438 CHAPTER 11
Health psychologists seek to understand how behavior (such as use of drugs, opti-
mism, personality, or the type of food one eats) can affect a person’s ability to fight off
illnesses—or increase the likelihood of getting sick. They also want to know how fac-
tors like poverty, wealth, religion, social support, personality, and even one’s ethnicity
can affect health. Clinical health psychology is a subfield of health psychology focused on
using the knowledge gained by researchers in the field to help promote healthy lifestyles,
help people maintain their health and also to prevent or treat illnesses (Boll et al., 2002).
Improving the health care system is another goal of clinical health psychologists. Health
psychology also has connections to behavioral psychology, a field combining both medi-
cine and psychology as well as numerous other scientific fields related to health issues
( Christensen & Nezu, 2013; Miller, 1983). In this age of a new and intense focus on health
care, health psychology is destined to become a more important force in future research.
One important area in which health psychologists may focus is on the psychological
effects of alternative medicines, as illustrated by the APA Goal 2: Scientific Reasoning
and Critical Thinking feature.Cognitive Factors in Stress
11.7 Summarize Lazarus’s cognitive appraisal approach to stress.
The physical effects of stress on the body and the immune system are only part of the
picture of the influence of stress in daily life. Cognitive factors, such as how an individual
interprets a stressful event, can affect the impact of stress.
Cognitive psychologist Richard Lazarus developed a cognitive view of stress called
the cognitive–mediational theory of emotions, in which the way people think about and
appraise a stressor is a major factor in how stressful that particular stressor becomes
(Lazarus, 1991, 1999; Lazarus & Folkman, 1984). to Learning Objective 9.10.
According to Lazarus, there is a two-step process in assessing the degree of threat or
harm of a stressor and how one should react to that stressor (see Figure 11. 4 ).
The first step in appraising a stressor is called primary appraisal, which involves
estimating the severity of the stressor and classifying it as a threat (something that could
be harmful in the future), a challenge (something to be met and defeated), or a harm or
loss that has already occurred. If the stressor is appraised as a threat, negative emotions
may arise that inhibit the person’s ability to cope with the threat. For example, a student
who has not read the text or taken good notes will certainly appraise an upcoming exam
as threatening. If the stressor is seen as a challenge, however, it is possible to plan to meet
that challenge, which is a more positive and less stressful approach. For example, the
student who has studied and read and feels prepared is much more likely to appraise the
upcoming exam as an opportunity to do well.
Perceiving a stressor as a challenge instead of a threat makes coping with the
stressor (or the harm it may already have caused) more likely to be successful. Whereas
perceiving the stressor as an embarrassment, or imagining future failure or rejection, is
more likely to lead to increased stress reactions, negative emotions, and an inability to
cope well (Folkman, 1997; Lazarus, 1993). Think positive!
In secondary appraisal, people who have identified a threat or harmful effect must
estimate the resources that they have available for coping with the stressor. Resources
might include social support, money, time, energy, ability, or any number of potential
resources, depending on the threat. If resources are perceived as adequate or abundant,
the degree of stress will be considerably less than if resources are missing or lacking.
Using the example of the student and the upcoming exam, a student who feels that she
has the time to study and the ability to understand the material in that time will feel
much less distress than the student who has little time to study and doesn’t feel that she
understood all the content of the lectures covered on the exam.
An addition to the cognitive appraisal approach is the cognitive reappraisal approach
(Jamieson et al., 2012, 2013). Researchers have found that instructing participants toprimary appraisal
the first step in assessing stress,
which involves estimating the severity
of a stressor and classifying it as either
a threat or a challenge.
secondary appraisal
the second step in assessing a stressor,
which involves estimating the
resources available to the person for
coping with the threat.