Health Psychology
Stress
Introduction
• Health psychology: scientific study of
psychological processes related to health
and health care (Friedman and Adler 2007)
• Focus on prevention
– It is now acknowledged that many health
problems are directly related to lifestyle choices
• Goal: Help people stay healthy, and to start
and adhere to treatments
Different Factors Causing Illness
• Biopsychosocial model of health and
illness:
– Biological factors
• Genetics, immune system, age, sex, viruses, infections, lesions
– Behaviors
• Smoking, drinking, sex life, eating habits
– Sociocultural factors
• Peer pressure, socio-economic status, ethnicity, expectations
– Psychological factors
• Sense of control, self-efficacy, optimism, stress and coping
Stress & Stressors
• Stress: negative emotional experience, accompanied
by various physiological, cognitive, and behavioral
changes
• Stressors: Cause stress
– Noise, violence, pain, job, exams
• Stress response: Physiological/psychological changes
– Stress hormones, distress
• Stress experience: Perception of experience and how
we deal with it
– Coping
– Not always a conscious experience
Stressors
• Humans are the only species that can imagine
stressors, and their body reacts as if it was real
– Robert Sapolsky <3
• Beliefs and expectations play a role in the
intensity and character of people’s methods of
coping with stressors
• Homeostasis: balance between external
environment and body’s normal physiological
state
– When your environment does not cause you stress
Stressors
• Acute stressors: appear suddenly, do not last
long, call for immediate attention
– Physical injuries, attacks
– Body is alert and deals with stress, then returns to
homeostasis
• Chronic stressors: last a long time, constant
source of worry
– Abusive relationships, bullying, intense jobs
– Damages the body overtime
– Body does not return to homeostasis because the
stressor is always there
Work Stressors
• Work-related stress arises if there is a
mismatch between the demands of a person
and their ability to cope with those demands
– i.e. not enough time, factors under their control,
not enough support
Stressors
• Even pleasant changes can be stressful
– Marriage, pregnancy, promotions
• Because they require the individual to adjust to a
new situation (find homeostasis again)
• The Holmes-Rahe Scale (1967)
– Rate life events in terms of how long it would take to
readjust/accommodate the stressor
• Findings:
– Evaluation of stressors is fairly constant across the US
– Small correlation between high stress ratings and more
illness and accidents
Coping
• Coping: efforts to deal with a threat in order to
remove it or diminish its impact
• Sarafino (1994): Stress arises when people
percieve their own resources can not meet the
demands of a situation
• The individual’s own evaluation of the situation is
what matters
– Impacts the way the person confronts a stressful
situation
Steptoe and Marmot (2003)
• Survey on the interaction of social, psychological,
and physiological aspects of stress
– Seven questionnaires about different stressors
– Blood samples taken
• Self-efficacy: person’s feeling of competence to
deal with a specific task or problem
• Perception of control and self-efficacy are
important psychological factors in stress
• High mean scores on all stressors = higher risk of
heart problems, depression, anxiety, etc
Steptoe and Marmot (2003)
• Stress research must focus on specific
stressors in isolation, as well as
combinations of stressors
• The accumulated effect of several stressors
may put individuals at increased risk
Physiological Aspects of Stress
• The changes of the sympathetic nervous
system prepare the individual to either
confront or escape from the source of stress
– Fight or Flight response!
• Body responds to stress with arousal
– Example: increased blood pressure and
providing glucose to the muscles
– Adrenal glands release stress hormones to
energize the body
General Adaptation Syndrome (GAS)
• Hans Selye (1956)
• Three staged stress process:
– The Alarm Stage
• Fight-or-flight response
– The Resistance Stage
• Coping
• Attempting to reverse effects of alarm stage
– Exhaustion
• Incapable of further coping
General Adaptation Syndrome
• Based off of rat research
• It explains the extreme fatigue people
experience after long-term stressors
• However, psychological factors play a small
role in the GAS model
• Later stress research based heavily on his
alarm and resistance stages
Stress & Health
• Long-term stress causes an increase in
cortisol
• Cortisol can lead to:
– Depression
– Memory problems
– Weakened immune system
• WHY: Cortisol decreases T-cells (natural killers of
infection)
• THEREFORE: Individual is more susceptible to
infection
Kiecolt-Glaser et al. (1984)
• Blood samples of students as final exams
approached
– First taken a month before
– Second taken the day of
• Second sample had a significant decrease in T-cell
activity
• High stress had diminished the effectiveness of the
immune system
• Psychological stress influences the immune system
as well (i.e. loneliness)
Cognitive Aspects of Stress
• Cognitive appraisal (thinking positively or
negatively) seemingly predicts health
outcomes
• Reed et al. (1999): HIV-positive people with
more pessimistic expectations developed
symptoms more quickly and died sooner
• Kemeny et al. (2006): Pessimistic
expectation makes people give up which
influences the immune system
Cognitive Aspects of Stress
• Kamen and Seligman (1987): Attributional style
could predict poor health later on
– EXAMPLE: pessimism or optimism
• Pessimism may be related to decrease in T-cells
and suppression of the immune system
– Caused by attributional style and beliefs on the body
• Greer et al. (1979): denial and a fighting spirit
predicted longer survival for breast cancer
– Optimism helps people cope with cancer in a way that
may prolong life!
Social Self-Preservation Theory
• Kemeny et al. (2005)
• Threats to one’s “social self” (self esteem and status) are
associated with specific negative cognitive and affective
responses
– Shame and humiliation
• Threats to social self can influence physical health
– Immune system, levels of cortisol, etc
• Predicts that biological responses to stress are mediated by
self-conscious emotions such as shame and sensitivity to
rejection
Psychoneuroimmunology (PNI)
• Based on the assumption that an
individual’s psychological state can
influence the immune system via the
nervous system
Social Aspects of Stress
• If our social relationships are stressful our well-
being may be threatened
– Bullying, abuse, violent neighborhood
• On the other hand: stress can be alleviated via
social support
• The early family environment, along with cultural
norms, seems to provide the groundwork for social
competence
– Warm/nurturing families teach kids to manage stress
effectively
Transactional Model of Stress
• Lazarus and Folkman (1975)
• Assumes stress involves a transaction
between an individual and the external world
• A potentially stressful event must be
perceived as stressful to elicit a stress
response
• Psychological factors are therefore
important
Transactional Model of Stress
• Appraisal of stressors within the transactional
model of stress:
– Primary appraisal:
• Event is judged to be irrelevant, positive, or negative
to one’s well-being
– Secondary appraisal:
• Different relevant coping strategies are considered
before choosing a way to deal with the stressor
• They both influence each other; they are
continuous and interdependent
Coping Strategies
• Folkman and Lazarus (1988)
• Problem-focused coping:
– Dealing with the stressor itself
– EXAMPLE: Quitting a stressful job
• Emotion-focused coping:
– Handling the emotional aspects of the stress
response rather than changing the situation
– EXAMPLE: Taking yoga to deal with stresfull job
Coping Strategies
• Carver (2007)
• Problem-focused is more likely to happen if the person
feels they can control the stressor
• Emotion-focused is more likely to happen if the person
feels they have little control of the stressor
• It is difficult to make a clear distinction between the
two
– Two kinds of strategies influence each other
– Problem-focused can reduce unpleasant emotions
– Emotion-focused can make problem-focused coping
more effective
Coping Strategies
• Emotion-focused coping may be effective short-
term, but not in long-term
– Can cause addictions like alcoholism if you use alcohol
to cope
• Thus the term avoidance coping
– Individual only wishes to avoid the negative feelings of
the stressor than deal with it/fix it
• Proactive coping: effort done prior to avoid a
stressful experience
– Like studying hard for an exam
Ursin and Erison (2004)
• Generally people benefit positively and
experience lower levels of stress if they
actively do things to reduce stress!
• If one believes they can manage stress, the
stress is less intensive and long-lasting
• So do some yoga and hang out with friends
often!
Social Support
• Social support: feeling that one is cared for
and part of a social network with mutual
obligations
• Forms of support:
– Emotional support: warmth and understanding
– Informational support: helping a person to
understand/logically evaluate a stressor
– Practical support: financial assistance, etc
Social Support
• Giving social support may strengthen a
relationship
• Provides a sense of purpose
– It signifies that one is important and needed
• Just knowing you could get support may be
the most beneficial factor of social support!
Social Coping: Men & Women
• Taylor (2002)
• Theory of “Tend and Befriend”
– Males tend to exhibit fight-or-flight response to
stressors
• Key hormone: testosterone
– Females “tend” (undergo nurturing activities)
and “befriend” (seek social support)
• Key hormone: oxytocin
Social Coping: Women & Men
• Thoits (1995): Women were more involved
than men in both giving and receiving social
support
• Women are generally more likely to mobilize
social support in times of stress
• Belle (1987): Women maintained more
same-sex close relationships than men did
• Reported more benefit from contacts with
their female friends and relatives
Culture
• Taylor (2008): Culture is a variable that may moderate how
social support is perceived
• Independence vs. interdependence
– Individualistic cultures see the self as independent
– Collectivist cultures perceive the individual as part of a social group
(interdependent)
• Taylor et al. (2004):
• European, US, and Korean students asked about their ways
of coping with stress
• Significantly less Korean students used social support
– Maybe due to Asian concerns with harmony, social criticism, or
losing face
Support Groups
• Evans (1979): 15 million Americans were using
social support groups to deal with mental health
• Kessler et al. (1997): Approx. 25 million people
participate in support groups at some point in their
lifetime
• Davison et al. (2000): Women, and white people as
a whole, are more likely to participate in support
groups than men and non-white people as a whole
Internet-based Social Support
• Help people who do not have IRL support
– Provides extra support for those that do!
• Participant privacy/security is important when
experimenting with it
• Klemm et al. (1999) content analysis of internet-based
support groups:
– Members usually sought information, gave information,
encouraged, gave support
• Women were more than twice as likely to provide
encouragement and support
• Men were more than twice as likely to offer information
Wenzelberg et al. (2003)
• Aim: Evaluate the beneficial effects of online
support groups
• Method: 72 women with breast cancer
assigned to a 12 week internet support
group
• Results: Moderately effective in reducing the
participants’ scores on perceived stress and
depression
Mindfulness Stress Reduction (MBSR)
• The mind is related to the body, so learning
to relax and concentrate on one thing at a
time can reduce stress
• Mindfulness-based stress reduction (MBSR):
relaxation technique developed by Kabat-
Zinn in 1979
MBSR
• Based off of Buddhist teachings
• Involves training in meditation
• Aim: cultivate mindfulness
– Mindfulness: awareness that emerges through
paying attention, on purpose, in the present
moment, and non-judgmentally to the unfolding
of experience moment by moment
– AKA: Respond to the situation instead of
reacting to it automatically
MBSR
• Wants the individual to develop the ability to calmly
step back from thoughts and feelings during
stressful situations
• Shapiro et al. (1998) compared stress of students
taking MBSR with those not taking MBSR as exams
came closer
– Before MBSR started there was no difference in stress
– As exams got closer and classes were taught:
• Non-MBSR students increased anxiety (control group)
• MBSR students were less anxious than they were at the start!
Evaluation of Shapiro et al. (1998)
• MBSR participants learned to cope with
stress better
• Generalization issues:
– Participants were medical students
– Self-selected samble
– Offered course credits (low number of drop-outs)
Speca et al. (2000)
• Cancer patients were split into MBSR group or
waiting-list group (control group)
• Results:
– MBSR group showed a reduction in total mood
disturbance (anger, anxiety, depression) by 65%
– Stress reduced by 35%
– More time spent meditating led to greater mood
improvement
• Have to keep social desirability effects in mind
while evaluating this study!

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Health Psychology: Stress

  • 2. Introduction • Health psychology: scientific study of psychological processes related to health and health care (Friedman and Adler 2007) • Focus on prevention – It is now acknowledged that many health problems are directly related to lifestyle choices • Goal: Help people stay healthy, and to start and adhere to treatments
  • 3. Different Factors Causing Illness • Biopsychosocial model of health and illness: – Biological factors • Genetics, immune system, age, sex, viruses, infections, lesions – Behaviors • Smoking, drinking, sex life, eating habits – Sociocultural factors • Peer pressure, socio-economic status, ethnicity, expectations – Psychological factors • Sense of control, self-efficacy, optimism, stress and coping
  • 4. Stress & Stressors • Stress: negative emotional experience, accompanied by various physiological, cognitive, and behavioral changes • Stressors: Cause stress – Noise, violence, pain, job, exams • Stress response: Physiological/psychological changes – Stress hormones, distress • Stress experience: Perception of experience and how we deal with it – Coping – Not always a conscious experience
  • 5. Stressors • Humans are the only species that can imagine stressors, and their body reacts as if it was real – Robert Sapolsky <3 • Beliefs and expectations play a role in the intensity and character of people’s methods of coping with stressors • Homeostasis: balance between external environment and body’s normal physiological state – When your environment does not cause you stress
  • 6. Stressors • Acute stressors: appear suddenly, do not last long, call for immediate attention – Physical injuries, attacks – Body is alert and deals with stress, then returns to homeostasis • Chronic stressors: last a long time, constant source of worry – Abusive relationships, bullying, intense jobs – Damages the body overtime – Body does not return to homeostasis because the stressor is always there
  • 7. Work Stressors • Work-related stress arises if there is a mismatch between the demands of a person and their ability to cope with those demands – i.e. not enough time, factors under their control, not enough support
  • 8. Stressors • Even pleasant changes can be stressful – Marriage, pregnancy, promotions • Because they require the individual to adjust to a new situation (find homeostasis again) • The Holmes-Rahe Scale (1967) – Rate life events in terms of how long it would take to readjust/accommodate the stressor • Findings: – Evaluation of stressors is fairly constant across the US – Small correlation between high stress ratings and more illness and accidents
  • 9. Coping • Coping: efforts to deal with a threat in order to remove it or diminish its impact • Sarafino (1994): Stress arises when people percieve their own resources can not meet the demands of a situation • The individual’s own evaluation of the situation is what matters – Impacts the way the person confronts a stressful situation
  • 10. Steptoe and Marmot (2003) • Survey on the interaction of social, psychological, and physiological aspects of stress – Seven questionnaires about different stressors – Blood samples taken • Self-efficacy: person’s feeling of competence to deal with a specific task or problem • Perception of control and self-efficacy are important psychological factors in stress • High mean scores on all stressors = higher risk of heart problems, depression, anxiety, etc
  • 11. Steptoe and Marmot (2003) • Stress research must focus on specific stressors in isolation, as well as combinations of stressors • The accumulated effect of several stressors may put individuals at increased risk
  • 12. Physiological Aspects of Stress • The changes of the sympathetic nervous system prepare the individual to either confront or escape from the source of stress – Fight or Flight response! • Body responds to stress with arousal – Example: increased blood pressure and providing glucose to the muscles – Adrenal glands release stress hormones to energize the body
  • 13. General Adaptation Syndrome (GAS) • Hans Selye (1956) • Three staged stress process: – The Alarm Stage • Fight-or-flight response – The Resistance Stage • Coping • Attempting to reverse effects of alarm stage – Exhaustion • Incapable of further coping
  • 14. General Adaptation Syndrome • Based off of rat research • It explains the extreme fatigue people experience after long-term stressors • However, psychological factors play a small role in the GAS model • Later stress research based heavily on his alarm and resistance stages
  • 15. Stress & Health • Long-term stress causes an increase in cortisol • Cortisol can lead to: – Depression – Memory problems – Weakened immune system • WHY: Cortisol decreases T-cells (natural killers of infection) • THEREFORE: Individual is more susceptible to infection
  • 16. Kiecolt-Glaser et al. (1984) • Blood samples of students as final exams approached – First taken a month before – Second taken the day of • Second sample had a significant decrease in T-cell activity • High stress had diminished the effectiveness of the immune system • Psychological stress influences the immune system as well (i.e. loneliness)
  • 17. Cognitive Aspects of Stress • Cognitive appraisal (thinking positively or negatively) seemingly predicts health outcomes • Reed et al. (1999): HIV-positive people with more pessimistic expectations developed symptoms more quickly and died sooner • Kemeny et al. (2006): Pessimistic expectation makes people give up which influences the immune system
  • 18. Cognitive Aspects of Stress • Kamen and Seligman (1987): Attributional style could predict poor health later on – EXAMPLE: pessimism or optimism • Pessimism may be related to decrease in T-cells and suppression of the immune system – Caused by attributional style and beliefs on the body • Greer et al. (1979): denial and a fighting spirit predicted longer survival for breast cancer – Optimism helps people cope with cancer in a way that may prolong life!
  • 19. Social Self-Preservation Theory • Kemeny et al. (2005) • Threats to one’s “social self” (self esteem and status) are associated with specific negative cognitive and affective responses – Shame and humiliation • Threats to social self can influence physical health – Immune system, levels of cortisol, etc • Predicts that biological responses to stress are mediated by self-conscious emotions such as shame and sensitivity to rejection
  • 20. Psychoneuroimmunology (PNI) • Based on the assumption that an individual’s psychological state can influence the immune system via the nervous system
  • 21. Social Aspects of Stress • If our social relationships are stressful our well- being may be threatened – Bullying, abuse, violent neighborhood • On the other hand: stress can be alleviated via social support • The early family environment, along with cultural norms, seems to provide the groundwork for social competence – Warm/nurturing families teach kids to manage stress effectively
  • 22. Transactional Model of Stress • Lazarus and Folkman (1975) • Assumes stress involves a transaction between an individual and the external world • A potentially stressful event must be perceived as stressful to elicit a stress response • Psychological factors are therefore important
  • 23. Transactional Model of Stress • Appraisal of stressors within the transactional model of stress: – Primary appraisal: • Event is judged to be irrelevant, positive, or negative to one’s well-being – Secondary appraisal: • Different relevant coping strategies are considered before choosing a way to deal with the stressor • They both influence each other; they are continuous and interdependent
  • 24. Coping Strategies • Folkman and Lazarus (1988) • Problem-focused coping: – Dealing with the stressor itself – EXAMPLE: Quitting a stressful job • Emotion-focused coping: – Handling the emotional aspects of the stress response rather than changing the situation – EXAMPLE: Taking yoga to deal with stresfull job
  • 25. Coping Strategies • Carver (2007) • Problem-focused is more likely to happen if the person feels they can control the stressor • Emotion-focused is more likely to happen if the person feels they have little control of the stressor • It is difficult to make a clear distinction between the two – Two kinds of strategies influence each other – Problem-focused can reduce unpleasant emotions – Emotion-focused can make problem-focused coping more effective
  • 26. Coping Strategies • Emotion-focused coping may be effective short- term, but not in long-term – Can cause addictions like alcoholism if you use alcohol to cope • Thus the term avoidance coping – Individual only wishes to avoid the negative feelings of the stressor than deal with it/fix it • Proactive coping: effort done prior to avoid a stressful experience – Like studying hard for an exam
  • 27. Ursin and Erison (2004) • Generally people benefit positively and experience lower levels of stress if they actively do things to reduce stress! • If one believes they can manage stress, the stress is less intensive and long-lasting • So do some yoga and hang out with friends often!
  • 28. Social Support • Social support: feeling that one is cared for and part of a social network with mutual obligations • Forms of support: – Emotional support: warmth and understanding – Informational support: helping a person to understand/logically evaluate a stressor – Practical support: financial assistance, etc
  • 29. Social Support • Giving social support may strengthen a relationship • Provides a sense of purpose – It signifies that one is important and needed • Just knowing you could get support may be the most beneficial factor of social support!
  • 30. Social Coping: Men & Women • Taylor (2002) • Theory of “Tend and Befriend” – Males tend to exhibit fight-or-flight response to stressors • Key hormone: testosterone – Females “tend” (undergo nurturing activities) and “befriend” (seek social support) • Key hormone: oxytocin
  • 31. Social Coping: Women & Men • Thoits (1995): Women were more involved than men in both giving and receiving social support • Women are generally more likely to mobilize social support in times of stress • Belle (1987): Women maintained more same-sex close relationships than men did • Reported more benefit from contacts with their female friends and relatives
  • 32. Culture • Taylor (2008): Culture is a variable that may moderate how social support is perceived • Independence vs. interdependence – Individualistic cultures see the self as independent – Collectivist cultures perceive the individual as part of a social group (interdependent) • Taylor et al. (2004): • European, US, and Korean students asked about their ways of coping with stress • Significantly less Korean students used social support – Maybe due to Asian concerns with harmony, social criticism, or losing face
  • 33. Support Groups • Evans (1979): 15 million Americans were using social support groups to deal with mental health • Kessler et al. (1997): Approx. 25 million people participate in support groups at some point in their lifetime • Davison et al. (2000): Women, and white people as a whole, are more likely to participate in support groups than men and non-white people as a whole
  • 34. Internet-based Social Support • Help people who do not have IRL support – Provides extra support for those that do! • Participant privacy/security is important when experimenting with it • Klemm et al. (1999) content analysis of internet-based support groups: – Members usually sought information, gave information, encouraged, gave support • Women were more than twice as likely to provide encouragement and support • Men were more than twice as likely to offer information
  • 35. Wenzelberg et al. (2003) • Aim: Evaluate the beneficial effects of online support groups • Method: 72 women with breast cancer assigned to a 12 week internet support group • Results: Moderately effective in reducing the participants’ scores on perceived stress and depression
  • 36. Mindfulness Stress Reduction (MBSR) • The mind is related to the body, so learning to relax and concentrate on one thing at a time can reduce stress • Mindfulness-based stress reduction (MBSR): relaxation technique developed by Kabat- Zinn in 1979
  • 37. MBSR • Based off of Buddhist teachings • Involves training in meditation • Aim: cultivate mindfulness – Mindfulness: awareness that emerges through paying attention, on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment – AKA: Respond to the situation instead of reacting to it automatically
  • 38. MBSR • Wants the individual to develop the ability to calmly step back from thoughts and feelings during stressful situations • Shapiro et al. (1998) compared stress of students taking MBSR with those not taking MBSR as exams came closer – Before MBSR started there was no difference in stress – As exams got closer and classes were taught: • Non-MBSR students increased anxiety (control group) • MBSR students were less anxious than they were at the start!
  • 39. Evaluation of Shapiro et al. (1998) • MBSR participants learned to cope with stress better • Generalization issues: – Participants were medical students – Self-selected samble – Offered course credits (low number of drop-outs)
  • 40. Speca et al. (2000) • Cancer patients were split into MBSR group or waiting-list group (control group) • Results: – MBSR group showed a reduction in total mood disturbance (anger, anxiety, depression) by 65% – Stress reduced by 35% – More time spent meditating led to greater mood improvement • Have to keep social desirability effects in mind while evaluating this study!