1
Q
WHO definition of Health
- definition
- aspects of wellness (3)
A
- complete state of physical well-being; not merely absence of disease/infirmity
- physical, mental and social aspects
2
Q
health psychology
- definition
- goals (4)
A
- psychological influences on how ppl stay healthy, why ppl become ill, and how ppl behave when ill
- promote and maintain health
- prevent and treat illness
- identify causes and diagnostic correlates of health, illness and related dysfunction
- analyze and improve healthcare systems and health policy
3
Q
psychology contributions
- health promotion and maintenance (2)
- illness prevention and treatment (3)
- identification of etiologic (causes) and diagnostic correlates of health, illness and dysfunction (3)
- improvement of healthcare systems/policy (2)
A
scientific, educational and professional contributions
- health promotion and maintenance
- encourage healthy eating habits in children
- promote physical activity - illness prevention and treatment
- prevent common diseases (CVD, cancer, diabetes
- effective ways to cope w chronic disease and influence illness trajectories
eg. prevent COVID-19 transmission: wash hands, distancing, face mask, etc - identification of etiologic (causes) and diagnostic correlates of health, illness and dysfunction
- does social isolation inc risk of disease
- does stress alter susceptibility to infections - improvement of healthcare systems/policy
- what impact do health institutions have on people’s behaviours
- how can we improve the communication between patients and providers
4
Q
Patient-provider communication importance: airplane story
A
- Atlanta man had rare tuberculosis (very contagious) and travelled on 2 commercial air flights which could have possibly exposed passengers to infection
- CDC told him to wait in isolation but he decided to take early flight because he didn’t want to miss his wedding, then he thought he was in trouble so he ran away on another flight
- CDC worked with the airlines to contact him and test the passengers near him
- luckily, his tuberculosis was not at the stage where it would spread
5
Q
Bonnie Henry
A
public health messaging for COVID
- she answers the public’s questions for an hour every single day so people will understand what is at stake and do the right thing
6
Q
leading causes of death in canada
- susceptibility
- life expectancy
- gender gap
- inuit
A
- cancer (29.9), CVD (19.7%), accidents (4.4%), etc
- susceptibility to disease/life expectancy are not evenly distributed»_space; psychosocial aspects matter!
- life expectancy: growing due to medical discoveries, hygiene, etc. and differs depending on socioeconomic status (less well off ppl have a shorter life expectancy)
- gender gap: women tend to outlive men (gap is narrowing)»_space; bigger gap in socioeconomic status (low vs high) for men (5yrs) than women (2yrs)»_space; stress hormones take a toll
- 15% diff between inuit (male) life expectancy and total expectancy »_space; stress and resources play a huge roll»_space; NOT just some biological difference
7
Q
health behaviours
- promoting behaviours
- compromising behaviours
A
promoting: physical activity, fruit/veg consumption (at least 5 times daily»_space; women eat more than men, but still not even 50% meet guidelines)
compromising: smoking, alc consumption, poor eating habits, obesity
8
Q
smoking ads (1960s)
- promotions
- health intervention
- age groups
- distribution
A
- doctors recommended smoking, athlete-endorsed
- successful health intervention!»_space; found out smoking is an issue to health and ti decreased significantly in the last 15 yrs (but ~20% of popn still smokes)
- w/in each age group there are differences»_space; ppl my age represented a lot :(
- smoking not evenly distributed w/in Canada
(15. 8% BC, 59.7% Nunavut)
9
Q
physical activity
- benefits
- intervention
- guidelines
A
- physical activity has great health benefits»_space; extends lifespan
- unsuccessful intervention»_space; no change in phys activity»_space; ~50% meet activity guidelines (150 mins per week, 10 min duration)
10
Q
sugar-rich diets
- 60s
- struggle to limit
- obesity rate, Canada’s rank
- differences (3)
A
- in the 60s ppl would give toddlers soda
- even though there is very solid evidence that sugar consumption is bad, it’s still a struggle to limit consumption (like tobacco/smoking) since outcomes don’t impact others like second-hand smoking does
- obesity has a clear upward trend (inc changes of CVD and diabetes)
- Canada is in the middle in terms of obesity rates
- different food culture, public healthcare, and transportation (eg. more walking = lower obesity rates)
11
Q
alcohol consumption
- inc?
- risk
A
- inc significantly during COIVD»_space; not evenly distributed
- alc consump can put people at risk (drunk driving)
12
Q
demographic changes
- projections
- demographic
- senior homes
A
- projections show drastic inc in age demographic (eg. in 2050)»_space; worry about how to distribute healthcare resources (most spent on older ppl 80+) and promote health/wellbeing (will reduce amt of money spent on chronic illnesses
- demographic used to look like a population pyramid (baby boomers at the bottom) but in 2050 it will look like a vase kind of thing (bigger at the top, skinny at the bottom)
- senior home care support in BC is at breaking point
13
Q
successful aging (3)
A
psychosocial factors
- maximize number of years spent in good health
- promote active engagement w/life
- foster independence
14
Q
mind body relationship
- holism (priests)
- dualism
- current views
A
holism: mind and body are same system
- priests = physicians»_space; treat mind
dualism: mind and body are 2 separate systems
current views: psychology and medicine initially embraced dualism, but we now know that psychological variables contribute to physical health
15
Q
Ancient Greeks
A
- they recognized lifestyle factors shape wellbeing»_space; if sick, go for a walk, eat well, etc.
- Plato first suggested that the mind and body are separate
16
Q
Humoral Theory
- polished by?
- 4 humors (what are humors, what are the diff types, unbalance?)
A
- Hippocrates proposed the humoral theory which was later expanded by Galen»_space; what happens in the mind affects the body
4 humors (circulating fluids in the body)»_space; if one dominated problems arose, but if all harmonious you would be healthy
- yellow bile: choleric (bad tempered), chronically irritable and angry (Type A personality)
- black bile: sad, melancholic, depressive
- blood: sanguine (optimistic), cheerful, positive
- phlegm: calm, listless
17
Q
Middle Ages
A
- disease = punishment (dogma) from God (for ill-doing)
- cure = torture evil out and do penance later
- healing = priests realm»_space; influence of church slowed medical knowledge
18
Q
Renaissance
A
- dualistic concept of mind and body (14th -15th centuries)
- breaking away from superstitions of the past centuries (catholic thinking)
- theologians, priests, philosophers would deal with the mind, and physicians would heal the body
19
Q
Cartesian Dualism
A
Descartes believed that the mind and the body are separate entities, but can communicate via the pineal gland»_space; body is like a machine that must obey laws of physics
20
Q
Technological strides
- Anton van Leeuwenhoek
- Giovanni Morgagni
- Medicine
A
- rejected humoral theory for new theories
- Anton van Leeuwenhoek: microscopy»_space; bacteria, blood cells, identified infectious diseases
- Giovanni Morgagni: autopsies»_space; atlas of anatomy
- Medicine: looked more to lab/scientific discoveries and less to mind
21
Q
Germ Theory
- cause of disease
- magic bullet
A
- in the 19th century, microorganisms (pneumonia, food poisoning) were discovered as cause of disease
- emphasis on biology as a sole cause of disease
» searched for “magic bullet” (antibiotic to get rid of all illnesses»_space; penicillin!»_space; found from a mold by Alexander Fleming
22
Q
The biomedical model
A
- focused on illness»_space; dominant model for past 300 years
- all illness can be explained by biological malfunction or physiological disturbance (eg. injury, biochemical imbalance, infections, etc)
- said that psychological/social processes are independent of disease (disease = affliction of the body)
23
Q
biopsychosocial model
- fundamental assumption
- discovery»_space; caused what?
- prevalent causes of death
- implications (2)
A
- fundamental assumption: health or disease is the consequence of the interplay between biological, psychological, and social factors
- discovery of microorganisms and the resultant development of antibiotics (as well as clean water and nutrition) led to a decrease in causes of death due to infectious agents
- the most prevalent causes of death are no longer infectious or acute conditions (eg. respiratory diseases, tuberculosis, gastroenteritis aka diarrhea)
Implications:
- diagnosis and treatment must consider interactions
- relationship between patient and healthcare practitioner is important for the delivery of care (full circle»_space; back to Greek way of thinking)
24
Q
acute disorders (examples = 2)
chronic disorders (examples = 3)
- stat?
- reasons for chronic illness increase (3)
A
acute: short term medical illnesses eg. diarrhea, pneumonia
chronic: slow-developing, persistent diseases, often cannot be cured, only managed, psychosocial factors often involved»_space; cause of 60% of deaths today
eg. degenerative illnesses (heart disease, cancer, stroke)
- people are living longer and chronic illnesses are more likely to affect older people
- increased exposure to harmful chemicals (industrialization)
- more rapid inc in low income/developing nations
25
Sigmund Freud
- what causes bodily illness?
- conversion?
- physicians opinion
- psychoanalysis + example (hypertension)
- unconscious conflicts lead to physical disturbance
- the person is freed from anx bec the conflict has been converted into a phys symptom
- for illnesses couldn't be fixed quickly, physicians were willing to listen to Freud
- psychoanalysis: psychiatric treatment focus
eg. hypertension is connected to an inability to express feelings of anger in an appropriate manner (unresolved conflicts)
26
psychosomatic medicine
- psychosomatic illness
- examples
- asthma causes
- psychosomatic illness (physical symptoms w no detectable organic disorder) is the result of underlying emotional chronic conflicts that surface in the form of physical symptoms
- anything that couldn't be explained reasonably by medical knowledge was categorized as psychosomatic
eg. ulcers, IBS, HBP, asthma, migraines and arthritis >> result from impaired immune function
asthma: caused by allergies, respiratory infections, or biopsychosocial arousal (stress/exercise)
27
peptic ulcer
- open sores on the stomach/intestine lining
ulcer >> stress (mind) >> bacterial disorder (body)
- bacterial disorders are not unique, but when stressed he immune system is weakened which increases the proliferation of the bacteria, and the chronic excess gastric juices erode the stomach lining
- you need both the bacterial disorder AND the high stress levels to get a peptic ulcer (both mind and body involved) >> high stress increases amount of gastric juices
28
```
past illnesses (2 types)
- causes
```
dietary diseases: malnutrition
infectious diseases: acute illnesses caused by harmful matter/microorganisms such as bacteria/viruses, pneumonia, tuberculosis, diarrhea, HIV/AIDS, etc >> leading causes of death in low income/developing countries
29
early settlers
- periodic pandemics
- indigenous ppls (2)
- periodic pandemics: smallpox, measles, flu, etc. >> thousands could die from a single pandemic
- settlers brought disease with them >> rapid inc in death toll of indigenous ppls because
a) they had no immunity (lacked exposure)
b) immune functions were lower due to low genetic variation
30
decline of infectious disease
| - causes (4)
- smallpox eradicated due to preventative measures such as improved physical hygiene, greater disease resistance because of nutrition improvement, and public health innovations (water purification and sewage treatment facilities)
31
risk factors for disease
- do risk factors cause disease?
- behavioural
- biological
risk factors are ASSOCIATED, not CAUSING the development of disease
- behavioural: smoking inc chance of cancer; unhealthy eating
- biological: inherited genes, family history
32
risk factors for leading causes of death
| - cancer, heart disease, stroke, COPD, accidents
1. cancer: smoking, high alc consumption, obesity
2. heart disease: smoking, HBP, high cholesterol, lack of exercise
3. stroke: smoking, HBP, high chol, lack of ex
4. chronic obstructive pulmonary disease (COPD): smoking
5. accidents: alc/drug use, not wearing seatbelts
33
personality and illness
- definition of personality
- low conscientiousness
- high positive emotions
- high anxiety, depn, hostility, pessimism
personality = cognitive, affective or behavioural tendencies
- low levels of conscientiousness (being thorough and organized) = more likely to die of CVD than other diseases
- high levels of positive emotions (happiness, enthusiasm) = tend to live longer
- high levels of anxiety, depn, hostility, pessimism = at risk of dying early and developing a variety of illnesses (esp. heart diseases)
34
behavioural medicine
| - conditioning
- interdisciplinary >> not just behaviourism (classical/operant conditioning)
- operant is good for modifying behaviours using behavioural methods, and emotions using cognitive methods which alter thought process
35
psychological factors (3)
- cognition: perceiving, learning, remembering, thinking, interpreting, etc
- emotion: subjective feelings >> affects thoughts, behaviour and physiology
- motivation: start, choose direction, and persist
36
role of social factors
- social relationships
- types of social factors
```
social relationships (family, friends, acquaintances) affect behaviour, susceptibility and long term health >> social support is important!
- culture, mass media, community, and env characteristics are also social factors
```
37
holistic approach (holism)
wide range of "alternative" approaches to promote health eg. aroma, healing herbs
- many indigenous people (First Nations, Metis, Inuit) rely on holistic healthcare
38
Systems: the world vs the person (2)
the world:
- social systems >> society, community, family
the person:
- psychological systems >> experience/behav >> cognition, emotion, motivation
- biological systems >> genetics/physiological >> organs, tissues, cells
39
sociocultural
- types of factors >> disease variation
- culture vs ethnicity vs race
social/cultural factors >> ethnicity, culture, nationality, sex/gender >> diseases vary by ethnicity due to health disparities/genetics
- culture = characteristics/knowledge of group in similar context
- ethnicity = ppl identify w e/o due to shared nation/ancestry
- race = social construct based on physical characteristics
40
Epidemiologist terms
| - mortality, morbidity, incidence, prevalence, epidemic, pandemic
- mortality: occurrence of death (large scale)
- morbidity: illness, injury or disability
- incidence: new cases in a period of time
- prevalence: number of cases (both past and present)
- epidemic: incidence increases rapidly
- pandemic: epidemic on a worldwide scale
41
Theories are useful if... (4)
- they are clearly stated
- bring together/organize known facts
- relates info that previously seemed unrelated
- enables predictions
42
retrospective vs prospective approaches
retrospective: looking at histories of subjects and find commonalities between ppl w same disease
prospective: study if the diff in a variable will relate to the diff in another variable at a later time >> eventual devel of disease
43
inter-related fields w psychology
medicine, bio, social work, epidemiology, public health, soci, arthro, health ec, health policy
44
acute stress vs chronic stress
- resilience
- chronic stressor long term outcomes
acute: we are hardwired to respond well (won't impact long term)
- high resilience (recover back to base hormone level)
chronic: less opportunity for recovery
- results in loss of resiliency, cognitive decline, physical/mental health problems, and mortality
45
Caregiving
- caregiving is prototypical chronic stressor
- role typically falls on women (wife, daughter)
- caregivers have elevated disease risk
46
factors affecting caregiving stressor
- eg. dementia (3)
- what makes it stressful?
- any positive experiences?
eg. dementia caregiving
- long duration (3-15yrs): not getting better, no breaks
- high demands (physical and emotional): unable to do things they used to do themselves >> need help with daily necessities like feeding and bathing
little control: can't change or plan things
stressful: economic stress, worry/anxiety
positives: emotional support, education for kids, spend more time with person
47
cortisol response
- acute (examples)
- chronic (original purpose of response, associated with?)
acute: after stressor is over, cortisol levels return to normal levels (eg. experiment = social stressor, naturalistic = ballroom dancing competition)
chronic: physiological changes occur in response to stress, but the original purpose was for short term mobilization of resources to fight or flee >> long term stressor = dysregulation of cortisol patterns which is associated w elevated disease risk
48
allostatic load
- Definition (2)
- Damage (2)
- Depends on (4)
Definition:
- allostatic load = accumulated effects of one's body adapting repeatedly to stressors over time (hormone fluctuations) >> impairs ability to adapt to future stressors
- physiological regulatory system that accommodates environmental demands >> key to adaptive functioning >> help adapt to internal/external challenges
Damage:
- repeated activation of physiological systems leads to wear and tear >> results in cumulative dysregulation of physiological systems
- price body pays to meet life's challenges
Depends on:
- amount of exposure
- magnitude of reactivity
- rate of recovery
- resource restoration (eg. sleep >> depends on quality and amount)
49
chronic stress and cognition
- damage (where? how? (2))
- consequence
damage to hippocampus
- systematic loss of dendrites
- reduction in hippocampal volume
consequence: memory problems
50
McGill research
correlational link between cortisol levels and detectable memory problems which aligns with the idea that there is a link between chronic stress and cognition
51
chronic stress and CVD risk
- damage
- consequences
- wear and tear on blood vessels
| - consequences: hypertension, risk for heart disease/stroke
52
chronic stress and glucose regulation
- damage
- consequences
- association
- repeated inc in blood sugar
- consequences: development of insulin resistance, type 2 diabetes
- associated with having a lower sEc status
53
Heart Diseases
- atherosclerosis and arteriosclerosis
- myocardial infarction (heart attack)
- angina pectoris
- aneurism
- stroke
atherosclerosis: accumulation and hardening of fatty plaques in artery wall >> causes arteriosclerosis: diameter/elasticity of artery is reduced
myocardial infarction: death of heart muscle (myocardium tissue) caused by arterial blockage (clot caused by atherosclerosis)
angina pectoris: pain caused by temporary obstruction
aneurism: bulge in weakened section of artery/vein which ruptures >> can cause death
stroke: blood supply going to portion of brain is disrupted by artery rupture >> causes hemorrhage in brain/blockage from blood clot
54
Trier Social Stress Test (TSST)
- 2 parts
- testing conditions
- cause and effect
- criticisms (4)
- used to study moderators of stress
1. free speech 5 min
2. mental arithmetic 2 min
- unresponsive audience and being recorded = very potent stressor
- cause and effect are clear (emotional support reduces stress response to social stressor)
criticisms:
- can have low ecological validity >> is the experimental manipulation relevant to real life? >> want to test things that are useful to patients
- practical issues >> we can't always manipulate/produce IV of interest in health psychology (eg. disease status)
- not all responses are uniform (gender diff) >> TSST does not capture differences >> go undetected
- it's easier to do this test on males because you wouldn't want to stress out a pregnant woman
55
time sampling research
- assessment
- advantages (4)
- disadvantages (3)
- focus on everyday life >> captures the moment
- assessment via diaries, phone calls, computer-based assessments, etc daily
Advantages:
- captures natural behav without changing them
- high ecological validity (generalize findings) >> real world relevance of positive interactions
- daily life processes may accumulate
- neither work stressors nor intimacy are easy to recreate in the lab, so time sampling is useful
Disadvantages:
- third variable problem
- labour intensive
- lots of info on few people
56
Time sampling - couples study
- number of participants
- measurements (3)
- association
- asked couples about everyday experiences
- 51 dual-earner couples with young kids
- chronic problems at work
Measured 6x a day for a week:
- time spent in intimacy
- current affect quality
- saliva samples for cortisol whenever they completed questions
association: between intimacy and lowered cortisol level is mediated by positive effect (inc intimacy = dec cortisol levels)
57
ways to do time sampling (3)
| - pros and cons
Paper:
- PROS: cheap and easy, familiar to participants
- CONS: low compliance, back-filing, time-intensive
Plastic: aka electronics
- PROS: high compliance, better data management
- CONS: time and resource intensive, may not work with all populations (eg. elderly)
Phone:
- PROS: high compliance, familiar, builds rapport
- CONS: time and resource intensive, intrusive
58
Cross-sectional self-reports
| - studies what? when? what do subjects do?
- studies naturally existing phenomena
- single time point (limit)
- subjects look back in time and report their experiences/ feelings over a specific time interval
59
Cross-sectional self-reports
- advantages (3)
- disadvantages (7)
Advantages:
- quick, simple, easy and cheap
- can be administered in group sessions, via email, over internet
- can be used to collect data from large samples (eg. statistics Canada)
```
Disadvantages: retrospective responses biases
- mood dependent memory (good mood = forget bad things, bad mood = remember every minor bad thing)
- memory distortions
- salience (memorableness) of an event
- recency
- systematic over/under reporting
- third variable problem
- cannot determine temporal precedence
(A => B or B => A)
```
60
Long-term longitudinal methods
- when? what is examined (2)? what for?
1. seven up project
2. alameda county study
- what did they consider?
findings
- age
- gender
- importance
- same indiv examined over a period of time
- examined naturally existing phenomena as they occur
- allow investigation of antecedents/consequences of certain events
- help to study time-ordered relationships
eg.
1. the seven up project: follow up every 7 years (49 years in total)
2. The Alameda County Study: 7,000 people measured at 9 year intervals; tracked mortality records
- social factors, health behaviours, environment
- midlife (before diagnosis to after) >> shapes onset of disease
Findings: people with most social connections had lowest % of death and vice versa
- older people with fewest social ties were more likely to die (of all causes) >> as age increases this trend becomes more pronounced >> older adults in isolated conditions (few ppl to rely on)
- association is weaker in males than females
- shows importance of social factors in shaping long-term health outcomes
61
Long-term longitudinal methods
- advantages (2)
- disadvantages (7)
Advantages:
- good method for determining lead-lag associations
- can examine long-term effects within same indiv
Disadvantages:
- costly, time-consuming, sample selectivity
- cohort/practice effects
- may need large number of ppl to get enough cases of interest/because of attrition
- reflect what people were interested in when they were launched
- many long-term longitudinal studies were not started with the intention of following people over decades
- limited in terms of measures that were included in baseline battery
- third variable problem
62
Stress and physics
- definition
- elastic
- plastic
- stress quantifies as a material response to strain
- elastic: external pressure does not change properties (returns to normal quickly) >> for stress, as long as you're in the elastic zone (acute) we are well equipped
- plastic: external force results in the degeneration of material >> low performance
63
Ways to define stress (3)
- organism's response >> physiological
- environmental stimulus >> event's impact
- person-environment transaction >> diff people have diff resources
64
Response definition of stress
- definition
- non-specific
- short term
stress = physiological response to noxious stimulus
- non-specific response: no matter what noxious stimulus, physiological response should be the same
- short term response: once stressor is removed you recover >> back to homeostasis >> well prepared for new encounter
65
fight or flight
- founder
- adaptive
- regulation (up/down?)
- Walter Canon
- when an organism percieves threat they will either
a) fight: agressive response
b) flight: withdrawal/escape
adaptive: allows quick response to threat >> VITAL!
- upregulate important things for fight/flight and downregulate unnecessary things like digestion/reproduction
66
sympatho-adrenomedulary system and HPA axis
sympatho-adrenomedulary system: quick, sympathetic, survivor mode, pay attention, fight response
HPA axis: hormone regulated, supports quick response and is maintained for a longer period of time (produces cortisol
67
TSST saliva test
- control
- what happens after stressor ends?
- delay?
- men vs women?
- people come to the lab and relax for a period of time, and their saliva is collected (base level cortisol)
- 15-20 min interval saliva samples >> inc in cortisol graphed
- after stressor ends, cortisol levels go back to base levels
- there is a delay between stress period and peak cortisol level on graph because it takes time for cortisol to reach saliva (takes time for cortisol to get to saliva)
- men respond (cortisol levels) more strongly than women to this stressor (TSST)
68
Tend and Befriend hypothesis
- women's response to stress
- why downregulate?
- oxytocin role
- gender diff under stress
- third way of responding to stress (other than fight/flight)
- women respond to stress w social and nurturing behaviour (but this hyp is not only limited to women!) >> group work/work together with others
- fight/flight response down regulated in females to keep offspring safe
- animals with high oxytocin levels (neuropeptide) show behaviour that is calmer, more relaxed, more social and more maternal (prairie voles are monogamous, woodland voles are polygamous, and that difference is due to their oxytocin levels)
- under stress, females are more likely to turn to others for help than males are
69
```
TSST lactation study
Women:
- sample size
- 2 groups
- results
```
Men:
- sample size
- 4 groups
- results
WOMEN
- N = 43 healthy breastfeeding women
- compared two groups:
1. hold baby before TSST
2. breastfeed baby before TSST
- much lower cortisol levels during TSST in women who had breastfed before compared to women who just held baby >> effect of oxytocin >> consistent with tend and befriend hyp
MEN
- N = 37
- compared 4 groups
1. alone before TSST: with OT (nasal spray)
2. alone before TSST: without OT (saline)
3. social support before: with OT
4. social support before: without OT
- men with no support + placebo had the strongest cortisol increase
- men with support and OT had the lowest cortisol increase
70
Response definition of stress (Hans Selye)
- rat conditions
- GAS definition and stages
```
GAS criticisms (2)
- physiological arousal factors (3 combinations)
```
- exposed rats to high/low temperatures, X rays, insulin injections, and excessive exercise
General adaptation syndrome: orchestrated set of bodily defenses against noxious stimuli >> different stages
1. Alarm: physiological mobilization for action (energy) >> mainly sympathetic, HPA axis
2. Resistance: body tries to adapt (upregulation) >> mainly HPA axis
3. Exhaustion: breakdown of organism (resources limited)
Criticisms:
- some stressors elicit stronger emotional response >> amount of hormone differs >> does not take into account the difference cognitive appraisal can make
- physiological arousal via stress depends on 2 factors:
a) effort
b) distress
- effort w/ distress = inc catecholamines (epi/norep)/cortisol
- effort w/out distress = happy, inc catecholamines
- distress w/out effort = helpless, give up, inc cortisol
71
Dutch famine birth cohort study
- exposure to nutritional deprivation in utero >> were compared to kids born a year earlier and a year after
relative to others, famine birth cohort had:
- increased risk of depression/schizo
- inc risk of diabetes/CVD
- lower cognitive performance in old age
*stress did not CAUSE these, only increased the chance of it occurring
72
2 components of stress
| - examination approaches (3)
- physical: direct material/bodily challenge
- psychological: involving how individual perceives circumstances
1. stress = stimulus caused by stressors: physically or psychologically challenging events/circumstances
2. stress = response to stressor aka strain: physiological (heart pounding) or psychological (anxiety)
3. stress = process (stressor + strain): transactions are interactions btwn person and env (relationship) >> person can influence impact of stressor
73
Components of stress
| - resources, demands, discrepancy, transactions
- can be real or perceived to exist
A. resources: biopsychosocial coping resources are limited
B. demands: amount of resources stressor requires
C. discrepancy: mismatch of demands and resources available >> exceeding or underutilizing resources
D. transactions: assess demands, resources and discrepancies btwn them >> affected by many factors (past experiences, current situation
74
PTSD
- caused by extremely severe stressor >> intense fear/horror
- difficulty sleeping/concentrating, reliving event, avoiding, etc
75
Characteristics of stressful situations (4)
- life transitions
- difficult timing: events happening earlier/later than expected
- ambiguity
- low desirability/controllability
76
reactivity
- effect of chronic stress
- fight/flight
- physiological portion of stress response >> sweat, heart rate inc, etc
- chronic stress = inc reactivity to stressors
- fight = aggression, flight = social withdrawal
77
depression traits (4)
- sad mood nearly every day
- listless, lost of energy, pleasure, concentration, interest, etc
- poor sleeping/appetite or large inc in appetite
- thoughts of suicide, hopelessness, low self esteem
78
Gender/sociocultural differences in stress (2 each)
- women report experiencing more major/minor stressors than men
- men show more reactivity to psychological stressors than women, and take longer to return to baseline after stressor
- minority groups/poverty inc stressors
- ppl w low income/education report more chronic stress/major stressors
79
intergenerational trauma
- trauma from European settlers (earlier gen of indig ppl) has lasting effects >> still felt today
- epigenetic changes make indiv more vulnerable//reactive to stress/trauma
80
sources of stress
- within the person (3)
- within the family (3)
- within job (2)
Sources within the person
1. illness: physical/psych demands >> depends on severity of illness, age etc
2. state of conflict: appraisal of opposing motivational forces >> having to make a choice
3. motives/goals: social >> need to be valued; concerns about achievement/status >> fear of rejection, isolation, competition, failure, etc
Sources within family
4. addition to family: stress to mother (preg) >> baby's temperament >> stress can affect pregnancy
5. marital strain/divorce
6. family illness, disability, or death: have to learn about healthcare, medical bills
Sources within job
7. demands of job tasks: high workload/hours
8. responsibility for people's lives: heavy work load, life/death situations, mistakes have dire consequences >> can result in burnout
81
3 main types of conflict
Approach-Approach: 2 appealing choices >> easy choice
Avoidance-Avoidance: 2 undesirable options >> difficult >> try to escape >> very stressful
Approach-Avoidance: single goal with both pros and cons >> difficult to resolve (eg. really good job, but really long hours)
82
stressful aspects (5)
- physical env: noise, temp, light, humidity
- perceived insufficient control
- poor interpersonal relationships
- perceived inadequate recognition/advancement
- job loss/insecurity
83
spillover vs crossover
spillover: when work stress carries over to home
crossover: when work stress affects someone else in home
84
polygraph
- measures what?
- other measures (pros and cons)
- measures blood pressure, heart rate, respiration rate and/or galvanic skin response (sweat)
- measures of corticosteroids or catecholamines
PROS: direct + objective + reliable
CONS: expensive + affected by sex, weight, etc
85
Hassles scale
- measures what
- ideal stress?
- scale depends on?
- daily hassles + study
- reactivity
measure ppls exp w day to day unpleasant things
- moderate stress = ideal
Depends on:
- distress (and effort) vs eustress
- stress appraisals: harm-loss, threat and challenge
Daily Hassles: potent predictors of disease risk (often more so than life events)
- National Study of Daily Experiences showed that daily hassles (arguments and social stressors, work overload, etc) are enough to inc daily secretion of cortisol (HPA axis ON)
- individuals differ in how strongly they respond to stressors (reactivity) >> predicts how they fair in the long term >> strong reactivity to daily stressors inc risk of reporting a chronic condition a decade later
86
stimulation definition of stress
Holmes and Rache (SRRS)
- established what?
- reports?
- checklist of events (4)
- SRRS ratings
stress = noxious stimulus >> examination via checklists
- Holmes and Rache inventory helped establish association btwn life events and disease risk
- subjects report past events (6mths, 1yr, 18 mths, etc)
checklist of events
- schedule of life experiences
- developed to allow judges to rate events
- ratings = amount of life change caused by event
- ratings of 0-100 >> higher scores are associated w higher risk of illness
Social Readjustment Rating Scale (SRRS): death of spouse = 100, divorce = 73...Christmas = 12, diving tickets = 11 etc.
87
criticisms of SRRS
- no change?
- other stressors?
- problems? (2)
- no change (eg. staying in a bad marriage) can also be stressful
- other important stressors are ignored (chronic stress, daily hassles)
- problems with retrospective self-reports (remembering events from past) and normative ratings (not the same for everyone)
88
socioeconomic status and stress
Whitehall I
Whitehall II
- sample size and demographic
- number of waves
- findings based on?
- job control rating
- new heart diseases
- indiv differences?
- Whitehall studies: better understand psychological characteristics and the link btwn socioE and stress
Whitehall I: socioeconomic status affects risk of disease (CVD)
Whitehall II: prospective longitudinal study of 10,308 male/female British civil servants (73% of all London-based servants) >> civil servants are still pretty high on the SocioE scale! differences may be more profound in other populations
- nine waves of data since 1985
- based on first 3 measurement waves (~5yrs, complete data on 72% of sample)
- Job control: self-rating and manager rating of skill discretion and decision authority
- new heart diseases (angina pectoris, long-lasting severe pain across chest, physician-diagnosed ischemia >> problem w blood vessels)
- men and women w/low job control had 1.5-1.8 higher risk of developing new heart disease than subjects w high job control
Important: there are indiv differences in sense of control at same hierarchy level
89
criticisms of stimulus definition of stress
- correlations
- variation
- third variables
correlations in the 0.3 range (eg. life change and illness)
- large indiv variation in effects of a stimulus on health
eg. control, neuroticism, as third variables being associated w both stress and illness
90
Transactional definition of stress (Lazarus)
- definition
- when does stress occur?
stress is neither a stimulus nor a response, it is a transactional process that includes both env stimulus and response of the organism
- stress occurs when env taxes/exceeds the resources of the indiv
91
Lazarus' transactional model of stress
- resources exceeded?
- most important factor?
- depends on (2)
- knowing when resources have been exceeded depends on cognitive appraisal
- proposes that the interpretation of stressful events is more important than the events themselves
- depends on the person (neuroticism, vulnerabilities, coping ability) and the stressor (controllability, intensity, duration)
noxious stimulus >>>> appraisal >>>> response
92
cognitive appraisal
- definition
- primary appraisal
- secondary appraisal
- indiv. interpretation of a psychological situation that defines stress
- mental process to assess two factors
1. Primary appraisal: whether demand threatens phys/psych well-being >> neutral/good = no stress; or stressful >> harm-loss, threat or challenge
2. Secondary appraisal: if the resources available meet demand >> condition of stress depends on appraisal
- concerned with evaluation of own ability to cope w situation >> depends on skills, experience and support
93
Types of stress appraisals
- harm/loss
- threat >> adequate resources?
- challenge
- negative emotional response
Harm/loss: involves actual physical/psychological loss/damage
Threat: anticipation of harm/loss >> allows to anticipate and prepare for the future
- if you have adequate resources to deal with threat then you will not be stressed
Challenge: event perceived as stressful >> focus on positive excitement >> refers to the person's confidence in overcoming difficult demands
- negative emotional response will lead to poor health decisions or SAM/HPA axis activation which increases risk of disease onset/progression
94
reappraisal
| - adjustments
Primary >> Secondary (back to primary) >> Coping
- this is a PROCESS >> continuous reassessments based on new info
- adjust: do something for secondary, see if it fixed anything in primary, repeat
- similar to initial process >> may lead to more/less perceived stress
95
criticisms of cognitive appraisal theory
- extremely noxious events
- bigger picture problems (2)
- some noxious events have been found to have an effect above and beyond that accounted for by cognitive appraisals of stress
Bigger picture problem:
- blaming the victim (assault, Dutch hunger winter) >> cant just say "be more positive"
- focuses on subjective experience >> value of evaluating stress "objectively" so we know its the stressful event and not aspects of the person causing stress-illness correlation
96
Perceived stress scale (cohen)
| - 10 questions
```
10 questions about: being upset, control, nervousness, handling personal problems, things going your way, inability to cope, controlling irritations, being on top of things, anger at lack of control, difficulties piling up
- rated on a 5 point scale
<10 = low stress (15% of ppl)
10-23 = avg stress (70%)
>23 = high stress (15%)
```
97
Perceived stress and colds (cohen)
- sample size + controls
- methods
- dependent measures
- results
- shows how health is affected by stress
n = 394 healthy (through assessment) volunteers and 26 controls
Methods:
- 2 week study
- nasal drops were used to give a respiratory virus (common cold) vs saline
- quarantine for 10 days (2 days before, 7 days after)
Dependent measures:
- measured clinical symptoms daily (sneezing, cough, watery eyes, nasal stuffiness)
- collected tissues to quantify mucus amount
- after 28 days they looked at antibody titers (measures presence in blood)
Results:
- vast majority developed infection
- most stressed (people who were rated a 5 for stress level) developed cold 90% of the time
- least stressed ( level 1) developed 70% of the time
BIG DIFFERENCE!
- nobody in the control got it
98
statistical controls for colds and stress study (cohen)
- individual subject variables (12)
- study condition variables (4)
- personality variables (3)
- age, sex, edu, allergies, weight (BMI), smoking, alc consumption, exercise, diet, quality of sleep, white cell counts, total immunoglobulin levels
- the season, number of subjects housed together, infectious status of subjects sharing the same housing, virus specific antibody status at baseline
- personality variables: self-esteem, personal control and introversion/extroversion
99
personal control
- definition
- depends on?
- 2 types
feeling of being able to make decisions and change outcome >> experience less strain from stressors
- depends on social learning/gender/sociocultural differences, etc
1. behavioural control: ability to take concrete actions to reduce impact of stressor
2. cognitive control: ability to use the thought processes/strategies to modify the impact of a stressor >> reappraisal
100
locus of control (2)
1. internal: control of events is within them >> they are responsible
2. external: ppl who believe their lives are controlled by forces outside themselves (eg. luck)
101
self-efficacy (2) vs learned helplessness
self efficacy: belief that you can succeed >> based on
a) outcome expectancy: behaviour >> favorable outcome
b) self-efficacy expectancy: can perform properly
learned helplessness: being in uncontrollable situations that lead to repeated failure >> characteristic of depression
102
attribution
- internal-external
- stable-unstable
- global-specific
- pessimistic vs optimistic explanatory style
cognitive process for when people experience uncontrollable negative events
1. internal-external: consider whether it is personal inability to control outcomes (lowers self esteem) or external and beyond control (doesn't lower)
2. stable-unstable: long lasting (stable) or temporary (unstable) cause >> long lasting = chronic disease = feeling helpless
3. global-specific: wide ranging effects or specific, narrow effects
- global = I am bad, specific = this part of me is bad
```
pessimistic = internal, stable, global
optimistic = external, unstable, specific
```
103
health locus of control scales (3)
assess the following:
1. internal health locus of control (controlled by you)
degree of external:
2. powerful - others' health locus of control (controlled by others eg. doctors)
3. chance locus of control (luck/fate)
104
```
5 factor model of personality
A. Neuroticism
B. Extraversion
C. Openness
D. Agreeableness
E. Conscientiousness
```
A. Neuroticism (vs emotional stability): tendency to experience negative emotions like anxiety, sadness, irritability >> vulnerable and can't cope w stress
B. Extraversion (vs introversion): outgoing, talkative, assertive >> experience positive emotions
C. Openness (vs closed mindedness): new experiences, intellectual curiosity, flexibility
D. Agreeableness (vs antagonism): altruistic, empathetic, trusting, cooperative, helpful
E. Conscientiousness (vs unreliability): high self-control, organized, self-disciplined, achievement-striving
*positive traits associate w good health and longevity
105
Type A Behaviour Pattern
- 4 traits
- stress response
- risk
- competitive: no joy from accomplishments, just competition
- time urgency: impatient w delays, overschedule
- anger/hostility
- vigorous vocal style: speak loud, rapid and emphatic >> take over conversations
- responds quickly to stressors >> threats to personal control (greater reactivity)
- more at risk for coronary heart disease (CHD), angina, and heart attacks than type B >> caused by anger and social dominance
106
Type B Behaviour Pattern
- traits (7)
- how to measure type?
- heredity
- low level competitiveness, time urgency and hostility
- easygoing, philosophical, speak slow and soft >> relaxed
* type A or B measured using The Structured Interview
* heredity plays a roll in type A/B >> MZ vs DZ twins
107
diathesis stress model
- ppls vulnerability to phys/physcho disorder (diathesis >> depends on env or genetics) and the amount of stress they experience
108
Stress >> Behaviour
- examples
- inc vs dec risk of illness
Stress >> Physiology
- examples
- inc vs dec risk of illness
Behaviours >> indirect route
eg. stress caused by divorce, or adverse childhood experience
inc risk of illness: dietary fat, tobacco use, alcohol use, accidents
dec risk of illness: dietary fruits/veg, exercise, sleep
Physiology >> direct route
eg. stress caused by allostatic load, pregnancy (stress can cause premature delivery/low birth weight)
inc: BP, bad lipids/platelets in the blood, clotting factors (thickens blood, can cause heart attack), stress hormones
dec: immune function
109
Metabolic Syndrome
- risk factors
- worsened by?
risk factors: high cholesterol, BP, insulin, etc
| - worsened by exposure to stressors, especially neuroendocrine response
110
inflammation
- cause
- how does it occur?
- link?
caused by chronic stressors which disrupts immune function (both specific and non-specific)
- inc cortisol/epi = dec activity of T/B cells >> important to devel/progression of various infectious diseases/cancer
- link between inflammation and depression
111
Feedback loop
| - between the body systems
nervous/endocrine systems sent NTs/hormones to inc/dec immune fxn >> cells produce chemicals (cytokines/ACTH) >> go to brain
112
conditioning immune function
immunosuppression can be conditioned
- sugar water given to rats >> nausea meds (suppress immune function)
- given sugar water for a while (conditioned stimulus) and died from illness
113
Recurrent headaches
- 2 types
- aura
- triggered by? (7)
Tension type: dull, steady ache for hours, days, weeks
Migraine: sharp throbbing on one side that extends >> hours or days
- aura: vision shimmery, dizzy, nausea, vomiting
- triggered by stressors, hormones, skipping meals, sunlight, poor sleep, alc, chocolate, etc
114
Hypertension
- definition
- disease risks (3)
- risk factors (6)
high BP over several weeks
- risk for CHD, stroke, kidney disease
- obesity, high salt/fat/chol diets, alc, phys inactivity, family history and psychosocial factors (chronic stress, anger. anx) are risk factors for hypertension
115
social connection
| - factors
depends on:
- connections to others via existence of relationships and their roles
- a sense of connection that results from actual or perceived support or inclusion
- the sense of connection to others that is based on +/- qualities
116
social connection types
1. structural: existence of /interconnections among diff social relationships and roles (marital status, social networks, integration, isolation, living alone)
2. functional: functions provided by/perceived to be available because of social relationships (received support, perceptions of social support/loneliness
3. quality: +/- aspects of social relationships (marital quality, relationship strain, social inclusion/exclusion)
117
social support
comfort, caring, help >> person believes they are loved, valued, and part of a social network that can help them >> can be actions (received support) or perceived support
118
Types of social support
1. Emotional/Esteem support
2. Tangible/Instrumental support
3. Informational support
4. Companionship support
5. invisible support
6. unasked-for support
1. Emotional/Esteem support: empathy, caring, concern, encouragement, comfort, reassurance
2. Tangible/Instrumental support: providing direct assistance/material support, services, money, goods
3. Informational support: giving advice, providing knowledge, directions, suggestions eg. from doctor
4. Companionship support: availability to spend time >> provides feeling of membership/belonging
5. invisible support: when one received help from another, but is unaware of it, that help is most likely to benefit
6. unasked-for support: unsolicited advice can imply incompetence and undermine self-esteem
119
recipients vs providers of social support >> why NOT?
- gender
- sociocultural differences
recipients: ppl are unlikely to receive support if they're unsociable, don't help others, and don't let others know when they need help
- not assertive enough, feel like a burden, can't confide, no one to ask
providers: maybe no resources, stressed themselves, insensitive
Gender:
- men have larger social networks than women, but women use theirs more effectively for support
- women get less support from their spouses than men
- also depends on sociocultural differences (eg. immigrants have smaller social networks)
- network size depends on social prestige, income and education
120
Matching Hypothesis
social support is most effective when it meets the need of the person
- when help is not perceived as supportive, it will not reduce stress
- can harm health when unhealthy behaviours are encouraged
121
Buffering Hypothesis
- definition
- difference from direct effects hyp
- social vs isolated
- evidence
protective factor (social support) buffers impact of env demands on indiv and lowers stress response >> protecting the person against the negative effects of high stress
- usually effective for mainly strong stressors >> not much buffering in low stress situations
- there is no difference between a very social person and an isolated person if they are stress-free
Evidence: study by Jim House >> work stress and social support
- interviewed 2000 men from a range of occupations >> factory workers to physicians
- found evidence for various measures of work stress (overload, responsibility) >> social support helped reduce stress response
- variety of outcomes (anx, depn, heart disease, all cause morbidity >> physical conditions)
122
Direct Effects Hypothesis
- difference from buffering hyp
- evidence
social support benefits health/well-being regardless of the amount of stress (works in both low and high stress situations)
- benefits in non-stressful and stressful times
Evidence: several longitudinal studies >> mortality rates drop with higher levels of social integration
eg. Alameda County Study
123
Human-animal interaction
- improves?
- reduces?
- oxytocin
- improved CV health, immune fxn, mood
- reduced BP, illness susceptibility, cortisol output, depression, aggression
- oxytocin: encourage bonding, friendly interactions (breastfeeding, sex, cuddling, etc) >> lowers HR and BP, and has a hand in many health benefits of human/animal int
124
cardiovascular reactivity and social support
- if it benefits you depends on...
- what does social support benefit?
inc in BP/heart rate from baseline
- benefits of social support depend on personality >> defensive/hostile = inc reactivity in stressful situations
- having social support benefits health >> lower risk of heart disease/cancer >> also quicker to recover from serious illness
125
TSST study on stranger support and gender effects
- sample size + 3 groups
- effects of gender, men (3) vs women
- perceived social support
- statistics on primary social support
n = 66 partnered young adults - 3 groups
- n = 23: no social support
- n = 22: social support by stranger
- n = 21: social support by partner
effects of gender:
- men w no support had highest cortisol levels
- men with stranger support had somewhat reduced cortisol levels
- men with partner support had very reduced cortisol levels
HOWEVER: women who received no support/stranger support had lower cortisol levels than women supported by their partners
Perceived social support: both men and women were saying that they received similar levels of social support for partner, but biology (cortisol levels) say
otherwise
stats:
- if you ask men who their primary social support is, most will say spouse (66%)
- if you ask women, most will say a relative (37%) or close friend (28%)
126
gender differences in social support
| - relationships, mobilization, provision, preference
women tend to:
- maintain more emotionally intimate relationships
- mobilize more social support when needed
- provide more frequent and more effective social support to others
- both men and women tend to prefer women as confidants
127
Stress prevention model
social support provides resources to avoid/minimize exposure to stressful events in the first place
128
social network diversity (cohen study #2)
- sample size
- methods
- stats
- measured?
- findings
- n = 276 healthy volunteers
- gave nasal drops w/common cold viruses, 40% got clinically ill
- people w less than 4 types of social relations were over 4x more likely to catch cold than those w 6 or more types
- measured bio markers (virus load) and measured Kleenexes before and after to see mucus production
- people with larger social networks produced less mucus and shed less virus
129
Coyne and DeLongis
- predictor of good health
- negative support >> example
- having at least one strong intimate relationship is an important predictor of good health
Negative support: dark side of close relationships
eg. undermining behaviour >> harmful
- predict health far better than "positive support"
130
loneliness as a signal
loneliness is the social equivalent of physical pain, hunger and thirst >> necessary for survival of genes
131
coping
- definition
- success?
- managing
- dynamic process
- attempt to... (4)
2 main functions of coping (types of coping)
- things we think/actions we take to ameliorate the negative aspects of a stressful situation (efforts are both action-oriented and intrapsychic)
- independent of success >> don't go by the outcome when studying coping!
- ppl try to manage the perceived discrepancy between the demands (internal/external) and resources they appraise in a stressful situation
dynamic process: we don't know what works best for everyone >> there is no ONE THING that always works
- depends on personality, situation, other people involved, person-env fit, and flexible adjustment
attempt to:
- correct/master the situation
- alter perception of discrepancy
- tolerate/accept the harm/threat
- escape/avoid the situation
main functions:
- alter the problem causing the stress
- regulate the emotional response to the problem
132
Lay definition of coping
often implies that the situation was handled well >> confounds the behaviour with the outcome
133
Emotion-focused coping (aka secondary coping)
- behavioural
- cognitive
controlling emotional response to stressful situation
- behavioural approach: alc/drug use, social support seeking, engaging in distractions
- cognitive approach: how ppl think abt situation >> redefine situation >> see something good. compare to those who are worse off, etc
134
defense mechanisms
- distort memory/reality in some way
| - denial, avoidance >> only work in the short-term
135
Problem-focused coping (aka primary coping)
- practical examples
- proactive coping
reduce demands of stressful situation and expand resources to deal with it
eg. quit job, get extensions, schedule, treatment seeking, learning skills
proactive coping: prevent/minimize stress BEFORE it occurs
136
Relationship-focused coping
- examples
- dyadic coping
- warning
involves emotions or problem focused coping intended to manage/maintain social relationships during stress
eg. compromise, empathy, confrontation, withdrawal
dyadic coping: partners work together to recognize interdependence in dealing with stressor >> lowers risk for divorce
**watch out for demand-withdrawal! one confronts, the other withdraws
137
Methods of coping
1. problem focused: examples
- changing what? (2)
2. emotion focused: examples
Problem focused
- assistance seeking, confrontive assertion, direct action, info seeking, logical analysis, planful problem solving
- changing the situation: fix the problem by thinking of options and making a plan
- change ourselves: better equip ourselves by seeking info and learning new skills
Emotion focused
- avoidance, denial, venting, distraction, humor, hiding feelings, worry, intrusive thoughts, physical exercise, positive reappraisal, prayer, resigned acceptance, substance use, self-criticism, support seeking
138
is problem focused better than emotion focused?
| - cancer children
- coping is an interplay between the two
- using only PFC, you will run into a wall >> there are some problems that can't be solved
- cancer children were interviewed abt coping strategies for painful medical procedures (eg. lumbar punctures >> CSF)
- emotion-focused is better in this case >> kids who were emotionally supported by parents showed less distress (pain and anx)/behavioural problems compared to parents who used problem-focused methods
- emotion focused is better in uncontrollable situations >> deal with stress internally because you cannot deal with it externally
139
religion vs spirituality
religion: personal involvement/commitment to an established religion
spirituality: general search for sacred aspects/ultimate life meaning (more intrinsically motivated)
- both associated with lower anx/depn, better phys health and longer life
- significant source of social support
140
Assertiveness
| - 2 responses to disagreement
expressing opinion without insult or intimidation
- after a disagreement, people can respond
a) aggressively: intimidate/control, see things as challenges
b) unassertively: fail to express their wishes/opinions, see things as threats
141
time management
1. set goals that are attainable
2. make daily to-do lists to prioritize
3. set schedule for day to allocate estimated time periods
142
preparing for stressful events
- preoperative fear
- how to prepare?
- behavioural control
- cognitive control
- informational control
higher preoperative fear results in worse post-operative adjustment/recovery
- prepare by enhancing patients feelings of control
eg.
behavioural control: rehab
cognitive control: focus on pleasant thoughts before surgery
informational control: info on procedures/sensations (but too much will result in confusion and fear)
143
stress management
- medication
- progressive muscle relaxation
- systematic desensitization
- biofeedback
- modelling
- cognitive restructuring
- cognitive therapy
- problem solving/stress alleviation training
- massage, meditation, hypnosis
medication: benzodiazepines (valium, xanax), beta blockers >> reduce arousal, anxiety, and BP
progressive muscle relaxation: focus on specific muscle groups and alternately tense and relax them
systematic desensitization: counterconditioning >> pair feared object with pleasant/neutral stimulus >> uses a stimulus hierarchy to gradually get used to stimulus
biofeedback: electrochemical device monitors status of physiological processes (HR, muscle tension) >> reports immed >> operant conditioning >> if they did something and it worked, it reinforces the behaviour
modelling: observational learning (similar to SD >> use stimulus hierarchy)
cognitive restructuring: stress-provoking thoughts replaced with more constructive/realistic ones >> reduce threat appraisal
cognitive therapy: bad things aren't all your fault, and it's not the end of the world
problem solving/stress alleviation training
massage (soothing), meditation (mindfulness >> no emotional distortions), hypnosis (suggestibility varies)
144
NUTS - recognizing stress
Novelty
Unpredictability
Threat to personality
Sense of low control
145
Anger management
- prepare for provocation: don't take things personally
- impact and confrontation: stay in control
- coping with arousal: relax, slow down, deep breaths
- subsequent reflection:
a) unresolved - forget aggravation
b) resolved - good job :)
psyc 314
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