Ch 15 Health Stress and Coping Pg 548 Health is greatly affected by stress. Periods of stress are commonly followed by illness. Stress 1. Occurs whenever a challenge or threat forces a person to adjust or adapt. 2. Also a behavioral factor that directly affects personal well being. Basic personal habits and behavior affect health We need to minimize risk factors Need to increase health promoting behaviors Personality type affects amount of stress people experience Behavioral Principles Unhealthy behavior - causes ½ of deaths Behavioral – medications manage medical problems Pain control Coping with illness Behavioral Risk Factors- Increase risk of death from disease Lifestyle diseases Obesity Tobacco Diet 45% of all deaths are due to unhealthy behavior = tobacco, drinking, drug use and lack of exercise Risk Factors: High level of stress Increased blood pressure Cigarette smoking Abuse of alcohol + drugs Overeating Unsafe sex Exposure to toxic substances Violence Disease Prone Personality Chronic depression (less exercise, eat poorly, sleep poorly) Anxious Hostile Frequently ill Not Disease Prone (generally good health) Intellectually resourceful Compassionate Optimistic Non hostile Health Promoting behaviors Exercise No excessive drinking No tobacco No overeating Early prevention Prevent smoking Refusal skills training Life skills training- help cope with day to day stress Stress reduction Decision making Self control Social skills Pg 554 Stress is a major behavioral Risk Factor if prolonged + severe Stress results as a matter of how we perceive events + react to them Definition of stress Stress is the mental + physical condition that occurs when a person must adapt to the environment Examples- work, marital problems, financial problems, travel, sports, dating Eustress Good stress, events and issues are seen as challenges, and potentially rewarding Stress reactions- Autonomic nervous system, arousal, with emotion Stressor – an event that challenges or threatens a person Pressure- when a person must meet urgent external demand or expectations Variables to stress: Control (less stress) and lack of control causes stress (less controls = more stress) Unpredictable events add to stress Emotional shocks- intense, repeated, pressure, unpredictable, uncontrollable=stress is magnified Nursing, teaching, police, social work and Burnout Burnout- being physically, mentally + emotionally drained 1. Emotional Exhaustion- fatigued tense +apathetic; feeling all used up 2. Cynicism- detached from job, ―I don’t give a damn.‖ 3. Feeling of reduced personal accomplishment Helpless, hopeless or angry, poor work performance 4. 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) Pg 555 Appraising Stressors Ultimately- stress is determined by how a situation is perceived Richard Lazarus- researcher said Making the appraisal of a situation= 1. Primary Appraisal – Q: Am I ok or in trouble? a. Decide if the situation is relevant or irrelevant positive or negative 2. Secondary Appraisal- Q: What can I do about this situation? a. Assess resources b. Choose a way to meet threat or challenge c. Coping with threats=coping Coping with Threats: 1. Problem-focused coping (control is the issue) a. Need to manage or alter the distressing situation 2. Emotion-Focused Coping: (when there is no control of the situation) a. People try to control their emotional reactions to the situation 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- personal characteristics Coping- Reactions to Frustration: Aggression- any response with intent of harming a person or object Most frequent response to frustration *Persistence to frustration- varied efforts to overcome frustration 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 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 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) Any mental process used to avoid, deny, or distort sources of threat or anxiety Help us keep from being overwhelmed by immediate threats Denial: (basic) protecting oneself from unpleasant reality by refusing to accept it or believe it Repression: Holding memories away from unpleasant reality by refusing to accept it or believe it Reaction Formation: Impulses held in check by exaggerating opposite behavior – I hate you- but act over protective Regression: Returning to earlier less demanding situations Projection: Unconscious process- protects us from anxiety to see out own faults in others Exaggerates negative traits in others Directs attention away from personal failings Rationalization: Making excuses Justifying behavior by giving rational but false reasons Can be reasonable and convincing but false Compensation: Over achieving in one area to compensate for failures in another area Defense against feelings of inferiority Overcoming a weakness Going to great lengths to do so Sublimation: Working off frustrated desires (especially sexual desires) through socially acceptable activities Rechanneling sexual energy into productive behavior Learned helplessness: An acquired- learned inability to overcome obstacles and avoid aversive stimuli Major element of depression Learning to passively endure Occurs when events seem to be uncontrollable especially after repeated failures Unpredictable and unavoidable punishment Leads to depression with feelings of learned helplessness, feelings of powerlessness, lowered aggression, decreased activity, loss of apetite, loss of sex drive, despondency, hopelessness… Other Defense Mechanisms Since Freud first described the original defense mechanisms, other researchers have continued to describe other methods of reducing anxiety. Some of these defense mechanisms include: Acting out –The individual copes with stress by engaging in attention-seeking behavior to try and get notice that they crave. (School children trying to be class clown) Affiliation – Involves turning to other people for support. (co-dependent behavior when one feels he/she can’t cope by self) Passive-aggression – Indirectly expressing anger. (teen silently resents chores; puts dishes in washer, but does sloppy job and bangs plates around—easier for parent to take charge of chore) Avoidance – Refusing to deal with or encounter unpleasant objects or situations. (dislike certain people at school and doesn’t join a club they’re in order to avoid contact with them) Altruism – Satisfying internal needs through helping others. Humor – Pointing out the funny or ironic aspects of a situation. Psychosomatic illness: Psychological factors contribute to actual body damge Not hypochondrias Examples: can be caused by stress Dyspepsia- stomach pain- not an ulcer Heart disease Sexual dysfunction Eczema Head, neck ache Hives Back ache Migrane headache Indigestion Rheumatoid arthritis Chronic diarrhea Hypertension Fatigue Colitis Insomnia Type A personality Type B Personality High risk of heart attack These people tend to be productive under Hard driving stress. Ambitious They are very much relaxed, patient and Highly competitive have a lot of self control. Achievement oriented One of the type B personality traits is that Persistent these people do not get irritated or angry Time urgency easily. Anger They are less competitive and their Hostility competitiveness is often productive with Very rigid in attitudes good intentions. They rarely tend to be aggressive or These people are also prone to heart frustrated. diseases because of the tensions, People belonging to type B personality are stress and worrying attitude. 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.