PowerPoint  Lecture Notes Presentation Chapter 7 Stress and Health Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson Psychological Factors Affecting Medical Conditions  DSM-IV-TR Criteria » A medical illness is present. » Psychological factors have influenced the course of the condition, interfered with treatment, increased health risks, or exacerbated symptoms. Copyright 2009 John Wiley & Sons, NY 2 Stress and Health  Behavioral medicine » Interdisciplinary approach involving medicine and behavioral science » Goals – To understand, prevent, and treat illnesses influenced by psychological factors  Health psychology » Branch of psychology concerned with role of psychological factors in health and illness – Includes:   Stress and stress management Prevention of disease Copyright 2009 John Wiley & Sons, NY 3 What is stress? Selye’s General Adaptation Syndrome Stress as a response  Problem with response-focused definitions: » Based on physiological and psychological responses » Similar responses can occur to non-stressful stimuli – e.g., pleasurable events Copyright 2009 John Wiley & Sons, NY 4 What is Stress?   Stress as a stimulus Stressors include: » Boredom, catastrophic life events, daily hassles, and sleep deprivation  Problem with stimulus-focused definitions » Based on nature of stimuli rather than response » Differences as to what constitutes a stressor – Major vs. daily hassles – Acute vs. chronic events Copyright 2009 John Wiley & Sons, NY 5 Definition of Stress  Subjective experience of distress in response to perceived environmental problems (Lazarus, 1966) » Whether event is stressful depends upon an individual’s perception or appraisal – Emphasis on how we perceive or appraise the environment Copyright 2009 John Wiley & Sons, NY 6 Coping and Health  Coping » Attempts to deal with problems and negative emotions elicited by stressors  Two dimensions » Problem-focused coping – Taking action to solve problem » Emotion-focused coping – Making efforts to reduce negative emotional reaction  Avoidance coping » Avoid acknowledging problem » Neglecting to do anything to solve it Copyright 2009 John Wiley & Sons, NY 7 Coping and Health  Effective coping varies by situation » Distraction may be adaptive in some situations (chronic pain) and maladaptive in others (financial problems)  Positive emotions » Smiling, laughing, seeing the humor in things, finding ‘the silver lining’ » Can buffer or blunt the effect of stress Copyright 2009 John Wiley & Sons, NY 8 Assessment of Daily Experiences (ADE)   Measures the relationship between stress & health Less reliance on retrospective reports than other measures » Responses collected at the end of each day  Results: » Increases in undesirable events and decreases in desirable events precede onset of respiratory illness (Stone et al., 1987) Copyright 2009 John Wiley & Sons, NY 9 Figure 7.2 Mean Number of Desirable Events Preceding Illness Copyright 2009 John Wiley & Sons, NY 10 Figure 7.3 Mean Number of Undesirable Events Preceding Illness Copyright 2009 John Wiley & Sons, NY 11 Coping Orientations to Problems Experience (COPE) Scale Measures the types of coping used to handle recent stressors  Coping methods of women with breast cancer (Carver et al., 1993)  » Humor linked to less distress » Avoidant coping linked to more distress Copyright 2009 John Wiley & Sons, NY 12 Table 7.1 Scales and Sample Items from the COPE Copyright 2009 John Wiley & Sons, NY 13 Social Support and Health  Types of social support » Structural – Networks of social relationships  Number of friends, marital status, etc » Functional – Quality of social relationships  Friends, family supportive and there when needed Copyright 2009 John Wiley & Sons, NY 14 Figure 7.4 Stress and Social Support Copyright 2009 John Wiley & Sons, NY 15 Theories of Stress-Illness Link  Most involve psychological and biological factors » Diathesis-stress models – Individual vulnerability to stress   Much research limited by self-report data Stress-illness link mediated by: » Changes in health related behaviors – e.g., smoking, substance abuse, lack of exercise » Changes in physiology – e.g., cardiovascular reactivity, reduced immune system functioning Copyright 2009 John Wiley & Sons, NY 16 Biologically Based Theories  Allostatic Load » Damage caused by prolonged exposure to stress hormones (e.g., cortisol) – Impaired immune system functioning – Increased susceptibility to disease   Higher allostatic load effects predicted greater risk for cardiovascular disease 2 years later (Seeman et al., 1997). Stress and the immune system » Psychoneuroimmunology – Study of how psychological factors impact immune system Copyright 2009 John Wiley & Sons, NY 17 Figure 7.5 Immune System Components Copyright 2009 John Wiley & Sons, NY 18 Stress and the Immune System  Natural immunity » Consists of macrophages and natural killer cells which stimulates release of cytokines – Cytokines     Key elements in the immune system Trigger fatigue, fever and HPA axis activation to fight infection Excessively high levels linked to diseases in older adults Specific immunity » Lymphocytes – Respond more slowly – T-helper and B cells. Copyright 2009 John Wiley & Sons, NY 19 Stress and the Immune System  Prenatal stress can impact offspring behavior and immune system functioning (Coe & Lubach, 2005) » Rhesus monkey infants, whose mothers were exposed to loud and unpredictable noise during pregnancy, showed emotion regulation difficulties. – Also exhibited immune system disturbances  Stress can trigger the release of cytokines such as interleukin-1 and interleukin-6, as if the body were fighting off an infection (Maier & Watkins, 1998). » Inflammation and higher levels of IL-6 linked to coronary heart disease, arthritis, multiple myeloma, non-Hodgkin’s lymphoma, osteoporosis, and type 2 diabetes Copyright 2009 John Wiley & Sons, NY 20 Psychological Theories  Psychodynamic » Anger-in theory (Alexander, 1950) – Unexpressed hostility → negative emotions which impact health  Cognitive » Appraisal of stressor is key – Appraising life events and experiences as exceeding one’s resources may be at risk for adverse health effects  Personality » Link between chronic negative emotion and cardiovascular disease » Negative emotions also linked to reduced immune system functioning – Slowed antibody production following a flu vaccine (Rosenkranz et al., 2003) Copyright 2009 John Wiley & Sons, NY 21 Cardiovascular Disorders Diseases involving heart and blood circulation system  Two cardiovascular disorders affected by stress:  » Essential hypertension » Coronary heart disease Copyright 2009 John Wiley & Sons, NY 22 Essential Hypertension  High blood pressure » Increases risk for: – Heart attack, stroke, atherosclerosis (clogged arteries)  Essential hypertension » No evident biological cause » 90% of all hypertension is essential  Hypertension are found in about 20 percent of the US adult population » 2x as frequent in African-Americans as in whites Copyright 2009 John Wiley & Sons, NY 23 Essential Hypertension  Systolic pressure » Arterial pressure when the ventricles contract and the heart is pumping  Diastolic pressure » Arterial pressure when the ventricles relax and the heart is resting  Normal levels » 120 systolic » 80 diastolic  High levels » 140 or higher systolic » 90 or higher diastolic Copyright 2009 John Wiley & Sons, NY 24 Etiology: Role of Psychological Stress   Real-world events (e.g., stressful interviews, natural disasters, job stress) can increase BP Stressful lab tasks trigger BP increases » Negative mood induction, cold pressor test, giving a speech, mental arithmetic, etc.   Unethical to test whether short term lab induced BP increases lead to prolonged hypertension Ambulatory BP monitoring studies: » Both positive and negative emotions linked to increases in BP » Paramedics high in anger and defensiveness had higher BP during stressful calls. Copyright 2009 John Wiley & Sons, NY 25 Etiology: Role of Anger  Anger » Inappropriate and excessive levels – –  Angering easily most problematic, especially for men In women, anger suppression, problematic Type A behavior (Friedman and Rosenman) » Three components 1. Achievement striving/competitiveness 2. Urgency/impatience 3. Hostility Copyright 2009 John Wiley & Sons, NY 26 Etiology: Role of Anger  CARDIA study » Urgency/impatience increased risk of developing hypertension – Especially for men » Hostility increased risk for both genders » Achievement striving/competitiveness – Predictor only for white men Copyright 2009 John Wiley & Sons, NY 27 Biological Risk Factors for Essential Hypertension  Cardiovascular reactivity » Extent to which BP and HR increase in response to stress » Predicts later development of high blood pressure and increased risk of hypertension » Influenced by heredity – Genes linked to the neurotransmitter serotonin  Especially one or two long alleles in the promoter region of the serotonin transporter gene Copyright 2009 John Wiley & Sons, NY 28 Coronary Heart Disease  Two forms » Angina pectoris – Intermittent chest pain caused by insufficient oxygen to heart (ischemia) – Silent ischemia  Insufficient oxygen without pain – Triggered by physical exertion or stress » Myocardial infarction (heart attack) – Also caused by insufficient oxygen to heart  Total blockage of coronary artery – Often results in permanent heart damage Copyright 2009 John Wiley & Sons, NY 29 Table 7.2 Risk Factors for Coronary Heart Disease (CHD) Age  Cigarette smoking  Diabetes  Elevated BP or serum cholesterol  Alcohol  Obesity  Lack of exercise  Sex (men more likely to have CHD)  Copyright 2009 John Wiley & Sons, NY 30 Etiology: Stress and Mycardial Infarction  Acute » Physical exertion and episodes of anger » Acute stress such as physical attack  Chronic » Marital conflict » Financial worries » Job strain – Excessive work load, lack of control over decision making, no opportunity to fully use one’s skills Copyright 2009 John Wiley & Sons, NY 31 Etiology: Other Psychological Risk Factors  Type A behavior » Predicted CHD in some studies but not all » Best type A predictors: – Anger, hostility, cynicism  Anger and hostility also related to other variables linked to CHD: » » » » » »  Greater blood pressure reactivity to stress Higher levels of cholesterol Abnormal calcium deposits Cigarette smoking and alcohol use Metabolic syndrome among adolescents Greater activation of platelets Anxiety and depression also linked to CHD Copyright 2009 John Wiley & Sons, NY 32 Figure 7.6 Major Structures of the Respiratory System Copyright 2009 John Wiley & Sons, NY 33  Asthma Severe constriction of the airways » Air passages narrow – Wheezing and labored breathing » Rales – Whistling sound on exhalation » Person feels as if they are suffocating  Biological risk factors » » » »  Respiratory infection Allergens Air pollution Exercise Stressful life event and negative emotions » Stress and negative emotion linked to lower peak flow and more reports of asthma symptoms. Copyright 2009 John Wiley & Sons, NY 34 Figure 7.7 Effect of Parenting Problems and Mothers’ Stress on Frequency of Asthma in Children Copyright 2009 John Wiley & Sons, NY 35 AIDS  AIDS » Acquired immunodeficiency syndrome     More than 25 million people worldwide have died of AIDS In 2007, more than 33 million people are HIVpositive Worldwide, women now account for nearly 50 percent of people infected with HIV In US, African American and Hispanic women are 17 times more likely than white women to become infected. Copyright 2009 John Wiley & Sons, NY 36 AIDS  Prevention through behavioral change » Modifying sexual practices – Condom use – Encouraging monogamy or reducing number of sexual partners – Abstinence only programs have not proven effective in decreasing risky behavior or reducing the risk of developing HIV. Copyright 2009 John Wiley & Sons, NY 37 AIDS  Strategies for effective prevention » Accurate information about HIV transmission » Explain risk factors (e.g., sharing needles) » Identify cues to high-risk situations (e.g., alcohol use) » Provide instruction in condom use » Teach sexual assertiveness skills – How to resist pressure to have sex » Community efforts to make safer sex the norm Copyright 2009 John Wiley & Sons, NY 38 Gender and Health   Women live longer than men Women in poorer health than men » Higher rates of diabetes, lupus, arthritis, anemia » Formerly believed that estrogen protected women from cardiac disease – Hormone replacement studies fail to find reduced risk  Women less likely to exhibit Type A Behavior » Not necessarily less likely to experience anger » More likely to suppress Copyright 2009 John Wiley & Sons, NY 39 Gender and Health  Gender differences in mortality decreasing. May be due to: » Increasingly similar lifestyles – More women smoke and drink   Lung cancer leading cause of cancer death since 1987 In 2004, only one state earned a passing grade in efforts to curb smoking in women » Differences in disease identification and treatment – Little public awareness that cardiovascular disease is the main cause of death in women – Stress test not a good predictor of heart disease risk in women, especially when no pain is present – Women less likely to receive referral for cardiac rehab following heart attack. Copyright 2009 John Wiley & Sons, NY 40 Socioeconomic Status, Ethnicity, and Health   Low SES linked to higher rates of health problems and mortality from all causes Differences attributed to: » Greater stress associated with SES » Environmental constraints – Less access to healthy foods – More liquor stores – Less opportunity to exercise » Limited access to health services » Stress associated with discrimination and prejudice Copyright 2009 John Wiley & Sons, NY 41 Socioeconomic Status, Ethnicity, and Health  Mortality rate in US for African Americans 2x as high as for whites » Some risk factors more common in people of color (e.g., smoking, obesity, hypertension) » Both ethnicity and SES important: – Lower family and neighborhood SES associated with greater cardiovascular reactivity for African American children and adolescents, but only lower family SES was associated with greater cardiovascular reactivity among white children and adolescents (Gump et al., 1999) Copyright 2009 John Wiley & Sons, NY 42 Stress Management  Techniques anyone can use to cope with stress » Relaxation training – Muscle relaxation – Deep breathing » Cognitive restructuring – Modify maladaptive thoughts – Enhance perception of control » Behavioral-skills training – Time management, prioritizing, assertiveness » Environmental-change – Workplace alterations, increase social support Copyright 2009 John Wiley & Sons, NY 43 COPYRIGHT Copyright 2009 by John Wiley & Sons, New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. Copyright 2009 John Wiley & Sons, NY 44