“Your One and Only Car”“Your One and Only Car”

Stress and HealthStress and Health§ Behavioral Medicine

§ interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease

§ Health Psychology§ subfield of psychology that provides

psychology’s contribution to behavioral medicine

§ Behavioral Medicine§ interdisciplinary field that integrates

behavioral and medical knowledge and applies that knowledge to health and disease

§ Health Psychology§ subfield of psychology that provides

psychology’s contribution to behavioral medicine

Stress and IllnessStress and Illness§ Leading causes of death in the US in

1900 and 2000§ Leading causes of death in the US in

1900 and 2000

Stress and IllnessStress and Illness§ Stress

§ the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging

§ Stress§ the process by

which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging

When stress is good and leads to something desirable such as studying for a big exam and then receiving a good grade on the exam, it is called eustress.

When the stress has negative effects such as confusion, an inability to make decisions, and illness, it is called distress.

StressStress is defined as the physical pressure and strain that result from change.

Stress AppraisalStress Appraisal

Stressful event(tough math test)

Threat(“Yikes! This isbeyond me!”)

Challenge(“I’ve got to apply

all I know”)

Panic, freeze up

Aroused, focused

Appraisal Response

Sequence of Steps in the Fight or Flight Behaviors

1. The brain appraises a situation as threatening and dangerous.

2. The lower brain structure secretes a stress hormone.

3. The stress hormone signals the adrenal glands to secrete adrenaline.

4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.

Fight or Flight (Walter Cannon)

The General Adaptation Syndrome (Hans Selye)

Defined as a series of stages the body goes through when exposed to stressful situations.

1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical.

2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor.

3. The third stage is exhaustion. It is marked by body exhaustion and health problems.

Alarm Resistance Exhaustion

Stress and IllnessStress and Illness§ General

Adaptation Syndrome § Selye’s

concept of the body’s adaptive response to stress in three stages

§ General Adaptation Syndrome § Selye’s

concept of the body’s adaptive response to stress in three stages

Stressresistance

Phase 1Alarm

reaction(mobilize

resources)

Phase 2Resistance(cope with stressor)

Phase 3Exhaustion(reservesdepleted)

The body’s resistance to stress canlast only so long before exhaustion sets in

Stressoroccurs

Stressful Life EventsStressful Life Events§ Catastrophic Events

§ earthquakes, combat stress, floods

§ Life Changes§ death of a loved one, divorce, loss of job,

promotion

§ Daily Hassles§ rush hour traffic, long lines, job stress,§ Burnout-- physical, emotional, and

mental exhaustion brought on by persistent job-related stress

§ Catastrophic Events§ earthquakes, combat stress, floods

§ Life Changes§ death of a loved one, divorce, loss of job,

promotion

§ Daily Hassles§ rush hour traffic, long lines, job stress,§ Burnout-- physical, emotional, and

mental exhaustion brought on by persistent job-related stress

Some Psychological Stressors for High School StudentsLife Event Stress Points

Divorce of parents 98

Expulsion from school 79

Major injury or illness 77

Getting a job 62

Major illness of close friend 56

Peer difficulties 45

Moving away 41

Christmas 30

Vacation 25

Traffic ticket 22

Perceived ControlPerceived Control Our personal control and optimism is

related to stress and our immune system.

With loss of perceived control, we are vulnerable to ill health.

Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.

Our personal control and optimism is related to stress and our immune system.

With loss of perceived control, we are vulnerable to ill health.

Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.

Perceived ControlPerceived Control§ Health consequences of a loss of control§ Health consequences of a loss of control

No connection to shock source

To shock control To shock source

“Executive” rat “Subordinate” rat Control rat

Poverty and InequalityPoverty and Inequality Poorer people are more at risk for

premature death. People also tend to die younger in

areas where there is greater income inequality.

People at every income level are at greater risk of death if they live in a community with great income inequality.

Poorer people are more at risk for premature death.

People also tend to die younger in areas where there is greater income inequality.

People at every income level are at greater risk of death if they live in a community with great income inequality.

Perceived ControlPerceived Control§ Equality and Longevity§ Equality and Longevity

Stress and the HeartStress and the Heart

§ Coronary Heart Disease§ clogging of the vessels that nourish the heart muscle

§ leading cause of death in many developed countries

§ Coronary Heart Disease§ clogging of the vessels that nourish the heart muscle

§ leading cause of death in many developed countries

Stress, Personality, & Heart DiseaseStress, Personality, & Heart Disease

Coronary heart disease is North America’s leading cause of death

Habitually grouchy people tend to have poorer health outcomes

Chronic negative emotions have negative effect on immune system

Coronary heart disease is North America’s leading cause of death

Habitually grouchy people tend to have poorer health outcomes

Chronic negative emotions have negative effect on immune system

6 factors that increase the risk of heart disease: 6 factors that increase the risk of heart disease:

1. Smoking 2. Obesity 3. High fat diet 4. Physical Inactivity 5. Elevated blood pressure 6. Elevated Cholesterol + stress

and personality

1. Smoking 2. Obesity 3. High fat diet 4. Physical Inactivity 5. Elevated blood pressure 6. Elevated Cholesterol + stress

and personality

Stress and the Heart Stress and the Heart Hopelessness

scores3.5

3

2.5

2

1.5

1

0.5

0 Heart attack DeathLow risk Moderate risk High risk

Men who feel extreme hopelessnessare at greater risk for heart attacksand early death

Stress and the Heart Stress and the Heart

§ Type A § Friedman and Rosenman’s term for

competitive, hard-driving, impatient, verbally aggressive, and anger-prone people

§ Type B§ Friedman and Rosenman’s term for

easygoing, relaxed people

§ Type A § Friedman and Rosenman’s term for

competitive, hard-driving, impatient, verbally aggressive, and anger-prone people

§ Type B§ Friedman and Rosenman’s term for

easygoing, relaxed people

Research on type A Personality

Time urgency & competitiveness not associated with poor health outcomes

Negative emotions, anger, aggressive reactivity

High levels of hostility increase chance of all disease (e.g., cancer)

Explanatory style

Optimism use external, unstable, & specific

explanations for negative events predicts better health outcomes

Pessimism use internal, stable, & global

explanations for negative events predicts worse health outcomes

Stress and the Heart

Stress and Disease§ Psychophysiological Illness

§ “mind-body” illness§ any stress-related physical illness

§ some forms of hypertension§ some headaches

§ distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease

Stress and Disease§ Lymphocytes

§ two types of white blood cells that are part of the body’s immune system

§ B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections

§ T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances

Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.

Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.

Stress and Disease

§ Conditioning of immune suppression

UCS(drug)

UCR(immunesuppression)

UCS(drug)

UCR(immunesuppression)

CS(sweetenedwater)

CS(sweetenedwater) CR

(immunesuppression)

Conflict

Conflict arises when a person needs to decide between two alternatives.

Types of conflict:

Approach - Approach

Avoidance - Avoidance

Approach - Avoidance

Double Approach - Avoidance

Approach-Approach

The person is attracted to two goals.

The approach - approach conflict is not all bad. You have to decide between two attractive choices.

Approach - Avoidance

The person is attracted to one goal but it comes with a

negative aspect.

The approach - avoidance conflict can be distressing.

Avoidance - Avoidance

The person has to choose between them.

The avoidance - avoidance conflict presents two undesirable goals.

Double Approach - Avoidance

The person has two goals, each has both good and

bad characteristics.

The double approach - avoidance conflict is the most common.

Stress and Disease§ Negative emotions and health-related

consequences§ Negative emotions and health-related

consequences

Unhealthy behaviors(smoking, drinking,

poor nutrition and sleep)

Persistent stressorsand negative

emotions

Release of stresshormones

Heartdisease

Immunesuppression

Autonomic nervoussystem effects

(headaches,hypertension)

Promoting Health

§ Aerobic Exercise§ sustained exercise that increases heart and lung fitness

Depressionscore

14

13

12

11

10

9

8

7

6

5

4

3

Before treatmentevaluation

After treatmentevaluation

No-treatmentgroup

Aerobicexercise

group

Relaxationtreatment

group

Why Does Exercise Work? Exercise and Mood Releases chemicals -- norepinephrine -- serotonin -- endorphins Sense of accomplishment Improved physique

Why Does Exercise Work?

Exercise and Health Strengthens heart Lowers blood pressure Lowers blood pressure

reactivity to stress Moderate exercise adds two

years to one’s expected life.

Promoting Health§ Biofeedback

§ system for electronically recording, amplifying, and feeding back information regarding a subtle physiological state

§ blood pressure§ muscle tension

BiofeedbackBiofeedback Feedback about subtle bodily responses

e.g., tension in forehead Not controlling body’s responses People can influence some of these

responses finger temperature forehead tension

Reduce intensity of migraines Help with some chronic pain Relaxation crucial to biofeedback success

Feedback about subtle bodily responses e.g., tension in forehead

Not controlling body’s responses People can influence some of these

responses finger temperature forehead tension

Reduce intensity of migraines Help with some chronic pain Relaxation crucial to biofeedback success

Promoting Health§ Modifying Type A life-style can

reduce recurrence of heart attacks§ Modifying Type A life-style can

reduce recurrence of heart attacks

Percentageof patients

with recurrentheart attacks

(cumulativeaverage)

6

5

4

3

2

1

0

Year1978 1979 1980 1981 1982

Life-style modification patients

Control patients

Modifying life-stylereduced recurrent

heart attacks

RelaxationRelaxation

Meditation can lower blood pressure, heart rate, oxygen consumption

Can it help with stress-related disease?

Meditation can lower blood pressure, heart rate, oxygen consumption

Can it help with stress-related disease?

Social SupportSocial Support Feeling liked, affirmed, and

encouraged by intimate friends and family--promotes happiness and health.

Social support calms the cardiovascular system and lowers stress hormones.

Feeling liked, affirmed, and encouraged by intimate friends and family--promotes happiness and health.

Social support calms the cardiovascular system and lowers stress hormones.

Promoting HealthPromoting Health§ Social support across the life span§ Social support across the life span

12-14 18-19 25-34 45-54 65-74 15-17 20-24 35-44 55-64 75+ Age in years

100%

90

80

70

60

50

Percentagewith high

support

Life events

Tendency toward

Health Illness

Personal appraisal

Challenge Threat

Personality typeEasy going

NondepressedOptimistic

HostileDepressedPessimistic

Personality habitsNonsmoking

Regular exerciseGood nutrition

SmokingSedentary

Poor nutrition

Level of social support

Close, enduring Lacking

Spirituality & Faith CommunitiesSpirituality & Faith Communities Personal prayer, meditation, or other

spiritual and religious practices can enhance medical treatment.

Those who attend religious services experience lower death rates from coronary heart disease.

Personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment.

Those who attend religious services experience lower death rates from coronary heart disease.

Promoting Health Promoting Health

§ Religious Attendance§ Religious Attendance

Promoting Health Promoting Health § Predictors of mortality§ Predictors of mortality

1

0.8

0.6

0.4

0.2

0

Men Women

Not smoking Regular exercise Weekly religious attendance

Relativerisk

of dying

Promoting Health § The religion factor is mulitidimensional§ The religion factor is mulitidimensional

Religiousinvolvement

Healthybehaviors

(less smoking,drinking)

Social support(faith

communities,marriage)

Positiveemotions

(less stress,anxiety)

Better health(less immune systemsuppression, stress

hormones, and suicide)

Promoting Health

§ Complementary and Alternative Medicine§ unproven health care treatments

not taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies

Alternative systems ofmedical practice

BioelectromagneticApplications

Diet, nutrition,life-style changes

Herbal medicine

Manual healing

Mind-body control

Pharmacological and biological treatments

Subfields of Alternative MedicineHealth care ranging from self-care according to folk principles,

to care rendered in an organized health care system based onalternative traditions or practices

The study of how living organisms interact with electromagnetic (EM) fields

The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention

Employing plan and plant products from folk medicine traditionsfor pharmacological use

Using touch and manipulation with the hands as a diagnosticand therapeutic tool

Exploring the mind’s capacity to affect the body, based on traditional medical systems that make use of the interconnected-ness of mind and body

Drugs and vaccines not yet accepted by mainstream medicine

Promoting Health Promoting Health § Smoking-related early deaths§ Smoking-related early deaths

40,000

30,000

20,000

10,000

0

33,348

1,686 1,135 556 202

Smoking Suicide Vehicle HIV/ Homicide crash AIDS

Cause of death

Numberof deaths

per 100,000

The Physiological Effects of Nicotine

Promoting Health Promoting Health § Fewer Canadian smokers§ Fewer Canadian smokers

Males

Females

1970 1974 1978 1982 1986 1990 1994- 1996- 1995 1997

Year

60%

50

40

30

20

10

0

Percentageof Canadians

smoking

Smoking PreventionSmoking Prevention

§ U.S. teen smoking§ U.S. teen smoking

Smoking Prevention

§ Results of a smoking inoculation program

§ Results of a smoking inoculation program

Percentageof studentswho smoke

20

15

10

5

0 0 4 9 12 16 21 33

Seventh grade Eighth grade Ninth grade

Months of study

Control school

School with smokingPrevention program

Fewer teens took upsmoking when “inoculated” against it

“You are what you eat”. Eating foods that provide the biochemical building blocks for those neurotransmitters affect our mood and behavior. People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.

“You are what you eat”. Eating foods that provide the biochemical building blocks for those neurotransmitters affect our mood and behavior. People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.

Obesity & Weight Control

§ Obesity and body mass index

§ Obesity and body mass index

Obesity and Weight Control § Obesity and mortality§ Obesity and mortality

18.5 18.5- 20.5- 22.0- 23.5- 25.0- 26.5- 28.0- 30.0- 32.0- 35.0- 40 20.4 21.9 23.4 24.9 26.4 27.9 29.9 31.9 34.9 39.9

Body-mass index (BM I)Men Women

2.8

2.6

2.4

2.2

2.0

1.8

1.6

1.4

1.2

1.0

0.8

0.6

Relativerisk ofdeath

Weight Discrimination

§ When women applicants were made to look overweight, subjects were less willing to hire

§ When women applicants were made to look overweight, subjects were less willing to hire

Willingnessto hire scale

(from1:definitely

not hire to7: definitely

hire)

0

1

2

3

4

5

6

7

Women Men

Normal Overweight

Weight ControlWeight Control§ Effects of a severe diet§ Effects of a severe diet

Caloric intake

in caloriesper day

Body weight

in kilograms

Metabolism:Oxygen

consumptionin liters

per hour

3000

2000

1000

0 8 16 24 32

Days

165

160

155

150

145

140

Days Days

26

25

24

23

22

218 16 24 32 8 16 24 32

Weight ControlWeight Control§ Trading risks§ Trading risks

Weight ControlWeight Control§ Thinning of Miss America§ Thinning of Miss America

Weight ControlWeight Control

§ Most lost weight is regained

§ Most lost weight is regained

-20

-15

-10

-5

0

5

10

1 2 3 4 5

Weightchange

in pounds

Posttreatment

Years of follow-up

Startingpoint

Normal trend for untreated obesepeople: Gradually rising weight

After participation in behavioralProgram: Much of initial weight

loss regained

Weight ControlWeight Control§ Obesity

was more common among those who watched the most television

§ Obesity was more common among those who watched the most television

<2 2-3 >4Hours of television watched per day

in 1990s study

Boys Girls

32

30

28

26

24

22

20

Skinfold fatmeasure (mm)

The Physiology of ObesityThe Physiology of Obesity Fat Cells

A fat cell can vary from relatively empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.

Fat Cells A fat cell can vary from relatively

empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.

Set points and MetabolismSet points and Metabolism Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.

Metabolism is the rate at which we burn calories.

Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.

Metabolism is the rate at which we burn calories.

The Genetic FactorThe Genetic Factor There is a genetic influence on

body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.

Rather, people’s weights resemble those of their biological parents.

Identical twins have closely similar weights, even when reared apart.

There is a genetic influence on body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.

Rather, people’s weights resemble those of their biological parents.

Identical twins have closely similar weights, even when reared apart.

Losing WeightLosing Weight

Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.

Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.

Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.

Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.

HELPFUL HINTS FOR LOSING WEIGHT

HELPFUL HINTS FOR LOSING WEIGHT

• Minimize exposure to tempting food cues

• Take steps to boost your metabolism• Be Realistic and Moderate• Modify both your metabolic rate and

your hunger by changing the food you eat.

• Don’t starve all day and eat one big meal at night.

• Beware of the binge.• Set realistic goals.

• Minimize exposure to tempting food cues

• Take steps to boost your metabolism• Be Realistic and Moderate• Modify both your metabolic rate and

your hunger by changing the food you eat.

• Don’t starve all day and eat one big meal at night.

• Beware of the binge.• Set realistic goals.