Ch14_Stress.ppt

Health, Stress, and Coping Stress is ubiquitous “Reality is the leading cause of stress among those in touch with it.” Lily Tomlin Health Psychology “A complete state of physical, mental, and social well-being and not merely the absence of disease and infirmity.” Human behaviour is a key factor...

Health, Stress, and Coping Stress is ubiquitous “Reality is the leading cause of stress among those in touch with it.” Lily Tomlin Health Psychology “A complete state of physical, mental, and social well-being and not merely the absence of disease and infirmity.” Human behaviour is a key factor in determining health. The Biopsychosocial Model Global Causes of Death Injuries Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies 9% 31% Noncommunicable diseases 60% Source: WHO, World Health Report 2000—Health Systems: Improving Performance (Geneva: WHO, 2000). LeadingCauses Causesof ofDeath, Death,1900-1990 1900-1990 Leading Causes of Death Before 65 The nine leading causes of death in the United States are shown in this graph. As you can see, eight of the top nine causes are directly related to behavioral risk factors (infection is the exception). At least 45 percent of all deaths can be traced to unhealthful behavior. The percentage of day-to-day health problems related to unhealthful behavior is even higher. Stress and Health •Getting 7 or 8 hrs of sleep daily •Drinking alcohol in moderation or not at all •Not smoking cigarettes •Exercising regularly •Maintaining a weight near prescribed level •People who practice all 5 live longer than those who practice 0-2 •Demonstrates how important behaviour can be in determining health Stress and Health Psychosocial factors directly affect physical health Health-Related Consequences Stress can have a variety of health-related consequences. The Enteric Nervous System • 100 million neurons • 30 neurotransmitters – 90% of the production and storage of serotonin • Gut-brain crosstalk occurs via – Vagus nerve – Gut microbiota A common condition arising from gut-brain miscommunication is irritable bowel syndrome (IBS), affecting 1 in 9 people globally IBS is more common in patients with pre-existing psychiatric illnesses such as depression or anxiety Symptoms of IBS worsen during times of heightened stress or anxiety Psychogastroenterology Gut-directed hypnotherapy: following hypnotic induction, the patient is guided through suggestive imagery to visualize their gut as a series of tubes with fast-flowing contents, improving symptoms of IBS. Mindfulness meditation: in this practice, based on Buddhist tradition, the patient is guided to bring their awareness to the present moment and accept physical sensations being experienced. This has been shown to improve symptoms of IBS. Cognitive-behavioral therapy (CBT) Standard American Diet (SAD) Standard American Diet (SAD) Some stats…. • New Zealand Smoke-Free 2025!? • https://www.ctvnews.ca/health/new-zealand-impose s-lifetime-ban-on-youth-buying-cigarettes-1.619413 4 • Quitting Smoking by Age 35 Years —A Goal for Reducing Mortality • https://jamanetwork.com/journals/jamanetwork open/fullarticle/2797599 • Cigarette warning labels are about to get even harder to ignore in Canada • https://www.cbc.ca/news/health/canada-cigarette-warning-labels-1.6860301 What is Stress? •Responses to threats and challenges range on a continuum from depression to excitement Typical Relationship Between Performance and Stress Too Little Stress Optimum Stress Excessive Stress Level of Performance High (excellent) Low (poor) Low Amount of Stress High There are two types of stress: Stress: A Focus of Health Psychology Many people report being affected by “stress.”   Some terms psychologists use to talk about stress: Stress refers to the process of appraising and  a stressor is an event or responding to condition which we view as events which we threatening, challenging, or consider overwhelming. threatening or  Examples include poverty, challenging. an explosion, a psychology test, feeling cold, being in a plane, and loud noises.  appraisal refers to deciding whether to view something as a stressor.  stress reaction refers to Stress and Stressors Stress is a slippery concept. At times it is the stimulus (missing an appointment) and at other times it is a response (sweating while taking a test). Stress and Stressors Stress is not merely a stimulus or a response. It is a process by which we appraise and cope with environmental threats and challenges. Bob Daemmrich/ The Image Works When short-lived or taken as a challenge, stressors may have positive effects. However, if stress is threatening or prolonged, it can be harmful. STRESS AS A STIMULUS • Life event scales – stress and illness • Holmes and Rahe (SRRS, 1967) Arbitrary, vague, ambiguous, insensitive to individual differences STRESS AS A STIMULUS COMMON COLLEGE STRESSORS Balancing work, school, and family life Health Class scheduling and credit load Costs of colleges/finances Grades and exams Preparing for post-graduation life Relationships Only 1.6 percent of undergraduates reported that they felt no stress in the last 12 months. e American Institute of Stress, 2019) (National College Health Assessment, 2019) Types of Stress • Chronic stress lasting a month or more boosts the risk of catching a cold Types of Stress Extreme Stress • PTSD may affect some persons whose coping mechanisms are overwhelmed, but not everyone exposed to a certain event will go on to develop PTSD, …just as not everyone will become “traumatized” by virtue merely of having lived through or witnessed violence Risk and Resilience • Resilience – ability to ‘bounce-back’ – It’s not what happens to you but what you make out of what happens to you that makes you resilient • Hardiness – More resistant to stress and its effects – strong Internal locus of control, sense of empowerment, will-power – See changes and problems as an opportunity for growth, not as a threat STRESS AS A RESPONSE • Focus on psychophysiology • Body’s 911 system • Emergency reactions to acute stress • Walter Cannon (1932)- fight-or-flight The Stress Response System Cannon proposed that the stress response (fast) was a fight-or-flight response marked by the outpouring of epinephrine and norepinephrine from the inner adrenal glands, increasing heart and respiration rates, mobilizing sugar and fat, and dulling pain. •SAM and HPA axes –hypothalamus - stress center – dual function: 1.control of ANS –SNS »adrenal medulla (epinephrine/norepinephrine) 2.activation of pituitary gland »adrenal cortex »glucocorticoids (stress hormones: cortisol) Endocrine System • Sympathetic Adrenal Medulla Response Hypothalamus Sympathetic NS Adrenal Medulla Epinephrine & Norepinephrine HR, BP, RR, BS Endocrine System HPA axis Hypothalamus ACTH Adrenal Cortex Glucocorticoids & Mineralcorticoids Protein & Fat Metabolism, BP & Blood volume Inflammatory Response Function of the Stress Response ► Physiologic stress is largely about energy – Handling a threat is metabolically very costly, whether the response is to fight or to flee ► Our stress systems divert energy from longterm processes to the immediate threat • Away from – – – – – digestion reproduction growth repair long-term immune processes (making antibodies for a secondary infection) • Toward – respiration – glucose to burn – increased heart rate to move energy to muscles – short-term immune processes (trafficking white blood cells to the site of infection) The Body’s Stress Response System When encountering a sudden trauma or other stressor, our body acts to increase our resistance to threat and harm. Phase 1: The “fight or flight” sympathetic nervous system responds, reducing pain and increasing the heart rate. The core of the adrenal glands produces norepinephrine and epinephrine (adrenaline). This system, identified by Walter Cannon (18711945), gives us energy to act. Phase 2: The brain sends signals to the outer part of the adrenal glands to produce cortisol and other stress hormones. These focus us on planning adaptive coping strategies and resisting defeat by the stressor. Hans Selye (1907-1982) indentified this extended “resistance” phase of the stress response, followed by: Phase 3: Exhaustion. General Adaptation Syndrome EPA/ Yuri Kochetkov/ Landov According to Selye, a stress response to any kind of stimulation is similar. The stressed individual goes through three phases. General Adaptation Syndrome [GAS] Our stress response system defends, then fatigues. Effects of Prolonged Stress  The General Adaptation Syndrome [GAS] works well for single exposures to stress.  Repeated and prolonged stress, with too much Phase 3 time, leads to various signs of physical deterioration and premature aging:  the production of new neurons declines  neural circuits in the brain break down  DNA telomeres (chromosome tips) shorten,  cells lose ability to divide,  cells die,  tissue stops regenerating,  early aging and death Prenatal Maternal Cortisol and Child Behavior Problems at 6 to 8 years Maternal Report Sample Items • Clings to adults • Fears going to school • Nervous, highstrung, or tense N=181 Davis & Sandman, 2012 Failure To Thrive 7/1/11 Failure To Thrive 7/1/11 Acute stress and women Neuroendocrine Basis • OXYTOCIN (Women > Men) Released during stress. Calms SAM and HPA systems,  cortisol & adrenalin. Counteracts the Fight-or-Flight response. • TESTOSTERONE (Men > Women) Released during stress, associated with aggression. Suppresses effects of Oxytocin. Fuels the F or F response Befriending: Behavioral Examples STUDENT QUESTION: WHAT DO YOU DO WHEN YOU ARE STRESSED? • WOMEN say: They talk to their friends. Share their problems. Talk on the phone. Ask directions when lost. • MEN say: They put their worries behind them. Female and Male Stress Response  In response to a stressor such as the death of a loved one, women may “tend and befriend”: nurture themselves and others, and bond together.  The bonding hormone oxytocin may play a role in this bonding.  Women show behavioral and neurological signs of becoming more empathetic under stress.  Men under stress are more likely to socially withdraw and numb themselves with alcohol.  Men are also more likely to become aggressive under stress.  In either case, men’s behavior and brains show LESS empathy and less tuning in to others under stress. Non-emergency responses? •Psychophysiological models don’t work well for “ordinary stress” –psychological stressors –when there is nothing to fight or flee from (nor tend and befriend) –ancestral residue •Adaptive preparations for dealing with danger often counterproductive in contemporary environments Early Stressors Stress and Illness • Evolution and the fight or flight response • Made great sense 100 000 years ago • Maybe today you just got pwned playing Halo2 FIGHT FLIGH T Non-emergency responses? •Many of the major stressors today trigger full activation of the fight or flight response causing us to become aggressive and over-reactive (road rage) •When activated, the response causes a surge of adrenaline and stress hormones to pump through the body •When in real danger, the fight or flight response is invaluable •But, stress hormones also flow into our bodies for events that cause no real danger What can we do to reduce our stress and turn down the activity of our fight or flight response? • Change the environment we are in • Exercise more – burns off stress hormones – increases our natural endorphins • Relaxation techniques Benson’s relaxation response. The relaxation procedure advocated by Herbert Benson is a simple one that should be practiced daily. Stress & Susceptibility to Disease A psychophysiological illness is any stress-related physical illness such as hypertension and some headaches. Psychoneuroimmunology (PNI) is a developing field in which the health effects of psychological, neural, and endocrine processes on the immune system are studied. Studying the Stress-Illness Relationship  How does stress increase our risk of disease?  This is the subject of a new field of study: psycho-neuroimmunology, the study of how interacting psychological, neural, and endocrine processes affect health.  Psychologists no longer use the term “psychosomatic” because it has come to mean an imagined illness.  We now refer to psychophysiological illness, a real illness caused in part by psychological factors such as the experience of stress. • • • • • • • • • Common Stress Associated Diseases Diminished Immunity Headache Fatigue Weight gain Dyslipidemia Hypertension Heart Disease Psoriasis/Eczema Digestive problems Anxiety Depression Alcoholism Substance abuse Insomnia Irritable bowel syndrome • Fibromyalgia • Decreased sex drive • • • • • • Psychoneuroimmunology B lymphocytes fight bacterial infections, T lymphocytes attack cancer cells and viruses, and microphages ingest foreign substances. During stress, energy is mobilized away from the immune system making it vulnerable. Lennart Nilsson/ Boehringer Ingelhein International GmbH Psychoneuroimmunology •Mind-body link studied by PNI researchers –psychological factors •stress can interfere with function of lymphocytes of immune system via glucocorticoids •immunoincompetence –academic stress compromises immunity •Stress-Illness link not so direct as response models suggest Moderating Variables Personality Types Type A is a term used for competitive, harddriving, impatient, verbally aggressive, and angerprone people. Type B refers to easygoing, relaxed people (Friedman and Rosenman, 1974). Type A personalities are more likely to develop coronary heart disease. Stress and the Heart Personality Types High levels of distress Type A Aggressive Hard Driven Impatient Type B Easy Going Laid-Back Patient Low levels of distress Stress and the Heart Stress that leads to elevated blood pressure may result in coronary heart disease, a clogging of the vessels that nourish the heart muscle. Plaque in coronary artery Artery clogged Type “A” Personality • • • Coined by Dr Friedman and Dr Roseman (cardiologists) in the 1960’s Competitive, overachieving, time pressured, impatient, hostile Hostility is the only component supported by current research – Especially social hostility Psychology and Stress •Type A personality –cynical or antagonistic hostility But it wasn’t discovered by cardiologists after all… • The upholstery guy noticed he was replacing the chairs in the cardiology unity the most • He mentioned it to Dr Friedman, who dismissed him • No one knows who the guy was Psychology and Stress •Not expressing hostility (suppression) makes it worse •Emotional inhibition –suppressors –Pennebaker (1989): •benefits of emotional venting Benefits of Confession & Letting Go • Confession (divulging private thoughts that make you ashamed or depressed) linked to better health • Forgiveness as a strategy to let go of grudges linked to better physical outcomes Psychology and Stress •Negative Affectivity: a pervasive negative mood marked by anxiety, depression, and hostility –Associated with elevated cortisol •Pessimistic Explanatory style has been related to suppressed immunocompetence Pessimism and Heart Disease Pessimistic adult men are twice as likely to develop heart disease over a 10-year period (Kubzansky et al., 2001). Psychology and Stress •Locus of control –External •believing that chance or outside forces beyond one’s control determine one’s fate –Internal •believing that one controls one’s own fate Rethinking the Problem • Three effective cognitive coping methods: 1. Reappraising the situation – Reappraisal: thinking about problem differently 2. Learning from the experience 3. Making social comparisons – Social comparison: compare self to others who are believed to be less fortunate Coping •Problem-focused Problem-focused coping emphasizes managing the stressor –forms of coping deal directly with the stressor to eliminate it –Controllable stressors •Emotion-focused Emotion-focused coping emphasizes managing your response –forms of coping change how we view a situation (our reaction) –Uncontrollable Psychology and Stress •Social support –emotional –tangible –informational –helps to decrease intensity of physical reactions to stress –make person less likely to experience negative emotions Stress factor: Perceived Level of Control Experiment: the left and middle rats  Only the below received shocks. The rat on the middle, left was able to turn off the shocks for subordinat both rats. Which rat had the worst e rat had stress and health problems? increased ulcers.  It is not the level of shock, but the level of control over the shock, which created stress. Learned Helplessness Learned Helplessness Learned Helplessness Experiment by Martin Seligman: Give a dog no chance of escape from repeated shocks. Result: It will give up on trying to escape pain, even when it later has the option to do so. Learned Helplessness vs. Personal Normally, most creatures Control try to escape or end a painful situation. But experience can make us lose hope. Learned Helplessness: Declining to help oneself after repeated attempts to do so have failed. Personal Control: When people are given some choices (not too many), they thrive A More Positive Psychology  Martin Seligman, who earlier kept dogs from escaping his shocks until they developed learned helplessness.  Developed Positive Psychology, the “scientific study of optimal human functioning,” finding ways to help people thrive.  Focus: building strengths, virtue, emotional wellbeing, resilience, optimism, sense of meaning. Compensatory Control Theory (CCT) • Compensatory Control Theory (CCT) suggests that religious belief systems provide an external source of control that can substitute a perceived lack of personal control. • In a seminal paper, it was experimentally demonstrated that a threat to personal control increases endorsement of the existence of a controlling God • The modified Snowy Pictures Task. There is an image in items 1, 3, 4, 5, 6, 10, 11, • The other items (2, 7, 8, 9, 12) were manipulated using digital media software so that no traces of the original picture remain. Religious Attendance and Life Expectancy Possible Reasons for Correlation Between Religious Involvement and Health Pet Support •Pets as stress moderators •in one study, a pet’s presence during a stressful task significantly lowered the stress reaction, measured in terms of pulse rate, compared to when a friend was present or to a control condition in which neither a friend nor a pet was present (Allen et al., 1991) Pet Support •Companionship of pets repeatedly found to be an effective form of social support •Ownership of a dog, in particular, is an excellent predictor of frequency of visits to the doctor in the elderly Summary of Stress You may not be able to smooth out the surf, but you can learn to ride the waves!