Stress and Physical and Mental Health

Chapter 5 Stress and Physical and Mental Health

Introduction • Daily stress causes negative consequences on physical and mental health. Sometimes, even leisure activities can be stressful.

Introduction • A loss of the Superbowl in the city of the team that lost has an increase in heart attacks and death over the next two weeks.

Introduction How are you affected by stress? How does it affect you physically?

Introduction • Health psychology – is concerned with the effects of stress and other psychological factors in the development and maintenance of physical problems. • Behavioral medicine – this field is concerned with psychological factors that may predispose an individual to medical problems. Stressful life events, certain personality traits, coping styles, and a lack of social support are included in these factors. This field also addresses the effects of stress on the physical body, including the immune, endocrine, gastrointestinal, and cardiovascular systems.

Introduction • The role that stress can play in triggering the onset of mental disorders in vulnerable people is explicitly acknowledged in the diathesis-model. • Exposure to extreme and traumatic stress may overwhelm coping mechanisms of otherwise apparently healthy people, leading to mental disorders such as post-traumatic stress disorder (PTSD).

What is stress? • Many personal and environmental obstacles get into the way of our lives. We may be rejected by someone we love. We may not have enough money. These are all obstacles within people's lives. • When we experience or perceive challenges to our physical and emotional well-being that exceed our coping resources, this is generally referred to as stress.

What is stress? • Stressors – external demands • Stress – the effects stress creates within the organism • Coping strategies – the efforts to deal with stress • All situations that require adjustment can be considered stressful. The word stress used to be used by engineers. • Hans Selye (a Canadian physician and endocrinologist) used the word to describe the difficulties and strains experienced by living organisms as they struggled to cope with and adapt to changing environments.

What is stress? • Selye's work provided the foundation for current stress research. • Selye also stated that stress could occur in negative as well as positive situations. Both types of stress can tax a person's resources and coping skills, although bad stress (distress) typically has the potential to do more damage. Stress can come in the form of continuous force and not always happens in one moment bursts.

Stress and the DSM • The relationship between stress and psychopathology is so important that stress is recognized in diagnostic formulations. • This is definitely noted in PTSD. The old DSM used to look at acute stress disorders and chronic stress disorders. These disorders involve patterns of psychological and behavioral disturbances that occur in response to identifiable stressors.

Factors Predisposing a Person to Stress • Everyone has stress and different people interpret that stress differently. No two people have the exact same stressors in their lives. Some people will develop long-term problems given stress. • Children are very vulnerable to the stressors of war and terrorism. Adolescents are vulnerable to parents that are depressed. • Those with higher levels of optimism, greater psychological control and mastery, increased, self-esteem, and better social support tend to do better with additional stress.

Factors Predisposing a Person to Stress • There is a gene that can predispose that a person will become depressed trying to face life's stress. • The amount of stress that we are exposed to early in life may also determine whether or not we are able to deal with stress. Each stressor could make us more vulnerable to future stress. • Animals that have experienced a stressful time tend to produce more stress creating hormone called cortisol. • Stress tolerance – refers to a person's ability to withstand stress without becoming seriously impaired. Stress can change how we think about what happens to us. Those with depression tend to have a more negative experience with negative events.

Characteristics of Stressors • Human beings definitely know which stressors are more dangerous than others. The key to stressors is: 1) the severity of the stressor, 2) how long it lasts, 3) its timing, 4) how closely it affects our own lives, and 5) how controllable it is. • The death of a loved one, a divorce, a job loss, a serious illness, or negative social exchanges – tend to be extremely stressful for people. Stressors have cumulative effects.

Characteristics of Stressors • Encountering many stressors at the same time is very difficult. The more closely involved the individual is given the stressful situation, the more it will impact them. • Events that are unpredictable and unanticipated and will cause severe stress. Given realistic expectations about the event will help the person. Those that know what is going to happen are generally less anxiety-ridden about the event. • With a bad stressor, there is no way to avoid or run away from severe situations.

The Experience of Crisis • Most of us experience occasional periods of acute stress (sudden and intense) stress. The term crisis – is when a stressful situation threatens to exceed or exceeds the adaptive capacities of a person or a group. • Crisis is not usually helped by coping mechanisms. A traumatic situation overwhelms a person's ability to cope with the event.

Measuring Life Stress • Even being promoted in a job brings new demands to a person, which means stress. This stress can bring problems to those with bipolar disorder or others disorders that do not deal well with change. • An LED (Life Event and Difficulty Schedule) is an interview-based survey that looks at acute and chronic forms of stress and comes with a manual. It can take into account a person's unique life circumstances. Interviews take more time and money to administer, but they are more reliable given the research than other methods.

Resilience • After going through a traumatic experience, some people do quite well in the following weeks and months. • This kind of healthy psychological and physical functioning after the event are called resilience. There is no single factor that improves resilience. This is linked to resources and different characteristics. • Being male, older, and being well-educated tends to give individuals more resilience. Having more economic resources is also important. Economics plays a huge role in this.

Resilience • Those individuals that can stay positive or look at the positive aspects of the situation tend to deal much better with situations. • Trying to find meaning, constantly going over the situation, and being negative about it does not tend to bring about positive aspects. • Those that tend to be overly positive and see themselves as better than what they might be, tend to do much better in traumas.

Stress and the Stress Response • The sympathetic adrenomedullary (SAM) system – is designed to mobilize resources and prepare for the fight-or-flight response. • The stress response begins in the hypothalamus, which stimulates the sympathetic nervous system (SNS). This causes the inner portions of the adrenal glands to secrete epinephrine and non-epinephrine. These cause an increase in heart rate. The body metabolizes glucose more rapidly. • The second system is called the hypothalamus-pituitary-adrenal (HPA) system. This releases a hormone called “corticotrophin-releasing hormone”. This stimulates the pituitary gland. The pituitary then secretes adrenocorticotrophic hormone (ACTH). This tells the adrenal cortex to produce stress hormones called glucocorticoids. This stress hormone is called cortisol. This is a good hormone to have in an emergency. It inhabits the body's immune system, which means the inflammatory response is delayed. This means escape has priority over healing. This is why cortisol injections are made to reduce inflammation in damaged joints.

Stress and the Stress Response There is a downside to cortisol, though. If the cortisol is not shut off, it can cause brain cell damage, especially in the hippocampus. At every level, stress is bad for your brain. The brain has no receptors to detect cortisol.

The Biological Cost of Stress • The biological cause of adapting to stress is called the allostatic load. When we are stressed and feeling pressured, our allostatic load is high. • Stress is becoming the underlining theme in virtually all physical illnesses. • Daily stressors are also important to note such as commuting, unexpected work deadlines, or even computer problems can cause stress. When a virus enters the body and the person has stress, it is thought that the body's immune system will be lessened and not be able to fight off the virus.

The Mind Body Connection Psychoneuroimmunology – is the study of the interaction of the immune system and the nervous system. The nervous system and the immune system communicate on a regular basis. The immune system is also influenced by the brain as the immune system also influenced the brain. A person's behavior and psychological state definitely impact the immune system. Glucocorticoids can cause stress-induced immunosuppression. This can be adaptive (escape first, heal later). Long-term stress can create problems for the future.

Understanding the Immune System The word “immune” comes from the Latin word “immunis”, which means “exempt”. The immune system protects the body from such things as viruses and bacteria. If the immune system is too strong and unselective, it can turn on the body's own healthy cells. If the immune system is too weak, it cannot function effectively and the body gets hit by viruses and bacteria. Lupus and Rheumatoid Arthritis are examples of autoimmune diseases where the immune system attacks the person.

Understanding the Immune System The front line of defense within the immune system is the white blood cells. These are called the leukocytes (or lymphocytes), which are produced in the bone marrow and then stored in various places in the body including the spleen and the lymph nodes. There are two types of leukocytes – 1) B-Cells – (in bone marrow) produces specific antibodies that are supposed to respond to different antigens. Antigen – are foreign bodies such as viruses and bacteria, as well as internal invaders such as tumors and cancer cells. 2) T-cell – (which matures in the thymus, which is important to the endocrine gland), and is stimulated when the immune system signals an attack. They multiple rapidly along with B Cells to counterattack.

Understanding the Immune System T-Cells circulate through the blood and lymph systems in an inactive form. Each T-Cell has a receptor on its surface that recognizes one specific type of antigen. The T-Cells become activated when immune cells called macrophages detect antigens and start to engulf and digest them. To activate the T-Cells, the macrophages release a chemical known as interleukin-1. Interleukins are a class of chemicals called cytokines. Cytokines – are chemical messengers that appear to be crucially important to health.

Understanding the Immune System B-Cells – are much different in structure than the T-Cells. When a B-Cell recognizes an antigen, it begins to divide and to produce antibodies that circulate in the blood. This process is facilitated by cytokines that are released by the T-cells. If the antigen ever appears in the future, it will be attacked sooner because there is a memory of it.

Stress, Depression, and the Immune System Stress slows the healing of wounds by as much as 24-40%. This is because stress is linked to suppression of the immune system. Sleep deprivation, marathon running, space flight, and being a caregiver, or the death of a spouse are linked to immunosuppression. There is a small amount of evidence that laughter can be associated with enhanced immune functioning. The immune system can go back to normal once the stress is gone.

Stress, Depression, and the Immune System Depression is associated with a compromised immune system. Chronic stress and depression may trigger the production of proinflammatory cytokines such as interleukin-6. One study showed that women that were caring for family members with Alheimer's disorder had higher levels of IL-6. Age of the woman did not seem to matter. Treatment with antidepressants can lower this level. Those that went to church seemed to have lower levels of IL-6.

Cardiovascular Disease Cardiovascular disease is the leading cause of death within the United States. The impact of stress on the heart is well researched.

Hypertension When we are stressed, the blood vessels supplying our internal organs constrict (become more narrow) and blood flows in greater quantity to the muscles of the trunk and limbs. When this happens, the heart must work harder. When the pulse quickens, the blood pressure increases. When the pressure decreases, the blood pressure goes back to normal. If there is emotional strain, high blood pressure may be a problem through the life.

Hypertension Ideally, blood pressure should be below 120/80. The first number is the systolic pressure when the heart contracts. The second is the diastolic or between-beat pressure. The definition of hypertension is having a persisting blood pressure of 140 or more and a diastolic of 90 or more. Blood pressure increases as we age. In younger adults, more young men suffer from high blood pressure. After the age of 50, hypertension is greater in women. Menopause amplifies the stiffness of the arteries. Sustained hypertension affects about 28% of the population in the U.S.

Hypertension Essential hypertension – having no specific cause for the disorder. Hypertension is an insidious disorder and very dangerous. The person that has it may not know it until medical complications come up. Hypertension increases the risk of coronary heart disease and stroke. There are theories that not being able to express anger in certain ways or trying to communicate with someone that is often angry, might also bring about cardiovascular problems.

Hypertension and African Americans African Americans have much higher hypertension levels than do European Americans (40% versus 27%). Their death rate is also three times higher. This is not just in the U.S., but throughout the world. High blood pressure in young people is also alarming. 10% of African American men 18-21 years of age have hypertension as compared to 1-2% in other groups. This could be because of the environment that some young Blacks live in. Exercise is also an issue with women and men because sometimes the neighborhood is not okay or safe to walk through.

Hypertension and African Americans Fast food may also be a potential reason why more African Americans have hypertension. African American retain sodium at higher rates than do other groups. This results in fluid retention and endocrine changes and that in turn changes blood pressure. Renin (an enzyme produced in the kidneys) is linked to blood pressure and is also processed differently by African Americans. Studies also suggest that nitric oxide (a dissolved gas that is crucial for the functioning of blood vessels and blood cells) is produced in lower levels in the blood vessels of African Americans and may be destroyed quite easily.

Coronary Heart Disease The heart is a pump made of muscle. Coronary heart disease (CHD) is a potentially lethal blockage of the arteries that supply blood to the heart muscle, or myocardium. If the muscles of the heart are not getting enough oxygenated blood, the person may experience chest pains. This is a sign that oxygen is not getting to the heart and that this organ is being overworked. An even more severe problem is myocardial infarction. This means there is a blockage in a section of the coronary arterial system. Because the heart muscle is deprived of oxygen, tissue may die, permanently damaging the heart. If the damage is extremely extensive the person may not survive.

Coronary Heart Disease In many instances of cardiac arrest, the victim might not have had any history of CHD or symptoms. There is a silent CHD. This generally happens when plague adheres to arterial walls and it breaks loose and heads into a smaller vessel, blocking it. Every year, more than 900,000 people in the United States experience a myocardial infarction.

Risk and Causal Factors in Cardiovascular Disease Stress increases the risk of having a heart attack. Death from CHD rise after an earthquake in an area. Those that have stress in their job and have little control over the decision making are at risk of a heart attack. For workers, most heart attacks occur on Monday. Smokers are also more at risk for CHD. Getting asked to give a speech can increase the risks. Mental stress is known to raise systolic blood pressure and can cause elevation given epinephrine. Mental stress can reduce the oxygen within the heart muscle.

Personality The Type A behavioral pattern – is characterized having an obsessive competitive drive, extreme commitment to work, impatience or time urgency, and hostility. Type A personality has been linked to a 2-fold increase in coronary arterial disease and an 8-fold increase in continued CHD. It is specifically the hostility portion of the Type A personality that is directly linked to coronary heart disease. Type D personality (the “distressed” personality”) - is a person that has a tendency to experience negative emotions and to feel anxious and insecure. Men that had this personality trait were more likely to have a fatal heart attack within 5 years as compared to those that did not have this personality. These individuals tend to have more problems after surgery.

Depression People with heart disease are three times more likely to have depression. Depression is more likely to be found with these individuals than with others that have major health problems. Those that have a heart attack that also have depression are more likely to die within the next five years than those that do not have it. Depression may also be a risk factor in developing CHD.

Anxiety There is a link between phobic anxiety and an increased risk of sudden cardiac death. Sudden cardiac death is six times higher in the men with the highest levels of anxiety.

Social Isolation and Lack of Social Support Monkeys that are caged alone have four times more atherosclerosis (blockage of the arteries of the heart) than do monkeys that are caged with other monkeys. People that consider themselves to have a small network of social support are at a higher risk of CHD. If an individual has already had a heart attack and now lives alone...the chance of that person having a heart attack is three times more likely within the next 5 years.

The Importance of Emotional Regulation Given this information, would it be beneficial to attempt to regulate your own emotions? Yes! Those individuals that have the least control over their emotions were the ones that seemed to be at the most risk of developing heart problems. Self-regulation skills are important in order to stay healthy.

Treatment of Stress Related Physical Disorders For those individuals that already have serious disease, they may have to have medical intervention or take pills so that their blood does not clot as regularly. Because of the link of depression with CHD, it is very important to treat depression early. Most people with depression go untreated. Physicians also fail to treat depression in their CHD patients. They tend to think it is a normal reaction to a medical scare. Thousands of lives could be saved by providing antidepressants to those that have had cardiac problems. In this case, cognitive behavioral therapy alone does not reduce the risk of future cardiac arrests.

Psychological Interventions Talking about or writing about one's feelings does seem to be an effective way of coping with problems within one's life. In a group of RA sufferers, those that wrote about their feelings toward the disease had less physical dysfunction than others. For those that are asked to write emotional disclosures, there is an initial distress, but show improvement with their medical follow-ups. This may help because they are “blowing off steam”. It may also help people to rethink their problems.

Biofeedback Biofeedback is a way to make patients aware of their blood pressure, level of muscle tension, or heart rate. This means hooking the person to a machine that tells them when they are relaxing and when those items are going back up. This machine is especially useful for people that have headaches. After 11 sessions, people are much more aware of how to relax and slow down these biological activities.

Relaxation and Meditation Researchers have studied various relaxation techniques in regards to stress. The results have been encouraging. Relaxation techniques have helped with hypertension. It can also help those that suffer from tension headaches. Daily meditation can also reduce blood pressure pretty significantly. The difficult part is getting someone to do this.

Cognitive-Behavioral Therapy CBT has been an important intervention for those that suffer from chronic headaches. Children with recurrent stomach pains were helped with family therapy and not one-to-one therapy. CBT has also been used for RA patients. Those that receive CBT tend to have better physical, social, and psychological functioning. Sometimes, just slowing down life helps to make things better.

Psychological Reactions to StressAdjustment Disorder Adjustment disorder – is a psychological response to a common stressor (divorce, death, the loss of a loved one, etc.) that results in clinically significant behavioral or emotional symptoms. It can be one stressor such as going away to college or two stressors – divorce and starting a new job. Someone that is experiencing a level of stress that they do not have coping strategies for may have an adjustment disorder. Symptoms must begin within three months of the stressor. The person must experience more stress than what is normal given other people in the same situation. The person's symptoms disappear when they adjust to the stressor. Adjustment disorder must be changed to some other mental illness if it goes beyond 6 months. A label of adjustment disorder is one of the mildest labels one can be given.

Adjustment Disorder because of Unemployment Since the recent recession, millions of Americans have been dealing with chronic unemployment. Unemployment reached a peak in 2010 in January at 10.6%. In almost every community, there are people who have been at jobs for years that were let go. They may also be facing the end of their unemployment compensation. Unemployment is especially difficult for young minority males, many of whom live in a permanent economic depression with few job prospects. Rates of unemployment for blacks are twice as high as compared to whites. Suicide can become more of a risk the longer someone is out of work. Children that live in families where one parent is unemployed is very difficult.

Adjustment Disorder caused by Divorce or Separation The deterioration of a relationship or a divorce is extremely stressful and many seek psychological treatment. Divorce can be difficult because people feel that they have failed at something. Another difficulty is explaining why the relationship ended to families and friends. There is generally a loss of friendships. There also tend to be economic problems. When children are involved, there tend to be court-battles, custody issues, living and visit arrangements, etc. Adjustment to single life may be difficult as it may become lonely. New friendships need to be made. Many seek counseling when they are going through a divorce.

Stress and Physical and Mental Health