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PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH

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Health Psychology­ PSY408
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Lecture 18
PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH
Another story...
They were best friends, Joan and Sally, on their way to an art museum a year ago when a car accident ended
their lives. Their husbands, Bob and Walt, were devastated, not only by their individual losses but also for
each other's. These men were also friends--both worked as engineers for the same company and shared
hobbies and other interests. The four of them used to party often, leaving the kids with one babysitter. How
did the terrible loss of their wives affect these men?
The initial impact of their loss was similar, but the amounts of stress that followed were different, Bob's
stress was not as severe as Walt's. One thing that helped Bob was that he had an extended family that lived
nearby. They provided consolation for his grief, a place to go to get out of the house and to socialize, and
help in caring for his children. After school, the kids would go to either Bob's or Joan's parents' house and
Bob would pick them up on his way home from work. Sometimes he and the children would stay there for
dinner. This helped save him time and money--both of which were in short supply. How was Bob doing a
year later? He had made a good adjustment, had a good relationship with his children, was starting to date,
and was in good health.
Walt was not so fortunate. For one thing, he had no nearby family to rely on. Compared to Bob, Walt had
little emotional support in his grief, and being a single parent made his workload and financial situation very
difficult. Walt had little time or money for socializing, and virtually all of his adult contacts were at work.
Although he and Bob often had lunch together, their interests were drifting apart. Unlike Bob, Walt had
never been very outgoing, and he felt awkward and insecure in meeting women. A year after Sally died, he
was isolated and lonely. His relationship with his children was deteriorating, and so was his health. He had
developed migraine headaches, neck problems, and high blood pressure. The stress in Walt's life was taking
its toll.
In this lecture we will be looking at psychosocial factors that can modify the stress people experience. And
we will address some questions about stress and illness that are of great concern today. Why can some
people experience one traumatic event after another without ill effects, but others cannot? Why the same
stressful situation affects some people far more than some others who seem to have received little or no
effect?
Psychosocial Modifiers of Stress
People's reactions to stress vary from one person to the next and from time to time for the same person.
These variations often result from psychological and social factors that seem to modify the impact of
stressors on the individual. Let's look at some of these modifiers, beginning with the role of social support.
Social Support
We saw in the bereavement experiences of Bob and Walt how important social ties and relationships can be
during troubled times. The social support Bob got from his family tempered the impact of his stressful loss
and probably helped him adjust. Social support refers to the perceived comfort, caring, esteem, or help a
person receives from other people or groups. This support can come from many different sources--the
person's spouse or lover, family, friends, coworkers, physician, or community organizations. According to
researcher Sidney Cobb (1976), people with social support believe they are loved and cared for, esteemed
and valued, and part of a social network such as a family or community organization, that can provide
goods, services, and mutual defense in times of need or danger.
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Types of Social Support
What specifically does social support provide to the person? To answer this question, researchers have tried
to classify various types of support. These classifications suggest that there are five basic types of social
support:
1. Emotional support involves the expression of empathy, caring, and concern toward the person. It
provides the person with a sense of comfort, reassurance, belongingness, and being loved in times of stress.
We saw earlier how Bob's family gave him emotional support after the death of his wife.
2. Esteem support occurs through people's expression of positive regard for the person, encouragement or
agreement with the individual's ideas or feelings, and positive comparison of the person with others, such as
people who are less able or worse off. This kind of support serves to build the individual's feeling of self-
worth, competence, and being valued. Esteem support is especially useful during the appraisal of stress,
such as when the person assesses whether the demands exceed his or her personal resources.
3. Tangible or instrumental support involves direct assistance, as when people give or lend the person
money or help out with chores in times of stress. Bob's family helped with childcare, for example, which
reduced the demands on his time and finances.
4. Informational support includes giving advice, directions, suggestions, or feedback about how the person
is doing. For example, a person who is ill might get information from family or a physician on how to treat
the illness. Or someone who is faced with a very difficult decision on the job might receive suggestions or
feedback about his or her ideas from coworkers.
5. Network support provides a feeling of membership in a group of people who share interests and social
activities.
How May Social Support Affect Health?
We have seen that prolonged exposure to high levels of stress can lead to illness. According to the
psychologists, social support affects health by protecting the person against these negative effects of high
stress. It provides a buffer against stress.
How does buffering work?
There are at least two ways. First, when people encounter a strong stressor, such as a major financial crisis,
those who have high levels of social support may be less likely to appraise the situation more stressful than
those with low levels of support. Individuals with high social support may expect that someone they know
will help them, such as by lending money or giving advice on how to get it. As a result, they judge that they
can meet the demands and decide that the situation is not very stressful.
Second, social support may modify people's response to a stressor after the initial appraisal. For instance,
people with high social support might have someone provide a solution to the problem, convince them that
the problem is not very important, or cheer them on to look on the "bright side" or "count their blessings".
People with little social support are much less likely to have any of these advantages--so the negative
impact of the stress is greater for them than for those with high levels of support.
A Sense of Personal Control
Another psychosocial factor that modifies the stress people experience is the degree of control people feel
they have in their lives. People generally like the feeling of having some measure of control over the things
that happen to them, and they take individual action when they want to influence events directly. In doing
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these things, people strive for a sense of personal control--the feelings that they can make decisions and
take effective action to produce desirable outcomes and avoid undesirable ones.
Studies have found that people who have a strong sense of personal control report experiencing less strain
from stressors.
Types of Control
How can feelings of personal control reduce the stress people experience? Let's see by considering the
process of giving birth--a stressful event. Women who attend natural childbirth classes learn many
techniques that enhance their personal control in the birth process. They, like other people in stressful
situations, can influence events in their lives and reduce the stress they experience in many ways. These
ways include four types of control:
1. Behavioral control involves the ability to take concrete action to reduce the impact of a stressor. This
action might reduce the intensity of the event or shorten is duration. During childbirth, for example, the
mother can use special breathing techniques that reduce the pain of labor.
2. Cognitive control is the ability to use thought processes or strategies to modify the impact of a stressor.
These strategies can include thinking about the event differently or focusing on a pleasant or neutral
thought or sensation. While giving birth, for instance, the mother might think about the event differently by
going over in her mind the positive meanings the baby will give to her life. Or she could focus her attention
on the sensation of the baby's movements or on an image, such as a pleasant day at the beach.
3. Decisional control is the opportunity to choose between alternative procedures or courses of action. The
mother and father have many choices to make about the birth process before it occurs. For many of these
decisions, the mother usually has the final word--such as in the choice of the obstetrician, whether to use
conventional or natural childbirth methods, and whether the birth will occur in a hospital, at home, or at an
alternative birth center. In other medical situations, the patient may be given a choice regarding which
treatment procedure to use, when the treatment will occur, and so on.
4. Informational control involves the opportunity to get knowledge about a stressful event--what will
happen, why, and what the consequences are likely to be. For example, a pregnant woman may get
information about the sensations she will experience during labor and delivery, the procedures she can
expect to happen, and the range of time the process generally takes. Informational control can help reduce
stress by increasing the person's ability to predict and be prepared for what will happen and by decreasing
the fear people often have of the unknown.
Each of these types of control can reduce stress, but one of them--cognitive control--seems to have the
most consistently beneficial effect.
When People Lack Personal Control
What happens to people who experience high levels of stress over a long period of time and feel that
nothing they do matter? They feel helpless--trapped and unable to avoid negative outcomes. A worker who
cannot seem to please his boss no matter what he does, a student who cannot perform well on exams
despite all the effort, or a patient who is unable to relieve his severe low back pain--each of these situations
can produce apathy. As a result, these people may stop striving for these goals, come to believe they have
no control over these and other events in their lives, and fail to exert control even when they could succeed.
This is the condition Martin Seligman (1975) has called learned helplessness--which he describes as a
principal characteristic of depression.
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Personal Control and Health
There are two ways in which personal control and health may be related. First, people who have a strong
sense of personal control may be more likely or able to maintain their health and prevent illness than those
who have a weak sense of control. Second, once people become seriously ill, those who have a strong sense
of control may adjust to the illness and promote their own rehabilitation better than those who have a weak
sense of control.
To summarize the material on personal control, people differ in the degree to which they believe they have
control over the things that happen in their lives. People who experience prolonged, high levels of stress
and lack a sense of personal control tend to feel helpless. Having a strong sense of control seems to benefit
people's health and help them adjust to becoming seriously ill. A sense of personal control contributes to
people's hardiness, which is the next psychosocial modifier of stress we will examine.
Hardy and Resilient Personality
According to researchers, individual differences in personal control provide only part of the reason why
some people who are under stress get sick whereas others do not. They have proposed that a broader array
of personality characteristics--called hardiness-- differentiates people who do and do not get sick under
stress.
Hardiness includes three characteristics:
(1) Control refers to people's belief that they can influence events in their lives--that is, a sense of personal
control.
(2) Commitment is people's sense of purpose or involvement in the events, activities, and people in their
lives. For instance, people with a strong sense of commitment tend to look forward to starting each day's
projects and enjoy getting close to people.
(3) Challenge refers to the tendency to view changes as incentives or opportunities for growth rather than
threats to security.
Another trait--resilience----seems to include high levels of three components: self-esteem, personal
control, and optimism (Major et al., 1998). Resilient people appraise negative events as less stressful: they
bounce back from life's adversities and recover their strength and spirit. For example, resilient children
develop into competent, well-adjusted individuals despite growing up under extremely difficult conditions.
Type A Behavior
What is the Type A behavioral and emotional style? The Type A behavior pattern consists of three
characteristics:
1. Competitive achievement orientation. Type A individuals tend to be very self-critical and to strive toward
goals without feeling a sense of joy in their efforts or accomplishments.
2. Time urgency. Type A people seem to be in a constant struggle against the clock. Often, they quickly
become impatient with delays and unproductive time, schedule commitments too tightly, and try to do
more than one thing at a time, such as reading while eating or watching TV.
3. Anger/hostility. Type A individuals tend to be easily aroused to anger or hostility, which they may or may
not express overtly.
In contrast, the Type B behavior pattern consists of low levels of competitiveness, time urgency, and
hostility. People with the Type B pattern tend to be more easygoing and philosophical about life--they are
more likely to "stop and smell the roses".
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As a summary of the role of psychosocial modifiers of stress, we have seen that social support, personal
control, hardiness, and the Type A and B behavior patterns are factors that can modify the impact of stress
on health. High levels of social support, personal control, and hardiness are generally associated with
reduced stress and resulting illnesses; Type A behavior is associated with increased stress and illness.
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Table of Contents:
  1. INTRODUCTION TO HEALTH PSYCHOLOGY:Health and Wellness Defined
  2. INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages
  3. INTRODUCTION TO HEALTH PSYCHOLOGY:Psychosomatic Medicine
  4. INTRODUCTION TO HEALTH PSYCHOLOGY:The Background to Biomedical Model
  5. INTRODUCTION TO HEALTH PSYCHOLOGY:THE LIFE-SPAN PERSPECTIVE
  6. HEALTH RELATED CAREERS:Nurses and Physician Assistants, Physical Therapists
  7. THE FUNCTION OF NERVOUS SYSTEM:Prologue, The Central Nervous System
  8. THE FUNCTION OF NERVOUS SYSTEM AND ENDOCRINE GLANDS:Other Glands
  9. DIGESTIVE AND RENAL SYSTEMS:THE DIGESTIVE SYSTEM, Digesting Food
  10. THE RESPIRATORY SYSTEM:The Heart and Blood Vessels, Blood Pressure
  11. BLOOD COMPOSITION:Formed Elements, Plasma, THE IMMUNE SYSTEM
  12. SOLDIERS OF THE IMMUNE SYSTEM:Less-Than-Optimal Defenses
  13. THE PHENOMENON OF STRESS:Experiencing Stress in our Lives, Primary Appraisal
  14. FACTORS THAT LEAD TO STRESSFUL APPRAISALS:Dimensions of Stress
  15. PSYCHOSOCIAL ASPECTS OF STRESS:Cognition and Stress, Emotions and Stress
  16. SOURCES OF STRESS:Sources in the Family, An Addition to the Family
  17. MEASURING STRESS:Environmental Stress, Physiological Arousal
  18. PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH
  19. HOW STRESS AFFECTS HEALTH:Stress, Behavior and Illness, Psychoneuroimmunology
  20. COPING WITH STRESS:Prologue, Functions of Coping, Distancing
  21. REDUCING THE POTENTIAL FOR STRESS:Enhancing Social Support
  22. STRESS MANAGEMENT:Medication, Behavioral and Cognitive Methods
  23. THE PHENOMENON OF PAIN ITS NATURE AND TYPES:Perceiving Pain
  24. THE PHYSIOLOGY OF PAIN PERCEPTION:Phantom Limb Pain, Learning and Pain
  25. ASSESSING PAIN:Self-Report Methods, Behavioral Assessment Approaches
  26. DEALING WITH PAIN:Acute Clinical Pain, Chronic Clinical Pain
  27. ADJUSTING TO CHRONIC ILLNESSES:Shock, Encounter, Retreat
  28. THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS:Asthma
  29. IMPACT OF DIFFERENT CHRONIC CONDITIONS:Psychosocial Factors in Epilepsy