This chapter discusses stress and health, including: 1) Stress is the process of perceiving and responding to threatening or challenging events, and can be appraised as a threat or challenge. 2) Prolonged stress can lead to exhaustion through stages of alarm reaction, resistance, and exhaustion as described in the general adaptation syndrome. 3) Stressful life events like catastrophes, life changes, and daily hassles can impact health. 4) Stress can influence health through behaviors, emotions, and physiological responses.

1. Myers’ PSYCHOLOGY (7th Ed) Chapter 14 Stress and Health James A. McCubbin, PhD Clemson University Worth Publishers

2. Stress and Health Behavioral Medicine interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease Health Psychology subfield of psychology that provides psychology’s contribution to behavioral medicine

3. Stress and Illness Leading causes of death in the US in 1900 and 2000

4. Stress and Illness Stress the process by which we perceive and respond to certain events, called stressors , that we appraise as threatening or challenging

5. Stress Appraisal Stressful event (tough math test) Threat (“Yikes! This is beyond me!”) Challenge (“I’ve got to apply all I know”) Panic, freeze up Aroused, focused Appraisal Response

6. Pituitary hormone in the bloodstream stimulates the outer part of the adrenal gland to release the stress hormone cortisol Sympathetic nervous system releases the stress hormones epinephrine and norepinephrine from nerve endings in the inner part of the adrenal glands Thalamus Hypothalamus Pituitary gland Adrenal glands Cerebral cortex (perceives stressor )

7. Stress and Illness General Adaptation Syndrome Selye’s concept of the body’s adaptive response to stress in three stages Stress resistance Phase 1 Alarm reaction (mobilize resources) Phase 2 Resistance (cope with stressor) Phase 3 Exhaustion (reserves depleted) The body’s resistance to stress can last only so long before exhaustion sets in Stressor occurs

8. Stressful Life Events Catastrophic Events earthquakes, combat stress, floods Life Changes death of a loved one, divorce, loss of job, promotion Daily Hassles rush hour traffic, long lines, job stress, burnout

9. Stressful Life Events Chronic Stress by Age

10. Perceived Control Health consequences of a loss of control No connection to shock source To shock control To shock source “ Executive” rat “ Subordinate” rat Control rat

11. Perceived Control Equality and Longevity

12. Stress and the Heart Coronary Heart Disease clogging of the vessels that nourish the heart muscle leading cause of death in many developed countries

13. Stress and the Heart Hopelessness scores 3.5 3 2.5 2 1.5 1 0.5 0 Heart attack Death Low risk Moderate risk High risk Men who feel extreme hopelessness are at greater risk for heart attacks and early death

14. Stress and the Heart Type A Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people Type B Friedman and Rosenman’s term for easygoing, relaxed people

15. Stress and the Heart

16. Stress and Disease Psychophysiological Illness “ mind-body” illness any stress-related physical illness some forms of hypertension some headaches distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease

17. Stress and Disease Lymphocytes two types of white blood cells that are part of the body’s immune system B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances

18. Stress and Disease Conditioning of immune suppression UCS (drug) UCR (immune suppression) UCS (drug) UCR (immune suppression) CS (sweetened water) CS (sweetened water) CR (immune suppression)

19. Stress and Disease Negative emotions and health-related consequences Unhealthy behaviors (smoking, drinking, poor nutrition and sleep) Persistent stressors and negative emotions Release of stress hormones Heart disease Immune suppression Autonomic nervous system effects (headaches, hypertension)

20. Promoting Health Aerobic Exercise sustained exercise that increases heart and lung fitness Depression score 14 13 12 11 10 9 8 7 6 5 4 3 Before treatment evaluation After treatment evaluation No-treatment group Aerobic exercise group Relaxation treatment group

21. Promoting Health Biofeedback system for electronically recording, amplifying, and feeding back information regarding a subtle physiological state blood pressure muscle tension

22. Promoting Health Modifying Type A life-style can reduce recurrence of heart attacks Percentage of patients with recurrent heart attacks (cumulative average) 6 5 4 3 2 1 0 Year 1978 1979 1980 1981 1982 Life-style modification patients Control patients Modifying life-style reduced recurrent heart attacks

23. Promoting Health Social support across the life span 12-14 18-19 25-34 45-54 65-74 15-17 20-24 35-44 55-64 75+ Age in years 100% 90 80 70 60 50 Percentage with high support

24. Life events Tendency toward Health Illness Personal appraisal Challenge Threat Personality type Easy going Nondepressed Optimistic Hostile Depressed Pessimistic Personality habits Nonsmoking Regular exercise Good nutrition Smoking Sedentary Poor nutrition Level of social support Close, enduring Lacking

25. Promoting Health Predictors of mortality 1 0.8 0.6 0.4 0.2 0 Men Women Not smoking Regular exercise Weekly religious attendance Relative risk of dying

26. Promoting Health Religious Attendance

27. Promoting Health The religion factor is mulitidimensional Religious involvement Healthy behaviors (less smoking, drinking) Social support (faith communities, marriage) Positive emotions (less stress, anxiety) Better health (less immune system suppression, stress hormones, and suicide)

28. Promoting Health Complementary and Alternative Medicine unproven health care treatments not taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies

29. Alternative systems of medical practice Bioelectromagnetic applications Diet, nutrition, life-style changes Herbal medicine Manual healing Mind-body control Pharmacological and biological treatments Subfields of Alternative Medicine Health care ranging from self-care according to folk principles, to care rendered in an organized health care system based on alternative traditions or practices The study of how living organisms interact with electromagnetic (EM) fields The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention Employing plan and plant products from folk medicine traditions for pharmacological use Using touch and manipulation with the hands as a diagnostic and therapeutic tool Exploring the mind’s capacity to affect the body, based on traditional medical systems that make use of the interconnected- ness of mind and body Drugs and vaccines not yet accepted by mainstream medicine

30. Promoting Health Smoking-related early deaths 40,000 30,000 20,000 10,000 0 33,348 1,686 1,135 556 202 Smoking Suicide Vehicle HIV/ Homicide crash AIDS Cause of death Number of deaths per 100,000

31. The Physiological Effects of Nicotine

32. Promoting Health Fewer Canadian smokers Males Females 1970 1974 1978 1982 1986 1990 1994- 1996- 1995 1997 Year 60% 50 40 30 20 10 0 Percentage of Canadians smoking

33. Smoking Prevention U.S. teen smoking

34. Smoking Prevention Results of a smoking inoculation program Percentage of students who smoke 20 15 10 5 0 0 4 9 12 16 21 33 Seventh grade Eighth grade Ninth grade Months of study Control school School with smoking Prevention program Fewer teens took up smoking when “inoculated” against it

35. Obesity and Weight Control Obesity and body mass index

36. Obesity and Weight Control Obesity and mortality 18.5 18.5- 20.5- 22.0- 23.5- 25.0- 26.5- 28.0- 30.0- 32.0- 35.0- 40 20.4 21.9 23.4 24.9 26.4 27.9 29.9 31.9 34.9 39.9 Body-mass index (BM I) Men Women 2.8 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 Relative risk of death

37. Weight Discrimination When women applicants were made to look overweight, subjects were less willing to hire Willingness to hire scale (from1: definitely not hire to 7: definitely hire ) 0 1 2 3 4 5 6 7 Women Men Normal Overweight

38. Weight Control Effects of a severe diet Caloric intake in calories per day Body weight in kilograms Metabolism: Oxygen consumption in liters per hour 3000 2000 1000 0 8 16 24 32 Days 165 160 155 150 145 140 Days Days 26 25 24 23 22 21 8 16 24 32 8 16 24 32

39. Weight Control Trading risks

40. Weight Control Thinning of Miss America

41. Weight Control Most lost weight is regained -20 -15 -10 -5 0 5 10 1 2 3 4 5 Weight change in pounds Post treatment Years of follow-up Starting point Normal trend for untreated obese people: Gradually rising weight After participation in behavioral Program: Much of initial weight loss regained

42. Weight Control Obesity was more common among those who watched the most television <2 2-3 > 4 Hours of television watched per day in 1990s study Boys Girls 32 30 28 26 24 22 20 Skinfold fat measure (mm)