Appraisal, Coping, and Health Flashcards
Modulators of the Stress Response
Appraisal of event
how you cope
how you feel (and how you manage those feelings)
social support and status
Stress and Coping Model
process that determines your psychological response to the stressor
Appraisal: Primary and Secondary
Coping
Outcome
(Lazarus and Folkman, 1984)
Stress and Coping Model: Primary Appraisal
what is at stake?
- Nothing/irrelevant
- Benign/positive
- stressful
“is there anything I need to be worried about?”
Stress and Coping Model: Secondary Appraisal
particularly relevant if, in your primary appraisal, there is something stressful going on
what can I do? what are my coping options?
Stress and Coping Model: Coping
cognitive and behavioral efforts to manage the situation and one’s emotional response to it
Stress and Coping Model: Outcome
emotional adjustment
health
Key Dimensions of stress appraisal linked to biology
threat and challenge
can I control it?
are people evaluating me? (this isn’t in the Lazarus and Folkman model)
Threat and Challenge appraisals
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
Threat Appraisals
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)
Challenge appraisals
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)
Threat, challenge and cortisol study
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
control appraisals
thought to be a key regulator of physiological responses
-uncontrollable = behavioral response can’t influence outcome
meta-analysis: Uncontrollable stressors
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
Control and the ANS (cardiovascular system)
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
health-related control and immunity
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
social evaluation
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
social evaluation results
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
Social Evaluative threat in daily life
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
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
-doing an uncontrollable task in the presence of a panel of evaluators
uncontrollable + social evaluation and the more people get a bigger reponse
Back to the Meta analysis: stressors with social evaluation
elicit acute cortisol increases
motivated performance with social-evaluative threat and uncontrollability gets the highest cortisol response
Uncontrollable Tasks, social evaluation and inflammation
lack of control + social evaluation also increases pro-inflammatory response to stress
manipulating appraisals
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
manipulating appraisal: arousal
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
Manipulating appraisal: stress
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)
manipulating appraisal: exercise
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
what would happen if you told people that walking from their car to their house met their daily exercise requirements?
they would lose weight
just because they think this, they would have a physiologically change - no behavior change
Manipulating appraisal: calories
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
summary of appraisal
changing appraisals seems to have effects on physiology
- cardiovascular responses
- performance
- weight
- blood pressure
- ghrelin (hunger hormone)
mechanisms??? no one knows
power poses
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
coping
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)
types of coping
approach - oriented processes
avoidance - oriented processes
approach - oriented processes
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
avoidance - oriented processes
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
coping and mental health
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
Coping and physical health
some evidence that avoidance coping predicts negative health outcomes
coping in HIV
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
Avoidance and immunity in HIV
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
avoidance and cancer progression
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
Approach- oriented coping and physical health
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
