普通心理学13心理压力与健康

1、Chapter 12Stress, coping & health疾病/健康病源学的转变Contagious diseases(传染病）：由传染源引起的疾病，如天花、伤寒、疟疾、白喉、黄热病、霍乱、脑灰质炎、肺结合等20世纪之前的致命疾病；与nutrition, public hygiene, sanitation and medical treatment等有密切关系.Chronic diseases(慢性病): heart disease、 cancer、 stroke(中风）等，生活压力（应激）、生活方式等因素是慢性病形成的主要原因。心身病（蔡能等，1985)心理因素在疾病的发生

2、和病程演变中起主导作用的躯体疾病。 例如情绪，通过植物神经、内分泌、肌肉骨骼系统、皮肤及免疫系统等受累而引起的症状群及疾病。病源分析（蔡能等，1985）身心分离观点（传统医学观点）：细胞疾病-组织结构改变-功能障碍；身心统一观点：情绪（心理）因素-功能障碍（？）-细胞疾病-组织结构改变。Health psychologyHealth psychologyDiscovery of causation, prevention, and treatment（病因、预防及治疗）Health promotion and maintenance（健康的促进和保持）Bio-psychosocial mode

3、l（生物心理社会模型）:身体疾病由生物、心理及社会文化等因素相互作用引起。Nature of stressDefination of stress（应激、紧张）Stressors(应激源): events or circumstance(what?)Threaten or perceived threaten ones well-being: (why?)Cognitive appraisal： what affect appraisal？ Need to coping: how ?Frustration Frustration（挫折、打击） -blocked goal（与目标不一致） -Tr

4、affic jams -failure -loss;情绪：愤怒、恐惧、悲伤；心境：抑郁、焦虑；生理：血压（Novaco,etal. 1990)；Conflicttwo or more incompatible motivations冲突的三种类型（Lewin,and Miller(1944)Approach-approach(双趋性冲突）：鱼与熊掌；Avoidance-avoidance（双避冲突）： approach-avoidance（趋避冲突）：进退两难、犹豫不决、举棋不定；Neal Miller(1944)的实验：趋（食物+电击）避（无食物+无电击）冲突；-Laura King and

5、 Robert Emmons(1991): 以问卷调查内心冲突与焦虑、抑郁、及生理症状的关系；conflictsconflictsChange:have to change Two issues:What changes led to stress? Degree ?What consequence? Holmes and Rahe: Social Readjustment Rating Scale(SRRS)耗费更多的能量。肺结核的心理因素调查：结婚、晋升、有小孩等；消极刺激；生活变化大，生理疾病和心理问题也多一些（Creed, 1993)；-疾病与生活应激的相关研究；Social read

6、justment rating scaleDeath of spouse 100Divorce 73Jail term 63Marriage 50Fired at work 47 Retirement 45Change in school 20Vacation 15学生压力量表(Holmes and Raber)Pressure: expectation to behave in certain waysPerformance pressureSalespeopleProfessorActorStudentConform pressure（相符）。来源于关系期望的压力（工作、学校、家庭、朋友等

7、）；与自我期望有关（idea self & real self);压力与心理问题、生理疾病。国内研究恋爱婚姻与家庭内部问题；恋爱婚姻；子女与父母关系；家庭关系变迁；学校与职业场所的问题；失学；失业；社会生活变化与个人特殊遭遇灾难性事件；生活事件量表Responding to stressEmotional respondingPhysiological respondingBehavioral respondingFigure 13.4Overview of the stress process. A potentially stressful event, such as a maj

8、or exam, elicits a subjective appraisal of how threatening the event is. If the event is viewed with alarm, the stress may trigger emotional, psychological, and behavioral reactions, as peoples response to stress is multidimensional.Responding to stress: emotional responsesStress-specific cognitive

9、reactionspecific emotion( Smith and Lazarus, 1991) Self blame自责-Guilt内疚；Helplessness无助-sadness悲伤；Common emotional response:annoyance(烦恼）, anger, and rage; apprehension（忧虑）； anxiety（焦虑）,and fear;dejection（沮丧）, sadness and grief（悲痛）； Emotional responsesCasper,etal.(1987)的研究被试：96女性，时间28天任务：报告她们每天生活中紧张事

10、件与心情；结果：stress led to negative mood; Emotional response to stress研究： 253 Care-giving partners of men with AIDs coping pattern（Folkman，1997)存在一定的正情绪；Positive emotions: interest and joy;Promote creativity and flexibility;加速信息加工过程；减弱不良的生理反应；情绪反应的作用情绪反应的作用/ /功能？功能？ Effects of emotional arousalEmotional

11、arousal and performance(成绩/绩效）The inverted-U-hypothesis（倒U曲线） -简单任务需要较高唤醒水平； -中等难度任务在中等唤醒状态下成绩最好； -复杂任务在较低唤醒状态下才有较好成绩。情绪与认知关系；Figure 13.5Arousal and performance. Graphs of the relationship between emotional arousal and task performance tend to resemble an inverted U, as increased arousal is associat

12、ed with improved performance up to a point, after which higher arousal leads to poorer performance. The optimal level of arousal for a task depends on the complexity of the task. On complex tasks, a relatively low level of arousal tends to be optimal. On simple tasks, however, performance may peak a

13、t a much higher level of arousal.Physiological ResponsesFight-or-flight response。W. Cannon(1932):cats与dogs的实验；result:increased in breathing and heart rate and decreased in digestive processes。现代生活与应激的生理反应；Responding to Stress PhysiologicallyResponding to Stress PhysiologicallyHans Selye：General Adap

14、tation SyndromePhysical and psychological stress: cold, heat, pain, mild shock,restraint, et. Al.Stressful response: nonspecific reactions.General adaptation syndrome:Alarm（警觉）: fight or flight response,Resistance（抵抗、坚持）: prolonged stress, Exhaustion（疲乏，衰竭）: disease of adaptation(适应疾病）； 一般适应症候群和慢性应激

15、长期压力带来的生理反应是什么长期压力带来的生理反应是什么? ?一般适应症候群 报警阶段 抵抗期 疲惫期心身失调 一般适应症候群的三个阶段Brain-body pathways（Felker & Hubbard, 1998)Pathway(I): Stress-hypothalamus(下丘脑）-ANS-adrenal medulla(肾上腺髓质）-catechizations(儿茶酚胺）-增强活动（心血管、呼吸、运动系统激活）。Pathway(II): Stress-hypothalamus-Pituitary gland(脑垂体)-ACTH肾上腺皮质激素-adrenal cortex

16、-corticosteroids(皮质类固醇素/可的松）-增强能量消耗（protein and fat）。Effect of stress on immune system(免疫系统）;Figure 13.6Figure 13.6Brain-body pathways in stress. In times of stress, the brain sends signals along two pathways. The pathway through the autonomic nervous system controls the release of catecholamine hor

17、mones that help mobilize the body for action. The pathway through the pituitary gland and the endocrine system controls the release of corticosteroid hormones that increase energy and ward off tissue inflammation(Felker & Hubbard, 1998) . 应激中的躯体反应 拖沓的健康成本研究者鉴别了研究者鉴别了拖沓和不拖沓拖沓和不拖沓者后要求被试者后要求被试在学期初和

18、学在学期初和学期末报告体验期末报告体验躯体疾病的症躯体疾病的症状状. .Coping应对 :Active efforts to master, reduce, or tolerate the demands created by stress.Adaptive & maladaptive coping;Problem-focused coping & emotional focused coping; Difference from concept of Emotion regulation(?)Coping styles：consistent across situation

19、s；Responding to Stress BehaviorallyResponding to Stress BehaviorallyLaunchVideo 几种应对反应应激预应付可控制的应激源不可控的应激源Giving up and blaming oneselfGiving up适当放弃：简单放弃：Learned helplessness(习得无助);Behavioral disengagement(行动脱离);Stress increased and led to depressionSelf blame 适当的自我批判；过分的自责导致焦虑上升; Catastrophic thinki

20、ng(自责思维/悲观思维/悲惨思维）Development of depression;Striking out at otherAggression（攻击）: Frustration-aggression hypothesis（Dollard,et al.，1939). Displacement（转移）：将攻击目标（挫折引起）转移到其它无关的对象，例如，家庭成员;Catharsis(宣泄）-释放发泄紧张情绪，宣泄与抑制对心理/生理适应的作用。Indulging oneself（纵容自己）Indulging oneself: 在其它方面获得替代满足。Smoking, Drinking，Drug

21、s using, Overeating,Spend money,Internet addiction（网迷).Defense mechanisms（防御机制）Repression（压抑）Projection（投射）Displacement（转移/迁怒）Reaction formation（反向形成）Regression（倒退）Rationalization（合理化）Identification（认同）Intellectualization(isolation)智力化,升华。Overcompensation(过度补偿）;Undoing（取消）；Denial of reality（否认）; Fan

22、tasy（幻想）；Constructive coping （Epstein,1989,1990) -更有效、更加健康的应付方式直接面对问题，积极解决问题；对引起应激环境和应付资源理性现实的评价；学习对可能引起的破坏性情绪反应进行重新组织，或者抑制；努力确保自身不受可能的伤害；-与IQ关系较弱，与社会关系、爱情及成功的工作有较大相关。The Effects of Stress1.On Psychological Functioning2.On Physical HealthFactors in Effects of stressStress: High & mediate & l

23、ow, which is optimal level? Effect: Positive & Negative short & term;Personality: how traits modulate the interaction?For what? Why? How? Stress Impaired task performanceStress Impaired task performance Baumeister(1984)的研究：hypothesis: Pressureself conscious increaseperformance decrease X: Pr

24、essure Y: Performance on the task of perceptionHome-team(主场）would be under greater pressure than the visiting team（客场）?Early games: home-team winsLast game: home team winsEffects of stress on Effects of stress on psychological functioningpsychological functioningBurnout（崩溃）Burnout involves physical,

25、 mental, and emotional exhaustion that is attributable to long-term involvement in emotional demanding situation(长期情绪紧张导致生理、心理及情绪上的衰竭）.Pines(1993)concluded, events undermine important and heroic beliefs gradually by heavy,chronic work-related stress.Eg. Retire from an important position.Antecedents

26、components consequencesWork overloadLack of social supportLack of control,Inadequate recognition,rewardsExhaustion疲惫不堪Cynicism牢骚Lowered self-efficacy低自我效能Increased physiological illnessIncreased absenteeism,turnoverDecreased commitment to jobReduced productivityPosttraumatic创伤 stress disorders(PTSD）

27、灾难经历：Mele:81.3%; women:74.2%。PTSD：too great fear；9%, or 45%。Psychological problems and disorders：depression, anxiety, schizophrenia, and eating disorder；灾难后精神安抚；Social support.Positive effects of traumaPromote personal growth or self-improvement;Force to develop new skills, reevaluate priorities, le

28、arn new insights, and acquire new strengths.Positive psychology: research on well being, hope, courage, perseverance, tolerance, and other human strengths and virtues. Psychosomatic diseases（心身病）:由心理因素，尤其是情绪因素引起的，生理上的健康问题（有器质性兵病变）； hypertension, ulcer（溃疡）, asthma（哮喘）, skin disorder, migraine and ten

29、sion headaches(偏头痛），stroke（中风）, tuberculosis（肺结合）, multiple sclerosis（硬化病）,arthritis（关节炎）, diabetes（糖尿病）, leukemia（白血病）, cancer, various types of infectious disease（传染病）, and the common cold（感冒） (Elliott, 1989)。Effects of Stress: PhysicalEffects of Stress: PhysicalType A and coronary heart disease（M

30、ayer Friedman & Ray Rosenman, 1974)Type A: strong competitiveness争强好胜, impatience没耐心 and time urgency，anger and hostility；Type B: relaxed, patient, easy going（随和）, amicable(友善）Type A: 更容易得冠心病。Anger and hostilityMore anger, and higher risk of coronary events 情绪反应与心脏病情绪反应增加心血管系统负担；负情绪反应（anger, str

31、ess)心血管病人-myocardial ischemia（心肌缺血）、chest pain（胸疼）等症状。心脏病人在治疗过程中要尽可能地保持平静心境，避免情绪刺激；抑郁与心脏病抑郁病人的心率比较高；Pratt, et al.(1996)发现，在他13年的临床经验看，在初诊心脏病人中，抑郁的病人是其他类型病人的4倍。愤怒、悲伤：心率上升；恐惧、厌恶：心率下降;Stress and immune functioning免疫反应：lymphocytes（淋巴细胞）的功能，以抵抗外来细菌、滤过性病毒媒体、外物的入侵。Stress reduced immune activity（动物和人类） Featured study: Connecting Stress to the common cold Cohen & Tyrrell(1993)Subjects: 154(men),266(women)Method: X: High- or Low- stress Y: Cold %结果：高紧张组患病概率更大。特点：考虑了人格和生活习惯等变量。人格变量的作用Stress and health：r