Chapter 14 - Stress Psych

Pessimism

A chronic tendency to explain negative events as due to internal, stable an global qualities of the self and to attribute positive events to external, unstable, and specific factors > The older you are, the more pessimistic you are, higher risk of poor health. If you are very pessimistic, you are less likely to follow through treatment recommendations, linked with earlier mortality. More pessimistic, more likely to be diagnosed with major depressive problems. Tend to avoid social support

What is Stress?

A perceived imbalance between dd and the resources needed to cope with them Accompanied by biochemical, physiological, emotional, cognitive, and behavioural changes Interaction between the body, the mind, and the environment.

Hostility

A persistent feeling of anger or resentment combined with a strong desire to express it or retaliate. Chronic hostility: > Greater reactivity to stress. Tend to have lasting high BP > Cope with stress in less effective ways in general. Report more interpersonal conflicts, more unhealthy daily habits, less social support (difficult to make friends)

Symptoms of PTSD

A) Intrusive symptoms > Constantly experiencing the trauma either awake (flashbacks) or sleeping (nightmares) B) Efforts to avoid reminders of the trauma > Avoid people/places around who remind you of the trauma > Actively try not to think of the event. A core symptom of PTSD as intrusive symptoms are generally caused when you avoid processing the traumatic events. C) Increased Arousal > Hyper vigilante, aggressive, irritable, difficulty sleeping/concentrating

Coping Styles: Approach vs. Avoidance

Approach - trying to gather as much information as possible about a stressful situation or taking direct action Avoidance - trying to avoid having to handle a stressful situation In the LT, chronic stressors won't disappear. We have to tackle the problems and deal with them. So in the long run, the Approach coping style is better. However, in certain situations, the Avoidance copping is better. E.g.: You have a lot of stressors to begin with and more stressors are coming in. It is better to use the avoidance coping style until you have the necessary resources needed to solve the situations

Effects of Social Support

Associated with faster recovery (more social support), lower mortality rate, less distress when facing chronic illness (lower levels of stress) and less medical complication when ill

Psychological Control

Believing that you can control behaviour, your environment, and create positive outcomes > Major goal for psychological interventions that have been developed Evidence: > Emotional and physical well-being > Successful coping with stress > Behaviour change to promote good health > Improved performance on cognitive tasks People dealing with pain on a constant basis. What has shown to be most effective to improve their QOL is to give them some control over the symptoms they are experiencing and it gives them an option to control their pain (psychological control)

PTSD

Common in front-line occupations. Can happen to anyone who suffered from extremely stressful and traumatic life events. Witness or experience Should be treated due to debilitating symptoms

Conflict vs. Coping styles

Conflict can also influence what type of coping style is better. > Conflict is within ourselves Df: Experiencing incompatible motivations

Tend and Befriend Theory

Considers gender difference on how men and women respond to a stressful event. Tries to explain Use evolutionary theories. Tend and Befriend theory Tend - caring for offspring Befriend - establishment and maintenance of social network. These are behaviours that are more adaptive for women than men previously. More clearly seen in stressful situation. When in stressful situation, women can be more social and nuturing One thing in common is that there is an underlying physiological response to explain the theory (oxytocin - regulate childbirth and breast feeding, also released during stressful situation). People who release more oxytocin, will be more paternal and caring. More adaptive for our female ancestors to promote their survival and their offspring.

External Resources

Coping is influenced by external resources as well > Time > Money > Education > Decent job > Children, friends, family > Pet

Social Support

Most influential external resource Various forms 1) Tangible assistance: Providing services, like money and goods > Feeling sick and your parents bring you food to take care of you 2) Informational support: a greater understanding of the stressor > E.g.: Friend got an abnormal result form PAP test and providing information will help them deal with this stressor 3) Emotional support: Nurturance > Type to get from their parents (BF/GF) 4) Invisible support: receives help from another, but is unaware of it > The most effective > E.g.: Dealing with a stressful situation in their life, and friend is talking about their own experience with something like this (considered invisible as it is not advice that they gave you. You can take ownership of the idea

Stress Moderators

Internal and external resources and vulnerabilities that modify how stress is experienced and its effect Stress > Alter health habits. Indirect effect on health. > Increases wear and tear on the physiological system. Chronic stress -> increase in hormones secretion > Interacts with pre-existing vulnerabilities to produce illness, both psychological and physical Both stress and the stress-illness relationship are importantly influenced by stress moderators

Optimism

Lead people to cope more effectively -> reduce risk of illness 'Life Orientation Test' (Scheier & Carver) > Looked at students levels of optimism at beginning of term and looked at # of times sick. > Results: Higher optimism levels, less likely to fall ill Optimism is associated with problem-focused coping, seeking social support, positive mood linked to better mental health and see the good in situation Pessimistic people can learn to be optimistic (learned optimism). Change in how you attribute stresses

Changing Patterns

More Canadians are living alone and family sizes are decreasing This change in patterns will have a direct impact on how much social support you will receive on a daily basis. So if you are single, you might not get sufficient support daily. More interest in trying to think of solutions for lack of support that people get on a daily basis. Now have internet-based support groups and gaining popularity. Not much research but is promising as it indicates that there might be some health benefits but it might not replace having a physical social support.

Burnout

Not a medical diagnosis (not in the DSM file) > When talking about it, it is low level of energy, need to sleep a lot, have a highly negative attitude to yourself and work. Also have lower self-esteem > Called a condition and caused by chronic work distress > Not a diagnosis as there is a debate on whether burnout is just another form of depression as they have very similar diagnosis > Symptoms of burnout is more specific to be associated to their workplace whole depression is more general feelings of sadness in different areas of life > Good coping skills and being able to use them flexibly can help prevent people from developing symptoms in the first place

Coping styles and factors that influence style

Several factors influence if 'problem-focus' or 'emotion-focus' is used: 1) Type of stressor > Work = problem-focused > Relationship = emotion-focused 2) Age > Middle aged = problem-focused > Elderly = emotion-focused > As people get older, control less things in life (people have more health problems as we get older). Beneficial to learn to use emotion-focus coping style to regulate the stressors that you can't change 3) Gender > Women = emotion-focused > Men = problem-focused

Fight-or-Flight: Public speaking

Standing up on your own and not in a group previously, would be dangerous otherwise you could get attacked > You are in open territory and can't hide and there is no way to defend yourself from an evolutionary stand point > "creatures" staring at you > Therefore for your ancestors it would mean they pretty much were about to die and get attacked This is why there is so much fear towards public speaking > Ancestors that survived this would have this fight or flight and we inherited this characteristic and we are now stuck with it

Stressors and Resources

Stress can be internal/external to you or a combo The meaning of stress is context dependent: > Stimulus view of stress: Stress is ex eternal or something that happens to us > Response view of stress: Stress is internal or the feeling we get when things become too much Stress in some ways comes from external events, also has to do with how you react and behave

Stress as a Stimulus

Stress has more to do with your own perception with if you have the resources to cope with the situation > Certain characteristics tend to make certain situations more stressful People tend to forget that positive events can be stressful as well, but on average, negative events tend to be more stressful > Wedding vs. divorce Central life task will usually have more of an impact than peripheral life tasks. Wha makes events stressful? > Negative events > Uncontrollable or unpredictable events > Ambiguous events > Overloaded > Central events

What my brain sees

What your brain sees when giving a public presentation Easy way to decrease fight or flight > To teach brain that you are not going to die > Only way to do this is to keep giving oral presentations so your brain understand this is not a dangerous situation and you are not going to die and do not need to enhance fight or flight response

GAS 3 phases

1) Alarm - body reacts to stressor, adrenaline creates fight or flight. Outpouring of epinephrine 2) Resistance - body begins to resist with stressors, eventually wears down. Physiological arousal will still be high here 3) Exhaustion - If stressor continues to be present beyond body's capacity, resource will be depleted. More susceptible to germs, and negative things.

3 Main types of Conflicts

1) Approach-Approach > Facing 2 attractive options, have to choose between the 2 > E.G Choosing between 2 different options (like food) > Can induce a significant amount of stress as people fear that they might regret the choice that they made as the other option might have been better. E.g.: Got accepted into 2 different universities but can only choose one. 2) Avoidance-Avoidance > Opposite of the first one. Both options are not interesting to you but you have to chose one of them. E.g.: Have to choose between 2 jobs that you aren't interested in but have to take one. 3) Approach-Avoidance type > Can happen when considering one option. Pros and cons to that option. Same option is both attractive and not attractive to you. Have to weigh the pros and cons to see if you would take it or not > Also can happen between 2 options > FOCUS is on weighing of pros and cons of the options > E.g.: Marriage

Other Coping Resources

1) High Self-Esteem 2) Conscientiousness > good health outcomes, tend to avoid situations that could affect someone negatively and tend to engage in good health behaviours 3) Humour > good sense of humor and using it is a good buffer from the stress that you could be experiencing. Laughing can help to reduce level of adrenaline and cortisol in your body. Try to integrate humor will have physiological impact on you. 4) Sense of coherence (sense of purpose/meaning) > good buffer. > When facing stressful events, being able to get something out of the situation and being able to attach some meaning to the stressful event can lessen the stress and have a positive affect on health. Just needs to make sense to you (e.g.: death of the family, what are you going to learn, etc)

Physiology of Stress: 2 Systems Involved

1) Sympathetic-adreno-medullary (SAM) system > Fight of flight response > Immediate reaction of the body > Hypothalamus activates Sympathetic NS which will stimulate adrenal medulla which will secrete catecholamine (epinephrine and norepinephrine). Important for body's initial and immediate physiological response (increases BP, HR, etc) 2) Hypothalamic-pituitary-adrenocortical (HPA) axis > If stressor continue to be present > Hypothalamus will be involved and it will activate the corticotrophin-releasing factor (CRF) which will stimulate the pituitary gland which secretes ACTH. ACTH will affect adrenal cortex to secrete corticosteroids (e.g. cortisol) and it tries to help the body to return to homeostasis from stressors

Goals of Coping

1) To reduce stressful environmental conditions and maximise the chance of recovery 2) To tolerate or adjust to negative events 3) To maintain a positive self-image 4) To maintain emotional equilibrium 5) To continue satisfying relationships with others They might not be the best behaviours. Coping process includes everything that happens due to the stressful events, both (+) and (-).

Criticisms of GAS

> Assigns a very limited role to psychological factors (i.e., perception of stressors) > Assumes that responses to stress are uniform (not all stressors have equal hormonal responses) Only assessed stress as an outcome variable > Evidence suggests that people experience effects of stress while the stressor in occurring and even beforehand. > This is not true. Humans can stress out over things about things that hasn't occurred yet

Selye's General Adaptation Syndrome (GAS)

> Father of stress research > Explored adrenocortical response to stress > Non-specific response of the body to a demand (more physical than psychological stressor) > Selye's said that the body responds to stressors pretty similarly so they can be called non-specific response He was looking at a specific affect of an ovarian extract on rats in his lab. He noticed that the rats didn't like the injections and he also noticed that after the injections, the rats had serious adrenal gland malfunction (they were enlarged). He concluded that it was the ovarian extract that caused this enlargement but he decided to do a control (injected with saline). He noticed that the control rats also had the same enlarged adrenal glands. It was due to the stress that the rats experienced (chronic stressor) that caused the enlarged adrenal glands.

Daily Stress

> Minor daily stressful events > Believed to have a cumulative effect in increasing the likelihood of illness Daily hassles create stress & illness by: > Cumulative impact wears you down Daily stressors have been shown to be better predictors of future health problems than the major life events > Because the cumulative effect (happening all the time) and wearing you down > Where the major life events tend to happen more rarely

Daily Stress: Hassles and Uplifts Scale

> More predictive of health problems than major life events > Frequency and intensify of minor irritations (hassles) & frequency of positive events of daily life that may counteract their damaging effects

Support from Whom? Spousal Support

> Most portective against stress (only if it is a happy marriage) > Major gender difference. Men have more health benefits linked to marriage compare to women. > Ending marriage and being unmarried can cause health issues > Staying in a marriage when things aren't working out also has negative health issues

Early Stress Theories: Fight-or-Flight Response

> Organism perceives a threat, the sympathetic NS and endocrine system becomes aroused > Physiological arousal primes either to: attack or flee > Often maladaptive in our modern society Ancestors faced with a lot of physical stress, used to be adaptive function > Less adaptive today because stressors are psychological now, not physical

SRRS - Limitations

> Some items are vague > SRRS includes both (+) and (-) events as well as events that people choose as well as events that simply happen > Individual differences not accounted for > Does not assess whether the events have been successfully resolved

Which is better?

Depends on the situation. Problem-focused: Emotion-focused: When there are some stressors that occur in your life and you have no control over it, this coping style is more preferable. Change how you react to the situation. Good to be flexible when tackling stress

Coping

Df: the thoughts/behaviours used to manage internal/external demands of stressful events Coping and stress is dynamic > Not a one-time event; a set of responses unfolding over time > Can occur much later in the future from the stressful event Coping is broadly defined > Many different actions (e.g. remove the problem) and reactions (e.g. emotions) are part of the coping process

Moderation of Stress by Social Support

Direct Effects of Hypothesis > Maintains that social support is beneficial for people's health at all times, regardless of what is going on in their life Buffering Hypothesis > Maintains that the health benefits of social support occur during periods of high stress; when there is little stress, social support may have few health benefits Evidence to support both > Some studies showed health benefits regardless of periods of life. Other studies indicate that these benefits seem to be greater in a stressful situation.

Psychological Appraisals of Stress: Primary Appraisal

Emphasized importance of conscience appraisal when facing potentially stressful situation Primary Appraisal > The perception of a new or changing environment as having beneficial, neutral, or negative consequences > Consider the meaning of the event > Negative events are then appraised for their potential to cause harm, threat or challenge E.g.: Losing your job. Harm (something negative that already happened) = embarrassment, Threat (something negative that could happen in the future) = financial problems, Challenge (demanding situation that could ultimately overcome and may eventually benefit from) = Career change

Procrastination

Habitual procrastination > Here and there, no worries! > Linked to higher stress anxiety, depression > More health compromising behaviours > Health problem (e.g.: headaches, insomnia, etc) E.g. : need to study but cleaning the kitchen. Will stress you as the thought of having to study will stress you and will cause an increase in hormones secretion Tend to adopt more health comprising behaviours (and have health problems) Procrastinators have tendency to negatively evaluate themselves Direct route -> increase stress levels, impact health Indirect route -> delay accessing health services. Will wait and see. Linked to poorer health outcomes

Animal Therapy

Having a pet has been shown to contribute to lower BP in response to stressful situations. Decrease the # of physicians visits with people suffering from CDV problems. Only just starting to look at the benefits of animal therapy. Looking at hormonal levels when interacting with pets. Increase in serotonin and dopamine. Increase levels of oxytocin also. All 'feel good' hormones. Observed after interacting with pets in the ST. Other changes at the hormonal levels is decrease in cortisol levels after having interaction with pets. People dealing with chronic conditions and live with pets could live longer compared to patients with the same conditions who don't have pets. Some hypothesizes are companionship with the pet could lead to an increase in lifespan, finding meaning to stressful situation and owning a pet could help, stories that pets could sense when people are going to have a heart attack and could alert them. Walking your dogs results in them exercising (motivates them to go out and walk around a little bit) VIDEO In the US, injured soldiers are taking riding lessons to help treat psychological and physical symptoms. Helps with depression and helps them relearn how to walk.

Most Stressful Events > Social Readjustment Rating Scale (SRRS)

Homes and Rahe Identified events that force the most amount of change > Death of one's spouse Being fired from a job > Moving to a new home Rankings are based on life change units (LCU) > Composite scores quantifying the amount of impact each event has > 0 = little effect; 100 = major life change Taking a vacation typically changes your daily routine > In a way stressful because you are asked to do things you don't typically do on a daily basis Mild to moderate to total amount of change in your life and your probability of getting sick > 300+ LCU in a year 90% of sample who ended up getting sick within three months after the completion of the study

Psychological Appraisals of Stress: Secondary Appraisal

If you conclude that the primary appraisal is bad, will go onto the secondary appraisal (looking at your resources to see if you can cope) > Assessment of one's coping abilities and resources and whether they will be sufficient to meet the harm, threat, or challenge of an event High threat + low coping = substantial stress Hight threat + high coping = minimal stress Combination of the primary and secondary appraisal that will explain the amount of stress people will experience. It will constantly take place. (e.g.: middle of the job interview. Feel that you are going well, person is smiling, you feel that you are coping real well so minimal stress until interviewer mentions that there are a lot of applicants and this could change the level of stress that you are experiencing due to secondary appraisal ) Assumes 2 things: 1) Level of stress depends on cognitive appraisal of an event 2) Appraisals may be affected by mood, health, etc.

What Kind of Support is Best?

Not all aspects of social support are equally protective against stress. > Having a confidant may be a superior form of social support > The more you have the better you get (NOT TRUE). Something's getting to much support is bad. Opposite effect of Invisible support. Become dependent on others The beneficial effects of social are not necessarily cumulative > Most important when getting social support: Have one person who you can talk to about anything (this outweighs all other options). Quality over quantity Invisible support is the preferable type across situations but there are times in your life where other types of social support is needed more than invisible support. Must be a bit flexible for it

Family support

Perception of parental support leads to greater ability to cope with stressors If as a child and a teenager, felt like you had adequate support from one parent, will end up having better abilities to cope with stresses as adults

Personality & Coping

Personality is an important moderator for the experience of stress and how they will cope Certain people are predisposed by their personalities to experience stressful events as especially stressful, which may affect their symptoms and/or rate of illness We can learn to minimise/control the personality

Negative Affectivity

Pervasive negative mood (anxiety, depression and hostility). Usually not satisfied with a wide range of situations in life. > Prone to substance use, depression, suicidal behaviour Neuroticism and negative affectivity do have some correlations (e.g. Woody Allen) Linked with higher cortisol levels. Provides a pathway for linking negative affectivity with diverse health outcome. At risk of health problems. Even if there are no objective symptoms, people who have high negative affectivity will complain more about their health, and have false impressions about their subjectivity of their health. (symptoms with no disease)

Coping Styles: Problem Focused vs. Emotion Focused

Problem-focused > Attempt to do something constructive about the stressful conditions. > Trying to reduce dd of situation > Develop early in life Emotion-focused > Attempt to regulate emotions experienced because of event > Develops later in life

Chronic Stress & Health

Prolonged epinephrine > Suppressed immune function > Hypertension > Heart arrhythmias or cardiac problems Prolonged HPA activation > Immune suppression > Problems memory & concentration (affects cognitive function - secretion of cortisol regularly will damage the hypothalamus) > Fat storage (to visceral areas)