CHAPTER 13

Stress,
Coping, and
Health

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 13.1 THE NATURE OF STRESS

Key Learning Goals

• Evaluate the impact of minor stressors and
people’s appraisals of stress.
• Identify four major types of stress.

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 STRESS
• The traditional view of physical illness as a purely biological phenomenon has
given way to a biopsychosocial model of illness.

• The biopsychosocial model holds that physical illness is caused by a complex

interaction of biological, psychological, and sociocultural factors. This model
does not suggest that biological factors are unimportant. It simply asserts that
these factors operate in a psychological and social context that is also
influential.

• We define stress as any circumstances that threaten or are perceived to

threaten one’s well-being and tax one’s coping abilities.

• The threat may be to immediate physical safety, long-range security, self-

esteem, reputation, peace of mind, or many other things one values.

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 STRESS
• The word stress tends to spark images of overwhelming, traumatic
crises. However, major disasters are unusual events and represent
only a small part of what constitutes stress. Many everyday events are
also stressful.

• You might guess that minor stresses would produce minor effects, but
that isn’t necessarily true. Research has shown that routine hassles
can have significant harmful effects on mental and physical health.
This may be because of the cumulative nature of stress. Stress
adds up.

• Routine stresses at home, at school, and at work might be fairly benign

individually, but collectively they can create great strain.

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 The Nature of Stress
• Biopsychosocial model – A model that holds that
physical illness is caused by a complex interaction of
biological, psychological, and sociocultural factors
• Stress – Any circumstances that threaten or are
perceived to threaten one’s well-being and tax one’s
coping abilities

Stress as an Everyday Event

• Routine hassles can have significant harmful effects on
mental and physical health.
• Stress is cumulative and collectively can create great
strain.
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 Figure 13.1

Figure 13.1
Primary and secondary appraisal of stress. Primary appraisal is an initial
evaluation of whether an event is (1) irrelevant to you; (2) relevant, but not
threatening; or (3) stressful. When you view an event as stressful, you are likely
to make a secondary appraisal, which is an evaluation of your coping resources
and options for dealing with the stress. (Based on Lazarus & Folkman, 1984)
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 Major Types of Stress
• Frustration – A type of stress experienced
whenever the pursuit of some goal is thwarted
• Conflict – A type of stress that occurs when two
or more incompatible motivations or behavioral
impulses compete for expression
• Life changes – Any substantial alterations in
one’s living circumstances that require
readjustment (HOLMES Q)
• Pressure – Expectations or demands that one
behave in a certain way
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© 2019 Cengage. All rights reserved.
 Figure 13.2

Figure 13.2
Types of conflict. Psychologists have identified three basic types of conflict. In
approach-approach and avoidance-avoidance conflicts, a person is torn
between two goals. In an approach-avoidance conflict, only one goal is under
consideration, but it has both positive and negative aspects.
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 In an approach-approach conflict,
• a choice must be made between two attractive goals.

• The problem, of course, is that you can choose just one of the two goals.

• Among the three kinds of conflict, the approach-approach type tends to be the
least stressful.

• Nonetheless, approach-approach conflicts over important issues can

sometimes be troublesome.

• Vacation - It's time to plan your family vacation for the year. Not shockingly, the
kids are leaning towards the Disney World vacation. You and your spouse are
leaning towards a tropical beach vacation in Hawaii. Each option has
advantages and disadvantages. It's your job as a parent to make the decision.
This falls under approach-approach conflict because you have to decide
between two pretty appealing destinations.

• More meaningful examples?

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 In an avoidance-avoidance conflict
• a choice must be made between two unattractive goals.
• Forced to choose between two repellent alternatives, you are, as they
say, “caught between a rock and a hard place.” Obviously, avoidance-
avoidance conflicts are most unpleasant and highly stressful.
• Sitting in the doctor's office after the examination, Lora could sense that something was
wrong. Her doctor informed her that he detected a lump in her breast. Although he was
going to conduct a biopsy to make sure, he was concerned that she might have breast
cancer. Given her family history, Lora was concerned that she might have breast cancer,
too. She knew that the whatever choices she'd be given would be undesirable; however,
she would have to make a choice regardless. Lora was facing what is known as an
avoidance-avoidance conflict, whereby an individual wants to avoid making a decision
because the alternatives are objectionable.
• After Lora's doctor received her biopsy results, he presented her with two possible courses
of action. They could try to reduce the tumors using chemotherapy, or they could perform a
double mastectomy and possibly avoid chemotherapy altogether.
• Neither decision offered a sure cure, and neither approach was going to be easy. Whether
Lora chooses surgery or chemotherapy, she will experience pain. She knows that she
has to make a decision, but is facing a conflict because both options have significantly
negative consequences.

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 In an approach-avoidance conflict
• a choice must be made about whether to pursue a single goal
that has both attractive and unattractive aspects.
• Approach-avoidance conflicts are common and can be quite
stressful.
• Any time you have to take a risk to pursue some desirable
outcome, you’re likely to find yourself in an approach-
avoidance conflict.
• Approach-avoidance conflicts often produce vacillation. That is,
you go back and forth, beset by indecision.
Tanya has been with Company X for 12 years.
She is offered a job promotion as vice president of the company. It would pay her
much more than she is currently making (approach).
However, if she was to accept this position, she would have to move to a city that
was far away from her extended family (avoidance) and where the weather was
much colder (avoidance).
LABORIT

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• https://www.youtube.com/watch?v=xN4
AxInXiQo

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 13.2 RESPONDING TO STRESS

Key Learning Goals

• Discuss the role of positive emotions in
response to stress, and describe the effects of
emotional arousal.
• Describe Selye’s general adaptation syndrome
and other physiological responses to stress.
• Evaluate the adaptive value of common coping
strategies.

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 Figure 13.3

Figure 13.3
Overview of the stress process. A potentially stressful event, such as a major
exam, elicits a subjective appraisal of how threatening the event is. If the event
is viewed with alarm, the stress can trigger emotional, physiological, and
behavioral reactions because people’s response to stress is multidimensional.
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 Emotions Commonly Elicited
• Common emotional responses to stress include:
– Annoyance, anger, and rage
– Apprehension, anxiety, and fear
– Dejection, sadness, and grief
• Positive emotions also occur during periods of stress.
• The broaden-and-build theory of positive emotions explains how
positive emotions promote resilience.
– Positive emotions alter people’s mindsets, broadening their scope of
attention and increasing their creativity and flexibility in problem solving.
– Positive emotions can undo the lingering effects of negative emotions, thus
short-circuiting the potentially damaging physiological responses to stress.
– Positive emotions can promote rewarding social interactions that help to
build valuable social support and enhanced coping strategies.
• A positive emotional style has many health benefits.

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• Many emotions can be evoked by stressful events, but some are
certainly more likely than others.

• Common emotional responses to stress include

• (1) annoyance, anger, and rage;
• (2) apprehension, anxiety, and fear; and
• (3) dejection, sadness, and grief.

• Investigators have tended to focus heavily on the connection between

stress and negative emotions.
• However, research shows that positive emotions also occur during
periods of stress.
• Although this finding seems counterintuitive, researchers have found
that people experience a diverse array of pleasant emotions even
while enduring the most dire of circumstances.
• Moreover, these positive emotions appear to play a key role in helping
people bounce back from the difficulties associated with stress.

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• Barbara Fredrickson’s broaden-and-build theory of positive emotions
sheds light on how positive emotions promote resilience in the face of
stress.
• First, positive emotions alter people’s mindsets, broadening their
scope of attention and increasing their creativity and flexibility in
problem solving.
• Second, positive emotions can undo the lingering effects of negative
emotions, and thus short-circuit the potentially damaging physiological
responses to stress.
• Third, positive emotions can promote rewarding social interactions that
help to build valuable social support and enhanced coping strategies.

• One particularly interesting finding has been that a positive emotional

style is associated with an enhanced immune response.

• Positive emotions also appear to be protective against heart disease.

• Indeed, evidence suggests that a positive emotional style may be

associated with enhanced physical health in general.

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 Figure 13.5

Figure 13.5
Arousal and performance. Graphs of the relationship between emotional
arousal and task performance tend to resemble an inverted U, as increased
arousal is associated with improved performance up to a point, after which
higher arousal leads to poorer performance. The optimal level of arousal for a
task depends on the complexity of the task. On complex tasks, a relatively low
level of arousal tends to be optimal. On simple tasks, however, performance
may peak at a much higher level of arousal.
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The General Adaptation Syndrome
• General adaptation syndrome – A model of the
body’s stress response, consisting of three
stages: alarm, resistance, and exhaustion
– Alarm stage – Physiological arousal occurs as the
body musters its resources to combat a threat.
– Resistance stage – Physiological changes stabilize as
coping efforts get under way.
– Exhaustion stage – If the stress can’t be overcome,
the body’s resources may be depleted.
• Diseases of adaptation – The harmful physiological effects
associated with chronic overactivation of the stress response

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Figure 13.7
Figure 13.7
Brain-body pathways in stress. In
times of stress, the brain sends signals
along two pathways. The pathway
through the autonomic nervous system
controls the release of catecholamine
hormones, which help mobilize the body
for action.

The pathway through the pituitary gland

and the endocrine system controls the
release of corticosteroid hormones,
which increase energy and ward off
tissue inflammation.

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© 2019 Cengage. All rights reserved.
 Behavioral Responses (slide 1 of 3)
• Coping – Active efforts to master, reduce, or tolerate the
demands created by stress

Giving Up and Blaming Oneself

• Learned helplessness – Passive behavior produced by
exposure to unavoidable aversive events

Striking Out at Others

• Aggression – Any behavior that is intended to hurt
someone, either physically or verbally
• Catharsis – The release of emotional tension

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 Behavioral Responses (slide 2 of 3)
Indulging Oneself
• Stress sometimes leads to reduced impulse control, or self-
indulgence.
• A relatively new manifestation of self-indulgence is Internet addiction.
– Excessive gaming
– Preoccupation with sexual content
– Obsessive socializing

Defensive Coping
• Defense mechanisms – Largely unconscious reactions that protect
a person from unpleasant emotions, such as anxiety and guilt
• Self-deception distorts reality so it seems less threatening.
• Defense mechanisms are largely unconscious.

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 Behavioral Responses (slide 3 of 3)
Constructive Coping
• Constructive coping – Relatively healthful
efforts that people make to deal with stressful
events
– Confront problems directly.
– Avoid excessive self-deception and highly unrealistic
negative thinking.
– Reappraise stressful events in less threatening ways.
– Ensure that your body is not especially vulnerable to
the damaging effects of stress.

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 13.3 STRESS AND PHYSICAL
HEALTH
Key Learning Goals
• Review the evidence linking personality factors,
emotional reactions, and depression to coronary
heart disease.
• Discuss how stress affects immune functioning,
and assess the link between stress and illness.
• Identify some factors that moderate the impact
of stress, and explain how stress may have
positive effects.

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Personality, Hostility, and Heart Disease

• Type A personality – A personality that includes

three elements:
– A strong competitive orientation
– Impatience and time urgency
– Anger and hostility
• Type B personality – A personality marked by
relatively relaxed, patient, easygoing, amicable
behavior
• A link exists between coronary risk and the anger
and hostility component of Type A personality.
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Emotional Reactions, Depression,
and Heart Disease
• Brief periods of mental stress can trigger sudden
symptoms of heart disease.
– Outbursts of anger can be particularly dangerous.
• Depression is a risk factor for heart disease.
– The emotional dysfunction of depression may cause
heart disease.
– Depression roughly doubles one’s chances of
developing heart disease.

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 Stress, Other Diseases,
and Immune Functioning
• Immune response – The body’s defensive
reaction to invasion by bacteria, viral agents, or
other foreign substances
– Some studies have related stress to suppressed
immune activity in humans.
• Exposure to long-term stress can sometimes
promote chronic inflammation, which is
recognized as a factor in heart disease.
– Chronic inflammation also contributes to arthritis,
osteoporosis, respiratory diseases, diabetes,
Alzheimer’s disease, and some types of cancer.
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 Figure 13.9

Figure 13.9
The stress-illness correlation. One or more aspects of personality, physiology,
and memory could play the role of a postulated third variable in the relationship
between high stress and a high incidence of illness. For example, neuroticism
may lead some subjects to view more events as stressful and to remember more
illness, thus inflating the apparent correlation between stress and illness.
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 Factors Moderating the
Impact of Stress (slide 1 of 2)
Social Support
• Social support – Various types of aid and emotional
sustenance provided by members of one’s social
networks
• The favorable effects of social support are strong enough
to have an impact on mortality, increasing people’s odds
of survival by roughly 50%.
• Cultural disparities exist in the type of social support that
people prefer.
– Americans prefer explicit social support—overt emotional solace
and instrumental aid from others.
– Asians prefer implicit social support—the comfort that comes from
knowing one has access to close others who will be supportive.
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 Factors Moderating the
Impact of Stress (slide 2 of 2)
Optimism and Conscientiousness
• Optimism – A general tendency to expect good
outcomes
• Conscientiousness, one of the Big Five personality traits,
is associated with good physical health and increased
longevity.

Stress Mindset
• A stress-is-enhancing mindset should be associated with
intermediate arousal in response to stress and more
effective coping strategies.

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 Positive Effects of Stress
• Positive effects of stress include resilience.
• Research on resilience suggests that stress can
promote personal growth or self-improvement.
– The adaptation process initiated by stress can lead to
personal changes for the better.
• Having to grapple with a moderate amount of
stress may build resilience in the face of future
stress.

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 13.4 HEALTH-IMPAIRING BEHAVIOR

Key Learning Goals

• Evaluate the negative health impact of smoking,
substance abuse, and lack of exercise.
• Clarify the relationship between behavioral
factors and AIDs.

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 Figure 13.11

Figure 13.11
The prevalence of smoking in the United States. This graph shows how the
percentage of U.S. adults who smoke has declined steadily since the mid-1960s.
Although considerable progress has been made, smoking still accounts for a
huge number of premature deaths in the United States each year. (Based on
data from the Centers for Disease Control and Prevention)
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 Alcohol and Drug Use/
Lack of Exercise
Alcohol and Drug Use
• Heavy alcohol consumption and use of various recreational drugs
increase the risks for disease.

Lack of Exercise
• Evidence links lack of exercise to poor health.
• Physical fitness is declining in the United States.
• Benefits of exercise:
– Enhances cardiovascular fitness
– Reduces risk for obesity-related health problems
– Helps diminish chronic inflammation
– Reduces damaging physical effects of stress
– Reduces the brain shrinkage normally seen after age 60

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 Behavior and HIV/AIDS
• Acquired immune deficiency syndrome – A disorder in which the
immune system is gradually weakened and eventually disabled by
the human immunodeficiency virus (HIV)
• Being infected with the HIV virus is not equivalent to having AIDS.
– AIDS manifests about 7–10 years after the original infection.
• AIDS inflicts its harm indirectly by opening the door to other
infectious diseases.
• The HIV virus is transmitted through person-to-person contact
involving the exchange of bodily fluids, primarily semen and blood.
– The two principal modes of transmission in the United States are sexual
contact and the sharing of needles by IV drug users.
– There is no evidence that the infection can spread through casual
contact.
• Many HIV carriers don’t know they are infected.

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 13.5 REACTIONS TO ILLNESS

Key Learning Goals

• Discuss differences in the willingness to seek
medical treatment and some barriers to effective
patient-provider communication.
• Review the extent to which people tend to
adhere to medical advice.

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 Deciding to Seek Treatment
• Many people tend to delay the pursuit of needed
professional consultation.
• Reasons people delay treatment:
– Misinterpret and downplay the significance of their
symptoms
– Fret about looking silly if the problem turns out to be
nothing
– Worry about “bothering” their physician
– Are reluctant to disrupt their plans
– Waste time on trivial matters before going to the ER

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 Communicating with Health Providers

• The quality of communication between patients and their health

providers can affect health outcomes.
• Barriers to effective provider-patient communication include:
– Economics dictate that medical visits be brief.
– Many providers use too much medical jargon.
– Patients forget to report some symptoms or ask questions.
– Patients are evasive because they fear a serious diagnosis.
– Patients are reluctant to challenge doctors’ authority.
• Ways to improve communication include:
– Prepare questions and concerns in advance of your medical visit.
– Be accurate and candid in reply to your doctor’s questions.
– Ask for clarification if you don’t understand something.
– Don’t be afraid to voice concerns about the suitability or feasibility of
your doctor’s recommendations.

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 Adhering to Medical Advice
• Many patients fail to follow medical advice.
– May not start treatment
– May stop treatment early
– May reduce or increase the levels of treatment prescribed
– May be inconsistent in following treatment procedures
• Reasons for noncompliance:
– Forgetfulness
– Lack of social support
– Lack of understanding instructions
– Difficulty level of instructions
– Negative attitude toward the physician

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 13.6 REFLECTING ON THE CHAPTER’S
THEMES
Key Learning Goals
• Identify the two unifying themes highlighted in
this chapter.

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Reflecting on the Chapter’s Themes

• Behavior is determined by multiple causes.

– Stress has only a modest impact on physical health.
– Health is governed by many factors, including:
• Inherited vulnerabilities
• Exposure to infectious agents
• Health-impairing habits
• Treatment-seeking behavior and compliance with medical advice
• Optimism and social support
• People’s experience of the world is subjective.
– When it comes to stress, objective reality is not nearly as
important as subjective perceptions.
– The impact of stressful events depends on people’s view of them.

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