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Psychology 2040A/B
Michael G Mac Donald

Chapter 15 – Stress, Coping, and Health The Nature of Stress • Stress viewed as in three different ways (stimulus, response, and organism-environment interaction) o Stimulus (stressors) – situations that place demands on organisms that tax or exceed their resources o Stress – a pattern of cognitive appraisals, physiological responses, and behavioural tendencies that occurs in response to a perceived imbalance between situational demands and the resources needed to cope with them • Stressors o Stressors range in severity  Microstressors – daily hassles and everyday annoyances we encounter  Catastrophic events – natural disasters, acts of war, etc.  Major negative events-victim of major crime or sexual abuse o Life event scales – questionnaires that measure the number of positive and negative life events that have occurred over a specific period of time—also appraisal of event whether positive or negative • The Stress Response o Four aspects of appraisal process are of particular significance:  Primary – appraisal of demands of situation—benign/threatening, significance to your well being and resources available to deal with it  Secondary – appraisal of resources available to cope with it—knowledge and abilities to cope with it and emotional support, demands>resources=stress  Judgments of what consequences of situation could be-failing to cope successfully, seriousness and likelihood or the consequence  Appraisal of personal meaning (what the outcome might imply about us)  Autonomic and somatic feedback can affect our reappraisals of how stressful a situation is and whether our resources are sufficient enough to cope with it. • Chronic Stress and the GAS o General adaptation syndrome (GAS)-Selye – a physiological response pattern to strong and prolonged stressors  Consists of three phases: • Alarm reaction – a rapid increase in physiological arousal • Occurs due to sudden activation of sympathetic nervous system and release of hormones-increase heart rate and respiration, dilates pupils helps deal with source of stress o Produces cortisol-increases blood sugars-extra blood to skeletal muscles-persistent secretion suppress immune-depression and anxiety • Resistance – body’s resources continue to be mobilized so that the person can function despite the presence of a stressor o Length of stage depends on severity of stress, individual’s health, available support, and other factors o Adrenal glands release epinephrine, norepinephrine, and cortisol to maintain arousal • Exhaustion – body’s resources are dangerously depleted o Occurs when stressor is intense and persists for too long—vulnerability to disease Stress and Health • Stress and Psychological Well-Being o Studies of results of catastrophic events has found average increase of 17% in rates of psychological disorders o Rape trauma syndrome – a pattern of cognitive, emotional, and behavioral responses that occurs in response to being raped o Negative life events cause distress, distress causes stress and possible third factor influences both o Neuroticism – a personality trait that involves the tendency to experience high levels of negative affect and to behave in self-defeating ways  People high in neuroticism have heightened tendency to experience negative emotions and to involved in stressful situations through maladaptive behaviors 1 • Post Traumatic stress disorder-happen to victims of extreme stress and trauma-severe anxiety disorder caused by exposure traumatic life events: o Severe anxiety, psychological arousal, Painful uncontrollable reliving of the events, Emotional numbing and avoidance of associated stimuli, Intense survivor guilt • Stress and Illness o Stress can combine with other physical and psychological factors to influence the entire spectrum of physical illness o Stress can trigger illness by causing a breakdown in immune system functioning o Stressors can release sufficient stress hormones to induce structural changes in the hippocampus that last for a month or longer—deterioration of memory function Vulnerability and Protective Factors • Vulnerability factors – increase people’s susceptibility to stressful events (includes lack of a support network, poor coping skills, tendencies to become anxious, etc.) • Protective factors – environmental or personal resources that help people cope more effectively (includes social support, coping skills, and personality factors such as optimism) • Social Support o One of the most important environmental resources that people can have o Enhances immune system functioning-produced more immune cells and antigens o Discussing traumatic incidences can enhance immune system functioning o Backing of others increase feelings of control over stressors-social pressures prevent maladaptive behaviors • Cognitive Protective Factors: The Importance of Beliefs o Hardiness – a stress-resistant personality pattern that involves the factors of commitment, control, and challenge  Hardy people are committed to work, families, and believe what they are doing is important  View themselves as having control over outcomes (strongest stress buffer)  Appraise demands of situations as challenges or opportunities, rather than threats o Coping self-efficacy – beliefs relating to our ability to deal effectively with a stressful stimulus or situation-specific to particular situation o Optimistic people are at lowered risk for anxiety and depression when confronted with stress o TypeApersonality-live under great pressure and demanding of themselves-exaggerate time urgency very irritated at delays or failures-competitive and ambitious o Type B-more relaxed agreeable less time urgency • Physiological Reactivity o People with high neuroticism tend to have intense and prolonged autonomic responses, o Physiological toughness – relations between two classes of hormones secreted by the adrenal glands in the face of stress  Catecholamines (which includes epinephrine and norepinephrine) and corticosteroids (cortisol) mobilize the body’s fight-or-flight response  Cortisol’s arousal affects last much longer, seem more damaging than those produced by catecholamines • Reduces immune system functioning and helps create fatty deposits in arteries that lead to disease • Catecholamines increase immune system functioning o Physiological toughness includes:  Alow resting level of cortisol, low levels of cortisol secretion in response to stressors, and a quick return to baseline level of cortisol after stress is over  Alow resting level of catecholamines, but a quick and strong catecholamine response when the stressor occurs, followed by a quick decline in catecholamine secretion and arousal when the stressor is over o Fact that physical exercise entail catecholamine-produced arousal may help account for exercise’s health-enhancing effects Coping with Stress • Coping strategies when faced with a stressor can be divided into three classes: 2 o Problem focused coping – attempt to confront and deal directly with demands of the situation, or change the situation so that it is no longer stressful (Examples: studying for a test, going directly to another person to work out a misunderstanding, etc.) o Emotion focused coping – attempt to manage the emotional responses that result from it (Examples: appraising the situation in a manner that minimizes the emotional impact, avoidance or acceptance of the stressful situation) o Seeking social support – turning to others for assistance and emotional support in times of stress • Problem focused coping and seeking social support often demonstrate favorable adjustment in stressors, while emotion focused coping often predict depression and poor adjustment • Situations we cannot control problem focused would do little help and emotion focused would be better, but maladaptive n situations we can control. • In hostage studies, problem focused coping and seeking social support fare better than those with no strategy, but emotion focused coping was found to help individuals adapt most to uncontrollable conditions of captivity • People with high stress who are too emotionally restrained to express negative feelings have a higher likelihood of developing cancer • Men are more likely to use problem focused coping, while women often seek social support and use emotion focused coping • Talking or writing about traumatic exposure can lead to extinction-best outcomes when flexibility to do either • NorthAmerican and Europeans show more of a problem focused thenAsian and Hispanic • Stress management can be accomplished through coping skills training. Cognitive reconstructing can be used to develop cognitive coping responses and relaxation techniques can be used to develop greater control of physiological arousal. Pain and Pain Management • Biological Mechanisms of Pain o Gate control theory – the experience of pain results from the opening and closing of “gating mechanisms” in the nervous system  Sensations from two types of sensory fibres enter the spinal cord, and activate neurons that travel up toward the brain regions responsible for our perception of pain  Thin fibres carry sharp pain impulses, thick fibres carry dull pain information  Experience of pain depends on ratio of thin-to-thick fibre transmission  Thin fibre activity opens spinal cord “gates”, while thick fibre activity closes them • rubbing a bruise or scratching an itch stimulate thick fibres, and produce relief • acupuncture may stimulate mostly thick fibres, causing pain relief o Endorphins – natural opiate-like substances that are involved in pain reduction  Inhibit release of neurotransmitters involved in synaptic transmission of pain impulses  Individuals often differ in pain experiences despite identical pain stimulation • Linked in variations in number of receptors for endorphins and ability to release endorphins  Stress-induced analgesia – a reduction in, or absence of, perceived pain that occurs under stressful situations • Cultural and Psychological Influences on Pain o Interpretation of pain impulses sent to brain depends in part on experiences and beliefs, and both are influenced by our culture o Women report pain more frequently than men o Differences in pain experience also occur within culture  Soldiers often require less pain medication than civilians for war-related wounds, since soldiers see the injury as a ticket home to their families, while civilians see the wound as a life disruption o Placebos – substances that have no medicinal value but are thought by the patient to be helpful o People in control of their own medication often feel less intense pain and will give themselves less medication than those with prescriptions • Psychological Techniques for Controlling Pain and Suffering o Cognitive strategies  Dissociation – involves dissociating, or distracting, oneself from the painful sensory input 3  Associative – involves focusing attention on the physical sensations and study them in a detached and unemotional fashion, without labeling them as painful or difficult to tolerate o Surgical patients with informational interventions show better courses of recovery and require less pain medication than those treated in a traditional fashion Health Promotion and Illness Prevention • Health psychology – the study of psychology and behavioural factors in the prevention and treatment of illness and in the maintenance of health • Health related behaviours fall into two main categories: o Health enhancing behaviours – serve to maintain or increase health o Health compromising behaviours – promote development of illness • How People Change: The Transtheoretical Model o Transtheoretical model – identifies six major stages in process of how people change  Precontemplation (problem unrecognized or unacknowledged), Contemplation (recognition of problem, contemplating change), Preparation (preparing to try and change, but not actively begun to do so), Action (implementing change strategies behaviour and environment-greatest commitment), Maintenance (behaviour change is being mastered), Termination (permanent change, no maintenance efforts required-so ingrained and under personal control that the original will not return)  People do not go through stages in smooth sequence • Often go back and forth, and failure is likely if previous stages not mastered • Stage-matched interventions-move people to action maintenance-usually a emotional experience • Increasing Behaviours That Enhance Health o Aerobic exercise – sustained activity that elevates heart rate and increases the body’s need for oxygen o Heart beats more slowly and efficiently, oxygen better utilized-moderate exercise o Yo-yo dieting – severe intermittent dieting that results in large weight fluctuations  Results in accumulation of abdominal fat, increased risk of dying from cardiovascular disease o Aids caused by human immunodeficiency virus which cripples the immune system by killing cells that coordinate the body’s attack against invading diseases o Prevention programs-educate people concerning risks, motivate people to change their behaviour, provide guidelines for change, give support and encouragement. NEED social support-can go along with beliefs of individual and culture. o Positive role models who have positive consequences and transitional models help the outcomes Combating SubstanceAbuse • Motivational interviewing – a treatment approach that avoids confrontation and leads clients to their own realization of a problem and to increased motivation to change—proven effective • Multimodal treatments – substance abuse interventions that combine a number of treatments o Often combines a biological measure (nicotine patch) with psychological measures  Aversion therapy – undesired behaviour is associated with an aversive stimulus, such as nausea, to create a negative emotional response to the substance  Relaxation and stress management-mindful meditation  Self-monitoring procedures that help understand consequences of abuse behaviors  Coping and social skills for high risk situations along with positive reinforcement procedures to strengthen change • Relapses – a return to the undesirable behaviour pattern o Often occurs after a lapse (one time “slip”) in a high-risk situation (stressful event, social pressure) o Lapse followed by abstinence violation effect (a person blames himself and concludes that he is incapable of resisting high risk situations) • Harm reduction – a prevention strategy that is designed not to eliminate a problem behaviour, but to reduce harmful consequences—if not eliminated then control under what conditions and how often Biphasic effect-initial stimulating effect followed by a depressive one Exercise- better after stick with it for six months 4 About a third of the north American population is obese as are one in six children, behavioral weight-control programs feature self monitoring stimulus control procedures and eating procedures designed to help people eat less but enjoy it more-addition of exercise enhances weight lossChapter 16 – Psychological Disorders Historical Perspectives on Psychological Disorders • Abnormal-behaviour extremely distressing to an individual, personally dysfunctional, very culturally deviant • The Demonological View o Abnormal behaviour was claimed to be work of the devil o Procedure called trephination drilled hole in skull to release evil spirits • Early Biological Views o Hippocrates suggested that mental illnesses are diseases just like physical disorders o Believed that site of illness was the brain o Biological emphasis increased after discovery that general paresis (mental deterioration disorder) resulted from brain deterioration • Psychological Perspectives o Freud believed that psychological disorders are caused by unresolved conflicts  Disorders that don’t involve a loss of contact with reality (obsessions, phobias, etc.) called neuroses  Severe disorders involving a withdrawal from reality called psychoses o Vulnerability-stress model – everyone has some degree of vulnerability to developing a disorder  Vulnerability can have biological basis, brain malfunction, or hormonal factor  Can also arise from personality factors such as low self-esteem  Vulnerability often only causes disorder when a stressor combines with it to trigger the appearance of the disorder  Disorder occurs when a stressor meets the vunerability Defining and Classifying Psychological Disorders • What is “Abnormal”? o Three criteria seem to govern decisions about abnormality:  Distressing – we are likely to label behaviours abnormal if they intensely distress an individual  Dysfunctional – most behaviours that are abnormal are dysfunctional for the individual or society  Deviance – abnormality of a behaviour is based on society’s judgments of the deviance of it o Abnormal behaviour – behaviour that is personally distressful, personally dysfunctional, and/or culturally deviant • Diagnosing Psychological Disorders o Classification must be set up that meets standards of reliability (high levels of agreement in decisions among clinicians) and validity (diagnostic categories accurately capture the essential features of disorders): anxiety, mood, somatoform, dissociative, schizophrenic, substance abuse, easting, personality o Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) most widely used diagnostic system  Allows diagnostic information to be represented along five dimensions: • Axis I – person’s primary clinical symptoms • Axis II – long-standing personality or developmental disorders that could influence behaviour and response to treatment • Axis III – physical conditions that might be relevant—rates intensity of environmental • Axis IV – intensity of environmental stressors • Axis V – person’s coping resources o Categorical system people placed within specific diagnostic categories-no severity o Dimensional system- relevant behaviors are rated along a severity measure- same disease just different degree o Personality that have greater psychological impairment-negative emotional stability(distress, depression), Schizotypy (odd), disinhibition(act out) Introversion,Antagonism, compulsivity: combinations leads to personality disorders • Critical Issues in Diagnostic Labeling o Diagnoses can have important legal consequences-accept label as individual rather than behaviour 5 o Law tries to take into account the mental status of individuals accused of crimes  Competency – defendant’s state of mind at time of a judicial hearing (not during committing of crime)  Insanity – presumed state of mind of defendant at time of crime (legal term not psychological) Anxiety Disorders • Anxiety disorders – group of behaviour disorders in which anxiety and maladaptive behaviors are core of the disturbance o Frequency and intensity of anxiety responses are out of proportion to situation that triggered them • Have four components: o Subjective-emotional component (feelings of tension and apprehension) o Cognitive component (feeling of inability to cope, sense of impending danger) o Physiological responses (increased heart rate and blood pressure, muscle tension) o Behavioural responses (avoidance of certain situations and impaired task performance) Incidence-number of new cases that occur during certain time period, prevalence refers to number of people who have a disorder • Phobic Disorder o Phobias – strong and irrational fears of certain situations or objects  Most common include agoraphobia (fear of open and public spaces), social phobias, and specific phobias (dogs, snakes, spiders, etc.) • GeneralizedAnxiety Disorder o Generalized anxiety disorder – a chronic state of diffuse, or “free-floating”, anxiety that is not attached to specific situations or objects • Panic Disorder o Panic disorders – anxiety disorder characterized by unpredictable panic attacks and a fear that another will occur  Much more intense than generalized anxiety disorder o Many people develop agoraphobia because of fear that they will have an attack in public-consistent fear it will happen o Must be a recurring attacks • Obsessive-Compulsive Disorder o Anxiety disorder characterized by persistent and unwanted thoughts and compulsive behaviors  People realize obsessions and compulsions have no value, and want to stop o Obsessions – repetitive and unwelcome thoughts, images, or impulses that invade consciousness o Compulsions – repetitive behavioral responses that are difficult to resist—lower anxiety-negative reinforcement o Genetic link found with Tourette’s, childhood disorder characterized by muscular/vocal tics, facial grimacing, vulgar language  Increased activity in frontal lobes, decreased serotonin activity • Post-Traumatic Stress Disorder o Apattern of distressing systems (flashbacks, nightmares, etc.) an anxiety responses that recur after a traumatic experience o Four major symptoms:  Person experiences severe symptoms of anxiety, arousal, and distress  Person relives the trauma in recurrent flashbacks, dreams, and fantasies  Person becomes numb to world and avoids stimuli that serves as reminder of the trauma  Personal experiences “survivor guilt” in instances where others were killed • Causal Factors in Anxiety Disorders o Genetic factors may create a vulnerability to anxiety disorders  Abnormally low levels of GABAactivity may cause people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors-could be serotonin  Biological preparedness makes it easier to learn to fear certain stimuli, and may explain why phobias seem to center on certain classes of primal stimuli and not on more dangerous modern ones, such as guns  Sex-linked biological predisposition for anxiety disorders-females higher then men  Could be due to prefrontal cortex, cingulate, caudate nucleus 6 o Anxiety is central feature of psychoanalytic conceptions of abnormal behaviour  Neurotic anxiety – state of anxiety that arises when impulses from the id threaten to break through into behaviour 1. Form of anxiety disorder determined by how ego’s defense mechanisms deal with neurotic anxiety o Cognitive theorists stress role of maladaptive thought patterns and beliefs in anxiety disorders-anxiety disorder magnify them into threats. Panic attacks triggered by exaggerated normal anxiety  Eliciting stimuli  physiological responses  catastrophic appraisals  panic attack o Behavioral perspective believes anxiety disorders result from emotional conditioning o Negatively reinforced-successful avoidance-panic attack reduced enforces some condition o Culture-bound disorders – behaviour disorders whose specific forms are restricted to one particular cultural context Eating disorders: Anorexia nervosa-intense fear of being fat and severely restricts their food intake till the point of self-starvation Bulimia nervosa- overly concerned with becoming fat binge eat and then purge the food. High females in both Bulimics who tend to be depressed or anxious exhibit low impulse control and lack stable sense of personal identity Psychological changes are a response to abnormal eating patterns once started they perpetuate eating regularities Mood (Affective) Disorders • Mood disorders -psychological disorders whose core conditions involve maladaptive mood states-anxiety, mood disorder (co- occur) • Depression o Major depression – mood disorder characterized by intense depression that interferes markedly with functioning o Dysthymia – a depressive mood disorder of moderate intensity that occurs over a long period of time but does not disrupt functioning as a major depression does—chronic misery with bursts of normal o Depression involves cognitive symptoms, motivational symptoms, and somatic (physical) symptoms o Motivational-inability to get started behaviour that might produce pleasure or accomplishment o Somatic (bodily) symptoms include loss of appetite and weight loss, severe depression • Bipolar Disorder o Bipolar disorder – depression alternates with periods of mania  Mania – state of highly excited mood-euphoric and grandoise and behaviour that is quite the opposite of depression  Norepinephrine drops during depression, increases during mania  Exhaustion sets in and mania slows down enters into depressive state  Women more than men in unipolar-same for bipolar • Prevalence and Course of Mood Disorders o People born after 1960 are ten times more likely to experience depression than are their grandparents o Women are twice as likely to suffer from depression o After depression, one of three patterns may follow:  Half of all cases, depression will never recur  Many people show recovery with recurrence some years later (recurring episode is shorter)  About ten percent will not recover • Causal Factors in Mood Disorders o Genetic and neurochemical factors are linked to depression-predisposed environmental and biological factors o Manic disorders may stem from overproduction of neurotransmitters that are underactive in depression o Psychoanalysts believe that early traumatic experiences create vulnerability for depression o Lewinsohn claims a loss of rewards leads to mood disorders o Martin Seligman suggested that overemphasis on individual attainment and lesser commitment to traditional values are likely to react strongly to failure and cause depression  Learned helplessness theory – depression occurs when people expect that bad events will occur and that nothing can be done to prevent or cope o Depressive cognitive triad (Beck) – triad of negative thoughts that depressed people cannot control or suppress  Triad includes the world, oneself, and the future 7 o Depressive attributional pattern – tendency of depressed people to attribute negative outcomes to their own inadequacies and positive ones to factors outside of themselves o Depression stop performing behaviors that previously provided reinforcement—must break this pattern (behavioral activation)-increases personal control over environment- o Cultural factors affect ways in which depression is manifested  Depression more commonly reported in western nations  Feelings of guilt and personal inadequacy in western nations, physical symptoms inAfrican nations  Manipulation and a desire to escape distress are two major motives for suicide-risk for suicide increases if person is depressed and lethal plan and past history or para-suicide. 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