Stress, Health, and Coping (U of R 2024) PDF

Stress, Health and Coping Big ideas What is emotion focused and problem focused coping? Emotion focused coping can include what three aspects of ourselves? What is sympathetic arousal and the HPA axis? What are some of the dangers of chronic stress? What is tend and befriend? What are...

Stress, Health and Coping Big ideas What is emotion focused and problem focused coping? Emotion focused coping can include what three aspects of ourselves? What is sympathetic arousal and the HPA axis? What are some of the dangers of chronic stress? What is tend and befriend? What are some of the coping techniques for exam anxiety? Describe the connection between stress and physical illnes Big names John Bowlby and attachment theory Hans Seyle and general adaptation syndrome Shelley Taylor and tend and befriend Stress Stress has been defined as the physiological and psychological experience of significant life events, trauma, and chronic strain (Thoits, 2010). Can I do anything about this stressor? So you are under lot of stress, and what university student isn’t? The first question to ask yourself is “Can I do anything about this stressor?” Lots of stuff, I can solve. I can block off more study time, I can break up with that jerk of a boyfriend. If you can solve the problem, that is your first task. Problem focused or emotion focused coping If this is a stressor you can change and you believe you have the ability or skill to tackle it, problem solving is the preferred route. If you can’t change it (it is someone else’s behaviour for instance) or you don’t have the skill you may use more emotion focused coping (seeing the positive for example) Problem solving focus Problem solving approach For solvable problems we want to be a bit thoughtful before we jump in. Make sure we have identified the problem correctly (Do I need more study time or is it that the way I study needs to change), brainstorm some solutions, pick one (I’m going to join a study group) and after a while reassess. Often the first thing you try works, but if it doesn’t don’t be overly distressed. Unsolvable problems Somethings we can’t do anything about: your exam schedule, your parents’ divorce, etc. Then you cope with the emotions of stress, even if you can’t fix the stressor. Self-responsibility model Although it doesn’t always fit, in general we think I am responsible for my own thought, feelings, and behaviours. I am largely not responsible, and can’t change other people’s thoughts, feelings, and behaviours. Emotion focused coping Take a deep breath. No seriously, in fact take a half dozen. Relax your shoulders, and breathe so deeply you can feel your abdomen rise and fall. In the face of stressors we can’t change we cope typically by doing one of three things: change my body (like deep breathing), change my attitude (gratitude, catching irrationality), or social support. Meditation. Now breathe deeply again, only this time try to consciously focus your attention on your breathing, maybe on the rise and fall of your abdomen. If you are like most people, your mind will wander occasionally. That is ok. Just bring it back to your breathing Why would I want to do that? Well what if you got a bit better focusing your mind away from your unhelpful worrying and could consciously choose to focus on what you are doing in the present? One foundation of meditation is to help you live more in the present.  Change my body In general, you want to be active. Do physical activity you love, but if you don’t have a preference, do something aerobic like walking. In general, active people experience less anxiety perhaps because their resting heart rates tend to be lower. Change your body II Then in moments of anxiety, do things that slow your body down: take a warm bath, do some deep breathing, meditate, do some guided imagery. Change your mind But anxiety isn’t just your heart beating faster, it is the worry thoughts going through your mind. How many times have you said “I couldn’t sleep. I just couldn’t turn my mind off.” The problem is our feelings distort our thinking. That is great when we are feeling confident, then we believe we can take on the world. But when anxious, we believe so many things that never come to pass. But how do I know if my anxiety is lying to me? In the moment, my fears seems justified. Everyone’s worries are different, but sometimes if you catch yourself being stuck in the future (but what if that happens, or what if this happens, or what if, what if, what if), black and white thinking (I never do well in interviews. Really, never or just the last time?) etc. it is a clue that we are getting irrational. Cognitive therapists will often give you a list of common ways we lie to ourselves. Just recognizing that your anxiety is lying to you may not stop the lying, especially if this is a message you have been telling yourself for a long time. Talk to a friend We know that suppression and repression typically don’t work. Trying not to think about what stresses us (which we all do occasionally) fails much more often than it works. Talking to someone is much more helpful. Sometimes you need to talk to a friend Managing your stress What do you do to reduce your stress? Exercise, talk to a friend, meditate, have a cold beer, snuggle with your dog? There is a bit of trial and error with coping skills. What works for you may not work for the next person. Sometimes you will use both problem- focused and emotion focused-coping at the same time. Maybe you realize your stress is from your very unsatisfying summer job. It may take you several weeks to find a new job and during that time it is wise to do a bit more self-care: go to the gym more, meditate more, etc. What my body does when I am stressed Hans Selye (1907-1982): General Adaptation Syndrome Working with rats, Hans Selye (pronounced “sell-ee-aa) found that regardless of the stress (infection, excessive exercise, shock, etc.) the rats had the same series of physiological changes: alarm, resistance, and exhaustion Sympathetic arousal and the HPA Axis When we feel threatened (scared or angry) we feel our heart beating faster, we breathe faster, and feel jittery. What is going on? Literally, our body is going into overdrive so we can deal with the threat. I’m in “fight or flight”. Sympathetic arousal and the HPA Axis Sympathetic arousal is speaking of the sympathetic nervous system; it is the neurons involved in fight or flight. HPA is the hypothalamus, the pituitary gland, and the adrenal gland that excrete hormones like adrenaline and cortisol. What does the sympathetic nervous system do? The sympathetic nervous system is moving blood from our viscera into our large skeletal muscles. (Which may give me butterflies in my stomach, but also help me move that bus), dilating our pupils, relaxing my bladder, inhibits activity of my intestines and stomach, etc. Sympathetic arousal occurs first What does the HPA do? The HPA response begins when the hypothalamus secretes releasing hormones that direct the pituitary gland to release the hormone ACTH. ACTH then directs the adrenal glands to secrete more hormones especially cortisol that releases sugars into the blood. Does sympathetic arousal benefit us in the modern world? Sympathetic arousal Fight or flight is adapted for literally fighting or running in the face of a threat. It is superlative when I must take massive physical action for a short period of time, not the long-term stressors we have now. Sympathetic arousal: brief is good; chronic is bad Short burst of stress can increase immune functioning and mental clarity. But chronic stress reduces immune functioning, contributes to heart disease, type II diabetes and a host of other problems. Danger of chronic stress “Stress also damages our DNA, making us less likely to be able to repair wounds and respond to the genetic mutations that cause disease. As a result, wounds heal more slowly when we are under stress, and we are more likely to get cancer” (Textbook p. 625). The Holmes and Rahe Stress Scale Any change, even positive change ( you add 28 points for an astounding personal achievement) increases stress. It isn’t just the stressor, it is how you react to it. Williams et al. (2001) found that people who scored high on measures of anger were three times more likely to suffer from heart attacks in comparison to those who scored lower on anger (Textbook, p. 628) (Williams et al.’s studies are examples of longitudinal designs, Williams et al. asked people to fill out questions about their emotions and then 6 years later asked about their health.) On average, men are more likely than women are to respond to stress by activating the fight-or-flight response. Two more ways stress may not be debilitative Tend and befriend Eustress Oxytocin With fight or flight we talk about increases in adrenaline and cortisol: hormones that ramp us up. With tend and befriend we talk about increases in oxytocin, the “cuddle hormone” that encourages affiliative relationships. Oxytocin is released during sex, during childbirth, bonding etc. But it can also be released during stress. Is tend and befriend mostly found with women? There is a sex difference and part of this is hormonal. Estrogen enhances the effects of oxytocin, whereas androgens inhibit oxytocin release Sex differences in tend and befriend So yes, tend and befriend is more common with females. However, one criticism of statements about females being less aggressive than males is that females can be aggressive, but often they are aggressive through social exclusion, gossip, mocking, what psychologists often call “relational aggression” rather than physical violence. The evolutionary value of tend and befriend Getting enough adrenaline pumping through me to kill that attacking tiger obvious increases my, and my family’s chance of survival. But what about tend and befriend. Studies conducted by Repetti (1989) show that mothers respond to highly stressful workdays by providing more nurturing behaviors towards their children. Being hardwired to nurture my children during hard times has huge evolutionary value. Eustress Hans Selye proposed the concept of eustress (said “you- stress”) to capture stress that is not necessarily debilitative and could be potentially facilitative to a person’s sense of well-being, capacity, or performance. Is stress a response, a stimulus or a transaction? Hans Selye largely saw stress as a physiological response, it was alarm, resistance and exhaustion. Holmes and Rahe focused on the environment what we know would call the stressor: the event or challenge that causes our distress. Richard Lazarus developed a cognitive mediation of stress model (often called the transactional theory of stress or the cognitive appraisal theory of stress) that realizes stress is a transaction between a person (including multiple systems: cognitive, physiological, affective, psychological, neurological) and his or her environment. It is that interaction between what happens to me, how I think about it, and how my body responds to it. Now we have at least three parts to stress What happens to us- how I think about what is happening- how my body responds to what is happening. Although we have some control over all three of these Lazarus focused much of his work on the second, how I think about what happens to me. To recap, Lazarus states, we perceive a stressor and right off the bat we think, “is this really a problem” (primary appraisal) and do I have what it takes to cope with this problem (secondary appraisal) Exam anxiety Can anything reduce exam anxiety? 1. If you can, study a little bit everyday. You have six chapter and seven days. You can go over your notes for one chapter a day and still get a day off. Cramming a lot of chapters the night before can leave you feeling overwhelmed. 2. In general, study in blocks. Read for 50 minutes, get up, have a snack or stretch, listen to a song. Your brain needs a few minutes to put into long term memory what you have been thinking about. 3. Monitor comprehension. Read a few slides and say to yourself “OK I get it Rogers believed a great deal of our distress was caused by distance between our self-image, actual self, and ideal self. We need congruence. I get those slides.” What can I do to reduce my anxiety: Don’t change your stimulant use just before the exam 4. Don’t change your stimulant use. It is tempting, esp. if you are a bit sleep deprived to drink a ton of coffee or smoke more, but this can leave you jittery and anxious. If you are a three cup a day coffee drinker, drink three cups of coffee. (Don’t decide the day before the test to stop your caffeine intake either. You may end up with headaches and fatigue the day of your exam. Yes, reducing caffeine can reduce anxiety but do that during fall break not during exam week). Use relaxation techniques: progressive relaxation 5. If you tend to get anxious, this week start a little relaxation routine. Just spend 5 or 10 minutes doing deep breathing or progressive relaxation, because if you start getting anxious during the exam, I want you to do those things. Everyone uses relaxation a little differently so it might take a couple days to figure out what works for you. For almost everyone deep breathing helps. Then after you slow down your breathing some people just focus on relaxing their body. Progressive relaxation is a term you have probably heard. It is progressively going through all the muscles in your body and tightening them for three seconds, and then relaxing them. Use relaxation techniques: imagery Other people slow down and deepen their breathing and then imagine something contrary to their worry. They will relax themselves with a relaxing scene (i.e., imagine their happy place as vividly as they can using as many senses as they can: imagine seeing the beach, hearing the seagulls, feeling the heat). Conversely they will increase their perceived self-efficacy by imagining themselves acing the exam, seeing the high mark show up on Canvas and their friends congratulating them. Use relaxation techniques 6. If you are getting anxious while writing, first change your body. Take a 30 second relaxation break and do a bit of deep breathing and relax your muscles. 7. Focus on your exam as best you can, but if you get distracted by negative self-talk “Oh my god this is hard, I’m going to screw up” change your self-talk. “I’m just going to do my best. I’m doing ok.” In fact the average on the quizzes is very high, and the test is going to be no harder than the quizzes. Realistically, people are doing well. During the exam 7. Do pace yourself a bit. If you have 60 minutes for 50 questions. At 20 minutes notice if you have 20 questions done. 8. Skip questions you don’t know, and come back to them if you have time. What is the Health Psychology the role of psychology in maintaining health, as well as preventing and treating illness. Health psychology considers how the choices we make, the behaviors we engage in, and even the emotions that we feel, can play an important role in our overall health (Cohen & Herbert, 1996; Taylor, 2012). Health psychology relies on the Biopsychosocial Model of Health. This model posits that psychological and social factors are just as important in the development of disease as biological causes (e.g., germs, viruses). Stress and immune function Less stressed, less colds Imagine that you are a research subject for a moment. After you check into a hotel room as part of the study, the researchers ask you to report your general levels of stress. Not too surprising; however, what happens next is that you receive droplets of cold virus into your nose! The researchers intentionally try to make you sick by exposing you to an infectious illness(Actually they give a few of you a placebo saline drops, and the rest of you (n=396) get one of five respiratory viruses. “After they expose you to the virus, the researchers will then evaluate you for several days by asking you questions about your symptoms, monitoring how much mucus you are producing by weighing your used tissues, and taking body fluid samples—all to see if you are objectively ill with a cold. Now, the interesting thing is that not everyone who has drops of cold virus put in their nose develops the illness. Studies like this one find that people who are less stressed and those who are more positive at the beginning of the study are at a decreased risk of developing a cold(Cohen, Tyrrell, & Smith, 1991; Cohen, Alper, Doyle, Treanor, & Turner, 2006)” (Textbook p. 657). Less stress, less colds When you look at the initial (1991) study the interesting thing is although with both respiratory illness and colds, the more stressed the more illness, this was true even when things like smoking, diet, even white blood cell counts were taken into account! We always talk about wanting better immune systems, more important is to be less stressed!! In addition to lower stress having a positive disposition, having a sense of control, and having good social supports will all improve your physical health. Positive emotional style: Just be happy!! Positive emotional style and colds and flus The second study mentioned (Cohen, Alper, Doyle, Treanor, & Turner, 2006) was similar except they were looking at what they called positive emotional style (PES). Volunteers were assessed for a PES characterized by being happy, lively, and calm; a negative emotional style (NES) characterized by being anxious, hostile, and depressed; other cognitive and social dispositions; and self-reported health. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms. Positive Emotional Style “For both viruses, increased PES was associated with lower risk of developing an upper respiratory illness as defined by objective criteria and with reporting fewer symptoms than expected from concurrent objective markers of illness. (previous research has found people with PES tend to under- report their symptoms). They were also independent of optimism, extraversion, mastery, self-esteem, purpose, and self-reported health”. To me this last sentence is interesting. I thought there would be so much overlap between being happy and being optimistic that the effect on whether you would catch a flu or cold would also largely overlap; seemingly not. Dispositions and emotions In the 1950s two cardiologists (Friedman & Rosenman) found that competitive, impatient, hostile individuals (Type A)had double the risk of heart disease than more laid back people (Type B people). We now know it the hostile competitive aspects that correlate best with heart disease. Conversely positive emotions (e.g., feeling happy or excited) have been tied to a wide range of benefits such as increased longevity, a reduced likelihood of developing some illnesses, and better outcomes once you are diagnosed with certain diseases (e.g., heartdisease, HIV). Control: no that isn’t it. It is believing you have control. Better skill. In one study when participants were forced to listen to unpleasant (stressful) noise (typewriters, people talking over each other, etc.), those who were led to believe that they had control over the noise performed much better on proofreading tasks afterwards (Glass & Singer, 1972). In other words, even though participants did not have actual control over the noise, the control belief aided them in completing the task. Better immune functioning and longevity. In similar studies, perceived control benefited immune system functioning (Sieber et al., 1992). Outside of the laboratory, studies have shown that older residents in assisted living facilities, which are notorious for low control, lived longer and showed better health outcomes when given control over something as simple as watering a plant or choosing when student volunteers came to visit (Rodin & Langer, 1977; Schulz & Hanusa, 1978). In addition, feeling in control of a threatening situation can actually change stress hormone levels (Dickerson& Kemeny, 2004). Social support Social Relationships and social integration Research has shown that the impact of social isolation on our risk for disease and death is similar in magnitude to the risk associated with smoking regularly (Holt- Lunstad, Smith, & Layton, 2010; House, Landis, & Umberson, 1988). (Thus tend and befriend). Helping physicians improve care Treatment adherence How do we help people give better information to their physician and follow through with treatment suggestions. For example, Schoenfeld et al (2001) found over one third of diabetic patients failed to get proper medical care that would prevent or slow down diabetes-related blindness. Technology can help, text messages as helpful reminders have improved treatment adherence and outcomes in depression, smoking cessation, and weight loss (Cole-Lewis, & Kershaw, 2010). Encouraging physicians to practice patient care has improved clinical outcomes. Patient centered care Too often physicians were not engaging the patients. They were doing very good jobs at identifying their patients difficulties and suggesting a treatment. They were not always doing a good job of listening. By asking, “what is it that bothers you about this problem? I’d suggest we try this medication, what do you think of that? Is this medication (or brace or physiotherapist) covered by your health plan? Compliance went up.