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PHC 6410 Health behavior and Public Health
Importance to Public Health
• Stress can contribute to illness
– Directly - physiological effects – Indirectly – bad health behaviors
• How the ill or at-risk for illness, cope. • Influence of friends, family, and health care
providers on stress and outcomes
Why study stress and coping in public health • The psychosocial aspects of a situation affect the determinants and consequences of health behaviors • Need to understand theories and concepts to develop effective strategies and intervention programs .
Historical Concepts • Stressors – Demands made by the internal or external environment that upset balance. thus affecting physical and psychological wellbeing and requiring action to restore balance .
History Concepts cont. • 30’s – 50’s: Research focused on physiological reactions to stressful stimuli – General Adaptation Syndrome – 3 stages (alarm reaction→ resistance →exhaustion) with each evoking both physiological and behavioral responses .
• 60’s – 70’s: Research focused on identifying and quantifying potential stressors called stressful life events – Social Readjustment Rating Scale (SRRS) • High scores had more illness episodes .History Concepts cont.
History Concepts cont. • Also 60’s and 70’s: Models with central concept of ‘events are perceived in different ways by various individuals and these perceptions – rather than the objective stressors – are main determinants of effects on behavior and health .
fatalism.e. emotional suppression) are linked to disease endpoints Chronic stressors and responses affect biology and thus occurrence and progression of problems such as cancers. Stress causes headaches in some. acid-reflux in others .History cont. hostility. Biology and Epidemiology suggests that: Some personalities and psychological states (i. infectious diseases Difficult to separate causal factors in health status and behavior as responses are different for everyone ex.
Transactional Model of Stress and Coping Purpose of Model: Framework for evaluating processes of coping with stressful events BASIC SEQUENCE OF MODEL Outcomes • Appraisals→Coping Efforts→Coping .
Diagram of Transactional Model of Stress and Coping Mediating Processes Outcomes Materials •Perceived susceptibility •Perceived severity •Motivational relevance Bad Design •Causal focus Primary Appraisal Poor •Problem Management •Emotional Regulation Coping Effort •Emotional well-being •Functional status •Health behaviors Adaptation Stressor Meaning-Based Coping Secondary Appraisal •Perceived control over outcomes •Perceived control over emotions •Self-efficacy •Positive reappraisal •Revised goals •Spiritual beliefs •Positive events Moderators •Dispositional coping style •Social support .
Appraisals • Primary appraisal – evaluate potential threat • Secondary appraisal – evaluate ability to alter situation and manage negative emotional reactions .
Actual coping efforts (negative and positive strategies used to mediate primary and secondary appraisals) are aimed at problem management and emotional regulation and give rise to the outcomes of the coping process (e. psychological well-being) *During stress event need to take positive psychological states into account as they may: Facilitate processing of self-relevant info Serve as a buffer against adverse physiological events Protect against depression .Transactional Model cont.g.
or irrelevant – Health problems usually seen initially as threatening or as negative stressors .Primary Appraisal • Definition – a person’s judgment of the significance of an event as stressful. controllable. challenging. positive. benign.
e. not getting screened as much) .Primary Appraisal • Two basic PA’s – perceptions of susceptibility to and severity of a threat – Prompt efforts to cope with the stressor – Ex. Woman who perceives risk of breast cancer may be motivated to obtain mammogram (problemfocused coping/ problem-management strategies) and may seek social support to cope with threat (emotion-focused coping/emotional regulation) • But…high risk perception may lead to distress and escapeavoidance behaviors – leads to less adherence (i.
Possible factors involved with a Primary Appraisal Appraisal Bias .If a person perceives themselves as the cause of the stressor they may generate more guilt and depression than anxiety .g when health threat is ambiguous or uncertain) Motivational relevance .when significance of threat is minimized (e.when a stressor is appraised as having a major impact on a person’s goals or concerns Causal focus .
e. coping self-efficacy) .Secondary Appraisal Definition – evaluation of the controllability of the stressor and a person’s coping resources – Examples • Perceived ability to change the situation • Perceived ability to manage one’s emotional reactions • Expectations about the effectiveness of one’s coping resources (i.
Secondary Appraisal Definition – evaluation of the controllability of the stressor and a person’s coping resources – Perceived control over health outcomes may improve health as it increases likelihood of adopting health behavior recommendations (i. safe-sex behavior) • But in situations with low control (severe or fatal disease) high levels of perceived control may actually increase distress and dysfunction and thus negatively affect health .e.
and denial • Best for stressors that are unchangeable or when after all problem-management strategies have been taken . venting of feelings.Coping Efforts • Emotional and functional effects of primary and secondary appraisals are mediated by actual coping strategies (positive and negative) – Emotional regulation – directed at changing the way one thinks or feels about a stressful situation • Ex. – seeking social support. avoidance.
problem solving.Coping Efforts • Emotional and functional effects of (positive and negative) primary and secondary appraisals are mediated by actual coping strategies – Problem-management strategies – directed at changing the stressful situation • Ex. and information seeking • Best for stressors that are changeable . – active coping.
Coping Efforts cont. denial – May minimize initial distress but can lead to increased distress over time . • Disengaging strategies – shifts attention away from stressor – Person more likely to use when stressor is perceived as highly threatening or uncontrollable – Ex. distraction. cognitive and behavioral avoidance. Distancing.
Coping Efforts cont. Active coping. planning problem solving. and using social support . information seeking. • Engaging strategies – Person more likely to use when stressor appraised as controllable and a person has high self-efficacy about problem – Ex.
acceptance.can induce positive emotion – Ex. Positive reinterpretation.Coping Efforts cont. use of religion or spirituality . • Meaning-based coping .
outcomes may occur at different time frames – Three main outcomes are: • Emotional well-being • Functional status (or health status. disease progression.Coping Outcomes • Represent a person’s adaptation to a stressor following their appraisal of the situation (primary) and resources (secondary) and is influenced by coping strategies – Because a problem or stressor may change over time.) • Health behaviors . etc.
Theoretical Extensions • Difference between coping efforts and coping styles – Coping styles are dispositional or stable characteristics of an individual – Coping styles can be generalized while coping efforts are situation-specific *Coping styles are enduring traits and thus drive appraisal and coping efforts *Coping styles are moderators of the impact of stress on coping processes and outcomes. coping efforts are mediators of the effects of stress and appraisals on emotional and functional outcomes – that is they attempt to resolve problem .
are relatively stable over time – Two types of influential styles • Optimism • Information Seeking .Theoretical Extensions cont. • Dispositional coping styles – generalized ways of behaving that can affect a person’s emotional or functional reaction to a stressor.
Optimism • Dispositional optimism – tendency to have positive (optimistic) rather than negative (pessimistic) generalized expectancies for outcomes • Optimists have better psychological adjustments and have been shown to have fewer physical symptoms during life stresses and faster recovery .
Information seeking • Monitoring – seeking info – Can contribute to heightened perceived risk and excessive worry about health – Can reduce worry and stress also if ways to reduce problem are found • Blunting – avoiding info * Both monitoring and blunting can produce positive and negative outcomes .
Social Support *Substantial evidence of beneficial effects on psychological and physical well-being Direct effects – extent of social network Indirect or stress buffering effects – perceived availability of support .
treatment technique in which people are trained to improve their health by using signals from their own bodies – Relaxation techniques such as relaxation training. and use of social support . yoga • Problem management approaches based on cognitive behavioral approaches similar to Transactional Model – Teaching individuals to achieve accurate primary appraisals and evaluate and possibly enhance coping resources – Involves information seeking. inhibition of action. hypnosis. direct action.Stress Management Interventions • Directed at emotional regulation – Biofeedback . intrapsychic processes.
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