CH-5 Health-Compromising Behaviors – Health Psychology : Chapter Notes

This document contains Chapters 5 to 8 Chapter 5 Health-Compromising Behaviors Chapter Outline I. Characteristics of Health-Compromising Behavior II. Obesity A. What Is Obesity? B. Obesity in Childhood C. SES, Culture, and Obesity D. Obesity and Dieting as Risk Factors for Obesity E. Stress and Eating F. Interventions G. Cognitive Behavioral Therapy (CBT) H. Evaluation of Cognitive-Behavioral Weight-Loss Techniques I. Taking a Public Health Approach III. Eating Disorders A. Anorexia Nervosa B. Bulimia IV. Alcoholism and Problem Drinking A. The Scope of the Problem V. What Is Substance Dependence? A. Alcoholism and Problem Drinking B. Origins of Alcoholism and Problem Drinking C. Treatment of Alcohol Abuse D. Treatment Programs E. Evaluation of Alcohol Treatment Programs F. Preventive Approaches to Alcohol Abuse G. Drinking and Driving H. Is Modest Alcohol Consumption a Health Behavior? VI. Smoking
A. Synergistic Effects of Smoking B. A Brief History of the Smoking Problem C. Why Do People Smoke? D. Nicotine Addiction and Smoking E. Interventions to Reduce Smoking F. Smoking Prevention Programs Learning Objectives 1. Define obesity and its risks. 2. Describe the prevalence of obesity in childhood. 3. Describe dieting as a risk factor for obesity. 4. Define the set point theory of weight. 5. Summarize the different interventions used in obesity. 6. Describe the use of cognitive-behavioral therapy. 7. Discuss how relapse can be prevented in obesity. 8. Define anorexia. 9. Describe how one develops anorexia and the treatment provided for it. 10. Define bulimia. 11. Describe how bulimia is developed and treated. 12. Describe the characteristics of health-compromising behaviors. 13. Define substance dependence, physical dependence, tolerance, craving, addiction, and withdrawal. 14. Define alcoholism and problem drinking. 15. Describe the origins of alcoholism and problem drinking. 16. Describe the goals and nature of treatment programs for alcoholism and problem drinking. 17. Describe the use of cognitive-behavioral therapy in the treatment of alcoholism and problem drinking. 18. Discuss stress management techniques used to help drinking problems. 19. Describe the problem of relapse. 20. Summarize the factors associated with favorable treatment outcomes and the effectiveness of treatment programs. 21. Summarize the effectiveness of preventive approaches to alcohol abuse. 22. Describe the nature and prevalence of drinking and driving. 23. Describe the relationship between modest alcohol intake and coronary heart disease. 24. Describe the prevalence and costs of smoking in the United States. 25. Describe the synergistic effects of smoking. 26. Trace social trends in smoking in the United States. 27. Describe the factors associated with smoking in adolescents. 28. Explain the nature of addiction in smoking. 29. Summarize the effectiveness of attitude-change campaigns to reduce smoking. 30. Describe the role of social support and stress management in smoking cessation. 31. Describe the role of relapse prevention in the maintenance of smoking cessation. 32. Describe the various characteristics of people who stop smoking on their own. 33. Describe the nature and advantages of smoking prevention programs. 34. Explain the use of social influence interventions in smoking cessation, and evaluate their effectiveness. Lecture Suggestions 1. Characteristics of Health-Compromising Behavior: Adolescents who try to combine long hours of employment with school have an increased risk of alcohol, cigarette, and marijuana abuse (Johnson, 2004). Lower-class children and adolescents are exposed more to problem behaviors and may use health compromising behaviors to cope with the stressors of low social class (Novak Ahlgren, & Hammarstrom, 2007). Problem behaviors, including obesity, smoking, and alcoholism, are more common in the lower social classes (Businelle et al., 2010; Latkin, Williams, Wang, & Curry, 2005; Pahl, Brook, Morojele, & Brook, 2010). 2. The Link between Obesity and One’s Psychological Components: People who are high in neuroticism, extraversion, and impulsivity and low in conscientiousness are more likely to be obese (Sutin, Ferrucci, Zonderman, & Terracciano, 2011). People who are depressed are more likely to gain weight, and people who are obese or overweight are more likely to be depressed (Kubzansky, Gilthorpe, & Goodman, 2012; van Reedt Dortland, Giltay, van Veen, Zitman, & Penninx, 2013). 3. Eating Disorders and Mortality: Eating disorders have some of the highest disability and mortality rates of all behavioral disorders (Park, 2007). Suicide attempts are not uncommon (Bulik et al., 2008). In a meta-analysis done of 36 studies, it was seen that those with eating disorders had significantly elated mortality rates, and those with anorexia had higher rates of mortality in comparison with bulimia and other eating disorder not otherwise specified (Arcel J. et al., 2011). 4. Alcohol Use and Misuse: The comprehensive handbook of alcohol-related pathology edited by Preedy and Watson (2004) provides a “stop-shop” for all those interested in alcohol use and misuse. A 2008 study by McIntosh and colleagues examines preteen children’s drinking experiences and motivations. Surprisingly, children report being motivated to drink because of pleasure and boredom and not so much because of peer pressure. In another study, linguistic acculturation was related with increased alcohol use and misuse among females, but not males (Raffaelli et al., 2007), and the two social variables, social facilitation and family drinking, mediated the effect. In the United States, young adults drink more than anyone else, and college students engage in binge drinking more than non-college individuals (Naimi et al., 2003). 5. Alcohol Prevention for Secondary and College Students: Biglan and others’ (2003) edited volume examines the prevention of five types of adolescent behavior using problem behavior theory. For each problem behavior, specific background information is provided followed by prevention suggestions. Prevention programs attempt to bring perceptions into line with reality, which is expected to lower the level of drinking the average student sees as acceptable for others in the peer group. Changing perceptions of the drinker from a fun party guy to a loser can foster alcohol reduction and prevention programs with students (Teunissen et al., 2012). 6. Alcohol Abuse or Dependence in Older Adults: There is mounting recognition that alcohol abuse or dependence is a problem for many older adults (Beechem, 2002). This text, written by a gerontologist and recovering alcoholic, covers a broad range of topics. It is a resource for a lecture examining the antecedents of late-onset alcoholism and potential prevention and treatment programs. A recent study examines late-onset drinkers versus problem drinkers who decrease alcohol consumption as they age (Wood, 2007). 7. Treatment for Alcohol Dependence: Monti and his colleagues (2002) provide a detailed manual for skills training for alcohol-dependent persons. Based on learning theory, this treatment program guide is designed for mental health professionals. Miller and Muňoz’s (2005) book is a self-help book. It, too, uses a social skills training approach to assist the individual in moderating or stopping alcohol consumption. Approximately 745,200 people in the United States received treatment for alcoholism in 2008 (National Institute on Drug Abuse, 2011). 8. Prevention of Smoking Programs for Adolescents: Programs for preventing adolescents from beginning smoking have spanned the last 40 years. Although there are initial reductions in rates of onset, these effects “water down.” Some factors that may play a role are reviewed. For instance, a study with adolescents (Wills et al., 2007) indicates a relationship between watching actors smoking in movies and the adoption of smoking by adolescents. Wills and colleagues (2004) examine the mechanism of movie-smoking exposure on adolescent smoking, and their results indicate a direct effect of motives on smoking onset and an indirect effect through peer smoking. Evans (2001) addresses smoking and the role of fear appeals in designing intervention programs. Botvin and Kanton (2000) provide a research update on life skills training. Biglan and Severson (2003) report on a community-based intervention. If their parents stopped smoking before the child turned approximately eight, smoking cessation actually reduces the risk of smoking, presumably because of the family’s anti-smoking attitudes (Wyszynski, Bricker, & Comstock, 2011).These can be used to expand the text’s treatment of this issue. 9. Why People Smoke, and Why It Is So Difficult to Quit: Dodgen (2005) examines the psychosocial and pharmacological factors associated with dependence and discusses various treatments. Grunberg et al. (2001) and Swan and colleagues (2003) provide material to expand the text’s treatment of the physiological, psychological, and social factors involved in smoking and smoking cessation. Baker, and colleagues’ (2004) review examines the nature and natural history of cigarette smoking. Their focus is on the development and maintenance of smoking. Wills and his colleagues (2004) and Wetter and his colleagues (2004) examine the correlates of smoking onset and maintenance at three different ages in high school and over the four years of college, respectively. Sloan and others (2003) present an economic model that assumes that consumers know or can form beliefs about risk that affect their well being. They present evidence from a variety of methodologies to support this model. There appear to be genetic influences on smoking (Piasecki, 2006). Genes that regulate dopamine functioning are likely candidates for these heritable influences (Timberlake et al., 2006). 10. Other Issues Relating to Alcohol Consumption and Smoking: Wills and colleagues (2007) examine the relations between parenting and individuals’ self control and self-esteem. O’Connel and colleagues (2007) found that using coping strategies were important during smoking cessation. Behavioral strategies (that is., keeping busy, food/drink) were used more often than cognitive strategies (56 percent and 44 percent, respectively), and the number of strategies used was related to resisting the urge to smoke. Smoking cessation effectiveness may differ based on race, ethnicity, gender, age, and education level (Velicer, Redding, Sun, & Prochaska, 2007). Carle’s findings (2008) suggest that future studies should focus on developing measures that are sensitive to ethnicity and cultures. The image of one’s self is a significant factor in beginning smoking (Hertel & Mermelstein, 2012). Recommended Reading 1. Sharon Akabas, Sally Ann Lederman, & Barbara J. Moore. (2012). Textbook of Obesity: Biological, Psychological and Cultural Influences. Wiley-Blackwell. This textbook talks about the causation, prevention, and treatment of obesity. 2. Arthur Gillard (2013). Anorexia and Bulimia (Perspectives on Diseases & Disorders). Greenhaven Press. This book provides information on the symptoms, causes, treatments, and cures for anorexia and bulimia. It also has narrative cases from people coping with the disorder. 3. Babor, T. F., & Del Boca, F. K. (2003). Treatment matching in alcoholism. Cambridge, UK: Cambridge University Press. The authors present the results of Project MATCH, an extensive set of clinical trials attempting to match alcohol addiction treatment type to client characteristics. Three treatment modalities were examined, cognitive-behavioral, motivational enhancement, and Twelve-Step Facilitation. Implications for further research are included. 4. Durrant, R., & Thakker, J. (2003). Substance use and abuse: Cultural and historical perspectives. Thousand Oaks, CA: Sage. This book takes a comprehensive approach in examining drug use and its social-cultural factors. In their attempt to explain the history and cultural context for drug use, the authors discuss the history of drug use and the evolutionary basis of drug use. 5. Kozlowski, L., Henningfield, J. E., & Brigham, J. (2001). Cigarettes, nicotine, & health: A biobehavioral approach. Thousand Oaks, CA: Sage. This brief text from the Behavioral Medicine and Health Psychology series uses an explicit biobehavioral approach for understanding the use of cigarettes as a nicotine delivery system. Chapters include a history of the use of nicotine, demographic information, and physiological and psychological processes involved in nicotine consumption and addiction. 6. Romer, D. (2003). Reducing adolescent risk: Toward an integrated approach. Thousand Oaks, CA: Sage. Romer brings together the current literature reviewing adolescent risk and discusses protection across various topics and disciplines. 7. Slovic, P. (Ed.). (2001). Smoking: Risk, perception, & policy. Thousand Oaks, CA: Sage. This edited volume provides in-depth coverage of current knowledge of smoking. Among the topics included are the demographic and background information, perceptions of risk, media influence, addiction, and legal and policy perspectives. The core information is based on two surveys from 1999 and 2000. 8. Weissberg, R. P., Gullotta, T. P., Hampton, R. L., Ryan, B. A., & Adams, G. R. (Eds.), (1997). Healthy children 2010: Enhancing children’s wellness. Thousand Oaks, CA: Sage. Many of the chapters in this edited volume address family, school, and community prevention programs targeting children’s mental and physical health. The co-occurrence of problem behaviors are described as well as preventive and health-promotion strategies targeting health-compromising behaviors such as drug abuse, high-risk sexual behavior, and accidental injury. 9. Wilson, D. K., Rodriguez, J. R., & Taylor, W. C. (Eds.), (1997). Health-promoting and health-compromising behaviors among minority adolescents. Washington, D.C.: American Psychological Association. This volume describes culturally sensitive approaches for health psychologists who work with minority adolescents. Chapters summarize biological, social, cultural, and psychological perspectives on minority adolescent health, as well as intervention programs targeting health-promotion and health-compromising behaviors. Activities 1. Obesity: Ask your students to speak to someone who recently has had to battle with obesity and write a report on them. Also, ask your students to include in their report the preventive measures they feel the person could’ve adopted to avoid obesity and the steps he or she took to overcome it. 2. Eating Disorders: Ask your students to write an elaborate report on how media and celebrities play a major role in the increased prevalence of eating disorders. Ask your students to give examples of advertisements that promote the Barbie-doll figure and also of ones that promote healthy eating and styles of living. 3. Substance Abuse Programs: Assign groups of three to four students each, the task of contacting community programs that target drug, alcohol, or other substance abuse. An increasing number of education and intervention programs that target school-aged children have been established, and many will be happy to provide educational materials that can form the basis of a discussion of the efficacy of such programs. Because many programs have a speaker board, an in-class presentation might also be effective in promoting discussion of different health-compromising behaviors. 4. The Surgeon General and Consumer Warnings: Ask students to bring to class advertisements for alcohol and cigarettes that carry a health warning from the Surgeon General. The message on these ads is varied, often in an attempt to heighten the message’s impact. An in-class discussion might focus on the use of the mass media in eliminating health-compromising behaviors, the health beliefs each message targets, how or why people may discount or fail to recall such messages, and so on. The ethics and success of social engineering might also be introduced, especially if state or local laws have recently been proposed or enacted (for example, smoking prohibitions in restaurants and bars). Videos 1. Students can gain more knowledge on the obesity epidemic, its prevalence is increasing, how to overcome it by watching this video: The Obesity Epidemic 2. American Psychological Association available at www.apa.org Teenage Eating Disorders Problems of Eating and Weight Management Cognitive-behavioral relapse prevention for addictions Drug and alcohol abuse HAM reduction with high school students Mindfulness for addiction problems Relapse prevention overtime 3. Films for the Humanities & Sciences available at http://ffh.films.com Feta alcohol syndrome and other drugs during pregnancy Young addicts: Drugs, alcohol, and America’s future Health news and interviews: Substance abuse and addiction video clips 4. Fanlight Productions available at www.fanlight.com Crystal fear, crystal clear: A documentary about the lives of three families devastated by methamphetamine. Mi droga preferida: My drug of choice explores special factors that affect Latina lesbians and substance abusers. Not a game: A sad and graphic warning about methamphetamine. References 1. Abrams, D., Niaura, R., Brown, R., Emmons, K., Goldstein, M., & Monti, P. (Vol. Ed.) (2003). The tobacco dependence treatment handbook. In D. Barlow, (Series Ed.), Treatment manuals for practitioners. NY: Guilford. 2. Baker, T., Brandon, T., & Chassin, L. (2004). Motivational influences on cigarette smoking. Annual Review of Psychology, 55, 463–491. 3. Beechem, M. (2002). Elderly alcoholism: Intervention Strategies. Springfield, IL: Charles C. Thomas. 4. Biglan, A., & Severson, H. (2003). The prevention of tobacco use. In T. Gullotta, H. Walberg, & R. Weisberg (Series Eds.), and A. Bigland, M. Wang, & H. Walberg (Vol. Eds.). Preventing youth problems (pp. 63–85). New York: Plenum. 5. Biglan, A., Wang, M., & Walberg, H. (Vol. Eds.) (2003). Preventing youth problems. In T. Gullotta, H. Walberg, & R. Weisberg (Series Eds.). New York: Plenum. 6. Botvin, G., & Kanton, L. (2000). Preventing alcohol and tobacco use through life skills training. Alcohol Research & Health, 24, 250–257. 7. Carle, A. C. (2008). Cross-cultural validity of alcohol dependence across Hispanics and non-Hispanic Caucasians. Hispanic Journal of Behavioral Science, 30, 106–120. 8. Dodgen, C. E. (2005). Nicotine dependence: Understanding and applying the most effective treatment interventions. Washington, D.C.: American Psychological Association. 9. Evans, R. (2001). Social influences in etiology and prevention of smoking and other health threatening behaviors in children and adolescents. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 459–468). Mahwah, NJ: Lawrence Erlbaum. 10. Grunberg, N., Faraday, M., & Rahman, M. (2001). The psychobiology of nicotine self-administration. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 249–261). Mahwah, NJ: Lawrence Erlbaum. 11. Knight, J. R, Wechsler, H., Kuo, M., Seibring, M., Weitzman, E. R., & Schuckit, M. A. (2002). Alcohol abuse and dependence among U.S. college students. Journal of Studies on Alcohol, 63, 263–270. 12. McIntosh, J., MacDonald, F., & McKeganey, N. (2008). Pre-teenage children’s experience with alcohol. Children & Society, 22, 3–15. 13. Miller, W., & Muñoz, R. (2005). Controlling your drinking: Tools to make moderation work for you. NY: Guilford. 14. Monti, P., Kadden, R., Rohsenow, D., Cooney, N., & Abrams, D. (2002). Treating alcohol dependence: A coping skills training guide. NY: Guilford. 15. Naimi, T. S., Brewer, R. D, Mokdad, A., Denny, C., Serdula, M. K., & Marks, J. S. (2003). Binge drinking among U.S. adults. Journal of the American Medical Association, 289, 70–75. 16. O'Connell, K. A.; Hosein, V. L.; & Schwartz, J. E; Leibowitz, R. Q.. (2007). How does coping help people resist lapses during smoking cessation. Health Psychology, 26, 77–84. 17. Preedy, V., & Watson, R. (2004). Comprehensive handbook of alcohol-related pathology, 1–3. San Diego, CA: Academic Press. 18. Raffaelli, M., Stone, R. A. T., Iturbide, M. I., McGinley, M., Carlo, G., & Crockett (2007). Acculturation, gender and alcohol use among Mexican American college students. Addictive Behaviors, 32, 2187–2199. 19. Sloan, F. A., Smith, V. K., & Taylor, D. H., Jr. (2003). The smoking puzzle: Information, risk perception, and choice. Cambridge, MA: Harvard University Press. 20, Velicer, W. F., Redding, C. A., Prochaska, J.O., & Sun. X. (2007). Demographic variables, smoking variables and outcome across five studies. Health Psychology, 26, 278–287. 21. Wetter, D., Kenford, S., Welsch, S., Smith, S., Fouladi, R., Fiore, M., & Baker, T. (2004). Prevalence and predictors of transitions in smoking behavior among college students. Health Psychology, 23, 168–177. 22. Wills, T. A., Murry, V. McBride, Brody, G. H., Gibbons, F. X., Gerrard, M., Walker, C., & Ainette, M. G. (2007). Ethnic pride and self-control related to protective and risk factors: Test of the theoretical model for the strong African American families program. Health Psychology, 26, 50–59. 23. Wills, T., Resko, J., Ainette, M., & Mendoza, D. (2004). Smoking onset in adolescence: A person-centered analysis with time-varying predictors, Health Psychology, 23, 158–167. 24. Wood, S. A. (2007). Development issues in older drinkers’ decision: To drink or not to drink. Alcoholism Treatment Quarterly, 24, 99–118. Chapter 6 Stress Chapter Outline I. What Is Stress? A. What Is a Stressor? B. Appraisal of Stressors II. Origins of the Study of Stress
A. Fight or Flight B. Selye’s General Adaptation Syndrome C. Tend-and-Befriend D. How Does Stress Contribute to Illness? III. The Physiology of Stress A. Effects of Long-Term Stress B. Individual Differences in Stress Reactivity C. Physiological Recovery D. Allostatic Load IV. What Makes Events Stressful? A. Dimensions of Stressful Events B. Must Stress Be Perceived as Such to Be Stressful? C. Can People Adapt to Stress? D. Must a Stressor Be Ongoing to Be Stressful? V. How Has Stress Been Studied? A. Studying Stress in the Laboratory B. Inducing Disease C. Stressful Life Events D. Daily Stress VI. Sources of Chronic Stress A. Effects of Early Stressful Life Experiences B. Chronic Stressful Conditions C. Stress in the Workplace D. Some Solutions to Workplace Stressors E. Combining Work and Family Roles Learning Objectives Define stress, stressor, and person-environment fit. Compare and contrast primary and secondary appraisal and their roles in the experience of stress. Describe Cannon’s fight-or-flight response. Describe Selye’s General Adaptation Syndrome and its criticisms. Describe the Tend-and-Befriend theory developed by Taylor and colleagues. Describe the physiological response to stress including the allostatic load. Describe the dimensions of stressful events. Evaluate the extent to which stress is an objective versus a subjective experience. Explain the process of habituation to stress and responses to ongoing stressors. Explain the impact of the anticipation and aftereffects of stress. Define posttraumatic stress disorder and its effects on individuals. Describe how the acute stress paradigm is used to study stress in the laboratory. Describe how inducing disease is used to study stress. Describe the nature of stressful life events and their relationship to stress. Describe the use of the Social Readjustment Rating Scale in the measurement of stress. Define daily hassles and chronic strain, and explain their relationship to physical and psychological health. Describe long-term effects of early stressful life experiences. Describe the sources of chronic stress and their impact on health. Describe the problems associated with studying chronic stress. Describe factors in the workplace that are related to stress. Describe the solutions used to reduce occupational stress. Explain the relationship of multiple roles to stress, and identify gender differences in work and family roles and the experience of stress. Lecture Suggestions Stress, Health, and Illness: Dougall and Baum (2001) provide background material for a lecture on the relationship of stress to health and illness. They review definitions and theories of the stress construct and discuss processes, including stress responses and their consequences, and the role of stress in specific diseases (e.g., cancer, infectious diseases, diabetes, rheumatoid arthritis, heart disease). Extreme stressors such as war, sexual victimization, disasters, or serious accidents may have several physiological and psychological effects (Schnurr & Green, 2003). Research on traumatic events (PTSD) has focused primarily on mental health, but such events have long-term health outcomes. Friedman and McEwen (2004) explore biological correlates of PTSD. They examine the potential causal effects of these correlates using the concept of allostatic load. They note that although traumatic events occur to a large part of the population, PTSD develops in a small percentage. They propose that allostatic support, or positive change, protects from the deleterious consequences of PTSD. On the other hand, Zautra (2005) proposes that being exposed to stressful emotions can be a valuable experience and help individuals in enhancing their ability to adapt to stress. In a recent article, Dr. Wright and Dr. Robinson pointed out that delayed diagnosis of PTSD often leads to alcohol abuse or/and depression (2013). However, timely treatment and therapy could have a positive affect on an individual’s recovery. Coping with Stress: Stress is often attributed to relationship problems. At the same time, being in a relationship can offer social support. Revenson, Kayser & Bodenmann’s Couples Coping with Stress: Emerging Perspectives on Dyadic Coping (2005) examines several pertinent topics that can be discussed with students. For instance, topics such as how partners communicate during stressful times or how they cope during a time of crisis can be explored with students. Rebecca Silver (2013) in her research study examines the association of substance-related coping behaviors with stress among college students. Her study reveals the gender difference in this coping behavior. Tend-and-Befriend: In the text, Taylor proposes a complementary model of stress response. Rather than the singular fight-or-flight model of primary physiological response to stress, she proposes that women are more likely to tend-and-befriend. She and her colleagues (Taylor, 2002; Taylor et al., 2000; Taylor et al., 2003) review the physiological processes that may lie at the core of this response. Some studies present supporting evidence (David & Lyons-Ruth Ennis, 2005; Ennis, Kelly & Lambert, 2001). Dickerson and Kemeny’s (2004) meta-analysis reviews 208 articles examining the stressor-cortisol relationship. Tend-and-befriend theory maintains that, in addition to fight or flight, people and animals respond to stress with social affiliation and nurturant behavior toward off spring (von Dawans, Fischbacher, Kirschbaum, Fehr, & Heinrichs, 2012). Personality, Stress, and Health: The role of personality in illness is an area of great interest to students. Contrada and Guyll (2001) provide an overview of the processes that connect personality factors to illness and the interaction with stress. Of particular interest is the treatment of the personality/stress interface. They conclude their chapter with an evaluation of the personality attributes identified as risk factors by epidemiological work. Recent work indicates a new personality construct, the Type D, or distressed, which is characterized by one’s inclination to interpret life events negatively and to avoid social contacts with others (Sher, 2005). Type D individuals tend be depressed, anxious, angry, and express more hostile feelings. Experiencing or anticipating a stressful situation is associated with increased salivary cortisol levels, and elevated cortisol may promote coronary heart disease. Virginia Hughes in a recent article talks about the relationship between stress experienced by an infant and how it consequently affects the teenage brain (2012). Stress and the Work Place: Dolan’s book Stress, Self-Esteem, Health and Work (2006) examines the work environment and provides valuable insight for individuals interested in enhancing an individuals’ sense of wellness at work and improving the work environment. Dolan also proposes to promote organizational self-esteem, a new philosophical approach for managing organizations, and creating organizations that are healthy emotionally, economically, and ethically. Additionally, in a recent research study conducted by Ladegård, the results reflect that stress management through coaching helps reduce stress levels at the workplace (2011). Recommended Reading 1. Friedman, H. S. (Ed.). (1990). Personality and disease. New York: Wiley. This book contains a collection of reviews and theoretical papers addressing general conceptual issues related to stress, emotion and health, and personality. Each chapter is authored by a prominent contributor to the field. 2. Lazarus, R. S. (1966) Psychological stress and the coping process. New York: McGraw-Hill. This classic book provides the background for Lazarus’ theory emphasizing the importance of cognitive processes in the stress process. 3. Lovallo, W. R. (1997). Stress and health: Biological and psychological interactions. Thousand Oaks, CA: Sage Publications. In this book, Lovallo begins with a review of the mind-body dichotomy and reviews the psychophysiological relationships between psychological processes and the stress response. 4. McNally, R. J. (2003). “Progress and Controversy in the Study of Posttraumatic Stress Disorder”. Annual Review of Psychology, 54, 229–252. This is a review on the problems associated with the study of posttraumatic stress disorder (PTSD). These include problems with subject populations, creeping diagnostic criteria, and controversies about repressed memories of sexual abuse. In addition, he chronicles the progress made in the field. 5. Selye, H. (1976). The Stress of Life. New York: McGraw-Hill. This classic volume presents Selye’s model of the general adaptation syndrome to a popular audience. Activities One way to get students to better understand stress is to ask them to complete the scale for “A Measure of Perceived Stress” in Box 6.4 or “The Measurement of Daily Strain” in Box 6.5. Then, get them to discuss their results in teams of two or three students. Another approach is to get students to discuss their personal experiences under stress using the following list of questions which has been developed to encourage discussion of the roles that physiological arousal, appraisal, and life events play in the experience of stress. How do you know when you are under stress? What does stress feel like? How does stress differ from anticipation? Excitement? Other emotions? Can positive events be stressful? How? John Henryism: Diversity issues may be introduced by using an activity on John Henryism, which is a coping strategy with continued exposure to stress. Ask students to read articles on John Henryism, such as “‘John Henryism’ Key to Understanding Coping, Health” by Duke Medicine News and Communications. Then, ask students to submit a report on their findings and opinions. A class discussion can also be initiated based on their findings. Daily Hassles and Uplifts: The text’s discussion of life events and hassles may be supplemented by administering the Hassles and Uplifts Scales in the class. The complete scales along with its scoring and normative information are available in the “Comparison of Two Modes of Stress Measurement: Daily Hassles and Uplifts Versus Major Life Events” by Kanner, Coyne, Schaefer, and Lazarus published in the Journal of Behavioral Medicine, Vol. 4, No. 1, 1981. Trauma: Dittmann and Greer published articles in the April 2005 edition of The Monitor on Psychology. These articles dealt with helping servicemen and their families deal with the trauma associated with the Iraq War. Students may be asked to read on these articles and to submit a report on their understanding of these topics. Videos 1. Annenberg/CPB Collection (Producer) available at http://www.learner.org/ Stress: Locus of Control and Predictability (The brain, Module #22): Using an animal model, this brief module discusses the impact of control and predictability of physical symptoms. Emotions, Stress, and Health. (The brain, Module #21): This module examines the biochemical changes associated with stress. 2. National Institute for Occupational Safety and Health available at http://www.cdc.gov/niosh/ Working with stress: This is a video produced by the Centers for Disease Control and Prevention. It presents evidence for the detrimental impact of job stress on health. Although recognizing the utility of individual stress management programs, the video argues that some stressors affect almost all persons, thus the most effective preventive technique is to change the workplace. Examples of organizational change are provided. 3. Films for the Humanities & Sciences available at http://ffh.films.com Stress: Keeping your cool (1994): This video examines the effect of stress on our society and the relationship between stress levels and health. Coping with stress (1998): This video highlights the role of stress in everyday life and how it shapes our overall physical and mental health. It also identifies some of the sources of stress and also suggests techniques for managing stress. One nation under stress: In several discrete segments, this video examines the causes and effects of stress and methods of coping with it. Brief appearances are made by Susan Folkman, Karen Matthews, and Martin Seligman, among others. 4. Fanlight Productions available at www.fanlight.com Hidden wound (2006): This is a video dealing with post-traumatic stress disorder (PTSD), its symptoms, and negative effects. It documents the gruesome reality of PTSD through the stories of soldiers returning from the war in Iraq. The Hidden Face of Fear (2008). This video looks at how the human brain responds to fear and anxiety. The video explores the traumatic impact of the 9/11 with interviews of people getting treated for PTSD and panic disorder after the event. References Bamber, M. R. (2006). CBT for occupational stress in health professionals: Introducing a schema-focused approach. London; NY: Routledge, 2006. Brown, J. D., & McGill, K. L. (1989). The Cost of Good Fortune: When Positive Life Events Produce Negative Health Consequences. Journal of Personality and Social Psychology, 57, 1103–1110. Contrada, R. J., & Guyll, M. (2001). On Who Gets Sick and Why: The Role of Personality and Stress. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 59–84). Mahwah, NJ: Lawrence Erlbaum. Cooper, C. L. (Eds), (2005). Handbook of Stress Medicine and Health. Boca Raton: CRC Press. David, D. H., & Lyons-Ruth, K. (2005). Differential Attachment Responses of Male and Female Infants to Frightening Material Behavior: Tend-or-Befriend versus Fight-or-Flight. Infant Mental Health Journal, 26, 1–18. Dickerson, S. S., & Kemeny, M. E. (2004). Acute Stressors and Cortisol Responses: A Theoretical Integration and Synthesis of Laboratory Research. Psychological Bulletin, 130, 355–391. Dolan, S. L. (2006). Stress, Self-Esteem, Health and Work. Basingstoke [England]; New York: Palgrave Macmillan. Dougall, A. L., & Baum, A. (2001). Stress, Health and Illness. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of Health Psychology (pp. 321–337). Mahwah, NJ: Lawrence Erlbaum. Ennis, M., Kelly, K. S., & Lambert, P. L. (2001). Sex differences in cortisol excretion during anticipation of a psychological stressor: Possible support for the tend-and-befriend hypothesis. Stress and Health, 17, 253–261. Friedman, M., & McEwen, B. (2004). Posttraumatic Stress Disorder, Allostatic Load, and Medical Illness. In Schnurr, P. & Green, B. (Eds.), Trauma and health: Physical health consequences of exposure to extreme stress (pp. 157–188). Washington, DC: American Psychological Association. Greer, M. (2005). A New Kind of War. The Monitor on Psychology, 36, 38–40. Lovallo, W. R. (2005). Stress & Health: Biological and Psychological Interactions. Thousand Oaks, CA: Sage Publications. McKeever, V. M., McWhirter, B. T., & Huff, M. E. (2006). Relationships between Attribution Style, Child Abuse History and PTSD Symptom Severity in Vietnam Veterans. Cognitive Therapy & Research, 30, 123–133. Revenson, T. A., Kayser, K., & Bodenmann, G. (2005). Couples Coping with Stress: Emerging Perspectives on Dyadic Coping. Washington, DC: American Psychological Association. Schnurr, P. P., & Green, B. L. (2003). Trauma And Health: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association. L., Sher (2005). Type D Personality: The Heart, Stress and Cortisol. Quarterly Journal of Medicine, 98, 323–329. Z. M., Shnek, J., Irvine, & D., Stewart, (2001). Psychological factors and depressive symptoms in ischemic heart disease. Health Psychology, 20, 141–145. Taylor, S. E (2006). Tend-and-Befriend: Biobehavioral Bases of Affiliation Under Stress. Current Directions in Psychological Science, 15, 273–277. Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral Responses to Stress in Females: Tend-and-befriend, not Fight-or-Flight. Psychological Review, 107, 411–429. Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung R. A. R., & Fernandes-Taylor, S. (2003). Affiliation, Social Support, and Biobehavioral Responses to Stress. In Suls, J., & Wallston, K. A. (Eds.), Social psychological foundations of health and illness (pp. 314–331). Malden, MA: Blackwell. Taylor, S.E. (2002). The Tending Instinct: Women, Men, and the Biology of Nurturing. New York: Holt Rinehart Winston. United States. Congress House. Committee on Veterans’ Affairs. Subcommittee on Health. Washington: U.S. G.P.O. Posttraumatic stress disorder and traumatic brain injury as emerging trends in force and veterans health: hearing before the Committee on Veterans' Affairs, House of Representatives, Subcommittee on Health, One Hundred Ninth Congress, second session, September 28, 2006. Whittlesey, V. (2001). Diversity Activities for Psychology. Boston: Allyn & Bacon. Zautra, A. (2005). Emotions, Stress and Health. Oxford, NY: Oxford University Press. Chapter 7 Coping, Resilience, and Social Support Chapter Outline I. Coping with Stress and Resilience A. Personality and Coping B. Psychosocial Resources C. Resilience D. Coping Style E. Problem-Focused and Emotion-Focused Coping II. Coping and External Resources III. Coping Outcome IV. Coping Interventions A. Mindfulness Meditation and Acceptance/Commitment Therapy B. Expressive Writing C. Self-Affirmation D. Relaxation Training E. Coping Effectiveness Training V. Social Support A. What Is Social Support? B. Effect of Social Support on Illness C. Biopsychosocial Pathways D. Moderation of Stress by Social Support E. What Kinds of Support Are Most Effective? F. Enhancing Social Support Learning Objectives Define stress moderators. Describe how stress may exert a direct effect on illness, interact with preexisting vulnerabilities and adversely affecting health habits. Define the coping process. Define negativity and the pessimistic explanatory style, and explain their relationship to stress and illness. Define optimism, and explain its relationship to stress and illness. Describe the relationship of psychological control to stress and illness. Describe the relationship of other personality variables (e.g., self-esteem and conscientiousness) to stress and illness. Define avoidance and confrontative coping styles, and explain their relationship to stress and illness. Explain the relationship of disclosure to coping with stress and illness. Describe problem-focused and emotion-focused coping styles and what determines their use. Compare and contrast different coping strategies, and explain their relationship to stress and illness. Describe the role of external resources in coping and their relationship to stress and illness. Describe the tasks and costs of coping. Explain the criteria by which coping outcomes are assessed. Describe relaxation training, and evaluate its effectiveness. Define social support. Compare and contrast the different forms of social support. Describe the effect of social support on psychological distress, physiological and neuroendocrine responses, and illness and health habits. Explain the biopsychosocial pathways by which social support influences health and illness. Explain how stress is moderated by social support. Compare and contrast the direct effects and buffering hypotheses. Describe the factors affecting the provision of effective social support. Lecture Suggestions 1. Hurricane Katrina: The setting of Hurricane Katrina provides examples that introduce new research in negative affectivity and its effect on general health and mortality. It also provides an example to discuss stress moderators, coping skills, stress management, social support, as well as a variety of other discussion possibilities. 2. History of Coping: Coping is a series of transactions between a person who has a set of resources, values, and commitments and a particular environment with its own resources, demands, and constraints (Folkman & Moskovitz), Following a review of the history of coping, Folkman and Moskowitz (2004) discuss problems identified in the last few years. These include measurement issues, issues of nomenclature, and the effectiveness of coping. They address new developments in coping theory. Of particular interest is the work on coping and positive emotions. Manne (2003) focuses on the impact of coping on physical health outcomes. Whereas Folkman and Moskowitz limit their discussion to cognitive approaches, Manne covers defense-focused approaches as well. Bongar’s (2006) book, Psychology of terrorism, includes the newest findings on treatment of and clinical responses to terrorism along with their respective underlying theories. 3. Coping with a Tragedy: How do we help individuals, especially children, cope with a hurricane, terrorist attack, school shooting, natural disaster, or family loss? Gaffney (2008) discusses strategies and approaches to help communities after a tragedy. Cryder and her colleagues (2006) examined children’s post-traumatic growth (PTG) and positive changes following a hurricane. They found that competency beliefs were related to PTG and a supportive social environment and ruminative thinking were associated with positive competency beliefs. Tatar and Amram (2007) examined Israeli adolescents’ coping strategies in response to terrorist attacks and found differences between males and females. For instance, male adolescents use more non-productive coping strategies (that is, keeping to oneself, ignoring the problem, or not coping) and females seek more social support. Sattler and colleagues (2007) examined the effects of powerful earthquakes in El Salvador. They were interested in demographics, traumatic event exposure, social support, resource loss, acute stress disorder symptoms, depression, and posttraumatic growth in college student. In the article “Helping Children Deal With the Tragedy in Boston” (2013) Dr. Winston said that parents must not pretend like the issue doesn’t exist, but must talk to the child about it and discuss with them what they know as well as answer any questions they might have. 4. Culture and Coping: The handbook of multicultural perspectives edited by Wong & Wong (2006) includes theoretical and methodical issues as well as a comprehensive review of various topics pertinent to cultures such as acculturation, culture, coping, and resilience, among others. Other chapters include several concepts such as religious, spiritual, and existential modes of coping, and a review of the knowledge gaps in the culture, stress and coping literature. Cross-cultural studies suggest that people everywhere want to share their emotions and their secrets. Smyth and Pennebaker (2001) present evidence indicating that such sharing, whether verbal or nonverbal, serves as a coping mechanism. In this chapter, they examine the efficacy of written disclosure and discuss the possible mechanisms through which this may occur. Another study (Sinhan & Watson, 2007) compared Indian and Canadian students and found that Indian students reported more psychological symptoms. Another study examines the self as it relates to coping with stress (Hardie, Critchley & Morris, 2006). The majority of people in the United States believe in God (80 percent), attend church services at least once a month (55 percent), and say that religion is important in their personal lives (80 percent) (Gallup, 2009). Religion is especially important to women and to African Americans (Holt, Clark, Kreuter, & Rubio). Religion (or spirituality, independent of organized religion) can promote well-being (Kashdan & Nezlek, 2012; McIntosh, Poulin, Silver, & Holman, 2011). 5. Collective Coping: James Pennebaker and Kent Harber (1993) present a model of collective coping that may be useful in fostering class discussion of the coping process. On the basis of survey data collected from San Francisco residents who had experienced the Loma Prieta earthquake and Dallas residents during and after the Persian Gulf conflict, Pennebaker and Harber developed a stage model of collective coping with social upheaval. They found that people talk and think about an event for approximately two weeks after it occurs (the emergency stage). Then, people move into an inhibition stage during which discussion is reduced but thinking and rumination continue. During this stage, negative reactions, such as hostility and dreaming, occur. Afterward, people progress into the adaptation phase where both discussion and thought about the event diminish. Ben C. H. Kuo (2013) in his article “Collectivism and coping: Current theories, evidence, and measurements of collective coping” stated that collective coping behaviors are conceived as an output of communistic rules and values of a cultural group. 6. Coping Strategies: Revenson (2003) notes “relatively few (studies) investigated how family members cope with the stressors they face…it is time to extend the study of stress, coping, and adaptation beyond the individual unit of analysis.” She argues that coping must be examined within an ecological framework that includes four contexts: sociocultural, interpersonal, situational, and temporal. In a chapter addressing coping issues and chronic illness, “using rheumatoid arthritis as the chronic illness,” she examines marital coping within these parameters. Individuals with a history of self-mutilation and women with alcoholic parents are more likely to use avoidance strategies (Andover et al., 2007; Amodeo et al., 2007). Stress due to the workplace costs about $300 billion per year, and 13 million workdays are lost. Interventions using stress reduction strategies such as mindfulness-based stress reduction result in positive changes (Walach et al., 2007). People who are able to shift their coping strategies to meet the demands of a situation cope better with stress than those who do not (Chen, Miller, Lachman, Gruenewald, & Seeman, 2012). 7. Conceptualizing Social Support: As the text notes, social support is a complex psychosocial variable. The social support measurement and intervention book edited by Cohen and colleagues (2000) provides a current and comprehensive review of social support research focusing on theories and practices issues. Manne (2003) presents a review of this construct that is useful in developing a lecture to present to students on the conceptual and methodological issues surrounding this construct. Another excellent instructor resource is Cohen’s (1988) review of the literature. Wills and Fegan (2001) address the mechanisms of social support. In addition, it may be useful to address the negative aspects of social support. Students often fail to consider the obligations that membership in a complex social network places on the individual. DiMatteo and Hays (1981) discuss the harmful effects social support may have on family functioning, compliance, and patient self-esteem. Social support can come from parents, a spouse or partner, other relatives, friends, social and community contacts (such as churches or clubs) (Rietschlin, 1998), or even a devoted pet (McConnell, Brown, Shoda, Stayton, & Martin, 2011). People with social support experience less stress when they confront a stressful experience, cope with it more successfully (Taylor, 2011), and even experience positive life events more positively (Gable, Gosnell, Maisel, & Strachman, 2012). Recommended Reading 1. Ora Gilbar and Hasida Ben-Zur. (2002). Cancer and the family caregiver: Distress and coping. American Psychological Association. This book expands the stress and coping literature to family caregivers of cancer patients and focuses on stresses experienced and coping methods used by cancer patients and their caregivers. 2. Allen, J. G. (2006). Coping with depression: From Catch-22 to Hope. Arlington, VA: American Psychiatric Publishing. Allen’s book is written for depressed individuals and those who care for them. His book describes techniques to engage depressed individuals who are limited by their illness. 3. Ghate, D. & Hazel, N. (2002). Parenting in poor environments: Stress, support and coping. Jessica Kingsley publishers. In this book, the authors examine poverty and its effects on individuals and family relationships. Several issues are discussed such as low income, poor mental health, and child behavioral problems. 4. Madsen, W. C. (2007). Collaborative therapy with multi-stressed families, second edition. Guilford Press. Activities 1. Assessing Coping Strategies: Students’ analysis of their daily coping strategies may form the basis of an independent assignment. This assignment may be integrated with the stress log discussed in the previous chapter. A sample assignment with suggested guidelines follows. Students are asked to work in teams of two or three students and review the log of stressors they listed in the previous chapter. Get students to focus not only on the stressors, but also on various factors that are noted above, under lecture suggestions. For instance, how do they view culture, religion, or individual differences such as optimism or perceived self-control with regard to stress and coping? Moreover, ask them to list coping strategies. How successful were your coping efforts? Did some coping strategies work better than others? Were certain efforts more successful with certain stressors? What role, if any, did social support play in your coping with stress? Were certain support efforts more effective than others? Why or why not? Do you feel that stress management techniques might improve your coping? Which one(s)? Why? Videos 1. American Psychological Association available at www.apa.org Reclaiming hope in a changed world: Broadcast version (2002). This video includes information and tools that will help viewers explore, understand, accept, and recover from their collective and individual reactions to terrorism. Mindfulness-based cognitive therapy for depression. This video demonstrates a mind–body approach to help depressed individuals. 2. Films for the Humanities & Sciences available at http://ffh.films.com Seriously stressed (2006): A 45-minute video about chronic stress and its effects on people’s health, relationships, and careers. Coping with stress (2001). This program analyzes the role of stress in day-to-day life and in overall physical and mental health. Sources of stress are identified, and techniques for managing stress are suggested. This video may be used at the end of Chapter 6 and before beginning this chapter. 3. Guilford Press videos available at http://www.guilford.com/cgi-bin/cartscript.cgi?page=home.html&cart_id=398348.12184 Crisis survival skills: Distracting and self-soothing. (2003). A video program that focuses on teaching individuals seven ways to distract themselves from painful events and emotions. Crisis survival skills: Improving the moment and pros and cons. This video covers skills to help individuals control the moment and protect themselves from impulsive or self-destructive responses. References 1. Amodeo, M., Griffin, M. L., Fassler, I., Clay, C., & Ellis, M. A. (2007). Coping with stressful events: influence of parental alcoholism and race in a community sample of women. Health & Social Work, 32, 247–257. 2. Andover, M. S., Pepper, C. M., & Gibb, B. E. (2007). Self-mutilation and coping strategies in a college sample. Suicide and Life-Threatening Behavior, 37, 238–243. 3. Bongar, B. (2006). Psychology of terrorism. Oxford University Press. 4. Cohen, S. (2000). Social support measurement and intervention: A guide for health and social scientists. Oxford University Press. 5. Cohen, S. (2000). Social support measurement and interventions: Psychosocial models of the role of social support in the etiology of disease. Health Psychology, 7, 269–297. 6. Cryder, C. H., Kilmer, R. P., Tedeschi, & Richard, G. (2006). An exploratory study of posttraumatic growth in children following a natural disaster. American Journal of Orthopsychiatry, 76, 65–69. 7. DiMatteo, M. R., & Hays, R. (1981). Social support and illness. In B. H. Gottlieb (Ed.), Social networks and social support (pp. 117–148). Beverly Hills: Sage. 8. Folkman, S., & Moskowitz, J. (2004). Coping: Pitfalls and promise. Annual Review of Psychology 55, 745–774. 9. Gaffney, D. A. (2008). Families, schools, and disaster. Family & Community Health, 31, 44–53. 10. Hardie, E. A., Critchley, C., & Morris, Z. (2006). Self-coping complexity: Role of self-construal in relational, individual and collective coping styles and health outcomes. Asian Journal of Social Psychology, 9, 224–235. 11. Manne, S. (2003). Coping and social support. In I. V. Weiner (Series Ed.) & A. M. Nezu, C. M. Nezu, & P. A. Geller (Vol. Eds.), Handbook of psychology: Vol. 9, Health psychology (pp. 51–74). Hoboken, NJ: John Wiley. 12. Pennebaker, J. W., & Harber, K. D. (1993). A social stage model of collective coping: The Loma Prieta earthquake and the Persian Gulf War. Journal of Social Issues, 49, 125–145. 13. Revenson, T. A. (2003). Scenes from a marriage: Examining support, coping, and gender within the context of chronic illness. In Suls, J., & Wallston, K. A. (Eds.), Social psychological foundations of health and illness (pp. 530–559). Malden, MA: Blackwell. 14. Sattler, D. N., de Alvarado, A. M. G., de Castro, N. B., van Male, R., Zetino, A. M., & Vega, R. (2006). El Salvador earthquakes: Relationships among acute stress disorder symptoms, depression, traumatic event exposure, and resource loss. Journal of Traumatic Stress, 19, 879–893. 15. Smyth, J. M., & Pennebaker, J. W. (2001). What are the health effects of disclosure? In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 339–348). Mahwah, NJ: Lawrence Erlbaum. 16. Tatar, M., & Amram, S. (2007). Israeli adolescents’ coping strategies in relation to terrorist attacks. Journal of Guidance & Counseling, 35, 163–173. 17. Walach, H., Nord, E., & Zier, C. (2007). Mindfulness-based stress reduction as a method for personnel development: A pilot evaluation. International Journal of Stress Management, 14, 188–198. 18. Wills, T. A., & Fegan, M. F. (2001). Social networks and social support. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 209–234). Mahwah, NJ: Lawrence Erlbaum. 19. Wong, P. T. P., & Wong L. C. J. (Eds.), (2006). Handbook of multicultural perspectives on stress and coping. New York: Springer. Chapter 8 Using Health Services Chapter Outline I. Recognition and Interpretation of Symptoms
A. Recognition of a Symptom B. Interpretation of Symptoms C. Cognitive Representations of Illness D. Lay Referral Network E. The Internet II. Who Uses Health Services?
A. Age B. Gender C. Social Class and Culture D. Social Psychological Factors III. Misusing Health Services
A. Using Health Services for Emotional Disturbances B. Delay Behavior Learning Objectives Describe the social and psychological factors that influence the recognition and interpretation of symptoms. Define illness representations and illness schema, and explain their influence on the interpretation of symptoms. Describe the nature and function of disease prototypes. Describe the nature and function of the lay referral network. Describe the use of the Internet as a lay referral network. Describe the demographic factors that predict the use of health services. Describe the sociocultural factors that predict the use of health services. Explain why people misuse health services for emotional disturbances. Explain the nature and consequences of delay behavior. Lecture Suggestions Somatization and Using Health Services: Patients with medically unexplained symptoms are frequent. Brown (2004) reviews the three classical theories: dissociation, conversion, and somatization. Each explains some but not all categories of symptoms. Brown presents a model that proposes that these unexplained symptoms can be understood within the framework of mainstream cognitive psychology. The model integrates and expands the three historical theories. Of particular note is that this is not a model of malingering. The assumption is that the pain and symptoms are real and disabling but are not attributable to underlying physical causes. He provides numerous schematics that are useful in understanding all of the models. Hiller and others (2006) investigate the prevalence of somatization or physical symptoms not caused by medical disease, and report that although a medically unexplained symptom is a common phenomenon, this problem is not well understood. Bishoff and colleagues (2007) conducted focus groups to better understand the providers’ experience with over users of medical services. Their study reveals that in some cases, the personality, life stress, and other physician characteristics may influence how patients respond to the physician. Ashley M. Harris and others (2008) tried to assess the extent of the overlap of somatization with other psychiatric disorders and medical problems to compare the functional disability and role impairment of somatizing and non-somatizing patients, and to determine the independent contribution of somatization to functional disability and role impairment. Their study concluded that patients with somatization had substantially greater functional disability and role impairment than non-somatizing patients. The degree of disability was equal to or greater than that associated with many major, chronic medical disorders. Adjusting the results for psychiatric and medical co-morbidity had little effect on these findings. The Old Stereotype and Medical Ageism: Geropsychologists seek to understand the negative age stereotypes with regard to health issues (Dittmann, 2008). Elderly people are often stereotyped as incompetent and forgetful (Cuddy et al., 2005; Erber et al., 1996), and such beliefs may lead elderly individuals and health professionals to associate health symptoms with aging, which can have tragic outcomes. For instance, Sarkisian and colleagues (2006) published an article regarding the growing body of research investigating beliefs about aging and health and reported that if older adults attribute their health problems to aging, they may not seek medical treatment, which results in greater mortality. Moreover, medication nonadherence is frequent among older adults because of low self-efficacy or lack of confidence in the physician’s knowledge (Chia et al., 2006). A study by Jerry H. Gurwitz and others, 2003 showed that adverse drug events are common and often preventable among older persons in the ambulatory clinical setting. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial. Such results indicate that personal and cultural beliefs are important considerations. Health practitioners hold cognitive representations of illness and the patient prototypes. Thus practitioner stereotypes about their patients may influence the diagnosis of symptoms as well as the quality of care provided to the patient (Mandy, Lucas & Hodgson, 2007). The Sick Role and Self-Enhancement: A study by Hamilton and Janata (1997) may be used to expand on the text’s discussion of the use of health services for nonmedical reasons. These researchers investigated abnormal illness behavior (that is, over-reporting or exaggerating of physical symptoms, preoccupation with illness, medical tests, and so forth) and proposed that people with low self-esteem or identity problems engage in these behaviors in an effort to construct a positive sense of self. A more recent article by Miczo (2004) argues that sick-role behavior may be better conceptualized as a set of illness attitudes and care-seeking behaviors. He found that attitudinal factors (release, consideration, burden, and deviance) were moderate predictors of care-seeking intentions as were stressors and social support for the sick role. Taking the study of sick-role behavior further, Frederick Anyan (2012) researched the differences between sick-role behavior in men and women. The findings from the study indicated that men’s conceptualization of illness involved the absence of strength, requiring assistance to function in daily activities, and exhaustion of internal bodily organs. Findings also indicate that women’s conceptualisation of illness involved mainly impairment in physiological functioning and feelings of weakness or nausea. Burnout: Leiter and Maslach (2001) present a review of Maslach’s multidimensional model of burnout. This model conceptualizes burnout as an individual experience occurring within the context of social relationships. Burnout consists of three components: emotional exhaustion, depersonalization, and reduced personal accomplishment. After reviewing the literature, the authors discuss the major conceptual questions, followed by recommendations for organizational intervention. Recent articles examine burnout and physical health (Langelann et al. , 2007) and the relationship between burnout and professional conduct and attitudes (Dyrbye, 2010). Recommended Reading Kate Hamilton-West (2011). Psychobiological Processes in Health and Illness. This book takes a biopsychosocial approach, and assembles studies from numerous field of studies including health psychology, psychoneuroimmunology, and behavioral genetics. Dean M. Harris. (2011).Ethics in Health Services and Policy: A Global Approach. This all-inclusive book examines the ethical topics of health and health care from a worldwide perspective. Michael D. Robinson, Edward R. Watkins, Eddie Harmon-Jones (2013). Handbook of Cognition and Emotion. The Guilford Press. Thoroughly analyzing the connection amidst cognition and emotion, this manual brings together best analysts from different psychological subdisciplines.. Activities Providing Quality Health Care: Ask students to form five groups for a critical-thinking exercise and team problem-solving assignments. Assign each group one of the following projects. After discussing the problems and potential interventions in each scenario for approximately 20 minutes, have the groups report their findings to the class. Project 1: You have been provided with state and federal funding to establish a comprehensive family practice clinic in the inner city. Describe your patients’ profiles. What steps will you take to maximize patient use of this clinic? Project 2: You are on the administrative board of County General Hospital. The hospital has charged the board with the task of developing a program targeting delay behavior (e.g., seeking treatment for a suspected tumor). Describe educational and institutional interventions you might implement to minimize delay behavior. Project 3: You are on the administrative board of a private hospital that is committed to increasing patient satisfaction with care. Describe your patients’ profiles. Describe the steps you might take to minimize depersonalization and to enhance patient perceptions of control. Project 4: You are on the administrative board of a pediatric hospital that is committed to increasing patient and parent satisfaction with care. Describe your patients’ profiles. Describe the steps you might take to minimize depersonalization and to enhance patient perceptions of control. Project 5: Discuss the various factors that medical schools should take into account when training their physicians (think of the various stereotypes that individuals have, vis-à-vis the elderly and/or the obese population and young children. Quackery: Discuss in class the factors that make patients susceptible to the influence of practitioners of medical fraud and quackery. Two examples that might stimulate classroom discussion are the claims that multivitamin compounds can reverse AIDS (Kapp, 2005) and human growth hormone can reverse aging (Perls, 2004). Videos Moore, M. Sicko (2007). A documentary examining health care in the United States and other countries. Films for the Humanities & Sciences available at http://ffh.films.com The uninsured: Forty-four million forgotten Americans (2000). Peter Jennings reporting: Breakdown—America’s health insurance crisis (2005). Brokaw, T. Reports: Critical condition (2004). Who cares: Chronic illness in America (2001). Geriatric medicine: Innovations and applications (2001). Investigative Reports. Medical mistakes. This documentary exposes some of the high-profile human errors in the medical profession. Charlie Rose available at www.charlierose.com 10/29/07, A conversation with Sir Paul Nurse and others about global health in the 21st century. References Applewhite, S. L. (1995). Curanderismo: Demystifying the health beliefs and practices of elderly Mexican Americans. Health & Social Work, 20, 247–24. Applewhite, S. L. (1995). Curanderismo: Demystifying the health beliefs and practices of elderly Mexican Americans. Health and Social Work, 20, 247–253. Biggar, H., Forehand, R., Devine, D., Brody, G., Armistead, L., Morse, E., & Simon, P. (1999). Women who are HIV infected: The role of religious activity in psychosocial adjustment. AIDS Care, 11, 195–199. Bischoff, R. J., Holist, C. S., & Patterson, J. (2007). Providers’ perspectives on troublesome overusers of medical services. Families, Systems, & Health, 25, 392–403. Brown, T. (2004). Psychological mechanisms of medically unexplained symptoms: An integrative conceptual model. Psychological Bulletin, 130, 793–812. Chia, K., Schlenk, E. A., & Dunbar-Jacob, J. (2006). Effects of personal and cultural beliefs on medication: Adherence in the elderly. Drugs and Aging, Vol 23, 191–202. Cuddy, A. J. C., Norton, M. I., & Fiske, S. T. (2005). This old stereotype: The pervasiveness and persistence of the elderly stereotype. Journal of Social Issues, 61, 267–285. Dittmann, M. (2008). Fighting ageism. The Monitor. Retrieved 2/1/08 from http://www.apa.org/monitor/may03/fighting.html Erber, J. T., Prager, I. G., Williams, M., & Caiola, M. A. (1996). Age and forgetfulness: Confidence in ability and attribution for memory failures. Psychology and Aging, 11, 310–315. Hamilton, J. C., & Janata, J. W. (1997). Dying to be ill: The role of self-enhancement motives in the spectrum of factitious disorders. Journal of Social and Clinical Psychology, 16, 178–199. Hiller, W., Rieft, W., & Brahler, E. (2006). Somatization in the population: From mild bodily misperceptions to disabling symptoms. Social Psychiatry & Psychiatric Epidemiology, 41, 704–712. Kapp, C. (2005). SA health minister urged to stop vitamin-peddling doctor. Lancet, 366, 1837–1838. Krause, N. Praying for others, financial strain and physical health status in late life. Journal for the Scientific Study of Religion, 42, 377–391. Langelaan, S., Bakker, A. B., Schaufeli, W. B.M. van Rhenen, W.; & van Doornen, L. J. P. (2007). Is burnout related to allostatic load? International Journal of Behavioral Medicine, 14, 213–221. Leiter, M.P., & Maslach, C. (2001). Burnout and health. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 415–426). Mahwah, NJ: Lawrence Erlbaum. Mandy, A., Lucas, K. & Hodgson, L. (2007). Clinical cducators’ reactions to ageing. The Internet Journal of Allied Health Sciences and Practic. Retrieved 2/1/08 from http://ijahsp.nova.edu/articles/vol5num4/pdf/mandy.pdf McCabe, G. H. (2007). The healing path: A culture and community derived indigenous therapy model. Psychotherapy: Theory, Research, Practice, Training, 44, 148–160. Miczo, N. (2004). 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International Journal of Disability, Development & Education, 53, 381–400, 20. Instructor Manual for Health Psychology Shelley E. Taylor 9780077861810