Chapter 14: Health

Health psychology: The study of physical health and illness by psychologists from various areas of specialization

Stress: an unpleasant state of arousal in which people perceive the demands of an event as taxing or exceeding their ability to satisfy or alter those demands

Appraisal: The process by which people make judgments about the demands of potentially stressful events and their ability to meet those demands

Coping: Efforts to reduce stress (Effective coping helps maintain good health, ineffective coping causes harm)

3 Categories of Stressors: Catastrophes, Major Life Events, Daily Hassles

Catastrophes

Psychological disorders (anxiety, phobias, depression, alcohol abuse, somatic complaints) are common among residents of areas hit by catastrophic events.

Posttraumatic stress disorder (PTSD): A condition in which physical and psychological symptoms are felt after an extremely stressful event

Symptoms: Anxiety, sleeplessness, nightmares, flashbacks, intrusive thoughts, attention problems, social withdrawals

Situations that we have no control over result in the most PTSD. PTSD is more prevalent in women.

Major Life Events

- Change is inherently stressful.

- "Happy" events (vacation, graduation, getting married) do not cause illness but can still cause distress.

- "Happiness is not the absence of distress and distress is not the absence of happiness. A person can simultaneously experience both emotions."

Daily Hassles: Microstressors

- Population density, loud noise, extreme heat or cold, cigarette smoke, etc.

- "The accumulation of daily stressors contributes more to illness than do major life events."

- Jobs most likely to result in "burnout" : teachers, doctors, nurses, police officers, social workers

- Commuting can cause stress

- Economic problems cause stress and can ruin marriages

How does stress affect the body?

- The term "stress" was popularized by endocrinologist Hans Selye

- He found that by exposing lab rats to stress, the rats experienced enlarged adrenal glands, shrunken lymph nodes, and bleeding stomach ulcers

General Adaptation Syndrome: three stage process by which the body responds to stress

Alarm: Recognition of threat. Heart rate, blood pressure, and breathing rates increase. Growth, digestion, and operation of the immune system are inhibited.

Resistance: Body remains aroused and alert. Release of stress hormones, local defenses activated.

Exhaustion: Overuse of stress-fighting resources causes other systems in the body to break down. Cause of illness and even death.

All mammals have stress response because it's an evolutionary to help living things in fight or escape in acute emergencies.

However, human beings get stressed about things that do not require bodily support. As a result, humans are more likely to get ulcers and other stress-caused illnesses than other mammals. We get stressed about things that other mammals don't.

Differences in Men and Women

- Walter Cannon described the body as "fight or flight" and men fall under that

- Women are more likely to exhibit the "tend and befriend" response

- When women feel unsupported or isolated, they exhibit elevated levels of oxytocin which increases their tendency to seek out social contact

What Stress Does to the Heart

Coronary heart disease is the leading cause of death in the United States (69 million Americans affected).

Three factors that cause it: hypertension or blood pressure, cigarette smoking, and high cholestrol

The FOURTH major risk factor is stress.

Type A behavior pattern: a pattern of behavior characterized by extremes of competitive striving for achievement, a sense of time urgency, hostility, and aggression

The main toxic ingredient in CHD ishostility.

- hostile people are less health conscious

- tend to smoke more

- less psychologically reactive

- consume more alcohol and caffeine

- exercise less, sleep less, eat less

What Stress Does to the Immune System

Immune system: body's first line of defense against illness

- a biological surveillance system that detects and destroys "nonself" substances that invade the body

- search and destroy cells

PNI (psychoneuroimmunology): a subfield of psychology that examines the links among psychological factors, the brain and nervous system, and the immune system

Cohen's common cold studies (1998)

Exposed different groups of people to different stressors and measured their immune system afterwards.

Stress weakens the immune system and leaves us more vulnerable to disease as a result.

Processes of Appraisal

Attributions and Explanatory Styles

Depression: feelings of sadness, pessimism, and apathy and slowed thought processes

Disturbances in sleep and eating patterns

Reduced interest in sex

"common cold" of psychological disorders

Twice as many women seek treatment

12% men and 21% women in a lifetime

Martin Seligman (1975): Learned helplessness – a phenomenon in which experience with an uncontrollable event creates passive behavior in the face of subsequent threats to well-being.

Abramson et al. (1989): state of hopelessness brought on by negative self-attributions people make for failure

Depressive explanatory style: a habitual tendency to attribute negative events to causes that are stable, global, and internal

When fail, blame factors that are within the self, unlikely to change, and broad enough to impair other aspect of life

Alloy et al. (1982): newly entered college students with negative explanatory styles more likely to suffer from major/minor depressive disorder in junior year.

The Human Capacity for Resilience

Kobasa et al. (1982): business executives of the same age, education, job status, income and ethnic and religious backgrounds become less ill when they displayed hardiness:

Commitment: having sense of meaning and mastery of one's life

Challenge: perception of change as a normal part of life

Control: belief that one's outcomes are controlled by one's actions

Hardiness serves as a buffer for stress

50-60% of U.S. population exposed to traumatic stress, only 5-10% suffer PTSD

Hobfoll et al. (2009): 64% of Israeli Jews and Arabs experienced chronic or delayed stress during time of intense terrorism, 36% mostly resistant

Resilience more common in

Men

Jews (majority of the population)

The more educated

More money

More social support from friends

Self-efficacy: person's belief that he/she is capable of the specific behavior required to produced a desired outcome in a given situation

Especially meaningful for people whose lives are largely regulated by others (i.e. elderly in nursing homes)

Sarkar et al. (2009): higher self-efficacy levels in heart disease patients, measured by the Cardiac Self-Efficacy scale, at the start = more likely to survive hospitalization years later.

Dispositional Optimism: generalized tendency to expect positive outcomes, characterized by non depressive explanatory styles (external, temporary and specific for failures)

Scheier & Carver (1985): Optimistic students suffered fewer illness symptoms during semester of college kids that pessimists.

more likely to take an active problem-focused approach in coping with stress.

Optimists exhibit a stronger immune response to stress than pessmists do

Petereson et al. (1988): optimists (specifically made global explanatory style) after 50 years less likely to have died an accidental, reckless, or violent death.

"positive expectations can be self-fulfilling."

Pollyanna's Health

By Eleanor Porter

Positive outlook cannot guarantee future good health

Drawbacks

Unrealistic

Sometimes disliked by friends who see them as boastful, inconsiderate, and oversensitive to criticism

Detrimental for when situation is uncontrollable

Those suffering from loss of kidney function became more depressed if they felt they had control over their health but the transplant failed.

Ways of Coping with Stress

Problem-focused coping: cognitive and behavioral efforts to alter a stressful situation

Better to confront and control than to avoid

Can be psychologically taxing; must stay vigilant, alert, and actively engaged

Cause problems if it leads us to develop an over-controlling, stress-inducing Type A behavior.

Janoff-Bulman (1979): behavioral self-blame paves way for control in effort to reduce current stresses or avoid future ones. Blaming own enduring personal characteristics not helpful.

Adaptive for victims of rape to have a sense of future control

Behavioral self-blame for past trauma does not guarantee the prevention of future trauma.

Most useful: sense of control of present: believed that they could help selves get better and facilitate in their own recovery were more optimistic about the future and least distressed.

Emotion-focused coping: cognitive and behavioral efforts to reduce the distress produced by a stressful situation

Lazarus & Folkman: tack on active PF (problem focused) approach when we think we can overcome a stressor but fall back on an EF (emotion focused) approach when perceive the problem as out of our control

Frederickson (2009); positive emotions help people to broaden their outlook in times of stress so they can cope with adversity – a welcome distraction from negative emotions

Mores resilient before the crisis were later the most likely to have positive emotions and least likely to suffer depression after.

Build personal resources

Do not over-intellectualize the coping process and underestimate the value of emotion-focused coping.

Shutting Down: trying to deny or suppress the unpleasant thoughts and feelings

Avoidance coping through distraction

Auebach et al.:

Airline employees trained with either PF (problem focused) or EF techniques and "held captive" by "terrorists" in a realistic training session

Those trained with EF coping were more effective in reducing distress that control or PF group

Wegner: rebound effect – when trying to suppress can become preoccupied

Solution: focused distraction, think of little red Volkswagon to stop thinking about white bear

Cioffi & Holloway (1993): those who coped with hand in ice through suppression were slower to recover from pain than those who used focused distraction

Keeping secrets and holding emotions also psychologically taxing

Gross & Levenson (1997): greater cardiovascular response when tried to inhibit feelings then when not.

Cole et al. (1996): homosexual men who were not completely "out of the closet" suffering from HIV more likely have infection spread more rapidly and to die sooner than those who were completely open about their homosexuality

Suppress turbulent emotional thoughts = decrease in activity of certain immune cells.

Opening up: acknowledging and understanding our emotional reactions

Pennebaker (1997): many forms of therapy involve confiding in someone

When opening up: systolic blood pressure levels rose during disclosure but dipped below pre-experiment after

Decline in number of time they visited for help

Especially strong when comfortable with disclosure, multiple sessions about recent events.

Freud: need for catharsis (discharge of tension)

Help you sort out thoughts and gain insight

Great distress if those we confide in react negatively or betray what was said to others.

Self-focus

Can bring out personal shortcomings, intensify undesirable consequences

Salovey (1992): both positive and negative moods increase self awareness

Self-perpetuating feedback loop: bad mood triggers self-focus, which in people with low self-esteem further worsens mood

Rumination and repetitive though – more likely to become anxious and depressed

More in females

Males resort to alcohol and other drugs, physical activity, antisocial behavior

Healthier alternative when in a bad mood:

Engage in difficult task that is demanding to distract

Erber & Tesser (1992); felt better after performing a difficult task than a simple task or none at all.

Aspinwall & Taylor (1997): Proactive coping: up-front efforts to ward off or modify the onset of a stressful event.

Proactive Coping

Consists of up-front efforts to ward off or modify the onset of a stressful event. Coping can be been as outgoing (we try to prevent as well as react to troubles).

The first line of defense is accumulation of resources—personal, financial, social

Social Support

In times of need and conflict, we look to close family ties, lovers, buddies, and community for support. These serve as a buffer against stress.

Social Support – The helpful coping resources provided by friends and other people

According to researchers, there is overwhelming evidence that social support has therapeutic effects on both our psychological and physical well-being.

The book gives an example of a breast cancer support group that gathered weekly. During this, the women cried, laughed, shared, and helped cope with the stress of dealing with breast cancer. The director of the group found that women who participated in this coping/support group lived an average of 18 months longer than similar women who did not participate.

Another study found over a nine-year period that those with more social contacts had a lower mortality rate than those without. The same study found that socially active men were 2-3 times less likely to die within nine to twelve years than those who were more isolated.

The list goes on and on: Married couples are more likely to survive cancer. People in relationships are less likely to contemplate suicide. People who have heart attacks are less likely to have a second one if they live with someone rather than live alone. Marriage and romantic partnerships are the most influential/powerful.

People with social contact had lowered heart rates, reduced levels of cortisol (stress hormone)

The importance of social connections

Friends and family may encourage us to be more healthy, to exercise, to eat well, and to take care of ourselves.

However, they can also encourage us to do hazardous things: smoke, drink, take dangerous risks

For people who are highly stressed and socially active, a study found that you are more likely to catch a cold or flu

Social contact models

The first says that people who are stuck in bad social relationships are more distressed. The more social contacts a person has increases the chance that the social support is diluted therefore it can be potentially lower than someone who has less social contacts.

The second model (intimacy model) focuses on the quality of a person's relationships rather than their quantity. i.e. having one special relationship may be all a person really needs.

Third model (perceived availability model) – individuals who believe that ample support is available as needed cope more effectively.

The religious connection

Obviously religion provides a deeply important social and emotional support system.

In summary, the connection between mortality rate, longevity, and religion is unclear.

While religion often promotes no smoking/drinking/bad habits that increase mortality rates, research says that correlation is not certain because nobody can know for sure what motivates a person to abstain from unhealthy or healthy behaviors

Researchers cite that those who don't drink/smoke/etc. might abstain from these unhealthy behaviors because of who they are, not because of religion

Cultural influences on coping

Differences between individualistic and collectivistic cultures

Most of the research on cultural coping is conducted with the western culture (individualistic).

In individualistic cultures, people often use others to service their personal goals. In collectivistic however, where social groups take precedence over the self, people are more reluctant to strain their relationships by calling on others for support.

Treatment and Prevention

Over the years, studies have shown that although there are vastly different schools of thought and techniques for doing psychotherapy, all approaches are effective and surprisingly all are generally equivalent.

First, all healers—regardless of whether they are medical doctors, psychologists, or others—provide social support, a close human relationship characterized by warmth, concern, someone to talk to, and a shoulder to cry on. This goes back to social contacts and how having someone or a group of people to talk to and rely on increases health.

Second, all therapies offer a ray of hope to people who are sick, demoralized, unhappy, or in pain. People are motivated by positive expectations. Optimism can increase our health and decrease stress in some situations. Think of placebo effects, etc.

Third, an important ingredient is choice. Ex: allowing patients to make meaningful choices, such as deciding on a type of treatment, increases the effectiveness of treatments for alcoholism. Choice decreases dissonance because highly motivated individuals (who make a choice) are more careful and conscientious.

Prevention

We live in an era of prevention in that many serious health threats are preventable. For the most part, we know what to do, when to do it, and how. But how do we convince ourselves and others to translate that knowledge into action?

Biggest problem with this has been with AIDS. AIDS was a very minor disease, starting with a few hundred cases in the 80's. Present day however, millions are dying each year from the HIV and AIDS viruses because we are not translating knowledge into action.

HIV/AIDS is associated not only with blood contact but with sex. The book says that unhealthy habits (implying sex with strangers, those we do not know very well) are sinfully enjoyable and people have a hard time stopping or controlling their behavior. Book says that people must recognize that their health is at risk however, regardless of how enjoyable the act is.

Book also says that role models serve a good purpose for society. If those in high publicity positions who practice healthy behaviors set a good example, people are more inclined to control their bad behaviors.

Positive role models/spokespersons contribute to the development of subjective norms, beliefs, and the like to affect our actions.

Another step to health emphasizes a person's confidence in his or her ability to succeed. Self-efficacy, the belief that we can do what needs to be done—enhance the adoption of various healthy behaviors.

People need reliable and accurate information about the effectiveness of the health behaviors they are urged to adopt in order to convince them. Book says they will be more likely to adopt these behaviors if they see the results.

The pursuit of happiness

Happiness or subjective well-being, is one's own life satisfaction as measured by self-report.

Using self reports, researchers found that 75% of American adults describe themselves as happy and in 86% of all nations sampled, the ratings were more positive than not. In general, people are happy!

Happiness leads to:

Cheerful moods, higher self-esteem, better physical health, a sense of personal control, more positive memories, and optimism

People are most happy on Friday/sat, least happy on Monday/Tuesday, students feel best during midday, and worst in the early morning and late evening.

Three predictors of happiness

Social relationships—people with an active social life, close friends, and a happy marriage are more satisfied than those who lack these intimate connections

Employment status—regardless of income, employed people are happier than those who are out of work

Physical and mental health—people who are health re happier than those who are not

Nationally, Iceland, Sweden and Australia are the happiest. Dominican republic, Cameroon, and China are the saddest.

Wealth

Like religion, the connection is unclear. Some millionaires report high levels of satisfaction in their lives while others don't.

On a 7 point scale (1 being unsatisfied), millionaires from Forbes report a 5.8 (they are highly satisfied). Some tribe in Africa, who basically has nothing materially, reports the same level of satisfaction in their life.

Studies show however that a nation's wealth definitely has an impact on the well-being of its people, ultimately satisfaction and happiness

Connection is still unclear however because of the differences in definition, standards, and attribution

Some people regard wealth as highly important while others not so much

According to the social comparison theory however, people tend to naturally compare themselves to others and feel contented or deprived depending on how they fare in this comparison.

People who make upward comparisons (I'm better off than that guy) are generally more satisfied/happy

Adaptation level theory says that our satisfaction with the present depends on the level of success to which we are accustomed.

Getting married, buying a new house, or making a lot of money quickly will give you a quick rush of happiness. Before long however, it will wear off and you'll adapt to the better situation and raise your standard of comparison.

People felt less pleasure doing things presently when they did in the past after winning the lottery.

Research shows however that the more materialistic people are, the less satisfied they seem to be. Once you get it all, you have no more to look forward to.

Perhaps each of us, as a result of both biological and environmental factors, has a set baseline level of happiness toward which we gravitate. This is supported by three recent findings.

Ratings of happiness are higher among pairs of identical twins than among fraternal twins, leading to the suggestion that there may be a genetic basis for having a certain level of contentment

Fluctuations in mood that accompany positive and negative life events tend to wear off over time.

Happiness levels, like personality traits, are relatively stable over time and place, which leads to the conclusion that some people are in general, happier than others.