Stress and Health

1. Stress and Health McElhaney November 2016

2. Organization • How do we understand Stress? (definition and causes) • How does stress affect us Physically and Emotionally? • What are some behaviors associated with stress? • How does personality relate to stress? • How can one cope to stress and maintain health?

3. WE all feel stress at some time. • Experience being frequently overwhelmed Relationships, deadlines, pressure, volunteering, sports, music, theater, work, college aps, grades, parents, AP CLASSES Relate to stress

4. Big Picture: Stress Responses are Physical/Psychological/Behavioral • Stress is basically a physical and emotional response to challenges = stressors • “Stress occurs whenever a challenge or threat forces a person to adjust or adapt.” • “Stress is a behavioral factor that directly affects personal wellbeing.” • Health is affected by stress.

5. Big Idea • Stress is a major risk factor for illness and disease • Stress is caused by interaction between people and the environment • The body’s reaction to stress damages internal organs and immune system Some people say stress is other people.

6. Types of Stress Catastrophes Significant Life Changes Daily Hassles

7. Catastrophes • Unpredictable • Large Scale Events • War/Earthquake Creates • Damages Physical or Emotional Health • Trouble concentrating • Trouble sleeping • Suicide • Responding to catastrophe by moving causes more stress…

8. Life Changes and Stress: Stressful Situations: • Separation • Divorce • Unemployment • Lack of Social Support/Loneliness • Caregiving for a family member with an illness • Bereavement • (Lack of Control and Depression can amplify) • Marriage (totally stressful) • Leaving to college (depends on your view of this) • Death in the family or close friend • Big Problem- Cluster of Crisis (lots of things happen at once)

9. Daily Hassles • Traffic • Everyday Aggravations (things add up) • Frustrations • Living with deprivation (economic)

10. Burnout • Nursing, teaching, police, social work and Burnout • Burnout- being physically, mentally + emotionally drained • Emotional Exhaustion- fatigued tense +apathetic; feeling all used up • Miss work frequently • Cynicism- detached from job, “I don’t give a damn.” • Feeling of reduced personal accomplishment • Helpless, hopeless or angry, poor work performance Indifference • Disorganized • Impulsive • Accident prone • Over sleeping • Poor job performance • Abuse of drugs and alcohol • Irritability • Suspicious • Withdrawn • Depressed • Burnout is the opposite of –Job engagement (work seen as important and meaningful, challenging) • To Prevent Burnout • Adjust workload • Keep social support (support gives encouragement)

11. PTSDPost Traumatic Stress Disorder • A pattern of adverse reactions following a traumatic event Characteristics • Anxiety • Depression • Irritability • Jumpiness • Inability to concentrate • Sexual Dysfunction • Difficulty getting along with others • Sleep disorders • Nightmares • Startle responses to noise or sudden stimuli • Vivid memories/re-experiencing the trauma • Long terms suppression of immune system • Common in Military especially associated with combat • Common with traumatic experiences/assaults/abuse/witnessing violence/bloody scenes etc. • Some research indicates some brain structures and functioning are permanently affected

12. How does the body react to stress? • Stress response is part of a unified Mind-Body system • Emotion arousing events trigger an outpouring of the stress hormones • Epinephrine and Norepinephrine form adrenal glands

13. Sympathetic Nervous System Stress Response System • Stress responses are physiological arousal • Cerebral cortex • Hypothalamus • Pituitary Gland • Adrenal Gland • Glucocorticoid stress hormone = Cortisol • Increase- heart rate and respiration • Blood diverted to skeletal muscles • Sugars released • Fat released • for fight or flight

15. Review: Identify 5 topics we covered yesterday and write one main ideas about each one. • Definition of Stress • Big Picture- Effects of Stress • Types of Stressful Experiences • Burnout- Causes, Characteristics • PTSD- Causes, Characteristics, • Stress Hormones • Sympathetic Nervous System Stress Response

16. Today • Reinforce Sympathetic Responses To Stress • GAS: General Adaptation Syndrome • Hans Seyle • Diathesis Stress Model • Stress Mediators • Cognitive Appraisal-Lazarus • Predictability and control • Personality Types and Stress

17. Stress Physiological Response • Short Term • Body needs the added arousal • It is useful to have the hormones and energy in challenging situations • Long Term • Body damage • Emotional shocks- intense, repeated, pressure, unpredictable, uncontrollable=stress is magnified

18. General Adaptation Syndrome • Hans Selye (1950s) • Alarm Reaction-Threat produces Emergency Reaction, Body mobilizes for action, Body responds to cope with stress • Resistance – Body consolidates response- physiological defense to minimize tissue damage, • Neurotransmitters carry messages to organs, adrenal glands release cortico-steroids= increase blood sugar for energy while reducing inflammation and pain. • Reducing blood flow to other body functions (reproduction, digestion, growth) are gradually shut down… • over time body becomes depleted… Exhaustion: • At this phase, the stress has continued for some time. Your body’s ability to resist is lost because its adaptation energy supply is gone. Often referred to as overload, burnout, adrenal fatigue, maladaptation or dysfunction – Here is where stress levels go up and stay up! • Vulnerable to Illness

20. Diathesis Stress Model • Argues that some people are pre-disposed to psychological disorders • Whether or not individuals actually display them depends on the frequency, nature and intensity of the stressors.” • So we may have dysfunctional tendencies that come out when we are under extreme or prolonged stress.

21. Stress Mediators • Are factors that increases or decreases the effects of stress • Perception of stress • Is it a threat? • Or is it a challenge to overcome? • Interpretation is key • Lazarus- Appraisal • Control • Social Support • Personality • Adaptive Coping • Maladaptive Coping • Freudian Defense Mechanisms

22. Cognitive Appraisal • Lazarus researcher on Stress said- • Physiological responses to stress can be reduced by Cognitive appraisal/evaluation of stressors • Example industrial accident movie • Emotional responses were reduced due to TRAINING of research participants • People who engage in Catastrophic thinking experience more physiological stress responses • People who have more optimistic outlook tend to be healthier and have milder stress responses • Primary Appraisal – Q: Am I ok or in trouble? • Decide if the situation is relevant or irrelevant positive or negative • Secondary Appraisal- Q: What can I do about this situation? • Assess resources • Choose a way to meet threat or challenge • Coping with threats=coping

23. Appraisal of Stress • Stress- is dependent on how we perceive events and react to them. • Eustress is good stress- example of seeing stress as a set of challenges to overcome • Example of the industrial movie: • Intellectualizers • Deniers • Unprepared • People can reduce the impact of stress if they are trained in advance of the stressful situation.

24. Predictability and Control (pg. 530) • Anticipating Stress = predictability= expectancy= can reduce stress • Perception of Control over stress = can reduce the impact of the stress • People who perceive no control over negative events appear especially prone to physical and psychological problems associated with stress. • Example- workers who perceive they have little or no control over their work environment were more likely to suffer from health effects of stress.

25. Review: Identify 5 topics we covered yesterday and write one main idea about each one • GAS • Hans Seyle • Diathesis Stress • Stress Mediators • Lazaraus • Cognitive Appraisal (role of perception) • EustressPredictability (training) • Control

26. Today 10/20/16 • Personality and Stress (Type A +Type B) • Dispositional Optimism • Gender Responses to Stress • Coping • Adaptive Coping • Problem Focused Coping • Emotion Focused Coping • Social Support- “tend and befriend” • Exercise • Meditation • Cognitive Therapy • Relaxation Therapy

27. Disease Prone Chronic depression Low exercise Poor diet Problematic sleep Anxious Hostile Frequently ill Health Promoting Behaviors Exercise Not excessive drinking No Tobacco Not over-eating Personality Types

28. Type A personality (disease Prone) High risk of heart attack Hard driving Ambitious Reactive Highly competitive Achievement oriented Persistent Time urgency Anger Verbally aggressive Hostility Very rigid in attitudes Toxicnegative emotions These people are also prone to heart diseases because of the tensions, stress and worrying attitude. Hardy Personality People who can resist stress Sense of personal commitment To self, to work, to family Sense of control over lives and work Tendency to see life as a series of challenges Personality Types Continued

29. Personality Types Related to Stress Type B Personality • These people tend to be productive under stress. • Relaxed, patient and have a lot of self control. • One of the type B personality traits is that these people do not get irritated or angry easily. • They are less competitive and their competitiveness is often productive with good intentions. • They rarely tend to be aggressive or frustrated. • People belonging to type B personality are also very much tolerant and flexible who can change in order to adapt to situations and changes. • These people do not get hyper if their time is wasted and do not mind waiting in queues or wait to get their work done. • Relaxation, enjoyment, fun comes very naturally to them. They spend their free time socializing, shopping or having a good time. • They are very calm as compared to their highly stung counterparts (type A). People of type A personality often wish they were working rather than spending their time in leisure and the type B personality traits are just the opposite. • People of B type personality tend to plan things in advance before executing them.

30. Personality Factors and StressPersonality characteristics can reduce stress reactionsThe impact of stress is mediated by cognitive style or how we think about stressors. • Optimism –Dispositional Optimism(type of personality) AKA “disease-resistant” • Stressors are Challenges to Overcome • Expectation that things will work out positively • Use problem focused coping • Think stressors are temporary • Not catastrophic thinking • Do not blame themselves • Have characteristics of sociability and optimistic outlook • They heal faster and live longer, and fewer health consequences • Pessimism- “disease prone” • Ignore stressors • Think of stressors are catastrophic events (catastrophizing) • Use emotion focused coping – avoidance • Pessimistic thinking

31. Gender Responses to Stress • Male Responses • Anger • Avoid stressors • Physiological responses are more intense for men • Heart rate • Blood pressure higher • “Fight or Flight” • Hormone- Oxytocin (interacts with sex hormones) • Have more intense emotional and behavioral responses. • Female Responses • Help others • Make use of social support • “Tend and befriend” • Hormone- Oxytocin (interacts with sex hormones) • Reacts in women as a stress reducer • Web Site Oxytocin • Women may live longer 5 years average

32. Adaptive Coping • Problem Focused Coping • Emotion Focused Coping • Social Support- “tend and befriend” • Exercise • Meditation • Cognitive Therapy • Relaxation Therapy

33. Coping • Problem-focused coping (control is the issue) • Need to manage or alter the distressing situation • Confronting • Seeking Social Support • Plan- problem solving • Emotion-Focused Coping: (when there is no control of the situation) • People try to control their emotional reactions to the situation • Self-controlling • Cognitive Appraisal • Distancing • Expressing feelings • Accepting responsibility • Humor • Search for positive aspects • Religious beliefs to bring meaning • Escape/Avoidance • Self-Medicating= Maladaptive/Alcohol/Drugs • Seeking Social Support • Companionship

34. Social Support • The presence of other people can help mediate stress • Can reduce the effects of stressors • Has health benefits • Better immune system functioning • Faster recovery from illness or surgery • Social Support Network • Your friends you can rely on for support • Support Groups allow people to express pent up thoughts and emotions • Social Support can be both Problem Focused or Emotion Focused • Quality of Social Support • Inadequate Social Support can be a problem (isolation) • Can double a person’s risk of dying from disease suicide or other causes • Not recognizing the value of Social Support can be a hindrance • Wrong Kind of Support- The support is too invasive- “overprotective” (may hinder people being self-active in coping) • Support can be annoying, disruptive, and interfering thus increasing stress

35. Behaviors that increase risk of disease and death can occur as stress coping responses Stress- responses Risky Behavior Sensation Seeking High blood pressure Cigarette smoking Drug and alcohol Abuse Obesity/Overeating Unsafe sex, for attention and comfort Exposure to toxic substances Aggression/Violence 45% of all deaths are due to unhealthy behavior = tobacco, drinking, drug use and lack of exercise Maladaptive Coping to Stress

36. Physical Fight 42% Carried Weapon 22% Had one or more drinks 30% Mary-Jane 33% Sex 53% Unsafe Sex 47% Cigarette Smokers 31% Eating Fatty Foods 34% Sedentary Lifestyle 34% High School Risky Behavior

38. Psychological Defense • Psychological Defense • Psycho-dynamic-Freud identified • Anxiety- comes with threatening situations • Tense, uneasy, apprehension, worried, vulnerable • Emotion-focused coping = defense mechanism helps us reduce anxiety • Defense Mechanism (definition) (Psychodynamic) • Any mental process used to avoid, deny, or distort sources of threat or anxiety • Help us keep from being overwhelmed by immediate threats

39. Freudian-Defense Mechanisms • Displaced Aggression • Conflicts- • Approach-Approach, • Avoidance-Avoidance, • Approach-Avoidance • Multiple Conflicts • Defense mechanisms • Repression • Reaction Formation • Regression • Projection • Rationalization • Compensation • Sublimation • Learned Helplessness • Acting out • Affiliation • Passive • aggression • Avoidance • Altruism • Humor

40. Frustration • Extreme Situations + Responses • Frustration-negative emotional state occurs when people are prevented from reaching desired goals (2 types) • 1 External Frustration- outside force or individual impedes progress toward a goal (flat tire) • Delays success • Can be social obstacles = people • Or • Non-social = objects • Frustration increases- as strength of blocked motive increases-frustration increases • 2. Personal Frustration- based on personal characteristics or limitations

41. Reactions to Frustration: • Aggression- any response with intent of harming a person or object • Most frequent response to frustration • *Persistenceas a response to frustration- varied vigorous efforts to overcome frustration help • Displaced Aggression • Focusing aggression toward some-other person or object- whoever or whatever is available • Redirection – usually to a safe, less likely to retaliate direction • *Chains of displacement • *Hostility and violence are largely due to displaced aggression • *Scapegoating- available sources blaming • Withdrawal or Escape, Avoidance

42. Conflicts • Conflict- a person must choose between contradictory desires, needs and motive demands  • 1. Approach-Approach Conflicts (weak conflict) • Two positive choices • Two desirable alternatives • 2. Avoidance-Avoidance Conflicts (difficult to resolve) • Choice between 2 negative undesirable alternatives • Based on personal needs or bias • 3. Approach-Avoidance Conflicts (difficult to resolve) • People are attracted to • + same goal or activity • Repelled • fear + attraction—could result in ambivalence= mixed positive and negative feelings • Multiple Conflicts- neither complete positive or negative options • AKA- double approach-avoidance- each alternative has positive + negative qualities

43. Physiology and Psychology of Health and Illness (p537) • The Relationship between stress and illness • “ways in which stress can directly or indirectly lead to physical illness by affecting immune system and cardiovascular system.” • Example: Physiological Stress Response and Louis Pasteur 3 chickens • 1 healthy no treatment • 1 healthy but infected with bacteria • 1 dead, infected but also stressed by cold weather (Bacteria + Stress = Death)

44. Health Effects of Stress • Extreme and prolonged STRESS damages health and inhibits our ability to resist disease • Psychoneruoimunologyis the study: • Neural Functioning • psychosomatic Illness • Endocrine/hormones • Immune System • Cardio-vascular System- heart disease

45. Neural Effects of Stress • Nerve growth is slowed • Degeneration of neural circuits • Pre-mature aging • DNA cells replication slowed • Resembles old cells

46. Psychosomatic illness: • Psychological factors contribute to actual body damage • Not hypochondrias • Dyspepsia- stomach pain- not an ulcer • Eczema • Hives • Migrane headache • Rheumatoid arthritis • Hypertension • Colitis • Heart disease • Head, neck ache • Back ache • Indigestion • Chronic diarrhea • Fatigue • Insomnia • Sexual dysfunction

47. Immune System: • Is weakened by stress  then the vulnerability to infectious disease increased • Function is to attack foreign and harmful substances/viruses/bacteria • Consists of White Blood Cells Leukosites • B-Cellsformed in bone marrow produce antibodies that attack foreign cells • T-Cells mature in the Thymus kill other cells • Natural Killer Cells kill other cells  anti-viral-anti-tumor • Macrophage digest foreign cells Phagocytosis “Eating Cells”

48. Immune Functioning • Stress suppresses the immune system • Immune system isolates and destroysbacteria and viruses • Lymphocytes • White blood cells • 2 types of Lymphocytes • B-Lymphocytes • In bone marrow • Produces antibodies • Antibodies attack foreign cells and toxins • Attack bacterial infections • T-Lymphocytes • In Thymus • Attack cancer cells • Attacks viruses • Attacks foreign substances

49. Immune 2 • Macrophage (big eaters) • Identifies • Pursues • Ingests harmful invaders and worn out cells • In blood stream that enter organs • ** when immune system is not working properly – could allow dormant disease to erupt=Herpes+Cancer

50. Immune 3 • Key Idea: • Energy during stressful times is directed to brain and muscle vs. • The Brain influences functions of immune system through: • Nerves affect the Thymus • the secretion of hormones (Cortisol) • All are affected by the release of Cortisol which suppresses immune functions • Thus people under stress are more likely to develop infectious disease • Example law school students