Social support, close relationships and health Stress management interventions

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Social support, close relationships and
healthStress management interventions
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What are we going to talk about today?

• Social support
• What is social support? How does it work to
  affect health?
• Couples coping with stress and adversity
• Spouses (personality, social support, coping)
  affect health by shaping coping processes
• What can you do to combat stress and its effects
  on your body and life?
• Stress management interventions
• Can pets have stress-buffering effects on health?

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Social support as a moderator of stress
Hey, howre you doing?
Oh, youd never guess what happened last night
..
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The Stress-illness relationship Figure 7.1
Social support
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Social support is associated with

• Faster recovery and fewer medical problems
• Faster recovery from coronary artery surgery,
  less likely to suffer heart attacks, fewer
  complications after childbirth
• Lower mortality
• Large number of social contacts associated with
  longer lifespan (2.8 yrs for women, 2.3 yrs for
  men)
• Less distress in the face of terminal illness
• Strong social support network associated with
  AIDS patients experiencing less depression and
  hopelessness

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Social support Sosa, 1980
Ss pregnant women admitted to a hospital for
their first delivery Methods Half were randomly
assigned to be accompanied by a female companion
(doula) who provided support. Half did not
receive a companion. Results Those with
a companion had quicker deliveries,
more contact with babies, fewer health
complications
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• Video on social support and happiness
• http//www.insidermedicine.ca/archives/Happy_Socia
  l_Networks_Impact_Personal_Happiness_Interview_wit
  h_Dr_Andrew_Steptoe_PhD_University_College_London_
  3095.aspx

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Four types of social support

• Emotional Support
• Feeling loved and cared for by others
• Informational Support
• Advice and information from others
• Tangible Support
• Material aid from others
• Self-Esteem Support
• Feeling valued and respected by others

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Invisible support

• 68 couples daily diary for 32 days leading to
  the Bar exam
• Examinees reports of receiving support vs.
  partners reports of providing support

• Providing support ? examinees lower anxiety and
  depression
• Receiving support ? examinees higher anxiety and
  depression

Bolger et al., 2000
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Why would having good friends benefit health?

• The buffering hypothesis social support
  positively influences health and well-being by
  protecting people from the pathogenic effects of
  stressors
• The direct effects hypothesis social support
  positively influences health regardless of
  whether stressors occur

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• Stressors include
• daily hassles (arguments, bad weather, unexpected
  change of plans)
• major life events (death of friend or relative,
  serious illness or injury, divorce)
• Moderators include support from family, friends,
  coworkers, classmates who offer advice, provide
  material aid, help overcome emotional distress,
  and share responsibilities

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Social networks vs. social support

• Social support functional content and quality of
  relationships
• Social networks the web and quantity of social
  relationships that surround individuals

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Social networks vs. Social support

• Structural aspects
• How many contacts?
• Friends vs. Relatives vs. Co-workers?
• may operate more via main or direct effects
• Functional aspects
• Perceived availability of support?
• Perceived quality of support?
• may operate more through stress-buffering
  mechanisms.

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The direct effects hypothesis
Low social support
High social support
Morbidity and Mortality
Low
Hi
Stress Level
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Evidence for the main effects hypothesis

• Alameda County Study
• Lisa Berkman and Len Syme
• Citation classic
• How many close friends do you have?
• How many relatives do you have that you feel
  close to?
• How often do you see these people each month?

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Social ties and 9 year mortality in Alameda
County, CA Men
Berkman L et al. Social networks, host
resistance, and mortality A nine year follow up
study of Alameda County residents. Am J Epidemiol
109186-204, 1979.
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Social ties and 9 year mortality in Alameda
County, CA Women
Berkman L et al. Social networks, host
resistance, and mortality A nine year follow up
study of Alameda County residents. Am J Epidemiol
109186-204, 1979.
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Social Support and CVD

• Evidence
• Alameda County study N6298 over 9 yrs
• Social network index
• Results Marriage and contact with friends were
  highest predictors of decreased mortality
• Alameda County study N6298 over 12 yrs
• Married men had lower mortality rates than single
  men

(Linda Heitman, 2004)
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Heitman (2004)

• Myocardial Infarction patients who had elevated
  mortality risk
• lacked social support
• lived alone
• had not been married

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The Buffering Hypothesis
Low social support
Morbidity and Mortality
High social support
Low
High
Stress Level
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Evidence for the buffering hypothesis

• Jim House, Work Stress and Social Support, 1984
• Citation classic
• Interviewed 2000 men from a range of occupations
• factory workers to physicians

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Evidence for the buffering hypothesis

• Found evidence for the buffering hypothesis
• for various measures of work stress
• Overload
• Responsibility
• Variety of outcomes
• Anxiety
• Depression
• Heart disease
• All cause morbidity

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Buffering Effects of social support on
Physiological/Neuroendocrine Response

• Acute stress paradigm
• The biological responses to stress are subdued
  when
• A companion is present
• There is a belief that support is available
• Contemplating typical sources of support
• In the presence of a pet
• Calming effects are greater when they come from a
  friend than a stranger

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Standard Psychosocial Stress Test (TSST)

• Free speech
• Mental arithmetic

Kirschbaum et al., Neuropsychobiol, 1993
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Neck shoulder massage
N 67 women (relationship duration gt 1 year
) Exclusion criteria smoking, hormonal
contraceptives, chronic diseases N no
interaction 22N social support 22N physical
contact 17
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Physical contact and stress
Time x group F(4.31/ 138.0) 2.64 p lt.05
Stress
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Physical contact and stress
Stress
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Social support and risk factors for prostate
cancer

• Although stress is associated with higher
  circulating levels of prostate-specific antigen
  (PSA, a marker of possible prostate malignancy)
• Those men highly satisfied with their social
  contacts showed lower levels of PSA

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Matching hypothesis

• The most effective type of support depends upon
  the specific dimensions of the stressor.
• Co-worker support is a match for work stress
• Informational support is a match for exam stress
• Tangible support is a match for parenting stress

Sheldon Cohen
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Gender differences

• Women tend to
• maintain more emotionally intimate relationships
• mobilize more social support when needed
• provide more frequent and more effective social
  support to others
• Both men and women tend to prefer women as
  confidants

(Kessler Wethington Umberson Veroff)
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Possible pathways

• Social support
• Influences self-esteem, coping mechanisms
• Influences health-related behaviour
• Influences immunological and neuroendocrine
  systems, cardiovascular reactivity

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Social network diversity and the common cold

• Ss 276 healthy volunteers
• Methods Gave nasal drops containing common cold
  viruses (Ss stayed in lab)
• Results 40 got clinically ill
• People with fewer than four types of social
  relations were over four times more likely to
  catch cold than those with six or more types.
• Not only were they less susceptible to
  developing colds, they produced less mucus, and
  shed less virus.

(Sheldon Cohen, 1998)
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Caveats and critical issues

• Having at least one strong intimate relationship
  is an important predictor of good health
• If youre married and your spouse is
  unsupportive, having supportive others is
  unlikely to undo the damage

James Coyne
(Coyne DeLongis)
(Brown Harris)
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Caveats and critical issues

• Emotional support is most strongly related to
  good health and well-being (Israel et al. 1987)
• Negative Support predicts outcomes far better
  than positive support. --
• Karen Rook

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Mixed effects of social support

• Social support can either promote a sense of
  self-efficacy and self-esteem or
• Become disabling by reinforcing dependence (e.g.,
  pain patients).
• Solicitiousness?

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Interventions

• Enhancing existing social network linkages
• Developing new social network linkages
• Enhancing networks through the use of indigenous
  natural helpers

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Social support as suicide prevention

• focusing on protective factors such as
  emotional well-being and connectedness with
  family and friends was as effective or more
  effective than trying to reduce risk factors in
  the prevention of suicide.

• Borowsky IW, et al. Suicide attempts among
  American Indian and Alaska Native youth risk and
  protective factors. Archives of Pediatrics and
  Adolescent Medicine, 1999, 153 543-547.

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Suicide prevention video for university students

• http//www.youtube.com/watch?vjMYdqKYyDbM

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Social factors in suicide risk protective

• Family cohesion (youth)
• Sense of social support
• Interconnectedness
• Married/parent
• Access to comprehensive health care

• History of interpersonal violence/conflict/abuse/
  bullying
• Exposure to suicide
• No-longer married
• Barriers to health care/mental health care
• Access to means (e.g., firearms)

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Benefits of social support

• The presence of social support
• tends to decrease mortality
• promotes adherence to medical regimens
• enhances coping
• reduces episodes of depression
• affects the HPA (hypothalamic-pituitary axis -
  improved immune functioning).

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Summary

• 4 types of social support
• Invisible support
• Buffering and direct effects hypotheses
• Quality vs. quantity of social support
• Matching hypothesis
• Social support and suicide prevention

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What are we going to talk about today?

• Social support
• What is social support? How does it work to
  affect health?
• Couples coping with stress and adversity
• Spouses (personality, social support, coping)
  affect health by shaping coping processes
• What can you do to combat stress and its effects
  on your body and life?
• Stress management interventions
• Can pets have stress-buffering effects on health?

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Close relationships and health
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Close relationships and healthCouples coping
with stress and adversity
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• Social isolation has a relative risk for
  all-cause morbidity and mortality that is similar
  to that of other major risk factors, like
  cigarette smoking, inactivity, and obesity.
• House et al., Science

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Men
RR for smoking 10 cg/day is 1.8
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Women
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• Do close relationships offer any special health
  benefits?
• Does the quality of the relationship matter?

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• Video on social support and blood pressure
• http//www.insidermedicine.ca/archives/Blood_Trans
  fusions__In-Hospital_Death_Happy_Marriage_Good_for
  _Blood_Pressure_Nutrition_Affects_Sperm_Quality_23
  07.aspx

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Chronic pain conditions Good grist for the mill

• Biomedical factors as instigators of pain
• Psychosocial factors can play significant role in
  disease course (e.g., Newth DeLongis, 2004)
• Social relationships may be particularly
  important (e.g., communal model of pain)

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• RA is one of most prevalent chronic pain
  conditions
• Symptoms
• Pain
• Stiffness
• inflammation of joints
• fatigue
• frequent mood changes
• Long term effect of joint deterioration and pain
• Disability

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(No Transcript)
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The Alameda county study Disease course among
patients with rheumatoid arthritis

• Study by the California State Department of
  Health
• Chronic health conditions, health behaviours,
  social involvements, psychological
  characteristics
• Age, race, height, eight, education, income,
  religion
• Marital and life satisfaction, parenting,
  physical activities, employment, childhood
  experiences.
• 1965 6928 adult participants (incl. 500 women
  aged 65 and above)
• 1974 6246

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What is the role of marital relationships in
disease?

• 590 participants were diagnosed with rheumatoid
  arthritis between the first 2 time-points.
• Prospective examination of predictors of
  disability
• Disability Self-Care, Mobility, Ability to work,
  Type of work

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Relative risks Absence of close relationships
predicts poor 9-year course of rheumatoid
arthritis
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Relative risks Marital strain predicts poor
9-year course of RA
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Conclusions

• The odds of ending up with limitations in
  mobility, having to quit or change the type of
  work done was about twice as high amongst those
  in bad versus good marriages.
• These findings suggest that something is going on
  between husbands and wives that matters a lot in
  terms of adjustment to RA.
• But what is it? Whats going on in these couples
  day-to-day lives that is affecting the course of
  the disease?

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How do close relationships affect health?

• Buffering model Social support protects from the
  otherwise harmful effects of stress
• Spouse may directly shape coping efforts and
  stress appraisals
• Spouse may impact the effectiveness of coping by
• validating the partners coping
• coping in a way that complements the partners
  coping

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How do close relationships affect health?

• Buffering model Social support protects from the
  otherwise harmful effects of stress
• Spouse may directly shape coping efforts and
  stress appraisals
• Spouse may impact the effectiveness of coping by
• validating the partners coping
• coping in a way that complements the partners
  coping

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Daily process research

• Intensive study of participants across weeks or
  months
• Allows examination of daily living
• Allows examination of how processes unfold within
  and across days
• Reduces retrospective contamination

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What role does the spouse play in Rheumatoid
Arthritis?

• Pain of variable intensity and duration most
  problematic symptom (Skevington et al., 1987)
• RA pain is both
• Significant source of stress
• Important biomarker of disease

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Holtzman, Newth, DeLongis, J Health Psychology
(2004) Newth DeLongis, Psychology and Health
(2004)
Appraisal and Coping
Pain
Support

Evening
Morning
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Holtzman, Newth, DeLongis, J Health Psychology
(2004) Newth DeLongis, Psychology and Health
(2004)
Appraisal and Coping
Pain
Support

Evening
Morning
Social Support
Positive Reframing

-
Pain
Emotional Expression



Pushing through Pain
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What are the specific types of support gestures
that are helpful to patients?

• Cognitive Coping Support

Tangible Support
Emotional Support Empathic Responding
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Positive spouse responses

• Cognitive Coping Support
• (Positive Reframing)
• Helped my spouse find something positive in her
  situation
• Suggested activities
• that might distract my spouse

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Positive spouse responses

• Tangible Support
• Was there when my spouse
• needed me
• Took care of many
• things for my spouse
• Took care of things my spouse
• could not manage on his
• own

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Positive spouse responses

• Emotional Support
• Showed my spouse that I love and accept her
• Made my spouse feel valued and important
• (I love you and think you are a wonderful
  person.)

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Positive spouse responses

• Empathic responding
• Tried to understand how my spouse felt about the
  pain.
• (Okay, so shes not feeling to well. I guess
  thats why she didnt feel like going out
  tonight.)

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Negative spouse responses

• complained
• about my spouse
• (Im tired of having
• to do everything
• myself.)

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Negative spouse responses

• Solocitous responses
• Expressed concern about my spouse condition.
• (Im really concerned about you. Are you going
  to be okay? Are you sure?)

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• Do these support gestures from the spouse affect
  the patients pain?

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Spouse reports of their behaviour associated with
changes in patient pain across the day
The effect of solicitous responses on pain is
consistent with operant models of pain they
reinforce pain behaviours, more pain
p.05, p lt.01, plt.001, plt.10
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How do close relationships affect health?

• Buffering model Social support protects from the
  otherwise harmful effects of stress
• Spouse may directly shape coping efforts and
  stress appraisals
• Spouse may impact the effectiveness of coping by
• validating the partners coping
• coping in a way that complements the partners
  coping

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The social context of pain and stress
Pt coping
PM Pain/Distress
AM Pain/ Stress
Social support and the response of others
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Coping with pain

• Key dysfunctional reaction to pain may be
  helplessness or catastrophizing
• Focusing on and exaggerating the negative threat
  value of pain and negatively evaluating ones
  ability to deal with pain (Keefe et al., 2000
  Sullivan et al., 2001)
• What role do social relationships play in
  catastrophizing and rumination?

(Holtzman DeLongis, Pain, 2007)
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Outcomes of pain catastrophizing

• Consistently associated with greater
• Psychological distress (Severeijns et al., 2001)
• Pain intensity (Tan et al., 2001)
• Functional disability (Sullivan et al., 1998)

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The social context of pain and stress
Patient catastrophizing
PM Pain/Distress
AM Pain/ Stress
Social support and the response of others
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The vicious cycle of pain and catastrophizing
Can support from the spouse disrupt it?
Pain Intensity
Catastrophizing
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Twice daily interview measuresPain
catastrophizing

• examples
• I felt like I couldnt stand it anymore.
• It was awful and I felt that it overwhelmed me.
  

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Vicious cycle of pain and catastrophizing
disrupted when patient is satisfied with support
from the spouse
Low satisfaction with spouses response
High satisfaction with spouses response
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Can a positive response from the spouse attenuate
the effect of patient catastrophizing on
subsequent pain?
82
Spouse reports of positive support buffer the
effects of catastrophizing on pain
Low cognitive support
High cognitive support
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The social context of stress
Rumination
PM or long- term distress
AM Stress
Social support and the response of others
84
Rumination as trait

• Do you find it hard to stop thinking about the
  problem afterward?
• When thinking about the problem afterward, do
  your thoughts tend to dwell on negative aspects
  of it, or how badly you felt about it?

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Rumination is a prospective predictor of
depression
Note. p ? .05, p .01, p .001
Puterman et al., 2009
86
Rumination as trait predicts daily rumination
only for those with unsupportive relationships
Low social support from family and friends
High social support from family and friends
Rumination as trait
87
Daily rumination predicts negative affect only
among those with unsupportive relationships
Low social support from family and friends
High social support from family and friends
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How do close relationships affect health?

• Buffering model Social support protects from the
  otherwise harmful effects of stress
• Spouse may directly shape coping efforts and
  stress appraisals
• Spouse may impact the effectiveness of coping by
• validating the partners coping
• coping in a way that complements the partners
  coping

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The spouses personality affects the other
spouses ability to cope effectively

• 83 couples living in stepfamilies reported their
  negative mood, and their interpersonal stressors,
  and how they coped with them on 7 consecutive
  days
• Also gave ratings of own neuroticism
• Results
• The husbands neuroticism affected the wives
  ability to cope effectively more than the
  converse

Pomaki DeLongis, 2009
90
Results

• When Ss were living with neurotic spouses, they
  tended to be more distressed
• Good coping buffered the negative effects of
  living with a neurotic husband

High neuroticism husband
Low neuroticism husband
Pomaki DeLongis, 2009
91
Results

• Good coping did not help husbands reduce their
  distress when their wife was neurotic
• In fact, good coping increased their distress
  when their wife was not neurotic
• Husbands would rather not deal with stressors
• any coping might indicate reactivity

High neuroticism wife
Low neuroticism wife
Pomaki DeLongis, 2009
92
Do supportive responses matter only when the
person is coping poorly (catastrophizing,
rumination)?

• Catastrophizing and rumination are dysfunctional
  responses to stress/pain.
• Maybe support is only important to protect people
  from their own poor coping responses?
• How about good coping?
• Two hallmarks of healthy coping
• (Positive) Cognitive Reappraisal
• Emotional Expression and Disclosure

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Cognitive reframing

• Efforts to perceive the problem positively.
• Items
• e.g., Changed or grew as a person in a good way
  
• e.g., Realized how, in some ways, Im more
  fortunate than others

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The effect of parents coping with a childs
chronic illness depends upon the spouse response
(Marin et al., Journal of Social and Personal
Relationships, 2008)
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Emotional expression and disclosure

• Efforts to express feelings to others.
• e.g., Expressed how I felt about the situation

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Emotional disclosure in colorectal cancer
patients

• Patients Select cancer-related issue that caused
  them considerable distress that they would like
  to discuss with their partner.
• Partners instructed to be involved in the
  discussion and to respond in whatever way felt
  natural to them.

(Haagedoorn et al., 2008)
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Procedure

• In home, video-taped interaction
• No investigator present
• 5 minute discussion of how they met
• 10-11 min. discussion of cancer concern
• Rated typical and realistic

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Most common concerns of colorectal cancer patients

• fear of recurrence
• uncertainty about the future
• concerns about their treatment
• worries about work
• concerns about their family

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Disclosure

• defined as the disclosure of a personal feeling,
  thought, wish or need.
• the speaker turn was the basic coding unit

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Cancer patients disclosure beneficial to him
only when wife discloses as well
Wife discloses
Wife doesnt disclose
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Wife discloses
Wife doesnt disclose
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Taken together the findings suggest

• Key role of close relationships in encouraging
  adaptive ways of coping.
• Difficulty of coping effectively without support
  and empathy from close others.
• Danger of overly-solicitous and critical
  responses from the spouse.
• Importance of involving close others in patient
  interventions.

103
Future directions and caveats

• Short- vs. Long-term Outcomes
• Ways of coping and support may show different
  outcomes over different periods of time
• Ex. Withdrawal associated with
• short-term reductions in family tension
• Long-term distant, poor family relations

104
Whats good for the goose isnt necessarily good
for the gander.

• Many diseases are gender specific, or at least
  gender-biased.
• RA ? 3X women
• Are the findings gender specific too?
• Male cancer patients benefit more from both their
  own and partners disclosure than do female
  cancer patients.

105
Whats good for the patient isnt necessarily
good for support provider

• Outcomes of support process differ for patient
  and caregiver
• e.g., complaining benefits support provider
• Key is determining types of supportive exchanges
  that are beneficial to both the support recipient
  and provider
• Cognitive coping support
• tangible support
• Emotional support
• Empathic responding

106

• Video on chronic illness and marital
  relationships
• http//video.aol.com/video-detail/when-chronic-ill
  ness-strikes/728835247

107
Summary

• Social support protects from the otherwise
  harmful effects of stress incurred by pain,
  catastrophizing and rumination
• Spouse directly shapes coping efforts and stress
  appraisals, which then influence pain
• Spouse may impact the effectiveness of coping
• Personality of spouse
• Responses of spouse (e.g., cognitive
  restructuring, disclosure)

108
What are we going to talk about today?

• Social support
• What is social support? How does it work to
  affect health?
• Couples coping with stress and adversity
• Spouses (personality, social support, coping)
  affect health by shaping coping processes
• What can you do to combat stress and its effects
  on your body and life?
• Stress management interventions
• Can pets have stress-buffering effects on health?

109
Stress management interventions

• A program for dealing with stress in which people
• Learn how to appraise stressful events
• Develop skills for coping with stress
• Practice putting those skills into effect

110
When do we know we coped well?

• Physiological/biochemical functions
• Reduced arousal, such as lower heart rate
• Lower blood/urine levels of catecholamines and
  corticosteroids
• Daily life activities
• Return to prestress activities
• Life changes in the direction of healthier
  adjustment
• Reduced psychological distress
• Reduced anxiety
• Reduced depression
• Termination, lessening, or shortening of the
  duration of the stressful event

111
Who needs stress management?

• Workplace workshops
• Stress-related disorders account for billions of
  dollars of lost productivity
• People who are at risk for stress-related illness
• Migraine headache, high blood pressure
• Multiple sclerosis
• Cardiovascular diseases

112
Basic techniques

• First Phase
• What is stress?
• How to identify lifes stressors
• Second Phase
• Acquire skills for coping with stress
• Practice skills for coping with stress
• Third Phase
• Practice techniques in targeted stressful
  situations
• Monitor effectiveness of the techniques

113
A stress management program

• Combat Stress Now (CSN) for university students
• First stage
• 1.Identify stressors of university life
• 2.Monitor stress and record responses
• 3.Identify stress antecedents to pinpoint ones
  own trouble spots
• 4.Avoid negative self-talk it perpetuates stress
• 5.Take-home assignments, include stress diaries

114

• Second Stage of Combat Stress Now
• Skill Acquisition and Practice
• 6.Cognitive-behavioral techniques, time
  management, behavioral regulation, diet, exercise
• 7.Setting new goals that are specific
• 8.Encouraging positive self-talk
• 9.Other cognitive-behavioral techniques

115
Relaxation training
progressive muscle relaxation

• Designed to reduce arousal
• thus affecting the physiological experience of
  stress
• CSN Example
• Learning to breathe deeply when the stress of
  university catches up with students

guided imagery
meditation
yoga
hypnosis
116
Breathing exercise

• http//www.mayoclinic.com/health/meditation/MM0062
  3

117
Supplementary skills

• Time management
• Setting specific work goals for the day
• Establishing priorities, avoiding time wasters
• Learning what to ignore
• Good Health Habits
• Appropriate eating habits
• Good exercise habits
• Social skills
• Assertiveness in social situations
• Using social support

118
Supplementary skills

• Assertiveness training
• Example from CSN program
• How to deal with stress carriersIndividuals who
  create stress for others without necessarily
  increasing their own levels of stress

My roommate constantly brags about how great she
is doing in the class we are taking together
Lets practice how you can confront her tactfully
119
An example of a stress management intervention
for university students

• http//www.dartmouth.edu/acskills/videos/video_sm
  .html

120
Research on the health effects of pet ownership
falls into three main categories 1. Studies of
peoples immediate physiological responses (heart
rate and blood pressure) to interactions with
animals. 2. Epidemiological comparisons of pet
owning and non-owning populations. 3.
Randomized, controlled trials of pets as a form
of healthcare intervention.
121
What have these studies shown?

• Sustained reductions in reactivity to
  experimental stressors.
• Less deterioration in health following negative
  life events (e.g. bereavement).
• Reduced physiological risk factors for
  cardiovascular disease.
• Improved survivorship with cardiovascular
  disease.
• Various improvements in mental health
  (depression, self esteem, well-being, etc.).
• Attached owners do better than unattached owners.
• Dog owners do better than cat owners.

These results are consistent with the view that
pets constitute a form of social support
122
Epidemiological survey of more than 1,800 gay and
bisexual men

• Men with AIDS compared to men without AIDS
• No pet 3X more likely to report symptoms of
  depression than men who did not have AIDS.
• Pet only slightly more likely to report symptoms
  of depression, as compared to men in the study
  who did not have AIDS.
• benefit is especially pronounced when people are
  strongly attached to their pets
• (other health behaviours controlled e.g.,
  exercise)

(Siegel et al., J. AIDS Care, 1999)
123
Randomized clinical trial

• 37 nursing home residents who
• scored high on a loneliness scale
• received weekly, 30-minute visits from dogs.
• ½ alone with the dog
• ½ with 1-3 other residents and dog
• both groups felt less lonely
• Alone with dog
• greater decrease in loneliness after 5-6 weeks.

(Banks, 2006)
124
Conclusion

• The main way pets reduce loneliness in nursing
  homes is simply by being with people, not by
  enhancing socialization between people for
  instance, giving nursing home residents something
  to talk about or an experience to share.

125
Video on pets and patients

• http//www.webmd.com/video/pets-health-see-spot-fe
  el-happy

126
Comparison of human vs pets as companions

• 240 married couples ½ with pet ½ no pet for 5
  yrs
• completed two stress tasks
• 1. mental arithmetic
• 2. cold pressor task
• Randomly assigned to complete in presence of
• alone
• Pet OR same-sex friend
• Spouse
• spouse AND pet OR same-sex friend

(Allen, 2002, Psychosomatic Medicine)
127
Comparison of human vs pets as companions

• Measured before and during task
• Blood pressure
• Heart rate
• Errors on math test
• Challenge vs threat?
• Results
• Pet owners (vs non-pet owners)
• lower baseline heart rate and blood pressure
• lower "reactivity" to the stress tests
• returned to baseline levels more quickly
• made fewer errors

128
More results

• pet owners with their pet present
• Less threat than in the other conditions.
• Non-pet-owners
• Less threat when alone than when they were in the
  presence of social supports.
• less reaction to stress when alone than with
  friends or spouses.

129
Conclusions

• "After the experiment many participants
  commented that because they did not know the
  experimenter ... they felt less threatened by her
  presence than by that of their friends and
  spousesalthough spouses and friends may have
  meant well and tried to provide support, they
  were not perceived as non-evaluative."

130
Conclusions

• pets can buffer reactivity to acute stress as
  well as diminish perceptions of stress.
• lowest stress response when they were alone or
  with their pets
• participants' perceptions of whether their
  friend, spouse or pet was "evaluative" of their
  performance could have played a role.

131
Conclusions

• The authors note that although their study found
  no major personality or demographic differences
  between pet owners and non-pet-owners, "we do not
  know if there is some other important overarching
  characteristic associated with pet ownership that
  we have not identified."

132
What evidence do we have that pets serve as
social support providers?

• Peoples attachments for their dogs are strongly
  influenced by the animals behaviour. (Serpell,
  J.A. 1996. Appl. Anim. Behav. Sci., 47 49-60).
• Pet owners whose pets are behaviourally
  compatible report better mental and physical
  health than those with less compatible pets.
  (Budge, R.C. et al. 1998. Society Animals,
  6(3), 219-234)
• Positive relationship provisions provided by pets
  are comparable to, and sometimes better than,
  those provided by other people. (Bonas et al.
  2000. In Companion Animals Us, eds. A.L.
  Podberscek et al., pp. 209-236, Cambridge CUP).
• Negative relationship provisions derived from
  pets are less extreme than those derived from
  other people. (Bonas et al. 2000. In Companion
  Animals Us, eds. A.L. Podberscek et al., pp.
  209-236, Cambridge CUP).

133
What did we talk about today?

• Social support
• What is social support? How does it work to
  affect health?
• Couples coping with stress and adversity
• Spouses (personality, social support, coping)
  affect health by shaping coping processes
• What can you do to combat stress and its effects
  on your body and life?
• Stress management interventions
• Can pets have stress-buffering effects on health?