Health Psych 150-Midterm 2

Examples of Aftereffects of stress

shortened attention span, poor performance on intellectual tasks ongoing psychological distress and physiological arousal, Difficulty concentrating, social behavior- less willing to help others, worry or rumination- increased heart rate and blood pressure, PTSD

Speeds aging

shortens telomeres - when they get very short they die and signs of aging appear Telomeres = aglets for your chromosomes •Marker and cause of biological aging

Children/adolescents and stress

social and academic failure=demanding and aversive behavior at home

Slows digestion

ulcers, colitis, bowel problems

Coping

• Process by which a person attempts to manage internal and external demands of stressful situations • Consists of effortful cognitive and behavioral activities aimed at dealing with the demands of specific situations that are appraised as stressful

Fight or Flight response

Walter Connon Stress causes physiological changes • They help mobilize the body to fight or flee • Useful: Helps you respond quickly • Problem: Disrupts normal emotional and physiological functioning

Demand-control-support model

When high demands and low control are combined with little social support at work Increases risk for coronary heart disease

Harms Brain

When stressed, your brain releases cortisol. This is helpful in small doses. • In extremely large doses, cortisol may harm your brain by shrinking an important brain structure - the hippocampus. • The hippocampus is involved in memory.

perceived stress scale (PSS)

asks how frequently a person has felt stressed or upset in the past month predicts psychological and physical symptoms as well as changes in the immune and endocrine system Ex: How often have you been upset because of something that happened unexpectedly? How often have you felt unable to control the important things in your life? How often have you felt nervous or stressed?

Raises heart rate/blood pressure

cardiovascular diseases, strokes

Control in the workplace

coronary artery disease, all-cause mortality

Person-Environment fit

degree to which individual and environmental characteristics match

Problem-Focused Coping

doing something constructive about the stressful situation; changing the situation in some way

Event-Based stress assessment (stressful life events)

focus on objective observable events that are normatively (i.e., for most people) associated with substantial demands Stress is caused when people have to adjust to environment Major events: bereavement, caregiving, divorce Minor hassles: traffic, arguments, etc Measured by checklist or interview- Holmes and Rahe

Sympathetic-adrenomedullary (SAM) system

harmful/threatening event ↦ cerebral cortex ↦ hypothalamus ↦ sympathetic nervous system ↦ medulla of adrenal gland ↦ epinephrine and norepinephrine ↦ increased blood pressure, sweating, constriction of peripheral blood vessels

Slows reproduction

impotence, loss of libido, delayed ovulation, miscarriage

Social relationships at work

inability to develop satisfying social relationships- job stress, psychological distress, poor physical and mental health coronary heart disease

Protective effects of multiple roles for women

increased self-esteem, Self-efficacy, Life satisfaction mothers have better resistance to colds Good income, control and flexibility at work, someone to help with housework, adequate child care, partner=reduce stress of multiple role demands

Suppresses immune system

infections, healing problems, serious illness

Low SES and stress

low-prestige occupations greater interpersonal conflict stress at work alterations in cortisol patterns, catecholamines, and inflammation at least some of the health risks are reversible if circumstances improve

Women and stress

multiple roles stress at work and at the home. work & children- increased cortisol level, higher cardiovascular reactivity, more home strain single mothers- most at risk

Measuring Appraisals: Subjective

perception that demands exceed one's ability to cope Examples: feeling overwhelmed, like you can't cope with all of the things you need to do

Blunts pain

possible worsening of injuries

Unemployment

psychological distress, physical symptoms, physical illness, alcohol abuse, difficulty achieving sexual arousal, low birth weight of offspring, elevated inflammation and compromised immune functioning, Depression, anxiety

Stress Moderators

Internal and external resources and vulnerabilities that modify how stress is experienced and its effects (Ex: Financial resources and social support) Impact: Stress itself, Relation between stress & psychological responses, stress & illness, degree to which stressful experience intrudes into other aspects of life

Stressful life event inventory cons

Items on list are vague Individual differences in how events are experienced are not taken into account Include both positive and negative events Do not assess if stressful event has been resolved May pick up chronic strain Time between stress and illness

Problems of measuring stress

Lack of agreement on what is stress and how to measure it Studies typically use different measures of stress, leading to different outcomes Associations between stress and health may depend on type of stressor (interpersonal vs. not), when it occurred (early life vs. later), its chronicity, etc. • If stress is not carefully assessed, may lead to inaccurate conclusions

Men and multiple roles

Men are more distressed by financial strain and work stress combining marriage and employment- good for men More withdrawn with their children after stressful day at work

Reducing stress at work

Minimize physical stressors (ex:noise) minimize unpredictability and ambiguity Involve workers in decision-making make jobs interesting meaningful social relationships reward for good work look for signs of stress workplace perks

What does stress do to the body

Mobilizes energy Raises heart rate/blood pressure Slows growth Slows digestion Slows reproduction Suppresses immune system Blunts pain Harms brain/memory

Exhaustion

Occurs if the person fails to overcome the threat and depletes its physiological resources in the process of trying

Desirability

Stress is not always a "bad" thing. In some cases, the things that happen to us are desirable and positive. A brief experience of stress can be beneficial: improved immune system response feeling engaged, energized, and satisfied providing challenges

Slows Growth

stress dwarfism

Effects of Excessive discharge of epinephrine and norepinephrine

suppression of cellular immune function, produce hemodynamic changes sich as increased blood pressure and heart rate, provoke variations in normal heart rhythms, such as ventricular arrhythmias, sudden death, neurochemical imbalances↦psychiatric disorders, lipid levels and free fatty acids ↦atherosclorosis

Stress on the immune system

terminates the immune system's ability to terminate inflammation Implicated in coronary artery disease

Psychological control

Belief that one can determine one's own behavior, influence one's environment, and bring about desired outcomes

Course

Brief, time-limited Sequential Chronic, intermittent Chronic, unremitting

Chronic Strain

A stressful experience that is a usual but continually stressful aspect of life

Stress

A negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects

Alarm phase

A person becomes mobilized to meet the threat

Resistance

A person makes efforts to cope with the threat

Proactive coping

People anticipate potential stressors and act in advance either to prevent them or to reduce their impact Ability to anticipate stressors Coping skills for managing them Self-regulatory skills

Resilience

Ability to bounce back after stressful events and adapt flexibility to the changing demands of a stressful situation Sense of coherence, sense of purpose or meaning, a sense of humor, trust in others, a sense that life is worth living, a religious belief promote resilience and effective coping

Richard Lazarus

According to Richard Lazarus, what matters is not what event occurs, but how we perceive and interpret that event. The process of perceiving and interpreting the event is called appraisal

Duration

Acute Stressors: These stressors demand immediate attention and don't last long. They tend to appear suddenly. Many physical stressors are acute Chronic Stressors: These stressors do not require immediate attention, but last a long time and are a constant source of worry. Most psychological stressors are chronic

Coping with HIV

Approach coping: Increased positive affect, Decreased negative affect, Better health behaviors, Better physical health Avoidance coping: Decreased positive affect, Increased negative affect, Worse health behaviors, Worse physical health 10-Week program (Antoni et al., 2003). Relaxation Training Stress Education Coping Strategies Interpersonal Skills Social Support Enhancement Reduces psychological distress Decreased depressed mood Improved quality of life 10 week, group-based intervention • Each session includes: - 90-minute stress management component - 45-minute relaxation component

Secondary Appraisal

Assess whether personal resources are sufficient to meet demands of the environment. Are my coping abilities and resources sufficient to overcome the harm or threat posed by the event?

Acute stress paradigm

Bring people into lab, expose them to short-term stressful events. observe the impact on their physiological, neuroendocrine, and psychological responses helpful in identifying who is most vulnerable to stress (ex: Chronic stress, high hostility)

Can people adapt to stress

Can people adapt to stress Depends on the type of stressor, the subjective experience of stress and the indicator of stress Most people adapt psychologically- moderate or predictable stressors Vulnerable population- children, elderly, poor= little adaptation

Event Lists cons

Checklists don't take into account context of event, or meaning for individual Interviews are very time-intensive and costly

Emotional-approach coping

Clarifying, focusing on and working through the emotions experienced in response to a stressor Improves adjustment to chronic conditions and medical conditions

Effects of excessive corticosteroids release

Compromise the functioning of the immune system destruction of neurons in the hippocampus, which can lead to problems with verbal functioning, memory, and concentration Senility:Dementia

Additional Psychological resources

Conscientiousness Self-confidence Intelligence, emotional stability

Optimism

Cope more effectively with stress and reduce risk for illness Better stress profiles on cortisol, blood pressure, and inflammation Active and persistent coping efforts, Fosters a sense of personal control, Use problem-focused coping, seek social support, emphasize the positive aspects of stress

Event Lists Pros

Cover major (and minor) events that might have impact on health Interviews can provide detailed information on stressor characteristics - timing, chronicity, and domain (rejection, loss, danger, etc.)

How do daily hassles affect physical and psychological health?

Cumulative impact of small stressors may wear a person down-illness Aggravate reactions to major life events or chronic stress to produce distress or illness

Other ways to measure stress

Daily diaries Exposures Biomarkers

Reactivity

Degree of change that occurs in autonomic, neuroendocrine and/or immune responses as a result of stress Some people are predisposed by their genetic makeup, prenatal experiences, and/or early life experiences to be more biologically reactive to stress than others psychobiological reactivity to stress is an important factor that influences stress-illness relationship

Threat

Demands are greater than resources Autonomic Response HPA Response

How does stress contribute to illness?

Direct effect on physiology- ex: immune system health behaviors-ex: drinking psychosocial resources- ex:social support health services and maintenance

Other regulators of HPA axis activity

Diurnal rhythm Negative feedback

Characteristics of Coping

Dynamic process (not a one-time action, but a set of responses occurring over time, by which the person and the environment influence each other Breadth-Emotional reactions, including anger and depression, are actions voluntarily undertaken to confront the event

Mobilizes energy

Fatigue; Diabetes; Fat deposition

Which of these responses to stress have implications for disease?

HPA axis activation↦ cardiovascular disease

General Adaptation Syndrome

Hans Selye- A non-specific response of the body to any demand placed upon it. • Any stressor, any organism - all the same • Enlarged adrenal glands • Shrunken lymph nodes • Bleeding ulcers

Why is research relating chronic stress to health outcomes difficult to conduct?

Hard to show that a particular chronic stressor is the factor that caused illness Chronic stress is difficult to measure objectively Inventories that attempt to assess chronic strain may also tap psychological distress/neuroticism

Stress is the Workplace

Help identify some of the most common stressors of everyday life Provide evidence for the stress-illness relationship Work stress may be one of our preventable stressors and provide possibilities for intervention Stress-related physical and mental health disorders account for a growing percentage of disability and social security payments to workers

Self-Esteem

High self-esteem↦protective at low levels of stress, at higher levels of stress, and stressful events can overwhelm the benefits of self-esteem lower levels of stress indicators, such as HPA axis activity Better health habits

HPA axis (lecture notes)

Hypothalamic-pituitary-adrenal axis, Activated by physical and psychological stress, Physical injury, hemorrhage, hunger, Uncontrollability and threat end product = release of glucocorticoids (cortisol in humans) from adrenal glands, Cortisol helps to mobilize energy and modulates other aspects of the stress response

Hypothalamic-pituitary-adrenocortical (HPA) axis

Hypothalamus↦Corticotrophin-releasing hormone (CRH)↦pitutitary gland↦ adrenocorticotropic hormone (ACTH)↦ adrenal cortex↦ glucocorticoids

Criticisms and limitations of General adaptation syndrome

Ignored psychological factors, particularly appraisals Not all stressors produce the same endocrinological responses Continued activation may be most important for accumulating damage to physiological systems Stress as an outcome, rather than a process

Tend-and-befriend

In addition to fight or flight, people and animals respond to stress with social affiliation and nurturant behavior toward offspring Especially true for women Oxytocin

Inducing disease

Intentionally exposing people to viruses and then assessing whether they get ill and how ill they get Stressed people- more likely to get ill Used to study factors that prevent against stress such as social support

HPA activation

More common in depression episodes of cortisol secretion being more frequent and longer among depressed than nondepressed people Storage of fat in central visceral areas (i.e., belly fat), rather than in the hip High waist to hip ratio=marker for chronic stress

Stressor: Events and their Objective Properties

Nature of threat Duration Course Controllability Predictability Desirability

What makes events stressful

Negative events- more stressful than positive events Uncontrollable events- unpredictable events are more stressful, especially if unexpected Ambiguous Events- more stressful than clear-cut., ability to take confrontative action- less stress Overload- more stress than people with less work Which stressors- central life domains

Negative Affectivity

Neuroticism, A pervasive negative mood marked by anxiety, depression, and hostility Chronic disorders such as arthritis, diabetes, chronic pain, and coronary artery disease, all-cause mortality

Primary Appraisal

Occurs as a person is trying to understand what the event is and what it will mean Is the event harmful or threatening? Harm - event that already took place Threat- future damage

Role Ambiguity Role Conflict

Occurs when a person has no clear idea what to do and no idea of the standards used for evaluating work Occurs when a person receives conflicting information about work tasks or standard from different individuals Chronically high blood pressure, heart rate

Aftereffects of stress

Performance and attentional decrements that occur after a stressful event has subdued Believed to be produced by the residual physiological, emotional and cognitive draining in response to stressful events

Nature of Threat

Physical These stressors are things that all animals (human and not) might list as stressful, e.g., heat, cold, pain, fatigue, injury, hunger, predators. Psychological These stressors are things that generally only humans would consider stressful, e.g.,grades, job security, money

Positivity and Illness

Promotes better mental and physical health and a longer life Lower levels of stress indicators, better immune responses to challenges such as exposure to flu virus Invest time and effort to overcome obstacles Promotes specific psychological resources

Coping style

Propensity to deal with stressful events in a particular way

Emotion-Focused Coping

Regulating emotions experienced because of the event

What links chronic negative affect to illness

Related to high levels of stress indicators such as cortisol, heart rate, inflammation, and risk factors for coronary heart disease Poor health habits (ex: drinking, using drugs) & Respond to treatment more poorly

Challenge

Resources are greater than demands

Effects of early stressful life experiences

Risk for disease and illness in adulthood Risk factors: low SES, exposure to violence, poverty, community-level stressors, physical/sexual abuse risky families- problems with emotion regulation, social skills, difficulty forming good social relationships, heightened sympathetic reactivity to stress, exaggerated cortisol responses, immune profile marked with chronic inflammation

Stress and Health

Stress predicts: • All-cause mortality • Cardiovascular disease incidence • Cardiovascular disease progression • Depression • Preterm birth • And many other health outcomes

Stress is adaptive unless...

Stress response is ideal for dealing with short term physical stressors requiring energy mobilization However, if stress system is activated for too long, or too frequently, or for no "good" physiological reason, may have detrimental effects on health (allostatic load)

Stressors

Stressful events Money, economy, work, family health problems and family responsibilities

Appraisal

Subjective evaluation of the stressful event

Anticipating stress

The anticipation of a stressor can be as stressful as its actual occurrence, sometimes more Ex: study with medical students before exam. more stressed on the day before than the day of the exam

Allostatic Load

The physiological costs of chronic exposure to the physiological changes that result from repeated or chronic stress Indicators ex: increasing weight and high blood pressure

Conclusions on the stress response

The stress response is good Without the stress response, you would never survive an acute stressor too much of the stress response is bad Constantly running the stress response for chronic psychological stressors does not help you deal with those stressors, and causes a slow accumulation of damage that can lead to serious illness.

approach (confrontative, vigilant) coping style

The tendency to cope with stressful events by tackling them directly and attempting to develop solutions; may ultimately be an especially effective method of coping, although it may -produce accompanying distress.

avoidant (minimizing) coping style

The tendency to cope with threatening events by withdrawing, minimizing, or avoiding them; believed to be an effective short-term, though not an effective long-term, response to stress.

Life Events and Difficulties Checklist (LEDS)

Two-hour structured interview in which interviewer asks about potential stressors in 10 domains of life - Health, employment, education, relationships These are presented to a panel of raters How stressful is this event given what happened and the person's biographical context? 520-page manual with 5,000 case vignettes used to anchor the rating process

Controllability

Uncontrollable events are more likely to be perceived as stressful Perceptions of control are important

Predictability

Unpredictable events are more likely to be perceived as stressful (even if they are uncontrollable)

Control-enhancing interventions

Use information, relaxation, and cognitive-behavioral techniques such as learning to think differently about the unpleasant sensations of a procedure, to reduce anxiety, improve coping, and promote recovery