Stress Models Coping Strategies Type A Personality Stress and Health Stress Models Coping Strategies Type A Personality Cato Grønnerød PSY2600

Stress, mestring, tilpasning og helse Mestringsstrategier Type A personlighet Cato Grønnerød PSY1006

Helsepsykologi Psykologiske faktorer og spesifik atferd har konsekvenser for vår helse Personlighet og helse-modeller Interaksjonsmodell Transaksjonsmodell Helseatferdsmodell Predisposisjonsmodell Sykdomsatferdsmodell Livsstil bidrar til mer enn halvparten av tidlige dødsfall (før 65)

Health Psychology Psychological factors and specific behavior both have health consequences Personality and health models Interactional model Transactional model Health behavior model Predisposition model Illness behavior model Lifestyle contributes to more than half of all premature deaths © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Fysiologisk aktivering Direkteeffektmodell Objektive hendelser Fysiologisk aktivering Sykdom Ikke aktuell som modell

Physiological activation Direct Effects Model Objective events Physiological activation Illness

Fysiologisk aktivering Interaksjonsmodell Objektive hendelser Mestrings-responser Fysiologisk aktivering Sykdom Objective events happen to a person, but personality determines the impact of events by influencing a person’s ability to cope Personality moderates the relation between stress and illness Coping response influences degree, duration, and the frequency of a stressful event Problem: Researchers are unable to identify stable coping responses that are consistently adaptive or maladaptive Personlighet

Physiological activation Interaction Model Objective events Coping responses Physiological activation Illness Objective events happen to a person, but personality determines the impact of events by influencing a person’s ability to cope Personality moderates the relation between stress and illness Coping response influences degree, duration, and the frequency of a stressful event Problem: Researchers are unable to identify stable coping responses that are consistently adaptive or maladaptive Personality

Fysiologisk aktivering Transaksjonsmodell Sykdom Fysiologisk aktivering Objektive hendelser Vurdering som truende Mestrings-responser Personality has three potential effects Can influence coping Can influence how a person appraises events Can influence events themselves Appraisal suggests that it is not the event itself that causes stress, but how the event is interpreted by a person People don’t just respond to situations, they also create situations through choices and actions Personlighet

Physiological activation Transactional Model Illness Physiological activation Objective events Appraisal as threatening Coping responses Personality has three potential effects Can influence coping Can influence how a person appraises events Can influence events themselves Appraisal suggests that it is not the event itself that causes stress, but how the event is interpreted by a person People don’t just respond to situations, they also create situations through choices and actions Personality

Fysiologisk aktivering Helseatferdsmodell Personlighet Helseatferd Sykdom Objektive hendelser Vurdering som truende Mestrings-responser Fysiologisk aktivering Personality does not directly influence the relation between stress and illness Instead, personality affects health indirectly, through health promoting or health degrading behaviors

Physiologicalactivation Health Behavior Model Personality Health behavior Illness Objective events Appraisal as threatening Coping responses Physiologicalactivation Personality does not directly influence the relation between stress and illness Instead, personality affects health indirectly, through health promoting or health degrading behaviors

Predisposisjonsmodell Sykdom Pre-disposisjon Fysiologisk reaktivitet Personlighet Associations may exist between personality and illness because of a third variable that is causing them both Association found between illness and personality because of some predisposition that underlies them both

Physiologicalreactivity Predisposition Model Illness Pre-disposition Physiologicalreactivity Personality Associations may exist between personality and illness because of a third variable that is causing them both Association found between illness and personality because of some predisposition that underlies them both

Sykdomsatferdsmodell Symptom-rapport Normal kropps-oppmerksomhet Forhøyet oppmerksomhet Sykdoms-oppfatning Helseatferd Personality influences the degree to which a person perceives and attends to bodily sensations, and the degree to which a person interprets and labels sensations as illness Personlighet

Illness Behavior Model Symptom report Normal physiological sensations Heightened awareness Labeling as illness Health behavior Personality influences the degree to which a person perceives and attends to bodily sensations, and the degree to which a person interprets and labels sensations as illness Personality

Fellesfaktorer Inkluderer stress som faktor Stress er ikke ”noe der ute”, noe som skjer med oss Stress er hvordan vi fortolker og reagerer på livshendelser Stress er en interaksjon mellom person og hendelse

A Common Theme in the Models Most models of personality and illness include a key variable of stress Stress is not “out there”, something that just happens to us Instead, stress lies in part in how we interpret and respond to those events Thus, stress lies “in between” the event and the person © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Begrepet stress Stress er en subjektiv følelse som følger av hendelser som oppfattes som ukontrollerbare og truende Stressorer: hendelser som er Ekstreme, overveldende Fører til motstridende tendenser: lyst/ulyst Oppfattes som ukontrollerbare

The Concept of Stress Stress is a subjective feeling produced by events perceived as uncontrollable and threatening Stressors: events that are Extreme in some manner, in that stressors produce a state of feeling overwhelmed Produce opposing tendencies in us, such as wanting and not wanting some activity or object Perceived as uncontrollable © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Stressreaksjon Aktivitet i det sympatetiske nervesystemet Økt puls Svette i håndflatene og fotsålene Høyere blodtrykk Økt oppmerksomhet mot omgivelsene Fight/flight-reaksjon

Stress Response Increase in sympathetic nervous system activity Startle Heart beats fast Blood pressure increases Sweaty palms and soles of feet Fight-or-flight response © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Stressreaksjon Generelt tilpasningssyndrom General Adaption Syndrome (GAS) Alarmstadiet Fight/flight-respons Motstand Kroppen bruker fysiologiske ressurser for å takle situasjonen Utmattelse Mer mottakelig for sykdom pga. nedsatt fysiologisk fungering Selye (1979)

Stress Response General Adaptation Syndrome (GAS) Alarm stage Fight-or-flight response Stage of resistance Body uses resources at above average rate, even though fight-or-flight response subsided Stage of exhaustion More susceptible to illness, because physiological resources are depleted Selye (1979) © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Store livshendelser Holmes & Rahe (1967) Både positive og negative stressorer Dødsfall i familien, miste jobben, fengslet Gifte seg, starte ny utdanning Økt sannsynslighet for sykdom i påfølgende år Dårligere immunforsvar gir økt sannsynlighet for infeksjoner Forsøk med å gi folk smitte i nesedråper, sykdom varierte med stressnivå

Major Life Events Holmes & Rahe (1967) Both positive and negative stressors Death in the family, lose job, imprisonment More likely to have a serious illness over the next year People under chronic stress deplete bodily resources and become vulnerable to infections Stress lowers the functioning of immune system, leading to lowered immunity to infection and resulting in illness © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Daglige trassigheter Daglige trassigheter er hovedårsak til det meste av stress i de flestes liv For mye å gjøre Bli sittende fast i trafikken Ugreie sjefer Pengeproblemer Problemer i parforhold Familiekonflikter Research indicates that people with a lot of minor stress suffer more from psychological and physical symptoms

Daily Hassles Major events stress, but infrequent Daily hassles provide most stress in most people’s lives Too many things to handle Stuck in traffic Difficult bosses Financial trouble Interpersonal problems Family conflicts Research indicates that people with a lot of minor stress suffer more from psychological and physical symptoms © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Typer stress Akutt stress Episodisk akutt stress Traumatisk stress Plutselig hendelse Episodisk akutt stress Gjentakende hendelser Traumatisk stress Svært belastende akutte hendelser PTSD Kronisk stress Vedvarende situasjon Stress has additive effects, cumulating in a person over time

Varieties of Stress Acute stress Episodic acute stress Sudden event Episodic acute stress Repeating events Traumatic stress Highly disturbing sudden events PTSD Chronic stress Lasting situation Stress has additive effects, cumulating in a person over time © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Situasjonsvurderinger Primærvurdering (Primary Appraisal) Personen vurderer om hendelsen er en trussel mot oppsatte mål Sekundærvurdering (Secondary Appraisal) Personen vurderer om det fins ressurser til å håndtere hendelsen Lazarus (1991): stress oppstår når begge er negative Stress er en subjektiv reaksjon overfor potensielle stressorer Primærvurdering: motivasjon Sekundærvurdering: mestringstro

Event Appraisals Primary appraisal Secondary appraisal Person perceives an event as a threat to important goals Secondary appraisal Person concludes they do not have resources to cope with demands of the threatening event Lazarus (1991): both events must occur Stress is the subjective reaction of a person to potential stressors © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Positive emosjoner og stress Positive emosjoner kan føre til lavere stressnivå Tre mekanismer Positiv revurdering Fokusere på det gode som skjer Problemfokusert mestring Tanker eller atferd som håndterer eller løser det underliggende problemet Skape positive hendelser Folkman & Moskowitz, 2000 Tenk på en soloppgang…

Positive Emotions in Coping with Stress Positive emotions and appraisals may lead to a lowered impact of stress on health Three coping mechanisms Positive reappraisal Focusing on the good in what is happening Problem-focused coping Thoughts and behaviors that manage or solve an underlying cause of stress Creating positive events Creating positive time-out from stress Generating positive emotion during stress (Folkman & Moskowitz, 2000) © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Attribusjonsstil Pessimistisk Optimistisk Disposisjonell optimisme Stabile, generelle og indre forklaringer Optimistisk Ustabile, spesifikke og ytre forklaringer Disposisjonell optimisme Forventning om gode hendelser Self-efficacy Tro på at man kan oppnå mål man setter Optimistisk bias Undervurderer risiko Stabile, generelle og indre forklaringer på negative hendelser

Attributional Style “Where does the person typically place the blame when things go wrong?” Three dimensions of attribution External versus internal Unstable versus stable Specific versus global Different measures Attributional Style Questionnaire Content Analysis of Verbatim Explanations (CAVE) © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Refinements to the Attributional Style Construct Optimism-pessimism (Peterson, 2000) People who make stable, global, and internal explanations for bad events termed “pessimists,” People who make unstable, specific, external explanations for bad events termed “optimists” Pessimism Lifelong vulnerability to illnesses Longitudinal study: pessimists from 1939-40 were more likely to develop physical illnesses during the next 35 years Pessimists recover more slowly from heart surgery Chronic arousal © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Refinements to the Attributional Style Construct Dispositional optimism (Scheier & Carver, 2000) Expectation that good events will be plentiful and bad events rare in future Self-efficacy (Bandura, 1986) Belief that one can do behaviors necessary to achieve desired outcome © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Refinements to the Attributional Style Construct Optimistic bias People generally underestimate their risks, with the average person rating risks as below true average Optimism and Physical Well-Being Optimism predicts good health and health promoting behaviors God helse Bedre immunforsvar Positiv helseatferd Mer trening, spiser sunnere Lengre liv Færre ulykker og voldelige dødsfall Pessimister dras mer til farlige situasjoner © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Optimisme og helse Optimisme henger sammen med God helse Bedre immunforsvar Positiv helseatferd Mer trening, spiser sunnere Lengre liv Færre ulykker og voldelige dødsfall Pessimister dras mer til farlige situasjoner Snakker om positive emosjoner som om det skulle være en pille Seligman: Pessisism prevention program

How Does Optimism Promote Health? Through the effects on the immune system Through an emotional mechanism Through a cognitive process Through effects on social contacts Through direct behavioral mechanism Snakker om positive emosjoner som om det skulle være en pille Seligman: Pessisism prevention program © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Håndtering av emosjoner Fortrengning fører til uønskede konsekvenser Undertrykking av følelser fører til forhøyet sympatetisk aktivitet Stressreaksjon Hindrer kommunikasjon Å gi uttrykk for emosjoner kan knyttes til bedre tilpasning og helse Gross og Levenson: skulle se video, noen fikk beskjed om å ikke vise følelser, disse fikk høyere aktivering Å skrive om vanskelige hendelser og følelser fører til bedre tilpasning selv om ingen leser det: restrukturering

Management of Emotions Emotional inhibition leads to undesirable consequences Other theorists see emotional inhibition more positively Chronically inhibited emotion may lead to effects of chronic sympathetic nervous system arousal Emotional expression facilitates communication Tied to better adjustment and good health Expressive writing Smyth (1998): writing pradigm is associated with positive health outcomes: physiological – health – general functioning, no effect on health behaviors Meads (2003): no indication of clinical use Fristna, Borod & Lepore (2004): increase in positive physiological health outcomes, less for psychological © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Illusory mental health Shedler, Mayman & Manis (1993) The illusion of mental health Two subgroups of those who appear “healthy” on mental health scales Psychologically “healthy” Illusory mental health: appear “healthy” by way of defensive operations and denial of dysfunction 3 studier Eysencks nevrotisisme, Early Memory Test, Kardiovaskulære mål Aritmetriske oppgaver, TAT, setningsassosiasjoner

Illusory mental health Method Clinical Evaluation Good Poor Self report Good mental health Illusory mental health Poor self representation Poor mental health

Illusory mental health Shedler, Mayman & Manis (1993)

Illusory mental health Many psychological processes are not available for conscious cognition Some protect themselves against unpleasant thoughts and feelings Supression of emotion is linked to increased risk of disease Nonnestudien (Danner et al., 2001) 60 år lang longitudinell studie De nonnene som uttrykte positive følelser i tidlig voksen alder levde over 10 år lengre enn de som ikke gjorde det

Type A og hjerte-/karsykdom Atferdsmønster Konkurranseorientert prestasjonsmotivasjon Hastverk Fiendtlighet og aggressivitet Fiendtlighet viktigste prediktor for hjerte- /karsykdommer Intervjuer og spørreskjema Intervjuene treffer bedre, men fordi de treffer fiendtlighet bedre

Type A atferdsmønster Høy på prestasjonsbehov og konkurranseorientering Liker å jobbe hardt og oppnå mål Hastverksfølelse Hater å kaste bort tid Fiendtlighet og aggressivitet Lett frustrert, lett sint Uvennlig og kanskje ondsinnet Always competitive, also in irrelevant situations, likes power, defeats obstacles Always in a hurry, setting unnecessary deadlines, does at least two things at a time Gets easily frustrated by obstacles which makes them unfriendly © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Type A Behavioral Pattern High achievement motivation and competitiveness Like to work hard and achieve goals Time urgency Hates wasting time Hostility and aggressiveness Easily frustrated, easily angered Becomes unfriendly and even malicious Always competitive, also in irrelevant situations, likes power, defeats obstacles Always in a hurry, setting unnecessary deadlines, does at least two things at a time Gets easily frustrated by obstacles which makes them unfriendly © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

Type A atferdsmønster Leger observerte at menn med hjerteproblemer oppførte seg annerledes Intervjuvurdering Observasjon av atferd Spørsmålsskjemaer Jenkins Activity Survey Mindre sannsynlighet for å predikere helseproblemer «My work improves as the deadline approaches» «I have been told I eat too fast», «I enjoy a good competition» Snakke sakte, avbryte, observere fikling, urolighet, prøver å fullføre intervjuers setninger

Type A Behavioral Pattern Physicians observed that men with heart diseases were behaving differently Interview assessment Observation of behavior Questionnaires Jenkins Activity Survey Less likely to predict health problems «My work improves as the deadline approaches» «I have been told I eat too fast», «I enjoy a good competition» Snakke sakte, avbryte, observere fikling, urolighet, prøver å fullføre intervjuers setninger

Type A atferdsmønster Kardiovaskulære sykdommer Dobbelt så høy risiko for Type A-personer Fiendtlighet og aggressivitet Forakt, mistenkelighet, antagonisme, mistro, sinne Viktigste prediktor for kardiovaskulære sykdommer Oftere engstelig og deprimert Friedman & Rosenman (1974): 3000 menn over 8,5 år, dobbelt så mange med hjerteproblemer med Type A, uavhengig av alder, røyking, spisevaner og andre risikofaktorer Bekreftet av flere andre studier, korrelerer med alvorlighetsgrad av blokkering Barefoot et al. (1989): hostility in law school gave 5 times higher risk of dying before 50

Type A Behavioral Pattern Cardiovascular disease Double risk for Type A-persons Hostility and aggressiveness Resentment, suspiciousness, antagonism, distrust, anger Most important predictor of cardiovascular disease More often anxious and depressed Friedman & Rosenman (1974): 3000 menn over 8,5 år, dobbelt så mange med hjerteproblemer med Type A, uavhengig av alder, røyking, spisevaner og andre risikofaktorer Bekreftet av flere andre studier, korrelerer med alvorlighetsgrad av blokkering Barefoot et al. (1989): hostility in law school gave 5 times higher risk of dying before 50

Type A atferdsmønster Skade på arteriene Kjønnsforskjeller Høyere nivåer av katecholaminer Høyere blodtrykk og innsnevring av arteriene Slitasje gjør at kolesterol fester seg lettere på arterieveggene og forårsaker arteriosclerose Kjønnsforskjeller Menn har høyere risiko Kvinner uttrykker vanligvis ikke aggresjon så mye som menn Catecholamines: stress-related substance Men: also higher risk for risk factors

Type A Behavioral Pattern Arterial damage Higher levels of catecholamines Higher blood pressure and arterial constriction Wear and tear makes cholesterol attach easier and cause arteriosclerosis Gender differences Men have a higher risk Women tend not to express aggression as much as men Catecholamines: stress-related substance Men: also higher risk for risk factors