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Chapter 13
Stress, Coping and Health
The Relationship Between Stress and
Disease
Contagious
diseases vs. chronic diseases
– Biopsychosocial model
– Health psychology
• Health promotion and maintenance
– Discovery of causation, prevention, and treatment
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Fig 13.1 – Changing patterns of illness. Trends in the death rates for various diseases during
the 20th century reveal that contagious diseases (shown in blue) have declined as a threat to
health. However, the death rates for stress-related chronic diseases (shown in red) have
remained quite high. The pie chart (inset) shows the results of these trends: three chronic
diseases (heart disease, cancer, and stroke) account for 61.9% of all deaths.
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Stress: An Everyday Event

Major stressors vs. routine hassles
– Cumulative nature of stress
– Cognitive appraisals

Major types of stress
– Frustration – blocked goal
– Conflict – two or more incompatible motivations
• Approach-approach, approach-avoidance, avoidance-avoidance
– Change – having to adapt
• Holmes and Rahe – Social Readjustment Rating Scale – Life Change
Units
– Pressure – expectations to behave in certain ways
• Perform/conform
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Fig 13.2 – Types of conflict. Psychologists have identified three basic types of
conflict. In approach-approach and avoidance-avoidance conflicts, a person is torn
between two goals. In an approach-avoidance conflict, there is only one goal under
consideration, but it has both positive and negative aspects.
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Responding to Stress Emotionally
 Emotional
–
–
–
–
Responses
Annoyance, anger, rage
Apprehension, anxiety, fear
Dejection, sadness, grief
Positive emotions
 Emotional
response and performance
– The inverted-U-hypothesis
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Fig 13.4 – Overview of the stress process. A potentially stressful event,
such as a major exam, elicits a subjective appraisal of how threatening the
event is. If the event is viewed with alarm, the stress may trigger emotional,
psychological, and behavioral reactions, as people’s response to stress is
multidimensional.
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Fig 13.5 – Arousal and performance. Graphs of the relationship between emotional arousal
and task performance tend to resemble an inverted U, as increased arousal is associated with
improved performance up to a point, after which higher arousal leads to poorer performance.
The optimal level of arousal for a task depends on the complexity of the task. On complex tasks,
a relatively low level of arousal tends to be optimal. On simple tasks, however, performance may
peak at a much higher level of arousal.
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Responding to Stress Physiologically
 Physiological
Responses
– Fight-or-flight response
– Selye’s General Adaptation Syndrome
• Alarm
• Resistance
• Exhaustion
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Responding to Stress Behaviorally

Behavioral Responses
– Frustration-aggression hypothesis
– catharsis
– defense mechanisms

Coping
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Effects of Stress: Behavioral and
Psychological
 Impaired
Task performance
 Burnout
 Posttraumatic
Stress Disorders (PTSD)
 Psychological problems and disorders
 Positive effects
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Fig 13.8 – The prevalence of traumatic events. People tend to think that traumatic events are
relatively unusual and infrequent, but research by Stein et al. (1997) suggests otherwise. They
interviewed over 1000 people in Winnipeg, and found that 74.2% of the women and 81.3% of the
men reported experiencing at least one highly traumatic event. The percentage of respondents
reporting specific types of traumatic events are summarized in this graph.
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Effects of Stress: Physical
Psychosomatic
diseases
Heart disease
– Type A behavior - 3 elements
• strong competitiveness
• impatience and time urgency
• anger and hostility
– Emotional reactions and depression
Stress
and immune functioning
– Reduced immune activity
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Fig 13.10 – Anger and
coronary risk. Working with a
large sample of healthy men
and women who were followed
for a median of 4-5 years,
Williams et al (2000) found an
association between anger and
the likelihood of a coronary
event. Among subjects who
manifested normal blood
pressure at the beginning of
the study, a moderate anger
level was associated with a
36% increase in coronary
attacks and a high level of
anger nearly tripled
participant’s risk for coronary
disease. (Based on data in
Williams et al., 2000)
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Fig 13.12 – The stress-illness correlation. One or more aspects of personality, physiology, or
memory could play the role of a postulated third variable in the relationship between high stress
and high incidence of illness. For example, neuroticism may lead some subjects to view more
events as stressful and to remember more illness, thus inflating the apparent correlation between
stress and illness.
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Factors Moderating the Impact of Stress
 Social support
– Increased immune functioning
 Optimism
– More adaptive coping
– Pessimistic explanatory style
 Conscientiousness
– Fostering better health habits
 Autonomic reactivity
– Cardiovascular reactivity to stress
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Health-Impairing Behaviors
 Smoking
 Poor
nutrition
 Lack of exercise
 Alcohol and drug use
 Risky sexual behavior
 Transmission, misconceptions, and prevention of AIDS
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Fig 13.13 – The prevalence of smoking in the United States. This graph shows how the
percentage of U.S. adults who smoke has declined steadily since the mid-1960’s. Although
considerable progress has been made, smoking still accounts for about 400,000 premature
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deaths each year. (Based on data from the Centers for Disease Control
and Prevention)
Fig 13.14 – Quitting smoking and cancer risk. Research suggests that various types of health
risks associated with smoking decline gradually after people give up tobacco. The data shown
here, from the U.S. Surgeon General’s (1990) report on smoking, illustrate the overall effects on
mortality rates. (Source: U.S. Department of Health Services, 1990)
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Reactions to Illness
 Seeking
treatment
– Ignoring physical symptoms
 Communication
with health care providers
– Barriers to effective communication
 Following
medical advice
– Noncompliance
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Fig 13.17 – Biopsychological factors in health. Physical health can be influenced by a
remarkably diverse set of variables, including biological, psychological, and social factors.
The host of factors that affect health provide an excellent example of
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multifactorial causation.