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Understanding Stress and Coping Strategies

The document discusses stress, its physiological and psychological effects, and coping strategies. It introduces Hans Selye's General Adaptation Syndrome (GAS), which outlines the body's response to stress in three stages: alarm, resistance, and exhaustion. Additionally, it highlights the importance of perception in stress and the potential positive outcomes of stress, while also acknowledging the negative impacts when stress is chronic and unmanaged.

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0% found this document useful (0 votes)

11 views46 pages

Understanding Stress and Coping Strategies

Uploaded by

Davy Wong

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Available Formats

Download as PDF, TXT or read online on Scribd

16

The Healthy Mind

STRESS AND COPING, HEALTH PSYCHOLOGY,
AND POSITIVE PSYCHOLOGY

LEARNING OBJECTIVES
1. Define stress, identifying 3. Compare and contrast 4. Summarize the 5. Differentiate the aims
key neural and hormonal strategies for coping psychosocial factors and principles of positive
aspects of Hans Selye’s with stress, including associated with psychology from those of
general adaptation problem-, emotion-, smoking, nutrition, other major movements in
syndrome (GAS). and relationship- alcohol use, and psychology, as described in
focused strategies. lack of exercise, and Chapter 1.
2. Distinguish among propose behavioral
adaptive elements of the interventions for these 6. Distinguish among meanings
short-term stress response problems. of happiness (pleasant,
and health problems good, and meaningful lives),
linked to chronic stress. and analyze the research
evidence on what makes
people happy.

WE HAVE ALL HAD DAYS LIKE THE WOMAN IN THIS PHOTO. Whether it comes in relatively
minor forms (losing your keys, getting a traffic ticket, or doing poorly on an exam) or in large
forms (death of a loved one or serious illness), stress is a fact of life.

We don’t know what kind of stress is producing this woman’s reactions, but we know a great deal
about what is happening to her physically and psychologically in response to her stress. Zooming in,
we look at one of her adrenal glands, shown in the larger image. Your adrenal glands are located on
top of your kidneys in your lower back, and they are the source of hormones that are dumped into
your bloodstream at times of stress. How does feeling stressed get translated into activity by a gland?

Here is how the system works. First, the woman must identify something as a threat to her. Making that
cognitive appraisal, or judgment, of her situation begins a cascade of processes designed to mobilize her
to either run (flight) or fight. Messages from her amygdala to her hypothalamus result in the activation
Cultura Creative (RF)/Alamy Stock Photo

of hormones that tell the adrenal glands to release a hormone called cortisol. In Chapter 6, we noted
that cortisol levels are naturally high in the morning. In other words, circulating cortisol wakes you up.
In response to the cortisol released by the adrenal glands, the body is mobilized for action.

We also have had enough stress in our lives to understand that too much is not a good thing.
Again, if we zoom in, we can understand that our bodies are usually protected from too much

639

While still at the microscopic level, we might also see that one person’s genetic makeup might predispose
that individual to have a more or less dramatic response to perceived stressors. By now, you can
probably anticipate that we have to zoom back out again to fully understand this situation. These genetic
differences among individuals interact with developmental and social factors, such as the possibility that
this woman was maltreated as a child or now enjoys a strong social network of family and friends.

We can’t make your stress go away, and it is probably not in your best interests for us to do so. Some
stress, such as the stress associated with exercise or even surviving a traumatic experience, actually can
have quite beneficial effects on your overall health. Instead, we can acquaint you with research findings
on coping and resilience that might help you deal with life’s inevitable challenges.
REUTERS/Alamy Stock Photo

What Is Stress?
College students rarely need much introduction to the concept of stress. They are no strangers
to the stress that accompanies worrying about assignments and grades, money matters, world
affairs, and relationships. Stress is an unpleasant emotional state that results from the
Professional athletes like Lydia Ko of perception of danger. The source of stress is called a stressor.
New Zealand have learned to cope The key to our definition is the word perception. No one set of stressors reliably produces
with stress to perform their best. stress in everybody. People’s stressors are highly individual and idiosyncratic. The object of one
person’s phobia may be another person’s beloved (although scaly and slithery) pet. Regardless
of the stressor responsible for feelings of stress, once people perceive that they are in some kind
of danger, a common and predictable set of responses to the stressor is set in motion.
Stressors vary along a number of dimensions (Segerstrom & Miller, 2004). Brief stressors
involve facing a short-term challenge, such as an exam, job interview, or close call on the
highway. Chronic stressors are ongoing and long-lasting, and usually require us to rethink our
identities and social roles. Chronic stressors are stable. We don’t know if or when they will be
gone. Stressors can arrive in sequence. For example, the loss of a loved one or a natural disaster
leads to a train of related stressors.
Psychologists have identified positive outcomes of our responses to stress (Selye, 1975).
Stress, by its nature, is a powerful adaptive response that mobilizes the body’s resources to en-
hance survival in dangerous situations (Meaney, 2010). Although sometimes unpleasant, stress
can motivate us to perform well and makes us healthier in the long run (Crum et al., 2013).
The exercise we do at the gym is undeniably stressful, but it produces significant benefits down
the road. Many of us do some of our best work under time pressure and are not too much the
worse for the wear as a result.
Stress might have additional positive impacts on groups of people, not just individuals.
People experiencing stress are actually more prosocial, at least with people they know well
(Buchanan & Preston, 2014; Margittai et al., 2015). Stress increases our ability to empathize
with others in pain (Tomova et al., 2016). While personally unpleasant, these advantages of
stress for our social networks could produce enormous benefits.
However, in other cases, stress can be counterproductive and interfere with our perfor-
mance and well-being. In extreme cases, as observed in Chapter 14, a diathesis–stress model
predicts that stress can contribute to the development of major depressive disorder (MDD),
schizophrenia, posttraumatic stress disorder (PTSD), and other serious conditions. These neg-
ative outcomes are more likely when we are unable to cope with or adapt to a stressor. We will
be focusing most of our discussion on coping more effectively with these negative situations.
stress An unpleasant emotional state that
results from the perception of danger. The Stress Response
stressor A stimulus that serves as a
source of stress. Walter Cannon, whom we met in Chapter 7, demonstrated the ability of a number of stressors
to activate the sympathetic division of the autonomic nervous system, described in Chapters 4

640 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

EXPERIENCING PSYCHOLOGY
What Is Your Stress Mindset?
USE THE SCALE in ● Table 16.1 to respond to this total to the final number that you pro- study by Crum et al. (2013), the mean SMM
the items listed. Select the number that best duced in step 1, and finally (4) divide the to- was 1.6, or on the “Stress is debilitating” side
describes you in the space provided. tal by 8 to produce your mean Stress Mind- of the scale. How does that mean compare
To obtain your overall mindset score, set Measure (SMM) score. The higher the with your score and your classmates’ scores?
(1) add up your scores for items 1, 3, 5, and score, the more likely you are to believe that What factors in your life do you think
7 and subtract this amount from 16, (2) add the effects of stress are enhancing. Among influence your score? ■
your scores for items 2, 4, 6, and 8, (3) add the college students participating in the

TABLE 16.1
The Stress Mindset Measure
The effects of stress are negative and should be avoided.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Experiencing stress facilitates my learning and growth.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Experiencing stress depletes my health and vitality.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Experiencing stress enhances my performance and productivity.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Experiencing stress inhibits my learning and growth.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Experiencing stress improves my health and vitality.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Experiencing stress debilitates my performance and productivity.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
The effects of stress are positive and should be utilized.
0 1 2 3 4
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

WHAT IS STRESS? 641

John Olson/Getty Images

(1946) found that the rats responded with a consistent pattern of behavior, which
he labeled the general adaptation syndrome (GAS).
The GAS occurs in three stages (see ● Figure 16.1). An alarm reaction is
initiated when a stressor is first perceived and identified. Selye’s alarm reaction is
essentially the same process as Cannon’s fight-or-flight response. All possible re-
sources are deployed to survive the danger, and all nonessential systems are inhibited.
Hans Selye identified a general It is likely that you have had at least one close call while driving a car, and you can
adaptation syndrome (GAS), which is our probably remember how that felt. Your heart pounds, you breathe rapidly, you feel
characteristic set of responses to stressors. unusually mentally alert and focused, and your hands may be sweaty. This is precisely
the way that your autonomic nervous system is supposed to react in an emergency.
general adaptation syndrome Some sources of danger do not go away as quickly as your close call on the freeway. Many
(GAS) Hans Selye’s three-stage model for students think, “Oh, if only I survive this term—everything else will be easy,” only to find
an organism’s response to stressors. themselves facing the same problems next term, along with some new ones. One of the chal-
lenges of modern living that our ancestors did not face is the need to worry about many fu-
ture events. For the hunter–gatherer, the challenge was usually surviving that day. In contrast,
today’s college students may be concerned not only with fairly immediate
problems, such as paying the rent and passing a midterm, but also more dis-
During extended periods of stress, judgment tant problems of future job markets, world events, climate change, and the
can suffer. You might have had the experience future of Social Security. If these uncertainties are perceived as threatening
of looking back at the decisions that you made or dangerous, they will act as stressors with the ability to initiate the GAS.
during a stressful time, scratching your head, and When stressors are prolonged, Selye suggests that we enter a stage of
asking, “What was I thinking?” resistance. During this stage, we continue to experience ongoing stress,
which requires us to adapt and cope as well as possible. Although resistance
is not as dramatic as the briefer and more intense
High alarm reaction, it can still take its toll. Under normal
circumstances, we alternate between periods of calm
and periods of relative arousal. You might calmly en-
joy your lunch on the lawn between classes but feel
aroused while taking a quiz in a later class. During the
calm periods, we have an opportunity to store nutrients
Resistance to stress

and rest and repair the body. During periods of arousal,

Stressor
such as during the quiz, we expend energy instead of
occurs storing it. In the resistance phase of the GAS, we at-
tempt to take care of both arousal and resting functions
simultaneously. Neither function operates as smoothly
under these circumstances as when it is operating
Normal alone. You might get an upset stomach when digesting
resistance your lunch is combined with the excitement of giving
an oral presentation to your classmates. In contrast to
Alarm Resistance Exhaustion the mental clarity that typically accompanies the brief
Low alarm reaction, judgment during the longer periods of
Time resistance may not be as good.
If stressors are severe and last long enough, a
FIGURE 16.1 person might reach Selye’s exhaustion stage, where
strength and energy drop to very low levels. As men-
The General Adaptation Syndrome (GAS). Hans Selye’s GAS has three tioned in Chapter 14, stress is a risk factor for MDD,
stages: alarm, resistance, and exhaustion. During the alarm stage, all and the exhaustion stage has much in common with
resources are mobilized for fight or flight. If stress is prolonged, we enter the criteria for this disorder. Exhaustion can even lead
the resistance stage, where we adapt and cope as well as possible. Finally, to death. Forced marches during war produce higher
resources are depleted when we reach the exhaustion stage. rates of death than the rate that might be expected

642 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Unexpected death of someone close

Illness/injury of someone close

Designated worst trauma events experienced by respondents

Sexual assault FIGURE 16.2

Worst Traumatic Exposures and Posttraumatic
Seeing someone injured or dead Stress Disorder (PTSD). Approximately 30,000
people with and without PTSD were asked
to identify the “worst trauma they had ever
Military combat experienced.” Among those who did not have
PTSD, the unexpected death, illness, or injury of
someone close and indirect exposure (television
Beaten by intimate partner and other news reports) to the 9/11 terrorist
attacks were the most commonly named “worst
traumas.” Among those with PTSD, unexpected
Indirect exposure to 9/11
death, illness, or injury were also commonly noted
traumatic experiences, but people with PTSD
Own serious accident were more likely than healthy controls to identify
sexual assault, intimate partner violence, and
combat as their worst traumatic experiences.
Other trauma to self Source: Adapted from R. H. Pietrzak et al. (2011).
“Prevalence and Axis I Comorbidity of Full and Partial
Posttraumatic Stress Disorder in the United States:
Other trauma to someone close
Results From Wave 2 of the National Epidemiologic
No PTSD
PTSD Survey on Alcohol and Related Conditions,” Journal
0 5 10 15 20 25 30 of Anxiety Disorders, 25(3), 456–465. doi:10.1016/j.
Percentage janxdis.2010.11.010

WHAT IS STRESS? 643

Photocase Addicts GmbH/Alamy Stock Photo

among the animals. Modern zoos
go to great lengths to provide more
natural, less stressful habitats for their

maratr/[Link]
animals, in recognition of the stress
that often accompanies captivity.

stress in large numbers of people. In the three to five days following the 9/11 terrorist attacks,
90% of Americans reported feeling unusually stressed (Schuster et al., 2002). As this book goes
to press, much work remains to be done to assess the impact of COVID-19 on stress, but early
reports suggest that somewhere between one-quarter to one-third of the population is experi-
encing higher levels of stress than normal (Cooke et al., 2020; Salari et al., 2020).
Stress because of disasters can produce long-range and cross-generational effects. Re-
searchers identified women who witnessed the 9/11 attacks in New York while pregnant and
who subsequently developed PTSD (Yehuda et al., 2005). One year later, the women and their
infants showed indications of long-term, chronic stress. As preschoolers, the children born to
the women who were diagnosed with both PTSD and MDD following 9/11 showed evidence
of higher reactivity to stimuli and more aggressive behavior than did children of terrorism-
exposed mothers who did not develop these disorders (Chemtob et al., 2010). The ability of
cortisol and other stress hormones to cross the placenta probably accounts for the effects of
stress beginning in the prenatal environment (Weinstock, 2005; Galbally et al., 2019).
As mentioned in Chapter 14, children are especially susceptible to PTSD. Three weeks
after a 2004 tsunami, prevalence of PTSD among children in areas of Sri Lanka ranged be-
tween 14% and 39% and could be predicted by variables such as family loss and severity of
exposure (Neuner et al., 2006). To put these high numbers of cases into perspective, we would
expect about 10% of the general population to experience PTSD after most large disasters
(Kessler et al., 1996). Automobile accidents are a major source of PTSD in childhood, with as
many as half of those injured in an accident going on to develop the disorder (de Vries et al.,
1999; Pervanidou et al., 2007).
Although disasters are dramatic, they are not the only sources of stress that we face.
Changes, including some changes for the better, can also trigger stress. Holmes and Rahe (1967)
compiled a list of life events (good and bad) that they believed might be correlated with stress
and then surveyed participants about the amount of adjustment that each event required. Sub-
sequently, researchers used the Holmes and Rahe Social Readjustment Rating Scale (SRRS) to
predict vulnerability to physical illness and psychological disorder because of different stress-
ors (Derogatis & Coons, 1993; Scully et al., 2000). According to the scales, Christmas is more
stressful than minor violations of the law. Getting married is more stressful than being fired
from your job. Research results from studies using the SRRS suggest that we should consider
spreading out controllable changes over time. In other words, it may not be the best strategy to
graduate from college, get married, move to a new city, and start a new job all at the same time.
AP Images

Not all psychologists are convinced that so-called good life events are as stressful as bad
ones, nor are they convinced that change per se is a reliable predictor of stress. Critics of the
SRRS argue that most items are quite negative and that these negative items are responsible
This man is obviously stressed. Is for more stress (McLean & Link, 1994). It is likely that stress associated with good changes
somebody being injured? Is he in occurs when the anticipated event does not live up to the person’s expectations. Vacations and
danger? No—he is witnessing a holidays may not be inherently stressful, but trying to fulfill unrealistic fantasies about what
tense moment during a baseball vacations and holidays should be like is probably stressful indeed.
game. Cognitive appraisal theories of Relatively insignificant sources of stress, often called hassles, also can contribute to a
stress suggest that different people person’s overall level of stress. Waiting in long lines, losing your keys, getting a parking ticket,
are likely to respond to stimuli with and oversleeping on the day of an important exam are not life-threatening events. However,
varying levels of stress based on their if enough of these hassles occur within a short period, people begin to react as if some-
individual appraisals of a situation. thing larger had occurred. The number of hassles that people report experiencing predicts

644 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

goodluz/[Link]

Tetra Images/Aurora
psychological symptoms of stress, even when the impact of major life events is factored out
(Kanner et al., 1981). You might hear advice to avoid “sweating the little stuff ” because enough
little stuff happening at the same time can still affect your well-being.
Some individuals, such as first responders and those serving in the military, deal with
major stressors as part of their job. Concerns regarding stress and consequent mental health
problems in the military have grown since the wars in Iraq and Afghanistan. Soldiers serving
in these conflicts have experienced especially high rates of mental health disorders and sui-
cide (Ramsawh et al., 2014). About 38% of living U.S. veterans have been exposed to combat
(Thomas et al., 2017). Younger combat veterans had higher rates of lifetime (30.6%) and cur-
rent (19.2%) PTSD and suicidal ideation (18.6%) than older combat veterans.
As in studies of civilians, research on military personnel suggests that feeling socially iso-
lated (loneliness) may be an early warning sign of, if not a contributing factor to, these mental
health disturbances (Solomon et al., 1986). Combat experiences do not lead directly to suicidal
ideation and behaviors, but they might do so indirectly by producing symptoms of PTSD (see
Chapter 14) and negative states including loneliness, sadness, anger, and frustration (Griffith,
2012, 2015). Leaving military service might disrupt the strong bonds that sustained veterans
during combat, and many veterans feel alienated from others who cannot comprehend their
experiences (Wilson et al., 2018). Soldiers who committed suicide had previously reported be-
ing lonelier and more depressed and tended to think in more catastrophic terms than soldiers
who did not commit suicide (Lester et al., 2011; Cacioppo et al., 2015).

What Are the Biological and

Social Correlates of Stress?
oliveromg/[Link]

Regardless of the identity of a stressor, once you appraise a stimulus as a danger, you initiate
Selye’s GAS. The first stage, the alarm reaction, is accompanied by a coordinated reaction
including physical, cognitive, and behavioral responses to perceived danger. Imagine for a
moment that one of your ancient ancestors was out hunting and suddenly found himself face
to face with a hungry lion. Physically, the autonomic nervous system prepared him for fight
or flight. The brainstem, described in Chapter 4, initiated the release of the neurotransmitter
norepinephrine, which increased vigilance and fear. Cognitively, your ancestor accessed his
Feeling socially isolated makes us
memory for information about lions, which he hoped would include ideas about how similar
feel unsafe, which triggers stress
situations were handled in the past. Behaviorally, your ancestor carried out his plan for escape.
responses. Loneliness makes people
We assume that given your presence today, your ancestor was successful.
behave in ways that make them
difficult to be around, such as
Stress and the Amygdala displaying greater pessimism, anxiety,
and hostility, beginning a loop of
We can trace the neural pathways that coordinate these responses to potentially hazardous self-fulfilling prophesies and more
stimuli. Sensory pathways provide information to higher cognitive centers in the cerebral loneliness.

WHAT ARE THE BIOLOGICAL AND SOCIAL CORRELATES OF STRESS? 645

FIGURE 16.3 CS Pathway UCS Pathway

Tone Shock
The Amygdala and Fear. The
amygdala participates in a “fear
circuit” that provides a rapid
response to a potentially dangerous
stimulus. After rats learn a classically
conditioned association of a tone
(a conditioned stimulus, or CS) that
signals the arrival of an electric shock Thalamus Thalamus
(an unconditioned stimulus, or UCS), (auditory part) (somatosensory part)
they freeze whenever they hear the
tone. If the amygdala is lesioned, the
rat no longer freezes when it hears the
tone, and it is unable to learn about
new signals for shocks. Auditory Somatosensory
cortex cortex

Amygdala

Freezing

646 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Adrenal Axis of epinephrine and norepinephrine into the

bloodstream.
Perceiving a potential source of danger mobilizes the body’s resources using two systems—the hypothalamic–pituitary–adrenal
sympathetic adrenal–medullary (SAM) system and the hypothalamic–pituitary–adrenal (HPA) axis A circuit that responds to
perceived stressors by initiating the release
(HPA) axis. The SAM system initiates the release of adrenaline (also known as epinephrine) of cortisol into the bloodstream.
and norepinephrine into the bloodstream from the adrenal glands, located above the kidneys
cortisol A hormone released into the
in your lower back. These chemical messengers circulate to many organs, including the brain, bloodstream from the adrenal glands.
producing many of the immediate, short-lived, fight-or-flight responses to stress, such as a
pounding heart and rapid breathing (see ● Figure 16.4).
Simultaneously, activation of the HPA axis sets an entirely different system in mo-
tion. Here’s how the circuit works. The hypothalamus (H) communicates with the pitu-
itary gland (P), located just above the roof of your mouth, which in turn tells the adrenal
glands (A) to release a hormone known as cortisol into the bloodstream. Circulating
cortisol boosts the energy available for dealing with a stressor. The HPA axis response to
stress can continue longer than the SAM response, which explains many of the outcomes
of chronic stress.
One of the possible outcomes of chronic stress is prolonged high levels of circulating cor-
tisol. Long-term exposure to cortisol can produce a number of harmful effects, including the
death of neurons. When rats received daily injections of the rat equivalent of cortisol, neural

Hypothalamic-pituitary-adrenal
(HPA) axis
Sympathetic adrenal-medullary
(SAM) system
FIGURE 16.4
(slower) (faster)
Two Systems Respond to a Stressor. In response to the
appraisal of a stimulus as a stressor, two systems mobilize
Cerebral cortex
Stressor the body’s resources. The sympathetic adrenal–medullary
Hypothalamus (SAM) system responds quickly by initiating the release
Hippocampus of epinephrine (adrenaline) and norepinephrine into
the bloodstream by the adrenal glands. These chemical
messengers initiate many immediate, short-lived
responses, such as a pounding heart and rapid breathing.
Pituitary gland Sympathetic Simultaneously, activation of the hypothalamic–
nerve pituitary–adrenal (HPA) axis results in the release of
cortisol into the bloodstream by the adrenal glands.
Cortisol acts to boost the energy available for dealing with
Heart the stress. Cortisol receptors in the hippocampus serve as
a feedback loop to keep the system from overreacting. The
effects of HPA axis activity are slower to develop and last
Adrenal glands longer than those of the SAM response. HPA axis activity
is associated with more of the effects of chronic stress,
such as suppression of the immune system.
© Argosy Publishing, Inc.

Suppresses Enhances
IMMUNE SYSTEM

Cortisol Norepinephrine Norepinephrine and epinephrine

(adrenalin)

WHAT ARE THE BIOLOGICAL AND SOCIAL CORRELATES OF STRESS? 647

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
death began to occur in just a few weeks (Stein-Behrens et al., 1994). Identical amounts of neu-
ral death occurred if the rats were stressed daily instead of receiving the injections, suggesting
that the action of cortisol is responsible for most of the neural damage observed to result from
stress. Cushing’s disease, a medical condition that causes unusually high cortisol levels, results
in reduced hippocampus volume, memory problems, abnormal sleep patterns, and depression
(Langenecker et al., 2012). Not only can high levels of cortisol damage neurons, but these same
levels appear to inhibit neurogenesis, or the birth of neurons, which might help to offset the
damage (Cowen, 2010; Borsini et al., 2020).
Normally, activity of the HPA axis is regulated by a feedback loop involving the hippo-
campus (Stokes, 1995). The hippocampus works like a rev limiter in an automobile engine that
prevents the driver from going over a certain speed. The hippocampus contains large numbers
of receptors for cortisol and other stress hormones. When the hippocampus detects high lev-
els of these hormones, it signals the hypothalamus, which in turn tells the adrenal glands to
reduce the release of cortisol, and arousal dissipates.
The role of the hippocampus as the rev limiter of the HPA axis might be the bridge
between stress and MDD. As observed in Chapter 14, many cases of MDD are preceded by
unusually stressful events. Consistently elevated levels of cortisol because of stress can over-
whelm the hippocampus’s feedback loop, leading instead to the continuous release of cortisol
and constant arousal. Without the regulation of cortisol usually provided by the hippocampus
acting as a rev limiter, a person can begin to experience depression (Stokes, 1995). People who
are treated with cortisol and similar stress hormones for medical conditions such as rheuma-
toid arthritis are often troubled by deep depression, reinforcing the role of excess cortisol in
depressed mood.
Not only can the hippocampus fail to regulate cortisol release under conditions of
extreme stress, but continued stress can damage the hippocampus further. The stressed
baboons mentioned earlier in this chapter experienced neural death, particularly in the
hippocampus, in addition to their other medical problems (Sapolsky, 2001). People with
PTSD, discussed in Chapter 14, also show evidence of having a
smaller hippocampus than trauma-exposed people who do not
develop PTSD (Logue et al., 2018). However, it remains unclear
whether reduced hippocampal volume precedes the onset of
PTSD (making it a risk factor), results from PTSD, or both (Hayes
et al., 2017).

The Epigenetics of Stress

In Chapter 3, we discussed the significant role played by the en-
FCG/[Link]

vironment in determining whether and when a particular gene

is expressed. We defined epigenetics as the influence on traits by
factors that determine how genes perform. The field of epigenetics
explores gene–environment interactions. For example, we ob-
served how both rats and human children who were well nurtured
The first 1,000 days after conception (until about age 2 years) by their mothers showed more resilience to stress later in life. The
strongly influences individual vulnerability to chronic disease and nurture received from the mother had influenced how the genes
life expectancy. While low birth weight indicates stress during responsible for producing and reacting to stress hormones be-
pregnancy, the 280 days or so between conception and birth are haved during later stressful experiences (Champagne et al., 2003;
only a fraction of the first 1,000 days. Having an asymmetrical Neigh et al., 2009).
lower face, however, appears to be a reliable biomarker of stress Severe stress early in life produces lasting challenges, includ-
during this early stage of childhood. The misalignment of this man’s ing increased HPA axis responses to stress, hyperactivity of the
upper and lower front teeth illustrates this effect of prenatal stress. norepinephrine system, reduced volume in the hippocampus, and
heightened responses by the amygdala to threat stimuli, such as
negative facial expressions (Osório et al., 2016). Genes and life stress also interact to pro-
duce MDD. The rate of expression of genes linked to MDD interacts with an individual’s
quality of social experience, from adversity to support (Logue et al., 2018). These gene–
stress interactions help explain why some people are more vulnerable to life stress, while
others seem relatively well protected against it.

648 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Socioeconomic Status and Stress

Beginning with initial observations that death rates were negatively correlated with
increases in occupational grades among British civil servants (Marmot et al., 1978;
Marmot et al., 1984), scientists have become aware that health disparities exist world-
wide as a function of wealth. People with lower socioeconomic status (SES) experi-
ence worse health. Absolute wealth is not the only factor here. People’s subjective

Sgt. Jessika Malott, 8th MP Bde. Public Affairs/photo courtesy of U.S. Army
estimation of their own status in the community also predicts susceptibility to disease
(Cohen et al., 2008).
What processes can explain SES effects on health disparities? The poor experi-
ence more noise, more toxins, more carcinogens, more violence, fewer resources, less
health care, higher levels of drugs and alcohol abuse, less exercise, more anger, less
control, and less trust (Adler, 2013). The items on this long list have something in
common—all of these factors are associated with high stress. Residents of low-income
neighborhoods reported higher rates of perceived stress, which in turn was related
to more risky health-related behaviors, such as smoking and lower physical activity
(Algren et al., 2018).

As this family faces the stress of the

father’s overseas deployment, the mother
responds with a tend-and-befriend
approach by comforting her daughter.
Visions of America, LLC/Alamy Stock Photo

Health disparities, or the differences

between the health of wealthy and
that of poor individuals, can result
from the greater exposure of poor
people to significant stressors.

WHAT ARE THE BIOLOGICAL AND SOCIAL CORRELATES OF STRESS? 649

Stress and the Immune System

Hans Selye believed that any stress produced a global reduction in immune response, but this
turns out to be overly simplistic. Instead, short-term bursts of stress can have a beneficial ef-
immune system The body system that fect on many biological systems, including the immune system, your body’s frontline defense
defends against infection and cancer. against infection and cancer (Segerstrom & Miller, 2004). After all, this is the type of stress that
characterized the hunter–gatherer experience, so it is unlikely we would evolve a response to
it that didn’t work well. Participating in a stressful memory task was correlated with an im-
provement in the response of the immune system, as measured by markers of immune system
activity in the saliva of volunteers (Bosch et al., 2001).
However, the immune system does not perform as well in the face of long-term, chronic
sources of stress (see ● Figure 16.5). If stressors persist long enough, an overall reduction
in immune response occurs. As a result, stress can lead to greater frequency and severity of
viral illnesses, as you may have noticed immediately following final exam periods (Wadee
et al., 2001). Numerous studies indicate that people experiencing chronic stress are more

Type of Stressor Immune Response Health

FIGURE 16.5
Improved
Types of Stress Predict Immune wound healing
Response. Acute, short-lived stress Protection
enhances our immune response in adaptive against
bacterial and
ways, promoting healing and resistance to
viral infections
infections. In contrast, chronic stressors
reduce immune responses, delaying healing Acute Stress
and inhibiting protection from infections like
COVID-19.

Reduced
wound healing
Reduced
protection
against
bacterial and
viral infections

Chronic Stress

650 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Blend Images/Alamy Stock Photo

Alex Dissanayake/Getty Images
of the ongoing, chronic sources of
stress that we face.

vulnerable to infectious diseases, like colds and the flu (Cohen et al., 1991). White blood cells, or
lymphocytes, protect us from invading organisms. Unfortunately, stress hormones directly lymphocyte White blood cells that are
suppress the activity of lymphocytes (Calcagni & Elenkov, 2006). Flare-ups of both oral and products of the immune system.
genital herpes are most likely to occur when a person is experiencing unusual stress (Cohen Type A personality A competitive,
workaholic, and in some cases hostile per-
& Herbert, 1996). The progression of HIV infection to AIDS is influenced by the person’s
sonality type.
level of stress (Harper et al., 2006). Stressed students show greater vulnerability to the virus
Type B personality A mellow, laid-back
responsible for mononucleosis, which normally is kept in check by a robust immune system personality type.
(Cacioppo & Berntson, 2011). Unfortunately, knowledge of these relationships can place an
even greater burden on sick people, who may be led to believe that their illness wouldn’t be so
bad if they were somehow better at managing stress.
Stress related to our social relationships seems to be especially harmful to our ability
to stay healthy. A meta-analysis of almost 300 studies and about 20,000 participants dem-
onstrated that chronic stressors affecting people’s social roles (e.g., death of a loved one or
divorce) produce the greatest suppression of the immune system (Segerstrom & Miller, 2004).
In particular, stressors that are outside a person’s sense of control and lead to little hope for im-
provement have the most damaging effects. Those who are older and already ill are especially
susceptible to adverse consequences of stress.

Stress and Heart Disease

Meyer Friedman and Ray Rosenman (1974) stimulated a large quantity of research by suggest-
ing that highly competitive workaholics, whom they called Type A personalities, were more
susceptible to heart disease than the mellower, laid-back people they called Type B personalities.
Further study, however, showed that simply being competitive had little to do with in-
creased risk of heart disease. Instead, the Type As who did develop heart problems exhibited
a pattern of interpersonal hostility. The Type As most at risk for heart disease were frequently
suspicious, angry, and resentful of other people. It is possible that their own hostile behavior
provoked more hostile situations and reactions from others, confirming their worldview and
maintaining their negative behavior. In addition, hostile people are not likely to build up net-
works of friends and loved ones, who are often our best protectors from the untoward effects
of stress (Jackson et al., 2007). In middle-aged adults, frequent conflict with members of a
person’s social network raised the risk of death 200% to 300% (Lund et al., 2014).
Stress puts the cardiovascular system at risk by affecting the ability of blood vessels to
expand when necessary. People whose arteries are already stiff or clogged because of age, poor
fitness, or disease often suffer from high blood pressure and might be especially susceptible
Ollyy/[Link]

to heart attacks following stress. In a heart attack, interruptions of blood flow to the heart
trigger death of a part of the cardiac muscle. Flexible blood vessels maintain blood flow and
blood pressure and lessen the chances of a heart attack. To test the effects of stress on blood
flow, healthy participants were given a standardized mental stress task in which colored but-
tons were to be pushed as quickly as possible in response to flashing lights of the same color
(Spieker, 2002). For the following 45 minutes, the ability of the participants’ blood vessels to Research shows that in middle-aged
expand was reduced by a factor of 50%. A participant’s change in blood pressure in response adults, frequent conflict with members
to a stressful situation was predictive of a later diagnosis with hypertension, or high blood of a person’s social network increased
pressure, which can lead to heart attacks or stroke (Spieker et al., 2002). the risk of death by 200% to 300%.

HOW DOES STRESS AFFECT OUR HEALTH? 651

stevenku/[Link]
surrogate mother than in monkeys raised by
METHODS their biological mothers. Genes involved in
In Chapter 11, we reviewed work by Harry basic defenses against bacteria and viruses
Harlow in which infant rhesus monkeys were were less active in these monkeys than in the
raised by cloth and wire surrogate “mothers” monkeys raised by their biological mothers.
to investigate questions about attachment.
Steven Cole and his colleagues (2012) also CONCLUSIONS Rhesus infants raised by surrogate mothers
exposed infant rhesus monkeys to surrogate The researchers believed that sympathetic or peers experienced changes in the
mothers, other peers, or both instead of nervous system responses to the stress of expression of genes related to their immune
their real mothers. The researchers then being raised by peers or a surrogate mother systems. These results help explain the
conducted analyses of genetic changes in and peers changed the basic way in which connection between adverse childhood
the infant monkeys’ immune systems. genes important to the immune system were experiences and poor adult health outcomes.

Stress, Mood, Sleep, and Obesity

As discussed in Chapters 4 and 14, mood, sleep, and appetite are closely intertwined. A
change in one of these behaviors usually results in changes in the others. Long-term, chronic
stress can begin a cascade of changes in mood, sleep, and appetite that compromise well-
being. Disruptions of sleep because of stress are particularly hazardous to health because
we need sleep to restore our bodies after the challenges of the day. Both sleep quantity and
sleep quality are associated with both overall health and cognitive outcomes (Hawkley &
Cacioppo, 2010).
Stress frequently serves as a trigger for a depressed mood. Self-reports of daily stressors,
like having an argument with a friend, were correlated with the participants’ mood (Stader &
Hokanson, 1998). The ability of stress to alter levels of circulating cortisol, discussed earlier in
this chapter, might form the basis for this connection between stress and depressed mood. As

652 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

3.5

3
Weight loss in kilograms

2.5

1.5

0.5
5.5 hours of sleep
0 8.5 hours of sleep
Total weight lost Body fat lost Lean body mass lost
Weight loss

FIGURE 16.6
Sleep and Diet Interact. Participants who slept 8.5 hours per night lost about the same amount
of weight during a treatment program as participants who slept 5.5 hours per night, but the
two groups differed in the amount of body fat and lean body mass that was lost. The group that
slept 8.5 hours per night lost more body fat and less lean body mass, which is characteristic of
desirable weight loss, than the group that slept 5.5 hours per night. These results remind us that
many of our health habits are intimately interconnected, and that changing one can have a large
effect on others.
Source: Adapted from A. V. Nedeltcheva et al. (2010). “Insufficient Sleep Undermines Dietary Efforts to
Reduce Adiposity,” Annals of Internal Medicine,
153, 435–441. doi: 10.1059/0003-4819-153-7-201010050-00006

HOW DOES STRESS AFFECT OUR HEALTH? 653

FIGURE 16.7
MACRO
An Interactive View of Stress Soc
ms ial
and Health. Individuals do not yste EXO no
rm
ls Soc
experience stress in a vacuum. ca s
il ti ce
s ial
ne
Personal factors, like genes and rvi tw
Po

se or
everyday experiences, influence an
d MESO ks
outcomes within an environment
s
od
Go

consisting of ever-larger circles

of social connectivity. The MICRO
relationships between social
environment and personal factors
t agencies

Neighborhood

Legal systems
are reciprocal. Individual actions
Peer g ps
Race/ethnicity

influence the social environment,

Family

rou

which in turn influences individual

ernmen

factors.
Source: Adapted from R.-P. Juster
Gov

et al. (2010). “Allostatic Load ch

Biomarkers of Chronic Stress and oo

l k
Wo r
Impact on Health and Cognition,”
ns

Neuroscience and Biobehavioral

tio
Tra

Reviews, 35(1), 2–16. doi:10.1016/j. M i c ro s y t e m

ca
ns

or u
ni

i n te rc
onnections
p

neubiorev.2009.10.002 ta m
Ec

tio om
on

n C i
at
om

ic uc
sy Ed
ste Mass media
ms

Culture

654 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

6
Subjective happiness

2
Randomized control group
1 Social-belonging treatment
White students African American
students

FIGURE 16.8
A Belongingness Intervention Improved the Performance and Health of African American College
Students. A one-time treatment aimed at framing the stress of fitting in to the college experience
as common to most students and limited in duration significantly improved the grade point averages,
happiness ratings, and health of African American students at Stanford University three years later.
White students did not experience the same treatment-related differences, with both treated and
nontreated White students experiencing the same health and subjective happiness as the treated
African American students. This result suggests that “fitting in” was already framed by White students
in positive ways.
Source: Adapted from G. M. Walton & G. L. Cohen (2011). “A Brief Social-Belonging Intervention Improves Academic
and Health Outcomes of Minority Students,” Science, 331(6023), 1447–1451. doi:10.1126/science.1198364

HOW DOES STRESS AFFECT OUR HEALTH? 655

Steven Errico/DigitalVision/Getty Images

about stress. Psychologists have identified a number of strategies that people can use to ef-
fectively reduce the negative impacts of stress on their happiness and health.
One of the most positive aspects of stress is that we adapt to it over time. Take a minute
to jot down the things that you found most stressful five years ago and then make a list of
the stressors that you face today. Would you trade today’s list for the one from five years
ago? Most people would do so in a heartbeat. Life gets more complicated and often more
stressful, but our skills for coping improve at the same time. People tend to report less stress
as they get older (Shields, 2004).
Earlier in this chapter, we described the role of cognitive appraisal in identifying a stimu-
The stress of middle school, such as lus or event as a stressor. Appraisal plays an important role in coping with identified stressors
attending school dances, is real to as well. Once a stressor has been identified, a second set of appraisals occurs that guides our
students at the time, but as we get coping responses (Lazarus, 1966). What harm has already occurred? What threats remain?
older and more experienced, our What resources do we need to overcome the challenge? Taking conscious control of our ap-
capacity to manage stress improves. praisals can contribute to our ability to cope.
With age, people report feeling less
stress, even though stressors tend
to become more complicated and Managing Stress
numerous at the same time.
An obvious starting place for keeping your levels of stress low is to ask whether stressors can
be eliminated. If you feel stressed about having too much to do and too little time to do it, it
might be possible to reduce your workload or practice better
time management skills. If money is tight, a visit to your cam-
Even when a stressor takes us by surprise, we can regain
pus’s financial aid office might provide you with solutions
a sense of control. Viktor Frankl (1959, p. 161), a Holocaust that you had not considered. The worst possible approach is
survivor, developed what he described as “tragic optimism” to withdraw and avoid stressors in the vain hope that they
for coping with unforeseen disasters. Instead of asking why will go away. Your latest credit card statement is not going to
these disasters should happen to us, Frankl recommends that get better magically if you ignore it. In fact, your emotional
people exert a sense of control by asking, “How can I face this response to seeing the statement on your desk every day is
likely to get a lot worse over time.
disaster with courage and responsibility?”
A major variable that predicts our response to stress is
the sense of control. Feeling surprised by life or out of control can lead to significant stress.
Some of the worst stressors are those that seem to strike randomly, such as being diagnosed
with lung cancer when you never smoked (Pietrzak et al., 2011). These seemingly random
events undercut our sense of control, countering the belief that “If I don’t smoke, I am ensur-
ing that my lungs will stay healthy.”
Many stressors are out of our control, however. We can’t wish our cancer away or magi-
cally ensure that enough money appears in our bank accounts to pay this month’s bills. How-
ever, we can respond to our stressors in ways that reduce our overall stress. This approach
Monkey Business Images/[Link]

is consistent with the elements of positive psychology, which we review later in this chapter.
Even if you are struggling with a life-threatening disease, stress can be reduced by educating
yourself as much as possible about your condition and participating fully in decisions about
your treatment. Residents of nursing homes who have more control over their choice of daily
activities live longer than those who are not given such choices (Rodin, 1986). We observed
in Chapter 12 that stressors have less effect on people who experience an internal locus of
control, which means that they believe that most of their outcomes result from their personal
efforts, as opposed to luck, chance, opportunities, or other external forces.
Because of the inevitability of stress, people cope best when they keep themselves as
Patients who educate themselves healthy as possible. If you follow good health habits, stress might still deplete your reserves
about their conditions and participate and inhibit your immune system, but a healthy body can take more abuse than an unhealthy
fully in treatment decisions one. Students are more likely to get sick during final exams if they have neglected good eating,
experience less stress. exercise, and sleeping habits all term long.

656 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Percentage mortality
Stressed Cardiac Patients. People
15 with cardiovascular disease were
assessed for psychosocial stress
10 levels during a rehabilitation
program that included exercise. A
control group did not have a formal
5
Low stress exercise program. Based on their
Alexander Raths/[Link]

High stress improvement in physical measures

0
No exercise Little improvement Greater following the exercise program,
due to exercise improvement the study participants were divided
due to exercise into low and high exercise change
Exercise group groups. In a follow-up five years later,
high levels of physical improvement
because of exercise did not affect
Regular aerobic exercise appears to be especially helpful. In one experiment, people with the mortality of the low psychosocial
heart disease were observed as they engaged in exercise as part of their rehabilitation pro- stress group but significantly reduced
grams. The exercise reduced the overall stress levels of all participants (Milani & Lavie, 2009). mortality in the high-stress group.
Exercise seemed particularly beneficial for the participants who also scored high on psycho- Source: Adapted from R. V. Milani & C.
social stress. None of the high-stress participants who showed the greatest physical benefits J. Lavie (2009). “Reducing Psychosocial
from exercise (such as increased oxygen uptake) died in the follow-up period, compared to Stress: A Novel Mechanism of Improving
19% of the high-stress participants who showed relatively low physical benefits from exercise Survival from Exercise Training,” American
(see ● Figure 16.9). Students would be wise to engage in some level of activity to offset the Journal of Medicine, 122(10), 931–938.
effects of increased stress. doi:10.1016/ [Link].2009.03.028
In Chapter 15, we discussed the use of mindfulness in the treatment of anxiety and MDD.
Mindfulness, or the trained awareness of our current thoughts, emotions, and actions, has also
been shown to be an effective method for reducing stress (Tang & Posner, 2009). In Chapter
6, we explored the effects of the altered state of consciousness produced through meditation.
Although many people meditate within a religious context, a large meta-analysis indicated
that meditation is an effective strategy for reducing psychological stress (Goyal et al., 2014).

Spc. Terence Ewings, 4th AAB PAO, 1st Cav. Div., USD-N/photo courtesy of U.S. Army
One of the most powerful antidotes to unhealthy effects of stress is social connectedness and
support. Social support from friends and family and belief systems that allow a person to make
sense of the world provide powerful buffers against stress (Montpetit et al., 2010). As we have ar-
gued on many occasions in this textbook, people with good social relationships and support are far
less vulnerable to adverse health and psychological conditions than are people who are lonely and
isolated (Hostinar et al., 2013; Cacioppo et al., 2015). In times of distress, people frequently turn to
others in an effort to cope. According to a study of responses to the terrorist attacks of 9/11, nearly
100% of the participants reported sharing their thoughts and feelings about the attacks with other
people (Schuster et al., 2002). More than 90% reported either praying or engaging in spiritual con-
templation appropriate to their faith. More than 60% engaged in relevant public activities. Nearly
40% focused on the needs of others by donating money or blood to relief efforts.
Understanding the importance of social support for coping helps to explain why people
living in poor neighborhoods often experience more stress and have higher rates of MDD.
Living in a neighborhood where few people know one another or help one another with tasks
like child care increases the risk of developing MDD (Russell & Cutrona, 2010). These socially
disconnected neighborhoods become more prevalent as the income of the residents decreases,
making people living below the poverty line especially vulnerable to stress and depression.
Although it is ideal to receive your social support from other people, having a pet can Specialist Lawrence Shipman and
also provide benefits to your health. Stockbrokers with high blood pressure who lived alone Sergeant First Class Jonathan Zeke,
were selected to receive a cat or dog from a local shelter (Allen, 2003). When stressed, the pet a combat stress–relief dog, received
owners experienced a much lower increase in blood pressure than their petless counterparts. an award for their work in reducing
The effect was most obvious among participants who listed few social connections with other the stress of soldiers deployed in Iraq.
people. Among individuals with Alzheimer’s disease in residential care, the use of robotic pets Shipman notes that Zeke acts as an
was not only associated with reduced anxiety and stress, but also with reduced need for pain icebreaker, encouraging soldiers to talk
medication and psychoactive medications (Petersen et al., 2017). to the behavioral health counselors.

HOW CAN WE COPE EFFECTIVELY WITH STRESS? 657

Fiona Hanson/PA Images/Alamy Stock Photo

Three Types of Coping
Coping with a stressor can take three forms: problem-focused, emotion-focused,
and relationship-focused (O’Brien & DeLongis, 1996). In each case, positive and
negative versions of each style can be observed.
Problem-focused coping is designed to address an issue head-on. If you just
flunked an important exam, positive problem-focused coping strategies might
include making an appointment with your professor to discuss your options, hir-
ing a tutor, taking a study skills seminar, or joining a study group formed by your classmates.
Owning a pet confers many
Negative problem-focused coping can include escape and avoidance. Instead of confronting the
advantages, but individuals with
problem, a student might stop going to class. Problem-focused coping is more frequently used
dementia usually cannot care for a pet
for work-related stressors, which would include schoolwork, than for interpersonal stressors like
properly. The PARO robotic seal has
the breakup of an important relationship (Terry, 1994).
produced such positive effects that
Emotion-focused coping helps you deal with the negative emotions associated with a
many insurance companies are willing
stressor. Flunking an exam might make you feel sad, discouraged, and depressed. Positive cop-
to pay the over $6,000 required to
ing with these negative emotions might involve sharing your concerns with your friends or
provide this “pet” to patients.
family, taking a break from your studies to enjoy a movie or go for a jog, or, when the negative
emotions seem overwhelming, visiting your campus’s counseling center for advice. Negative
emotion-focused coping, such as eating food that you do not need or using alcohol to dull
problem-focused coping A response your stress, might simply add to your problems and increase your overall levels of stress.
to stress designed to address specific prob-
Relationship-focused coping helps you maintain and protect social relationships in
lems by finding solutions.
response to stress (O’Brien & DeLongis, 1996). This type of coping has both positive and
emotion-focused coping A response
to stress that targets the negative emo-
negative aspects. For example, people caring for Alzheimer’s patients, which can be stressful,
tions arising from the situation. exhibited both positive coping, including empathy, support, and compromise; and negative
relationship-focused coping A re- coping, including confronting, ignoring, blaming, and withdrawal (Kramer, 1993).
sponse to stress designed to maintain and As we have seen so frequently in our discussions of human behavior, the choice of a cop-
protect social relationships. ing approach results from interactions between people and the situation in question (Aldwin,
1994). For example, people who score high on the Big Five trait of neuroticism (discussed in
Chapter 12) tend to experience more distress than people with low neuroticism scores (Bolger
& Schilling, 1991). When responding to stressors in the work situation, people high in neuroti-
cism are more likely to engage in negative problem-focused coping, such as escaping the situ-
ation (O’Brien & DeLongis, 1996). When dealing with interpersonal stress, however, people
with high neuroticism use the negative relationship-focused coping strategy of confrontation.

(a) (b) (c)

At times of stress, we often engage

in three types of coping. (a) Problem-
focused coping is usually used to
Image navi - QxQ images/Alamy Stock Photo

solve problems at work. (b) Emotion-

focused coping helps us deal with
Lucky Business/[Link]

the negative emotions of stress. The

suhendri/[Link]

use of strategies like overeating,

however, can lead to more problems.
(c) Relationship-focused coping helps
us maintain and strengthen social
networks at times of stress.

658 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

r
esy Ride
tionships (coworkers and neighbors). They are more likely to

blishing ssociates/Court
use a positive relationship-focused coping method, empathy,

Katharina Vesely/Imagno/Getty Images

when dealing with distant relationships than when dealing
with close relationships (O’Brien & DeLongis, 1996).

Books/E gned by Two A

bury Pu
Resilience: Individual

esi
Cover d
Differences in Response
to Stress
You might have observed that under the same stressful circumstances, such as an upcoming Austrian psychiatrist Viktor Frankl
exam, some students seem calm and others appear to be in a state of panic. What determines (1905–1997) was sent to the dreaded
these individual differences in coping? Nazi concentration camp Auschwitz,
We have already seen how epigenetic interactions between genes and nurturing can influ- where he lost his pregnant wife,
ence later responses to stress. In addition, people differ in resilience, or the ability to adapt parents, and brother. Frankl used his
to life’s challenges in positive ways. Early research in resilience focused on children’s ability experiences in developing his theories
to thrive even in conditions of poverty, neglect, and abuse (Masten et al., 1999). Low resilient of logotherapy, after logos, the Greek
people have higher levels of perceived stress (García-León et al., 2019). Resilient people do not word for “meaning.” The ability to find
ignore feelings of sadness or stress, but like Holocaust survivor Viktor Frankl, they remain op- meaning even in the depths of despair
timistic and confident about their abilities to cope with adversity. In contrast, when people lack by recalling pleasant memories or
resilience, they feel overwhelmed, helpless, and victimized. They become more vulnerable to the helping a suicidal inmate helped
use of negative coping strategies, including alcoholism and drug abuse, to escape their problems. Frankl survive the stress and horror
The personality trait of hardiness contributes to resilience (Maddi, 2006). As mentioned surrounding him.
in Chapter 12, a personality trait is likely to be stable and enduring over time. Compared to
less hardy people, people with high hardiness experience less threat or People who write “scripts” for how their life
disruption in response to the normal stressors of life. Hardiness combines
“should” happen, such as thinking that everyone
commitment, control, and challenge (Bartone, 2000). People with high
commitment see the world as interesting and seek involvement rather than should enjoy a set schedule of activities over a
withdrawal. Control refers to individuals’ belief in their ability to influence holiday, often experience high stress levels when
events. Challenge is a state of mind that sees change and new experiences events take an unexpected turn. Maintaining a
not as negative stressors, but as opportunities for learning and personal flexible approach to meeting your life’s goals is far
growth. Among college students, hardiness did not predict grades, but it less likely to create stress.
was negatively correlated with health complaints and stress related to aca-
demic work (Hystad et al., 2009; also see ● Figure 16.10).

resilience The ability to adapt to life’s

10
challenges in positive ways.
9

8
Number of health complaints

6 FIGURE 16.10
5
Hardiness Protects Students From the Health Impacts of
4 Stress. The personality trait of hardiness, which combines
commitment, a sense of control, and the appraisal of stressors
3 as challenges, seems to protect college students from the health
consequences of high academic stress.
2
Source: Adapted from S. W. Hystad et al. (2009). “Academic Stress
1 Low hardiness and Health: Exploring the Moderating Role of Personality Hardiness,”
High hardiness Scandinavian Journal of Educational Research, 53(5), 421–429.
0
Low academic stress High academic stress doi:10.1080/00313830903180349

HOW CAN WE COPE EFFECTIVELY WITH STRESS? 659

SUMMARY 16.1 Stages in Hans Selye’s General Adaptation Syndrome

Stage What’s Happening?
Alarm Mobilization of resources for fight-or-flight

Resistance Continued coping with chronic stress

Exhaustion Systems begin to fail

Credits: Top row—AP Images; Second row—Sgt. Jessika Malott, 8th MP Bde. Public Affairs/photo courtesy of U.S. Army; Bottom row—oliveromg/[Link]

What Is the Relationship

Between Psychology
and Health?
You might be surprised to see a section about health psychology in your psychology textbook.
Isn’t health the exclusive domain of medical personnel rather than of psychologists? It all de-
pends on how you define health. For most of its history, the field of medicine viewed health as
a lack of disease (Juster et al., 2010). Treatments were designed to make sick people feel better.
In more recent years, however, health has been more commonly defined as the attainment of
a positive state of well-being rather than simply the absence of disease. Medicine today is more
likely to use a biopsychosocial model of health, in which health is viewed as the sum of bio-
logical (such as genetics, infection, and injury), psychological (such as lifestyle, stress, and
health psychology A branch of psychol- health beliefs), and social factors (such as culture, family, and social support; McEwen &
ogy that investigates the relationships be- Gianaros, 2011) (see ● Figure 16.11).
tween psychological variables and health.
In 1948, the World Health Organization (WHO) proposed a definition that reflects
biopsychosocial model A model that
this more contemporary model of health: “a state of complete physical, mental, and social
sees health as the result of biological,
psychological, and social factors. well-being and not merely the absence of disease or infirmity” (World Health Organization
[WHO], 2003, para. 1). In addition to making sick people feel better, which is an important

660 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

forestpath/[Link]
Adaptation

HEALTH OUTCOMES

function of medicine, this new view of health seeks to improve the well-being of people who
are not currently sick.
One reason for this transition from the biomedical model to the biopsychosocial model
is the changing face of health and medicine over the last 100 years or so. Because of improved
sanitation and vaccination, the threats to health faced today are quite different from those faced
by earlier generations. In 1900, the leading causes of death in the United States were pneumonia,
influenza, and tuberculosis, but by 2005, the leading causes of death were heart disease, cancer,
lung disease, and stroke (see ● Figure 16.12). In other words, we have gone from facing major
threats from infectious, short-duration conditions to noninfectious, long-term conditions.
Perhaps this is one of the reasons why the threat of COVID-19 has been difficult to grasp—it
is not typical of the health threats we normally face today. In the last few decades, considerable
progress was made in the treatment of heart disease, cancer, and stroke. This improvement in
turn has resulted in a larger number of Americans who are living long enough to be diagnosed
with age-related conditions such as Alzheimer’s disease and Parkinson’s disease.

Suicide FIGURE 16.12

Kidney disease Leading Causes of Death in the
Influenza and United States. Over the last
pneumonia 100 years, infectious diseases had
Diabetes been replaced as the leading causes
of death in the United States until
Alzheimer’s
the emergence of the COVID-19
Cause of death

disease
pandemic.
Stroke Source: Adapted from the Centers
Chronic lower for Disease Control and Prevention
respiratory disease (CDC; 2020). “Leading Causes of
Death.” Retrieved from [Link]
Accidents
[Link]/nchs/fastats/leading-causes-of
COVID-19 -[Link]

Cancer

Heart disease

0 100 200 300 400 500 600 700

Deaths per year (thousands)

WHAT IS THE RELATIONSHIP BETWEEN PSYCHOLOGY AND HEALTH? 661

Behavior and Health

Consumer Reports conducted a survey of 1,000 Americans to see how many engaged in everyday
prevention behaviors ([Link], 2009). As shown in ● Table 16.2, the respondents
did rather well in a number of categories (91% read the warnings that come with a prescription
drug, and 87% report not drinking beer while using a power tool or mower) but neglected some
obvious preventive steps (58% never wear a bike helmet, 24% report being in a car without using
a seat belt, and 27% do not use sunscreen when outdoors for an extended period). We do worry
about those 13% who are drinking beer while using power tools or mowing the lawn, but the
point is that many of our choices contribute to the prevention of accidents and disease.
Behaviors that contribute to our major causes of death include smoking, poor nutrition,
alcohol use, lack of exercise, and loneliness (see ● Figure 16.13), which are discussed in more
detail in the following sections.

TABLE 16.2
Americans’ Safety Practices
Behavior Yes No
Use cotton swabs to clean ears 73% 26%
Let your kids play on a trampoline 43% 56%
Eat raw dough when making cookies 39% 61%
Use the top step of a ladder 31% 69%
Fail to use the car’s seat belt 24% 75%
Drink beer while using a power tool or mower 13% 87%
Have a rubber mat in the shower 39% 61%
Have a carbon-monoxide detector in home 51% 48%
Eat burgers only well done 67% 32%
Change batteries in the smoke alarm annually 79% 21%
Clean lint trap in the dryer after each use 81% 18%
Read warnings on prescription medicines 91% 9%
Wear a bike helmet 42% 58%
Wear sunscreen when outside for an extended time 73% 27%
Source: Adapted from [Link] (2009). “Risky Business.” Retrieved from [Link]
/cro/magazine-archive/march-2009/money/risk-taking/overview/[Link]

662 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Julian Rovagnati/[Link]
9.1
between 35 and 65 years of age
10 had all four habits. Most people
4.0
0 reported following only one to
Never BMI < 30 Physical activity Diet index 0 1 2 3 4 three of the four health habits.
smoked ≥ 3.5 hours/week > median Source: Adapted from E. S. Ford et al.
Number of health
Health habits habits followed (2009). “Healthy Living Is the Best
Revenge: Findings from the European
Prospective Investigation into Cancer
and Nutrition–Potsdam Study,” Archives
Tobacco Use Cigarette smoking is considered to be the leading preventable cause of of Internal Medicine, 169(15), 1355–1362.
death in the United States, with a direct responsibility in one of five deaths each year (Centers
doi:10.1001/archinternmed.2009.237
for Disease Control and Prevention [CDC], 2020c). Over 8 million people worldwide die
due to tobacco each year (WHO, 2020b). On average, smokers die 13–14 years earlier than
nonsmokers. Tobacco use can lead to additional health problems. Nicotine is a well-established
gateway drug, capable of producing epigenetic changes that
increase the likelihood of addiction to cocaine (Li et al., 2014). 35
Tobacco’s effects are not restricted to its users either. In the 2007 2017
United States, exposure of nonsmokers to secondhand smoke 30
27.0
causes 7,300 lung cancer deaths, 34,000 premature deaths
from heart disease, 8,000 deaths in nonsmokers from stroke, 25
22.1 22.5
21.6
Prevalence (%)

higher rates of SIDS, and asthma attacks and ear infections in

20 19.5 19.2
children (CDC, 2020b).
Cigarette smokers in the United States dropped from
21% of adults in 2005 to just 13.7% in 2018 (CDC, 2019; 15 13.9
Jamal et al., 2016). Worldwide rates also continue to drop (see 11.2
● Figure 16.14; WHO, 2020b). 10
Gender, race, ethnicity, education, mental health, and in-
come are strong determinants of the likelihood of smoking. In 5
the United States, men are more likely to smoke than women
(15.6%, as opposed to 12%). American Indians or Alaska 0
High-income Middle-income Low-income Global
Natives reported the highest incidence of smoking (22.6%), countries countries countries
followed by non-Hispanic multirace individuals (19.1%), non-
Hispanic Whites (15%), non-Hispanic Blacks (14.6%), Hispanics (9.8%), and FIGURE 16.14
Asians (7.1%). Lesbian/gay/bisexual individuals were more likely to smoke
cigarettes (20.6%) than heterosexual individuals (13.5%). Smoking drops with Fewer People Are Smoking Cigarettes. Between
increasing education, from 36% of individuals with a general equivalency 2007 and 2017, global rates of smoking among adults
diploma (GED) certificate to 3.7% of adults with a graduate degree. Poverty dropped from 22.5% to 19.2%. At the same time,
plays a strong role in smoking; 26.1% of adults living below the poverty line however, use of e-cigarettes and heated tobacco
compared to 13.9% living at or above the poverty line report smoking. increased. It is unclear how much of the drop in
You might be wondering how trends regarding e-cigarettes (i.e., vaping) cigarette smoking is related to these alternate
might influence these numbers. It is unclear how much of the overall decline patterns of use.
in cigarette use is related to e-cigarette use. In 2020, 3.2% of U.S. adults used Source: World Health Organization (WHO; 2019). WHO report
e-cigarettes, and 58% of these were also current cigarette smokers (CDC, on the global tobacco epidemic, 2019. Geneva: World Health
2020a). However, among e-cigarette users aged 18–45, 40% have never used Organization.

WHAT IS THE RELATIONSHIP BETWEEN PSYCHOLOGY AND HEALTH? 663

Carlos Barria/Reuters/Newscom
Given the carnage produced by tobacco, why do people start smoking
and then continue? An understanding of the initiation of tobacco use re-
quires combining the perspectives discussed in this textbook—development,
biological psychology, cognitive, clinical, and social/personality psychology.
Most tobacco users begin smoking in childhood or early adolescence,
long before decision-making abilities are mature. Because of the addictive na-
ture of nicotine, about half of those who experiment with tobacco continue to
use it. In addition to its action on synapses where the neurotransmitter acetylcholine is released,
China is the world’s largest consumer
as discussed in Chapter 6, nicotine has the ability to stimulate the dopamine reward circuits of
and producer of tobacco. Over 350
the brain and to produce a particularly unpleasant set of withdrawal symptoms. As discussed in
million Chinese smoke. Sixty percent
Chapter 11, adolescence is also a time when people try out new roles and learn important skills
of male Chinese physicians smoke,
for getting along with peers, frequently making them susceptible to peer pressure. Teens often
compared to 3.3% of physicians in
overestimate how many other people are using tobacco, so they might begin using it to avoid
the United States. The 2011 ban on
looking “different” (Institute of Medicine [IOM], 1994). Finally, most smokers have friends and
smoking in bars, in restaurants, and on
parents who also smoke, suggesting a role for social learning (Biglan et al., 1995). It is also pos-
transportation does not apply to offices
sible, however, that prenatal exposure to tobacco raises the likelihood that a child will smoke.
and factories. The ban was required
A troubling aspect of the initiation of smoking is the prevalence of tobacco use among
when China signed the World Health
people with diagnosed psychological disorders (see ● Figure 16.15). Of the approximately 20%
Organization Framework Convention on
of American adults diagnosed with any mental disorder (see Chapter 14), 40.6% were current
Tobacco Control. Public health officials
smokers—a much higher rate than that found in the general population (Jamal et al., 2016).
fear that the lack of an awareness
Adults diagnosed with mental disorders smoke 31.6% of all cigarettes consumed by adults
program and penalties will encourage
in the United States (CDC, 2019). Tobacco use among people with schizophrenia and other
the population to ignore the ban.
severe mental illnesses is as high as 88%, many times higher than the approximately 14% of
users in the general population as reported by the CDC (Lucatch et al., 2018).
In addition, the severity of smoking, which includes such factors as how many cigarettes
are smoked per day, appears to be much higher among people with psychological disorders
than in the general population. In a large-scale study of more than 50,000 adults who did not
live in mental institutions, individuals with serious psychological distress (a global measure of
psychological disorder) were more likely to smoke currently and heavily and were less likely
to quit than individuals without serious psychological distress (Sung et al., 2011). Although

FIGURE 16.15 40
Percentage Who Smoke

Psychological Distress Is Related to Higher Rates of

Smoking. Individuals identified as having high levels of 30
psychological distress, including being diagnosed with
severe psychological disorders such as schizophrenia, are
more than three times as likely to smoke cigarettes as 20
people with low or no psychological distress. This might
represent efforts to self-medicate, but a causal role for
tobacco in a number of psychological disorders has not been
ruled out. 10 High psychological distress
Source: Adapted from A. Jamal et al. (2016). “Current Cigarette Moderate psychological distress
Smoking Among Adults—United States, 2005–2015,” Morbidity Low psychological distress
and Mortality Weekly Report, 65(44), 1205–1211. doi:10.15585/ No psychological distress
0
mmwr.mm6544a2

664 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

NeydtStock/[Link]
not advocating that a prospective quitter abandon the essential social support
needed at a difficult time; rather, we are suggesting that people trying to quit
smoking might benefit from physically separating themselves when friends and
family light up. As noted in Chapter 8, being exposed to conditioned stimuli,
such as the smell of tobacco, can initiate a variety of conditioned behaviors that
might make refusing a cigarette difficult for the person trying to quit.
Smoking cessation programs also can take advantage of the self-
reference effect, discussed in Chapter 12. This effect explains the superior In the United States, ex-smokers
recall for information relevant to the self by suggesting that the self serves as an important outnumber smokers (Chapman &
schema for organizing information. Participants experiencing interventions for smoking that MacKenzie, 2010). Smokers use a
were tailored to their own lives, needs, interests, and obstacles not only were more successful variety of techniques to quit, including
at quitting smoking, but also showed brain activity in parts of the prefrontal cortex that are simply stopping all use abruptly (cold
believed to participate in thinking about the self (Chua et al., 2011). turkey), gradually reducing intake,
The benefits of quitting smoking appear within minutes to hours as the body begins to using nicotine patches and gum or
repair itself. After 5 years of abstention from smoking, risk of stroke is the same for ex-smokers other nicotine replacement tools,
and nonsmokers. After 10 years of abstention, the risk of lung cancer is cut in half. If the participating in counseling and support
smoker quits before the age of 30 years, life expectancy remains the same as for someone who groups, or some combination of these.
has never smoked (Doll et al., 2004).

Nutrition Nutrition plays a significant part in overall physical development, including brain
development, and is believed to be responsible for many differences in psychological and health
outcomes related to SES (Rosales et al., 2009). Prenatally, the maternal diet can have long-lasting One of the challenges that we face
epigenetic effects on a child’s later risk for disease (Randunu & Bertolo, 2020). People need the today is the high cost of eating a
right amount and quality of nutrients to support optimum health and brain functioning, and healthy diet. If you have $1.50 in your
being either underweight or obese is associated with reduced health. Obesity increases the rates pocket, you can buy about 1,100
of many chronic conditions, including heart disease, stroke, diabetes, arthritis, and breast and calories at McDonald’s (breakfast of
colon cancers. As noted previously, maintaining a body mass index (BMI) below 30 (nonobese) pancakes and sausage) or 250 calories
was one of the four protective factors associated with much lower risk of disease. Returning the of fresh apples. We can guess which
U.S. population to normal weight (a BMI of between 18.5 and 24.9) would produce about the choice financially struggling parents
same improvement in overall life expectancy as the elimination of smoking (Stewart et al., 2009). with hungry children are likely to make.
As mentioned in Chapter 7, not only do we face problems in the form of eating disorders, such
Chuck Franklin/Alamy Stock Photo

as anorexia nervosa and bulimia nervosa, but the world also has experienced an unprecedented
obesity epidemic over the last 30 years (see ● Figure 16.16). In the United States, the percentage
of obese adults rose from 12% in 1991 to 42% in 2018 (CDC, 2020). It is likely that multiple fac-
tors have contributed to this change, including our sedentary lifestyle, increases in caloric intake,
changes in the types of food that we eat, changes in sleep patterns, and social factors. WHO (2020a)
describes low- and middle-income countries as facing a “double burden” of disease because
undernutrition and obesity occur at the same time, often in the same households. A com-
bination of inadequate nutrition prenatally and in childhood, followed by exposure
to high-calorie but nutrient-poor foods, sets the stage for a lifetime of poor
health, possibly because of epigenetic factors (Haemer et al., 2009).
As was the case with smoking, we can see evidence of social
factors that maintain our eating habits and weight. Our recent
history of eating cheap, fatty, and sugary foods interacts with
poverty. Nutritionists have raised the alarm that eating healthy
[Link]/Arsgera; istock.

foods is becoming more expensive than ever. Gender, ethnicity, and

age also interact with obesity (Hales et al., 2020). Obesity is highest cilo
/A
in non-Hispanic Black adults (49.6%), followed by Hispanic adults . c om
com/assalve

ock
iSt
(44.8%) and non-Hispanic White adults (44.7%). Obesity is lowest
among non-Hispanic Asian adults (17.4%).

WHAT IS THE RELATIONSHIP BETWEEN PSYCHOLOGY AND HEALTH? 665

40
Obesity1

Percent
20

Ljupco Smokovski/[Link] Severe obesity1

0
1999– 2001– 2003– 2005– 2007– 2009– 2011– 2013– 2015– 2017–
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Survey years

FIGURE 16.16
The Obesity Epidemic. In 1960, fewer than 15% of American adults were obese (body mass index,
or BMI, > 30), but today about 42% are obese. The number of people who are severely obese (BMI > 40)
also has climbed during this period. The reasons for the obesity epidemic are not well understood and are
likely to be complex.
Source: C. M. Hales et al. (2020). “Prevalence of Obesity and Severe Obesity Among Adults: United States,
2017–2018.” NCHS Data Brief No. 360. Hyattsville, MD: National Center for Health Statistics.
[Link]

As observed in Chapter 7, there are no quick fixes for obesity and poor nutrition. Many of the
same challenges face people who want to lose weight that we observed among people attempting to
quit smoking. One advantage that would-be ex-smokers enjoy, however, is the option of complete
abstinence. In contrast, we cannot abstain from eating; instead, we must choose to eat differently.
In addition to addressing concerns about obesity, current research in nutrition is focusing
on the specific nutrients needed for healthy development and psychological well-being. As
mentioned in Chapter 14, prevalence of bipolar disorder is much lower in countries consum-
ing large amounts of seafood than in countries where seafood consumption is rare (Noaghiul
& Hibbeln, 2003). Although much remains to be explored in this area, a further understanding
of the consequences of changes in our modern diet should help us achieve a healthier lifestyle.

Alcohol Alcohol is widely used in the United States and in many other countries around the
world. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2020),
86.3% of American adults consumed alcohol at some point in their lifetime, 70% consumed
alcohol in the past year, and 55.3% consumed alcohol in the past month. About 26% of the adult
population engaged in binge drinking (five or more alcoholic beverages on the same occasion)
during the past month, and 7% reported heavy drinking (five or more alcoholic beverages on one
occasion on each of five or more days in the past month); 6% of adults and 1.6% of adolescents
meet criteria for alcohol use disorder. Alcohol use is the third-leading preventable cause of death
in the United States (number one is tobacco and number two is poor diet and inactivity).
Globally, alcohol contributes to 5.3% of deaths, but as shown in ● Figure 16.17, the con-
tribution of alcohol to death varies by age (WHO, 2020). The largest threats to health from
alcohol use are to the liver, which is responsible for clearing the body of toxins, but alcohol use
also contributes to lower life spans because of stroke, high blood pressure, and some cancers
(breast, digestive, and liver). In the United States alone, excessive alcohol consumption leads
to approximately 88,000 deaths annually, at a cost of $249 billion (NIAAA, 2020). Alcohol-
impaired driving accounts for 31% of all driving fatalities in the United States.
In addition, alcohol poses a risk of abuse and dependence for many people. Psychologists
define alcohol abuse as repeated use despite adverse consequences and alcohol dependence

666 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Southeast Asia Western Pacific World

Percentage (%) of deaths attributable to Total
35.0

30.0
alcohol consumption

25.0

20.0

15.0

10.0

5.0

0.0
14

4
19

ol and
–7
–2

–2

–3

–4

–5

–6

–7

–8
0–

r
70
15

de
20

85
Age (years)

FIGURE 16.17
Alcohol Contributes to Death and Disability. The World Health Organization (WHO) reports that
worldwide, alcohol causes more deaths than tuberculosis, HIV/AIDS, and diabetes. In addition, alcohol is
responsible for 5.1% of all disability-adjusted life years (DALYs). Alcohol accounts for more deaths of young
and middle-aged adults compared to children, adolescents, and older adults.
Source: Adapted from World Health Organization (WHO; 2018). Global Status Report on Alcohol and Health 2018.
Geneva, Switzerland: Author.

as alcohol abuse accompanied by tolerance, withdrawal, and a compulsive urge to drink more
(APA, 2013). As observed in Chapter 4, tolerance is defined as the need to administer greater
quantities of a drug to maintain the same subjective effect, and withdrawal refers to symptoms
that occur when a habitually used drug is no longer used.
As we have seen in so many other domains of human behavior, complex interactions between
biological and environmental factors lead to alcohol abuse and dependence. Genes related to the body’s
ability to break down alcohol in the liver are not evenly distributed across the world’s populations.
Certain types of genes found primarily in Asians are correlated with lower rates of alcohol depen-
dence (Eng et al., 2007). As usual, genes are not the whole story. Consider the example of
Native Americans. This ethnic group has much higher rates of alcohol dependence than do
many others, despite a high prevalence of the supposedly “protective” genes (Ehlers, 2007).
Among the environmental influences on problem drinking is the age of first intoxication
(Newton-Howes et al., 2019). Age of first intoxication is more predictive of later drinking
problems than the frequently used age at first drink measure.
Many of the same factors that encourage teens to begin smoking also encourage
drinking. Peer pressure, the need to fit in or look cool, overestimates of “Everybody’s
doing it,” modeling the behavior of parents and other family members, and the teen’s
Diverse Images/Univer/AGE Fotostock

characteristic sense of being immune to harm from risky behavior can contribute to
decisions to begin drinking. Because alcohol reduces anxiety, socially anxious teens
are especially at risk for problem drinking. If teens feel more socially competent while
drinking, they are likely to continue this practice because of operant conditioning, as
described in Chapter 8. Reduced feelings of anxiety are rewarding, so a person is likely
to repeat the behavior (alcohol consumption, in this case) associated with this reward.
Treatment for very heavy drinkers often requires medical supervision because
withdrawal from alcohol can produce life-threatening seizures. Recall from Chapter 4 that alco-
hol boosts the inhibition produced by GABA, leading to alcohol’s classification as a central ner- People who are exposed to alcohol at
vous system depressant. Because withdrawal symptoms are usually the opposite of drug effects, younger ages have the highest risk for
withdrawing from a depressant produces excitation, and too much excitation leads to seizures. alcohol abuse.

WHAT IS THE RELATIONSHIP BETWEEN PSYCHOLOGY AND HEALTH? 667

MBI/Alamy Stock Photo

Exercise Exercise was not a choice for our hunter–gatherer ancestors,
for whom physical work meant the difference between death and survival.
In today’s sedentary world, however, in which many workers spend hours
commuting in cars to sit for more hours in front of computers, exercise
In contrast to previous generations, who simply “played,” becomes something that we must consciously remember to do. Children in
it is not uncommon today to find children as young as previous generations would dash from school to play outdoors, but social
3 to 5 years of age involved with adult-organized formal changes, including lack of supervision at home and safety concerns, have led
sports. Further research is necessary to determine the to much less spontaneous outdoor activity. Parents might prefer that their
long-term impacts of this social trend on adult patterns of children stay indoors playing video games rather than ride their bicycles in
play and exercising. the neighborhood. For many middle-aged and older adults, loneliness might
lead to less physical activity (Hawkley et al., 2009; Hawkley & Cacioppo, 2010).
Lack of exercise and sitting are related but different issues. Children and adults in the United
States spend an average of 55% of their day sitting while riding in cars, watching television, doing
work or attending school, and playing video games or doing other computer work (Matthews et
al., 2008). A person’s amount of sitting time is correlated with risk of death (see ● Figure 16.18).
However, high levels of moderately intense activity (60–75 minutes per day) seems to offset some
of this risk (Ekelund et al., 2016). Although the highest risk of death occurs in obese individuals

100
Percentage of cumulative survival

Time spent sitting:

80 Almost none of the time
1/4 of the time
Rex Features/[Link]

75 1/2 of the time

3/4 of the time
70 Almost all of the time
0 2 4 6 8 10 12 14
Follow-up years

FIGURE 16.18
Time Spent Sitting and Mortality. Data showing decreased survival as a function of the amount of your day
spent sitting have led to a market for “standing desks.” If you find these desks comfortable, by all means use them,
but recall that again, the sitting data are correlational, and we cannot conclude that sitting causes death. We are
not randomly assigning people to sitting groups. People who sit all day are likely to be obese or have other health
problems that contribute to their higher risk of mortality.
Source: Adapted from P. T. Katzmarzyk et al. (2009). “Sitting Time and Mortality from All Causes, Cardiovascular Disease, and
Cancer,” Medicine and Science in Sports and Exercise, 41(5), 998–1005. doi:10.1249/MSS.0b013e3181930355

668 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Loneliness and Health Loneliness, or a perceived deficit in social connectivity, has

long been understood as a risk factor for psychological disorders, but now it is understood to
contribute to mortality in older adults as well (Cacioppo & Cacioppo, 2018). Even when other
factors are controlled, loneliness produces a 26% increase in the odds of early death. Given
the growing number of older adults and high prevalence of loneliness among them (20%–60%
report being lonely some of the time, and 5%–10% feel lonely frequently or always), this
presents a significant risk to health and well-being.
Loneliness produces risk for death along a number of pathways that are familiar to you
by now: poor sleep quality, increased activity in the HPA axis, increased sympathetic activity
relative to parasympathetic activity, altered gene expression in immune system cells, decreased
immunity to viruses, increased inflammation, decreased impulse control, and increased symp-
toms of depression (Cacioppo & Cacioppo, 2018). While the amount of harm from changes in
each of these pathways might be small, the combined and cumulative changes due to loneli-
ness can produce significant damage to health and well-being (see ● Figure 16.19).

FIGURE 16.19
Loneliness Is a Risk Factor
for Mortality. Loneliness, or
perceived social isolation, does
Sleep not directly reduce life expectancy.
Environment HPA axis Instead, loneliness exerts its
Sympathetic influence on mortality through
Loneliness NS activity complex interactions between
(Perceived Altered gene Premature
Gene–environment
social isolation) genetics and environment, which
interactions expression mortality
in turn affect important health
Immunity
factors like inflammation.
Inflammation
Source: Adapted from J. T. Cacioppo
Impulse
Jesada Sabai/[Link]

Genes
control & S. Cacioppo (2018), “Loneliness in
Depression the Modern Age: An Evolutionary
Theory of Loneliness (ETL).”
Advances in Experimental Social
Psychology, 58, 127–197. doi: 10.1016/
[Link].2018.03.003

WHAT IS THE RELATIONSHIP BETWEEN PSYCHOLOGY AND HEALTH? 669

Culture and Health

Many health-related variables, including poverty, education, access to medical care, nutrition,
and substance abuse, vary widely from country to country and within ethnic groups living in the
United States. The United States, despite its high standard of living, ranks 36th among countries
of the world in terms of life expectancy, suggesting that wealth alone is insufficient to guarantee
good health (United Nations, 2020; also see ● Figure 16.20). However, within the United States,
life expectancy increases continuously with income (Chetty et al., 2016). Life expectancy gaps
between the highest and lowest 1% of income were 15 years for males and 10 years for females.
In the United States, death rates for all ethnic groups have declined over the last decade, but
ethnic differences remain. Risk of death is lowest among Asians and Pacific Islanders and high-
est among the non-Hispanic Black population (Kochanek et al., 2017). Although life expectancy
for White and Black Americans differs, the gap continues to narrow. In 2000, life expectancy for
Whites was 5.5 years more than life expectancy for Blacks, but this gap was reduced to 3.8 years
by 2010. Increases in life expectancy across all ethnic groups resulted from reductions in the
rate of death from leading causes, including heart disease, cancer, chronic respiratory diseases,
and stroke. However, COVID-19 has disproportionately impacted non-Hispanic Blacks, poten-
tially widening the life expectancy gap back to previous levels.
In addition to ethnic and cultural differences in overall health and health habits, discrep-
ancies occur in mental health. Minorities living in the United States have less access to mental
health services, are less likely to receive needed services, receive a poorer quality of care, and
are underrepresented in mental health research (U.S. Department of Health and Human

Life expectancy at
birth (years)
85 to 90
80 to 85
75 to 80
70 to 75
65 to 70
60 to 65
55 to 60
50 to 55
No data

FIGURE 16.20
Culture and Health Interact to Predict Life Expectancy. Many health-related variables, including poverty, education, access to
medical care, nutrition, and substance abuse, vary widely from country to country and interact to determine average life expectancy.
Source: Adapted from [Link]

670 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Distinctive Images/[Link]
exact prevalence remains unknown because many people living in
poverty do not have access to care. Stress from poverty, discrimination,
and violence might contribute to higher rates of stress-related health
problems and disorders. Distrust of clinicians who might seem to be
disrespectful or whose approach is culturally insensitive also might
deter people from obtaining the treatment that they need.

An Integrated Understanding Poverty is a significant risk factor for

of Health Behaviors many types of psychopathology.

If you haven’t already noticed during our discussions of stress, sleep, nutrition, smoking, al-
cohol use, and exercise, let us highlight the fact that these variables interact. Stress can lead to
poor sleep, additional consumption of calories, more smoking, more drinking, and less exer-
cise. People who eat poorly are unlikely to sleep well or feel like going to the gym. Smoking
reduces weight (naming a cigarette marketed to women “Virginia Slims” was no accident), but
of course, it has negative effects on health that far outweigh that advantage. Problem drink-
ers either cut back on nutritious food or become obese (Breslow & Smothers, 2005). College
students engage in drunkorexia, or the deliberate restriction of calories before planned alcohol
consumption for the purpose of avoiding weight gain (Burke et al., 2010). Most of if not all
these behaviors are affected by our social context. We eat, drink, and smoke but also exercise
more in the company of our fellow humans.
These interactions in health behaviors remind us of the need to zoom out to look at the
whole picture of individuals within their social contexts when we attempt to apply interventions
leading to better health (see ● Figure 16.21). We have amassed a significant amount of data
on why people engage in a particular problem behavior, whether that is smoking, drinking, or
overeating, and we are now in a better position to identify the overlapping patterns of epigenesis,
stress, child maltreatment, peer pressure, and motivation that underlie these behaviors.

Death
FIGURE 16.21
The Adverse Childhood Experiences (ACE)
Early death
Study: An Integrated Model of Health. An
example of contemporary research that uses
Whole life perspective

Disease, disability, an integrated model of health is the ACE Study,

and social problems being undertaken by researchers affiliated with
the Centers for Disease Control and Prevention
Adoption of Scientific
health-risk behaviors (CDC). The study plans to address identified gaps
gaps
in our understanding about the relationships
Social, emotional, and between adverse childhood experiences, such as
cognitive impairment abuse and neglect, and later social, emotional,
and cognitive impairments, which in turn could
Adverse childhood experiences influence the adoption of risky health behaviors.
Source: Adapted from Centers for Disease
Conception Control and Prevention (CDC, 2010a). “Pyramid:
Adverse Childhood Experiences (ACE) Study.”
[Link]

WHAT IS THE RELATIONSHIP BETWEEN PSYCHOLOGY AND HEALTH? 671

Nutrition • Obesity increases rates of many chronic diseases, including heart disease, stroke,
diabetes, arthritis, and some cancers.
• Specific nutrients, not just calories, are necessary for optimum functioning.

Alcohol • Alcohol’s main effect on life span is its contribution to accidents, but use is also
correlated with liver disease, stroke, high blood pressure, and some cancers.

Exercise • Exercise improves overall health, mood, and cognition.

Loneliness • Loneliness produces indirect effects on health by affecting sleep, immunity, HPA axis
function, sympathetic nervous system function, gene expression, inflammation, impulse
Loneliness
(Perceived
control, and depression.
social isolation)

Credits: Top row—Carlos Barria/Reuters/Newscom; Second row—[Link]/Acilo, [Link]/Arsgera, Chuck Franklin/Alamy Stock Photo, [Link]/assalve; Third row—Diverse Images/Univer/AGE Fotostock; Fourth row—MBI/Alamy Stock Photo;
Fifth row—Jesada Sabai/[Link].

What Is Positive Psychology?

Although helping people with problems is an important part of psychology, some psy-
chologists have pointed out that there are differences between making people less uncom-
fortable and helping them live happier, more fulfilling lives. The interventions explored
in Chapter 15 are designed to alleviate psychological pain, but these treatments are not
intended to make people who do not have psychological disorders happier. At the same
time, we know a great deal about people with psychological problems, whom we described
in Chapter 14 as representing a minority of the population. What about those who lead
relatively untroubled, typical lives? As observed in Chapter 10, we quite possibly know the
least about people with unusual strengths, such as talent and genius. The field of positive
psychology focuses on these relatively neglected areas of behavior and mental processes
by using scientific methods to understand positive human experiences and adjustment.
A new set of interventions should emerge from this understanding that will guide indi-
viduals, families, and communities in their attempts to maximize their potential (Seligman &
positive psychology An approach to
Csikszentmihalyi, 2000).
psychology that emphasizes normal behav-
ior and human strengths. William James foreshadowed positive psychology in his 1902 book The Varieties of
Religious Experience. In this book, James discussed people who achieve “healthy mindedness”

672 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Mary Evans Picture Library/The Image Works

1973). In addition to making observations of living people whom he admired, Maslow
combed through biographies and autobiographies of famous people in search of common
features of healthy mindedness.
Running parallel to the humanistic psychologists’ rejection of a negative, sickness model
The Varieties of
of human behavior were innovations among cognitive and behavioral approaches. As men- Religious Experience
tioned in Chapter 15, Albert Ellis and Aaron Beck were achieving excellent results with
cognitive restructuring around the same time that the humanistic psychologists began recon-
sidering Freud. Ellis and Beck were able to help their clients with MDD see a glass of water as
WILLIAM JAMES
half full as opposed to half empty, improving their mood and optimism in the process.
One of the most significant voices leading to contemporary positive psychology ap-
In his book The Varieties of Religious
proaches is that of Martin Seligman (2019). (We discussed his concept of learned helplessness
Experience, William James foreshadowed
in Chapter 14.) If people’s outcomes do not seem connected to their behaviors, the resulting
the development of positive psychology
feelings of helplessness and lack of control could result in depression. Based on his investiga-
by considering what makes some
tions of learned helplessness, Seligman proposed that optimism, or thinking positively about
people healthy minded and what gives
the future, can be learned, just as helplessness can (Seligman, 1990).
others a “sick soul.”
Positive psychology embraces humanistic emphases on human growth and fulfillment yet
applies the scientific reasoning and research characteristic of cognitive and behavioral psy-
chology. Positive psychology incorporates five elements of well-being into a PERMA model:
positive emotion, engagement, relationships, meaning, and accomplishment (Seligman, 2012).

Positive Emotions optimism Thinking positively about the

future.
Positive emotions and the experiences that produce them, including happiness, love, gratitude,
contentment, and hope, contribute to our well-being. For our social species, it is not an ac-
cident that many of the situations that produce these positive feelings, such as promotions at
work, marriage, and other successes, involve people who are important to us.

Martin Seligman (right) and the Dalai

Lama (left), spiritual leader of Tibetan
Buddhism, discussed the important
role of positive emotions at a “Mind
and Its Potential” conference in 2009.
Gaye Gerard/Getty Images

WHAT IS POSITIVE PSYCHOLOGY? 673

Diverse Voices in Psychology

Optimism Across Race and Ethnicity
LIKE MOST OF AMERICAN PSYCHOLOGY, is needed regarding racial and ethnic It is likely that concepts that are
positive psychology has been criticized as differences in optimism within the United as value-oriented as those studied by
being overly influenced by the values of the States, lack of hope was shown to be a positive psychologists will show nuanced
White majority. To what extent are concepts risk factor for suicidal ideation for Hispanic variations across different groups, and our
like happiness the same or different and African American students, but not for understanding of these concepts would be
depending on race, ethnicity, or culture? To White students (Davidson et al., 2010; enriched by further investigation into these
what extent are such values simply “human”? Chang et al., 2013). similarities and differences. ■
Optimism, or a positive
expectation for the future, is 27
linked with both physical and
Outcome expectancy score

25
psychological well-being (Carver
et al., 2010). Previous studies have 23
shown little variability in the level of
optimism across cultures, although 21
some differences seem to be
associated with the individualistic– 19
collectivistic dimension of cultures
17
(Jeglic et al., 2016). While Asian Optimism
and Asian American individuals 15 Pessimism
report similar levels of optimism Asian White
compared to White Americans, they FIGURE 16.22
report higher levels of pessimism
at the same time (Chang, 1996; Optimism and Pessimism Vary Across Cultures. White and Asian college students demonstrate
see ● Figure 16.22). Comparisons similar levels of optimism, but the Asian students show much higher levels of pessimism. These
between American and Ghanaian perspectives appear to have different implications for White and Asian students, however. High levels
college students found that the of pessimism were associated with better problem-solving performance in Asian students, but worse
Ghanaian students demonstrated performance in White students.
higher optimism and hope, while Source: E. C. Chang (1996). “Cultural Differences in Optimism, Pessimism, and Coping: Predictors of Subsequent
expressing less suicidal ideation Adjustment in Asian American and Caucasian American College Students,” Journal of Counseling Psychology, 43(1),
(Eshun, 1999). While more research 113—123. doi: 10.1037/0022-0167.43.1.113

674 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Happiness and Marriage Among interpersonal relationships, the institution of

marriage is particularly likely to contribute to happiness (see ● Figure 16.23). In a study
of more than 42,000 Americans beginning in 1972, 40% of married adults, but only
22% of never-married adults, report that they are “very happy” (Davis et al., 2006). Also, 18%
of divorced adults report being “very happy,” and remarriage increases happiness only in
a minority of cases. In a large-scale study that followed 13,000 adults for five years, people
who remained married experienced higher well-being than those who separated or divorced
(Waite et al., 2009; Waite & Gallagher, 2001). Among the benefits of marriage are reduced
infidelity, longer-lasting relationships, and longer life (Waite & Gallagher, 2001).
People who are married and living with their spouse enjoy a significantly lower death rate
than those who are unmarried. People who have never married, particularly males, experience
an especially high risk for premature death (Kaplan & Kronick, 2006). Married individuals
have lower cortisol levels compared to never married or previously married individuals (Chin
et al., 2017). As we observed earlier, cortisol release is correlated with stress.
Why would marriage make people happy? One possibility is that the relationship be-
tween marriage and happiness is a false one because of the likelihood that happy people
produce happy marriages instead of the other way around. However, careful research that
controls for premarital happiness does not support this hypothesis (Horwitz et al., 1997;
Grover & Helliwell, 2019). Regardless of how happy people are before marrying, on average
being married makes them happier. The positive effects of marriage on happiness
are about twice as large for couples who consider their spouse to be their best friend
(Grover & Helliwell, 2019). If you’re thinking of cases that you know in which mar-
Mean subjective well-being score
ried couples are miserable, time together seems to help. Among the unhappiest 5.8
couples, only 12% report being unhappy five years later, and 70% of the formerly 5.6
unhappy partners report being “very” or “quite” happy (Horwitz et al., 1997).
5.4
What is the source of this marital happiness? Traditionally, psychologists have
suggested that marital happiness results from the perceptions that one partner has 5.2
of the other. But more sophisticated analyses have shown that the factors associated 5.0
with marital happiness are more complicated (Luo et al. 2010). While it’s true that
perceptions of your partner influence how satisfied you are in a relationship (“I’m 4.8
with a great person”), it is also true that your overall satisfaction with the relation- 4.6
ship affects how you see your partner (“I’m happy, so I must be with a great person”). Single Dating Cohabiting Married
Relationship status
Then, what is the source of that satisfaction? A major factor in satisfaction with a
relationship is how you think your partner sees you (“My partner thinks I’m terrific, FIGURE 16.23
which makes me happy, and because I’m happy, I must be with a great person”).
Relationship Status and
Happiness and Wealth Another common-sense notion about happiness is that wealth Happiness. Many studies have
can make you happy. After all, we see frequent images of ecstatic lottery winners and smiling pointed to a strong relationship
sports superstars who have signed megabuck contracts. At both national and individual levels, between being married and subjective
being poor does appear to be correlated with being unhappy. However, once basic needs are well-being.
met, additional money does not guarantee happiness (see ● Figure 16.24). Interviews with Source: Adapted from J. P. M. Soons et al.
the 100 richest people in the United States indicated that they were only slightly happier than (2009). “The Long-Term Consequences
average (Diener et al., 1985). In addition, how people use their wealth can influence happiness. of Relationship Formation for Subjective
People who are less materialistic report being happier than people who are materialistic Well-Being,” Journal of Marriage and
(Tsang et al., 2014). People who spend money on experiences rather than materialistic goods Family, 71(5), 1254–1270. doi:10.1111/j.1741
experience improved well-being (Howell & Hill, 2009). -3737.2009.00667.x

WHAT IS POSITIVE PSYCHOLOGY? 675

Percentage of after-tax disposable personal

220
Wealth and Happiness. When

income (adjusted for inflation)

adjusted for inflation, Americans’ 200
after-tax disposable income grew
dramatically between 1946 and 180
1989, but measures of subjective 160
well-being remained flat. Increases
in income above a certain point 140
where basic needs can be met
tend to have mild, if any, long-term 120
impact on happiness.
100
Source: Adapted from E. Diener Income
et al. (1999). “Subjective 80 Subjective well-being
Well-Being: Three Decades of 47 52 57 64 66 71 73 75 78 82 84 86 88
1946 48 56 63 65 70 72 74 76 80 83 85 87 1989
Progress,” Psychological Bulletin,
Year
125(2), Figure 1. doi:10.1037/0033
-2909.125.2.276
Now we return to the idea that happiness occurs because of changing circumstances.
Perhaps the 100 richest Americans had simply adapted to their wealthy lifestyles. What about
people who suddenly become wealthy? The Camelot Group, which manages the national lot-
tery in the United Kingdom, reported that winning the lottery did have an impact on happi-
ness (Camelot Group, 2004). According to these findings, 65% of winners reported that they

THINKING SCIENTIFICALLY

Does Parenting Increase Happiness?

IN CHAPTER 7, we noted that an update marriages has less to do today with ing roles might make the new mother less
of Abraham Maslow’s hierarchy of needs financial survival or raising families than it happy with her circumstances (Dew &
pyramid featured parenting at the top to has with meeting partners’ emotional needs Wilcox, 2011).
represent this role’s importance from an (Dew & Wilcox, 2011). A major predictor Other researchers disagree. In another
evolutionary perspective (Kenrick et al., 2010). of marital satisfaction is time spent with a set of studies, parents evaluated their lives
If parenting is such an important motivation, partner, so where does that need fit with more positively than nonparents, felt better
do we feel happier when we fulfill it? the challenges of meeting the demands of a than nonparents from day to day, and found
family of young children? more satisfaction in caring for their children
WHAT AM I BEING ASKED TO Some research suggests that parenting than in other daily activities (Nelson et al.,
BELIEVE OR ACCEPT? results in reductions in marital satisfac- 2013, 2014). Parenting contributed to more
We are being asked to believe that being tion, which increase with the number of positive emotions on a daily basis and to
a parent makes people happier than they children (Twenge et al., 2003). This result is the sense of having a meaningful life—
would be if they were not parents. most pronounced among younger, higher- concepts consistent with the approach
income mothers of infants. Even in the to happiness held by some positive
WHAT EVIDENCE SUPPORTS THIS 21st century, the arrival of the first child psychologists.
POSITION? has a tendency to “traditionalize” the gen-
der roles of the new parents. Fathers begin ARE THERE OTHER WAYS THIS EVI-
Parenting in the 21st century probably
to take on more of the income-earning re- DENCE COULD BE INTERPRETED?
shares little similarity with the way
parenting was for our hunter–gatherer sponsibilities and mothers take on more of What might be the source of these
ancestors. The goal of contemporary the childcare and housework. Her chang- conflicting findings? One possibility is

676 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

John Tlumacki/The Boston Globe/Getty Images

The correlation between happiness and income has been assumed to
reflect the effect of money on happiness. However, longitudinal research
suggests that happiness may influence income (Cacioppo et al., 2008). As
in prior studies, happiness and income in middle-age and older adults
were correlated. However, happiness predicted bigger increases in income,
whereas higher income did not predict increases in happiness. Happy peo-
ple form better relationships, and these better relationships contribute to
larger increases in income, perhaps because of improved job performance,
better performance reviews and promotions, and better networking oppor-
tunities that lead in financially productive directions. Lottery winners experience an
The World Happiness Report, now in its eighth edition, looks at measures of happiness in increase in happiness, but they tend
over 150 countries (Helliwell et al., 2020). The variables used to assess happiness did include to be cautious about changing their
financial measures, but also measures of positive and negative emotions, social support, free- lifestyles. Most continue working and
dom to make life choices, generosity, health, and perceptions of corruption. Based on these attempt to maintain as normal a life as
measures, Scandinavian countries appear to be very happy places, occupying the five top slots, possible.
including number 1 (Finland). The United States, ranked number 1 in the world in gross do-
mestic product (GDP), is ranked number 18 in happiness. To be fair, the differences in happi-
ness among the top 20 countries are quite slim. At the bottom of the list are Zimbabwe, South
Sudan, and coming in last, Afghanistan (see ● Figure 16.25).

that parents as a group are highly diverse. also require some investigation of cohort effects insights from the different
Parenting under some circumstances can (see Chapter 2). perspectives of psychology
be more stressful than others. Young, (biological, cognitive, developmental,
unpartnered parents, not too surprisingly, WHAT ARE THE MOST REASONABLE social, and clinical) are needed
reported less happiness and satisfaction CONCLUSIONS? to completely understand the
than their nonparent age peers, yet they William James’s concept of functionalism, circumstances leading to a happy
still indicated that they felt their lives were described in Chapter 1, would predict that parenting experience for any one
meaningful (Nelson et al., 2013). Parents may becoming a parent is likely to be highly individual. ■
experience differing levels of support from motivating for many people. Nonetheless,
governments, employers, communities, and
families. Globally, institutional policies such
as paid time off and child-care subsidies for
parents are associated with less unhappiness
Evolutionary theories view
on the part of parents (Glass et al., 2016).
parenting as an important
motivation for human behavior,
WHAT OTHER EVIDENCE WOULD
yet contemporary psychologists
I NEED TO EVALUATE THESE
debate whether parents are
Mint Images Limited/Alamy Stock Photo

ALTERNATIVES?
truly happier than nonparents.
It is likely that we need further research
outlining the characteristics, perhaps at the
individual, family, and community levels, that
predict happiness during parenting. This would

WHAT IS POSITIVE PSYCHOLOGY? 677

Can We Increase Happiness? Some psychologists have moved past research

identifying the causes and correlates of happiness to make recommendations for how to
increase individual happiness. Among the steps recommended for improving happiness are
practicing time management, exercising regularly, sleeping well, finding interesting work to do,
nurturing close relationships, and following a chosen religious faith (Myers, 1993).
Methods for increasing happiness can be tailored to three types of happiness: the pleasant
life (hedonics) and two sources of eudaimonic happiness—the good life and the meaningful
life (Seligman & Csikszentmihalyi, 2000; Seligman, 2002). The pleasant life describes the plea-
sures that we enjoy from moment to moment. Enjoying a great meal or a beautiful sunset en-
hances our daily experiences. The good life occurs when we are maximizing our strengths in
our work, hobbies, and other activities, making time subjectively slow down. The meaningful
life describes our ability to focus away from the self to serve others or participate in something
more permanent and larger than ourselves.
In general, people taking tests designed to assess their involvement with these three
types of happiness are happiest overall if either their good life or their meaningful life score
is high. If the score in one of these aspects is high, then a high score on the pleasant life can
raise overall happiness, like having a cherry on top of an already-delicious ice cream sundae.
Unfortunately, those who score highest on the pleasant life, without comparable scoring in
either the good or the meaningful life category or both, tend to be less happy (Seligman, 2002).
Two reasons help explain why isolated pleasant life scores fail to greatly affect overall hap-
piness. First, these scores tend to be highly heritable, which means that you can’t do much to
improve your sense of pleasure. Some people seem to respond more intensely than others to
pleasurable experiences. Second, these feelings do not last long and habituate quickly. Think
about the last time you had a delicious dessert. The first few bites are fantastic, but the last
ones are usually less so. A short time later, you might have forgotten how delicious the dessert
even was.

678 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

BlueOrange Studio/[Link]
your strengths and find ways to use them in your important work and
hobby activities. During activities that contribute to the good life, people
experience flow, in which they are absorbed in their current activity, usu-
ally related to work, problem solving, or creativity (Csikszentmihalyi, 1990,
1996). The word flow was chosen to describe this experience on the basis
of interviews in which people spontaneously used the metaphor to explain
their own experiences. These experiences may qualify as altered states of
consciousness and are usually perceived as highly positive. Time appears Researchers studying happiness identify
to stand still for people who are immersed in flow. three types. The pleasant life consists
People who do not play video games are often astonished by the nearly compulsive at- of pleasures, like ice cream, that are
tractiveness of the activity for those who do play. However, video games meet many of the enjoyed from moment to moment.
criteria for a flow experience (Csikszentmihalyi, 1990). The games have clear goals (reaching The good life features “flow” and a
the next level or beating a dungeon boss), they provide the opportunity to focus, they encour- sense that time is standing still. The
age a merging of action and awareness (as opposed to self-consciousness), and players gener- meaningful life describes the positive
ally experience a distortion of subjective time. In addition, games provide instant and precise emotions obtained by helping others.
feedback (you succeed or not), a balance between ability and difficulty (gamers reject games
that are either too easy or too challenging), and a sense of personal control (you’re the one
making the moves). Finally, gaming, like other flow activities, is intrinsically reinforcing. Many flow A state characterized by complete
a parent has diabolically used access to gaming as a reinforcer for other desired behaviors, absorption in a current activity, such as
work, problem solving, or creativity.
such as chores or homework. It is likely that video games, at least for some people, tap into a
predisposition to find activities that meet these flow criteria to be highly reinforcing.
The meaningful life can take multiple forms and provides numerous opportunities to
boost happiness. As we’ve already seen, many people find meaningfulness within religious
practice, but that is not the only approach that works. People who perform
acts of kindness toward others experience a boost in well-being (Layous et We are not suggesting that happiness can be
al., 2012). Volunteering for a cause that is close to your heart not only im- found by spending all your time playing video
proves well-being but might also reduce feelings of depression (Jenkinson games; instead, we recommend that you seek this
et al., 2013). Spending money on other people results in increased happiness type of flow in the work and hobbies that you
(Dunn et al., 2014). Reminding us of the complexity of many psychological
enjoy.
processes, we find that a strong personal identity, or the expression of an
authentic self, gives people a sense of meaningfulness, but does not always
correlate with happiness (Baumeister et al., 2013).

According to Mihaly Csikszentmihalyi,

video games can be compelling because
they meet many of the criteria required
of a flow-inducing experience, such as
clear goals, the opportunity to focus, the
merging of action and awareness, and the
aslysun/[Link]

experience of distortion of time for the

player. The popularity of team e-sports
suggests that even watching others play can
be reinforcing.

WHAT IS POSITIVE PSYCHOLOGY? 679

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Positive Traits
In an effort to further understand the sources of well-being, positive psychologists have built
upon the trait theories discussed in Chapter 12. Among the traits that contribute to well-being
are hope, resilience, spirituality, and gratitude.
Hope refers to an expectation that your goals will be met in the future. You are probably
hopeful that you will complete your college education and find a good job. The trait of hope is
tightly linked to feelings of optimism. Hope in turn is determined by motivation and planning
(Snyder, 1994). Your expectations for a college degree are based on beliefs that you can achieve
a degree through hard work and that following your plans will give you the results that you
desire. Being a hopeful person provides a number of benefits to well-being. Hopeful people
can withstand more pain and stress because they believe that the future will be better
(Snyder et al., 2005). Hopeful people are more capable problem solvers because they are likely
to consider alternative pathways for meeting their goals instead of giving up at the first ob-
stacle. Finally, hopeful people usually enjoy strong social networks because other people find
hope attractive (Snyder et al., 2002).
We discussed resilience in an earlier section of this chapter. Resilience not only serves as
a buffer for stress but can lead to growth following a traumatic experience (Davis & Nolen-
Hoeksema, 2009). None of us likes being traumatized, but when we look back on difficult
episodes of our lives, we often feel like a traumatic experience led to growth and improved
strength. Among the positive changes associated with posttraumatic growth are perceptions
of the self as a survivor rather than a victim, increased self-confidence and self-efficacy, and
greater appreciation for the fragile nature of life. Many people respond to prior trauma with
increased compassion for others, closer bonds with family and friends, and enhanced willing-
ness to share emotions. Trauma also can lead people to reduce the value that they place on
material aspects of life, such as money and possessions, while increasing their sense of what
is truly meaningful about life. A resilience program developed by Martin Seligman and his
colleagues for the U.S. Army resulted in lower rates among deployed soldiers of posttrau-
matic stress disorder, anxiety, and depression, and reduced the rate of substance abuse by half
(Harms et al., 2013).
As we mentioned in a previous section, the experience of a meaningful life enhances
well-being and happiness. Although finding meaning simply encompasses recognizing
things that are bigger than one’s personal existence, some people achieve meaningfulness
through spirituality and religious practice (Myers, 1993). Religious beliefs and practice
also have been associated with a long list of health benefits because most major world
religions promote healthier lifestyles (Emmons et al., 2008). Many people find religious
prohibitions to be a helpful tool for resisting the temptation to engage in risky, unhealthy
behaviors. Although participation in religious or spiritual ac-
tivities is a behavior, it is strongly predicted by a person’s need
for deeper meaning, or trait spirituality (Pargament & Krumrei,
2009).
The idea of individual traits related to well-being has been
extended to include shared social values and experiences, result-
ing in values or virtues. A value can be defined as “an enduring
belief that a specific mode of conduct or end state of existence is
personally or socially preferable to an opposite or converse mode
of conduct or end state of existence” (Rokeach, 1968–1969, p. 5).
The voluntary nature of values is stressed by many psychologists,
including Gordon Allport, who defines a value as “a belief upon
which a man acts by preference” (Allport, 1961, p. 454). One effort
to identify values combined those listed by major world religions
Masterfile

and such organizations as the Boy Scouts, Rotary International,

and Alcoholics Anonymous with data from major personality
tests (Franken, 2002). The resulting values are social, cheerful,
Hopeful people are capable problem peaceful, tolerant, kind, generous, trusting, assertive, self-control, self-confidence, communica-
solvers who believe that their goals tion, leading, and autonomous. Additional lists have added some interesting items, such as
can be met in the future. awe and forgiving (Peterson & Seligman, 2004).

680 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

ZUMA Press Inc/Alamy Stock Photo

addition, explosiveness, or a propensity to violence, was negatively cor-
related with a person’s values ratings. As ratings on the values increased,
a person’s potential for violent behavior decreased. People with high
values scores were the least likely to experience alcohol or tobacco ad-
dictions or to experience anxiety and depression.

Positive Institutions Nobody wants to experience trauma,

but some survivors report experiencing
Positive psychologists study the roles of institutions such as workplaces, schools, and families
posttraumatic growth. Mike Atherton
in promoting well-being in the community. What characteristics should we strive for in our
lost both legs and his left arm in a
institutions to raise the likelihood that members of the community will lead satisfying lives?
boating accident, but he has returned
Positive institutions share several features (Peterson, 2006). They share a purpose in the form
to performing with the Tampa Bay
of institutional goals. Their rules and consequences are fair. They feature a reciprocal caring by
Water Ski Show Team and reports
the institution for its members and by the members for the institution. A positive institution
feeling optimistic about his future.
provides safety for its members and treats them with respect.
One of your goals in completing a college education is probably related to the type of work
you’ll be able to do as a result. Your future working conditions will have significant influence on
your overall well-being. Positive psychologists have identified three ways that people feel about

Rotary International
their work (Wrzesniewski et al., 1997). Some people just have jobs. A job is viewed as a way of
supporting your family, and workers with jobs emphasize this role without asking more of their
work life. A career not only pays the bills but also fulfills workers’ needs for status and achievement.
Finally, a calling satisfies both personal and cooperative goals. The worker pays the bills while gain-
ing both personal achievement and a sense of contributing to the community. When workers view
Organizations such as Rotary
their employment as a calling, they are less concerned with work conditions, salary, benefits, and
International often reinforce the
status. Positive workplaces facilitate the workers’ abilities to meet their personal work-related goals.
values of their members, such as
Schools from kindergarten through college are particularly important to the health and
“service above self.”
future of a community. In a manner similar to psychology’s emphasis on disorders, most of
Source: Service Above Self and the
the research in education has focused on what goes wrong in schools rather than on what
Service Above Self logo are trademarks
schools are doing well. Positive schools promote growth and produce a sense of satisfaction
of Rotary International and used herein
with permission.

Forbes America’s Best Employers

1. Trader Joe’s 6. Google
Forbes rankings of “best employers”
2. Southwest Airlines 7. Stanford University
for 2019 cover a wide variety of
3. Lilly 8. SC Johnson industries. Positive psychologists
4. Costco Wholesale 9. Mayo Clinic attempt to find common features of
organizations that make them positive
5. Garmin 10. Michelin Group institutions.

WHAT IS POSITIVE PSYCHOLOGY? 681

Positive Psychology and the Future

Positive psychology is not without its critics. Among the weaknesses seen in positive psychol-
ogy are its unintended negative effects on people who face medical and psychological chal-
lenges (Held, 2004). Although research indicates that optimism and health are linked, this
finding might give sick people the unfortunate impression that all they have to do to cure
their illness is to maintain a positive attitude. A second criticism is related to the integration
theme that we have featured in this textbook. Positive strengths are valuable, but they are best
studied within the entire context of individuals interacting in environments. Positive and
negative emotions can coexist, and we cannot fully understand one type of experience without
considering the other (Cacioppo et al., 2011).
It is unlikely that psychology will ever abandon its goal of helping troubled people feel
better, but positive psychology’s emphasis on what goes right is also illuminating. We do not
know at this time whether the label of positive psychology will drop out of favor, like Wilhelm
Wundt’s structuralism, or enjoy the fate of William James’s functionalism by becoming so
integrated into mainstream psychology that a label is no longer necessary. By applying the
same evidence-based criteria that we have described for evaluating interventions for “nega-
tive” behaviors to interventions based on positive psychology, we will figure out the role that
positive psychology should play in our continued search for understanding the human mind.

Interpersonal Relationships
The Health Psychology Perspective
HOW DO INVESTMENT AND EXPERIENCES OF GRATITUDE AFFECT
RELATIONSHIPS?
WE HAVE STUDIED RELATIONSHIPS from the vantage points of 15 psychological per-
spectives so far in this textbook, and we end the journey with an analysis of the role of a posi-
tive emotion—gratitude—on relationship building.
Psychologists traditionally have focused on how an individual invests in relationships and
report that individuals’ perceptions of how much they have already invested (time, energy, and
other resources) influence how committed they feel. However, researchers know relatively
little about how our perceptions of our partner’s investment in the relationship influence our
commitment.
When a partner invests in a relationship, the typical response is the experience of the posi-
Matthias Tunger/Corbis

tive emotion of gratitude. Gratitude includes the feelings of thankfulness and appreciation felt
for the partner, which in turn affects the perception of who the partner is as a person (Joel et
al., 2013). When people experience gratitude for a partner, it stimulates further commitment.
The amount of commitment that an individual experiences is linked to the perceived invest-
ment in the relationship on the part of the partner.
What types of investment promote more gratitude, and through those feelings, greater
commitment? You might guess that financial investments would be important, but research It’s often the little things that people
has shown that intangible investments, like emotional involvement, have a greater impact on do for their partners that result in
commitment (Goodfriend & Agnew, 2008). This is reminiscent of the finding discussed earlier gratitude and a stronger commitment
that it is not wealth that makes us happy, but rather our social connectivity. ■ to the relationship.

682 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Disruptions in normal functioning

trauma, some individuals experience short not been thoroughly
term and less intense distress. Others investigated, but Chronic
recover quickly but then experience a cohesion, adaptability,

Mild moderate severe

Delayed
decrease in their ability to cope. Finally, communication, and
some people do not experience much financial management
disruption at all (see ● Figure 16.26; appear to contribute to
Bonanno, 2004). It is this latter group that family-level resilience.
displays resilience. Prior research shows that Resilient communities
this is not a small group. Following most feature higher social
types of trauma, the resilient group makes cohesion, lower
up about two-thirds of those affected (Chen crime rates, and less Recovery
& Bonanno, 2020). disaster exposure.
We are still too close to the ongoing Socioeconomic status Resilience
COVID-19 pandemic to be able to make firm and access to health Event 1 year 2 year
conclusions about how many people remain care are essential
resilient, but we can use past pandemics to variables in community FIGURE 16.26
make some educated predictions. The 2003 resilience. It is likely
severe acute respiratory syndrome (SARS) that individual, family, Posttraumatic Responses Are Diverse. Following a traumatic
epidemic in Hong Kong can provide insight. and community experience, people respond in one of four different ways. Some
SARS was more lethal than COVID-19, killing characteristics interact may experience chronic distress (blue line), potentially leading
14% to 15% of infected persons overall and in important ways to to a diagnosis of posttraumatic stress disorder (PTSD). A second
more than 50% of those over the age of 64 influence resilience. group gradually recovers functioning over time (green line). A
years with infections. Nonetheless, at least As we come to the third responds well initially but experiences more disruption later
half of the survivors demonstrated resilience end of our textbook on (orange line). Finally, resilience, which is the most frequent
(Chen & Bonnanno, 2020). and conclude this reaction, is characterized by relatively little disruption in ongoing
While resilience often occurs based exploration of how functioning (purple line).
on a variety of pre-existing factors, psychological science Source: G. A. Bonanno (2004). “Loss, Trauma, and Human Resilience:
including personality and other individual can address some of the Have We Underestimated the Human Capacity to Thrive After
differences, family context, and community big problems of the day, Extremely Aversive Events?” American Psychologist, 59(1), 20–28. doi:
characteristics, we can still take action to our hope is that your 10.1037/0003-066X.59.1.20

WHAT IS POSITIVE PSYCHOLOGY? 683

The good life Find ways to incorporate your key Choose an occupation that you truly
strengths into your activities. enjoy, not just one that pays the bills.

The meaningful life Focus on something bigger than Volunteer for a cause that’s important
yourself. to you.

Credits: Top row—BlueOrange Studio/[Link]; Second row—aslysun/[Link]; Bottom row—Rotary International.

KEY TERMS The Language of Psychological Science

Be sure that you can define these terms and use them correctly.

alarm reaction, p. 642 hypothalamic–pituitary–adrenal resistance, p. 642

biopsychosocial model, p. 660 (HPA) axis, p. 647 stress, p. 640
cortisol, p. 647 immune system, p. 650 stressor, p. 640
emotion-focused coping, p. 658 lymphocyte, p. 651 sympathetic adrenal–medullary
exhaustion, p. 642 optimism, p. 673 (SAM) system, p. 647
flow, p. 679 positive psychology, p. 672 tend and befriend, p. 649
general adaptation syndrome (GAS), problem-focused coping, p. 658 Type A personality, p. 651
p. 642 relationship-focused coping, p. 658 Type B personality, p. 651
health psychology, p. 660 resilience, p. 659

684 Chapter 16 THE HEALTHY MIND: STRESS AND COPING, HEALTH PSYCHOLOGY, AND POSITIVE PSYCHOLOGY

Common questions

A stress mindset, which involves viewing stress as either enhancing or debilitating, significantly influences how an individual perceives and manages stress. Those with a positive stress mindset may see stress as a challenge that can lead to growth and better performance, thereby enhancing coping abilities and reducing negative impacts .

Stress triggers the 'fight or flight' response through activation of the sympathetic division of the autonomic nervous system, escalating heart rate, blood pressure, and respiration, and redirecting blood flow from non-essential functions to muscles . This response is part of an adaptive process that prepares the body to deal with emergencies .

Effective coping strategies involve cognitive appraisal, which contribute to managing stress more effectively by helping individuals identify, assess, and confront stressors with the right resources . Managing stress can involve strategies such as reducing workloads or enhancing time-management skills. Ineffective coping, such as avoidance, tends to worsen stress impacts .

Stress functions as an adaptive response by mobilizing the body’s resources to enhance survival in dangerous situations. This is achieved through activation of the sympathetic division of the autonomic nervous system, leading to increased heart rate, blood pressure, and respiration, as well as the release of stored energy for physical exertion . The benefits of stress include improved motivation, performance under pressure, and increased empathy and prosocial behaviors . However, drawbacks can occur if the stress is chronic and unmanaged, potentially contributing to conditions like major depressive disorder (MDD) and PTSD .

Increased seafood consumption is associated with lower prevalence of bipolar disorder, as observed in countries with high seafood intake compared to those with less . Omega-3 fatty acids in seafood may contribute to healthier brain function and mood stabilization, suggesting a potential nutritional strategy for improving mental health outcomes .

Stress can enhance prosocial behaviors, increasing empathy and cooperation within social networks . While stress can promote social bonding, excessive stress without adequate coping mechanisms can lead to psychological disorders such as depression and PTSD . Thus, understanding stress's dual nature helps in designing interventions that leverage its beneficial aspects while mitigating harmful effects.

Behavior and lifestyle choices, such as smoking, significantly impact tobacco-related health issues. Smoking is the leading preventable cause of death, causing lung cancer, heart disease, and other serious conditions. Tobacco use also increases the likelihood of other substance dependencies and exposes non-smokers to secondhand smoke risks . Public health strategies encourage smoking cessation and healthier lifestyle choices to mitigate these effects .

Social-belonging interventions improve minority students' academic and health outcomes by reshaping their perceptions of 'fitting in.' For instance, African American students at Stanford University benefited significantly from such interventions, while White students did not show the same treatment-related differences possibly because they already frame belonging in positive ways . This highlights the role cognitive appraisal and social context play in intervention effectiveness.

Individual differences in genetic makeup and life experiences affect how stress is perceived and responded to. A malfunction in the feedback loop controlling cortisol can result in stress-related disorders, such as depression . Furthermore, interactions with developmental and social factors, like childhood maltreatment or social support networks, also influence stress perception and responses .

Lifestyle factors like obesity, smoking, lack of exercise, and poor nutrition are connected to major health conditions such as heart disease, cancer, and diabetes. Preventive behavior modifications like regular exercise, smoking cessation, and improved dietary choices significantly reduce these health risks . Psychological interventions promote these behavior changes by focusing on education and motivation for healthier lifestyles .

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