Summary of Chapter 4: Stress, Biopsychosocial Factors, and Illness PDF

CHAPTER 4 STRESS, BIOPSYCHOSOCIAL FACTORS, AND ILLNESS CHAPTER OUTLINE I. Psychosocial Modifiers of Stress A. Section Introduction 1. Individual differences in reactions to stress often result of psychological and social factors that modify impact of stressor...

CHAPTER 4 STRESS, BIOPSYCHOSOCIAL FACTORS, AND ILLNESS CHAPTER OUTLINE I. Psychosocial Modifiers of Stress A. Section Introduction 1. Individual differences in reactions to stress often result of psychological and social factors that modify impact of stressors on individual B. Social Support 1. Definition = perceived comfort, caring, esteem or help received from others 2. Types/functions of social support a. emotional or esteem support i. expression of empathy, caring, concern, positive regard, encouragement toward person that provides comfort and reassurance with sense of belongingness and love during times of stress b. tangible or instrumental support i. direct assistance such as lending money or helping with chores c. informational support i. giving advice, directions, suggestions, or feedback about how person is doing d. companionship i. availability of others to spend time with person providing feeling of membership to a group that shares interest and social activities 3. Social support needed and received a. type of support needed and received depends on the circumstances. i. example: cancer patients find emotional and esteem support helpful whereas patients with less serious chronic illness report different types of support equally helpful b. research shows students received more forms of social support following stressful situations i. emotional/esteem and informational support occurred more frequently than tangible support ii. emotional/esteem support protects people from negative emotional consequences of stress 4. Who gets social support? a. factors that determine receiving support i. qualities of recipients of support 1) sociability towards others 2) whether they help others 3) whether they let others know help is needed ii. qualities of support providers  1) less likely to give support if don't have needed resources 2) under stress or need help themselves 3) are insensitive to need of others iii. social support in old age 1) elderly may exchange less support due to loss of spouse or inability to reciprocate iv. composition and structure of social network 1) receiving social support depends on size, composition, intimacy and frequency of contact with social network b. assessing social support i. Social Support Questionnaire 1) 27-item questionnaire that measures sources of and satisfaction with support. 5. Gender and sociocultural differences in receiving support a. gender and social support i. women receive less support from spouses than men do and rely on women friends for social support 1) differences may be due to greater intimacy in women’s friendships and differences in seeking and providing emotional/esteem support b. sociocultural groups and social support i. African Americans have smaller social networks than European Americans or Hispanics. ii. minority men's networks are larger than women's. iii. for different race/ethnic groups, support networks include: 1) Hispanics: family 2) European American: friends/coworkers 3) African American: family and church 6. Social support, stress and health a. greater social support leads to less stress i. example: lower psychological strain, blood pressure in employees with more available social support b. cardiovascular reactivity lower in stressful situations for individuals with supportive friend present i. may depend on person's gender and type of support given c. is relationship between social support and health purely correlational? i. Berkman & Syme research equated participants on health dimensions and later found people with less social support had higher mortality rates. d. other research found social support has been linked to lower mortality rates, less illness, faster recovery from illness i. may depend on beliefs that one can cope with demands of illness 7. How social support affects health? a. two theories on how social support influences health  i. buffering hypothesis - support protects during times of high stress 1) effective only or mainly when person encounters strong stressor; under low-stress, buffering doesn’t occur 2) buffering works in two ways a) person less likely to appraise situation as stressful b) social support modifies response to stress after initial appraisal ii. direct effects hypothesis - support is beneficial to health regardless of stress level 1) how direct effects works a) social support increases feelings of belongingness and self-esteem b) social contacts encourage us to lead healthier lifestyles 8. Does social support always help? a. may not be perceived as supportive or match needs i. instrumental support = valuable for stress that is controllable ii. emotional support = important for stress that is uncontrollable b. impact of marriage i. protective health benefits = married people live longer ii. marriage itself may not protect health 1) differences in death rates may depend on personality and satisfaction level with marriage c. circumstances in which social ties harm health i. frequent social contacts exposes people to infectious illness ii. family and friends may set bad examples or interfere with healthy behavior B. A Sense of Personal Control 1. People strive for personal control a. definition: feeling that they can make effective decisions and take actions to produce positive outcomes and avoid negative 2. Types of control a. behavioral = concrete action(s) to reduce stress i. reduces intensity or shortens duration of event b. cognitive = using thought processes or strategies to reduce stress i. appears to have most consistent effect of reducing stress c. decisional = choice of a course of action d. informational = getting knowledge about stressful event 3. Beliefs about oneself and control a. section introduction i. people differ in degree to which they believe they have control over their lives b. types of locus of control i. internal = control of events lies within us ii. external = situations/others control what happens c. assessing locus of control i. I-E Scale by Rotter = scale used to measure the degree of internality or externality of beliefs about personal control d. how self-efficacy affects sense of control i. self-efficacy involves the estimate of chances of success based on: 1) belief that behavior would produce positive outcome 2) we are capable of producing the behavior properly ii. strong self-efficacy is linked to lower psychological and physiological strain 4. Determinants and development of personal control a. assessed through our past success/failure performances and social learning b. information used to determine personal control is usually retrospective, complex, not clear-cut i. result is that feelings of personal control are often not based on fact or particularly objective ii. illusion of control – Langer’s notion that we think we have control over otherwise chance events 5. Gender and sociocultural differences in personal control a. gender and sociocultural differences in personal control depend on social experience i. teachers and parents can foster beliefs in external control and low self-efficacy in girls ii. for people of color and the poor, limited access to power and economic development can also foster external locus of control beliefs 6. When people lack personal control a. section introduction i. under high stress over long periods of time when nothing one does seem to matter, feelings of helplessness and apathy may develop b. Seligman’s theory of learned helplessness i. learning that actions don't result in expected outcomes ii. a principal characteristic of depression c. extension of theory i. observations that influenced extension of theory 1) exposure to uncontrollable negative events doesn’t always result in learned helplessness 2) depressed people report loss of self-esteem ii. revision of theory included attribution for cause of event iii. attributions for uncontrollable events judged on 3 dimensions 1) internal-external - are events due to personal inability or external causes? a) internal attribution connected to loss of self-esteem 2) stable-unstable - are events long-lasting or temporary? a) stable attribution connected to helplessness and depression 3) global-specific - are effects of events wide- ranging or narrow? a) global attribution connected to helplessness and depression iv. pessimistic world view consists of an internal-stable- global attribution style 7. Personal control and health a. relationship between personal control and health i. strong sense of personal control may be related to: 1) maintaining health and preventing illness 2) adjusting to illness and promoting rehabilitation b. measuring personal control i. Multidimensional Health Locus of Control scales 1) 18 items on three subscales measuring the following beliefs: a) internal health locus of control: control for one’s health lies within oneself b) powerful other’s health locus of control: one’s health is controlled by other people c) chance locus of control: luck or fate controls health c. beliefs of personal control influence health in various ways i. pessimism: poorer health habits, contract more illness, less likely to take active steps to treat illness ii. internal/powerful other’s control beliefs: related to less depression and increases hopefulness  iii. internal control beliefs: influences realization that have effective ways to control stress iv. use of cognitive control: influenced adjustment in women with breast cancer v. self-efficacy beliefs: increased adherence to rehabilitation efforts 8. Health and personal control in old age a. section introduction i. declines in health and opportunities for responsibility observed in elderly in nursing or retirement homes 1) Langer and Rodin nursing home study found increasing responsibility related to better health and increased longevity 2) Schulz and other’s studies found withdrawing personal control had negative effects on health b. overall conclusions i. even minor levels of personal control have positive impact on health ii. facility staff need to carefully consider what kind of responsibility to introduce and what will happen if it is removed C. Personality as Resilience and Vulnerability 1. Hardiness a. personality style Kobasa says differentiates between people who do and do not get sick under stress i. differences in personal control only part of reason people vary in odds of getting sick b. characteristics of hardiness i. control = belief that one can influence events ii. commitment = sense of purpose or involvement iii. challenge = viewing changes as opportunities for growth 2. Sense of coherence, mastery, optimism, and resilience a. relationship between these conceptually similar terms i. sense of coherence - when the world is seen as comprehensible, manageable, meaningful 1) low sense of coherence related to more stress and illness symptoms ii. sense of mastery – belief that individuals can effectively deal with the events of life iii. optimism – point of view that good things are likely to happen 1) higher optimism related to less distress, better health habits, better mental and physical health and faster recovery from illness iv. resiliency - having high levels of self-esteem, personal control, and optimism 1) characterized by appraising negative events as less stressful, using positive emotions in face of distress and finding meaning from negative experiences  2) etiology of resilience: genetics and compensating life experiences 3. Personality strengths and health a. retrospective and prospective studies found hardy people have fewer illnesses and deal with stress more effectively b. status as research/theoretical concept uncertain i. may actually be measuring negative affect, not hardiness 4. Personality strengths and health in old age a. stamina - a triumphant, positive outlook during adversity i. low stamina related to negative outlook, feelings of helplessness and hopelessness regarding life events of old age 5. The five-factor model of personality a. neuroticism vs. emotional stability b. extraversion vs. introversion c. openness vs. closed mindedness d. agreeableness vs. antagonism e. conscientiousness vs. unreliability D. Type A Behavior and Beyond 1. Defining and Measuring behavior patterns a. Type A behavior pattern characteristics i. competitive achievement orientation 1). includes being self-critical and striving towards goals with joy in efforts or achievements ii. time urgency 1). includes impatience with delays/unproductive use of time, over-scheduling of commitments, multi-tasking iii. anger/hostility 1). heightened tendency toward anger or hostility iv. vigorous vocal style 1) speak loudly and control conversation 2. Type B behavior pattern is characterized by low levels of above plus more easygoing and “philosophical” about life 3. Types of measures a. Structured Interview i. face-to-face interview conducted by trained interviewer 1). yields information historical behavioral responses as well as reactions during interview d. strength/weakness of measure i. structured interview 1) strengths a) assesses all three major components of Type A b) classification of Type A with this method is consistent with health outcomes 2) weaknesses a) time-consuming b) expensive to use  c) procedure may affect outcome 4. Behavior patterns and stress a. Type A individuals respond more quickly, rapidly to stressors, seeing them as threats and show greater reactivity 5. Age and developmental differences in Type A behavior a. Type A behavior pattern remains from childhood to middle age and then tends to decline in prevalence i. part of decline may be due to early death b. origins of Type A linked to early temperament and heredity 6. Type A behavior and health a. two methods of study and their findings i. looking at differences between Type A/Type B persons for risk of getting sick 1) relationship between Type A and general illnesses is weak ii. studying relationship between Type A and heart disease 1) Western Collaborative Group Study found Type A’s twice as likely to develop CHD and to have died from CHD 2) link esp. clear when structured interview used as measure for Type A 3) survey data helpful when predicting timing of heart attack 7. Type A's "deadly emotion" a. what difference between structured interview and survey results reveals about the relationship between Type A and CHD i. SI measures all three components of Type A well whereas surveys don’t capture anger/hostility component well 1) observation led researchers to focus on anger/hostility as main component linking Type A to CHD b. research supporting relationship i. Barefoot et al study of physicians 1) high scores on Cook-Medley Hostility Scale were prospectively related to CHD and death ii. other findings linking anger/hostility to CHD 1) chronically very high/very low anger expression damaging to cardiovascular health 2) hostility esp. damaging when expressed outwardly and involves cynical or suspicious mistrust of others c. physiological explanations for relationship i. chronically high levels of stress hormones injure heart ii. high blood pressure strains heart d. cynical/suspicious beliefs and behaviors provokes and worsens social conflicts and undermines social support 8. Are there other dangerous aspects of the Type A pattern?  a. social dominance is associated with coronary atherosclerosis and CHD b. Type A associated with greater physiological reactivity and strain II. How Stress Affects Health A. Introductory Section 1. Diathesis-stress model a. viewpoint that a person’s vulnerability to a physical or psychological disorder depends on interplay between predisposition to disorder and amount of stress they experience b. findings of common cold experiment i. people under high stress more likely to develop cold when exposed to virus ii. people experiencing positive emotion less likely to develop cold 2. Causal sequence of stress to illness a. direct route i. changes that stress produces in body’s physiology b. indirect route ii. impact of person’s behaviors when under stress B. Stress, Behavior, and Illness 1. Under high stress conditions, changes in behaviors are likely to increase risk of illness a. more likely to consume high fat diets, engage in less exercise, consume more alcohol, smoke cigarettes b. also impairs sleep which leads to inattention and carelessness and probably more accidents C. Stress, Physiology, and Illness 1. Section introduction a. increase in allostatic load when stress is chronic and severe is linked to wear and tear on body that accumulates over time and leads to illness 2. Cardiovascular system reactivity and illness a. cardiovascular reactivity = any change in the heart, blood vessels or blood in response to stress i. levels of reactivity have been found to be stable throughout life ii. link found between high cardiovascular reactivity and development of CHD, hypertension and stroke. iii. levels laboratory reactivity assumed to reflect reactivity in daily life b. cardiovascular changes related to CHD development i. under stress, there are more activated platelets and lipids which hastens atherosclerosis 3. Endocrine system reactivity and illness a. catecholamines and corticosteroids are released due to activation of hypothalamus-pituitary-adrenal axis during stress i. may increase atherosclerosis and irregular heartbeat b. high levels of social support reduces endocrine reactivity  4. Immune system reactivity and illness a. as result of stress, increases in cortisol and epinephrine associated with decreases in : i. activity of T and B cells against antigens which increases development and progression of infectious disease ii. the production of anti-carcinogen enzymes involved in repair of damaged DNA in body cells D. Psychoneuroimmunology 1. Section introduction a. psychoneuroimmunology = field of study that focuses on the relationship between psychosocial processes and the activities of the nervous, endocrine, and immune system i. feedback loop exists between nervous and endocrine systems and the immune system 1) too little activity results in infection/disease 2) too much activity results in autoimmune disease 2. Emotions and immune function a. negative emotions such as pessimism, depression and stress impair immune function i. research on caregivers of Alzheimer’s patients show lowered immune function and more days of illness ii. less stress associated with increased flu antibodies after vaccination b. Stone’s research shows positive emotions give immune function a boost i. positive events enhance antibody content for several days ii. negative events reduce antibody content only for day of event c. long-lasting, intense interpersonal events produce large immune reductions d. individual’s reaction to specific stressor stable over time 3. Psychosocial modifiers of immune system reactivity a. social support/hardiness can reduce stress and strengthen immune system b. verbally expressing feelings about an event improves immune function, esp. among the cynically hostile c. optimism interacts with length of stressor in reduction of immune function i. for short-term stressors, immune function declines among pessimists ii. for chronic stressors, immune function declines among optimists 4. Lifestyle and immune function a. people with healthy lifestyles (getting exercise, enough sleep, balanced meals, not smoking) show stronger immune functioning 5. Conditioning immune function  a. immunosuppression and immuno-enhancement may be conditioned i. process involves both antibody-mediated and cell- mediated immune processes III. Psychophysiological Disorders A. Section Introduction 1. Psychosomatic = symptoms or illnesses caused or aggravated by psychological factors 2. Psychophysiological disorders = physical symptoms or illnesses that result from interplay of psychosocial and physiological processes B. Digestive System Diseases 1. Types of diseases a. ulcers i. wounds found in the stomach and duodenum ii. causal processes includes combination gastric juices eroding stomach lining/duodenum that has been weakened by bacterial infection b. inflammatory bowel disease i. wounds in the small and large intestine that cause pain and bleeding c. irritable bowel syndrome i. pain, diarrhea, and constipation without organic evidence of disease 2. Specific role of stress in these diseases is unclear but is related to flare-ups C. Asthma 1. Asthma = respiratory disorder in which inflammation, spasms and mucous obstruct bronchial tubes resulting in breathing difficulties 2. Three factors appear related to the development of asthma a. specific allergies b. respiratory infections c. biopsychosocial arousal from stress or exercising 3. Attacks appear to be triggered by a combination of allergic and psychosocial processes D. Recurrent Headache 1. Types of recurrent headache a. tension-type (or muscle contraction) headaches i. caused by combination of CNS dysfunction and persistent contraction of head and neck muscles ii. symptoms include dull, steady ache that feels like band of pressure around head b. migraine headaches i. result from dysfunction in brainstem and dilation of blood vessels ii. headache may be preceded by an aura accompanied by dizziness, nausea, and vomiting iii. higher prevalence in women 2. Headache triggers may include hormonal changes, diet, lack of sleep and environmental factors including sunlight and stress  E. Other Disorders 1. Other diseases in which stress is a trigger or aggravates episodes a. rheumatoid arthritis i. pain and inflammation of joints b. dysmenorrhea i. painful menstruation accompanied by nausea, headache, dizziness c. skin disorders such as hives, eczema, and psoriasis 2. Although stress appears related to onset and course of these disorders, exact mechanisms remain unclear IV. Stress and Cardiovascular Disorders A. Section Introduction 1. Research supports idea that stress is related to development of CHD B. Hypertension 1. Clinical definitions a. hypertension = elevated blood pressure of over 140 systolic and 90 diastolic consistently over several weeks or more b. normal blood pressure = 120 systolic and 80 diastolic 2. Prevalence a. hypertension rates increase after age of 40 3. Classifications of hypertension a. secondary hypertension – caused by medical disorder of body systems or organs (e.g., kidneys) b. primary or essential hypertension - causal mechanism is unknown i. accounts for 90% of cases 4. Risk factors associated with hypertension a. obesity b. diet, including salt, fats, and cholesterol c. excessive alcohol use d. physical inactivity e. family history of hypertension f. psychosocial factors such as stress, anger and hostility 5. Stress, emotions, and hypertension a. situational correlates to hypertension i. stressful occupations (e.g., traffic controllers) ii. crowded, aggressive environments iii. high cardiovascular reactivity also linked to chronic stressors 1) heart rate and blood pressure reactivity linked to stressors that require active involvement 2) persons with severe hypertension show reactivity to all types of stressors b. psychosocial correlates to hypertension i. negative emotions esp. pessimism, anger, and hostility 1) blood pressure higher in pessimists 2) persons with hypertension more likely to be chronically hostile and resentful 3) resting blood pressure higher among persons  that dwell on anger-provoking events 6. Stress and sociocultural differences in hypertension a. an interaction between race and environmental stressors is linked to hypertension i. example: African American men in high-stress areas of city were more likely to be hypertensive ii. experiences of racism influence both blood pressure and blood pressure reactivity to stressors C. Coronary Heart Disease 1. CHD incidence is higher in technologically advanced countries a. people live longer and thus have more years to develop disease b. people have more risk factors including obesity and less physical activity c. psychosocial stressors may be different in advanced countries d. people in less advanced countries may have more social support and/or perceive less reason for anger/hostility. 2. Example research supporting link between stress and CHD a. occupational stressors such as heavy workload, increased job responsibility, job dissatisfaction are related to higher levels of CHD b. higher levels of atherosclerosis associated with perceived high levels of stress, unfair treatment, racial discrimination c. using prospective studies, positive relationship between CHD and major life stressors has been determined 3. Physical processes that link stress to CHD a. chronically high levels in catecholamine and corticosteroid damage arteries and heart b. stress elicits cardiac arrhythmia c. stress associated with smoking and high alcohol use d. development of metabolic syndrome i. condition of being over-weight, having hypertension, high cholesterol, poor insulin level control which follows after progression through chronic stress to poor health habits V. Stress and Cancer A. Personality has been linked to cancer since the time of Galen B. Common characteristic of cancers 1. Definition = broad class of disease in which cells multiply and grow in an unrestrained manner 2. Dozens of diseases share this characteristic a. complicates finding causal mechanisms and treatments b. examples i. leukemias - excess production of white blood cells by bone marrow ii. carcinomas - growth of a tumor in tissue C. Attempts to link cancer and stress have included retrospective studies 1. Cancer patients report having had high levels of stress 2. Problems with this approach  a. cancer diagnosis made years after disease started b. perceptions may be distorted by the diagnosis 3. Research conclusions a. little connection between moderate stress and developing cancer later has been found b. relapses tend to be accompanied by stress or low social support c. high levels of stress after diagnosis is linked to lower immune functioning 4. Concluding thoughts a. influence of stress on cancer probably due to i. severity of stress ii. whether stress is chronic iii. how person reacts to stress iv. whether stress is encountered before or after cancer development b. causal role of stress likely due to i. impairment of immune system ii. increase in behavioral risk factors for cancer due to stress