Chapter 12: Stress and Health Psychology
Chapter Review

Sources of Stress
Coping With Stress
How Stress Affects Health
Sources of Extreme Stress
The Well-Adjusted Person

We experience stress when we are faced with a tense or threatening situation that requires us to change or adapt our behavior. Adjustment refers to any attempt we make to cope with a stressful situation, balancing our needs and desires against the demands of the environment and the realistic possibilities available to us. How we adjust to the stresses in our lives affects our health; prolonged or severe stress can contribute to physical and psychological disorders. Health psychology is a subfield of psychology concerned with the relationship between psychological factors and physical health.

Some life-and-death situations, such as war and natural disasters, are inherently stressful. Even events that are usually viewed as positive, such as a wedding or a job promotion, may be stressful because they require change or adaptation.

Because most people have a strong desire to maintain order in their lives, any event that involves change will be experienced as stressful. The Social Readjustment Rating Scale (SRRS) developed by Holmes and Rahe measures how much stress a person has undergone in any given period by assigning point values to a series of life-changing events. An alternative measure of stress experienced by college students has been developed by Renner and Mackin.

Click here to view the College Life Stress Inventory table

Much stress comes from nonevents or hassles, defined as petty annoyances, irritations, and frustrations. Major events often trigger the little hassles that give rise to stress.

Pressure also contributes to stress. Pressure can derive from both internal and external forces; in either case, we feel forced to intensify our efforts or to perform at higher levels.

We feel frustrated when someone or something stands between us and our goal. Five basic sources of frustration are delays, lack of resources, losses, failure, and discrimination.

Conflict arises when we are faced with two or more incompatible demands, opportunities, needs, or goals. Kurt Lewin analyzed conflict in terms of approach and avoidance, and showed how these tendencies combine to characterize three basic types of conflict. Someone who is simultaneously attracted to two incompatible goals experiences an approach/approach conflict, in which the person must either make a choice between the two goals or opportunities or modify them so as to take some advantage of both goals. The reverse of this problem is avoidance/avoidance conflict, in which a person confronts two undesirable or threatening possibilities. People usually try to escape this kind of conflict or vacillate between the two possibilities. Also difficult to resolve is an approach/avoidance conflict, in which a person is both attracted to and repelled by the same goal or opportunity. People in this dilemma eventually reach a point where the tendency to approach equals the tendency to avoid and they vacillate until they finally make a decision or until the situation changes.

Click here to view the Types of Conflict table

Self-imposed Stress
Sometimes people subject themselves to stress by internalizing a set of irrational, self-defeating beliefs that add unnecessarily to the normal stresses of living.

Stress and Individual Differences
Some people perceive a particular situation as stressful, whereas others are able to take the same situation in stride. Stress-resistant people may share a trait called hardiness—a tendency to experience difficult demands as challenging rather than threatening. Those who feel they have some control over an event are far less susceptible to stress than those who feel powerless in the same situation.

People generally adjust to stress in one of two ways: Direct coping describes any action people take to change an uncomfortable situation; defensive coping denotes the various ways people convince themselves—through a form of self-deception—that they are not really threatened or do not really want something they cannot get.

Direct Coping
When we cope directly with a particular threat or conflict, we do it in one of three ways: confrontation, compromise, or withdrawal. Confronting a stressful situation may lead us to learn new skills, enlist other people's aid, try harder to reach our goal, or express anger. Compromise usually resolves a conflict by forcing us to settle for less than we originally sought. Sometimes the most effective way of coping with a stressful situation is to distance oneself from it, but the danger of withdrawal is that it may become a maladaptive habit.

Defensive Coping

Click here to view the Defense Mechanisms table

When a stressful situation arises and little can be done to deal with it directly, people often turn to defense mechanisms as a way of coping. Defense mechanisms are ways of deceiving ourselves, consciously or unconsciously, about the causes of stressful events, thus reducing conflict, frustration, pressure, and anxiety.

Denial is the refusal to acknowledge a painful or threatening reality. Repression is the blocking out of unacceptable thoughts or impulses from consciousness. When we cannot deny or repress a particular problem, we might resort to projection—that is, attributing our repressed motives or feelings to others, thereby locating the source of our conflict outside of ourselves. Identification is another form of defensive coping in which people take on the characteristics of a powerful person in order to gain a sense of control.

People under severe stress sometimes revert to childlike behavior, a kind of defensive coping called regression. Intellectualization is a defense mechanism whereby people emotionally distance themselves from a particularly disturbing situation. In reaction formation, a form of denial, people express with exaggerated intensity ideas and emotions that are the opposite of their own. Through displacement, repressed motives and feelings are redirected from their original objects to substitute objects. Sublimation involves transforming repressed emotions into more socially accepted forms.

Socioeconomic and Gender Differences in Coping with Stress
People living in poverty tend to experience greater stress than other people, primarily because the environments in which they live are generally more threatening and they have fewer resources to draw on in coping with that stress. As a result, they experience more health problems than do people in better financial circumstances. Contrary to popular belief, women and men seem to be equally affected by stress, although women are more likely than men to experience stress when their marriage or other long-term relationships are deeply troubled. This appears to be a sign of greater commitment to the relationship rather than an indication of greater vulnerability to stress.


Physiologist Hans Selye identified three stages of reacting to physical and psychological stress that he called the general adaptation syndrome (GAS). In Stage 1, alarm reaction, the body recognizes that is must fight off some physical or psychological danger and acts accordingly. If neither direct nor defensive coping mechanisms succeed in reducing the stress, we move to Stage 2 of adaptation. During this resistance stage, physical symptoms of strain appear as we intensify our efforts to cope both directly and defensively. If these attempts to regain psychological equilibrium fail, psychological disorganization rages out of control until exhaustion, Stage 3 is reached. In this phase, we use increasingly ineffective defense mechanisms to bring the stress under control. Some people lose touch with reality, while others show signs of "burnout."

Stress and Heart Disease
Stress is known to be an important factor in the development of coronary heart disease (CHD). Type A behavior pattern, a set of characteristics that includes hostility, urgency, competitiveness, and striving, has been linked to a greater likelihood of CHD. Stress-reduction programs can slow, and sometimes arrest, the progress of CHD.

Stress and the Immune System
Studies in psychoneuroimmunology have shown that stress can suppress the functioning of the immune system, increasing one's susceptibility to the common cold as well as to cancer in situations of prolonged exposure to stress. Stress-reduction techniques can help cancer patients cope.

Social Support and Health
People with strong social support systems enjoy better health and in some cases increased longevity. Some evidence suggests that social support may directly affect immune system functioning. It may be that people with high levels of social support more frequently engage in healthier behaviors, such as better diets and more physical exercise.

Extreme stress derives from a number of sources, including unemployment, divorce and separation, bereavement, combat, and natural disasters. People try to cope with these intense, life-altering events in various ways; most resort to defense mechanisms at one or more stages to allow themselves time to gather their energies for more direct coping efforts later on.

Post-traumatic Stress Disorder

Extreme trauma may result in post-traumatic stress disorder (PTSD), a disabling emotional disorder whose symptoms include anxiety, sleeplessness, and nightmares. Combat veterans and people with a history of emotional problems are especially vulnerable to PTSD.

What constitutes good adjustment? Some psychologists believe that well-adjusted people live according to social norms, having learned to control socially forbidden impulses and limit their goals to those that society allows. Barron, on the other hand, argues that the refusal to adjust to social norms is the mark of a healthy character. He suggests that well-adjusted people accept and enjoy challenges because they are confident of their ability to deal with problems in a realistic and mature way. Still other psychologists believe that well-adjusted people are those who have learned to balance conformity and nonconformity, self-control and spontaneity. Finally, some psychologists use specific criteria to evaluate a person's ability to adjust, such as how well the adjustment solves the problem and satisfies both personal needs and the needs of others.

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