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C H A P T E R

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Stress, Coping, and Health

The blessings of life are not equal to its ills, though the number of the two may be equal; nor can any pleasure compensate for the least pain.

—Pliny the Elder, 77 A.D.

Life is not merely being alive, but being well. —Martial, 95 A.D.

■ Simply put, stress moves people into action. It motivates them to manipulate stressors so as to alter their impact. And it also motivates people to support behavior aimed at diminishing or removing stressors (Baum & Posluszny, 1999). This is the main theme of this chapter, and the following questions can help guide your understanding:

1. When are life events stressful, and when are they not?

2. How do stressors affect people physically, psychologically, and behaviorally?

3. Can the appraisal of life events alter their impact on a person’s well-being?

4. How can a person cope with life events and the stress they evoke?

5. Do people differ in the way they appraise and cope with stressors and stress?

Relationship between Life Events and Stress Have you ever had days like this?

If one more thing goes wrong today, I’ll scream. I overslept this morning because my alarm did not go off. Then I tried to make it to my first class but my car wouldn’t start. Conse- quently, I was late for my psychology exam and did poorly. I received an e-mail message stating “We need to talk,” which can only mean the end of my romantic relationship. A friend borrowed a textbook and has not returned it and I need to study from it tonight. Of course this may not matter, since my boss called to say I had to fill in this evening for a sick coworker. In addition, I’ve had this lingering cold and sore throat that I cannot seem to shake. I feel as if I am in a vicious cycle: the more things go wrong, the more frustrated, tense, irritable, and sick I become, and this in turn makes things go wrong even more. Things have got to get better; they cannot get any worse.

The purpose of this first section is to examine the nature of stress, the characteristics of the life events or stressors that are responsible, and the stressor-stress relationship.

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Demands, Strain, Coping, and Stress The previous tale of woe illustrates how life events make demands on an individual’s moti- vation and behavior. Completing projects, preparing for final exams, and considering career goals are examples of positive demands that motivate an individual to achieve them. A bro- ken printer and a car that needs repair are negative events that motivate a person to remedy them. The death of a friend, a “broken heart,” or being in a bad traffic accident are severe neg- ative events that require adjustment necessary for recovery. Background stimulation from noise, light, and overcrowding plus invisible germs motivate action that taxes the body’s adaptation energy. Action to meet the demands of life requires the appropriate resources. Does a person have enough time, tangible resources, adaptation energy, and motivation? Strain occurs when resources are not adequate for a person to achieve positive events or to avoid or escape negative events. For instance, a student runs out of time before assignments are due and a low grade results. Fixing the printer or car strains a person’s budget and means giving up buying other things. When family, friends, or counselors are not available for lis- tening and advice, the student may be unable to dispel grief or make career decisions. Strain also results, for example, when inadequate resources mean losing a romantic relationship, failing to recover from an accident, or being unable to fight off germs. Coping refers to be- havior that is motivated to meet life’s demands and their consequences. Stress results when life demands strain-coping resources either because the demand is too great or the resources are inadequate (Lazarus & Folkman, 1984). Stress endangers a person’s well-being and shows up as negative feelings, physiological arousal, psychophysiological disorders, illness, or maladaptive behaviors. For example, a person can feel depressed, have trouble sleeping, develop headaches, catch a cold, and drink too much alcohol trying to alleviate negative feel- ings and stress.

Characteristics of Stress Do you eat a lot of your favorite ice cream when you feel under pressure? Have you been troubled by the inability to sleep or to slow down? Have you felt anxious or depressed lately? Do you have a cold or flu? Are you trying to fight off various low-grade infections? A “yes” to any of these questions may indicate stress, which manifests in three domains: physical or psychological symptoms and maladaptive behaviors (see Table 7.1).

Physical Symptoms of Stress. Physical symptoms of stress involve a cold, influenza (flu), headache, sleep disturbance, and being unable to slow down (see Table 7.1). These symptoms are measured by inventories, such as the Cohen-Hoberman Inventory of Physical Symptoms (Cohen & Hoberman, 1983) and the Hopkins Symptom Checklist (Derogatis et al., 1974). In addition to these self-reports, studies are conducted of the lives of patients with actual physi- cal ailments, such as tuberculosis, heart problems, or skin diseases (Mittleman et al., 1995; Rahe et al., 1964). Visits to the campus health center or infirmary also serve as indicators of physical symptoms (Crandall et al., 1992), as do days absent from school or work.

Psychological Symptoms of Stress. Psychological symptoms of stress consist of nega- tive feelings like anxiety, depression, and hopelessness (see Table 7.1). These and other psychological symptoms are measured by self-report scales, such as the Positive and Negative Affect Scale, which measure the intensity of an individual’s positive and negative

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TABLE 7.1 Symptoms Indicating Stress

Physical Symptoms Psychological Symptoms Maladaptive Behaviors

Allergies

Colds

Diarrhea

Flu

Headaches

Inability to slow down, relax

Indigestion

Infections (low grade)

Nausea, vomiting

Neck/shoulder aches

Psychophysiological disorders

Stomach aches

Sweating (nervous)

Sleep disturbance

Anxiety

Boredom

Depression

Feeling helpless

Feeling hopeless

Forgetfulness

Irritableness

Low self-confidence

Low self-esteem

Negative emotions (anger, disgust, fear, sadness)

Negative mood

Drinking more alcohol

Drinking more coffee, cola

Taking drugs (cocaine, heroin, marijuana)

Eating poorly (poor diet, too many sweets)

Resting badly (not enough rest, sleeping more than usual)

Filling time passively (too much TV watching, sitting and staring)

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mood (Watson et al., 1988). Positive mood reflects the degree to which a person feels alert and enthusiastic about life, while negative mood indicates feelings of subjective distress. The General Health Questionnaire measures depression, anxiety, insomnia, social functioning, and anhedonia, which is a lack of pleasure from things usually enjoyable (Goldberg et al., 1976). The Perceived Stress Questionnaire presented in Table 7.2 assesses the amount of stress a person experiences in general (Fliege et al., 2005). The questionnaire covers three components of psychological stress. One component refers to worries like anxi- ety about the future and feelings of desperation and frustration. A second refers to tension like uneasiness, exhaustion, and a lack of relaxation. A final component refers to a lack of joy as shown by the absence of energetic arousal and low feelings of security. In testing this ques- tionnaire, Fliege and coresearchers (2005) found, for example, that hospital patients with psy- chosomatic disorders, such as affective, eating, and personality disorders, experienced the most stress, followed by patients who suffered from tinnitus (hearing a ringing or buzzing). Medical students experienced the next most stress while healthy adults experienced the least stress. Finally, as the health of patients improved, their level of worries and tension decreased.

Behavioral Symptoms of Stress. Drinking to forget, seeing a funny movie to alleviate the blues, eating “comfort foods,” or talking to a sympathetic friend are behavioral indica- tors of stress and coping (see Table 7.1). In some instances, however, these behaviors can themselves be stressful. For instance, coffee drinkers and cigarette smokers increase their consumption when their job stress increases (Conway et al., 1981). Witnesses of terrorist attacks have reported an increase in their smoking, alcohol consumption, and marijuana use (Vlahov et al., 2002). Certain individuals, when faced with stress, tend to overeat

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TABLE 7.2 Perceived Stress Questionnaire

In general, rate the extent the following 15 statements apply to you using this 4-point scale:

1 � almost never, 2 � sometimes, 3 � often, 4 � usually

The extent of your worries You are afraid for the future. You have many worries. Your problems seem to be piling up. You fear you may not manage to attain your goals. You feel frustrated.

The extent you feel tension You feel tense. You feel rested. (R) You feel mentally exhausted. You have trouble relaxing. You feel calm. (R)

The extent you feel joy You feel you’re doing things you really like. (R) You enjoy yourself. (R) You are lighthearted. (R) You are full of energy. (R) You feel safe and protected. (R)

Note: To score, first reverse the numbers of the items designated with an (R) so that 1 � 4, 2 � 3, 3 � 2, and 4 � 1. Sum the numbers to obtain your level of stress. Higher scores mean more stress.

Source: Adapted from “The Perceived Stress Questionnaire (PSQ) Reconsidered: Validation and Reference Values from Different Clinical and Healthy Adult Samples” by H. Fliege et al., 2005, Psychosomatic Medicine, 67, table 1, p. 81. Copyright 2005 by Lippincott Williams & Wilkins. Reprinted by permission.

(Greeno & Wing, 1994). These coping behaviors are maladaptive and add to stress that is already there. For example, caffeine produces insomnia, cigarettes are linked to cancer, drugs produce addiction, and overeating leads to obesity.

Characteristics of Stressors Many demands in life motivate an individual to make adjustments. Passing university courses, fixing your car, and working are dealt with effectively by most people. Demands that are not dealt with effectively, however, become stressors; that is, they produce stress. In the words of Hans Selye (1976), one of the originators of the stress concept, “A stressor is naturally ‘that which produces stress’” (p. 78). If you lost sleep worrying about getting the money to fix your car, then the broken car is a stressor. If you lost no sleep, then the bro- ken car was not a stressor but merely a demand to be coped with. This definition is circu- lar, since the demand is defined as a stressor only after knowing that stress resulted. In spite of this circularity, however, certain characteristics are likely to make events stressful: when

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they have a negative valence, when too many have accumulated, when they are of a large magnitude, and when they are unpredictable or uncontrollable (Lazarus & Cohen, 1977; Perkins, 1982).

Negative Life Events as Stressors. Both positive and negative life events motivate coping actions. Repairing a printer, tolerating a neighbor’s noisy stereo, or suffering disappointment are negative events a person would like to escape. Starting a romance, accepting new respon- sibilities at work, or planning a surprise birthday party are positive events that motivate a per- son to act. Early stress researchers often disregarded whether an event was positive or negative; both were considered stressful (Holmes & Rahe, 1967; Selye, 1976). Physiological arousal that resulted from positive events was called eustress (Selye, 1976), especially if the level of arousal was just right—not too low or not too high. Eustress is a concept similar to the ideal level of arousal described in Zuckerman’s (1969) optimal level of stimulation theory (see Chapter 6). Distress, in contrast, is the opposite of eustress and occurs when arousal is too low or too high. Moreover, distress has additional symptoms consisting of negative feelings, phys- ical ailments, diseases, and maladaptive behavior. Thus, stress usually means distress. In com- paring positive and negative life events, Zautra and Reich (1983) found what they refer to as the same domain effect. Negative events produce distress and reduce the quality of life. Pos- itive events, however, increase positive feelings and increase the quality of life. For instance, Cohen and Hoberman (1983) discovered that positive events reduced students’ psychologi- cal and physical symptoms resulting from a number of negative events. Blair and associates (1981) showed that negative events in the lives of counselors and social workers increased job burnout, which is a form of occupational stress. Positive life events, in contrast, did not increase job burnout but instead reduced the likelihood of its occurrence. Finally, Myers and associates (1974) found that an increase in undesirable life events is associated with a wors- ening of physical and psychological symptoms. A decrease in negative events or an increase in positive events, however, is linked with a decrease in symptoms.

Predictability and Controllability of Life Events. Would you like to know when an im- portant exam is coming up, when a violent thunderstorm covers your campus, or when peo- ple will argue in your presence? Predictability, or lack thereof, is another life event characteristic that determines the severity of stress. Individuals prefer predictable over un- predictable stressors. Imagine taking part in the following experiment on how people deal with the predictability of an aversive event (Badia et al., 1974). Your task is to avoid an elec- tric shock to the forearm by pressing a button located on your right. When you do so the shock is postponed for 15 seconds; otherwise, it is delivered once every three seconds. This avoidance task can be carried out under one of two conditions: In the unsignaled avoidance condition you will not know when the shock will be delivered. In the signaled avoidance condition, a light comes on signaling the delivery of shock. You can trigger this signal by pressing a button on the left. Would you prefer to know when the shock is coming? Most participants in this experiment clearly favored signaled avoidance and pressed the left but- ton. In a second experiment, participants could only turn off (escape) but not avoid the shock. Again a participant could choose to be in an unsignaled escape or signaled escape condition. By pressing the right-hand button, a participant could turn off (escape) the shock. But by also pressing the left button, a light would come on signaling the delivery of shock. In this experiment, although nothing could be done to avoid shock, escape was possible. The results of this experiment also showed that participants preferred signaled shock overIS

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unsignaled shock (Badia et al., 1974). Most of the work on the predictability of stressful events like electric shock comes from animal research, which shows that rats, like humans, prefer knowing when they will be shocked even if they cannot do anything about it (Badia et al., 1979; Harsh & Badia, 1975).

Two hypotheses have been proposed to account for the preference of signaled shock over unsignaled shock. The preparatory response hypothesis states that a signal preced- ing a biologically relevant event allows the organism to prepare for that event (Perkins, 1955). By knowing when the shock is coming, an animal or person can prepare and thus re- duce the aversive event. In the college student experiment, knowing when the shock would be delivered helps a person avoid it. If the shock cannot be avoided, then knowing when it will be delivered allows a person to prepare, which may decrease its aversiveness and allow for more rapid escape. For instance, by knowing when an exam or storm is coming a per- son can prepare for it and thus reduce any stress that may result. As an alternative, the safety hypothesis maintains that it is crucial to distinguish safe intervals when shock is not being delivered from unsafe intervals when it is (Seligman, 1971). Thus, rats and humans choose signaled shock because it allows for discriminating safe periods from unsafe ones. In the college student experiment, participants could relax during the safe period and only worry about shock when the signal light came on. Thus, safe periods are those days when exams are not scheduled, when a tornado warning has not sounded, or when people indicate that they are not about to fight. A person can relax during these safe times. Unsafe periods con- sist of those intervals signaling an exam, a tornado, or a forthcoming argument. These in- tervals are times of stress and anxiety. In daily life perhaps both hypotheses can explain human behavior. If we know when a negative life event is coming, then perhaps we can do something about it. Perhaps we can avoid it or reduce the negative impact it will have. And according to the safety hypothesis, we can relax during those times when no negative life events are signaled.

Stressor-Stress Relationship In addition to magnitude, the effects of a life event also depend on its position in the accu- mulation of stressors. Was the event among the first or the last? Even a small stressor at the end of a line of stressors can act like “the straw that broke the camel’s back.” This occurs because the effects of stressors are cumulative (Singer & Davidson, 1986). If they keep coming, they eventually overtake the individual’s resources to cope. However, the cumula- tive effects of life events at the level of daily hassles may not be stressful until some thresh- old has been exceeded (Lloyd et al., 1980; Perkins, 1982). For example, for students this threshold may occur toward the end of the semester when projects and papers are due, final exams are to be studied for, and plans to vacate residence halls or apartments are made. Although the stress curve keeps rising, it eventually levels off, indicating that after a certain point additional stressors will not have much impact (Perkins, 1982).

Determining the Impact of Stressors. Life’s demands require adjustments. At what magnitude, however, do demands become so great that the required adjustments exceed a person’s coping resources? A serious car accident versus a fender bender, flunking out of university versus flunking an exam, or the end of a long versus a brief romantic relation- ship illustrate demands that involve different levels of adjustment. One assumption is that greater demands require more adjustment and potentially more stress. In order to determine

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the shape of the stressor-stress relationship, it is necessary to quantify the impact of life de- mands and any subsequent stress. To this end, psychologists have employed both objective and subjective measures of stressor magnitude. With both measures, individuals indicate if the event happened to them. In the case of objective measures, the degree of adjustment already has an assigned value. For subjective measures, however, individuals assign their own value to the degree of adjustment.

An example of an objective measure comes from early stress research performed by Holmes and Rahe (1967) when they developed their concept of the life change unit. Each unit equals a degree of adjustment considered necessary to cope with a life change event (Holmes & Masuda, 1974).Adjusting to different life events, however, requires different numbers of life change units. Holmes and Rahe (1967) had a large sample of participants rate various life events for the number of life change units they considered necessary for adjustment. These ratings were summarized into the Social Readjustment Rating Scale, which consists of 43 items rang- ing from death of a spouse (100 adjustment units) to minor violations of the law (43 adjustment units). (These point values were obtained by dividing the original ratings points by 10.) Since publication of this scale, several other life event rating scales have been developed (Miller, 1993).The Social Readjustment Scale contains many items pertinent to the general population, such as a mortgage, trouble with in-laws, change in line of work, being fired, or retirement. However, most of these items have little relevance to the life of college students. Life event items pertinent to university students can be found in the Undergraduate Stress Questionnaire (Crandall et al., 1992). It contains a number of items that have been rated for the severity of their stressfulness. Some example items, in order of decreasing stressfulness, are “had a lot of tests, had a class presentation, registration for classes, and got to class late.”

➣ A complete version of the Undergraduate Stress Questionnaire without the severity scores is available at http://www.utulsa.edu/cpsc/undergraduate_questionnaire.htm

Objective ratings scales, however, imply that the same life event is equally severe or stressful for every person.Yet, one life event may require a great deal of adjustment on the part of one individual and little adjustment for another. Being interrupted from studying might be very annoying for one student but be judged a welcome relief by another. Other stress scales take into account the possibility that the same stressor does not impact everyone the same. For instance, the College Students Life Events Scale in Table 7.3 requires a student to assign a numerical value to both the degree and duration of tension created by a particular demand. The combination of tension and duration indicates the subjective impact a demand has on an individual. The accumulation of a greater score on this scale implies more life demands and thus a greater likelihood of stress. Finally, most stress questionnaires like the one in Table 7.3 make hardly any reference to positive events. Most stressors have a negative valence, which supports the idea described earlier that stressors are composed mainly of negative, not positive, events.

Stressor Magnitude and Stress. A cataclysmic stressor or traumatic event that threatens a person or others with death or serious injury can result in an acute stress disorder and later a posttraumatic stress disorder (PTSD). With this disorder, a person reacts with in- tense fear and helplessness to a traumatic event and may continue to experience intrusive and distressing recollections, thoughts, dreams, and physiological reactivity after the event.

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TABLE 7.3 College Students Life Events Scale

Instructions:

Tension: Indicate how much tension you felt while the most recent occurrence of the event was going on. By feelings of tension we mean feeling worried, anxious, irritable, or depressed. Such feelings may be accompa- nied by difficulty in sleeping or concentrating on other things. Use the following scale:

1 None

2 Slight

3 Some

4 Moderate

5 Significant

6 Severe

7 Almost

Unendurable

Duration: If there was tension associated with the event, think about how long the tension associated with the event lasted (or has lasted if it is still going on). Use the following scale:

1 Less than 1

day

2 More than 1 day, but less than 1 week

3 More than 1 week, but

less than 1 month

4 About 1 month

5 About

6 weeks

6 About

2 months

7 More than 2 months

Tension Duration

1. Increase in normal academic course load (e.g., more academic work than previously, much harder work, etc.)

2. Increased conflict in balancing time for academic-social activities 3. Struggled with decision about major or career goal 4. Inability to get desired courses or program 5. Received much poorer grade than expected on a test or in a course 6. Repeated arguments, hassles with cohabitants (e.g., racial, sexual, religious,

personal idiosyncracies, financial, etc.) 7. Living arrangements consistently too noisy (to study, to sleep) 8. Moved to new quarters on or off campus 9. Realized that finances are increasingly inadequate to meet living expenses

10. Significant increase in level of debt (e.g., took out large loan, charged more than can easily pay, gambling debts, etc.)

11. Serious attempt to stop, decrease, or moderate use of drugs, alcohol, or smoking

12. Significant increase in use of alcohol, resulting in problems in school, work, or other areas of life

13. Increased attendance or participation in religious services or practices 14. Decreased attendance or participation in religious services or practices 15. Increased commitment or participation in political or social activism 16. Began sexual unfaithfulness to a partner to whom you are not married 17. Engaged in initial sexual intercourse 18. Engaged in sex act without use of birth control measures (i.e., feared

pregnancy) 19. Became pregnant out of wedlock or partner became pregnant out of

wedlock

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TABLE 7.3 (Continued)

20. Experienced rejection of a more than casual sexual overture 21. Unable to find a satisfactory sex partner 22. Divorce or separation of parents 23. Death of member of immediate family (e.g., parent, sibling, grandparent, etc.) 24. Parental remarriage 25. Decided for the first time not to go home for major holiday 26. Increased conflict with parent (e.g., sex, drug use, dress, religious practices,

lifestyle, sleeping out of home, etc.) 27. Increased peer pressure to experiment with sex, drugs, etc. 28. Lost a friend due to personal conflict 29. Lost a good friend or friends because you or they moved, or transferred, etc. 30. Realized necessity to make new friends 31. Got married 32. Entered new, serious relationship with boyfriend or girlfriend (e.g.,

engaged, living together, etc.) 33. Boyfriend or girlfriend broke up your relationship 34. You broke up with boyfriend or girlfriend 35. Increased conflict with boyfriend or girlfriend (e.g., over sex, drugs,

alcohol, independence, recreation, division of responsibilities, etc.) 36. Deeply attracted to someone who showed no interest in you 37. Important date was disappointing 38. Your friend went out with someone you were interested in 39. Struggled with decision to break up with boyfriend or girlfriend 40. Increased job responsibilities 41. Increased hassles on the job with boss or supervisor 42. Quit job 43. Realized job responsibilities interfered with academic work 44. Victim of assault 45. Busted for drug related activity 46. Victim of robbery or burglary 47. Involved in auto accident as driver, without injury 48. Involved in auto accident as passenger, without injury 49. Illness or injury kept you out of school for one week or more 50. Car broke down 51. Activity run by your group was a flop (e.g., play, team lost game, no one

came to your party, etc.) 52. Realized responsibilities in extracurricular activities interfered with school

work 53. Unable to find adequate recreational or athletic outlets

Source: Adapted from “College Students Life Events Scale” by Murray Levine, University at Buffalo, and David Perkins, Ball State University. Printed with their permission.

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P er

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xp er

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T S

Distance < 2 miles?

Directly witnessed?

Lost possessions?

Lost job?

No Yes

FIGURE 7.1 PTSD from Terrorist Attacks. The incidence of PTSD from the September 11th terrorist attack increased with closeness to the site, directly witnessing the attack, and losing possessions or employment as a consequence.

Source: Adapted from “Psychological Sequelae of the September 11 Terrorist Attacks in New York City” by S. Galea et al., 2002, New England Journal of Medicine, 346, table 1, p. 984.

The person also tries to avoid stimuli associated with the trauma, experiences persistent arousal symptoms (e.g., sleep difficulty), and suffers social impairment. In the case of acute stress disorder, the symptoms must occur and subside within four weeks of the traumatic stressor. If the symptoms continue, the diagnosis changes to PTSD (American Psychiatric Association, 2000).

Both acute and posttraumatic stress disorders resulted from the terrorist attacks per- petrated against the United States on September 11, 2001. Two airplanes crashed into the World Trade Center in New York City, a third airplane crashed into the Pentagon, and a fourth crashed in a Pennsylvania field. The combined terrorist attacks killed an estimated 3,000 people and destroyed billions of dollars worth of property. In addition, the attacks and media replays produced psychological havoc in the form of fear, anxiety, a sense of vulner- ability, and uncertainty about the future (Susser, Herman, & Aaron, 2002). In one nation- wide random telephone survey three to five days after the attack, respondents were asked the extent they felt the following stress reactions: (1) feeling very upset by reminders of the events, (2) disturbing memories, (3) difficulty concentrating, (4) trouble falling or staying asleep, and (5) feeling irritable or having angry outbursts (Schuster et al., 2001). The survey showed that 44% of the adults reported at least one of the stress symptoms, and 35% of their 5- to 18-year-old children did also. Even individuals thousands of miles from the attack site experienced stress symptoms, which may have resulted from the images being shown re- peatedly on televison (Schuster et al., 2001). Five to eight weeks after the attack, a random telephone survey of NewYork City adults living within eight miles of the World Trade Cen- ter showed that overall, 7.5% of the respondents experienced PTSD. Figure 7.1 shows that

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the likelihood of suffering PTSD increased with being close (< 2 miles) to the attack site, directly witnessing the attack, and losing one’s possessions or job (Galea et al., 2002).

Cumulative Effects of Stressors. Do demands pile up at the end of the semester? Does something need repair the same time you are low on money? Is there so much to do and too little time to do it? In order to determine the cumulative effects of stressors, Holmes and Masuda (1974) tabulated life changes for a large group of physicians and recorded the occurrence of illness or health changes that occurred within a two-year period following a cluster of such changes. Their results, in Figure 7.2, show that as life change units increase, health changes increase also. In a prospective study, life change scores of resident physicians covering the previous 18 months were correlated with illnesses occurring in the next 9 months. The relationship was positive: the percentage of individuals getting ill was greater for those with a larger number of life change units (Holmes & Masuda, 1974). Other research shows that as the number of life change units increases over a period of years, the likelihood of tuberculosis, heart disease, and skin diseases also increases (Rahe et al., 1964). In reviewing this research, Holmes and Masuda (1974) conclude that life change events require adaptive effort by the individual, or what Selye (1976) calls adaptation energy. A decline in adapta- tion energy lowers the body’s resistance and thereby increases the likelihood of disease.

In addition to affecting illness, life changes can also depress behavior such as academic performance and GPA. Lloyd and colleagues (1980) assessed life changes among college stu- dents by having them indicate what changes had occurred in their lives. For instance, students were asked if they had experienced changes in sleeping, eating, recreation and family get- togethers, living conditions, or moving; or injury, illness, or the death of a friend or family member. Students were also asked to subjectively weigh each life change in regard to the amount of adjustment each required. Two measures were of interest: the total number of events that occurred in the previous year and the subjective weighted event total, which involved the

Number of Life Change Units

P er

ce n

ta g

e o

f H

ea lt

h C

h an

g es

Mild (150–199) Moderate (200–299) Major (300+) 0

FIGURE 7.2 Accumulated Stress and Health. As the number of life change units increases, the percentage of health changes also increases.

Source: Adapted from “Life Change and Illness Susceptibility” by T. H. Holmes and M. Masuda, 1974, in B. S. Dohrenwend and B. P. Dohrenwend, Eds., Stressful Life Events, table 1, p. 61, New York: John Wiley.

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subjective impact of a change. The life change measures were associated with a declining GPA: as life change scores went up, GPA went down. This finding was especially true for the sub- jective weighted event total. In addition, life changes in recreation, in work responsibilities, and in changing to a new line of work had a greater impact on students with lower GPAs.

The cumulative effects of traumatic stressors can be very detrimental for the mental health of people. One group of individuals to whom this has happened are soldiers and Marines, who have experienced ground combat or dangerous security duty in places of war. In one study, Hoge and coresearchers (2004) gave an anonymous survey to returning soldiers and Marines, who had experienced combat or other dangerous duty in either Afghanistan or Iraq. The survey included questions that covered depression, generalized anxiety, and PTSD. A checklist from the Department of Veteran Affairs was used to diag- nose PTSD. The checklist contained 17 items that were rated on a scale 1 � not at all to 5 � extremely. For example, how much in the past month have you been bothered by “Repeated, disturbing memories, thoughts or images of a stressful military experience?” Other ques- tions addressed stressful experiences that were of a noncombat origin (National Center for Posttraumatic Stress Disorder, 2008). In order to be diagnosed with PTSD, the individual had to score above the midpoint on the checklist. The survey examined a multitude of trau- matic stressors. These included being in firefights, which is an exchange of gunfire between combatants and can include being ambushed; shot at by artillery, rockets, or mortar fire; and shooting the enemy in return. Stressors also included killing enemy combatants, seeing and handling dead bodies, knowing someone who was killed or seriously injured. A final set of stressors included being wounded, injured, or having a close call with death, saving someone’s life, but also being unable to save the lives of others (Hoge et al., 2004).

The general results of the survey showed that mental health problems increased as a re- sult of being deployed in Afghanistan and Iraq. Furthermore, there was a direct relationship between the incidence of PTSD and the number of firefights. As Figure 7.3 indicates, the greater the number of firefights that individuals had experienced, the greater their likelihood of being diagnosed with PTSD. Even without participating in a firefight, 4.5% of the Marines and soldiers experienced PTSD as a result of their deployment in either Afghanistan or Iraq.

Racism as a Stressor. Stressors also accumulate by virtue of an individual’s minority group membership. Based on physical characteristics, people may be members of minorities, such as being an African American in the United States. As a member of a minority group, individuals often experience the stresses of discrimination and racism. Utsey and Ponterotto (1996) devel- oped the Index of Race-Related Stress, which measures the impact of four categories of racism (see Table 7.4). Cultural racism results from the practices of one group being imposed on another, while institutional racism stems from the policies ingrained in an organization. Indi- vidual racism is experienced personally, while collective racism occurs when an entire organi- zation discriminates against an individual (Utsey & Ponterotto, 1996). The stressful nature of racism, as measured by the index in Table 7.4, was demonstrated in two ways. First, cultural and individual racism scores on the Index of Race-Related Stress correlated positively with scores obtained with the Perceived Stress Scale (Cohen & Hoberman, 1983). In other words, the more upset individuals were as a result of cultural and personal racism, the more stress they experienced. Second, African Americans scored significantly higher on all four racism cate- gories measured by the index than did a group of nonblacks (whites and Asian Americans), which indicates African Americans experience more racism than do other groups.

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FIGURE 7.3 Cumulative Effects of Traumatic Stressors. The likelihood of a soldier or Marine developing PTSD increased as their participation in firefights increased. Firefights refer to an ex- change in gunfire, artillery, rockets, or mortar fire between combatants.

Source: Adapted from “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care” by C. W. Hoge et al., 2004, The New England Journal of Medicine, 351, p. 17.

TABLE 7.4 Four Illustrations of Racism from the Index of Race-Related Stress

If the following events happened to you, to what extent were you upset by them (Not bother me, Slightly upset, Upset, Extremely upset)?

Cultural Racism “You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.”

Institutional Racism “You have discovered that the White/non-Black person employed in the same capacity as you with equal or less qualifications is paid a higher salary.”

Individual Racism “While shopping at a store or when attempting to make a purchase, you were ignored as if you were not a serious customer or didn’t have any money.”

Collective Racism “You were the victim of a crime and the police treated you as if you should just accept it as part of being Black.”

Source: Adapted from “Development and Validation of the Index of Race-Related Stress (IRRS)” by S. O. Utsey and J. G. Ponterotto, 1996, Journal of Counseling Psychology, 43, table 1, pp. 494–495.

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Experiencing racism is associated with psychiatric symptoms. Landrine and Klonoff (1996) developed the Schedule of Racist Events to assess the effects of racist discrimination in the lives of African Americans. A sample from this schedule is “How many times have you been treated unfairly by strangers because you are Black?” (Never, to Almost all of the time) (p. 162). Evidence for the stressful effects of racism came from examining the relationship between the schedule scores and stress-related psychiatric symptoms obtained from the Hopkins Symptoms Checklist (Derogatis et al., 1974).Analyses showed that the schedule scores were positively correlated with symptoms like obsessive-compulsive disorders, depression, anxiety, and physical symptoms. In addition, people who were more stressed from racist events, as measured by the schedule, were also more likely to use smoking as a stress reducer.

Finally, there are also ethnic differences in hypertension. For instance, African Amer- icans have a higher incidence of hypertension (high blood pressure) than white Americans. Racism is thought to be one factor responsible for this (Barnes et al., 1997). However, as a note of caution, it is not possible to say that perceived racism is a cause of stress, although the two variables are associated together. Perhaps laboratory research will allow psycholo- gists to determine whether one causes the other (for example, see Vrana & Rollock, 1998).

Section Recap At times a person is motivated to do too many things at once because of the many demands made on an individual. This can result in strain, which means that a person’s resources are inadequate to meet those demands. Stress is the reaction to strain. It is detrimental to a per- son’s well-being and is manifested by negative feelings, excessive physiological arousal, psychophysiological disorders, illness, and maladaptive behavior. Coping behaviors are motivated by the necessity of managing life’s demands and the resulting stress. Stressors consist mainly of negative life events that produce stress. Positive life events produce a type of arousal known as eustress, especially if the level of arousal is optimal. Stress usually means distress and is the opposite of eustress. According to the same domain effect, nega- tive events produce distress, while positive events produce positive feelings and increase the quality of life and eustress. Stressors vary in magnitude.

Both animals and humans prefer to know when a stressor, such as shock, is coming. According to the preparatory response hypothesis, knowing when a shock is coming allows the organism to prepare for it. According to the safety hypothesis, it is important to distin- guish shock from shock-free intervals, since a shock-free interval allows the person to re- lax and feel safe. In general, as the magnitude of the stressor increases and as stressors accumulate, stress increases. Scales have been developed to measure the impact of various stressors and the amount of adjustment they require. Some scales measure stress in terms of life change units, which refer to the amount of adjustment a stressor requires. Extremely traumatic events, such as the terrorist attacks of September 11, 2001, result in an acute stress disorder, which if it persists more than four weeks is diagnosed as a posttraumatic stress disorder (PTSD). These disorders are characterized by distressing dreams, flash- backs, psychological distress, and behaviors reminiscent of the original event. The effects of extreme stressors can accumulate as observed in the increased incidence of PTSD among soldiers and Marines who participated in more and more firefights. Finally, racism as experienced by African Americans and other minority groups is associated with stress and higher levels of psychiatric symptoms.

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Bodily Effects of Stress BODY: What a fine mess you’ve gotten me into. I’m stuck here in bed with a fever

and achy joints. Why didn’t you defend me?

IMMUNE SYSTEM: I did the best I could. Can I help it that you expose yourself si- multaneously to the viruses of many individuals? A drafty classroom on a winter’s day is really not the place for you to be when I am so weak. My defenders did the best they could, fighting the viruses when they invaded. But they were over- whelmed by the onslaught. Besides, you have only yourself to blame.

BODY: Now it’s my fault, is it? What did I do wrong?

IMMUNE SYSTEM: Yes it’s your fault. You are motivated in too many directions at once. You spend too many hours attending classes, studying, working, recreating while at the same time not getting enough sleep and not eating properly. As a result, I suffer. If you were a bit less active, I would be stronger and thus better able to fight off an attacking virus. Now you will just have to kill them off with heat by raising your temperature. If you decrease your activity level a bit, I will become stronger. However, do not become totally inactive because that will also decrease my strength below an optimal level.

This imaginary conversation shows that some stress is good for the immune system, while too little or too much is bad. The purpose of this section is to describe how stressors affect the physiological system, the immune system, and ultimately a person’s well-being.

Physiological Effects of Stressors GeneralAdaptation Syndrome. One of the earliest and major investigators of the phys- iological consequences of stressors was Hans Selye (1976, 1993). As a medical student in 1936, he discovered how a variety of different stressors produced similar physiological stress reactions. Regardless of whether the stressors included cold, heat, trauma, hemor- rhage, or nervous irritation, the body’s physiological reaction was the same. He coined the term general adaptation syndrome (GAS) to refer to the observation that stress involved the whole body as it went through three stages: alarm reaction, stage of resistance, and stage of exhaustion. The alarm reaction is the body’s first and generalized response to a stressor. During this phase sympathetic nervous system arousal increases, and stress hormones are released, such as epinephrine, norepinephrine, and glucocorticoid. These hormones can enlarge the adrenal glands, shrink the thymus gland, and produce stomach ulcers. In addition, there is a tendency to suppress the body’s immune system, thus making the body more susceptible to disease. The initial decrease in resistance to stressors is fol- lowed by the stage of resistance, during which the body is successfully controlling the stress. Stress hormone production is no longer necessary and drops back to normal. The body’s response to fighting stress also goes from being generalized to being localized to where the stressor impacts the body. At this stage the body is more resistant to the original stressor while at the same time being more vulnerable to new stressors. During this time, a person is using adaptation energy in defending against a stressor and adjusting to its ef- fect. In the final stage, the stage of exhaustion, a person runs out of adaptation energy, and the ability to combat stress becomes completely exhausted, resulting in death. During this

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stage, the level of stress hormones rises in the bloodstream, and they become sources of stress themselves (Selye, 1976).

Psychological Stressors and Physiological Responses. Physiological stressors are capable of producing physiological responses. Strenuous exercise (e.g., distance running or bicycling) increases the release of stress hormones (Davies & Few, 1973; Farrell et al., 1983; Luger et al., 1988). However, psychological stressors like public speaking, being evaluated in a job interview, or doing mental arithmetic also release stress hormones. Meyerhoff and associates (1988) investigated the effects a voluntary promotion interview had on soldiers when conducted by superior officers. Heart rate and stress hormone levels were measured before, during, and after the interview. All these indicators of stress increased from before to during the oral interview and then decreased afterward. These results confirm one of Selye’s (1976) main points: regardless of the nature of the stressor, the stress reaction is the same.

Stressors and Psychophysiological Disorders Certain medical diseases are caused or made worse by stressors. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), general medical condi- tions combined with psychosocial and environmental problems lead to diagnoses termed “psychological factors affecting medical condition” (APA, 2000). Stressors adversely affect medical conditions by intensifying, delaying recovery, interfering with treatment, or adding additional health risks. Psychophysiological or psychosomatic disorders is another name given to these medical conditions, including such classic examples as asthma, headaches, heart disease, hypertension, and ulcers.

The news “broke my heart.” This statement implies that a single psychological stres- sor is capable of producing a strong psychophysiological reaction characterized by heart at- tack symptoms. Evidence for this claim comes from an analysis of 19 (18 were women) healthy patients with a median age of 63 years, who reported to a hospital with symptoms of chest pain, heart failure, hypotension (extremely low blood pressure), or difficult and labored breathing (Wittstein et al., 2005). The patients had reacted to the death of a loved one (nine cases), surprise party or reunion (two cases), a car accident, fear of a procedure, argument, court appearance, fear of choking, and tragic news. These case studies illustrate how a psychological stimulus can cause severe psychophysiological distress.

Stressors that bring on bouts of anger have also been linked to the onset of heart attacks. In one study conducted by Mittleman and colleagues (1995), coronary patients were interviewed an average of four days after their heart attacks. They were asked to rate the intensity of any anger episodes they may have experienced during the 26 hours preced- ing their attacks on a scale using the following anger descriptors: calm, busy, mild, moder- ate, very, furious, or enraged. The 26-hour interval allowed the researchers to compare the incidence and intensity of any anger episodes occurring two hours before the onset of a heart attack with the same two hours on the day previous to the attack. A comparison of the two intervals showed that a heart attack was twice as likely to follow within two hours of a very angry, furious, or enraged episode. Family members, work conflicts, and legal problems were the most frequently reported causes of anger.

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Stressors and the Immune System When you catch a cold or flu, does it happen at a time when there are many demands in your life? Are you more likely to be ill at the end of the semester than at the beginning? If so, this may not be your imagination. A relatively new field known as psychoneuroimmunology concerns the relationship between psychological stressors, the immune system, and disease. Scientists working in this field examine how stressors and stress are detrimental to the immune system and whether or not this increases an individual’s susceptibility to diseases such as colds and flus (Cohen & Herbert, 1996; Kiecolt-Glaser et al., 2002; Kiecolt-Glaser & Glaser, 1995).

The body’s immune system is the line of defense against invading microorganisms, such as bacteria and viruses, that are responsible for various diseases. The body defends itself against these infectious invaders in various ways. One line of defense consists of a particular type of white blood cells, known as phagocytes, that roam the bloodstream in- gesting any and all invading microorganisms. Another type of white blood cells are natural killer cells. They have the job of detecting and killing damaged or altered cells like infected or cancerous ones. Yet another line of defense involves recognizing and attacking any microorganisms that have invaded the body previously. Important for this process are white blood cells known as B cells and T cells. B cells originate in bone marrow as do T cells, but these then mature in the thymus gland. When the same microorganism invades again, the body sends out B and T cells, which are capable of recognizing the invader and attack it and only it (Benjamini et al., 1996).

Stressor Effects on the Immune System. To the extent that stressors can reduce the effectiveness of the immune system, the likelihood of a particular disease will be increased (Cohen & Herbert, 1996; Cohen & Williamson, 1991; Kiecolt-Glaser et al., 2002). Life changes or stressors affect the nervous system, hormonal responses, and behavior. All of these, in turn, can affect immune system functioning and thereby increase the likelihood of disease. The central nervous system affects the immune system, since some of its nerve endings terminate at the organs where B cells and T cells develop. The sympathetic nervous system is instrumental in the release of stress hormones like epinephrine and norepineph- rine, which briefly decrease some of the T cells in the bloodstream and also depress the ac- tion of phagocytes. Selye (1976) discovered that one consequence of prolonged stressors was a notable shrinkage of the thymus gland, where T cells mature. He also found a dramatic shrinkage of the lymph nodes, which cluster in the neck, armpits, abdomen, and groin. The nodes serve as a kind of home base for lymphocytes in their fight against infectious invaders. Thus, through these intermediate steps, stressors alter the immune system, thereby increas- ing susceptibility to disease (Black, 1995; Cohen & Herbert, 1996; Kiecolt-Glaser & Glaser, 1995). Behavioral changes may also affect the immune system, since people under stress of- ten engage in bad health practices by drinking too much alcohol, maintaining a poor diet, smoking more, and sleeping less (Cohen & Williamson, 1991; Conway et al., 1981).

Open Window Hypothesis. Strenuous exercise is a behavioral stressor that has been examined to determine how stress affects the immune system. One finding is that exercise affects the immune system in a J-shaped fashion (Nieman, 1994). The left tip of the J rep- resents the likelihood of a respiratory infection as a result of being sedentary (no exercise).

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Then as the amount or intensity of exercise increases to a moderate amount, the likelihood of a respiratory infection decreases, as indicated by the bottom part of the J. Further increases in exercise, however, begin to increase the likelihood of infection to the point where high amounts of intense exercise are associated with the greatest risk of respiratory infection (upper right of the J) (Nieman, 1994; Pedersen & Ullum,1994). To account for this J relationship, Pedersen and Ullum (1994) postulated the open window hypothesis, which states that a few hours after strenuous exercise the immune system is suppressed and allows an “open window” when natural killer cell activity is low and when there is greater opportunity for a virus or bacteria invade and infect the body. Thus, too much physical exercise, such as running, can actually increase one’s likelihood of respiratory diseases. For instance, Nieman (1994) reports that 12.9% of participants in the Los Angeles (26.2 mile) marathon developed respiratory infections compared to only 2.2% of similar runners who did not participate in the marathon. Also, during the two months prior to the marathon, the more miles per week an individual ran in training, the more likely she was to develop a respiratory infection.

Many psychological stressors also follow the J curve. In the case of short-term psy- chological stressors that are studied in the laboratory, there appears to be an increase in im- mune system functioning (downward slope of the J curve). Stressors like doing mental arithmetic while being harassed, naming the color that a color name is written in (Stroop task), or placing one’s hands in very cold water show an initial increase in natural killer cell activity, which then subsides minutes after the stressor ends (Delahanty et al., 1996; Herbert et al., 1994). Long-term stressors, however, seem to downgrade the immune system. For instance, residents living near a nuclear power reactor that broke down were compared with a group of control residents living in an area more than 80 miles away. The report of this accident was very stressful because it raised the possibility of radioactive contamination for people living nearby. Analyses of blood samples from both areas showed lower immune system functioning up to six years later among residents living near the reactor. They had fewer B cells and fewer natural killer cells than residents from the control town (McKinnon et al., 1989).

Stressors, Immune System, and the Common Cold. Although stressors can down- grade the immune system, additional evidence is required to show that stressors also con- tribute to the occurrence of disease. In one investigation, Cohen and associates (1998) investigated how the duration of chronic stressors interacted with the ability of cold viruses to produce colds. Healthy volunteers with no chronic stressors and those with various types of chronic stressors lasting more than two years received two different types of respiratory cold viruses. The percentage of volunteers experiencing cold symptoms and getting colds was greater for those who had experienced at least one month of stressors compared to those with no stressors. In addition, the longer the duration of the chronic stressor the more likely a volunteer would catch cold, especially if the stressor lasted more than two years. Finally, the likelihood of catching a cold was greater for those with interpersonal or work stressors compared to other types of stressors or no stressors. These results indicate that a virus causes a cold provided that the person is undergoing enough stress to downgrade her immune system. In addition to colds, stressors have been implicated in the onset of a vari- ety of infections, such as hepatitis, upper respiratory infection, herpes, and mononucleo- sis (Black, 1995; Peterson et al., 1991).

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Section Recap Regardless of the type of stressor, the body’s adaptive physiological reaction or general adap- tation syndrome is generally the same. The first stage is known as the alarm reaction, which is the body’s initial generalized response to the stressor. The sympathetic nervous system is aroused and stress hormones are released. During the second stage, or stage of resistance, the body successfully controls the stress by localizing its response to where the stressor impacts the body. Adaptation energy is used in defense against a stressor and adjusting to its effect. During the final stage, or stage of exhaustion, a person exhausts his adaptation energy, his ability to combat stress and disease declines, and death results. Diseases caused or worsened by stressors have been referred to as psychophysiological (psychosomatic) disorders, such as asthma, headaches, heart disease, hypertension, and ulcers. Tragic news, unexpected events, and anger can worsen coronary heart disease and even precipitate heart attacks.

Psychoneuroimmunology is a field that examines how psychological stressors de- grade the immune system, making disease more likely. The body’s immune system defends against invading microorganisms, such as bacteria and viruses, which are responsible for various diseases. A J-shaped curve describes the relationship between stressors and the in- tegrity of the immune system. As stressors increase, the immune system becomes stronger and then weaker. According to the open window hypothesis, strenuous exercise such as marathon running can so weaken the immune system that it provides an “open window” of opportunity for foreign agents to invade and infect the body. Psychological stressors, when of sufficient magnitude, can also degrade the immune system. The consequence of this increases the likelihood of becoming ill from some invading virus.

Variables Moderating the Impact of Life Events When life hands you a lemon, do you turn sour or do you make lemonade? In a letter to Ann Landers, one distraught reader wrote that her husband left her for another woman.The writer claimed that as a result she suffered a heart attack even though she was only in her 40s. She went on to write, “Since then my life has taken a 360-degree turn. I no longer smoke. I joined [a weight loss organization] and lost 58 pounds. I watch my salt, cholesterol and fat intake and exercise daily. How do I feel? Wonderful! . . . It’s tough to admit, but I owe this new- found happiness to my ex-husband who dumped me. What I thought was the worst tragedy of my life turned out to be a blessing.” Ann Landers responded by writing, “When life hands you a lemon, make lemonade.” The idea of making lemonade out of life’s lemons illustrates the fact that people’s reactions to life change demands are not fixed but variable. Stress depends on the appraisal of the life event and on characteristics of the individual.

This section describes the process from appraising a life event to coping with it. An individual appraises a life event and inventories her coping strategies. The outcome deter- mines how the individual copes with both the event and the accompanying stress, if any. Along the way, social support and personality traits are important factors that determine the outcome of the appraisal process and coping.

Appraisal of Life Events When plotting time changes in the course of stress, Tice and Baumeister (1997) discovered that students differed in the number of symptoms at semester’s end. Some students reported

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Intense stressorsNo stressors

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Magnitude of Life Change Events

FIGURE 7.4 Moderators of Stressors and Stress. As the level of life changes or stressors increases, the level of stress increases. The increase in stress, however, is significantly less for individuals who possess some moderator variables. Less stress is experienced by individuals who appraise events positively, have good social support, do not procrastinate, have a good sense of humor, and are hardy.

more stress than others. How could this be possible if there is a precise relationship between the accumulation or magnitude of life events and stress? It turns out that the accumulation of life events is only mildly correlated with the level of stress (Rabkin & Struening, 1976). Why is the number or magnitude of previous life change events so weakly predictive of stress? The reason is a set of moderator variables, which are characteristics of the envi- ronment or of the person that alter the relationship between stressors and stress. These vari- ables can make the person either more or less vulnerable to life events. For example, not everyone interprets a life event the same way—that is, some individuals turn sour, while others make lemonade. One individual may be thankful he was not killed in a traffic acci- dent, while another is bitter about the loss of his car. Two individuals may experience the same number of negative life events, but one may also experience positive life events to help alleviate stress. One individual may be a member of a close-knit family where she can turn for help, while another may not have this resource available. Finally, there may be person- ality traits like sense of humor and hardiness that help people weather stressors. Figure 7.4 previews how these moderator variables influence the impact of a stressful life event.

Appraisal and Stress. Appraisal is the process whereby initial negative life events can be viewed positively or even more negatively. The metaphor of making lemonade from life’s lemons illustrates how appraisal can turn negative events into positive ones. Appraisal alters the meaning of a life change event and consequently how an individual reacts (Folkman & Lazarus, 1985; Lazarus & Folkman, 1984). Does a student look

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forward to writing a course paper as a challenge or as a threat? Does the rejected lover dwell on what might have been or view the end of the romantic relationship as a new beginning? In primary appraisal a potential event is evaluated as to whether or not it is relevant, benign, positive, or stressful. If the event is judged irrelevant, then a person may have little reaction to it. Benign or positive events produce little reaction or result in positive emotions but provide little if any stress. An event is appraised as stressful, however, if it implies a threat, challenge, or has the potential for harm or loss. Threat refers to the potential for harm or loss, while challenge means that an event, although potentially damaging, is controllable.

Assessing what strategies can meet the demands of life events illustrates secondary appraisal (Folkman & Lazarus, 1985; Lazarus & Folkman, 1984). First, an individual can take an inventory to determine if she has the appropriate resources to cope with the event. She can decide what coping strategy to employ and evaluate the likelihood that it will suc- ceed. For example, a student realizes that she will not have enough time to complete a course paper of the quality she would like. What can be done in this situation? Should she turn in the paper and earn a lower grade than she is capable of earning? Should she curtail other ac- tivities in order to finish her paper? Should she ask for an extension? What is the likelihood that it will be granted? All of these considerations are part of secondary appraisal.

Appraisal as a Moderator. The possibility that appraisal can affect an individual’s level of stress was demonstrated in a classic series of experiments by Lazarus and associates (Lazarus & Alfert, 1964; Lazarus et al., 1965; Speisman et al., 1964). Lazarus combined several stressful films with soundtracks designed to affect the viewer’s cognitive orientation toward the various scenes in the films. One film depicted primitive subincision rites show- ing deep cuts being made into the penises of adolescent boys. Another stressful film showed workshop accidents of fingers being cut off. Soundtracks that fostered denial, intellectual- izing, and trauma orientations accompanied all films except the control. In the denial orientation, the harmful aspects of subincision were minimized; instead the event was emphasized as a happy one for the boys. In the denial orientation, the soundtrack of the shop accident film emphasized that the events were acted, the blood was fake, and no one was injured. In the intellectual orientation, the soundtrack offered a technical description, thus providing emotional distance from the scenes shown. For example, in the film on job acci- dents the shop foreman was described as training workers in safety procedures. In the trauma orientation, the emphasis was on the pain and terror the boys must have experienced during subincision. As a control, another group of participants watched these films without soundtracks. Electrodermal (skin conductance) and heart rate responses were used as indicators of arousal and stress. The results of these experiments showed that denial and intellectual orientations produced lower levels of physiological arousal or stress compared to the control group. The trauma orientation, however, increased the level of arousal. The moderating variable in this research was the viewer’s orientation in appraising the films. Appraised one way, as in trauma orientation, stress increased; appraised another way, as in denial or intellectualization, stress decreased.

Coping and Behavior We can infer from her letter to Ann Landers that the woman coped with her husband’s de- parture and with the stress that resulted. Coping has two functions: trying to deal with a life change demand and with any distress the demand produces (Folkman & Lazarus, 1985;

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Lazarus & Folkman, 1984). Problem-focused coping involves trying to identify the prob- lem more clearly and to consider potential solutions. Emotion-focused coping involves managing the negative reactions of the accompanying stress. There are a number of emotion- focused coping strategies. Wishful thinking is the desire that the problem would somehow go away or that the person would feel differently about it. Distancing refers to biding one’s time before doing anything or trying to forget about the problem. Coping by emphasizing the positive means interpreting the problem in a positive light—that is, “making lemonade when life hands you lemons.” Self-blame as a way of coping refers to the realization that you are responsible for your actions and their consequences. Smoking, drinking, drug taking, eating, and jogging are tension reduction coping strategies that make the person feel better. Finally, some people employ self-isolation in which they keep other people ignorant of their prob- lems or avoid people in general (Folkman & Lazarus, 1985).

Coping strategy depends on the controllability of the stressor. Controllable events are more likely to elicit problem-focused coping, while events requiring acceptance and adaptation elicit more emotion-focused coping. Problem- and emotion-focused coping can occur together. For example, a person might seek the advice of a career counselor to learn about potential careers for which she is suited and thereby also reduce anxiety about an uncertain future.

Appraisal and subsequent coping are processes rather than static events (Folkman & Lazarus, 1985; Lazarus & Folkman, 1984). As part of a process, how an event is appraised determines the coping strategies that will be used. To demonstrate this dynamic process, Folkman and Lazarus (1985) studied coping strategies employed by students two days be- fore a midterm exam, five days later but before grades were announced, and five days after grades were announced. They found that problem-focused coping was highest before the exam and decreased afterward, since nothing more could be done. The emotion-focused coping strategy of wishful thinking also decreased after the exam and again after grades had been posted. Wishful thinking as a way of reducing negative emotions (fear, anxiety) is most beneficial when those emotions are at their highest just before the exam. Wishful thinking was also stronger for students with lower grades than those with higher grades. After all, a student is not likely to wish for something else if she earns an A. Wishful thinking is more likely to be employed when a student earns a D in order to help alleviate feelings of disap- pointment or guilt. Emphasizing the positive also decreased after the exam but did not decline significantly after that. Coping by distancing was greatest while waiting for grades, which was at that point an uncontrollable outcome. Although seeking social support occurred in each exam phase, it also depended on the grade a student had earned. Students who earned a lower grade were more likely to seek social support. For example, a student who earns a D is more likely to experience harmful emotions, such as disappointment, guilt, or disgust, and to therefore seek social support as a way of alleviating these emotions.

Coping strategies that students employ to deal with the stresses of college life may depend on their level of academic experience. Toray and Cooley (1998) compared first-year and upperclass female students regarding their coping strategies during finals week. Both groups of students did not differ in their stress levels during this time or in their perceived test-taking abilities. However, they did differ in their coping strategies. First-year students were more likely to use distancing and self-isolation as a coping strategy compared to their upper-class counterparts. Upper-class students, however, were more likely to employ problem-focused and self-blame coping during the week. Perhaps they had learned that by attacking the problem and holding oneself responsible final exams are less stressful. The

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students also differed in regard to an aspect of coping by tension reduction. Upper-class stu- dents reported a greater likelihood to think about food and to eat in anticipation of finals. Perhaps they were more likely to eat “comfort foods” to help them alleviate their stress.

Social Support as a Moderator When you need help, is it available? Do you have someone to go to for money, for practi- cal help, or to talk to when troubled? Social support is provided by a network of helpful individuals during both primary and secondary coping. According to the buffering hy- pothesis, various forms of social support buffer or protect an individual from the harm of potential stressors (Cohen & Wills, 1985). Having a friend you can talk to about a forth- coming job interview, for example, can act as a buffer against feelings of anxiety and lack of confidence. The lack of social support from friends and family or of professional help increases the likelihood that a stressor will have a negative impact on the individual.

As a test of the buffering hypothesis, Cohen and Hoberman (1983) measured the ex- tent to which social support protects students against the stressors of college life. Different scales assessed the level of various stressors experienced by students during the previous year, along with depressive and physical symptoms. Other scales measured students’ level of social support from friends and family and the availability of physical resources like money. Other scales measured the availability of people in whom an individual could con- fide and also the extent she felt esteemed, respected, and valued by others. The results showed that as the number of negative life events increased, both depressive and physical symptoms increased. However, social support and physical resources buffered the effect of negative life events. Stress symptoms were less pronounced for individuals who had a greater amount of social support and physical resources, greater feelings of belonging, and higher self-esteem. In a one-semester prospective study, Demakis and McAdams (1994) found that introductory psychology students who reported being highly satisfied with their social support network were more satisfied with university life and tended to have lower negative affect compared to students less satisfied with their social support. Finally, the likelihood of developing PTSD from the September 11th terrorist attack was lower for people who had a high compared to a low level of social support (Galea et al., 2002).

Social support also buffers the immune system and physical health against stressors. It is linked to lowering blood pressure and better immune system functioning (Uchino et al., 1999). For instance, Kiecolt-Glaser and associates (1984) investigated the effects previous life changes and course exams had on the immune system of medical students. Analyses showed that the number of prior life events and the exams contributed to a de- crease in natural killer cell activity in the immune system. Buffering effects were observed, however, based on how lonely the students felt. Students who reported being lonely showed a greater decline in natural killer cell activity than students who reported being less lonely. Taft and associates (1999) examined the relationship between social support, PTSD, and the physical health of Vietnam veterans. Social support was measured by inquiring if the veterans had friends and relatives who could provide psychological assistance and practical help, such as lending a car. Veterans benefitted from social support, since those who received it suffered less from combat-related PTSD and from poor physical health. Uchino and associates (1999) theorized that social support lessens the impact of stressors on physical health in several ways. First, the support of others may lessen the impact of a

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stressor. For example, sympathetic others may serve as a buffer against college- or job- related stress. Being able to complain to a sympathetic roommate about a boring profes- sor or to a sympathetic spouse about a demanding boss may be great stress relievers. Second, even in the absence of stressors, friends and family affect physiological processes by influencing one’s self-esteem, feelings of self-efficacy, and mood. Third, social support may increase health-enhancing behaviors and decrease health-impairing behaviors. Thus, with the encouragement of others an individual may be more likely to eat well and exer- cise and be less likely to smoke and eat an unhealthy diet. Of course, not all social rela- tionships are positive and thus buffers against stress. Housemates and spouses who are hard to get along with are more likely to be a source of stress than buffers against it.

Personality Differences as Moderator Variables People differ in their outlook on life. One person may react quite negatively to minor life changes, while another might bear up well even under severe setbacks. These different re- actions are related to personality traits that are linked to appraisal and coping. This section examines the personality traits of procrastination, sense of humor, and hardiness as ways of accounting for differences in people’s stress reactions. These traits, as examples of moder- ator variables, are illustrated in Figure 7.4.

Procrastination. Are you good or lousy at time management? Do you study for exams and complete course assignments well in advance, or do you put them off until the last moment? These questions address differences in the tendency to procrastinate. Tice and Baumeister (1997) questioned whether student procrastination was beneficial, harmless, or harmful at various times in the semester. They divided students into nonprocrastinators and procrastinators and then examined the students’ level of stress early and late in the semester. Figure 7.5 shows that procrastinators benefitted early in the semester from putting things off. The end of the semester was a different story, however. At that point, procrastinators reported more stress, more physical symptoms, and more visits to health care professionals. Stressors that naturally occur at the end of the semester add to those that have accumulated from procrastination, which results in greater stress. Procrastination illustrates a personality variable that worsens the impact of time-related stressors, since the strategy of putting things off leads to stressor accumulation.

Sense of Humor. “A cheerful heart is a good medicine” (Proverbs 17:22). It has long been known that a sense of humor can moderate the impact of negative life events. Sense of humor has no clearly agreed-on definition but does involve the propensity to habitually smile, laugh, and be amused in a variety of situations (Deckers & Ruch, 1992; Martin & Lefcourt, 1984). To measure sense of humor, Martin and Lefcourt (1984) developed the Situational Humor Response Questionnaire, which measures people’s reaction to life events that are both common and unusual, pleasant and unpleasant. People responded to these statements on a 1 to 5 scale ranging from 1 � “I wouldn’t have found it particularly amusing,” to 5 � “I would have laughed heartily.” Using this five-point scale, how likely are you to respond with humor to such negative events as “You are eating in a restaurant with some friends and the waiter accidently spills a drink on you” or to such positive events as “You are having a romantic evening alone with someone you really like.” Martin and Lefcourt (1984) assumed that a greater likelihood of laughing in such situations indicates

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S tr

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Early Semester

Late Semester

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FIGURE 7.5 Procrastination as a Stressor. The number of stress symptoms reported rose more sharply for procrastinators than for nonprocrastinators as the semester progressed.

Source: From “Longitudinal Study of Procrastination, Performance, Stress, and Health” by D. M. Tice and R. F. Baumeister, 1997, Psychological Science, 8, figure 1, p. 456. Copyright 1997 by Blackwell Publishers. Reprinted by permission.

a greater sense of humor. The Coping Humor Scale was designed specifically to measure how humor is used for coping (Martin & Lefcourt, 1983). Examples of items from this scale are “I have often found that my problems have been greatly reduced when I tried to find something funny in them” and “I can usually find something to laugh or joke about, even in trying situations.”

➣ Situational Humor Response Questionnaire is available at http://www.umm.edu/news/ releases/humor_survey.html

Is there any empirical evidence for the ancient wisdom that humor moderates stress?Ac- cording to a review by Lefcourt and Thomas (1998), “there is enough evidence to encourage the belief that humor can have positive effects in alleviating distress” (p. 201). For instance, Lefcourt and Martin (1986) examined how sense of humor affected the relationship between negative life events and mood disturbance (anger, anxiety, and depression). Using the Situational Humor Response Questionnaire, Coping Humor Scale, and other sense-of-humor measures, they found that as the number of experienced negative life events increased, mood disturbance increased. However, this increase in stress was much greater for students with a low compared to a high sense of humor. Later research examined the possibility that sense of humor affects both appraisal of and coping with life events. Kuiper and associates (1993) com- pared students with high and low senses of humor on the strategies they used in appraising and coping with an exam. Students who scored higher on the Coping Humor Scale appraised the exam more as a positive challenge. They were also more likely to use distancing as a form of coping as well as to use confrontive coping by meeting the exam head on.

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Laboratory research has also supported the hypothesis that sense of humor moderates the appraisal of life events. In one study, participants had to appraise for challenge and threat the task of drawing “a person on a winter day.” Participants with a higher sense of humor appraised the task as more challenging and slightly less threatening (Kuiper et al., 1995). Newman and Stone (1996) examined how a humorous interpretation of a stressful event affects physiological distress. They had male participants create a humorous mono- logue to go along with an industrial accident film, while control participants created a serious monologue. Physiological distress, as indicated by electrodermal responses, heart rate, and skin temperature, was lower for participants who created a humorous monologue than for those who created a serious monologue. Although sense of humor appears to mod- erate the stress of mild life events, its efficiency has been questioned for very negative life events. For example, DesCamp and Thomas (1993) found that sense of humor did not buffer nurses from job stress such as work load, meeting the emotional needs of patients and their family members, and exposure to dying and death. Nevertheless, when tragedy occurs, people can lessen its negative impact somewhat by seeing the humorous aspects of the situation. Can you think of your ex spilling soup on herself? Can you think of a humorous event you shared with a deceased friend? Humor in these examples may provide momen- tary relief from feelings of disappointment and grief.

Several possibilities exist for why humor is a stress reducer (Martin, 2001). First, hu- mor may simply be one of several positive emotions that is beneficial in counteracting stress (Folkman & Moskowitz, 2000; Salovey et al., 2000). Laughing and feeling amused enhance positive moods, which are incompatible with feelings of distress. Also, humor moderates stress through the appraisal process. Examining life change events from a humorous out- look may be part of a larger appraisal process by which events can be viewed either more positively or less negatively. An additional benefit comes from the social nature of humor. People with a good sense of humor attract more individuals to them. In this way, they have a greater network of social support to rely on when experiencing stress.

Hardiness. When it comes to withstanding stressors and stress, some individuals just seem stronger or hardier than others. Hardiness is a personality trait composed of three charac- teristics: control, commitment, and challenge. The hardy individual perceives herself to be in control of life’s events, is committed or involved in daily activities, and views unexpected events, whether threatening or positive, as challenging rather than as aversive (Kobasa, 1979). In a scale measuring hardiness (Kobasa, 1984), control was assessed by statements that hard work makes a difference. Commitment was depicted by statements indicating that one is enthusiastic about working on the day’s projects. A willingness to forgo financial security in order to do something challenging was a statement designed to measure challenge. In one study, Kobasa (1979) examined 200 executives who had experienced a high number of life change events during the past three years. Using her questionnaire, she concluded that har- diness was the factor that differentiated the low- from the high-stress group. Independent of income, age, wealth, or level of education, the hardier executives were ill less frequently than the less hardy executives. Hardy executives viewed the events in their lives as challenges to be met head on rather than trying to avoid or escape any anxiety the events created. In addi- tion, they felt in control of the life events or stressors rather than being controlled by them.

Hardiness has also been shown to moderate the relationship between combat expo- sure, PTSD, and subsequent physical health conditions.Taft and associates (1999) measured

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the intensity of combat exposure experienced by both men and women during their Vietnam experience. They examined the intensity of such exposure by asking veterans whether they had been fired on, had fired a weapon, or had observed “Americans being killed or wounded” (p. 8). The intensity of combat predicted the degree of PTSD and physical health, such as high blood pressure, ulcers, asthma, or joint stiffness. More intense experiences were associated with greater PTSD and greater negative health symptoms. However, hardi- ness moderated or served as a buffer against the intensity of combat. Taft and associates found that the severity of PTSD and physical health were negatively related to hardiness. In other words, although combat produces PTSD and ill health, hardier male and female Viet- nam veterans had been better able to withstand the stressors of combat. As a consequence, they experienced lower levels of PTSD and less serious adverse health consequences.

The influence of hardiness can be observed during primary appraisal. Allred and Smith (1989) required low- and high-hardy participants to work on either a threatening or non- threatening task, which consisted of difficult analogy questions and the mental rotation of various cubes. To create high stress, half of the participants were told that their performance predicted success on a variety of academic and vocational activities. To create low stress, the other half of the participants were told that the accuracy of their answers was not important. As a way of assessing task appraisal, the researchers inventoried the positive and negative thoughts that occurred to the participants. An example of a positive thought is “I think I am performing well,” while a negative thought is “I am thinking lower of my ability” (p. 260). The effects of hardiness were seen in the high-stress condition. Hardy participants reported more positive thoughts during the task than did less hardy participants. Thus, hardiness moderates the effects of a stressor through such cognitive strategies as appraising an event in a positive manner.

Section Recap The effect of a stressor is regulated by moderating variables. These variables are features of the environment or person that transform the stressor-stress relationship. How a life event is appraised is one type of moderating variable. In primary appraisal an event is analyzed for whether it is positive, negative, or irrelevant for the individual’s well-being. If appraised as negative, then an individual uses secondary appraisal to inventory the resources that can be used to manage the event. Following appraisal, an individual can cope with either the origi- nal stressor or with the stress. Problem-focused coping involves clarifying and trying to solve the stressor, while emotion-focused coping requires alleviating the accompanying distress. Social support is another moderating variable. The buffering hypothesis states that social support provided by other individuals cushions or protects an individual from the harm of potential stressors. The tendency to procrastinate, sense of humor, and hardiness are per- sonality traits that also affect life event appraisal and stress. Sense of humor is the habitual inclination to smile, laugh, and be amused by various events. Humor is a feeling incompat- ible with distress, alters stressor appraisal, and draws people to us to provide social support when needed. Hardiness is a personality trait manifested by seeing life events as challeng- ing, feeling in control of those events, and being committed to various activities.

➣ Helpful information about stressors, stress, and coping is provided at The American Insti- tute of Stress, http://www.stress.org/, and at HELPGUIDE, http://www.helpguide.org/ mental/stress_signs.htm

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A C T I V I T I E S

1. To make the relation between life demands, re- sources, strain, and stress more concrete, think of a situation in your life where these factors might apply. a. What are some demands? Describe these

demands (e.g., final exams, getting a job over the holidays, bills that are due).

b. What are some of your resources to meet those demands (e.g., study time, job prospects, money)?

c. Is there any strain (i.e., resources are not enough to meet demands)? Describe the strain you feel (e.g., not enough time for studying, no job prospects, lack of money).

d. Describe any stress you are experiencing in the psychological, physiological, or behav- ioral domains (see Table 7.1).

2. When is the next exam for this course? List strategies that would be part of primary appraisal and problem-focused coping in

preparing for the exam. In what circumstances would you use secondary appraisal and emotion-focused coping after the exam is completed?

3. Recall the last time you were ill. Did this occur during a time when you were experiencing stress? Can you use the magnitude and number of stressors to predict when you will be sick? Describe a specific instance.

4. Of the people you know, think of those that have little sense of humor and those that have a good sense of humor. Do they differ in the number of stress symptoms that they exhibit? Are these symptoms related to their sense of humor? Although sense of humor alleviates stress, can the reverse happen? In other words, can stress depress one’s sense of humor? If so, how?

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