Chapter 13
Stress, Coping and Health –
The Relationship Between Stress
and Disease
• Contagious diseases vs. chronic diseases
• Biopsychosocial model
• Why?
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The Biomedical Model is unable to fully account for health
Mind-body question
Biomedical treatments only
Failures to account for many psychological factors and health
Placebo effects – how to explain
• Health psychology
– Health promotion and maintenance
• Discovery of causation, prevention, and treatment
– Primary prevention, secondary prevention, tertiary prevention
– Changing pattern of what is the primary cause of death in last
100+ years. – F 13.1
Levels of Prevention
Primary Prevention
•Prevent disease
•Identify causes
•Promote health behaviors
Secondary Prevention
•Catch disease in early stages
•Prevent further deterioration
Tertiary Prevention
•Manage illnesses with no
cure
Stress: An Everyday Event
• Major stressors vs. routine hassles
– Cumulative nature of stress
– Psychological Stress - Lazarus
– Cognitive appraisals: primary and secondary
• Major types of stress
– Frustration – blocked goal
– Conflict – two or more incompatible motivations
• Approach-approach, approach-avoidance, avoidance-avoidance –
Figure 13.2
– Change – having to adapt
• Holmes and Rahe – Social Readjustment Rating Scale – Life Change
Units – Table 13.1
– Pressure – expectations to behave in certain ways
• Perform/conform
• Figure 13.3 – pressure and psychological symptoms – Weiten (1988)
• Overview of Stress Process – Figure 13.4
Appraisal Process
• The primary appraisal process determines
whether the environment is perceived as
psychologically threatening, harmful, or
challenging to the person.
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• The secondary appraisal process is a
complex evaluative process in which a
person considers resources available to
cope with the primarily appraised stressor.
Responding to Stress Emotionally
• Emotional Responses
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Annoyance, anger, rage
Apprehension, anxiety, fear
Dejection, sadness, grief
Positive emotions
Slide 12, after 9/11 – correlations between emotion
and resilience
• Emotional response and performance
– The inverted-U-hypothesis – Figure 13.5 –
performance and task complexity
Responding to Stress
Physiologically
• Physiological Responses
– Fight-or-flight response
– Selye’s General Adaptation Syndrome
• Alarm
• Resistance
• Exhaustion
• Brain-body pathways in stress – Figure 13.6
– sympathetic adrenal medullary (SAM)
– hypothalamic pituitary adrencortical (HPA)
Physiological Stress
Hans Selye first introduced the term
stress to medicine in 1936. He noted
that animals were induced by a
variety of stimuli to show the
“syndrome of just being sick” which
resulted in adrenal enlargement,
gastrointestinal ulcers, shrinkage of
the thymus and lymph nodes. This
reaction was termed the “general
adaptation syndrome” and “stress is
the nonspecific response of the body
to any demand made upon it”.
Figure 13.6 – Brain-body
pathways in stress:
Responding to Stress Behaviorally
• Behavioral Responses: Coping –
emotion focused
– Frustration-aggression hypothesis
– catharsis
• Defensive Coping – ego defense
mechanisms –Freud – Table 13.2
• Constructive Coping – problem focused
Table 13-3, p. 523
Emotion-focused coping and Problemfocused coping
• “Emotion-focused (or palliative) coping refers to
thoughts or actions whose goal is to relieve the
emotional impact of stress. These are apt to be mainly
palliative in the sense that such strategies of coping
do not actually alter the threatening or damaging
conditions but make the person feel better.” Monat
and Lazarus (1991, p. 6)
• “Problem-focused coping refers to efforts to improve
the troubled person-environment relationship by
changing things, for example, by seeking information
about what to do, by holding back from impulsive and
premature actions, and by confronting the person or
persons responsible for one’s difficulty.” Monat and
Lazarus (1991, p. 6)
Effects of Stress: Behavioral and Psychological
• Impaired Task performance
• Burnout – antecedent-componentsconsequences – Figure 13.7
• Posttraumatic Stress Disorders (PTSD) –
effects on hippocampus (cortisol) –
prevelance of traumatic events – Slide 22
• Reaction to traumatic stress – Figure 13.8
• Psychological problems and disorders – more
in Chapter 14
• Positive effects – eustress – Positive
Psychology – Flow (Csikszentmihalyi)
Figure 13.7 – The antecedents, components,
and consequences of burnout
Effects of Stress: Physical
• Psychosomatic diseases
• Heart disease
– Cholesterol and inflammation (C-reactive protein) and risks –
Figure 13.9
– Type A behavior - 3 elements
• strong competitiveness
• impatience and time urgency
• anger and hostility (note in F 13.10 most related to cornary
events)
– Emotional reactions and depression – Figure 13.11 – study
by Pennix et al. (2001) – anger and coronary risk
• Stress and immune functioning
– Reduced immune activity
– Possible health problems linked to stress – Table 13.3
– Stress-illness correlation – Figure 13.12
Table 13.3a Health Problems that may be Linked to Stress
Table 13.3b Health Problems that may be Linked to Stress
Factors Moderating the Impact of Stress
• Social support
– The perceived comfort, caring, esteem or help received from others.
– Types: emotional, belongingness, instrumental (tangible),
informational, esteem/relational, and network (Facebook and
MySpace?)
– The existence or quantity of social relationships
– the amount of assistance individuals believe is available to them
– the amount of assistance individuals receive
– Alameda County Study in 1965 – related to health outcomes, tend to
live longer
– Increased immune functioning
• Optimism
– expectation of good things will happen and bad things will not
happen, contrasted to pessimism
– Related to psychological well-being, physical well-being
– More adaptive coping
– Pessimistic explanatory style
• Conscientiousness
– Fostering better health habits
• Autonomic reactivity
– Cardiovascular reactivity to stress
Figure 13.18 – Albert Ellis’s A-B-C
model of emotional reactions
Figure 13.19 – Possible examination for the link
between humor and wellness
Fig. 13-18, p. 543
Stress management techniques adapted from Monat & Lazarus (1991)
• Environment/Lifestyle: time management, proper
nutrition, exercise, finding alternatives to
frustrated goals, stopping bad habits
• Personality/Perception: assertiveness training,
thought stopping, refuting irrational ideas, stress
inoculation, modifying type A behavior
• Biological responses: progressive relaxation,
relaxation response, meditation, breathing
exercises, biofeedback, autogenics