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Stress, Health & Well-Being
T h r i v i n g i n t h e 2 1st C e n t u r y
Rick Harrington
University of Houston, Victoria
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To Cindy,
Thank you for all of your love and support. You are the best!
—Rick
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Brief COn t en t s
Part 1 Stress, Health, and Positive Psychology 1
1 Stress and Health 1
2 Positive Psychology 33
Part 2 The Biology of Stress and Illness 67
3 Stress and the Nervous System 67
4 Stress, Illness, and the Immune System 95
5 The Impact of Stress on Health Conditions 131
Part 3 Stress, Personality, and Emotions 171
6 Personality and Stress 171
7 A nxiety, A nger, and Depression 209
Part 4 Interpersonal and Job Stress 243
8 Interpersonal Stress 243
9 Job Stress 271
Part 5 Emotional and Behavioral Self-Regulation 301
10 Cognitive and Behavioral A pproaches 301
11 Physical Activity and E xercise 329
12 Nutrition 361
Part 6 Mind-Body Strategies 397
13 Self-Regulation Relaxation Strategies 397
14 Meditation, Yoga, and Biofeedback 419
Part 7 Guidelines for Stress Management
and Well-Being Enhancement 453
15 Guidelines for Stress Management and Well-Being Enhancement 453
v
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Con t en t s
P r e fa c e xv
Part 1 Stress, Health, and Positive Psychology 1
1 Stress and Health 1
What Is Stress? 2
● Insight Exercise 1.1
The College Life Stress Inventory 5
What Is Health? 9
Antonovsky’s Salutogenic Model 11
● Insight Exercise 1.2
The Short Form of the Orientation to Life Questionnaire
(Antonovsky, 1987) 13
The Impact of Stress on Health and Performance 15
The Impact of Stress and Lifestyle on Longevity 16
The Physiology of Stress 18
Cannon’s Fight-or-Flight Model 18
Selye’s General Adaptation Syndrome 20
The Psychology of Stress 23
Lazarus’s Appraisal and Coping Model 24
The Promise of Positive Psychology 27
Chapter Summary and Concept Review 29
Critical Thinking Questions 30
Key Terms and Concepts 30
Media Resources 31
2 Positive Psychology 33
A Brief History of Positive Psychology 35
Positive Emotions 36
Fredrickson’s Broaden-and-Build Model 37
vii
viii C on t en ts
Well-Being 39
Measurement of Subjective Well-Being 40
● Insight Exercise 2.1
The Fordyce Emotions Questionnaire 41
● Insight Exercise 2.2
Satisfaction with Life Scale 42
Happiness Set Point and Hedonic Adaptation 43
Traits of Happy People 46
Life Circumstances 48
Optimism 53
Flow and Goal Pursuit 54
Hope Theory 56
Mindfulness and Savoring 57
Love and Relationships 59
Meaning and Purposeful Living 61
Chapter Summary and Concept Review 63
Critical Thinking Questions 64
Key Terms and Concepts 65
Media Resources 65
Part 2 The Biology of Stress and Illness 67
3 Stress and the Nervous System 67
The Nervous System 71
Central Nervous System 73
The Peripheral Nervous System 80
Stress and the Endocrine System 82
The Sympathetic-Adrenal-Medulla Axis 83
The Hypothalamic-Pituitary-Adrenal Axis 84
The Thyroxine Axis 85
Traumatic Stress and the Brain 86
Posttraumatic Growth 88
Chapter Summary and Concept Review 91
Critical Thinking Questions 92
Key Terms and Concepts 93
Media Resources 93
4 Stress, Illness, and the Immune System 95
Illness 96
Research Strategies for Examining Stress and Illness 99
The Life Events Model of Stress and Illness 104
C on t en ts ix
Daily Hassles Model 108
Linking Stress, Illness, and the Immune System 109
The Human Immune System 109
The Immune System and Acute Stressors 115
The Immune System and Chronic Stressors 117
Stress and Immunosuppression 117
Strengthening the Protective and Immune Systems 123
Chapter Summary and Concept Review 128
Critical Thinking Questions 129
Key Terms and Concepts 129
Media Resources 130
5 The Impact of Stress on Health Conditions 131
The Strong Evidence 133
Cardiovascular Disease 133
Skeletal Muscle Conditions 147
Atopic Disorders—Asthma, Allergic Rhinitis, and Atopic Dermatitis 150
The Mixed Evidence 154
Cancer 154
The Weak Evidence 160
Gastrointestinal System Conditions 160
Systemic Autoimmune Disorders 163
Chapter Summary and Concept Review 167
Critical Thinking Questions 169
Key Terms and Concepts 169
Media Resources 170
Part 3 Stress, Personality, and Emotions 171
6 Personality and Stress 171
Models of Personality, Stress, and Health 174
What Is Personality? 175
Eysenck’s PEN Model 176
The Big Five 180
Stress and Health Personality Vulnerability Factors 182
Neuroticism 182
The Type A Behavior Pattern 190
Stress and Health Protective Personality Factors 195
Conscientiousness 195
Extraversion, Openness to Experience, and Agreeableness 198
Dispositional Optimism 200
Dispositional Constructs Involving Perceptions of Control 202
x C on t en ts
● Insight Exercise 6.1
What Is Your Locus of Control? 203
Chapter Summary and Concept Review 205
Critical Thinking Questions 207
Key Terms and Concepts 207
Media Resources 208
7 Anxiety, Anger, and Depression 209
Anxiety 210
● Insight Exercise 7.1
Self-Analysis Questionnaire 212
Generalized Anxiety Disorder (GAD) 213
Panic Disorder 214
Phobias 214
Obsessive-Compulsive Disorder 215
Posttraumatic Stress Disorder (PTSD) 216
Treatments for Anxiety Disorders 217
Anxiety Management 219
■ Stress Management Exercise 7.1
Abdominal Breathing 221
Anger 223
Anger Management 227
Depression 231
Dealing with Depression 236
Positive Mental Health 237
Chapter Summary and Concept Review 240
Critical Thinking Questions 241
Key Terms and Concepts 242
Media Resources 242
Part 4 Interpersonal and Job Stress 243
8 Interpersonal Stress 243
Interpersonal Conflict 245
High Drama—Raising Tensions and Creating Distance 245
Low Drama—Lowering Tension and Creating Closeness 249
■ Stress Management Exercise 8.1 255
Social Support, Social Strain, and Health 257
Social Support and Health 258
Social Strain and Health 261
Adjusting to Differences 261
Stress and Health Effects of Racism and Discrimination 263
C on t en ts xi
Gender Differences in Response to Stress 266
Chapter Summary and Concept Review 267
Critical Thinking Questions 269
Key Terms and Concepts 269
Media Resources 270
9 Job Stress 271
Models of Organizational Stress 273
Organizational Role Stress 273
Person-Environment Fit Model 274
Job Demands-Control (Job-Strain) Model 274
Effort-Reward Imbalance (ERI) Model 275
Organizational Injustice Model 275
Stress and Occupations 275
Work Stress and Health 278
Shift Work and Other Work Schedules 279
What Is Burnout? 281
● Insight Exercise 9.1
Burnout Measure: Short Version 282
Burnout and Health 285
Burnout Prevention and Treatment 286
Workplace Harassment and Discrimination 287
Time Management 289
Time Management Strategies 291
■ Stress Management Exercise 9.1
Managing Time Stress 293
Job-Related Well-Being 293
Work Stress Organizational Interventions 295
A Positive Psychology Approach 296
Chapter Summary and Concept Review 298
Critical Thinking Questions 299
Key Terms and Concepts 299
Media Resources 300
Part 5 Emotional and Behavioral Self-Regulation 301
10 Cognitive and Behavioral Approaches 301
General Types of Coping Strategies 302
● Insight Exercise 10.1
What Is Your Coping Strategy? 304
Measurement of Coping Strategies 308
xii C on t en ts
Specific Types of Coping Strategies 309
Cognitive Restructuring 314
■ Stress Management Exercise 10.1
Employing the Triple Column Method 317
Stress Inoculation Training 317
Learned Optimism 319
Additional Coping Strategies 320
Expressive Writing 320
Self-Forgiveness 321
Humor 321
Pets 323
Music 324
Chapter Summary and Concept Review 325
Critical Thinking Questions 326
Key Terms and Concepts 327
Media Resources 327
11 Physical Activity and Exercise 329
● Insight Exercise 11.1
What Are My Exercise Barriers? 334
Meaning of Physical Activity, Exercise, and Fitness 334
Benefits of Aerobic Activity and Exercise 336
Health Benefits of Physical Activity 336
Well-Being Benefits of Physical Activity 343
Beginning an Exercise Program 349
■ Stress Management Exercise 11.1
Stress Busting Through Step Counting 354
Maintaining an Exercise Program 355
Eustress, Flow, and Physical Activity 358
Chapter Summary and Concept Review 358
Critical Thinking Questions 360
Key Terms and Concepts 360
Media Resources 360
12 Nutrition 361
Food and Nutrients 363
Food as Medicine 373
Coffee, Tea, Caffeine, and Stress 380
■ Stress Management Exercise 12.1
Caffeine and Stress 382
Alcohol 383
C on t en ts xiii
Tobacco Use 384
Obesity and Weight Loss 386
Healthy Eating 392
Chapter Summary and Concept Review 393
Critical Thinking Questions 395
Key Terms and Concepts 395
Media Resources 396
Part 6 Mind-Body Strategies 397
13 Self-Regulation Relaxation Strategies 397
Progressive Muscle Relaxation 399
Abbreviated Progressive Muscle Relaxation 400
Potential Issues in Progressive Relaxation Training 401
Progressive Muscle Relaxation Exercise 403
Brief Relaxation Exercise 403
■ Stress Management Exercise 13.1
Progressive Muscle Relaxation 404
Systematic Desensitization 405
■ Stress Management Exercise 13.2
Brief Relaxation Exercise 406
Autogenic Training 408
■ Stress Management Exercise 13.3
Autogenic Exercise 412
Guided Imagery Relaxation 412
Using Guided Imagery to Promote Deep Relaxation 414
■ Stress Management Exercise 13.4
Creating Your Personal Guided Imagery Relaxation Script 416
Chapter Summary and Concept Review 416
Critical Thinking Questions 417
Key Terms and Concepts 418
Media Resources 418
14 Meditation, Yoga, and Biofeedback 419
Historical Perspective 420
Meditation 425
What Is the Meditative State? 426
● Insight Exercise 14.1
Meditation Experiences 428
How Meditation Achieves Its Effects 428
Forms of Meditation 430
Mindfulness Approaches 430
xiv C on t en ts
Applications and Benefits of Meditation 434
The Practice of Meditation 439
■ Stress Management Exercise 14.1
Mantra Meditation 441
■ Stress Management Exercise 14.2
Mindfulness Meditation 442
Biofeedback 442
Headache 444
Raynaud’s Disease and Raynaud’s Phenomenon 446
Essential Hypertension 447
Biofeedback Conclusions and Recommendations 448
Chapter Summary and Concept Review 449
Critical Thinking Questions 450
Key Terms and Concepts 450
Media Resources 451
Part 7 Guidelines for Stress Management
and Well-Being Enhancement 453
15 Guidelines for Stress Management
and Well-Being Enhancement 453
Living a Healthy Lifestyle 454
Nutrition 455
Physical Exercise 457
Restoration 458
Use Effective Coping and Self-Regulation Strategies 459
Fostering Positive Relationships 462
Enhancing Happiness and Well-Being 465
■ Stress Management Exercise 15.1
Seligman’s (2011) What-Went-Well Exercise 469
Chapter Summary and Concept Review 470
Critical Thinking Questions 471
Key Terms and Concepts 472
Media Resources 472
G l o s s a ry 473
Re f e re n c e s 489
N a m e I n de x 52 3
S u b j e ct IN de x 5 31
Preface
Welcome to Stress, Health & Well-Being: Thriving in the 21st Century. It is
my hope that this book will provide readers an understanding of and apprecia
tion for the interconnection of stress, health, and well-being and how the
strategies employed regarding stress can optimize health and well-being.
Since my graduate student days conducting a dissertation on the effects of
heart rate biofeedback on the experience of anxiety, I have been fascinated by
the mind-body connection, especially as it relates to managing stress. Upon
receiving my doctorate, as part of my licensure in psychology training and beyond,
I was able to help others apply this information through their participation in
the numerous stress management groups I conducted. Later, as a psychology
professor, it has been my good fortune to teach an exciting course called Stress
and Health where I can share my knowledge, experience, and enthusiasm for
this subject with students.
Another exciting course I teach, called the Psychology of Happiness, is a
class that inspires intense interest in the “good life.” The more general related
field of study, a burgeoning new area called positive psychology, has a lot to
say about how to enhance well-being. I have discovered, as have others, that
positive psychology is a natural partner to the stress and health field. It begins
to fill the gaps, to provide understanding for how a person can move beyond
managing distress toward a greater sense of well-being, and ultimately toward
the goal of flourishing and thriving, a goal we can all relate to.
This text is designed with that integrative perspective in mind. It surveys
the topics of stress and health while adding positive psychology theory and
r esearch to fill the gaps and enrich our understanding. It is tailor-made for
an upper-level undergraduate class in stress and health or stress management,
and it also is suitable for a course in health psychology that has a particular
emphasis on stress in all its dimensions.
While giving full coverage to the negative side of stress, this book also
adds balance by introducing more information on the positive side of issues
related to stress and health. It addresses questions like “What is the adaptive
value of stress?” “What kind of benefits, if any, can come from a traumatic
encounter?” “How can stress and challenge lead to greater well-being?” “How
can a person go beyond managing stress toward the goal of thriving?”
xv
