Transcript 5. Stress

Defining & measuring stress
Assist. Prof. Merve Topcu
PSY 411 Health Psychology
Department of Psychology Çankaya University
2016-2017, Fall
Slide 11.2
The Nervous System (NS) & Physiology of Stress
• NS is to integrate all the body’s systems
• Billions of individual cells in NS called neurons
• Electrically charged ions hold the potential for an electrical discharge
• The electrical charge leads to the release of chemicals called neurotransmitters
(NTs)
• Excitatory or inhibitory NTs
• Excitatory or inhibitory messages have cumulative effect
• Neurons’ threshold must be exceeded in order to be activated
• If the threshold is exceeded, then neuron fires
• The released neurotransmitters diffuse across the synaptic cleft
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.3
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.4
Types of neurons
• Afferent neurons (Sensory neurons)
• Relay information from the sensory organs to CNS (spinal cord & brain)
• Efferent neurons (Motor neurons)
• Impulses travel from the CNS & cause contraction of muscles of stimulation of
glands and organs
• Interneurons
• Connect sensory neurons to motor neurons w/in the spinal cord
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.5
Organization of NS
CNS
Brain
Peripheral NS
Spinal
cord
Autonomic
NS
Sympathetic
NS
Parasympathetic NS
Somatic NS
Sensory &
Motor
nerves
(Skin &
muscles)
Cranial
nerves
(Head &
neck)
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.6
The Nervous System
• Two major divisions of the NS
1. Central NS (CNS)
• The brain & spinal cord
2. Peripheral NS
• All other neurons
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.7
Peripheral Nervous System
• That part of the NS lying outside of the brain & spinal column
and is divided into two parts
1. Somatic NS
2. Autonomic NS (ANS)
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.8
Peripheral Nervous System
1. Somatic NS
• Serves the skin and the voluntary muscles
• Moving your fingers
• Things you think to do
Stimulation
of skin &
muscles
Travel
through
spinal cord
By sensory
nerves to
SNS
• Motor nerves that activate muscles are part of SNS
• 12 pairs of cranial nerves has role in the transmission through spinal cord
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.9
Peripheral Nervous System
2. Autonomic NS
• Self-governing, involuntary & automatic
• Outside realm of conscious or voluntary control
• E.g., controlling heart rate / breathing
• Can be learned to control
• Primarily serves internal organs
• Important in understanding responses to stress
• Neurons in the ANS are activated by neurotransmitters, principally
acetylcholine and norepinephrine
• Complex effect on organ systems bc organs contain different
neurochemical receptors
• 2 divisions:
• Differs both anatomically & functionally
1. Symphatetic NS
2. Parasympathetic NS Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3
rd
Edition, © Pearson Education Limited 2013
Slide 11.10
Peripheral Nervous System
2. Autonomic NS
• 1 & 2 works reciprocally
• Maintaining appropriate level of activation called allostasis
• Means, different circumstances requires different levels of physiological action
1. Symphatetic NS
• Mobilizes the body’s resources in emergency, stressful, and emotional
situations
• Fight / flight response (Cannon)
2. Parasympathetic NS
• Promotes relaxation, digestion, and normal growth functions
• Non-stressful situations
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.11
Peripheral Nervous System - Autonomic NS
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.12
The Neuroendocrine System
• The endocrine system consists of ductless glands distributed throughout
the body
• The neuroendocrine system consists of those endocrine glands that are
controlled by and interact with the nervous system
• Use hormones via bloodstream for messaging in body
• may have a direct effect or may cause the secretion of another hormone
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.13
The Neuroendocrine System
• Similarities for endocrine system & neuroendocrine system
• Systems share, synthesize, and release chemicals
• Have communication & control functions
Differences btw Endocrine System & Neuroendocrine Systems
Endocrine system
Neuroendocrine system
Chemicals called hormones
Chemicals called NTs
Activation of neurons are slow & long-termeffective
Activation of neurons are rapid & shortterm-effective
Synthesized by endocrine cells, released
into the blood, reach target even in hours
w/ prolonged effect
Released by stimulation of neural impulses,
flow across synaptic cleft, & immediately
reabsorbed or inactivated
Like the radioshow, transmits everywhere at
once
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.14
The Neuroendocrine System
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.15
The Neuroendocrine System
• The Pituitary Gland
• Excellent example of the intricate r/ship btw the NS & endocrine systems
• Connected to the hypothalamus
• A structure in the forebrain
• Sometimes referred to as the “master gland” bc
• it produces 7 hormones that affect other glands and prompt the production of yet other
hormones
• Influence secretions of tyroids, pancreas, adrenals, and gonads
• Secrets growth hormone
• Adenocorticotropic Hormone (ACTH)
• Produced by pituitary gland
• Plays an essential role in stress
• When stimulated by the hypothalamus, the pituitary gland releases ACTH which acts on the
adrenal glands
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.16
The Neuroendocrine System
• The Adrenal Glands
• located on top of each kidney
• Controls salt & carbonhydrate metabolism
• Secretes hormones for arousal & sleep
• Contains 2 structures that produce different hormones
• Each gland is composed of outer covering (the adrenal cortex, cortisol) & an
inner part (the adrenal medulla, E & NE)
• Both secretes hormones that are important in the response to stress
• Cortisol is the most important stress hormone
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Release of
glucocorticoids
Stimulation of adrenal
cortex & medulla
Accumulation of ACTH
Hypothalamus
glands
of adrenal
Situmulation
Pituitary gland
Stress
Slide 11.17
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.18
The Neuroendocrine System
• The Adrenal Glands
• The adrenomedullary response includes activation of the adrenal medulla by
SNS
• Prompts thesecretion of catecholamines
• A class of chemicals that contain epinephrine & noreepinephrine
• Epinephrine: sometimes known as adrenaline, is produced exclusively by the
adrenal medulla & accounts for about 80 % of hormone production of the
adrenal glands
• Noreepinephrine is produced in many places besides the adrenal medulla. It is also a
NT.
• Both hormones act slower than NT, acts in bloodstream and synaptic cleft, & their
effect is more prolonged
• Catecholamines is used as stress index (e.g., in urine)
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.19
Physiology of Stress Response – HPA Axis
• Physiological reactions to stress starts w/ the perception of stress!
• SNS controls mobilization of the body’s resources in emotional, stressful, and
emergency situations.
• Stress initiates a complex series of events w/in the neuroendocrine system
• The anterior pituitary gland secrets ACTH which stimulates the adrenal glands
to secrete glucocorticoids, including cortisol.
• This mobilizes the body’s energy resources, raising the level of blood sugar to
provide energy.
• Cortisol also has an-inflammatory effect which defends against swelling from
injuries.
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.20
Physiology of Stress Response
– HPA Axis
HPA Axis:
Hypothalamus / Pituitary Gland / Adrenal Axis
Stress
ANS stimulates
Hypothalamus
H activates P
P secretes ACTH
Adrenal cortex
secretes Cortisol
Energy resources
mobilizes
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.21
Physiology of Stress Response – SAM response
• Activation of th edarenal medulla results in secretion of
catecholamines (NE & E)
• E is produced exclusively in the adrenal medulla & is used as an index
of stress
• The amount of E secreted can be determined by assaying a person
‘s urine
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.22
Physiology of Stress Response – SAM response
SAM = Sympatho-adrenal-medullary
• Stress
• ANS stimulates Posterior hypothalamus
• Hypothalamus has direct neural connections to Adrenalmedula
• Adrenal medulla secretes NE & E
• Energy resourses mobilized
• Increasing heart rate
• Decreased digestion
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.23
• An understanding of the physiology of stress does not completely
clarify the meaning of the stress
• So, we have several models that have been constructed to better
define & explain stress
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.24
Theories of stress
• Stress has no simple definition
• It has been defined in 3 different ways
• As a stimulus
• ‘I have a high-stress job’
• As a response
• ‘my heart races when I feel a lot of stress’
• As an interaction
• ‘I feel stressed when I have to make financial decisions at work, but other types of
decisions do not stress me.’
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.25
Theories of stress
• Walter Cannon- Harvard Medical School
• First to describe the effects of acute stress
• Termed this stress reaction as the fight-or-flight response
• A primitive response that quickly increases heart rate, respiration, blood pressure,
and serum cholesterol
• Acute Alarm Reaction
•
•
•
•
•
•
•
Body prepares for fight or flight
Time of emergency
Heart pumps blood faster and with greater force
Blood pressure elevates abruptly
Lungs send more oxygen to muscles
Faster blood clotting
Widening of the pupils to admit more light in order to heighten visual acuity and
awareness
• Increase in breathing rate
• Endorphins released – decrease in body’s sensitivity to pain
• Elevated blood sugar levels
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.26
Definitions
• Stressor- a stimulus with the potential for triggering Fight or Flight in four
categories (Social, Environmental, Psychological, Philosophical)
• Stress reactivity- Body changes to meet demands (F or F response)
• Strains - Outcomes of stress reactivity and may be physical, psychological, or
behavioral. (tension headache, phobias, addictions)
• Stress- The wear and tear on the body when there is reactivity. Combination of
a stressor, stress reactivity, and strain.
• Homeostasis- The body’s balanced state
• Eustress- Good stress
• Distress- Bad Stress
• Duration/Degree• Duration= the amount of time our body’s physiology varies
• Degree=Condition or the amount of physiological variance
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.27
Types of stress
Stress and resource loss
Stress will result when there is actual or threatened loss of resources, or a lack
of gain after investing resources (Hobfoll 1989).
Acute stress
Chronic stress
Natural catastrophes symptoms:
• Job features associated with
occupational stress:
•
•
•
•
Panic
Phobias
Survivor guilt
Isolation, withdrawal, etc.
Examination stress impairs:
• Memory
• Attention
•
•
• Demand
• Controllability and perceived
self-efficacy
• Predictability
• Ambiguity
• Lack of support
Chronic illness
War
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.28
Hans Selye’s view of stress
• Studied the effects of long-term (chronic) stress
• Concept of stress & how body defends itself in a stressful situation
• Stress is- “The nonspecific response of the body to any demand made
upon it”
• Summarized his findings by proposing a three-phase process called the
general adaptation syndrome
• Alarm reaction
• Stage of resistance
• Stage of exhaustion
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.29
Hans Selye’s view of stress
• In the alarm reaction, resources are quickly mobilized as th SNS springs into
action
• If the stressor remains, the organism enters a defensive resistance stage
• Following prolonged exposure to a stressor, the energy necessary for
adaptive resistance may become depleted in a stage of exhaustion
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.30
Hans Selye’s view of stress
• Prolonged resistance to stress may lead to ‘disease of adaptation’
•
•
•
•
•
•
•
•
•
•
•
•
•
Adrenal tumors
Vascular lesions
Gastrointestinal erosions
Rheumatism
Arthiritis
Peptic ulcer
Ulcerative colitis
Hypertension
CV disease
Hyperthyroidism
Bronchial asthma
Various psychosomatic disorders
Depressed immune system, etc.
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.31
Critics of Hans Selye’s view of stress
• Theory is influencial in the learning & measuring stress
• But ignores psychological factors
• Experiences are mostly on non-humans
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.32
Lazarus’s view
• Interpretation of stressful event is more important than the event itself
• Perception includes
•
•
•
•
Potential harms
Threats
Challenges
Individuals’ perceived ability to cope w/ them
• Transactional / interactionist approach
• Stress as a transaction
• Stress refers to a r/ship btw person & environment
• Stress is a subjective experience!
• Stress is a result of an interaction between
• an individual’s characteristics and appraisals,
• the external or internal event (stressor) environment
• the internal or external resources that a person has available to them
• Motivational and cognitive variables are considered central
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.33
Lazarus’s view
Appraisal processes
Primary appraisal processes
Person considers quality and nature of a stimulus event:
«How does this stressor affect my wellbeing?»
•
•
•
those that pose harm (potential damage that has already been done. E.g. illness or injury)
those that threaten (anticipation of harm)
those that set a challenge (the person’s confidence in overcoming difficult demands)
Secondary appraisal processes
Assessment of one’s resources and abilities to cope with the stressor (coping
potential):
«Will I be able to cope w/ this stressor?»
•
•
internal resources (e.g. determination, knowledge, strength)
external (e.g. social support, money)
Reappraisal processes
«What changes in coping do I need to make based on new information?»
• Appraisals changes as new information becomes available
• Does not always result in more stress, sometimes it decreases stress
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.34
Transactional model of stress
Figure 11.1 Lazarus’s early transactional model of stress
Source: adapted from Lovallo (1997: 77).
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.35
What factors influence appraisal?
There are many aspects of the stimuli event itself which can influence
the appraisals that a person makes.
• Events that are imminent (e.g. medical results due the next day; driving test that
day).
• Events at an unexpected time in life (e.g. being widowed in one’s 40’s).
• Events that are unpredictable in nature (e.g. being made redundant).
• Events that are ambiguous in terms of:
─
─
personal role (e.g. starting a new job)
potential risk or harm involved (e.g. undergoing surgery)
• Events that are undesirable (e.g. moving house due to job loss).
• Events over which the individual perceives no control (behavioural or
cognitive, e.g. noisy neighbours).
• Events that elicit high amounts of life change (e.g. childbirth).
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.36
Lazarus’s view
• Appraisals illustrated
Consider forthcoming examinations as a potential stressor:
•
There is no way I can possibly deal with this, I simply know I will fail
(threat + no resources = stress)
•
This will be really hard, I just am not as clever as the other students
(threat + limited internal resources = stress)
•
Maybe I can manage this, if I revise really hard
(challenge + possible internal resources = less stress)
•
I could perhaps do it if I get some help from my friends
(challenge + external resources = less stress)
•
This isn’t a problem, I know the material really well
(benign, no stress)
•
I managed to pass the last time, I’ll be okay this time
(benign, no stress)
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.37
Lazarus’s view
• Development
Lazarus 1993)
of primary appraisals (Lazarus 1991; Smith and
• Motivational relevance: i.e. extent event is relevant to goals
• Motivational congruence: i.e. extent situation is congruent with goals
• Ego involvement: i.e. appraisals of threat to self-esteem/moral code
• elicit anger, guilt, anxiety
Cognitive appraisals of harm, threat and challenge were attached to emotion
types, e.g.
Table 11.2 Appraisal-related emotions
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.38
Lazarus’s view
Development of secondary appraisals (Smith and Lazarus 1993)
1. Internal/external accountability (‘blame/credit’): attributing responsibility for
the event. Distinguishes between anger (other-blame) and guilt (self-blame)
emotions. Credit may associate with pride.
2. Problem-focused coping potential*: the extent to which the situation is
perceived as changeable by instrumental (practical, problem-focused) coping
options. If not, fear and anxiety may result.
3. Emotion-focused coping potential*: perceiving an ability to cope emotionally
with the situation. If not, fear, sadness and anxiety may result.
4. Future expectancy concerning situational change: perceived possibilities of the
situation being changeable. Perceived unchangeability may cause sadness.
* Lazarus merged 1 and 2, referring simply to ‘coping potential’.
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.39
Lazarus’s view
• Vulnerability
• Stress is more likely to be aroused when a person is vulnerable
• When s/he lacks of resources in a situation of some personal importance
• Resources may be physical or social, but their importance is determined by
psychological factors such as perception & evaluation of the situation
• Vulnerability differs from threat in that represents only the potential threats
• Threat exists when one perceives that his or her self-esteem in jeopardy
• Vulnerability exists when the lack of resources creates a potentially threatening or
harmful situation
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.40
Lazarus’s view
Stress and coping
• five main coping functions, each of which contribute to
successful adaptation to a stressor:
1. reducing harmful external conditions;
2. tolerating or adjusting to negative events;
3. maintaining a positive self-image;
4. maintaining emotional equilibrium and decreasing
emotional stress;
5. maintaining a satisfactory relationship with the environment or
with others.
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.41
Lazarus’s view
• Coping is a dynamic process involving a constellation of
cognitions and behaviour that arise from the primary and
secondary appraisals of events, and the emotions attached to
them.
• Anything a person does to reduce the impact of a perceived or
actual stressor
• Operate to alter or reduce negative emotion(s) attached to the
stressor, or it can directly target the stressor
• May or may not succeed, but it is concerned with trying to
achieve adaptation
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.42
Coping taxonomies
Table 12.1 Coping dimensions
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.43
Other Influential Researchers
• Simeons
• Psychosomatic disease
• Benson
• Relaxation response
• Vogt
• Autogenic training
• Jacobson
• Progressive relaxation
• Several theories explain the causes of stress:
• Holmes and Rahe - Life events theory: stress occurs when the situation
requires more resources than are available
• Kobasa and colleagues- Hardiness theory: one’s attitude toward the events
determines stress, not the event.
• Social support theory: insufficient social support for responding to event
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.44
Sources of stress
1. Cataclysmic events w/ natural or human causes
• “sudden, unique, and powerful single life-events requiring major adaptive
responses from population groups sharing the experience” by lazarus
• natural disasters
• posttraumatic stress disorder
• physical proximity to the event
• time elapsed since the event
• the intention of the perpetrators
2. Changes in an individual’s life history
• major & minor life events both are stressful
• the importance of change
• life events usually evolve more slowly than cataclysmic events
3. Ongoing hassles of daily life
• unlike life events that call for people to make adjustments in their lives, daily
hassles are part of everyday life
• can originate from both the physical and the psychosocial environment
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.45
• Family Relationships
Sources of stress
• Work, Money, Sexuality
• Having A Family Member w/ Chronic Disease
• Workplace Demands
•
•
•
•
Discrimination & stigmatization
lack of control, status, and compensation
Lower-level occupations are actually more stressful than executive jobs
Middle-level managers such as foremen and supervisors also have highly stressful jobs
• Multiple Roles
• Community Conditions
• Urban press
• the environment of poverty
• Pollution, noise, violence
• Crowding
• Population density as a physical condition in which a large population occupies a
limited space
• Crowding is a psychological condition that arises from a person’s perception of the
high-density environment in which that person is confined
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.46
Measurement of stress
• First measure stress in order to understand the effect of stress on disease
• Methods of measurement
• Two broad categories:
1. Physiological measures
• Associated w/ the view that stress is a response
• focus is on the biology of stress
2. Self-reports
• Often used by health psychologists who tend to take a tranactional
view of stress
• Either life events or daily hassles
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.47
Measurement of stress
1. Physiological measures
•
•
•
•
• Physiological indexes
• Blood pressure
• Heart rate
• Galvanic skin response
• Respiration rate
• Increased secretion of stress hormones such as cortisol and
epinephrine
The activation of the body’s sympathetic nervous system and HPA axis
Epinephrine and norepinephrine can be measured in blood or urine
samples and can provide an index of stress
Physiological measures of stress is that they are direct, highly reliable, and
easily quantified
The mechanical and electrical hardware, and clinical settings that are
frequently used may themselves produce stress
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.48
Measurement of stress
1. Self-reports
• Life events scale
• The earliest and best known of these self-report procedures is the Social
Readjustment Rating Scale by Holmes & Rahe in 1967
• a list of 43 life events arranged in rank order from most to least stressful
• the previous 6 to 24 months
• scores can be correlated with future events such as incidence of illness
• The Life Events Scale for Students (Clements & Turpin, 1996)
• The Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983)
• assesses three components of stress
• daily hassles
• major events
• changes in coping resources
• Everyday Hassles Scales by Lazarus
• Daily hassles are “experiences and conditions of daily living that have been
appraised as salient and harmful or threatening to the endorser’s well-being”
• Inventories must be both reliable and valid to predict future stress-related
illness
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.49
Stressful life events
Representative life event items from the social readjustment rating scale and their
LCUs Source: Holmes and Rahe (1967).
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.50
Coping with stress
• Personal Resources
•
•
•
•
•
•
Health & energy
Positive belief
Problem solving skills
Material sources
Social skills
Social support
• Social support refers to a variety of material and emotional supports a
person receives from others
• Social contacts / network refer to the number and types of people w/ whom
one associates
• Social isolation, which refers to an absence of specific, meaningful
interpersonal relations
• Stress-buffering hypothesis
• Personal control
• confidence that they have some control over the events that shape their
lives
• Locus of control
• Coping strategies
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.51
Goals for Stress Management
• Do not eliminate all stress
• Use as a motivator for peak performance
• Stress can be useful, stimulating, and welcome
• Limit harmful effects
• Limit the harmful effects of stress while maintaining life’s quality and
vitality
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.52
Behavioral interventions for managing stress
• Relaxation training
• Progressive muscle relaxation
• patients first receive the explanation that their present tension is mostly a
physical state resulting from tense muscles
• Autogenics training
• a series of exercises designed to reduce muscle tension, change the way people
think, and change the content of people’s thoughts
• Cognitive behavioral therapy
• a combination of behavior modification
• Influence on mental processes
• Stress inoculation includes three stages
• Conceptualization: identify and clarify their problems
• Skills acquisition and rehearsal: patients learn and practice new ways of coping
with stress; improve self-instruction by changing cognitions
• Follow-through or application: put into practice the cognitive changes they have
achieved in the two previous stages
• Emotional disclosures
• distinguished from emotional expression
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.53
Thoughts leading to emotions
Beck (1976) identified a number of automatic thoughts that lead
to negative emotions, including:
•
Catastrophic thinking: considering an event as completely negative, and
potentially disastrous: ‘That’s it – I’ve had a heart attack. I’m going to lose
my job, and I won’t be able to afford to pay the rent’.
•
Over-generalisation: drawing a general (negative) conclusion on the basis
of a single incident: ‘That’s it – my pain stopped me going to the cinema –
that’s something else I can’t do’.
•
Arbitrary inference: drawing a conclusion without sufficient evidence to
support it: ‘The pain means I have a tumour. I just know it’.
•
Selective abstraction: focusing on a detail taken out of context: ‘OK, I
know I was able to cope with going out, but my joints ached all the time,
and I know that will stop me going out in future’.
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.54
How stress can increase risk for health
problems through biological processes?
• Stress can influence health-related behaviors, which can increase risk for
disease or death
• Physiology of the Immune System
• The immune system consists of tissues, organs, and processes that protect
the body from invasion by such foreign microorganisms
• immune system performs housekeeping functions by removing worn-out or
damaged cells and patrolling for mutant cells
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.55
Physiology of the Immune System
• Organs of the Immune System
• The immune system is spread throughout the body in the form of the
lymphatic system
• The tissue of the lymphatic system is lymph
• Red cells and platelets
• Leukocytes (white blood cells)
• lymph nodes
• Lymphocytes
• Natural killer (NK) cells
• Thymus
• Thymosin hormone
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.56
Function of the Immune System
• The immune system’s function is to defend against foreign
substances that the body encounters
• System must be extraordinarily effective to prevent 100% of the
invading bacteria, viruses, and fungi from damaging our bodies
• Invading organisms can enter the body in many ways, and the
immune system has methods to combat each mode of entry
1. Nonspecific Immune System Responses
2. Specific Immune Systems Responses
3. Creating Immunity
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.57
Function of the Immune System
• Nonspecific Immune System Responses
• To enter the body, foreign substances must first pass the skin and
mucous membranes
• Thus, these organs and tissues are the body’s first line of defense
against the outside world
• Foreign substances that are able to pass these barriers face two
general (nonspecific) mechanisms
1. Phagocytosis, the attacking of foreign particles by cells of the
immune system
1. Granulocytes
2. Macrophages
2.
Inflammation, which works to restore tissues that have been
damaged by invaders
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.58
Function of the Immune System
• Specific Immune Systems Responses
• Specific immune responses are specific to one invader, such as a certain virus or
bacteria
• T-cells & B-cells
• When a lymphocyte encounters a foreign substance for the first time, both the
general response and a specific response occur
• microorganisms are killed and eaten by macrophages, which present fragments of
these invaders to T-cells that have moved to the area of inflammation
• This contact sensitizes the T-cells, and they acquire specific receptors on their
surfaces that enable them to recognize the invader
• An army of cytotoxic T-cells forms through this process, and it soon mobilizes a
direct attack on the invaders
• This process is referred to as cell-mediated immunity
• because it occurs at the level of the body cells rather than in the bloodstream
• especially effective against fungi, viruses that have already entered the cells,
parasites, and mutations of body cells.
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.59
Function of the Immune System
• Specific Immune Systems Responses
•
•
•
•
•
• With help of T-cells, the B-cell, mobilizes an indirect attack on invading
microorganisms
• B-cells differentiate into plasma cells and secrete antibodies
• Foreign substances that provoke antibody manufacture are called antigens (for
antibody generator)
The specific reactions of the immune system constitute the primary immune
response
During initial exposure to an invader, some of the sensitized T-cells and B-cells
replicate
Rather than go into action, are held in reserve
These memory lymphocytes form the basis for a rapid immune response on second
exposure to the same invader
This specifically tailored rapid response to foreign microorganisms that occurs with
repeated exposure is called immunity
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.60
Function of the Immune System
• Specific Immune Systems Responses
• Immune response through B-cell recognition of antigens and their manufacture
of antibodies is called humoral immunity because it happens in the bloodstream
• Creating Immunity
• One widely used method to induce immunity is vaccination
• In vaccination, a weakened form of a virus or bacterium is introduced into the
body, stimulating the production of antibodies
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.61
Immune System Disorders
• Immune deficiency, an inadequate immune response, may occur for
several reasons
• As a side effect of treatment
• E.g., side effect of chemotherapy
• Natural causes
• Breast feeding
• Born w/ innate deficiency
• A much more common type of immune deficiency is acquired immune
deficiency syndrome (AIDS)
• This disease is caused by a virus, the human immunodeficiency virus (HIV),
which destroys the T-cells and macrophages in the immune system
• People infected with HIV may progress to AIDS and become vulnerable to a wide
range of bacterial, viral, and malignant diseases
• Allergies are another immune system disorder
• allergic response is an abnormal reaction to a foreign substance that normally
elicits little or no immune reaction
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.62
Immune System Disorders
• For reasons not well understood, the immune system may attack its own
body. This situation occurs with autoimmune diseases
• E.g., Multiple sclerosis
• Transplant rejection
• the immune system identifies the organ as an invader, because the
organ has biochemical markers from the donor that are different from
those of its host
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.63
Psychoneuroimmunology (PNI)
• A multidisciplinary field that focuses on the interactions among behavior, the
nervous system, the endocrine system, and the immune system
• In the early 1900s, Ivan Pavlov discovered that through the process of classical
conditioning, environmental events could become automatic triggers of basic
physiological processes
• In 1975, Robert Ader and Nicholas Cohen published a study
• CS was a saccharin and water solution that rats drank
• UCS was the administration of a drug that suppresses the immune system
• During the conditioning process, the rats were allowed to drink the saccharin
solution and then were injected with the immunosuppressive drug
• The rats later showed immune suppression when they were given only the
saccharine solution
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.64
Psychoneuroimmunology (PNI)
• The immune system and other body systems exchange information
in a variety of ways
• E.g., Cytokines, chemical messengers secreted by cells in the immune system
• One type of cytokine is known as proinflammatory cytokine because it
promotes inflammation
• Cytokines include several types of interleukins
• May underlie a number of states, including feelings associated with
sickness, depression, and social withdrawal
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.65
Research in Psychoneuroimmunology
• Aims to understand of the role of behavior in changes in the immune system and
the development of disease
• Research should include all three components to establish the connection
between stress and disease
1. Psychological factors such as stress
2. immune system malfunction
3. Development of disease
• Reasons explaining difficulty in research
• Not all people with impaired immune systems become ill
• Methodology
• measure the immune system’s function by testing blood samples rather
than by testing immune function in people’s bodies
• the types of stressors, the species of animals, and the facet of immune system
function studied varied
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.66
Research in Psychoneuroimmunology
• Results revealed that
• Stress show correlations between sympathetic nervous system activation and
immune responses
• Sympathetic activation may be a pathway through which stress can affect the
immune system
• Medical students show more symptoms of infectious disease immediately before
and after exams
• Anxious students taking exams experience a lowering of immune function
• Effects of marital conflict may include poorer response to immunization and
slower wound healing
• Lack of partner support may play a role in increased stress during pregnancy
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.67
Is it possible to boost immunocompetence
through changes in behavior?
• Hypnosis, relaxation, and stress management
• But only modest effect
• Cognitive behavioral interventions
• 10-week cognitive behavioral stress management intervention
• some improvements in immune measures over a 6-month period
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.68
Physical Mechanisms of Influence
• How does stress influence the functioning of the immune system?
• The effects of stress can occur through the relationship of the nervous system to the
immune system through two routes
1. The peripheral nervous system
• PNS provides connections to immune system organs such as the thymus, spleen, and
lymph nodes
• Cytokines communicate with the brain via PNS
• This interconnection makes possible bidirectional interactions of immune and nervous
systems and may even enable effects on behavior such as fatigue, depression, which
are common symptoms of sickness
2.
The secretion of hormones
• releasing factors, hormones that stimulate endocrine glands to secrete hormones
• T-cells and B-cells have receptors for the glucocorticoid stress hormones
• Elevated cortisol is associated with a number of physical and emotional distress
condition & has anti-inflammatory effect
• Stress also changes helath-related behaviours
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.69
Does Stress Cause Disease?
• Experience substantial stress do not develop a disease
• Why does stress affect some people to get sick and leave others
unaffected?
• The diathesis–stress model
• some individuals are vulnerable to stress-related diseases because
either genetic weakness or biochemical imbalance inherently
predisposes them to those diseases
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.70
The Diathesis–Stress Model
• Important theory in explaining the development of psychological disorders
• Some people are predisposed to react abnormally to environmental stressors
• Predisposition (diathesis)
• inherited through biochemical or organ system weakness
• learned patterns of thought and behavior
• assumes that
• the person must have a relatively permanent predisposition to the disease
• person must experience some sort of stress
• Personal and psychosocial factors have the power to create vulnerabilities to
disorders
• The diathesis–stress model may explain why life event scales are so
inconsistent in predicting illness
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.71
Stress and Disease
• Stress affects through interactions among the nervous, endocrine, and
immune systems & unhealthy coping behaviors
• Headaches
• This source of pain is a major cause of disability
• The most frequent type is tension headache
• The type of stress that people associate with headaches tends not to be
traumatic life events but, rather, daily hassles
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.72
Stress and Disease
• Infectious Diseases
• Case of the common cold
• the higher the person’s stress, the more likely it was that the person
would become ill
• duration of a stressful life event was more important than severity
• Stress may also influence the extent to which vaccinations provide
protection against infectious disease
• People under substantial stress show weakened antibody production
following flu vaccination compared with people under less life stress
• HIV
• stress affects both the progression of HIV infection and the infected
person’s immune response to antiviral drug treatment
• The herpes simplex virus (HSV)
• Stress predicts these symptomatic outbreaks of HSV symptoms
• Stress also plays a role in other bacterial, viral, and fungal infections, including
pneumonia, hepatitis, and recurrent urinary tract infections
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.73
Stress and Disease
• Cardiovascular Disease
• Two roles of stress in CVD
• as a precipitating factor
• stress increases the risks
• A set of psychological stressors workplace and home stress, financial
problems, major life events in the past year, depression, and external
locus of control
• as a cause in the development
• even positive stress may create a risk for cardiovascular problems
• The role of stress in the development of heart disease is indirect
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.74
Stress and Disease
• Hypertension
• no simple relationship exists between stress and blood pressure
• External factors can elevate blood pressure
• E.g., noise
• But turns into normal when external factor is gone
• Reactivity
• some people react more strongly to stress than others
• Related to CVDs
• reactivity relates to incidence of stroke
• racist provocations produce reactivity
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.75
Stress and Disease
• Ulcers
• ulcers were the result of a bacterial infection rather than stress
• smoking, heavy drinking, caffeine consumption, and use of nonsteroidal antiinflammatory drugs all relate to ulcer formation
• behavioral factors play a role in the development of ulcers
• Diabetes
• Type 1, insulin-dependent
• Usually begins in childhood and requires insulin injections for its control
• Type 2, noninsulin-dependent
• Appears during adulthood and can most often be controlled by dietary
changes
• Stress may contribute to the development of both types of diabetes
• Premature delivery for pregnant women
• stressful environments relate to lower birth weight and developmental
delays
• infants of stressed mothers show higher reactivity to stress
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.76
Stress and Disease
• Asthma
• a respiratory disorder characterized by difficulty in breathing due to
reversible airway obstruction, airway inflammation, and increase in airway
responsiveness to a variety of stimuli
• stress plays a role in the development of this disorder, but stress is also
involved in asthma attacks
• living in inner-city neighborhoods, & low SES are risk factors
• Rheumatoid arthritis
• a chronic inflammatory disease of the joints may be related to stress
• rheumatoid arthritis is believed to be an autoimmune disorder in which a
person’s own immune system attacks itself
• Stress is a factor in the development of autoimmune diseases through the
production of stress hormones and cytokines
• Stress can make arthritis worse by increasing sensitivity to pain, reducing
coping efforts, and possibly affecting the process of inflammation itself
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.77
Stress and Psychological Disorders
• Stress leads mood changes
• Mood changes may change immune function, in turn yielding psychopathology
• Depression
• Ineffective coping may be one source of vulnerability to depression
• “kindling” hypothesis
• major life stress provides a “kindling” experience that may prompt the
development of depression
• This experience then sensitizes people to depression, and future
experiences of stress need not be major to prompt recurrences of
depression
• A negative outlook to the problems
• Rumination
• Genetic vulnerability
• Some types of stressful situations (E.g., Chronic workplace stress, Illness, )
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.78
Stress and Psychological Disorders
• Anxiety Disorders
• Include a variety of fears and phobias, often leading to avoidance
behaviors
• Included such conditions as panic attacks, agoraphobia, generalized
anxiety, obsessive-compulsive disorders, and posttraumatic stress
disorder
• Vulnerability
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013
Slide 11.79
Val Morrison and Paul Bennett, An Introduction to Health Psychology, 3rd Edition, © Pearson Education Limited 2013