PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH

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Health Psychology PSY408

Lecture 18

PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH

Another story...

They were best friends, Joan and Sally, on their way to an art museum a year ago when a car accident ended

their lives. Their husbands, Bob and Walt, were devastated, not only by their individual losses but also for

each other's. These men were also friends--both worked as engineers for the same company and shared

hobbies and other interests. The four of them used to party often, leaving the kids with one babysitter. How

did the terrible loss of their wives affect these men?

The initial impact of their loss was similar, but the amounts of stress that followed were different, Bob's

stress was not as severe as Walt's. One thing that helped Bob was that he had an extended family that lived

nearby. They provided consolation for his grief, a place to go to get out of the house and to socialize, and

help in caring for his children. After school, the kids would go to either Bob's or Joan's parents' house and

Bob would pick them up on his way home from work. Sometimes he and the children would stay there for

dinner. This helped save him time and money--both of which were in short supply. How was Bob doing a

year later? He had made a good adjustment, had a good relationship with his children, was starting to date,

and was in good health.

Walt was not so fortunate. For one thing, he had no nearby family to rely on. Compared to Bob, Walt had

little emotional support in his grief, and being a single parent made his workload and financial situation very

difficult. Walt had little time or money for socializing, and virtually all of his adult contacts were at work.

Although he and Bob often had lunch together, their interests were drifting apart. Unlike Bob, Walt had

never been very outgoing, and he felt awkward and insecure in meeting women. A year after Sally died, he

was isolated and lonely. His relationship with his children was deteriorating, and so was his health. He had

developed migraine headaches, neck problems, and high blood pressure. The stress in Walt's life was taking

its toll.

In this lecture we will be looking at psychosocial factors that can modify the stress people experience. And

we will address some questions about stress and illness that are of great concern today. Why can some

people experience one traumatic event after another without ill effects, but others cannot? Why the same

stressful situation affects some people far more than some others who seem to have received little or no

effect?

Psychosocial Modifiers of Stress

People's reactions to stress vary from one person to the next and from time to time for the same person.

These variations often result from psychological and social factors that seem to modify the impact of

stressors on the individual. Let's look at some of these modifiers, beginning with the role of social support.

Social Support

We saw in the bereavement experiences of Bob and Walt how important social ties and relationships can be

during troubled times. The social support Bob got from his family tempered the impact of his stressful loss

and probably helped him adjust. Social support refers to the perceived comfort, caring, esteem, or help a

person receives from other people or groups. This support can come from many different sources--the

person's spouse or lover, family, friends, coworkers, physician, or community organizations. According to

researcher Sidney Cobb (1976), people with social support believe they are loved and cared for, esteemed

and valued, and part of a social network such as a family or community organization, that can provide

goods, services, and mutual defense in times of need or danger.

Health Psychology PSY408

Types of Social Support

What specifically does social support provide to the person? To answer this question, researchers have tried

to classify various types of support. These classifications suggest that there are five basic types of social

support:

1. Emotional support involves the expression of empathy, caring, and concern toward the person. It

provides the person with a sense of comfort, reassurance, belongingness, and being loved in times of stress.

We saw earlier how Bob's family gave him emotional support after the death of his wife.

2. Esteem support occurs through people's expression of positive regard for the person, encouragement or

agreement with the individual's ideas or feelings, and positive comparison of the person with others, such as

people who are less able or worse off. This kind of support serves to build the individual's feeling of self-

worth, competence, and being valued. Esteem support is especially useful during the appraisal of stress,

such as when the person assesses whether the demands exceed his or her personal resources.

3. Tangible or instrumental support involves direct assistance, as when people give or lend the person

money or help out with chores in times of stress. Bob's family helped with childcare, for example, which

reduced the demands on his time and finances.

4. Informational support includes giving advice, directions, suggestions, or feedback about how the person

is doing. For example, a person who is ill might get information from family or a physician on how to treat

the illness. Or someone who is faced with a very difficult decision on the job might receive suggestions or

feedback about his or her ideas from coworkers.

5. Network support provides a feeling of membership in a group of people who share interests and social

activities.

How May Social Support Affect Health?

We have seen that prolonged exposure to high levels of stress can lead to illness. According to the

psychologists, social support affects health by protecting the person against these negative effects of high

stress. It provides a buffer against stress.

How does buffering work?

There are at least two ways. First, when people encounter a strong stressor, such as a major financial crisis,

those who have high levels of social support may be less likely to appraise the situation more stressful than

those with low levels of support. Individuals with high social support may expect that someone they know

will help them, such as by lending money or giving advice on how to get it. As a result, they judge that they

can meet the demands and decide that the situation is not very stressful.

Second, social support may modify people's response to a stressor after the initial appraisal. For instance,

people with high social support might have someone provide a solution to the problem, convince them that

the problem is not very important, or cheer them on to look on the "bright side" or "count their blessings".

People with little social support are much less likely to have any of these advantages--so the negative

impact of the stress is greater for them than for those with high levels of support.

A Sense of Personal Control

Another psychosocial factor that modifies the stress people experience is the degree of control people feel

they have in their lives. People generally like the feeling of having some measure of control over the things

that happen to them, and they take individual action when they want to influence events directly. In doing

Health Psychology PSY408

these things, people strive for a sense of personal control--the feelings that they can make decisions and

take effective action to produce desirable outcomes and avoid undesirable ones.

Studies have found that people who have a strong sense of personal control report experiencing less strain

from stressors.

Types of Control

How can feelings of personal control reduce the stress people experience? Let's see by considering the

process of giving birth--a stressful event. Women who attend natural childbirth classes learn many

techniques that enhance their personal control in the birth process. They, like other people in stressful

situations, can influence events in their lives and reduce the stress they experience in many ways. These

ways include four types of control:

1. Behavioral control involves the ability to take concrete action to reduce the impact of a stressor. This

action might reduce the intensity of the event or shorten is duration. During childbirth, for example, the

mother can use special breathing techniques that reduce the pain of labor.

2. Cognitive control is the ability to use thought processes or strategies to modify the impact of a stressor.

These strategies can include thinking about the event differently or focusing on a pleasant or neutral

thought or sensation. While giving birth, for instance, the mother might think about the event differently by

going over in her mind the positive meanings the baby will give to her life. Or she could focus her attention

on the sensation of the baby's movements or on an image, such as a pleasant day at the beach.

3. Decisional control is the opportunity to choose between alternative procedures or courses of action. The

mother and father have many choices to make about the birth process before it occurs. For many of these

decisions, the mother usually has the final word--such as in the choice of the obstetrician, whether to use

conventional or natural childbirth methods, and whether the birth will occur in a hospital, at home, or at an

alternative birth center. In other medical situations, the patient may be given a choice regarding which

treatment procedure to use, when the treatment will occur, and so on.

4. Informational control involves the opportunity to get knowledge about a stressful event--what will

happen, why, and what the consequences are likely to be. For example, a pregnant woman may get

information about the sensations she will experience during labor and delivery, the procedures she can

expect to happen, and the range of time the process generally takes. Informational control can help reduce

stress by increasing the person's ability to predict and be prepared for what will happen and by decreasing

the fear people often have of the unknown.

Each of these types of control can reduce stress, but one of them--cognitive control--seems to have the

most consistently beneficial effect.

When People Lack Personal Control

What happens to people who experience high levels of stress over a long period of time and feel that

nothing they do matter? They feel helpless--trapped and unable to avoid negative outcomes. A worker who

cannot seem to please his boss no matter what he does, a student who cannot perform well on exams

despite all the effort, or a patient who is unable to relieve his severe low back pain--each of these situations

can produce apathy. As a result, these people may stop striving for these goals, come to believe they have

no control over these and other events in their lives, and fail to exert control even when they could succeed.

This is the condition Martin Seligman (1975) has called learned helplessness--which he describes as a

principal characteristic of depression.

Health Psychology PSY408

Personal Control and Health

There are two ways in which personal control and health may be related. First, people who have a strong

sense of personal control may be more likely or able to maintain their health and prevent illness than those

who have a weak sense of control. Second, once people become seriously ill, those who have a strong sense

of control may adjust to the illness and promote their own rehabilitation better than those who have a weak

sense of control.

To summarize the material on personal control, people differ in the degree to which they believe they have

control over the things that happen in their lives. People who experience prolonged, high levels of stress

and lack a sense of personal control tend to feel helpless. Having a strong sense of control seems to benefit

people's health and help them adjust to becoming seriously ill. A sense of personal control contributes to

people's hardiness, which is the next psychosocial modifier of stress we will examine.

Hardy and Resilient Personality

According to researchers, individual differences in personal control provide only part of the reason why

some people who are under stress get sick whereas others do not. They have proposed that a broader array

of personality characteristics--called hardiness-- differentiates people who do and do not get sick under

stress.

Hardiness includes three characteristics:

(1) Control refers to people's belief that they can influence events in their lives--that is, a sense of personal

control.

(2) Commitment is people's sense of purpose or involvement in the events, activities, and people in their

lives. For instance, people with a strong sense of commitment tend to look forward to starting each day's

projects and enjoy getting close to people.

(3) Challenge refers to the tendency to view changes as incentives or opportunities for growth rather than

threats to security.

Another trait--resilience----seems to include high levels of three components: self-esteem, personal

control, and optimism (Major et al., 1998). Resilient people appraise negative events as less stressful: they

bounce back from life's adversities and recover their strength and spirit. For example, resilient children

develop into competent, well-adjusted individuals despite growing up under extremely difficult conditions.

Type A Behavior

What is the Type A behavioral and emotional style? The Type A behavior pattern consists of three

characteristics:

1. Competitive achievement orientation. Type A individuals tend to be very self-critical and to strive toward

goals without feeling a sense of joy in their efforts or accomplishments.

2. Time urgency. Type A people seem to be in a constant struggle against the clock. Often, they quickly

become impatient with delays and unproductive time, schedule commitments too tightly, and try to do

more than one thing at a time, such as reading while eating or watching TV.

3. Anger/hostility. Type A individuals tend to be easily aroused to anger or hostility, which they may or may

not express overtly.

In contrast, the Type B behavior pattern consists of low levels of competitiveness, time urgency, and

hostility. People with the Type B pattern tend to be more easygoing and philosophical about life--they are

more likely to "stop and smell the roses".

Health Psychology PSY408

As a summary of the role of psychosocial modifiers of stress, we have seen that social support, personal

control, hardiness, and the Type A and B behavior patterns are factors that can modify the impact of stress

on health. High levels of social support, personal control, and hardiness are generally associated with

reduced stress and resulting illnesses; Type A behavior is associated with increased stress and illness.

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