Chapter 15:
Health, Stress, and Coping

I. The Role of Psychology in Health and Illness
    A.  Views
        1.  dualism - philosophical position that assumes that mind and body are separate and distinct
            a.  health has always been considered a physicians business
            b.  new evidence indicates strong correlation between health and psychology.
        2.  behavioral medicine - new approach to health, incorporating knowledge from the medical, behavioral, and social sciences
        3.  health psychology - distinct from behavioral medicine in that is specifically involved with the role of psychology in health and illness.
    B. Health and Life-Style
        1.  Leading Causes of death
            a.  in 1900 - diseases like pneumonia, tuberculosis
            b. in 1980 - illnesses related to life style: cancer and heart attacks
        2.  The Paleolithic Prescription - argues that understanding our health needs begins with understanding our evolutionary history
            a.  In natural environment, sugar and fat were rare and highly prized
            b.  now, they are easy to get, so we stock up on them
        3.  Experiments find correlation between health practices and illness:
            a.  practices: sleeping 7-8 hours a day; eating breakfast; no snacking; maintaining normal weight; no smoking; moderate use of alcohol; regular exercise.
            b.  people who practice few or none are more likely to die younger.
    C.  Psychological Control and Health
             a.  behavioral control - belief that one has available responses that can affect health status or the experience of stress
 
 
Behavior Control Is the person responsible for beginning the behavior?
Yes No
Is the person responsible for changing the behavior? Yes Character Compensatory
No Enlightenment Medical
 
                i.    Character model - responsible for beginning and changing behavior.  Used by tobacco to avoid suits.
                ii    Enlightenment model - responsible for beginning, but unable to change behavior.  Alcoholics Anonymous.
                iii.  Medical model - not responsible for beginning or changing behavior.  Views addictions as diseases
                iv.  Compensatory model - not responsible for beginning the behavior, but can change.  Genetic predisposition or social conditions create the behavior, but people can take an active role.
            b.  cognitive control -  belief that one has the cognitive strategies that can affect outcomes related to health and stress.
                i.    visualization, attribution (chapter 14) are cognitive strategies.
                ii.   behavioral self blame - perceiving oneself as the cause of misfortune.  Gives sense of control over future outcomes.
            c.  information control - communications about the nature of health-related situations given to potential recipient of stressful event.  If you expect stress, it be better dealt with.
            d.  Loss of Psychological Control with Aging
                i.    nursing homes take away apparent control, develop learned helplessness
                ii.   loss of friends leads to loss of feedback on social self
    D.  Health and Personality
            a.  Type A personality - highly motivated to achieve, competitive, impatient, fast paced, and more prone to heart attacks
            b.  Type B personality - calm, relaxed, patient, and at a lower risk for heart problems
            c.  specificity theory - view that certain personality traits predispose individuals to specific health problems
            d.  generality theory - view that psychological characteristics can leave individuals vulnerable to a variety of illnesses
            e.  grief - intense emotional suffering usually caused by loss
                i.   encourages group cohesiveness, individual learns to deal with loss
                ii.  stages: protest and yearning; disorganization and despair; detachment and reorganization.
    E.  Addictive Behaviors and Health
            a.  Addictive behaviors are repetitive behavior patterns
            b.  substance use disorder - involves abuse or dependence on drugs and alcohol
                i.  substance abuse - use of a chemical substance on a regular and continuos basis to the point that it interferes with work and family life,
                ii. substance dependence - when an individual is unable to reduce intake of a substance.
            c.  alcohol abuse and dependence
                i.    more than 90% of Americans try alcohol
                ii.   may be predisposed, characteristic brain waves of alcoholics
            d.  cigarette smoking - single most preventable cause of mortality and illness
                i.    social learning model - smoking is reinforced by media and peer groups
                ii.   arousal model - smoking causes arousal, extroverts seek this arousal
                iii.  addiction model - people become addicted to nicotine and have to keep smoking
                iv.  personality model - Type A are more likely to smoke
    F.  Sexual Behavior and Health: The AIDS Crisis
            a.  AIDS - acquired immune deficiency syndrome
                i.    attacks helper T-cells, leave body defenseless
                ii.   cause by Human Immunodeficency Virus (HIV)
            b.  spread by behavior, easy to avoid if you practice certain precautions. 

II.  Stress - physiological and psychological responses to excessive stimulation
    A.  Sources of Stress
        1.  Major versus minor stressors
            a.  life change events - positive and negative stressors in a person life
            b.  Holmes & Rahe scale - ranking of life changing events used to predict future health
        2.  Emergency situations
            a.  emergencies make extreme psychological demands on the individual
            b.  effects:
                i.   psychological numbing - reduction in the capacity to experience emotions
                ii.  also: nightmares, fear of death, reduced social relations.
        3.  Stress in the Work Place
            a.  stress management - complex of treatment methods developed to deal with job stress
                i.    includes meditation, relaxation, group therapy
                ii.   try to prevent or anticipate stressors
            b.  stress inoculation - program that prepares individuals for stressors and deal with them rationally
                i.    cognitive preparation - understand inevitability of stress
                ii.   acquisition and rehearsal - discuss how certain incidents should be handled
                iii.  simulated job-related incidents - practice coping techniques
    B.  Models of Stress
        1. general adaptation syndrome (GAS) - Seyle's model of the body's reaction to stressful situations
            a.  Alarm - body prepares for action; increased arousal
            b. Resistance - Attempts made to cope with stressor
            c. Exhaustion - Body can no longer resist, physiological breakdown begins
        2.  Lazarus's Model
            a.  primary appraisal - the individual attempts to determine how the stressor will affect him
            b.  secondary appraisal - individual attempts to determine sufficient coping strategies and selects the best
            c.  if the individual can cope, stress is minimal, otherwise, the individual experiences lots of stress
    C.  Determinants of the Stress Reaction
        1.  intensity and duration of stressor
        2.  predictability of stressor - being prepared to cope with a stressor minimizes the stress
        3.  motivation of person - the individual has to want to get out of the situation
        4.  competency of person - really determined by person's belief in ability to deal with the situation
        5.  social support


III.  Coping - behaviors and thoughts that enable a person to handle stress or anticipated stress
    A.  Types of Coping Strategies - eight different methods to deal with stress
        1.  Direct Action
            a.  most common form of coping
            b.  also labeled conflict resolution
        2.  Social Support - 4 types:
            a.  emotional concern - expression of empathy, caring and concern
            b.  instrumental aid - giving money or other forms of material assistance
            c.  information - giving advice or directions
            d. appraisal - giving feedback to others that is helpful in their self-evaluation
        3.  Relaxation Training - set of techniques to relax muscles voluntarily in order to reduce stress
        4.  Meditation - alter state of consciousness used to achieve bodily awareness and relaxation
        5.  Biofeedback Training - intervention procedure where the individual monitors and controls normally automatic functions
        6.  Catharsis - pent-up emotions are released to reduce stress
        7.  Situation Redefinition - individual tries to think about the stress in a different way to make it more acceptable
        8.  Religious strategies - the person seeks spiritual guidance from friends or a minister
    B.  Coping with Test Anxiety
        1.  test anxiety is the distress experienced by someone being evaluated
        2.  most treatments have used relaxation training or biofeedback
        3.  cognitive behavior modification - therapy techniques used to change people's perception's of themselves.
    C.  The Hardy Personality - individuals who are especially resistant to illness in spite of increased stress.
        1.  learned optimism - Seligmann's description of a particularly effective explanatory style
        2.  explanatory style - "self talk" we use to explain life change events


Andrew Parker
updated 6.9.98