health psych quiz 2. lecture 15-20

A system is an

integrated set of separate things that collectively achieve a purpose.​ -ex: the 3 houses of govt, an orchestra

Repression =

unconsciously hide thoughts/feelings from self

Parent / Child coalition:

Child sides with one parent​

catharsis

-emotional buildup causes stress -release pent up emotions releases stress -language provides an outlet for venting pent up emotions

Use of Child in Avoiding Family Conflict​: Warring parents enlist kids to help them reach personal goals.​ Put kids in "no-win" situation. How so?​

"Triangulation": Kid has three undesirable choices​ 1. Side with dad, 2. Side with mom, 3. Become silent/invisible​ Parent / Child coalition: Child sides with one parent​ Detouring: Parents divert tensions with each other by controlling or blaming child. ​

Statement of Over-involvement​

"When I tell you to lift your leg and stop dragging it, I am only doing it for your own benefit, because if you concentrate hard enough on lifting that leg you are physically able to do it".​ ​ Wife's comments to her stroke-disabled husband.

Low tolerance for conflict: due to enmeshment + status quo priority​

* Avoid problems, OR​ * Low-level bickering ​ * Typically one spouse the "avoider"

Rigidity​

* Committed to status quo​ * Threatened by children's natural change, growth​ * Can't change family rules as people change​ * Over-emphasis on stasis inhibited stress​ * Deny need for change

Overprotectiveness​

* Nuturing and protectiveness predominate​ * People seen in terms of their vulnerabilities​ * Autonomy, exploration, growth retarded​

Enmeshment​

* Overly responsive and involved​ * Lack of privacy​ * Interrupted conversations​ * Weak hierarchies: parents = kids = parents

Pennebaker Disclosure and Health Model​

--Emotional suppression is hard work (Wegner studies)​ --Short term suppression leads to (arrow) physiological arousal (physio studies)​ --Long term suppression is chronic stressor leads to (arrow) immunocompromise​ --Immunocompromise leads to (arrow) illness​

Personality Differences In Giving Directive and ​ Non-Directive Social Support​ Harber, Jussim, Kennedy, Freyberg, & Baum, 2008​

--People who Prefer to Give Directive Support​: Need for Certainty​ and Just World Beliefs​ ---People who Prefer to Give Non-Directive Support​: Empathy: Concern​, Empathy: Perspective​, Emotional Range & Clarity​, Use Emotions as Information​

Why Would Social Support from Close Others "Go Bad"? ​

-Continues over time​ ​-Requires higher level of commitment​ -Draws on past history​

Emotional​ social support characteristics

-Disclosure​ -Belonging​ -Worthiness​ - Affection​

Informational​ social support characteristics

-How to get help​ -Nature of problem​ -Poss. solutions​

tangible​ social support characteristics

-Provide funds​ -Provide materials​

insight

-uncompleted problems are emotionally arousing -uncompleted tasks stay alive until completed -language helps people get closure on unfinished business

"Recipe" for Negative Social Support: ​ Husbands of Dieting Women​

91% of men support wives' attempts to lose weight.​ Study observes behavior of husbands and dieting wives at dinner.​ Finds that husband, compared to wives, are:​ Four times more likely to offer food.​ Seven times more likely to discuss food​ Ratio of criticism to praise: 12:1​ Solution: Tell husband to just be uninvolved = ​ Actively involve husband in dieting training ​

Family Systems That Promote Illness​

1. Autonomy is curtailed by hyper-concern​ 2. Mind and body under others' control ​ 3. Control is under guise of concern​ 4. Denial of self for others ​

Serendipity and Scientific Discovery: ​ Pennebaker's Inhibition and Illness Hypothesis​

1. Communication studies: ​ People like groups more when they get to talk more.​ ​2. Polygraph (lie detector) studies: ​Liberation through confession​ 3. Personal Experience: ​Asthma and parents; relief about marital problems; career problems through writing

What Are Types of Social Support?​

1. Emotional 2. Informational​ 3. Instrumental 4. Tangible​

Summary of Social Support Benefits

1. General health promoter—effects all physio-systems​ ​2. Reduces rates of illness​ 3. Reduces death rates (e.g., post MI)​ ​4. Quicker recovery from major illness

Phase II: Flagging Morale Helper:::: Recipient​

1. Increased pressure to inhibit and fake.​ 2. No-win of inhibition​ a. Blamed for not disclosing​ b. Blamed for complaining

James Pennebaker Inhibition and Illness Model​

1. Inhibiting thoughts and feelings is stressful​ 2. In short term, suppression leads to physiological arousal.​ 3. Over the long term, suppression leads to immunocompromise.​ 4. The result is increased susceptibility to a wide range of illness. ​

Causes of Negative Social Support​

1. Nature of illness: How acquired, duration, limitations​ 2. Nature of symptoms: Objective vs. Subjective​ 3. Orientation to situation: ​ Motives (affection vs. guilt)​ Choice to be in helping role​ Helpee's responsibility for illness​ ​4. Tasks that helper takes on: Clearly defined vs. ambiguous​ 5. Social network: Backup supporters vs. isolated​ 6. Relationship factors​ Degree of affection pre-illness​ Quality of communication pre-illness​

Types of Traumas Disclosed ​in the Initial Test of the Inhibition of Health Model Pennebaker & Beal, 1986

1. Parents' divorce: " Son, the problem with me and your ​mother was having kids in the first place. Things haven't been ​the same since you and your sister's birth".​ 2. Responsibility for grandmother's death.​ 3. Molestation by grandfather, at age 13.​ 4. Hiding sexual orientation from parents​ ---"Family abuse, alcoholism, suicide attempts, public humiliation ​ were frequent topics" ​

Reviewing Clues Leading to Inhibition and Illness Hypothesis​

1. People like to talk, and learn from talking about themselves.​ 2. Certain kinds of events create communication conflicts— want to talk but afraid to talk.​ 3. Response to this conflict is inhibition, which is a stressor.​ ​ 4. Confronting difficult topics reduces inhibition, reduces stress.

Maladies (ILLNESSES) Related to Social Isolation

1. Pregnancy complications ​ 2. Herpes outbreaks​ 3. Arthritis pain​ 4. Cancer ​ 5. Diabetes mismanagement​ 6. Cardiac illness and recovery​ 7. Suppressed recovery from other illnesses​

How to Maintain Good Social Support? ​

1. Realistic expectations​ ​ 2. Coordinate perspective of helper and helpee​ ​ 3. Provide specific tips on how to help​ ​ 4. Prepare both parties for possible set-backs​ ​ 5. Describe miscarried helping​ ​ 6. Inform helpers how own anxiety over-involvement​ ​ 7. Urge both helper and helpee to focus on own, personal needs​

Phase II: Flagging Morale Helper (Helper)

1. Reassurance and support statements become forced, not sincere​ 2. Signs of worry, concern become more common​

Family Systems Therapy​

1. Therapist points out how child uses symptoms to manipulate family.​ 2. Parent is coached to not reward child's symptoms.​​ 3. Child seeks better ways to assert self.​​ 4. Underlying conflicts allowed to surface. ​ 5. Family system corrects itself.​ 6. Child learns he/she doesn't need to depend on symptom​

Why Does Writing Promote Coping?​ Harber & Pennebaker, 1991​

1. Thought Intrusions classic symptom of trauma​ 2. Ironic effect of suppression​ ​3. Emotions and recurring thoughts​

Writing about negative events may boost morale. How so? ​

Active coping​ Purposeful activity​ Improved self-image​ ​Psychologically and socially safe​

Social support challenges the bio-med model. Why? ​

Biomed model predicts 1 cause for illness, specific to illness. Social support indicates multiple, general causes for specific illness.​

Dysfunctional Families Over-Value Homeostasis​

Change/growth inhibited Change in individual member seen as threat to family Rigid Conflict averse, BUT rigidity and enmeshment --> tension --> leads to crisis.

Directive​ support

Decided what help I needed​ Solved problems for me​ Organized my schedule for me​ Decided who could help me​ Took charge of my problem​

Social Support: ​ Better to Give than to Receive?​ Brown, Nesse, Vinokur, & Smith, 2003​

Design: Prospective study conducted over five years.​ Subjects—Older couples, where husband is 65 + years old​ ​Time 1 measures: ​ a. Receive social support​ b. Supply social support​ c. Dependency​ d. Age, gender, physical health, mental health, SES, personality.​ ​-------Time 2 measure: Mortality. ​

Results of Family Systems Therapy​

Diabetes: Reduced hospital admissions​ ​Asthma: Ratings reduced from Level 3 (serious) ​ to Level 1 (routine maintenance). ​ ​Anorexia: Change from 32% wgt. loss to wgt.gain. ​ 85% recovery rate.​

Domains Where Directive and Non-Directive Support Are Relevant​

Dieting​ Self-harm​ Risk taking​ Illness management​ Illness investigation​ Depression, other mental/emotional problems​ Work, school, other life domains​

Other Disclosure Studies Show:​

Disclosure leads to higher T-Cell count​ and improved antibody response to Epstein-Barr​ improved antibody response to Hepatitis B​ Improved management of chronic illness:​ Diabetes​ Asthma​ Other chronic illness​ Effect replicated in scores of studies, by many different researchers​

Lending a Hand Coan, Shaefer, & Davidson, 2006​ RESULTS

Effect of spousal hand holding on neural threat response was moderated by relationship quality: Closer relationships led to lower threat response, but only when holding husband's hand.​

Stress: Non-specific health threat. Why?​

Effects cardiovascular, respiratory, digestive, emotional health. ​

Social Support: Non-specific resistance factor. Why?​

Effects cardiovascular, respiratory, digestive, emotional health.​

When is Directive Support appropriate?​

Emergencies, dire situations.​ ----So, you say there is a rabid dog in your house. I understand how that might upset you.​

Discrepancy Theories of Emotion and Trauma​

Emotions arise from schema violations​ Emotions alert us when schemas (beliefs) and experience (facts) conflict​ Emotions stay active until schemas and experience difference is resolved​ Traumas arise when fundamental beliefs are violated by experience (world is just...) Changing fundamental beliefs very hard, people resist doing so​ Victim blaming, traumatic amnesia, emotional dissociation​ Listeners don't want to hear stories that offend their own basic beliefs.​ Trauma victims in compound double bind: internal and external ​ resistance to revealing trauma.​

Key Points of Family Systems​

Families are systems Systems seek homeostasis Systems use feedback, pos and neg, to maintain homeostasis

Open System:

Feedback comes from things outside system​ Free press in US ​ Science

Closed System:

Feedback comes only from other parts of system ----Clique, cult​ "Group think", Bay of Pigs and JFK

Bereavement and Disclosure Study​

Finds: NO Differences between spouses of accident/suicide ​ BUT: Among all survivors, those who DO disclose get sick less often ​

Dan Wegner "White Bear"

For the next 2 minutes think about anything you wish. Anything at all. ​ HOWEVER, do not think about a WHITE BEAR. ​ YOU MUST NOT THINK ABOUT A WHITE BEAR. ​ Every time you do think about A WHITE BEAR, knock on your desk.​ Now, close your eyes and think about anything but A WHITE BEAR​

Childhood traumas most health-debilitating. Why?

Hardest to talk about.​

How does sick child resolve family conflicts?​

Health crisis pulls family together​ Recall "Emergency Phase" of collective coping Initial phase of social support--enhanced closeness​ ​ Distracts family from immediate cause of crisis- family problems appears trivial compared to health emergency.​ ​ Distracts family from underlying system-problems​

Social Support and Resistance to Cold Virus​ Cohen, et al., 1997​

Healthy volunteers report degree of social support​ -Vols. Get nasal drops that contain cold virus​ ​---Outcome: Who gets more colds?​ LOW SOCIAL SUPPORT group

Why do People Give Directive Support?​

Hearing other's stories disturbs feelings of control​ Threatens "just world" beliefs Blaming​ Threatens sense that the self is competent ​

Pennebaker & Beale (1986) Results ​

Immediate Moods: Thoughts & Feelings (T & F) lowest​ ​--Health Center visits over 6 months:​ Thoughts & feelings = 0.5 visits​ All other groups = 1.5 visits​ ​---Long term coping (after 4 months)​ T& F higher on: * Moods​ * Optimism​ * Self-reported health ​

Social Support Affects Multiple Biological Mechanisms​

Immune system functioning​ Neuroendocrine functioning​ Cardiovascular functioning ​

Why is Directive Support Often Harmful?​

Implicit message of Directive Support:​ * You are not capable​ * You don't make sense​ * You are not in charge​ * My care is conditional​ —do what I say or I quit.​

Why is Non-Direct Support Often Helpful?​

Implicit message of Non-Directive Support:​ * You are in charge​ * I'm not judging you​ * I believe you can work this out​ * My care does not require you to ​follow my instructions. ​

Directive support is related to:

Increased depression, loneliness​

Phases of Negative Social Support​ Coyne, et al. 1988​

Initial phase: high morale​ Flagging morale​ Re-definition of situation​ Overwhelmed phase​ Stalemate​

Which method is more reliable, prospective or retrospective. Why?​

Prospective: 1. Not biased by recall.​ 2. Causality more easily determined, because causes "don't work backwards."​

"Triangulation":

Kid has three undesirable choices​ 1. Side with dad, 2. Side with mom, 3. Become silent/invisible​

Nondirective support

Knew when to back off from helping​ Helped me w/o making me helpless​ Helped w/o taking over.​ Tried not to take over.​

what is social support

Knowledge that one is not alone when facing stressors.​

Serendipidy:

Making desirable discoveries by accident, good fortune; Finding something valuable when not looking for it

Rebound Effect:

More one tries to suppress, more suppressed material occupies thoughts.​ Effect is strong for arousing content (e.g., "Sex" vs. "Dean of Arts and Sciences")​

Does Writing Actually Heal Traumatic Memory? Harber & Pennebaker:

No claims about the potency of intentionally-recovered memories. Instead, focus on their ability to spontaneously intrude. ​

Secondary psychosomatic symptoms​

No pre-existing physical disorder: e.g., Bulimia​ --Psychological factors: transformation of emotional conflict into​ physical symptoms.​

Does Writing Actually Heal Traumatic Memory?​ Rimé:

No, it doesn't. Ss write/don't write about trauma. X days later return, asked to think about trauma, then rate how upsetting it is to recall trauma. No differences between expt. groups. ​ This being so, what good is writing?​

No se vive sin amour.​

One cannot live without love​

Qualities of Systems​

Organized around, and defined by, a common goal​ --Strive for homeostasis: Balance and harmony​ --Depend on feedback systems​ Function: Retain homeostasis, keep things running smoothly, allow system to do its job.​

Retrospective Study:

Outcomes identified first, then characteristics of sample identified. ​ OUTCOME: Rates of Illness ( arrow to the left) Interview sample, find out who got sick.​

Detouring:

Parents divert tensions with each other by controlling or blaming child. ​

Primary psychosomatic symptoms: ​

Physiological disorder already present: Diabetes, asthma​ ​ -Psychological element—exacerbates, doesn't create, symptoms.

Redefinition of Problem​

Problem persists —helpers and copers become emotionally exhausted​ ​--inability to fix problem --> threatened sense of control​ ​---Helpers want to take direct action to regain personal control​ a. Advice giving: "Try harder", "Do more"​ b. Monitoring​ ​Effects of helper's actions​ a. Close monitoring undermines performance​ b. Undermines intrinsic motivation to cope​

Prospective Studies on Social Support and Health​

Prospective study: Research sample identified first, then outcomes measured. ​ SAMPLE: People lacking support Outcome: Illness rates​

Disclosure and Immunocompetence Pennebaker, Kiecolt-Glaser, & Glaser, 1988​

Questions: 1. Are initial disclosure and health findings "real" 2. Does disclosure improves immune functioning?​ Method: Same as initial study, but 1. Just two groups: Thoughts & Feelings vs. Control 2. Write 20 min., over 4 days​ Blood samples taken at: 1. Day one of study 2. Last day of writing 3. 6 weeks after study ends​ Use "mitogen test" --​bodies that stimulate antibody production

Effects of Giving Vs. Receiving Support on Mortality​

Results from logistic regression analyses indicated that mortality was significantly reduced for individuals who reported providing instrumental support to friends, relatives, and neighbors, and individuals who reported providing emotional support to their spouse. Receiving support had no effect on mortality once giving support was taken into consideration

Disclosure and Immunocompetence Pennebaker, Kiecolt-Glaser, & Glaser, 1988​ RESULTS (mitogen test one)

Results: Which group produced more antibodies to mitogen?​ the thought and feelings group --Role of Insight: 80% of T&F writers report insight-related benefits (perspective shift, new ideas about self, etc.)​ Quality of Writing: Writing that improved health was:​ 1. More emotional 2. Images and analogies 3. Clear organization: Beginning, middle, end.​

Advantages/Costs of Closed vs. Open Systems: closed

Retains homeostasis, less disrupted in short term.

Advantages/Costs of Closed vs. Open Systems: OPEN

Sacrifices homeostasis, more adaptive in long term.​

Does being excluded actually hurt? -Social Exclusion and Pain Perception​ Eisenberger, Lieberman, & Williams (2003) Science, 302, 290-292.​

Social Exclusion arouses the dorsal anterior cingulate cortex (ACC), same area aroused in physical pain. ​

Minuchin point: Families as Systems​

Some family systems can promote illness in children.​ How so? Kid's symptoms play a role in maintaining family homeostasis.​

Initial Test of the Inhibition of Health Model​ Pennebaker & Beal, 1986

Subjects (n = 46) assigned to one of four writing conditions:​ 1. Thoughts and Feelings (Insight)​ 2. Emotions only (Catharsis)​ 3. Facts only (Suppress)​ ​4. Trivial topics (Control)​ ​-Conditions 1-3 write about some past, negative event.​ -Condition 4 writes about trivial, non-emotional topic​ ​-Subjects write on four consecutive days, 15 minutes each time. ​

Self-Affirmation Mediates Disclosure and Health​ Creswell, et al., 2007​

Subjects: 63 early-stage female breast cancer patients​ Method: Disclose / Don't Disclose regarding condition​ Outcome: Cancer related symptoms (coughing, fatigue)​

Social support, loneliness, and telomere length for POWs. ​ Stein, Levin, et al. (2018)

Telomeres are protective caps on the ends of DNA​ ​-Telomeres shorten with cell division, and at critical length cell stops dividing or dies. ​ ----Longer telomeres = greater cell health = greater longevity. ​

Lending a Hand Coan, Shaefer, & Davidson, 2006​

Thesis: Social contact helps people regulate disturbing emotion.​ Method:​ 16 married women expected to receive painful shocks​ Women placed in fMRI scanner with shock electrodes on ankle.​ Women receive signal indicating shock/no shock will be delivered. ​ Fear measured at signal onset. This is repeated for 3 blocks of 12 trials.​ During these trial blocks, women hold: 1) husband's hand 2) Experimenter's hand 3) no hand. ​

Model 1: Child as instigator​

Tight control --> rebellion --> family threat --> pressure on kid-->symptoms --> change of identity (not rebel, but victim) --> homeostasis --> symptom reinforced​

Model 2: Other family member as instigator​

Tight control --> rebellion by other --> family threat --> kid sensitive to tension OR takes on role of peace-maker-->symptoms --> change of focus (from rebel to sick child) --> homeostasis --> symptom reinforced: kid learns "power in symptoms", family learns to divert attn. to "sick kid".​

Instrumental​ social support characteristics

Transportation​ Help clean​ Track meds.​

Does Writing Actually Heal Traumatic Memory? Klein & Boals, 2001.

Yes -- Expressive writing reduces intrusions.

​ Zale Corporation employee study​

a. Interviews employees b. Those with childhood trauma most often ill c. Nature of trauma (sexual, death of parent, etc.) didn't determine illness. What did?​ d. Whether or not person talked about trauma. ​

Psychology Today Survey, May 1982​

a. Question: Ever had a sexual trauma? b. 22% women, 10% men report trauma c. Traumas linked to ulcers, infections, heart problems. d. Childhood traumas most health-debilitating. Why? Hardest to talk about.

Suppression

blank is ACTIVELY, CONSCIOUSLY hiding or not- showing arousing thoughts and/or feelings.​ -- Upset in argument with boss, don't want to show it -- Stifling a fit of giggles in church. -- Attracted to someone, but don't want to be obvious ---------------intentionally hide thoughts/feelings from others​

Mitogen test

bodies that stimulate antibody production​

N. Karelia, CA Study:

focuses only on CHD​ -Admits only patients with pre-existing CHD/CHD risks​ -Isolated men (not women) higher CHD mortality ​

Community Based Studies, 1979-1984​ --Alameda County: Men and women w/o support were 1.9 to 3.1 times more likely to die in 9 year follow up.​ -WHAT WAS THE MAIN CAUSE OF DEATH?

heart disease, stroke, cancer, respiratory, gastrointestinal -Problems with this study: Doesn't account for pre-study illness ​

non-directive support is related to

increased hope, optimism.​

what does Dan Wegner "White Bear" show?

it shows the rebound effect: when someone tries to suppress something the more the suppressed material occupies your thoughts

Our emotions, stress, and health diary study is: ​

prospective