Chapter 12
Sources of Stress
n Social
Readjustment Rating Scale (SRRS)
• Outline of 43 life events from most to least
stressful
• Point value assigned to each event
• Negative and positive events both cause stress
• Point totals describe impact of stress and chance of
illness over a two-year period
• Score of 150-300: 50% chance of stress-related
illness within 2 years
• Score of 300+: 80% chance of stress-related illness
within 2 years
n Shortcomings
of SRRS include:
• Individual’s coping styles not taken into account
• Good coping strategies reduce impact of each
stressful event
Holmes & Rahe’s
Social Readjustment Scale
100 Death of a spouse
73 Divorce
65 Marital separation
63 Detention in jail or other
institution
63 Death of a close family member
53 Major personal injury or
illness
50 Marriage
47 Fired from work
45 Marital reconciliation
45 Retirement
44 Change in health or behavior of
family
member
40 Pregnancy
40 Sex difficulties
39 Gain new family member
through
birth,
adoption, or marriage
39 Major business readjustment
38 Change in financial state
37 Death of close friend
36 Dhange
to a different line of work
35 Change in number of arguments
with
partner
31 Taking on a new mortgage
30 Foreclosure on a mortgage or loan
Daily Hassles and Uplifts
Making Choices
n Approach-Approach J J
•
A choice between two positive alternatives.
n
Choosing
which movie to see
n
Continuing
a career or raising a child
n Avoidance-Avoidance L L
•
A forced
choice between two negative alternatives
n
Avoid
studying for a test or fail a test
n Approach-Avoidance J L
• A choice that has both a good and a bad alternative
• Drawn by a choice and repelled by a choice
n Wanting to take a vacation but having to empty your
savings account to do it
n Conflict
• Stress that arises from knowing that choosing one
alternative means foregoing another
Unpredictability and Lack of Control
n Unpredictable
stressors are more difficult to cope with than predicable stressors
• Lab rats receiving shocks with out
warnings develop more ulcers than rats given shocks after receiving warnings
• Humans warned of stress beforehand have a chance to
prepare for it and, thus, experience less stress
n Physical
and psychological well-being profoundly influenced by sense of control over our
lives
• When given choices, nursing home residents showed:
n
Improved
health and well-being
n
Lower
death rates
• Sense of control over daily physical symptoms and
emotional reactions in cancer patients more important than disease itself
n We are
less subject to stress when we have the power to do something about it,
• Whether we exercise that power or not
Stress in the Workplace
n
Everyone
is subject to job-related stress
n
Amount
and sources differ depending on:
Stress in the Workplace
n Workload
• Too much (or too little) makes workers feel anxious, frustrated,
and unrewarded
n Clarity
of job description
• Confusion of responsibilities
• Performance criteria
• Rigid job description leaves no room for individual
initiative
n Physical
• Temperature, noise, humidity, and pollution
• Amount of workspace
• Physical positions required (standing or sitting)
n Job
status
• Low-paying, low status jobs cause greatest
psychological discomfort
• Celebrity status and stress that fame brings
Stress in the Workplace
n Accountability
• Underload occurs when jobs are perceived as meaningless
• Overload occurs with:
n
Responsibility
for physical or psychological well-being of others
n
But
limited degree of
control
n Task
variety
• Comfortable amount of variety and stimulation needed
n Human
contact
• Amount varies greatly with each person
n Physical
challenge
• Amount varies from demanding, with physical risk, to
none
n Mental
challenge
• Too little or beyond mental capacity cause most
stress
Job Stress
Stress in the Workplace
n
Women
• Increased the negative effects on health and well-being of women caused by:
n
Sexual
discrimination
n
Sexual
harassment
n
Difficulties
combining work and family roles
n
Consequences
of Job Stress
• Reduced effectiveness on the job
• Absenteeism
• Tardiness
• Accidents, substance abuse
• Lower morale
n
Unemployment
• Far more stressful than on-the-job stress
• Most choose a high-stress job over no job at all
Catastrophic Events
Racism and Stress
n
A
significant source of chronic stress
n
Being
one of the few (or only) people
of a different race in:
• A
classroom
• Workplace
• Social
situation
• Even in
the absence of racist attitudes, may face discrimination or overt acts of racism
n
Historical
racism
• Experienced by members of a group with a history of
racism
• Research focused primarily on African Americans
n
Experience more race-related stress than other
minorities
n
Have a stronger sense of ethnic identity
n
Display higher cardiovascular reactivity to
experimentally induced stressors
n
Correlation between perceived racism and hypertension
n
High blood pressure
• Firm conclusions can not be
drawn yet
Socioeconomic Status and Stress (SES)
Responding to Stress
n The
General Adaptation Syndrome
•
The
predictable sequence of reactions (stages) that organisms show in response to
stressors
•
Alarm Stage
n
Burst of
energy that aids in dealing with the stressful situation
n Adrenal cortex releases hormones called glucocorticoids
n
Increased
heart rate, blood pressure, and blood sugar levels
•
Resistance stage
n
Intense
physiological efforts to either resist or adapt
n
Glucocorticoids continue
to be released
n
Length of
stage based on stressor intensity and ability to adapt
•
Exhaustion stage
n
Occurs if
an organism fails in its efforts to resist the stressor
n
Stores of
energy are depleted
n
Disintegration
and death may follow
The General Adaptation
Syndrome
Lazarus’s Cognitive Theory of Stress
n
A person’s perception, not the stressor, determines the amount
of stress
n
Cognitive
process leads to appraisal of the stressor
•
Primary Appraisal
n
A
cognitive evaluation of a potentially stressful event to determine whether its
effect is positive, irrelevant, or negative.
n
The
personal meaning and significance of the situation
n
Stressful
event could involve:
• Harm, loss, or damage that has already occurred
• Threat or potential harm or loss
• Challenge, an opportunity to grow or change
Lazarus’s Cognitive Theory of Stress
n Secondary
appraisal
n
If the
situation is within the person’s
control, they evaluate available resources to alleviate the stress
• Physical ( health, energy,
stamina)
• Social (support network)
• Psychological (skills, morale, self-esteem)
• Material (money, tools, equipment)
• Time
n
Options
are considered and a decision is made on how to deal with the stressor
n
Stress
level is a function of adequate resources and how severely they will be taxed
in the process
Lazarus’s & Folkman’s
Psychological Model of
Stress
Coping Strategies
n Coping
• Efforts through action and thought to deal with
demands that are perceived as taxing or overwhelming
n Problem-focused
coping
• Direct response aimed at reducing, modifying, or
eliminating a source of stress
n
After
getting a poor grade, student decides to study harder or get a tutor
n Emotion-focused
coping
• A response involving reappraising of a stressor to
reduce its emotional impact
n
View loss
of a job as a challenge or opportunity not a tragedy
n Proactive
coping
• Measures taken in advance to prevent or minimze consequences of stress
Health and Illness
n Wellness
• An approach encompassing:
n
Lifestyle
n
Preventive
care
n
The need
to maintain wellness (rather than thinking of health matters only after a
sickness)
n Biomedical
model
• Explains illness solely in terms of biological
factors
n Health
psychology
• Devoted to understanding psychological influences on:
n
How
people stay healthy
n
Why they
become ill
n
How they
respond when they do get ill
The Biopsychosocial
Model of Health and Stress
n
Focuses
on health as well as on illness
n
Holds
that both are determined by a combination of biological, psychological, and
social factors
n
Most
health psychologists endorse this model
Coronary Heart Disease
n
Caused
by narrowing or blockage of the coronary arteries
n
Leading
cause of death in the United States
n
Coronary
heart disease is attributable to:
•
Lifestyle
n
Sedentary
lifestyle largest risk factor
n
Job with
most of the time spent sitting
n
Less than
20 minutes of exercise three times per week
n
High
serum cholesterol level
n
Cigarette
smoking
n
Obesity
•
Family history
n
Both
genetic and behavioral
•
Stress and job strain
n
Blood
platelets release substance that builds up plaque
Coronary Heart Disease
n Personality
type
•
Type A behavior pattern
n
Marked
by a sense of urgency, impatience, excessive competitiveness, hostility, and
anger
n
Involved
in a chronic, incessant struggle to achieve more and more in less and less time
n
Considered
a risk factor in heart disease
Coronary Heart Disease
n Personality
type
•
Type B behavior pattern
n
Marked
by a relaxed, easygoing approach to
life, without the time- urgency, impatience, and hostility of the type A pattern
n
Relax
without guilt
n
Play for
fun and relaxation not to exhibit superiority
n
As
bright and ambitious and often more successful than Type A persons
Cancer
n Second
leading cause of death in the United States
• 22% of all deaths
• 30% of adults will develop cancer
• More children aged 3 to 14 die of cancer than any
other disease
n Causes
• Unhealthy diet
• Smoking
• Excessive alcohol
• Promiscuous sexual behavior
• Becoming sexually active as an early teen
n
Especially
females
Cancer
n
Treatment
should also include psychological and behavioral factors that influence quality
of life
•
Less distress experienced when patient:
n
Has an
optimistic outlook
n
Accepts
the reality of the situation
n
Maintains
a sense of humor
•
More distress experienced when patient:
n
Engages
in denial
n
Fantasizes
and withdraws socially
n
Has
thoughts of giving up
•
Most effective coping strategies
n
Social
support (self-help groups)
n
Positive
focus and distraction
Cancer
The Immune System and Stress
n Lymphocytes
• Key components of the immune system in the white
blood cells, including B and T cells
• B cells: produced in the bone marrow
n
Produce
antibody proteins
• Destroy antigens in the bloodstream and surrounding
body tissues
• T cells: produced in the thymus gland
n
Defeat
harmful foreign invaders that reside inside the body’s cells
n
Psychoneuroimmunology
• Field where psychologists, biologists, and medical
researchers combine expertise
• Study the effects of psychological factors on the
immune system
The Immune System and Stress
n Periods
of high stress are correlated with:
• Symptoms of infectious disease
• Oral and genital herpes and mononucleosis
• Susceptibility to colds and flu
• Potential reduction in the effectiveness of vaccines
• Decreased levels of B and T cells
• Worsened autoimmune diseases
• Increased illness behaviors (reporting and seeking
medical care)
• Suppressed immune system long after a stressful event
is over
n
Increased
academic pressures,
poor marital relationships, severe depression, and sleep
deprivation due to suppressed immune system
n
Severe
bereavement affects physical and mental ailments up to 2 years following a
partner’s death
Personal Factors Reducing
The Impact of Stress and Illness
n Optimism
• Cope more effectively with stress
• Reduced risk of illness
• Generally expect good outcomes
• Find positives even in the darkest circumstances
• Generally more stress resistant
n Pessimism
• Expect bad outcomes
• Hopelessness
Personal Factors Reducing
The Impact of Stress and Illness
n Hardiness
• A combination of three psychological qualities shared
by people who can handle high levels of stress and remain healthy
l Commitment
l To both work and personal life
l Control
l Do not see themselves as victims of what life brings
l Believe they have control over consequences and
outcomes
l Challenge
l Act to solve their own problems
l Welcome challenges in life
l View challenges as opportunities for growth and
improvement
Personal Factors Reducing
The Impact of Stress and Illness
n Social
Support
•
Tangible
and/or emotional support provided in time of need by family members, friends,
and others
•
The
feeling of being loved, valued, and cared for by those toward whom we feel a
similar obligation
•
Has a
positive effect on the immune, cardiovascular, and endocrine systems
•
Encourages
health-promoting behaviors and reduces impact of stress
n
Less
likely to use unhealthy methods of coping
•
Reduces
depression and enhances self-esteem in those who have chronic illnesses
•
Aids
quicker recovery from illnesses
•
Lowers
risk of death
•
May
increase probability of surviving a heart attack
Gender and Health
n Women
• More likely to seek medical care
• Post-open heart surgical mortality rate is higher
• Physicians more likely to see women’s health complaints as emotional in nature
n Men
• Overall higher death rates from all causes
• Lung disease caused by smoking afflicts men and women
equally
n
Males
are afflicted more seriously
n
More
likely to die from lung disease
Race and Health
n Group
differences
•
African Americans
n
Higher
rates of diabetes, arthritis, and high blood pressure
n
More
likely to die of heart disease or cancer
n
Higher
mortality rates with similar illness
n
AIDS
rate is three time higher
•
Hispanic Americans
n
More
than 20% of tuberculosis cases in the U.S.
n
Hypertension
and diabetes more common
n
Heart
problems are less prevalent
Race and Health
n Group
differences
•
Native Americans
n
Higher
rate of diabetes than any other group
n
Infant
mortality is two times higher
•
Asian Americans
n
Comparatively,
very healthy
n
Wide
disparity among subgroups
n
Vietnamese
women — cervical
cancer is 5 times more likely
n
Infant
mortality lowest among Chinese Americans
n
Age-adjusted
death rate is 40% lower than White Americans
n
Death
rate from strokes is 8% higher than White Americans
•
Social economic status
n
African
Americans, Hispanic Americans, and Native Americans are more likely to be poor
n
Lack
access to good health care
n
Exposed
to more physical and psychological stress
n
Changes
in health-related behaviors benefit all equally
Lifestyle and Health
n Smoking
and health
•
The
foremost preventable disease and cause of death
•
Prevalence
has been decreasing
•
Viewed as
socially unacceptable
•
Rates of Smoking
n
Highest
among Native Americans
n
Lowest
among Asian Americans
•
More than
1 million young Americans become smokers yearly
•
More than
400,000 Americas adults die from diseases related to tobacco use
•
Increases risk for
n
Heart
disease, lung and other cancers, and emphysema
n
Suppresses
T cells in the lungs
n
Susceptibility
to respiratory tract infections and tumors
n
Chronic
bronchitis and respiratory problems
n
Deaths
and injuries from fires
n
Low birth
weight and retarded fetal development
n
Increases
babies’ risk for
anxiety and depression
n
Second
hand smoke exposure brings twice the risk of heart attack
Lifestyle and Health
n Alcohol
abuse
•
Substance abuse
n
Continued
use of a substance that interferes with a person’s major life roles at home, in school, at work, or
elsewhere, and contributes to legal difficulties or psychological problems
•
Alcohol
is the most frequently abused substance
•
10
million Americans are alcoholics
•
Alcoholism
is 3 times more prevalent in males
•
Alcoholism
is 4 times more likely if drinking begins before age 15
•
80%
complain of depressive episodes
•
Can damage
every organ in the body, especially the liver
•
3 times
more likely to die in auto accidents
•
Causes
staggering health costs
•
Shrinkage
in cerebral cortex
n
Diminished
cognitive capacity among all ages
n
Continues
even after drinking stops
Lifestyle and Health
n Alcohol
abuse
•
Considered a disease by the American Medical
Association
n
Once an
alcoholic, always an alcoholic
n
A small
amount can cause an irresistible craving
n
Total
abstinence seen as only effective treatment method
n
Alcoholics
Anonymous endorses both abstinence and the view that alcoholism is a disease
•
Genetic influence
n
Research
lends support to disease model
n
Brains
of alcoholics respond differently to visual and auditory stimuli
n
Relatives
of alcoholics display same brain response patterns
n
Brain
imaging may help determine who is genetically predisposed
Lifestyle and Health
n Diet
•
Obesity
n Increases
chances of chronic diseases
•
High blood pressure,
•
Type 2 diabetes
•
Gallbladder disease
•
Arthritis
•
Respiratory disorders
•
Coronary heart disease
•
Insufficient nutrients
n Anemia
•
Dietary iron deficiency
n Calcium
•
Degeneration of bones
n Folic
acid
• In
pregnant women, deficiency may cause infant spinal defects
Lifestyle and Health
n Diet
•
Fast food
n Increases
risk of obesity and nutritional deficits
n Should
be eaten infrequently or not at all
•
5-a-day plan
n Eat at
least 5 servings of fruits and vegetables daily
n Reading
labels of processed foods
n Avoiding
foods high in
•
Saturated fats
•
Trans-fats
•
Sodium
• U.S. Dietary Guidelines
n
Published
in 2005
n
Include
diet and exercise guidelines
Lifestyle and Health
n Exercise
• Regular exercise pays rich dividends in physical and
mental fitness
• Many Americans express reluctance to exercise, and
30% get no exercise at all
•
Aerobic exercise
n
Running,
swimming, brisk walking, bicycling, rowing, and jumping rope
n
Exercises
large muscle groups in continuous, repetitive action, increasing oxygen intake,
breathing, and heart rates
n
3-4
times per week for 20-30 minutes with warm-up and cool down periods recommended
for pro-health benefits
n
Less
than 20 minutes 3 times a week has no beneficial effects
n
Over 3
hours a week helps lose and keep off weight
Lifestyle and Health
n Exercise
Benefits
•
Increases efficiency of heart
n
Enables
more blood to be pumped with each beat
n
Reduces
the resting pulse rate
n
Improves
circulation
•
Raises HDL (good blood cholesterol)
n
Helps rid
the body of LDL (bad cholesterol)
n
Removes
plaque build up on artery walls
•
Burns extra calories
n
Enables
weight loss or maintenance
•
Makes bones denser and stronger
n
Helps
prevent osteoporosis
•
Moderates
the effects of stress
•
Gives
more energy and increases resistance to fatigue
•
Benefits the immune system
n
Increased
natural killer cell activity
Exercise
Lifestyle and Health
n
Alternative
Medicine
•
Any treatment or therapy that has not been
scientifically demonstrated to be effective
n Taking vitamin C to protect against the common cold
•
People may believe in alternative medicine because:
n
It’s easier than a lifestyle change
n
They may
find something helpful that’s unknown
to their doctor
•
Risks
n
Food
supplements can interfere with pharmacological treatments when physician is
unaware
n
May delay
receiving other needed treatment
•
Lifestyle changes are shown to be more effective
overall
Benefits of Lifestyle Changes
Lifestyle
Change
n
If
overweight, lose just 10 pounds
•
Benefits:
n
34%
reduction in triglyceride levels
n
16%
decrease in total cholesterols
n
18%
increase in HDL (good cholesterol)
n
Significant
reduction in blood pressure
• Decreased
risk of:
n
Diabetes
n
Sleep apnea
n
Osteoarthritis
Benefits of Lifestyle Changes
Lifestyle
Change
n
Add 20
to 30 grams of fiber to
your diet each day
• Benefits
n
Improved bowel function
n
Reduced risk of colon
cancer and other digestive system diseases
n
Decrease in total
cholesterol
n
Reduced blood pressure
n
Improved insulin function
in both diabetics and non-diabetics
Benefits of Lifestyle Changes
Lifestyle Change
n Engage
in moderate physical activity
every day
• Walk up and down stairs for 15 minutes
• Spend 30 minutes washing a car
•
Benefits
n
Reduced feelings of
anxiety and sadness
n
Increased bone density
•
Reduced risk of
n
Diabetes
n
High blood pressure
n
Many other
life-shortening diseases.
Benefits of Lifestyle Changes
Lifestyle
Change
n
Stop
smoking at any age, after any number of years of smoking
•
Immediate benefits
n
Improved
circulation
n
Reduced
blood level of carbon monoxide
n
Stabilization
of pulse rate and blood pressure
n
Improved
sense of smell and taste
n
Improved
lung function and endurance
n
Reduced
risk of lung infections such as pneumonia and bronchitis
•
Long-term benefits
n
Reduced
risk of lung cancer (substantial decline each year)
n
Decreased
risk of other smoking-related diseases
• Emphysema and heart disease
n
Decreased
risk of cancer recurrence in those who have been treated for some form of
cancer
Interpreting Health Information on the Internet
n
An
increasing number of people are getting information about their health from the
Internet
n
One
study found 50% of 188 breast cancer patients used the internet to find out
more about the disease.
When
surfing the web for medical information:
n
Remember
that there are no rules governing what is published on the Internet.
n
Consider
the source.
n
Get a
second opinion.
n
Examine
references.
n
How
current is the information?
n
Is it
too good to be true?