Stress, Illness, and Coping - Lecture Notes

Stress, illness and coping 3/11/2024 Dr. Abdalla Content What is stress Three Views of Stress 1. Stress as a stimulus 2. Stress as a response 3. Stress as an interaction Major sources of Stress Factors Affecting Stress Appraisal 3/11/2024 Dr. Abdalla What is Stress https://www.youtube.com/watch?v=Nr...

Stress, illness and coping 3/11/2024 Dr. Abdalla Content What is stress Three Views of Stress 1. Stress as a stimulus 2. Stress as a response 3. Stress as an interaction Major sources of Stress Factors Affecting Stress Appraisal 3/11/2024 Dr. Abdalla What is Stress https://www.youtube.com/watch?v=Nrt_amb 8_y0 Stress is mental and physical condition that occurs when a person must adjust or adapt to the environment. Major stressors vs. routine hassles Major: Cumulative nature of stress. Hassles: Cognitive appraisals. 3/11/2024 Dr. Abdalla Three Views of Stress 1. Stress as a stimulus (stressors): focus on the environment. 2. Stress as a response (distress): reaction to stress. 3. Stress as an interaction: relationship between person and the environment. 3/11/2024 Dr. Abdalla Stressors (as stimulus) Examples: War Overcrowding Deadlines Dense traffic Marital conflict, and Work stress. 3/11/2024 Dr. Abdalla Acute vs. Chronic Stress Acute stress Sudden, typically short-lived, threatening event (e.g., robbery, giving a speech). Chronic stress Ongoing environmental demand (e.g., marital conflict, work stress, personality). https://www.youtube.com/watch?v=vLV4WsKl YhA 3/11/2024 Dr. Abdalla Stress as a response Selye’s General Adaptation Syndrome (1956, 1976, 1985) Series of bodily reactions to prolonged stress, occurs in three stages. 1. Stage of Alarm Reaction: Body resources are mobilized to cope with threat (stress). 2. Stage of Resistance: Body adjusts to stress but at a high physical cost; resistance to other stressors is lowered. 3. Stage of Exhaustion: Body’s resources are drained and stress hormones are depleted (exhausted), possibly resulting in psychosomatic disease or complete collapse. 3/11/2024 Dr. Abdalla Stress as a response, Cont. Selye’s General Adaptation Syndrome (1956, 1976, 1985) Perceived Stressor 3/11/2024 Alarm Reaction Fight or flight Resistance Arousal high as body tries defend and adapt. Dr. Abdalla Exhaustion Limited physical resources; resistance to disease collapses; death Figure 10.3: Organ Systems Involved in the GAS 3/11/2024 Dr. Abdalla Psychophyiological model of the stress response 3/11/2024 Dr. Abdalla Stress as a response physiological model of the stress response 3/11/2024 Dr. Abdalla Cognitive Model of Stress Lazarus & Folkman Primary appraisal: Is there a potential threat? Outcome – Is it irrelevant, positive, or stressful? If stressful, evaluate further: Harm-loss – amount of damage already caused. Threat – expectation for future harm. Challenge – opportunity to achieve growth, etc. Secondary appraisal: Do I have the resources to deal effectively with this challenge or stressor?- If not, then distress. 3/11/2024 Dr. Abdalla Cognitive Model of Stress Lazarus & Folkman, Cont. 3/11/2024 Dr. Abdalla Cognitive Model of Stress Lazarus & Folkman Low Resources High Stress High Threat High Resources High Demands High/low demands Low Threat Low Resources Low demands High Stress Low Threat High Resources Low demands Low or no stress 3/11/2024 Dr. Abdalla Moderate Stress Major sources of Stress Frustration: blocked goal Conflict: incompatible motivations – Approach-approach – Approach-avoidance – Avoidance-avoidance Change: having to adapt – Social Readjustment – Life Change Pressure: Perform/conform 3/11/2024 Dr. Abdalla Major sources of Stress https://www.youtube.com/watch?v=ALiCToVg 24g 3/11/2024 Dr. Abdalla Personal Factors Affecting Stress Appraisal Intellectual Motivational Personality Beliefs 3/11/2024 Dr. Abdalla Situational Factors Affecting Stress Appraisals Strong demands Imminent Life transition Timing Ambiguity – role or harm ambiguity Desirability, and Controllability – Behavioral control – perform an action – Cognitive control – using a mental strategy. 3/11/2024 Dr. Abdalla Job Strain – Role of control Demands High High Control Low 3/11/2024 STRAIN Dr. Abdalla Low Job Stress – Other aspects Physical environment Poor interpersonal relationships Perceived inadequate recognition or advancement Unemployment (even anticipated) Role conflict, and High responsibility for others. 3/11/2024 Dr. Abdalla Fig. 15.2. Stress is the product of an interchange between a person and the environment. 3/11/2024 Dr. Abdalla Biopsychosocial Aspect of Stress How stress affects health Via behavior Via physiology See the video: How Stress Affects Your Brain – http://www.youtube.com/watch?v=prG3NI__ Bf4 3/11/2024 Dr. Abdalla Psychophyiological model of the stress response 3/11/2024 Dr. Abdalla Behavioural Aspects Increased alcohol intake Smoking Increased caffeine Poor diet, and Inattention leading to carelessness. 3/11/2024 Dr. Abdalla Physiological Aspects 1. Cardiovascular reactivity – increased blood pressure, platelets, lipids (cholesterol). 2. Endocrine reactivity – increased catecholamines and corticosteroids. 3. Immune reactivity – increased hormones impairs immune function. 3/11/2024 Dr. Abdalla Psychophysiological Disorders Digestive system – e.g., ulcers, irritable bowel syndrome Respiratory system – e.g., asthma Cardiovascular system – e.g., hypertension, lipid disorders (altered levels of blood lipids, e.g. elevated levels of blood cholesterol), heart attack, angina 3/11/2024 Dr. Abdalla Stress-Illness Relationship Illness Preexisting physiological or psychological vulnerability Physiological & psychological wear and tear Illness precursors, symptoms Exposure to stress 3/11/2024 Behavioural changes & Coping efforts Dr. Abdalla Illness behaviour Stress and the Cardiovascular System Repeated exposure to stress linked to cardiovascular problems – Especially for those who display strong physical reactions to stressors. Physical reactions depend partly on one’s personality. 3/11/2024 Dr. Abdalla CHAPTER FOUR Illness Cognitions and Representations  Schezophrenia  https://www.youtube.com/watch?v=hDroA6eawsE Abdullah 3/11/2024 Illness Cognitions and Representations  Illness cognition:  “a patient’s own implicit common sense beliefs about their illness” (Leventhal et al. 1980, 1997)  Knowledge about disease, meaning of illness, beliefs about illness……..  Illness representations / schemas: organized conceptions of illness. Abdullah 3/11/2024 Illness Cognitions and Representations  Acquired through personal experience, family and friends, contacts with health care system, mass media  Provide patients with a framework or schema for  Understanding their illness  Coping with their illness  Telling them what to look out for if they are becoming ill Abdullah 3/11/2024 Illness Representations Five dimensions of illness representations: 1. 2. IDENTITY Label given to the illness and the symptoms experienced Beliefs about associated symptoms Disease prototype PERCEIVED CAUSE OF ILLNESS Biological, psychological, behavioral Cultural influences Internal versus external locus of control Abdullah 3/11/2024 Illness Representations 3. TIME LINE Beliefs about the duration of illness Acute Chronic Cyclic 4. CONSEQUENCES beliefs about the impact of illness on their life (physical, emotional, social consequences) beliefs about treatments that result Abdullah 3/11/2024 Illness Representations 5. CURABILTY & CONTROLLABILITY Abdullah Can the illness be treated? How? Extent to which the outcome is controllable by self or external factors Who can control the outcome of the illness (patients themselves, doctors, fate….) ? 3/11/2024 Self-Regulatory Model of Illness Cognitions  Developed by Leventhal et al. (1980, 1997) to explain how illness cognitions affect coping strategies  Basis for model:  Humans develop problem solving techniques when normal state is altered (i.e. when health turns for the worse)  Motivated to re-establish state of normality and equilibrium  Three processes (interpretation, coping, appraisal) that interrelate in an on-going and dynamic manner Abdullah 3/11/2024 Self-Regulatory Model Representation of health threat - identity - cause - consequences - time line - cure/control Stage 1: Interpretation - symptom perception - social message -> deviation from norm Stage 2:Coping - approach coping - avoidance coping Stage3:Appraisal - Was my coping strategy effective? Emotional response to health threat - fear - anxiety - depression Abdullah 3/11/2024 Stage 1: Interpretation     Initial confrontation with the illness An individual may be aware of illness either from symptom perception or social messages Symptom perception, e.g. I have a pain in my chest Social messages may take the form of doctor’s diagnosis, lab test result, or messages from lay referral system Abdullah 3/11/2024 Stage 1: Interpretation  Individual differences in symptom perception, e.g. attentional differences, neuroticism, mood, expectations, situational factors  Interpretation activates illness representation in attempt to give meaning to the problem Abdullah 3/11/2024 Stage 2: Coping    Consideration and application of different coping strategies Coping with illness as well as emotional reactions to illness Can be broadly categorized into:  Approach coping  E.g. Consulting a doctor, adhering to treatment, rest, lifestyle change, seeking information, seeking support from others  Avoidance coping  E.g. Denial, wishful thinking Abdullah 3/11/2024 Stage 3: Appraisal  Evaluating if the coping efforts are effective  If not effective, reconsider coping strategies Abdullah 3/11/2024 Chronic Illness and The Self-Regulatory Model of Illness Cognitions  The model is useful in understanding and/or predicting:  Emotional reactions to illness  Coping with illness  Adherence with treatment and lifestyle changes  Outcomes of illness Abdullah 3/11/2024 Chronic Illness  Characteristics:  Long in duration  Long-term consequences  Usually involves multiple causes, including health habits  Cannot be fully cured; can only be managed  As many as 50% of population has some chronic condition  Cancer, heart diseases, diabetes, hypertension, arthritis, stroke……… Abdullah 3/11/2024 Challenges  Change in perception of self  Worries concerning the illness and one’s life Abdullah 3/11/2024 Chronic Illness  Emotional reactions to chronic illness Shock and Denial Anxiety Depression Abdullah 3/11/2024 Chronic Illness  Illness as crisis  Unexpected appearance of illness  Unclear and ambiguous information about illness and the course of illness  Need to make quick decisions (on treatment, telling others, taking time off work)  Little experience with illness (limited past history) Abdullah 3/11/2024 Coping Strategies for Chronic Illness  Similar to coping strategies for other stressful events in life except that chronically ill patients use less active coping methods:  Social support and direct problem-solving  “I talked to someone to find our more about the situation”  Distancing  I didn’t let it get to me”  Cognitive escape / avoidance  “I wished that the situation would go away”  Behavioral escape / avoidance  “Avoiding the situation by eating, drinking, sleeping etc” Abdullah 3/11/2024 Chronic Illness and The Self-Regulatory Model of Illness Cognitions  The Self-Regulatory Model has been found to be useful in understanding and/or predicting:  Adherence with treatment and lifestyle changes  Brewer et al. (2002): belief that illness has serious consequences was related to medication adherence, and belief that illness is stable, asymptomatic, and with serious consequences was related to actual cholesterol control among patients with hypercholesterolaemia Abdullah 3/11/2024 Chronic Illness and The Self-Regulatory Model of Illness Cognitions  Outcomes of illness  Johnston et al. (1999): perceived control predicted recovery among stroke patients at one and six months after discharge from hospital  Petrie et al. (1996): Longitudinal study of 143 first-time MI patients aged 65 or below for 12 months following admission to hospital  Belief that the illness had less serious consequences and would last a shorter time (at baseline) predicted return to work at six weeks  Belief that the illness could be controlled or cured predicted attendance at rehabilitation classes Abdullah 3/11/2024 CHAPTER 3 HEALTH BEHAVIORS OUTLINE What is wellness?  What is health behaviors?  Attribution: The patient assigns reasons for his/her health/illness  Inconsistency in health behavior  Psychological patterns and health  Personal control and health  Stages of Change  https://www.youtube.com/watch?v=ZJ1SntT6lg4  DEFINITIONS  What is wellness  Wellness is an active process of becoming aware of and making choices toward a more successful existence  https://www.youtube.com/watch?v=tDzQ dRvLAfM DEFINITIONS, CONT.  Preventative health behavior: “any activity undertaken by a person believing himself to be healthy for the purposes of: increasing health, preventing disease or detecting it at an asymptomatic stage”  (Kasl & Cobb, 1966) DEFINITIONS, CONT. Illness: a condition of pronounced deviation from the normal healthy state How does someone make the decision that s(he) is ill?  Illness is subjective HEALTH BEHAVIORS  We may act to promote health by:    Engaging in wellness activities Getting enough sleep Eating a balanced diet  We may avoid ill health by:    Not smoking Wearing seatbelts and crash helmets Washing our hands and brushing our teeth HEALTH BEHAVIOR  Illnesses are influenced by lifestyle factors such as diet, alcohol intake, smoking, and exercise  If we want to increase our chances of remaining healthy, we may be able to adopt healthy behavior into our lifestyle  This would mean a balanced diet, exercising, drinking in moderation, and not smoking  Do advise people on healthy behaviors?  chiropractor (A person whose job is to treat disease by pressing a person's joints, specially those in the back) HEALTH BEHAVIOR We tend to practice some health habits but not others  Health behavior is not always rational or logical  People are not consistent in their health habits  People often postpone health behaviors   Why? ATTRIBUTION  Some people will attribute their state of health to living a healthy lifestyle  However, is it true that if we lead a healthy lifestyle then we will remain healthy? PSYCHOLOGICAL FACTORS AND HEALTH Predispositions to think, feel, and act in particular ways – personality (Type A Behavior Pattern?) PSYCHOLOGICAL FACTORS AND HEALTH    Highly stressed people may be perceived as being at risk for heart attacks 1950s cardiologists Friedman and Rosenman first described TABP Certain personality characteristics have been associated with risk for heart attacks PSYCHOLOGICAL FACTORS AND HEALTH  Type A Behavior Pattern: Highly competitive Sense of time urgency Achievement striving Impatient with delays Try to do several things at once Chronically aroused *chronic hostility, anger, aggression, basic distrust of others  PSYCHOLOGICAL FACTORS AND HEALTH Hostility     and chronic heart disease 255 medical students filled out a measure of hostility 30 years later their health status was assessed Results: Fivefold increase in CHD incidence among those physicians with the higher hostility scores Number of deaths – 6 times greater among those with the most hostility (Barefoot et al, 1983) PERSONAL CONTROL MODELS People differ in their views about their health  Locus of control – Some people see it as something over which they have a great deal of control and others may be content to leave the control of their health in the hands of health professionals  Personal control is made up of a person’s beliefs about how well he or she can bring about good events or avoid bad events  PERSONAL CONTROL MODELS People with a high level of personal control are more likely to: have a healthy lifestyle  seek and follow a health professional’s advice when ill  PERSONAL CONTROL MODELS  Locus of Control    On one end of the scale, people believe that they are responsible for their own destiny and can control their own behavior and therefore their health (internal locus of control) At the other end of the scale, people believe that their lives are controlled by external events beyond their control, such as powerful others or fate (external locus of control) Which locus of control type would you like to see in your offices? PERSONAL CONTROL MODELS Individuals with higher internal locus of control tend to: Cope better with life’s crises  Have more social support that buffers them against illness  Have a more competent immune system  Report feeling more positive emotion  PERSONAL CONTROL MODELS   Which type of patient (internal or external locus of control) do you expect to see in your office? Does chiropractic care encourage a patient to have an internal or an external locus of control? HEALTH BEHAVIOR People are not consistent in their health habits They make resolutions but fail to keep them, or they postpone attempts at giving up smoking or losing weight  Why?  LOCUS OF CONTROL https://www.youtube.com/watch?v=0mKDhwk4a_ g  Locus of control  https://www.youtube.com/watch?v=Q0guTERGP K0  Locus of Control: Quick Coping Skill for Anxiety  INTRODUCTION  The health belief model (HBM) is a health behavior change and psychological model developed by Irwin Rosenstock in 1966 for studying and promoting the uptake of health services.  Subsequent changes to the model were made in 1988, to accommodate the role that knowledge and perceptions play in personal responsibility. INTRODUCTION, CONT.  The HBM has been adapted to explain and predict: https://www.youtube.com/watch? v=3ZFcYZJ8Os4  COMPONENTS OF THE HEALTH BELIEF MODEL (HBM) of susceptibility to disease (perceived personal vulnerability)  Perception  Perceived severity (seriousness)of disease costs of action  Perceived benefits of action  Perceived cues to action  Perceived PERCEPTION OF SUSCEPTIBILITY VULNERABILITY)  Perceived Susceptibility: (an individual's assessment of their risk of getting the condition) My chances of getting lung cancer  how likely do you think you will have this health issue?  PERCEIVED SEVERITY (SERIOUSNESS)  Perceived Severity: how serious a problem do you believe this health issue is? Refers to an individual's assessment of the seriousness of the condition, and its potential consequences  E.g. lung cancer is serious  PERCEIVED COSTS( NEGATIVE ) OF ACTION  Individual's assessment of the influences that discourage adoption of the promoted behavior  What are the potential negative aspects of doing this recommended behavior? E.g. stopping smoking will make me irritable. PERCEIVED BENEFITS OF ACTION  Perceived Benefits: an individual's assessment of the positive consequences of adopting the behavior.  how well does the recommended behavior reduce the risk(s) associated with this health issue? PERCEIVED CUES TO ACTION  An individual's perception of the levels of susceptibility and seriousness provide the force to act. Benefits (minus barriers) provide the path of action  Cues may be internal (symptoms of breathlessness) or external (information in form of health education leaflets) THE HBM-MEDIATING FACTORS Demographic variables (such as age, gender, ethnicity, occupation)  Socio-psychological variables (such as social economic status, personality, coping strategies)  Health motivation (whether an individual is driven to stick to a given health goal)  Perceived control (a measure of level of selfefficacy)  HEALTH BELIEFS MODEL HEALTH BELIEF MODEL (BECKER, 1974, 1988; JANZ & BECKER, 1984) INDIVIDUAL PERCEPTIONS OF ACTION Perceived Susceptability to Disease “X” MODIFYING FACTORS LIKELIHOOD Demographic variables (age, sex, race, ethnicity, etc.) Perceived benefits of preventive action Sociopsychological variables Perceived barriers to preventive action Perceived Threat of Disease “X” Perceived Seriousness (Severity) of Disease “X” Cues to Action Mass media campaigns Advice from others Reminder postcard from physician/dentist Illness of family member or friend Newspaper or magazine article minus Likelihood of Taking Recommended Preventive Health Action THE REVISED HEALTH BELIEF MODEL Becker Rosenstock (1987) revised the HBM and added self-efficacy to the original factors of the model  Self-Efficacy: one’s “conviction that one can successfully execute the behavior required to produce the outcomes” (Bandura, 1977).  SELF-EFFICACY (BANDURA, 1986, 2004) OUTCOME EXPECTATIONS PHYSICAL SOCIAL SELF-EVALUATIVE SELF-EFFICACY GOALS SOCIOSTRUCTURAL FACTORS FACILITATORS IMPEDIMENTS Adapted from Bandura (2004). Health Education & Behavior, 31, 143-164. BEHAVIOR Concept Definition Perceived Susceptibility Define population(s) at risk, risk levels; personalize risk based on a One's opinion of chances of getting person's features or behavior; a condition heighten perceived susceptibility if too low. Perceived Severity One's opinion of how serious a Specify consequences of the risk and condition and its consequences are the condition One's belief in the efficacy of the Perceived Benefits advised action to reduce risk or seriousness of impact Application Define action to take; how, where, when; clarify the positive effects to be expected. Perceived Barriers One's opinion of the tangible and psychological costs of the advised action Identify and reduce barriers through reassurance, incentives, assistance. Cues to Action Strategies to activate "readiness" Provide how-to information, promote awareness, reminders. Self-Efficacy Confidence in one's ability to take action Provide training, guidance in performing action. Becker Rosenstock (1987) revised the HBM and added self-efficacy to the original factors of the model What is wellness: Wellness/ ‫ صحة‬is an active process of becoming aware of and making choices toward a more successful existence Illness/‫ مرض‬is subjective Highly stressed people may be perceived as being at risk for heart attacks Type A Behavior Pattern: Achievement striving Impatient with delays chronic hostility, anger, aggression, basic distrust of others Sense of time urgency Highly competitive Locus of Control (internal locus of control): people believe that they are responsible for their own destiny and can control their own behavior and therefore their health (external locus of control); people believe that their lives are controlled by external events beyond their control, such as powerful others or fate Five dimensions of illness representations: 1. IDENTITY Label given to the illness and the symptoms experienced Beliefs about associated symptoms Disease prototype 2. PERCEIVED CAUSE OF ILLNESS Biological, psychological, behavioral Cultural influences Internal versus external locus of control 3. TIME LINE Beliefs about the duration of illness 1. Acute 2. Chronic 3. Cyclic 4. CONSEQUENCES beliefs about the impact of illness on their life (physical, emotional, social consequences) beliefs about treatments that result 5. CURABILTY & CONTROLLABILITY Can the illness be treated? How? Extent to which the outcome is controllable by self or external factors Who can control the outcome of the illness (patients themselves, doctors, fate….) ? Self-Regulatory Model of Illness Cognitions:  Developed by Leventhal et al. (1980, 1997) to explain how illness cognitions affect coping strategies Stage 1: Interpretation Stage 2:Coping - symptom perception - approach coping - social message - avoidance coping -> deviation from norm Stage3:Appraisal Evaluating if the coping efforts are effective If not effective, reconsider coping strategies The model is useful in understanding and/or predicting: Emotional reactions to illness Coping with illness Adherence with treatment and lifestyle changes Outcomes of illness Chronic Illness Long in duration Long-term consequences Usually involves multiple causes, including health habits Cannot be fully cured; can only be managed As many as 50% of the population has some chronic condition Emotional reactions to chronic illness o Shock and Denial o Anxiety o Depression Stress: is mental and physical condition that occurs when a person must adjust or adapt to the environment 1. Stress as a stimulus (stressors): focus on the environment. 2. Stress as a response (distress): reaction to stress. 3. Stress as an interaction: relationship between person and the environment. Cognitive Model of Stress made by Lazarus & Folkman Stress response 1. Stage of Alarm Reaction: Body resources are mobilized to cope with threat (stress). 2. Stage of Resistance: The body adjusts to stress but at a high physical cost; resistance to other stressors is lowered. 3. Stage of Exhaustion: The body’s resources are drained and stress hormones are depleted (exhausted), possibly resulting in psychosomatic disease or complete collapse Acute stress Sudden, typically short-lived, threatening event (e.g., robbery, giving a speech). Chronic stress Ongoing environmental demand (e.g., marital conflict, work stress, personality). Major sources of Stress Frustration Conflict Change Pressure How stress affects health Via behavior Via physiology Repeated exposure to stress linked to cardiovascular problems We may act to promote health by: Engaging in wellness activities Getting enough sleep Eating a balanced diet We may avoid ill health by: Not smoking Wearing seatbelts and crash helmets Washing our hands and brushing our teeth Individuals with higher internal locus of control tend to: Cope better with life’s crises Have more social support that buffers them against illness Have a more competent immune system Report feeling more positive emotion