What is *myocardial infarction*?

Heart attack. Angina pectoris, chest pains caused by insufficient supply of blood and thus oxygen to the heart; and myocardial infarction, or heart attack, in which the blood and oxygen supply is reduced so much that heart muscles are damaged.

Tying together this interest in CHD and negative emotions—anger, anxiety, and depression—is the proposed Type __ personality,

D

What other hassles can be assessed?

Daily hassles, illness-specific hassles (associated with higher levels of anger, fatigue, and depression)

The role of stress in disease progression is indicated by what?

Data linking stress and distress with cytokine secretion by tumour cells (for certain individuals, stress can kill)

The theories in the stress-illness link are primarily what?

Diathesis-stress

What are *psychophysiological disorders*?

Disorders with physical symptoms that may involve actual tissue damage, usually in one organ system, and that are produced in part by continued mobilization of the autonomic nervous system under stress. Hives and ulcers are examples. (also asthma, hypertension, headache, and gastritis)

Describe how functional support is related to illness/mortality:

Higher levels of functional support have been found to be related to lower rates of atherosclerosis (clogging of the arteries) and to the ability of women to adjust to chronic rheumatoid arthritis

Describe how the The Brief College Hassles Scale is related to illness:

Higher scores on the BCHS have been linked with greater psychological distress and frequency of headaches

Hypertension without an evident biological cause is called _____ (or sometimes _____) hypertension.

Essential, primary

What is silent ischemia?

In many patients with coronary heart disease, episodes of ischemia do not result in the report of pain

What is *specific-reaction theory*?

Individuals respond to stress in their own idiosyncratic ways, and the body system that is the most responsive becomes a likely candidate for the locus of a subsequent psychophysiological disorder (ex. the heart rate of one individual may increase, whereas another person may react with an increased respiration rate but no change in heart rate)

Describe subsequent research that sought to identify the neural systems mediating blood pressure reactivity:

It was found that individuals with greater stress-evoked changes in mean arterial pressure had greater amygdala activation, lower amygdala grey matter volume, and stronger connectivity between the amygdala and both the perigenual anterior cingulate cortex and the brainstem pons (a follow-up study found that there is a neurobiological correlate (i.e., heightened resting corticolimbic activity) of high blood pressure reactivity)

What are *cardiovascular disorders (CVD)*?

Medical problems involving the heart and the blood circulation system, such as hypertension or coronary heart disease.

A wide range of stressors have been found to produce changes in the immune system:

Medical-school examinations, depression and bereavement, marital discord and divorce, job loss, caring for a relative with Alzheimer's disease, and the Three Mile Island nuclear disaster in Pennsylvania, among others

What factors predict less positive ratings of health status?

More negative assessments by students from Canada were associated with poorer child-parent relationships, lower interest and achievement in school, lower self-esteem, smoking, and being female

How do negative emotions affect us physically?

Negative emotions, such as resentment, regret, and worry, may keep the body's biological systems aroused and the body in a continual state of emergency, sometimes for far longer than it can bear (at risk for heart problems)

Does serious muscle damage result from angina pectoris?

No-however, the narrowing of one or more coronary arteries progresses to the point of producing a total blockage, a myocardial infarction, or heart attack, is likely to occur

How does social support exert its beneficial effects?

One possibility is that people who have higher levels of social support perform positive health behaviours more frequently: eating a healthy diet, not smoking, and moderating alcohol intake

The _____ nervous system is involved in deactivation and restoring the organism to a lower state of activation

Parasympathetic

What can be done to eliminate the negative effects of rumination?

Ruminators must learn to gain cognitive control over the thought cycle and engage in a cognitive process of thought stopping when the ruminative cycle and the distress it generates is getting out of control

Biological approaches attribute particular psychophysiological disorders to what?

Specific organ weaknesses, to overactivity of particular organ systems in responding to stress, to the effects of exposure to stress hormones, or to changes in the immune system that are caused by stress

Describe how appraisal of a potential stressor is central to how it affects the person:

People who continually appraise life experiences as exceeding their resources may be chronically stressed and at risk for the development of a psychophysiological disorder

Describe how structural support is a well-established predictor of mortality:

People with few friends or relatives tend to have a higher mortality rate than those with a higher level of structural support

What are the symptoms of angina pectoris?

Periodic chest pains, usually located behind the sternum and frequently radiating into the back and sometimes the left shoulder and arm

Both angina and episodes of silent ischemia are precipitated by what?

Physical or emotional exertion and are commonly relieved by rest or medication

What is also a main focus of health psychology?

Prevention-The causes of CVD involve behaviour—people's lifestyles—such as smoking, eating too much, and excessive alcohol use. Thus, it is believed that many CVD cases can be prevented by changing unhealthy lifestyles. Health psychologists are at the forefront of prevention efforts that address CVD and other illnesses.

What do psychoanalytic theories believe about psychophysiological disorders?

Propose that specific conflicts and their associated negative emotional states give rise to psychophysiological disorders

Stress is often implicated in the development of _____ disorders

Psychophysiological

What are *psychosomatic disorders*?

Same as psychophysiological disorders, disorders in which the psyche, or mind, is having an untoward effect on the soma, or body.

What is *general adaptation syndrome (GAS)*?

Selye's model to describe the biological reaction of an organism to sustained and unrelenting stress. There are several stages, culminating in death in extreme circumstances.

_____-term stress may actually be beneficial in activating the immune system; it is the _____-term stress that tends to undermine and weaken the immune system

Short, long

The experience of stress or the anticipation of stress activates the _____ nervous system

Sympathetic

Blood pressure is measured by two numbers: one represents _____ pressure, and the other represents _____ pressure

Systolic, diastolic

What is the *somatic nervous system*?

That part of the nervous system that controls muscles under voluntary control.

Research on the effects of stress on human health has sought to measure what?

The amount of life stress a person has experienced and then to correlate this measurement with illness

What is the key to the theory of prolonged exposure to stress hormones?

The body pays a price if it must constantly adapt to stress-through exposure to high levels of stress hormones, it may become susceptible to disease because of altered immune system functioning + high levels of cortisol can have direct effects on the brain; for example, high levels can kill cells in the hippocampus, which itself regulates the secretion of cortisol (over time, the person may become even more susceptible to the effects of stress)

What is *diastolic pressure*?

The diastolic measure, the lower number, is the degree of arterial pressure when the ventricles relax and the heart is resting

What is the *sympathetic nervous system*?

The division of the autonomic nervous system that acts on bodily systems—for example, contracting the blood vessels, reducing activity of the intestines, and increasing the heartbeat—to prepare the organism for exertion, emotional stress, or extreme cold.

What is the *parasympathetic nervous system*?

The division of the autonomic nervous system that is involved with maintenance. It controls many of the internal organs and is active primarily when the organism is not aroused.

What is the *autonomic nervous system (ANS)*?

The division of the nervous system that regulates involuntary functions; innervates endocrine glands, smooth muscle, and heart muscle; and initiates the physiological changes that are part of the expression of emotion. See also parasympathetic and sympathetic nervous systems.

What is the general research strategy for cardiovascular disease?

The general research strategy is to assess cardiovascular reactivity to a laboratory stressor (or, even better, a battery of stressors) among people who are not currently hypertensive and then to follow up with the participants some years later to determine whether the reactivity measure (usually the amount of change from a baseline condition after exposure to the stressor) predicts blood pressure.

Why has the high level of cognition in humans been a somewhat negative thing?

The high level of cognition made possible in humans through evolution creates the potential for distressed thoughts, which can bring about bodily changes that persist longer than they were meant to-our higher mental capacities, it is theorized, subject our bodies to physical storms that they were not built to withstand

What is *somatic-weakness theory*?

The hypothesis that a weakness in a particular organ or organ system can make it vulnerable to psychological stress and thereby to a particular psychophysiological disorder (ex. genetic factors, prior illnesses, diet, and the like may disrupt a particular organ system, which may then become weak and vulnerable to stress)

What is the *social gradient of health*?

The link between low socio-economic status and poor health

What is the major cause of angina pectoris?

The major cause of these severe attacks of pain is an insufficient supply of oxygen to the heart (called ischemia), which in turn is due to coronary atherosclerosis, a narrowing or plugging of the coronary arteries by deposits of cholesterol, a fatty material, or constriction of the blood vessels