2022年普通心理學(xué)之心理壓力與健康

1、Chapter 12Stress, coping & health疾病/健康病源學(xué)的轉(zhuǎn)變Contagious diseases(傳染?。河蓚魅驹匆鸬募膊?，如天花、傷寒、瘧疾、白喉、黃熱病、霍亂、腦灰質(zhì)炎、肺結(jié)合等20世紀(jì)之前的致命疾??；與nutrition, public hygiene, sanitation and medical treatment等有密切關(guān)系.Chronic diseases(慢性病): heart disease、 cancer、 stroke(中風(fēng)）等，生活壓力（應(yīng)激）、生活方式等因素是慢性病形成的主要原因。心身?。ú棠艿龋?985)心理因素在疾病的發(fā)生和病程演

2、變中起主導(dǎo)作用的軀體疾病。 例如情緒，通過植物神經(jīng)、內(nèi)分泌、肌肉骨骼系統(tǒng)、皮膚及免疫系統(tǒng)等受累而引起的癥狀群及疾病。病源分析（蔡能等，1985）身心分離觀點(diǎn)（傳統(tǒng)醫(yī)學(xué)觀點(diǎn)）：細(xì)胞疾病-組織結(jié)構(gòu)改變-功能障礙；身心統(tǒng)一觀點(diǎn)：情緒（心理）因素-功能障礙（？）-細(xì)胞疾病-組織結(jié)構(gòu)改變。Health psychologyHealth psychologyDiscovery of causation, prevention, and treatment（病因、預(yù)防及治療）Health promotion and maintenance（健康的促進(jìn)和保持）Bio-psychosocial model（生物

3、心理社會模型）:身體疾病由生物、心理及社會文化等因素相互作用引起。Nature of stressDefination of stress（應(yīng)激、緊張）Stressors(應(yīng)激源): events or circumstance(what?)Threaten or perceived threaten ones well-being: (why?)Cognitive appraisal： what affect appraisal？ Need to coping: how ?Frustration Frustration（挫折、打擊） -blocked goal（與目標(biāo)不一致） -Traffi

4、c jams -failure -loss;情緒：憤怒、恐懼、悲傷；心境：抑郁、焦慮；生理：血壓（Novaco,etal. 1990)；Conflicttwo or more incompatible motivations沖突的三種類型（Lewin,and Miller(1944)Approach-approach(雙趨性沖突）：魚與熊掌；Avoidance-avoidance（雙避沖突）： approach-avoidance（趨避沖突）：進(jìn)退兩難、猶豫不決、舉棋不定；Neal Miller(1944)的實(shí)驗(yàn)：趨（食物+電擊）避（無食物+無電擊）沖突；-Laura King and Rob

5、ert Emmons(1991): 以問卷調(diào)查內(nèi)心沖突與焦慮、抑郁、及生理癥狀的關(guān)系；conflictsconflictsChange:have to change Two issues:What changes led to stress? Degree ?What consequence? Holmes and Rahe: Social Readjustment Rating Scale(SRRS)耗費(fèi)更多的能量。肺結(jié)核的心理因素調(diào)查：結(jié)婚、晉升、有小孩等；消極刺激；生活變化大，生理疾病和心理問題也多一些（Creed, 1993)；-疾病與生活應(yīng)激的相關(guān)研究；Social readjust

6、ment rating scaleDeath of spouse 100Divorce 73Jail term 63Marriage 50Fired at work 47 Retirement 45Change in school 20Vacation 15學(xué)生壓力量表(Holmes and Raber)Pressure: expectation to behave in certain waysPerformance pressureSalespeopleProfessorActorStudentConform pressure（相符）。來源于關(guān)系期望的壓力（工作、學(xué)校、家庭、朋友等）；與自

7、我期望有關(guān)（idea self & real self);壓力與心理問題、生理疾病。國內(nèi)研究戀愛婚姻與家庭內(nèi)部問題；戀愛婚姻；子女與父母關(guān)系；家庭關(guān)系變遷；學(xué)校與職業(yè)場所的問題；失學(xué)；失業(yè)；社會生活變化與個(gè)人特殊遭遇災(zāi)難性事件；生活事件量表Responding to stressEmotional respondingPhysiological respondingBehavioral respondingFigure 13.4Overview of the stress process.A potentially stressful event, such as a major exam,

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

9、pecific emotion( Smith and Lazarus, 1991) Self blame自責(zé)-Guilt內(nèi)疚；Helplessness無助-sadness悲傷；Common emotional response:annoyance(煩惱）, anger, and rage; apprehension（憂慮）； anxiety（焦慮）,and fear;dejection（沮喪）, sadness and grief（悲痛）； Emotional responsesCasper,etal.(1987)的研究被試：96女性，時(shí)間28天任務(wù)：報(bào)告她們每天生活中緊張事件與心情；結(jié)果：s

10、tress led to negative mood; Emotional response to stress研究： 253 Care-giving partners of men with AIDs coping pattern（Folkman，1997)存在一定的正情緒；Positive emotions: interest and joy;Promote creativity and flexibility;加速信息加工過程；減弱不良的生理反應(yīng)；情緒反應(yīng)的作用/功能？ Effects of emotional arousalEmotional arousal and performan

11、ce(成績/績效）The inverted-U-hypothesis（倒U曲線） -簡單任務(wù)需要較高喚醒水平； -中等難度任務(wù)在中等喚醒狀態(tài)下成績最好； -復(fù)雜任務(wù)在較低喚醒狀態(tài)下才有較好成績。情緒與認(rèn)知關(guān)系；Figure 13.5Arousal and performance. Graphs of the relationship between emotional arousal and task performance tend to resemble an inverted U, as increased arousal is associated with improved perf

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

13、 of arousal.Physiological ResponsesFight-or-flight response。W. Cannon(1932):cats與dogs的實(shí)驗(yàn)；result:increased in breathing and heart rate and decreased in digestive processes?，F(xiàn)代生活與應(yīng)激的生理反應(yīng)；Responding to Stress PhysiologicallyHans Selye：General Adaptation SyndromePhysical and psychological stress: cold, h

14、eat, pain, mild shock,restraint, et. Al.Stressful response: nonspecific reactions.General adaptation syndrome:Alarm（警覺）: fight or flight response,Resistance（抵抗、堅(jiān)持）: prolonged stress, Exhaustion（疲乏，衰竭）: disease of adaptation(適應(yīng)疾?。?； 一般適應(yīng)癥候群和慢性應(yīng)激長期壓力帶來的生理反應(yīng)是什么?一般適應(yīng)癥候群 報(bào)警階段 抵抗期 疲憊期心身失調(diào) 一般適應(yīng)癥候群的三個(gè)階段Brain

15、-body pathways（Felker & Hubbard, 1998)Pathway(I): Stress-hypothalamus(下丘腦）-ANS-adrenal medulla(腎上腺髓質(zhì)）-catechizations(兒茶酚胺）-增強(qiáng)活動（心血管、呼吸、運(yùn)動系統(tǒng)激活）。Pathway(II): Stress-hypothalamus-Pituitary gland(腦垂體)-ACTH腎上腺皮質(zhì)激素-adrenal cortex-corticosteroids(皮質(zhì)類固醇素/可的松）-增強(qiáng)能量消耗（protein and fat）。Effect of stress on immu

16、ne system(免疫系統(tǒng)）;Figure 13.6Brain-body pathways in stress.In times of stress, the brain sends signals along two pathways. The pathway through the autonomic nervous system controls the release of catecholamine hormones that help mobilize the body for action. The pathway through the pituitary gland and

17、 the endocrine system controls the release of corticosteroid hormones that increase energy and ward off tissue inflammation(Felker & Hubbard, 1998) . 應(yīng)激中的軀體反應(yīng) 拖沓的健康成本研究者鑒別了拖沓和不拖沓者后要求被試在學(xué)期初和學(xué)期末報(bào)告體驗(yàn)軀體疾病的癥狀.Coping應(yīng)對 :Active efforts to master, reduce, or tolerate the demands created by stress.Adaptive &

18、 maladaptive coping;Problem-focused coping & emotional focused coping; Difference from concept of Emotion regulation(?)Coping styles：consistent across situations；Responding to Stress BehaviorallyLaunchVideo 幾種應(yīng)對反應(yīng)應(yīng)激預(yù)應(yīng)付可控制的應(yīng)激源不可控的應(yīng)激源Giving up and blaming oneselfGiving up適當(dāng)放棄：簡單放棄：Learned helplessness

19、(習(xí)得無助);Behavioral disengagement(行動脫離);Stress increased and led to depressionSelf blame 適當(dāng)?shù)淖晕遗?；過分的自責(zé)導(dǎo)致焦慮上升; Catastrophic thinking(自責(zé)思維/悲觀思維/悲慘思維）Development of depression;Striking out at otherAggression（攻擊）: Frustration-aggression hypothesis（Dollard,et al.，1939). Displacement（轉(zhuǎn)移）：將攻擊目標(biāo)（挫折引起）轉(zhuǎn)移到其它無關(guān)的

20、對象，例如，家庭成員;Catharsis(宣泄）-釋放發(fā)泄緊張情緒，宣泄與抑制對心理/生理適應(yīng)的作用。Indulging oneself（縱容自己）Indulging oneself: 在其它方面獲得替代滿足。Smoking, Drinking，Drugs using, Overeating,Spend money,Internet addiction（網(wǎng)迷).Defense mechanisms（防御機(jī)制）Repression（壓抑）Projection（投射）Displacement（轉(zhuǎn)移/遷怒）Reaction formation（反向形成）Regression（倒退）Rationali

21、zation（合理化）Identification（認(rèn)同）Intellectualization(isolation)智力化,升華。Overcompensation(過度補(bǔ)償）;Undoing（取消）；Denial of reality（否認(rèn)）; Fantasy（幻想）；Constructive coping （Epstein,1989,1990) -更有效、更加健康的應(yīng)付方式直接面對問題，積極解決問題；對引起應(yīng)激環(huán)境和應(yīng)付資源理性現(xiàn)實(shí)的評價(jià)；學(xué)習(xí)對可能引起的破壞性情緒反應(yīng)進(jìn)行重新組織，或者抑制；努力確保自身不受可能的傷害；-與IQ關(guān)系較弱，與社會關(guān)系、愛情及成功的工作有較大相關(guān)。The Ef

22、fects of StressOn Psychological FunctioningOn Physical HealthFactors in Effects of stressStress: High & mediate & low, which is optimal level? Effect: Positive & Negative short & term;Personality: how traits modulate the interaction?For what? Why? How? Stress Impaired task performance Baumeister(198

23、4)的研究：hypothesis: Pressureself conscious increaseperformance decrease X: Pressure Y: Performance on the task of perceptionHome-team(主場）would be under greater pressure than the visiting team（客場）?Early games: home-team winsLast game: home team winsEffects of stress on psychological functioningBurnout（

24、崩潰）Burnout involves physical, mental, and emotional exhaustion that is attributable to long-term involvement in emotional demanding situation(長期情緒緊張導(dǎo)致生理、心理及情緒上的衰竭）.Pines(1993)concluded, events undermine important and heroic beliefs gradually by heavy,chronic work-related stress.Eg. Retire from an im

25、portant position.Antecedents components consequencesWork overloadLack of social supportLack of control,Inadequate recognition,rewardsExhaustion疲憊不堪Cynicism牢騷Lowered self-efficacy低自我效能Increased physiological illnessIncreased absenteeism,turnoverDecreased commitment to jobReduced productivityPosttraum

26、atic創(chuàng)傷 stress disorders(PTSD）災(zāi)難經(jīng)歷：Mele:81.3%; women:74.2%。PTSD：too great fear；9%, or 45%。Psychological problems and disorders：depression, anxiety, schizophrenia, and eating disorder；災(zāi)難后精神安撫；Social support.Positive effects of traumaPromote personal growth or self-improvement;Force to develop new skil

27、ls, reevaluate priorities, learn new insights, and acquire new strengths.Positive psychology: research on well being, hope, courage, perseverance, tolerance, and other human strengths and virtues. Psychosomatic diseases（心身?。?由心理因素，尤其是情緒因素引起的，生理上的健康問題（有器質(zhì)性兵病變）； hypertension, ulcer（潰瘍）, asthma（哮喘）, sk

28、in disorder, migraine and tension headaches(偏頭痛），stroke（中風(fēng)）, tuberculosis（肺結(jié)合）, multiple sclerosis（硬化?。?arthritis（關(guān)節(jié)炎）, diabetes（糖尿?。? leukemia（白血?。? cancer, various types of infectious disease（傳染?。? and the common cold（感冒） (Elliott, 1989)。Effects of Stress: PhysicalType A and coronary heart disease

29、（Mayer Friedman & Ray Rosenman, 1974)Type A: strong competitiveness爭強(qiáng)好勝, impatience沒耐心 and time urgency，anger and hostility；Type B: relaxed, patient, easy going（隨和）, amicable(友善）Type A: 更容易得冠心病。Anger and hostilityMore anger, and higher risk of coronary events 情緒反應(yīng)與心臟病情緒反應(yīng)增加心血管系統(tǒng)負(fù)擔(dān)；負(fù)情緒反應(yīng)（anger, stres

30、s)心血管病人-myocardial ischemia（心肌缺血）、chest pain（胸疼）等癥狀。心臟病人在治療過程中要盡可能地保持平靜心境，避免情緒刺激；抑郁與心臟病抑郁病人的心率比較高；Pratt, et al.(1996)發(fā)現(xiàn)，在他13年的臨床經(jīng)驗(yàn)看，在初診心臟病人中，抑郁的病人是其他類型病人的4倍。憤怒、悲傷：心率上升；恐懼、厭惡：心率下降;Stress and immune functioning免疫反應(yīng)：lymphocytes（淋巴細(xì)胞）的功能，以抵抗外來細(xì)菌、濾過性病毒媒體、外物的入侵。Stress reduced immune activity（動物和人類） Featured study: Connecting Stress to the common cold Cohen & Tyrrell(1993)Subjects: 154