250 words DQ

Chapter 13:

Social Psychology, Stress, and Health

A doctor sits and talks with a soldier.


Learning Objectives

By the end of the chapter you should be able to:

Define stress and contrast the fight-or-flight

response, the tend-and-befriend pattern, the

general adaptation syndrome, and the transaction model of stress

Explain the connections between stress and health

Compare problem-focused and emotion-focused


Define emotional social support and tangible, or instrumental social support, and perceived social support

Explain how personal control, learned helplessness, optimism, unrealistic optimism, and pessimism relate to health

Describe how premature closure, confirmation bias, primacy effect, recency effect, and stereotypes affect the decisions of health care providers

Explain how the theory of planned behavior and the health belief model help predict health behavior

Chapter Outline

13.1 Stress

Theories of Stress


13.2 Personal Beliefs and Health

13.3 Decision Making by Health Care Providers

13.4 Encouraging Healthy Behaviors

Chapter Summary

* * *

Expand Your Knowledge: Health Psychology

As a subfield of psychology health psychology looks at behavioral factors in health. To learn more about health psychology see: http://healthpsychology.org/what-is-health-psychology/.

Medicine has made enormous strides in treating diseases. In 1900, the leading causes of death in the United States were pneumonia and influenza, tuberculosis, diarrhea and other intestinal disorders and diseases of the heart (Centers for Disease Control, n.d.). Many of these causes for death are rare today. In recent years the leading causes of death have been heart disease, cancer, chronic lower respiratory diseases, stroke, and accidents (Centers for Disease Control, 2013). Among the major contributors to these health issues is lifestyle and behavior. As society has brought down rates of diseases that can be treated with medication, surgery, and other medical interventions, health related behavior has become more of a factor. Psychology, as a field that studies human behavior, can be helpful in understanding health. Health psychology is a subfield of psychology that studies the behavioral factors in health. As a close sibling of social psychology, the fields contribute to one another. Some of the findings of the basic research in social psychology are applied by health psychologists, and the findings of health psychologists allow for better understanding of these theories and contribute new ideas for social psychologists to consider.

13.1 Stress

A woman holds her face in frustration as she sits in front of her laptop.


The assignment of a difficult research paper could be a stressor for students.

Bodies, thoughts, and behaviors clearly interact in the case of stress. Stress occurs when people perceive the demands upon them to require additional resources from them. The events and issues that create stress for a person are called stressors. Stressors come in a variety of forms. Changes in people's lives can be stressors. Losing a job, moving, or getting a cancer diagnosis are all stressors. Though we generally think of negative events as being stressful, positive events can also create stress in our lives. Starting a new job, getting married, and celebrating a holiday can all be stressors (Holmes & Rahe, 1967). Stressors also come in the form of daily hassles. Getting stuck in traffic, having a phone that drops your calls, and dealing with a broken elevator can all create stress and have a negative impact on the person (Chamberlain & Zika, 1990; McIntyre, Korn, & Matsuo, 2008).

When we experience stress, our bodies release hormones (Charmandair, Tsigos, & Chrousos, 2005). These hormones are designed to allow the body to deal with a stressor. The hormones affect the body by increasing blood pressure, respiration, and heart rate and suppressing digestion. This physiological reaction has been called the fight-or-flight response (Cannon, 1932). The fight-or-flight response involves a preparation to either fight the stressor or get away from the stressor. When, for example, you are faced with a bear in the woods the body's stress response prepares you to either fight that bear off or run away. The body needs you to be activated to run and does so by increasing blood pressure, respiration, and heart rate and shutting down things that do not need to be done right away, like digestion.

Expand Your Knowledge: Fight-or-Flight

A variety of hormones are released and systems are activated when the fight-or-flight response occurs. Check out this link for more details on how specific body systems respond to stress: http://science.howstuffworks.com/life/fear2.htm.

Although the fight-or-flight response has received support from a large number of studies over decades, there is some debate about its applicability to women. Taylor and colleagues (2000) argue that for women the stress response is better characterized with a tend-and-befriend pattern. Rather than fighting or fleeing, the tend-and-befriend pattern leads people to focus on protecting and caring for others, particularly offspring, and to turn to others for help in the face of stress. This is an adaptive mechanism for women because they invest a great deal in and are often primarily responsible for vulnerable offspring, as discussed in the chapter on gender and culture. Fighting might put a woman and her offspring at risk and fleeing is difficult when pregnant or carrying a young child. Quieting a child so one is not noticed and turning to others to help when faced with a stressor can keep a woman and her offspring alive. Tend-and-befriend can be an adaptive stress reaction pattern for women.

Test Yourself

Click on each question below to reveal the answer.

What is the difference between stress and stressors?

Of the fight-or-flight response and tend-and-befriend pattern, which better characterizes the stress response of women?

Theories of Stress

The theories of stress and coping described in this section incorporate biological and psychological responses. One of the first researchers to describe the stress process is Hans Selye. Selye's model of the process is called the general adaptation syndrome (Selye, 1951). What Selye noticed was that organisms tended to have the same response to challenge no matter what that challenge might be. In other words, whether you are faced with a bear in the woods or a difficult test in class, your body reacts the same way. The first stage of the general adaptation syndrome is the point at which the body is marshaling its resources. This stage is called the alarm stage. If you imagine the body like a country getting ready to fight an enemy, this would be the stage where the country amasses the troops and moves them to the battlefield. If a stressor goes away before a person moves on to the next stage, that person might notice having a great deal of energy, a preparation to fight without a battle to be fought. If you have ever been in a situation where you thought you might be in danger but then found out all was well, you may have found yourself jittery or shaky with too much adrenaline. Your reaction illustrates the alarm stage of the general adaptation syndrome.

The next stage is called the resistance stage. In this stage, you use your marshaled resources to deal with and adapt to the stressor. The resistance stage can be short if the stressor is successfully dealt with, or longer if the stressor continues to be present. If we return to the analogy of the body like a country dealing with an enemy, the resistance stage involves continual battles to defeat the enemy. If the battle is won and the enemy is defeated the country can go back to its peace-time activities, but if the battle continues, then the country is likely to suffer. Although the body's response in the resistance stage can be helpful for dealing with a stressor, dealing with long-term stressors can be harmful to the body. Constant stress is related to cardiovascular disease, hypertension, ulcers, and many other negative health outcomes (Jackson, Knight, & Rafferty, 2010; Juster, McEwen, & Lupien, 2010).

When a stressor continues for too long eventually the body's resources are depleted and the final stage in the general adaptation syndrome is reached, the exhaustion stage. The depletion of resources can lead to things like depression or other types of mental breakdown. Sometimes the exhaustion stage manifests itself in physical illness or even, in truly extreme circumstances, death (Appels, 1999; Kop, 2003). Workers who experience burnout have reached this stage of the general adaptation syndrome. Burnout is related to emotional exhaustion, depersonalization, as well as physical problems (Bernier, 1998; Daniel & Schuller, 2000; Pearlman & Hartman, 1982). Recovery from work burnout can take years (Bernier, 1998).

The general adaptation syndrome model that Selye developed assumes that all organisms deal with all stressors in the same way. Other models of stress take into account differences in the way people view and handle stressors. Lazarus and Folkman (1984) propose that stress involves a relationship between the person and the environment, not simply the environment imposing stressors on the person. In order for an issue to be stressful, individuals must view the issue as taxing or exceeding their ability to deal with the stressor. For example, if you found out you had a presentation next Thursday, that is a potential stressor, but how it affects you depends on how you think about it. Lazarus and Folkman's stress management technique, known as the transactional model, is based on the interaction between people and their environment. The first step according to this model is to appraise the event or issue, called "primary appraisal." If you view your presentation on Thursday as stressful, you must then assess your ability to cope with it, which is "secondary appraisal." If you have a lot of other work between now and Thursday and are unfamiliar with the topic of your presentation, you will view the event as much more stressful than if you know you have plenty of time and are very familiar with the topic. Even after secondary appraisal, new information about the event can change your perspective through reappraisal. For example, if you find out that the presentation you thought had to be an hour was actually 15 minutes, you may find it much less stressful than you had initially thought. As you can see, the same event might be quite stressful to one individual and hardly stressful to another.

Stress can make people more vulnerable to infectious diseases, like colds, and can contribute to more severe or chronic diseases like cardiovascular disease and diabetes as well as mood disorders (Calabrese, Molteni, Racagni, & Riva, 2009; Kendall-Tackett, 2010; Marsland, Bachen, & Cohen, 2012; Pedersen, Bovbjerg, & Zachariae, 2011; Phillips, Der, Shipton, & Benzeval, 2011; Stone, Reed, & Neale, 1987). This occurs through bodily reactions, such as a reduced immune system response and increased inflammatory response, and through the use of fewer health-promoting and more health-harming behaviors in times of stress (Boardman & Alexander, 2011; Jackson et al., 2010; Kendall-Tacket, 2010; Miller, Chen, & Cole, 2009). In times of stress, some people's eating habits might tend toward foods that are high in fat and calories, or they may engage in habits like smoking or drinking in excess. Stress, then, induces a physiological response and influences peoples' behavior. The body's response to stress makes us more vulnerable and exacerbates factors related to disease.

Test Yourself

Click on each question below to reveal the answer.

What are the three stages of Selye's general adaptation syndrome?

Do people always reach the exhaustion stage of the general adaptation syndrome?

When you are faced with a stressor, what happens, according to the transactional model?


What a person does to deal with a stressor is called coping. Coping comes in a variety of forms, which have different effects on the individual. One major differentiation in the types of coping is a focus on dealing directly with the problem or a focus on dealing with the emotions that stressor invokes (Folkman & Lazarus, 1988; Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986). Problem-focused coping will differ depending on the stressor; examples might include developing a study plan and studying for the test on Thursday, sitting down and having a discussion with a significant other who is acting strangely, or going to the doctor for help with a persistent cough. No matter the specific strategy used, problem-focused coping involves confronting a problem head on and coming up with or implementing a plan to deal with the problem (see Figure 13.1). Emotion-focused coping also contains a variety of specific strategies. Using emotion-focused coping might involve talking to someone about one's emotions, focusing on emotions brought up by the issue rather than the stressor itself, denying the event occurred or reinterpreting it and one's emotional response to it (Carver, Scheier, & Weintraub, 1989).

Figure 13.1: Problem-focused versus emotion-focused coping

Diagram showing the difference between problem-focused coping and emotion-focused coping. The top of the illustration shows the stressor, giving a speech, and the silhouette of a person standing in front of a microphone. Two arrows point down from this illustration to two separate boxes. One box is labeled "problem-focused coping" and shows the person talking into a mirror. The other box is labeled "emotion-focused coping" and shows the person talking with a friend.

Problem-focused coping deals with directly confronting the stressor (in this case, practicing for the speech). Emotion-focused coping involves managing emotions (in this case, speaking with a friend about the stressor).

Generally, confronting a problem results in a better outcome than simply managing one's emotions (Ben-Zur, 2009; Penley, Tomaka, & Wiebe, 2002). Often times, both of these strategies are employed when confronted with a problem, which also can be effective (Billings & Moos, 1981). If a parent received a note from a teacher about a child's disruptive behavior, the parent might call the school to set up an appointment to talk with the teacher, a problem-focused coping strategy, and then call up a friend to talk about the frustration the note evoked, an emotion-focused coping strategy. This combination of strategies is helpful to dealing with all the aspects of stress (Sideridis, 2006).

Positive, emotion-focused coping strategies are important for avoiding rumination. Rumination occurs when we focus attention on and continue to think about a stressful event (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Rumination has been found to lead to depression, particularly when stress levels are high, as well as bulimia and substance abuse (Nolen-Hoeksema, Stice, Wade, & Bohon, 2007; Mezo & Baker, 2012). Emotion-focused coping strategies that allow people to deal with their emotions and get past them result in a decrease in stress. Rumination keeps the stressor in mind and leads to continued high levels of stress (Rood, Roelofs, Bögels, & Arntz, 2012; Zoccola & Dickerson, 2012). Emotion-focused coping that allows one to identify and deal with emotions is positive for well-being and may also be related to more effective problem-focused coping (Baker & Berenbaum, 2007).

Although some coping styles may be more adaptive than others, what is most needed is a match of the type of stressor and the type of coping used (Penlye et al., 2002). When a stressor is one that can be controlled, such as dispute with a neighbor, coping that is more active and focuses on the problem, like talking with that neighbor, is likely to be helpful. If, however, the stressor is largely uncontrollable, such as violence in the neighborhood, such active coping strategies are maladaptive and unhelpful to the individual (Homberg, 2012). When a stressor cannot be controlled or changed by using problem-solving strategies, then focusing one's efforts on dealing with the negative emotions the stressor creates is the most adaptive strategy.

In addition to coping strategies, psychological resources can help make stress less problematic. Social support—the relational support one gets from other people—can be a resource in dealing with stress. Social support received during a time of stress can help the individual deal with the stressor (Bolger, Zuckerman, & Kessler, 2000; Krause, 2007; Liang, Krause, & Bennett, 2001). For example, talking with a friend about how an angry client at work made you unhappy can be helpful in dealing with the emotions created by a stressor. Social support where one expresses or gains assistance in dealing with emotions is called emotional support. Support might also be in the form of resources, like a ride to the doctor or a bag of groceries; this type of social support is called tangible support (or instrumental support). Social support can also be described as the perception that one is supported, called perceived support (Antonucci, 2001). Perceived support can act as a buffer when a potentially stressful event occurs (Carpenter, Fowler, Maxwell, & Andersen, 2010; Greenglass, Fiksenbaum, & Burke, 1996; Luszczynska & Cieslak, 2005). Simply knowing that support would be there if needed can make a stressor feel less stressful, no matter if the support networks are called upon or not.

Positive relationships are correlated with better health. People who exhibit greater trust in their intimate relationships tend to report fewer issues with anxiety and depression, and have fewer health problems (Schneider, Konijn, Righetti, & Rusbult, 2011). An association between better health and positive relationships may come through the positive effect of relationships on health practices. For example, adults' weight management is impacted by communication with their partners, and young adults who were more securely attached were more likely to use safe sex practices, such as using a condom, than those who were not (Dailey, Romo, & Thompson, 2011; Feeney, Peterson, Gallois, & Terry, 2000). Overall, individuals who are securely attached and those who have fewer ambivalent relationships within their social network tend to engage in more positive health practices and have better health (Pietromonaco, Uchino, & Schetter, 2013; Uchino et al., 2012).

Test Yourself

Click on each question below to reveal the answer.

Watching television so you do not have to worry about the car that needs repair is what type of coping?

Is continuing to think about and focus on a stressful event helpful or harmful?

13.2 Personal Beliefs and Health

People's behavior regarding their health can be partly explained by how they think about their experiences, and how much control they feel they have over their health. When a person believes that behaviors can make a difference, they are more likely to engage in such behaviors (Armitage, 2003; Infurna, Gerstorf, & Zarit, 2011). Sometimes, after trying to make a change, people learn that they do not have control over what is happening to them. The belief that behavior will not make a difference because it has not made a difference in the past is called learned helplessness. In the original research on learned helplessness, dogs were placed in a chamber and received a mild electrical shock through the floor. The shock was unpleasant but not harmful or damaging to the dogs. When the dogs first experienced the shock, they tried to get away from it by moving around the enclosure and making noise, but they eventually found that nothing they did made a difference. The researchers later put the dogs in another chamber where they could easily get away from the shock by jumping over a low barrier to the other side of the cage. Despite the ease of getting away from the shock, the dogs stood where they were placed and did not attempt to get away from the shock (see Figure 13.2). The researchers termed this learned helplessness because the initial experiences of not being able to get away from the shock taught the dogs there was nothing they could do, they learned to be helpless, so when they were placed in another situation where they actually did have some control they failed to realize it and endured the unpleasant circumstance (Overmier & Seligman, 1967; Seligman & Maier, 1967). Individuals who have learned to be helpless have a pessimistic explanatory style.

Figure 13.2: Seligman's learned helplessness study

Illustration of the tools used in Seligman's study. The illustration shows a dog jumping over a barrier that divides the floor into two halves. The left half is labeled "electrified side" and the right half is labeled "safe side."

Although the dogs in Seligman's study could easily jump a barrier to avoid shocks, they instead stayed in place.

Learned helplessness can negatively affect mental and physical health, and may be a factor in depression (Mikulincer, Glaubman, Ben-Artzi, & Grossman, 1991; Smith, Peck, & Ward, 1990). If people do not feel that their actions have any impact on their environment, they might give up trying, no longer engaging with others and the world. Battered women who experience learned helplessness are more vulnerable to posttraumatic stress disorder (Bargai, Ben-Shakhar, & Shalev, 2007). Learned helplessness can also impact recovery from an accident or illness. If an accident victim feels helpless regarding the ability to regain capacities lost in the accident, that person is unlikely to engage in rehabilitation (Bulman & Wortman, 1977). Often times, the hospital setting itself demands that patients give up some degree of control if they are to be considered good patients, leading to feelings of helplessness and having exactly the opposite effect on wellness than is desired (Solomon, 1982; Taylor, 1979).

Different Settings For Social Psychology

Discoveries of social psychology have implications for our health.

Critical Thinking Questions

Why do you think the presence of other patients in post-operative recovery made such an impact on the recovery process?

How might this finding be applied to other situations?

In general, being optimistic about one's health has positive effects on physical well-being. Optimists believe they have some control over their health and are more likely to engage in healthy behaviors (Rasmussen, Scheier, & Greenhouse, 2009; Ruthig, Hanson, Pedersen, Weber, & Chipperfield, 2011). If you believe that a good diet will have a positive effect on your health, you are more likely to try eating a healthy diet than if you believe your genes or the environment are responsible for your health and longevity. However, it is possible to be too optimistic. Being very unrealistic about risk, either unrealistic optimism or unrealistic pessimism, can lead to negative health behaviors and therefore, less positive health outcomes (Asimakopoulou, Skinner, Spimpolo, Marsh, & Fox, 2008; Davidson & Prkachin, 1997; Waters et al., 2011). For example, patients with hepatitis C with unrealistic optimism delay seeking help and are more likely to drop out of treatment (Treloar & Hopwood, 2008). These patients may be unrealistic in their expectations about treatment and not expect negative side effects to impact them; when they do, the patient may stop treatment.

Test Yourself

Click on the question below to reveal the answer.

Is optimism good for your health?

13.3 Decision Making by Health Care Providers

Health care professionals are influenced by psychological variables just like patients are. In making diagnoses, physicians get a variety of information about symptoms and the results of tests they might run. One variable that contributes to errors in judgment is premature closure (Eva, Link, Lutfey & McKinlay, 2010). Premature closure occurs when a physician makes a diagnosis based on limited information, and additional information is either not sought or the physician does not pay attention to it. At times, the doctor will be correct in the diagnosis, but making a decision before the full picture emerges can lead to errors.

Without full information, the doctor is more likely engage in confirmation bias, searching for information that confirms a diagnosis (Mendel et al., 2011). Confirmation bias is partly responsible for the results of a famous study by Rosenhan (1973), in which he and his research assistants, all without psychiatric illness, gained admittance to mental hospitals. They claimed to be hearing voices, leading, for many of them, to an early diagnosis of schizophrenia. After being admitted, Rosenhan and the research assistants behaved normally and no longer claimed to hear voices. Despite normal behavior, the pseudo patients' deception was not detected by the staff. When they responded honestly to questions about their lives and their background, the information was interpreted as supporting the diagnosis of schizophrenia. It took days or weeks to have them released, despite their normal behavior.

A neurosurgeon examines brain scans.

John Foxx/Stockbyte/Thinkstock

Doctors should take into account all relevant information in order to make the most accurate diagnoses.

The order in which information is presented also impacts clinical judgments of physicians. Both the primacy effect and the recency effect are found in diagnoses. The primacy effect is the tendency for information presented first to be remembered, and therefore carry more weight in judgments (Cunnington, Turnbull, Regher, Marriott, & Norman, 1997). If a patient lists symptoms and begins that list by noting stomach pain, then stomach pain will have a greater influence on the doctor's judgment than the bloody mucus that is mentioned later. The recency effect is the tendency for the information mentioned most recently to be better remembered and therefore influence judgments (Chapman, Bergus, & Elstein, 1996). If a patient ends a list of symptoms by describing fatigue, that symptom will have more impact on the doctor's judgment than things mentioned in the middle of the list of symptoms. For patients, this means that how they lists symptoms, not just the symptoms themselves, may influence their diagnosis.

Stereotypes that physicians have about patients may also influence the decisions they make. Moskowitz and colleagues (Moskowitz, Stone, & Childs, 2012) found that when doctors were primed with an African American face without being consciously aware of the priming, thereby activating an implicit stereotype, physicians reacted more quickly to diseases that are stereotypically associated with African Americans (Moskowitz et al., 2012). In a doctor's office, such tendencies might lead a physician to make a diagnosis of a stereotypical disease, even when another diagnosis might fit the symptoms. Even if implicit stereotypes do not influence the diagnosis, the options given for treatment might be affected. Based on the implicit stereotype that White patients are more cooperative, physicians were more likely to suggest treating a (fictitious) White patient with a blood clot removing treatment (thrombolysis) for coronary artery disease than Black patients (Green et al., 2007). Such stereotypes and other decision-making problems can potentially have a devastating effect on a person's life and health.

Test Yourself

Click on each question below to reveal the answer.

Are quick decisions by health care professionals about the meaning of a patient's symptoms good or bad?

If a doctor seemed to focus on the last symptom you mentioned in making his or her diagnosis that doctor would be doing what?

13.4 Encouraging Healthy Behaviors

A physiotherapist accompanies a patient with a prosthetic leg.

Barry Austin/moodboard/SuperStock

The theory of planned behavior encompasses the individual's attitude and perceived behavioral control as well as the attitude of others.

Why do people engage in healthy behaviors? Is there anything we could do to encourage healthy behavior? Two models that help explain healthy behavior are the theory of planned behavior and the health belief model. Both models help predict whether an individual will engage in a healthy behavior, and they can assist in focusing health interventions.

As introduced in Chapter 4, the theory of planned behavior predicts behavior through a combination of attitudes, subjective norms, and perceived behavioral control (Ajzen, 1991). The theory can apply to behavior regarding health as well. For example, if you wanted to predict attendance at screenings for cancer or other diseases, you could inquire about attitudes toward screenings, beliefs about screenings by those in someone's social network (subjective norms), and whether people felt they could attend and complete the screening (perceived behavioral control) (Cooke & French, 2008). Many health behaviors have been predicted using the pieces of this model, including exercise, breast self-examination, testicular self-examination, smoking cessation, using dental floss, and fruit and vegetable consumption (Kothe, Mullan, & Butow, 2012; Lee, 2011; McClenahan, Shevlin, Adamson, Bennett, & O'Neill, 2007; Norman, Conner, & Bell, 1999; Norman & Cooper, 2011; Rise, Astrom, & Sutton, 1998; Vallance, Lavallee, Culos-Reed, & Trudeau, 2012). While each part of this model is important to accurately predicting behavior, the model does better when it is focused on new or infrequent behaviors, rather than habitual behaviors (Armitage & Connor, 2001; Norman & Cooper, 2011).

Expand Your Knowledge: Identifying and Seeking Help for a Stroke

When people experience symptoms of a stroke it may take some time before they get help. For an example, of the factors in the path to getting help, including a discussion of the health belief model, click here.

The health belief model predicts behavior by evaluating people's beliefs regarding a specific health threat, and the behavior needed to deal with that threat. People may differ in how susceptible to a particular outcome they believe themselves to be, and how severe the outcome might be. For example, imagine Joe was told that he needed to lose weight or he would be at great risk for diabetes. Joe might believe he is not at all susceptible to diabetes, and that the effects of diabetes are mild. Individuals differ in terms of what they believe to be the possible benefits of changing a behavior to reduce risk, the possible barriers to that behavior, the particular cues they have from the environment or from their own bodies, and their confidence in their ability to pursue a behavior (Rosenstock, 1966; Rosenstock, Strecher, & Becker, 1988). Joe might believe that: losing weight will not really reduce his risk of diabetes; dieting will be expensive, inconvenient, and unpleasant; he feels fine and shouldn't need to diet; and he does not believe he has the ability to diet. Believing he has low risk and little ability to perform the behaviors needed to deal with the threat, it is unlikely Joe would do as his doctor recommended and work on losing weight. Although it may differ depending on the particular issue, a meta-analysis of studies of the health belief model found that perceived benefits of changing a behavior and perceived barriers to engaging in that behavior were most predictive of engaging in a behavior (Carpenter, 2010).

Test Yourself

Click on each question below to reveal the answer.

With the theory of planned behavior, what three things are used to predict behavior?

What are the most important predictors of behavior for the health belief model?


Many of the most deadly diseases we encounter in modern life have behavioral components, so studying behavior can shed light on how to combat those diseases. Psychological variables can help us to understand how people recognize symptoms and maintain their health, how health care providers make decisions, and how the most positive health behavior can be encouraged.

Chapter Summary


When we perceive that events may stretch our resources, we experience stress. In Hans Selye's general adaptation syndrome, we go through three stages when dealing with stress: first alarm, then resistance, and finally exhaustion. The transactional model proposed by Lazarus and Folkman focuses on perceptions of stressors and one's perceived ability to cope. Coping comes mainly in the forms of problem-focused and emotion-focused coping.

Personal Beliefs and Health

When individuals perceive they have control over their health, they do not feel helpless and are also not unrealistic in their perceptions; they have better health behaviors and better health.

Decision Making by Health Care Providers

While trying to make good decisions about the care of their patients, health care providers may find they made a decision too quickly, showing premature closure and confirmation bias. Information presented first and last is remembered best and influences the decisions health care providers make. Stereotypes also impact the decisions health care providers make.

Encouraging Healthy Behaviors

Two models help us to understand healthy behaviors. The theory of planned behavior predicts behavior from attitudes, subjective norms, and perceived behavioral control. The health belief model proposes that behavior can be predicted from the perceived threat and the ability to deal with that threat.

Critical Thinking Questions

Does your own pattern of response to stress fit the fight-or-flight response or tend-and-befriend pattern?

What might be a stressor where problem-focused coping is not helpful but may create more stress for someone?

If you were to experience premature closure in an interaction with a physician, how might you counteract it?

If you were going to work on encouraging children to wear bicycle helmets how might the theory of planned behavior or the health belief model assist you?

Key Terms

Click on each key term to reveal the definition.

alarm stage


emotion-focused coping

emotional support

exhaustion stage

fight-or-flight response

general adaptation syndrome

health belief model

health psychology

perceived support

premature closure

primacy effect

problem-focused coping

recency effect

resistance stage


social support



tangible support

tend-and-befriend pattern

transactional model