Acute stress paradigm
Expose Ps to short-term stressful events; observe responses
Consistent finding: Stressful tasks -> psychological distress & physiological arousal
Identifies people most vulnerable to stress
Chronically stressed vs. hostile
Presence of partner or stranger
Aftereffects of stress
Persist long after stressful event is no longer present
Shortened attention span
Poor performance on intellectual tasks
Ongoing psychological distress
Physiological arousal
Allostatic load
Physiological costs of chronic exposure to changes from repeated or chronic stress
Begin to accumulate in childhood, affect multiple disease risks across life
Exacerbated if cope w/high-fat diet, infrequent exercise, alcohol/drugs
Chronic strain
Develops when a stressful event becomes a permanent or chronic part of environment
Adaptation depends on:
Vulnerable pop? (kids, elderly, low SES)
Current level of stress
Intensity of stressors (mild, predictable vs. severe)
Daily hassles
Minor stressful events that lead to...
-Psychological distress
-Adverse physiological changes
-Physical symptoms
-Use of health care services
Dimensions of stressful events
More stress from...
-Negative, uncontrollable, ambiguous events
-Already overloaded
-Affecting central life domains
Effects of long-term stress
-Suppression of immune function
-Increase blood pressure and heart rate
-Psychiatric disorders
-Development of atherosclerosis
-Problems with verbal functioning, memory, concentration
-Storage of fat in central visceral areas
-Decreased immune functioning
Fight-or-flight response
Physiological mobilization
General adaptation syndrome
Expose rats to extreme stress; measure physiological responses
ALL stressors produced same pattern of changes physiologically (figure at right)
Nonspecific response
Three phases: Alarm, resistance, exhaustion
Criticisms to General Adaptation Syndrome
Limited role to psychological factors
Not all stressors produce same biological responses
Continued activation accumulates most damage to physiological systems (2nd phase)
NOT exhaustion of physiological resources (3rd phase)
Addresses stress as endpoint
How does stress cause illness?
Four pathways:
-Direct physiological effects (elevated blood pressure, decreased immunity, increased hormonal activity)
-Health behavior changes (increased smoking, alcohol use, decreased sleep and nutrition)
-Psychosocial resources (threatened social sup
Person-environment fit
Determines experience of stress
Results- stress? magnitude?
Primary appraisal
Understanding event, what it will mean
Appraise for harm, threat, or challenge
Reactivity
Degree of change that occurs in autonomic, neuroendocrine, and/or immune responses
People vary in reactivity
(Genetics, prenatal and early life experiences)
E.g., Cohen et al. (2002): High level of stress + negative life events = vulnerability to upper re
Role conflict
Conflicting information about work tasks or standards
E.g., Publish! Teach! Publish and teach!
Chronically high BP and HR
Secondary appraisal
Are personal resources sufficient to meet demands of environment?
Sources of chronic stress
Long-term and grinding
-Contribute to psychological distress and physical illness
-workplace
Stress
Negative emotional experience
-Predictable biochemical, physiological, cognitive, and behavioral changes
-Aimed at altering stressful event or accommodating to its effects
Stressful life events
Adjustment to changing environment -> stress
Top 3 stressful life events
1. Death of a spouse
2. Divorce
3. Detention in jail or other institution
Stressors
Events that cause stress
Tend-and-befriend
Tend-and-Befriend
Fight-or-flight & exhaustion NOT the whole story...
Respond to stress with:
-Social affiliation
-Nurturant behavior toward offspring
-Especially true of women?
Oxytocin released during stressful events
-Acts as an impetus for affiliation
Workplace stress
Causes:
-Work and sedentary lifestyle: changing nature of work
-Work overload: too long, too many tasks
-Ambiguity and role conflict
-Inability to develop satisfying social relationships at work
-Lack of control over one's work life
-Unemployment
Outcomes of work related stress
-Higher rates of absenteeism
-Job turnover
-Tardiness
-Job dissatisfaction
-Sabotage
-Poor performance on the job
Approach coping style
Coping by gathering information or taking action
-Generally more effective
-Better for long-term stressors
-BUT short-term anxiety and reactivity?
Avoidant coping style
Coping by avoiding the cause of stress
Better for short-term stressors?
Buffering hypothesis
Physical and mental health benefits of social support are evident during periods of high stress
-Low stress: Not so much
Control-enhancing interventions
-Reduce anxiety, improve coping, promote recovery
-Use information, relaxation, and cognitive-behavioral techniques
Coping
Thoughts & behaviors used to manage demands of stressful situations
Internal and external
Coping outcomes
-Reducing or eliminating stressors
-Tolerating or adjusting to negative events or realities
-Maintaining a positive self-image
-Maintaining emotional equilibrium
-Continuing satisfying relationships with others
-Enhancing reovery when ill
-Keeping low phy
Coping style
Tendency to deal with stressful events in a particular way
Direct effects hypothesis
Social support is generally beneficial
-Nonstressful & stressful times
Effects of social support on illness
The good...
Lowers likelihood of illness
Speeds up recovery
Reduces the risk of mortality
Encourages use of health services and adherence to medical regimens
The not so good...
BUT can lead to some bad health habits
Peers who drink, smoke, do drugs...
Emotion-focused coping
Efforts to regulate emotions
Effective when situation must be accepted
E.g., Positive reappraisal of situation
Emotional support
Reassuring someone that they are important and cared for
E.g., "It'll be fixed soon!
External resources
Greater resources Better coping
More ways of dealing w/an event
SES is especially potent
Informational support
Providing support through information
E.g., Suggesting a good mechanic
Matching hypothesis
Support that meets the needs of a stressful event is most effective
E.g., Have someone to talk to, but need to borrow car - useless! But if upset about relationship...
Responsiveness to needs of support recipient
Negative affectivity
Pervasive negative mood
Anxiety, depression, hostility
Experience stress especially strongly
Distress, discomfort, dissatisfaction in many situations
Related to:
Poor health
All-cause mortality
Higher levels of stress indicators
Associated with poor healt
Problem-focused coping
Attempts to do something constructive
Effective when something can be done
E.g., Seeking social support
Psychological control
Belief that we can exert control over stressful events
(closely related to self-efficacy) Did I tell you this would keep coming up?
Help deal w/stress!
Emotional well-being, coping, health behaviors (esp. physical activity)
Psychological resources
Confront & cope w/stressors
BUT also help us...
Bounce back from bad experiences
Adapt flexibly to stressful situations
Psychosocial resources
Social resources
Self-esteem
Tied to effective coping, lower levels of stress indicators, better health habits
At high levels of stress, not as effective
Social support
Information from others that we are...
Loved and cared for
Esteemed and valued
Part of a network of communication and mutual obligations
Helps reduce stress, cope better, and experience positive life events
Most vital of protective psychosocial resources
Stress moderators
Modify people's experience of stress
And effects it has on them
Impact on...
Stress itself
Relation b/w stress & psychological responses
Relation b/w stress & illness
Degree stress experience affects rest of life
Tangible assistance
Provision of material support
Services, financial assistance, or goods
E.g., Fixing your car for you
Threats to social support
Stressful events
Distress may drive possible supporters away
Unsupportive support!
Aggravate negative event
Intrusive social contact
Controlling or directive support
Benefits for health behaviors, but psychological distress?
Acupuncture
Long, thin needles are inserted into designated areas of the body
Theoretically influence the areas w/problem
Triggers the release of endorphins, reduces experience of pain
Coupled w/relaxation, belief it'll work - could reduce pain alone!
Overall, benefi
Adherence
Adherence is highest when:
Practitioners...
Offer clear, jargon-free explanation
Repeated instructions more than once
Patients...
Repeat, write down instructions
Single out and clarify unclear instructions
Ayurvedic medicine
a system of healing that originated in ancient India
-Ayurveda has been defined as the "knowledge of living" or the "science of longevity.
Chiropractic medicine
Performing adjustments on the spine and joints to correct misalignments
Believed to prevent and cure illness
20% of US use at some point
Beneficial effects limited to small studies
Overall, need more data!
Complementary and alternative medicine (CAM)
Diverse group of therapies, products, and medical treatments
E.g., prayer, herbs, meditation, yoga, acupuncture, homeopathy
Vast and unevaluated aspect of care
$50 BILLION/year in US!
National Center for Complementary and Alternative Medicine (NCCAM)
Eval
Creative nonadherence
Modifying and supplementing prescribed regimen
E.g., OTC to treat "ignored" symptoms
Dietary supplements
Contain nutrients in high or higher than recommended amounts
Over 50% of US!
Vitamin D and depression?
Overall, NOT related to improved health
Effectiveness of CAM treatments
Need more data!
Difficult because treatments highly individualized
Placebo component?
Intrinsically enjoyable!
Yoga, meditation, massage
Impact on well-being w/o "working
Double-blind experiment
an experimental procedure in which neither the subjects of the experiment nor the persons administering the experiment know the critical aspects of the experiment
Factors affecting quality of
communication
-Setting
Medical office: Unlikely setting for effective communication
Short visits, interruption
Tasks at odds?
Patient: Explain symptoms quickly, accurately
Provider: Extract significant information quickly from patient
Factors affecting quality of
communication
-Provider behaviors
Inattentiveness
Type of language
Jargon vs. baby talk
Nonperson treatment
Valuable medical functions vs. adverse patient effects
Stereotypes of patients Distrust, dissatisfaction
Black & Hispanic patients: Less info, support, clinical performance from do
Factors affecting quality of
communication
-Patient contributions
Poor education and understanding
Health literacy!!!
Inability to present complaints effectively
Ability to follow treatment guidelines declines because of old age
Neurotic patients exaggerate symptoms
Anxiety, stress, negative affectivity affect learning
Factors affecting quality of
communication
-Interactive factors
Little opportunity for feedback to provider
Return visit? No return? Hard to know why
When is there a relationship w/patient?
Related to lack of feedback
Impact & success rate of advice?
Positive (vs. negative) feedback fosters learning
If most provider f
Nonadherence
Patients do not adopt the behaviors and treatments providers recommend
-Overall, 85% fail to adhere completely
Guided imagery
Meditative procedure used to control discomfort related to illness and treatment
Conjure up a picture to hold in mind during the experience of discomfort
Used to induce relaxation OR rouse into confrontation
Overall, can reduce stress and induce relaxatio
Holistic medicine
Approach to treatment that deals with the physical, psychological, and spiritual needs of the person
Traditional Chinese medicine
Ayurvedic medicine
Homeopathy
Naturopathy
Homeopathy
the treatment of disease by minute doses of natural substances that in a healthy person would produce symptoms of disease
Hypnosis
the induction of a state of consciousness in which a person apparently loses the power of voluntary action and is highly responsive to suggestion or direction. Its use in therapy, typically to recover suppressed memories or to allow modification of behavi
Integrative medicine
Combo of alternative medicine w/conventional medicine
Massage
Manipulation of soft tissue
Reduces stress, pain
Believed to boost immune functioning
Flushes waste out of the system
Effective for persistent back pain? Need more data!
Meditation
Variety of therapies that focus and control attention
Mindfulness most studied
Helpful for managing pain
Controlling stress & anxiety
Effective treatment for certain functional disorders (e.g., fibromyalgia)
Difficult to conduct controlled experiments
Wai
Mindfulness
Helpful for managing pain
Controlling stress & anxiety
Effective treatment for certain functional disorders (e.g., fibromyalgia)
Prayer
Spiritual beliefs tied to health practices, better health, and longer life
Promotion of healthy lifestyle?
Calm, relaxation
Social support
Overall, does NOT reliably improve health
Traditional Chinese Medicine
Type of holistic medicine
Yoga
Breathing techniques, posture, strengthening exercises, and meditation
21 million in US regularly practice
Used to treat:
Chronic pain, bronchitis, symptoms of menopause
Mental and physical ailments related to stress
Cancer-related fatigue
Lower stress an