Chapter 12: by u49y989


									                                  Chapter 10: Stress, Health, and Coping
I. Stress
   A. Stress describes the psychological and bodily response to a stimulus that alters a person’s state of
      1. Stressors can lead to a stress response, which works to help you cope with the stressor and
            bring your body back into equilibrium.
            a. Stressors can be acute or chronic.
            b. Stressors can be physical or psychological.
      2. Our perception of a stimulus is usually what determines whether it elicits a stress response.
   B. The General Adaptation Syndrome is the name Hans Selye gave to the predictable 3-stage
      process in which the body responds to stress.
      1. The alarm phase (fight or flight response).
            a. Characterized by activation of the sympathetic nervous system and inhibition of the PNS
            b. The accompanying changes sharpen the senses, increase strength and speed, and improve
               some aspects of memory.
            c. These reactions were designed to deal with short-term physical threats.
            d. Today, most stressors are not physical, and many are chronic.
      2. The resistance phase is where your body mobilize resources to achieve equilibrium despite
            the continued presence of a stressor. Many normal bodily functions are altered, decreased, or
            stopped, and immune system functioning is depressed.
      3. The exhaustion phase is when the stress response itself begins to harm the body for bodily
            systems are impaired, damaged, and begin to break down
   C. Sources of stress
      1. Perceptions:
            a. Many stressors are only stress-producing if they are perceived as stressful.
            b. There are two phases to appraising a potential stressor:
               (1) Primary appraisal in which the likelihood of danger is assessed.
               (2) Secondary appraisal in which the person determines what resources are available.
      2. Perceived control:
            a. Perception of control is more important than actual control.
            b. Control is most effective when the perceived control matches the preferred level of control.
            c. Cultural factors affect people’s perceptions of control.
            d. Chronic uncontrollable stressors can be less stressful than sporadic, unpredictable ones.

           e. Perceived lack of control can lead to learned helplessness.
           f. Warnings of upcoming stressors can lower sensations of stress, but only if the warning
               information is specific.
       3. Internal conflict that occurs when people make difficult choices can be stressful. 3 types of
           a. An approach-approach conflict
           b. An avoidance-avoidance conflict
           c. An approach-avoidance conflict
       4. Hassles
           a. Early research on stress focused on the effects of major life events.
           b. Recent research has focused more on the effects of daily hassles on subjective stress.
           c. People with high levels of daily hassles report more physical and psychological symptoms.
       5. Hostility
           a. Most important component of Type A personality in predicting heart disease is hostility.
           b. Men are generally more hostile than women, and men’s blood pressure is more affected by
               hostility than women’s.
           c. People high in hostility have higher blood pressure throughout the day.
           d. Treatment programs can lower hostility and anger-related physiological changes.
           e. Contrary to popular belief, venting your anger tends to keep you angry and may increase
               aggressive behavior toward others.
II. Stress, Disease, and Health
   A. Stress can negatively affect immune system functioning.
       1. The stress response leads to increased production of glucocorticoids.
       2. Glucocorticoids hinder the formation of some white blood cells or kill white blood cells.
       3. People who exhibit greater sympathetic responses to stress show the most changes in immune
           system functioning.
       4. Lack of control, unpredictability, and negative feelings were the best predictors of whether
           participants in one study would catch cold.
       5. High levels of stress can cause wounds to take longer to heal.
       6. People who develop PTSD tend to be more physiologically reactive to stressors to begin with.
   B. Cancer
       1. While stress does not cause cancer, it can affect the growth of some cancerous tumors. This
           happens because:

       a. Stress suppresses immune system functions and lowers NK cell activity. This allows
          tumors to grow that otherwise might have been destroyed.
       b. Stress facilitates the growth of capillaries feeding in to the tumor.
       c. Stress is often linked to feelings of lack of control. People who perceive a lack of control
          are more likely to have recurrences of cancer and die sooner.
       d. Physiological factors can still outweigh any psychological factors in the progression and
          course of cancer.
C. Heart Disease
   1. Stress-linked hormones and increased blood pressure promotes atherosclerosis.
   2. This leads to the heart having to work harder, which creates continued high blood pressure and
       increased arterial damage.
   3. This eventually leads to heart damage, which can lead to heart attack and sudden death.
   4. Depression increases the likelihood of heart disease.
D. Sleep is the naturally recurrent experience during which normal consciousness is suspended.
   1. Stages of sleep
       a. Stage 1 sleep is the 5-minute transition phase from relaxed wakefulness to sleep and is
          often called hypnogogic sleep.
       b. Stage 2 sleep is characterized by sleep spindles and K-complexes and lasts about 20 min.
       c. Stage 3 sleep marks the appearance of delta waves, but they make up less than 50% of the
          overall brain-wave pattern, and is a much deeper sleep than stage 2 sleep.
       d. Stage 4 sleep is the deepest sleep and is dominated by delta waves.
       e. REM (rapid eye movement) sleep is marked by brain activity that surpasses that of when
          you are awake. It is also marked by physiological and sexual arousal and dreams that are
          vivid enough to remember.
   2. The sleep cycle takes about 90 minutes with the longest stage 4 episode during the first cycle
       and the longest REM episode during the last cycle.
       a. As people age they spend less time in REM sleep and stages 3 and 4 sleep.
       b. As the quality of sleep declines, so does its restorative effects.
   3. Dreams
       a. REM dreams are more vivid, emotional, and story-like than are nonREM dreams.
       b. People are more likely to recall REM dreams than nonREM dreams.
       c. There are several theories about why we dream:
          (1) Freud argued that dreams allow us to fulfill unconscious desires

               (a) Manifest content, which is the obvious content of the dream
               (b) Latent content, which is the symbolic content and meaning of the dream
           (1) The activation-synthesis hypothesis argues that dreams arise from the brain’s attempt
               to make sense of random bursts of brain activity.
           (2) Crick argues that dreams are an attempt to edit out unnecessary or accidental neural
               connections formed during the day.
           (3) Karni argues that dreams are used to strengthen neural connections
           (4) Solms argues that dreams arise from any type of arousal that motivates brain structures
               involved in motivation.
   4. The chemistry of sleep
       a. We spend about 1/3 of our lives asleep.
       b. When you are awake, acetylcholine production is inhibited. Opposite is true during REM.
       c. When awake, production of serotonin and norepinephrine stimulated, asleep it is inhibited.
       d. Melatonin is a hormone produced by the pineal gland that promotes sleep.
   5. Circadian rhythms are the body’s daily physiological fluctuations in response to the dark and
light cycle, and affect numerous bodily systems.
       a. Each of us has an internal clock regulated by the suprachiasmatic nucleus.
       b. In absence of external cues, people will extend their circadian rhythms to a 24.9 hour day.
       c. Some people, “larks,” peak in their circadian rhythms in the morning, “owls,” peak much
           later in the day or at night.
       d. Most people have a dip in energy between 1 and 4 p.m.
       e. Minor alterations in daily schedule can affect circadian rhythms,mood, attention, alertness.
   6. Sleep deprivation
       a. Two out of three people are regularly not getting enough sleep.
       b. If deprived of REM sleep one night, you will experience REM rebound the next night.
           (1) Alcohol and sleep medications suppress REM sleep.
           (2) Cessation of these drugs can cause REM rebound with such severe dreams that cause
           people to want to resume using the drugs again.
       c. 37% of adults claim to be so sleepy during the day that their daily activities are affected.
       d. Sleepy drivers account for about 100,000 car crashes each year and 25% of survey
   respondents say they have fallen asleep at the wheel at some time.
       e. Sleep deprivation leads to increased cortisol levels linked to memory deficits and increased
   risk of diabetes.

           f. Sleep deprivation negatively affects mood.
       7. Sleep Disorders
           a. Insomnia involves repeated difficulty getting to sleep, staying asleep, or waking too early.
               (1) Half of American adults experience occasional insomnia
               (2) Chronic insomnia is related to anxiety and depression
               (3) Because of tolerance and addiction problems, sleeping pills are not a good
                   long-term choice for treating insomnia
               (4) Four nonmedicinal techniques can help:
                   (a) Restrict your sleeping hours
                   (b) Control bedtime stimuli
                   (c) Avoid ingesting substances with stimulant properties
                   (d) Consider meditation or progressive muscle relaxation
           b. Sleep apnea is characterized by brief, temporary cessation of breathing
               following a period of difficult breathing and snoring.
               1. This affects 1 to 4 % of Americans
               2. It can be fatal, so treatment is imperative
               3. Treatment can range from losing weight (in obese patients) to the use of a
                   CPAP (Continuous Positive Airway Pressure)
       8. Shift work can cause increases in accidents, insomnia, and medical/psychological pxs.
           a. It is easier to shift to progressively later shifts than vice-versa. Limiting time on these
       shifts to no more than three consecutive days can minimize effects on circadian rhythms.
III. Strategies for coping
   A. Different people use different coping strategies, depending on the situation.
       1. Problem-focused coping focuses on changing the environment itself, or how the person
           interacts with the environment. It includes the following strategies:
           a. Active coping
           b. Planning
           c. Instrumental social support
           d. Suppressing competing activities
           e. Restraint coping
       2. Emotion-focused coping focuses on changing the person’s response to the stressor.
           a. Emotional social support
           b. Venting emotions

       c. Positive reinterpretation/growth
       d. Behavioral disengagement
       e. Mental disengagement
   3. Thought suppression is an avoidant strategy, but can result in a rebound effect that magnifies
       the intensity of the thought and the physiological reactions linked to it.
   4. Aggression
       a. A number of specific stressors are associated with or lead to aggression.
          (1) External environmental factors such as noise and heat can spark aggression.
          (2) Internal factors such as pain and depression can lead to aggression.
          (3) People experiencing stress may negatively misinterpret the behaviors and intentions of
              others in what is called the hostile attribution bias.
          (4) Frustration is closely linked to aggressive behavior.
       b. Some people respond to the “fight or flight” stress response by becoming aggressive
          (“fight”), while other try to flee or avoid the situation (“flight”).
       c. Males are more physically aggressive than females, but females are just as aggressive
          when the aggression is nonphysical. Males are more aggressive than females in response to
          criticism of their intellectual ability.
       d. Hostile people are more aggressive than other people.
       e. Aggressive people tend to have an exceedingly high self-opinion.
          (1) They see insults as a threat to their positive self-image.
          (2) They are likely to have an unstable and overinflated view of themselves (narcissists).
       f. Sensation seekers are more likely to put themselves in situations that lead to violence.
B. Drugs and alcohol
   1. Substance abuse involves drug or alcohol use that leads to legal difficulties,
       causes distress or difficulty in major areas of life, or occurs in dangerous situations.
   2. Substance dependence is chronic abuse that is characterized by the following 7 symptoms
       a. Tolerance
       b. Withdrawal
       c. Larger amounts of substance taken over a longer period of time than intended
       d. Unsuccessful efforts or a persistent desire to decrease or control the substance use
       e. A lot of time spent in obtaining the substance, using it, or recovering from its effects
       f. Important work, social, or recreational activities are given up as a result of the substance
       g. Despite recurrent physical or psychological problems, substance abuse continues

3. Depressants are a class of substances that depress the central nervous system, decreasing the
user’s behavioral activity and level of awareness; also called sedative-hypnotic drugs. Drugs in
this category include alcohol, barbiturates, opiates, and antianxiety drugs.
   a. Alcohol
       (1) 9% of American adults have either alcohol abuse or dependence problems.
       (2) 5% of Americans are considered to be heavy drinkers.
       (3) The younger people begin drinking more likely that they will develop a disorder.
       (4) Men are more likely than women to be binge), but women are more slightly more
           affected by a specific amount of alcohol than men of similar size and weight.
       (5) People’s reactions to alcohol are affected by their genes, experience, expectations.
   b. Physiological effects of alcohol
       (1) While alcohol is a CNS depressant, it also depresses the activity of some inhibitory
   neurons causing disinhibition.
       (2) At low doses the user experiences decreased awareness and increased relaxation.
       (3) At moderate doses, the user experiences slowed reaction time and impaired judgment.
       (4) At high doses, cognition, self-control, and self-restraint are impaired.
       (5) At very high doses the user has a diminished sense of cold, pain , and discomfort, and
   an increased chance of respiratory arrest, coma, or death.
   c. Psychological effects of alcohol
       (1) Alcohol tends to lower people’s inhibitory conflict making them more likely to engage
   in previously unacceptable behaviors as they consume more alcohol.
       (2) Alcohol facilitates aggressive behavior through lowering inhibitions and impairing the
   user’s ability to correctly process information, process ambiguous social situations, or read
   situational cues, a phenomenon called alcohol myopia.
       (3) Alcohol lowers the user’s ability to abstract and conceptualize information, with the
   result that the user overly focuses on superficial, and sometimes misleading aspects of the
   d. Chronic alcohol abuse
       (1) More males than females are alcoholics, although the gap is narrowing.
       (2) Chronic alcohol abuse can cause severe memory deficits and blackouts.
       (3) Although alcohol is high in calories, it is lacking in nutrients, therefore many alcoholics
   are malnourished, which can contribute to their memory deficits.
       (4) Severe alcoholics may develop Korsakoff’s syndrome.

        (5) Problematic alcohol use leads to tolerance and withdrawal symptoms, that may include
   weakness, tremors, anxiety, and increased blood pressure, respiration rate, and pulse rate;
   extremely heavy drinkers experience DTs, convulsions, confusion, and even hallucinations.
   e. Barbiturates include Amytal, Nembutal, and Seconal
       (1) Usually prescribed to aid sleep and reduce anxiety
       (2) Can be lethal when combined with alcohol
       (3) Users develop both tolerance and resistance
4. Stimulants a class of substances that excite the central nervous system, leading to increases in
   behavioral activity and heightened arousal. They include amphetamines, cocaine, and crack.
   a. Low doses of amphetamines and cocaine lead to a sense of increased energy,
       diminished hunger, and feelings of invulnerability.
   b. Of all drugs, stimulants are the most likely to induce dependence.
   c. Cocaine was used by an estimated 1.5 million Americans in 1997.
       (1) It is usually inhaled and has a local anesthetic effect.
       (2) The use has an enhanced sense of mental and physical capacity and a loss
           of appetite.
       (3) Chronic users develop paranoia, teeth grinding, repetitive behaviors, and
           experience disturbances in their visual field.
   d. Crack is cocaine in crystalline form that is usually smoked in a pipe or rolled in a cigarette.
       (1) It is faster acting and more intense in its effect than cocaine.
       (2) Because of its effects wear off faster than those of cocaine, users tend to use more of it,
   increasing its potential for abuse and dependence.
       (3) It increases heart rate, blood pressure, and constricts blood vessels –can be lethal.
       (4) When it wears off, users experience an intense “crash” and intense depression, making
   them crave more crack.
       (5) Both cocaine and crack create strong dependence and tolerance.
       (6) Sudden death can result even among healthy users who only use occasionally.
   e. Amphetamines are synthetic stimulants that include Benzedrine, Dexadrine, and MDMA
       (ecstasy) and are usually taken in pill form or injected.
       (1) High doses can cause amphetamine psychosis; similar to paranoid schizophrenia.
       (2) Chronic use stimulates violent behaviors.
       (3) MDMA is neurotoxic and can permanently damage serotonin neurotransmitters,
           affecting memory, sleep, and appetite.

   f. Caffeine is a mild stimulant that causes increased alertness, raised pulse and heart rate,
       insomnia, restlessness, and ringing in the ears. Users develop some tolerance, and chronic
       user experience withdrawal headaches.
   g. Nicotine can cause increased alertness, increased blood pressure, relaxation, as
       well as irritability, stomach pains, dizziness, emphysema, heart disease, and cancer.
       (1) It triggers the release of several neurotransmitters that lead to a pleasurable
       (2) It is addictive, with some level of tolerance and withdrawal symptoms.
5. Narcotic Analgesics are a class of strongly addictive drugs that relieve pain.
   These drugs include heroin, morphine, codeine, Percodan, and Demerol.
   a. They affect certain endorphin receptors, resulting in their pain-relieving effects.
   b. Heroin and morphine are opiates.
       (1) Heroin is a CNS depressant.
       (2) Heroin causes short-term feelings of euphoria and relaxation that are quickly followed
   by negative changes in mood and behavior.
       (3) Heroin users develop tolerance and withdrawal symptoms.
6. Hallucinogens are substances that induce hallucinations. They include LSD, PCP,
   ketamine, and marijuana.
   a. All can induce hallucinations at mod. doses, except marijuana, which requires high doses.
   b. LSD is a synthetic substance that produces perceptual alterations and hallucinations. It
       alters serotonergic functioning
       (1) Symptoms can last for hours and can be largely affected by the user’s expectations.
       (2) Research does not support claims that they are more creative as a result of taking LSD.
       (3) LSD can result in “bad trips” that produce frightening experiences.
       (4) Flashbacks can occur weeks or even years after taking the drug.
   c. Marijuana is the most commonly used hallucinogen in America.
       (1) Every year approximately 100,000 Americans attend treatment centers in effort to stop.
       (2) Its effects depend on the user’s mood, expectations, and environment.
       (3) Effects include subtle perceptual distortions, distortions of space and time, and
           impairment of perceptual motor skills.
   d. Ketamine is legally used as an anesthetic for animals.
       (1) Human use can result in hallucinations, anesthesia, and stimulation of the
           cardiovascular and respiratory systems.

           (2) Its use is associated with violence, impaired thinking, and a loss of contact
               with reality.
           (3) Users are likely to develop tolerance and dependence.
C. Coping and social support
   1. Social support buffers the effects of stress. Certain types of support can have as positive health
       effects as not smoking or being physically active.
   2. Social support is linked to better immune system functioning.
   3. It is perceived social support, not enacted social support, that provides the buffer against
       stress. Perceived social support is unrelated to actual social support
D. Mind-body interventions focus on adapting to a stressful stimulus.
   1. Hypnosis, deep breathing, sitting quietly, and moderate physical exercise can all buffer the
       effects of stress.
   2. Simply believing you are receiving a treatment can improve immune system functioning
       (placebo effect).
E. Gender, culture and coping
   1. Women in Western cultures experience more stress than men. Women tend to have multiple
       roles loading them with more to do than men.
   2. Culture helps define what stressors are and can determine when and how to ask for help.
       Crowding is a culturally defined stressor.
   3. In the U. S., people in the lower socioeconomic classes tend to have poorer health and higher
       mortality rates.


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