Stress og mestring

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

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

© 2008 The McGraw-Hill Companies, Inc. All rights reserved.

DIREKTEEFFEKTMODELL

Objektive hendelser

Fysiologisk aktivering

Sykdom

DIRECT EFFECTS MODEL

Objective events

Physiological activation

Illness

INTERAKSJONSMODELL Objektive hendelser

Mestringsresponser

Personlighet

Fysiologisk aktivering

Sykdom

INTERACTION MODEL Objective events

Coping responses

Personality

Physiological activation

Illness

TRANSAKSJONSMODELL Sykdom

Fysiologisk aktivering

Objektive hendelser

Vurdering som truende

Mestringsresponser

Personlighet

TRANSACTIONAL MODEL Illness

Physiological activation

Objective events

Appraisal as threatening

Coping responses

Personality

HELSEATFERDSMODELL

Personlighet

Objektive hendelser

Vurdering som truende

Helseatferd

Sykdom

Mestringsresponser

Fysiologisk aktivering

HEALTH BEHAVIOR MODEL

Personality

Objective events

Appraisal as threatening

Health behavior

Illness

Coping responses

Physiological activation

PREDISPOSISJONSMODELL Sykdom

Predisposisjon

Fysiologisk reaktivitet

Personlighet

PREDISPOSITION MODEL Illness

Predisposition

Physiological reactivity

Personality

SYKDOMSATFERDSMODELL Symptomrapport

Normal kroppsoppmerksomhet

Forhøyet oppmerksomhet

Sykdomsoppfatning

Personlighet

Helseatferd

ILLNESS BEHAVIOR MODEL Symptom report

Normal physiological sensations

Heightened awareness

Labeling as illness

Personality

Health behavior

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

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

© 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

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

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

© 2008 The McGraw-Hill Companies, Inc. All rights reserved.

TYPER STRESS  Akutt stress • Plutselig hendelse

 Episodisk akutt stress • Gjentakende hendelser

 Traumatisk stress • Svært belastende akutte hendelser • PTSD

 Kronisk stress • Vedvarende situasjon

VARIETIES OF STRESS  Acute stress • Sudden event

 Episodic acute stress • Repeating events

 Traumatic stress • Highly disturbing sudden events • PTSD

 Chronic stress • Lasting situation

© 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

EVENT APPRAISALS  Primary 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

© 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

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 © 2008 The McGraw-Hill Companies, Inc. All rights reserved.

ATTRIBUSJONSSTIL  Pessimistisk • 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

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

© 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

© 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

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

© 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

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 © 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

ILLUSORY MENTAL HEALTH Method

Clinical Evaluation

Good

Poor

Good

Good mental health

Illusory mental health

Poor

Poor self representation

Poor mental health

Self report

ILLUSORY MENTAL HEALTH

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

TYPE A OG HJERTE-/KARSYKDOM  Atferdsmønster • Konkurranseorientert prestasjonsmotivasjon • Hastverk • Fiendtlighet og aggressivitet

 Fiendtlighet viktigste prediktor for hjerte/karsykdommer

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

© 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

© 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

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

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

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

TYPE A ATFERDSMØNSTER  Skade på arteriene • 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

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