The Big Picture: Chapter Overview

With few exceptions, historically, physical illness was viewed in biological terms alone, not in terms of mental factors. Health psychology is a field of psychology that specializes in promoting and maintaining health and preventing and treating illness. As an interdisciplinary field, behavioral medicine focuses on developing and integrating behavioral and biomedical knowledge to promote health and reduce illness. Psychological and social factors play important roles in chronic illnesses.

One of the main areas of research in health psychology and behavioral medicine is the relationship between stress and illness. Stress is the response to circumstances and events that threaten us or tax our coping abilities. To understand stress we must consider personality, environmental, and social factors. Among the personality factors are behavior patterns, such as Type A and Type B. Type A behavior is a cluster of characteristics such as competitiveness, hostility, and impatience; Type B behavior refers to characteristics such as being calm and easygoing. The Type A behavior cluster was thought by many psychologists to be related to the incidence of heart disease; however, it is hostility that is most associated with coronary disease. Another personality factor is hardiness, which refers to a personality style characterized by a sense of commitment, control, and a perception of problems as being challenges. Having a sense of personal control reduces stress. Environmental factors that can produce stress include life events and daily hassles. Another environmental factor, conflict, occurs when we must decide between options and can be of these types: approach/approach conflict, avoidance/avoidance conflict, and approach/avoidance conflict. Overload occurs when stimuli become so intense that we can no longer cope with them; this can lead to burnout. People experience work-related stress when their jobs don't meet their expectations. Sociocultural factors include acculturation stress and poverty. Acculturation stress is the negative contact between two distinct cultural groups. People can adapt to acculturation in four ways: assimilation, integration, segregation, and marginalization. Marginalization and separation are the least adaptive responses to acculturation. Poverty can also cause considerable stress and is related to threatening and uncontrollable life events. Ethnic minority families are disproportionately among the poor.

According to Selye, the body's reaction to stress is called the general adaptation syndrome and consists of the alarm stage, the resistance stage, and the exhaustion stage. Selye also described eustress as the positive features of stress. The neuroendocrine-immune pathway describes the relationship between the endocrine system and immune system; cortisol can have a negative effect on the immune system. The sympathetic nervous system pathway describes how the release of hormones during the fight-or-flight response can be harmful over time. According to Lazarus, how we respond to stress depends on how we cognitively appraise and interpret events in our lives. As we interpret a situation, we go through primary appraisal and secondary appraisal.

The field that explores the relationship between psychological factors, the nervous system, and the immune system is called psychoneuroimmunology. The immune system is similar to the nervous system in the following characteristics: both have a way of receiving information from the environment, both can carry out an appropriate response, and both engage in chemically mediated communication. Research supports the connection between the immune system and stress. Acute stressors can produce immunological changes. Chronic stressors are associated with a compromised immune system. Positive social circumstances and low stress are associated with increased ability to fight cancer. Chronic stress is associated with high blood pressure, heart disease and early death, taking up smoking, overeating, and avoiding exercise. The relationship between stress and cancer can be best understood by exploring how cancer treatment can negatively affect a person's quality of life, by recognizing that a diagnosis of cancer can cause some people to engage in damaging behaviors, and by studying the biological ways in which stress can contribute to compromising the immune system of people with cancer. Positive emotions have been associated with keeping colds at bay and overall facilitate the ability to cope with problems.

Coping refers to managing taxing circumstance, expending effort to solve life's problems, and seeking to master or reduce stress. In problem-focused coping, individuals squarely face their troubles and try to solve them. When we use emotion-focused coping, we respond to stress in an emotional manner, especially using defensive appraisal. Depending on the context, either approach may be adaptive. Cognitive restructuring refers to modifying the thoughts, ideas, and beliefs that maintain a person's problems. Self-talk is mental speech we use when we think, plan, or solve problems. Illusions are related to one's sense of self-esteem. The ideal overall orientation may be an illusion that is mildly inflated. Sometimes defensive pessimism may actually work best in handling stress; however, optimism is the best overall strategy. Self-efficacy is the belief that one can master a situation and produce positive outcomes; self-efficacy can improve an individual's mental health and ability to cope. Social support provides information and feedback from others that one is loved and cared for, esteemed and valued, and included in a network of communication and mutual obligations. The benefits of social support include tangible assistance, information, and emotional support. Assertive behavior illustrates how we can deal with conflict in social relationships. Stress management programs teach people how to appraise stressful events, how to develop skills for coping with stress, and how to put these skills into use in everyday life. Other ways to cope with stress include meditation, relaxation, and biofeedback. Multiple strategies for coping with stress work better than any one single strategy.

Exercise is one of the most effective ways of promoting health. Aerobic exercise, even to a moderate degree, can reduce the risk of heart attacks and provide positive benefits for self-concept, anxiety, and depression. Proper nutrition is vital in maintaining good health. Many of us are unhealthy eaters. There is a link between fat intake and cancer. A sound diet includes fat, carbohydrates, protein, vitamins, minerals, and water. Smoking has significant effects on health. Although the adverse consequences of smoking have been widely publicized, smoking is still widespread because it is addictive and reinforcing. Five methods have been developed to help smokers quit: nicotine substitutes, taking antidepressants, stimulus control, aversive conditioning, and going "cold turkey." Making healthy decisions with regard to sexuality is important. Making the correct decisions is dependent on having accurate knowledge about sex, contraception, STDs, and AIDS.