• Chapter 14

• Stress, Coping, and Health

• What is Stress?

• “Stress” is used to refer to a range of concepts from external environmental stimuli to internal
experiences and bodily responses

• Stressors: external stimuli and events that represent a perceived potential for harm,
loss, damage, challenge, or other deviations from a balanced state

• Stress responses: internal integrated psychological (cognitive) and biological responses

to stressors that then work to restore a balanced state

• The Importance of Perceptions

• Primary Appraisals: based on perceptions of stressor characteristics, magnitude of demand, and

relevance

• Secondary Appraisals: based on perceptions of the resources available for coping with a specific
stressor

• Internal factors: e.g. personality and personal abilities

• External factors: e.g. social support or financial resources

• Challenge and Threat Theory

• Challenges - situations where resources exceed the demands of the situation

• The potential for positive outcomes and gain are more likely to be perceived as
challenges

• Threats - situations where demands exceed the resources available for coping

• Danger, uncertainty, uncontrollability, novelty, and high levels of effort all have
higher “demands” and are more likely to be perceived as threats

• Threat vs. Challenge

• Different Types of Stress

• Types of stressors can be defined by duration and severity

• Acute stressors: short-term external circumstances or stimuli, lasting minutes to hours

• Chronic stressors: enduring external circumstances or stimuli, lasting weeks to years

• Traumatic stressors: stressors involving threat to your own or another’s life or physical
integrity

• Frustration
• Frustration: feeling of being upset or annoyed, especially due to inability to change or achieve
something

• For psychology, emotion or state we experience when we fail in the pursuit of a goal

• Can lead to aggression

• Internal Conflict

• Conflict: when 2+ incompatible motivations or behavioural impulses compete for expression

• Lewin (1935) described 3 basic types of conflict:

• Approach-approach

• Choose between two attractive goals

• Avoidance-avoidance

• Choose between two unattractive goals

• Approach-avoidance

• Choose if you want to pursue a single goal with attractive and unattractive
aspects

• Life Events

• Life changes: any substantial alteration in your living circumstances that require adjustments

• Change can be stressful

• Good and bad changes

• Pressure

• Pressure involves expectations (demands) that you behave a certain way

• Time pressure – get it done by a deadline

• Pressure to conform – match group expectations

• Performance pressure – meet a certain goal/level

• Can come from ourselves or others

• Responding to Stress

• Emotional Responses

• Complicated and changing relationship between stress and emotion

• Lazarus (2006) linked specific cognitive reactions (appraisals) to specific emotions

• Self-blame → guilt
 • Helplessness → sadness

• Chronic negative emotions linked to negative health outcomes

• Emotional Arousal and Performance

• Yerkes-Dodson Law: inverted U shaped curve for relationship between stress and performance

• Too little or too much stress impairs performance

• (Yerkes & Dodson, 1908)

• Emotional Arousal and Performance

• Maximal Adaptability Model: emphasizes that animals are highly adaptive to stressors and can
maintain high levels of performance even when experiencing underload or overload in terms of
the demands of the environment

• (Hancock & Warm, 1989).

• Physiological Responses

• The stress response serves to protect us from harm and restore balance to the body

• Homeostasis: the state of balance that is upset by stressors and then restored by the
stress response

• A coordinated response that allowed us to mobilize energy to deal with a stressor, avoid injury,
and reduce risk for infection

• Neurobiological Response

• Neurobiological Response

• Amygdala: responds rapidly to potential stressors; earliest stress responses

• Works in coordination with other brain areas that can increase or decrease the
amygdala’s response

• Hippocampus: learning and memory

• Prefrontal cortex: higher-order processing of stimuli

• Biological Response

• Autonomic nervous system

• Sympathetic nervous system (SNS)

• Fight or flight

• Release of stress hormones

• epinephrine and norepinephrine

 • Parasympathetic nervous system (PNS)

• Dampening the stress response

• Biological Response

• Hypothalamic pituitary adrenal (HPA) axis

• Amygdala > hypothalamus

• Release corticotropin-releasing hormone (CRH)

• CRH > pituitary gland

• Release adrenocorticotropic hormone (ACTH)

• ACTH > adrenal glands

• release of cortisol

• Fight, Flight, or Freeze?

• Freeze response: become immobile in the face of perceived stressors

• Regulation

• Feedback loops: output from one system influences the output of another system by either
increasing (positive feedback) or inhibiting (negative feedback) the second system

• HPA axis contains negative feedback loops

• ANS can work by reciprocal inhibition

• The sympathetic nervous system serving as the activator and the parasympathetic
nervous system acting as the regulator/inhibitor

• The Immune System

• Inflammatory response: immune system response to injury, infection, and psychological

stressors that allows for killing of any foreign invaders such as viruses and bacteria as well as
healing of bodily tissue

• When encountering acute psychological stressors, the body increases levels of proteins
called cytokines that regulate inflammation

• Good and Bad Stress

• Hans Selye, the “Father of Stress Research” emphasized the upside of “stress” in our lives (Selye,
1980)

• “Stress is unavoidable and, in fact, it would be undesirable to avoid it. I have often said
that stress is the spice of life: it can be a great stimulus to achievement.”

• Good and Bad Stress

• Eustress: “good stress”

• Includes external circumstances, internal emotional experiences, and bodily responses

that can be beneficial and motivating

• Distress: “bad stress”

• Includes external circumstances, internal emotional experiences, and bodily responses

that can be harmful, reduce motivation, and impair functioning

• General Adaptation Syndrome

• General Adaptation Syndrome

• Alarm - 1st phase

• Activation of sympathetic nervous system

• Release of stress hormones

• Triggers increase in blood sugars

• Suppresses immune system

• Cannot last indefinitely

• Parasympathetic system tries to restore homeostasis

• If stressor persists - so does response

• General Adaptation Syndrome

• Resistance - 2nd phase

• Continued recruitment of resources

• Can last long time, but resources being depleted

• Exhaustion - 3rd phase

• Resources dangerously depleted

• Increased vulnerability to disease

• Can manifest itself with cardiovascular problems; immune system difficulties

• Behavioural Responses

• Coping Stress: active efforts to master, reduce, or tolerate the demands created by stress

• Efforts can be healthful or maladaptive

• Behavioural Responses

• Learned Helplessness: passive behaviour due to exposure to unavoidable aversive events

 • Giving up, fatalism and resignation, acceptance

• “It’s out of my control”

• Self-blame – become overly self-critical

• Behavioural Responses

• Self-Indulgence: reduced self-control when facing stressors; acting on impulses

• Increased levels of stress can lead to changes in eating habits, spending habits, etc.

• Linked to addiction

• Defense Mechanisms: (mainly) unconscious actions to handle emotions triggered by stress

• Behavioural Responses

• Constructive Coping: relatively healthful efforts to deal with stressful events

• Doesn’t guarantee successful outcome

• Allows us to approach or frame the stressor in a useful way

• Burnout

• Burnout: physical and emotional exhaustion, cynicism, and a lowered sense of self-efficacy

• Comes on gradually due to chronic work-related stress

• Linked to:

• Too much work

• Too few resources

• Lack of recognition

• Lack of control

• Post-Traumatic Stress Disorder

• Post-Traumatic Stress Disorder (PTSD): enduring psychological disturbance after experiencing

traumatic event(s)

• Distress

• Flashbacks

• Depression

• Anxiety

• Insomnia

• Effects of Stressors on Health

• Diathesis-Stress Model

• “Theory that mental and physical disorders develop from a genetic or biological predisposition
for that illness (diathesis) combined with stressful conditions that play a precipitating or
facilitating role.”

• Diathesis-Stress Model

• Diathesis-Stress Model

• Stress and Illness

• Stress associated with increase in chronic conditions

• Arthritis, bronchitis, emphysema

• Stress can be precursor to health problems

• Increased risk with number of stressors

• Stress and Illness

• Decrease immune function

• Demonstrated to occur within 24 hours

• Worsen pre-existing conditions

• Stress hormones contribute to blocked arteries

• Deterioration of hippocampus and memory impairment

• Personality and Stress

• Type A Personality

• Strong competitive orientation

• Impatience and time urgency

• Anger and hostility

• Type B Personality

• Relatively relaxed and easygoing

• Amicable behaviour

• Less competitive and aggressive

• Neuroticism

• High neuroticism = experience negative emotions and get themselves into stressful situations
through their maladaptive behaviours

• Relaxation Techniques
• Mindfulness is characterized by a focus on the present moment and a nonjudgmental and
accepting approach to one’s thoughts and feelings

• Mindfulness Based Stress Reduction (MBSR) enhanced physical health as indexed by medical
symptoms, pain perception, physical impairments and functional quality of life

• Optimism

• Belief in the outcome – “Things will work out”

• Optimists have

• Appraisal of being less helpless

• Better adjustment to negative life events

• Sense of less helplessness

• Better health

• Stress and Mental Health

• Stressors involving social rejection most likely to trigger depression

• Childhood stressors have been shown to be particularly harmful with long lasting effects

• Stress and Physical Health

• Acute illnesses can last longer when an individual is stressed

• Asthma attacks can be more severe when an individual is stressed

• Latent viruses (e.g. HSV-1, EBV) can be reactivated under stressful conditions

• Stress and Physical Health

• Chronic illnesses can be more severe when an individual is stressed

• Cardiovascular diseases can be influenced by stress

• Autoimmune diseases can be influenced by stress

• Adverse Childhood Experiences Study evidence

• Pathways from Stress to Disease

• Chronic inflammation: increased levels of inflammatory proteins in the body

• Prolonged exposure to pro-inflammatory cytokines can lead to cell death and tissue
damage

• Pathways from Stress to Disease

• Biological aging: tendency for reduced cellular performance as we age

• Diseases consist of cardiovascular, autoimmune and neurodegenerative

 • Telomeres: DNA-protein complexes that cap chromosomes and protect against the
damage to the DNA that encodes our genes

• Important Considerations

• Increased risk is not determinism

• Can enhance resilience to stressors, even with a diathesis

• Observational studies cannot show causal relationships, only associations

• Difficult to control confounding variables

• Vulnerability to Stress

• Vulnerability Factors

• Increase susceptibility to stress

• What Reduces Resistance?

• Lack of support network

• Poor coping skills

• Pessimism

• Protective Factors

• Social Support

• Blunts impact of stress

• Sense of identity, meaning

• May prevent maladaptive ways of coping

• Enhances immune system

• Shown among cancer patients - people who talk about negative life events

• Social Support

• Emotional support: expressions of empathy, love, and care when someone is experiencing
stressors

• Instrumental support: tangible help

• E.g., offering to take notes for someone

• Informational support: advice and information that people can give us to change the impact of a
stressor

• Appraisal support: help evaluating the demands of a situation and the resources available to
cope with it
• Bottling Up Feelings

• Inability to express negative feelings has costs

• Higher likelihood of cancer

• Expressing emotions in an adaptive manner

• Long-term positive consequences on health

• Bottling Up Feelings

• Protective Factors

• Hardiness

• Commitment - What they do is important

• Control - Control (perceived) over situation

• Challenge - Situation is a challenge not a threat

• Which is the strongest component? - Control

• Coping Self-Efficacy

• Increased efficacy from:

• Previous successes

• Observing others

• Social persuasion / encouragement

• Low levels of arousal

• Shown to increase immune system functioning

• Health Psychology

• Recognizes the role that behaviour plays in health maintenance

• Studies psychological and behavioural factors in the prevention and treatment of illness and in
the maintenance of health

• Health Promotion

• Health-enhancing behaviours

• Serve to maintain or increase health

• Exercise, healthy diets, safe sexual practices, regular medical checkups, and
breast and testicular self-examination

• Health-compromising behaviours
 • Promote the development of illness

• Smoking, fatty diets, a sedentary lifestyle, and unprotected sexual activity

• How People Change

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

6. Termination

• Increase Health-Enhancing Behaviours

• Sedentary lifestyle & health problems

• E.g., Heart disease, obesity

• Benefits of exercise

• Aerobic exercise

• Oxygen better utilized; lower cholesterol levels

• Moderate levels of exercise produce best results

• Physical health

• Longevity

• Positive Psychology

• First used by the humanistic psychologist Abraham Maslow (1954)

• Current usage and meaning is based on Martin Seligman

• Since the 1950s psychology has focused too strongly on pathology—on treating illness

• Positive Psychology

• Psychological research-derived suggestions that may help you maintain and enhance personal
happiness:

• Spend time with others, and work to develop close relationships

• Look for ways to be helpful to others, and reach out to the less fortunate

• Set meaningful personal goals, and make progress toward them

• Positive Psychology
• Psychological research-derived suggestions that may help you maintain and enhance personal
happiness:

• Make time for enjoyable activities

• Nurture physical well-being

• Be open to new experiences

• Cultivate optimism, and count your blessings