Health Psychology 150 Study Guide Final Wednesday, December 12th, 8:00-11:00a.m.

Chapter 6 Stress and Coping

Stress is a negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects. Stressors- stressful events. In the United States, for example, people report money, the economy, work, family health problems, and family responsibilities as their top five stressors. Stress is the consequence of a persons appraisal processes: the assessment of whether personal resources are sufficient to meet the demands of the environment. Stress, then, is determined by personenvironment fit. Walter Cannons (1932) description of the fight-orflight response. Cannon proposed that when an organism perceives a threat the body is rapidly aroused and motivated via the sympathetic nervous system and the endocrine system. This concerted physiological response mobilizes the organism to attack the threat or to flee; hence, it is called the fight-or-flight response. Selye (1956) developed his concept of the general adaptation syndrome. He argued that when an organism confronts a stressor it mobilizes itself for action. The response itself is nonspecific with respect to the stressor; that is, regardless of the cause of the threat, the individual will respond with the same physiological pattern of reactions. The general adaptation syndrome consists of three phases. 1. In the first phase, alarm, the organism becomes mobilized to meet the threat. 2. In the second phase, resistance, the organism makes efforts to cope with the threat, as through confrontation. 3. The third phase, exhaustion, occurs if the organism fails to overcome the threat and depletes its physiological resources in the process of trying. Tend-and-befriend. The theory maintains that, in addition to fight or flight, humans respond to stress with social affiliation and nurturing behavior toward off spring. These responses may be especially true of women. When individuals confront a new or changing environment they engage in a process of primary appraisal to determine the meaning of the event. Can be positive neutral negative

1. Harm- The assessment of the damage that has already been done by an event 2. Threat-the assessment of possible future damager that may be brought about by the event. 3. Challenge-the potential to overcome and even profit from the event. The importance of primary appraisal in the experience of stress is illustrated in a classic study of stress by J. Speisman and colleagues (Speisman, Lazarus, Mordkoff , & Davidson, 1964). College students viewed a gruesome film depicting unpleasant tribal initiation rites that included genital mutilation. Before viewing the film, they were exposed to one of four experimental conditions. Result: Stress not only was intrinsic to the gruesome film itself but also depended on the viewers appraisal of it. At the same time that primary appraisals of stressful circumstances are occurring, secondary appraisal is initiated. Secondary appraisal is the assessment of ones coping abilities and resources: whether they will be sufficient to meet the harm, threat, and challenge of the event. Ultimately, the subjective experience of stress is a balance between primary and secondary appraisals. The physiology of stress: Two interrelated systems are heavily involved in the stress response. They are the sympathetic-adrenomedullary (SAM) Sympathetic arousal stimulates the medulla of the adrenal glands, which, in turn, secrete the catecholamines epinephrine (EP) and norepinephrine (NE). Sympathetic arousal leads to increased blood pressure, increased heart rate, increased sweating, and constriction The hypothalamic-pituitaryadrenocortical (HPA) axis. The hypothalamus releases corticotrophin-releasing hormone (CRH), which stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which, in turn, stimulates the adrenal cortex to release glucocorticoids. significant. It acts to conserve stores of carbohydrates and helps reduce inflammation in the case of an injury. It also helps the body return to its steady state following stress. In addition, HPA activation produces elevations in growth hormone and prolactin, secreted by the pituitary gland. People vary in their reactivity to stress. Reactivity is the degree of change that occurs in autonomic, neuroendocrine, and/or immune responses as a result of stress. Allostatic load(McEwen & Stellar, 1993). This concept refers to the fact that physiological systems within the body fluctuate to meet demands from stress, a state called allostasis. This buildup of allostatic loadthat is, the longterm costs of chronic or repeated stresscan be assessed by a number of indicators

What makes events stressful? To summarize, then, events that are negative, uncontrollable, ambiguous, or overwhelming or that involve central life goals are perceived as more stressful than are events that are positive, controllable, clear-cut, or manageable or that involve peripheral life tasks. Can People adapt to Stress? If a stressful event becomes a permanent or chronic part of their environment, will people eventually habituate to it, or will they develop chronic strain? People (and animals) show signs of long-term strain but also long-term habituation to chronically stressful events. Most people can adapt moderately well to mildly stressful events; however, it may be difficult or impossible for them to adapt to highly stressful events, and already-stressed people (children, the elderly, and the poor) may be unable to adapt to even moderate stressors. Moreover, even when psychological adaptation may have occurred, physiological changes in response to stress may persist. Physiological Adaption Low-level stress may produce habituation in most people, but with more intense stress, damage from chronic stress can accumulate across multiple organ systems, as the allostatic load model suggests. Habituation is more likely for HPA responses to stress than for sympathetic responses to stress. But chronic stress can also impair cardiovascular, neuroendocrine, and immune system recovery from stressors and, through such effects, contribute to an increased risk for diseases such as cardiovascular disorders. Must a stressor be ongoing to be stressful? NO. Unlike lower animals, human beings do not have to be exposed to a stressor to suffer stress. For example, The anticipation of a stressor can be as stressful as its actual occurrence, and sometimes more so. After effects of stress Adverse aftereffects of stress, such as decreases in performance and attention span, often persist long after the stressful event itself is no longer present. Stressors can produce deleterious aftereff ects on social behavior as well as on cognitive tasks. For example, when people are exposed to avoidable stress, such as noise or crowding, they are less likely to help someone in distress when the stressor is over. Post-Traumatic Stress Disorder The term post-traumatic stress disorder (PTSD) has been developed to explain these effects. The person suffering from PTSD has typically undergone a stressor of extreme magnitude (Lamprecht & Sack, 2002). One response to this stressful event is a psychic numbing that may include reduced interest in once-enjoyable activities, detachment from friends, or constriction in emotions. In addition, the person often

relives aspects of the trauma, as the Iraq War veteran did. Other symptoms include excessive vigilance; sleep disturbances, feelings of guilt, impaired memory or concentration, avoidance of the experience, an exaggerated startle response to loud noise (and even suicidal behavior. PTSD can produce temporary and permanent changes in stress regulatory systems as well. People with PTSD may experience permanent changes in the brain involving the amygdala and the hypothalamic-pituitary adrenal (HPA) axis. Those suffering from PTSD show substantial variability in cortisol patterns as well as higher levels of norepinephrine, epinephrine, and testosterone. Women are more likely than men to experience such longterm reactions. PTSD predicts poor health, especially cardiovascular and lung disorders, and early mortality, especially from heart disease. It also is tied to poor habits such as problem drinking, and worsening symptoms of existing disorders. Nearly half of adults in the United States experience At least one traumatic event in their lifetime, but only 10% of women and 5% of men develop PTSD. Who is most likely to develop PTSD? Poor cognitive skills, catastrophic thinking about stress, a preexisting emotional disorder or vulnerability, use of avoidant coping, low levels of social support, a history of chronic stress, preexisting heightened reactivity to trauma-related stimuli and general negativity all predict who will develop PTSD in the wake of a traumatic stressor How to treat PTSD The goals of repeated exposure involve isolating the trauma as a discrete event, habituating to it and reducing overwhelming distress, providing new interpretive information about the event and its implications, and reducing anxiety and building a sense of mastery (Harvey et al., 2003). Once habituation is achieved, cognitive restructuring is added to integrate the trauma into the clients self-view and worldview, and anxiety management training is often included so that the patient can recognize and deal with intrusive traumatic memories. Acute stress paradigm-This paradigm involves bringing people into the laboratory and eposing them to short term stressful events and then observe the impact of that stress on their physiological, neuroendocrine, psychological responses. The paradigm finds that when people perform stressful tasks (such as counting backwards quickly by 7s or delivering an impromptu speech to an unresponsive audience) they show both psychological distress and strong indication of sympathetic activity and neuroendocrine responses.

Chapter 7 Stress and Coping

People with many resources, such as money or social support, may find a stressful experience to be less so. Others, without resources or coping skills, may cope very poorly. We term these factors stress moderators because they modify how stress is experienced and the effects it has. Moderators of the stress experience may have an impact on stress itself, on the relation between stress and psychological responses, on the relation between stress and illness, and on the degree to which a stressful experience intrudes into other aspects of life. Coping is therefore defined as the thoughts and behaviors used to manage the internal and external demands of situations that are appraised as stressful. Coping has several characteristics: 1. First the relationship between coping and a stressful event is dynamic process. Thus coping is not a one-time action that someone takes but rather a set of responses, occurring over time, by which the environment and the person influence each other. 2. A second important aspect of the definition of coping is its breadth. The definition clearly encompasses a great many actions and reactions to stressful circumstances. According to this definition, then, emotional reactions, including anger or depression, are part of the coping process, as are actions that are voluntarily undertaken to confront the event. In turn, coping efforts are moderated by the resources available to the individual. Research has especially focused on negative affectivity a pervasive negative mood marked by anxiety, depression, and hostility. Psychological control is the belief that one can determine ones own behavior, influence ones environment, and bring about desired outcomes. Control-enhancing interventions that make use of information, relaxation, and cognitive-behavioral techniques, such as learning to think differently about the unpleasant sensations of a procedure, are all successful in reducing

Chapter 8 The patient in the Medical Care System Chapter 9 Interactions with Health Care Providers Chapter 10 The experience and Management of Pain

Chapter 11 Coping with Chronic Illness Chapter 12 Advancing and Terminal Illness Chapter 13 pg 312-326 Psychological Aspects of Specific Illneses Chapter 14 344-352, 363-372 Psychological Aspects of Specific Illneses