Health Psychology An Introduction to Behavior and Health Brannon 8th Edition Test Bank

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 CHAPTER 6
Understanding Stress, Immunity, and Disease
Lecture Outline
I. Physiology of the Immune System
The immune system consists of tissues, organs, and processes that protect the body from
invasion by foreign material such as bacteria, viruses, and fungi. It also removes worn-out or
damaged cells from the body.
A. Organs of the Immune System
The immune system includes lymph (circulating fluid that contains a type of white blood
cell called lymphocytes) and lymph nodes (interspersed oval capsule structures) through
which lymph circulates (see Figure 6.1). Various types of lymphocytes include T-cells, B-
cells, and natural killer (NK) cells. The thymus, tonsils, and spleen are also involved with
the production, maturation, or differentiation of the various types of lymphocytes.
B. Function of the Immune System
The immune system is the body’s defense against foreign invaders, and it must be
virtually 100% effective in destroying invaders (see Figure 6.2).
1. Nonspecific Immune System Responses
Phagocytosis (attack of foreign particles by granulocytes or macrophages) and
inflammation (the sequence of events that restores damaged tissue) target a wide variety
of invading particles.
2. Specific Immune System Responses
Contact with invading microorganisms sensitizes T-cells, allowing the cytotoxic T-
cells to subsequently recognize these invaders and create a specific immunity called cell-
mediated immunity. After coming into contact with an antigen, B-cells differentiate into
plasma cells that manufacture specific antibodies that mark invading cells for later
destruction (see Figure 6.3). Even after the invaders have been destroyed, the immune
system keeps the critical information that allows future manufacture of antibodies,
creating immunity to an invader that can persist for years (see Figure 6.4).
3. Creating Immunity
Vaccination is the introduction of weakened or dead bacteria or viruses, thus creating
a specific immunity. Each virus requires such treatment, which makes this process
effective for some viruses, such as smallpox, but not for others, such as the variety of
viruses that cause the common cold.
C. Immune System Disorders
Failures of the immune system leave a person open to infection from viruses, bacteria,
fungi, and parasites. The immune systems of some children fail to develop, and acquired
immune deficiency syndrome (AIDS) destroys the immune systems of adults and children.
Allergies are the result of overactive immune systems, and autoimmune diseases result
when the immune system fails to distinguish body cells from invaders and starts to attack and
destroy body cells.

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II. Psychoneuroimmunology
Psychoneuroimmunology is the interdisciplinary field that focuses on the interactions
among behavior, the nervous system, the endocrine system, and the immune system.
A. The History of Psychoneuroimmunology
Until the 1960s, the immune system was thought to be independent of the nervous system
and uninfluenced by behavior. In 1975, Ader and Cohen demonstrated that the immune
system could be conditioned, laying the foundation for psychoneuroimmunology. One way
that the nervous system and immune system communicate is through cytokines, chemical
messengers secreted by the immune system. Proinflammatory cytokines, a type of
cytokines, promotes inflammation.
B. Research in Psychoneuroimmunology
Research in psychoneuroimmunology has attempted to reveal the interactions among
behavior, the nervous system, the endocrine system, and the immune system by
demonstrating that behavior can affect the immune system and that disease can result from
these effects. Research has demonstrated that behavior can depress immune system function,
and a growing body of research has linked lowered immune system function and subsequent
disease. Depression of the immune system appears to be easier than enhancement of the
immune system’s functioning. Research in psychoneuroimmunology should also demonstrate
that behavior affects immune system functioning and that such impaired immune function
causes disease. A substantial body of research has demonstrated the link between behavior
and depressed immune function and also between lowered immune function and disease.
Most studies in psychoneuroimmunology have demonstrated that behavior can suppress
immune system function, but a few studies have used behavioral interventions to attempt to
boost immune system function.
C. Physical Mechanisms of Influence
The link between behavior and depressed immune function must occur through some
physical mechanism, and research has examined both the action of the peripheral nervous
system during stress and neuroendocrine responses in the brain. The immune system also
signals the nervous system by way of cytokines. Stressed people behave differently, often
paying less attention to a healthy lifestyle. Thus, the interrelationship between nervous
system and immune system is complex, with many possibilities for mutual influence.

III. Does Stress Cause Disease?

Disease is caused by many factors, and stress may be one of those factors. However, most
people at risk from stressful experiences do not develop a disease. Although stress and disease
are related, stress does not seem to be a major cause of either physiological or psychological
disorders. Just as most smokers will not die of lung cancer, most people who experience high
levels of temporary stress will not develop a disease. In addition, many people who become sick
have not experienced unusually high levels of stress immediately prior to their illness.
A. The Diathesis-Stress Model
Why does stress affect some people, apparently causing them to get sick, while leaving
others unaffected? The diathesis-stress model offers a possible answer to this question. This
model suggests that some individuals are vulnerable to stress-related diseases because either
genetic weakness or biochemical imbalance inherently predisposes them to those diseases.
Whether inherited or acquired, the vulnerability to stress-related disease is relatively
permanent. For people with a strong predisposition to a disease, even a mild environmental
stressor may be sufficient to produce an illness episode.
B. Stress and Disease

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The link between stress and disease may come through effects to the nervous, immune, or
endocrine system. Indirect effects could include health threats that occur because of changes
in health-related behaviors related to stress. Some evidence exists concerning the link
between stress and a variety of physical and psychological problems.
1. Headaches
Headaches are a common experience, but most do not require medical attention. Of
those that do, tension and migraine headaches are the most common, and stress is a factor
in both. Daily hassles are more important than life events in producing chronic
headaches, and research shows that vulnerability and stress interact to produce
headaches.
2. Infectious Disease
Early research indicated that stress was a weak factor in developing infectious
disease. However, later research by Sheldon Cohen and his associates intentionally
exposed people to respiratory viruses and found that those who were the most stressed
prior to the exposure were the ones who were most likely to develop an infectious
disease. Later research has shown that stress is a factor in many infectious diseases and in
the progression of HIV infection.
3. Cardiovascular Disease
Cardiovascular disease has a number of risk factors, some of which are related to
stress. For people with preexisting CVD, stress increases their risk of heart attack. A
large international study identified several psychological stressors as a risk for heart
attack; these risks included workplace and home stress, financial problems, major life
events, depression, and external locus of control.
a. Hypertension
The relationship between stress and temporary increases in blood pressure is
stronger than the evidence for stress as a factor in chronic hypertension. No simple
relationship exists between stress and hypertension.
b. Reactivity
Reactivity is the tendency for some people to react more strongly than other
people to stress. Reactivity is a stable characteristic in some people, with blood
pressure, heart rate, and other biological responses used as indexes of reactivity.
Ethnic background and discrimination may be factors that affect the reactivity of
African Americans, increasing their vulnerability.
4. Ulcers
Despite the widespread belief that stress causes ulcers, the underlying cause of most
ulcers is a bacterium, H. pylori. This infection may create a vulnerability to form ulcers,
and psychological behavioral factors may play a role in ulcer formation. In addition,
stress exacerbates existing ulcers.
5. Other Physical Disorders
Stress may be implicated in the development and management of Type 1 and Type 2
diabetes mellitus and rheumatoid arthritis. Stress experienced by pregnant women
increases the chances of premature delivery. Stress may contribute to the development of
asthma through effects on cytokines involved in inflammation. Rheumatoid arthritis is an
autoimmune disorder, and stress contributes to this disorder in both direct and indirect
ways.

C. Stress and Psychological Disorders

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Stress is also related to several psychological disorders in ways that the diathesis-
stress model predicts: Some people exposed to stressors develop these disorders, whereas
most do not. Research has also suggested that cytokines in the immune system play a role in
mood and the development of psychological disorders.
1. Depression
Stress is one factor that makes people vulnerable to depression, but effective coping
protects against depression. The tendency to ruminate over negative events increases the
risk for depression, and genetic vulnerability is also a risk. Chronic workplace stress,
poor health, and caregiving are stressors that increase the risk for depression. The route
through which stress may produce depression is through the effect on proinflammatory
cytokines produced by the immune system, which is related to the development of
depression.
2. Anxiety Disorders
Anxiety disorders include panic attack, agoraphobia, generalized anxiety, obsessive-
compulsive disorders, and posttraumatic stress disorder (PTSD). PTSD is, by
definition, related to stress, and PTSD also produces suppression of the immune system.
Stress is less clearly related to the other anxiety disorders, partly because the overlap
between anxiety and depression makes it difficult to disentangle these two problems.

Exploring Health on the Web

The vast amount of information about stress on the Internet also includes diseases related to
stress. Websites listed in Chapters 5 and 8 may also be of interest.

http://apahelpcenter.org/
This website is provided by the American Psychological Association and offers help for
various problems. The section “For a Healthy Mind and Body” includes topics related to health
psychology. The articles on this site change but will always relate to behavior and health. Other
sections frequently relate to stress and its management.

http://www.ptsd.va.gov/
A government website featuring information on Posttraumatic Stress Disorder. The site
provides details about causes of, consequences of, and ways of coping with and treating PTSD.

Suggested Activities
Personal Health Profile — Recording Stress
For Chapter 5 we suggested asking your students to fill out a life events scale, such as
The Undergraduate Stress Questionnaire. For this chapter we suggest that your students begin
keeping a stress diary or daily log as part of their Personal Health Profile. Such a procedure
allows students to record daily stresses and to rate them on a scale of 1 to 10, with 1 being least
stressful and 10 being most severe. This activity enables each student to profile his or her own
stresses, and to look for external events, such as examinations or interpersonal problems, to
determine any possible pattern. Also, your students may discover personal variables that tend to
magnify stressful events. This diary will add useful information that will give the students some
clues regarding changes they may wish to make in their lifestyle.
Stress and Health Habits

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Chapter 6 presented a great deal of information about how stress might affect health
through its influence on the immune system. Another possible link between stress and disease
that Chapter 6 also mentions is the relationship between stress and health habits. When people
are stressed, their behavior changes, and they often indulge in unhealthy behaviors that they
might not if they felt better. Also, stress may reduce people’s motivations to adhere to healthy
habits, such as a healthy diet or an exercise regimen. Therefore, stress can reduce people's
adherence to a healthy behaviors in two ways—adding unhealthy behaviors and failing to enact
healthy ones.
Encourage your students to explore this stress-illness link by examining their own health
habits when they are under stress. Do they become more likely to overeat, drink, smoke, or use
drugs as ways to manage stress and feel better? If so, prompt them to formulate some alternative
coping strategies that present less risk to their health.

Debate: Does Stress Cause Disease?

After considering the evidence presented in the text and from other sources, organize a class
debate around the question “Does Stress Cause Disease?” Debating this issue can help your
students explore the role of stress in disease and come to understand the research evidence rather
than the publicity about this link. Organize either a formal or informal debate. You may create
teams or divide into working groups to prepare background information. You may either use
formal debate rules or take turns presenting information and arguments.

Stress and Illness in Your Class

Crandall and his associates determined that scores on the USQ were correlated with
health care visits. Determine if this relationship holds for the students in your class. Based on
your students' scores for the USQ, determine the relationship between scores and recent health
care visits or problems. This procedure may include gathering USQ scores and number of health
problems within the past month and computing a correlation.

Stress and Illness on Campus

You can examine the relationship between stress and illness on your campus by charting
the number of times students seek medical care during the school year. If your school has a
campus health center, hospital, or student infirmary, you may be able to obtain records
concerning number of visits during each week of the year. If you can find out how many students
sought health care, then your students can chart the number of visits per week and examine the
school’s calendar to determine possible stressors during the preceding weeks to determine any
relationship.
You will not need any personal information about the patients who sought health care, so
confidentiality should not be an issue in obtaining this information. The ideal data would consist
of the number of visits per week by diagnosis so that your students can eliminate patients who
sought care for problems that have no relationship to immune system function.

Sociocultural Factors, Stress, and Health

Have students discuss the impact of sociocultural factors on the health of minorities. The
following videos (https://www.youtube.com/user/unnaturalcausesdoc) present information on
how one’s social environment can impact health. How do sociocultural factors impact an
individual’s health behavior choices? What type of culturally-sensitive interventions could health
psychologists design and implement to help ethnic minorities cope with stress?

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Post-Traumatic Stress Disorder

Have students discuss Post-Traumatic Stress Disorder (PTSD) from a variety of
viewpoints: the diathesis-stress model; a biopsychosocial perspective; a cultural or social
phenomenon only; or a psychoneuroimmunology explanation. What research supports each
viewpoint? Can we, at this time, definitively choose one model that best explains PTSD?

Video Recommendations
From Films for the Humanities & Sciences:

Your Immune System (2003) presents the function of the immune system and the problems that
may affect it.

Seriously Stressed (2006) explores the stress produced by modern society, including symptoms
of chronic stress and potential negative effects by featuring case studies of individuals and the
stresses in their lives.

Videos from the Web:

http://www.pbs.org/saf/1310/video/watchonline.htm – A series of videos from PBS’ American

Frontline entitled “Worried Sick” investigate the links between stress and health. One video,
“Angry at Heart” examines the link between hostility and heart disease. The third video, “To
Heal or Not to Heal,” examines how marriage can affect the immune system. “Just Relax”
features stress researcher Herbert Benson teaching relaxation techniques that can help reduce
stress.

http://www.youtube.com/watch?v=eYG0ZuTv5rs – This documentary, “Stress, Portrait of a

Killer,” features Robert Sapolsky (56:04),

http://www.youtube.com/watch?NR=1&v=4g25d7_Afmc – This video explains the Fight or

Flight Response in the body (6:37).

http://www.youtube.com/watch?v=OsBtjW61Vyw – Sheldon Cohen talks about stress and

immunity (1:43).

http://www.pbs.org/thisemotionallife/topic/ptsd?ct=video – Three different vides from PBS that

examine aspects of Post-Traumatic Stress Disorder. Two videos talk with two PTSD patients and
the third video features a general overview of PTSD.

http://youtu.be/vQ14PEz8stg This CBS News video examines how individuals living in rural
settings are less likely to get sick or develop asthma (2:07).

http://youtu.be/Non4MkYQpYA - An overview of the immune system, that starts with

explaining external barriers, nonspecific responses, and then discusses antibodies and t-cell
receptors (11:33).

Multiple Choice Questions

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1. The main function of the immune system is to

a. manufacture white blood cells.
b. manufacture red blood cells.
c. protect internal organs.
d. defend against foreign invaders.
ANS: d REF: Physiology of the Immune System

2. Leukocytes are
a. white blood cells.
b. red blood cells.
c. platelets.
d. capillaries.
ANS: a REF: Physiology of the Immune System

3. A function of lymph nodes is to

a. secrete thymosin.
b. serve as a holding station for red blood cells.
c. cleanse lymph of foreign debris.
d. all of these.
ANS: c REF: Physiology of the Immune System

4. Which of these is NOT an organ of the immune system?

a. liver
b. spleen
c. tonsils
d. thymus
ANS: a REF: Physiology of the Immune System

5. Which of the following performs specific immune responses?

a. phagocytosis
b. T-cells and B-cells
c. granulocytes
d. macrophages
ANS: b REF: Physiology of the Immune System

6. Nonspecific immune system response

a. provides the first line of defense against foreign substances in the body.
b. occurs in a nonspecific order.
c. has the ability to create a type of memory that confers immunity.
d. protects against specific immune responses that threaten the body.
ANS: a REF: Physiology of the Immune System
7. Immunity occurs when
a. memory lymphocytes persist after initial exposure to a virus.
b. antigens build up.
c. antibody levels fall.
d. interferon is transferred from one person to another.
ANS: a REF: Physiology of the Immune System

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8. The development of immunity depends on the creation of

a. leukocytes.
b. natural killer cells.
c. antigens.
d. antibodies.
ANS: d REF: Physiology of the Immune System

9. HIV is caused by
a. a viral infection.
b. a bacterial infection.
c. exposure to a cancer-causing agent.
d. homosexuality.
ANS: a REF: Physiology of the Immune System

10. Suppression of the immune system

a. is a desirable action following most major surgery.
b. will stop infection.
c. leaves the body vulnerable to infection.
d. never occurs naturally, but can be induced with drugs.
ANS: c REF: Physiology of the Immune System

11. Allergic reactions are

a. a result of digestive system dysfunction.
b. an abnormal immune system reaction to a foreign substance.
c. caused by viruses.
d. more common in people whose immune systems are not fully functional at birth.
ANS: b REF: Physiology of the Immune System

12. Autoimmune disease occurs when

a. the immune system loses its effectiveness.
b. T-cells are reduced by 90%.
c. malignant cells proliferate, producing a demand for numerous immune system
responses.
d. the immune system attacks body cells rather than invaders.
ANS: d REF: Physiology of the Immune System

13. Increasing the efficiency of the immune system would be a problem for whom?
a. people with cancer
b. people with AIDS
c. people who have received transplanted organs
d. people with bacterial diseases
ANS: c REF: Physiology of the Immune System

14. Enhancing immune system function would be useful in the treatment of

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a. allergies.
b. organ transplant patients.
c. AIDS.
d. cardiovascular disease.
ANS: c REF: Physiology of the Immune System

15. The two general, or nonspecific, mechanisms that foreign substances “face” are:
a. phagocytosis and inflammation
b. phagocytosis and mucous membranes
c. inflammation and mucous membranes
d. the spleen and inflammation
ANS: a REF: Physiology of the Immune System

16. Substances that evoke the production of one or more antibodies are called _____.
a. antigens
b. vaccination
c. phagocytes
d. lymph nodes
ANS: a REF: Physiology of the Immune System

17. __________ enable the immune system to have a rapid response when the foreign
invader reappears.
a. Antigens
b. Phagocytes
c. Memory lymphocytes
d. Leukocytes
ANS: c REF: Physiology of the Immune System

18. The highest concentration of the virus for HIV is found in ______.
a. saliva and in the blood.
b. saliva and in semen.
c. blood and in semen.
d. saliva, in the blood, and in semen.
ANS: c REF: Physiology of the Immune System

19. The discipline concerned specifically with the interactions among behavior, the endocrine
system, the immune system, and the nervous system is
a. transactional analysis.
b. behavioral medicine.
c. health psychology.
d. psychoneuroimmunology.
ANS: d REF: Psychoneuroimmunology

20. Ader and Cohen demonstrated that

a. the immune system could be conditioned.

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b. the immune system was independent of the nervous system.

c. the adrenomedullary response was independent of the adrenocortical response.
d. allostasis does not apply to the General Adaptation Syndrome.
ANS: a REF: Psychoneuroimmunology

21. What relationship is the basis of psychoneuroimmunology?

a. Endocrine function affects behavior, and behavior can either raise or lower
immune system function.
b. Behavior affects the immune system, and immune system function affects health.
c. Health and disease affect immune system function, and behavior affects the
nervous system as well as the endocrine system.
d. The action of the immune system is independent of behavior, and the endocrine
and nervous systems are less dependent than has been previously assumed.
ANS: b REF: Psychoneuroimmunology

22. Research in the field of psychoneuroimmunology has found evidence that immune
function can be decreased by
a. exam stress.
b. caring for someone with Alzheimer's disease.
c. relationship conflict.
d. all of these.
ANS: d REF: Psychoneuroimmunology

23. Research by Kiecolt-Glaser and her colleagues has shown that Alzheimer’s caregivers,
compared with other people of the same age and gender,
a. had poorer psychological and physical health.
b. had lowered immune system function.
c. more quickly recovered their own health after the death of the Alzheimer's
patient.
d. both a and b are correct.
ANS: d REF: Psychoneuroimmunology

24. Recent research that presented photographs of infectious disease to participants found
that, after viewing this pictures, participants
a. sneezed and felt nauseous.
b. reported more trips to the health center that semester.
c. had increased production of proinflammatory cytokines.
d. all of the above.
ANS: c REF: Psychoneuroimmunology

25. Marital conflict is associated with __________

a. faster response times to dangerous stimuli.

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b. slower response times to dangerous stimuli.

c. faster wound healing.
d. slower wound healing.
ANS: d REF: Psychoneuroimmunology

26. __________ experience poorer psychological and physical health, longer healing times
for wounds, and lowered immune functioning.
a. First-time mothers
b. First-time fathers
c. Alzheimer’s caregivers
d. The elderly
ANS: c REF: Psychoneuroimmunology

27. Which of the following individuals would be most likely to have decreased immune
system functioning?
a. Anna, who is taking her first exam in psychology this week
b. Nathan, who has an hour commute to school each week
c. Marissa, who just had her first child
d. Claude, who is unemployed and lives in a high-crime neighborhood
ANS: d REF: Psychoneuroimmunology

28. Antoni and colleagues (2009) designed a cognitive behavioral stress management
intervention for women with breast cancer, and over a 6-month period, improvements in
______ were found.
a. depression levels
b. anxiety levels
c. immune measures
d. cortisol
ANS: c REF: Psychoneuroimmunology

29. These chemicals secreted by the immune system signal the nervous system:
a. cytokines
b. leukocytes
c. phagocytes
d. antigens
ANS: a REF: Psychoneuroimmunology

30. In order for stress to cause illness, stress must affect physiological processes that produce
illness. The most likely candidate for a mechanism is the _____ system.
a. immune
b. nervous
c. endocrine
d. digestive
ANS: a REF: Psychoneuroimmunology

31. Direct effects of stress on the immune system occur through ______, and indirect effects
can occur through ______.
a. the cardiovascular system . . . autonomic nervous system activation effects

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b. the sympathetic nervous system . . . parasympathetic nervous system suppression

c. connections between the immune and nervous systems . . . secretion of hormones
d. the adrenal medulla . . . activation of the pituitary gland and releasing factors
ANS: c REF: Psychoneuroimmunology

32. One route through which stress may affect the immune system is through
a. lowered epinephrine levels.
b. elevated cortisol levels.
c. reverse peristalsis.
d. any of these.
ANS: b REF: Psychoneuroimmunology

33. With regard to stress and illness, which of these statements is true?
a. Stress is a better predictor of heart disease than it is of hypertension.
b. Most people at risk from stressful experience will not develop a disease.
c. Stress is a better predictor of heart disease than cigarette smoking.
d. Both a and c are correct.
ANS: b REF: Does Stress Cause Disease?

34. Stress may relate to disease because people under stress may
a. abuse alcohol.
b. eat unhealthy foods.
c. use illicit drugs.
d. do any or all of these.
ANS: d REF: Does Stress Cause Disease?

35. The diathesis-stress model hypothesizes that

a. stress is most likely to produce illness in a healthy person.
b. stress and psychological functioning interact to produce better health.
c. some people are more inherently vulnerable to the effects of stress.
d. some people learn to cope with stress but not with stressful life events.
ANS: c REF: Does Stress Cause Disease?

36. With regard to stress and disease,

a. executives are more likely than middle-level managers to develop stress-related
diseases.
b. stress can affect the development of disease directly through the immune system
or indirectly through unhealthy behaviors.
c. stress is more likely to result in psychological disorders than in physical diseases.
d. both a and c are correct.
ANS: b REF: Does Stress Cause Disease?

37. The diathesis-stress model assumes that to become ill

a. a person must have a relatively permanent predisposition to the illness.
b. a person must experience some sort of stress.

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c. both a and b are necessary to produce illness.

d. neither a nor b is necessary to produce illness.
ANS: c REF: Does Stress Cause Disease?

38. Stress is a factor in

a. tension but not vascular headaches.
b. vascular but not tension headaches.
c. both vascular and tension headaches.
d. neither tension nor vascular headaches.
ANS: c REF: Does Stress Cause Disease?

39. The type of stress that is most closely associated with headaches is
a. major life events, such as loss of a loved one.
b. daily hassles.
c. persistent fears and anxiety.
d. depression.
ANS: b REF: Does Stress Cause Disease?

40. When Sheldon Cohen and his colleagues intentionally exposed healthy volunteers to
common cold viruses, they found that their previous level of stress was
a. unrelated to subsequent number of colds.
b. related in a dose-response manner to subsequent number of colds.
c. positively related to subsequent number of colds but not in a dose-response
manner.
d. inversely related to subsequent number of colds.
ANS: b REF: Does Stress Cause Disease?

41. Sheldon Cohen and his colleagues found that development of colds
a. was more strongly related to the duration of stress than its severity.
b. was not reliably related to the severity of the stress but was related to the presence
of stress.
c. occurred only with both long-term stress and severe stress.
d. showed no relationship between previous stress and the subsequent development
of colds.
ANS: a REF: Does Stress Cause Disease?
42. Evidence now suggests that most colds are caused by an interaction of exposure to the
virus and
a. diet.
b. lack of sleep.
c. white blood count.
d. stress.
ANS: d REF: Does Stress Cause Disease?

43. Evidence is strongest for the hypothesis that

a. there is little relationship between stress and heart disease.
b. stressful experiences increase the risk of heart attack.
c. stressful experiences can buffer people against cardiovascular disease.
d. most heart attacks among middle-age men are related to marital stress.

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ANS: b REF: Does Stress Cause Disease?

44. The notion that some people respond more strongly to stress than do others is called
a. Type A behavior pattern.
b. Type B behavior pattern.
c. reactivity.
d. responsively.
ANS: c REF: Does Stress Cause Disease?

45. In what way does reactivity relate to ethnic background?

a. African American men show more reactivity to stress than do European American
men.
b. European American children show more reactivity than do African American
children.
c. Children with the highest rate of reactivity are European American children with a
family history of heart disease.
d. Both b and c are correct.
ANS: a REF: Does Stress Cause Disease?

46. Robert, a middle-aged African American man believes that he has just been called a
derogatory name. According to research, Robert is most likely to
a. react by insulting the other person.
b. react by moving away from the other person.
c. react with increased blood pressure.
d. realize that he may have misinterpreted the other person's words.
ANS: c REF: Does Stress Cause Disease?

47. Research on the 2006 World Cup soccer championship indicated that
a. the stress of watching matches raised the risk of cardiac events for people with
cardiac problems.
b. the excitement of watching matches provided relief from reactivity.
c. men’s but not women’s risk of heart attack increased as a result of watching
matches.
d. soccer fans were more likely to experience an initial cardiac event, but individuals
with a history of heart disease actually experienced a lowered risk of cardiac
events during and after matches.
ANS: a REF: Does Stress Cause Disease?

48. Stress probably plays some role in the development of

a. Type 1 diabetes.
b. Type 2 diabetes.

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c. both Type 1 and Type 2 diabetes.

d. neither type of diabetes.
ANS: c REF: Does Stress Cause Disease?

49. The most solid research evidence suggests that

a. stress can trigger an asthma attack.
b. stress is the strongest risk factor for cardiovascular disease.
c. stress is the chief cause of depression.
d. stress is unrelated to both depression and anxiety.
ANS: a REF: Does Stress Cause Disease?

50. The connection between the immune system and asthma may occur through
a. the stress that comes from treatment for the disorder.
b. inflammation.
c. triggers such as smoke or dust.
d. the ethnic background of the person with the disease.
ANS: b REF: Does Stress Cause Disease?

51. Evidence regarding the effects of stress on depression indicates that

a. stress seems to be a necessary condition for depression.
b. stress is a sufficient condition for depression.
c. stress is involved in more than half of all depressive episodes.
d. vulnerability and coping ability mediate the effects of stress on depression.
ANS: d REF: Does Stress Cause Disease?

52. People with a negative outlook and a tendency to ruminate over problems
a. are less likely than others to complain about being sick.
b. are at higher risk for depression than those with a more positive attitude.
c. express more satisfaction with life than do other people.
d. all of these.
ANS: b REF: Does Stress Cause Disease?

53. Austin suffers from recurrent intrusive memories of his experiences as a fire fighter at the
time of the World Trade Center attacks. He also has unpleasant dreams that replay some
of these experiences. Austin is most likely suffering from
a. clinical depression.
b. schizophrenia.
c. posttraumatic stress disorder.
d. transcendent psychosis.
ANS: c REF: Does Stress Cause Disease?

54. Personality may also play a role in who develops a cold. In one study, people who were
______ developed fewer colds than others.
a. neurotic
b. extraverted
c. agreeable
d. conscientious
ANS: c REF: Does Stress Cause Disease?

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55. Vaccinations may be less effective in protecting against stress among people who
experience ________.
a. stress
b. many daily hassles
c. few daily hassles
d. exposure to cigarette smoke.
ANS: a REF: Does Stress Cause Disease?

56. In a study of women with the sexually transmitted form of herpes simplex virus, women
experiencing psychosocial distress were more likely to
a. transfer the virus to someone else.
b. show the onset of genital lesions a few days later.
c. contract other herpes viruses.
d. all of the above.
ANS: b REF: Does Stress Cause Disease?

57. Which of the following ethnic groups has been shown to have lowest reactivity in
response to a laboratory stressor?
a. Asian American
b. African American
c. European American
d. Caribbean Americans
ANS: a REF: Does Stress Cause Disease?

58. Though stress may not directly cause ulcers, there may be an indirect link between stress
and ulcers, as stress may increase all of the following EXCEPT:
a. heavy drinking
b. smoking
c. caffeine consumption
d. exercise
ANS: d REF: Does Stress Cause Disease?

59. Stress may contribute to diabetes through its possible effects on _______.
a. smoking
b. heavy drinking
c. obesity
d. exercise
ANS: c REF: Does Stress Cause Disease?

60. In regards to the effects of stress on pregnancy, research indicates that __________
a. acute stress is the riskiest for pregnancy complications.

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b. stress early in the pregnancy is riskier than stress later in the pregnancy.
c. stress late in the pregnancy is riskier than stress early in the pregnancy.
d. both a and c.
ANS: c REF: Does Stress Cause Disease?

61. ________ children show the greatest asthma symptoms following an acute stress task.
a. Overweight
b. Underweight
c. Low socioeconomic status
d. High socioeconomic status
ANS: c REF: Does Stress Cause Disease?

62. There is evidence that stress contributes to the development of __________.

a. depressive symptoms
b. anxiety symptoms
c. both anxiety and depressive symptoms.
d. neither anxiety nor depressive symptoms.
ANS: c REF: Does Stress Cause Disease?

63. One explanation as to why some individuals are more vulnerable to depression is that
these individuals
a. have a small, but active, social support network.
b. have ineffective coping strategies.
c. have too many stressful experiences.
d. all of the above
ANS: b REF: Does Stress Cause Disease?

64. Which of the following is not an adequate explanation for why some individuals are more
vulnerable to depression than others?
a. Ineffective coping strategies may increase vulnerability to depression.
b. Rumination may increase vulnerability to depression.
c. Major life stress may provide a “kindling” experience that increases vulnerability
to depression.
d. Certain genes have been implicated in vulnerability to depression, regardless of
environmental factors.
ANS: d REF: Does Stress Cause Disease?

65. _______ may help explain why stress can lead to depression.
a. Increased cytokine production
b. Decreased cytokine production
c. Increased T-cell production
d. Increased activity of natural killer cells
ANS: a REF: Does Stress Cause Disease?

66. The ethnic group that is most vulnerable to developing PTSD is

a. Asian Americans

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b. Hispanic Americans
c. European Americans
d. African Americans
ANS: b REF: Does Stress Cause Disease?

True/False Questions
1. The immune system protects the body against bacteria but not viruses.
ANS: F

2. T-cells are a type of nonspecific immune system response.

ANS: F

3. Psychoneuroimmunology is a multidisciplinary field that focuses on the interactions among

behavior, the nervous system, the endocrine system, and the immune system.
ANS: T

4. The functioning of the immune system occurs only in the lymph nodes.
ANS: F

5. The diathesis-stress model suggests that recent stress predisposes people to illness.
ANS: F

6. Most tension headaches are the result of traumatic life events.

ANS: F

7. Evidence from research by Sheldon Cohen and his colleagues demonstrated that stress has
no relationship to catching the common cold.
ANS: F

8. Most heart attacks are caused by sudden traumatic experiences.

ANS: F

9. Compared with people who have little reaction to stressful events, those who react with strong
emotions are more likely to have cardiovascular disease.
ANS: T

10. Almost all ulcers are caused by stress.

ANS: F

11. The immune system has one way to fight invading foreign substances: specific immune
system responses.
ANS: F

12. Chronic stress is more damaging to the immune system than short-term stress.
ANS: T

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13. Stress may “get under the skin” by altering health-related behaviors, such as people drinking
more alcohol to cope with stressful life events.
ANS: T

14. The higher a person’s level of stress, the more likely that person will become ill.
ANS: T

15. A recent study on over 55,000 Japanese adults showed greater perceived stress increased the
risk for Type 2 diabetes.
ANS: T

Essay Questions
1. What functions do nonspecific and specific immunity serve, and why are both necessary?
A. Nonspecific immune responses occur as a general response to all invading bacteria,
viruses, fungi, and other foreign particles.
1. The processes include
a. Phagocytosis, a type of attack in which the invaders are engulfed and killed by
targeting foreign particles.
b. Inflammation, a complex response that acts to restore tissue that has been
damaged through the increase of blood flow, release of enzymes, and migration of
cells that attack invaders (granulocytes and macrophages).
2. These immune system responses occur to all invaders and do not depend on contact
with each invader for mobilization of the response.
B. Specific immune response occurs as a result of the immune system’s contact with
invaders, tailoring cells that can kill specific invaders.
1. This process occurs when
a. T-cells are sensitized by contact with invaders.
b. B-cells differentiate into plasma cells that secrete antibodies that circulate in the
blood, find the antigen that provoked their manufacture, bind to the antigens, and
mark them for future destruction. The remnants of these antibodies can produce
immunity to the antigens for years.

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2. These immune system responses occur as a result of contact with specific invaders
and are tailored to protect against them.
C. Both types of immune responses are necessary to combat the variety of bacteria, viruses,
fungi and other foreign particles that threaten the body.

2. Discuss the implications of immune deficiency.

A. Although immune overactivity can be a problem (such as allergies and autoimmune
disorders), immune deficiency can result in several life-threatening diseases.
1. The function of the immune system must be virtually 100% effective in order to
maintain health, and any substantial decrement of that efficiency would have serious
consequences.
2. A weakened immune system leaves the body open to infection from viral and
bacterial invaders as well as fungal and parasitic invasion.
3. Impairment of nonspecific immune function produces problems for tissue repair,
inflammation, and phagocytosis.
4. Impairment of specific immune function affects antibody production, leading to a
failure to attack specific invaders and form immunity.
5. Attempts at immunization could be dangerous because immunization typically occurs
through the introduction of weakened forms of the disease; without the ability to form
antibodies, these weakened pathogens could cause disease.
B. Immune deficiency occurs both as an inherent condition and as the result of infection
with the human immunodeficiency virus.
1. Children born without functional immune systems must remain isolated from
pathogens or they will die from exposure to the many diseases that most people can
withstand.
2. People infected with HIV lose their immune function and die from one of the many
infections that their bodies can no longer fight.

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3. Explain the goals of the field of psychoneuroimmunology and evaluate its progress toward
these goals.
A. Psychoneuroimmunology is the multidisciplinary field that focuses on the interactions
among behavior, the nervous system, the endocrine system, and the immune system.
B. The goals of the field include an understanding of how each of the areas contribute to
disease by establishing a connection between psychological factors and immune function and
understanding how immune function relates to disease.
C. Research in psychoneuroimmunology has focused on the connection between
psychological factors and immune functioning.
1. The immune system can be conditioned.
2. Experiences can affect immune system function, especially negative experiences such
as stress.
3. The link between immune system function and the development of disease has been
demonstrated by a few studies in the field of psychoneuroimmunology.
4. Before the field can be considered successful, research must link psychological
factors, immune system functioning, and disease.

4. How does the diathesis-stress model explain how some people get sick when exposed to
stress while others remain healthy?
A. The diathesis-stress model suggests that some people are predisposed to disease because
of some genetic or biochemical weakness or vulnerability.
1. Acquired vulnerability may also constitute a diathesis.
2. For individuals with such predisposition, even low levels of stress may prompt the
development of disease.
B. For individuals without the predisposition, low levels of stress will not prompt the
development of disease; even high stress may not.

5. How strong is the relationship between stress and headache, heart disease, infectious
disease, ulcers, diabetes, or any other disease?
A. Stress is a factor in both vascular and tension headaches.
B. The relationship between stress and cardiovascular disease is not straightforward.
1. Stress does not cause hypertension.
2. Some people show high levels of reactivity to stress, which may be a factor in the
development of cardiovascular disease.
C. Stress is related to vulnerability to infectious illness.
D. Stress may exacerbate ulcers but is not the underlying cause of the development of ulcers.
E. Stress may prompt people to engage in risky behaviors such as smoking or drinking as
ways to cope with their problems.

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F. Other disorders such as diabetes, premature delivery in pregnancy, asthma, and

rheumatoid arthritis are related to stress, but the exact role of stress in the development of
these diseases is not clear.
G. Evidence exists that stress is related to physical disorders, but the evidence is less clear
than most people assume.

6. Evaluate the evidence for stress as a factor in psychological disorders.

A. The relationship between stress and depression is complex.
1. People with effective coping skills can avoid depression, even if they experience high
levels of stress.
2. Genetic vulnerability may contribute to the link between stress and depression,
providing the vulnerability that produces depression when vulnerable people experience
stress.
3. The link between stress and depression may be through proinflammatory cytokines,
which produce effects that are similar to depression.
B. Anxiety disorders
1. Posttraumatic stress disorder is one of the anxiety disorders.
a. This disorder is by definition related to stress.
b. Some types of stress are more likely to produce PTSD than other types; for
example, victims of sexual abuse, domestic violence, and natural disasters are
especially vulnerable.
2. The link between stress and other anxiety disorders is less clear.

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