Chapter 5 Coping with stress (Health)

What is problem-focused solving?

- A coping strategy for dealing directly with a stressor, in which we either reduce the stressor's demands or increase our resources for meeting its demands.

What is emotion-focused solving?

- A coping strategy in which we try to control our emotional response to stressor - Tend to rely on this strategy when we believe that little or nothing can be done to alter a stressful situation or when we believe that our coping resources or skills are insufficient to meet the demands of the stressful situation.

What is approach (vigilant) coping?

- A coping strategy that directly confronts a stressor and attempts to develop a solution.

What is negative affectivity?

- A coping style of personality dimension consisting of chronic negative emotions and distress; also known as neuroticism. - People who score high of measures of NA are extremely tense, anxious, insecure, jealous, hostile and emotionally unstable.

What is progressive muscle relaxtion?

- A form of relaxation training that reduces muscle tension through a series of tensing and relaxing exercises involving the body's major muscle groups. - First you tense a particular muscle and hold that tension for about ten seconds. - Then you slowly release the tension, focusing on the soothing feeling as the tension draws away. - Then, you tense, then relax other major muscle groups. - After practicing for several weeks you will identify the particular spots in your body that tense up during moments of stress, and will be able to learn to relax these at will.

When is social support not needed?

- A person may not perceive the help as beneficial (does not want it, thinks its inadequate, too distracted to notice help is being offered). - May not be what is needed at the moment. There is a difference between instrumental and emotional support. - Too much social support may actually increase a person's stress.

What is avoidant (minimising) coping?

- A strategy for coping with stressors by withdrawing, minimising or avoiding them through o Passive behaviors o Antisocial behaviours o Fantasising

How does social support make a difference?

- According to the buffering hypothesis, social support mitigates stress indirectly by helping us cope more effectively. For instance, people would be less likely to ruminate. - According to the direct hypothesis, social support enhances the body's physical response to challenging situations. Example, those low in social support had significantly higher PSA levels. - Even perception of social supportive personal relationships can help. - Quality of ones personal relationships may affect cellular aging.

To develop a more positive explanatory style you need to (ABC's op optimism):

- Adversity, by interpreting difficulties in terms that are o External o Temporary o Specific - Beliefs - Consequences TIP: It's learning to counter-argue, to offer alternative causes and to recognise that you are overreacting.

What coping strategy to use depends on:

- Age - Duration of the stressor - Whether the stressor is controllable

Biopsychosocial view, coping with and managing stress effectively:

- Biological Influences: o Greater regulatory control o Hardy personality - Social influences: o Experiencing helpful social support o Interacting with pets o Disclosing emotional experiences articulately to family or friends or in writing. - Psychological influences: o Using active coping mechanisms o Developing an optimistic explanatory style o Being grateful o Maintaining a sense of humour o Establishing a feeling of personal control o Exercising o Using relaxation techniques o Utilising cognitive therapy techniques

Why is optimism beneficial to health?

- Broaden-and-build theory, believes that positive emotions increase our physical. cognitive, and social resources, which in turn help us cope more effectively with stressful experiences and live healthier lives.

TIP basically things which reduce our stress:

- Decrease our epinephrine levels - Decrease our secretion of cortisol - Decrease our blood pressure - Increase dopamine, oxytocin and serotonin

Repressive coping is associated to:

- Differs heart rate variability (time between heart beats) - Development of cancer - High cortisol - High blood pressure - Development of asthma - Development of diabetes (increase in insulin and glucose) - Have high number of white blood cells called eosinophiles. -

How people cope with a stressor is influenced by:

- Family - Friends - Education - Employment - Time - Money - Socioeconomic status (most)

Those with social support have:

- Faster recovery and fewer medical complications - Lower mortality rates - Less distress in the face of terminal illness

Resilience is associated to many specific characteristics among adults:

- Forgiveness - Sense of coherence and purpose in life - Self-efficacy - Lower incidence of depression, anxiety, and perceived stress

Other factors that may affect our ability to cope include:

- Gratitude - Humor - Pets - Spirituality

Skeptics have suggested that hardy people are healthier because they have:

- Greater personal resources, such as income, education, social support, and coping skills, and tend to be younger than the less hardy.

Types of internal resources when dealing with stress:

- Hardiness - Optimism - Pessimism - Personal control - Disclosure

Those with a positive explanatory style tend to:

- Lead healthier, longer lives. - Short hospital stays - Faster recovery from coronary artery bypass surgery - Greater longevity when battling AIDS.

What accounts for the correlation between strong religious practices and longevity?

- Lifestyle (normally safer, healthier) - Social support (more social ties from communal services) - Positive emotions (

Hardiness has been linked to:

- Lower levels of anxiety - Active coping styles - Decreased caregiver burden - Reduced vulnerability to depression in older people living in a long-term care facility - Better adaptation of professional women to the stress of multiple roles - Greater spiritual well-being in elderly people - Fewer negative health outcomes during periods of extended stress

Gender and coping strategies:

- Men are more likely to use problem-focused coping - Women are more likely to use emotion-focused coping

Cognitive behavioural stress management:

- Often begins by teaching people to confront stressful events with a variety of coping strategies that can be used before the events become overwhelming. - Individuals are able to "inoculate" themselves against the potentially harmful effects of stress. - Stress inoculation training has three stages, which use a weakened dose of a stressor in an attempt to build immunity against the full-blown stressor.

Duration of the stressor

- Problem focused coping proving more effective with chronic stressors than acute stressors.

Age and coping strategies:

- Problem-focused coping skills appear to emerge during childhood - Emotion-focused skills develop later, in early adolescence.

Types of stress methods:

- Relaxation Therapies o Progressive Muscle Relaxation o Relaxation Response o Deep breathing and visualisation - Cognitive Behavioural Therapy - Expressive Writing

Emotion-focused coping has been linked to emotional distress and a variety of health problems such as:

- Rumination

Self regulation is associated to:

- Success in dieting - Quitting smoking - Maintaining good interpersonal relationships - Less likely to resort to maladaptive coping response such as angry venting or emotions or avoidant coping. In children: - Good self-control are calmer - More resistant to frustration - Better able to delay gratification - Less aggressive

What is coping?

- The cognitive, behavioural, and emotional ways in which we manage stressful situations and includes any attempt to preserve mental and physical health. - It is a dynamic process, and is a series of responses involving our interactions with the environment.

What is Emotional-approach coping (EAC)?

- The process of working through, clarifying, and understanding the emotions triggered by a stressor. - It is comprised of two emotion-regulating processes: emotional processing and emotional expression. - We use behavioural strategies, seeking out others who offer encouragement, or keeping ourselves busy to distract attention from the problem. - We use cognitive strategies, such as changing the way that we appraise a stressor or denying unpleasant information.

What is cognitive behavioural therapy?

- The use of principle from learning theory to change unhealthy patterns of thinking and behaviour. - If thinking of the environment can be changed, and sills acquired to make positive changes in behaviour, stress can be reduced. - Types of CBT: o Distraction (Pleasant imagery (visualisation), counting aloud, focusing attention on relaxing stimuli). o Calming & Self-statements (to emphasise the temporary nature of the stressor, are aimed at reducing autonomic arousal, or are directed at preserving a sense of personal control). o Cognitive restructuring (directed at replacing maladaptive, self defeating thoughts with healthier adaptive thinking, therapists teach clients to reinterpret their thoughts in a less negative way and to raise awareness of distorted and maladaptive thinking).

Optimists and pessimist differ in the ways:

- Their bodies react to stress - How they cope with stress

Who is more likely to receive social support?

- Those with better social skills because they create stronger social networks. - Agreeable people

How can deep breathing and visualisation help?

- When we are stressed our breathing is often short and hurried. - Slow and long, deep breathes can help induce relaxation - The key to deep breathing are to breathe with your diaphragm, or abdomen, rather than your chest, and to take at least as long to exhale each breathe, as you do inhale. - Visualisation is a form of focused relaxation used to create peaceful images in your mind. - In guided imagery, the person is directly to recall or create a pleasant, relaxing image, and focusing attention on sensory details such as sensations or colour, sound and touch. - Breathing techniques and visualisation can be combined with positive self-affirmations, or self-talk, as you relax. - The goal is to identify negative self-talk and convert it into healthier, positive self-talk. - Examples of positive statements to practice: o I am healthy and strong o There is nothing that I cannot handle o I am safe

Benson (1996) identified four requirements for achieving the relaxation response:

1. A quiet place in which distraction and external stimulation are minimised. 2. A comfortable position, such as sitting in an easy chair 3. A mental device, such as focusing you attention on a single through or word and repeating it over and over 4. A passive, nonjudgemental attitude

The two most basic style of coping are:

1. Approach (vigilant) coping 2. Avoidant (minimizing) coping

What traits form the personality style hardiness?

1. Commitment 2. Challenges 3. Control

A typical stress management program involves three stages:

1. Education (Learn what stress is, how it takes toll on health, and that stress is more a process of their own cognitive appraisal than a characteristic of situations themselves). 2. Acquiring skills (Trained to monitor own stress in everyday lives using some of ht techniques of ecological momentary assessment, by charting people can recognise and then focus on, the triggers of stress). 3. Practicing skills (Learning new skills to either eliminate potential stressors or to reduce the experience of stress in healthy ways).

Pessimism is linked with earlier mortality and there are four mechanisms by which pessimism might shorten life:

1. Experience more unpleasant events which have been linked to shorter lives. 2. Believe that "nothing I do matters," so they are less likely than optimists to comply with medical regiments or take preventive actions (such as exercising). 3. Are more likely to be diagnosed with major depressive disorder, which is associated with mortality. 4. Have weaker immune systems than optimists.

Where does resilience come from?

1. Individual traits (well developed social, academic, or creative skills; easy temperaments; high self-esteem; self-discipline; and strong feelings of personal control (elements of social cognition)). 2. Positive life experiences/social support (person who is a model of resilience).

David Williams (2003) has identified three factors that help explain the interactions among socioeconomic status, gender, and ethnicity among African-Americans:

1. Middle-class African-American men report higher levels of racial discrimination than African-American women. The more years of education that an African-American male has completed, the stronger his perception of racial discrimination. Particular type of discrimination that people of colour experience daily are micro aggressions, which are insults, indignities, and marginalising messages sent by well-intentioned people who seem unaware of the hidden messages they are sending. Microagression fatigue has been noted among African-American men who live or work in environments that are predominately white. 2. The attainment of middle-class status may be tenuous and marginal for some African-Americans. College educated African Americans are more likely than European-Americans to experience unemployment and job insecurity. Less likely to convert their socioeconomic achievements into more desirable housing and community living conditions. 3. African-American males may experience a unique source of stress because the educational attainment associated with their higher SES has not been rewarded with equitable increases in income. The pay gap between African-American and European-Americans is larger for men than for women.

Richard Lazarus's coping strategies:

1. Problem-focused solving 2. Emotion-focused solving

Two competing hypotheses have been offered to explain differences in how women and men cope with stress:

1. Socialisation 2. Role constraint

What is mindfulness- based stress reduction?

A form of therapy that focuses on using structured meditation to promote mindfulness, a moment to moment, non-judgemental awareness. - Stress can be reduced and quality of life can be improved by overriding "autopilot" mode and inserted focusing on the present moment. - Has been used to improve peoples ability to self-regulate negative reactions to stress. - It seems to increase activity in prefrontal cortex of the brain which is an area important in regulating activity in the amygdala and other parts of the limbic system related to anxiety and other negative emotions? - Increased tissue density in the brains hippocampus? This is the area believed to play a central rile in mediating some of the benefits of mindfulness training due to its involvement in regulating cortical arousal and emotion. - Decreased density of hippocampus is associated to major depression, PTSD, and others. - May improve immune functioning and reduce risk of a number of chronic medical conditions.

What is the relaxation response?

A meditative state of relaxation in which metabolism slows and blood pressure lowers.

What is John Henryism (JH)?

A pattern of prolonged, high-effort coping with psychosocial demands and stressors, including barriers to upward social mobility.

Optimists are more likely to cope with stress using _____________, where as pessimists are more likely to use _____________ when dealing with stress.

Actively engage ; passively disengage and ruminate

What is repressive coping?

An emotion focused coping style in which we attempt to inhibit our emotional responses, especially in social situations, so we can view ourselves as imperturbable. Emotional suppression activates the sympathetic division of the autonomic nervous system.

Social support is?

Companionship from others that conveys emotional concern, material assistance, or honest feedback about a situation.

Most commonly people with JH are:

Extremely goal oriented but often lack the resources they need for success, such as financial or emotional support. (May explain why African-Americans develop high blood pressure more often, and at an earlier age than European-Americans and Hispanic-Americans)

What is invisible support?

Like in a church/religious setting, its the perception that people in the community care and are standing by to provide assistance, if needed.

What is explanatory style?

Our general propensity to attribute outcomes always to positive causes or always to negative causes, such as personality, luck or another person's actions.

What is rumination and what can it cause?

Rumination refers to thinking repetitively about an upsetting situation and how it relates to past and future problems associated with a stressor. This type of coping may spiral out of control into an emotional cascade, a vicious cycle in which intense rumination makes the person more upset, which in turn causes more rumination. The end result is a self-amplifying feedback loop rumination and negative emotion that ultimately may lead to self-destructive behaviours.

Stressful experiences are especially common among many ethnic minority families, who tend to be overrepresented in groups of low _____.

SES They also suffer poor nutrition, limited education, low-paying work, a lack of health insurance and access to health care.

What is expressive writing? What does it do?

Sometimes writing down your deepest thoughts and stories is a way of helping people find new meaning to their traumatic experiences. (skin conductivity, heart rate, and systolic and diastolic blood pressure all decrease, decreased absenteeism, fewer medical visits, and even improved immune functioning).

Three stages of stress inoculation training:

Stage 1: Reconceptualisation - Reconceptualize the source of the stress, and learn that your discomfort is at least partially the result of psychological factors such as dwelling. Once convinced that some of your pain is psychological in nature, you will be more likely to accept that CBT can offer some relief. Stage 2: Skills acquisition - Taught relaxation and controlled breathing skills. The logic is inescapable, being relaxed means you can't be tense and physically aroused. Other techniques includes, use of pleasant mental imagery, dissociation or humour. Stage 3: Follow-through - Will learn to use these coping skills in everyday life. Family members may be taught ways of reinforcing your new healthier behaviours.

What is personal control?

The belief that we make our own decisions and determine what we do and what others do to us. Also known as self-efficacy.

What is the faith factor?

The idea that people who are religiously active tend to live longer than those who are less religious. However, it is hard to make this call due to uncontrollable factors and more women are religiously active and they outlive men regardless of whether or to they are religious. Only correlation and not causation.

What is resilience?

The quality of some children to bounce back from environmental stressors that might otherwise disrupt their development and to adapt flexibly to changing environmental demands.

Changes in heart rate, such as those that occur in response to challenging physical and emotional demands, are controlled by:

The tenth cranial nerve (Vagus active, heart rate decreases and vice versa)

What is stress-management?

The various psychological methods designed to reduce the impact of potentially stressful experiences.

What is regulatory control?

The various ways in which we modulate our thinking, emotions, and behaviour over time and across changing circumstances.

What is biological resilience?

Various protective factors (genetic, demographic, social-cultural, psychological, gender-linked, and environmental) that contribute to positive outcomes in the elderly.

Westerner's VS non-Westerner's

Westerner's: More likely to assume personal responsibility Non-Western: Where individuals is subordinate to cooperation and a sense of community, depression is less common.

People were carriers of a particular allele of the apolipoprotein E gene (APOE) had _________ outcomes.

adverse

Instrumental social support is more valuable for __________ stressors, whereas emotional support is more valuable for ___________ stressors.

controllable ; uncontrollable

Too much choice in the workplace or other places may be _______________ to motivation and well-being.

detrimental

However, when researchers compare men and women of similar occupation, education, and income, gender differences in physiological responses to stress and coping strategies often _________.

disappear

Threat appraisals have been linked with ______________ vascular responses. As reflected by increase in diastolic blood preside and total peripheral resistance.

enhanced

Choice ___________ feelings of personal control.

enhances

Those with a negative explanatory style tend to:

explain failures in terms that are global, stable, and internal.

Jh appears to have a substantial ____________ component.

genetic

Hardy people may be ________ because they are less likely to become aroused by stressful situations. As a result they avoid stress-related physical and psychological reactions that lead to illness.

healthier

Health disparities ______ with each step down the SES ladder.

increase

People who are low in SES have _________ risk for chronic disease, disability, and premature mortality.

increased

Challenge appraisals have been linked to _________ myocardial reactivity. As reflected by increase in heart rate and cardia output.

increases

When faced with repeated, uncontrollable stress, people sometimes learn that they cannot affect what happens to them, this is known as _____________.

learned helplessness

European-Americans, those with a strong sense of freedom of choice and control had __________ levels of depression and anxiety than those who perceived less control and choice in their lives.

lower

In individualistic cultures, it has been assumed that perceiving oneself as having less choice (Asians & Latin Americans) will have ________ effects on well-being.

negative

People of low SES tend to rely less on ________ than do people with more education and higher incomes.

problem-focused

People with a strong sense of personal control tend to engage in adaptive, _______________ coping.

problem-focused

People who have low SES have demeaning social experiences may cause them to develop a feeling of hopelessness and to believe that they have little or no _______________ over events in their lives.

psychological control

Cognitive behavioural stress management combines:

relaxation training, visualisation, cognitive restricting, reinforcement, and other techniques into a multimodal intervention that has helped people cope with a range of stressors.

A ________ perception of control has also been associated with a heather lifestyle, a stronger immune response to allergens, and a lower overall risk of death.

stronger

Neighbourhood SES is linked to health because it.....

strongly influences the social and psychological experiences of residents living in a particular neighbourhood.

Some strategies provide _______ relief but tend to be maladaptive in the ___________.

temporary ; long run