Individual Health Psychological Factors Stress Wellbeing 2024 PDF

Determinants : Stress & Health I,II 1st years BHME222 Naseema Vawda, PhD (UKZN) Postdoctoral Fellow (UCLA) Fulbright Visiting Scholar (John Jay College of Criminal Justice, CUNY) Dept. of Behavioural Medicine...

Determinants : Stress & Health I,II 1st years BHME222 Naseema Vawda, PhD (UKZN) Postdoctoral Fellow (UCLA) Fulbright Visiting Scholar (John Jay College of Criminal Justice, CUNY) Dept. of Behavioural Medicine UKZN What is Stress? “Stress is the health epidemic of the 21st century” World Health Organization (WHO) What is stress? Difficult to define because researchers approach it in different ways: Some use the word stress to refer to circumstances that threaten well being or refer to the response people have to threatening circumstances Others use it as a process of evaluating & coping with threatening circumstances Others refer to the experience of being threatened by challenging circumstances What is a “stressor”? The term “stressor” is used to describe a wide range of exogenous and endogenous stimuli ranging from minor frustrations to major disasters Turner and Wheaton (1995) have divided stressors into 3 categories: 1) cataclysmic events or extreme stressors (eg. earthquakes, hurricanes, tornados). These are noxious agents generating fear, producing unavoidable injury, opportunities to respond to them are limited, no predictable end to event What is a “stressor”? (cont.) 2) Personal stressors or negative life events. These can range from death of a loved one, loss of a job, divorce, adjustment to a new academic environment, etc. 3) Daily hassles: chronic, low intensity minor events & daily frustrations or difficulties, eg. losing/misplacing things, traffic delays etc.  Stress is a part of life In the right doses, stress is helpful and motivating for our learning, growth and for achieving our goals  There are two pathways to stress: Physiological pathway Psychological pathway Stress & your nervous system Physiological pathway Nervous system controls your ability to see, hear, smell, feel cold, respond to danger, etc. Together with endocrine system continually it acts to preserve homeostasis (balance)in your life , thus enabling you to survive and thrive Central Nervous system is main control center: somatic nervous system has nerves & receptors concerned with changes to your external environment. Those that regulate internal environment are autonomic Physiological pathway- your nervous system  Autonomic nervous system The autonomic nervous system, which governs these responses, is divided into two parts with opposite effects: The sympathetic nervous system “revs” up the body in response to perceived dangers. It operates to stimulate organs & to mobilize energy especially in response to stress. (“FLIGHT or FIGHT” - “Accelerator”) Autonomic nervous system (cont.) Its counterpart, the parasympathetic nervous system, calms the body after the danger has passed. It conserves & restores energy especially when you are calm and rested (“REST & DIGEST ” system- “Brake But in today’s society, stressors often pile up rather than passing rapidly. As a result, the sympathetic system often remains engaged long after it should have yielded to the soothing influence of the parasympathetic system Autonomic nervous system Typical description of a stress response “ My hands felt clammy”, “my heart was pounding so fast I felt it would burst out of my chest”. “ I felt keyed up and started breathing fast”. The muscles in my body felt tight….” “My hair stood on end” Body is ready to deal with any threat in order to survive Muscles get ready to supply oxygen, blood and sugar , etc Brain produces endorphins to block out pain All geared up to deal with stressor physically – “flight – fright – fight”  A Hypothalam The Stress us Pituitary Gland Response Senses sharpen Blood pressure rises Muscl Breath es quickens, tighte lungs n take in more Heart beats oxygen faster B Glucose & fats Adrenal gland released into releases cortisol, bloodstream adrenaline (epinephrine) & nor-adrenaliine  The stress response The Hypothalamus, pituitary gland & adrenal glands make up the HPA axis: play impt. role in triggering stress response Hypothalamus sends chemical messenger (CRF-corticotropin releasing factor)to pituitary gland. This then releases its own chemical messenger –ACTH (adrenocortico-tropic hormone) into bloodstream (A) ACTH travels to cortical portions of adrenal glands which respond by releasing various stress hormones into the bloodstream (B) The sympathetic nervous system sends out impulses to glands and smooth muscles and tells the adrenal medulla to release epinephrine (adrenaline) and norepinephrine (noradrenaline) into the bloodstream. These "stress hormones" cause several changes in the body, including an increase in heart rate and blood pressure. Endocrine system Endocrine glands secrete hormones to regulate the activities of various tissues and organs Hormones act as “messengers” to influence functioning of various organs Some secretions are: estrogen, cortisol, adrenaline/ epinephrine, nor-epinephrine. There’s an “Adrenaline rush’ Continuous exposure to stress releases hormones constantly - leads to wear and tear of organs -> eg. cardiovascular disease, autoimmune diseases Endocrine system (cont.) CT/PET scans show that people with a highly active Amygdala (almond shaped neuron cluster in the brain which is involved in stress processing) have higher risk of cardiac diseases and stroke Stressed amygdala may send signals to bone marrow to produce extra white blood cells. These may cause arteries to narrow and become inflamed causing cardiovascular problems Chronic stress (job or social stress) is thus a true risk factor for cardio-vascular disease, (Tawakol et al., in The Lancet, 2016) General adaptation syndrome (GAS) Developed by Hans Selye (1956) Defined GAS as a nonspecific response of the body to any demand made on it 3 stages to a stress response: i) Alarm stage: organism recognizes a threatening situation. Sympathetic nervous system activates –digestive processes slow down, blood pressure and heart rate increases, adrenal hormones (nor/epinephrine) are released, blood is drawn from skin to muscles. Immediate psycho-physiological response (fright-flight) ii) Resistance: when stress continues , where an adaptation response occurs and /or a return to equilibrium replaces alarm. Resistance cannot go on indefinitely. If alarm happens all the time, energy is depleted and iii) If stress is prolonged : Exhaustion/collapse/death occurs as body’s resources run out. Physiological arousal decreases. Organisms become more susceptible to diseases Stress Curve What is appropriate? Too much stress? Leads to distress and dis- ease Too little stress? Idleness Just the right amount? “Eustress” or “healthy stress” This leads to clear thinking and good planning Adequate amounts of energy Two pathways Stress response is a complex process that involves the inter-relationship between the Body (physical) and Mind (psychological) Physiological responses contains physical and emotional responses which act to prepare your body for actions Psychological involves responses which occur when you perceive and evaluate the stressors  Stress and the Body – Mind connection Our minds and bodies don’t function as separate entities Health is not the absence of disease Its is a complete state of physical, psychological and social well being (bio-psycho-social) When all three are optimised, people function best!!!! Psychological Pathway Transactional model of Lazarus and Folkman (1984) defines stress as: “ a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his /her resources and endangering his/her well being” Two important processes The definition highlights two processes: 1)Cognitive appraisal : Individuals constantly monitor their environment in relation to their well being and goals This is an evaluative process that determines why and to what extent a particular transaction/s between a person and the environment may or may not be appraised as stressful Cognitive appraisals are a key element in psychological perspectives on stress and coping Two types of cognitive appraisal Primary appraisals are evaluations of the personal significance of a person-environment encounter If the individual evaluates that there is no harm or potential harm to their well being, the situation is appraised as irrelevant If the person-environment interaction is appraised as harmful/threatening or challenging the well being of a person, the situation is appraised as stressful Primary appraisal (cont.) This is influenced by the persons beliefs about him/herself, the world , about resources available for coping , level of problem solving skills and financial resources Individual differences in these beliefs may lead one person to appraise a situation as stressful while another person may appraise the situation as irrelevant Secondary appraisal If a situation is appraised as stressful- a secondary appraisal is made in which the individual evaluates his/her options for coping. This includes an assessment of what coping options are available, how likely a particular coping option will work and whether the person will be successful in applying that particular coping strategy Coping appraisals occur continuously and are not necessarily a conscious process “ Men are disturbed not by things themselves, but by the views they take of things ” (Epictetus, as quoted by Fontana,1989)  Two Important processes (Cont.) 2) Coping: this is process through which individual manages the demands of the person- environment relationship that is perceived /appraised as stressful and the emotions they generate Two broad types of coping: Problem focused coping: aimed at resolving the stressful situation or event Can result in increase in anxiety levels esp. if the stressor cannot be changed or there cannot be emotional assimilation of the threat. Can lead to worrying/overthinking about it- is time consuming /non productive Coping (cont.) Emotion focused coping: directed at minimizing negative emotions ( “emotional self regulation”)elicited by the stressful situation. Directed at minimizing the negative emotions elicited by the stressful situation & may include strategies such as expressing emotion (eg. crying, anger ); selective attention or avoiding the source of stress. In some cases emotion focused coping may lead to a reappraisal of the situation as not being stressful Regarding the different ways of coping, generally no one method is exclusively used Coping (cont.) Coping can be adaptive or maladaptive Adaptive coping strategies: involve confronting problems directly, making reasonable realistic appraisals of problems, recognizing & changing unhealthy emotional reactions , & trying to prevent adverse effects on the body. Maladaptive coping includes using alcohol or drugs to escape problems Some researchers say: people have characteristic ways of coping irrespective of the situation/problem. Others believe that people use different coping styles in different situations and may change over time Common coping strategies Relaxation (eg. meditation) & exercise (gym, swimming, walking) Humour Releasing pent up emotions by talking or writing about it Spirituality/faith /helping others/comparing self to others who are worse off Self indulgent behaviour, eg. overeating, excessive use of alcohol/drugs Aggressive behaviour (eg. road rage) Avoidance Proactive coping (Blum et al, 2012) These future- and action-oriented behaviors prepare a person not only for specific stressors, but for those that are likely to arise in the normal course of life. It includes building and strengthening all resources (e.g., from practical and academic knowledge, experiences, and sufficient numbers and varied kinds of social contacts. Proactive coping involves gaining skills and abilities to assess the changing environment more accurately, from signs of a possible stressor, to appropriate strategies and resource use, to feedback on a given situation. Psychological pathway Role of mediators and moderators Differentiate between coping strategies which act as mediators of the stress process and psychosocial resources which act as moderators of the stress process. Mediators are variables which are generated within encounters and which change the relationship between the stressor and the outcome. As a mediator ,coping arises during the encounter and changes/transforms the original appraisal and its attendant emotions in some way Role of mediators and moderators (cont.) Moderators are conditions such as age, gender, socioeconomic status or personality traits which interact with other conditions to produce outcomes. Summarize: Coping occurs in a specific context and involves cognitve appraisal which is mediated through specific coping strategies and moderated through personal & environmental coping resources such as personality and social support What fits whom? Little consistency in the literature regarding which coping strategies are best in reducing psychological distress/ill health People often use both strategies An individuals personality plays a big role in choice of coping strategy eg. individuals high in self esteem are more likely to use active problem solving coping. Low self esteem predict more passive or avoidant coping strategies. What fits whom? (cont.) Coping flexibility is important: successful copers are those who are able to adjust their behavioural and emotional repertoire Coping flexibility is the hallmark of a resilient individual. Individuals who combine problem focused and emotional focused coping in dealing with stressors are less susceptible to negative health outcomes than those who rely on one style only  The concept of resilience in stress Resilience is the ability to “bounce back” from life’s knocks. Researchers call such individuals: “healthy minded” (William James ,19th Century Harvard philosopher) Another researcher, wrote that: fragility is the tendency to be damaged by volatility and uncertainty- the kinds of things that create a chronic stress response (NN Taleb, 2014). He states the “antifragile person” realizes that stress is the price we pay for being alive. We must cultivate antifragility to use our various strengths to overcome challenges and become stronger in the process Coping resources These can be defines as social and personal characteristics which individuals draw upon when dealing with stressors Most commonly studied personal coping resources are: i) Personal control or mastery over life ii) Self esteem iii) Optimism Personal control/mastery “Human beings are not just interested in avoiding pain and seeking pleasure but are motivated to achieve mastery” Control is the ability to regulate or influence outcomes through selective responding It refers to expectations of having the power to participate in decision making to achieve desirable consequences  Self esteem Defined as an individuals total positive and negative thoughts about himself /herself themselves that is stable over time Self esteem affects he stress and coping process by preventing people form becoming overwhelmed by stressful events Optimism Optimism- a tendency to believe that one will generally experience good versus bad outcomes The differences in outcome derive partly from the differences between optimist’s and pessimist’s in the manner which they cope with life’s adversity  Environmental Resources Demographic and situational factors have an important role as moderators of stress Research supports hypotheses that : female gender , the aged, unmarried individuals individuals from low socioeconomic backgrounds experience higher levels of stress.  Environmental resources Marital status is strongly related to physical and mental health: married people are healthier and enjoy higher levels of social integration than the divorced, single or widowed-changing now Individuals from low socioeconomic groups have fewer skills, lower levels of education and low personal control Hence, are more vulnerable to feelings of powerlessness, alienation and lack of control -> feeling demoralized  Environmental resources Transition and change such as relocation also pose as stressors. Relocation (even by choice) involves simultaneous loss of close experiences of familiar psychosocial environment and exposure to new environment (which may include social /linguistic differences)  Social support Defined as “helpful functions performed for an individual by significant others (eg. family, friend’s, colleagues) It can be considered as a “Social fund “ from which people may draw upon when dealing with stress Various kinds of social support : instrumental eg cooking a meal; socio-emotional eg. listening /taking your calls when you are upset and informational eg. giving advice  Health outcomes Stress is an important mediator of health-behaviour relationships as its broad effects can influence a range of bodily systems and behaviour Psychological processes and emotional states influence the etiology and progression of diseases and can contribute to overall host resistance/vulnerability to illness Health outcomes Research points out role of stress in physical illnesses, eg, asthma, common cold, cold sores, upper respiratory tract infections, cancer, rheumatoid arthritis, multiple sclerosis, gastrointestinal disorders, etc. Uchakin et al (2001) studies human immune function which may predispose students to an increased susceptibility to infections. Took blood sample from 1st year medical students 30 day s before an examination and 24 to 48 hours after exams. Stress can alter immune cell distribution and production & secretion of cytokines- decline in % of natural killer cells 24 hours after the exam. Conclusion: when healthy people are exposed to stress, their immuno -competence is compromised. Health outcomes Cohen et al ( 2000) examined the impact of stress on DNA repair capacity(DRC) which they proposed is central to maintaining a normal cell cycle. Defective DRC is one of the factors responsible for carcinogenesis. Results indicated that DRC was higher during stressful periods (exams ) suggesting a positive association between stress levels and DRC -body has to work harder at times of stress to repair compromised cells. Constant stress can cause allostatic load which can make you physically sick eg. CVD, shingles (herpes zoster),aggravate psoriasis, eczema, etc Psychological outcomes Stress also impacts on psychological health/well being and can cause: psychopathology (depression, acute stress disorder/ post traumatic stress disorders etc.) impaired relationships (eg ,divorce, physical abuse,etc.), substance abuse, other high risk behaviour (suicidal and homicidal behaviour, driving over speed limit, promiscuity ,etc.)  Stressors coping mechanisms (appraisal ) coping strategies (cognitive, emotional) coping resources ( self esteem, optimism, social support, finances, gender, age, etc.) Perceived stress Benign stress Stress outcome Physical ill health Psychological ill health Well being ********!!! Don’t want to shed your hair or your spots !!! Don’t want to be a mean loser!!! ….Or a Drunk!!!! Reliant on pills !!!! Suicidal !!!! Paper pushing bureaucrat!!!! Out of your Mind!!!!! Idle/Lazy!!!! In a hurry ALL the time !!! Important take home message Stress affects our thoughts, emotions, behaviour and our body’s reactions Not “ All in the Mind”!! It is a circular process and the physical cannot be divorced or separated from the emotional or psychological Why do you need to know this? How health care professional (HCP)students cope with the stressors of university may lay the ground work for your future professional lives where stress is central to your work. Adaptive or maladaptive coping skills developed during your training may lay the groundwork for future professional adjustment. The long term psychosocial well-being of AHCP is of concern given our access to legal and illegal substances, exposure to stress (eg.nature of work, working conditions, self -inflicted pressures ,etc) Why do you need to know this?(cont.) These factors also have an impact on patient care as you as an HCP directly or indirectly influence the health of the community / society in which you live and work. This is done directly through your clinical and preventive work in your communities and indirectly as a role model for society (Bewley, 1990). Healthy ….. students are likely to become healthy (doctors) who can then model and promote healthy lifestyles with your patients (Wolf,1994). Impact on patients Stress can lead people not to take care of their health: eg. overeating especially a poor diet rich in salty, fatty foods, etc., can lead to obesity , hypertension, diabetes, cardiovascular diseases. Poverty can lead people to experience high levels of stress which may leave them susceptible to illness/diseases, delay access to healthcare, can lead to non-adherence to treatment regimens Thank you for listening to me Welcome questions, feedback and comments [email protected]