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Chapter 14 549- 567

Behavioral medicine- an interdisciplinary field that integrates behavioral and medical

knowledge and applies that knowledge to health and disease
Health psychology- a subfield of psychology that provides psychology’s contribution to
behavioral medicine
Stress- the process by which we perceive and respond to certain events, called stressors,
which we appraise as threatening or challenging
General adaptation syndrome (GAS) - Selye’s concept of the body’s adaptive response to
stress in three stages- alarm, resistance, exhaustion
Coronary heart disease- the clogging of the vessels that nourish the heart muscle; the leading
cause of death in many developed countries
Type A- Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally
aggressive, and anger-prone people
Type B- Friedman and Rosenman’s term for easygoing, relaxed people
Psychophysiological illness- literally, “mind-body” illness; any stress-related physical illness,
such as hypertension and some headaches
Lymphocytes- the two types of white blood cells that are part of the body’s immune system: B
lymphocytes form in the bone marrow and release antibodies that fight antibacterial infections;
T lymphocytes form in the thymus and other lymphatic tissue and attack cancer cells, viruses,
and foreign substance
Coping- alleviating stress using emotional cognitive, or behavioral methods
Problem-focused coping- attempting to alleviate stress directly- by changing the stressor or the
way we interact with that stressor
Emotion-focused coping- attempting to alleviate stress by avoiding or ignoring a stressor and
attending emotional needs related to one’s stress reaction
Aerobic exercise- sustained exercise that increases heart and lung fitness; may also alleviate
depression and anxiety
Biofeedback- a system for electronically recording, amplifying, and feeding back information
regarding a subtle physiological state, such as blood pressure or muscle tension
What is stress?
a. An event that triggers tension or worry
b. A person’s perception of an event
i. A perceived difference between a demand placed in a person and his/her
ability to handle it; usually based on a past experience
c. A person’s physical or psychological response to an event or situation
d. Stressor- the stress producing situation, event, or person
e. Stress reaction- our body’s response
i. Heart rate, immune system clinking, etc.
1. hormones: released from adrenal glands- epinephrine,
norepinephrine, glucorticoids, cortisol
f. Distress- negative stress; stems from acute anxiety or pressure; takes a toll on
the body and mind
g. Eustress- positive stress; results from striving to do well
h. Death- complete freedom from stress
What is conflict?
a. Choice between alternates in order to be resolved- consequences involved
i. Approach-approach
1. two-attractive choices
ii. Approach-avoidance
1. one attractive choice and one unattractive
2. intensity or desire to do the attractive or the perceived threat of
avoiding the unattractive determines stress level
a. i.e. watch T.V./text-do homework
iii. Avoidance-avoidance
1. two unattractive alternatives
2. creates high stress level “lesser of two evils”
a. crash or swerve
iv. Double-approach avoidance
1. most common
2. both alternative have good/bad aspects.
3. degree of stress depends on intensity of attractiveness or repulsion
a. i.e. quit job-friends or no friends (with job)
• Stress hormones: epinephrine and norepepinephrine from adrenal glands


• Cerebral cortex-more stress; outer parts of adrenal glands let off glucocorticoid stress
• Our behaviors, such as smoking regular exercise, nutrition, and exposure to prolonged
stress can affect our susceptibility to heart disease, cancer, stroke, and chronic lung
disease, as well as making us more vulnerable t high blood pressure, skin rashes, and
other illnesses. The field of behavioral medicine is based on the understanding that
mind and body interact. Within that field, health physiology studied the ways out
attitudes, emotions, behaviors, and personality influence our health well-being, and risk
of disease
• Stress is not an action or condition; instead, it is a process by which we respond to
stressful events (stressors). An important part of that process is our appraisal of an
event as threatening, challenging, or unimportant. Our appraisals help determine
whether our response will be healthy feelings of energized and directed arousal, or
overwhelming feelings of distress
• Our response to stress is a prime example of mind-body interaction. The first (and
faster) track of the stress-response system is the fight-or-flight response, identified by
Walter Cannon, in which the sympathetic nervous system responds to a stressor on
several fronts: the inner parts of the adrenal glands pour out epinephrine and
nopreinephrine, heart and respiration rates increase, blood flows away from digestive
organs and towards skeletal muscles sensation of pain diminish, and the body releases
stored sugar and fat, on the slower track of the immune system, the cerebral cortex,
perceiving a stressor, stimulates the hypothalamus and pituitary gland to trigger the
release of glucocorticoid stress hormones, such as cortical, from the outer part of the
adrenals. The three stages of general adaptation syndrome, Hans Selye’s concept of
the body’s response to stress are alarm (temporary shock state in which the body
mobilizes resources), resistance (period of coping with the stressor), and exhaustion
(depilation of reserves following prolonged stress)

• Large-scale catastrophic events can increase depression and anxiety and cause
problem with concentrating and sleeping. Significant personal life events, such as
losses and even changes may leave people vulnerable to disease. But daily hassles-the
continuing series of small, everyday stressors-are the most significant sources of stress
for most people and can damage health and well-being.
• Stress can increase the risk of coronary heart disease. The vital link in this stress-
disease path is negative emotions-depression, pessimism, but especially anger. The
Friedman-Rosenman study, the first to show the anger-heart-disease link, contrasted
Type A personalities with Type B. Under stress, Type A people are psychologically more
reactive, with an outpouring of hormones that accelerate the buildup of plaque to artery
walls, leading to high blood pressure and increased risk of strokes and heart attacks.
• Psychologists use the term psychophysiological illness to describe stress-related
physical illness such as hypertension and some headaches. These real illnesses differ
from hypochrondriasis, or misinterpreting normal physical sensations as symptoms of a
• The immunes systems V lymphocytes release antibodies that fight bacterial infections.
The T lymphocytes fight cancer cells, viruses, and foreign substances. Other immune-
system agents, the macrophages, ingest harmful invaders, worn-out cells, and other
internal debris. Stress does not directly cause disease, but when energy is diverted
away from the immune system activities are redirected toward the stress-response
system, we become more vulnerable to infections and disease
• AIDS is caused by HIV virus, not by stress. But stress and negative emotions may
accelerate the progression from viral infection to actual AIDS. HIV-positive individuals
benefit more from drug treatments, but programs that reduce stress do seem to help
• Stress does not create cancer cells. Researches disagree on whether stress influences
the disease’s progression, but they do agree that avoiding stress and maintain a hopeful
and determined attitude cannot reverse the destructive processes under way in
advanced cancer
• Researchers have conditioned immune system suppression in lab experiments.
Encouraged by these results, others are working on ways to condition immune-system
• When we use problem-focuses coping we attempt to reduce stress by changing the
events that trigger stress reactions or by changing the way we react to those events.
We tend to use emotion-focused coping when we believe-rightly or wrongly- that we
cannot change a stressful situation
• A perceived lack of control has been associated with higher than normal susceptibility o
bacterial infections, cardiovascular disease, and, possibly, a shorter life span due to
elevated levels of stress hormones and diminished immune system responses
• Compared with people with a pessimistic explanatory style, optimists tend to feel they
have more control over stressors, cope better with stressful events, enjoy better moods,
have stronger immune systems, and live longer than pessimists. Laughter (but not
sarcasm) may reduce stress and strengthen the immune system
• Supportive family member, marriage partners, close friends, and companionable pets
help people cope with stressful events. Social support fosters stronger immune
functioning, calms the cardiovascular system, and lowers blood pressure

• Stress-management programs often include aerobic exercise (sustained exercise that

increases heart and lung fitness) which raises energy levels, increases self-confidence,
lowers tension, and may alleviate depression and anxiety. Studies have linked aerobic
exercise to lowered blood pressure, increased arousal, higher levels or
neurotransmitters that boost moods (such as norepinephrine, serotonin, and the
endorphins), enhanced cognitive abilities, and (in mice) the growth of new brain cells

• Biofeedback techniques have helped people control tension headaches, but simple
relaxation exercises have been equally effective in combating hypertension, anxiety,
and insomnia, and in lowering rates of recurring heart attacks. Some have searched for
relief from stress and illnesses in complementary and alternative medicine. Studies of
people while meditating have shown increases left frontal lobe activity and improved
immune functioning, compared with their counterparts in control groups

• Regular religious attendance has been a reliable predictor of a longer life span.
Researchers trying to determine the cause-effect relationship have isolated three
intervening variables: (1) religiously active people have healthy lifestyles (smoking and
drinking less, for example) (2) faith communities often function as social support
networks and often encourage marriage (which, when happy, is associated with better
health and longer life spans) (3) religious attendance-with its accompanying coherent
worldview, sense of hope for the future, feelings of acceptance, and relaxed meditative
state-may enhance feelings of positive emotions (such as hope and optimism) and
decrease feelings of stress and anxiety

• Smoking’s allure for teens comes in part from social rewards- identifying with or being
accepted by “cool” people. Depending on their genetic inheritance, one in three early
smokers will develop a psychological addiction to nicotine, as hard to break an addiction
to heroin or cocaine. By triggering a release of epinephrine, norepinephine, dopamine,
and the opioids, nicotine takes away unpleasant cravings and delivers rewards