Stress, CHD, etc.ppt

Sources of Stress Stressors - changes (esp. negative) Holmes & Rahe?s Social Readjustment Scale Death of spouse highest Divorce 2nd Marriage 7th Retirement 10th Outstanding personal achievement 25th Beginning or ending school 27th Other Sources of Stress Hassles - minor events (parking, gas) Uncontrollability - ability to terminate negative event reduces impact, study showing violent deaths w/ & w/o opportunity to terminate, GSR measured Unpredictability -warning reduces impact of negative events Physiology of Stress Selye?s GAS General Adaptation Syndrome Alarm Mobilizing to combat threat Fight or flight response CNS & physiological arousal (higher b.p., pulse, hormone release thru HPA - hypothalamic-pituitary-adrenal gland - axis) Increased mental activity Other Stages (ARE) Resistance - active coping efforts involving fight or flight, physiological arousal maintained Exhaustion - prolonged resistance depletes physiological resources, ineffective coping, less thinking, decreased immunocompetence Gender Differences in Stress Responses Females less physically capable of fighting off aggressors & have more responsibility for offspring Stress response is ?tend & befriend,? joining social groups to reduce vulnerability Origins - evolution, survival value Health Psychology Direct effects model Psych. factors - physiological changes - disease Interactive model Diathesis-stress interaction causes physiological changes which then cause disease Indirect effects model Psych. factors - health-related beh. -disease Coronary Heart Disease Results from narrowing of blood vessels supplying heart muscle or closing by plaque (fatty substance) Leading cause of death & chronic illness Higher rates in African-Americans & Hispanic-Americans Risk Factors for CHD Hypertension - high b.p. High cholesterol Obesity Age Smoking Diabetes Sedentary Family hx Certain life circumstances, jobs Type A Behavior Pattern Psychological contributor to CHD (direct effects model) Friedman & Rosenman (cardiologists) identified pattern based on serendipity Uneven wear on office chairs, front part of office chairs wore out first Measurement of Type A (Jenkins Activity Schedule) Has your spouse or friend ever told you that you eat too fast? How would your spouse/friend rate your general activity level? When interrupted at work, how do you feel? Do you set quotas for yourself? Type A Components Exaggerated sense of time urgency - set unnecessary deadlines, multitasking Ambition, competitiveness even when unnecessary (e.g., try to be first in line) Easily aroused & chronic hostility proves to be crucial component, inc. resentments, cynicism, distrust Hostility (Pervasive Anger) In 2 hrs. after anger episode heart attack risk doubles (in those over 50) Venting hostility lowers b.p. High-hostility men (in med school, at Western Electric) had much highest CHD (5X in Western Electric study) More on CHD Type A probably contributes thru chronic high sympathetic nervous system arousal Working 2 jobs Combination of high demand & low choice (or decision latitude) Helplessness - Type A?s may get into & react stronger to frustration, may fight or give up More on CHD Harvard study - inhibited need for power better predictor of b.p. decades later than original b.p. Hopelessness, depression, anxiety also contribute (those depressed after heart attack 5X more likely to have another) Contributors to Health Pessimism causes perception of uncontrollability, poorer health-related beh. Social support - md. people less likely to die from ca, heart disease, surgery Marriage better for men (than women), possibly due to sensitivity to conflict, partner as confidante for men Women have larger social networks, seek them out more under stress Health-Enhancing Interventions Biofeedback - for hypertension, migraines, pain Teach relaxation Provide info on finger temperature, b.p. Support groups - increase ca survival Coping Coping Appraisal (loss, threat, challenge) precedes & influences Emotion- vs. problem-focused Approach vs. avoidant Avoidant tends to be ineffective, others vary by situation Cope Items Got upset & let emotions out Sought God?s help Made a plan of action Learned to live w/ it Slept more than usual Made jokes about it Took direct action Thought about how to best handle COPE Scales Active Coping Planning Suppression of Competing Activities Restraint Coping Acceptance Seeking support-instrumental Seeking support- emotional Positive reinterpretation & growth Acceptance Turning to religion Focusing on, venting emotions Denial Disengagement - behavioral, mental, alcohol/drdug