Stress

Stress & Health

Health psychologists have examined (I) environmental events or stressors that affect people, (II) physiological reactions to stressors, and (III) intervening psychological or person factors which either help or interfere with people's abilities to cope with the stressors.

I. Types of Stressors

Daily Hassles - are annoyances encountered in daily life. Examples include traffic problems, differences in lifestyles between roommates, deadlines, expectations of parents or teachers, bills and money problems, bad weather, car problems, and so on. Daily hassles are not necessarily encountered everyday but represent disruptions of or annoyances to one's daily routine.

Major Life Changes - are milestone events in a person's life, which cause substantial change in one's daily routine. Examples include graduating from college, changing jobs, getting married or divorced, breaking up a long-term relationship, having a family member diagnosed with a chronic disease, death of a loved one, moving, becoming a parent, and so on. Major life changes happen once or only a few times in a person's life.

Catastrophes - are large-scale events that disrupt the lives of many people and strain or overwhelm community services. Examples include natural disasters such as the 1993 Hurricane Andrew in south Florida, the 1999 floods in North Carolina, the wars in Bosnia & Kosovo, and so on. In these cases, public utilities (e.g. water and sanitation, electricity, grocery stores and food supply routes) may be destroyed; health care services are overburdened and cannot care for all those in need, etc. Often many people lose their homes, means of self-support and may completely leave the area to start life over in some other place.

II. Physiological Reactions

When people experience stressors, the typical physiological reaction is a "fight-or -flight response." The sympathetic nervous system (SNS) is activated, arousing the body to either escape from or defend against the stressor. With mild stressors, the "fight-or-flight" response includes release of excitatory neurotransmitters and hormones, increased heart rate and blood pressure, more rapid and shallow respiration, and perspiration on brow or palms.

When a stressor lasts more that a few minutes, physiological reactions are more extreme.

More excitatory substances (i.e., adrenaline, noradrenaline, and corticosteroids) are secreted by the brain, the adrenal gland, pituitary, and thymus.

These substances, in turn, activate other biochemical processes, including the liver and kidneys releasing more blood sugar for energy. Fuel for energy is stored in fat tissue and the liver in the form of glycogen. Under stress, the liver and kidneys convert glycogen into glucose or blood sugar that is burned as energy.

In the short-term, extra glucose quickens reflexes, helps to fight inflammation and infections (in case of injuries), and focuses one's attention as in hypervigilance.

The immune system temporarily produces more B lymphocytes & T lymphocytes (white blood cells) and macrophages. These substances identify and/or attach to foreign bacteria, viruses and other junk that may cause illness, so that these foreign substances can be destroyed or eliminated from the body.

General Adaptation Syndrome

SNS arousal is an adaptive process. Evolutionarily speaking, a surge of energy, quickened reflexes, and production of immune-enhancing substances are necessary and beneficial responses to threatening situations. Initially, this arousal process acts as an alarm so an individual can recognize and respond to threatening situations. The SNS maintains arousal for several minutes or longer, and the individual's resistance to the stressor is more effective. After a prolonged period of arousal, the body resources are depleted and the SNS can no longer maintain even a normal arousal level. At this exhaustion phase, fatigue sets in, there are fewer lymphocytes in the immune system, less adrenaline, and hypervigilance becomes carelessness & distractibility. In this exhaustion phase, an individual becomes more vulnerable to infections and injuries. Prolonged stress reaction and exhaustion increases a person's susceptibility to a whole range of stress-related illnesses, e.g. coronary heart disease, high blood pressure, ulcers, stroke, and depression. Exhaustion also can cause flare-ups of other chronic illnesses, e.g., arthritis, asthma, Parkinson's disease, multiple sclerosis, or herpes. The General Adaptation Syndrome is a model of this stress reaction process developed by Hans Selye and depicted below.

Hardiness & Gender

Generally, women have stronger immune systems than men. Reserve energy for resisting stressors is stored in body fat and women have a higher body fat to muscle mass ratio than men. As a result, women produce more lymphocytes and other stress resistant substances over a longer time period than do men. Consequently, women in general are somewhat less likely to suffer from viral infections but somewhat more likely to suffer from self-attacking diseases, such as Lupus or Multiple Sclerosis.

From birth to very old age, the death rate of males exceeds the death rate of females.

Stage Ratio of males to females Explanation

Conception 120 - 100 Male is the "default" gender. Even if an individual is genetically female, certain hormones must be released at critical periods of pregnancy for female sex characteristics to develop. If these critical periods are missed, the baby will not develop all the secondary sex characteristics of a female.

Birth 108 - 100 Pregnancy is a big demand on the body and about 1 in 4 pregnancies end in miscarriage. Although the medical reasons are not known, a woman is more likely to have a miscarriage with a boy baby than with a girl baby.

25 years 102 - 100 In adolescence and early adulthood, boys are more likely to engage in
dangerous, risky behavior (e.g., racing cars, shooting guns) than girls.
Boys also are more likely to fight in wars. Therefore, young men die from
accidents, suicide, homicide, and other injuries at a higher rate than young
women.

65 years 2 - 3 Throughout life, women are more likely to go to a physician for care, are
better at following treatments & taking prescriptions, talk more about their feelings with friends than do men. Stereotypically, men often think of themselves are tough, able to deal with stressors on their own, and believe they will get over illnesses on their own. Women get help & support --> and have an average life expectancy of 7 years longer than that of men.

100 years 1 - 4 Surveys of mortality statistics reveal that men are more likely to die within one year of when their life-long spouse dies, while women are more likely to live several years after losing a life-long spouse.

III. Intervening Psychological Factors

Life threatening situations are sources of stress for everyone but there are many stressors in everyday life that are not real threats to life and survival. The way individuals perceive these non-life-threatening stressors (as well as severe, life-threatening stressors) can influence physiological reactions and subsequent development of real physical illness. Some examples of factors that influence how people perceive stress, which in turn affect health, include (1) Type A Personality, (2) Perceived Control /Optimistic or Pessimistic Explanatory Style, (3) Lifestyle Habits, and (4) Social Relationships.

Type A Personality - In the 1950s, cardiologists Friedman and Rosenman noticed that about 45% of deaths from coronary heart disease (CHD) occurred in men under 55 years old. This observation plus the fact the CHD was a leading cause of death among men, led to research on cholesterol intake and other possible causes of CHD. An example of one such study compared diets of women and men for animal fats, cholesterol and other foods thought to clog arteries. The results showed no differences between men's and women's diets, but the men had more heart problems. Friedman & Rosenman then studied blood serum and cholesterol levels in a group of professional accountants for several weeks. The serum and cholesterol levels increased up to April 15 (tax deadline), then dropped back to normal levels by June (in about 6 weeks).

Based on these studies and similar research, Friedman & Rosenman proposed a Type A Personality - which is set of personality traits, including a hurrying sense of time urgency.   Individuals displaying this pattern seem to be engaged in a chronic, ceaseless, and often fruitless struggle - with themselves, others, circumstances, time, and sometimes with life itself. They also frequently exhibit a free-floating but well-rationalized form of hostility and almost always a deep-seated insecurity.@

The next step is testing the hypothesis: "Type A Personality causes CHD." Friedman & Rosenman started doing predictive or longitudinal studies. They identified relatively health young men who exhibited Type A Personality traits and others who did not (these were called Type B Personalities). After 10 years, the Type As were 3 times as likely to have heart disease as were type B personalities. By the 1970s, several similar studies had been completed and results were inconsistent. At lot of competitive, hard-driving professional men did not seem to have heart problems. Now, we know that there is an additional trait in this Type A personality that predicts better whether someone will develop CHD. Specifically, there is an aggression / hostility aspect that seems to be an important factor in causing competitive individuals to develop heart problems.

Characteristics of a Type A Behavior Pattern

Hurry sickness - a sense of time urgency; trying to accomplish too much in too little time.

Quest for numbers - preoccupied with ratings, being better than others, earning more money, etc.

Insecurity of status - strong need for "objective" measure of self-worth, pursues achievement to get admiration from others.

Aggression & hostility - competes with or challenges others continually; struggles to beat others, quick-tempered and angry.

Reducing health risks associated w/Type A behavior

Get rid of activities that are not directly helpful to work, social life, or economic goals. Schedule more time for appointments or other tasks. Wake up 15 - 20 minutes earlier in the day.

Create a more relaxed or peaceful environment for work. Organize, get rid of paper and other clutter, add some personal objects e.g. artwork, toys, etc.

Think before speaking - try not to blurt out the first thing that comes to your mind.

Plan to spend some time alone daydreaming, talking with friends about non-work activities, browse in a book store or library.)

Perceived Control /Optimistic or Pessimistic Explanatory Style

People like to believe that they are "in control" of their behavior, thoughts and feelings - and therefore in control of at least some of their life. When their life is out of control, people usually experience a range of negative psychological reactions such as depression and anxiety.

Psychologists became interested in learning more about perceived control and well-being for many reasons. One phenomenon involved survivors of imprisonment in Nazi concentration camps during world war II. In these camps, prisoners would be gathered in large groups (100 people or more), then stripped, searched, and examined by a physician while everyone else looked on. Malnutrition and starvation were common because too little food was provided. Prisoners were shot for minor rule violations or no reason at all. Victor Frankel (a psychologist) was one survivor who wrote about how prisoners coped. Some prisoners were wealthy community leaders and had high status jobs before imprisonment. In spite of this success, these people became depressed, angry, bitter, selfishly grabbing food from others, and so forth. Some people maintain a sense of dignity and personal worth, helping other prisoners by sharing their limited food ration or providing emotional support. This positive coping with adverse circumstances was relatively rare. How did they do it? (Schniedler's list clip)

Concentration camp prisoners who maintained a sense of personal worth and most effectively coped with their circumstances also maintained a sense of hope and optimism. They believed that the Nazi's would be defeated, the concentration camp hell would end, and their would have a happy, productive life in the future. Was this a delusion or unrealistic belief?

Empirical support for conclusion that (1) loss of perceived control leads to learned helplessness.

Seligman's executive monkey, dog, rat studies -- lack of control led to ulcers, failure to learn in new situation when control was possible.

Rodin's nursing home study w/ plants.

(2) perceived control (a.k.a optimistic explanatory style) lead to longer life (selgiman's study of baseball players - coding attributions from verbal statements) and greater job success (Seligman's life insurance salesman study).

attributions (explanations about past events) & optimism or expectations about the future

global, stable & internal dimensions

positive events with global stable, & internal attributions + negative events with specific, unstable, and external attributions seem to promote optimism.

How to cultivate optimism?

- seems to be high in individualistic cultures e.g. U.S.
- religion - Christians, Jewish & Muslim conservatives tend to be more optimistic that liberals
- modeling - explanatory styles of children often correspond to those of the parent
- social barriers / obstacles could be reduced to reduce stress
- humor - enhances immune system and one's positive outlook on life.

Life Style - smoking, drinking, nutrition, exercise, time management

Social Relationships - problem-focused coping vs. emotion-focused coping

IV. Humor, Happiness & Positive Psychology

Stage	Ratio of males to females	Explanation
Conception	120 - 100	Male is the "default" gender. Even if an individual is genetically female, certain hormones must be released at critical periods of pregnancy for female sex characteristics to develop. If these critical periods are missed, the baby will not develop all the secondary sex characteristics of a female.
Birth	108 - 100	Pregnancy is a big demand on the body and about 1 in 4 pregnancies end in miscarriage. Although the medical reasons are not known, a woman is more likely to have a miscarriage with a boy baby than with a girl baby.
25 years	102 - 100	In adolescence and early adulthood, boys are more likely to engage in dangerous, risky behavior (e.g., racing cars, shooting guns) than girls. Boys also are more likely to fight in wars. Therefore, young men die from accidents, suicide, homicide, and other injuries at a higher rate than young women.
65 years	2 - 3	Throughout life, women are more likely to go to a physician for care, are better at following treatments & taking prescriptions, talk more about their feelings with friends than do men. Stereotypically, men often think of themselves are tough, able to deal with stressors on their own, and believe they will get over illnesses on their own. Women get help & support --> and have an average life expectancy of 7 years longer than that of men.
100 years	1 - 4	Surveys of mortality statistics reveal that men are more likely to die within one year of when their life-long spouse dies, while women are more likely to live several years after losing a life-long spouse.