Chapter 15.pdf

chapter

Health, Stress, and Coping

THEME:

Health is affected greatly by

lifestyle and behavior

patterns, especially those

related to stress.

Key Questions

What is health psychology? How does

behavior affect health?

What are defense mechanisms?

What do we know about coping with

feelings of helplessness and depression?

What is stress? What factors determine

its severity?

How is stress related to health and

disease?

What causes frustration and what are

typical reactions to it?

What are the best strategies for manag-

ing stress?

Are there different types of conﬂ ict? How

do people react to conﬂ ict?

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Health, Stress, and Coping

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Preview

Taylor’s (Not So Very) Fine Adventure

Somehow, Taylor had managed to survive the rush of make-

or-break term papers, projects, and classroom speeches.

Then it was on to ﬁ nals, where his tests seemed perfectly

timed to inﬂ ict as much suffering as possible. His two

hardest exams fell on the same day! Great. What luck!

On the last day of ﬁ nals, Taylor got caught in a trafﬁ c

jam on his way to school. Two drivers cut him off, and

another gave him a one-ﬁ nger salute. When Taylor ﬁ nally

got to campus the parking lot was swarming with frantic

students. Most of them, like him, were within minutes of

missing a ﬁ nal exam. At last, Taylor spied an empty space.

As he started toward it, a Volkswagen darted around the

corner and into “his” place. The driver of the car behind

him began to honk impatiently. For a moment, Taylor was

seized by a colossal desire to run over anything in sight.

Finally, after a week and a half of stress, pressure, and

frustration, Taylor’s ﬁ nals were over. Sleep deprivation,

gallons of coffee, junk food, and equal portions of

cramming and complaining had carried him through. He

was off for the summer. At last, he could kick back, relax,

and have some fun. Or could he? Just four days after the

end of school, Taylor got a bad cold, followed by bronchitis

that lasted for nearly a month.

Taylor’s experience illustrates what happens when stress,

emotion, personal habits, and health collide. Although the

timing of his cold might have been a coincidence, odds

are it wasn’t. Periods of stress are frequently followed by

illness (Biondi & Zannino, 1997).

In the ﬁ rst part of this chapter we will explore a variety

of behavioral health risks. Then we will look more closely

at what stress is and how it affects us. After that, we will

stress ways of coping with stress, so you can do a better

job of staying healthy than Taylor did.

Health Psychology—Here’s

to Your Good Health

personal habits. Examples include heart disease, stroke, and lung

cancer (McGinnis & Foege, 1993) ( ● Figure 15.1). Clearly, some

lifestyles promote health, whereas others lead to illness and death.

As one observer put it, “We have met the enemy and he is us.”

What kinds of behavior are you referring to as unhealthy? Some

causes of illness are beyond our control, but many behavioral

risks can be reduced. Behavioral risk factors are actions that in-

crease the chances of disease, injury, or early death. For example,

approximately 435,000 people die every year from smoking-

related diseases. Similarly, being overweight doubles the chance of

dying from cancer or heart disease. Roughly 60 percent of all

American adults are overweight. As a result, obesity may soon

overtake smoking as the main cause of preventable deaths. Being

fat is not just a matter of fashion—in the long run it could kill

Health is priceless. It’s also free. Despite the high cost of health-

care, one of the most important sources of health is free for the

taking. Health psychologists have shown that many of the dis-

eases that bedevil us are caused by unhealthy behavior. Let’s see

which personal habits contribute the most to leading a long,

healthy, and happy life.

Most people agree that health is important—especially their

own. Yet half of all deaths in North America are primarily due to

unhealthy behavior (Mokdad et al., 2004). Health psychology

aims to do something about such deaths by using behavioral prin-

ciples to promote health and prevent illness. Psychologists work-

ing in the allied ﬁ eld of behavioral medicine apply psychology

to manage medical problems, such as diabetes or asthma. Their

interests include pain control, helping people cope with chronic

illness, stress-related diseases, self-screening for diseases (such as

breast cancer), and similar topics (Brannon & Feist, 2004).

Health psychology Study of the ways in which behavioral

principles can be used to prevent illness and promote health.

Behavioral medicine The study of behavioral factors in

medicine, physical illness, and medical treatment.

Lifestyle disease A disease related to health-damaging personal

habits.

Behavioral risk factors Behaviors that increase the chances of

disease, injury, or premature death.

Behavioral Risk Factors

Around the turn of the twentieth century, people primarily died

from infectious diseases and accidents. Today, people generally

die from lifestyle diseases, which are related to health-damaging

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498

CHAPTER 15

TABLE 15.1

Cause of death

Tobacco

Percentage of U.S. High School Students Who Engaged

in Health-Endangering Behaviors

Diet/inactivity

Alcohol

RISKY BEHAVIOR

PERCENTAGE

Infection

Rode with drinking driver (previous month)

Were in a physical ﬁ ght (previous year)

Toxic agents

Carried a weapon (previous month)

Firearms

Had ﬁ ve or more drinks on one occasion

(previous month)

Sexual behavior

Motor vehicles

Have used marijuana

Illicit use of drugs

Have engaged in sexual intercourse

Did not use condom during last sexual intercourse

Percentage of all deaths

● Figure 15.1 The nine leading causes of death in the United States are

shown in this graph. As you can see, eight of the top nine causes are directly

related to behavioral risk factors (infection is the exception). At least half of

all deaths can be traced to unhealthful behavior. The percentage of day-to-

day health problems related to unhealthful behavior is even higher (Mokdad

et al., 2004). (Data from McGinnis & Foege, 2002.)

Smoked cigarettes (previous month)

Ate high-fat food (previous day)

No vigorous exercise (previous week)

Kolbe, Collins, & Cortese, 1997.

you. A person who is overweight at age 20 can expect to lose 5 to

20 years of life expectancy (Fontaine et al., 2003).

Each of the following factors is a major behavioral risk (Baum &

Posluszny, 1999): high levels of stress, untreated high blood pres-

sure, cigarette smoking, abuse of alcohol or other drugs, overeat-

ing, inadequate exercise, unsafe sexual behavior, exposure to toxic

substances, violence, excess sun exposure, reckless driving, and

disregarding personal safety (accidents). Seventy percent of all

medical costs are related to just six of the listed factors—smoking,

alcohol and drug abuse, poor diet, insufﬁ cient exercise, and risky

sexual practices (Orleans, Gruman, & Hollendonner, 1999).

■ Table 15.1 shows how many high school students in the

United States engage in risky behaviors of the kind listed here.

The health habits you have by the time you are 18 or 19 greatly

affect your health, happiness, and life expectancy years later

(Vaillant & Mukamal, 2001).

Speciﬁ c risk factors are not the only concern. Some people

have a general disease-prone personality that leaves them de-

pressed, anxious, hostile, and . . . frequently ill. In contrast, peo-

ple who are intellectually resourceful, compassionate, optimistic,

and non-hostile tend to enjoy good health (Taylor et al., 2000).

Depression, in particular, is likely to damage health. People who

are depressed eat poorly, sleep poorly, rarely exercise, fail to use

seat belts in cars, smoke more, and so on (Allgower, Wardle,

Steptoe, 2001).

cally raising the chance of illness. If stress is a frequent part of

your life, visualize your body seething with emotion, day after

day. If you smoke, picture a lifetime’s worth of cigarette smoke

blown through your lungs in a week. If you drink, take a lifetime

of alcohol’s assaults on the brain, stomach, and liver and squeeze

them into a month: Your body would be poisoned, ravaged, and

soon dead. If you eat a high-fat, high-cholesterol diet, fast-

forward a lifetime of heart-killing plaque clogging your arteries.

This discussion is not meant to be a sermon. It is merely a re-

minder that risk factors do make a difference. To make matters

Lifestyle

In your mind’s eye, fast-forward an imaginary ﬁ lm of your life all

the way to old age. Do it twice—once with a lifestyle including a

large number of behavioral risk factors, and again without them.

It should be obvious that many small risks can add up, dramati-

In the long run, behavioral risk factors and lifestyles do make a difference in

health and life expectancy.

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499

one who has had a heart attack or lung disease who couldn’t

change the habits that led to their illness.

In some cases, diseases can be treated or prevented by making

relatively minor, but very speciﬁ c changes in behavior. For exam-

ple, hypertension (high blood pressure) can be deadly. Yet for

some people simple lifestyle changes will fend off this “silent

killer.” Here’s the recipe for lower blood pressure: lose weight,

consume less sodium (salt), use alcohol sparingly, and get more

exercise (Georgiades et al., 2000).

In addition to removing risk factors, psychologists are inter-

ested in getting people to increase behaviors that promote health.

Health-promoting behaviors include such obvious practices as

getting regular exercise, controlling smoking and alcohol use,

maintaining a balanced diet, getting good medical care, and man-

aging stress (Glik, Kronenfeld, & Jackson, 1996). In fact, a recent

medical study revealed that just four of these factors can greatly

increase life expectancy. The risk of dying was cut by 65 percent

during a 10-year period for adults who were careful about diet, al-

cohol, exercise, and smoking (Knoops et al., 2004).

Do health-promoting behaviors seem restrictive or burden-

some? They don’t have to be. For instance, maintaining a healthy

diet doesn’t mean surviving on tofu and wheat grass. The healthi-

est people in the study just described ate a tasty “Mediterranean

diet,” high in fruit, vegetables, and ﬁ sh and low in red meat and

dairy products. Likewise, you don’t need to exercise like an Olym-

pic athlete to beneﬁ t from physical activity. All you need is 30

minutes of exercise (the equivalent of a brisk walk) three or four

times a week. Almost everyone can ﬁ t such “lifestyle physical ac-

tivity” into his or her schedule (Pescatello, 2001).

What about alcohol? Moderation in drinking doesn’t mean that

you must be a teetotaler. Consuming one or two alcoholic drinks

per day is generally safe for most people, especially if you remain

alcohol free two or three days a week. However, having three or

more drinks a day greatly increases the risk of stroke, cirrhosis of

the liver, cancer, high blood pressure, heart disorders, and other

diseases (Knoops et al., 2004).

To summarize, a small number of behavioral patterns accounts

for many common health problems (Kolbe, Collins, & Cortese,

1997). ■ Table 15.2 lists several major ways to promote good

health.

TABLE 15.2

Major Health-Promoting Behaviors

SOURCE

DESIRABLE BEHAVIORS

Nutrition

Eating a balanced, low-fat diet;

appropriate caloric intake; main-

tenance of healthy body weight

Exercise

At least 30 minutes of aerobic

exercise, 5 days per week

Blood pressure

Lower blood pressure with diet

and exercise, or medicine if

necessary

Alcohol and drugs

No more than two drinks per

day; abstain from using drugs

Tobacco

Do not smoke; do not use

smokeless tobacco

Sleep and

Avoid sleep deprivation; provide

relaxation

for periods of relaxation every

day

Sex

Practice safer sex; avoid un-

planned pregnancy

Injury

Curb dangerous driving habits,

use seat belts; minimize sun

exposure; forgo dangerous

activities

Stress

Learn stress management; lower

hostility

worse, unhealthy lifestyles almost always create multiple risks.

That is, people who smoke are also likely to drink excessively.

Those who overeat usually do not get enough exercise, and so on

(Emmons et al., 1998). Even infectious diseases are often linked to

behavioral risks. For example, pneumonia and other infections

occur at high rates in people who have cancer, heart disease, lung

disease, or liver disease. Thus, many deaths attributed to infec-

tions can actually be traced to smoking, poor diet, or alcohol

abuse (Mokdad et al., 2004).

Early Prevention

Of the behavioral risks we have discussed, smoking is the largest

preventable cause of death and the single most lethal factor

(Mokdad et al., 2004). As such, it illustrates the prospect for pre-

venting illness.

Health-Promoting Behaviors

To prevent disease, health psychologists ﬁ rst try to remove behav-

ioral risk factors. All the medicine in the world may not be enough

to restore health without changes in behavior. We all know some-

Disease-prone personality A personality type associated with

poor health; marked by persistent negative emotions, including

anxiety, depression, and hostility.

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CHAPTER 15

What have health psychologists done to lessen the risks? Attempts

to “immunize” youths against pressures to start smoking are a

good example. The smoker who says, “Quitting is easy, I’ve done

it dozens of times,” states a basic truth—only one smoker in ten

has long-term success at quitting. Thus, the best way to deal with

smoking is to prevent it before it becomes a lifelong habit. For ex-

ample, school-based prevention programs have used quizzes

about smoking, antismoking art contests, poster and T-shirt give-

aways, antismoking pamphlets for parents, and questions for stu-

dents to ask their parents (Biglan et al., 1996). Such efforts are de-

signed to persuade kids that smoking is dangerous and “uncool.”

Apparently, many teens are getting the message, as attitudes to-

ward smoking are now more negative than they were twenty years

ago (Chassin et al., 2003).

Some of the best antismoking programs include refusal skills

training. In this case, youths learn to resist pressures to begin

smoking (or using other drugs). For example, junior high students

can role-play ways to resist smoking pressures from peers, adults,

and cigarette ads. Similar methods can be applied to other health

risks, such as sexually transmitted diseases and teen pregnancy

(Wandersman & Florin, 2003).

The latest health programs also teach students general life

skills. The idea is to give kids skills that will help them cope

with day-to-day stresses. That way, they will be less tempted to

escape problems through drug use or other destructive behaviors.

Life skills training includes practice in stress reduction, self-

protection, decision making, goal setting, self-control, and social

skills (Tobler et al., 2000).

People who enjoy a sense of well-being also have supportive

relationships with others, they do meaningful work, and they

live in a clean environment. Many of these aspects of wellness

are addressed elsewhere in this book. In this chapter we will give

special attention to the effect that stress has on health and sick-

ness. Understanding stress and learning to control it can improve

not only your health, but the quality of your life as well (Suinn,

2001). For these reasons, a discussion of stress and stress manage-

ment follows.

KNOWLEDGE BUILDER

Health Psychology

REFLECT

If you were to work as a health psychologist would you be more

interested in preventing disease or managing it?

Make a list of the major behavioral risk factors that apply to

you. Are you laying the foundation for a lifestyle disease?

Which of the health-promoting behaviors listed in Table 15.2

would you like to increase?

If you were designing a community health campaign, who

would you use as role models of healthful behavior?

LEARNING CHECK

1. Adjustment to chronic illness and the control of pain are

topics that would more likely be of interest to a specialist in

_____________________________ _______________________

rather than to a health psychologist.

2. With respect to health, which of the following is not a major

behavioral risk factor?

Community Health

In addition to early prevention, health psychologists have had

some success with community health campaigns. These are

community-wide education projects designed to lessen major risk

factors. Health campaigns inform people of risks such as stress,

alcohol abuse, high blood pressure, high cholesterol, smoking,

STDs, or excessive sun exposure. This is followed by efforts to mo-

tivate people to change their behavior. Campaigns sometimes

provide role models (positive examples) who show people how to

improve their own health. They also direct people to services for

health screening, advice, and treatment. Health campaigns may

reach people through the mass media, public schools, health fairs,

their work, or self-help programs. Such programs are increasingly

successful in helping people make healthful changes in their be-

havior (Orleans, 2000).

a. overexercise

c. stress

b. cigarette smoking

d. high blood pressure

3. Lifestyle diseases related to just six behaviors account for 70

percent of all medical costs. The behaviors are smoking, alco-

hol and drug abuse, poor diet, insufﬁ cient exercise, and

a. driving too fast

c. unsafe sex

b. excessive sun exposure

d. exposure to toxins

4. Health promoting behaviors that combat hypertension include

the following: lose weight, consume less sodium, use alcohol

sparingly, and get more

a. sleep

c. carbohydrates

b. exercise

d. cholesterol

5. Health psychologists tend to prefer ______________________

rather than modifying habits (like smoking) that become dif-

ﬁ cult to break once they are established.

6. The disease-prone personality is marked by ________________

__________, anxiety, and hostility.

CRITICAL THINKING

7. The general public is increasingly well informed about health

risks and healthful behavior. Can you apply the concept of

reinforcement to explain why so many people fail to act on

this information?

Positive Psychology: Wellness

Health is not just an absence of disease. People who are truly

healthy enjoy a positive state of wellness or well-being. Main-

taining wellness is a life-long pursuit and, hopefully, a labor of

love. People who attain optimal wellness are both physically

and psychologically healthy. They are happy, optimistic, self-

conﬁ dent individuals who can bounce back emotionally from ad-

versity (Tugade, Fredrickson, & Barrett, 2004).

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