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stress & health.docx

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Department
Psychology
Course Code
PSY-0012
Professor
Jackquelyn Mascher

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Stress and Health 04/15/2014 Stress and Health Outline Basic themes Adherence (following medical advice) Theoretical frames Health psychology  Focuses on the role psychological factors play in physical illness/health Behavioral medicine Uses psychology to inform treatment, largely through behavioral approaches Why focus on behavior? All health problems have behavior components Behavior is observable and measurable Stress factors Coping strategies Physical factors Cognitive factors Environmental and cultural factors Personality factors Basic Themes in Health Psychology (don’t need to know names and dates) Coping styles to decrease stress Problem­focused coping Solution focused therapy solves a problem that generates stress Promotes self­efficacy, mastery, agency More stereotypically men Emotion­focused coping  Therapy to gain mastery over one’s subjective state of stress If a thing does not bother you, then it is not necessarily a problem E.g. if angry at doctor, fix anger (not doctor) More stereotypically women Avoidance coping Can predict greater progression of disease Avoidance of triggers (e.g., substance recovery) okay Avoidance of perpetrators or other toxicity okay E.g. not taking medication Social capital Functional (quality) social support vs. structural (quantity) social support (when you have a preexisting  disease) For social capital, function is more important than structure In general, isolation and few friends predicts higher mortality (but still quality over quantity) – isolation is a  huge risk factor for illness People with diverse friendship networks less likely to develop colds following exposure  Support quality predicts disease rates “Allostatic load” (how stressed out you are): stressing, wear and tear on body due to… High levels of cortisol, growth hormone, norepinephrine or other stress­related substances in system Frequent stressful experiences Difficulty adapting to stress (e.g., absence of normal decline in reaction) – overreaction  Genetically slow­to­adapt stress reaction – under­reaction  Poor coping skills that make stress worse Thoughts, feelings, behaviors that interfere with adaptation Difficulty returning to balance Initial under­response to stress Psychoneuroimmunology (1975) Study of the relationship between immunology and psychology Evidence that overstressed people… Are slower to develop antibodies May have slower wound healing May have deficiency in pro­inflammatory cytokines May release cytokines or hormones (signaling molecules) in response to stress in a way that contributes to  disease (e.g., coronary heart disease, arthritis, cancer in plasma cells or lymphatic cells, osteoporosis,  T2D) Immune response and stress In rats, uncontrolled shocks predicted enhanced tumor growth, reduced tumor rejection rates, and  decreased survival times In other non­human animals, sustained prenatal levels of stress in mother predicted long­lasting effects on  the immune system of offspring In humans, significant difference in lymphocyte response to relaxation, predictable stress, controllable  stress Emotion and appraisal patterns (negative emotions and appraisals are correlated with disease, whereas  positive emotions and appraisals are therapeutic and correlated with resilience) Negative emotional states Resentment Regret Worry Anger Cynicism Negative appraisals About self About world About future Positive emotional states and appraisals Hope  Optimism Agency (control) Choice Efficacy Belonging Connectedness SES, stress, and health Low SES associated with Higher rates of health problems Higher rates of mortality High allostatic load Poor neighborhoods have More liquor stores Poorer food choices in convenience stores, grocery stores, restaurants Fewer health clubs, parks, exercise options More toxins and pollutants SES and race Disproportionate representation of POC (people of color) in low SES groups Hypertension 2x more frequent in Blacks versus whites in U.S. Microstressors (highly stressful issues that build up over time like discrimination)/daily hassles greater for  Blacks in the U.S. Traumatic stress due to discrimination greater in targeted groups Mortality (deaths per unit time) rate 2x higher for Blacks versus whites in U.S. Higher in POC: Smoking, obesity, hypertension, reduced exercise, BMI, fat intake, cardiovascular reactivity Race and health in the U.S. Ethnic differences in detection, adherence, survival, quality of life (QoL) Infant mortality of Blacks 2x that of whites Life expectancy of Blacks ~6 years less than whites Less than one death in 200 attributable to hereditary disease in Blacks (e.g., sickle cell) Rate of diabetes in Blacks 2x that of whites Blacks suffer more complications: limb loss, blindness, kidney disease, terminal heart disease Cervical cancer incidence in Latinas 2x that of non­Latina whites Stomach cancer incidence in Asians 2x that of whites Heart disease claims 50% more Blacks than whites Blacks die from heart attacks at higher rates than whites Blacks more likely to develop liver problems (e.g., hep C) Less likely to receive aggressive treatment for many possible reasons HIV/AIDS and Hep C kills Blacks at higher rates 49% of HIV+ Americans are Blacks 86% of children with AIDS are Black or Hispanic Blacks 10x more likely to develop AIDS from HIV Cancer: Blacks in U.S.A. Blacks have highest rates of cancer, cancer deaths overall Cancer diagnosed later in Blacks Black women have lower survival rate of breast cancer Tend to receive poorer quality care, including screening Develop breast cancer sooner (before age 40) Diagnosed at more advanced stage Worse overall prognosis; worse prognosis at each stage Black men have highest rates of developing and dying from prostate and lung cancers Research Focus: Conditions and Significant Psychological Components  Cardiovascular disease Accounts for ~1/2 deaths in U.S. each year An American Heart Association’s slogan: “Your lifestyle is your best defense against a heart attack” Primary hypertension High blood pressure with no evident biologic
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