普通心理学13心理压力与健康

Chapter12Stress,coping&health疾病/健康病源学的转变Contagiousdiseases(传染病）：由传染源引起的疾病，如天花、伤寒、疟疾、白喉、黄热病、霍乱、脑灰质炎、肺结合等—20世纪之前的致命疾病；与nutrition,publichygiene,sanitationandmedicaltreatment等有密切关系.Chronicdiseases(慢性病):heartdisease、cancer、stroke(中风）等，生活压力（应激）、生活方式等因素是慢性病形成的主要原因。心身病（蔡能等，1985)心理因素在疾病的发生和病程演变中起主导作用的躯体疾病。例如情绪，通过植物神经、内分泌、肌肉骨骼系统、皮肤及免疫系统等受累而引起的症状群及疾病。病源分析（蔡能等，1985）身心分离观点（传统医学观点）：细胞疾病--》组织结构改变---》功能障碍；身心统一观点：情绪（心理）因素---》功能障碍（？？）---》细胞疾病---》组织结构改变。HealthpsychologyHealthpsychologyDiscoveryofcausation,prevention,andtreatment（病因、预防及治疗）Healthpromotionandmaintenance（健康的促进和保持）Bio-psychosocialmodel（生物心理社会模型）:身体疾病由生物、心理及社会文化等因素相互作用引起。NatureofstressDefinationofstress（应激、紧张）Stressors(应激源):eventsorcircumstance(what?)Threatenorperceivedthreatenone’swell-being:(why?)Cognitiveappraisal：whataffectappraisal？Needtocoping:how?FrustrationFrustration（挫折、打击）-blockedgoal（与目标不一致）-Trafficjams-failure-loss;情绪：愤怒、恐惧、悲伤；心境：抑郁、焦虑；生理：血压（Novaco,etal.1990)；Conflict——twoormoreincompatiblemotivations冲突的三种类型（Lewin,andMiller(1944)Approach-approach(双趋性冲突）：鱼与熊掌；Avoidance-avoidance（双避冲突）：approach-avoidance（趋避冲突）：进退两难、犹豫不决、举棋不定；NealMiller(1944)的实验：趋（食物+电击）避（无食物+无电击）冲突；---LauraKingandRobertEmmons(1991):以问卷调查内心冲突与焦虑、抑郁、及生理症状的关系；conflictsconflictsChange:havetochangeTwoissues:Whatchangesledtostress?Degree?Whatconsequence?HolmesandRahe:SocialReadjustmentRatingScale(SRRS)—耗费更多的能量。。。。肺结核的心理因素调查：结婚、晋升、有小孩等；消极刺激；生活变化大，生理疾病和心理问题也多一些（Creed,1993)；----疾病与生活应激的相关研究；SocialreadjustmentratingscaleDeathofspouse100Divorce73Jailterm63Marriage50Firedatwork47Retirement45Changeinschool20Vacation15学生压力量表(HolmesandRaber)Pressure:expectationtobehaveincertainwaysPerformancepressureSalespeopleProfessorActorStudentConformpressure（相符）。来源于关系期望的压力（工作、学校、家庭、朋友等）；与自我期望有关（ideaself&realself);压力与心理问题、生理疾病。国内研究恋爱婚姻与家庭内部问题；恋爱婚姻；子女与父母关系；家庭关系变迁；学校与职业场所的问题；失学；失业；社会生活变化与个人特殊遭遇灾难性事件；《生活事件量表》RespondingtostressEmotionalrespondingPhysiologicalrespondingBehavioralrespondingFigure13.4Overviewofthestressprocess.Apotentiallystressfulevent,suchasamajorexam,elicitsasubjectiveappraisalofhowthreateningtheeventis.Iftheeventisviewedwithalarm,thestressmaytriggeremotional,psychological,andbehavioralreactions,aspeople’sresponsetostressismultidimensional.Respondingtostress:emotionalresponsesStress-》specificcognitivereaction—》specificemotion(SmithandLazarus,1991)Selfblame自责--》Guilt内疚；Helplessness无助---》sadness悲伤；Commonemotionalresponse:annoyance(烦恼）,anger,andrage;apprehension（忧虑）；anxiety（焦虑）,andfear;dejection（沮丧）,sadnessandgrief（悲痛）；EmotionalresponsesCasper,etal.(1987)的研究被试：96女性，时间28天任务：报告她们每天生活中紧张事件与心情；结果：stressledtonegativemood;Emotionalresponsetostress研究：253Care-givingpartnersofmenwithAIDs’copingpattern（Folkman，1997)存在一定的正情绪；Positiveemotions:interestandjoy;Promotecreativityandflexibility;加速信息加工过程；减弱不良的生理反应；情绪反应的作用/功能？EffectsofemotionalarousalEmotionalarousalandperformance(成绩/绩效）Theinverted-U-hypothesis（倒U曲线）--简单任务需要较高唤醒水平；--中等难度任务在中等唤醒状态下成绩最好；--复杂任务在较低唤醒状态下才有较好成绩。情绪与认知关系；Figure13.5Arousalandperformance.GraphsoftherelationshipbetweenemotionalarousalandtaskperformancetendtoresembleaninvertedU,asincreasedarousalisassociatedwithimprovedperformanceuptoapoint,afterwhichhigherarousalleadstopoorerperformance.Theoptimallevelofarousalforataskdependsonthecomplexityofthetask.Oncomplextasks,arelativelylowlevelofarousaltendstobeoptimal.Onsimpletasks,however,performancemaypeakatamuchhigherlevelofarousal.PhysiologicalResponsesFight-or-flightresponse。W.Cannon(1932):cats与dogs的实验；result:increasedinbreathingandheartrateanddecreasedindigestiveprocesses。现代生活与应激的生理反应；RespondingtoStressPhysiologicallyHansSelye：GeneralAdaptationSyndromePhysicalandpsychologicalstress:cold,heat,pain,mildshock,restraint,et.Al.Stressfulresponse:nonspecificreactions.Generaladaptationsyndrome:Alarm（警觉）:fightorflightresponse,Resistance（抵抗、坚持）:prolongedstress,Exhaustion（疲乏，衰竭）:diseaseofadaptation(适应疾病）；一般适应症候群和慢性应激长期压力带来的生理反应是什么?一般适应症候群报警阶段抵抗期疲惫期心身失调一般适应症候群的三个阶段Brain-bodypathways（Felker&Hubbard,1998)Pathway(I):Stress-hypothalamus(下丘脑）-ANS-adrenalmedulla(肾上腺髓质）-catechizations(儿茶酚胺）--增强活动（心血管、呼吸、运动系统激活）。Pathway(II):Stress-hypothalamus-Pituitarygland(脑垂体)-ACTH肾上腺皮质激素-adrenalcortex-corticosteroids(皮质类固醇素/可的松）--增强能量消耗（proteinandfat）。Effectofstressonimmunesystem(免疫系统）;Figure13.6Brain-bodypathwaysinstress.Intimesofstress,thebrainsendssignalsalongtwopathways.Thepathwaythroughtheautonomicnervoussystemcontrolsthereleaseofcatecholaminehormonesthathelpmobilizethebodyforaction.Thepathwaythroughthepituitaryglandandtheendocrinesystemcontrolsthereleaseofcorticosteroidhormonesthatincreaseenergyandwardofftissueinflammation(Felker&Hubbard,1998).应激中的躯体反应拖沓的健康成本研究者鉴别了拖沓和不拖沓者后要求被试在学期初和学期末报告体验躯体疾病的症状.Coping应对:Activeeffortstomaster,reduce,ortoleratethedemandscreatedbystress.Adaptive&maladaptivecoping;Problem-focusedcoping&emotionalfocusedcoping;DifferencefromconceptofEmotionregulation(?)Copingstyles：consistentacrosssituations；RespondingtoStressBehaviorallyLaunchVideo几种应对反应应激预应付可控制的应激源不可