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    What is stress?

    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 perception of danger. The source of stress is called a stressor.

    The key to our definition is the word perception. No one set of stressors reliably produces 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.

    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 enhance survival in dangerous situations (Meaney, 2010). Although sometimes unpleasant, stress can motivate us to perform well and makes us healthier in the long run. 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.

    However, in other cases, stress can be counterproductive and interfere with our performance and well-being. In extreme cases, as we observed in Chapter 14, a diathesis–stress model predicts that stress can contribute to the development of depression, schizophrenia, posttraumatic stress disorder (PTSD), and other serious conditions. These negative 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 these negative situations.

    The Stress Response

    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 and Chapters 7 (Cannon, 1929). Cannon reported that extreme cold, lack of oxygen, and emotional experiences all had the capacity to initiate a fight-or-flight response. During such a response, heart rate, blood pressure, and respiration all increase, while nonessential functions, like digesting food, are inhibited. Stored energy is released, and blood is shunted from the surface of the body to the muscles needed for exertion. These physical responses reflect a process that has been finely tuned through evolution to maximize our survival in emergencies.

    Hans Selye identified a general adaptation syndrome, which is our characteristic set of responses to stressors.


    John Olson/Time & Life Pictures/Getty Images

    Hans Selye, in a research career lasting more than 40 years, extended Cannon’s findings by studying the effects of stronger, longer lasting stressors. Selye worked primarily with rats, exposing them to a variety of stressors and measuring the amount of time they could subsequently swim before giving up. (They were then rescued.) Cold water, restraint, electric shock, surgery, and having their whiskers cut off were some of Selye’s stressors that greatly reduced the amount of time the rats would swim before giving up. Regardless of the nature of the stressor, Selye found that the rats responded with a consistent pattern of behavior, which he labeled the general adaptation syndrome (GAS; Selye, 1946).

    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 resources are deployed to survive the danger, and all nonessential systems are inhibited. It is likely that you have had at least one close call while driving a car, and you can probably remember how that felt. Your heart pounds, you breathe rapidly, your hands may be sweaty, and you feel unusually mentally alert and focused. This is precisely the way your autonomic nervous system is supposed to react in an emergency.

    Figure 16.1The General Adaptation Syndrome (GAS) Has Three Stages.

    Hans Selye’s GAS has three stages: alarm, resistance, and exhaustion. During the alarm stage, all resources are mobilized for fight or flight. If stress is prolonged, we enter the resistance stage, where we adapt and cope as well as possible. Finally, resources are depleted when we reach the exhaustion stage.


    © Cengage Learning®

    Some sources of danger do not go away as quickly as your close call on the freeway. Many students think, “Oh, if only I survive this term—everything else will be easy,” only to find themselves facing the same problems next term, along with some new ones. One of the challenges of modern living that our ancestors did not face is the need to worry about many future events. For the hunter–gatherer, the challenge was usually surviving that day. In contrast, today’s college student may be concerned not only with fairly immediate problems, such as paying the rent and passing a midterm, but also more distant problems of future job markets, world events, climate change, and the future of Social Security. If these uncertainties are perceived as threatening or dangerous, they will act as stressors with the ability to initiate GAS.

    When stressors are prolonged, Selye suggests we enter a stage of 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 alarm reaction, it still takes its toll. Under normal circumstances, we alternate between periods of calm and periods of relative arousal. You might calmly enjoy 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 and rest and repair the body. During periods of arousal, such as during the quiz, we expend energy instead of storing it. In the resistance phase of GAS, we attempt to take care of both arousal and resting functions simultaneously. Neither function operates as smoothly under these circumstances as when it is operating alone. You might get an upset stomach when digesting your lunch is combined with the excitement of giving an oral presentation to your classmates. In contrast to the mental clarity that typically accompanies the brief alarm reaction, judgment during the longer periods of resistance may not be as good.

    During extended periods of stress, judgment can suffer. You might have had the experience of looking back at the decisions you made during a stressful time, scratching your head, and asking, “What was I thinking?”

    If stressors are severe and last long enough, a person might reach Selye’s exhaustion stage. Strength and energy drop to very low levels. As we mentioned in Chapter 14, stress is a risk factor for depression, and the exhaustion stage has much in common with the criteria for major depressive disorder. Exhaustion can even lead to death. Forced marches during war produce higher rates of death than the rate that might be expected to occur because of injuries and lack of food. Similar observations of stress, exhaustion, and death have been made among baboons in Kenya (Sapolsky, 2001). Under normal circumstances, lower status baboons avoid higher status baboons whenever possible. Unfortunately, because of fears of losing their crops, the Kenyan villagers caged the local baboons 1 year. While caged, the lower status baboons had no way to escape the higher status animals, and many died as a result. They did not die, as you might have guessed, from battle wounds resulting from fights with the higher status animals. Instead, the baboons died from stress-related medical conditions such as cardiovascular disease.


    Sources of Stress

    Stressors exist in the eye of the beholder. Stressing over an exam might seem reasonable to many students, but this behavior might look silly to people stressed by war, poverty, and disease, who would probably be thrilled to have the opportunity to attend college.

    Cognitive appraisal models help us to predict when a particular stimulus or event is likely to be a stressor for an individual person (Lazarus, 1966). According to this approach, we make appraisals, or rapid initial assessments, of potential stressors to determine whether they are irrelevant or harmless, positive or negative. Because people appraise situations from the vantage point of their own strengths and experiences, we would expect that a single potential stressor might produce different amounts and intensity of stress for different people.

    Older zoos featured cages that often contributed to stress and illness among the animals. Modern zoos go to great lengths to provide more natural, less stressful habitats for their animals in recognition of the stress that often accompanies captivity.


    maratr/Shutterstock Photocase Addicts GmbH/Alamy

    Despite this variability in response to stressors, we can identify several types of events that are likely to produce significant stress in most people (see ● Figure 16.2). Large-scale disasters, such as the terrorist attacks of 9/11, the Haiti earthquake of 2010, the 2011 Japanese earthquake and tsunami, and the 2013 Oklahoma tornadoes typically produce stress in large numbers of people. PTSD in New York following 9/11 was estimated to affect 130,000 people in that city alone. In the 3 to 5 days following the attacks, 90% of Americans reported feeling unusually stressed (Schuster et al., 2002).

    Figure 16.2Worst Traumatic Exposures and Posttraumatic Stress Disorder (PTSD).

    Approximately 30,000 people with and without PTSD were asked to identify the “worst trauma they had ever experienced.” Among those who did not have PTSD, the unexpected death, illness, or injury of someone close and indirect exposure (television and other news reports) to the 9/11 terrorist attacks were the most commonly named “worst traumas.” Among those with PTSD, unexpected death, illness, or injury were also commonly noted traumatic experiences, but people with PTSD were more likely than healthy controls to identify sexual assault, intimate partner violence, and combat as their worst traumatic experiences.


    Source: Adapted from “Prevalence and Axis I Comorbidity of Full and Partial Posttraumatic Stress Disorder in the United States: Results From Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions,” by R. H. Pietrzak, R. B. Goldstein, S. M. Southwick, and B. F. Grant, 2011, Journal of Anxiety Disorders, 25(3), pp. 456–465, doi:10.1016/j.janxdis.2010.11.010. © Cengage Learning®

    This man is obviously stressed. Is somebody being injured? Is he in danger? No—he is witnessing a tense moment during a baseball game. Cognitive appraisal theories of stress suggest that different people are likely to respond to stimuli with varying levels of stress, based on their individual appraisals of a situation.


    AP Images

    Stress because of disasters can produce long-range and cross-generational effects. Researchers 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 depression 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).

    As we 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 between 14% and 39% and could be predicted by variables such as family loss and severity of exposure (Neuner, Schauer, Catani, Ruf, & Elbert, 2006). To put these very high numbers of childhood cases into perspective, we would expect about 10% of the general population to experience PTSD after most large disasters (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1996). Automobile accidents appear to be a major source of PTSD in childhood, with about 25% of children developing the disorder after being injured in an accident (de Vries, Kassam-Adams, Cnaan, Sherman-Slate, Gallagher, & Winston, 1999).

    According to Holmes and Rahe (1967), positive life events, such as weddings and holidays, can be equally or even more stressful than some negative events, such as flunking an important assignment.


    Goodluz/ Tetra Images/Aurora

    Although disasters are dramatic, they are not the only sources of stress we face. Changes, including some changes for the better, can also trigger stress. In the 1960s, Holmes and Rahe compiled a list of life events they believed might be correlated with stress and then surveyed participants about the amount of adjustment each event required (Holmes & Rahe, 1967). Subsequently, researchers used the Holmes and Rahe scales to predict vulnerability to physical illness and psychological disorder because of different stressors (Derogatis & Coons, 1993; Scully, Tosi, & Banning, 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 Holmes and Rahe scales 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.

    Not all psychologists are convinced that “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 Holmes and Rahe approach argue that most items on their list are quite negative and that these negative items are responsible for more stress (McLean & Link, 1994). It is likely that most of the stress associated with “good” changes occurs when the anticipated event does not live up to the person’s expectations. Vacations and holidays may not be inherently stressful, but trying to fulfill unrealistic fantasies about what vacations and holidays should be like is probably stressful indeed.

    Relatively insignificant sources of stress, often called hassles, can also contribute to a person’s overall level of stress. Waiting in long lines, losing your keys, getting a parking ticket, and oversleeping on the day of an important exam are not life-threatening events. However, if enough of these hassles occur within a short period, people begin to react as if something larger had occurred. The number of hassles people report experiencing predicts psychological symptoms of stress, even when the impact of major life events is factored out (Kanner, Coyne, Schaefer, & Lazarus, 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.

    Feeling socially isolated makes us 
feel unsafe, which triggers stress responses. Loneliness makes people behave in ways that make them difficult to be around, such as displaying greater pessimism, anxiety, and hostility, beginning a loop of self-fulfilling prophesies and more loneliness.



    Social relationships and their disruption can be a significant source of stress for many people. When we feel socially isolated, we feel unsafe, and at this point in our discussion, you probably know what happens whenever we feel unsafe—more stress. Because lonely people see the social environment as threatening, they respond with feelings of hostility, stress, pessimism, anxiety, and low self-esteem (Hawkley & Cacioppo, 2010). Their behavior begins a loop of self-fulfilling prophesies. Thinking that nobody wants to be around them, they begin to act in negative ways that ensure nobody wants to be around them, yet they do not see the reactions of others as related to their own negativity. There are no easy fixes for loneliness, but most people cope more effectively with feelings of loneliness when they consciously attend to the needs of other people rather than focusing on their own situations (Cacioppo & Patrick, 2008).

    16-2What Are the Biological Correlates of Stress?

    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 stage, 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 your ancestor 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 memory for information about lions, which he hoped would include ideas about how similar situations were handled in the past. Behaviorally, your ancestor carried out his plan for escape. We assume that given your presence today, your ancestor was successful.

    16-2aStress and the Amygdala

    We can trace the neural pathways that coordinate these responses to potentially dangerous stimuli. Sensory pathways provide information to higher cognitive centers in the cerebral cortex, letting our hunter know that the object in front of him is a lion. Memories of lion behavior, including eating habits, contribute to accurately identifying the lion as a stressor.

    Simultaneously, sensory input travels from the thalamus to the amygdala, which plays an important role in the identification of dangerous stimuli, as discussed in Chapters 4 and Chapters 7. The amygdala participates in a “fear circuit” that provides a rapid assessment of a stimulus or situation as potentially dangerous (LeDoux, 2000, 2014). If the amygdala is lesioned, animals no longer respond with conditioned fear to previously learned classically conditioned associations between a stimulus (perhaps a tone or light) and an electric shock, an example of classical conditioning discussed in Chapter 8 (see ● Figure 16.3). Animals with lesions in the amygdala are also unable to learn to respond appropriately to unfamiliar dangerous stimuli (Wilensky, Schafe, Kristensen, & LeDoux, 2006).

    Figure 16.3The 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 (an unconditioned stimulus, or UCS), 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.


    © Cengage Learning®

    Because sensory information can reach the amygdala along routes that are separate from 
the pathways for information going to the cortex, we might find ourselves frightened by stimuli that we don’t immediately understand or consciously view as dangerous (Knight, Nguyen, & Bandettini, 2003). As we mentioned in Chapter 4, a man who was blind because of damage to his visual cortex still showed normal response in his amygdala when shown faces expressing fear (Pegna, Khateb, Lazeyras, & Seghier, 2005). You might have found yourself feeling anxious while returning to your car after an evening class without knowing why you are reacting this way, but it is probably a good idea to listen to your amygdala until further information becomes available.

    Once the amygdala has identified a stimulus as potentially dangerous, it communicates with the hypothalamus. As we mentioned in Chapter 4, the hypothalamus most directly commands the autonomic nervous system, particularly the sympathetic division. This part of the autonomic nervous system is responsible for our fight-or-flight response to danger.

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    16-2bStress, the Sympathetic Adrenal–Medullary System, and the Hypothalamic–Pituitary–Adrenal Axis

    Perceiving a potential source of danger mobilizes the body’s resources using two systems—the sympathetic adrenal–medullary (SAM) systemand the hypothalamic–pituitary–adrenal (HPA) axis. The SAM system initiates the release of adrenaline (also known as epinephrine) and norepinephrine into the bloodstream from the adrenal glands located above the kidneys in your lower back. These chemical messengers circulate to many organs and to the brain, 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).

    Figure 16.4Two Systems Respond to a Stressor.

    In response to the appraisal of a stimulus as a stressor, two systems mobilize the body’s resources. The sympathetic adrenal–medullary (SAM) system responds quickly by initiating the release 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. Simultaneously, activation of the hypothalamic–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 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 longer lasting than those of the SAM response. HPA axis activity is associated with more of the outcomes of chronic stress, such as suppression of the immune system.


    Argosy Publishing, Inc.

    Simultaneously, activation of the HPA axis sets an entirely different system in motion. Here’s how the circuit works. The hypothalamus (H) communicates with the pituitary 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 cortisol. 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 death began to occur in just a few weeks (Stein-Behrens, Mattson, Chang, Yeh, & Sapolsky, 1994). Identical amounts of neural 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. Studies in humans who have a medical condition called Cushing’s disease that results in unusually high cortisol levels suggest that cortisol abnormalities might contribute to 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 the neurogenesis, or birth of neurons, that might help to offset the damage (Cowen, 2010).

    Normally, activity of the HPA axis is regulated by a feedback loop involving the hippocampus (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 levels 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 extreme stress and depression. As we observed in Chapter 14, many cases of depression are preceded by unusually stressful events. Consistently elevated levels of cortisol because of stress can overwhelm 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 rheumatoid 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 than average hippocampus (Bossini et al., 2008; Bremner et al., 1995). Having a smaller than average hippocampus appears to be a result of PTSD as opposed to a risk factor for PTSD (Chao, Yaffe, Samuelson, & Neylan, 2014).

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    16-2cGender Differences in the Stress Response

    Although psychologists typically discuss fight or flight as the common response to stressors, an alternate response has been suggested that might be more typical of women’s responses to stressors (Taylor, 2006). Noting that from an evolutionary standpoint, a mother with small children is unlikely to find either fight or flight easy to do, Taylor (2006) suggested that women are more likely to tend and befriend in response to stressors. Soothing frightened children, hiding, and forming social alliances for further protection might be more effective strategies.

    Instead of the traditional hormones associated with fight and flight, a tend-and-befriend response is more closely associated with the release of oxytocin, a hormone related to social bonding that we discussed in Chapters 4 and Chapters 7. As we mentioned in Chapter 4, added oxytocin relieves stress in animals but only when the animals are in a social group as opposed to being isolated (Taylor & Master, 2010; Yee et al., 2010).

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    16-2dSocioeconomic Status and Stress

    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.


    Sgt. Jessika Malott, 8th MP Bde. Public Affairs/ photo courtesy of U.S. Army

    Beginning with initial observations that death rates were negatively correlated with increases in occupational grades among British civil servants (Marmot, Rose, Shipley, & Hamilton, 1978; Marmot, Shipley, & Rose, 1984), scientists have become aware that health disparities exist worldwide as a function of wealth. People with lower socioeconomic status (SES) experience worse health. Absolute wealth is not the only factor here. People’s subjective 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 are exposed to 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). This long list has something in common—all of these factors are associated with high stress. In essence, this type of stress accelerates the aging process, including the shortening of telomeres, the “caps” found at the end of chromosomes (Needham et al., 2013). Premature aging, of course, is also going to lead to earlier death.

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    16-2eThe Epigenetics of Stress

    In Chapter 3, we discussed the significant role played by the environment 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 observed how both rats and human children who were well nurtured by their mothers showed more resilience to stress later in life. The nurture received from the mother had influenced how the genes responsible for producing and reacting to stress hormones behaved during later stressful experiences (Champagne, Francis, Mar, & Meaney, 2003; Neigh, Gillespie, & Nemeroff, 2009).

    Genes and life stress also interact to produce depression. As we observed in Chapter 14, depression is often accompanied by dysfunction in systems using the neurotransmitter serotonin. Life stress affects people differently depending on whether they possess a short form or a long form of a gene related to serotonin function. Having the long or short version of the gene interacts with life stress to produce different levels of activity in the amygdala and hippocampus, differences in the pathways connecting the amygdala and hippocampus with other regions of the brain, differences in gray matter, and different levels of rumination, the repetitive rethinking of problems that is particularly characteristic of depressed people (Canli et al., 2006). These gene–stress interactions help explain why some people are more vulnerable to life stress while others seem relatively well protected against stress.

    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 stressors.


    Visions of America, LLC/Alamy

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    16-3How Does Stress 
Affect Our Health?

    Our stress response was forged by the challenges our hunter–gatherer ancestors were most likely to face. The result is a system that has beneficial effects in the short term but can lead to negative effects when stress becomes chronic (Cacioppo & Berntson, 2011). After all, it would not take your ancestors hours, days, months, or years to figure out what to do to escape a hungry lion. For better or for worse, the outcome would be decided quickly.

    In contrast, many of the stressors we face in modern living are not brief, and as a result, we are fairly constantly experiencing Selye’s resistance phase, which combines stress and coping. You might be worried about finding a job after you graduate from college, which might be years away. Any long-term, chronic stress has the potential to affect health in negative ways. Not only does responding to stress require large amounts of energy, but while in the resistance stage, you do a less efficient job of storing nutrients and giving your body the rest and repair it needs. Improved understanding of the relationships between stress and health can guide our quest for physical and psychological well-being.

    16-3aStress and the Immune System

    Very short-term bursts of stress can have a beneficial effect on many biological systems, including the immune system, your body’s frontline defense against infection and cancer. Participating in a stressful memory task was correlated with an improvement in the response of the immune system, as measured by markers of immune system activity in the saliva of volunteers (Bosch, De Geus, & Kelder, 2001).

    However, the immune system does not perform as well in the face of long-term, chronic sources of stress (see ● Figure 16.5). When responding to an emergency, our stress response system prioritizes body functions. Those that are not necessary for handling the immediate emergency are taken offline. Unfortunately for those suffering from chronic, ongoing stress, one of those expendable systems is the immune system (Thornton, Andersen, Crespin, & Carson, 2007). As a result, stress can lead to greater frequency and severity of illnesses, as you may have noticed immediately following final exam periods (Wadee, Kuschke, Kometz, & Berk, 2001).

    Figure 16.5Stress Interacts With Anxiety to Predict Immune Response.

    Students with high anxiety, but not those with low anxiety, experienced a drop in immune function in anticipation of an exam coming up in 2 weeks. Immune system function had returned to normal 2 weeks following the exam.


    Source: Adapted from “Personality Factors, Stress and Immunity,” by A. A. Wadee, R. H. Kuschke, S. Kometz, and M. Berk, 2001, Stress and Health: Journal of the International Society for the Investigation of Stress, 17(1), pp. 25–40. © Cengage Learning®

    Many of the dangers faced by these San hunters in South Africa are likely to arise and resolve quickly. Our responses to stress are better suited for short-term stressors than for many of the ongoing, chronic sources of stress we face in industrialized settings.


    Alex Dissanayake/Lonely Planet Images/Getty Images Jetta Productions/Blend Images/Alamy

    Numerous studies indicate that people experiencing chronic stress are more vulnerable to infectious diseases, like colds and the flu (Cohen, Tyrrell, & Smith, 1991). White blood cells, or lymphocytes, protect us from invading organisms. Unfortunately, stress hormones directly suppress the activity of lymphocytes (Calcagni & Elenkov, 2006). Flare-ups of both oral and genital herpes are most likely to occur when a person is experiencing unusual stress (Cohen & Herbert, 1996). The progression of HIV infection to AIDS is influenced by the person’s 
level of stress (Harper et al., 2006). Stressed students show greater vulnerability to the virus responsible for mononucleosis, which normally is kept in check by a robust immune system (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 demonstrated 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 improvement have the most damaging effects. Those who are older and already ill are especially susceptible to adverse consequences of stress.

    Stress and Heart Disease

    In the 1970s, Meyer Friedman and Ray Rosenman (1974) stimulated a large quantity of research by suggesting 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.

    Connecting to Research

    Social Challenges Early in Life Affect 
the Developing Immune System

    IN THIS TEXTBOOK, WE HAVE explored a number of examples of interactions between people’s genetic makeup and their life experiences that predict psychological and physical health. We have also seen how some early life experiences, such as child maltreatment, seem to have especially pronounced effects on people’s outcomes throughout the rest of their life. What is there about experiences early in life that is so important? How does the experience of stress early in life affect health later? To examine these questions, researchers evaluated the effects of early stress on genetic pathways that shape the immune system (Cole et al., 2012).

    The Question:

    • How does adverse early life experience produce effects on later health?


    In Chapter 11, we reviewed work by Harry Harlow in which infant rhesus monkeys were raised by cloth and wire surrogate “mothers” to investigate questions about attachment. Steven Cole and his colleagues (2012) also exposed infant rhesus monkeys to surrogate mothers, other peers, or both instead of their real mothers. The researchers then conducted analyses of genetic changes in the infant monkeys’ immune systems.


    Rhesus infants raised by surrogate mothers or peers experienced changes in the expression of genes related to their immune systems. These results help explain the connection between adverse childhood experience and poor adult health outcomes.



    When the monkeys were only 4 months old, the researchers identified changes in the expression of genes in the monkeys’ developing immune systems. Genes that were related to inflammation and activation of the immune system were more active in monkeys raised by peers or by peers plus a surrogate mother than in monkeys raised by their biological mothers. Genes involved in basic defenses against bacteria and viruses were less active than in the monkeys raised by their biological mothers.


    The researchers believed that sympathetic nervous system responses to the stress of being raised by peers or a surrogate mother and peers changed the basic way genes important to the immune system were expressed. Their results were similar to genetic studies of adults who had experienced adverse childhood events. These changes help to explain why people with early social challenges have a more difficult time responding to diseases caused by bacteria or viruses. ●

    Research shows that in middle-age adults, frequent conflict with members of a person’s social network increased the risk of death by 200% to 300%.



    Further study, however, showed that simply being competitive had little to do with increased 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 others. 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 networks of friends and loved ones, who are often our best protectors from the untoward effects of stress (Jackson, Kubzansky, Cohen, Jacobs, & Wright, 2007). In middle-age adults, frequent conflict with members of a person’s social network raised the risk of death 200% to 300% (Lund, Christensen, Nilsson, Kriegbaum, & Hulvej Rod, 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 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 buttons were to be pushed as quickly as possible in response to flashing lights of the same color (Spieker et al., 2002). For the following 45 minutes, the ability of the participants’ blood vessels to expand was reduced by a factor of 50%. A participant’s change in blood pressure in response to a stressful situation was predictive of a later diagnosis with hypertension, or high blood pressure, which can lead to heart attacks or stroke (Spieker et al., 2002).

    16-3cStress, Mood, Sleep, and Obesity

    As we mentioned in Chapters 4 and Chapters 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 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 we observed in Chapter 14, many people diagnosed with depression show signs of abnormal cortisol function (Aihara et al., 2007).

    Cortisol is not just released in response to perceived stressors. As we observed in Chapter 6, cortisol also plays a role in maintaining our natural cycles of sleep and waking. Cortisol is released in large quantities early in the morning, contributing to wakefulness. As the day progresses, cortisol levels drop off, reducing wakefulness and setting the stage for sleep. If you experience a big jolt of cortisol because of a stressor late in the evening, getting to sleep is going to be difficult, even when you’re tired. Even when you do get to sleep, high levels of cortisol interfere with good sleep quality (Van Cauter, Leproult, & Plat, 2000). Both high levels of stress and depression can produce sleep disturbances, especially the experience of waking frequently throughout the night (Koenigsberg et al., 2004).

    Long before vaccinations and antibiotics were available, death rates because of infectious diseases began to drop in the United States. Improved wages and nutrition, coupled with more rest time away from work, allowed people to recuperate from their daily stresses (Cacioppo & Berntson, 2011).

    Mood and sleep can both affect appetite. Among the criteria for major depressive disorder, discussed in Chapter 14, are changes in appetite. Some people who are depressed lose weight without dieting, while others gain weight. By now, it shouldn’t surprise you to learn that stress, along with depression, can also contribute to obesity. In response to stress-related hormones, fat cells behave differently, growing in both size and number (Kuo et al., 2009). Stressed mice gained more weight than mice that were not stressed, even when both were fed the same high-fat, high-sugar diet. In addition to this direct effect of stress on appetite, stress can produce indirect effects on obesity by interfering with sleep. Dieters who enjoyed a full-night’s sleep lost the same amount of weight as dieters who slept less, but there was a difference in the kind of weight that was lost (Nedeltcheva, Kilkus, Imperial, Schoeller, & Penev, 2010). Dieters who slept well lost a healthy amount of fat. Sleep-deprived dieters lost only half as much fat as the sleeping dieters, and three quarters of their weight loss consisted of precious bone and muscle tissue instead (see ● Figure 16.6).

    Figure 16.6Sleep 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 “Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity,” by A. V. Nedeltcheva, J. M. Kilkus, J. Imperial, D. A. Schoeller, and P. D. Penev, 2010, Annals of Internal Medicine, 153, pp. 435–441. © Cengage Learning®

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    An Integrated View of Stress and Health

    We have reviewed a number of studies in this section that demonstrate the adverse effects that chronic, prolonged stress can have on our health. Popular wisdom suggests that people with the highest levels of stress should therefore experience the worst health. However, we have already seen one example, the healthy Type As, in which this was not the case. In another study, 5,000 men reported their stress levels, which were then compared 20 years later to their medical records. Surprisingly, the men who had reported the highest levels of stress had experienced the least amount of heart disease (Macleod, Davey Smith, Heslop, Metcalfe, Carroll, & Hart, 2002). How can we explain these apparently contradictory results?

    One approach to reconciling the good health enjoyed by some stressed people with data demonstrating the harmful effects of stress in others is to step back and look at the whole person within her environment over the entire life span. Health can be described as not just the absence of disease but also as the ability to respond to the challenges of being alive (Juster, McEwen, & Lupien, 2010; McEwen & Gianaros, 2011).

    Personal factors, including your genes, interact with the parental care you receive, as we discussed previously in this chapter. Other protective factors, such as your social networks and sense of meaning or purpose in life, contribute to your resilience in the face of the negative and cumulative effects of a lifetime of responding to stressors (Cacioppo & Berntson, 2011). These protective factors occur at critical periods, such as the impact of parenting in early childhood, so a complete understanding of protective mechanisms should be examined within the context of life-span development. Once we fully understand these protective processes, psychologists should be in the exciting position of being able to design effective interventions for improving health and well-being (see ● Figure 16.7).

    Figure 16.7An Interactive View of Stress and Health.

    Individuals do not experience stress in a vacuum. Personal factors, like genes and everyday experiences, influence outcomes within an environment consisting of ever 
larger circles of social connectivity. The relationships between social environment and personal factors are reciprocal. Individual actions influence the social environment, which in turn influences individual factors.


    Source: Adapted from “Allostatic Load Biomarkers of Chronic Stress and Impact on Health and Cognition,” by R.-P. Juster, B. S. McEwen, and S. J. Lupien, 2010,” Neuroscience and Biobehavioral Reviews, 35(1, pp. 2–16), doi:10.1016/j.neubiorev.2009.10.002. © Cengage Learning®

    Psychology as a Hub Science

    Belongingness, Stress, Achievement, and Health


    We don’t need to tell you that being in college can be stressful. For many students, college can mean new environments, new rules and routines, new social interactions, less sleep, not-so-great eating habits, and more sitting than exercising. Can the application of psychological research make the transition into college easier and less stressful?

    We can’t make many of these stressors go away, but a simple, one-time intervention at the beginning of the first year of college made a large difference in the academic performance and health of a group of students (Walton & Cohen, 2011). Incoming first-year students at Stanford University were randomly assigned to a control group or a social-belonging group. The 
social-belonging group read what they thought were the results of a survey of older students, who said that they had worried about fitting in during their first year but had grown more confident over time. Participants were asked to write an essay comparing their own first-year experiences with the survey results and then deliver a speech based on their essay to a video camera for use with future students. At no time were the participants aware that they were actually experiencing a “treatment” designed to make them see the social stressors of college life as typical of all students and of short duration.

    Over the next 3 years, the participants’ grade point averages and health were monitored. The “belongingness” intervention had little impact on the health and grades of European American students, but it had significant and positive effects on African American students. Compared to African American students in the control group, the students who had received the one-time reassurance that their concerns about fitting in were normal and were not 
permanent had higher grades, fewer visits to the doctor, and higher subjective happiness (see ● Figure 16.8).

    Figure 16.8A 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 3 years later. European American students did not experience the same treatment-related differences, with both treated and nontreated European American students experiencing the same health and subjective happiness as the treated African American students. This result suggests that “fitting in” was already framed by European American students in positive ways.


    Source: Adapted from “A Brief Social-Belonging Intervention Improves Academic and Health Outcomes of Minority Students,” by G. M. Walton and G. L. Cohen, 2011, Science, 331(6023), pp. 1447–1451, doi:10.1126/science.1198364. © Cengage Learning®

    While further research is necessary to know how far these results can be generalized to other students, the results emphasize the importance of how you interpret your situation and whether you feel like you belong to your overall performance, health, and well-being. ●

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    16-4How Can We Cope Effectively With Stress?

    The stress of middle school, such as attending school dances, is real to students at the time, but as we get older and more experienced, our capacity to manage stress improves. With age, people report feeling less stress, even though stressors tend to become more complicated and numerous at the same time.


    Left Lane Productions/Left Lane Productions/Corbis

    Stress is inevitable. That simple statement does not imply that there is nothing you can do about stress. Psychologists have identified a number of strategies people can use to effectively 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 you found most stressful 5 years ago and then make a list of the stressors you face today. Would you trade today’s list for the one from 5 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 stimulus or event as a stressor. Appraisal plays an important role in coping with identified stressors as well. Once a stressor has been identified, a second set of appraisals occurs that guides our coping responses (Lazarus, 1966). What harm has already occurred? What threats remain? What resources do we need to overcome the challenge?

    16-4aManaging Stress

    Even when a stressor takes us by surprise, we can regain a sense of control. Viktor Frankl (1959, p. 161), a Holocaust survivor, developed what he described as “tragic optimism” for coping with unforeseen disasters. Instead of asking why these disasters should happen to us, Frankl recommends that people exert a sense of control by asking, “How can I face this disaster with courage and responsibility?”

    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 campus’s financial aid office might provide you with solutions you had not considered. The worst possible approach is to withdraw and avoid stressors in the vain hope that they will go away. Your latest credit card statement is not going to get better magically if you ignore it. In fact, your emotional response to seeing the statement on your desk every day is likely to get a lot worse over time.

    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, Goldstein, Southwick, & Grant, 2011). These seemingly random events undercut our sense of control, countering the belief that “If I don’t smoke, I am ensuring my lungs will stay healthy.”

    Patients who educate themselves about their conditions and participate fully in treatment decisions experience less stress.


    Monkey Business Images/

    Many stressors are out of our control. We can’t wish our cancer away or magically ensure that enough money appears in our bank accounts to pay this month’s bills. However, we can respond to our stressors in ways that reduce our overall stress. This approach 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 most of their outcomes are because of their personal efforts as opposed to luck, chance, or other external forces.

    Because of the inevitability of stress, people cope best when they keep themselves as healthy as possible. If you follow good health habits, stress will still deplete your reserves and inhibit your immune system, but a healthy body can take more abuse than an unhealthy one. Students are more likely to get sick during final exams if they have neglected good eating and sleeping habits all term.

    Regular aerobic exercise appears to be especially helpful. In one experiment, people with heart disease were observed as they engaged in exercise as part of their rehabilitation programs. The exercise reduced the overall stress levels of all participants (Milani & Lavie, 2009). Exercise seemed particularly beneficial for the participants who also scored high on psychosocial stress. None of the high-stress participants who showed the greatest physical benefits from exercise (such as increased oxygen uptake) died in the follow-up period compared to 19% of the high-stress participants who showed relatively low physical benefits from exercise (see ● Figure 16.9). Students would be wise to engage in some level of activity in college to offset the effects of increased stress.

    Figure 16.9Exercise Reduces Mortality in Stressed Cardiac Patients.

    People with cardiovascular disease were assessed for psychosocial stress levels during a rehabilitation program that included exercise. A control group did not have a formal exercise program. Based on their improvement in physical measures following the exercise program, the study participants were divided into low and high exercise change groups. In a follow-up 5 years later, high levels of physical improve­ment because of exercise did not affect the mortality of the low psychosocial stress group but significantly reduced mortality in the high-stress group.


    Source: Adapted from “Reducing Psychosocial Stress: A Novel Mechanism of Improving Survival From Exercise Training,” by R. V. Milani and C. J. Lavie, 2009, American Journal of Medicine, 122(10), pp. 931–938, doi:10.1016/j.amjmed.2009.03.028. Illustration: © Cengage Learning®; photo: Alexander Raths/

    In Chapter 15, we discussed the use of mindfulness in the treatment of anxiety and depression. 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).

    Specialist Lawrence Shipman and Sergeant First Class Jonathan Zeke, a combat stress–relief dog, received an award for their work in reducing the stress of soldiers deployed in Iraq. Shipman notes that Zeke acts as an icebreaker, encouraging soldiers to talk to the behavioral health counselors.Spc. Terence Ewings, 4th AAB PAO, 1st Cav. Div., USD-N/photo courtesy of U.S. ArmyOne of the most powerful antidotes to the 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 out of the world provide powerful buffers against stress (Montpetit, Bergeman, Deboeck, Tiberio, & Boker, 2010). As we have argued 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 (Cacioppo, Cacioppo, Capitanio, & Cole, 2015; Hostinar, Sullivan, & Gunnar, 2013). 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 talking about their thoughts and feelings about the attacks with other people (Schuster et al., 2002). More than 90% reported either praying or engaging in spiritual contemplation 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 depression. Living in a neighborhood where few people know one another or help one another with tasks like child care increases the risk of developing major depressive disorder (Russell & Cutrona, 2010). These socially disconnected neighborhoods become more prevalent as the income of 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 also provide benefits to your health. Stockbrokers with high blood pressure who lived alone were selected to receive a cat or dog from a local shelter (Allen, 2003). When stressed, the pet owners experienced a much lower increase in blood pressure than their petless counterparts. The effect was most obvious among participants who listed few social connections with other people.

    Many people find that having religious beliefs helps them cope with stress. People who report having religious beliefs appear to withstand the challenges of unemployment, low income, and widowhood better than people who report no religious beliefs (Diener & Seligman, 2004). Across a number of nations practicing different forms of religion, a higher rate of belief in a god predicts higher ratings of life satisfaction and lower rates of suicide (Helliwell, 2003).

    16-4bThree Types of Coping

    Coping with a stressor can take three forms: problem-focused, emotion-focused, and relationship-focused coping (O’Brien & DeLongis, 1996). In each case, positive and negative versions of each style can be observed.

    Problem-focused coping is designed to address the problem. If you just flunked an important exam, positive problem-focused coping strategies might include making an appointment with your professor to discuss your options, hiring a tutor, taking a study skills seminar, or joining a study group formed by your classmates. Negative problem-focused coping can include escape and avoidance. Instead of confronting the problem, a student might stop going to class. Problem-focused coping is more frequently used for work-related stressors (which would include schoolwork) than for interpersonal stressors (like the breakup of an important relationship; Terry, 1994).

    Emotion-focused coping helps you deal with the negative emotions associated with a stressor. Flunking an exam might make you feel sad, discouraged, and depressed. Positive coping with these negative emotions might involve sharing your concerns with your friends or 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 you do not need or using alcohol to dull your stress, might simply add to your problems and increase your overall levels of stress.

    Relationship-focused coping helps you maintain and protect social relationships in response to stress (O’Brien & DeLongis, 1996). This type of coping has both positive and negative aspects. For example, people caring for Alzheimer’s patients, which can be stressful, exhibited both positive coping (empathy, support, and compromise) and negative coping (confronting, ignoring, blaming, and withdrawal; Kramer, 1993).

    At times of stress, we often engage in three types of coping. (a) Problem-focused coping is usually used to solve problems at work. (b) Emotion-focused coping helps us deal with the negative emotions of stress. The 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.


    Lucky Business/ Hana/Datacraft-QxQ images/Alamy visi.stock/

    As we have seen so frequently in our discussions of human behavior, the choice of a coping approach results from interactions between people and their situation (Aldwin, 1994). For example, people who score high on the Big Five trait of neuroticism, which we 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 neuroticism are more likely to engage in negative problem-focused coping, such as escaping the situation (O’Brien & DeLongis, 1996). When dealing with interpersonal stress, however, people with high neuroticism use the negative relationship-focused coping strategy of confrontation. People with high neuroticism also cope differently with stress involving close relationships (significant others, family members, and close friends) than with stress involving distant relationships (coworkers and neighbors). They are more likely to use a positive relationship-focused coping method, empathy, when dealing with distant relationships than when dealing with close relationships (O’Brien & DeLongis, 1996).

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    16-4cResilience: Individual Differences 
in Response to Stress

    Austrian psychiatrist Viktor Frankl (1905–1997) was sent to the dreaded Nazi concentration camp Auschwitz, where he lost his pregnant wife, parents, and brother. Frankl used his experiences in developing his theories of logotherapy, after the Greek word for “meaning.” The ability to find meaning even in the depths of despair by recalling pleasant memories or helping a suicidal inmate helped Frankl survive the stress and horror surrounding him.


    Katharina Vesely/Imagno/Hulton Archive/Getty Images Cover designed by Two Associates/Courtesy Rider Books/Ebury Publishing

    You might have observed that under the same stressful circumstances, such as an upcoming exam, some students seem calm and others appear to be in a state of panic. What determines these individual differences in coping?

    We have already seen how epigenetic interactions between genes and nurturing can influence later responses to stress. In addition, people differ in resilience, or the ability to adapt to life’s challenges in positive ways. Resilient people do not ignore feelings of sadness or stress, but like Holocaust survivor Viktor Frankl, they harness their inner strengths to enable them to remain optimistic and get on with the business of life. In contrast, when people lack resilience, they feel overwhelmed, helpless, and victimized. They become more vulnerable to the use of negative coping strategies, including alcoholism and drug abuse, to escape their problems. Early research in resilience focused on children’s ability to thrive even in conditions of poverty, neglect, and abuse (Masten et al., 1999).

    People who write “scripts” for how their life “should” happen, such as thinking that everyone should enjoy a set schedule of activities over a holiday, often experience high stress levels when events take an unexpected turn. Maintaining a flexible approach to meeting your life’s goals is far less likely to produce stress.

    Some psychologists refer to individual differences in the ability to cope with stress as resulting from a personality trait of hardiness (Hystad, Eid, Laberg, Johnsen, & Bartone, 2009; Maddi, 2013). As we mentioned 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 disruption in response to the normal stressors of life. Hardiness combines commitment, control, and challenge (Bartone, 2000). People with high commitment see the world as interesting and seek involvement rather than withdrawal. Control refers to individuals’ belief in their ability to influence events. Challenge is a state of mind that sees change and new experiences not as negative stressors but as opportunities for learning and personal growth. Among college students, hardiness did not predict grades, but it was negatively correlated with health complaints and stress related to academic work (Hystad et al., 2009; see ● Figure 16.10).

    Figure 16.10Hardiness Protects Students From the Health Impacts of Stress.

    A personality trait of hardiness, which combines commitment, a sense of control, and the appraisal of stressors as challenges, seems to protect college students from the health consequences of high academic stress.


    Source: Adapted from “Academic Stress and Health: Exploring the Moderating Role of Personality Hardiness,” by S. W. Hystad, J. Eid, J. C. Laberg, B. H. Johnsen, and P. T. Bartone, 2009, Scandinavian Journal of Educational Research, 53(5), pp. 421–429, doi:10.1080/00313830903180349. © Cengage Learning®

    Other protective factors contributing to individual differences in resilience are cognitive skills, social skills, and flexibility in response to new situations (Garmezy, 1991). Individual differences in resilience might also have their roots in emotion. People who are generally more positive in mood tend to build the resources they need, including strong social networks, to sustain them at difficult times (Cohn, Fredrickson, Brown, Mikels, & Conway, 2009).

    Summary 16.1

    Stages in Hans Selye’s General Adaptation Syndrome

    StageWhat’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 / .

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    16-5What 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 depends 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, 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 biological (such as genetics, infection, and injury), psychological (such as lifestyle, stress, and health beliefs), and social factors (such as culture, family, and social support; McEwen & Gianaros, 2011). In 1948, the World Health Organization (WHO) proposed a definition that reflects this more contemporary model of health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2003, para. 1). In addition to making sick people feel better, which is an important function of medicine, this new view of health seeks to improve the well-being of people who are not sick (see ● Figure 16.11).

    Figure 16.11A Biopsychosocial Model of Health.

    Health today is viewed as the product of interactions among individual characteristics, life experiences, cognitions, and behavior.


    Source: Adapted from “Allostatic Load Biomarkers of Chronic Stress and Impact on Health and Cognition,” by R.-P. Juster, B. S. McEwen, and S. J. Lupien, 2010,” Neuroscience and Biobehavioral Reviews, 35(1), pp. 2–16, doi:10.1016/j.neubiorev.2009.10.002. Illustration: © Cengage Learning®; photo: forestpath/

    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. 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.

    Figure 16.12Leading Causes of Death in the United States.

    Over the last 100 years, infectious diseases have been replaced as the major causes of death in the United States by heart disease, cancer, lung disease, and stroke. As medical progress decreases deaths because of these causes, age-related diseases such as Alzheimer’s disease have become more common causes of death.


    Source: Adapted from “Sitting Time and Mortality From All Causes, Cardiovascular Disease, and Cancer,” by P. T. Katzmarzyk, T. S. Church, C. L. Craig, and C. Bouchard, 2011, Medicine and Science in Sports and Exercise, 41(5), pp. 998–1005, doi:10.1249/MSS.0b013e3181930355. © Cengage Learning®

    The contemporary leading causes of death just listed (heart disease, cancer, lung disease, and stroke) form significant interactions with behavior, because their risk factors include obesity, smoking, lack of exercise, and alcohol consumption. Even when we consider infectious diseases, we see evidence of strong behavioral components, such as the amount of stress you’re experiencing (Cohen et al., 1991) or the likelihood you practice prevention by washing your hands during flu season. In addition, lifestyle factors and adherence to treatment plans can be extremely important to achieving and maintaining wellness. Health psychologists are interested in helping people to better prevent and recover from disease and to cope with the stress of chronic health problems and pain.

    When we discuss the contributions of behavior to health, by no means do we want to “blame the victims” of poor health. People who have never smoked still get lung cancer, and thin, fit people get heart disease. The relationships between lifestyle factors and health are derived from the statistical analyses of large populations, not single individuals. At the same time, understanding that most people who engage in particular behaviors have certain health outcomes can provide us with clues for maintaining the healthiest lifestyles possible.

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    16-5aBehavior and Health

    In 2009, Consumer Reports conducted a survey of 1,000 Americans to see how many engaged in everyday prevention behaviors (, 2009). As shown in Table 16.1, 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. The point is that many of our choices contribute to the prevention of accidents and disease.

    table 16.1

    Americans’ Safety Practices

    Use cotton swabs to clean ears73%26%
    Let your kids play on trampoline43%56%
    Eat raw dough when making cookies39%61%
    Use top step of ladder31%69%
    Fail to use car’s seat belt24%75%
    Drink beer while using power tool or mower13%87%
    Have a rubber mat in shower39%61%
    Have a carbon-monoxide detector in home51%48%
    Eat burgers only well done67%32%
    Change batteries in smoke alarm annually79%21%
    Clean lint trap in dryer after each use81%18%
    Read warnings on prescription medicines91%9%
    Wear a bike helmet42%58%
    Wear sunscreen when outside for an extended time73%27%

    Source: Adapted from “Risky Business,” by, 2009, retrieved from

    Behaviors that contribute to our major causes of death include smoking, poor nutrition, alcohol use, and lack of exercise (see ● Figure 16.13), which we discuss in more detail in the next sections.

    Figure 16.13Four Simple Habits Make Major Contributions to Health.

    Following four simple health habits—never smoking, exercising 30 minutes per day, maintaining a nonobese weight, and eating a healthy diet including fruits and vegetables—reduced overall risk of chronic disease by 78%. Unfortunately, only 9.1% of a sample of more than 20,000 adults between 35 and 65 years of age had all four habits. Most people reported following only one to three of the four health habits.


    Source: Adapted from “Healthy Living Is the Best Revenge: Findings From the European Prospective Investigation into Cancer and Nutrition–Potsdam Study,” by E. S. Ford, M. M. Bergmann, J. Kroger, A. Schienkiewitz, C. Weikert, and H. Boeing, 2009, Archives of Internal Medicine, 169(15), pp. 1355–1362, doi:10.1001/archinternmed.2009.237. Illustration: © Cengage Learning®; photo: Julian Rovagnati/

    Tobacco Use

    Cigarette smoking is considered to be the leading preventable cause of death in the United States, with a direct responsibility in one of five deaths each year (Centers for Disease Control and Prevention [CDC], 2014. On average, smokers die 13 to 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). Tobacco’s effects are not restricted to its users. In the United States, exposure to secondhand smoke leads to 3,400 lung cancer deaths, 46,000 heart disease deaths, 430 cases of sudden infant death syndrome (SIDS), 24,500 low-birth-weight babies, 71,900 preterm deliveries, and 200,000 episodes of childhood asthma each year (WHO, 2008).

    Despite considerable educational efforts aimed at smoking prevention, 18.1% of American adults smoked as of 2012 (CDC, 2014c). Worldwide, rates of smoking are even higher than those found in the United States and other developed countries. According to the WHO (2008), two thirds of current smokers live in developing countries, with 30% of smokers residing in China and 10% in India. Gender, race, ethnicity, education, mental health, and income are strong determinants of the likelihood of smoking. In the United States, men are more likely to smoke than women (20.5%, as opposed to 15.8%). Multirace individuals reported the highest incidence of smoking (26.1%), followed by American Indians or Alaska Natives (21.8%), non-Hispanic Whites (19.7%), non-Hispanic Blacks (18.1%), Hispanics (12.5%), and Asians (10.7%). Smoking drops with increasing education, from 41.9% of individuals with a general equivalency diploma (GED) certificate to 5.9% of adults with a graduate degree. Poverty plays a strong role in smoking; 27.9.1% of adults living below the poverty line compared to 17.0% living at or above the poverty line report smoking (see ● Figure 16.14).

    Figure 16.14Geographical Distribution of Smokers in the United States.

    In the United States, nearly one in five adults is a smoker. In 2012, an estimated 18.1% of adults in the United States were current smokers. Smoking is more common among men, ethnic minorities, people with less education, people living below the poverty line, and people diagnosed with a psychological disorder.


    Source: Adapted from “Vital Signs: Current Cigarette Smoking Among Adults Aged ³18 Years—United States, 2005–2010,” by Centers for Disease Control and Prevention, 2011b, Morbidity and Mortality Weekly Report. Retrieved from © Cengage Learning®

    One of every three cigarettes lit each day is smoked by a person in China, where it is a conventional courtesy for one businessperson to greet another by offering a cigarette. The 2011 ban on smoking in bars, in restaurants, and on transportation does not apply to offices and factories. The ban was required when China signed the World Health Organization Framework Convention on Tobacco Control five years ago. Public health officials fear that the lack of an awareness program and penalties will encourage the population to ignore the ban.


    Carlos Barria/Reuters/Corbis

    Given the carnage produced by tobacco, why do people start smoking and then continue? An understanding of the initiation of tobacco use requires combining many of the perspectives we have discussed in this textbook—in particular, development, biological psychology, learning, and social psychology.

    Most tobacco users begin smoking in childhood or early adolescence, long before decision-making abilities are mature. Because of the addictive nature 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, as discussed in Chapter 6, nicotine has the ability to stimulate the dopamine reward circuits of the brain and to produce a particularly unpleasant set of withdrawal symptoms. As we discussed in Chapter 11, adolescence is also a time when people try out new roles and learn important skills for getting along with peers, making them frequently susceptible 
to peer pressure. Teens often overestimate how many other people are using tobacco, so 
they might begin using it to avoid looking “different” (Institute of Medicine, 1994). Finally, most smokers have friends and parents who also smoke, suggesting a role for social learning (Biglan, Duncan, Ary, & Smolkowski, 1995).

    A troubling aspect of the initiation of smoking is the prevalence of tobacco use among people with diagnosed psychological disorders. Of the approximately 20% of American adults diagnosed with any mental disorder (see Chapter 14), 36.1% were current smokers, a much higher rate than that found in the general population (CDC, 2013). Adults diagnosed with mental disorders smoke 31% of all cigarettes consumed by adults in the United States (CDC, 2013). Tobacco use among people with schizophrenia and other severe mental illnesses is about 70% in the United States, more than 3 times as high as the approximately 20% of users in the general population as reported by the CDC (Dixon et al., 2007). In addition, the severity of smoking among these individuals, 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, Prochaska, Ong, Shi, & Max, 2011). Although many smokers with psychological disorders report using cigarettes to feel better, most began smoking long before their symptoms emerged and they were diagnosed with a disorder (Sacco, Termine, & Seyal, 2005).

    People do quit smoking, although some find it difficult. Again, the social nature of our species plays a role in this process. A person’s chances of successfully quitting are reduced by 67% if a spouse smokes, 25% if a sibling smokes, 36% if a friend smokes, and 34% if a coworker smokes (Schroeder, 2008). We are 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 physically separate themselves when friends and family light up. As we 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.

    In the United States, ex-smokers now outnumber smokers (47 million to 46 million; Chapman & MacKenzie, 2010). Smokers use a variety of techniques to quit, including simply stopping all use abruptly (cold turkey), gradually reducing intake, using nicotine patches and gum or other nicotine replacement tools, participating in counseling and support groups, or some combination of these.



    Smoking cessation programs can also take advantage of the self-reference effect that we discussed in Chapter 12. The self-reference effect explains the superior recall for information relevant to the self by suggesting that the self serves as an important schema for organizing information. Participants experiencing interventions for smoking that were tailored to their own 
lives, needs, interests, and obstacles not only were more successful at quitting smoking but also showed brain activity in parts of the prefrontal cortex believed to participate in thinking about the self (Chua et al., 2011).

    The benefits of quitting smoking appear within minutes to hours as the body begins 
to repair itself. After 5 years of abstention from smoking, risk of stroke is the same for ex-smokers and nonsmokers. After 10 years of abstention, the risk of lung cancer is cut in half. If the smoker quits before the age of 30 years, life expectancy remains the same as for someone who has never smoked (Doll, Peto, Boreham, & Sutherland, 2004). Eliminating all tobacco smoking in the United States would produce a gain of 1.73 years of life expectancy for an 18-year-old (Stewart, Cutler, & Rosen, 2009).


    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, Reznick, & Zeisel, 2009). People need the right amount and quality of nutrients to support optimum health and brain functioning, and being either underweight or obese is associated with reduced health. Obesity increases the rates of many chronic conditions, including heart disease, stroke, diabetes, arthritis, and breast and colon cancers. As we noted previously, maintaining a BMI below 30 (nonobese) was one of the four protective factors associated with much lower risk of disease. Returning the United States population to normal weight (a body mass index, or BMI, between 18.5 and 24.9) would produce about the same improvement in overall life expectancy as the elimination of smoking (Stewart et al., 2009).

    As we mentioned in Chapter 7, not only do we face problems in the form of eating disorders, such as anorexia and bulimia, but the world has also experienced an unprecedented obesity epidemic over the last two decades (see ● Figure 16.15). In the United States, the percentage of obese adults rose from 12% in 1991 to 35% in 2012 (Ogden, Carroll, Kit, & Flegal, 2014). It is likely that multiple factors have contributed to this change, including our sedentary lifestyle, increases in caloric intake, changes in the types of food we eat, changes in sleep patterns, and social factors. WHO (2006) 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 combination 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, Huang, & Daniels, 2009).

    Figure 16.15The Obesity Epidemic.

    In 1960, fewer than 15% of American adults were obese (body mass index, or BMI, ≥ 30), but today about one third are obese. The number of people who are extremely or morbidly obese (BMI ≥ 40) has also climbed during this period. The reasons for the obesity epidemic are not well understood and are likely to be complex.


    Source: Adapted from “Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008,” by C. L. Ogden and M. D. Carroll, June 2010, NCHS Health E-Stats. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from Illustration: © Cengage Learning®; photo: Ljupco Smokovski/Shutterstock

    One of the challenges we face today is the high cost of eating a healthy diet. If you have $1.50 in your pocket, you can buy about 1,100 calories at McDonald’s (pancakes and sausage breakfast) or 250 calories of fresh apples. We can guess which choice financially struggling parents with hungry children are likely to make.


    Chuck Franklin/Alamy

    As was the case in smoking, we can also see evidence of social factors that maintain our eating habits and weight. Our recent history of cheap, fatty, and sugary foods is now colliding with increased rates of poverty because of a downward spiraling economy. Nutritionists have raised the alarm that eating healthy foods is becoming more expensive than ever. We seem to use the people around us as a measure of “how we’re doing” in terms of our weight. Having an obese spouse increases your risk of obesity by 37%, and having obese friends increases your risk by 57% (Christakis & Fowler, 2007).

    As we 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 would-be ex-smokers enjoy, however, is the option of complete abstinence. In contrast, we cannot abstain from eating but instead must choose to eat differently. Research identifying the contagious aspects of smoking and obesity might provide a hopeful note. If people in your social circle begin to eat healthier diets and maintain healthier weights, perhaps it will become easier for you to do so as well. Although losing weight can seem difficult, small changes in behavior can be helpful. People using smaller plates unconsciously ate less (Wansink, 2006).

    In addition to addressing concerns about obesity, current research in nutrition focuses on the specific nutrients we need for healthy development and psychological well-being. As we mentioned in Chapter 14, prevalence of bipolar disorder is much lower in countries consuming 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 is widely used in the United States and in many other countries around the world (see ● Figure 16.16). According to the National Institute on Alcohol Abuse and Alcoholism (2014), 87.6% of American adults consumed alcohol at some point in their lifetime, 71% consumed alcohol in the past year, and 56.3% consumed alcohol in the past month. Nearly one quarter 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).

    Figure 16.16Alcohol Is the Third-Leading Cause of Worldwide Loss of Disability-Adjusted Life Years (DALYs).

    The World Health Organization reports that worldwide, alcohol is third behind only childhood starvation and unsafe sex (leading to HIV/AIDS) as a cause of loss of years of “healthy life” because of disability and poor health.


    Source: Adapted from “Alcohol (Fact Sheet)” by World Health Organization, 2011a, retrieved from © Cengage Learning®

    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 and 2.5 million years of potential life lost annually at an annual cost of $223.5 billion (CDC, 2014a).

    Alcohol also poses a risk of abuse and dependence for many people. Psychologists define alcohol abuse as repeated use despite adverse consequences and alcohol dependence as alcohol abuse accompanied by tolerance, withdrawal, and a compulsive urge to drink more (American Psychiatric Association [APA], 2013). As we 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 dependence (Eng, Luczak, & Wall, 2007). To illustrate the need to consider more than simply genetic predisposition, however, we find that Native Americans have much higher rates of alcohol dependence than those of many other ethnic groups in the United States, despite a high prevalence of the supposedly “protective” genes (Ehlers, 2007).

    Many of the same factors that encourage teens to begin smoking also operate to encourage drinking. Most people who go on to abuse alcohol are drinking heavily by late adolescence, and most cases of alcohol dependence are well established by the age of 30 years (Enoch, 2006). This timeline provides insight into when prevention programs are likely to be most effective. 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 characteristic sense of being immune to harm from risky behaviors 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) that is associated with this reward.

    People who are exposed to alcohol at younger ages have the highest risk for alcohol abuse.


    Diverse Images/Universal Images Group/Getty Images

    Among the environmental influences on problem drinking is the age at which people take their first drink. Individuals exposed to alcohol at earlier ages show a much higher rate of alcohol dependence later in life. Again, we find that age of first drink interacts with a person’s genetic predisposition to alcohol dependence (Agrawal et al., 2009). In yet another example of the epigenetic mechanisms we discussed in Chapter 3, early exposure to alcohol might affect the expression of genes related to problem drinking. A similar interaction is found between the maltreatment and neglect of a child and the genetic vulnerability to alcohol dependence. Not all children who are maltreated go on to become dependent on alcohol, although many do (Shin, Edwards, & Heeren, 2009; Shin, Edwards, Heeren, & Amodeo, 2009). The maltreated children who do not develop drinking problems are likely to be protected by combinations of genetic predisposition and the presence of peer and parental support (Enoch, 2006).

    Treatment for very heavy drinkers often requires medical supervision, because withdrawal from alcohol can produce life-threatening seizures. Recall from Chapter 4 that alcohol boosts the inhibition produced by GABA, leading to alcohol’s classification as a central nervous system depressant. Because withdrawal symptoms are usually the opposite of drug effects, withdrawing from a depressant produces excitation, and too much excitation leads to seizures.

    One of the remaining controversies in the treatment of alcohol dependence is whether a person can safely return to moderate drinking. Most psychologists do not believe it is possible for recovered problem drinkers to resume alcohol consumption without relapse. In one 60-year longitudinal study of men with problem drinking, few returned to moderate drinking without experiencing a relapse (Vaillant, 2003).


    Exercise was not a question for our hunter–gatherer ancestors, for whom physical work meant the difference between death and survival. In today’s sedentary lifestyle, in which many workers spend hours commuting in cars to sit for more hours in front of computers, exercise becomes something we have to consciously remember to do. Children in previous generations would dash from school to play out of doors, but social changes including lack of supervision at home and safety concerns have led to much less spontaneous, outdoor activity. Parents might prefer that their children stay indoors playing video games rather than ride their bicycles in the neighborhood. For many middle-age and older adults, loneliness might lead to less physical activity (Hawkley & Cacioppo, 2010; Hawkley, Thisted, & Cacioppo, 2009).

    In contrast to previous generations, who simply “played,” it is not uncommon today to find children as young as 3 to 5 years of age involved with adult-organized formal sports. Further research is necessary to determine the long-term impacts of this social trend on adult patterns of play and exercising.



    Lack of exercise and sitting are related but different. Today’s children and adults in the United States spend an average of 55% of their day sitting while riding in cars, watching television, sitting at work or school, and playing video games or doing other computer work (Matthews et al., 2008). Sitting predicts risk of death independently from a person’s level of exercise (see ● Figure 16.17). Although the highest risk of death occurs in obese individuals who spend nearly all their time sitting, the amount of time spent sitting also predicts mortality within a group of active individuals (Katzmarzyk, Church, Craig, & Bouchard, 2009).

    Figure 16.17Time 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 “Sitting Time and Mortality From All Causes, Cardiovascular Disease, and Cancer,” by P. T. Katzmarzyk, T. S. Church, C. L. Craig, and C. Bouchard, 2009, Medicine and Science in Sports and Exercise, 41(5), pp. 998–1005, doi:10.1249/MSS.0b013e3181930355. Illustration: © Cengage Learning®; photo: AP Images/REX

    Exercise not only benefits our bodies by keeping our muscles and cardiovascular systems in good shape but also benefits our psychological well-being. A brisk 30-minute walk has emerged as an effective way to treat major depressive disorder, as discussed in Chapter 15 (Blumenthal et al., 1999). In addition to improving mood, exercise increases cognitive performance (Hogan, Mata, & Carstensen, 2013). One mechanism for this improvement could be the increased delivery of oxygen to the brain that results from a fit cardiovascular system. Other research suggests that exercise also has the capacity to boost neurogenesis, the production of new neurons, particularly in the hippocampus of the brain (Gibbons et al., 2014). As you learned in Chapter 4, the hippocampus plays important roles in learning and memory.

    We mentioned in an earlier section that stress can be detrimental to the functioning of the immune system. Exercise can be stressful. Not too surprisingly, we find complex relationships between the amount and type of exercise a person experiences and the response of the immune system. Compared to sedentary people, those who engage in regular moderate exercise enjoy a lower rate of infection (Gleeson, 2007). However, too much of a good thing, in the form of continuous, prolonged, and high-intensity exercise, such as competition in marathons and triathlons, can produce a temporary decrease in immune system function for about a day. Elite athletes, because of their constant and intense training schedules, often experience more minor illnesses, such as sniffles and colds, but the long-term benefits of exercise far outweigh these small vulnerabilities.

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    16-5bCulture 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 not sufficient to guarantee good health (United Nations, 2007; see ● Figure 16.18).

    Figure 16.18Culture 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 World Population Prospects: The 2006 Revision” in United Nations, 2007, retrieved from © Cengage Learning®

    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 highest among the non-Hispanic Black population (CDC, 2013). 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 result from reductions in the rate of death from leading causes, including heart disease, cancer, chronic respiratory diseases, and stroke.

    Before the implementation of the Affordable Care Act, African Americans, Hispanics, and Native Americans were 2 to 3 times more likely to be uninsured (Derksen, 2013). Not only do these discrepancies burden minorities with increased disability, but they contribute to continued poverty and violence affecting society as a whole. A shortage of physicians willing to treat racial and ethnic minorities and non-English-speaking patients contributes to health disparities (Marrast, Zallman, Woolhandler, Bor, & McCormick, 2013).

    In addition to ethnic and cultural differences in overall health and health habits, discrepancies 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 (Department of Health and Human Services, U.S. Public Health Service, 2007). Among possible variables accounting for increased mental health problems among minorities are poverty, discrimination, and violence. Poverty in particular is an important risk factor for psychological disorders, with people living at the lowest levels of the socioeconomic scale experiencing 2 to 3 times greater rates of psychological disorder (Department of Health and Human Services, U.S. Public Health Service, 2007). The 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 might also deter people from obtaining the treatment they need.

    Culture contributes to risk for suicide. Between 2005 and 2009, the highest rates of suicide in the United States among individuals aged 10 years or older occurred among American Indians/Alaska Natives (17.48 per 100,000). Whites had higher risk of suicide (15.99 per 100,000) than non-Hispanic Blacks, Hispanics, and Asian or Pacific Islander groups (between 6 and 7 per 100,000; CDC, 2014b). These data suggest the presence of protective mechanisms within some cultures that offset the negative effects of minority status.

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    16-5cAn Integrated Understanding of Health Behaviors

    Poverty is a significant risk factor for many types of psychopathology.


    Distinctive Images/Shutterstock

    If you haven’t already noticed during our discussions of stress, sleep, nutrition, smoking, alcohol use, and exercise, all of these variables interact. Stress can lead to poor sleep, additional consumption of calories, more smoking, more drinking, and less exercise. People who eat poorly are unlikely to sleep well or feel like going to the gym. Smoking reduces weight (the choice of the tobacco industry to market a cigarette called “Virginia Slims” to women was no accident) but of course has negative effects on health that far outweigh that advantage. Problem drinkers 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, Cremeens, Vail-Smith, & Woolsey, 2010). Most, if not all, of 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 16.19). 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.

    Figure 16.19The Adverse Childhood Experiences (ACE) Study: An Integrated Model of Health.

    An example of contemporary research that uses an integrated model of health is the ACE Study, being undertaken by researchers affiliated with the Centers for Disease Control and Prevention. The study plans to address identified gaps in our understanding about the relationships between adverse childhood experiences, such as abuse and neglect, and later social, emotional, and cognitive impairments, which in turn could influence the adoption of risky health behaviors.


    Source: Adapted from “Pyramid: Adverse Childhood Experiences (ACE) Study.” in Centers for Disease Control and Prevention, 2010a, retrieved from © Cengage Learning®

    Summary 16.2

    Four Domains of Health Behavior

    Tobacco Use ·         Smoking is the leading preventable cause of death in the United States.
    Nutrition ·         Obesity increases rates of many chronic diseases, including heart disease, stroke, diabetes, arthritis, and some 

    ·         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.

    Credits: Top Row. Carlos Barria Reuters / Corbis . Second Row. Chuck Franklin Alamy ; / assalve ; / Arsgera ; / acilo . Third Row. Diverse Images / Universal Images Group / Getty Images . Bottom Row: Stockbroker / MBI / Alamy .

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    16-6What Is Positive Psychology?

    Although helping people with problems is an important part of psychology, some psychologists have pointed out that there are differences between making people less uncomfortable and helping them live happier, more fulfilling lives. The interventions we 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 most people, who lead relatively untroubled, typical lives? As we 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 individuals, families, and communities in their attempts to maximize their potential (Seligman & Csikszentmihalyi, 2000).

    William James foreshadowed positive psychology in his 1902 book The Varieties of Religious Experience. In this book, James discussed people who achieve “healthy mindedness” as having an understanding of the “goodness of life” and a soul (a word often used by people in James’s era as synonymous with mind) with “a sky-blue tint” (James, 1905, pp. 79–80). James goes further to speculate about the origins of healthy mindedness. For the lucky few, healthy mindedness occurs naturally and effortlessly. For others, it must be achieved through effort.

    In his book The Varieties of Religious Experience, William James foreshadowed the development of positive psychology by considering what makes some people healthy minded and gives others a “sick soul.”Mary Evans Picture Library/The Image WorksDespite James’s efforts, psychology continued its fascination with the abnormal and the unhealthy into the 20th century and did not direct the same energy toward understanding the normal and healthy. Voices of dissent arose from among the humanistic psychologists, including Abraham Maslow, whom we discussed in Chapters 7 and Chapters 12. Maslow argued that psychologists could learn more about human behavior by studying outstanding individuals than by studying people with severe problems. As part of Maslow’s thinking about self-actualization, the pinnacle of social motivation in his theory, he took detailed notes on people he admired in a “GHB (Good Human Being) notebook” that he kept between 1945 and 1949 (Lowry, 1973). In addition to making observations of living people he admired, Maslow combed through biographies and autobiographies of famous people looking for common features of healthy mindedness.

    Running parallel to the humanistic psycholgists’ rejection of a negative, sickness model of human behavior were innovations among cognitive and behavioral approaches. As we mentioned in Chapter 15, Albert Ellis and Aaron Beck were achieving excellent results with cognitive restructuring around the same time the humanistic psychologists began reconsidering Freud. Ellis and Beck were able to help their clients with depression see a glass of water as 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 approaches is that of Martin Seligman. We discussed his concept of learned helplessness in Chapter 14. If people’s outcomes do not seem connected to their behaviors, the resulting feelings of helplessness and lack of control could result in depression. Based on his investigations of learned helplessness, Seligman proposed that optimism, or thinking positively about the future, can be learned, as well as helplessness (Seligman, 1990).

    Positive psychology embraces humanistic emphases on human growth and fulfillment, yet applies the scientific reasoning and research characteristic of cognitive and behavioral psychology. Positive psychology has focused on the study of positive emotions, positive traits, and positive institutions.

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    16-6aPositive Emotions

    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

    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 accident that many of the situations, such as promotions at work, marriage, and victories, that produce these positive feelings involve other people who are important to us.

    What Is Happiness?

    We all know happiness when we experience it, and most people prefer the state of happiness to the alternatives of unhappiness and depression. Yet happiness often seems fleeting or transient. The primary reason for this elusiveness is that happiness is typically relative (see ● Figure 16.20). We quickly adapt to our current circumstances, and it is only change in those circumstances that provokes feelings of happiness or unhappiness.

    Figure 16.20Global Happiness.

    In a study of life satisfaction, health, wealth, and education were the three most important predictors of happiness. The five happiest countries were Denmark, Switzerland, Austria, Iceland, and the Bahamas, with the United States ranked 23, China ranked 82, Japan ranked 90, and Russia ranked 167.


    Source: Adapted from “First Ever World Map of Happiness Produced,” by, July 28 2006, retrieved from © Cengage Learning®

    Research with identical twins suggests that we have a happiness “set point” that is largely influenced by genetics (Lykken & Tellegen, 1996). Changes in circumstances might raise or lower happiness from the set point, but the effect would be temporary. However, having a genetic predisposition to being happy or to being cranky does not mean that a person’s behavior has no influence. Instead, people can do a great deal to improve their happiness. Rather than looking for external things to boost happiness, such as a new car or a new nose, looking within is more effective. Happiness can be improved by thinking carefully about what things interfere with our happiness, such as allowing ourselves to stay mad at a partner following an argument, and working to avoid these situations.

    One critical factor in people’s happiness is the strength of their interpersonal relationships. When participants are asked, “What is necessary for your happiness?” or “What is it 
that makes your life meaningful,” nearly everybody talks about their close relationships first—family, friends, and romantic partners (Berscheid & Peplau, 1983). This finding is consistent with one of the ongoing themes of this text: social environment plays a central role in human behavior.

    Happiness and Marriage

    Among interpersonal relationships, the institution of marriage is particularly likely to contribute to happiness (see ● Figure 16.21). 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, Smith, & Marsden, 2006). Eighteen percent 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 5 years, people who remained married experienced higher well-being than those who separated or divorced (Waite, Luo, & Lewin, 2009). 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).

    Figure 16.21Relationship Status and Happiness.

    Many studies have pointed to a strong relationship between being married and subjective well-being.


    Source: Adapted from “The Long-Term Consequences of Relationship Formation for Subjective Well-Being,” by J. P. M. Soons, A. C. Liefbroer, and M. Kalmijn, 2009, Journal of Marriage and Family, 71(5), pp. 1254–1270, doi:10.1111/j.1741-3737.2009.00667.x. © Cengage Learning®

    Why would marriage make people happy? One possibility is that the relationship between marriage and happiness is a false one because of the likelihood that happy people produce happy marriages instead of the other way around. Careful research that controls for premarital happiness does not support this hypothesis (Horwitz, White, & Howell-White, 1997). Regardless of how happy you are before marrying, on average being married makes people happier. If you’re thinking of cases you know in which married couples are miserable, time together seems to help. Among the unhappiest couples, only 12% report being unhappy 5 years later. Seventy percent of the formerly unhappy partners report being “very” or “quite” happy (Horwitz et al., 1997).

    What is the source of this marital happiness? Traditionally, psychologists have suggested that marital happiness results from the perceptions one partner has of the other. More sophisticated analyses have shown that the factors associated with marital happiness are more complicated (Luo, Zhang, Watson, & Snider, 2010). While it’s true that perceptions of your partner influence how satisfied you are in a relationship (“I’m with a great person”), it is also true that your overall satisfaction with the relationship affects how you see your partner (“I’m happy, so I must be with a great person”). Then, what is the source of that satisfaction? A major factor in satisfaction with a relationship is how you see yourself perceived by your partner (“My partner thinks I’m terrific, which makes me happy, and because I’m happy, I must be with a great person”).

    Thinking Scientifically

    Does Parenting Increase Happiness?

    IN Chapter 7, we noted that an update of Abraham Maslow’s hierarchy of needs pyramid featured parenting at the top to represent this role’s importance from an evolutionary perspective (Kenrick, Griskevicius, Neuberg, & Schaller, 2010).

    Parenting in the 21st century, however, probably shares little similarity with parenting for our hunter–gatherer ancestors. The goal of contemporary marriages has less to do today with financial survival or raising families than it has with meeting partners’ emotional needs (Dew & Wilcox, 2011). A major predictor of marital satisfaction is time spent with a partner, so where does that need fit with the challenges of meeting the demands of a family of young children?

    Some research suggests that parenting results in lower marital satisfaction, which increases with the number of children (Twenge, Campbell, & Foster, 2003). This result is most pronounced among younger, higher income mothers of infants. Even in the 21st century, the arrival of the first child has a tendency to “traditionalize” the gender roles of the new parents. Fathers begin to take on more of the income-earning responsibilities and mothers take on more of the childcare and housework. Her changing roles might make the new mother less happy with her circumstances (Dew & Wilcox, 2011).

    Other researchers disagree. In another set of studies, parents evaluated their lives more positively than nonparents, felt better than nonparents from day to day, and found more satisfaction in caring for their children than in other daily activities (Nelson, Kushlev, Dunn, & Lyubomirsky, 2014; Nelson, Kushlev, English, Dunn, & Lyubomirsky, 2013). Parenting contributed to more positive emotions on a daily basis and to the sense of having a meaningful life, concepts consistent with the approach to happiness held by some positive psychologists.

    Evolutionary theories view parenting as an important motivation 
for human behavior, 
yet contemporary psychologists debate whether parents are truly happier than nonparents.


    Mint Images Limited / Alamy

    What might be the source of the discrepancies? One possibility is that parents as a group are highly diverse. Parenting under some circumstances can be more stressful than under others. Young, unpartnered parents not too surprisingly reported less happiness and satisfaction than their nonparent age peers yet still indicated they felt their lives were meaningful (Nelson 
et al., 2013). ●

    Happiness and Wealth

    Another commonsense notion about happiness is that wealth can make you happy. After all, we see frequent images of ecstatic lottery winners and smiling sports superstars who have signed megabuck contracts. At both national and individual levels, being poor does appear to be correlated with being unhappy. However, once basic needs are met, additional money does not guarantee happiness (see ● Figure 16.22). Interviews with the 100 richest people in the United States indicated that they were only slightly happier than average (Diener, Horwitz, & Emmons, 1985). In addition, how people use their wealth can influence happiness. People who are less materialistic report being happier than people who are materialistic (Tsang, Carpenter, Roberts, Frisch, & Carlisle, 2014).

    Figure 16.22Wealth and Happiness.

    When adjusted for inflation, Americans’ after-tax disposable income grew dramatically between 1946 and 1989, but measures of subjective well-being remained flat. Increases in income above a certain point where basic needs can be met tend to have mild, if any, long-term impacts on happiness.


    Source: Adapted from “Subjective Well-Being: Three Decades of Progress,” by E. Diener, E. M. Suh, R. E. Lucas, and H. L. Smith, 1999, Psychological Bulletin, 125(2), Figure 1, doi:10.1037/0033-2909.125.2.276. © Cengage Learning®

    Lottery winners experience an increase in happiness, but they tend to be cautious about changing their lifestyles. Most continue working and attempt to maintain as normal a life as possible.


    John Tlumacki/The Boston Globe/Getty Images

    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 United Kingdom national lottery, reported that winning the lottery did have an impact on happiness (Camelot Group, 2004). Sixty-five percent of winners reported that they were happier following the win because of financial security and increased freedom. Thirty-five percent said that they were about as happy after winning as before. None reported feeling less happy than before the win. Although the winners traded up in terms of lifestyle (most had bought new cars and new homes), 92% of those who were married when they won were still married to the same spouse.

    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. Additional analyses by these same researchers further indicated that happy people form better relationships and that these better relationships contribute to larger increases in income, perhaps because of improved job performance, better performance reviews and promotions, and better “networking” opportunities that lead in financially productive directions.

    Results from the Gallup World Poll, the first representative sample of all people on the planet, showed that financial wealth and social psychological “wealth” predict different types of well-
being across many cultures (Diener, Ng, Harter, & Arora, 2010). Social psychological wealth is measured by the respect you received; closeness with family and friends; the opportunities to learn, do what you do best, and choose how to spend your time; and the need to work long hours. A single “happiest nation” measure does not seem supported by the data. Central American and some African nations have greater social psychological wealth than financial wealth, while nations previously in the Soviet bloc experience much higher financial wealth than social psychological wealth. The United States ranks first in financial wealth and 19th in social psychological wealth. Financial wealth predicted global measures of life satisfaction, but social psychological wealth made much stronger predictions of the presence of positive emotions like happiness.

    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, the good life, and the meaningful life (Seligman, 2002; Seligman & Csikszentmihalyi, 2000). The pleasant life describes the pleasures we enjoy from moment to moment. Enjoying a great meal or a beautiful sunset enhances our daily experience. 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 scores are high. If scores on one of these aspects are 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 scores 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 happiness. 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 was.

    Researchers studying happiness identify three types. The pleasant life consists of pleasures, like ice cream, that are enjoyed from moment to moment. The good life features “flow” and a sense that time is standing still. The meaningful life describes the positive emotions obtained by helping others.


    BlueOrange Studio/Shutterstock

    Even if heritability affects our ability to experience pleasure, positive psychology has some suggestions for enhancing our experiences. How often have you eaten your meals while watching television, reading, or working on your computer? If you try to multitask in this way, it is unlikely that you will derive much pleasure or satisfaction from your food, which can lead to overeating. Learning to “savor” pleasurable experiences by paying more attention to them can make them more memorable and enjoyable (Bryant & Veroff, 2007).

    The good life is somewhat easier to modify than the pleasant life. To enhance your happiness from the good life, all you have to do is identify 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, usually 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 to stand still for people who are immersed in flow.

    We are not suggesting that happiness can be found by spending all your time playing video games; instead, we recommend that you seek this type of flow in the work and hobbies you enjoy.

    People who do not play video games are often astonished by the nearly compulsive attractiveness of the activity for those who do play. However, video games meet many of the criteria for a flow experience (Csikszentmihalyi, 1990). The games have clear goals (reaching the next level or beating a dungeon boss), they provide the opportunity to focus, they encourage a merging of action and awareness (as opposed to self-consciousness), and players generally experience a distortion of subjective time (hours go by quickly). In addition, games provide instant and precise 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 a parent has diabolically used access to gaming as a reinforcer for other desired behaviors, 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.

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    16-6bPositive Traits

    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 experience of a distortion of time for the player.



    In an effort to further understand the sources of well-being, positive psychologists have built upon the trait theories we discussed in Chapter 12. Among the traits that contribute to well-being are hope, resilience, spirituality, and gratitude.

    Hopeful people are capable problem solvers who believe that their goals can be met in the future.



    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, or a belief in a positive future. 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 you desire. Being a hopeful person provides a number of benefits to well-being. Hopeful people withstand more pain and stress, because they believe the future will be better (Snyder et al., 2005). Hopeful people are more capable problem solvers, because they are likely to consider alternate pathways for meeting their goals instead of giving up at the first obstacle. Finally, hopeful people usually enjoy strong social networks, because other people find hope attractive (Snyder, Rand, & Sigmon, 2002). You can test your levels of hope in the following section.

    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 willingness to share emotions. Trauma can also lead people to reduce the value they place on material aspects of life, such as money and possessions, while increasing their sense of what is truly meaningful about life.

    Experiencing Psychology

    The Trait Hope Scale

    USE THE SCALE in Table 16.2 to respond to the items listed on the next page. Select the number that best describes you in the space provided.

    table 16.2

    The Trait Hope Scale

Definitely false2 
Somewhat false4 
Slightly false5 
Somewhat true7 
Definitely true
    _____  1. I can think of many ways to get out of a jam.
    _____  2. I energetically pursue my goals.
    _____  3. I feel tired most of the time.
    _____  4. There are lots of ways around any problem.
    _____  5. I am easily downed in an argument.
    _____  6. I can think of many ways to get the things in life that are important to me.
    _____  7. I worry about my health.
    _____  8. Even when others get discouraged, I know I can find a way to solve the problem.
    _____  9. My past experiences have prepared me well for my future.
    _____ 10. I’ve been pretty successful in life.
    _____ 11. I usually find myself worrying about something.
    _____ 12. I meet the goals I set for myself.

    © Cengage Learning®

    Scores on this test can range from 8 to 64. To obtain your overall hope score, add your responses to items 1, 2, 4, 6, 8, 9, 10, and 12. (The other items are distractors.) The higher your score, the greater hope you have for the future. The average score among college students in 1991 was 25 (Snyder et al., 1991). How does that compare with your score and your classmates’ scores? What factors in your life do you think influence your score? ●

    Nobody wants to experience trauma, but some survivors report experiencing posttraumatic growth. Mike Atherton lost both legs and his left arm in a boating accident but has returned to performing with the Tampa Bay Water Ski Show Team and reports feeling optimistic about his future.


    ZUMA Press, Inc/Alamy

    As we mentioned in a previous section, the experience of a meaningful life enhances well-being and happiness. Although finding meaning simply refers to recognizing things that are bigger than one’s personal existence, some people achieve meaningfulness through religious practice (Myers, 1993). Religious beliefs and practice have also been associated with a long list of health benefits, because most major world religions promote healthier lifestyles (Emmons, Barrett, & Schnitker, 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 activities is a behavior, it is strongly predicted by a person’s need for deeper meaning, or trait spirituality (Pargament & Krumrei, 2009).

    Organizations such as Rotary International often reinforce the values of their members, such as “service above self.” Source:Service Above Self and the Service Above Self logo are trademarks of Rotary International and used herein with permission.Rotary InternationalThe idea of individual traits related to well-being has been extended to include shared social values and experiences, resulting 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, 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” (1961, p. 454). One effort to identify values combined those listed by major world religions 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, peaceful, tolerant, kind, generous, trusting, assertive, self-control, self-confidence, communication, leading, and autonomous. Additional lists have added some interesting items, such as awe and forgiving (Peterson & Seligman, 2004).

    One interesting difference between the positive psychologist’s discussion of values and the personality psychologist’s discussion of traits is the judgmental approach to values. In discussing personality traits, we don’t want to think of traits as necessarily good or bad. A variety of personalities, such as the introverted computer programmer and the extroverted salesperson, helps meet the needs of societies. In contrast, the values discussed by positive psychologists are good, and to be without them is not so good. This deviation from being nonjudgmental represents a significant departure by the positive psychologists from the humanistic psychologists, who argue strongly against any type of outward judgments of others.

    Do values matter in everyday life? As we saw in Chapter 13, attitudes and behavior may or may not correlate. However, possessing certain values seems to correlate with a number of positive outcomes. Participants’ self-ratings on the 13 values mentioned earlier are positively correlated with measures of self-esteem (Franken, 2002). In addition, explosiveness, or a propensity to violence, was negatively correlated 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 addictions or to experience anxiety and depression.

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    16-6cPositive Institutions

    Google captured the coveted number one spot in the 2014 Fortune list of 
the top employers. The company encourages the “meaningful life” by donating $50 for every 5 hours of volunteer work completed by an employee. Google’s practice of making every employee a stockholder is an example of a positive institution’s reciprocal caring.


    Самолыго Юрий/ITAR-TASS/Newscom

    Positive psychologists study the roles of institutions such as workplaces, schools, and families in promoting well-being in the community. What characteristics should we strive for in our institutions to raise the likelihood that members of the community will lead satisfying lives? Positive institutions share several features (Peterson, 2006). They share a purpose in the form of institutional goals. Their rules and consequences are fair. They feature a reciprocal caring by the institution for its members and by the members for the institution. A positive institution 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 people feel about their work (Wrzesniewski, McCauley, Rozin, & Schwartz, 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 gaining both personal achievement and a sense of contributing to the community. When workers view their employment as a calling, they are less concerned with work conditions, salary, benefits, and status. Positive workplaces facilitate the workers’ abilities to meet their personal work-related goals.

    Schools from kindergarten through college are particularly important to the health and future of a community. In a manner similar to psychology’s emphasis on disorders, most of the research in education has focused on what goes wrong in schools rather than on what schools are doing well. Positive schools promote growth and produce a sense of satisfaction in students. Although this area is sparsely studied, student satisfaction with schools predicts a number of positive outcomes, including higher grades and fewer problem behaviors, even as early as kindergarten (Ladd, Buhs, & Seid, 2000).

    Significant challenges face today’s families, and identifying what works could provide guidance for many. Family-centered positive psychology (FCPP) focuses on the characteristics of positive families (Sheridan & Burt, 2009). Consistent with the general approach of positive psychology, FCPP identifies the strengths of families rather than emphasizing their failures and weaknesses.

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    16-6dPositive Psychology and the Future

    Positive psychology is not without its critics. Among the weaknesses seen in positive psychology are its unintended negative effects on people who face medical and psychological challenges (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 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, Berntson, Norris, & Gollan, 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 we described for evaluating interventions for “negative” behaviors to interventions based on positive psychology, we will figure out the role 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?

    It’s often the little things that people do for their partner that result in gratitude and a stronger commitment to the relationship.Matthias Tunger/CorbisWe have studied relationships from the vantage points of 15 psychological perspectives so far in this textbook, and we end the journey with an analysis of the role of a positive 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) influences 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 positive emotion of gratitude. Gratitude includes the feelings of thankfulness and appreciation felt for the partner, which in turn affects perceptions of who the partner is as a person (Joel, Gordon, Impett, MacDonald, & Keltner, 2013). When people experience gratitude for a partner, it stimulates further commitment. The amount of commitment an individual experiences is linked to the perceived investment in the relationship on the part of the partner.

    What types of investment promote stronger gratitude, and through those feelings, greater commitment? You might guess that financial investments would be important, but research has shown that intangible investments, like emotional involvement, have a greater impact on commitment (Goodfriend & Agnew, 2008). This is reminiscent of the finding discussed earlier that it is not wealth that makes us happy but rather our social connectivity. ●

    Summary 16.3

    Types of Happiness

    Source of happinessHow to get itExamples
    The pleasant life Savor your experience without trying to multitask.Turn off the TV when you’re trying to enjoy a meal.
    The good life Find ways to incorporate your key strengths into your activities.Choose an occupation that you truly enjoy, not just one that pays the bills.
    The meaningful life Focus on something bigger than 
yourself.Volunteer for a cause that’s important 
to you.
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