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Chapter 12 : Health, Stress, and Coping

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William Cockrell

on 6 April 2017

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Transcript of Chapter 12 : Health, Stress, and Coping

Chapter 12 : Health, Stress, and Coping
Health Psychology
50% of all deaths in America are attributed to preventable diseases and poor health decisions (e.g., diabetes, smoking related deaths, obesity, alcohol, etc.).
Health Psychology :
a "reorientation" towards the positive aspects of the human lifespan. Health psychology is the blending of physiological research and clinical therapy to prevent poor health decisions.
Behavioral Medicine :
clinical therapists using behavioral therapy to help patients with chronic illnesses. The focus is to guide the patients to a healthier lifestyle, which in turn makes almost all illnesses more manageable.
Common aspects of behavioral medicine : managing problems (taking prescriptions & going to appointments), pain control, coping with chronic illnesses, coping with stress, and health management.
Lifestyle Diseases :
diseases that occur to personal habits that cause health problems. Examples include heart disease, stroke, HIV/AIDS, lung cancer, and obesity.
Behavioral Risk Factors :
the specific behaviors that cause lifestyle diseases to occur. Examples would be overeating, unprotected sex, smoking, drinking, or taking illicit drugs.
Behavioral Risk Factors Continued
Almost 20% of all deaths (443,000 people) die
every year
due to tobacco exposure.
65% of all American adults are overweight with around 32% of those people being obese.
The consequences of being overweight leads to many factors that can reduce life expectancy up to 20 years!
The most common American behavioral risks are as follows : stress, untreated high blood pressure,
smoking, alcohol or drug abuse, overeating, lack of exercise, unsafe sexual practices
, pollution, violence, sun damage, and reckless accidents.
The highlighted behavioral risks account for 70% of American medical costs each year.
Disease - prone personality :
people who have higher chances of becoming depressed, anxious, hostile, and less effective immune systems. These people are at higher risks of encountering lifestyle diseases.
Why We Need Health Psychologists
Medical doctors prescribe medicine for symptoms not habits.
They can treat a heart attack, but they typically treat the symptoms not the cause of the disease.
The health psychologist's job is to stop the negative behaviors before they cause problems OR to stop the behaviors once they have caused health problems.
One VERY famous health psychology study compared participants who participated in positive health behaviors to participants who did not. After a 10 year study they found that the participants who practiced healthy behaviors reduced mortality rates by 65%!!!
Health Psychologists continuously stress that going from "Couch surfer to an Olympian" is virtually impossible and typically leads to giving up. One has to gradually increase their positive health behaviors.
Health Psychologists typically focus on negative health behaviors that minors are greatly influenced by (e.g., alcohol consumption).
2-3 drinks a day is okay
IF you do NOT drink 2 or 3 days out of the week
. 2-3 drinks every day of the week is considered alcoholism.
Health Psychology Findings
Health psychology focuses on trying to solve problems that are established through research.
For instance, sociological and psychological research has reported since the 1970s that people's weight, smoking habits, and sexual behaviors are all relative to their social network.
Health psychologists used this information to conduct research which found that if one spouse quits smoking there is a 67% chance the other spouse will stop smoking.
Many successful adolescent anti-alcohol and smoking campaigns are based on health psychology research.
Refusal Skills Training :
role-playing that helps prepare children and adolescents how to say "no" under specific circumstances (e.g., alcohol, drugs, smoking, sex, bullying, etc).
The focus is on the behavior never starting.
Life skills training :
reorienting children away from self-destructive behaviors and towards a healthier lifestyle. Typically focuses on stress reduction skills, setting goals, social skills, and self-control.
Stress :
an evolved adaptation that allows us to respond to changes in our environment.
A major focus of stress research is that the important part is how a person perceives and responds to stress.
stress that is good for the body.
General Adaptation Syndrome (GAS) :
how the body automatically responds to long-term stress. It consists of 3 stages : alarm reaction, stage of resistance, and stage of exhaustion. Starts by autonomic nervous system.
Alarm Reaction :
the initiator of the general adaptation syndrome. It is activated by the pituitary and adrenal glands to produce more adrenaline, noradrenaline, and cortisol into the bloodstream. Almost all illnesses cause the SAME SYMPTOMS in this stage (Selye, 1976).
Common bodily reactions to stress: headaches, fever, fatigue, sore muscles, shortness of breath, diarrhea, stomach problems, and lack of energy.
Stage of resistance :
the body has developed a hypersensitivity to the stress that initiated the alarm reaction. All bodily defenses are allocated to the stressor. This leaves the body vulnerable to other stressors (e.g., if you are placed in a cold environment, you will adapt to the cold (stress) but become more susceptible to other illnesses.)
Stage of exhaustion :
the body has depleted it's temporary resources of hormones that protect against stress. The patient will typically display some form of psychosomaticism.
Negative Outcomes of Excessive Stress
Stress is a physical advantage we have. Without it we would waddle happily towards death with no fear a la Lemmings.
Instead of being overwhelmed by stress, you should view it as "how can I change or overcome this situation to reduce stress?".
In other words, do not stew in your stress, use it as a motivator to make changes.
The major consideration with stress is : how long have you been experiencing the stress?
Symptoms of reaching the stage of exhaustion:
Emotional symptoms :
anxiety, apathy, irritability, and mental fatigue.
Behavioral (Psychological) symptoms :
avoidance of responsibilities and relationships, extreme mood swings, self-destructive behavior, self-neglect, and poor judgment.
Physical Symptoms :
excessive focus on illness, frequent illnesses (psychosomatic?), exhaustion, and medicine abuse.
Comparative research studies found that animals plagued with stress displayed the following physiological symptoms : enlarged adrenal glands, shrunken internal organs, and stomach ulcers (this one is continuously found in humans).
Stress & the Immune System
As mentioned, during the stage of resistance, the immune system turns it's attention to defending against stress instead of it's normal job.
Psychoneuroimmunology :
let's break it down! Psychology + Neuroscience + Immunology. This equals the scientific study of how the brain responds to stress by influencing the immune system.
Common stressful situations that lower the immune system : divorce, bereavement, marital conflict, job loss, lack of sleep, depression, etc.
It is almost to be expected that people will experience a physical illness when they are dealing with high amounts of stress.
Caregiver's burden :
research shows that family members caring for Alzheimer's patients sometimes die before the person with Alzheimer's!
Stress causes the immune system to create inflammation in the body. This is a physiological response and actually not completely necessary (why?), but actually causes the person to get sick easier.
Health psychologists, yet again, found the positive out of this research. They discovered that positive emotions and behaviors (happiness, laughter, delight, and love)
the immune system.
Social networks that reduce stress : support groups, relaxation techniques, guided imagery, and stress management techniques.
The Strains of Stress
Stressor :
anything that causes stress. Typically creates a negative reaction in organisms. Some stressors influence everybody (extreme temperatures), but some are subjective (spiders).
are two major factors that increase stress in a person.
: a related concept of stress. Stress can me measured by it's amount of pressure. This typically refers to the stress of performance dictated by deadlines or evaluations.
People who feel that they are more in
of their life typically report lower levels of stress.
Burnout :
a more specialized form of stress that is related to employment or repetitive tasks. This occurs when workers are physically, mentally, or emotionally drained. Symptoms include : exhaustion, cynicism, detachment, alienation, and attendance issues.
Primary Appraisal of Stress :
the first question a person unconsciously asks when stressed, "Am I in a dangerous situation?".
Secondary Appraisal of Stress :
the second question unconsciously asked, "How can I avoid/fix this stress?".
Think of the textbook example of public speaking and appraisals of stress. You can either appraise public speaking as a threat or a chance to show off. Which appraisal causes more stress? This is CENTRAL to stress research!!
Coping With Stress
Emotion-focused coping :
trying to deal with stress by controlling our emotions related to the stress. The focus is on how to
with the stress.
Problem-focused coping :
more efficient form of coping that deals with attempting to remove the source of stress.
Why wouldn't we use problem-focused coping every time?
Traumatic Stress :
stress that occurs due to extreme situations such as war, rape, robbery, abuse, wrecks, natural disasters, terrorist attacks, etc.
Typical symptoms of traumatic stress include : nightmares, flashbacks, insomnia, irritability and aggression, grief, emotional numbing, depression, and suicidal thoughts.
Frustration :
a "mild" form of aggression that ranges on the negative affective side. Frustration occurs when an individual's goals are blocked.
Frustration is evident across countless forms of animals. Think of two animals finding the same source of food, one of them is about to have their goal blocked.
External Frustration :
environmental blockers that are outside of the person's control. Examples include : the malfunctioning snack machine, your Wi-Fi shutting off, rejection, loss, etc.
External frustrations can be
. You can also view them as
Obviously, due to the larger frontal lobe, humans are more sensitive to social (organic) frustrations. Solitary animals would rarely experience social frustrations.
Frustration is influenced primarily by : strength, urgency, or importance.
Road Rage/Going Postal :
pop psychology terms, but research does show that a large "build up" of weak, unimportant frustrations can cause people to react aggressively.
Internal Frustrations :
personal characteristics that prevent an organism from reaching their goal. Often due to unrealistic expectations or goals.
Aggression :
any act that
harms another person or object. Aggression is the most common outcome of frustration for both humans and other animals.
From an evolutionary perspective, humans often experience conflicting emotions with aggression. Aggression used to be necessary for survival, but is now socially unacceptable.
In modern times, it is often impossible to display aggression against certain sources of frustration. You typically cannot harm your boss when they upset you.
Displaced Aggression :
aggression that is inappropriately used against an unsuspecting victim (be it organic or inorganic). Could sports be a form of displaced aggression?
During unemployment and divorce, children are a major victim of their parent's displaced aggression. Bullying is also considered a form of displaced aggression.
Scapegoating :
blaming a person or event for conditions that they did not cause. Many racial conflicts occur because the minority is deemed the scapegoat (e.g., think of the extreme hate towards illegal immigrants during economic downturns). The most current example for our generation is blaming all Middle-Eastern people for terrorist attacks.
Escape :
if all else fails, the organism tends to run away
How to Deal with Conflict
The following research is an accurate description of how most people approach conflict,but I think it could have been studied more seriously.
Textbook Description of the Rat-Kamikaze Study
(Coon & Mitterer, 2010, pg. 517-518).
In a classic experiment, a psychologist studying frustration placed rats on a small platform at the top of a tall pole. Then he forced them to jump off the platform toward two elevated doors, one locked and the other unlocked. If the rat chose the correct door, it swung open and the rat landed safely on another platform. Rats who chose the locked door bounced off it and fell into a net far below. The problem of choosing the open door was made unsolvable and very frustrating by randomly alternating which door was locked. After a time, most rats adopted a stereotyped response. That is, they chose the same door every time. This door was then permanently locked. All the rat had to do was jump to the other door to avoid a fall, but time after time the rat bounced off the locked door.
The key aspect, even though the research is quite ludicrous, is that when organisms are highly frustrated they tend to stick to one specific behavior. Quite often this behavior is very maladaptive to the situation. This behavior is commonly referred to as
"abnormal fixation"
Conflict :
as the term implies, this is when people experience frustration and/or stress because they are restricted to one choice among multiple options.
Approach-approach conflict :
This happens when a person have to pick between multiple,
alternatives. This is the lowest level of conflict.
Avoidance-avoidance conflict :
this conflict occurs when people are required to pick between multiple undesirable alternatives.
Think of the rats again, with avoidance-avoidance conflict people are more likely to freeze and do nothing during very stressful conflict situations.
Approach-Avoidance Conflict :
the type of frustration occurs when there are both positive and negative aspects of the
same choice
. With this conflict the person has to internally evaluate the positive and negative aspects to determine if they approach or avoid the conflict.
Ambivalence :
a combination of both positive and negative emotions towards a particular stimuli. This emotion is very common in approach-avoidant conflict.
Double approach-avoidance conflict :
there are now two alternatives that have both positive and negative aspects. This makes a decision even more complicated.
Multiple approach-avoidance conflict :
the same as the previously mentioned conflicts but now there are multiple alternatives with both positive and negative aspects.
Psychological Defense Mechanisms
Defense Mechanism :
any behavior that is commonly used to avoid, deny, or distort sources of threat. Are the strongest when they are related to a person's self-image.
Denial :
defense mechanism where the person refuses to believe or accept negative situations.
Repression :
mixed consensus on it's validity. The most reliable research on repression deals with people repressing threatening images to their self-esteem. This is highly different from the "Hollywood" childhood repression we are most familiar with.
Reaction Formation :
similar to repression in that we cannot consciously acknowledge our true feelings. Therefore, we tend to display the exact opposite of what we are afraid to acknowledge.
Regression :
stress-induced avoidance where the person removes themselves from the stressful situation. As the name implies, this is counter-productive behavior.
Projection :
thinking your negative traits are present in everybody BUT you. Think of the pious priest who finds sin in everybody but never acknowledges his own faults.
Rationalization :
the most commonly used defense mechanism. Think of how many times you have heard the same person say "I'm running behind today" EVERY SINGLE DAY. This is a rationalization, they are not always running behind, just rude. Rationalization is when you try to justify your behaviors with "hollow" explanations.
Defense mechanisms are helpful when people experience great stress, but continued and excessive use tends to cause negative characteristics to develop.
Compensation :
a positive defense mechanism where people try to make up for other faults that are considered lacking. The person's faults can be an influential motivator to increase performance.
Sublimation :
the process of "channeling" your inner urges into socially acceptable outlets. Think of a very angry person who spends a lot of time in the gym.
Depression and anxiety are two different psychological disturbances. View depression as alcohol (depressant) and anxiety as a red bull (stimulant)
Even though the two are different, it is VERY common for people to experience symptoms of both depression and anxiety.
Comorbidity :
the description of a patient that has been diagnosed with multiple disorders or illnesses. Sometimes the diseases are unrelated, other times they influence each other (e.g., anxiety and depression).
Learned Helplessness :
first discovered in animal laboratory experiments. If an organism is unable to avoid punishment or pain they eventually stop trying to avoid the pain.
Learned helplessness and depression are very similar in that they both produce the same result. This end result being a lack of motivation or hope to change your situation.
Mastery Training :
physically forcing the person or animal to try to avoid pain or punishment. It does not matter if the attempt is successful or not. The whole goal is that the organism starts to
Mastery training has been found to be effective for children who have experienced bullying, sexual assault, and child abuse.
College Students and Depression
In our masculine-oriented society, discussing symptoms of depression is typically responded with "toughen up, grown up, stop complaining, etc".
These types of comments only reinforce people to hide their experiences with depression and anxiety.
Students also using these disorders as scapegoats mock the severity of mental illnesses.
One study reported that depressed students, on average, scored half a grade point lower than nondepressed students (e.g., Nondepressed students = 60, Depressed Student = 55).
Factors that influence college depression : pressure to pick your career path, isolation and loneliness, being unprepared for the difference in high school and college work, changes in romantic and social relationships, and unrealistic self-images.
Alcohol is a cyclical pattern for depressed people. Depressed people are more likely to abuse alcohol. Alcohol is also a depressant, this means it intensifies the feelings of depression.
Warning signs of depressive moods (not a diagnosed depressive state) : Consistent negative opinion of yourself, frequent self-criticism and self-blame, negative explanations and viewpoints of neutral events, you avoid thinking about the future because it looks bleak, and you are overwhelmed with your obligations.
Rumination :
the most common and harmful characteristic that depressed people display. This is a lack of activity and focus on negative thoughts, behaviors, and memories.
"Starting small" is the best way to overcome feelings of depression (e.g., think of a college student with a "D" who wants to improve).
Stress in everyday life
Social Readjustment Rating Scale (SRRS) :
a measurement used to determine if your everyday life is creating stress.
A more efficient way to take the test would be to complete it yourself (alone) and then ask a close, loved one to take the test for you. Then you compare the scores. Why is this better than only looking at your own evaluation?
While the measurement is questionable, the data has been verified multiple times.
"A total of 150 or less is good, suggesting a low level of stress in your life and a low probability of developing a stress-related disorder. If your score is 300 or more, statistically you stand an almost 80% chance of getting sick in the near future. If your score is 150 to 299, the chances are about 50%. At less than 150, about 30%. This scale seems to suggest that change in ones life requires an effort to adapt and then an effort to regain stability".
Microstressors :
minor yet daily stressors that also impact levels of stress. Examples include laundry, cleaning the house, traffic, passive-aggressive Facebook posts by friends, the neighbor being loud every day, etc.
Microstressors are better at predicting your immediate health status whereas the SRRS is better at predicting health 2 years after the major life events.
Psychosomatic Disorders and Biofeedback
Psychosomatic Disorders :
physical symptoms that occur due to depression and/or stress. Remember, physical symptoms are present (e.g., high blood pressure), but biological causes are not (e.g., no history of blood pressure problems, not taking medications that increase it, is not overweight, does not smoke, etc).
The original perspective was that these people needed to be institutionalized right away. We now understand that the much more humane method is to help the people reduce their stress. This typically alleviates the physical symptoms.
The most common psychosomatic symptoms are : stomach pains, gas, constipation, asthma attacks, skin rashes, migraines, arthritis, high blood pressure, heart disease, body aches, diarrhea, insomnia, severe premenstrual pains, and sexual dysfunctions.
Biofeedback/Neurofeedback :
giving a person biological or neurological information about their body through electronic monitoring. The person can then use this information to "manipulate" their biological state.
Personalities that promote stress
People are not in complete control of their ability to deal with stress. Genetic research shows that depression is probably hereditary.
Type A Personality :
Personality type that tends to cause people to be at a much higher risk of cardiac disease. Personality traits include : hard working, competitive, ambitious, time urgency, a focus on achievement, disdain for relaxation, etc.
Famous Type A Personalities : Hillary Clinton, Madonna, Tiger Woods, Bill Gates, Steve Jobs, Ryan Seacrest.
The traits mentioned above promote success in employment and goals but also fosters an increase in frustration and aggression.
One study found that 15% of 25 year old participants labeled as Type A had passed away by 50 due to cardiac related disorders.
Test yourself! Use table 12.6 on page 534 to see if you are a Type A person. Remember, sometimes people rate themselves as Type A when they really aren't (i.e., rate yourself and then get a friend to rate you).
Hardy Personality :
the opposite of Type A personality. These people are very resistant to stress and often do not experience the physical symptoms of stress.
Hardy Personality and Type A personality share identical traits EXCEPT people with hardy personalities display : personal commitment, a feeling of control, and positive evaluations of challenges instead of viewing them as threats.
It is all a matter of perspective! Type A personalities tend to have more negative and aggressive emotions whereas Hardy personalities try to find humor in challenging situations.
Physical Changes in Early Adulthood
Cardiovascular disease is the highest cause of death for adults. For the most part this disease is both genetic and lifestyle choices (food & diet).
The heart itself,
without external factors
, typically does not decay or decline in performance with age.
Healthy older adults usually notice a slight decline in strenuous activity due to the heart muscles becoming more rigid.
The lungs lose 50% of their respiratory volume by age 75. Exposure to pollutants and smoking can greatly reduce the lung's efficiency.
For professional athletic competitions, we see that the human body typically peaks around ages 20-35, depending on the sport.
Significant decline typically does not occur until the 60s for many motor skills. Swimming is VERY beneficial for aging people.
The best way to offset the decline in motor activities is consistent physical training and exercise.
The immune system typically declines as we age. This is due to
T cell
production decreasing which in turn reduces the efficiency of
B cells
Health and Fitness
The United States has one of the highest death rates for all causes of most industrialized countries.
"Longitudinal evidence confirms these trends : economically advantaged and well-educated individuals sustain better health over most of their adult lives, whereas the health of lower-income individuals with limited education steadily declines".
The most common factors that influence negative health impairments in low SES environments are : stress, neighborhood crowding, pollution, diet, lack of exercise/obesity, substance abuse, jobs with health hazards, and lacking of social connections.
Primary reasons that the United States SES differences are amplified compared to other industrialized countries : lack of universal healthcare, greater wealth discrepancy, the poor people are "poorer" in the United States, and income segregation.
There is a strong correlation between childhood obesity and adult obesity. Use this statistic carefully given that it provides "self-defeating" information for people trying to lose weight.
Most common discriminatory treatment that overweight people receive : less likely to be in a relationship, higher chance of being denied an apartment, less likely to receive financial aid (how do they know?), and lower chances of being offered a job.
Behavioral dieting is most successful when it includes maintaining a "food diary", receiving social support (this is why weight watchers can be very successful), and interventions that last up to 40 weeks. People cannot dramatically change eating behaviors in just a few weeks.
Trans Fat and processed sugar are the deadliest forms of food that a person can eat and are highly linked to obesity.
Exercising and Physical Activity
Only 30% of Americans participate in moderate exercise for 20 minutes a day, five times a week. This is the bare minimum suggested by most medical doctors.
40% of Americans do not participate in any physical activities.
Women and people in lower SES are at highest risk of not exercising regularly.
Consistent exercise (20 minutes a day, 5 days a week) has been reported to increase a person's immune system. Adding onto this, in a comparison study, obese people were much more likely to report getting sick than people who exercised regularly.
Longitudinal studies demonstrate that over 20 years of consistent exercise dramatically reduces a person's chances for being diagnosed with cancer.
The most common cancer that obese people are treated for is colon cancer.
Animal research with rats found that rats who exercised consistently (running on the rat wheel) inhibited the growth of cancerous tumors. The rats who were not allowed to exercise continued to display developing tumors.
Neuroscience research demonstrates that consistent exercise supports an improvement in cognitive functioning.
Exercising helps reduce stress by producing endorphins. This is commonly referred to as a "runner's high"
"Currently, the U.S. government recommends 30 minutes of moderate-intensity physical activity on five or more days per week or 20 or more minutes of vigorous-intensity exercise on three of more days".
We have automatic implicit associations with gay men and AIDS. Lesbians tend to not experience this associations (only one woman has been confirmed by the medical field to have contracted HIV in a lesbian relationship).
From the 1980s - 2000, gay men were the largest group to be HIV+. Since the early 2000s, African-American women are now the largest group to be HIV+ in the United States
It does not matter who is the largest group to have HIV, we are all still humans!
Around 25 million people have died from AIDS. Up to 34 million people are living with AIDS (not HIV) across the world.
If left untreated, HIV will progress to AIDS (Auto Immune Deficiency Syndrome)
In 2012, there were 1.3 million people living with HIV in the United States. Around 150,000 (12%) are unaware of their status (CDC, 2012).
Safe Sex:
making "sound and rational" judgements about sexual partners, not sharing needles, and using condoms. Now, Truvada is also considered a form of safe sex.
Around 1.2 million people in the United States have been diagnosed with AIDS by 2014 (CDC, 2014).
Teenage Depression
The DSM symptoms for depression : sadness, frustration, hopelessness, disturbances in sleep (insomnia or hypersomnia), appetite change, problems focusing, and lack of energy.
15-20% of teenagers have had at least one major depressive episode.
A depressive episode would be experiencing at least five of the above mentioned symptoms for two weeks or more.
Globally, by adolescence, girls are twice as likely to report depressive symptoms. This could be analyzed two ways. 1) It is more acceptable for girls to report feeling "upset" than boys and 2) Girls may actually experience higher rates of depression due to unequal gender treatment.
Like many other psychological disorders, depression is both due to genetics and parenting (environment).
When examining gender instead of sex, researchers find that people who display feminine characteristics are more prone to depression.
Depression is a serious illness considering the most common outcome, is help is not received, is suicide.
Biopsychosocial model:
the approach that health is something to achieve instead of the absence of illness. It encourages us to understand mental health and physical health are related.
Many behavioral risk factors become additive (e.g., when one smokes they are more likely to also drink).
Community Health Campaigns:
public education projects/commitments appear to be effective in reducing negative lifestyle habits. Heart walks, breast cancer screenings, and STD testing events are examples.
Biofeedback is a much newer form of therapy
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