Appraisal, Coping, and Health

Question 1

Modulators of the Stress Response

Answer 1

Appraisal of event
how you cope
how you feel (and how you manage those feelings)
social support and status

Question 2

Stress and Coping Model

Answer 2

process that determines your psychological response to the stressor

Appraisal: Primary and Secondary
Coping
Outcome

(Lazarus and Folkman, 1984)

Question 3

Stress and Coping Model: Primary Appraisal

Answer 3

what is at stake?

• Nothing/irrelevant
• Benign/positive
• stressful

“is there anything I need to be worried about?”

Question 4

Stress and Coping Model: Secondary Appraisal

Answer 4

particularly relevant if, in your primary appraisal, there is something stressful going on
what can I do? what are my coping options?

Question 5

Stress and Coping Model: Coping

Answer 5

cognitive and behavioral efforts to manage the situation and one’s emotional response to it

Question 6

Stress and Coping Model: Outcome

Answer 6

emotional adjustment

health

Question 7

Key Dimensions of stress appraisal linked to biology

Answer 7

threat and challenge
can I control it?
are people evaluating me? (this isn’t in the Lazarus and Folkman model)

Question 8

Threat and Challenge appraisals

Answer 8

Combination of primary and secondary appraisal:

• is there something at stake for me in this situation? yes (answer in either threat or challenge)
• do I have the resources to meet it?
  threat: no I don’t
  challenge: yes I do

Question 9

Threat Appraisals

Answer 9

Insufficient resources to meet situational demands (you’re doing something that you care about and feel like you don’t have what it takes to manage)

• eg taking an exam that you haven’t studied for
• associated with feelings of stress, worry and fear
• results in less efficient cardiac output (heart not pumping blood well in the context of threat - this is similar to when you “freeze” in the presence of a predator not to be seen)

Question 10

Challenge appraisals

Answer 10

resources are sufficient to meet situational demands

• eg taking an exam that you feel well prepared for
• associated with feelings of challenge and control
• results in more efficient cardiac output and greater blood flow to periphery (same pattern seen during aerobic exercise - thought to represent efficient mobilization of energy for coping)

Question 11

Threat, challenge and cortisol study

Answer 11

threat AND challenge appraisals are associated with elevated cortisol response to acute stress - this is how you feel BEFORE you do the task

• both threat and challenge influence cortisol output in response to stress task
• although you get different effects on the cardiovascular system in response to threat or challenge appraisal, this suggests that you get the same reaction on the HPA axis regardless of threat or challenge - it care if you feel threatened or challenged, just if you’re feeling a lot of either one you’re mobilizing a more effective response

those who found the task both threatening and challenging, the task elicits a high cortisol response than the Low threat/challenge group

may be hard to get good ACCURATE self-report measures because of multiple reasons - people’s appraisals don’t really match with their biological responses

Question 12

control appraisals

Answer 12

thought to be a key regulator of physiological responses

-uncontrollable = behavioral response can’t influence outcome

Question 13

meta-analysis: Uncontrollable stressors

Answer 13

elicit acute cortisol (HPA response) increases

went through acute stress studies and categorized the different tasks

• some are passive (watching a movie)
• motivated performance task (you have to do something)
• motivated performance w/uncontrollability (you have to do it but no matter what you do you can’t influence the outcome)
• motivated performance with social-evaluative threat
• motivated performance with social-evaluative threat and uncontrollability

tasks where you don’t do anything or where you have control over the outcome don’t elicit a cortisol response
-if anything there’s a reduction because of diurnal cycle
If you have to do an uncontrollable motivated performance task it notches up the cortisol response

UNCONTROLLABILITY SEEMS TO ACTIVATE THE HPA AXIS

Question 14

Control and the ANS (cardiovascular system)

Answer 14

30 min (intervals) assessments - asked how much control they have at that moment (when they’re at their job)
individuals who report low levels of control over their jobs show higher blood pressure throughout the day
-high control is associated with Lower blood pressure

this suggests that you can see these “control” effects outside of laboratory settings

Question 15

health-related control and immunity

Answer 15

ask kids with asthma how much control they feel over their health

health-related locus of control in children with asthma
low control associated with increased production of cytokines that make asthmas worse (IL-4)
low control also associated with poor pulmonary function

Question 16

social evaluation

Answer 16

stress theories often focus on physical self-preservation
-eg running away from a lion

social self-preservation may also be important

• threats to the social self: situations that provide potential for loss of social esteem, social status, or social acceptance
• elicited by Trier Social Stress Test
• TSST is the best way to make people feel the most negatively evaluated socially
• social threats may be co-opting some of the same stress that physical threats do

Question 17

social evaluation results

Answer 17

elevated SNS and cortisol response to TSST in social evaluation condition (with evaluator in room) vs. non-evaluative (in room alone)
-math with someone in the room or without someone in the room

both elicit a cardiovascular response; ANS doesn’t care about social evaluation - HPA axis no response to non-evaluative condition
-just having to do the task isn’t enough, it requires the extra nudge of someone in there evaluating you

another study adds to it with the # of people in the room; they find:
-the effect is magnified with larger audience (heart rate : just doing the task elicits a response; BP: goes up the more people in the room; but makes the most difference for the HPA axis (more people = stronger cortisol response)

yet another study adds to it “someone in the room not paying attention to you” they find:
presence of inattentive confederate DOESN’T induce cortisol response
-social evaluation component is the most important aspect

Question 18

Social Evaluative threat in daily life

Answer 18

participants reported on experiences of social evaluation throughout the day
-worried about what others think of me; concerned about the impression I’m making

find that higher levels of social evaluative threat is associated with elevated ambulatory BP
-the effect seems to be stronger in women

Question 19

What condition would elicit the largest cortisol response?

• doing an uncontrollable task alone
• doing an uncontrollable task in the presence of an experimenter who isn’t paying attention to you
• doing an uncontrollable task in the presence of an experimenter who is paying attention to you
• doing an uncontrollable task in the presence of a panel of evaluators

Answer 19

-doing an uncontrollable task in the presence of a panel of evaluators
uncontrollable + social evaluation and the more people get a bigger reponse

Question 20

Back to the Meta analysis: stressors with social evaluation

Answer 20

elicit acute cortisol increases

motivated performance with social-evaluative threat and uncontrollability gets the highest cortisol response

Question 21

Uncontrollable Tasks, social evaluation and inflammation

Answer 21

lack of control + social evaluation also increases pro-inflammatory response to stress

Question 22

manipulating appraisals

Answer 22

this is what CBT is about but people also use this for acute laboratory framework

Reappraising Arousal

• experimentally manipulate appraisal of arousal (feeling of being “stressed”) by telling participants that arousal is functional and adaptive (will help you deal with stressor better)
• by changing feelings about their arousal, you see beneficial effects on physiology and performance

Question 23

manipulating appraisal: arousal

Answer 23

participants randomly assigned to reappraise their arousal to a stressful task as adaptive (vs maladaptive) showed “good” cardiovascular response vs. ignore or control conditions
-just telling them to think about their physiological arousal in a certain way actually changes their physiology

a follow up study (GRE study):
participants randomly assigned to reappraise their arousal into a practice GRE test as adaptive scored higher on actual GRE
-higher scores just by virtue of reappraisal

Question 24

Manipulating appraisal: stress

Answer 24

reappraising stress: what happens when you tell people that stress is good for them?
-people who saw “stress is enhancing” video showed improved health symptoms and work performance relative to control and “stress is debilitating” conditions (not look at physiological outcomes)

Question 25

manipulating appraisal: exercise

Answer 25

reappraising exercise: the housekeeper study

housekeepers were informed that their regular daily activities meet CDC exercise recommendations (informed group), or did not receive this information (controls)
-completed assessments at baseline and 4 weeks
-informed group perceived that they were getting more exercise, although their behavior didn’t change
-also saw improvements in BP and weight (decrease)
all because of a difference in what they thought they were doing

Question 26

what would happen if you told people that walking from their car to their house met their daily exercise requirements?

Answer 26

they would lose weight

just because they think this, they would have a physiologically change - no behavior change

Question 27

Manipulating appraisal: calories

Answer 27

reappraising calorie intake: the milkshake study
participants consumed two milkshakes on two separate occasions
-one labeled “indulgent” (620 calorie shake), one labeled “sensible” (140 calorie shake)
-in reality, both were the same : 380 calories

looked at effects on ghrelin, a “hunger” hormone

• when stomach is empty, ghrelin is secreted by the gut and signals the brain to induce sensation of hunger
• when stomach is full, ghrelin is suppressed and signals the brain to induce sensation of satiety

20 min: see label
60 min: consume shake
-steeper decline in ghrelin after shake in “indulgent” condition, indicating greater satiety
-after consuming the exact same thing your body has a different physiological response based on what you think you have eaten

Question 28

summary of appraisal

Answer 28

changing appraisals seems to have effects on physiology

• cardiovascular responses
• performance
• weight
• blood pressure
• ghrelin (hunger hormone)

mechanisms??? no one knows

Question 29

power poses

Answer 29

does changing what you do with your body change physiology?

individuals randomly assigned to high or low power poses

• high: taking up more space, open libs
• low: taking up less space, closed limbs

the high power pose condition led to:

• feeling more powerful
• more likely to take risks in gambling task
• lower cortisol levels

low power pose has slight increase in cortisol levels

Question 30

coping

Answer 30

a very broad construct
efforts to deal with demands taxing or exceeding one’s resources
can be cognitive, behavioral, or emotional
may or may not be deliberate
(may not be aware that you’re doing it to cope with stress)

Question 31

types of coping

Answer 31

approach - oriented processes

avoidance - oriented processes

Question 32

approach - oriented processes

Answer 32

designed to deal with situation and/or one’s thoughts and feelings about it
-ie problem solving, planning, seeking social support

I’ve been getting help and advice from other people
I’ve been taking action to make the situation better
I’ve been trying to see it in a different light, to make it seem more positive

these are really different strategies but they are all directed toward the stressor

Question 33

avoidance - oriented processes

Answer 33

designed to avoid situation and/or one’s thoughts and feelings about it
-ie disengagement, denial

I’ve been giving up trying to deal with it

learning to live with it is acceptance
making jokes about it is acknowledging it but with humor
-these two scenarios may sound like avoidance but they aren’t

Question 34

coping and mental health

Answer 34

avoidance strategies may be helpful for dealing with short-term, unavoidable stressors
-use of cognitive avoidance predicted lower anxiety among women undergoing mammography

however, avoidance strategies may have detrimental effects over long-term

• avoiding thoughts and feelings around persistent stressors predicts elevated distress (cancer patients, individuals coping with terrorist attacks)
• also predicts poor behavioral outcomes (risky sexual behavior, lower medical regimen adherence)

in general, avoidance is bad for psychological and physical

Question 35

Coping and physical health

Answer 35

some evidence that avoidance coping predicts negative health outcomes

Question 36

coping in HIV

Answer 36

approach coping:

• increased positive affect
• decreased negative affect
• better health behaviors
• better physical health

avoidance coping:

• decreased positive affect
• increased negative affect
• worse health behaviors
• worse physical health

Question 37

Avoidance and immunity in HIV

Answer 37

177 HIV+ men and women assessed at 6 month intervals over 2 years

avoidant coping = denial and behavioral disengagement

• I admit to myself I can’t deal with it, and stop trying
• I just give up trying to reach my goal

avoidant coping predicts faster decline in CD4 T cells and increase in viral load

another study found:
denial coping predicts faster progression to AIDS in 82 HIV+ gay ment
-denial = I refuse to believe that it has happened, I pretend that it hasn’t happened

Question 38

avoidance and cancer progression

Answer 38

meta-analysis of 23 studies examining avoidance/denial and cancer-related outcomes
-15 studies of survival, 8 studies of recurrence
NO EVIDENCE for effects on either outcomes

may be fewer health behavior effects than with HIV - they aren’t sure

Question 39

Approach- oriented coping and physical health

Answer 39

findings are even more mixed than avoidance

could be diverse variety of strategies subsumed under approach coping
-active coping, planning, seeking social support, acceptance, turning to religion
effects may depend on what type of coping strategy used in what situation