Transcript Document

Class 9
Stress II, Continued
and
Psychoneuroimmunology
Checking In and Updates
Daily Diaries: Complete this start of class
Mid-term:
1. ONLY covers what we covered in class.
2. Midterm format: Multiple Choice, Short Answer
3. How to study:
a. Power Point Slides
b. Use slides to structure readings/studying
4. Dates:
a. Midterm Review: March 6
b. Midterm: March 11
Measuring Stress
How could stress be measured?
Stress Over the Past Year
(A Home Grown Scale for This Class)
Over the past 12 months, how much stress did you experience, overall?
___ 1.
___ 2.
___ 3.
___ 4.
___ 5.
___ 6.
___ 7.
None or almost none
Far less than usual
Somewhat less than usual
Same as usual
More than usual
Far more than usual
An extreme amount
Problems with this measure?
Definitions of “House”
House as object
2400 sq feet,
large back lot,
aged heating and plumbing
Colonial style
House as place
Where grandparents settled after WW II
Where mom and Uncle Joe were born
Where we had 4th of July every year
Where Suzy learned to drive.
Definitions of “Stress”
Stress as Event
Number of tasks due
Clarity re. stressors
Degree of control
Consequences of failure
Stress as Experience
How confident I feel.
How overwhelmed I feel
Point: How a thing is defined affects how it is understood. Defining stress in terms of
events (Holmes & Rahe) vs. in terms of how people feel about events (Cohen, et al).
Social Readjustment Scale
Holmes & Rahe, 1967
In the past year, have you experienced:
1. __ Death of a spouse/partner 100
26. __ Wife starting/ending work 26
2. __ Divorce 73
29. __ Change in personal habits 24
3. __ Marital separation 65
32. __ Change in residence 20
7. __ Marriage 50
33. __ Change to a new school 20
8. __ Being fired 47
35. __ Change in church activities 19
17.__ Death of a close friend 37
36. __ Change in social activities 18
18.__ Changing to different work 36
38. __ Change in sleeping habits 16
19.__ Change in # spouse arguments 35
41. __ Vacation 13
20.__ Taking a loan on house 31
43. __ Minor law issue (ticket, etc.) 11
CRITIQUE OF
SOCIAL READJUSTMENT RATING SCALE
(Holmes & Rahe, 1967)
1. Vague terms
2. Numeric values
3. Relevance across populations
4. Doesn’t distinguish between pos and neg events
5. Doesn't consider how well event was resolved
6. Individual diffs. in propensity to mark events
7. Memory lapses
SUBJECTIVE STRESS MEASURE
Cohen, Kamarck, & Mermelstein, (1983)
For each question, choose from the following alternatives:
0
Never
1
Almost never
2
Sometimes
3
Fairly often
4
Very often
1. In the past month, how often have you been upset because of something
that happened unexpectedly?
2. In the last month, how often have you felt nervous and “stressed”?
3. In the last month, how often have you found that you could not cope with
all the things that you had to do?
4. In the last month, how often have you been angered because of things that
were out of your control?
Hassles
The Measurement of Hassles
Kanner, et al. 1981
Severity
1. somewhat severe
2. moderately severe
3. extremely severe
1.
2.
3.
4.
Misplacing or losing things.
Troublesome neighbors.
Social obligations.
Inconsiderate smokers.
1
1
1
1
2
2
2
2
3
3
3
3
5. Thoughts about death.
6. Health of a family member.
1
1
2
2
3
3
“Unspoken” Danger of Hassles?
Joey, did Gramps tell you
about the Great Flood of
1934?
Joey, did Gramps tell you
about the day the cable
guy never came?
Disclosing major events health benefit—but normal
“hassles” don’t merit disclosing.
Chronic Stress and Acute Stress
Chronic
Acute
On-going illness
Natural disaster
Family responsibilities
Childhood sexual abuse
Workload
Auto accident
Environmental noise
Job loss
Financial worries
Loss of loved one
Workplace Stress
Workplace stress is most common,
most preventable, chronic stressor
What are elements of workplace stress?
Overload: perception more important than total hours.
Time pressure: Time pressed 3X more likely to die early
Role conflict /ambiguity: Japanese baseball interpreters
Social isolation: Higher catecholamines, higher BP
Lack of control: Person/environment fit. Leads to coronary heart disease
Class 9
Psychoneuroimmunology
Psychoneuroimmunology
The relationship between psychological processes and the
activities of the nervous, endocrine, and immune systems.
Immune System Review
Primary function: Distinguish self from non-self, attack foreign elements.
Main components:
Humoral response – anti-bacterial, prevent viral re-infection
Cell-mediated response – T cells from Thymus gland, Tc respond to
specific antigens, produce anti-antigen toxins.
Other blood components
Immunocompetence and Immunocompromise
Immunocompetence: How well immune system is working
Assessment:
a. Quantities of immune agents (T cells, white blood cells)
b. Functioning of immune agents
1. Activity
2. Proliferation
3. Transformation
4. Cytotoxicity
Immunocompromise: When immune system is impaired
Key Point: Stress can lead to immunocompromise
Stress and Immune Functioning
Stress and immunocompetence shown in:
Animal studies: stressed rats display immune dysfunction
Observations: TB pats’ white blood cells less robust after stress
Accumulated Research: 38 studies show more stress 
immunocompromise
The bigger the stressor, the worse the compromise.
Hurricane Andrew (1992), NK cell cytotoxicity
decreases. Tied to lack of sleep.
NOTE: This outcome fits which with measure
X
____Holmes
& Rahe ___ Cohen et al.
Stress-Induced Immunocompromise and Illness
Stress  Immunocompromise  colds, flu, herpes flare-ups
Daily hassles  reduced NK activity
Anticipatory stress  less robust TH cells. Mt. St. Helens/Pennebaker
School stress: 5 yr olds show increased cortisol, immunocompromise,
upon starting kindergarten. Esp. if earthquate co-occurs!
Social Relations, Stress, and Illness
Personal relationships are key moderators of stress/illness connection.
(More on this when we discuss Social Support)
Rat pups separated from mothers show
immunocompromise
Social Conditions linked to illness?
Bereavement
(but mainly if linked to depression)
Loneliness
Marital separation
Spitz Foundling Home Studies
René Spitz
Orphaned babies, in foundling homes, all material needs met
Do not have an emotional care-giver
Tragically high levels of grief
Highly susceptible to disease
High mortality rate
DEPRIVATION DWARFISM
Social Connections as a Health Risk
Newlyweds Study
90 newlywed couples, discuss marital problems
Style of discussion coded as:
a. Negative/hostile
b. Positive/collaborative
Assessed immune functioning after discussions.
Which group shows immunocompromise?
X Neg/hostile ___ Pos/collaborative
____
Caregivers of chronically ill
Produce fewer immune agents, wounds heal slowly, weaker
reaction to flu vaccine. Why?
Relation Between Stress and Health Not Perfect
Mediators
Mediator: If A  B  C, then “B” is what mediates
the relation between A and C.
B
A
C
Immunocompromise
Stress
Illness
Moderators
A
B
Stress
Social Isolation
C
Illness
Stress * Social Isolation
A*B
12
Days Ill Per Year
10
8
Low Isolation
Med Isolation
Much Isolation
6
4
2
0
Low Stress Med Stress
Much
Stress
Moderators of the
Stress and Health Connection
Physical Constitution
1. Genetic make-up
2. Age
3. Material resources
Behavior
1.
2.
3.
4.
5.
Sleep
Diet
Substance abuse
Isolation
Exercise
Personality
Personality Moderators of the
Stress  Illness Connection
1.
2.
3.
4.
5.
6.
7.
Negative affect
Optimism and pessimism
Hardiness
Self-efficacy
Hostility
Depression
Coping styles
The Coping Sequence
Stressor
Moderators
Primary Appraisal
(Harm, Threat, Challenge)
Tangibles
Social Support
Other life stressors
External Resources and
Impediments
Internal Resources and
Impediments
Secondary Appraisal
Coping Tasks/Goals
Coping Outcomes
Moderators
Typical coping style
Other personality
factors
Negative Affect
(Watson, Clark, & Tellegen)
Defined: Pervasive negative mood marked by anxiety, depression,
and hostility.
Find many situations difficult to manage
Resort to unhealthy coping behaviors (such as?)
Related to poor health: asthma, arthritis, ulcers, headaches, CHD
Related to excess complaining:
a.
b.
c.
d.
More symptoms
Higher use of health services
Higher rates of self-reported illness
These people may compromise validity of self-reported illness