Chapter 10: Health and Stress

Type B behavior pattern

A behavior pattern marked by a relaxed, easygoing approach to life, without the time urgency, impatience, and hostility of the Type A pattern. · They are not impatient or hostile and are able to relax without guilt. They play for fun and relaxation rather than to exhibit superiority over others. Yet, a Type B individual may be as bright and ambitious as a Type A person, and more successful as well.

Type A behavior pattern

A behavior pattern marked by a sense of time urgency, impatience, excessive competitiveness, hostility, and anger; considered a risk factor in coronary heart disease. · Most try to achieve as much as possible in as little time as is feasible. · In addition to time urgency, some people with Type A personality are also excessively competitive, hostile, and easily angered. Research indicates that these facets of Type A personality are largely responsible for its association with heart disease. These associations have been found across cultures and in both men and women. As a result, contemporary research on personality and heart disease focuses more specifically on the relationship between hostility and heart disease than on the more general Type A behavior pattern.

Primary appraisal

A cognitive evaluation of a potentially stressful event to determine whether its effect is positive, irrelevant, or negative. · According to Lazarus, when people are confronted with a potentially stressful event, they engage in a cognitive process that involves a primary and a secondary appraisal. An event appraised as stressful could involve (1) harm or loss—that is, damage that has already occurred; (2) threat, or the potential for harm or loss; or (3) challenge—that is, the opportunity to grow or to gain. An appraisal of threat, harm, or loss can occur in relation to anything important to you—a friendship, a part of your body, your property, your finances, your self-esteem. When people appraise a situation as involving threat, harm, or loss, they experience negative emotions, such as anxiety, fear, anger, and resentment. An appraisal that sees a challenge, on the other hand, is usually accompanied by positive emotions such as excitement, hopefulness, and eagerness.

Secondary appraisal

A cognitive evaluation of available resources and options prior to deciding how to deal with a stressor. · People judge the situation to be within their control, they make an evaluation of available resources—physical (health, energy, stamina), social (support network), psychological (skills, morale, self-esteem), material (money, tools, equipment), and time. Then, they consider the options and decide how to deal with the stressor. The level of stress they feel is largely a function of whether their resources are adequate to cope with the threat, and how severely those resources will be taxed in the process. Research supports their claim that the physiological, emotional, and behavioral reactions to stressors depend partly on whether the stressors are appraised as challenging or threatening.

Socioeconomic status

A collective term for the economic, occupational, and educational factors that influence an individual's relative position in society. · For example, in some neighborhoods, police officers have low status even though they may have more education and higher incomes than the people who live in the communities they serve. In other neighborhoods, police officers have high status despite having less education and lower incomes than many members of the community. Thus, socioeconomic status is a fairly complex variable. · Despite these complexities, large-scale studies of health and other variables of interest often rely on data such as income and educational level to sort people into socioeconomic status categories. When this technique is used, as you can probably predict, people who are low in socioeconomic status are usually found to more frequently have stress-related health conditions such as colds and the flu. In addition, health risk factors such as high levels of LDL cholesterol (the bad cholesterol associated with heart disease) are typically more common among them.

Hardiness

A combination of three psychological qualities—commitment, control, and challenge—shared by people who can handle high levels of stress and remain healthy. · The term was coined by psychologist Suzanne Kobasa. In a classic study of male executives with high levels of stress, Kobasa and her colleagues found that "hardy" individuals feel a strong sense of commitment to both their work and their personal life. They see themselves not as victims of whatever life brings but as people who have control over consequences and outcomes. They act to solve their own problems, and they welcome challenges in life, viewing them not as threats but as opportunities for growth and improvement.

Osteoporosis

A condition in which the body's bones become weak and break easily. Loss of bone mass.

Approach-approach conflict

A conflict arising from having to choose between equally desirable alternatives. · For example, some approach-approach conflicts are minor, such as deciding which movie to see. Others can have major consequences, such as the conflict between building a promising career or interrupting that career to raise a child.

Avoidance-avoidance conflict

A conflict arising from having to choose between undesirable alternatives. · For example, you may want to avoid studying for an exam, but at the same time you want to avoid failing the test.

Approach-avoidance conflict

A conflict arising when the same choice has both desirable and undesirable features. · The person facing this type of conflict is simultaneously drawn to and repelled by a choice—for example, wanting to take a wonderful vacation but having to empty a savings account to do so.

Acquired immune deficiency syndrome (AIDS)

A devastating and incurable illness that is caused by infection with the human immunodeficiency virus (HIV) and progressively weakens the body's immune system, leaving the person vulnerable to opportunistic infections that usually cause death.

Problem-focused coping

A direct response aimed at reducing, modifying, or eliminating a source of stress. · If you are getting a poor grade in history and appraise this as a threat, you may study harder, talk over your problem with your professor, form a study group with other class members, get a tutor, or drop the course.

Psychoneuroimmunology

A field in which psychologists, biologists, and medical researchers combine their expertise to study the effects of psychological factors on the immune system. · Their studies show that periods of high stress are correlated with increased inflammation in many kinds of tissue as well as symptoms of many infectious diseases, including oral and genital herpes, mononucleosis, colds, and flu. Stress may also decrease the effectiveness of certain kinds of vaccines. · Stress has the power to suppress the immune system long after the stressful experience is over. An experimental group of medical students who were enduring the stress of major exams was compared with a control group of medical students who were on vacation from classes and exams. When tested for the presence of disease-fighting antibodies, participants in the exam group, but not those in the control group, had a significant reduction in their antibody count because of the stress. The lowered antibody count was still present 14 days after the exams were over. At that point, the students were not even aware that they were still stressed and reported feeling no stress. · In addition to academic pressures, poor marital relationships and sleep deprivation have been linked to lowered immune response. Likewise, for several months after the death of a spouse, the widow or widower suffers weakened immune system function and is at a higher risk of mortality. Severe bereavement weakens the immune system, increasing a person's chance of suffering from a long list of physical and mental ailments for as long as 2 years following a partner's death.

Biomedical model

A perspective that explains illness solely in terms of biological factors. · Consequently, it focuses on illness more than it does on health. In some cases, the biomedical model works quite well. For example, streptococcus bacteria cause many infections of the respiratory system. Thus, when a person who has one of these ailments takes an antibiotic drug that kills streptococcus, she usually experiences a speedy and complete recovery. But why doesn't everyone who is exposed to streptococcus get sick?

Biopsychosocial model

A perspective that focuses on health as well as illness and holds that both are determined by a combination of biological, psychological, and social factors. · Individual differences in people's responses to pathogens (microorganisms that cause illness) such as streptococcus suggest that there's more to health than the biomedical model suggests. Moreover, the biopsychosocial model seeks answers to questions about what keeps us healthy as well as what makes us sick.

Risk/resilience model

A perspective that proposes that risk and protective factors interact to produce or protect us from illness. · Risk factors such as exposure to pathogens, hereditary predispositions for certain illnesses, and stress increase the chances of getting sick. Protective factors counteract the effects of risk factors and enable us to "bounce back" from their effects, that is, to exhibit resilience. Researchers have identified several factors that promote resilience in the face of stress.

Posttraumatic stress disorder (PTSD)

A prolonged and severe stress reaction to a catastrophic event or to severe, chronic stress. · Catastrophic events such as war, terrorist attacks, earthquakes, hurricanes, plane crashes, and the like are stressful both for those who experience them directly and for people who learn of them via news media. Studies show that the effects of such traumatic events can linger for years, particularly for those who have some kind of personal connection to them. For example, surveys of New York City residents indicate that some were continuing to suffer from symptoms of PTSD up to 6 years after the terrorist attacks of 2001. · Moreover, PTSD sometimes does not appear until many years after an event has been experienced, and in some cases, it is triggered by the anniversary of a traumatic event. For example, mental health professionals in the United States reported that the number of World War II veterans seeking treatment from the Veterans Administration for war-related symptoms of PTSD increased substantially in the years that followed the fiftieth anniversary of the war's end in 1945. Researchers hypothesize that age-related changes in the brain lessened some older veterans' ability to manage the emotions that were associated with traumatic combat experiences, an effect that was particularly marked in veterans who also suffered from dementia. · People with PTSD often have flashbacks, nightmares, or intrusive memories that make them feel as though they are actually re-experiencing the traumatic event. Many survivors of war or catastrophic events experience survivor guilt, one factor in a cluster of variables known as moral injury, because they lived while others died. Some feel that perhaps they could have done more to save others; moral injuries experienced by others include deep feelings of regret over having taken another person's life. Extreme combat-related guilt is a risk factor for suicide and other mental health issues. There is also an association between PTSD and substance abuse. Individuals with PTSD also experience cognitive difficulties, such as poor concentration.

Emotion-focused coping

A response involving reappraisal of a stressor to reduce its emotional impact. · Research has shown that emotion-focused coping can be a very effective way of managing stress. If you lose your job, you may decide that it isn't a major tragedy and instead view it as a challenge, an opportunity to find a better job with a higher salary. Despite what you may have heard, ignoring a stressor—one form of emotion-focused coping—can be an effective way of managing stress.

Fight-or-flight response

A response to stress in which the sympathetic nervous system and the endocrine glands prepare the body to fight or flee. · The sympathetic nervous system responds to threats (stressors) by preparing the body to resist or escape. It does so by increasing heart rate, blood pressure, and respiration rate while at the same time shutting down unnecessary functions, such as those of the digestive system. When the stressor is no longer present, the parasympathetic nervous system reverses the fight-or-flight response, and the body returns to normal. But when stressors are present for long periods, and the person's efforts to adjust to them fail, the body's tendency to keep the fight-or-flight response going can threaten our health. · Maintaining the fight-or-flight response over an extended period influences health in two ways. FIRST, research suggests that the biochemicals associated with the fight-or-flight response directly affect how the body functions. For example, when we are exposed to stressors, our bodies pump out large amounts of a substance called neuropeptide Y (NPY). NPY helps us adapt to stress by reducing anxiety. However, it also constricts the blood vessels that serve the heart and brain. As a result, the vessels become more vulnerable to blockages, an important cause of heart attacks and strokes.

Proactive coping

Active measures taken in advance of a potentially stressful situation in order to prevent its occurrence or to minimize its consequences. · Proactive copers anticipate and then prepare for upcoming stressful events and situations. For example, one certain stressor associated with attending college is that college bookstores are very busy at the beginning of the semester. To cope with this stress proactively, that is, to avoid the stress associated with standing in line with a heavy stack of books, you may order some of your books online or go to the bookstore well in advance of the start of the semester. · Parents proactively cope, too, when they take along their children's favorite snacks and toys in anticipation of the children becoming hungry and restless at a relative's home or a doctor's office. Research suggests that proactive coping diminishes the anxieties that are associated with everyday stressors such as these. Moreover, trauma survivors who learn to cope proactively with PTSD symptoms are less likely to develop other types of emotional problems.

Stressor

Any stimulus or event capable of producing physical or emotional stress. · Everyone would probably agree that major events such as changing jobs, starting a new intimate relationship, breaking up with an intimate partner, graduating from college, and so on, are stressful. Notice, too, that stressors can be either positive or negative life events. Change is the critical factor, not whether an event is perceived as desirable or undesirable.

Alternative medicine

Any treatment or therapy that has not been scientifically demonstrated to be effective.

Coping

Efforts through action and thought to deal with demands that are perceived as taxing or overwhelming.

Aerobic exercise

Exercise that uses the large muscle groups in continuous, repetitive action and increases oxygen intake and breathing and heart rates. · The following are benefits to exercising: o Improves mood o Combats chronic diseases such as high blood pressure, diabetes, and osteoporosis o Helps manage weight o Boosts energy level o Promotes better sleep o Improves sexual intimacy o Enhances enjoyment of life

Social Readjustment Rating Scale (SRRS)

Holmes and Rahe's measure of stress, which ranks 43 life events from most to least stressful and assigns a point value to each. · The classic studies of researchers Thomas Holmes and Richard Rahe are representative of this approach (1967). Life events that produce the greatest life changes and require the greatest adaptation are considered the most stressful, regardless of whether the events are positive or negative. The 43 life events on the scale range from death of a spouse (assigned 100 stress points) to minor law violations, such as getting a traffic ticket (11 points). · Holmes and Rahe claim that there is a connection between the degree of life stress and major health problems. People who score 300 or more on the SRRS, the researchers say, run about an 80% risk of suffering a major health problem within the next 2 years. Those who score between 150 and 300 have a 50% chance of becoming ill within a 2-year period. More recent research has shown that the weights given to life events by Holmes and Rahe continue to be appropriate for adults in North America and that SRRS scores are correlated with a variety of health indicators. · One of the main shortcomings of the SRRS is that it assigns a point value to each life change without considering how an individual copes with that stressor. One study found that SRRS scores did reliably predict disease progression in multiple sclerosis patients. But the patients who used more effective coping strategies displayed less disease progression than did those who experienced similar stressors but coped poorly with them.

Sexually transmitted diseases (STDs)

Infections that are spread primarily through intimate sexual contact.

Hassles

Irritating demands that occur daily and may cause more stress than major life changes do. · Richard Lazarus says daily hassles include irritating, frustrating experiences such as standing in line, being stuck in traffic, being put on hold when you are trying to resolve an issue over the phone, and so on. Relationships are another frequent source of hassles, such as happens when another person misunderstands us or when co-workers or customers are hard to get along with. Likewise, environmental conditions such as traffic noise and pollution are among the daily hassles reported by city dwellers.

Burnout

Lack of energy, exhaustion, and pessimism that results from chronic stress. · For example, one survey suggested that nearly half of the social workers in the United Kingdom suffer from burnout, and the sense of being unappreciated was the best predictor of the condition. Likewise, nurses who care for patients in vegetative states exhibit higher rates of emotional exhaustion and burnout than other types of health care professionals do.

Type D behavior pattern

People who exhibit chronic emotional distress combined with a tendency to suppress negative emotions. · Many studies have revealed a link between Type D behavior pattern and heart disease. For example, in one study of men who were enrolled in a rehabilitative therapy program after having had a heart attack, those with the Type D profile were found to have four times the risk of death as other patients in the program. However, more research is needed before the correlation between Type D personality and heart disease will be fully understood. Critics of this line of research point out that it is based on small samples and that personality is not as strong a predictor of heart disease as factors such as heredity, diet, and exercise · For example, individuals who, like those with Type D personality, tend to have a negative view of life, are less likely to abstain from tobacco after completing a smoking cessation program. Furthermore, researchers have found that Type D personality in the partners of patients who have coronary heart disease impairs these partners' ability to be supportive. As you can see, the ramifications of personality for heart disease may turn out to be quite complex.

Fact on stress (biologically)

Selye found that the most harmful effects of stress are due to the prolonged secretion of glucocorticoids, which can lead to permanent increases in blood pressure, suppression of the immune system, weakening of muscles, and even damage to the hippocampus. Thanks to Selye, the connection between extreme, prolonged stress and certain diseases is now widely accepted by medical experts.

Bacterial STDs

Sexually transmitted diseases that are caused by bacteria and can be treated with antibiotics.

Viral STDs

Sexually transmitted diseases that are caused by viruses and are considered to be incurable.

Social support

Tangible and/or emotional support provided in time of need by family members, friends, and others; the feeling of being loved, valued, and cared for by those toward whom we feel a similar obligation. · Social support appears to have positive effects on the body's immune system as well as on the cardiovascular and endocrine systems. Social support may help encourage health-promoting behaviors and reduce the impact of stress so that people are less likely to resort to unhealthy methods of coping, such as smoking or drinking. Further, social support has been shown to reduce depression and enhance self-esteem in individuals who suffer from chronic illnesses, such as kidney disease.

Alarm stage

The first stage of the general adaptation syndrome, in which the person experiences a burst of energy that aids in dealing with the stressful situation. · The adrenal cortex releases hormones called glucocorticoids that increase heart rate, blood pressure, and blood sugar levels, supplying a burst of energy that helps the person deal with the stressful situation, that is, the fight-or-flight syndrome.

Sarcopenia

The loss of muscle mass, strength, and function that comes with aging.

Stress

The physiological and psychological response to a condition that threatens or challenges a person and requires some form of adaptation or adjustment.

Uplifts

The positive experiences in life, which may neutralize the effects of many hassles.

General adaptation syndrome (GAS)

The predictable sequence of reactions (alarm, resistance, and exhaustion stages) that organisms show in response to stressors. · Hans Selye (1907-1982), the researcher most prominently associated with the effects of stress on health, established the field of stress research.

Resistance stage

The second stage of the general adaptation syndrome, when there are intense physiological efforts to either resist or adapt to the stressor. · The adrenal cortex continues to release glucocorticoids to help the body resist stressors. The length of the resistance stage depends both on the intensity of the stressor and on the body's power to adapt.

Health psychology

The subfield within psychology that is concerned with the psychological factors that contribute to health, illness, and recovery. · Health psychologists use principles of psychology to prevent illness and to help restore people who are ill to health. Furthermore, for health psychologists, the concept of health extends beyond the simple absence of disease. It includes all aspects of well-being in the physical, psychological, and social domains. Consequently, the scope of health psychology is quite broad. · One important goal of health psychology is to find ways to improve communication between health care professionals and the people they serve. Another is to identify the psychological, behavioral, and social factors that contribute to conditions such as chronic pain, asthma, heart disease, diabetes, cancer, and so on. Health psychologists also design strategies for helping people make behavioral changes that can enhance people's health. · Health psychologists have found that stress contributes to individual differences in each of these areas. For example, some patients find communicating with health professionals about their condition to be highly stressful. Researchers hypothesize that stress distracts such patients from the information that care providers are attempting to convey to them. As a result, these patients are less likely to follow instructions about medication and other aspects of their treatment than those for whom communication with providers is less stressful. Thus, patients' responses to providers' instructions may improve if they learn how to manage their stress responses more effectively.

Exhaustion stage

The third stage of the general adaptation syndrome, which occurs if the organism fails in its efforts to resist the stressor. · All the stores of deep energy are depleted, and disintegration and death follow.

Life events approach

The view that a person's state of well-being can be threatened by major life changes. · This approach includes events that most people experience at one time or another, such as beginning and ending romantic relationships. It also includes both positive and negative events that most of us never or rarely experience first-hand, such as winning the lottery, combat, and natural disasters.

Human immunodeficiency virus (HIV)

The virus that causes AIDS.

Lymphocytes

The white blood cells—including B cells and T cells—that are the key components of the immune system. · SECOND, the fight-or-flight response indirectly affects health by suppressing the body's immune system. Composed of an army of highly specialized cells and organs, the immune system works to identify and search out and destroy bacteria, viruses, fungi, parasites, and any other foreign matter that may enter the body. T cells derive their name from the thymus gland, where they are produced. All cells foreign to the body, such as bacteria, viruses, and so on, are known as antigens. B cells produce proteins called antibodies, which are highly effective in destroying antigens that live in the bloodstream and in the fluid surrounding body tissues. For defeating harmful foreign invaders that have taken up residence inside the body's cells, however, T cells are critically important. Thus, the fight-or-flight response on its own is not detrimental to health. Instead, its influence on health operates through its indirect effects on the cells that protect the body from stressors.

The Hassles and Uplifts Scale

· Unlike the Holmes and Rahe scale, the Hassles Scale considers the fact that items may or may not represent stressors to individuals and that the amount of stress produced by an item varies from person to person. People completing the scale indicate the items that have been a hassle for them and rate those items for severity on a 3-point scale. · Lazarus and his colleagues also constructed an Uplifts Scale. As with the Hassles Scale, people completing this scale make a cognitive appraisal of what they consider to be an uplift. Research has demonstrated links among hassles, uplifts, and a personal sense of well-being. It appears that a hectic daily schedule increases hassles, decreases uplifts, and diminishes their subjective sense of how well they feel.

Albrecht (1979) suggested that if people are to function effectively and find satisfaction on the job, the following nine variables must fall within their comfort zone:

· Workload. Too much or too little to do can cause people to feel anxious, frustrated, and unrewarded. · Clarity of job description and evaluation criteria. Anxiety arises from confusion about job responsibilities and performance criteria or from a job description that is too rigidly defined to leave room for individual initiative. · Physical variables. Temperature, noise, humidity, pollution, amount of workspace, and the physical positions (standing or sitting) required to carry out job duties should fall within a person's comfort zone. · Job status. People with very low-paying, low-status jobs may feel psychological discomfort; those with celebrity status often cannot handle the stress that fame brings. · Accountability. Accountability overload occurs when people have responsibility for the physical or psychological well-being of others but only a limited degree of control (air-traffic controllers, emergency room nurses and doctors); accountability underload occurs when workers perceive their jobs as meaningless. · Task variety. To function well, people need a comfortable amount of variety and stimulation. · Human contact. Some workers have virtually no human contact on the job (forest-fire lookouts); others have almost continuous contact with others (welfare and employment office workers). People vary greatly in how much interaction they enjoy or even tolerate. · Physical challenge. Jobs range from being physically demanding (construction work, professional sports) to requiring little to no physical activity. Some jobs (firefighting, police work) involve physical risk. · Mental challenge. Jobs that tax people beyond their mental capability, as well as those that require too little mental challenge, can be frustrating.