CHAPTER 10

STRESS, HEALTH, AND COPING

Stress: the response of the body to any demand made upon it. We experience stress when we are faced with a threatening situation that requires us to change our behavior; to intensify our efforts or to perform at higher levels. Hassles, defined as everyday petty annoyances, irritations and frustrations. Major events often trigger the little hassles that give rise to stress.Stress is also experienced in positive events: graduation, a new job, getting married, going on vacation, moving, etc. Eustress: Positive stress (exciting opportunities & challenges).

Distress: Negative stress (high demands & undesirable tasks).

Physical stress: The body is often subjected to physical stress like exercise, sports and hard physical labor, which in some cases can be invigorating and refreshing. It can be eustress or distress.

Environmental stress: This form of stress occurs with exposure to a change of altitude, climate, or pollution in the atmosphere. Even extreme temperature changes from hot to cold or vice versa can strain the human adaptation processes.

Psychological/Emotional stress: This form of stress includes all of the cognitive and behavioral causes and outcomes that strain our coping mechanisms.

Ex: Noise - exposure to loud noise Bereavement & loss - through death, divorce, etc. Work-related problems - conflict with co-workers or supervisors, high-pressure and/or high responsibility jobs. Swing shift and disruption of sleep schedules. Poor physical work conditions.Relationships - abusive, unstable, divorce, custody, child-care, chores, roles, etc.Illness chronic or fatal diseasePoverty and powerlessness - lower socioeconomic circumstances: poor diet and medical care, high crime rates, bad housing, exposure to pollution and contaminants. Being unemployed or employed in low wage jobs mean that you are unable to pay bills, afford good food, etc.

Stressors can be acute (short-term) or chronic (long-term). Type of Stressor Duration of Stressor

Acute Chronic

Physical Injured in a car crash Malnutrition, Dx of fatal illness

Psychological Taking a test, working on a deadline Bad work environmentconflict with boss, overbearing workload

Social Being humiliated,

ConflictsChronic isolation, overcrowding, poverty

Adjustment: refers to any attempt to cope with a stressful situation, balancing our needs and desires against the demands of the environment and the realistic possibilities available. Physiological Responses (the biology of stress) The bodys response to stress causes a change in the homeostatic equilibrium of the body which can have short and long term effects.

The body responds to stress by activating the Sympathetic Nervous System: preparing the body for fighting or escape ("fight or flight"). Tense muscles

Heart rate goes up Rate of respiration increases Adrenalin begins to flow

Digestion slows down

decreased appetite, decreased muscular strength and endurance, and lowered levels of ambition or driveThe body's response is the same, regardless of what is causing the stress.Seyle (1925) studied the stages of how stress progresses.General Adaptation Syndrome (GAS):

Alarm: a brief period of high arousal of the Sympathetic Nervous System.The stressor has been perceived and recognized and the fight-or-flight response kicks in Resistance (or Adaptation): a state of prolonged, moderate arousal due to continuing exposure to a stressor. During this time the body attempts to reach equilibrium (homeostasis). This may make one susceptible to other stressors since the body is putting a lot of effort into attempting to return to equilibrium Exhaustion: maintenance of heightened state of arousal (the resistance phase) and the continuing attempt to reach a new homeostatic balance has a detrimental effect on bodily systems, such as immune system. Prolonged stress wears the body and its systems out, possibly damaging the body and increasing vulnerability to other stressorsIntervening Factors that affect Stress: Perception, Personality, and Context1. Perception or Cognitive Appraisal: What is stressful and what isn't depends upon the person and the situation. What one person may see as highly stressful, another may see as not very stressful at all (non-traditional students in college tend to be less stressed by exams and study than traditional students). Internal Conflict: relating to the choices one has available in some circumstances. Miller (1959) outlined three basic conflicts:

Approach-approach: one is attempting to choose between two or more relatively equally positive choices (one receives two job offers and both are good; acceptance to three good graduate programs; etc). This is not necessarily unpleasant, but it does create stress.

Avoidance-avoidance: the competing alternatives are equally negative (unemployment versus a BAD job). This can create a great deal of stress and often either choice will also result in stress of its own.

Approach-avoidance: a course of action has both positive and negative aspects (a GOOD job that means moving far from friends and family; choosing which parent to live with in a divorce/custody battle). There are both positive and negative aspects to each choice, creating varying levels of stress. Multiple approach-avoidance:

Distorted Thinking, Delusions Irrational Beliefs (Albert Ellis) Negative thoughts impact your attitude and how you handle stress major or minor situations.Ex: I will never get over this relationship. I will never by successful. I must be good at everything. I feel everyone should like me a lot. There is only one good way to do itCognitive Distortions (Aaron Beck) certain mental disorders can be traced to errors in logic and false beliefs. Ex: minimizing, awfulizing, blaming, victimization, Locus of Control - helps to determine how stressful things are is our sense of "locus of control." Internal locus of control - the person believes that they are in control of what happens to them and that they can change things if they wish to. External locus of control - the person believes that they are not in control of what happens to them, that fate, luck, and other people control their future

Self-perception: Low self-esteem and self-confidence together with the absence of feeling connected or empowered, can all precipitate stress reactions. Taken to excess (self-confidence) these can lead to egoism and cockiness which will cause different stress reactions.

Moral codes: Spiritual values, measures of guilt, prejudices, repentance and forgiveness all contribute to the amount of stress you put yourself under. They become guidelines to the way you perceive situations.

Traumatic experiences: Injury, abuse, neglect and isolation are all experiences that shape the way you view things. An abused or neglected childhood could forever color your perception of life. 2. Personality A person's personality, way of dealing with the world and other people, appears to be highly correlated with their health and stress. Type A Personality: Highly competitive, strong desire to win, impatient, easily angered, often hostile, usually in a hurry Type B Personality: relatively easygoing, less hurried, less hostileOptimistic vs. pessimistic styles - people who are optimistic, who see the bad but believe that things will have to get better, tend to be healthier and live longer than those who are pessimistic. Optimism is a trait highly correlated with better coping with stress. People who are optimistic tend to recover from surgery or injury more quickly, tend to get sick less often and less severely during stressful periods, etc. Pessimism, whether it be true pessimism or defensive pessimism, the latter being more situation oriented, tends to be correlated with longer recovery times, greater illness, lower quality of life. The Hardy Personality: the group of personality traits most associated with health and effectively dealing with stress. These traits include a commitment to self good self-esteem (not too low, not over inflated),

an internal locus of control

the ability to view stressors as a challenge Habits: Bad habits add to stress: eg: Always late or early, messy or fastidious.

Gender: Men are from Mars, Women are from Venus. Inherent differences between the ways men and women view and handle situations can be a source of conflict and lead to stress.3. ContextThe context of the stressor may also mediate how stressful it is: if something disturbing is presented in a detached or clinical manner, peoples' physiological arousal tends to be less than for those who are given a more emotional appraisal of the same stressor. Attitudes like perfectionism, obsessive and compulsive behaviors induce stress when desired outcomes cannot be met.Social support network: Helpful and supportive backgrounds and a strong social support network of good friends and strong relationships help build confidence. Perceived control:

Perception of control is more important than actual control.

Control is most effective when the perceived control matches the preferred level of control.

Cultural factors affect peoples perceptions of control.

Chronic uncontrollable stressors can be less stressful than sporadic, unpredictable ones.

Perceived lack of control can lead to learned helplessness.

Warnings of upcoming stressors can lower sensations of stress, but only if the warning information is specific.

Coping with Stress How do we cope with stress? How can we make sure that the effect of stress on our health and quality of life is minimized?

People generally adjust to stress in one of two ways: Direct of Defensive Coping

Direct Coping describes any action people take to change an uncomfortable situationWhen we cope directly with a particular threat or conflict, we do it in one of three ways: Confronting a stressful situation may lead us to learn new skills, enlist other people's aid, try harder to reach our goal, or express anger. Compromise usually resolves a conflict by forcing us to settle for less than we originally sought. Withdrawal: Sometimes the most effective way of coping with a stressful situation is to distance oneself from it, but the danger of withdrawal is that it may become a maladaptive habit.

PROBLEM FOCUSED STRATEGIES:

Active coping: find a way to remove or avoid the stress.

Planning: plan for the stressor and its effects to minimize their impact

Social support: seek helpful advice or assistance about the stressor and what to do about it

Suppression of competing activities: put other activities on hold until the stressor is dealt with

Restraint coping: you may have to wait until a better time to deal with the stressor Relaxation Exercises

Systematic DesensitizationEMOTION-FOCUSED STRATEGIES:

Emotional social support: encouragement, moral support, sympathy and understanding from others, gain new insight. Venting emotions Positive reinterpretation/growth: Reinterpret the stressor as a challenge, or as having positive qualities

Humor: while humor is not a curative, the positive outlook that it fosters can help reduce the stress level and promote immune function. Behavioral disengagement: reduce efforts to deal with the stressor, GIVE UP learned helplessness. Shut off, isolate Mental disengagement or Thought suppression: turn to other activities to ignore or avoid the stressor. Avoidance. actively attempt to NOT think about the stressorThis usually has the reverse effect and we think about it more often Aggression: many people use aggression to cope, which is unhealthy for them and for those around them. Forgiveness appears to have a positive effect. One can continue to nurse anger or hurt or dislike for someone that has done them wrong, but this behavior, when it is the way the person deals with many things, is stressful in and of itself. Finding forgiveness allows one to put that stress behind them and move on. Defensive Coping denotes the various ways people convince themselvesthrough a form of self-deceptionthat they are not really threatened or do not really want something they cannot get. These are NOT healthy ways of coping.Freuds Defense Mechanisms: Denial, projection, suppression, regression, etc.Different Theoretical Perspectives on StressFreud: unconscious conflicts, fixation and lack of resolution in a developmental stage, use of self-deceptive techniques for reducing stress - defense mechanisms. Adler: overcoming feelings of inferiority Karen Horney: basic anxiety, despised self vs. ideal selfSocial Cognitive Theorists: stress is due to irrational beliefs, cognitive distortions, faulty beliefs, locus of control, person's expectancies, self-efficacy Carl Rogers: incongruence between concept of real self and ideal self Stress & Anger

Environmental factors: noise, heat, pain, depression, mood... these can all lead to a more aggressive response to what might otherwise be a neutral or positive stimulus

Hostile attribution bias: some people view others' behaviors as hostile, & then tend to become more suspicious and hostile themselves

Aggressive tendencies: genetics, the person and culture can all contribute to determining how aggressive a response an individual might make.

Gender differences: males tend to be more physically aggressive, but males and females tend to be equally aggressive in terms of non-physical aggression (socially excluding people, gossiping, and withdrawal of acceptance).

Self-esteem: people who have an over-inflated or unrealistic sense of self-esteem tend to react more aggressively to a perceived threat or insult. Narcissism: people with very unrealistic views of themselves as being exceptionally talented or special or beautiful are aggressive when confronted with something that might shake that view. (This is an extreme version of the previous, "self-esteem" listing.Stress and Disease Ones attitude can influence not only whether one gets sick or not, but how long one remains sick and how well one recovers. Psychosomatic Illness is a condition in which the state of mind (psyche) either causes or mediates a condition of actual, measurable damage in the body (soma).Examples include: ulcers, asthma, migraine headaches, arthritis, and even cancer.

People who experience predominantly negative emotions (anxiety, depression, helplessness, hostility) often heal from injuries slower; get better from illness slower, etc. Positive feelings are highly correlated with more rapid and more complete healing.

A large body of research indicates that stress is linked to a variety of health problems, including cancer, heart disease, rheumatoid arthritis, periodontal disease, yeast infections, and the common cold, etc. Stress affects the functioning of the immune system, as do age, nutrition, and genetic factors. The immune system is the bodys defense against harmful agents such as bacteria, viruses, and other foreign substances.The type A personality is associated with a higher risk of coronary heart disease. Depression makes people more vulnerable to heart disease.People who have a tendency to suppress emotions such as fear, anxiety, and anger have a higher risk of becoming ill than people who can acknowledge and express their feelings.

Stress

Reactions

Physiological

Emotional

Behavioral

Intervening

Factors

Appraisal

Perceived control

Personality

Social support

Coping behaviors

Stressors

Catastrophes

Life changes

Hassles

Response

Appraisal

Aroused, focused

Panic, freeze up

Challenge

(Ive got to apply

all I know)

Threat

(Yikes! This is

beyond me!)

Stressful event

(Tough math test)

Lacking

Close, enduring

Level of social support

Smoking

Sedentary

Poor nutrition

Healthy eating habits

Regular exercise

Good nutrition

Personality habits

Hostile

Depressed

Pessimistic

Easy going

Non-depressed

Optimistic

Personality type

Threat

Challenge

Personal appraisal

Illness

Health

Tendency toward

Life events