34-1 In what two ways do people try to alleviate stress?

Stressors are unavoidable. This fact, coupled with the fact that persistent stress correlates with heart disease, depression, and lowered immunity, gives us a clear message: We need to learn to cope with the stress in our lives, alleviating it with emotional, cognitive, or behavioral methods.

Some stressors we address directly, with problem-focused coping. If our impatience leads to a family fight, we may go directly to that family member to work things out. We tend to use problem-focused strategies when we feel a sense of control over a situation and think we can change the circumstances, or at least change ourselves to deal with the circumstances more capably. We turn to emotion-focused coping when we believe we cannot change a situation. If, despite our best efforts, we cannot get along with that family member, we may relieve stress by reaching out to friends for support and comfort.

When challenged, some of us tend to respond with problem-focused coping, others with emotion-focused coping (Connor-Smith & Flachsbart, 2007). Our feelings of personal control, our explanatory style, and our supportive connections all influence our ability to cope successfully.

34-2 How does a perceived lack of control affect health?

Picture the scene: Two rats receive simultaneous shocks. One can turn a wheel to stop the shocks. The helpless rat, but not the wheel turner, becomes more susceptible to ulcers and lowered immunity to disease (Laudenslager & Reite, 1984). In humans, too, uncontrollable threats trigger the strongest stress responses (Dickerson & Kemeny, 2004).

At times, we all feel helpless, hopeless, and depressed after experiencing a series of bad events beyond our control. Martin Seligman and his colleagues have shown that for some animals and people, a series of uncontrollable events creates a state of learned helplessness, with feelings of passive resignation (FIGURE 34.1 below). In one series of experiments, dogs were strapped in a harness and given repeated shocks, with no opportunity to avoid them (Seligman & Maier, 1967). Later, when placed in another situation where they could escape the punishment by simply leaping a hurdle, the dogs cowered as if without hope. Other dogs that had been able to escape the first shocks reacted differently. They had learned they were in control and easily escaped the shocks in the new situation (Seligman & Maier, 1967). In other experiments, people have shown similar patterns of learned helplessness (Abramson et al., 1978, 1989; Seligman, 1975).

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Perceiving a loss of control, we become more vulnerable to ill health. A famous study of elderly nursing home residents with little perceived control over their activities found that they declined faster and died sooner than those given more control (Rodin, 1986). Workers able to adjust office furnishings and control interruptions and distractions in their work environment have experienced less stress (O’Neill, 1993). Such findings may help explain why British executives have tended to outlive those in clerical or laboring positions, and why Finnish workers with low job stress have been less than half as likely to die of stroke or heart disease as those with a demanding job and little control. The more control workers have, the longer they live (Bosma et al., 1997, 1998; Kivimaki et al., 2002; Marmot et al., 1997).

Increasing control—allowing prisoners to move chairs and to control room lights and the TV; having workers participate in decision making; allowing people to personalize their work space—has noticeably improved health and morale (Humphrey et al., 2007; Wang et al., 2010). In the case of the nursing home residents, 93 percent of those encouraged to exert more control became more alert, active, and happy (Rodin, 1986). As researcher Ellen Langer concluded, “Perceived control is basic to human functioning” (1983, p. 291).

Control also helps explain a link between economic status and longevity (Jokela et al., 2009). In one study of 843 grave markers in an old cemetery in Glasgow, Scotland, those with the costliest, highest pillars (indicating the most affluence) tended to have lived the longest (Carroll et al., 1994). Likewise, American presidents, who are generally wealthy and well-educated, have had above-average life spans (Olshansky, 2011). Across cultures, high economic status predicts a lower risk of heart and respiratory diseases (Sapolsky, 2005). Wealthy parents tend to have healthy children, too (Chen, 2004). With higher economic status come reduced risks of low birth weight, infant mortality, smoking, and violence. Even among other primates, individuals at the bottom of the social pecking order have been more likely than their higher-status companions to become sick when exposed to a cold-like virus (Cohen et al., 1997).

Why does perceived loss of control predict health problems? Because losing control provokes an outpouring of stress hormones. When rats cannot control shock or when humans or other primates feel unable to control their environment, stress hormone levels rise, blood pressure increases, and immune responses drop (Rodin, 1986; Sapolsky, 2005). Captive animals experience more stress and are more vulnerable to disease than their wild counterparts (Roberts, 1988). Human studies confirm that stress increases when we lack control. The greater nurses’ workload, the higher their cortisol level and blood pressure—but only among nurses who reported little control over their environment (Fox et al., 1993). The crowding in high-density neighborhoods, prisons, and college and university dorms is another source of diminished feelings of control—and of elevated levels of stress hormones and blood pressure (Fleming et al., 1987; Ostfeld et al., 1987). By boosting feelings of control, people often lead happier and healthier lives (Ng et al., 2012).

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INTERNAL VERSUS EXTERNAL LOCUS OF CONTROL If experiencing a loss of control can be stressful and unhealthy, do people who generally perceive they have control of their lives enjoy better health? Consider your own perceptions of control. Do you believe that your life is beyond your control? That getting a good job depends mainly on being in the right place at the right time? Or do you more strongly believe that you control your own fate? That being a success is a matter of hard work? Did your parents influence your feelings of control? Did your culture?

Hundreds of studies have compared people who differ in their perceptions of control. On one side are those who have what psychologist Julian Rotter called an external locus of control—the perception that chance or outside forces control their fate. On the other side are those who perceive an internal locus of control, who believe they control their own destiny. In study after study, the “internals” have achieved more in school and work, acted more independently, enjoyed better health, and felt less depressed than did the “externals” (Lefcourt, 1982; Ng et al., 2006). In one long-term study of more than 7500 people, those who had expressed a more internal locus of control at age 10 exhibited less obesity, lower blood pressure, and less distress at age 30 (Gale et al., 2008). Compared with nonleaders, military and business leaders have lower-than-average levels of stress hormones and report less anxiety, thanks to their greater sense of control (Sherman et al., 2012).

Another way to say that we believe we are in control of our own life is to say we have free will, or that we control our own willpower. Studies show that people who believe in their freedom learn better, perform better at work, behave more helpfully, and have a stronger desire to punish rule breakers (Clark et al., 2014; Job et al., 2010; Stillman et al., 2010).

Compared with their parents’ generation, more young Americans now express an external locus of control (Twenge et al., 2004). This shift may help explain an associated increase in rates of depression and other psychological disorders in young people (Twenge et al., 2010).

DEPLETING AND STRENGTHENING SELF-CONTROL

34-3 How can our self-control be depleted, and why is it important to build this strength?

Self-control is the ability to control impulses and delay short-term gratification for longer-term rewards. Self-control predicts good health, higher income, and better grades (Kuhnle et al., 2012; Moffitt et al., 2011). In one year-long study of eighth-graders’ academic success, self-control had double the predictive power of intelligence score (Duckworth & Seligman, 2005).

Self-control constantly changes—from day to day, hour to hour, and even minute to minute. Like a muscle, self-control weakens after use, recovers after rest, and grows stronger with exercise (Baumeister & Tierney, 2011; Hagger et al., 2010; Vohs & Baumeister, 2011). Exercising willpower temporarily depletes the mental energy needed for self-control on other tasks (Grillon et al., 2015; Vohs et al., 2012). In one experiment, hungry people who had resisted the temptation to eat chocolate chip cookies abandoned a tedious task sooner than those who had not resisted the cookies (Baumeister et al., 1998). And after expending willpower on laboratory tasks, such as stifling prejudice or ignoring flashing words on a computer screen, people were less restrained in their aggressive responses to provocation and in their sexual behavior (Finkel et al., 2012; Gaillot & Baumeister, 2007). Similar self-control weakening happens when people flex their self-control muscle outside the laboratory, such as when trying to control alcohol use (Hofmann et al., 2012).

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Exercising willpower decreases neural activation in brain regions associated with mental control (Wagner et al., 2013). Might sugar provide a sweet solution to self-control fatigue? Sugar not only makes us feel good, it also increases neural activation in mental control regions (Chambers et al., 2009). In one study, giving sugar (in a naturally rather than an artificially sweetened lemonade) had a sweet effect: It reduced people’s financial impulsiveness (Wang & Dvorak, 2010). Even dogs can experience self-control depletion and rejuvenation with sugar (Miller et al., 2010).

Researchers do not encourage candy bar diets to improve self-control. Even rinsing your mouth with sugary liquid can activate the brain’s self-control centers (Hagger & Chatzisarantis, 2013; Sanders et al., 2012). You will get the boost in self-control without the bulge in your waistline.

The decreased mental energy after exercising self-control is short-lived. But the long-term effect of exercising self-control is strengthened self-control, much as a hard physical workout leaves you temporarily tired out, but stronger in the long term. Strengthened self-control improves people’s performance on laboratory tasks and improves their self-management of eating, drinking, anger, and household chores (Denson et al., 2011; Oaten & Cheng, 2006a,b).

The point to remember: Develop self-discipline in one area of your life, and your strengthened self-control may spill over into other areas as well, making for a healthier, happier, and more successful life (Tuk et al., 2015).

34-4 How does an optimistic outlook affect health and longevity?

In The How of Happiness, social psychologist Sonja Lyubomirsky (2008) tells the true story of Randy, who has lived a hard life. His dad and best friend both died by suicide. Growing up, his mother’s boyfriend treated him poorly. Randy’s first wife was unfaithful, and they divorced. Despite these misfortunes, Randy has a sunny disposition. He remarried and enjoys being the stepfather to three boys. His work is rewarding. Randy says he survived his life challenges by seeing the “silver lining in the cloud.”

Randy’s story illustrates how our outlook—what we expect from the world—influences how we cope with stress. Pessimists expect things to go badly (Aspinwall & Tedeschi, 2010; Carver et al., 2010; Rasmussen et al., 2009). When bad things happen, pessimists knew it all along. They attribute their poor performance to a basic lack of ability (“I can’t do this”) or to situations enduringly beyond their control (“There is nothing I can do about it”). Optimists, such as Randy, expect to have more control, to cope better with stressful events, and to enjoy better health (Aspinwall & Tedeschi, 2010; Boehm & Kubzansky, 2012; Carver et al., 2010; Hernandez et al., 2015). During a semester’s last month, students previously identified as optimistic reported less fatigue and fewer coughs, aches, and pains. And during the stressful first few weeks of law school, those who were optimistic (“It’s unlikely that I will fail”) enjoyed better moods and stronger immune systems (Segerstrom et al., 1998). Optimists also respond to stress with smaller increases in blood pressure, and they recover more quickly from heart bypass surgery.

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Optimistic students have also tended to get better grades because they often respond to setbacks with the hopeful attitude that effort, good study habits, and self-discipline make a difference (Noel et al., 1987; Peterson & Barrett, 1987). When dating couples wrestle with conflicts, optimists and their partners see each other as engaging constructively, and they then tend to feel more supported and satisfied with the resolution and with their relationship (Srivastava et al., 2006). Optimism relates to well-being and success in many places, including China and Japan (Qin & Piao, 2011). Realistic positive expectations fuel motivation and success (Oettingen & Mayer, 2002).

Consider the consistency and startling magnitude of the optimism and positive emotions factor in several other studies:

Optimism runs in families, so some people truly are born with a sunny, hopeful outlook. With identical twins, if one is optimistic, the other often will be as well (Bates, 2015; Mosing et al., 2009). One genetic marker of optimism is a gene that enhances the social-bonding hormone oxytocin (Saphire-Bernstein et al., 2011).

The good news is that all of us, even the most pessimistic, can learn to become more optimistic. Compared with a control group of pessimists who simply kept diaries of their daily activities, pessimists in a skill-building group, who learned ways of seeing the bright side of difficult situations and how to view their goals as achievable, reported lower levels of depression (Sergeant & Mongrain, 2014). Optimism is the light bulb that can brighten anyone’s mood.

34-5 How does social support promote good health?

Social support—feeling liked and encouraged by intimate friends and family—promotes both happiness and health. People in different cultures vary in how much they seek social support. Those from collectivist cultures tend to keep their struggles to themselves, in part because they do not want to show signs of weakness that may reflect poorly on their group (Kim et al., 2008). In individualist cultures, distressed people feel more comfortable turning to friends and family (Mortenson, 2006). Despite these cultural differences, social support is universally related to greater happiness (Brannan et al., 2013; Chu et al., 2010; Gable et al., 2012; Ren et al., 2010).

Close relationships have also predicted health. People are less likely to die early if supported by close relationships (Shor et al., 2013; Uchino, 2009). When Brigham Young University researchers combined data from 70 studies of 3.4 million people worldwide, they confirmed a striking effect of social support (Holt-Lunstad et al., 2010). Compared with those with ample social connections, those with few connections had a 30 percent greater death rate during the average 7-year study period. Social isolation’s association with risk of death is equivalent to smoking (Holt-Lunstad et al., 2010).

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To combat social isolation, we need to do more than collect lots of acquaintances. We need people who genuinely care about us (Cacioppo et al., 2014; Hawkley et al., 2008). Some fill this need by connecting with friends, family, co-workers, members of a faith community, or other support groups. Others connect in positive, happy, supportive marriages. One seven-decade-long study found that at age 50, healthy aging was better predicted by a good marriage than by a low cholesterol level (Vaillant, 2002). On the flip side, divorce predicts poor health. In one analysis of 32 studies involving more than 6.5 million people, divorced people were 23 percent more likely to die early (Sbarra et al., 2011). But it’s less marital status than marital quality that predicts health—to about the same extent that healthy behaviors, such as a healthy diet and physical activity predict health (Robles, 2015; Robles et al., 2014).

What explains the link between social support and health? Are middle-aged and older adults who live with little social engagement more likely to smoke, be obese, and have high cholesterol—and therefore to have a doubled risk of heart attacks (Nielsen et al., 2006)? Or are healthy people simply more sociable? Research suggests that social support itself creates health benefits.

Social support calms us and reduces blood pressure and stress hormones. Numerous studies support this finding (Hostinar et al., 2014; Uchino et al., 1996, 1999). To see if social support might calm people’s response to threats, one research team subjected happily married women, while lying in an fMRI machine, to the threat of electric shock to an ankle (Coan et al., 2006). During the experiment, some women held their husband’s hand. Others held the hand of an unknown person or no hand at all. While awaiting the occasional shocks, women holding their husband’s hand showed less activity in threat-responsive areas. This soothing benefit was greatest for those reporting the highest-quality marriages. People with supportive marriages also have lower-than-average stress hormone levels 10 years later (Slatcher et al., 2015). Even animal support helps buffer stress. After stressful events, Medicare patients with a dog or other companionable pet have been less likely to visit their doctor (Siegel, 1990).

Social support fosters stronger immune functioning. Volunteers in studies of resistance to cold viruses showed this benefit (Cohen et al., 1997, 2004). Healthy volunteers inhaled nasal drops laden with a cold virus and were quarantined and observed for five days. (In these experiments, more than 600 volunteers received $800 each to endure this experience.) Age, race, sex, and health habits being equal, those with the most social ties were least likely to catch a cold. If they did catch one, they produced less mucus. People whose daily life included frequent hugs likewise experienced fewer cold symptoms and less symptom severity (Cohen et al., 2015). More sociability meant less susceptibility. The cold fact is that the effect of social ties is nothing to sneeze at!

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Close relationships give us an opportunity for “open heart therapy,” a chance to confide painful feelings (Frattaroli, 2006). Talking about a stressful event can temporarily arouse us, but in the long run it calms us, by calming limbic system activity (Lieberman et al., 2007; Mendolia & Kleck, 1993). In one study, 33 Holocaust survivors spent two hours recalling their experiences, many in intimate detail never before disclosed (Pennebaker et al., 1989). In the weeks following, most watched a video of their recollections and showed it to family and friends. Those who were most self-disclosing had the most improved health 14 months later. Confiding is good for the body and the soul. In another study, of surviving spouses of people who had committed suicide or died in car accidents, those who bore their grief alone had more health problems than those who could share it with others (Pennebaker & O’Heeron, 1984).

Suppressing emotions can be detrimental to physical health. When psychologist James Pennebaker (1985) surveyed more than 700 undergraduate women, some of them reported a traumatic childhood sexual experience. The sexually abused women—especially those who had kept their secret to themselves—reported more headaches and stomach ailments than did other women who had experienced nonsexual traumas, such as parental death or divorce. Another study, of 437 Australian ambulance drivers, confirmed the ill effects of suppressing one’s emotions after witnessing traumas (Wastell, 2002).

Even writing about personal traumas in a diary can help (Burton & King, 2008; Hemenover, 2003; Lyubomirsky et al., 2006). In an analysis of 633 trauma victims, writing therapy was as effective as psychotherapy in reducing psychological trauma (van Emmerik et al., 2013). In another experiment, volunteers who wrote trauma diaries had fewer health problems during the ensuing four to six months (Pennebaker, 1990). As one participant explained, “Although I have not talked with anyone about what I wrote, I was finally able to deal with it, work through the pain instead of trying to block it out. Now it doesn’t hurt to think about it.”

If we are aiming to exercise more, drink less, quit smoking, or attain a healthy weight, our social ties can tug us away from or toward our goal. If you are trying to achieve some goal, think about whether your social network can help or hinder you. That social net covers not only the people you know but friends of your friends, and friends of their friends. That’s three degrees of separation between you and the most remote people. Within that network, others can influence your thoughts, feelings, and actions without your awareness (Christakis & Fowler, 2009).