Stress, health and coping

Created by

Madoodles _

Cards (52)

Health
“a complete state of physical, mental and social wellbeing and not merely the absence of disease or infirmity” - WHO 1948
Health psychology is about understanding psychological influences on:
how people stay healthy
why they become ill
Health promotion: how to get people to develop good health habits
Interventions to change health behaviours
Minimise effects of factors such as stress
medical advances
vaccinations and medication improvements
Social changes
Sanitation etc improved
Different aetiologies
medical model of illness
Traditionally
seen as a physical condition only, could be diagnosed and treated by a medic
Illness explained by somatic dysfunction
Diagnosis and treatment
Health improvements by advances in medical science,
However:
Reductionist: reduces illness to cellular and/or chemical malfunction
ignores any contribution from the mind
Mind-body dualism
suggesting the mind and body are 2 separate entities
Can’t always explain individual differences:
Why some people get ill and others don’t
Why treatment works for some and not others
Biopsychosocial model
Interaction of factors are determinants of health
Biological (physical somatic malfunction)
Psychological (e.g. personality, emotions, stress, coping)
Social (e.g. social support, life events, social economic status, education)
Individual differences in these result in variations in health and illness
Between individuals
In different populations within society
Changes in social circumstances & lifestyles to make the population healthier.
What is stress
Physical and emotional response to a stressor:
an external event that is perceived as threatening and potentially damaging
negative event/something new and challenging/life changes
Fight or flight response (Cannon, 1932):
organism perceives threat,
physiological arousal occurs
Organism is motivated to attack or to flee
This response is what we call stress
What are the most stressful life experiences? (social readjustment rating scale- Holmes & Rahe 1967)
Death of a spouse (or child): 100
Divorce: 73
Marital separation: 65
Imprisonment: 63
Death of a close family member: 63
Personal injury or illness: 53
Marriage: 50
Dismissal from work: 47
Marital reconciliation: 45
Retirement: 45
Health inequality“the circumstances in which people live & work are intimately related to risk of illness and length of life” (Marmot, 2004, page 14).
People living in different socio-economic environments face very different risks of ill health and death.
Genes, healthcare & lifestyle important, but
Social hierarchy defines differences in health status
Social determinants of health
Health gradient
Health Gradient–Health gradient
could change to income or education level and there would be a similar effect
Social hierarchy defines Social determinants of health status
Stress
Health behaviors/habits
smoking/drugs/alcohol
poor nutrition
disturbed sleep
treatment/illness behvaiors
Direct physiological effects
elevated lipids and blood pressure
decreased immunity
increased hormonal activity
brain funciton
symptoms of stress
all features of flight or fight too
Heart pounding, muscles tightening, blood pressure rises, may feel sick, butterflies, sticky palms, etc
Fear, anxiety, worry, fatigue, quick to anger, depressed etc
Production of catecholamines leads to
blood clot formation
increased blood pressure and heart rate
irregular heartbeat
fat deposits
plaque formation
immunosuppression
CHD, kidney disease ...
HPA produces cortisol which has an effect on
serotonin
dopamine
memory (as it involves the hippocampus)
Cortisol
decreased immune function
damage to hippocampus
infection, psychiatric problems, loss in memory and concentration
links to CFS and FBS
speculation about long-covid
Coronary heart disease (CHD) & hypertension
CHD leading cause of death and ill-health worldwide
Multiple risk factors, many behavioural
Stress accounts for about a third of the risk
Lower SES groups, poverty, poor job security etc
Work, demanding but little control; high effort low reward
Prolonged cortisol release leads to wear & tear in cardiovascular system
Atherosclerosis (hardening of the arteries)
Examples of conditions linked to chronic stress
Chronic pain: tension
Obesity: Excess cortisol - fatty deposits around midsection
Diabetes: Stress raises glucose levels
Depression/anxiety: by as much as 80%.
Gastrointestinal disorders: diet changes. Cortisol
Accelerated aging: effect on telomeres, a structure at the end of each chromosome that protects against deterioration. Stress shortens telomeres = less protection.
Alzheimer’s disease: brain lesions accelerate the progression of Alzheimer’s disease
Inflammatory conditions/CFS/FMS: overproduction of cortisol over time a possibility
Individual difference in Stress Reactivity
Genetically based predisposition to respond physiologically to environmental threats & challenges
Individuals differ in reactivity & susceptibility to stress related illness
Keys (1971) Baseline blood pressure in response to cold pressor test
Keys (1971) Baseline blood pressure in response to cold pressor test
if you put your hand in cold water after a while it starts to hurt
measure stress by how long people can keep their hands in the cold water
look at how blood pressure and heart rate changes
reactivity predicted heart disease at 23 year follow up
measured natural level when they were students
found that stress reactivity could predict which students developed heart disease 23 years later
stress appraisals
Primary - is this stressful
Secondary - are my personal resources sufficient?
stress responses occurs if the perceived demand of threatening situation tax or exceeds perceived resources of the person
Intereaction: differing impact depending on the individual, event characteristics and situation
Attempt to manage demands which we think tax or exceed personal resources (Lazarus & Folkman, 1984*)*
sometimes we have more capability to deal with it then we realise
so we use a coping strategy to cop instead
Coping strategies are situation specific:
Strategy modified according to situation, and perception of it
And also person specific
tendency to cope in a given way
Learned
Personality
Goals of coping
Reduce stressful conditions & maximise chance of recovery
Adjust to, or learn to tolerate negative events
Maintain positive self-image
Continue satisfying relationships with others
Problem focused coping: Attempt to take direct action, do something constructive to:
Reduce demands of the stressor
Increase resources available to manage it
e.g too much work at your job
Setting a timed schedule for a busy day
Getting career guidance
Seeking help from the boss
Emotion focused coping: attempt to manage the negative emotions evoked by the event
e.g too much work at your job
Distraction
Positive thinking
Drinking alcohol
could be detrimental
If EF only, or dominant, method
Anxiety; Self-blame; Rumination
Tendency to EFC associated with
Low levels of optimism, hardiness, low internal locus of control
However, EFC can be effective
But, on the positive side, if used as precursor to Problem focused coping, EFC becomes functional
–Helps us to control emotions & rally mental & physical resources to change the situation
–Management of emotions (EFC) may be necessary before active problem solving can occur (e.g. Lazarus & Folkman, 1984)
Coping with chronic asthma
Problem focussed approach
Accept have asthma & need medication
Find out information
Take their meds
Good outcomes
Emotion focussed approach
Denial of diagnosis and asthma identity
denial maintains positive self-concept
Less likely to stick to treatment problems
Poor outcomes
Folkman et al (1986) goodness-of-fit hypothesis
effects of problem vs. emotion-focused coping moderated by the appraised controllability of the stressor
E.g. low-control situation
attempt to manage actively (problem-focused coping) = frustration & little effect
emotion-focused coping = adaptive because of need to deal with feelings generated by low-control stressors
Health not always amenable to direct action, just has to be tolerated
Goodness-of-fit (control and coping
Forsythe and Compas (1987) health events perceived as uncontrollable
emotion-focused – low levels of symptom
problem-focused - high levels of symptoms
Felton and Revenson (1984) patients suffering from illnesses perceived to have little potential for control—rheumatoid arthritis and cancer:
information seeking (a problem-focused strategy) associated with better adjustment,
Wishful thinking (an emotion-focused strategy) negative association with adjustment
Terry & Hynes (1998) low-control stressor—women's adjustment to failed IVF
Escapism (Hoped a miracle would happen)
Problem-appraisal (try to see upside/make best of situation)
Problem management (consider alternatives, set goals, get information)
Emotional approach (talk about feelings)
Measured adjustment to stressor over 3 time points
escapist & problem-management - poor adjustment
problem-appraisal - better adjustment
emotional approach coping – positive association with adjustment
A form of emotion focused coping
Clarifying, focussing on & working through emotions associated with stressor Emotion based, but focus on change or progress (proactive)
Improves adjustment to chronic conditions
Useful when low control
Effective?
Taylor & Stanton (2007) on reading list
Benefits of emotional approach coping
Particularly beneficial for women
Emotional approach & problem focused predicts wellbeing (e.g. Park & Adler, 2003; Creswell et al, 2007; Low et al, 2006)
Why is emotional approach coping effective?
May moderate stress response
Affirm positive aspects of self-identity
Emotion focussed coping takes 2 forms:
Distressed/avoidant (poor health outcome)
self-blame, wishful thinking, avoidance, negative focus
Emotional approach coping (positive health outcomes)
support seeking, positive thinking, reinterpretation
Express emotions & use them constructively
Individual differences:
Why do people experience stressors differently-
There is a complex interaction between biological, psychological and social factors.
Personality factors:
`There are 2 types of personality profiles-
Type A-
Competitive
Achievement orientated
Time urgency(hurry sickness)
anger/hostility
Type B-
Non competitive
Low achievement orientation
Low time urgency
Low anger/hostility
Laid back and easy going
Friedman and rosenman(1959),
saw that some chairs in waiting rooms had more wear on them because cardiac patients were ‘on the edge of their seats’,
from this they developed the idea of the personality types(A/B)
Rosenman et al(1976)(prospective study 1960-69)
3454 participants, healthy males aged 39-59 years
Gave them questionnaires to assess type A personalities as well as medical exams
Approximately half of the sample classified as a type A after the tests
8.5 years later there was a follow up-
71% of the type A participants had some kind of heart disease
257 participants had had a full heart attack, and of that 257 175 were type A
cardiac stress management program(CSMP) by Suinn (1980) to try and modify the behavior of type to reduce the risk of heart disease. :
`An intervention of 3 sessions of anxiety management training(AMT) and 2 sessions of visuomotor behavioral rehearsal(VMBR) were given to the experimental group
the control group given normal treatment
All patients received a exercise rehabilitation programme as well as cardiac stress tests, dietary assistance and smoking management.
The experimental group who received the type A interventions had fewer repeat episodes of heart attacks.
However there is a toxic component of type A:
Hostility:
Cynical hostility-
Suspiciousness
Resentment
frequent anger
antagonism, distrust of others/see others as threatening
inappropriate expressions of aggression
anger/frustration
This cynical hostility can be turned against the self.
Who tends to be hostile-
Hostility is higher in men than in women
There is a genetic component(MAOA gene)
Hostility is higher in lower SES(social economic status) individuals
Often develops from early childhood/comes from parenting
Seems from low self esteem/insecurity with the self
Hostile people often experience high levels of stress, their primary method of appraising stressful situations is as a threat, making them respond with hostility.
This constant high stress leads to-
Poor mental health
Compromised immune system
Substance abuse
Managing stress: