STRESS AND COPING

We all experience stress, but we dont all find the same situations stressful. Some people find flying in planes highly stressful, while others take up skydiving as a hobby. Some people thrive in fast-paced, deadline-heavy careers, while others prefer less stimulating work. Stress means different things for different people, and everyone has their own way of coping with it. In some cases, people can worry themselves sickliterallyand some research links stress directly to illness. Today, most researchers use a biopsychosocial model to explain disease. According to the biopsychosocial model, physical illness results from a complicated interaction among biological, psychological, and sociocultural factors. In recent decades, the recognition that psychological factors can affect health has given rise to a new branch of psychology called health psychology. Health psychologists study ways of promoting and maintaining health. Their research focuses on the relationship between psychosocial factors and the emergence, progression, and treatment of illness.

Stress
Stress is difficult to define because researchers approach it in different ways. Some use the term stress to refer to circumstances that threaten well-being or to refer to the response people have to threatening circumstances. Others think of stress as the process of evaluating and coping with threatening circumstances. Yet others use the term to refer to the experience of being threatened by taxing circumstances. This chapter will use the term stress in the last sense: the experience of being threatened by taxing circumstances.

Appraisal Researchers agree that stress is subjective. People dont have the same response to the same circumstances. Instead, stress depends on how people appraise or evaluate environmental events. If people believe that a challenge will severely tax or exceed their resources, they experience stress. Types of Stressors Stressors are psychologically or physically demanding events or circumstances. Research links stressors to increased susceptibility to physical illnesses such as heart disease as well as to psychological problems such as anxiety and depression. Stressors dont always increase the risk of illness. They tend to affect health more when they are chronic, highly disruptive, or perceived as uncontrollable. Researchers who study stress usually distinguish among three types of stressors: Catastrophic events: Large earthquakes, hurricanes, wars Major life changes, positive or negative: Marriage, divorce, death of a parent, beginning a new job, starting college y Minor hassles: Standing in line, traffic jams, noisy environments Health, Wealth, and Power

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People who live in conditions of poverty and powerlessness have an increased risk of poor health. Many factors make such people more susceptible to illness. For instance, poor people tend to have low access to preventive care. When ill, they often do not have access to good medical care. Their nutrition tends to be poor, since high-fat, high-salt foods are cheaper and more easily available than many healthy foods. They also encounter many chronic environmental stressors, including high crime rates, discrimination, and poor housing conditions.

Internal Sources of Stress Exposure to difficult circumstances doesnt produce stress by itself. Rather, stress occurs when people experience frustration, conflict, or pressure:

y Frustration is the experience of being thwarted when trying to achieve a goal. Example: A student worked very hard on a term paper with the hope of getting an A but ends up with a B. y Conflict occurs when people have two or more incompatible desires or motives. Conflict can occur in three forms:
The approach-approach conflict, the least stressful, occurs when people try to choose between two desirable alternatives. Example: A student tries to decide between two interesting classes. 2. The approach-avoidance conflict, typically more stressful and quite common, occurs when people must decide whether to do something that has both positive and negative aspects. Example: A boy invites a girl to a party. She finds him attractive, but going to the party means she wont have time to study for one of her final exams. 3. The avoidance-avoidance conflict, also typically stressful, occurs when people have to choose between two undesirable options. Example: Because of his financial situation, a man might have to choose whether to keep his nice-looking car, which breaks down frequently, or buy a badly dented, but reliable, used one. y Pressure occurs when people feel compelled to behave in a particular way because of expectations set by themselves or others. Example: A high school student wants to be accepted by the popular crowd at school, so she tries hard to distance herself from her old friends because the popular crowd considers them geeky or undesirable. The Physiology of Stress The experience of stress is accompanied by many physiological changes. Selyes General Adaptation Syndrome Hans Selye, a pioneer in the field of stress research, proposed that stressors of many different kinds result in a nonspecific bodily response. He said the bodys stress response consists of a general adaptation syndrome, which has three stages: alarm, resistance, and exhaustion. 1.

Stage 1. In the alarm stage, an organism recognizes a threatening situation. The sympathetic nervous system activates, giving rise to the fight-or-flight response. Digestive processes slow down, blood pressure and heart rate increase, adrenal hormones are released, and blood is drawn away from the skin to the skeletal muscles.

Stage 2. The resistance stage occurs when stress continues. Physiological arousal stabilizes at a point that is higher than normal.

Stage 3. If stress is prolonged, organisms reach the exhaustion stage. The bodys resources run out, and physiological arousal decreases. In this stage, organisms become more susceptible to disease.

Modification of Selyes Theory: Research has supported Selyes idea that prolonged stress can cause physical deterioration. Research has also shown, however, that the bodily response to stress isnt as nonspecific as Selye believed. Different kinds of stressors produce subtly different bodily responses. Also, different people respond to the same stressor differently, depending on their gender, medical condition, and genetic predisposition to problems such as high blood pressure and obesity. Pathways from the Brain In stressful situations, the brain sends signals to the rest of the body along two pathways. In the first pathway, the hypothalamus of the brain activates the sympathetic division of the autonomic nervous system, which in turn stimulates the inner part of the adrenal glands, which is called the adrenal medulla. The adrenal medulla releases hormones called catecholamines, which include epinephrine and norepinephrine. The action of the catecholamines results in the fight-or-flight response. In the second pathway, the hypothalamus sends signals to the pituitary gland. The pituitary releases adrenocorticotropic hormone (ACTH) , which in turn stimulates the outer part of the adrenal glands, which is called theadrenal cortex. The adrenal cortex then releases hormones calledcorticosteroids, which include cortisol. Corticosteroids increase blood sugar levels, providing energy. Corticosteroids also help to limit tissue inflammation in case injuries occur.

Coping
Coping refers to efforts to manage stress. Coping can be adaptive or maladaptive. Adaptive coping strategies generally involve confronting problems directly, making reasonably realistic appraisals of problems, recognizing and changing unhealthy emotional reactions, and trying to prevent adverse effects on the body. Maladaptive coping includes using alcohol or drugs to escape problems. Some researchers believe that people have characteristic ways of coping, even in different sorts of situations. Other researchers believe that people use different coping styles in different situations and that peoples ways of coping change over time. Coping Strategies There are many different coping strategies. Some common ones include:

Using defense mechanisms Aggressive behavior Self-indulgent behavior, such as overeating, smoking, and excessive use of alcohol or drugs The Frustration-Aggression Hypothesis

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Relaxation Humor Releasing pent-up emotions by talking or writing about them Exercise Getting social support Reappraising an event or changing perspective on the problem Spirituality and faith Problem solving Comparing oneself to others who are worse off Altruism or helping others

Several years ago, some researchers proposed the frustration-aggression hypothesis, which states that aggression is always caused by frustration. Today, researchers believe that frustration doesnt always lead to aggression and that it can lead to other responses, such as apathy. However, frustration does sometimes lead to aggressive behavior. Factors That Improve Coping Some people cope more effectively than others. Some important factors that influence coping are social support, optimism, and perceived control:

Social support: Many studies show that having good social support correlates with better physical and mental health. Researchers believe that supportive social networks buffer the effects of stressful circumstances. In stressful situations, a social network can provide a person with care and comfort, access to helpful resources, and advice about how to evaluate and manage problems. Optimism: A tendency to expect positive outcomes, optimism is associated with better physical health.

Optimistic people are more likely to find social support, appraise events in less threatening ways, take good care of themselves when sick, and use active coping strategies that focus on problem solving. y Perceived control: The term locus of control refers to peoples perception of whether or not they have control over circumstances in their lives. People with an internal locus of control tend to believe they have control over their circumstances. People with an external locus of control tend to believe that fate, luck, or other people control circumstances. Having an internal locus of control is associated with better physical and emotional health. Primary and Secondary Control Some researchers have pointed out that people in different cultures have different kinds of perceived control. The Western approach emphasizes the importance of primary control. When faced with a problematic situation, people in Western cultures tend to focus on changing the situation so that the problem no longer exists. A different approach, seen in many Asian cultures, emphasizes secondary control. When faced with a problematic situation, people in these cultures focus on accommodating the situation by changing their perspective on it. Both kinds of control can be beneficial.

Stress and Disease

Chronic stress is linked to the development of many psychological problems, such as depression, anxiety, and schizophrenia. A large body of research also indicates that stress is linked to a variety of physical problems, including cancer, heart disease, rheumatoid arthritis, genital herpes, periodontal disease, yeast infections, and the common cold, to name just a few. Stress and Immune Function Stress affects the functioning of the immune system, as do age, nutrition, and genetic factors. The immune system is the bodys defense against harmful agents such as bacteria, viruses, and other foreign substances. It communicates constantly with the brain and the endocrine system. The immune system has many different kinds of disease-fighting cells, including B lymphocytes, T lymphocytes, and macrophages: y B lymphocytes are formed in the bone marrow and release antibodies. Antibodies are protein molecules that travel through the blood and lymph and defend the body against bacteria and cancer cells. y T lymphocytes are formed in the thymus gland and defend the body against cancer cells, viruses, and other foreign substances. y Macrophages destroy foreign substances by absorbing them. Stress affects the immune system in many ways. For instance, hormones that are released in response to stress can inhibit the activity of lymphocytes.

The Link Between Emotions and Illness Researchers have linked negative emotional states to disease. Depression Recent research suggests that depression makes people more vulnerable to heart disease. Type A Behavior and Hostility Researchers have identified a type of personality, called the type A personality, that is associated with a higher risk of coronary heart disease. People with type A personalities tend to be competitive, impatient, easily angered, and hostile. People with type B personalities, on the other hand, are relaxed, patient, easygoing, and amiable. Type A personalities may be more prone to heart disease for several reasons:

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Type A people tend to be more physiologically reactive than type B people. In challenging situations, type A people have higher pulse rates, blood pressure, and hormone levels. This physiological reactivity can impair health in the long term. For instance, frequent release of stress hormones increases the likelihood ofatherosclerosis, or hardening of the arteries because of cholesterol deposits. Type A people may encounter more stressors. For example, because of their behavior, they may be more likely to have marital stress and work-related problems. Type A people may have less social support because of their characteristic ways of relating to people. Type A people may pay less attention to health-promoting behaviors such as getting exercise and resting when tired. They also smoke more and consume more caffeine.

Hostility, a key type A personality feature, relates most to increased risk of heart disease. A tendency to get angry easily is associated not only with heart disease but also impaired immune function and high blood pressure. Emotional Inhibition People who have a tendency to suppress emotions such as fear, anxiety, and anger have a higher risk of becoming ill than people who can acknowledge and express their feelings. Lifestyles That Endanger Health Peoples lifestyles can endanger their health. Three features of problematic lifestyles include smoking, not exercising, and eating poorly. Smoking Smoking increases the risk of many cardiovascular and lung diseases, including heart disease, hypertension, stroke, bronchitis, and emphysema. Smoking also increases the risk of cancers of the lung, mouth, bladder, kidney, larynx, esophagus, and pancreas. Although formal smoking cessation programs dont help most people quit, many people eventually do stop smoking. Research shows that many people quit only after several unsuccessful attempts. Lack of Exercise Lack of exercise can also have strong negative effects. Regular exercise leads to longer life expectancy, promotes cardiovascular health, decreases obesity-related problems such as diabetes and respiratory problems, and decreases the risk of colon, breast, and reproductive system cancers. Poor Nutrition Research shows that bad eating habits contribute to health problems:

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Chronic overeating increases the risk of heart disease, hypertension, stroke, respiratory problems, arthritis, and back problems. Low-fiber diets and diets that increase serum cholesterol levels are linked to heart disease. Eating too much salt may contribute to high blood pressure. High-fat, low-fiber diets are linked to cancers of the colon, prostate, and breast. A low-calcium diet may contribute to osteoporosis.

Getting Medical Treatment Once people develop symptoms of illness, their behavior influences whether their health will improve or worsen. Peoples behavior can have an impact at three different stages. Seeking Medical Help People who are highly anxious, who score high on the personality trait of neuroticism, who are very health-conscious, and who are very aware of bodily sensations tend to report more physical symptoms than other people. Delaying seeking medical help can have serious consequences, as early diagnosis can improve the treatment of many health problems. Despite this, people often delay seeking medical help for several reasons: Fear of appearing ridiculous if their symptoms turn out to be benign Reluctance to bother their physicians The tendency to minimize symptoms Unwillingness to have a medical appointment interfere with other plans. Communicating Effectively

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People often have trouble communicating effectively with health care providers. Communication difficulties frequently happen for the following reasons: Medical providers often use jargon and unclear explanations when talking to patients. Patients sometimes forget to ask questions they should have asked. People sometimes forget to mention symptoms they have or avoid mentioning the extent of their problems for fear of a serious diagnosis. y People are sometimes passive in their interactions with health care providers because they feel intimidated by health care providers authority. Adhering to Treatment Regimens

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Peoples chances of recovery decrease if they dont adhere to the treatment regimens that their health care providers prescribe. People dont adhere to medical advice for three main reasons:

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Not understanding the instructions they are given Not following treatment regimens that are unpleasant or interfere significantly with daily routines Not following advice if they are displeased about their interactions with their health care provider